Fact associations Flashcards
S/s of 2º Syphilis
- Fever + generalized lymphadenopathy
- Maculopapular rash includes PALMS & SOLES
- Condyloma lata (white/gray flat lesions)
patient has s/s of urethral injury, NBSM?
Retrograde cystourethrogram!
Which statistical test do you use to analyze if there is a difference in outcome between these two groups 1 group with tampons, 1 group without
Chi Square
(Why? use when comparing ≥ 2 groups of categorical data)
What do you test for before giving a patient a TNF-alpha inhibitor (eg infliximab)
TB
If stroke patient is not a candidate for tPA, which drug do you give them instead?
Aspirin
A diabetic patient wants to know if he has progressed to diabetic nephropathy, what test do you do?
check for microalbumin on urinalysis
Young boy has bruising + recurrent infections + eczema
Wiskott Aldrich
Where is the non-healing ulcer located in a patient with venous insuffiency?
Above the medial malleolus
The following s/s within minutes of blood transfusion:
- dark urine
- abdo or flank pain
- Hemolytic anemia
Hemolytic Transfusion Reaction
(Note: MC d/t ABO incompatibility)
Patient with Ulcerative Colitis shows intracellular inclusion bodies on intestinal biopsy
Which infection?
Cytomegalovirus
(Common in severe cases of UC)
Patient either got a cut or ate oysters, now he has sepsis + cellulitis-like s/s
Necrotizing Fasciitis
S/s of necrotizing fasciitis, blood cultures are pending. In addition to IV antibiotics, what is the next best step?
Surgical debridement
MC type of kidney injury in a patient with sepsis/bacteremia
Acute Tubular Necrosis
(d/t ischemic injury)
A Sickle Cell patient is having an acute pain crisis. What is the initial NBSM?
IV fluids + supplemental O2
(next would be opioids)
(Hydroxyurea for multiple eps)
Differentials for a positive Direct Coombs test?
1) Autoimmune hemolytic anemia
2) Alloimmune hemolytic anemia (eg, transfusion reaction, or hemolytic disease of the newborn)
3) Drug-induced hemolysis
Any age pt with painful swollen red knee + fever + limited range of motion + leukocytosis
Septic arthritis
(NBSM would be arthrocentesis which shows > 50k WBC’s)
Treatment of septic arthritis
urgent IV empiric antibiotics –> give combo vancomycin (to cover MRSA) + penicillin or cephalo (to cover less common strains of S.aureus)
Then joint irrigation in the operating room
AV block + facial droop including the forehead
Lyme Disease
Treatment for Lyme
Early stages (bulls eye rash + flu-like) –> treat with Doxycycline (c/i in kids and pregnancy)
Late stages (heart + neuro) –> treat with Ceftriaxone (parenteral)
Management of Peritonsillar abscess
Initial step is Needle aspiration of peritonsilar space.
Then, empiric IV antibiotics
Adolescent throat/neck pain + uvular deviation
Peritonsillar abscess
Management of Acute Gastroenteritis
oral rehydration therapy
(then IV saline if can’t tolerate orally)
After colorectal cancer is identified on endoscopy, what it the NBSM?
CT scan of abdomen
(to evaluate extent of local invasion & distant mets)
Unexplained iron deficiency in a child
Celiac’s
Initial step in management of Diabetic Ketoacidosis
First IV fluids with 0.9% saline (for volume repletion
Quickly followed by IV insulin infusion & the electrolyt repletion
Recent gastric bypass surgery + S/s wernickes encephalopathy
B1 (thiamine) deficinecy
(Note: NBSM would be B1 repletion > EtOH abstinence)
Postpartum fever s/p c-section + severe uterine tenderness
Endometritis
(note: after urinalysis, NBSM –> broad-spect abx
Marfans patients should have which annual screen? (2)
Echo, and eye exam
Pseudogout treatment?
NSAIDs, and colchicine
Holosystolic murmur @ the left 4th intercostal space mid-clavicular line, ratiates to the L-axilla
Mitral regurgitation
Place patient in which position as part of supportive treatment for an air-embolism
left-lateral decubitus and trendelenberg position
Supportive preventative measures for a UTI
1) void immediately after intercourse
2) oral hydration
3) improve feminine hygeine
Proventative measure for a patient with frequent UTI’s?
antibiotics post-coidal, or daily
Evaluation of a breast mass involves
imaging (type depends on age):
Ultrasound (if > 35 yo)
mammmography (if > 35 yo)
If signs of malignancy:
do a breast biopsy
Distinguish between Fibroids and Adenomyosis, in terms of:
uterine features on pelvic exam
irregular shape of uterus –> Fibroids
symmetrically enlarged boggy uterus –> adenomyosis
Patient with nephrolithiasis confirmed on xray + hypeRcalcemia, NBSM?
measure serum PTH
(hypeRparathyroidism causes hypeRcalcemia)
Recurrent kidney stones + bone pain + polyuria + volume depletion + constipation + psychiatric disturbances
HypeRcalcemia
Treatment for post-partum thyroiditis
beta-blocker!!
AIDs patient with white plaques on tongue/buccal mucosa that can be scraped
oral candidiasis
(note: treat with fluconazole)
Treatment for oral candidiasis
Fluconazole
Strongest modifiable and non-modifiable risk factor for stroke
Hypertension (modifiable)
Age (non-modifiable)
(note: for each decade after age 55, stroke risk doubles)
Initial step in diagnostic eval for placenta previa (placenta over cervical os; painless vaginal bleeding in 3rd trimester)
pelvic ultrasound
(note: will require c-section)
Treatment of Kawasaki’s
high-dose aspirin + IVig
(note: this is the only time it’s acceptable to give aspirin to children)
Patient with personal and family history of mucosal bleeding, in the setting of normal platelet count + normal prothrombin time, but decreased factor 8 + increased bleeding time
von Willibrand’s Disease
(is one of the most common causes of hereditary bleeding disorders)
Do asplenic patients require prophylactic antibiotics prior to a dental procedure?
no
S/s of acute limb ischemia (6 P’s) in a hemodynamically unstable patient, BSM?
evaluate iin operating room (intra-operative angiography) for timely diagnosis and treatment
The extrinsic pathway of the clotting cascade includes which factor?
factor 7
(Note: Intrinsic has —> 8, 9 , 11, 12)
CSF glucose measurement in bacterial meningitis
glucose is low ( less than 40)
(Note: glucose is normal in viral)
Treatment for alcohol withdrawal
benzodiazepine
Uvular deviation seen in peritonsillar abscess or retropharyngral abscess?
Peritonsillar abscess
PTSD s/s present for less than1 month
Acute Stress Disorder
Candida diaper rash treatment?
topical nystatin (or azole)
(vs. mupirocin is for bacterial skin rash)
Patient with conotralateral hemiparesis + contralateral sensory deficit of the face & upper extremities
Interal Carotid Artery occlusion
The internal carotid artery supplies ACA & MCA (which vascularize both the 1º motor & sensory cortices)
Which type of lung cancer would you see hypeRcalcemia due to PTHrP
Squamous Cell Carcinoma
vs. paraneoplastic syndrome of Small Cell Lung Cancer –> Lambert Eaton + Cushingss (ectopic ACTH) + SIADH (HypOnatremia)
Chovstek & Trousseau’s sign indicate?
HypOcalcemia
Slowly progressive loss of bilateral peripheral vision
Glaucoma
vs. loss of central vision –> Age-related macular degeneration
Preferred initial imaging in Cholecystitis
Right upper quadrant Ultrasound
All A-fib patients should be on which drug, in order to prevent thromboembolic events like recurrent strokes
Warfarin
stroke prophylaxis in non-AFib pts (TIAs or past stroke) —> anti-platel
Initial step mgmt in a patient with mild acne vulgaris
Topical retinol
note: comedone is the initial lesion of acne vulgaris —> it is a hair follicle that has been blocked by keratin debris. (Retinol Vs. Use of bactericidal soap—good adjunct treatment, but no effect on its own)
Most common primary Lung cancer?
Adenocarcinoma
Presents as a consolidation in the periphery of the lung
This is the most common type in all lung cancer patients together (including smokers, even though it most common in non-smokers)
Cancers that most commonly metastasize to the bone? (5)
Prostate, breast, kidney, lung, thyroid
Initial management of stable supraventricular tachycardia
vagal manuevers + IV adenosine
Note#1: Adenosine —> short-term AV nodal blocker, effective at terminating a majority of SVTs. (Note#2: other AV nodal blocking drugs incl: B-block or CCB would be next, thennn if stilll unresponsive —> Amiodarone
Weak and delayed peripheral pulse seen on physical exam, is called?
Its called Pulsus parvus et tardus
This is a finding in Aortic Stenosis
Treatment of Aortic Stenosis
Valve replacement
This is the criteria but this is most patients –> sympto (syncope, SOB O/E), or evid syst dysfxn (typically considered an EF <50%) . If not then observe I think?
Immigrant patient who had BGC vaccine in the past, has a positive-PPD (or serum IGRA) + a negative chest xray + positive risk factors
This is latent TB
You should initiate treatment with isoniazid now
Any new neck mass in an adult
This is concerning so initial management is biopsy
Note: Can biopsy either by fine-needle aspiration, core biopsy, or excisional/surgical biopsy
A patient with GERD s/s is unresponsibe to the max dose of Proton pump inhibitors
NBS?
Confirm diagnosis of GERD with a 24-hour pH monitor
Note: switching to a different PPI has shown the same efficacy as max dose, so this is wrong ans
Note: 24-hr pH monitor is the gold standard diagnostic tool for GERD –> it may detect increased concentration of acid in the distal esophagus in patients who have not yet shown manifestatinos of Esophagitis
A pregnant lady presents with S/s of acute appendicitis
NBS?
Exploratory Laparotomy
What term describes:
the proportion of positive-test results that are actually true positives
Positive Predictive value
calculated as TP/(TP + FP)
Factor most predictive of patient survival in breast cancer
Tumor stage (ie. lymph node involvement)
67M presents with a small right pupil + right sided ptosis + nystagmus + weakness in the right palate + decreased sensation in the right face & left extremities + incoordination on finger-nose testing on the right
Occlusion of which artery?
Vertebral Artery occlusion
Vertebral A occlusion –> posterior circulation stroke. COmmonly involves brainstem, cerebellum, and occipital lobes.
(In general presents with Horner’s, vestibulocerebellar, contralat hemiparesis & sens loss (body); ipsilat (face)
Newborn with inability to feed (eg, regurgitates) and manage oral secretions (eg, drools constantly, has not peed)
Esophageal Atresia
(often occurs with concommittant TEF)
Confirm dx—> esophagography w/ contrast (insertion of radioopaque NG tube*) —> inability pass NG tube + coiling in prox esoph on CXR conf’s dx.
Management of Hand Foot & Mouth Disease
Observation/support only
Cochlear hair cell loss is the pathophysiology of which kind of hearing loss
Presbycusis (age-related hearing loss),-should do hx & whispered voice test, Conf dx — audiometric test.
Note #1:
Presents with –> Bilateral high-frequence progressive sensorineural hearing loss + social withdrawal
Dx –> audiometric testing
Wrong ans would be reassurance
Note #2:
*Loss of mobility of the ossicles —> otosclerosis (in younger pts w/ conductive hearing loss)
How to diagnose exudative pleural effusions
using Lights Criteria:
Ratio of protein (pleural fluid) : protein (serum) >0.5
Ratio of LDH (pleural fluid) : LDH (serum > 0.6
3M normocytic anemia + abdominal pain with diarrhea + thrombocytopenia + normal PT & PTT + schistocytes & heinz bodies on peripheral smear
Hemolytic Uremic Syndrome
Heinz bodies are pathognomonic for ______
G6PD deficiency
(Heinz bodies are pink spots which are denatured hemoglobin. Don’t confuse with Howell Jolly bodies seen in asplenia —> which is a small basophilic spot in the periphery of the RBC, these are the ones associated with bite cells due to splenic macrophages)
-Bipolar I patient is currently stable on valproate but she wants to get pregnant, which drug should she switch to?
Lamotrigine
(This is another anti-epileptic drug that’s safe in pregnancy)
(Note #2: Valproate & carbamazepine are both contraindicated in pregnant women)
A woman comes in for her initial pre-natal visit. Her last pregnancy was complicated by gestational diabetes. What test should you run now?
Oral Glucose Tolerance Test
(Even though this is typically done between gestational weeks 24-28, you can still do it at initial visit if patient has a history of GDM or had a Pre-pregnancy BMI > 30)
When is azathioprine or infliximab indicated in a Crohns (or UC) patient?
in patients that have failed first line therapy, which is the 5-aminosalicyclic acid family (mesalamine, sulfasalazine)(because these have more side effects)
42M alcoholic with cirrhosis hx, was found unconscious outside a homeless shelter. He has fever 99.9 + moans on abd palpation + icterus + ascites with a positive fluid wave
Spontaneous Bacterial Peritonitis
(Note: this occurs most commonly cirrhosis patients. he also has jaundice).
(Previous question where you had to know that SBP is due to—> translocated enteric flora (like E.coli).
NBS? —> paracentesis of abdominal fluid (dx is confirmed if total WBC > 1k, or Neutrophils > 250). Gram stain not sensitive for SBP.
Tx —> abx with gram neg rod coverage (eg, 3rd gen cephalosporins are 1st line)
Fever + diffuse abdominal pain & tenderness in a patient with ascites
Spontaneous Bacterial Peritonitis!
(Symptoms can include fever, encephalopathy, abdo pain, s/s sepsis)
***Otherwise healthy 42M with a tota cholesterol level of 190, HDL 40, triglyceride level of 150, NBSM?
Repeat panel in 5 years
(Note: the ACP recommends a cholesterol assessed in asymptomatic Males > 35 & asymptomatic Females > 40/45. For patients between age 40-75 with no cardiovascular disease risk factors —> use ASCVD risk calculator to determine the benefit of a statin to lower cholesterol
The ASCVD provides estimate of probability that a patient will experience a stroke or MI in next 10 yrs based on age, smoke, race, BP, cholest. A risk < 5% —> no intervention needed;
vs. risk> 7.5% meets criteria for statin;
vs. risk bw 5-7.5% requires a discussion wit’s the patient about risks/benefits.
-IV drug user with slowly progressive low back pain (dull, achy, present @ rest, worse with activity) + 99.9ºF + exquisite point tenderness on palpation + spasm paravertebral muscles
Vertebral osteomyelitis
Mupirocin
Topical antibiotic cream
Adopted child with unknown past medical history with intellect disability + hearing loss + short stature + VSD + flat nasal bridge
Down Syndrome
(Note: distinguish from fetal alcohol syndrome —> smooth philtrum, thin vermillion border)
After history and physical exam, the initial diagnostic Evaluation of a pt with substernal chest pain + abnormal vitals include
ECG and cardiac biomarkers (to rule out an MI)
Do NOT choose Echo*!!
Alcoholic patient with productive cough + Chest X-ray showing an infiltrate in the right lung with a dense area of consolidation
Aspiration pneumonia
(Note: may present with abscess instead, which is a complication)
How do we treat the 2º HTN in hypeRaldosteronism.
Spironolactone
( which is a K+ sparing diuretic that serves as an aldosterone receptor blocker)
Why are estrogen containing contraceptives contraindicated in women over the age of 35 who smoke?
It increases clotting factors and puts the patient in a pro-thrombotic state
How do you treat a patient for an uncomplicated UTI if they have a sulfa allergy?
Fluoroquinolines
(Note: the standard TMP-SMX, nitrofurantoin, and fosfomycin are sulfa drugs)
(Note#2: this is also how you treat complicated UTIs)
Newborn 1st day of life presents with hypOtension + tachypnea + diffuse cyanosis that fails to improve with 100% O2
ductal-dependent congenital heart disease
(With these you see sx when physiologically the PDA begins to close [within 1st 24 hours of life])
(Note#2: management with PGE2 to keep Ductus arteriosclerosis open which is life-saving)
How to manage a stable patient with placenta previa found on antenatal ultrasound
Continue with Normal antenatal management
Make sure not to do any cervical exams
An agitated patient was given IV haloperidol with lorazepam on admission, then he develops torsades de points. Why?
Haloperidol causes QT prolongation leading to torsades
Causes of Secondary Hypertension
RECENT
R: Renal –> Renal artery stenosis, glomerulonephritis
E: Endocrine –> Cushings, HypeRthyroidism, Conn’s/ primary hypeRaldosteronism
C: Coarctation of the Aorta
E: Estrogen –> OCPs
N: Neurological –> raised ICP, stimulant use
T: Treatments –> glucocorticoids, NSAIDs
How do NSAIDs affect the kidney
They cause vasoconstriction of the afferent arteriole
(Note: vasoconstriction effect is due to blocking the vasodilatory effects of prostaglandins at the afferent arteriole)
(Note#2: vs. ACE inhibitors: which dilate the efferent arteriole and are therefore renal-protective)