day 2 stuff Flashcards
0
Q
structural deformity of hypertrophic cardiomyopathy
A
asymetric septal hypertrophy and abnormal motion of mitral valve leafles- systolic anterior motion that increases the outflow obstruction.
1
Q
HOCM murmur
A
Crescendo decrecendo murmur at the left lower sternal border that increases with valsalva due to dec preload.
2
Q
proteinuria (>3+), hypoalbuminemia, edema, hyperlipidemia + lipiduria=
A
Nephrotic syndrome
3
Q
Common complications of nephrotic syndrome
A
many complications due to protein loss protein malnutrition, Fe resistant microcytic hyporhcomic anemia (transferin loss), vit D defiticiency, def thyroxin levels, inc susceptibitly to infection, hypercoagulable state.
4
Q
Most common manifestation of hypercoaglulatibility in nephrotic syndrome- esp membranous glomerulonephropathy
A
renal vein thrombosis
5
Q
Goal oxy Hb sat in COPD?
A
90-94%
6
Q
What happens when chronic COPD pts are over oxygenated?
A
worsening hypercapnia and CO2 narcosis- increasing CO2 retention pt will be lethargic and confused.
7
Q
Congenital dermal melanocytosis=
A
mongolian spots
8
Q
Male under 5 yo with proxmila muscle weakness + gower sign + bilatral calf pseudohypertrophy.
A
Duchene muscular dystrophy
9
Q
Labs in duchene’s-
A
elevated serum creatinine phosphokinase and aldolase elevated before weakness.
10
Q
Abnormality in Duchene’s muscular dystrophy
A
absent dystrophin gene on genetic testing
undetectable dystrophin gene with muscle bx
XR
11
Q
long term complicatoins of duchenes muscular dystrophy
A
Cardiomypathy- often die from resp or heart failure
intellectual disability
12
Q
Elderly person with BP 165/75- dx, pathophys, risks, and tx
A
Isolated systolic HTN due to stiffening of arteiral wall, common in elderly.
Assoc with inc risk of cardiovascular events, esp with wide pulse pressure
Tx- low dose thiazide, ACE-I, CCB
13
Q
cancers reduced by breast feeding
A
breast and ovarian
14
Q
benefits to infant of breast feeding
A
decreased risk of otitis media, infxns of resp/GI? and UT, as well as dec risk of necrotizing enterocolitis.
lower rates of T1DM, and childhood cancers.
15
Q
Infant pathology that is absolute CI to breast feeding
A
Galactosemia
16
Q
Deformed joints (especially foot) with decreased sensation, arthritis arthropathy, mild pain, fractures that are unsuspected by the pt, and degenerative joint dis and loose bodies on joint imaging=
A
Chacot Joint- a neurogenic arthropathy
17
Q
Tx of Charcot joint
A
tx underlying neurologic condition (B12, DM, peripehral nerve or spinal cord damage, syringomyelia, tabes dorsalis).
Mechanical devices
X-rays if trauma is present
18
Q
Congenital aromatase deficiency
A
enzyme deficiency that prevents conversion of androgens to estrogens.
gestational maternal virilization with 46 XX fetus
Normal internal genitalia w/ ambiguous external genitalia
19
Q
Complications of congenital aromatase deficiency
A
delayed puberty ( primary amenorrhea)
osteoperosis
undetectable estrogens in the setting of high gonatropins
clitoral hypertrophy
20
Q
pt w/ cirrhosis and ascities with low gradefever, abdominal discomfort, AMS
A
spontaenous bacterial peritonitis
21
Q
Confirmatory tests for SBP, SAAG
A
ascitic fluid with PMN’s > 250 and positive peritoneal cutlure.
SAAG >1.1
22
Q
MCO of SBP
A
E. Coli, Klebsiella- gram negs
23
Q
Tx of SBP
A
3rd gen cephalosporins- Cefotaxime
24
Which children with UTIs get eval- what is it
Child 2-24 months get renal US with first febrile UTI
| Children with recurrent febrile UTIs get voiding cystourethrogram to eval for VUR
25
Longterm complication of VUR
recurrent UTIs and pyelo ==> renal scarring
26
Common AE of antithyroid meds, presentation, management
agranulocytosis- presents with fever and sore throat normally w/in first 90 days.
Stop meds and check WBC's- 1500 meds likely not the problem
27
Arrhthymia most specific for digitalis toxicity
Multifocal atrial tachycardia with AV block.
| Results from inc ectopy and increased vagal tone
28
Ssx of glucocorticoid deficiency
Fatigue, weakness, loss of appetite, EOSINOPHILIA
29
HIV pt with dry cough, exertional dyspnea, fever.
Hypoxia out of proportion with radiographic findings
LDH?
PCP, LDH is elevated.
30
Indications for steroid use in treating PCP
PaO2 35
31
Drug to treat PCP if TMP-SMX is CI
Pentamidine
32
Requirements for dx of Lewy body dementia
1) Fluctuating cognition w/ pronouced variations in attn and alertness
2) recurrent visual hallucinations- well formed and detailed
3) spontaneous motor features of PD
Req 2/3
33
supporting features of Lewy body dementia
```
repeated falls
Syncope
transient LOC
neuroleptic sensitivity
systematized delusoins
```
34
Afebrile pt with new onset blood tinged suputum w/o systemic ssx- dx and tx
acute bronchtitis- generally viral
tx is close clinical FU and obs
Often have wheezing
35
ddx for hemoptysis
Acute bronchitis- no fever, wheezing
Pneumonia- severe fever
Tb or Malignancy- constitutional signs or weight loss
36
Hypertensive pt w/ low Renin levels- suspect, labs
primary hyperaldosetronism
HTN, mild HyperNa, HypoK, metabolic alk
Inc Ald, dec Renin
37
When an elderly pt is on NSAIDs what type of anemai must alway be considered
Fe deficiency secondary to GI bleeding
38
TMP and lab changes
TMP can cause Hyper K bc blocks epithelial Na channels in collecting tubule.
Also causes artificial inc in serum Cr by competitive inhibition of renal tubular acid secretion w/o affecting GFR
39
Meds that inc K
Non selective BB- blocks Beta 2 mediated K uptake
ACE, ARB, K sparing diurectics- blocks ENaC
Digitalis- blockas Na/K ATPase
Cyclosporine- blocks aldosterone
Heparin- blocks aldosterone prod
NSAIDs- dec renal perfution--> dec K delivery to CD
Succinycholine- extracellular leakage of K via Ach receptors
40
Tx for heparin OD
Protamine Sulfate
41
Buspirone is used to tx
GAD
42
Passive aggrestion
Expresses aggression toward another person via repeated passive failures to meet that persons needs
43
Breast bx shows foamy macrophages and fat globules
Fat necrosis of the breast.
Similar findings to breast caner- skin/ nipple retraction, calcifications on mamography.
No tx, self limited
44
Parasthesias or pain in distribution of median nerve during pregnancy= ?
Carpal tunnel syndrome (inc incidence during preg due to E mediated depolymerization of ground substance)
45
Tx of carpal tunnel syndrome
NSAID's + neutral wrist splinting --> corticosteroid injxns--> surgical decompression
46
Evaluation for uric acid stones should be prompted by
finding of needle shaped crystals on UA
47
How are Uric acid stones evaluated for
CT or IVP
48
can nephrolithiasis cause bowel ileus
Yes
49
Most common AE for Olanzapine
Sedation and weight gain
Weight gain from H1 and 5HT2c antagonism
sedation H1 antagosnism
50
Antipsychotics associated with amenorrhea
Paliperidone and risperidone via increase in prolactin levels (block dopamine receptors)
51
Antipsychotic associated with leukopenia and angraulocytosis
Clozapine
52
Olanzapine AE
Most common is weight gain
assoc w/ elevation in LFT, full hepatotox is rare
orthostatic hypoTN from alpha 1 antagonism
53
MC form of atypical penumoniae in ambulatory setting
Mycoplasma
54
Presentation of atypical pneumonia
Indolent course, higher incidence of extrapulm manifestations.
CXR- out of proportion to physical exam
55
Bugs responsible for atypical penumonia
Mycoplasma, chlamydia, legionaella, coxeilla, influenza
56
Atypical pneumonia with erythema multiforme (target lesion) and no organisms on gram stain
Mycoplasma
57
Atypical pneumonia assoc with environmental water sources, occurring in outbreaks
Legionaella
58
Screen for GBS with vaginal and rectal swab when?
between weeks 35-37
| prophylactic Abx= penicillin or ampicillin at time of delivery
59
Which women get GBS prophylaxis
positive screen at 35-57 weeks
previous child that dev early onset GBS
has GBS bacteuria during the preg
60
during what weeks is amniocentesis done
16-18
61
what is the best test to detect chromosomal abnormalities in the first timester
CVS done between weeks 10 and 12
62
When is CVS indicated?
mother over age 35 w/ abnormal US
63
Meds to withhold 18 hours prior to stress testing (unless pt has known CAD)
BB, CCB, nitrates
64
Meds to be withheld 48 hrs prior to vasodilator stress testing
dipyridamole
65
meds to be withheld 12 hours prior to vasodilator stress testing
Caffeinated foods or drinks
66
Meds that can be continued
ACE-I, ARB
dig
statins
diuretics
67
Infants that are SGA are at increased risk for
```
Polycythemia- inc Epo in response to hypoxia
Hypoxia
perinatal asphyxia
meconium aspiration
hypothermia
hypoglycemia
hypocalcemia
```
68
Definition of SGA=
birth weight is < 10% for GA
69
Double duct signs indicates
pancreatic cancer due to compression of pancreatic and common bile duct
70
Pt with abdominal pain + weight loss + jaundice + GB distention=
tumor in the head of the pancreas- classically presents with painless jaundice.
Imagining shows dilation of intra and extraheptaic biliary tract dilatrion
71
Pulmonary contusion- manifestations, timeline, ABG
Tachypnea, tachycardia, hypoxia. May have dec breath sounds
ABG will show hypoxia
CXR- unilateral patchy infiltrates
Manifests in first 24 hours
72
ARDS- timeline and presentation
Usually manifests in the first 24-48 hours after the trauma
| bilateral lung involvement
73
Cyanotic infant with LAD + decreased pulm markings= ?
| Other EKG findings
Tricuspid atresia
| also have small absent R waves in precordial leads and peaked P waves from R. atrial enlargement
74
RF for tricuspid atresia
Congenital rubella
DS
maternal DM
fam hx of congenital heart dz
75
Murmur of tricuspid atresia
holosystolic murmur heard best at LLSB from VSD
76
Bechet syndrome- presentation
multi system inflammatory condition- recurrent oral and genital ulcers, skin lesions (erythema nodosum- painful), anterior or posterior uveitis, retinal vascularization
77
Tx of bechet sydrome
Coricosteroids
78
Long term complicatons of bechet
dementia or blindness- not prevented by tx with corticosteroids
79
Hypostheuria is common in what populations
SCD and SC trait
80
CI to Li tx, alternative tx
Li should not be administered to pts with renal dysfunction (elevated Cr)
use Valproic acid +/- antipsychotic for initial tx of bipolar do, manic, or mixed phase
81
Tx of mild bipolar do
Atypical antipsychotic
82
Tx of severe bipolar do
Li or valproic acid + antypical anti psychotic- has faster onset of axn
83
what does each of the hazard ratios indicate:
1
=1
```
1= more likely in tx group
=1= equally likely in both groups
```
84
what does the hazard ratio tell you
indicate chance of an even occurring in the tx group compared to control group
85
When is rotavirus vaccine normally given
between 2 and 6 months
86
AE of rotavirus vaccine
Intussiception
87
CI to rotativurs vaccine
anaphylaxis to a vaccine ingredient
hx of uncorrected congenital malformation of GI tract (meckels divertic)
SCID
hx of intussiception
88
Presentation of achalasia
progressive dysphagia, chest pain, food regurgitation, aspiration
89
achalasia barrium swallow
Birds beak deformity of LES and dilated esophagus
90
Pleuritic chest pain, tachyardia, dyspnea- especially if pt is on OCP, or just had a long flight =
Most likely dx is PE
91
Digoxin is used to tx
Atrial arrthmias- second line rate control in A.fib and A. flutter bc inc AV node refractory period.
Symptomatic relief in heart failure
92
Lidocaine is used to tx
```
class 1 anti arrhythmic
tx ventricular arrhythmias
```
93
First line tx for newly dx stage 1 HTN=
Lifestyle modification
94
Most effective life style mod to reduce BP?
weight loss especially via DASH diet
| dec BP 5-20/ 10 kg weight loss
95
broad waxy casts in UA
chronic renal failure
96
fatty casts in UA
nephrotic syndrome
97
WBC casts on UA
interstitial nephritis, pyelonephritis
98
If EKG reading states "NO P waves" = A.fib- tx=
rate/ rhythm control
99
A. fib manifestations on echo
Can show LV dilation w/ dec EF b/c of loss of atrial kick
| Mild MR due to LV dilation
100
Niacin AE- underlying mechanism, tx
flushing and pruritis - PGe induced peripheral vasolidation
| tx= ASA
101
EKG of long standing Coarc
LVH- high voltage QRS w/ down-sloping ST seg depression, T wave inversion in leads V5 and V6
102
Coarc CXR
"3 sign"
| ribnotching in ribs 3-8
103
Treatment of coarc
balloon angioplasty
104
Conditions assoc with Coarc
bicuspid AV
VSD
Turner syndrome
105
Sudden onset of vertigo, vom, and occipital HA in Hypertensive pt=?
Other manifestations
Cerebellar hemorrhage
| Also have 6th nerve paralysis, conjugate gaze deviation, blepharospasm, and coma
106
High body temp (105), DEHYDRATION, CONFUSION, COMA, AND dry flushed skin=?, pathophys
heat stroke
| caused by failure of body to thermoregulate in setting of high environmental temps
107
what interventions for continuity of care when pts are moving between facilities are most effective for improving the quality of patient care?
interventions that target pharmacy personnel and high risk pts.
108
Damage to the lateral STT causes contralateral loss of pain and temperature sensation beginning at what dermatomes
2 levels below the level of the lesion
109
In utero abnormalities due to congenital diaphragmatic hernia
polyhydramnios due to esophogeal compression
110
Neonate with congenital diaphragmatic hernia which with hypoxia and respiratory distress which intervientions are CI
bag valve mask and blow by O2 bc can pump air into stomach exacerbation condition
111
After ET tube has been secured in Congenital diaphragmatic hernia what is next intervention
nasal or orgogastric tube to decompress the viscera.
Umbilical artery line to measure- blood gas and blood pressure
Umbilical vein line- administer fluids
112
viruses that cause dilated cardiomyopathy
COXACKIE B
Parovirus B19, HHV6, adenovirus, enterovirus
Often preceded by viral illness
113
Findings of dilated cardiomyopathy on echo
dilated ventricles w/ diffuse hypokinesia --> systolic dysfunction
114
Tx for viral induced cardiomyopathy
management of CHF ssx
115
mechanism of damage in viral induced dilated cardiomyopathy
direct viral damage from humoral or cellular immune response to persistent viral infxns
116
What are the cardiac contours in acute cardiac temponade
normal
117
early dumping syndrome
postgastrectomy complication
ssx- post parandial abdominal cramps, weakness, lightheadedness and diaphoresis.
tx is dietary modifications or ocretotide. if intractable- reconstructive sx
118
Amphetamine intoxication-
SNS overload + agitaion or other beh manifestations
ie HTN, diaphoresis, mydriasis, agitation, irritability, paranoia, delerium.
Cardiac arrhythmias, seizures, hypothermia, intra cerebral hemorrhage
119
Torsades de points definition
polymorphic ventricular tachycardia
120
setting of torsades
prolonged QT interval ie familial long QT syndrome pts predisposed to hypoMg (alcoholics), pts taking TCA,s, amiodarone, sotalol, moxifloxacin, fluconazole
121
Tx of torsades is
stop offending agent
| initiate MgSO4
122
pregnant women with surgically tx graves dz run a risk of what in the baby
thyrotoxicosis bc anti TSH Ab are Ig and cross placentat --> stimulate TH production
123
Ssx of neonatal thyrotoxicosis
presents w/in 1-2 days of preg w/
| tachycardia, cardiomegaly, restlessness, diarrhea + poor weight gain, goiter
124
How should a tick be removed
ASAP with tweezers as close to the skin as possible. pull straight up with steady pressure
125
Criteria for Llyme dz prophylaxis
Must meet all 5-
1) Tick is ixodes scapularis (deer tick)- nymph or adult
2) Tick is attached for >36 hours or engored
3) Prophylaxis is started within 72 hours of tick removal
4) Local B. burgdorpheri infxn rate is greater than or = to 20%
5) No CI to doxy- age <8, preg, lactating
126
Prophylaxis for Lyme disease is
one dose of doxycycline
127
Causes of acute pancreatitis
MC- alcohol or gal stones
Meds that cause acute pancreatitis- furosemide, thiazide, sulfasalazine, 5- ASA, azathioprine, didanosine, pentamidine, metronidazole, tetracycline, valproic acid
128
Femoral central venouc cath vs subclavian centarl venous cath- higher rate of infxn-
Femoral
129
Common bugs assoc with central venous line infxn
Staphylococci
| Femoral lines can also have gram negs (enterics)
130
If a mother has active uncontrolled antepartum hemorrohage, w/ unstable vital signs and unreassuring fetal monitoring requires
emergent C/S
131
Pt's with placenta accreta often require what to stop post partum hemorrhage
Hysterectomy
132
MEN 1
Parathyroid adenoma
Pituitary tumors
Enteropancreatic tumors
133
MEN type 2A
medullary thyroid cancer (100%)
Pheochromocytoma (60%)
Parathyroid hyperplasia (10-20%)
134
MEN 2B
Medullary thyroid cancer- more aggressive then MTC in 2A
Pheochromocytoma
Mucosal and intestinal neuromas- tongue, eyelids, lips, GI
Marfanoid habitus- or kyphoscoliosis, lordosis
135
Dysmenorrhea + heavy menses + enlarged uterus
Fibroids- often inc in size with OCPs or pregnancy and regress after menopause
136
Pelvic congestion syndrome
dull/ ill defined pelvic ache, worse prior to mesntruation and relieved by menses.
assoc with hx of sexual problems
137
Mucopurulent urethral dc, absent bacteuria, hx of multiple sexual partners=
chlamydia
138
which is more common chlamydia or gonorrhea
chlamydia
139
FEV1/FVC ratio >80% is- restictive or obstructive
Restrictive lung disease
140
FEV1/FVC <80% is restrictive of obstructive
Obstructive
141
Causes of restrictive lung disease-
interstitial lung dx, NM dz, alveolar edema, pleural fibrosis, and chest wall abnormalities
142
PFT's of ankylosing spondylitis
FEV1/FVC >80% bc restrictive BUT FRC is greater than predicted bc fusion of costovertebral joints --> chest wall motion restriction and maintains chest in inspiratory position.
143
RIng enhancing lesion on brain MRI with fever, HA, confusion, and ataxia in HIV + pt=
Reactivation of toxo
| should screen for toxo in new onset HIV and give TMP-SMX to any pt with toxo Ab
144
What HIV opportunistic infections are prophylaxed w/ TMP SMX
Toxo
| PCP
145
X ray findings of Ewings Sarcoma
```
Onion skinning (periosteal retraction)
lytic, central, endosteal scalloping.
Onion skinning leads to moth eaten appearance that extends to the soft tissue
```
146
Epidemiology of Ewing sarcoma
white male in 1st or second decade of life
147
Extra articular manifestations of RA
Tenosynofitis of palm= trigger finger
TA nodules esp on elbows (non tender)
cervical joint invovlement leading to spine subluxation and SC compression
148
Tx for bacterial vaginosis?
Metronidazole
| alternatives include vaginal metronidazole and clindamycin
149
Drug used to prevent acute urate nephropathy
Allopurinol
150
causative organism assoc with pneumonia in debilitated subjects especially alcoholics, primarily affects upper lobe, mucoid colonies=
Klebsiella pneumonia - encapsulated gram neg bacilli
151
SSx of TCA OD
CNS depression, hypoTN (MCC death in TCA OD), anticholinergic effects (hot has a hare, red as a beet, intestinal illeus, dilated pupils)
QRS prolongation --> increased susceptibility to vent arrhythmia's
152
TCA OD tx
ABC's-secure airway
| NaHCO3- improves BP, shortesn QRS, and prevents arrhythmias
153
Lab studies defining anemia of prematurity
1) Normocytic/ normochromic anemia w/ no abnormal forms
2) Low retic count, dec RBC precursors in BM
3) normal WBC and platelet counts
4) nortal total billirubin level
154
Tx of anemia of prematurity
Fe supplementation even though not an Fe deficiency
periodic Hb checking
blood transfusions- if needed
155
who gets anemia of prematurity
low BW infants and premies
156
cause of anemia of prematurity
diminished RBC prod, shortened RBC life span, blood loss
157
In the setting of BPH, if renal function deteriorates next step is
Renal imaging ie US to assess for hydronephrosis and worsening kidney function
158
Dz that causes: EOM weakness (diplopia, pitosis), symetrical proximal muscle weakness (Upper>Lower), neck (flexor/ extensor), and bulbar muscles (dysarthria, dysphagia)- and pathophys
Myesthnia gravis- Anti poststynaptic ACh receptors.
| Characterized by fatigue-ability
159
Chronic GI dz that cause steatorrhea, Celiac Dz --> effect on Ca, PO4, PTH, and vit D
--> lead to vit D deficiency --> hypoCa and low PO4 + inc PTH--> osteomalacia, bone pain, muscle weakness, cramps, ataxic abnormalitties
160
Tx for Enterobius
Albendazole and mebendazole- CI in pregnancy
| Alternative is Pyrantel Pamoate.
161
Prader-Willi syndrome is loss of...
Paternal copy of 15q11-q13
162
ssx of Prader-Willi syndrome and complications
hypotonia, hyperphagia, obesity
| complications- sleep apnea, T2DM, gastric rupture
163
Angleman syndrome is loss of
maternal copy of 15q11-q13
164
Beckwith- Wiedemann syndrome
disregulation of imprinted gene expression of chrom 11 p15: fetal macrosomia, rapid growth until late childhood, macroglossia, hemihyperplasia, umbilical hernia, or omphalocele
165
Dx criteria for DKA
BG >250
pH <15-20
detection of plasma ketones
166
most appropriate initial management in DKA
rapid IV admin of NS and regular insulin
167
Complications of beckwith wiedeman syndrome
Wilms tumor
| Hepatoblastoma
168
Surveillance in Beckwith- Weidemann syndrome
serum AFP and Abdominal/renal US q 3 months till age 4
Ab U/S q 3months Age 4-8
Renal U/s age 8-adolesence
169
when should those dx with UC begin getting colonoscopies
8-10 years after initial dx
170
Travel associated diarrhea of rotavirus and norovirus
brief illness w/ vom
171
ETEC, EnPEC
contaminated food and drinking water
172
Campylobacter diarrrhea
Prominent abdominal pain resembling a pseudoappendicitis, bloody diarrhea
173
salmonella
frequent fever
174
Shigella diarrhea
fever, bloody diarrhea and abdominal pain
175
Diarrhea assoc with Cryptosporidium, Cystisosporia, Microsporidia
Chronic in immunosuppresssed, common in travelers
| >2weeks
176
Diarrhea assoc with cyclospora
> 2weeks
| causes prolonged relapsing infxn
177
Diarrhea assoc with Giardia
> 2 weeks- common in wilderness and rural areas of US, asymptomatic pts will shed for months
178
Common pathology in pts that have ssx of appendicitis for >5 days
contained appendiceal abscess w rupture
Fever leukocytosis, anterior palpation maneuvers are negative but obturator, psoas and anal exam are more likely to be positive.
Tx of otherwise stable pts- IV Abx, bowel rest, +/- percutaneous abscess drainage, elective appendectomy in 6-8 weeks
179
How long can sx be delayed in an elderly pt with femoral neck fracture and why would you delay it?
72 hours to ensure pt is medically stable
180
MGUS vs MM
| SPEP, plasma cells in BM, definitive test
MGUS- no ssx vs MM which does
in MGUS- SPEP 3% and MGUS >10% plasma cells in bone marrow
differentiate with metastatic skeletal bone survery- long bones and skull to r/o lytic lesions.
181
MGUS rate of MM transformation / yr
1%
182
RF for pancreatic adenocarcinoma
Smoking, hereditary pancreatitis, non hereditary chronic pancreatitis, obesity and lack of physical activity
183
Ssx of pancreatic adenocarcinoma
systemic ssx
abdominal pain/ back pain- often worse at night
jaundice
recent onset of atypical DM
unexpalined migratory superficial thrombophlebitis
HSM and ascites with mets
184
Labs in pancreatic adenoCa
cholestatic pic
elevated CA 19-9
US is jaundiced
CT w/o jaundice
185
ABO rxns in newborns
Typically in O mothers w/ A or B child.
Generally cause minimal dz and may present in the first preg.
Can present w/ hemolytic dz of the newborn- may have absent or mild anemia and dev neonatal jaundice tx w/ phototherapy
186
Langerhans cell histiocytosis/ Langerhans cell granulomatosis/ histiocytosis X
Causes solitary lytic long bone lesions.
| and HyperCa
187
Histiocytosis X- eosinophillic granuloma
least severe form of histiocytosis X- children/ young adulst with a solitary bone lesion +/- pain, overlying tender swelling, cause pathologic fractures.
Can be locally destructive but resolves on its own, benign and tx conservatively
188
Serum sickness like rxn timeline
1-2 weeks after administration of drugs
189
Serum sickness like rxn associated w what meds
penicillin, amoxicillin, cefaclor in the setting of a viral illness.
190
Serum sickness like rxn prominent symptoms
fever, utricarrial rash, polyarthralgia, LAD
191
Serum sickness like rxn tx
resolves w stopping offending agent
| Not true drug allergy
192
middle aged individual who holds books at arms length to read=
Presbyopsia
| age related dec in lens elasticity --> difficulty with near vision.
193
Infant in first 2 weeks of life w/ poor sucking and fatigue followed by rigidity, spasm and opisthotonus
Neonatal tetanus from clostridium tetani
infants of unimmunized mother
umbilical stump inxn
194
Newborn with- webbned neck, high palate, short 4th metacarpal, and nail dysplasia
Turner syndrome
195
HPV vaccine is recommended for
females age 9-26 regarless of sexual activity
| males age 9-21
196
dx of renal stones in pregnancy
US
197
Immune thrombocytopenia
Antecedent viral infxn w/ asyptomatic petichiae and echymosis. as well as mucocutaneous bleeding ie hematuria, GI bleeding, epistaxis
198
ITP lab finidngs
Isolated thrombocytopenia <100,000
| Peripheral smear with megakaryocytes and no other abnormalitites
199
ITP tx in kids
Obs skin manifestations
| Bleeding- IVIG or glucoccorticoids
200
ITP tx Adults
platelets > 30,000 2/o bleeding- obs
| P<30,000 OR bleeding- IVIG or glucocorticoids
201
Preferred initial imaging modality for suspected gynecologic tumors is
U/S
202
Tx of ascending cholangitis
Start with supportive care and broad spectrum Abx
| if dont respond ERCP for biliary drainage
203
Development of AV block in pt w/ infective endocarditis should raise suspicion for
perivalvular abscess extending into adnjacent cardiac conduction tissue
204
Endocarditis of which valves is most highly associated with extension of endocarditis to aabscess
aortic valve and IV drug abuse
205
Xanthelesthemia occur in setting of what dz
Primary billiary cirrhosis but are most commonly idiopathic.
| They are benign lesions w/ lipid filled macrophages in the dermis
206
Primary pulmonary HTN- cardiac and pulm ssx, CXR, EKG
SSX- weakness, dyspnea, fatigue --> chest pain, hemoptysis, syncope, hoarseness.
Right vent heave, JCD, tender hepatomegaly, ascites, edema. eventual RHF/ Cor Pulmonale
CXR- enlargement of pulmonary art, rapid tapering of distal vessels (pruning), enlarged R. vent
EKG- RAD
207
Rubella = German Measles
fever + cervical or posterior cervical LAD followed by maculopapular rash that spreads in cranio caudal fashion sparing palms and soles.
Women have have arthritis that last up to 1 month post resolution.
similar prodrome to measles- cough and coryza
208
Pain with eye movement, prottosis, opthalmoplegia, diplopia=
MC RF
Dx
Orbital cellulitis
RF= bacterial sinusitis
dx= CT w/ contrast to look and see if there is abscess req Sx
209
Complications of orbital cellulitis
blindness, subperiosteal abscess, cavernous sinus thrombosis, intracranial infxn, death
210
newborn or young infant with FTT, bilateral cataracts, jaundice and hypoglycemia- suspect, dz and complicatoins
Galactosemia- galactose 1 phosphate uridyl transferase deficiency
Tx by eliminating galactose from diet
may have MR and at risk for neonatal sepsis from E. Coli
211
Fibrocystic change of breast- management
Aspirate and obs for 4-6 weeks, if fluid is clear
212
Management of acute diverticulitis
start with IB abx should resolve if not do CT to evaluate for abscess or perforation
213
MVP pathophys and what happens when it becomes severe
myxomatous degeneration of mitral valve
| can cause L atrial and L vent enlargement --> A.fib, L. vent dysfx, and CHF
214
What should everyone about to start trastuzamab get?
An echo, esp those with borderline left vent function EF< 55%
215
Pts with hypoTN, and acute massive increase in ALT AST, and milder increase in total billirubin and alk phos=?, prognosis?
Ischemic hepatic injury or shock liver
| If pt survives the reasons for hypoTN, enzymes will return to normal in a few weeks
216
Multiple dome shaped lesions with central umbilication
Mollsuscum Contagiosum
