5/3 Flashcards
1
Q
Why are cephalohematomas limited to surface of one cranial bone
A
Subperiosteal hemorrhages
2
Q
What is caput succedaneum
A
A diffuse, sometimes ecchymotic swelling of the scalp usually involving the portion of the head presenting during vertex delivery
may cross suture lines
3
Q
Two big patterns of Crohn’s
A
Fibrostenotic obstructing pattern or penetrating fistulous pattern
4
Q
GI granulomas w/ what diseases besides CD
A
GI TB
Sarcoidosis
Yersinia infections
5
Q
What is torus palatinus
A
Fleshy, immobile mass on midline hard palate
young folks
6
Q
Who should be tested for GC
A
All sexuality active women 24 and younger
7
Q
Best GC screening test
A
Nucleic acid amplification test
8
Q
First Workup for missed abortipn
A
Fetal heart tones and pelvic US
9
Q
Exam of uterine atony
A
Soft (boggy) uterus that is enlarged
10
Q
What does a thin endometrial stripe on postpartum US mean
A
Empty and normal uterine cavity
11
Q
4 big risks for uterine atony
A
- Prolonged labor
- Induction of labor
- Operative vaginal delivery
- Fetal weight >4000g (8.8 lbs)
12
Q
Uterine atony tx
A
Bimanual message, IV fluids/O2, and oxytocin (methylergonovine if oxytocin doesn’t work)
13
Q
Contra to carboprost in uterine atony
A
Asthma (causes bronchial constriction)
14
Q
Hemodynamic monitoring in septic shock
A
Low PCWP
Low SVR
Increase CO
High mixed venous O2 sat%
15
Q
What should be suspected in any HTN pt with hypokalemia
A
Primary hyperaldosteronism (these pt’s also more prone to diuretic induced hypoK if not baseline)
16
Q
MC nutritional def in kids
A
Iron def
17
Q
Gold standard for HIV dx in kids form birth to 18 months? why?
A
PCR –> HIV ab testing unreliable due to passing of maternal antibodies to fetus
18
Q
CT of porcelain gallbladder? inc risk of?
A
Calcified rim in gallbladder wall with central bile-filled dark area
Inc risk of gallbladder adenocarcinoma
19
Q
What should raise suspicion for MAC in aid’s pt
A
Non spec systemic symptoms (fever, cough, diarrhea) plus splenomegaly and elevated alk phos
20
Q
Lyme arthritis features
A
Usually knee
Synovial fluid shows leukocytes around 25k
21
Q
Dx of lyme arthritis? tx?
A
Confirm with ELISA and western blot
Tx is oral doxy or amoxicillin
22
Q
B2 (riboflavin) def
A
- Angular cheilosis, stomatitis, glossitis
- Normocytic anemia
- Seborrheic dermatitis**
23
Q
B6 (pyridoxine def) features
A
- Cheilosis, stomatitis, glossitis
- Irritability, confusion, depression
24
Q
Primary solitary brain mets from what cancers
A
Breast, colon, renal cell
25
Stage 1 hepatic encephalopathy featurs
Sleep pattern disturbances and impaired cognition)
26
Murmur of IVDU endocarditis
Tricuspid regurg (holosytolic increasing with inspiration)
27
Good screening for microalbuminuria
urine microalbumin/creatinine ratio
| *24 urine collection better but inconvenient*
28
Pneumo vaccine for HIV patients
PCV 13 1x
| PPSV23 8 weeks later, then every 5 years
29
What is elevated in PCP PNA
Serum lactate dehydrogenase
30
Severe PCP features and tx
PaO2 (70 or A-a gradient >35 on room air
| TMP-SMX + corticosteroids
31
Contrast enema of meconium ileus
Microcolon (caused by viscous meconium accumulation and obstruction in terminal ileum)
*contrast enema can also tx by breaking up*
32
CXR of radiation fibrosis
Volume loss with coarse opacities
33
Aspergilloma CXR
Mobile intra-cavity mass with an air crescent in the periphery
34
Most common paraneoplastic syndrome with squamous cell lung Ca
Hypercalcemia from PTrP
35
Mixed cryoglobulinemia features
Hep C usually
| Arthralgia's, palpable purprua, and elevated transaminase + nephrotic syndrome
36
Risk calculation
Divide number of diseased subjects by overall subjects at risk
37
What causes Zener's diverticulum
Posterior herniation b/w the fibers of the cricopharyngeal muscle
38
If test result is negative, probability of having the disease formula
1- negative predictive value
39
Sarcoidosis big symptoms
Cough, erythema nodosum, anterior uveitis, and arthritis
40
Metformin should not be given with what acutely ill patients
Acute renal failure, liver failure, or sepsis
41
Chronic cough that is worse at night likely? Workup?
Asthma
| PFTs for workup
42
Varicella post exposure ppx for healthy and immunocompromised
Healthy: Varicella vaccine w/in 3-5 days
Immunocompromised: varicella zoster Ig
43
Varicella complications
Bacterial superinfection in children
| Pneumonia in adults
44
Akathisia tx
Propranolol or lorazepam
45
New antipsychotic med and pt won't sit down think
Akathisia
46
Initial massive hemoptysis mgmt
Establish airway, maintain perfusion, and ensure hemodynamic stability
*place bleeding lung in dependent position*
47
Most common rotator cuff injury? Why
Supraspinatus --> repeated bouts of ischemia near its insertion on the humerus induced by compression b/w humerus and acromion
48
Positive drop arm test in shoulder injury
Rotator cuff tear
49
Acalculous cholecystisis presentation
Unexplained fever an RUQ pain in severe sick
| Leukocytosis on lab
50
Physiologic leukorrhea
Copious white vaginal d/c that doesn't stink and no other findings
51
Mild hyperkalemia in ckd pt tx
Remove K from body w/ loop diuretics (driving into cells will only transiently change)
52
What should be suspected in all children w/ recurrent intussusception
Meckels (most common GI abnormality)
53
Sporadic burkitt's lymphoma often affects
Distal ileum
54
When to operate on a hydrocele? why?
After 1 year old, due to risk of inguinal hernia
55
Physical/sexual child abuse risk factors
1. Unexplained changes in behavior or scholastic performance
2. Unstable family economic conditions
3. Caregiver hx of substance abuse
56
Focal nodular hyperplasia in liver features
- Ass w/ anomalous arteries
| - Arterial flow and central scar on imaging
57
Elevated what in hepatocellular adenoma
Alpha fetoprotein
58
COPD exacerbation 3 features
1. Increased dyspnea
2. Cough
3. Sputum production change
59
Drug induced parkinsonism tx
Benztropine or Diphenhydramine
60
AIDs exposure ppx
Tenofovir-emtricitabine w/ raltegravir
61
Detrusor instability w/ what type of urinary incontenence
Urge
62
How can an epidural cause sustained bladder dysfunction
Over distends it, causing impaired ability to contract causing retention and overflow incontinence
63
ITP tx when platelets below 30k
IvIg or glucocorticoids
| *platelet transfusion rare because it can cause further platelet destruction--> only in very severe cases*
64
Common complication of intraventricular hemorrhage in neonates
Communicating hydrocephalus --> blood irritates arachnoid villi, impairing its ability to reabsorb CSF
65
Lights criteria**
Exudate if:
1. Pleural protein/serum > 0.5
2. Pleural LDH/serum > 0.6
3. Pleural fluid LDH > 2/3 upper limit normal for serum
66
Plural fluid glucose
Empyema or rheumatic effusion
| -Due to high metabolic activity of leukocytes/bacteria in fluid
67
What is a hepatic hydrothorax
Increased permeability of right hemidiaphragm leading to R pleural effusion in cirrhosis (transudate)
68
Why is R kidney easier to palpate that left
Lies lower than left kidney
69
ADPKD exam
HTN and palpable kidneys
70
Increased levels of what in hemolytic anemia
LDH and bilirubin
71
Elevated alk phos out of proportion to LFTs suggest
Intrahepatic cholestasis or biliary obstruction
72
Best test for histo in immunocompromised pt's
Urine or serum assay for histoplasma antigen
73
Tx for histo
Itraconazole
| *Ampho if really really bad*
74
Treatment resistant schizophrenia drug
Clozapine (after 2 failed trials)
75
What causes intermittent claudication
Atherosclerotic narrowing of the arteries feeding the leg
76
Why is cooking bad for folate
Folate is heat sensitive
77
How long for B12 to be depleted in healthy adults
3-4 years
78
Suspect Diamond-Blackfan syndrome in who
In a child with microcytic anemia, low retic count, and congenital anomalies
79
Absent thumbs in what disease
Fanconi's anemia
80
Preferred tx for MCL tears
Early ambulation (rarely surgery)
81
Hyperthyroid induced myopathy favors what
Proximal hip flexors and quadriceps, can progress to involve proximal muscles of UE
82
Most common DM neuropathy
Symmetric and distal sensorimotor polyneuropathy
83
Chorioamnionits dx with maternal fever plus what?
1 of: Uterine tenderness, maternal or fetal tach, malodorous amniotic fluid, or purulent vaginal discharge
84
What are tocolytics for
To prevent labor
85
Why iron def in celiac dz
Poor iron absorption secondary to duodenal villous atrophy
86
2 common ass. w/ celiac dz
Type 1 DM and Dermatitis herpetiformis
87
What causes Meckels
Incomplete obliteration of the fetal vitelline (omphalomesenteric) duct
88
What does pos anserinus pain syndrome present with
Localized pain and tenderness over the anteromedial part of the tibial plateu just below the just line of the knee
89
Where does patellofemoral syndrome hurt? what makes it worse
Anterior knee pain
| Worse with activity of prolonged sitting (sustained flexion)
90
3 types of diabetic retinopathy
1. Background (simple) - micro aneurysms, hemorrhages, exudate and edema
2. Pre-proliferative - with cotton wool spots
3. Proliferative - newly formed vessels
91
What part of vision does macular degeneration affect
Central vision
92
Characteristic systemic blasto features
Ulcerated skin lesions and lytic bone lesions
93
What is Small intestine bacterial overgrowth ? dx?
Malabsorption due to anatomic or dysmotility disorders with bloating, flatuence, and diarrhea
Dx: endoscopy with jejunal aspirate showing >10(5) organisms/mL
94
What should a healthy 6 month old baby be able to do
Sit momentarily on propped hands, transfer objects from hand to hand, and respond to name
95
What is the Hawthorne effect
Tendency os study population to affect the outcome since they are aware they are being studied
96
Congenital syphillis
Hepatosplenomegaly, cutaneous lesions, jaundice, and rhinorrhea
97
Congenital rubella
Sensonerual hearing loss, cataracts, HEART DEFECTS, blueberry muffin rash
98
Nocardia micro
Filamentous, aerobic, gram + acid fast bacteria
99
Rickets exam findings
Craniotabes, rachitic rosary, and gene varum
100
What should be immediately ruled out in a patient presenting with sudden onset severe SOB
Upper airway obstruction
101
Quad screen of trisomy 21
Dec A-fetoprotien and estriol
| Inc B HCG
102
Quad Screen of trisomy 18
Dec A-feto and estriol
| DEC B -HCG
103
Inhibin A in quad screen of trisomy 18 vs 21
18: Normal
21: Increased
104
DOC to treat opiod withdrawal
Methadone
105
Raising the cutoff of a test (smaller inclusion) effect on sensitivity and specificity
Increases specificity
Decreases sensitivity
(false and true positives decrease)
106
3 big causes of symmetric IUGR
-Genetic disorders (aneuploidy)
-Congential heart dz
-Intrauterin infection
(fetal factors)
107
Substance abuse disorder causes what kind of IUGR
Asymmetric (maternal factor)
108
DOC for stabilizing bony mets
Bisphosphonates (presents hypercalcemia of malignancy and pathologic fractures)
109
What is calcinosis cutis
Deposition of Ca and PO4 in the skin --> scattered whitish papules, plaques or nodules
110
Chronic tophaceous gout tumors
Chalky white
111
Extra-renal manifestations of ADPKD
1. Hepatic cysts (most common(
2. Berry aneurysms
3. Valvular heart dz (MVP and aortic regurg)
4. Colonic diverticula
5. Abdominal wall and inguinal hernia
112
Heated cysts from? features?
Areas where sheep are raised
Fluid filled cysts with an inner germinal layer and outer acellular laminated membrane (germinal layers give rise to 2ndary daughter cysts)
