3 Flashcards
Septic arthritis most common organism & Tx
S.aureus
Vancomycin
Osteomyelitis most common pathogen & Tx
S.aureus
1st or 2nd generation Cephalosporin
A child with osteomyelitis and a Hx of oral lesions and fever 2 wks prior to the event and also in other children at the daycare - pathogen
Kingella kingae (2nd MCC of osteomyelitis in children <4yrs, 2nd to S.aureus)
Pediatrics - a presentation of - arthritis preceded by -
Spiking fevers on a once daily basis for at least two weeks - accompanied by at least 2 of:
Non-fixed erythematous (salmon-colored) rash
Generalized lymph node enlargement
Hepatomegaly &/or splenomegaly
Serositis
Systemic juvenile idiopathic arthritis sJIA
HBV Post exposure prophylaxis for infants of infected mothers consists of:
Immediately administering passive and active HBV vaccines
Paediatrics- signs and symptoms of nephritic syndrome + Low C3 suggest
Post-strep glomerulonephritis - Tx: Fluid and Sodium Restriction (BP control) , diuretics & antihypertensives
In a neonate - cyanosis and a single S2 heart sound without murmurs
Transposition of the great arteries
PCOS in an adolescent or an adult not desiring fertility- Tx
Combined OCPs are 1st-line
PCOS in an adult desiring fertility- Tx
Metformin
PCOS - ovulation induction is with
Aromatase inhibitors; Letrozole and Anastrozole
Pathogens for impetigo
Bollous ________
Non-bollous ______
Staph.aureus -> Bullous impetigo
Strep.pyogenes (GAS) -> Non-bullous impetigo
A solid mass behind the knee that is more pronounced upon extension, with normal X-RAY findings
Popliteal cyst “Baker cyst” -> Reassurance/Observation
Infant with severe hypoglycemia without positive urinary ketones
Hyperinsulinemia
Infant - severe hypoglycemia after meals, positive urinary ketones & insulin deficiency
Adrenal insufficiency
Infant - hypoglycemia if missed meals, hepatomegaly, ketonuria & insulin deficiency
Glycogen storage disease
RSV - Bronchiolitis Tx
Supportive - supplemental oxygen as needed
Newborn presenting with severe indirect hyperbilirubinemia that’s refractory to phototherapy and requires phenobarbital
Crigler-Najjar syndrome type II
(As there’s NO response to phenobarbital in type I)
TTN - associated risk factors
Twin gestation
Maternal asthma
Late prematurity
Precipitous delivery
CS without labour
Gestational diabetes
8 Pediatric indications for growth hormone treatment to promote linear growth:
- GH deficiency
- Turner syndrome
- Chronic renal failure before transplantation
- Idiopathic short stature
- Small-for-gestational age short stature
- Prader-Willi syndrome
- SHOX gene abnormality
- Noonan syndrome
Neuroimaging is indicated in headache in children younger than
6 years old or any child who cannot adequately describe their headache
Etiology of most cases of nephrotic syndrome
Idiopathic
Skin ecchymoses, anemia, thrombocytopenia, hepatosplenomegaly and bone pain
Gaucher diseases (glucocerebroside accumulation) -> Tx is Enzyme replacement
Absolute contraindications for physical activity
Fever
Carditis
Elevation of liver enzymes in child treated with Acetaminophen ->
IV/PO N-acetylcysteine
Steeple sign
CrouP - Parainfluenza virus
Hepatoblastoma occurs predominantly in children under _____ y/o
And the median age of diagnosis is _____
3 years
1 year old
IBD - crypt abscesses
Ulcerative colitis
Meckel’s diverticulum is true/false diverticulum?
True - involves all layers
Biliopancreatic diversion is mainly
Malabsorptive
The only IV induction agent that Increases blood pressure & HR and Decrease bronchi motor tone
Ketamine
مليح بحالات التروما لما يكون الضغط منخفض
Anesthetic that causes hypotension
Propofol
After STEMI/NSTEMI - postpone elective surgery for ____ after balloon angioplasty
14 days
After STEMI/NSTEMI postpone elective non-cardiac surgery for _____ after placing a bare-metal stent.
And ______ after drug-eluting stents
30 days (BMS)
12 Months (DES)
In dirty wounds
Evidence of severe inflammation and pus in the wound which is open and suppurative
Treatment of choice for intestinal obstruction in pts with Crohn’s disease
Segmental resection of the involved segment with primary anastomosis
Medullary thyroid carcinoma, Pheochromocytoma, Parathyroid tumors
MEN2
Benzodiazepines before surgery
Contraindicated and MUST be discontinued before surgery
Origin of cremaster muscle fibers
The internal oblique muscle
Chance of rebleeding of a visible non-bleeding vessel on gastroscopy
High
The only case of intermediate bleeding risk of a vessel on gastroscopy is
Adherent clot
Lowest rebleeding risk in PUD on endoscopy
Ulcer with black spot
Clean, non-bleeding ulcer bed
With lithium use - there’s no need to monitor / follow-up
Liver function test
Most common eating disorder
Binge-eating disorder
Analgesics that decrease lithium clearance thereby causing lithium toxicity
Indomethacin, Phenylbutazone, Diclofenac, ketoprofen, Oxyphenbutazone, Ibuprofen, Piroxicam, and Naproxen
ECT indications
Major depression, catatonia, mania, schizophrenia and NMS
SDA (serotonin-dopamine antagonist) least like to cause extrapyramidal side effects
Quetiapine (Seroquel)
Self harm is present in psychogenic non-epileptic seizure/ Epileptic seizure?
Epileptic seizure
Psychotherapy treatment method that is NOT recommended in PTSD
Dialectic behaviour therapy DBT
SSRI with anticholinergic activity
Paroxetine
Pts treated with Clozapine who present with symptoms of chest pain, SOB, fever or tachypnea - should be evaluated for
Myocarditis
Most common SE of SSRIs
Sexual dysfunction
Paroxetine not in
Pregnancy
Measures that decrease the risk of having ovarian cancer
OCPs (effect persists even after d/c)
Tubal ligation
Breastfeeding
Progesterone
Solid ovarian mass that secretes LDH in an adolescent/young female
Dysgerminoma
Ovarian tumors that produce AFP
Teratomas
Ovarian tumors that produce inhibin, AMH and sometimes estrogen
Granulosa-cell tumor
hCG-producing ovarian tumor
Choriocarcinoma
Indications for adjunctive radiation therapy in Endometrial carcinoma
Extrauterine extension
Lower uterine segment or cervical involvement
Poor histologic differentiation
Papillary , serous or clear-cell histology
>1/3 full thickness myometrial invasion
Most accurate Dx method for infertility due to distal tubal obstruction
Hysterography
Pathological semen analysis
Repeat
Postmenopausal bleeding + US suggesting a uterine lesion ->
Surgical Hysteroscopy
In pregnant women with Myasthenia gravis
Assisted/instrumental second stage may be considered due to maternal fatigue
In myasthenia gravis - can acetylcholine receptor antibodies transfer placentally to the fetus?
Yes, so the fetus should be monitored at frequent intervals with kick counts and ultrasound
Progesterone levels are highest
During and shortly following ovulation
Alcoholic hepatitis with MDF <32 / MELD =<20 -> management
Moderate -> supportive; fluids and lab follow-up
Severe alcoholic hepatitis - MDF =/>32 / MELD >20 - management
Prednisone / Prednisolone
Infective endocarditis in IVDU
S.aureus - Tricuspid valve
CLL - secondary malignancies are
Skin, prostate and breast
Richter’s transformation
CLL -> an aggressive lymphoma, most commonly DLBCL
Anti-IL-6 receptor effective for Giant cell arteritis treatment
Tocilizumab
Pts with suspected APS (+lupus anticoagulant) who experience a thrombotic event - should be placed on
Warfarin (VitK antagonist)for life
Complements in IgA nephropathy
Normal
Pulmonary capillary wedge pressure in ARDS
Should be normal 4-12 mmHg
Factor Xa inhibitors
Rivaroxaban, Apixaban, Edoxaban (DOACs)
A DOAC that’s a thrombin-inhibitor
Dabigatran
Diabetes medications that pose increased Bladder cancer risk
Pioglitazone (thiazolidinediones)
Dapagliflozin (SGLT2-I)
Hyponatremia and ADH suppression
Psychogenic polydipsia
Management of toxic (functioning) thyroid adenoma - (increased uptake on thyroid scan)
Antithyroid treatment followed by radioactive iodine ablation
Amphotericin B Nephrotoxicity
Polyuria, Hypomagnesemia, Hypocalcemia and non-anion gap metabolic acidosis
Extra-intestinal manifestations that correlate with IBD activity
Erythema nodosum and Peripheral arthritis
Sustained VT after PCI for STEMI - Hemodynamically unstable pt
Immediate cardioversion
Keep Toxic shock syndrome in mind in case of acute severe infection picture esp in menstruating females - Tx
Clindamycin + Oxacillin/Nafcillin/Cefazolin
Exocrine pancreatic insufficiency, Cytopenias, Neutropenia, skeletal abnormalities
Shwachman-Diamond syndrome
Tx includes pancreatic enzyme replacement
Erysipelas - S.pyogenes Tx
Clindamycin, Cephalosporin, Penicillin
Restless leg syndrome - give ______ supplementation
Iron
Progressive myoclonic epilepsy, Mitochondrial myopathy, Cerebellar ataxia with dysarthria and nystagmus, Elevated serum lactate, Ragged red fibers on muscle biopsy
Dx: Myoclonic epilepsy affects and ragged red fibers syndrome (MERFF) - A mitochondrial DNA disease
Positive EBV VCA IgM & VCA IgG
Primary EBV infection
A positive EBNA indicates
Past EBV infection or recent primary infection (it is the last to develop)
Pediatric nephrotic syndrome - Minimal change disease - Indications for biopsy
Age 1yr or less
12 yrs or more
Gross hematuria
Renal insufficiency
Hypertension
Hypocomplementemia
Femoral vein is _______ to the femoral hernia
Lateral
The inferior mesenteric vein passes to the______ of the ligament of Treitz and drains into the splenic vein
Left
For colon cancers without metastasis->
Surgical resection is curative and sufficient and no neoadjuvant chemo or radiotherapy is needed
Compression of the third portion of the duodenum by the superior mesenteric artery - could be caused by
Rapid weight loss
“Superior mesenteric artery syndrome”; “Wilkie syndrome”
Surgery using _________ mesh, substantially reduces the risk of inguinal hernia recurrence
Non-absorbable
Tx of surgical/ICU SIADH (Hyponatremia in surgical/ICU pts) is
Water restriction
Bariatric surgery that carries the lowest mortality risk
Gastric banding (LAGB)
E-lyte abnormality that supports the diagnosis of hypovolemia in a surgical pt
High serum sodium (hypernatremia)
Earliest compensatory mechanism in hypovolemic shock
Increased sympathetic activity
Clozapine should not be combined with drugs that cause _______
Agranulocytosis
(Carbamazepine, Phenytoin, Prophylthiouracil, Sulfonamides & Captopril)
When encountering Schizophrenia suspected for an underlying medical condition
(Pt’s complaints are partially or non-responsive to appropriate Tx) ->
Electroencephalogram
In delirium tremens - hallucinations are mostly
Tactile
Treating schizophrenia in a pt with Parkinson - A drug that doesn’t cause EPS
A quiet drug ; Quetiapine
Management of mitral stenosis pts during labour
Vaginal delivery is indicated (CS for obstetric indications)
Fluid balance, O2, left lateral decubitus position
Antibiotic prophylaxis in gynaecology
Hysterectomy and urogynecology procedures (e.g colporrhaphy)
hysteroscopic polypectomy does NOT require AB prophylaxis
Ovulatory reserve evaluation
- FSH and Estradiol level in the early follicular phase (beginning of the cycle; day 2-4)
- AMH level; remains consistent through the cycles; reliable
- Antral follicles count in the early follicular phase
In hypernatremia, normal saline (0.9%) should NOT be used unless there is
Very severe hypernatremia (in which case, NS is more hypotonic than plasma) OR in cases of prominent hypotension and significant hypovolemia
Severe symptomatic Hyponatremia Tx
Hypertonic saline (3%)
Familial hypercholesterolemia, Cases of both statins and ezetimibe failure -> (drug)
PCSK-19 inhibitors
PCSK19 inhibitors MOA and route of administration
Decrease LDL Levels
Administered subcutaneously every 2-4 weeks
PCSK19 Inhibitors have been proven to reduce
Cardiovascular events in patients with coronary artery disease
Persistence of fever and empyema despite drainage suggest sequestration/adhesions of the empyema ->
Fibrinolysis (infuse fibrinolytic into drain)
Thoracoscopy to breakdown adhesions is also possible
In aortic valve infective endocarditis a _________ may indicate infectious spread to nearby tissues and abscess formation
Prolonged PR segment
Monoclonal gammopathy of undetermined significance criteria
M protein in serum < _____
BM clonal plasma cells < ____
No evidence of other B cell proliferative disorders
And no ______
M protein < 30g/L
Bone marrow clonal plasma cells <10%
No myeloma-defining events (hypercalcemia, impaired kidney function, anemia, etc)
UTI + Penicillin-allergy
Fluoroquinolones (Ciprofloxacin)
1st-line Tx of hypocalcemia
Calcium supplements
Severe Hyponatremia -> IV Ca gluconate
Mild asymptomatic-> PO Ca
Most important predictor of bleeding risk
History of bleeding
Infant with sleep apnea, nighttime hypercarbia with daytime normocarbia - suggests
Congenital central hypoventilation syndrome CCHS - Dx: Sleep lab
20% of pts with congenital central hypoventilation syndrome, also have ______
Hirschsprung disease (presentation is with nighttime hypercarbia and constipation)
Patients who undergo Fontan procedure for congenital heart defects are at risk for sick sinus syndrome - Tx is with
Beta-blockers and Pacemaker implantation
Hx of recurrent respiratory infection, normal blood counts, low Igs of all types, low CD19 & no response to immunisations - manifesting after 6-9mo of birth
X-linked agammaglobulinemia - absence of circulating B cells; small-absent tonsils and NO lymph nodes
Management of myocarditis caused by a viral disease (e.g EBV)
Supportive; IV fluids and beta blockers
Diabetic mothers
Infants ______
Neonatal ________
Hyperglycemia
Hypoglycemia
Optic nerve hypoplasia, midline facial abnormalities, pituitary hypoplasia (hypopituitarism- endocrine abnormalities e.g DI) & CNS abnormalities
Septo-optic dysplasia
Mildly Dysmorphic facial features, congenital heart disease , bleeding disorders, short stature & skeletal malformations
Noonan syndrome
Cerebral gigantism- children are >90 percentile for both height and weight at birth and may also have increased head circumference
Sotos syndrome
Diagnosis of Granulomatosis with Polyangiitis
LUNG biopsy
How do glucocorticoids impair wound healing
Glucocorticoids impair fibroblast proliferation and collagen synthesis
Most significant risk factors for morbidity and mortality in esophageal perforation
Hypotension and Cancer
Mild Hyponatremia (>121) after surgeries- SIADH is most likely- management
Free water restriction
Most common etiology of liver abscess
Infections from the biliary tree
The _______ is the most common location for perforation in closed-loop obstruction
Cecum
Carbamazepine side effects unrelated to dose
Pancreatitis, Hematologic, Steven-Johnson syndrome, Agranulocytosis, Hepatic failure and rash
Complex grief reactions can be treated with
Dynamic or Group psychotherapy
A uterotonic agent that is contraindicated in women with hypertensive disorders (pre-eclampsia) in case of postpartum haemorrhage
Methylergonovine
The risk of subsequent NTD after a pregnancy complicated by an NTD is
2-5%
Antiproteinase 3 ANCA autoantibody
Granulomatosis with polyangiitis
Peripartum cardiomyopathy risk factors
Increased maternal age
Increased parity
Multiple gestation
Malnutrition
Preeclampsia
Tocolytics in preterm labor
Pt with CF, deterioration, high serum eosinophils and IgE
Allergic broncho-pulmonary aspergillosis ABPA-TX: Antifungals
Neonate with hypokalemic, hypochloremic, metabolic alkalosis with hypercalciuria and salt wasting
Bartter syndrome
A depolarizing neuromuscular blocking agent that’s associated with hyperkalemia in pts with burns, paraplegia, quadriplegia and massive trauma
Succinylcholine
Case in which laparoscopic hernia repair is NOT superior to open repair
Pts with previous radical/extensive lower abdominal surgery (e.g radical retropubic prostatectomy)
Anal fissures that appear in the _______ part, suggest diseases such as Crohn’s, TB, Syphilis, HIV or Carcinoma
Lateral
The most important predictor of cardiac arrest outcome is
The duration between the collapse and the resuscitation, rhythm assessment and defibrillation
Specific reversal agent for Dabigatran
Idarucizuumab
Rivaroxaban reversal agent
Andexanet Alfa
Antiphospholipid syndrome + thrombotic event in a NON-pregnant woman - Tx
Life-long warfarin
Erysipelas - clear borders - S.pyogenes - Tx
Penicillin or Cefazolin
Acyclovir side effects
Acute renal failure
CNS symptoms (rarely)
Indications for Tx in Subclinical hypothyroidism (isolated TSH elevation)
TSH > 10, Pregnancy
Teardrop RBD (dacrocytes)
Myelofibrosis
Dx of AML is made when there’s _____ myeloid blasts, except in cases of genetic abnormalities, such as:
> 20%
Inversion(16), t(15;17), t(8;21), t(16;16) - diagnostic of AML regardless of blast count
Latent TB Tx
Rifampin 4 months, or
INH for 9 months
Langerhans cell Histiocytosis can cause :
Central diabetes insipidus, failure to thrive, even panhypopituitarism
And it usually involves the bones
Tuberous sclerosis + Infantile spasms Tx
Vigabatrin (Sabry)
Migraine prophylaxis
Amitriptyline
Anti-epileptics (Topiramate, Valproic acid and Levetiracetam)
Lymphangitis Tx
Cefalexin
Best timing to administer preop prophylactic antibiotics
An hour before the operation
(120 min for Vanco & Fluoroquinolones)
Vaginal vault prolapse surgery that causes gluteal and posterior leg pain
Sacrospinous ligament fixation (pudendal nerve injury)
Unique feature of appendicitis in pregnancy
Masking of leukocytosis
Danazol MOA
Acts on the hypothalamus to decrease secretion of LH and FSH
Protocol for magnesium sulfate administration for neuroprotection
At week 24-32, a bolus of 6g in 20-30mins and maintenance with 2g/hr for 12 hours
Fecundity
Live-birth achieved by performing unprotected intercourse during one menstrual cycle
In a case of IgE-mediated hypersensitivity to Penicillin- which antibiotic is least likely to cause a hypersensitivity reaction
Aztreonam
Mild hyperemesis gravidarum Tx
Pyridoxine 10-30mg up to 4 times a day
Pneumonia (CAP) in pregnant women Tx
Azithromycin or Azithromycin + Ceftriaxone
Most innervated area of the female genitalia
Mons pubis
Pap smear in HIV +ve women
Twice in the first year of diagnosis & then annually
Juvenile idiopathic arthritis JIA - Initial Tx in case of oligoarthritis (not systemic)
NSAIDs
DOACs are not approved for stroke prevention in ________ valve replacement pts
Mechanical
Child with dysentery (fever+bloody diarrhea) and neurological symptoms - Dx & Tx
Shigellosis
Ceftriaxone (Rocephine)
Ulcerative colitis treatment
5-ASA (mild-mod UC) -> Glucocorticoid (mod-severe) -> Azathioprine & 6-MP +/ Infliximab -> Cyclosporine
Infants/children with septic arthritis and not-bacteremic Tx is with
Cefazolin or Naficillin
Increased uptake in a solitary thyroid nodule indicates _______ Tx is:
Toxic thyroid adenoma
Ablation with radioactive iodine
In child with osteomyelitis ( no lab evidence of septic arthritis; normal CRP ESR) Tx is
Cefazolin or Cefuroxime
Amphotericin B Nephrotoxicity
Polyuria, hypomagnesemia, hypocalcemia and non-anion gap metabolic acidosis
For a stable pt with VT - management
IV Amiodarone or IV Procainamide
