Doc facts Flashcards
(75 cards)
1
Q
MOBITZ 2 second degree AV block
A
Intermittent non-conducted P waves with a REGULAR PR INTERVAL. Has high rate of progression to Type 3 COMPLETE HB/sudden cardiac death
2
Q
MOBITZ 1 second degree AV block
A
Non-conducted P waves w/ progressive elongation of PR intervals. Usually asymptomatic and/or benign
3
Q
Albumin corrected Ca2+ calculation
A
.8(4 - albumin) + measured calcium
*Immobilization can lead to hypercalcemia; bone resorption exceeds bone formation which is most readily observed in ppl w/ high bone turnover (e.g. adolescent & Pagets dz). PTH positively correlates w/ renal conversion of 25 to 1,25 Vit D
TX - bisphosphonates
4
Q
Hep B infxn lab findings
A
- ^^aminotrxes(stabilize ~ 2-8 wks)
- HepB SURFACE antigen(+) if present > 6mos =chronic
- HepB CORE IgM(+)
- Hep B DNA(+)
- HepB E ANTIGEN(Indication of high infectivity!!!)
- 70% asymp, 30% symp(fatigue, jaundice), most resolve spontaneously
5
Q
OSA (Stop BANG); 3-4 intermed. risk, >5(high)
A
- Snoring
- Tired (fatigue)
- Observed apnea/choking in sleep
- Pressure (hypertension)
- BMI >35
- Age > 50
- Neck size > or = 17
- Gender (male)
6
Q
Clinical fx of Compartment Syndrome
(any condition that causes increased pressure in confine space and decreases blood flow
A
- Pain out of proportion to injury
- Pain increase w/ passive stretching
- Paresthesia (early sign)
- Rapidly increased size and swelling(tense) of region
- tissue pressure measurement is diagnostic
7
Q
Peripheral arterial dz
A
- Manifests as a result of atherosclerotic narrowing of the proximal segments of large peripheral arteries
- decreased ABI and claudication common
- CHADS VASC score
- aspirin shown to reduce risk of stroke and should be started at time of dx. Also start high dose statin(<75 YO)
8
Q
Tx of symptomatic PAD
A
(1) - Stop smoking(if done), Decrease BP, Optimize DMII tx regimen, Aspirin and Statin
(2) - Supervised exercise therapy
(3) - Cilastozol > pentoxyfilline
(4) - Angioplasty +/- stent, Autonomous vs synthetic bypass
9
Q
Flash pulmonary edema
A
development of RESPIRATORY DISTRESS related to the RAPID ACCUMULATION of fluid within the lung interstitium (the tissue and space around the air sacs of the lungs) secondary to ELEVATED CARDIAC FILLING PRESSURES.
10
Q
Peritoneal dialysis related peritonitis
A
- most commonly secondary to touch contamination of the dialysis catheter lumen or extension from a catheter site skin infection
11
Q
Peritoneal dialysis related peritonitis
A
- cloudy peritoneal fluid is sufficient for dx
- > 50% neutrophils regardless of leukocyte count is sufficient for dx
- fluid gram stain usually negative, fluid cx usually positive
- gram positive bacteria causal >66% of time(eg staph epidermidis)
- intraperitoneal abx > IV abx for tx unless CLEAR EVIDENCE OF SEPSIS
12
Q
Congenital adrenal hyperplasia(^^^17-OHPrg)
A
- autosomal recessive
- 21 hydroxylase deficiency = low production of gluco and mineral corticoids
- Excess substrates are shunted to androgen synthesis; ambiguous genitalia for girls and precocious puberty in boys
- ACTH elevated b/c ADRENAL HYPERPLASIA
13
Q
PBC(primary biliary cholangitis)
A
- progressive autoimmune dz = fibrosis and obliteration of the intrahepatic bile ducts, potentially leading to cirrhosis
- fatigue and pruritus are most common chief complaints associated with it
- high incidence of osteopenia/osteoporosis
14
Q
PBC(primary biliary cholangitis)
A
- usually in white women from 30-65
- elevations in ALK-PHOS(i.e. cholestasis)
- Anti- mitochondrial Ab’s are highly sensitive/specific
- URSODEOXYCHOLIC acid slows progression
Assoc w/ jaundice, steatorrhea, xanthelasma, HLD, hyperpigmentation
15
Q
Acanthosis Nigricans
A
Acanthosis nigricans typically occurs in people who are obese or have diabetes. More rarely, it can be a warning sign of a cancerous tumor in an internal organ, such as the stomach or liver.
Dark, velvety patches of skin often appear in the armpits, groin, and neck.
16
Q
Multifocal atrial tachycardia
A
- result of atrial conduction abnormalities(e.g. atrial enlargement, catecholamine surge as seen in sepsis, electrolyte imbalances(eg decreased Mg/K)
- usually seen in age >70 w/ acute exacerbation of pulmonary dz
- irregular rhythm, rapid rate, P waves w/ at least 3 different morphologies
- TX: RESOULUTION OF INCITING ILLNESS
17
Q
Colon cancer screening(ppl at avg risk)
A
- begin at age 45
- Colonoscopy every 10 years
- Stool guaiac or fecal immunohistochem annually
- (FIT-DNA) Multi-target stool DNA testing
- CT Colonography or Flex sig every 5 yrs
18
Q
Colorectal cancer screening of ppl w/ 1st degree relative or high risk adenomatous polyp
A
- begin at 40 or 10 years prior to the age of dx in first degree relative
- repeat screening every 5 years (every 10 if FDR diagnosed at or above 60)
19
Q
Erythropoeitin use in Chronic Kidney Dz
A
- Mixed concentric(chronic HTN, AS) and eccentric(volume overload, AR or MR) are common in CKD
- Erythropoesis stimulating agents mimic endogenous EPO and are useful in treating CKD after iron stores have been repleted
- CKD Pts w/ Hgb <10 have been shown to have improved quality of life & reduced LVH
20
Q
New York Heart Association Categories
Stages of Heart Failure
A
- Class I - No symptomatic limitation of physical activity
- Class II - slight limitation w/ physical activity(e.g. dyspnea w/ climbing stairs)
- Class III - marked limitation of physical activities (e.g. dyspnea w/ ADLs and house chores)
- Class IV - inability to perform physical activity w/o significant discomfort
21
Q
Biventricular Cardiac pacing guidelines
A
- LV systolic dysfunction (i.e. EF of < 35%)
- abnormal ventricular conduction secondary to ischemia
- BV pacing shown to improve NYHA class & exercise tolerance. Reduced mortality seen
- LBBB w/ QRS interval of > 150msecs
- NYHA classes II, III, and IV
22
Q
GOLD (Global Initiative for Chronic Obstructive Lung Dz) recs for COPD exaceration tx
A
- recommends ABX for pts with COPD w/ 2 or more of following:
1) increased sputum purulence
2) increased sputum volume
3) worsening dyspnea
4) requiring mechanical ventilation (invasive or non-invasive)
23
Q
Atrial Septal Defects
A
- 2nd most common congenital heart defect seen in adults (bicuspid aortic valve most common)
- most are asymptomatic until adulthood
- Signs and symptoms: dyspnea, fatigue, atrial arrhythmias
- wide fixed splitting of second HS
- mid-systolic ejection murmur(^ flow @ PV)
- mid- diastolic rumble (^ flow @ TV)
24
Q
1st and 2nd line prevention of variceal bleeds
A
- Non-selective beta blockers are primary prevention if pt has never had a bleed but has known varices
- Tx of those w/ multiple prior bleeds is secondary prevention
- Addition of nitrates may help w/ NSBBs as they both decrease portal venous pressure
- Octreotide also decreases splanchnic blood flow, may decrease bleeding
25
Central retinal arterial occlusion(Cherry Red macula)
- acute, monocular, painless vision loss
- usually seen in patients >60 YO w/ underlying CV risk factors
- usually due to carotid atherosclerosis(i.e. carotid art>>opthalmic art>>CRAO progression)
- can also be embolic in origin vs DMII, HTN or arteritis(Giant cell)
- red macula b/c supply from posterior ciliary arteries
26
Central retinal artery tx
- can cause irreversible damage in 90-100min
| - lower intraocular pressure right away (ocular massage, IV acetazolamide, mannitol, anterior chamber paracentesis)
27
Dementia w/ Lewy Bodies(may be diagnosed in the setting of dementia)
HIGHLY SENSITIVE TO ANTIPSYCHOTICS!!
- Dementia is progressive cognitive decline that leads to functional impairment
- > or = 2 of the 4 following:
(1) fluctuating cognition (tx w/ cholinesterase Inhib)
(2) Visual hallucinations (tx w/ Antipsychotic)
(3) Parkinsonism
(4) Rapid Eye movement sleep d/o(tx w/ melatonin)
- ~ 75 YO @ onset and 4X more common in men
- 2nd leading cause of dementia behind Alzheimers
28
TNM tx of vocal cord lesions
RADIATION IS THE PRIMARY NON-SURGICAL TX FOR EARLY STAGE GLOTTIC TUMORS!
- T1a lesion is confined to one vocal cord
- T2 lesion extends to sub or supra glottis and impairs vocal cord function.
CO2 laser is also effective tx, but radiation offers for favorable outcomes.
29
Bells Palsy (Unilateral/Idiopathic)
Idiopathic neuropathy of CN VII that results in inability to raise eyebrow/close eye on affected side, drooping of corner of mouth or disappearance of nasolabial fold.
Forehead muscle sparing is indicative of CNS pathology (eg tumor, ischemia)
30
PPAR gamma agonists ( eg Pioglitazone)
PPAR Gamma receptors are present in the collecting tubule of the nephron. Stimulation of those receptors by Thiazolidindiones causes increased sodium reabsorption(aldosterone receptor) which can cause excess fluid retention in ~ 5% of pts.(most have underlying heart failure)
TX: aldosterone receptor antagonist (e.g. Spironolactone)
31
Frontotemporal Dementia (DARE HEr)
- Early age of onset, usually 50s-60s
- usually involves abnormal inclusion of hyperphosphorylated Tau protein, or 43 kD TAR-DNA binding protein.
- neuronal death at frontal/temporal regions = behavioral changes
- disinhibition, apathy, empathy(decline), ritualistic actions, hyperorality, executive dysfunction
- combo of UMN and LMN signs like ALS
32
Risk factors for reactivation of VZV(Shingles)
- Advancing age(waning VZV cell mediated)
- Malignancy
- Liver dz
- Kidney dz
- Immunocompromise(e.g. Glucocorticoids)
- pts < 72 hours w/ lesions should receive valacyclovir
* **disseminated dz warrants hospital admission and IV Acyclovir(prevents complications(eg ocular infxns)
33
Common causes of endobronchial obstruction
- presentation is generally recurrent episodes of bacterial pneumonia
- In elderly/extensive smoking hx = bronchogenic carcinoma
- In young and non-smoker = carcinoid tumor
34
Differential Dx for unresolving/recurrent pneumonias
- Malignant tumor
- Carcinoid tumor
- bronchoalveolar cell carcinoma
- lymphoma
- eosinophilic pneumonia
- bronchiolitis obliterans organizing pneumonia
35
MEN 1 syndrome
- Enteropancreatic tumors ~ 65% of cases
- Primary Hyperparathyroidism in >90% cases
- Pituitary tumors
36
MEN 2A syndrome
- Medullary thyroid carcinoma in ~ 90% cases
- Pheochromosytoma in ~ 45% of cases
- Parathyroid hyperplasia ~ 15% of time
37
MEN 2B syndrome
- Medullary thyroid carcinoma
- Pheochromocytoma
- Other: mucosal and intestinal neuromas and/or marfanoid habitus
38
Thyroid cancer TX after surgery or ablation
- thyroid hormone replacement to lower residual TSH production made to stimulate cells that remain has been shown to decrease the risk of recurrence
***as a caveat, suppression of TSH with levothyroxine is also assoc. w/ increase risk of bone loss and atrial fibrillation. Dosing dependent on other prognostic factors
39
Pre-term labor management
- <32 wks:Betamethasone, Penicillin if GBS(+) or unknown, Tocolysis(eg indomethacin), MgSO4
- 32-34 wks: Betamethasone, Penicillin if GBS(+) or unknown, tocolysis (eg nifedipine)
- 34-37 wks: Betamethasone, Penicillin if GBS(+) or unknown
40
Classification of angina
Classic
- Typical location(eg retrosternal), duration and quality
- exercise and/or stress induced
- relieved by rest or nitroglycerin
* Atypical is 2 out of 3 of the above*
* Non-anginal is < 2 of the above*
41
ABX treatment of aspiration pneumonia
- polymicrobial coverage (gram + and gram - )
- outpatient = Augmentin
- Inpatient(not critically ill) = Ampicillin + Sulbactam
- Inpatient(critically ill) = carbapenem or piperacillin-tazobactam
42
Findings consistent with Herpes Keratitis
- blurry vision, eye pain, photophobia, clear discharge
- Dendritic (linear, branched) corneal ulcerations on fluorescein examination
- MOST COMMON CAUSE OF corneal blindness in resource rich countries
- TX w/ topical antiviral meds, usually gone in 2 wks
43
Treatment of Psoriasis/Psoriatic arthritis
- Pts w/ < 10% skin involvement are typically treated with topical corticosteroids or VIT D derivative like Calcipotriene
- Patients with more extensive skin involvement or joint involvement require treatment with more potent agents like methotrexate
44
Chronic Hypoparathyroidism treatment
- high doses of VIT D(25,000 to 100,000 units/day) & Ca2+ supplementation
- adjust supplements to achieve serum Ca2+ [ ] to b/w 8.5-9.0
- Thiazide diuretics are good adjuncts to primary therapy b/c they help increase renal Ca2+ reabsorption in the setting of low PTH production
45
Normal hearing assessment findings
Rinne: AC>BC in both ears
Weber: Midline
46
Conductive hearing loss findings
Rinne: BC>AC in affected ear, AC>BC in unaffected ear
Weber: lateralizes to AFFECTED ear
47
Sensorineural hearing loss
Rinne: AC>BC in both ears
Weber: lateralizes to UNAFFECTED ear away from affected ear
**Sudden sensorineural hearing loss warrants URGENT ENT evaluation b/c can lead to permanent hearing loss
48
Mixed hearing loss
Rinne: BC>AC in AFFECTED ear AC>BC in UNAFFECTED ear
Weber: lateralizes to UNAFFECTED ear away from AFFECTED ear
49
Congenital Rubella clinical presentation
- congenital heart defects
- eye abnormalities
- hearing impairment
50
Congenital Toxoplasmosis clinical presentation
Risk factors: undercooked meat, unwashed produce(contaminated soil), handling cat feces
Classic triad seen in newborn:
- Chorioretinitis
- Hydrocephalus
- Diffuse intracranial calcifications
*microcephaly b/c of brain atrophy/macrocephaly b/c of severe hydrocephalus are both seen w/ concomitant seizures*
TX: pyrimethamine, sulfadiazine, folinic acid
51
Acrochordons (Skin tags)
- benign outgrowths of skin in areas of high friction
- Associated with obesity, insulin resistance,
overt diabetes, and metabolic syndrome
52
Breast feeding benefits(maternal & newborn)
Maternal: infant bonding, reduced risk of breast and ovarian cancer
Infant: maternal antibody transfer results in lower infection rates/severity
*first few days are colostrum which is antibody rich but low in volume*
53
TABES DORSALIS
```
D- dorsal column degeneration
O- orthopedic pain (Charcot arthropathy)
R- Refelexes decrease (deep tendon)
S- Shooting pain
A- Argyll Robertson pupils(bilaterally small pupils that do not constrict when exposed to bright light but do constrict when focused on a nearby object)
L- Locomotor ataxia
I- impaired proprioception
S- Syphilis
```
54
Allergic Bronchopulmonary Aspergillosis
- hypersensitivity rxn that occurs in ppl with asthma or CF
- non-invasive colonization of the airways with Aspergillus fumigatus
- diseased state results from exaggerated IgE and IgG responses to Aspergillus fumigatus
- Common fx: fever, recurrent asthma attacks, cough w/ brown mucus plugs
55
Spontaneous Bacterial Peritonitis Dx criterion
- mental status changes in the setting of liver cirrhosis w/ concomitant abdominal pain
- positive culture or > or = 250 neutrophils/mm within ascites obtained on paracentesis
- In setting of cirrhosis use SAAG. (Serum ascites to albumin gradient)
- SAAG of > or = 1.1 g/dL is suggestive of dx
Tx: IV ABX b/c untreated = high mortality
also give IV albumin which = decreased renal failure.
56
Treatment of Cryptococcal Meningitis(yeast)
- CNS counts typically below 100/mm^3
- Fever, headache and lethargy manifest over ~ 1-2 weeks
- markedly elevated opening pressure(250-300 mmH2O)
- elevated protein w/ low glucose
- Positive india ink test
- Lymphocytic predominance WBC count
*TX w/ > or = 14 days of Flucytosine and Amphotericin B
57
Wells criteria for assessment of suspected PE
- < or = to 4 means unlikely, while > or = to 4 indicates likely PE
1 pt: Hemoptysis or Cancer
1.5 pt: Hx of prior PE or DVT, HR > 100bpm, Recent surgery or immobilization
3 pt: Clinical signs of DVT, alternate dx less likely than PE
58
Catalase postitive bacteria(capable of destroying superoxide radicals)
- Staph Aureus
- Burkholderia Cepacia
- Nocardia
- Aspergillus
59
Uterine atony
- in post-partum period can present with post-partum hemmorhage (i.e. > or = 1L blood loss) +/- concomitant hypovolemia
- occurs when uterus fails to contract to establish hemostasis after placental separation
- earliest recommended means' of treating it are UTERINE MASSAGE and OXYTOCIN
- 2nd line uterotonic options should prior methods fail are (methylergonovine, carboprost, and misoprostol)
60
Type 1 error (Epidemiology/Statistics)
Refusal to accept the null hypothesis when it is in fact true
61
Type 2 error (Epidemiology/Statistics)
Accepting the null hypothesis to be true when it is in fact false
62
Breastmilk jaundice
- unconjugated hyperbilirubinemia in exclusively breastfed infants
- starts ~ 3-5 days old and peaks at ~ 2 weeks old
- thought to be caused by high beta glucuronidase activity in breast milk that deconjugates intestinal bilirubin and results in increased intestinal absorption and enterohepatic circulation of bilirubin
- typically resolves with persistent exclusive breastfeeding by 3 months of age
63
Findings consistent w/ Trisomy 21
- DECREASED Pregnancy associated plasma protein A
| - INCREASED Beta HCG
64
Phases of Clinical Trials
Pre-Clinical - LAB based and animal models(i.e. does it work)
I - Small number of ppl ~ 20 HEALTHY subjects to assess HUMAN SAFETY (i.e. toxicity, maximum dose, adverse effects)
II - Few hundred AFFECTED ppl (i.e. exploring efficacy/optimal dosing)
III - RCT (treatment vs control arms) w/ hundreds to thousands of ppl. Compare new tx to Gold standard therapy
IV - Post-market surveillance (rare and long term effects of therapy of interest)
65
Clinical treatment of severe hyperkalemia
- 1st line treatment is Ca2+ gluconate or Ca2+ chloride (rapidly stabilizes cardiac membrane potentials in setting of hyperkalemia)
- Beta agonists or Insulin and glucose given as adjunct to help drive potassium into cells
66
Infectious (Corneal) Keratitis
Bacterial(eg Staph A, Pseud A): Caused by improper contact use, foreign bodies, or corneal trauma. Clinical fx = central round ulcer, stromal abscess, MUCOPURULENT d/c, ACUTE
Viral(eg HSV): seen in temporary or chronic immunodeficiency. Clinical Fx = branched dendritic ulcerations, reduced corneal sensation, WATERY d/c, ACUTE
Fungal(eg candida):Immunocompromised with corneal injury involving soil. Clinical fx = ulcers w/ feathery margins & satellite lesions, MUCOPURULENT d/c, INDOLENT
67
Rate Ratio
Incidence rate of an event / incidence rate in control group = rate ratio
Rate ratio < 1 = incidence rate lower in intervention group ( intervention benefited)
Rate ratio = 1 = incidence rate was same in both groups
Rate ratio > 1 = incidence rate higher in intervention group (intervention risks high)
68
NNT vs NNH
1 / the difference between the relative risks of the treatment(intervention) group and the control group
69
Acute management of Acetaminophen overdose
- activated charcoal for absorption within the stomach if ingestion occurred within 4 hours
- N-acetyl-cysteine can be administered for increased intrahepatic glutathione stores which facilitates removal of N-acetyl-benzoquinone(primary metabolite of acetaminophen)
70
Digoxin toxicity fx
- nausea, vomiting, anorexia, fatigue, confusion, visual disturbances,
71
Clinical presentation of Subarachnoid Hemmorhage
- Sudden onset of a severe headache
- Nausea and/or vomiting
- +/- nuchal rigidity
72
Type 1 Statistical Error
Rejecting the null hypothesis when it is actually true(False Positive)
73
Type 2 Statistical Error
Accepting the null hypothesis when it is actually false(False Negative)
74
Parkland Formula for fluid replacement (Skin barrier injuries)
- should be utilized only in 2nd and 3rd degree burns
- Use Lactated Ringers sol'n
FORMULA = 4 ml x area of damage percent of body area x body weight in kilograms
- 1st half administered over 1st 8 hours, and second half over remaining 16 hours
Rule of 9s : 9% (head and each arm), 18% (front and back torso each)
18% each leg, 1% per hand
75
Clinical Presentation of Vertebral Artery Dissection
- typically a young person w/ a severe occipital headache & concurrent nuchal pain
- ipsilateral face dysesthesia (pain & numbness)*MOST COMMON*
- ipsilateral loss of taste (nucleus and tractus solitarius)
- Hoarseness CN's IX and X palsy
- contralateral loss of pain and temperature of TRUNK and LIMBS
- hiccups (CN X)
- vertigo
- nausea and vomiting
