Test Flashcards
TB effusions breakdown?
EXUDATIVE
- High protein levels (>4)
- Lymphocytic leukocytosis
- Low glucose levels (500)
- low pH
Empyema has high amount of what type of cells in effusion fluid?
neutrophils
reactive nonstress test (pregnancy)
- baseline fetal HR 110-160
- Mod variability (6-25/min)
- > =2 acceleration in 20 min each peaking >-15/min above baseline and lasting >=15 sec
HSV encephalitis findings in CSF?
- lymphocytic predominance
- WBC elevated, but not severely
- inc protein
- elevated RBC count (high)
- nL glucose
Acute bacterial meningitis CSF pattern?
- HIGH WBCs (1000s)
- Neutrophil predominence
- low glucose
- elevated protein
Chronic bacterial meningitis (ie TB) CSF findings?
- inc WBCs (100s)
- Lymphocytic predominence
- Very low glucose
- inc protein
neurogenic claudication is?
low extremity pain w/ extension of spine (walking, prolonged standing, etc)
neurogenic claudication (pseudoclaudication) - think?
spinal stenosis
pain on walking and prolonged standing w/ relief w/ leaning forward or walking up hill, think?
spinal stenosis
ACTH is what type of molecule
polypeptide
Calcitrol is what type of molecule?
Sterol vitamin
Cortisol is what type of molecule
steroid hormone
name some arachidonic acid derivatives?
- leukotrienes
- prostaglandins
AA derived hormone examples?
- serotonin
- NE
- Epi
amniotomy is aka?
artificial rupture of membranes
> =2 on CHADVASC w/ afib treat how?
oral anticoagulants
1 on CHADVASC w/ afib treat how?
none, aspirin, or oral anticoagulants – discretionary
prophylaxis against MAC for CD4
Azithromycin
headache worse when leaning forward - think?
SVC syndrome
facial and upper extremity swelling, JVD, no peripheral edema, headache worse when leaning foward - think?
SVC syndrome
most common cause of SVC syndrome?
malignancy (lung or lymphoma)
Primary treatment for malignancy related SVC syndrome?
radiation therapy
concern for aspiration pna do what?
- diet modification
- elevated head of bed
- jejunal feeding can dec aspiration risk, but others (NG tube, PEG actually INC risk of aspiration)
greater than 250 neutrophils in ascitic fluid is?
Spontaneous bacterial peritonitis
subepidermal cleavage is?
bullous pemphigoid
intraepidermal clevage is?
pemphigus vulgaris
+acantholysis
neurodermatitis?
skin picking disorder
Ab against hemisdesmosomes?
bullous pemphigoid
Ab against desmosomes?
–> acantholysis
Pemphigus vulgaris
treatment of bullous pemphigoid?
high potency topical glucocorticoids
brain mets look like what on MRI?
peripheral, circumscribed, enhancing lesions w/ vasogenic edema surrouding
tension pneumothorax cardiovascular effect?
HypOtension due inc intrathoracic pressure –> DEC Venous return
evidence of denervation think what type of gen neuro disease?
LMN disease
m. atrophy, fasciculations
hyperreactive reflexes, UMN or LMN?
UMN
muscle atrophy, UMN or LMN?
LMN
complex seizures involve?
loss of consciousness
partial seixure involve
seizure activity w/in focal area of brain
Initial treatment for stable monomorphic V tach?
Loading dose of IV Amiodarone
adenosine used to treat what cardiac issue?
Supraventricular tachycardia
Pt w/ chest pain, hematemesis, SOB, L pleural effusion, post esophageal procedure – think?
esophageal rupture
Associated w/ esophageal rupture (2)?
- pleural effusion (esp L)
- Pneumomediastinum –> mediastinitis
chronic pancreatitis usually due to?
alcoholism
simple non invasive test for Peripheral vascular disease?
Ankle brachial Index
1 - 1.3 = nL
0.4 - 0.9 = PVD
pts w/ strep gallolyticus endocarditis should also have what done?
Colonoscopy
strep gallolyticus infx inc risk for what two things?
- endocarditis
- colorectal cancer
most common organisms that can cause epiglottitis in adults (esp unvax)?
Hib
Step pyogenes
rupture of maternal dcidual vessels –>?
placental abruption
vaginal bleeding + hypertonic, distended, tender uterus – think?
placental abruption
substances that inc risk of placental abruption?
cocaine
tobacco
painless vaginal bleeding after ROM - think?
vasa previa
painful 3rd trimester bleeding?
- placental abruption
- uterine rupture
painless 3rd trimester bleeding?
- vasa previa
- placenta previa
risky sex –> papule –> painless ulceration w/ painless inguinal denopathy – think?
syphilis
painful ulcer + painful lymphadenopathy - think?
Chancroid (h. ducreyi)
painless genital ulcer w/ red, beefy base and NO adenopathy - think?
Granuloma inguinale (Klebsiella caused)
differences b/t granuloma inguinale and syphilis caused chancre?
S: adenopathy & ulcer will resolve on own w/o treatment (moving to 2nd stage of syphilis)
GI: NO adenopathy, will NOT resolve w/o abx
recurrent sinopulmonary and GI infx beginning after 6mo w/ small tonsils suggests?
X-linked agammaglobulinemia (Bruton’s)
x-linked aggamaglobulinemia due to? causes?
defect in tyrosine kinase –> prevents dev of mature B cells
–> dec immunoglobulins and B cells (nL T cells) & NO response to vax
treatment of x-linked agammaglobulinemia?
monthly IVIG
+/- prohylactic abx (only if IVIG not protective enough)
what vaccines are contraindicated in x-linked agammaglobulinemia?
LIVE vax
can give others, but won’t generate meaningul Ab response
which bugs associated w/ complement deficiencies?
disseminated bacterial infx particularly w/ ENCAPSULATED bacteria (ie strep pneumo, neisseria)
which ingx associated w/ CGD?
recurrent skina nd pulm infx w/ CATALASE-positive org (staph, serratia, etc)
adenosine deaminase deficiency effects what cells?
impaires T cell dev –> SCID
most common predisposing factor for acute bacterial sinusistis?
Viral upper respiratory infx
First line treatment for acute bacterial sinusisits?
Amoxicillin w. clavulanic acid
low PCWP, low RA pressure, inc SVR, and low mixed oxygen venous sat – what type of shock?
Hypovolemic
inc RA pressure, inc PCWP, inc SVR, dec mixed venous osxygen sat - what type of shock?
cardiogenic
slight dec RA pressure and PCWP, dec SVR, inc mixed venous oxygen sat - what type of shock?
Septic shock
nL avg RA pressure?
4mm Hg
nl avg PCWP pressure?
9mm Hg
RA pressure and PCWP pressure can indicate what overall vascular situation?
preload
SVR indicates what greater vascular situation?
afterload
most common bacterial infx for kids w/ CF?
staph aureus! (20)
First line antiHTN meds in pregnancy?
- Beta blocker (labetalol)
- Methyldopa
- Hydralazine
*Calcium channel blockers (nifedipine) – other 3 more common
contradindicated HTN meds in pregnancy?
- ACE inhibitors
- ARBs
- Aldosterone blockers
- Furosemide
- Direct renin inhibitors (aliskiren)
most common septic arthritis organisms birth - 3mo old?
- staph
- GBS
- Gram neg bacilli
abx for septic arthritis birth - 3mo old?
- antistaph agent (ie nafcillin or vanco)
AND - Gentamicin or cefotaxime (cover for gram negs)
Most common septic arthritis organisms >3mo?
- staph
- strep A
- Strep pneumo
abx for septic arthritis >3mo?
Nafcillin clinda, cefazolin, or vanco
gradual loss resulting in tunnel vision think?
open angle glaucoma
cupping of optic disc - think?
open angle glaucoma
retinal detachment presents how?
unilateral blurred vision that progressively worsens
retina hanging in vitreous w/ unilateral blurred vision that has progressively been worsening?
retinal detachment
macular degeneration effects where in the vision?
central vision
distorted vision and central scotoma - think?
macular degernation
multiple sores in macular region w/ central scotoma?
atrophic macular degernation
new blood vessels in retina that are bleeding or scarring the retina w/ central scotoma think?
exudative macular degeneration
sudden, unilateral visual impairement usually noted upon waking in the morning - think?
Central retinal vein occlusion
disc swelling, venous dilation and tortuiosity, retinal hemorrhages, and cotton wool spots - think?
central retinal vein occlusion
microaneurysms, hemorrhages, exudates, and retinal or macular edema - think?
simple retinopathy
microaneurysms, hemmorrhages, macular edema, w/ cotton wool spots think?
preprolierative retinopathy
microaneurysms, hemorrhages, macular edema, exudates w/ newly formed vessels think?
proliferative or malignant retinopathy
n/v, abd pain, diffuse muscle aches w/ dilated pupils, yawning, piloerections, and lacrimation - think?
heroin withdrawal
inc appetite, hypersomnia, fatigued, irritable, severe depression - think?
stimulant withdrawal
(ie cocaine, meth)
epigastric pain w/ high BMI, ALT >150 and elevated alk phos – think?
gallstone pancreatitis
hydrocele?
fluid collection w/in processus or tunica vaginalis
communicating vs non communicating hydrocele?
diff is whethere procesus vaginalis has obliterated or not
comm: PV NOT obliterated (so fluid can communicate w/ peritoneal fluid still - still a track there)
non comm: PV obliterated (canNOT communicate b/c no track, so just a fluid collection)
mass transilluminates in scrotum think?
hydrocele
treatment of hydrocele in infant?
reassure and observe, most will sponaneously resolve by 1yo
communicating hydrocele at 18 mo - treat?
surgical repair
communicating hydroceles that persist beyond 12mo of age are unlike to self resolve and –> inc risk of indirect inguinal hernia
1 episode of MDD that responds to acute treatment - how long due you treat for?
continue antidepressent for 4-9 months (continuation phase)
When do you choose maintenance phase for depression treatment and how long is it?
Maintenance treatment is 1-3 yrs on stable regimen
For:
- recurrent MDD (multi epi)
- chronic epi (>=2yrs)
- strong fam hx
- severe epi (ie suicide attempt)
when do you keep pts on antidepressants indefinitely?
Pt w/ hx of highly reccurent (>= 3 epi)
very severe, chronic maj depressive episodes (last a long time w/ severe symp - ie suicide attempt)
diff dx for t wave inversion? (5)
- MI
- Myocarditis
- Old pericarditis
- Myocardial contusion
- Digoxin toxcitiy
best treatment for acute low back pain likely due to disk herniation?
early mobilization and NSAIDs
- get back to daily activities ASAP
what type of gait in parkinson’s disease?
hypokinetic w. narrow base and stooped posture w/ short steps that cause shuffling
waddling gait –?
muscular dystrophy due to weakness of gluteal m.
acute COPD exacerbation treat w/?
- O2
- short acting bronchodilators (b2 adrenergic agonist or anticholinergic agent)
- SYSTEMIC steroids
- abx as needed
sialadenosis is?
benign, noninflammatory swelling of the salivary glands (non tender)
what is sialadenosis associated w/
- advanced liver disease
- malnutrition (DM, bulemia, etc)
submandibular glandular swelling and pain w/ meals - think?
salivary gland stone
initial treatment of dermatitis herpetiformis?
Dapsone
atrophy of caudate nucleus - think?
huntington’s
huntington typical finding on CT?
atrophy of caudate nucleus
diffuse atrophy of cerebral cortex feature of what disease?
alzheimer’s
atrophy of lenticular nucleus feature of?
Wilson’s disease
Atrophy of front and/or temporal lobes is a feature of ?
Pick’s disease
Alzheimer’s finding on CT head?
diffuse atrophy of cerebral cortex
bone pain + headache + unilateral hearing loss + femoral bowing - think?
Paget disease of bone
paget disease of bone due to?
osteoclast dysfunction –> inc bone breakdown and turnover
mosaic pattern of lamellar bone - most common?
Paget disease of bone (osteoclast dysfunction)
steatorrhea can –> bone pain, why?
stetorrhea –> malabsorption of vit D –> vid D deficiency –> 2ndary hyperparathyroidism (low Ca, low phos, high PTH) –> osteomalacia
urine hydroxyproline is from?
breakdown of collagen
what are levels of urine hydroxyproline in paget’s disease?
elevated
paget disease serum Ca and Phosphate levels are?
NORMAL
high alk phos, high urine hydroxyproline, nL Ca and phos - think?
Paget disease of bone
