uworld dec 3 Flashcards
What are most common bugs in cellulitis?
Grp A strep and S. Aurea, also can have C. Perfringens
What is usual cause of cellulitis?
IV catheters, incision, bites/wounds. Also can happen w/ venous stasis, lymphedema, DB ulcer
What is erysipelas?
Cellulitis confined to dermis & lymphatics. Usuall due to GAS.
What bug causes tetanus and how tx?
Clostridium tetani, G+ anaerobic tetani, tx with
What is osteomyelitis usually due to ?
S. aureus if catheter septicemia, coag - staph if prosthetic joint, salmonella in sickle cell
What are risks for osteomyelitis?
open fx, DM, IV drug use, sepsis
How use ESR & CRP w/ osteomyelitis
Used to trend tx effectiveness w/ cellulitis and other infxns
Best imaging study for osteomyelitis?
MRI is best for dx & assesing extent of disease
How tx osteomyelitis?
requires long term IV ABX with ABX used based cx. may require surgical debridement if significant bone involvement.
How easily r/o septic arthritis?
If painless ROM, then septic arthritis highly unlikely.
How get acute septic arthritis?
most often w/ hematogenous spread, can occur w/ contiguous spread as well from abscess etc.
Most common bugs of septic arthritis?
s. aureus most common, also strep. If young think N. gonorrhea,
Signs of septic arthritis of joint aspirate?
WBC>50k, mostly segs, no crystals
How tx septic arthritis?
tx immediately w/ empiric ABX, vanc or other staph ABX, consider surgical drainage
How does stg 1 of lyme disease px?
eryhtema migrans-> tx w/ dox
What causes hypertrophic cardiomyopathy?
usually px in younger pts, due to assym septal hypertrophy causing outflow obstrxn
What causes concentric hypertrophy of the heart?
constant pressure overload such as in AS or uncontrolled HTN, (eccentric hypertrophy does not cause CHF)
Best way to dx rotator cuff tear?
MRI of shoulder
What is case control study?
takes groups of disease patients and group of healthy pts, looks back @ freq of particular risk fx in the 2 groups. Looks at outcomes first, then risk fx
What is retrospective cohort study?
reviews records, looks @ positive risk fx and negative risk fx and determines who gets sick. (e.g. those who smoke vs those who didnt in cancer pts)
What is a cross-sectional study?
Looks at exposure and outcome at the same time, cannot establish causation. determines rate of illness in 2 groups.
What causes intraparenchymal hemmorrhage?
uncontrolled htn most commonly, leads to lacunar strokes in BG, putamen, thalamus, cerebellum. Rarely get lobar hemorrhages due to htn
How do putaminal strokes px?
get hemiplegia, hemisensory loss
first step in evaluation of solitary pulm nodule?
based on probability of having malignancy, if low risk- do serial CT scans, if interm risk & >1cm, do FDG-PET and surgical excision if positive, if <1cm do CT to further asses
Sx of open angle glaucoma?
loss of periph vision w/ cupping optic disc, tx w/ beta blocker drops -> timolol
Cause of lambet eaton syndrome?
Associated w/ small cell lung cancer, due to Ab against voltage gated Ca channels of muscle
Infxs causes of BLOODY diarrhea?
shigella, E.Coli, campylobacter
Signs of pulmo htn?
enlrgment of pulmo arteries w/ distal tapering on Cxr, enlarged Rvent, R axis deviation
Adv effects of antithyroid drugs?
methimazole is teratogen, causes cholestatic jaundice, PTU can cause vasculitis, both can cause arthralgia, hepatitis, agranulocytosis
Adv effects of radiation ablation for hyperthyroid tx?
Leads to permanent hypothyroidism, and worsening opthalmopathy
Why ptu usually avoided?
can cause svr liver injury leading to acute liver failure
How differntiate cushing disease & ectopic ACTH prodxn?
w/ incrsd ACTH and incrsd cortisol, if high dose dexa fails to suppress, then ectopic, if high does does suppress then cushing disease (ACTH producing pit adenoma)
Other si/sx of ectopic ACTH prodxn?
rapidly develops usually, hypokalemic alkalosis, pigmentation, htn, lack of florid cushing syndrome features since so rapid
What can cause ectopic ACTH prodxn?
small cell lung cancer, pancreatic cancer, neuroendo tumors, bronchogenic carcinoma
What are si/sx of carboxyhbg?
polycythemia, dizziness, HA, nausea
How tx dermatitis herpetiformis?
Gluten free diet and dapsone if refractory
How manage CR cancer screening in UC pts?
Begin colonoscopies 8 yrs after dx, do annually w/ multiple biopsies each time, do prophylactic total proctocolectomy when dysplasia discovered
Sx of hypokalemia?
weakness, fatigue, muscle cramps, flaccid paralysis, hyperreflexia, rhabdo, arryth
ECG findings w/ hypoK
broad flat T waves, u waves, ST depression + pvcs
Common cause of hypoK?
diarrhea, vomiting, anorexia, hypoaldosteronism
Si/sx of ALS?
degen motor neuron disease affecting upper and lower motor neurons = hyperreflexia, spasticity, fasciculations -> no tenderness or muscle pain
How determine rhabdo on lab?
Incrsd CK, lrg amt of blood on dipstick but no RBCs under micro, myoglobinuria
Incrsd risk of infxn w/ alpha antitrypsin deficiency?
NOPE
What are 2 most common inflamm myopathies? Si/Sx
polymyositis + dermatomyositis, px w/ incrsd ESR, CK, and prox muscle weakness, tx w/ corticosteroids
Tx for myasthenia gravis?
pyridiostigmine (anticholineterase)
Cause of dermatomyositis & polymositis?
humoral immune mechanisms in dermato, cell-mediated for polymyositis
Si/sx of myositis?
Symmetric prox muscle weakness, myalgia, dysphagia in some patients
Unique sx of dermatomyositis?
heliotrope rash, gouttrons papules, (MCP, PIP,DIP), shawl sign. periungal erythema, incrsd risk of cancer in lung, breast, ovary, GI tract w/ dermato
Other causes of myopathy?
hypothyroidism, thyrotoxicosis, cushing syndrome, electrolytes abnormalities (dcrsd K, Ca, PO4), drugs (steroids, zidovudine, colchicine)
Si/sx of hypothyroidism?
fatigue, prox muscle weakness, sluggish ankle reflexes, nml ESR, incrsd CK
How tx goodpastures syndrome?
removal of circulating anti-glomerular basement membrane Ab via emergent plasmapheresis.
Goodpastures px w/?
hemoptysis, dyspnea, ankle edema, hematuria, UA shows dysmorphic RBCs, mod proteinuria, red cell casts
How tx wegeners?
cyclophosphamide + steroids
What is AERD?
aspirin exacerbated respiratory disease
How does AERD px?
get wheezing following naproxen ingestion
How manage infective endocarditis?
draw cx 1st, then begin empiric ABX, then do imaging studies.
How manage acetominophen OD?
in first 2 hours, give activated charcoal, begin @ hr four, obtain serum levels and admin N-acetylcysteine. Do not give NAC if >8hrs since ingestion.
Si/sx of hyperammonemia?
asterixis, irritability, inversion of sleep-wake cycle, confusion, disorientation, anorexia, coma
Si/sx of cobalamin deficieny?
dcrs position, vibratory sense & gait abnormalities
How prevent recurrent Ca renal calculi?
dcrs protein intake and oxalate intake, restrict Na intake
What immune fxn is impaired in post-splenectomy patients?
impaired phagocytosis due to failure of activate B cells, get no Ab prodxn leading to lack of phagocytosis
Causes of defective cell-mediated immunity?
thymic aplasia for one
Best initial tx following ischemic stroke?
give aspirin, if w/in 3-4.5 hrs give alteplase, use clopidogrel if cant tolerate or tried and failed aspirin therapy. DONT USE HEPARIN
What is d-xylose test?
Absorbed w/out any digestion so only requires small bowel mucosa, determines absorptive capacity of small intestines. Suggests presence of malabsor dx like celiac.
Si/sx of b12 deficiency?
macrocytic anemia, glossitis, periph neuropathy
What is ranolazine?
late sodium channel blocker used in stable angina w/ sx at max therapy
What is doxazosin? When contraindicated
alpha blocker. Only give 4 hours before/ after taking sildenafil
What are categories of alkalosis?
chloride sensitive and chloride resistant
What is Cl sensitive alkalosis?
hypochloremic alkalosis will respond to saline, chloride low in this case
What is Cl resistance alkalosis?
normochloremic alkalosis that will not respond to saline infusion
What is baker’s cyst?
tender mass in popliteal fossa assoc w/ RA. Due to excessive fluid collection in inflamed synovium. Also occurs in OA and cartilage tear
Si/sx of hypertrophic cardiomyopathy?
epsodes of syncope, systolic murmur @ left sternal border, family hx of early HD
tx for familial hypertrophic cardiomyopathy?
beta blockers -> have anti-anginal effect
Si/sx of acute pancreatitis?
epigastric pain partially improved w/ sitting up, leaning forward, N/V
How tx vtach?
if stable- amiodarone, lidocaine, procainamide. If unstable, synchronized cardioversion
Who at risk for asbestosis?
hx of mining, shipbuilding, insulaters, pipe workers
What are si/sx of asbestosis?
dyspnea, end inspiratory crackles, clubbing, incrsd risk of bronchogenic carcinoma and mesothelioma
Rheumatoid Arthritis and boney problems?
incrsd risk of osteopenia and osteoporosis
When use tetanus immune globulin?
only in pts who have not received complete series of tetanus immunization.
Who doesnt need tetanus booster?
Omitted in pts who received booster w/in last 5 years, in pts w/ clean minor wounds who recevied vaccination w/in past 10 years.
Who most likely to get vtach?
those w/ advanced systolic HF & underlying ischemic HD
What is definition of orthostatic hypotension?
systolic bp decrease of 20 or more or diastolic dcrs of 10 or more.
What meds commonly cause orthostatic hypotension?
alpha blockers, nitrates, ED meds, and antidepressants
Other causes of orthostatic hypotension?
neurogenic (diabetes/ alcoholic neuropathy), MS, multiple system atrophy
How does vasovagal syncope px?
commonly w/ prolonged standing w. prodrome of nausea, lightheadedness, diaphoresis, may have brief myoclonic jerks after losing conciousness
What is sign of syncope due to heart block?
forehead bruise is classic sign because of sudden loss of conciousness & lack of preceding sx resulting in pt falling and injuring himself
Best way to evaluate recurrent syncope?
Place implantable loop recorder if recurrent/ infrequent events
Best way to tx depression after failure?
switch to another drug first, can be within same class
When medically tx depression 2/2 to death?
if 2 consecutive wks of sx 8+ weeks after death
Clinical findings of cocaine intox?
tachy, htn, hyperthermia, mydriasis, agitation, psychosis
what is 1st line tx for cocaine intox?
sedation w/ lorazepam. Controls agitation = usually dcrses HR, BP, temp.
Best way to treat alcohol dependence?
use naltrexone which has been shown to dcrs frequency of relapse
How manage lumbar stenosis?
Manage non-surgically for 3 mo-2 yrs, failure of tx is considered when sx progression occurs w/ neuro deficits and svr pain.
Si/Sx of vertebral osteomyelitis?
localized back pain, tender to palp, hx of IV drug use, fvr, incrsd ESR
management of spinal osteomyelitis?
urgent spinal MRI followed by ABX + surgical debridement if necessary
Si/sx of spinal cord compression?
spinal or radicular pain that may precede onset of neuro sx, weakness, numbness, sphincter disturbance
what are most ommon causes of chronic cough?
asthma, post nasal drip, GERD
How manage cough variant asthma?
trial of inhaled albuterol, if fails likely eosinophillic bronchitis, confirm dx w. BAL and biopsy
most common cause of hemoptysis in outpatient?
infxn or malignancy
How manage pt w. hemoptysis?
get cxr, then CT &/or bronchoscopy.
