Flashcards in Random1 Deck (130):
Onset of mild alcohol withdrawal?
Onset of Seizures from alcohol withdrawal?
Alcoholic hallucinosis onset?
12-24 hrs, resolves w/in 48hrs
Delirium tremens onset?
alcoholic hospitalized for operation, now 24 hrs later having visual hallucinations, stable VS and orientation. Dx?
Normal saline is a crystalloid or colloid?
When are colloid solutions used?
In burns or conditions w/ hypOproteinemia
mainstay of dehydration treatment?
rehydration w/ IV sodium containing crystalloid solutions
acute onset unilateral weakness + positive Babinski sign = think?
acute ischemic stroke
tPA should be given to stroke pt w/o hemorrhage w/in?
3-4.5 hrs of symptom onset
what should be held and for how long should a stroke pt receive fibrinolytic therapy?
aspirin for 24hrs
fears of negative evaluation and embarrassment in social and performance situations = Dx?
Social anxiety disorder
poor eye contact + anxiety attacks when doing presentations = think?
social anxiety disorder
performance anxiety is included in what type of anxiety disorder?
social anxiety disorder
acute onset polyarticular and symmetric arthritis that resolves w/in 2mo, Dx?
monoarticular arthritis (4)?
- Septic arthritis
- Crystalline arthritis (gout)
- Seronegative spondyloarthropathies (+ back pain)
Symmetrical arthritis (2)?
- Rheumatoid arthritis
Effective treatment of cancer-related anorexia/cachexia syndrome? (2)
- Progesterone analogues (megestrol acetate)
- Corticosteroids (more side fx)
Effective treatment of advanced HIV cachexia?
delayed treatment of appendix (>5days) may dev into?
Appendiceal rupture --> appendiceal abscess
What maneuvers are best for appendiceal abscess dx?
- Psoas sign (extension)
- Obturator sign (internal rotation)
- Rectal tenderness (esp on R rectal wall)
ant palpation may be less useful bc is deep tissue
Rx of appendiceal abscess if pt is stable?
- IV abx, bowel rest, and possibly percutaneous drainage of abscess
- return in 6-8 wks for appendectomy
immediate surgery has high complication rate so wait for it to calm down
arthralgias + psychosis + hematuria + proteinuria - concerning for?
acute onset of psychosis in a child or adolescent --> psych rare, what else is on diff dx? (7)
- CNS injury, infx, dysfunction (epilepsy)
- Metabolic disturbances (urea cycle disorder, acute intermittent porphyria, wilson disease, renal/liver fail)
- Autoimmine (Lupus, Thyroiditis)
- Electrolyte disrturbances (glucose, Na, Ca, Mg)
- Illicit substances or withdrawal from them
- Medication intoxication (serotonin syndrome, steroids, abx, anticholinergics, etc)
- Medication withdrawal (baclofen, benzo's)
Prior gyn surgery esp a LEEP or cone biopsy puts pt at risk of?
gold standard for evaluating cervix for cervical incompetence/insufficiency?
-abdominal u/s not accurate
Complications of diethylstilbestrol? (5)
- Clear cell adenocarcinoma of the vagina and cervix
- Structural anomalies of rep tract (hooded cervix, T shaped uterus, etc)
- Pregnancy problems (ectopic, preterm, etc)
- Males: Cryptorchidism, microphallus, hypospadias, & testicular hypoplasia
Clear cell adenocarcinoma of vagina and cervix --- maj risk factor?
Diethylstilbestrol exposure in utero
Overriding aorta is? think?
- when the aorta is over a VSD rather than LV
- Tetralogy of Fallot
What are quad in tetralogy of fallot?
- Right ventricular outflow tract obstruction (ie pulm stenosis or atresia)
- Overriding aorta
Harsh systolic ajection murmur over L upper sternal border + single s2?
Tetralogy of Fallot
Right to L shunts? (5)
1. Truncus arteriousis (1 vessel)
2. Transposition (2 switched vessels)
3. Tricuspid atresia (3 - tri)
4. Tetralogy of Fallot (4 - tetra, most common)
5. Total Anomalous Pulmonary Venous Return (5 words, TAPVR)
Early cyanosis (eaR-->Ly)
Uncorrected L--> R shunt causing pulm HTN --> RVH --> shunt becomes R to L --> cyanosis, clubbing, polycythemia in KIDs (LateR)
cyanosis in a kid w/ clubbing and polycythemia - think?
(L--> R shunt that switches and causes cyanosis LateR)
Transposition of great vessels associated w/?
Ebstein Anomaly associated w/?
Prenatal Li exposure
Ebstein anomaly is?
Supravalvular aortic stenosis associated w/?
Williams syndrome (deletion in elastin)
22q11 syndromes (ie DiGeorge) associated w/ what cardiac issues (2)?
- Truncus arteriosus
- Tetralogy of Fallot
Alcohol exppsure in utero (fetal alcohol syndrome) --> what cardiac issues (4)?
- Tetralogy of Fallot
Boot shaped heart on xray think?
Tetralogy of Fallot
Low birth weight + closed fists w/ overlapping fingers + micrognathia + rocker-bottom feet - think?
Edward's syndrome (Trisomy 18)
Undersized jaw (mandibule hypoplasia)
Hypotonia + flat face + upward and slanted palpebral fissure + hypoplasia of middle phalanx of 5th finger + brushfield spots + high arched palate - think?
cleft lip + flexed fingers w/ polydactyly + low set ears + large distance b/t eyes (ocular hypotelorism) + hypoplastic ribs - think?
Patau's syndrome (Trisomy 13)
microcephaly w/ protruding metopic suture - think?
Obstructive lung disease FEV/FVC
DECREASED ---> FEV/FVC
Restrictive lung disease FEV/FVC?
Normalish --> FEV/FVC >70%
Mom w/ Graves disease + euthyroid during pregnancy --> neonatal tachy w/ low birth weight and irritable - think?
Neonatal thyrotoxicosis (hyperthyroid)
Neonatal thyrotoxicosis caused by?
Transplacental passage of maternal anti-TSH receptor Ab (Abs bind to infant's TSH receptors --> excessive thyroid hormone release --> hyperthyroid)
Dx neonatal thyrotoxicosis cause?
Test for ant-TSH receptor Ab
Rx of neonatal thyrotoxicosis?
- short term rx w/ methimazole + beta blocker
- self resolves over weeks - months
Does levothyroxine cross placenta?
Trihexyphenidyl can cause what maj side fx?
Anticholinergic excess (blind as a bat...etc)
- headache, dizziness, tachy, acute glaucoma
Selegiline is? maj complication?
GI perforation + pt on warfarin for afib --> best initial step (after fluids, abx, NG tube compression)?
Fresh frozen plasma prior to surgery
- (to rapidly normalize PT by restoring vit K dependent clotting factors - don't want to bleed in surg)
Acute bleeding in pt w/ liver failure, best treatment?
Fresh Frozen Plasma
- to rapidly replace clotting factors that liver normally makes
Obstructive lung diseases? (4)
- COPD (Emphysema &Chronic Bronchitis
Obstructive lung disease causes inc in what and dec in what PFTs?
Inc: RV --> inc TLC, FRC
Dec: VC, FEV, FEV/FVC (
Restrictive lung disease causes inc in what and dec in what PFTs?
Dec: FVC (a lot) --> FEV/FVC (>70%) + TLC, FEV
non caseating granulomas + cough + hyperCalcemia + uveitis + issues w/ saliva and lacrimal glands - think?
(can mimic sjogren's syndrome, but has sarcoid has non-caseating granulomas which sjogren's doesn't)
Restrictive lung diseases? (2)
- interstitial lung diseases (fibrosis, pneumoconioses, sarcoid, hypersensitivity pneumonitis)
- wall abnormalities (ie obesity, ankylosing spondylitis)
Silicosis is found where and inc risk of what?
- Nodules upper lobe
- Inc risk of TB
noncaseating granulomas have what type of metabolic derangement?
Lung disease + Aerospace industry or mining (specific type) - think?
Lung disease + sand blaster work - think?
Lung disease + coal miners - think?
Coal worker pneumoconiosis or black lung
Lung disease + construction worker or plumber or shipyard worker - think?
Asbestos inc risk of what? (2)
- lung CA (most common)
coal dust exposure
long golden brown fibers w/ associated iron think?
"reticular" or "reticulonodular" or "ground glass" or "honeycombing" -- think?
Interstitial lung disease (restrictive)
elevated serum findings in sarcoidosis? (2)
Main lung findings on xray in sarcoidosis?
Bilateral hilar adenopathy
- usually spontaneously self resolves
- Symptomatic --> corticosteroids
- Refractory --> methotrexate
hemoptysis + dyspnea + kidney issues - think?
Goodpasture what type of hypersensitivity?
type 2 (Ab mediated)
Type 3 hypersensitivity is caused by and ex (3)?
- SLE, RA, HSP
treatment of goodpasture syndrome (3)?
Antiglomerular basement membrane Ab?
Ground glass appearance w/ bilateral alveolar infiltrates that resemble a bat shape?
Pulmonary alveolar proteinosis (restrictive lung disease)
Pulmonary alveolar proteinosis is?
accumulation of surfactant-like protein and phopholipids in alveoli --> restrictive lung disease
Pulmonary alveolar proteinosis looks like on CXR?
Ground glass appearance w/ bilateral alveolar infiltrates that resemble a bat shape
Pulmonary alveolar proteinosis treat?
lung lavage and Granulocyte colony-stimulating factor
- NO steroids
mesothelioma --> what in pleura?
Exudative effusions have at least one of the following:
- Pleural protein/Serum protein >0.5
- Pleural LDH/Serum LDH >0.6
- LDH > 2/3 upper limit of normal serum LDH ()
Budd chiari syndrome is?
thrombosis of hepatic vein --> infarction of liver
cyanosis w/ chocolate colored blood?
IV methylene blue
Room temp, room air, sea level A-a gradient formula?
(150 - 5/4PCO2) - PaO2
estimated nL A-a gradient by age?
normal PaO2/FiO2 ratio?
Acute Respiratory Distress Syndrome
- mild: 200- 300
- Mod: 100-200
PCWP >18 + pulm edema - think?
cardogenic pulm edema
Main line of treatment in ARDS?
high PEEP w/ low tidal volumes
middle mediastinal mass? (6)
- bronchogenic cyst
- tracheal tumor
- pericardial cyst
- lymph node enlargement
- aortic aneurysm of arch
anterior mediatstinal masses? (5)
- restrosternal thyroid
- nonseminomatous germ cell tumor
Posterior mediastinal masses? (6)
- meningocele (all neurogenic tumors are posterior)
- enteric cysts
- diaphragmatic hernias
- esophageal tumors (ie leiomyomas)
- aortic aneurysms
Priority of treatment for rib fracture?
- pain management and respiratory support in order to prevent hypoventilation --> atelectasis and PNA
Treatment options for rib fracture?
- Intercostal nerve block (if oral meds not sufficient)
Exudative effusion - main 2 types?
- Compicated parapneumonic effusion
Findings in pleural fluid of exudative effusion?
- Low glucose (
Distinguish b/t complicated parapneumonic effusion from empyema how?
- Pleural fluid gram stain usually NEG in CPE and POS in empyema
- Pleural fluid cx usual NEG in CPE and POS in empyema
Continued fever post abx treatment + loculation in CXR - think? (2)
- complicated paranpeumonic effusion
Pulmonary contusion is?
parenchymal bruising of the lung
pulmonary contusion dev in what time frame?
minutes - 24hrs
ARDS manifest how soon post trauma?
How to distinguish b/t ARDS and pulmonary contusion?
1) Timeframe: Pulm contusion sooner (
Recurrent pneumonias in the same anatomic region of the lung suggests?
Bronchial obstruction due to an underlying abnormality (ie CA, foreign body, bronchial stenosis)
bronchiolitis caused by what virus?
respiractory syncytial virus
prophylaxis for RSV and to what category pts?
- Palivizumab (monoclonal Ab)
bronchiolitis has inc risk of what?
Lymphoma and nasopharyngeal CA associated w/ what virus?
EBV associated w/ what CAs? (2)
- nasopharyngeal CA
who do you give palivizumab to?
elevated AFP and B-hCG - think? (2)
- Endodermal sinus tumor (ie nonseminomatous germ cell tumor)
tell difference b/t seminoma and nonseminomaotus germ cell tumor?
NSGCT has elevated AFP, seminoma does not
- both elevated B-hCG
dysgerminomas are equivalent to what male tumor?
panacinar emphysema caused by?
alpha-1 antitrypsin deficiency
panacinar emphysema located where usually?
AAT deficiency --> where emphysema useuall?
panacinar emphysema descruction in lower lobes
Pt w/ COPD at young age (
COPD w/ minimal or no smoking hx - consider?
Basilar-predominant COPD - consider?
PE can --> what lung abnl?
small Pleural effusion (due to hemorrhage or inflammation) --> pain