UW - Med/Misc Flashcards
What does Hazard ratio measure?
Chance of an event occurring in the Tx group compared to chance of event in control group (w/in set period)
HR 1 event more likely in Tx group, HR ~ 1 little difference between 2 groups
What is the best treatment to reverse osteoarthritis?
Weight loss for patients w/ high BMI
What factor is most important in determining quality of patient randomization in case/control study?
Baseline patient characteristics
What are case/control studies?
Analytical observational studies that retrospectively associated outcomes w/ specific risk factors (select case w/ outcome, and control w/o outcome, determine risk of getting outcome - exposure risks etc.)
What are retrospective cohort studies?
Unlike in case control, risk factor exposure is determined before the outcome is known, allowing calculation of relative risk (similar to prospective cohort except risk factor exposure and outcome all occur in past)
What sort of bias may occur when a treatment regimen selected for a patient depends on severity of patient’s condition? How do you avoid this?
A type of Selection bias called susceptibility bias (confounding by indication)
Randomly assign patients to treatments to minimize potential confounding variables, and Intention-to-Treat (ITT) analysis
What is recall bias?
Study participant’s answer to a question is affected by prior exposures (common in retrospective studies)
What type of drug is methotrexate and what are its major side effects? How can you avoid?
Folate antimetabolite
Hepatotoxicity, Stomatitis (oral ulcers), Cytopenias (also alopecia, pulm tox)
Provide Folic acid
What are the TNF alpha inhibitors and their major side effects?
Etanercept, infliximab, adalimumab
Neutropenia, Infections (TB reactivation), HF exacerbation, demyelinating diseases, increased risk of malignancy
What is the leading cause of blindness in industrialized nations and its clinical features?
Macular degeneration - distortion of straight lines into wavy lines, risks = old age, smoking, driving/reading first to be impaired
What are the key clinical causes of erythema nodosum and correlations?
#1 = Recent strep infection Sarcoid (female AA), TB (endemic region), Histoplasmosis (caves), Inflammatory bowel disease (GI sx),
What is Osgood-Schattler disease?
Chronic/repetitive strain at insertion of patellar tendon on tibial tubercle, seen in pre-adolescent and adolescent patients undergoing rapid growth spurts
-Pain w/ sports, relieved by rest, tenderness/swelling at tibial tubercle
In what situations are Relative risk and relative rate calculated?
Cohort studies where patients are followed over time for occurrence of disease
What steps should be taken in a patient who presents with organophosphate poisoning?
- Give atropine
- Remove clothing (especially if vomit/urine/stool covered) to ensure no continued absorption of organophosphates through skin
What does prussian blue stain indicate in the urine?
Presence of hemosiderin, hemolysis
What are the clinical features of psoriatic arthritis? How can you differentiate from RA?
-Arthritis of DIP joints (MCP/PIP more in RA), Asymmetric oligoarthritis, symmetric polyarthritis, arthritis mutilans (destructive), Spondylarthritides (sacrilitis, spondylitis)
-Soft tissue/nail involvement: Enthesitis (inflammation at tendon insertion), Dactylitis (sausage fingers), nail pitting and oncholysis, swelling in hands/feet w/ pitting
-Psoriatic lesions: plaques w/ silvery scaling on dorsum of hand
[skin findings, soft tissue/nail involvement not in RA)
What is a factorial design study? Cluster analysis? Parallel study?
- Factorial - Involves 2 or more experimental interventions, each with 2 or more variables that are studied independantly
- Cluster - Grouping of different data points into similar categories
- Parallel - Randomizes 1 tx to 1 grp, and a different Tx to a different grp
What is a baker’s cyst? What are Tophi?
BC - Develop from excessive fluid production by inflamed synovium (like in RA, OA, cartilage tears). As synovial fluid expands, excessive fluid accumulates in popliteal bursa
Tophi - collections of urate crystals which form firm yellow nodules at sites of involved joints, in patients w/ chronic gout
What is the pathogenesis and clinical features of pseudogout?
- Acute arthritis induced by release of calcium pyrophosphate dehydrate (CPPD) crystals from sites of CHONDROCALCINOSIS (calcification of articular cartilage) into the joint space
- Acute pain, swelling, redness, and limited joint movement (knees most common)
What is a chalazion and how do you manage it?
- Painful swelling mass on eyelid that can progress to nodular rubbery mass - chronic granulomatous condition that occurs when meibomian gland becomes obstructed
- If persistent/recurrent it may be Meibomian gland Carcinoma (sebaceous carcinoma) –> histopathology to rule out malignancy
What are the types of TCAs?
Ends w/ -ptyline or -pramine
What toxicities are associated w/ TCA overdose? How do you treat it?
CNS: Sedation, Seizures, Coma
CV: Sinus tach, HoTN, Prolonged PR/QRS/QT, arrhythmia
Anticholinergic: Dry mouth, blurred vision, dilated pupils, urinary retention, flushing, hyperthermia
Tx: Suppl O2/intubation, IV fluids, Activated charcoal (if w/in 2hr ingestion unless ileus present), IV NaHCO3 for QRS widening or Ventricular arrhythmia
What Derm side effect can be induced by steroid use?
Steroid induced folliculitis, or steroid acne; monomorphous pink papules and absence of comedones
When can doctors respond to employer’s request of health info?
Only if patient provides specific verbal or written authorization for release of info to employer
How do Stage 2 decubitus pressure ulcers form? Which patients are at risk?
- Pressure ulcers common in patients w/ conditions that reduce normal sensation and movement (paraplegia, stroke), most often over bony prominence in contact w/ bed
- Immobility is biggest risk factor
What are the features of Dermatomyositis? How do you diagnose and properly manage for associated risks?
- Proximal muscle weakness (same in UE vs. LE)
- Gottron’s papules (rash over joints of hand) and heliotrope rash on skin (panda eyes, swollen)
- Interstitial lung disease, dysphagia, myocarditis
Dx: High CPK, aldolase, ADH; anti RNP, jo, mi2 (EMG/biopsy if uncertain)
Tx: High dose glucocorticoids PLUS gluc-sparing agent
SCREEN FOR MALIGNANCY
What is adhesive capsulitis and its features?
- Chronic inflammation, fibrosis and contracture of joint capsule cause glenohumeral joint to lose normal distensibility
- Frozen shoulder: decreased passive/active range of motion
- Stiffness»_space; than pain
What features are consistent w/ rotator cuff impingement or tendinopathy?
- Pain w/ abduction and external rotation
- Subacromial tenderness
- Normal range of motion, w/ positive impingement tests (Neer, Hawkins)
What symptoms are associated w/ vertebral compression fracture? What underlying problems is this associated w/?
- Acute back pain and point tenderness after strenuous activity (gradual onset can be Asymptomatic), decreased spinal mobility after bending, coughing or lifting. Does not improve w/ rest
- Can get Kyphosis -> decreased resp capacity -> Atelectasis pneumonia risk
- Osteoporosis is most common cause, and osteomalacia (loss of bone mineral density)
What symptoms indicate lumbar disk degeneration?
Low back pain in elderly, pain worsens w/ activity and relieved w/ rest (nighttime pain unlikely)
What is fluorescein examination?
Dye application w/ wood’s lamp or slit lamp exam to look for corneal abrasions
What are the features of crystal induced arthritis?
Warm, painful, swollen joint, accompanied by low grade fever, WBC counts of 5k-80k, crystals under polarized light
What should always be considered in patients with unexplained elevations in creatine kinase? What should be checked?
HYPOTHYROIDISM - Check serum TSH; ANA may be positive if Hashimoto’s thyroiditis
What other clinical conditions/features would be seen in a patient with polymyositis that may help distinguish from other myopathies like hypothyroidism?
Raynaud’s disease & Interstitial lung disease
What lab abnormalities are seen in Paget’s disease?
Normal Calcium and phosphate, elevated alk phos, increased urinary hydroxyproline (or deoxypyridinoline and telopeptides; all markers of bone destruction)
What is Hordeolum? Stye?
Purulent infection of eyelid glands, caused by staph
Stye is a specific small type of hordeolum involving Zeis’s or Mol’s glands
What antibodies are associated w/ rheumatoid arthritis? SLE?
RA: anti-cyclic citrullinated peptide and rheumatoid factor
SLE: Antinuclear Ab is sensitive, anti-dsDNA abs highly specific
you look into a patient’s eyes and notice loss of transparency of the lens. They have painless blurred vision, glare, and notice halos around lights. What is this condition, how is it caused, and what are potential risk factors for it?
Cataracts (lens opacification) - oxidative damage to lens w/ aging
Risks: Age, diabetes, smoking, chronic sunlight exposure, glucocorticoid use
What part of vision is affected by macular degeneration and what are the 2 forms of this condition?
Affects CENTRAL vision. Can be 1) Atrophic or dry form, which is slow progressive b/l vision loss (drusins/patchy depigmentation of macula) or 2) Exudative/neovascular or wet form, unilateral aggressive vision loss
How can you treat a patient presenting w/ signs of cocaine overdose?
Supplemental O2 and IV benzodiazepine (for HTN and anxiety)
Can also give aspirin to stop thrombus formation, Nitro and Ca channel blockers to counteract vasoconstriction induced by cocaine
What is the best study to determine incidence between two patient populations?
Cohort
What does sensitivity measure?
True positive rate - how many correct + tests among all w/ actual disease
TP/(TP + FN)
What are the signs of TCA overdose? How do you treat this?
Sx: Hyperthermia, Anticholinergic effects (dilated pupils, intestinal ileus), seizures, QRS prolongation (decreased myocardial conduction velocities, risk of Ventricular arrhythmia)
Tx: Secure Airway, Breathing and Circulation, Sodium bicarbonate for cardiac sx (improves SBP, narrows QRS, decreases vent arrhythmias)
What is the presentation for uveitis?
- Blurred vision w/ moderate pain, conjunctival injection, and constricted pupils
- Hypopyon (severe injection) in severe cases
- Keratic precipitates (“Mutton fat”) and iris nodules may be seen
- Associated w/ HLA B27
What is the presentation for postoperative endophthalmitis?
- Recent eye surgery
- Swollen eyelids, and conjuctiva, hypopyon, corneal edema and infection
- In severe infection can inject Abx or do vitrectomy
What is dacryocystitis?
Infection of lacrimal sac - sudden onset of pain and redness in the medial canthal region
What are the features tinea capitis?
scaly erythematous patch on scalp that can progress to alopecia w/ residual black dot (more common in blacks, shared combs)
How do you treat reactive arthritis in an afebrile patient?
NSAIDs (only give Abx w/ strong clinical suspicion of infection)
what intervention is most helpful to decrease medication related medical error?
Pharmacist-directed interventions
What is seborrheic dermatitis?
Common inflammatory disease affecting sebaceous glands in scalp (dandruff) and face
-Pruritic erythematous plaques w/ fine, loose, yellow, and greasy looking scales
What are the symptoms of opioid withdrawal?
N/V, cramps, diarrhea, dysphoria, restlessness, lacrimation, myalgias, arthralgias
PE: Mydriasis, piloercetion, Hyperactive bowel sounds
What is chlordiazepoxide used in the management of?
Alcohol withdrawal
What is the purpose of the Schilling test? Rapid plasma reagin test?
Schilling - Test to see if patient is absorbing Vit B12 properly
RPR - Test for treponema pallidum
What effect does raising the cut off point (i.e. increasing inclusion criteria) have on a screening test?
Higher chance to rule in disease (SPIN) so Specificity will increase, less likely to rule out disease (SNOUT) so sensitivity decreases
What are the early clinical signs of primary open angle glaucoma? Risks of getting this?
- Asymptomatic early on
- May reveal loss of peripheral vision (eventually tunnel vision), cupping of optic disk,
- Common in Blacks, diabetics and FHx of glaucoma,
What is the most common cause of v B12 deficiency in european whites? clinical features? how can you diagnose?
- Pernicious anemia
- Other autoimmune diseases (thyroid dz, vitiligo), Atrophic glossitis (shiny tongue), ataxia (shuffling broad gait), neuro abnormalities (loss of position and vibration), macrocytic/megaloblastic anemia, thrombocytopenia and leukopenia in severe disease
- Anti-intrinsic factor Abs can confirm
How does someone w/ herpes simplex keratitis present, and what are the causes?
- Pain, photophobia, blurred vision, tearing and redness
- Eye exam reveals corneal vesicles and dendritic ulcers
- Precipitated by excessive sun exposure, working outdoors, fever, immunodeficiency
What effects can Amitriptyline have on bladder activity?
Urinary retention by reducing detrusor muscle contractions
Which drugs are associated with acute pancreatitis?
- Diuretics (furosemide, thiazides)
- Drugs for IBD (sulfasalazine, 5-ASA)
- Immunosuppressive agents (azathioprine)
- HIV-related meds (didanosine, pentamidine)
- Antibiotics (metronidazole, tetracycline)
- Anti-seizure meds (Valproic acid)
What are the features of rosacea?
rosy hue w/ telangiectasias over cheek nose and chin, precipitated by hot drinks, heat, emotions , can be permanent and have pustules
What is most commonly affected in the core of the body with Rheumatoid arhtritis?
Cervical spine joints in axial skeleton (leading to spine subluxation and cord compression),
What are the signs of benzo toxicity?
slurred speech, unsteady gait, drowsiness
What is the most common malignancy in women aged 25-29?
Melanoma
What are the clinical signs of dermatomyositis?
Symmetrical proximal muscle weakness, erythematous rash on dorsum of fingers (Gottron’s sign) and/or upper eyelids (heliotrope rash), reflexes intact
What is enthesitis and where is it most commonly seen?
- Inflammation and pain at sites where tendons and ligaments attach to bone
- Recurrent tendon/ligament stress and HLA-B27 associated arthropathies
What are the main side effects of Tacrolimus? Mycophenolate? Azathioprine?
Tacro - Neurotoxicity, diarrhea, and glucose intolerance
MFF - bone Marrow suppression
Azath- dose related diarrhea, leukopenia, hepatotoxic
What is surveillance bias?
When exposed groups undergo increased surveillance/monitoring vs. the general population, which increases disease dx compared to general population
What are red flags for back pain and how should they be evaluated?
Age >50, cancer Hx, Constitutional sx (fever/weight loss), nighttime pain causing sleep difficulty, pain >1month, no response to previous therapy, neuro sx
-XRay films and ESR level
How do you confirm a suspected melanoma?
Excisional biopsy w/ NARROW margins (don’t want to remove margins around a benign lesion)
What are the signs and features of fibromyalgia and how do you treat?
Young-middle aged woman, widespread pain/fatigue/cog-mood disturbances. Point muscle tenderness to gentle palp over neck/shoulder/back muscles
Tx: Regular aerobic exercise and good sleep hygiene
What is adult Still’s disease?
Inflammatory disorder characterized by recurrent high fevers (>39C), rash (maculopapular, non-pruritic, trunk/extm), and arhtritis
What Abs are present in systemic sclerosis?
Antinuclear autoantibodies, anti-topoisomerase I abs
