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Family Medicine > Case Files 43-48 (J) > Flashcards

Case Files 43-48 (J) Flashcards

1
Q

The large local allergic reactions surrounding an insect sting is due to _____.

A

IgE mediated response (Type I hypersensitivity reaction). its natural history is 24-48 hours

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2
Q

What are the signs/symptoms of the local reaction to insect stings?

A

erythema, swelling, pain, and itching. Occurs immediately and resolve in a few hours. It is due to the venom itself causing a histamine reaction.

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3
Q

What is the treatment of choice for type I hypersensitivity reactions?

A

Oral steroids.

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4
Q

Signs/symptoms and treatment for anaphylaxis?

A

hypotension, airway edema, shock, and death

Treat with 0.3-0.5 mL of 1:1000 Epinephrine. Except the death. this won’t treat the death.

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5
Q

What is the treatment for a minor animal/human bite?

A

clean the site with soap and water, debride any devitalized tissue, irrigate with saline, and give a tetanus vaccine if not up to date.

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6
Q

What is the treatment for a minor animal/human bite?

A

Same as with a minor bite (clean the site with soap and water, debride any devitalized tissue, irrigate with saline, and give a tetanus vaccine if not up to date.) plus antibiotic prophylaxis using 5-7 days of augmentin. If cellulitis has started to develop (because they waited a couple of days to come in) then its a 7-14 day course of Augmentin.

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7
Q

What bacterium do you have to consider as possible sources of infections in human bites?

A

The usual Staph, Strep, and anaerobic species, PLUS Eikenella (the one likely to be tested)

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8
Q

What bacterium do you have to consider as possible sources of infections in dog/cat bites?

A

The usual Staph, Strep, and anaerobic species, PLUS pasteurella (the one likely to be tested)

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9
Q

What is a TIA?

A

a Transient Ischemic Attach. An episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia WITHOUT infarction. Symptoms last

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10
Q

What us a stroke?

A

Infarction of central nervous tissue. Symptoms by definition last >24 hours, though treatment is (hopefully) started sooner.

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11
Q

What are the risk factors for stroke?

A

HTN (most important), history of TIA, Diabetes, age, male, dyslipidemia, smoking

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12
Q

What are the two most common (testable) types of ischemic stroke?

A

Thrombotic (occluded due to atherosclerosis) or embolic (usually clots occasionally vegetations from infective endocarditis)

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13
Q

a 67 yo male presents with sudden onset aphasia, spatial neglect, and right sided hemiparesis. Which artery is occluded?

A

Left MCA. This is usually the dominant side of the brain and thus where Broca’s area is. remember that it will be contralateral hemiparesis.

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14
Q

What are the 2 most common (testable) types of stroke?

A

ischemic and Hemorrhagic

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15
Q

What is the initial test for a suspected stroke?

A

brain CT without contrast. It may not show ischemia for up to 72 hours but can quickly rule out a hemorrhage thus allowing the use of tPA

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16
Q

What secondary tests should be done for a stroke?

A

ECG to rule out MI or AFib as the cause of the stroke.

Blood glucose, CMP, creatinine, drug screen

17
Q

What is the first step in treating a suspected stroke (ABCs have been done)?

A

If within 3-4 hours of the onset of symptoms and a hemorrhage has been ruled out treat with IV tPA. If between 4-48 hours give ASA, O2, and early mobilization. Be cautious of anti-hypertensives unless >220/120

18
Q

You suspect a subarachnoid hemorrhage in a 84 yo woman but the CT without contrast does not show it. What is your next step?

A

Lumbar Puncture.

19
Q

What is the long term preventive treatment post stroke?

A

unless a source of the embolism is found, put the pt on anti-platelet therapy.

20
Q

A 39yo homeless, IV drug abuseing, man who has sex with men presents to the ED for fever, cough , and dyspnea. His chest has bilateral interstitial infiltrates on CXR. What is the most likely (on a test) cause of his pneumonia?

A

Dude has AIDS. these are the 3 “risk factors” for AIDS according to the NBME. on the test the AIDS related cause of pneumonia is Pneumocystic Jiroveci (Carinii)

21
Q

What is the treatment of choice for P. Jiroveci?

A

trimethoprim-sulfamethoxazole (TMP-SMX)

Prophylactic treatment should be started on all patients with a Tcell count

22
Q

What is the standard screening test for HIV?

A

ELISA assay. Positive assays are confirmed with Western Blot.

23
Q

If a person comes back HIV positive what other tests should be drawn?

A

CD4 count, Viral load

The book says syphilis, Hep B/C, and G/C as well. Because, you know, they must be dirty.

24
Q

What are some common AIDS defining diseases and opportunistic infections?

A

P. Jiroveci, TB, Candida (in places like esophagus and lungs), Kaposi Sarcoma, CMV retinits, and CNS lymphoma.

25
Q

What is the first step in treating a newly diagnosed HIV patient?

A

refer them to a specialist.

26
Q

What vaccines are contraindicated in HIV positive patients?

A

all live virus vaccines (including flu)

27
Q

a 33yo man with no siginificant medical history presents with acute onset diarrhea, abdominal pain, hepatomegaly and jaundice about a month after traveling to central america. What is the most likely diagnosis?

A

Acute Hepatitis A.

28
Q

If a patient is high in unconjugated (indirect) bilirubin, what are the likely sources?

A

Unconjugated bili means that the jaundice is pre-hepatic.

If mild think Gilbert syndrome,

If moderate-severe think hemolysis

29
Q

What is Gilbert syndrome?

A

a genetic defect that affects glucuronidation of bilirubin in the liver.

30
Q

What are the common causes of hemolysis?

A

spherocytosis, thalassemia, sickle cell, malaria, TTP, and HUS

31
Q

If a patient is high in conjugated (direct) bilirubin, what are the likely sources?

A

Hepatitis (A,B,C,D or E), Alcohol abuse, or physical obstruction of the bile duct (bile stone or pancreatic cancer)

32
Q

What is the cause of ~80% of hepatocellular carcinoma?

A

Hepatitis B

33
Q

What are the signs/symptoms and mode of transmission of HepA?

A

S/SX: jaundice, fever, fatigue, abdominal pain, diarrhea, nausea, vomiting, RUQ pain.

Transmitted: contaminated food and water.

34
Q

How can you tell if a Hep B infection is acute, chronic, or resolved?

A

by looking at the different serology markers.

HBsAg is + Acute, +Chronic, -resolved

Anti-HBsAg is -Acute, +Chronic, +resolved

HBeAG is + if infective

35
Q

Hepatitis D requires what?

A

a coinfection with hepatitis B as it uses the viral envelope of Hep B.

Family Medicine (10 decks)

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