Deck 1 Flashcards
Question
Explanation
what do you do for infacnts with brachial plexus injury
you just observe them and can do physical therapy
what causes irregular menses and anovulatory bleeding in adolescesnts
immature HPA axis
what population of HIV patients get HIV associated dementia
patients with uncontrolled HIV that are not on ART
skin findings of NF1
cafe-au-lait spots, axillary and inguinal freckling, lisch nodules
tumors associated with NF1
optic glioma, pheo, neurofibromas
skin findings NF2
skin nodules (schwannomas)
tumors associated with NF2
bilateral vestibular schwannoma
skin findings tuberous sclerosis
multicle facial adenomas, ash-leaf spots, shagreen patchs, ungual fibromas
neuro findings tuberous sclerosis
seizures, intellectual disability
tumors associated with tuberous sclerosis
hamartomas, giant cell astrocytoma, cardiac rhabdomyomas, renal angiomyolipoma, cysts and RCC
findings of von-hippel lindau disease
cerebellar and retinal hemangioblastomas, pheo, RCC
what color does blood show on non contrast CT
white
what is bright in T1 weighted MRI
fat and contrast
what is bright in T2 weighted MRI
water (CSF), and fat (but less intense than T1)
flesh colored raised papules in anogenital area
condyloma accuminata (HPV)
sudden decline in development of a young girl
Rett syndrome
signs of Rett syndrome
gait disturbances, sudden decline in development, hand movements, loss of speech
signs of myotonic dystrophy
myotonia and weakness, distal mm atrophy
complications of myotonic dystrophy (heart)
cardiomyopathy, arrythmias,
if a vertebral body goes forward what joint get dislocated
facet joint dislocation
what brain issues do people with ADPCKD get
aneurysms (berry)
what is associated with difficulty with an upward gaze
pinealoma
functional tremor signs
abrupt stopping in the tremor, stops with distraction, changeable features of the tremor
where do neuroblastomas arise
adrenal medulla or along the sympathetic chain
where do medulloblastomas arise
in the cerebellum
clinical features of neuroblastoma
opsoclonus-myoclonus, periorbital eccymosis, abdominal mass
clincal features of medulloblastoma
cerebellar signs (gait changes, central uncoordination), hydrocephalus
what cervical nerve is injured if patient has claw hand and wrist extension
C8 and T1
are antipsychotics safe in pregnancy
yes, use for acute mania
dx of a fluid collection spanning multiple vertebra on MRI
spinal epidural abcess
treatment of spinal epidural abcess
ABX and urgent laminectomy
what is most specific to seizure activity
tongue biting
treatment of organophosphate poisoning
atropine and then pralidoxime
what is physostigmine
achetylcholineesterase inhibitor
complications of asymptomatic bacteruria of pregnancy
pyelo or preterm labor
what nerve can be compressed with uncal herniation
occulomotor (CNIII)
what type of brain hernation occurs after epidural hematoma
uncal
signs of pelvic organ prolapse
any mass that increases in size with valsalva
what is the main defining feature of PTSD
exposure to a life-threatening trauma
difference between rathkes cleft cyst and craniopharyngioma
craniopharnygioma will have calcifications seen on imaging
day and night time eneureis in children with red flags eval
MRI
treatment of NPH
high volume lumbar puncture
what does the head thrust test evaluate
vestibuloocular reflex
what happens to TSH during pregnancy
decreased because HCG stimulates thyroid hormone production so TSH decreases bc neg feedback
presentation of conus medullaris vs. cauda equina pain
conus medullaris is severe low back pain and cauda equina is radicular pain (down leg
presentation of conus medullaris vs. cauda equina upper motor or lower motor neuron signs
conus medullaris has upper motor and cauda equina has lower
presentation of conus medullaris vs. cauda equina bladder symptoms
both have bowel and bladder dysfunction because of pudendal nerve
alcohol withdrawal vs. thiamine deficiency differentiation
alcohol withdrawal has autonomic instability and thiamine is more of an encephalopathy
central cord syndrome signs
sensory distubances in upper extremities, upper extremity weakness because the corticospinal tract has arms closest to the center of the cord
1hr glucose tolerance test cutoff
200
do absence seizures have a postictal period
no!
best form of emergency contraception
IUD and then levonorgestrel
time course for alteplace/TNK for stroke
<4.5 hours
signs of PTSD in kids
emotional dysregulation, play that imitates trauma, nightmares
signs of reactive attachment disorder
lack of emotional responsiveness, no seeking of comfort from caregivers
what causes reactive attachment disorder
early childhood abuse
what types of hemorrhage is cause by nonaccidental trauma
subdural and retinal hemorrhage
what is pituitary apoplexy
hemorrhage or acute ischemia of the pituitary causing acute adrenal insufficiency
what is the most common childhood brain tumor
low-grade astrocytoma
what do you use for benzo overdose
flumenazil
what does elevation of the diaphragm on chest xray typically indicate
this means that there is diaphragmatic weakness likely from ALS
why do pts with spinal cord injurys get autonomic dysreflexia
because the parasympathetic response cannot be sent down the spinal cord
noxious stimulus below a spinal cord injury effects
you get autonomic dysreflexia which means you get sweating, palpitations, etc, above the lesion and
clinical signs of sturge webber
seizures, port wine stain, glaucoma,
signs of methamphetamine intoxication vs. acute manic disorder
meth often has severe dental symptoms, more tactile hallucinations, and skin excoriations vs. mania which is more grandiose delusions and no sympathetic overdrive
PML on imaging
multiple NON enhancing lesions
new onset psychosis plus tremor/parkinsonism
wilsons diseaseI
pH of genitourinary syndrome of menopause
elevated pH (6.5) due to decreased vaginal secretions that are acidic
CNS lesions in tuberous sclerosis
subependymal tumors, giant cell astrocytoma, etc
where are brachial cleft cysts on the neck
lateral
difference between nightmare disorder and sleep terror disorder
nightmare the child is fully aware and they are able to communicate but in sleep terror disorder they are not aware and have amnesia
long term complication of delerium
cognitive decline
main difference between serotonin syndrome and neuroleptic malignant syndrome
serotonin syndrome has hyperreflexia vs. NMS is just rigidity
4 clinical manifestations of IgA vasculitis
palpable purpura, arthralgia/arthritis, abdominal pain, renal disease
signs of cerebellar dysfunction
truncal or gait ataxia, wide-based gait, poor heel-toe coordination
what happens with blood pressure in TRALI
tanks
is INO ipsilateral/contralateral in terms or MLF lesion to eye not adducting
ispilateral
orthopedic signs of tethered cord
back pain, scoliosis, foot deformities
is a sputum cytology helpful for cancer dx
no!
difference between illness anxiety disorder and somatic symptom
illness anxiety is where you have preoccupation with having a serious illness vs. somatic symptom disorder you have unexplained symptoms and anxiety around the symptoms
treatment of stroke in sickle cell
exchange transfusion
5-alpha reductase defiency genotype
46 XY
5 alpha reductase signs
virulization at puberty due to increased testosterone (acne, cliteromegaly, increased muscle mass, male pattern hair)
treatment of phantom limb pain
multimodal, antidepressants, CBT etc.
return to sports after concussion timeline
rest for 2 days, gradual progression of activity with return to rest if there is headaches etc.
who gets cyclic vomiting syndrome
people with migraines or fam hx of, identifialble triggers like stress
timeline for adjustment disorder
sx onset within 3mo of an identifiable stressor
management of hyaditiform mole after curretage
month B-hcg levels and 6mo of contraception
physical exam of a patient with cervical insufficiency
shortened cervix or dilated cervix, no vaginal bleeding, pelvic pressure
signs of placenta previa
painless vaginal bleeding at >20 weeks gestation
sleep changes in MDD
decreased REM sleep latency, increased REM, decreased non-rem, multiple nighttime awakenings
5 P’s of acute intermittent porphyria
painful abdomen, polyneuropathy, psychologic disturbances, port wine pee, precipitated by drugs
can scfe be bilateral
yes
pain with internal rotation in a child with hip pain
SCFE
management of frostbite
rapid warming, angiography if rewarming not successful
triad of wiskott aldrich
recurrent infections, eczema, purpura
what is transient hypogammoglobulinemia of infancy
this is when the infant has delayed rise in IgG after physiologic nadir after 6mo of age, will resolve
ultrasound findings of placenta accreta
US with placenta previa, numberou lacunae, myometrial thinning
what is considered adequate contractions
> 200 montevideo units
dx of hirschsprungs
biopsy, contrast enema, anorectal manometry
who gets uterine rupture
patients with previous uterine surgeries
what does the uterus feel like in uterine rupture
can feel palpable fetal parts
clinical presentation of placental abruption
sudden onset vaginal bleeding, abdominal pain, high freq/low intensity contractions, rigid uterous
when do you do a ERCP for pancreatitis
if there is CBD dilation indicating stone or evidence of acute cholangitis
management of gallstone panc after panc resolved and no cholangitis/biliary issue
cholecystectomy once pancreatitis resolved
treatment of periorbital hemangioma in infant
propanolol
treatment of port wine stain
laser (cosmetic)
can you give metronidozole in pregnancy
Yace
treatment of binge eating disorder
SSRI
signs of NMDA (ecstacy) toxicity
sympathomimetic tox and serotonin sydrome and hyponatremia
signs of blunt thoracic aortic injury
bruising on the chest, weak femoral pulses, cool limbs, proximal hypertension
what is aspirin exacerbated respiratory disease (triad)
asthma, bronchospasm following aspirin use, chonic rhinosinusitis with nasal polyps
treatment of parkinsons tremor
anticholingergic therapy
signs of separation anxiety
reluctance to leave, avoidance of activities, excessive worry
signs of growing pains
worse at night, primarily at night
what does a positive arm drop test mean
rotator cuff tear
what newborns get ABO incompatability hemolytic disease
newborns who are AB that have mothers who are O
in a neonate with cyanosis does their O2 sat change when they are given oxygen if it is a heard issue
no it wont change so if it increases they have a pulmonary pathology
effects of gestational diabetes on fetal lungs
immaturity, poor surfactant maturation
what are pulses like in aortic regurg
wide pulse pressure
treatment of NEC
stopping enteral feeds, fluids, BCX and then ABX, if no improvement or has bowel perf, then surgery
treatment of migraine in pregnancy
acetominophen, antiemetics, NSAIDs, opioids
treatment of croup
dexamethasone and racemic epinephrine
when does uric acid precipitate from the urine
it precips at low pH <5.5
why do crohns or CF patients get Ca oxalate stones
because they absorb less Ca and Ca binds oxalate in the intestine so more oxalate gets absorbed and then excreted in the kidney which causes increased Ca oxalate stones
treatment of frequent uric acid stones due to gout
alkalinazation of the urine
what part of the brain gets atrophy in alzheimers
temporal lobe (with the hippocampus and amygdala
signs of croup
barking cough, hoarseness, inspiratory stridor
signs of babeosis
flu like sx, DIC, anemia, thrombocytopenia, increased bili, LDH etc.
consequenses of preeclampsia
ischemic stroke, seizures, AKI, hepatic subcapsular hematoma, ARDS, placental abruption
signs of central brain herniation
decorticate to decerebrate posturing
why do you get thrombocytopenia in SLE
peripheral destruction due to immune thrombocytic purpura
can you hear a bruit on exam for aortic aneurysm
no
what do nitrates do to the heart
they decrease preload which decreased left ventricular end diastolic volume because of venous dilation
which is external vs. internal in CNIII for parasympathetic vs. motor
external is parasympathetic and internal is motor
is parasympathetic or motor (somatic) fibers more susceptible to ischemia
motor because the center of the nerve is more susceptible to ischemia because the blood vessel is on the outside
granulomatosis with polyangiitis pulmonary findings
ulceration, lung nodules with cavitation
signs of retinal detachment in the history
flashes of lights, dark spots or webs, floaters, peripheral vision defects
describe odds ratio
the odds that an event with occur in one group vs. the odds of an event occuring in another group
describe risk ratio
the likelihood of an outcome in one group exposed to a potential risk factor compared to the risk in another unexposed group
what is considered macrocephaly
> 97th percentile
what is the uterus like in adeomyosis
symetrically enlarged and painful
what is the mutation in CML and what is the chromosome
this is chrom 22 which is the BCR ABL gene creating always active tyrosine kinase
differences in TM in acute otitis media vs. otitis media with effusion
AOM has bulging and erythema of the TM whereas otitis media with effusion is not bulging just immobility
management of prepnant people with HSV prior to pregnancy
if they have lesions you do a c section if they are asymtomactic you do antiviral therapy starting at 36 weeks
how do you treat SCFE
screw fixation
size of ovary in torsion
enlarged due to trapped blood flow
CHARGE syndrome
Coloboma, heard defects, choanal atresia, retardation of growth, genitourinary anomalies, ear abnormalities
VACTERL features
vertebral anomalies, anal atresia, cardiac issues, TEF, renal and limb issues
signs of choanal atresia
hypoxia during breast feeding or sleeping that gets better with crying
two main causes of pleural fluid with glucose less than 30mg/dl
rheeumatoid pleuracy or empyema
causes of infectious adrenalitis
TB, CMV, histo
risks for somatic sx disorder
sexual trauma, lower education level, chroic chiIdhood illness, female
signs of mesenteric ischemia
rapid onset periumbilical pain, hematochezia, extreme pain
lab abnormalities in acute mesenteric ischemia
leukocytosis, elevated hemoglobin, elevated amylase, metabolic acidosis
signs of psychosis
delusions, hallucinations, disorganized speech
what is the mutation in fanconi anemia
DNA repair defect
clinical findings of fanconi anemia
short stature, hypo or hyper pigmented macules, abnormal thumbs, genitourinary findings
thyroid changes in pregnancy
TSH goes down (BHCG), free T4 and total T4 goes up
signs of open globe injury
fixed tear drop pupil, relative afferent pupillary defect, decreased intraocular pressure
urticarial transfusion reaction
hives and itching NO RESP DISTRESS
treatment of urticarial transfusion reactions
cessation of transfusion, antihistamines, then resume if theyre well
what is a dupuytren contracture
thickening of palmar fascia at the 3/4/5th digits
neuro sx of B12 deficiency
sensory ataxia, upgoing plantar reflexes, lower extremity paresthesias, neuropsychiatric changes
emypema vs. abscess imaging
empyema is just puss filled NO AIR FLUID LEVEL // abcess has an air fluid level
what is transverse myelitis
this is immune mediated destruction of the spinal cord
clincial features of transverse myelitis
bilateral motor weakness, LMN to UMN symptoms, bilateral sensory dysfunction, autonomic dysfunction
likely dx of a person with fluctuating bulbar weakness
myasthenia gravis
WAGR syndrome
wilms tumor, aniridia, genitourinary abnormalities, range of developmental delays
clinical features of fat necrosis of the breat
firm irregular mass, skin/nipple retraction
signs of urethral injury
blood at urethral meatus, high riding prostate
what does an MECP2 mutation do
rett syndrome (girls X dom, hands)
tay sachs enzyme and common findings
hexosaminidase A and this is severe neurodegeneration and death by 2-5
clinical features of osteogenesis imperfecta
frequent fractures, blue sclera, dentinogenesis imperfecta
symptoms of pelvic organ prolapse
pelvic pressure, voiding dysfunction (incontinence, urinary retention, etct)
what lab abnormality is seen in von willebrand disease
long bleeding time, normal PT and PTT
methotrexate adverse effects
myelosuppression, pulmonary fibrosis, hepatotoxicity, nephrotoxicity,
causes of duodenal vs. jejenal atresia
duodenal is typically failure to recanalize vs. jejenal is due to vascular accident
most common cause of potter sequence in males
posterior urethral valves
where are venous vs. arterial ulcers on the maleoli of legs
venous are on the medial side and arterial are on the lateral maleolus
first step in evaluation of hypospadias
karyotype analysis
features of disseminated neisseria gonorrhea infection
skin manifestations, tenosynovitis, polyarthralgias, purulent arthritis
what mutation causes osteosarc and retinoblastoma
Rb
frequent bronchitis, pneumonia and bronchiectasis
common variable immunodeficiency
treatment of wide complex tachycardia
synchronized cardioversion
epidural hematoma shape
lemon aka DOES NOT cross suture lines
which type of hematoma has a lucid interval
epidural hematoma
signs of eosinophilic esophagitis on EGD
circumfrential lesions, strictures, linear longtitudinal furrows
what is the best way to improve burnout
organization directed interventions like scribes, and reducing workload
clinical features of x linked agammaglobulinemia
recurrent pyogenic infections, hypoplastic tonsils, absent B cells on flow
treatment of x linked agammaglobulinemia
IV immunoglobulin therapy
which is associated with IBD PSC or PBC?
PSC!!!
pathology of PSC
inflammation and fibrosis of intra and EXTRA hepatic ducts, strictures and dilatations
pathology of PBC
autoimmune destruction of intrahepatic dugs, lymphocytic infiltration of portal areas and granulomas
how are becker/duchenne dx
genetic analysis, only do mm bx if genetics inconclusive!
respiratory changes in pregnancy
respiratory alkalosis due to increased minute ventilation to facilitate gas exchange at the placenta
what is the depot shot made of
progesterone, hypercoag ppl can take it
definition of mood disorder with psychotic features
this is like MDD or bipolar with psychosis DURING the manic/depressive episode, you dont see the psychosis anytime else
what is schizoaffective disorder
features of both schizophrenia AND mood disorder and the pscyhosis has to be >2 weeks from the mood disorder, essentially you have psychosis episodes AND depressive/manic episodes
brief psychotic disorder vs. schizophreniform vs. schizophrenia
brief psychotic : 1 day -1 month // schiziphreniform: 1-6months // schizophrenia: >6mo
management of laryngomalacia
reassurance and follow up
treatment of lead poisoning
oral succimer
where do you see herpetic whitlow
fingers and sometimes orally
do healthly term neonates need VZV PEP
no! only if they are premature or their mother was infected at birth
treatment of chronic suppurative otitis media
fluoroquinolone topical
best way to prevent cathether associated UTI
do intermittent catheterization instead of leaving an indwelling cathether in
treatment of condyloma accuminata (anal warts)
curretage, cryotherapy, laser, etc.
fibromyalgia vs. myofascial pain syndrome
fibromyalgia is widespread pressure points whereas myofascial pain syndrome is more focal in one anotomic position
what is the treatment for Myasthenia gravis
pyridostigmine which increases the availability of Ach by inhibiting Achesterase
what is edrophonium
this is also an achetylcholinesterase inhibitor
when does babinski sign dissipate
max two years
steps in treatment of malignant hyperthermia
discontinue anesthetics, then dantroline and then cooling measurres
signs of sjogrens
dry mouth, dry eyes, arthritis, etc.
what ab is positive in sjogrens
anti Ro/SSa and SSb
what ab is positive in systemic sclerosis
anti topoisomerase/ scl-70 or centromere
hepatic and pulmonary granulomas in an infant infection
listeria
if a child missed a vaccination do they need to restart
NO!!
if there is gas in the stomach where is the TEF
the TEF is connected to the esophagus somehow likely the distal part
in trauma, what is the main difference in imaging modalities in a stable vs. unstable patient
stable: can do CT unstable: do FAST scan with ultrasound
treatmenbt of ITP plts <10k and <30k
<10k you transfuse plts <30k you do steroids IVIG
signs of horner syndrome
ptosis, miosis, anhydrosis (too much parasympathetic bc no sympathetic input
premenstrual dysphoric disorder vs. premenstrual syndrome
PMDD is more severe mood disturbances prior to the onset of menses whereas PMS is more just bloating cramping and off mood
when do you give the tetanus vaccine for wounds
if it is a tetanus prone wound and they either have an unknown vax hx or <3 doses OR it has been 5yrs since they got a booster
what is the typical genotype of pts with 5 alpha reductase deficiency
46XY
differentiate between acute fatty liver of pregnancy vs. intrahepatic cholestasis of preg
AFLP: sudden onset jaundice, nausea, vom, RUQ pain, coagulopathy // cholestasis: pruritis, jaundice
treatment of acute fatty liver of pregnancy vs. intrahepatic cholestasis of preg
AFLP: immediate delivery // cholestasis: ursodeoxycholic acid
what is a luteoma and how do you manage it
this is a rare benign tumor of the ovary caused by hormonal effects of pregnancy, causes virulization, just observe bc it will likely regress on it sown
how often do braxton hicks contractions occur
couple an hour
what is considered true labor
coordinated regular contractions about every 10 minutes AND cervical change
management of duodenal hematoma
NG tube to decompress the stomach and TPN for
what is the most common side effect of ECT
reversable amnesia headaches, nausea
what is the confirmatory test for multiple myeloma
bone marrow biopsy
what is the purpose of intention to treat analysis
helps avoid selection bias by keeping the balance of characteristics that was created during randomization
when do you use unpaired t tests
comparing two groups independent data
when do you use paried t tests
comparing one groups dependent variables across two points in time
when do you use ANOVA
comparing the means of dependent variables between 2 or more categories
what are the greatest two things that impact COPD patients survival
1- smoking cessation 2- long term oxygen
what is a potential AE of local anesthetic
methemoglobinemia, perioral numbness, dysgeusia, tinnitus, etc.
what antibodies/antigen are present in chronic Hep B infection
Hbc IgG, HBsAg, antiHbe
what infections are common in kids with selective IgA deficiencyI
mucosal infections (sinusitis, giardia)
treatment of dermatitis herpetiformis in celicacs
oral dapsone
first step in evaluation of precocious puberty
GnRH stim test, increase in LH means this is central
treatment of body dysmorphic disorder
CBT
what does meconium aspiration put a term neonate at risk of
persistent pulmonary hypertension of the newborn
for wounds is it best to do tension free or with tension
tension free
dx of a patient with low total Ca but normal ionized Ca
pseudohypocalcemia mostly due to low albumin
how do you dx appendicitis in pregnant ppl
graded compression ultrasonography
abdominal compartment syndrome effect on the heart
decreased preload because fo compression of the vena cava which restricts blood flow causing decreased preload. There is increased CVP though due to the compression it just cant get to the heart
what is the equation for Number needed to treat
1/ARR
which tay sachs or nieman pick has hepatomegaly
nieman pick
what disorder does a neonate with e coli sepsis likely have
galactosemia
signs of benzo overdose
normal vitals, ataxia, lethargy, coma, slurred speech
meniscal tear vs. mcl tear
both have joint line tenderness and delayed effusion but only meniscal tear has clicking
what is the child version of a pheo
neuroblastoma
what shape are calcium oxalate crystals
dumbell or envelope rhomboid
signs of glucose 6 phosphatase deficiency
hepatomegaly, hypertriglyceridemia, hyperuricemia, elevated lactate,
which cells make testosterone
leydigs
what is waldenstrom
this is abnormal production of IgM
signs of IgM
progressive nephropathy, impaired platelet function, hyperviscosity, anemia
management of ectopic pregnancy with surgery vs. methotrexate
do surgery if the patient is unstable or bhcg is >5000
what leads show elevation in LAD infarct
I, aVL, V1-V6
treatment of lichen sclerosis in the vagina
topical steroids
if a patient has hepatojugular reflux, is it a heart or a liver issue
heart! because there wouldnt be reflux if the right heart could keep pumping
signs of alport syndrome
cant pee cant see cant hear a bee (kidneys, eyes, ears)
treatment of symptomatic pagets
IV bisphosphonates
do you need to give rhogam in ectopic pregnancies
yace
when can you administer stimulants for ADHD
> 6yo
what is transient proteinuria and who gets it
this is minimal proteinuria transiently which is seen in kids just do urinalysis 1x ayear
what type of intubation do you do if you cannot do endotracheal in an emergency setting
cricothyroidotomy
what does a positive direct coombs mean
Ab against the RBC surface
jauncide with a positive coombs test
autoimmune hemolytic anemia
hwo do you treat genitourinary schistosomiasis
praziquantel
treatment of fulminant hepatic failure
liver transplantation
signs of congenital toxo
chorioretinitis, diffuse calcifications, ventriculomegaly
what is systemic vascular resistance like in hypovolemic shock
high! because the sympathetic sys is telling the body to try to increase blood pressure
treatment of vtach
amiodarone
what is considered prolonged labor in the first stage
slow progression with <6cm in dilation
whta is considered prolonged second stage of labor
> 3 hours in nulliparous or >2 hours in multiparous
what causes prolonged labor
3 Ps, passenger (too big of head), pelvis (pelvic inadequacy), <200 montevedo units in 10 minutes
skin effects of warfarin
warfarin induced skin necrosis
who gets warfarin skin induced necrosis
strongest factor is defiency or protein C
signs of amaurosis fugax on fundoscopy
bright yellow plaques at bifucation of retinal arterioles, microaneurysms, increased tortuosity of retinal arteries
signs of retinal vein occlusion
dilated tortuous retinal veins, macular edema, papilledema, retinal hemorrhages
what is the cause of abdominal pain in HELLP syndrome
stretching of the glisson capsule
complication of IgA vasculitis
intussusception
when do transplanted kidneys get RAS
within the first two years
timeline for when isoniazid can cause liver injury
can cause it months later as it has a variable latent period
seminoma elevations
bhcg
leydigs hormone elevations
estrogen or testosterone
sertoli hormone elevations
estrogen
non seminoma germ cell (yolk, embryonal carcinoma, teratoma, chorio)
bhcg and AFP
complications of pprom
placental abruption, preterm labor, intraamniotic infection, cord prolapse
what do patients with beta thal need who also get frequent transfusions
chelation therapy
when do you initiate nutritional support for critically ill patients
asap
which two foodborne illnesses do you ingest the toxin
bacillus cereus and staph aureus
does craniopharyngioma or pit ademomas have calcifications
cranios
von hippel lindau
hemangioblastomas, RCC, pheos
evaluation of a post menopausal adnexal mass
ultrasound and then if no malignant features, do CA-125, if malignant do surgery
what does the tinel sign dx
tarsal tunnel syndrome
when does acute chest syndrome happen like timing wise
it happens later down the line like after somethign that triggers it liek infection or vasoocclusive pain crisis
common cause of intraventricular hemorrhage in the newborn
prematurity, low birth weight
treatment of vesicouretal reflex
prophylacitic abx in mild-severe cases and surgery in severe reflux
drugs to avoid in parkinsons patients
first gen antipsychotics, because of their potent dopamine antagonism
management of rectus diastasis
observation and reassurance
what disorder has multiple personality states
dissociative identity disorder
what is the main feature of depersonalization disorder
feelings of detachment from or observing yourself
causes of jitteriness in neonates
hypoglycemia and hypocalcemia
difference in dementia with lewy bodies vs. parkinsons demenita
in lewy body disease the dementia occurs at the same time as the parkinsonism and in parkinsons it occurs late in the disease
what tumor gives opsoclonus myolconus syndrome
neuroblastoma
what does each value increased from 1 mean for odds ratio
1 = 100% chance increased odds, 2 = 200% chance increase etc.
management of sleep terrors
reassurance
management of drowning
if they have problems obviously admit them but if theyre chilling still admit them to observe for ARDS
signs of preeclampsia
RUQ pain, hyperreflexia, ankle clonus, headache,
what does an immature hypothal-pit-ovary axis do to periods
it causes irregular and anovulatory bleeding NOT heavy bleeding
cause of primary dysmenorrhea
increased prostaglandin production
what causes hand foot mouth disease
coxsackie A
description of molluscum contagiosum
flesh colored papule with umbilicated center
classic findings of sphincter of oddi dysfunction
increased pain after opioids due to increased contraction, dilated bile duct without stones
where do you see toxo in the brain
basal ganglia! multiple lesions
who gets erythema nodosum
strep, histo, sarcoid, crohns
what is polyarteritis nodosa
fibrinoid necrosis of the arterial wall with tissue ishcmia
clinical features of polyarteritis nodosa
fever, weight loss, malaise, livdeo reticularits, ulcers, purpura, headahces, GI ischemia, myalgias, arthritis, neuropathy
signs of wernicke encephalopathy
encephalopathy, oculomotor dysfunction, postural and gait ataxia
signs of essential tremor
bilateral, worsens with stress, improves with alcohol, worsens with
treatment of essential tremor
propanolol, primidone
what is the hawthorne effect
this is when people change their actions based on the knowledge that they are being observed
what are uterine fibroids made of
proliferation of smooth muscle within the myometrium
signs of inhalent use
loss of consciousness, elevated LFTs, perioral rash
cause of hypoxemia in ARDS
increased R to L shunting, the blood is not getting oxygenated
tinea capitis skin appearance
tiny black dots from broken hair shafts and scaly patches, can have boggy scaly pus
manifestations of granulomatosis with polyangiits
sinusitis, interstitial lung disease, alveolar hemorrhage, glomerulonephritis, ulcers
management of placenta previa
c section at 36-37 weeks
clinical signs of placenta previa
sudden painless bright red bleeding
clinical signs of placental abruption
sudden onset PAINFUL bleeding, tender uterus, fetal distress, hypertonic rigid uterus
when do you give tdap in pregnancy
27-36 weeks
treatment of adjustment disorder
pscyotherapy, short term sleep aids, anti anxiety meds etc
difference between malingering and factitious disorder
in malingering you are doing this for another gain, and in factitious disorder you fake your sx with no gain and to assume sick role
somatic sx disorder vs. illness anxiety
somatic sx you have multiple physical sx that cause distress and have lots of dx testing, illness anxiety you are anxious about having a specific disease despite absent or mild sx
what uterine surgeries cause contraindications for trial of labors
prior classical vertical c section, myomectomy with entry to the uterine cavity
avoidant personality disorder
this is when people avoid situations due to fear of criticism and rejection
benzo withdrawal signs
seizures, tremors, anxiety, psychosis, diaphoreisis, nausea, vom, HTN
normal vaginal pH
4-4.5
what stage of labor do epidurals effect
stage 2 pushing
what SSR is used in people with cardiac disease
sertraline
complications of bicornate uterus
preterm labor, infertility, recurrent miscarriage
contraception to avoid in the postpartum period
estrogen because you are hypercoaguable from the estrogen increase during pregnancy
naltrexone vs. buprenophrine
naltrexone is a full antagonist vs buprenorphine which is partial agonist
treatment of magnesium toxicity
calcium gluconate
what causes tardive dyskinesia
dopamine receptor supersensitivity
what happens with constant stimulation vs. blockade of a receptor
it downregulates in stimulation and upregulates with blockade
most common cause of lobar intracranial hemorrhage
cerebral amyloid angiopathy
causes of SIADH
small cell lung cancer, pulmonary infections, head trauma, etc.
what drug is contraindicated in post partum hemorrhage for pts with asthma
carboprost tromethamine
what drug is contraindicated in post partum hemorrhage for pts with HTN
methylergonovine (methergine)
complications of rapid deceleration from falls or motor vehicle collisions
blunt thoracic aortic injury, hypotension, cool extremities, tachy, hemothorax, widened mediastinum
signs of measles
4Cs cough, coryza, conjunctivitis, koplik spots, high fever
signs of rubella
cephalocaudal spread of maculopapular rash fever
indications for removal of endometrial polyps
postmenopausal, premenopausal with: abnormal bleeding, infertility, lynch syndrome, obesity
do you give anticoagulation in the setting of stroke
NO you give antiplatelet therapy instead
what is the argyll robertson pupil
when pupils are miotic and irregular and do not accomodate to light but have normal
what is histrionic personality disorder
excessive emotionality, attention seeking behavior, inappropriate sexual remarks, highly involved in relationships and thinking they are more intimate than they really are
narcissistic PD signs
lack of empathy, interpersonal exploitation, NO EMOTIONAL DISPLAYS (thats histrionic)
stevens johnson syndrome vs. staphylococcal scalded skin
SJS is blistering of the skin due to medications and is in adults +Mucus membranes involved vs SSSS which is due to staph aureus and has NO MUCUS membranes and is IN CHILDREN
difference between 5 alpha and androgen insensitivity syndrome presentation
5alpha has no breast development because there is no estrogen vs. androgen insensitivity HAS breasts because the excess androgens get converted to estrogen via adipose tissue
clincial signs of wiscott aldrich syndrome
eczema, thrombocytopenia, infections with encapsulated bugs
pathophys of TACO
this is when you get transfusion overload due to accumulation of fluid within a couple hours, not immunologically related
what does HSV encephalitis look like on MRI
uni or bilateral hyperintensity in the temporal lobe
dx of vertebral osteomyelitis
MRI
do you give fluids to someone who is hemodynamically stable and has hx of heart failure and is admitted for some sort of infectino
no!
contraindications to NO administration
right ventricle MI, recent PDE-5 use
whats a positive PPD in HIV patients
5 or greater
when to use chi squared tests
when comparing means of things or categoral values
signs of necrotizing faciitis on the skin
hemorrhagic bullae, crepitus
what occurs after a miscarriage, hyaditiform mole or chorioCA
chorioCA
signs of juvenile spinal muscular atrophy
degeneration of motor neurons, scoliosis, hypotonia, areflexia, autosomal recessive
signs of duchenne muscular dystrophy
calf pseudohypertrophy, proximal muscular weakness, gower sign
what is a pterygium
this is a winged like overgrowth of the conjuctival tissue tha tcan sometimes cover the iris, wear sunglasses and lubricate the eye
uremia manifestations
pericarditis, uremic encephalopathy
does myeloma cause hematuria
no, just proteinuria
ketorlac administration method
injection, not good for outpatient managment
ecg changes in cardiac tampenode
this is just electrical alternans
fev1:FVC ratio and peak expiratory flow rate in asthma
both decreased
when to test for hemophelia in newborns
immediately test the cord blood
protective factors of ovarian cancer
things that decrease the number of ovulatory cycles such as OCP use
signs of graves opthalmology
prominant appearing eyes, bilateral scleral injetion, limited upward gaze, and diplopia
what is the length bias
this is when you have bias in a study that occurs when the disease is going to take a long time to show up so you make the analysis that the intervention isnt doing much
management of empyema
chest tube
onset of exposure to UV rays to cancer
decades
signs of cutaneous leishmaniasis
slow heaing lesion with ulceration and edema
what arrythmia is typically provoked by caffeine, stress, alcohol etc in a structurally normal heart
av node reentry tachycardia (AVNRT)
valsalva effect on afterload
this decreases after load because it decreases venous return which decreases CO and decreases blood pressure
complications of inserting central venous catheter
collapsed lung, air embolism
management of suspected air embolism
place patient in lateral decubitus position, and in trendelenburg
treatment of whipple disease
ceftriaxone followed by TMP-SMX
epidemiology of zenker diverticulum
older male patients, likely achalasia in a younger person
is the bili direct or indirect in breastfeeding jaundice
indirect because there is not enough of the enzyme
predominance of conjugated (direct) bili in a newborn with jaundice
biliary atresia
management of the thyrotoxic phase of subacute thyroiditis
beta blockers, NO ANTI THYROID DRUGS
management of breast mass concerning for malignancy on physical
> 35yrs, mammography and biopsy // <35yrs ultrasound
what drugs allow for positive inotropic support in cardiogenic shock
dopamine, dobutamine, norepi
odds ratio or relative risk for case/control studies
odds ratio (odds of developing X with exposure)
when do we use relative risk
cohort study looking at people with exposure and seeing the risk of developing X
what is the equation for positive predictive value
True positives/ (TP + FP)
is sensitivity/specificity affected by disease prevalence in the pop or is PPV/NPV
PPV and NPV are affected by prevalence
what type of bias is it when you do statistical analysis after the data is seen and collected ie. when you see the outcome and then tweak the analysis
post hoc analysis
first step in suspected placenta previa
pelvic ultrasound then c section
when do patients who underwent splenectomy need abx prophylaxis
ONLY for procedures involving respirtory track
SCID b/t cell levels
both are low
digeorge b and t cell levels
only T cells are low
signs of medication overuse headache
taking medications at minimum every other day who experiences headaches everyother day
what is a hyphema
this si when you get blood in the anterior chamber of the eye due to damange to the vasculature of the iri, ciliary body, etc.
what is felty syndrome
fevers, neutorpenia, splenomegaly, and pleuritic chest pain in a person with RA
when to give the tdap vax during pregnancy
27-36 weeks EVERY pregnancy
screening of type 1 diabetics
lipids, kidney #s, eye exam, monofilament testing, foot exam, blood pressuer
timeline criteria for dx panic disorder
sx >1month
signs of gas bloat
upper abdominal bloating after eating, discomfort, feeling of food getting stuck
complication of umbilical artery catheterization
renal artery thrombosis
first line management of prolactinoma
bromocriptine, if fails then can go to surgery
does VSD cause cyanosis
NO
cyanosis in a child that worsens with exertion/crying
tetrology of fallot
principles to medication prescribing in elderly patients
limiting # prescribers, BEERS criteria, time to benefit of the drug, tailor regimine to life expectancy, frequently assess needs of prescriptions
when is a relative risk and odds ratio considered statistically significant
if the confidence interval does not contain 1
what is the complement of specificity
the false positive rate which is 1-specificity
what is best way to reduce sign out errors
using a standard template when conducting sign out
what are the best things in engineering strategies to reduce human errors
forcing functions, computerized automation, environmental design
what is a cluster study design
grouping data points with simular categories, involves randomization at the level of groups
what is a factorial design
this is when there are differentent interventions and there are multiple end points
saline use in right vs. left MI
use saline in Right MI to avoid low preload and avoid in left MI to avoid fluid overload
signs of acute heart failure in the setting of MI
basilar crackles halfway up lung fields, low O2, S3
signs of vasovagal syncope
brief LOC, vagal prodrome (diaphoresis, warmth), enciting factor like emotional stress or prolonged standing
sudden onset acute limb ischemia etiology
embolism or trauma
what heart defect is necessary to maintain oxygenation in tricuspid atresia
VSD
what does amyloidosis do to the heart
restrictive cardiomyopathy
noninfectoius thrombotic endocarditis
hypercoaguable states, noninfectious thrombi on a healthy valve
what heart valve is affected in ankylosing spondylitis
aortic valve (regurg)
what are the 6Ps of acute limb ischemia
pain, pallor, poikilothermia, paralysis, pulselessness, paresthesia
management of suspected acute limb ischemia
heparin
meds for acute coronary syndrome
nitrate, beta blocker, antiplatelet (aspirin and clopidegrel), anticoag, statin
when do you not give a beta blocker for ACS
hypotension or acute heart failure
treatment of hypertrophic cardiomyopathy in an infant of diabetic mother
beta blockers and fluids
what does inspiration do to preload
increases preload because it increases pressure to the venous system
cardiovascular complications of turner syndrome
coarc, bicuspid valve, aortic dilatation/dissection, metabolic syndrome
in the setting of possible ACS what do you give regardless of etiology of chest pain
you give aspirin
management of pulseless electrical activity
NO SHOCK, you just do CPR and treat the cause of the arrythmia
what rhythms are shockeable
ventricular fibrillation, pulseless ventricular tachycardia
what are the nonshockeable rhythms
pulseless electrical activity, asystole
characteristic murmur of tetrology of fallot
Left upper sternal border due to RVOT obstruction
what type of PFT pattern is seen in sarcoid
this is a restrictive pattern
restricive FEV1, Total lung, DLCO
FEV1 is normal or decreased, TLC is decreased, DLCO is decreased
treatment of toxic megacolon
IV steroids
congential cmv signs
calcifications mainly in the periventricules, chorio, sensorineuronal hearing loss, microcephaly
common sign of cryptococcal meningitis
increased ICP
signs of toxo
focal neurological signs, seizures, confusion, headaches
meningitis skin findings (by pathogen)
viral: maculopapular rash // neisseria meningitidis: petichiae // cryptococcall: umbilicated papules
management of unstable angina
same as STEMI, nitrates, beta blocker, antiplatelet, anticoag, statin, corinary reperfusion
what is bicarb like in anion gap acidosis
high gap means low bicarb
treatment of high altitude sickness
supplemental O2, acetazolamide, dexamethasone
screening age for low dose ct vs. AAA ultrasound
low dose CT is yearly at 50 and ultrasound is one time at 65
signs of hyperkalemia on EKG
peaked T waves, widened QRS with low amplitude which causes a sine wave pattern
when do you get low aldosterone in adrenal insufficiency
ONLY when its primary adrenal insufficiency so like in addisons
what are the main nerve roots in knee and achilles reflex
knee: L4 achilles: S1
what are the ulcerations like in bacterial vs. herpes vs. fungal keratitis
bacterial is a central round ulcer // herpes is branched keratitis // fungal is feather margins with satellite lesions
what is the formula for number needed to harm
1/ARI (absolute risk increase)
aldosterone in primary vs. secondary adrenal insufficiency
primary it is decreased but in secondary its normal
management of a myasthenic crisis
intubation –> plasmapheresis or IVIG with steroids
what is selection bias
this is when the sample group is not representative of the population from which the participants are drawn because the sampling or treatment allocation is not random
what is susceptibility bias
one disease predisposes affected individuals to another disease and the treatment for the first disease is mistakenly interpreted sa a predisposing factor for the second disease
what is measurement bias
poor data collection methods with inaccurate results
signs of physiologic tremor
tremor that worsens with stress and can be seen at rest and during action
what does a succession splash mean
gastric outlet obstruction
what is an afferent pupillary defect
this is when the eye cannot react to light but can accomodate. the direct pupillary reflex is absent in affected eye but DOES accomodate when light is shone in the non affected eye. there is NO consensual response in the non affected eye
risk factors for sigmoid volvulus
chronic constipation and colonic dysmotility.
effect of tamoxifen on the uterus
agonist affect
adverse effects of tamoxifen
hot flashes, endometrial hyperplasia, VTE, uterine sarcom
timing of worsening symptoms for different types of strokes
embolic is worst at onset, thrombotic is fluctuating, and hemorrhagic is progressively worse and worse
signs of stroke in the putamen
strokes in the putamen almost always involve the internal capsule so you will get contralateral hemiparesis and contralateral sensory loss
do you have focal neuro signs in subarachnoid hemorrhage
no!
who gets optic gliomas
NF1
genetic syndromes with pheo
VHL, MEN2
what is associated with wilms tumor
WAGR, beckwith wiedman syndrome
next step in management of person with anorectal fistula
surgery with fistulagram to evaluate tracks
causes of asymmetric fetal growth
maternal hyptertension, maternal malnourishment
causes of symmetric fetal growth restriction
chromosomal abnormalities, infections
management of superficial wound dehiscence vs. rectus dehiscence
superficial: regular dresssing changes // rectus: urgent surgery
lab abnormalities in DIC
high PT and PTT, low platelets, low fibrinogen (because it is being used up)
what type of cholecystitis do pts. get that are critically ill
acalculous cholecystiits, can happen with TPN
what is RBC mass
total # of red blood cells in circulation NOT the mass of the individual RBC
which thalassemia has HIGH HbA2
beta thal
what does it mean if the patient has no bleeding with progesterone challenge test
there is a structural issue or there is estrogen deficiency
what antibodies are seen in UC vs. Crohns
UC: p-ANCA // Crohns: anti-saccharomyces cerevisiae antibodies
whats the leading cause of death for adults over 65yrs
cardiovascular disease
management of distal biceps tendon rupture
surgical repair within 2-3 weeks
adverse effects of nitrates
hypotension, headaches, flushing, cyanide toxicity
what is bronchopulmonary dysplasia
this is premature arrest of pulmonary development, continued 02 requirement >28 days from birth
common presentation of chronic bacterial prostatitis
recurrent UTI, pain with ejaculation, transient improvement with ABX, typically no swelling or tenderness of prostate
signs of ecthyma gangrenosum
painless red macules that quickly progress to pustules and form gangrenous punched out ulcers
what is the threshold in which you can visualize a pregnancy
> 3500 bhcg
when do you do ABX for mammalian bites
if its a puncture wound, if its on the face, hand/foot, joint or genitals, immunocompromised pts, if they need primary closure
