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ITE > Pearls_02 > Flashcards

Pearls_02 Flashcards

1
Q

Patient with pharyngitis in clinic use CENTOR criteria (fever, absence of cough, tender anterior cervical lymphadenopathy, tonsillar exudate).

Do what if only one condition met?

If 2-3 criteria?
If all 4 present?

What is tx?

A

If 1 don’t treat

If 2-3 –> obtain rapid strep and treat if positive.

If all 4 criteria present treat.

Tx with PCN.

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2
Q

CENTOR criteira for strep/pharyngitis?

A

fever, absence of cough, tender anterior cervical lymphadenopathy, tonsillar exudate

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3
Q

If young patient describing solid-food dysphagia and food impaction consider what dx?

DxM?
Tx? and for how long?
- if no response, do what?

A

eosinophilic esophagitis.

Biopsy with >15 eosinophils/hpf. T

Treat initially with PPI x6 weeks.

If no response add swallowed aerosolized corticosteroids.

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4
Q

Patients with testicular mass should undergo testicular ultrasonography and be referred for urologic evaluation.

Initial urologic evaluation of a patient with suspected testicular cancer includes what 2 diagnositc imaging?

what type of tumor markers?
and determination of

A

chest radiograph
CT Abd/Pelvis

(so do a testicular u/s, then send to Urology, they will do CXR, CT Abd/Pelvis)

serum tumor marker levels (AFP and β-hCG ).

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5
Q

Pts with testicular mass
- get AFP and b-hcg

what does elevated serum AFP mean and why?

what does elevated b-hcg mean?

A

elevated AFP
- always = nonseminomatous component bc this marker is produced by embryonal or yolk sac tumor cell

elevated b-hcg
- may be in seminomatous OR nonsemnomatous tumors

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6
Q

Suspect stroke -> get what imagin?

A

CT Head without contrast

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7
Q

suspect stroke
- get CT head wo contrast

  • when would you give TPA?
A

-> if no hemorrhage and within 4.5 hours of symptom onset -> consider TPA*

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8
Q

suspect stroke

- contraindications to TPA?

A

Contraindications to TPA -> think of anything bad inside the head (mass, bleed), active bleed, or BP >185/110

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9
Q

suspect stroke
- If you cannot give TPA for ischemic stroke -> then give ___ and consider permissive ___ (note: do NOT treat unless BP is greater than what?)

A

give ASA 325mg and consider permissive hypertension -> do not treat unless greater than 220/120 because you actually want a high BP for stroke pts to maintain perfusion

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10
Q

If hemorrhagic stroke -> BP goal should be less than what?

A

If hemorrhagic stroke -> BP goal should be

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11
Q

New onset paresthesia, intermittent blurry vision and pain with movement of the effected eyes (optic neuritis), ataxia, hyperreflexia

DX?

order what two images and what do you look for?

A

multiple sclerosis
(esp in young female)

MRI brain and C spine to look for white matter lesions of demyelination

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12
Q

> not necessary but lumbar New onset paresthesia, intermittent blurry vision and pain with movement of the effected eyes (optic neuritis), ataxia, hyperreflexia

Dx?
Is LP necc?
- what would you look for?

Tx?

A

multiple sclerosis

lumbar puncture can be helpful to look for oligoclonal bands.

Tx

  • acute: IV steroids
  • maintenance: glatiramer acetate or interferon beta
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13
Q

IV steroids

- give when in multiple sclerosis?

A

IV steroids when acute

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14
Q

glatiramer acetate or interferon beta

These are tx for what?

A

maintenance (as opposed to acute conditions) for mult sclerosis

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15
Q

oligoclonal bands

- found in what test and for what dx?

A

LP for mult sclerosis

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16
Q

Patient with fever, malaise, photosensitivity, joint pain/effusions

Dx?

A

SLE vs Drug induced lupus erythematosus (DILE)

17
Q

Meds causing drug induced lupus erythematosus (DILE)?

What lab to order?

A 
Hydralazine
Procainamide,
Isoniazid
Etanercept
Infliximab

check anti-histone antibodies (Etanercept can also have dsDNA but it’s still DILE).

18
Q

anti-histone Abs are used in dx for what condition?

A

DILE

- drug induced lupus erythematosus

19
Q

Patient with gritty sensation/dry eyes and dry mouth

Dx?
Labs?
Screen with what test?
Tx?

A

Sjogren’s Syndrome -> anti-Ro (SSA) and anti-La (SSB) -> screen with Schirmer’s test -> treat with hydration and pilocarpine.

20
Q

anti-ro (SSA) and anti-La (SSB)

A

Sjogen’s Syndrome

21
Q

schirmers test screens for what?

A

Sjogren’s syndrome

22
Q

Associate Sjogren’s with increased risk for what three conditions?

If pregnant think about what condtion bc there is an inc risk with SSA and SSB? -> if CHB in fetus then treat mom with Dexamethasone (crosses placenta)

–> if they have this condition in the fetus, then treat mother with what and why?

A

lymphoma, celiac sprue, and Type I RTA

If pregnant with sjogren’s, watch for congenital heart block bc of inc risk of SSA and SSB

–> if congenital heart block in fetus, then tx mother with dexamethasone bc it crosses the placental and can get to the fetus

23
Q

Young patient with low back pain that is worse after rest and better with exercise -> “bamboo-spine” on plain film -> often assoc with HLA-B27 (nonspecific) -> Dx?

DxM?
Tx?
- 1st line
- if no response to 1st line?

This condition is assoc with what two co-morbids?

A

Ankylosing Spondylitis -> will have positive Schober’s test -> treat with NSAIDS and if no improvement then TNF alphas.
- Also associated with aortitis and uveitis.

24
Q

aortitis and uveitis is assoc with what condition?

A

Ankylosing Spondylitis

25
Q

bamboo spine

A

Ankylosing sponylitis

26
Q

buzz phrase for Ankylosisng spondyitis

A

bamboo spine

- seen on plain film

27
Q

schober test

schirmer test

A

schober
- ankylosisng spondylitis

schirmer
- sjogren’s

28
Q

NSAISs first, if no response, TNF alphas

these are tx for what?

A

ankylosing spondylitis

29
Q

Patient presents with testicular mass:

-next step? (i.e. DxM?)

A

Testicular ultrasound

30
Q

Pt with testicular mass –> get testicular u/s –>
US reveals a solid mass -> think?

And what will the pt then need?
- hint: will need two images, 3 labs

A

testicular cancer -> patient will need CXR, CT scan of the abdomen and pelvis, and serum α-fetoprotein, β-human chorionic gonadotropin, and lactate dehydrogenase levels.

31
Q

What type of tumors account for 95% of testicular cancers?

How are they classified? which one has better prognosis?

Describe the the markers that can distinguish btw these two types

A

Germ cell tumors

Classified as:

  • pure seminomas (better prognosis)
  • nonseminomas (embryonal carcinoma, choriocarcinoma, yolk sac carcinoma, and teratoma)

β-HCG levels can be elevated in both
- elevated αFP defines the tumor as a nonseminoma.

32
Q

For germ cell tumors:

B-HCG is elevated in which type(s)?
αFP is elevated in which type(s)?

A

β-HCG (elevate in seminomas or nonseminoma)

αFP (elevated in nonsem only)

33
Q

All patients with testicular cancer (either seminoma or nonseminoma) require what type of intervention?

A

radical orchiectomy

ITE (11 decks)

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