S2 RR_2 Flashcards
Fetal mortality?
Number of deaths from 20 weeks’ gestation to birth per 1000 total births
Perinatal mortality?
Number of deaths from 20 weeks’ gestation to one month of life per 1000 total births
Maternal mortality?
Number of deaths during pregnancy to 90 days postpartum per 100000 live births
True or false: Once patients sign a statement giving consent they must continue treatment.
False. Patients may change their minds at any time. Exceptions to the requirement of informed consent include emergency situations and patients without decision-making capacity
A 15-year-old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?
No. Parental consent is not necessary for the medical treatment of pregnant minors
A doctor refers a patient for an MRI at a facility he/she owns.
Conflict of interest
Involuntary psychiatric hospitalization can be undertaken for which three reasons?
The patient is a danger to self a danger to others or gravely disabled (unable to provide for basic needs)
True or false: Withdrawing life-sustaining care is ethically distinct from withholding sustaining care.
False. Withdrawing and withholding life are the same from an ethical standpoint
When can a physician refuse to continue treating a patient on the grounds of futility?
When there is no rationale for treatment maximal intervention is failing a given intervention has already failed and treatment will not achieve the goals of care
An eight-year-old child is in a serious accident. She requires emergent transfusion but her parents are not present.
Treat immediately. Consent is implied in emergency situations
Conditions in which confidentiality must be overridden.
Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse
Involuntary commitment or isolation for medical treatment may be undertaken for what reason?
When treatment noncompliance represents a serious danger to public health (e.g. active TB)
A 10-year-old child presents in status epilepticus but her parents refuse treatment on religious grounds.
Treat because the disease represents an immediate threat to the child’s life. Then seek a court order
A son asks that his mother not be told about her recently discovered cancer.
A patient’s family cannot require that a doctor withhold information from the patient
Patient presents with sudden onset of severe diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?
Emergent laparotomy to repair perforated viscus likely stomach
The most likely cause of acute lower GI bleed in patients > 40 years old.
Diverticulosis
Diagnostic modality used when ultrasound is equivocal for cholecystitis.
HIDA scan
Sentinel loop on AXR.
Acute pancreatitis
Risk factors for cholelithiasis.
Fat female fertile forty flatulent
Inspiratory arrest during palpation of the RUQ.
Murphy’s sign seen in acute cholecystitis
Identify key organisms causing diarrhea: Most common organism
Campylobacter
Identify key organisms causing diarrhea: Recent antibiotic use
Clostridium difficile
Identify key organisms causing diarrhea: Camping
Giardia
Identify key organisms causing diarrhea: Traveler’s diarrhea
ETEC
Identify key organisms causing diarrhea: Church picnics/mayonnaise
S. aureus
Identify key organisms causing diarrhea: Uncooked hamburgers
E. coli O157:H7
Identify key organisms causing diarrhea: Fried rice
Bacillus cereus
Identify key organisms causing diarrhea: Poultry/eggs
Salmonella
Identify key organisms causing diarrhea: Raw seafood
Vibrio HAV
Identify key organisms causing diarrhea: AIDS
Isospora Cryptosporidium Mycobacterium avium complex (MAC)
Identify key organisms causing diarrhea: Pseudoappendicitis
Yersinia
A 25-year-old Jewish male presents with pain and watery diarrhea after meals. Exam shows fistulas between the bowel and skin and nodular lesions on his tibias.
Crohn’s disease
Inflammatory disease of the colon with inc’d risk of colon cancer.
Ulcerative colitis
Extraintestinal manifestations of IBD.
Uveitis ankylosing spondylitis pyoderma gangrenosum erythema nodosum 1Á sclerosing cholangitis
Medical treatment for IBD.
5-aminosalicylic acid +/- sulfasalazine and steroids during acute exacerbations
Difference between Mallory-Weiss and Boerhaave tears.
Mallory-Weisssuperficial tear in the esophageal mucosa Boerhaavefull-thickness esophageal rupture
Charcot’s triad.
RUQ pain jaundice and fever/chills in the setting of ascending cholangitis
Reynolds’ pentad.
Charcot’s triad plus shock and mental status changes with suppurative ascending cholangitis
Medical treatment for hepatic encephalopathy.
Decrease protein intake lactulose neomycin
First step in the management of a patient with acute GI bleed.
Establish the ABCs
A four-year-old child presents with oliguria petechiae and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?
Hemolytic-uremic syndrome (HUS) due to E. coli O157:H7
Post-HBV exposure treatment.
HBV immunoglobulin
Classic causes of drug-induced hepatitis.
TB medications (INH rifampin pyrazinamide) acetaminophen and tetracycline
A 40-year-old obese female with elevated alkaline phosphatase elevated bilirubin pruritus dark urine and clay-colored stools.
Biliary tract obstruction
Hernia with highest risk of incarcerationindirect direct or femoral?
Femoral hernia
A 50-year-old man with a history of alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. Management?
Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids O2 analgesia and tincture of time
Four causes of microcytic anemia.
TICSThalassemia Iron deficiency anemia of Chronic disease and Sideroblastic anemia
An elderly male with hypochromic microcytic anemia is asymptomatic. Diagnostic tests?
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer
Precipitants of hemolytic crisis in patients with G6PD deficiency.
Sulfonamides antimalarial drugs fava beans
The most common inherited cause of hypercoagulability.
Factor V Leiden mutation
The most common inherited hemolytic anemia.
Hereditary spherocytosis
Diagnostic test for hereditary spherocytosis.
Osmotic fragility test
Pure RBC aplasia.
Diamond-Blackfan anemia
Anemia associated with absent radii and thumbs diffuse hyperpigmentation caf_-au-lait spots microcephaly and pancytopenia.
Fanconi’s anemia
Medications and viruses that worsen aplastic anemia.
Chloramphenicol sulfonamides radiation HIV chemotherapeutic agents hepatitis parvovirus B19 EBV
How to distinguish polycythemia vera from secondary polycythemia.
Both have dec’d hematocrit and RBC mass but polycythemia vera should have normal O2 saturation and low erythropoietin levels
Thrombotic thrombocytopenic purpura (TTP) pentad?
Pentad of TTPFAT RN: Fever Anemia Thrombocytopenia Renal dysfunction Neurologic abnormalities
HUS triad?
Anemia thrombocytopenia and acute renal failure
Treatment for TTP.
Emergent large-volume plasmapheresis corticosteroids antiplatelet drugs
Treatment for idiopathic thrombocytopenic purpura (ITP) in children.
Usually resolves spontaneously; may require IVIG and/or corticosteroids
Which of the following are elevated in DIC: fibrin split products D-dimer fibrinogen platelets and hematocrit.
Fibrin split products and D-dimer are elevated; platelets fibrinogen and hematocrit are dec’d.
An eight-year-old boy presents with hemarthrosis and inc’d PTT with normal PT and bleeding time. Diagnosis? Treatment?
Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements
A 14-year-old girl presents with prolonged bleeding after dental surgery and with menses normal PT normal or inc’d PTT and inc’d bleeding time. Diagnosis? Treatment?
von Willebrand’s disease; treat with desmopressin FFP or cryoprecipitate
A 60-year-old African-American male presents with bone pain. Workup for multiple myeloma might reveal?
Monoclonal gammopathy Bence Jones proteinuria punched-out lesions on x-ray of the skull and long bones
Reed-Sternberg cells
Hodgkin’s lymphoma
A 10-year-old boy presents with fever weight loss and night sweats. Examination shows anterior mediastinal mass. Suspected diagnosis?
Non-Hodgkin’s lymphoma
Microcytic anemia with dec’d serum iron dec’d total iron-binding capacity (TIBC) and normal or inc’d ferritin.
Anemia of chronic disease
Microcytic anemia with dec’d serum iron dec’d ferritin and inc’d TIBC.
Iron deficiency anemia
An 80-year-old man presents with fatigue lymphadenopathy splenomegaly and isolated lymphocytosis. Suspected diagnosis?
Chronic lymphocytic leukemia (CLL)
A late life-threatening complication of chronic myelogenous leukemia (CML).
Blast crisis (fever bone pain splenomegaly pancytopenia)
Auer rods on blood smear.
Acute myelogenous leukemia (AML)
AML subtype associated with DIC.
M3
Electrolyte changes in tumor lysis syndrome.
dec’d Ca2+; inc’d K+ phosphate uric acid
Treatment for AML M3.
Retinoic acid
A 50-year-old male presents with early satiety splenomegaly and bleeding. Cytogenetics show t(922). Diagnosis?
CML
Heinz bodies?
Intracellular inclusions seen in thalassemia G6PD deficiency and postsplenectomy
An autosomal-recessive disorder with a defect in the GPIIbIIIa platelet receptor and dec’d platelet aggregation.
Glanzmann’s thrombasthenia
Virus associated with aplastic anemia in patients with sickle cell anemia.
Parvovirus B19
A 25-year-old African-American male with sickle cell anemia has sudden onset of bone pain. Management of pain crisis?
O2 analgesia hydration and if severe transfusion
A significant cause of morbidity in thalassemia patients. Treatment?
Iron overload; use deferoxamine
The three most common causes of fever of unknown origin (FUO).
Infection cancer and autoimmune disease
Four signs and symptoms of streptococcal pharyngitis.
Fever pharyngeal erythema tonsillar exudate lack of cough
A nonsuppurative complication of streptococcal infection that is not altered by treatment of 1Á infection.
Postinfectious glomerulonephritis
Asplenic patients are particularly susceptible to these organisms.
Encapsulated organisms–pneumococcus meningococcus Haemophilus influenzae Klebsiella
The number of bacterial culture on a clean-catch specimen to diagnose a UTI.
105 bacteria/mL
Which healthy population is susceptible to UTIs?
Pregnant women. Treat this group aggressively because of potential complications
A patient from California or Arizona presents with fever malaise cough and night sweats. Diagnosis? Treatment?
Coccidioidomycosis. Amphotericin B
Nonpainful chancre.
1Á syphilis
A blueberry muffin rash is characteristic of what congenital infection?
Rubella
Meningitis in neonates. Causes? Treatment?
Group B strep E. coli Listeria. Treat with gentamicin and ampicillin
Meningitis in infants. Causes? Treatment?
Pneumococcus meningococcus H. influenzae. Treat with cefotaxime and vancomycin
What should always be done prior to LP?
Check for inc’d ICP; look for papilledema
CSF findings: Low glucose PMN predominance
Bacterial meningitis
CSF findings: Normal glucose lymphocytic predominance
Aseptic (viral) meningitis
CSF findings: Numerous RBCs in serial CSF samples
Subarachnoid hemorrhage (SAH)
CSF findings: inc’d gamma globulins
MS
Initially presents with a pruritic papule with regional lymphadenopathy and evolves into a black eschar after 7-10 days. Treatment?
Cutaneous anthrax. Treat with penicillin G or ciprofloxacin
Findings in 3Á syphilis.
Tabes dorsalis general paresis gummas Argyll Robertson pupil aortitis aortic root aneurysms
Characteristics of 2Á Lyme disease.
Arthralgias migratory polyarthropathies Bell’s palsy myocarditis
Cold agglutinins.
Mycoplasma
