Incorrects Flashcards
(201 cards)
1
Q
Extraperitoneal vs intraperitoneal pain differences?
A
Intraperitoneal involves the peritoneum (rigidity/rebound tenderness). Extraperitoneal may leak into the pelvis causing lower abd pain but no peritoneal signs.
2
Q
Virus assoc with focal segmental glomerulosclerosis?
A
HIV
3
Q
Virus assoc with membranous glomerulonephritis?
A
HIV with HepB coinfxn
4
Q
Preferred HIV test?
A
One that includes the HIV p24 antigen and HIV antibodies. This will Dx acute or early infxn vs antibodies alone.
5
Q
When is HIV RNA testing to be used over HIV p24 and antibody testing?
A
It is recommended in pts with negative serologic tests and high clinical suspicion of acute HIV.
6
Q
Pseudoallergic rxns are often 2° to what?
A
Often due to NSAIDs (ASA, ibuprofen, etc.) in asthmatics, chronic rhinosinusitis with nasal polyposis, or pts with chronic urticaria.
7
Q
Aspirin-exacerbated respiratory disease path?
A
Pseudoallergic rxn due to ASA in asthmatics (atopic individuals) that causes allergic-rxn-like response due to inhibition of COX1 and 2 and shunting toward LOX pathway. This overproduces Leukotrienes which are proinflammatory.
8
Q
Due to increased RFs what are pregnant women all screened for via urine?
A
Asymptomatic bacteriuria. RFs increase possibility of pyelonephritis, preterm delivery, and low birthweight all due to infxn.
9
Q
What is Rx for acute asymptomatic bacteriuria in pregnant females?
A
Amox-clav
Cephalexin
Nitrofurantoin
Fosfomycin
10
Q
Allergic conjunctivits presentation?
A
Always bilateral
Watery discharge
Pruritis
11
Q
Bacterial conjunctivitis presentation?
A
Unilateral or bilateral
Purulent discharge
Unremitting discharge
12
Q
Viral conjunctivitis presentation?
A
Uni/bilateral
Watery/mucoid
Viral prodrome associated with Sx
13
Q
Leukocyte adhesion deficiency presentation?
A
Delayed umbilical cord separation
Recurrent skin/mucosal bacterial infxn (w/o purulence)
Severe periodontal disease
Marked leukocytosis with neutrophil predominance common
14
Q
Best contraception method in female with breast cancer Hx?
A
Copper IUD. All hormone containing contraception is absolutely contraindicated in females with breast cancer. Hx of thromboembolis, stroke, liver disease, smoking, CV disease, and HTN ≥160/100 are also contrad.
15
Q
How effective are condoms at preventing pregnancy?
A
Only 80% in typical condom use.
16
Q
What emergency (postcoital) contraceptive is the most efficacious?
A
Copper IUD. Can be used in nulliparous women and adolescents.
17
Q
Hypopituitarism characterized by?
A
Glucocorticoid deficiency
Hypogonadism
Hypothyroid
Aldosterone unaffected (Renin controlled)
18
Q
Next step in female with positive pregnancy test, free fluid in posterior cul-de-sac, and tachycardia with BP of 90/55?
A
Surgical exploration. Hemodynamic instability due to ruptured ectopic pregnancy requires emergency surgery.
19
Q
What is a cornual ectopic pregnancy?
A
Implantation of the gestational sac in the outer quadrant (cornual) areas of the uterus. This is abnormal. This does not mean the pt has a bicornuate uterus. The corners where the tubes enter the uterus is called the cornuate (horns).
20
Q
1 y/o presenting with recurrent, severe viral, fungal, or opportunistic infxns (PCP, etc.) and failure to thrive (height/weight below 5%) with chronic diarrhea likely has?
A
SCID. Failure of T cell development leads to B cell dysfxn. Absent T cells (CD 3+) and low B cells (CD 19+) leads to globally low Ig.
21
Q
SCID treatment?
A
Stem cell transplant.
22
Q
What is methemoglobinemia?
A
Oxidation of one of the iron groups on Hgb to the ferric (Fe3+) state. This has a decreased affinity for O2 than the other ferrous heme groups and leads to poor O2 delivery to tissues.
23
Q
Methemoglobinemia Sx?
A
Low SpO2 (~85% - actually an overestimation of O2 bound Hgb) Fatigue Lethargy Cyanosis Dark blue/red blood
24
Q
What causes methemoglobinemia?
A
Oxidizing agent exposure (Dapsone, nitrites, local/topical anesthetics like lidocaine, benzocaine)
25
Methemoglobinemia Rx?
Methylene blue and discontinuation of drug
26
Dimercaprol use?
Lead poisoning as chelating agent
27
Fomepizole use?
Ethylene glycol or methanol (inhibits EtOH dehy)
28
Glucagon antidote use?
ß-blocker or Ca++ channel blocker OD
29
3 treatments in CN poisoning?
Hydroxycobalamin preferred. Sodium thiosulfate is alternative. Nitrites that induce methemoglobinemia only if others not available. Cyanide binds avidly to Fe3+.
30
Cyanide toxicity pathophys?
Inhibits cytochrome oxidase a3 in ETC by binding ferric iron (Fe3+) inhibiting its reduction to ferrous iron (Fe2+). This forces cells to anaerobic metabolism, lactic acid formation, and acidosis.
31
Senile purpura pathophys?
Loss of elastic fibers in perivascular CT leads to skin fragility that leads to small ecchymosis, despite normal lab studies. Normal daily trauma leads to small bruises under the skin that would normally not result in bleeding in the young person.
32
Gold standard for Dx of Duchenne MD?
Genetic testing for Xp21 dystrophin gene. Hence, X-linked recessive.
33
Active TB treatment
Rifampin, INH, pyrazinamide, ethambutol
34
Latent TB treatment
9 months of INH and pyridoxine
35
A postmenopausal woman with symptoms of bleeding with wiping after urination and a normal pap smear. Her vaginal pH is 6 and she has sparse pubic hair and normal UA. She likely has symptoms due to?
Menopause. Loss of vaginal epithelial elasticity leads to these symptoms. Bleeding is almost solely due to menopause and rarely arises in BV, lichen sclerosis, or vulvar intraepithelial neoplasia (VIN) even.
36
Classic Sx of systemic juvenile idiopathic arthritis?
Rash
High fever
Large joint involvement
37
Hypertrophic osteoarthropathy is a clinical syndrome involving what?
Digital clubbing and bony swellings of the toes/fingers due to CF or malignancy
38
Is Hib vax safe in pregnancy?
Yes. It is inactivated, but it is indicated only in unvaccinated or high-risk patients (HIV, Sickle cell, splenectomy Hx)
39
What vaccines are OK in pregnancy?
Injectable influenza
Tdap
Rho (D) immunoglobulin
40
What is the most prognostic sign in malignant melanoma?
Breslow depth. This is the distance from the epidermal granular cell layer to the deepest visible melanoma cells.
41
When is antepartum fetal surveillance performed and why?
When fetal demise is a high risk and to evaluate for fetal hypoxia.
42
What is the typical surveillance modality in antepartum fetal surveillance?
Biophysical profile (BPP). Usually composed of:
NST (fetal tone, movement, and breathing movements.)
US (assess amniotic fluid)
***Each individual assessment worth 2 points for total of 10.
43
What is a normal non-stress test (NST) in antepartum fetal surveillance?
≥2 HR accelerations (≥15BPM over baseline and ≥15 seconds long) within a 20 minute period
44
The Biophysical profile scores mean what?
0-4: fetal hypoxia indicating urgent delivery
6: Equivocal (repeat in 24hrs)
8-10: No fetal hypoxia
45
A mother with gestational HTN requires weekly BPPs starting when?
32 weeks gestation until birth.
46
When is mag sulfate administered for fetal neuroprotection?
24-32 weeks gestation when preterm birth anticipated within 24 hrs.
47
When would doppler US be used of the umbilical artery?
If fetoplacental vascular pathology is suspected in a growth-restricted fetus (<10th percentile weight for gestational age).
48
Define growth-restriction in the fetus
<10th percentile weight for gestational age.
49
When is vibroacoustic stimulation used during NST?
To differentiate from lack of accelerations or a sleep cycle in the fetus.
50
Indications for renal/bladder US in a child?
Infants <24 months with a first febrile UTI
| Recurrent febrile UTIs in any aged child
51
Indications for daily prophylactic antibiotics in children with UTI Hx?
Recurrence or evidence of high-grade vesicoureteral reflux
52
Voding cysturethrogram is considered when in a child?
If hydronephrosis or scarring is seen on US. Or in a child<2 with recurrent UTIs or a first UTI from an organism other than E coli
53
What type of cardiomyopathy occurs from viral myocarditis?
Dilated cardiomyopathy. Dilated ventricles and diffuse hypokinesia results in systolic dysfxn (i.e. low ejection fraction).
54
Concentric hypertrophy develops in response to what most commonly?
Chronic pressure overload. Aortic stenosis or HTN often lead to concentric hypertrophy. Concentric hypertrophy develops only in chronic conditions and never acutely, unlike dilated heart failure (viral myocarditis).
55
Eccentric hypertrophy develops in response to what change?
Chronic volume overload (e.g. valvular regurgitation). This does not present acutely, only over time in response to overloading of volume.
56
Dilated cardiomyopathy most commonly results from what virus?
Coxsackievirus B. Echo is diagnostic.
57
Nitrous oxide abuse is associated with what vitamin deficiency?
B12 deficiency and can lead to polyneuropathy.
58
MR murmur?
Holosystolic heard at apex that radiates to axilla.
59
Bupropion major SE?
Sz
60
Clozapine major SE?
Neutropenia
61
Lamotrigine major SE?
Rashes (Stevens-Johnson syndrome)
62
Lithium major SE?
DI and thyroid issues
63
Trazodone major SE?
Priapism - "trazabone"
64
Management of thyroid storm?
Propanolol
PTU followed by iodine (SSKI) to reduce hormone synth/release
Glucocorticoids (to reduce T4-T3 conversion
65
Cystercercosis cause and location?
Taenia solium (pork). Cysts in brain or muscle.
66
Hydatid cyst cause and location?
Echinococcus granulosis (dogs). Eggshell calcified lesion in liver commonly.
67
Amebic liver abscess Sx?
Fever, RUQ pain after weeks of intestinal amebiasis. Eggshell calcification would not be present as in hydatid cyst.
68
Define primary ovarian insufficiency.
Cessation of ovarian fxn at an age <40. It is a form of hypergonadotropic hypogonadism (high GnRH and FSH, low estrogen).
69
Hypothalamic hypogonadism is characterized by?
Low GnRH causing low FSH and estrogen. MCC by low caloric intake or strenuous exercise.
70
PCO characterized by what hormone levels?
Elevated GnRH, normal FSH, elevated estrogen. Increased peripheral androgen to estrone conversion occurs, leading to elevated, nonpulsatile GnRH levels and favoring LH prodxn over FSH prodxn. (LH high, FSH low)
71
Dx test for Type 2 HIT?
Serotonin release assay. This is the gold std confirmatory test.
72
Management of HIT?
Stop heparin. Start direct thrombin inhibitor (argatroban) or fondaparinux.
73
First step in suspected toxic megacolon (fever, abd. distention, luekocytosis, hypotension)?
Abdominal Xray. Barium is contra'd.
74
What heparin is used in renal failure for DVT Rx?
Unfractionated heparin. This is heparin that is unchanged from its normal form as is LMWH. LMWH has less SE than heparin due to lower affinity for other receptors.
75
Wells score >4 indicates what next step?
CTA. Emperic anticoagulation is appropriate in these patients also, but CTA is the next diagnostic step.
76
Wells score ≤4 indicates what next step?
D-dimer.
77
When is IVC filter considered in DVT and PE?
When bleeding risks (ulcer, diverticulosis, etc.) are present and anticoagulation is contraindicated.
78
Six drugs needed after acute STEMI?
Dual antiplatelet (ASA and P2Y12 receptor blocker)
Statins
Anticoagulation
PCI
ß blocker (only if no bradycardia or cardiogenic shock)
79
Broca's aphasia is often associated with what deficits?
Right hemiparesis due to damage to the motor cortex nearby.
80
Wernicke's aphasia associated deficits?
Right superior visual field defect due to damage to the visual areas nearby.
81
Conduction aphasia is due to damage to?
Arcuate fasciculus connecting the two together. Poor repetition of spoken language.
82
What side of the brain is dominant in a right handed person?
The left hemisphere. This is usually the case with lefties also (70%) and is the area of the brain where verbal/written language fxn is harbored.
83
MCC if PTH independent hypercalcemia?
Humoral hypercalcemia of malignancy (due to PTHrP). Often presents with very high levels (>14) of Ca++ snd symptomatic (polyuria, constipation, nausea), but Vit D conversion is not as effective as PTH so PTH is often low-normal.
84
Reticulocytes and platelets in splenic crisis in sickle cell?
Reticulocytes: elevated
Platelets: decreased (trapped in spleen also)
85
Reticulocytes and platelets in aplastic anemia in SS disease?
R: low (reduced due to ineffective erythropoiesis)
P: normal (typically unaffected)
86
FFP is given when?
Known or suspected coagulopathy (eg INR>1.5) with bleeding
87
Cerebral angiography is useful for Dx of what?
Cerebral aneurysms and AV malformation
88
Conduct disorder is on the same spectrum of disorder of what when a patient turns 18?
Antisocial personality disorder. Violating rights of others, social norms and laws, these people are impulsive, irritable, and aggressive often fighting and showing no remorse. Evidence of conduct disorder must be present before turning 15 for Dx.
89
Vaccinations that are critical to reducing death in HepC positive patients are?
HepA and Hep B vaccines. An Acute viral hepatitis could be life threatening. Both are inactivated vaccines and can be given during pregnancy also.
90
Does breastfeeding increase risk of HCV infxn in the newborn?
No. Only if the nipples are actively bleeding is there a risk of Tx.
91
MOA of flutamide?
Anti-androgen provides androgen blockade by binding dihydrotestosterone receptors. Can be used in combo with other drugs to prolong survival in prostate cancers with limited disease.
92
What cystic ovarian changes are associated with hydatidiform moles?
Theca lutein cysts. These cysts are bilateral and multiloculated that respond to high ß-hCG from the mole.
93
Theca lutein cysts are associated with what abnormality?
Hydatidiform mole. Moles produce high hCG that result in theca lutein cell proliferation.
94
Complete hydatidiform moles are produced in what two ways?
One sperm fertilizes an egg with inactive/nonfxnal maternal chromosomes and divides and fertilizes or two sperm fertilize an egg at the same time.
95
Partial hydatidiform moles are produced in what way?
Two sperm fertilize one egg and the 3 sets of genes produce a cell with 69, XXX or XXY or XYY.
96
MCC of congenital hypothyroidism worldwide?
Thyroid dysgenesis (aplasia, hypoplasia, ectopic gland).
97
A newborn screen comes back with high TSH and low T4. Most likely Dx?
Thyroid dysgenesis. These newborns appear normal at birth, but with waning T4 from mother after birth they develop lethargy, an enlarging fontanelle, protruding tongue, poor feeding, dry skin, constipation, and jaundice. Rx: levothyroxine
98
Newborn presents with jitteriness, tachycardia, and poor feeding. Suspicion leads to a maternal drug test, which is negative. What is good to check next?
TSH-receptor antibodies. Grave's disease can lead to transplacental movement of Ig that can affect the baby.
99
Therapy for Legionnaires disease?
Macrolide or fluoroquinolone
100
Elderly patients with evidence of cognitive impairment require what testing first?
Neurocognitive testing. (Mini-mental state examination or MMSE). This is prior to TSH and B12, drug screen, thiamine, etc.
101
Wernicke syndrome cause and Sx?
Thiamine deficiency leads to encephalopathy, occulomotor dysfxn (horizontal nystagmus), and gait ataxia.
102
PPROM <34 weeks with signs of infxn or fetal compromise requires what Rx?
Antibiotics
Corticosteroids (betamethasone)
Mag (if <32 wks)
Delivery
103
PPROM <34 weeks, but no signs of infxn or fetal compromise requires what Rx?
Antibiotics
Steroids
Fetal surveillance
104
PPROM (34-37 wks) requires what Rx?
Antibiotics
+/- Steroids
Delivery
105
PPROM complications include?
Infxn (chorioamnionitis, endometritis)
Cord prolapse
Abruptio placentae
106
When is external cephalic version be performed to correct malpresentation birth?
≥37wks delivery
107
Combined hormonal contraceptives are contraindicated in what cases?
```
Breast cancer
Migraines w/ aura
Smokers>35
HTN
CV disease, DVT/stroke
DM w/ end organ dmg
Antiphospholipid antibody syndrome
Cirrhosis
Recent major surgery
<3wks postpartum
```
108
Typical Sx of Lyme disease?
Early: Erythema migrans
Fatigue
Flu-like Sx
Migratory arthritis (aspirate ~25K WBCs, negative gram stain)
Worsening rash, CN palsy, and carditis (AV block) indicate progression
Late: Arthritis, encephalitis, neuropathy
109
Lyme Rx in the absence of neurologic Sx?
Doxy or amoxicillin are first line. Ceftriaxone is used with neuro Sx due to penetration into CNS.
110
What is the biggest difference between grief and MDD?
Functional decline is far less noticeable. MDD is severe and suicidality is related to hopelessness rather than "joining the deceased". MDD must be treated with SSRI.
111
Mirtazapine MOA
Tetracyclic antidepressant causes alpha 2 antagonism resulting in NE/serotonin release. Mixed alpha1, and histamine agonism with antimuscarinic effects also.
112
Sustained hand grip causes?
Increased afterload
113
Squatting from standing causes?
Increased afterload and preload
114
Passive leg raise causes
Increased preload
115
Valsalva (straining phase) causes?
Reduced preload
116
Abrupt standing causes?
Reduced preload
117
NItroglycerin causes what effect on preload/afterload?
Reduced preload
118
What effects increase HOCM murmur?
Decreased afterload and/or decreased preload (both result in decreased LV size, thus, increasing obstrxn and murmur)
119
What effects increase MVP murmur?
Increased afterload and increased preload
120
AR, MR, VSD are all increased by?
Squatting and handgrip
121
All right sided murmurs are increased by?
Increased venous return (aka preload increase)
122
First-line Rx for acute angle closure glaucoma?
Acetazolamide.
123
MC kidney stone formed by?
Calcium oxalate. Envelope-shaped on microscopic exam. Fat malabsorption leads to increased oxalate absorption leading to Ca++ chelation.
124
CaPO4 stones are common in?
Hyperparathyroidism
| Renal tubular acidosis (Type 1)
125
Uric acid stones are formed commonly in?
Increased cell turnover leads to hyperuricemia and hyperuricosuria.
126
Cysteine stones form when?
Usually familial AA reabsorption issues. Cysteinuria is a classic example.
127
Struvite stones form when urine is?
Alkaline from urease producing bacteria (proteus)
128
Adverse clinical events are most commonly associated with what problem in the hospital environment?
Communication failures.
129
What is the best way to reduce communication errors in the hospital environment?
Checklists prevent undesired medical outcomes from communication failures during the handoff process.
130
Renal transplant dysfxn typically presents as?
Oliguria
HTN
Increased Cr/BUN
131
First line Rx in acute organ transplant rejection?
High dose steroids
132
Renal transplant rejection in early postop period is most commonly due to?
```
Ureteral obstrxn
Vascular obstrxn
Cyclosporine toxicity
Acute rejxn
Cyclosporine toxicity
Acute tubular necrosis
***US, MRI, biopsy, and radioisotope scanning helps differentiate.
```
133
Minimal change disease assoc. with what disease?
Lymphoma
134
Membranoprolif. glomerulonephritis commonly assoc. with what disease?
Hep B and C
135
Focal segmental glomerulosclerosis commonly assoc. with what disease?
HIV
| Heroin use
136
IgA nephropathy commonly assoc. with what disease?
URI
137
Gold std for testing in suspected ovarian torsion?
US showing mass with absent doppler flow.
138
Appropriate compensation in acute respiratory acidosis?
Serum HCO3 increases by 1 for each 10 PaCO2 rise
139
Appropriate compensation in acute respiratory alkalosis?
Serum HCO3 reduced by 2 for each 10 PaCO2 decreased
140
Appropriate compensation in metabolic acidosis?
Winter's formula: PaCO2 will equal 1.5xHCO3 +8 +/- 2
141
Appropriate compensation in metabolic alkalosis?
Increased PaCO2 by 0.7 for each 1 mEq HCO3 elevation
142
Rx for radial head subluxation?
Hyperpronation of forearm OR supination of forearm with flexion of elbow.
143
Steppage gait (prominent lifting of leg when walking due to foot drop) is commonly due to?
L5 radiculopathy OR neuropathy of common peroneal nerve
144
Difficulty initiating forward movement of the feet (magnetic gait) is due to damage where?
White matter fibers of the frontal lobe (cortico-cortical fibers). Often due to normal pressure hydrocephalus.
145
Cerebellar hemisphere pathology leads to?
Limb ataxia
146
Cerebellar vermis pathology leads to?
Truncal ataxia.
147
Precipitous drops in sodium levels can result in what pathology?
Cerebral edema.
148
Management of severe hypovolemic hypernatremia?
Normal saline. Anything else (hypotonic solutions) could lead to cerebral edema.
149
Drugs to reduce vasospasm after subarachnoid bleed?
Nimendipine or other Ca++ channel blockers
150
AV malformation is the MCC of intracerebral hemorrhage in what population?
Children
151
Wallenberg syndrome cause?
Posterior inferior cerebellar artery (PICA) injury. Leads to lateral medullary syndrome (vertigo/nystagmus, ipsilateral cerebellar signs, loss of pain/temp in ipsilateral face and contralateral body, bulbar weakness, ipsilateral Horners).
152
Donepezil (Aricept) use?
Alzheimer's disease. Improves cognitive fxn.
153
Widespread or recalcitrant seborrheic dermatitis management?
Low dose steroids creams or topical ketoconazole
154
Young female athlete with amenorrhea for several months denies visual changes, heat intolerance, hot flashes, or night sweats usually has her period q 28 days for 4 days. Her vitals are stable. BMI is 20. Habitus is muscular. She has mild acne, no thyromegaly or facial hair. She is Tanner stage V. Pregnancy test negative. TSH/prolactin are normal. Dx?
Hypothalamic amenorrhea. Due to low GnRH resulting in low LH/FSH and estrogen. She has athlete's triad (amenorrhea, osteoporosis, and an eating disorder.
155
Athlete's triad?
Amenorrhea (low GnRH secretion --> low LH/FSH --> low estrogen)
Osteoporosis (low estrogen)
Eating disorder (caloric deficiency relative to expenditure)
156
Two-sample "T" test and "Z" test are used for what?
Both are used for comparing the means of two groups. T test is used for samples and Z tests for population, rather than a subset (sample).
157
ANOVA is used for what?
Comparing 3 or more means
158
Chi-squared test is used for what?
Categorical data/proportions
159
4 C's of measles (rubeola)?
Cough
Coryza
Conjunctivitis
Koplik spots
160
B6 deficiency leads to?
Neurologic impairment and skin/mucus breakdown (stomatitis, cheilosis)
161
Vitamin E deficiency leads to?
Hemolytic anemia and ataxia (and other neuro sx)
162
First line Rx in exercise induced asthma?
Short acting ß agonist 10-20 mins before workout. Steroid inhalers or montelukast are appropriate in athletes who exercise daily in addition to the SABA.
163
Can fibroids lead to problems during pregnancy?
Obstetrical complications like miscarriage, malpresentaiton, abruption, and preterm birth can occur all due to fibroids.
164
Classic signs of molar pregnancy are?
Vaginal bleeding
Hyperemesis gravidarum
Diffusely enlarged uterus with regular contour
165
PE signs in a patient with Leiomyomata?
Irregularly enlarged uterus
Size-date discrepancy
Pressure on colon/bladder resulting in sensations of incomplete boiding
166
RFs for uterine inversion?
Nulliparity
Fetal macrosomia
Placenta accreta
Rapid labor/delicery
167
Placenta accreta RFs?
Uterine surgery (Csxn, myomectomy, D&C)
168
In uterine prolapse after childbirth where placenta is still attached to the uterus, when should the placenta be removed?
After replacement of the uterus. Otherwise massive hemorrhage may ensure. Uterotonics (oxytocin and misoprostol) should be given afterwards to prevent hemorrhage.
169
Classic aspergillosis Sx?
Pulm. disease (fever, pleuritic pain, hemoptysis)
| Nodular/focal infiltrates on CXR
170
Cryptosporidium classic Sx?
Diarrheal disease in immunosuppressed
171
Delayed and diminished carotid pulse, soft second heart sound, and a mid or late systolic murmur with maximal intensity at the 2nd right IS, most likely?
Aortic stenosis. The soft heart sound is due to thick/calcified leaflets with severely reduced mobility.
172
First line Rx for trigeminal neuralgia?
Carbamazepine or oxcarbazepine. 2nd line: nerve decompression/ablation
173
Pathophys behind trigeminal neuralgia?
Compression if CNV (trigeminal). Usually leads to V2-3 nerve pain, but V1 can occur rarely and lead to lacrimation or rhinorrhea.
174
Evidence of a small VSD over a large VSD include?
Harsh and loud murmur at LLSB
Normal ECG
Absence of concerning Sx (tachycardia, tachypnea, failure to thrive, heave)
175
Management of suspected VSD?
Echo for Dx
Most close spontaneously by 2 years
Large or symptomatic VSDs can lead to Eisenmenger syndrome and may need surgery
176
Innocent "flow" murmur of childhood sound?
Low grade (1 or 2) midsystolic ejection murmur
177
Rx for at risk children with RSV?
Palivizumab. Premies, lung disease of prematurity, congenital heart disease are indivations for use.
178
Prophylactic Rx for cluster HA?
Verapamil
Lithium
***Should be started after onset of acute attacks.
179
Cluster HA paroxysms?
Attacks begind during sleep, peak rapidly, last 90 minutes or so and occur up to 8x daily for 6-8 weeks followed by a remission period. Verapamil and lithium can be used prophylactically to reduce episodes after the first attacks begin.
180
Sx associated with small fiber injury from long-term DM?
"Positive" symptoms: pain, paresthesias, allodynia (painful response and sensitization to non-painful stimuli)
181
Sx associated with large fiber injury from long-term DM?
"Negative" symptoms: numbness, loss of proprioception/vibration sense, diminished ankle reflexes
182
RFs for preterm labor?
```
Prior PTL
Multiple gestation
Short cervix
Cervical surgery
Cigarettes
```
183
Screening for preterm labor?
TVUS for short cervix. If ID'ed then cerclage is Rx.
184
Leading cause of neonatal M&M?
Preterm birth (<37wks GA).
185
Basal ganglia dysfxn usually leads to what signs?
Extrapyramidal signs. Resting tremor, rigidity, bradykinesia, choreiform movements.
186
Cerebellar dysfxn usually causes what?
Ataxia
Intention tremor
Dysdiadochokinesia
187
What local changes may be expected in area surrounding PE?
Pleural effusion due to hemorrhage/inflammation.
188
A child with an IgA nephropathy and palpable purpura, arthritis, and abdominal pain and/or intussusception likely has?
Henoch-Schönlein purpura. Results in a glomerular disease due to IgA-mediated leukocytoclastic vasculitis.
189
Nodular lesion on the skin with hyperpigmented appearance and firm to the touch. It dimples in the middle when pinched. Dx?
Dermatofibroma. Fibroblastic proliferation causes lesions. May result from trauma. BCC does not dimple as does dermatofibroma.
190
What arrhythmia is common after CABG?
Atrial fibrillation. Usually self-limited and resolves in <24hrs.
191
Pt presents with fever, CP, leukocytosis, and mediastinal widening on chest Xray. He recently had CABG. Dx?
Acute mediastinitis. Rx: Drainage, debridement, ABx
192
Easy ulcer staging method?
Each stage is another layer of the skin. For example, stage 1 is the outer epidermis irritation, 2 is down into dermis, 3 is into SubQ fat, 4 is full thickness into muscle, bone, tendon.
193
Allergic contact dermatitis appearance?
Well demarcated
Erythema
Papules/vesicles
Chronic lichenification
194
Irritant contact dermatitis apperance?
Often on hands
Erythema
Fissures
195
Metformin is contra'd in acute renal failure, liver failure, and sepsis due to risk of ?
Lactic acidosis. Short stent of insulin can replace it for DM Rx.
196
Classic signs of iron overdose?
Hours: Hematemesis, melena, hypotensive shock (iron is a potent vasodilator), anion-gap metabolic acidosis
Days: Liver necrosis
Weeks: Gastric scarring and pyloric stenosis
197
Iron chelator?
Deferoxamine
198
Vitamin A OD?
N, V, blurry vision
| Chronic can lead to increased intracranial pressure (pseudotumor cerebri.
199
Underlying pathology in lacunar stroke?
HTN, DM, high LDL, and smoking all lead to microatheroma and lipohyalinosis formation in small vessels of brain (BG, Pons, subcortical white matter).
200
Drugs used for ovulation induction if pregnancy unsuccessful in PCOS?
Clomiphene.
201
Sx in failure of müllerian duct fusion?
Müllerian agenesis leads to primary amenorrhea, foreshortened vagina with no palpable uterus, and normal hormone levels.
