TEST 10-13 Flashcards
What is the difference between ACUTE, SUBACUTE, and CHRONIC LOWER BACK PAIN?
ACUTE12 weeks
What is the management of ACUTE LOWER BACK PAIN?
1) Maintain moderate activity
2) NSAIDs/acetaminiophen
What is the management of CHRONIC LOWER BACK PAIN?
1) Intermittent NSAID/acetaminophen usage
2) Exercise therapy (stretching/strengthening)
Consider: TCA, duloxetine
PHARMACOTHERAPY/non-pharm TX for URGE INCONTINENCE?
PHARMACOTHERAPY/non-pharm TX for OVERFLOW INCONTINENCE?
URGE INCONTINENCE (Increased detrusor) - anti-muscarinic OXYBUTYNIN + bladder training/kegel pelvic floor exercises (=1st line)
OVERFLOW INCONTINENCE (Neurogenic, decreased detrusor) - cholinergic BETHANECHOL +/- INTERMITTENT CATHETERIZATION
What are some of the differences between CHRONIC BRONCHITIS vs CHRONIC BRONCHIECTASIS?
CHRONIC BRONCHIECTASIS
1) MUCOPURULENT SPUTUM: (>100mL sputum = larger volume)
2) Fever/hemoptysis
3) Association w/ infections (PSEUDOMONAS/ ASPERGILLOSIS)
What diagnostic testing is needed for initial diagnosis of CHRONIC BRONCHIECTASIS?
HIGH-RES CT SCAN OF CHEST
AFTER CHRONIC BRONCHIECTASIS is first confirmed by HRCT, what is the next step in management?
After this, what test needs to be done for FOCAL DISEASE? DIFFUSE DISEASE?
SPUTUM CULTURE- Analyze for bacteria and mycobacteria
AFTER sputum culture
1) FOCAL DISEASE: Get BRONCHOSCOPY - Localized airway obstruction
2) DIFFUSE - Congenital disorders/immune dysfn
FEBRILE d/o with PULMONARY (dyspnea/cough) + MUCOCUTANEOUS (papules/nodules) + RETICULONODULAR INFILTRATES on CXR + RETICULOENDOTHELIAL (LAD/HSM) + PANCYTOPENIA/ ELEVATED ALT/LDH in pt in OHIO/MISSOURI
DISSEMINATED HISTOPLASMOSIS
What is the Tx of DISSEMINATED HISTOPLASMOSIS?
1-2wk: SYSTEMIC IV amphotericin B
Post-2wks: ORAL ITRACONAZOLE for >=1yr for maintenance therapy
Which type of dementia characterizes LANGUAGE PROBLEMS (word recall) + VISUOSPATIAL problems (getting lost while driving) BEFORE executive function dysfunction?
ALZHEIMER’S DEMENTIA
Which type of dementia characterizes OCCASIONAL forgetfulness but does NOT interfere with ADL?
NORMAL AGING
Which type of dementia characterizes EXECUTIVE FUNCTION DECLINE after stroke inhibiting ADL + abnormal neuro findings (eg. HEMIPARESIS/PRONATOR DRIFT/ROMBERG SIGN) + early mild memory loss?
VASCULAR DEMENTIA
How is CREUTZFELDT-JAKOB DISEASE diagnosis confirmed?
1) BRAIN BIOPSY - spongiform changes on postpartem brain biopsy
2) Prion protein genetic mutations
What is PSEUDODEMENTIA? (Hint: Correlated with a psychiatric condition)
PSEUDODEMENTIA = Reversible cognitive decline changes associated with MAJOR DEPRESSION DISORDER
What is the Tx of ACUTE CHOLANGITIS?
- SUPPORTIVE CARE
- ANTIBIOTICS (Broad-spectrum): Beta-lactam/beta lactamase inhibitor + 3rd gen CEPHALOSPORIN + METRONIDAZOLE
- BILIARY DRAINAGE - by ERCP with sphincterotomy OR percutaneous trans-hepatic cholangiography
Common side effects of MTX (disease modifying agent for RA) = ?
What can be given as SUPPLEMENTATION to reduce incidence of AE?
HEENT: ORAL ULCERS +
ALOPECIA
LUNGS: PULM toxicity
CBC/BMP: ELEVATED ALT/AST +
BONE MARROW SUPPRESSION (Macro-ovalocytic anemia, leukopenia, thrombocytopenia)
FOLATE SUPPLEMENTATION
Difference between DKA and HHS: (Glc levels, ketones, AG, Sosm)
DKA: Glc 250-500, Ketones +, Elevated AG, Sosm600 (generally 1000), Ketones - , Nl AG, Sosm>320
Lab findings associated with SCHISTIOCYTOSIS:
1) HEMOLYSIS VALUES: Decreased haptoglobin + Increased LDH/bilirubin
2) THROMBOCYTOPENIA
3) HEMOLYTIC ANEMIA
When can one see NEW ONSET RBBB? When can one see NEW ONSET LBBB?
pathology wise
RBBB: pulmonary embolism
LBBB: Acute MI
ELECTRICAL ALTERNANS is fairly specific for “X”
What condition predisposes to developing X?
“X” + JVD/hypotension/muffled heart sounds = Y
X= PERICARDIAL EFFUSION
Often secondary to VIRAL PERICARDITIS
Y= developing CARDIAC TAMPONADE
What do EHRLICHIOSIS and BABESIOSIS have in common? How do you distinguish between them?
(Hint: Pt population + Sx)
Both = THROMBOCYTOPENIA + Mild LEUKOPENIA + do NOT have rash
BABESIOSIS: More common in pts who do NOT have a spleen or immunocompromised +
+ JAUNDICE [elevated ALT/AST]/ HEMOLYTIC SX
EHRLICHIOSIS: NO JAUNDICE/ HEMOLYSIS
Tx of BABESIOSIS = ?
Tx of EHRLICHIOSIS = ?
BABESIOSIS: Atovaquone - Azithromycin OR Quinidine-Clindamycin
ERLICHIOSIS: Doxycycline - EMPIRICALLY treat before confirmatory testing
What is the GOLD STANDARD test when OSA is suspected (daytime somnolence, snoring, morning headaches, poor concentration, restless sleep)?
NOCTURNAL POLYSOMNOGRAPHY
MEGAESOPHAGUS + MEGACOLON +/- CARDIAC DYSFUNCTION = what infectious disease?
CHAGAS DISEASE - protozoa Trypanosoma cruzi
How do you differentiate between LIPOMAs and EPIDERMAL INCLUSION CYSTS?
LIPOMAS - SOFT and rubbery/ do NOT regress and recur
INCLUSION CYSTS - FIRM, freely movable but stable, YES regress and recur (resolves spontaneously)
All probable BPH pts based on history should also get what 2 tests?
1) UA - Assess UTI + hematuria
2) PSA - Screen for prostate cancer
What are the two most common Sx in ALCOHOL WITHDRAWAL pt 12-48hrs after last drink?
1) SINGLE/MULTIPLE TONIC-CLONIC SEIZURES
2) ALCOHOLIC HALLUCINOSIS
What is the most common Sx in ALCOHOL WITHDRAWAL pt 48-96hrs after last drink?
DELIRIUM TREMENS
CN- poisoning can most commonly present in what 2 settings?
How does CN-poisoning present?
COMBUSTION FIRE
NITROPRUSSIDE during HTN EMERGENCY
LACTIC ACIDOSIS + AMS + COMA/SEIZURES
In a HYPERKALEMIC pt, what is the QUICKEST way to LOWER SERUM K+?
Out of 3 options (INSULIN/GLC, BICARB, BETA AGONIST ALBUTEROL) - INSULIN is the quickest
Generally don’t want to use ALBUTEROL in pt with STABLE ANGINA since it will cause TACHYCARDIA/ precipitate angina
In any pt with UNEXPLAINED ELEVATED CREATININE KINASE + MYOPATHY (proximal muscle weakness), what test should always be ordered first?
TSH and free T4 - r/o HYPOTHYROIDISM
SERUM TSH = MOST SENSITIVE TEST to diagnose HYPOthyroidism
**Hyperthyroidism - Myopathy + NORMAL CK, contrast to HYPOthyroidism with ELEVATED CK
Which murmur is best heard in LEFT STERNAL BORDER with pt sitting up/leaning forward/ while holding breath in FULL EXPIRATION?
AR
Holding breath in full expiration - DECREASED PRELOAD/ More volume stays in the systemic circulation during ejection
Ab associated with AUTOIMMUNE HEPATITIS = ?
What is 1st line of Tx?
anti-smooth muscle Ab
ORAL glucocorticoids
With cholestasis, what distinguishes INTRAHEPATIC vs EXTRAHEPATIC cholestasis?
RUQ ABDOMINAL US
INTRA-HEPATIC - No CBD dilation (PBC)
EXTRA-HEPATIC - YES CBD dilation (PSC)
YOUNG PT: Unexplained chronic hepatitis + LOW ceruloplasmin + ELEVATED urinary Ca excretion + KAYSER-FLEISCHER RINGS (greenish-brown deposits around both corneas)
WILSON’S DISEASE or HEPATOLENTICULAR DEGENERATION
What is the most common cause of AORTIC REGURG in YOUNG ADULTS in DEVELOPED countries?
How about in DEVELOPING countries?
DEVELOPED COUNTRIES: BICUSPID AORTIC VALVE
DEVELOPING COUNTRIES: RHEUMATIC HEART DISEASE
Staging of asthma and tx plans:
1) MILD INTERMITTENT - SABA albuterol PRN
2) MILD PERSISTENT - LOW DOSE IHC**
3) MODERATE PERSISTENT (FEV1 between 60 and 80) - LABA
4) SEVERE PERSISTENT (FEV1
HIGH FEVER/CHILLS + TENOSYNOVITIS + POLYARTHRALGIA + PUSTULAR LESIONS (trunk/extremities) in sex worker/risk factor for sex pt = ?
DISSEMINATED GONOCOCCAL INFECTION (N. GONORRHEA) - Blood cultures may be negative due to picky growth requirements of N.gonorrhea
(Need heated chocolate agar + VPN)
Ddx of SPHEROCYTES (multiple small round dense HYPERCHROMIC RBC)
HEREDITARY SPHEROCYTOSIS + G6PD DEFICIENCY + IMMUNE HEMOLYTIC ANEMIA
Differentiate IMMUNE HEMOLYTIC ANEMIA with others by IHA (Coomb test POSITIVE)
What anemia shows ELEVATED MCHC + ELEVATED RDW?
FE DEFICIENCY ANEMIA + HEREDITARY SPHEROCYTOSIS
TYPICAL CLASSIC TRIAD OF HEREDITARY SPHEROCYTOSIS
EXTRAVASCULAR HEMOLYSIS - autoimmune hemolytic anemia + jaundice + splenomegaly
Increased risk for bilirubin gallstones + Parvovirusb19 infn (aplastic crisis)
Maintenance Tx of HEREDITARY SPHEROCYTOSIS = ?
What can help reduce anemia and gallstone risk?
MAINSTAY - BLOOD TRANSFUSIONS + FOLATE SUPPLEMENTATION
SPLENECTOMY - Reduces anemia and gallstone risk