Incorrects 7 Flashcards
(200 cards)
1
Q
All sexually active women ≤24 should undergo SCREENING for?
A
Chlamydia and gonorrhea. This is an unsolicited test so they could be asymptomatic.
2
Q
Universal screening for dyslipidemia occurs when?
A
Age 9-11 and 17-21 as well as men ≥35.
3
Q
At what age is the one-time screening for osteoporosis using DEXA done in women?
A
Age≥65 OR in women with RFs with 10 year risk of Fx.
4
Q
Frequently what supplementation is needed in unresponsive anemia in CKD with EPO Rx?
A
Iron supplementation. This is especially true of people on dialysis.
5
Q
Telling apart Fanconi anemia and Diamon-Blackfan anemia just based on labs?
A
DBA has pure red cell aplasia within the first 3 months of life. FA has pancytopenia between 4-12 years.
6
Q
Transient erythroblastopenia of childhood presents with red cell aplasia in 6months to 5 year olds. How is this different from Diamond Blackfan?
A
There is no congenital anomalies in TEC. DB has many (triple jointed thumb).
7
Q
Ash leaf spots (areas of hypopigmentation in leafy pattern/shape) are associated with?
A
Tuberous sclerosis.
8
Q
Port-wine stains are assocaited with?
A
Sturge-Weber syndrome
9
Q
Uremic pericarditis does not typically cause what?
A
ECG changes as the inflammation does not occur in the myocardium.
10
Q
What is the proper management in pericarditis due to uremia?
A
Dialysis. NSAIDs and Colchicine are only for viral or idiopathic forms. Uremia is not inflammatory.
11
Q
Urine alkalization (pH>8) in the presence of recurrent UTIs raises suspicion for?
A
Proteus infxn. Ureas production can lead to this result.
12
Q
Winter’s formula?
A
The appropriate CO2 for a purely metabolic acidosis will fall within the range calculated by Winter’s formula. PaCO2 = 1.5 (serum HCO3-) + 8 +/-2
13
Q
A 15yo girl with a mass in the upper outer quadrant of her right breast comes in with concerns over it. What is the appropriate way to handle this?
A
This is likely a fibroadenoma. If the mass decreases in size and/or tenderness after menstruation, the patient can be reassured that it is likely benign.
14
Q
When is octreotide used in variceal Rx?
A
Active bleeding from varicele. This causes splanchnic vasoconstriction due to reduced glucagon release.
15
Q
A foreign immigrant who is pregnant comes to the office with Sx of A. fib. with RVR. Medical Hx includes recurrent sore throat and tonsillectomy. What could cause her A. fib.?
A
Mitral stenosis secondary to Rheumatic heart. Often pregnant women present with new onset AF during pregnancy due to increased HR and blood volume resulting in increased L. atrial pressure, enlargement, and A. fib.
16
Q
Intermediate risk of malignancy is defined as?
A
Between 0.8-2cm
Age 40-60
Current smoker
Quit between 5-15yrs ago
Scalloped quality to nodule (not spiculated as in high)
***Any numbers below this size or age are low malignancy potential. Any above are high. Cessation within past 5 years = high. Over 15 years = low.
17
Q
If a solitary lung nodule is 8mm or larger, what testing is next?
A
PET scan (with FDG) or biopsy. If suspicious, excise. If not, do serial CTs.
18
Q
Sx of digoxin toxicity?
A
GI upset, nausea, confusion, weakness, visual changes. This may be due to loop diuretic use and is exacerbated by hypokalemia. Measure PT/INR and do an ECG as well to check for arrythmia risk and coagulopathy.
19
Q
Any woman with Hx of GBS bacteriuria or invasive early-onset GBS disease in a prior child needs?
A
Intrapartum antibiotic prophylaxis aka penicillin. Women who miss testing need to be treated or even those with ROM ≥18 hours or intrapartum fever.
20
Q
Where is the typical obstruction in a child born with cystic fibrosis?
A
Ileum. The meconium illeus occurs there leaving the colon narrow and delaying the passage of meconium.
21
Q
Meconium ileus at birth is virtually diagnostic of?
A
Cystic fibrosis. Almost all newborns with meconium ileus have CF.
22
Q
A newborn presents with bilious vomiting several days after birth. He has narrowing at the rectosigmoid jxn. What is his likely congenital illness?
A
Hirschsprung disease. This is associated with Down syndrome.
23
Q
What is the characteristic PE sign in Hirshsprung disease?
A
Squirt sign. This is a forceful expulsion of stool after rectal exam.
24
Q
Children with CF have frequent debridement of what?
A
Sinuses. This is due to poor mucociliary clearance. Imaging of the sinuses frequently shows opacification of all sinus spaces.
25
What is the DX for intussusception?
Air or saline enema. This may reduce the intussusception, but if it does not surgery is indicated.
26
What is RX for intussusception?
Surgery to remove the pathological lead point. This may not always be identifiable. Peyer patch hypertrophy are the nidus for the pathologic process.
27
What song can help with asthma severity and treatment?
I: 2 (wk) and 2 (mo)
Mild: 3 (week) and 3 (month)
Mod: 4 (week) and more than 1 a week
Sev: Daily and nightly
28
When do seizures begin after alcohol withdrawal?
12-48 hours after last drink. Followed by DTs 48-96 hours after last drink.
29
Best Rx for alcohol withdrawal?
Lorazepam.
30
In a patient with ascites, a neutrophil count under what level indicates the episode is not due to peritonitis?
Under 250/mm3 indicates no peritonitis.
31
How do you calculate the SAAG (serum-ascites albumin gradient)?
Subtract peritoneal albumin from the serum albumin concentration. If ≥1.1g/dL then this indicates portal HTN and a hydrostatic cause. If 1.0 or lower, then another cause is responsible.
32
Vertical Tx of what two illnesses cause calcifications on neuroimaging?
CMV and toxoplasma
33
Congenital rubella presents with?
Hearing loss, heart defects (PDA), microcephaly, cataracts, and blueberry muffin rash.
34
Congenital syphillis is called?
"Snuffles". Rash, drippy nose, and hepatomegaly as well as long bone abnormalities occur.
35
Congenital varicella presents with?
Growth restriction, skin lesions, ocular defects, and limb malformations.
36
Congenital Zika presents with?
Sz, microcephaly, hypertonia, contractures, and hearing loss.
37
When can the liver dysfxn manifest in alpha-1-antitrypsin deficiency?
Infancy and childhood. Emphysema develops later in life. Cirrhosis and periportal eosinophilic inclusions are seen on liver biopsy.
38
Macrovesicular fatty changes are seen in?
Alcoholic hepatitis and NASH (obese Pts).
39
Where are Gartner duct cysts found?
Generally in the upper anterior vagina. They do NOT involve the vulva as do Bartholin gland cysts. They are remnants of the Wolffian ducts.
40
A young child presents with 2 weeks of fever occuring once a day and arthritis of his right knee and left wrist. He has a rash at night with a fever. Dx?
Systemic-onset juvenile idiopathic arthritis. Usually presents with over 2 weeks of fever occurring daily (quotidian fever) accompanied by at least one enflamed joint and a pink, macular rash worsening during the fever. ESR may be up and anemia or leukocytosis or thrombocytosis may occur.
41
A young child with thrombocytopenia must rule out what?
ALL. Cytopenias, particularly thrombocytopenia, gives rise for malignancy concern.
42
A nonreactive NST normally lasts?
20 minutes.
43
A nonreactive NST can be extended to?
40-120 minutes if during a sleep cycle.
44
NST should be followed with?
BPP or contraction stress test to conclude the fetus isn't hypoxic (placental insufficiency, cardiac issues)
45
Typical symptoms of milk-alkali syndrome?
Polyuria, polydipsia, constipation
46
Where is the tissue biopsy done in amyloidosis?
Abdominal fat pad.
47
Top 3 pediatric cancers in the first year of life?
Leukoemia
Brain tumors
Neuroblastoma (usually adrenal)
48
What time frame is Wilms tumor common?
2-5 years.
49
Though both pleural effusion and consolidation present with dull percussion, what differentiates them?
Consilidation presents with increased breath sounds and egophony as well as increased tactile fremitus. BS are decreased in pleural effusion and fremitus decreased.
50
Interstitial lung sounds?
Resonant to percussion and normal/decreased breath sounds. Crackles are present.
51
Mucus plugging causes?
Atelectasis in downstream alveoli.
52
Cutaneous larva migrans is?
Hookworm larvae(Dog: Ancylostoma caninum or Cat: A. braziliense). Often acquired from walking barefoot on a sandy beach. Present with itchy, red, serpiginous tracks under the skin.
53
What is indicated for Rx of stable Pt WITHOUT comorbidity in Hgb<7?
Packed RBCs. If the Pt has ACS, give if under 9g/dL.
54
FFP indications?
Severe coagulopathy (DIC, liver disease) with active bleeding. INR over 1.6 is usually the indication.
55
When are whole blood transfusions used?
This blood containing PBCs AND plasma us used in severe hemorrhage for volume expansion. (usually trauma).
56
Proper management of pericarditis due to uremia?
Hemodialysis. Colchicine is reserved for inflammatory or idiopathic causes. BUN>60 can lead to uremic pericarditis, but they do not always correlate. Uremic pericarditis often does NOT have EKG changes as is expected in inflammatory and idiopathic pericarditis.
57
Physiology in angiotensin II release?
Preferential constriction of efferent renal arterioles (some afferent). This reduces net renal blood flow, but maintains GFR by increasing intraglomerular pressure. Na+ reabsorption is stimulated in the PCT. Aldosterone release stimulated by the adrenals leads to Na+ reabsorption in the collecting tubule and decreased distal Na+ delivery and increased ECF overall.
58
How can Marfan and Homocysteinuria be differentiated?
They share pes deformities, stature/arm:height ratio, joint hyperlaxity, skin hyperelasticity, etc. Marfan has UPPER lens dislocation and NORMAL intellect. Homocysteinura has intellectual disability and DOWNWARD lens dislocation. A CVA in a child with this habitus must consider homocysteinura.
59
Ehlers Danlos Sx?
Scoliosis, joint laxity, and skin hyperelasticity. No tall stature, lens dislocation, or hypercoagulability.
60
Fabry disease Sx?
Angiokeratoma
Peripheal neuropathy
Asymptomatic corneal dystrophy
61
Musty body odor with eczema and intellectual disability are typical in?
PKU. Phenylalanine hydroxylase deficiency.
62
Tay-Sachs enzyme deficiency?
ß-hexosaminidase A. "The Hex of the Ashkinazi Jews."
63
Krabbe disease enzyme deficiency?
Galactocerebrosidase deficiency.
64
CML gene fusion?
BCR-ABL (t9;22). Leads to Tyrosine kinase constitutive activation of cancer genes.
65
Rx for CML?
Imatinib (TK inhibitor).
66
Acute promyelocytic leukemia Rx?
All-trans retinoic acid (Vitamin A essentially).
67
What does CXR reveal in fat embolism?
Nothing initially. Usually unremarkable. Reveals bilateral pulmonary infiltrates within 24-48 hours.
68
Rx in primary ovarian failure?
HRT. Provides menopausal symptom relief and bone loss protection.
69
Which hormone in the thyroid pathway causes increased prolactin that affects menstrual cycles in women?
TRH secretion is stimulated by low T3/T4 in hypothyroid state leading to prolactin release, which inhibits GnRH prodxn. Thus, FSH/LH fall.
70
Consider what testing if Molluscum is widespread or involving the face?
HIV.
71
Young man with low back pain and reduced Vital capacity with normal FEV1/FVC, but increased or normal FVC likely has?
Ankylosing Spondylitis.
72
Restrictive pattern due to pulmonary fibrosis causes?
FVC and FEV1 each are low, but their ratio is normal. FRC, TLC, and RV are all typically reduced in fibrosis.
73
COPD PFTs?
FEV1<80
| FEV1/FVC<70
74
Post strep glomerulonephritis occurs how long after infxn VS IgA nephropathy?
PSG: 10-21 days after URI - common in kids 6-10
IgA: 5 days - common in men age 20-30
75
Dx labs in IgA nephropathy and post strep glomerulonephritis?
IgA: Normal complement and mesangial IgA deposits
PSG: Low C3, subepithelial humps made of C3
76
What is acute interstitial nephritis?
Inflammation after drug exposure. Eosinophilia is classic as are WBC casts. Rash may occur.
77
Alport syndrome Sx?
Hearing loss, eye problems, and hematuria with progressive renal insufficiency.
78
Benign recurrent hematuria presents as?
Isolated microscopic hematuria. No worsening kidney fxn or gross hematuria.
79
Henoch-Schönlein purpura presents as?
Skin, joint, intestine, and glomerular disease. Children get red/papular skin rash, abd. pain, arthralgia/arthritis, and microscopic hematuria/proteinuria.
80
Lupus nephritis Sx?
Low C3/C4 in the presence of systemic signs. POsitive ANA, Anti-dsDNA or anti-Sm occur.
81
Goals of aortic dissxn management initially?
Pain control
Reduce systolic BP (ß-blocker first, then nitroprusside if SBP>120). Reduce LV contractility to reduce aortic wall stress (this is where the ß-blocker comes in).
82
What parts of the colon are at risk of ischemia after AAA surgery?
Left and sigmoid colon.
83
Aortic stenosis occurs due to what in Pts under 70?
Bicuspid aortic valve. Rheumatic heart can cause it, but usually MS occurs instead.
84
What is both the earliest sign of and pathophysiologic mechanism of glomerular injury in diabetics?
Glomerular hyperfiltration. Intraglomerular HTN occurs resulting in progressive damage and renal fxn loss. ACEI work by reducing this intraglomerular HTN and reduce the changes. Thickening of the glomerular BM is the first visible change to be quantifiable, then mesangial expansion, then nodular sclerosis.
85
Infertility is defined as?
No pregnancy after 12 months if under 35yo. If over 35yo, then 6 months.
86
Mid-luteal phase serum progesterone and basal body temp are for?
Ovulation tracking.
87
Evaluation of infertility due to tubal problems is done by?
Hysterosalpingography.
88
If mom feels decreased fetal movements in her belly she needs what testing?
NST. This is done regularly in high-risk pregnancies starting at about 32 weeks as well.
89
What is a contraction stress test?
Oxytocin challenge test. The mother is given Oxytocin to cause 3 contractions every 10 minutes and the effect on fetal HR are recorded. Delivery is recommended if late decelerations occur.
90
40s woman presents with dry mouth, dental caries, dry skin and vaginal pain with intercourse. She has regular periods, no pain with periods, and desire to have sex. Dx?
Sjögren syndrome. Dry mouth, salivary hypertrophy, skin xerosis, and keratoconjunctivitis sicca are classic exocrine signs. Raynaud's, cutaneous vasculitis, arthralgias/arthritis, and interstitial lung disease may occur also.
91
Antibodies in Sjögren's disease?
Anti-Ro (SSA) and anti-La (SSB).
92
Vulvodynia Sx?
aka Vestibulodynia. This is painful entry dyspareunia. Painful superficial touching of the vagina vestibule, but not due to dryness.
93
Lichen sclerosis Sx?
Dyspareunia due to itching. White vulvar plaques occur also.
94
Vaginismus Sx?
aka penetration disorder. Dyspareunia due to vaginal muscle spasm. Can even prevent speculum entry.
95
How is Catatonia managed?
Lorazepam (or a benzo) first. If refractory, ECT. Antipsychotics can worsen catatonia and should be avoided.
96
A healthy child with no Hx of Varicella vaccine or the illness requires what on exposure to it?
The varicella vaccine. If the child is immunocompromised, then VZIG is given. If he has prior Hx of it or has had 2 doses previously, just observe the Pt.
97
Infants (<1) exposed to VZV require?
Neither the vaccine nor VZIG. They are at lower risk of getting it. Neonates and nonimmune pregnant women need VZIG however.
98
Pertussis causes what on labs?
Lymphocyte-predominant leukocytosis.
99
Biggest RF for Histoplasma capsulatum?
Bat or bird droppings. Usuualy Hx of farming, chicken coop exposure, bird roosts, or caves.
100
Testing for Histoplasma?
Urine or blood Histoplasma antigen testing AND serology. Biopsy would reveal granulomas with narrow-based budding yeasts.
101
Rx for Histoplasmosis?
Oral itraconazole or IV amphoteracin B.
102
What formulas are used to calculate proper PaCO2 in metabolic acidosis and metabolic alkalosis?
M. acid: PaCO2 = [1.5 * HCO3 ] + 8 (+/- 2)
| M. alkalosis: PaCO2 = [0.9 * HCO3] + 16 (+/- 2)
103
Diarrhea causes what metabolic disorder?
Metabolic acidosis (loss of HCO3)
104
Vomiting causes what metabolic disorder?
Metabolic alkalosis (loss of HCl).
105
How can transiet synovitis of the hip be differentiated from a septic joint? Rx?
Well appearing, afebrile and able to bear weight are more benign findings in transient synovitis of the hip. If septic, they'd be non-weight bearing and febrile with ill appearance. Sepsis is usually unilateral also and synovium reveals WBCs>50K. Dx of sepsis involves synovial analysis, but only done in suspected cases.
106
Signs of hydrocephalus in a baby?
Tense/bulging fontanelles, prominent scalp veins, widely spaced cranial sutures, rapidly increasing head circumference. Dx is done with head CT.
107
Pt with HIV presents with confusion, paresis, ataxia, and seizures. A CT shows white matter lesions with no enhancement/edema. Dx?
Progressive multifocal leukoencephalopathy. JC virus reactivates and destroys oligodendrocytes causing demyelination. LP can be done for PCR for JC virus. Rx involves antiretrovirals in HIV.
108
Cerebral toxoplasmosis Sx imaging?
Multiple ring-enhaced lesions with edema
109
Herpes encephalitis imaging?
Unilateral temporal lobe enhancing lesions with mass effect
110
HIV associated dementia imaging?
Cerebral atrophy with ventricular enlargement
111
MS imaging?
Well circumscribed (not irregular) white matter lesions
112
Primary CNS lymphoma imaging?
Well-defined, enhancing focal lesion (not multiple or asymmetric)
113
Subacute sclerosing panencephalitis imaging?
Brain scarring and atrophy occur years after measles infxn
114
What is aldosterone escape?
A phenomenon that occurs during hyperaldosterone state where Na+ reuptake does not result in severe hypernatremia (may be mild) due to an increase in blood volume, which stimulates GFR increase and ANP release resulting in Na+ excretion.
115
Causes of postop fever in first 2 hours
Prior infxn/trauma
Blood products
Malignant hyperthermia
116
Causes of postop fever 1 - 7 days?
Nosocomial infxn (Catheter)
GAS/C. perfringens
Noninfxn (MI, DVT, PE)
117
Causes of postop fever 1 week - 1 month?
Catheter infxn (nonGAS/C. perfringens)
C. difficile
Drug fever
PE/DVT
118
Causes of postop fever past a month?
Viral infxn
| Weird, indolent organism
119
5 Ws of postop fever?
```
Wind (PE, Pneumonia, aspiration)
Wound
Water (UTI)
Walk (DVT)
Wonder drugs (drugs, blood products, IV lines)
```
120
Healthy 30s Man steps on rusty nail and gets puncture wound. Rx?
Clean wound: Give Tdap if they've had 3 doses previously and their last dose ≥10 years ago (if severe/dirty wound give if ≥5 years ago).
121
30s Man with HIV steps on rusty nail. Rx?
Td or Tdap vaccine. Only give Tetanus IG if really nasty wound/severe.
122
Is alcoholic cardiomyopathy reversible?
Yes. Stop drinking and the cardiomyopathy can reverse.
123
Is tachycardia-mediated cardiomyopathy reversible?
Yes, potentially. Restoring sinus rhythm or controlling ventricular HR in someone with longstanding A.fib can reverse the disease process.
124
Two studies are done, one with a wider confidence interval than the other. Which is more precise?
The narrower the CI, the more precise.
125
Accuracy (validity) is a measure of?
Systematic error (bias). Accuracy is reduced if the result does NOT reflect the true value of the parameter measured. Increasing sample size improves precision, not accuracy.
126
MCC of osteomalacia?
Vitamin D deficiency. Malabsorption, intestinal bypass surgery, celiac sprue, chronic liver or kidney diseases are the MCCs of Vit D deficiency.
127
Sx of osteomalacia?
Low Vitamin D causes reduced Ca++ and PO4- absorption in the intestine leading to secondary hyperPTH causing bone resorption/PO4 wasting. Decreased bone density with codfish vertebrae and pseudofractures occur. Bone pain, muscle weakness are common.
128
What is a stratified analysis?
Separating groups (smokers who are alcohol drinkers from smokers who are not alcohol drinkers) and seeing which group develops the disease in question. This is a method to unmask confounders (smoking does NOT cause cirrhosis).
129
Outpatient Rx for CAP?
Healthy: Macrolide OR Doxycycline
Comorbid: Levo/moxifloxacin OR Beta-lactam and macrolide
130
Inpatient (nonICU) CAP Rx?
Levo/moxifloxacin OR
| ß-lactam and macrolide
131
Inpatient ICU CAP Rx?
ß-lactam and macrolide OR ß-lactam and Levo/moxifloxacin
132
CURB-65 criteria are for?
Determining hospitaliation in pneumonia.
133
CURB-65 criteria are what?
```
Confusion
Urea>20
Respirations>30
BP<90/<60
Age>65
***Anything over 1 generally inpatient Rx. 3-4 has high mortality requiring inpatient Rx. Over 4 = ICU admittance.
```
134
A child presents to the office with pertussis. Prophylaxis for her family involves?
Macrolide for all family members, including young children.
135
Early Rx of pertussis (during catarrhal stage) will?
Reduce course of illness.
136
Later Rx of pertussis (after catarrhal stage) will?
Reduce transmission only.
137
How long is a child with pertussis contagious after ABx regimen begins?
5 days.
138
Alcoholic liver disease causes what kind of AST and ALT levels?
Under 500. Only in tylenol OD, ischemia, or viral disease are levels really high (25x the upper limit).
139
Alcoholic liver disease would present with an elevation in what acute phase reactant?
Ferritin. GGT is also elevated in liver disease.
140
CHF with low CO has a poor prognosis with what lab?
Hyponatremia. ADH, renin, and norepinephrine release all lead to free water retention leading to dilutional hyponatremia. Restriction of water and salt tablets can reduce SIADH, but Rx mainstay is fluid restriction, ACEI, and loop diuretics.
141
What hormone is primarily responsible for anovulatory cycles in the first year after menarche?
Low progesterone (unopposed estrogen). Normally, progesterone prodxn occurs after ovulation by the corpus luteum. The endometrium differentiates into secretory endometrium and degenerates after the corpus luteum slows progesterone prodxn. This is why progesterone trials and withdrawal can treat low progesterone states.
142
Pregnant female at 35weeks gestation arrives with abd and back pain and vaginal bleeding. The fetus has had some decelerations. Her fundal height is 38cm. Dx?
Abruptio placentae. Typical presentation is described. Vaginal bleeding may be concealed. Her fundal height is greater than expected due to blood between the uterus and placenta.
143
Pregnant female at 35 weeks gestation arrives with abd pain and back pain and vaginal bleeding. Bimanual reveals loss of uterine station and diminishing contraction frequency. Dx?
Uterine rupture. This usually accompanies Hx of uterine surgery. Similar presentation as abruption, but loss of fetal station and diminishing contractions as well as palpable fetal parts may occur.
144
Pregnant female at 25 weeks gestation arrives with painless vaginal bleeding. She has prior Csxn Hx and is pregnant with twins. Next step? Dx?
US to evaluate for placenta previa (painless vaginal bleeding at 20 weeks GA). Intercourse and digital cervical exam are contraindicated due to risk of placental rupture. If bleeding occurs, inpatient admission recommended. Csxn scheduled at 36-37weeks GA.
145
Biophysical profile evaluates what?
BF ATM.
Fluid (NST): ≥2x1cm or amniotic fluid index>5.
Movement: 3 or more general body movements
Tone: 1 or more flexion/extension of limbs/spine
Breathing: 1 or more breathing episodes for 30+ seconds.
***A score under 6 indicates Csxn required due to poor oxygenation.
146
Decreased, absent, or reversed end-diastolic flow is seen on Doppler of umbilical artery. What does this mean?
Possible IUGR.
147
A patient with new onset HTN requires what labs?
UA (hematuria, Protein/Cr ratio), chemistry panel (electrolyte abnormalities), lipid profile (CAD risk), and baseline ECG (CAD and LVH).
148
When are oral antibiotics given to children with an ear infection?
Any child under 6 months gets ABx. Any child ≥6 months with suspected OM and fever, severe pain, or bilateral disease requires antibiotics. Those with milder symptoms (low fever, mild pain, unilateral disease) can receive supportive care.
149
Proper Rx for OM?
1: Amoxacillin (high dose)
2: Amox-clav
150
Chronic hemolysis in Sickle cell disease can lead to elevated MCV. Why?
Chronic hemolysis can cause folate deficiency as the marrow utilizes folate for RBC prodxn. Expected erythropoiesis would be low also, thus, reticulocyte count may be low.
151
What is the corrected reticulocyte count calculation?
Corrected retic count = Measured % reticulocytes X (Hct/45%)
152
Lithium SE of OD?
Tremor, hyperreflexia, ataxia, seizure, vomiting, diarrhea
153
Phenytoin toxicity?
Horizontal nystagmus, cerebellar ataxia, confusion
154
A homeless Pt presents with the complaint of "small red dots on the skin and weird coiled hairs" on his arms and legs. He also notes arthralgias, malaise, and weak legs. What vitamin deficiency is present?
Vitamin C. On further examination, the dots turn out to be petechiae. He has receding gingiva that bleed easily and impaired wound healing also.
155
What associated CBC changes are expected in alcoholics?
Up to 80% of alcoholics have thrombocytopenia. Anemia and leukopenia can occur also.
156
Essential tremor pattern of symptoms?
Improves during rest and worsens with activity (intention tremor). Parkinson's is the opposite.
157
Trihexyphenidyl use?
Anticholinergic in Parkinson's. This is typically used in younger patients where tremor is the predominant Sx.
158
Primidone use?
Barbiturate class drug (phenobarb-like) can be used for tremors or seizures.
159
What are the RFs for ARDS?
Infection
Trauma
Massive transfusion
Acute pancreatitis (alcoholics)
160
Pathology in ARDS?
Lung injury causes protein release, inflammatory cytokines, and PMNs into the alveolar space. Blood and proteinacious fluid cause alveolar collapse (loss of surfactant) and diffuse damage. V/Q mismatch results, lung compliance decreases (stiff lungs), and PAH ensues. PaO2 decreases leading to greater need for FiO2. Thus, PaO2/FiO2 is decreased (≤300 mmHg).
161
Onset of ARDS after insult?
Within a week.
162
Will the monospot test be positive in the first week of illness?
No. It takes time to build antibodies. Repeat test after several more days and then it may be positive. A negative monospot early on in the disease cannot rule it out.
163
Classic AML presentation?
Generally older patients with lymphadenopathy and hepatosplenomegaly. Neutropenia, anemia, or thrombocytopenia generally occur at onset.
164
What lymphocyte abnormalities present in Mono?
Convoluted nuclei and highly vacuolated cytoplasm. (ie atypical lymphocytes)
165
What 3 common infxns present with exudative pharyngitis and fever?
EBV: hepatosplenomegaly occurs with abnormal lymphocytes and +monospot
Adenovirus: general lymphadenopathy can occur, but lymphocytes are not abnormal
GAS: usually no hepatosplenomegaly and no abnormal lymphocytes. Rapid strep test +.
166
Hodgkin lymphoma Sx?
Asymptomatic lymphadenopathy with B symptoms (sometimes). No viral prodrome. Lymph biopsy shows Reed-Sternberg cells (Owl eye).
167
What is an alternative Rx for stimulants and atomexitine in ADHD?
Alpha-2 adrenergic agonists (clonidine, guanfacine)
168
MCC of blindness in industrialized countries?
Macular degeneration.
169
Pneumomediastinum on Xray might be found in?
Esophageal rupture. Air is found in the space around the heart.
170
What are the causes of pulmonary HTN?
```
Idiopathic
LV heart disease
COPD/ILD
Chronic PE
Sarcoid and other diseases
```
171
Signs of Pulmonary HTN?
Right ventricular heave, Loud P2, right sided S3, pansystolic tricuspid murmur or regurgitation, JVD, ascites, etc.
172
Niacin can cause flushing due to what?
Prostaglandin induced vasodilation. This is treated with low-dose ASA.
173
Unvaccinated health care workers exposed to Hep B require hat Rx?
HepB Vaccine within 12 hours (and two additional at normal vaccine intervals) and HepB IG within 24hours.
174
During the window phase of HepB infxn, what antibody is present?
IgM anti-HBc. HBV DNA is also present. IgG anti-HBc arrives during recovery phase with anti-HBs and anti-HBe.
175
Sx of hemochromatosis?
Skin: hyperpigmentation (may not be present)
MSK: arthralgia, arthropathy, chondocalcinosis
GI: High LFTs early, cirrhosis later, HCC risk
Endo: DM, hypogonad, hypothyroid
CV: restrictive or dilated cardiomyopathy
Infxn: Higher risk of Listeria, Vibrio, Yersinia enterocolitica
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Pts with pseudogout should be evaluated for?
Hyperparathyroidism
Hypothyroidism
Hemochromatosis
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Initial evaluation of hemochromatosis?
Iron studies. High serum iron, ferritin, and transferrin saturation are present.
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Long term management of hemochromatosis?
Serial phlebotomy. This depletes iron stores.
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Metaclopramide use?
Antiemetic. Has D2 blocker Fx and serotonin antagonist/agonist Fx.
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Metoclopramide SE?
Tarditive dyskinesia, dystonia and other pyramidal Fx.
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Prochlorperazine MOA? Use?
Phenergan family antiemetic. D2 antagonist Fx.
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What is hemiballismus?
Unilateral, violent arm flinging due to contralateral subthalamic nuclei damage.
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Cisplatin and carboplatin comon SEs?
Nephro and ototoxicity.
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Ethambutol and hydroxychloroquine common SE?
Optic neuritis.
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Amiodarone and lithium share what endocrine dysfxn?
Thyroid dysfxn.
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Cyclosporine can lead to toe pain due to?
Gout.
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Normal pressure hydrocephalus pathophys?
Decreased reabsorption of CSF at the arachnoid villi or obstructive hydrocephalus.
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What lab value has the highest SENSITIVITY for CHF?
BNP (>100 especially). Over 400 usually correlates with dyspnea.
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What is a hepatic hydrothorax?
A transudative pleural effusion that occurs secondary to portal HTN and cirrhosis. Fluid travels through small defects in the diaphragm leading to effusion.
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First line to Dx MS?
T2 weighted MRI. If this fails or is not classic then LP is performed for CSF analysis (oligoclonal bands in ~90%). T-lymphocytes may predominate, but opening pressure, protein, cell count are normal.
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What is the latency period expected between exposure and onset in asbestosis?
≥20 years. Progressive dyspnea occurs over months. Cough, sputum, and wheezing are uncommon. Clubbing and crackles occur in 50%. Can lead to cor pulmonale. Restrictive pattern on PFTs.
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Aspestosis imaging hallmark?
Pleural plaques.
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Can atelectasis cause hypoxemia?
Yes. If large enough it can lead to V/Q mismatch and increased work of breathing to correct it. This commonly presents on day 2 postoperatively. Compensation involves hyperventilation leading to respiratory alkalosis.
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Next step if needlestick with HIV+ IV?
Draw blood for HIV serology (establish baseline for worker and Pt) and start antiretroviral therapy with 3 drugs (with hours of exposure) for 4 weeks.
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A girl presents with mononucleosis and enlarged tonsils. If her airway shows risk of obstruction what is the Rx?
Corticosteroids.
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Rx for amebic liver abscess?
Metronidazole and paromomycin (destroys intestinal colonies). Rarely, if ever, are they aspirated/drained. They resolve with ABx.
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Rx for Echinococcus liver cyst?
Albendazone and aspiration of cyst.
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A 30s female taking OCPs comes in with HTN on two visits. What is the next step to Rx?
Try alternative contraceptive first. If HTN persists despite lifestyle changes, then essential HTN more likely and antihypertensives can be considered.
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A young female presents with scleral icterus and normal LFTs, but an elevated urine bilirubin. Likely Dx?
Dubin-Johnson syndrome (defect in hepatic excretion into biliary system) or Rotor syndrome (defect in uptake and storage). Rotor has both unconjugated and conjugated elevations of bilirubin. DJ has only conjugated elevations.
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Biopsy result expected in Dubin-Johnson syndrome?
Grossly dark liver with dark, lysosomal granular pigments in hepatocytes (retained bilirubin).
