✅FACTIONLESS Flashcards
1
Q
(⬜ dx?) is typically caused by ⬜
Pts with risk factors should undergo ⬜ and make Modifications to their ⬜-2 to prevent recurrence
A
Lung Abscess; [aspiration of anaerobic bacteria]
________________
[speech/swallow evaluation] ;
Diet (thickened liquids) and/or Positioning (chin tuck)
2
Q
Describe the Chest CT
What’s the dx?
A
Lung [AIR FLUID LEVEL] amid pulmonary consolidation = LUNG ABSCESS
these pts also have sour tasting sputum
3
Q
In addition to skin, Patients with Rosacea may also experience ⬜ symptoms
A
Ocular
________________
burning/foreign body sensation/blepharitis/keratitis/conjunctivitis/recurrent chalazion
4
Q
[Actinic solar Keratosis] is a precursor to ⬜ and should be biopsied if concerning
________________
Tx -4
A
SQC
________________
isolated AK = [liquid nitrogen cryotherapy]
diffuse AK = [topical 5-fluorouracil] vs imiquimod vs tirbanibulin
5
Q
Actinic solar Keratosis cp
A
chronic scaly papules or scaly plaques with sandpaper texture in sun damaged areas
6
Q
Tx for Rosacea -5
A
- Avoid Triggers (hot/spicy foods/EtOH/cold/stress)
________________
[Erythema + Telangiectasia] only
- 2.* Topical Brimonidine
- ________________*
- papules or pustules*
3. Topical Metronidazole
4. Azelaic acid
5. oral abx (severe / refractory)
- papules or pustules*
7
Q
What’s the tx for Severely depressed patients who require URGENT treatment
A
Electroconvulsive Therapy
8
Q
When should [Actinic Solar Keratosis] be biopsied? -5
A
≥ 1 cm
rapid growth
ulcerated
TTP
initial tx failure
________________
1-20% transforms to SQC
9
Q
Electroconvulsive Therapy indications -6
A
- unipolar depression (with psychosis or suicidality)
- bipolar depression (with psychosis or suicidality)
- bipolar mania
- depression requiring rapid treatment
- depression during pregnancy when rx contraindicated
- catatonia
________________
ECT is safe for pregnancy!
10
Q
Buproprion MOA
A
NorEpinephrine \ Dopamine reuptake inhibitor
11
Q
⬜ side effects are common when 1st starting an SSRI, but should improve over a recommended drug trial of ⬜
________________
what should u do if side effects are intolerable or inadequate response?
A
GI ; 6 weeks
________________
change antidepressant
12
Q
infant pt presenting with undescended testis = ⬜
________________
At what age should this infant be referred for Orchiopexy?
________________
When should Orchiopexy occur?
A
Cryptorchidism
________________
≥ 6 months old
________________
Orchiopexy before 1 yo
13
Q
What kind of study should be used to investigate an
acute infectious disease OUTBREAK?
A
Case-Control Study
________________
allows quick localization of outbreak source
14
Q
What is [Root Cause Analysis] ?
A
QA tool that identifies and addresses factors leading up to an adverse medical event
15
Q
1st line tx for Heat Stroke is ⬜, which should be used to ⬇︎core body temperature by ⬜C/min .
Describe it
________________
List 3 adjunct Heat Stroke therapies
A
[augmentation of EVAPORATIVE COOLING] ; [0.2C/min]
(naked pt is sprayed with tepid (warm) water mist or pt is covered in wet sheet – while large fans circulate air ➜ ⇪ evaporative heat loss)
________________
ice water lavage / ice packs / cold IVF
16
Q
[mild/mod Aortic Stenosis] differs in cp than [SEVERE Aortic Stenosis]
________________
How does [SEVERE Aortic Stenosis] affect heart sounds? -2
A
- [1 soft single second heart sound]
- [LATE peaking systolic murmur] (early = mid/mod Aortic Stenosis)
________________
(normally, inspiration ⇪ blood into right heart ➜ pulmonic valve closes after aortic valve – but in SEVERE Aortic Stenosis, the stenotic Aortic valve will have delayed closure also ➜ single second heart sound)
17
Q
When are IV medications preferred over oral? (4)
A
- Hemodynamic INstability
- PO INtolerance
- PO meds failed
- < 2 yo
18
Q
Reconstruction of cleft lip is generally performed at (⬜age)
A
10 weeks old
________________
(in accordance with rule of 10s = 10 lbs|10 weeks old|10 g hgb)
19
Q
Breastfeeding contraindications -7
A
- active TB
- HIV (unless in poor country)
- Herpes breast lesion
- Active varicella
- Chemoradiation
- Active Substance Use Disorder (but methadone regimen for tx is OK)
- Galactosemia
20
Q
At what HIV viral load count is Vaginal Delivery safe?
A
Vaginal Delivery ≤ 1000 HIV copies
________________
> 1000 copies = C Section
21
Q
How do you manage HIV in a newly pregnant patient?
________________
How is the newborn managed once it’s born?
A
MOM = [TRIPLE ANTIRETROVIRAL THERAPY] THROUGHOUT PREGNANCY
________________
newborn = Zidovudine ≥ 6 wks
________________
viral load/CD4 count labs q 3 months
22
Q
Tx for [Scleroderma renal crisis] -2
A
Captopril = HTN
+
Nitroprusside IV = (if CNS or papilledema)
________________
etx: abnormal deposition of collagen in multiple organ systems
23
Q
4 clinical features of [Scleroderma renal crisis]
A
[HTN (Captopril tx)]
renal failure
Raynaud phenomenon (scleroderma)
GERD (scleroderma)
________________
etx: abnormal deposition of collagen in multiple organ systems
24
Q
6 major causes of Syncope
A
MVC BSD
- ⬇︎ Cardiac Output (Valvular Dz/HOCM/Pulm HTN/PE/Tamponade/myxoma/aFib)
- Bradyarrhythmia (SA Node dysfunction/AV Block)
- [VANS - Vasovagal Autonomic Neurocardiogenic Syncope]
- Dehydration
- Stroke
- Metabolic (⬇︎Glucose vs ⬇︎Na+)
OBTAIN ECHOS ON ANY PT WITH SUSPICIOUS SYNCOPE!
25
clinical presentation for Disseminated Histoplasmosis - 4
"Histoplasma spreads to **PBS L**"
1. **P**ulmonary
2. [**B**lood (pancytopenia 2/2 marrow infiltration)]
3 [**S**kin (Mucocutaneous papules/nodules)]
4. [**L**ymphatic RES involvement]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
* RES = ReticuloEndothelial System (Lymph node/Spleen/Liver)*
* Dx = serum or urine Histoplasma antigen immunoassay*
26
Acute Leukemia will present with signs of \_\_\_\_\_
Which acute leukemia is associated with Auer rods (eosinophilic inclusions)?
**PAN**cytopenia ; promyelocytic M3 (chromo 1517)
## Footnote
*Dx = smear showing blast --\> flow cytometry for confirmation*
27
what is the major potential adverse effect of Ginkgo?
INC bleeding
## Footnote
(especially if combined with ASA/antiplatelet drugs)
28
Licorice is commonly found in ⬜
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
how does iv z dlldfx affect BP?
herbal teas;
29
*A pt has a **single** episode of major depression but responds well to antidepressant SSRI tx*
What do you do when he ask to stop the SSRI since he's now feeling "great"?
At Remission, Cont Antidepressant rx for an **additional 4-9 months** then d/c
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
* This is called continuation phase tx*
* Pt with multiple episodes of MDD should cont SSRI for additional 1-3 years after reaching remission and indefinitely if their depression is SEVERE*
30
[**LEMS** - Lambert Eaton Myasthenic Syndrome] Clinical Presentation - 3
1. **Weakness of [Proximal limbs and trunk]** mimicking myopathy, better with exercise
2. Autonomic sx (Dry mouth /Orthostasis / Impotence)
3. ⬇︎Deep Tendon Reflexes
31
A: **Potters Sequence** etx
B: Clinical Presentation - 6
A: [Fetal **R**enal Agenesis bilaterally / Dysfunction] --\> Oligohydraminos (No Amniotic Fluid)
B: **POTTER**
**P**ulm hypOplasia
**O**ligohydraminos
**T**wisted Face
**T**wisted and shortened Limbs
**E**ars set low
**R**enal agenesis = cause
32
management of Acute Mastoiditis -2
[middle ear drainage (via mastoidectomy or {tympanostomy +/- ear tube placement})]
+
IV Abx
33
Between [Prerenal failure] and [Acute Tubular Necrosis -Intrinsic renal failure]
which responds to aggressive IVF?
[Prerenal failure]
34
Acute Tubular Necrosis (a type of ⬜ renal failure) is caused by what 3 things?
intrinsic
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*ATN* comes from **SIN**
**S**epsis
**I**schemia
**N**ephrotoxic meds
35
*Patient s/p severe hypOtension subsequently develops oliguria*
Dx?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Management? -4
Acute Tubular Necrosis
## Footnote
* look for muddy brown cast & FENa\>2%*
* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*
1. Maintain Euvolemia
2. Maintain Electrolytes
3. Maintain Nephrotoxin avoidance (*ACE inhibitors/ARBS/NSAIDs*)
4. Hemodialysis if AEIOU (*ph\<7.1/hyperK/intoxication/overload-Fluid/uremia*)
36
*Adolescents have ⇪ risk for peripartum complications*
What are the fetal complications?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
etx?
1. **PRETERM DELIVERY**
2. low birth wt
3. perinatal Mortality
4. [Maternal anemia]
5. [Maternal Preeclampsia]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Inadequate nutrition and physiologic immaturity
37
*After receiving anesthesia, pt develops hypOtension, elevated peak pressures and DEC end tidal CO2. This is concerning for ⬜*
how should you work this up? Tx?
ddx: Anaphylaxis (*to rocuronium/abx/skin antisepsis products/blood*);
dx: PHYSICAL EXAM (look for cutaneous rash/flushing!)
tx: Epinephrine
38
All women *planning* pregnancy should take
[⬜ mg (or ⬜ mg if HIGH RISK) of ⬜ for ⬜] prior to conception to ⬇︎risk of Neural Tube Defects
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[0.4 (or 4 IF HIGH RISK) mg daily] of **folic acid B9** ; ≥1 month
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*high risk = antiepileptics / prior NTD pregnancy*
39
*Anaphylaxis is difficult to diagnose in peds*
describe the criteria
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Tx for peds Anaphylaxis
after allergen exposure, pt has acute allergic sx in ≥2 systems
* [Skin/Neurologic/Respiratory/CV/GI]*
* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*
[Epinephrine 0.1 mg/kg IM]
40
Anemia of Chronic Disease
MOD
normocytic normochromic anemia that occurs in patients with chronic medical conditions
41
Describe the Approach to a patient who's resistant to disclosing genetic test results with relatives also at risk? -2
[acknowledge their resistance] + [open ended questioning/motivational interviewing]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*"You have reasons for not wanting to contact your brother; what are some possible benefits of sharing the results?"*
42
at what hgb should you consider blood transfusion?
hgb \< 7
43
*Metformin can dangerously cause ⬜*
Name Metformin contraindications? -5
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
how is iodine contrast related to Metformin?
lactic acidosis ;
1. renal failure
2. liver dysfxn
3. EtOH abuse
4. sepsis
5. CHF (especially if GFR \< 30)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[large dose IV **iodine contrast**] ⇪ lactic acidosis risk ... so Metformin IS HELD ON DAY contrast is given ➜ Metformin restarted 2 days later
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*common SE = GI upset and VB12 malabsorption*
44
BPPV (Benign Paroxysmal Positional Vertigo) etx and CP-3
Ca+ otoliths accumulated within semicircular canals --\> Dizzines, Nystagmus and Nausea only
45
By 18 years old, a **fully immunized patient** should have ⬜ total [TETANUS toxoid vaccines] .
Name the vaccines and what age they're given
5
## Footnote
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[DTaP = (2 / 4 / 6 / 15 ) months old]
+
[TDaP at 11 years old]
46
Causes of Papillary Necrosis - 5
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
MOD
**NSAID**
1. **N**SAIDs
2. **S**ickle Cell
3. **A**nalgesic/ASA/APAP abuse
4. **I**nfection from PYELO
5. **D**M
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**NSAID** ➜ BL ATiN ➜ [vasa recta vasoconstriction] ➜ [*chronic* renal papilla necrosis] ➜ [papilla sloughing]
➜ gross hematuria/ proteinuria / [pyuria with WBC cast] / [neg urine cx] + renal colic
*tx = correct underlying etx*
47
[Cell-free fetal DNA test] is routinely offered at ⬜ weeks gestation prenatal screens to ⬜ patients due to ⬜
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What does [Cell-free fetal DNA test] screen for? -4
≥10WG ; [Advanced Maternal age \> 35 yof] ; higher risk of chromosomal abnormalities in this group
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
1. [Pateau trisomy 13]
2. [Edwards trisomy 18]
3. [Down syndrome trisomy 21]
4. Sex Chromosome aneuploidies
48
*Cerebral Palsy is a group of clinical syndromes generally characterized as \_\_\_\_\_\_*
What are the 3 types? What's the greatest risk factor for Cerebral Palsy?
Nonprogressive motor dysfunction ;
## Footnote
Cerebral Palsy is just **SAD**
1. **S**pastic
2. **A**taxic
3. **D**yskinetic
Greatest RF = prematurity ( \< 32 wks gestation) but EtOH is second
49
Childhood Absence Epilepsy
cp
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Dx?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Tx?
multiple brief (\< 20 seconds) lapses in consciousness every day
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[EEG 3 Hz Spike] ; Ethosuximide
50
clinical course for Guillain Barre syndrome
[progressive ascending motor weakness +/- paralysis over 2 wks] ➜
[plateau x 2-4 wks] ➜
[spontaneous recovery over months]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*tx (plasma EXchange/ IVIG ) shortens course duration by 50%*
51
describe clinical course for this infant
[superficicial infantile **hemangioma**] proliferate and grow the 1st year of life
BUT REGRESS EARLY CHILDHOOD
= observation only unless cosmetic/bleeding/functional impairment
52
clinical course for [Dengue Yellow Fever]
[4-7d incubation by Aedes mosquito] ➜ SEVERE [break bone *MARF*] + [hemorrhagic sx (tourniquet petechiae)]
-----(POSSIBLY)----\>
[DENGUE SHOCK = LIFE THREATENING CAPILLARY LEAKAGE ➜ CIRCULATORY COLLAPSE, 3RD SPACING, END ORGAN DAMAGE]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*[break bone MARF =**M**yalgia/**A**rthralgia/**R**etroorbital Pain/**F**EVER]*
53
Clinical presentation for Illness Anxiety disorder
Anxiety over the possibility of having a specific Illness even though there are **little to no symptoms**
## Footnote
*In Somatic symptom disorder....Somatic symptoms ARE present!*
54
*PML Clinically Presents like Multiple Sclerosis*
Describe **PML-P**rogressive **M**ultifocal **L**eukoencephalopathy
Opportunistic infection 2º to [John Cunningham PolyomaVirus]----\> [**multiple white** matter lesions] (***Hyperintense Flair signal on radiology***) --\> Death vs. Severe Neuro injury
55
*Conflict arises between multiple children of a terminally ill patient regarding his medical decisions*
Management?
Hospital ETHICS Committee
56
Congenital Rubella
Sx -3
1. eye❌
2. hearing❌
3. heart❌
57
Congenital Toxoplasmosis is given to baby via ⬜ but acquired by Mom via ⬜-3
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Sx-4
Transplacental
- Raw undercooked meat
- unwashed produce (contaminated soil)
- cat feces
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*Tox- **HICH***
**H**ydrocephalus
**I**ntracranial Calcifications
**C**horioretinitis
(also **H**earing impairment)
58
Tx for Congenital Toxoplasmosis -3
Pyrimethamine
SulfaDiazine
Folinic acid
59
cp for Febrile Seizure -4
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
⬜ is the primary management. When do you give [Abortive Antiepileptics]?
1. [child [6 month - 5 year old] with [\< 15m nonfocal seizure]]
2. **NO** previous afebrile seizure within prior 24h
3. **NO** signs of CNS infection (meningismus, bulging fontanelles)
4. **NO** acute metabolic derangement (hypOglycemia)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
tx = AntiPyretics ➜ [AntiEpileptics if seizure ≥5 min]
60
cp for Meckel's Diverticulum
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
dx
PAINLESS hematochezia
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
technetium 99 pertechnetate scan
61
cp for [Measles rubeOla] -2
[fever + conjunctivitis + coryza + Koplik spots + cough] *prodrome* --(2-4days)--\> [maculopapular rash sspreading head to body]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*tx = supportive +/- [Vitamin A if hospitalized]*
62
cp for [Suppurative Bacterial Otitis Media]
[fever + cranky] ➜ [purulent ear drainage + resolution of cranky]
and [NO **pinna manipulation pain]**
63
[Suppurative Bacterial Otitis Media] etx
GASP (from nasopharynx) infects middle ear ➜ TM pressure/bulging --(if untreated)--\> TM perforation ➜ otorrhea purulent ear drainage **with [NO pinna manipulation pain**] = SBOM
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*[fever + cranky] ➜ [purulent ear drainage with resolution of cranky] but with [NO **pinna manipulation pain**]*
64
Asymptomatic Bacteriuria is self-limited to 2 weeks, and defined as ⬜ + ⬜
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Which **3** populations should actually be treated for Asymptomatic Bacteriuria?
[clean catch urine \> 100,000 CFU/mL of ≥1 organism]
+
[No UTI sx(*SUD)*]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Pregnant / [urologic procedures] / [within 3 mo kidney transplant]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*SUD: Suprapubic TTP/Urinary Freq-Urgency/Dysuria*
65
Dementia with Lewy Bodies (DLB) CP - 3
DLB at the **DMV**
1. **D**ementia confusion periodically
2. **M**ichaelJFox Parkinsonism (PARK + hamp) tht **does NOT respond to dopaminergic tx**
3. **V**isual Hallucinations
*Lewy Body= [**LABS** (**L**ewy **α**-synuclein **B**odie**S**)] that are Eosinophilic intracytoplasmic accumulations*
66
Describe insulin regimen for IDDM or Type 1
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Basal + [3 prn meal]
## Footnote
* basal = [NPH BID] or [GluLargine QD]*
* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*
* 3 prn meal = [3 reg insulin c meals]*
67
Describe what Transferrin measures?
The amount of iron being transferred in the blood
68
Describe what Total Iron Binding Capacity (TIBC) measures?
The Capacity of Iron transferrin can actually carry
69
In peds \> 1 yo ⬜ and/or ⬜ are primary contributors to the development of iron deficiency anemia
How does this present?
[excessive milk intake \> 24 oz/day] ; [low intake of iron-rich food]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
microcytic anemia + elevated RDW
70
Frontotemporal Pick's Dementia
Sx -2
Prounouced Frontal & Temporal lobe atrophy --\>
[**Socially inappropriate** Behavior] + aphasia
*OCCURS MORE IN FEMALES!!!*
71
Demographic of Frontotemporal Pick's Dementia?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Mode Of Inheritance
50-60 yo Females
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
AUTO DOM
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*Alzheimers \>60 yo*
72
⬜ can be confirmed with ⬜. | (⬜3) are major risk factors
candida Intertrigo ; KOH exam
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
obestiy / DM / immunosuppresion
73
Diagnosis? Tx?
candida Intertrigo
*(occurs in inguinal/perineal/genital/intergluteal/inframammary)*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Topical Antifungals
74
diagnosis? | tx?-2
[Tinea capitis *ring worm*]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[PO griseofulvin] or [PO terbinafine]
*cp = scaly pruritic erythematous patches of hair loss*
75
Diagnosis?
What other syndrome is this disease a/w?
Hirschsprung disease
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
DOWN SYNDROME trisomy 21
76
Diagnostic criteria for Panic disorder - 2
1. Panic attacks +
2. Persistent concern about additional attacks and +/- attempts to avoid them
## Footnote
*Be sure to r/u medical conditions that mimic them*
77
Disulfiram MOA
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
How do you decide if you should give a patient Disulfiram or Naltrexone?
[inhibits aldehyde dehydrogenase ➜ **SEVERE NV** with EtOH] ;
## Footnote
*Disulfiram for* [Die-Hard ABSTINENTS who want to stay Abstinent]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Naltrexone ( ⬇︎EtOH cravings) for [moderate/SEVERE Alcoholism in opioid-free patients that are Alcoholic]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*[acamprosate (glutamate modulator)] is also used in Alcoholism*
78
During pregnancy, what's Oxytocin indicated for?
labor protraction 2/2 **inadequate uterine contractions \< every 3-5 min**
79
dx for Acute Cholecystitis -2
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What if this method is inconclusive?
*Ultrasound showing*
[cholelithiasis]
+
[gallbladder wall thickening] OR [sonographic Murphy sign]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
➜ HIDA (*if above inconclusive*)
80
Dx for Creutzfeldt Jakob disease - 6
1. [PRNP prion protein] genetic testing
2. EEG Biphasic vs Triphasic **sharp wave complexes**
3. Postmortem brain biopsy
4. ⬆︎CSF 14-3-3 proteins
5. MRI Cortical Ribbons
6. MRI basal ganglia hyperintensity
81
Dx?
Varicella Zoster shingles
82
Dx?
[Poison Ivy Type 4 Contact Dermatitis]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*pruritic linear papules and clear fluid-filled vesicles on exposed areas - after camping*
83
Management? -3
*[Poison Ivy Type 4 Contact Dermatitis]*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[**Minimize spread** (remove contaminated clothes + gently clean exposed areas)] ➜ [**Symptomatic Tx** (topical CTS+cool compress] ➜
[**PO CTS** *if SEVERE/facial/genitalia dermatitis*]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*pruritic linear papules and clear fluid-filled vesicles on exposed areas - after camping*
84
Dx? | Management?-2
Vetebral Compression Fracture
pain control + resume normal activity ASAP (NO unnecessary bed rest)
85
Dx? Clinical Course?
[Erythema Toxicum Neonatorum] ; [benign asx erythematous papules/pustules in 1st 2 weeks of life ➜ resolve within 1 week]
86
dx? organism that causes it?
Tinea Cruris ; Trichophyton rubrum
87
Endometrial Polyps cause what type of vaginal bleeding?
**intermenstrual** vaginal bleeding
88
⬜ is a risk factor for developing Eosinophilic Esophagitis (which is triggered by ⬜)
cp? -3
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Tx?
ATOPY (*asthma/food allergy/eczema*) ; food antigens
1. dysphagia
2. reflux/regurgitation
3. epigastric abd pain
4. [eosinophilic esophageal **linear furrows** on endoscopy]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
elimination diet | PPI | Topical CTS (*fluticasone spray*)
89
Erysipelas, most commonly caused by ⬜, presents as (⬜2) . The 1st line Tx is ⬜
GASP; fever + [acute rapidly spreading erythema with well demarcated and raised borders]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
PCN
90
Explain what an XR with a posterior fat pad indicates?
[nondisplaced **OCCULT** fracture (usually supracondylar)]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*fat pad = radiolucency posterior to humerus that represents displaced fat 2/2 traumatic elbow effusion*
91
Genetic Consultation for recurrent miscarriage is required for women with ≥ ⬜ spontaneous abortions
≥3
92
*When it's indicated, Group B Strep prophylaxis abx must be given ≥4 hours before delivery to be adequate!*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
How do you manage postpartum neonatal GBS prevention
93
When it's indicated, Group B Strep prophylaxis abx (which consist of ⬜ ) must be given ⬜ hours before delivery to be adequate!
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
How do you manage neonatal GBS prevention **POST**partum
[PCN*or* ampicillin *or* ceFAZolin] ; ≥**4**
**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**
94
Hemolytic Uremic Syndrome in kids p/w ⬜ secondary to which 2 microbes?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Name the 3 clinical features of Hemolytic Uremic Syndrome
**bloody diarrhea** ; [EColi O157:H7] or [Shigella dysenteriae]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[HUS HAT]
[**H**emolytic Anemia (schistocytes)] / **A**KI / **T**hrombocytopenia
95
[Hidradenitis Suppurativa Acne Inversa] etx
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
cp?
chronic recurring inflammatory occlusion of the FolliculoPiloSebaceous units --\>
Painful intertriginous nodules that can --\> abscess and scarring
96
[Hidradenitis Suppurativa Acne Inversa] management for:
mild
Moderate
SEVERE -2
[Topical Clindamycin]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*sinus tracts/scar formation*
**[PO Doxy]**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*EXTENSIVE SINUS TRACT/DIFFUSE*
**[surgical incision + infliximab (TNFα-inhibitors)]**
97
how do you diagnose Bronchogenic Carcinoma (or any endobronchial obstructing lesion) ?
Name an alternative
[CONFIRMATORY FLEXIBLE BRONCHOSCOPY]
## Footnote
\_\_\_\_\_\_\_\_or\_\_\_\_\_\_\_\_\_
[alternative **non**Confirmatory HRCT]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*HRCT: High Res CT*
98
Describe the Pre-operation management for aFib
99
How do you manage newly diagnosed [LCIS (Lobular carcinoma in situ)]
LCIS is nonmalignant, but still has ⇪ risk for development into [invasive breast CA or DCIS] = **excisional biopsy** + lifetime surveillance
100
how do you mitigate [DEC appetite] in kids taking Stimulants for ADHD? -3
1. [monitor growth (if compromised ➜ drug holiday vs nonstimulant alternative)]
2. adjust administration time (i.e. after breakfast)
3. eat nutrient-dense meals around medication's active period
101
how do you treat acute asthma exacerbation in pregnant patients? -3
*same as non-pregnant asthma exacerbation = **BOC***
[**B**ronchoDilator (albuterol+ipratropium ➜ terbutaline ➜ Magnesium IV)]
**C**TS PO
**O**yxgen to SaO2 ≥95% (nonpregnant ≥90%)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
short term CTS benefit \> minor risk in pregnant patients
102
How does [GnRH agonist] help treat Leiomyoma?
GnRH agonist ➜ temporary amenorrhea ➜ ⬇︎Leiomyoma size and ⬇︎vaginal bleeding
103
How is smoking related to surgery?
smoking cessation ≥4 weeks prior to surgery ⬇︎ pulmonary complication risk postop
## Footnote
*PFT, ABG, etc. preop will not help*
104
[FENa (Fractional Excretion of Na+] for Prerenal failure?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
FENa for Acute Tubular Necrosis?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
explain why
Prerenal failure FENa \< 1%
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
ATN Intrinsic renal failure FENa \> 2%
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Prerenal failure ➜ Na+ conservation
ATN impairs Na+ reabsorption ➜ more Na+ in urine
105
Huntington's Dz Clinical Presentation (2)
* "Hunting 4 food is way too **aggressive** & **dancey**"*
1st: **Aggressive** Dementia w/ strange behavior
2nd: **D****ance**-like Chorea mvmnts
* AUTO DOM = Affects BOTH sexes equally!!*
106
*[Nausea/Vomiting in Pregnancy] ranges from mild to severe. Severe NVP is AKA ⬜*
What's sx discern [mild NVP] from [SEVERE NVP] -3
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
How do you manage mild NVP? -3
* SEVERE NVP = HYPEREMESIS GRAVIDARUM*
* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*
107
*[Nausea/Vomiting in Pregnancy] ranges from mild to severe. Severe NVP is AKA ⬜*
What's sx discern [mild NVP] from [SEVERE NVP] -3
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
How do you manage [SEVERE NVP]? -3
* SEVERE NVP = HYPEREMESIS GRAVIDARUM*
* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*
108
On a Central Tendency Graph below Identify
Mean, Median, Mode
**cOIN**
**c**entral tendency graph =
1: m**O**de
2: med**I**an
3. mea**N**
109
In Infants, what is "Periodic Breathing" ?
***BENIGN*** physiologic breathing pattern in young infants in which they demonstrate
(➜ [**breath pause x 5-10 seconds**] ➜ [rapid shallow breaths x 10-15 seconds] ➜)
x several cycles before returning to normal breathing
110
In Infants, what is [Apnea of Prematurity]?
[**TRUE** apnea episodes ≥20 seconds] in premature infants, that resolves by [corrected gestational age 37 WG]
111
Injury to the ⬜ causes ⬇︎ ability to Dorsiflex
[(DCP) Deep Common Peroneal nerve]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*Damaged* *DCP ➜ DEC Dorsiflex*
112
Juvenile Idiopathic Arthritis
**J**uvenile **I**diopathic **A**rthritis = **J**oint **I**nflammation by **A**utoantibodies
## Footnote
*autoantibody-induced joint inflammation ➜ chronic pain/swelling of multiple joints (wrist/ankles)*
113
Large volume Hematochezia should make you suspicious for (⬜ upper|lower) GI bleed , which should be evaluated with ⬜ after IVF
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*Hematochezia = Bright Red Blood Per Rectum*
*brisk* UPPER ; EGD
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*hematochezia (BRBPR) is usually a/w lower GI bleed but **BRISK** upper GI bleeds also cause hematochezia*
114
[DLB (Dementia with Lewy Bodies)] Tx
**Rivastigmine** AChinesterase inhibitor
115
Select mode of Delivery (*Vaginal | Cesarean*) for [Dichorionic Diamniotic twins] positioned:
Vertex/Vertex
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Vertex/BREECH
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
BREECH/Vertex
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
BREECH/BREECH
116
List the *Sexual* Side Effects of SSRI
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
How do you manage this? -3
⬇︎Libido | ⬇︎Orgasm | ⬇︎(delayed) ejaculation
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
- SWITCH to non-SSRI (buproprion/mirtazapine)
- AUGMENT with buproprion/sildenafil
- DOSAGE reduce cautiously (for pts taking high-dose/long term SSRI)
117
Malrotation and Volvulus are both diagnosed with ⬜
What would Volvulus look like on this diagnostic?
[Upper GI series barium swallow]
corkscrew image
*Try not to use CT scans in kids*
118
Malrotation and Volvulus are both diagnosed with ⬜
What would Volvulus look like on this diagnostic?
[Upper GI series barium swallow]
corkscrew image
*Try not to use CT scans in kids*
119
4 most common symptoms of Heat Stroke
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
1. Hyperthermia
2. [**Flushed** but not sweaty Skin]
3. [Neuro⬇︎ (Confusion/Dizziness/Agitation/Seizure/HA/LOC)]
4. Tachycardia
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*[⬇︎ core temp by 0.2C/minute] using [Augmentation of EVAPORATIVE COOLING]*
120
Most Cryptogenic Stroke are ⬜ in origin. What is Cryptogenic Stroke ⬜ ?
Describe thew workup? -2
embolic;
ischemic stroke w/o obvious source on initial eval
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
advanced cardiac imaging + ambulatory cardiac monitoring
*to detect paroxysmal arrhythmia (afib)*
121
Name 4 distinguishing features for differentiating **Non**Allergic rhinitis from Allergic Rhinitis
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Tx for NAR? -2
1. \> 20 yo
2. Nasal sx mostly (little ocular sx) - *blockage/rhinorrhea/postnasal drip*
3. No identifiable allergen
4. sx throughout the year
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[Intranasal Fluticasone] or [Intranasal Azelastine (antihistamine)]
122
Marfan Syndrome and Ehlers Danlos can present similarly
How do you discern the two?-2 ; What is the etx for Ehlers Danlos?
"Marfan **BAATHES** a lot! "
BUT Ehlers Danlos does NOT have
1. **E**ctopia Lentis
2. **A**rm-to-Height Ratio that's INC
Ehlers Danlos etx = defective collagen production
123
Name the 7 most common manifestations of **Marfan Syndrome**
etx = mutation of fibrillin 1 gene
"Marfan **BAATHES** a lot! "
1. **E**ctopia Lentis
2. **A**rm-to-Height Ratio ⬆︎
3. **H**eart issues (*MVP or [idiopathic _Aortic_ cystic medial degeneration]--\> _Aortic Dissection and Aneurysm_*)
4. **S**coliosis vs. Kyphosis
5. **B**reastbone structural abnormalities
6. **A**rachnodactyly (Steinberg thumb & wrist)
7. **T**all / slender / flat feet
etx = mutation of fibrillin 1 gene
124
Name the markers of onset Puberty for
Girls
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Boys
[girls wth NO Breast by 12 yo]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[boys with NO (testicular enlargement ≥4 mL) by 14 yo]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*delayed secondary sexual characteristics + delayed XR bone age = [Constitutional Delay of Puberty]*
125
For teens, what's the difference/define [Constitutional Delay of Puberty]-4
and [Familial Short Stature]-2 ?
[Constitutional **DELAY** of Puberty] = [**DELAYED** secondary sexcharacteristics] + [**DELAYED** XR wrist bone age] + [**DELAYED**"short" height] + [**DELAYED** sx also in fam hx]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[Familial Short Stature] = Short Stature + [Normal XR wrist bone age]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*BOTH MUST HAVE NORMAL GROWTH VELOCITY*
126
*Newborn failure to pass meconium **within 48 hours of birth** likely indicates ⬜*
how is this diagnosed? -3
Hirschsprung Disease
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Abd XR ➜ [contrast enema showing transition zone] ➜ [**RECTAL SUCTION BIOPSY** (***gold standard*****)]**
127
*Newborn failure to pass meconium **within 48 hours of birth** likely indicates ⬜*
MOD
Hirschsprung Disease
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[absence of ganglion cells in rectosigmoid (*confirmed by* *rectal suction biopsy*)] ➜ **transition zone** cutoff between
[narrow aganglionic rectosigmoid] and [markedly dilated innervated descending colon] EARLY AFTER BIRTH
128
normal ALP level
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*ALP = Alkaline Phosphatase*
25 - 100
129
normal blood glucose is ⬜
What is Whipple's triad and what does it indicate?
60-100
## Footnote
*(some people can go down to 45 with no sx)*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Whipples = [low BG] + [low BG sx] + [sx improve after glucose administration] = **true hypOglycemia**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*hypOglycemia sx = need **PISH** juice = **P**alpitations/**I**rritability/**S**weating/**H**A*
130
Octreotide is a ⬜ used to treat ⬜
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
explain how
[somatostatin 14 analogue] ; [Somatotrope - Functional Pituitary Adenoma]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
inhibits [pituitary somatotrope] from releasing Growth Hormone in a [functional pituitary adenoma]
131
Oligohydramnios --\> ⬜ sequence.
Name the 3 most common causes of Oligohydramnios
Oligohydraminos --\> **POTTER** Sequence
**POSTERIOR URETHRAL VALVES** are the most common cause of obstruction in newborn boys (which causes renal damage --\> oligohydramnios during utero)
132
Oligohydramnios --\> ⬜ sequence.
Name the 3 most common causes of Oligohydramnios
Oligohydraminos --\> **POTTER** Sequence
**POSTERIOR URETHRAL VALVES** are the most common cause of obstruction in newborn boys (which causes renal damage --\> oligohydramnios during utero)
133
*organisms most commonly associated with*
dental abscess -2
Streptococcus
PeptoStreptococcus
134
*organisms most commonly associated with*
Infective Endocarditis -3
Staph
Strep
Enterococci
135
*organisms most commonly associated with*
intraAbdominal -2
E coli
Bacteroides fragilis
136
Ovarian hyperstimulation syndrome etx
rare complication of ovulation induction.
etx: hCG injections which artifically matures follicles for IVF ➜**BILATERAL OVARY ENLARGEMENT WITH TOO MANY FOLLICLES**
PLUS ovaries **overexpress** [Vascular endothelial growth factor] =
[INC Ovarian VEGF] ➜ INC capillary permeability ➜ abd 3rd spacing ➜ [ascites/effusions/electrolyte imbalance] ➜ eventually
renal failure, hypOvolemic shock, hemoconcentration, hypercoagulability, DIC, death
137
*Patient is diagnosed with HOCM*
what would an [Implantable Cardioverter-defibrillator] be used to prevent in HOCM pts?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
diagnostic criteria? -2
Sudden Cardiac Death
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
HOCM + ≥1 risk factor
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*risk factors: [SCD in close relative\<50 yo]/suspected syncope from Vt Arrhythmia/LV\<50%*
138
*patient p/w ascities*
How do you diagnose Spontanous Bacterial Peritonitis?
Cell Count ≥250
139
*Patient presents with Suicidal Ideation*
What 2 factors determine if this patient should receive inpatient tx or outpatient tx?
*+Ideation*
[+**PLAN** and +**INTENT**] = Inpatient Tx
[No Plan and No Intent] = Outpatient tx
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
140
Patients with bicuspid aoritc valve are also at risk for developing what 3 aortic abnormalities?
aortic DISSECTION
aortic ANEURYSM
aortic DILATION
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*screen aortic root and proximal aorta*
141
*Pediatric patient comes in with c/f PNA*
What are the 4 classic symptoms of PNA?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
How do you work up pediatric PNA ?
*PNA?* **FACT**
**F**ever / **A**dventitious lung sounds / **C**ough / **T**achypnea
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
142
Which abx is used for [Community Acquired PNA]?
**high-dose** oral AMOXICILLIN
## Footnote
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*PNA?* **FACT**
143
*Pediatric patient p/w new diagnosis of Major Depressive Disorder*
In addition to CBT, what's 1st line pharmacotherapy for pediatric MDD?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What's the black box warning of this drug in pediatrics?
Fluoxetine
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**increased risk of suicidal thinking in pediatric patients**
144
Pineal tumors p/w ⬜ syndrome and some are ⬜ that secrete ⬜
Describe cp for this syndrome -4
[Parinaud's dorsal midbrain syndrome] ; Germinomas ; HCG
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Vertical Gaze paralysis
ataxia
pupil light rxn LOSS
nystagmus LOSS
145
[Nevus Simplex] are ⬜ , classically located on ⬜-3
[blanchable pink patches ➜ fade with time]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[eyelids / glabella (between eyebrows) / nape of neck]
146
[Port-Wine Stain (Nevus Flammeus)] are [⬜ common | uncommon] and may be a/w with what syndrome? Explain
UNcommon ; sturge weber = possible leptomeningeal vascular malformations = obtain brain MRI for evaluation
147
prior to medium/high risk procedures, interrupting ⬜ is necessary to DEC surgical bleeding
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
which patients do require bridging prior to surgery?
[anticoagulation 1-3 days before surgery]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
pts on warfarin must be bridged to [Enoxaparin LMWH] if they are CHADS VASC ≥7, recent stroke, mechanical valve or moderate risk
148
Prolactin level of ⬜ = Prolactinoma
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Tx? -2
\> 200
## Footnote
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[Cabergoline (dopamine agonist)] \< 1cm \< [Surgery for MACROademona]
149
*Pt presents with Fever, Jaundice and RUQ pain*
Management? -2
[ERCP biliary decompression/drainage - *within 48h*]
+
enteric abx
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*dz = Acute Cholangitis*
150
*Pt s/p penile circumcision develops postprocedural bleeding*
management?
apply **compressive elastic dressing** (direct pressure) to bleeding surgical site, BUT ONLY FOR SHORT TIME (to prevent necrosis)
and then remove [compressive elastic dressing] after hemostasis ... and prior to discharge
151
*postop*
CXR shows [linear opacifications in the b/l lung bases]
dx?
Atelectasis
152
Postoperative atelectasis is common ⬜ days after operation
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
how is this managed? -2
2-5
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
+respiratory secretions = [Chest Physiotherapy + suctioning]
NO respiratory secretions = CPAP
153
Name the 6 major causes of Postoperative Hypoxemia
154
*pt with Eisenmenger syndrome wants to get pregnant*
What should you tell her?
Pregnancy is a contraindication for pts with Eisenmenger syndrome (untreated VSD/HF) due to high maternal mortality rate and poor fetal pgn
Pregnancy should be avoided/terminated
155
*Pt (without previous DM) now with gestational DM delivers baby w/o complication*
How do you manage her postpartum course? -2
d/c antiHyperglycemic therapy after delivery
➜ At [6-12 wk postpartum] = [2h oral glucose tolerance test] (due to ⇪ DM2 risk)
156
⬜ is the leading cause of death in pts with Acromegaly. What other comorbidity are they at risk for?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
which comorbidity is reversible with treatment?
[Cardiovascular disease (REVERSIBLE)] ; Colon CA
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Cardiovascular Disease is reversible with tx
157
Although RARE, Recurrent Pulmonary Embolism can (rarely) present as nonresolving ⬜ , but will have what distinguishing symptom?
[*persistent* Recurrent PNA] ; [pleuritic cp with hypoxia]
158
Pts with Giardiasis should refrain from attending ⬜ to minimize disease transmission
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Tx for Giardiasis? -3
[Tinidazole or NiTazoxanide]
## Footnote
➜ [metronidazole (2nd line/kids)]
159
Giardiasis is transmitted via ⬜-2
What are the Risk factors for Giardiasis -3
Fecal-Oral or ingestion
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Contaminated food/water
Fecal incontinence with crowding (day care/nursing home)
Immunodeficiency
*⬇︎ with hand sanitizer*
160
s/s of Opioid Withdrawal -7
*the* **MAILMAN** *went through opioid withdrawal!*
**M**yDriasis
**A**bd cramps
**I**rritability
**L**acrimation
**M**yalgia
**A**rthralgias
**N**V
161
S3 on auscultation typically indicates ⬜, but why is S3 less useful in younger patients \< 40 yo?
Ventricular Enlargement (HF) ;
**S3 = NORMAL FINDING IN YOUNG PTS\<40 y/o**
162
*Seizures and Syncope are difficult to differentiate*
Name features that help differentiate Seizures from Syncope - 3
**Seizures** has...
1. Postictal confusion & lethargy
2. Triggered by flashing lights
3. Tongue laceration
*beware: Clonic jerks can occur during syncope associated w/cerebral hypoxia!!*
163
SjoGren Syndrome sx -4
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Dx labs -2?
164
St.John's wort is an OTC herbal supplement used alternatively for ⬜.
Why should it be used with caution?
[mild/moderate depression]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
It **upregulates** [CYP P450] ➜ ⇪ metabolism
165
*Stimulant toxicity and Anticholinergic toxicity have a lot of sx overlap*
What symptom helps to differentiate the two?
SKIN
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**S**weating = **S**timulant tox
**A**LL Dry = **A**nticholinergic tox
166
Sydenham chorea is one of the Major features of ⬜
Describe Sydenham chorea clinical presentation
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
tx for Sydenham chorea?
Acute Rheumatic Fever
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[**DANCING:** ***MIND**(emotionally labile) / **FACE** / **HANDS** / **FEET** (rapid jerky movements)*]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[**PCN** until adulthood] (to prevent recurrent rheumatic fever)
167
*Acute Rheumatic Fever requires (2M) or (1M/2m) for dx*
List the
5 **M**AJOR clinical features
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
4 **m**inor clinical features
*late sequelae =* Mitral regurgitation/stenosis
168
Tetrabenazine
## Footnote
* MOA*
* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*
* Indication*
[dopamine R blocker] ; Huntington's disease
169
the presence of [HbA 60% : HbS 40%] on electrophoresis is c/w ⬜ . What are the subsequent sx of this?
Sickle Cell **TRAIT** = ASYMPTOMATIC (does not cause Anemia)
170
the timing of neonatal jaundice differentiates [G6PD deficiency] from [Hemolytic Disease of Newborn] explain
_neonatal jaudice presenting within first_
HDN: 24 hours of life
(*+ direct Coombs | A or B infant born to O mother)*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
G6PD deficiency: 2-3 DAYS of life
171
CP of VertebroBasilar TIA - 4
Brainstem: **Diplopia**, **Dysarthria**
Cerebellum: **BL Clumsiness**
Spinal Cord: **BL Weakness**
Labyrinths
172
Transient Synovitis is a common cause of HIP pain in peds age ⬜.
Describe the clinical presentation -3
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Tx?
[3-8 yo]
1. [Hip pain + Limp but able to bear weight still]
2. often s/p **post**infection
3. small hip effusions on US
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
NSAIDs (since self limited to 1-2 weeks)
173
Treatment?
*Icanthosis*
topical Lactic Acid (keratolytic)
174
How do you diagnose Catatonia?
Lorazepam challenge =
[Lorazepam 2 mg IV] ➜ observe patient ➜ if pt relieved **within 5 min** = catatonia.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*note: a negative response does NOT rule out catatonia*
175
Tx for Catatonia - 2
Lorazepam
## Footnote
and/or
ECT
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*consider Lorazepam challenge = Lorazepam 2 mg IV ➜ observe result (if pt relieved within 5 min = catatonia)*
176
Tx for Croup-2
1. Mild = Humidified air +/- CTS
2. \> Mild = CTS +/- Racemic Epi nebulized
## Footnote
*Croup = paraflu that --\> subglottic edema and narrowing*
177
Tx for Croup-2
1. Mild = Humidified air +/- CTS
2. \> Mild = CTS +/- Racemic Epi nebulized
## Footnote
*Croup = paraflu that --\> subglottic edema and narrowing*
178
tx for Guillain Barre syndrome -2
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
when is this tx indicated?
plasma **EXCHANGE**
or
IVIG
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**nonambulatory pts** should receive tx if their sx have been present \< 4 wks
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*ambulatory pts recover on their own*
179
Tx for Major Depression **with psychotic features** - 2
1. ECT \> antipsychotic ➕
2. Antidepressant
## Footnote
*Use ECT in elderly as it is more rapid acting*
180
tx for Malignant Necrotizing Otitis Externa (MOE) -4
**mild = topical acetic acid**
moderate = topical cipro
[SEVERE (canal 100% occluded) = wick placement adjunct]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
INVASIVE! = CIPRO IV
*7 day treatment*
181
Tx for Panic Disorder - 6
**CBT** (can be used alone)(breathing technique, exposure therapy) +/-
## Footnote
2. SSRI (1st line rx)
3. SNRIs
4. [Benzo or BBlocker for situational]
5. TCA
6. MAOi
* Similar to Social Phobic Anxiety Disorder tx*
182
Tx for *outpatient* acute pyelonephritis
cipro PO x 7d
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*DW SLUFF: dysuria/WBC Pyuria/suprapubic pain/Leukocytosis/Urinary sx/Flank Pain/Fever*
183
Uterine Sarcoma is an aggressive CA originating from ⬜ or ⬜ tissue, and has 2 major risk factors
What are they?
endometrium or myometrium
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
RF = tamoxifen vs pelvic radiation
184
What are 5 ways to determine if a pt truly has Leakage of Amniotic Fluid?
1. **Amnisure** immunoassay (detects placental ⍺-microglublin1)
2. POOL test (there's pool of fluid in vaginal vault)
3. NITRAZINE test (fluid turns blue when placed on nitrazine paper since amniotic fluid is **alkaline**)
4. FERN test (fern-like estrogen crystals under microscopy)
5. US to determine fluid quantity (Normal = 6-23 cm AFI)
185
What are the 2 most important clinical values to monitor for Guillain Barre syndrome?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*cross reacting abs against peripheral nerves*
Negative Inspiratory Force
Tidal Volume vital capacity
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*assess' respiratory status*
186
What are the 4 main inquries pts should be asked when coming in for L&D checks?
***C**an **M**om **F**eel **B**aby?*
**C**ontractions?
**M**ovement from Fetus?
**F**luid leak vaginally?
**B**lood leak vaginally?
187
What are the clinical features of a Supracondylar Fracture -2
188
Tx for Supracondylar Fracture that's:
Nondisplaced ?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Displaced?
long arm split/sling
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
surgical reduction/pinning
189
how do you prevent Tumor Lysis Syndrome? - 2
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
how do you *treat* Tumor Lysis Syndrome (with AKI) -2?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Why do these differ?
**AF** ➜ **RF**
px = **A****F**: [**A**llopurinol (xanthine oxidase inhibitor)] +**F**luids IV]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
TX (for AKI 2/2 TLS) = **RF**: [**R**asburicase (urate oxidase analogue)] + **F**luids IV]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**[A**llopurinol prevents *A*dditional serum uric acid formation] whilst [**R**asburicase metabolizes *R*ealtime (already existing) serum uric acid]
190
What are the clinical features of Tumor Lysis Syndrome - 4
[cytotoxic chemotherapy] or [high grade lymphoma] ➜ tumor cell lysis ➜ release of [intracell (*PUK*)] ➜ makes you **PUKE**
## Footnote
1. [⬆︎ **P**hosphate serum (binds and ⬇︎ serum Ca+ )] ➜ CaPO4 stones
2. [⬆︎ **U**ric acid serum from p**U**rines (px = allopurinol and IVF) = DIAGNOSIS
3. [⬆︎ **K**+ serum ( ➜ cardiac arrhythmias)]
4. **E**lectrolyte kidney stones ➜ AKI
191
What are the renal complications of sickle cell TRAIT - 5
1. **Painless Hematuria 2/2 papillary necrosis**
2. Inability to concentrate urine (due to vasa recta damage)
3. Distal Renal Tubular Acidosis
4. UTI
5. Renal Medullary CA
## Footnote
*Sickle cell trait is a benign condition with Hgb AS that can cause fleeting papillary necrosis*
192
What are the risk factors for Uterine Rupture? -4
[PRIOR UTERINE SURGERY (CSection/myomectomy)]
Truama
Macrosomia
abnl placentation
193
What are the toxicities for MTX?
194
What are the major functions of [Vagus CN10] - 5
**VAGUS**
**V**ocal Cord Phonation
[**A**ortic baro/chemoreceptor Parasympathetics]
[**G**ag reflex - EFFerent (loss of Gag = CN9 problem)]
**U**'ll COUGH reflex- *when vagus receives signal* afferently
[**S**wallowing & Palate Elevation]
*Image: **Left** Ipsilateral CN10 palate dysfunction*
195
What are triggers of **VAN** (Vasovagal Autonomic Neurocardiogenic) Syncope? -8
1. EMOTION
2. PAIN
3. Carotid Stimulation
4. Prolonged Standing
5. Coughing
6. Meals
7. Defecation
8. Urination
## Footnote
*VAN Syncope is preceded by nausea, sweating and dizziness*
196
Full term infant = 37 -42WG
How do you manage Preterm Labor 32 to 33+6 WG - 3
***P****regnant **B**itches **T**ake*
197
Full term infant = 37 - 42WG
How do you manage Preterm Labor \< 32WG - 4
***P**regnant **B**itches **T**ake **M**oney*
198
Full term infant = 37- 42WG
Most Tocolytics are not used in managing Preterm Labor 34 to 36+6 WG
Why specifically is Nifedipine not used?
***P**regnant **B**itches*
Maternal hypOtension with reflex tachycardia
199
Full term infant = 37- 42WG
Most Tocolytics are not used in managing Preterm Labor 34 to 36+6 WG
Why specifically is Nifedipine not used?
***P**regnant **B**itches*
Maternal hypOtension with reflex tachycardia
200
Full term infant = 37- 42WG
Most Tocolytics are not used in managing Preterm Labor 34 to 36+6 WG
Why specifically is Indomethicin not used? - 2
***P**regnant **B**itches*
1. Premature closure of ductus arteriosus
2. Oligohydramnios
201
Full term infant = 37- 42WG
Most Tocolytics are not used in managing Preterm Labor 34 to 36+6 WG
Why specifically is Mg not used?
***P**regnant **B**itches*
It's a **weak tocolytic** so it doesn't actually help with slowing contractions down in preterm delivery
202
What does APGAR stand for? ; How is it done? ; How is it used?
**A**ppearance, **P**ulse, **G**rimace(reflex irritability), **A**ctivity(tone), **R**espiration
Performed at **1** and **5** min postpartum, All scaled from 0 to 2 and then added together
[\< 3 = Critical] / [4-6 = fair: PPV] / [7-10 = normal: No intervention]
203
What does APGAR stand for? ; How is it done? ; How is it used?
**A**ppearance, **P**ulse, **G**rimace(reflex irritability), **A**ctivity(tone), **R**espiration
Performed at **1** and **5** min postpartum, All scaled from 0 to 2 and then added together
[\< 3 = Critical] / [4-6 = fair: PPV] / [7-10 = normal: No intervention]
204
What is a normal Ejection Fraction?
\> 50%
205
What is Bile Salt-Induced Diarrhea?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
tx?
5-10% of patients after [cholecystectomy vs short bowel syndrome] have ⇪ [secondary bile acids] into the large intestine ➜ INC diarrhea
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Cholestyramine
([*bile salt-binding resin] that sequesters excess bile salts in the intestine*)
206
Charcot Triad consist of [⬜3] and indicates ⬜
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Describe this disease
[Fever + Jaundice + RUQ pain] = **Acute Cholangitis** = [bile **duct** gallstone obstruction] ➜ impaired biliary drainage ➜ ascension and infection of enteric bacteria in biliary **duct**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
207
What is Factitious disorder?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
which 2 demographics does it occur most in?
faking/inducing illness **solely to assume the sick role** - WITHOUT OBVIOUS EXTERNAL BENEFIT
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Women | healthcare workers
208
What is gallstone pancreatitis?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Management for gallstone pancreatits? (mild vs severe)
pancreatitis (epigastric abd pain/NV/cholic/⇪ lipase) in the setting of [cholelithiasis with no EtOH or TAG]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[mild (no organ dysfxn)] = cholecystectomy within 7 days of inflammation resolution
SEVERE = cholecystectomy **AS SOON AS INFLAMMATION RESOLVES**
209
What is the diagnostic clinical criteria for Panic Disorder? - 4
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*DSM5 no longer considers this its own DO but now as a Specifier for other conditions*
1. **Recurrent** Panic Attacks
2. **Unexpected** Panic Attacks
3. ≥1 attack is followed by ≥1 mo. of [Anticipatory Anxiety and/or behavior ∆] (details below)
## Footnote
- AA = persistent worry of having another panic attack
- behavior ∆ to try and avoid future panic attacks
4. ≥ 4 Panic Attack Specifiers - *image*
* And obvs can't be 2/2 drugs or other condition*
210
Why are abx **NOT** used in treating Hemolytic Uremic Syndrome?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What is the management for Hemolytic Uremic Syndrome?
*HUS HAT*
killing bacteria could ➜ ⇪ release of Shiga toxin
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
SUPPORTIVE CARE ONLY
(*fluid/electrolyte mgmt | blood transfusions | dialysis*)
211
What is the mngmt for an ingested coin? - 3
1. Obs for up to 1 day after ingestion UNLESS
2. Pt is symptomatic = flexible endoscopy
3. Pt has no recollection of ingestion time = flexible endoscopy
212
What is the mngmt for an ingested coin? - 3
1. Obs for up to 1 day after ingestion UNLESS
2. Pt is symptomatic = flexible endoscopy
3. Pt has no recollection of ingestion time = flexible endoscopy
213
What is the most common cause of Fatal Sporadic Encephalitis in the U.S.? Should you use CT or MRI for dx?
Herpes Encephalitis ; MRI **(and then CSF PCR=Gold Standard Dx)**
214
What is the purpose of Palliative Care? -2
★ [interdisciplinary ⬇︎of unnecessary medical interventions] while [**⇪ quality of life** for terminal/seriously ill patients (and their family)].
★ Can occur concurrently with life-prolonging tx
215
What is the majority recommendation for Romantic or Sexual relationships between Physicians and **current** Patients?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
what about **former** patients?
*current patient =* **UNETHICAL 100%**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*former patient* = Unethical if MD exploits knowledge or influence derived from previous professional relationship
216
What is the strongest single risk factor for suicide
previous suicide attempt
217
What is [Diamond Blackfan anemia]?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
cp? -4
congenital bone marrow failure in infancy
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
1. absent thumbs
2. craniofacial abnormalities
3. [SEVERE Macrocytic anemia (hgb \< 9 at birth)]
4. reticulocytopenia
218
What is [Physiologic anemia of infancy]?
ASYMPTOMATIC and Expected DEC in newborn hgb during 1st month
2/2 INC oxygen to newborn (compared to utero) ➜ transient downregulation of erythropoietin ➜ DEC RBC
DEC RBC resultantly = [Hgb \> 14 at birth] to [**Hgb 9-11 by 3 months old**]
After 3 months, erythropoietin drive returns to normal
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*red flags: anemia 1st month / hgb \< 9 / hemolysis (constant jaundice|reticulocytosis) / hypOchromic|microcytic RBC (iron deficiency/thalassemia)*
219
What new onset comorbidity should you anticipate following renal transplant?
DM
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*INC insulin excretion and gluconeogenesis by healthy transplanted kidney*
220
What type of psychiatric side effects does CTS (CorTicoSteroids) have? - 4
**S**teroids **M**ake **P**eople **D**epressed!
1. **S**uicidality
2. **M**ania
3. **P**sychosis
4. **D**epression
221
What's important to remember regarding BNP in Obese patients?
Obesity causes **FALSELY LOW** **BNP** levels
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*Bigger people have Bigger BNP than they show*
222
*pt s/p PE just started Heparin but develops HIT*
What's the first step for suspected [Heparin Induced Thrombocytopenia (HIT)]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
when is management with Warfarin typically ok to start after HIT ?
d/c **ALL**forms of Heparin ➜ alternate anticoagulants (i.e. *direct thrombin inhibitors*) [even if no thrombosis present]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
platelet \> 150K
223
What's the general recommendation regarding
Exericse during Pregnancy?
Healthy uncomplicated pregnant women are recommended to do
[**Moderate exercise** **30 minutes daily - for most days of the week]**
**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**
*yoga/walking/running/light strength training/swimming*
224
what's the most effective way to improve patient sign out/handoff between providers?
systematic template checklist
225
Which 2 organisms cause ABSCESS?
MsSA
MRSA
226
Which 4 drugs can you give to treat HTN in pregnant patients?
**M**others **L**oathe **N**efarious **H**TN
**M**ethyldopa / **L**abetalol \> **N**ifedipine / **H**ydralazine
227
Which 4 Bite Wounds receive
[left open to heal by secondary intention + ⬜ prophylaxis]?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Why?
**TECH** bites are *left open to secondary healing with **AMOX/CLAV** px*
1. [**T**ime of bite \> 12 hours old]
2. [**E**xtremity (hand or foot) bite]
3. [**C**AT bites (except if on face\*\*)]
4. [**H**UMAN bites (except if on face\*\*)]
* \*1° \< [CAT/HUMAN Face bite 24h old] \< 2°*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
These bite wounds are high risk for subsequent infection
228
Which areas of the brain are affected by [HSE-Herpes Simplex Encephalitis]? - 2
1. Medial temporal
2. Inferior frontal
229
Which Second Generation Antipsychotics are most associated with
Prolonged QTc -5
ZIPRASIDONE \>\> **CORQ**
## Footnote
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*CORQ = Clozapine/Olanzapine-Risperidone/Quetiapine*
230
Which Second Generation Antipsychotics are most associated with
Weight Gain -4
**CORQ**
[**C**lozapine | **O**lanzapine] \> [**R**isperidone | **Q**uetiapine]
231
Which Skin Cancers are associated with Sun exposure?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
How is this prevented?
ALL 3!
(SQC / Basal Cell Carcinoma / Malignant Melanoma)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Daily liberal application of [SPF ≥ **30** sunscreen] before/during outdoors
(Tight clothing and sun avoidance are also important but impractical)
232
Which two renal pathologies is analgesic nephrophathy associated with?
1. [ATiN (Acute Tubulointerstitial nephritis)]
2. Papillary necrosis
233
Why are patients undergoing [major surgery with extensive transfusions] at ⇪ risk of developing [Hyperactive Deep Tendon Reflexes]?
major surgery require massive blood transfusions, which has large amts of citrate (to anticoagulate blood) ➜ this [citrate chelates free serum calcium] ➜ hypOcalcemia ➜ [HYPERACTIVE Deep Tendon Reflexes]
234
Why are pts who've experienced 1 shoulder dislocation, at even higher risk for experiencing recurrent shoulder dislocations? -2
[residual **ligament instability/laxity**]
+
[incomplete healing of prior labral tears]
235
s/s of Anterior Shoulder Dislocation -5
1. Flattened shoulder
2. Acromion prominent
3. Humeral head prominent
4. ABduction of Arm
5. External Rotation of Arm
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*ANT shoulder dislocation of [glenohumeral shoulder joint]*
236
Why do pts with hypOthyroid require INC dose of levothyroxine if they start taking estrogen-containing OCP?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
how is this managed?
**Estrogen** stimulates liver to make ⇪ [thyroxine binding globulin] ➜ ⇪ binding sites to saturate➜ DEC free T3/T4
Normal thyroid ⇪ [free T3/T4] to saturate the additional TBG binding sites
BUT hypOthyroid patients are unable to INC thyroid hormone synthesis
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
get TSH weeks after starting Estrogen-OCP and titrate to normal thyroid function
237
Why is BNP an unreliable marker of volume status in patients taking [(ARNI) Angiotensin Receptor/Neprilysin Inhibitor] ?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*ARNI = [sacubitril-valsartan]*
Neprilysin normally degrades BNP ➜ ARNI ➜ falsely higher BNP/**over**States HF status
238
*You have a patient admitted to Hospice*
Which 3 groups of drugs should be discontinued?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Why?
[CV prevention] / anti-HTN / [PRN Insulin]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
meds taken at end of life should be comfort meds only
239
*You suspect a pt had an ischemic Stroke*
After FIRST, ruling out Hemorrhagic stroke with ⬜ , what thrombolytic therapy should be given?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
When should you give it?
NonContrast Head CT; IV Alteplase
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**WITHIN 4.5 HOURS OF SX ONSET!**
240
[T or F] Pt confidentiality shuld be maintained even when a pt is having Active suicidal ideation
FALLLSEE!!!!
## Footnote
Active (i.e. plans to hang themself) suicidal or homocideal ideation warrants breaking confidentiality and informing parents or whomever
241
[1st trimester combined test] screens for ⬜ by measuring what 3 things?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
positive [1st trimester combined test] ➜ ⬜
aneuploidy; [(**BNP** - (**β**HCG/**N**uchal translucency/[**P**regnancy associated plasma protein A])
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
confirmation by [chorionic villus sampling] or amniocentesis
*to evaluate fetal karyotype*
242
[Amyotrophic Lateral Sclerosis] (Lou Gehrig's) etx - 2
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
clinical presentation? -4
1. Rare = [Superoxide Dismutase gene mutation] --\> copper-zinc dysfunction ---\>[Upper **AND** Lower Motor Neuron Disease!]
2. Common = Idiopathic
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
progressive weakness + [UMN deficits **AND** LMN deficits] + [cognition/ocular/bowel/bladder are preserved]
*UMN Dz includes loss of neurons in motor nc. 5/9/10/12*
243
[Anabolic Androgen Steroids] ➜ symptomatic ⬜ from DEC ⬜
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
how long after d/c does it take to naturally recover?
hypOgonadism ; endogenous testosterone
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
recovers weeks/months after d/c but will be permanently suppressed if chronic abuse
244
[Bacterial otitis externa] and [Necrotizing malignant otitis externa] both present with ⬜ and ⬜ from ⬜
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
how do you differentiate the two?
[pain with ear manipulation] and [purulent ear drainage] ; pseudomonas
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
NMOE = FEVER/ involves neighboring skull bone / only in elderly-DM-immunocompro
vs
BOE = no fever
245
[Creutzfeldt Jakob Dz] etx
PrP (prion protein), normally in neurons as [α -helical structure] converts--\> [**INFECTIOUS** **Beta pleated sheets**] --\> Protease resistance --\>
Vacuoles in [**Gray** Matter Neurons & Neutrophils] develop --\> Cyst = [**Spongiform** Gray Matter]
246
[Creutzfeldt Jakob Dz] CP - 2
[**RAPIDLY** Progressive Dementia] + [STARTLE Myoclonus] --\> DEATH
## Footnote
*Can be Acquired vs. Inherited*
247
*[Functional Pituitary Adenomas] consist of what 3 adenomas?*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Describe etx for [**NON**Functional Pituitary Adenoma]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Tx?
Functional Pituitary Adenoma=
**Lactotrope \> Somatotrope \> Corticotrope**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[**NON**functional pituitary adenomas] arise from [LH/FSH Gonatrope cells of the PITUITARY GLAND ➜ unique [isolated ⇪ α subunit (nonfunctional)] ➜ low LH/FSH gonadotropin levels (from negative feedback) ➜ hypOgonadism
+
mass effect if tumor large enough
Tx = Trans-Sphenoidal Surgery
248
[PSPST (Pancoast SUP Pulmonary Sulcus Tumor)]
has 4 main clinical symptoms
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
⬜ is the most common PSPST sx
\> ⬜ and ⬜
which are \> [⬜ (only present in 25% PSPST pts)]
1. SHOULDER PAIN
2. [Horner's Syndrome (*PAM*)] (2/2 sympathetic chain/stellate ganglion invasion)
3. [Hand atrophy/weakness] (2/2 C8-T2 invasion)
4-[Spinal Cord Compression ➜ asymmetric LE HYPERreflexia] = *only 25% of PSPST pts*
*\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*
Tx = CTS + Radiation + Surgery
249
[Serous Otitis Media with effusion] etx
sOME = asymptomatic middle ear effusion **in the absence of infection /inflammation**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*SBOM (➜sOME)*
250
what adjustments should be made for exercise induced hypoglycemia in a IDDM/Type 1 DM? -3
- [⬇︎*basal* insulin (NPH BID vs GluLargine QD)]
- eat before exercise
- avoid insulin injection into "exercise" limbs
251
⬜ is a common cause of AKI in patients with Cirrhosis, but is a diagnosis of exclusion
what's the maangement for this?
[HepatoRenal Syndrome (➜preRenal AKI)] = dx of exclusion]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
1st: [IVF bolus challenge] ➜
(if BP response = preRenal AKI from intravascular volume depletion)
(if **no** BP response) = HepatoRenal ➜ 2nd: ([Midodrine + Octreotide] + Albumin )
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*Octreotide= somatostatin analog / Midodrine= Αlpha 1 agonist*
252
⬜ is the GREATEST risk factor for Male Breast Cancer.
⬜ is the second greatest risk factor for Male Breast Cancer.
And ⬜ is the third greatest risk factor for Male Breast Cancer
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Etx for Greatest risk factor? ; etx for 2nd greatest risk factor?
BRCA mutation \> \> \> Klinefelter Syndrome
## Footnote
\> [**LAME** (**L**iver failure/(**A**lways Eating {Obese})/**M**arijuana/(**E**strogen:androgen ratio ⇪ {gynecomastia})]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
BRCA = auto DOM mutations ➜ [⇪ Male Breast CA risk x 100]
[klinefelter syndrome XXY] = male having extra "X" chromo ➜ [Estrogen:androgen ratio ⇪] ➜ [⇪ Male Breast CA risk x 20]
253
⬜ is the most common cause of [Dilated Cardiomyopathy HFrEF] and should be evaluated with what 2 test?
[Coronary Artery Diseasse] ;
stress test | coronary angiography
254
⬜ is the most late (months/years after exposure) complication of Lyme Disease
What is the tx for this?
[**DOXY** (or Amoxicillin) PO x 28 days]
## Footnote
*Lyme Disease (Arthritis)*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*septic arthritis = synovial fluid WBC \> 50K*
255
⬜ is the most late (months/years after exposure) complication of Lyme Disease
How is Lyme Disase diagnosed? -2
Lyme Arthritis [synovial fluid WBC 20-50K];
[serum ELISA + Western blot]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*septic arthritis = synovial fluid WBC \> 50K*
256
⬜ is the preferred imaging for Pyloric Stenosis
How does this present?
Abdominal ultrasound
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[newborn 4-8 weeks old] ➜ Non-bilious emesis **withOUT abdominal distension**
257
In Smokers, ⬜ may be first sign of Bronchogenic Carcinoma
Why is this?
[*persistent* Recurrent PNA]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[Bronchogenic Carcinoma in older/Smokers or Carcinoid tumor in younger/nonsmoker] = **endobronchial obstructing lesion** ➜ ⬇︎clearance and eventually stasis of airway secretions
➜ [*persistent* Recurrent PNA (reoccuring despite previous tx successes)]
258
⬜ treats ALS. What the MOA?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*Amyotrophic Lateral Sclerosis*
Riluzole ; [Glutamate R Blocker]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*progressive weakness + **UMN AND LMN deficits** + [cognition/ocular/bowel/bladder preservation]*
