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STEP2: Tidbits > TEST7 > Flashcards

TEST7 Flashcards

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1
Q

New PREGNANT mothers who hold their infants with THUMBS OUTSTRETCHED have inflammation of abductor pollicus longus + extensor pollicis previs tendons

+ FINKELSTEIN TEST: Passively stretching affected tendons by grasping flexed thumb over radial styloid into palm of fingers elicits pain

A

DE QUERVAIN TENOSYNOVITIS

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2
Q

Fall on outstretched hand -> FORECEFUL HYPEREXTENSION OF WRIST most commonly results in what type of fracture?

A

SCAPHOID FRACTURE

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3
Q

Pt with HL, HTN comes in with GRADUAL PAINLESS LOSS OF VISION and NO focal neuro deficits. What test is best to order first?

A

**DUPLEX NECK

High suspicion for AMAUROSIS FUGAX (painless loss of vision from cholesterol hollenhorst body emboli generally at CAROTID BIFURCATION) = warning sign for IMPENDING STROKE

NOT CT/MRI of head since there are NO focal neuro deficits

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4
Q

2 NORMOCYTIC ANEMIA conditions with INCREASED MCHC (Shrunk RBC causing increased HGB concenctration)

A
  1. HEREDITARY SPHEROCYTOSIS (Extravascular hemolysis- Coombs, Northern European)
  2. IMMUNE HEMOLYTIC ANEMIA (IgG - extra, IgM- intra, + Coombs)
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5
Q

What is the SINGLE most important prognostic consideration in BREAST CANCER TREATMENT?

A

TNM STAGING

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6
Q

What type of antibiotic is AZTREONAM

A

MONOBACTAM antiboitic used to treat Gm- bacterial infections INCLUDING PSEUDOMONAS

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7
Q

MOTOR/SENSORY loss (e.g. loss of sensation in perianal area) + Loss of rectal tone + Urinary retention = high suspicion of ___?

Why not cauda equina syndrome?

A

ACUTE SIPNAL CORD COMPRESSION

Not cauda equina syndrome (below level of cona medullaris typically at sacral roots) because of + LOSS OF SENSORY/MOTOR = less common with cauda equina

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8
Q

Management of ACUTE SPINAL CORD COMPRESSION = ?

hint: consult, imaging, pharmacotherapy

A
  1. EMERGENCY NEUROSURG CONSULT/RAD-ONC
  2. MRI
  3. IV GLUCOCORTICOIDS (if malignant compression is suspected)
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9
Q

ADENOCARCINOMA of the lung is typically associated with what condition?

A

HYPERTROPHIC PULMONARY OSTEOARTHROPATHY

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10
Q

Classic findings of SARCOIDOSIS

A

1) Non-caseating granulomas
2) Bilateral hilar adenopathy
3) Erythema nodosum

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11
Q

FLUCTUATING OCULAR (ptosis, diplopia) + FACIAL/BULBAR weakness that WORSENS with REPETITIVE TASKS = ?

A

MYASTHENIA GRAVIS

autoAb against POST-SYNAPTIC Ach-R

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12
Q

PROXIMAL MUSCLE WEAKNESS + DRY MOUTH/erectile dysfunction (autonomic dysfn) + PTOSIS + DIMINISHED/ABSENT DTR that IMPROVES with REPEAT ISOMETRIC CONTRACTION

A

LAMBERT EATON SYNDROME = auto-Abs against PRE-SYNAPTIC Ca2+ channels

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13
Q

How is diagnosis of DERMATOMYOSITIS made?

A

MUSCLE FIBER BIOPSY

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14
Q

What is the FIRST STEP of evaluating a THYROID NODULE? (Hint: Lab + imaging)

A

1) Measure TSH

2) Thyroid Ultrasound

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15
Q

What is the drug of choice for BENIGN ESSENTIAL TREMOR?

A

PROPANOLOL

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16
Q

What is the drug of choice for PARKINSONIAN TREMOR?

A

BENZTROPINE (anti-cholinergic)

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17
Q

What is the drug of choice for MYOCLONUS? (2)

A

SODIUM VALPROIC ACID

CLONAZEPAM

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18
Q

What are the sx of ANKYLOSING SPONDYLITIS?

A 
AREDU
A - arthritis (sacroiliatis)
R - reduced chest expansion/ spinal mobility = RESTRICTIVE LUNG DZ
E - enthesitis
D - dactylitis
U - uveitis
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19
Q

What are possible complications of ANKYLOSING SPONDYLITIS?

A

OAC
O - Osteoporosis/vertebral fractures
A - Aorta regurg**
C - cauda equina

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20
Q

Eye involvement in IBD, RA versus Ankylosing spondylitis

A

IBD, RA - EPISCLERITIS (inflammation seen in the whites of eye)
AS - anterior UVEITIS (inflammation of uveal tract - iris, ciliary body, choroid + KERATIC precipitates)

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21
Q

What are the 3 most common causes of SUBACUTE (3-8wk) or CHRONIC (>8wk) cough? What is the empiric initial Tx of each?

A
  1. UPPER AIRWAY COUGH SYNDROME (Post-nasal drip) -
    Tx= oral 1st gen anti-histamine (CHLORPHENIRAMINE) or combined anti-histamine-decongestant (BROMPHENIRAMINE)
  2. GERD - Empiric PPI
  3. Asthma - PFTs
  4. ACE INHIBITOR - Stop ACE
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22
Q

Uses of TRANSTHORACIC ECHOCARDIOGRAM (TTE):

Study These Flashcards
A

To detect THROMBI

  • LA thrombus due to Afib
  • LV thrombus
  • Septic emboli from INFECTIVE ENDOCARDITIS
  • Thrombi from prosthetic valves
23
Q

Bilateral Lung Opacities CXR + Worsening respiratory distress after 1wk of insult + Hypoxemia PaO2/FiO2

Study These Flashcards
A

ARDS - shunting/ elevated Aa gradient -> Impaired gas exchange + Decreased compliance + Pulm HTN

Lower PaO2
Increased fractin of inspired oxygen requirement = LOWER RATIO correlating with severity of ARDS

24
Q

Risk factors/Insults triggering ARDS (4)

Study These Flashcards
A

1) Infection - Pneumonia/sepsis
2) Trauma
3) Acute pancreatitis
4) Massive transfusion

25
What diagnostic values distinguish ARDS from CHF when both show "congestion" like substance on CXR?
ARDS: ELEVATED PAP Pulmonary arterial pressure (measure of Pulmonary vascular resistance) CHF: ELEVATED Pulmonary capillary wedge pressure (measure of LA)
26
Colorectal cancer screening for IBD pts:
Begin 8 years post-diagnosis | Colonoscopy + biopsy every 1-2yrs
27
Colorectal cancer screening for FAP pts:
Begin age 10-12 | Colonoscopy every year
28
Lynch Syndrome (HEREDITARY NONPOLYPOSIS CRC)
Begin at age 20-25 | Colonoscopy every 1-2 years
29
Colorectal cancer screening for family history of adenomatous polyps or CRC (3-2-1):
Colonoscopy at age 40 | Repeat every 3-5yrs
30
Risk factors for ANGIODYSPLASIA (painless GI bleeding)
1. RENAL DISEASE 2. AORTIC STENOSIS 3. vWF Disease - multimers traverse turbulent valve space by aortic stenosis
31
LOCALIZED pain and tenderness over ANTEROMEDIAL TIBIA below knee joint - exacerbated by pressure from opposite knee while lying on side
PES ANSERINUS PAIN SYNDROME (ANSERINE BURSITIS)
32
OVERUSE injury - POORLY LOCALIZED PAIN over lateral knee + lateral femoral condyle tenderness with knee movement
ILIOTIBIAL BAND SYNDROME
33
DIFFUSE ANTERIOR KNEE pain reproduced by patellofemoral compression during knee extension in YOUNG WOMEN Pain worsened by ACTIVITY or prolonged sitting (SUSTAINED FLEXION). Crepitus with motion of patella
PATELLOFEMORAL PAIN SYNDROME
34
BONY ENLARGEMENT/TENDERNESS (OSTEOPHYTES) + Crepitus with movement + Painful/decreased ROM in age>50, obese, female with prior joint injury
OSTEOARTHRITIS
35
1st line of Tx of ACUTE GLAUCOMA (CLOSED ANGLE)
IV MANNITOL - osmotic diuretic
36
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
37
Which medication is CONTRA-INDICATED for ACUTE GLAUCAOMA?
ATROPINE = muscarinic-R antagonist - MYDRIATIC EFFECT
38
SYMPTOMATOLOGY difference between ALZHEIMER DEMENTIA and FRONTOTEMPORAL DEMENTIA
AD DEMENTIA: Early insidious SHORT TERM MEMORY LOSS/ language and spatial memory deficits first LATER PERSONALITY CHANGES FRONTOTEMPORAL DEMENTIA: Early personality changes/ apathy/ disinhibition /compulsive behavior -> LATER memory changes
39
What acid-base imbalance characterizes ALLERGIC RXN + STRIDOR?
RESPIRATORY ACIDOSIS - due to decreased ventilation and CO2 retention
40
What acid-base imbalance characterizes ASTHMA EXACERBATION?
RESPIRATORY ALKALOSIS - Tachypnea
41
What acid-base imbalance characterizes persistent vomiting + excessive diuresis?
CONTRACTION ALKALOSIS 1) PERSISTENT VOMITING - Hypochloremic metabolic alkalosis: Due to loss of H+ contents 2) Excessive diuresis
42
IBD pt with acute worsening FEVER, LEUKOCYTOSIS, ABDOMINAL DISTENSION**, HEMODYNAMIC INSTABILITY (hypotension, tachycardia) Other possible signs: Peritonitis, AMS, electrolyte abnormalities. What is the first diagnostic test that should be ordered?
ABDOMINAL X-RAY - 1) Check for colonic distension (TOXIC MEGACOLON >6mm dilation of right colon) 2) Can exclude perforation
43
What is the management of TOXIC MEGACOLON?
Generally conservative: | Bowel rest + NG suction + steroids +/- broad spectrum antibiotics targeting C.diff (METRONIDAZOLE)
44
WIDE-BASED GAIT Ddx:
SENSORY ATAXIA CEREBELLAR DYSTURBANCES MUSCULAR DYSTROPHY (also may be waddling)
45
What type of error is PRECISION? What increases precision?
RANDOM ERROR | Increase sample size - Increases precision
46
BILATERAL erythema nodosum Ddx:
INFECTIOUS - S.pneumo pharyngitis, TB AUTOIMMUNE - Sarcoidosis INFLAMMATORY - IBD IDIOPATHIC
47
Which acid-base imbalance characterizes CHRONIC DIARRHEA?
HYPOKALEMIC METABOLIC ACIDOSIS - Loss of bicarb and K+ in stool
48
Which acid-base imbalance characterizes BLIND LOOP SYNDROME (i.e. SIBO)?
HYPOCHLOREMIC METABOLIC ACIDOSIS | Due to INCREASED gut production and absorption of LACTIC ACID
49
Which acid-base imbalance characterizes POSTICTAL STATE after seizure?
LACTIC ACIDOSIS - Due to INCREASED BMR -> Insufficient O2 present in tissues -> Anaerobic metabolism
50
CYSTIC SWELLING over patella following TRAUMA
PRE-PATELLA BURSITIS
51
PAIN between 3rd and 4th TOES on plantar surface + clicking sensation (MULDER SIGN) occurring when simultaneously palpating this space/squeezing metatarsal joints - MECHANICALLY induced degen neuropathy Seen in RUNNERS
MORTON NEUROMA
52
SPINAL CORD COMPRESSION by METASTASIS TO BONE SX: ACUTE PHASE of SCC: What is SPINAL SHOCK?
1) WORSENING BACK PAIN especially at NIGHT 2) LE weakness + SENSORY loss below a certain level 3) + HYPER-REFLEXIA + BABINSKI RESPONSE + Fecal/urinary incontinence retention (later signs) **Most commonly affects THORACIC 60%, rather than lumbar** SPINAL SHOCK = ABSENT REFLEXES + FLACCID PARAPLEGIA
53
DIABETIC POLYNEUROPATHY - What gets lost first? What happens to reflexes?
Affects primarily DISTAL LE Loss of PAIN/TEMP/ PROPRIOCEPTION/VIBRATORY LOSS OF DEEP TENDON REFLEXES

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