2025 Daily read Step2 CK Flashcards
SvO2 is ↓ in all types of shock, except which?
distributive (septic [anphylax] + neurogenic)
Can give HPV vaccine to patients as young as which age?
age 9
Cervical cancer screening with pap test begins at which age?
age 21
What is the ML diagnosis in a patient post-gastrectomy with symptoms sounding like c.diff but also with symptoms like palpitations, sweating, or tachy?
Dumping syndrome has vasomotor sx (eg, palpitations, tachy), diarrhea. Seen post-gastrectomy, prolonged abx. Can seem like c.diff. Tx: Dietary mods.
What is the treatment for dumping syndrome?
Dietary mods
What is the treatment for specific phobia?
Exposure therapy
Which drugs improve mortality in heart failure with reduced ejection fraction?
- ACEi’s or ARBs
- B-blockers
- mineralocorticoid-R antagonists (*eplerenone, spironolactone)
- SGLUT-2 inhibitors
- Sacubitril- valsartan
- Hydralazine w isosorbide dinitrate in black patients
What intervention is most likely to improve cardiovascular and overall long-term mortality in patients with acute STEMI?
Prompt restoration of coronary blood flow (e.g., PCI, fibrinolysis)
- Percutaneous coronary intervention (PCI) = angioplasty + stent
- Early reperfusion also reduces likelihood of complications such as peri-infarction pericarditis
What is the recommended pharmacological therapy to reduce overall cardiovascular mortality in patients with peripheral arterial disease?
Anti-platelet agent (e.g., aspirin) and statin
- Recommended to prevent stroke and heart attack due to strong association between PAD and atherosclerosis
What are the skin findings in someone with PAD
Pale (no blood)
Hairless
Scaly, dry
Thin skin (no blood = no nutrients)
Ulcers = round and ‘punched-out’
In septic shock, all paramers are ↓ except for ___
CO
↓ breath sounds + dullness to percussion
Can be either pleural effusion, or hemothorax
Describe how late decelerations look in relation to a contraction
Late decelerations begin at the peak of a contraction.
The peak of the decel is at end of contraction.
(Note: late decels are d/t uteroplacental insuff and subseq fetal hypoxemia)
This is a fetal heart tracing showing what?
Late decelerations
Which type(s) of deceleration(s) may indicate fetal hypoxia and/or acidosis?
Late and recurrent variable decelerations
Which type of study is useful for calculating relative risk (RR)?
- CohoRt = Relative Risk
- Case contrOl = Odds ratio
What statistical test is used to compare 2 categorical values?
Chi-squared
What statistical test is used to compare 3 or more means (numerical) values?
ANOVA
Compared to:
- Checking differences between the means of 2 more groups = t-test
- Checking differences between two categorical groups = Chi-square (χ2 ) test
Hypercalcemia + ↓ PTH =
Malignancy - paraneoplastic syndrome PTHrP in SCC of the lung
Hypercalcemia + ↑ PTH =
Primary hyperparathyroidism
What is the FeNa+ in pre-renal azotemia?
FeNa+ < 1%
What is the FeNa+ in intra-renal azotemia?
FeNa+ >2%
What is a normal FEV1/FVC ratio?
FEV1/FVC > 70%
What is FEV1/FVC ratio in obstructive disease?
FEV1/FVC = ↓↓ / ↓ ➞ ratio ↓
If a patient is pulseless but we are getting a rhythm, what are the 3 potential diagnoses?
- PEA (has a nl rhythm!)
- Asystole (flatline)
- V-tach (can be pulseless or have pulse)
What is the treatment for:
VT + pulse + HDUS
Synchronized cardioversion
What is the treatment for:
VT + no pulse
UNsynchronized cardioversion (defibrillator)
What is the treatment for:
VT + pulse + HDS
Amiodarone (or sotolol or lodocaine or procainamide)
What is the treatment for:
SVT + HDS
Adenosine (or B-block or CCB)
AVNRT is a type of ___
SVT
What is a normal glucose level in CSF?
40-70
Low glucose level in CSF means ______
it could either be bacterial or TB meningitis
(viral has normal glucose level)
What is the CD4+ count in an HIV patient that would put them at risk for toxoplasmosis
CD4+ <100
What is the treatment for toxoplasmosis
Sulfadiazine + pyrimethamine
What do you give for prophylaxis against toxoplasmosis?
When do you give it?
TMP-SMX
Give if CD4+ count < 100
Tender erythematous streaks extending from wound + regional LAD =
Lymphangiitis
What is the treatment for HSV?
Acyclovir or valacyclovir
(not ganicyclovir - that’s CMV)
What are clinical features of genital herpes?
Group of painful ulcers/vesicles
Systemic sx (fever, malaise)
*Regional LAD
+/- Dysuria + sterile pyuria (can seem like UTI)
What is the treatment for CMV?
Ganicyclovir
(NOT acyclovir - that’s HSV)
Which pulmonary condition do you confuse with cardiac tamponade?
Exacerbation of COPD (can have JVD, muffled breath sounds, but non hypotension)
Tamponade has triad JVD + muffled heart sounds + hypotensionn
In which pediatric syndrome is subependymal nodules a characteristic feature?
Tuberous sclerosis
In which pediatric syndrome do you see hypopigmented macules?
Tuberous sclerosis
(ash-leaf spots)
In which pediatric syndrome do you see big red blotch on the face?
Sturge-Weber syndrome
(port wine stain)
Cardiac rhabdomyoma is a cardiac tumor associate with which pediatric condition?
Tuberous Sclerosis
In which pediatric syndrome do you see inguinal and axillary freckling?
Neurofibromatosis type 1
In which pediatric syndrome do you see Cafe-au-lait macules?
Neurofibromatosis type 1
In which pediatric syndrome do you see optic gliomas?
Neurofibromatosis type 1
What annual screenings do NF-1 patients need?
Annual ophthalmological screening exam + MRI brain / orbits for any new onset vision changes
In which pediatric syndrome do you see schwannomas
Neurofibromatosis type 2
↑ tactile fremitus + dullness to percussion =
Consilodation
How long does a patient need to have symptoms to be diagnosed with acute stress disorder?
If symptoms last longer than this, what is the diagnosis?
Symptoms for < 1 month after traumatic event
(If sx ≥1 mo it’s PTSD)
What is the treatment for transient synovitis?
Supportive, NSAIDs
How long does a patient need to have symptoms to be diagnosed with panic disorder?
Symptoms for ≥1 momnth
Kids aged 3-8 after viral illness. Poss fever (but low-grade, can be 100.1). Typ hip/thigh pain + limp +/- hip eff.
Diagnosis?
Transient synovitis
What is the likely diagnosis in a child that presents with hip pain and limp several days after a viral URI with normal physical exam, labs, and X-ray?
Transient synovitis (AKA toxic synovitis)
- Ultrasound reveals small unilateral or bilateral effusions (even when symptoms are confined to one hip)
What is the next best step in management of a patient with overlapping clinical features between transient synovitis and septic arthritis?
Bilateral ultrasound ± arthrocentesis
Most lung conditions have ↓/absent breath sounds, except which one?
Consolidation (has ↑ breath sounds)
Something is hypotonic is if _____ mOsm ; hypertonic is ______
< 275 mOsm. ; >295 mOsm
What is the treatment for empyema?
Chest tube (or video assist) AND abx
What is the pleural fluid like in a patient with empyema?
Thick, purulent, foul-smelling
What is lights criteria for exudative pleural effusions?
pl protein : ser protein > 0.5
pl LDH: ser LDH > 0.6
pl LDH > 133 (2/3 ULN)
Only has to meet 1 of the above criterias
What comes first in the ratio we calculate in lights criteria for pleural effusionn
always pleural fluid / serum
What is the ULN that LDH must be greater than in exudative pleural effusion
> 133
Which type of parapneumonic effusion is characterized by the following values:
pH < 7.2
Glucose < 60 mg/dl
WBC > 50,000/mm3
Gram stain/culture: negative
Complicated parapneumonic
- Bacteria eat the sugar (low glucose) and generate lactate (low pH)
- Ddx. with empyema which has a (+) pleural gram stain / culture
Which type of parapneumonic effusion is characterized by the following values:
pH < 7.2
Glucose < 60 mg/dl
WBC > 50,000/mm3
Gram stain/culture: positive
Empyema
- Ddx. with complicated parapneumonic effusion which has a (-) pleural gram stain / culture
Which type of parapneumonic effusion is characterized by the following values:
pH ≥ 7.2
Glucose ≥ 60 mg/dl
WBC ≤ 50,000/mm3
Gram stain/culture: negative
Uncomplicated parapneumonic
Which type of parapneumonic effusion, uncomplicated or complicated, is characterized by pH < 7.2?
Complicated
(bacterial generate lactate)
Complicated or uncomplicated parapneumonic pleural effusion has the following:
- Leukocyte counts > 50,000
- pH < 7.2
- Glucose < 60
Complicated
- Glucose is lower since the bacteria are eating the sugar
- Empyema = if (+) gram stain showing bacteria / pus
What are the potential paraneoplastic syndromes in lung squamous cell carcinoma?
Hypercalcemia (↑ PTHrP, stones bones groans)
Hypertroph pulmonary osteoarthropathy (diffuse jt pains)
What are the potential paraneoplastic syndromes in small cell lung cancer?
SIADH (hyponatremia)
Cushings (↑ ACTH)
LEMS
SIADH is a paraneoplastic syndrome in which type of lung cancer?
Small cell lung cancer
Hypercalcemia is a paraneoplastic syndrome in which type of lung cancer?
Squamous cell carcinoma of the lung
Hypercalcemia (↑ PTHrP, stones bones groans),
What is the treatment for exacerbation of COPD?
IV abx + steroids (systemmic, not ICS) + inhaled bronchodilators
What statistical test is used to check differences between the means (numerical) of TWO groups ?
(e.g., comparing the mean blood pressure between men and women)
t-test
Compared to:
- Checking differences between the means of ≥3 groups = ANOVA
- Checking differences between two categorical groups = Chi-square (χ2 ) test
What is ambulation?
the act/action of moving about or walking
Where is a, b, c, d in the biostats table
How do you distinguish between syringomyelia and anterior cord syndrome
Syringomyelina = Cape-like distrib (upper extremities, neck), loss of pain/temp, preserved DCML. Poss weakness.
Ant cord syndrome = also preserved DCML. Also urinary incont. Here it’s everything below lesion affected, wouldn’t just be arms.
What happens to acetylcholine with a drug that inhibits acetylcholinesterase
↑ acetylcholine
(***OPPOSITE of anti-cholinergic toxicity symptoms!!)
↑ Preload = ↑ or ↓ intensity of HOCM murmur?
Decreased intensity
(Increased preload [blood return] means less obstruction = softer HOCM murmur)
What are the parameters in septic shock?
everything ↓, except CO and svO2(↑)
What is the treatment for shingles?
Antiviral agents (eg, acyclovir, famciclovir, valacyclovir)
-Not steroids
Hypotonic hyponatremia + low urine osm (<100 mOsm/kg) is diagnostic for _____ ?
Primary polydipsiaa
What value is considered low for urine osm?
<300 mOsm
Describe the HOCM murmur.
How is this differentiated from the AS murmur?
HOCM murmur = SEM, crescendo-decrescendo @ LSB. No carotid radiation
(AS radiates carotids, heard in R-2nd ICS, also cresc-decresc)
When calcium level is >14
What is the most like etio of the hypercalcemia?
Malignancy
Is the SN hearing loss in congenital infections B/L or U/L or either?
Can be either
Girl with yellow-green cervical discharge, friable cervix. She was treated for UTI but is having refractory symptoms.
Dx?
Chlamydia/ gonorrhea
(acute cervicitis +/- urethritis [dysuria, sterile pyuria])
Note: If cervical motion tenderness present - means PID
Microcytic anemia ↓Hb + ↓ ferritin = ACD or iron deficiency anemia?
Iron deficiency anemia
(ACD has ↑ ferritin)
Which blistering skin disorder presents as groups of itchy rash with vesicles (or papules) & some crusted over on extensor surfaces (forearms, elbows, knees)
Dermatitis herpetiformis (Celiac’s)
Is hypersensitivity pneumonitis an obstructive or restrictive lung disease?
Restrictive
What are the 3 potential causes of hyponatremia in a euvolemic patient?
- SIADH
- Primary polydipsia
- Beer potomania (malnutrition)
What is the triad seen in congential rubella?
- Cataracts
- PDA
- SN hearing loss
↓ breath sounds L-lung base with dullness to percussion =
- Pleural eff
- Atelectasis (eg, mucus plugging)
- Hemothorax
What is a common complication of mature cystic teratoma (dermoid cyst)
Ovarian torsion
Ultrasound findings that can include: heterogeneous, solid components, thin echogenic bands/hyperechogenic nodules, partial calcifications
Describe which pathology?
Mature cystic teratoma (dermoid cyst)
(Thin echogenic bands [hair] /hyper-echogenic nodules, partial calcifications [teeth])
Treatment for acute (<48h sx) symptomatic hyponatremia.
What does the Na+ level need to be to receive treatment?
hypertonic 3% saline if Na <130 ?or is it <120?
Treatment for chronic (≥48h) symptomatic hyponatremia
What does the Na+ level need to be to receive treatment?
Hypertonic 3% saline is reserved for those with severe hyponatremia (Na <120) with severe sx (seizures)
because chronic has lower risk brain issues.
How do you manage a newborn to hepB(+) mom?
Give HepB immune globulin + hepB vaccine (within 12h of birth) to the neonate
If you suspect septic arthritis in a kid or overlapping symptoms with transient synovitis, what is the NBS?
B/L hip ultrasound
Hypopigmented elliptical macule on chest =
Ash-leaf spot in tuberous sclerosis
What are charcot bouchard aneurysms?
Tiny aneurysm bubbles on lenticulostriate A.s ➞ affect deep brain structure
What virus do a lot of transplant patients get?
CMV
Treatment for botulism?
Equine anti-toxin (even before diagnostic confirmation testing)
What are some causes of conductive hearing loss?
Otosclerosis, Cholesteatoma
Chronic otitis media Foreign body
Which drug should be given to all SAH patients in order to prevent the complication of cerebral vasospasm ?
CCB
(Cerebral vasospasm = delayed cerebral ischemia/stroke - FNDs)
Management for peritonsillar abscess?
needle aspiration
Trismus, muffled voice, deviated uvula, unilateral swelling =
Peritonsillar abscess
(Treatment is needle aspiration)
Presence of WBC casts on urinalysis means it’s always either one of two things =
AIN or pyelonephritis!
ADHD/autism symptoms, long face w large ears =
Fragile X
(Also macroorchidism if >8yo)
Adolescent initially presenting with a single salmon-colored plaque that develops into a generalized rash with multiple, oval, scaly papules and plaques in a characteristic “christmas-tree” pattern on the trunk
Pityriasis rosacea
single salmon-colored plaque = herald patch
____
- Adolescent/young adult
- Self-limited
- Image on the right is a herald patch
With derm condition has the dandruff association?
Seborrheic dermatitis
CHF symptoms + holosytolic murmur @ LSB =
Tricuspid regurg
Normal PT
11-15 seconds
Normal PTT
25 - 40 seconds
Polyarteritis nodosa
Renal insuff/↑Cr (100%)
GI - abdo pain
Mononeuritis multiplex (70%)
Spares the lungs
(-)ANCA
Transient synovitis treatment
Supportive, NSAIDs
When testing hearing loss, the tuning fork lateralizes to the left ear. Then AC > BC in both ears.
=
Right SN hearing loss
(Weber test localizes to the unaffected hear)
Toxoplasomsis treatment
sulfadiazine + pyrimethamine
(note: CD4+ < 100)
Toxoplasmosis prophylaxis
TMP-SMX when CD4<100
Tender erythem streaks extending from wound + regional LAD =
Lymphangitis
Hyperaldosteronism presents with the following findings:
(write hyper- or hypo-
______tension
______natremia
______kalemia
______ (metab/resp) ______ (acidosis/alkalosis)
Hypertension
Hypernatremia
Hypokalemia
Metabolic alkalosis
Resistant hypertension, hypokalemia and abdominal bruit is suggestive of
Renal artery stenosis
(Due to hyperaldosteronism: low renal perfusion → activation of the RAAS → induces aldosterone secretion → augments potassium excretion → hypokalemia)
Treatment of primary hyperaldosteronism (conn’s)
Aldosterone antagonists such as spironolactone or eplerenone
Urinary chloride in metabolic alkalosis:
Vomiting + nasogastric aspiration causes metabolic alkalosis with ↑ or ↓ urinary Cl?
Decreased urinary Cl- (<10)
(volume loss, saline responsive)
(vs Mineralocorticoid excess state will result in a high urine chloride [>20] and hypervolemia that thus will not be saline responsive)
The next step in the workup of metabolic alkalosis is
Check urine Cl-
_______________
-Saline responsive (urine chloride low [<10] because low vol): think about volume loss, activation of RAAS, causing Na+ in and H+/K+ out; Cl- is lost through gastric secretions
- Saline resistant: think about other random causes (urine chloride high [>20] because hypervolemia) (e.g., hyperaldosteronism, Cushing’s, genetic stuff)
What acid-base disorder may be caused by thiazide diuretics?
Metabolic alkalosis
(same with loops)
What acid-base disorder may be caused by loop diuretics?
Metabolic alkalosis
(same with thiazides)
What acid-base disturbance is classically found in patients with laxative abuse?
Metabolic alkalosis
In laxative abuse, osmotic losses of potassium → hypokalemia → cellular buffering → H+ moves into cell → alkalosis
(vs. the metabolic acidosis typically found with diarrhea)
What is the likely diagnosis in a patient taking HCTZ, levothyroxine, and OTC mineral supplements (for osteoporosis) that develops symptomatic hypercalcemia, metabolic alkalosis, and AKI?
Milk-alkali syndrome
(Hypercalcemia causes renal vasoconstriction with ↓ GFR and also causes diuresis due to impaired ADH activity, with hypovolemia and contraction alkalosis)
What is the likely diagnosis in a young female with hypokalemia, metabolic alkalosis, normotension, and low urine Cl-?
Surreptitious vomiting
- Lose HCl and KCl via stomach
(Low urine Cl- helps distinguish vomiting from other causes of hypokalemia, alkalosis, and normotension (e.g., diuretic abuse, Bartter syndrome, and Gitelman syndrome which all have high urinary chloride)
What is the likely diagnosis in a young patient with hypertension that develops severe hypokalemia after beginning a low-dose thiazide diuretic (eg, muscle weakness, leg cramps)?
PRIMARY hyperaldosteronism
(Volume depletion → ↑ aldosterone → more Na+ in, H+/K+ out)
_______ is the probability that when the test is negative, the disease is absent
NPV
(vs - Specificity is the probability that when the disease is absent, the test is negative)
______ is the probability that when the disease is absent, the test is negative
Specificity
(vs- NPV is the probability that when the test is negative, the disease is absent)
What is the recommended primary prophylaxis against MAC for HIV patients with CD4 count < 50 for:
- Patient on or starting cART?
- Patient NOT on cART?
Patient on or starting cART = None
Patient NOT on cART = Macrolide (azithromycin or clarithromycin)
HIV with CD4 < 50, high fever, and watery diarrhea is suggestive of
MAC
Is primary prophylaxis against CMV recommended for patients with HIV?
No
(it’s coccidiomycosis not cryptococcus)
Pneumocystis jirovecii prophylaxis in HIV patients should be started at CD4 counts < ______ with TMP-SMX.
CD4 < 200
What is the likely diagnosis in an HIV patient with a CD4+ count of 25 that presents with 3 weeks of fever, night sweats, abdominal pain, diarrhea, and weight loss? CXR, CMV serology, and PPD are all negative
Disseminated MAC
(TB and CMV are less likely given the normal CXR, induration, and negative CMV IgG)
Normal ABG ranges for:
1. pH
2. pCO2
3. pO2
- pH = 7.35 - 7.45
- pCO2 = 33 - 45
- pO2 = 75 - 105
Normal serum calcium range
8.4 - 10.2
How do the following labvalues change in primary hyperparathyroidism?
PTH:
Ca2+:
Phosphorus:
PTH: ↑ or inappropriately normal
Ca2+: ↑
Phosphorus: ↓
Normal serum phosphorus range
3.0 - 4.5
How do the following labvalues change in secondary hyperparathyroidism due to chronic kidney disease ?
PTH:
Ca2+:
Phosphorus:
PTH: ↑
Ca2+: ↓
Phosphorus: ↑
Hypercalcemia + elevated PTH + high urine Ca2+ =
Primary hyperparathyroidism
- High urine Ca2+ helps distinguish from familial hypocalciuric hypercalcemia
In primary hyperparathyroidism, is serum phosphate ↑ or ↓ ?
Decreased (hypophosphatemia)
- Due to ↑ PTH secretion (the primary defect)
- Can be normal in mild disease (↓ in moderate to severe)
What is the likely diagnosis in a patient presenting asymptomatically with mild hypercalcemia, hypocalciuria and normal / increased PTH levels?
Familial hypocalciuric hypercalcemia (FHH)
- Due to defective Ca2+-sensing receptor (CaSR)
- Higher than normal Ca2+ needed to suppress PTH
- Hypocalciuria = want to reabsorb more Ca2+ to suppress the PTH
- Low urine Ca2+ helps distinguish from primary hyperparathyroidism
↑ HbA2 and ↑ HbF = alpha or beta thalassemia?
Beta
(↑ HbA2 and ↑ HbF is result of having little/no HbA)
-HbH and Hb Barts = alpha thalassemia
Ventilator settings:
If ↓ PaCO2 and ↑ pH → should _____(↑/↓) the RR or TV?
decrease RR or TV
How do SVR and afterload change during cardiogenic and obstructive shock?
↑
How do the following pressures change with pulmonary embolism?
RA pressure:
Pulmonary A. pressure:
LAP:
RA pressure: increased
Pulmonary A. pressure: increased
LAP: decreased or normal
How does cardiac index change in septic shock?
Increased
-Important distinguishing feature from cardiogenic and hypovolemic shock;
How does cardiac output change during cardiogenic and obstructive shock?
severely ↓
How does cardiogenic shock affect the following?
CVP:
PCWP:
Cardiac index:
SVR:
SvO2:
CVP: increased
PCWP: increased
Cardiac index: decreased
SVR: increased
SvO2: decreased
In cardiac tamponade, cardiac output decreases due to ________ (↓ / ↑ ) left ventricular _________
↓ CO due to: ↓ LV preload
What is the likely diagnosis in a patient on post-MI day 5 that presents with sudden-onset cardiogenic shock and a harsh holosystolic murmur at the left sternal border with a palpable thrill?
Interventricular septal rupture
- Compare with papillary muscle rupture, leading to MR (no thrill, soft murmur)
- Left-to-right shunt may manifest as an ↑ in O2sat from the right atrium to the right ventricle; signs of left and right heart failure are present (e.g., pulmonary edema, JVD)
What is the likely diagnosis in a patient s/p lung biopsy who presents with severe SOB and chest pain with a ↓ cardiac output and ↑ PCWP?
Cardiogenic shock (2/2 MI)
- ↑ PCWP is indicative of cardiac etiology (helps rule out pulmonary etiologies, such as pneumothorax and PE since less blood is flowing to the LA)
- Backup of blood into the lungs causes pulmonary edema
- Peri-operative MI is common in patients undergoing noncardiac surgery; intra-operative hemorrhage requiring blood transfusion ↑ the risk
Electrical alternans
is specific but poorly sensitive finding for pericardial effusion w cardiac tamponade; it results from heart changing position within the fluid-filled pericardial sac w each heartbeat.
- Tx: emerg pericardiocentesis(to relieve pericardial pressure).
Young boy presents with advanced bone age, coarse pubic hair, and severe cystic acne with low basal LH levels and normal testicular exam.
Diagnosis?
Late-onset (nonclassic) congenital adrenal hyperplasia
-Due to 21-hydroxylase deficiency → shunting to adrenal androgen production → peripheral precocious puberty
Late decelerations
Early decelerations
_______ measures ability of a test to correctly identify those with the disease
Sensitivity
- answers how often a test misses a dz
- It measures ability of a test to correctly identify those w the dz. A test w high sensitivity has low likelihood of missing dz.
- NBME Q: Pt concerned about the accuracy of a test and if could have missed the ca. Basically questioning the failure rate in detecting her breast ca.
disting from:
PPV: measures the probability that a person with positive test actually has the disease. Doesn’t tell you how often thw disease is missed.
Treatment?
Amiodarone
- MC benign bone tumor
Mgmt for stone retained in CBD (ie, choledocholithiasis)
ERCP immediately
If signs of cholecystitis + pericholecystic fluid (edema in gallbladder wall) or wall thicken.
Next best step?
Antibiotics first
Then cholecystectomy within 72h (gives time for abx to kick in)
Ascending cholangitis management
Antibiotics first
Then ERCP (within 24-48h)
Why do you see no/minimal breast development in Turner’s?
Ovarian dysgenesis causes EST deficiency → no breast development
(girl will be like 15yo w tanner 1 breasts).
-gpt: no breast devel means the ovaries are not functioning
What are the only times we do ERCP?
- Choledocholithiasis (stone in CBD)
- Ascending cholangitis: After antibiotics
Give magnesium sulfate for preterm labor if < _____ weeks gestation
<32 weeks gestation
Distinguish between:
- Chronic hypertension
- Gestational hypertension
- Preeclampsia
≥20 weeks = gestational HTN or preeclampsia. (preeclampsia if proteinuria or end-organ signs
<20 weeks = chronic HTN
Management for preterm labor if <32 weeks gestation?
- Tocolytics (nifedipine, terbutaline) ➞ delay delivery
- Corticosteroids (betamethasone) ➞ fetal lung maturity
- Magnesium sulfate ➞ neuroprotection, ↓ risk cerebral palsy
- If unknown GBS status/ no prenatal care ➞ GBS prophylaxis
What is the recommended management for
pregnant patient 35 weeks gestation presenting with preterm labor + fetus in vertex presentation on ultrasound?
Expectant management
- Betamethasone ± penicillin may be administered
Low serum osm
+ low urine osm(<300 mOsm)
+ hyponatremia
Diagnosis =
Primary polydipsia (ie, psychogenic)
Low ser osm
+ ↓ urine osm(<300 mOsm)
+ nl or ↑ Na+
Diagnosis =
DI (ADH deficient/resistant)
What level is considered low urine osmolarity?
<300 mOsm
What level is considered high urine osmolarity?
What does that indicate?
> 600 mOsm
Indicates solute diuresis/ concentrated urine (if also ↑ glu, it’s d/t hyperglycemia)
- don’t confuse this w SIADH, both can be w head injury, and have ↓ Na+
↑ HbA2 and ↑ HbF =
B-thalassemia
- Will have little/no HbA
Post-MI complication that looks like another MI several months later
LV aneurysm
How do the following laboratory values change in a patient with hypovolemia?
ADH:
Renin:
Aldosterone:
ADH: ↑
Renin: ↑
Aldosterone: ↑
- ↑ ADH due to angiotensin II, hypovolemia and hypotension. [goal is to replete volume]
- ↑ Renin/aldosterone due to decreased renal perfusion → RAAS
Hyponatremia, low plasma osmolality (< 280) and low urine osmolality (< 250) is suggestive of which diagnosis?
Primary polydipsia
- Hypo-osmolarity (< 280 mM) → ↓↓ ADH → pee out H2O → dilute urine - everything is diluted
NNT formula
NNT = 1/ARR
ARR = c/(c + d) - a/(a + b)
