4 Flashcards
Alopecia areata
Tinea capitis
well-demarcated, non-scarred, round patches of hair loss, exclamation point hairs, history of autoimmune conditions, nail pitting
erythema, scaling, black dot alopecia, LAD
Early pubic hair growth + acne with no testicular enlargement
only pubic hair with normal bone age
congenital adrenal hyperplasia, dx: ACTH stimulation test, elevated 17-hydroxyprogesterone, tx: hydrocortisone
idiopathic premature pubarche
painful oral ulcers+ rash on palms/soles/buttocks, nonitchy
HSV6
hand-foot-mouth disease, coxsackie virus, supportive care
roseola, rash after high fever
Chronic adrenal insufficiency electrolytes
hyponatremia, hyperkalemia, hyperchloremic metabolic acidosis
decreased hair, myalgia
chronic pancreatitis pain meds
TCAs, NSAIDs, pregabalin, conservative measures first
Pyelo in child
antibiotics before imaging
Pyelo in child
antibiotics before imaging
Antidepressant trial
6 weeks before adjusting
Loss of antidepressant response
substance use
post exposure HIV prophylaxis
triple therapy within 72 hours for 4 weeks
webbed neck, congenital lymphedema, high arched palate
Turner (random error (nondisjunction) resulting in one X, no increased risk of recurrence)
evaluate for coarctation, horseshoe kidney, celiac, hypothyroidism
premalignant complication of GERD
Barrett’s esophagus
PMS, increased risk for
mood and anxiety disorders
Acute heart failure that doesn’t respond to diuretics
vasodilator (nitroglycerin)
- give before diuretics in flash pulm edema due to hypertension*
- no digoxin in acute heart failure*
pelvic organ prolapse
bleeding due to erosions, treat erosions with estrogen
pruritic excoriated lichenified plaques
allergic contact dermatitis
exercise induced amenorrhea complications
osteoporosis, breast and vaginal atrophy, mild hypercholesteremia, infertility
febrile illness+ rash+ mucocutaneous ulcer+ leukopenia + thrombocytopenia
acute HIV
eisenmenger (unrepaired VSD->pulm htn->R to L shunt) pregnancy
abort
*also LVEF<40%, Class III-IV heart failure, aortic dilation>40 mm
if distribution tail is on the right side
if symmetric
median < mean and vice versa
median=mean=mode
stuck on lesions
seborrheic keratosis-do not treat unless symptomatic
itchy ones associated with GI/lung malignancies
iron deficiency in babies
cow’s milk, limit milk, rec count will rise before H/H
iron deficiency in babies
cow’s milk, limit milk, rec count will rise before H/H
Antiepileptics can reduce efficacy of OCPs
not gabapentin/ valproate
IUD/ implant preferred
vertigo, hearing loss, tinnitus
Meniere’s disease
Parinaud’s syndrome (no pupillary reaction, vertical gaze paralysis, no optokinetic nystagmus, ataxia)
pineal tumor (some secrete hcg)
valproic acid pregnancy
neural tube defects
Mini-mental state exam will not distinguish
late life depression linked to increased risk of
pseudodementia from dementia
Alzheimer, vascular dementia
when informing about involuntary hospitalization
acknowledge feelings, treatment in a safe environment
constructional (can’t draw) and dressing apraxia
aphasia
acalculia, finger agnosia, agraphia
nondominant parietal lobe
dominant temporal lobe
dominant parietal lobe (gerstmann syndrome)
Kawasaki
scarlet fever (strep)
febrile >5 days + 4/5: rash, LAD, mucosal changes, conjunctivitis, extremity erythema/edema
if not all criteria met-obtain CRP/ESR, reexamine
tx: IVIG (no live vaccines for a year), aspirin, echo at presentation and 2 and 6 wks
circumoral pallor, sandpaper rash, strawberry tongue
better test in study->higher power
better at establishing difference
honey colored crust
impetigo
tx: topical mupirocin, cephalexin
polymyalgia rheumatica
pain and stiffness in shouders, pelvic girdle
dx: ESR, tx: low dose prednisone
isolated elevated anti-Hbc
repeat serologies, measure IgM anti-Hbc and LFTs to determine acuity
Transfusion related acute lung injury long term
neurocognitive deficits, impaired muscle strength and lung function, psychiatric illness
Pericarditis EKG
pericarditis vs dressler syndrome
persistent ST elevation and q waves in same leads weeks post MI
post MI pericarditis treatment
Diffuse PR depression, ST elevation
days post Mi vs weeks
ventricular aneurysm
high dose aspirin, colchicine, narcotics
TSH secreting pituitary adenoma
thyroid resistance syndrome
elevated TSH and thyroid hormone levels, elevated alpha subunit, increased sex hormone binding globulin
tx: somatostatin analog, transsphenoidal surgery
normal alpha subunit and sex horm binding globulin
subclinical thyrotoxicosis
decreased TSH, normal thyroid hormone
meralgia paresthetica
entrapment of lateral femoral nerve, lose weight, avoid tight fitting garments
meralgia paresthetica
entrapment of lateral femoral nerve, lose weight, avoid tight fitting garments
Pheo treatment
hypertensive crisis
cardiac tachyarrhythmias
alpha blockers after testing->imaging-> if negative, MIBG scan
optimize alpha blockade (10-14 days) and volume status before surgery
nitroprusside, phentolamine
esmolol, lidocaine
perioral numbness, muscle cramps, twitching post massive transfusion
serum calcium will be normal
obtain ionized calcium
gradual onset of fever, cough, extreme dyspnea/hypoxia, tachypneic with diffuse rales in immunocompromised
PCP, prevent with Bactrim
Babies should walk by
16 months
Insomnia therapy
CBT
parathyroidectomy in hyperparathyroidism if
MEN 1
symptomatic/ urinary calcium >400/ end-organ complications/ <50 yo
calcitonin is for medullary thyroid cancer
pituitary, parathyroid, GI tumor
splenic rupture treatment
supportive care
if do not improve-e lap
Kleuihuaer-Betke test
detect abruptio placentae after trauma in order to give Rho-D
Enterococcus
vanc, ampicillin
primordial prevention
quarternary prevention
prevention of risk factors
prevent unnecessary interventions
complex regional pain syndrome
allodynia, burning, edema, skin changes, decreased ROM after joint injury
tx: nerve block/ IV anesthesia
standardized incidence ratio
for cancer
observed cases in population/ expected cases in gen pop
Most effective contraception
implant (can cause headaches, weight gain and unscheduled bleeding)
Tympany post lap surgery
post op urinary retention due to
due to insufflation of air, self-resolves
anesthesia and fluid resus, foley, voiding trial in a week
Do not biopsy ovarian mass
pregnancy ovarian mass
remove in 2nd trimester, chemo can be given
premature coronary athero in young women
lupus
leading cause of lupus death: heart
ferritin < 30
target cells
iron deficient
thalassemia
grapy vagina
blind vaginal pouch
sarcoma botyroides in childhood or infancy
mullerian agenesis
HIV vaccines
pneumo, hepatitis, no live vaccines
opioid withdrawal treatment
methadone/buprenorphine in controlled settings
otherwise clonidine
lichen planus
skin, nails, mucous membranes, external genitalia
shiny, discrete, pruritic, violaceous plaques and papules on flexural surfaces, wrists
white lacy striae
punch biopsy
associated with hepatitis C liver
24-28 weeks preg testing
cbc, 50g glucose tolerance test (if +-100 g 3 hour test)
if rh-d negative, antibody screening
epidural contraindication
platelets <70k
chronic hypopth treatment
vitamin d, calcium, thiazide if high urinary calcium
TB pleural effusion
lymphocytic, exudative, elevated adenosine deaminase
biopsy-granulomas
Neonatal polycythemia
hematocrit >65% in peripheral draw
glucose, fluids
if refractory-partial exchange transfusion
NPH treatment
lumbar tap test
if improvement-VP shunting
Acute uterine bleeding
stable-OCPs with high dose estrogen
D&C if unstable/ VTE/ refractory
Any sharp object in esophagus
urgent flexible endoscopy
Contraception with clots
CI for estrogen, not progestin
progestin also decreases bleeding
copper IUD associated with more bleeding
Antiphospholipid antibody syndrome testing
lupus anticoagulant, anticardiolipin antibody, anti beta2 glycoprotein 1 antibody
torsades de pointes
hypocalcemia, hypomagnesemia, hypokalemia
long QT syndrome
-> v fib -> death
give IV mag, if refractory-transvenous pacing
odds ratio
odds of exposure in case group/ odds of exposure in control group
OSA can cause mild cognitive impairment in elderly
don’t need daytime sleepiness
henoch-schnonlein purpura
preceding URI
pediatric vasculitis from IgA deposition
abd pain and nausea due to intussusception, arthralgia, renal insufficiency, self-resolves
HUS follows bloody diarrhea
fever in a traveller
<10 days: typhoid, dengue, chikungunya, influenza, legionellosis
1-3 weeks: malaria, typhoid, leptospirosis, schitosomaniasis, rickettsial
>3 weeks: TB, leishmania, enteric parasites
young woman, 2 UTIs in 6 months or 3 in a year
antibiotic ppx with Bactrim, fluoros, nitrofurantoin
Treat subclinical hypothyroidism if
anti-TPO antibodies, abnormal lipid profile, symptomatic, ovulatory and menstrual dysfunction
drugs that cause hypercalcemia
thiazides, lithium
feeding goal
30 kcal/kg/day and 1g/kg/day of protein
lower if fear of refeeding syndrome
tamponade echo
early diastolic collapse of RV and right atrium
severe aortic stenosis
low intensity, single second heart sound during inspiration (no split S2), delayed and diminished carotid pulse, loud and late peaking systolic murmur
*AR- wide pulse pressure (volume)
cardiotoxic chemo monitoring (-rubicin)
radionuclide ventriculography/MUGA (measures EF)
EF <50%-reduce dose
<30% or more than 10 point decrease-discontinue
hepatic adenoma in young woman
OCP
well-demarcated lesion with peripheral enhancement when contrast is injected
asymptomatic-discontinue OCP, serial imaging, AFP
>5 cm-resect
uniform enhancement-focal nodular hyperplasia
Dementia workup
CBC, CMP, TSH, vitamin b12, folate, syphilis, vitamin D
Immune thrombocytopenia treatment
isolated thrombocytopenia, antiplatelet antibodies
IVIG/steroids if platelet count <30K with mucosal bleeding
BTW, negative direct antiglobulin test
Long term maintenance of sinus rhythm when rate control fails
Rhythm control: amiodarone, dofetilide
psoriatic arthritis treatment
methotrexate
skin-high potency topical steroids, ultraviolet light therapy
post MI sex
high risk/ intermediate risk patients (refractory angina, significant valve disease, arrythmia, class IV heart failure) should undergo testing/assessment
Tachycardia in asthma exacerbation
not CI for SABA use
Mg in severe exacerbation-PEF <40% of baseline/ refractory
Carbamazepine side effects
SIADH, neutropenia, bone marrow suppression, anticholinergic effects
Akathisia treatment
propranolol
Rabies
treatment
hydrophobia
immunized: booster (2 doses)
nonimmunized: immunoglobulin + vaccine (4 doses)
Exercise CI in pregnancy when
cerclage, active vaginal bleeding, placenta previa, increased risk for preterm birth, preeclampsia, heart/lung issues
Prevent AAA expansion
smoking cessation
