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7.9.13
qbank
25
Medical
Graduate
07/09/2013

Additional Medical Flashcards

 


 

Cards

Term
what is Rovsing sign
Definition
appendicitis sign: RLQ pain w/ deep palpation of LLQ
Term
person comes in with classic appenicitis symptoms, e.g. RLQ pain that started as dull abdominal pain, leukcytosis, Rovsing sign.

What is the first step in management?
Definition
immediate surgery. Doing ultrasound/other imaging delays treatment

CT or ultrasound is good practice for atypical presentation or women of childbearing age, or older adults (the latter because they have a higher rate of negative exploratory laparotomy)

women should be first evaluated for pelvic pathology w/ abdominal ultrasound
Term
what is a phlegmon?
Definition
walled off inflammatory mass, usually without bacteria. Examples include:
- untreated appendicitis (>5 days; if this happens, don't do surgery, just give IV antibiotics, bowel rest, and delay appendectomy)
- diverticulitis
- spondylodiscitis (inflammation of disc and vertebra, may start in disc(children) or vertebra(adults) and spread to the other. a common symptom of sepsis)
Term
in alcohol withdrawal, when do seizures begin to appear?

hallucinations?
Definition
12-48 hrs after last drink

12-24 hrs
Term
what is first line treatment of alchohol withdrawal?
Definition
long acting benzos:
diazepam
lorazepam
chlordiazepoxide

these stimulate GABA to cause seadtion

diazepam and lorazepam are prefered in sick, hospitalized pts b.c. they have active metabolites and result in fewer recurrent symptoms
Term
Flumazenil MOA
Definition
benzodiazepine receptor antagonist; used for benzo overdose
Term
antisiezure drug for alcohol withdrawal seizures?
Definition
Phenytoin
Term
what must be ruled out before alcohol withdrawal can be diagnosed?
Definition
electrolyte abnormalities, infection, hypoxia (all can cause seizures)
Term
drug that can be used to treat depression and smoking cessation
Definition
bupropion

it is a dopamine and NorEp uptake inhibitor
Term
class of antidepressants that have been used for chronic pain
Definition
tricyclics (e.g. amitriptyline used for diabetic neuropathy and migraine prevention)
Term
antidepressant used in depression w/ anorexia &/or insomnia
Definition
mirtazapine (will increase appetite and cause weight gain as well as treating depression
Term
painless bleeding from rectum in elderly patient
Definition
diverticulosis

diverticulitis is painful
Term
where do diverticula herniate?
Definition
areas where vasculature penetrates bowel wall

this is why they can bleed so much
Term
most common site of diverticulosis?

most common site of bleeding diverticulosis?
Definition
sigmoid colon

right colon

have to do CT scan to see them (not seen well w/ plain xray)
Term
complement factor decreased in SLE and poststreptococcal glomerulonephritis?
Definition
C3; this is because immune complexes activate and deplete this complement factor
Term
what beta HCG level can you observe a pregnancy with a:
-transvaginal ultrasound?
-transabdominal ultrasound?
Definition
- transvag: as low as 1500 IU/L

- transabdom: >6500 IU/L


if you can't see a pregnancy, check beta-HCG levels. Doubling every 48 hrs = normal pregnancy. Lower rate of rise = ectopic pregnancy
Term
treatment for PID?
Definition
cephalosporin for gonnorrhea (e.g. cefoxitin)
doxycycline for chlamydia

hospitalize and give parenteral for patients at risk for low compliance
Term
result of giving beta blocker to a person with pheochromocytoma
Definition
rapid incrase in blood pressure. THIS IS EXTREMELY DANGEROUS!

this happens b.c. blocking hte beta receptors on the vasculature will cause increase in the alphas and vasoconstriction

labetalol, which is a dual alpha and beta blocker, can be used safely
Term
what is slipped capital femoral epiphysis?
Definition
classically presents in obese adolescent males.

it is when the femoral epiphysis (head) slips out of the joint. presents with knee pain, loss of abduction and internal rotation of hip, and external rotation of the thigh while the hip is flexed. frog-leg lateral xray is diagnositc

TREAT with surgical pinning of the slipped epiphysis where it lies (to avoid avascular necrosis)
Term
acute onset, bilateral patchy airspace disease on CXR, PCWP <18 (normal) or no evidence of increased LVEDP, PaO2/FiO2 < 200
Definition
diagnostic criteria for ARDS

NOTE: FiO2 is 21% normally, can be as high as 100% if being given O2 supplementation
Term
most common cause of short stature and pubertal delay?
Definition
constitutional growth delay:
- normal birth weight
- between 6 mo to 3 yrs the height growth velocity slows
- around 3 yrs, the child grows normally, but just at a lower percentage height
- bone age is delayed and pubertal signs will be absent
Term
bias introduced by loss of followup
Definition
selection bias
Term
loss of vision ("curtain-like") with complaints of photopsia and/or floaters

can occur b.c. of trauma or myopia, causing fluid to separate the retinal layers
Definition
retinal detachment

this occurs in people between ages 40-70
Term
large volume, frequent, foul smelling stools that are difficult to flush
Definition
steatorrhea. Think chronic pancreatitis (alcoholic), pancreatic or bile duct obstruction (CF, cancer), bacterial overgrowth in small intestines (they will disrupt the micelles by digesting them), malabsorption (celiac, tropical sprue, whipples.

rarely lymphatic obstruction can cause this (congenital dysplasia or acquired)
Term
skin area that never tans, scales when scraped, and has a spaghetti and meatballs appearance in a KOH prep
Definition
Malasezzia furfur (aka Tinea versicolor)
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