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WELL > U world/ true learn review 6/19/23 > Flashcards

U world/ true learn review 6/19/23 Flashcards

1
Q

what causes the webbing of the neck and swelling og the hands and feet in turner syndrome (45XO)

A female with primary amenorrhea, wide-set nipples, broad chest, and a short stature should be worked up for possible Turner syndrome

A

congenital lymphedema

A 14-year-old female presents to the office for a well-child exam. She states that she has not yet had her first period. Vitals reveal a blood pressure of 149/95 mmHg in the right arm and 110/65 mmHg in the left arm, a heart rate of 70/min, a respiratory rate of 14/min, and a temperature of 37°C (98.6°F). Her weight is 45.4 kg (100 lb) and her height is 1.35 m (4’5”). Physical examination reveals a shortened fourth metacarpal bone and an III/VI systolic murmur. The most likely karyotype of this patient

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2
Q

what is the most common cause of congenital primary hypogonadism

A

klinefelters syndrome (46 XXY)

This is the karyotype of a patient with Klinefelter’s syndrome. This is the most common cause of congenital primary hypogonadism (1/1000 births). Phenotypically male, affected patients have a tall stature, long arms and legs, mild mental retardation, and often cryptorchidism. Further workup will reveal testosterone deficiency and increased FSH and LH. These patients have an increased risk of breast cancer, autoimmune disease (systemic lupus erythematosus), and extragonadal germ cell tumors.

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3
Q

the vagus nerve exits the occiput via the

A

jugular foramen and carrier parasympathetic fibers to visceral structures in the chest and abdomen

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4
Q

tissue texture changes for SA node dysfunction would be expected where

A

T1-T5 on the right

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5
Q

Myocardium and AV node tissue texture changes would be seen where

A

T1-T5 on the left

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6
Q

what are the two most important causes of tick borne relapsing fever in north america

A

Borrelia Hermsii and Borrelia Recurrentis

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7
Q

what are the symptoms of Borrelia hermsii

A

high fever for 3 days followed by an afebrile period of 7 days

extra: malaise, abdominal pain, macular rash (petechiae), gi symptoms

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8
Q

what causes the relapsing fever in borrelia hermsii

A

the rapid alteration of surface antigens by bacteria preventing long lasting protective immunnity

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9
Q

treatment of tick borne relapsing fever

A

first like: tetracycline

second line: erythromycin

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10
Q

babesia microti

A

tick borne illness that causes babesiosis with influenza like symptoms, hemolytic anemia, hepatosplenomagly, hemoglobinuria and hemosiderinuria

periopheral blood smear shows intraerythrocytic rings/maltese cross

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11
Q

colorado tick fever

A

viral infection spread by dermacentor tick that causes conjunctival injection, pharyngeal erythema, and cervical lymphadenopathy.

peripheral blood would show atypical lymphocytes

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11
Q

colorado tick fever

A

viral infection spread by dermacentor tick that causes conjunctival injection, pharyngeal erythema, and cervical lymphadenopathy.

peripheral blood would show atypical lymphocytes

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12
Q

what is the pathophysiology of NSAID exacerbated respiratory disease

A

inhibition of cyclooxygenase 1 leads to increased leukotriene production

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13
Q

what drugs cause NSAID exacerbated respiratory disease

A

aspirin and other NSAIDs that inhibit COX-1 like naproxen or ibuprofen

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14
Q

what is the presentation of NASID exacerbated respiratory disease

A

QUICK ONSET (20 mins-3 hours) wheezing, gives, nasal congestion, coughing, swelling of lips, upper or lower respitatory bronchospams

triad: asthma, nasal polyps and chronic rhinosinusitis

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15
Q

treatment of NSAID excerbated respiratory disease

A

avoid COX-1 inhibiting NSAIDS

short acting beta adrenergic receptor agonists for bronchospasm

leukotriene receptor antagonists

desensitization

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16
Q

primary site of metabolism for NSAIDs

A

the liver

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17
Q

what is cromolyn sodium

A

a mast cell stabalizer used to control inflammation in asthma and to prevent excercise induced bronchospam

works by inhbiiting degranulation of mast cells

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18
Q

mast cells contain _ granules

A

basophilic

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19
Q

a forced expiratory volume in 1 second less that 0.80 is diagnostic for

A

airflow obstruction

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20
Q

HIV binds _ cells

A

CD4+ T cells

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21
Q

bilobed nuclei

A

eosinophil

helminth and parasitic infections

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22
Q

multiloped nuclei

A

neutrophils

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23
Q

large round densely staining nucleus with minimal amounts of pale cytoplasm

A

lymphocytes

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24
Q

pretibial myxedema

A

thickening of the skin over the anterior tibia seen in graves disease

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25
Q

graves disease

A

an autoimmune disease caused by increased stimulatino of TSH receptors by thyroif stimulating immunoglobulin (thyroid stimulating antibody)

receptor antibodies

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26
Q

Thyroid stimulating immunoglobulin may cross react with _ cells that contain TSH receptors

A

connective tissue cells

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27
Q

myxedema is caused by infiltration of _ and deposition of _ into the dermis

antibody cross reactivity with fibroblasts in the extremities

A

lymphocytes

glycosaminoglycans (HA)

orbitopathy as well

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28
Q

signs of graves disease

A

pretibial myxedema, goiter, onycholysis, thinning of hair, tremors, lid lag, sweating, heat intolerance

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29
Q

labs for graves

A

increased TSI and T4/T3
decreases TSH and HDL
hyperglycemia

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30
Q

treatment of graves disease

A

thianomides (methimazole and propylthiouracil)
radioactive iodine
thyroidectomy

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31
Q

type 1 collagen is found where ?

A

bones, skin, tendons, dentin, fascia, and cornea

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32
Q

type _ collagen is involved in late wound repair

A

1

osteogenesis imperfecta

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33
Q

type 3 collagen is found where

A

aka reticulin

found in the skin, blood vessels, uterus, fetal tissue and granulation tissue

ehlers danlos

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34
Q

type 4 collagen is found where

A

in the basement membrane

alport syndrome

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35
Q

alport syndrome

A

hereditary nephritis, deafness (x-linked dominant)

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36
Q

subacute thryoiditis

A

painful thyroid

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37
Q

thyrotoxicosis

A

usually has a normal thyroid examination

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38
Q

toxic multinodular goiter

A

discrete thyroid nodules

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39
Q

beta blocker overdose can cause

A

slow heart rate, hypotensions, hypoglycemia, and fatigue

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40
Q

how do you reverse beta blocker overdose

A

give glucagon

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41
Q

aspirin overdose symptoms

A

tinnitus, fever, respiratory alkalosis that turns into metabolic acidosis

Aspirin is an irreversible inhibitor of cyclooxygenase that reduces thromboxane and platelet aggregation. An overdose of aspirin activates the medulla’s respiratory center, increasing the rate of breathing and alkalosis, due to a loss of bicarbonate. Later, there is an uncoupling of oxidative phosphorylation leading to a loss of fluid and metabolic acidosis. This is managed by ionizing the urine with sodium bicarbonate. In addition, the patient would present with ringing of the ears with a salicylate toxicity and this patient is not experiencing this effect.

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42
Q

antidote for apirin overdose

A

sodium bicrobonate

ionizes the urine

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43
Q

acetaminphen overdose symptoms

A

RUQ pain, centrilobular necrosis of the liver

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44
Q

antidote for acetaminophen overdose

A

N-acetylcysteine

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45
Q

dabigatran overdose symptoms

A

bleeding (nose, stool, urine)

oral anticoagulant that inhibits clotting by binding to thrombin

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46
Q

dabigatran overdose antidote

A

idarucizumab

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47
Q

warfarin or rat poisoning overdose symptoms

blocks vitamin K epoxide reductase

A

bleeding (nose, stool, urine)

elevated PT

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48
Q

warfarin / rat poisoning overdose antidote

A

vitamin K for minor bleed

FFP

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49
Q

calcium channel blocker overdose symptoms

A

bradycardia
hypotension
hyperglycemia
dizziness
(tachycardia for dihydropyridines)

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50
Q

treatment of calcium channel blocker overdose

A

IV calcium
insulin

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51
Q

glucagon increases _

A

cAMP

increase HR and cardiac contractility

increases glycogen conversion to glucose in the liver

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52
Q

hemophilia A is a def in

A

factor VIII

(elevated PTT time)

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53
Q

what is the treatment and prophlaxis for hemophilia A

A

desmopressin (DDVAP)

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54
Q

what does desmopressin do

A

it is a synthetic analog of vassopressin that promotes endothelial release for factor VIII, vone willebrand factor and tissue plasminogen

also a treatment for central diabetes insipidus

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55
Q

what increases stroke volume and therefore cardiac output in pregnancy

A

increased serum estrogen will increase the plasma volume and increase preload and SV

progesterone will dialte the vessels and result in a decrease SVR (afterload)- how much you have to contract against

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56
Q

cardiac output =

A

HR X SV

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57
Q

how is there an increased GFR in pregnancy

A

there is decreased systemic vascular resistance which inreaces renal plasma flow

low serum creatinine in pregnancy

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58
Q

how does insulin resistance occur in pregnancy

A

an increase in human placental lactogen can lead to hyperglycemia and gestational diabetes

insulin antagonists

also causes maternal lipolysis and fatty acid metabolism

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59
Q

why does anemia occur in pregnancy

A

an increase in plasma volume (estrogen) results in a dilutional anemia

decreased hemoglobin and hematocrit

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60
Q

cholestasis in pregnancy is caused by

A

decreased gall bladder contraction due to progesterone relaxation

reduced biliary transport of bile mediated by estrogen

pruritis, cholelithiasis, and cholecystitis

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61
Q

PFTs in a pregnant woman will show

A

decreased expiratory reserve volume, residual volume and functional residual capacity

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62
Q

due to acute and rapidly evolving nature of necrotizing fasciitis, _ treatments are contrainticated as they could increase the spread of infection

A

lymphatic treatments

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63
Q

treatment of necrotizing fascitis

A

debriedment and IV antibiotics

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64
Q

phenytoin MOA

A

used in generalized and focal seizures

slows the rate of recovery of voltage activated Na+ channels from inactivation

it induces CYP3A4

zero order elimination

sodium channel blocker

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65
Q

side effects of phenytoin

A

gingival hyperplasia, CNS effects (ataxia), osteomalacia, excessive hair growth (hirtuism) , megaloblastic anemia

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66
Q

what virulence factor allow H pylori ti inhabit the stomach

A

urease

cleaves urea into ammonia and carbon dioxide

(ammonia neutralizes the stomach acid and raises the pH allowing for colonization of H. Pylori)

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67
Q

H. pylori will colonize the gastric surface using urease but damage is mediated by?

A

urease byproducts

mucinase, vaculoating cytotoxin A, cytoxin associated gene A, phophorubosylanthranilate isomerase

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68
Q

treatment of H. pylori infection

A

amoxicillin + clarithromycin + PPI

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69
Q

which ulcers are better with eating

A

duodenal

70
Q

what drug is used for psuedomonas in burn victims

A

aminoglycosides (bind to the 30s ribosome subunit)

-bacteriocidal
-mycin suffix

71
Q

antibiotics effective against Puedomonas

A

penicillins, cephalsporins, monobactams, carbapenems, aminoglycosides

72
Q

hypertensive emergency

A

> 180/120

73
Q

nitroprusside side effects

A

kidney injury, lactic acidosis, cyanoid toxicity, and hypotension

74
Q

MOA of nitroprusside

A

activates guanylate cyclase in the vascular s mooth muscle and leads to increased cGMP allowing calcium to move from the cytoplasm into the endoplasmic reticulum causing venule and arterial vasodilation

75
Q

how does nitroprusside cause lactic acidosis

A

when it is metabolized it produces 1 product of cyanmetheglobin and 4 cyanide ions that can accumulate and cause renal dysfunction, metabolic acidosis and elevated lactate levels

76
Q

what drugs are used in a hypertensive emergency

A

nitroprusside
nifedipine/clevidipine
fenoldopam
labetalol
esmolol
phentolamine

77
Q

nifedepine/clevidipine MOA and side effects

A

inhibits the dihydropyridine calcium channel and relaxes arterioles

SE: tachycardia, hypotension, edema

78
Q

fenoldopam MOA and side effects

A

peripheral dopamine -1 receptor agonist that maintains renal perfusion

SE: flushing, hypotension, headache

79
Q

labetalol MOA and side effects

A

blocks alpha 1, beta 1 and beta 2 receptors

SE: worsens asthma and COPD, AV block and bradycardia

80
Q

esmolol MOA and side effects

A

beta 1 adrenergic receptor antagonist

class II antiarrythmic

SE: hypotension

81
Q

phentolamine MOA and side effects

A

nonselective alpha adrenergic receptor antagonist used for overdose of catecholamine excess

SE: tachycardia, flushing, headache

82
Q

monitoring for _ is required for people taking ace inhibitors

A

hyperkalemia

83
Q

multiple myeloma

A

malignancy of plasma cells that produce abnormal antibodies that cause kidney problems, bone lesions, hypercalcemia, anemia and fatigue

elevated protein gap

84
Q

total serum protein measures both _ and _ when the difference beyween protein and albumin is greater than _ it is called a protein gap

A

immunoglobulin

albumin

> 4.5

85
Q

lytic lesions in multiple myeloma is caused by

A

activation of osteoclasts that lead to pathological fractures and compression fractures

(elevated Alkaline phosphatase)

86
Q

hypercalcemia in multiple myeloma is caused by

A

breakdown of the bone releases calcium

87
Q

why does MM have bence jones proteins

A

people in MM lose monoclonal immunoglobulines called bence jones protein - they are not losing albumin so a dipstick will often be negative

bence jones proteins can infiltrate the kidney tubular cells

-protein creatine ratio will be elevated

88
Q

how do you correct the calcium levels in multiple myeloma

A

its based on albumin level

corrected calcium= (4-albumin)X 0.8 + measured calcium)

89
Q

what are the symptoms of multiple myeloma (CRAB)

A

calcium >11
renal insufficency (creatinine >2 or renal clearance less than 40)
anemia (hemoglobin <10)
bone lesions

90
Q

patients with MM have tumors that metastaize to bone (ribs and spine) and _ will elicit a sharp pain response

A

percussion

91
Q

NSAID induced nephropathy causes

A

intersitial nephritis, and papillary necrosis

92
Q

papillary necrpsos presents as

A

painless gross hematuria

93
Q

microscopy evaluation of a wet mount specimen from vaginal fluid is diagnoistic for what 3 conditions

A

Trichomoniasis: Motile, flagelleted protozoa is characteristic of trichomonas. Although very specific, the sensitivity of this test is only 60% and may be even less in asymptomatic women.
Candida albicans: Pseudohyphae and budding yeast would readily be seen on wet mount prep.
Bacterial vaginosis (BV): Clue cells (coccobacilli on vaginal epithelial cells) with a fishy odor when KOH prep is applied is characteristic of BV.

NAAT also works

94
Q

in polymyositis the cellular infiltrate is predominately within the

A

fascicle with inflammatory cells invading the muscle fiber

endomysial infiltration

95
Q

pathogenesis of polymyositis

A

anti-jo1 antibodies in polymyositis have a CD8+ T cell and macrophage infiltrate in the endomysium, capillaries. And increased connective tissue due to muscle fiber necrosis .

CD8+ mediated

96
Q

polymyositis symptoms

A

insidious proximal muscle weakness in the upper and lower extremities (inability to comb hair, walk up and down the steps)

muscle pains, pain and myalgia can fluctuate, weakness of the chest wall muscles

97
Q

polymyositis can cause _ dysfunctions of the rib cage

A

exhalation

98
Q

labs for polymyositis

A

elevated creatine kinase, lactate dehydrogenase, aldolase, anti-jo-1 antibodies

**muscle biopsy is definitive

99
Q

treatment for polymyositis

A

prednisone

100
Q

dermatomyosistis pathogenesis and clinical features

A

immune complex deposition with Cd4+ T cells and B cells in the perimysium and perifascicular regions

symmetric proximal muscle weakness with gottron papules, shawl sign, mechanics hands

elevated CK, lactate and aldolase, anti-jo-1 antibodies

101
Q

inclusion body myositis

A

inflammation and endomysial infiltrates of CD8+ T cells and marcophages

more common in men older than 50

distal weakness starting at the fingers and wrist

usually asymmetric

(loss of finger dexterity and grip strength)

102
Q

polymyalgia rheumatica is associated with

A

giant cell arteritis

103
Q

what is polymyalgia rheumatics

A

myalgias of the hip and shoulder girdles with NO weakness

stiffness, difficulty rising from chair or raising arm above head

ESR > 40

104
Q

sarcoidosis is an inflammatory disease that predominately affects which organs

A

lungs and intrathoracic lymph nodes

noncaseating granulomas

-fever, anorexia, arthralgias, SOB, dyspnea, erythema nodosum, anterior uveitis

105
Q

labs in sarcoidosis

A

elevated calcium due to secretion of 1,25 vitamin D by the noncaseating granuloma

106
Q

plain film radiograph of sarcoid

A

bilateral hilar lymphadenopathy

107
Q

antisocial personaility disorder stems in childhood as _ disorder

A

conduct

108
Q

conduct disorder

A

pattern of behavior that violates basic rights of others or deviates from societal norms that leads to imapirment in social academic or occupational functionnig

agreession to people and animals
destruction of property
deceitfulness or theft
serious violations of the rules

109
Q

antisocial personalitis disorder cannot be diagnosed below the age of

A

18 years old

110
Q

antisocial personaility disorder criteria

A

3 or more occuring since age 15

repeated acts that are grounds for arrest
lack of remorese
lack of planning ahead
decietfulness for personal profit
aggressiveness
inability to assume responsibility
disregard for safety of others or self

111
Q

disruptive mood dysregulation disorder

A

frequent temper outbursts out of proportion that can lead to verbal rages or physical aggression in those under 18 years old

112
Q

diagnosis of oppositional defiant disorder requires

A

6 month period of being hostile and defiant

with 4 or more criteria or loss of temper, arguing with adults, defying adults, deliberately annoying people, anger, spitegulness, blaming others, and easy annoyance.

113
Q

lithium toxicity side effects (HEAT)

A

HEAT

hypothyroidism
edema
acne
tremor (hyperreflexia, ataxia)- neurological

narrow theraputic index

114
Q

most common ECG finding in lithium toxicity

A

T wave flattening

115
Q

what 3 drug classes potentiate lithium toxicity

A

diuretics, angiotensin converting enzyme inhibitors, and NSAIDS

116
Q

thyroid problems are most common associated with a _ lesion of T_

A

flexion lesion of T2

117
Q

lithium can cause _ diabetes insipidus

A

nephrogenic

inhibits ADH action on the distal renal tubule

118
Q

la crosse virus

A

a bunyaviridae family virus; helical nucelocapsid

negative sense circular RNA virus that is enveloped in 3 segments that is transmitted through the bite of an aedes triseritaus mosquito

prodomal stage, fever somnolence and metal status changes.

focal neurological deficits : aphasia, incoordation

119
Q

eastern equine encephalitis

A

togavirdae family

enveloped positive sense, linear single stranded RNA virus with icosahedral nueclocapsits

120
Q

st louis encephalitis

A

flavivirdiae family

positive sense enveloped linear single stranded icoshaedral nucleocapside

121
Q

west nile encaphalitis

A

flavivridae family

positive snese, linear single stranded RNA enveloped icosahedral nucleocapsid

122
Q

western equine encephalitis

A

Western equine encephalitis is caused by an alphavirus genus member of the Togaviridae family. These viruses are enveloped with a positive sense, linear, single-stranded RNA genome with icosahedral nucleocapsids. Western equine encephalitis is transmitted by the mosquitos of the Culex and Culiseta genera.

123
Q

which atypical antidepressant can be used for smoking cessation and can cause weight loss

A

bubropion

124
Q

bupriopion MOA

A

norepinephrine and dopamine reuptake inhibitor

125
Q

what are the agents used to help with smoking cessation

A

bubropion, nicotine replacement therapy and varenicline

126
Q

containdications to useing burprion

A

seizure or eating disorders (lowers seizure threshold)

127
Q

MOA of nicotine replacement therapy

A

stimulation of nicotine receptors and reduces cravings

128
Q

varenicline MOA

A

partial nicotinic acetylcholine receptor agonist

avoid in suicidal patients, can cause abnormal dreams

129
Q

adductor pollicis is inervated by _ and it can be tested with the _ sign

A

ulnar nerve

froment sign (paper between thumb and index finger–> hyperflexion of the interphalangeal joint due to compensatory engagement of the flexor pollicus longus

130
Q

the 1st and 2nd lumbicals are innervated by the

A

median nerve

131
Q

3rd and 4th lumbricals are innervated by

A

ulnar nerve

132
Q

lumbicals function to

A

flex the metacarpophalangeal joint and extend the interphalangeal joint

133
Q

abductor pollicis brevis is innervated by

A

median nerve

abduction of the thumb and opposition

134
Q

extensor digiti minmi is innervated by

A

posterior interosseous nerve from the raidal nerve

extendion of the wrist and 5th digit

humeral shaft fracture (wrist drop)

135
Q

portal hypertension can cause anorectal varices with increased pressure where

A

within the superior rectal vein (portal system) and inferior rectal vein (systemic system)

dilated veins engorged with blood

-bleeding from butt

136
Q

esophageal varices due to portal hypertension occurs between what anastamoses

A

left gastric vein and azygous vein

137
Q

caput medusa from portal hypertension is an anatomosis between

A

paraumbilical vein (portal) and superficial epigastric vein

138
Q

aniocytosis

A

variety of size in any cell type

139
Q

anisocytosis is synonymous with

A

red blood cell distribution width (RDW)

140
Q

an increased RDW is specific for _ anemia

A

iron deficiency

In women of child-bearing age who present with symptoms of anemia, suspect iron deficiency caused by blood loss. Typical laboratory findings include a decreased MCV, decreased serum iron, increased RDW, increased TIBC, decreased ferritin, and increased apoferritin.

141
Q

increased mean corpuscular hemoglobin content decribes

A

hereditary spherocytosis

a condition in which a protein vital to the red blood cells concave structure is missing, resulting in a spherical shape. The mean corpuscular hemoglobin content refers to the red blood cell’s increased volume and capacity to store hemoglobin. A peripheral blood smear will reveal loss of the biconcave shape of the red blood cells. Patients typically present with intermittent jaundice, splenomegaly, and bilirubin gallstones. The most accurate test is an osmotic fragility test. This patient had a normal physical examination. Due to the positive history for menorrhagia, iron deficiency should be high on the differential.

142
Q

increased urinary levels of methylmalonic acid describes

A

megaloblastic anemia due to B12 def

143
Q

poikilocytosis means

A

abnormal shapes and sizes from intravascular hemolysis

144
Q

subfalcine herniation

A

medial aspect of the frontal lobe the cingulate cyrus herniates across the midline under the free edge of the anterior falx and may compress the anerior cerebral arteries

145
Q

ACA supplies

A

medial portion of the frontal lobe and superior portion of the parietal lobe

146
Q

ACA occulsion/lesion

A

contralateral lower extremity weakness withOUT sensory loss

dysfunction of the frontal lobe causes abulia, akinesa, mutism, slowless, and frontal release signs: rooting reflex and sucking reflex

147
Q

subdural hemorrhage occurs due to tearing of

A

bridging veins

increased intracranial pressure

148
Q

hydrocephalus ex vacuo

A

enlarged brain ventricles due to loss of parenchyma

149
Q

tonsillar herniation

A

increased posteiror fossa pressure causes the cerebellar tonsils to displace down through the foramen magnum can compress the brainstem and spinal cord leading respiratory arrest, cardiac arrest, compress the medulla and cause coma

150
Q

transcalvarial herniations

A

portions of brain matter herniate through disruption in the skill

(head trauma, skull fracture_

151
Q

uncal transtenorial herniations

A

medial part of the temportal lobe the uncus herniates over the edge of the tenrotium

can compress the PCS, oculomotor nerve or cerebral peduncle , duret hemorrhages

oculomotor and cerebral peduncle –> ipsilateral dilated pupil and contralateral hemiparesis

kerhans notch

down and out eye

152
Q

caudal displacement of the brainstem caused by central transtentorial herniation causes

A

paramedial basilar artery rupter and duret hemorrhages (fatal )

153
Q

antibodies in graves

A

IgG antibodies stimulate thyroid stimulating hormone receptors to create more thyroif hormone

thyroid stimulating immunoglobulins (IgG)

154
Q

graves is a type _ HSR

A

type II

155
Q

radioactive iodine uptake scan in graves

A

diffuse evenly distrubited uptake

156
Q

what onfection can be a potential triggering event for graves disease

A

yersinia entercolitica

157
Q

acetaminophen toxicity causes necrosis where in the liver

A

centrilobular

N-acetylcysteine (NAC) should be administered as soon as possible, preferably within 8-10 hours of overdose. This drug donates sulfhydryl groups, and decreases free radical damage. In addition, activated charcoal can be given if ingestion is within 4 hours.

158
Q

stages of acetaminophen toxicity

A

stage 1: N.V, CNS disturbances
Stage 2: RUQ pain
Stage 3: hepatic dysfunction

159
Q

N-acyetlcysteine should be adminstered when

A

within 8-10 hrs of acetaminophen overdose

160
Q

portal vein thrombosis is most commonly causes by

A

oral contraceptive pills/estrogen

161
Q

extensive microvesicular lipid accumulation inside hepatocytes describes

A

reye syndrome

Reye syndrome is caused by salicylate use, commonly aspirin, in the pediatric population.

162
Q

the spinal dura attaches where

A

foramen magnum

posterior aspect of the C2 dens

posterior aspect of C3 body

posterior aspect of S2 body

posterior aspect of the coccyx

163
Q

the filum terminale is an extension of the

A

pia matter

164
Q

henoch-schnlein purpura

A

small vessel vasculitits

type III hypersenitivity

IgA immune complex deposition leading to : palpbable purpura on the buttocks and lower extremities with non pitting edema and aarthralgias and abdominal pain

can deposit in the kidney, gi tract leading to hematuria or mesenteric ischemia

165
Q

henoch scholein purpura typically follows

A

upper respiratory tract infection (group A strep)

166
Q

complications of henoch schonlein purpura

A

instussception

167
Q

leukocyte invasion of medium sized blood vessel walls causing transmural necrotizing inflammation

A

polyarteritis nodosa

This vasculitis generally occurs secondary to either hepatitis B, hepatitis C, or hairy cell leukemia. The tetrad for diagnosis is fever, hypertension, abdominal pain with melena, and renal disease, which are absent in this patient.

168
Q

what is the PERC criteria for pulmonary embolism assessment

A

age older than 50
heart rate greater than 100
02 sat less than 95%
hemoptysis
unilateral leg edema
recent surgery
history of DVT
hormone therapy

negative means no cirteria was fulfilled
if they are low risk check d dimer level
high risk or positive d-dimer—> Chest CT scan with angiography CTA

169
Q

oxacillin resistant=

A

methicillin resistant

170
Q

treatment for phenochromocytoma

A

phenoxybenzamine (irreersible alpha blockers)

phentolamine (reversible)

alpha blockers must be give before beta blockers

171
Q

what are the two instances where you must give an alpha blocker. before. a beta blocker

A

cocaine toxicity and pheochromocytoma (urinary VMA)

172
Q

the aortic valve opens _ in hypertension

A

later

173
Q

isovolumetric contraction is _ in hypertension

A

longer (reduced coronary blood flow for longer)

WELL (8 decks)

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