UWorld All Subjects 3 Flashcards
Pt and management of gender dysphoria
Pt: experiences persistent (>/= 6 months) incongruence between assigned + felt gender
- desires to be another gender
- dislikes own anatomy, desires sexual trains of another gender
- believes feelings/reactions are of another gender
- feels significant distress/impairment
Management: assessment of safety, support w/ psychotherapy (individual or family); referral to specialist services (medical + mental health multidisciplinary)
Mechanism, Pt, Dx, and management of optic nerve injury
Mechanism: indirect: shearing forces from facial trauma
direct: penetrating eye trauma
Pt: acute vision loss, decreased color vision, afferent pupillary defect
Dx: CT scan of the orbit
Management: urgent ophthalmology referral; +/- surgical decompression
Pt, Dx, and complications of prader-willi syndrome
Pt: hypotonia, weak suck/feeding problems in infancy; hyperphagia/obesity, short stature, hypogonadism, intellectual disability, dysmorphic features (narrow forehead, almond-shaped eyes, downturned mouth)
Dx: deletions on paternal 15q11-q13
Complications: sleep apnea, T2DM, gastric distension/rupture, death by choking
What is the MOA of flushing as a side effect of niacin? How can this be managed?
flushing and generalized pruritus are side effects of high-dose niacin therapy due to niacin-induced peripheral vasodilation via drug-induced release of histamine and prostaglandins
low-dose aspirin can greatly reduce or prevent sx if taken 30 min before niacin; flushing and pruritus usually improve after 2-4 weeks of therapy
Risk factors, Pt, and management of pubic symphysis diastasis
Risk factors: fetal macrosomia, multiparity, precipitous labor, operative vaginal delivery
Pt: difficulty ambulating, radiating suprapubic pain, pubic symphysis tenderness, intact neurologic examination
management: conservative, NSAIDs, physical therapy, pelvic support
Risk factors, Pt, and management of ABO hemolytic disease
Risk factors: infants with blood types A or B born to a mother with blood type O
Pt: jaundice within 24 hours of birth, anemia, increased reticulocyte count, hyperbilirubinemia, positive Coombs test
Management: serial bilirubin levels, oral hydration + phototherapy for most neonates; exchange transfusion for severe anemia/hyperbilirubinemia
acalculous cholecystitis path, pt, dx, and tx
Path: cholestasis danders gallbladder ischemia leading to secondary infection by enteric organisms and resultant edema and necrosis of the gallbladder
Pt: severely ill patients in the ICU with multi organ failure, severe trauma, surgery, burns, sepsis, or prolonged parenteral nutrition; fever, leukocytosis
Dx: gallbladder wall thickening, distension, and presence of pericholecystic fluid
Tx: Abx followed by percutaneous cholecystectomy with drainage of any associated abscesses
Path, Pt, Dx, and management of Ogilvie syndrome
Path: major surgery, traumatic injury, severe infection; electrolyte derangement (decreased K+, decreased Mg, decreased Ca2+), medications (opiates, anticholinergics), neurologic disorders (dementia, stroke)
Pt: abdominal distension, pain, obstipation, vomiting; tympanic to percussion, decreased bowel sounds; if perforation: guarding, rigidity, rebound tenderness
Dx: X-ray: colonic dilation, normal hausfrau, noldilated small bowel
CT scan: colonic dilation without anatomic obstruction
Management: NPO, nasogastric/rectal tube decompression; neostigmine if no improvement within 48 hours
Path, Pt, Dx, and Tx of sporotrichosis
Path: sporothrix schenckii (dimorphic fungus), decaying plant matter/soil, gardeners + landscapers
Pt: subacute/chronic; skin papule -> ulceration with non purulent, odorless drainage; proximal lesions along lymphatic chain; LAD, deeper spread + systemic sx are rare
Dx: cultures (aspirate fluid or biopsy)
Tx: 3-6 months of oral itraconazole
hypertrophic osteoarthropathy (HOA) vs hypertrophic pulmonary osteoarthropathy (HPOA)
Pt; digital clubbing + sudden-onset arthropathy, commonly affecting the wrist and hand joints
Hypertrophic pulmonary osteoarthropathy is a subset of HOA where the clubbing and arthropathy are attributable to underlying lung disease like lung cancer, TB, bronchiectasis, or emphysema
What do you expect the plasma renin and plasma aldosterone to be in secondary hyperaldosteronism? What can cause this?
elevated plasma renin and elevated plasma aldosterone
causes of secondary hyperaldosteronism:
- diuretic use
- cirrhosis or CHF
- renovascular HTN
- renin-secreting tumor
- malignant HTN
- coarctation of the aorta
What do you expect the plasma renin and plasma aldosterone to be in primary hyperaldosteronism?
decreased plasma renin, increased plasma aldosterone
what causes of HTN and hypokalemia would have decreased plasma renin and plasma aldosterone?
- CAH
- glucocorticoid resistance
- exogenous mineralocorticoid
- Cushing’s syndrome
- altered aldosterone metabolism
What is included in post exposure prophylaxis for sexual assault?
chlamydia: azithromycin
gonorrhea: ceftriaxone
Trichomonas vaginalis: metronidazole
HIV: multidrug regimen (tenofovir-emtricitabine with raltegravir)
Hep B: hep B vaccine +/- Hep B immunoglobulin
Dx and Tx of social anxiety disorder
Dx:
- marked anxiety about >/= 1 social situations for >/= 6 months
- fear of scrutiny by others, humialtion, embarrassment
- social situations avoided or endured with intense distress
- marked impairment (social, academic, occupational)
- subtype specifier: performance only
Tx: SSRI/SNRI, CBT, beta blocker or benzodiazepine for performance-only subtype
Human bite with possible rabies exposure in a low-risk wild animal (squirrel, chipmunk, mouse/rat, rabbit)?
no post exposure prophylaxis
Human bite with possible rabies exposure in a high-risk wild animal (bat, raccoon, skunk, fox, coyote)?
If available for testing: euthanize + test; start PEP if rabies test is positive
Not available for testing: start PEP (post-exposure prophylaxis)
Human bite with possible rabies exposure in a pet (dog, cat, ferret)?
If available for quarantine: observe for 10 days; no PEP if animal is healthy
Not available for quarantine: start PEP
Generalized convulsive status epileptics path, dx, and tx
Path: structural brain abnormality (brain tumor, stroke), metabolic abnormality (hyponatremia, hypoglycemia), infection (meningitis), or drug withdrawal (alcohol, benzos), epilepsy esp with noncompliance
Dx: seizure lasting >/= 5 mins OR >/= 2 seizure events in which the patient does not completely regain consciousness
Tx: ABC, IV benzos (lorazepam, m diazepam) for seizure termination, then a nonbenzo anti epileptic med should be administered to prevent seizure recurrence (fosphenytoin, phenytoin, levetiracetam, or valproic acid)
Path, Risk factors, Pt, and Management of primary dysmenorrhea
Path: excessive prostaglandin production Risk factors: 1. age <30 2. BMI < 20 3. tobacco use 4. Menarche at age < 12 5. Heavy/long menstrual periods 6. sexual abuse Pt: pain first 2-3 days of menses, N/V/D, normal pelvic examination Management: NSAIDs, combo OCPs
Pt of prolapsing leiomyoma uteri
a uterus with irregular enlargement on exam suggests uterine liomyomata; speculum and bimanual examination confirms the firm, smooth, round mass at the cervical os consistent with an aborting sub mucous myxoma
What is the Cushing triad? tx?
HTN, bradycardia, and irregular expirations (indicates elevated ICP); immediate tx is hypertonic saline to decrease the ICP and reduce the risk of cerebral herniation
Precipitating factors, Pt, and Tx of myasthenic crisis?
Precipitating factors: infection or surgery, pregnancy or childbirth, tapering of immunosuppressive drugs, medications (ahminoglycosides, beta blockers)
Pt: increased generalized and oropharyngeal weakness, respiratory insufficiency/dyspnea
Tx: intubation for deteriorating respiratory status; plasmapheresis or IVIG as well as corticosteroids
Path, Pt, and Complications of Sjogren syndrome
Path: immune-mediated destruction of the lacrimal and salivary glands; can occur as primary disease or secondary with other autoimmune disorders (SLE, RA)
Pt:
- dry eyes (keratoconjunctivitis sicca)
- dry mouth (xerostomia), salivary hypertrophy
- dry sin (xerosis)
- Raynaud phenomenon
- Cutaneous vasculitis
- Positive anti-Ro (SSA) and/or anti-La (SSB)
Complications: non-hodgkin lymphoma; corneal damage, dental caries
Risk factors for avascular necrosis
- steroid use
- alcohol abuse
- SLE
- Antiphospholipid syndrome
- Hemoglobinopathies (sickle cell)
- Infections (osteomyelitis, HIV)
- Renal transplantation
- Decompression sickness
What steps are known to minimize the risk of long term opioid abuse?
- check the prescription drug-monitoring program data for undisclosed coprescription
- perform random urine drug screening
- schedule frequent follow-up visits (q 3 months min)
Wafarin-associated intracerebral hemorrhage Path and management
Path: use of over-the-counter cold meds, which often contain acetaminophen (potentiates anticoagulant effect of warfarin) and decongestants such as phenylephrine (may elevated BP)
Management: IV Vit K, prothrombin complex concentrate (PCC) (consider FFP if PCC not available)
subclavian steel syndrome Path, Pt, PE, Dx, and Tx
Path: severe atherosclerosis of the left subclavian artery proximal tot he origin of the vertebral artery (left more commonly affected than the right)
Pt: ischemia in the affected UE (pain, fatigue, paresthesias), vertebrobasilar ischemia with concurrent atherosclerosis of the circle of Willis (dizziness, ataxia, disequilibrium)
PE: lower brachial systolic BP (>15) in the affected arm and a systolic bruit in the suprclavicular fossa on the affected side; S4 may be present due to LVH
Dx: dopper u/s or MR angiography
Tx: lifestyle management (lipid-lowering meds, smoking cessation) and sometimes stent placement
In patients with abnormal uterine bleeding, what does bleeding after progesterone administration indicate?
confirms normal endogenous estrogen production and proliferative endometrium; rules out causes of estrogen deficiency (primary ovarian insufficiency), endometrial abnormalities (intrauterine adhesions), and outlet tract abnormalities (imperforate hymen)
Path, Pt, Labs and Tx of serum sickness-like reaction
Path: type III hypersensitivity, immune complex formation, Abx (beta-lactam, sulfa), acute Hep B
Pt: symptoms 1-2 weeks after exposure; fever, skin rash, polyarthralgia
Labs: nonspecific hypocomplementemia and elevated inflammatory markers (ESR, CRP)
Tx: remove/avoid offending agent, supportive care, steroids or plasmapheresis if severe
UTI with urinary alkalinization (pH > 8) indicates what causes? What other sx might you see?
urease-producing bacteria such as Proteus mirabilis (MC) or klebsiella pneumoniae; might also see struvite stones (magnesium ammonium phosphate)
Congenital contractural arachnodactyly Path and Pt
Path: autosomal dominant with mutations in fibrillin-2 gene
Pt: tall stature, arachnodactyly, multiple contractures involving large joints
Path, Pt, and Dx of pheochromocytoma
Path:
- arises from neuroendocrine cells in adrenal medulla
- 25% inherited: VHL gene, RET gene (MEN 2), NF1
- symptoms result from increased catecholamine secretion
Pt: HA, tachycardia/palpitations, sweating, HTN
Dx: elevated urinary and plasma catecholamines + metanephrines
What is the rule of 10s in pheochromocytoma?
- 10% bilateral
- 10% extraadrenal
- 10% malignant
Path, Pt, Dx, and Tx of pediatric septic arthritis
Path: age < 3 months: Staph aureus, group B strep, gram negative bacilli
- Age >/= 3 months: staph aureus, group A strep
Pt: acute-onset joint pain, swelling, limited motion; refusal to bear weight; fever >/= 101.3
Dx: increased WBC, ESR, CRP; blood culture; joint aspiration (synovial WBC of > 50,000), effusion on u/s or MRI
Tx: joint drainage + debridement; IV Abx
UTI in infants Risk factors, Pt, Labs, and Tx
Risk factors: female, uncircumcised males, vesicoureteral reflux, constipation
Pt: fever, fussiness, poor feeding, decreased urine output
Labs: pyuria, bacteriuria
Tx: Abx, renal u/s (if febrile), +/- voiding cystourethrogram
(third-get cephalosporin, such as cefixime)
Path, Pt, Dx, Tx of SIBO; what organisms would you expect?
Path: anatomical abnormalities (strictures, surgery); motility disorders (DM, scleroderma)
Pt: abdominal pain, diarrhea, bloating, flatulence; malabsorption, WL, anemia, vitamin deficiency
Dx: jejunal aspirate + culture showing >10^5 organisms; carbohydrate breath testing (lactulose, glucose)
Tx: Abx (rifaximin, amox-clav), avoid antimotility agents (narcotics), dietary changes (high-fat, low carb), promotability agents (metoclopramide)
Organisms: streptococci, bactericides, escherichia, lactobacillus
Dumping syndrome Pt
Path: complication of gastric bypass and occurs when high-carb foods are rapidly emptied into the small bowel, leading to osmotically driven fluid shifts from the plasma to the intestine
Pt: abdominal pain and diarrhea < 30 min after meals, sympathetic activation due to fluid shifts -> tachycardia, diaphoresis, flushing; hypoglycemia may also occur
Path, Risk factors, Pt, Dx, and Tx of adenomyosis
Path: abnormal endometrial tissue within the uterine myometrium
Risk factors: age >40, multiparty, prior uterine surgery
Pt: dysmenorrhea, heavy menstrual bleeding, chronic pelvic pain, diffuse uterine enlargement (globular uterus), +/- uterine tenderness
Dx: clinical presentation, MRI + u/s: thickened myometrium; confirm via pathology
Tx: hysterectomy
What is the difference between adenomyosis and leiomyomata uteri?
adenomyosis can cause chronic pelvic pain whereas leiomyomata uteri (fibroids) can cause pelvic pressure, but usually not chronic pelvic pain. Fibroids cause a firm, irregularly enlarged uterus whereas adenomyosis causes diffuse uterine enlargement (globular)
diplopia, right eye ptosis, ophthalmoplegia, and pupillary dilation - dx?
non-pupil-sparing oculomotor nerve palsy
What are the causes of non-pupil-sparing CN III palsies? Next step in management?
mass effect should be considered an intracranial aneurysm until proven otherwise; patients should undergo immediate MR or CT angiography
What are the causes of pupil-sparing CN III palsies? What is the next step in management?
typically caused by microvascular ischemia associated with diabetes, hypertension, hyperlipidemia, and advanced age; observation and supportive care may be appropriate
What are the potential side effects of lithium therapy?
hyperparathyroidism, nephrogenic diabetes insipidus, CKD, thyroid dysfunction (most often hypothyroidism), teratogenic effects in first trimester (Ebstein anomaly)
What are the symptoms of Lyme disease at the early localized stage (days to 1 month)?
- erythema migrans
- fatigue, HA
- myalgias, arthralgias
What are the symptoms of Lyme disease at the early disseminated stage (weeks to months)?
- multiple erythema migrans
- U/L or B/L CN palsy (CN VII)
- Meningitis
- Carditis (AV block)
- Migratory arthralgias
What are the symptoms of Lyme disease at the late stage (months to years)?
- arthritis
- encephalitis
- peripheral neuropathy
What is the definition of fetal tachycardia, and what are the common causes?
fetal baseline heart rate > 160/min
Common causes include maternal infection, poorly controlled maternal hyperthyroidism, medication use 9terbutaline), and abruptio placentae
Path, Pt, Dx, and Tx of esophageal perforation?
Path: instrumentation (endoscopy), trauma; effort rupture (Boerhaave syndrome), esophagitis (infectious/pills/caustic)
Pt: chest/back +/or epigastric pain, systemic signs (fever0; crepitus, harman sign (crunching on auscultation); pleural effusion with atypical (green) fluid
Dx: CXR or CT scan: widened mediastinum, pneumonmediastinum, pneumothorax, pleural effusion
CT scan: esophageal wall thickening, mediastinal fluid collection
EGD with water-soluble contrast: leak from perforation
Management: NPO, IV Abx + PPI; emergency surgical consultation
What murmur is associated with aortic dissection?
aortic regurgitation
What will you see on u/s of a tubo-ovarian abscess?
complex multiloculated adnexal mass with thick wall and internal debris
Toxic megacolon treatment
IVF, broad-spectrum Abx, and bowel rest; IV corticosteroids are preferred for treating IBD-induced toxic megacolon; emergency surgery may be required if the colitis does not resolve
posterior urethral injury
Pt: blood at the urethral meatus, inability to void (due to urethral discontinuity), perineal bruising, and a high-riding prostate on digital rectal examination
Dx:
urethrography - extravasation of contrast from the urethra is diagnostic
Tx: anterior urethral injuries (penile fracture, straddle injury) are typically repaired urgently (within 24 hours) whereas most PUIs are treated with temporary urinary diversion via suprapubic catheter, followed by delayed repair
Risk factors, Pt, Dx, and Tx of Takayasu arteritis
Risk factors: female, asian, age 10-40
Pt: constitutional (fever, WL), arterio-occlusive (claudication, ulcers) in upper extremities, arthralgias/myalgias
PE: BP discrepancies, pulse deficits, arterial bruits
Dx: elevated inflammatory markers (ESR, CRP); CXR: aortic dilation, widened mediastinum; CT/MRI: wall thickening, narrowing of lumen
Tx: systemic glucocorticoids
Pt, Dx and Tx of congenital hypothyroidism
Pt: initially normal at birth; symptoms develop after maternal T4 wanes: - lethargy - enlarged fontanelle - protruding tongue - umbilical hernia - poor feeding - constipation - dry skin - jaundice Dx: increased TSH + decreased free T4 levels; newborn screening Tx: levothyroxine
What are migraine preventive options that are acceptable during pregnancy?
beta blockers, such as propranolol or metoprolol; CCBs (verapamil) are also safe and effective in pregnancy
Pt and Dx criteria for acute liver failure
Pt:
- generalized symptoms (fatigue, lethargy, anorexia, nausea)
- RUQ pain
- pruritus + jaundice due to hyperbilirubinemia
- renal insufficiency
- thrombocytopenia
- hypoglycemia
Dx criteria:
- severe acute liver injury (ALT + AST often > 1000)
- signs of hepatic encephalopathy (confusion, asterixis)
- synthetic liver dysfunction (INR >/= 1.5)
melena, RUQ pain, jaundice, anemia, and hyperbilirubinemia after recent livery biopsy - Dx? Tx?
hemobilia (u/s or CT scan can identify heamtomas and intraabdominal free fluid, and endoscopic evaluation may reveal oozing of blood from the papilla)
Tx: usually self-limited and managed conservatively
What is the treatment for toxoplasmosis encephalitis?
sulfadiazine + pyrimethamine (plus leucovorin)
involved site and pt of myasthenia gravis as a paraneoplastic syndrome
Involved site: acetylcholine receptor in postsynaptic membrane Pt: fluctuating muscle weakness: - ocular (ptosis, diplopia) - bulbar (dysphagia, dysarthria) - facial, neck + limb muscles
Involved site and pt of Lambert-eaton syndrome as a paraneoplastic syndrome
involved site: presynaptic membrane voltage-gated calcium channels
Pt: proximal muscle weakness, autonomic dysfunction (dry mouth), cranial nerve involvement (ptosis), diminished or absent DTRs
(~50% associated with an underlying malignancy, mostly small cell lung cancer)
Involved site and pt of dermatomyositis/polymyositis as a paraneoplastic syndrome
Involved site: muscle fiber injury
Pt:
- symmetrical + more proximal muscle weakness
- interstitial lung disease, esophageal dysmotility, Raynaud phenomenon
- polyarthritis
- esophageal dysmotility
- skin findings (Gottron papules, heliotrope rash) in dermatomyositis
Bell palsy Path, Pt
Path: peripheral neuropathy involving CN VII due to reactivation of a neurotrophic virus, most commonly HSV; results in nerve compression and degeneration of the myelin sheath
Pt: unilateral mouth drooping, disappearance of the nasolabial fold, involvement of the upper face (distinguishes from UMN disorders like stroke), decreased ipsilateral eye lacrimation, hyperacusis, and decreased sensation of taste of the anterior 2/3 of the ipsilateral tongue; weakness typically develops at night; sx progress over 2-3 weeks with gradual improvement over 3-6 months
Tx: glucocorticoids
migraine with aura involving the brainstem pt
vertigo, dysarthria, diplopia, and possible LOC, typically followed by a severe occipital HA
antipsychotic medication effect of the mesolimbic, nigrostriatal, and tuberoinfundibulnar dopamine pathways
mesolimbic: antipsychotic efficacy
nigrostriatal: extrapyramidal symptoms: acute dystonia, akathisia, Parkinsonism
tuberoinfundibulnar: hyperprolactinemia
humoral hypercalcemia of malignancy path/pt
Path: due to PTHrP; associated with squamous cell (lung, head, and neck), renal, bladder, breast, or ovarian carcinomas Pt: - very high (>14) calcium levels - polyuria, constipation, nausea - low PTH
Path and PT of cyclic vomiting syndrome
Path: personal or family hx of migraines; episodes often have identifiable trigger (infection, stress)
Pt: stereotypical vomiting episodes with acute onset of N/V/HA and abdominal pain; self-limited, lasting 1-2 days; asymptomatic between episodes; often regular intervals (2-4 weeks)
CSF rhinorrhea path, pt, dx, and management
Path: accidental trauma (MC), surgical trauma, non traumatic (elevated ICP)
Pt: U/L watery rhinorrhea with salty or metallic taste; possible complication: meningitis
Dx:
- test for CSF-specific proteins (beta-2 transferrin, beta-trace protein)
- imaging (with intrathecal contrast)
- endoscopy (+/- intrathecal fourescein dye)
Tx: bed rest, head of bed elevation, avoidance of straining; lumbar drain placement; surgical repair
description, normal result, and abnormal result of fetal non stress test
description: external fetal HR monitoring for 20-40 mins
normal: reactive: >/= 2 accelerations
abnormal: nonreactive: < 2 accelerations; recurrent variable or late decelerations
description, normal result, and abnormal result of fetal biophysical profile
description: non stress test plus u/s assessment of the following:
- amniotic fluid volume
- fetal breathing movement
- fetal movement
- fetal tone
(2 points per category if normal + 0 points if abnormal)
normal: 8-10 points
abnormal: equivocal: 6 points; abnormal: 0, 2, 4 points; oligohydramnios
description, normal result, and abnormal result of fetal contraction stress test
description: external fetal HR monitoring during spontaneous or induced (oxytocin, nipple stimulation) uterine contractions
normal: no late or recurrent variable decelerations
abnormal: late decelerations with >50% of contractions
description, normal result, and abnormal result of fetal doppler sonography of the umbilical artery
description: evaluation of umbilical artery flow in fetal intrauterine growth restriction only
normal: high-velocity diastolic flow in umbilical artery
abnormal: decreased, absent, or reversed end-diastolic flow
Pt, Dx, and Tx of vasovagal syncope
Pt: inciting event (stress, prolonged standing), prodrome (pallor, nausea, diaphoresis), consciousness regained rapidly (<1 minute)
Dx: mainly clinical; upright tilt table testing in uncertain cases
Tx: reassurance, avoidance of triggers, counter pressure techniques for recurrent episodes
acute poststreptococcal glomerulonephritis Pt & Labs
Pt: can be asymptomatic; if symptomatic:
- gross hematuria (tea- or cola-colored urine)
- edema (periorbital, generalized)
- HTN
Labs:
- U/A: + proteins, + blood, +/- RBC casts
- serum: low C3 and possible low C4, increased serum Cr, increased anti-DNase B + AHase, increased ASO and anti-NAD (from preceding pharyngitis)
acute hemolytic transfusion reaction Path, Pt, Labs, complications
Path: ABO incompatibility, intravascular hemolysis
Pt: onset within minutes to 24 hours of transfusion; fever, chills, hypotension; hemoglobinuria, flank pain
Labs: positive direct Coombs test; hemolysis (increased LDH, increased indirect bilirubin)
Complications: acute renal failure, DIC
Pt of acute PCP intoxication
- violent behavior
- dissociation
- hallucinations
- amnesia
- nystagmus (horizontal or vertical)
- ataxia
Pt of acute LSD intoxication
- visual hallucinations
- euphoria
- dysphoria/panic
- tachycardia/HTN
Pt of acute cocaine intoxication
- euphoria
- agitation/psychosis
- chest pain
- seizures
- tachycardia/HTN
- mydriasis
Pt of acute methamphetamine intoxication
- violent behavior
- psychosis, diahphoresis
- tachycardia/HTN
- choreiform movements
- tooth decay
Pt of acute marijuana intoxication
- increased appetite
- euphoria
- dysphoria/panic
- slow reflexes, impaired time perception
- dry mouth
- conjunctival injection
Pt of acute heroin intoxication
- euphoria
- depressed mental status
- miosis
- respiratory depression
- constipation
Path, Pt, Dx, and Tx of spinal epidural abscess
Path: staph aureus (65%); inoculating sources:
- distant infection (cellulitis, joint/bone)
- spinal procedure (epidural catheter)
- injection drug use
Pt: classic triad
- fever
- focal/severe back pain
- neurologic findings (motor/sensory change, bowel/bladder dysfunction, paralysis
Dx: elevated ESR, blood and aspirate cultures, MRI of the spine
Tx: broad-spectrum Abx (vancomycin plus ceftriaxone), aspiration/surgical decompression
What is the treatment of a pelvic fracture in a stable vs unstable patient?
in an unstable patient, they are at risk of life threatening hemorrhage from the venous plexus so rapid external stabilization with a pelvic binder should be performed as soon as possible to promote tamponade of venous bleeding
Path, Pt, Dx, and Tx of syringomyelia
Path: destruction of the crossing fibers of the spinothalamic tract int he ventral white commissure
Pt: progressive loss of pain and temp sensation (cape-like distribution)
Dx: MRI will show intramedullary cavity
Tx: usually requires surgical shunt placement
What can you infer from a HgA1c of >10% as compared to HgA1c of around 8%?
HgA1c of > 10% suggest significant hyperglycemia throughout the day, whereas lesser abnormalities are often due to elevation sin only postprandial glucose levels
uremic coagulopathy path, pt, labs, and tx
Path: abnormal hemostasis in the setting of chronic renal failure due to platelet dysfunction
Pt: ecchymoses and epistaxis are MC but GI bleeding, hemoperricardium, subdural hematoma, and bleeding from surgical or invasive sites can still occur
Labs: aPTT, PT, and TT normal, bleeding time (reflective of platelet function) is prolonged, normal platelet count
Tx: DDAVP, cryoprecipitate, and conjugated estrogens have been used to correct this
chronic suppurative otitis media
otorrhea and hearing loss for > 6 weeks and TM perforation one xam
otitis media with effusion
may cause hearing loss and poor TM mobility BUT in contrast to acute otitis media, there is a lack of acute inflammation (fever, TM bulging)
tinea versicolor
Path: malassezia globes skin flora grows in exposure to hot and humid weather
PT: hypo pigmented, hyper pigmented, or middle erythematous lesions, +/- fine scale, +/- pruritus
Dx: KOH prep shows hyphae and yeast cells in a “spaghetti + meatballs” pattern
Tx: topical ketoconazole, terbinafine, or selenium sulfide
bacterial conjunctivitis treatment options
- erythomycin ointment
- polymyxin-trimethoprim drops
- azithromycin drops
- preferred agent in contact lens wearers: fluroquinolone drops
viral conjunctivitis treatment
warm or col compresses +/- antihistamine/decongestant drops
allergic conjunctivitis treatment
- OTC antihistamine/decongestant drops for intermittent symptoms
- mast cell stabilizer/antihistamine drops for frequent episodes
Clinical manifestations of hemochromatosis based on body system
skin - hyperpigmentation (bronze diabetes)
MSK - arthralgia, arthropathy + chondrocalcinosis
GI - elevated hepatic enzymes with hepatomegaly (early), cirrhosis (late) + increased risk of hepatocellular carcinoma
Endocrine - DM, secondary hypogonadism + hypothyroidism
Cardiac - restrictive or dilated cardiomyopathy + conduction abnormalities
Infections: increased susceptibility to Listeria, Vibrio vulnficus + Yersinia enterocolitica
clinical associations of infective endocarditis with staph aureus
- prosthetic valves
- intravascular catheters
- implanted devices (pacemakers, defibrillator)
- IV drug use
clinical associations of infective endocarditis with viridans strep and which bugs belong in this group?
- gingival manipulation
- respiratory tract incision or biopsy
viridans group:
- strep sanguinis
- s mitis
- s oralis
- s mutans
- s sobrinus
- s milleri
clinical associations of infective endocarditis with staph epidermidis
- prosthetic valves
- intravascular catheters
- implanted devices
clinical associations of infective endocarditis with enterococci
- nosocomial UTIs
clinical associations of infective endocarditis with strep gallolyticus
- colon carcinoma
- IBD
clinical associations of infective endocarditis with fungi (candida)
- immunocompromised host
- intravascular catheters
- prolonged Abx therapy
PT, PTT, BT, platelet count, RBC count of von Willebrand disease
PT - normal PTT - high BT - high Platelet count - normal RBC count - normal **autosomal dominant (look for family hx)
PT, PTT, BT, platelet count, RBC count of hemophilia A/B
PT - normal PTT - high BT - normal Platelet count - normal RBC count - normal **x-linked recessive; A = low factor 8; B = low factor 9
PT, PTT, BT, platelet count, RBC count of DIC
PT - high PTT - high BT - high Platelet count - low RBC count - normal/low **appropriate history, low level of factor 8
PT, PTT, BT, platelet count, RBC count of liver failure
PT - high PTT - high BT - normal Platelet count - normal/low RBC count - normal/low **jaundice, normal factor 8 level; do not give vitamin K (ineffective), use FFP
PT, PTT, BT, platelet count, RBC count of heparin use
PT - normal PTT - high BT - normal Platelet count - normal RBC count - normal **watch for thrombocytopenia and thrombosis
PT, PTT, BT, platelet count, RBC count of warfarin use
PT - high PTT - normal BT - normal Platelet count - normal RBC count - normal **Vitamin K antagonist (factors 2, 7, 9, 10)
PT, PTT, BT, platelet count, RBC count of ITP (idiopathic thrombocytopenia purpura)
PT - normal PTT - normal BT - high Platelet count - low RBC count - normal **watch for preceding URI
PT, PTT, BT, platelet count, RBC count of TTP (thrombotic thrombocytopenia purpura)
PT - normal PTT - normal BT - high Platelet count - low RBC count - low **hemolysis (smear), CNS symptoms (hallucinations, AMS, HA, stroke); tx with plasmapheresis; DO NOT give platelets
PT, PTT, BT, platelet count, RBC count of scurvy
PT - normal PTT - normal BT - normal Platelet count - normal RBC count - normal **fingernail and gum hemorrhages, bone hemorrhages; caused by vitamin C deficiency
Lab findings of X-linked agammaglobulinemia
decreased or absent. cells
decreased immunoglobulines
Lab findings of common variable immunodeficiency
Normal B cells
decreased immunoglobulins
Lab findings of IgA deficiency
Normal B cells
decreased IgA
Lab findings of Hyper-IgM syndrome
normal B cells
decreased IgG + IgA
increased IgM
What is the next step in management after initial stabilization of acute MI with persistent pain, HTN, or heart failure?
IV nitroglycerin (not if hypotension, RV infarct, or severe aortic stenosis occurs)
What is the next step in management after initial stabilization of acute MI with persistent severe pain?
IV morphine
What is the next step in management after initial stabilization of acute MI with unstable sinus bradycardia?
Intravenous atropine
What is the next step in management after initial stabilization of acute MI with pulmonary edema?
IV furosemide (not if Patience’s tis hypotensive or hypovolemic)
Risk factors, Pt, and Tx of calcaneal apophysitis (Sever disease)
Risk factors: running/jumping sports, growth spurts, athletic cleat use or footwear without heel padding
Pt: heal pain (50% b/l), pain with calcaneal palpation or compression, decreased gastrocnemius/soleus flexibility
Tx: NSAIDs, ice, activity limitation
Path, Pt, Dx, and Tx of infant botulism
Path: ingestion of Clostridium botulinum spores (environmental dust/soil, honey), spores colonize GI tract + produce toxin; toxin inhibits presynaptic ACh release
Pt: age < 12 months; constipation, poor feeding, hypotonia; oculobulbar palsies (absent gag reflex, ptosis), symmetric descending paralysis, autonomic dysfunction (decreased salivation, fluctuating HR/BP)
Dx: clinical, confirmation by stool C botulinum spores or toxins
Tx: botulism immune globulin
Path, Pt, Dx, and Tx of neonatal thyrotoxicosis
Path: transplacental passage of maternal anti-TSH receptor Abs; Abs bind to infant’s TSH receptors + cause excessive thyroid hormone release
Pt: warm, moist skin; tachycardia; poor feeding, irritability, poor weight gain; low birth weight or preterm birth
Dx: maternal anti-TSH receptor Abs (>500% normal)
Tx: self-resolves within 3 months; methimazole PLUS beta blocker
What drugs are indicated in the treatment of preeclampsia to lower BP acutely to decrease stroke risk?
hydralazine IV (vasodilator), labetalol IV (beta blocker with alpha-blocking activity), or nifedipine PO (CCB)
Modified Wells criteria for pretest probability of pulmonary embolism
\+3 points = - clinical signs of DVT - alternate diagnosis less likely than PE \+1.5 points = - previous PE or DVT - HR > 100 - recent surgery or immbolization \+ 1 point = - hemoptysis - cancer Total score = 4 = PE unlikely > 4 = PE likely
Pt of ED due to vascular causes?
- cardiovascular risk factors (HTN, smoking, diabetes)
- abnormal vascular examination (bruits, decreased pulses)
Pt of ED due to neurologic causes?
- neurologic comorbidity (diabetic neuropathy, MS, spinal injury/surgery)
- gradual onset, loss of bulbocavernous reflex
Pt of ED due to psychogenic causes?
- suddent onset
- situational (ED with partner, normal erection during masturbation)
- normal nonsexual nocturnal erections
Pt of ED due to endocrine causes?
- additional symptoms due to underlying disorder
- abnormal hormone levels (TSH, prolactin)
Pt of ED due to medication causes?
- onset related to starting medication
- antihypertensives, SSRIs, anti-androgenic medications
Pt of ED due to hypogonadism causes?
- gradual onset
- decreased libido, gynecomastia, testicular atrophy
- low serum testosterone
DSM-5 criteria for schizoaffective disorder
- major depressive or manic episode concurrent with symptoms of schizophrenia
- Lifetime history of delusions or hallucinations for >/= 2 weeks in the absence of major depressive or manic episode
- mood episodes are prominent + recur throughout illness
- not due to substances or another medical condition
How do you differentiate major depressive or bipolar disorder with psychotic features from schizoaffective disorder?
major depressive or bipolar disorder with psychotic features: psychotic symptoms occur exclusively during mood episodes
How do you differentiate schizophrenia from schizoaffective disorder?
schizophrenia: mood symptoms may be present for relatively brief periods
Path, manifestations, and management of von hippel-lindau disease
Path: mutation in the VHL tumor suppressor gene on chromosome 3
Manifestations: cerebellar + retinal hemangioblastomas; pheochromocytoma; renal cell carcinoma (clear cell)
Management: surveillance for associated malignancies:
- eye/retinal examination
- plasma or urine metanephrines
- MRI of the brain + spine
- MRI of the abdomen
tumor resection
Path and Pt of tabes dorsalis
Path: increased incidence of syphilis in men who have sex with men + HIV-infected patients; HIV positive patients develop neurosyphilis more rapidly
Treponema pallidum spirochetes directly damage the dorsal sensory roots; secondary degeneration of the dorsal columns
Pt: sensory ataxia, lancinating pains, neurogenic urinary incontinence, associated with argyll Robertson pupils
What are risk factors for homicide?
young male unemployed impoverished access to firearms substance abuse antisocial personality disorder history of violence or criminality history of childhood abuse impulsivity
Name the drugs, indication, C/I, and side effects of bisphosphonates
Drugs: alendronate, risedronate
Indication: first-line tx for osteoporosis
C/I: not recommended for patients with renal impairment
SE: atypical fractures possible with prolonged use
*Take with water on an empty stomach an hour before food + other meds
Indication and SE of denosumab
Indication: osteoporosis
SE: risk of infection + skin reactions; close monitoring for hypocalcemia needed
Indication and SE of teriparatide
Indication: severe osteoporosis
SE: monitor serum calcium, uric acid, and renal function
Name and SE for selective estrogen receptor modulators as tx for osteoporosis
Name: raloxifene
SE: may lower risk of breast cancer, increased risk of DVT
**Less effective than bisphosphonates
Path, Pt, Dx, and Tx of fat embolism syndrome
Path: fracture of marrow-containing bone, orthopedic surgery, pancreatitis
Pt: 24-72 hours following inciting event; clinical triad: respiratory distress, neurologic dysfunction (confusion), petechial rash
Dx: based on clinical experience
Tx: early immobilization of fracture; supportive care (mechanical ventilation)
CD4 count + Pt of cryptosporidium diarrhea in AIDS
CD4: < 180
Pt: severe watery diarrhea, low-grade fever, WL
CD4 count + Pt of micros-iridium/Isosporidium diarrhea in AIDS
CD4: < 100
Pt: watery diarrhea, crampy abdominal pain, WL, fever is rare
CD4 count + Pt of mycobacterium avium diarrhea in AIDS
CD4: <50
Pt: watery diarrhea, high fever (>102.2), WL
CD4 count + Pt of CMV diarrhea in AIDS
CD4: <50
Pt: frequent, small-volume diarrhea, hematochezia, abdominal pain, low-grade fever, WL
Path, Pt, and Tx of severe combined immunodeficiency
Path: gene defect leading to failure of T cell development; B cell dysfunction due to absent T cells; X-linked recessive and autosomal recessive
Pt: recurrent, severe viral, fungal, or opportunistic (pneumocystis) infections, failure to thrive, chronic diarrhea
Tx: stem cell transplant
Path, Pt, and causes of fetal hydrops
Path: increased cardiac output demand causing heart failure, increased fluid movement into interstitial spaces (third spacing) Pt: pericardial effusion, pleural effusion, ascites, skin edema, placental edema, polyhydramnios Causes: immune: - Rh(D) alloimmunization Nonimmune: - parvo B19 - fetal aneuploidy - CV abnormalities - thalassemia (hemoglobin Barts)
Pt, Labs, and Tx of intrahepatic cholestasis of pregnancy
Pt: develops in 3rd trimester, generalized pruritus, pruritus worse on hands + feet, no associated rash, RUQ pain
Labs: increased total bile acids (>10), increased transaminases, +/- increased total + direct bilirubin
Tx: delivery at 37 weeks gestation, ursodeoxycholic acid, antihistamines
What are the obstetric risks of intrahepatic cholestasis of pregnancy?
intrauterine fetal demise
preterm delivery
meconium-stained amniotic fluid
neonatal respiratory distress syndrome
What are the risk factors for gout?
- medications (diuretics, low-dose aspirin)
- surgery, trauma, recent hospitalizations
- volume depletion
- diet: high protein foods (meat, seafood), high fat foods, fructose or sweetened beverages
- heavy alcohol consumption
- underlying medical conditions (HTN, obesity, CKD, organ transplant)
What factors decrease the risk of gout?
- dairy product intake
- vitamin C (>/= 1500 mg/day)
- coffee intake (>/= 6 cups/day)
Path, Risk factors, Pt, Dx, and Tx of onychomycosis
Path: trichophyton rubrum
Risk factors: advanced age, tinea pedis, diabetes, peripheral vascular disease
Pt: thick, brittle, discolored nails
Dx: KOH, periodic acid-Schiff stain, culture
Tx: first line: terbinafine, itraconazole; second line: griseofulvin, fluconazole, ciclopirox
What are the primary indications and features of cognitive behavioral therapy?
Primary indications: depression, GAD, PTSD, panic disorder, OCD, eating disorders, negative thought patterns
Features:
- combines cognitive and behavioral therapy
- challenges maladaptive cognitions
- targets avoidance with behavioral techniques (relaxation, exposure, behavior modification)
What are the primary indications and features of interpersonal psychotherapy?
Primary indications: depression
Features: links symptoms to current relationship conflicts and interpersonal skill deficits
What are the primary indications and features of supportive psychotherapy?
Primary indications: lower functioning; psychotic disorders, patients in crisis
Features:
- maintains hope; provides encouragement
- reinforces coping skills, adaptive defenses
What are the primary indications and features of psychodynamic psychotherapy?
Primary indications: higher functioning, personality disorders
Features:
- builds insight into unconscious conflicts + past relationships
- uses transference
- breaks down maladaptive defenses
What are the primary indications and features of motivational interviewing?
Primary indication: substance use disorders
Features:
- nonjudgmental; acknowledges ambivalence + resistance
- enhances intrinsic motivation to change
What are the primary indications and features of dialectical behavioral therapy?
Primary indications: borderline personality disorder
Features:
- improves emotion regulation, distress tolerance, mindfulness
- decreases self harm; builds skills
What are the primary indications and features of biofeedback?
Primary indications: prominent physical symptoms; pain disorders
Features:
- improves control over physiological reactions to emotional stressors
What are the absolute contraindications to combined hormonal contraceptives?
migraine with aura >/= 15 cigarettes/day PLUS age >/= 35 HTN >/= 160/100 heart disease diabetes mellitus with end-organ damage history of thromboembolic disease antiphospholipid-Ab syndromne - Hx of stroke - breast cancer - cirrhosis + liver cancer - major surgery with prolonged immobilization - use < 3 weeks postpartum
Path, Pt, Dx, and Tx of cutaneous larva migrans
Path: hookworm larvae; dog (ancylostoma canine) or cat (A braziliense); humans are incidental hostos
- barefoot contact with contaminated sand or soil
Pt: primarily lower extremity; cutaneous (deeper infection rare); erythematous, pruritic papule at site of entry; intensely pruritic, migrating, serpiginous, reddish-brown tracks
Dx: history and clinical findings; eosinophils usually normal
Tx: antihelmintic (ivermectin)
What effect do beta 1 blockers have on the RAAs system?
inhibit beta 1 sympathetic stimulation of the juxtaglomerular apparatus of the kidney (which would normally stimulate renin release)
What conditions predispose to aspiration pneumonia?
- altered consciousness impairing cough reflex/glottic closure (dementia, drug intoxication)
- dysphagia due to neurologic deficits (stroke, neurodegenerative disease)
- Upper GI tract disorders (GERD)
- Mechanical compromise of aspiration defenses (nasogastric + endotracheal tubes)
- protracted vomiting
- large volume tube feedings in recumbent position
Pt, Labs, U/sm and Tx of epithelial ovarian carcinoma
Pt:
- acute: SOB, obstipation/constipation with vomiting, abdominal distension
- subacute: pelvic/abdominal pain, bloating, early satiety
- asymptotic adnexal mass
Labs: increased CA-125
U/s: solid mass, thick separations, ascites
Tx: exploratory laparotomy
Pt and Dx of chronic granulomatous disease
Pt: majority of cases X-linked recessive; recurrent pulmonary and cutaneous infections with catalase-positive pathogens (Staph aureus, Serratia, Burkholderia, Aspergillus
Dx: neutrophil function testing (dihydrorhodamine 123 test, nitro blue tetrazolium test)
Path, Pt, and CXR of transient tachypnea of the newborn
Path: inadequate alveolar fluid clearance at birth results in mild pulmonary edema
Pt: tachypnea begins shortly after birth + resolves by day 2 of life
CXR: bilateral perihilar linear streaking
Path, Pt, and CXR of respiratory distress of the newborn
Path: surfactant deficiency result Sina alveolar collapse + diffuse atelectasis
Pt: severe respiratory distress + cyanosis after premature birth
CXR: diffuse, reticulogranular (ground-glass) appearance, air bronchograms, low lung volumes
Path, Pt, and CXR of persistent pulmonary HTN as a cause of neonatal respiratory distress
Path: high pulmonary vascular resistance results in right-to-left shunting and hypoxia
Pt: tachypnea + severe cyanosis
CXR: clear lungs with decreased pulmonary vascularity
Path, Pt, Labs, Tx of classic congenital adrenal hyperplasia
Path: autosomal recessive, 21-hydroxylase deficiency
Pt: ambiguous genitalia in girls, salt-wasting syndrome: affects most girls + boys; hypotension, dehydration + vomiting
Labs: decreased sodium, increased potassium, decreased glucose; increased 17-hydroxyprogesterone
Tx: glucocorticoids + mineralocorticoids; high-salt diet; genital reconstructive surgery for girls; psychosocial support
When should you expect to begin to see salt wasting in classic congenital adrenal hyperplasia?
1-2 weeks of age
Path, Management, complications of infantile hemangioma
Path: may present as patch of telangiectasia at birth
- proliferation: age 0-1; bright red, raised nodule
- involution: age 1-9; deeper red/violent, regression in size
Management: observation; topical beta blocker (propranolol) for ulcerated or cosmetically sensitive ares (face)
Complications: ulceration/scarring, vision impairment if near eye, life-threatening if near airway
Risk factors, Pt, Dx and Management of postpartum uriary retention
Risk factors: primiparity, regional neuraxial anesthesia, operative vaginal delivery, perineal injury, cesarean delivery
Pt: inability to void >/= 6 hours after vaginal delivery, incomplete bladder emptying, dribbling of urine
Dx: urethral catheterization; post-void residual volume of >/= 150 mL
Tx: self-limited; intermittent catheterization
Causes, Pt, Dx, and management of sciatica (acute lumbosacral radiculopathy)
Causes: herniated intervertebral disk (MC), degenerative spondylosis, malignancy, epidural abscess
Pt:
- pain in low back radiating down posterior leg to food
- positive straight-leg raising test
- possible dermatomal sensory loss and weakness of hip dorsiflexion
Dx: primarily clinical; MRI recommended for:
- significant/progressive or B/L neurologic deficits
- suspected malignancy or epidural abscess
Management: activity modification, NSAIDs, surgery for disabling symptoms
In what circumstances can minors provide thier own consent?
Medical emancipation:
- emergency care
- sexually transmitted diseases
- mental health + substance abuse tx
- pregnancy care
- contraception
Legal emancipation:
- financially independent
- parent
- married
- active military service
- high school graduate
Path, U/S, Pt, Dx, and Tx of congenital toxoplasmosis
Path: undercooked meat, unwashed produce, unprotected handling of cat feces
U/S: bilateral ventriculomegaly, diffuse intracranial calcifications
Pt: chorioretinitis, hydrocephalus, seizures, intellectual disability, sensorineural hearing loss
Dx: maternal: serology
fetal: amniotic fluid PCR
Tx: spiramycin
Path, pleural fluid analysis, pleural fluid gram stain + culture, Tx of uncomplicated parapneumonic effusions
Path: steroid exudate in pleural space
pleural fluid analysis: pH >/= 7.2, glucose >/= 60, WBC = 50,000
pleural fluid gram stain + culture: negative
Tx: Abx
Path, pleural fluid analysis, pleural fluid gram stain + culture, Tx of complicated parapneumonic effusions
Path: bacterial invasion of pleural space
Pleural fluid analysis: pH <7.2, glucose < 60, WBC > 50,000
pleural fluid gram stain + culture: negative
Tx: Abx and drainage
What are complications of excessive weight gain in pregnancy?
- gestational diabetes mellitus
- fetal macrosomia
- cesarean delivery
What are complications of inadequate weight gain during pregnancy?
- fetal growth restriction
- preterm delivery
Pt, Dx, Management, and Complications of acute diverticulitis
Pt: abdominal pain (usually lower left quadrant), fever, nausea, vomiting, ileus (peritoneal irritation)
Dx: abdominal CT (oral + IV contrast)
Management: bowel rest, Abx (ciprofloxacin, metronidazole)
Complications: abscess, obstruction, fistula, perforation
What are the indications for surgical repair of primary mitral regurgitation?
- surgery if LVEF 30-60% (regardless of sx)
- consider surgery if successful valve repair is highly likely:
- symptoms + LVEF < 30%
- asymptomatic + LVEF >60%
Path, Pt, Dx, and Tx of eosinophilic esophagitis
Path: chronic, immune-mediated esophageal inflammation
Pt: dysphagia, chest/epigastric pain, reflux/vomiting, food impaction, associated atopy
Dx: endoscopy + esophageal biopsy (>/=15 eosinophils per high-power filed)
Tx: dietary modification, +/- topical glucocorticoids
What protein level is considered high-protein ascites? What are the common causes of this? What about low-protein ascites?
> /= 2.5 (high-protein ascites):
- CHF, constrictive pericarditis, peritoneal carcinomatosis, TB, Budd-Chiari syndrome, fungal
<2.5 (low-protein ascites): cirrhosis, nephrotic syndrome
What SAAG ratio indicates portal HTN? What are the common causes? What about in the absence of portal HTN?
> /= 1.1 (indicates portal HTN): cardiac ascites, cirrhosis, Budd-Chiari
<1.1 (absence of portal HTN): TB, peritoneal carcinomatosis, pancreatic ascites, nephrotic syndrome
Characteristics and time frame of rotavirus + norovirus diarrhea
short-term
brief illness
vomiting common
Characteristics and time frame of enterotoxigenic E. coli and Enteropathogenic E coli diarrhea
short-term
contaminated food + drinking water
Characteristics and time frame of campylobacter diarrhea
short-term
prominent abodminla pain
pseudoappendicitis
bloody diarrhea
Characteristics and time frame of salmonella diarrhea
short-term
frequent fever
Characteristics and time frame of shigella diarrhea
short-term
fever
bloody diarrhea
abdominal pain
Characteristics and time frame of entamoeba histolytica
long-term (>2 weeks)
prolonged bloody diarrhea
Characteristics and time frame of giardia diarrhea
long-term (>2 weeks)
prolonged watery diarrhea
fat malabsoprtion, bloating common
asymptomatic patients may continue to shed organism for months
Characteristics and time frame of cryptosporidium, cystoisospora (formerly isospora), microscporidia species diarrhea
long-term (>2 weeks)
chronic watery diarrhea in immunosuppressed patients
Characteristics and time frame of cyclosporine diarrhea
long-term (>2 weeks)
may cause prolonged, relapsing infection
characteristics of focal nodular hyperplasia as a cause of a solid liver mass
- associated with anomalous arteries
- arterial flow + central scar on imaging
characteristics of hepatic adenoma as a cause of a solid liver mass
- women on long-term OCPs
- possible hemorrhage or malignant transformation
characteristics of regenerative nodules as a cause of a solid liver mass
acute or chronic livery injury (cirrhosis)
characteristics of hepatocellular carcinoma as a cause of a solid liver mass
- systemic symptoms
- chronic hepatitis or cirrhosis
- elevated alpha-fetoprotein
characteristics of liver metastasis as a cause of a solid liver mass
- single/multiple lesions
- known extra hepatic malignancy
What is ascertainment (sampling) bias?
type of selection bias: study population differs from target population due to nonrandom selection methods
What is nonresponse bias?
type of selection bias: high nonresponse rate to surveys/questionnaires can cause errors if non responders differ in some way from responders
What is Berkson bias?
type of selection bias: disease studied using only hospital-based patients may lead to results not applicable to target population
What is prevalence (Neyman) bias?
Type of selection bias: exposures that happen long before disease assessment can cause study to miss disease patients that die early or recover
