True learn missed Flashcards
Alpha-1 antitrypsin deficiency causes what?
Emphysema and Liver Failure (genetic disease that presents in adult hood)
this is a hereditary disease (family members will have history of it) , alpha-1 antitrypsin cannot leave the liver leading to liver failure and therefore cannot exert its protectional effects on the lung tissue (protects lungs from proteases)
Bicipital tendonitis presents with pain located where
pain is exacerbated with what movements?
over the anterior shoulder worst at the bicipital groove
exacerbated with supinator or flexion
tx: conservative–> glucorticoid–>surgery
speed and yeargon tests are positive
subacromial bursitis pain is located where?
it is often poorly localized but pain can be around the acromion and is worse with overhead activities
pain can awaken you up at night
what are the treatment regimine options for latent TB (positive ppd but negative CXR)
Isoniazid for 9 months (pregnancy)
Isoniazid + rifapentine for 3 months (not in pregnancy)
Rifampin for 4 months (if isoniazid isnt tolerated)
Positive PPD <5mm
HIV patients with close contact to a person with active contagious disease
PPD >5mm
HIV, abnormal CXR, immunosuppressed patients on steroids, chemotherapy organ transplantation, TNF alpha, close contact with someone with active TB
PPD >10
children less than 4 years old
healthcare workers
Hep C, IV drug use, dialysis, diabetes, underweight
foreigner with high TB incidence (MEXICO)
PPD >15
health individuals older than 4 years old
What class of medications are recommended for initial treatment for fluid management in congestive heart failure- name the drugs in this class (4)
Loop diuretics
- bumetanide
- furosemide
- ethacrynic acid
- torsemide
Electrolyte abnormalities from loop diuretics
hypokalemia, hypomagnesemia, metabolic alkalosis
what are the electrolyte abnormalities from thiazide diuretics?
hypokalemia, hypomagnesemia, metabolic alkalosis
(inhibits Na/Cl in the distal tubule)
Acetazolamide indications and electrolyte derangments
glaucoma, mountain sickness, pseduotumor cerebri
metabolic acidosis and hypokalemia
Amiloride MOA and electrolyte derangments
inhibits ENaCs in the late distal tubule and collecting duct
hyperkalemia , decreased blood pressure
Why do people with COPD have increased hemoglobin and hematocrit
because hypoxia from a lung disease increases erythropoietin secretion and stimulates erythropoiesis
when should supplemental oxygen be given to patients with COPD?
when PaO2 <55mmHg or resting oxygen saturation is <88%
people with cor pulmonale, pulmonary hypertension, and hematocrit greater than what should be put on supplemental oxygen
55%
what are the two treatments that are shown to reduce mortality in patients with COPD?
smoking cessation and supplemental oxygen therapy
epiglottis sign on X-Ray
thumbprint sign (softened voice/hot potato voice)
seen on lateral X-ray- differentiate from retropharyngeal abscess
Lead pipe sign is seen in what pathology
ulcerative colitis (the colon loses its haustra)
steeple sign is found in?
Laryngotracheal broncitis (croup)
-tracheal narrowing
string sign is seen in
chrons disease (inflammation and fibrosis)
What is an alternative to steroid treatment in asthma for a patient who DOES NOT want to take a steroid
a leukotriene receptor antagonists aka montelukast
salmeterol is what class
long acting beta agonist (always given in conjunction with an inhaled glucocorticoid because monotherapy is linked to increased mortality)
workup for dermatitis herpetiformis
direct immunofluorescence, and serologic testing for any of the following
antigliadin
anti tissue transglutaminase 2 (preferred)
anti endomysium antibodies
treatment of dermatitis herpetiformis
dapsone and avoidance of gluten
imaging for scabies
mineral oil preperation of skin scraping
A positive sphix test means what
sacrum is backwards/extended
what does a positive lumbosacral spring test indicate (decreased spring at the lumbosacral junction)
sacrum is extended or backwards
description of a phyllodes tumor and treatment
description: large fast growing solid hypoechoic well circumscribed mass that may present with cystic areas (overlying can be taut and shiny with visible veins)
treatment: wide local excision
diagnosis of diabetes (3 criteria)
hemoglobin A1c > 6.5%
fasting glucose > 126 on 2 seperate occasions
2 hours plasma glucose test >200 in asymptomatic patient
random blood glucose > 200 in symptomatic patient
oral hypoglycemic medications should be given if the HbA1c is well above the 6.5% threshold
metformin is contraindicated in what instance
if GFR <30 of severe BUN/CR abnormalities
in patients with a hemoglobin A1C greater than 10 what is the first line treatment
INSULIN, diet modification, weight loss, and exercise
social smile develops when
3 months
sitting up without support develops when
6 months
raking grasp develops when
6 months (transfers objects between hands)
when do babies develop a pincer grasp and can crawl?
9 months
when can babies walk and throw objects, with separation anxiety
1 year
patients with severe burns greater than 20% should have what monitored?
urine output (along fluid resuscitation)
what is the parkland formula for burns?
4ml X % BSA burned = total amount given in the first 24 hours
administer half in the first 8 hours and the remaining half in the next 16 hours
complications of receiving too much fluid in burn victims
pulmonary edema, compartment syndrome, swelling of the arms and legs
which lung cancer has a poor prognosis, metastasizes easily, but has a great response to chemotherapy
small cell lung cancer
(associated with smoking)
dx: squamous cell poor response to radiation/chemo, treat with excision , can also present with hypercalcemia
the diagnosis of pancreatitis requires 2 out of the 3
epigastric pain
amylase or lipase 3X upper limit
and imaging ( if the first 2 are present IMAGING IS NOT NECESSARY TO START TREATMENT)
treatment of pancreatitis
IV hydration, NPO , antiemetics and analgesics
scoring for morality in pancreatitis
Ranson score >3
APACHE score > 8
howell-jolly bodies are seen in what pathology
sickle cell disease
they are inclusions of nuclear chromatin remnants due to autosplenectomy
patellofemoral syndrome symptoms
pain going up and down stairs
crepitius on ROM
pain with flexion and with sitting for a long time
meniscal tear symptoms
knee pain, locking and clicking of the knee joint
clinical trials compare what?
therapeutic benefit of a treatment and placebo or of 2 or more treatments
open label trial
RCTs that have more bias than double blinded RCTs in which both the subjects and investigators are aware of treatment assignments
one group goes to treatment group second group goes to placebo or standardized treatment
post herpetic neuralgia
persistence of pain at the initial site of herpes zoster after resolution of the rash
risk is increased with advanced age
employers are NOT allowed to require genetic testing as a prerequisite of employment, this is a violation of what act
The genetic information Nondiscrimination act of 2008 (GINA)
tell the patient this is a violation
What states it is ehtical for a physician to provide palliative therapy to relieve pain and sufffering even if treatment may hasten/cause death in said patient if the purpose is to relieve suffering and medications are titrated for that purpose
doctrine of double effect
euthanasia vs. physician assisted suicide
euthanasia- physician adminsters drug that kills patient with the goal to kill patient (illegal)
physician assisted suicde- physician prescribes drug that patient then self adminsters to end their own life (legal in oregon, washington and montana)
TCAS effect on the heart
block fast sodium channels which can cause QRS widening and a prolonged QT interval
how to combat QRS widening in TCA overdose
administer sodium bicarbonate to prevent sodium channel blockade
how to stabalize cardiac membrane in the setting of hyperkalemia
calcium gluconate
“peaked T waves, wide QRS”
if there is suspected bacterial meningitis what do you do
- lumbar puncture
- antibiotics >50 ampicillin, vancomycin, and ceftriaxone and steroids
acute epididymitis symptoms
untilateral scrotal pain
tenderness, swelling, relieve of pain with scrotal elevation known as phren sign, urinary frequency, localized tenderness along the posterior aspect of the testicle
MCC of epididymitis in <35 and >35
<35: Chlamydia and Gonorrhea - treatment is with oral doxy and IM ceftriazone
> 35 E. Coli- treatment is with oral levofloxacin for 10 days
what medication can cause epididymitis
amiodarone
what are the dysfunction of fryettes first principle of vertebral motion?
dysfunction includes more than 1 vertebrae
there is a neutral curve and rotation and side bending are in opposite directions
veterbral rotation and translation are to the same side (translation induces opposite side sidebending)
Small bowel obstrucution initial imaging
supine and upright abdominal radiographs (X-rays)
What is klienfelter syndrome
testicular atrophy/fibrosis leading to hypergonadotrophic hypogonadism
increased FSH and LH
decreased testosterone
gynecomastia, long arms and legs, small testes, and intellectual disabilities. 47XXY
(high estradiol as well)
what is the workup for klienfelters syndrome
total testosterone, LH and FSH
what is idopathic endolymphatic hydrops
meniners disease (vertigo, hearing loss, and tinnitus)
increased pressure in the inner ear
viral labyrnitis
tinnitus and hearing loss following a virus that is self limited and resolves with time
when accepting gifts in general esp from a pharmacetical rep what is accepted
you can accept gifts that will benefit patients (medical supplies, medical textbook, smart phone app) not any that will not benefit the patient ( sporting tickets, dinner)
ascending tracts responsible for
sensation
niopsy in primary sclerosing cholangitis shows what
periductal sclerosis (aka onion skinning)
associated with HLA-DR52a and Ulcerative cholitis
primary biliary cirrhosis biopsy shows
granulomatous destruction of the intrahepatic bile ducts
central depressed scar containing blood vessles in the liver
focal nodular hyperplasia
treatment of asystole or pulseless electrical activity
epinephrine and CPR (rounds)
CPR at a rate of 100-120/min
chest pulse and ryhtmn every 2 minutes
when is defibrillation used?
ventricular fibrilation of pulseless ventricular tachycardia
shockable ryhtmns
Vtach, Vfib
nonshockable rhythmns
PEA, asystole
reversible causes of cardiac arrest
5H’s
5T’s
hypovolemia, hypoxia, hydrogen ions, hypo/hyperkalemia, hypothermia
tension pneumothorax, tamponade, toxins, thrombosis (pulmonary or cardiac)
treatment of wide complex tachcardia
amiodarone
treatment of narrow complex tachycardia
vagal, adenosine
unstable: synchronized cardioversion
treatment of bradycardia
atropine if stable
unstable: transcutaneous pacing
