join Flashcards
Antineutrophil cytoplasmic antibodies (ANCA) Antiendomysial antibodies (AEA) Antinuclear antibodies (ANA) Anti-Saccharomyces cerevisiae antibodies (ASCA)
pANCA: UC, polyangitis
AEA, anti-gliadin: CEliAc sprue
ANA, anti-smith, anti-dsDNA: SLE
ASCA: Crohns
What examination finding would be expected in a patient with von Willebrand disease? Gingival bleeding Splenomegaly Muscle weakness Hemarthrosis
A patient with von Willebrand disease most commonly presents with mucosal bleeding seen in epistaxis, gingival bleeding, and menorrhagia.
established risk factor for osteoporosis
low body weight female advanced age Caucasian b/l ooph prior to menopause c/o estrogen replacement
52 year-old obese patient with persistent heavy menses undergoes an endometrial biopsy and is diagnosed with atypical adenomatous hyperplasia. What is the next step in the management of this patient?
Total abdominal hysterectomy
Observation and endometrial biopsy in 3 months
Endometrial curettage followed by progesterone daily
Oral progesterone days 16-25 of the month for 6 months and repeat biopsy
Atypical adenomatous hyperplasia contains cellular atypia and mitotic figures in addition to glandular crowding and complexity. This has a 20-30% risk of progression to endometrial cancer and the recommendation is hysterectomy
A 72 year-old male presents to the emergency department with crushing chest pain, dyspnea and palpitations for 2 hours in duration. Enzymes are pending and he has been given aspirin and sublingual nitroglycerin. He is rushed to the catheterization lab where they find a totally occluded distal right coronary artery. Which of the following electrocardiogram (ECG) findings supports the diagnosis?
Q waves in leads I, aVL, V5-V6
ST segment elevation in leads II, III, aVF
Hyperacute T waves in leads I, aVL
Flipped T waves with repolarization changes in leads V1-V4
ST segment elevation in leads II, III, aVF, represents an acute process in the right coronary artery.
A patient presents with occasional wheezing and chest tightness that occurs approximately once a week and at night only about once a month. Peak expiratory flow is 85% of predicted. Which of the following is the most appropriate initial treatment? Albuterol (Proventil) inhaler Montelukast (Singular) Salmeterol (Serevent) inhaler Sustained release theophylline
This patient has mild intermittent asthma which is initially treated with inhaled beta 2-agonists as needed. No long-term control medications are indicated.
Which of the following medications decreases the exchange of hydrogen for potassium by inhibiting hydrogen, potassium-ATPase? Ranitidine (Zantac) Misoprostol (Cytotec) Sucralfate (Carafate) Omeprazole (Prilosec)
Omeprazole, a proton pump inhibitor, works by inhibiting hydrogen, potassium-ATPase.
Who is most likely to require subacute bacterial endocarditis (SBE) prophylaxis prior to a dental procedure?
22 year-old female with mitral valve prolapse
36 year-old male with a bio-prosthesic mitral valve
45 year-old female with an ASD closure 8 months ago with no residual defect
15 year-old male with a bicuspid aortic valve
AHA recommends that patients with prosthetic heart valves receive antibiotic prophylaxis. As should cardiac transplant recipients with valve disease, unrepaired cyanotic CHD, repaired CHD with prosthetic material or device during the first six months of the procedure and repaired CHD with residual defects at site of patch or prosthetic device.
A 3 month-old male presents with two days of worsening hoarse cough and thick purulent rhinorrhea associated with increasing problems breathing and trouble feeding. Examination reveals a temperature of 100.2 degrees F and respiratory rate of 80/minute with nasal flaring and retractions. Lung examination reveals a prolonged expiratory phase with inspiratory rales. He is tachycardic. Pulse oximetry reveals oxygen saturation of 89%. Chest x-ray reveals hyperinflation with diffuse interstitial infiltrates. Which of the following is the most appropriate intervention? Antibiotics Hospitalization Inhaled corticosteroids Racemic epinephrine
most likely has bronchiolitis. While most cases are mild and can be treated at home, hospitalization is recommended for infants with hypoxia on room air, moderate tachypnea with feeding difficulties and marked respiratory distress with retractions. Additionally hospitalization is recommended for infants less than 2-3 months of age, a history of apnea or an underlying chronic cardiopulmonary disease.
preterm labor may be given corticosteroids to ___________ for____ wks
enhance pulmonary maturity
given from 24-34 wks
Which indicate an optic nerve lesion? Excessive conjunctival edema Ptosis Inability to gaze laterally Afferent pupillary defect
Pupil size, controlled centrally by the Edinger-Westphal nucleus in the midbrain, is primarily based on the afferent light stimulus transmitted via the optic nerve
18 year-old female c/inc. vaginal d/c + odor & urinary frequency.
PE = thin, gray, frothy vaginal d/c, red cervix, pH 6. Which of the following is the most likely diagnosis?
-Candida vaginitis
-Bacterial vaginosis
-Trichomonas vaginitis
-Chlamydia Trachomatis
-Gonorrhea
Tric = thin frothy or bubbly, pale yellow-green to gray adherent vaginal d/c, red vulva/vagina, petechiae on cervix, amine odor, dysuria/dyspareunia, pH 5 to 6.5 (basic).
• Candida = hypha (KOH) & cottage cheese
• BV = clue cells, Sniff test, Fishy odor
• Tric = Protozoa, strawberry cervix, thin frothy/bubbly, yellow-green-gray
• Chlamydia = clear d/c
• Gonorrhea = yellow prulent d/c
A patient with a history of severe peptic ulcer disease is 5 weeks status post Billroth I surgery. One week ago he restarted his normal diet and has had the onset of severe nausea, abdominal cramping, and light-headedness that occur approximately thirty minutes after eating. The abdominal exam reveals a healing surgical scar without areas of unusual tenderness or any palpable masses. Which of the following is the most likely diagnosis? Anxiety disorder Celiac sprue Dumping syndrome Irritable bowel syndrome
Dumping syndrome typically occurs after Billroth type I surgeries as well as gastric bypass surgeries when the patient attempts to eat a large amount of simple sugars.
A 41 year-old female complains of 3 weeks of gradually worsening pain at the base of the thumb and radial aspect of the wrist. She and her husband have been renovating their home for the past 2 months and it has become increasingly difficult for her to hold a hammer. She denies numbness or tingling. She denies any history of previous trauma to the wrist. On examination, there is tenderness over the distal radial styloid and pain reproduced with ulnar deviation of a fist clenched over the abducted thumb. Which of the following is the most likely diagnosis? Carpal tunnel syndrome deQuervain's tenosynovitis Ganglion cyst Volar flexor tenosynovitis
deQuervain’s tenosynovitis typically results from repetitive activity involving pinching the thumb while moving the wrist. There is often pain and tenderness over the radial styloid and Finkelstein’s is positive in this patient.
A 40 year-old female presents with a Pap smear abnormality revealing atypical glandular cells (AGUS). What is the most appropriate intervention?
HPV DNA testing
Colposcopy with endometrial curretage(ECC)
Repeat Pap smear in 3 months
Colposcopy and endometrial sampling
Colposcopy and endometrial sampling are important to perform in patients with AGUS Pap results because glandular cells are associated with squamous and glandular precursor lesions and carcinoma.
