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Flashcards in Misc Deck (47):
1

strongest known risk factor for male breast cancer

Klinefelter's Syndrome (47, XXY) - carries a 50-fold increase in risk of breast cancer compared to men w/ a normal genotype

2

What is the single most important risk factor for osteoporosis and osteoporotic bone fracture?

AGE

3

When should you start bone density screening?

age 65 in women w/o risk factors

or

post-menopausal women age <65 if they have risk factors (body weight <58kg, chronic steroid use, smoking, malabsorptive disorders (ie pancreatic insufficiency in CF), parental history of hip fractures, or personal history of low-impact fractures

4

Most common side effect of isoniazid (INH)

asymptomatic hepatotoxicity (can range from mild hepatotoxicity/transaminitis to hepatitis)

5

inheritance pattern of a mitochondrial disease

mother-to-offspring inheritance (i.e. males can acquire the disease from motthers but do NOT transmit it further, whereas females will transmit it to ALL of their offpsring)

6

common ADR in patients on pioglitazone

how to counteract this particular ADR?

pulmonary edema 2/2 activation of PPAR-g receptors (which are also present in the nephron collecting tubules, resulting in increased Na reabsorption and subsequently fluid retention)

Since this is the same channel which aldosterone mediates its effects on sodium retention, give spironolactone to remove excess fluid

7

What GCS score is intubation recommended?

8

8

which antibiotics are most likely to trigger seizures? 

penicillin

cephalosporin

monobactams

carbapenems (inc. imipenem)

fluoroquinolones

9

pt w/ history of cardiovascular risk factors and acute sudden painless vision loss

classic exam finding

management?

central retinal artery occlusion - usually due to carotid artery atherosclerosis

pale fundus with cherry red spot

unable to make fine distinctions but able to identify large objects 

urgent ophthalmology consultation and interventions to lower intraocular pressure (ocular massage, anterior chamber paracentesis, IV acetazolamide, mannitol)

10

monocular vision loss, with eye pain, HA, N/V, conjunctival erythema

acute angle-closure glacuoma

11

monocular vision loss associated w/ eye pain that worsens with eye movement. exam shows optic disc edema

optic neuritis

patients likely have a history of MS as well

12

patient w/ otitis media presents w/ pain swelling behind R ear

acute mastoiditis - usually occurs when there is a severe, acute inflammatory response to the otitis media OR the otitis media is not adequately treated, resulting in an accumulation of pus within the mastoid cavities

13

most common cause of decreased vision in the elderly

cataracts

macular degeneration

14

acute onset of vision loss w/ flashing lights w/ floaters in field of vision

exam shows fundus with vitreous hemorhage and marked elevation of retina

retinal detachment

surgical emergency

15

common cause of bacterial infections in contact lens wearers

treatment?

pseudomonas

ciprofloxacin

16

elderly w/ chronic pneumonitis, recurrent sinusitis/otitis media, and glomerulonephritis

Wegener's granuomatosis and polyangiitis - systemic necrotizing vasculitis

17

Slit lamp exam shows presence of leukocytes in the anterior segment of the eye

Penlight exam demonstrates a hazy flare

anterior uveitis

hazy flare refers to the protein accumulation secondary to a damaged blood-aqueous barrier

18

diagnose this:

periodic vertigo, unilateral hearing loss, tinnitus

vertigo provoked by change in position

Meniere's disease

BPPV

19

patient w/ 3cm non-tender, slightly fluctuant, midline neck mass in front of the hyoid bone. swelling moves w/ protrusion of the tongue

remnant thyroglossal duct cyst 

20

patient p/w squamous cell carcinoma of the head w/ significant cervical lymphadenopathy

management?

combined radiation and chemotherapy (CRT) - promises superior results over chemotherapy and radiotherapy alone; renders some inoperable cases operable after treatment

21

management of squamous cell carcinoma of the glottis depends on the stage:

T1 - confined to vocal cords

T2 - extends to supraglottis or subglottis w/ impaired vocal cord mobility

T3 - tumor confined to larynx w/ vocal cord fixation

T4 - tumor invades through thyroid cartilage or direct extra-laryngeal spread

T1 - confined to vocal cords = radiation

T2 - extends to supraglottis or subglottis w/ impaired vocal cord mobility = radiation, laser excision w/ CO2 laser

T3 - tumor confined to larynx w/ vocal cord fixation = induction chemotherapy followed by radiation

T4 - tumor invades through thyroid cartilage or direct extra-laryngeal spread = total laryngectomy

22

rhinitis - how do differentiate allergic vs non-allergic based on history and physical exam?

allergic

  • pale/bluish nasal mucosa w/ occasional polyps
  • usually occurs at an earlier age <20
  • identifiable triggers
  • association w/ eczema, asthma

non-allergic

  • erythematous nasal mucosa
  • usually occurs after age 20
  • no identifiable triggers

23

difference between keratitis and conjunctivitis

keratitis - inflammation of cornea (corneal opacity/ulceration); foreign body sensation; trmt: antibiotics

conjunctivitis - inflammation of conjunctival membrane overlying the cornea; gritty sensation, can lead to keratitis if untreated

24

two types of conjunctivitis and management of both

bacterial - purulent discharge -> erythromycin ointment, sulfa drops, polymyxin/trimethoprim drops. HIGHLY CONTAGIOUS. MUST BE TREATED FOR 24 HOURS OF ANTIBIOTICS BEFORE RETURNING TO SCHOOL 

viral/allergic - morning crusting followed by watery discharge -> antihistamines

25

treatment of orbital cellulitis

IV broad spectrum antibiotics (vanco + ampicillin/sulbactam)

26

patient w/ DM w/ tenderness w/ motion of earlobe, periauricular erythema, lymphadenopathy, and fever. PE: purulent discharge/granulation tissue on floor of the external auditory canal at the osseocartilaginous junction, TM intact

diagnosis?

common culprit?

treatment?

malignant otitis externa 

pseudomonas aeruginosa

treatment: IV cipro

27

ear pain, vesicles in the external auditory canal, ipsilateral facial paralysis

Ramsay Hunt Syndrome

28

Patient p/w 24 hr of mild eye pain followed by decrease in visual acuity, fundoscopy exam demonstrates floating, white layer in the anteiror chamber.

diagnosis?

management?

endophtlamitis - infection of vitreous fluid. layer of leukocytes in is called "hypopyon"

don't confuse w/ anterior uveitis, where slit exam shows layer of leukocytes in the anterior chamber

refer to opthalmologist for aspiration/vitrectomy for cultures and intravitreal antibiotics

29

what are contraindications to receiving the measles, mumps, and rubella vaccine?

anaphylaxis to neomycin, gelatin

pregnancy 

immunocompromised states (since MMR is a life-attenuated vaccine)

30

patient w/ history of asthma presents w/ recurrent asthma exacerbations, cough w/ brown mucus plugs, and fleeting infiltrates seen on CXR

diagnosis?

labs?

treatment?

Allergic bronchopulmonary aspergillosis (APBA) - hypersensitivity disorder that is due ot an exaggerated IgE/IgG mediated immune response to the aspergillus fungus

labs: skin test for aspergillus, eosinophilia >500/µL, IgE ≥417 IU/mL, IgG/IgE for aspergillus

treatment: steroids + itraconazole

31

difficult to control asthma, allergic rhinitis w/ nasal polyps, chronic sinusitis, granulomas, palpable purpura

churg-strauss (eosinophilic granulomatosis)

32

when should HPV vaccine ideally be administered?

contraindications?

ages 11-12

history of severe hypersensitivity reaction to yeast, latex

33

confusion, lethargy, bradycardia, skin flushing, miosis, wheezing, garlic like odor from clothes

organophosphate poisoning

34

treatment of moderate lead toxicity (45-69 µg/dL)

severe lead toxicity (≥70 µg/dL)

PO meso-2,3-dimercaptosuccinic acid (DMSA, succimer)

dimercaprol + EDTA

35

botulism can be derived from ingestion of botulinum spores from environmental dust (aka infant botulism) or ingestion of preformed c-botulinum toxins (aka foodborne botulism). how do the treatments differ?

infant - HUMAN derived botulism Ig

foodborne - EQUINE derived botulism antitoxin

36

what is the cause of fevers, chills, malaise that occur 6 hours after blood transfusion? what can prevent this?

due to residual plasma and/or leukocyte debris, which can release cytokines that when transfused, can cause transient fevers, chills, and malaise w/o hemolysis

leukoreduced blood

37

what symptoms would be consistent w/ history of antifreeze ingestion?

treatment?

rapid shallow breathing (kussmaul's respiration) secondary to severe anion gap acidosis 

other signs: N/V, slurred speech, ataxia, nystagmus, lethargy

treatment: fomepizole infusion

38

39

infant presents w/ signs and symptoms consistent w/ infant botulism. What should you look for in the physical exam?

impaired gag reflex

constipation - usually first manifestation

lethargy, poor sucking, weak crying

40

lithium toxicity can be precipitated by these medications

how do you manage lithium toxicity?

anything that precipitates volume depletion and drug interactions:

thiazide

ACEi

NSAIDs

manage w/ hemodialysis

41

gastric endoscopy in a patient with pernicious anemia will reveal: 

absent rugae in body + fundus

42

in a patient w/ suspected dermatomyositis, what is the confirmatory test to confirm the diagnosis?

what is this usually associated with?

serology testing (ANA, antinuclear antibodies), including

anti-Ro

anti-La

anti-RNP

anti-Jo1

associated w/ malignancy

43

which four types of patients should you give prophylactic calcium gluconate when  you transfuse blood?

patients w/ renal failure, hepatic failure, hypothermia, or shock

why? citrate is normally metabolized into lactate in the liver/kidney. An excess of citrate binds calcium, which leads to hypocalcemia

44

Two contraindications for DTaP vaccination

anaphylaxis or encephalopathy within 7 days of DTP or DTaP vaccination

45

Etiologies of anemia in patients w/ ESRD on HD

decreased renal EPO production

functional iron deficiency (normal iron stores w/ inability to mobolize the stores in response to EPO, defined as transferrin saturation <20% w/ ferritin of 100-800ng/mL or higher)

46

when is tetanus toxoid globulin (TIG) ever indicated? 

when patient's immunization status is unknown AND they have a dirty/severe wound laceration. All other times, the tetanus toxoid is indicated.

47

treatment for organophosphate poisoning

atropine (reverses muscarinic receptor effects) and pralidoxime (cholinesterase activator)