✅FACTIONLESS Flashcards
(⬜ dx?) is typically caused by ⬜
Pts with risk factors should undergo ⬜ and make Modifications to their ⬜-2 to prevent recurrence
Lung Abscess; [aspiration of anaerobic bacteria]
________________
[speech/swallow evaluation] ;
Diet (thickened liquids) and/or Positioning (chin tuck)
Describe the Chest CT
What’s the dx?
Lung [AIR FLUID LEVEL] amid pulmonary consolidation = LUNG ABSCESS
these pts also have sour tasting sputum
In addition to skin, Patients with Rosacea may also experience ⬜ symptoms
Ocular
________________
burning/foreign body sensation/blepharitis/keratitis/conjunctivitis/recurrent chalazion
[Actinic solar Keratosis] is a precursor to ⬜ and should be biopsied if concerning
________________
Tx -4
SQC
________________
isolated AK = [liquid nitrogen cryotherapy]
diffuse AK = [topical 5-fluorouracil] vs imiquimod vs tirbanibulin
Actinic solar Keratosis cp
chronic scaly papules or scaly plaques with sandpaper texture in sun damaged areas
Tx for Rosacea -5
- Avoid Triggers (hot/spicy foods/EtOH/cold/stress)
________________
[Erythema + Telangiectasia] only
- 2.* Topical Brimonidine
- ________________*
- papules or pustules*
3. Topical Metronidazole
4. Azelaic acid
5. oral abx (severe / refractory)
- papules or pustules*
What’s the tx for Severely depressed patients who require URGENT treatment
Electroconvulsive Therapy
When should [Actinic Solar Keratosis] be biopsied? -5
≥ 1 cm
rapid growth
ulcerated
TTP
initial tx failure
________________
1-20% transforms to SQC
Electroconvulsive Therapy indications -6
- unipolar depression (with psychosis or suicidality)
- bipolar depression (with psychosis or suicidality)
- bipolar mania
- depression requiring rapid treatment
- depression during pregnancy when rx contraindicated
- catatonia
________________
ECT is safe for pregnancy!
Buproprion MOA
NorEpinephrine \ Dopamine reuptake inhibitor
⬜ side effects are common when 1st starting an SSRI, but should improve over a recommended drug trial of ⬜
________________
what should u do if side effects are intolerable or inadequate response?
GI ; 6 weeks
________________
change antidepressant
infant pt presenting with undescended testis = ⬜
________________
At what age should this infant be referred for Orchiopexy?
________________
When should Orchiopexy occur?
Cryptorchidism
________________
≥ 6 months old
________________
Orchiopexy before 1 yo
What kind of study should be used to investigate an
acute infectious disease OUTBREAK?
Case-Control Study
________________
allows quick localization of outbreak source
What is [Root Cause Analysis] ?
QA tool that identifies and addresses factors leading up to an adverse medical event
1st line tx for Heat Stroke is ⬜, which should be used to ⬇︎core body temperature by ⬜C/min .
Describe it
________________
List 3 adjunct Heat Stroke therapies
[augmentation of EVAPORATIVE COOLING] ; [0.2C/min]
(naked pt is sprayed with tepid (warm) water mist or pt is covered in wet sheet – while large fans circulate air ➜ ⇪ evaporative heat loss)
________________
ice water lavage / ice packs / cold IVF
[mild/mod Aortic Stenosis] differs in cp than [SEVERE Aortic Stenosis]
________________
How does [SEVERE Aortic Stenosis] affect heart sounds? -2
- [1 soft single second heart sound]
- [LATE peaking systolic murmur] (early = mid/mod Aortic Stenosis)
________________
(normally, inspiration ⇪ blood into right heart ➜ pulmonic valve closes after aortic valve – but in SEVERE Aortic Stenosis, the stenotic Aortic valve will have delayed closure also ➜ single second heart sound)
When are IV medications preferred over oral? (4)
- Hemodynamic INstability
- PO INtolerance
- PO meds failed
- < 2 yo
Reconstruction of cleft lip is generally performed at (⬜age)
10 weeks old
________________
(in accordance with rule of 10s = 10 lbs|10 weeks old|10 g hgb)
Breastfeeding contraindications -7
- active TB
- HIV (unless in poor country)
- Herpes breast lesion
- Active varicella
- Chemoradiation
- Active Substance Use Disorder (but methadone regimen for tx is OK)
- Galactosemia
At what HIV viral load count is Vaginal Delivery safe?
Vaginal Delivery ≤ 1000 HIV copies
________________
> 1000 copies = C Section
How do you manage HIV in a newly pregnant patient?
________________
How is the newborn managed once it’s born?
MOM = [TRIPLE ANTIRETROVIRAL THERAPY] THROUGHOUT PREGNANCY
________________
newborn = Zidovudine ≥ 6 wks
________________
viral load/CD4 count labs q 3 months
Tx for [Scleroderma renal crisis] -2
Captopril = HTN
+
Nitroprusside IV = (if CNS or papilledema)
________________
etx: abnormal deposition of collagen in multiple organ systems
4 clinical features of [Scleroderma renal crisis]
[HTN (Captopril tx)]
renal failure
Raynaud phenomenon (scleroderma)
GERD (scleroderma)
________________
etx: abnormal deposition of collagen in multiple organ systems
6 major causes of Syncope
MVC BSD
- ⬇︎ Cardiac Output (Valvular Dz/HOCM/Pulm HTN/PE/Tamponade/myxoma/aFib)
- Bradyarrhythmia (SA Node dysfunction/AV Block)
- [VANS - Vasovagal Autonomic Neurocardiogenic Syncope]
- Dehydration
- Stroke
- Metabolic (⬇︎Glucose vs ⬇︎Na+)
OBTAIN ECHOS ON ANY PT WITH SUSPICIOUS SYNCOPE!
clinical presentation for Disseminated Histoplasmosis - 4
“Histoplasma spreads to PBS L”
- Pulmonary
- [Blood (pancytopenia 2/2 marrow infiltration)]
3 [Skin (Mucocutaneous papules/nodules)]
- [Lymphatic RES involvement]
________________
- RES = ReticuloEndothelial System (Lymph node/Spleen/Liver)*
- Dx = serum or urine Histoplasma antigen immunoassay*
Acute Leukemia will present with signs of _____
Which acute leukemia is associated with Auer rods (eosinophilic inclusions)?
PANcytopenia ; promyelocytic M3 (chromo 1517)
Dx = smear showing blast –> flow cytometry for confirmation
what is the major potential adverse effect of Ginkgo?
INC bleeding
(especially if combined with ASA/antiplatelet drugs)
Licorice is commonly found in ⬜
________________
how does iv z dlldfx affect BP?
herbal teas;
A pt has a single episode of major depression but responds well to antidepressant SSRI tx
What do you do when he ask to stop the SSRI since he’s now feeling “great”?
At Remission, Cont Antidepressant rx for an additional 4-9 months then d/c
________________
- This is called continuation phase tx*
- Pt with multiple episodes of MDD should cont SSRI for additional 1-3 years after reaching remission and indefinitely if their depression is SEVERE*
[LEMS - Lambert Eaton Myasthenic Syndrome] Clinical Presentation - 3
- Weakness of [Proximal limbs and trunk] mimicking myopathy, better with exercise
- Autonomic sx (Dry mouth /Orthostasis / Impotence)
- ⬇︎Deep Tendon Reflexes
A: Potters Sequence etx
B: Clinical Presentation - 6
A: [Fetal Renal Agenesis bilaterally / Dysfunction] –> Oligohydraminos (No Amniotic Fluid)
B: POTTER
Pulm hypOplasia
Oligohydraminos
Twisted Face
Twisted and shortened Limbs
Ears set low
Renal agenesis = cause
management of Acute Mastoiditis -2
[middle ear drainage (via mastoidectomy or {tympanostomy +/- ear tube placement})]
+
IV Abx
Between [Prerenal failure] and [Acute Tubular Necrosis -Intrinsic renal failure]
which responds to aggressive IVF?
[Prerenal failure]
Acute Tubular Necrosis (a type of ⬜ renal failure) is caused by what 3 things?
intrinsic
________________
ATN comes from SIN
Sepsis
Ischemia
Nephrotoxic meds
Patient s/p severe hypOtension subsequently develops oliguria
Dx?
________________
Management? -4
Acute Tubular Necrosis
- look for muddy brown cast & FENa>2%*
- ________________*
1. Maintain Euvolemia
2. Maintain Electrolytes
3. Maintain Nephrotoxin avoidance (ACE inhibitors/ARBS/NSAIDs)
4. Hemodialysis if AEIOU (ph<7.1/hyperK/intoxication/overload-Fluid/uremia)
Adolescents have ⇪ risk for peripartum complications
What are the fetal complications?
________________
etx?
- PRETERM DELIVERY
- low birth wt
- perinatal Mortality
- [Maternal anemia]
- [Maternal Preeclampsia]
________________
Inadequate nutrition and physiologic immaturity
After receiving anesthesia, pt develops hypOtension, elevated peak pressures and DEC end tidal CO2. This is concerning for ⬜
how should you work this up? Tx?
ddx: Anaphylaxis (to rocuronium/abx/skin antisepsis products/blood);
dx: PHYSICAL EXAM (look for cutaneous rash/flushing!)
tx: Epinephrine
All women planning pregnancy should take
[⬜ mg (or ⬜ mg if HIGH RISK) of ⬜ for ⬜] prior to conception to ⬇︎risk of Neural Tube Defects
________________
[0.4 (or 4 IF HIGH RISK) mg daily] of folic acid B9 ; ≥1 month
________________
high risk = antiepileptics / prior NTD pregnancy
Anaphylaxis is difficult to diagnose in peds
describe the criteria
________________
Tx for peds Anaphylaxis
after allergen exposure, pt has acute allergic sx in ≥2 systems
- [Skin/Neurologic/Respiratory/CV/GI]*
- ________________*
[Epinephrine 0.1 mg/kg IM]
Anemia of Chronic Disease
MOD
normocytic normochromic anemia that occurs in patients with chronic medical conditions
Describe the Approach to a patient who’s resistant to disclosing genetic test results with relatives also at risk? -2
[acknowledge their resistance] + [open ended questioning/motivational interviewing]
________________
“You have reasons for not wanting to contact your brother; what are some possible benefits of sharing the results?”
at what hgb should you consider blood transfusion?
hgb < 7
Metformin can dangerously cause ⬜
Name Metformin contraindications? -5
________________
how is iodine contrast related to Metformin?
lactic acidosis ;
- renal failure
- liver dysfxn
- EtOH abuse
- sepsis
- CHF (especially if GFR < 30)
________________
[large dose IV iodine contrast] ⇪ lactic acidosis risk … so Metformin IS HELD ON DAY contrast is given ➜ Metformin restarted 2 days later
________________
common SE = GI upset and VB12 malabsorption
BPPV (Benign Paroxysmal Positional Vertigo) etx and CP-3
Ca+ otoliths accumulated within semicircular canals –> Dizzines, Nystagmus and Nausea only
By 18 years old, a fully immunized patient should have ⬜ total [TETANUS toxoid vaccines] .
Name the vaccines and what age they’re given
5
________________
[DTaP = (2 / 4 / 6 / 15 ) months old]
+
[TDaP at 11 years old]
Causes of Papillary Necrosis - 5
________________
MOD
NSAID
- NSAIDs
- Sickle Cell
- Analgesic/ASA/APAP abuse
- Infection from PYELO
- DM
________________
NSAID ➜ BL ATiN ➜ [vasa recta vasoconstriction] ➜ [chronic renal papilla necrosis] ➜ [papilla sloughing]
➜ gross hematuria/ proteinuria / [pyuria with WBC cast] / [neg urine cx] + renal colic
tx = correct underlying etx
[Cell-free fetal DNA test] is routinely offered at ⬜ weeks gestation prenatal screens to ⬜ patients due to ⬜
________________
What does [Cell-free fetal DNA test] screen for? -4
≥10WG ; [Advanced Maternal age > 35 yof] ; higher risk of chromosomal abnormalities in this group
________________
- [Pateau trisomy 13]
- [Edwards trisomy 18]
- [Down syndrome trisomy 21]
- Sex Chromosome aneuploidies
Cerebral Palsy is a group of clinical syndromes generally characterized as ______
What are the 3 types? What’s the greatest risk factor for Cerebral Palsy?
Nonprogressive motor dysfunction ;
Cerebral Palsy is just SAD
- Spastic
- Ataxic
- Dyskinetic
Greatest RF = prematurity ( < 32 wks gestation) but EtOH is second
Childhood Absence Epilepsy
cp
________________
Dx?
________________
Tx?
multiple brief (< 20 seconds) lapses in consciousness every day
________________
[EEG 3 Hz Spike] ; Ethosuximide
clinical course for Guillain Barre syndrome
[progressive ascending motor weakness +/- paralysis over 2 wks] ➜
[plateau x 2-4 wks] ➜
[spontaneous recovery over months]
________________
tx (plasma EXchange/ IVIG ) shortens course duration by 50%
describe clinical course for this infant
[superficicial infantile hemangioma] proliferate and grow the 1st year of life
BUT REGRESS EARLY CHILDHOOD
= observation only unless cosmetic/bleeding/functional impairment
clinical course for [Dengue Yellow Fever]
[4-7d incubation by Aedes mosquito] ➜ SEVERE [break bone MARF] + [hemorrhagic sx (tourniquet petechiae)]
—–(POSSIBLY)—->
[DENGUE SHOCK = LIFE THREATENING CAPILLARY LEAKAGE ➜ CIRCULATORY COLLAPSE, 3RD SPACING, END ORGAN DAMAGE]
________________
[break bone MARF =Myalgia/Arthralgia/Retroorbital Pain/FEVER]
Clinical presentation for Illness Anxiety disorder
Anxiety over the possibility of having a specific Illness even though there are little to no symptoms
In Somatic symptom disorder….Somatic symptoms ARE present!
PML Clinically Presents like Multiple Sclerosis
Describe PML-Progressive Multifocal Leukoencephalopathy
Opportunistic infection 2º to [John Cunningham PolyomaVirus]—-> [multiple white matter lesions] (Hyperintense Flair signal on radiology) –> Death vs. Severe Neuro injury
Conflict arises between multiple children of a terminally ill patient regarding his medical decisions
Management?
Hospital ETHICS Committee
Congenital Rubella
Sx -3
- eye❌
- hearing❌
- heart❌
Congenital Toxoplasmosis is given to baby via ⬜ but acquired by Mom via ⬜-3
________________
Sx-4
Transplacental
- Raw undercooked meat
- unwashed produce (contaminated soil)
- cat feces
________________
Tox- HICH
Hydrocephalus
Intracranial Calcifications
Chorioretinitis
(also Hearing impairment)
Tx for Congenital Toxoplasmosis -3
Pyrimethamine
SulfaDiazine
Folinic acid
cp for Febrile Seizure -4
________________
⬜ is the primary management. When do you give [Abortive Antiepileptics]?
- [child [6 month - 5 year old] with [< 15m nonfocal seizure]]
- NO previous afebrile seizure within prior 24h
- NO signs of CNS infection (meningismus, bulging fontanelles)
- NO acute metabolic derangement (hypOglycemia)
________________
tx = AntiPyretics ➜ [AntiEpileptics if seizure ≥5 min]
cp for Meckel’s Diverticulum
________________
dx
PAINLESS hematochezia
________________
technetium 99 pertechnetate scan
cp for [Measles rubeOla] -2
[fever + conjunctivitis + coryza + Koplik spots + cough] prodrome –(2-4days)–> [maculopapular rash sspreading head to body]
________________
tx = supportive +/- [Vitamin A if hospitalized]
cp for [Suppurative Bacterial Otitis Media]
[fever + cranky] ➜ [purulent ear drainage + resolution of cranky]
and [NO pinna manipulation pain]
[Suppurative Bacterial Otitis Media] etx
GASP (from nasopharynx) infects middle ear ➜ TM pressure/bulging –(if untreated)–> TM perforation ➜ otorrhea purulent ear drainage with [NO pinna manipulation pain] = SBOM
________________
[fever + cranky] ➜ [purulent ear drainage with resolution of cranky] but with [NO pinna manipulation pain]
Asymptomatic Bacteriuria is self-limited to 2 weeks, and defined as ⬜ + ⬜
________________
Which 3 populations should actually be treated for Asymptomatic Bacteriuria?
[clean catch urine > 100,000 CFU/mL of ≥1 organism]
+
[No UTI sx(SUD)]
________________
Pregnant / [urologic procedures] / [within 3 mo kidney transplant]
_________________
SUD: Suprapubic TTP/Urinary Freq-Urgency/Dysuria
Dementia with Lewy Bodies (DLB) CP - 3
DLB at the DMV
- Dementia confusion periodically
- MichaelJFox Parkinsonism (PARK + hamp) tht does NOT respond to dopaminergic tx
- Visual Hallucinations
Lewy Body= [LABS (Lewy α-synuclein BodieS)] that are Eosinophilic intracytoplasmic accumulations
Describe insulin regimen for IDDM or Type 1
________________
Basal + [3 prn meal]
- basal = [NPH BID] or [GluLargine QD]*
- ________________*
- 3 prn meal = [3 reg insulin c meals]*
Describe what Transferrin measures?
The amount of iron being transferred in the blood
Describe what Total Iron Binding Capacity (TIBC) measures?
The Capacity of Iron transferrin can actually carry
In peds > 1 yo ⬜ and/or ⬜ are primary contributors to the development of iron deficiency anemia
How does this present?
[excessive milk intake > 24 oz/day] ; [low intake of iron-rich food]
________________
microcytic anemia + elevated RDW
Frontotemporal Pick’s Dementia
Sx -2
Prounouced Frontal & Temporal lobe atrophy –>
[Socially inappropriate Behavior] + aphasia
OCCURS MORE IN FEMALES!!!
Demographic of Frontotemporal Pick’s Dementia?
________________
Mode Of Inheritance
50-60 yo Females
________________
AUTO DOM
________________
Alzheimers >60 yo
⬜ can be confirmed with ⬜. | (⬜3) are major risk factors
candida Intertrigo ; KOH exam
________________
obestiy / DM / immunosuppresion
Diagnosis? Tx?
candida Intertrigo
(occurs in inguinal/perineal/genital/intergluteal/inframammary)
________________
Topical Antifungals
diagnosis? | tx?-2
[Tinea capitis ring worm]
________________
[PO griseofulvin] or [PO terbinafine]
cp = scaly pruritic erythematous patches of hair loss
Diagnosis?
What other syndrome is this disease a/w?
Hirschsprung disease
________________
DOWN SYNDROME trisomy 21
Diagnostic criteria for Panic disorder - 2
- Panic attacks +
- Persistent concern about additional attacks and +/- attempts to avoid them
Be sure to r/u medical conditions that mimic them
Disulfiram MOA
________________
How do you decide if you should give a patient Disulfiram or Naltrexone?
[inhibits aldehyde dehydrogenase ➜ SEVERE NV with EtOH] ;
Disulfiram for [Die-Hard ABSTINENTS who want to stay Abstinent]
________________
Naltrexone ( ⬇︎EtOH cravings) for [moderate/SEVERE Alcoholism in opioid-free patients that are Alcoholic]
________________
[acamprosate (glutamate modulator)] is also used in Alcoholism
During pregnancy, what’s Oxytocin indicated for?
labor protraction 2/2 inadequate uterine contractions < every 3-5 min
dx for Acute Cholecystitis -2
________________
What if this method is inconclusive?
Ultrasound showing
[cholelithiasis]
+
[gallbladder wall thickening] OR [sonographic Murphy sign]
________________
➜ HIDA (if above inconclusive)
Dx for Creutzfeldt Jakob disease - 6
- [PRNP prion protein] genetic testing
- EEG Biphasic vs Triphasic sharp wave complexes
- Postmortem brain biopsy
- ⬆︎CSF 14-3-3 proteins
- MRI Cortical Ribbons
- MRI basal ganglia hyperintensity
Dx?
Varicella Zoster shingles
Dx?
[Poison Ivy Type 4 Contact Dermatitis]
________________
pruritic linear papules and clear fluid-filled vesicles on exposed areas - after camping
Management? -3
[Poison Ivy Type 4 Contact Dermatitis]
________________
[Minimize spread (remove contaminated clothes + gently clean exposed areas)] ➜ [Symptomatic Tx (topical CTS+cool compress] ➜
[PO CTS if SEVERE/facial/genitalia dermatitis]
________________
pruritic linear papules and clear fluid-filled vesicles on exposed areas - after camping
Dx? | Management?-2
Vetebral Compression Fracture
pain control + resume normal activity ASAP (NO unnecessary bed rest)
Dx? Clinical Course?
[Erythema Toxicum Neonatorum] ; [benign asx erythematous papules/pustules in 1st 2 weeks of life ➜ resolve within 1 week]
dx? organism that causes it?
Tinea Cruris ; Trichophyton rubrum
Endometrial Polyps cause what type of vaginal bleeding?
intermenstrual vaginal bleeding
⬜ is a risk factor for developing Eosinophilic Esophagitis (which is triggered by ⬜)
cp? -3
________________
Tx?
ATOPY (asthma/food allergy/eczema) ; food antigens
- dysphagia
- reflux/regurgitation
- epigastric abd pain
- [eosinophilic esophageal linear furrows on endoscopy]
__________________
elimination diet | PPI | Topical CTS (fluticasone spray)
Erysipelas, most commonly caused by ⬜, presents as (⬜2) . The 1st line Tx is ⬜
GASP; fever + [acute rapidly spreading erythema with well demarcated and raised borders]
________________
PCN
Explain what an XR with a posterior fat pad indicates?
[nondisplaced OCCULT fracture (usually supracondylar)]
________________
fat pad = radiolucency posterior to humerus that represents displaced fat 2/2 traumatic elbow effusion
Genetic Consultation for recurrent miscarriage is required for women with ≥ ⬜ spontaneous abortions
≥3
When it’s indicated, Group B Strep prophylaxis abx must be given ≥4 hours before delivery to be adequate!
________________
How do you manage postpartum neonatal GBS prevention
When it’s indicated, Group B Strep prophylaxis abx (which consist of ⬜ ) must be given ⬜ hours before delivery to be adequate!
________________
How do you manage neonatal GBS prevention POSTpartum
[PCNor ampicillin or ceFAZolin] ; ≥4
________________
Hemolytic Uremic Syndrome in kids p/w ⬜ secondary to which 2 microbes?
________________
Name the 3 clinical features of Hemolytic Uremic Syndrome
bloody diarrhea ; [EColi O157:H7] or [Shigella dysenteriae]
________________
[HUS HAT]
[Hemolytic Anemia (schistocytes)] / AKI / Thrombocytopenia
[Hidradenitis Suppurativa Acne Inversa] etx
________________
cp?
chronic recurring inflammatory occlusion of the FolliculoPiloSebaceous units –>
Painful intertriginous nodules that can –> abscess and scarring
[Hidradenitis Suppurativa Acne Inversa] management for:
mild
Moderate
SEVERE -2
[Topical Clindamycin]
________________
sinus tracts/scar formation
[PO Doxy]
________________
EXTENSIVE SINUS TRACT/DIFFUSE
[surgical incision + infliximab (TNFα-inhibitors)]
how do you diagnose Bronchogenic Carcinoma (or any endobronchial obstructing lesion) ?
Name an alternative
[CONFIRMATORY FLEXIBLE BRONCHOSCOPY]
________or_________
[alternative nonConfirmatory HRCT]
_______________
HRCT: High Res CT
Describe the Pre-operation management for aFib
How do you manage newly diagnosed [LCIS (Lobular carcinoma in situ)]
LCIS is nonmalignant, but still has ⇪ risk for development into [invasive breast CA or DCIS] = excisional biopsy + lifetime surveillance
how do you mitigate [DEC appetite] in kids taking Stimulants for ADHD? -3
- [monitor growth (if compromised ➜ drug holiday vs nonstimulant alternative)]
- adjust administration time (i.e. after breakfast)
- eat nutrient-dense meals around medication’s active period
how do you treat acute asthma exacerbation in pregnant patients? -3
same as non-pregnant asthma exacerbation = BOC
[BronchoDilator (albuterol+ipratropium ➜ terbutaline ➜ Magnesium IV)]
CTS PO
Oyxgen to SaO2 ≥95% (nonpregnant ≥90%)
________________
short term CTS benefit > minor risk in pregnant patients
How does [GnRH agonist] help treat Leiomyoma?
GnRH agonist ➜ temporary amenorrhea ➜ ⬇︎Leiomyoma size and ⬇︎vaginal bleeding
How is smoking related to surgery?
smoking cessation ≥4 weeks prior to surgery ⬇︎ pulmonary complication risk postop
PFT, ABG, etc. preop will not help
[FENa (Fractional Excretion of Na+] for Prerenal failure?
________________
FENa for Acute Tubular Necrosis?
________________
explain why
Prerenal failure FENa < 1%
________________
ATN Intrinsic renal failure FENa > 2%
________________
Prerenal failure ➜ Na+ conservation
ATN impairs Na+ reabsorption ➜ more Na+ in urine
Huntington’s Dz Clinical Presentation (2)
- “Hunting 4 food is way too aggressive & dancey”*
1st: Aggressive Dementia w/ strange behavior
2nd: Dance-like Chorea mvmnts - AUTO DOM = Affects BOTH sexes equally!!*
[Nausea/Vomiting in Pregnancy] ranges from mild to severe. Severe NVP is AKA ⬜
What’s sx discern [mild NVP] from [SEVERE NVP] -3
________________
How do you manage mild NVP? -3
- SEVERE NVP = HYPEREMESIS GRAVIDARUM*
- ________________*
[Nausea/Vomiting in Pregnancy] ranges from mild to severe. Severe NVP is AKA ⬜
What’s sx discern [mild NVP] from [SEVERE NVP] -3
________________
How do you manage [SEVERE NVP]? -3
- SEVERE NVP = HYPEREMESIS GRAVIDARUM*
- ________________*
On a Central Tendency Graph below Identify
Mean, Median, Mode
cOIN
central tendency graph =
1: mOde
2: medIan
3. meaN
In Infants, what is “Periodic Breathing” ?
BENIGN physiologic breathing pattern in young infants in which they demonstrate
(➜ [breath pause x 5-10 seconds] ➜ [rapid shallow breaths x 10-15 seconds] ➜)
x several cycles before returning to normal breathing
In Infants, what is [Apnea of Prematurity]?
[TRUE apnea episodes ≥20 seconds] in premature infants, that resolves by [corrected gestational age 37 WG]
Injury to the ⬜ causes ⬇︎ ability to Dorsiflex
[(DCP) Deep Common Peroneal nerve]
________________
Damaged DCP ➜ DEC Dorsiflex
Juvenile Idiopathic Arthritis
Juvenile Idiopathic Arthritis = Joint Inflammation by Autoantibodies
autoantibody-induced joint inflammation ➜ chronic pain/swelling of multiple joints (wrist/ankles)
Large volume Hematochezia should make you suspicious for (⬜ upper|lower) GI bleed , which should be evaluated with ⬜ after IVF
________________
Hematochezia = Bright Red Blood Per Rectum
brisk UPPER ; EGD
________________
hematochezia (BRBPR) is usually a/w lower GI bleed but BRISK upper GI bleeds also cause hematochezia
[DLB (Dementia with Lewy Bodies)] Tx
Rivastigmine AChinesterase inhibitor
Select mode of Delivery (Vaginal | Cesarean) for [Dichorionic Diamniotic twins] positioned:
Vertex/Vertex
________________
Vertex/BREECH
________________
BREECH/Vertex
________________
BREECH/BREECH
List the Sexual Side Effects of SSRI
________________
How do you manage this? -3
⬇︎Libido | ⬇︎Orgasm | ⬇︎(delayed) ejaculation
________________
- SWITCH to non-SSRI (buproprion/mirtazapine)
- AUGMENT with buproprion/sildenafil
- DOSAGE reduce cautiously (for pts taking high-dose/long term SSRI)
Malrotation and Volvulus are both diagnosed with ⬜
What would Volvulus look like on this diagnostic?
[Upper GI series barium swallow]
corkscrew image
Try not to use CT scans in kids
Malrotation and Volvulus are both diagnosed with ⬜
What would Volvulus look like on this diagnostic?
[Upper GI series barium swallow]
corkscrew image
Try not to use CT scans in kids
4 most common symptoms of Heat Stroke
________________
- Hyperthermia
- [Flushed but not sweaty Skin]
- [Neuro⬇︎ (Confusion/Dizziness/Agitation/Seizure/HA/LOC)]
- Tachycardia
________________
[⬇︎ core temp by 0.2C/minute] using [Augmentation of EVAPORATIVE COOLING]
Most Cryptogenic Stroke are ⬜ in origin. What is Cryptogenic Stroke ⬜ ?
Describe thew workup? -2
embolic;
ischemic stroke w/o obvious source on initial eval
________________
advanced cardiac imaging + ambulatory cardiac monitoring
to detect paroxysmal arrhythmia (afib)
Name 4 distinguishing features for differentiating NonAllergic rhinitis from Allergic Rhinitis
________________
Tx for NAR? -2
- > 20 yo
- Nasal sx mostly (little ocular sx) - blockage/rhinorrhea/postnasal drip
- No identifiable allergen
- sx throughout the year
________________
[Intranasal Fluticasone] or [Intranasal Azelastine (antihistamine)]
Marfan Syndrome and Ehlers Danlos can present similarly
How do you discern the two?-2 ; What is the etx for Ehlers Danlos?
“Marfan BAATHES a lot! “
BUT Ehlers Danlos does NOT have
- Ectopia Lentis
- Arm-to-Height Ratio that’s INC
Ehlers Danlos etx = defective collagen production
Name the 7 most common manifestations of Marfan Syndrome
etx = mutation of fibrillin 1 gene
“Marfan BAATHES a lot! “
- Ectopia Lentis
- Arm-to-Height Ratio ⬆︎
- Heart issues (MVP or [idiopathic Aortic cystic medial degeneration]–> Aortic Dissection and Aneurysm)
- Scoliosis vs. Kyphosis
- Breastbone structural abnormalities
- Arachnodactyly (Steinberg thumb & wrist)
- Tall / slender / flat feet
etx = mutation of fibrillin 1 gene
Name the markers of onset Puberty for
Girls
________________
Boys
[girls wth NO Breast by 12 yo]
________________
[boys with NO (testicular enlargement ≥4 mL) by 14 yo]
________________
delayed secondary sexual characteristics + delayed XR bone age = [Constitutional Delay of Puberty]
For teens, what’s the difference/define [Constitutional Delay of Puberty]-4
and [Familial Short Stature]-2 ?
[Constitutional DELAY of Puberty] = [DELAYED secondary sexcharacteristics] + [DELAYED XR wrist bone age] + [DELAYED“short” height] + [DELAYED sx also in fam hx]
________________
[Familial Short Stature] = Short Stature + [Normal XR wrist bone age]
________________
BOTH MUST HAVE NORMAL GROWTH VELOCITY
Newborn failure to pass meconium within 48 hours of birth likely indicates ⬜
how is this diagnosed? -3
Hirschsprung Disease
________________
Abd XR ➜ [contrast enema showing transition zone] ➜ [RECTAL SUCTION BIOPSY (gold standard)]
Newborn failure to pass meconium within 48 hours of birth likely indicates ⬜
MOD
Hirschsprung Disease
________________
[absence of ganglion cells in rectosigmoid (confirmed by rectal suction biopsy)] ➜ transition zone cutoff between
[narrow aganglionic rectosigmoid] and [markedly dilated innervated descending colon] EARLY AFTER BIRTH
normal ALP level
________________
ALP = Alkaline Phosphatase
25 - 100
normal blood glucose is ⬜
What is Whipple’s triad and what does it indicate?
60-100
(some people can go down to 45 with no sx)
________________
Whipples = [low BG] + [low BG sx] + [sx improve after glucose administration] = true hypOglycemia
________________
hypOglycemia sx = need PISH juice = Palpitations/Irritability/Sweating/HA
Octreotide is a ⬜ used to treat ⬜
________________
explain how
[somatostatin 14 analogue] ; [Somatotrope - Functional Pituitary Adenoma]
________________
inhibits [pituitary somatotrope] from releasing Growth Hormone in a [functional pituitary adenoma]
Oligohydramnios –> ⬜ sequence.
Name the 3 most common causes of Oligohydramnios
Oligohydraminos –> POTTER Sequence
POSTERIOR URETHRAL VALVES are the most common cause of obstruction in newborn boys (which causes renal damage –> oligohydramnios during utero)
Oligohydramnios –> ⬜ sequence.
Name the 3 most common causes of Oligohydramnios
Oligohydraminos –> POTTER Sequence
POSTERIOR URETHRAL VALVES are the most common cause of obstruction in newborn boys (which causes renal damage –> oligohydramnios during utero)
organisms most commonly associated with
dental abscess -2
Streptococcus
PeptoStreptococcus
organisms most commonly associated with
Infective Endocarditis -3
Staph
Strep
Enterococci
organisms most commonly associated with
intraAbdominal -2
E coli
Bacteroides fragilis
Ovarian hyperstimulation syndrome etx
rare complication of ovulation induction.
etx: hCG injections which artifically matures follicles for IVF ➜BILATERAL OVARY ENLARGEMENT WITH TOO MANY FOLLICLES
PLUS ovaries overexpress [Vascular endothelial growth factor] =
[INC Ovarian VEGF] ➜ INC capillary permeability ➜ abd 3rd spacing ➜ [ascites/effusions/electrolyte imbalance] ➜ eventually
renal failure, hypOvolemic shock, hemoconcentration, hypercoagulability, DIC, death
Patient is diagnosed with HOCM
what would an [Implantable Cardioverter-defibrillator] be used to prevent in HOCM pts?
________________
diagnostic criteria? -2
Sudden Cardiac Death
________________
HOCM + ≥1 risk factor
________________
risk factors: [SCD in close relative<50 yo]/suspected syncope from Vt Arrhythmia/LV<50%
patient p/w ascities
How do you diagnose Spontanous Bacterial Peritonitis?
Cell Count ≥250
Patient presents with Suicidal Ideation
What 2 factors determine if this patient should receive inpatient tx or outpatient tx?
+Ideation
[+PLAN and +INTENT] = Inpatient Tx
[No Plan and No Intent] = Outpatient tx
________________
Patients with bicuspid aoritc valve are also at risk for developing what 3 aortic abnormalities?
aortic DISSECTION
aortic ANEURYSM
aortic DILATION
________________
screen aortic root and proximal aorta
Pediatric patient comes in with c/f PNA
What are the 4 classic symptoms of PNA?
________________
How do you work up pediatric PNA ?
PNA? FACT
Fever / Adventitious lung sounds / Cough / Tachypnea
________________
Which abx is used for [Community Acquired PNA]?
high-dose oral AMOXICILLIN
________________
PNA? FACT
Pediatric patient p/w new diagnosis of Major Depressive Disorder
In addition to CBT, what’s 1st line pharmacotherapy for pediatric MDD?
________________
What’s the black box warning of this drug in pediatrics?
Fluoxetine
________________
increased risk of suicidal thinking in pediatric patients
Pineal tumors p/w ⬜ syndrome and some are ⬜ that secrete ⬜
Describe cp for this syndrome -4
[Parinaud’s dorsal midbrain syndrome] ; Germinomas ; HCG
________________
Vertical Gaze paralysis
ataxia
pupil light rxn LOSS
nystagmus LOSS
[Nevus Simplex] are ⬜ , classically located on ⬜-3
[blanchable pink patches ➜ fade with time]
________________
[eyelids / glabella (between eyebrows) / nape of neck]
[Port-Wine Stain (Nevus Flammeus)] are [⬜ common | uncommon] and may be a/w with what syndrome? Explain
UNcommon ; sturge weber = possible leptomeningeal vascular malformations = obtain brain MRI for evaluation
prior to medium/high risk procedures, interrupting ⬜ is necessary to DEC surgical bleeding
________________
which patients do require bridging prior to surgery?
[anticoagulation 1-3 days before surgery]
________________
pts on warfarin must be bridged to [Enoxaparin LMWH] if they are CHADS VASC ≥7, recent stroke, mechanical valve or moderate risk
Prolactin level of ⬜ = Prolactinoma
________________
Tx? -2
> 200
________________
[Cabergoline (dopamine agonist)] < 1cm < [Surgery for MACROademona]
Pt presents with Fever, Jaundice and RUQ pain
Management? -2
[ERCP biliary decompression/drainage - within 48h]
+
enteric abx
________________
dz = Acute Cholangitis
Pt s/p penile circumcision develops postprocedural bleeding
management?
apply compressive elastic dressing (direct pressure) to bleeding surgical site, BUT ONLY FOR SHORT TIME (to prevent necrosis)
and then remove [compressive elastic dressing] after hemostasis … and prior to discharge
postop
CXR shows [linear opacifications in the b/l lung bases]
dx?
Atelectasis
Postoperative atelectasis is common ⬜ days after operation
________________
how is this managed? -2
2-5
________________
+respiratory secretions = [Chest Physiotherapy + suctioning]
NO respiratory secretions = CPAP
Name the 6 major causes of Postoperative Hypoxemia
pt with Eisenmenger syndrome wants to get pregnant
What should you tell her?
Pregnancy is a contraindication for pts with Eisenmenger syndrome (untreated VSD/HF) due to high maternal mortality rate and poor fetal pgn
Pregnancy should be avoided/terminated
Pt (without previous DM) now with gestational DM delivers baby w/o complication
How do you manage her postpartum course? -2
d/c antiHyperglycemic therapy after delivery
➜ At [6-12 wk postpartum] = [2h oral glucose tolerance test] (due to ⇪ DM2 risk)
⬜ is the leading cause of death in pts with Acromegaly. What other comorbidity are they at risk for?
________________
which comorbidity is reversible with treatment?
[Cardiovascular disease (REVERSIBLE)] ; Colon CA
________________
Cardiovascular Disease is reversible with tx
Although RARE, Recurrent Pulmonary Embolism can (rarely) present as nonresolving ⬜ , but will have what distinguishing symptom?
[persistent Recurrent PNA] ; [pleuritic cp with hypoxia]
Pts with Giardiasis should refrain from attending ⬜ to minimize disease transmission
________________
Tx for Giardiasis? -3
[Tinidazole or NiTazoxanide]
➜ [metronidazole (2nd line/kids)]
Giardiasis is transmitted via ⬜-2
What are the Risk factors for Giardiasis -3
Fecal-Oral or ingestion
________________
Contaminated food/water
Fecal incontinence with crowding (day care/nursing home)
Immunodeficiency
⬇︎ with hand sanitizer
s/s of Opioid Withdrawal -7
the MAILMAN went through opioid withdrawal!
MyDriasis
Abd cramps
Irritability
Lacrimation
Myalgia
Arthralgias
NV
S3 on auscultation typically indicates ⬜, but why is S3 less useful in younger patients < 40 yo?
Ventricular Enlargement (HF) ;
S3 = NORMAL FINDING IN YOUNG PTS<40 y/o
Seizures and Syncope are difficult to differentiate
Name features that help differentiate Seizures from Syncope - 3
Seizures has…
- Postictal confusion & lethargy
- Triggered by flashing lights
- Tongue laceration
beware: Clonic jerks can occur during syncope associated w/cerebral hypoxia!!
SjoGren Syndrome sx -4
________________
Dx labs -2?
St.John’s wort is an OTC herbal supplement used alternatively for ⬜.
Why should it be used with caution?
[mild/moderate depression]
________________
It upregulates [CYP P450] ➜ ⇪ metabolism
Stimulant toxicity and Anticholinergic toxicity have a lot of sx overlap
What symptom helps to differentiate the two?
SKIN
________________
Sweating = Stimulant tox
ALL Dry = Anticholinergic tox
Sydenham chorea is one of the Major features of ⬜
Describe Sydenham chorea clinical presentation
________________
tx for Sydenham chorea?
Acute Rheumatic Fever
________________
[DANCING: MIND(emotionally labile) / FACE / HANDS / FEET (rapid jerky movements)]
________________
[PCN until adulthood] (to prevent recurrent rheumatic fever)
Acute Rheumatic Fever requires (2M) or (1M/2m) for dx
List the
5 MAJOR clinical features
________________
4 minor clinical features
late sequelae = Mitral regurgitation/stenosis
Tetrabenazine
- MOA*
- ________________*
- Indication*
[dopamine R blocker] ; Huntington’s disease
the presence of [HbA 60% : HbS 40%] on electrophoresis is c/w ⬜ . What are the subsequent sx of this?
Sickle Cell TRAIT = ASYMPTOMATIC (does not cause Anemia)
the timing of neonatal jaundice differentiates [G6PD deficiency] from [Hemolytic Disease of Newborn] explain
neonatal jaudice presenting within first
HDN: 24 hours of life
(+ direct Coombs | A or B infant born to O mother)
________________
G6PD deficiency: 2-3 DAYS of life
CP of VertebroBasilar TIA - 4
Brainstem: Diplopia, Dysarthria
Cerebellum: BL Clumsiness
Spinal Cord: BL Weakness
Labyrinths
Transient Synovitis is a common cause of HIP pain in peds age ⬜.
Describe the clinical presentation -3
________________
Tx?
[3-8 yo]
- [Hip pain + Limp but able to bear weight still]
- often s/p postinfection
- small hip effusions on US
________________
NSAIDs (since self limited to 1-2 weeks)
Treatment?
Icanthosis
topical Lactic Acid (keratolytic)
How do you diagnose Catatonia?
Lorazepam challenge =
[Lorazepam 2 mg IV] ➜ observe patient ➜ if pt relieved within 5 min = catatonia.
________________
note: a negative response does NOT rule out catatonia
Tx for Catatonia - 2
Lorazepam
and/or
ECT
________________
consider Lorazepam challenge = Lorazepam 2 mg IV ➜ observe result (if pt relieved within 5 min = catatonia)
Tx for Croup-2
- Mild = Humidified air +/- CTS
- > Mild = CTS +/- Racemic Epi nebulized
Croup = paraflu that –> subglottic edema and narrowing
Tx for Croup-2
- Mild = Humidified air +/- CTS
- > Mild = CTS +/- Racemic Epi nebulized
Croup = paraflu that –> subglottic edema and narrowing
tx for Guillain Barre syndrome -2
________________
when is this tx indicated?
plasma EXCHANGE
or
IVIG
________________
nonambulatory pts should receive tx if their sx have been present < 4 wks
________________
ambulatory pts recover on their own
Tx for Major Depression with psychotic features - 2
- ECT > antipsychotic ➕
- Antidepressant
Use ECT in elderly as it is more rapid acting
tx for Malignant Necrotizing Otitis Externa (MOE) -4
mild = topical acetic acid
moderate = topical cipro
[SEVERE (canal 100% occluded) = wick placement adjunct]
________________
INVASIVE! = CIPRO IV
7 day treatment
Tx for Panic Disorder - 6
CBT (can be used alone)(breathing technique, exposure therapy) +/-
- SSRI (1st line rx)
- SNRIs
- [Benzo or BBlocker for situational]
- TCA
- MAOi
* Similar to Social Phobic Anxiety Disorder tx*
Tx for outpatient acute pyelonephritis
cipro PO x 7d
________________
DW SLUFF: dysuria/WBC Pyuria/suprapubic pain/Leukocytosis/Urinary sx/Flank Pain/Fever
Uterine Sarcoma is an aggressive CA originating from ⬜ or ⬜ tissue, and has 2 major risk factors
What are they?
endometrium or myometrium
________________
RF = tamoxifen vs pelvic radiation
What are 5 ways to determine if a pt truly has Leakage of Amniotic Fluid?
- Amnisure immunoassay (detects placental ⍺-microglublin1)
- POOL test (there’s pool of fluid in vaginal vault)
- NITRAZINE test (fluid turns blue when placed on nitrazine paper since amniotic fluid is alkaline)
- FERN test (fern-like estrogen crystals under microscopy)
- US to determine fluid quantity (Normal = 6-23 cm AFI)
What are the 2 most important clinical values to monitor for Guillain Barre syndrome?
________________
cross reacting abs against peripheral nerves
Negative Inspiratory Force
Tidal Volume vital capacity
________________
assess’ respiratory status
What are the 4 main inquries pts should be asked when coming in for L&D checks?
Can Mom Feel Baby?
Contractions?
Movement from Fetus?
Fluid leak vaginally?
Blood leak vaginally?
What are the clinical features of a Supracondylar Fracture -2
Tx for Supracondylar Fracture that’s:
Nondisplaced ?
________________
Displaced?
long arm split/sling
________________
surgical reduction/pinning
how do you prevent Tumor Lysis Syndrome? - 2
________________
how do you treat Tumor Lysis Syndrome (with AKI) -2?
________________
Why do these differ?
AF ➜ RF
px = AF: [Allopurinol (xanthine oxidase inhibitor)] +Fluids IV]
________________
TX (for AKI 2/2 TLS) = RF: [Rasburicase (urate oxidase analogue)] + Fluids IV]
________________
[Allopurinol prevents Additional serum uric acid formation] whilst [Rasburicase metabolizes Realtime (already existing) serum uric acid]
What are the clinical features of Tumor Lysis Syndrome - 4
[cytotoxic chemotherapy] or [high grade lymphoma] ➜ tumor cell lysis ➜ release of [intracell (PUK)] ➜ makes you PUKE
- [⬆︎ Phosphate serum (binds and ⬇︎ serum Ca+ )] ➜ CaPO4 stones
- [⬆︎ Uric acid serum from pUrines (px = allopurinol and IVF) = DIAGNOSIS
- [⬆︎ K+ serum ( ➜ cardiac arrhythmias)]
- Electrolyte kidney stones ➜ AKI
What are the renal complications of sickle cell TRAIT - 5
- Painless Hematuria 2/2 papillary necrosis
- Inability to concentrate urine (due to vasa recta damage)
- Distal Renal Tubular Acidosis
- UTI
- Renal Medullary CA
Sickle cell trait is a benign condition with Hgb AS that can cause fleeting papillary necrosis
What are the risk factors for Uterine Rupture? -4
[PRIOR UTERINE SURGERY (CSection/myomectomy)]
Truama
Macrosomia
abnl placentation
What are the toxicities for MTX?
What are the major functions of [Vagus CN10] - 5
VAGUS
Vocal Cord Phonation
[Aortic baro/chemoreceptor Parasympathetics]
[Gag reflex - EFFerent (loss of Gag = CN9 problem)]
U‘ll COUGH reflex- when vagus receives signal afferently
[Swallowing & Palate Elevation]
Image: Left Ipsilateral CN10 palate dysfunction
What are triggers of VAN (Vasovagal Autonomic Neurocardiogenic) Syncope? -8
- EMOTION
- PAIN
- Carotid Stimulation
- Prolonged Standing
- Coughing
- Meals
- Defecation
- Urination
VAN Syncope is preceded by nausea, sweating and dizziness
Full term infant = 37 -42WG
How do you manage Preterm Labor 32 to 33+6 WG - 3
Pregnant Bitches Take
Full term infant = 37 - 42WG
How do you manage Preterm Labor < 32WG - 4
Pregnant Bitches Take Money
Full term infant = 37- 42WG
Most Tocolytics are not used in managing Preterm Labor 34 to 36+6 WG
Why specifically is Nifedipine not used?
Pregnant Bitches
Maternal hypOtension with reflex tachycardia
Full term infant = 37- 42WG
Most Tocolytics are not used in managing Preterm Labor 34 to 36+6 WG
Why specifically is Nifedipine not used?
Pregnant Bitches
Maternal hypOtension with reflex tachycardia
Full term infant = 37- 42WG
Most Tocolytics are not used in managing Preterm Labor 34 to 36+6 WG
Why specifically is Indomethicin not used? - 2
Pregnant Bitches
- Premature closure of ductus arteriosus
- Oligohydramnios
Full term infant = 37- 42WG
Most Tocolytics are not used in managing Preterm Labor 34 to 36+6 WG
Why specifically is Mg not used?
Pregnant Bitches
It’s a weak tocolytic so it doesn’t actually help with slowing contractions down in preterm delivery
What does APGAR stand for? ; How is it done? ; How is it used?
Appearance, Pulse, Grimace(reflex irritability), Activity(tone), Respiration
Performed at 1 and 5 min postpartum, All scaled from 0 to 2 and then added together
[< 3 = Critical] / [4-6 = fair: PPV] / [7-10 = normal: No intervention]
What does APGAR stand for? ; How is it done? ; How is it used?
Appearance, Pulse, Grimace(reflex irritability), Activity(tone), Respiration
Performed at 1 and 5 min postpartum, All scaled from 0 to 2 and then added together
[< 3 = Critical] / [4-6 = fair: PPV] / [7-10 = normal: No intervention]
What is a normal Ejection Fraction?
> 50%
What is Bile Salt-Induced Diarrhea?
________________
tx?
5-10% of patients after [cholecystectomy vs short bowel syndrome] have ⇪ [secondary bile acids] into the large intestine ➜ INC diarrhea
________________
Cholestyramine
([bile salt-binding resin] that sequesters excess bile salts in the intestine)
Charcot Triad consist of [⬜3] and indicates ⬜
________________
Describe this disease
[Fever + Jaundice + RUQ pain] = Acute Cholangitis = [bile duct gallstone obstruction] ➜ impaired biliary drainage ➜ ascension and infection of enteric bacteria in biliary duct
________________
What is Factitious disorder?
________________
which 2 demographics does it occur most in?
faking/inducing illness solely to assume the sick role - WITHOUT OBVIOUS EXTERNAL BENEFIT
________________
Women | healthcare workers
What is gallstone pancreatitis?
________________
Management for gallstone pancreatits? (mild vs severe)
pancreatitis (epigastric abd pain/NV/cholic/⇪ lipase) in the setting of [cholelithiasis with no EtOH or TAG]
________________
[mild (no organ dysfxn)] = cholecystectomy within 7 days of inflammation resolution
SEVERE = cholecystectomy AS SOON AS INFLAMMATION RESOLVES
What is the diagnostic clinical criteria for Panic Disorder? - 4
________________
DSM5 no longer considers this its own DO but now as a Specifier for other conditions
- Recurrent Panic Attacks
- Unexpected Panic Attacks
- ≥1 attack is followed by ≥1 mo. of [Anticipatory Anxiety and/or behavior ∆] (details below)
- AA = persistent worry of having another panic attack
- behavior ∆ to try and avoid future panic attacks
4. ≥ 4 Panic Attack Specifiers - image - And obvs can’t be 2/2 drugs or other condition*
Why are abx NOT used in treating Hemolytic Uremic Syndrome?
________________
What is the management for Hemolytic Uremic Syndrome?
HUS HAT
killing bacteria could ➜ ⇪ release of Shiga toxin
________________
SUPPORTIVE CARE ONLY
(fluid/electrolyte mgmt | blood transfusions | dialysis)
What is the mngmt for an ingested coin? - 3
- Obs for up to 1 day after ingestion UNLESS
- Pt is symptomatic = flexible endoscopy
- Pt has no recollection of ingestion time = flexible endoscopy
What is the mngmt for an ingested coin? - 3
- Obs for up to 1 day after ingestion UNLESS
- Pt is symptomatic = flexible endoscopy
- Pt has no recollection of ingestion time = flexible endoscopy
What is the most common cause of Fatal Sporadic Encephalitis in the U.S.? Should you use CT or MRI for dx?
Herpes Encephalitis ; MRI (and then CSF PCR=Gold Standard Dx)
What is the purpose of Palliative Care? -2
★ [interdisciplinary ⬇︎of unnecessary medical interventions] while [⇪ quality of life for terminal/seriously ill patients (and their family)].
★ Can occur concurrently with life-prolonging tx
What is the majority recommendation for Romantic or Sexual relationships between Physicians and current Patients?
________________
what about former patients?
current patient = UNETHICAL 100%
________________
former patient = Unethical if MD exploits knowledge or influence derived from previous professional relationship
What is the strongest single risk factor for suicide
previous suicide attempt
What is [Diamond Blackfan anemia]?
________________
cp? -4
congenital bone marrow failure in infancy
________________
- absent thumbs
- craniofacial abnormalities
- [SEVERE Macrocytic anemia (hgb < 9 at birth)]
- reticulocytopenia
What is [Physiologic anemia of infancy]?
ASYMPTOMATIC and Expected DEC in newborn hgb during 1st month
2/2 INC oxygen to newborn (compared to utero) ➜ transient downregulation of erythropoietin ➜ DEC RBC
DEC RBC resultantly = [Hgb > 14 at birth] to [Hgb 9-11 by 3 months old]
After 3 months, erythropoietin drive returns to normal
________________
red flags: anemia 1st month / hgb < 9 / hemolysis (constant jaundice|reticulocytosis) / hypOchromic|microcytic RBC (iron deficiency/thalassemia)
What new onset comorbidity should you anticipate following renal transplant?
DM
________________
INC insulin excretion and gluconeogenesis by healthy transplanted kidney
What type of psychiatric side effects does CTS (CorTicoSteroids) have? - 4
Steroids Make People Depressed!
- Suicidality
- Mania
- Psychosis
- Depression
What’s important to remember regarding BNP in Obese patients?
Obesity causes FALSELY LOW BNP levels
________________
Bigger people have Bigger BNP than they show
pt s/p PE just started Heparin but develops HIT
What’s the first step for suspected [Heparin Induced Thrombocytopenia (HIT)]
________________
when is management with Warfarin typically ok to start after HIT ?
d/c ALLforms of Heparin ➜ alternate anticoagulants (i.e. direct thrombin inhibitors) [even if no thrombosis present]
________________
platelet > 150K
What’s the general recommendation regarding
Exericse during Pregnancy?
Healthy uncomplicated pregnant women are recommended to do
[Moderate exercise 30 minutes daily - for most days of the week]
________________
yoga/walking/running/light strength training/swimming
what’s the most effective way to improve patient sign out/handoff between providers?
systematic template checklist
Which 2 organisms cause ABSCESS?
MsSA
MRSA
Which 4 drugs can you give to treat HTN in pregnant patients?
Mothers Loathe Nefarious HTN
Methyldopa / Labetalol > Nifedipine / Hydralazine
Which 4 Bite Wounds receive
[left open to heal by secondary intention + ⬜ prophylaxis]?
________________
Why?
TECH bites are left open to secondary healing with AMOX/CLAV px
- [Time of bite > 12 hours old]
- [Extremity (hand or foot) bite]
- [CAT bites (except if on face**)]
- [HUMAN bites (except if on face**)]
* *1° < [CAT/HUMAN Face bite 24h old] < 2°*
________________
These bite wounds are high risk for subsequent infection
Which areas of the brain are affected by [HSE-Herpes Simplex Encephalitis]? - 2
- Medial temporal
- Inferior frontal
Which Second Generation Antipsychotics are most associated with
Prolonged QTc -5
ZIPRASIDONE >> CORQ
________________
CORQ = Clozapine/Olanzapine-Risperidone/Quetiapine
Which Second Generation Antipsychotics are most associated with
Weight Gain -4
CORQ
[Clozapine | Olanzapine] > [Risperidone | Quetiapine]
Which Skin Cancers are associated with Sun exposure?
________________
How is this prevented?
ALL 3!
(SQC / Basal Cell Carcinoma / Malignant Melanoma)
________________
Daily liberal application of [SPF ≥ 30 sunscreen] before/during outdoors
(Tight clothing and sun avoidance are also important but impractical)
Which two renal pathologies is analgesic nephrophathy associated with?
- [ATiN (Acute Tubulointerstitial nephritis)]
- Papillary necrosis
Why are patients undergoing [major surgery with extensive transfusions] at ⇪ risk of developing [Hyperactive Deep Tendon Reflexes]?
major surgery require massive blood transfusions, which has large amts of citrate (to anticoagulate blood) ➜ this [citrate chelates free serum calcium] ➜ hypOcalcemia ➜ [HYPERACTIVE Deep Tendon Reflexes]
Why are pts who’ve experienced 1 shoulder dislocation, at even higher risk for experiencing recurrent shoulder dislocations? -2
[residual ligament instability/laxity]
+
[incomplete healing of prior labral tears]
s/s of Anterior Shoulder Dislocation -5
- Flattened shoulder
- Acromion prominent
- Humeral head prominent
- ABduction of Arm
- External Rotation of Arm
________________
ANT shoulder dislocation of [glenohumeral shoulder joint]
Why do pts with hypOthyroid require INC dose of levothyroxine if they start taking estrogen-containing OCP?
________________
how is this managed?
Estrogen stimulates liver to make ⇪ [thyroxine binding globulin] ➜ ⇪ binding sites to saturate➜ DEC free T3/T4
Normal thyroid ⇪ [free T3/T4] to saturate the additional TBG binding sites
BUT hypOthyroid patients are unable to INC thyroid hormone synthesis
________________
get TSH weeks after starting Estrogen-OCP and titrate to normal thyroid function
Why is BNP an unreliable marker of volume status in patients taking [(ARNI) Angiotensin Receptor/Neprilysin Inhibitor] ?
________________
ARNI = [sacubitril-valsartan]
Neprilysin normally degrades BNP ➜ ARNI ➜ falsely higher BNP/overStates HF status
You have a patient admitted to Hospice
Which 3 groups of drugs should be discontinued?
________________
Why?
[CV prevention] / anti-HTN / [PRN Insulin]
________________
meds taken at end of life should be comfort meds only
You suspect a pt had an ischemic Stroke
After FIRST, ruling out Hemorrhagic stroke with ⬜ , what thrombolytic therapy should be given?
________________
When should you give it?
NonContrast Head CT; IV Alteplase
________________
WITHIN 4.5 HOURS OF SX ONSET!
[T or F] Pt confidentiality shuld be maintained even when a pt is having Active suicidal ideation
FALLLSEE!!!!
Active (i.e. plans to hang themself) suicidal or homocideal ideation warrants breaking confidentiality and informing parents or whomever
[1st trimester combined test] screens for ⬜ by measuring what 3 things?
________________
positive [1st trimester combined test] ➜ ⬜
aneuploidy; [(BNP - (βHCG/Nuchal translucency/[Pregnancy associated plasma protein A])
________________
confirmation by [chorionic villus sampling] or amniocentesis
to evaluate fetal karyotype
[Amyotrophic Lateral Sclerosis] (Lou Gehrig’s) etx - 2
________________
clinical presentation? -4
- Rare = [Superoxide Dismutase gene mutation] –> copper-zinc dysfunction —>[Upper AND Lower Motor Neuron Disease!]
- Common = Idiopathic
________________
progressive weakness + [UMN deficits AND LMN deficits] + [cognition/ocular/bowel/bladder are preserved]
UMN Dz includes loss of neurons in motor nc. 5/9/10/12
[Anabolic Androgen Steroids] ➜ symptomatic ⬜ from DEC ⬜
________________
how long after d/c does it take to naturally recover?
hypOgonadism ; endogenous testosterone
________________
recovers weeks/months after d/c but will be permanently suppressed if chronic abuse
[Bacterial otitis externa] and [Necrotizing malignant otitis externa] both present with ⬜ and ⬜ from ⬜
________________
how do you differentiate the two?
[pain with ear manipulation] and [purulent ear drainage] ; pseudomonas
________________
NMOE = FEVER/ involves neighboring skull bone / only in elderly-DM-immunocompro
vs
BOE = no fever
[Creutzfeldt Jakob Dz] etx
PrP (prion protein), normally in neurons as [α -helical structure] converts–> [INFECTIOUS Beta pleated sheets] –> Protease resistance –>
Vacuoles in [Gray Matter Neurons & Neutrophils] develop –> Cyst = [Spongiform Gray Matter]
[Creutzfeldt Jakob Dz] CP - 2
[RAPIDLY Progressive Dementia] + [STARTLE Myoclonus] –> DEATH
Can be Acquired vs. Inherited
[Functional Pituitary Adenomas] consist of what 3 adenomas?
________________
Describe etx for [NONFunctional Pituitary Adenoma]
________________
Tx?
Functional Pituitary Adenoma=
Lactotrope > Somatotrope > Corticotrope
________________
[NONfunctional pituitary adenomas] arise from [LH/FSH Gonatrope cells of the PITUITARY GLAND ➜ unique [isolated ⇪ α subunit (nonfunctional)] ➜ low LH/FSH gonadotropin levels (from negative feedback) ➜ hypOgonadism
+
mass effect if tumor large enough
Tx = Trans-Sphenoidal Surgery
[PSPST (Pancoast SUP Pulmonary Sulcus Tumor)]
has 4 main clinical symptoms
________________
⬜ is the most common PSPST sx
> ⬜ and ⬜
which are > [⬜ (only present in 25% PSPST pts)]
- SHOULDER PAIN
- [Horner’s Syndrome (PAM)] (2/2 sympathetic chain/stellate ganglion invasion)
- [Hand atrophy/weakness] (2/2 C8-T2 invasion)
4-[Spinal Cord Compression ➜ asymmetric LE HYPERreflexia] = only 25% of PSPST pts
________________
Tx = CTS + Radiation + Surgery
[Serous Otitis Media with effusion] etx
sOME = asymptomatic middle ear effusion in the absence of infection /inflammation
________________
SBOM (➜sOME)
what adjustments should be made for exercise induced hypoglycemia in a IDDM/Type 1 DM? -3
- [⬇︎basal insulin (NPH BID vs GluLargine QD)]
- eat before exercise
- avoid insulin injection into “exercise” limbs
⬜ is a common cause of AKI in patients with Cirrhosis, but is a diagnosis of exclusion
what’s the maangement for this?
[HepatoRenal Syndrome (➜preRenal AKI)] = dx of exclusion]
________________
1st: [IVF bolus challenge] ➜
(if BP response = preRenal AKI from intravascular volume depletion)
(if no BP response) = HepatoRenal ➜ 2nd: ([Midodrine + Octreotide] + Albumin )
________________
Octreotide= somatostatin analog / Midodrine= Αlpha 1 agonist
⬜ is the GREATEST risk factor for Male Breast Cancer.
⬜ is the second greatest risk factor for Male Breast Cancer.
And ⬜ is the third greatest risk factor for Male Breast Cancer
________________
Etx for Greatest risk factor? ; etx for 2nd greatest risk factor?
BRCA mutation > > > Klinefelter Syndrome
> [LAME (Liver failure/(Always Eating {Obese})/Marijuana/(Estrogen:androgen ratio ⇪ {gynecomastia})]
________________
BRCA = auto DOM mutations ➜ [⇪ Male Breast CA risk x 100]
[klinefelter syndrome XXY] = male having extra “X” chromo ➜ [Estrogen:androgen ratio ⇪] ➜ [⇪ Male Breast CA risk x 20]
⬜ is the most common cause of [Dilated Cardiomyopathy HFrEF] and should be evaluated with what 2 test?
[Coronary Artery Diseasse] ;
stress test | coronary angiography
⬜ is the most late (months/years after exposure) complication of Lyme Disease
What is the tx for this?
[DOXY (or Amoxicillin) PO x 28 days]
Lyme Disease (Arthritis)
________________
septic arthritis = synovial fluid WBC > 50K
⬜ is the most late (months/years after exposure) complication of Lyme Disease
How is Lyme Disase diagnosed? -2
Lyme Arthritis [synovial fluid WBC 20-50K];
[serum ELISA + Western blot]
________________
septic arthritis = synovial fluid WBC > 50K
⬜ is the preferred imaging for Pyloric Stenosis
How does this present?
Abdominal ultrasound
________________
[newborn 4-8 weeks old] ➜ Non-bilious emesis withOUT abdominal distension
In Smokers, ⬜ may be first sign of Bronchogenic Carcinoma
Why is this?
[persistent Recurrent PNA]
________________
[Bronchogenic Carcinoma in older/Smokers or Carcinoid tumor in younger/nonsmoker] = endobronchial obstructing lesion ➜ ⬇︎clearance and eventually stasis of airway secretions
➜ [persistent Recurrent PNA (reoccuring despite previous tx successes)]
⬜ treats ALS. What the MOA?
________________
Amyotrophic Lateral Sclerosis
Riluzole ; [Glutamate R Blocker]
________________
progressive weakness + UMN AND LMN deficits + [cognition/ocular/bowel/bladder preservation]
