Deck 2 Flashcards
What is the pathophysiology of ARDS?
Lung injury leads to release of proteins, cytokines, and neutrophils into the alveolar space. This leads to leakage of blood/proteinaceous fluid into the alveoli, alveolar collapse due to loss of surfactant, and diffuse alveolar damage. As a result, 1. gas exchange is impaired, 2. there is decreased lung compliance ** (due to loss of surfactant and increased elastic recoil of edematous lungs), and 3. pulmonary HTN (increased pulm arterial pressure)
a gestational sac at the uterine cornu means….
ectopic pregnancy!
this type is cornual or interstitial ectopic pregnancy.
pts w/ bicornuate “heart-shaped” uteruses are at risk for this type of ectopic pregnancy.
How do patients w/ Kawasaki disease present?
They must have a fever for >/= 5 days, and 4 of the following:
- conjunctivitis
- “strawberry tongue” (oral mucosal changes)
- rash
- erythema, edema, desquamation of the hands and feet
- cervical LAD, usually unilateral
Untreated patients with Kawasaki disease are at risk of what major complication? how do you tx Kawasaki disease?
coronary artery aneurysm
Tx w/ aspirin and IVIG - this decreases the risk of complications.
ECHO should be performed at the time to dx and repeated 6-8wks later.
intrauterine fetal demise associated w/ growth restriction, multiple limb fractures, short femurs, and a hypoplastic thoracic cavity?
type II osteogenesis imperfecta
autosomal dominant, defective type 1 collagen synthesis
What is the greatest risk factor for cerebral palsy? and what form is most commonly seen in these infants?
premature birth before 32 weeks.
spastic diplegia is most commonly seen in these preterm infants – it presents w/ hypertonia and hyperreflexia (mainly in the LEs) with both feet pointing down and inward (equinovarus deformity)
how do you tx beta-thalassemia minor?
you don’t.
no specific tx is required.
usually pts are of mediterranean descent, asymptomatic w/ mild anemia, disproportionately high RBC count, low MCV, and hgb > 10.
pts initially diagnosed w/ HTN should have a H&P, and what basic testing?
- Urinalysis (for occult hematuria and urine protein/creatinine ratio)
- chemistry panel
- lipid profile
- baseline ECG
In blastomycosis, extrapulmonary dz most commonly affects the skin. What do the skin lesions look like?
Skin lesions in blasto characteristically present as heaped-up verrucous or nodular lesions w/ a violaceous hue that may evolve into microabscesses. wartlike lesions, may even have skin ulcers.
HIV pt w/ CD4 < 100 has vascular cutaneous lesions that began as small reddish/purple papules and evolved into friable pedunculated/nodular lesions. Also has constitutional sxs (fever, malaise, night sweats) and may even have organ involvement (liver, CNS, bone). What do they have?
Bacillary angiomatosis!
a Bartonella infection – infx occurs via cat scratch (Bartonella henselae) or body/head lice bite (Bartonella quintana)
Tx = Abx (doxycycline, erythromycin), and the initiation of antiretroviral therapy
What are the chronic symptoms of irritant contact dermatitis?
excoriations, hyperkeratosis, and fissuring of the skin.
this can be triggered by a variety of chemicals/cleaning products.
it is nonimmunologically mediated, but can sometimes resemble allergic contact dermatitis (pruritus, erythema, local swelling and vesicles)
what are common symptoms of Premenstrual syndrome (PMS)? Dx? Tx?
common symptoms include mood swings, irritability, fatigue, bloating, hot flashes, and breast tenderness. Dx can be confirmed w/ a Symptom diary over 2 menstrual cycles, which may demonstrate recurrence of symptoms 1-2wks prior to menses during the luteal phase and resolution w/ menses. Tx = SSRIs, or OCPs.
harsh, holosystolic murmur best heard at the left lower sternal border in a young child. what is it? Should I do anything?
VSD!
ECHO should be done to determine location/size and r/o other defects.
What do you see in tricyclic antidepressant overdose?
mental status changes, seizures, tachycardia, hypotension, cardiac conduction delay (prolonged QRS), and anticholinergic effects (dilated pupils, hyperthermia, flushed and dry skin, intestinal ileus)
What is bullous pemphigoid? How do you Dx and Tx it?
Bullous pemphigoid is an autoimmune disorder characterized by pruritus and tense bullae on an erythematous base. Common in pts >65 and those w/ malignancy or neuro disorder (parkinsons, MS).
Caused by IgG autoantibodies against the hemidesmosome and BM zone.
Dx via skin biopsy – LM shows subepidermal cleavage; immunofluorescence shows linear IgG and C3 deposits along the BM.
Tx: high-potency topical glucocorticoid – CLOBETASOL
What do you see with laxative abuse (diarrhea characteristics, electrolyte abnormalities)? How do you dx?
Diarrhea is typically watery, frequent, and voluminous – nocturnal BMs and abdominal cramps are common.
Hypokalemia and metabolic alkalosis (due to increased serum bicarb from impaired chloride-bicarb exchange).
Dx via positive laxative screen or colonoscopy w/ characteristic findings of melanosis coli (dark brown discoloration w/ pale patches of lymph follicles).
How do you tx uterine inversion?
immediate manual replacement of the uterus.
if the placenta is still attached, it should not be removed until after the uterus is replaced due to risk of massive hemorrhage.
Uterotonics (oxytocin, misoprostol) should be administered after uterine replacement to prevent further hemorrhage and recurrence of prolapse.
Pt presents w/ sensory ataxia, impaired vibration/proprioception, frequent loss of balance, lancinating pains, reduced/absent DTRs, urinary incontinence, and normal pupillary constriciton w/ accommodation but not with light. What do they have and how do you tx it?
Tabes dorsalis and Argyll Robertson pupils, which are findings in late neurosyphilis.
Tx w/ IV penicillin
How do you tx idiopathic intracranial HTN (IIH) or pseudotumor cerebri?
Acetazolamide!
it inhibits choroid plexus carbonic anhydrase, thereby decreasing CSF production and intracranial HTN.
statins should be given to all diabetic pts between ages?
40-75
When is infective endocarditis due to Eikenella corrodens seen?
in the setting of poor dentition and/or periodontal infection, along w/ dental procedures that involve manipulation of the gingival or oral mucosa.
ya(E. corrodens is a gram-neg anaerobe and part of normal human oral flora)
What is Osler-Weber-Rendu syndrome?
aka hereditary telangiectasia.
characterized by diffuse telangiectasias, recurrent epistaxis, and widespread AV malformations.
AVMs tend to occur in the mucous membranes, skin, and GI tract, but may also occur in the liver, brain, and lung. AVMs in the lungs can shunt blood from the right to the left heart, causing chronic hypoxemia (digital clubbing) and reactive polycythemia!
What is dacryocystitis?
an infection of the lacrimal gland, characterized by the sudden onset of pain and redness in the medial canthal region. Sometimes a purulent discharge is noted from the punctum.
Describe the criteria for Schizoaffective disorder?
- major depressive or manic episode concurrent w/ sxs of schizophrenia
- lifetime hx of delusions or hallucinations for > 2 weeks in the absence of major depressive or manic episode
- mood sxs are present for majority of illness
- not due to substances or another medical condition
reperfusion of a limb following arterio-occlusive ischemia for longer than 4-6 hrs can lead to what complication?
intracellular and interstitial edema, which may lead to compartment syndrome (acute pain and paresthesias, rapidly increasing and tense swelling, pain on passive stretch)
For an adjustment disorder to be diagnosed, what time frame does it have to occur in?
an adjustment disorder involves emotional or behavior symptoms developing within 3 months of an identifiable stressor, and lasting no longer than 6 months once the stressor ceases.
What’s the MOA of 2nd-gen antipsychotics, like risperidone?
serotonin 2A and dopamine D2 receptor blockers
Pts on high dose beta-2 agonists (albuterol) for acute asthma attacks may develop what electrolyte abnormality? (sxs?)
hypokalemia – may present w/ muscle weakness, arrhythmias and EKG abnormalities
other common beta-2 agonist SEs include tremor, palpitations and HA
In HIV pts, what virus causes acute retinal necrosis associated w/ pain, keratitis, uveitis, and funduscopic findings of peripheral pale lesions and central retinal necrosis?
Herpes simplex virus
(in contrast, CMV retinitis is painless and characterized by funduscopic findings of hemorrhages and fluffy or granular lesions around the retinal vessels)
Persistent, eczematous or ulcerating rash on the nipple that spreads to the areola. It is itchy and may hurt, and topical corticosteroids don’t resolve it. What is it? What type of cancer is associated w/ it?
Mammary Paget disease.
Adenocarcinoma (the most common type of breast cancer) is found in Paget disease.
In dermatomyositis/polymyositis, muscle weakness is due to injury of what particularly?
muscle fiber injury!
What are the specific names of the skin findings seen in dermatomyositis?
erythematous rash over the dorsum of the fingers = Gottron’s papules; and/or on the upper eyelids = heliotrope eruption
Pt presents w/ watery diarrhea that is tea colored, muscle weakness/cramps and hypokalemia, hypo- or achlorhydria, as well as facial flushing, lethargy, n/v, abdominal pain and weight loss. What do they have?
VIPoma!!
this is a rare tumor affecting the pancreatic cells, VIP (vasoactive intestinal peptide) binds to intestinal epithelial cells to increase fluid and electrolyte secretion into the intestinal lumen – most pts develop this VIPoma syndrome (pancreatic cholera)
(may have hypercalcemia due to increased bone resorption, and hyperglycemia due to increased glycogenolysis)
*pts may have coexisting hyperparathyroidism as part of MEN
pt presents with a mild prodrome of fever and malaise and shows you a small area on his hand of grouped vesicles on an erythematous base. He describes a tingling, burning pain. He recently had unprotected sex. What is this rash?
Herpetic whitlow
caused by HSV
all pts w/ an initial dx of rheumatic fever should be tx’d w/ Abx therapy to eradicate GAS regardless of the presence or absence of pharyngitis at the time of dx. What Abx do you use?
IM benzathine PENCILLIN G
continuous Abx prophylaxis to prevent recurrent GAS pharyngitis, give every 4 weeks
What is the most common side effect of Tamoxifen? and other side effects?
most common = hot flashes
other side effects = venous thromboembolism, endometrial hyperplasia and carcinoma
What is the motor and sensory function of the femoral nerve?
Motor: leg flexion at the hip, leg extension at the knee (innervates anterior compartment of the thigh)
Sensory: anterior/medial thigh and medial leg via the saphenous branch
What imaging study do you use to diagnose Meckel’s diverticulum?
Technetium-99m pertechnetate scan
What are the medications commonly used in the tx of Acute Bipolar Depression?
Quetiapine and Lurasidone (2nd gen antipsychotics)
Lamotrigine (anticonvulsant)
Pt presents after blunt head trauma. They receive fluid resuscitation and develop HTN, bradycardia, and respiratory depression (Cushing’s reflex)… what is going on?
They likely have an epidural hematoma from rupture of the middle meningeal artery. Fluid resuscitation is increasing the rate at which the hematoma expands and the sxs are caused by elevated ICP. Transtentorial (uncal) herniation is likely to occur and cause pressure on the ipsilateral oculomotor nerve (mydriasis, ptosis, down-and-out gaze of the ipsilateral pupil), ipsilateral posterior cerebral artery (contralateral homonymous hemianopsia), and contralateral cerebral peduncle against the edge of the tentorium (ipsilateral hemiparesis).
How do you tx chorioamnionitis?
broad-spectrum antibiotics (ampicillin, gentamicin, clindamycin) and delivery!
*chorioamnionitis is NOT an indication for c-section… oxytocin may be given to accelerate labor
ultrasound findings of an ovarian mass with solid components, thick septations, and peritoneal free fluid (ascites) are concerning for what?
epithelial ovarian carcinoma
the presence of peritoneal fluid in a postmenopausal woman is pathologic and is the origin of typical sxs of bloating, pain, early satiety-anorexia, and abdominal distension seen in ovarian cancer.
How do you treat an Acute dystonic reaction (sudden, sustained contraction of the neck, mouth, tongue, or eye muscles) – SE of antipsychotics?
Benztropine or Diphenhydramine
benztropine is an anticholinergic med, and diphenhydramine is an antihistamine w/ significant anticholinergic activity.
