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All topics Flashcards

1
Q

Mgmt after ingestion of caustic substances (burn/corrode) i.e. cleaner

A

Endoscopy within 24 hours, CXR if resp sxs.

Activated charcoal, corticosteroids, emetics, and acid neutralization is not recommended

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2
Q

Blood in urine but no rbc on microscopy

A

Myoglobinuria –> Rhabdomyolysis

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3
Q

Difference btwn heat stroke and heat exhaustion

A

Heat stroke: failure of thermoregulation. Rhabdomyolysis. CNS dysfunction and temps can go >104

Heat exhaustion: inadequate fluid/electrolyte replenishment. No CNS dysf(x), temps usually <104

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4
Q

Tinnitis, fever, hyperventilation, and anion gap metabolic acidosis after ingestion of too much of this

A

Aspirin

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5
Q

Victims of smoke inhalation (i.e. burning house) should be treated empirically for _______ poisoning to prevent cardiorespiratory arrest and neuro sxs

A

Cyanide

  • ->hydroxycobalamin or sodium thiosulfate
  • ->can give nitrites to induce methemoglobinemia
Carbon Monoxide (neuro sxs)
-->100% O2 via non-rebreather
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6
Q

Pt with depression, comes in with anticholinergic effects (dilated pupils, intestinal ileus, tachycardia, dry mouth, urinary retenion), respiratory redepression, arrythmia/cardiotoxicity

A

TCA OD…antiCholinergic, Cardiotoxicity, Coma, Confusion

–>Tx: NaHCO3

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7
Q

Benzo toxicity/OD

A

CNS depression without much else. Less risk of resp depression/coma than barbiturates. Pupil size normal, respiratory rate may be normal.

–>phenytoin and alcohol OD look similar but will have +Nystagmus

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8
Q

Lithium toxicity

A

tremor, hyperreflexia, ataxia, seizures

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9
Q

Farmer comes in with organophosphate poisoning (all PNS type signs). Mgmt?

A

Atropine

Also, remove all clothes and wash body to prevent trasncutaneous absorption

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10
Q

Tx for acetaminophen ingestion/toxicity

A 
Activated charcoal (for gastric decontamination)
-->if high enough for liver damage, give N-acetyl cysteine
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11
Q

Diphenhydramine toxicity

A

looks like TCA OD cause strong anticholinergic effects. also have drowsiness and confusion from antihistamine effects.
–> Reverse with Physostigmine (cholinesterase inhibitor)

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12
Q

Ingestion leading to hypocalcemia + calcium oxalate crystals (flank pain + anion gap metabolic acidosis)

A

Ethylene glycol (anti-freeze)

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13
Q

Reversal of ethylene glycol OD (calcium oxalate stones/flank pain)

A

Fomepizole (or ethanol) –>inhibit alcohol DHase
NaHCO3 –>alleviate acidosis

may need hemodialysis in severe cases

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14
Q

Cyanosis and respiratory depression after Dapsone or Anesthesia

A

Methemoglobinemia –> Tx with Methylene Blue

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15
Q

what color will skin be in methemoglobinemia

A

blue (cynotic). tx with methylene blue.

unlike Carbon monoxide or cyanide poisoning

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16
Q

patient is having signs of opioid withdrawal. med?

A

Methadone!! do NOT give naloxone (this is going to make withdrawal worse)

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17
Q

most common cause of Mitral Regurgitation

A

MVP!!!!!!!!!!!! Mxyomatous degen. MS less common.

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18
Q

decreased globin chain synthesis vs defective globin chain synthesis

A

dec: thalasemmia
def: Sickle cell! defective beta-globin gene

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19
Q

difference btwn uncomplicated and complicated parapneumonic effusion

A

uncomp (sterile exudate in pleural space): pH>7.2, glucose >60, wbc <50k. Tx: ABx

comp (bacterial invasion in pleural space) Tx ABx, drain

vs Empyema = +gram stain and culture (neg in both uncomp and comp effusions)

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20
Q

T/F: Antipsychotics can cause unilateral bloody discharge from nipple

A

False. it would cause bilateral galactorhhea with amenorhhea

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21
Q

how do you work up abnormal nipple discharge?

A

Bloody or serous: MRI or US

Milky/nonbloody: blood tests
–>BUT…if there are skin changes/lumps, do MRI/US first

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22
Q

Endometriosis is discovered during an operative procedure. How is this treated?

A

Asx endometriosis = no treatment…OBSERVE

if sx, could do nsaids, OCPs, progesterone IUD

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23
Q

diagnostic peritoneal lavage vs exploratory laparotomy

A

lavage: for BLUNT abdominal trauma and hemo unstable and inconclusive FAST

ex lap: for PENETRATING trauma and hemo unstable/inconclusive FAST

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24
Q

Inhaled O2(+/- sumatriptan) with prophylactic verapamil

A

Tx of cluster headache

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25
Q

Sumatriptan with prophylactic propranolol, topiramate, valproate

A

Tx of migraine

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26
Q

Viridans streptococci that cause subacute endocarditisi include

A

mutans, sanguinis, oralis, mitis

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27
Q

this bugger causes UTI, is part of normal colonic flora, cause SUBacute ENDOcarditis following the GI/GU procedure (manipulation of urinary tract)

A

Enterococcus (faecalis)

–>VRE is an important source of nocosomial infx

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28
Q

T/F: Staph epi can cause endocarditis

A

true its a common cause. seen in patients with indwelling intravascular catheter or implanted prosthetic valve

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29
Q

how would LV free wall rupture post MI present and when?

A

within 2 weeks; present as tamponade/large pericardial effusion. can progress to pulseless electrical activity

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30
Q

why does patient develop MR within a week of MI?

A

Papillary muscle rupture.

Vs a ventricular aneuryms, which can occur within the next few months, will present with EKG changes (ST elevation) and HF.

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31
Q

Wallenberg: describe the lesions and location

A

-Lateral medulla. PICA. Vertebral artery.

  • N/V and Vertigo (fall to the IPSI side of lesion). Hoarseness/dysphagia
  • Diplopia and nystagmus (hor and ver)
  • IPSIlat: Horners (miosis, anhydrosis, ptosis); loss of pain/temp on face
  • CONTRAlat: loss of pain/temp body
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32
Q

lesion of posterior cerebral artery (PCA)

A

Contralateral homonymous hemianopsia with macular sparing (the shape of a p)
–> so right side PCA, then on both eyes the left half of the visual field lost (except the half circle in middle for macular sparing)

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33
Q

side effect of anti-muscarinic used to treat parkinsons features (cogwheel rigidity, resting tremor) i.e. Benztropine, Trihexyphenidyl

A

Anticholinergics can cause Acute Angle Glaucoma: sudden onset severe eye pain, n/v, unilateral conjunctival injection, dilated pupil with poor light response . can develop perm blindness.

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34
Q

Tx of OCD

A

SSRIs

Clomipramine

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35
Q

Tx for restless leg syndrome

A

Ropinorole, or pramipexole

dopamine agonists

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36
Q

what is the difference between steven johnson and toxic epidermal necrolysis?

A

both have +nikolsky, +oral mucosal involvement
Steven johnson: <10% body surface area affected
TEN: >30% affected

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37
Q

common triggers for SJS (<10%) and TEN (>30%)?

A 
allopurinol
antibiotics (sulfa)
anticonvulsants (lamotrigine: bipolar, mood stabilizer)
nsaids
sulfasalazine
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38
Q

T/F: Ankylosing spondylitis can be treated with steroids

A

FALSE FALSE FALSE HOMEBOY DO NOT DO IT
they dont work
Tx for AS: NSAID, Infliximab/adalumab, sulfasalazine

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39
Q

how do you treat major depression with psychotic features?

A

-combo of antidepressant/antipsychotic
OR
-ECT (esp if urgent…i.e. geriatric pt not eating, suicidal, PREGNANT)

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40
Q

TRH and Estrogen(+ AP stim) increases Prolactin.
Prolactin increases Dopamine. PRL inhibits GnRH.
Dopamine inhibits Prolactin.

A

Yup, so antipsychotics (dopamine antagonists) and OCPs/pregnancy increase prolactin

Bromocriptine (DA agonist) decreases PRL. use for prolactinoma

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41
Q

Tourettes (multiple motor and at least one verbal tic) is comorbid with: _______
Tourettes is tx with:

A 
with OCD and ADHD
Tourettes Tx:
1. Nonpharm: Habit Reversal Therapy
2. Pharm
---> ANTIPSYCHOTICS BITCH, alpha-2-agnoists (clonidine, guanficene)
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42
Q

what are the high potency first gen antipsychotics?

  • ->increased EPS/NMS/TD
  • ->Less anti-HAM
A

Haloperidol, Fluphenazine, Pimozide, Trifluoperazine

High Flu? Tri Halo and Pims, Cutie!
Pims: QT prolongation/vtach

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43
Q

what are the low potency first gen antipsychotics?

  • ->less EPS/NMS/TD
  • ->more anti-HAM
A

Chlorpromazine (BLUE-GREY discoloration, photosensitivity, PIGMENT (LENS/CORNEA for ChLorpromazine)

THIORIDAZINE (pigment reTinitis)

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44
Q

what are the anti-HAM side effects? seen esp with low potency antipsychotics (chlorpromazie/thioridazine)

A

anti-histamine: wt gain, sedation
anti-alpha1adrenergic: ortho hypo, sex dysfx, arrythmia
anti-muscarinic: dry mouth, urinary retention

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45
Q

the + sxs of schizophrenia are due to the _______ tract

the - sxs: _____ tract

A

mesolimbic (+) –>tx well by antipsychotics

mesocortical (-)

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46
Q

how do you treat EPS sxs?

A

Dystonia: Benztropine, diphenhydramine, trihexyphenidyl
Akathisia: beta blockers, benzo’s
Parkinsonism: Benztropine, amantadine, trihexyphenidyl

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47
Q

what happens in HIT and how do you tx?

A

Thrombocytopenia and THROMBUS (arterial and venous) formation. IgG on platelet surface.
Use Argatroban/Fondaparinux (BAD) = anti coag with a non-heparin

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48
Q

vaginosis by pH

A 
pH>4.5: Bacterial vaginosis (-inflammation) and Trichomonas (+ inflammation)
normal pH (3.8-4.5): Candida (+inflammation)
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49
Q

Which meds are held and continued prior to cardiac stress test?

A

Hold for 48 hours: BB, CCB, Nitrates
–>no caffeine 12 hours before

Continue: ACEI, ARB, Statins, Diuretics, Digoxin

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50
Q

comorbid conditions with Absence seizures

A

ADHD, Anxiety

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51
Q

How do you restore coronary blood flow (main priority) in patient with STEMI?

A

PCI (percutaenous coronary intervention) or Fibrinolysis (tPA)

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52
Q

T/F: Short cervical length, detected by transvag US in a patient with prior cervical surgery, is a strong predictor of preterm delivery

A

true

  • ->give progesterone injections (maintain quiescence) if short
  • ->if hx of preterm and short now, do cerclage as well
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53
Q

anemia and thrombocytopenia are classically seen in malaria/dx gold standard =

A

peripheral smear

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54
Q

how do you tx cardiotoxicity of tca overdose?

A

Sodium bicarbonate

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55
Q

who gets MVP?

A
  • most common presentation: YOUNG FEMALES in general population; might have PALPITATIONS and atypical Chest Pain not ass with exertion
  • Specific syndromes: ADPKD; Marfans; Fragile X; Ehlers-Danlos
  • most common valvular anomaly. heard at apex.
  • early: midsystolic click, murmur shortens with squatting (preload). late: holosystolic MR murmur, increases with squatting (afterload)
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56
Q

Patient is screened with PAP and has abnormal findings (non-ASCUS). What’s the next step?

A

Reflexive COLPOSCOPY!
–>Ectovervix only: Local destruction (LEEP, Cryo)
–>Ecto + Endo: Cone bx
–>if patient is pregnant, can defer until afterwards
If ASCUS, either get HPV DNA (if +, do colp) or repeat in 3 months

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57
Q

Management of CIN III

A

CONE BIOPSY (if >25 and not pregnant: have to sample transition zone to look for SCC

CIN III = HSIL = HPV (high risk subtypes).

If CIN 1, CIN 11, or ASCUS/AGUS, can do HPV testing to see if its high risk

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58
Q

classic presentation of molar pregnancy

A
  • vaginal bleeding, hyperemesis gravidarum, hyperthyroidism, diffusely enlarged uterus with regular contour
  • pelvic US: Snowstorm appearance
  • PE: “grape-like mass”
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59
Q

reflexes (spinal level)

A

Bicep: C5
Tricep: C7
Patella: L4
Ankle: S1

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60
Q

Conus medullaris vs cauda equina

A

Conus: sudden onset back pain; perianal anesthesia; SYMMETRIC weakness; HYPERreflexia; early onset bowel/bladder dysfx

(more common) Cauda Equina: bilat, severe radicular pain; saddle anesthesia; ASYYmetric weakness; HYPOreflexia; late onset bladder/bowel dysfx. affects SACRAL roots. so +sensory dysfx at Umbilicus (t10) would rule this out.

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61
Q

inspiratory stridor better with pronation/extension vs biphasic stridor better with extension

A

Insp: Laryngomalacia
Biphasic: Vascular ring (aortic arch bring encircles trachea/esophagus)
(these are both chronic causes. acute causes = foreign body and croup)

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62
Q

what are causes of renal transplant dysf(x) in the early post op period?

A
  • HYQ
  • ureteral obstruction (i.e. US shows dilated calcyce)
  • Acute Rejection (graft tenderness, wbc infiltrate on bx)
    - -> Tx with Steroids
  • Cyclosporine toxicity
  • ATN (Tx with IV diuretics/fluids)
  • Vascular obstruction
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63
Q

Tx of essential tremors

A

Beta blockers and PRIMIDONE.

“amazon PRIME is ESSENTIAL, BETA”

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64
Q

3 causes of retinopathy in HIV

A

Pain: HSV or VZV

No Pain: CMV

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65
Q

Pneumonia causes hypoxemia due to:

A

R-L Intrapulmonary Shunting –> huge V/Q mismatch!!!! (alveoli are filled with fluid can’t participate in gas exchange)

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66
Q

ACEI, ARB, Beta blockers, Digoxin, Spironolactone, Furesomide: all give benefit to CHF patients. Which ones improve survival (vs sx only)?

A

All except for digoxin and furesomide

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67
Q

WHAT THE FUCK ARE YOU GONNA DO IF SOMEONE COMES IN LOOKING LIKE THEYRE HAVING A STROKE?

A

CT WITHOUT CONTRAST. RULE OUT HEMORRHAGE. DO NOT GIVE ASPIRIN. DO NOT DO ANYTHING EXCEPT NONCON CT

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68
Q

What workup for a stroke after the acute presentation is over (i.e. day 2)?

A
  1. Transesophgeal ECHO: assesses cardiac valves/thrombus
  2. ECG: Afib assessment/thrombus
  3. Carotid US: assess stenosis.

could do CT angio/MRI? look at blood vessels of brain and ischemia

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69
Q

Patient has atypical glandular cells on pap. Next step?

A

So obvi Reflexive Colposcopy always!
-but if also >35, or <35 with obesity/anovulation/high estrogen, have to look for endometrial cancer on top of cervical
= Reflexive Colp (ectocervix), Endocervical curettage (endocervix), and Endometrial biopsy (endometrium)

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70
Q

FOOSH in little kid results in:

A

Supracondylar fracture of humerus (most common peds fracture)

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71
Q

complications of supracondylar fracture of humerus

A
  • Brachial artery injury
  • Median nerve injury
  • Cubitus varus malformation
  • (rare)Compartment syndrome/volkmann contracture
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72
Q

who gets transient tachypnea of newborn and what causes it?

A

term babies that underwent C/s (or quick 2nd stage of labor)
–>caused by fluid still in the lungs (doesnt get squeezed out) = increased resistance/decreased complicance
–> look for +CXR findings: fluid in fissues, increased pulm vasc markings, perihilar streaking
Tx: O2

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73
Q

what does US show for ovarian torsion?

A

adnexal mass with absent Doppler flow to ovary

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74
Q

features of vertebrobasilar insufficiency (emboli/thrombus/dissection)

A

Vertigo
N/V
DYSARTHRIA, Diplopia, numbness,
Ataxia

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75
Q

Vancomycin toxicity and prevention

A

NOT problem free. Nephrotoxicity, Ototoxicity, Thromboplebitis. Red man syndrome (flushing) prevented by antihistamines!! and slow infusion rate
(vs flushing of niacin with aspirin cause PG)

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76
Q

Interventricular septal rupture vs Ventricular free wall rupture

A

Septal Rupture: 3-5 days (same as papillary muscle rupture). Presents like a VSD: Holosystolic murmur, hypotension, shock, chest pain, Right heart failure sxs

Free wall rupture: 5 days - 2 weeks. acute chest pain, profound shock, tamponade and pulseless electrical activity/death

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77
Q

how does ventricular aneurysm post MI present?

A

Late (weeks to months later). Heart failure, arrythmia, refractory angina, may have systemic arterial embolism from mural thrombis

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78
Q

when is a transesophageal echo used?

A
  • Endocarditis!!! This + blood cultures
  • Aortic dissection: get either a TEE, CT angio or MR angio (if any renal dz i.e. elevated Cr, get the TEE)
  • after acute stroke presentation. look at valves/thrombus
  • Aortic stenosis
  • Zollinger Ellison…?
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79
Q

when is coronary angiography used?

A
  • determine who needs CABG
  • if stress test is abnormal maybe do it
  • usually not the right answer
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80
Q

symmetric vs asymmetric IUGR

A

Symmetric: 1st trimester. Chromosomal anomaly or intrauterine infx
Asymmetric: 2nd/3rd. Uteroplacental insuff (HTN, DM), maternal malnutrition (spares head)

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81
Q

Asplenic patients (i.e. abdominal trauma) are at increased risk for which infxs and why?

A

ENCAPSULATED

  • deficits in antibody response/antibody-mediated phagocytosis and complement activation (splenic macrophages)
  • these pts need vaccines: meningococcal, pneumococcal, HIB
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82
Q

T/F: Intra and extrahepatic biliary tract dilation can be seen in a patient with painless gallbladder distention

A

True. Pancreatic cancer (courvosier sign)

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83
Q

What did a patient receive too much if she is seizing in the early postpartum period?

A

Oxytocin!!! Similar to ADH so causes HYPONATREMIA
and hypotension

(not magnesium: hyporeflexia/lethargy/resp and cardiac failure)

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84
Q

leading cause of B12 deficiency and its long term complication

A

Pernicious Anemia
Gastric Cancer (intestinal type) and Carcinoid tumor
(due to atrophic gastritis)

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85
Q

Entamoeba histolytica vs Echinococcus granulosus

A

E. histolytica: GI. Liver abscess, RUQ pain, BLOODY DIARRHEA (i.e. DYSENTERY). cysts in water. metro.

E granulosus: Tapeworm, dog feces/sheep. Hydatid cysts in liver: cause RUQ pain, fever (not always), hepatomegaly, eosinophilia. can cause pulm sxs hemoptysis. albendazole

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86
Q

what are the 2nd gen antipsychotics?

A

Clozapaine (agranulocytosis, tx refractory), risperidone (hyperprolactinemia), quietiapine, olanzapine, ziprasidone, aripiprazole, lurasidone

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87
Q

Why is “failure of follicular maturation” part of PCOS?

A

High androgen = high estrone = neg feedback on GnRH = abnormal LH/FSH = lack of LH surge –> causes lack of follicular maturation and oocyte release i.e. Anovulation. mic drop

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88
Q

Wtf is sex chromosome monosomy?

A

XO = Turners

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89
Q

Premature ovarian failure aka primary ovarian insufficiency is associated with:

A

Autoimmune disorders. “menopause before 30”. Normal testosterone level. Infertility and oligomenorrhea (if high testosterone its PCOS pick failure of follicular maturation)

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90
Q

how do you treat migraines in kids?

A

Supportive (dark room etc) + nsaids/tylenol

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91
Q

How far does the placenta have to be from opening for vaginal delivery to be allowed?

A

at least 2 CENTIMETERS. INCHES IS A FUCK TON. CEntimeters from the CErvix.

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92
Q

ovarian mass causing breast tenderness, postmenopausal bleeding or precocious puberty

A

Granulosa cell tumor: secretes estrogen baba

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93
Q

Vitiligo (depigmentation on hands, feeth, face) is associated with:

A

autoimmune disorders habibti

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94
Q

Losing balance during Romberg test (+)

A

Proprioception fucked up: pick B12 def or tabes dorsalis

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95
Q

+Pronator drift test

A

UMN or Pyramidal tract dz.

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96
Q

ataxia, intention tremor, problem with rapidly alternating movements

A

Cerebellar dysfx

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97
Q

Acute renal failure (rising Cr) in patient with severe liver disease and portal hypertension

A

Hepatorenal syndrome

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98
Q

Pulsus bisifiriens

A

Aortic regurg, HOCM. 2 strong aortic peaks of systolic pulse.

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99
Q

Hypotension and elevated JVP

A

Look for becks triad (+ muffled heart sounds) = Cardiac Tamponade i.e. pericardial effusion

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100
Q

how do you treat pneumonia?

A

CAP: Ceftriaxone + Azithromycin
HCAP: Vancomycin + Pip/Tazo

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101
Q

EKG findings of LVH + htn in a young person

A

(t wave inversion V5, V6; high voltage QRS; lateral ST segment depression)
Coarctation of aorta
some random clues may be epistaxis, headaches, LE claudication. may hear continuous murmur.

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102
Q

high frequency age related sensorineural hearing loss. harder to hear in crowds /noisy environemnts

A

Presbycusis

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103
Q

scaly papules/plaques on sun exposed areas (scalp/face/arms/hands). Premalignant for SCC. Dz and Tx

A

Actinic Keratosis

  • ->local ablation: Cryotherapy
  • ->f/u: 5-Fluoruracil (5-FU) = chemo
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104
Q

Anti-cyclic citrullinated peptide and rheumatoid factor associated with:

A

rheumatoid arthritis

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105
Q

What might parvo virus in an adult look like?

A

Rheumatoid! Dont be fooled:

  • <6 week of sxs
  • school teacher/daycare worker
  • absence of joint swelling/sxs won’t last at least an hour in the morning like in RA
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106
Q

decreased sensation 4th/5th digits plus decreased hand grip (due to interosseous mm)

A

Ulnar nerve entrapment at the elbow (medial epicondylar groove)

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107
Q

EKG leads

A 
Limbs: 
I, aVL: Lateral 
II, III, aVF: Inferior (many of them are R sided infarct)
Precordial: 
V2, V3, V4: Anterior
V5, V6: Lateral (LVH)
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108
Q

why are nitrates and diuretics avoided in treating Right heart failure (i.e. II, III, avF)?

A

In RHF, theres a big problem with preload and hypotension. Nitrates and diuretics would further decrease preload.

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109
Q

T-test compares two ______,

Chi square test compares two or more _______

A

t-test: means (i.e. blood pressure). ANOVA compares 3 or more means
chi square: proportions i.e. high, low, etc

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110
Q

T/F: A muffled voice should make you consider a dx other than uncomplicated pharyngitis/tonsillitis

A

TRUE AF HOMEBOY. think about peritonsillar abscess (i.e. deviation of the uvula, unilateral LN. needs aspiration/drainage + ABx)

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111
Q

Why might I might mistake McCune Albright for cushings?

A

Includes endocrine disorders like cushings syndrome.
Unilatearl Cafe-Au-Lait spots + Precocious Puberty + Multiple bone defects (Polyostic fibrous dysplasia) + endocrine disorders

3 P’s: Precocious Puberty, Polyostic bone shit, Pigmentation

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112
Q

If you have an abnormal first trimester screen (i.e. elevated bhcg), do you do a second semester screen?

A

Nope, you do diagnostic testing (in 2nd tri this means Amniocentesis).
First and 2nd tri screens pick up aneuploidy (i.e trisomies)

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113
Q

when does second trimester start?

A

week 13 - 28

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114
Q

dates to do CVS and amniocentesis

A

CVS (first tri): week 10-13
Amnio (second tri): week 15-20

give you a fetal karyotype

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115
Q

when do you stop Pap?

A

Age 65 + no hx CIN2 or higher + 3 consecutive negative paps/2 consecutive negative cotesting
(if CIN2 or greater, 20 years since then of testing)

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116
Q

How do you manage PPROM?

A

<34 weeks: Antibiotics, Steroids!!! (beclamethasone). If infection/fetal compromise, and deliver. Otherwise, fetal surveillance. If <32 weeks you give Mg.

34-37 weeks: Antibiotics, +/- Steroids, DELIVER

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117
Q

T/F: PPROM at 34-37 weeks youre going to deliver

A

TRUE. with antiobiotics and +/- steroids
(<34 weeks you only deliver if infx/fetal compromise. still give antibiotics and steroids. if less than 32 give mg and deliver if looks shitty)

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118
Q

when an orbital cellulitis like picture looks worse, CN deficiencies and neuro signs, whats the dx

A

Cavernous sinus thrombosis (cn 3 4 5 6 affected, severe HA, bilat periorbital edema)

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119
Q

side effects of levodopa/carbidopa

A

Hallucinations! confusion/HA/dizziness/agitation

much much later: involuntary movements (dystonia/dyskinesia…5-10 years later).
On/off phenomenon

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120
Q

Which parkinson drug side effect causes choreiform dyskinesia?

A

COMT inhibitors: EntaCapones, TolCapone

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121
Q

Which parkinson drug can cause Livedo Reticularis?

A

Amantadine b/c a man is much more likely to have high cholesterol .
Also causes Ankle edema

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122
Q

What is trihexyphenidyl?

A

Its just like Benztropine…its an anticholinergic medication. Can treat parkinson’s (or side effects of antipsychotics)
–>i.e. these drugs would be causing urinary retention as a side effect

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123
Q

What’s the difference between malignant hypertension and hypertension encephalopathy?
–>By definition, HTN Emergency = severe HTN with one of these or end-organ damage

A

Malignant: associated with retinal hemorrhages, exudates or papilledema. can have renal sxs. from long-standing htn.

HTN Encephalopathy: associated with cerebral edema

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124
Q

adverse effects of ACE-I

A

Hyperkalemia, angioedema, cough, can precipitate acute renal failure in pts with RAS

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125
Q

when is prednisone (steroids) given with bactrim for PCP pneumonia?

A

PaO2 <70 or A-a>35

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126
Q

toxicity of bactrim

A

neutropenia (TriMethoprim Treats Marrow Poorly), rash, hyperkalemia, elevated AST/ALTs

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127
Q

T/F: Urinary retention can be a common sign of spinal cord compression in elder men

A

False, look for INCONTINENCE.

BPH is a common obstructive cause of retention.

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128
Q

Drugs that increase Lithium levels (look out for GI sxs, tremors, ataxia)

A

NSAIDs (non aspirin), tetracyclines, thiazides, ACE-I, metronidazole

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129
Q

what kind of murmur do Patau syndrome (overlapping fingers) have?

A

Holosystolic: VSD

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130
Q

features of patau syndrome

A
  • prominent occiput
  • overlapping digits
  • micrognathia
  • microcephaly
  • VSD
  • low set ears
  • rocker bottom feet
  • limited hip abduction
  • absent palmar creases
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131
Q

fever, cough, diarrhea, hepatosplenomegaly, increased ALP, CD4 <50

A

MAC

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132
Q

risks of ocps

A

HYPER HYPER HYPER HYPERTENSION SON
Hepatic Adenoma: LIVER (not breast fibroadenoma)
VTE. sometimes stroke/mi

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133
Q

T/F: OCPs can cause breast fibroadenoma

A

false, they cause Hepatic Adenoma.
OCPs decrease risk of benign breast dz i.e. fibrocystic changes, fibroadenoma. also dec risk of endometrial/ovarian cancer (not breast cancer)

134
Q

Testing for GBS occurs weeks:

Rho-gham in given:

A 
GBS = 35-37 (remember, its only good for 5 weeks)
Rho-gham = 28-32 weeks in blood type - females; again within 72 hours if baby is +.
135
Q

T/F: one of the indications for RHo-gham is external cephalic version

A

YES true

136
Q

which lab tests are done at 24-28 weeks gestation?

A
  • Oral glucose tolerance test (50g, 1 hour)
  • Antibody screen if Rh-
  • Hemoglobin/hematocrit
137
Q

polyarthralgias
tenosynovitis
vesicopustular skin lesions

A

disseminated gonorrhea

138
Q

immuno of 23 vs 13 valent pneumococcal vaccines

A

23: capsular polysachharide (t cell ind. B cell response)
13: capsular polysachharide conjugated to a protein antigen (T cell dep. B cell response)

139
Q

what will patients say indicating retinal detachment?

A

Floaters/flashes of light.

A curtain shade dropping from the sides (periphery)

140
Q

cherry red spot at fovea (center of macula), acute painless monocular vision loss

A

central retinal artery occlusion (embolic)

141
Q

Tx of Narcolepsy

A

-sleep hygiene, scheduled naps, avoidance of alcohol and drugs that cause drowsiness (no melatonin)
-meds: Daytime sleepiness: amphetamines, Modafinil, methylphenidate
Cataplexy: sodium oxybate

142
Q

T/F: Look out for septic emboli from endocarditis

A

true. strokes occur in Middle Cerebral Artery. don’t put them on aspirin or heparin, just tx with antibiotics (i.e. has ischemic stroke from septic emboli).

143
Q

T/F: Adenomatous polyps are considered neoplastic (risk of malignant transformation)

A

True. Villous ones are the villains (worse than tubular)

144
Q

who gets screened for chlamydia and gonorrhea?

A

all sexually active women under 25 (asx infection can lead to infertility)

145
Q

tx of confirmed gonorrhea or chlamydia

A

confirmed chlamydia: Azithromycin

confirmed gonorrhea: Azithromycin + Ceftriaxone

146
Q

Isoniazid is ____toxic

A

HEPATO. also, can cause drug-induced lupus and neurotoxicity (INH Injures Neurons and Hepatocytes)

147
Q

glucose goals in a GDM patient

A

Fasting <95
1 hour <140
2 hour <120
Tx: Dietary mods; Insulin/Glyburide/Metformin(doesnt cross placenta, any are 1st line)

148
Q

What is trichophyton rubrum?

A

Causes ringworm and tinea pedis. pruritic and scaly

149
Q

What are the exposures for CO poisoning vs Cyanide poisoning (both can present very similar, HA/n/v/abdominal discomfort)hat a

A

CO: Automobile, furnace, charcoal grill
–>Tx 100% O2 (hyperbaric)

Cyanide: Burning of rubber or plastic (not wood)
–>Tx: Nitrite and Thiosulfate (induces methemoglobinemia aka Fe3+ ferric form, which has affinity for cyanide&raquo_space;02); Hydroxycobalamin

150
Q

What’s the TTP pentad?

TTP = formation of small vessel thrombi that consume plt

A

-Neuro sxs
-Renal sxs
-Thrombocytopenia
-Hemolytic anemia (with schistocytes and LDH increase)
-Fever
Dx: Peripheral Smear Tx: Plasma Exchange, steroids

151
Q

What are the FOUR types of reactions you can have to a transfusion?

A
  1. ANAPHYLAXIS (IgA def). seconds-mins
  2. Bacterial SEPSIS (fever/shock/DIC). min-hours
  3. Primary HYPOTENSION RXN (transient hypotension in pt taking ACE-I, due to bradykinin in transfusion). mins
  4. Transfusion-related ACUTE LUNG INJURY: resp distress, flash pulm edema (noncardio), caused by Donor ANTI-LEUKOCYTE ANTIBODIES. w/in 6 hours
152
Q

how often are men (>35, risk factors) and women (>45, risk factors) screened with lipid panel?

A

q5 years

153
Q

how often are adults (>18) screened for hypertension?

A

Technically every 2 years

154
Q

how often are women (age 50-75) screened with mammogram?

A

once every 2 years

155
Q

how do you dx Acromegaly?

A
  1. Measure IGF-1 levels
  2. If elevated, Oral Glucose suppression test
    3a. Adequate Growth Hormone suppression r/o Acromegaly
    3b. If GH not supressed: get MRI of brain

4a. Pituitary Mass: Ocretotide, Pegvisomant, Resect
b. No mass…look for ectopic GH

156
Q

IVDU has fever. what are you going to start assessing for?

A

ENDOCARDITIS BABY. HIV increases risk

  • ->right sided. won’t have as many of the peripheral manifestations i.e. no splinter hemorrhages etc
  • ->look for septic emboli (usually Staph Aureus), basically lungs have some fucked up shit
157
Q

Someone has an elevated Alk Phos. How does GGT help you?

A

GGT Normal: Bone origin

GGT elevated: Biliary origin. Do RUQ US and AMA level (anti mitochondrial).

  • ->both normal: Do liver bx, ERCP, observation
  • ->dilated bile ducts: ERCP
  • ->AMA+ or abnormal liver: Liver bx
158
Q

How would you describe PBC?

A

A chronic, progressive liver disease with cholestasis from autoimmune destruction of INTRHEPATIC biliary ducts, seen in middle aged women, presenting intially with pruritis and fatigue. Drug of choice: URSDA

159
Q

T/F: Anemia of chronic dz is treated with Iron

A

False, you tx the underlying disease!!

160
Q

Prosthetic joint infx cause

A

<3 mo: Staph Aureus, G- rods, anaerobes
3-12 mo: Staph Epi (coag -), Enterococci, propionibacter
>12: Staph aureus, GAS

161
Q

osteomyelitis vs avascular necrosis (both painful)

i.e. Sickle cell pt

A

Osteo: +blood culture, Fever, erythema, warmth
Avas: - blood cx, - fever, edema. just pain.

both of these = pain at 1 site. In SCD pt, if pain at multiple sites consider Vaso-occlusive

162
Q

whats the quick rule for making dx of Schizoaffective disorder over MDD with psychotic features?

A

Presence of psychotic sxs without mood sxs for at least 2 weeks makes it schizoaffective (even if they had previously met criteria for MDD and now are having psychotic shit)

163
Q

delayed umbilical cord sepration (>21 days)

A

Leukocyte Adhesion Deficiency. recurrent skin/mucosal/peridontal infections. ton of neutrophils actually, but no pus.

164
Q

who gets frequent encapsulated organism infxs (strep, hib, neisseria men, e coli)?

A

ASPLENIC PATIENTS

Complement deficiency

165
Q

impaired respiratory burst and increased susceptibility to catalase + organisms

A

chronic granulomatous disease…chronic GRANDMA PLAYING WITH CATS disease

166
Q

t/f: chediak higashi = failure of phago-lysosome fusion (due to lysosomes and microtubules), get recurrent pyogenic strep/staph infxs, albinism, periph neuropathy, and huge granulocyte cells with lots of granules

A

true
Chediak: phagolysosomal fusion
CGD: ROS, catalase + infx

167
Q

skin lesions, lytic bone changes, and pulmonary findings that could resemble TB, may be immunocompetent

A

Blasto

168
Q

Chancroid aka

A

H ducreyi!!!

169
Q

Middle eastern/asian person with oral and genital apthous ulcers, eye stuff (uveitis, optic neuritis), skin stuff (hyper reactivity to needle sticks i.e. sterile abscess), Tx with prednisone and colchicine

A

Behcet syndrome

170
Q

Primary Syphillis may have negative RPR/VDRL tests (almost 1/3 of patients have FN) early in the disease!

A

CONSTANT VIGILANCE

Treponema cannot be cultured so do not get a bx and culture. Just treat with Pen

171
Q

If you suspect multiple myeloma in a patient, what is your workup?

A

S/UPEP (M-spike)
Peripheral smear (rouleux)
Serum free light chain analysis

Confirmatory test: Bone marrow biopsy

172
Q

multiple duodenal and jejunal ulcers, refractory to PPI, + chronic diarrhea

A 
ZE syndrome (gastrinoma)
-->diarrhea due to inactivation of pan enzymes
173
Q

FAST exam is negative in a patient with penetrating abdominal injury. What would make you still go back for urgent ex lap?

A
  • Peritonitis (REBOUND TENDERNESS/GUARDING)
  • hemo instability
  • Evisceration (organs are exposed)
  • NG tube/rectal exam shows blood
174
Q

2 signs (specific) of severe pancreatitis

A

Cullen sign: periumbilical bluish discolaration = hemoperitoneum

Grey-Turner sign: reddish-brown coloration around flanks = retroperitoneal blood

Note: Pseudocyst usually forms 3-4 weeks after onset

175
Q

inhertiance of DMD, BMD, and Myotonic dystrophy

A

DMD/BMD: X-linked recessive (look 4 cardiomyopathy)

Myotonic dystrophy: Autosomal dominant

176
Q

Drugs that improve survival in patients with LV dysfx

A

ACEI, ARB, spironolactone/eplerone

In blacks, additionally combo of Nitrates and Hydralazine

177
Q

what tracts does Syringomyelia fuck up?

A
  • Crossing spinothalamics in the anterior commisure (bilat loss of pain/temp in cape like dist)
  • Anterior horn gray matter (with enlargement) = LMN signs in the UE

doesnt affect dorsal spinal column so proprioception/vibration is intact

178
Q

Fanconi vs Blackfan diamond anemias

A

Fanconi: 8 year old with pancytopenia, macrocytosis (MCV>100), cafe au lait, horseshoe kidney, microcephaly, absent thumbs

Blackfan: pure red cell aplasia; webbed neck, short stature, shielded chest, triphalangeal thumbs. Look for a kid with macrocytic anemia, low retic count, congenital deformities.

179
Q

T/F: Glucagon can be used after OD of beta blocker, CCB

A

true

180
Q

severe features of pre-eclampsia

A 
SBP >160, DBP >110, 
Thrombocytopenia
elevated TRANSAMINASES bruh 
elevated Creatinine 
Pulm edema
visual/cerebral sxs
181
Q

mgmt of pre-e

A

w/o severe features: Delivery @ 37
w/ features : Delivery @ 34
Mg obvi

182
Q

Tx of PreE

A

BP: Hydralazine, labetolol, or nifedipine. Dec stroke risk
(note: methyldopa is for long term stuff)

Mg Sulfate. Dec/tx seizures

183
Q

VIPomas are associated with diarrhea during:

A

fasting or dehydration. tea colored stools. hypochlorhydria, hypokalemia.

184
Q

T/F: hypovolemia triggers in increase in Aldosterone/Renin ratio

A

False, this is typical of Primary Hyperaldosteronism.

–> In hypovolemia, you have a proprotional increase in Renin and Aldosterone

185
Q

What’s required for dx of acute liver failure?

A
  • elevated transaminases
  • signs of Hepatic Encephalopathy
  • synthetic dysfx (INR >1.5)
186
Q

how does chronic pancreatitis present (clinically)?

A

Chronic epigastric pain that can radiate to the back and partially relieved by leaning forward/sitting upright

187
Q

most common causes (2) of hyperandrogenism in pregnancy

A
  • Theca Lutein Cysts (ass. with molar pregnancy)
  • Luteoma (solid; regress after pregnany; can induce virilization in female fetus)

->both are BENIGN. no maternal tx needed, will regres

188
Q

how do you tx anticholinergic toxicity (including from diphenhydramine or any cholinergic)?

A

Physostigmine

189
Q

Lichen sclerosis is a benign lesion

A

False, it has malignant potential. This is why you have to vet punch biopsy…to r/o squamous cell carcinoma

190
Q

T/F: Tx for atrophic vaginitis and lichen sclerosis = Topical estrogen

A

False. Atrophic vaginitis: topical estrogen (low dose); Lichen sclerosis: Topical corticosteroids (high dose) i.e clobetasol

191
Q

how do you treat lyme disease in pregnancy or kid <8?

A

Amoxicillin

192
Q

what is considered an adequate trial for an antidepressant?

A

4-6 weeks. Can switch to another class after this if no improvement at an adequate dose

193
Q

Pemphigus vs Bullous: Which one + Nikolskys?

A

Pemphigus (desmosomes)

194
Q

Immunofluorence of Pemphigus vs Bullous Pemphigoid?

A

Pemphigus: intercellular IgG depots, “net like”
(desmosomes)
Bullous: linear IgG along basement mem (hemidesmosome)

195
Q

Patient has non-tender lymphadenopathy + B sxs. Whats the next step?

A

Excisional biopsy! do NOT do needle bx
Look for Reed sternberg or not.
Staging: CXR, CT and bone marrow bx

196
Q

most common cause of spontaneous lobar hemorrhage, esp >60 yo

A

Cerebral Amyloid Angiopathy (WTF?). associated with Alzheimers (beta-amyloid deposition)

197
Q

T/F: unfractionated Heparin and LMW Heparin should not be used in ESRD

A

False. Unfractionated is used, LMWH should not be used (nor should rivaroxaban)

198
Q

whats the clue to distinguish methanol from ethylene glycol poisoning?

A

organ affected: methanol hits the eyes, ethylene glycol the kidneys
(both cause anion gap metab acidosis)

199
Q

name the shock: Dilated ventricles and apical hypokinesis

A

cardiogenic

200
Q

name the shock: engorgement of IVC

A

cardiogenic

201
Q

when would you see RV dilation and hypokinesis?

A

after massive PE

202
Q

diastolic collapse due to increased RV filling pressure is characteristic of:

A

cardiac tamponade .

diastolic collapse = failure of ventricular filling

203
Q

When would a man get myasthenia gravis?

A

60-80 years old

vs female is 20s-30s

204
Q

Granulosa cell tumor features:

A
  • produces estrogen. Highly malignant tumor
  • Pre-pubertal girls: Precocious Puberty
  • Post-menopausal women: AUBleeding
205
Q

how do you differentiate virulization and precocious puberty in girls? which tumors might cause these

A

Virilization: becoming manly. Look for hirsuitism, clitiromegaly, deepening of voice. Sertoli-Leydig cell tumor (androgens/testosterone)

Precocious Puberty: just having puberty early. so breast bud, pubic hair, increased height etc. Granulosa cell tumor (secretes estrogen)

206
Q

Increased MCHC

A

spherocytosis

207
Q

Egg on a string xray finding + cyanosis + single s2 in newborn

A

Transposition of the great vessel. Require a hole to survive, either a VSD, PDA (cause murmurs) or Patent Foramen Ovale (no murmur, also keep open with PGs)

208
Q

signs of chorioamnionitis

A
  • maternal tachy, fever
  • fetal tachy (>160)
  • foul smelling vaginal discharge
  • uterine tenderness
209
Q

drugs that cause folate deficiency (due to decreased jejunal absorption)

A
  • phenytoin
  • primidone
  • phenobarbitol
  • Bactrim
  • Methotrexate
210
Q

which infants get ABO incompatibility and how would this manifest in an adult?

A

Blood type A or B babies born to mother with O blood (don’t care about + or - here, thats hemolytic disease of newborn/rhesus incompatability). it is VERY MILD, no worries!

In an adult, it can be serious…occurs with transfusion of the wrong blood type (Note: O is the universal donor, but they can only receive O blood)

211
Q

drugs that can reduce intraocular pressure during acute glaucoma episode

A

acetazolamide, pilocarpine, timolol, mannitol

do NOT use atropine (causes pupillary dilation )

212
Q

referred pain to the ear, worse with chewing. pt has hx of teeth grinding (at night)

A

TMJ

213
Q

patient goes tanning and notices some patchy depigmentation (areas that didn’t tan)

A

Tinea versicolor (malasezzia globosa). can be covered by scales, hyperpigmented, or itchy.
Dx: KOH prep (spaghetti meatballs) hyphae, spores
Tx: topical ketoconazole, selenium sulfide, teribinafine

214
Q

what is the function of Aromatase?

A

Converts Androgens –> Estrogens.

–>AromatasE A–>E A—>E

215
Q

Female has estrogen deficiency, increased androgens. Does this look like virilization or precocious puberty?

A

VIRILAZATION. Looking more like VIRaj. no breast dev.

Precocious Puberty means they get to Preview their Pussies early. PP: Preview Pussies. +breast dev.

216
Q

Patient suspected to have sarcoidosis deteriorates after steroids

A

Histoplasmosis (mimics sarcoid). Both histo and blasto look like TB and form granulomatous lesions/lung shit/skin shit in the MIssissipi/Ohio river basins. hilar adenopathy makes histo more likely

217
Q

In terms of gait, basal ganglia disorders present as:

A

shuffling gait, like in Parkinsons (depeletion of dopamine in the basal ganglia). BG disorders also responsible for athetosis, chorea in Hungtingtons

218
Q

autoimmune dx of melanocytes

A

vitiligo. pt will have other autoimmune dz

219
Q

mneumonic for causes of Syncope

A 
Woman PE
VV: Vaso Vagal
O: Orthostatics
M: Mechanical cardiac (exertional)
A: Arrythmia
N: Neuro (vertebrobasilar insuff)
P: PE
E: Electrolytes
220
Q

Why does asthmatic have muscle weakness after being treated for exacerbation?

A

Was treated with beta agonists and steroids, which can pricipitate HYPOKALEMIA (muscle weakness, arrythmia, EKG changes)

221
Q

Drugs to help drinking abstinence

A

Reduce cravings: Naltrexone

maintain abstinence: Acomprosate (glutamate modulator)

222
Q

How does protein C def present?

A

warfarin induced skin necrosis

223
Q

no change in PTT with heparin

A

Antithrombin deficiency

224
Q

activated protein C resistance

A

Factor V leiden (mutated factor V doesn’t respond to to protein C, an innate anticoagulant)

225
Q

initial step in dx cushings

A

-low dose dexamethasone supp test
-24 hr urinary cortisol
or -late night cortisol

226
Q

how do you work someone up if you’re suspecting cushings? (full workup)

A
  1. Confirm hypercortisol: 24 hour free cortisol AND low-dose dexamethasone suppression
    –>high cortisol = cushings syndrome + (now figure out)
  2. Measure ACTH
    –>Low ACTH = Adrenal tumor
    –>High ACTH = nope, keep working it up.
    do a high dose suppression test: if suppressed, its pituitary tumor cushings dz get MRI, if not its ectopic get CT lung/abdomen
227
Q

what does liver bx show in PSC?

A

fibrous obliteration of bile ducts with concentric replacement by connective tissue in an onion skin

228
Q

T/F: A missed abortion presents with empty uterus on US and tx is to followup hcg levels

A

No, this is complete abortion. Missed means theres a dead baby in there, mom didnt experience any passage of stuff. If <24 weeks, D/C; If >24 weeks, induce labor

229
Q

complicatons of cryptorchidism

A
  • Subfertility
  • testicular cancer

the following are risks if orchioplexy not performed only:

  • inguinal hernia
  • testicular torsion
230
Q

painful vision loss with abnormal pupillary response to light in a woman

A

Optic Neuritis –> MS

231
Q

T/F: Papilledema is a sign of true tumor but not pseudotumor

A

false

232
Q

Increasing the true positive rate is directly proportional with ________
Increasing the false positive rate is indirectly proportional with _________

A

TP: Sensitivity
FP: Specificity

233
Q

what’s the 2x2 epi table?

A

D+ D-
t+ TP FP
t- FN TN

234
Q

T/F: Initial prenatal visits includes screening for diabetes (fasting glucose) and STDs like gonorrhea NAAT)

A

False:

  • you screen for gDM at 24-28 weeks with 1hr GTT
  • you only screen for gonorrhea at first visit in high risk patients (<25, hx of STD, new/multiple sex partners)

Note: Chlamydia PCR, HIV/ VDRL/RPR/HBsAG ARE DONE AT INITIAL PRENATAL

235
Q

pregnant mom is has active Hep B, how do you prevent vertical transmission?

A

C/s + baby gets both Heb B IVIg and Hep B vaccine on day of delivery

236
Q

T/F: Reactivation of herpes or varicella during pregnancy causes viremia and is danger for baby

A

False, only primary infection causes viremia (and crosses placenta). If reactivation, only danger is through contact so do a c/. Give mom Acyclovir. You can’t give varicella vaccine to a preggo (keep her away from sick kiddos)

237
Q

most important point about varicella/chicken pox and pregnant patients

A

keep pregnant patient isolated from children who could potentially give her the virus

238
Q

Saddle nose, Saber shins, snuffles (rhinnorhea), hutchinSon teeth

A

congenital syphillis

239
Q

Mom has mono-like syndrome in first trimester, baby has symmetric IUGR and brain calcifications

A

Toxoplasmosis (keep her away from litter box)
–>antibodies to toxo are tested on prenatal screen. if shes already been exposed she will be immune and baby not at risk

240
Q

Cataracts, congenital hearts defects and cleafness

A

3 C’s of Congenital rubella . mom must be unvaccinated and exposed for first time (normally you get this live vaccine 3 mo before preg)

241
Q

risk factors for GDM

A

-advanced maternal age
–preconception obesity
>1 pound/week weight gain

242
Q

T/F: we do NOT use A1c or fasting glucose to screen for gDM

A

TRUE. use GTT. 1 hr>140 is +, do the 3 hr.

243
Q

Does vasa previa present with fetal tachycardia or bradycardia?

A

BRADY BRADY BRADY BRADY BRADY

244
Q

for genetic screening, what comprises the first tri screen?

A
  1. hCG
  2. PAPP-A
  3. US Nuchal Translucency
245
Q

for genetic screening, what comprises the second tri screen (Triple vs Quadruple?

A

Triple: hCG, AFP, Estriol
Quadruple : “ “ + Inhibin A

Downs is HI up

246
Q

if a multip has bleeding intrapartum/post-partum, what are they most likely to have?

A

“old used up, like an oil well”
placenta may go wide: Placenta Previa (intrapartum)
or it goes deep: Retained placenta (PPH, firm)

247
Q

smooth muscle constrictor that act on the uterus, helps with PPH especially for uterine atony

A

Methylergometrine (methergine).

Atony tx: Massage + Methergine + Oxytocin. Worst case go to surgery Tx

248
Q

how do you tx retained placenta (Accreta, Increta (into the myometrium), Percreta (to serosa) ?

A
  • manual removal, D and Curettage (esp if its due to accessory lobe/piece stuck)
  • hysterectomy (more likely with percreta/increta)
249
Q

Placenta comes out and you see blood vessels going to the edge:

A

Retained placenta, there is an accessory lobe or fractured placenta. This is a cause of PPH with firm uterus. Tx with manual extraction/D and C/hysterectomy

250
Q

T/F: If you suspect chorioamnionitis (baby in) or endometritis (baby not in), next step is vaginal culture

A

FALSE. The vagina is NASTY with flora, and its an ascending infection so doesnt tell you anything.
Give Amp/Gent/Metro and get a UA/blood cx/CXR

251
Q

what are your options for tocolysis?

i.e. preterm labor with LS<2 and need to get some steroids on deck

A
  • # 1 = Magnesium

- beta agonists (terbutaline), CCB (nifedipine), PG inhibitor (indomethacin)

252
Q

how do you define premature ROM?

A

ROM at term but no contractions

253
Q

when would you not give tocolytics?

A 
Maternal CI (pre eclampsia)
Fetal CI (fetal distress/demise)
high OB risk (pROM, abruption)
...baby is headed straight to NICU in these cases
254
Q

how do you manage post dates?

A
  1. If dates are certain, you check the cervix. Favorable = induce labor. Unfavorable = c/s
  2. if dates are uncertain, you do NST and amniotic fluid index (AFI via US)…c/s when baby is ready or in trouble
255
Q

most common cause of a prolonged latent phase of labor (stage 1) and mgmt

A

Analgesics!

–>Either just rest and wait, or balloon to stimulate head engagement (cervical ripening) or Oxytocin

256
Q

causes of prolonged active phase of labor (stage 1) and mgmt

A

Passenger, Pelvis, Power
-if adequate ctxs, C/s
-if inadequate ctxs, Oxytocin
(so this is a cervix that is not fully dilated, vs prolonged 2nd stage)

257
Q

mgmt of prolonged second stage of labor (fully dilated)

A

-2 hours in non epidural, 3 hrs if epidural
-if ctxs not adequate, give Oxytocin
-if adequate: 0, -1, -2 station = C/S.
+1, +2 = vacuum/forcep

258
Q

mgmt prolonged third stage

A 
the problem here can only be "Power"
1. Uterine massage
2. Oxytocin
3. Manual manipulation
Note: D and C is not done for the whole placenta, it would only be done for retained parts
259
Q

When is ECV performed for breech baby?

A

AT 37 WEEKS WITH LEOPOLD MANUEVER

260
Q

What does station 0 mean anatomically?

A

ischial spines

261
Q

T/F: You can have ectopic pregnancy after undergoing tubal ligation (irreversible form of contraception)

A

True

262
Q

how should you think about the 24-28 week prenatal visit in terms of screening?

A

See what mom has developed while cooking baby in the oven.
-Developed anemia? Check Hgb/Hct
-Developed anti-Rh? Check Rh Antibody (if mom Rh-)
-Developed gDM? Check GTT
remember, we wait til 35-37 weeks to check GBS

263
Q

all multiple gestations are at risk for:

A
  • Breech birth
  • Preterm delivery
  • Placenta previa
264
Q

if forced to pick, which seizure meds can you use in pregnancy?

A

Levetiracetam and Lamotrigine. For abortive, phenobarbitol

265
Q

T/F: PreE htn is treated with alpha methyldopa

A

False, this is the drug for more chronic htn in pregnancy.

For acute, Hydralazine, Labetolol (not if bradycardic), or Nifedipine (always add Mg for seizure prophy)

266
Q

____ _____ is a premalignant skin lesion that can lead to squamous cell cancer. It is seen in sun exposed areas (head/neck/dorsal hands), and it is treated:

A

Actinic Keratosis

Cryotherapy and 5-Fluorouracil

267
Q

Squamous cell carcinoma (skin) is a malignancy of _____ that can metastasize, unlike BCC. It is usually seen on the ____ ____

A

keratinocytes. Lower Lip

268
Q

“stuck on” skin lesion

A

Subhorreic Keratosis is StucK on

269
Q

T/F: Albinism = autoimmune dx of melanocytes

A

False, this describes vitiligo.

Albinism: melanocytes are normal but the enzyme is deficient (tyrosinase), genetic disorder (auto recessive)

270
Q

How do you differentiate SJS/TEN from staph scalded skin syndrome (all have +Nikolsky)?

A

SJS/TEN: +mucosal; responds to taking AWAY ABx

SSSS: - mucosal; responds to GIVING ABx

271
Q

How do you differentiate SJS from TEN?

A

SJS: <10% BSA, basal cell degeneration
TEN: >30%, full thickness epidermal necrosis

272
Q

How do you tx suborrheic dermatitis?

A

Eyebrows/face etc. Think D for Dandruffy (vs keratosis is StucK on)

Selenium shampoo

273
Q

Increased Keratinocytes in the Stratum Corneum

A

Psoriasis

274
Q

T/F: Psoriasis is an auto rec condittion

A

False, autoimmune disease causing prolif of keratinocytes

275
Q

Tx for psoriasis

A

UV light and Topical steroids

276
Q

Where would you see lichen planus?

A

Wrists, ankles, oral and vaginal mucosa. Tx with topical steroids

277
Q

Pemphigus Vulgaris (desmoglein) vs Bullous Pemphigoid (hemidesmosomes) : which has Oral mucosa lesions and +Nikolskys?

A

Pemphigus Vulgaris

278
Q

Intact epithelium that’s detached from the basement membrane. IF shows antibodies at dermal/epidermal j(x). is NOT life threatening and does NOT involve mucosa.

A

Bullous Pemphigoid. Usually 60-80 yo

279
Q

T/F: Pemphigus vulgaris is a life-threatning disease, invoves the mucosa, and occurs in people 30-50

A

TRUE AF. + Nikolskys

280
Q

What’s the ladder for tx of acne?

A

Retinoids (comedones)

  • -> Benzoyl Peroxide (inflamed/pustular comedones)
  • -> ABx/Doxycycline (severe pustular/nodulocystic)
  • -> Isoretinoin (get a preg test first)
281
Q

T/F: Impetigo can cause ARF and PSGN

A

False, Impetigo can only cause PSGN

282
Q

step pyo in adults, infects lymphatics and climbs up the extremity

A

Erysipelas (looks kind of like cellulitis). Tx with amoxicilin

283
Q

Tx for Tinea unguium (onychomycosis) and Tinea capitus

A

Onycho: Terbinafine
Capitus: Griseofulvin
get a dx with KOH prep first since these oral meds are hepatotoxic

284
Q

T/F: Progesterone and OCPs are protective against endometrial cancer

A

True

285
Q

order for incidence and mortality of cancers

A

Incidence: Sex, Lung, Colon
Mortality: Lung, Sex, Colon
sex = breast and prostate

286
Q

Girl with precocious puberty. If GnRH stim test = increased LH with GnRH admin, its central…MRI brain + resection. How do you work up peripheral prec pub?

A
  1. Tx with continous leuprolide for 2-4 years
  2. Workup…find the estrogen!
    - US of the ovaries and adrenals
    - Measure estradiol (overies), DHEAS (adrenals), and 17-OH progesterone (CAH…tx w/steroids)
287
Q

How do you define delayed puberty?

A

absence of secondary sex characteristics by 13 or absence of menstruation by 15

288
Q

T/F: Tx for constitutional delay is GH

A

FALSE. no growth hormone, just reassure (look for +FHx and bone age, FSH and LH normal)

289
Q

T/F: SSRIs, especially VENLAFAXINE, are useful for treating hot flashes

A

TRUE HOMEBOY. HRT causes endometrial cancer, and estrogen/soy doesnt work

290
Q

T/F: Never given an alcoholic a benzo

A

False. For withdrawals especially, we use a Benzo taper (chlordiazepoxide aka librium, diazepam, lorazepam)

291
Q

T/F: Wernickes and Korsakoffs are irreversible

A

False. Wernickes = reversible cerebellar dysfx

Korsakoff = irreversible, confabulations (cerebral atrophy)

292
Q

Tx of phobia and social anxiety

A

CBT

If its performance anxiety, Beta Blocker

293
Q

Tx of PTSD

A

SSRI/SNRI

For nightmares: Alpha blockers (Prazosin)

294
Q

Tx of Catatonia

A

Benzo or ECT

295
Q

Tx of Panic disorder

A

SSRIS, Benzos for acute

296
Q

what’s the difference in asperger and autism?

A

Asperger has intact language f(x)

297
Q

T/F: Lamotrigine is effective against bipolar manic episdoes

A

False, it is good for bipolar depressive episodes. Watch out for SJS

298
Q

how does juvenile myoclonic epilepsy present?

A

teenager with myoclonic movements usually within the first hour of waking. Irregular spike and wave EEG. Treat with Valproate

299
Q

seizures that can be provoked by hyperventilation and have classic EEG findings

A

3 Hz spike and wave, Absence seizures. last 10-20 seconds usually

300
Q

Impaired strength and loss of pain/temp in the UE months after a whiplash injury

A

Syringomyelia. Enlargement of the central canal due to CSF retention.

301
Q

most common cause of esophagitis in HIV

A

candida!

other causes: HSV (round ulcers), CMV (linear ulcer)

302
Q

transient vision loss caused by ischemia of the optic nerve

A

Amaurosis fugax possibly from FMD

AF just = painless transient vision loss

303
Q

noninflammatory and nonatherosclerotic narrowing (cellular) of renal, carotid, and/or vertebral arteries

A

Fibromuscular dysplasia

304
Q

new-onset htn after 20 weeks gestation + proteinuria or end organ damage

A

PreE. UPC>.3 or 24 hour protein >300mg

305
Q

mgmt of PreE

A

w/o severe features: delivery @ 37
w/severe features: delivery @ 34
Mg sulfate and antihypertensives

306
Q

what are the “severe features” of PreE (delivery @ 34)?

A
  • BP >160, 110
  • thrombocytopenia
  • increased Cr
  • increased transaminases
  • pulmonary edema
  • visual/cerebral sxs
307
Q

T/F: All HCV patients except pregnant should be given HAV and HBV vaccine

A

False, EVERYONE including pregnant gets them now if not already immune

308
Q

Tx for Asx gallstones

A

NOTHING

309
Q

when is meningococcal vaccine given?

A

11-12 with a booster at 16-21.

Also given to high risk pts: travel to Africa, college students/military recruits, asplenic

310
Q

meds that can idiopathic intracranial htn?

A

GH, tetracyclines, excessive vitamin A and derivs (isoretinoin, ATRA)

311
Q

these blue bloaters get RHF (JVD, CLUBBING, edema, hepatosplenomegaly)

A

chronic bronchitis

312
Q

what’s the order of tx for COPD?

A

SABA (ipra>alb), LAMA (tio), LABA (salmeterol), ICS, PDE4 (roflumilast), Oral steroids

313
Q

which interventions in COPD will prolong life

A

O2 and smoking cessation only (i.e. rehab does not)

314
Q

What are the indications for chronic home O2 for COPDers, and what is the goal?

A

have to be pO2 <55 or SPO2 <88% on pulse ox @rest.

Goal: SpO2 between 88-92 (maintain drive)

315
Q

Whats the tx for acute COPD exacerbation?

A

O2!!!!

  • duonebs (Ipratropium, Albuterol)
  • May need oral or IV steroids (oral steroids usually reserved for acute exacerbations, not for chronic)
  • if purulent/increased sputum, ABx (Doxy, Azithro, Amp)
316
Q

how are you going to remember Lights criteria?

A 
Always remember the exudative. FLuid comes first. 
2x3 = 6...
1. LDH>2/3 of normal (200), or...
2. LDHfluid/LDHserum >0.6, or...
3. Total proteinfluid>TPserum >0.5
317
Q

Qualify this statement: For pleural effusions, don’t tap if its small, loculated or CHF

A

Tap = thoracentesis

  1. Small = <1 CC
  2. Loculated (not free moving i.e. on recumbent xray/CT/US): needs thoracostomy (chest tube) or surgery (thoracotomy)
  3. CHF: Just do diuresis, no tapping
318
Q

transient synovitis occurs after:

Septic hip occurs after:

A

TS: URI
SH: Febrile illness

319
Q

FOOSH: toddler; young kid; old lady

A

toddler: Supraclavicular humeral fracture (watch out for compartment syndrome = Volkmann contracture)

old lady: Colles fracture (distal radius)

young adult: Scaphoid fracture(xrays are negative for 3 weeks, do thumb spica cast)

320
Q

what do you fracture when you punch a wall?

A

metacarpal neck (4th and 5th)

321
Q

most common places for compartment syndrome

A

Lower leg (fracture w/closed reduction) and forearm. ——>Increasing pain after a casting requires immediate cast removal

  • ->due to PROLONGED ISCHEMIA, followed by reperfusion
  • ->excruciating PAIN WITH PASSIVE EXTENSION. pulses may be normal!
322
Q

Tx for gas gangrene (i.e. deep penetrating dirty wound, few days later pat is toxic with tender swollen discolored site)

A

Penicillin and Clindamycin
Surgical debridement
Hyperbaric O2

323
Q

Worst fungal infection in a pat with extensive bruns or widespread trauma

A

Mucormycosis…area turns black, get tissue bx. IV amphotericin B for mucormycosis (vs broader spectrum for gangrene and necrotiing fasciitis)

324
Q

next step if you have any closed head injury, neck trauma or facial fractures

A

Eval of cervical spine (CT)

325
Q

what kind of lesiosn are seen with mets to the spine?

A

Women: Lytic lesions from breast
Men: Blastic lesions from prostatei

326
Q

how does phototherapy improve hyperbilirubinemia?

A

ISOMERIZES/ionizes (does NOT conjugate boi) bilirubin which makes it more water soluble

327
Q

what does CXR of TTN show?

A

Perihilar streaking, air trapping, fluid in fissures. Term infant born by c/s has retained fluid (dec compliance, inc resistance)

328
Q

Tx for impetigo

A

mupirocin (topical antibiotics)

329
Q

when can you give hormone replacement therapy?

A
  • vasomotor sxs (menopausal hot flashes)
  • genitourinary atrophy
  • dyspareunia
330
Q

how do you increase appetite in cachexic/cancer pt?

A

should let them Smoke Pot, instead we give

-Steroids or Progesterone (megestrol acetate) analog

331
Q

Transudative effusion with low glucose vs Exudative with low glucose

A

Transudative: Rheumatoid arthritis (lots of wbcs eat up glucose)
Exudative: complicated; parapneumonic

332
Q

Transudative effusions: bloody? high lymphocytes?

A

Bloody: PE or cancer
wbcs: TB

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