5/5 Flashcards
What is treatment response defined as
When a patient demonstrates significant improvement (with or without a remission) generally 50% better
What fluids correct alkalosis
Volume resuscitation with normal saline
Who is most likely to get acute bacterial parotitis? most common bug?
Dehydrated post op patients and the elderly
Most common bug is S. aureus
Hyperestrogenism in cirrhosis causes
Gynecomastia
Spider angiomas
Palmar erythema
Testicular atrophy
What differentiates delirium from other psychotic illnesses
Fluctuating levels of consciousness
Acuity of onset
Association w/ underlying medical illness and/or offending mechanisms
Post-partum blues timing
2-3 days (resolves within 10 days)
When to give bethmethason to pregnant ladies w/ PPROM
When
Fanconi’s anemia dx made by? tx?
Made by chromosomal breaks on genetic analysis combined with clinical findings
Tx: hematopoietic stem cell transplant
Anemia in Fanconi’s
Usually microcytic (w/ congenital marrow failure)
Imaging for DDH
Big complication with bronchiectasis
Hemoptysis
13 vs 23 pneumo vaccine immune response
13- polysaccharides conj to protein –> T cell dependent B cell response
23- capsular polysaccharide–> T cell independent B cell response
Who gets PCV13
All infant and young children
Who gets PPSV23
Adults
PBC ass w/
Ant-Mitochondrial Ab
Sever hyperlipidemia
Metabolic bone disease
What causes referring syndrome? clinical manifestations?
Carb intake stimulates insulin activity, promoting cellular uptake of PO4*, K, and Mg
-Arrhythmias and cardiopulmonary failure
Drug-induced interstitial nephritis features
Fever, rash, and arthralgia
sterile pyuria w/ eosinophils
How long for PSGN
10-20 days after strep throat or skin infections
What is salvage therapy
Treatment for a disease when standard therapy fails
Why follow giant cell arteritis patients with serial chest X-rays
Aortic aneurysms are a well known complication
EM usually occurs after?
Herpes simplex lesion
SJS by sudden onset of
Mucocutaneous lesions and systemic signs of toxicity
Common features of psoriatic arthritis
Morning stiffness
Sausage fingers
Nail involvement
Ataxia hemiparesis from stroke where
Pons
What is needed differentiate follicular thyroid adenoma from carcinoma
Carcinoma will show invasion of the capsule and blood vessels
Lyme tx
Doxy (unless pregnant or under 8 years old)
Best initial test for esophageal squamous cell carcinoma
Pandendoscopy (esophagoscope, bronchoscopy, and laryngoscopy)
Renal vein thrombosis most commonly seen with what nephropathy? why
Membranous
Loss of antithrombin III
Renal vein thrombosis presentation
Acute abdominal pain, fever, and hematuria
Or progressive with gradual renal worsening and proteinuria
What causes orthostatic hypotension in elderly
Progressively decreasing baroreceptor sensitivity and defects in myocardial response
Greatest risk in completing homicide
Access to firearms
Most appropriate test to identify intrauterine fetal demise
Real time US to demonstrate an absence of fetal movements and cardiac activity
When should be done in all cases of stillbirth
Autopsy of the fetus and placenta (with permission from the parents)
Can pregnant women get Hep A and B vaccines
A resounding yes!
Most common cause of decreased fertility in women in their 30s+ who still have periods
Age-related decrease in ovarian reserve
Breast milk vs feeding failure jaundice timing
Failure: First week of life
BMJ: starts at 3-5 days, peaks at 2 weeks
Cause of breastfeeding failure jaundice
- Decreased bilirubin elimination
- Increased enterohepatic circulation
* signs of DEHYDRATION*
Cause of breast milk jaundice
High levels of B-glucuronidase in beast milk deconjugate intestinal bill and increase enterohepatic circulation
What should be suspected in any patient with pancytopenia following drug, toxin, or viral exposure
Aplastic anemia
TTN CXR
Bilateral perihilar linear streaking
Persistent pulmonary HTN of newborn CXR
Clear lungs with decreased pulmonary vasulcairty
TTN pathophys
Inadequate alveolar fluid clearance at birth resulting in mild pulmonary edema
Factitious diarrhea colon biopsy
Dark brown discoloration w/ lymph follicles singing through as pale patches (melanosis coli)
1st line therapy for patients w/ HTN and renal artery stenosis
ACEi or ARBs
Lab test good for dx of gallstone pancreatitis
ALT > 150
Why dec in BUN and Cr in pregnant patients
Inc. in renal plasma flow and GFR
In setting of liver disease, what two labs suggests ALF
- Worsening PT/INR
2. Inc bilirubin
What causes acute mitral regurg in inferior MI
Papillae muscle displacement
Acute mitral regurg heart changes
Elevated L atrial an ventricular filling pressures
Acute pulmonary edema
chronic would change atrial/ventricle size and compliance
How dose insulin resistance cause NASh
Inc. lipolysis, TG synthesis, and hepatic uptake of FA
–> Hepatic FA increase oxidative stress and production or pro-inflammatory cytokines
What do factorial design studies do
Involve randomization of different interventions with additional study of 2 or more variables
What is a cross over study
One group treated and other alternate treatment, then they switch
What is a “rare disease assumption”
In case-control studies, if outcome is uncommon in the population, odds ratio is a close approximation to the Relative Risk (which can normally only be calculated from cohort study)
RR calculation in cohort study
Compare risk (incidence) of disease among exposed to unexposed *can't calculate RR in case control study*
Relative risk vs OR
RR –> Cohort study
OR –> Case control study
Demeocyline used for treating
SIADH –> inhibits ADH-mediated aquaporin insertion in the cortical collecting tubule
3 ways to dx lactose intolerance
- hydrogen breath test
- stool test for reducing substances
- Low stool pH and increased stool osmotic gap
Post-op endothalmitis presentation
Pain and decreased visual acuity
Ex: Swollen eyelids and conjunctiva, hypopyon, corneal edema and infection
A-fib EKG features
Irregularly irregular R-R interval
Absent P waves
Narrow QRS complexes
Aspergillus serology test
Aspergillus IgG
Drug for stable patients with torsades
IV magnesium
First step in evaluating post op oliguria
Rule out obstruction
2 reasons for low back pain in pregnancy
- Increases in lumbar lordosis
- Relaxation of the ligaments supporting the joints of the pelvic girdle
Simple breast cysts management
Needle aspiration (if patient desires)
If breast mass in women under 30 is complex cysts/solid looking, next step?
Image-guided core biopsy
Mgmt of asymptomatic women with pelvic masses
Transvaginal US and then CA-125 level
2 drugs that increase appetite in chronic cancer patients
Progesterone analogues and corticosteroids
Splenectomy patients bad w/ encapsulated bugs do to
Impaired antibody mediated opsonization in phagocytosis
Congenital rubella triad
- Sensorineural deafness
- Cardiac defects (PDA)
- Cataracts
2 Turners heart defects
Bicuspid aortic valve
Coarctation
Also aortic root dilation
Reactive arthritis tx
NSAIDs
Calcium phosphate stones common in
Primary hyper PTh
RTA
What is Neurogenic arthropathy
Complication of neuropathy and repeated joint trauma affects weight bearing joints w/ deformity and loose bodies on imaging
Big 4 of carbon monoxide poisoning
Polycythemia
Nausea
Dizziness
Headaches
Grip myotonia seen in
Myotonic muscular dystrophy
Pos PPD tx in HIV pt’s
Isoniazid (and pyridoxine) for 9 months
Angina like episodes at likely? tx? avoid?
Prinzmentals
CCB and/or nitrates
Avoid non-selective B-blockers and aspirin
Most effective way to prevent systemic embolization in patients with non-valvular a-fib
Antithrombotic therapy
How does wilsons hurt liver
Hepatolenticular degneration
What causes familial hypocalciruic hypercalcemia
Abnormal calcium-sensing receptors on PTH and renal tubules –> Hypercalcemia and borderline high PTH
Chronic bronchitis def
Chronic productive cough for 3 month in 2 successive years
Phenytoin impairs absorption of what? other drugs do what to this?
Folic acid
MTX and TMP-SMX antagonize its physiologic effects
What can you take from drug reps
Only non-monetary gifts that are of minimal value and directly beneficial to patients
Pertussis tx
Macrolide antibiotics
