Flashcards in random6 Deck (158):
fetal anemia presents w/?
sinusoidal fetal heart tracing w/ no variability
fetal head compression -->?
early decels due to?
fetal head compression
placental insufficiency -->?
late decels due to?
variable decels due to?
compression of umbilical cord
compression of umbilical cord --?
rotavirus vax contraindicated if?
- Hx of intussusception
- Hx of uncorrected congenital malformations in GI tract (ie Meckel's)
- anaphylaxis to vax ingredients
loss of pain and temp in cape distribution (along dermatomes) - think? issue where?
- distrubance of crossing spinothalamic tracts at the ant commisure
ursodeoxycholic acid can be used for?
prophylactically prevent gallstones (esp after gastric bypass)
risk of esophageal variceal bleed --> med treatment?
Non-selective B-Blocker (ie propranolo or nadolol)
- reduces portal venous pressure ---> dec risk of hemorrhage
dec appetite, abd discomfort, abdominal fullness, now w/ painless jaundice -- think?
- even w/ elevated bili and alk phos bc can be due to mass in panc blocking bile
iron toxicity --> ?
- n/v/d - hemorrhagic (BRB v and dark green stools) --> hypovolemic shock
- severe lactic acidosis
- organ failure
new onset seizures can make you worry for what?
most common adult brain CA?
Astrocytomas (specifically glioblastoma multiforme which is type grade IV)
what effects prognosis of astrocytomas most?
degree of anaplasia (atypia, mitoses, neovascularity or necrosis)
common first line therapy for CLL?
Rituximab (monoclonal Ab against CD20 on B lymphocytes)
monoclonal Ab against CD20 is what med to treat what?
Imatinib inhibits what and is for what disease?
- Inhibits product of BCR-ABL tyrosine kinase fusion
BCR-ABL - think?
arm twitching - think?
simple partial seizure
dx of brain abscess uses what imaging?
gadolinium enhanced brain MRI
nL serum osmolality?
285 - 295
most common bacteremia in sickle cell pts?
can cause sepsis
what do you use for empiric abx in febrile sickle cell pt?
1) 3rd gen cephalosporin (ie ceftriaxone)
2) add vanco if concern for meningitis or osteoarticular infx
who received abx prophylaxis b4 dental appts? (3)
High risk pts for bad outcomes w/ IE:
- prosthetic valves
- prior hx of IE
- unrepaired congenital heart disease
acute dystonic reaction treat w/?
halperidol can cause what via dopamine receptor antagonism?
acute dystonia (EPS, ie torticollis)
treatment of epi ovarian CA?
exploratory laparotomy and tumor debulking followed by platinum based chemo
PCOS wants to get preggers treat?
1) weight los
sensation of spinning
feeling like one is about to faint
disquilibrium is ?
sense of imbalance
sensation of spinning?
feeling like one is about to faint?
sense of imbalance?
injury to the radial nerve may cause?
wrist drop due to weakness of the extensor muscles
test for intact sensation of radial nerve by?
testing dorsal surface of hand
oblique fracture of middle humerus most at risk of what being damaged?
radial nerve (travels in spiral groove along dorsal aspect)
supracondylar fracture of humerus worry what is being injured?
abduction and adduction of fingers controlled by?
weakness of elbow flexion and forearm supination - think?
injury to musculocutaneous nerve
palliative treatment of pancreatic adenocarcinoma causing extrahepatic cholestatis?
First line: endoscopic stent placement
2nd: surgical bypass
ursodeoxycholic acid is the only FDA approved treatment for what?
primary biliary cirrhosis
(doesn't change mortality, just symp help)
malignant pleural effusions appear how?
- low pH (
absent p waves w/ irregularly, irregular QRS complexes?
rate control meds for a fib?
1) beta blockers (adrenergic antagonists) - ie metoprolol or exmolol
2) non-dyhyidrophyridine Ca channel blockers - ie diltiazem or verapamil
dementia w/ early onset ataxia, urinary incontinence and dilation of ventricles on neuroimaging?
finding on neuroimaging for NPH?
round, eosinophilic, intracytoplasmic inclusions w/in neurons of substantia nigra - is?
Lewy body dementia
pt w/ multiple myeloma w/ renal issues but no proteinuria - where is kidney issue?
Renal tubular damage (from monoclonal light chains clogging tubules -> casts & toxicity)
(proteinuria would be seen if it was in the glomerulus)
slow rise in creatinine in pt w/ severe HTN and recurrent flash pulm edema - think?
Renal artery stenosis
4 big trinucleotide repeat disorders?
"X-Girlfriend's First Aid Helped Ace My Test!"
friedreich ataxia symp?
- muscle weakness
- loss of DTR, vib and proprio
- staggering gait
- hammer toes or high instep (pes cavus)
--> hypertrophic cardiomyopathy
fragile X features?
- intellectual disability
- autistic features
- elongated face w/ large ears
- enlarged testes
- delayed milestones
first line treatment of acute sundowning w/ agitation ?
Antipsychotic (ie haloperidol)
nL cardiac output?
nL RA pressure ?
nL RV pressure?
nL pulm artery pressure?
Right heart pressures elevated w/ nL to low PCWP in a pt w/ hypoxia, tachypnea, and tachycardia - think?
palpable purpura, proteinuria, and hematuria -- think?
(can also have arthralgias, hapatosplenomegaly, and hypocomplementemia)
confirmatory finding for mixed cryoglobulinemia?
circulating serum cryoglobulins
what is a common underlying infx found w/ pts w/ mixed cryoglobulinemia?
what should pts w/ mixed cryoglobulinemia be tested for?
trendelenburg sign caused by?
weakness in gluteus medius and minimus m.
(potentially bc of superior gluteal n. dysfunction)
superior gluteal nerve dysfunction can lead to what sign?
(bc of weakness of gluteus minimus and medius m.)
complicated diverticulitis w/
IV abx and observation
worsening symp --> surg
complicated diverticulitis w/ >3cm abscess treatment?
CT guided percutaneous drainage
if after 5 dys symp not controlled --> surgical drainage and debridement
complicated diverticulitis w/ fistuala, perforation w/ peritonitis, obstruction or recurrent attacks - treatment?
med to close PDA?
med to keep open PDA?
avoid lithium use in pts w/ what organ issues?
renal disease pts
avoid valproate in pts w/ what organ issues?
liver disease pts
most effective med to treat bipolar depressive episode?
most significant side effect of lamotrigine?
Steven Johnson syndrome
Acute behavioral agitation in manic episode -- treat?
Antipsychotic (1st or 2nd gen)
- lithium, valproate, carbamazepine would take too long
Treatment for anorexia? (3)
- Nutritional Rehab
- Olanzapine if no response to above
Treatment for Bulimia (3)?
- Nutritional Rehab
- SSRI (fluoxetine), of in combo w/ above
Binge eating disorder treatment (4)?
- Behavior weight loss therapy
- Lisdexamfetamine, topiramate
difference b/t bulimia and binge eating disorder?
Bulimia compensates for the binging w/ purging of some type --> maintenance of nL weight
Binge eating disorder just binges --> becomes overweight
difference b/t anorexia and bulimia?
treatment of serious iron poisoning?
radioopaque tablets on xray in child w/ low HCO3, hypotension, hematemesis, abd pain, and cool extremities --think?
Iron poisoning --> shock
give IV resuscitation and deferoxamine
What is used in TCA or aspirin overdose?
Torsades de points due to prolonged QT interval give?
Severe lithium toxicity - treat?
moderate to severe lead poisoning give?
child w/ irritability, poor appetite, headaches, abdominal pain, and anemia - toxin is?
mild to moderate lead poisoning treat w/?
Acetaminophen toxicity treat w/?
abd pain, hematemesis, shock, and metabolic acidosis after a child ingests something radioopaque - think?
pt on TPN w/ epigastric and RUQ pain - likely?
gallstones due to gallbladder stasis
why does an ileal resection contribute to formation of gallstones?
Decreased enterohepatic circulation bile acids --> altered hepatic bile composition --> supersaturation w/ cholesterol --> gallstones
incred RBC destruction inc risk of what type of gallstone?
what is cause of inc dev of cholestrol gallstones in pregnancy?
- Estrogen-induced inc in chol secretios
- Progesterone causes a) reduction in bile acid and b) slows gallbladder emptying
when is Anti - D immune globulin (RhoGAM) administered?
In Rh- women at:
- 28 wks
- or 2/in 72 hrs of any procedure where feto-maternal blood may mix (ie abortion, amniosentesis, delivery, trauma etc)
difference b/t shin splints and stress fracture?
no tibial tenderness on palpation w/ shin splints
shin splints aka?
medial tibial stress syndrome
pain at specific area that inc w/ jumping or running w/ local swelling and point tenderness to palpation - think?
best imaging for stress fracture?
MRI or bone scan
marfans is due to mutation of what?
fibrillin 1 gene
homocystinuria caused by?
cystathionine synthase deficiency
fibrillin 1 gene mutation -->?
cystathionine synthase deficiency -->?
defective collagen production -->?
Ehlers-Danlos due to?
collagen production defect
Klinefelter due to?
nondisjunction resulting in an extra X chromosome
upward lens dislocation - think?
downward lens dislocation think?
first marker to appear in serum in acute hep B infx?
HBsAg (4-8 wks after infx)
2nd marker in HBV that appears around when clinical symp appear and elevation of aminotransferase levels?
what is best test to diagnose new infx of Hep B (pick 2 markers)
b/c HBsAg is first marker to dev and IgM anti-HBc may be only marker apparent during window period
transaminase levels >25 times nL limit w/ ALT>AST - think?
best test for HAV?
(IgM Ab to HAV)
Anti-HAV (IgG) positive indicates (2)?
- Prior HAV infx
- Prior HAV vaccination
HBsAg is and indicates?
-antigen found on surface of HBV
-Indicates HBV infx (can't tell if acute or chronic)
Anti-HBs is and indicates?
-Ab to HBsAg
- Indicates immunity to HBV (recovered or immunized)
What will you never see if you've only been vaccinated against HBV?
What may be only positive marker during infx window period of HBV?
IgM Anti-HBc indicates?
IgG Anti-HBc indicates?
prior exposure or chronic incx
Positive for: HBsAg, HBeAg, IgM Anti-HBc -- means?
acute HBV infx
Positive for Anti-HBe and IgM Anti-HBc - means?
Positive for HBsAg, HBeAg, and IgG Anti-HBc - means?
Chronic HBV w/ high infectivity (bc HBeAg pos)
Positive for HBsAg, Anti-HBe, and IgG-Anti HBc - means?
Chronic HBV w/ low infectivity (bc Anti-HBe pos)
Positive for Anti-HBs, Anti-HBe, and IgG Anti-HBc - means?
Recovered from HBV infx
Positive Anti-HBs only means?
which illicit drug can cause vertical nystagmus?
what do you use for treatment of severe psychomotor agitation due to PCP use?
Initial treatment of AOM?
10 day course of oral high dose Amoxicillin
If pt returns w/in 1 month w/ AOM post initial treatment, now treat w/?
Oral Amoxicillin and clavulanic acid (to fight presumably a strain w/ beta lactamase resistence)
common bugs --> AOM?
- Strep pneumo
- nontypeable Haemophilus
- Morazella catarrhalis
IE w/ nosocomial UTI - what bug?
enterococcus ( U heart trees)
fanconi anemia caused by?
defect in DNA repair --> chromosomal breaks
benzene exposure can cause what blood issue?
iability to palpate PMI consistent w/?
large pericardial effusion
pulsus bisferiens (biphasic pulse) seen with?
- AR (+/- AS)
- Large PDA
post cardiac cath worry for?
cholesterol emboli post cardiac cath --> what manifestations? (3ish)
- SKIN: Livedo reticularis, blue toe syndrome
- GI: pancreatitis, mesenteric ischemia
pt w/ RA has inc risk of what type of bone issues? (3)
- Bone fractures
paget's disease of bone -- aka?
osteitis deformans - aka?
paget's disease of boen
osteitis fibrosa cystica aka?
Von Recklinghausen disease of bone
osteitis fibrosa is?
excessive osteoclastic resorption of bone --> replacement w/ fibrous tissue (brown tumors)
osteitis fibrosa cystica is seen in pts w/ what additional disease?
- parathyroid carcinoma
- primary, 2ndary, tertiary hyperparathyroidism (ie renal disease)
anti-CCP Ab -thnk?
fibrous obliteration of small bile ducts w/ concentric replacement by connective tissue in an onion skin pattern -- think?
Primary SCLEROSING cholangitis
onion skin pattern in liver biopsy - think?
primary sclerosing cholangitis
Meniere disease due to?
excess endolymphatic fluid pressure in inner ear
triad in meniere disease?
- hearing loss
sensation of objects moving around in visual field when looking in any direction
- seen w/ aminoglycoside toxicity esp gentamicin
contraindications for breastfeeding? (7)
- active untreated TB (can start post 2wks of treatment)
- Maternal HIV
- Herpetic breast lesions
- Varicella infx
preferred confirmatory test for giardia?
stool antigen assay (direct immunofluorescence or ELISA)
nitrates primary anti-ischemic effect is?
Systemic venodilation --> lower preload --> lower LVEDV --> dec myocardial O2 demand by reducing wall stress
*they also vaso dialate coronary a., but above is main effect
dark brown discoloration of the colon w/ lymph follicles shining through as pale patches - think?
- seen w/ laxative use
pigment in the macrophages of the lamina propria can indicate?
- seen w/ laxative use