11 June Flashcards
What to look for when thinking MDD
Look for psychotic features, treatment is different as you need to add anti psychotics
What are the 2 primary complications of symptom onset of aortic dissection and how to differentiate between them
Aortic insufficiency and pericardial effusion, in pericardial effusion there is JVD symptoms and symptoms of right sided failure whereas aortic insufficiency there is predominantly pulmonary edema
Next step in single metastatic tumor at the gray white junction in the brain?
Surgical resection
Complicated pyelo in a pediatric patient next step
Abx and renal and bladder US
Varicella post exposure prophylaxis
Varicella vaccine if immunocompetent, if not varicella Ig
What blood lead levels warrant chelation therapy
> 44
NEXT step when suspected nephrolithiasis
Abdominal and pelvis US or NON CONTRAST spiral CT
Abnormal uterine bleeding in a 14 year old most probable cause
Hypothalamic pituitary axis immaturity, in the question the patient had heavy bleeding
Major toxicity of mycophenolate
bone Marrow suppression (myco for marrow, m for m)
Major toxicity of azathiopurine
Diarrhea, leukopenia and hepatotoxicity
Major toxicity of cyclosporine
Neurotoxicity, nephrotoxicity, hyperkalemia, bone marrow supression, gym hypertrophy, HTN, tremor, hirsutism
Major toxicity of tacrolimus
Same as cyclosporine except for hirsutism and gum hypertrophy
Ambiguous genitila in CAH
Only ambiguous in girls
Another name of supraventricular tachycardia and what is its tx in stable and unstable patients?
Narrow complex tachycardia, stable patients vagal maneuvers or adenosine, unstable pts -> synchronized cardioversion
Most common childhood leukemia and what is the presentation
ALL: lymphadenopathy, hepatosplenomegaly, fever, anemia, leukocytosis/leukopenia, bone pain, night sweats, chills, weight loss, thrombocytopenia leading to bruising
How to differentiate aplastic anemia from ALL
Aplastic anemia does not cause fever or pain
What disease do we see Auer rods in?
AML, presents more acutely than CML
Tests to confirm Hep C
Serology and PCR
Transposition of great vessels associated with?
DiGeorge
Tetralogy of Fallot associated with?
Down syndrome or DiGeorge
What is the name of the pulseless disease and what are its symptoms
Takayasu arteritis, differences in BP between both arms
Most important risk factor for abdominal aortic aneurysm expansion
Size more than 5.5 cm, rapid expansion and active smoking
Nephrotic syndrome puts the patient at risk for what
Thromboembolism and atherosclerosis
Untreated giardia infection complication?
Lactose intolerance
Tx for metastatsis of the cancer to the bone
Usually results in hypercalcemia for which the tx is bisphosphonates, for prostate cancer it is radiation
Whats the difference between Waldenstorm macroglobulinemia, MM and monoclonal gamoopathy of undetermined significance
Waldenstorm has a single Ig spike usually of IgM, MM has spikes of all Igs, monoclonal usually has a spike in only one other than IgM (like IgG or IgE etc) but it does not cause hyperviscosity syndrome and stuff like Waldenstorm causes
Symptoms of Waldenstorm macroglbulinemia
Hepatosplenomegaly, lymphadenopathy, hyper viscosity syndrome, neuropathy, bleeding, Roleoux formation
Ideal respiratory settings for intubation
- Low tidal volume ventilation - 6 ml/kg
- SpO2 more than 88%,
- FiO2 of less than 0.6
Most common complication of sickle cell trait
Hypothenuria and hematuria
Whats different about vascular dementia
It presents with sudden change in executive function and mild memory loss, like within an year
2 tests to check for CGD
Dihydrorhodamine test and nitroblue tetrazoleum test
2 tests to check for CGD
Dihydrorhodamine test and nitroblue tetrazoleum test
Most common cause of acute cervical lymphadenitis in children?
Staph aureus
What changes are seen in methemoglobulinemia
Cyanosis, oxidized iron binds to O2 more tightly, normal PaO2 since that is the O2 in plasma, the O2 bound to Hb is tightly held causing cyanosis, pulse oximetry shows reduced reading since the oxidised Fe3+ changes hemoglobin structure and the light absorbed by it.
PaCO2 actually decreases because patients hyperventialte in cyanosis
Difference between complicated pleural effusion and empyema
Both have pH less than 7.2, empyema has positive bacterial culture
Precoccious puberty evaluation in a pediatric patient
- Measure bone age
- If bone age is normal, then its premature therlarche or adrenarche
- If bone age is advanced measure LH
- If LH is low, do GnRH stimulation test to see if there is an increase in LH
- If LH increases with GnRH or is high by itself, then it is central precocious puberty - patient require an MRI although most of the cases are idiopathic and treated with GnRH analog to make them tall
- If LH remains low then it is peripherap precocious puberty and a more thorough medical eval is required
Most common cause of mastoiditis and the best next step when mastoiditis is suspected
Head MRI, Strep pneumo
Explain the cardinal features of serum sickness
Starts 1-2 weeks after medication exposure, fever, hives (maculopapular rash) and joint pain
Treatment of varicella zoster infection - whether its chicken pox or shingles
Valcyclovir
What causes increased BP in thyrotoxicosis
Increased HR and inotropy, I said increased vascular resistance
What is PSC associated with in term of antibody
pANCA
Beads on a string appearence
PSC
Muddy brown cast RBC cast WBC cast Fatty cast Broad and waxy cast Hyaline cast
Muddy - ATN RBC - Glomerulonephritis WBC - Interstitial nephritis or pyelo Fatty cast - nephrotic syndrome Broad and waxy cast - chronic renal failure Hyaline cast - normal
Urine Na and FENA when there is ATN
Urine Na > 20 and FENA is >2%
What is the buzzword for fibrocystic changes of breast on physical exam
Diffusely nodular breast, nodular breast etc
Myotonic dystrophy features
Unable to release hand after shaking, autosomal dominant, inverted V shaped cheeks, temporal wasting, cardiac conduction abnormalities and arrythmias, testicular atrophy, insulin
Increased DLCO
Asthma
How can you differentiate between SCID and CVID
Depending on what lab values they give you it can be hard to distingusih, just know SCID presents in infancy, like wayyy early than CVID
Management of CVID
IVIG
Tx of reactive arthritis
NSAIDs
Does asbestosis cause restrictive lung disease by itself?`
No, it is the collective pulmonary fibrosis due to multiple etiologies that can cause ILD, pleural calcifications on their own do not cause lung disease
Symptoms of scarlet fever and tx
Pharyngeal erythema with exudate, strawberry tongue, sandpaper rash, tender lymphadenopathy, penicillin
What is choanal atresia associated with
CHARGE syndrome
Next best step when lupus is suspected
ANA titers
Most common thrombophilias
Factor V Leiden deficiency and 2nd most common is prothrombin mutation
