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STEP2: Tidbits > TEST6/EYE > Flashcards

TEST6/EYE Flashcards

1
Q

BRONCHIECTASIS Tx with goals of aiding sputum clearance

A

Chest physiotherapy with percussion and vibration

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2
Q

Primary long-term therapy of asthma?

A

IHC

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3
Q

Primary long-term therapy of COPD?

A

LAMA inhaler - tiotropium, aclidinium

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4
Q

Tx for SEVERE, LIFE-THREATENING asthma exacerbations

A

IV Mg sulfate

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5
Q

ISOLATED SYSTOLIC HTN criteria =?

Pathophys =?

A

SBP >140

DBP

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6
Q

What abnormal values are seen with OSTEOPOROSIS?

A

NONE

Normal Ca, PO4, PTH, ALP

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7
Q

Which vitamin toxicity (2) presents with hypercalcemia?

A

VitA toxicity

VitD toxicity

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8
Q

Which murmur is most common with INFECTIVE ENDOCARDITIS?

A

Aortic Regurg

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9
Q

What are the 2 major criteria of DUKE for INFECTIVE ENDOCARDITIS?

A
    • BLOOD CULTURE for micro-organism (S. viridans, S. aureus, Enterococcus)
  2. ECHO showing valvular vegetation
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10
Q

What are the 6 minor criteria of DUKE for INFECTIVE ENDOCARIDITS?

A
    • BLOOD CULTURE not typical (s. aureus, viridans, enterococcus)
  2. Temp >38C (100.4)
  3. Embolic phenomena (Janeway lesions, neuro phenomena)
  4. Immunologic phenomena (Glomerulonephritis, Osler nodes)
  5. IVDA
  6. Pre-disposing cardiac lesion
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11
Q

Management/Diagnostic testing of ACUTE IE

A

3 serial blood cultures from separate venipuncture sites over 1hr period -> antibiotics

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12
Q

Management/Diagnostic testing of SUBACUTE IE

A

3 Blood cultures over SEVERAL hours -> antibiotics

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13
Q

NECROLYTIC MIGRATORY ERYTHEMA (lesions that enlarge/central clearing/blistering/crusting and scaling at borders- generally in FACE/ PERINEUM/ EXTREMITIES) over 7-14d + MILD HYPERGLYCEMIA (not requiring insulin) + NORMOCYTIC, NORMOCHROMIC ANEMIA + Weight loss + secretory diarrhea

A

GLUCAGONOMA

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14
Q

Radiographic imaging to confirm GLUCAGONOMA

What level of glucagon confirms GLUCAGONOMA diagnosis?

A

Abdomen CT or MRI - Localize pancreatic neuroendocrine tumor

GLUCAGONOMA (glucagon >500)

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15
Q

LOW INSULIN + anti-glutamic acid decarboxylase Abs = ?

A

INDOLENT LATE-ONSET AUTOIMMUNE TYPE 1 DIABETES

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16
Q

CARCINOID SYNDROME (most commonly small bowel) WITH METASTASIS TO LIVER presents with _?

A

BRONCHOSPASM + SECRETORY DIARRHEA + SKIN FLUSHING (5-HIAA goes from hepatic veins to lungs and skin)

RIGHT SIDED Ds - PULMONIC STENOSIS + TR

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17
Q

Steatorrhea and mal-absorption disrupts absorption of which vitamins?

A

Prevents usual fat emulsification -> Disrupts chylomicron-mediated VitD absorption
VITD DEFICIENCY -> LOW Ca, LOW PO4

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18
Q

HACEK - EIKENELLA CORRODENS INFECTIVE ENDOCARDITIS is most commonly seen in what setting?

A

POOR DENTITION and/or periodontal infection + dental procedures involving gingival or oral mucosa

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19
Q

What is the first management step of elderly pts with ACUTE URINARY INCONTINENCE?

A

URINARLYSIS + CULTURE = UTI = leading cause of urinary incontinence in elderly

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20
Q

What are the reversible causes of ACUTE URINARY INCONTINENCE in the elderly?

A 
"DIAPPERS"
D- delirium, I - Infection (UTI), A- atrophic urethritis/vaginitis
P- pharmaceuticals 
P- psychological (depression) 
E- excess urine output (e.g. DM, CHF)
R- restricted mobility (post-surgery)
S- stool impaction
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21
Q

What medications can cause ACUTE URINARY INCONTINENCE in elderly?

A

1) ALPHA BLOCKERS - Urethral relaxation
2) anti-cholinergics, Opiates, CCB - Urinary retention/overflow
3) DIURETICS - Excess urine production

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22
Q

What are the 3 stages of DIABETIC RETINOPATHY

A

1) SIMPLE/BACKGROUND = Microaneurysms + hemorrhages + exudates + macular edema
2) PRE-PROLIFERATIVE = Cotton wool spots
3) PROLIFERATIVE/MALIGNANT = Neovscularization + often Vitreous hemorrhage

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23
Q

What is the main driving factor of visual impairment of DIABETIC RETINOPATHY?

A

MACULAR EDEMA from SIMPLE or BACKGROUND RETINOPATHY (by IDDM or NIDDM)

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24
Q

What is the Tx of preventing visual impairment complications of DIABETIC RETINOPATHY?

A

ARGON LASER PHOTOCAGULATION (since this is a microaneurysm)

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25
Q

GRADUAL loss of PERIPHERAL vision “tunnel vision” followed by loss of CENTRAL VISION = ?

Fundoscopy = OPTIC DISC CUPPING

A

OPEN ANGLE GLAUCOMA

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26
Q

Distorted vision + CENTRAL SCOTOMA (either atrophic Dry or exudative Wet) + DRUSEN deposits

EARLIEST FINDING: Straight lines appear wavy

A

MACULAR DEGENERATION

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27
Q

SUDDEN, UNILATERAL visual impairment noted at WAKING UP in morning + DISC SWELLING + VENOUS DILATION + TORTUOS RETINAL HEMORRHAGES (tomato squashed) + COTTON WOOL SPOTS

A

CENTRAL RETINAL VEIN OCCLUSION

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28
Q

CARDINAL Sx of HEAT STROKE:

A

TEMP>105 (40C)
ALTERED MENTAL STATUS
HYPOTENSION, TACHYCARDIA, JVD, TACHYPNEA

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29
Q

Pathophysiology of HEAT STROKE

A

Failure of thermoregulatory center to dissipate heat at a rapid enough rate to maintain EUTHERMIA

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30
Q

COMPLICATION OF HEAT STROKE if body temp >41C (105.8) = ?

A

RHABDOMYOLYSIS
UA sign of rhabdo =
+ Large gross blood
0 RBC

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31
Q

Which two anesthetic drugs can cause MALIGNANT HYPERTHERMIA (uncontrolled Ca efflux from SR) + Temp>45C (113)?

A

HALOTHANE

SUCCINYLCHOLINE

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32
Q

What is difference between HEAT EXHAUSTION and HEAT STROKE?

A

HEAT EXHAUSTION:

1) Pathophys - Due to inadequate Na and H2O retention -> Failed CO
2) Temp40 (105)
3) YES Altered mental status

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33
Q

Abdomen Exam: SHIFTING DULLNESS or POSITIVE FluiD WAVE are signs of?

A

ABDOMINAL ASCITES

34
Q

Most common complication of LE VENOUS VALVE INCOMPETENCE?

A

VENOUS ULCERATIONS +

Dermatitis/eczema + edema + skin pigmentation

35
Q

IATROGENIC causes of CONSTRICTIVE PERICARDITIS [CP] (CP = Important cause of right-sided heart failure, cardiac cirrhosis)

A
  1. RADIATION THERAPY (Mediastinal irritation)
  2. CHEMO (Anthracycline therapy)
  3. CARDIAC SURGERY
36
Q

INFECTIOUS causes of CONSTRICTIVE PERICARDITIS

A

VIRAL

TB (Endemic areas)

37
Q

What imaging is used to confirm diagnosis of ADPKD? (early onset HTN preceding decline in renal function, OR flank pain due to renal calculi, OR cyst rupture/hemmorhage OR upper UTI)

A

Abdominal US

38
Q

What is the preferred HTN medication for ADPKD pts?

A

ACE INHIBITORS

39
Q

CYST ASSOCIATIONS with ADPKD

A
  1. Cerebral aneurysms
  2. Hepatic/pancreatic cysts
  3. Cysts of the heart (MVP, AR)
  4. Cysts of the colon - Colonic diverticula
  5. Cysts of the abdomen - inguinal/ventral hernias
40
Q

Tx of celiac disease particularly the dermatitis herpatiformis component

A

ORAL DAPSONE + gluten free diet

41
Q

Triggers of hemolysis in G6PD pts

A

1) INFECTIONS
2) DRUGS (PAIDS - primaquine, ASA, INH, dapsone, sulfa)
3) FAVA BEANS

42
Q

HIV pt + AMS + CSF EBV DNA + SOLITARY weakly RING-ENHANCING mass in PERIVENTRICULAR area on MRI = ?

A

PRIMARY CNS LYMPHOMA

43
Q

MULTIPLE ring-enhancing spherical lesions in BASAL GANGLIA on MRI = ?

A

Toxoplasmosis

44
Q

Tx of HYPOVOLEMIC HYPERNATREMIA (marked volume depletion + hemodynamic instability)?

What is the Tx after pt is euvolemic?

A
  1. 9% NaCl NS
    * Normally don’t use ISOTONIC fluid for hypernatremia but first goal is to RESTORE VOLUME

After pt is euvolemic, then use HYPOTONIC fluid (5% DEXTROSE&raquo_space; preferred over 0.45% NaCl)

45
Q

Tx of EUVOLEMIC hypernatremia

A

FREE WATER SUPPLEMENTATION

46
Q

Guidelines of Na+ correction: How fast should Na+ be corrected?

A

0.5mEq/dL/hr WITHOUT exceeding 12mEq/dl/24hr

47
Q

Sx of LITHIUM TOXICITY? When should hemodialysis be considered?

A

SEIZURES + DEPRESSED MENTAL STATUS
Hemodialysis for serum Li>4 OR Li>2.5+clinical sx OR inability to excrete Li (decompensatied heart failure/renal disease)

48
Q

What is the difference between HYPERNATREMIA (dehydrated state) vs HYPERNATREMIA (volume depletion)?

A

Dehydrated state hypernatremia = free water loss

Hypotension/tachycardia/poor skin tugor = volume depletion

49
Q

Which is associated with a lower risk of UTIs - Indwelling catheters OR intermittent catheterization?

A

INTERMITTNET CATHETERIZATION

50
Q

Which drugs can resemble SIADH by stimulating hypothalamic ADH production?

A

CARBAMAZEPINE
CYCLOPHOSPHAMIDE
SSRI - eg fluoxetine

51
Q

How would adrenal insufficiency present in terms of serum osmolality ?

A

Low volume -> Increased ADH -> Hyponatremia

Uosm>Sosm

52
Q

Which cardiac drugs should be with-held prior to nuclear stress test?
Which ones should be continued?

A

Drugs that will decrease extent and severity of ischemia during stress test - BETA BLOCKERS, Ca CHANNEL BLOCKERS, NITRATES

Withhold oral DM drugs, caffeine/stimulators
Continue - ACE-I, ARB, Diuretics, Statins, digoxin

53
Q

RING-ENHANCING LESIONS on brain MRI

A
  1. PRIMARY CNS LYMPHOMA - in EBV/HIV pt
  2. TOXOPLASMOSIS
  3. ANGIOINVASIVE ASPERGILLOSIS
54
Q

Asian woman >40yo:
RAPID onset of severe eye pain + RED/TEARY + Halo around lights (steamy, hazy cornea) + FIXED, MID-DILATED pupil NOT reactive to light + N/V as IOP increases

What is the gold standard for diagnosis?
What can be helpful if ophtho consult is unavailable?

A

ACUTE ANGLE CLOSURE GLAUCOMA

GOLD STANDARD = GONIOSCOPY

TONOMETRY - if ophtho consult unavailable

55
Q

DIABETIC RETINOPATHY PT: Sudden loss in vision + FLOATING DEBRIS** + LOSS OF FUNDUS** + Dark red glow = what pathology?

A

VITREOUS HEMORRHAGE (in Proliferative/malignant phase of DIABETIC RETINOPATHY)

56
Q

How do you distinguish between RETINAL DETACHMENT due to diabetes vs VITREOUS HEMORRHAGE due to diabetes?

A

RETINAL DETACHMENT: Fundoscopy shows ELEVATED RETINA with folds +/- tear

VITREOUS HEMORRHAGE:
Fundoscopy shows NO FUNDUS

57
Q

Female pt 20-45yo: SLUGGISH AFFERENT PUPILLARY RESPONSE to light + CHANGES IN COLOR PERCEPTION + DECREASED VISUAL ACUITY
UNILATERAL eye pain

FUNDOSCOPY: Swollen disc

A

OPTIC NEURITIS

58
Q

What is the Tx of EXERTIONAL HEAT STROKE with Temp>104 and AMS?

A

RAPID COOLING - preferably by ICE WATER IMMERSION

59
Q

LOSS OF TRANSPARENCY of lens + difficulty driving at night/reading fine print

A

CATARACTS

60
Q

POST-Transplant pts (on immunosuppressants) presenting with TACYPNEA, HYPOXIA, DRY COUGH, FEVER, ELEVATED LDH

CXR: BILATERAL DIFFUSE INTERSTITIAL INFILTRATES

What are the 2 most likely organisms? How do you diagnose?

A

PCP pneumonia
CMV pneumonia

1) First by SPUTUM culture
2) If not successful, BRONCHOSCOPY + BRONCHOALVEOLAR LAVAGE

61
Q

FUNDOSCOPY: **yellow-white, FLUFFY, hemorrhagic GRANULAR lesions along vasculature + BLURRED VISION + BLINDNESS + PHOTOPSIA (sensation of flashing lights)
Complications: INCREASED RISK OF RETINAL DETACHMENT + BLINDNESS

A

CMV RETINITIS

62
Q

PAINFUL red eye + Impaired vision, cornea opacification, CORNEAL VESICLES + DENDRITIC ULCERS + PERIPHERAL PALE LESIONS + ACUTE CENTRAL RETINAL NECROSIS = ?

How is diagnosis made?
Tx?

A

HSV KERATITIS

Diagnosis: FLUORESCEIN STAINING
Tx = ORAL ACYCLOVIR or topical antivirals

ALL CORNEAL ULCERS should be cultured to make sure that it’s not viral

63
Q

CONJUNCTIVAL INFLAMMATION + WATERY DISCHARGE in setting of URI = ?

A

ADENOVIRAL CONJUNCTIVITIS - viral “pink eye”

Tx = COLD MOIST COMPRESSES

64
Q

What is the difference between ALLERGIC and VIRAL CONJUNCTIVITIS? Tx?

A

ALLERGIC CONJUNCTIVITIS = Episodic + shorter duration sx, Tx = mast cell stabilizing agents (OLOPATADINE + AZELASTINE)

VIRAL CONJUNCTIVITIS = Tx = COLD MOIST COMPRESSES

65
Q

MULTIPLE STROMAL ABSCESSES after corneal injury in AGRICULTURAL WORKERS + IMMUNOCOMPROMISED pts = ?

A

FUNGAL KERATITIS

66
Q

ENLARGED BLIND SPOT in cornea + vision loss that is worse with head position (in the morning) = ?

A

PAPILLEDEMA - Increased ICP

67
Q

What is the difference between HSV/VZV keratitis/uveitis and CMV retinitis?

A

HSV/VZV - PAINFUL + acute CENTRAL RETINAL NECROSIS + peripheral pale lesions/central retinal necrosis

CMV - PAINLESS, retinitis + NO keratitis/conjunctivitis + fluffy/granular hemorrhagic lesions around retinal vessels

68
Q

DRY SCALY PAPULES on sun-exposed areas with ERYTHEMATOUS BASE that may progress to SCC = ?
Tx = ?

A

ACTINIC KERATOSIS

Tx = FLUOROURACIL CREAM

69
Q

FLASHING LIGHTS (photopsia) + blurred vision + “CURTAIN came down” over eye + floaters + sluggish pupil + RETINAL TEARS/GRAYIS APPEARING [usually PAINLESS] = ?

A

RETINAL DETACHMENT

70
Q

SUDDEN PAINLESS LOSS OF VISION in one eye

FUNDOSCOPY: Optic disc pallor + cherry red fovea + blood segmentation of retinal veins

TX = ?

A

CENTRAL RETINAL ARTERY OCCLUSION

TX = OCULAR MASSAGE - to dislodge the embolus to a point further down arterial circulation + HIGHFLOW O2 THERAPY

71
Q

CONTACT LENS WEARERS: Hazy cornea following corneal trauma/PAINFUL RED EYE+ central ulcer/OPACIFIATION + adjacent stromal abscesses

A

BACTERIAL KERATITIS
= Medical emergency

Tx = TOPICAL BROAD SPECTRUM ANTIBIOTICS

72
Q

DENDRIFORM CORNEAL ULCERS** + Vesicular rash in trigeminal distribution = ?

A

HERPES ZOSTER OPHTHALMICUS

73
Q

What is the difference btw ANTERIOR UVEITIS and POSTERIOR UVEITIS?

A

Anterior: + Pain/redness
Posterior: Painless + floaters/reduced visual acuity

74
Q

Few hours or days after a mild TBI: HA + CONFUSION/AMNESIA + DIFFICULTY CONCENTRATING + VERTIGO + MOOD ALTERATION/ANXIETY + SLEEP DISTURBANCE = ?

A

POST CONCUSSIVE SYNDROME - Can last more than 6mo

75
Q

Facial trauma + RETROBULBAR INJECTION + PAINFUL proptosis + INCREASED IOP + Afferent pupillary defect (Marcus Gunn)

A

RETROBULBAR HEMATOMA

76
Q

History of ORBITAL INJURY + VERTICAL DIPLOPIA + ENTRAPMENT of the eye muscle inferior rectus muscle (looks white/severe pain)

A

ORBITAL FLOOR FRACTURE

77
Q

Eye involvement in IBD, RA versus Ankylosing spondylitis

A

IBD, RA - EPISCLERITIS (inflammation seen in the whites of eye)
AS - anterior UVEITIS (inflammation of uveal tract - iris, ciliary body, choroid + KERATIC precipitates

78
Q

1st line of Tx of ACUTE GLAUCOMA (CLOSED ANGLE)

A

IV MANNITOL - osmotic diuretic

79
Q

Tx for ACUTE GLAUCOMA (4) - PMAT

A
  1. MANNITOL - osmotic diuretic
  2. ACETAZOLAMIDE - CA inhibitor: Decreases aqueous humor production
  3. TOPICAL TIMOLOL - beta blocker: Decreases aqueous humor production
  4. PILOCARPINE - muscarinic agonist - Increases aqueous humor outflow
80
Q

Which medication is CONTRA-INDICATED for ACUTE GLAUCAOMA?

A

ATROPINE = muscarinic-R antagonist - MYDRIATIC EFFECT

STEP2: Tidbits (9 decks)

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