5/10 Flashcards
Who is ECT best for
Depressed geriatric patients who are not eating, drinking, psychotic, or actively suicidal
3 systems TCA overdose involved
- CNS (seizures, coma)
- Anticholinergic
- Cardiac
TCA effect on myocardium
Inhibits fast Na channels in the His-Purkinje system and myocardium
Cardioprotection for TCA overdose
Sodium bicarb (when QRS inc. pH and extracellular sodium, deceasing drug avidity for Na channels
Pneuomo vaccine for high risk pt’s (not very high risk)
PPSV23 alone at 19-64
then normal schedule at 65
All pt’s w/ bilateral Carpal tunnel should be screened for
Hypothyroidism
Two common complications w/ SS trait
- Hematuria from sickling in the renal medulla
2. Isosthenuria (impaired concentrating ability)
What kind of Anemia does B6 def cause
Sideroblastic (microcytic but elevated total serum iron and dec TIBC)
2 Tet murmurs
- Harsh systolic ejection murmur at left upper sternal border
- Single S2 (from pulmonary stenosis)
Tx for any pt post stent placement
Dual anti platelet (aspirin and P2y12 receptor blocker)
Big B and T cell markers
B = CD19
T=CD3
What causes B-cell dysfunction in SCID
Absent T cells
What kids should get a renal US w/ UTI
- All under 24 months (when febrile)
- Recurrent in any age
- Fam hx or poor response to Ab
Typical x-ray of supracondylar fracture of the humerus
Triangular anterior fat pad and posterior fat pad (lucent on X-ray)
Two late findings of compartment syndrome
Pulselessnes and paralysis
Red flags for orbital cellulitis vs preseptal
- Decreased visual acuity
- Diplopia
- Ophthalmoplegia
- Proptosis
Hyperandrogenism during pregnancy usually from
Ovarian masses (Luteoma - bilateral and solid)
Bilateral theca lutein cyst ass w/
Molar pregnancy and multiple gestation
First step for suspected VAP, then what?
- CXR
2. Lower respiratory tract sampling and empiric antibiotics
What is Enthesitis
Inflammation and pain at sites of tendon and ligament attachment to bone
Commonly found in AS
Metastatic bone pain features
Constant progressive pain that wakes the patient up at night
Common clinical features of Vasa previa
- Painless vaginal bleeding that occurs with rupture of membranes
- Fetal deterioation (sinusoidal tracing or brady)
- Maternal vital signs unchanged as bleeding comes from fetus
Retinal harmartoma typical of
Tuberous sclerosis
What is primidone? what can it cause?
Anticonvulsant that converts phenylethylmalonamide and phenobarbital
Can cause acute intermittent porphyria
Acute intermittent porphyria symptos
Abdominal pain, neuralgic and psychiatric abnormalities
Anemia on methotrexate
Macrocytic
Antimitochondrial Ab for
Primary biliary cholangitis
What must be done if a patient on warfarin needs emergent surgery
Reversal with FFP
What causes itchy butt worms? tx?
Enterobius vermicularis
Tx is Albenazole
Most common neuro symptoms of HHS
- Decreased consciousness (MCC)
2. Blurred vision
What is positive in UC
p-ANCA (also see it w/ AS)
What causes symptoms in cardiac tamponade
Exaggerated shift of inter ventricular septum toward left ventricular cavity, which reduces left ventricular pre-load, SV, and cardiac output
Leukemoid reaction vs CML
- High LAP score
- Greater proportion of late neutrophil pre-cursors
- Lack of absolute basophilia
Tx for complicated diverticulitis w/ abscess formation
CT-Guided percutaneous drainage
Who gets nasopharyngeal carcinoma? ass w/?
Mediterranean and far est
Ass w/ EBV infection
Nasopharyngeal carcinoma presentatoin
Recurrent otitis media (from eustachian tube obstruction by tumor)
Recurrent epistaxis
Nasal obstruction
Lichen sclerosis exam
Porcelain-white atrophy and “cigarette paper” skin
punch biopsy these
Hyatic cyst buzzword
Cystic hepatic lesion with eggshell calcification
Hyatid cyst tx
Surgical resection under the cover of albenazole
How does dipyridamole cause coronary steal
Redistributes blood flow to non-disease segments (diseased segments already maximally dilated)
Suspect leprosy in who? how do you dx
Asian patient with an insensate, hypo pigmented patch of skin
Dx by acid fast bacilli on skin biopsy
Randomization used to control what in a study
Confounders
First line tx of atopic dermatitis
Topical emoilments
How can SS cause folate def
Increased red blood cell turnover and increased consumption of folate in bone marrow
What should be suspected in a cyanotic infant w/ LAD
Tricuspid valve atresia
Goodpastures dx by
Renal biopsy showing linear IgG antibodies along the glomerula basement membrane
Laryngomalacia features
- Inspiratory stridor what worsens in the supine position and w/ crying
- Peaks at 4-8 months
- Dx w/ flexible laryngoscopy
NNT formula
1/ARR
ARR formula
Incidence without treatment - incidence with treatment
Underlying pathology of lacunar strokes
Microantheroma and lipohyalinosis
Most common site for a lacunar infarct w/ features
Internal capsule –> pure motor stroke (w face, arm and leg equally)
Exam of open angle glaucoma
Cupping of the optic disk w/ loss of peripheral vision
Open angle glaucoma first line
Timolol eye drops
Tina capitis treatment
Oral griseofulvin
2 mCC of epilgottitis in adults
H influenza
Streptocus progenies
MC complication seen post thyroidectomy
Hypocalcemia
MC presenting symptoms of whipples disease
Chronic malabsorptive diarrhea, weight loss, migratory arthritis, lymphadenopathy, and low grade fever
Anti-neutrophil cytoplasmic antibodies ass w/
Wegener’s (granulomatosis w/ polyangitis)
Ab ass w/ systemic sclerosis
Anti-nuclear
Anti-topoisomerase-1
First line for osteoarthritis pain
Acetaminophen
Fatigue and dyspnea w/ splenomegaly and reticulocytosis
Autoimmune hemolytic anemia
Liver abscess + Mexican + recent bloody diarrhea
Amebiasis w/ Entamoeba histolytic
Tx Metronidazole
What has decreased passive and active range of motion int he shoulder
Adhesive capsulitis
Classic presentation with a clavicle fracture kid walks in
Supporter w/ contralateral hand
Thiazide diuretics metabolic AE**
Hyperglycemia
Increased LDL cholesterol and plasma triglycerides
Thiazide electrolyte abnormalities
Hyponatremia
Hypokalemia
Hypercalcemia
Postpartum endometritis tx
Iv Clindamycin and gentamicin
Why is GERD more common in kids
- Shorter esophagus
- Incomplete closure of LES
- Grat time spent in the supine position
A puncture wound in an adult resulting in osteomyelitis most likely due to
Pseudomonas aeruginosa
Acute liver failure most often due to
- Acute viral hepatitis
- Acetaminophen toxicity
- ischemic hepatopathy (shock liver)
When did blood start getting tested for Hep C
1992
UA w/ normal appearing RBCs
Papillary necrosis
Classic extra pulmonary manifestation of mycoplasma pneumonia
Erythema multiforme
Drug that inhibits ventricular remodeling after MI
ACE inhibitors
Lung contusion CXR
Patchy, irregular alveolar infiltrates
Bite from family dog w/ unknown rabies exposure
Observe animal for 10 days
Don’t start PEP yet
Wide complex tachycardia drug
Amioderone or lidocaine
Narrow complex (SVT) drug
Adenosine or vagal manuevers
Can unmask “hidden” P waves in pt’s with a-flutter or atrial tachycardia
Cryptococcal meningitis
Amphoteric B + flucytosine
CT scan and colonoscopy of ischemic colitis
CT: Thickening of the bowel wall
Colonoscopy: Cyanotic mucosa and hemorrhage ulcerations