NBME 11 Flashcards
Heat exhaustion
vs
heat stroke
exercise intolerance, increased core body temp, no neuro disturbances
hyperthermia + AMS + neuro deficits
hypernatremia, hyperchloremia, hyperkalemia
tx: remove individual from the heat, remove excess clothing, initiate cooling measures: immersion in cool water or evaporative cooling
rapidly progressive dementia and ataxia with stimulus indiuced or spontaneous myoclonas
Creutzfeldt Jakob disease
dx: CSF 14-4-4
autopsy: spongiform degeneration of the cortex
tx: death within one year, hospice, benzo for myoclonus
ethambutal ae
optic neuropathy : scotoma, red-green color blindness, blurred vision, partial visioin loss
neutropenia
thrombocytopenia
Isoniazid ae
inhibits synthesis of mycolic acids in cell walls
hepatoxic, neurotoxic, B6 pyridoxine deficiency (peripheral nueropathy and sideroblastic anemia)
Pyraxinamide ae
hepatoxic
hyper-uricemia
arthralgia
criteria for causation: (4)
- biologic plausibility
- dose-relationship
- specificity and strength of association
- temporal relationship
biological plausibility
observed association can be explained by a known biological pathway or mechanism
Specificy of the association
Strenght of the association
Specificy: one to one relationship between the exposure and the outcome
risk factor is the cause of ONE disease
Strenght: NEED R value (closer to 1 higher correlation)
Temporal relationship
if the exposure is known to precede the outcome
if pt were known to have no cardio dx prior to use of cigarettes then developed cardio dx
Dose-response relationship
the positive correlatino found between increased risk for cardiovasc dx and number of cigarettes smoked daily indicates that as the number of cig smoked daily, so does the risk for cardio vasc dz
number of cigs is dose
cardiovasc dz is response
hospital workers or high risk population PPD skin test:
greater than 10mm must treat
do xray
if active: quad tx
if latent: isoniazid for 9 months
pt with pneumonia, given abx, then preceded to have developed a parapneumonic effusion and then inot empyema (bacterial infection in pleural space)
next step
abx alone wont help, MUST PLACE CHEST TUBE
infusion of tissue plasminogen activator and recombinant deoxyribonuclease (DNAse) and iv abx into pleural space through chest tube
if chest tube fails –> video-assisted thorascopic surgery for decortication and drainage
children with hypertension
next step?
renal doppler ultrasound
serum renin and aldosterone
serum/urine metanephrines
on echo: pericardial effusion
collapse of right atrium at end of diastole
collapse of right ventricle in early part of diastole
cardiac tamponade
JVD hypotension, distant heart sounds
imapired right ventricular diastolic filling
risk factors any of: family hx of cvd, htn, dm, smoking
USPTF screening for men aged > 35 and women >45
lipid studies
tx: statins
anti-depressants with no sexual ae
mirtazapine : selective alpha 2 antagonist and serotonin modulator
Bupropion (dopamine and norepi)
ulcerative colitis managment meds
1) mesalamine enema , sulfasalazine
2) Corticosteroids: prednisone, Budesonide, hydrocortisone
3) anti-TNF (infliximab)
4) Janus Kinase enzyme inhibitor: Tofactinib
baby (less than 1yr) with recurrent UTI, voiding cystourethrography shows backflow of urine from bladder to renal pelvis
next step?
vesicoureteral reflux
can lead to pyelonephritis which later leads to renal scarring, htn, ckd
give: prophylactic daily antibiotc therapy
pelvic u/s: enlarged endometrial stripe
aub in post-menopausal
aub in premeno with prolonged exposure to estrogen
endometrial carcinoma
endometrial glands within the myometrium
large globular boggy diffusely enlarged uterus
transvag u/s : diffusely enlarged uterus, asymmetrical myometrial thickening, loss of endomyometrial border, subednometrial cysts
adenomyosis
tx: definitive: hysterectomy
conservative: progesterone IUD
gonadotropin-releasing hormone analogs
aromatase inhibitors
monoamniotic preg
vs
monochorionic preg
complications
conjoined twins or cord entaglement
twin twin trasnfusion or selective fetal growth restriction
hyperemesis gravidum management:
IV fluids
B6 supplements
antiemetics
usually seen in molar pregnancy so do a pelvic u/s and B-hcg levels
will see ketonuria or ketonemia
fever in pt with sickle cell and no spleen
any encapsulated pathogen: haemophilus influenza, neisseria meingitidis, streptococcus pneuomiae, pseudomonas, klebsiella
tx: ceftriaxone
friable ulcerative lesion on cervix painless bleeding
cervical cancer