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Flashcards in 5/3 Deck (112)
1

Why are cephalohematomas limited to surface of one cranial bone

Subperiosteal hemorrhages

2

What is caput succedaneum

A diffuse, sometimes ecchymotic swelling of the scalp usually involving the portion of the head presenting during vertex delivery
*may cross suture lines*

3

Two big patterns of Crohn's

Fibrostenotic obstructing pattern or penetrating fistulous pattern

4

GI granulomas w/ what diseases besides CD

GI TB
Sarcoidosis
Yersinia infections

5

What is torus palatinus

Fleshy, immobile mass on midline hard palate
*young folks*

6

Who should be tested for GC

All sexuality active women 24 and younger

7

Best GC screening test

Nucleic acid amplification test

8

First Workup for missed abortipn

Fetal heart tones and pelvic US

9

Exam of uterine atony

Soft (boggy) uterus that is enlarged

10

What does a thin endometrial stripe on postpartum US mean

Empty and normal uterine cavity

11

4 big risks for uterine atony

1. Prolonged labor
2. Induction of labor
3. Operative vaginal delivery
4. Fetal weight >4000g (8.8 lbs)

12

Uterine atony tx

Bimanual message, IV fluids/O2, and oxytocin (methylergonovine if oxytocin doesn't work)

13

Contra to carboprost in uterine atony

Asthma (causes bronchial constriction)

14

Hemodynamic monitoring in septic shock

Low PCWP
Low SVR
Increase CO
High mixed venous O2 sat%

15

What should be suspected in any HTN pt with hypokalemia

Primary hyperaldosteronism (these pt's also more prone to diuretic induced hypoK if not baseline)

16

MC nutritional def in kids

Iron def

17

Gold standard for HIV dx in kids form birth to 18 months? why?

PCR --> HIV ab testing unreliable due to passing of maternal antibodies to fetus

18

CT of porcelain gallbladder? inc risk of?

Calcified rim in gallbladder wall with central bile-filled dark area
Inc risk of gallbladder adenocarcinoma

19

What should raise suspicion for MAC in aid's pt

Non spec systemic symptoms (fever, cough, diarrhea) plus splenomegaly and elevated alk phos

20

Lyme arthritis features

Usually knee
Synovial fluid shows leukocytes around 25k

21

Dx of lyme arthritis? tx?

Confirm with ELISA and western blot
Tx is oral doxy or amoxicillin

22

B2 (riboflavin) def

-Angular cheilosis, stomatitis, glossitis
-Normocytic anemia
-Seborrheic dermatitis**

23

B6 (pyridoxine def) features

-Cheilosis, stomatitis, glossitis
-Irritability, confusion, depression

24

Primary solitary brain mets from what cancers

Breast, colon, renal cell

25

Stage 1 hepatic encephalopathy featurs

Sleep pattern disturbances and impaired cognition)

26

Murmur of IVDU endocarditis

Tricuspid regurg (holosytolic increasing with inspiration)

27

Good screening for microalbuminuria

urine microalbumin/creatinine ratio
*24 urine collection better but inconvenient*

28

Pneumo vaccine for HIV patients

PCV 13 1x
PPSV23 8 weeks later, then every 5 years

29

What is elevated in PCP PNA

Serum lactate dehydrogenase

30

Severe PCP features and tx

PaO2 (70 or A-a gradient >35 on room air
TMP-SMX + corticosteroids

31

Contrast enema of meconium ileus

Microcolon (caused by viscous meconium accumulation and obstruction in terminal ileum)
*contrast enema can also tx by breaking up*

32

CXR of radiation fibrosis

Volume loss with coarse opacities

33

Aspergilloma CXR

Mobile intra-cavity mass with an air crescent in the periphery

34

Most common paraneoplastic syndrome with squamous cell lung Ca

Hypercalcemia from PTrP

35

Mixed cryoglobulinemia features

Hep C usually
Arthralgia's, palpable purprua, and elevated transaminase + nephrotic syndrome

36

Risk calculation

Divide number of diseased subjects by overall subjects at risk

37

What causes Zener's diverticulum

Posterior herniation b/w the fibers of the cricopharyngeal muscle

38

If test result is negative, probability of having the disease formula

1- negative predictive value

39

Sarcoidosis big symptoms

Cough, erythema nodosum, anterior uveitis, and arthritis

40

Metformin should not be given with what acutely ill patients

Acute renal failure, liver failure, or sepsis

41

Chronic cough that is worse at night likely? Workup?

Asthma
PFTs for workup

42

Varicella post exposure ppx for healthy and immunocompromised

Healthy: Varicella vaccine w/in 3-5 days
Immunocompromised: varicella zoster Ig

43

Varicella complications

Bacterial superinfection in children
Pneumonia in adults

44

Akathisia tx

Propranolol or lorazepam

45

New antipsychotic med and pt won't sit down think

Akathisia

46

Initial massive hemoptysis mgmt

Establish airway, maintain perfusion, and ensure hemodynamic stability
*place bleeding lung in dependent position*

47

Most common rotator cuff injury? Why

Supraspinatus --> repeated bouts of ischemia near its insertion on the humerus induced by compression b/w humerus and acromion

48

Positive drop arm test in shoulder injury

Rotator cuff tear

49

Acalculous cholecystisis presentation

Unexplained fever an RUQ pain in severe sick
Leukocytosis on lab

50

Physiologic leukorrhea

Copious white vaginal d/c that doesn't stink and no other findings

51

Mild hyperkalemia in ckd pt tx

Remove K from body w/ loop diuretics (driving into cells will only transiently change)

52

What should be suspected in all children w/ recurrent intussusception

Meckels (most common GI abnormality)

53

Sporadic burkitt's lymphoma often affects

Distal ileum

54

When to operate on a hydrocele? why?

After 1 year old, due to risk of inguinal hernia

55

Physical/sexual child abuse risk factors

1. Unexplained changes in behavior or scholastic performance
2. Unstable family economic conditions
3. Caregiver hx of substance abuse

56

Focal nodular hyperplasia in liver features

-Ass w/ anomalous arteries
-Arterial flow and central scar on imaging

57

Elevated what in hepatocellular adenoma

Alpha fetoprotein

58

COPD exacerbation 3 features

1. Increased dyspnea
2. Cough
3. Sputum production change

59

Drug induced parkinsonism tx

Benztropine or Diphenhydramine

60

AIDs exposure ppx

Tenofovir-emtricitabine w/ raltegravir

61

Detrusor instability w/ what type of urinary incontenence

Urge

62

How can an epidural cause sustained bladder dysfunction

Over distends it, causing impaired ability to contract causing retention and overflow incontinence

63

ITP tx when platelets below 30k

IvIg or glucocorticoids
*platelet transfusion rare because it can cause further platelet destruction--> only in very severe cases*

64

Common complication of intraventricular hemorrhage in neonates

Communicating hydrocephalus --> blood irritates arachnoid villi, impairing its ability to reabsorb CSF

65

Lights criteria**

Exudate if:
1. Pleural protein/serum > 0.5
2. Pleural LDH/serum > 0.6
3. Pleural fluid LDH > 2/3 upper limit normal for serum

66

Plural fluid glucose

Empyema or rheumatic effusion
-Due to high metabolic activity of leukocytes/bacteria in fluid

67

What is a hepatic hydrothorax

Increased permeability of right hemidiaphragm leading to R pleural effusion in cirrhosis (transudate)

68

Why is R kidney easier to palpate that left

Lies lower than left kidney

69

ADPKD exam

HTN and palpable kidneys

70

Increased levels of what in hemolytic anemia

LDH and bilirubin

71

Elevated alk phos out of proportion to LFTs suggest

Intrahepatic cholestasis or biliary obstruction

72

Best test for histo in immunocompromised pt's

Urine or serum assay for histoplasma antigen

73

Tx for histo

Itraconazole
*Ampho if really really bad*

74

Treatment resistant schizophrenia drug

Clozapine (after 2 failed trials)

75

What causes intermittent claudication

Atherosclerotic narrowing of the arteries feeding the leg

76

Why is cooking bad for folate

Folate is heat sensitive

77

How long for B12 to be depleted in healthy adults

3-4 years

78

Suspect Diamond-Blackfan syndrome in who

In a child with microcytic anemia, low retic count, and congenital anomalies

79

Absent thumbs in what disease

Fanconi's anemia

80

Preferred tx for MCL tears

Early ambulation (rarely surgery)

81

Hyperthyroid induced myopathy favors what

Proximal hip flexors and quadriceps, can progress to involve proximal muscles of UE

82

Most common DM neuropathy

Symmetric and distal sensorimotor polyneuropathy

83

Chorioamnionits dx with maternal fever plus what?

1 of: Uterine tenderness, maternal or fetal tach, malodorous amniotic fluid, or purulent vaginal discharge

84

What are tocolytics for

To prevent labor

85

Why iron def in celiac dz

Poor iron absorption secondary to duodenal villous atrophy

86

2 common ass. w/ celiac dz

Type 1 DM and Dermatitis herpetiformis

87

What causes Meckels

Incomplete obliteration of the fetal vitelline (omphalomesenteric) duct

88

What does pos anserinus pain syndrome present with

Localized pain and tenderness over the anteromedial part of the tibial plateu just below the just line of the knee

89

Where does patellofemoral syndrome hurt? what makes it worse

Anterior knee pain
Worse with activity of prolonged sitting (sustained flexion)

90

3 types of diabetic retinopathy

1. Background (simple) - micro aneurysms, hemorrhages, exudate and edema
2. Pre-proliferative - with cotton wool spots
3. Proliferative - newly formed vessels

91

What part of vision does macular degeneration affect

Central vision

92

Characteristic systemic blasto features

Ulcerated skin lesions and lytic bone lesions

93

What is Small intestine bacterial overgrowth ? dx?

Malabsorption due to anatomic or dysmotility disorders with bloating, flatuence, and diarrhea
Dx: endoscopy with jejunal aspirate showing >10(5) organisms/mL

94

What should a healthy 6 month old baby be able to do

Sit momentarily on propped hands, transfer objects from hand to hand, and respond to name

95

What is the Hawthorne effect

Tendency os study population to affect the outcome since they are aware they are being studied

96

Congenital syphillis

Hepatosplenomegaly, cutaneous lesions, jaundice, and rhinorrhea

97

Congenital rubella

Sensonerual hearing loss, cataracts, HEART DEFECTS, blueberry muffin rash

98

Nocardia micro

Filamentous, aerobic, gram + acid fast bacteria

99

Rickets exam findings

Craniotabes, rachitic rosary, and gene varum

100

What should be immediately ruled out in a patient presenting with sudden onset severe SOB

Upper airway obstruction

101

Quad screen of trisomy 21

Dec A-fetoprotien and estriol
Inc B HCG

102

Quad Screen of trisomy 18

Dec A-feto and estriol
DEC B -HCG

103

Inhibin A in quad screen of trisomy 18 vs 21

18: Normal
21: Increased

104

DOC to treat opiod withdrawal

Methadone

105

Raising the cutoff of a test (smaller inclusion) effect on sensitivity and specificity

Increases specificity
Decreases sensitivity
(false and true positives decrease)

106

3 big causes of symmetric IUGR

-Genetic disorders (aneuploidy)
-Congential heart dz
-Intrauterin infection
(fetal factors)

107

Substance abuse disorder causes what kind of IUGR

Asymmetric (maternal factor)

108

DOC for stabilizing bony mets

Bisphosphonates (presents hypercalcemia of malignancy and pathologic fractures)

109

What is calcinosis cutis

Deposition of Ca and PO4 in the skin --> scattered whitish papules, plaques or nodules

110

Chronic tophaceous gout tumors

Chalky white

111

Extra-renal manifestations of ADPKD

1. Hepatic cysts (most common(
2. Berry aneurysms
3. Valvular heart dz (MVP and aortic regurg)
4. Colonic diverticula
5. Abdominal wall and inguinal hernia

112

Heated cysts from? features?

Areas where sheep are raised
Fluid filled cysts with an inner germinal layer and outer acellular laminated membrane (germinal layers give rise to 2ndary daughter cysts)