thoracoscopy OR open thoracotomy

Rosh Material #3 Flashcards by Alice Richards

primary PTX mc occurs in what pt pop

tall, thin boys

men aged 10-30 yo

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what do you think when you see: abrupt onset of SOB, decreased chest excursion, diminished breath sounds, decreased tactile fremitus

PTX

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what do you think when you see: hypotension, tachycardia, mediastinal/tracheal shift

tension PTX

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what do you think when you see: visceral pleural line that can be seen only on expiratory films

PTX

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increased radiolucent costophrenic sulcus on CXR

contralateral shift in the mediastinum

deep sulcus sign → PTX

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order of tx for PTX based on severity

obs and O2
simple drainage w. small bore catheter
small bore chest tube
chest tube w. suction

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which PTX require chest tube w. suction

large PTX

tension PTX

secondary PTX

severe sx

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tx for recurrent PTX

thoracoscopy

open thoracotomy

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4 types of PTX

spontaneous → primary (tall, thin men) vs secondary (chronic dz)

iatrogenic

traumatic

catamenial → result of thoracic endometriosis

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what drug is used for prevention of pneumocystis PNA

bactrim

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what do you think when you see: HA, aquagenic pruritis, ruddy facial plethora, palpable splenomegaly, erythromalagia

polycythemia vera

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leading cause of death in polycythemia vera pt

thrombosis

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what gene mutation is associated w. polycythemia vera

JAK2

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complications of polycythemia vera

malignancy

myelogibrosis

AML

myelodysplastic syndrome

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tx for polycythemia vera

phlebotomies to maintain Hct <45
low dose ASA
cytoreductive therapy for high risk → hydroxyurea or interferon
anticoagulation

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bone marrow bx findings of: hypercellularity for age w. trilineage growth (panmyelosis), prominent erythroid, granulocytic, and megakaryocytic proliferation w. pleomorphic mature megakaryocytes

polycythemia vera

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pruritis following a warm bath or shower

polycythemia vera

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what is Budd Chiari syndrome

disorder that occurs when the hepatic venous outflow is obstructed dt a thrombus w.in a hepatic vein

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what do you think when you see: pallor, jaundice, dark urine, anemia, hepatosplenomegaly

beta thalassemia major

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iron storage disorder in which iron absorption is increased and stored as hemosiderin in the liver, heart, pancreas, pituitary testes, kidneys and adrenals

hereditary hemochromatosis

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sx of hereditary hemochromatosis

fatigue

arthralgia

arthropathy

hepatomegaly

skin pigmentation

hepatic dysfxn

cardiac enlargement/failure

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liver bx showing Prussian blue stain

hereditary hemochromatosis

→ due to intense iron stores in the liver

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how much etch intake/day increases risk of developing cirrhosis

>30 grams

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how much etch intake/day increases risk of developing cirrhosis

>30 grams

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dx for hereditary hemochromatosis

MRI OR liver bx *also HFT genotype*

which DM med has been shown to lower A1C levels and reduce the risk of CVD in adults w. T2DM

empagliflozin

pneumococcal vaccine is recommended for what 2 pt pops

adults 65 or older adults \< 65 w. rf

mc s.e of isoniazid

peripheral neuropathy hepatitis rash mild CNS

mc s.e of rifampin

hepatitis flu like GI bleed kidney failure

mc s.e of Pyrazinamide

hyperuricemia hepatotoxic rashGI joint aches

mc s.e of ethambutol

optic neuritis

mc s.e of streptomycin

CN VIII damage nephrotoxic

how many mm of induration will be present on a pt w. HIV and TB who undergoes TB skin test

5 or more

6 p's of acute arterial embolism

paresthesia pain pallor pulselessness paralysis poikilothermia

childhood condition that is most acute follows viral infxn sx include: petechiae, gingival bleeding, epistaxis, menorrhagia, GI bleeding, intracranial hemorrhage

immune thrombocytopenia of childhood

management of immune thrombocytopenia of childhood

supportive platelets corticosteroids IVIG or anti-D immunoglobulin splenectomy *emergent care if severe sx (ex GI bleeding)*

labs associated w. immune thrombocytopenia of childhood

isolate thrombocytopenia w. normal Hgb, Hct, and WBC platelet count \< 100,000

autoantibodies associated w. immune thrombocytopenia of childhood

glycoprotein IIb/IIIA complex

what steroid sparing agents are appropriate for chronic immune thrombocytopenia in children

rituximab thrombopoietin receptor agonists (romiplostim, eltrombopag) azathioprine mycophenolate mofetil

meds that commonly cause pill esophagitis

abx NSAIDs bisphosphonates KCl quinidine vitamin C iron

3 abx that commonly cause pill esophagitis

tetracyclines bactrim clindamycin

gradually progressive dysphagia to solids can be due to GERD, pt's undergoing xrt, eosinophilic esophagitis

esophageal stricture

first line tx for benign esophageal strictures

esophageal dilation

2 mc presenting sx of colorectal ca

painless hematochezia change in bowel habits

bowel obstruction and change in bowel habits are mc with __ sided colorectal ca

left

hematochezia and IDA are mc seen w. __ sided colorectal ca

right

what does “apple core lesion” make you think of

circumferential colorectal carcinoma

anemias w. low MCV

IDA sideroblastic thalassemia anemia of chronic dz

anemias w. high MCV

B12/megaloblastic/pernicious

what does basophilic stipling make you think of

lead poisoning thalassemias etch heavy metal poisoning

only anemia associated w. increased TIBC

iron deficiency anemia

mc cause of large bowel obstruction in older pt

neoplasm

mc cause of PUD

h pylori NSAIDs

duodenal ulcers affect what pt pop gastric ulcers affect what pt pop

duodenal: young gastric: older

gs dx for peptic ulcers

endoscopy

gs testing for h. pylori

urea breath test fecal antigen assay serology

quadruple therapy for h. pylori

bismuth metronidazole tetracycline omeprazole *areas of macrolide resistance*

triple therapy for h. pylori

omeprazole clarithromycin amoxicillin *metronidazole if pcn allergy*

most sensitive test for h. pylori

urea breath

where in the stomach are the most benign ulcers found

antrum

chronic insomnia is defined as

sx at least 3x/week for at least 3 months

first line tx for insomnia

CBT

when would you order polysomnography for insomnia

cases where organic cause is suspected ex OSA

pharm for insomnia

benzos non benzo receptor agonists sedatives melatonin agonists suvorexant antipsychotics

2 mc relaxation based strategies for insomnia d.o

progressive muscle relaxation diaphragmatic breathing

pt takes a deep breath while examiner palpates upward in area of gallbladder fossa

murphy sign

cholecystitis PLUS elevated bilirubin and alk phos is concerning for (4)

biliary obstruction cholangitis choledocholithiasis mirizzi syndrome

order of dx tests for cholecystitis

1. US 2. cholescintigraphy (HIDA) → if dx unclear 3. CT

preferred definitive tx for cholecystitis

cholecystectomy

test to order for cholecystitis with coexisting elevated bilirubin, elevated liver enzymes, or e.o bile duct dilation on US

MRCP (magnetic resonance cholangiopancreatography) *to r.o choledocholithiasis*

what is Charcot triad

jaundice fever RUQ pain

hyperesthesia, increased or altered sensitivity below the right scapula

boas sign → cholecystitis

painful linear tear in the anal canal

anal fissure

causes of anal fissure

low fiber diet passage of hard or large stools anal trauma

what do you think when you see “severely painful BM and bright red blood per rectum during BM”

anal fissure

primary anal fissures are located \_\_ and caused by __ (6)

posterior midline local trauma, constipation, diarrhea, vaginal delivery, anal intercourse

lateral anal fissures are located \_\_ and caused by \_\_

lateral Crohn dz, granulomatous dz, malignancy, communicable dz

management of anal fissures

topical nifedipine or nitroglycerin topical analgesic stool softener sitz bath fiber

what do you think when you see “erythematous ulcer on anal margin”

Crohn dz

what do you think when you see: "perineal induration" accompanied by erythema, fever, drainage

anorectal abscess

what do you think when you see: “tender palpable mass on anal margin” and rectal bleeding

external hemorrhoids *less painful than anal fissure*

if anal fissures are located \_\_, search for pathologic etiologies

laterally

what is second-line tx for persistent anal fissures

topical nitroglycerin or nifedipine ointment

mc type of lung ca not associated w. smoking

adenocarcinoma

acute purulent inflammation of the eyelid mc at or near eyelash follicle

hordeolum (stye)

mc cause of hordeolum

staph aureus

tx for hodeolum

warm compress *abx are rarely effective*

blocked oil gland on eyelid mc found above eyelashes on upper lid firm, painless

chalazion

tx for chalazion

warm compress steroid injxn surgery

diffuse eyelid inflammation often associated w. rosacea or seborrhea dermatitis

blepharitis

sudden and rapid rise in intraocular pressure

acute angle closure glaucoma

classification finding on fluorescein stain for HSV keratitis

dendritic branches

what is this showing

basal cell carcinoma

slow growing waxy/pearly nodule rolled borders telangiectasias

basal cell carcinoma

tx for basal cell carcinoma

topical imiquimod 5 fluoracil curettage and electrodessication excision mohs micrographic sx

which tx for skin ca has the highest cure rate and results in least amount of tissue loss

mohs micrographic sx

painless, firm, shiny, flesh colored or bluish-red nodule on sun exposed area rarely has ulceration or crusting

merckle cell carcinoma

non healing ulcers/warty nodules may crust or bleed common in pt who sunburn easily

squamous cell carcinoma

which type of Hodgkin lymphoma is mc

non-hodgkin

what pathogen mc causes prostatitis in men \> 35 yo

**e.coli** *also: proteus, enterobacteriaceae, pseudomonas*

fever, urinary retention, irritation w. voiding, fever warm, edematous, exquisitely tender prostate often in setting of recent urinary catheter

prostatitis

tx for prostatitis

bactrim fluoroquinolone **x 4-6 weeks**

pathogens associated w. prostatitis in men \< 35 yo

Neisseria gonorrhoeae chlamydia trachoma's

tx for prostatitis associated w. STI

ceftriaxone doxycycline

uniform, enlarged, firm prostate w. a palpable median sulcus

BPH

what class of med is recommended in the initial tx for symptomatic prostatic hyperplasia

alpha-1 adrenergic antagonists → **tamsulosin, terazosin**

avoid what tx for prostatitis

vigorous prostatic massage

what type of bacteria is associated w. struvite stones

**proteus mirabilis** *urease producing bacteria → magnesium phosphate crystals*

what do you think when you see: pyuria and WBC casts

pyelonephritis

imaging of choice for pyelo

abd/pelvis CT

what do you think when you see: f/c, recent UTI, flank pain, CVA tenderness, n/v

pyelonephritis

mc bacteria associated w. acute pyelonephritis

**e.coli** proteus mirabilis klebsiella staph

op management for pyelonephritis

cipro, levo OR bactrim

inpt tx for moderate pyelonephritis

ceftriaxone OR cipro/levo

inpt tx for severe pyelonephritis

cefepime OR zosyn OR meropenem

how many colony forming unites of a single organism on urine culture are suggestive of UTI

100,000

mc pathogens associated w. acute bronchitis

influenza A and B parainfluenza coronavirus rhinovirus RSV

bacterial causes of acute bronchitis

mortadella pertussis mycoplasma pneumoniae chlamydia pneumoniae

sx of acute bronchitis

cough lasting 5 days or more purulent or non purulent d.c +/- preceding URI

widening of bronchioles d.t chronic infxn persistent cough w, mucopurulent sputum recurrent lung infxns hemoptysis

bronchiectasis

differentiating factor between bronchitis and PNA

f/c anorexia abnormal vitals lung consolidations on CXR

what is the name of the pulmonary PE test performed by placing the ulnar aspects of both hands agains the pt's chest while pt says “99”

tactile fremitus

mc location for disc herniation

L4-5 L5-S1

test to order if you suspect cauda equina

MRI

2 mc surgical procedures for lumbar radiculopathy

open discectomy microdiscectomy

pain down the back of the leg is associated w. which myotome

pain down the lateral leg is associated w. which myotome

pain down the anterior leg is associated w. which myotome

pain down the medial leg is associated w. which myotome

what condition is a kyphoplasty used to treat

vertebral compression fx

mc tick borne (vector) illness in US

Lyme dz

lime dz is caused by

Borella burgdorferi

3 stages of Lyme dz

early localized early disseminated late disseminated

what rash is associated w. Lyme dz

erythema migrans

erythema migraines and cardiac sx CN palsy occur in which stage of Lyme dz

early disseminated

erythema migraines is associated w. which stage to Lyme dz

early localized

rheumatologic sx, encephalopathy, and polynephropathy are associated w. which stage of Lyme dz

late disseminated

tx for prophylaxis of Lyme dz (w.in 72 hr of tick removal)

single dose of doxy 200 mg PO *no alternative if doxy can not be taken*

tx for early disseminated Lyme dz

doxycycline

duration of tx for late disseminated Lyme dz

30 days

bacterial spirochete responsible for Rocky Mountain spotted fever

rickettsia rickettsii

tx for pregnant pt w. Lyme dz

amoxicillin

\_\_ is pathognomonic for Lyme dz

bilateral facial nerve palsy

hypo pigmented spots on the abdomen and chest oval shaped macules KOH prep shows hyphae w. spores

tinea versicolor

what do you think when you see “malassezia”

tinea versicolor genus

tinea versicolor worsens w.

sun exposure

what do you think when you see “spaghetti and meatballs appearance” on KOH prep

tinea versicolor

management of tinea versicolor

topical antifungal → selenium sulfide 2.5% or ketoconazole oral if severe or refractory

benign, self limited, common skin condition in kids characterized by hypo pigmented macule and patches on the face likely related to atopic dermatitis

pityriasis alba

superficial fungal dz characterized by erythematous, annular, patchy plaques - often w. raised border irritating, pruritic

tinea corporis

well circumscribed, depigmented, macule and patches not painful or pruritic associated w. AI d.o - ex thyroid abnormalities affects face, neck, arms, feet, fingers, trunk, scalp

vitiligo

which anti fungal is no longer recommended as first line oral tx d.t risk of drug induced hepatitis

ketoconazole

excruciating unilateral orbital/supraorbital/temporal pain associated w. autonomic sx → ptosis mitosis, anhidrosis associated w. nasal congestion/lacrimation mc in men

cluster HA

how long do cluster HA last how often

short lived → 15-180 min daily in clusters, followed by remission

tx for cluster HA

100% O2 sumatriptan

t/f: cluster HA can be bilateral

F! always unilateral, but can switch sides with new attack

similar to cluster HA but shorter attacks and less severe sx occur 5 or more times daily mc in women

proxysmal hemicrania

gradual nonspecific unilateral HA with impaired vision, hormone deficiencies worsen over time

pituitary adenoma

what are the 4 types of trigeminal autonomic cephalagias

cluster HA paroxysmal hemicrania short-lasting unilateral neuralgiform Ha attacks hemicrania continua

prophylaxis for cluster HA

verapamil

which congenital heart disorder is associated w. Turner syndrome and intracranial aneurysms

coarctation of the aorta

what do you think when you see: new onset murmur, early-onset HTN difference in brachial and popliteal bp rib notching on CXR

coarctation of the aorta

what is 3 sign

rib notching on CXR

tx for coarctation of the aorta

end to end anastomosis balloon angioplasty stent

what congenital heart disorder is associated w. recurrent respiratory infxns, failure to thrive, exertion dyspnea commonly asymptomatic until 30 yo

atrial septal defect

continuous machinelike murmur heard best on pulmonic area w, wide pulse pressures

patent ductus arteriosus

tetralogy of Fallot is relieved by the patient \_\_

squatting

what would ECG for pt with coarctation of aorta show

LVH

primary adrenal insufficiency

addison's dz

dx test for addison's

morning serum cortisol rapid ACTH test

tx for Addison's

lifelong supplementation of glucocorticoids → prednisone, hydrocortisone, dexamethasone and mineralocorticoids → fludrocortisone

in addison's dz, the HPA axis is \_\_ cortisol levels are \_\_ and ACTH levels are \_\_

intact decreased increased

mc cause of addison's

AI destruction of adrenal cortex

in secondary adrenal insufficiency the HPA axis is \_\_ and ACTH is \_\_

not intact → impaired stimulation of adrenal glands low

which endocrine disorder is associated w. skin pigmentation

addison's dz

which food craving is characteristic of primary adrenal insufficiency

salt

presenting sx of addison's

abd pain, vomiting, diarrhea fever confusion

criteria for diagnosing DM (4)

sx PLUS a random BG 200 or higher OR fasting BG 126 or higher on 2 separate occasions BG over 200 2 hr after 75 g OGTT A1C 6.5 or higher *should be repeated for confirmation unless 2 or more clinical criteria are met*

what type of obesity is associated w. insulin insensitivity

visceral dt accumulation of fat in mental and mesenteric regions

classifications of rhino sinusitis

acute → \< 4 wees subacute → 4-12 weeks chronic → \> 12 weeks recurrent acute → 4 or more episodes/year w. interim resolution

mc pathogen associated w. bacterial rhino sinusitis

**strep pneumo** *also common: m. cat, strep pyogenes*

mc cause of chronic sinusitis (lasting \> 12 weeks)

staph aureus

major s.e of pseudoephedrine (esp if used \> 3 days)

rebound congestion

tx for bacterial sinusitis lasting 10 days or more

augmentin

chronic abdominal pain relieved w. BM, and altered bowel habits absence of any organic cause

IBS

4 subtypes of IBS

predominant constipation → IBS-C IBS w. predominant diarrhea → IBS-D mixed → IBS-M unclassified IBS

tx for IBS-D

**loperamide** cholestyramine rifamixin or alosetron

tx for IBS-C

**psyllium** polyethylene glycol → Miralax lubiprostone

antispasmodic meds for IBS to treat abd discomfort/pain

dicyclomine hyoscyamine

alarm features that suggests alternative dx to IBS

more tha minimal rectal bleeding wt loss unexplained IDA nocturnal sx fam hx colon ca IBD celiac

rome IV criteria for IBS

recurrent abd pain at least 1/week for 3 months associated w. 2 or more: related to defamation associated w. change in stool frequency associated w. change in stool form

erythema multiforme is a __ sensitivity

type IV

what is this showing

erythema multiforme

raised, blanching, target shaped lesions with 3 concentric zones of color change

erythema multiforme

mc cause of erythema multiforme

**HSV** also mycoplasma

blanching, erythematous macular rash that becomes petechial over time classically begins on ankles and wrists → spreads to trunk

rash associated w. Rocky Mountain spotted fever

what spirochete causes syphilis

treponema pallidum

diffuse, macular or papular rash affecting trunk and extremities macule appear copper, red, or brown scaly or smooth

secondary syphilis rash

t/f: HSV 1 can not cause genital herpes

drugs that commonly cause erythema multiforme

**SOAPS:** sulfa orał hypoglycemics anticonfulsants pcn NSAIDs

menière disease triad

episodic vertigo sensorineural hearing loss tinnitus

dx for meunière disease

2 spontaneous episodes of rotational vertigo lasting 20 min or more audiometric confirmation of sensorineural hearing loss tinnitus or perception of aural fullness or both

type of hearing loss associated w. menière disease

low frequency sensorineural loss over 8-10 years

management of meniere disease

avoid salt, caffeine, etoh, nicotine, msg diuretic benzos betahistine diuretics prednisone

what do you think of when you see high frequency sensorineural hearing loss

prebycusis (age related hearing loss)

causes of conductive hearing loss

cerumen otitis media w. and w.o effusion cholesteatoma

which disorder is characterized by progressive unilateral sensorineural hearing loss, disequilibrium, and facial numbness 2/2 to compression of CN VIII

vestibular schwannoma aka acoustic neuroma

mc cause of meniere disease

too much inner ear endolymph → increased pressure w.in inner ear

neck circumference \> __ is rf for OSA

16 in

questionnaire for OSA

STOP-Bang → snoring tiredness observed apnea high bp bmi age neck circumference gender - male

first line dx test for OSA

polysomnography

first line tx for OSA

CPAP

complications of OSA

CVD mortality metabolic syndrome and T2DM NAFLD

first line tx for OSA in kids

tonsillectomy

what is pickwickian syndrome

hypoventilation dt obesity

acute sharp pain described as ripping +/- syncope, stroke, MI, HF

aortic dissection

pleuritic cp accompanied by dyspnea and cough

pulmonary embolism

sharp pleuritic cp that improves w. sitting up and leaning forward

pericarditis

egg findings of pericarditis

diffuse ST elevations PR depressions

lesion in which vessel is indicated by ST elevations in V1, V2, V3. V4

LAD

initial tx for acute invasive fungal sinusitis

IV amphotericin B surgical debridement

what pear shaped protozoan has four flagella at its anterior end and can be seen on urine microscopy

trichomonas vaginalis

what food borne illness is associated w. reactive arthritis

salmonellosis

tx for severe salmonellosis

ciprofloxacin

what food borne illness is associated w. staph aureus

mayo

what food borne illness is associated w. ingestion of raw hot dogs

listeria

what food borne illness is associated w. ingestion of raw seafood

vibrio spp

which virus is associated w. outbreaks of gastroenteritis on cruise ships

norovirus

what 3 foods are associated w. salmonellosis

poultry meat eggs

labs for salmonellosis

fecal WBCs

what food borne illness is associated w. osteomyelitis in kids w. sickle cell

salmonellosis

what is seen on coronary angiography in vasospastic angina

coronary vasospasm w. IV ergonovine or acetylcholine administration

5 rf for vasospastic angina

htn smoking dm obesity cocaine

transient ST elevations normal cardiac enzymes pain at rest

vasospastic angina

tx for vasospastic angina

CCB nitrates

phases of a migraine

prodrome → hours to days aura → 5-60 min HA → 4-72 hr postdrome → 24-48 hr

tx for acute migraines

OTC analgesics triptans dihydroergotamine antiemetics

prophylactic tx for migraines

bb ccb amitriptyline valproic acid, **topiramate (1st line)** botulinum toxin

which med for migraine prophylaxis is not recommended for women of child bearing age and can cause weight gain, hair loss, tremor

valproate

prophylactic migraine med that may be good for older pt, smokers, or pt w. Raynaud

verapamil

common s.e of topiramate

paresthesias anomia wt loss anorexia metabolic acidosis nephrolithiiasis

first line prophylactic migraine med that can aid in wt loss

topiramate

contraindications for triptans and DHE

HTN CVD

mc pain presentation of migraines

gradual onset unilateral

mc nonverbal STI infxn

trichomoniasis

frothy, greenish yellow vaginal d.c hyperemic, friable cervical mucosa → strawberry cervix pH \> 5 WBCs

trichomoniasis

wet mount findings: flagellated motile trichomonads

trichomoniasis

tx for trichomoniasis

metronidazole 2 g po single dose OR metronidazole 500 mg bid x 7 days *2nd line: tinidazole*

vulvar/vaginal itching/burning external dysuria odorless, thick, cottage cheese d.c budding yeast acidic pH

vaginal candidiasis

what causes BV

gardnerella vaginalis

fishy vaginal d.c thin ivory to gray homogenous d.c pH \> 4.5 clue cells

STI affecting membranes of urethra, cervix, uterus, Fallopian tubes yellow to greenish urethral d.c, dysuria or asymptomatic

Neisseria gonorrhoeae

nonmotile diplococci in pairs

Neisseria gonorrhoeae

which test can be used to confirm dx of trichomoniasis

NAAT

3 mc causes of aortic stenosis

calcific dz congenital abnormality rheumatic heart dz

dyspnea on exertion, decreased exercise tolerance, exertional dizziness, exertional angina delayed/diminished carotid pulses paradoxically split S2 narrow pulse pressure

aortic stenosis

crescendo decrescendo murmur heard best at second right ICS harsh radiates to carotid arteries

aortic stenosis

tx for aortic stenosis

aortic valve replacement

harsh crescendo decrescendo systolic murmur heard best at the apex and lower left sternal border increases w. standing up, valsalva, and with nitro decreases from standing to sitting, handgrip, passive leg elevation

HOCM

holosystolic murmur heard best at apex mc blowing and high pitched radiates to axilla

mitral regurgitation

mc causes of mitral regurgitation

degenerative dz w. prolapse CAD

low pitched diastolic rumble heard best at apex opening snap

mitral stenosis

mc cause of tricuspid stenosis

rheumatic heart disease

3 rf for aortic stenosis

age DM HTN

aortic stenosis murmur __ with valsalva

decreases

what drug is considered first line for dyslipidemia that is recalcitrant to lifestyle mods

statins

med used in HFrEF and SVT

digoxin

meds for AA w. HFrEF

hydralazine PLUS nitrate

med for HFrEF 35% or less with persistent sx despite therapy

spironolactone

which class does sacubitril-valsartan belong to

ARNI

gastronomes that secrete excessive gastrin multiple peptic ulcers

Zollinger Ellison syndrome

for how long should psi be discontinued prior to performing urea breath tests and fecal antigen assays

7-14 days

spiral shaped gram negative rod

h pylori

mc causes of acute gastritis

1. NSAIDs 2. etoh

types and causes of atrophic gastritis

A chronic → pernicious anemia B chronic → h. pylori

cosyntropin stimulation test is used to dx

addison's *measures cortisol after ACTH is injected*

2 tests for addison's

1, cosyntropin stimulation 2. CRH stimulation

what androgen is androstenedione converted to

testosterone

what are these showing

aphthous ulcers → canker sores

painful condition affecting oral and genital mucosa recurrence of small, painful, round to oval ulcers last 1-2 weeks

aphthous ulcers

ulcer with peripheral rim of edema surrounding yellowish, central exudate

aphthous ulcer

what type of mucosa do aphthous ulcers appear on

nonkeratinized mucosa

4 tx for aphthous ulcers

chlorhexidine mouth rinse topical lidocaine dexamethasone elixir oral prednisone if refractory

when is prophylactic antiviral therapy recommended for HSV

at least 6 outbreaks/year

differentiating factors btw aphthous ulcers and HSV

HSV appears outside the mouth HSV has prodrome HSV break open and crust over

which virus causes a flesh colored cauliflower like genital lesion

HPV

conductive hearing loss w. cholesteatoma is mc dt erosion of which of the ossicles

distal portion of incus

rounded bilobed cells w. 2 nuclei owl's eye appearance

reed-sternberg cells → Hodgkin lymphoma

3 rf for hodgkin lymphoma

Epstein barr immunosuppression AI dz

chemo tx for Hodgkin lymphoma

ABVD → doxorubicin, bleomycin, vinblastine, decarbazine

gallium 67 uptake in a pattern assembling lambda

sarcoidosis

granulomatous inflammation w, caseation necrosis

tuberculosis

monomorphic medium sized cells w. basophilic cytoplasm starry sky appearance

Burkitt lymphoma → aggressive non hodgkin lymphoma of jaw or face tumor lysis syndrome

what is the waldeyer ring

pharyngeal ring of lymphoid tissue made up of adenoid, tubal, palatine, lingual tonsils

painless cervical LAD, pruritis, fever, night sweats, wt loss, frequent infxns

hodgkin lymphoma

dx for hodgkin lymphoma

lymph node bx → reed sternerg cells

first line med for generalized epileptic sz

valproate

preferred tx for focal onset sz can worsen generalized epilepsy

carbamazepine

med used for status elepticus can worsen generalized epilepsy syndrome

phenytoin

term used to describe periodic paralysis following a seizure

Todd paralysis

what med has been shown to reduce suicide risk in depressed pt

lithium

fx of proximal ulnar shaft w. radial head dislocation

monteggia fx

distal radius fx distal radioulnar joint dislocation

galeazzi fx

distal radius fx distal radioulnar joint dislocation

galeazzi fx

fx of the distal radius w. volar angulation

smith fx

fx of proximal fibular and tear of tibiofibular syndemosis and interosseous membrane

Maisonneuve fx

radiographic finding that describes metaphyeseal triangular portion in a salter II fx

thurstan holland fragment

when should prenatal visits be scheduled

q 4 weeks from 4-28 weeks gestation q 2 weeks from 28-36 weeks gestation weekly after 36 weeks gestation

what 4 things are done at every prenatal visit

weight bp fetal heart rate UA for infxn protein, glucose

when is fundal height measured

each prenatal visit beginning at 20 weeks

what should be done btw 6-12 weeks gestation

random BG CBC syphilis chlamydia rubella titer varicella titer HIV testing Hep B surface antigen ABO/Rh

what is a maternal quad screen when is it performed

alpha fetoprotein, hCG, estradiol, inhibin A performed during second trimester tests for aneuploidy and spina bifida

when is testing for group B strep done in prenatal care

35-37 weeks gestation

at which point of gestation is chrionic villus sampling typically performed

10-13 weeks

Rosh Material #3 Flashcards

(315 cards)