Week 2 Flashcards
(237 cards)
1
Q
Treatment of uncomplicated cdiff?/ what about fulminant? -
A
oral vanc or fidaxomicin, high dose oral vanc and iv metronidazole
2
Q
Most likely Septic arthritis bugs birth to 3 months (plus treatment)
A
Staph, GBS, gram neg bacillus - Naf or vanc PLUS gent or cefotaxime
3
Q
> 3 mo septic arthritis bugs and antibiotics
A
Staph, GAS, strep pneumo - Naf, clinda, cefazolin, or van
4
Q
How can HS purpura increase the risk of intussusception?
A
Formation of small bowel hematoma from autoimmune vasculitis
5
Q
4 T’s of anterior mass
A
Thymoma, teratoma, thyroid neoplasia, and terrible lymphoma
6
Q
Differentiate seminomatous and nonseminomatous germ cell tumor in med?
A
AFP is essentially always normal in seminomatous tumors, nonseminomatous germ cell generally have levated AFP and b-hcg
7
Q
Systolic murmur at apex that shortens with squatting in young healthy woman with chest pain?
A
Mitral valve prolapse
8
Q
Murmurs that worsen with valsalva strain? Why?
A
HCM - decreased preload causes noisier murmur
9
Q
The confusion murmur pattern of MVP?
A
Louder with decreased preload because murmur extends over longer period, softer with increased preload because murmur happens later/shorter in cycle
10
Q
Murmurs that worsen with squatting? Why?
A
Aortic regurg, mitral regurg, VSD - up venous return, afterload, and regurgitant fraction
11
Q
Murmurs that get worse with handgrip
A
AR, MR, VSD - up afterload, up blood pressure, up regurgitant fraction
12
Q
Murmurs that get better with squatting
A
HCM, MVP - presumed opposite of valsalva strain
13
Q
Murmurs that get better with handgrip?
A
HCM and AS
14
Q
Most dangerous component of hereditary angioedema? What levels are depressed?
A
Laryngospasm. C4 levels depressed due to C1 complex cleavage
15
Q
Examples of Type II (antibody mediated) hypersensitivity
A
Immune hemolytic anemia, Rh disase of newborn. IgG or IgM react with cell-bound antigens
16
Q
Examples of Type IV hypersensitivity
A
tuberculin skin test and allergic contact dermatitis
17
Q
IgE-mediated hypersensitivity examples
A
anaphylaxis caused by mast cell and basophil degranulation
18
Q
Example of Type III hypersensitivity
A
Antibody complex as in serum sickness - causes joint swelling, fever, and rash
19
Q
Cyclophosphamide side effects on bladder
A
Hemorrhagic cystitis and bladder cancer from metabolite
20
Q
Acute symmetrical arthralgias with mild synovitis involving the small joints of the hands and normal ESR
A
likely viral parvo B19 - related to anti-parvovirus IgM levels
21
Q
Guanfacine, clonidine mechanism of action?
A
Alpha 2 adrenergic receptor agonists
22
Q
Venlafaxine mech of action
A
SNRI
23
Q
Clomipramine mech of action
A
TCA
24
Q
Preferred drug of treatment for refractory tourette’s
A
Risperidone - first gen approved but second gen studied
25
Treatment of macroprolactinoma's/ symptomatic tumors?
Dopaminergic agonists (like cabergoline and bromocriptime) both can normalize prolalctin and potentially reduce tumor size
26
Normocytic anemia, thrombocytopenia, and acute renal injury following diarrheal illness (Cl/Path/Tr)
HUS - Ecoli O157H7), fluid and electrolyte management, blood transfusions, dialysis
27
Path of HUS:
Shiga toxin damages renal glomeruli, leading to platelt agregation, microthrombi formation, and microangiopathic hemolytic anemia
28
Dangerous polyp signs -
adenomatous, vilious, high grade dysplasia, large, and high number
29
Finding a sessile polyp and treatming, what next?
Careful follow-up as sessile polyps can indicate synchronous advanced neoplasia
30
Differentiate glucocorticoid myopathy and statin myopathy
Statin myopathy hurts and has elevated CK
31
How does high estrone levels produce infertility?
High estrone levels cause more frequent GnRH and preferentially produce LH resulting in imbalance in LH and FSH, resulting in FAILURE of folicular maturation and oocyte release
32
Nausea, vomiting, uterine fundal tenderness with PROM - suspect
Chorioamnionitis
33
Dx of chorioamnionitis
maternal fever plus either fetal tachy >160 for 10 minutes, maternal leukocytosis, maternal tachy, or purulent amniotic fluid
34
Standard Ob indications for C-section
nonreassuring fetal tracing, breech presentation, prior uterine surgeries
35
Treatment for uncomplicated chorio
broad spectrum antibiotics and expedited delivery
36
Clicking sensation when palpating space between 3rd and 4th toes in a runner -
Morton neuroma - mechanically induced neuropathic degeneration of the interdigitdal nerve
37
Phenytoin effect on fetus
Hydantoin syndrome - orofacial clefts, microcephaly, nail/digit hypoplasia, cardiac defects, dysmorphic faces
38
Age >65, monoarticular arthritis, chondrocalcinosis in knees or ankles
pseudogout
39
Constochondral joint hypertrophy in an infant - "rachitic rosary", large anterior fontanel, femoral and tibial bowing, and craniotabes
Ricketts- deficiency of vitamin D or calcium
40
Risk factors for Rickets
breast milk alone or homeamde baby food - need vitamin D supplementation
41
Rickets X-ray finding
genu varum, enlargement of costochondral joints, and metaphyseal cupping and fraying
42
Large anterior fontanel, lethargy, feeding difficulties, and macroglossia
congenital hypothyroidism
43
Frontal bossing, anterior bowing of shins, saddle nose deformity, and notched, gap teet
Hutchinson teeth
44
Lab findings of Ricketts
low/normal calcium, phosphorous, elevated alkaline phosphatase, elevated PTH, low Vit D
45
Secondary causes of psuedogout?
Hyperparathyroidism, hypothyroidism, hemochromatosis
46
Bronze diabetes?
Hemochromatosis
47
Most common cause of septic arthritis in a young, sexually active individual?
Migratory asymmetric polyarthralgias
48
Migratory asymmetric polyarthralgias
Differentiate gonococcal and non-gonococcal septic arthritis?
Nongonococcal is usually a single joint
49
Comorbidity with ankylosing spondylitis?
Anterior uveitis
50
Risk factors for compressive neuropathy?
Obesity, diabetes, hypothyroidism, and pregnancy
51
Muscle biopsy in polymyositis?
Mononuclear infiltrate surrounding necrotic regenerating muscle fibers
52
Chronic malabsorptive diarrhea, protein enteropathy, weight loss, and migratory non-deforming arthritis with lymphadenopahty,with small intestinal biopsy showing PAS-positive macrophages with non-acid fast gram-positive bacilli
Whipples - watch for CNS, myocardium, or eye
53
Workujp for developmental hip dysplasia -
hip ultrasound
54
Loss of abduction and internal rotation of the hip in a 12 year old boy?
SCFE
55
Catching during loaded rotation or etension of the knee
medial meniscus tear
56
Adverse effects of methotrexate:
Macrocytic anemia 0 inhibits dihydrofolate reductase - interfering with the cellular utilization of folic acid and causing folic acid depletion
57
Mechanism of action of succinylcholine
depolarizing neuromuscular blocker - causes influx of sodium ions and efflux of potassium ions
58
When to avoid succinylcholine
crush, burn, disuse muscle atrophy, and denervation injury - upreg of acetylcholine receptors and hyperkalemia at baseline - use nondepolarizing neuromuscular blockers instead
59
Side effect of halothane
hepatoxic intermediary compounds
60
Who to avoid using etomidate
elderly and critical illness patients, inhibits 11b-hydroxylase leaving to insufficient stress reaction
61
NO reaction with B12
inhibition, can lead to serious neurotoxicity if used in someone with preexisting vitamin deficiency
62
Propofol effect on blood pressure?
Severe hypotension, watch out in cardiac patients
63
Intense pruitus after hot bath, headaches, hepatosplenomegaly? Common comorbidity?
Polycythemia vera. Gout
64
Polycythemia vera. Gout
5-7
65
Groin and upper thigh pain with weight bearing and activity in an elderly gentleman?
OA
66
What is osteitis deformans?
Paget's disease
67
Why use bisphosphonates in RA?
Pain makes activity level low raising risk of osteoporosis
68
Examination findings of Ankylosing spondylitis
- Reduced chest expnasion
- Enthesitis
- Dactylitis
- Uveitis
- Arthritis
69
Complications of Ank Spon
- Osteoporosis/vertebral fractures
- Aortic regurg
- Cauda equina
70
What is polymyalgia rheumatica?
Pain and stiffness of neck, shoulder, and hip muscles in patient over 50
71
Fevers and symmetric polyarthralgia in young person which resolves over the course of weeks?
Parvo
72
Nephrotic syndrome with palpable kidneys, hepatomegaly, and ventricular hypertrophy in the setting of chronic inflammation is likely due to....
Secondary amyloidosis - aim to resolve the chronic disease
73
Supportive labs for Kawasaki's
ESR, CRP, thrombocytosis, and sterile pyuria
74
Treatment for Kawasaki
Aspirin plus IVIG
75
Echo for kawasaki
at time of diagnosis then 6-8 weeks later
76
Pain at the inferior pole of the patella with overuse?
Patellar tendonitis
77
Overuse knee injury with worsening pain with descending steps or hills?
Patellofemoral stress syndrome
78
Traction apophysitis of tibial tubercle?
Osgood- Schlatter
79
Innapropriate response to local skin trauma with underlying inflammatory disease?
Pyoderma gangrenosum
80
Diagnosis of adhesive capsulitis
decreased passive and active range of motion <50%
81
What can you use for chronicc paraspinal pain?
TCA's or duloxetine - avoid opioids
82
What can loop diuretics cause heart wise? What other medication side effects can it potentiate?
Loop diuretics can cause hypokalemia and hypomagnesemia leading to v tach, potentiates side effects of digoxin
83
First line therapy for torsades in conscious stable patients?
IV mag
84
Acute termination of paroxsysmal supraventricular tachy?
Adenosine
85
Torsades due to quinine?
Sodium bicarb
86
Macrolides, fluoroquinolones, antifungals effect on the heart?
Prolonged QT
87
How to confirm amyloidosis
Abdominal fat pad tissue biopsy
88
What is the strongest predictor of stent thrombosis?
Premature discontinuation of antiplatelet therapy
89
Unique drug to improve mortality in AA patients in Heart failure?
hydralazine and nitrates
90
Temp of 104 after collapse with CNS dysfunction? Can be accompanied by?
Exertional heat stroke, DIC or hepatic/renal fialure
91
Hypertension in an otherwise well woman of child bearing age?
Check for oral contraceptive use, can cause hypertension
92
What is the primary mechanism of action of nitrates?
Systemic vasodilation and decrease in cardiac preload - reduction in left ventricular wall stress - arteries are already vasodilated by phsiologic properties
93
How does niacin cause flushing and pruitius?
Prostaglandin-reated reaction through drug induced release of histamine and prostaglandins - can be improved by aspirin prophylactically before
94
165/75 regular blood pressure?
Isolated systolic hypertension due to reduced compliance of aorta
95
How does adenosine stress testing work?
Adenosine is a coronary vasodilator - preferentially dilates non-stenosed vessels
96
Management of Acute decompensated heart failure
IV furosemide and nitroglycerin if patient does not have hypotension
97
Symptoms of acute dig toxicity?
norexia, nausea, vomiting, pain, weakness, and confusion.
98
Symptoms of chronic dig toxicity
more pronounced neuro than gi, lethergy, fatigue, confusion and visual issues
99
What to do with digoxin when starting amiodarone?
Decrease by 25%-50%
100
Effect of green veggies on warfarin?
Lots of vit K, decrease effect
101
CYP p450 inhibitors -
all the common drugs - acetaminophen, NSAIDS, antibiotics/antifungals, omeprazole, SSRI's
Outliers - thyroid hormone, amiodarone, cimetidine
102
Diminished pulses in all lower extremity areas with claudication signs - sight of occlusion?
Aortoilliac occlusion (Leriche syndrome) at the bifurcation
103
Altered mental status, lactic acidosis, seizures, and coma in a patient who is being treated for volume overload HFrEF
Cyanide toxicity
104
splitting inccreasing with inspiration, high pitched noise after S1, and crescendo decrescendo systolic murmur over left second intercostal space in a 18 yo F
Pulmonic stenosis
105
Elevation and equalization of intracardiac diastolic pressures?
Cardiac tamponade
106
Triad of hypotension, elevated JVP, distant heart sounds?
Beck's triad, cardiac tamponade
107
Medication causes of SIADH?
Carbamazepine, SSRI's, NSAIDS
108
Non medication causes of SIADH
Lung disease, ectopic ADH from SC lung cancer
109
Lab findings of SIADH
hypotonic blood <275 mOsm/kg, hypertonic urine >100 mOSM/kg, Urine sodium >40
110
Who is at risk of INH induced peripheral neuropathy?
Pregnant, diabetes mellitus, comorbidity resulting in reduced stores of pyridoxine
111
Can PCP be cultured?
No
112
Placental abruption vs placental accreta
abruptions - placenta prematurely separates leadign to bleeding beedtween placenta and decidua - uterus distended, tender, vaginal pbleeding, fetal hypoxia
Accreta - placenta into myometrium, PPH
113
Keep eating in end stage colon cancer?
Megesterol acetate
114
Watery diarrhea with facial flushing, lethergy, muscle weaknesses/cramps and pancreatic mass (D/BT)? Check for?
VIPoma, VIP level (>75), hyperthyroidism as part of MEN syndrome
115
Sturge Weber chromosome, path, diagnosis, managment -
GNAQ, leptomeningeal capillary-venous malformation resulting in seizures, visual field defects, glaucoma delay, MRI of brain w/t contrast, laser therapy and IOP reduction
116
Iron levels in thalassemia?
Elevated
117
TIBC in anemia of chronic disease?
Decreased (trying to hide the iron
118
Confirmation of priamry schlerosing cholangitis?
ERCP or MRCP
119
What to do for medium to large sized non-bleeding esophagela varices
nonselective beta blockers - decreases portal flow through alpha mediated vasoconstriction- can do ligation as alternate
120
Tremors, agitation, anxiety, delirium, psychosis, seizures, tachy, palpitations
Alcohol or benzo's
121
Opiod withdrawal onset
within 6-12 hours, peak within 3 days
122
Causes of symmetric fetal growth restriction
Fetal growth anomalies and first trimerster infection
123
Assymettric fetal growth restriction cause
-Abdominal growth restriction more pronounced dthan head growth restriction due to fetal adaption to chronic insufficiency
124
Sjogran's syndrome diagnostic antibodies
anti-Ro, anti-La
125
Flank pain and hematuria after blunt trauma workup -
contrast enhanced CT then IV pyelography if surgery needed
126
Most common cause of spontaneous lobar hemmorhage in adults >60
Cerebral amyloid angiopathy - amyloid deposition leads to arterial weakness - related to Alxheimer disease
127
All children < 2yo with their first febrile UTI should undergo what test?
Renal and bladder ultrasound
128
Newborns < 1 month with UTI or children with recurrent UTI's or non ECOLI UTI what test?
Voiding cystourethrogram
129
Diffuse hypertonicity and difficulty feeding in unimmunized infant?
Neonatal tetanus
130
Treatment for neonatal tetanus?
Penicillin and tetanus IgG
131
Lambert Eaton spot of dysfunction
voltage gated calcium channels in presynaptic motor nerve terminal
132
LE associaton?
Small cell lung cancer in up to 50%
133
Sideroblastic anemia vitamin malfunction/deficiency
pyridoxine - B6 (INH can bind)
134
HCV during pregnancy increases risk for what?
Gestational diabetes, cholestasis, preterm delivery
135
Gradual onset of back pain, unilateral radiculopathy, saddle area numbness, hyporeflexia, marked assymetric lower-extremity weakness- what is compressed?
Cauda equina syndrom - spinal nerve roots
136
CES compared to conus medullarus syndrome
bladder distrubances happen earlier, motor weakness more symmetric and involves hyperreflexia (some upper lesion)
137
Succusion splash
pyloric stricture
138
What to do for ethylene glycol poisoning?
Fomepizole - prevents preakdown of ethylene glycol to toxic metabolites - may need hemodialysis
139
Flank pain, hematuria, oliguria, and severe AGMA
ethylene glycol intoxication- also calcium oxalate stones
140
Fever, chills, flank pain after transfusion (D/BT)
ABO incompatibility, Direct coombs test
141
Differentiate ABO incompatibility and IgA def transfusion -
gA deficiency has anaphylaxis at seconds to minutes with andioedema, hypotension, and difficulty breathing, not fever, flank pain, chills within hours
142
Define intrauterine fetal demise
death of fetus at >20 weeks
143
What is the second stage of labor?
Starts when cervix is fully dilated (10 cm), ends with delivery
144
How long wihthout progress before second stage of labor considered arrested?
>3 hours nulliparous, >2 hours multiparous
145
Solitary periventricular weakly ring enhancing mass with EBV DNA in the CSf
CNS lymphoma
146
Niemann-Pick vs Tay-Sachs differentiators
NP has hepatosplenomegaly and areflexia, Tay-Sachs has no hepatosplenomegaly and hyperreflexia
147
Progressive loss of motor milestones at 2-6 months iwht hepatosplenomegaly and one other finding
NPD, cherry red macula, missing sphingomyelinase
148
Developmental regression, hypotonia, and areflexia with no cherry red spot
Krabbe - "the galactic crab stole the cherry - galactocerebrosidase deficiency
149
Anemia, thrombocytopenia, and hepatosplenomegaly due to biochem?
Gaucher disease - glucocerebrosidase defieincy
150
6 mo to 2 yo with coarse features, hernias, corneal clouding, and hepatosplenomegaly?
hurler syndrome, lysosomal hydrolase deficiency
151
Prodrome of cough, coryza, and conjunctivitis followed by maculopapular rash?
Measles
152
Changed vaccination for planned international travel for measles?
Additional dose at 6-11 months before the doses at age 1 and 4
153
Loss of movement of upper extremities after MVA with history of degenerative changes in cervical spine
Central cord syndrome - happens with hyperextension in elderly patients, selectively damages the central portion of anterior spinal cord, such as the central corticospinal tracts and decussating lateral spinothalamic tract
154
Medication that can cause Idiopathic Intracranial hypertension?
Growth hormone, tetracyclines, and excess vitamin A (or isoretinoin)
155
Infant or newborn with failure to thrive, bomiting, convulsion bilateral cataracts, jaundice, and hypoglycemia (D/P/increased risk)
Galactosemia - galactose-1-phosphate Uridyl transferase deficiency. Increased risk for E.Coli neonatal sepsis
156
"Galactokindase"
galactokinase deficiency only results in cataracts, not terrible other consequences
157
HIV prophylaxis for contact:
28 days of 3 drug regimen, two NRTI's and a protease inhibitor, integrase inhibitor or NNRTI
158
Preventative meds for migraines?
Topiramate, divalproex sodium, tricyclic antidepressants, B-blockers
159
Yellow-green frothy discharge with pruitus and pear shaped motile organisms on wet mount (D/Tr)?
Trich, Oral metronidazole for patient and partner
160
What to avoid while taking metronidazole?
Alcohol consumption - disulfiram like reaction
161
Lab findings of BV
Elevated pH > 4.5, Clue cells, positive whiff test (amine odor with KOH)
162
Management of MG crisis?
Intubate, hold pyridostigmine to reduce risk of aspiration, and plasmapheresis and steroids
163
What is the huge danger of status epilepticus?
Cortical laminar necrosis due to excitatory toxicity
164
Gait dysfunction and headaches with nausea worse in the mornings and focal weakness? Difference between this and neuroglycopenia?
Intracranial tumor. Neuroglycopenia will only last minutes to hours
165
Deep cat bite treatment prophylactiaccly?
Amox/clavulanate for P. multocida
166
when is observation and close follow-up appropriate for a dog/human bite?
superficial wounds not on hands, feet, or genitalia
167
Causes of acute cervical adenitis in kids
1. Unilateral, very tender and red
2. Unilateral, dental and gum disease
3. Unilateral, papular nodular with cat bite
4. Unilateral, nontender, gradual
5. Bilateral with pharyngoconjunctivits
6. Bilateral with signs of mononucleosis
1. Staph aureus/pyogenes
2. Anaerobic bacteria/prevotella
3. Bartonella henselae
4. Mycobacterium avium
5. Adenovirus
6. CMV/EBV
168
Empiric antibiotic for uncomplicated unilateral lymphadenitis?
Clindamycin
169
GBS Upper or lower? Sensory involvement?
LOWER motor neuron signs, sensory involvement very rare
170
Prophylaxis for toxo?
Bactrim
171
Mechanism of pressure increase in normal pressure hydrocephalus -
decreased CSF reabsorption
172
How soon do thrombolytics need to be administered after stroke?
3-4.5 hours
173
Exclusion criteria for thrombolytics
1. Hemorrhage >33%
2. Stroke/head trauma in last 3 months
3. Any hx of intracranial hemmorhage, neoplasm, vascular malformation
4. Recent neurosurgery
5. Reent bleeding issues
6. BP >185/110
7. Low platelets or glucose
8. INR>1.7
174
Renal effect of infectious endocarditis
immune complex mediated glomerulonephritis
175
Risk factors for brain abscess in a child
Right to left shunts (bypass pulmonary circulation) and recurrent sinusitis
176
Fever, severe headache, focal neuro changes
triad of brain abscess
177
Arthralgias and malaise with erythema nodosum, common cause, other causes? Best initial test?
Common cause - benign hypersensitivity reaction to antigens, self resolution in weeks. Other causes to work up, strep, sarcoid, TB, histo, IBD, and Behcet's. Anti strep O, TB skin testing, CBC and BMP,and a chest x-ray looking for sarcoidosis (as high as 28% comorbidity)
178
Intensely pruitic clusters of papules and vesicles on elbows, knees, back, or buttocks? Management?
Dermatitis herpetiformis, dapsone and gluten free diet (usually associated with celiac disease)
179
what causes pemphigoid vulgaris?
Antibodies against desmogleins 1 and 3
180
Why doesn't the entire epidermis detatch in pemphigoid vulgaris
does not target hemidesmosomes connecting bottom row of cells to basement membrane
181
How to differentiate between acute cholecystitis and common bile duct obstruction?
Alk phos, some mild elevation in bilirubin and liver transaminases as gallbladder sludge passes into common bile duct
182
What is elevated in the "window period" 2-4 months after Hep B infection during the symptomatic period? What are the "frames" of the window?
The window period is the time between the disappearance of HBsAg and appearance of anti-HBs, IgM anti-HBc is elevated during the window. Therfore, during initial infection, check for HBsAg (initial infection) or IgM anti-HBc (are we in the window
183
Pain, jaundice, and palpable mass in a kid <10 (D/BT)
Biliary cyst, ultrasonography and surgical resection ( can use ERCP instead)
184
Antiarryhtmic for afib in WPW?
Procainamide - no rate control!
185
Maculopapular rash with cephalocaudal spread and postauricular and suboccipital adenopathy after prodrome of low fever, lymphadenopathy, and malaise
Rubella
186
Rubella extra symptom in adolescents, particularly females?
Polyarthralgia
187
Looks like strep throat then somebody gives amoxicillin and now they have a polymorphous maculopapular rash?
EBV - key look - hepatosplenomegaly
188
Celiac sprue with bone pain and elevated PTH?
Osteomalacia - severe vit D deficiency
189
Effect of osteomalacia on bones?
Impaired osteoid matrix mineralization
190
When to use ultrasound and when to use CT in evaluation of pancreatic adenocarcinoma?
US in the head of the pancreas if evidence of obstructive jaundice, CT scan if no obstructive jaundice
191
Causes of HIV related diarrhea:
1. <180 / mm3, severe watery diarrhea and low grade fever?
2. <100/mm3, watery diarrhea w/o fever
3. <50 - HIGH fever and watery diarrhea
4. <50 - Frequent small volume diarrhea with hematochezia and abdominal pain
1. Cryptosporidium
2. Microsporidium
3. Mycobacterium avium
4. CMV
192
Best test for cryptosporidium?
Modified acid fast stain
193
What to remember treating a 7 yo Lyme Disease patient
HE'S LESS THAN 8, DON'T USE DOXY, use oral amoxacillin
194
Localized impetigo treatment. What if extensive or bullous?
Topical mupirocen. Then use oral antibiotics
195
Vulvovaginitis in prepubertal girls with perianal scratching (D/Tr) -
pinworms (helminth) treat with albendazole or pyrantal pamoate as well as the household
196
Acute hypertensive crisis in setting of CKD recently starting EPO?
Erythropoietin related hypertension, up to 30% of patients develop within 2-8 weeks of treatment
197
How does epidural cause hypotension even without going into a vein?
Sympathetic nerve fibers responsible for vascular tone are blocked -> vasodilation -> decreased venous return to right side of heart -> decreased cardiac output - prevented by aggressive IV expansion and repositioning patient
198
How to diagnose CO poisonin?
ABG plus cooximetry
199
What abnormal sound can be heard in most patients during an acute coronary syndrome?
Abnormal S4 gallop due to ischemia induced myocardial dysfunction
200
S3 sounds normal findings and abnormal meanings?
Rapid filling of ventricles, normal in children, young adults, and pregnancy, abnormal in >40, heart failure, restrictive cardiomyopathy, and high output states
201
What if a FAST test is limited or equivocal?
Diagnostic periotoneal lavage
202
When does ASD become PTSD?
1 month
203
Intermittent foot trop with numbness/tingling over dorsal foot and lateral shin, impaired ankle dorsiflexion (walking on heels) and preserved plantar flexion?
Common fibular neuropathy
204
Anticonvulsant/mood stabilizer med that can cause hepatotoxicity? Other effects?
Valproate - usually within first 6 months of treatment. Tremor, thrombocytopenia, and alopecia
205
Buproprion risk?
Seizures
206
Clozapine risk?
Severe neutropenia
207
Seems like an absence seizure but lasts 2-3 minutes?
Focal seizures, absence only 10-20 s
208
Tamoxifen effect on bone -
estrogen like, only antiestrogen at the breast
209
Tamoxifen effect on uterus
estrogen agonists, increases risk of polyps, hyperplasia, cancer
210
7 yo with 3 episodes vomitting in 6 month period with stereotypical timing lasting 1-10 days with >=4 times/hr at peak and no symptoms between vomitting episodes with family hx of migraines (D/Tr)
Cyclical vomitting syndrome, antiemetics and sumatriptan if migraine hx
211
Colonic polyps and osteomas in family? Colorectal cancer risk? Follow-up?
Familial adenomatous polyposis, almost universally develop colorectal cancer. Annual colonoscopies with proctocolectomy once high-grade dysplasia is reached
212
CAP for >1 week+arthralgias+erythema nodosum?
Coccidioides - desert southwest - treat with fluconazole only if immunocompromised
213
Early decrescendo murmur best heard with diahragm of stethoscope at upper sternal border especially when holding a full breath with expiration
Aortic regurgitation
214
Treatment of thrush in HIV?
Oral fluconazole
215
Focal substernal pain with large liniear ulcerations in distal esophagous and presence of intranuclear intracytoplasmic inclusions?
CMV esophagitis
216
Primary HIV prophylaxis ladder:
< 200 - PCP - Bactrim
<100 - Toxo - Bactrim
<50 - MAC - Azithro
Endemic histo and <150 - Itraconazole
217
Normal discharge after delivery
1-3 days - lochia rubra - red vaginal discharge from the shedding of the uterine decidua and blood
3-4 days - lochia serosa - thin, pink/brown
2-3 weeks - lochia alba, white or yellow
218
Sudden vasomotor collapse on symptoms of meningococcemia -
Waterhouse-Friederichsen due to adrenal hemmorhage (10-20% of infants)
219
Large fiber injuries symptom type?
negative symptoms - numbness, loss of proprioception and vibration
220
Fungal infections affecting upper lobes of lungs and how to differentiate?
Aspergillus - acid fast hyphae, Norcardia - weakly acid fast filamentous rods
221
Workup for suspected VAP?
First X-ray, then if positive gram stain and culture or respiratory secretions, start empiric antibiotics while waiting for return
222
Photosensitivity with concomittant hep C?
Porphyria cutanea tardis - deficiency of uroporphyrinogen decarboxylase
223
Thrombocytopenia, hemolytic anemia, essential with maybe renal insufficiency, neuro changes, and fever?
Thrombotic thrombocytopenic purpura
224
Pathophys of TTP
decreased ADAMSTS13 level either due to autoantibody or hereditary sources
225
Treatment of TTP?
Plasma exchange, glucocorticoids, rituximab
226
Difference between TTP and HUS:
HUS related to Ecoli and primarily renal, TTP related to aDAMS and has neuro findings and fever
227
Diffuse telangiectasias, recurrent epistaxis, and widespread AV malformations?
Hereditary telangiectasia (Osler-Weber-Rendu)
228
when to use casting or internal fixation for stress fracture?
Only for the fifth metatarsal, 2,3,4 act as a self-splint
229
Causes of hyperglycemic hyperosmolar syndrome
Infection, (glucocorticoids, thiazides, pentamidine, atypical antipsychotics), interruption of insulin therapy, trauma or acute illness
230
lytic bone lesion, rash, signs of diabetes insipidus (D/P/Tr) -
Langerhans cell histiocytosis, proliferation of macrophages that can lead to lytic bone lesions, skin lesions, lymph node lesions, lungs (cough/pulm nodules), and CNS (central diabetes insipidus). Treat with chemo or curretage
231
Where are Langerhans cell histiocytosis typically found?
Skull
232
Cuttoff for normal MoCA score
<26/30
233
What causes jejunal or ileal atresia?
vascular access in utero
234
Impaired tandem walking but intact finger-nose testing?
Alcohol neurotoxicity
235
What is damaged in alcoholic cerebellaropathy?
Purkinje cells - selective for truncal dycoordination
236
Fever >24 hours postpartum, purulent lochia, and uterine tenderness (D/P/Tr)
Postpartum endometritis, polymicrobial infection of uterine cavity - treat with clindamycin + gent until patient is afebrile for 24 hours
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treatment of PPROM
expectant management until 34 weeks with steroids
