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