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Cumulative Review Flashcards

1
Q

Calcineurin Inhibitors

A

Cyclosporine

Tacrolimus

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2
Q

Major side effects of Cyclosporine

A 
Nephrotoxicity
Hyperkalemia
Hypertension
Gum Hypertrophy
Hirsutism
Tremor
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3
Q

Major side effects of Tacrolimus

A

Nephrotoxicity
Hyperkalemia
Hypertension
Tremor

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4
Q

Fleshy immobile mass on the midline hard palate

A

Torus Palatinus
Congenital
May increase in size over time
No intervention necessary unless it becomes symptomatic

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5
Q

Niemann-Pick Vs. Tay-Sachs

A

Niemann-Pick - Sphingomyelinase Deficiency

Tay-Sachs - Beta Hexosaminidase A deficiency

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6
Q

Baby meets milestones
Within first 6 months, regresses from milestones
Cherry red macula
Feeding difficulty/hypotonia

A

Areflexia = Niemann-Pick (Sphingomyelinase deficiency)
Also has hepatosplenomegaly

Hyperreflexia = Tay-Sachs (Beta Hexosamindase deficiency)

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7
Q

Someone is resuscitated with 1/2 NS

A

Think iatrogenic hyponatremia

Treat with hypertonic saline & close monitoring of lytes

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8
Q

Flu Vaccine guidelines

A

Annually in all adults

IM inactivated is more effective than live attenuated

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9
Q

Td booster guidelines

A

Every 10 years

Tdap as one-time dose in place of Td

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10
Q

Pneumococcal vaccine guidelines

A

All adults >=65 get PCV13 (conjugate), then PPSV23 (polysaccharide) later

Also true for adults < 65 with high-risk comorbid conditions:
CSF Leaks
Sickle Cell Disease
Cochlear Implants
Asplenia
Immunocompromised
Adults <65 with conditions increasing the risk of invasive pneumococcal disease:
Heart or lung disease
Diabetes
Smoking
Chronic liver disease

Start with PPSV23 alone, then do the PCV13 PPSV23 sequence after 65

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11
Q

Cat bite care

A

Irrigation & ceaning
Augmentin (PPX for pasturella)
Tetanus booster (if not up to date)
Avoid closure

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12
Q

School-age child comes in with viral symptoms and proteinuria but no hematuria

A

Repeat urine dipstick on 2 separate occasions

Probably transient proteinuria or orthostatic proteinuria, but if still positive 2 more times, investigate for significant renal disease

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13
Q

Meningococcal vaccine guidelines

A

Primary vaccination at age 11 - 12
Booster at age 16 - 21

High Risk:
Complement deficiency
Asplenia
College students in residential housing (age <= 21)
Military recruits
Travel to endemic environments (Africa, Mecca, Saudi Arabia)

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14
Q

Patients receiving TNF antagonists should not get

A

Live-Attenuated Vaccines:
Varicella
Influenza (intranasal)
MMR

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15
Q

Yellow fever vaccination

A

Required for some countries in central africa

If allergic to eggs, or immunocompromised, must get a documented medical waiver instead, and be counseled on mosquito protection

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16
Q

Properties of a confounder

A

It is linked to the exposure

It is linked to the outcome

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17
Q

Pericardial thickening & calcification

Sharp X & Y descents

A

Constrictive pericarditis

TB causes this in Africa, India & China

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18
Q

First line therapy for narcolepsy

A

Modafinil (nonamphetamine, promotes wakefulness)

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19
Q

Most common cause of aplastic crisis in sickle cell anemia patients?

A

Parvovirus B19

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20
Q

PAS-positive material in the lamina propria of small intestine

A 
Whille's Disease
Tropheryma Whillelii (Bacillus)

Arthralgias
Weight Loss
Feber
Diarrhea
Abdominal Pain
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21
Q

Patient presents with iron deficiency anemia

A

Do endoscopy to look for source of bleeding

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22
Q

Tricuspid valve infective endocarditis in IVDU

A

Throws septic emboli with staph aureus

Pulmonary infiltrates, abscesses, infarct, gangrene, cavities

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23
Q

Transaminitis
Macrocytosis
Early morning waking

A

Alcohol use disorder

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24
Q

Recurrent sinopulmonary infections (sinusitis, pneumonia)
Recurrent GI infections (giardia)
Associated with autoimmune diseases & atopy

A

Selective IgA deficiency

Transfusions lead to anaphdylaxis from Ab against IgA

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25
Temperature in neonatal sepsis
High OR Low
26
Causes of amaurosis fugax
Temporal Arteritis | Carotid Atherosclerosis
27
Kid has a virus | Kid gets Aspirin or other NSAIDs
Kid gets Reye syndrome ``` Microvesicular fatty infiltration of the liver. Causes acute liver failure: Transaminitis Coagulopathy Nausea/Vomiting Hypermmonemia Encephalopathy ```
28
Sensory loss Rest pain Muscle weakness
Immediately threatened limb | Start anticoagulation
29
Alkalosis has what effect on calcium?
More is bound to albumin | Functional hypocalcemia even though total body calcium is normal.
30
Stroke in an IVDU
Think endocarditis, especially if there is a fever | Antiplatelet therapy is only good for patients with atherosclerotic disease, so no need to put them on that therapy.
31
Tick bite in the south Fever, malaise, AMS Transaminitis & high LDH Leukopenia and/or Thrombocytopenia
Ehrlichiosis Give empiric doxy while awaiting confirmatory testing Diagnosis is clinical, but can be confirmed by seeing: Intracytoplasmic morulae in WBC Also can confirm with PCR
32
Treatment for Ehrlichiosis
First Line - Doxycycline | Second LIne - Chloramphenicol
33
Appearance of a TOA on ultrasound
Complex multiloculated adnexal mass CRP & CA-125 will be elevated Leukocytosis
34
Lymphadenopathy that is small, mobile, nontender, soft
Will regress on its own within several weeks. Observe. Only evaluate with CBC, viral titers, inflammatory markers if the LAD persists
35
Risk factors for neonatal respiratory distress syndrome
PREMATURITY Male Sex Perinatal Asphyxia MATERNAL DIABETES (Delays maturation of surfactant production) C-section without labor
36
Mechanism of maternal diabetes leading to fetal underdevelopment of surfactant
Maternal hyperglycemia triggers fetal hyperglycemia Hyperinsulinism antagonizes cortisol Sphingomyelin can't mature, and surfactant needs that.
37
``` High Sed Rate Positive Rheumatoid Factor Nonspecific infectious symptoms Cardiopulmonary symptoms Immune-complex glomerulonephritis Painful hand nodes ```
Infective endocarditis
38
Peripheral Neuropathy Heart Failure Wernicke-Korsakoff Syndrome
Thiamine Deficiency Whole grains, meat, fortified cereal, nuts, legumes
39
``` Angular cheilosis Stomatitis Glossitis Normocytic anemia Seborrheic dermatitis ```
Riboflavin Deficiency Dairy, eggs, meat, green vegetables
40
Dermatitis Diarrhea Delusions/Dementia Glossitis
Niacin Deficiency Meat, whole grains, legumes
41
``` Cheilosis Stomatitis Glossitis Irratibility Confusion Depression ```
Pyridoxine Deficiency Meat, whole grains, legumes, nuts
42
Megaloblastic anemia | Neural tube defects
Folate Deficiency Green leafy vegetables, fruit, meat, fortified cereal/grains
43
Megaloblastic anemia Confusion Paresthesias Ataxia
Cobalamin Deficiency Meat, dairy
44
Punctate hemorrhage Gingivitis Corkscrew hair
Scurvy Citrus fruits, strawberries, tomatoes, potatoes, broccoli
45
Causes of normal anion gap metabolic acidosis
``` Diarrhea Fistulas Carbonic anhydrase inhibitors RTA Ureteral diversion Iatrogenic ```
46
Non-anion gap metabolic acidosis | Preserved kidney function
RTA
47
Type 4 RTA
Hyperkalemic RTA Metabolic acidosis Preserved renal function Poorly controlled diabetes
48
Elevated T4 | Normal TSH
T4-binding globulin is increased Could be from estrogen (OCPs, pregnancy, HRT, hepatic dysfunction, tamoxifen)
49
Preterm labor < 32 weeks
Betamethasone Tocolytics Magnesium sulfate Penicillin if GBS positive or unknown
50
Reversible causes of asystole/PEA
``` Hypovolemia Hypoxia Hydrogen ions Hypokalemia (or hyperkalemia) Hypothermia ``` ``` Tension pneumothorax Tamponade Toxins (narcotics, benzos) Thrombosis Trauma ```
51
12 month milestones
Gross motor: Stands well Walks first steps Throws a ball Fine: 2 finger pincer grasp ``` Language: First words (other than mama and dada) ``` Social: Separation anxiety Follows 1-step commands with gestures
52
18 month milestones
Gross Motor: Runs Kicks a ball Fine: Builds a tower of 2 - 4 cubes Removes clothing Language: 10 - 25 words Identifies at least 1 body part Social: Understands "mine" Begins pretend play
53
2 year milestones
Gross Motor: Stairs w/ both feet on each step Jumps Fine: Builds a tower of 6 cubes Copies a line Language: 50+ words 2-word phrases Social: Follows 2-step commands Parallel play Begins toilet training
54
3 year milestones
Gross Motor: Stairs with alternating feet Tricycle Fine: Copies circle Uses utensils Language: 3-word sentences Speech 75% intelligible Social: Knows age/gender Imaginative play
55
4 year milestones
Gross Motor: Balances & hops on 1 foot Fine: Copies a cross Language: Identifies colors Speech 100% intelligible Social: Cooperative play
56
Side effects of Beta-2 Agonists
Hypokalemia (Drive potassium into cells) Tremor Headache Palpitations
57
Why does polycythemia in the neonate lead to respiratory distress?
As hematocrit rises, so does viscosity of blood. It can't reach vital organs, and it also leads to hypoglycemia and hypocalcemia from increased cellular uptake
58
Mediastinal mass
``` Bronchogenic cyst (benign) Tracheal tumors Pericardial cysts Lymphoma Lymph node enlargement Aortic aneurysms of the arch ```
59
Where are neurogenic tumors in the mediastinum found?
Posterior mediastinum ``` Meningocele Enteric cysts Lymphomas Diaphragmatic hernias Esophageal tumors Aortic aneurysms ```
60
Fanconi Anemia
AR or XLR Chromosomal breaks on genetic analysis ``` Aplastic anemia Progressive bone marrow failure Short stature Microcephaly Abnormal thumbs Hypogonadism Hypopigmented/hyperpigmented areas Cafe au lait spots Large freckles Strabismus Low-set ears Middle ear abnormalities ```
61
Acquired causes of aplastic anemia
``` Drugs Toxins (benzene, glue, etc) Idiopathic Viral infections Immune disorders Thymoma ```
62
Most common congenital cause of aplastic anemia
Fanconi Anemia AR or XLR Chromosomal breaks Genes involving DNA repair are implicated
63
Things that make Crohns different from UC
``` Crohns: Multiple portions of the GI tract Noncaseating granulomas Rectal sparing Fistula formation ```
64
Toddler hematochezia
``` Hemorrhoids Infectious colitis Intussusception Meckel's diverticulum Inflammatory bowel disease ```
65
Technetium-99m Pertechnetate Scan
Scan to detect Meckel's!
66
Waldenstrom macroglobulinemia
``` Lymphoplasmocytic malignancy Excessive monoclonal IgM End organ damage >10% clonal B cells by bone marrow biopsy Hyperviscosity syndrome comes with it ```
67
``` Diplopia Tinnitus Headache Dilated/segmented funduscopic findings Neuropathy Infiltrative disease (hepatosplenomegaly, anemia, thrombocytopenia) ```
Hyperviscosity Syndrome
68
UTI with alkaline urine
Proteus (most common) Klebsiella (also possible) Elevated risk for struvite stones (magnesium ammonium phosphate)
69
Wallenberg Syndrome
Hoarse voice and falling to the right Lateral medulla Ipsilateral horner's syndrome Contralateral hemianesthesia in the body (ipsilateral in the face)
70
Eczema Microthrombocytopenia (small platelets, low count) Recurrent infections
Wiskott-Aldrich Syndrome XLR in WAS protein gene Impaired cytoskeleton changes in leukocytes & platelets Treatment is stem cell transplant
71
RLQ pain & tenderness that isn't appendicitis but is infectious
Psoas abscess | Abdominal CT scan to diagnose
72
Cardioversion vs. Defibrillation
Cardioversion is synchronized to the QRS complex, appropriate for persistent tachyarrhythmia causing hemodynamic instability Defibrillation gives electricity at at a random point in the cycle. Appropriate for VFib or pulseless VTach
73
Electrolytes of Tumor Lysis Syndrome
Increased: Potassium Phosphorous Uric Acid Decreased: Calcium (bound by phosphate that is released) Leads to AKI (uric acid and calcium phosphate deposition) & cardiac arrhythmias Prophylaxis = Allopurinol or rasburicase, IV Fluids Treatment = Continuous telemetry, aggressive electrolyte management
74
Jaundice Nontender, but palpable gall bladder (Courvoisier's sign) L supraclavicular adenopathy
Pancreatic adenocarcinoma Abdominal untrasound first Then abdominal CT ERCP has very high sensitivity & specificity, but is so invasive that it only should be done if CT is nondiagnostic.
75
``` Infant with: Growth failure Recurrent respiratory infections Greasy stool Bruises ```
Cystic Fibrosis! | Pancreatic insufficiency leads to malabsorption and Vitamin K deficiency
76
Patient has Hodgkin's Lymphoma and is cured. Now has a pulmonary mass on CXR. What is it?
Second malignancy Having hodgkin's gives you an 18.5 fold chance of developing another malignancy in your life
77
Prinzmetal angina
Vasospastic angina | Recurrent angina during rest or sleep
78
ESRD patient needs bridge to warfarin. What do you use?
Unfractionated heparin. LMWH is too associated with bleeding.

Mistakes (8 decks)

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