Step 2 stuff Flashcards
1
Q
WAGR
A
Wilms tumor- doesn’t cross midline
Aniridia
GU abnormalities
Mental retardation
2
Q
CATCH-22
A
Cardiovascular abnormalities Abnormal facies Thymic aplasia Cleft palate HypoCa 22q11 del
3
Q
VACTERAL
A
vertebral Anal Cardiac Trachea Esophagus Renal Limb
4
Q
Causes of PEA= 5H’s and 5T’s
A
Hypovolemia Hypoxia H+ ions: Acidosis Hyper/HypoK Tablets- drug OD or ingestion Tamponade- cardiac tamponade Tension pneumothorax Thrombosis- coronary thrombosis, Pulmonary embolism
5
Q
Rate control in A.fib
A
Diltiazem
Beta blockers
6
Q
Quad scrn for DS
A
MSAFP- dec
Estriol- dec
Inhibin A- inc
HcG- Inc
7
Q
Quad scrn for trisomy 18
A
AFP- dec
Estriol- dec
Inhibin- dec
HcG- dec
8
Q
Reactive NST=
A
2 accel > or = 15 BPM in if over 32 weeks of 10 if less than 32 weeks for > 15 secs over 20 min period
9
Q
a positive CST (contraction stress testing) means
A
deliver baby
10
Q
a negative CST means
A
baby is ok
11
Q
Things tested during biophysical profile
A
Fetal Tone Tetal Breathing Fetal Movement Amniotic fluid vol NST
12
Q
modified BPP includes
A
BPP + AFI
13
Q
when is OGTT preformed in preg
A
weeks 24-28
14
Q
Classic triad of pre-ecplampsia
A
HyPE
HTN, proteinuria, Edema
15
Q
HELLP syndrome
A
Hemolysis
Elevated liver enzymes
low platelets
16
Q
positive pregnancy test with inappropriate hCG doubling + empty uterus on US
A
Ectopic pregnancy- tx methotrexate or surgical with salpingectomy or salpingostomy
17
Q
When to give RhoGAM
A
Give at 28 weeks- Rh neg mother and: father is RH+ or unknown.
Postpartum: Rh + baby w/ Rh neg mother
Rh neg mothers who have: abortion, ectopic preg, amniocentesis, vaginal bleeding, placenta previa/ placental abruption. Type and screen is critical. follow beta hcg closely for 1 year to prevent preg.
18
Q
Fever > 38, uterine tenderness, and malodorous lochia
A
Pospartum endometritis- give clinda and gent, add amp if complicated
19
Q
Precocious puberty, osteolytic bone lesions, cafe- au lait spots
A
Mccune Albright syndrome- stimulation of ovarian aromatase to produce estrogen
20
Q
3 causes of primary amenorrhea w/ secondary sex characteristics
A
Mullerian agenesis- absence of 2/3 of vagina, uterine abnormalities
Complete androgen insensitivity- have breasts, lack pubic hair 46 XY
21
Q
MCC of primary amenorrhea
A
constitutional growth delay- short stature with bone age <12, and normal growth velocity
22
Q
noncyclical pain, menorrhagia, enlarged uterus
A
Adenomyosis- tx = NSAIDs + OCP and progestins, endometrial ablation, hysterectomy is only definitive tx, can rarely progress to endometiral cancer
23
Q
Tx for vWD is
A
desmopressin
24
Q
Acute causes of pelvic pain
A
A ROPE Appendicitis Ruptured ovarian cyst Ovarian torsion or abscess PID Ectopic preg
25
Major causes of death in TSS
ARDS, intractable hypoTN, DIC
26
Tumor markers in Epithelial Ovarian cancer
CA- 125
27
Tumor markers in Endodermal Sinus tumor
AFP
28
Tumor markers in Embryonal Carcinoma
AFP, hCG
29
Tumor markers in Choriocarcinoma
hCG
30
Dygerminoma
LDH
31
Graunlosa cell tumor
Inhibin
32
Hemoptysis (lower Resp) + Hematuria (Renal)
Goodpastures Syndrome- Anti GBM Ab
33
Sinusitis (Upper Resp) + Hemoptysis (lower reap) + Hematuria (Renal)
Wegners granulomatosis= c-ANA
34
Anti mt- Ab
Billiary cirrhosiis
35
Anti parietal cell Ab
Pernicious anemia
36
Anti Smooth muscle Ab
autoimmune hepatitis
37
Back or Chest Pain (lytic bone lesions- worse with activity) + Anemia + thrombocytopenia + HyperCa + RF
Multiple Myeloma- confirm w/ bone marrow bx.
| Have monoclonal protein in serum or Urine
38
Facial Plethora + Splenomegaly in the setting of high counts in all cell lines predominantly RBC
Multiple myeloma- low EPO, elevated Alk phos, common tosis of all cell lines due to Fe deficiency (microcytosis). Often have itching after hot bath
39
Foreigner or foreign travel with new onset seizures that is otherwise healthy
Neurocysticercosis- tx is albendazole with gluccocorticoids, occasinally sx. dx with abnormal head CT and immunoblot from LP
40
In ventilated pt- unilateral opacification + shift of mediastinal structures to the opposite side=
Obstruction via mucous plug- tx and prevent with suction
41
Cirrhosis + Platypnea + Orthodexia=
Heptaopulmonary Syndrome- complication of renal failure
42
In the setting of PE can an echo be helpful
Yes to evaluate for Right heart strain which would strongly indicate a PE, leading to a CT angio for further eval
43
Sensineural hearing loss + hematuria + Lenticonus=
Alport syndrome- XR defect in type IV collagen- most have absence of alpha-5 chain, may be alpha 3 or 4.
44
How is Alport syndrome dx
immunohistochemical skin assay demonstrating lack of alpha 5 chain from type IV collagen
45
Lab abnormalities in rhabdo
Hyper- K, PO4, uricemia.
HypoCa
Elevated CK-MM, LDH, aldolase, aminotransferase.
UA + for blood w/o RBC on microscopy.
Metabolic acidosis from- PO4, sulfate, uric acid, and lactic acid
46
Beneficial diet in RF
supplement Ca
47
INH AE
Hepatotoxicity and Anion gap metabolic lactic acidosis
48
Pathophysiology of RTA 1
no distal tubular acid secretion
49
Nephrocalcinosis and nephrolithiasis are features of which RTA
1
50
Which RTA has a U/A with alkalotic urine and low serum H
1
51
RTA with a low serum K
1 and 2
52
how is RTA 1 diagnosed
acid load test
53
treatment for RTA 1
Oral HCO3
54
Pathophys of RTA 2
no proximal tubular HCO3 absorption. Associated with Acetazolamide.
55
Which RTA has osteomalacia and rickets, osteolytic bone lesions
2
56
U/A of RTA2
alkalotic urine with decreased urine output
57
diagnosis of RTA 2
HCO3 load test- level remain low
58
treatment of RTA2
1) Volume restriction
| 2) High dose HCO3 +/- thiazide
59
pathophys of RTA 4
adrenal/ aldosterone deficiency
60
Which RTA has hyperkalemia
4
61
U/A of RTA 4
Na excretion with K-H retention
62
Diagnosis of RTA 4
Na restriction- will still show high urine Na
63
tx of RTA 4
fludracortisone
64
low Urine output and low urinary Na in the setting of cirrhosis or billiard obstruction
Hepatorenal syndrome- requires liver transplant
| ESLD --> renal vasoconstricion ---> DCT conserves Na
65
HTN + hematuria + bilateral cystic kidneys=
Adult polycystic kidney disease- autosomal dom. AKPD-2 has better prognosis then 1
66
Extra or intra glomerular hematuria: color is pink/red, clots- present (may not be), port <500 mg.day, RBCs have normal morphology, RBC casts are absent
Extraglomerular- ie trauma to kidney or urologic tract, nephrolithiasis, cystitis, cancer of kidney or urologic tract
67
Extra or intraglomerular hematuria: Color is red/ smoky brown/ or coca cola, absent clots, protein >500 mg/day, dysmorphic RBC's, and RBC casts may be present.
Intraglomeruluar- glomerular disease i.e. glomerulonephritis, vasculitis, and glomerulopathies
68
HTN + hematuria + proteinuria (<2+)
Nephritic syndrome- MC in adults= IgA nephropathy, PSGN, Rapidly progressive glomerulonephritis, SLE. Most accurate test is Kidney bx
69
In the setting of testicular mass- U/s shows homogenous hypoechoic mass=
Seminoma
70
In the setting of testicular mass- U/S shows cystic mass with Ca =
Non Seminoma- elevated AFP
71
Tx of Uric acid stones
Fluid, NSAIDs, Alk urine w/ Kcitrate or KHOC3 .
| Uric acid stones (even larger ones) rarely require lithotripsy
72
ST segment depression, T wave flattening, U waves
hypoK- weakness, cramping, fasiculations, paralysis, tetany, rhabdo, hypoTN, paralytic illeus.
Can also cause arrhythmias and AV block
73
Effect of Epi on K
increases cellular uptake, therefore beta blockers can cause hyper K.
74
Causes of HyperCa- CHIMPANZEES
```
Ca supplementation
HyperPTH/HyperTH
Iatrogenic (thiazides)/ Immobility (ICU)
Milk-Alkalai syndrome
Paget's disease
Adrenal insufficiency/Acromegaly
Neoplasm- breast, SqCC, Mult Myeloma
Zollinger Ellison Syndrome- MEN 1
Excess vitamin A
Excess vitamin D
Sarcoidosis or other granulomatis diseases
Tx with IV hydration and furosemide
```
75
EKG findings in hyper Ca
shortened QT interval
76
EKG findings in HypoCa
prolonged QT interval
77
Electrolyte abnormalities associated with Hypo Mg
HypoCa and HypoK (diarrhea)- neither will correct without correcting underlying Mg
78
EKG in HypoMG
prolonged PR and QT
79
anion gap metabolic acidosis- MUDPILES
```
Methanol (formic acid)
Uremia
DKA
Paraldehyde or Phenformin
Iron tablets, INH
Lactic Acidosis- mesenteric ischemia
Ethylene glycol (oxalic acid)
Salicylates
```
80
Indications for Dialysis- AEIOU
Acidosis
Electrolyte abnormalities- HyperK
Ingestion- Salicylates, Theophylline, methanol, barbiturates, LI, Ethylene glycol
Overload- fluid
Uremic symptoms- pericarditis, encephalopathy, bleeding, nausea, pruritis, myoclonus
81
in setting of AKI- hyaline casts=
volume depletion, can be a normal finding
82
Red cell casts/ dysmorphic RBC's
glomerulonephritis
83
White cell casts. eosinophils
Allergic interstial nephritis, arthroembolic disease
84
muddy brown casts, granular casts, renal tubular casts
Acute tubular necrosis
85
White cells, White cell casts
Pyelonephritis
86
Loop diuretics that aren't sulfa's
Ethacrynic acid
87
Type of diuretic that causes ototoxicity
loop diuretics
88
Equal diastolic pressures in all 4 heart chambers =
constrictive pericarditis
89
Most specific auto Ab for lupus
Anti dsDNA- can be used to follow progression of dz
| Anti-Smith
90
Most sensitive autoAb for SLE
ANA
91
Anticentromere Ab
CREST
92
Antihistone ab
drug induced lupus- hydrazine, procainamide
93
Antijo-1 ab
Dermatomyositis
94
Anti-Ro Ab
Sjogrens syndrome
subacute cutaneous lupus
neonatal lupus erythematous
95
At what Na level is 3% Saline indicated in hypoNa
<110 or AMS, seizure or coma. Rate of correction should not exceed 0.5-1 mEq/L/hr. and should stop when symptoms resolve
96
Arthritis that involves Herberdeens (PIP) and Brouchards (DIP) nodes
OA
97
foul smelling/ green frothy vaginal discharge with punctate hemorrhages (strawberry cervix)
Trichomonas- KOH wet mout for dx, tx is metronidazole
98
Unexplained CHF that is predominantly diastolic dysfunction, echo w/ inc vent wall thickness, and normal ventricular cavity dimensions. Especially in the absence of hypoTN + low voltage EKG
Cardiac amyloidosis
99
Hypertensive urgency
severe HTN >180/120 w/ no ssx or acute end organ damage
100
Malignant HTN
severe HTN with retinal hemorrhages, exudate, or papilledema
101
Hypertensive encephalopathy
severe HTN with cerebral edema and non localizing neurologic ssx
