Deck 3 Flashcards
How do you dx chorioamnionitis (intraamniotic infection)?
maternal fever ( >100.4) + 1 or more of the following:
- Maternal: tachycardia >/= 100/min, uterine tenderness, malodorous/purulent amniotic fluid or vaginal discharge, WBC > 15,000
- Fetal: Tachycardia - baseline heart rate > 160/min
associated w/ prolonged rupture of membranes
What are possible maternal complications from abruptio placentae?
hypovolemic shock
disseminated intravascular coagulation (due to tissue factor released by decidual bleeding)
What is Todd paralysis?
it is a self-limited, focal weakness that occurs after a focal or generalized seizure.
it presents in the postictal period w/ a partial or complete hemiplegia involving an ipsilateral upper and lower extremity
paralysis usually resolves w/in 36 hrs
in complicated diverticulitis with an abscess, how should you treat the abscess?
if fluid collection < 3cm, tx w/ IV antibiotics and observation
if fluid collection > 3cm, tx w/ CT-guided percutaneous drainage
a child < 8 yrs old presents with erythema chronicum migrans, the classic targetoid rash of Lyme disease. How do you treat him/her?
oral amoxicillin or cefuroxime! (same tx for a pregnant women)
Doxycycline is contraindicated in children < 8 or pregnant women bc it can slow bone growth in exposed fetuses and cause enamel hypoplasia and permanent teeth stains during tooth development in young children.
What is one of the earliest findings in macular degeneration (as may be seen with the grid test)?
distortion of straight lines such that they appear wavy
risk factors = increasing age and smoking
driving and reading are some of the first activities that are affected
What is syringomyelia? and what physical exam findings are associated w/ it?
syringomyelia is a fluid-filled cavity in the spinal cord (commonly associated w/ Arnold Chiari malformation type 1, but may be acquired)
presents w/ loss of pain/temperature sensation in the dermatomes corresponding to the site of spinal involvement (“cape” distribution) - due to disturbance of the crossing spinothalamic tracts in the anterior commissure
as the cavity enlarges, there can be interruption of the anterior horn gray matter, resulting in LMN signs in the upper limbs (decreased/absent DTRs)
What is a Leukemoid reaction? and what lab values help you distinguish it from CML?
Leukemoid reaction occurs as a response to severe infection and is marked leukocyte counts > 50,000
it is characterized by the presence of:
- HIGH alkaline phosphatase score
- a greater proportion of late neutrophil precursors (metamyelocytes, bands)
- a lack of absolute basophilia (seen in CML)
Pts infected with Streptococcus gallolyticus (S bovis biotype 1) are at significantly increased risk of what?
Colorectal cancer! and endocarditis!
bc of this, all pts should have colonoscopy to look for underlying occult malignancy
What are the clinical characteristics of Bronchiectasis? and how do you dx it?
Bronchiectasis is a dz of bronchial thickening and dilation due to recurrent infx and inflammation
pts commonly present w/ large-volume mucopurulent sputum production, hemopytsis, and dyspnea – exacerbations are typically bacterial and require Abx
Dx is made using HIGH-RESOLUTION CT SCAN OF THE CHEST
Penile fracture is a urologic emergency and requires urgent operative repair. What is the only imaging test commonly used in evaluation?
retrograde urethrogram
employed in cases of suspected urethral injury – indications include blood at the meatus, hematuria, dysuria, and urinary retention
What is the recommended treatment for CIN 3? and what are possible complications of the procedure?
cervical conization (excision of the intact transformation zone)
complications include:
- cervical stenosis!! (may cause secondary dysmenorrhea or impaired fertility)
- cervical incompetence leading to preterm delivery
- preterm premature rupture of membranes
- 2nd trimester pregnancy loss
VEAL CHOP
Variable decelerations = Cord compression
Early decelerations = Head compression
Accelerations = Okay!
Late decelerations = Placental insufficiency
what are the first and second line interventions to reduce cord compression (seen w/ variable decels) and improve blood flow to the placenta?
1st tx = maternal repositioning
2nd tx = amnioinfusion – instillation of saline into the amniotic sac may decrease cord compression and eliminate variable decels (in the case of prior rupture of membranes)
bc the facial/ophthalmic venous system is valveless, uncontrolled infection of the skin can result in what? red-flag sxs may include severe HA; bilateral periorbital edema; and CN 3, 4, 5, and 6 deficits.
Cavernous sinus thrombosis
Dx w/ MRI/MR-venography
Tx w/ IV broad-spectrum Abx and prevent/reverse cerebral herniation
a single brain abscess appearing as a ring-enhancing lesion w/ central necrosis on CT scan usually results from direct extension of an adjacent infection (eg, otitis media, sinusitis, dental infection). What are the two most commonly isolated organisms?
Viridans streptococcus
Staphylococcus aureus
a loud S1 and a mid diastolic rumbling murmur at the apex
mitral stenosis
How do you tx chlamydial infx diagnosed by NAAT? gonorrhea was negative.
Azithromycin or Doxycycline (contraindicated in pregnancy)
**concurrent tx is not indicated if the gonorrhea NAAT is negative
Maternal serum alpha-fetoprotein is measured between 15-20 weeks gestation. What are causes of elevated MSAFP?
open neural tube defects (anencephaly, open spinal bifida) abdominal wall defects (gastroschisis, omphalocele) multiple gestations (watch for fundal height in comparison to gestational age)
pleuritic CP in the setting of a long-distance flight, hemoptysis, dyspnea, tachypnea, tachycardia, and OCP use. what does this patient have?
Pulmonary embolism – likely w/ occlusion of a peripheral pulmonary artery by thrombus, causing PULMONARY INFARCTION (pleuritic chest pain and hemoptysis*)
What organisms are most commonly implicated in acute bacterial rhinosinusitis?
Strep pneumoniae (30%) nontypeable H influenzae (30%) Moraxella catarrhalis (10%)
Tx = amoxicillin-clavulanic acid
Aspirin-exacerbated respiratory disease (AERD) is a pseudoallergic rxn to NSAIDs. What pts does it typically occur in?
pts w/ comorbid asthma, chronic rhinosinusitis with nasal polyposis, or chronic urticaria
usually presents w/ asthmatic sxs (cough, wheezing, chest tightness), nasal and ocular sxs (nasal congestion, rhinorrhea, or periorbital edema), and facial flushing w/in 30 mins - 3 hrs after NSAID ingestion
In polycythemia vera, RBC production is driven by a constitutively active JAK2 gene rather than by tissue hypoxia, there EPO levels are ??
EPO levels are LOW
normally EPO activates the JAK2 tyrosine kinase, which differentiates late myeloid cells into erythrocytes. In polycythemia vera, EPO isn’t needed to activate JAK2 so it remains low.
If a pt presents with feature suggestive of Raynaud phenomenon that are asymmetric and accompanied by features of tissue ischemia (numbness, ulcers) and systemic dz (autoimmune or vascular), you should suspect what kind of Raynaud’s?
Secondary Raynaud phenomenon – may be due to SLE, scleroderma, thromboangiitis obliterans
workup includes:
- CBC and metabolic panel
- urinalysis
- ANA and RF
- ESR and C3/C4 levels
Asymptomatic bacteriuria in pregnancy – most common pathogen is E. coli. How do you tx?
1st line Abx =
- Cephalexin
- Amoxicillin-clavulanate
- Nitrofurantoin
What does tx for preterm labor at < 34 weeks include? what additional medication do you add if < 32 weeks?
Tocolytics (indomethacin, nifedipine) to postpone delivery
Corticosteroids (betamethasone) to decrease the risk of neonatal RDS
Penicillin if GBS positive or unknown
If < 32 weeks, MAGNESIUM SULFATE to lower the risk of neonatal neuro morbidities (cerebral palsy)
How do you tx urge incontinence – the sudden, overwhelming, or frequent need to empty the bladder?
voiding is mediated through the PS system, and antimuscarinic drugs (OXYBUTYNIN) increase bladder capacity and decrease detrusor contractions by reducing ACh activity
How do you tx overflow incontinency – the constant involuntary dribbling of urine and incomplete emptying?
cholinergic agonist = BETHANECOL
(and/or intermittent urethral catheterization)
post-void residual volume <150ml in women and <50ml in men is normal.
What is the initial therapy for pts w/ HTN and renal artery stenosis?
ACE-inhibitors or ARBs.
What does an S4 heart sound occurring at the end of diastole just before S1 indicate?
rhythm = “TEN-nes-see”
S4 is an indicator of a stiff left ventricle, which occurs in the setting of restrictive cardiomyopathy or left ventricular hypertrophy from prolonged HTN!!
Pt presents w/ sxs suggestive of a brain tumor and CT/MRI findings of a butterfly appearance w/ central necrosis. What kind of tumor?
Glioblastoma multiforme – classic butterfly!!
the heterogenous, serpiginous contrast enhancement is typical of high-grade astrocytoma
What is the MOA of succinylcholine? and what is a potentially major side effect if used in certain patients?
succinylcholine is a depolarizing neuromuscular blocker that works by binding to postsynaptic ACh receptors to trigger influx of Na ions and efflux of K+ ions through ligand-gated ion channels – depolarization occurs and temporary paralysis ensues (delayed repolarization of the skeletal muscle membrane)
in certain pts it can cause life-threatening cardiac arrhythmia due to severe hyperkalemia!! (pts specifically at risk are those who have experienced extensive muscle injury - rhabdomyolysis, burn injury, disuse muscle atrophy, or denervation – conditions that may cause upregulation of ACh receptors)
How do you treat TTP?
Plasma exchange!!
this removes the pts plasma and replaces it w/ donor plasma – this replenishes ADAMTS13 and removes autoantibodies.
What should you do if a woman in labor has active genital herpes lesions?
Cesarean delivery!!
the risk for neonatal HSV infection is drastically increased if the infant passes through the vaginal canal and is directly exposed to an active HSV eruption
pregnant women w/ a hx of genital HSV should receive prophylactic acyclovir or valacyclovir beginning at 36 wks of pregnancy
what are the clinical features suggestive of biliary atresia?
initially well-appearing, followed by development of the following over 1-8 weeks:
- jaundice
- acholic (pale) stools or dark urine
- hepatomegaly
- conjugated hyperbilirubinemia
- mild elevation in transaminases
for a child with incomplete immunization to varicella, what is post-exposure prophylaxis?
varicella vaccine in immunocompetent!!
if immunocompromised, they get varicella immunoglobulin.
children receive 2 doses of VZV vaccine, at ages 1 and 4 yrs
a pt has an abnormal first-trimester screen, with elevated beta-hCG and increased nuchal translucency (thickness). What follow-up diagnostic testing would you do based on gestational age?
if 10-13 weeks gestation – chorionic villus sampling
if 15-20 weeks gestation – amniocentesis
pt presents w/ fragile, photosensitive skin that develops vesicles and bullae w/ trauma or sun exposure. Healed lesions typically scar and can form both hypo- and hyperpigmented areas. Pt may also have fatigue, elevated transaminases, and arthralgias. What do they have and what is it strongly associated w/?
Porphyria cutanea tarda, which is strongly associated with chronic Hepatitis C
case control and retrospective cohort studies are both retrospective studies. what is the critical distinction between the two?
case control studies determine the OUTCOME and then look for associated risk factors
retrospective cohort studies ascertain RISK FACTOR EXPOSURE and then determine the outcome
pt presents following hysterectomy with clear watery vaginal discharge for two weeks, that occurs in the day and at night. UA shows signs of infection. What does she have?
vesicovaginal fistula
- may occur after pelvic surgery
- present as a painless loss of urine into the vagina
- PE shows pooling of clear watery fluid in the vagina
pts with upper GI bleeding who have a depressed level of consciousness and ongoing hematemesis should have what done prior to endoscopic tx with ligation or sclerotherapy?
endotracheal intubation!! to prevent airway compromise due to aspiration of blood
Pregnant pts w/ asymptomatic bacteriuria are at risk for what?
- ascending infection (eg, acute pyelonephritis)
- preterm labor and low birth weight
What is the most common cause of second stage of labor arrest?
fetal malposition
- the optimal fetal position is occiput anterior
- deviations from this position (occiput transverse, occiput posterior) can cause cephalopelvic disproportion and arrest of second stage
after gastric adenocarcinoma is identified histologically, tumor staging must occur. What type of imaging is initially used for staging?
CT scan of the abdomen and pelvis
supracondylar fractures of the humerus are the most common fractures in the pediatric population. What is the most common complication?
entrapment of the brachial artery or median nerve
woman presents with persistent HTN and is on OCPs. What should your next step in management be?
stop the OCPs first
-can reduce BP over 2-12 month period and often correct the problem
which cancer occurs more commonly in ppl exposed to asbestos?
bronchogenic carcinoma > mesothelioma
pleural mesothelioma typically presents as a unilateral pleural abnormality w/ a large pleural effusion
bronchogenic carcinoma is an actual mass that arises from the epithelium of a bronchus or bronchiole
pleural plaques and pulmonary fibrosis are signs of asbestosis (which itself isn’t cancer, but the effects of working w/ abestos)
What medication used to tx anxiety can result in seizures following abrupt discontinuation?
short-acting benzos, like alprazolam (xanax)
other sxs can include tremors, anxiety, perceptual disturbances, and psychosis
What are major side effects of the 2nd gen antipsychotics Olanzapine and Clozapine? how should you monitor for these side effects?
metabolic adverse effects, such as weight gain, dyslipidemia, hyperglycemia, and increased risk of diabetes
BMI should be measured monthly; and fasting plasma glucose and lipids, blood pressure, and waist circumference should be assessed at baseline, 3 months, and then annually
what are the pregnancy-related risks due to HTN?
Maternal: -superimposed Pre-E -postpartum hemorrhage -gestational diabetes -abruptio placentae -C-section delivery Fetal: -fetal growth restriction -perinatal mortality -PRETERM DELIVERY -oligohydramnios
lithium exposure in the first trimester increases the risk of what?
increased risk of cardiac malformations, specifically septal defects and possible Ebstein’s anomaly (a malformed and inferiorly attached tricuspid valve, causing a portion of the RV to bc functionally part of the RA)
How does minimal change appear with renal biopsy?
Light microscopy and immunofluorescence show NO ABNORMALITIES.
electron microscopy shows diffuse effacement of foot processes of podocytes (renal epithelial cells).
what primary immune deficiency has recurrent sinopulmonary and GI infections as well as severe anaphylaxis to blood transfusions?
Selective IgA deficiency
pt presents w/ multiple risk factors for atherosclerosis (diabetes, HTN, smoking) and sxs consistent w/ intermittent claudication. What is the next best step?
Ankle-brachial index (ABI) to confirm the presence of peripheral arterial disease
what is often the type/mechanism of urinary incontinence in diabetic pts?
diabetic autonomic neuropathy - can cause a NEUROGENIC BLADDER w/ decreased ability to sense a full bladder, incomplete emptying, urinary retention, and distended bladder – these pts will develop overflow incontinence w/ sxs in the day and night… PE may show a distended bladder and high post-void residual urine volume
in a pt in DKA, what are the best markers that indicate the resolution of ketonemia?
serum anion gap
direct assay of beta-hydroxybutyrate (the predominant ketone)
MEN 1 is an autosomal dominant condition. What are the 3 primary tumor types associated w/ it?
“the 3 Ps”
Parathyroid adenomas/hyperplasia – may show sxs of primary hyperparathyroidism
Pancreatic/gastrointestinal neuroendocrine tumors – like Zollinger-Ellison syndrome/gastrinomas
Pituitary adenomas
What is the most important direct role of hCG in pregnancy?
hCG is secreted by the syncytiotrophoblast and is responsible for PRESERVING THE CORPUS LUTEUM during early pregnancy in order to maintain progesterone secretion until the placenta is able to produce progesterone on its own.
production begins 8 days after fertilization, and level double q48h until they peak at 6-8wks gestation.
What is the most dangerous/common cardiac complication in pts w/ Marfan syndrome? what physical exam findings are present?
Aortic dissection!
aortic regurgitation is a complication of aortic dissection and presents with an early diastolic murmur
What are some side effects that can result from the use of loop diuretics (furosemide) to tx cor pulmonale?
hypovolemia, low cardiac output, and renal hypoperfusion – leading to development of prerenal azotemia/AKI
“eggshell” calcification of a hepatic cyst on CT scan is highly suggestive of what?
Hydatid cyst
- due to Echinococcus granulosus
- humans contract the infection from close and intimate contact w/ dogs
- unilocular cystic lesions that can occur in any organ
What does the CSF show in viral meningitis? what are most cases caused by?
increased WBC count w/ lymphocytic predominance
protein is normal/slight elevated
GLUCOSE IS NORMAL
gram stain shows no organisms
90% of cases are caused by non-polio enteroviruses, such as ECHOVIRUS and COXSACKIEVIRUS
what are the defining features of Obesity Hypoventilation syndrome?
obesity (BMI > 30)
daytime hypercapnia (PaCO2 > 45 mm Hg)
Alveolar hypoventilation
pts “can’t breathe” due to excess weight and altered lung mechanics, and “won’t breathe” due to decreased chemosensitivity to hypercapnia from persistent nocturnal hypoventilation.
how do you tx localized non-bullous impetigo?
topical antibiotics = MUPIROCIN
oral antibiotics (cephalexin, clindamycin) are indicated when there is widespread non-bullous impetigo (so topical is impractical) or in the case of extensive bullous impetigo.
unilateral foot drop is characterized by a “steppage” gait = exaggerated hip and knee flexion while walking. What is the most common cause?
L5 radiculopathy or
COMMON PERONEAL NEUROPATHY
Normal pressure hydrocephalus has classic triad of abnormal gait, dementia, and urinary incontinence. what does the gait look like? and what are prominent features of the dementia?
the gait is broad-based and shuffling (appears early in dz)
subcortical and frontal features dominate the cognitive disturbances of NPH but occur much later in the dz
how do you tx pts w/ macro-prolactinomas or symptomatic tumors of any size?
dopaminergic agonists = CABERGOLINE, bromocriptine
-these can normalize prolactin levels and reduce tumor size
pts who fail to respond or who have very large tumors (<3 cm) should be referred for transsphenoidal resection.
malignant HTN?
same as emergency… greater than 180/120 w/ end organ damage
hemochromatosis increases risk of what cancer?
hepatocellular carcinoma bc liver cirrhosis
what is a cancer that occurs in long-standing cases of lymphadema?
lymphangiosarcoma (or angiosarcoma)
may first appear as a purple lesion on the extremity
foot drop (or unable to bend foot) is what nerve problem?
peroneal neuropathy
S1 problem you can’t walk on your toes (can’t plantar flex)
how do you prevent renal insufficiency in a pt with pre-existing renal dz who needs an imaging study with contrast?
infusion of 0.9% saline
dysregulation of which neurotransmitter happens in Alzhiemer’s dementia?
ACh
scattered papules w/ some scaly areas on the scalp, hair is broken near the base w/ mild alopecia. what is it? how do you prevent and tx?
tinea capitis
prevention –avoidance of sharing hats
tx w/ griseofulvin
post-strep glomerulonephritis. what immune-mediated substance is decreased?
C3 is decreased
pt presents with symptoms of otitis media, but they also have a bump behind their ear and their ear is turned forward. What complication do they have?
Mastoiditis
need a CT scan I think
Name this psych condition:
Exposure to actual or threatened trauma; intrusive memories, nightmares, flashbacks; amnesia for event and avoidance of reminders; negative mood; arousal w/ sleep disurbance, irritability, hypervigilance, exaggerated startle, impaired concentration.
Lasting >/= 3 days and = 1 month!!
Acute stress disorder!!
if symptoms persist for > 1 month and meet the criteria for PTSD, then dx is changed to PTSD.
How do you tx (prevent) vasospastic angina?
CCBs!!!
Diltiazem is commonly used bc it is a potent coronary arterial dilator.
The dihydropyridines (amlodipine, felodipine) are also effective.
When may pap smears/testing be stopped in pts who have had adequate pap testing w/o prior high-grade cervical lesions or cervical cancer risk factors (smoking, immunocompromised status)?
age 65
if a pt has a history of CIN2 or higher on histology, screening continues for another 20 years after detection (past age 65 if indicated).
Thrombosis and a hx of miscarriages in a pt w/ suspected SLE (photosensitive rash and symmetric oligoarthritis) suggests what syndrome?
Antiphospholipid syndrome
(occurs more commonly in pts w/ an underlying dz such as SLE, but can occur independently)
Pts may also have the presence of an antiphospholipid antibody such as Lupus anticoagulant (LA), anticardiolipin Ab, or beta 2 glycoprotein 1 Ab
In vitro, LA prolongs the PTT – so in a pt, prolonged PTT is an indirect indicator for the presence of LA and is highly suggestive in the correct clinical setting.
How do you tx uric acid kidney stones?
usually see an unusually low urine pH; uric acid stones are radiolucent but can often be seen on renal US or CT scan
Hydration, Alkalinization of the urine with oral Potassium citrate!, and a low-purine diet
alkalinization of the urine to pH 6.0 - 6.5 with oral potassium citrate is recommended as uric acid stones are highly soluble in alkaline urine. citrate is also a stone inhibitor and reduces crystallization.
allopurinol can be added if sxs persist.
Pt presents w/ distended jugular veins, pulsatile and tender hepatomegaly, abdominal distension w/ ascites, and lower extremity edema. Cardiac exam reveals a holosystolic murmur best heard at the left sternal border. He has a feeling of pulsation in his neck when he lays down. He underwent permanent pacemaker implantation 6 months ago. What is the dx? what is it from?
Tricuspid regurgitation
due to an adverse effect of his permanent pacemaker – the right ventricular lead of a transvenous implantable pacemarker or cardoverter-defibrillator passes through the SVC into the right atrium and then through the tricuspid valve to terminate in the endocardium of the RV. Damage to the tricuspid valve leaflets or inadequate leaflet coaptation can occur, leading to severe TR.
Sensitivity = ?
sensitivity = TP / TP + FN
it determines how well the test identifies people with the disease.
man presents w/ decreased libido and ED, minimal bilateral gynecomastia w/o galactorrhea, and decreased testicular size. He has normal/low LH/FSH and decreased testosterone. What do you suspect? how do you evaluate for it?
Secondary (central) hypogonadism
- low levels of testosterone normally increase LH and FSH levels due to loss of feedback inhibition – so low/nl levels of LH/FSH suggest an inappropriate hypothalamic-pituitary response.
- can be due to a mass lesion in the hypothalamus or pituitary, hyperprolactinemia, long-term glucocorticoid or opiate use, or severe systemic illness
- MEASURE SERUM PROLACTIN!! (should also have screening for other pituitary hormone deficiences)
- MRI is indicated for pts w/ elevated prolactin or mass-effect sxs
What is initial management for sciatica (lumbosacral radiculopathy)?
short-term relief of sxs w/ NSAIDs or acetaminophen (most pts experience spontaneous resolution)
most likely due to nerve root compression by a herniated disc – radiation of pain to the calf and foot is consistent w/ sciatica
traction on the nerve root during the straight leg raise test causes worsening or reproduction of the pain
What is the first line tx for Restless legs syndrome?
Dopamine-agonists like Pramipexole or Ropinirole
RLS pts w/ comorbid insomnia, chronic pain syndrome, or anxiety may benefit from alpha-2-delta Calcium channel ligands (gabapentin) over dopaminergic agents.
what is the name of the rare AD inherited blood disorder that causes episodic attacks of swelling that may affect the face, extremities, genitals, GI tract, or upper airway? swelling of the intestinal mucous membranes may lead to vomiting and painful, colic-like intestinal spasms (may mimic obstruction). airway edema can be life threatening.
Hereditary angioedema!!
aka C1 esterase deficiency
What is adenomyosis? how does it present?
Adenomyosis is endometrial tissue IN the myometrium of the uterus.
Classic triad of NONcyclical pain, menorrhagia, and an enlarged uterus.
(endometriosis is functional endometrial glands and stroma OUTSIDE the uterus with CYCLICAL pelvic and/or rectal pain and dyspareunia).
How do you tx candida esophagitis?
Fluconazole PO!
or nystatin oral suspension
how does a middle cerebral artery stroke present?
MCA stroke can cause CHANGes:
- C*ontralateral paresis and sensory loss in the face and arms
- H*omonymous hemianopsia
- A*phasia (dominant)
- N*eglect (nondominant)
- G*aze preference toward the side of the lesion
pt presents with severe RUQ abdominal pain and fever. They immigrated from a developing country. for some reason and US of the RUQ is done (probz for elevated liver enzymes) and a single cystic mass is seen. you should get serum Ab titers to test for what?
Entamoeba histolytica
caused by ingestion of contaminated food or water – look for hx of travel in developing countries. incubation period can last up to 3 months. chronic amebic colitis mimics IBD. endoscopy shows “flask-shaped” ulcers.
Tx w/ metronidazole.
a pt with AIDS has sxs of pneumonia and silver stain of sputum is positive for cysts and organisms. what do they have and how do you tx it?
PCP
trimethoprim-sulfamethoxazole
Pts with lesions affecting the posterior inferior FRONTAL gyrus (BROCA’S AREA) have what deficits?
they can comprehend and follow commands, but are unable to verbalize or write properly (expressive aphasia)
Broca’s aphasia often represents Broken speech system.
Describe Wernicke’s aphasia?
difficulty comprehending and following commands, but are able to SPEAK FLUENTLY
pts with lesions in this area (temporal lobe) may have right superior visual field defects
What personality disorder prefers to be a loner, detached, and unemotional?
Schizoid
what personality disorder is eccentric; odd thoughts, perceptions and behaviors?
schizotypal
Name this syndrome: a rare, benign hereditary condition with chronic or fluctuating conjugated hyperbilirubinemia (see a positive urine bilirubin assay) due to a defect in hepatic secretion of conjugated bilirubin into the biliary system. LFTs are normal. Tx is unnecessary.
Rotor’s syndrome
What are fasting, 1-hour and 2-hour postprandial target blood glucose levels in pregnant pts w/ gestational DM? What is 1st and 2nd line tx?
fasting < 95
1-hour postprandial < 140
2-hour postprandial < 120
1st line tx: dietary modifications
2nd line tx: Insulin, metformin, glyburide
women with gestational DM are at increased risk for gestational HTN, pre-E, fetal macrosomnia, and cesarean delivery
How do you manage a shoulder dystocia? *BE CALM
B - Breath; do not push
E - Elevate hips against abdomen (McRoberts position)
C - Call for help
A - Apply suprapublic pressure
L - enLarge vaginal opening with episiotomy
M - Maneuvers: Deliver posterior arm; rotate 180 degrees (woods corkscrew); collapse anterior shoulder (Rubin maneuver); replace fetal head into pelvis for cesarean delivery (Zavanelli maneuver)
pt presents w/ abdominal pain, fatigue, and decreased urination after a bloody diarrheal illness. this is concerning for what? what is the classic triad it causes?
Hemolytic Uremic Syndrome (HUS)
- most commonly occurs after infx w/ Shiga toxin produced by E. coli O157:H7
- class triad of HUS: microangiopathic hemolytic anemia, thrombocytopenia, and AKI (poor urine output, edema, and elevated Cr and BUN)
- the hemolytic anemia leads to decreased haptoglobin and elevated bilirubin causing scleral icterus and jaundice
infants w/ a history of what should not receive the Rotavirus vaccine (a live attenuated vaccine)?
Intussusception – there is a small risk of intussusception associated w/ it
also contraindicated in pts w/ anaphylaxis to vaccine ingredients, hx of uncorrected congenital malformation of the GI tract (Meckel’s), or SCIDs
normocytic anemia, splenomegaly, reticulocytosis, jaundice w/ elevated indirect bilirubin, increased serum lactate dehydrogenase, and decreased serum haptoglobin levels. pt may have just been tx’d with a penicillin drug, which triggered this. ??
Autoimmune hemolytic anemia
Dx of warm AIHA is confirmed by a Direct antiglobulin (coombs) test
Tx w/ high-dose glucocorticoids
define incidence and cohort study.
incidence = the number of new cases of a dz arising in a pop. at risk over a specified period of time. subjects w/o the dz are followed over a period of time to discover how many eventually develop the dz
cohort study = an observational study in which groups are chosen based up presence of absence of 1+ risk factors. all subjects are observed over time for development of the dz of interest, allowing estimation of incidence w/in the total pop. and comparison of incidence btw groups
pt that is hospitalized and ill after a recent major surgery presents with unexplained fever and RUQ abdominal pain – might also have jaundice, RUQ, leukocytosis, and high/nl LFTs. What might they have?
acalculous cholecystitis! an acute inflammation of the gallbladder in the absence of gallstones
- it is most often seen in hospitalized pts who are critically ill! – pts may have had recent surgery, severe trauma, extensive burns, sepsis or shock, prolonged fasting or TPN, or critical illness requiring mechanical intubation
Dx via abdominal US
Tx: enteric Abx coverage, cholecystostomy for initial drainage, cholecystectomy once clinically stable
What murmurs get louder with squatting (increase venous return, increase afterload)? and which get softer?
louder w/ squatting = AR, MR, VSD
softer w/ squatting = MVP, HCM
What do you do in pts w/ placenta previa for delivery?
Cesarean delivery! at 36-37 weeks
- labor and expectant management are contraindicated due to the risk of hemorrhage
- pelvic rest is recommended for the duration of the pregnancy as intercourse can cause contractions, which in turn can lead to bleeding (shearing the placenta off the cervix and lower uterine segment)
pts w/ recurrent renal calculi, particularly calcium stones, should do what to prevent more stones in the future?
Restrict sodium intake
increased sodium intake enhances calcium excretion (hypercalciuria), and low sodium intake promotes sodium and calcium reabsorption through its effect on the medullary concentration gradient
