2 review Flashcards
Classic findings of Wiskott-Aldrich syndrome : WisPER
stands for ???
(Wiskott-Aldrich syndrome, Purpura, Eczema, Recurrent infections)
genetic condition characterized by impaired function of T cells and thrombocytopenia
Epidemiology: occurs primarily in males
Etiology: mutated WASp gene (X-linked recessive inheritance) → impaired signaling to actin cytoskeleton reorganization → defective antigen presentation
patients which high disease activity of UC should have what treatment and subsequent workup ??
begin TNF-a inhibitor therapy (infliximab) + TB rule out
what is the first and main step in mngmt of acute pain crisis of sickle cell disease
***FLUIDs + pain management
blood transfusion only held for severe sickel crises w/anemia and end-organ damage
??? typically occurs within minutes or a few hours of blood product transfusion. It manifests with acute hypoxemic respiratory failure and bilateral pulmonary infiltrates.
Transfusion-related acute lung injury
In contrast to patients with transfusion-associated circulatory overload, those with TRALI typically have normal brain natriuretic peptide and no jugular venous distension.
patients after gastric bypass surgery are at risk for vitamin def.
presentation with ataxia, opthalmoplegia (nystagmus), and acutely altered mental status suggest which def ???
thiamine (B4)
when are fluids indicated for infection in patient with HF w/ reduced EF, cirrhosis, and ESRD
ex. CAP infection
**give fluids if evidence of hypoperfusion/severe sepsis: hypotension, altered mental status, or labs pointing toward organ dysfunction
**if no signs of hypoperfusion; (NORMAL BP) just febrile, tachy - just remove volume-depleting and BP lowering meds
when should screening for hyperlipidemia begin
35 in asymptomatic men
40-45 in asymptomatic women
ulcers caused by PAD vs. venous insufficiency
PAD typically occurs at distal digits/toes
Venous insufficiency typically at medial malleolus/lower leg + also accompanied with bronzing of skin, dermis changes
which finding ??
sun-bursting as part of osteosarcoma
- Frequently first manifests with pain (progressive, worsens at night and with activity)
- Progressive swelling (tissue mass that is tender to palpation and accompanied by erythema)
- Pathologic fractures
- Limping, decreased range of motion
patients with HIV are considered to have a postive PPD with induration above ???
5mm
**also applies to immunosuppressed/comprimised and known recent exposure to active TB
if CD4 count <200; need a retest after CD4 is above 200
???? is a type of cancer that typically occurs in the urinary system. It is the most common type of bladder cancer and cancer of the ureter, urethra, and urachus. It accounts for 95% of bladder cancer cases
Transitional cell carcinoma, also called urothelial carcinoma,
women with unexplained late-term stillbirth at greater than 32 weeks should undergo what ??
weekly nonstress testing in the 3rd trimester starting at 32 weeks
in general: prior hx of fetal demise requires serial US, screening for anomalies, amniotic fluid volume, and routine monitoring for fetal growth
??? heart condition can occur in children born to mothers of SLE and Sjogren’s syndrome
Congenital AV block
as a result of developing AV node to maternal autoantibodies
**associated with Anti Ro and La
comparing tampon use accross two groups is a comparison of categorical values (presence vs absence), this is best assessed by ? test
chi-square test
patient with liver disease has wound on foot from beach and has pain radiating to groin developing into hemorrhagic bullae over the leg
what is the diagnosis and tx?
likely vibrio vulnificus and tx is surgical debridement and antibiotics due to rapid progression to nec fasc.
what are the two necessary tx for anaphylactic shocks ???
epinephrine AND fluids
what finding
tx ?
pterygium - benign growth of conjuctival tissue
tx. topical lub and avoidance of UV
*thought to be caused by UV exposure
older man presents with hematuria + lytic bone lesion; what is the most likely cause ???
metastatic renal cell carcinoma
commonly metastasizes to bone, lung, and brain
MM may cause renal problems but not gross hematuria
three types of spinal muscular atrophy - what are they ??
The most common causes of death among patients with SMA are respiratory insufficiency (due to respiratory muscle weakness) and aspiration pneumonia (due to bulbar weakness)!
The older the age of onset, the better the prognosis!
Type I → non-sitters, type II → sitters, type III → walkers
which EKG pattern is indicative of PE
S1Q3T3
S wave in Lead I, Q wave in Lead I, inverted T wave in lead III
? is the most likely diagnosis with an aortic aneurysm, livedo reticularis, petechiae, and renal dysfunction
multiple cholesterol emboli syndrome
aortic dissection increases the risk for atherosclerotic plaque disruption and can lead to emboli
asthma was ??? peak expiratory flow rate
decreased **
*FEV and expiratory flow rate may be normal during asymptomatic periods; but signs of wheezing suggest sx onset and lower respiratory function values
??? is the most frequent pathogen that causes suppurtive parotitis (infection of the parotid gland)
staph aureus
apart from protein and Cr clearance, what lab is important to check for CKD ??
hemoglobin concentreation
CKD leads to decreased EPO; often see normocytic anemia
how should babies born to mothers with a family hx of hemophilia be checked??
only males; check factor VIII concentration immedietly after birth through sampling of umbilical cord blood
genetic counseling for BRCA is indicated for who (3)
personal breast cancer diagnosed before 45
personal/family history of ovarian cancer
personal/family history of male breast cancer
**this is the first step before any additional imaging/diagnostic is done
a postpartum patient with fever and severe uterine tenderness raises suspicion for ???
endometritis - polymicrobial infection of uterine endometrium involving aneorobes and aerobes
severe tenderness of uterine fundus and mucupurulent vaginal discharge
Tx is antibiotics ; **no cultures needed in suspected case
protective factors for ovarian cancer: (4)
removal of ovaries, use of OCPs for >5 yrs, lactation, multiple pregnancies
increased rx: nulliparity, early menarche/late menopause, decreased fertility, delayed childbearing, family history, mutation
common presentation includes cryptorchidism or small testes, learning disabilities, delayed pubertal development, signs of androgen deficiency (gynecomastia), infertility in a patient who is tall with disproportionate leg-arm length
Klinefelter caused by XXY genotype
sx caused by lack of testosterone production due to fibrotic semniferous tubules and leydig cells
first step in tx of diabetic ketoacidosis??
first step is volume repletion with isotonic fluids , followed closely by IV insulin and electroylte correction
??? can occur in patients taking long term corticosteroids after they stop and/or have a physiologic stressor such as surgery, trauam, or infection
sx include altered mental status, tachycardia, abnormal vasodilation
**adrenal crisis
treatment is administration of IV corticosteroids
?? should be done after consumption of drain cleaners (alkali solution)
Esophogoscopy - in order to evaluate damage
*gastric lavage, ipecac, charcoal all not recommended
patients with multiple myeloma are sensitive to which infections??
encapsulated organisims: strep pneumo, h flu, neisseria meng, Salmonella typhi, klebsiella pneumo, and group B strep
which toxicity can occur from benzotropine administration with antipsychotics
anticholinergic toxicity - seadation, delirium, dry mouth, urinary retention, constipation
**benzotropine antagonizes muscarinic ACh rc
tx for empyema / complicated parapneumonic effusion
placement of chest tube (thoracostomy) + antibiotic administration
Randomized control trial with a large number of patients with a specific disease (∼ 100–1000)
which phase of clinical trial ??
phase 3
what is the test for oral herpes (presents with vesicular eruption of the posterior oropharynx and mouth + cervical lymphadenopathy)
PCR of sample from unroofed vessicle
?? can cause ipsilateral hearing loss and positional dizziness, and if compressing the trigeminal nerve can lead to facial numbness and paresthesia
acoustic neuroma
cultures are imperfectly sensitive for gonococcal septic arthritis (no organisms visible on gram stain either becase N. gonorrhoeae is an intracellular organism). Diagnosis should be made by strong clinical suspicion. Treatment is for how long??
1-2 weeks of IV ceftriaxone and oral azithromycin; need IV treatment for 1-2 weeks
??? is the most common supraventricular tachycardia and is often provoked by alcohol, caffeine, exertion, stress or sympathomimetic medications. Characterized by regular rythm along with abrupt onset and termination
AV nodal reentrant tachy
Valsalva maneuver does what for hypertrophic cardiomyopathy
murmur becomes louder
valsalva = decreased preload and increased afterload; worsens LVOT
what can reduce the risk of aspiration in a stroke patient with dysarthria
thickened liquids
when does a small pleural effusion not require any work-up
asymptomatic + a known cause
also no SOB, tachypnea, or chest pain
an example is a small pleural effusion after a treated pneumonia - no further work-up needed
**if the cause is unknown, pursue thoracentesis
antimitochondrial antibody is specific for which disorder?
primary biliary cholangitis/cirrhosis
lymphocytic infiltratios in portal tracts and bile ducts
?? is first line therapy for primary biliary cirrhosis/cholangitis
Ursodiol (ursodeoxycholic acid) - inhibits cholesterol secretion into bile = improvese biliary excretion
used to treat biliary colic, primary biliary cirrhosis, and intrahepatic cholestasis of pregnancy
(ex. 16 day old) infant with jaundice + preponderance of conjugated bilirubin (direct) is indicated of ???
biliary atresia
**use abdominal US to look for irregular gallbladder
tx is with surgery : hepatoportoenterostomy
patients with symptomatic postpartum thyroiditis can be treated with ??
oral b-blocker such as metoprolol or propanolol
what to do for a patient’s large firm, and irregulary shaped breast mass ??
mammography AND breast biopsy
macrosomia is defined as fetal weight > ???
if hx of macrosomia, what is the management ?
4000g
women should be followed in the postpartum period for development of DM with fasting serum glucose
marcosomia means maternal hyperglycemia/gestational DM most likely
what is the treatment for cardiogenic shock ??? (3)
positive inotrope
dobutamine, NE, or dopamine (at middle doses it works on B1 rc)
NE with combo of dobutamine is most commonly used
PPV and NPV vary with ??
disease prevalence
third trimester vaginal bleeding that is painless suggests???
how to diagnose ??
placenta previa
**need to use pelvic US
**also if found, C-Section is indicated
digital exam is not recommended due to disruption of placental bed
?? (2) is used to treat Clostridioides difficile infection in most patients, including those with nonsevere or severe disease.
Oral fidaxomicin or vancomycin
in fulminant Cdif add metronidazole
Severe acute pancreatitis (SAP) occurs in 15%-25% of patients with acute pancreatitis and causes failure of ≥1 organ systems lasting >48 hours. Predictors of SAP include signs of the systemic inflammatory response syndrome and evidence of ??? Patients with SAP have increased risk of morbidity and mortality and usually require intensive monitoring.
(eg, elevated blood urea nitrogen or hematocrit) of intravascular volume depletion.
for which procedures do patients with splenectomy require prophylactic antibiotics
procedures of the respiratory or paranasal sinuses because of colonization with encapsulated bugs
Patients with left-sided adenomas or adenocarcinomas detected on sigmoidoscopy have increased risk for ??
synchronous neoplasia on the right side and require visualization of the entire colon with colonoscopy
what is the management of asymptomatic sliding hiatal hernia ?
just observation
those with GERD should be managed medically
those with refractory GERD can be considered for Nissen fundoplication
when to iniate feeding in burn patient and which form of feeding?
Enteral nutrition is the optimal form of nutrition for patients with moderate to severe burn injuries. Early initiation helps offset the hypermetabolic response after burns and has multiple clinical benefits (eg, maintenance of gut integrity, reduced rate of sepsis, decreased mortality).
**ideally done within 24 hours
pooling of blood in anterior chamber of the eye is ??
caused by trauma
increased risk for??
hyphema
increased rx for gluacoma, corneal blood staining, and rebleeding
usually managed with topical agents
what are the signs of Felty syndrome in RA ??
what is the tx ?
new-onsent splenomegaly and neutropenia (+ infections and fever)
**rituximab - CD20 inhibitor is treatment of choice
increases rx of non-Hodgkin Lymphoma
Pyogenic liver abscess typically presents with fevers, right upper quadrant pain, leukocytosis, and altered liver function tests. It can result from direct spread from the biliary tract or from hematogenous seeding of distal infection, particularly those involving the portal system (eg, diverticulitis). Diagnosis requires abdominal imaging, and management includes blood cultures, antibiotics, and
aspiration + drainage
who should receive endocarditis prophylaxis for dental procedure (3)
Only if : unrepaired congenital cyanotic heart disease, prior hx of endocarditis, or those with prosthetic valves
what imaging for suspected gallstone pancreatitis (elevated LFTs and amylase/lipase)
first RUQ US, then ERCP if nondiagnostic US
long tern management of gallstone pancreatitis
Early cholecystectomy is recommended for medically stable patients who recover from acute pancreatitis and are surgical candidates. Cholecystectomy can markedly reduce the risk of recurrent gallstone pancreatitis.
imaging for suspected appendicitis ??
CT of abdomen and pelvis
US +/- MRI for pregnant patients
Perforated appendicitis management (2 options)
Treat with antibiotics and either percutaneous drainage (for stable patients with a contained RLQ abscess [ie, contained perforation]) or emergency appendectomy (for patients with diffuse intraabdominal contamination [ie, free perforation]).
conservative management for SBO (no fever, hemodynamic instability, gaurding, leukocytosis, or significant metabolic acidosis (low bicarb)
bowel rest, NG tube suction, and fluids
if progression at all, procedue with ex lap
??? is an uncommon but life-threatening complication of hematologic malignancy, infection, and systemic inflammatory disease, and anticoagulation increases the risk. Examination may reveal hemodynamic instability, diffuse abdominal pain, and signs of peritonitis (eg, rebound, guarding). On occasion, pain may be referred from the diaphragm and phrenic nerve to the left shoulder (Kehr sign). Focused abdominal ultrasound or CT scan demonstrates free intraperitoneal fluid.
Atraumatic splenic rupture
Splenectomy is the management of choice in hemodynamically unstable patients, although catheter-based angioembolization may be attempted in stable patients.
patients commonly present with ispilsateral cranial nerve dysfunction, contralateral hemiparesiss, and contralateral impairment in pain and temp sensation
**sx occur with neck movement
vertebral artery stenosis
if high suspicion for PE what imaging
first chest-xray, but diagnosis is commonly made via CT angiography (spiral CT scan)
cirrhosis causes excessive production of prostoglandins leading to release of what and which electrolyte abnormality??
prostoglandin stimulate release of ADH and cause hyponatremia
treatment of hep C includes treatment with ??/
combo antiretroviral therapy
ledipasvir-sofosbuvir or glecaprevir-pibrentasvir
most important recommendation for minimizing progression of liver disease in patient with hepatitis (C)
alcohol abstinence
scrotal pain + abdominal distension points to ??
incarcerated inguinal hernia
*indication for surgery
how can an Rh negative mother develop Rh isoimmunization in first pregnancy
via early term vaginal bleeding or amniocentesis
RhoGAM binds to RhD positive cells that enter maternal circulation, preventing the immune system from developing antibodies
RhoGAM is ineffective however in a patient that already developed Rh antibodies (fetus at risk for hydrops fetalis and death)
complication of amniocentesis/increases risk for ???
premature rupture of membraines
others include: fetal injury, maternal/fetal infection, and fetal demise
adults with DM1 are at increased rx of CAD - cardiomyopathy, atherosclerotic changes, and ????
dyslipidemia - thus should be screened annually if lipids are abnormal or DM is poorly controlled
what to administer to patient with elevated LFTs + altered mental status, bilateral nystagmus, ataxia/broad-based gait
thiamine
sx likely due to chronic alcohol abuse
cellulitis is most commonly caused by staph aureus and group ?? strep
group A (strep pyogenes)
Acute or chronic liver injury can lead to ????. This is usually multifocal and occurs most commonly in the setting of cirrhosis.
nodular regeneration
?? is a rare complication of umbilical artery catherization in infants and can present up to several weeks after catheter has been removed. Presents with HTN in infant
renal artery thrombosis
tx is systemic anticoag + fluids, surgery if refractory
which pharm can be used for irritable bowel syndrome (3)
loperamide - antidiarrheal
dicyclomine - antispasmodic
diphenoxylate - slows gut motility
Chest x-ray may show leaked fluid collecting in the mediastinum (mediastinal widening) or pleural space (pleural effusion). Pleural fluid analysis may show low pH and very high amylase (>2500 IU/L). Confirmation with esophagography or CT scan using water-soluble contrast should prompt emergent surgical consultation.
esophageal rupture
Recurrent, episodic pain in the right upper quadrant or epigastric region, with corresponding aminotransferase and alkaline phosphatase elevations, is common; visualization of a dilated common bile duct in the absence of stones increases the likelihood of ???
occurs in postcholecystectomy patients
Sphincter of Oddi dysfunction is a functional biliary disorder due to dyskinesia or stenosis of the sphincter of Oddi.
Sphincter of Oddi manometry is the gold standard for the diagnosis of SOD; sphincterotomy is the treatment of choice in most cases.
patient has turbid green drainage (gastrointestinal contents) into his chest tube following blunt chest trauma, most consistent with ???
esophageal perforation (EP).
??? should be suspected in patients with multiple duodenal ulcers refractory to treatment or ulcers distal to the duodenum or associated with chronic diarrhea. In these patients, inactivation of pancreatic enzymes by increased production of stomach acid may lead to malabsorption.
Zollinger-Ellison syndrome
Uncontrolled gastrin secretion leads to parietal cell hyperplasia, with excessive production of gastric acid. Multiple duodenal (and sometimes jejunal) ulcers are typical, and the ulcers can be refractory to standard acid-reducing medications. The excess gastric acid in the small intestine can cause diarrhea and steatorrhea due to inactivation of pancreatic enzymes and injury to the mucosal brush border.
??? is a prospective, systematic, team-based approach that consists of identifying steps in a process and finding solutions to any problems that may arise, with the goal of ensuring safe outcomes. It can be performed before any problems are identified.
Failure mode and effects analysis (FMEA)
recommendations for lung cancer screening???
age 50-80 yearly low dose CT scan IF:
current smoker/quit smoking <15 years ago
or
>20 pack year smoking history
**no screening if quit for more than 15 years
Falls are a major source of injury in older patients. In addition to primary prevention strategies (eg, supervised exercise, home safety assessment), patients at high risk for falls should be screened how ? (5)
Screening: musculoskeletal (eg, “get up & go” test*), vision, hearing, bone density, orthostasis
Elderly patients are vulnerable to both overprescribing and underprescribing of medications and have increased susceptibility to adverse drug events. Clinicians should tailor therapeutic decisions to each patient’s individual context, considering factors such the medication’s ?? and absolute treatment effects and the patient’s health status (eg, life expectancy) and goals of care.
time to benefit
A ?? is a quality improvement tool that graphs a process performance outcome (eg, no-show rate) over time (eg, before and after a quality improvement intervention). they allow visualization of trends (≥5 consecutive points with consistent directional change) and systematically determines effectiveness of a quality improvement intervention.
run chart
??? represent the most effective intervention to improve sign-out safety.
Standardized sign-out templates
Fall risk is multifactorial; therefore, fall prevention is best achieved using an individualized approach in which staff determine prevention strategies based on the patient’s ??? rather than a summary risk score.
individual risk factors
Valid informed consent for nonurgent treatment requires intact capacity. When the patient’s decision-making capacity is impaired by reversible factors (eg, acute psychosis), it should be restored by treating the underlying cause how ??
in this case of acute psychosis, administer antipsychotics and defer request for now
Low health literacy is associated with worse health outcomes and underuse of recommended care like ???. Signs may be subtle, but clinical clues include having a poor understanding of health conditions, not remembering medications, and asking to take forms home to review with family.
frequently missed appointments
lung transplant recipient with progressive dyspnea, an obstructive pattern (ie, FEV1/FVC <70%) on pulmonary function testing (PFT), and no evidence of infection (eg, no fever, chest x-ray abnormalities, or organisms on bronchoalveolar lavage) likely has ???
bronchiolitis obliterans, the major manifestation of chronic lung transplant rejection
*acute rejection occurs <6 months and tx with high dose glucocorticoids
what are an example of a environmental design intervention
Misreading look-alike drug vials is a leading cause of medication error in operative settings. Human factors engineering strategies can prevent such errors by designing systems that decrease human effort and facilitate correct action. Examples include environmental design changes separating look-alike medications, standardizing and simplifying processes, and using visual cues.
Errors in medication reconciliation (ie, the process of reviewing and updating the current medication regimen) occur frequently during the transfer of care. Prevention includes ?
independent review by multiple care team members, interprofessional review (eg, physicians, nurses, pharmacists), and updated review prior to medication orders.
Physicians are ethically obligated to report suspected physician impairment to protect patient safety. ??? are organizations designated to investigate reported concerns and arrange for comprehensive assessment and treatment if necessary.
Physician Health Programs
PHPs are confidential resources that provide extensive support and expert education and monitoring. If intervention is required, the PHP can assist the physician in getting necessary treatment.
Provision of data-driven feedback on physicians’ individual clinical performance (eg, rate of cesarean delivery) compared to peer performance or recognized benchmarks is effective in improving quality of care (eg, reducing unnecessary cesarean delivery).
true or false?
true
Female undergoing epidural analgesia for delivery : Patients have an exaggerated ascending paralysis with upper extremity weakness (eg, C5-C7 blockade) and respiratory paralysis due to blockade of the diaphragm (eg, C3-C5)
High spinal or total spinal anesthesia can occur if the epidural catheter accidentally punctures the dura and anesthetic enters the subarachnoid (ie, intrathecal) space
female under-going epidural anesthesia for delivery: When the anesthetic is absorbed into the maternal circulation, it initially blocks inhibitory neural pathways to cause CNS overactivity (eg, perioral numbness, tinnitus), potentially followed by seizure. In addition, patients often develop increased cardiovascular sympathetic activity (eg, hypertension, tachycardia), followed by cardiovascular collapse.
Local anesthetic system toxicity can rarely occur with epidural analgesia (eg, bupivacaine).
Hypotension, a common adverse effect of epidural analgesia, is caused how ??
blockage of L5 sympathetic fibers decrease lower extremity vascular tone. This causes vasodilation and venous pooling, which decreases right heart venous return, diminishes cardiac output, and often causes symptomatic hypotension (eg, light-headedness). Compensatory tachycardia develops in response to the decreased cardiac output.
Patients with prolonged or profound maternal hypotension from epidural anesthesia prior to delivery can have decreased uteroplacental perfusion, resulting in late fetal decelerations. Treatment includes ???
maternal position change (left uterine displacement) to improve venous return, intravenous fluid bolus, and/or vasopressor administration (eg, phenylephrine, ephedrine).
A ??? study is an observational study in which groups are chosen based upon presence or absence of one or more risk factors. All subjects are observed over time for development of the disease of interest, allowing for estimation of incidence within the total population and comparison of incidences between groups.
cohort
In ecological studies, the unit of observation is a population. Disease rates and exposures are measured in 2 (or more) populations, and the association between disease rates and exposures is determined. However, results about associations at the population level may not translate to the individual level. Ecological studies cannot be used to determine ???
incidence
Loss to follow-up in prospective studies creates a potential for attrition bias, a subtype of ??? bias. When a substantial number of subjects are lost to follow-up, the study may overestimate or underestimate the association between the exposure and the disease. Investigators try to achieve high rates of follow-up to reduce the potential for attrition bias
selection
The odds ratio (OR) is a measure of association in case-control studies to compare the odds of exposure in cases relative to controls. The OR is not a direct measure of ???.
risk
The fishbone diagram (cause-and-effect diagram) is often used in root-causes analysis to ??? leading to a quality-of-care problem. Its main components include the problem being analyzed, main categories influencing the problem, and the specific sub-causes pertaining to each category
visually organize the categories and causes of errors
Hospital readmissions are used as a quality metric because they are often preventable through improved patient communication and follow-up. ??? after discharge reduces readmissions rates by preventing loss to follow-up, increasing patient engagement (proactively identifying and addressing potentially serious concerns) and care coordination (effective transition between inpatient and outpatient care).
Telephone-based outreach shortly
principles for medication prescribing in eldery (5)
- Limit the number of prescribers
- Review criteria for geriatric populations (eg, Beers,* START**)
- Consider time to benefit for drug
- Tailor regimen to the patient’s goals & life expectancy
- Frequently reassess appropriateness of medication
strategies to decrease fall risk inpatient
- Assess fall risk & customize strategies to patient’s specific risk factors
- Optimize environment (eg, minimize furniture, lower the bed, place in direct view of nurses if high risk)
- Perform frequent checks on high-risk patients
- Avoid restraints & overreliance on fall alert systems
Hospitalized patients who have infections caused by multidrug-resistant gram-negative organisms (eg, extended-spectrum beta-lactamase–producing Klebsiella pneumoniae) require contact precautions for the duration of their hospital stays. Contact precautions include ???
use of gowns and gloves when interacting with the patient and single-use equipment (eg, stethoscope).
metabolic acidosis + optic neuritis / vision symptoms
most likely which cause ???
methanol toxicity
is a type of reflex syncope typically preceded by a trigger (eg, strong emotion) and a prodrome (eg, pallor, light-headedness).
Vasovagal syncope
A neurally mediated reflex response (cardioinhibitory and vasodepressor) leads to brief (eg, <1-2 min) loss of consciousness, followed by rapid and complete recovery
patient with dementia has acute urinary incontinence (UI). what is the first step in workup
UA and culture
Acute urinary incontinence in elderly patients may have atypical presentations. Consider reversible etiologies first, especially if new onset (remember: DIAPPERS). Fever may not present with urinary tract infections limited to the lower urinary tract. Initial evaluation should include urinalysis with culture.
review murmurs
The risk for Clostridioides difficile infection is high in hospital settings and is increased for patients placed in rooms formerly occupied by infected patients. Infection-control measures include implementing ?? and strict adherence to hand hygiene and contact isolation precautions (use of gowns and gloves in patient rooms).
uniform cleaning and disinfection procedures to be performed by a dedicated team
Capnography is the measurement ofcarbon dioxide concentration over time. It can provide valuable information about ventilation/perfusion and metabolic status and is the most reliable method for verifying endotracheal tube (ETT) placement. Patients with abnormal waveforms should be assessed for ???
proper ETT placement.
Trigeminal neuralgia is characterized by episodic severe pain in the dermatome supplied by the trigeminal nerve (CN V). what is the work-up for someone presenting with symptoms ???
MRI with MR angiography should be obtained to evaluate for vascular or mass lesions that may be compressing the CN V root.
which bone finding ???
ewing sarcoma - onion skinning
2nd most common primary bone malignancy (typically adolescents)
Spiral fractures of the distal tibia can be seen in ambulatory children age ≤3 and are known as toddler’s fractures. workup??
no additional workup except for x-ray; treatment is immobilization + pain control
normal fracture in children
Adherence to recommended hand hygiene protocols remains low in most hospital settings. Suboptimal adherence that persists despite recommended systems changes (eg, increasing the number of hand hygiene stations) suggests the need to improve ??
organizational culture and individual accountability.
what are the 4 types of quality improvement processes
lean, six sigma, change management, model for improvemet (Plan-Do-Study-Act)
?? is characterized by acute onset of pruritic patch followed by numerous smaller macules and patches in the setting of a recent viral illness
**patches are oval in shape and have a rim
pityriasis rosea
self resolves in 6-8wks, can be treated symptomatically with topical corticosteroids
**characteristic herald patch starts it all
management of seborrheic keratosis
**benign and it needs to work-up
if there are sudden, numerous lesions on back and trunk, this is Leser-Trelat sign and can be a paraneoplastic manifestation of GI malignancy
treatment of high grade second-degree and third degree AV blocks require what treatment ?
urgent placement of a pacemaker
even in infants with neonatal lupus AV block
patients with sickle cell anemia and signs of infection should be treated with ???
parenteral (IV) empiric antibioitics - ex. ceftriaxone
patient with sickle cell trait has community-acquired pneumonia, what is the treatment ?
For patients without COPD, diabetes, liver or cardiace disease, the first-line is oral azithromycin, doxycycline, or amoxicillin
with comorbidities: amox + clauv or levofloxacin
Bony outgrowth (exostosis) with a cartilaginous cap on the surface of long bones adjacent to growth plates
Osteochondroma
vs. chondroblastoma shown here: benign growth near epiphyses of long bones
?? is a subtype of malignant melanoma that occurs on the fingers and toes of asians + african americans
acral lentiginous melanoma
hyperosmoler hyperglycemia nonketotic state can cause what change in sodium ?
hyponatremia - hypertonic solute draws out water into the plasma and dilutes sodium
in general, hyponatremia should be investigated by calculating serum osmolality
Rapid growth (within 2–3 months) in areas of skin exposed to the sun (e.g., the ears)
Lesion: round dome-shaped, erythematous nodule with central crater
Histology: central, hyperkeratotic crater surrounded by squamous epithelium
Keratoacanthoma
Treatment: The tumor usually heals without treatment. Nonetheless, surgical removal is preferred because keratoacanthoma histologically resembles a cSCC, which is malignant.
MEN syndromes consist of ???
medullary thyroid cancer
also pheocytochroma
Type A: hyperparathyroidism (parathyroid hyperplasia) + pancreatic tumors
Type B: marfinoid habitus & mucosal neuromas
name of lesion and treatment ???
typically in patients > 50 in sun-exposed areas
Actinic keratosis (AK)
- single lesions (defined as 1–5 lesions): cryotherapy with liquid nitrogen
- Multiple lesions (defined as ≥ 6 lesions): 5-fluorouracil, imiquimod, Photodynamic therapy
Lesions may either regress, persist, or progress to squamous cell carcinoma (SCC).
TLC in obstructive vs. restrictive
TLC is normal or increased in obstructive and decreased in restrictive
RV and VC in obstructive disease vs. restrictive
RV increased in obstructive and decreased in restrictive
**VC is lower for both
