5/6 Flashcards
Target INR for A-fib or idiopathic VTE
2.0-3.0
Target INR for patients with prosthetic heart valves
2.5-3.5
What should be checked in every patient w/ menopause like symptoms
TSH and FSH
CGD defect
NADPH oxidase enzyme complex –> can’t form hydrogen peroxidase
Cause of LAD
Impaired neutrophil migration to the site of infection
LAD features
Delayed umbilical chord separation, recurrent NON PURULENT infections, marked neutropenia, and severe periodontal
Type 1 vs 2 HIT timing
type 1: within 2 days and usually fixes itself
type 2: 5-10 days
Initial carpal tunnel tx
Splinting and NSAIDs
Presentation of vasa previa
Painless vaginal bleeding that occurs w/ rupture of membranes followed by fetal deterioration
First line tx for symptomatic bradycardia
IV Atropine
What is Ludwig’s angina? MCC of death with this
Infection of the submandibular and sublingual glands
MCC of death with this is asphyxiation
SCFE in pt’s w/ endocrinopathies
Likely bilateral with early presentation
Edwards features
Trisomy 18 –> Rocker bottom feet, VSD, absent palmar creases, overlapping fingers, microcnathia
Newborns with Hep B pos mothers
HBIG (passive immunization) followed by active immunization with HBV vaccine
Dx conformation of ALL
Bone marrow biopsy showing >25% lymphoblasts
Why can severe pain prevent urination in BPH dudes
They need to valsalva in order to pee
Why bone loss in AS patients
Increased osteoclast activity in the setting of chronic inflammation
Inflammatory back pain feature of AS
Relieved with exercise but not rest
Hgb electrophoresis of beta-thal minor
Increased Hgb A2
Heme studies of Thal minor
MCV out of proportion to degree of anemia (Hgb > 10) and disproportionately high RBC count
When does iron def anemia become microcytic
When Hgb drops below 10
Tricomonas tx
Metronidazole
K in ACE use
Hyperkaelmia and rise in creatinine due to reduced GFR
CLL conforation
Flow cytomerty –> can demonstrate lymphocyte clonality
What bug causes endocarditis associated with nosocomial UTIs
Enterococci
Viridans group strep endocarditis with (2)
- Dental procedures
2. Procedures involving incision and biopsy of respiratory tract
Lateral epicondylitis features
Pain w/ supination or extension of the wrist and point tenderness just distal to lateral epicondyle
Test for radial tunnel syndrome
Flexing patients long finger while patient actively extends the finger and wrists
MCC of paroxysmal tachycardia in people without structural heart disease? What causes it
PSVT
Usually caused by re-entry circuit in AV node
What is often associated with breath holding spells in children
Iron deficiency anemia
2ndary hyper-PTH from renal failure features
Hypocalcemia
Hyperphosphatemia
Increased PTH
What can thyroid surgery cause
Hypoparathyroidism
When do sickle cell kids spleens usually auto-infarct
First 18-36 months of life
What are Heinz bodies
Aggregates of denatured Hgb seen in G6PD def and thalassemia
form bite cells with macrophages get them
Alports defect? kidney biopsy?
X-linked defect in collagen-IV formation
Kidney biopsy usually shows thinning of GBM
Two organs goodpasutures affects
Lung and Kidney
Increased deposition of poorly mineralized osteoid is seen in
Vit D def
Most common part of the spine RA affects?
Cervical joints in the axial skeleton –> can lead to cervical spine subluxation
Serous otitis media otoscope exam
Dull TM that is hypomobile on pneumatic otoscope
Big acute interstitial nephritis drugs
Penicillins, TMP-SMX, cephalosporins, NSAIDs
Barter/Gittlemans syndrome labs
Normotensive w/ hypokalemia and alkalosis
high urine [Cl]
MCC of a-fib
Ectopic foci within the Pulmonary veins
Who gets plasma HIV RNA tests
Patients with negative serologic tests but high clinical suspicion of HIV
Project
Attributing undesirable feelings to someone else
What do MEN 2A and 2B have in common? different?
Both have MTC and Pheos
2A has parathyroid hyperplasia
2B have mucosal neuromas and marfanoid habitus
Lab of congenital toxo
Hyperbilirubinemia and thrombocytopenia
What can prolonged nitroprusside therapy cause? presentation?
Cyanide toxicity –> presents with AMS, lactic acidosis, seizures, and coma
Gold standard to dx cervical incompetence
Transvaginal US –> look for funneling of cervix or short cervical length
Two best tx for stress incompetence
- Pelvic muscle exercises
2. Urethropexy
MCC of isolate proteinuria in children
Transient proteinuria –> repeat urine dipstick for protein 2x to rule out anything else
Whistling noise after rhinoplast
Nasal septal perforation likely 2/2 septal hematoma
After MI, rupture of ventricular free wall presentation
5 days to 2 weeks after –> Acute chest pain and profound shock, w/ rapid progression to PEA and death
Best diagnostic test for diverticulitis
Abdominal CT (w/ oral contrast)
Earliest signs of serious infection in neonate
Poor feeding and decreased levels of alertness
Why is a head CT not needed in neonates before an LP
They do not herniate, as their open fontanelles serve to relieve intracranial pressure
Pertussis ppx for house w/ sick contact
Macrolide for all close contacts
Viral myocarditis MCC by what virus
Coxsackievirus B
herpes simplex keratitis characterized by
Corneal vesicles and dendritic ulcers
Most common nerve injury in association with mid-shaft fracture of the humerus
Radial nerve injury
Most reliable sign for spinal osteomyelitis
Tenderness to gentle percussion over the spinous process
Inc ESR and Inc platelets
R Ventricular MI features
Hypotension
JVD
Clear lung fields
Right MI mgmt
Avoid nitrates and diuretics, as these patients are preload dependent
Bolus them
Most common vaccine-preventable disease among travelers
Hepatitis A
What should DM patients age 40-75 get regardless of baseline lipid levels
Statin
BCC features
Slow growing papule with pearly rolled borders
Two Ab for cellulite w/ systemic signs
IV nafcillin or cefazolin
Aspergillosis CT
Pulmonary nodules with a halo sign or lesions with an air crescent
Histo CXR
Hilar adenopathy and areas of pneumonitis
Acute angle closure glaucoma presentation
Unilateral orbitoforntal headache ass w/ n/v, unilateral hey pain w/ conjunctival injection, and dilated pupil w/ poor light response
Drugs that causes idiosyncratic liver injury w/ histological features similar to viral hepatitis
Isoniazid
Halothane
Phenytoin
Alpha-methyldopa
pronator drift a sign of
upper motor neuron damage in UE
Dx for esophageal perf
Water soluble contrast esophagram
What is constitutional growth delay characterized by
Delayed growth spurt
Delayed puberty
Delayed bone age
Anterior shoulder dislocation can cause damage tow hat
Axillary nerve or artery
What is Kehr’s sign
Pain radiating to the shoulder due to diaphragmatic irritation
Neonatal thyrotoxicosis results from? tx?
Transplacental passage of anti-TSH receptor antibodies
Tx: Methimazole + B blocker
All RA patients should get what
MTX early in the course to prevent joint damage
An adolescent with a solitary breast mass is likely
Fibroadenoma
re-examine after menses for decrease in mass size or tenderness
Why hypocalcemia from blood transfusion
Citrate in transfused blood binds ionized calcium
Two worst kinds of mutation
Non-sense and frameshift
Dx of CO poisoning
Carboxyhemoglobin level
One of the earliest manifestations of macular degeneration
Distortion of straight lines so they appear wavy
When should COPD patients get home O2
PaO2
Prolactin stimulated by and inhibited by what
Stimulated by serotonin and TRH and inhibited by dopamine
Nocardia micro
Gram+ weakly acid fast filament branching rod
Descending aortic dissection tx
Labetalol–> lower BP and HR, minimizing stress on the aortic wall
Risk factors for polyp progressing into malignancy
Villous adenoma
Sessile adenoma
Size > 2.5cm
Most common non-neoplastic polyps of the colon
Hyperplastic polyps
Non-vaccinated healthcare workers exposed to Hep B blood
Hep B vaccine and Hep B Ig
Early symptoms of CO poisoning
Typically neurologic (agitation, confusion, and somnolence)
Surgery for Androgen insensitivity folks
Bilateral gonadectomy after completion of puberty (e.g. after attainment of adult height)
Acute transplant rejection tx
IV steroids
AS is characterized by
Chronic inflammatory bain pain and stiffness, lumbosacral tenderness, and reduced spinal range of motion
