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Mixed 5 Flashcards

1
Q

What is Ludwig angina?

A

Rapidly progressive cellulitis of the submandibular and sublingual spaces.

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2
Q

Most cases of Ludwig angina arise from contiguous (rather than lymphatic) spread of polymicrobial dental infections in the ___.

A

Mandibular molars

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3
Q

What causes acute airway obstruction in Ludwig angina?

A

As the submandibular area becomes tender and indurated, the floor of the mouth becomes elevated and displaces the tongue posteriorly

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4
Q

Infections originating in the ___ space can spread to the infratemporal space and orbit and progress to cavernous sinus thrombosis.

A

Maxillary

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5
Q

Complications of drowning are a result of ___.

A

Hypoxemia from fluid aspiration; the aspirated liquid washes out alveolar surfactant, causing pulmonary edema, respiratory insufficiency, and ARDS, which can develop insidiously over the next 72 hours

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6
Q

Indications for intrapartum prophylaxis against GBS?

A

GBS bacteriuria or GBS UTI in current pregnancy (regardless of treatment)
GBS+ rectovaginal culture in current pregnancy
Unknown GBS status PLUS any of the following: <37 weeks, intrapartum fever, rupture of membranes for 18+ hours
Prior infant with early-onset neonatal sepsis or GBS infection

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7
Q

Intrapartum prophylaxis for GBS?

A

IV pencillin

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8
Q

Presentation - relapsing-remitting fevers associated with endometritis

A

Septic pelvic thrombophlebitis

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9
Q

What is uterine incarceration?

A

Rare disorder that occurs during pregnancy as a retroverted uterus enlarges and the fundus becomes entrapped under the sacral promontory; patients have pelvic pain and urinary retention due to bladder obstruction

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10
Q

DDx - flaccid paralysis?

A

Infant botulism
Foodborne botulism
Guillain-Barre syndrome

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11
Q

Compare the pathogenesis of the 3 main causes of flaccid paralysis.

A

Infant botulism - ingestion of C. botulinum spores from environmental dust

Foodborne botulism - ingestion of preformed C. botulinum toxin

GBS - autoimmune peripheral nerve demyeliation

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12
Q

Compare the presentation of the 3 main causes of flaccid paralysis.

A

Infant and foodborne botulism: descending flaccid paralysis

GBS - ascending flaccid paralysis

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13
Q

Compare the Rx of the 3 main causes of flaccid paralysis.

A

Infant botulism - human-derived botulism immune globulin

Foodborne botulism - equine-derived botulism anti-toxin

GBS - pooled human immune globulin

Administer as soon as possible, even before diagnostic confirmation

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14
Q

The incidence of C. botulinum is highest in what three states (greatest concentration of soil botulism spores)?

A

California
Pennsylvania
Utah

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15
Q

Effect of botulinum toxin?

A

Blocks ACh release at presynaptic neuromuscular junctions

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16
Q

Congenital myasthenia gravis is a rare neuromuscular condition - how can it be distinguished from botulism?

A

Lack of autonomic symptoms (constipation, drooling); fluctuating generalized hypotonia

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17
Q

Characteristic features of spinal muscular atrophy?

A

Generalized symmetric proximal muscle weakness and hyporeflexia; does not affect the pupils, weakness is greater in the lower extremities than the upper

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18
Q

What are the two types of diabetes insipidus and how do they differ?

A
  1. Central - 2/2 decreased production of ADH by the pituitary (trauma, hemorrhage, infection, tumors)
  2. Nephrogenic - 2/2 renal ADH resistance (hypercalcemia, severe hypokalemia, tubulointerstitial renal disease, meds)
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19
Q

Common medications causing nephrogenic DI?

A 
Lithium
Demeclocycline
Foscarnet
Cidofovir
Amphotericin
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20
Q

Presentation of DI (labs)?

A

Euvolemic hypernatremia
Urine Osm <300 (complete) or 300-600 (partial) -> elevated in both types
Increased serum Osm

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21
Q

Describe the development of a left ventricular aneurysm after an MI.

A

Late complication that can occur up to several months following a transmural (STEMI); delayed coronary reperfusion increases the risk.

The healing process results in replacement of necrosed myocardium with fibrous scar tissue, which in the case of a large MI can result in convexity of a large portion of the left ventricular

Aneurysm is dyskinetic with the remaining healthy wall, resulting in impaired ejection fraction

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22
Q

Possible presentations of left ventricular aneurysm?

A

Heart failure (most common)
Angina (increased oxygen demand 2/2 elevated wall stress)
Ventricular arrhythmia
Systemic embolization (mural thrombus)

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23
Q

EKG findings of a left ventricular aneurysm?

A

Persistent ST-segment elevation
Deep Q waves

Found in the leads corresponding to the previous MI

24
Q

Echo findings of a left ventricular aneurysm?

A

Thinned and dyskinetic myocardial wall

25
Q

Presentation of right ventricular infarct?

A

Hypotension
Elevated JVP
Clear lung fields
ECG findings of ST-segment elevation in the inferior leads (II, III, aVF)

26
Q

List 5 mechanical complications of acute MI.

A
  1. R ventricular failure
  2. Papillary muscle rupture
  3. Interventricular septum rupture
  4. Free wall rupture
  5. L ventricular aneurysm
27
Q

Compare the time course of the 5 mechanical complications of acute MI.

A
  1. R ventricular failure - acute
  2. Papillary muscle rupture - acute or within 3-5 days
  3. Interventricular septum rupture - acute or within 3-5 days
  4. Free wall rupture - within 5 days to 2 weeks
  5. L ventricular aneurysm - up to several months
28
Q

Compare the involved coronary artery of the 5 mechanical complications of acute MI.

A

R ventricular failure and papillary muscle rupture - RCA

Interventricular septum rupture - LAD (apical septal) or RCA (basal septal)

Free wall rupture and L ventricular aneurysm - LAD

29
Q

Clinical and echo findings of R ventricular failure?

A

Hypotension, clear lungs, Kussmaul sign

Hypokinetic RV

30
Q

Clinical and echo findings of papillary muscle rupture?

A

Severe MR with flail leaflet

31
Q

Clinical and echo findings of interventricular septum rupture?

A

Chest pain, new holosystolic murmur, biventricular failure, shock

L->R ventricular shunt, increase in O2 level from RA to RV

32
Q

Clinical and echo findings of free wall rupture?

A

Chest pain, shock, distant heart sounds

Pericardial effusion with tamponade

33
Q

Clinical and echo findings of L ventricular aneurysm?

A

Subacute heart failure, stable angina

Thin and dyskinetic myocardial wall

34
Q

Pertussis is a highly contagious disease and transmission occurs by spread of ___. Recommended first-line treatment? Timing of treatment?

A

Respiratory droplets

Macrolide antibiotic (azithro/clarithro/erythro)

Rx during catarrhal stage may help shorten the course; treatment later will not shorten the duration but will reduce transmission

35
Q

Prophylactic recommendations for close contacts of patients with pertussis?

A

Recommended for all close contacts despite vaccination status; macrolides are preferred.

If <1 month, only azithromycin

If not fully immunized, give vaccination according to recommended schedule

36
Q

Etiology of acute bacterial prostatitis?

A

Intraprostatic reflux of pathogens in urine

Primarily GN bacilli (75% E. coli)

37
Q

Manifestations of acute bacterial prostatitis?

A

Flu-like illness
Lower urinary symptoms (dysuria, urine retention, pelvic pain, etc.)
Perineal pain

38
Q

Dx acute bacterial prostatitis?

A

Digital rectal exam (tender, swollen prostate)

Urine culture

39
Q

Rx acute bacterial prostatitis

A

6 weeks TMP-SMX or FQ

40
Q

Complications of acute bacterial prostatitis?

A

Bacteremia/systemic spread
Prostatic abscess
Chronic prostatits

41
Q

What should be avoided in patients with acute bacterial prostatitis and why?

A

Cystoscopy and urethral catheterization; passage of instruments through the urethra can cause septic shock due to release of bacteria from the prostate or prostatic rupture

42
Q

Presentation - headache worse at night, N/V, mental status changes, papilledema, focal neuro deficits

A

Intracranial hypertension

43
Q

What is the Cushing reflex?

A

HTN
Bradycardia
Respiratory depression

44
Q

Possible etiologies causing intracranial HTN?

A

Trauma, space-occupying lesions, hydrocephalus, impaired CNS venous outflow, idiopathic ICH (pseudotumor cerebri)

45
Q

What maneuvers increase ICP?

A

Leaning forward
Valsalva
Cough

46
Q

Presentation - headache with decreased vision, age >60, conjunctival erythema, mid-dilated pupil poorly reactive to light

A

Acute angle closure glaucoma

47
Q

What is a case-control study?

A

Study used to compare the exposure of the people with the disease (cases) to the exposure of the people without the disease (controls)

48
Q

What is the main measure of association in a case-control study?

A

Exposure odds ratio

49
Q

Why can incidence measures such as relative risk or relative rate not be directly measured in case-control studies?

A

Because the people being studied are those who have already developed the disease

50
Q

Bell palsy is a peripheral neuropathy of the ___ nerve characterized by facial weakness involving both the upper and lower face. What causes it?

A

Facial nerve (CN VII); reactivation of neurotrophic viruses (eg, HSV), resulting in inflammation, edema, and degeneration of the myelin sheath

51
Q

Presentation of Bell palsy?

A

Unilateral mouth dropping, loss of nasolabial fold, involvement of the upper face (weakness in closing the eye or raising the eyebrow)

52
Q

What distinguishes Bell palsy from UMN disorders like stroke?

A

Upper face involvement in Bell palsy; UMN lesions spare the upper face

53
Q

Timing of Bell palsy presentation?

A

Weakness typically develops acutely over a course of hours; often occurs at night. Symptoms progress over 2-3 weeks, gradual improvement over the following 3-6 months

54
Q

Rx Bell palsy?

A

Glucocorticoids; some experts recommend adding valacyclovir

55
Q

The ___ tract carries input from upper motor nuclei and innervates CN V, VII, IX, I, XI, XII.

A

Corticobulbar

56
Q

Most of the CNs innervated by the corticobulbar tract receive bilateral input and are unaffected by a unilateral lesion like stroke. What are the exceptions to this?

A

CN XII (innervates the genioglossus muscle -> tongue)

CN VII (innervates the lower face)

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