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A Medicine Study Session > Life Study > Flashcards

Life Study Flashcards

1
Q

Long term use if immunomodulator medications increases the risk of ______

A

Lymphoma

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2
Q

A chronic inflammatory skin disorder that often starts in infancy and persists into adulthood. Characterized by pruritus leading to lichenification.

A

Atopic Dermatitis = Eczema

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3
Q

What is the atopic triad

A

Asthma, eczema, and allergic rhinitis

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4
Q

What is the first line therapy for eczema

A

Topical corticosteroids

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5
Q

What type of hypersensitivity reaction is contact dermatitis

A

Type IV

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6
Q

What is the first line treatment for contact dermatitis

A

Topical corticosteroids and allergen avoidance

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7
Q

What is a common chronic inflammatory skin disease that may be caused by a hypersensitivity reaction to Malassezia further (found in sebum and hair follicles)

A

Seborrheic dermatitis

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8
Q

Cradle cap is associated with which diagnosis

A

Seborrheic dermatitis in infants

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9
Q

Which patients are at most risk for developing severe cases of seborrheic dermatitis

A

HIV/AIDS and Parkinson’s pts

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10
Q

What is the treatment for seborrheic dermatitis

A

Selenium sulfide or zinc pyrithione shampoos for scalp and topical antifungals and/or topical corticosteroids for skin

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11
Q

What is the first line treatment for cradle cap

A

Routine bathing and application of emollients

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12
Q

Altered consciousness or lamentation suggests what in terms of localization

A

Bicerebral hemispheres

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13
Q

Localization of gaze preference

A

Ipsilateral frontal lobe

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14
Q

Localization of left hemi neglect

A

Right parietal cortex

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15
Q

Localization of left homonymous hemianopsia

A

Right cerebral hemisphere, posterior to optic chiasm in parietotemporal or occipital lobe

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16
Q

Localization of left hemiparesis (face, arm, and leg)

A

Right subcortical area, usually posterior limb of internal capsule

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17
Q

Localization of left hemibody sensory loss (equal face, arm, leg)

A

Posterior limb of internal capsule or thalamus

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18
Q

What are the 3 stroke types

A

Ischemic stroke- occlusion 85%
Hemorrhagic stroke- bleed into brain10%
Subarachnoid hemorrhage- bleed around brain 5%

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19
Q

How to differentiate hemorrhagic vs ischemic stroke

A

Imaging - CT or MRI

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20
Q

What is the risk of stroke associated with TIA

A

5% within 2 days, 10% within 3 mo.

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21
Q

What labs are needed in possible acute stroke assessment

A

CBC, Chemistries, PT/INR, PTT, cardiac biomarkers

–> r/o infection, metabolic abnormalities and assess for contraindications to tPA

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22
Q

For which type of stroke do you give tPA

A

Ischemic

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23
Q

Why should permissive hypertension be allowed in most stroke cased

A

Increases blood flow to the penumbra and reduces permanent damage

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24
Q

What is the BP criteria for the administration of tPA in acute ischemic stroke

A

<= 185/110

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25
Q

When should BP be lowered in treatment of acute ischemic stroke, pre tPA

A

At BP between 185/110 and 220/120

  • do not use tPA if greater than 220/120
  • *DOC: nicardipine, labetalol
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26
Q

To where does impaired insight localize

A

Frontal lobes

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27
Q

To where does memory impairment localize

A

Hippocampi of medial temporal lobes

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28
Q

To where does difficulty with calculations localize

A

Dominant parietal lobe

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29
Q

What does back pain with valsalva maneuver suggest in terms of localization

A

Suggests nerve root compression as source, e.g. disc herniation

30
Q

Decreased senstaion of the lateral foot localizes to where

A

S1 dermatome innervated by fibers from ipsilateral S1 nerve root

31
Q

Ankle reflex is associated with spinal reflex arc. This arc is conducted by fibers from which nerve roots

A

S1 and S2

32
Q

Positive straight leg raise suggests radiculopathy where

A

L5 and/or S1

33
Q

What is the most common cause of radiculopathy

A

disc herniation

34
Q

Patellar (knee) reflex is conducted by fibers from which nerve roots

A

L3 and L4

35
Q

Sciatic nerve compression is associated with which nerve roots

A

L4-S3

36
Q

Metastasis to bone is most common with which tumors

A

Breast, lung, thyroid, renal, and prostate

37
Q

What is Cushings Response

A

A triad of symptoms associated with increased intracranial pressure including hypertension, bradycardia, and irregular respirations

38
Q

what are Chyene-Stokes respirations

A

Variable respiratory rate associated with periods of apnea.
**may be due to bilateral deep brain lesions or congestive heart failure most ofen

39
Q

What are the signs of a basilar skull fracture

A

Raccoon sign
Battle Sign (postauricular hematoma)
CSF rhinorrhea
CSF otorrhea

40
Q

Where does diffuse hyperreflexia localize to

A

Upper motor neuron–> corticospinal tract–>bilateral brain lesions or increased ICP

41
Q

Describe decerebrate posturing

A

Arm is rigidly extended and internally rotated, wrist is flexed, and leg is extended

42
Q

Describe decorticate posturing

A

leg is extended, arm is flexed and adducted over chest

43
Q

What are some risk factors for intracranial aneurysm

A
  • Polycystic kidney disease
  • fibromuscular dysplasia
  • AV malformation
  • Connective tissue disorder
  • Aortic Coarcation
  • Cigarette smoking
  • Family hx
44
Q

What are the percentages of locations of cerebral aneurysms by artery

A
  1. Anterior communicating 40%
  2. Posterior communicating 30%
  3. Middle cerebral 20%
  4. Basilar 10%
45
Q

What are the major complications associated with Subarchnoid hemorrhage

A
  • rebleeding
  • vasospasm
  • seizures
  • hyponatremia
  • hydrocephalus
  • cardiac arrhythmias, MI
46
Q

What is the acute management of subarchnoid hemorrhage

A
  • Consult neurosurgery if aneurysm present
  • dark quiet room in ICU
  • elevated HOB >30 degrees
  • ECG monitoring
  • neuro checks
  • IV normal saline
  • stool softner, antiemetic, narcotic, sedative
  • H2 blocker
  • DVT prophylaxis SCDs NO ANTICOAGS
  • fosphenytoin for seizure prophylaxis
47
Q

Where does decreased consciousness localize to

A

Brainstem or bicerebral process

48
Q

Where does CN3 palsy w/ dilated pupil localize to

A

ipsilateral upper midbrain

**dilation think compression

49
Q

Where does decerebrate posturing localize to

A

Contralateral upper midbrain

50
Q

Where does Cheyne Stokes respirations localize to

A

upper midbrain

51
Q

What are the symptoms of C6 radiculopathy

A
  • weak wrist extensors & brachioradialis

- weak biceps

52
Q

What are the symptoms of radial nerve palsy

A
  • weak wrist extensors and brachioradialis

- normal biceps

53
Q

How to differenitiate radial nerve palsy from C6 radiculopathy

A

C6 radiculopathy has weak biceps

Radial nerve palsy has normal biceps

54
Q

What is the difference between massive and submassive pulmonary embolism

A

Hemodynamic stability.
Massive = high-risk = unstable (hypotension for >15 or that requires vasopressors or other support & does not have alternative cause) = more likely to die from obstructive shock (risk elevated 2-72 hrs post PE)
Submassive = intermediate risk = stable w/ associated right heart strain

**UpToDate: Overview of acute pulmonary embolism in adults

55
Q

What is the timeline for an adjustment disorder diagnosis

A

start within 3 months of stressor and do not last more than 6 months (bereavement or co-occuring psychiatric disorder excluded)

Adjustment disorder is depressed mood charaterized by depressive symptoms that start within 3 months of an identiable stressor

56
Q

What do you call the symptoms of an adjustment disorder without an identifiable stressor

A

Subsyndromal Depressive Disorder

57
Q

How do you define a dysthymic disorder

A

Depressed mood most of the day, more days than not, for at least 2 yrs without a symptom free period of more than 2 consecutive months.
Depressed mood + At least 2 symptoms must be present:
-appetite change
- sleep change
- decreased energy
- decreased self-esteem
-poor concentration &/or difficulty making decisions
- hopelessness

**Also not better explained by alterative diagnosis

58
Q

Antidepressant therapy has been associated with increased risk of suicidal thoughts/behaviors in which populations

A
  • Children
  • Adolescents
  • Young Adults to 24 yrs
  • *No change in SI for adults 25-64 yrs
  • *Decreased SI for 65+ yrs
59
Q

True or False: The risk of depression relapse increases after each subsequent major depressive episode

A

True

60
Q

What is the recommended first line therapy for allergic rhinitis

A

Intranasal corticosteroid monotherapy

** combination with oral antihistamine is not recommended b/c data does not show marked improvement with dual therapy

61
Q

Which drugs have high level of evidence for causing microscopic colitis

A
  • NSAIDs (including aspirin)
  • PPIs
  • Sertraline
  • Acarbose
  • Ticlopidine
62
Q

What is the first line management of ganglion cyst

A

Watchful waiting: 50% resolve spontaneously
Additional tx indicated if:
- significant pain, numbness, weakness, cosmetic desire
Additional tx: 1) aspiration (85% recurrence rate), 2) excision (10-15% recurrence)

63
Q

What affect on hemoglobin A1c does education with diabetic educator typically produce

A

0.2-0.8 reduction

64
Q

Having a dog in the home reduces which allergy in newborns/children

A

Eggs

65
Q

How can risk of food allergy be reduced in infants

A

Induction of peanut-containing foods when solids are started

66
Q

Which class of antihypertensives is least likely to exacerbate erectile dysfunction

A

Angiotensin receptor blodkers (ARBs)

67
Q

What organism causes bullous impetigo

A

S. aureus - treatment with bactrim, small lesions poss. mupirocin

68
Q

What is the treatment for bullous impetigo in children under 8 yrs

A

Bactrim

caused by s. aureus, may consider mupirocin in small lesions

69
Q

Why is tetrcycline avoided in children under 8 yrs

A

It causes teeth staining

70
Q

Which of the following is a contraindication to statin use?
A. current pregnancy
B. chronic hepatitis C infection
C. end stage renal disease
D. Myositis associated with creatine kinase level five times upper limit of normal
E. transaminitis due to nonalcoholic staetohepatitis

A

Current pregnancy - contraindicated in lactation as well due to fetal anomalies

71
Q

What are the criteria for diagnosis of diabetes

A
  • Hemoglobin A1c >/=6.5%
  • fasting glucose >/=126
  • 2 hr plasma glucose >/=200 on GTT
  • Random plasma glucose >/= 200 w/ symptoms
72
Q

What electrolyte derangements are associated with tumor lysis syndrome

A
  • Hyperkalemia
  • Hyperuricemia
  • Hyperphosphatemia
  • Hypocalemia (due to calcium binding with free phosphorous)

A Medicine Study Session (5 decks)

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