Random :-) Flashcards
(145 cards)
1
Q
Name the bulk forming laxatives.
A
- Methylcellulose
- Psyllium
- Polycarbophil
2
Q
What is the MOA of bulk forming laxatives?
A
Retain fluid in the stool to increase weight and consistency
3
Q
Name the osmotic laxatives.
A
- Lactulose
- Saline cathartics
- Sorbitol
- Polyethylene glycol
4
Q
What is the MOA of osmotic laxatives?
A
Increase water in the colon
5
Q
Name the stool softeners.
A
- Docusate
- Glycerin
- Mineral oil
6
Q
What is the MOA of stool softeners?
A
Decrease surface tension which facilitates penetration of fat and water into the stool
7
Q
Name the stimulant laxatives.
A
- Bisacodyl
- Senna
- Cascara Sagrada
- Castor oil
8
Q
What is the MOA of stimulate laxatives?
A
Irritants that stimulate muscle walls of the intestines to produce movement
9
Q
List the B vitamins and their names.
A
- B1 = thiamine
- B2 = riboflavin
- B3 = niacin
- B6 = pyridoxine
- B7 = biotin
- B9 = folate
- B12 = cobalamin
10
Q
What diseases can be caused by vitamin B1 deficiency?
A
- Beriberi - tingling, poor coordination, edema, cardiac dysfunction
- Wernicke’s encephalopathy - ataxia, confusion
- Korsakoff syndrome - confabulation, retrograde and anterograde amnesia
*Vitamin B1 = thiamine
11
Q
What disease can be caused by vitamin B3 deficiency?
A
- Pellagra (4 D’s) - dermatitis, dementia, diarrhea, death
*Vitamin B3 = niacin
12
Q
How do you treat anthrax?
A
Ciprofloxacin
13
Q
What is the other name for Cat-Scratch disease? How does it present? How is it treated?
A
- Bartonellosis
- Gradual regional lymph node enlargmeent (axilla, groin, neck) which may last 2-3 months or longer
- Azithromycin (1st line). If patient has optic neuritis or neurologic disease, Doxycycline is preferred
14
Q
Which drug is commonly used for pre-op antibiotic prophylaxis?
A
Cefazolin
15
Q
Which stain is used in the diagnosis of cryptococcosis and what does it show?
A
India ink stain → shows encapsulated, budding round yeast
16
Q
What drug is given as prophylaxis for close contacts of a patient diagnosed with diphtheria?
A
Erythromycin for 7-10 days
17
Q
Describe the symptoms of dengue hemorrhagic fever.
A
- Biphasic fever - high fever that breaks in 2 days followed by joint pain (“break bone”), HA
- Biphasic rash - flushed skin → defervescence with onset of maculopapular rash → petechiae on extensor surface of limbs
- Hemorrhagic fever - ecchymosis, GI bleeding, epistaxis
18
Q
What is dengue hemorrhagic fever caused by? How is it treated?
A
- Aedes mosquito
- Permethrin on clothes, DEET on body
19
Q
How is AIDS defined?
A
CD4 count < 200 or the development of an AIDS-defining illness with or without HIV testing
20
Q
At what CD4 count can you see CMV retinitis? CMV colitis?
A
- Retinitis = CD4 < 50
- Colitis = CD4 < 100
21
Q
What are the symptoms of shigella infection? Treatment?
A
- Lower abdominal pain, high fever, tenesmus, explosive watery diarrhea (mucoid, bloody)
- Treat with bactrim or a fluoroquinolone
22
Q
How is a liver abscess caused by entamoeba histolytica treated?
A
Metronidazole
23
Q
How long must a tick be attached to have the highest likelihood of transmission?
A
72 hours
24
Q
How do you diagnose Lyme disease?
A
Serologic testing → ELISA followed by Western blot to confirm. ELISA can be falsely positive in patients with syphilis
25
How do you treat Lyme disease?
* Early disease
* Doxycycline BID for 10-21 days; if allergic, azithromycin or erythromycin
* Kids \< 8 YO or pregnant women - Amoxicillin
* Late/Severe disease
* IV ceftriaxone
26
What is malaria caused by? How is it transmitted?
* Plasmodium falciparum
* Transmitted by the female Anopheles mosquito
27
How is malaria diagnosed? Treated?
* Gemsa stain peripheral smear (thin and thick)
* Treatment:
* Uncomplicated - chloroquine phosphate
* Uncomplicated, chloroquine resistant - quinine (PO) + doxy
* Complicated or P. falciparum - quinidine (IV) + doxy (IV)
28
At what CD4 count is mycobacterium avium complex (MAC) seen? What is given for treatment? HIV prophylaxis?
* CD4 \< 50
* Treatment - clarithromycin + ethambutol
* Prophylaxis - clarithromycin, azithromycin
29
What is the rabies post-exposure prophylaxis for someone who is not previously vaccinated?
* Rabies immune globulin - 20 units/kg; give 1/2 within the wound and 1/2 IM
* Human diploid cell vaccine - 1 mL IM injection on days 0, 3, 7, and 14 (+/- day 28)
30
What is the triad for Ramsay Hunt syndrome?
* Ipsilateral facial paralysis (Bell's palsy, CN 7)
* Ear pain
* Vesicles of the auditory canal/auricle
31
What causes schistosomiasis? How is it treated?
* Parasitic flatworm. Most human infections are caused by **Schistosoma mansoni**, S. haematobium, or S. japonicum.
* Praziquantel
32
How does toxic shock syndrome present?
Sudden onset high fever, tachycardia, hypotension, N/V/D, rash (diffuse erythematous macular rash that includes the palms and soles)
33
At what CD4 count do you see toxoplasmosis? What might you see on head CT or MRI?
* CD4 \< 100
* Ring-enhancing lesions
34
What is given prophylactically to prevent toxoplasmosis?
Bactrim
35
True or False?
Rabies post-exposure prophylaxis for a patient who is previously vaccinated consists of the vaccine only.
**True.** The vaccine is given 1 mL IM on days 0 and 3
36
What is the most common intestinal helminth worlwide? Where is it found?
* Ascaris lumbricoides
* Soil contaminated by human feces or uncooked food contaminated by soil that contains roundworm eggs
37
What is the vaccine schedule for Hepatitis B?
* Birth
* 1-2 months
* 6-18 months
38
What is the vaccine schedule for MMR?
* 12-15 months
* 4-6 years
39
What is the vaccine schedule for DTaP?
* 2 months
* 4 months
* 6 months
* 15-18 months
* 4-6 years
40
What is the vaccine schedule for rotavirus? This vaccine increases the risk of which disease?
* Schedule:
* 2 months
* 4 months
* 6 months (3-dose series only)
* Intussusception
41
What is the vaccine schedule for the pneumococcal conjugate vaccine (PCV13)?
* 2 months
* 4 months
* 6 months
* 12-15 months
42
What is the vaccine schedule for inactivated poliovirus?
* 2 months
* 4 months
* 6-18 months
* 4-6 years
43
What is the vaccine schedule for varicella?
* 12-15 months
* 4-6 years
44
In coronary arteriography, what drug is used to induce coronary vasospasm?
Ergonovine
45
What are the drugs of choice for MI due to cocaine use?
Nitrates and CCBs
46
Why are beta blockers avoided in patients with a cocaine-induced MI?
Concerns for coronary artery vasoconstriction and systemic hypertension which can result from unopposed alpha-adrenergic stimulation
47
What is the initial test of choice for a dissecting aortic aneurysm? Gold standard test?
* CT with contrast
* MRI angiography
48
What is the treatment for Dressler syndrome?
Aspirin or colchicine
49
Describe the changes in mitral stenosis with position changes and respiration.
* Decreases with valsalva, standing, and inspiration
* Increases with laying supine, squatting, and expiration
50
What is the MOA for cilostazol and what disease is it used to treat?
* MOA - decreases platelet aggregation and is a direct arterial vasodilator
* Peripheral arterial disease
51
What is the most common cause of acute bronchitis? What is the hallmark symptom?
* MCC = Adenovirus
* Cough that lasts 1-3 weeks
52
In acute bronchitis, who might antibiotics be appropriate for if refractory to conservative treatment?
* Patients with a cough for \> 7-10 days
* The elderly
* Patients with COPD
* Immunocompromised patients
53
What are the lab findings for acute respiratory distress syndrome?
* ABG - PaO2/FiO2 ratio \< 200 mm Hg that is not responsive to 100% O2
* CXR - diffuse bilateral pulmonary infiltrates ("white out")
* Cardiac cath of pulmonary artery (Swan-Ganz) - PCWP \< 18 mm Hg
54
What are the chest x-ray findings of asbestosis?
Pleural calcifications/plaques. **Lower lobes** are primarily affected.
55
What areas of the body does aspergillosis most commonly affect? What type of toxin does it produce?
* Lungs, sinuses, CNS
* Aflatoxin B1 → associated with an increased risk of hepatocellular carcinoma
56
How is aspergillosis diagnosed?
* CXR - may show an aspergilloma (fungal ball)
* Biopsy - dusky necrotic tissue; septate hyphae with regular branching at wide angles (\>45 degrees)
57
How is aspergillosis treated?
* If allergic - tapered corticosteroids
* Severe or sinusitis - voriconazole
* Aspergilloma - surgical resection of symptomatic
58
What is the term for a pulmonary artery coupled with a dilated bronchus?
Signet ring sign
59
What is the study of choice in bronchiectasis?
High-resolution CT scan
60
What pulmonary disease is haemophilus influenza pneumonia associated with?
COPD
61
How is legionella pneumonia treated?
Levofloxacin or azithromycin
62
How is pertussis treated?
* Supportive - O2, nebulizers, ventilation if needed
* Macrolides - azithromycin, erythromycin
* If allergic to macrolides - bactrim
63
Name the industries specific to each of the pneumoconioses: silicosis, coal worker's pneumoconiosis, berylliosis, byssinosis, and asbestosis
* Silicosis - **mining,** quarry work, pottery, sandblasting
* Coal worker's pneumoconiosis - coal or carbon mines
* Berylliosis - electronics, aerospace, **ceramics**
* Byssinosis - cotton
* Asbestosis - destruction or renovation of **old buildings**, insulation, ship building, pipe fitters
64
What are the physical exam findings for pneumonia?
* Dullness to percussion
* Increased tactile fremitus
* Positive egophony
* Bronchial breath sounds
65
What are the physical exam findings of pneumothorax?
* Hyperresonance to percussion
* Decreased tactile fremitus
* Decreased breath sounds over affected area
66
What do the following HBV markers indicate?
(+) HBsAg, Anti-Hbs IgM, (+) HBeAg
Acute hepatitis B infection
67
What do the following HBV markers indicate?
(+) HBsAg, Anti-HBc IgG, (+) HBeAg
Chronic hepatitis B with active viral replication
68
What do the following HBV markers indicate?
(+) Anti-HBs, Anti-HBc IgG, +/- Anti-HBe
Recovery from hepatitis B (immunity)
69
What does the following HBV marker indicate?
(+) Anti-HBs
Immunity from **previous vaccination**
70
Discuss what each of the HBV antigens or antibodies indicates.
* Surface antigen (HBsAg) - earliest routine indicator of acute HBV
* Surface antibody (Anti-Hbs) - detects **previous exposure**; can **develop from vaccination**
* Core antibody (Anti-HBc) IgM - first antibody produced after infection; **used to detect acute infections**
* Core antibody (Anti-HBc) IgG - produced in response to core antigen
* E antigen - marker of infectivity; used to monitor the effectiveness of treatment
71
What is Budd-Chiari syndrome? How does it manifest?
* Hepatic venous outflow tract obstruction
* Primary - caused by an obstruction due to a venous process (thrombosis or phlebitis)
* Secondary - due to compression or invasion of the hepatic veins and/or IVC by a lesion that originates outside of the vein (malignancy)
* Abdominal pain, distension due to ascites, hepatomegaly, GI bleeding, acute liver failure (5%)
72
In acute compartmental syndrome, what compartmental pressure would you likely see?
Pressure \> 30-45 mm Hg
73
Which test for an ACL injury is most sensitive? What injury is pathognomonic for an ACL tear?
* Lachman's test
* Segond fracture
74
Wht is the name for a vertical compression fracture of the atlas? What is the mechanism of injury for a Hangman's fracture and what bone is involved?
* Jefferson (Burst) fracture
* Hyperextension then flexion of the axis pedicle
75
What is the most common malignant bone tumor in children? What are the common x-ray findings? What is the most common site of metastasis?
* Osteosarcoma
* Sun ray/burst or "hair on end" appearance
* Lungs
76
What is the term for chronic degenerative changes of the spine? Describe spondylolysis. What is the term for a stress fracture and sliding of the vertebra?
* Spondylosis
* Stress fracture in the Pars interarticularis
* Spondylolisthesis
77
What are the lab findings you would expect to see in a patient with dermatomyositis? What antibody is specific for this disease?
* Elevated CPK and ESR
* **Anti-Mi-2**
78
Describe a Bennett fracture. Describe a Rolando fracture.
* Benentt = intraarticular fracture through the base of the 1st metacarpal (thumb)
* Rolando = comminuted intraarticular fracture of the base of the 1st metacarpal
79
Describe a Galeazzi fracture. Describe a Monteggia fracture.
* Galeazzi - mid-distal radial shaft fracture with dislocation of the distal radial ulnar joint
* Monteggia - proximal ulnar shaft fracture with an anterior radial head dislocation
80
What is the best initial treatment for osteoarthritis in an elderly patient with a bleeding risk and mild to moderate disease?
Acetaminophen
81
What population is most commonly affected in acute osteomyelitis? What is the most common cause of both acute and chronic osteomyelitis?
* Children
* Staph aureus
82
Describe pes anserinus pain syndrome (aka, pes anserine bursitis).
Inflammation of the bursa located between the tibia and the 3 tendons of the hamstring muscles (sartorius, gracilis, semitendinosus) at the medial knee
83
Describe polymyalgia rheumatica. What condition is it associated with?
* **Symmetrical** aching and stiffness about the **shoulders**, **hip girdle**, neck and torso. Patient will complain of difficulty combing their hair, putting on a coat, or getting out of a chair.
* Giant cell (Temporal) arteritis
84
What antibody is most specific for polymyositis?
**Anti-Jo 1**
85
What joints are most commonly affected in rheumatoid arthritis? Describe Boutonniere deformity. Describe swan neck deformity.
* MCP, wrist, PIP, knee, MTP (metatarsophalangeal joint), shoulder, ankle
* Boutonniere = PIP in flexion, DIP in hyperextension
* Swan neck = PIP in hyperextension, DIP in flexion
86
What antibodies would be positive in rheumatoid arthritis? Which one is most specific?
* Rheumatoid factor (RF), anti-citrullinated peptide/protein antibody (ACPA), anti-cyclic citrullinated peptide antibody (anti-CCP)
* **anti-CCP**
87
Describe the two types of scleroderma. What the the antibodies specific to each type?
* Types:
* Limited (aka, CREST syndrome) - calcinosis cutis, Raynaud's phenomenon, esophageal dysmotility disorder, sclerodactyly, telangiectasia
* Diffuse - trunk and proximal extremities
* **Anti-centromere** is specific for **limited.****Anti-SCL 70**is specific for**diffuse.**
88
Describe a Smith fracture. What nerve is most commonly injured? How is the fracture immobilized?
* A distal radius fracture with **volar angulation and displacement**
* Median nerve injury
* Sugar tong splint or cast
89
Describe a Colles fracture. What nerves are commonly injured?
* Distal radius fracture with dorsal angulation and displacement
* Median and ulnar nerves
90
What antibodies are found in systemic lupus erythematosus?
anti-Smith, anti-dsDNA
91
What are the organisms most associated with acute otitis media? Which organism is most common?
* **S. pneumo (MC)**
* H. flu
* M. catarrhalis
* Strep pyogenes
92
What is the treatment of choice for acute otitis media?
Amoxicillin 80-90 mg/kg/day for 10-14 days
93
What is the most common cause of acute sinusitis? Which sinuses are most commonly involved? How is it treated?
* S. pneumo, H. flu, Moraxella catarrhalis
* Maxillary sinuses
* Amoxicillin for 10-14 days
94
What is the most common cause of vision loss in people over 65 YO?
Macular degeneration
95
Describe the types of macular degeneration. What are the symptoms of this disease?
* Types:
* Exudative - due to leakage of serous fluid and blood due to neovascularization under the retina
* Nonexudative - characterized by atrophy and degeneration of the central retina. **Drusen** (yellowish-white deposits) form under the pigment epithelium
* **Loss of central vision**, metamorphopsia (straight lines appear bent); peripheral vision is preserved
96
How is macular degeneration diagnosed? Treated?
* Dx: Amsler grid testing, Fluorescein angiography
* Treatments:
* Exudative - anti-VEGF inhibitors
* Nonexudative - OTC vitamins (zinc; vitamins A, C, E); Amsler grid to monitor stability
97
What is the most common cause of bacterial conjunctivitis? Viral conjunctivitis?
* Staph aureus
* Adenovirus
98
How is bacterial conjunctivitis treated? Under what circumstances would you use a fluoroquinolone for treatment?
* Erythromycin ophthalmic ointment
* The patient is a contact lens wearer
99
What type of blepharitis is caused by inflammation of the Mebomian glands? What conditions is this type of blepharitis associated with?
* Posterior (most common type)
* Rosacea, allergic dermatitis
100
What are the symptoms of cholesteatoma? What type of hearing loss can result from this condition?
* **Painless otorrhea**, brown/yellow discharge with a strong odor, may have dizziness or vertigo
* Conductive hearing loss
101
What is the most common cause of vision loss or blindness in people between 25-74 YO?
Diabetic retinopathy
102
Describe the types of diabetic retinopathy.
* Nonproliferative - early stage; retinal blood vessels are weakened
* Proliferative - advanced disease; circulation issues deprive the retina of oxygen resulting in new, fragile, blood vessel growth. New vessels may leak blood into the vitreous humor clouding vision
103
Describe the fundoscopy findings of diabetic retinopathy.
* Nonproliferative - microaneurysms, hard exudates, **cotton wool spots**, **blot and dot hemorrhages**, venous dilation
* Proliferative - neovascularization
104
What structures are inflammed in anterior uveitis? Posterior uveitis?
* Iris or ciliary body
* Choroid
105
How is uveitis diagnosed? How is it treated?
* Slit lamp - inflammatory "**cells** (WBCs) **and flare** (proteins in the vitreous humor)"
* Treatment:
* Anterior - topical glucocorticoids
* Posterior - systemic glucocorticoids
106
What is the anatomical location of Wharton's duct? Stenson's duct? Which duct is most commonly affected in sialolithiasis?
* Whartons' duct - submandibular
* Stenson's duct - in the rear of the mouth near the 2nd upper molar
* **Wharton's duct is most commonly affected**
107
How is sialolithiasis treated?
* Conservative (1st line) - sialogogues, increase fluids, gland massage, moist heat to affected area; **avoid anticholinergic drugs**
* If refractory to conservative tx, extracorporeal lithotripsy
108
What is the most common cause of sialadenitis? How is it treated?
* Staph aureus
* Dicloxacillin or nafcillin +/- metronidazole for anaerobic coverage; Clindamycin if severe
109
Describe the types of retinal detachment. Which type is most common?
* **Rhegmatogenous (MC)** - full-thickness retinal tear causes the retinal inner sensory later to detach from the choroid plexus
* Tractional - adhesions separate the retina from its base
* Exudative (serous) - fluid accumulates beneath the retina causing detachment
110
How is retinal detachment managed?
Ophthalmologic emergency → keep the patient supine with their head turned toward the side of detachment until opthalmology arrives
111
What is the most common cause of a peritonsilar abscess?
Strep pyogenes
112
What electrolyte abnormalities might you see in bulimia nervosa?
Hypokalemia, hypomagnesemia
113
List 5 physical abnormalities that can manifest in a patient with anorexia nervosa. List 5 lab abnormalities.
* Amenorrhea, bradycardia, arrhythmia, constipation, lanugo hair
* Can also have hypotension, acute coronary syndrome, MVP, alopecia, peripheral neuropathy, seizures, hypothyroidism, osteopenia, osteoporosis
* Hyponatremia, hypochloremic hypokalemic alkalosis, QT prolongation, hypercholesterolemia, transaminitis
* Can also have leukopenia, anemia, elevated BUN, increased GH, increased cortisol, decreased LH and FSH, hypoglycemia
114
When is it appropriate to hospitalize a patient with anorexia? What is the treatment?
* If the patient is \< 75% of their expected body weight
* CBT, supervised weight-gain programs
115
What labs must be monitored in a patient taking lithium? What are the adverse effects of lithium?
* Lithium levels, BUN/Cr, TSH
* **Nephrogenic DI,** thyroid enlargement, **hypothyroidism**, QT prolongation, Ebstein's anomaly
116
What is the name for calluses on the dorsum of the hand in a patient with bulimia nervosa? Treatment?
* Russell's sign
* CBT and **fluoxetine**
117
When does maternal (postpartum) blues typically manifest? When do the symptoms resolve? What is the treatment?
* Onset of symptoms 2-3 days after delivery
* Symptoms typically resolve within 10 days
* Treatment is supportive
118
Define MDD with peripartum onset (aka, postpartum depression). What is the treatment?
* Depressed affect, anxiety, and poor concentraiton for **≥ 2 weeks**
* Treatment is CBT and SSRIs (1st line)
119
Define postpartum psychosis. What is the treatment?
* A condition characterized by mood-congruent delusions, hallucinations, and thoughts of harming the baby or self
* Treatment is hospitalization and initiation of atypical antipsychotics. If refractory, ECT may be used
120
What is the MOA of 1st-gen antipsychotics? What is the MOA of 2nd-gen antipsychotics?
* 1st gen - block dopamine (D2) receptors
* 2nd gen - block dopamine (D2) and serotonin (2A) receptors
121
Which generation of antipsychotics is better for positive symptoms? Negative symptoms?
* Both typical and atypical antipsychotics have **similar efficacies** in treating positive symptoms
* Atypical antipsychotics are more effective at treating negative symptoms
122
How does treatment with antipsychotics result in extrapyramidal symptoms? What hormone level increases due to the use of antipsychotics?
* Extrapyramidal symptoms occur through blockage of the dopamine pathways in the nigrostriatum
* Prolactin levels increase due to dopamine blockade in the tuberoinfundibular area
123
List the antidopaminergic effects of antipsychotics.
* **Parkinsonism** - bradykinesia, masklike face, cogwheel rigidity, pill-rolling tremor
* **Akathisia** - anxiety and restlessness
* **Dystonia** - sustained painful contractions of the neck, tongue, and eye muscles
* **Hyperprolactinemia** - decreased libido, galactorrhea, gynecomastia, impotence, amenorrhea
124
List the anti-histaminic, adrenergic, and muscarinic effects of antipsychotics.
* **Antihistaminic** - sedation, weight gain
* **Anti-alpha-1 adrenergic** - orthostatic hypotension, cardiac abnormalities, sexual dysfunction
* **Antimuscarinic** - dry mouth, tachycardia, urinary retention, blurry vision, constipation
125
What is the most common histological type of vulvar cancer? What is the most common presenting symptom?
* Squamous
* Pruritus
126
Define gestational hypertension.
Hypertension that **develops after 20 weeks gestation** without proteinuria or other signs/symptoms of preeclampsia
127
What is the term for hypertension in pregnancy that develops before 20 weeks gestation?
Chronic or pre-existing hypertension
128
What is the MOA for ethinyl estradiol (estrogen)? MOA for progestin?
* Ethinyl estradiol - **decreases FSH**, prevents maturation of the follical, potentiates progestin effects
* Progestin - **decreases LH**, inhibits ovulation, **thickens cervical mucus**, alters peristalsis of the fallopian tube
129
Name 5 absolute contraindications to the use of OCPs.
* History of thromboembolic disease (DVT, pulmonary embolism)
* Undiagnosed abnormal vaginal bleeding
* Cerebral vascular disease
* Known or suspected breast cancer
* Smokers \> 35 YO
130
List the types of intrauterine devices and their respective lifespans. List 3 contraindications to the use of IUDs. What medical conditions are progestin-only contraceptives indicated for?
* Copper T380A (10 years), Mirena (5 years), Skyla (3 years)
* CI's - pregnancy, acute pelvic infection (PID, cervicitis), unexplained vaginal bleeding
* Indicated for women with DM, thromboembolism, menorrhagia, dysmenorrhea, or women who are breastfeeding
131
List the options for emergency contraception. Which drug blocks the LH surge if taken in the pre-ovulatory period? Which drug delays ovulation in both the pre-ovulatory period and after the LH surge?
* Levonorgestrel, estrogen + progesterone, mifepristone, copper IUD, ulipristal
* Levonorgestrel
* Ulipristal
132
What is the strongest risk factor for endometritis? How is it treated?
* C-section
* Treatment:
* Post C-section - clindamycin + gentamicin
* Post vaginal delivery or chorioamnionitis - ampicillin + gentamicin
133
What is the most common inherited cause of intellectual disability? Describe the physical manifestations of this disease.
* Fragile X syndrome
* Long protruding ears, long face, prominent jaw, hyperextensible joints, micropenis, macroorchidism
134
When is the screening for gestational diabetes done? Briefly describe the screening tests and the values that indicate the patient has gestational diabetes.
* 24-28 weeks gestation
* Testing:
* 50-g 1 hour glucose test → positve if glucose \> 140 mg/dL
* 100-g 3 hr glucose test → positive if:
* Fasting \> 95 mg/dL
* 1 hr \> 180 mg/dL
* 2 hr \> 155 mg/dL
* 3 hr \> 140 mg/dL
135
What drugs can be used to treat gestational hypertension?
* **Methyldopa (1st line)**
* Labetalol
* Hydralazine
* Nifedipine
136
What is a complete hydatidiform mole?
It is when an egg with no maternal DNA is **fertilized by 2 sperm** resulting in two paternal sets of DNA. The genotype is **46, XX.** This has associated with a higher risk of malignancy (choriocarcinoma).
137
What is an incomplete hydatidiform mole?
It is when an egg is fertilized by 2 sperm. The karyotype is 69, XXY.
138
What are the hormone levels you would expect on labs in hypothalamic amenorrhea?
Normal to decreased FSH and LH, decreased estradiol, normal prolactin
139
What are the hormone levels you would expect on labs in polycystic ovarian syndrome?
Decreased FSH, increased LH, increased testosterone, and increased estrogen
140
Define preeclampsia.
Hypertension + proteinuria +/- edema after 20 weeks gestation
141
When is it unsafe to have a vaginal birth after C-section?
* Placenta previa
* Inverted T-incision with prior pregnancy
* Heart disease
* Shortness of breath
142
Define premature labor. How can you diagnose premature labor?
* Cervical dilation \> 3 cm and/or \> 80% effacement before 37 weeks
* Dx:
* Nitrazine pH paper test turns blue if pH \> 6.5 indicating amniotic fluid
* The presence of fetal fibronectin → a protein produced by cells at the border of the amniotic sac and the mother’s uterus, attaching the amniotic sac to the uterine lining
143
What causes acromegaly? How is it diagnosed?
* Pituitary adenoma
* Dx:
* Screening - insulin-like growth factor 1 (IGF-1)
* Confirmatory - oral glucose suppression test
144
What causes Charcot's foot? What is the most commonly affected part of the foot?
* aka, Diabetic foot → Caused by joint damage and destruction as a result of peripheral neuropathy from DM
* Most commonly affects the midfoot
145
What is the cause of cushing's disease? Cushing's syndrome? How is it diagnosed?
* Disease - ACTH-secreting pituitary adenoma
* Syndrome - excessive levels of glucocorticoids due to any cause
* Dx:
* Low-dose dexamethasone suppression test
* 24-hour urinary free cortisol
* Salivary cortisol levels
* High-dose dexamethasone suppression test
* Elevated ACTH + suppression = Cushing's disease
* Elevated ACTH + no suppression = likely an ectopic ACTH-producing tumor
* ACTH level
* If low, cause is likely an adrenal tumor or hyperplasia
* If high, likely an ACTH-secreting pituitary adenoma
* Corticotropin-releasing hormone (CRH) stimulation test
* Increased ACTH/cortisol = Cushing's
* No response = ectopic ACTH secretion or an adrenal tumor
