Spring Final Flashcards
(344 cards)
1
Q
Bence Jones protein is seen in
A
multiple myeloma
immunoglobulin light chain found in urine
2
Q
“smudge cells” are seen in
A
Chronic Lymphocytic Leukemia (CLL)
3
Q
Tx for nausea, vomiting
A
Dexamethasone
Zofran (Ondansetron)
4
Q
pt presents w/hematochezia, what exam should you do?
A
DRE
5
Q
Lupron (Leuprolide)
A
inhibit luteinizing hormone from pituitary
suppresses sex hormones (Testosterone, Estrogen)
Tx prostate ca
6
Q
leucovorin when given with methotrexate
A
chemoprotective of ADR of MTX
(a reduced folic acid)
Tx for non-hodgkin’s lymphoma
7
Q
head and neck cancers can be caused by
A
tobacco
8
Q
Risk of cancer w/second hand smoke
A
1.5x risk of ca
9
Q
What cancers are BRCA gene associated with?
A
breast and ovarian ca
10
Q
Hairy Cell Leukemia
A
no fever 80-90% splenomegaly* B cell lymphoproliferative disorder almost never in children, usu. 50-55y indolent lymphoma
11
Q
AML (Acute Myelogenic Leukemia)
A
rapidly lethal unless Tx w/intensive chemo or other targeted therapies together w/supportive care
Sx: weakness, infection, bleeding
bone marrow blood smear: dark purple AML cells
risk: exposure to radiation or chemo*, rare familial Dz
12
Q
Auer Rods** on peripheral blood smear
A
Acute Myelogenic Leukemia
13
Q
Tx of neuropathic pain
A
TCA, SNRI, 2nd gen anti-convulsant, topical lidocaine, tramadol
14
Q
chemotherapeutic agents for breast cancer
A
Cyclophosphamide
Methotrexate
5-FU
15
Q
Toxicity of Doxorubicin
A
cardiotoxicity
16
Q
Toxicity of Doxorubicin
A
cardiotoxicity
generation of free radicals in cardiomyocyte
17
Q
Nutritional Deficiency Test includes
A
albumin, transferrin, prealbumin, retinol-binding protein
18
Q
NOT a risk factor for colon cancer
A
inflammatory bowel SYNDROME
19
Q
Herceptin (trastuzumab)
A
HER2 inhibitor
breast cancer
20
Q
most common prostate ca cell type
A
adenocarcinoma
21
Q
most common cell affected in ALL/LBL
A
B cell
but T cell better prognosis
22
Q
Most common childhood malignancy**
A
ALL/LBL (75% in children), peak 2-5yo
23
Q
Why should you order an XRay after the resolution of pneumonia?
A
check for underlining lung ca
24
Q
Overweight BMI
A
25-29.9
25
BMI of Obesity: 3 classes
Class I – 30.0 to 34.9
Class II – 35.0 to 39.9
Class III – 40+ (severe obesity, morbidly obese)
26
cytotec
misoprostol
| Tx NSAID peptic ulcer dz
27
Crohn's Dz
chronic inflammatory condition of GI tract
may result in ulceration, stricture formation, and perforation
defect in the host immune response to environmental factors, such as bacteria
not curable
28
Where does Crohn's dz affect?
May involve any portion of the GI tract but primarily affects the terminal ileum/right colon
full thickness and patchy
29
What should be considered in any patient with anemia, weight loss, and fever of unknown origin
Crohn's Dz, even in the absence of overt GI symptoms (especially in relatively young patients)
Non-bloody diarrhea could be a sign of Crohn's disease
30
typical feature of ulcerative colitis
perirectal involvement*
| bloody diarrhea**
31
Ulcerative Colitis
Chronic, recurrent condition marked by exacerbations and remissions
inflammation localized primarily in the mucosa and is uniform and continuous
32
Cigarette smoking in ulcerative colitis v Crohn's
Cigarette smoking appears to protect against UC (associated w/worsening of Crohn’s dz)
33
p-ANCA positive is 40 – 80 %
Ulcerative colitis
34
p-ANCA negative. + ASCA is
Crohn's dz
35
Best Dx study for Crohn's and UC
Colonoscopy
36
omentum function
adipose tissue and macrophage
| limit spread of infection
37
Mackler's Triad
lower chest pain
vomiting
subQ emphysema
*Boerhaave's Syndrome
38
Where does diverticulosis occur most often?
```
sigmoid colon (highest intraluminal pressure)
(L more common in US but mostly false diverticula)
```
39
Courvoisier's Sign
Non-tender, but distended, palpable Gall Bladder
Associated with Jaundice
possible pancreatic malignancy
40
What nerve is associated with nausea and vomitting
vagus nerve
41
Reglan (metoclopramide)
treats GERD, gastroparesis in DM
antiemetic, gut motility stimulator
**watch for tardive dyskinesias (stop medication to prevent permanent Sx)
42
superior mesenteric artery supplies
lower part of the duodenum through two-thirds of the transverse colon, as well as the pancreas
43
Dx study for pancreatic ca
helical CT
44
Dx study for diverticulitis
CT
45
"thumb" sign
epiglottitis
46
what natural process decreases intrinsic factor
aging, can cause B12 deficiency
47
what cells line the esophagus v stomach
esophagus: squamous
stomach: columnar
48
PPI MoA
inhibits gastric acid secretion by inhibiting the K+/H+ pump (potassium pump) located on the apical membrane of the gastric parietal cell, inhibiting secretion of H+ into the stomach
49
orlistat
Lipase inhibitor that acts by inhibiting the absorption of dietary fats (30% of ingested dietary fat)
Interferes with beta-carotene & vit. E & D absorption
50
Phentermine, Diethylpropion
Sympathomimetic Drugs
Stimulate the release of norepinephrine or inhibit its reuptake
Reduce food intake by causing anorexia and early satiety
Contraindications include severe hypertension, coronary artery disease, glaucoma, and a history of drug abuse, only approved for short term (12 weeks)
Potential for abuse
51
parietal cells secrete
HCl, intrinsic factor
52
why are systemic effects of Budesonide (Entocort) reduced?
Steroid whose systemic effects are reduced due to first pass in the liver
53
enteroinvasive e. coli SxS
Visible blood or mucus (not watery)
| Typically associated with fever and abdominal pain
54
H. pylori Tx
1st line: Triple therapy regimen (10-14 days)
Clarithromycin: 500mg PO BID
Amoxicillin: 1g PO BID or Metronidazole: 500mg PO BID
PPI PO BID (eg esomeprazole, lansoprazole)
55
osmotic diarrhea causes
Celiac Sprue/disease
Lactose intolerance
Electrolyte absorption is not impaired*
56
Celiac disease
malabsorptive immune mediated disorder that is triggered by an environmental agent (gluten) in genetically predisposed individuals
Specifically intolerance to gliadin (the alcohol-soluble fraction of gluten)
Immune-mediated small bowel inflammation causes decreased absorption of food and essential nutrients
57
classic SxS of celiac's dz
malabsorption: steatorrhea, weight loss
characteristic histologic changes (villous atrophy) on small intestine biopsy
Resolution of mucosal lesions and symptoms upon withdrawal of gluten– usually within weeks to months
58
#1 cause of Upper GI bleed**
Ulcer disease, erosions (esophageal, stomach, duodenum)
59
What are Mallory-Weiss tears often assoc w/?
Alcohol
60
Where do diverticular bleeds most often occur?*
Right 50-90%
Ascending colon**
(not assoc w/diverticulitis bc typically PAINLESS*)
61
Where does diverticulitis most commonly occur?*
primarily left colon
62
Wilson's dz Tx
life long chelating Tx
63
Rules of 2s for Meckel Diverticulum (PIMP)
2% of the population, within 2 feet of the ileocecal valve, 2 inches in length, two types of heterotopic mucosa (gastric and pancreatic), and presentation before the age of two.
64
Isolated Hyperbilirubinemia - UNCONJUGATED**
Gilbert's Syndrome: Bili goes up in period of stress*
| Crigler-Najjar Syndrome*
65
Isolated Hyperbilirubinemia - CONJUGATED**
think decreased excretion or leakage of pigment from hepatocytes
Dubin-Johnson Syndrome*
Rotor Syndrome*
66
Most common cause of drug-induced liver injury**
Acetaminophen*
67
Rovsing's sign
sign of appendicitis
| palpation of the LLQ of a person's abdomen increases the pain felt in the RLQ
68
Contraindications of NG tubes
Esophageal stricture
Basilar Skull fracture
Esophageal varices
69
Pellagra
advance deficiency of B3 (Niacin)
70
Where does diverticula most commonly occur?*
```
sigmoid colon (highest intraluminal pressure)
(L more common in US but mostly false diverticula)
```
71
Charcot's Triad
Ascending Cholangitis:
Fever
RUQ Pain
Jaundice
72
eating with gastric v duodenal ulcers
gastric: exacerbates pain, no relief w/antacids
duodenal: eating minishes pain, relief w/antacids, nocturnal pain
73
H. pylori testing
urea breath test
| stool antigen test
74
what should you do after treating PUD?
repeat endoscopy in 6-8wks to verify healing!
| non-healing ulcer is ca until proven otherwise*
75
what nodes are associated with gastric ca
```
sister mary joseph node (firm nodule in umbilicus)
irish node (enlarged L axillary LN)
```
76
what can be the 1st sign of gastric ca
virchow's node (L supraclavicular lymphadenopathy)
77
Tx of Boerhaave's syndrome
urgent surgical eval
| broad spectrum antibiotics (rapid sepsis)
78
Gatroparesis
delayed emptying of the stomach due to an issue with motility (NOT obstruction)
DM common cause*
79
Alk Phos elevated out of proportion to aminotransferases
think obstruction (liver/bile ducts) - cholestatic
80
aminotransferases elevated out of proportion to alk phos
think liver inflammation - hepatocellular
81
isolated hyperbilirubinemia - unconjugated
gilbert's syndrome
| crigler-najjar syndrome
82
isolated hyperbilirubinemia - conjugated
dubin-johnson syndrome
| rotor syndrome
83
contraindications to breast feeding
Uncontrolled TB
HIV
Herpes lesions on breast
Chickenpox within five days antepartum or within two days postpartum
Malabsorption diseases in children: classic galactosemia, maple syrup urine disease, phenylketonuria
Severe illness that prevents a mother from caring for her infant, for example sepsis.
Drugs: “street” drugs, Chemotherapy, Radioactive compounds, prescriptive medications should be chosen carefully
84
Types of estrogen
estrone: older
estradiol: young women
estriol: pregnancy** (sudden decline can indicate fetal compromise; precursor = fetal androgens)
85
which thyroid hormone crosses placenta?
T4, fetus dependent on maternal T4 for normal neurologic develop 1st 12wks
(TRH crosses also, TSH does not)
86
Tachysystole
more than 5 contractions (spontaneous or stimulated) in 10 minutes averaged over 30 min
too many contractions
check for fetal heart rate abnormalities
87
Basic Warning Signs in Labor
Contractions lasting longer than 90 seconds (fetus not getting O2)
Relaxation between contractions of less than 60 seconds
Resting uterine tone above 20 mmHg (impairs O2/CO2 exchange btw contractions)
Peak pressure of contractions above 90 mmHg (except in second stage)
88
The inflow of maternal blood into the intervillous spaces ceases at a pressure of
~ 50 mmHg
89
Normal Fetal Heart Rate at Term
110-160 bpm
90
FHR: late deceleration
fetal HR changes only AFTER contraction over; not-synchronized
cause: uteroplacental insufficiency (reduced blood flow or gas exchange)
non-reassuring/needs intervention
ominous, borderline hypoxic
91
FHR: variable deceleration
saw-tooth appearance, see drastic drops
cause: cord compression (causes incr BP, bradycardia from baroreceptors, hypoxia if prolonged)
needs intervention
most common type of deceleration
92
Response to Late Decelerations
Change maternal position to side (supine position compresses maternal aorta and vena cava)
Stop oxytocin (pitocin contracts the uterus, impedes blood flow/oxygen exchange)
Increase IV fluids (correct hypotension)
Oxygen (up to 100%)
Proceed to delivery expeditiously
93
Sinusoidal Pattern
```
cycle freq 3-5/min, 20+min
associated with severe fetal anemia (eg severe Rh dz)
response:
STIMULATE THE FETUS
CHANGE THE MATERNAL POSITION
INCREASE IV
GIVE OXYGEN
STOP OXYTOCIN
```
94
What bacteria are NOT part of the normal flora of lower genital tract?
staph aureus and beta hemolytic strep groups A and B
| normally mostly anaerobes
95
UTI and asymptomatic bacteriuria are associated with
preterm delivery, preeclampsia, maternal anemia, amnionitis, and low birth weight
UTIs BAD in pregnancy, high recurrence
96
70-80% of UTIs in pregnancy caused by
E. coli
97
1/3 of asymptomatic UTIs during pregnancy progresses to
Pyelonephritis*
98
What drugs to AVOID in UTIs in pregnancy*
Sulfa (Bactrim or Septra) – inhibits folate (increased Neural tube defect) and raises bilirubin late in pregnancy (kernicterus)
Fluoroquinolones – fetal arthropathy
Tetracyclines – affect fetal bones and teeth
99
Tx of UTIs in pregnancy*
Empiric 1st and then tailor to culture
Nitrofurantoin 100mg PO BID (2nd, 3rd Trimester) 7 days (good for risk of ESBL-prod enterobacter)
Augmentin 500/125mg PO BID 3-7days, less resistance
Fosfomycin 3g PO QD
100
Pyelonephritis effect on fetus
freq assoc w/septicemia --> tanks BP --> low uterine perfusion/bacterial endotoxin damage on placenta --> fetus cerebral hypoperfusion
OB EMERGENCY!*
most common 2nd trimester
U/S to r/o obstruction/hydronephrosis
101
In-patient Tx of pyelonephritis
Ceftriaxone* (can also be IM outpatient)
or IV ampicillin & gentamycin (but caution in preg)
carbapenem if ESBL-prod enterobacteria
AVOID: nitrofurantoin, fosfomycin (inadequate tissue levels)
Stop IV antibiotic(s) 24-48 hrs after fever subsides – transition to oral x 10-14 days*
monitor for CURE
102
Prophylaxis Tx for UTI recurrence
nitrofurantoin
103
Most common cause of neonatal sepsis (and significant mortality)*
Group B Beta Hemolytic Strep (Strep. agalactiae)
| vertical transmission from mother to fetus
104
when do you treat Group B Beta Hemolytic Strep*
If culture pos, treat at least 4 hours before delivery (6hrs best)
105
TORCHES
```
Toxoplasmosis
Other (Hep B, Coxsackie, VZV, West Nile, Measles, HIV, Zika)
Rubella
Cytomegalovirus
Herpes simplex
Erythema infectiosum (Parvovirus B19)
Syphilis
```
106
Toxoplasmosis Risk Factors
Raw or undercooked meat (esp. pork)
Unpasteurized milk
Gardening – contaminated soil, unwashed veg
Contaminated water
Travel to developing nation
Cat feces – litter box
(prior infections confer immunity; risk only w/primary)
10% prenatal infection cause abortion/neonatal death
107
Untreated toxoplasmosis in fetus can cause*
sensorineural hearing loss
| 67-80% asymp at birth but develop Sx later in life
108
Congenital toxoplasmosis
chorioretinitis: blindness, uveitis
CNS lesions – hydrocephalus, microcephaly, MR, seizures, cysts, periventricular calcifications
CSF – pleocytosis, elevated proteins (20%)
Muscle infections, petechia, maculopapular rash, HSM, jaundice, interstitial pneumonia, anemia, thrombocytopenia
109
Congenital Rubella Syndrome*
```
"Blueberry muffin" baby: thrombocytopenia purpura
Cataracts
Heart Defects (>50%)
Hearing defects (sensorineural)
small gestational age most common
```
110
How long do infants shed Rubella virus?
atleast for 1 year!* need STRICT isolation
111
Most common congenital viral infection
CMV (50% microcephaly*)
| maternal ABs DO NOT protect! Moms mostly asymp
112
Most common sequelae of congenital CMV?*
Sensorineural hearing loss
113
Even with adequate treatment of maternal syphilis
infant can be born with congenital syphilis
| mothers w/primary or secondary syphilis unlikely to have normal infants (premature death or congenital syphilis)
114
Tx of syphilis in mother*
Single dose IM benzathine penicillin 2.4 million units
| ONLY drug that can be used in pregnant women w/syphilis
115
Listeria Monocytogenes effect on fetus
septicemia/gastroenteritis/respiratory distress/meningitis 50% mortality
116
What drugs should you avoid 1st trimester*
Metronidazole
117
What drugs should you avoid 2nd trimester*
Sulfonamides (Hyperbilirubinemia - kernicterus)
| Nitrofurantoin (hemolysis in G6PD deficiency)
118
Post-Partum Fever after Day 1*
Pelvic infection until proven otherwise**
esp w/C section*
10% of maternal death
recognize early and treat
119
Gonorrhea Tx
Ceftriaxone (Rocephin) 250 mg IM + azithromycin 1 g po x 1 dose (Azithromycin covers Chlamydia)
screen and treat at first prenatal visit
newborns all get erythromycin ophthalmic ointment prophylaxis
120
Trichomonads Tx IN PREGNANCY
Metronidazole 2 g x 1 dose (risks, may delay until 37wks)
121
Tocolytics
Medications that suppresses premature labor
122
Neural Tube Defect IS CAUSED BY
Folic acid deficiency
123
Quad screen
AFP/hCG/estriol/inhibin A
124
Alpha-fetoprotein (AFP)*
Produced by the fetal liver.
Tends to be ELEVATED* in pregnancies supporting fetuses with neural tube defects (spina bifida) and is LOWERED* in cases of Down’s syndrome.
Measured in second trimester
regulates fetal intravascular volume as an osmoregulator and may also be involved in immunoregulation.
125
screening in 1st trimester*
blood test
sonogram
*screen Down Syndrome and Trisomy 18*
PAPP-A
hCHG
Ultrasound nuchal transluceny screen: looks at skin on neck and spine
30% w/abnormal screening spontaneously abort
126
cffDNA(cell free fetal DNA)
Fetal DNA fragments from shed placental macrophages
Maternal phlebotomy
Non-invasive
Numbers as good or better than Nuchal measurement plus PAPP A
(cant always get U/S)
screen for aneuploidy and sex
covered by insurance!
127
Second Trimester Screening
AFP (alpha fetoprotein) finds 20% of Down syndrome babies
AFP + hCG + Estriol + inhibin A finds 80% of affected fetuses
15 to 19 weeks
This also finds neurotube defects such as anencephaly and spina bifida
(more confirmatory than 1st trimester screening)
128
Bleeding in the first trimester**
Implantation bleeding: ~time of expected next menses
Subchorionic hemorrhage: U/S Dx, no Tx, resolves
Miscarriage
Ectopic
Cervical infection
Trauma (sex)
(25 % of pregnancies, ½ of those will lose the pregnancy)
129
Asherman’s Syndrome
Intrauterine adhesions
| get hysteroscopy
130
Abortion terminology
Threatened Ab- cramping & bleeding without passage of tissue; os is closed
Inevitable Ab- threatened Ab with more severe cramping & opened Os
Incomplete Ab- bleeding & passage of tissue but some is retained
Complete Ab- Abortion is complete, tissue has passed, Os now closed
Missed Ab- retention of dead products of conception for several weeks
Recurrent Ab- 3 or more consecutive
131
Discriminatory zone of when hCG of intrauterine pregnancy can be detected
hCG ~1500 Units
132
Tx of miscarriage
800 mcg misoprostal intravaginally and repeat in 2 days if needed
(MoA: prostaglandin analogue, binds to myometrial cells to cause strong myometrial contractions leading to expulsion of tissue. This agent also causes cervical ripening with softening and dilation of the cervix)
Mifepristone (abortion pill, anti-progesterone) not effective since progesterone already low in these pregnancies
133
Tx of incomplete or missed abortion
D & C or medical
134
Criteria for Medical Tx of abortion/ectopic*
Tubal ectopic is no larger than 3.5 cm on ultrasound
no cardiac activity present
hemodynamically stable patient
no signs of intra-abdominal bleeding
hCG is less than 15,000 units
no medical contraindications to methotrexate—check liver functions, CBC
(NEED sign of ectopic on U/S AND 2 hCG levels)
135
Medical Tx of ectopic pregnancy
METHOTREXATE—50MG PER METER SQUARE OF BODY SURFACE
RECHECK HCG DAY 3, 7, 14, ETC.
HCG SHOULD FALL COULD RISE ON DAY 3 BUT THEN SHOULD PROGRESSIVELY FALL
FLAT OR RISING LEVELS INDICATE FAILURE.
136
Low birth weight
<2500g
very low birth weight: <1500g
extremely low: <1000g (only extremely low in more danger)
137
guidelines for induction and for elective repeat cesarean section (strict)
no sooner than 39 wk gestation
138
Tocolytics
Beta adrenergics (Terbutaline) - B2 relax uterus & vessels
Magnesium sulfate – smooth muscle relaxation
Indomethacin
Calcium channel blockers
Treatment failure if cervix reaches 5cms
IM weekly injections, only in women w/prior preterm
ineffective in twins
139
Maternal supplementation with twin or more gestations
Additional iron supplement: Actively removed from maternal circulation by placenta; can cause severe anemia in mother; may require infusion of mother at delivery
Additional 1mg folate daily
140
What AED should you avoid in pregnancy
```
Valproate and Carbamazepine esp in Fam Hx of neural tube defect (switch away BEFORE conception)
phenytoin
Lamotrigine
Topiramate
phenobarbital
```
141
Tx of seizures/prophylaxis during delivery or post-partum**
Lorazepam drug of choice (ativan) - benzo
142
What AED should you avoid during lactation*
Avoid sedating AED--phenobarbitol
All AED’s are present in breast milk (Newborn development of AED breast fed no different than in utero exposed infants that were not breast fed
143
FETAL HYDANTOIN SYNDROME (PHENYTOIN, CARBAMAZEPINE)
```
CRANIOFACIAL ANOMALIES
FINGERNAIL HYPOPLASIA
IUGR
DEVELOPMENTAL DELAY
CARDIAC DEFECTS
FACIAL CLEFTS
```
144
Safest anti-coagulant during pregnancy*
Heparin unless mechanical heart valves --> doesnt cross placenta
Unfractionated heparin is used the last month of pregnancy (more easily reversed than lovenox)
145
Anticoagulated patients are not eligible*
for epidural analgesia
146
DM screening during pregnancy
```
BETWEEN 24 AND 28 WKS
50g GLUCOLA LOAD DONE RANDOMLY WITH A THRESHOLD OF 140 mg/dl WILL IDENTIFY 80% and 130 will identify nearly 90%
SCREEN SOONER OR MORE OFTEN IF RISK FACTORS ARE PRESENT
PLASMA GLUCOSE CAN NOT EXCEED
FASTING 95 mg/dl
1 HR 185
2 HR 165
3 HR 145
```
147
Gestational DM
DM diagnosed during pregnancy
Most women revert back to euglycemia post-partum
cause: HPL- human placental lactogen stimulates insulin release; HPL also decreases glucose uptake & gluconeogenesis
…mom gets progressively more insulin resistant as pregnancy progresses!!!
Estrogen & progesterone also increase during pregnancy and in turn increase maternal insulin levels!!
As the placenta grows it releases more & more hormones(HPL) included.
As the pregnancy progresses into the 3rd trimester hyperinsulinemia & hyperglycemia!!! (glu for fetus)
148
DM tx in pregnancy
Insulin (NPH and Regular)* if diet doesn’t reduce FBS < 95 or 2H PP sugar <120
Diet
Exercise
Metformin safe, but by itself usually insufficient
Best to control DM PRIOR to pregnancy**
Daily glucose monitoring 4 times! Fasting and post-prandial to adjust insulin
149
Deadly triad in pregnancy
hemorrhage and infection and hypertension
| HTN most deadly
150
GESTATIONAL HYPERTENSION*
BP= OR > 140/90 after 20 weeks of pregnancy!!!!
(Before 20 weeks --> chronic HTN and persist after pregnancy)
NO PROTEINURIA! (<300mg 24hr urine)
BP RETURNS TO NORMAL < 12 WEEKS POSTPARTUM.
151
PRE-ECLAMPSIA*
minimum:
BP= OR > 140/90 AFTER 20 WEEKS OF GESTATION
PROTEINURIA 300 mg/24 h OR 1+ OR > DIPSTICK
(only in pregnancy)
152
Indications of severity in pregnancy HTN
```
DIASTOLIC BP
PROTEINURIA
HEADACHE
SCOTOMATA
EPIGASTRIC PAIN
OLIGURIA
SEIZURES
SERUM CR
LOW PLATELETS
LIVER ENZYMES
IUGR
PULMONARY EDEMA*
```
153
ECLAMPSIA
MEETS CRITERIA FOR PRE-ECLAMPSIA
SEIZURES CAN NOT BE ATTRIBUTED TO OTHER CAUSES
A rapid increase in blood pressure followed by convulsions is usually preceded by an unrelenting severe headache
Seizures preceded by headaches, epigastric pain, hyperreflexia, and hemoconcentration
generalized seizures or coma ensues
Capillary leak
incidence falling from better prenatal care
154
SUPERIMPOSED PRE-ECLAMPSIA (ON CHRONIC HYPERTENSION)
NEW ONSET PROTEINURIA > 300MG/24H AND NO PROTEINURIA BEFORE 20 WEEKS
SUDDEN INCREASE IN BP, PROTEINURIA OR DROP IN PLATELETS IN WOMEN WITH HYPERTENSION AND PROTEINURIA BEFORE 20 WEEKS
155
HELLP Syndrome**
H - hemolysis (elevated LDH)
EL - elevated liver enzymes (AST/ALT usu 2x normal)
LP- low platelet count (<100k)**
complication of pre-eclampsia
156
Pathophysiology of HTN in pregnancy*
arterial VASOSPASM!! and increased peripheral resistance
| leak fluid from capillary and third space
157
What may be helpful to prevent recurrence of eclampsia/gestational HTN in a subsequent pregnancy*
low dose ASA, in ALL pregnant women
| start low dose aspirin 81 mg after the first trimester*
158
most effective therapy for preeclampsia
delivery of fetus and placenta (deliver as close to term as possible, 37wks; if pre-eclampsia w/severe features, deliver at 34wks or sign of end organ damage)
need to have precise knowledge of the age of the fetus **
159
Tx for seizures in eclampsia
magnesium sulfate (during labor) or lorazepam
CXR to look for aspiration
ABG
severe HA often precedes*
160
Tx for chronic HTN in pregnancy
Labetolol first choice
2nd: CCB
3rd: diuretics
AVOID ACE/ARB: teratogenicity**
161
IF PRE-ECLAMPSIA WITH SEVERE FEATURES, ALL GET REFERRAL TO
Cardiology, eval in unpregnant state too
| risk of CVD and death
162
CARDINAL MOVEMENTS OF LABOR***
```
ENGAGEMENT
DESCENT
FLEXION
INTERNAL ROTATION
EXTENSION
EXTERNAL ROTATION
EXPULSION
```
163
Caput succedaneum
edema in the fetal scalp (esp obvious in 1st baby) in the portion immediately over the cervical os
cone shaped head
crosses suture line
164
Contra-indications of induction
```
Vasa previa
Complete previa
Umbilical cord prolapse
Previous classical cesarean
Active genital herpes
Previous myomectomy that entered the uterine cavity
```
165
Shoulder Dystocia Complications
Transient brachial plexus palsies most common :65% (hrs to wks to heal)
Fractured clavicle: 38%
Humeral fracture: 17%
Permanent palsy or fetal death rare
use McRobert’s maneuver: sharply flexing the legs upon the abdomen
166
Causes of Abnormal Uterine Bleeding: structural*
```
Palm (structural causes)
P olyp
A denomyosis
L eiomyoma
M alignancy and hyperplasia
```
167
Causes of Abnormal Uterine Bleeding: non-structural*
```
COEIN (non-structural causes)
C oagulopathy
O vulatory dysfunction
E ndometrial
I atrogenic
N ot yet classified
```
168
Pregnancy related vaginal bleeding*
- Miscarriage
- Placenta Previa: covering cervical opening
- Placental Abruption: pulls away from wall prematurely
- Ectopic (bleeding may be internal)
- Uterine Rupture (bleeding may be internal)
- Gestational Trophoblastic Dz
169
causes of pelvic pain w/o bleeding
```
Mittelschmerz
Ruptured ovarian cyst
Salpingitis/PID
Torsion
Abdomen (appy)
```
170
causes of pelvic Pain & Bleeding
Dysmenorrhea
Endometritis
Endometriosis
171
PID Tx
Combination Tx: Doxy + Metronidazole (cover anerobes) inpatient and outpatient
PLUS one of the following to cover GC: DOC Azithromycin Ig single dose,Ciprofloxacin 500 mg,Cefixime 1-g oral single dose
REPORT! Treat Partner
172
APGAR
```
Integrity of the cardiopulmonary system:
Appearance
Pulse
Grimace (reflex irritability)
Activity (muscle tone)
Respiratory effort
```
173
What APGAR score indicates infant at risk?
<7
174
Lab Dx of jaundice
total bilirubin >5 mg/dL
175
Lab value of kernicterus
>20-25
176
when does physiologic jaundice occur
Becomes present on the 2nd or 3rd day of life
| Never in 1st 24hrs and pathologic if total bili >17
177
when does anterior fontanel close?*
9-15mon of age
178
Choanal atresia
blockage of the nasal airway by tissue or bone, it is congenital
179
Apnea in infants
respiratory pause is for a duration of more than 20 seconds and has bradycardia with it
180
A delay or absence of the femoral pulse should raise the suspicion of...***
coarctation of the aorta
| ORDER ECHO
181
umbilical hernia in newborn
quite common, typically not a problem
| usu closes by 2yo, reassure parents
182
what should you check in the umbilical cord stump?*
presence of two umbilical arteries and one vein. Presence of a single umbilical artery may indicate congenital renal abnormalities
yellow staining of cord can be from meconium staining
183
absence of passage of meconium by 24hrs suggest
cystic fibrosis or Hirschsprung's Dz
184
Hirschsprung disease
birth defect
absence of particular nerve cells (ganglions) in a segment of the bowel in an infant; prevents peristalsis --> difficulty passing stool
185
signs suggestive of a dislocated femur in infant
presence of asymmetric skin folds on the medial aspect of the thigh, a positive galeazzi sign, and positive Ortolani and Barlow maneuvers
186
only vaccine before 6 weeks of age*
Hep B
187
Interval between live vaccines**
4weeks
| if given within 4 weeks, INVALID. must repeat
188
antibody containing blood products' effect on live vaccines
interferes with replication
must wait long enough to reduce chance of interference
If the vaccine was given first, wait 2 weeks before giving the antibody*
If the antibody was given first, wait 3 months or longer before giving vaccine*
189
Grace period of vaccines*
Vaccine doses administered up to 4 days before the minimum interval or age can be counted as valid
(except Rabies vacc)
190
The most common type of heart defect*
ventricular septal defect
191
most common obstructive lesion CHD
Coarctation of aorta 8-10%
192
most common Cyanotic Congenital Heart Defect
Tetralogy of Fallot, 10%
193
Tetralogy of Fallot*
combination of four congenital abnormalities:
ventricular septal defect (VSD)
pulmonary valve stenosis
a misplaced aorta
thickened right ventricular wall (right ventricular hypertrophy)
194
Lennox-Gastaut Syndrome
```
Triad with
Mental Retardation
Absence and tonic seizures
Slow spike-wave discharges on EEG
Onset 2–7 years
History of Infantile Spasms often present
1/3 have SE as initial manifestation
```
195
Tx for absent seizures
petit mal
| ethosuximide (zarontin)
196
Sprains in children
Children rarely get sprains!
Growth plates more vulnerable than bone or ligament
Should still put in cast
Growth plate injuries bc ligaments stronger than bones. Pulls pieces of bones away
197
Most common elbow fracture
Supracondylar
Elbow fractures high risk: nerves and arteries
posterior fat pad sign
198
Nursemaids elbow*
Radial head subluxation
199
Sign of transposition of great vessel
Egg on string sign
Aorta from right ventricle
Pulmonary artery from left
200
Infant Hyperbilirubinemia Tx
Phototherapy
201
Necrotizing enterocolitis
MC surgical dz of newborns
202
Midgut Volvulus
Intestines twisted from malrotation of intestines during fetal development
203
all medications with contraindication to breastfeeding***
Amphetamines
Chemotherapy agents
Ergotamines (migraine)
Statins
204
When do you introduce solid foods
6months ideally but anywhere 4-6mon
205
PDA (Patent ductus arteriosus) murmur
1st year of life
| machine-like, harsh, continuous
206
when do craniofacial deformities occur?
6-12wks
207
which developmental measurement is most concerning
change in head circumference
208
omphalocele
```
Intestinal contents herniate through the umbilical and supraumbilical portions of the abdominal wall into a sac covered by peritoneum (COVERING MEMBRANE*)
cord at apex of sac
High assoc w/malformations
tendency in obese and older mothers
Tx: surgery
```
209
gastroschisis
Herniation without a covering sac, of a length of small intestine and occasionally part of the liver
to the right of umbilical cord
SURGICAL EMERGENCY*
210
Diaphragmatic Hernia
Respiratory distress - classic symptoms of cyanosis, dyspnea and cardiac dextroposition
PE: scaphoid abdomen
usu L, compress lung and displace heart
most another defect, usu heart
211
How does Meckel's Diverticulum usu present?***
painless GI bleeding before 2yo** (secondary to ulcer)
| also intestinal obstruction, local inflammation
212
Coloboma
Absence or defect of tissue
Commonly affects the eye (i.e. iris or eyelid)
“Keyhole” defect of the iris
Failure of choroid fissure to fuse during fetal development
213
Beckwith-Wiedemann Syndrome
Microcephaly, Macroglossia, Umbilical Hernia
214
potential causes of hydrocephalus
Overproduction (rare) or decreased absorption of CSF (eg after subarachnoid hemorrhage)
Obstructed flow of CSF – Aqueduct stenosis (*most common*): Vein of Galen malformation, Arnold-Chiari malformation, Dandy-Walker malformation
acquired: Tumors, meningitis, hemorrhage, trauma
215
Craniosynostosis
Premature closure of 1 or more cranial suture(s) (should open until 1-3yo)
cause largely unknown
216
2 most common craniosynostosis**
```
Synostotic scaphocephaly (sagittal): most common
Synostotic anterior plagiocephaly (unicoronal): 2nd common
```
217
Severe sepsis
Sepsis plus organ dysfunction of one or more major systems
| Kidney, lung (ARDS), heart, CNS
218
Septic shock
Severe sepsis plus persistent hypotension despite aggressive fluid resuscitation
219
Most common cause of gastric outlet obstruction in infants
Hypertrophic pyloric stenosis
220
Most common cause of vomiting in infants requiring surgical intervention
Hypertrophic pyloric stenosis
221
palpable olive shaped mass, stomach
Hypertrophic pyloric stenosis
| develop progressive bilious vomiting 3rd-4th week of life, lose weight with time, becomes projectile
222
Passage of “currant- jelly” stool**
Intussusception
223
Most common cause of intestinal obstruction in infants after the neonatal period
Intussusception
224
Intussusception
Invagination of proximal bowel into distal segment
more common in males
Dx: U/S
225
Intussusception Presentation
Paroxysmal, severe, colicky pain & pallor at roughly 20 minute intervals followed by lethargy and bilious vomiting
Sausage-shaped mass palpable
Passage of "currant- jelly” stool (blood-tinged mucus)
226
Intussusception Tx
IV fluids
NG suction; then air contrast barium enema (successfully reduces in 60 to 80% of patients)
Surgery if enema fails
227
What is regurgitation NOT associated with?**
nausea or retching
228
Kawasaki Dz
```
acute, multi-system vasculitis
CARDIOVASCULAR main cause of mortality
Fever >5 days*, and atleast 4 of:
bilateral conjunctivitis
oral mucous membrane changes
extremity changes
rash
cervical lymphadenopathy
```
229
Tx of Kawasaki Dz
ASA high dose WITHIN 10 DAYS*
| May cause Reye's (swelling of liver and brain)
230
most common predisposing factor for development of acute bacterial sinusitis in children
80% Viral URI
231
Acute bacterial sinusitis Tx
Amoxicillin with or without Clavulanate (Augmentin)
| no role of adjunctive therapies (intranasal corticosteroids, saline lavage, decongestants, mucolytics, antihistamines)
232
Most common cause of acute pharyngitis
50% VIRAL
233
Clinical findings that suggest GABHS pharyngitis
```
sudden onset (acute)
sore throat
fever
headache
nausea, vomiting, abdominal pain
```
234
Tx of GABHS
To prevent rheumatic fever, not likely to prevent post streptococcal AGN
self-limiting, can be postponed up to 9 days and still prevent rheumatic fever
235
Retropharyngeal abscess Tx
Antibiotics and drainage: Clindamycin first line, or in combo w/cefoxitin or piperacillin or ampicillin
untreated can lead to: airway compromise, mediastinitis, sepsis, and eventually death
GABHS most common
236
Most common acute otitis media pathogens
47% H. influenzae
| 33% S pneumoniae
237
recurrent AOM Tx
tympanostomy tube (prophylactic antibiotic NOT recommended)
238
AOM complications
Mastoiditis
Meningoencephalitis
conductive hearing loss
239
steeple sign
subglottic narrowing
| Croup
240
classic form of croup
Laryngotracheitis
URI, usu parainfluenza virus type I
varying respiratory Sx
Dx: barking cough, prodrome viral upper respiratory infection and inspiratory stridor
241
Moderate Croup Tx
Give humidified oxygen, racemic epinephrine (nebulized), nebulized budesonide (or oral dexamethsaone), and intramuscular dexamethasone (if vomiting)
242
Epiglottitis Tx
Airway management takes priority in treatment**
then, Tx w/antibiotics and admitted to ICU
ceftriaxone, cefotaxime, and cefuroxime (for nonmeningitic infections)
most likely S. aureus or Group A strep (HIB in non-immunized)
243
Thumb print sign
epiglottitis
244
Classic presentation of epiglottitis
progressive sore throat, drooling, and dysphagia
| can develop respiratory distress
245
#1 Cause of childhood diarrhea*
Rotavirus (1/4 of all episodes)
246
What is the last VS to change in dehydration?
BP, severe if BP changes
247
Phimosis
Tightness of the penile foreskin which prevents retraction over the glans
Physiologically normal < 5 years old
In adults can be caused by Lichen Sclerosis (40-84%)
intervention only if can't urinate (eg balanoposthitis)
248
Phimosis Tx
topical corticosteroid 3-4x daily x 6weeks
249
Paraphimosis
Inability to reduce proximal foreskin over the glans resulting in distal venous congestion and trapped foreskin
Medical emergency!*
factors: failure to return foreskin post exam, cath, infx
can cause arterial compression, necrosis, gangrene
250
When is priapism a medical emergency?**
>4hrs
251
Priapism Tx
non-ischemic: observe
| ischemic: aspiration, phenylephrine
252
what can be a risk factor for epididymitis?
sexual activity*, Chlamydia most common
Cryptococcus in HIV pts
(very tender* epididymis/testicle)
253
Orchitis Sx
similar to epididymitis, hematuria*, ejaculation of blood*
bacterial or viral (Mumps)
can lead to infertility
254
Testicular Torsion*
Medical Emergency*
Peak incidence 13 y/o*
good prognosis if treated within 5-6 hours*
Absence of cremasteric reflex 100%**
delay Tx can lead to: sperm loss, necrosis, or gangrene
255
Scoring system for testicular torsion
```
●Nausea or vomiting – 1 point
●Testicular swelling – 2 points
●Hard testis on palpation – 2 points
●High-riding testis – 1 point
●Absent cremasteric reflex – 1 point
A score ≥5 diagnosed testicular torsion with a positive predictive value of 100 percent
```
256
Varicocele
Incomplete drainage of spermatic veins
“bag of worms”
Left-sided 85-95%** (longer and more drainage)
Tx: Do not require intervention, scrotal support
257
Inguinal Hernia
Peaks at 1 y/o and 40 y/o
Male to female ratio is 25:1
INDIRECT much more common in peds**
Direct may occur from repairing indirect
258
Consequences of cryptorchidism
**undetected testicular malignancy, subfertility, testicular torsion, and inguinal hernia
malignancy risk NOT reduced w/early intervention!*
surgery by 1yo if possible
259
Most common type of testicular carcinoma**
Seminomas typically, may have elevation of serum beta-hCG*
| high cure rate w/radiation
260
most common urologic anomaly in children*
Vesicoureteral Reflux:
| retrograde passage of urine from the bladder into the upper urinary tract; can get recurrent UTI
261
ANY boy w/ UTI should
be worked up! unless sexually active or prior urologic hx
| VCUG (voiding cystourethrogram) and U/S
262
Most common childhood cancer*
Leukemia (ALL)
263
Exudative Pharyngitis can be
```
Infectious Mono (more exudative, debilitating fatigue)
Strep Pharyngitis (more erythema)
```
264
subacute thyroiditis*
usu. virally mediated (from previous infection)- incr ESR
initial hyperthyroid, the hypothyroid (as stores run low), then eventual total resolution (2-3mon)
dont usu. recur
SELF LIMITING***
265
Hashimoto's - autoimmune Hypothyroidism
lymphocytic infiltration of thyroid*
POS peroxidase antibody (marker)
can be either iodine deficiency or excess
266
when to treat subclinical hypothyroidism
if TSH >10 (always treat)*
| or TSH <10 in pregnant, goiter, pos thyroid AB
267
Vit D effect on Ca
active Vit D increases Ca absorption from gut and increase PTH mediated bone resorption (inc serum Ca)
268
How does PTH affect Ca levels?
Maintain extracellular fluid Ca balance by acting on bone (resorption /absorption), kidneys (reabsorb ca), Vit D absorption of gut from diet
neg feedback
269
when do you treat acute hypocalcemia?*
when total calcium < 7.5mg/dl
| 1mg/ml calcium gluconate in D5W
270
Causes of Cushing's Syndrome
Adrenal hyperplasia: pituitary ACTH overproduction, ectopic ACTH production
Adrenal adenoma - Benign tumor
Adrenal cancer
Iatrogenic - prolonged use of steroids
271
Cushing's Disease*
primary pituitary problem resulting in excess cortisol
| called syndrome if not from pituitary
272
Tests to screen for Cushing's Syndrome*
Overnight Dex Suppression Test – 1 mg Dexamethasone at 11PM, serum cortisol the next day at 8AM. normal < 2 µg/dl
24 hour urine free cortisol – normal < 50-75 μg in 24hr
Late night salivary cortisol
273
Cushing's syndrome: after high dose 8mg dexamethasone, ACTH and cortisol both high -->**
means pituitary ACTH secreting tumor (pituitary MRI) or ectopic ACTH secreting tumor (chest CT)
274
Cushing's syndrome: after high dose 8mg dexamethasone, ACTH low and cortisol high -->**
suggest adrenal lesion or iatrogenic (ex pt taking steroids)
275
addisonian crisis
adrenal crisis or acute adrenal insufficiency. It is a rare and potentially fatal condition where the adrenal glands stop working properly and there is not enough cortisol in the body
276
Cushing's Treatment
hydrocortisone and several months of slow taper until AM cortisol >12*
taper to prevent addisonian
277
Addison's disease*
Primary adrenalcortical deficiency, Progressive destruction of > 90% of adrenal mass
Causes: Autoimmune*, TB, hemorrhage, HIV, mets
278
Addison's disease SxS
Fatigue, weakness, anorexia, N/V
| Wt loss, pigmentation*, hypotension, hypoglycemia
279
Addison's Dz Tx
Daily maintenance hydrocortisone 20 mg in AM, 10 mg in late afternoon (not night bc insomnia)
Mineralocorticoid replacement: Fludrocortisone (Florinef) 0.1 mg/d with salt (to exchange w/K)
during minor stress/illness: 3X3 rule, triple dose 3 days
hyperglycemia management: consider NPH or mix
280
*what test to perform in suspected adrenal crisis?
ACTH stimulation AND cover pt w/dexamethasone, and Iv saline w/glu
281
Pheochromocytoma Management - pre op*
ALPHA BLOCK FIRST - control BP
THEN BB - control BP
Enzyme blocker to block catecholamine production
282
most common pituitary adenoma and mechanism on secretion*
prolactinoma --> decreased dopaminergic inhibition --> increased prolactin
283
Diabetes Insipidus
Deficiency of ADH or effect (cant absorb h2o to concen urine)
Large volumes of dilute urine
Polydipsia
284
at what level of hypercalcemia require treatment?*
<12mg/dL: doesnt require immediate Tx
| >14mg/dL: URGENT regardless of Sx**
285
Sensory symptoms of diabetic neuropathy
Early:
Night cramps
Paresthesia
```
Later (in order):
Loss of touch
Pain
Temperature
Deep pain
Vibration
Position sense
```
Last:
Anesthesia
Loss of deep tendon reflex
286
1st seizure after 30 yo...
rule out tumor!
287
what kind of headache do young obese women in childbearing years get
idiopathic intracranial HTN (pseudotumor cerebri)
288
Migraine HA*
Usually UNILATERAL, throbbing, pulsatile, photophobia, phonophobia, nausea
289
Tension HA characteristics*
BILATERAL, pressing/tightening, mild to moderate
NOT aggravated by routine activity (more consistent)
NON-THROBBING, "head fullness", "dull"*
290
Who is affected by migraines
more women, 30's
HIGHLY genetic!
very debilitating, hrs to days
291
"suicide headache"*
cluster HA
| RULE OUT BRAIN LESIONS*
292
Cluster HA characteristics
severe orbital, supraorbital/temporal pain
UNILATERAL
Autonomic Sx: ptosis, miosis, lacrimation, conjunctival injection, rhinorrhea, nasal congestion
15-180 MINUTES
occur in clusters then remission
293
What syndrome can you get w/cluster HA?
Horner's syndrome: ptosis, pupil constriction, anhidrosis unilaterally
294
Eye stroke
amaurosis fugax from ischemia of ophthalmic a. from carotid
295
Ischemia of middle cerebral artery (Anterior or posterior)*
Anterior: Broca's aphasia
Posterior: Wernicke's aphasia
296
Vertebral or basilar artery ischemia*
affect anterior portion of PONS
| "LOCKED IN" SYNDROME: no mvmt except eyelids
297
When can you treat ischemic strokes with IV tPA?*
<4.5hr of onset*
298
Medications for secondary prevention of stroke w/TIA**
Anti-thrombotic
ARB/ACE-I
Statin
ALL PTS (REGARDLESS OF LEVELS)
299
Dx of COPD
spirometry: FEV1/FVC RATIO less than .70 confirms
| risk factors
300
what do all pts with COPD need
flu and pneumococcal vaccine bc can cause exacerbations
301
Goal of --> Gout: Chronic Pharmacological Treatment with ULT
GOAL is to reach a serum uric acid ≤ 6.0 mg/dl (even below 5.0 mg/dl in patients with tophi)
302
Felty’s Syndrome***
Triad: Splenomegaly, RA, Neutropenia
| with associated infections (recurrent bc low WBC) and leg ulcerations
303
Who does not get gout?*
pre-menopausal women
| Bc Estrogen gets rid of uric acid through kidneys (uricosuria)
304
Limited Scleroderma: CREST*
```
Calcinosis
Raynaud’s phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasias
Anticentromere antibodies*
MAKE DZ OFF SKIN EXAM***
```
305
If you see MCP involvement in suspected OA, *
think secondary cause, bc normally spare MCP
306
OA in DIP
Heberden's node*
307
OA in PIP
Bouchard's node*
308
Polymyalgia Rheumatica (PMR) Tx
Excellent response to moderate dosage of prednisone* (15mg daily) --> confirms DX!!!***
May taper over months to years following symptoms and ESR
309
Fibromyalgia
common cause of chronic widespread musculoskeletal pain, often accompanied by fatigue, cognitive disturbance, psychiatric symptoms, and multiple somatic symptoms
no evidence of tissue inflammation***
usu younger popu, female
310
Common Features of Spondyloarthropathies*
Assoc w/HLA-B27*
| Enthesitis*
311
Joint emergencies
```
septic joint**
compartment syndrome**
acute myelopathy
osteomyelitis
avascular necrosis
cancer, mets
```
312
Most organism that causes septic arthritis*
S. aureus
313
Gouty Arthritis on Xray*
Large, punched out erosions with overhanging edges
314
Leading cause of mortality in scleroderma*
Pulmonary manifestation
Interstitial lung disease; 80%
Occurs in SSc and CREST
Pulmonary hypertension; 50%
315
Vasculitis is commonly associated with*
constitutional symptoms: Fever, weight loss, fatigue
anemia
elevated ESR
316
Lofgren’s Syndrome*
Acute polyarthritis
Symmetric bilateral hilar lymphadenopathy
Erythema nodosum
Relatively common
Form of sarcoidosis with good prognosis
Often self-limited
Lofgrens’ Syndrome has a ~90% remission rate
Tx: NSAIDs
317
Most common organisms causing acute bacterial rhinosinusitis*
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella (Branhamella) catarrhalis
318
what medication can't you give for Mono?*
Amoxicillin bc rash
319
Hallmark of allergic rhinitis**
nasal itching
| also post nasal drainage
320
"grey, white exudate" (pseudomembrane), bull neck
Diphtheria - pharyngitis
321
most common cause of Croup
80% parainfluenza virus
322
What should be suspected in "croup" greater than 3 days
bacterial tracheitis
323
most common cause of epiglottitis
H. influenzae
324
epiglottitis Sx
Sore throat (95%), dysphagia/odynophagia (95%), “hot potato voice” (muffled)
325
most common cause of deep neck infection in children
tonsilitis
326
most common cause of deep neck infection in adults
dental abscess
327
Which organism should you consider with chronic bacterial rhinosinusitis?
Pseudomonas aeruginosa
328
most common congenital neck mass in children
thyroglossal duct cyst
329
most common pediatric primary neck malignancy.
lymphoma
330
Ludwig’s Angina
Bilateral infection of submandibular and sublingual space space
Serious, medical emergency
compromise airway
331
"hot potato voice"**
peritonsillar abscess
| can also be epiglottitis
332
"Steeple Sign", think
Croup
| narrowing of trachea on X Ray
333
cause of 90% of acute epiglottitis
H. influenza Type B
334
"Thumb" sign on X ray
acute epiglottitis
335
acoustic neuroma
tumor of vestibular branch of CN8
| "vestibular schwannomas"
336
SxS of Mono
Fatigue, Weakness, Sore throat, splenomegaly, lymphadenopathy
337
primary cause of small cell lung cancer*
smoking
338
Small Cell Lung Cancer (oat cell)
Derived from remnants of fetal lung in neuroendocrine cells (Kulchitsky cells)
25% of all primary lung cancers
pt can present as hyponatremic
339
what side is virchow's node on
left, take supply from lymph of abdominal cavity
340
Ulcerative Colitis
Precancerous condition
| Need frequent colonoscopy
341
mid-systolic murmur*
innocent and physiologic, aortic stenosis
| diminishes before second sound
342
Where does aortic stenosis radiate to?
neck and carotid
343
Where does mitral regurgitation radiate to?
axilla
344
Where does aortic regurgitation radiate to?
apex
