R&E F,G,H part Flashcards
1
Q
dx or imaging soft tissue lesion how
A
MRI
2
Q
inflammatory vs non-inflammatory joint disease on history
A
inflam =
- swelling with the pain
- constitutional symptoms (fever, anorexia, fatigue)
- morning stiffness 30 min + morning pain
- wake up at night
- better with mobility
3
Q
vertebral fracture management
A
- rule out pathology
- send home with tylenol
4
Q
rhabdomyolysis triad
A
- generalized weakness
- myalgias
- dark urine
5
Q
dx of bone tumors is done how
A
XR
6
Q
shoulder dislocation most common type
A
anterior (90%)
7
Q
shoulder dislocation associated problems
A
- Bony Bankart (fracture of anterior glenoid rim)
- Hill-Sachs impression fracture (posterior humeral head)
8
Q
osteosarcoma most common site
A
distal femur
9
Q
osteosarcoma most common age of presentation
A
10-20 yo
10
Q
Ewing sarcoma what bones
A
diaphyseal bones
- femur
- tibia
- humerus
11
Q
Ewing sarcoma most common age of presentation
A
10-20 yo
12
Q
Ewing sarcoma pathology
A
large soft tissue reaction
13
Q
Ewing sarcoma how good XR is
A
not the best bc underestimates the large soft tissue reaction
14
Q
chondrosarcoma what bones
A
- hip
- shoulder
- proximal long bones
15
Q
chondrosarcoma common age of pres
A
40-60 yo
16
Q
chondrosarcoma appearance on XR
A
lytic lesions often with fracture
17
Q
osteoporosis who do you treat
A
high risk patients
18
Q
osteoporosis def of high risk patients
A
either of
- had >1 non vertebral fragility fracture
- has had 1 vertebral or hip fracture
19
Q
inflammatory vs non inflam joint disease on PE
A
inflammatory = -pain worse with rest -warm -PIPs non inflammatory = -cold deformed -DIP
20
Q
how to treat inflammatory joint disease like RA
A
anti-inflammatories
- steroids
- immune modulation
- DMARD (like methotrexate)
21
Q
how to treat non inflam joint disease like OA
A
analgesics (acetaminophen, topical NSAID)
22
Q
febrile neutropenia def
A
- fever (>38.3 once or >38 twice on 1 hour+ inteval)
- ANC<500
23
Q
feb neut management and why
A
- emergency IV Abx. want to cover gram+ and gram-
- blood culture
- CXR
24
Q
how do you take the temperature in feb neut
A
NOT RECTAL. anything else
25
feb neut: management if fever persists or recurs after droping
suspect fungal infection
26
most common UTI bacteria
E.coli
27
rule in tx UTIs and how do you treat
TX ONLY IF SYMPTOMATIC
| -Septra (sulfamethoxazole-trimethroprim)
28
strep throat management and why
- ALWAYS tx with Abx
| - bc can progress to rheumatic fever
29
rheumatic fever is what
- type 2 hypersensitivity reaction
| - caused by molecular mimicry
30
management of fever in returning traveller
suspect malaria***
(Dengue if SE Asia)
-even if fever with something else (don't forget there's fever so don't think of another disease before malaria)
31
important parasite to avoid in pregnancy, why and how
- toxoplasma
- because crosses the placenta
- avoid changing cat litter boxes
32
maternal-fetal transmission main organisms
TORCH
- toxoplasma
- (others like varicella)
- rubella
- cytomegalovirus
- herpes and HIV
33
only DROP FORM Abx (2 names) you can give for otitis externa
fluoroquinolones (ciprofloxacin)
34
why can't give DROP FORM Abx other than fluoroquinolones (ciprofloxacin) in otitis externa
if there's tympanic membrane perforation that you saw or didn't see, giving will cause
35
treatment of otitis media
amoxicillin per os
36
a patient has a positive PPD test for TB: next step in management
CXR
37
latent TB (TB infection): risk of converting to tuberculosis (active TB) and specific case
- 10%
| - >10% if have HIV
38
latent TB (TB infection treatment)
optional isoniazid for 9 mo or rifampin 4 mo
39
how UTIs are diagnosed
- leukocyte esterase
| - nitrites
40
meningitis signs on PE
- neck stiffness
- Brudzinski's sign
- Kernig's sign
41
lumbar puncture of a bacterial meningitis and how it compares to LP for viral meningitis
- increased pressure (not in viral)
- WBCs present
- protein present (not in viral)
- low glucose (not in viral)
* VIRAL = ONLY HAS WBCs*
42
meningitis treatment
- cefotaxime or ceftriaxone AND vancomycin if older than 1 mo
- cefotaxime or ceftriaxone and AMPICILLIN if <1 mo
- *IV dexamethasone (CS) as adjuvant therapy in certain cases to decrease brain inflamamtion and prevent neurological damage
43
when give IV dexamethasone as adjuvant tx in meningitis and why
- Strep pneumo in adult
- H influenza in kid
- GEL (GBS (like agalactiae), E.coli, Listeria) in <1 mo
* to decrease brain inflamamtion and prevent neurological damage*
44
when do you administer the adjuvant IV dexomethasone in meningitis if needed
before taking the Abx (cef + amp or vanco) or in the 20 mins after
45
brain function in meningitis how is it affected
is normal (only altered mental status if late meningitis)
46
encephalitis difference with meningitis
causes altered brain function
- personality change
- sensory dysfunction
- motor dysfunction
47
HIV initial symptoms
- initially infection to lymph nodes
| - then get a secondary viremia (mono-like ilness) = maculopapular rash, myalgia, headache, hepatohsplenomegaly, etc.)
48
treatment of HIV (to everyone)
HAART
49
definition of AIDS
CD4 count below 200
50
AIDS = at risk for what infections and problems
- All infections
- pneumocystis jeroveci pneumonia (especially neonates)
- lymphocytic interstitial pneumonia
- HIV nephropathy
- HIV dementia
51
infection routes for HIV
most common to least common
- blood transfusion
- perinatal exposure
- needlestick injury
- breastfeeding
52
pt vomiting + has non bloody (watery) diarrhea: think what infection
norovirus (cruise ship virus)
53
pt has non bloody (watery) diarrhea but NOT vomiting: think what infection
- rotavirus
- ETEC (enterotoxic E.coli)
- vibrio
54
pt has bloody diarrhea: think what infection
SSCYE + 1 parasite
- shigella spp
- salmonella spp
- yersinia enterocolitica
- campylobacter jejuni
- EHEC (E.coli O157)
- entamoeba histolytica
55
HPV infection different symptoms depending on type of HPV
can get any of these
- warts (molluscum)
- cervical cancer
56
HPV types that give warts
6 and 11
57
HPV types that give cervical cancer1
16 and 18
58
herpes ulcers vs syphilis chancres how to differentiate
- herpes ulcer is painful
| - syphilis chancre is painless
59
bacterial meningitis LP (CSF content)
- 1000-5000 cells (high cell count)
- 1.0 to 5.0 g/L prot (high protein)
- glucose <2.5 (low glucose)
- CSF:serum glucose ratio <0.4 (decreased)
60
viral meningitis LP (CSF content)
- <1000 cells
- <1.0 g/L prot
- normal glucose (3.0 to 5.0)
- normal CSF:serum glucose ratio (0.4)
61
hepA symptoms
- jaundice
| - liver inflammation
62
hepA transmission
fecal-oral
63
hepA vaccine exists yes or no
yes. vaccine available for hepA
64
hepB symptoms
have some prodromal symptoms (before the high LFTs = liver function tests) and then the actual symptoms (when high LFTs):
- jaundice
- fatigue
- dark urine
- abdominal pain
65
hepB transmission
```
body fluids (note: 30% risk with a needlestick)
-note: survives long time on surfaces
```
66
hepB vaccine yes or no
yes. vaccine available for hepB
67
hepC symptoms
- 80% are asymptomatic
| - mild symptoms
68
risk with hepC and how you act to reduce it
- risk of developing chronic cirrhosis
| - so treat with direct acting antiviral
69
hepC transmission
-body fluids (note: 3% risk with needlestick injury)
70
hepC vaccine yes or no
NO. no vaccine for hepC
71
in what pts are live vaccines (varicella, MMR, etc.) contraindicated
- immunocompromised
| - pregnant
72
vaccines that the immunocompromised and pregnant pts must have
mnemonic: rotating (rotavirus) chickens (chickenpox) on poles (polio) does not give tuberculosis (BCG vaccine) or autism
(MMR)
73
structure of the hepB virus + diff in Abs our bodies make for the two
has surface Ags (Abs to this will ELIMINATE the virus and stay for life) + core Ags (Abs for these are just there but don't do anything and also stay for life)
74
positive for sAg indicates what in hepB
you're infected (acute or chronic)
75
positive for sAb indicates what in hepB
resolved acute infection (resolved bc you were able to make sAb)
76
positive for cAg indicates what in hepB
you're infected acutely (it hasn't been long since you got infected) bc
77
hepB: sAg, sAb, cAb and cAg in the vaccinated (vaccination = give surface antigen bc we want sAb (the efficient Ab) to be produced)
- sAg negative
- sAb positive
- cAg negative
78
3 tests for hepB
- surface Ags
- surface Abs (Abs to the surface Ag)
- core Abs (Abs to the core Ag)
* NO CORE Ag TEST*
79
how the 3 tests for hepB + total core Abs (includes IgG cAb) evolve with time when you get acute hepatitis B (infection in adult life, unprotected sex for example)
1. sAg up then back down
2. cAb IgM up a bit later then back down too
3. Total cAb (IgM + IgG) goes up with cAb IgM and present for life (bc IgG stays)
4. sAb goes up and stays for life (after cAb IgM down) IS PRESENT ONLY AFTER INFECTION
80
how the 3 tests for hepB + total core Abs (includes IgG cAb) evolve with time when you get chronic hepatitis B (infection perinatally)
1. sAg up and there for life
2. then cAb IgM up and then down
3. Total cAb (IgM + IgG) goes up with cAb IgM and present for life (bc IgG stays)
81
how the 3 tests for hepB differ for chronic hepB vs acute hepB
1. acute = sAg will go up then back down
chronic = sAg stays up for life
2. acute = sAb will go up late and stay for life. chronic = sAb never appears bc immune system can't clear the sAg
*but both have cAb go up and stay for life (and IgM back down long term)
82
what tests do you order to know if a patient is currently infected with hepB (acute or chronic, doesn't matter)
sAg
83
what tests do you order to know if a patient has ever been exposed to hepatitis B
total cAb
84
what test do you order to know if a patient is immune to hepB (means acute and healed it. you're not immune if chronically infected)
sAb
85
what test do you order to know if a patient has ACUTE HEP B INFECTION SPECIFICALLY (want to discriminate acute vs chronic)
cAb IgM*
| -NOT sAg bc is always there with chronic
86
what is the Ab to hepB that gives you immunity to hepB
sAb
87
meaning of sAg-, sAb- and cAb-
no prior exposure
88
meaning of sAg-, sAb+, cAb-
vaccination (vaccine only has sAg in it bc anws it is the sAb that gives you immunity)
89
(IMPORTANT) meaning of sAg-, sAb+, cAb+
resolved acute infection
90
meaning of sAg+, sAb-, cAb+
acute or chronic infection (sAb- bc only have sAb AFTER acute infection and not during acute)
91
if you got a sAg+, sAb-, cAb+, how will you differentiate the acute infection from the chronic infection
by knowing if cAb IgM is + (acute) or - (chronic)
92
if a needle contains hepB, hepC or HIV what is the respective risk ok getting infected in a needlestick injury with a needle containing one of these
- hepB: 30%
- hepC: 3%
- HIV: 0.3%
93
Parkland formula to estimate how much fluid you need to give a burn patient within the first 24 hours + over what time interval specifically
4 x m (kg) x % of TBSA (burnt) = V to give (in mL)
- half in first 8 hours
- half in next 16 hours
94
how to estimate TBSA burnt in a burn injury
- arm = 9% each
- leg = 18% each
- torso = 18%
- back = 18%
- head = 9%
- palm = 1%
95
SIRS definition
2 of these 4 criteria
- temp <36 or >38
- PaCO2 <32 or RR>20
- WBCs <4000 or >12000 or >10% band neutrophils
- HR>90
96
chronic granulomatous disease is what
deficiency in NAPDH oxidase in phagocytes
97
CGD susceptibility to which bacteria
- aspergillus
- burkholderia
- strep
- nocardia
98
CGD what to be careful about
infected patient may have no fever and no leukocytosis because the signaling is impaired (CGD affects inflammatory cells)
*can't rule out infection if no fever or leukocytosis*
99
most common food allergen + other one common too
- milk #1
| - raw egg (but cooked = no allergy bc no more allergens)
100
milk allergy appears when during life usually
children under 1 yo
101
actual most common allergies in children and adults as taught in the lectures
- peanut in children (is a legume, grows in ground) and tree nut is #2 (grows in trees)
- shellfish in adult #1 and tree nut #2
102
ddx of child <1 yo with a rash
- VIRAL INFECTION
| - milk allergy
103
anaphylaxis definition
allergic rxn involving at least 2 systems
104
treatment of anaphylaxis
IM epipnephrine
105
GVHD happens when
in allogeneic tissue transplant (allogeneic = healthy person to someone with disease).
*most often in HSCT *hematopoietic stem cell transplant*
106
treatment of GVHD
steroids
107
DLBCL (diffuse large B cell lymphoma) treatment (is the tx for non-Hodgkin lymphomas in general)
CHOP
- cyclohosphamide
- doxorubicin
- vincristine
- prednisone
108
Hodgkin's lymphoma tx
ABVD
- adriamycin (doxorubicin)
- bleomycin
- vinblastine
- dacarbazine
