3 Flashcards
acute painless monocular vision loss
central retinal artery occlusion, cherry red macula (preserved circulation via posterior ciliary arteries), retinal pallor
Renal failure that does not respond to fluids in cirrhotic
hepatorenal syndrome
midodrine, octreotide, albumin
BUN/Cr ratio >20-pre renal
serotonin syndrome
autonomic dysfunction, fever, GI, clonus, hyperreflexia, tremor, rigidity
disseminated gono
systemic symptoms, tenosynovitis, dermatitis, polyarthralgia
ceftriaxone and azithromycin
herpangina
coxsackie group A, painful vesicles on posterior oropharynx, tx: supportive care
group A pharyngitis would have cervical LAD and tonsillar exudates
Refractory carpal tunnel
Nerve conduction studies in prep for surgery
Chagas
LV apical aneurysm in absence of CAD
protozoa, trypanosome cruzi, complete heart block, ventricular tachy
lyme-AV conduction block
WPW arrhythmia
treatment
short PR, delta wave, wide QRS
tachy->syncope
catheter ablate
trastuzumab (chemotherapy for breast cancer, HER 2) cardiotox
reversible after discontinuation
anthracycline isn’t reversible
Lead poisoning
at risk with level <5: repeat level in a year
5-44: remove sources, repeat level within a month
>45: chelation with EDTA, succimer
Unstable angina, NSTEMI management
no trops vs trops
TIMI score: low risk-stress test, cath otherwise
cirrhosis thrombocytopenia due to
portal hypertension and splenic sequestration
Prostaglandin for baby hypoxia
PDA dependent conditions (transposition, hypoplastic left heart)
st johns wort depression
effective for mild to moderate, multiple drug interactions, do not use with SSRIs-serotonin syndrome
External cephalic version timing
37 weeks if still breech
Ischemic stroke in the setting of DVT
Diagnosis
Paradoxical emboli, from venous system to arterial system through intracardiac shunt
TEE or bubble study
multi-nutrient malabsorption in young adult
screening
skin findings
celiac disease, can present without GI symptoms
anti-endomysial, anti-tissue transglutaminase antibodies
vitiligo, dermatitis herpetiformis
patellofemoral pain syndrome
treatment
prepatellar bursitis
patellar tendonitis
reproduced on extension of knee with anterior pressure on patella, squatting, stairs
stretching and strengthening exercises
being on knees
inferior patella, jumping sports
Transfusion/volume expansion electrolyte abnormality
hypocalcemia- hyperactive DTRs
hypermagnesemia-hypoactive DTRs
tachypnea(respiratory alkalosis), tachycardia, fever, dizziness, GI symptoms, lactic acidosis
salicylate toxicity
deep dyspareunia, dysmenorrhea, chronic pelvic pain, dyschezia, rectovaginal nodularity, ovarian mass
endometriosis
NSAIDs and combined OCPs
Diabetic baby heart
transient HCOM - spontaneous resolution within a few weeks
hypoplastic left ventricle in second trimester ultrasound
pancreatitis severity assessment
obesity, age, hematocrit, BUN, CRP
hypocalcemia post parathyroidectomy
hungry bone syndrome, bilateral neuro symptoms
cremasteric reflex
L1-L2, can be affected by diabetic neuropathy
acute multiple sclerosis treatment
maintenance therapy
pregnancy
spasticity treatment
IV steroids, plasmapheresis if refractory
beta-interferon/ glatiramer
gets better, but increased c/s and assisted delivery
baclofen/ tinazidine
hemophilia A genetics
x linked recessive
nursemaid’s elbow
normal xray, manual reduction by flexion and supination
salicylate toxicity treatment
sodium bicarb, glucose, activated charcoal
aspirin at 12 weeks gestation
renal disease, DM, HTN, prior preeclampsia
postpartum eclampsia
Sheehan syndrome
htn, end-organ damage, edema, tx: magnesium, antihtn
post partum pituitary infarct
peripartum cardiomyopathy surveillance
serial echos
If LV dysfunction is persistent, advise against pregnancy
MEN 2A
MEN 2B
MEN 1
medullary thyroid cancer (get calcitonin, CEA, neck ultrasound, RET)
hyperparathyroid, pheo (rule out before thyroidectomy)
no hyperparathyroid
hyperparathyroid, enteropancreatic tumors, pituitary
HCOM medical management
Refractory
ICD if
beta blocker, verapamil, disopyramide
alcohol ablation
history of cardiac arrest or v tach
nuchal rigidity + AMS
treatment
diagnosis
viral meningoencephalitis
coxsackie, echo, herpes, arbo (west nile)
supportive care
CSF aseptic pleocytosis, viral serologies
nonallergic rhinitis
chronic nasal blockage, postnasal drip, rhinorrhea
tx: topical intranasal steroids, intranasal antihistamines
* eye symptoms-allergic rhinitis, same tx
urethral diverticulum
diagnosis
postvoid dribbling, dysuria, dyspareunia, anterior vaginal mass, recurrent UTIs
MRI or TVUS
Fat pad displacement on xray after fall on outstretched hand
supracondylar fracture
immobilize
Baby BMs
After the first month, okay to be 1-2 a week
keloid treatment (can have pain and itching)
intralesional steroids
Paresthesias in hands with dorsal sparing, worse at night, relieved by shaking hands
pain reproduced by
carpal tunnel syndrome
elevating hands above head, hyperflexion of wrist, tapping over median nerve
*dequervian tenosynovitis-sharp pain at base of thumb
benzo withdrawal
autonomic instability, tremors, delirium, psychosis
CCB edema
decreased when combined with ACEIs
precapillary dilation vs post capillary dilation
scleroderma renal crisis
activaton of RAAS->hypertension
treat with captopril, + nitroprusside if papilledema
Localized abdominal itching in pregnancy
treatment
intrahepatic cholestasis of pregnancy management
normal
oatmeal baths, UV light exposure, antihistamines
delivery at 37 weeks, urso, antihistamines
randomization removes
confounding
pancreatic mass biopsy
endoscopic aspiration
Type I DM medication regimen
basal-bolus regimen
scrombroid poisoning
pufferfish poisoning
improperly stored seafood
histamine->flushing, headache, palpitations, cramps, diarrhea, oral burning, tachy, hypotension
self-limited
neuro symptoms
Benzo falls
discontinue
Donor nephrectomy complications
pregnancy complications, complete childbearing before if necessary
hormone replacement increases risk of
stroke ,CAD, breast cancer, VTE , higher > 60
no increased mortality if <60
fibromyalgia, rule out
anemia (CBC), rheum (ESR, CRP), hypothyroid (TSH)
igg3 deficiency
recurrent sinopulmonary and GI infections
If GERD does not resolve with PPI
24 hour ph monitoring
neck stiffness not only in meningitis but also
subarachnoid hemorrhage
SBP prophylaxis
Advanced liver disease mortality
fluroquinolone
INR, creatinine, bilirubin, sodium
Mastoiditis
treatment
post auricular symptoms, complication of otitis media
IV antibiotics, drainage
multiple myeloma imaging
hyperviscosity syndrome
skeletal survey
CNS symptoms, mucosal bleeding, tx: plasmapheresis
Inoperable head and neck cancers
chemoradiotherapy
Dyspepsia (epigastric fullness, burning or early satiety)
GERD->PPI
>55->endoscopy
weight loss/vomiting/anemia->endoscopy
otherwise->h. pylori testing
Subarachnoid hemorrhage rule out
CT Head, then LP
Asthma testing
normal till methacholine challenge (reduced FEV1 and FEV1/FVC ratio
Acute stress disorder vs PTSD
Less than a month vs more than a month
thyroglossal duct cyst
branchial cleft cyst
midline, moves upward with tongue protrusion
remove because of high risk of infection
lateral neck, associated with sinus tract/fistula
pemphigoid gestationis
treatment
autoimmune, abdominal itching, then rash around umbilicus and trunk, urticarial papules and plaques->bullae, no mucous involvement
topical steroids
Depression with insomnia
no trazodone, it’s not a first line antidepressant and is only effective at sedating doses
tocolysis <32 weeks
32-34 weeks
indomethacin
nifedipine
PCP intoxication
nystagmus, lasts 8 hours
immediate benzos
tunneled dialysis catheter related bacteremia, remove if:
severe sepsis, hemodynamic instability, pus, symptomatic after 72 hours, endocarditis (evidence of met infection)
Marfans + intellectual disability+ VTE
homocystinuria
Mitigating lack of power due to small sample size
meta analysis
Stress testing assesses
risk of cardiovascular events, can’t catch nonobstructive CAD
male breast cancer risk factors
BRCA mutation, klinefelter
hepatic dysfunction, marijuana, obesity
shaken baby imaging
CT Head
Wernicke
korsakoff
ataxia, oculomotor dysfunction, encephalopathy
mammillary body atrophy-confabulation and amnesia
Cyanide toxicity due to nitroprusside
treatment
in setting of renal insufficiency, metabolic acidosis, AMS , seizures, flushing, cyanosis
sodium thiosulfate
small rough erythematous keratotic lesions in sun exposed areas
actinic keratosis
if numerous-5 FU cream
primary nocturnal enuresis
> 5, nighttime bedwetting
urinalysis, behavioral changes, desmopressin
pain and numbness in wrist and palmar surfaces of first three digits
carpal tunnel syndrome
scabies
treatment
itchy, contagious
topical permethrin, oval ivermectin
diaper dermatitis with beefy red plaques, satellite papules, involvement of genitucrural folds
candida
topical nystatin/ clotrimazole
pustules/ honey crusted drainage-bacterial superinfection-mupirocin
Stroke BPs
ischemic, received TPA-185/105
no TPA-<220/120
Hirschsprung
diagnosis
malrotation with volvulus diagnosis
don’t pass meconium, abdominal distension
rectal suction biopsy-no innervation
upper GI series
ectopia lentis
marfan’s
annual echo, beta blocker
berry aneurysm-ehlers danlos
B12 deficiency
treatment adverse effect
peripheral neuropathy AND spinal cord degeneration
hypokalemia
Normocytic anemia lab
Rec count
diverticular bleeding
painless hematochezia due to erosion of artery
blepharospasm
treatment
focal dystonia, involuntary eye closure
botox
vasovagal syncope
predrome and postdrome of nausea, pallor, warmth, diaphoresis
active preterm labor
IM betamethasone to prevent respiratory distress, necrotizing enterocolitis, intraventricular hemorrhage
low T3, normal T4, normal TSH
euthyroid sick syndrome, recheck when patient is healthy
sarcoid biopsy
most accessible spot-noncaseating granulomas
Meningitis prophylaxis for contacts
Close contact, direct contact with secretions
rifampin/Cipro/IM ceftriaxone
diaphragmatic paralysis in ALS (tongue fasciculations, muscle atrophy)
diagnosis
orthopnea, retraction of abdomen on inspiration,
sniff test
spinal stenosis treatment
diagnosis
conservative, epidural block, laminectomy
MRI
history of transfusion, difficulty finding cross-matched blood
alloantibodies
