TEST8 Flashcards
Which part of spinal cord results in PARAPLEGIA, BLADDER/FECAL INCONTINENCE, ABSENT SENSATION from nipple downwards?
UPPER THORACIC SPINAL CORD (T4 = NIPPLE)
Which part of spinal cord results in ABSENT SENSATION FROM UMBILICUS downwards?
LOWER THORACIC SPINAL CORD (T10 = UMBILICUS)
Lesion of POSTERIOR FOSSA causes what sx?
N/V + ataxia
Typical presentation of MYELODYSPLASTIC SYNDROME?
Pt age, CBC panel, blood smear
Elderly
PANCYTOPENIA + macro-ovalocytic anemia (Elevated MCV, but not hypersegmented)
What is the mainstay Tx for VARICEAL BLEEDING?
OCTREOTIDE = SST analog
Inhibits vasodilator hormones -> Indirectly leads to splanchnic vasoconstriction + Decreased portal flow
What is the cutoff value of INR for transfusing FRESH FROZEN PLASMA (FFP)?
INR>1.6
What is the cutoff value of PLT transfusions?
PLT
What diagnostic tests should ALL cirrhosis pts undergo? Why?
What surveillance test should all cirrhosis pts undergo?
1) ESOPHAGEAL ENDOSCOPY - Because esophageal varices = major cause of morbidity/mortality that occurs in 50% of pts
2) Ultrasound surveillance for HEPATOCELLULAR CARCINOMA +/- aFP every 6mo
What is the PRIMARY prevention of VARICEAL HEMORRHAGE?
NON-SELECTIVE BETA BLOCKERS
Repeat EGD every year
What is the best anti-malaria chemoprophylaxis for short-term travelers to Sub-saharan Africa, southeast Asia?
Africa, Southeast Asia = high rates of chloroquine-resistant P falciparum
CHEMOPROPHYLAXIS with “MAD” - MEFLOQUINE, ATOVAQUONE-PROGUANIL, DOXYCYCLINE
What is the most commonly used anti-malaria chemoprophylaxis for travelers to Korea peninsula, Mexico?
Highest rates of P. ovale and vivax
Chemoprophylaxis with PRIMAQUINE
MRI: Multiple, hypodense, NON-ENHANCING lesions with no mass effect
Immunocompromised pt with HIV CD4Ct
PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY
What is seen on imaging studies of AIDS Dementia?
CORTICAL/SUB-CORTICAL ATROPHY + secondary ventricular enlargement
When a SLE pt starts HYDROXYCHLOROQUINE therapy (TNF and IL-1 suppressor), what evaluation should be done periodically?
EYE EXAM
AE = retinopathy
LAB signs of ALCOHOLIC HEPATITIS:
- AST:ALT>=2
- Macro-ovalocytic anemia - MCV>100
- LOW PLT
- Slight ELEVATED INR
What distinguishes METABOLIC ALKALOSIS of SURREPTITIOUS VOMITING vs DIURETIC/GITELMAN/BARTTER?
Distinguish by URINE CL-
Vomiting = Saline-responsive MA = hypovolemia = HYPOCHLOREMIC = LOW URINE Cl-
Diuretic/Bartter/Gittelman = NORMOTENSIVE and HIGH URINE Cl-
Saline-resistant MA = EXCESS MINERALOCORTICOID = Increased H+/K+ loss and Increased Na+ retention = INCREASED EXTRACELLULAR VOLUME = INCREASED Na+/Cl- diuresis = HIGH URINE Cl-
What is the pharmacotherapy for RESTLESS LEG SYNDROME?
- FIRST LINE = DOPAMINE agonists (PRAMIPEXOLE)**
2. ALPHA-2-DELTA CALCIUM channel ligands (GABAPENTIN, enacarbil)
What is the non-pharmacotherapy therapy of PSVT (HR between 160-220 generally due to re-entry in AV node)?
What is the pharmacotherpy?
DECREASE AV NODE CONDUCTIVITY by INCREASING VAGAL TONE (Vagal maneuvers - valsalva, carotid sinus massage, immersion in cold water)
PHARM: ADENOSINE
Diseases that generally cause Mitral valve prolapse (4)
MARFAN
EHLER DANLOS SYNDROME
MUSCULAR DYSTROPHY
GRAVES DISEASE
Criteria for Long term O2 therapy
- PaO2 55%, or POLYCYTHEMIA VERA
Female pt with acute HIRSUTISM:
Which hormone can STIMULATE ERYTHROPOIESIS by suppressing hepcidin -> Increases HGB? Which pathology is thus associated?
Female pt: TESTOSTERONE
Associated with hyper-androgenism (either OVARIAN or ADRENAL GLAND)
How do you distinguish between HYPERANDROGENISM (ovarian source) and HYPERANDROGENISM (Adrenal source)
OVARY: Elevated testosterone + NORMAL DHEAS
ADRENAL: Elevated testosterone + ELEVATED DHEAS
PROLONGED PTT + FALSE POSITIVE VDRL + THROMBOCYTOPENIA + recurrent miscarriages = ?
Tx = ?
ANTI-PHOSPHOLIPID SYNDROME
Tx = Low dose ASA + LMWH
HYPERCALCEMIA + NORMOCYTIC ANEMIA + renal insufficiency (bence jones proteins) + PROTEIN GAP (total protein - albumin >4) = ?
Screening test?
How is diagnosis confirmed?
MULTIPLE MYELOMA
M-spike SPEP
Confirmation: Bone marrow biopsy (>10% clonal cells)
What is the PRIMARY INTERVENTION to slow decline of DIABETIC NEPHROPATHY?
INTENSIVE BP CONTROL to target BP of 140/90
**Use ACE inhibitors/ARBs
What are the radiologic hallmark abnormalities of ASBESTOSIS - progressive dyspnea + clubbing + end-inspiratory crackles
What is the associated occupational exposure?
INTERSTITIAL FIBROSIS + PLEURAL PLAQUES**
Asbestos exposure - plumbers, shipyard workers, construction workers
What is the cutoff value for normal JVP?
5
What is the management for a pt with amitryptiline-induced urinary retention (SUPRAPUBIC FULLNESS + ABDOMINAL PAIN)?
URINARY CATHETERIZATION + D/c amitriptyline
What is an UPRIGHT ABDOMINAL X-RAY generally used for?
ILEUS
SMALL BOWEL OBSTRUCTION
TOXIC MEGACOLON
SIGNS of acute abdomen (e.g. BOWEL PERFORATION or MECHANICAL OBSTRUCTION)
GUARDING
Absent bowel sounds (PERFORATION)
GI Sx: Mod-severe abdominal pain, N/V
DILATED BOWEL LOOPS WITH AIR FLUID - imaging
BRIGHT RED FRIABLE EXOPHYTIC NODULES in HIV infected pt = ?
BACILLARY ANGIOMATOSIS
NORMAL CSF GLC + ELEVATED CSF PROTEIN + ELEVATED CSF WBC (LYMPHOCYTES) Ct
+ FEVER/ AMS/ AGITATION/SEIZURES
What is the most common etiological microbe? Empiric Tx while waiting for PCR?
ASCEPTIC (VIRAL) ENCEPHALITIS
HSV
IV ACYCLOVIR - empiric tx after LP results
Confirm diagnosis - CSF viral DNA PCR
What is the main distinguish factor between CRYPTOCOCCAL MENINGOENCEPHALITIS and HSV ENCPHALITIS?
CRYPTOCOCCAL MENINGOENCPHALITIS = MARKEDLY ELEVATED opening pressure
HSV encephalitis = nl opening pressure
CSF LOW Glc + CSF ELEVATED PROTEIN (>250mg) + CSF ELEVATED WBC Ct (neutrophil predominance) = ?
What is the empiric Tx?
BACTERIAL SEPTIC MENINGITIS
Empiric Tx = IV Ceftriaxone + Vancomycin
Ampicillin if age>50yo
What is used to treat ALCOHOL WITHDRAWAL in hospitalized pts?
CHLORDIAZEPOXIDE (LLIBRIUM)
HIGH-VELOCITY EYE INJURY (drilling, hammering, grinding) - Greater probability of globe penetration + FOREIGN BODY** formation than low-velocity eye injury
What is the next step of management?
FLUORESCEIN application -> Wood’s lamp/slit lamp exam
How does an UPPER AIRWAY OBSTRUCTION (larygnospasm during extubation) cause NEGATIVE PRESSURE PULM EDEMA?
UPPER AIRWAY OBSTRUCTION - Inspiration against obstruction -> large negative intrathoracic pressure -> Non-cardiogenic pulm edema
2 Days after intubation, pt presents with high-grade fever. What does pt have?
VENTILATOR-associated PNEUMONIA
EXQUISITE TENDERNESS to gentle percussion over involved vertebra in IVDU/SICKLE CELL/ IMMUNOSUPPRESSED pt/ RECENT DISTANT SITE INFN (e.g. UTI) has highest suspicion for __?
OSTEOMYELITIS
What is the confirmatory diagnostic test for OSTEOMYELITIS?
MRI
What are the drugs that cause ACUTE INTERSTITIAL NEPRHITIS (fever, rash, arthralgia, eosinophilia in urine and blood, hematuria)? Tx?
6P's: P - pee diuretics (thiazide) P - PPI P - pain analgesics (NSAIDS) P - rifampin, phenytoin P - Penicillins, cephalosporins, sulfa P - alloPurinol
How does ACUTE INTERSTITIAL NEPHRITIS present? What does UA show?
FEVER + MACULOPAPULAR RASH + RENAL FAILURE
UA: WBC Casts + EOSINOPHILS
