SmartyPance Q's Flashcards
treatment for acute prostatitis
FQ’s or TMP-SMX for 4-6 weeks
s/s of Rickettsia?
fever, chills, headache, rash
rash develops 2-4 days after fever begins
what disease is caused by Rickettsia rickettsii?
Rocky Mountain Spotted Fever
s/s of acute glacoma
acutely painful eye elevated intraocular pressure acute eye pain w/ unilateral headache n/v cloudy vision colored rings around lights
Acute glaucoma is an ocular emergency that presents as an acutely painful eye and elevated intraocular pressure. Patients typically complain of acute eye pain associated with unilateral headache, nausea/vomiting, cloudy vision, and colored rings around lights. On exam the pupil is fixed and mid dilated with prominent ciliary flush.
thin frothy/bubbly pale yellow-green to gray vaginal discharge,
may have petechiae on cervix,
amine odor may be present
pH 5-6.5
trichomonas vaginitis
A football player complains of burning pain, numbness, and tingling extending from the left shoulder down into the hand after he tackled a player. These symptoms resolved spontaneously in minutes. Following resolution of the symptoms, he has full strength and normal sensation in the left arm. What is the most likely etiology of his symptoms?
stretching of nerve roots and brachial plexus
Brachial plexus neurapraxia, commonly called “stinger” injuries, results from stretching of the cervical nerve roots and brachial plexus by a mechanism such as that described in this question.
best imaging for subarachnoid hemorrhage (pt presents with “worst headache of her life”)
CT scan
A 68 year-old male with history of COPD is brought to the emergency department following a motor vehicle collision. On physical examination there is evidence of head trauma. The left side of the chest wall appears to move inward with inspiration and outward with expiration. A chest x-ray reveals multiple rib fractures on the left. Which of the following is the most appropriate intervention?
endotracheal intubation and mechanical ventilation
Indications for early endotracheal intubation and mechanical ventilation in treatment of flail chest include patients that are over the age of 65, have comorbid lung disease and associated severe head trauma. Other indications include shock, three or more associated injuries and fracture of eight or more ribs.
In a patient with amaurosis fugax what is the most appropriate initial diagnostic study?
carotid ultrasound
amaurosis fugax usually = atherosclerotic plaque in carotid artery, i.d.’d with u/s
In the treatment of alcohol-related hypoglycemia, thiamine is administered before glucose to prevent which of the following?
Wernicke’s encephalopathy
Alcoholics are typically deficient in thiamine. If glucose alone is given to treat hypoglycemia, Wernicke’s encephalopathy can be precipitated since thiamine is not available for nutritional purposes when glucose is replaced. Therefore, thiamine is always given prior to glucose until a satisfactory diet can be given in order to prevent Wernicke’s encephalopathy.
A 3-year-old boy is seen in the office with a 5-day history of fever, erythema, edema of the hands and feet, a generalized rash over the body, bilateral conjunctival injections, fissuring and erythema of the lips, and cervical adenopathy. Antistreptolysin O (ASO) titer and throat culture are negative. The most serious systemic complication associated with this disorder is
cardiac
The patient most likely has Kawasaki syndrome. The major complication with this disorder is coronary artery aneurysms, which are reported in up to 20% of affected children. The etiology of this disorder is uncertain, although a bacterial toxin with super antigen properties may be involved.
pharyngitis pt with small grayish vesicles and punched-out ulcers probably has which virus?
coxsackievirus
Coxsackievirus presents with small grayish vesicles and punched-out ulcers in the posterior pharynx.
primary sign of Tetralogy of Fallot
cyanosis (progressing cyanosis)
Which of the following drugs is first-line therapy for schizophrenia?
chlorpromazine (thorazine)
clozapine (clozaril)
haloperidol (haldol)
olanzapine (Zyprexa)
Olanzapine (Zyprexa)
Initial pharmacologic therapy of schizophrenia should begin with one of the newer, “atypical” antipsychotic drugs, such as olanzapine, risperidone, quetiapine, and ziprasidone because their side effect profile is significantly better than the older drugs, and they may be more effective for negative psychotic symptoms.
a fracture of the proximal ulna with anterior dislocation of the radial head.
Monteggia fracture
A 20-year-old male presents with a mass in the groin. On examination with the patient standing, a mass is noted that extends into the scrotum. The patient denies any trauma. The most likely diagnosis is
a) an indirect inguinal hernia
b) direct inguinal hernia
c) obturator hernia
d) femoral hernia
indirect inguinal hernia
An indirect inguinal hernia is caused by a patent processus vaginalis and the hernial contents may be felt in the ipsilateral scrotum.
A 28-year-old female, who has experienced occasional painful migratory arthralgias, complains now of a tender, swollen, and hot left ankle. The joint was aspirated and the synovial fluid showed 55,000 WBCs, 75% polymorphonuclear leukocytes, low glucose level, and no crystals. Which of the following would be the most likely diagnosis?
a) RA
b) septic arthritis
c) gouty arthritis
d) osteoarthritis
septic arthritis
Septic arthritis presents with a large number of WBCs, predominantly polymorphonuclear, and with glucose levels much lower than serum levels.
use of systemic corticosteroids can cause what adverse effect in the eye?
glaucoma
Acute rebound hypertensive episodes have been reported to occur with the sudden withdrawal of
a) verapamil
b) lisinopril
c) clonidine
d) HCTZ
clonidine
Clonidine (Catapres) is a central alpha agonist and abrupt withdrawal may produce a rebound hypertensive crisis.
A 72-year-old female presents with vulvar pruritus for the last nine months, which has progressively worsened over the last two months. She states that she went through menopause at age 54 and has been on estrogen and progesterone therapy since that time. Physical examination reveals red lesions with white plaques on the vulva. What should the next course of management include?
refer to a gynecologist for biopsy
Vulvar squamous cell hyperplasia causes thickening and hyperkeratosis of the vulva. The lesions are red and moist and cause intense pruritus over time the area becomes thickened and a white plaque may develop. Biopsy must be done to evaluate for intraepithelial neoplasm or invasive tumor.
The most common causes of transudative pleural effusions in the United States
heart failure
and
cirrhosis
The finding of egophony is most consistent with
lobar pneumonia
Egophony occurs with consolidation caused by lobar pneumonia
A patient presents with edema, which is most noticeable in the hands and face. Laboratory findings include proteinuria, hypoalbuminemia, and hyperlipidemia. The most likely diagnosis is
nephrotic syndrome
Proteinuria, hyperlipidemia, and hypoalbuminemia are consistent with nephrotic syndrome.
Which of the following can be used to treat chronic bacterial prostatitis?
penicillin
cephalexin
nitrofurantoin
levofloxacin
levofloxacin
Chronic bacterial prostatitis (Type II prostatitis) can be difficult to treat and requires the use of fluoroquinolones or trimethoprim-sulfamethoxazole, both of which penetrate the prostate.
A 25-year-old male with a history of syncope presents for evaluation. The patient admits to intermittent episodes of rapid heart beating that resolve spontaneously. 12 Lead EKG shows delta waves and a short PR interval. Which of the following is the treatment of choice in this patient?
radiofrequency catheter ablation
Radiofrequency catheter ablation is the treatment of choice on patients with accessory pathways, such as Wolff-Parkinson-White Syndrome.
Gallstones usually result in biliary symptoms by causing inflammation or obstruction following migration into the common bile duct or
cystic duct
Obstruction of the cystic duct by gallstones causes the typical symptom of biliary colic. Once obstructed the gallbladder distends and becomes edematous and inflamed. Gallstones can also migrate into the common bile duct through the cystic duct leading to a condition known as choledocholithiasis.
An elderly patient with poorly-controlled Type 2 diabetes and renal disease develops a fever of 102°F orally, productive cough, and dyspnea. Physical examination demonstrates a respiratory rate of 32/min, labored breathing, and rales at the left base. Pulse oximetry is 90%. Which of the following is the next appropriate step in the management of this patient?
a) administer nebulized corticosteroids
b) admit to hospital
c) oral antimicrobial therapy
d) endotracheal intubation
ADMIT TO HOSPITAL
Community acquired pneumonia is the most deadly infectious disease in the U.S. Important risk factors for increased morbidity and mortality include advanced age, alcoholism, comorbid medical conditions, altered mental status, respiratory rate greater than 30 breaths/min, hypotension, and a BUN greater than 30.
An 80-year-old female presents with pain in her vertebral column. Radiography reveals compression fracture of T12 that is consistent with an osteoporotic compression fracture. Which treatment modality has the potential to cause analgesia of the fracture site with its use?
Calcitonin (Miacalcin) nasal spray
Calcitonin has the ability to cause analgesia when used for acute compression fracture of the vertebral body.
A 29-year-old patient with idiopathic thrombocytopenia purpura (ITP) is treated with prednisone therapy. Despite therapy, platelet counts remain consistently below 20,000/microliter over the course of 6 weeks. Which of the following is the most appropriate intervention for this patient?
splenectomy
Persistently low platelet counts (less than 20,000) require effective long-term treatment, and splenectomy is the treatment of choice.
A 57-year-old male was working on his farm when some manure was slung hitting his left eye. He presents several days after with a red, tearing, painful eye. Fluorescein stain reveals uptake over the cornea looking like a shallow crater. Which of the following interventions would be harmful?
a) ophthalmic antibiotics
b) pressure patch
c) exam for visual acuity
d) copious irrigation
b) pressure patch
Patching of the eye after abrasion associated with organic material contamination is contraindicated due to increased risk of fungal infection.
Which of the following physical examination findings would be consistent with a pleural effusion?
hyperresonance to percussion
increased tactile fremitus
unilateral lag on chest expansion
egophony
unilateral lag on chest expansion
A lag on chest expansion may be seen in the presence of a pleural effusion.
(The presence of egophony would be consistent with a consolidation.)
A 53-year-old male is seen in the emergency department following a motor vehicle collision in which his knee impacted against the dashboard. The patient has a posterior knee dislocation that is promptly reduced in the emergency department. The patient currently has a palpable pulse in the dorsalis pedis and posterior tibial areas. Which of the following studies is mandatory?
a) anterior plain film of knee
b) sunrise view of knee
c) measurement of compartment pressures
d) angiography
ANGIOGRAPHY
The popliteal artery is at risk for injury whenever a patient sustains a posterior dislocation of the knee and should be evaluated with an arteriogram despite the presence of pedal pulses.
A 70-year-old presents with headache and neck stiffness. On physical exam, the patient is febrile, Kernig’s sign is present, and no rash is noted. A spinal tap reveals a white count of 250/cm3 with 100% neutrophils, total protein 250 mg/dL, and glucose 35 mg/dL. Which of the following is the most appropriate treatment?
AMPICILLIN AND CEFTRIAXONE (ROCEPHIN)
Ampicillin and ceftriaxone is used to treat bacterial meningitis, secondary to Listeria monocytogenes , which is common in the elderly. Ceftriaxone will cover other common etiologic agents such as Streptococcal pneumonia.
A 62-year-old male presents with complaints of vague epigastric abdominal pain associated with jaundice and generalized pruritus. Physical examination reveals jaundice and a palpable non-tender gallbladder, but is otherwise unremarkable. Which of the following is the most likely diagnosis?
a) viral hepatitis
b) pancreatic cancer
c) acute cholecystitis
d) Gilbert’s syndrome
PANCREATIC CANCER
Pancreatic cancer is suggested by the vague epigastric pain with the jaundice resulting from biliary obstruction due to cancer involving the pancreatic head. The presence of a palpable non-tender gallbladder (Courvoisier’s sign) also indicates obstruction due to the cancer.
Which of the following rotator cuff tendons is most likely to sustain injury because of its repeated impingement (impingement syndrome) between the humeral head and the undersurface of the anterior third of the acromion and coracoacromial ligament?
a) supraspinatus
b) infraspinatus
c) teres minor
d) subscapularis
SUPRASPINATUS
A critical zone exists for the supraspinatus tendon due to its superior insertion site. It is susceptible for injury because it has a reduction in its blood supply that occurs with abduction of the arm. Impingement of the shoulder is most commonly seen with the supraspinatus tendon, the long head of the biceps tendon and/or the subacromial bursa.
A 75-year-old woman presents to the office with complaint of vision loss. Examination reveals a palpable cord in the temporal region. Which of the following is the most helpful initial test to order on this patient?
a) carotid u/s
b) chest xray
c) complete blood count
d) ESR
ESR
The patient is suspected of having temporal arteritis. This disease is most commonly noted in patients over age 50 and should be suspected in patients with sudden vision loss and a palpable cord in the temporal region. Erythrocyte sedimentation rate is almost always increased in this disease.
A 33-year-old male presents to your office with a complaint of right knee injury associated with pain and swelling. He states he was running after his loose dog and suddenly stopped, hyperextended his knee, heard a pop and noticed immediate swelling. On physical examination, the Lachman test and anterior drawer test demonstrates joint laxity. Which ligament is most likely injured?
ANTERIOR CRUCIATE LIGAMENT
Anterior cruciate ligament injuries occur with sudden deceleration injuries. Patients often hear a pop and the diagnosis is aided by assessing the anterior drawer test and Lachman test. The immediate swelling as well as laxity with anterior drawer test and Lachman test should raise suspicion of anterior cruciate ligament injury.
hematuria, cola-colored urine, oliguria, and edema of the face and eyes in the morning
glomerulonephritis
Glomerulonephritis presents with hematuria, cola-colored urine, oliguria, and edema of the face and eyes in the morning. Urinalysis reveals red blood cells, mild proteinuria and red blood cell casts. Glomerulonephritis can occur 1-3 weeks after a strep infection.
A 25-year-old male presents to the emergency department for evaluation of a wound on his hand. He cut his hand while tearing down a chicken coop. On examination of his right hand you note a dirty 3 cm jagged laceration. The patient is unaware of his tetanus immunization status. Besides cleaning and debriding the wound, what is the recommended clinical intervention in this patient?
ADMINISTER TETANUS-DIPTHERIA TOXOID (Td) AND TETANUS IMMUNE GLOBULIN (TIG)
Td or Tdap with TIG is recommended as tetanus prophylaxis in a patient with a contaminated wound and unknown tetanus vaccination status.
A 57-year-old male recently on a high protein diet presents with an exquisitely tender, erythematous, warm right great toe. What is the treatment of choice for this patient?
NSAIDs
Nonsteroidal antiinflammatory drugs (NSAIDs) are the drugs of first choice in most settings. There is no evidence that one NSAID is superior to another in the treatment of gout. Systemic corticosteroid therapy can be used for patients with acute polyarticular gout who have not responded to other therapies as well as for patients in whom other therapies are contraindicated. Intra articular injections of corticosteroid medication are usually effective in patients with acute monoarticular gout.
Which of the following is a cause of acute kidney failure due to prerenal azotemia?
excessive diuresis
urinary tract obstruction
radiologic contract media
aminoglycosides
EXCESSIVE DIURESIS
Prerenal azotemia is due to renal hypoperfusion which can occur with intravascular volume depletion such as excessive diuresis, hemorrhage, and gastrointestinal losses.
A 49-year-old female presents complaining of several episodes of chest pain recently. Initial ECG in the emergency department shows no acute changes. Two hours later, while the patient was having pain, repeat electrocardiogram revealed ST segment elevation in leads II, III, and AVF. Cardiac catheterization shows no significant obstruction of the coronary arteries. What is the treatment of choice in this patient?
NIFEDIPINE
This patient is most likely having coronary artery spasm. This can be treated prophylactically with calcium channel blockers such as nifedipine.
what is the gross rupture of membranes in the presence of cervical dilation?
inevitable abortion
characteristic of threatened abortion
bleeding in the first trimester without loss of fluid or tissue
describe incomplete abortion
Incomplete abortion is when the cervical os is open and allows passage of blood. The products of conception may remain in utero or may partially extrude through the open os.
A 50-year-old male with history of alcohol abuse presents with complaint of worsening dyspnea. Physical examination reveals bibasilar rales, elevated jugular venous pressure, an S3 and lower extremity edema. Chest x-ray reveals pulmonary congestion and cardiomegaly. Electrocardiogram shows frequent ventricular ectopy. Echocardiogram shows left ventricular dilatation and an ejection fraction of 30%. Which of the following is the most likely diagnosis in this patient?
hypertrophic cardiomyopathy
dilated cardiomyopathy
restrictive cardiomyopathy
Takotsubo cardiomyopathy
DILATED CARDIOMYOPATHY
Dilated cardiomyopathy is often caused by chronic alcohol use. It is characterized by signs and symptoms of left-sided heart failure, a dilated left ventricle and decreased ejection fraction.
