Random Flashcards
Will urine dip be positive in Rhabdomyolysis?
Yes. Myoglobinuria and hemoglobinuria both produce positive urine dip. May cause tea colored urine. Myoglobinuria will have few to no RBC’s
Name benign and pathologic causes for random proteinuria
Benign causes include fever, intense activity or exercise, dehydration, emotional stress and most acute illness. More serious causes include glomerulonephritis and multiple myeloma. Alkaline, dilute or concentrated urine; gross hematuria; and the presence of mucus, semen or white blood cells can cause a dipstick urinalysis to be falsely positive for protein.
But urine dip will not pick up Bence Jones Proteins
Will Bence Jones proteins dip positive in random urine
No, usually not
What are classic symptoms of Rhabdomyolysis
Muscle cramps, aches, or pains that are more severe than expected.
Dark urine (tea- or cola-colored)
Feeling weak or tired, unable to complete job tasks or finish a workout routine.
In treating rhabdomyolosis, what is the goal
Saline infusion with U/O goal of 200-300ml/hr
What diagnosis must be considered in a Sickle Cell Anemia patient with Fever, chills, pleuritic CP and hypoxemia?
Acute chest syndrome
What long term medication should Sickle cell anemia patients take that will help prevent up to 50% of occurrences acute chest syndrome
Hydroxyurea increases total and fetal hemoglobin in children with SCD The increase in fetal hemoglobin retards gelation and sickling of RBCs. It also reduces levels of circulating leukocytes, which decreases the adherence of neutrophils to the vascular endothelium (see image below.) In turn, these effects reduce the incidence of pain episodes [71] and acute chest syndrome episodes.
Does hydroxyurea result in cytogenetic or molecular remissions?
Rarely, but it will result in hematologic remission in 1-2 months
what is the ultimate treatment for a SCD patient who has severe unrelenting episode
exchange tranfusion for Acute infarctive stroke, Severe acute chest syndrome with hypoxemia,
Right upper quadrant syndrome
Priapism that does not resolve after adequate hydration and analgesia
Name 4 diseases caused by Parvovirus B19
Fifths disease (erythema infectiosum), Aplastic anemia in SCD, Anemia in AIDs patients, Hydrops Fetalis
At what core temperature is passive rewarming not effective?
Below 30 degrees, the body does not have enough endogenous heat for passive rewarming like blankets. Must do active rewarming
Best way to rewarm a frostbitten limb
Warm water 37-40 degrees
Are thin or obese individuals more prone to heat stroke?
What about hypothermia?
What about children
Obese
Thin
More likely heat stroke due to less sweating
What is the difference between heat exhaustion and heat stroke?
Heat exhaustion has symptoms and temp <40
Heat stroke has CNS symptoms and temp >40 usually elevated liver enzymes, AKI, Respiratory compromise and metabolic derangements
TORCH
Toxoplasmosis
Other (shingles, parvovirus B19, syphillis
Rubella
Cytomegalovirus
Herpes
TORCH infections may cause miscariage, stillbirth, or intrauterine growth restriction. In addition, they can cause non-specific signs and symptoms in the fetus or infant, such as microcephaly, lethargy, cataracts, hearing loss, and congenital heart diseases.
What is Allergic bronchopulmonary aspergeillosis
Allergic bronchopulmonary aspergillosis (ABPA) is a complex hypersensitivity reaction in response to colonization of the airways with Aspergillus fumigatus that occurs almost exclusively in patients with asthma or cystic fibrosis. Occurs in 1-2% of chronic asthmatics
strongest evidence base for prophylactic migraine therapy, then give other 3 with Strong Recommendation
Amitriptyline
Propranolol, metoprolol, topamax
What type of virus causes herpes zoster
enveloped dbl stranded DNA virus
What type of virus causes herpes zoster
enveloped dbl stranded DNA virus. Tzanck smear positive - multinucleated in the tissue of these lesions
Abx choice for pregnant patient with Group B strep and allergic to PCN
Vancomycin unless previous cultures prove other option is ok like clinda or macrolide
T/F Generalized anxiety disorders are the most common psychiatric disorder of childhood
T
What is perioral dermatitis and how should it be treated.
a common papulopustular eruption, characterized by an acneiform eruption of erythematous papules or papulopustules that appear clustered around perioral, perinasal, or periorbital areas of the face. Stop offending irritant, tetracycline or topical Abx like metronicazole
Lichen planus
Lichen planus is a chronic, inflammatory, autoimmune disease that affects the skin, oral mucosa, genital mucosa, scalp, and nails. Lichen planus lesions are described using the six P’s (planar [flat-topped], purple, polygonal, pruritic, papules, plaques. It is self limited but treat with topical steroids
Primary blood test to verify PCO dx
serum testoserone can help
When should an athlete do static stretching?
after exercise. Dynamic range of motion before
What is a mongolian spot
dermal melanocytosis. Often in sacral area. No tx unless in cosmetically sensitive area then lazer
What is Alpha-thalassemia silent carrier state?
Alpha-thalassemia silent carrier: 3 functional copies of alpha globin, completely asymptomatic or associated with mild microcytosis and hypochromia.
What is Dengue fever
Dengue is a mosquito-borneviral illness found worldwide - sometimes call breakbone fever. Infection may be asymptomatic or present as a mild, self-limited febrile illness in most patients. HA, Rash, fever, joint and muscle pain. leukopenia
A minority of patients may progress to severe disease, which may be characterized as: plasma leakage, potentially progressing to shock, hemorrhage.
severe organ impairment.
90% of sternoclavicular dislocations are …
anterior
What is Auspitz sign
pinpoint bleeding that can occur when the surface of a scaling rash has been removed and capillaries just beneath the skin’s surface rupture.
Brief description of Hip displasia vs LCP vs SCFE
Hip displasia- birth, dislocation, malformation
LCP- 4-10, avascular necrosis, can resolve on own with conservative mgt
SCFE- 10-15, growth plate fractures, obesity, results in avascular necrosis of femoral head, surgical fix
Up to how long after a bee sting can there be a biphasic reaction
48hrs
What is the most common underlying etiology of testicular torsion in adolescents
Bell Clapper deformity- Inappropriately high attachment of the tunica vaginalis
what is the surgical procedure to fix testicular torsion
orchioplexy
Define odds ratio
The odds ratio is a value representing the odds that exposure to a risk factor lead to disease compared to disease occurring without that exposure.
If a trauma patient arrives hypotensive, and after a liter of fluid remains hypotensive, what should be considered?
transfusion
If blood is transfused, more than just a unit or two of blood, in what ration should FFP and platelets be given?
1:1:1
False lumen in aortic dissection may cause a discrepancy in pressure between the upper arms. Which is the pressure to believe
the higher one
first line medical treatment for HTN in aortic dissection
Esmolol
What Immunizations are Live Attenuated?
MMR Varicella, rotavirus, smallpox, yellow fever
Do inactivated vaccines create cellular response
No T cell response, only humoral
Can T cell immunity occur with polysaccharide Immunization ?
No. Only B cell
T cell scan only respond to protein antigens
What cell line does Hodgkin’s lymphoma involve
B Cell lymphoma, genetic change occurs in the lymph node, not bone marrow
What are some signs of autism in a 2 year old
May have delayed speech, upset by loud noises
what rash fluoresces with a wood’s light
erythrasma - superficial gram-positive bacterial infection caused by Corynebacterium minutissimum. The fluorescence is caused by porphyrins. Erythrasma is most often seen between the toe web spaces where it is commonly misdiagnosed as tinea pedis, followed by the rashes in the groin and axillae.
The classic triad of fever, back pain and neurological deficits =
Spinal (not cranial) epidural abscess. The classic triad for the presentation of SEA is fever, back pain and neurological deficits although commonly the presentation is non-specific. Back pain is the most common presenting symptom followed by motor weakness, radicular pain and fever
What is more successful, bariatric surgery or medical treatment for reducing cardiovascular risks factors in obese patients?
Randomized clinical trials have demonstrated that bariatric surgery is superior to medical treatment alone in improving glycemic control and reducing cardiovascular risk factors.
After assessing for benign causes, patients with microscopic hematuria should have what?
CT then cystoscopy
when should a patient that has a BMI greater than 25kg/m2 be screened for prediabetes/diabetes?
In 2021 the U.S. Preventive Services Task Force updated its recommendation for screening for prediabetes and type 2 diabetes and now recommends that any person age 35–70 years of age who has a BMI ≥25 kg/m2 (overweight category or higher) should be screened for these conditions
CO poisoning cause the formation of ?
and does it decrease O2 saturation?
CO poisoning results in the formation of carboxyhemoglobin, which does not carry oxygen. All oxygen-carrying sites are occupied by CO, Oxygen saturation is not effected and usually very high
When should PAP tests start
USPSTF.recommends Papanicolaou testing is recommended starting at 21 years of age. It should be noted that the American Cancer Society recently updated the age at which cervical cancer screening should begin to age 25.
What is the significance of a Virchow’s node
GI malignancy
painless jaundice and a palpable nontender gallbladder (Courvoisier’s sign) suggest….?
Pancreatic Ca
When is the best the best time to get an iron level drawn after overdose
2-4 hours
5 phases of iron toxicity- clinical sx
1 abdominal pain, N/V 2 asympmtomatic (storage in peripheral tissue) 3 acidosis, hypotension, organ injury/failure 4 hepatic necrosis and liver failure 5 can have bowel obstruction where iron sat in GI tract
How is whole bowel irrigation done?
Polyethylene glycol per NGT at 10-15ml/kg /hr up to 2000 ml/hr. Continue until rectal fluid is clear
name two chelation agents and their use
EDTA- chelation of lead
Deferoxamine- chelation of iron (make sure pt is well hydrated as it can cause hypotension
Can you dialyze out iron?
nope
what is listeria and who gets it
Listeriosous is a food borne illness from raw veggies usuall. It can be transmitted transplacentally and dangerous to newborns
Describe N. menigitides
Gram- diplococcus. Is in respiratory microbiome of up to
Describe GBS
Group B Strep can normally colonize female genital tract. Newborns may get it with vaginal birth and usually causes illness in first 7 days of life. Is a common cause of chorioamnionitis
why is rocephin not recommended in newborns less than one month age?
It can displace bilirubin from albumin and have been reports of kernicterus
when should button batteries be removed
if stuck in esophagus, if > 1.5 cm, If stays in stomach too long (debated length of time) if < 6yrs old
5H’s
5T’s
Hyper/hypokalemia, hypovolemia, hydrogen (acidosis), hypoxemia, hypothermia
Tension pneumo, tamponade, toxins, thrombosis (PE, Cadiac)
response to iron therapy best measured by…
checking a reticulocyte count in 1-2 wks
What does the ACC/AHA calculator use for risk factors of CAD
Age, gender, race, total cholesterol, HDL cholesterol, systolic and diastolic bp, diabetes, smoking and whether or not being treated for HTN.
Typical ADL’s
What about IADL’s
Common ADLs include feeding oneself, bathing, dressing, grooming, work, homemaking, cleaning oneself after defecating
Instrumental ADL’s are more complex tasks
describe medicare a,b,c,d
a- Hospital b- outpatient c-medicare advantage (a+b+extras) d- drugs
recommendations for Hep C screening
The US Preventive Services Task Force (USPSTF) today expanded its recommendation for one-time hepatitis C virus (HCV) screening to include all asymptomatic US adults ages 18-79 years
Best single test to screen for celiac disease
immunoglobulin A (IgA) anti-tissue transglutaminase antibody (tTG) is preferred single serologic test in patients of any age (EScCD Strong recommendation, High level of evidence) if patient already on gluten-free diet prior to diagnosis, consider having patient resume normal diet with 3 slices of wheat bread daily for 1-3 months before repeat determination of IgA-TG2
Age for screening of men for AAA
The U.S. Preventive Services Task Force recommends a screening test for men who are ages 65 to 75 and have ever smoked.
What protein is being tested in a urine dipstick
Mostly for albumin. Many things can cause an elevated protein in urine which is benign
What injection may be helpful for muscle spasms associated with anal fissure
Botox- Botulinum toxin
what type of hallucinations with Parkinson’s dx
Visual
Permethrin vs pyrethrum
Permethrin is synthasized and most effective tx for both Head Lice (Nix) 1% shampoo and scabies (elimite) 5% body lotion pyrethrum
Treatment for male pattern baldness for women
2% minoxidil for 6 months
can lyrica (pregabalin) effect sex drive
yes, negatively
what does close contacts mean when deciding who should get Antibiotic prophylaxis when exposed to N. Meningitidis
Close contact with a patient within 7 days before the disease onset, regardless of vaccination status. “Close contact” applies to:
Household members living with a sick person
People who are in intimate contact with the patient
People sleeping in the same bedroom with the patient (students, soldiers, officers)
People who have been in direct contact with secretions from the patient’s respiratory tract during medical procedures, including mouth-to-mouth resuscitation, suctioning, and endotracheal intubation, before or less than 24 hours after antimicrobial therapy was initiated
People traveling with the patient in the same plane, ship, bus, or car for longer than 8 hours
What level of MIC indicates better choice of Abx
A lower MIC value indicates that less drug is required for inhibiting growth of the organism; therefore, drugs with lower MIC scores are more effective antimicrobial agents.
what ingestion is known to have metabolic alkalosis
licorice. Has similar metabolic findings to Addison’s
is viral diarrhea inflammatory?
No, that is primarily due to SSYCE + c.diff. i.e. bacterial
is viral gastroenteritis secretory or osmotic?
Can be both. Injury to the Villa cellular mechanisms decrease absorption and slough of enzymes leaves undigested macronutrients to cause osmotic diarrhea
Don’t get HSP and HUS confused
HUS- typical (3 characteristics Anemia, Thrombocytopenia, AKI) Atypical 5 (add fever, AMS)
HSP- is a vaculitis
Vasculitis always associated with…
inflammation and increased CRP and ESR
Large vessel vasculitis- types
Giant Cell or Temporal arteritis
Takayasu Arteritis
Medium vessel vasculitis- types
Polyarteritis Nodosa- rare multi-system disorder characterized by widespread inflammation, weakening, and damage to small and medium-sized arteries. Blood vessels in any organ or organ system may be affected, including those supplying the kidneys, heart, intestine, nervous system, and/or skeletal muscles. joint and muscle pain, palpable purpura
Kawasaki Disease- CRASH and burn
Kawasaki’s disease
C- conjunctivitis
R- maculopapular rash or morbilliform rash
A- adenopathy, cervical
S- strawberry tongue
H- hands swollen
BURN- fever
How is Kawasaki’s dx treated?
High dose aspirin and IVIG
Small vessel vaculitis -types
Divide into two groups. Non Immune Complex (+ANCA) vs Immune Complex
HSP- Henoch-Schonlen purpura- describe
Henoch–Schönlein purpura (HSP) is defined as a vasculitis with immunoglobulin (Ig)A-dominant immune deposits affecting small vessels and typically involving the skin, gut, and glomeruli and associated with arthralgias or arthritis [1]. It is the most common childhood primary systemic vasculitis. Most often treat symptomatically
Wernike vs Korsakoff syndrome
Wernicke encephalopathy causes brain damage in lower parts of the brain called the thalamus and hypothalamus. Korsakoff syndrome results from permanent damage to areas of the brain involved with memory.Feb
USPSTF recommendations Osteoporosis
All postmenopausal women over 65 get screened. If at risk for osteoporosis and postmenopausal before 65
describe 2 types of muscular dystrophy
Duchenne- x-linked. Duchenne muscular dystrophy is a severe, progressive, muscle-wasting disease that leads to difficulties with movement and, eventually, to the need for assisted ventilation and premature death. The disease is caused by mutations in DMD (encoding dystrophin) that abolish the production of dystrophin in muscle.
Becker’s also x-linked recessive, more mild
ACID -acronym for hypersensitivity reactions
A- Acute or immediate, Type I, IgE meditated, Anaph
C- Cytotoxic, IgG/IgM attach to tissue and destroyed.
Think Myasthenia Gravis, Grave’s dx Autoimmune
I- Immune complex, Think PostSGN, Lupus, Serum Sick
D- Delayed. T-cell and Macrophage Think Contact
Derm, TB test
