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Bloc H - Movement > R&E F,G,H part > Flashcards

R&E F,G,H part Flashcards

1
Q

dx or imaging soft tissue lesion how

A

MRI

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2
Q

inflammatory vs non-inflammatory joint disease on history

A

inflam =

  • swelling with the pain
  • constitutional symptoms (fever, anorexia, fatigue)
  • morning stiffness ­30 min + morning pain
  • wake up at night
  • better with mobility
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3
Q

vertebral fracture management

A
  • rule out pathology

- send home with tylenol

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4
Q

rhabdomyolysis triad

A
  • generalized weakness
  • myalgias
  • dark urine
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5
Q

dx of bone tumors is done how

A

XR

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6
Q

shoulder dislocation most common type

A

anterior (90%)

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7
Q

shoulder dislocation associated problems

A
  • Bony Bankart (fracture of anterior glenoid rim)

- Hill-Sachs impression fracture (posterior humeral head)

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8
Q

osteosarcoma most common site

A

distal femur

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9
Q

osteosarcoma most common age of presentation

A

10-20 yo

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10
Q

Ewing sarcoma what bones

A

diaphyseal bones

  • femur
  • tibia
  • humerus
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11
Q

Ewing sarcoma most common age of presentation

A

10-20 yo

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12
Q

Ewing sarcoma pathology

A

large soft tissue reaction

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13
Q

Ewing sarcoma how good XR is

A

not the best bc underestimates the large soft tissue reaction

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14
Q

chondrosarcoma what bones

A
  • hip
  • shoulder
  • proximal long bones
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15
Q

chondrosarcoma common age of pres

A

40-60 yo

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16
Q

chondrosarcoma appearance on XR

A

lytic lesions often with fracture

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17
Q

osteoporosis who do you treat

A

high risk patients

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18
Q

osteoporosis def of high risk patients

A

either of

  • had ­­­>1 non vertebral fragility fracture
  • has had 1 vertebral or hip fracture
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19
Q

inflammatory vs non inflam joint disease on PE

A 
inflammatory =
-pain worse with rest
-warm
-PIPs
non inflammatory =
-cold deformed
-DIP
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20
Q

how to treat inflammatory joint disease like RA

A

anti-inflammatories

  • steroids
  • immune modulation
  • DMARD (like methotrexate)
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21
Q

how to treat non inflam joint disease like OA

A

analgesics (acetaminophen, topical NSAID)

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22
Q

febrile neutropenia def

A
  • fever (>38.3 once or >38 twice on 1 hour+ inteval)

- ANC<500

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23
Q

feb neut management and why

A
  • emergency IV Abx. want to cover gram+ and gram-
  • blood culture
  • CXR
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24
Q

how do you take the temperature in feb neut

A

NOT RECTAL. anything else

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25
Q

feb neut: management if fever persists or recurs after droping

A

suspect fungal infection

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26
Q

most common UTI bacteria

A

E.coli

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27
Q

rule in tx UTIs and how do you treat

A

TX ONLY IF SYMPTOMATIC

-Septra (sulfamethoxazole-trimethroprim)

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28
Q

strep throat management and why

A
  • ALWAYS tx with Abx

- bc can progress to rheumatic fever

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29
Q

rheumatic fever is what

A
  • type 2 hypersensitivity reaction

- caused by molecular mimicry

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30
Q

management of fever in returning traveller

A

suspect malaria***
(Dengue if SE Asia)
-even if fever with something else (don’t forget there’s fever so don’t think of another disease before malaria)

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31
Q

important parasite to avoid in pregnancy, why and how

A
  • toxoplasma
  • because crosses the placenta
  • avoid changing cat litter boxes
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32
Q

maternal-fetal transmission main organisms

A

TORCH

  • toxoplasma
  • (others like varicella)
  • rubella
  • cytomegalovirus
  • herpes and HIV
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33
Q

only DROP FORM Abx (2 names) you can give for otitis externa

A

fluoroquinolones (ciprofloxacin)

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34
Q

why can’t give DROP FORM Abx other than fluoroquinolones (ciprofloxacin) in otitis externa

A

if there’s tympanic membrane perforation that you saw or didn’t see, giving will cause

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35
Q

treatment of otitis media

A

amoxicillin per os

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36
Q

a patient has a positive PPD test for TB: next step in management

A

CXR

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37
Q

latent TB (TB infection): risk of converting to tuberculosis (active TB) and specific case

A
  • 10%

- >10% if have HIV

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38
Q

latent TB (TB infection treatment)

A

optional isoniazid for 9 mo or rifampin 4 mo

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39
Q

how UTIs are diagnosed

A
  • leukocyte esterase

- nitrites

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40
Q

meningitis signs on PE

A
  • neck stiffness
  • Brudzinski’s sign
  • Kernig’s sign
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41
Q

lumbar puncture of a bacterial meningitis and how it compares to LP for viral meningitis

A
  • increased pressure (not in viral)
  • WBCs present
  • protein present (not in viral)
  • low glucose (not in viral)
  • VIRAL = ONLY HAS WBCs*
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42
Q

meningitis treatment

A
  • cefotaxime or ceftriaxone AND vancomycin if older than 1 mo
  • cefotaxime or ceftriaxone and AMPICILLIN if <1 mo
  • *IV dexamethasone (CS) as adjuvant therapy in certain cases to decrease brain inflamamtion and prevent neurological damage
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43
Q

when give IV dexamethasone as adjuvant tx in meningitis and why

A
  • Strep pneumo in adult
  • H influenza in kid
  • GEL (GBS (like agalactiae), E.coli, Listeria) in <1 mo
  • to decrease brain inflamamtion and prevent neurological damage*
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44
Q

when do you administer the adjuvant IV dexomethasone in meningitis if needed

A

before taking the Abx (cef + amp or vanco) or in the 20 mins after

45
Q

brain function in meningitis how is it affected

A

is normal (only altered mental status if late meningitis)

46
Q

encephalitis difference with meningitis

A

causes altered brain function

  • personality change
  • sensory dysfunction
  • motor dysfunction
47
Q

HIV initial symptoms

A
  • initially infection to lymph nodes

- then get a secondary viremia (mono-like ilness) = maculopapular rash, myalgia, headache, hepatohsplenomegaly, etc.)

48
Q

treatment of HIV (to everyone)

A

HAART

49
Q

definition of AIDS

A

CD4 count below 200

50
Q

AIDS = at risk for what infections and problems

A
  • All infections
  • pneumocystis jeroveci pneumonia (especially neonates)
  • lymphocytic interstitial pneumonia
  • HIV nephropathy
  • HIV dementia
51
Q

infection routes for HIV

A

most common to least common

  • blood transfusion
  • perinatal exposure
  • needlestick injury
  • breastfeeding
52
Q

pt vomiting + has non bloody (watery) diarrhea: think what infection

A

norovirus (cruise ship virus)

53
Q

pt has non bloody (watery) diarrhea but NOT vomiting: think what infection

A
  • rotavirus
  • ETEC (enterotoxic E.coli)
  • vibrio
54
Q

pt has bloody diarrhea: think what infection

A

SSCYE + 1 parasite

  • shigella spp
  • salmonella spp
  • yersinia enterocolitica
  • campylobacter jejuni
  • EHEC (E.coli O157)
  • entamoeba histolytica
55
Q

HPV infection different symptoms depending on type of HPV

A

can get any of these

  • warts (molluscum)
  • cervical cancer
56
Q

HPV types that give warts

A

6 and 11

57
Q

HPV types that give cervical cancer1

A

16 and 18

58
Q

herpes ulcers vs syphilis chancres how to differentiate

A
  • herpes ulcer is painful

- syphilis chancre is painless

59
Q

bacterial meningitis LP (CSF content)

A
  • 1000-5000 cells (high cell count)
  • 1.0 to 5.0 g/L prot (high protein)
  • glucose <2.5 (low glucose)
  • CSF:serum glucose ratio <0.4 (decreased)
60
Q

viral meningitis LP (CSF content)

A
  • <1000 cells
  • <1.0 g/L prot
  • normal glucose (3.0 to 5.0)
  • normal CSF:serum glucose ratio (­0.4)
61
Q

hepA symptoms

A
  • jaundice

- liver inflammation

62
Q

hepA transmission

A

fecal-oral

63
Q

hepA vaccine exists yes or no

A

yes. vaccine available for hepA

64
Q

hepB symptoms

A

have some prodromal symptoms (before the high LFTs = liver function tests) and then the actual symptoms (when high LFTs):

  • jaundice
  • fatigue
  • dark urine
  • abdominal pain
65
Q

hepB transmission

A 
body fluids (note: 30% risk with a needlestick)
-note: survives long time on surfaces
66
Q

hepB vaccine yes or no

A

yes. vaccine available for hepB

67
Q

hepC symptoms

A
  • 80% are asymptomatic

- mild symptoms

68
Q

risk with hepC and how you act to reduce it

A
  • risk of developing chronic cirrhosis

- so treat with direct acting antiviral

69
Q

hepC transmission

A

-body fluids (note: 3% risk with needlestick injury)

70
Q

hepC vaccine yes or no

A

NO. no vaccine for hepC

71
Q

in what pts are live vaccines (varicella, MMR, etc.) contraindicated

A
  • immunocompromised

- pregnant

72
Q

vaccines that the immunocompromised and pregnant pts must have

A

mnemonic: rotating (rotavirus) chickens (chickenpox) on poles (polio) does not give tuberculosis (BCG vaccine) or autism
(MMR)

73
Q

structure of the hepB virus + diff in Abs our bodies make for the two

A

has surface Ags (Abs to this will ELIMINATE the virus and stay for life) + core Ags (Abs for these are just there but don’t do anything and also stay for life)

74
Q

positive for sAg indicates what in hepB

A

you’re infected (acute or chronic)

75
Q

positive for sAb indicates what in hepB

A

resolved acute infection (resolved bc you were able to make sAb)

76
Q

positive for cAg indicates what in hepB

A

you’re infected acutely (it hasn’t been long since you got infected) bc

77
Q

hepB: sAg, sAb, cAb and cAg in the vaccinated (vaccination = give surface antigen bc we want sAb (the efficient Ab) to be produced)

A
  • sAg negative
  • sAb positive
  • cAg negative
78
Q

3 tests for hepB

A
  • surface Ags
  • surface Abs (Abs to the surface Ag)
  • core Abs (Abs to the core Ag)
  • NO CORE Ag TEST*
79
Q

how the 3 tests for hepB + total core Abs (includes IgG cAb) evolve with time when you get acute hepatitis B (infection in adult life, unprotected sex for example)

A
  1. sAg up then back down
  2. cAb IgM up a bit later then back down too
  3. Total cAb (IgM + IgG) goes up with cAb IgM and present for life (bc IgG stays)
  4. sAb goes up and stays for life (after cAb IgM down) IS PRESENT ONLY AFTER INFECTION
80
Q

how the 3 tests for hepB + total core Abs (includes IgG cAb) evolve with time when you get chronic hepatitis B (infection perinatally)

A
  1. sAg up and there for life
  2. then cAb IgM up and then down
  3. Total cAb (IgM + IgG) goes up with cAb IgM and present for life (bc IgG stays)
81
Q

how the 3 tests for hepB differ for chronic hepB vs acute hepB

A
  1. acute = sAg will go up then back down
    chronic = sAg stays up for life
  2. acute = sAb will go up late and stay for life. chronic = sAb never appears bc immune system can’t clear the sAg
    *but both have cAb go up and stay for life (and IgM back down long term)
82
Q

what tests do you order to know if a patient is currently infected with hepB (acute or chronic, doesn’t matter)

A

sAg

83
Q

what tests do you order to know if a patient has ever been exposed to hepatitis B

A

total cAb

84
Q

what test do you order to know if a patient is immune to hepB (means acute and healed it. you’re not immune if chronically infected)

A

sAb

85
Q

what test do you order to know if a patient has ACUTE HEP B INFECTION SPECIFICALLY (want to discriminate acute vs chronic)

A

cAb IgM*

-NOT sAg bc is always there with chronic

86
Q

what is the Ab to hepB that gives you immunity to hepB

A

sAb

87
Q

meaning of sAg-, sAb- and cAb-

A

no prior exposure

88
Q

meaning of sAg-, sAb+, cAb-

A

vaccination (vaccine only has sAg in it bc anws it is the sAb that gives you immunity)

89
Q

(IMPORTANT) meaning of sAg-, sAb+, cAb+

A

resolved acute infection

90
Q

meaning of sAg+, sAb-, cAb+

A

acute or chronic infection (sAb- bc only have sAb AFTER acute infection and not during acute)

91
Q

if you got a sAg+, sAb-, cAb+, how will you differentiate the acute infection from the chronic infection

A

by knowing if cAb IgM is + (acute) or - (chronic)

92
Q

if a needle contains hepB, hepC or HIV what is the respective risk ok getting infected in a needlestick injury with a needle containing one of these

A
  • hepB: 30%
  • hepC: 3%
  • HIV: 0.3%
93
Q

Parkland formula to estimate how much fluid you need to give a burn patient within the first 24 hours + over what time interval specifically

A

4 x m (kg) x % of TBSA (burnt) = V to give (in mL)

  • half in first 8 hours
  • half in next 16 hours
94
Q

how to estimate TBSA burnt in a burn injury

A
  • arm = 9% each
  • leg = 18% each
  • torso = 18%
  • back = 18%
  • head = 9%
  • palm = 1%
95
Q

SIRS definition

A

2 of these 4 criteria

  • temp <36 or >38
  • PaCO2 <32 or RR>20
  • WBCs <4000 or >12000 or >10% band neutrophils
  • HR>90
96
Q

chronic granulomatous disease is what

A

deficiency in NAPDH oxidase in phagocytes

97
Q

CGD susceptibility to which bacteria

A
  • aspergillus
  • burkholderia
  • strep
  • nocardia
98
Q

CGD what to be careful about

A

infected patient may have no fever and no leukocytosis because the signaling is impaired (CGD affects inflammatory cells)
can’t rule out infection if no fever or leukocytosis

99
Q

most common food allergen + other one common too

A
  • milk #1

- raw egg (but cooked = no allergy bc no more allergens)

100
Q

milk allergy appears when during life usually

A

children under 1 yo

101
Q

actual most common allergies in children and adults as taught in the lectures

A
  • peanut in children (is a legume, grows in ground) and tree nut is #2 (grows in trees)
  • shellfish in adult #1 and tree nut #2
102
Q

ddx of child <1 yo with a rash

A
  • VIRAL INFECTION

- milk allergy

103
Q

anaphylaxis definition

A

allergic rxn involving at least 2 systems

104
Q

treatment of anaphylaxis

A

IM epipnephrine

105
Q

GVHD happens when

A

in allogeneic tissue transplant (allogeneic = healthy person to someone with disease).
*most often in HSCT hematopoietic stem cell transplant

106
Q

treatment of GVHD

A

steroids

107
Q

DLBCL (diffuse large B cell lymphoma) treatment (is the tx for non-Hodgkin lymphomas in general)

A

CHOP

  • cyclohosphamide
  • doxorubicin
  • vincristine
  • prednisone
108
Q

Hodgkin’s lymphoma tx

A

ABVD

  • adriamycin (doxorubicin)
  • bleomycin
  • vinblastine
  • dacarbazine

Bloc H - Movement (48 decks)

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