Deck FIVEEE Flashcards
vaginal bleeding, dilated cervical os, products of conception may be seen or felt at or above cervical os. what is this?
inevitable abortion
*in missed (no vaginal bleeding) and threatened (vaginal bleeding) abortions, the cervical os is closed
Adenomatous polyps carry increased malignant potential. what specific features make that risk even higher?
large polyps (>/= 1 cm) **adenomas with high-grade dysplasia or VILLOUS features (a villan is bad) high number (>/= 3 concurrent adenomas)
immunocompromised pt has systemic sxs, lung nodules, and brain abscess (causing seizures), and the cultures grow gram-positive, partially acid-fast, filamentous, branching rods. What is the organism? how do you tx?
Nocardia
Tx for pulmonary nocardiosis is TMP-SMX!!
(when the brain is involved, the carbapenems are added for better coverage)
what is the mechanism responsible for rapid pain relief when nitroglycerin is given for angina?
it causes systemic vasodilation, which causes a decrease in cardiac preload and thus a decrease in left ventricular end diastolic volume – this leads to a REDUCTION IN LEFT VENTRICULAR SYSTOLIC WALL STRESS, which results in decreased myocardial oxygen demand
refusal to speak in a specific social situation for greater than 1 month but engagement in normal communication in situations in which you feel comfortable (eg, at home w/ siblings) is what?
Selective mutism
pts are often asymptomatic but can present w/ extreme fatigue, B symptoms, infx, or weight loss. usually elderly. lymphadenopathy and splenomegaly are often present. Dramatic Lymphocytosis!! peripheral smear shows Mature Lymphocytes with the presence of Smudge cells.
Chronic lymphocytic leukemia!! -the most common type of leukemia in the United States
what is a well-known complication of giant cell arteritis?
Aortic aneurysm!
- bc giant cell arteritis can involves the branches of the aorta
- follow pts w/ serial CXRs
for pts w/ suspected postnasal drip, what is initial empiric treatment?
first-gen antihistamine (chlorpheniramine)
or combined antihistamine-decongestant (brompheniramine and pseudoephedrine)
what is the difference between dissociative amnesia and dissociative identity disorder?
dissociative amnesia is a pts inability to recall important personal information, it can consist of localized or selective amnesia for a specific period or event, or generalized amnesia for personal identity and life history. onset is typically sudden and preceded by overwhelming or intolerable events
dissociative identity disorder = multiple personality disorder
pts with large surface area (>20%) burns are at highest risk for wound infection. what organisms predominate immediately after severe burn? and after 5 days? and what are the signs of infection?
immediately after a severe burn = gram + organisms (staph aureus)
after 5 days, most infxs are due to gram-negative organisms (pseudomonas aeruginosa) or fungi (candida)
the earliest sign is usually a change in burn appearance (partial-thickness injury turns into a full-thickness injury).
will see high/low temp, tachycardia, tachypnea, refractory hypotension.
Oliguria!, unexplained hyperglycemia, thrombocytopenia, and AMS are common.
in pts with native valve infective endocarditis, what can decrease the risk of septic embolic events?
IV antibiotics (tx aimed at the underlying cause) anticoagulation is not needed in this case
what are the main risk factors associated w/ abdominal aortic aneurysm expansion and rupture?
large diameter
rate of expansion
current cigarette smoking**
what is serous otitis media? who does it most commonly occur in?
the presence of a middle ear effusion w/o signs of an active infection - conductive hearing loss is the most common sx
exam typically reveals a dull tympanic membrane that is hypomobile on pneumatic otoscopy
most common middle ear pathology in pts with AIDS
agranulocytosis, or leukopenia (neutropenia) is a rare but major side effect of what 2nd-gen antipsychotic used in tx-resistant schizophrenia?
clozapine
hyperthyroidism with a suppressed TSH and decreased radioiodine uptake (suggesting the release of preformed thyroid hormone). thyroid gland is mildly enlarged, mobile, and nontender.
painless thyroiditis! (silent thyroiditis)
*subacute thyroiditis (granulomatous or De Quervain thyroiditis) has similar presentation, but is associated w/ a painful, tender goiter!
pt with a known cystic teratoma (dermoid cyst) on their ovary presents w/ unilateral pelvic pain and n/v. what do you suspect?
ovarian torsion – dermoid cysts have a higher likelihood of torsion than other types of ovarian masses
sxs arise due to ISCHEMIA and eventually NECROSIS of the ovary
what acid-base disorder do you see with hyperemesis gravidarum?
Metabolic alkalosis
vomiting leads to significant volume depletion and loss of gastric acid
when should you suspect choriocarcinoma? and what lab test should you get?
choriocarcinoma typically presents <6 months after pregnancy
presents sxs = irregular vaginal bleeding, an enlarged uterus, and pelvic pain
most common site of metastasis is the lungs – sxs include CP, hemoptysis, and dyspnea
if you suspect this, get a Quantitative beta-hCG (it will be elevated)
pt presents w/ gradual onset of severe back pain with unilateral radiculopathy, saddle area numbness, hyporeflexia, and marked asymmetric lower extremity weakness. also bowel and bladder dysfunction (late-onset). What is this?
Cauda equina syndrome!! (the lumbosacral nerve roots form this area)
Bell’s palsy (CN7 palsy) presents with sudden onset of unilateral facial paralysis. what are common findings of the affected side when the lesion is below the pons (peripheral facial palsy)?
inability to raise the eyebrow or close the eye (**the forehead is spared if the lesion in the CNS occurs above the facial nucleus)
drooping of the mouth corner
disappearance of the nasolabial fold
(pts may also have decreased tearing, hyperacusis, and/or loss of taste sensation over the anterior 2/3rds of the tongue)
a pt presented in septic shock (hypotensive, tachycardic, decreased O2saturation, unresponsive at home) and developed massive AST and ALT elevations one day later, with modest elevation in T. bili and alk phos. what is this?
Ischemic hepatic injury, or shock liver
if pts survive the underlying cause of their hypotension, liver enzymes usually return to normal w/in 1-2 weeks
what drug do you administer when someone has ingested ethylene glycol?
Fomepizole!
(a competitive inhibitor of alcohol dehydrogenase) (or ethanol) – this prevents further breakdown of ethylene glycol into its toxic metabolites
sodium bicarb may help alleviate the acidosis, and hemodialysis may be required
48 yo with dyspareunia and vaginal irritation, hx of radiation and chemo to cervix. on exam there is thin vulvar skin with shrinkage of clitoral tissue, and the vaginal mucosa appears pale and thin, narrowed introitus, can be petechiae and fissures, loss of labial volume. what is the cause?
Atrophic vaginitis!
or vulvovaginal atrophy from estrogen deficiency due to menopause (or chemo/radiation induced menopause)
in constrast, lichen sclerosus does not affect the vagina – in this vulvar skin appears thin and wrinkled like “cigarette paper” with plaques obliterating the labia majora and minora as well as scarring (sclerosis) of normal external landmarks
spontaneous cerebellar hemorrhage is typically caused by poorly controlled HTN. how does it present?
occipital HA, neck stiffness, n/v, nystagmus, and IPSILATERAL HEMIATAXIA
(usually no hemiparesis or sensory loss)
what physical exam findings are required for the dx of malignant HTN (which is a subset of HTN emergency)?
retinal hemorrhages, exudate, and/or papilledema
these PE findings should be present along with severe HTN (usually > 180/120)
pt presents with episodic flushing, secretory diarrhea, wheezing, and murmur of tricuspid regurgitation. what is this most likely?
Carcinoid syndrome
what cranial nerve is responsible for sensation to the cornea?
Trigeminal nerve (V1 branch)
carries sensory fibers to the scalp, forehead, upper eyelid, conjuctiva, cornea, nose, and frontal sinuses
Infants age < 2 months who have (RSV) bronchiolitis are at high risk of developing what?
apnea, and respiratory failure
what is the target of treatment in CML?
Tyrosine kinase
CML is driven by the abnormal fusion gene BCR-ABL (Due to translocation between chromosomes 9 and 22) – this creates a constitutively active Tyrosine kinase
Imantinib, a tyrosine kinase inhibitor, is the key therapy in tx of CML!
ITP is usually a dx of exclusion. What should pts with presumed ITP be tested, for as thrombocytopenia may be the sole presenting sign of infection?
Hep C and HIV
a pt presents with repeated episodes of tender, erythematous, and palpable cord-like veins on the arm and upper chest. What is this called? what is it related to? what study should you get next?
Migratory superficial thrombophlebitis, classically known as Trousseau’s syndrome
- it is a hypercoagulable disorder that usually presents w/ unexplained superficial venous thrombosis at unusual sites (arm, chest)
- usually diagnosed prior to or at the same time as an occult visceral malignancy (the tumor likely releases mucins that react w/ platelets to form platelet-rich microthrombi)
- CT scan of abdomen is next step to evaluate for an occult tumor
victims of smoke inhalation injury, should worry about what two poisonings?
Cyanide poisoning - tx empirically w/ an antidote, such as hydroxocobalamin or sodium thiosulfate
Carbon monoxide poisoning – check carboxyhemoglobin level (nonsmoker nl <5%, smoker nl <10%)
anterior vs posterior pituitary hormones released?
anterior = FLAT PiG
FSH, LH, ACTH, TSH, Prolactin, GH
posterior = oxytocin and ADH (which are similar to each other anyways so makes since)
if a child is < 2 years old and has their first febrile UTI, what should you do?
RENAL AND BLADDER ULTRASOUND
- to evaluate for any anatomic abnormalities that might predispose the child to UTIs
**typically older children and adults do not need further evaluation of a first-time UTI (lower likelihood of predisposing anatomic issues, lower risk of complications, and lower risk of recurrent UTI)
a pt has ischemic heart failure secondary to an acute anterior wall MI (can’t pump the blood well so it’s backing up to the lungs) causing acute pulmonary edema (“flash pulmonary edema”). what medicine do you give them?
loop diuretic (furosemide)
- rapidly relieves pulmonary edema by decreasing the cardiac preload, thereby decreasing pulmonary capillary pressure
- also causes venodilation, which further decreases the preload
- *be careful in normo- or hypo-volemic pts, bc aggressive diuresis may lead to hypotension and AKI
what should you do next in a male pt that presents w/ migratory pain, n/v, fever, leukocytosis, McBurney point tenderness, and Rovsing sign?
Immediate appendectomy
*Imaging such at CT or US are only needed in pts w/ nonclassic sxs
a 14 yo presents with acute psychosis, and has a recent hx of arthralgia. lab work reveals thrombocytopenia, hematuria, and proteinuria. what lab test should you do next?
ANA – concerning for lupus
- other neuropsych manifestation seen in SLE include seizures, HA, peripheral neuropathy, strokes and chorea; psychosis, depression, mania or anxiety
- sudden onset of psychosis in a child/adolescent is rare, important to r/o medical causes such as SLE, thyroiditis, metabolic or electrolyte disorders, CNS infection, and epilepsy
when doing preconception counseling, what is the most important first test to get when trying to identify couples who are at risk for hemoglobinopathies that might affect their offspring during pregnancy or after birth?
CBC in a female!!
- if no abnormality is found, no further testing
- if anemia and a reduced MCV, further testing is required
how do you differentiate hyperemesis gravidarum from typical n/v of pregnancy?
the presence of ketones on UA!!
- in HG, ketonuria occurs due to prolonged hypoglycemia and resultant ketoacidosis (suggesting more severe dz)
what are the most effective oral forms of emergency contraception?
Levonorgestrel (Plan B) and Ulpristal (typically more difficult to obtain)
Copper IUD is the most effective emergency contraception (but is not oral-duh!)
what is first-line pharmacotherapy for enuresis (urinary incontinence in children >5 yo)?
Desmopressin
what is this?- painful, flaccid bullae, mucosal erosions, and separation of epidermis from dermis by light friction (Nikolsky sign). the roof of the bullous lesions is fragile and rapidly desquamates, leaving raw ulcers.
Pemphigus vulgaris
- autoimmune disorder caused by antibodies directed against desmogleins 1 and 3, components of desmosomes
- immunofluorescence shows netlike intercellular IgG
*in contrast, bullous pemphigoid causes tense bullae (primarily at flexural surfaces, groin, and axilla) and mucosal lesions are rare
is weight gain a side effect of OCPs?
NO!
