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Step 2 Internal Medicine > Test 23 - IM > Flashcards

Test 23 - IM Flashcards

1
Q

Empiric antibiotic regimen for suspected meningitis in uncomplicated patient between 2-50 yrs

A

Vancomycin (strong gram +)

3rd Gen Ceph (cefepime, ceftriaxone) (strong gram -)

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2
Q

Bugs worried about for suspected meningitis in uncomplicated patient between 2-50 yrs

A

N. meningitidis

S. pneumo

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3
Q

Empiric antibiotic regimen for suspected meningitis in uncomplicated patient over 50 yrs

A

Vancomycin (strong gram +)
Ampicillin (for listeria mono)
3rd Gen Ceph (cefepime, ceftriaxone) (strong gram -)

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4
Q

Bugs worried about for suspected meningitis in uncomplicated patient over 50 yrs

A

N. meningitidis
S. pneumo
Listeria monocytogenes

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5
Q

Empiric antibiotic regimen for suspected meningitis in neurosurgery patient

A

Vancomycin (strong gram +)

3rd Gen Ceph (cefepime, ceftriaxone) (strong gram -)

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6
Q

Bugs worried about for suspected meningitis in neurosurgery patient

A

Gram Negative Rods
S. Aureus
Coagulase Negative Staph

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7
Q

Empiric antibiotic regimen for suspected meningitis in immunocompromised patient

A

Vancomycin (strong gram +)
3rd Gen Ceph (cefepime, ceftriaxone) (strong gram -)
Ampicillin (for listeria mono)

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8
Q

Bugs worried about for suspected meningitis in immunocompromised patient

A

N. meningitidis
S. pneumo
Listeria mono
gram neg rods

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9
Q

Empiric antibiotic regimen for suspected meningitis in patient w/ penetrating trauma to the skull

A

Gram Negative Rods
S. Aureus
Coagulase Negative Staph

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10
Q

Bugs worried about for suspected meningitis in patient w/ penetrating trauma to the skull

A

Vancomycin (strong gram +)

3rd Gen Ceph (cefepime, ceftriaxone) (strong gram -)

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11
Q

Diagnostic criteria for RLS (Restless Leg Syndrome)

A
  1. Urge to move legs -AND-
  2. One of the following
    -unpleasant sensation in the legs that worsens with inactivity
    -unpleasant sensation in the legs relieved by movement
    unpleasant sensation in the legs that worsens at night
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12
Q

When considering RLS, have to rule out: (6)

A 
Iron-deficiency anemia
uremia
DM
MS, Parkinsons
Pregnancy
Drugs (antidepressants, metoclopramide)
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13
Q

Treatment mild/ intermittent RLS

A
  1. Iron supplementation if ferritin is less than 75 ug/L
  2. Supportive trt (massage, heat pad, exercise)
  3. Avoid aggravating factors (sleep deprivation, drugs)
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14
Q

Treatment severe/ persistant RLS

A

1st line: Dopamine agonists

Alt: Alpha-2-delta calcium channel ligands (ie gabapentin)

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15
Q

What is essential mixed cryoglobinemia?

A

MOA: circulating immune complexes that deposit in small to medium vessels and may be associated with low serum complement levels.
Symptoms: palpable purpurae, arthalgias and weakness or weight loss.
Labs: larger INR (takes longer to clot)

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16
Q

Extrahepatic manifestations of Hep C

A

Heme: essential mixed cryoglobinemia
Renal: Membranoproliferative GM
Skin: Porphyria cutanea tarda, lichen planus
Endocrine: Increased risk of diabetes

17
Q

Clinical presenation of Hep C

A
  • Fatigue
  • Non-specific symtoms ( nausea, anorexia, myalgia, arthralgia, weakness, weight loss)
  • Serum transaminases elevated 1/3 of time
  • can progress to cirrhosis 20% of the time
  • increased risk of hepatocellular carcinoma
18
Q

What is porphyria cutaneous tarda?

A

Fragile skin, photosensitivity, vesicles and erosions on the dorsum of hand. Strongly correlated with HCV. If they have PCT they should be screened for HCV.

19
Q

What is the glucocorticoid’s effect on blood cells?

A
  • decrease eosinophils and lymphocytes

- increase neutrophil count by increasing bone marrow release and mobilizing the marginated neutrophil pool

20
Q

Uthoff phenomenon

A

worsening of MS symptoms with heat

21
Q

Lhermitte’s sign

A

Electric shock sensation down the spine or limbs when the neck is flexed. Seen in MS.

22
Q

Diagnosis of MS

A
  1. ) T2 MRI showing the presence of cerebral and spinal plaques that are made up of clusters of demyelinated axons worsening over time.
  2. ) Lumbar puncture shows oligoclonal IgG bands in the CSF found in 95% of cases.
23
Q

Presenting symptoms of MS

A

2 or more flare ups of:

  • optic neuritis (painful loss of vision)
  • diplopia
  • sensory deficits
  • motor weakness
  • bowel and bladder dysfunction

cognitive deficits and depression are also often seen with MS

Step 2 Internal Medicine (14 decks)

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