✅MAIN Flashcards
what is Length-Time Bias
[progressive benign] disease cases have LONGER lifetime duration -> they are more likely to be detected incidentally by a screening xm -> artificially inflates the “detection success” of that screening xm
what is the Hawthorne effect
when pts modify their behavior just because they know they’re being studied
what is lead time bias
occurs when, even though [pt Test A] and [pt Test B] both die 5 years after the same disease..
bc [pt Test A] test diagnosed their dz 2yrs earlier…it’ll SEEM like [pt Test A] had longer survival time when actually they’re both only 5 years
what is Observer bias
when Observers (researchers) subconsciously (or conciously :-( ) manipulate the study b/c of preconceived notions
what is sampling bias?
sampling pts in a NON-random manner -> lky to exclude certain members of the target population than others
how do you mitigate Observer bias
Blinding
(Observer bias = Observer [researcher] alters elements of the study (like over reporting a dz) either consciously or subconsciously)
Active TB is transmitted up to ___ months before sx even start
what’s the Mgmt for for ppl exposed to Active TB?- 2
3
- 1 of 2 [tuberculin skin or interferon gamma] screening
if #1 is…
2A.#1 NEGATIVE = 2 of 2 [tuberculin skin or interferon gamma] screening 8-10 wks later
2B. #1 POSITIVE = CXR + [acid fast sputum testing]–> if BOTH negative –> [latent ( -IP- ) TB tx], othw [ACTIVE (RIPE) TB tx]
Dx Celiac Disease- 3
- SMALL INTESTINAL BX = gold standard
- Anti-Endomysial Ab
- Anti-Tissue Transglutaminase Ab
Triad for Disseminated Gonococcal infection
STD
- Several migratory arthralgias
- Tenosynovitis pain along tendon sheaths
- Dermatitis pustular rash
pts may NOT have urinary or pelvic sx with Disseminated Gonococcal infection!
Describe Serology for Hepatitis B -7
S - SEC - SCEb - Core - CEbSAb - CSAB - SAb
- unvaccinated pts acutely exposed to Hep should STILL get vaccinated in addition to the immunoglobulin*
- CSAB = RESOLVED HEP B INFECTION*
Tx for Neurosyphillis
(drug) (route) x (duration)
PCN IV x 10-14 days
How do you know when a pt is fully cured from Syphilis?
Must be [4-fold FTA titer DEC] by 12 month mark
Name the specific signs of congenital syphilis - 3
- Rhinorrhea
- Maculopapular rash ofo the palms and soles that dequamates or becomes bullous
- Abnormal long bone xrays (i.e. metaphyseal lucency)
Describe the type of rash you’ll see with secondary syphilis
Diffuse Maculopapular rash starting at trunk and spreading to extremities TO INCLUDE PALMS AND SOLES
PCN IM is the first line tx for Syphilis.
The alternative tx to Syphilis is ____. When is it indicated to desensitize and still give PCN?-3
- Pregnancy (No DOXY for POXY)
- 3° CNS syphilis
- refractory to initial tx
Why is RPR not reliable when on a person first develops syphilis?
There is a possible false negative result early in infection - follow with FTA
What is the Jarisch Herxheimer Rxn?
acute fever right after starting syphilis tx
48H
NO TX FOR THIS!
what are the indications for giving Abx to pts with Anal Abscess? - 4
- Cellulitis extensively
- Immunosuppression (DM, HIV, CA)
- Valvular Heart Disease
* 50% of Anal Abscesses –> Fistula!! Tx = I & D that mofo!*
List Main differences between Esophageal SQC and ADC :
- Location
- What each are associated with
[SQC = UPPER esophagus = Tobacco , EtOH]
[ADC = lower esophagus = GERD/Barrett’s]
What is the TRIAD PRIORITY for managing [Brain-Dead Organ Donors] ?
MUST MAINTAIN NORMAL PET w IVF / Desmopressin
Pressure
Euvolemia
Temperature (or mild hypothermia)
Prognosis for Rabies
VERY POOR ONCE HAPPY SX START! = Die within weeks
Remember! Post-Exposure Px IgG and Vaccine are ONLY HELP TO PREVENT ONSET OF SX. Once HAPPY sx starts….it’s Over
HAPPY RABIE = Sx of Rabies
Sx of Rabies - 5
HAPPY RABIE = Sx of Rabies
HYDROPHOBIA (fear of water triggering Pharyngeal spasms) = PATHOGNOMONIC FOR RABIES!
Aerophobia
Pharyngeal spasms
[Paralysis (Spastic –> Ascending flaccid)] -> respiratory failure within wks
Yankin’ Agitation
What Lipase level is c/f Acute Pancreatitis in kids?
GOE 7 x upper limit of nl for that age group
What Lipase level is c/f Acute Pancreatitis in Adults?
GOE 1,000
Name the most effective predictors of SEVERE Acute Pancreatitis - 5
HOBCO hurt the Pancreao
- Hematocrit > 44%
- Obesity
- BUN GOE 20
- older age
- obesity
- CRP > 150
Serum Sickness is a Type __ reaction
Describe the reaction
3
Antibodies+ Antigens –> Compliment activation
(Ab bind to antigens -> Compliment activation -> fever, polyarthritis, Dermatitis)
Autoimmune Hemolytic Anemia is a Type __ reaction
Describe the reaction
2
Autoantibodies directed against the host cells
Contact Dermatitis is a Type __ reaction
Describe the reaction
4
[T-CELL-mediated hypersensitivity] rxn
Anaphylaxis is a Type __ reaction
Describe the reaction
1
[IgE-mediated immediate hypersensitivity] rxn
pts with Recurrent PNA should make you think of ______ as the cause
Endobronchial Obstruction
Bronchogenic Carcinoma, Carcinoid Tumor
GOLD STANDARD DX = FLEX BRONCHOSCOPY
7 common causes of Dilated Cardiomyopathy
“the PIG PAID for Dilated Cardiomyopathy”
- Post Viral Myocarditis (Coxsackie B)
- Alcohol related (direct toxicity vs. nutritional deficiency)
- [Doxorubicin & Daunarubicin Chemo] (dose-dependent)
- Peripartum (late in pregnancy vs 5 mo. post partum)
- Genetic (affects cytoskeleton)
- Iron Overload: [Hereditary Hemochromatosis] or [Multiple Blood Transfusion Hemosiderosis] = Iron accumulates and interferes with metal-dependent enzyme system in myocytes
-
Idiopathic
* DILATED IS MOST COMMON CARDIOMYOPATHY and CAN BE ACUTE*
List the common causes of Restrictive Cardiomyopathy - 8
RAMILIES
- Radiation Fibrosis (includes coronaries and valves)
- Amyloidosis (heterogenous misfolded proteins)
- Sarcoidosis= [Noncaseating granuloma formation] in multiple organs 2º to [CD4 Helper T] attack on unidentified antigen
- Metastatic Tumor
- Inborn metabolism errors
- Endomyocardial fibrosis= Common in [African/Tropic children]
- [Loeffler Endomyocardial fibrosis] = (Has [Peripheral blood eosinophilia and infiltrate])
- Idiopathic
Spontaneous Bacterial Peritonitis dx- 3
Peritoneal fluid with:
- [Peritoneal Neutrophils GOE 250]
- [Peritoneal Protein < 1]
- [SAALG GOE 1.1]
mgt = IMMEDIATE EMPIRIC ABX + IV ALBUMIN
How do you prognosticate advanced Liver disease?
MELD “B SIC” score (90-day survival) based on BSIC!
Bilirubin
Sodium
INR
Creatinine
What size is concerning for a skin lesion?
How is an excisional biopsy done?
GOE 6 mm
Excise ENTIRE SKIN LESION with 1-3 mm margins of surrounding fat
Optimal BG range while pts are in the hospital?
140-180
How do you determine Tetanus Mgmt? - 3
WTF, Tetanus!
- Wound simple or Complex?
- TOTAL tetanus vaccine Lifetime [unknown/LOE 3]?
- Final/LAST one [>10y] vs [>5y] ago?
Lichen Planus is associated with what infectious disease?
Advanced Liver Disease 2/2 Hep C
T or F
It is NEVER acceptable to allow industry-sponsored programs to influence lecture content
TRUE
Physicians have to retain FULL CONTROL over psntn content
Dengue Fever Sx- 4
- Break Bone Fever
- [Thrombocytopenia w POSITIVE TOURNIQUET TEST]
- RetroOrbital Pain
- Rash
what are the hallmarks of Splenic Vein Thrombosis? - 2
- [isolated stomach fundal varices] -> variceal hematemesis
- [splenomegaly] -> anemia/thrombocytopenia
Splenic Vein Thrombosis is commonly a/w pancreatitis
What supplements will pts s/p RYGB (Gastric bypass Surgery) require? - 6
[B-1, 9, 12]
Calcium
D3 vitamin
Fe
Classic Sx of Sarcoidosis-8
CCUBBEDD
Cardiac (Restrictive Cardiomyopathy)
HYPERCalcemia
Uveitis –> Vision loss
Bilateral Hilar LAD!
Bell’s Palsy
Erythema Nodosum (SubQ Fat lesions)
[Dry cough & Dyspnea]
Diffuse interstitial fibrosis
- elevated ACE and 1-25VitD production –> HYPERCalcemia and HYPERCalciuria*
- Image showing b/l Hilar LAD*
Sarcoidosis Etx-2 (Etiology)
[CD4 Helper T] inappropriately respond to environmental triggers + Suppressed TRegs –> Non-Caseating Granulomas in Lung
Image showing b/l Hilar LAD
Sarcoidosis Tx-4
“Sarcoidosis is a SCAM”
Steroids
Cyclosporine
Azathioprine
MTX
Image showing b/l Hilar LAD
Name the conditions associated with Granulomas - 6
- TB
- Tertiary syphillis gummas
- Blastomycosis
- Histoplasma
- Sarcoidosis
- Churg Strauss Eosinophilic Granulomatosis with Polyangiitis
Describe Serology for Hepatitis B -7
S - SEC - SCEb - Core - CEbSAb - CSAB - SAb
- unvaccinated pts acutely exposed to Hep should STILL get vaccinated in addition to the immunoglobulin*
- CSAB = RESOLVED HEP B INFECTION*
What 2 laboratory values are the best diagnostic test for Hepatitis B?
S - SEC - SCEb - Core - CEbSAb - CSAB - SAb
[SAg and CoreIgM]
Mgmt for Hepatits B- 2
S - SEC - SCEb - Core - CEbSAb - CSAB - SAb
- OUTPATIENT FOLLOW UP! (most HepB resolves spontaneously)
- Admit IF SERIOUS DECOMPENSATION ONLY
What 2 laboratory values are the best diagnostic test for Hepatitis B?
S - SEC - SCEb - Core - CEbSAb - CSAB - SAb
[SAg and CoreIgM]
Describe Serology for Hepatitis B -7
S - SEC - SCEb - Core - CEbSAb - CSAB - SAb
- unvaccinated pts acutely exposed to Hep should STILL get vaccinated in addition to the immunoglobulin*
- CSAB = RESOLVED HEP B INFECTION*
Hepatitis B can develop into Chronic HepB infection depending on ___
What % adults actually develop Chronic Hep infection?
S - SEC - SCEb - Core - CEbSAb - CSAB - SAb
< 5%
CSAB = RESOLVED HEP B INFECTION
Which infectious disease is associated with cervical and vaginal punctate hemorrhages?
Trichomoniasis
Trichomoniasis Tx
Metronidazole 2 grams PO x 1
What is Confounding Bias?
a Confounding variable skews the assocation between the exposure and the outcome
(Randomization helps to remove confounding variables)
What is Effect Modification?
Effect Modifying variable changes the magnitude or direction of the Effect the independent variable has on the dependent variable
Why is Succinylcholine contraindicated in pts with burns, myopathies, crush injuries or denervating Dz
Can cause SIGNIFICANT K+ RELEASE –> VFIB in pts at high risk for Hyperkalemia
Recall the [2 x 2 Test vs. Disease] diagram
How many ATP are yielded in Aerobic vs. AnAerobic metabolism?
Aerobic = 32
AnAerobic = [2 + Lactate]
Define [p-value] and its relation to Null hypothesis
[p-value] = Chance that study results happened randomly
[p-value] < 0.05 means you can Reject Null hypothesis since it means there’s lil chance the results happened randomly
Why is Succinylcholine contraindicated in pts with burns, myopathies, crush injuries or denervating Dz
Can cause SIGNIFICANT K+ RELEASE –> VFIB in pts at high risk for Hyperkalemia
Sensitivity
Formula(2) & meaning
What is the Formula for Negative Likelihood Ratio?
Are Positive/ Negative Likelihood Ratios dependent or indepedent of a disease’s prevalence?
N = (1-N) / P
“Number 1 Nigga, Positivity”….
Positive LR = seNsitivity / (1 - sPecificity)
Negative LR = (1 - seNsitivity) / P
INDEPEDENT
What is the Formula for Positive Likelihood Ratio?
Are Positive/ Negative Likelihood Ratios dependent or indepedent of a disease’s prevalence?
P = N / (1-P)
“Number 1 Nigga, Positivity” ….. “Positivity… Number 1 Plan”.
Negative LR = (1 - seNsitivity) / P
Positive LR = seNsitivity / (1 - sPecificity)
INDEPEDENT
What is the Formula for Positive Likelihood Ratio?
Are Positive/ Negative Likelihood Ratios dependent or indepedent of a disease’s prevalence?
P = N / (1-P)
“Number 1 Nigga, Positivity” ….. “Positivity… Number 1 Plan”.
Negative LR = (1 - seNsitivity) / P
Positive LR = seNsitivity / (1 - sPecificity)
INDEPEDENT
What is the Formula for Specificity?- 2
Definition?
Criteria for Recurrent Pregnancy Loss
GOE 3 consecutive spontaneous abortions
Major causes of Rhabdomyolysis - 4
- Immobilization prolonged (direct damage)
- Cocaine (direct damage)
- Physical restraints
- Dehydration
Muscle breakdown –> ⬆︎CPK, ⬆︎K, ⬆︎myoglobin(which causes renal damage when filtered)
Why does compartment syndrome cause kidney damage?
compartment syndrome –> myoglobin release –> [myoglobin heme] is nephrotoxic
Compartment Syndrome Dx- 2
- [Direct Pressure > 30]
- [delta pressure < 20-30] (diastolic BP - compartment pressure]
When should PEP (Post Exposure Px) for incidental HIV exposure began? ; What regimen should be given? ; for how long?
WITHIN 72 HOURS
Triple drug regimen
28 days long!
of weeks given for a trial of SSRI?
6
An Employer hands you a signed “release of information” for a pt.
How does this affect HIPPA?
If given written authorization, HIPPA allows MDs to give the minimum necessary information to satisfy the employer’s request
Dx for [avascular necrosis osteochondritis dissecans]
MRI
causes of [avascular necrosis osteochondritis dissecans]- 12
- CORTICOSTEROIDS
- ETOH
- SLE
- Sickle Cell Disease
- Antiphospholipid Ab Syndrome
- CKD
- HD
- Trauma
- HIV
- Gaucher’s
- Caisson’s
- Renal Transplant
MRI = most sensitive dx
Criteria for having [Decision Making Capacity]? - 4
Pts with [Decision Making Capacity] have to pass the LIAR test
- Lists Decision CLEARLY
- Information about Decision is understood
- Appreciates consequences of Decision
- Rationale for Decision given
Criteria for giving out Pt medical information? - 3
Pt must… PDA
1st: Present (or otherwise available prior to disclosure)
2nd: Decision Making Capacity (LIAR)
3rd: Agrees to disclose information
In PostOp Hypoxemia, how do you tell the difference between Atelectasis and Residual Anesthetic Effect?
Atelectasis = POD 2-5
[Residual Anesthetic Effect] (DEC central resp drive)can occur immediately
List the main causes of hypoxemia in PostOp?- 6
Why do pts with High Risk Cardiovascular conditions (i.e. valvular problems) MUST receive abx specifically against_____?
Enterococci (ampicillin, vancomycin)
high risk CV pts are at greater risk for infectious endocarditis 2/2 GU/GI infxn.
IF THEY ACTUALLY HAVE GI/GU INFXN, GIVE PX ABX prior to GU/GI procedure
What is Amarousis Fugax?
Sudden Transient Monocular Blindness
Which part of the Esophagus is [Esophageal SQC] located?
UPPER
a/w SMOKING AND EtOH
Which part of the Esophagus is [Esophageal ADC] located?
LOWER
a/w Barrett’s and GERD
1st line tx for ADHD in
[PreSchool 3-5 y/o]
[EE GOE 6 y/o]
[PreSchool 3-5 y/o] = CBT first!
[EE GOE 6 y/o] = Rx
When is it appropriate to trial a different rx for ADHD? - 2
- [Continued Side Effects] after 4 wk trial
- [Poor clinical response] after 4 wk trial
which medication is given for Migraine HA px?
Propranolol
which medication is given for Cluster HA px?
Verapamil
Describe the Character for the HA:
Migraine
Cluster (3)
Tension (2)
Migraine = POUND = [Pounding/One Day-3 day Duration/Unilateral/Nausea/Disabling] + photo vs. phonophobia & [flashing dots aura]
Cluster = [Excruciating, sharp & steady] (100% O2 tx)
Tension = Dull & tight
Describe the Duration for the HA:
Migraine
Cluster
Tension
Migraine = POUND = [Pounding/One-3 Day Duration /Unilateral/Nausea/Disabling] + photo vs. phonophobia & [flashing dots aura]
Cluster = 15 - 90 MINUTES (100% O2 tx)
Tension = 30 min to 7 DAYS!!!! (Tammy’s Entire Work Week)
How are migraines associated with Pregnancy?
Migraines commonly start 2nd trimester of Pregnancy
But also be suspicious of [Pseudotumor Cerebrii]
Why is it common for adolescents to have irregular and anovulatory menstruation
immaturity of hypothalamic-pituitary-gonadal axis –> inadequate amounts of GnRH –> low FSH and LH –> lack of ovulation –> lack of Menses
Menses normally occurs when corpus lutem (byproduct after ovulation) produces progesterone and this progesterone drops –> Menses/shedding. No ovulation –> No menses
- Tx = Progestin-only or Combined OCPs*
- this self-resovles 1-4 yrs after menarche*
How does Obesity commonly cause amenorrhea?
Obesity –> anovulation without affecting LH/FSH levels which–> Amenorrhea
MOD for PCOS
Hyperinsulinemia and Elevated LH –> ⬆︎ Androgen release from Ovarian Theca which is converted to Estrone–> Elevated Estrone which feedbacks on the hypothalamus –> ⬇︎GnRH –> ⬇︎FSH imbalance –> failure of follicle maturation and anovulation –> No progesterone –> Endometrial CA
- tx = weight loss and clomiphene citrate*
- Note: if pt has high levels of sex hormone binding globulin, total testosterone may be low. so clinical dx may be necessary*
What is Mittelschmerz?
Mittelschmerz = “Middle of the cycle” uL pelvic pain that occurs when blood released from rupture of follicle during ovulation irritates peritoneum
order: LH surge –> 36 hrs will pass –> Ovulation
Benign [Pregnancy Induced Pruritus] Tx- 3
- Oatmeal baths
- UV light
- Antihistamines
How does [Pregnancy Induced Pruritus] present?- 2
- Benign Abdominal pruritus during pregnancy
- NO RASH associated
Pemphigoid Gestationis occurs during the __ or __ trimester
Dx?- 2
Tx?- 3
2nd OR 3rd
Clinical , Biopsy
Tx = Steroids, Antihistamines, Delivery
Pemphigoid Gestationis occurs during the __ or __ trimester
CP- 3
2nd OR 3rd
[prodromal Pruritus] -> [Periumbilical papules + plaques that spare mucus membranes] -> [Bullae Eruption]
Clinical Manifestation of Multiple Sclerosis (9)
Charcot classic triad of MS is a [SLUM SiiiN] !
Sensory sx (think BL Trigeminal Neuralgia)
Lhermittes sign = “electric tingling” down spine into arm & legs when chin is touched to chest
Uhthoff phenomenon (sx ⬆︎ during heat)
Motor sx
Scanning Speech
[Internuclear Ophthalmoplegia (MIOS)] / Intention Tremor / Incontinence
Neuritis Optic - (uL eye pain + vision loss + Marcus Gunn afferent pupillary defect) = ALSO RISK FACTOR
Dx for Multiple Sclerosis - 5
- Clinical (SLUM SiiiN)
- T2 MRI: [Periventricular white matter demyelinating plaques with lipid laden macrophages]
- T1 MRI Black holes
- CSF Oligoclonal IgG bands
- Visual conduction velocity test
Sx will be disseminated in time and space
Which drugs are used to treat Multiple Sclerosis maintenance?-3
Maintenance:
1. [β-interferon]
2. [Glatiramer acetate]
- Natalizumab
1st: High Dose IV Methylprednisolone = Exacerbation
2nd: (Refractory): Plasmapharesis
Which drugs are used to treat Multiple Sclerosis Exacerbation?-2 ;
Which are used for maintenance?-3
1st: High Dose IV Methylprednisolone
2nd: (Refractory): Plasmapharesis
Maintenance:
- β-interferon
- Glatiramer acetate
- Natalizumab
Why are Multiple Sclerosis pts at risk for BL Trigeminal Neuralgia
Demyelination may occur at Trigeminal nucleus –> BILATERAL neuralgia
Sx will be disseminated in space and time
Which 3 Neuro Diseases Cross the Corpus Callosum?
- Gliomas (AGE - i.e. Glioblastoma)
- Multiple Sclerosis
- CNS Lymphoma
Pt has advancing foot crossing over opposite foot similar to closing scissor blades
What causes Scissors Gait?
UMN (Corticospinal Tract spasticity) lesions
Spasticity causes Scissors Gait
The most common enzyme deficiency for Congenital Adrenal Hyperplasia is ______
cp?-3
21 hydroxylase
- Virilization (acne, premature adrenarche/pubarche)
- Loss of Aldosterone
- Loss of Cortisol
The most common enzyme deficiency for Congenital Adrenal Hyperplasia is ______
Which lab value is diagnostic for this deficiency?
21 hydroxylase
⬆︎17 HydroxyPROGESTERONE
how long does Jarisch Herxheimer Rxn last?
48H
Tx
for
Jarisch Herxheimer Rxn?
NO TX !
[________white lacy lesion] is caused by Lichen Planus, and Lichen Planus is caused by ____
[Wickham Striae] ; [Hep C Advanced Liver Disease]
3 Main causes of Spinal Cord Compression
- DJD Disc Herniation (Smoking risk factor)
- [Epidural Staph a. Abscess (think IV drug user vs DM)]
- Tumor (Prostate/Renal/Lung/Breast/Multiple Myeloma mets)
Dx = MRI, Positive Straight Leg, Classic S/S
DJD=Degenerative Joint Disease
Sciatica tx ; dx?
“Having Sciatica makes you break LAWS”
NSAIDs + APAP = 1st line as Sciatica sx are self limited
Dx = CLINICAL (Only use MRI for confirmation of disc herniation if sensory/motor deficit, cauda equina syndrome sx or epidural abscess r/o)
