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)
Adenosine
Adenosine is a short-term AV nodal blocker
It is effective at terminating most Supraventricular arrhythmias
List the AV nodal blocking drugs (4)
1) Adenosine
2) Nondihydropyridine calcium channel blockers (verapamil & diltiazem)
3) Beta-blockers
4) Amiodarone
(Note: these treat a large majority of SVTs)
The tremor in drug-induced parkinsonism
may be symmetric or asymmetric
Structural brain abnormality in Schizophrenia
Enlarged lateral ventricles
(and small amygdala –not large)
Bradykinesia + rigidity + tremor after starting an anti-psychotic
Drug-induced parkinsonism
Difference in neck veins in hypovolemic shock vs cardiogenic shock
Hypovolemic –> would have flat neck veins
Cardiogenic –> would have distended neck vains (JVD)
Boy with weight loss + profuse, oily nonbloody diarrhea after a recent lake vacation
Giardia
can last up until 1 month
2 types thyroiditis with low radioactive iodine uptake
1) Painless (silent) thyroiditis –>
2) Subacute (deQuervains) thyroiditis –> w/ mild hyperthyroid
Painless (silent) thyroiditis —> has brief hypeRthyroid phase with subsequent hypOthyroid. V. similar to post-partum thyroiditis. Both are variants of hashimotos (lymphocytic) thyroiditis, and both have TPO (thyroid peroxidase) Ab’s
deQuervains –> is usually after viral infection. Has prominent feaver and elevated ESR
Tx of Acute Bacterial Prostatitis
TMP-SMX or fluoroquinolone
54M with fever + malaise + back pain + marked anterior tenderness on digital rectal exam
Acute Bacterial Prostatitis
Pts arre acutely ill and have ≥1 of the following:
1) Flu-like sxs (myalgias-incl back pain)
2) UTI sxs
3) Acute urinary retention (d/t prostatic swelling –> compresses urethra)
Right ventricular MI
see ST elevation in lead V4R + ischemic changes in leads II, III, aVF (ie, inferior leads)
the only 3 drugs that decrease mortality in MI
1) Aspirin
2) B-blockers
3) ACE inhibitors
How do nitrates work in MI to decrease chest pain
it’s a venodilator –> decreases preload –> decreases stress on the myocardium
It also dilates the coronary arteries- but this is NOT the effect that reduces chest pain
How to diagnose Latent TB
With a positive response to TB antigens (either positive-PPD, or IGRA)
You suspect a patient has TB, Following a positive PPD test, what is the NBS?
First order a chest X-ray (in order to differentiate between active and latent TB)
What is the next step in management for an HIV patient who has an 8-mm induration at 48 hours following PPD testing and a normal chest X-ray?
{{c1::9 months of Isoniazid and pyridoxine (B6)}}
Give isoniazid (with B6) for 9 months (for latent TB)
59M Fever + dysuria + leukocytosis + tender swollen prostate
Acute Bacterial Prostatitis
(Note: most cases d/t E.coli, Proteus)
Management of Acute Bacterial Prostatitis
FQ or TMP-SMX.
(Note: Patients also often require a suprapubic cather to drain urine due to urinary retention 2/2 swollen prostate)
Treatment of an acute-asthma exacerbation in the ER
includes albuterol (inhales SABA) + systemic glucocorticoid (eg, prednisone)
What size does a skin lesion have to be in order for it to be suspicious of melanoma
6 or more millimeters
(Note: ABCDE criteria to decide if a lesion is suspicious for melanoma [ if lesion has ≥1-2 it is suspicious. ABCDE = Asymmetry, color varies [within the same lesion, or compared to other lesions the patient has—this is also called the “ugly ducking” sign”], diameter ≥ 6mm, evolving appearance over time)
How long must a patient cease from smoking before a scheduled surgery, or order for it to have preventative post-op benefits
At leastt 4-8 weeks prior to surgery
New onset vaginal spotting + right-sides adnexal tenderness + positive pregnancy test
Ectopic pregnancy.
(Note: NBS —> TVUS (for better visualization of pelvic strictures vs. trans abd U/S)
A patient presents with signs of ectopic pregnancy on physical exam. NBSM?
Transvaginal ultrasound to try and visualize the sac
how long must a patient have sx to be diagnosed w/ Delusional Disorder
1 month or more
Diagnostic criteria for delusional disorder
1 or more delusions, for a duration of 1 or more months
Pregnant lady with dark irregularly shapped macules bilaterally on the cheeks and nasal bridge, spares nasolabial folds
Melasma
(esp common in preg women, dark macules on sun-exposed areas)
Does the malar rash in SLE spare the nasolabial folds?
YES
and the rash is erythematous (vs. Meslasma– darkened macules in malar distribution- also spares nasolabial folds)
Treatment for ischemic stroke in sickle cell disease
Exchange transfusion
NOT anti-platelets (which is given for many non-sickle cell ischemic stroke patients)
What is the etiology of a patient with signs of acute pancreatitis with elevated AST, ALT, and ALP?
Gallstone pancreatitis
(Note: ALT will be > 150 specifically)
Interventions that improve continuity of care (pt transit bw different facilities)
Interventions that target _______? (2)
- Interventions that target pharmacy personnel
- Interventions that target high risk patients
These are most effective ways to improve quality of patient care
If a confidence interval does NOT include 1, it is statistically _________
(significant/nonsignificant)
Significant
A patient reads in a magazine that Drug Z reduces the risk of new fractures in patience with osteoporosis bu 60%
Which calculation was most likely presentated as the 60% reduction in fractures?
Relative risk reduction
Prophylaxis for pregnant women so test positive for group B strep
Intrapartum Penicillin
(note#1: administration of penicillin prior to labor is not beneficial)
(Note#2: women with a history of GBS bacteriuria/UTI during current pregnancy or history of an infant with early-onset GBS disease should receive prophylaxis without testing)
28F with breast mass. Ultrasound shows solid mass, NBSM?
Biopsy!
(Note: simple cyst benign vs complex cyst/solid mass)
Most common childhood cancer
ALL
DOC for mycoplasma (Atypical) Pneumonia
Azithromycin
S3 heart sound
Indicates?
Associated condition?
Indicates volume overload, systolic dysfunction
Seen in CHF and dilated cardiomyopathy
How do the calcifications differ between congenital CMV and congenital Toxoplasmosis
Toxo —> intracranial calcifications
CMV —> peri-ventricular calcifications
Which pediatric condition is essentially avascular necrosis of the femoral head?
Legg-calves-perthes disease
A wide-complex tachyarrhythmia originates from _____
Ventricles
(Note: vs narrow complex from atria)
Bite cells & heinz bodies are specific to
G6PD deficiency
-A continence pessary is used to treat only which type of incontinence
Stress Incontinence
Failure for newborn to pass meconium in first 48 hours of life is usually due to which two conditions?
Hirschsprungs (commonly associated with Down’s syndrome)
Or
Meconium ileus (commonly associalted with cystic fibrosis)
A diagnosis of schizo affective disorder requires?
A history of ≥ 2 weeks of psychotic sxs in the absence of a mood episode (depressive, or manic)
6F develops axillary hair, pubic hair, and breast buds + past history of 2 long-bone fractures + 2 hyper-pigmented macules with irregular contours
McCune Albright
Presents with recurr F’x (d/t fibrous dysplasia) + irreg cafe-au-lait macules (‘coast of maine’) + precocious puberty (periph/GnRH-indep).
(Note#2: vs. NF1 —> the # of cafe-au lait spots normally ≥ 6 w/ reg borders & assoc *axillary freckling)
The strongest single risk factor predictive of suicide
Prior suicide attempt
Treatment for Body Dysmorphic Disorder
SSRI &/or CBT
(not reassurance annd follow up)
≥10-mm induration on a PPD is positive for which patients? (6)
1) recent immigrants in last 5 years
2) IVDU
3) Residents/employees of high risk settings (prison, nursing home, hospital, homeless shelter)
4) Immunocompromised (ESRD, leukemia, DM, chronic malabsorption, low body weight).
5) Children < 5-yo, or those exposed to adults in high-risk categories
6) Mycobacterium lab personnel
(Note: a PPD induration of ≥ 15 is positive in healthy pts)
Mgmt for neg PPD
no further management or workup
When low-risk patient’s PPD shows pos induration, NBS?
usually repeat PPD or get IGRA to exclude false-positive results
(Note: repeat testing not recommended for high-risk/high liklihood of TB)
≥5-mm induration on a PPD is positive for which patients? (4)
1) HIV
2) Recent contact with known TB patient
3) Pts with nnodular or cystic changes on CXR consistant with previously healed TB
4) Organ transplant and other immunocompromised
Symptomatic patient that is hemodynamically stable
NBS?
order abdo CT (conf dx)
vs. HDUS patients –> get emergent surgical repair with confirmation obtained via bedside U/S, if necessary.
unilateral irregular soft scrotal mass that increases in size with valsalva, and decreases when supine
Varicocele
d/t dilation of the pampiniform plexus. More common on L-side, typically present in adolescent males, irregular = bag of worms. (vs. Inguinal hernias –> very similar but are reducible on physical exam, and doesn’t have the irregular/”bag of worms” texture of varicoceles)
Treatment for Dressles/ Post-cardiac injury syndrome
high-dose aspirin
Treatment of exercise-induced bronchoconstriction
inhaled corticosteroid and beta-agonist (eg, budesonide and albuterol)
Patient developed tachycardia + dyspnea + generalized muscle rigidity + dark urine, soon after general anesthesia
Malignant hyperthermia
Most cases present just after administering anesthesia, but can occur soon after anestheia cessation (20 min after operation)
44M with erectile dysfunction & loss of sexual desire. Mild hepatomegaly (w/o splenomegaly) + tender swelling of MCP joints.
Hereditary Hemochromatosis
(Note: the decreased sexual desire & erectile dysfunction is from the hypOgonadism)
(Note#2: arthropathy is d/t pseudogout)
45M with nausea & vomiting + constant epigastric pain that is partially relieved by leaning forward + HypOcalcemia
Acute Pancreatitis
(Note: NBSM would. befluid resus)
Pregnant lady with new-onset hypertension @ ≥ 20 weeks gestation with eithere severe-range blood pressure (ie, systolic ≥ 160 or diastolic ≥ 110) or, signs. ofsevere end-organ damage (eg, elevated creatinine)
Pre-eclampsia with severe features
(Note#2: Pre-eclampsia w/o severe features would be blood pressure <160/110 and NO signs of end-organ damage. Delivery is indicated @ term aka ≥ 37 weeks)
Woman is @ 35 weeks gestation with pre-eclampsia with severe features. NBSM?
Immediate delivery
(Note: Pre-eclampsia with severe features always gets immed delivery if ≥ 34 weeks gestation)
58M with Erectile dysfunction with no AM erections but normal nexual desire in a patient with cardiovascular disease.
Mechanism of the erectile dysfunction?
decreased pelvic blood flow
58M with a 40-pack-year smoking history + proximal muscle weakness + absent deep tendon reflexes
should raise suspicion for?
Lung cancer (SCLC) causing Lambert-Eaton myasthenic syndrome (LEMS)
(Note: NBS would. be CT chest to eval fora lung mass)
Pregnant women are universally screen for Group B strept when?
at 36-38 weeks gestation
(note: if they test pos or have unknown GBS status (+ RF of deliv/PROM @ < 37-wk), they are given intra-partum antibiotic prophylaxis w/ Penicillin)
Condylomata acuminata
Anogenital warts associated with HPV
- See skin-colored papules or verrucous lesions (NOT a solitary ulcer)
Lymphogranuloma venereum
caused by Chalmydia
anogenital ulcer (primary stage)
Lymphadenitis (secondary)
Ventricular Tachycardia
(regular wide-complex tachy)
Indication for an AIDs patient to get prophylaxis for Toxoplasmosis?
CD4+ <100
Indication for an AIDs patient to get prophylaxis for Pneumocystis jiroveci
CD4+ < 200
Differences in pharmacotherapy for prophylaxis of Toxoplasmosis vs. treatment of Toxoplasmosis
Prophylaxis –> TMP-SMX
Treatment –> Pyrimethamine-Sulfadiazine
Cancer patient presenting with myoclonus + hypeRreflexia
Serotonin syndrome (2/2 Tramadol)
Name everything you can about Strept Agalactiae (group B strept) in pregnancy
Include:
-when to screen mom
-management
-prophylaxis indication
-prophylactic drug
1) typically asympto in pregnant women
2) can be vertically transmitted from mom to baby during vaginal delivery, or after ROM, causing early-onset neonatal GBS (eg, sepsis, Pneumonia). 3) To prevent vertical transmission, women are screened @ 36-38 wks gestation
4) management if positive test —> requires intrapartum prophylaxis (w/ IV Penicillin)! (not c-sect).
4) management If GBS status is unknown (eg, no prenatal care) depends on how many weeks gestation mom is. if ≥37 wks —> no prophylaxis is required.
5) Women w/ the following risk factors do req prophylaxis —> ROM for ≥ 18-hr, intrapartum fever, fetal prematurity (< 37 wks)
What does an HIV patients CD4+ count have to be to warrant prophylaxis for pneumocystis pneumonia?
And which drug to give?
if CD4+ < 200
give TMP-SMX
(Note: don’t confuse with prophylaxis for toxoplasmosis, which requires CD4+ of < 100, also with TMP-SMX)
Nifedipine & Terbutaline are ______ used to ______ in patients with ________
Tocolytics
Delay delivery
Premature labor
18F @ 35 weeks gestation with PROM and unknown GBS status.
NBSM?
(Note: unknown GBS status because test is done @ 36-38 weeks, and this patient is 35 weeks)
Penicillin now (as intra-partum prophylaxis)
Indications for intra-partum prophylaxis for group B strept?
if mom has unknown GBS status (i.e. all women < 36 weeks-because not tested yet, or no prenatal care)
AND
1 of the following 3:
1) <37 weeks gest OR,
2) intrapartum fever OR,
3) ROM for ≥ 18-hr
Or
Pos GBS screen at 36-38 weeks
≥1 painFul genital ulcers w/ lymphadenitis
Chancroid (haemophilus ducreyi)
(Note: Lymphadenitis, NOT painLess LAD)
(Note#2: this is extremely rare in developed countries)
“Rusty sputum” is classic for
pneumococcal pneumonia
Pneumocystis Pneumonia is seen in HIV pts w a CD4+ count of?
< 200
(Note: CXR will show B/L diffuse interstitial infiltrates)
Pneumococcal vaccine and HIV patients
Recommended for all HIV pts to decrease the risk of S.pneumo
MCC of CAP in HIV pts
Strept pneumo
When could CVID present?
typically does NOT present until after adolescence
An unexplained rise in Creatinine (> 30%) after starting an ACE inhibitor (or ARB), is a clue for?
Renovascular disease
Schistocytes
Form due to mechanical RBC shearing within the vascular system
Seen in MAHA (eg, HUS, DIC, TTP) and mechanical valve shearing.
Schistocytes
(Note: seen in MAHA —> TTP/HUS or DIC. Also mechanical heart valves)
Schistocytes
(Note: seen in MAHA —> TTP/HUS or DIC. Also mechanical heart valves)
How long after surgery would a PE present (as a Post-op complication)?
Over 24 hours (due to immobility)
Contraindications for IUD placement (both copper & progestin)
unexplained, abnormal vaginal bleeding
(eg, an irregular menstrual bleed pattern)
bc IUD can mask symptoms and delay diagnosis
Hydrops Fetalis 3 main etiologies
Thalassemia (HbBarts)
parvo B19
Rh alloimmunization
Tx for Urge Incontinence
First — lifestyle modifications
Second— try bladder training
If still unresponsive, then try anti-muscarinics like Oxybutynin.
(Note: vs. M-agonist —> Overflow like Bethanechol)
A Shallow 2-mm sacral dimple in NB
Normal
Norma liver span
6-12 cm
-#1 cancer causing liver mets
Colon cancer
Most feared complication in any knee dislocation
Injury to popliteal artery
(bc resulting lower leg ischemia can cause irreversible damage, requiring an above-the-knee amputation)
(Note: for mgmt, after IMMED reduction of dislocated knee, do meticulous vascular exam (incl palpate popliteal & distal pulses,** ABI**, duplex U/S-if avail)
Management after finding any type of knee dislocation on xray
1) 1st do an IMMED reduction of dislocated knee
2) Afterwards, do a meticulous vascular exam (including palpate popliteal & distal pulses,** ABI**, and duplex U/S-if avail)
(Note: because examining pulses alone provides minimal accuracy, doing an ABI is CRITICAL)
A combo of normal pulses + ABI ≥ 0.9 –> virtually excludes vascular injury.
If there are any signs of vascular injury (ie. diminished pulse, ABI ≤ 0.9) –> warrants emergency IMG w/ CT angio + vascular consult.
Pregnant patients with breech presentation who do not want to undergo scheduled C-ssection, can instead be offered which procedure?
External cephalic version (ECV)
(Note: placenta previa and prior classical C-section [ie, vertical scar] are contraindication for ECV & vag delivery. So in pt’s w/ breech + c/i to vag delivery –> require a scheduled C-section, @ 37wks)
Osteomyelitis in a patient with a deep diabetic foot ulcer.
infection is:
Polymicrobial or monomicrobial?
Spread is:
Contiguous or hematogenous?
Polymicrobial infections
and
Contiguous spread (from the overlying ulcer)
(Note: pt would req wound debridement, eval of his arterial insuff, and empiric IV abx {eg, piper/tazo)
(Note#2: superficial diabetic foot infections may be monomicrobial, but deeper infections are almost always polymicrobial)
Signs of a deep (vs. superficial) diabetic foot infection
size ≥ 2 cm
chronic (present 1-2 weeks)
presence of osteomyelitis
In adults, osteomyelitis is usually a result of which type of spread?
vs. in children?
Adults –> contiguous spread (80%)
(Note: this is almost always the case in underlying osteomyelitis with an overlying wound)
Child –> hematogenous
9M with anemia with high reticulocyte count (eg, 8%) + previous admissions for diffuse abdominal pain, and hematuria
Sickle Cell
The common vaccinations of childhood that use live-attenuated viruses
measles
mumps
rubella
chicken pox
The common vaccinations of childhood that are bacterial toxoiod vacciness include..
tetanus and diphtheria
pt with ESRD has tingling, numbness, and burning of both hands, that worsen during hemodialysis
carpal tunnel syndrome (CTS)
(note: CTS is the MC mono-neuropathy in patients on hemodialysis, with up to 33% reporting sxs. Also sxs usually more severe in the arm with vascular access)
(Note#2: don’t confuse with uremic polyneuropathy- which is also common. in ESRD but causes progressive pain + paresthesia in the FEET, not the hands. And bc it is due to uremia, ths sx typically resulve with diaphysis is initiated!))
Common causes of Gastric Outlet Obstruction (5)
1) Malignancy
2) Peptic Ulcer Disease
3) Crohns
4) Pyloric stricture (w/ pyloric stenosis). (Note: this is secondary to ingestion of caustic agent (eg, ingest acid during suicide attempt leads to fibrosis)
5) Gastric Bezoars
Triggers for vasovagal syncope (8)
1) Pain
2) Emotional stress & anxiety
3) Heat
4) Prolonged standing
5) Coughing
6) Micturition
7) Defecation, eating
8) Hair combing
Symptoms of vasovagal prodrome (5)
1) warmth
2) Pallor
3) Nausea
4) Diaphoresis
5) Dizziness
25M with 3-months of progressive dyspnea on exertion and non-productive cough + Calcium level 11.4
Pulmonary Sarcoidosis
(Note: Ppys includes granuloma-induced scarring & fibrosis of the lung causes restrictive pattern)
(Note#2: HypeRcalcemia in sarcoid. is due to vitamin D conversion by lung macrophages)
(Note#3: lung exam is often normal. And up to 70% have abnormal PFTs)
Usually symptoms of post-concussive syndrome resolve within a few weeks to months following TBI; however, some patients can have persistant symptoms lasting up to …..
up to 6-months
Arrest of active phase of labor
No cervical change in 4-hrs despite adequate contractions
OR
No cervical change in ≥ 6-hrs if inadequate contractions
(Note: Active phase of labor is 6-10 cm cervical dilation. It has an expected predictable rate of cervical dilation of ≥1 cm every 2-hrs.
Management of active phase arrest of labor
C-section
Shingles treatment
anti-viral drugs (like acyclovir, famiciclovir, valacyclovir). This decreases the duration of symptoms and the incidence of post-herpetic neuralgia
MRI in toxoplasmosis typically reveals
multiple bilateral ring-enhancing lesions
Treatment of legionella
usually a resp fluoroquinolone (eg, levofloxacin), or newer macrolides (eg, azithromycin).
FQs preferred (excellent coverage many CAP bugs like S.pneumo, mycoplasma pneumo)
Mgmt for symptomatic aortic stenosis
(eg, exertional dyspnea, angina, presyncope/syncope)
Valve replacement
Relative Risks & Odds Ratio’s values >1 indicate …
increased risk/higher odds of development (positive association)
Relative Risks & Odds Ratio’s values < 1 indicate …
Decreased risk/lower odds of development (negative association)
Confidence intervals containing the null value
(= 1 in the case of relative risk & odds ratio’s)
indicates…
result is NOT statistically significant
Absent cremasteric reflex + elevated testicle
Testicular torsion
Lung ccanccer that causes SIADH
SCLC
Drugs that can cause SIADH (3)
Carbamazepine
SSRI’s
NSAIDS
Labs in SIADH, incl:
Serum osmolality
Urine osmolality
Urine sodium
Serum osmolality –> low/ hypOtonic (< 275 mOsm)
Urine osmolality –> high (> 100 mOsm)
Urine sodium –> high (>40 mEq/L)
low serum osmolality + low urine osmolality
primary polydipsia
(Note: kidneys able to excrete dilute urine, but get overwhelmed by excess free water intake –> result in hypOtonic hypOnatremia)
Low serum osmolality + low urine sodium
can occur in patients with hypOnatremia due to hypOvolemia
(bc kidneys attempt to retain sodium in effort in increase blood vol. Urine is concentrated causing increased urine osmolality. Will also see evidence of dehydration)
heavy menses + uterine enlargement w/ a ttender, globular (ie, uniformly shaped) uterus
Adenomyosis
(Note: dont confuse with fibroids–which has irregularly shaped uterus)
A platelet level of ____ indicative of a need for platelet transfusion
< 50,000
Treatment for panic disorder
SSRI/SNRI (or CBT)
(Note: can give benzo’s for acute distress short-term relief, but c/i if hx substance abuse)
Late decelerations
Acid base disturbance in diarrhea
Metabolic acidosis (non-anion gap)
Chi square
Analyzing TWO groups of categorical values!
WBC level 15k-30k on arthrocentesis
Inflammatory arthropathy
Rhomboid crystals on arthrocentesis
Calcium pyrophosphate (CPPD) crystals in pseudogout
Treatment of Torsades in a stable patient
Magnesium
(Note: Cardioversion if unstable)
Location of thyroglossal duct cyst vs branchial cleft cyst
Thyroglossal duct cyst—- is midline neck mass
Branchial cyst— is lateral neck mass, anterior to SCM
Staghorn calculus in patient with recurrent UTIs
Struvite (Ammonium Magnesium Phosphate) stones. Commonly due to urease producing organisms like serratia.
Are SSRIs a first line treatment for bulimia?
Yes
Drooling kid with uvular deviation
Peritonsillar abscess
Von Hippel Lindau
retinal & cerebellar hemangioblastomas (can present as retinal detachment and blindness)
And assoc pheochromocytomas (can present as hypertension)
Acid base disturbance in hyperaldosteronism
Metabolic alkalosis (can present as high bicarbonate)
Conns syndrome
Primary hyperaldosteronism
Patient has HIT, NBS?
1st: STOP heparin
Then: switch to a non-Heparin Anticoagulant (1st line is Agatroban)
Note: Fondiparinux is also an option)
(-from DirtyUSMLE)
Location of venous stasis ulcers
Above medial malleolus or, pre-tibial area
(Note: usually occur with brawny skin discoloration & stasis dermatitis)
Lymphocytic pleocytosis on CSF indicated
viral or fungal etiology
14 month old boy with recurrent, nonpurulent infections, and marked neutrophilia
Leukocyte Adhesion Deficiency (LAD)
(Note: due to reduced CD18 antigen on neutrophil surface, which prevents neutrophil migration to site of infection)
relative risk
risk in exposed
divided by
risk in un-exposed
Interval of post-partum period
First 6-8 weeks after delivery
