5/11 Flashcards
When are symptoms during somatic symptom disorder usually worse? tx?
During periods of stress
Focus on discussing the role of psychosocial stressors and promote stress reduction/healthy behaviors
Meds to withhold before stress testing? how long?
exception?
B-blockers, CCBs and nitrates for 48 hours
Exception: in pt’s with known CAD to asses efficacy of anti-anginal drugs
Why low intubation threshold in burns
Progressive airway edema may preclude incubator later in clinical course
Pre-patellar bursitis features
Anterior knee pain, tenderness, and localized swelling
By S. aureus
Who gets patellar tendonitis
Athletes in jumping sports or occupations with repetitive forceful knee extension
What test can be considered in a woman w/ very strong hx of ovarian Ca
BRCA1 and 2
Think of what in a patient w/ erythema gangrenosum
IBD, RA, or AML (underlying systemic disease)
Most useful test for re-occlusion following recent MI
CK-MB (typically returns to normal w/in 1-2 days)
3 things that dec HOCM murmur
Sustained hand grip
Squatting
Passive leg raise
What does valsalva do to pre-load
Decreases it
Best step for undiagnosed pleural effusion on CXR
Thoracentesis, except inpatients w/ clear-cut evidence of CFH
Acid/Base status of Conn’s
Metabolic alkalosis
MC site of ulnar nerve entrapment
Elbow where the ulnar nerve lies at the medial epicondylar groove
Why UA for bedwetting after age 5
Screen for UTI, DM, and DI
4 tests for all pt’s w/ new HTN diagnosis
- UA (occult hematuria and protein/cr ratio)
- Chemistry panel
- Lipid profile
- Baseline EKG
Erlichiosis labs
Leukopenia
Thrombocytopenia
Elevated LFTs and LDH
What should be considered when a pt suspected of sarcoidosis decompensated following steroids
Histoplasmosis (closely mimics - normally caseating granulomas but can have non)
Type 2 RTA causes
Defective tubular HCO3 reabsorption
What differentiates acute Hypercarbia from chronic CO2 retention in COPD
Acute has associated acidosis and low bicarb level
What can happen with changes in head position in papilledema
transient vision loss lasting a few seconds
4 big pancreatitis complications
- Pleural effusion
- ARDS
- Ileus
- Renal failure
What causes morton’s neuroma
Mechanically induced neuropathic degeneration of the interdigital nerves
Pleural fluid indicators of empyema? what do you do
pH
Always do what in croup before intubation
Give a trial of race-epi
What is eliminated in a case control study when neighbors of pt’s are chosen
Confounders
Euthyroid sick syndrome characterized by
Fall in total and free T3 levels w/ normal T4 and TSH
Chikungunya fever presentation
Caribbean trip and back with Polyarthralgias, rash, lymphopenia, and thrombocytopenia
What classifies saline response vs unresponsive metabolic alkalosis
Saline responsive will have low urinary chloride (
3 PE findings of aortic stenosis
- Pulsus parvus et trades (delayed and diminished)
- Mid to late peaking systolic murmur
- Soft and single second heart sound
Why single soft S2 in aortic stenosis
Aortic valve closure is delayed and occurs simultaneously w/ pulmonic valve closure
Duodenal hematoma mgmt
Conservatively w/ nasogastric suction and parenteral nutrition
Odansetron MOA
Blocks 5HT3 receptors
for preventing chemotherapy induced nausea and vomiting
Next step if a CXR identifies a new suspicious pulmonary nodule
CT scan
High risk pulmonary nodule features
Size > 2.0cm
> 60 years old
Current or
CXR diagnostic indicator of diaphragmatic rupture
Nasogastric tube in the pulmonary cavity
why is aldosterone normal in pan-hypopituitarism
Aldosterone secretion from adrenal glands is ACTH independent and primarily regulated by RAAS
Vit D def labs
Low Ca and PO4
elevated PTH
What mediates Vit D absorption in the intestine
Chylomicrons
Why is insulin good for GDM
It does not cross the placenta
Gold standard dx for bowl ischemia
Mesenteric angiography
Suspect PML in who
HIV infected patient with focal neurological signs and multiple non-enhancing lesions w/ no mass effect on CT scan
When does subacute sclerosing panencephalitis occur?
What does CT scan show?
Many years after antecedent measles infection
CT scan shows scarring and atrophy
MCC of thyrotoxicosis w/ low RAI uptake? why?
Subacute painless thyroiditis
From leakage of thyroid hormones into the circulation
2 drugs that cause serum-sickness like reaction
B-lactams (penicillin, amoxicillin, cefaclor) or TMP-SMX
Hx of CAD + severe dyspnea after fluids likely
Pulmonary edema
SEM of alports? big 3 features?
Alternating areas of thinned and thickened capillary loops w/ splitting of GBM
Recurring hematuria, sensorineural deafness, and fam hx of renal failure
What is chlorpheniramine
1st gen antihistamine
Fever and sore throat in patient on anti-thyroid drugs suggestive of
Agranulocytosis –> stop taking and count WBC
Volvulus Abdominal xray
“corkscrew”
Gold standard for diagnosing malrotation
Upper GI contrast study
When does pyloric stenosis manifest
1-2 year olds
Most common source of PE
Proximal deep leg veins (Iliac, femoral, popliteal)
Cutaneous findings of coccidioidmycosis
Erythema multiform and erythema nodosum
2 big screenings all patients with cirrhosis need
- Endoscopy for varies
2. HCC screening w/ US every 6 months
Tx for asymptomatic variceals
Non-selective B-blockers
What characterizes normal hyperventilation of pregnancy
- Increased TV
- Inc minute ventilation
- Chronic respiratory alkalosis
Presentation and cause of dysarthria-clumsy hand syndrome
Bulbar dysfunction (dysarthria, dysphagia) Contralateral facial and limb weakness Due to infarction in paramedic basis points
Risk w/ Hashimoto’s thyroiditis
Thyroid lymphoma
Langerhan’s histiocytosis presentation
Solitary, painful lytic long bone lytic lesion w/ overlying swelling and hypercalcemia
What are ahminoglycosides used for
Serious gram negative infections
What is present in AIN urine
WBCs and eosinophils
Hallmark EKG of ventricular aneurysm
Persistent ST-segment elevation after a recent MI and deep Q waves in the same leads
Immunofluorescence of bullous pemhigoid
IgG and C3 distributed linearly along BM zones
Pemphigus vulgaris Ab
Surface bound IgG to desmoglein
What is adjustment disorder characterized by
Increased anxiety, depression, or disturbed behavior that develops in response to a stressor
4 features of atypical depression
- Hypersomnia
- Increased appetite
- Rejection sensitivity
- Leaden paralysis
Most important steps in management of lactic acidosis from septic shock
IV Normal saline with or without vasopressor therapy to maintain the intravascular pressure and Ab
Can laboring patients w/ placental abruption deliver?
Yes, unless mother is hypotensive w/ severe bleeding or if the condition of the fetus deteriorates
Inevitable vs Incomplete abortion
Inevitable: products of conception may be seen or felt at or above cervical os
Incomplete: some products of conception expelled and some remain
Arrhythmias after MI
Immediate (0-10 min) - reentrant ventricular (f-fib)
Delayed (10-60 min) from abnormal automaticity
3 causes for travelers diarrhea lasting longer than 2 wees
- Cryptosporidium
- Cyclospora
- Giardia
What causes Amebiasis
Entamoeba histolytic (bloody diarrhea from Asia)
How does type IV RTA present? Who gets it?
Hyperkaelmia, mild renal insufficiency, and non anion-gap metabolic acidosis
-Pt’s with poorly controlled DM get it
GAS treatment in kids vs adults
Always test in children w/ rapid streptococcal antigen testing prior to starting Ab
What is needed to make dx of delayed sleep phase syndrome
Accurate history and/or sleep diary
Caustic poisoning presentation
Dysphagia, severe pain, heavy salivation, and mouth burns
not change in consciousness
Bitter almond odor with
Cyanide inhalation
2 things elevated in Pagets
Alk phos
Urinary hydroxyproline levels
5 AE w/ amioderone
- Pulm fibrosis
- Thyroid dysfunction
- Hepatotoxic
- Corneal deposits
- Blue skin color
Levodopa/Carbidopa AE
- Hallucinations
- Dizziness
- Headache
- Agitation
TSS presentation
Fever, myalgias, marked hypotension, and diffuse erythematous macular rash
Azathioprine tox
Dose related diarrhea, leukopenia, and hepatoxocity
major tox of mycophenolate
bone Marrow suppression
Main cyclosporine AE
Nephrotoxicity Hyperkaelmia Hypertension Gum hypertrophy Hirsutism Tremor
MC cyclosporine AE
Nepphrotoxicty
What causes HTN in thyrotoxicosis
Hyper dynamic circulation resulting form increased myocardial contractility and heart rate
