Exam 1 Flashcards
Rhinitis Medicamentosa is caused by overuse of topical nasal decongestants. The overuse causes a rebound increase in nasal congestion, leading to continued topical nasal decongestant use and difficulty weaning use. Which of these is least likey to help wean off?
- Topical Steroids
- Systemic Steroids
- Systemic Decongestants
- Systemic Antihistamines
- Systemic Antihistamines are innefective in treating rhinitis medicamentosa because this condition is not associated with degranulation of mast cells and no histamine is released. The other options have been effective in weaning off topical decongestants.
Partners exposed to a pt with primary, secondary, or early latent syphilis within the previous 3 months should also be treated for syphilis, even if serologic test results are negative. If a pt was exposed within the 3 months, he should be treated for primary syphilis. What is the treatment?
The preferred treatment is Benzathine Penicillin G at 2.4 million units IM in a single dose
One of the reasons it is difficult to distinguish primary small bowel lymphoma from extranodal disease is because the GI tract is the most common site for extranodal involvement. GI involvement account for 20% of extranodal disease. Primary small bowel lymphomas acount for <10% of small bowel malignancies. Thus, it is key to know the characteritics distinguishing these entities. Dawsons criteria are used to distinguish primary small bowel lymphoma from extranodal lymphoma involving the GI tract. What is the criteria?
- At the time of presentation there should be no peripheral lymphadenopathy
- Mediastinal lymph nodes should not be enlarged
- peripheral WBC count and differential are normal
- Disease is present only in the GI tract and regional lymph nodes
- There is no hepatic or splenic disease
Note: >90% of primary small bowel lymphomas are B-cell lymphomas, while only 10% are T-cell
The generation of action potential within cardiac myocytes is largely governed by ion movement. Movement of several ions generates 4 general phases of each action potential: rapid depolirazation, rapid repolarization, plateu, final rapic repolarization, and resting. Which ion is primaraly responsible for rapid depolarization?
- Sodium
- Potassium
- Calcium
- Chloride
Sodium
A ciggerate smoker with a history of lower extremity claudication is started on an ACE inhibitor for hypertension that failed to improve with lifestyle modifications. His serum Cr doubled after the initiation of ACE inhibitors. This is suggestive of which findings?
- Significant bilateral renal artery stenosis
- Pheochromocytoma
- Primary Altdosteronism
- Atherosclerotic emboli from the aorta
In bilateral renal aretery stenosis, GFR is preserved by the actions of Angiotensin II, afferent arteriolar vasodilation, and efferent arteriolora vasoconstriction. ACE inhibitors and and angriotensin II receptor blockers these responses, resulting in a decrease GFR and increase in serum Cr. Thiazide diuretics and CCB are better choices for hypertensive patients with bilateral renal artery stenosis
ACE inhibitors blunt intrinsic responses of the afferent and efferent arterioles to renal artery stenosis. This may lead to decreased renal perfusion and AKI
Which of the following is a first line evaluation of vulvovaginal candidiasis?
- Polymerase chain reaction
- serum antibody titers
- wet mount
- yeast cultures
A wet mount with KOH application will lyse human cells and facilitate the visualization of yeast hyphae.
Flucanozole is the fist line treatment for yeast infection; if no response is noted to antifungal medications, then yeast culture and sesitivities are indicated to rule out yeast strains that are resistant to fluconazole.
What is Chrons disease?
Chrons disease is a disorder of uncertain etiology that is characterized by transmural inflammation of the GI tract. CD may involve the entire GI tract from the mouth to the perianal area. The clinical manifestations of CD are more variable than those of UC. Patients can have symptoms for many years prior to diagnosis. Fatigue, prolonged diarrhea with abdominal pain, weightloss, fevers, with or without gross bleeding, are the hallmarks of CD. Although stools frequently reveal microscopic levels of blood (e.g. positive guaiac or immunochemical test), gross bleeding is less frequent than in UC. UC is unlikely in a normal looking colon all the way to ascending colon. In the abscence of negative work up for infections and a catastrophic event precipitating ischemia, infectious and ischemic cuses are less likely.
What is the most common ocular manifestation in patients with rheumatoid arthritis?
- Uveitis
- Keratoconjunctivitis sicca
- Conjunctivitis
- Keratitis
The most common ocular problem in pt with RA is keratoconjunctivits sicca or secondary Sjogren syndrome associated with connecrtive tissue disease. Dry eyes occur in 11-13% of these patients, and the condition is characterized by lymphocytic infiltration of lacrimal and salivary glands with subsequent glandular destruction. Scleritis is the second most common finding
When is Arterial Brachial Index used?
ABI is th eeasiest and least invasive approach to identify arterial insufficiency, although its accuracy and benefits are unclear in asymptomatic patients who do not have significant risks factors for coronary artery disease. Anything under 0.9 is considered abnormal.
What is the null hypothesis?
The null hypothesis states that there are no significant differences between specified populations and that any differences observed are due to chance alone.
What is p-value?
The p-value reflects the likely variation in a sample due to chance when the null hypothesis is true in the population.
example: p= .012,
drug x is better than placebo , and there is only a 1.2% chance that this is due to chance alone. In other words, there is a 1.2% probability of achieiving the same study outcome if the null hypothesis is true.
What is pneumoconiosis?
Pneumoconiosis is one of a group of interstitial lung disease caused by breathing in certain kinds of dust particles that damage your lungs. Because you are likely to encounter these dusts only in the workplace, pneumoconiosis is called an occupational lung disease. Pneumoconiosis usually take years to develop.
Individuals with silicosis have higher incedence of mycobacterial infections and increased risk of lung cancer.
How do you diagnose and treat chronic myelogenous leukemia (CML)?
t (9;22) is the philedelphia chromosome
The only known curative therapy is bone marrow transplant, but this procedure carries significant risk of early mortality. Because imatinib induces long-lasting remissions in the majority of patients, transplant is usually deferred until the time imatinib and other tyrosine kinase inhibitoirs fail.
Pt comes in with two days of increasing confusion and weakenss. Recently diagnosed with squamous cell lung cancer.
Ca 13.2, EKG with shortening of the QT interval, Na 135, K 3.8, Chloride 102, Bicarb 24, BUN 12, Cr 1.1 )
How do you initially treat hypercalcemia?
Administer normal saline at 200ml an hour for hydration
the correct management of hypercalcemia of malignancy requires decreasing the concentration in the serum and correcting the underlying cause. The most important initial therapy to reduce the concentration of calcium is hydration. Patients should be hydrated to maintain a urine output of 100-150 ml/hr. Aggressive hydration is usually required since most pt will be volume depleted on presentation. Hydration should be carefuly monitored due to possible renal insufficiency associated with hypercacemia and the likelihood of heart failure in this population.
How do you treat cystic fibrosis related diabetes?
Insulin
Cystic Fibrosis related diabetes is a common finding in cystic fibrosis. The abnormality in glucose metabolism is likely from the pathology of the endocrine pancreas, causing insulin and possibly glycogen deficiency. Hence, the the most physioilogic way to manage diabetes would be to replace insulin.
A woman presents with pancreatitis likely due to an entraped gallstone. The ECG demonstrates a prolonged QT interval. What is the next step in managing pt?
- obtain IV access and administer 1 mg of atropine
- obtian iv access and administer 4g of magnesium sulfate
- obtain iv access and give amps of calcium gluconate
- obtian iv access and give 2 amps of calcium glucnate and 4 g of magnesium sulfate
obtian iv access and give 2 amps of calcium glucnate and 4 g of magnesium sulfate
he ECG demonstrates a prolonged QT interval related to the precense of hypocalcemia. Hypocalcemia accompanies pancreatitis and is largely due to free fatty acid precipitation of calcium. The preferred agent for correcting hypocalcemis is calcium gluconate in addition to correcting possible hypomagnesemia which may also occur in pancreatitis
A 32 year old male was just diagnosed with celiac disease. Which of the following deficiencies would you expect
- IgG1 sublass
- IgD
- IgA
- IgE
IgA deficiency
1 in 40 pt with celiac disease can have associated IgA deficiency while in the general population the prevelance is 1 in 400. This IgA def. also has implications for anti-TTG antibody detection, as IgA can lead to false negative results. Thus, it is recommended that pts in whom celiac disease is suspected undergo endoscopy with biospy.
