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STEP2: Tidbits > TEST6/EYE > Flashcards

TEST6/EYE Flashcards

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1
Q

BRONCHIECTASIS Tx with goals of aiding sputum clearance

A

Chest physiotherapy with percussion and vibration

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2
Q

Primary long-term therapy of asthma?

A

IHC

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3
Q

Primary long-term therapy of COPD?

A

LAMA inhaler - tiotropium, aclidinium

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4
Q

Tx for SEVERE, LIFE-THREATENING asthma exacerbations

A

IV Mg sulfate

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5
Q

ISOLATED SYSTOLIC HTN criteria =?

Pathophys =?

A

SBP >140

DBP

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6
Q

What abnormal values are seen with OSTEOPOROSIS?

A

NONE

Normal Ca, PO4, PTH, ALP

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7
Q

Which vitamin toxicity (2) presents with hypercalcemia?

A

VitA toxicity

VitD toxicity

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8
Q

Which murmur is most common with INFECTIVE ENDOCARDITIS?

A

Aortic Regurg

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9
Q

What are the 2 major criteria of DUKE for INFECTIVE ENDOCARDITIS?

A
    • BLOOD CULTURE for micro-organism (S. viridans, S. aureus, Enterococcus)
  2. ECHO showing valvular vegetation
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10
Q

What are the 6 minor criteria of DUKE for INFECTIVE ENDOCARIDITS?

A
    • BLOOD CULTURE not typical (s. aureus, viridans, enterococcus)
  2. Temp >38C (100.4)
  3. Embolic phenomena (Janeway lesions, neuro phenomena)
  4. Immunologic phenomena (Glomerulonephritis, Osler nodes)
  5. IVDA
  6. Pre-disposing cardiac lesion
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11
Q

Management/Diagnostic testing of ACUTE IE

A

3 serial blood cultures from separate venipuncture sites over 1hr period -> antibiotics

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12
Q

Management/Diagnostic testing of SUBACUTE IE

A

3 Blood cultures over SEVERAL hours -> antibiotics

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13
Q

NECROLYTIC MIGRATORY ERYTHEMA (lesions that enlarge/central clearing/blistering/crusting and scaling at borders- generally in FACE/ PERINEUM/ EXTREMITIES) over 7-14d + MILD HYPERGLYCEMIA (not requiring insulin) + NORMOCYTIC, NORMOCHROMIC ANEMIA + Weight loss + secretory diarrhea

A

GLUCAGONOMA

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14
Q

Radiographic imaging to confirm GLUCAGONOMA

What level of glucagon confirms GLUCAGONOMA diagnosis?

A

Abdomen CT or MRI - Localize pancreatic neuroendocrine tumor

GLUCAGONOMA (glucagon >500)

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15
Q

LOW INSULIN + anti-glutamic acid decarboxylase Abs = ?

A

INDOLENT LATE-ONSET AUTOIMMUNE TYPE 1 DIABETES

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16
Q

CARCINOID SYNDROME (most commonly small bowel) WITH METASTASIS TO LIVER presents with _?

A

BRONCHOSPASM + SECRETORY DIARRHEA + SKIN FLUSHING (5-HIAA goes from hepatic veins to lungs and skin)

RIGHT SIDED Ds - PULMONIC STENOSIS + TR

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17
Q

Steatorrhea and mal-absorption disrupts absorption of which vitamins?

A

Prevents usual fat emulsification -> Disrupts chylomicron-mediated VitD absorption
VITD DEFICIENCY -> LOW Ca, LOW PO4

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18
Q

HACEK - EIKENELLA CORRODENS INFECTIVE ENDOCARDITIS is most commonly seen in what setting?

A

POOR DENTITION and/or periodontal infection + dental procedures involving gingival or oral mucosa

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19
Q

What is the first management step of elderly pts with ACUTE URINARY INCONTINENCE?

A

URINARLYSIS + CULTURE = UTI = leading cause of urinary incontinence in elderly

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20
Q

What are the reversible causes of ACUTE URINARY INCONTINENCE in the elderly?

A 
"DIAPPERS"
D- delirium, I - Infection (UTI), A- atrophic urethritis/vaginitis
P- pharmaceuticals 
P- psychological (depression) 
E- excess urine output (e.g. DM, CHF)
R- restricted mobility (post-surgery)
S- stool impaction
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21
Q

What medications can cause ACUTE URINARY INCONTINENCE in elderly?

A

1) ALPHA BLOCKERS - Urethral relaxation
2) anti-cholinergics, Opiates, CCB - Urinary retention/overflow
3) DIURETICS - Excess urine production

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22
Q

What are the 3 stages of DIABETIC RETINOPATHY

A

1) SIMPLE/BACKGROUND = Microaneurysms + hemorrhages + exudates + macular edema
2) PRE-PROLIFERATIVE = Cotton wool spots
3) PROLIFERATIVE/MALIGNANT = Neovscularization + often Vitreous hemorrhage

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23
Q

What is the main driving factor of visual impairment of DIABETIC RETINOPATHY?

A

MACULAR EDEMA from SIMPLE or BACKGROUND RETINOPATHY (by IDDM or NIDDM)

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24
Q

What is the Tx of preventing visual impairment complications of DIABETIC RETINOPATHY?

A

ARGON LASER PHOTOCAGULATION (since this is a microaneurysm)

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25
GRADUAL loss of PERIPHERAL vision "tunnel vision" followed by loss of CENTRAL VISION = ? Fundoscopy = OPTIC DISC CUPPING
OPEN ANGLE GLAUCOMA
26
Distorted vision + CENTRAL SCOTOMA (either atrophic Dry or exudative Wet) + DRUSEN deposits EARLIEST FINDING: Straight lines appear wavy
MACULAR DEGENERATION
27
SUDDEN, UNILATERAL visual impairment noted at WAKING UP in morning + DISC SWELLING + VENOUS DILATION + TORTUOS RETINAL HEMORRHAGES (tomato squashed) + COTTON WOOL SPOTS
CENTRAL RETINAL VEIN OCCLUSION
28
CARDINAL Sx of HEAT STROKE:
TEMP>105 (40C) ALTERED MENTAL STATUS HYPOTENSION, TACHYCARDIA, JVD, TACHYPNEA
29
Pathophysiology of HEAT STROKE
Failure of thermoregulatory center to dissipate heat at a rapid enough rate to maintain EUTHERMIA
30
COMPLICATION OF HEAT STROKE if body temp >41C (105.8) = ?
RHABDOMYOLYSIS UA sign of rhabdo = + Large gross blood 0 RBC
31
Which two anesthetic drugs can cause MALIGNANT HYPERTHERMIA (uncontrolled Ca efflux from SR) + Temp>45C (113)?
HALOTHANE | SUCCINYLCHOLINE
32
What is difference between HEAT EXHAUSTION and HEAT STROKE?
HEAT EXHAUSTION: 1) Pathophys - Due to inadequate Na and H2O retention -> Failed CO 2) Temp40 (105) 3) YES Altered mental status
33
Abdomen Exam: SHIFTING DULLNESS or POSITIVE FluiD WAVE are signs of?
ABDOMINAL ASCITES
34
Most common complication of LE VENOUS VALVE INCOMPETENCE?
VENOUS ULCERATIONS + | Dermatitis/eczema + edema + skin pigmentation
35
IATROGENIC causes of CONSTRICTIVE PERICARDITIS [CP] (CP = Important cause of right-sided heart failure, cardiac cirrhosis)
1. RADIATION THERAPY (Mediastinal irritation) 2. CHEMO (Anthracycline therapy) 3. CARDIAC SURGERY
36
INFECTIOUS causes of CONSTRICTIVE PERICARDITIS
VIRAL | TB (Endemic areas)
37
What imaging is used to confirm diagnosis of ADPKD? (early onset HTN preceding decline in renal function, OR flank pain due to renal calculi, OR cyst rupture/hemmorhage OR upper UTI)
Abdominal US
38
What is the preferred HTN medication for ADPKD pts?
ACE INHIBITORS
39
CYST ASSOCIATIONS with ADPKD
1. Cerebral aneurysms 2. Hepatic/pancreatic cysts 3. Cysts of the heart (MVP, AR) 4. Cysts of the colon - Colonic diverticula 5. Cysts of the abdomen - inguinal/ventral hernias
40
Tx of celiac disease particularly the dermatitis herpatiformis component
ORAL DAPSONE + gluten free diet
41
Triggers of hemolysis in G6PD pts
1) INFECTIONS 2) DRUGS (PAIDS - primaquine, ASA, INH, dapsone, sulfa) 3) FAVA BEANS
42
HIV pt + AMS + CSF EBV DNA + SOLITARY weakly RING-ENHANCING mass in PERIVENTRICULAR area on MRI = ?
PRIMARY CNS LYMPHOMA
43
MULTIPLE ring-enhancing spherical lesions in BASAL GANGLIA on MRI = ?
Toxoplasmosis
44
Tx of HYPOVOLEMIC HYPERNATREMIA (marked volume depletion + hemodynamic instability)? What is the Tx after pt is euvolemic?
0. 9% NaCl NS * Normally don't use ISOTONIC fluid for hypernatremia but first goal is to RESTORE VOLUME After pt is euvolemic, then use HYPOTONIC fluid (5% DEXTROSE >> preferred over 0.45% NaCl)
45
Tx of EUVOLEMIC hypernatremia
FREE WATER SUPPLEMENTATION
46
Guidelines of Na+ correction: How fast should Na+ be corrected?
0.5mEq/dL/hr WITHOUT exceeding 12mEq/dl/24hr
47
Sx of LITHIUM TOXICITY? When should hemodialysis be considered?
SEIZURES + DEPRESSED MENTAL STATUS Hemodialysis for serum Li>4 OR Li>2.5+clinical sx OR inability to excrete Li (decompensatied heart failure/renal disease)
48
What is the difference between HYPERNATREMIA (dehydrated state) vs HYPERNATREMIA (volume depletion)?
Dehydrated state hypernatremia = free water loss Hypotension/tachycardia/poor skin tugor = volume depletion
49
Which is associated with a lower risk of UTIs - Indwelling catheters OR intermittent catheterization?
INTERMITTNET CATHETERIZATION
50
Which drugs can resemble SIADH by stimulating hypothalamic ADH production?
CARBAMAZEPINE CYCLOPHOSPHAMIDE SSRI - eg fluoxetine
51
How would adrenal insufficiency present in terms of serum osmolality ?
Low volume -> Increased ADH -> Hyponatremia | Uosm>Sosm
52
Which cardiac drugs should be with-held prior to nuclear stress test? Which ones should be continued?
Drugs that will decrease extent and severity of ischemia during stress test - BETA BLOCKERS, Ca CHANNEL BLOCKERS, NITRATES Withhold oral DM drugs, caffeine/stimulators Continue - ACE-I, ARB, Diuretics, Statins, digoxin
53
RING-ENHANCING LESIONS on brain MRI
1. PRIMARY CNS LYMPHOMA - in EBV/HIV pt 2. TOXOPLASMOSIS 3. ANGIOINVASIVE ASPERGILLOSIS
54
Asian woman >40yo: RAPID onset of severe eye pain + RED/TEARY + Halo around lights (steamy, hazy cornea) + FIXED, MID-DILATED pupil NOT reactive to light + N/V as IOP increases What is the gold standard for diagnosis? What can be helpful if ophtho consult is unavailable?
ACUTE ANGLE CLOSURE GLAUCOMA GOLD STANDARD = GONIOSCOPY TONOMETRY - if ophtho consult unavailable
55
DIABETIC RETINOPATHY PT: Sudden loss in vision + FLOATING DEBRIS** + LOSS OF FUNDUS** + Dark red glow = what pathology?
VITREOUS HEMORRHAGE (in Proliferative/malignant phase of DIABETIC RETINOPATHY)
56
How do you distinguish between RETINAL DETACHMENT due to diabetes vs VITREOUS HEMORRHAGE due to diabetes?
RETINAL DETACHMENT: Fundoscopy shows ELEVATED RETINA with folds +/- tear VITREOUS HEMORRHAGE: Fundoscopy shows NO FUNDUS
57
Female pt 20-45yo: SLUGGISH AFFERENT PUPILLARY RESPONSE to light + CHANGES IN COLOR PERCEPTION + DECREASED VISUAL ACUITY UNILATERAL eye pain FUNDOSCOPY: Swollen disc
OPTIC NEURITIS
58
What is the Tx of EXERTIONAL HEAT STROKE with Temp>104 and AMS?
RAPID COOLING - preferably by ICE WATER IMMERSION
59
LOSS OF TRANSPARENCY of lens + difficulty driving at night/reading fine print
CATARACTS
60
POST-Transplant pts (on immunosuppressants) presenting with TACYPNEA, HYPOXIA, DRY COUGH, FEVER, ELEVATED LDH CXR: BILATERAL DIFFUSE INTERSTITIAL INFILTRATES What are the 2 most likely organisms? How do you diagnose?
PCP pneumonia CMV pneumonia 1) First by SPUTUM culture 2) If not successful, BRONCHOSCOPY + BRONCHOALVEOLAR LAVAGE
61
FUNDOSCOPY: **yellow-white, FLUFFY, hemorrhagic GRANULAR lesions along vasculature + BLURRED VISION + BLINDNESS + PHOTOPSIA (sensation of flashing lights) Complications: INCREASED RISK OF RETINAL DETACHMENT + BLINDNESS
CMV RETINITIS
62
PAINFUL red eye + Impaired vision, cornea opacification, CORNEAL VESICLES + DENDRITIC ULCERS + PERIPHERAL PALE LESIONS + ACUTE CENTRAL RETINAL NECROSIS = ? How is diagnosis made? Tx?
HSV KERATITIS Diagnosis: FLUORESCEIN STAINING Tx = ORAL ACYCLOVIR or topical antivirals ALL CORNEAL ULCERS should be cultured to make sure that it's not viral
63
CONJUNCTIVAL INFLAMMATION + WATERY DISCHARGE in setting of URI = ?
ADENOVIRAL CONJUNCTIVITIS - viral "pink eye" Tx = COLD MOIST COMPRESSES
64
What is the difference between ALLERGIC and VIRAL CONJUNCTIVITIS? Tx?
ALLERGIC CONJUNCTIVITIS = Episodic + shorter duration sx, Tx = mast cell stabilizing agents (OLOPATADINE + AZELASTINE) VIRAL CONJUNCTIVITIS = Tx = COLD MOIST COMPRESSES
65
MULTIPLE STROMAL ABSCESSES after corneal injury in AGRICULTURAL WORKERS + IMMUNOCOMPROMISED pts = ?
FUNGAL KERATITIS
66
ENLARGED BLIND SPOT in cornea + vision loss that is worse with head position (in the morning) = ?
PAPILLEDEMA - Increased ICP
67
What is the difference between HSV/VZV keratitis/uveitis and CMV retinitis?
HSV/VZV - PAINFUL + acute CENTRAL RETINAL NECROSIS + peripheral pale lesions/central retinal necrosis CMV - PAINLESS, retinitis + NO keratitis/conjunctivitis + fluffy/granular hemorrhagic lesions around retinal vessels
68
DRY SCALY PAPULES on sun-exposed areas with ERYTHEMATOUS BASE that may progress to SCC = ? Tx = ?
ACTINIC KERATOSIS Tx = FLUOROURACIL CREAM
69
FLASHING LIGHTS (photopsia) + blurred vision + "CURTAIN came down" over eye + floaters + sluggish pupil + RETINAL TEARS/GRAYIS APPEARING [usually PAINLESS] = ?
RETINAL DETACHMENT
70
SUDDEN PAINLESS LOSS OF VISION in one eye FUNDOSCOPY: Optic disc pallor + cherry red fovea + blood segmentation of retinal veins TX = ?
CENTRAL RETINAL ARTERY OCCLUSION TX = OCULAR MASSAGE - to dislodge the embolus to a point further down arterial circulation + HIGHFLOW O2 THERAPY
71
CONTACT LENS WEARERS: Hazy cornea following corneal trauma/PAINFUL RED EYE+ central ulcer/OPACIFIATION + adjacent stromal abscesses
BACTERIAL KERATITIS = Medical emergency Tx = TOPICAL BROAD SPECTRUM ANTIBIOTICS
72
DENDRIFORM CORNEAL ULCERS** + Vesicular rash in trigeminal distribution = ?
HERPES ZOSTER OPHTHALMICUS
73
What is the difference btw ANTERIOR UVEITIS and POSTERIOR UVEITIS?
Anterior: + Pain/redness Posterior: Painless + floaters/reduced visual acuity
74
Few hours or days after a mild TBI: HA + CONFUSION/AMNESIA + DIFFICULTY CONCENTRATING + VERTIGO + MOOD ALTERATION/ANXIETY + SLEEP DISTURBANCE = ?
POST CONCUSSIVE SYNDROME - Can last more than 6mo
75
Facial trauma + RETROBULBAR INJECTION + PAINFUL proptosis + **INCREASED IOP** + Afferent pupillary defect (Marcus Gunn)
RETROBULBAR HEMATOMA
76
History of ORBITAL INJURY + VERTICAL DIPLOPIA + ENTRAPMENT of the eye muscle inferior rectus muscle (looks white/severe pain)
ORBITAL FLOOR FRACTURE
77
Eye involvement in IBD, RA versus Ankylosing spondylitis
IBD, RA - EPISCLERITIS (inflammation seen in the whites of eye) AS - anterior UVEITIS (inflammation of uveal tract - iris, ciliary body, choroid + KERATIC precipitates
78
1st line of Tx of ACUTE GLAUCOMA (CLOSED ANGLE)
IV MANNITOL - osmotic diuretic
79
Tx for ACUTE GLAUCOMA (4) - PMAT
1. MANNITOL - osmotic diuretic 2. ACETAZOLAMIDE - CA inhibitor: Decreases aqueous humor production 3. TOPICAL TIMOLOL - beta blocker: Decreases aqueous humor production 4. PILOCARPINE - muscarinic agonist - Increases aqueous humor outflow
80
Which medication is CONTRA-INDICATED for ACUTE GLAUCAOMA?
ATROPINE = muscarinic-R antagonist - MYDRIATIC EFFECT

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