Step 2 Flashcards
1
Q
lethal triad =
A
acidotic + hypothermic + coagulopathic
2
Q
CT head shows gray-white blurring =
A
Diffuse axonal injury
- occurs via angluar trauma
- no treatment
- poor prognosis
3
Q
How to calculate fluids for a burn patient?
A
Parchland Formula
4 x kg body weight x % surface area burned = fluids in 24 hr
- give first 50% in first 8h
- give next 50% in next 16h
To calculate % surface area burned = rule of 9s
4
Q
infection prophylaxis for burn patients?
A
Topical mupirocin
Topical silver sulfadiazine
5
Q
How to assess the long term treatment of someone with Afib
A
Rate control (Beta blocker), Rhythm control, Anticoagulation
Angicoagulation (CHA2DS2-VASc)
- CHF
- HTN
- Age >75
- DM
- Stroke
- Vascular disease
- Age 65-74
- Sex (female)
If score 0-1 = ASA only
If score 2+ = oral anticoagulation (NOAC, Warfarin with INR 2-3)
6
Q
What does giving fluids to someone and then them becoming hypertensive, bradycardic and go into respiratory depression indicate?
A
Cushing’s reflex = indicates elevated ICP
7
Q
Blunt abdominal trauma leading to a GI perforation most commonly affects what portion of the tract?
A
Damage to mesenteric blood supply leads most commonly to jejunal ischemia
8
Q
AFP? beta-hCG?
nonseminomatous germ cell tumor
seminomatous tumor
A
Nonseminomatous = elevated AFP, elevated beta-hCG
- embryonal (normal AFP)
- yolk sac tumors
- choriocarcinoma
- teratomas
Seminomatous = normal AFP, elevated beta-hCG, increased placental Alk Phos
9
Q
calf is rapidly worsening, swollen, tense, exquisitely tender, pain worsened by passive extension, distal pulses intact =
A
compartment syndrome (soft tissue swelling)
- dx via measuring tissue pressure (>30 mmHg) or dela pressure (Diastolic BP - Compartment P <20-30 mmHg)
- tx = fasciotomy
DDX
- arterial embolism - absent pulses, pallor of affected limb
- DVT - vague aching pain
10
Q
Emergent warfarin reversal
A
Fresh Frozen Plasma (FFP) - the most rapid method
Vit K - reverses slowly, depends on the synthesis of new vit K dependent clotting factors
Prothrombin Complex Concentrate (PCC) - has prothrombin for rapid reversal + Vit K for long term reversal - used for Intracranial hemorrhage
11
Q
pathogenesis of vasovgal syncope
A
increased parasympathetic activity -> bradycardia -> peripheral vasodilation -> decreased CO -> syncope
12
Q
Differential for Low Ca, High Phos
A
Low PTH - primary hypoparathyroidism
- 2/2 post-surgical, autoimmune, defective receptor, non-autoimmune infiltrative destruction
- will have normal kidney function
Low Vit D 2/2 CKD
- results in secondary hyperparathyroidism (PTH will be high)
- will have poor kidney function (high Cr)
13
Q
pathology of hyperventilation as a treatment for increased ICP
A
Hyperventilation -> decreases PaCO2 -> cerebral vasoconstriction -> decreased cerebral blood flow -> decreased cerebral blood volume -> decreases ICP
14
Q
What is ICP consist of (3) and what are ways to reduce it
A
ICP = 3 compartments
- brain parenchyma (can reduce this pressure via mannitol)
- CSF (can reduce this pressure via therapeutic lumbar punctures)
- cerebral blood flow (can reduce this pressure via hyperventilation)
15
Q
Ankle Brachial Index cut off for occlusive PAD
A
ABI greater than 0.90 is diagnostic for occlusive PAD
16
Q
Fever, lower abdominal/flank pain, leukocytosis, increased pain when hip is extended, less pain when hip is flexed
A
Psoas abscess
- Dx = CT
- Treatment = drainage
17
Q
metaclopramide - pro motility or anti motility?
A
Promotility - dopamine antagonist
18
Q
Colonic watershed areas (2)
A
- Splenic flexure (superior mesenteric artery, inferior mesenteric artery)
- Rectosigmoid junction (sigmoid artery, superior rectal artery)
19
Q
Premature infants with grunting, flaring, retractions, central cyanosis immediately after birth =
Treatment?
A
Respiratory Distress Syndrome
Treatment = continuous
20
Q
Acrocyanosis =
A
Blue extremities + Pink body
- common
- benign
- may last for 1-2 days
21
Q
Indomethacin contraindication =
A
intraventricular hemorrhage
-Indomethacin used to close PDA
22
Q
To keep PDA open =
Which conditions require an open PDA to survive? (4)
A
prostaglandin E1
PDA is required in =
- transposition of great vessels
- tetralogy of fallot
- hypoplastic L heart
- coarctation of aorta
23
Q
Pathogenesis of Fanconi anemia
A
Chromosomal breaks due to DNA repair problem
- congenital aplastic anemia
- pancytopenia
- macrocytosis
- cafe au lait spots
- absent thumbs
- short stature
- horseshoe kidney
24
Q
Down syndrome + Upper motor neuron symptoms =
A
atlantoaxial instability
25
Treatment of strabismus
Strabismus = ocular misalignment
- tx: penilization therapy (cycloplegid drops to blur the normal eye), occlusion therapy to normal eye, prescription glasses, surgery
- may be normal up until age 5
26
dermal melanocytosis
Mongolian spot
| -self resolving
27
Neuroblastoma vs Wilms Tumor
Neuroblastoma
- neural crest cell tumor
- abdominal mass that does cross midline
- yes systemic symptoms
- calcification seen on XR
- elevated urine and serum catecholamines
Wilms Tumor
- renal malignancy
- abdominal mass that does not cross midline
- asymptomatic
28
Physiologic jaundice causes (3)
- increased RBC concentration at birth and therefore increased breakdown (unconj BR)
- decreased amount/activity of enzyme (unconj BR)
- increased enterohepatic recycling because there are not enough colonic bacteria to make uroBR therefore increased reabsorption of conj BR (conj BR)
Arises >3 days after birth
Resolves within 1-2 weeks
29
Treatment of Impetigo
Impetigo -
- Nonbullous: Staph aureus or Group A Strep, painful nonpruritic pustules that become honey-crusted lesions
- Bullous: Staph aureus, rapidly enlarging flaccid bullae with yellow fluid, painful
- Tx: minor - topical mupirocin; severe - oral cephalexin, dicloxacillin, clindamyin
- Dx: clinical
30
Infant contraindication to breastfeeding =
Galactosemia
- Absence in galactose-1-phosphate uridyltransferase
- Accumulation of galactose 1-phosphate in liver, kidney, and brain
- increased risk for E coli neonatal sepsis
31
Centor Criteria
```
Used to diagnose Group A Strep Pharyngitis in adults
Criteria
-Fever (measured or via history)
-Tender anterior cervical lymph nodes
-Tonsillar exudates
-No cough
```
0-1 positive = no diagnosis, no treatment
2-3 positive = rapid strep antigen test, treat if positive
4 positive = treat
32
Treatment for Group A Strep Pharyngitis
Oral penicillin or amoxicillin
33
Traction apophysitis
Osgood Schlatter Disease
- caused by rapid growth which causes the quadriceps tendon to put traction on the apophysis of the tibial tubercle
- dx via xray
34
When is the varicella vaccine given
2 doses
- 1 year old
- 4 year old
35
palpable _ lymph nodes are always pathologic until proven otherwise
supraclavicular
36
exclusively breastfed infants require what supplementation?
- Vitamin D
| - If premature, also require Iron for 1 year
37
Treatment of tourettes
- nonpharmacological
- pharmacological
Nonpharm:
-Habit reversal training (HRT)
Pharm:
- Alpha2 adrenergic agonists (Clonidine, Guanfacine)
- First generaltion antipsychotics (Haloperidol, Pimozide) - lots of side effects
- Second generation antipsychotics (Risperidone)
38
Floppy baby ddx
- Infant botulism (spores in honey or environment)
- Werding Hoffman Syndrome (degeneration of anterior horn cells and CN motor nuclei)
- Pompe disease (elevated ck, lactic acidosis)
- Prader Willi (hyperphagia, undescended testicles, missing Dad's chromosomes)
39
otitis externa (2 bugs)
tx =
otitis externa = "swimmer's ear"
- Pseudomonas aeruginosa
- Staph aureus
tx = remove debris, topical abx (fluoroquinolone), +/- topical glucocorticoid
40
recurrent skin infections and oral mucosal infections. lab shows marked neutrophilia.
Leukocyte Adhesion Deficiency
41
macrosomic fetus size
greater than 4.5 kg (9.9 lbs)
42
treatment for minimal change disease
steroids
| -do not need to do a biopsy unless patient does not respond to steroids
43
Basophilic stippling (2)
- thalassemia
| - heavy metal poisoning
44
Howel Jolley Bodies
people with functional asplenia or actually no spleen
45
Heinz bodies
-G6PD
46
How to work up developmental hip dysplasia
If less than 4 months old - ultrasound hips
If greater than 4 months old - XRay hips
Refer to ortho
47
Recurrent skin infections and oral mucosa infections. Takes a long time for injuries to heal.
Leukocyte Adhesion Deficiency (LAD)
- defect in chemotaxis of leukocytes
- may also present with delayed cord separation, no pus in wounds
- Leukocytosis with increased neutrophils in the blood (because they cannot get out)
- tx = bone marrow transplant
48
Treatment of Methemoglobinemia
Cyanotic, Pulse ox ~85%, Dark chocolate colored blood, Normal PaO2
Administration of oxygen will not improve symptoms
Path: decrease in O2 delivery to tissues
Tx = Methylene blue
49
Recurrent pulmonary and cutaneous infections
Chronic Granulomatous Disease
- XR
- Catalase positive orgnisms
- Dx: neutrophil function tests (Dihydrorhodamine test, Nitroblue tetrazolium test)
50
Strawberry hemangioma vs Cherry hemangioma
Strawberry = in infants/children
- present at birth
- may get larger but then spontaneously regresses
- benign
Cherry = adults/elderly
- may increase in number as we age
- benign
51
Symmetric dorsal swelling of hands and feet in an African American infant
Dactylitis
| -vasooclusion in sickle cell diseae
52
Child with lymphadenopathy, splenomgaly, an increased number of blasts on peripheral blood and positive PAS and positive TdT
ALL
| -most common in children
53
infant with acute abdominal distension, bilious vomiting, gasless abdomen on Xray = next step
Upper GI series (barium)
- volvulous = corkscrew
- malrotation = ligament seen on R instead of L
54
muscular dystrophy with testicular atrophy, facial muscle wasting
Myotonic Dystrophy
- AD
- grip myotonia, dysphagia
- associated with arrhythmia, cataracts, balding, testicular atrophy
- death from respiratory or heart failure
Duchenne and Becker are XR
55
When can external cephalic version of a baby be done?
37 weeks or greater
contraindications
- placental abnormalities
- oligohydramnios
- hyperextended fetal head
- fetal/uterine abnormalities
- multiple gestations
56
Tamoxifen VS Raloxefen
Both are SERMs and work to prevent breast cancer
sfx: hot flashes, VTE (2/2 protein C resistance leading to a hypercoag state)
Tamox - also has a sfx of endometrial hyperplasia
Ralox - also for post menopausal osteoporosis prevention
57
new onset dysmenorrhea in a woman over 40 yo who on exam has an enlarged uterus
Adenomyosis
58
What is a and what are contraindications to a contraction stress test (2)
Contraction stress test = oxytocin and nipple stimulation to try to elicit contractions - 2 within 10 min
Do it when the baby is less than 36 weeks
Contraindications
- placenta previa
- prior myomectomy
59
GBS swab is done at _-_ weeks
35-37 weeks
60
"lumpy uterus" (3)
- Endometrial polyps - inter-menstrual spotting
- Uterine sarcoma - very rare, post menopausal woman
- Leiomyomata uteri (Fibroid) - very common in reproductive age women, recurrent pregnancy loss, dysmenorrhea
61
in a post-menopausal woman, ultrasound pelvis shows thick septations, solid components and peritoneal free fluid
Epithelial ovarian ca
| -usually already has mets by the time of discovery
62
side effects/adverse effects of oxytocin (3)
- Hyponatremia (may lead to seizures)
- Hypotension
- Tachysystole (abnormally frequent contractions - 6 in 10 minutes)
63
How to dx preeclampsia
Preeclampsia = proteinuria + HTN
```
Proteinuira dx via
-24 hr urine protein collection >300mg
OR
-urine protein/cr ratio >0.3
OR
-dipstick >1+
```
64
CA-125
tumor marker for epithelial cell ovarian tumor
- postmenopausal women
- appears late, often has mets
- dx: TVUS + tumor marker levels
65
Treatment of endometrial biopsy that shows endometrial hyperplasia (symptom: abnormal uterine bleeding)
Progesterone
| -P is protective to the endometrium
66
Path and treatment of
- neurogenic/overflow incontinence
- urge incontinence
- stress incontinence
Neurogenic/Overflow - no contractions of the detrusor
-cholinergic agonist (Bethanechol)
Urge - random spasms of the detrusor
- bladder training
- muscarinic antagonist (Oxybutynin) or beta-agonist
Stress - weak pelvic floor
- kegel exercises
- pessaries
- surgery
67
Trisomy 21 on quad screen
- MS-AFP
- beta-hCG
- Estriol
- Inhibin A
- MS-AFP = low
- beta-hCG = high
- Estriol = low
- Inhibin A = high
68
Elevated MS-AFP on screening =
NTD or abdominal wall defect
69
Best test to test for Trisomy 21 in utero?
Cell-free fetal DNA test
- can be done >10 weeks
- non-invasive
- not diagnostic but has a high sensitivity and specificity for aneuploidy
70
antibiotics for chorioamnionitis
Chorioamnionitis = ascending infection while the baby is still in
- premature ROM + fever
- elevated IL-6, low glucose on amniocentesis
- tx: ampicillin + gentamicin
71
antibiotics for endometritis
Endometritis = ascending infection after the baby is out
- hx of premature ROM + current fever
- tx: clindamycin + gentamicin
72
At what beta-hCG can you see an intrauterine pregnancy on transvaginal ultrasound?
at greater than 1500
73
Do not give tocolytics after _ weeks
What are 4 different tocolytics and when can they be used?
Do not give tocolytics after 34 weeks
- Indomethacin - cox inhibitor (<32 weeks)
- Nifedipine - ccb (<32-34 weeks)
- Terbutaline - beta agonist - not used due to side effects
- Mag sulfate - very weak
74
Dx and treatment of hyperemesis gravidarum
Dx:
- first rule out molar pregnancy with ultrasound + beta-hCG
- evaluate labs: ketonemia, ketonuria, hyponatremia, hyokalemic, hypochloremic metabolic alkalosis
Tx:
not severe = it B6 + Doxylamine (Anti-histamine)
severe = anti-emetics + IVF
75
Child ingested unknown pills and now has nausea, vomiting with blood, green diarrhea
Iron poisoning
- GI symptoms are first: hemorrhagic because iron is caustic to the GI tract, green diarrhea because of the iron reaction
- later symptoms include: severe lactic acidosis, hepatotoxicity, and diffuse organ failure
76
adult with recent onset fatigue, weight loss, splenomegaly, diffuse lymphadenopathy, lymphocytic leukocytosis =
treatment =
CLL
- lymphocytic leukocytosis
- smudge cells
- treatment = monoclonal Ab against CD 20 antigen
```
CML = neutrophilic leukocytosis
-treatment = BCR-ABL tyr kinase inhibitors
```
77
Wide QRS indicates impulse is generated =
treatment for almost all wide complex tachycardias
in the ventricles
tx = amiodarone
78
main risk with parenteral nutrition via central line?
central line associated blood stream infection
- coagulase negative staph
- staph aureus
- gram negative (klebsiella, pseudomonas)
- candida
79
refeeding syndrome is due to _
| and occurs in _
due to rapid fluid and electrolyte shifts
| occurs in very malnourished patients
80
what is antifreeze
ethylene glycol
- HAGMA
- calcium oxalate crystals
- AKI
81
vasovagal syncope prodrome
nausea, pallor, diaphoresis
82
orthostatic hypotension prodrome
dizzy, blurry vision
hx of supine to standing or of new antihypertensive medications
83
viral pericarditis -> which heart defect
viral myocarditis -> which heart defect
viral pericarditis -> recurrent pericarditis -> cardiac tamponade
viral myocarditis -> dilated cardiomyopathy -> cardiogenic shock
84
Factitious disorder vs Malingering
Factitious disorder = gain is the attention you get as the sick person (internal reward)
Malingering = external reward
85
ovalomacrocytosis, neutrophil hyposegmentation indicates =
MDS - hematopoetic stem cell neoplasm
- may transform to acute leukemia
- dx via bone marrow biopsy
86
medical treatment of hyperprolactinemia
Bromocriptine (Dopamine agonist)
87
anti-endomyseal Ab =
celiac disease
88
hypoxia + tachypnea + tachycardia + clear lungs on exam =
PE
89
anemia most commonly associated with malginancy =
DIC
90
Buprenorphine
treatment for opioid overdose
91
Teardrop RBS on peripheral smear = (2)
- myelofibrosis
| - beta thalassemia s/p splenectomy
92
most common cause of sterile pyuria + dysuria in a young sexually active female =
Chlamydia trachomatis
| -eventually will lead to scaring of tubules
93
pathogenesis of central cyanosis
decreased arterial oxygen saturation
| indicates congenital heart defect
94
most common cause of pediatric hemoptysis =
CF with bronchiectasis
95
Ectopic treatment
- stable/not ruptured
- ruptured/fluid in posterior cul de sac/hemodynamically unstable
- stable = methotrexate
| - unstable = surgical exploration/laparotomy
96
misoprostol is used for
treatment of an incomplete abortion
| -causes cervical dilation and myometrial contractions
97
Appropriate form of birth control for a pre-menopausal woman who is undergoing chemo for breast cancer
Hormonal birth control is avoided in someone with breast cancer because the breast tissue may respond to the E/P.
Especially true if the breast cancer is BRACA positive because those are most likely ER/PR positive as well.
Most appropriate birth control = copper IUD
98
withdrawal from what drug causes acute depression with suicidal ideation but no physical symptoms?
cocaine withdrawal
- fatigue
- hypersomnia
- increased dreaming
- hyperphagia
- impaired concentration
99
pseudohyphae with budding yeasts + skin infection
Candida
100
skin infection + septate hyphae
Tinea cruris
101
treatment for mild sunburn
cool compress, calamine lotion, NSAIDs, aloe vera
102
gout treatment and ppx
```
treatment:
first line = NSAIDs
if contraindicated, then
second line colchicine (sfx: dose dependent diarrhea)
-contraindicated if renal dysfunction
```
ppx:
- allopurinol
- febuxostat
103
9 weeks pregnant + vaginal bleeding + closed cervix + ultrasound confirms 9 week fetus and normal FHR =
threatened abortion
- may continue into normal pregnancy
- tx: observe and repeat ultrasounds
104
3Hz spike wave activity on EEG =
absence seizures
105
recent travel + diarrhea with blood and mucus + cramping + pain to deep palpation + antibiotics didn't work
E. histolytica
- dx via stool ova and parasite
- tx metro + paramycin
106
Child with eczema + recurrent infections + small platelets on peripheral smear =
Wiskott Aldrich Syndrome
- XR defect in WAS protein gene
- impaired cytoskeleton
- tx stem cell transplant
107
Wide QRS is > _ms
Wide QRS >100ms
108
treatment for acute pancreatitis
- IVF
| - pain control
109
"loud pulmonary component of S2" =
indicates pulmonary HTN
110
most common solid malignancy in young men
Germ cell tumor/testicular cancer
- unilateral, painless testicular nodule
- firm, does not trans-illuminate
- usually asymptomatic and found incidentally after injury to groin or via sexual partner
- Dx: AFP and beta hCG and scrotal ultrasound
- Tx: radical orichetcomy + chemo
111
Liver mass with central scar =
focal nodular hyperplasia
- no treatment
- benign
112
child born with cleft lip and palate who has had numerous infections and is having seizures
Think of Di George Syndrome
- Cardiac defects(tetrallogy, tructus, interrupted aortic)
- Abnormal facies
- Thymic aplasia (T cell deficiency)
- Craniofacial abnormalities (cleft lip/palate)
- Hypocalcemia/Hypoparathyroidism (low Ca->seizures)
113
Painful erythematous lump along the eyelash line
Painless erythematous rubbery lump along the eyelash line
Painful swelling of the nasal aspect of the lower lid +/- purulen discharge
Painful lump = hordeolum - bacterial infection of an eyelash follicle, staph aureus
Painless rubbery lump = chalazion - granulomatous occlusion of meobmian tear gland, rubbery nodular lesion
Painful swelling = dacrocystitis - bacterial infection of the lacrimal gland, staph aureus, strep pneumo, H flu, can spread to cavernous sinus
114
adolescent boy with bone pain + imaging showing periosteal elevation =
Osteosarcoma - osteoblast/mesenchyma
- metaphasis of long bones
- suburst pattern
- may present with lung mets
115
adolescent boy with bone pain + imaging showing onion skinning + systemic symptoms =
Ewing Sarcoma - neuroectoderm
| -Midshaft of long bones
116
Cupping of optic disc = (2)
- painless
- painful
Increased IOP -> atrophy of the optic nerve head
- open angle glaucoma = 2/2 decreased outflow of aqueous humor -> increased IOP, loss of peripheral vision, painless
- acute angle closure glaucoma = 2/2 occlusion of anterior chamber -> outflow obstruction -> rapid increase in IOP, opthalmologic emergency as it can lead to permanent blindless, painful, sudden blurring + n/v
- tx: tonometry to measure IOP
117
cherry red fovea + retinal pallor + acute painless monocular vision loss
central retinal artery occlusion
- key word is that current vision loss, NOT transient
- 2/2 embolization from carotid artery
- tx: ocular massage to dislodge embolus, high flow O2
118
ERCP shows bead-like dilations of intra- and extra-hepatic bile ducts + jaundice + pruritis + weight loss + bloody diarrhea =
complications
Primary Sclerosing Cholangitis
- intra and extra hepatic bile duct thickening + lumenal narrowing
- chronic, idiopathic
- insidious onset/symptoms
- bx: fibrous replacement of bile ducts, onion skinning
- tx: liver transplant, cholestyramine for symptoms
- associated with ulcerative colitis (bloody diarrhea)
Complications
- colangiocarcinoma
- portal HTN
- liver failure
- colon cancer
119
destruction of intrahepatic bile ducts + autoimmune association + pruritis + xanthelasma =
Primary biliary cirrhosis
- anti-mitochondrial Ab
- associated with
- hepatocellular carcinoma
- metabolic bone disease - osteoporosis, osteomalacia
- liver biopsy to confirm diagnosis
- tx: cholestyramine and calcium/bisphosphonates for symptoms , ursodeoxycholic acid to slow progression, liver transplant
120
holosystolic murmur in the 4th intercostal space on the L sternal border with a palpable thrill =
VSD
121
startle myoclonus + dementia =
CJD
122
waxing and waning demenita ("good days and bad days") + shuffling gait + visual hallucinations
Lewy Body Dementia
123
lymphogranuloma venereum =
chalmydia trachomatis
124
sonohysterography is used for
used to dx intramural fibroids
125
SIADH labs
- LOW serum osmolality
- HIGH urine osmolality
- HIGH urine Na
- EUVOLEMIC clinically
126
smoker + cavitary lung lesion =
squamous cell carcinoma
- can be found in apex of lung
- cavitation on CXR
- hypertrophic osteoarthropathy - long bone pain
127
smoker + lung nodule =
small cell lung cancer
- hilar mass
- mediastinal lymphadenopathy
- often has extrinsic compressive symptoms
128
direct hernia occurs 2/2
weakness of transversalis fascia/inguinal canal floor
- older men
- bulge in inguinal area
129
indirect hernia occurs 2/2
laxity of the deep inguinal ring + patent process vaginalis
- young boys
- into scrotum
130
treatment of catatonia-type of schizophrenia
- benzo (lorazepam)
| - ECT
131
Psychotherapy - exposure and response prevention
| is used for _
OCD
132
Psychotherapy - Dialectical behavior therapy
| is used for _
Borderline personality disorder
133
What drug can also cause serotonin syndrome?
MDMA, Ecstasy
| sfx: HTN, tachycardia, hyperthermia, hyponatremia, serotonin syndrome
134
Treatment of acute dystonia
occurs shortly after starting an antipsychotic
| tx = anticholinergic, antihistamine
135
Treatment of tardive dyskinesia
occurs after long term antipsychotic or metaclopromide use
| tx = stop offending agent, switch to Clozapine
136
Treatment of akathesia
can occur at any point during an antipsychotic treatment
| tx = beta blocker
137
smoking cessation treatment (3)
- nicotine replacement
- Varenecline - sfx: mood changes, suicide
- Bupropion - contraindicated in bullemia or seizure disorders
138
V Fib or Pulse-less V Tach ->
defibrillation followed by epi, vasopressin and amiodarone or lidocaine
139
yes pulse and V Tach ->
amiodarone and synchronized cardioversion
140
how to investigate a potentially suspicious malignant mole?
excisional biopsy
141
When can cervical cancer screening stop?
65 years old - as long as adequate negative prior screenings and no history of CIN2 or higher
pap+HPV co-test Q3 years from 21-65 yo
if both HPV and cytology are negative in women >30 yo, can test Q5 years
142
postpartum fever unresponsive to broad-spectrum antibiotics
Septic pelvic throbophlebitis vs abscess
- thrombophlebitis tx = IV heparin
- abscess = percutaneous drainage + continue abx
143
increased hemoglobin A2 and anemia =
thalassemia
144
koilocytosis (2)
- HPV
| - CMV
145
rash develops after administration of Amp or Amox for sore throat =
EBV
146
painless palpable gallbladder + jaundice =
Courvoisier sign = pancreatic cancer
147
opthalmoplegia =
paralysis of extra-ocular muscles
148
calf erythema, tenderness, palpable "cord" =
superficial thrombophlebitis
- benign
- clot in a superficial vein
- does not cause PE
- tx: NSAIDs + warm compress
if recurrent, then it is a sign of underlying malignancy
149
Treatment for rosacia? (2)
- topical metronidazole
| - oral tetracycline
150
what does paget's disease of the breast indicate?
underlying breast cancer that has traveled to the nipple
- invasive ductal carcinoma
- ductal carcinoma in situ
151
fissuring of the corners of the mouth=
angular stomatitis
stomatitis = inflammation of the mucous membranes of the mouth
-B deficiency - riboflavin, niacin, pyridoxine
-C deficiency
152
hearing loss + vertigo + tinnitus + nausea/vomiting
- dx
- tx
```
Meniere disease
tx:
-Benzo
-Scopolamine (Anticholinergic)
-Antihistamines (Meclizine, Dimenhydrinate)
-Thiazide diuretics
```
153
vesicles on tympanic membrane
Infectious myringitis (bullous myringitis)
- inflammation of TM
- Mycoplasma, Strep pneumo, viruses
- Tx: erythromycin, clarithromycin
154
hyperthyroidism + tender painful thyroid + preceeding viral infection =
subacute thyroiditis
155
what other 3 diseases are associated with Hashimoto?
- Hashimoto
- vitiligo
- pernicious anemia
- diabetes
156
triple therapy for H Pylori
- PPI
- Clarithromycin
- Amoxicillin
157
best imaging for head trauma =
noncontrast CT
158
penetrating trauma of the neck location and tx
- zone I
- zone 2
- zone 3
```
1 = base of clavicles to above clavicle -> arteriogram
2 = top of clavicle to angle of mandible -> OR
3 = angle of mandible to base of skull -> arteriogram
```
159
Tx of
hypertensive urgency
hypertensive emergency
Urgency - high BP with no symptoms
-PO furosemide, clonidine, captopril
Emergency - high BP with symptoms
-IV nitroprusside, labetalol, nicardipine
160
Hereditary Angioedema is a deficiency of _
- acute tx
- long term tx
Hereditary Angioedema = deficiency of C1 esterase inhibitor (compliment)
- C4 compliment levels are low (differentiating it from acquired angioedema)
- acute treatment = (similar to anaphylaxis) IM Epi, H1/H2 receptor blockers, steroids
- long term treatment = androgens (because it increases liver production of C1 esterase inhibitor)
161
what is the classic cause and symptoms of SCID?
cause: Adenosine deaminase deficiency (AR)
symptoms: B and T cell dysfunction
162
giant granules in neutrophils + oculocutaneous albinism + recurrent infections in a child
Chediak- Higashi syndrome
- AR
- abnormal protein trafficking leading to impaired phagocytosis
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kidney disease that is most common in caucasian adults, granular deposits of IgG and C3 in BM
Membranous Nephropathy
- most common nephrotic in caucasian adults
- associated with HBV, syphilis, malaria, gold
- tx Prednisone
164
tram track BM kidney disease
Membranoproliferative nephropathy
- associated with HCV, cryoglobulinemiia, SLE, subacute bacterial endocarditis
- tx Prednisone
165
retinal findings of dot-blot hemorrhages, microaneurysms, neovascularization of the retina, macular edema =
Diabetes
| -most common cause of blindness in adults under 50 yo
166
retinal findings of arteriolar narrowing, "wiring", cotton-wool spots =
HTN
| -may lead to central retinal vein occlusion (acute painless, unilateral vision loss)
167
when is it indicated to give betamethasone to a pregnant mom
when is indicated to give mag to a pregnant mom
steroids: if preterm labor <34 weeks
mag: if preterm labor <32 weeks
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Multiple Sclerosis
Chronic treatment
Acute treatment
```
Chronic = Interferon
Acute = high dose steroids
```
169
Treatment of trigeminal neuralgia
Carbamazepine
170
Stroke:
- pure motor =
- pure sensory =
- pure motor = internal capsule
| - pure sensory = thalamus
171
nephrolithiasis diagnostic study of choice =
- ultrasound
| - noncontrast CT
172
transient monocular vision loss, "shade pulled over one eye", painless
amaurosis fugax
- key word is transient
- occurs 2/2 embolus from carotid artery
- dx via carotid duplex us
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fever + wheezing + elevated eosinophils + rash =
Churg Strauss
- Granulomatous vasculitis
- Dx - positive P-ANCA
- Treatment - systemic glucocorticoids
174
Differentiating factor between polymyalgia rheumatica vs polymyositis
Polymyalgia rheumatica does not have weakness. Polymyositis does have weakness.
PMR: pectoral and pelvic girdles, elevated ESR, EMG normal, associated with temporal arteritis, dx is response to steroid treatment
Polymyositis: proximal muscles, elevated ESR, abnormal EMG, dx via muscle biopsy, elevated CPK, increased risk of malignancy
175
what should you think about if you see a patient with unprovoked hypothermia
hypothermia <35 C
myxedema coma is a cause of hypothermia
- obtain appropriate thyroid labs
- low Na, high PaCO2
- tx: rapid administration of levothyroxine and glucocorticoids
176
3 things to think about that cause erythema multiforme
erythema multiforme = target lesions, may occur on palms/soles
- sulfa drugs
- penicillins
- HSV
177
3 things to think about that cause erythema nodosum
treatment
erythema nodosum = inflammation of subcutaneous tissue and skin, classically over the shins
- sarcoidosis
- cocci
- ulcerative colitis
treatment = symptomatic therapy - NSAIDs, leg elevation, compression bandages
178
amaurosis fugax vs central retinal artery occlusion
both are caused by occlusion of the retinal artery most often due to emboli from carotid artery
AF is very transient, curtain coming down over the eye
CRAO is when someone is complaining about current monocular vision loss that has not resolved
-will have particular occular findings (central pallor, cherry red macula)
179
"popcorn calcifications" on a solitary lung nodule =
hammartoma
- benign
- pt <40 yo with no risk factors
180
When you dx CPPD/Pseudogout, what 3 associated syndromes/diseases should you think of
- hemochromatosis
- hypothyroidism
- hyperparathyroidism
181
small bowel biopsy showing PAS positive material in the lamina propria =
Whipple Disease
- multisystem illness
- arthralgias + malabsorptive diarrhea + weight loss + fever + cough + myocardial/valvular issues + myoclonus + hyperpigmentation
- T whippelii
182
Hydroxycobalamin and Sodium Thiosulfate are treatments for what toxicity?
CN poisoning
183
Treatment of Paget's disease of bone =
Bisphosphonates
184
child with recurrent sinusitis + asthma + episode of giardia =
Common variable insufficiency - B cell problem
| -tx: IVIG
185
Protamine sulfate
reversal of Heparin
186
Prothrombin complex concentrate (PCC)
reversal of Warfarin after an intracranial hemorrhage
-FFP and Vit K are the other Warfarin reversal agents
187
what does the "null hypothesis" indicate
that there is no association between the variables of interest
188
Tick-borne ascending paralysis vs Gullian Barre Disease
Tick-borne:
- asymmetrical
- occurs over hours
- no autonomic symptoms
- normal CSF
- normal sensation
- tx: look for tick
GBS:
- symmetrical
- occurs over days-weeks
- yes autonomic symptoms (tachycardia, urinary retention, arrhythmia)
- abnormal CSF
- normal sensation
- tx: IVIG and/or plasmapheresis
189
Pregnant woman in 3rd trimester with jaundice, nausea, vomiting, RUQ abdominal pain, leukocytosis, hypoglycemia, AKI =
Acute Fatty Liver of Pregnancy (AFLP)
190
Preeclampsia hypertension treatment (3)
- IV hydralazine
- IV labetalol - do not give if patient is bradycardic
- PO nifedipine - do not give if patient is having n/v (because it is PO)
191
protator drift indicates a _ lesion
UMN lesion - pyramidal/corticospinal tract
192
hypogonadotrophic hypogonadism indicates a problem _
in the hypothalamus or pituitary
| tx: GnRH agonists
193
what to think about when there is an thoracic aorta repair/surgery =
risk of anterior spinal cord infarction due to loss of radicular arteries that come off the thoracic aorta that lead to the anterior spinal artery
194
Imaging tests after blunt abdominal trauma (2)
1) FAST
| 2) CT with contrast
