Questions Review Flashcards
Shiga toxin-producing Escherichia coli
*pathogenesis:
-ingestion of contaminated/undercooked beef or contact with farm animals
-invasion of intestinal epithelial cells
-production of Shiga toxin
*clinical features: watery → bloody diarrhea within 3 days; NO high fever
*dx: multiplex stool PCR testing / stool Shiga toxin assay / stool culture
*management: supportive care (fluids); avoidance of Abx & antidiarrheals
*complications: HUS (1-2 weeks after diarrhea onset)
pyelonephritis in pregnancy
*risk factors: asymptomatic bacteriuria, DM, age < 20
*common pathogens: E. coli (most common), Klebsiella, Enterobacter, GBS
*clinical presentation: preceding sx of cystitis, followed by fever, chills, back pain, maternal & fetal tachycardia, CVA tenderness
*complications: preterm labor, low birth weight, ARDS
*treatment: IV Abx, supportive therapy
tricyclic antidepressant (TCA) overdose
*clinical presentation: mental status changes, seizures, tachycardia, hypotension, cardiac conduction delay, anticholinergic effects (dilated pupils, hyperthermia, flushed & dry skin, intestinal ileus)
*best predictor of complications: QRS duration > 100 msec associated with increased risk for ventricular arrhythmia & seizures; used as an indication for sodium bicarbonate therapy
workup for new-onset atrial fibrillation
*ECG of AF: irregularly irregular rhythm, absence of organized P waves
*triggers:
-hyperthyroidism
-excessive alcohol use
-increased sympathetic tone (acute illness, cardiac surgery)
-sympathomimetic drugs (cocaine)
epidural hematoma
*pathogenesis: tearing of the middle meningeal artery → accumulation of blood b/w dura mater and skull
*often occur with fracture in the pterion region (junction of frontal, parietal, temporal, and sphenoid bones)
*classic presentation: loss of consciousness, followed by a lucid interval
*CT head reveals hyperdense biconvex (lens) lesion that does not cross suture lines
non-pupil-sparing oculomotor nerve (CN III) palsy
*clinical presentation: motor & parasympathetic involvement - diplopia, monocular ptosis, ophthalmoplegia, pupillary dilation
*causes: mass effect / intracranial aneurysm
*dx: immediate MR or CT angiography of the head
pupil-sparing CN III palsy
*clinical presentation: motor-only deficit (parasympathetics spared) - diplopia, ptosis, ophthalmoplegia
*causes: microvascular ischemia, associated with DM, HTN, HLD, advanced age
initial pharmacotherapy for acute asthma exacerbation
- short-acting beta-2 agonist (inhaled albuterol) - bronchodilator; continuous or repeated dosing
- anticholinergic (inhaled ipratropium bromide) - bronchodilator; repeated dosing only in ACUTE setting & in conjunction with albuterol
- glucocorticoid (prednisone, methyprednisolone, dexamethasone) - antiinflammatory; delayed effect; multiday dosing for control of late-phase inflammation
intussusception
*pathogenesis: telescoping of one bowel segment into adjacent segment; bowel edema → ischemia & necrosis
*epidemiology: age 6mo to 3y
*clinical presentation: sudden, intermittent abd pain & vomiting; sausage-shaped mass in R abd; currant jelly stools; lethargy or AMS
*dx: US (target sign)
*management: air (pneumatic) or saline enema; surgical intervention if failed enema reduction
secondary spontaneous pneumothorax
*occurs in patients with known lung disease (COPD, CF)
*clinical presentation: acute-onset SOB, hypoxia, unilaterally decreased breath sounds, chest pain, hyper-resonance on percussion
*pathogenesis: chronic destruction of alveolar sacs → formation of large alveolar blebs, which can eventually rupture and leak air into pleural space
*dx: CXR (demonstrates visceral pleural line beyond which no apparent pulmonary markings)
meningococcal meningitis
*epidemiology: Neisseria meningitidis; most common in young children & young adults
*clinical presentation:
-initial: nonspecific fever, HA, vomiting, myalgia, sore throat, signs of poor perfusion (cold hands/feet, mottled skin)
-within 12 to 24h: petechiae/purpura, meningeal signs (nuchal rigidity), AMS
*dx: lumbar puncture
*tx: ceftriaxone
preeclampsia with severe features
*risk factors: nulliparity, obesity, preexisting medical condition, multiple gestation, advanced maternal age
*definition: new-onset HTN (SBP 140+ or DBP 90+) at 20+ weeks AND proteinuria or s/s of other end-organ damage
*management: delivery (if 34+ weeks w severe features, or 37+ weeks w/o severe features)
conditions associated with aspiration pneumonia
- reduced consciousness: sedatives, antipsychotics, illicit drugs/alcohol, anesthesia, generalized seizure
- dysphagia: neuro disorders, esophageal motility defects, protracted vomiting, GERD
- pharyngeal or glottal dysfunction: tracheostomy, intubation, NG feeding
- dental issues: gingivitis, poor dental hygiene
organophosphate poisoning
*cholinergic toxicity
*common exposures: pesticides (farmer/field worker, pediatric ingestion, suicide attempt)
*manifestations:
1. muscarinic (DUMBELS): diarrhea/diaphoresis, urination, miosis, bronchospasms/bradycardia, emesis, lacrimation, salivation
2. nicotinic: muscle weakness, paralysis, fasciculations
*tx: atropine (reverses muscarinic sx) followed by pralidoxime (reverses nicotinic & muscarinic sx)
clinical features of cocaine use
*clinical presentation:
-sympathetic hyperactivity: tachycardia, hypertension, dilated pupils (mydriasis)
-chest pain (due to coronary vasoconstriction)
-psychomotor agitation, seizures
*complications: acute MI, aortic dissection, ICH
*management: IV benzos for BP & anxiety
chest x-ray findings suggestive of traumatic aortic dissection
*widened mediastinum
*obliteration of the aortic knob
*obliteration of the medial aspect of the left upper lobe apex
*deviation of the trachea to the right
*depression of the left mainstem bronchus / elevation of the right mainstem bronchus
pellagra
*result of severe niacin (vitamin B3) deficiency
*classic triad: dermatitis (photosensitive), diarrhea, dementia
gastritis
*inflammation associated with gastric mucosal injury
*causes include H. pylori, NSAIDs, alcohol, and autoimmune disease
*dx: evaluation of biopsy specimen obtained from EGD
*tx: varies based on the underlying causes
empiric antibiotic treatment of bacterial meningitis in adults
*age 18-50 years: ceftriaxone + vancomycin
*age > 50 years: ceftriaxone + vancomycin + ampicillin (to cover Listeria)
which lung cancer is associated with hypercalcemia?
squamous cell carcinoma
most common lung site of foreign body aspiration
*RIGHT mainstem bronchus
*the R mainstem bronchus then bifurcates into the superior lobar bronchus and the bronchus intermedius
central cord syndrome
*mechanism: forced hyperextension
*clinical presentation: bilateral sensory AND motor deficits, upper > lower extremity weakness, loss or change in temperature and pain sensation
anterior cord syndrome
*mechanism: flexion or vascular
*clinical presentation: complete loss of motor, pain, and temperature below injury, but retains proprioception and vibratory sensation (carried by the posterior columns)
Brown-Sequard syndrome
*mechanism: penetrating trauma
*clinical presentation: ipsilateral loss of motor, vibratory sensation, and proprioception with contralateral loss of pain and temperature sensation
posterior cord syndrome
*rare
*clinical presentation: loss of proprioception & vibration, with preserved motor function
hangman fracture
*traumatic spondylolisthesis of axis
*characterized by: bilateral fracture or displacement of C2 pedicles (pars interarticularis) and wide canal at C2
*hyperextension injury
*considered an unstable cervical spine injury
*dx made by XR using NEXUS criteria
opioid withdrawal syndrome
*often resembles a flu-like illness
*clinical presentation: rhinorrhea, sneezing, yawning, lacrimation, abdominal cramping, hyperactive bowel sounds, leg cramping, piloerection, nausea, vomiting, diarrhea, and dilated pupils
