All topics Flashcards
Mgmt after ingestion of caustic substances (burn/corrode) i.e. cleaner
Endoscopy within 24 hours, CXR if resp sxs.
Activated charcoal, corticosteroids, emetics, and acid neutralization is not recommended
Blood in urine but no rbc on microscopy
Myoglobinuria –> Rhabdomyolysis
Difference btwn heat stroke and heat exhaustion
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
Tinnitis, fever, hyperventilation, and anion gap metabolic acidosis after ingestion of too much of this
Aspirin
Victims of smoke inhalation (i.e. burning house) should be treated empirically for _______ poisoning to prevent cardiorespiratory arrest and neuro sxs
Cyanide
- ->hydroxycobalamin or sodium thiosulfate
- ->can give nitrites to induce methemoglobinemia
Carbon Monoxide (neuro sxs) -->100% O2 via non-rebreather
Pt with depression, comes in with anticholinergic effects (dilated pupils, intestinal ileus, tachycardia, dry mouth, urinary retenion), respiratory redepression, arrythmia/cardiotoxicity
TCA OD…antiCholinergic, Cardiotoxicity, Coma, Confusion
–>Tx: NaHCO3
Benzo toxicity/OD
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
Lithium toxicity
tremor, hyperreflexia, ataxia, seizures
Farmer comes in with organophosphate poisoning (all PNS type signs). Mgmt?
Atropine
Also, remove all clothes and wash body to prevent trasncutaneous absorption
Tx for acetaminophen ingestion/toxicity
Activated charcoal (for gastric decontamination) -->if high enough for liver damage, give N-acetyl cysteine
Diphenhydramine toxicity
looks like TCA OD cause strong anticholinergic effects. also have drowsiness and confusion from antihistamine effects.
–> Reverse with Physostigmine (cholinesterase inhibitor)
Ingestion leading to hypocalcemia + calcium oxalate crystals (flank pain + anion gap metabolic acidosis)
Ethylene glycol (anti-freeze)
Reversal of ethylene glycol OD (calcium oxalate stones/flank pain)
Fomepizole (or ethanol) –>inhibit alcohol DHase
NaHCO3 –>alleviate acidosis
may need hemodialysis in severe cases
Cyanosis and respiratory depression after Dapsone or Anesthesia
Methemoglobinemia –> Tx with Methylene Blue
what color will skin be in methemoglobinemia
blue (cynotic). tx with methylene blue.
unlike Carbon monoxide or cyanide poisoning
patient is having signs of opioid withdrawal. med?
Methadone!! do NOT give naloxone (this is going to make withdrawal worse)
most common cause of Mitral Regurgitation
MVP!!!!!!!!!!!! Mxyomatous degen. MS less common.
decreased globin chain synthesis vs defective globin chain synthesis
dec: thalasemmia
def: Sickle cell! defective beta-globin gene
difference btwn uncomplicated and complicated parapneumonic effusion
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)
T/F: Antipsychotics can cause unilateral bloody discharge from nipple
False. it would cause bilateral galactorhhea with amenorhhea
how do you work up abnormal nipple discharge?
Bloody or serous: MRI or US
Milky/nonbloody: blood tests
–>BUT…if there are skin changes/lumps, do MRI/US first
Endometriosis is discovered during an operative procedure. How is this treated?
Asx endometriosis = no treatment…OBSERVE
if sx, could do nsaids, OCPs, progesterone IUD
diagnostic peritoneal lavage vs exploratory laparotomy
lavage: for BLUNT abdominal trauma and hemo unstable and inconclusive FAST
ex lap: for PENETRATING trauma and hemo unstable/inconclusive FAST
Inhaled O2(+/- sumatriptan) with prophylactic verapamil
Tx of cluster headache
Sumatriptan with prophylactic propranolol, topiramate, valproate
Tx of migraine
Viridans streptococci that cause subacute endocarditisi include
mutans, sanguinis, oralis, mitis
this bugger causes UTI, is part of normal colonic flora, cause SUBacute ENDOcarditis following the GI/GU procedure (manipulation of urinary tract)
Enterococcus (faecalis)
–>VRE is an important source of nocosomial infx
T/F: Staph epi can cause endocarditis
true its a common cause. seen in patients with indwelling intravascular catheter or implanted prosthetic valve
how would LV free wall rupture post MI present and when?
within 2 weeks; present as tamponade/large pericardial effusion. can progress to pulseless electrical activity
why does patient develop MR within a week of MI?
Papillary muscle rupture.
Vs a ventricular aneuryms, which can occur within the next few months, will present with EKG changes (ST elevation) and HF.
Wallenberg: describe the lesions and location
-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
lesion of posterior cerebral artery (PCA)
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)
side effect of anti-muscarinic used to treat parkinsons features (cogwheel rigidity, resting tremor) i.e. Benztropine, Trihexyphenidyl
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.
Tx of OCD
SSRIs
Clomipramine
Tx for restless leg syndrome
Ropinorole, or pramipexole
dopamine agonists
what is the difference between steven johnson and toxic epidermal necrolysis?
both have +nikolsky, +oral mucosal involvement
Steven johnson: <10% body surface area affected
TEN: >30% affected
common triggers for SJS (<10%) and TEN (>30%)?
allopurinol antibiotics (sulfa) anticonvulsants (lamotrigine: bipolar, mood stabilizer) nsaids sulfasalazine
T/F: Ankylosing spondylitis can be treated with steroids
FALSE FALSE FALSE HOMEBOY DO NOT DO IT
they dont work
Tx for AS: NSAID, Infliximab/adalumab, sulfasalazine
how do you treat major depression with psychotic features?
-combo of antidepressant/antipsychotic
OR
-ECT (esp if urgent…i.e. geriatric pt not eating, suicidal, PREGNANT)
TRH and Estrogen(+ AP stim) increases Prolactin.
Prolactin increases Dopamine. PRL inhibits GnRH.
Dopamine inhibits Prolactin.
Yup, so antipsychotics (dopamine antagonists) and OCPs/pregnancy increase prolactin
Bromocriptine (DA agonist) decreases PRL. use for prolactinoma
Tourettes (multiple motor and at least one verbal tic) is comorbid with: _______
Tourettes is tx with:
with OCD and ADHD Tourettes Tx: 1. Nonpharm: Habit Reversal Therapy 2. Pharm ---> ANTIPSYCHOTICS BITCH, alpha-2-agnoists (clonidine, guanficene)
what are the high potency first gen antipsychotics?
- ->increased EPS/NMS/TD
- ->Less anti-HAM
Haloperidol, Fluphenazine, Pimozide, Trifluoperazine
High Flu? Tri Halo and Pims, Cutie!
Pims: QT prolongation/vtach
what are the low potency first gen antipsychotics?
- ->less EPS/NMS/TD
- ->more anti-HAM
Chlorpromazine (BLUE-GREY discoloration, photosensitivity, PIGMENT (LENS/CORNEA for ChLorpromazine)
THIORIDAZINE (pigment reTinitis)
what are the anti-HAM side effects? seen esp with low potency antipsychotics (chlorpromazie/thioridazine)
anti-histamine: wt gain, sedation
anti-alpha1adrenergic: ortho hypo, sex dysfx, arrythmia
anti-muscarinic: dry mouth, urinary retention
the + sxs of schizophrenia are due to the _______ tract
the - sxs: _____ tract
mesolimbic (+) –>tx well by antipsychotics
mesocortical (-)
how do you treat EPS sxs?
Dystonia: Benztropine, diphenhydramine, trihexyphenidyl
Akathisia: beta blockers, benzo’s
Parkinsonism: Benztropine, amantadine, trihexyphenidyl
what happens in HIT and how do you tx?
Thrombocytopenia and THROMBUS (arterial and venous) formation. IgG on platelet surface.
Use Argatroban/Fondaparinux (BAD) = anti coag with a non-heparin
vaginosis by pH
pH>4.5: Bacterial vaginosis (-inflammation) and Trichomonas (+ inflammation) normal pH (3.8-4.5): Candida (+inflammation)
Which meds are held and continued prior to cardiac stress test?
Hold for 48 hours: BB, CCB, Nitrates
–>no caffeine 12 hours before
Continue: ACEI, ARB, Statins, Diuretics, Digoxin
comorbid conditions with Absence seizures
ADHD, Anxiety
How do you restore coronary blood flow (main priority) in patient with STEMI?
PCI (percutaenous coronary intervention) or Fibrinolysis (tPA)
T/F: Short cervical length, detected by transvag US in a patient with prior cervical surgery, is a strong predictor of preterm delivery
true
- ->give progesterone injections (maintain quiescence) if short
- ->if hx of preterm and short now, do cerclage as well
anemia and thrombocytopenia are classically seen in malaria/dx gold standard =
peripheral smear
how do you tx cardiotoxicity of tca overdose?
Sodium bicarbonate
who gets MVP?
- 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)
Patient is screened with PAP and has abnormal findings (non-ASCUS). What’s the next step?
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
Management of CIN III
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
classic presentation of molar pregnancy
- vaginal bleeding, hyperemesis gravidarum, hyperthyroidism, diffusely enlarged uterus with regular contour
- pelvic US: Snowstorm appearance
- PE: “grape-like mass”
reflexes (spinal level)
Bicep: C5
Tricep: C7
Patella: L4
Ankle: S1
Conus medullaris vs cauda equina
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.
inspiratory stridor better with pronation/extension vs biphasic stridor better with extension
Insp: Laryngomalacia
Biphasic: Vascular ring (aortic arch bring encircles trachea/esophagus)
(these are both chronic causes. acute causes = foreign body and croup)
what are causes of renal transplant dysf(x) in the early post op period?
- 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
Tx of essential tremors
Beta blockers and PRIMIDONE.
“amazon PRIME is ESSENTIAL, BETA”
3 causes of retinopathy in HIV
Pain: HSV or VZV
No Pain: CMV
Pneumonia causes hypoxemia due to:
R-L Intrapulmonary Shunting –> huge V/Q mismatch!!!! (alveoli are filled with fluid can’t participate in gas exchange)
ACEI, ARB, Beta blockers, Digoxin, Spironolactone, Furesomide: all give benefit to CHF patients. Which ones improve survival (vs sx only)?
All except for digoxin and furesomide
WHAT THE FUCK ARE YOU GONNA DO IF SOMEONE COMES IN LOOKING LIKE THEYRE HAVING A STROKE?
CT WITHOUT CONTRAST. RULE OUT HEMORRHAGE. DO NOT GIVE ASPIRIN. DO NOT DO ANYTHING EXCEPT NONCON CT
What workup for a stroke after the acute presentation is over (i.e. day 2)?
- Transesophgeal ECHO: assesses cardiac valves/thrombus
- ECG: Afib assessment/thrombus
- Carotid US: assess stenosis.
could do CT angio/MRI? look at blood vessels of brain and ischemia
Patient has atypical glandular cells on pap. Next step?
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)
FOOSH in little kid results in:
Supracondylar fracture of humerus (most common peds fracture)
complications of supracondylar fracture of humerus
- Brachial artery injury
- Median nerve injury
- Cubitus varus malformation
- (rare)Compartment syndrome/volkmann contracture
who gets transient tachypnea of newborn and what causes it?
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
what does US show for ovarian torsion?
adnexal mass with absent Doppler flow to ovary
features of vertebrobasilar insufficiency (emboli/thrombus/dissection)
Vertigo
N/V
DYSARTHRIA, Diplopia, numbness,
Ataxia
Vancomycin toxicity and prevention
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)
Interventricular septal rupture vs Ventricular free wall rupture
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
how does ventricular aneurysm post MI present?
Late (weeks to months later). Heart failure, arrythmia, refractory angina, may have systemic arterial embolism from mural thrombis
when is a transesophageal echo used?
- 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…?
when is coronary angiography used?
- determine who needs CABG
- if stress test is abnormal maybe do it
- usually not the right answer
symmetric vs asymmetric IUGR
Symmetric: 1st trimester. Chromosomal anomaly or intrauterine infx
Asymmetric: 2nd/3rd. Uteroplacental insuff (HTN, DM), maternal malnutrition (spares head)
Asplenic patients (i.e. abdominal trauma) are at increased risk for which infxs and why?
ENCAPSULATED
- deficits in antibody response/antibody-mediated phagocytosis and complement activation (splenic macrophages)
- these pts need vaccines: meningococcal, pneumococcal, HIB
T/F: Intra and extrahepatic biliary tract dilation can be seen in a patient with painless gallbladder distention
True. Pancreatic cancer (courvosier sign)
What did a patient receive too much if she is seizing in the early postpartum period?
Oxytocin!!! Similar to ADH so causes HYPONATREMIA
and hypotension
(not magnesium: hyporeflexia/lethargy/resp and cardiac failure)
leading cause of B12 deficiency and its long term complication
Pernicious Anemia
Gastric Cancer (intestinal type) and Carcinoid tumor
(due to atrophic gastritis)
Entamoeba histolytica vs Echinococcus granulosus
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
what are the 2nd gen antipsychotics?
Clozapaine (agranulocytosis, tx refractory), risperidone (hyperprolactinemia), quietiapine, olanzapine, ziprasidone, aripiprazole, lurasidone
Why is “failure of follicular maturation” part of PCOS?
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
Wtf is sex chromosome monosomy?
XO = Turners
Premature ovarian failure aka primary ovarian insufficiency is associated with:
Autoimmune disorders. “menopause before 30”. Normal testosterone level. Infertility and oligomenorrhea (if high testosterone its PCOS pick failure of follicular maturation)
how do you treat migraines in kids?
Supportive (dark room etc) + nsaids/tylenol
How far does the placenta have to be from opening for vaginal delivery to be allowed?
at least 2 CENTIMETERS. INCHES IS A FUCK TON. CEntimeters from the CErvix.
ovarian mass causing breast tenderness, postmenopausal bleeding or precocious puberty
Granulosa cell tumor: secretes estrogen baba
Vitiligo (depigmentation on hands, feeth, face) is associated with:
autoimmune disorders habibti
Losing balance during Romberg test (+)
Proprioception fucked up: pick B12 def or tabes dorsalis
+Pronator drift test
UMN or Pyramidal tract dz.
ataxia, intention tremor, problem with rapidly alternating movements
Cerebellar dysfx
Acute renal failure (rising Cr) in patient with severe liver disease and portal hypertension
Hepatorenal syndrome
Pulsus bisifiriens
Aortic regurg, HOCM. 2 strong aortic peaks of systolic pulse.
Hypotension and elevated JVP
Look for becks triad (+ muffled heart sounds) = Cardiac Tamponade i.e. pericardial effusion
how do you treat pneumonia?
CAP: Ceftriaxone + Azithromycin
HCAP: Vancomycin + Pip/Tazo
EKG findings of LVH + htn in a young person
(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.
high frequency age related sensorineural hearing loss. harder to hear in crowds /noisy environemnts
Presbycusis
scaly papules/plaques on sun exposed areas (scalp/face/arms/hands). Premalignant for SCC. Dz and Tx
Actinic Keratosis
- ->local ablation: Cryotherapy
- ->f/u: 5-Fluoruracil (5-FU) = chemo
Anti-cyclic citrullinated peptide and rheumatoid factor associated with:
rheumatoid arthritis
What might parvo virus in an adult look like?
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
decreased sensation 4th/5th digits plus decreased hand grip (due to interosseous mm)
Ulnar nerve entrapment at the elbow (medial epicondylar groove)
EKG leads
Limbs: I, aVL: Lateral II, III, aVF: Inferior (many of them are R sided infarct) Precordial: V2, V3, V4: Anterior V5, V6: Lateral (LVH)
why are nitrates and diuretics avoided in treating Right heart failure (i.e. II, III, avF)?
In RHF, theres a big problem with preload and hypotension. Nitrates and diuretics would further decrease preload.
T-test compares two ______,
Chi square test compares two or more _______
t-test: means (i.e. blood pressure). ANOVA compares 3 or more means
chi square: proportions i.e. high, low, etc
T/F: A muffled voice should make you consider a dx other than uncomplicated pharyngitis/tonsillitis
TRUE AF HOMEBOY. think about peritonsillar abscess (i.e. deviation of the uvula, unilateral LN. needs aspiration/drainage + ABx)
Why might I might mistake McCune Albright for cushings?
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
If you have an abnormal first trimester screen (i.e. elevated bhcg), do you do a second semester screen?
Nope, you do diagnostic testing (in 2nd tri this means Amniocentesis).
First and 2nd tri screens pick up aneuploidy (i.e trisomies)
when does second trimester start?
week 13 - 28
dates to do CVS and amniocentesis
CVS (first tri): week 10-13
Amnio (second tri): week 15-20
give you a fetal karyotype
when do you stop Pap?
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)
How do you manage PPROM?
<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
T/F: PPROM at 34-37 weeks youre going to deliver
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)
when an orbital cellulitis like picture looks worse, CN deficiencies and neuro signs, whats the dx
Cavernous sinus thrombosis (cn 3 4 5 6 affected, severe HA, bilat periorbital edema)
side effects of levodopa/carbidopa
Hallucinations! confusion/HA/dizziness/agitation
much much later: involuntary movements (dystonia/dyskinesia…5-10 years later).
On/off phenomenon
Which parkinson drug side effect causes choreiform dyskinesia?
COMT inhibitors: EntaCapones, TolCapone
Which parkinson drug can cause Livedo Reticularis?
Amantadine b/c a man is much more likely to have high cholesterol .
Also causes Ankle edema
What is trihexyphenidyl?
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
What’s the difference between malignant hypertension and hypertension encephalopathy?
–>By definition, HTN Emergency = severe HTN with one of these or end-organ damage
Malignant: associated with retinal hemorrhages, exudates or papilledema. can have renal sxs. from long-standing htn.
HTN Encephalopathy: associated with cerebral edema
adverse effects of ACE-I
Hyperkalemia, angioedema, cough, can precipitate acute renal failure in pts with RAS
when is prednisone (steroids) given with bactrim for PCP pneumonia?
PaO2 <70 or A-a>35
toxicity of bactrim
neutropenia (TriMethoprim Treats Marrow Poorly), rash, hyperkalemia, elevated AST/ALTs
T/F: Urinary retention can be a common sign of spinal cord compression in elder men
False, look for INCONTINENCE.
BPH is a common obstructive cause of retention.
Drugs that increase Lithium levels (look out for GI sxs, tremors, ataxia)
NSAIDs (non aspirin), tetracyclines, thiazides, ACE-I, metronidazole
what kind of murmur do Patau syndrome (overlapping fingers) have?
Holosystolic: VSD
features of patau syndrome
- prominent occiput
- overlapping digits
- micrognathia
- microcephaly
- VSD
- low set ears
- rocker bottom feet
- limited hip abduction
- absent palmar creases
fever, cough, diarrhea, hepatosplenomegaly, increased ALP, CD4 <50
MAC
risks of ocps
HYPER HYPER HYPER HYPERTENSION SON
Hepatic Adenoma: LIVER (not breast fibroadenoma)
VTE. sometimes stroke/mi
T/F: OCPs can cause breast fibroadenoma
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)
Testing for GBS occurs weeks:
Rho-gham in given:
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 +.
T/F: one of the indications for RHo-gham is external cephalic version
YES true
which lab tests are done at 24-28 weeks gestation?
- Oral glucose tolerance test (50g, 1 hour)
- Antibody screen if Rh-
- Hemoglobin/hematocrit
polyarthralgias
tenosynovitis
vesicopustular skin lesions
disseminated gonorrhea
immuno of 23 vs 13 valent pneumococcal vaccines
23: capsular polysachharide (t cell ind. B cell response)
13: capsular polysachharide conjugated to a protein antigen (T cell dep. B cell response)
what will patients say indicating retinal detachment?
Floaters/flashes of light.
A curtain shade dropping from the sides (periphery)
cherry red spot at fovea (center of macula), acute painless monocular vision loss
central retinal artery occlusion (embolic)
Tx of Narcolepsy
-sleep hygiene, scheduled naps, avoidance of alcohol and drugs that cause drowsiness (no melatonin)
-meds: Daytime sleepiness: amphetamines, Modafinil, methylphenidate
Cataplexy: sodium oxybate
T/F: Look out for septic emboli from endocarditis
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).
T/F: Adenomatous polyps are considered neoplastic (risk of malignant transformation)
True. Villous ones are the villains (worse than tubular)
who gets screened for chlamydia and gonorrhea?
all sexually active women under 25 (asx infection can lead to infertility)
tx of confirmed gonorrhea or chlamydia
confirmed chlamydia: Azithromycin
confirmed gonorrhea: Azithromycin + Ceftriaxone
Isoniazid is ____toxic
HEPATO. also, can cause drug-induced lupus and neurotoxicity (INH Injures Neurons and Hepatocytes)
glucose goals in a GDM patient
Fasting <95
1 hour <140
2 hour <120
Tx: Dietary mods; Insulin/Glyburide/Metformin(doesnt cross placenta, any are 1st line)
What is trichophyton rubrum?
Causes ringworm and tinea pedis. pruritic and scaly
What are the exposures for CO poisoning vs Cyanide poisoning (both can present very similar, HA/n/v/abdominal discomfort)hat 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»_space;02); Hydroxycobalamin
What’s the TTP pentad?
TTP = formation of small vessel thrombi that consume plt
-Neuro sxs
-Renal sxs
-Thrombocytopenia
-Hemolytic anemia (with schistocytes and LDH increase)
-Fever
Dx: Peripheral Smear Tx: Plasma Exchange, steroids
What are the FOUR types of reactions you can have to a transfusion?
- ANAPHYLAXIS (IgA def). seconds-mins
- Bacterial SEPSIS (fever/shock/DIC). min-hours
- Primary HYPOTENSION RXN (transient hypotension in pt taking ACE-I, due to bradykinin in transfusion). mins
- Transfusion-related ACUTE LUNG INJURY: resp distress, flash pulm edema (noncardio), caused by Donor ANTI-LEUKOCYTE ANTIBODIES. w/in 6 hours
how often are men (>35, risk factors) and women (>45, risk factors) screened with lipid panel?
q5 years
how often are adults (>18) screened for hypertension?
Technically every 2 years
how often are women (age 50-75) screened with mammogram?
once every 2 years
how do you dx Acromegaly?
- Measure IGF-1 levels
- 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
IVDU has fever. what are you going to start assessing for?
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
Someone has an elevated Alk Phos. How does GGT help you?
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
How would you describe PBC?
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
T/F: Anemia of chronic dz is treated with Iron
False, you tx the underlying disease!!
Prosthetic joint infx cause
<3 mo: Staph Aureus, G- rods, anaerobes
3-12 mo: Staph Epi (coag -), Enterococci, propionibacter
>12: Staph aureus, GAS
osteomyelitis vs avascular necrosis (both painful)
i.e. Sickle cell pt
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
whats the quick rule for making dx of Schizoaffective disorder over MDD with psychotic features?
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)
delayed umbilical cord sepration (>21 days)
Leukocyte Adhesion Deficiency. recurrent skin/mucosal/peridontal infections. ton of neutrophils actually, but no pus.
who gets frequent encapsulated organism infxs (strep, hib, neisseria men, e coli)?
ASPLENIC PATIENTS
Complement deficiency
impaired respiratory burst and increased susceptibility to catalase + organisms
chronic granulomatous disease…chronic GRANDMA PLAYING WITH CATS disease
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
true
Chediak: phagolysosomal fusion
CGD: ROS, catalase + infx
skin lesions, lytic bone changes, and pulmonary findings that could resemble TB, may be immunocompetent
Blasto
Chancroid aka
H ducreyi!!!
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
Behcet syndrome
Primary Syphillis may have negative RPR/VDRL tests (almost 1/3 of patients have FN) early in the disease!
CONSTANT VIGILANCE
Treponema cannot be cultured so do not get a bx and culture. Just treat with Pen
If you suspect multiple myeloma in a patient, what is your workup?
S/UPEP (M-spike)
Peripheral smear (rouleux)
Serum free light chain analysis
Confirmatory test: Bone marrow biopsy
multiple duodenal and jejunal ulcers, refractory to PPI, + chronic diarrhea
ZE syndrome (gastrinoma) -->diarrhea due to inactivation of pan enzymes
FAST exam is negative in a patient with penetrating abdominal injury. What would make you still go back for urgent ex lap?
- Peritonitis (REBOUND TENDERNESS/GUARDING)
- hemo instability
- Evisceration (organs are exposed)
- NG tube/rectal exam shows blood
2 signs (specific) of severe pancreatitis
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
inhertiance of DMD, BMD, and Myotonic dystrophy
DMD/BMD: X-linked recessive (look 4 cardiomyopathy)
Myotonic dystrophy: Autosomal dominant
Drugs that improve survival in patients with LV dysfx
ACEI, ARB, spironolactone/eplerone
In blacks, additionally combo of Nitrates and Hydralazine
what tracts does Syringomyelia fuck up?
- 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
Fanconi vs Blackfan diamond anemias
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.
T/F: Glucagon can be used after OD of beta blocker, CCB
true
severe features of pre-eclampsia
SBP >160, DBP >110, Thrombocytopenia elevated TRANSAMINASES bruh elevated Creatinine Pulm edema visual/cerebral sxs
mgmt of pre-e
w/o severe features: Delivery @ 37
w/ features : Delivery @ 34
Mg obvi
Tx of PreE
BP: Hydralazine, labetolol, or nifedipine. Dec stroke risk
(note: methyldopa is for long term stuff)
Mg Sulfate. Dec/tx seizures
VIPomas are associated with diarrhea during:
fasting or dehydration. tea colored stools. hypochlorhydria, hypokalemia.
T/F: hypovolemia triggers in increase in Aldosterone/Renin ratio
False, this is typical of Primary Hyperaldosteronism.
–> In hypovolemia, you have a proprotional increase in Renin and Aldosterone
What’s required for dx of acute liver failure?
- elevated transaminases
- signs of Hepatic Encephalopathy
- synthetic dysfx (INR >1.5)
how does chronic pancreatitis present (clinically)?
Chronic epigastric pain that can radiate to the back and partially relieved by leaning forward/sitting upright
most common causes (2) of hyperandrogenism in pregnancy
- 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
how do you tx anticholinergic toxicity (including from diphenhydramine or any cholinergic)?
Physostigmine
Lichen sclerosis is a benign lesion
False, it has malignant potential. This is why you have to vet punch biopsy…to r/o squamous cell carcinoma
T/F: Tx for atrophic vaginitis and lichen sclerosis = Topical estrogen
False. Atrophic vaginitis: topical estrogen (low dose); Lichen sclerosis: Topical corticosteroids (high dose) i.e clobetasol
how do you treat lyme disease in pregnancy or kid <8?
Amoxicillin
what is considered an adequate trial for an antidepressant?
4-6 weeks. Can switch to another class after this if no improvement at an adequate dose
Pemphigus vs Bullous: Which one + Nikolskys?
Pemphigus (desmosomes)
Immunofluorence of Pemphigus vs Bullous Pemphigoid?
Pemphigus: intercellular IgG depots, “net like”
(desmosomes)
Bullous: linear IgG along basement mem (hemidesmosome)
Patient has non-tender lymphadenopathy + B sxs. Whats the next step?
Excisional biopsy! do NOT do needle bx
Look for Reed sternberg or not.
Staging: CXR, CT and bone marrow bx
most common cause of spontaneous lobar hemorrhage, esp >60 yo
Cerebral Amyloid Angiopathy (WTF?). associated with Alzheimers (beta-amyloid deposition)
T/F: unfractionated Heparin and LMW Heparin should not be used in ESRD
False. Unfractionated is used, LMWH should not be used (nor should rivaroxaban)
whats the clue to distinguish methanol from ethylene glycol poisoning?
organ affected: methanol hits the eyes, ethylene glycol the kidneys
(both cause anion gap metab acidosis)
name the shock: Dilated ventricles and apical hypokinesis
cardiogenic
name the shock: engorgement of IVC
cardiogenic
when would you see RV dilation and hypokinesis?
after massive PE
diastolic collapse due to increased RV filling pressure is characteristic of:
cardiac tamponade .
diastolic collapse = failure of ventricular filling
When would a man get myasthenia gravis?
60-80 years old
vs female is 20s-30s
Granulosa cell tumor features:
- produces estrogen. Highly malignant tumor
- Pre-pubertal girls: Precocious Puberty
- Post-menopausal women: AUBleeding
how do you differentiate virulization and precocious puberty in girls? which tumors might cause these
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)
Increased MCHC
spherocytosis
Egg on a string xray finding + cyanosis + single s2 in newborn
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)
signs of chorioamnionitis
- maternal tachy, fever
- fetal tachy (>160)
- foul smelling vaginal discharge
- uterine tenderness
drugs that cause folate deficiency (due to decreased jejunal absorption)
- phenytoin
- primidone
- phenobarbitol
- Bactrim
- Methotrexate
which infants get ABO incompatibility and how would this manifest in an adult?
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)
drugs that can reduce intraocular pressure during acute glaucoma episode
acetazolamide, pilocarpine, timolol, mannitol
do NOT use atropine (causes pupillary dilation )
referred pain to the ear, worse with chewing. pt has hx of teeth grinding (at night)
TMJ
patient goes tanning and notices some patchy depigmentation (areas that didn’t tan)
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
what is the function of Aromatase?
Converts Androgens –> Estrogens.
–>AromatasE A–>E A—>E
Female has estrogen deficiency, increased androgens. Does this look like virilization or precocious puberty?
VIRILAZATION. Looking more like VIRaj. no breast dev.
Precocious Puberty means they get to Preview their Pussies early. PP: Preview Pussies. +breast dev.
Patient suspected to have sarcoidosis deteriorates after steroids
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
In terms of gait, basal ganglia disorders present as:
shuffling gait, like in Parkinsons (depeletion of dopamine in the basal ganglia). BG disorders also responsible for athetosis, chorea in Hungtingtons
autoimmune dx of melanocytes
vitiligo. pt will have other autoimmune dz
mneumonic for causes of Syncope
Woman PE VV: Vaso Vagal O: Orthostatics M: Mechanical cardiac (exertional) A: Arrythmia N: Neuro (vertebrobasilar insuff) P: PE E: Electrolytes
Why does asthmatic have muscle weakness after being treated for exacerbation?
Was treated with beta agonists and steroids, which can pricipitate HYPOKALEMIA (muscle weakness, arrythmia, EKG changes)
Drugs to help drinking abstinence
Reduce cravings: Naltrexone
maintain abstinence: Acomprosate (glutamate modulator)
How does protein C def present?
warfarin induced skin necrosis
no change in PTT with heparin
Antithrombin deficiency
activated protein C resistance
Factor V leiden (mutated factor V doesn’t respond to to protein C, an innate anticoagulant)
initial step in dx cushings
-low dose dexamethasone supp test
-24 hr urinary cortisol
or -late night cortisol
how do you work someone up if you’re suspecting cushings? (full workup)
- Confirm hypercortisol: 24 hour free cortisol AND low-dose dexamethasone suppression
–>high cortisol = cushings syndrome + (now figure out) - 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
what does liver bx show in PSC?
fibrous obliteration of bile ducts with concentric replacement by connective tissue in an onion skin
T/F: A missed abortion presents with empty uterus on US and tx is to followup hcg levels
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
complicatons of cryptorchidism
- Subfertility
- testicular cancer
the following are risks if orchioplexy not performed only:
- inguinal hernia
- testicular torsion
painful vision loss with abnormal pupillary response to light in a woman
Optic Neuritis –> MS
T/F: Papilledema is a sign of true tumor but not pseudotumor
false
Increasing the true positive rate is directly proportional with ________
Increasing the false positive rate is indirectly proportional with _________
TP: Sensitivity
FP: Specificity
what’s the 2x2 epi table?
D+ D-
t+ TP FP
t- FN TN
T/F: Initial prenatal visits includes screening for diabetes (fasting glucose) and STDs like gonorrhea NAAT)
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
pregnant mom is has active Hep B, how do you prevent vertical transmission?
C/s + baby gets both Heb B IVIg and Hep B vaccine on day of delivery
T/F: Reactivation of herpes or varicella during pregnancy causes viremia and is danger for baby
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)
most important point about varicella/chicken pox and pregnant patients
keep pregnant patient isolated from children who could potentially give her the virus
Saddle nose, Saber shins, snuffles (rhinnorhea), hutchinSon teeth
congenital syphillis
Mom has mono-like syndrome in first trimester, baby has symmetric IUGR and brain calcifications
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
Cataracts, congenital hearts defects and cleafness
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)
risk factors for GDM
-advanced maternal age
–preconception obesity
>1 pound/week weight gain
T/F: we do NOT use A1c or fasting glucose to screen for gDM
TRUE. use GTT. 1 hr>140 is +, do the 3 hr.
Does vasa previa present with fetal tachycardia or bradycardia?
BRADY BRADY BRADY BRADY BRADY
for genetic screening, what comprises the first tri screen?
- hCG
- PAPP-A
- US Nuchal Translucency
for genetic screening, what comprises the second tri screen (Triple vs Quadruple?
Triple: hCG, AFP, Estriol
Quadruple : “ “ + Inhibin A
Downs is HI up
if a multip has bleeding intrapartum/post-partum, what are they most likely to have?
“old used up, like an oil well”
placenta may go wide: Placenta Previa (intrapartum)
or it goes deep: Retained placenta (PPH, firm)
smooth muscle constrictor that act on the uterus, helps with PPH especially for uterine atony
Methylergometrine (methergine).
Atony tx: Massage + Methergine + Oxytocin. Worst case go to surgery Tx
how do you tx retained placenta (Accreta, Increta (into the myometrium), Percreta (to serosa) ?
- manual removal, D and Curettage (esp if its due to accessory lobe/piece stuck)
- hysterectomy (more likely with percreta/increta)
Placenta comes out and you see blood vessels going to the edge:
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
T/F: If you suspect chorioamnionitis (baby in) or endometritis (baby not in), next step is vaginal culture
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
what are your options for tocolysis?
i.e. preterm labor with LS<2 and need to get some steroids on deck
- # 1 = Magnesium
- beta agonists (terbutaline), CCB (nifedipine), PG inhibitor (indomethacin)
how do you define premature ROM?
ROM at term but no contractions
when would you not give tocolytics?
Maternal CI (pre eclampsia) Fetal CI (fetal distress/demise) high OB risk (pROM, abruption) ...baby is headed straight to NICU in these cases
how do you manage post dates?
- If dates are certain, you check the cervix. Favorable = induce labor. Unfavorable = c/s
- if dates are uncertain, you do NST and amniotic fluid index (AFI via US)…c/s when baby is ready or in trouble
most common cause of a prolonged latent phase of labor (stage 1) and mgmt
Analgesics!
–>Either just rest and wait, or balloon to stimulate head engagement (cervical ripening) or Oxytocin
causes of prolonged active phase of labor (stage 1) and mgmt
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)
mgmt of prolonged second stage of labor (fully dilated)
-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
mgmt prolonged third stage
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
When is ECV performed for breech baby?
AT 37 WEEKS WITH LEOPOLD MANUEVER
What does station 0 mean anatomically?
ischial spines
T/F: You can have ectopic pregnancy after undergoing tubal ligation (irreversible form of contraception)
True
how should you think about the 24-28 week prenatal visit in terms of screening?
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
all multiple gestations are at risk for:
- Breech birth
- Preterm delivery
- Placenta previa
if forced to pick, which seizure meds can you use in pregnancy?
Levetiracetam and Lamotrigine. For abortive, phenobarbitol
T/F: PreE htn is treated with alpha methyldopa
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)
____ _____ 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:
Actinic Keratosis
Cryotherapy and 5-Fluorouracil
Squamous cell carcinoma (skin) is a malignancy of _____ that can metastasize, unlike BCC. It is usually seen on the ____ ____
keratinocytes. Lower Lip
“stuck on” skin lesion
Subhorreic Keratosis is StucK on
T/F: Albinism = autoimmune dx of melanocytes
False, this describes vitiligo.
Albinism: melanocytes are normal but the enzyme is deficient (tyrosinase), genetic disorder (auto recessive)
How do you differentiate SJS/TEN from staph scalded skin syndrome (all have +Nikolsky)?
SJS/TEN: +mucosal; responds to taking AWAY ABx
SSSS: - mucosal; responds to GIVING ABx
How do you differentiate SJS from TEN?
SJS: <10% BSA, basal cell degeneration
TEN: >30%, full thickness epidermal necrosis
How do you tx suborrheic dermatitis?
Eyebrows/face etc. Think D for Dandruffy (vs keratosis is StucK on)
Selenium shampoo
Increased Keratinocytes in the Stratum Corneum
Psoriasis
T/F: Psoriasis is an auto rec condittion
False, autoimmune disease causing prolif of keratinocytes
Tx for psoriasis
UV light and Topical steroids
Where would you see lichen planus?
Wrists, ankles, oral and vaginal mucosa. Tx with topical steroids
Pemphigus Vulgaris (desmoglein) vs Bullous Pemphigoid (hemidesmosomes) : which has Oral mucosa lesions and +Nikolskys?
Pemphigus Vulgaris
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.
Bullous Pemphigoid. Usually 60-80 yo
T/F: Pemphigus vulgaris is a life-threatning disease, invoves the mucosa, and occurs in people 30-50
TRUE AF. + Nikolskys
What’s the ladder for tx of acne?
Retinoids (comedones)
- -> Benzoyl Peroxide (inflamed/pustular comedones)
- -> ABx/Doxycycline (severe pustular/nodulocystic)
- -> Isoretinoin (get a preg test first)
T/F: Impetigo can cause ARF and PSGN
False, Impetigo can only cause PSGN
step pyo in adults, infects lymphatics and climbs up the extremity
Erysipelas (looks kind of like cellulitis). Tx with amoxicilin
Tx for Tinea unguium (onychomycosis) and Tinea capitus
Onycho: Terbinafine
Capitus: Griseofulvin
get a dx with KOH prep first since these oral meds are hepatotoxic
T/F: Progesterone and OCPs are protective against endometrial cancer
True
order for incidence and mortality of cancers
Incidence: Sex, Lung, Colon
Mortality: Lung, Sex, Colon
sex = breast and prostate
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?
- Tx with continous leuprolide for 2-4 years
- Workup…find the estrogen!
- US of the ovaries and adrenals
- Measure estradiol (overies), DHEAS (adrenals), and 17-OH progesterone (CAH…tx w/steroids)
How do you define delayed puberty?
absence of secondary sex characteristics by 13 or absence of menstruation by 15
T/F: Tx for constitutional delay is GH
FALSE. no growth hormone, just reassure (look for +FHx and bone age, FSH and LH normal)
T/F: SSRIs, especially VENLAFAXINE, are useful for treating hot flashes
TRUE HOMEBOY. HRT causes endometrial cancer, and estrogen/soy doesnt work
T/F: Never given an alcoholic a benzo
False. For withdrawals especially, we use a Benzo taper (chlordiazepoxide aka librium, diazepam, lorazepam)
T/F: Wernickes and Korsakoffs are irreversible
False. Wernickes = reversible cerebellar dysfx
Korsakoff = irreversible, confabulations (cerebral atrophy)
Tx of phobia and social anxiety
CBT
If its performance anxiety, Beta Blocker
Tx of PTSD
SSRI/SNRI
For nightmares: Alpha blockers (Prazosin)
Tx of Catatonia
Benzo or ECT
Tx of Panic disorder
SSRIS, Benzos for acute
what’s the difference in asperger and autism?
Asperger has intact language f(x)
T/F: Lamotrigine is effective against bipolar manic episdoes
False, it is good for bipolar depressive episodes. Watch out for SJS
how does juvenile myoclonic epilepsy present?
teenager with myoclonic movements usually within the first hour of waking. Irregular spike and wave EEG. Treat with Valproate
seizures that can be provoked by hyperventilation and have classic EEG findings
3 Hz spike and wave, Absence seizures. last 10-20 seconds usually
Impaired strength and loss of pain/temp in the UE months after a whiplash injury
Syringomyelia. Enlargement of the central canal due to CSF retention.
most common cause of esophagitis in HIV
candida!
other causes: HSV (round ulcers), CMV (linear ulcer)
transient vision loss caused by ischemia of the optic nerve
Amaurosis fugax possibly from FMD
AF just = painless transient vision loss
noninflammatory and nonatherosclerotic narrowing (cellular) of renal, carotid, and/or vertebral arteries
Fibromuscular dysplasia
new-onset htn after 20 weeks gestation + proteinuria or end organ damage
PreE. UPC>.3 or 24 hour protein >300mg
mgmt of PreE
w/o severe features: delivery @ 37
w/severe features: delivery @ 34
Mg sulfate and antihypertensives
what are the “severe features” of PreE (delivery @ 34)?
- BP >160, 110
- thrombocytopenia
- increased Cr
- increased transaminases
- pulmonary edema
- visual/cerebral sxs
T/F: All HCV patients except pregnant should be given HAV and HBV vaccine
False, EVERYONE including pregnant gets them now if not already immune
Tx for Asx gallstones
NOTHING
when is meningococcal vaccine given?
11-12 with a booster at 16-21.
Also given to high risk pts: travel to Africa, college students/military recruits, asplenic
meds that can idiopathic intracranial htn?
GH, tetracyclines, excessive vitamin A and derivs (isoretinoin, ATRA)
these blue bloaters get RHF (JVD, CLUBBING, edema, hepatosplenomegaly)
chronic bronchitis
what’s the order of tx for COPD?
SABA (ipra>alb), LAMA (tio), LABA (salmeterol), ICS, PDE4 (roflumilast), Oral steroids
which interventions in COPD will prolong life
O2 and smoking cessation only (i.e. rehab does not)
What are the indications for chronic home O2 for COPDers, and what is the goal?
have to be pO2 <55 or SPO2 <88% on pulse ox @rest.
Goal: SpO2 between 88-92 (maintain drive)
Whats the tx for acute COPD exacerbation?
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)
how are you going to remember Lights criteria?
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
Qualify this statement: For pleural effusions, don’t tap if its small, loculated or CHF
Tap = thoracentesis
- Small = <1 CC
- Loculated (not free moving i.e. on recumbent xray/CT/US): needs thoracostomy (chest tube) or surgery (thoracotomy)
- CHF: Just do diuresis, no tapping
transient synovitis occurs after:
Septic hip occurs after:
TS: URI
SH: Febrile illness
FOOSH: toddler; young kid; old lady
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)
what do you fracture when you punch a wall?
metacarpal neck (4th and 5th)
most common places for compartment syndrome
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!
Tx for gas gangrene (i.e. deep penetrating dirty wound, few days later pat is toxic with tender swollen discolored site)
Penicillin and Clindamycin
Surgical debridement
Hyperbaric O2
Worst fungal infection in a pat with extensive bruns or widespread trauma
Mucormycosis…area turns black, get tissue bx. IV amphotericin B for mucormycosis (vs broader spectrum for gangrene and necrotiing fasciitis)
next step if you have any closed head injury, neck trauma or facial fractures
Eval of cervical spine (CT)
what kind of lesiosn are seen with mets to the spine?
Women: Lytic lesions from breast
Men: Blastic lesions from prostatei
how does phototherapy improve hyperbilirubinemia?
ISOMERIZES/ionizes (does NOT conjugate boi) bilirubin which makes it more water soluble
what does CXR of TTN show?
Perihilar streaking, air trapping, fluid in fissures. Term infant born by c/s has retained fluid (dec compliance, inc resistance)
Tx for impetigo
mupirocin (topical antibiotics)
when can you give hormone replacement therapy?
- vasomotor sxs (menopausal hot flashes)
- genitourinary atrophy
- dyspareunia
how do you increase appetite in cachexic/cancer pt?
should let them Smoke Pot, instead we give
-Steroids or Progesterone (megestrol acetate) analog
Transudative effusion with low glucose vs Exudative with low glucose
Transudative: Rheumatoid arthritis (lots of wbcs eat up glucose)
Exudative: complicated; parapneumonic
Transudative effusions: bloody? high lymphocytes?
Bloody: PE or cancer
wbcs: TB
