Board Vitals Question Review Content Flashcards
What is paroxysmal nocturnal hemoglobinuria (PNH)? -presentation, age, diagnostics, treatment
Presentation: thrombosis in unusual places- abdominal veins
Median age: mid-30s
Anemia
Coombs negative hemolytic anemia** is positive for PNH
Labs: high LDH, low haptoglobin, low hemoglobin, high reticulocyte count: hemolytic process & bone marrow compensation
Tx: Eculizumab: inhibits process, decreases RBC lyses- helps to stabilize hemoglobin without transfusions
What is purpose of IRB?
protecting rights of human subjects at a research institution
How does renal disease affect calcium levels?
renal disease–> reduced production of active vitamin D (requires conversion to activate)- due to decreased activity of enzyme 1-alpha hydroxylase and decreased gut absorption-
results in renal osteodystrophy: increased bone resorption and secondary hyperparathyroidism
decreased GFR, kidney impaired phosphate excretion- hyperphosphatemia.
If PCWP is higher than pulmonary artery diastolic pressure….
suggests catheter malplacement- in non-zone III position of the lung.
PCWP should be lower than pulmonary artery diastolic pressure
Requires**Swan Ganz catheter = pulmonary artery catheter.
Catheter would need to be withdrawn, not moved forward- typically high PCWP means catheter is too far forward.
What is a Swan Ganz catheter?
Pulmonary artery catheter- located in R side of heart and arteries leading to the lungs- monitor heart function, blood flow and pressures in and around the heart.
What is most common bacteria for community acquired pneumonia?
Haemophilus influenza- gram negative bacteria- common in COPD patients. associated with lobal pneumonia.
What bugs are associated with interstitial infiltrates on CXR?
legionella pneumonia, mycoplasma pneumoniae, pneumocystis jirovicii
Describe Bell’s Palsy characteristics:
paralysis of upper and lower face. facial droop, cannot move eyebrows, flattened nasolabial fold, ** loss of taste sensation of ipsilateral anterior 2/3 of tongue.
lower motor lesion
What is Ramsay Hunt syndrome?
lower 7th cranial nerve lesion-
herpes zoster of external auditory meatus and geniculate ganglion
What is gold standard test for diverticulitis
CT abd with oral and IV contrast- sensitivity and specificity of 97%. most of inflammation is seen in extraluminal space- intraluminal studies of colonoscopy may not identify this.
moderate persistent asthma treatment recommendations….
daily symptoms, nocturnal awakening, daily rescue inhaler
low-dose inhaled glucocorticoids, plus long acting inhaled beta agonist (LABA) or medium dose of inhaled glucocorticoids, or trial of low-dose corticosteroids
What are the ranges of ABI by arterial disease severity?
0.71-0.9 = mild disease
0.41-0.7 moderate obstruction
<0.4 severe obstruction
What are risk factors for arterial disease?
old age, smoking, diabetes, HLD, HTN, renal insufficiency
What is torus palatinus?
painless bony protuberance on hard palate of mouth-
20-30% occurrence in population
this is normal finding, asymptomatic, may grow slightly with age
no treatment needed
what is diabetic nephropathy? how to diagnosis?
HTN, proteinuria, microalbuminuria, elevated serum creatinine, diabetic retinopathy.
This is slow onset, doesn’t have acute onset.
what is treatment for acute angle glaucoma?
ocular emergency- increased intraocular pressure, decreased visual acuity
IV acetazolamide, topical beta blocker, topical steroid
500 mg IV acetazolamide, and 500 mg PO
decrease production of aqueous humor
what is the MOST COMMON bug for CLABSI?
coagulase negative staphylococcus- S. epidermidis. introduced by contamination of insertion
S. aureus is associated with CLABSI, but not most common
What cardiac drug is risky in diabetic patients?
metoprolol or beta blockers- can mask early signs of hypoglycemia and lead to severe hypoglycemia symptoms before patients realizes
which thiazolidinedione has better cardiac risk profile? rosiglitazone vs pioglitazone
Pioglitazone- better lipid profile. All thiazolidinediones are contraindicated in heart failure patients.
What is a helical CT?
allows direct visualization of pulmonary arteries. diagnostic for PE
What is gonococcal arthritis?
migratory arthralgias; knees, wrists, ankles, elbows
rash also common.
tx: broad spectrum cephalosporin- ceftriaxone
What is preferred treatment for DVT outpatient?
enoxaparin q12 subQ
not warfarin- high side effect profile
when is it indicated to prescribe warfarin for DVT treatment?
if there is renal insufficiency; enoxaparin contraindicated in this case
what is wernicke’s encephaloapthy?
thiamine deficiency- chronic alcohol use disorder
triad: ophthalmoplegia, ataxia, confusion
tx: thiamine supplementation
Korsakoff psychosis is also common presentation
what are risk factors for osteoporosis?
smoking, excessive alcohol use, chronic steroid use, insufficient calcium or vitamin D intake, sedentary lifestyle, post-menopause, early menopause.
Caucasian and asian females - greater risk
metabolic acidosis: MUDPILERS
Methanol Uremia Ddiabetic ketoacidosis Pparaldehyde toxicity Isooniasiz toxicity Lactic acidosis Etoh, ethylene glycol Renal failure, or rhabdo Salicylate toxicity
what is anion gap calculation? what is normal range
(Na+ + K+) – (Cl- + HCO3-) = Anion Gap
normal range 4-12
what is gold standard for diagnostic of renal calculus?
non-con CT scan
KUB will only show radiopaque urinary stones, and bowel gas and bony structures can obscure stones
how often should thyroid levels be checked in pregnancy if history of thyroid disease?
every 4 weeks during first half of pregnancy.
at least 1x between 26-32 weeks
check thyroid antibody- if positive, these women need monitoring during pregnancy
what is ankylosing spondylitis: incidence, diagnosis, management
males age 15-40. inflammatory back pain, insidious onset, dull quality. causes spine bones to fuse overtime, similar to kyphosis posture
back pain worse in morning, improves with activity, worse at night
inflammation of Achilles tendon and plantar fascia is common
symptoms: fatigue, anorexia, mild fever, eye pain, red eye, blurry vision,
diagnostics: HLA-B27 gene.
sclerosis/ erosive changes of sacroiliac joints- bamboo spine- vertebrae closer together
TX: NSAIDS- inflammation reduction
asbestosis: affect on FVC and TLC
decreased FVC and TLC
what is allodynia?
allodynia- centrally stimulated pain sensitization- occurs after repetitive stimulation, causing pain response that is exaggerated, from stimuli that would not normally provoke pain. Common symptom in patients with neuropathic pain.
Ex. pain on wrists from wearing long sleeves.
what are symtpoms of uremic pericarditis
fever, pleuritic chest pain, increased in recumbent position. no ST segment T wave elevations
