Practice Test 5 Flashcards
Molluscum contagiosum
- Virus in the Poxvirus family
- Self-limited epidermal infection
- Characterized by flesh colored papules/vesicles that may be umbilicated
- Common in children and sexually active adults (NOT an STI tho), kids in daycare or adolescents in team sports
- Simply transmitted by body-to-body contact
Haemophilus ducreyi
- Gram negative coccobacillus
- Causes the STD called chancroid-painful sores on the genitalia and suppurative regional LAD
- Increased risk of HIV transmission (test for HIV coinfx)
- Grows on chocolate but not blood agar b/c it requires factor X (heme) to grow
Herpes simplex 2
- dsDNA virus of the herpesviridae family
- Causes genital herpes
- Lesions appear as a cluster of vesicles/ulcerations with significant pain and regional LAD
What is the protocol for HIV testing?
- Screen for HIV/AIDS with a highly sensitive test (ELISA)
- Confirm with a highly specific test (western blot)
Compare the V/Q ratios of the different parts of the lungs
- Apex of the lung has a higher V/Q ratio, base of the lung has a lower V/Q ratio
- Apex has both lower ventilation and perfusion
A pulmonary embolism would result in what V/Q ratio?
A pulmonary embolism would result in a high V/Q ratio (embolism blocks perfusion (flow) but not ventilation
Asthma would result in what V/Q ratio?
Asthma would cause a lower V/Q ratio because it only lowers ventilation
What is autonomy?
- Respect for persons
- Respecting the informed decision-making of capacitated individuals
What is beneficence?
Acting to promote a patient’s interests or preferences
-Example-Doctor helping to facilitate consultation with another doctor
What is justice?
The fair treatment and distribution of medical goods and services
- Patients with the same conditions should be treated equally
- Example-providing appropriate medical care (such as a C-section) even if a patient does not have insurance
What is non-maleficence?
Avoidance of patient harm and/or what would be against a patient’s wishes
What is confounding bias?
Occurs when an unaccounted-for variable affects the dependent or independent variable
What is late-look bias?
Occurs when study design error causes info to be gathered at a time that skews results
What is lead-time bias?
Occurs when a test identifies a disease in an early stage and artificially predicts a longer survival period
What is recall bias?
When a study participant’s previous knowledge or opinion affects the result of the study
What is sampling bias?
Occurs when the group being studied does not represent the group about which the conclusions of the study are being made
What are characteristics of sarcoidosis?
- Restrictive lung disease with bilateral hilar LAD seen on chest xray
- Non-caseating granulomas
- Commonly associated with Bell’s palsy, erythema nodosum, and Lofgren syndrome
- Common for patients to have elevated ACE levels and hyperCa
What is Bell’s palsy?
- Peripheral 7th nerve palsy
- Presents with unilateral drooping of the eyelid and mouth
- MC cranial nerve lesion assoc w/ sarcoidosis
What is the treatment for sarcoidosis?
Most patients do not require tx-spontaneous remission
-Severe disease-tx with glucocorticoids and other immunosuppressants
What is the triad for lofgren syndrome?
- Bilateral hilar LAD
- Erythema nodosum
- Arthritis
What is myasthenia gravis?
Autoimmune dz
- Abs against the nAchRs/NMJ on skeletal muscle tissue
- Present with motor muscle weakness, severe dz can involve the diaphragm -> acute resp failure
- Diagnosed with tensilon test (administer edrophonium, which will inhibit AchE inhibitor, and improve motor neuron strength)
If the tensilon test is negative and motor strength does not improve?
Lambert-Eaton myasthenic syndrome
What is the mnemonic to remember the signs/sx of sarcoidosis?
ABCDE
- -A*CE (elevated)
- -B*ilateral hilar LAD
- -C*a (hyperCa)
- -D*(elevated vitamin D)
- -E*rythema nodosum
What is granulomatosis with polyangitis?
Small vessel vasculitis
- Presents with fever, malaise, weight loss
- Affects the lungs and kidneys too
- C-ANCA (PR3) Abs
- Tissue biopsy has necrotizing granulomatous vasculitis
Explain the pupillary light reflex
Tests both CN 2 and CN 3
- When light enters the eye, the optic nerve sends that information to the brain (afferent pathway)
- The signal to constrict the pupils travels from the cortex on the oculomotor nerve bilaterally so that the light entering one eye will cause pupil constriction in both eyes
What would the results of the pupillary light reflex be in a patient with a lesion of the right optic nerve?
- When you shine the light in the left eye, both pupils constrict
- When you shine the light in the right eye, both pupils dilate (right optic nerve is not transmitting the light to the brain, afferent pathway, afferent pupillary defect (APD))
What would the results of the pupillary light reflex be in a patient with a lesion of the left oculomotor nerve?
No pupil constriction in the left eye regardless of which eye the light is entering (efferent pathway is broken, pupil constriction signal is not being transmitted from the brain)
What are the most common causes of a lesion of the optic chiasm and what does it cause?
Lesion of the optic chiasm is typically from a pituitary tumor and causes a bilateral hemianopsia
What does optic tract damage cause?
Homonymous hemianopsia
-May produce a relative afferent pupillary defect in the eye contralateral to the side of the lesion (defect of the right optic tract may cause left APD)
For observational studies, if groups are organized by DISEASE STATUS, it is what type of study?
Case control (a retrospective study)
What is the main problem in case control studies?
Recall bias
For observational studies, if groups are organized by EXPOSURE STATUS, it is what type of study?
Cohort (a prospective study)
What is the main problem in cohort studies?
Loss to follow-ups
What is a cross sectional study?
- A study that collects data from a group of people in order to assess the prevalence of disease and related risk factors as a particular point in time
- No loss to follow-up (b/c no follow-up needed)
- Associations to risk factors can be studied
- Causality of the risk factors cannot be determined with this study type, only their prevalence with the dz
What is the inheritance pattern of factor 7 deficiency?
Autosomal recessive
Factor 13 deficiency
- Autosomal dominant
- AKA fibrin stabilizing factor-acts to cross-link fibrin to form an insoluble clot
- Normal PT and PTT (factor 13 not technically in the clotting cascade)
- Will cause abnormal clot formation though
Von Willebrand disease
- Autosomal dominant
- Results in the characteristic platelet dysfx manifestations of mucocutaneous bleeding into the oral cavity, nasal cavity, and GI tract
- Excessive bleeding after minor cuts and petechiae are common
- Platelet count is normal
- vWF plays an important role in primary hemostasis -> binds to the endothelium and causing plt activation
- vWF is also a carrier protein for factor 8
- Will have prolonged bleeding time and PTT
- Patients should avoid aspirin
What is the most sensitive test for vWF disease?
Ristocetin cofactor assay
What is the treatment for vWF disease?
Desmopressin -> blood vessels release more vWF
What is Berger’s disease?
AKA IgA nephropathy
- Type 3 hypersensitivity AI disorder characterized by IgA deposits in the mesangium of kidney tissue, can progress to ESRD
- Patients present with hematuria following a recent URI (synpharyngitic hematuria)
What other diseases can Berger disease be associated with?
- Celiac dz
- Dermatitis herpetaformis
- Akylosing spondylitis
- T cell lymphomas/mycosis fungoides
What is the tx for Berger disease?
- Control risk factors such as HTN and proteinuria
- Glucocorticoids and immunosuppressants
What is Graves’ disease?
- Type 2 hypersensitivity AI disorder that involves IgG Abs against TSH receptors
- MCC of hyperthyroidism
- Patients present with sx related to increased metabolic rate such as anxiety, weakness, palpitations, unintentional weight loss, sweating, diarrhea, and amenorrhea
- Hyperreflexia and goiter may also present
What is the best initial laboratory test when you suspect Graves’ disease?
TSH level-will be LOW because the Abs are binding to the receptor instead of regular TSH
What is the treatment for Graves’ disease?
Sx control
-Anti-thyroid medications-PTU and methimazole
-Beta blockers-propanolol and atenolol
Definitive tx
-Eliminate thyroid tissue via either radioactive iodine ablation or surgical removal
What is courvoisier’s sign?
Enlarged non-tender gallbladder secondary to pancreatic disease or cancer
-Jaundice and palpable painless mass in the RUQ
Definitive diagnosis of pancreatic cancer requires what test?
Abdominal CT
What are the symptoms of primary biliary cirrhosis?
- More common in women
- Unexplained itching, fatigue, jaundice, unexplained weight loss, RUQ discomfort
- Hyperpigmentation of skin (due to melanin deposition)
- Extremely elevated ALP
- Xanthomas-yellow lipid filled nodules in the skin, common near the eyelids (xanthelasma)
What are the 4 antihypertensive agents that are safe during pregnancy?
- Labetalol
- Hydralazine
- Nifedipine
- Methyldopa
Why are ACE inhibitors contraindicated in pregnancy?
Result in uterine ischemia and interfere with fetal kidney development
Why are diuretics avoided in pregnancy?
Can aggravate low plasma volume to the point of uterine ischemia
What is magnesium sulfate used for?
Seizure prophylaxis in patients with preeclampsia-trying to prevent progression to eclampsia
Why is nitroprusside contraindicated in pregnancy?
Fetal cyanide poisoning
Women with preeclampsia are at increased risk for life-threatening events such as?
- Placental abruption
- Acute renal failure
- Cerebral hemorrhage
- Liver failure
- Pulmonary edema
- DIC
- Progression to eclampsia
Diagnosis of DIC is based on what lab values?
- Reduced levels of fibrinogen and plts
- Prolongation of thrombin, PT, and PTT
What is hyperemesis gravidarum?
- Severe form of morning sickness
- Characterized by excessive pregnancy-related nausea and/or vomiting that prevents adequate intake of food and fluids
- Associated with elevated beta-hCG
What are the characteristics of HELLP syndrome?
Severe variant of preeclampsia (poor prognosis)
- Hemolytic anemia
- Elevated liver enzymes
- Low plts
What is the only cure for preeclampsia/eclampsia?
Delivery of the fetus
What are the signs of Mg toxicity?
- Loss of DTRs (hyporeflexia)-always appears first, continually test DTRs
- Respiratory paralysis
- Coma
What is Ca gluconate used for?
Mineral supplement that can be used to reverse Mg poisoning
What is polycystic ovarian syndrome?
- Caused by abnormal function of the hypothalamus-pituitary-ovarian (HPO) axis -> deranged steroid synthesis by theca cells
- Leads to inc LH, dec FSH, inc testosterone, inc, androgens, and inc estrogens
- Manifests clinically as amenorrhea, infertility, obesity, and hirsutism
- Also commonly assoc with T2DM/metabolic syndrome
What is the treatment for PCOS?
Ovulatory stimulation with clomiphene +/- metformin
What are the important hormone levels in Turner syndrome?
- Dec estrogen
- Inc LH and FSH
What are the signs and sx of Turner syndrome?
- Ovarian dysgenesis-failure of gonad development
- Primary amenorrhea (MCC), streak ovaries
- Short stature, shield chest, bicuspid aortic valve, webbing of the neck (d/t cystic hygromas), and preductal coarctation of the aorta
What are the characteristics of diffuse large B cell lymphoma (DLBCL)?
- MC histologic subtype of non-Hodgkin lymphoma
- Pts present with enlarging symptomatic mass (neck or abdomen) and systemic ‘B’ symptoms
- Tumor cells ecpress B cell Ags-CD19, CD20, CD22, and CD79a
- BCL-2 and BCL-6 protein expressions are common
- Most follicular lymphomas have the 14;18 translocation -> BCL-2
What are the systemic ‘B’ symptoms?
- Fever
- Weight loss
- Drenching night sweats
What is the equation for Fick’s principle?
CO = O2 consumption/(arterial O2 content-venous O2 content)
Don’t understand #26
…
What are the symptoms of acute cholecystitis?
- RUQ pain (no palpable mass)
- Positive murphy’s sign-inspiratory arrest during deep palpation of the RUQ
- No jaundice-since the blockage occurs at the cystic duct (not common bile duct)
