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13 Cards in this Set
- Front
- Back
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An alcoholic develops pneumonia in a dependent lung lobe, and has purulent foul-smelling sputum.
What may be a causative agent to this pneumonia? Escherichia coli Peptostreptococcus Mycobacterium tuberculosis Bacillus anthracis Legionella pneumophila |
Peptostreptococcus
Alcoholics are prone to aspiration pneumonias caused by anaerobic and normal oral flora agents. Such flora include: Streptococcus pneumoniae Peptostreptococcus Bacteroides melaninogenicus Fusobacterium |
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What diagnostic modalities are used to diagose active TB?
PPD, sputum analysis, CXR, and clinical symptoms Sputum analysis, CXR, and clinical symptoms CXR and clinical symptoms Sputum analysis and CXR Acid fast stain of sputum |
Sputum analysis, CXR, and clinical symptoms
ACTIVE TB does not require a PPD test for diagnosis because PPD tests are often falsely negative during an active infection |
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What is the number one cause of chronic gastritis?
Anti-parietal cell auto-antibodies Infection with H. Pylori NSAID use Alcohol use Gastric mucosa cell hyperplasia |
NSAID use
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Which of the following may result from portal hypertension?
Recanalizeation of the epigastric veins Varicose veins of the lower extremities Contracted spleen Encephalopathy External, but not internal, hemorrhoids |
Encephalopathy
Portal HTN can result in shunting of blood around the liver to compensate. Due to the shunting, many absorbed substances from the gut are NOT detoxified, thus leading to encephalopathy |
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A 54 yo male is evaluated for ascites.
Ascitic fluid samples demonstrate a serum:ascites albumin gradient of 0.99. Other lab values include normal serum amylase and lipase, and normal CBC. The pt does have a social hx of binge drinking during his 20's and 30's. His PPD is neg. What is a possible etiology given these findings thus far? Peritoneal carcinomatosis Pancreatitis Peritoneal TB CHF Alcoholic hepatitis |
Peritoneal carcinomatosis
A serum:ascites albumin gradient of <1 is a sign of increased albumin within the ascitis fluid, likely due to decreased serum oncotic pressure. Decreased serum oncotic pressure can be caused by Cancer, Pancreatitis, Peritoneal TB or Nephrosis. Since the lipase was neg., PPD test was neg., and Nephrosis is not an option the correct answer must be Cancer (Peritoneal Carcinomatosis). Alcoholic hepatitis would result in elevated hydrostatic pressure, causing a decreased ascitic albumin |
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An unconscious individual is brought to the ER.
It is determined that the pt. should receive D5NS. The order and content of IV administartion will be as follows: Administer Thiamine first, and then administer D5NS Administer D5NS, then give Thiamine after fluid and glucose levels reach normal levels in the pt. Administer D5NS, then give Thiamine only after it is established that the pt. has an alcohol abuse history Administher Thiamine first, and see if the pt. improves. If he doesn't, then administer D5NS Administer Thiamine first if the pt. is demonstrating odd behavior. Otherwise, just give D5NS |
Administer Thiamine first, then administer D5NS
Anyone suspected of alcohol abuse MUST have Thiamine administered first. Glucose should be avoided first because if the pts. symptoms are due to alcohol and they are in a Wernicke's encephalopthy state, glucose could flip them into Korsakoff's psychosis and cause marked memory impairment. |
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A hospitalized pt. suddenly develops elevated creatinine, elevated BUN, oliguria, and hyperkalemia.
Further evaluation demonstrates a BUN:Creatinine ratio of 24 and a FEna of 0.7%. Urinary Na is 18. What is this pt's diagnosis? Pre-renal acute renal failure Renal acute renal failure Post-renal acute renal failure Chronic renal failure Acute renal failure, but too little data to determine the type |
Pre-renal acute renal failure
Pre-renal cases have a BUN:Creatinine ratio of >20, Urinary Na <20, and FEna <1% Post-renal has BUN:Creatinine ratio of 15-20, Urinary Na >40, FEna >4% |
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What is the formula for calculating FEna?
Plasma Na divided by Urinary Na, and that result divided by Plasma Creat divided by Urinary Creat Plasma Creat divided by Urinary Creat and that result divided by Plasma Na divided by Urinary Na Urinary Na divided by Plasma Na, and that result divided by Urinary Creat divided by Plasma Creat Urinary Creat divided by Plasma Creat, and that result divided by Urinary Na divided by Plasma Na Urinary Na divided by Urinary Creat, and that result divided by Plasma Na divided by Urinary Na |
Urinary Na divided by Plasma Na, and that result divided by Urinary Creat divided by Plasma Creat
Which comes out to be: Una x Pcreat / Pna x Ucreat |
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A 28 yo male presents to the ER complaining of sharp, right-sided flank pain.
He can't find a position of comfort and so he keeps moving about in a feeble attempt to reduce the excruciating pain. He denies having any fevers, nausea, or vomiting. He does admit to increased urinary frequency in the last few days. His past medical history includes keloids and gouty arthritis. What is the first radiologic test to order? Abdominal X-ray Renal ultrasound Intravenous pyelography Pelvic and abdominal CT scan with IV contrast Pelvic and abdominal CT scan without IV contrast |
Pelvic and abdominal CT scan without IV contrast
This pt. most likely has renal calculi and are best seen with a diagnostic abdominal X-ray; however, he has a history of gouty arthritis and may likely have uric acid stones which are radiopaque. Thus, he requires a CT scan. CT without contrast is used because the contrast may mask some stones |
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A 32 yo female with AIDS presents to her PCP with complaints of fever, hemoptysis and chest pain that hurts when she inhales.
She complians of progressively worsening dyspnea and has also developed a productive cough over the past few days. On PE the head, neck and abdomen all appear to be normal; however, chest auscultation reveals bilateral rales. Labs demonstrate WBC = 2900, Neutrophils = 1160 (normal <3600), Lymps = 150 (normal <2500). Both sputum and blood cultures are negative after 2 days. A CXR shows bronchopneumonia bilaterally. Bronchoscopy is performed and the biopsy results demonstrate V-shaped septate hyphae. What is the most likely etiologic agent? Bacillus anthracis Aspergillus niger Coccidoides immitis Candida albicans Pneumocystitis jiroveci |
Aspergillus niger
Pts. with AIDS are more likely to suffer from fungal infections or Pneumocystitis jiroveci when they develop pneumonia symptoms. Since her culture results were neg, Jiroveci is out. Bronchoscopy demonstrated V-shaped septate hyphae, which is pathomnemonic for Aspergillus (Think "A" for Acute Angles in Aspergillus since they produce septate hyphae that branch at Acute Angles) Candida demonstrate PSEUDOHYPHAE W/ BRANCHING BUDDING YEAST Coccidoides develops spherules and are typically found in SW US (San Joaquin Valley Fever) |
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A 29 yo woman with mitral valve prolapse is planning to have a dental cavity repaired.
PE of the heart reveals no evidence of murmur other than the evident mid-systolic click. What is the appropriate prophylactic treatment for this patient? Amoxicillin Clindamycin Cefazolin Vancomycin No treatment is needed |
No treatment is needed
Asymptomatic murmurs require no prophylactic treatment for dental work. If she were symptomatic, amoxicillin is the drug of choice for prophylaxis |
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A 65 yo man who has worked as a ship builder for the past 40 years has been suffering from ongoing shortness of breath.
It started 3 years ago and has gotten progressively worse. Which of the following findings is expected? Decreased total lung capacity Increased forced vital capacity Increased residual volume Increased vital capacity Unchanged vital capacity |
Decreased total lung capacity
Ship building and brake lining are two industries which have a high likelihood of developing RESTRICTIVE lung disease. Restrictive disease results in decreased total lung capacity (TLC), decreased residual volume (not increased), decreased FEV1, and increased FEV1/FVC. |
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A 49 yo Asian male presents to his PCP with complaints of abdominal pain and diarrhea.
He explains that he also lost 12 pounds. He is also suffering from discomfort when he breathes, and pain in multiple joints. PE reveals rales on auscultation of the lungs. Stool cultures are negative. CXR demonstrates hilar lymphadenopathy. Biopsy of the hilar nodes is PAS positive for foamy macrophages. What is the most likely diagnosis? Celiac disease Crohn's disease Hemochromatosis Tropical sprue Whipple disease |
Whipple diasese
Whipples is caused by Tropheryma whippelii which causes abdominal pain, arthralgias, diarrhea, rash and anemia. Weight loss and steatorrhea are common because it causes malabsorption. Tx is TMP/SMX, Tetracycline, Ampicillin, or Penicillin for 6-12 months. Celiac's disease is specific for gluten and is associated with wheat, rye, barley or oats ingestion. Crohn's disease affects the entire alimentary canal and causes abdominal pain and diarrhea, with occasional blood. Hemochromatosis causes excessive absorption of iron resulting in cirrhosis, diabetes, CHF and ruddy skin nodules. Tropical sprue causes diarrhea and abdominal pain and is associated with tropical travel. It typicall presents with sore tongue, steatorrhea and weight loss. |
