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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
Q

BMI of Obesity: 3 classes

A

Class I – 30.0 to 34.9
Class II – 35.0 to 39.9
Class III – 40+ (severe obesity, morbidly obese)

26
Q

cytotec

A

misoprostol

Tx NSAID peptic ulcer dz

27
Q

Crohn’s Dz

A

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
Q

Where does Crohn’s dz affect?

A

May involve any portion of the GI tract but primarily affects the terminal ileum/right colon
full thickness and patchy

29
Q

What should be considered in any patient with anemia, weight loss, and fever of unknown origin

A

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
Q

typical feature of ulcerative colitis

A

perirectal involvement*

bloody diarrhea**

31
Q

Ulcerative Colitis

A

Chronic, recurrent condition marked by exacerbations and remissions
inflammation localized primarily in the mucosa and is uniform and continuous

32
Q

Cigarette smoking in ulcerative colitis v Crohn’s

A

Cigarette smoking appears to protect against UC (associated w/worsening of Crohn’s dz)

33
Q

p-ANCA positive is 40 – 80 %

A

Ulcerative colitis

34
Q

p-ANCA negative. + ASCA is

A

Crohn’s dz

35
Q

Best Dx study for Crohn’s and UC

A

Colonoscopy

36
Q

omentum function

A

adipose tissue and macrophage

limit spread of infection

37
Q

Mackler’s Triad

A

lower chest pain
vomiting
subQ emphysema
*Boerhaave’s Syndrome

38
Q

Where does diverticulosis occur most often?

A
sigmoid colon (highest intraluminal pressure)
(L more common in US but mostly false diverticula)
39
Q

Courvoisier’s Sign

A

Non-tender, but distended, palpableGall Bladder
Associated withJaundice
possible pancreatic malignancy

40
Q

What nerve is associated with nausea and vomitting

A

vagus nerve

41
Q

Reglan (metoclopramide)

A

treats GERD, gastroparesis in DM
antiemetic, gut motility stimulator
**watch for tardive dyskinesias (stop medication to prevent permanent Sx)

42
Q

superior mesenteric artery supplies

A

lower part of the duodenum through two-thirds of the transverse colon, as well as the pancreas

43
Q

Dx study for pancreatic ca

A

helical CT

44
Q

Dx study for diverticulitis

A

CT

45
Q

“thumb” sign

A

epiglottitis

46
Q

what natural process decreases intrinsic factor

A

aging, can cause B12 deficiency

47
Q

what cells line the esophagus v stomach

A

esophagus: squamous
stomach: columnar

48
Q

PPI MoA

A

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
Q

orlistat

A

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
Q

Phentermine, Diethylpropion

A

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
Q

parietal cells secrete

A

HCl, intrinsic factor

52
Q

why are systemic effects of Budesonide (Entocort) reduced?

A

Steroid whose systemic effects are reduced due to first pass in the liver

53
Q

enteroinvasive e. coli SxS

A

Visible blood or mucus (not watery)

Typically associated with fever and abdominal pain

54
Q

H. pylori Tx

A

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
Q

osmotic diarrhea causes

A

Celiac Sprue/disease
Lactose intolerance
Electrolyte absorption is not impaired*

56
Q

Celiac disease

A

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
Q

classic SxS of celiac’s dz

A

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
Q

1 cause of Upper GI bleed**

A

Ulcer disease, erosions (esophageal, stomach, duodenum)

59
Q

What are Mallory-Weiss tears often assoc w/?

A

Alcohol

60
Q

Where do diverticular bleeds most often occur?*

A

Right 50-90%
Ascending colon**
(not assoc w/diverticulitis bc typically PAINLESS*)

61
Q

Where does diverticulitis most commonly occur?*

A

primarily left colon

62
Q

Wilson’s dz Tx

A

life long chelating Tx

63
Q

Rules of 2s for Meckel Diverticulum (PIMP)

A

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
Q

Isolated Hyperbilirubinemia - UNCONJUGATED**

A

Gilbert’s Syndrome: Bili goes up in period of stress*

Crigler-Najjar Syndrome*

65
Q

Isolated Hyperbilirubinemia - CONJUGATED**

A

think decreased excretion or leakage of pigment from hepatocytes
Dubin-Johnson Syndrome*
Rotor Syndrome*

66
Q

Most common cause of drug-induced liver injury**

A

Acetaminophen*

67
Q

Rovsing’s sign

A

sign of appendicitis

palpation of the LLQ of a person’s abdomen increases the pain felt in the RLQ

68
Q

Contraindications of NG tubes

A

Esophageal stricture
Basilar Skull fracture
Esophageal varices

69
Q

Pellagra

A

advance deficiency of B3 (Niacin)

70
Q

Where does diverticula most commonly occur?*

A
sigmoid colon (highest intraluminal pressure)
(L more common in US but mostly false diverticula)
71
Q

Charcot’s Triad

A

Ascending Cholangitis:
Fever
RUQ Pain
Jaundice

72
Q

eating with gastric v duodenal ulcers

A

gastric: exacerbates pain, no relief w/antacids
duodenal: eating minishes pain, relief w/antacids, nocturnal pain

73
Q

H. pylori testing

A

urea breath test

stool antigen test

74
Q

what should you do after treating PUD?

A

repeat endoscopy in 6-8wks to verify healing!

non-healing ulcer is ca until proven otherwise*

75
Q

what nodes are associated with gastric ca

A
sister mary joseph node (firm nodule in umbilicus)
irish node (enlarged L axillary LN)
76
Q

what can be the 1st sign of gastric ca

A

virchow’s node (L supraclavicular lymphadenopathy)

77
Q

Tx of Boerhaave’s syndrome

A

urgent surgical eval

broad spectrum antibiotics (rapid sepsis)

78
Q

Gatroparesis

A

delayed emptying of the stomach due to an issue with motility (NOT obstruction)
DM common cause*

79
Q

Alk Phos elevated out of proportion to aminotransferases

A

think obstruction (liver/bile ducts) - cholestatic

80
Q

aminotransferases elevated out of proportion to alk phos

A

think liver inflammation - hepatocellular

81
Q

isolated hyperbilirubinemia - unconjugated

A

gilbert’s syndrome

crigler-najjar syndrome

82
Q

isolated hyperbilirubinemia - conjugated

A

dubin-johnson syndrome

rotor syndrome

83
Q

contraindications to breast feeding

A

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
Q

Types of estrogen

A

estrone: older
estradiol: young women
estriol: pregnancy** (sudden decline can indicate fetal compromise; precursor = fetal androgens)

85
Q

which thyroid hormone crosses placenta?

A

T4, fetus dependent on maternal T4 for normal neurologic develop 1st 12wks
(TRH crosses also, TSH does not)

86
Q

Tachysystole

A

more than 5 contractions (spontaneous or stimulated) in 10 minutes averaged over 30 min
too many contractions
check for fetal heart rate abnormalities

87
Q

Basic Warning Signs in Labor

A

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
Q

The inflow of maternal blood into the intervillous spaces ceases at a pressure of

A

~ 50 mmHg

89
Q

Normal Fetal Heart Rate at Term

A

110-160 bpm

90
Q

FHR: late deceleration

A

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
Q

FHR: variable deceleration

A

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
Q

Response to Late Decelerations

A

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
Q

Sinusoidal Pattern

A
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
Q

What bacteria are NOT part of the normal flora of lower genital tract?

A

staph aureus and beta hemolytic strep groups A and B

normally mostly anaerobes

95
Q

UTI and asymptomatic bacteriuria are associated with

A

preterm delivery, preeclampsia, maternal anemia, amnionitis, and low birth weight
UTIs BAD in pregnancy, high recurrence

96
Q

70-80% of UTIs in pregnancy caused by

A

E. coli

97
Q

1/3 of asymptomatic UTIs during pregnancy progresses to

A

Pyelonephritis*

98
Q

What drugs to AVOID in UTIs in pregnancy*

A

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
Q

Tx of UTIs in pregnancy*

A

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
Q

Pyelonephritis effect on fetus

A

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
Q

In-patient Tx of pyelonephritis

A

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
Q

Prophylaxis Tx for UTI recurrence

A

nitrofurantoin

103
Q

Most common cause of neonatal sepsis (and significant mortality)*

A

Group B Beta Hemolytic Strep (Strep. agalactiae)

vertical transmission from mother to fetus

104
Q

when do you treat Group B Beta Hemolytic Strep*

A

If culture pos, treat at least 4 hours before delivery (6hrs best)

105
Q

TORCHES

A
Toxoplasmosis
Other (Hep B, Coxsackie, VZV, West Nile, Measles, HIV, Zika) 
Rubella
Cytomegalovirus
Herpes simplex
Erythema infectiosum (Parvovirus B19)
Syphilis
106
Q

Toxoplasmosis Risk Factors

A

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
Q

Untreated toxoplasmosis in fetus can cause*

A

sensorineural hearing loss

67-80% asymp at birth but develop Sx later in life

108
Q

Congenital toxoplasmosis

A

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
Q

Congenital Rubella Syndrome*

A
"Blueberry muffin" baby: thrombocytopenia purpura
Cataracts
Heart Defects (>50%)
Hearing defects (sensorineural)
small gestational age most common
110
Q

How long do infants shed Rubella virus?

A

atleast for 1 year!* need STRICT isolation

111
Q

Most common congenital viral infection

A

CMV (50% microcephaly*)

maternal ABs DO NOT protect! Moms mostly asymp

112
Q

Most common sequelae of congenital CMV?*

A

Sensorineural hearing loss

113
Q

Even with adequate treatment of maternal syphilis

A

infant can be born with congenital syphilis

mothers w/primary or secondary syphilis unlikely to have normal infants (premature death or congenital syphilis)

114
Q

Tx of syphilis in mother*

A

Single dose IM benzathine penicillin 2.4 million units

ONLY drug that can be used in pregnant women w/syphilis

115
Q

Listeria Monocytogenes effect on fetus

A

septicemia/gastroenteritis/respiratory distress/meningitis 50% mortality

116
Q

What drugs should you avoid 1st trimester*

A

Metronidazole

117
Q

What drugs should you avoid 2nd trimester*

A

Sulfonamides (Hyperbilirubinemia - kernicterus)

Nitrofurantoin (hemolysis in G6PD deficiency)

118
Q

Post-Partum Fever after Day 1*

A

Pelvic infection until proven otherwise**
esp w/C section*
10% of maternal death
recognize early and treat

119
Q

Gonorrhea Tx

A

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
Q

Trichomonads Tx IN PREGNANCY

A

Metronidazole 2 g x 1 dose (risks, may delay until 37wks)

121
Q

Tocolytics

A

Medications that suppresses premature labor

122
Q

Neural Tube Defect IS CAUSED BY

A

Folic acid deficiency

123
Q

Quad screen

A

AFP/hCG/estriol/inhibin A

124
Q

Alpha-fetoprotein (AFP)*

A

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
Q

screening in 1st trimester*

A

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
Q

cffDNA(cell free fetal DNA)

A

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
Q

Second Trimester Screening

A

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
Q

Bleeding in the first trimester**

A

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
Q

Asherman’s Syndrome

A

Intrauterine adhesions

get hysteroscopy

130
Q

Abortion terminology

A

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
Q

Discriminatory zone of when hCG of intrauterine pregnancy can be detected

A

hCG ~1500 Units

132
Q

Tx of miscarriage

A

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
Q

Tx of incomplete or missed abortion

A

D & C or medical

134
Q

Criteria for Medical Tx of abortion/ectopic*

A

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
Q

Medical Tx of ectopic pregnancy

A

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
Q

Low birth weight

A

<2500g
very low birth weight: <1500g
extremely low: <1000g (only extremely low in more danger)

137
Q

guidelines for induction and for elective repeat cesarean section (strict)

A

no sooner than 39 wk gestation

138
Q

Tocolytics

A

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
Q

Maternal supplementation with twin or more gestations

A

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
Q

What AED should you avoid in pregnancy

A
Valproate and Carbamazepine esp in Fam Hx of neural tube defect (switch away BEFORE conception)
phenytoin
Lamotrigine
Topiramate
phenobarbital
141
Q

Tx of seizures/prophylaxis during delivery or post-partum**

A

Lorazepam drug of choice (ativan) - benzo

142
Q

What AED should you avoid during lactation*

A

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
Q

FETAL HYDANTOIN SYNDROME (PHENYTOIN, CARBAMAZEPINE)

A
CRANIOFACIAL ANOMALIES
FINGERNAIL HYPOPLASIA
IUGR
DEVELOPMENTAL DELAY
CARDIAC DEFECTS
FACIAL CLEFTS
144
Q

Safest anti-coagulant during pregnancy*

A

Heparin unless mechanical heart valves –> doesnt cross placenta
Unfractionated heparin is used the last month of pregnancy (more easily reversed than lovenox)

145
Q

Anticoagulated patients are not eligible*

A

for epidural analgesia

146
Q

DM screening during pregnancy

A
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
Q

Gestational DM

A

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
Q

DM tx in pregnancy

A

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
Q

Deadly triad in pregnancy

A

hemorrhage and infection and hypertension

HTN most deadly

150
Q

GESTATIONAL HYPERTENSION*

A

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
Q

PRE-ECLAMPSIA*

A

minimum:
BP= OR > 140/90 AFTER 20 WEEKS OF GESTATION
PROTEINURIA 300 mg/24 h OR 1+ OR > DIPSTICK
(only in pregnancy)

152
Q

Indications of severity in pregnancy HTN

A
DIASTOLIC BP         
PROTEINURIA 
HEADACHE 
SCOTOMATA
EPIGASTRIC PAIN
OLIGURIA
SEIZURES
SERUM CR 
LOW PLATELETS
LIVER ENZYMES
IUGR 
PULMONARY EDEMA*
153
Q

ECLAMPSIA

A

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
Q

SUPERIMPOSED PRE-ECLAMPSIA (ON CHRONIC HYPERTENSION)

A

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
Q

HELLP Syndrome**

A

H - hemolysis (elevated LDH)
EL - elevated liver enzymes (AST/ALT usu 2x normal)
LP- low platelet count (<100k)**
complication of pre-eclampsia

156
Q

Pathophysiology of HTN in pregnancy*

A

arterial VASOSPASM!! and increased peripheral resistance

leak fluid from capillary and third space

157
Q

What may be helpful to prevent recurrence of eclampsia/gestational HTN in a subsequent pregnancy*

A

low dose ASA, in ALL pregnant women

start low dose aspirin 81 mg after the first trimester*

158
Q

most effective therapy for preeclampsia

A

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
Q

Tx for seizures in eclampsia

A

magnesium sulfate (during labor) or lorazepam
CXR to look for aspiration
ABG
severe HA often precedes*

160
Q

Tx for chronic HTN in pregnancy

A

Labetolol first choice
2nd: CCB
3rd: diuretics
AVOID ACE/ARB: teratogenicity**

161
Q

IF PRE-ECLAMPSIA WITH SEVERE FEATURES, ALL GET REFERRAL TO

A

Cardiology, eval in unpregnant state too

risk of CVD and death

162
Q

CARDINAL MOVEMENTS OF LABOR***

A
ENGAGEMENT
DESCENT
FLEXION
INTERNAL ROTATION
EXTENSION
EXTERNAL ROTATION
EXPULSION
163
Q

Caput succedaneum

A

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
Q

Contra-indications of induction

A
Vasa previa
Complete previa
Umbilical cord prolapse
Previous classical cesarean
Active genital herpes
Previous myomectomy that entered the uterine cavity
165
Q

Shoulder Dystocia Complications

A

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
Q

Causes of Abnormal Uterine Bleeding: structural*

A
Palm (structural causes)
Polyp
Adenomyosis
Leiomyoma
Malignancy and hyperplasia
167
Q

Causes of Abnormal Uterine Bleeding: non-structural*

A
COEIN (non-structural causes)
Coagulopathy
Ovulatory dysfunction
Endometrial
Iatrogenic
Not yet classified
168
Q

Pregnancy related vaginal bleeding*

A
  • 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
Q

causes of pelvic pain w/o bleeding

A
Mittelschmerz
Ruptured ovarian cyst
Salpingitis/PID
Torsion
Abdomen (appy)
170
Q

causes of pelvic Pain & Bleeding

A

Dysmenorrhea
Endometritis
Endometriosis

171
Q

PID Tx

A

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
Q

APGAR

A
Integrity of the cardiopulmonary system:
Appearance
Pulse
Grimace (reflex irritability)
Activity (muscle tone)
Respiratory effort
173
Q

What APGAR score indicates infant at risk?

A

<7

174
Q

Lab Dx of jaundice

A

total bilirubin >5 mg/dL

175
Q

Lab value of kernicterus

A

> 20-25

176
Q

when does physiologic jaundice occur

A

Becomes present on the 2nd or 3rd day of life

Never in 1st 24hrs and pathologic if total bili >17

177
Q

when does anterior fontanel close?*

A

9-15mon of age

178
Q

Choanal atresia

A

blockage of the nasal airway by tissue or bone, it is congenital

179
Q

Apnea in infants

A

respiratory pause is for a duration of more than 20 seconds and has bradycardia with it

180
Q

A delay or absence of the femoral pulse should raise the suspicion of…***

A

coarctation of the aorta

ORDER ECHO

181
Q

umbilical hernia in newborn

A

quite common, typically not a problem

usu closes by 2yo, reassure parents

182
Q

what should you check in the umbilical cord stump?*

A

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
Q

absence of passage of meconium by 24hrs suggest

A

cystic fibrosis or Hirschsprung’s Dz

184
Q

Hirschsprung disease

A

birth defect
absence of particular nerve cells (ganglions) in a segment of the bowel in an infant; prevents peristalsis –> difficulty passing stool

185
Q

signs suggestive of a dislocated femur in infant

A

presence of asymmetric skin folds on the medial aspect of the thigh, a positive galeazzi sign, and positive Ortolani and Barlow maneuvers

186
Q

only vaccine before 6 weeks of age*

A

Hep B

187
Q

Interval between live vaccines**

A

4weeks

if given within 4 weeks, INVALID. must repeat

188
Q

antibody containing blood products’ effect on live vaccines

A

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
Q

Grace period of vaccines*

A

Vaccine doses administered up to 4 days before the minimum interval or age can be counted as valid
(except Rabies vacc)

190
Q

The most common type of heart defect*

A

ventricular septal defect

191
Q

most common obstructive lesion CHD

A

Coarctation of aorta 8-10%

192
Q

most common Cyanotic Congenital Heart Defect

A

Tetralogy of Fallot, 10%

193
Q

Tetralogy of Fallot*

A

combination of four congenital abnormalities:
ventricular septal defect (VSD)
pulmonary valve stenosis
a misplaced aorta
thickened right ventricular wall (right ventricular hypertrophy)

194
Q

Lennox-Gastaut Syndrome

A
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
Q

Tx for absent seizures

A

petit mal

ethosuximide (zarontin)

196
Q

Sprains in children

A

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
Q

Most common elbow fracture

A

Supracondylar
Elbow fractures high risk: nerves and arteries
posterior fat pad sign

198
Q

Nursemaids elbow*

A

Radial head subluxation

199
Q

Sign of transposition of great vessel

A

Egg on string sign
Aorta from right ventricle
Pulmonary artery from left

200
Q

Infant Hyperbilirubinemia Tx

A

Phototherapy

201
Q

Necrotizing enterocolitis

A

MC surgical dz of newborns

202
Q

Midgut Volvulus

A

Intestines twisted from malrotation of intestines during fetal development

203
Q

all medications with contraindication to breastfeeding***

A

Amphetamines
Chemotherapy agents
Ergotamines (migraine)
Statins

204
Q

When do you introduce solid foods

A

6months ideally but anywhere 4-6mon

205
Q

PDA (Patent ductus arteriosus) murmur

A

1st year of life

machine-like, harsh, continuous

206
Q

when do craniofacial deformities occur?

A

6-12wks

207
Q

which developmental measurement is most concerning

A

change in head circumference

208
Q

omphalocele

A
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
Q

gastroschisis

A

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
Q

Diaphragmatic Hernia

A

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
Q

How does Meckel’s Diverticulum usu present?***

A

painless GI bleeding before 2yo** (secondary to ulcer)

also intestinal obstruction, local inflammation

212
Q

Coloboma

A

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
Q

Beckwith-Wiedemann Syndrome

A

Microcephaly, Macroglossia, Umbilical Hernia

214
Q

potential causes of hydrocephalus

A

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
Q

Craniosynostosis

A

Premature closure of 1 or more cranial suture(s) (should open until 1-3yo)
cause largely unknown

216
Q

2 most common craniosynostosis**

A
Synostotic scaphocephaly (sagittal): most common
Synostotic anterior plagiocephaly (unicoronal): 2nd common
217
Q

Severe sepsis

A

Sepsis plus organ dysfunction of one or more major systems

Kidney, lung (ARDS), heart, CNS

218
Q

Septic shock

A

Severe sepsis plus persistent hypotension despite aggressive fluid resuscitation

219
Q

Most common cause of gastric outlet obstruction in infants

A

Hypertrophic pyloric stenosis

220
Q

Most common cause of vomiting in infants requiring surgical intervention

A

Hypertrophic pyloric stenosis

221
Q

palpable olive shaped mass, stomach

A

Hypertrophic pyloric stenosis

develop progressive bilious vomiting 3rd-4th week of life, lose weight with time, becomes projectile

222
Q

Passage of “currant- jelly” stool**

A

Intussusception

223
Q

Most common cause of intestinal obstruction in infants after the neonatal period

A

Intussusception

224
Q

Intussusception

A

Invagination of proximal bowel into distal segment
more common in males
Dx: U/S

225
Q

Intussusception Presentation

A

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
Q

Intussusception Tx

A

IV fluids
NG suction; then air contrast barium enema (successfully reduces in 60 to 80% of patients)
Surgery if enema fails

227
Q

What is regurgitation NOT associated with?**

A

nausea or retching

228
Q

Kawasaki Dz

A
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
Q

Tx of Kawasaki Dz

A

ASA high dose WITHIN 10 DAYS*

May cause Reye’s (swelling of liver and brain)

230
Q

most common predisposing factor for development of acute bacterial sinusitis in children

A

80% Viral URI

231
Q

Acute bacterial sinusitis Tx

A

Amoxicillin with or without Clavulanate (Augmentin)

no role of adjunctive therapies (intranasal corticosteroids, saline lavage, decongestants, mucolytics, antihistamines)

232
Q

Most common cause of acute pharyngitis

A

50% VIRAL

233
Q

Clinical findings that suggest GABHS pharyngitis

A
sudden onset (acute)
sore throat
fever
headache
nausea, vomiting, abdominal pain
234
Q

Tx of GABHS

A

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
Q

Retropharyngeal abscess Tx

A

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
Q

Most common acute otitis media pathogens

A

47% H. influenzae

33% S pneumoniae

237
Q

recurrent AOM Tx

A

tympanostomy tube (prophylactic antibiotic NOT recommended)

238
Q

AOM complications

A

Mastoiditis
Meningoencephalitis
conductive hearing loss

239
Q

steeple sign

A

subglottic narrowing

Croup

240
Q

classic form of croup

A

Laryngotracheitis
URI, usu parainfluenza virus type I
varying respiratory Sx
Dx: barking cough, prodrome viral upper respiratory infection and inspiratory stridor

241
Q

Moderate Croup Tx

A

Give humidified oxygen, racemic epinephrine (nebulized), nebulized budesonide (or oral dexamethsaone), and intramuscular dexamethasone (if vomiting)

242
Q

Epiglottitis Tx

A

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
Q

Thumb print sign

A

epiglottitis

244
Q

Classic presentation of epiglottitis

A

progressive sore throat, drooling, and dysphagia

can develop respiratory distress

245
Q

1 Cause of childhood diarrhea*

A

Rotavirus (1/4 of all episodes)

246
Q

What is the last VS to change in dehydration?

A

BP, severe if BP changes

247
Q

Phimosis

A

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
Q

Phimosis Tx

A

topical corticosteroid 3-4x daily x 6weeks

249
Q

Paraphimosis

A

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
Q

When is priapism a medical emergency?**

A

> 4hrs

251
Q

Priapism Tx

A

non-ischemic: observe

ischemic: aspiration, phenylephrine

252
Q

what can be a risk factor for epididymitis?

A

sexual activity, Chlamydia most common
Cryptococcus in HIV pts
(very tender
epididymis/testicle)

253
Q

Orchitis Sx

A

similar to epididymitis, hematuria, ejaculation of blood
bacterial or viral (Mumps)
can lead to infertility

254
Q

Testicular Torsion*

A

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
Q

Scoring system for testicular torsion

A
●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
Q

Varicocele

A

Incomplete drainage of spermatic veins
“bag of worms”
Left-sided 85-95%** (longer and more drainage)
Tx: Do not require intervention, scrotal support

257
Q

Inguinal Hernia

A

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
Q

Consequences of cryptorchidism

A

**undetected testicular malignancy, subfertility, testicular torsion, and inguinal hernia
malignancy risk NOT reduced w/early intervention!*
surgery by 1yo if possible

259
Q

Most common type of testicular carcinoma**

A

Seminomas typically, may have elevation of serum beta-hCG*

high cure rate w/radiation

260
Q

most common urologic anomaly in children*

A

Vesicoureteral Reflux:

retrograde passage of urine from the bladder into the upper urinary tract; can get recurrent UTI

261
Q

ANY boy w/ UTI should

A

be worked up! unless sexually active or prior urologic hx

VCUG (voiding cystourethrogram) and U/S

262
Q

Most common childhood cancer*

A

Leukemia (ALL)

263
Q

Exudative Pharyngitis can be

A
Infectious Mono (more exudative, debilitating fatigue)
Strep Pharyngitis (more erythema)
264
Q

subacute thyroiditis*

A

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
Q

Hashimoto’s - autoimmune Hypothyroidism

A

lymphocytic infiltration of thyroid*
POS peroxidase antibody (marker)
can be either iodine deficiency or excess

266
Q

when to treat subclinical hypothyroidism

A

if TSH >10 (always treat)*

or TSH <10 in pregnant, goiter, pos thyroid AB

267
Q

Vit D effect on Ca

A

active Vit D increases Ca absorption from gut and increase PTH mediated bone resorption (inc serum Ca)

268
Q

How does PTH affect Ca levels?

A

Maintain extracellular fluid Ca balance by acting on bone (resorption /absorption), kidneys (reabsorb ca), Vit D absorption of gut from diet
neg feedback

269
Q

when do you treat acute hypocalcemia?*

A

when total calcium < 7.5mg/dl

1mg/ml calcium gluconate in D5W

270
Q

Causes of Cushing’s Syndrome

A

Adrenal hyperplasia: pituitary ACTH overproduction, ectopic ACTH production
Adrenal adenoma - Benign tumor
Adrenal cancer
Iatrogenic - prolonged use of steroids

271
Q

Cushing’s Disease*

A

primary pituitary problem resulting in excess cortisol

called syndrome if not from pituitary

272
Q

Tests to screen for Cushing’s Syndrome*

A

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
Q

Cushing’s syndrome: after high dose 8mg dexamethasone, ACTH and cortisol both high –>**

A

means pituitary ACTH secreting tumor (pituitary MRI) or ectopic ACTH secreting tumor (chest CT)

274
Q

Cushing’s syndrome: after high dose 8mg dexamethasone, ACTH low and cortisol high –>**

A

suggest adrenal lesion or iatrogenic (ex pt taking steroids)

275
Q

addisonian crisis

A

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
Q

Cushing’s Treatment

A

hydrocortisone and several months of slow taper until AM cortisol >12*
taper to prevent addisonian

277
Q

Addison’s disease*

A

Primary adrenalcortical deficiency, Progressive destruction of > 90% of adrenal mass
Causes: Autoimmune*, TB, hemorrhage, HIV, mets

278
Q

Addison’s disease SxS

A

Fatigue, weakness, anorexia, N/V

Wt loss, pigmentation*, hypotension, hypoglycemia

279
Q

Addison’s Dz Tx

A

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
Q

*what test to perform in suspected adrenal crisis?

A

ACTH stimulation AND cover pt w/dexamethasone, and Iv saline w/glu

281
Q

Pheochromocytoma Management - pre op*

A

ALPHA BLOCK FIRST - control BP
THEN BB - control BP
Enzyme blocker to block catecholamine production

282
Q

most common pituitary adenoma and mechanism on secretion*

A

prolactinoma –> decreased dopaminergic inhibition –> increased prolactin

283
Q

Diabetes Insipidus

A

Deficiency of ADH or effect (cant absorb h2o to concen urine)
Large volumes of dilute urine
Polydipsia

284
Q

at what level of hypercalcemia require treatment?*

A

<12mg/dL: doesnt require immediate Tx

>14mg/dL: URGENT regardless of Sx**

285
Q

Sensory symptoms of diabetic neuropathy

A

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
Q

1st seizure after 30 yo…

A

rule out tumor!

287
Q

what kind of headache do young obese women in childbearing years get

A

idiopathic intracranial HTN (pseudotumor cerebri)

288
Q

Migraine HA*

A

Usually UNILATERAL, throbbing, pulsatile, photophobia, phonophobia, nausea

289
Q

Tension HA characteristics*

A

BILATERAL, pressing/tightening, mild to moderate
NOT aggravated by routine activity (more consistent)
NON-THROBBING, “head fullness”, “dull”*

290
Q

Who is affected by migraines

A

more women, 30’s
HIGHLY genetic!
very debilitating, hrs to days

291
Q

“suicide headache”*

A

cluster HA

RULE OUT BRAIN LESIONS*

292
Q

Cluster HA characteristics

A

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
Q

What syndrome can you get w/cluster HA?

A

Horner’s syndrome: ptosis, pupil constriction, anhidrosis unilaterally

294
Q

Eye stroke

A

amaurosis fugax from ischemia of ophthalmic a. from carotid

295
Q

Ischemia of middle cerebral artery (Anterior or posterior)*

A

Anterior: Broca’s aphasia
Posterior: Wernicke’s aphasia

296
Q

Vertebral or basilar artery ischemia*

A

affect anterior portion of PONS

“LOCKED IN” SYNDROME: no mvmt except eyelids

297
Q

When can you treat ischemic strokes with IV tPA?*

A

<4.5hr of onset*

298
Q

Medications for secondary prevention of stroke w/TIA**

A

Anti-thrombotic
ARB/ACE-I
Statin
ALL PTS (REGARDLESS OF LEVELS)

299
Q

Dx of COPD

A

spirometry: FEV1/FVC RATIO less than .70 confirms

risk factors

300
Q

what do all pts with COPD need

A

flu and pneumococcal vaccine bc can cause exacerbations

301
Q

Goal of –> Gout: Chronic Pharmacological Treatment with ULT

A

GOAL is to reach a serum uric acid ≤ 6.0 mg/dl (even below 5.0 mg/dl in patients with tophi)

302
Q

Felty’s Syndrome***

A

Triad: Splenomegaly, RA, Neutropenia

with associated infections (recurrent bc low WBC) and leg ulcerations

303
Q

Who does not get gout?*

A

pre-menopausal women

Bc Estrogen gets rid of uric acid through kidneys (uricosuria)

304
Q

Limited Scleroderma: CREST*

A
Calcinosis
Raynaud’s phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasias
Anticentromere antibodies*
MAKE DZ OFF SKIN EXAM***
305
Q

If you see MCP involvement in suspected OA, *

A

think secondary cause, bc normally spare MCP

306
Q

OA in DIP

A

Heberden’s node*

307
Q

OA in PIP

A

Bouchard’s node*

308
Q

Polymyalgia Rheumatica (PMR) Tx

A

Excellent response to moderate dosage of prednisone* (15mg daily) –> confirms DX!!!***
May taper over months to years following symptoms and ESR

309
Q

Fibromyalgia

A

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
Q

Common Features of Spondyloarthropathies*

A

Assoc w/HLA-B27*

Enthesitis*

311
Q

Joint emergencies

A
septic joint**
compartment syndrome**
acute myelopathy
osteomyelitis
avascular necrosis
cancer, mets
312
Q

Most organism that causes septic arthritis*

A

S. aureus

313
Q

Gouty Arthritis on Xray*

A

Large, punched out erosions with overhanging edges

314
Q

Leading cause of mortality in scleroderma*

A

Pulmonary manifestation
Interstitial lung disease; 80%
Occurs in SSc and CREST
Pulmonary hypertension; 50%

315
Q

Vasculitis is commonly associated with*

A

constitutional symptoms: Fever, weight loss, fatigue
anemia
elevated ESR

316
Q

Lofgren’s Syndrome*

A

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
Q

Most common organisms causing acute bacterial rhinosinusitis*

A

Streptococcus pneumoniae
Haemophilus influenzae
Moraxella (Branhamella) catarrhalis

318
Q

what medication can’t you give for Mono?*

A

Amoxicillin bc rash

319
Q

Hallmark of allergic rhinitis**

A

nasal itching

also post nasal drainage

320
Q

“grey, white exudate” (pseudomembrane), bull neck

A

Diphtheria - pharyngitis

321
Q

most common cause of Croup

A

80% parainfluenza virus

322
Q

What should be suspected in “croup” greater than 3 days

A

bacterial tracheitis

323
Q

most common cause of epiglottitis

A

H. influenzae

324
Q

epiglottitis Sx

A

Sore throat (95%), dysphagia/odynophagia (95%), “hot potato voice” (muffled)

325
Q

most common cause of deep neck infection in children

A

tonsilitis

326
Q

most common cause of deep neck infection in adults

A

dental abscess

327
Q

Which organism should you consider with chronic bacterial rhinosinusitis?

A

Pseudomonas aeruginosa

328
Q

most common congenital neck mass in children

A

thyroglossal duct cyst

329
Q

most common pediatric primary neck malignancy.

A

lymphoma

330
Q

Ludwig’s Angina

A

Bilateral infection of submandibular and sublingual space space
Serious, medical emergency
compromise airway

331
Q

“hot potato voice”**

A

peritonsillar abscess

can also be epiglottitis

332
Q

“Steeple Sign”, think

A

Croup

narrowing of trachea on X Ray

333
Q

cause of 90% of acute epiglottitis

A

H. influenza Type B

334
Q

“Thumb” sign on X ray

A

acute epiglottitis

335
Q

acoustic neuroma

A

tumor of vestibular branch of CN8

“vestibular schwannomas”

336
Q

SxS of Mono

A

Fatigue, Weakness, Sore throat, splenomegaly, lymphadenopathy

337
Q

primary cause of small cell lung cancer*

A

smoking

338
Q

Small Cell Lung Cancer (oat cell)

A

Derived from remnants of fetal lung in neuroendocrine cells (Kulchitsky cells)
25% of all primary lung cancers
pt can present as hyponatremic

339
Q

what side is virchow’s node on

A

left, take supply from lymph of abdominal cavity

340
Q

Ulcerative Colitis

A

Precancerous condition

Need frequent colonoscopy

341
Q

mid-systolic murmur*

A

innocent and physiologic, aortic stenosis

diminishes before second sound

342
Q

Where does aortic stenosis radiate to?

A

neck and carotid

343
Q

Where does mitral regurgitation radiate to?

A

axilla

344
Q

Where does aortic regurgitation radiate to?

A

apex