Medicine- PBL, PDX, SIM Flashcards Preview

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Flashcards in Medicine- PBL, PDX, SIM Deck (45):
1

What value is the normal A-a gradient?

10-15

2

If hypoxic and A-a gradient is > 15 what does that suggest?

Pulmonary pathology

3

If hypoxic and A-a gradient is

Extra-pulmonary cause

4

What is the equation to determine the A-a gradient?

(150- (PaCO2/0.8)) - PaO2

5

Describe Birt-Hogg-Dube Syndrome?

An autosomal dominant syndrome

Mutation in folliculin (tumor suppressor gene)

More likely for pulmonary cyst

Could then rupture and cause a pneumothorax

6

How can stress lead to elevated blood glucose?

Increased catecholamines
Act on B2 receptors of liver
Glycogenolysis
Increased blood glucose

7

How can Vit. C. deficiency contribute to a pneumothorax?

Vit C is an enzyme that hydroxlates proline and lysine which converts procollagen to collagen

With decreased collagen, there is weaking of pulmonary elastic fibers

Leads to bleb

8

What is the treatment for persistent aneroxia nervosa?

Cognitive behavioral therapy

9

What is cavitation?

Formation of empty space within a solid object

10

Describe the physical characteristic differences between primary and secondary TB

Primary TB- settles right out of bronchi, in fissure (Gohn complex)

Secondary TB- normally in APEX of lung, fibrocaseous cavitary lesion

11

What is the Ghon complex?

Ghon focus (spot on lower lobe) + hilar nodes

12

What type of calcification is found in TB?

Dystrophic calcification
-Calcium deposition in abnormal tissues (lungs and pericardium)
-Patient normocalcemic

13

What is PPD?

Purified protein derivative (type IV hypersensitivity)
+ If current infection or past exposure

14

When would you not perscribe bactrim?

>20% resistance
Has been given Bactrim for UTI in past 3 months

15

Treatment for acute uncomplicated cystitis?

Nitrofurantoin (accumulates at therapeutic levels in bladder NOT KIDNEY)

16

Unilateral flank tenderness
Hematuria
Colicky pain radiating to groin
Nausea/vomitting

Nephrolithiasis

17

What are newborn risk factors diabetes?

Advanced maternal age
High birth weight
Childhood obesity

18

What does insulin bind? What happens after that?

It binds growth factor receptor
Tyrosine Kinase Activity
Glut 4 is stored in vesicles and moves to membrane

19

What is the triad for HSP?

Palpable purpura
Abdominal pain/GI signs and symptoms
Arthritis

20

What type of hypersensitivity is HSP?

Type 3

21

What are you looking for when you do a renal biopsy in HSP?

Looking for crescents

22

What would you find in a skin biopsy of luekocytoclastic vasculitis?

IgA and C3 (alternative pathway complement activation)

23

Direction of trachea in spontaneous pneumo?
Tension?

Towards in spontaneous
Tension away

24

How does a vitamin C deficiency contribute to the developement of a pneumothorax?

Vit. C converts procollagen to collage (by hydroxylating prline and lysine)

If deficiency, weakened pulmonary elastic fibers

Causes bleb

25

How do you treat persistent anorexia nervosa?

Enhanced cognitive behavioral therapy

26

normal A-a gradient?

10-15

27

A 58-year-old truck driver with a 30-year
history of smoking one pack of cigarettes
per day presents for a physical examination.
He reports increased frequency of urination
and nocturia, but does not have gross
hematuria. Physical examination reveals an
enlarged prostate. Results of his urinalysis
with microscopy are shown in Table 2.
Based on this patient’s history, symptoms,
and urinalysis findings, which one of the
following is the most appropriate next step?

❏ A. Repeat urinalysis in six months.
❏ B. Obtain blood urea nitrogen and
creatinine levels, perform computed
tomographic urography, and refer for
cystoscopy.
❏ C. Treat with an antibiotic and repeat
the urinalysis with microscopy.
❏ D. Inform him that his enlarged prostate
is causing microscopic hematuria,
and that he can follow up as needed.
❏ E. Perform urine cytology to evaluate
for bladder cancer.

B

28

A 33-year-old woman with a history of nephrolithiasis presents with
a four-week history of urinary frequency, urgency, urge incontinence,
and dysuria. She recently had ureteroscopy with lithotripsy of a 9-mm
obstructing left ureteral stone; she does not know if a ureteral stent was
placed. She has constant dull left flank pain that becomes sharp with
voiding. Results of her urinalysis with microscopy are shown in Table 4.
Based on this patient’s history, symptoms, and urinalysis findings, which
one of the following is the most appropriate next step?
❏ A. Treat with three days of ciprofloxacin (Cipro), and tailor further
antibiotic therapy according to culture results.
❏ B. Treat with 14 days of ciprofloxacin, and tailor further antibiotic
therapy according to culture results.
❏ C. Obtain a urine culture and perform plain radiography of the
kidneys, ureters, and bladder.
❏ D. Perform a 24-hour urine collection for a metabolic stone workup.
❏ E. Perform computed tomography.


The correct answer is C.

29

A 49-year-old man who has a history of neurogenic bladder due to a
spinal cord injury and who performs clean intermittent catheterization
visits your clinic for evaluation. He reports that he often has strongsmelling
urine, but has no dysuria, urge incontinence, fever, or
suprapubic pain. Results of his urinalysis with microscopy are shown in
Table 5.
Based on this patient’s history, symptoms, and urinalysis findings, which
one of the following is the most appropriate next step?
❏ A. Inform the patient that he has a urinary tract infection, obtain a
urine culture, and treat with antibiotics.
❏ B. Refer him to a urologist for evaluation of a complicated urinary
tract infection.
❏ C. Perform computed tomography of the abdomen and pelvis to
evaluate for kidney or bladder stones.
❏ D. Inform him that no treatment is needed.
❏ E. Obtain a serum creatinine level to evaluate for chronic kidney
disease.

The correct answer is D.

30

5 mm TB skin test

Positive for immunocompromised

31

10 mm TB skin test

Positive for high risk people (moved from endemic country in last 5 years, prisoners, health care workers, IV drug users)

32

15 mm TB skin test

Positive for anyone

33

Type of acid base condition in Pneumothorax?

Respiratory Alkalosis

34

What happens to fremitus with a pleural effusion?

Decreased

35

What conditions make it so you hear dullness to percussion? 3

Consolidation
Atelectasis
Effusion

36

When do you hear hyperresonance to percussion? 3

Pneumothorax
COPD (diffusely)
Asthma (resonant to diffusely hyperresonant)

37

What are breath sounds like over a consolidation?

Bronchial

38

Breath sounds are usually absent with what conditions? 4

Atelectasis
Effusion
Pneumothorax
COPD

39

Adventitious sounds in asthma?

Crackles
Wheezes

40

With what 2 lung conditions may you hear a pleural rub?

Pneumothorax
Effusion

41

What are the adventitious sounds with a consolidation?

Later inspiratory crackles over involved area

42

Late inspiratory crackles, vesicular breath sounds, trachea midline, percussion is resonant, and tactile fremitus is normal...what are you thinking?

Left-sided Heart Failure

43

When is the only time that tactile and vocal fremitus will be increased?

What 3 other things are present?

Consolidation

Bronchopony
Egophony
Whispered Pectoriloquy

44

In a pleural effusion, what is tactile/vocal fremitus like?

Decreased to absent

45

If there is excess air in the thoracic cavity or lungs, what happens to transmitted voice sounds?

Decreased