9 Flashcards
shoulder dystocia
management
inability to deliver anterior shoulder, retraction of fetal head into perineum after it delivers
McRoberts maneuver: thighs against abdomen
suprapubic pressure
zavanelli: push head back in for c/s if all else fails
ALS treatment
riluzole
Preggo warts
vaginal delivery
Reduction in mortality for quitters vs current smokers
within 5 years
microcytic, hypochromic anemia, normal RDW, increased ferritin
thalassemia
electrophoresis in both parents
recurrent anemia post EPO in ESRD
give iV iron if ferritin <500 and transferrin sat <20%
cortical cataracts associated with
macular degeneration
proliferative retinopathy in diabetes
MVP
nonejection click, MR
varies in timing depending on body position (venous return)
increases with decreased venous return like HCOM
treat subclinical hyperthyroidism when
TSH persistently < 0.1, >65yo, comorbidities
serious bacterial infection in neonates (<28 days)
treatment
e. coli, GBS
ampicillin + gentamicin/cefotaxime
*no ceftriaxone or sulfas
allergic bronchopulm aspergillosis
treatment
fleeting infiltrates, recurrent asthma exacerbations, central bronchiectasis
peripheral eosinophilia
steroids, itraconazole
TURP (for refractory BPH) complication
retrograde ejaculation
Dumping syndrome
treatment
complication of gastrectomy, abd pain, diarrhea, N/V, dizziness, sweating, dyspnea
high protein, low carb diet, smaller, more frequent
autoimmune hepatitis
diagnosis
primary biliary cirrhosis
GGT
elevated AST/ALT
ANA, anti-smooth muscle
elevated alk phos, antimitochondrial antibodies
cholestasis
C. diff when to give vanc
3rd recurrence
fever/WBC>15k/cr >1.5x baseline
vanc ff by oral rifaximin/ fidaxomicin
post TPA BP
keep below 185/105
factor V leiden
atrial myxoma
VENOUS thrombosis
mitral stenosis, heart failure, a fib, tumor plop, emboli
proteinuria in children
rule out orthostatic proteinuria with split urine collection
elevated in daytime only
benign, nothing further
auricular hematoma
bruising over mastoid
prompt evacuation to prevent cauliflower ear, prophylactic abx
basilar skull fracture
Fasting glucose DM
Impaired glucose
impaired glucose increases risk for
> 126
100-126
CAD
itching and urticarial followed by tense bullae
diagnosis
treatment
pemphigus vulgaris
bullous pemphigoid
skin biopsy, serum assay
steroids
flaccid bullae, sloughing, oral lesions
> 6 months with undescended testicle
orchiopexy
risk of cancer remains higher
Acne lifestyle interventions
avoid vigorous scrubbing, use water-based skin products, ph-neutral detergent cleansers
do not pick lesions
No live vaccines in preggo
MMR, varicella, rotavirus
meconium ileus
down syndrome gut
cystic fibrosis
bilous emesis, abdominal distension
dilated loops of small bowel, absent air-fluid levels, right sided ground glass mass
duodenal atresia, hirschsprung
GDM postpartum
stop insulin
screen at 6 weeks postpartum with 2 hour glucose tolerance test
invasive aspergillosis
imaging
treatment
hemoptysis, cough, pleuritic chest pain
nodular disease with surrounding ground glass opacities, cavitations with air fluid levels
legionella-GI symptoms
IV voriconazole
cryptorchidism diagnosis
clinical, no imaging
DKA ICU
signs of cerebral edema, severe acidosis
kava kava adverse effects
gingko biloba
ginseng
liver failure
bleeding
headache, insomnia, GI, vaginal bleeding, insomnia
opioid withdrawal treatment
methadone/ clonidine
hypertonia, hyperreflexia and delayed motor milestones in preterm infant, sustained clonus, scissoring
cerebral palsy, get MRI
Acute gout in renal insufficiency
NSAIDs and colchicine CI
oral steroids if polyarticular, CSI if mono articular
raloxifene and selective estrogen receptor modulators preop
discontinue 4 weeks before surgery (VTE)
hold diuretics and metformin morning of surgery
hold ACEI if not being taken for heart failure
Ecologic fallacy
applying population level findings to individuals
h/o of spontaneous abortions (>3 consecutive), uterine filling defect
uterine septum
resect
ACL injury
meniscus
popping ff by rapid hemarthrosis and instability
locking/ catching
congenital hypothyroidism
start synthroid ASAP
primary ovarian insufficiency treatment
estrogen (+ progesterone if intact uterus) up to age 50
croup treatment
mild: humidified air and IM steroids
severe: steroids + nebulized epinephrine
Preggo UTI treatment
preggo pyelo
nitrofurantoin, cephalexin, augmentin
admit, ceftriaxone
afebrile for 48 hours->discharge on abx->daily suppressive therapy till 6 weeks postpartum
loud S1+ mid diastolic rumble at apex
mitral stenosis
most commonly due to rheumatic heart disease
Tinea capitis can cause hair loss.
treatment
oral griseofulvin/ terbinafine
Asthma
house dust mites
prostate cancer screening if you have to
55-69 yo
confounding vs effect modification
variable associated with both exposure and outcome, no change in direction or strength of effect vs third variable changes direction or strength of effect
skin tags associated with
obesity, metabolic syndrome, insulin resistance, diabetes
persistent rhinosinusitis
complicated sinusitis
5-7 days of PO augmentin
beyond sinuses->imaging
Elevated AFP in pregnancy next step
anatomic u/s
refractory osteoporosis
screen for multiple myeloma, search for secondary causes
otherwise iv bisphosphonate or teriparatide
priaprism treatment
nonischemic priaprism
aspiration of corpora cavernosa->injection of phenylephrine
angiographic embolization
steroid taper
not necessary if administration <3 weeks
iron deficiency anemia in infants
Mentzer index
iron deficient milk
MCV/RBC, >13: iron def, otherwise: thalassemia
postischemic compartment syndrome
post thrombectomy
infectious cause of stroke in young adults
HSV encephalitis
syphilis
hemorrhagic infarction of temporal lobe, RBCs in CSF
PEA/ asystole
CPR, epi every 3-5mins
identify underlying cause
latent TB resistant to isoniazid
rifampin for 4 months
Acoustic neuromas are
schwannomas.
Tinea capitis can cause hair loss.
treatment
oral griseofulvin/ terbinafine
area under curve (AUC)=
diagnostic accuracy, the larger, the better
Anemia of chronic disease in rheumatoid arthritis
TNF-alpha inhibitor
if on methotrexate->folinic acid
Glasgow score <=8
intubate
Elevated AFP in pregnancy next step
repeat test->anatomic u/s
if u/s normal->amniocentesis
TCA overdose
sodium bicarb->mag/ lidocaine
hematuria evaluation
u/a and culture->imaging->cystoscopy
well-diff adenocarcinoma without involvement of stalk or resection margins
removal alone, surveillance
bilateral nipple discharge
even though likely benign, evaluate
lead toxicity consequences
cognitive impairment and behavioral issues
brief shooting back pain provoked by bending forward and straining
nerve root irritation
positive straight leg raise test
night pain-alarm symptom
pellagra (niacin deficiency)
dementia, diarrhea, dermatitis, stomatitis, cheilosis
Angiodysplasias associated with
ESRD, von Willebrand disease, aortic stenosis
superior vena cava syndrome diagnosis
CT neck and chest with contrast
Glucagonoma rash (pancreatic tumor)
necrolytic migratory erythema: erythematous, painful, itchy rash clearing from center
mild diabetes
evidence of gallstones with pancreatitis (no other causes, even if not in CBD)
remove in same hospitalization
if severe disease with organ dysfunction->wait and ERCP
urinary incontinence diagnosis
history, exam, u/a
diphtheria
complications
treatment
URI, sore throat, pharyngitis with grey exudates that coalesce into pseudomembrane
myocarditis (complete heart block, heart failure), nervous system, kidneys
penicillin G, erythromycin
melasma
treatment
irregularly shaped hyperpigmented macules on the face, associated with pregnancy
avoid sun exposure
intracranial hemorrhage on warfarin
dabigatran reversal
urgent reversal with prothrombin concentrate and vit k
idarucizimab
Adenomatous polyps on sigmoidoscopy
colonoscopy now
CAP in kids
strep pneumo, amoxicillin
steroid taper
not necessary if administration <3 weeks
progressive hip pain and altered gait in obese adolescent
diagnosis
treatment
slipped capital femoral epiphysis
x ray-posterior and inferior displacement (falling ice cream)
immediate surgical pinning
prolactinoma treatment
first line: dopamine agonists (bromocriptine, cabergoline)
Post otitis media treatment serous fluid
may persist for 3 months
watchful waiting
if unresolving->miringotomy with insertion of tympanostomy tubes
Centor criteria
tonsillar exudate, anterior cervical LAD, no cough, fever
test if >=3
orbital fat tissue in wound
septum injury, levator palpebrae injury
asymptomatic first degree AV block or LVH in athletes
reassure
B12 deficiency can cause delirium/ dementia in elderly.
look for pancytopenia, elevated indirect bilirubin
DEXA screening beginning at age
65
NSTEMI treatment
aspirin, BB, statin, heparin drip, nitro prn
no BB if signs of heart failure
Metformin cath
discontinue till 2 days after
intractable BPPV
other cause of vertigo
plugging of posterior canal
image
EBV smear
atypical lymphocytes
polymyalgia rheumatica without arteritis
low dose prednisone
Normal hep b series
0,2,6 months
serology should be obtained at 9 months (3 months after last dose) if hep B mother
functional constipation in children
diet modifications->osmotic laxative
Sensitivity analysis is
Repeating analysis after modifications
Actinic keratosis cancer
Squamous cell carcinoma
Brain death apnea
8-10 minutes
Lewy body dementia on antipsychotics adverse events
Autonomic dysfunction, worsening of disease
Closed cervix
Not in labor
Fitz Hugh Curtis
PID, RUQ pain, fever, elevated transaminase
Thalassemia anemia
Microcytic
