8 Flashcards
low back pain w/ alarm symptoms (worsening at night, >50 yo, fever, trauma, radiculopathy)
cord compression
back x rays, inflammatory markers
MRI
obese diabetic med
metformin
enuresis alarm vs desmopressin therapy
when behavioral interventions fail
alarm has better long term success, desmopressin is short term solution has high rate of relapse
type I
type II
treatment of type II
progressive elongation of PR, then drop->benign
regular PR, intermittent nonconducted Ps->progression to complete AV block->pacemaker
IV atropine if unstable (hypotension, confusion, chest pain)
long term->pacemaker
Nursemaid’s elbow imaging
treatment
unnecessary
hyperpronation/ supination
persistent and localized LAD
biopsy (lymphoma)
disagreement about futile care
ethics committee
optimal kidney donor
living, related, identical blood type
Rotator cuff tendonitis
lateral shoulder/deltoid pain, aggravated by abduction and external rotation
Amiodarone chronic interstitial pneumonitis
treatment
nonproductive cough, chest pain, weight loss, DOE, interstitial opacities on CXR
stop amiodarone, steroids if severe
amaurosis fugax
sudden, transient monocular blindness
marker of advanced CAD, carotid bruit
Polymyalgia rheumatica associated with
muscle weakness without pain
giant cell arteritis
polymyositis
Hemophilia A genetics
X linked recessive
Rash post ampicillin/amoxicillin in mono
discontinue and observe
preggo tdap
26-36 weeks of gestation
Unilat, spontaneous nipple d/c
imaging (mammogram + u/s in >30 yo)
papilloma
splenic vein thrombosis causes — bleeding
variceal
in dyspepsia, only test for h. pylori if
h. pylori diagnosis
NSAID induced
no history of nsaid/cox 2 or persistent symptoms after PPI
breath/stool antigen (not serum)
give PPI
HIV associated thrombocytopenia
active bleeding
if refractory
give ART
steroids or IVIG
splenectomy
In treatment naïve HIV, ART should decrease VL to
<50 in 6 months
<500 in 8-16 weeks
<5000 in 4 weeks
TB meningitis
diagnosis
choroidal tubercles (yellow-white nodules near optic disc) basilar meningeal enchancement CSF: prot >250, gluc <10, lymphocytic pleocytosis, adenosine deaminase
serial LPs->acid fast bacilli smear and culture
TB meningitis treatment
RIPE + fluoroquinolone/aminoglycoside for 2 months, then 9-12 months of rifampin and isoniazid
adjuvant steroids
Vulvodynia treatment
pelvic physiotherapy, CBT->botox
preterm labor at 34-36 weeks
penicillin (if positive or unknown GBS) and steroids
- tocolytics before 34 weeks*
- Rh doesn’t have to happen during labor*
Infant botulism
diagnosis
treatment
neurotoxin that inhibits presynaptic ach release
constipation, oculobulbar weakness, desc flaccid paralysis, hyporeflexia
stool studies
IV botulism immune globulin
pain out of proportion to fracture/muscular injury
physical exam
fasciotomy
compartment syndrome
tightness, weakness, pain on passive movement
pressure > 20-30
investigate outbreak of infectious disease
prevalence
case-control study
cross sectional study
Occupational back pain, likelihood of returning to work
recovery expectation
lung cancer screening with low dose CT false positive rate
96%
Menopausal transition bleeding
diagnosis
> 45 yo->endometrial biopsy
clinical, no labs needed
EEG in AMS
nystagmus, hippus, automatism
Hep B serum sickness
treatment
immune complexes activate complement
fever, polyarthritis, dermatitis, fatigue, malaise
polyarteritis nodosa, glomerulonephritis
supportive care, steroids/plasmapheresis if severe
syncope without prodrome, structural heart disease
cardiogenic, work up, tele and echo
Pulm sarcoid treatment
1-2 years of steroids if symptomatic, usually resolves
schizotypal vs schizoid
odd vs robot
scrapable white lesion in mouth
ok in antibiotics, chemo, inhaled steroids
otherwise,
candida
test for HIV
scrapable white lesion in mouth
ok in antibiotics, chemo, inhaled steroids
otherwise,
candida
test for HIV
metoclopramide side effects
akathisia, dystonia, Parkinson-like
breastmilk jaundice management
spontaneous resolution by 3 months
f/u and check bilirubin
phototherapy only if bilirubin rises
conjugated hyperbilirubinemia is always pathologic
Monotherapy hypoglycemic that causes significant hypoglycemia
sulfonylurea, meglitinide
bilirubin>20 or ineffective phototherapy
plasma exchange
onychomycosis/ severe tinea pedis
oral terbinafine
Hyperkalemia EKG
treatment
peaked Ps, prolonged PR, QRS, no P waves
calcium
cervical change during active labor
if less
no cervical change for >4 hrs with adequate contractions/ >6 hours without
variable decelerations
1 cm/ 2 hr
oxytocin, amniotomy
c/section
umbilical cord compression->amnioinfusion
silicone breast implants morbidity
contracture, deflation, rupture
investigate ischemic cardiomyopathy with
stress test or cath
good prognosis in schizophrenia
sudden onset, later age, positive psych symptoms
nonmetastatic squamous cell carcinoma of one vocal cord
radiation, laser or partial vocal cordectomy
Cough 5 days-3 weeks
> 3 months in 2 consecutive years
acute bronchitis
viral->symptomatic treatment
chronic bronchitis->PFTs
porcelain gallbladder
increased risk of cancer, prophylactic chole if punctuate calcifications (not curvilinear) or biliary colic
white spots, discoloration on teeth
decay
prevent with fluoride
white spots, discoloration on teeth
decay
prevent with fluoride
No fruit juice when kids have viral gastro
hypotonic fluids (not water)
Pulmonary cachexia syndrome
loss of lean muscle mass due to energy imbalance and inflammation
PCOS patient seeking pregnancy first line treatment
weight loss ->ovulation induction->IVF
IVF first line if there’s tubal obstruction
Acute paronychia
treatment
Chronic paronychia with loss of cuticle
localized infection of nail fold
warm soaks, antiseptics, topical antibiotics
if abscess->drain
steroids
penicillamine
lead toxicity
copper chelator
<45: nothing, 45-69: succimer, DMSA >70: EDTA, dimercaprol
chronic psychotic symptoms w/o mania/ depression (stable mood)
not bipolar, schizoaffective
in bipolar/depression, psychosis always comes with mood changes.
Ischemic stroke prevention
blood pressure control, smoking cessation, control of blood sugar and lipids
Nonsuicidal self-injury (cutting)
assessment of suicidality and comprehensive psych eval
Nonsuicidal self-injury (cutting)
Bulimia nervosa treatment
assessment of suicidality and comprehensive psych eval
fluoxetine
polycythemia initial test
EPO
low: polycythemia vera
high: secondary cause such as hypoxia (rule out carbon monoxide poisoning with carboxyhemoglobin) or RCC
polyhydramnios
causes
AFI > 24cm
maternal DM, multiple gestation, congenital abnormalities
Drug induced lupus drugs
diagnosis
presentation
hydralazine, procainamide, minocycline, etanercept, infliximab
ANA, anti-histone antibodies
fatigue, night sweats, serositis, arthralgia, fever, organomegaly
phencyclidine
PCP
Snoring management
smoking and alcohol cessation, weight loss
Organophosphate poisoning treatment
atropine and pralidoxime
sac overlying lumbar spine
associated with
diagnosis
myelomeningocele
neurogenic bladder, bowel
elevated AFP, u/s
Chronic urticarial
diagnosis
treatment
prognosis
itchy wheals/rash comes and goes spontaneously
clinical
daily cetirizine->oral steroids
spontaneous resolution in 2-5 years
studying difference in mean values among several groups
2 paired proportions, patients as controls
analysis of variance
mcnemar test
hidradenitis suppurativa
treatment
intertriginous areas (axilla, groin, medial thigh, perineum)
weight loss, smoking cessation, cleaning
topical abx->oral abx (sinus tracts, scarring)->TNF alpha inhibitors and surgery
cherry angioma vs strawberry hemangioma
adult, increase with age, no treatment vs infant, regress with age, no treatment
rectocele
treatment
protrusion of posterior vaginal wall
constipation, pelvic pressure, lower back pain, fecal incontinence
pessary, surgery
refractory hypoglycemia
treatment
sulfonylurea poisoning
dextrose, octreotide
dextrose can cause transient hyperglycemia->insulin release->rebound hypoglycemia
IgA nephropathy vs post strep glomerulonephritis
gross hematuria (benign) vs >10 days post infection, no hematuria, decreased complement levels
epiglottitis
intubate if
lateral neck x ray
Hib,
stridor, drooling, dysphonia
thumbprint sign
racemic epi for croup (barking cough)
inability to find significance
Type II error
sudden cardiac death in young athlete with normal ECG and echo
diagnosis
brugada and long QT
anomalous aortic origin of coronary artery
angina/lightheadedness/syncope
coronary CTA/ MRA
not exertional
rapid, shallow breathing with normal VS post MVA
treatment
flail chest
oxygen, pain control, positive pressure ventilation, surgery
heat stroke
treatment
flushed, hot dry skin
evapourative cooling
catatonia
treatment
treatment of anti-psychotic induced dystonia, parkinsonism
stuck
benzo
benztropine
Likelihood ratio
negative likelihood ratio
probability of patient with disease to have finding/ probability of patient without disease to have finding
sensitivity/ 1- specificity
1-sensitivity/ specificity
Preop eval METS
Even if symptomatic during performance, ability to complete is what matters?
Features of benign pulm nodules
malignancy
popcorn calcification, concentric/central/diffuse/laminated homogenous calcification
eccentric, reticular, punctuate
tibial stress fracture
x ray
management
pain, localized tenderness, swelling
normal
pneumatic splinting, reduced weightbearing, graduated exercise
Negative symptoms in schizo
usually don’t respond to antipsychotics
refer for social skills training
stool cysts, flagellated trophozoites with 2 nuclei, persistent diarrhea after camping
prevention of outbreak
treatment
giardia
treat symptomatic people (don’t just treat stool), stay away from recreational water
flagyl
Pseudotumor cerebri not just obesity, but also
endocrine disorders, minocycline, isotretinoin
Salmonella in anyone more than a year old
supportive care
complex adnexal mass, positive B HCG, no evidence of intrauterine pregnancy
ectopic pregnancy
early pregnancy of undetermined location
bcg <1500, not visualized
chronic steroid therapy, add vitamins
D and calcium
annual DEXA
lactational mastitis treatment
breast abscess
oral dicloxacillin/ cephalexin
fine needle aspiration
tertiary hyperparathyroidism
parathyroidectomy when
CKD->elevated phosphorus->binds calcium->low free calcium->elevated pth->gets out of control->remains elevated
persistent hypercal/phos, very high PTH, soft tissue calcification/calciphylaxis, intractable bone pain
Parkinson psychosis
can be caused by medications
carbidopa/levodopa should be last to be reduced
if refractory, start quetiapine, clozapine, pimavanserin
NPH vs long-acting basal
hypoglycemia
pear shaped motile organisms
trichomonasiasis
postpartum endometritis treatment
most important risk factor
PID
clindamycin+ gentamicin
c/s, chorioamnionitis, preterm, protracted labor, PROM
ceftriaxone + azithromycin
Analgesic nephropathy
papillary necrosis->hematuria, pyuria, renal colic, proteinuria, sterile urine
