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Patient management > Final Questions > Flashcards

Final Questions Flashcards

1
Q

What is microcytic anemia?

A

MCV < 80 (small volume of RBC)
There is insufficient Hb production, chronic disease, or defective heme synthesis (Iron def. anemia, Pb poisioning)
Defective globin chains (thalassemia)

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2
Q

What is macrocytic anemia?

A

MCV >100 (large volume of RBC)
Due to:
- Megaloblastic (VB12 def, folate def) - there is impaired DNA synthesis
- Nonmegaloblastic (liver dx, alcohol)

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3
Q

FUO is defined as

A

Fever >= 38.3 on 2 separate occasions
Illness duration of >= 3 weeks
No known immunocompromised state
Uncertain dx

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4
Q

What is thrombotic thrombocytopenic purpura (TTP)? Etiology? SX?

A

A thrombotic microangiopathy
Microthrombi (made of platelets) occlude the arterioles/capillaries.
Due to acquired autoAb vs ADAMTS13 (cleaves vWF)
SX: fever, neurological abnormalities, thrombocytopenia, microangiopathic hemolytic anemia, impaired renal function)

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5
Q

Coombs test

A

Direct: a hemagglutination test that can detect hemolytic antibodies or complement proteins bound to RBC’s
Indirect: Test which finds autoAb’s/Proteins in the serum

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6
Q

When is d-dimer (a fibrin degradation product) increased?

A

Increased serum concentrations of D-dimer indicate recent intravascular coagulation and/or fibrinolysis (e.g., from deep vein thrombosis, pulmonary embolism, disseminated intravascular coagulation).

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7
Q

When is d-dimer (a fibrin degradation product) increased?

A

Increased serum concentrations of D-dimer indicate recent intravascular coagulation and/or fibrinolysis (e.g., from deep vein thrombosis, pulmonary embolism, disseminated intravascular coagulation).

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8
Q

What is Well’s criteria?

A

To identify VTE risk in DVT and PE. It considers: malignancy, hemoptysis, tachycardia, previous PE/DVT, clinical symptoms for DVT, immobilisation.
>7 is high probablitity of PE. Modified >4 is high PTP

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9
Q

What is giant cell arthritis?

A

Chronic granulomatous vasculitis of extracranial branches of carotids. Assoc. with polymyalgia rheumatics

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10
Q

Large vessel vasculidities:

A

Giant cell arteritis (Temporal headache-blindness)
Takayasu (pulseless dx)

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11
Q

Medium vessel vasculitis

A

polyarteritis nodosa (HX of HBV, BX, CyloPho)
Kawasaki (children, CRASH BURN, aspirin)

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12
Q

Variable vessel vasculitis

A

Bechets: oral genital ulcers (+ pathergy test)

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13
Q

WHO analgesic ladder

A

Mild: NSAIDS, acetaminophen, aspirin (adjuvant)
Mod: opiods (codeine, tramadol) + above
Severe: opioids (morphine, fentanyl) + above

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14
Q

Non selective NSAID complications

A

(ibruprofen, naproxen)
gastric ulcers, renal damage

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15
Q

Selective NSAID complications

A

(-coxibs for COX2i) they increase coagulation so risk of CAD

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16
Q

Side effects of acetaminophen (inhibits PGE synthesis)

A

HTN, liver damage/failure

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17
Q

Colchicine uses

A

Its an anti-inflammatory and prevents microtubule formation.
Used in gout, and recurrent pericarditis

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18
Q

What is fulminant myocarditis?

A

A rare and life-threatening type of myocarditis characterized by cardiogenic shock, hemodynamically significant arrhythmias (e.g., heart block, ventricular tachycardia), and multiorgan failure.

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19
Q

Most common location of aortic dissection

A

Right lateral wall of ascending aorta

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20
Q

Debakey and Stanford classification of aortic dissection

A

De Bakey: I (ascending + descending), 2 (ascending), 3 (descending a above renal, b below renal).
- Stanford A (De Bakey I and 2), Stanford B (De Bakey 3)

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21
Q

What labs to determine end organ damage?

A

troponin, basic metabolic panel, lactate

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22
Q

Hypotensive pts hemodynamic support includes

A

Target MAP: 70mmHg
IV fluids
Vasopressors (norepinephrine, phenylephrine)

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23
Q

Hypertensive pt management in aortic dissection

A

Target SBP 100-120 HR<60
IV BB: to avoid reflex tachycardia
Vasodilators: IV sodium nitroprusside
If BB contraindicated: non-DHT CCB

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24
Q

Most common site of malignancy in breast cancer?

A

Upper outer quadrant (close to axilla)

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25
Q

Age differential for breast nodules

A

20: fibroadenoma, benign nodules
50: cysts
60: cancer

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26
Q

Which imaging study if liver cirrhosis is present?

A

MRI
CT: enhancement in late arterial phase and hypoattentuation in portal venous phase

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27
Q

What is zollinger ellison syndrome?

A

Multiple peptic ulcers due to gastrinoma

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28
Q

What is whipples triad

A

used to identify hypoglycemia
Presents with Hypoglycemia SX, relief with glycemia normalises, low plasma glucose

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29
Q

Transudative pleural effusion is due to which conditions?

A

Increased hydrostatic pressure
HF, cirrhosis, hypoalbuminemia (CKD)

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30
Q

Exudative pleural effusion occurs in which situations?

A

Increased capillary permeability
Pneumonia, cancer, PE, TB

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31
Q

What spatial organisation does typical/atypical pneumonia have?

A

Typical: lobar
Atypical/interstitial

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32
Q

Scores for pneumonia are CURB65 and PSI which include

A

CURB65 (confusion, urea >7, RR>30, SBP<90, age 65)

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33
Q

The treatment of PE should last how long

A

6 months
If stable: initial dose of LMWH/fondaparinaux, with 6mo of DOAC/warfarin
If unstable: thrombolytis or embolectomy
IVC filter if acute VTE

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34
Q

Congestive HF is due to?

A

due to CAD, DM, HTN. These conditions cause ventricular dysfunction with low CO.

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35
Q

Acute Heart failure can be

A

A de novo episode (due to post-MI, pulmonary embolism, pericardial effusion.) or decompensation of pre-existing HF (common in hospitalised old pt)

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36
Q

Pulmonary edema is , and is caused by?

A

Is fluid right outside the alveoli. Can be cardiogenic (LVHF), or non cardiogenic (sepsis, severe infection)

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37
Q

Pulmonary effusion is, and is caused by?

A

Is fluid in the pleural space. Can be transudative or exudative. Due to infections, malignancy, HF

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38
Q

Hemoptysis is? It is most commonly due to

A

Bleeding from the lower respiratory tract.
Due to pulmonary infection (TB) then lung cancer

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39
Q

Indications for endotracheal tube

A

Airway obstruction: (anaphylaxis)
Airway protection (if you have lost reflexes during general anesthesia, coma, severe altered mental status, or if deterioration is anticipated (smoke inhalation injury, overdose)

40
Q

What are purpura?

A

subtype of hematoma which does NOT blanch with pressure (meaning it is due to RBC extravasation and not vasodilation)

41
Q

What are non palpable purpura?

A

Which are either petechia or ecchymosis (bigger)

42
Q

Where do disks herniate?

A

posteriorly as posterior longitudinal ligament is thinner than anterior longitudinal ligament

43
Q

Which scale is used for AMS

A

AVPU (alert, verbal, pain, unresponsive), GCS, four score is useful in intubated patients bc doesn’t rely on verbal responses (eye, motor, brainstem reflexes, respiration. Max 16)

44
Q

What are cheyne stokes respirations

A

progressively deeper and faster, until there is apnea, this is repeated -damage to brainstem respiratory centres or cardiac failure

45
Q

Three types of hyponatremia and the movement of water in them

A

Hypertonic: water moves into capillaries - volume overload - diabetic hyperglycemia
Hypotonic: water moves out of capillaries and into cells - cerebral edema and AMS
Pseudohyponatremia:
Correct chronic hyponatremia slowly to avoid acute demyelinating syndrome

46
Q

Hypoglycemia levels in diabetics and non diabetics

A

Diabetics <70
Non diabetics <50

47
Q

Types of syncope and what they are caused by

A

Cardiac: Arrythmias (decreased EF -> cerebral hypoperfusion), Structural heart disease -> myocardial dysfunction, decreased EF (aortic stenosis, pulmonary embolism, hypertrophic cardiomyopathy, cardiac tamponade etc)
Non-Cardiac:
- Reflex: can be vasovagal
- Orthostatic
-Swallow syncope

48
Q

Normal functioning of the carotid/aortic baroreceptors?

A

sense the fall in BP and block the inhibitory activity of the vagal/glossopharyngeal nerves

49
Q

Explain the valsalva maneuvre

A

1) px blows into syringe, BP increases, HR decreases
2) decreased BP due to reduced CV return due to increased intrathoracic pressure (blowing) + increased HR
3) px stops blowing, starts to breathe normally -> decreased BP with increased HR
4) increased BP and reflex decrease in HR

50
Q

Define cardiac syncope

A

Arrythmogenic, myocardial, and vascular causes of syncope that are often life threatening

51
Q

Pathophysiology of cardiac syncope?

A

Reduced cerebral perfusion post insufficient CO due to cardiac/circulatory failure.
Due to: PSVT (self limiting), LVOT, MI, PE, hemorrhage before physiological response of sympathetic activation occurs.

52
Q

What causes pulmonary HTN?

A

Left sided HF

53
Q

Define non cardiogenic syncope and its most common causes

A

Benign causes of syncope that are neurological, hormonal, metabolic. E.g: reflex syncope, vasovagal, situational, carotid sinus syndrome, orthostatic
HAS PRODROME
It is triggered by physiological/environment triggers. Do tilt table test.
PNS hyperactivity, SNS hypoactivity

54
Q

Midodrine is an

A

Alpha one agonist
Used: vasovagal syncope

55
Q

What is meckels diverticulum and what does it cause?

A

A congential abnormality (incomplete obliteration of omphalomesenteric duct). Painless LGIB (hematochezia) in <2yrs. If it gets perforated ten intussesception/volvulus, diverticulitis, peritonitis. DX with scintigraphy, CTA, laprascopy. TX: resection

56
Q

What is initial harmacological management of Upper GIB?

A

PPI and ocreotide (inhibits HCl acid and pepsin secretion)

57
Q

GLASGOW BLATCHFORD SCORE is for?

A

is a screening tool to assess the likelihood that a person with an acute UGIB will need medical intervention such as a blood transfusion or endoscopic intervention: BUN, Hb, SBP, HR, melena, syncope, liver dx, heart disease

58
Q

Oakland score is used for

A

LGIB: age, gender, previous LGIB, DRE positive, HR, SBP, Hb

59
Q

What should your INR be on anti-coagulants

A

if px is taking anticoagulants: INR SHOULD BE AROUND 1. IF:
-INR > 2.5: reverse anticoagulants (Vit K/protamine sulfate) before endoscopy
-INR < 2.5: straight to endoscopic hemostasis

60
Q

If a pt is taking anti platelets and you need to perfrom urgent surgery what do you do?

A

Give platelets

61
Q

Whats the forest classification for?

A

Bleeding peptic ulcers.
Stage 1: active hemorrhage)
Stage 2: evidence of a recent hemorrhage
Stage 3: clean based ulcer

62
Q

what is the hinckey classification used for

A

perforation due to diverticulistis
1A: pericolonic phlegmon with inflammation
1B: pericolonic abscess
2: abscess >4cm or fistula
3: peritonitis
4: fecal peritonitis

63
Q

What score for sepsis

A

SOFA (confusion, RR>30, hypotension)

64
Q

Sepsis tx

A

O2
take blood and urine vulture
IV broad spectrum abx (pip/tazobactam, ceftriaxone, merepenem)
IV fluids
check hourly fluid output
check lactate level

65
Q

DDX for pelvic pain in women according to age

A

Menarche to 21: menstrual pain, first intercourse, imperforate hymen
21-35: ovarian cyst, endometriosis
35 to menopause: uterine fibroids, cancer

66
Q

What is a klatskin tumor

A

Cancer that forms in the common hepatic duct. Klatskin tumor is a type of extrahepatic bile duct cancer.

67
Q

Probably pathogen in acute diarrhea according to time of symptom onset

A

sx < 6h after eating = S.aureus
-sx 8-16h after eating = C.Perfringens
-sx >16h after eating = viral or E.Coli

68
Q

What are the causes of A fib

A

Pulmonary embolism
Ischemia
Respiratory disease
Atrial enlargement or myxoma
Thyroid disease
Ethanol
Sepsis/sleep apnea

69
Q

What are the indications for bariatric surgery

A

BMI>40 without comorbidities, or BMI>35 with comorbidities

70
Q

What are the MOA of the following drugs used in nausea and vomiting:
Prochlorperazine
metclopramide
domperidone
erythromycin/bethanchol

A

Prochlorperazine: antiemetic (yes in pregnancy)
metclopramide (D2R antagonist, antiemetic, prokinetic properties)
domperidone same as above but doesnt penetrate BBB (less dystonia/anxiety)
erythromycin/bethanchol (prokinetics, improves gastric emptying without improving nausea)

71
Q

When to use NJ tube instead of NG?

A

NJ or N-duodenum if pt has gastroparesis, reduced risk of aspiration (GERD, hiatal hernias)

72
Q

When do you use peripheral parenteral nutrition

A

peripheral venous access for 1-2w only in px with low risk of malnutrition and those who just need hydration

73
Q

When to use total/central parenteral nutrition

A

needs CVC (jugular, subclavian, femoral) or PICC
-can cause pneumothorax, arrythmias, brachial plexus injury, sepsis, CVC occlusion/thrombosis
-can cause overhydration/dehydration, hypoglycemia, hyperglycemia =electrolyte abnormalities

74
Q

Most probable causes of bilateral pitting edema, generalised pitting edema, non pitting edema

A

bilateral pitting edema in lower limbs is usually due to congestive heart failure (+ CCB)
-generalised pitting edema with swelling of the eyelids is due to hypoalbuminemia eg nephrotic syndrome
-non pitting edema is seen in px with lympatic and thyroid conditions (lymphedema/myxedema)

75
Q

What is anasarca

A

severe, massive generalised edema

76
Q

NOTE

A

adverse effects of diuretics in px with ascites: hepatic encephalopathy and kidney failure

77
Q

What are stokes adams attacks

A

episodes of loss of consciousness associated with self limited rapid tachyarrythmias at the onset of heart block or transient asystole

78
Q

What are the indications for liver transplant?

A

decompensated chronic liver dx
Acute liver failure (injury w/ encephalopathy +INR>1.5)
HCC

79
Q

What does the MELD score do? What does it measure? If the pt has HCC do you use this for them? What does the child pugh score measure?

A

predicts 3 months mortality in px waiting for transplant (you must have >15 to be on the list)
Includes: creatinine, INR, bilirubin, serum sodium
If a pt has HCC use the milan criteria (1 nodule<5cm, 3 noduels <3cm no vascular invasion)
Child pugh: prognosis of chronic liver dx. Albumin, ascited, bilirubin, encephalopathy, PT/INR)

80
Q

What is small for size syndrom in liver transplant?

A

is a clinical syndrome that can be defined by the presence of prolonged cholestasis, coagulopathy, and ascites in the absence of ischemia within the first week of liver transplant caused by a partial liver graft that is inadequate to sustain metabolic demand in the recipient

81
Q

What is the outflow (IVC) inflow (PV HA) problem?

A

vessel clamping during reconstruction causes diffuse hypotension/ischemia SO hyperkalemia and lactic acidosis which can spread after reperfusion. Portal clamping can cause splanchnic hypertension THEN small bowel congestion and post op renal failure

82
Q

Donor cold ischemia time is

A

between the chilling of a tissue, organ, or body part after its blood supply has been reduced or cut off and the time it is warmed by having its blood supply restored reduce to about 6.25 +/- 2.3h

83
Q

Donor warm ischemia time

A

time a tissue, organ, or body part remains at body temperature after its blood supply has been reduced or cut off but before it is cooled or reconnected to a blood supply

84
Q

Post liver transplant lymphoproliferative dx

A

tumor only in post transplant patients caused by EBV reactivation due to immunosuppression == uncontrolled B cell proliferation. Treat with rituximab and slight reduction of immunosuppressive drugs

85
Q

Hounsfield units on CT

A

-0 Hounsfield is water
-minus 1000 Hounsfield is air
-negative values are usually fat (hypoattenutation)

86
Q

What is the bosniak classification?

A

For renal cysts
1 to 4: septa, calcifications and enhancement

87
Q

Which pathogen is most often responsible for Potts disease?

A

Mycobacterium

88
Q

TX for septic arthritis
GP cocci
GN bacilli
GN cocci

A

GP cocci: vanco, if MSSA give cefazolin is MRSA give linezolid (S.aureus)
-GN bacilli: piperacillin/tazobactam + aminoglycoside if septic, otherwise give cefepime (Pseudomonas)
-GN cocci: ceftriaxone

89
Q

Non metastatic causes of generalised muscle weakness

A

a thymoma is associated with myasthenia gravis in 10% of cases.
Eaton lambert myasthenic syndrome is associated with small cell lung carcinoma

90
Q

Diagnosis/Tx of myasthenia gravis

A

EMG, Blood test for ACh receptor antibodies
tx: Corticosteroids

91
Q

Test urine antigens for which pneumonia pathogens?

A

S pneumoniae
Legionella

92
Q

What is virchows triad

A

stasis, clotting factors, damaged vessel endothelium

93
Q

CHAFVASC score and HASBLED score

A

CHADVASC looks at risk of thromboembolic events while HASBLED defines risk of bleeding

CHAD VASC >2/3 == anticoagulant tx
if HASBLED > CHADVASC do not start anticoagulation

94
Q

TB therapy regimen

A

Isoniazide, rifampicin, pyrazinamide, ethambutol (8 weeks)
Continutation phase of isoniazide and rifampicin for 4 months

95
Q

HEPB therapy

A

nucleoside polymerase inhibitors (tenofovir, entecavir); oral daily antivirals
Note that they cause: renal failure, myopathy, neuropathy

96
Q

What does the FNCLCC include?

A

Tumor differentiation
Mitotic count
Tumor necrosis
Histiological grade

97
Q

Scores to assess pancreatitis severity

A

APACHE: (considers 12 variables)
Marshall: (Pa02/fio2, SBP, serum creatinine,
ATLANTA: (mild moderate severe)
Ranson criteria for gallstone pancreatitis (age>70, WBC, glucose, LDH, AST)

Patient management (11 decks)

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