S2 RR_3 Flashcards by Kevin G

A 24-year-old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?

Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension

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Begin Pneumocystis carinii pneumonia (PCP) prophylaxis in an HIV-positive patient at what CD4 count? Mycobacterium avium-intracellulare (MAI) prophylaxis?

_ 200 for PCP (with TMP); _ 50-100 for MAI (with clarithromycin/azithromycin)

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Risk factors for pyelonephritis.

Pregnancy vesicoureteral reflux anatomic anomalies indwelling catheters kidney stones

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Neutropenic nadir postchemotherapy.

7-10 days

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Erythema migrans.

Lesion of 1Á Lyme disease

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Classic physical findings for endocarditis.

Fever heart murmur Osler’s nodes splinter hemorrhages Janeway lesions Roth’s spots

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Aplastic crisis in sickle cell disease.

Parvovirus B19

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Ring-enhancing brain lesion on CT with seizures

Taenia solium (cysticercosis)

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Name the organism: Branching rods in oral infection.

Actinomyces israelii

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Name the organism: Painful chancroid.

Haemophilus ducreyi

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Name the organism: Dog or cat bite.

Pasteurella multocida

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Name the organism: Gardener.

Sporothrix schenckii

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Name the organism: Pregnant women with pets.

Toxoplasma gondii

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Name the organism: Meningitis in adults.

Neisseria meningitidis

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Name the organism: Meningitis in elderly.

Streptococcus pneumoniae

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Name the organism: Alcoholic with pneumonia.

Klebsiella

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Name the organism: Currant jelly sputum.

Klebsiella

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Name the organism: Infection in burn victims.

Pseudomonas

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Name the organism: Osteomyelitis from foot wound puncture.

Pseudomonas

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Name the organism: Osteomyelitis in a sickle cell patient.

Salmonella

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A 55-year-old man who is a smoker and a heavy drinker presents with a new cough and flulike symptoms. Gram stain shows no organisms; silver stain of sputum shows gram-negative rods. What is the diagnosis?

Legionella pneumonia

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A middle-aged man presents with acute-onset monoarticular joint pain and bilateral Bell’s palsy. What is the likely diagnosis and how did he get it? Treatment?

Lyme disease Ixodes tick doxycycline

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A patient develops endocarditis three weeks after receiving a prosthetic heart valve. What organism is suspected?

S. aureus or S. epidermidis.

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A patient presents with pain on passive movement pallor poikilothermia paresthesias paralysis and pulselessness. Treatment?

All-compartment fasciotomy for suspected compartment syndrome

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Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips.

Spinal stenosis

Joints in the hand affected in rheumatoid arthritis.

MCP and PIP joints; DIP joints are spared

Joint pain and stiffness that worsen over the course of the day and are relieved by rest.

Osteoarthritis

Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.

Osteogenesis imperfecta

Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?

Suspect ankylosing spondylitis. Check HLA-B27

Arthritis conjunctivitis and urethritis in young men. Associated organisms?

Reactive (Reiter's) arthritis. Associated with Campylobacter Shigella Salmonella Chlamydia and Ureaplasma

A 55-year-old man has sudden excruciating first MTP joint pain after a night of drinking red wine. Diagnosis workup and chronic treatment?

Gout. Needle-shaped negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid

Rhomboid-shaped positively birefringent crystals on joint fluid aspirate.

Pseudogout

An elderly female presents with pain and stiffness of the shoulders and hips; she cannot lift her arms above her head. Labs show anemia and inc'd ESR.

Polymyalgia rheumatica

An active 13-year-old boy has anterior knee pain. Diagnosis?

Osgood-Schlatter disease

Bone is fractured in fall on outstretched hand.

Distal radius (Colles' fracture)

Complication of scaphoid fracture.

Avascular necrosis

Signs suggesting radial nerve damage with humeral fracture.

Wrist drop loss of thumb abduction

A young child presents with proximal muscle weakness waddling gait and pronounced calf muscles.

Duchenne muscular dystrophy

A first-born female who was born in breech position is found to have asymmetric skin folds on her newborn exam. Diagnosis? Treatment?

Developmental dysplasia of the hip. If severe consider a Pavlik harness to maintain abduction

An 11-year-old obese African-American boy presents with sudden onset of limp. Diagnosis? Workup?

Slipped capital femoral epiphyses. AP and frog-leg lateral view

The most common 1Á malignant tumor of bone.

Multiple myeloma

Unilateral severe periorbital headache with tearing and conjunctival erythema.

Cluster headache

Prophylactic treatment for migraine.

beta-blockers Ca2+ channel blockers TCAs

The most common pituitary tumor. Treatment?

Prolactinoma. Dopamine agonists (e.g. bromocriptine)

A 55-year-old patient presents with acute broken speech. What type of aphasia? What lobe and vascular distribution?

Broca's aphasia. Frontal lobe left MCA distribution

The most common cause of SAH.

Trauma; the second most common is berry aneurysm

A crescent-shaped hyperdensity on CT that does not cross the midline.

Subdural hematomabridging veins torn

A history significant for initial altered mental status with an intervening lucid interval. Diagnosis? Most likely etiology? Treatment?

Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation

CSF findings with SAH.

Elevated ICP RBCs xanthochromia

Albuminocytologic dissociation.

Guillain-Barre (inc'd protein in CSF with only a modest increase in cell count)

Cold water is flushed into a patient's ear and the fast phase of the nystagmus is toward the opposite side. Normal or pathological?

Normal

The most common 1Á sources of metastases to the brain.

Lung breast skin (melanoma) kidney GI tract

May be seen in children who are accused of inattention in class and confused with ADHD.

Absence seizures

The most frequent presentation of intracranial neoplasm.

Headache

The most common cause of seizures in children (2-10 years).

Infection febrile seizures trauma idiopathic

The most common cause of seizures in young adults (18-35 years).

Trauma alcohol withdrawal brain tumor

First-line medication for status epilepticus.

IV benzodiazepine

Confusion confabulation ophthalmoplegia ataxia.

Wernicke's encephalopathy due to a deficiency of thiamine

What % lesion is an indication for carotid endarterectomy?

Seventy percent if the stenosis is symptomatic

The most common causes of dementia.

Alzheimer's and multi-infarct

Combined UMN and LMN disorder.

ALS

Rigidity and stiffness with resting tremor and masked facies.

Parkinson's disease

The mainstay of Parkinson's therapy.

Levodopa/carbidopa

Treatment for Guillain-Barr_ syndrome.

IVIG or plasmapheresis

Rigidity and stiffness that progress to choreiform movements accompanied by moodiness and altered behavior.

Huntington's disease

A six-year-old girl presents with a port-wine stain in the V2 distribution as well as with mental retardation seizures and leptomeningeal angioma.

Sturge-Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe

Caf_-au-lait spots on skin.

Neurofibromatosis 1

Hyperphagia hypersexuality hyperorality and hyperdocility.

KlÙver-Bucy syndrome (amygdala)

Administer to a symptomatic patient to diagnose myasthenia gravis.

Edrophonium

1Á causes of third-trimester bleeding.

Placental abruption and placenta previa

Classic ultrasound and gross appearance of complete hydatidiform mole.

Snowstorm on ultrasound. Cluster-of-grapes appearance on gross examination

Chromosomal pattern of a complete mole.

46XX

Molar pregnancy containing fetal tissue.

Partial mole

Symptoms of placental abruption.

Continuous painful vaginal bleeding

Symptoms of placenta previa.

Self-limited painless vaginal bleeding

When should a vaginal exam be performed with suspected placenta previa?

Never

Antibiotics with teratogenic effects.

Tetracycline fluoroquinolones aminoglycosides sulfonamides

Shortest AP diameter of the pelvis.

Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis

Medication given to accelerate fetal lung maturity.

Betamethasone or dexamethasone x 48 hours

The most common cause of postpartum hemorrhage.

Uterine atony

Treatment for postpartum hemorrhage.

Uterine massage; if that fails give oxytocin

Typical antibiotics for group B streptococcus (GBS) prophylaxis.

IV penicillin or ampicillin

A patient fails to lactate after an emergency C-section with marked blood loss.

Sheehan's syndrome (postpartum pituitary necrosis)

Uterine bleeding at 18 weeks' gestation; no products expelled; membranes ruptured; cervical os open.

Inevitable abortion

Uterine bleeding at 18 weeks' gestation; no products expelled; cervical os closed.

Threatened abortion

The first test to perform when a woman presents with amenorrhea.

beta-hCG; the most common cause of amenorrhea is pregnancy

Term for heavy bleeding during and between menstrual periods.

Menometrorrhagia

Cause of amenorrhea with normal prolactin no response to estrogen-progesterone challenge and a history of D&C.

Asherman's syndrome

Therapy for polycystic ovarian syndrome.

Weight loss and OCPs

Medication used to induce ovulation.

Clomiphene citrate

Diagnostic step required in a postmenopausal woman who presents with vaginal bleeding.

Endometrial biopsy

Indications for medical treatment of ectopic pregnancy.

Stable unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks' gestation

Medical options for endometriosis.

OCPs danazol GnRH agonists

Laparoscopic findings in endometriosis.

Chocolate cysts powder burns

The most common location for an ectopic pregnancy.

Ampulla of the oviduct

How to diagnose and follow a leiomyoma.

Ultrasound

Natural history of a leiomyoma.

Regresses after menopause

A patient has inc'd vaginal discharge and petechial patches in the upper vagina and cervix.

Trichomonas vaginitis

Treatment for bacterial vaginosis.

Oral or topical metronidazole

The most common cause of bloody nipple discharge.

Intraductal papilloma

S2 RR_3 Flashcards

(100 cards)