Test 66 Flashcards
Seborrheic dermatitis
Seborrheic dermatitis is characterized by pruritic, erythematous plaques with greasy scales and typically affects the scalp, central face, and ears. It usually occurs as an isolated condition but has an increased incidence in association with Parkinson disease and HIV infection, in which it may be a presenting feature.
Ischemic stroke
Perioperative patients with new neurologic deficits should receive a full stroke evaluation, including an emergency noncontrast CT scan of the head. Those with perioperative stroke may be eligible for time-dependent reperfusion therapies.
Ethical principles in healthcare
Unilateral termination of the physician-patient relationship by the physician may be warranted for nonpayment. However, for the termination to not constitute patient abandonment, the patient must have no immediate medical need and should be given reasonable time to find an alternate provider.
Hearing loss
The decreased ability to discriminate speech in patients with presbycusis is especially obvious in a noisy, distracting environment.
Rheumatic fever
The benefits of a 10-day course of penicillin for streptococcal pharyngitis include decreased sx severity and duration, prevention of spread to close contacts, and prevention of acute rheumatic fever.
Sickle cell
Patients with sickle cell disease who have a severe vaso-occlusive episode and are hemodynamically stable should be treated promptly with intravenous opioids.
Contrast nephropathy
AKI occurring 24-48 hours following arterial contrast administration (coronary angiography, ventriculography) is consistent with contrast-associated AKI. The diagnosis is clinical (biopsy typically not required), with supporting features that include a fractional excretion of sodium <1% and muddy brown casts on urine microscopy.
Contrast nephropathy
Most patients with contrast-associated acute kidney injury experience complete recovery to baseline renal function within 3-7 days after contrast exposure.
Multifocal atrial tachycardia
Multifocal atrial tachycardia most commonly occurs in elderly patients who are hospitalized with an exacerbation of underlying pulmonary disease (COPD). The dx is made by ECG demonstrating P waves of at least 3 different morphologies and an atrial rate >100/min. Tx involves appropriate management of the underlying inciting illness.
Multifocal atrial tachycardia
The initial management of multifocal atrial tachycardia (MAT) is directed toward correction of underlying disturbances (exacerbation of pulmonary disease, hypokalemia). Calcium channel blockers or beta blockers can be used for rate control in patients for whom MAT persists despite correction of potential underlying causes.
COPD
After adjusting for age, FEV1 remains as the single most important factor in determining the prognosis of patients with COPD.
Chronic kidney disease
Mixed concentric and eccentric left ventricular hypertrophy (LVH) is common in patients with chronic kidney disease (CKD), largely related to the high prevalence of systemic hypertension and anemia. Treatment of severe anemia (hemoglobin <10 g/dL) with erythropoiesis-stimulating agents has been shown to improve quality of life and reduce LVH in patients with CKD.
Ectopic pregnancy
An ectopic pregnancy can be managed medically with methotrexate or surgically. Contraindications to methotrexate include hepatic disease, renal disease, immunodeficiency, and a ruptured ectopic pregnancy.
Bell’s palsy
Peripheral facial neuropathy (CN VII) can be the presenting sign of early disseminated Lyme disease. Any patient with facial weakness and risk factors for Lyme disease should undergo serologic testing. In contrast to Bell palsy, in Lyme disease, glucocorticoids do not seem to speed recovery. Most patients recover facial nerve function in approximately a month.
Hypoglycemia
Iatrogenic hypoglycemia can occur following treatment for hyperkalemia. Patients with end-stage renal disease are particularly susceptible due to impaired renal gluconeogenesis and reduced renal insulin clearance. Frequent blood glucose testing should be performed.
Sensitivity, specificity, NPV, PPV
Highly sensitive tests are useful for screening; highly specific tests are useful for confirmation.
Prostatitis
Chronic prostatitis is a common condition that usually presents with >3 months of dysuria, pelvic pain, and/or pain during ejaculation. Patients with suspected chronic prostatitis should receive a urinalysis and urine culture before and after prostate massage.
Prostatitis
Chronic prostatitis/chronic pelvic pain syndrome is characterized by >3 months of dysuria and pelvic pain. Urine studies following prostate massage usually show pyuria (>20 leukocytes/hpf) with no microorganisms.
Prostatitis
The underlying cause of chronic prostatitis/chronic pelvic pain syndrome is unknown. Patients are generally treated with a combination of therapies including medications for prostate enlargement (alpha blockers), antibiotics, anti-inflammatories, and/or psychotherapy.
Opioids
Opioid intoxication presents with the triad of respiratory depression, miosis, and depressed mental status. Renal dysfunction can increase the risk of opioid toxicity, especially with morphine. Immediate management involves the administration of intravenous naloxone as well as ventilatory support when needed.
Pituitary apoplexy
Pituitary apoplexy (pituitary hemorrhage or infarction, usually in a large adenoma) presents with headache and cranial nerve compression symptoms (opthalmoplegia, hemianopsia). It is a life-threatening disorder that requires immediate evaluation. CT scan of the had usually obtained initially; MRI is highly sensitive and specific.
Prerenal azotemia
Acute kidney injury (AKI) due to unilateral urinary obstruction is rare in the presence of a functioning contralateral kidney. Prerenal azotemia should be the suspected cause of AKI in patients with unilateral obstruction, particularly if there is evidence of volume depletion (vomiting, elevated blood urea nitrogen/creatinine ratio).
