Day 2 Flashcards
what eye finding is associated with MS?
internuclear opthalmoplegia
what is internuclear opthalmoplgeia?
conugate horizontal gaze
what is issue in internuclear opthalmoplegia?
medial longitudinal fasciculus
what are features of PNH?
dark urine, hemolysis, hepatic vein thrombosis, fatigue
what is rx of PNH?
eculizumab
pregnant patient has significant hemorrhage, what position should they be in?
left lateral decubitus
what are drug options for mild to moderate dementia?
rivastigmine, donepezil and galantamine
what is drug option for severe dementia?
memantine
women with migraines with aura should stop what medication? why?
OCP, at increased risk of stroke
what is cause of infertility in klinefelter?
semineferous tubule dysgenesis
what is karyotype of klinefelter?
47XXy
what are findings in klinefelter?
tall stature, small balls, infertility, gynecomastia
what is fetal hydantoin syndrome?
in utero exposure to phenytoin, valproate or carbamazapine
what are findings of fetal hydantoin syndrome?
cleft lip/palate, wide anterior fontanelle, cardiac isses, distal phalange hypoplasia
what are classic findings of interstitial nephritis?
rash, fever, eosinophilia, WBCs in urine
vertigo can be presenting symptom of what type of stroke?
posterior circulation (vertebral artery)
hyper IgE syndrome is associated with what blood finding?
eosinophilia
hyper IgE leads to what type of infections?
lots of eczema and reccurent abscesses and sinopulmonary infections
what is unique about development in hyper IgE syndrome?
retained primary teeth
what is treatment of hyper IgE syndrome?
supportive skin care
what are some topical treatment options for acute angle closure glaucoma?
timolol, pilocarpine and apraclonidine
what are risk factors for vaginal hematoma?
forceps delivery, big baby, prolonged 2nd stage of labor
what is clinical sign of vaginal hematoma?
patient getting shocky and has a vaginal mass
what is treatment of vaginal hematoma?
if not expanding, observe. if expanding surgery
what is formula for Number needed to harm?
1/absolute risk increase….to calculate absolute risk increase it is rate of AE with intervention minus rate of AE without intervention
two options for endometrial hyperplasia management?
give progestins or hysterectomy
what are lab findings in MM?
normocytic anemia,
renal insufficiency,
hypercalcemia
M spike
what is radiology finding in MM?
osteolytic lesions of bones
what are some common signs/sx of MM?
bone pain, constipation, weight loss, fatigue and recurrent infections
what Ig is elevated in MM?
IgG or IgA
IgM spike is daignostic of what?
waldentstroms macroglobulinemai
what age should baby begin to respond to name?
6 months
what are emergency contraception options?
single pill of ulirpristal, oral levanorgestrol, IUDs
in secondary adrenal insufficiency, what are levels of ACTH, cortisol and aldosterone?
ACTH and cortisol low, aldosterone normal
in primary adrenal insufficiency, what are levels of ACTH, cortisol and aldosterone?
cortisol and aldosterone are low and ACTH is high
which of primary or secondary adrenal insufficiency has skin changes?
primary gets skin hyperpigmentation
what are three main findings in cauda equina syndrome?
saddle anesthesia, severe unilateral radicular pain, bowel/bladder issues
what is rx of cauda equina syndrome?
surgical decompression
what heme findings can occur in HELLP syndrome?
MAHA and thrombocytopenia
what can happen to lungs in HELLP/preeclampsia?
pulmonary edema
what med should sickle cell pregnant patients be taking?
aspirin
what are obstetric complications that patients with sickle cell are at increased risk for?
abruption, preeclampsia, spontaneous abortion
what acid base disturbance is normal in pregnancy?
respiratory alkalosis
what happens to HR and CO in pregnancy?
both go up
when do patients get peripatum cardiomyopathy?
within a month of delivery or 5 months after
what are common symptoms of opioid/heroin withdrawal?
abdominal pain, N/V/D, muscle aches
what are PE signs of heroin withdrawal?
dilated pupils, yawning, hyperactive bowel sounds
how does nasal mucosa appear in allergic rhinitis?
pale edematous
what are characteristic features of trisomy eighteen?
micrognathia, low set ears, clenched hands and overlapping fingers, heart defects, rocker bottom feet
what is most common heart defect in trisomy 18?
VSD
what is CXR finding in neonat respiratory distress syndrome?
diffuse reticulogranular pattern with air bronchograms
symmetric fetal growth restriction likely onset when? what are most likely causes?
first trimester…cause likely genetics of infection
asymmetric fetal growth restriction likley onset when? what are causes?
2/3rd trimester…uteroplacental insufficiency and maternal malnutrition
what are two meds used to treat organophosphate poisoning?
atropine first then pralidoxime
what are muscarinic toxicities noted in organophosphate poisoning?
Diarrhea Urination Mmiosis Bronchospasms Emesis Lacrimation Salivation
what are some things that put pregnant patient at high risk of preeclampsia?
multiple gestations, DM, prior preeclampsia, chronic HTN
patients at high risk of preeclampsia should be on what?
low dose aspirin
what is treatment of submucosal fibroids in patient who wants future kids?
hysteroscopic myomectomy
what is triad of wernickes?
ataxia, encephalopathy and occulomotor dysfunction
whatis korsakoff syndrome?
retrograde and antegrade amnesia in alcoholic
what is rx of wernickes?
thiamine
three indications for statin as primary prevention?
LDL over 190
DM and 40+ years old
ASCVD greater than 7.5
what are the two phases of the first phase of labor?
latent and active
what is latent phase of first stage of labor?
0-6cm dilation…no specific rate
what is active phase of first stage of labor?
6-10 cm dilation, must be more than 1cm/2hours
when is active phase of first stage of labor considered arrested?
no cervical change for 4 hours with adequate contractions or 6 hours with inadequate contractions
watery diarrhea and maculopapular rash in post transplant patient should make you think about what?
GVHD
what cells mediate GVHD?
CD8
what is mainstay of rx for GVHD?
steroids
giant cell bone tumor occurs where? what appearance?
epiphysis…soap bubble
MC pediatric primary brain tumor?
astrocytoma
medulloblastoma is common in kids or adults? where does it occur? what symptom is common?
kids…cerebellum…ataxia
what is cause of lactation failure jaundice?
baby dehydrated, leads to decrease in elimination of bilirubin through pee
when does lactation failur jaundice onset?
within 1 week of life
what causes breastmilk juandice?
bilirubin gets deconjugated by glucorinidase in breast milk
when does breast milk jaundice onset?
1 week and beyond
what is rx of lactation failure jaundice?
if milk is in increase feeding and follow up closely, if milk not in formula
two long QT syndromes, which has sensorineural hearing loss
romano ward and Jervell lange nielsen (SNHL)
what med should patient with long QT syndrome be taking?
propanolol
what is protein, glucose and WBC count for viral CSF?
normal glucose, mild protein elevation, mild leukocytosis
what abx can cause hyperkalemia?
bactrim
what is mnemonic for manic episode
Distractability Impulsivity Grandiosity Flight of idease Activity increase Sleep decrease Talkative
what is rx of lithium toxicity?
dialysis
what is cutoff for amniotic fluid index for polyhydramnios?
greater than 8cm
when does hcg peak?
end of first trimester
what is hcg level in hydatiform mole?
100k or more
what is a missed abortion?
no bleeding, closed cervix, no cardiac activity or empty sac
what is a threatened abortion?
vaginal bleeding with closed cervix and still has cardiac activity
what is an incomplete abortion?
vaginal bleeding, dilated cervix, some products remain
what is an inevitable abortion?
vaginal bleeding, dilated cervix and products of conception seen at or above level of cervix
what are two main meds given in COPD exacerbation?
inhaled bronchodilators and systemic roids
weber test (one you put on top of head) lateralizes to unaffected or affected in sensorineural?
unaffected
weber test (one you put on top of head) lateralizes to unaffected or affected in condctive?
affected
1st line rx for primary dysmenorrhea?
NSAIDs
what are findings in GPA?
sinusitis, pulmonary nodules, glomerulonephritis,
which Ab in GPA?
c-anca
what is rx of GPA?
steroids and methotrexate or cyclophosphamide
what are symptoms of central retinal artery occlusion?
severe vision loss with temporal sparing
what is PE finding in central retinal artery occlusion?
pale fundus with cherry red spot
what is symptom of central retinal vein occlusion?
blurred vision to severe vision loss
what is PE finding of central retinal vein occlusion?
fundus with retinal hemorrhage and optic disc edema
what is rx of central retinal vein occlusion?
observation
what are symptoms of retinal detachment?
floaters, flashing lights and progressive visual field defect
what are PE findings of retinal detachment ?
fundus with vitreous hemorrhage and marked elevation of retina
what is rx of retinal detachment?
surgery
what are sx of vitreous hemorrhafe?
floaters and hazy vision
what are PE findings of vitreous hemorrhage?
decreased red reflex, RBCs/floating debris in vetrous, obscured view of fundus
what is rx for vitreous hemorrhage?
bed rest and head of bed elevation
is FRC increased or decreased in COPD?
increased
is vital capacity increased or decreased in COPD?
decreased
what is management of laryngomalacia?
should resolve on own
is LA enlarged in athlete heart or hypertrophic cardiomyopathy?
enlarged in hypertrophic cardiomyopathy not in athletes heart
