Life Study Flashcards
Long term use if immunomodulator medications increases the risk of ______
Lymphoma
A chronic inflammatory skin disorder that often starts in infancy and persists into adulthood. Characterized by pruritus leading to lichenification.
Atopic Dermatitis = Eczema
What is the atopic triad
Asthma, eczema, and allergic rhinitis
What is the first line therapy for eczema
Topical corticosteroids
What type of hypersensitivity reaction is contact dermatitis
Type IV
What is the first line treatment for contact dermatitis
Topical corticosteroids and allergen avoidance
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)
Seborrheic dermatitis
Cradle cap is associated with which diagnosis
Seborrheic dermatitis in infants
Which patients are at most risk for developing severe cases of seborrheic dermatitis
HIV/AIDS and Parkinson’s pts
What is the treatment for seborrheic dermatitis
Selenium sulfide or zinc pyrithione shampoos for scalp and topical antifungals and/or topical corticosteroids for skin
What is the first line treatment for cradle cap
Routine bathing and application of emollients
Altered consciousness or lamentation suggests what in terms of localization
Bicerebral hemispheres
Localization of gaze preference
Ipsilateral frontal lobe
Localization of left hemi neglect
Right parietal cortex
Localization of left homonymous hemianopsia
Right cerebral hemisphere, posterior to optic chiasm in parietotemporal or occipital lobe
Localization of left hemiparesis (face, arm, and leg)
Right subcortical area, usually posterior limb of internal capsule
Localization of left hemibody sensory loss (equal face, arm, leg)
Posterior limb of internal capsule or thalamus
What are the 3 stroke types
Ischemic stroke- occlusion 85%
Hemorrhagic stroke- bleed into brain10%
Subarachnoid hemorrhage- bleed around brain 5%
How to differentiate hemorrhagic vs ischemic stroke
Imaging - CT or MRI
What is the risk of stroke associated with TIA
5% within 2 days, 10% within 3 mo.
What labs are needed in possible acute stroke assessment
CBC, Chemistries, PT/INR, PTT, cardiac biomarkers
–> r/o infection, metabolic abnormalities and assess for contraindications to tPA
For which type of stroke do you give tPA
Ischemic
Why should permissive hypertension be allowed in most stroke cased
Increases blood flow to the penumbra and reduces permanent damage
What is the BP criteria for the administration of tPA in acute ischemic stroke
<= 185/110
When should BP be lowered in treatment of acute ischemic stroke, pre tPA
At BP between 185/110 and 220/120
- do not use tPA if greater than 220/120
- *DOC: nicardipine, labetalol
To where does impaired insight localize
Frontal lobes
To where does memory impairment localize
Hippocampi of medial temporal lobes
To where does difficulty with calculations localize
Dominant parietal lobe
What does back pain with valsalva maneuver suggest in terms of localization
Suggests nerve root compression as source, e.g. disc herniation
Decreased senstaion of the lateral foot localizes to where
S1 dermatome innervated by fibers from ipsilateral S1 nerve root
Ankle reflex is associated with spinal reflex arc. This arc is conducted by fibers from which nerve roots
S1 and S2
Positive straight leg raise suggests radiculopathy where
L5 and/or S1
What is the most common cause of radiculopathy
disc herniation
Patellar (knee) reflex is conducted by fibers from which nerve roots
L3 and L4
Sciatic nerve compression is associated with which nerve roots
L4-S3
Metastasis to bone is most common with which tumors
Breast, lung, thyroid, renal, and prostate
What is Cushings Response
A triad of symptoms associated with increased intracranial pressure including hypertension, bradycardia, and irregular respirations
what are Chyene-Stokes respirations
Variable respiratory rate associated with periods of apnea.
**may be due to bilateral deep brain lesions or congestive heart failure most ofen
What are the signs of a basilar skull fracture
Raccoon sign
Battle Sign (postauricular hematoma)
CSF rhinorrhea
CSF otorrhea
Where does diffuse hyperreflexia localize to
Upper motor neuron–> corticospinal tract–>bilateral brain lesions or increased ICP
Describe decerebrate posturing
Arm is rigidly extended and internally rotated, wrist is flexed, and leg is extended
Describe decorticate posturing
leg is extended, arm is flexed and adducted over chest
What are some risk factors for intracranial aneurysm
- Polycystic kidney disease
- fibromuscular dysplasia
- AV malformation
- Connective tissue disorder
- Aortic Coarcation
- Cigarette smoking
- Family hx
What are the percentages of locations of cerebral aneurysms by artery
- Anterior communicating 40%
- Posterior communicating 30%
- Middle cerebral 20%
- Basilar 10%
What are the major complications associated with Subarchnoid hemorrhage
- rebleeding
- vasospasm
- seizures
- hyponatremia
- hydrocephalus
- cardiac arrhythmias, MI
What is the acute management of subarchnoid hemorrhage
- 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
Where does decreased consciousness localize to
Brainstem or bicerebral process
Where does CN3 palsy w/ dilated pupil localize to
ipsilateral upper midbrain
**dilation think compression
Where does decerebrate posturing localize to
Contralateral upper midbrain
Where does Cheyne Stokes respirations localize to
upper midbrain
What are the symptoms of C6 radiculopathy
- weak wrist extensors & brachioradialis
- weak biceps
What are the symptoms of radial nerve palsy
- weak wrist extensors and brachioradialis
- normal biceps
How to differenitiate radial nerve palsy from C6 radiculopathy
C6 radiculopathy has weak biceps
Radial nerve palsy has normal biceps
What is the difference between massive and submassive pulmonary embolism
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
What is the timeline for an adjustment disorder diagnosis
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
What do you call the symptoms of an adjustment disorder without an identifiable stressor
Subsyndromal Depressive Disorder
How do you define a dysthymic disorder
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
Antidepressant therapy has been associated with increased risk of suicidal thoughts/behaviors in which populations
- Children
- Adolescents
- Young Adults to 24 yrs
- *No change in SI for adults 25-64 yrs
- *Decreased SI for 65+ yrs
True or False: The risk of depression relapse increases after each subsequent major depressive episode
True
What is the recommended first line therapy for allergic rhinitis
Intranasal corticosteroid monotherapy
** combination with oral antihistamine is not recommended b/c data does not show marked improvement with dual therapy
Which drugs have high level of evidence for causing microscopic colitis
- NSAIDs (including aspirin)
- PPIs
- Sertraline
- Acarbose
- Ticlopidine
What is the first line management of ganglion cyst
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)
What affect on hemoglobin A1c does education with diabetic educator typically produce
0.2-0.8 reduction
Having a dog in the home reduces which allergy in newborns/children
Eggs
How can risk of food allergy be reduced in infants
Induction of peanut-containing foods when solids are started
Which class of antihypertensives is least likely to exacerbate erectile dysfunction
Angiotensin receptor blodkers (ARBs)
What organism causes bullous impetigo
S. aureus - treatment with bactrim, small lesions poss. mupirocin
What is the treatment for bullous impetigo in children under 8 yrs
Bactrim
caused by s. aureus, may consider mupirocin in small lesions
Why is tetrcycline avoided in children under 8 yrs
It causes teeth staining
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
Current pregnancy - contraindicated in lactation as well due to fetal anomalies
What are the criteria for diagnosis of diabetes
- Hemoglobin A1c >/=6.5%
- fasting glucose >/=126
- 2 hr plasma glucose >/=200 on GTT
- Random plasma glucose >/= 200 w/ symptoms
What electrolyte derangements are associated with tumor lysis syndrome
- Hyperkalemia
- Hyperuricemia
- Hyperphosphatemia
- Hypocalemia (due to calcium binding with free phosphorous)
