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
What is the single most important risk factor for osteoporosis and osteoporotic bone fracture?
When should you start bone density screening?
age 65 in women w/o risk factors
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
Most common side effect of isoniazid (INH)
asymptomatic hepatotoxicity (can range from mild hepatotoxicity/transaminitis to hepatitis)
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)
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
What GCS score is intubation recommended?
which antibiotics are most likely to trigger seizures?
carbapenems (inc. imipenem)
pt w/ history of cardiovascular risk factors and acute sudden painless vision loss
classic exam finding
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)
monocular vision loss, with eye pain, HA, N/V, conjunctival erythema
acute angle-closure glacuoma
monocular vision loss associated w/ eye pain that worsens with eye movement. exam shows optic disc edema
patients likely have a history of MS as well
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
most common cause of decreased vision in the elderly
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
common cause of bacterial infections in contact lens wearers
elderly w/ chronic pneumonitis, recurrent sinusitis/otitis media, and glomerulonephritis
Wegener's granuomatosis and polyangiitis - systemic necrotizing vasculitis
Slit lamp exam shows presence of leukocytes in the anterior segment of the eye
Penlight exam demonstrates a hazy flare
hazy flare refers to the protein accumulation secondary to a damaged blood-aqueous barrier
periodic vertigo, unilateral hearing loss, tinnitus
vertigo provoked by change in position
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
patient p/w squamous cell carcinoma of the head w/ significant cervical lymphadenopathy
combined radiation and chemotherapy (CRT) - promises superior results over chemotherapy and radiotherapy alone; renders some inoperable cases operable after treatment
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
rhinitis - how do differentiate allergic vs non-allergic based on history and physical exam?
- pale/bluish nasal mucosa w/ occasional polyps
- usually occurs at an earlier age <20
- identifiable triggers
- association w/ eczema, asthma
- erythematous nasal mucosa
- usually occurs after age 20
- no identifiable triggers
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
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
treatment of orbital cellulitis
IV broad spectrum antibiotics (vanco + ampicillin/sulbactam)
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
malignant otitis externa
treatment: IV cipro
ear pain, vesicles in the external auditory canal, ipsilateral facial paralysis
Ramsay Hunt Syndrome
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.
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
what are contraindications to receiving the measles, mumps, and rubella vaccine?
anaphylaxis to neomycin, gelatin
immunocompromised states (since MMR is a life-attenuated vaccine)
patient w/ history of asthma presents w/ recurrent asthma exacerbations, cough w/ brown mucus plugs, and fleeting infiltrates seen on CXR
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
difficult to control asthma, allergic rhinitis w/ nasal polyps, chronic sinusitis, granulomas, palpable purpura
churg-strauss (eosinophilic granulomatosis)
when should HPV vaccine ideally be administered?
history of severe hypersensitivity reaction to yeast, latex
confusion, lethargy, bradycardia, skin flushing, miosis, wheezing, garlic like odor from clothes
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
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
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
what symptoms would be consistent w/ history of antifreeze ingestion?
rapid shallow breathing (kussmaul's respiration) secondary to severe anion gap acidosis
other signs: N/V, slurred speech, ataxia, nystagmus, lethargy
treatment: fomepizole infusion
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
lithium toxicity can be precipitated by these medications
how do you manage lithium toxicity?
anything that precipitates volume depletion and drug interactions:
manage w/ hemodialysis
gastric endoscopy in a patient with pernicious anemia will reveal:
absent rugae in body + fundus
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
associated w/ malignancy
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
Two contraindications for DTaP vaccination
anaphylaxis or encephalopathy within 7 days of DTP or DTaP vaccination
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)
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.
treatment for organophosphate poisoning
atropine (reverses muscarinic receptor effects) and pralidoxime (cholinesterase activator)