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TEST7 Flashcards

1
Q

New PREGNANT mothers who hold their infants with THUMBS OUTSTRETCHED have inflammation of abductor pollicus longus + extensor pollicis previs tendons

+ FINKELSTEIN TEST: Passively stretching affected tendons by grasping flexed thumb over radial styloid into palm of fingers elicits pain

A

DE QUERVAIN TENOSYNOVITIS

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2
Q

Fall on outstretched hand -> FORECEFUL HYPEREXTENSION OF WRIST most commonly results in what type of fracture?

A

SCAPHOID FRACTURE

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3
Q

Pt with HL, HTN comes in with GRADUAL PAINLESS LOSS OF VISION and NO focal neuro deficits. What test is best to order first?

A

**DUPLEX NECK

High suspicion for AMAUROSIS FUGAX (painless loss of vision from cholesterol hollenhorst body emboli generally at CAROTID BIFURCATION) = warning sign for IMPENDING STROKE

NOT CT/MRI of head since there are NO focal neuro deficits

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4
Q

2 NORMOCYTIC ANEMIA conditions with INCREASED MCHC (Shrunk RBC causing increased HGB concenctration)

A
  1. HEREDITARY SPHEROCYTOSIS (Extravascular hemolysis- Coombs, Northern European)
  2. IMMUNE HEMOLYTIC ANEMIA (IgG - extra, IgM- intra, + Coombs)
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5
Q

What is the SINGLE most important prognostic consideration in BREAST CANCER TREATMENT?

A

TNM STAGING

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6
Q

What type of antibiotic is AZTREONAM

A

MONOBACTAM antiboitic used to treat Gm- bacterial infections INCLUDING PSEUDOMONAS

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7
Q

MOTOR/SENSORY loss (e.g. loss of sensation in perianal area) + Loss of rectal tone + Urinary retention = high suspicion of ___?

Why not cauda equina syndrome?

A

ACUTE SIPNAL CORD COMPRESSION

Not cauda equina syndrome (below level of cona medullaris typically at sacral roots) because of + LOSS OF SENSORY/MOTOR = less common with cauda equina

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8
Q

Management of ACUTE SPINAL CORD COMPRESSION = ?

hint: consult, imaging, pharmacotherapy

A
  1. EMERGENCY NEUROSURG CONSULT/RAD-ONC
  2. MRI
  3. IV GLUCOCORTICOIDS (if malignant compression is suspected)
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9
Q

ADENOCARCINOMA of the lung is typically associated with what condition?

A

HYPERTROPHIC PULMONARY OSTEOARTHROPATHY

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10
Q

Classic findings of SARCOIDOSIS

A

1) Non-caseating granulomas
2) Bilateral hilar adenopathy
3) Erythema nodosum

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11
Q

FLUCTUATING OCULAR (ptosis, diplopia) + FACIAL/BULBAR weakness that WORSENS with REPETITIVE TASKS = ?

A

MYASTHENIA GRAVIS

autoAb against POST-SYNAPTIC Ach-R

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12
Q

PROXIMAL MUSCLE WEAKNESS + DRY MOUTH/erectile dysfunction (autonomic dysfn) + PTOSIS + DIMINISHED/ABSENT DTR that IMPROVES with REPEAT ISOMETRIC CONTRACTION

A

LAMBERT EATON SYNDROME = auto-Abs against PRE-SYNAPTIC Ca2+ channels

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13
Q

How is diagnosis of DERMATOMYOSITIS made?

A

MUSCLE FIBER BIOPSY

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14
Q

What is the FIRST STEP of evaluating a THYROID NODULE? (Hint: Lab + imaging)

A

1) Measure TSH

2) Thyroid Ultrasound

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15
Q

What is the drug of choice for BENIGN ESSENTIAL TREMOR?

A

PROPANOLOL

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16
Q

What is the drug of choice for PARKINSONIAN TREMOR?

A

BENZTROPINE (anti-cholinergic)

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17
Q

What is the drug of choice for MYOCLONUS? (2)

A

SODIUM VALPROIC ACID

CLONAZEPAM

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18
Q

What are the sx of ANKYLOSING SPONDYLITIS?

A 
AREDU
A - arthritis (sacroiliatis)
R - reduced chest expansion/ spinal mobility = RESTRICTIVE LUNG DZ
E - enthesitis
D - dactylitis
U - uveitis
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19
Q

What are possible complications of ANKYLOSING SPONDYLITIS?

A

OAC
O - Osteoporosis/vertebral fractures
A - Aorta regurg**
C - cauda equina

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20
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)

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21
Q

What are the 3 most common causes of SUBACUTE (3-8wk) or CHRONIC (>8wk) cough? What is the empiric initial Tx of each?

A
  1. UPPER AIRWAY COUGH SYNDROME (Post-nasal drip) -
    Tx= oral 1st gen anti-histamine (CHLORPHENIRAMINE) or combined anti-histamine-decongestant (BROMPHENIRAMINE)
  2. GERD - Empiric PPI
  3. Asthma - PFTs
  4. ACE INHIBITOR - Stop ACE
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22
Q

Uses of TRANSTHORACIC ECHOCARDIOGRAM (TTE):

A

To detect THROMBI

  • LA thrombus due to Afib
  • LV thrombus
  • Septic emboli from INFECTIVE ENDOCARDITIS
  • Thrombi from prosthetic valves
23
Q

Bilateral Lung Opacities CXR + Worsening respiratory distress after 1wk of insult + Hypoxemia PaO2/FiO2

A

ARDS - shunting/ elevated Aa gradient -> Impaired gas exchange + Decreased compliance + Pulm HTN

Lower PaO2
Increased fractin of inspired oxygen requirement = LOWER RATIO correlating with severity of ARDS

24
Q

Risk factors/Insults triggering ARDS (4)

A

1) Infection - Pneumonia/sepsis
2) Trauma
3) Acute pancreatitis
4) Massive transfusion

25
Q

What diagnostic values distinguish ARDS from CHF when both show “congestion” like substance on CXR?

A

ARDS: ELEVATED PAP Pulmonary arterial pressure (measure of Pulmonary vascular resistance)

CHF: ELEVATED Pulmonary capillary wedge pressure (measure of LA)

26
Q

Colorectal cancer screening for IBD pts:

A

Begin 8 years post-diagnosis

Colonoscopy + biopsy every 1-2yrs

27
Q

Colorectal cancer screening for FAP pts:

A

Begin age 10-12

Colonoscopy every year

28
Q

Lynch Syndrome (HEREDITARY NONPOLYPOSIS CRC)

A

Begin at age 20-25

Colonoscopy every 1-2 years

29
Q

Colorectal cancer screening for family history of adenomatous polyps or CRC (3-2-1):

A

Colonoscopy at age 40

Repeat every 3-5yrs

30
Q

Risk factors for ANGIODYSPLASIA (painless GI bleeding)

A
  1. RENAL DISEASE
  2. AORTIC STENOSIS
  3. vWF Disease - multimers traverse turbulent valve space by aortic stenosis
31
Q

LOCALIZED pain and tenderness over ANTEROMEDIAL TIBIA below knee joint - exacerbated by pressure from opposite knee while lying on side

A

PES ANSERINUS PAIN SYNDROME (ANSERINE BURSITIS)

32
Q

OVERUSE injury - POORLY LOCALIZED PAIN over lateral knee + lateral femoral condyle tenderness with knee movement

A

ILIOTIBIAL BAND SYNDROME

33
Q

DIFFUSE ANTERIOR KNEE pain reproduced by patellofemoral compression during knee extension in YOUNG WOMEN

Pain worsened by ACTIVITY or prolonged sitting (SUSTAINED FLEXION). Crepitus with motion of patella

A

PATELLOFEMORAL PAIN SYNDROME

34
Q

BONY ENLARGEMENT/TENDERNESS (OSTEOPHYTES) + Crepitus with movement + Painful/decreased ROM in age>50, obese, female with prior joint injury

A

OSTEOARTHRITIS

35
Q

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

A

IV MANNITOL - osmotic diuretic

36
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
37
Q

Which medication is CONTRA-INDICATED for ACUTE GLAUCAOMA?

A

ATROPINE = muscarinic-R antagonist - MYDRIATIC EFFECT

38
Q

SYMPTOMATOLOGY difference between ALZHEIMER DEMENTIA and FRONTOTEMPORAL DEMENTIA

A

AD DEMENTIA: Early insidious SHORT TERM MEMORY LOSS/ language and spatial memory deficits first
LATER PERSONALITY CHANGES

FRONTOTEMPORAL DEMENTIA: Early personality changes/ apathy/ disinhibition /compulsive behavior -> LATER memory changes

39
Q

What acid-base imbalance characterizes ALLERGIC RXN + STRIDOR?

A

RESPIRATORY ACIDOSIS - due to decreased ventilation and CO2 retention

40
Q

What acid-base imbalance characterizes ASTHMA EXACERBATION?

A

RESPIRATORY ALKALOSIS - Tachypnea

41
Q

What acid-base imbalance characterizes persistent vomiting + excessive diuresis?

A

CONTRACTION ALKALOSIS

1) PERSISTENT VOMITING - Hypochloremic metabolic alkalosis: Due to loss of H+ contents
2) Excessive diuresis

42
Q

IBD pt with acute worsening FEVER, LEUKOCYTOSIS, ABDOMINAL DISTENSION**, HEMODYNAMIC INSTABILITY (hypotension, tachycardia)
Other possible signs: Peritonitis, AMS, electrolyte abnormalities.

What is the first diagnostic test that should be ordered?

A

ABDOMINAL X-RAY -

1) Check for colonic distension (TOXIC MEGACOLON >6mm dilation of right colon)
2) Can exclude perforation

43
Q

What is the management of TOXIC MEGACOLON?

A

Generally conservative:

Bowel rest + NG suction + steroids +/- broad spectrum antibiotics targeting C.diff (METRONIDAZOLE)

44
Q

WIDE-BASED GAIT Ddx:

A

SENSORY ATAXIA
CEREBELLAR DYSTURBANCES
MUSCULAR DYSTROPHY (also may be waddling)

45
Q

What type of error is PRECISION? What increases precision?

A

RANDOM ERROR

Increase sample size - Increases precision

46
Q

BILATERAL erythema nodosum Ddx:

A

INFECTIOUS - S.pneumo pharyngitis, TB
AUTOIMMUNE - Sarcoidosis
INFLAMMATORY - IBD
IDIOPATHIC

47
Q

Which acid-base imbalance characterizes CHRONIC DIARRHEA?

A

HYPOKALEMIC METABOLIC ACIDOSIS - Loss of bicarb and K+ in stool

48
Q

Which acid-base imbalance characterizes BLIND LOOP SYNDROME (i.e. SIBO)?

A

HYPOCHLOREMIC METABOLIC ACIDOSIS

Due to INCREASED gut production and absorption of LACTIC ACID

49
Q

Which acid-base imbalance characterizes POSTICTAL STATE after seizure?

A

LACTIC ACIDOSIS - Due to INCREASED BMR -> Insufficient O2 present in tissues -> Anaerobic metabolism

50
Q

CYSTIC SWELLING over patella following TRAUMA

A

PRE-PATELLA BURSITIS

51
Q

PAIN between 3rd and 4th TOES on plantar surface + clicking sensation (MULDER SIGN) occurring when simultaneously palpating this space/squeezing metatarsal joints - MECHANICALLY induced degen neuropathy

Seen in RUNNERS

A

MORTON NEUROMA

52
Q

SPINAL CORD COMPRESSION by METASTASIS TO BONE SX:

ACUTE PHASE of SCC: What is SPINAL SHOCK?

A

1) WORSENING BACK PAIN especially at NIGHT
2) LE weakness + SENSORY loss below a certain level
3) + HYPER-REFLEXIA + BABINSKI RESPONSE + Fecal/urinary incontinence retention (later signs)

Most commonly affects THORACIC 60%, rather than lumbar

SPINAL SHOCK = ABSENT REFLEXES + FLACCID PARAPLEGIA

53
Q

DIABETIC POLYNEUROPATHY - What gets lost first? What happens to reflexes?

A

Affects primarily DISTAL LE
Loss of PAIN/TEMP/ PROPRIOCEPTION/VIBRATORY

LOSS OF DEEP TENDON REFLEXES

STEP2: Tidbits (9 decks)

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