7s HEAVEN Flashcards
in central retinal artery occlusion, what does funduscopic exam show?
The retina is pale/whitened with a cherry red macula!
pt with a painful, red eye (scleral injection) and opacification and ulceration of the cornea. he uses extended-wear contact lense and had difficulty removing the lenses last week. what is this? what bug causes it?
Contact lens-associated keratitis (infx of the cornea)
most cases are due to gram negatives like PSEUDOMONAS and serratia
what is the most common brain tumor in children? bc of its location, it classically presents w/ seizures, weakness, and sensory changes; as well as signs of increased ICP.
Low-grade astrocytoma (pilocytic astrocytoma)
*glioblastomas are also supratentorial, high-grade astrocytic tumors that typically arise in the cerebral hemispheres and present w/ seizures and signs of increased ICP, but they are much less common than low-grade astrocytomas in children!
how do you manage mild to moderate cancer-related pain when nonopioid analgesics are no longer effective?
short-acting opioids (morphine, hydromorphone, oxycodone)
- the dose and schedule can be varied depending on the pt’s pain pattern
- if the pt has pain requiring frequent dosing or if bedtime dosing does not provide adequate relief through the night, a long-acting opioid (sustained-release morphine) may be added
when are antibiotics indicated in treatment of COPD acute exacerbation?
indicated in moderate-severe COPD exacerbation, defined as >/= 2 of the cardinal symptoms (increased dyspnea, increased cough, sputum production-change in color/volume) – especially indicated if there is increased sputum purulence
also indicated if mechanical ventilation is required (endotracheal intubation or noninvasive positive pressure)
vaginal pruritus and discharge is CC of pt. on exam, she has thick yellow cervical discharge and the cervix easily bleeds on contact with a swab. what is empiric tx?
azithromycin and ceftriaxone
this pt has acute cervicitis with mucopurulent discharge and a friable cervix –either chlamydia or gonorrhea
what drugs are commonly associated with SIADH? (elder pts are especially at risk)
SSRIs!!!!
also carbamazepine and NSAIDs
how is diagnosis of a solid testicular mass made? and what is the initial management?
a painless hard mass felt in the testicle + suggestive ultrasound = DX
initial managment is removal of the testis and it’s associated cord – ORCHIECTOMY
what is the mechanism by which vagal maneuvers (carotid sinus massage, cold-water immersion or diving reflex, Valsalva maneuver, eyeball pressure) slow the heart rate or terminate atrioventricular nodal reentrant tachycardia?
vagal maneuvers increase parasympathetic tone in the heart, resulting in a temporary slowing of CONDUCTION IN THE AV NODE and an increase in the AV node refractory period!
what is necessary for diagnosis of ankylosing spondylitis?
demonstrating radiographic changes of the axial skeleton! – first get plain X-RAY of the pelvis, which will show SACROILIITIS
x-rays may be negative in early stages, in which cases MRI can confirm sacroiliitis
(fusion of the vertebral bodies with ossification of intervertebral discs [bamboo spine] is also suggestive of the dx)
***HLA-B27 is not specific for AS (even though there is a strong association) and is not necessary for dx
a pt had speech and motor delays in early childhood and also displays features of ADHD and autism spectrum disorder in the classroom. Genetic testing demonstrates a significant CGG’ trinucleotide repeat expansion. what does he have? what is the classic phenotype?
Fragile X syndrome – x-linked disorder with expansion of CGG’ trinucleotide repeats in the fragile X mental retardation 1 gene on the X chromosome
classic phenotype in affected males: large head, long face, prominent forehead, protruding ears, and macroorchidism
pelvic cramping during the first few days of menses with radiation to the upper thighs and back. physical exam is normal. what is this?
primary dysmenorrhea (caused by increased prostaglandin release from endometrial sloughing during menses)
*in contrast, endometriosis presents as tenderness along the uterosacral ligaments, nodularity in the cul-de-sac, and adnexal enlargement due to an endometrioma. Pain from endometriosis usually precedes menses by a few DAYS.
in hyperosmolar hyperglycemic state in type 2 DM, what is the reason for the altered sensorium?
neurologic symptoms (ranging from confusion to coma) are attributed to HIGH SERUM OSMOLALITY! (usually >320 mOsm/kg)
52 yo man presents with decreased libido and inability to achieve/maintain erections. he also has fatigue, anorexia, and weight loss. he drinks alcohol. exam shows b/l gynecomastia and firm but small testes. lab shows normal TSH and decreased total T3 and T4. what is the dx?
Chronic liver disease (w/ cirrhosis)
- cirrhosis can cause hypogonadism due to primary gonadal injury or hypothalamic-pituitary dysfunction, leading to erectile dysfunction and testicular atrophy
- also associated w/ elevated circulating levels of estradiol (increased conversion from androgens), with findings of telangiectasias, palmar erythema, testicular atrophy, and gynecomastia
- cirrhosis also leads to decreased synthesis of serum binding proteins for thyroid hormones (thyroxine-binding globulin, etc), which lowers TOTAL T3 and T4 in circulation, however free T3 and T4 level are unchanged, and TSH will be normal (euthyroid status)
what is observer bias?
when the investigator’s decision is adversely affected by knowledge of the exposure status
what is selection bias?
it results from the manner in which the subjects are selected for the study, or from the selective losses from the f/u
what is Winter’s formula? which is used to determine appropriate respiratory compensation in the case of a metabolic acidosis.
arterial pCO2 = 1.5 [HCO3] + 8 +/- 2
if appropriate compensation is not occurring, a mixed acid-base disorder may be present
what are the most common causes of secondary clubbing of the digits?
LUNG MALIGNANCIES
cystic fibrosis
right-to-left cardiac shunts
What are the Jones criteria (major and minor) for diagnosing acute rheumatic fever? and how many major or minor criteria must you meet for diagnosis?
Dx = evidence of a preceding Group A strep infx along with 2 major criteria, or 1 major + 2 minor criteria
Major criteria: Joints (Migratory arthritis), O (Carditis), Nodules (subcutaneous), Erythema marginatum, Sydenham chorea
Minor criteria: fever, arthralgias, elevated ESR/CRP, prolonged PR interval
what should you offer mom if fetus is breach at 37 weeks of gestation and she wants a vaginal delivery?
External cephalic version – manual conversion of the fetus to vertex presentation
-a pt w/ a singleton breech fetus w/ no contraindications to vaginal delivery (eg, placenta previa, active herpes lesion, prior classical c-section [low transverse not contraindicated]) and no contraindications to ECV (eg, ruptured membrane, abnormal fetal heart tracing, oligohydramnios) SHOULD BE OFFERED ECV AT >/= 37 WEEKS GESTATION
how should you evaluate minimal bright red blood per rectum based on age groups?
< 40 = anoscopy
40-49 = sigmoidoscopy
>50 = colonoscopy
what is the most common cause of bacterial pneumonia in young children with CF?
staph aureus!!!
**especially in those with coexisting influenza infx!
OMG plz remember this
in pts w/ Paget disease of bone, what do lab tests usually show?
Elevated Alk Phos
Elevated bone turnover markers like URINE HYDROXYPROLINE and PINP
NORMAL Ca and phosphorus!!
HIV pt has a PPD skin test with >5mm induration and CXR is normal. He has no symptoms. How do you treat him?
Tx latent TB with 9 months of ISONIAZIDE + pyridoxine
how does acute interstitial nephritis present? what drugs cause it?
maculopapular rash, fever, new drug exposure, +/- arthralgias
labs show AKI, pyuria, hematuria, WBC casts, eosinophilia, URINARY EOSINOPHILS
drugs that can cause it = penicillins, cephalosporins, TMP-SMX, rifampin, NSAIDs, and diuretics
(can also be caused by infectious agents- Legionella, TB, strep)
what electrolyte abnormality can Trimethoprim cause, especially at high-doses (which may be required when treating HIV pts)?
Hyperkalemia!!
- due to blockade of the epithelial Na channel in the collecting tubule
- it also competitively inhibits renal tubular creatinine secretion and may cause an artificial increase in serum creatinine w/o affecting GFR
in a pt that drinks a lot of alcohol (which is also evident by their macrocytic anemia, thrombocytopenia, and >2:1 ratio of AST to ALT) and has signs of decompensated CHF, what measure is most likely to reverse their heart function?
complete abstinence from alcohol!!
- Alcoholic cardiomyopathy (a dx of exclusion) is dilated cardiomyopathy in pts with a hx of alcohol abuse and there is no other potential cause of cardiomyopathy suspected or identified
- the degree of LV dysfunction is directly related to the daily amount and overall duration of alcohol intake
- abstinence is associated with improvement or normalization of LV function over time
what are the characteristics of fetal hydantoin syndrome, usually caused my phenytoin or carbamazepine use in pregnancy?
midfacial hypoplasia microcephaly cleft lip and palate digital hypoplasia hirsutism developmental delay
pt was in a bad car wreck. CXR shows persistent pneumothorax despite chest tube placement and pneumomediastinum, and he has subcutaneous emphysema (palpable crepitus below the skin) on PE. what is this most likely?
Tracheobronchial rupture
-right mainstem bronchus is most commonly injured
*esophageal rupture following blunt trauma is rare!! manifestations would include pneumomediastinum and pleural effusions
how is Mg excreted?
Mg is solely excreted by the kidneys!!
*so a common risk factor for Mg toxicity is renal insufficiency!!
what is the most beneficial long-term tx for stress urinary incontinence?
Urethral sling surgery!!
- stress urinary incontinence is associated w/ urethral hypermobility w/ or w/o pelvic organ prolapse (cystocele)
- all pts should be advised to do Kegel exercises (1st suggestion before jumping to surgery)
name this defense mechanism:
an individual transforms unacceptable emotions or impulses into their extreme opposites.
Reaction formation
*ex: a woman is pissed about having to care for her neglectful father. she masks these unacceptable angry emotions by professing to be happy that her father is living with her.
pt with a Marfanoid body habitus in addition to fair hair and eyes, developmental delay, and cerebrovascular accident. what is this?
Homocystinuria
Dx made be on elevated homocysteine and methionine levels
Tx includes vit B6, folate, and vit B12 to lower homocysteine levels. also antiplatelets or anticoagulation should be given to prevent stroke, coronary heart dz, and venous thromboembolic dz
what drug frequently prescribed in the treatment of acne commonly causes a phototoxic drug reaction?
Doxycycline!
an HIV pt with a CD4 count <50 has fatigue, low-grade fever, wt loss, and frequent, low-volume stools that are often bloody. what organism is causing his diarrhea?
CMV!!
in contrast, MAC does infect with a CD4 count <50, but pts have Watery diarrhea and a high fever.
what is the condition that classically affects new mothers who hold their infants with the thumb outstretched (abducted/extended)?
pain can be elicited with direct palpation of the radial side of the wrist at the base of the hand.
De Quervain tenosynovitis
-inflammation of the abductor pollicis longus and extensor pollicis brevis tendons as they pass through a fibrous sheath at the radial styloid process
Also the Finkelstein test, which is conducted by passively stretching the affected tendons by grasping the flexed thumb into the palm with the fingers, elicits pain.
what skin cancer is especially common in pts who have a hx of organ transplant and are on chronic immunosuppressive therapy?
Squamous cell carcinoma
- these lesions often become keratinized (with a thickened, rough surface) or ulcerate with crusting and bleeding
how does vertebral osteomyelitis usually present?
PE usually shows exquisite focal tenderness on percussion at the posterior spinous process of the affected vertebra, increased muscle spasm in the contiguous area, and decreased range of motion in the back
leukocyte count may be normal, but ESR and CRP are usually markedly elevated
plan x-rays can be normal in the first few weeks so you should get an MRI
what are possible complications of primary biliary cholangitis?
malabsorption, fat-soluble vitamin deficiencies
metabolic bone dz (osteoporosis, osteomalacia**)
hepatocellular carcinoma
