Step studying 9 Flashcards by Giselle McIntyre

How do you calculate serum osmols and what is the normal value

(2 x Na) + (Gluc / 18) + (BUN / 2.8)

Normal = 280

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How do you correct sodium in hyperglycemia

♣ For every 100 that glucose is above 100, you need to correct the sodium by 1.6
♣ E.g. Pt with glucose of 500, that is four 100s above 100, so correct sodium with (4 x 1.6) = 6.5
• So if measured Na was 130, then corrected sodium is 136.5

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What is the difference between hypertensive urgency and hypertensive emergency

Hypertensive urgency = Severe HTN (>180/120) without symptoms of acute end-organ damage

Hypertensive emergency = Severe HTN with acute, life-threatening, end-organ complications

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Define Malignant hypertension

Malignant hypertension = Severe HTN with retinal hemorrhages, exudates, or papilledema

Falls under category of HTN emergency

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Meds that can be used to treat fibromyalgia

TCAs, SNRI, Gabapentin

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What do you see histologically in diabetic nephropathy

Glycosylation of basement membrane

- Sclerosing of mesangium (Kimmelstien-Wilson nodules)

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How does fetal alcohol syndrome present

o Midfacial hypoplasia, microcephaly and stunted growth
o 3 pathognomonic facial dysmorphisms
♣ Small palpebral fissures
♣ Smooth philthrum (vertical groove above the upper lip)
♣ Thin vermilion border
o CNS damage may manifest as hyperactivity, mental retardation, or learning disability

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What lab value can help you diagnose hereditary spherocytosis

Elevated mean corpuscular hemoglobin concentration (MCHC) - due to membrane loss and cellular dehydration

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Describe cause and symptoms of Meniere disease

• Increased pressure and volume of endolymph
• Features:
o Episodic vertigo with nausea and vomiting
o Recurrent episodes lasting 20 min to several hours
o Ear fullness/pain
o Unilateral sensorineural hearing loss
o Tinnitus

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Tx of Meniere disease

o Salt restriction
o Thiazide diuretics
o Symptomatic treatment (Meclizine)

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Pt presents with sx of URI + crackles in the setting of recent sick contact - what is next step in management

CXR - needed before starting abx

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Tx of outpatient CAP

Macrolide (azithro) or Doxy

Fluoroquinolone or beta-lactam + macrolide if comorbidities

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What is the leading cause of B12 deficiency

Pernicious anemia

Autoimmune destruction of parietal cells leads to intrinsic factor deficiency and decreased absorption of B12

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What long-term complication should you worry about in pernicious anemia

Gastric cancer

♣ Recall that parietal cells produce both IF and HCl, so destruction will lead to hypochlorhydria
♣ Hypochlorhydria will lead to increased gastrin production from antral G-cells
♣ This increases risk of gastric cancer

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What should you be worried about in fall to outstretched hand

Scaphoid fracture

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Sx of rheumatic fever

JONES

Joints (migratory arthritis)
Cardiac (carditis)
Nodule (subcutaneous)
Erythema marginatum
Sydenham chorea

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Which antibody is sensitive for SLE and which is specific

ANA is sensitive

- anti-dsDNA and ant-Smith are more specific

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Which antibody level should be ordered first in evaluation of SLE

ANA

If positive then test for more specific antibodies

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Medical treatment of aortic dissection

Pain control (Morphine)
IV beta blockers (want to decrease SBP and LV contractility to reduce aortic wall stress)
Nitroprusside only is SBP >120

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Management of threatened abortion

Expectant outpatient observation

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Management of serotonin syndrome

Discontinuation of serotenergic agents
Supportive (e.g. hydration)
Benzos for sedation

Clinical features of Wiskott Aldrich

WATER - Wiskott Aldrich, microThrombocytopenia, Eczema (especially truncal), Recurrent infections

Differentiate between manic and hypomanic episode

Mania
♣ Lasts at least 1 week unless hospitalized
♣ Symptoms are more severe
♣ Marked impairment in social or occupational functioning or hospitalization necessary
♣ May have psychotic features; makes episode manic by definition

Hypomania 
♣	Last at least >/=4 consecutive days
♣	Symptoms less severe
♣	Not severe enough to cause marked impairment in social or occupational function 
♣	No psychotic features

When do you deliver in Pre-eclampsia w/o severe features

> 37 weeks

When do you deliver in Pre-eclampsia with severe features

>34 weeks

Next step in management of a preterm mom with regular contractions but no cervical change

Check fetal fibronectin - If negative = expectant management - If positive = antenatal corticosteroids, tocolysis if <34 weeks, mag sulfate, GBS prophylaxis

At what gestational age is mag sulfate indicated for fetal CNS protection in preterm labor

<32 weeks

Describe lesion and lymph nodes in chancroid

- Painful, usually multiple and deep lesions | - Painful lymphadenitis

Describe lesion and lymph nodes in lymphogranuloma venereum

- Caused by chlamydia - Lesion is not painful with small and shallow ulcers - Painful lymphadenitis ("buboes")

What are good prognostic factors for schizophrenia

- Late onset - Clear precipitant - Positive psychotic symptoms only - Sudden onset

What are the time frames of the disorders on the spectrum on schizophrenia

- Brief psychotic disorder = >1 day and <1 month - Schizophreniform disorder = >1 month and <6 months - Schizophrenia = >6 months

Describe imaging of hepatic focal nodular hyperplasia

* Most common benign nonvascular livre lesion * Usually asymptomatic and discovered incidentally * Arterial flow and central scar on imaging

Cause of weight loss in a pt with COPD and no masses of XR

Pulmonary cachexia secondary to COPD | - Not likely due to cancer if normal XR

Which presents with "beaded" appearance on MRCP - PBC or PSC

PSC = even though it's opposite of what you would expect with the "bitches" analogy

What part of the bone does Ewing Sarcoma usually occur

Diaphysis

What part of the bone does osteosarcoma usually occur

Metaphysis - distal femur or proximal tibia

What will you see on funduscopic exam in diabetic retinopathy

Neovascularization

What will you see on funduscopic exam in hypertensive retinopathy

♣ Arteriovenous nicking ♣ Ateriolar narrowing ♣ Cotton wool sots

What might you see in a baby born to a diabetic mother

* Macrosomia * Stillbirth * Hypoglycemia * Polycythemia * Hyperbilirubinemia * Hypocalcemia * Respiratory distress

Whats the time frame of adjustment disorder

♣ Lasts < 6 months

Medications used to treat PTSD

- SSRI/SNRI | - Prazosin (alpha-1 antagonist) used for nightmares

Diagnostic requirements for acute liver failure

- Severe acute liver injury (ALT/AST often >1000) - Signs of hepatic encephalopathy - Synthetic liver dysfunction (INR > 1.5)

Causes of acute liver failure

* Viral hepatitis (e.g. HSV, CMV, hepatitis) * Drug toxicity (e.g. acetaminophen overdose, idiosyncratic) * Ischemia (e.g. shock liver, Budd-Chiari) * Autoimmune hepatitis * Wilson disease * Malignant infiltration

What is a common presentation of Hemphilia other than easy bleeding

Hemarthrosis - joint pain or swelling followed by little to no trauma due to spontaneous bleeding into a joint

What should you think when you see pneumobilia (air in the biliary duct)

Think of gallstone ileus - gallstone passing through biliary-enteric fistula in to the intestines

Tx of dystonia

Antimuscarinics (Benztropine or Diphenhydramine)

Tx of Akathisia

Beta blockers (Propranolol), Benzodiazepine (Lorazepam), Benztropine

Tx of tardive dyskinesia

Valbenazine (vesicular monamine transporter inhibitor)

Tx of drug-induced parkinsonsim

Benztropine, Amantadine

Tx of pseudotumor cerebri

1. Acetazolamide 2. Surgery (lumboperitoneal shunt or optic nerve sheath decompression) for refractory cases 3. Serial LP's to bridge while waiting for surgery

Tx of incompletely vaccinated child who is exposed to chicken pox

If immunocompetent - administer vaccine If immunocompromised - administer varicella immunoglobulin If pt was fully vaccinated (2 doses of vaccine) - then just observe