5/4 Flashcards
Spinal chord compression workup
Surgery consult
Neuroimaging
IV steroid (maybe)
How long to treat a single episode of depression
6 months
Ethylene glycol tox
Hypocalcemia and calcium oxalate deposition in kidneys
–>Massive anion gap (HCO3
Ethylene glycol tx tx
Fomepizole or ethanol to inhibit alcohol dehydrogenase
can also give sodium bicarb to alleviate acidosis
Cat bite bacteria to worry about and tx
Pasturella
Tx w/ Amox/clavulanate
Growth and weight by 1 year old
Weight should triple
Height should increase by 50%
PSVT EKG and tx
Sudden onset, regular, and narrow complex tachycardia
Adenosine (slows AV nodal conduction)
1st step for A-fib w/ RVR
Rate control with B-blockers or CCB (Dilitazam)
Aromatase def features
XX- normal internal genitalia w/ ambiguous external genetalia, literal hypertrophy
High FSH/LH with low estrogen
McCune-Albright triad
Cafe au last spots
Polycystic fibrous dysplasia
Endocrine hyperfunction
Gold standard for dx’ing VUR
Voiding cystourethrogram
Tx for all children w/ a UTI age 2-24 monhs
Renal and bladder US to evaluate for any anomalies that may predispose to VUR
When are loop diuretics recommended for SIADH
If urine osmolarity is more than 2x serum osmolarity
If a girl has lots of early pubic hair but no breast budding, where is the premature adrenarche coming from
Adrenals
What causes isolated precocious puberty
Early HPA activation
What should be suspected in a well appearing neonate with painless bloody stools
Milk or soy protein proctoclitis
Tx for sphincter of oddi dysfunction
ERCP w/ sphincterotomy
2 big causes for pediatric myocarditis
Cox B
Adenovirus
Viral myocarditis featuers
Acute left heart failure signs after viral syndrome
Holsytolic murmur from functioning mitral regurg
Hepatomegaly and cardiomegaly
Biopsy shows endometrial hyperplasia: next step if atypia? if no atypia?
Atypia: Hysterectomy
No atypia: Progestin therapy
2 big burn sepsis bugs
S. aureus
Pseudomonas
Spherocytosis tests
Inc. MCHC
Osmotic fragility on acidified glycerol lysis test
Abnormal eosin-5-maleimide binding test
A reliable test gives what
Similar results on repeated measurements
Transferrin saturation highest in what
Thalassemia (Iron/TIBC)
Antipsychotic most likely to increase prolactin
Risperidone
Aripiprazole MOA
Partial D2 agonist (rather than antagonist)
Epo side affects
- Worsening of HTN
- Headaches
- Flu-like syndrome
- Red cell aplasia
COPD exacerbation tx
- Supplemental O2 (sat 88-92%)
- Inhaled bronchodilators (b2 agonist and anticholinergics)
- Antibiotics
- Systemic glucocorticoids
Mild intermittent asthma
- Symptoms
Acetaminophen OD guidlines
Charcoal if
What type of cancer increases Vit D production
All lymphomas
CML mutation? tx?
9:22 fusion of BCR/ABLE gene
Tx with imatinib (non-receptor tyrosine kinase inhibitor)
What is isolated systolic hypertension? tx?
HTN in elderly patients caused by decreased elasticity of the arterial wall
Tx: thiazide, ACE, or CCB
Best drug to slow progression of DM nephropathy
Ace inhibitors
Meningococcal vaccination schedule
Age 11-12 (or 13-18 if not before)
Booster at 16-21 (if primary before 16th birthday)
1st step when gastric adenocarcinoma is diagnosed
Staging w/ CT scan
First line tx for PCOS
Weight loss and COC therapy
Surgical hx + bad ab pain + persistent variable decelerations worry about?
Uterine rupture
Do laparotomy and delivery (C-section)
Contra to catheter in trauma patient
Obvious pelvic injury or blood at the urethral meatus
Chronic tearing that is often unilateral in neonate
Dacryostenosis (nasolacrimal duct obstruction)
Endometriosis exam
May show rectovaginal tenderness or tenderness w/ movement of uterus due to tissue in rectovaginal septum, peritoneum, uterosacral ligaments
Thickening or uterosacral ligaments on exam
Think endometriosis
How does endometriosis incr. infertility risk
Chronic inflammation and adhesion formation
Edema in nephritic glomerulonephritis due to
Decreased GFR and retention of Na and H2O by kidneys
Breast feeding mastitis tx
Dicloxacillin or cephalexin
Things that can cause pulsus paradoxus besides tamponade? why?
Asthma and COPD (due to greatly exaggerated drop in intrathoracic pressure during inspiration)
Think what when CT shows gas in gallbladder? who gets it?
Emphysematous colitis
Seen in immunocompromised people (DM)
Aortic rupture CXR
Widened mediastinum and left sided hemothorax
Food borne vs non infantile botulism
Foodborn- ingestion of preformed C botulinum toxin
Non-foodborne- Ingestion of SPORES from the environment
Marfan mutation
Fibrillin-1
Visual acuity testing at well child visits
Infants: observe fixation and tracking
Older infants: cover-uncover test
Over 3: visual acuity testing begins
Who gets the rotavirus vaccine
2-8 months old (highest risk from severe dehydration at this age range)
Children who suffer from selective mutism features
Talkative at home but refuse to speak in specific settings, like school
Why gout in myeloproliferative disorders
Excessive turnover of purines and resulting increase in uric acid production
Why elevated BUN/Creatinine ratio in upper GI bleed
Increased urea production (from intestinal Hgb breakdown) and increased urea reabsorption (due to hypovolemia)
Why angina in aortic stenosis
Increased myocardial oxygen demand due to increased left ventricular mass
Hallmark of asbestosis imaging
Pleural plaques
Contact lens associated keratitis due to
Pseudomonas and Serratia
Eczema herpeticum features
Painful vesicular rash w/ “punched out” erosions and hemorrhagic crusting
MCC of death in acromegaly
Cardiovascular
Idiopathic (central) precocious puberty seen almost always in
Girls
Late onset CAH features
Advanced bone age
Coarse axillary and pubic hair
Severe cystic acne
Test to determine central vs peripheral precious puberty
LH level after GnRH stimulation (in gonadotropin independent (peripheral) LH will be low before and after)
Triad in disseminated gonococcal disease
- Polyarthralgia
- Tenosynovitis
- Painless vesicopustular skin lesions
When should you suspect SBP
Any patient with cirrhosis and ascites accompanied by either fever or change in mental status
+ SBP test
Positive ascites fluid culture and neutrophil count >250mm3
When is confounding bias present
When at lest part of the exposure-disease relationship can be explained by another variable (confounder)
What is notorious for causing refractory hypokalemia
Hypomagnesemia (be sure to correct Mg and K)
Acute pancreatitis complicated by hypotension thought to arise from
Intravascular volume loss 2/2 local and systemic vascular endothelial injury
Smudge cells seen in
Chronic lymphocytic leukemia
What makes alcoholic hallucinations different from DT
24-48 hours of last drink and sensorium remains intact w/ stable vitals
GAD tx
SSRI or SNRI
What is increased in yolk sac tumor
AFP
What is increased in leydig cell tumors
Testosterone and Estrogen (Inc aromatase activity) w/ secondary inhibitio of LH and FSH
Most common ped’s fracture
Supracondylar fracture of the humerus
Most common complication of the supracondylar fracture of the humerus
Entrapment of the brachial artery or median nerve
HELLP
Hemolysis
Elevated Liver enzymes
Low Platelets
Also RUQ pain
What causes pulmonary edema in severe Preeclampsia
Increased systemic vascular resistance, capillary permeability, pulmonary cap hydrostatic pressure, and decreased albumin
Primary vaginal cancer characterized by
Bloody malodorous discharge and an irregular vaginal lesions
dx by biopsy before excision
Aspirin is a common trigger for bronchoconstriction in what asthma patients
Those with chronic rhinitis an nasal polyps
What is amantadine
Dopa agonist (PD)
Shape of Calcium oxalate crystals
Envelope
What is vaginismus caused by
Involuntary contraction of the perineal musculature (psychosocial underlying cause)
Two things that help ARDS (vent wise)
Low tidal volumes
PEEP
TB common cause of what dz
Primary adrenal insufficiency
All patients with precocious puberty and elevated LH should get what
Brain MRI with contrast
Primary tx for idiopathic GDPP? why?
RnRH agonist therapy to prevent premature epiphyseal plate fusion and maximize height potential
What grave’s dz tx can temporarily make graves opthalmopathy worse
Radioactive iodine
What drug is contraindicated in acute MI w/ pulmonary edema
B-blockers (but good for MIs without)
Rubella vaccine in pregnancy
Not recommended but probably not harmful
Tx to reduce hypercalcemia in immobilized people
Hydration and bisphosphonates
