1. grey white junction 2. surgical resection + whole brain radiotherapy
1024.what conditions should leukocyte alkaline phos be used to confirm a
diagnosis
leukemoid reaction - high Polycythemia vera - high CML - low
1025.hyposthenuria inability to concentrate urine from
sickling in the vasa recta impairing countercurrent exchange and free water reabsorbtion
1026.what drugs cause folate deficinecy
phenytoin, primidone, phenobarbital, trimethoprim (inhibits DHFR), MTX
1027.why must
warfarin always be bridged
temporary increase in risk of DVT, venous limb gangrene or skin necrosis
due to loss of protein S/C (HL only 9 hours vs 60 hours for other factors) leading to temporary hypercoagulable state
1028.what tumors never metastasize to the brain
non-melanoma skin cancer oropharyngeal cancer esophageal cancer prostate cancer 1029.graft vs host disease 1. patho 2. organs effected
1. donor T cells recognise host minor/major HLA antigens 2. skin, intestine, liver
1030.mycobacterium leprae
1. clinical pres
1. hypopigmented patches with areas of anesthesia
1031.contact dermatitis 1. what kind of reaction
1. type 4 hypersensitivity urushiol, nickel, formaldehyde, certain fragrances, preservatives, rubber, chemicals
2. calamine lotion, topical antihistamines, topical corticosteroids, oral steroids
1032.prophyria cutanea tarda
1. patho
1. uroporphyrinogen decarboxylase deficiency in heme synth path triggers - ethanol/estrogens 2. painless blisters,, skin fragility, facial
hypertrichosis/hyperpigmentation 3. elevated urinary porphyrin tx = phlebotomy,
hydroxychloroquine, interferon alpha
1033.treatment for seborrheic dermatitis
moisturizers, topical antifungals, anti-dandruff shampoos, topical steroids
1034.ichthyosis gradual scaling of dry skin
progressing to horny plates over the extensor surfaces worsens during the winter
1035.1. cherry hemangiomas 2. strawberry hemangioma
1 .appear in 3rd or 4th decade, do not regress spontaneously
2. grow rapidly and regress by 5-8 years of age 1036.what skin conditions associated with parkinsons disease seborrheic dermatitis 1037.1. chalazion 2. hordeolum 3. stye
1. sterile granulomatous inflammatory lesion of meibomian glands
2. purulent infection of an eyelid gland (staph)
3. external hordeolum involving zeis or molls glands 1038.immune deficiency associations 1. C3 deficiency 2. C5-C8 deficiency 3. C1 inhibitor deficiency 4. phagocytosis 5. C1q deficiency
1. recurrent pyogenic infections 2. neisseria infections
3. hereditary angioedema (unopposed C2b and bradykinin production).. not infection...
4. bacterial infections
5. systemic lupus erythematosus
1039.scarlet fever 1. patho 2. clinical pres
1. streptococcus pyogenes infection 2. higher fever, sandpaper rash, exudative pharyngitis, rash desquamates
1040.eczema herpeticum
HSV infection associated with atopic dermatitis
life threatening start acyclovir
1041.felon needle injury (ie. tailors) causes
bacterial infection of distal volar space --> tense abscess, intermittent throbbing pain
1042.what patients at high risk for herpetic whitlow
those who are in contact with orotracheal secretions - ex. dentists
1043.rubella 1. clinical pres
1. fever/malaise, suboccipital adenitis polyarthralgia, maculopapular face rash that spreads to involve trunk and extremities
1044.dermatitis herpetiformis treatment
dapsone - both therapeutic and diagnostic
1045.vancomycin side effects
nephrotoxicity, ototoxicity, red man syndrome
1046.delirium tremens 48-96 hours after last drink
hypertension, hyperthermia, agitation, hallucinations (tactile), death
tx= benzodiazepines
1047.how does bicarb treat aspirin overdose vs TCA overdaose
aspirin - alkalinizes the urine and enhances excretion
TCA - narrows the QRS complex by alleviating the cardio-depressant action on sodium channels
1048.treatment of neuroleptic malignant syndrome
dantrolene
bromocriptine (dopamine agonist) amantadine (antiviral with dopamine agonist properties)
1049.what is the most reliable indicator of opioid intoxication
bradypnea
- not miosis becuase there are often coingestions
1050.iron toxicity clinical presentation
5 phases
1. GI phase - first 6 hours - nausea, vomiting, hematemesis, melena, abdominal plain
latent phase - 24 hours - asymptomatic
metabolic acidosis/shock - 72 hours hepatotoxicity - 96 hours
mucosal scarring and bowel obstruction weeks to months post ingestion
1051.TCA overdose clinical presentation
anticholinergic - dilated pupils, flushed dry skin, ileus
EKG- dec. myocardial conduction velocity and widening of QRS- tx = bicarb
1052.torsade de pointes 1.risk factors 2. tx
1. malnourished, familial long QT, hypomagnesemia, TCA, amiodarone, sotalol, fluoroquinolones, fluconazole 2. magnesium sulfate 1053.1. methanol overdose clinical pres 2. ethylene glycol clinical pres 3. aspirin overdose clinical pres 4. lithium ""
1. anion gap metabolic acidosis, disc hyperemia, n/v, abdominal pain
2. similar to methanol except it damages the kidneys
3. anion gap met. acid, tinnitus, fever, hyperventilation (resp alk.) 4. hyperreflexia, ataxia, seizures
1054.how to differentiate alcohol from benzodiazepene intoxication
benzodiazepine intoxication does not have nystagmus
1055.poisoning treatments 1. aspirin/TCA overdose 2. torsades 2/2 prolonged QT 3. lithium 4. lead poisoning 5. acetaminophen 6. iron 7. ethylene glycol 8. organophosphate 9. diphenhydramine 1. sodium bicarb 2. mgSO4 3. hemodialysis
4. succimer, calcium EDTA 5. N-acetylcysteine 6. deferoxamine
7. ethanol, fomepizole (ADH inhibitor), sodium bicarbonate, hemodialysis 8. atropine, pralidoxime 9. physostigmine 1056.ethylene glycol poisoning 1. patho
1. ethylene glycol metabolized by ADH to oxalic acid*** (binds calcium causing
hypocalcemia/calcium oxalate crystals) and glycolic acid (damages renal tubules)
1057.phencyclidine intoxication treatment
haloperidol and calm setting, urine acidification
1058.beta blocker toxicity clinical pres/ treatment
bradycardia, AV block,
hypotension, diffuse wheezing*** tx = atropine, IV fluids, calcium, glucagon** (inc. cAMP and inc. Calcium levels --> improved cardiac contractility)
1059.digoxin toxicity clinical pres
blurred vision, disturbed color perception, fatigue, headache, abdominal pain
1060.acetaminophen toxicity
1. treatment
1. activated charcoal within 4 hours rumack-matthew nomogram - measure at 4 hours and decided whether or not to give N- acetylcysteine 1061.carbon monoxide poisoning diagnosis carboxyhemoglobin levels tx = hyperbaric oxygen 1062.cyanide poisoning 1. patho
1. burning rubber or plastic 2. headaches, n/v abdominal discomfort, confusion, coma, BITTER ALMOND BREATH
1063.methemoglobinemia 1. clinical pres
1. cyanosis, blue discoloration of the skin/mucus membranes
1064.organophosphate poisoning 1. clinical pres 2. tx
cholinergic excess - bradycardia, miosis, fasciculations, salivation, lacrimation, urination, defecation 2. tx = atropine, pralidoxime
1065.when to screen for ovarian cancer
patients who are at higher than average risk - screen with CA125 and transvaginal ultrasound
1066.what kind of immune response from pneumococcal vaccine
T cell independent B cell response because it is a polysaccharide vaccine
1067.what CD4 count needed to give a live vaccine
>200
1068.what drugs are best for raising HDL
fibrates
1069.CRAO vs CRVO CRAO - pallor of the disk, cherry red
fovea, boxcar segmentation of blood in both retinal arteries and veins
1070.CRVO - disk swelling, venous dilatation, tortuosity, retinal hemorrhages, cotton wool spots ...
1071.CRAO treamtent ocular massage and high flow
oxygen
1072.trachoma 1. clinical pres
1. follicular conjunctivitis, pannus neovascularization of the cornea, 2. oral tetracycline or erythromycin 1073.1. HSV retinitis 2. CMV retinitis 3. toxo retinitis
1. widespread pale peripheral lesions and central necrosis of the retina - rapid vision loss "acute retinal necrosis"
2. painless, yellowish white fluffy or granular retinal lesions near retinal vessels, retinal
hemorrhages
3. necrotizing retinochoroiditis - fluffy white lesions surrounded by retinal edema and vitritis
1074.sympathetic ophthalmia
2/2 damage to an eye via penetrating injury leads to immunologic reaction to hidden antigens- anterior/panuveitis, papillary edema
1075.retropharyngeal abscess
1. clinical pres
1. fever, neck pain, trsimus, limited cervical extension
1076.diphtheria 1. clinical pres
1. pseudomembranous pharyngitis, low grade fever, nasal discharge, cervical adenopathy
1077.otitis externa 1. patho 2. treatment
1. pseudomonas>staph infection of the external ear - causes severe ear pain/drainage, can progress to skull base or TMJ, destruction of VII
2. topical neomycin, or systemic ciprofloxacin if severe
1078.key distinguishing features of orbital cellulitis vs preseptal cellulitis
orbital cellulitis - has proptosis/dec. visual acuity
1079.***both may have pain with eye movement
...
1080.ACE inhibitor side effects
cough, hyperkalemia, angioedema
1081.beta blocker side effets
bradycardia, inc. airway resistance, fatigue, depression, sexual dysfunction
1082.most common middle ear pathology in HIV patients
serous otitis media - due to auditory tube dysfunction from HIV
lymphadenopathy, or obstructing lymphomas
1083.cholesteatoma 1. patho
1. chronic middle ear disease leads to formation of a retraction pocket in the tympanic membrane that fills with granulation tissue
2.
1084.aspirin exacerbated
respiratory disease
asthma, nasal polyps, chronic rhinosinusitis, bronchospasm following NSAIDS
1085.peritonsillar abscesses clinical pres
uvular deviation, hot potato voice, lymphadenopathy
1086.allergic rhinitis diagnosis
clinical history, eosinophils on nasal cytology
1087.cause of ascending vs descending aortic aneurysms
ascending - cystic medial degeneration
descending - atherosclerosis
1088.PTU/methimazole side effects
agranulocytosis - look for sore throat
and discontinue medication immediately
1089.hypercalcemia of bedrest
2/2 activation of osteoclasts causing increased bone turnover
tx = bisphosphonates
1090.why must beta blocker not be given alone in
pheochromocytoma
beta blocker leads to unopposed alpha and a sudden rise in blood pressure
1091.***give alpha blocker first THEN beta blocker