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TrueLearn Flashcards

1
Q

Diverticulitis

A

Diverticulitis without peritonitis or hemodynamic instability can be managed conservatively with intravenous antibiotics and NPO status.

Abscesses less than 4 cm can generally be treated with antibiotics alone.

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2
Q

Medial Meniscus Injury Examination

A

The McMurray test is the best test to assess injury to the medial meniscus.

“Passive flexion and extension of the joint with internal and external rotation”

performed by holding the knee with one hand placed along the knee joint line, and flexing the knee to 90° while the foot is held by the calcaneus of the other hand. The tibia is externally rotated while the knee is extended through a full range of motion. If this maneuver is painful or if crepitus is palpated along the medial joint line, this constitutes a positive test and typically indicates a tear in the posteromedial meniscus. This test can be adjusted to assess the lateral meniscus as well, as the tibia can be internally rotated as the leg is extended. If pain or a “click” is felt, then this is consistent with a positive test and may indicate a lateral meniscus tear.

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3
Q

Corneal Abrasion

A

Corneal abrasions are a common ocular injury in POST-SURGICAL patients and are best diagnosed by slit-lamp examination with fluorescein staining (or an ocular exam with an ophthalmoscope, if a slit lamp is unavailable).

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4
Q

ACL tear

A

The anterior cruciate ligament (ACL) is the most common knee ligament to be injured, and patients commonly report a twisting motion before the injury. An ACL tear presents classically with a “pop,” swelling, instability, and LATERAL knee pain.

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5
Q

Paronychia

A

Paronychia is acute or chronic inflammation that involves the lateral or proximal nail folds and if associated with abscess, should be treated with incision and drainage followed by targeted antibiotics if it does not resolve

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6
Q

Abdominal Aortic Aneurysm

A

Aneurysm diameter and expansion rate are predictors of aneurysm rupture, with diameters greater than 5.5 cm and/or expansion of over 1 cm within a year increasing the risk exponentially. These patients should be referred to vascular surgery for potential repair.

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7
Q

Tinea Versicolor

A

Tinea versicolor is a fungal infection caused by Pityrosporum orbiculare or ovale. It causes annular hypopigmented scaly macules, which usually appear on the chest and back. It is common in young adults and teenagers due to increased sebaceous gland activity. A diagnosis can be made by the appearance of the classic “spaghetti and meatballs” on KOH prep. Initial treatment of choice is topical ketoconazole 2% or selenium sulfide 2.5% suspension. Oral antifungals may be used in resistant or recurrent cases.

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8
Q

Viscerosomatic for heart

A

T1 - T5

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9
Q

Brown-Sequard Syndrome characteristics

A
  1. ipsilateral loss of vibration
  2. ipsilateral spastic paresis below the lesion,
  3. ipsilateral flaccid paralysis at the level of the lesion
  4. and contralateral loss of pain and temperature below the lesion
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10
Q

Celiac dz histology characteristics

A

intestinal mucosa with flattened microvilli

villous atrophy that leads to the malabsorption of nutrients and many of the sequelae of the celiac disease

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11
Q

Lichens Planus

A 
Rash recognized by the 6 P's 
pruritus, 
purple, 
planar, 
polygonal, 
papule/plaque) and 
Wickham striae.

It is classically associated with hepatitis C virus.

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12
Q

Disseminated Intravascular Coagulopathy

A

When a patient is in disseminated intravascular coagulopathy, the platelet levels are decreased, the fibrinogen level is decreased, and the fibrin degradation products are increased

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13
Q

Physiology jaundice

A

Physiologic jaundice occurs in most newborns and manifests as mild unconjugated hyperbilirubinemia and jaundice. It usually resolves within 1-2 weeks without treatment.

– total bilirubin exceeds 25 mg/dL = infants are at risk for potentially lethal kernicterus

– Unconjugated hyperbilirubinemia may be physiologic. Conjugated hyperbilirubinemia is never physiologic

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14
Q

Breslow Depth

A

Tumor thickness is the most important prognostic factor on biopsy, and a depth of invasion >0.8 mm is an indication for sentinel lymph node biopsy.

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15
Q

Acute viral or idiopathic pericarditis treatment

A
  1. NSAIDs
  2. Colchicine

**steroids only if there are contraindications to NSAIDs

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16
Q

Causes of A-Fib

A

Conditions associated with the development of atrial fibrillation

  • hypertensive heart disease (most common)
  • coronary artery disease
  • left atrial enlargement
  • valvular pathology (most common: mitral stenosis)
  • cardiac surgery
  • hyperthyroidism
  • electrolyte abnormalities
  • **alcohol **ingestion (both acute intoxication and chronic ingestion).
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17
Q

Iron intoxication diagnostic finding and treatment

A

CXR: Iron, as a metal, is also radio-opaque and can be visible on x-ray examinations

Tx: deferoxamine

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18
Q

MEN type I, IIa and IIb

A

Type 1:
-Pancreatic islet cell tumor

  • Parathyroid hyperplasia
  • Pituitary adenomas

Type IIa:

  • Medullary thyroid cancer
  • Parathyroid hyperplasia
  • Pheochromocytoma

Type IIb:

  • Medullary thyroid cancer
  • Pheochromocytoma
  • Marfanoid habitus
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19
Q

Rule of 9’s : % of body surface area

A

9%— head, each arm (front + back)

18% — each leg (front+ back)

18% — chest + abd only one side

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20
Q

Parkland formula for fluid management in patients with second- and third-degree burns.

A

The formula is mL of fluid/24 hours = 4 x body mass (kg) x % body surface area affected. 

Use rule of 9’s for BSA calculation

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21
Q

How to rule out preterm labor?

A

Collect FETAL FIBRONECTIN first in patients with signs or symptoms of preterm labor between 22 and 35 weeks of gestation.

negative fetal fibronectin result, the physician can be 99% sure that the patient will not go into preterm labor in the next 2 weeks

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22
Q

Corneal abrasion

A
  • appears fluorescent green on slit-lamp exam
  • tx: TOPICAL antibiotics (so NOT eye drops but instead an eye ointment)
    »erythromycin
    »trimethoprim/polymyxin B
    »sulfacetamide sodium
  • if pt uses contacts – need abx to target pseudomonas
    » ciprofloxacin
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23
Q

Acute pancreatitis – important lab value that is a mortality predictor

A

In any patient presenting with acute pancreatitis, the greatest laboratory predictor of mortality is change in BUN over the first 48 hours

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24
Q

Magnesium toxicity

A

–common findings of early onset toxicity include nausea, muscle weakness (often detected as decreased deep tendon reflexes), and low blood pressure

–As serum magnesium levels rise, the sinoatrial (SA) and atrioventricular (AV) node can be affected causing EKG changes such as a prolonged PR interval and intraventricular conduction delay. Eventually there will be loss of respiratory muscle tone leading to respiratory paralysis and/or arrhythmia leading to cardiac arrest

–Magnesium in high concentrations acts as a calcium antagonist, preventing muscular contraction

–tx: IV calcium gluconate.

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25
Q

Main cause of fluid retention in cirrhosis

A

activation of the renin-angiotensin-aldosterone system (RAAS) due to a perceived low-flow state – this causes retention of salt and water

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26
Q

Kehr’s sign

A

occurs in response to blood or fluid accumulation under the diaphragm. This blood or fluid causes irritation of the phrenic nerve, which refers pain to the shoulder.

ex. pt gets kicked in the ribs –> causes a rib fracture that punctures the spleen –> splenic rupture –> blood accumulation below diaphragm –> diaphragmatic irritation –> referred shoulder pain

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27
Q

Transient tachypenia of newborn

  • definition
  • cxr finding
  • tx
A

– TTN = newborn presents with respiratory distress within 2-hours of delivery (c-section is a risk factor), clear lungs on auscultation

– CXR: hyperexpansion of the lungs with signs of fluid on chest x-ray

– treated with supportive care and supplemental oxygen

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28
Q

SERMs (selective estrogen receptor modulators) and their different effects of diff. tissues

  1. Clomiphene
  2. Tamoxifen
  3. Raloxifene
A
  1. CLOMIPHENE
    > used for anovulation
    > antagonist at hypothalamus
  2. TAMOXIFEN
    > used for tx of breast cancer (antag. at breast)
    > agonist at uterus (thus inc risk of endometrial cancer)
    > agonist at bone (can be useful in osteoporosis or when you need more bone turnover/formation)
  3. RALOXIFENE
    > used for tx of breast cancer (antag. at breast)
    > used for tx of osteoporosis (agonist at bone)
    > antag. at uterus = no risk of endometrial cancer
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29
Q

Concerns for ischemic stroke – can give TPA but what is the window in which TPA can be given?

A

3 hours, if symptoms >3h then TPA is useless

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30
Q

The one thing that causes BOTH a PRIMARY respiratory alkalosis and PRIMARY metabolic acidosis

A

Aspirin (SALICYLATE) poisoning
–only single causes of both a primary respiratory alkalosis and primary metabolic acidosis

–due to direct stimulation of the respiratory center (alkalosis) and

–uncoupling of oxidative phosphorylation with renal dysfunction (buildup of lactic, phosphoric, and sulfuric acids as well as generation of ketone bodies)

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31
Q

Thyroglossal duct cyst

A
    • subhyoid portion of the tract and most present as a midline swelling
    • cyst will move upwards on protrusion of the tongue, given its attachment to the embryonic duct, as well as on swallowing, due to attachment of the tract to the foramen cecum
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32
Q

Cancers that metastasize to the bone

A
  • lung
  • breast ** (so ask women about mammograms)
  • thyroid
  • renal
  • prostate

> lytic bone lesions = multiple myeloma or lymphoma (can drive from any of the above)

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33
Q

Guillain-Barre Synd

A

– acute, progressive, ascending, symmetrical loss of motor function

– treat with plasma exchange or IVIG

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34
Q

Chronic myeloid leukemia (CML)

A

t(9:22)

    • BCR-ABL1
    • Philadelphia chromosome
    • Responsive to tyrosine-kinase inhibitors (ie. -nibs)
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35
Q

Brukitt Lymphoma

A

t(8:14)

    • c-MYC
    • Translocation of MYC and Ig heavy-chain genes
36
Q

Mantel-Cell lymphoma

A

t(11:14)

    • BCL1
    • Results in overexpression of cyclin D1
37
Q

Ewing Sarcoma

A

t(11:22)

    • ages 10 - 20yo mostly boys
    • onion-skin bones
38
Q

M3-type acute myeloid leukemia (AML)

A

t(15:17)

– PML-RAR alpha fusion protein, responsive to all-trans retinoic acid

39
Q

Follicular Lymphoma

A

t(14:18)

– BCL2

40
Q

Toxicity from house fires

A
  1. Carbon monoxide — give 100% FiO2

2. CYANIDE toxicity – give hydroxycobalamin

41
Q

Arsenic toxicity tx

A

Dimercaprol, succimer

42
Q

Beta blocker toxicity

Calcium-channel blocker toxicity

A
  1. BB – glucagon

2. CCC – glucagon, calcium chloride

43
Q

Iron toxicity tx

A

Deferoxamine

44
Q

Tx of

  1. Anticholinergic toxicity
  2. Organophosphate toxicity
A
  1. Anticholinergic toxicity
    » Physostigmine
    » Neostigmine
  2. Organophosphate toxicity
    » Pralidoxime
    » Atropine
45
Q

Transient vision loss that only lasts for a few minutes; just one eye; “like a curtain falling over the eye”

A

Retinal emboli

    • usually d/t carotid artery stenosis
    • do carotid US
46
Q

Medications for new-onset systolic congestive heart failure and coronary artery disease (or ischemic cardiomyopathy)?

A
  1. Beta-blocker (ie. carvedilol)
  2. ACE-I (ie lisinopril) or ARB
  3. Statin (ie atrovastatin)
47
Q

Acrodermatitis enteropathica (AE)

A
    • ZINC deficiency :
    • growth delay (dwarfism)
    • hypogonadism in older child
    • perioral + perianal rash
    • diarrhea
    • frequent infections
48
Q

Etiology of gasteroenteritis that occurs very soon after eating (ie quick onset food poisoning)

A

Staph aureus

49
Q

Inflammatory infiltrates composed of macrophages and CD4+ lymphocytes in all arterial layers

this is a biopsy finding for what condition?

A

Giant cell arteritis (GCA)

Giant-cell arteritis is a chronic large vasculitis that typically manifests in elderly patients. It is commonly associated with polymyalgia rheumatica (pts complain of jaw pain, pelvic girdle pain)

50
Q

The “plague” is caused by what microbe?

Tx?

A

Yersinia pestis

Tx:
1st – aminoglysides (ie gentamycin)
2nd – either tetracyclines or fluoroquinolones

51
Q

Behcet Syndrome

A

Multisystem inflammatory vasculitis

    • painful genital + oral ulcers
    • arthritis
    • uveitis
    • fibromyalgia often co-exists with behcet’s
52
Q

Positive spring test

explain it – what does it mean? flexion or ext?

A

POSITIVE test = NO motion NO spring; restricted

+spring see in:

    • backward sacral torsion
    • sacral EXTENSIONS
53
Q

Late fetal heart tone decelerations – due to?

Early decels due to?

Varial decels due to?

A

LATE — uteroplacental insufficiency

EARLY — inc. vagal tone 2/2 head compression

VARIABLE – umbilical cord compression

54
Q

Stuck-on appearance for lesion

A

Sebhorrheic keratosis (SK)

– do a SHAVE biopsy

55
Q

Methemoglobinemia

    • cause
    • pathophys
    • tx
A

Methemaglobinemia - hemoglobin that contains oxidized (Fe3+) heme groups

– can be caused by oxidant stressors like nitrites, sulfur-containing compounds, sepsis, or local anesthetics
EX. mountain water has a lot of nitrites

    • In order for oxygen to bind to hemoglobin, the heme groups need to be in the reduced state (Fe2+).
    • Oxidized heme groups cannot bind oxygen, which leads to shortness of breath and fatigue.

TX: IV methylene blue - reduces oxidized heme groups (giving O2 won’t help)

56
Q

Hyperthyroid medication for first-trimester of pregnancy vs later on

A

First-trimester: PTU

2nd - 3rd trimester: methimazole OR CAN CONTINUE PTU

57
Q

Bioterrorism bacteria that causes breathing difficulty and chest pathology, hemoptysis in only a few hours/couple days after exposure?

A

Yersenia pestes = PNEUMONIC PLAGUE
– G NEGATIVe bacilli

**anthrax is a G POSITIVE bacili

** Tularemia is VERY similar, almost exact same symptoms but it is a G negative COCCOBACILLI

58
Q

Pt suspected of alcohol withdrawal, what is your initial work up (3 required things)

A

Workup = labs and diagnostic tests (NO TREATMENTS yet)

  1. BMP – check electrolytes ( severe hyponatremia, hypokalemia, and hypomagnesemia; acidosis, hyperglycemia)
  2. CBC – leukocytosis, thrombocytopenia, or anemia
  3. Liver function tests – ;ook for signs of alcoholic hepatitis or severe liver injury
59
Q

Pt suspected of alcohol withdrawal pretty sever symptoms, what is your management (3 required things)

A

Management = do you admit to hospital? what treatments do you give?

  1. Admit to hospital
  2. IV benzodiazepine like lorazepam
  3. Thiamine (all alcoholics need this for withdrawal to prevent Wernicke’s encephalopathy)
    4 IV fluid hydration with NS or LR
60
Q

Most sensitive exam to test for ACL tear?

A

Lachman test! (NOT anterior drawer)

performed by placing the knee in approximately 30 degrees of flexion, with one hand stabilizing the distal femur. The other hand pulls the proximal tibia anteriorly while attempting to produce an anterior translation of the tibia on the femur.

61
Q

What is cradle cap and what is first line tx?

A

Cradle Cap - infantile seborrheic dermatitis of the scalp

    • looks like yellow greasy scales on head
    • 1st tx: EMOLLIENTS = petrolatum, vegetable oil, mineral oil, or baby oil) followed by removal with a brush or comb
62
Q

Most common benign tumor of the liver

A

Cavernous hemangioma

**focal nodular hyperplasia is not an actual tumor so can’t say this

63
Q

Tx for patient with symptomatic third-degree heart block

A

Transcutaneous pacing – Transcutaneous pacing can be performed almost immediately, does not require IV access, and can reverse the cause of shock which is likely profound bradycardia

Other considerations for treatment include
IV atropine
IV dopamine
or IV dobutamine
which can all increase AV conduction. IV dopamine and dobutamine can also increase contractility

64
Q

What is Von-Hippel-Lindau disease (VHL)

A

VHL
– rare disease that causes growth of tumors and cysts throughout body
– hallmarks of VHL= development of…..
» retinal and central nervous system (CNS) hemangioblastomas (blood vessel tumors)
» pheochromocytomas
» multiple cysts in the pancreas and kidneys
» increased risk for malignant transformation of renal cysts into renal cell carcinoma

-- signs/symptoms:
>> headaches
>> problems with balance and walking (due to involvement in the cerebellum with an hemangioblastoma)
>> dizziness
>> weakness of the limbs
>> vision problems
>> high blood pressure
65
Q

ECG characteristic of a second degree heart block type 1 (Mobitz 1)

A

Mobitz 1 = Wenckebach

    • lengthening of PR interval right before it drops
    • PR interval is shortest directly after the dropped beat and longest just before the next dropped beat.
66
Q

Name the renal disease associated with the following electron microscopic findings:

  1. Apple-green birefringence
  2. Basement membrane splitting
  3. Linear anti-GBM deposits
  4. Spike and dome granular basement membrane deposits
  5. Tram-track double-layered basement membrane
A
  1. Apple-green birefringence
    » Renal amyloidosis (i.e. multiple myeloma, plasma cell dyscrasias)
  2. Basement membrane splitting
    » Alport syndrome
  3. Linear anti-GBM deposits
    » Goodpasture syndrome
  4. Spike and dome granular basement membrane deposits
    » due to granular deposits of IgG and C3
    » assoc. w/membranous nephropathy
    » assoc w/ these types of nephrotic synd: hepatitis viruses, lupus, NSAIDs, gold salts, and malignancies
  5. Tram-track double-layered basement membrane
    » d/t subendothelial and mesangial deposits seen in membranoproliferative glomerulonephritis (MPGN)

> > underlying causes of MGFN — hepatitis viruses, lupus, monoclonal gammopathies, and inherited complement abnormalities

67
Q

Genetic quad screen in trisomy 21 fetus (high or low: AFP, estriol, inhibin, beta hCG)

A
  1. AFP = low
  2. Estriol = low
  3. Inhibin = HIGH
  4. beta-hCG = HIGH
68
Q

Most common form of thyroid cancer

A

Papillary thyroid cancer

**psammoma bodies

69
Q

lifts head/chest when prone, tracks past midline, alert to sound, coos, recognizes parent, social smile

What age based on these milestones?

A

2 months old

70
Q

rolls front to back and back to front, grasps rattle, orients to voice, enjoys looking around, laughs

What age based on these milestones?

A

4-5 months old

71
Q

sits unassisted, transfers objects, raking grasp, babbles, stranger anxiety

What age based on these milestones?

A

6 months old

72
Q

crawls, pulls to stand, uses 3-finger pincer grasp, says mama/dada (nonspecific), waves bye-bye, plays pat-a-cake

What age based on these milestones?

A

9 - 10 months old

73
Q

cruises, walks alone, uses 2-finger pincer grasp, says mama/dada specific, imitates actions

What age based on these milestones?

A

12 months old

74
Q

walks backward, uses a cup, uses 4 to 6 words, temper tantrums

What age based on these milestones?

A

15 months old

75
Q

runs, kicks a ball, builds tower of 2 to 4 cubes, names common objects, copies parents in tasks

What age based on these milestones?

A

18 months old

76
Q

walks up/down steps with help, jumps, builds tower of 6 cubes, uses 2-word phrases, follows 2-step commands, removes clothes

What age based on these milestones?

A

2 years old

77
Q

rides tricycle, climbs stairs with alternating feet (3 to 4 years), copies a circle, uses utensils, uses 3-word sentences, brushes teeth with help, washes/dries hands

What age based on these milestones?

A

3 years old

78
Q

hops, copies a cross, counts to 10, cooperative play

What age based on these milestones?

A

4 years old

79
Q

Medication treatment for primary biliary cholangitis?

A

Ursodeoxycholic acid

slows the progression of primary biliary cholangitis by slowing the immune-mediated destruction of the intrahepatic bile ducts

(antimicrobial antibodies)

80
Q

Jarisch Herxheimer reaction

A

reaction to endotoxinlike products released by the death of harmful microorganisms within the body during antibiotic treatment.

– usually occurs 2 hours after administering antibiotic

81
Q

Res ipsa loquitur

A

The thing speaks for itself

– injury to patient due to NEGLIGENCE– like leaving a scalpel in the abdomen during surgery

82
Q

4 year old WCC vaccines

A
  1. Measles, mumps, and rubella (MMR)
  2. Varicella
  3. IPV (polio)
  4. Dtap (diphtheria, tetanus, and pertussis)
83
Q

Pulseless vtach first treatment

A

Emergent defibrillation

Synchronized cardioversion = for unstable VT - characterized by patients with EKG evidence of VT while presenting with symptoms such as presyncope, hypotension, or chest pain.

84
Q

Organ –> What Spinal Level would show hypertonicity for problems with these organs?

Head and Neck (ears are included)
Heart	
Lungs
Esophagus
Stomach
Small intestine
Ascending colon
Descending colon
Pancreas
Liver/ gallbladder
Spleen
Kidney
Ureter
Prostate
Uterusl
A
  1. Head and Neck (think ear infections) T1-T5
  2. Heart T1-T5 left
  3. Lungs T1-T4
  4. Esophagus T3-T6 right
  5. Stomach T5-T10 left
  6. Small intestine T8-T10 bilateral
  7. Ascending colon T11-L1 right
  8. Descending colon L1-L3 left
  9. Pancreas T5-T9 right or bilateral
  10. Liver/ gallbladder T5-T10 right
  11. Spleen T7-T9 left
  12. Kidney T9- L1 ipsilateral
  13. Ureter T11-L3 ipsilateral
  14. Prostate T10-L2 bilateral
  15. Uterus T9-L2 bilateral
85
Q

S1Q3T3 what is it

A

ECG finding showing
Downward S wave in lead I
Q wave in lead III
Inverted T wave in lead III

Associated with right ventricular strain pattern = think PE or other RV issues

86
Q

Most common cause of microcytosis ? What does peripheral smear show?

so a patient has normal iron studies and normal erythrocyte count, just their hemaglobin is low and MCV is low

A

Thalassemia !

Peripheral smear will show condocytes = target cells

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