Assorted Flashcards
(354 cards)
1
Q
Prophylaxis for meningitis exposure is generally
A
Rifampicin or ceftriaxone
2
Q
Tx for acute gout
A
Corticosteroids, colchicine, or NSAIDS
3
Q
Common tx for chronic gout
A
Allopurinol
4
Q
Pharmacological tx for meningitis
A
Ceftriaxone + vancomycin + dex (admin before/with abx)
(+ampicillin if risk of Listeria - elderly, immunocompromised, newborns, pregnancy)
5
Q
Initial meds for status epilepticus (2 meds with doses)
A
Midazolam 10mg IV/IM
Lorazepam 4mg IV/PR
6
Q
Indications to do a CT before LP
A
FAILS
Focal neuro deficit
AMS
ICP elevated, Immunocompromise
Lesions in brain
Seizures (not in young children)
**do NOT delay empiric tx for meningitis bc of this
7
Q
THe main pathophys of ILD can be summed up as
A
Pulmonary inflammation –> fibrosis
8
Q
Findings of ILD on imaging
A
Reticular opacities (fibrosis)
Ground-glass opacities (increased density but can still see bronchial structures/vessels)
Honeycombing (air-filled cysts w/ fibrotic walls)
9
Q
3 drugs for Afib rate control
A
Beta blocker
ND-CCB
Digoxin
10
Q
Gram-positive cocci in clusters
A
Staph aureus
11
Q
Gram-positive cocci in chains
A
Streptococcus
12
Q
What blood product contains Vit-K dependent factors? Uses?
A
PCC
Can reverse warfarin (+vit K), DOACs if no other antidote (idarucizumab) available
13
Q
What blood product Is prepared from plasma and contains fibrinogen, factor VIII, von Willebrand factor, factor XIII and fibronectin
A
Cryoprecipitate
14
Q
Most patients with afib should be on what type of med? What do you add and when?
A
DOAC
CAD/PAD –> antiplatelet therapy
15
Q
When can you cardiovert Afibwithout 3 weeks of OAC or TEE?
A
1) Hemodynamically unstable acute AF
2) NVAF <12 hrs (no recent stroke)
3) NVAF 12-48 hrs and CHADS 0-1
16
Q
Gonorrhea Tx
A
Ceftriaxone 500mg IM (or cefixine PO) + azithro (co-tx for chlamid)
17
Q
Chlamydia treatment
A
Azithro (1g PO x 1)
OR
Doxycycline 100mg PO BID x 7 days
18
Q
Location of STEMI with changes in leads II, III, aVF
A
Inferior
19
Q
Location of STEMI with changes in leads I, aVL, V5, V6
A
Anterolateral
20
Q
Location of STEMI with changes in leads V3/V4
A
anteroapical
21
Q
Location of STEMI with changes in leads V1/V2
A
Anteroseptal
22
Q
U wave shows up in what condition?
A
Hypokalemia
23
Q
Mnemonic for determining reciprocal changes
A
PAILS
e.g. Posterior STEMI causes depression in Anterior leads
*lateral can have reciprocal in inferior/septal
24
Q
Normal PR interval
A
3-5 small boxes = 0.12-0.2
25
1 large box on ECG = ? seconds
0.2 (so 1 small = 0.04)
26
Normal QRS complex
0.1 sec (<2.5 small boxes)
27
Normal QTc
Shortcut?
<0.44
Shortcut if normal HR (60-100): if QT <50% interval b/w QRS complexes, then it’s ok
28
Contraindications to thrombolysis
Prior ICH
Non structural cerebral vascular lesion or intracranial malignancy
Ischemic stroke within 3 months
Suspected aortic dissection
Active bleeding or bleeding diathesis (excluding menses)
Significant facial/closed head trauma within 3 months
29
Enoxaparin, Dalteparin, and Tinzaparin are all examples of...
Low molecular weight heparin
30
Mechanism/treatment of ITP
Autoimmunity, often follows viral infection in children
Usually no tx, but steroids/IVIG if severe
31
An indirect inguinal hernia protrudes through the...
Deep inguinal ring (LATERAL to inferior epigastric vessels)
32
Congenital hydrocele treatment
Usually resolves spontaneously by 6 months
Consider Sx if present @ 1 yr
33
Colon cancer screening for no FMHx of colon cancer
Age 50-74
FIT q2 years
34
Colon cancer screening for FMHx colon cancer (parents, sibilng, child)
Colonoscopy q5 years if family member had it before age 60, q10 if after
starts 10 years before their diagnosis (age 50 latest)
35
Freq of pap tests
q3 years
36
When can you stop paps
After age 70 if 3+ normal in past 10 yrs
37
Lung cancer screening
Age 55-74 years old
Smoke 20 year hx (non-consecutive)
Low-dose CT
38
Breast cancer screening guidelines
Age 50-74 mammogram q2 yrs
39
A1C for prediabetes
6.0-6.4
40
Who gets screened for diabetes and how often
>40 years or high-risk --> q3 yrs
Very high risk --> q6mo-1yr
41
Diabetes pt >40 or >30 with diabetes 15+ yrs should be on a
Statin
42
Pt with diabetes >55yo with CV risk factors OR microvascular disease should be on...
Stain + ACEi/ARB
43
Pt with diabetes and CV disease should be on...
Statin + ACEi/ARB + ASA (add GLP-1 agonist or flozin)
44
Outpt abx for febrile ndutropenia
Fluroquinolone (cipro or levofloxacin)
+ Amox-clav
45
Inpt abx for febrile neutropenia
Pip-tazo OR cefepime OR merepenem
Add vanco if indication (MRSA coverage)
46
Abx in otitis media
Amoxicillin
(try amox clav if that doesn't work for H influenzae coverage)
47
Abx for strep throat (GAS)
Amoxicillin (UNIVERSALLY SUSCEPTIBLE TO BETA LACTAM - do not need amox-clav)
48
Attributes of hypercalcemia
Bones (fractures)
Stones (kidney stones, polyuria, dehydration)
Groans (headache, abdo pain, nausea, ileus, constipation)
Psychiatric overtones (lethargy, stupor depression, psychosis, cognitive dysfunction)
49
For every 10 decrease in albumin how do you change Ca level?
+0.2 Ca (more unbound)
50
Cornerstones of hypercalcemia of malignancy management?
IV saline & bisphosphonates
(also replete phosphate if low)
51
What do you suspect in a pt with JIA or Still disease who has a high, unremitting fever, leukopenia/anemia/thrombocytopenia, elevated liver enzymes/feritin...
Macrophage Activation Syndrome
52
Major risk in children with oligoarticular JIA that should be proactively prevented
Anterior uveitis (can be asymptomatic, early detection/tx useful due to chance of glaucoma, cataracts, optic nerve damage)
- Slit lamp exams, q3 months if ANA positive
53
Prognosis of JIA
95% resolve by puberty
(worse prognosis if early onset with growth issues/deformities), polyarticular/symmetrical, auto-antibodies
54
Transient salmon-pink rash, intermittent fever, leukocytosis hepatosplenomegaly, serositis, and arthritis are features of...
Systemic JIA (Still disease)
55
Most common type of JIA
Oligoarticular (good prognosis)
56
Mismatch between the rapid growth of the femoral epiphyses and the slower development of adequate blood supply to the area --> juvenile hip pain
Legg-Calve-Perthes disease
| [idiopathic, avascular necrosis of the femoral head]
57
superior and anterolateral displacement of the femoral neck due to weakening of the proximal femoral epiphyseal growth plate --> peds hip pain
Slipped capital femoral epiphesis
58
Name 5 differentials for peds hip pain
Transient synovitis (usually resolves in <1 week with rest/NSAIDS)
Septic arthritis
SCFE
Legg-Calve-Perthes disease
Developmental dysplasia of hip
59
traction apophysitis that occurs where the patellar tendon attaches to the tibial tuberosity --> anterior knee pain = ? disease
Who usually gets this
Osgood Schlatter
Children 9-14 in athletics
60
Tx for Osgood-Schlatter
Relative rest, NSAIDS, ice; brace if persistent
NOT steroid injections (can weaken tendon)
90% resolve once full bone maturity reached
61
Main pathogen causing croup
Parainfluenza virus 1
62
Flashes/floaters/curtain in PERIPHERAL vision is a sign of
Retinal detachment
63
Sudden vision loss/double vision in pt >60, always think...
GCA! If CRP elevated --> high-dose steroids
64
Sudden vision changes with RAPD in young person (30F), think....
Optic neuritis
65
Young person, wears contact lenses (sleeping/swimming) --> think
Bacterial infectious keratitis --> corneal ulcer (white spots on cornea)
66
Pt with sudden acute severe eye pain, blurry vision, temporal headache...
Acute angle closure glaucoma
67
Hx of being in the dark --> blurry vision, headache, nausea/vomitting
Acute angle closure glaucoma
68
Definitive tx for Acute angle closure glaucoma
Laser iridotomy (make hole in iris)
69
Non-surgical management of AAC glaucoma
Pilocarpine (muscarinic, constrict pupil)
Acetazolamide, dorzolamide (decrease aqueous humor prod)
Hyperosmotic agents (glycerol, mannitol)
Timolol (also decrease prod)
70
Charcot's triad of acute ascending cholangitis
Fever + RUQ pain + jaundice
71
Reynold's pentad for acute suppurative cholangitis
Fever + RUQ pain + jaundice + AMS + hypotension
72
Gilbert syndrome and Crigler-Najjar syndrome are disorders of...
Bilirubin conjugation
73
Most common type of neonatal jaundice? Natural history?
Physiologic jaundice
Usually resolves within ~1 week of life
74
2 types of non-pathological unconjugated hyperbili in infants?
1) Breastfeeding (not enough! --> increased enterohepatic circulation reabsorbs bilirubin)
2) Breast milk (B-glucuronidase in breast milk --> deconj/reabsorb bili)
75
Jaundice at what time period is always pathologic in a baby?
<24 hours old if term
76
Limited internal hip rotation in a child with thigh pain should make you think...
Slipped capital femoral epiphysis (SCFE)
77
Adjustment disorder time period
Starts within 3 months of stressor
Sx last <6 months following stressor resolution
78
First-line lab test for celiac disease
tTG IgA (sensitivy/specificity >95%)
79
Alternative lab tests for celiac disease
Total IgA --> if deficient, perform IgG-based testing
HLA testing (NPV ~100% if neg for HLA-DQ2 & DQ8)
Anti-endomysial antibody (higher specifity but expensive)
80
Calculate specificity
Specificity = True negative/True negative + false positive
81
5 cyanotic heart lesions
Truncus arteriosus (aorta/pulmonary artery join to make 1)
Transposition of the great vessels
Tricuspid atresia
Tetralogy of fallot
Total anomalous pulmonary vascular return
82
4 defects in tetralogy of fallot
RV hypertrophy
Overriding aorta
Subvalvular pulmonic stenosis
VSD
83
what is Eisenmenger syndrome
Shunt reversal due to chronic L>R shunting through congenital defect --> increased pulmonary flow --> severe pulmonary vascular obstruction --> shut reversal (R->L; cyanotic)
84
Explain Wolff-Chaikoff effect
Excess iodine --> transient inhibition of TH production (to avoid hyperthyroidism, but eventually gland "escapes" unless there is a disorder)
85
Explain Jod Basedow effect
In pts with multinodular goiters/Graves, excess iodine --> hyperthyroid (no Wolff-Chaikoff)
86
What is the one "opposite" effect of hyperthyroidism?
Lowers DIASTOLIC pressure by decreasing PVR
87
In thyroid storm why must iodine load be given AFTER a thioamide?
To prevent Jod basedow!
88
Hashimoto's autoimmune thyroiditis cases ____ TH
Low
89
Thioamides include
PTU (given in thyroid storm bc inhibits production & peripheral conversion, safe in T1 pregnancy)
Methimazole (generally 1st line, inhibits production)
90
Scoop on a PFT is an indicator of
Emphysema
91
Bottom of Flow-volume loop is ___, top is ____
Bottom = Inspiration
Top = expiration
92
Indicator of obstruction on PFT
FEV1/FVC ratio (actual value) <0.7 or
93
How to grade severity of obstruction on PFT
by FEV1 PERCENT PREDICTED
Mild >70%
94
FCV low with normal FEV1/FVC ratio indicates
Restriction
95
Ectopic pregnancy should be suspected if no IU gestational sac and beta higher than...
1500
96
Rhogam should be given when?
28-32 weeks (if RH neg)
WIthin 72 hr of delivery if infant Rh+
97
What does mono-di mean for twins
What is the risk?
Monochorionic diamniotic
*must be monozygotic to be monochorionic
RIsk of twin-twin transfusion syndrome
98
What is normal baseline variabilit in intrapartum fetal surveillance?
6-25 bpm
99
What is the maternal mortality rate
Maternal deaths per 100,000 live births (while pregnant or within 42d postpartum)
100
Define fetal mortiality
Stillbirths/1000 total births
101
Define infant mortality rate
Infant deaths within first year of life/1000 live births
102
Kawasaki disease mnemonic
CRASH and BURN
Conjunctivitis (painless/bilateral)
Rash (polymorphous, originating on trunk)
Adenopathy (cervical, mostly unilateral)
Strawberry tongue
Hands and feet (erythema/edema)
BURN = Fever 5+ days
103
Treatment of kawasaki
IVIG (reduces risk of coronary artery aneurysms)
High-dose oral aspirin (exception to rule re Reye syndrome)
104
Kawasaki is an acute necrotizing ___ and its most concerning complication is _____
Vasculitis
Coronary artery aneurism
105
5 Ws of postpop fever
Wind (atelectasis/lungs)
Water (UTI/catheter)
Wound (superficial or deep)
Walking (DVT)
Wonder drugs (or blood products)
106
____ do NOT reduce bleeding secondary to leiomyomas. Try what instead?
NSAIDS do NOT
Try OCP/GnRH agonist/depo
107
2 alternative surgeries apart from hysterectomy for fibroids
Myomectomy (risk of recurrence, req C/S in future preg)
Uterine artery embolization
108
Stages of labour
1st latent: ends at 6cm dilation, mild/irregular contractions
1st active: 6-10cm, increased contractions/dilation
2nd: complete dilation - birth
3rd: birth - placenta delivery
4th: 1-2 hr postpartum
109
Clinical features of amniotic fluid embolism
ARDS
DIC
Shock/cardiac arrest
110
What is the most frequent cause of medication-induced hyperprolactinemia --> secondary amenorrhea
Antipsychotics
111
Abnormal uterine bleeding mnemonic
PALM-COEIN (structural-nonstructural)
Polyps
Adenomyosis
Leiomyomas
Malignancy
Coagulopathy
Ovulatory dysfunction
Endometrial (local hemostasis dysreg)
Iatrogenic
NYS
112
Name a few absolute contraindications to COCP
- current pregnancy or <6wks postpartum if breastfeeding
- Undiagnosed vaginal bleeding
- Smoker >35 years old (>15 cigs/day)
- HTN (sBP>160 or dBP>100)
- Current or past VTE
- PMHx of ischemic heart disease, CVA, complicated valvular heart disease
- Migraine with focal neuro Sx (aura = relative contraindications)
- Current breast cancer
- Diabetes with end-organ involvement
- Severe cirrhosis or liver tumour
113
Preconception folic acid dosing
400mcg
4g if high-risk (prev NTD, epilepsy, diabetes)
114
Abx for GBS
Pen G
allergic --> erythromycin or clindamycin
115
When is GBS swab done
35-37 wks
116
Antihypertensives for preeclampsia
Hypertensive Moms Need Love
Hydralazine Methyldopa Nifedipine Labetalol
117
Green/yellow foul-smelling purulent discharge & strawberry cervix likely indicates
Trichomonas
118
Treatment for trich
Metronidazole (2g) + treat partner
119
Diffuse thin/grey discharge with fish small likely is
Bacterial vaginosis
120
Tx for bacterial vaginosis if symptomatic
Metronidazole 500mg BID x 7d (don't need to tx partner)
121
Micro testing for BV includes
Looking for clue cells, "whiff test" with KOH
122
First line & 2nd line tx of lichen sclerosis
Clobetasol (superpotent topical steroid)
Topical calcineurien inhibitor (tacrolimus)
123
Bleeding, cramps, but cervix closed = ___ abortion
Inevitable
124
Heavy bleeding + cramps + passage of tissue with cervix open = ___ abortion
nIcomplete
125
No bleeding, cervix closed, fetal death = ___ abortion
Tx?
Missed
Watch/wait, mifepristone + miso, or D&C
126
How to confirm success of medical abortion
Reduction in beta HCG (50% after 2 days or 80% after 1 week)
127
Until what time can medical abortion be used?
9 weeks from LMP (evidence supports up to 10 wks)
128
Reactive (normal) NST entails?
2+ FHR accelerations of at least 15 bpm above baseline and 15+ seconds
129
Biophysical profile has what 4-5 key components?
Fetal movement
Fetal tone
Fetal breathing
Amniotic fluid level
[+/- Nonstress test]
evaluated with 2 points each
130
Normal amniotic fluid index
5-25cm
131
What is the routine prenatal genetic screening and when are they done
eFTS (1st trimester) - week 11-14
if too late, MSS (no NT in this)
132
When can NIPT be done
10 weeks to end of pregnancy
133
Amnio vs CVS timeline
CVS 11-14 wks
Amnio >15 wks
134
Name the TORCH infections
Toxoplasmosis
Other (syphilis, varicella, Parvovirus B19, Listeriosis, Zika)
Rubella
CMV
HSV
135
Anticoagulant to use during pregnancy
Heparin
136
What is erythema infectiosum (fifth disease) cased by? Main clinical Sx?
Human parvovirus B19
Fever --> "slapped cheek" rash/maculopacular examthum
Can cause arthralgias in adults
Can also cause transient anemia, and more severe hematological effects in people with predisposion (sickle cells, immunocompromise)
137
Primary hereditary hemochromatosis involves what mechanism?
No functional HFE protein --> NO HEPCIDIN --> unregulated ferroportin --> FE oerload
(HEPCIDIN DOWNREGULATES FE ABROPTION)
138
How to tell the difference between anticholinergic OD and serotonin syndrome?
Anticholinergic = dry as a bone
SS = hot and wet! w/ nausea/vomiting
139
NMS vs SS key differences?
Onset (SS faster onset & resolution)
NMS more "sluggish" neuro, serotonin neuro hyperactivity
NMS more mute/staring, SS more hyperkinetic/agitated
140
Management of serotonin syndrome
STOP agent(s)
Supportive care, IV hydration
Meds: benzos, antihypertensives, anticonvulsants, PRN
Cyproheptatine (serotonin antagonist) and Dantrolene (muscle relaxant)
141
Serotonin syndrome typically resolves within ___ of meds being stopped
24 hours (vs ~9d for NMS)
142
Management of NMS
STOP causal agents
Supportive care, IV hydration
Meds: Benzos, ECT, Dantrolene (muscle relaxant)
143
Prolonged ROM is considered
>18 hrs between rupture --> delivery
144
Diagnosis of ROM
Nitrazine paper turns blue (pH>6)
Ferning pattern on glass slide
145
What are tocolytics used for? examples?
To DELAY labour so corticosteroids can be given!
Indomethacin (NSAID, 24-32 wks)
Nifedipine (CCB, 32-34 wks)
IV MgSO4 for neuro protection until 24 weeks
146
When are corticosteroids given during labor
Between 24-34 weeks in all case of PPROM and in PTL if delivery expected within 7 days
A single rescue course if >14 days since admin and delivery again expected
From 34-36 weeks if PPROM or PTL occurs and no prior steroids --> 1 dose betamethasone (ALPS)
147
MgSO4 given for preterm labour up to how many weeks
24-32 wks
148
Preferred approach to GDM testing
50g GCT --> if abnormal. 75g OGTT
(alternative is one-step 75g)
149
All pregnant women not known to have pre-existing DM should be screened when?
24-28 wks
150
Most common site of ectopic pregnancy
Ampulla
151
Methotrexate can be used for ectopic if...
<3.5 cm unruptured ectopic, beta <5000, no FHR
Also must be assured of compliance/FU
152
Most common pathogens in asplenic sepsis
Encapsulated bacteria
Think: "Has No Spleen"
H infuenzae, N meningitidis, S pneumonia
(note that pts with sickle cell can have functional asplenia)
153
Common meds used chronically in sickle cell
Daily prophylactic penicillin & hydroxyurea in children, some adults
(hydroxyurea increases HbF --> fewer vasoocclusive episodes)
154
Pneumonia + sickle cell crisis should be managed as
Acute chest syndrome
155
Howell-Jolly bodies indicate...
Asplenia (e.g. in sickle cell)
156
2 types of alpha-thalassema that cause significant symmptoms
Hemoglobin H disease (3 defective alleles --> HbH)
Hemoglobin Bart's (4 defective --> Hb Bart --> hydrops fetalis)
157
Alpha and Beta thalassemia are common in what populations
Alpha: Asian/African (think "A")
Beta: Mediterranean
158
Why does thalassemia B not appear until ~6 months old vs A has immediate clinical features?
Because Hb F = 2 alpha + 2 gamma and so compensates in B-thal
159
Treatment for thalassemia major/intermedia
Transfusion therapy
Chelating if iron overload
160
Target cells, teardrop cells (extramedullary hematopoiesis), and anisopoikilocytosis (varying RBC shape/size) on PBS indicate
Likely thalassemia
161
___ should be strongly suspected if HbA2 (2 alpha + 2 delta) is elevated
Beta-thalassemia
162
HbH =
bet-globin tetramer
163
HbF =
a2y2
164
Microcytosis cutoff
MCV <80
165
Thalasemmia presents with ___ anemia
Microcytic
166
GSC components
Eyes
Verbal
Motor
167
GCS Eyes most to least
Spontaneously open
Open to voice
Open to pain
Closed
168
GCS Verbal highest to lowest
Oriented
Confused
Inappropriate words
Sounds
None
169
GCS Motor
Follows commands
Localizes pain
Withdraws to pain
Decorticate
Decerebrate
None
170
CF causes what type of alkalosis
Contraction (loss of fluid w/ NaCl though sweat) = chloride-responsive!
RAAS activation --> H+/K+ loss (hypokalemia)
171
Best first test for CF when suspected (+NBS, sibling with it, Sx)
Quantitative pilocarpine iontophoresis (sweat test)
if moderate (30-60) --> need genetic analysis
172
What are the most common pathogens in CF
Staph aureas & Pseudomonas aeruginosa (for PA may need chronic azithromycin)
173
Meds for CF
High-dose ibuprofen (can slow lung disease)
Bronchodilators (SABA)
Mucolytics: hypertonic saline neb, aerosolized Dornas alfa
Pancreatic enzymes
supplement NaCl/fat-soluble vits
CFTR modulators are new, target underlying protein defect in pts with specific mutations!!
174
What is both diagnostic & therapeutic for meconium ileus?
Gastrografin enema
175
Double bubble xray in newborn indicates
Duodenal atreisa
176
In CF, residual lung volume is...
Increased (obstructive disease w/ air trappin)
177
Why do CF patients have elevated PT?
Vit K deficiency (fat soluble, exocrine pancreatic insufficiency)
178
Bell palsy is often precipitated by what infection?
EBV
HZ
Borreliosis (lyme)
HSV
179
A "good baby" who doesn't cry much and has a large anterior fontanel, umbilical hernia, and macroglossia likely has...
Congenital hypothyroidism
180
Is normal CO2 during an acute asthmatic episode a good sign or bad sign
BAD because it should be low due to hyperventilation --> impending resp failure!!
181
The only thing you should NOT do in COPD is _____ as monotherapy.
The only thing you should NOT do in asthma is ______ monotherapy.
ICS
LABA
182
Indications for intubation (5 not including GCS <8)
1) Airway obstruction
2) Can't oxygenate
3) Can't ventilate
4) Can't protect airway
5) Anticipated clinical deterioration to the above
183
5 sources of hemorrhage where blood may be lost
Thorax
Abdomen
Retroperitoneum (pelvic fractures)
Long bone fractures (femur)
"The street"
184
Cushing's triad for ICP
Hypertension
Bradycardia
Irregular respirations
185
Management for circumferential chest burns impeding resp
Escharotomy
186
Tx for CO poisoning from burning environment
100% O2, hyperbaric if available
187
Second degree burn penetrates the
Dermis
188
If tactility is impaired the burn is likely what degree?
3rd (full thickness) or 4th (deep structures, e.g. muscles)
189
Surgery is always mandated in what degree(s) of burns
3rd/4th, but commonly deep 2nd as well
190
Rule for peds fluid maintenance
4,2,1 (mg/kg/hr)
191
What is a greenstick fracture
Discontinuity of cortex.periosteum on convex side, just bending on concave side
usually in kids
192
Open fracture AKA
Compound fracture
193
When should pt be given tetanus toxoid immunization if they have an open fracture
No booster in 5 yrs
If >10 yrs or immnocompromised, give both toxoid & human tetanus immune globin
194
What is a salter-harris fracture?
Fracture of physis (growth plate)
195
Name the 5 types of salter-harris fractures
SALTER
Straight across physis
Above
Below
Through everything
cRush
196
6 Ps of compartment syndrome
Pain
Pallor
Pulselessness
Paresthesia
Paralysis
Poikilothermia (temp dysreg)
197
Management of compartment syndrome
Fasciotomy
198
Anion gap calculation
Na - (HCO3 + Cl)
199
How to adjust normal AG in hypoalbuminemia
For every 10 g/L decrease, reduce "normal" by 2.5 (albumin = major unmeasured anion)
200
Formula to check for additional metabolic disorders in AG metabolic acidosis
(AG-12) + HCO3
<23 --> primary non-AG met acidosis
>30 --> primary met alkalosis
201
Expected PCO2 compensation in non-mixed metabolic acidosis
PCO2 = 1.5(HCO3) + 8 +/-2
202
Expected metabolic compensation for increase in PaCO2 of 10 (acute & chronic)
1, 4
| (increased)
203
Expected metabolic compensation for decrease in PaCO2 of 10 (acute & chronic)
2, 5
| (decrease)
204
Causes of AG-metabolic acidosis
MUDPILES
Methanol
Uremia
DKA
Propylene glycol
Iron tablets / Isoniazid
Lactic acidosis
Ethylene glycol
Salicylates
205
Causes of non-AG metabolic acidosis
HARD-ASS
Hyperalimentation
Addison disease
Renal Tubular Acidosis
Diarrhea
Acetazolamide
Spironolactone
Saline infusion
206
What is Beck triad?
Hypotension + muffled heart sounds + distended neck veins
Seen in CARDIAC TAMPONADE
207
Diffuse ST elevation in all leads except aVR & V1 is an indicator of...
Pericarditis
208
Electrical alternans is a sign of
Large pericardial effusion
209
Infants who may have esophageal atresia should not be ______ under any circumstances!
Fed orally (likely fistula to trachea --> aspiration!!)
210
Esophageal atresia often presents with what finding during pregnancy?
Polyhydramnios (fetal can't swallow fluid)
211
What is Kussmaul sign
Distention of jugular veins during inspiration
Sign of constrictive pericarditis
212
What is Dressler syndrome?
Pericarditis occuring weeks after MI (usually happens acutely)
213
How to treat post-MI pericarditis?
Rest & aspirin
214
Treatment of minimal change disease
Prednisone
215
3 characteristics of nephrotic syndrome
Nephrotic-range proteinuria (>3.5 g/day)
Low albumin
Edema/anasarca
(+/- hyperlipidemia, thromboses)
216
Which nephrotic syndrome causes immune complex deposition between basement membrane and podocytes with a "spike & dome" appearance
Membranous nephropathy/glomerulonephritis
(Membranoproliferative glomerulonephritis can also cause immune complex deposition but involves thickened glomerular BM, and typically nephritic syndrome)
217
Nephritic syndrome is characterized by
Glomerular capillary damage --> hematuria (RBC casts), pyuria, hypertension (also edema)
218
How does nephrotic syndrome impact coagulability?
Hypercoag due to loss of antithrombin III, protein C/S
219
Red cell casts =
Glomerulonephritis
Vasculitis
220
White cell casts =
Acute interstitial nephritisF
221
Fatty casts =
Nephrotic syndrome, minimal change disease
222
Muddy brown casts =
Acute tubular necrosis
223
Mainstays of tx for nephrotic syndrome
Treat underlying cause (if primary --> immunosuppression)
Edema: loop diuretics
Proteinuria: ACEi
*no role for anticoagulation prophylaxis
224
ATN most commonly cause by what 2 main categories?
Ischemic (typically damages LoH)
Toxic (PCT)
225
Indications for RRT
AEIOU
Metabolic acidosis <7.1
Electrolytes: hyperkalemia/hypercalcemia
Toxic Infection/Intoxication (poisoning)
Fluid overload
Uremia
226
5 Ps of drugs causing AIN
Penicillin
PPIs
Pee (diuretics)
rifamPin
Pain (NSAIDS)
227
Symptoms of AIN
Painless hematuria (no RBC casts!)
Sterile pyuria
Diffuse maculopaular rash, peripheral eosinophilia
Fever
Arthralgias
228
Main treatment for drug-induced AIN
D/C causative agent & fluids
229
3 main causes of rapidly progressive (crescent) glomerulonephritis
Anti-glomerular BM Abs (goodpasture - affects lungs as well)
Lupus nephritis
Vasculitis-associated glomerulonephritis
230
4 main causes of intra-renal AKI
Vascular (vasculitis, emboli)
Acute glomerulonephritis (post-infectious, RPGN)
Acute interstitial nephritis ("kidney allergy")
Acute Tubular Necrosis (ischemic/nephrotoxic)
231
1st line medical treatment for portal hypertension
Beta blockers (leads to unopposed alpha action on splanchnic circulation --> splanchnic vasoconstriction --> reduced portal/collateral blood flow)
232
Drug for acute esophagial variceal hemorrhage
Octreotide (+IV abx prophylaxis)
233
Ideal surgery for esophageal bleed
Endoscopic band ligation
234
1st line tx for hepatic encephalopathy
Lactulose (leads to NH3 protonation --> excretion/not absorbed in bowel)
Rifaximin = 2nd line (reduced NH3-producing intestinal bacteria)
235
ALT/AST in 1000s (suuuuper high) probably
acute viral hepatitis
236
Alpha-1 antitrypsin defieicny manifests with
Panacinar emphysema
Hepatic fibrosis, sometimes HCC
237
Budd Chiari involves
Obstructino of hepatic vein
238
Procedure for portal hypertension/complications
TIPS (transjugular intrahepatic portosystemic shunt)
239
In women with uncomplicated pre-existing diabetes, induction should be considered between
38-39 weeks (reduces risk of stillbirth)
240
Naegel's rule
-3 months + 1 week
241
What nephropathy commonly occurs immediately after (or potentially during) URTI or GI infection
IgA nephropathy
242
Main difference between IgA nephropathy and Post-Strep GN?
IgA onset faster
## Footnote
PSGN occurs after a latent period of approximately 10 days following group A strep pharyngitis. Generally, PSGN occurs up to 3 weeks following group A strep skin infections.
243
What is Henoch-Schonlein purpura
Iga Vasculitis
Like IgA nephropathy onset preceded by URTI/GI infx
Manigests in palpable purpura, arthritis/arthralgia, abdo pain, usually in children (nephro usually more in adults)
244
What is HUS typically caused by? Who is usually affected
Bacterial toxins (e.g. Shiga-like toxin of enterhemorrhagic E coli) --> platelet microthrombi --> hemolytic anemia, thrombocytopenia, AKI
Young children
245
Main differentiator of TTP and HUS
TTP more in adults (median 40 yrs)
TTP is ADAMTS13 deficiency (usually acquired/autoantibodies related to systemic disease, drugs, pregnancy); HUS triggered by bacterial toxins
246
Child who comes un with pain/limited ROM of arm, held in flexed/pronated position likely has
Radial head subluxation (caused by traction, e.g. adult grabbing child's arm to prevent fall)
247
Most common cause of traveler's diarrhea
Enterotoxicenic E Coli
248
What Abx in EHEC?
NONE!!! Contraindicated bc lead to toxin release
249
Prefererd Abx for bite wound
Amox/clav
250
Strong family history of facial/laryngeal edema with abdo symptoms and possibly extremity edema likely indicates what condition? Inheritance?
Hereditary angioedema (Autosomal Dom)
(Inherited C1 inhibitor deficiency)
251
3 autoimmune-type liver disorders
Primary sclerosing cholangitis
Primary biliary cholangitis
Autoimmune hepatitis
252
Children under 9 years of age who have never had an influenza vaccine need...
2 doses, 4 weeks apart
253
Older pt describes "curtain coming down" in front of eye (unilateral) intermittently, episodes last up to 30 min. Likely diagnosis/initial tx?
Amaurosis fugax (retinal ischemia following transient occlusion of retinal artery by microemboli)
Harbinger of stroke!! --> start aspirin
**can be part of GCA --> steroids
254
Difference between selective IUGR vs twin-twin transfusion syndrome in monochorionic diamniotic?
TTTS will have amniotic fluid abnormalities
255
Unhappy triad involves what ligaments of the knee?
ACL (most commonly injured)
MCL
Medial meniscus
256
When are Abx indicated in acute otitis media?
<2 years old
Severe Sx
Otorrhea
257
What are Koplik spots?
Grains-of-sand-like spots in buccal mucosa
PATHOGNOMONIC for measels!!
258
What populations should be treated with asymptomatic bacteruria
Pregnant women, or undergoing endourological procedure
NOT older adults/diabetes/catheters/SC injuries
259
Benzos ___ risk of opioid overdose
Increase!
260
Incidental finding of large abdominal mass in child 2-5yo with hematuria, think...
Nephroblastoma (Wilms tumor)
261
Next step for incidental solitary pulmonary nodule <3cm on CXR
If prev imaging shows stability >2 years, no further testing
Otherwise obtain CT and assess risk via lesion/personal characteristics.
If intermediate risk, serial CT for 2-3 yrs; if high risk, surgical excision
262
3 important vaccines 2 weeks after splenectomy
Pneumococcal
Hib
Meningococcal
263
Post-splenectomy Abx
Daily proph of pen or amox in children to 5 years, everyone 1 yr after surg, and lifelong if IC or hx sepsis
Early empiric amox-clav if any signs of infx
264
2 meds for urge incontinence
Muscarinic antagonist = oxybutynin
Sympathomimetic - mirabegron
265
Most common cause of pancreatitis
Biliary (alcochol 2nd)
266
Most important therapeutic measure in pancreatitis
Fluid replacement!!
Note: ECRP can be necessary if gallstone is cause, but also can make pancreatitis worse :( - in these cases likely will need cholecystecomy
267
Test to determine exocrine pancreas function
Fecal elastase-1 in stool (low = insufficiency)
*Test this in chronic pancreatitis
268
After fine needle aspirate, what breast cysts need core needle biopsy to evaluate for breast cancer?
Bloody fluid or if doesn't resolve after draining
269
ND-CCBs are contraindicated in heart failure with..
Reduced EF
Systolic dysfunction
(so in these pts with AFib use digoxin - BB also not ideal in this population due to need for slow titration)
270
Acute asthma exacerbation drugs
Supplemental O2
SABA + SAMA
*IV corticosteroids* (key)
IV MgSO4
271
4 key pharmacological pillars in pts with HFrEF
●Renin-angiotensin-aldosterone system antagonist, with a preference for an angiotensin receptor-neprilysin inhibitor (ARNI; ie, sacubitril-valsartan)
●Beta blocker.
●Mineralocorticoid receptor antagonist (MRA) = aldosterone antagonists (spironolactone, eplerenone)
●Sodium-glucose co-transporter 2 (SGLT2) inhibitor.
+ loop diuretics as needed for volume overload
272
Pharmacotherapy for HFpEF
sodium-glucose co-transporter 2 (SGLT2) inhibitor
AND
mineralocorticoid receptor antagonist (MRA)
+loop diuretics as needed for volume overload
273
When are inotropes (dobutamine, milrinone) given in Heart Failure?
Severe acute decompensated HF (not if preserved systolic fn i.e. HFpEF)
274
When are Abx indicated in COPD exac?
Cardinal Sx: increased dyspnea, sputum volume, sputum purulence
At least 2/3 and must include increased purulence
275
Fever during a transfusion could indicate what 3 conditions
Bacterial sepsis/contamination (rare)
Acute hemolytic transfusion reaction
Febrile non-hemolytic transfusion reaction
276
Acute hemolytic transfusion reaction typically caused by what?
ABO incompatibility (often human/clerical error)
277
How to manage Febrile Non-Hemolytic Transfusion Rxn
Acetaminophen
(pre-medication doesn't seem helpful)
278
Dyspnea during transfusion likely indicates what 3 dx
TRALI
TACO
Anaphylaxis
279
TRALI management
Typically mechanical ventilation
280
Pharmacotherapy for tourettes
Alpha-adrenergic agonists: clonidine, guanfacine
Dopamine-blocking agents: antipsychotics
281
Is ODD or conduct disorder more likely to involve legal infractions, aggression toward people/animals, deceit
Conduct disorder
282
Current first-line therapy for H pylori eradication
Non-bismuth quadruple therapy (regimen with bismuth is rescue therapy, more effective but +++tablets)
PPI BID
Amoxicillin
Clarithromycin
Metronidazole
283
Recommended testing for H pylori eradication (AFTER pt has used abx)
NOT serology (false positives, not specific to active infx)
Urea breath test or stool antigen test test (or scope)
284
Bismuth quadruple therapy for H pylori
Bismuth
Metronidazole
PPI
Tetracycline
285
Most common site if diverticulosis
Sigmoid colon
286
Workup if borderline B12/folate
Increased homocysteine & methylmalonic acid --> B12 deficiency confirmed (folate possible)
Increased homocysteine only --> folate deficiency confirmed
287
VITAMIN CDE mnemonic for ddx
Vascular
Inflammatory/Infectious
Traumatic
Autoimmune
Metabolic
Iatrogenic/Idiopathic
Neoplastic
Congenital
Drugs
Endocrine
288
Diagnosis of diverticolosis vs diverticulitis
Diverticulosis --> Colonoscopy
Diverticulitis --> Do not scope (perf risk)! CT abdo with contrast
289
Management of diverticulitis
Uncomplicated --> clear fluids, supportive care; empiric Abx in specific cases
Complicated (perf, abscess, peritonitis, obstruction, fistula) --> Broad-spectrum IV abx, admission, urgent or later elective colectomy, abscess drainage PRN
290
Eosinophilic esophagitis diagnosis & tx
Histopathological dx
PPIs; +/- topical steroids, dietary eliminiation of allergens
291
Define achalasia
Failure of LES to relax (degeneration of inhibitory neurons in esophageal wall)
292
Tx of achalasia
Pneumatic dilation, myotomy, botox
CCBs (nifedpine) if refractory
293
Diagnosis of Achalasia
Upper endoscopy
Barium swallow
Esophageal manometry = confirmatory (looks at peristaylsis, LES perssure)
294
What is pseudoachalasia
A dilation of the esophagus in an achalasia-like pattern due to distal esophageal narrowing from causes other than primary achalasia. Causes of pseudoachalasia include malignancy (most common), Chagas disease, amyloidosis, and sarcoidosis.
295
How to differentiate alcohol-induced psychotic disorder (alcoholic hallucinosis) vs alcohol withdrawal delirium (delirium tremes)
Hallucinosis onset within 12-14 hrs of heavy drinking, vitas often normal
Delirium tremens starts 3-4 days after stopping
296
Triad of Wernicke encephalopathy
1) Confusion
2) Oculomotor dysfunction (diplopia, nystagmus, etc.)
3) Gait ataxia (small wide-based steps)
297
Wernicke/Korsakoff are caused by a deficiency of...
Thiamine (B1)
298
Meniere triad
1) Peripheral vertigo
2) Tinnitus
3) Asymmetric fluctuating SNHL
299
Synthetic cathinones AKA ____. How to differentiate from PCP?
PCP intoxication of shorter duration, usually tested on urine tox. Can also cause nystagmus.
Synthetic Cathiones can last up to a week
300
What is the most common type of RTA
Type 4 (hyperkalemic)
E.g. hypoaldosteronism (addison), K-sparing drugs
Hyperkalemia impairs ammonium excretion
301
Early-onset ___ is common in T21
Alzheimers
302
Tx for syphilis
Pen G
303
Very early cervical cancer -->
Any kind of advancement -->
LEEP
Chemo + rad
304
Most common type of uterine cancer
Adenocarcinoma
305
In terms of EPS, dystonia and parkinsonism are managed by ___. Akathisia managed by ____
a) Benztropine
b) Beta blockers/benzos
306
Tx for Wernickes
Give IV thiamine THEN glucose (glucose can cause toxicity if thiamine low!!)
307
Do alcohol withdrawal seizures or delirium tremens come first
Seizures first
308
First line pharmaceuticals for AUD
Naltrexone
Acamprosate (modulates glutamate receptors)
309
2 main classes of stimulants for ADHD
Methylpheidate and amphetamine anologues
310
In ADHD use behavioural interventions only for children of what age
<6 years old
311
Characteristics of FASD
Microcephaly
Epicanthal folds
Smooth philtrum
Downslanting/short palpebral fissures
Thin upper lip
312
Indications for admitting an adolescent with anorexia nervosa
Weight <75% of ideal body weight
Tempt < 35.5
HR < 45
SBP <80 or orthostatic hypotensions
313
What psychotropic drug can cause myocarditis
Clozapine
314
Treatment for myasthenia gravis
Cholinesterase inhibitors (pyridostigmine)
Supplemental immunosuppressants if refractory
Thymectomy can help
315
Treatment for myasthenic crisis
IVIG, plasmapheresis, intubation, steroids
316
Differentiate myasthenic crisis vs cholinergic crisis (caused by too much of the anticholinesterase meds)
Cholinergic --> muscle fasciulations, lacrimation, salivation, tachycardia, diarrhea (SLUDGE syndrome)
Can be hard to tell if mild
317
Inheritence of DMD
X-linked recessive
318
Atrophy = reduction in __ of muscle fibres
Dystrophy = reduction in ____
Size
Number
319
What serum markers are elevated in DMD
CK
Aldolase
320
Typically proximal weakness = ___ issue
Distal weakness = ___ issue
Proximal = muscle
Distal = nerve
(in general not always)
321
What is Pellagra? Characteristics?
Vitamin B3 deficiency (Niacin)
4 Ds: Diarrhea, dermatitis, dementia, [death]
+Glossitis
322
MS is the most common cause of what visual disorder? Clinical features?
Optic neuritis
Subacute vision loss, visual field defects, reduced acuity/colour perception
Retrobulbar PAIN, worse w/ eye movements
**typically monocular
323
Gram negative diplococci with vaginal discharge -->
Gonorrhea
324
Black box warning for haldol
Increased risk of death (usually cardiac or infx) in elderly pts with dementia-related psychosis
325
Key component of physical exam in someone with suspected SBO
Palpate inguinal area (hernia)
326
Top 3 causes of SBO
- A = adhesion
- B = bulge (hernia)
- C = cancer, crohn’s (gallstone ileus, radiation, FB)
327
Top 3 causes of LBO
- Colorectal cancer (65%)
- Diverticular disease (20%)
- Volvulus (sig > cecum)
- (hernia, adhesions, ovarian Ca, endometriosis)
328
4 main types of hernias
inguinal (direct/indirect), femoral, umbilical, incisional
329
Upper GI bleed most important med
IV PPI! Even more important than octreotide
330
_____ are a common cause of massive LGIB. Treatment?
Diverticular bleed
Usually conservative tx, usually resolve
331
Name a few diagnoses to rule out when someone presents with apparent panic disorder
Hyperthyroidism (or other endocrine)
Substance use/withdrawal
Cardiac/resp
332
Tx for nec fasc
Immediate surgery
Immediate IV Abx (pen, clindamycin, IVIG)
333
Most common cause of acute diarrhea in Canada is attributed to ____ but rapid onset is more likely ____
Campylobacter jejuni (onset at least 12-48 hr later)
Staph aureus toxin is preformed so onset in 1-4 hrs
334
Shortcut for mean SBP in kiddos
90mmHg + 2(age)
335
Normal infant resp rate
~40
336
Fluid deficit for mild, mod, severe clinically assessed dehydration by % of body weight
<2 yrs old: 5%, 10%, 15%
>2 yrs: 3%, 6%, 9%
337
Management of severe peds dehydration
NS boluses (10-20mL/kg) PRN
Fluid replacement over 24-48 hrs using 1.5-2x maintenance
338
General best peds fluid if pt is voiding
D5NS + KCl (20mEq/L)
339
Most common cause of traveler's diarrhea
Enterotoxigenic E coli
340
Ethosuximide is 1st line tx for what? What is 2nd line?
Childhood absence seizures
Valproate 2nd line
341
Rabies post-exposure prophylaxis consists of...
Rabies immunoglobulin into the site of wound (passive immunization to tie them over until they can make own antibiodies)
PLUS inactivated rabies vaccine on days 0, 3, 7, 14
342
Who should you send for BMD
Age >50 with prev fracture or 2+ RFs
>65 with 1 RF
Age >70
(note - if prev hip/spine fracture or 2+ fractures, just treat)
343
Hyp__thyroidism --> hyponatremia
Hypothyroid
344
Catch-up immunization is necessary for any adult who has not received what MMR schedule?
2 MMR doses after 12 months at least 1 month apart
345
PEP for measels
Active immunization (MMR vaccine) for immunocompetent individuals after direct exposure, passive for immunocompromised
*indicated if negative or indeterminate serology
346
2 central principles of the Canada Health Act
Universality
Accessibility
347
Pts with hypertension and adrenal incidentaloma should be tested for ___ via _____
Primary aldosteronism
Plasma aldosterone to renin ratio
348
Urine osmolality and urine sodium in SIADH
Osmolality high (>100)
Na high (>30) - because aldosterone isn't kicking in bc pt isn't actually IV depleted
349
Most common inherited thrombophilia
Factor V Leiden mutation heterozygote (resistant to cleavage by activated Protein C)
350
Post-menopausal woman with abdo distention and solid mass on pelvic exam, think...
Epithelial ovarian cancer
351
All pregnant women should be offered U/S at ___ wks to confirm viability/GA. And then at __ weeks for anatomy (incld NT)
7+ weeks
11-14 wks
352
Organic nitrates can lead to ___ and therefore should be co-administered with ___
Reflex tachy
BBs
353
PCI if available within what time period?
90 min in centre, 120 if transferring
354
ACS tx concurrent to PCI (or general conservative strategy)
Anti-ischemic: BB, nitrates, +/- CCB
Anti-platelets x2
Anticoagulants x1
Statin + ACEi
