Bina's HY Flashcards
45 yo M w/ epigastric pain, diarrhea. Hx of PUD, 20 yrs smoking. Endoscopy shows prominent gastric folds, 3 duodenal ulcers, upper jejunal ulceration. Suspect?
Z-E (Gastrinoma)
Urethritis, conjunctivitis, arthritis, mucocutaneous lesions, Achilles tendon pain
Reactive arthritis
What is the triad of Wernicke’s encephalopathy?
- Encephalopathy 2. Gait ataxia 3. Oculomotor dysfunction
Dysmenorrhea, dyspareunia, infertility
Endometriosis
Relative bradycardia despite fever
Legionella
Periorbita edema, myositis, eosinophilia
Trichinellosis
Malignant hyperthermia s/s
Muscle rigidity. High T and HR. High CK and K. High CO2.
Gallstone ileus triad
Small bowel obstruction, gas within the biliary tree and a gallstone (stone gets impacted in ileocecal valve)
Bounding pulses and increased pulse pressure in a child
PDA
Heart sound increased with inspiration
Right sided
Fatigued and dyspnic pt w/ loud S1, sharp sound after S2, low-freq diastolic murmur at apex that increases in intensity before S1
Mitral stenosis
Loud S1 = calcified mitral valves snapping shut.
Sharp sound after S2 = opening snap
CXR of child shows streaky densities bilaterally w/ mild hyperinflation
CF
Glucagonoma
Classic necrolytic erythema
What are common psych features of fragile X?
ADHD
CSF shows
=
Young person w/ lung and liver sx
A1 Antitrypsin deficiency
Lesion in what nerve causes wrist drop?
Posterior cord (–> Axillary and Radial)
Lesion in what nerve causes deltoid paralysis?
Axillary
Lesion in what nerve causes difficulty flexing elbow?
Musculocutaneous
Lesion in what nerve affects intrinsic muscles of the hand?
Ulnar
Lesion in what nerve causes saturday night palsy?
Radial - had a rad time. 2/2 compression of axilla –> wrist drop
Lesion in what nerve causes loss of wrist flexion?
Median
Lesion in what nerve causes foot drop?
Common peroneal
Lesion in what nerve causes loss of sensation on sole of foot?
Tibial (Knee trauma, Baker cyst)
Lesion in what nerve causes difficulty adducting leg?
Obturator
Lesion in what nerve causes difficulty flexing thigh?
Femoral
Lesion in what nerve causes difficulty extending leg?
Femoral
Young guy with HF sx
Myocarditis –> dilated cardiomyopathy
Over 3 months, a 30 yo F has had intermittent h/a, palpitations, sweating, irritability, pallor.
Pheochromocytoma (Sustained or paroxysmal hypertension, H/a, Sweating)
What are the agents used for malignant htn (3)?
- Labetolol, 2. Nitroprusside, 3. Nicardipine
BP is >= 180/120. Reduce to 100mmHg
What workup should all pts w/ htn receive (4)?
- Lipid profile
- Chem panel
- Baseline EKG
- UA (occult hematuria, urine protein/creatinine ratio)
Severe htn after 55 yo, abd bruit, recurrent pulm edema or resistant HF
Renovascular dz (2ndary htn)
Htn w/ confusion, depression, psychosis
Primary hyperparathryoidism (2ndary htn)
Htn w/ brachia-femoral pulse delay
Coarctation of aorta (2ndary htn)
Htn w/ fatigue, dry skin, cold intolerance
Hypothyroid (2ndary htn)
CSF shows WBC 1200, glucose 30, protein 300
Bacterial
CSF shows WBC 800, glucose 50, protein 90
Viral (high WBC, normal ish everything else)
CSF shows WBC 800, glucose 5, protein 300
TB (similar to bacterial, but WBC not as high, glucose very low)
CSF shows WBC 1, glucose 50, protein 300
GBS
Baby has craniofacial anomalies, growth def, cardiac defects, facial cleft. Mom used what in utero
Phenytoin (funny toe)
DM pt w/ ear pain and drainage, +/- granulation tissue
Malignant OE
Abx effective against pseudomonas?
-
Fracture of humeral midshaft injures
Radial nerve (wrist drop)
Fracture of medial epicondyle of humerus injures
Ulnar nerve
WBC casts
Tubulointerstitial nephritis
66 yo M w/ 4 wk hx increasing back pain, severe constipation, constant urination. Hb 9.5, BUN 28, Cr 1.9, ESR 80. Suggests
Multiple myeloma
70 yo M w/ 3h severe constant chest and neck pain radiating to back. Hx htn and DMT2. bp 189/110 on R and 181/112 on L. Decr diastolic murmur at R sternal border. EKG shows T wave inversions in V5 and 6.
Aortic dissection
65 yo M w/ severe CP radiating to back, bp 170/110 on R and 130/110 on L.
Aortic dissection
75 yo M w/ severe CP radiating to back, weak peripheral pulses.
Aortic dissection
Constipation, anorexia, vomiting, weakness, polyuria, confusion/lethargy suggests
HyperCa
Which macrocytic anemia associated w/ neuro sx?
B12 - vegans, pernicious anemia
Muddy brown casts
Acute tubular necrosis
66 yo w/ 3 mo hx back pain, recent hearing loss
Paget’s disease
Waxy casts
CKD
Fatty casts
Nephrotic syndrome
Serotonin syndrome s/s
Hyperreflexive (myoclonic jerk), Tachycard, High bp, n/v/d
78 yo M in ED after syncope, has CP and neck pain. Hx includes htn, hld, DMT2. T 99.2, bp 144/92 R 142/90 L, P 109. EKG shows sinus tach, LV hypertrophy, no other changes. TTE shows pericardial effusion.
Aortic dissection –> pericardial effusion
Rx in the meantime for high bp in aortic dissection?
BB
74 yo F w/ 1 w n/d/decr app. Few days incr fatigue and palpitations. PMH afib and cardiomyopathy Rx Lasix, metop, digoxin, warfarin. BP 140/90 P 70 irregularly irregular. Scattered wheezing. INR 2.3. Next steps?
- Digoxin
- EKG
- PT/INR
R/o digoxin tox, life threatening arrhythmias, and coagulopathy 2/2 dehydration
Signs of HF, elevated JVP w/o inspiratory decline, tracings show prominent x and y descents, decr heart sounds,
Constrictive pericarditis
Young woman has myopathy. Don’t forget about
Thyroid myopathy (includes tremor) - both hypo and hyper
What is osteitis deformans?
Paget’s dz of bone
Nephrotic syndrome + palpable kidneys, hepatomegaly, ventricular hypertrophy, recurrent infx
Secondary AA AS A COMPLICATION of chronic inflammatory conditions
Rx: Colchicine
Painless bleeding in preggo w/ fetal deterioration
Vasa previa
Neovascularization and conjuctivitis
Trachoma 2/2 Chlamydia
Rx: topical tetracycline or PO azithro
Ingestion: CNS depression, disconjugate gaze, absent ciliary reflex
Iospropyl alcohol ingestion
No increased anion gap, no metabolic acidosis!
Htn retinopathy s/s
Not typically vison loss
AV nicking, coper/silver wiring, exudates, hemorrhage
Displaced retinal emobli vs. occlusion of central retinal vein thrombus
Both can cause vision loss, but
displaced retinal thrombus - white edema around arterioles vs. dilated tortuous veins w/ hemorrhage
Allergic conjunctivitis vs. atopic keratoconjunctivitis?
Both 2/2 allergy but atopic keratoconjunctivitis is more severe (thick mucous d/c, blurred vision)
High alk phos but nl Ca, PO4, and LFTs suggest
Paget dz of bone
Ophthalmoscopy shows microaneurysm, dot and blot hemorrhage, hard exudate, macular edema
DM retinopathy
Ophthalmoscopy shows multiple sores in macular region
Atrophic macular degen
Ophthalmoscopy shows new blood vessels that leak, bleed, and scar retina
Macular degeneration
What are the indications for prompt delivery with induction of labor (2)?
- Chorioamniotitis 2. Eclampsia
What counts for prolonged ROM?
> = 18 to 24 h
Rx for Chagas?
Benznidazole (Cruz in a Benz)
Uticaria, abd pain, resp problems (dry cough, dyspnea, wheezing). Dx and rx?
Strongyloidiasis. Ivermectin
Rx for pinworm?
Albendazole, pyrantel pamoate
Palms and sole rashes
CaRS:
Coxsackie
Rocky Mountain Spotted Fever
Syphilis
Histology of fungus: macrophage filled w/ fungus
Histo
Histology of fungus: broad-base budding
Blastomycosis
Histology of fungus: spherule filled w/ endospores
(larger than RBC like larger than Cali)
Irregular, broad, nonseptae at wide angles
Mucor
Germ tubes at 37 degrees C
Candida
Pseduohyphae and budding yeasts at 20 degrees C
Candida
Septae hyphae at 45 degree angles
Aspergillus
Disc-shaped yeast on silver stain
Pneumocystis jirovechi
Fever, headache, retro-orbital pain, rash, myalgia and arthralgia.
+/- hemorrhage in skin or nose
Dengue fever
Progressive disease: fever in 1st week, abd pain and salmon rash (trunk to extremities) in 2nd week, hepatosplenomegaly w/ abd complications in 3rd week
Typhoid (TRIphoid) fever
Pt w/ fevers/chills, LUQ pain, splenic fluid collection, and L side pleural effusion concerning for
Splenic abscess (classic triad: fever, leukocytosis, LUQ abd pain)
Pt w/ 3 yr hx of upper abd pain. Dull epigastric and LUQ pain for hours. Not relieved by antacids. Precipitated by food. Occasional diarrhea. Lost 15 lbs over last 12 mo. Smokes and drinks daily. Likely
Chronic pancreatitis (chronic epigastric pain w/ intermittent pain-free interval, malabs, DM +/- changes in amylase/lipase)
Ddx:
- Stomach cancer = early satiety
- Esophageal cancer = dysphagia, emesis
Brick red crystals in urine
Sign of dehydration –> suspect breastfeeding jaundice
Hyperactive BS
SBO
Pancreatitis due to this HIV therapy
Didanosine
Hypersensitivity due to this HIV therapy
Abacavir (hypersensitive in the heart of the monster)
Lactic acidosis due to this HIV therapy
Any of the NRTIs
SJS due to this HIV therapy
Any of the NNRTIs
Needle shaped crystals in urine sediment (crystal-induced nephropathy) due to this HIV therpy
Indinavir
Liver failure due to this HIV therapy
Navirapine
What is trihexyphenydyl?
Anticholinergic used in PD (Tri Hussies having Fun at the beach)
Cellulitis in the face of a child likely 2/2
H. influenze
Erysipelas likely 2/2
GAS
Fomepizole is used to reverse
Ethylene glycol poisonsing
Sodium thiosulfate is used to reverse
CN tox
high-grade reflux in females that persists into adulthood with no clear secondary cause
surgical repair
multiple 2nd trimester spontaneous abortions
cervical cerclage
erythematous knee with effusion and fever
arthrocentesis [ need to tell apart gout from septic arthritis]
spontaneous pneumothorax in a tall young man
supplemental oxygen
clue cells seen in vaginal swab in a fertile woman
oral metronidazole
acute open-angle glaucoma
1)beta-2-antagonist eye drops i.e. timolol, betaxolol
chronic sinusitis
CT scan of the face (coronal section)
someone with tinnitus, progressive hearing loss, and multiple episodes of vertigo
dietary restrictions- particularly of caffeine, salt, and tobacco (Meniere’s disease)
someone that comes in with headaches and shows papilledema in the opthalmic exam
CT scan of the head non-contrast - r/o mass
treament for scabies
permethrin
Scaphoid fracture that is negative on X-ray
spica cast and re-evaluate in 2~3 weeks
3-hour old infant with poor feeding who vomits green material and has a double-bubble on KUB
decompression of the GI tract…requires nasogastric tube
mini-mental status exam of
neuropsychologic testing to rule-out alzheimer’s (other causes of dementia)
cord compression confirmed with CT-spine
dexamethasone ( before MRI of the spine to gold-standard confirm cord compression)
borderline personality disorder
dialectical behavioral therapy
Pulmonary edema in acute CHF exacerbation
100% O2 therapy
Pulmonary edema in acute CHF exacerbation after 100% O2 therapy
IV furosemide
supraventricular tachycardia with HR=160 bpm with p-wave preceding all QRS sinus rhythm
Vagal manuevers first -carotid massage, then valsalva , then pharmacological-CCBs or adenosine
Asymptomatic aortic stenosis
Hydrocholorothiazide to reduce preload
Hypertension with underlying diabetes type 2
ACE-inhibitor or ARB
Syncope with normal vitals and no previous episodes
Check the electrolytes and medications - thiazide diuretics can cause hypokalemia and arrythmia
PR interval=o.3 sinus rhythm normal
Nothing, no management needed; PR>0.2 is first degree heartblock
A-fib secondary to hypertension for >48 hours
Diltiazem; rate control + anticoagulant
A patient presents with hypertension and chest pain on exertion
IV nitroglycerin for lowering the blood pressure
Palpitations with underlying lung disease i.e. COPD
72 hr Holter monitor
Angina symptoms
Beta-blockers - they increase the threshold of amgina
Post anterolateral MI and Percutaneous coronary intervention
Clopidogrel
teenage patient grunting and blinking many times a day for at least 1 year
haloperidol
suspected pulmonary embolism
spiral CT scan
prinzmetal angina
calcium channel blockers or nitrates (also for esophageal spasm)
Lambert Eaton Syndrome
radiation and chemotherapy as it is the manifestation of a pre-existing small cell carcinoma of the lung.
stroke outside the 3 hour period but within 6 hours
intra-arterial tPA administration
osteopenia in an elderly patient
calcium, vitamin D, and weight-baring exercise
tracheobronchial rupture
bronchoscopy (flexible or rigid)
abdominal pain out of proportion to clinical findings
laparatomy
Guillane Barre Syndrome
plasmapheresis or IVIG with admission to ICU
shoulder dystocia on observing the Turtle sign(retraction of head back into perineum)
McRoberts maneuver - flexion of mother’s thighs against her abdomen
central retinal artery occlusion
ocular massage with high flow oxygen
malaria protection for a trip to India spent outdoors
Mefloquine
avoiding calcium oxalate stones
decrease protein,oxalate, and sodium intake
nephrogenic diabetes insipidus
free water and hydrochlorothiazide
carbon monoxide poisoned pregnant lady with carboxyhemoglobin >15%
hyperbaric oxygen (oxygen >100%)
flu-like illness with cherry red lips; multiple family membersl; carboxyhemoglobin
100% oxygen
a digoxin user with a potassium of 5.5 mg/dL
Digibind (Fab fragment
Wernicke’s Encephalopathy
thiamine, then glucose ( in that order)
Alcohol withdrawal
fluid resuscitation, thiamine, dextrose, folate, benzodiazepines(diazepam, chlordiazepoxide)
septic arthritis
ceftriaxone + vancomycin
prophylaxis against acute limb ischemia in a person with a-fib
dabigatran
acute febrile non-hemolytic transfusion reaction
discontinue transfusion, give IV acetaminophen
acute cholecystitis
IV fluids, pain medication, and cholecystectomy within 72 hours
abscess size >3cm
CT-guided percutaneous drainage
single 2cm nodule on Chest X-ray in a 25 yo male
check old Chest-X-ray to compare size or presence of the nodule.
ulcer that is not infected and does not involve the bone
debridement
how to diagnose hepatorenal syndrome
IV colloid challenge , if no improvement then positive for hepatorenal syndrome
Primary light chain amyloidosis
mephalan and prednisone
local baldness
minoxidil
severe acute pancreatitis >30% necrosis on MRI
imipenem followed by percutaneous needle biopsy
pseudocyst on CT-abdomen
if expanding or pain symptoms, then drain it. otherwise leave it alone.
elderly patient with intermediate to high risk factors for coronary artery disease
stress test
needle-stick and unvaccinated for HepB
give HepB IV-IgG and HepB vaccine
MRI contraindicated in suspicious looking equivocal X-ray
Technetium bone scan
man comes in with a painless chancre on the penis
swab the exudate and perform dark-field microscopy
Tzanck positive
acyclovir
methods of genital warts
cryotherapy , lasers, trichloroacetic acid or podophyllin
acute viral pericarditis recurrence prevention
colchicine
pericardial effusion
pericardial window placement or pericardiocentesis
pneumonia, dyspnea, dry cough fever chest pain in HIV patient
Bronchoscopy with alveolar lavage
dysuria, suprapubic pain, and hematuria continue despite empiric antibiotics for UTI
CT-scan of the abdomen and pelvis
the first test to determine beta-thalassemia anemia in genetic counseling
complete blood count in the female (if no abnormality found, then there is no need for hemoglobin electrophoresis testing; if abnormal then test the partner)
no menarche in a 15 year old with no medical problems and Tanner stage 1 with a uterus
measure serum FSH (do not measure estrogen because the lack of breast development already tells you there is a lack of it)
dog bite with suspicion of rabies
quarantine the dog for 10 days; if asymptomatic the whole time, then no need for management (post-exposure prophylaxis)
pinpoint calcifications in a newborn whose mother owns a cat
pyramethamine and sulfadiazine (Treats toxoplasmosis)
peripartum cardiomyopathy - biventricular cardiac failure
supportive care
eisenmenger’s syndrome in a pregnant woman
avoid hypotension give pressors
Rheumatic mitral stenosis in a pregnant woman
decrease the heart rate to allow time for blood to fill the left ventricle; reduce the IV fluid volume
pregnant woman of 16 weeks gestation with fasting blood glucose of 140 mg/dL
do quadruple marker screen assess for neural tube defects - specifically caudal regression syndrome - she has overt diabetes mellitus.
Estimated fetal weight is >4.5kg by sonogram
C-section
perinatal management of gestational diabetes
IV D5w with insulin drip maintain glucose within 80-100mg/dL
non-reactive stress test
vibroacoustic stimulation- wake up the baby because most commonly non-reactive ST due to the baby sleeping
non-reactive stress test with positive contraction stress test
delivery the baby immediately
fibromuscular dysplasia
percutaneous angioplasty with stent placement
a patient undergoing heparin treatment has right arm pain and cold right upper extremity pain with no peripheral pulse
…
4 month old boy with leg-length discrepancy and positive Ortolani test
U/S of the hip followed by Pavlik Harness (splint that holds hip in flexion and abduction) - prevents extension and adduction
45 yr old woman overdosed on pills comes in with tinnitus, fever, and tachypnea
aspirin intoxiciation - supportive care, activated charcoal, IV hydration, bowel irrigation
suspicion in an immigrant man with hypopigmented skin patch with loss of sensation. Had a flu-like illness 1 month prior.
perform a skin biopsy -> top ddx is Lepromatous leprosy.
A man with mediastinal widening on chest X-ray and equal blood pressures on both arms and moderate pericardial effusion
Trams esophageal echo
5 day old newborn has lost 7% of their body weight
follow up 10-14 days to see if baby has regained it (normal loss of fluid due to labor and in-utero)
skin lesions in a patient with celiac disease
dapsone (Tx for dermatitis herpetiformis)
clinical suspicion for abnormal uterine bleeding
endometrial biopsy
reproductive-age woman with widespread pain ,fatigue, poor-sleep, frequent headaches and tenderness to palpation of her neck, shoulders and back. Vitals and labs are normal.
exercise program with aerobic conditioning (Tx for fibromyalgia). Medications - duloxetine, TCAs are a secondary measure.
1 month old boy with a harsh holosystolic murmur over the left lower sternal border
echocardiography - he has a VSD
infant with symmetric descending paralysis, drooling and constipation, poor suck and gag reflex also seen
botulism immuneglobulin + supportive therapy(respiratory support, NGT feeding)
Lichen sclerosus
corticosteroids
admission to inpatient ward with febrile neutropenia
piperacillin-tazobactam
cafe au lait spots with sensorineural hearing loss
MRI with gadolinium (suspect acoustic neuroma)
MI status post CABG post-op day 5 small pericardial effusion with fever, tachycardia, a-fib.
drainage, surgical debridement and antibiotics ( acute mediastinitis)
DVT identified on ultrasound
CT scan of abdomen, chest, and pelvis - search for any embolism
Rhabdomyolysis
IV fluids, mannitol and bicarbonate
Baseline EKG changes on patient with SSx of stable angina
Stress echocardiography instead of exercise treadmill stress test – (echo you need to have a normal EKG reading at rest)
presence of bilateral popliteal artery aneurysms
CT Abdomen -> 25% chance of abdominal aortic aneurysm present.
Asystole
CPR and epinephrine(lowers defibrillation threshold, increases myocardial and cerebral blood flow) ; defibrillation does not work for asystole
hepatorenal syndrome
midodrine and octreotide
