Online Med Ed Wrongs Flashcards by Kalee Woody

Barretts esophagus histologically changes from normal tissue of the esophagus to tissue in the duodenum. What tissue will be seen histologically?

columnar epithelium

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What are the “alarm” sx of GERD?

weight loss, emesis, dysphagia

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What test do you skip to if the patient presents with alarm sx?

EGD

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What is the treatment for someone with long time GERD and Barretts that has ANY amount of dysplasia?

Endoscopic destruction of the lesion

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Which type of antihypertensive drugs can cause hypokalemia?

thiazide diuretics (and loop)

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What type of anticoagulation do you use to prevent stroke in someone with AFIB?

warfarin

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What are you wanting to increase in someone with right sided infarct? (II, V, avF)?

preload (give IV fluids)

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Which drugs cause hypokalemia (and can be useful in patients with hyperkalemia)?

beta agonists (albuterol)
- increases K+ uptake by cells
Insulin
- enhances Na/K/ATPase pump with glucose
loop diuretics (furosemide)
- inhibits Na/K/Cl pump in Loop of Henle
intestinal cation exchange resins
alkalinaizing agents (sodium bicarbonate)
- increases serum pH causing potassium, shift into cells

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What is the most common cause of secondary nephrotic syndrome?

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What is the most likely complication of nephrotic syndrome?

venous thrombosis

(due to hypercoagulable state)

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Why do you get edema with nephrotic syndrome?

proteins (albumin) are lost in the urine and the oncotic pressure is decreased in the CV system–>edema

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How is nephrotic syndrome defined?

>3.5 grams collected in a 24 hour urine protein collection

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What are 5 complications of nephrotic syndrome?

protein malnutrition
hypovolemia
acute kidney injury
infection
thromboembolism

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Unilateral, complete hemi-facial paralysis (including forehead muscles) is due to what?

peripheral facial nerve palsy: characterized by dysfunction of the lower motor neuron of CN VII

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Unilateral paralysis in the lower face (can still wrinkle forehead) is caused by what?

central facial nerve palsy: characterized by dysfunction of the upper motor neuron of CN VII (at a level in the brain above the pons)

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What are the signs of peritonsilar abscess?

trismus (inability to open mouth), dysphagia, ear pain, fever, red, enlarged, medially displaced tonsil with uvular deviation away from the affected side

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What is pemphigoid gestationis?

pregnancy-associated auto-immune disease; pruritis with papules and plaques which progress to become vessicles and bullae

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What will a biopsy positive for pemphigoid gestationis show?

subepidermal bliasteing with eosinophil predominant infiltrate at the dermal-epidermal junction.

Direct immunofluorescence is positive for deposition of C3 and/or IgG along the basement membrane.

“salt split” technique shows deposition along the floor of the lesion

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What does a positive “salt split” technique for a bullous pemphigoid show?

deposition along the roof of the blister

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What is the treatment of corneal abraision in non-contact wearers?

polymyxin B/trimethoprim eye drops

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What is the treatment of corneal abraision in contact wearers?

fluoroquinolones (ciprofloxacin) or aminoglycosides

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What are the screening tests for dysplasia of the hip?

Barlow=hip flexed 90 degrees, and b/l hips adducted with posterior pressure directed at the knee

Ortolani=hip flexed at 90 degrees and b/l hips abducted and push forward on the head of the femur to push back into acetabulum

+ test=clunking sensation felt

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Next step in a infant with both + Barlow and Ortolani tests?

refer to ortho

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Next step in infant with - Bartlow and + Ortlani?

ortho

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Next step in infant with + Bartlow only?

monitor/observe patient and repeat exam at a later date

Child with new onset, **conductive hearing loss** with intact TM with invaginaitons, granulation tissue, and small **white mass beyond TM** would indicate what?

cholesteatoma

What are the sx of avascular necrosis?

groin pain that is worse with bearing weight

What are risk factors for avascular nevrosis?

chronic use of corticosteroids and heavy alcohol use

What is senn on imaging in avascular necrosis?

"crescent sign"; a subchondral crescent-shaped radiolucent area representing an area of necrotic bone.

Who is at risk for avascular necrosis?

sickle cell, femoral neck fx, SLE, smokers

how does an anal fissure present?

sharp tearing pain with bloody bowel movements

Pt presents with b/l leg pain, aching, cramping that is worse with exertion and is relieved by rest. Dx?

intermittent claudication (angina of the legs) \*eitiology linked to peripheral artery disease and secondary atherosclerosis

what is minimal change disease?

the most common cause of nephrotic syndrome in children less than 10, gets better with corticosteroids

painless , gross/frank hematuria in males 10-20 within days of a viral infection (URI) or pharyngitis and HTN (no edema)?

IgA nephropathy

hematuria with RBC casts, edema, and HTN, associated with group A strep or URI **weeks** prior?

post strep/infectious glomerulonephritis

unexplained hyperthyroidism?

struma ovarii; look for elevated levothyroxine (T4)

Why are people with crohns more likely to get calcium oxalate kidney stones?

decreased intestinal absorption of bile salts and fatty acids

Pts with PCOS have increased risk for what type of cancer?

endometrial

name important P450 inhibitors:

erythromycin, cimetidine, ketoconazole, itraconozole

What additional vaccine are children with sickle cell supposed to get at 2 years old?

23-valent pneumococcal polysaccharide vaccine (PPSV-23)

neonatal foot deformity: midline deviation of all metatarsal bones

metatarsus adductus

neonatal foot deformity: "up and out" appearance of the foot/feet

calcaneovalgus

neonatal foot deformity: "rocker bottom feet"

congenital vertical talus; "reversed arch"

neonatal foot deformity: "clubfoot" or "down and in" foot/feet

talipes equinovarus

first line treatment for insomnia?

CBT

what testing should pregnant women recieve at 28 weeks?

gestational diabetes; 1 hr 50 gram glucose tolerance test

what testing should pregnant women get at 36 weeks?

group B strep

treatment for group b strep in pregnant patients:

normal=penicillin small penicillin allergy(simple rash, no hives)=cefazolin true penicillin allergy=clindamycin last resort=vancomycin

who should be treated for group b strep in pregnancy?

* + swab or urine * previous child born with GBS infection * nuknown GBS status at \<37 weeks * at risk for preterm labor

how is pneumococcal infection prevented in sickle cells kids up to 5 years old?

vaccine and prophylactic penicillin

what is the next step in diagnosing a kid with gross hematuria with clots?

treatment for febrile seizures?

acetaminophen and reassurance

side effect of ethosuximide?

pancytopenia

what is the next step in testing someone who has a thyroid nodule, but normal labs (euthyroid)?

FNA

How long should pts fast from food before getting lipid panel? Alcohol?

12 hrs, 24 hrs

What is positive in UC?

bloody diarrhea, wieght loss, pANCA +, elevated ESR and CRP rectum to colon Increased risk of colon cancer

What is the findings in celiac disease?

anti-tissue transglutaminase antibody (IgA)

Findings in Crohn's disease?

bloody stool, transmural, any part/skip lesions, string sign, +ASCA

A patient seems depressed and refuses treatment fotr a normal problem. What is the next step?

psych eval for depression

Young pt is diagnosed with HIV. What vaccine do they need?

13 and 23 valent pneumococcal vaccines need to be given in pts iwth HIV

medication for ALS?

riluzole; inhibits glutamate release

what can bile acid sequestrants be used for besides lipid control?

pruritis due to hyperbilirubinemia in liver failure patients

how do you biopsy a hard, thyroid mass?

Reidels thyroiditis; open surgical biopsy

H pylori treatment?

* OAC * LAC * BMT (bismuth, metronidazole, tetracycline)

how do you prevent G6PD crisis?

avoid dietary precipitants (beans)

how often do you do a lipid pannel in someone who last had normal lipids?

5 years

Pt presents with a lesion that looks like ring worm, but is absent of hyphae. What is it?

granuloma annulare

normocytic, normochromic anemia in a pt with htn and dm?

ckd

what is the most significant risk factor for stroke?

HTN

what do you do with actinic keratosis?

cryotherapy so it doesnt become squamous cell carcinoma

smoking cessation:

first line: nicotine pathc (dont use in people with cardiac problems) also can use buproprion; not in alcoholics or those with liver failure

adult polycystic kidney disease is dx by:

renal us; look for a pt with frank blood and kidney disease and aneurysm in family

wide fixed split S2 heart sound at left second intercostal space?

atrial septal defect

a patient with BP disorder experiences positive psychotic findings/hallucinations between manic and depressive episodes for at least 2 weeks. what is this?

schizoaffective disorder

sx of schizophreniza lasting from 1-6 months?

schizophreniform disorder

what is schizophrenia?

at least two of the following for more than 6 months (one must be a positive sx): positive: delusions, hallucinations, pressured speech pattern Negative: depression, etc

schizotypal personality disorder:

magical thnking, thinking the news and other public messages are directed personally at them; otherwise normal

painless hematuria in someone over 40:

bladder cancer: transitional cell carcinoma biggest risk factor=cig smoking

child with acute bloody diarrhea. WYD?

bacterial stool culture; DO NOT DO ABX until culture is done because treating e.coli O157:H7 with abx can cause HUS

vaccines that should be given to women in each pregnancy:

influenza and TDAP

when should fluoride supplementaiton begin in infants?

6 months; 0.6 ppm screen at 4 month visit

first line treatment for dysmeorrhea?

NSAIDS, then birth control

stepwise testing for mono:

1: heterophile antibodies 2: CBC 3: EBV viral capsid antibody

what is the range for dx of prediabetes?

A1C of 5.7%- 6.4% fasting sugars of 100-125

chronic worsening pain in between the toes, worse with wearing shoes, better when taking off shoes, a "click" can be heard when palpated

Morton's neuroma

bad seide effect that should be monitored with ethosuximide?

pancytopenia

what is a still;s murmur?

low pitched, vibratory, systolic ejection murmur heard at the left lower sternal border that gets louder when lying down is innocent; reassure parent

a test is 94% **specific** for dm. What does this mean?

94% of people without dm will test negative

a test is 94% **sensitive** for dm. What does this mean?

94% of people with dm will test positive

painless vaginal bleeding in 3rd trimester?

placenta previa

why are NSAIDS contraindicated in pregnancy?

premature closure of patent ductus arteriosus and oligohydramnios

what med is ok for pain management in pregnancy?

acetaminophen NSAIDS and salicylates are category D; never use them

carcinoembryonic antigen (CEA) is elevated and used to asses treatment in what cancers?

colon and some gyn

cancer antigen 125 is elevated in what type of cancer?

ovarian

cancer antigen 15-3 is used to monitor treatment in what kind of cancer?

breast

cancer antigen 19-9 is used to monitor treatment in what kind of cancer?

pancreatic

what marker is seen in liver and germ cell tumors?

alpha feto protein

developmental milestones at ages 4, 6, 9, 12, and 15 months?

what is craniosynostosis?

premature closure of the fontanelles; get x-ray, then CT

who should recieve skin cancer screening and counseling?

fair skinned pts 6 months-24 years

pt presents with evidence of B12 deficiency and mac rocytic anemia after eating raw fish. Dx?

diphyllobothrium latum

why do certain men get testicular torsion?

congenital malformation of the processus vaginalis

increased AFP in pregnancy indicates ? decreased?

increased: neural tube defects or multiple gestations decreased: down syndrome

first line for osteoporosis treatment and prevention?

bisphosphonates: -dronates monoclonal antibodies: denosumab

what do you use for pain relief in someone iwth OA who has CHF?

duloxwtine; a serotonin/norepi reuptake inhibitor

elderly woman presents with pain in shoulder and hip joints and has a hx of temporal arteritis. What is the dx?

polymyalgia rheumatica

which population can you not use A1C to monitor DM in?

CKD

pt with hx of eczema or psoriasis has a thick scaly rash on extensor surfaces

lichen simplex chronicus

Online Med Ed Wrongs Flashcards

(108 cards)