High Yield Facts Flashcards
Cardiac tamponade
Beck’s triad
HoTN + distant heart sounds + JVD
Drugs that slow heart rate
BB, CCB, digoxin, amiodarone, adenosine
HOCM murmur
systolic ejection murmur heard along the lateral sternal border, increases w/ decreased preload (Valsalva)
Aortic insufficiency
Austin Flint murmur, a disastolic decrescendo, low-pitched, blowing murmur that is best heard sitting up; increases with increased afterload (handgrip)
Aortic stenosis
Systolic crescendo/decrescendo; increases with increased preload (squatting)
Mitral Regurg
holosystolic murmur; increases with increased afterload (handgrip)
Mitral stenosis
diastolic mid-to-late low pitched. Opening snap
Tx afib or a flutter
unstable = cardiovert stable/chronic = rate ctrl BB or CCB
Dressler’s syndrome
autoimmune rxn w/ fever, pericarditis + high ESR
2-4 weeks post-MI
Pulsus paradoxus
decrease in SBP > 10 w/ inspiration
cardiac tamponade
Pericarditis EKG
low voltage diffuse ST segment elevation
Indications for surgical repair AAA
> 5.5 cm, rapidly enlarging, symptomatic, ruptured
Tx acute coronary syndrome
ASA, heparine, clopidogrel, morphine, O2, sublingual nitro, IV BB
Metabolic syndrome
1) abdominal obesity
2) high TG
3) low HDL
4) HTN
5) insulin resistance
Med used for phramacological stress test
dobutamine
Target LDL pt w/ diabetes
< 70
Signs of active ischemia during stress test
angina
ST changes
decrease BP
Anterior/septal wall MI artery
LAD
Inferior MI artery
RCA
Posterior/left MI artery
left circumflex
young pt + angina at rest + ST segment elevation w/ normal cardiac enzymes
Prinzmetal’s
Common sx associated w/ silent MIs
CHF, shock, AMS
Diagnostic test for pulmonary embolism
spiral CT + contrast
Heparin antidote
protamine
What lab check w/ warfarin
PT
MCC HTN young women
OCP
MCC HTN young men
Etoh
MC type of skin cancer
BCC
Pearly papule + translucent + telangiectasias
BCC
Nikolsky +
younger
mucous membranes + flaccid blisters
Pemphigus vulgaris
Nikolsky -
autimmune + elderly
tense blisters
Bullous pemphigoid
puritic, purple, polygonal, planar, papules/patches
Lichen planus
steroids
Iris-like target lesion
erythema multiforme
pink, scaling flat lesion
spaghetti/meatballs on KOH
Tinea versicolor
Premalignant lesion for SCC
actinic keratosis
dewdrops on a rose petal
varicella
Exophytic nodules on skin w/ varying degrees of scaling or ulceration
SCC
HA + weakness + fatigue + polyuria
exam shows HoTN + tetany
labs = HoK, metablic alkalosis
primary hyper-aldosteronism (from Conn’s syndrome or bilateral adrenal hyperplasia)
tachy + wild swings in BP + HA + diaphoresis + panic
tumor of chromaffin tissue
assoc MEN 2a and 2B
paroxysmal (short/frequent) sx
pheo
tumor of chromaffin tissue
assoc MEN 2a and 2B
alpha blockers for pheo
phentolamine
phenoxybenzamine
Hx lithium + copious dilute urine
nephrogenic diabetes insipidus
tx central DI
DDAVP + free water restriction
antidiabetic med associated w/ lactic acidosis
metformin
weakness + nausea + vomiting + weight loss
tan skin
HoNa + HypK
primary adrenal insufficiency - addisons
gluco + mineral corticoids
treatment DKA
fluids
insulin
K+
Risk factors cholelithiasis
fat female fertile forty flatulent
MCC small bowel obstruction in pts w/ no hx abd surgery
hernia
Peritoneal signs + AXR shows free air under diaphragm. Management?
emergent laparotomy to repair perforation
Tx hepatic encephalopathy
decrease protein intake
lactulose
rifaximin
child w/ oliguria + petechiae + JAUNDICE
following illness w/ BLOODY DIARRHEA
HUS from e coli O157:H7
Hemolysis + uremia + THROMBOCYTOPENIA
causes of drug-induced hepatitis
TB meds (INH, rifampin, pryazinamide), acetaminphen, tetracycline
Tx IBD
5 ASA + steroids during acute exacerbations
extra intestinal manifestations of IBD
uveitis ank spnd p. gangrenosum erythema nodosum PSC
MCC cause diarrhea
campy
camping diarrhea
giardia
traveler’s diarrhea
ETEC
picnics/mayonnaise
s aureus
uncooked hamburgers
E O157:H7
poultry/eggs
salmonella
AIDs diarrhea
crytosporidium, MAC, isospora
pseudoappendicitis
Yersinia, Campy
post-HBV exposure tx
HBV immunoglobulin
40F, obese + itching + dark urine + clay colored stool
high bili, high alk phos
biliary tract obstruction
4 causes microcytic anemia
"TICS" Thalassemia Iron deficiency anemia of Chronic disease Sideroblastic anemia
precipitants of hemolytic crisis G6PD
sulfs, antimalaria drugs, fava beans
MC inherited hypercoagulability
Factor V
MC inherited bleeding d/o
von Willebrands
MC inherited hemolytic anemia
hereditary spherocytosis
Dx test for hereditary spherocytosis
osmotic fragility test
Meds/viruses that lead to aplastic anemia
Chloramphenicol Sulfonamides Radiation HIV Chemo hepatitis parvovirus B19 EBV
high hematocrit + high RBC mass + low EPO
polycythemia vera
TTP pentad
"FAT RN" fever anemia thrombocytopenia renal dysfunction neruo abnormalities
Tx TTP (thrombotic thrombocytopenic purpura)
emergent large volume plasmapheresis
corticosteroids
antiplatelets
what is CI in TTP
platelet transfusion
Tx ITP
resolves spontaneously
maybe IVIG/corticosteroids if unstable
which are elevated in DIC: fibrin split products, d-dimer, fibrinogen, platelets, hematocrit
high: fibrin split products + d-dimer
low: platelets, fibrinogen, HCT
8y/o boy
hemarthrosis + increased PTT
normal PT + normal bleeding time
Hemophelia A or B
DDAVP, factor 8 or 9 supplements
14 y/o F prolonged bleeding
normal PT
increased bleeding time
vW disease
DDAVP, FFP or cryoprecipitate
Monoclonoal gammopathy
Bence jones proteinuria
punched out lesions on XR
multiple myeloma
Reed-Sternberg cells
Hodgkin’s lymphoma
kid w/ fever, weight loss, night sweets
anterior mediastinal mass
non-hodgkin’s lymphoma
Microcytic anemia
low serum iron
low TIBC
normal/high ferritin
anemia of chronic disease
Microcytic anemia
low serum iron
high TIBC
low ferritin
Fe deficiency anemia
old
splenomegaly, lemphadenopathy
lymphocytosis (super high)
CLL
Satiety, splenomgaly, bleeding
t(9,22)
CML
Heinz bodies
intracellular inclusions
thalassemia
G6PD
postsplenectomy
virus assoc w/ aplastic anemia in sickle cell pts
parvoirus B19
Significant cause of morbidity in thalassemia pts: tx?
Fe overload
deferoxamine
What to do before LP
check for ICP via papilledema
Aplenic pts are susceptible to these organisms
encapulated organisms pneumococcus meningococcus H flu klebsiella
Pt from CA or AZ
fever + malaise + cough + night sweats
Coccidiodomycosis
Amp B
Blueberry muffin rash
cataracts
deafness
mental retardation
Congenital rubella
CSF low glucose, mostly PMNs
bacterial meningitis
CSF normal glucose, mostly lymphocytes
viral meingitis
high ICP
xanthochromia
RBCs in serial CSF samples
subarachnoid hemorrhage
CSF w/ high gamma globulins
MS
3 syphilis findings
tabes dorsalis - loss coordination
argyll roberson pupil - no reaction to light but ok accomodation
aortic root aneurysms
lyme disease sx
erythema migrans arthralgia migratory polyarthropathies Bell's palsy myocarditis
Cold agglutinins
mycoplasma
Dog or cat bite
pasteurella multocida PCN augmentin Cipro Doxy
Gardener w/ bumps/sores slow to heal
“rose gardner’s disease”
sporothrix schenckii
itraconazole
meningitis adults
N meningitidis
meningitis elderly
strep pneumo
Meningoencephalitis AIDS pt
cryptococcus neoformans
Red currant jelly sputum
alcoholic pneumonia
klebsiella
Infxn in burn victims
pseudomonas
smoker/drinker
new cough + flu-like sx + diarrhea
gram stain shows nothing
silver stain sputum = gram- rods
Legionella pneumonea
Macrolides
Quinolones
Organisms for reactive arthritis
chlamydia
campy
shigella
salmonella
pain/stiffness shoulders + hips
anemia
high ESR
polymyalgia rheumatica
MC primary malignant tumor of bone
multiple myeloma
“Broken speech”
type of aphasia, lobe, vessel
Broca’s aphasia
Frontal lobe
Left MCA
MCC SAH
trauma #2 is berry aneurysm
Crescent shaped hyperdensity that does not cross midline
subdural hematoma
torn bridging veins
initial AMS then lucid interval
epidural hematoma
middle meningeal artery
albuminocytologic dissociation
Guillain Barre
high protein in CSF w/o significant increase in cell count
caloric response to water in ear
COWS is normal
cold water = opposite
warm = same
confusion + confabulation + opthalmoplegia (eye muscle paralysis) + ataxia (loss ctrl bodily mvmts)
Wernicke’s
What % lesion is indication for CEA
70% if stenosis is symptomatic
combo UMN and LMN d/o
ALS
Tx Guillain Barre
IVIG or plasmapheresis
NO steroids
Complete hydatidiform mole on US
“snowstorm”
“cluster of grapes”
Abx w/ teratogenic effects
tetracycline
fluoroquinolones
aminoglycosides (“mycin”)
sulfonamides
Med to accelerate fetal lung maturity
Betamethasone or dexamethasone x 48H
Tx postpartum hemorrhage
uterine massage or oxytocin
Abx for GBS prophylaxis in pregnancy
IV PCN
ampicillin
heavy bleeding during and between periods
menometrorrhagia
amenorrhea w/ normal prolactin
no response to estrogen/progesterone challenge
hx D&C
Asherman’s
Med to induce ovulation
clomiphene citrate
Tx for endometriosis
OCP
danazol
GnRH agonist (Lupron)
Chocolate cysts
endometriosis
Natural progression of leiomyoma
regress after menopause
Annual screening for F w/ strong FHx ovarian CA
CEA 125
TVUS
unpredictable urine loss (urge incontinence) tx
anticholinergics (oxybutynin) B adrenergics (metroproterenol)
leakage urine w/ laughing/coughing (stress incontinence) tx
kegel
estrogen
pessaries
MCC female infertility
endometriosis
follow up for 2 consecutive finding ASCUS
colposcopy and endocervical curettage
Breast CA type that has high risk of invasive carcinoma in both breasts
Lobular carcinoma in situ
bilious emesis w/in hours after 1st feeding
duodenal atresia
neonate w/ meconium ileus
CF
failure to pass meconium for 48H
Hirschsprung dz
barium enema - narrowed distal colon w/ proximal dilation
rectal bx = no myenteric (Aurebach’s plexus) or submucosal (Meissner’s) plexus
tx: surgery colostomy then “pull through” procedure
high fever + onset rash as fever breaks
Roseola
HHV 6-7
risk for febrile seizures
Acute phase tx for Kawasaki disease
high dose ASA for inflammation/fever
IVIG to prevent coronary artery aneurysms
tx for mild and sever unconjugated hyperbilirubinemia
phototherapy (mild)
exchange transfusion (severe)
NO phototherapy for conjugated hyperbili
Sudden onset AMS + emesis + liver dysfunction + recent ASA intake
Reye’s syndrome
child w/ loss of red reflex
retinoblastoma
increased risk osteosarcoma
Vaccinations for 6mon WCE (6 total)
HBV DTap Hib IPV PCV Rotavirus
Red currant jelly stool
colicky abdominal pain
bilious vomit
sausage shaped mass
intussusception
target on US
air contrast barium enema = dx + tx
Croup cause
Parainfluenza virus
Peeling skin and swollen belly
Kwashiorkor (protein malnutrition)
Continous machinery murmur
PDA
tx w/ indomethacin
Webbed neck + shield chest
Coarctation of aorta
Lymphedema hands/feet as neonate
high FSH
Turner (45 XO)
Inactivated X (Barr body) hypogonadism, testicular atrophy, tall, female hair
Klinefelters (47, XXY)
Tx w/ testosterone
Rocker-bottom feet
overlapping 4-5 digits
micrognathia
Death w/in 1 year
Edward’s (Trisomy 18)
Simian crease, upslanted eyes
Duodenal atresia, Hirschsprung’s, ASD/VSD/PDA
increased risk ALL and Alzheimers
Down’s
Meiotic nondisjunction
Erythema Infectiosum
parvovirus B 19
slapped check
worse w/ sun exposure
aplastic crisis for sickle cell
Measles (Rubeola)
paramyxovirus
C’s - conjunctivitis, cough, coryza, Koplik’s
Rash spreads from head to toe
Rubella (3 day measles)
rubella virus
non-ill looking kid w/ rash spreads down from head to toe
Roseola infantum
HHV 6-7
High fever + rash starting on TRUNK and spreads outward
Febrile seizures
Varicella
VZV
vesicles in different stages of healing
infectious from 24H before eruption until crusted over
Reye’s Syndrome
symmetric proximal muscle weakness + difficulty breathing or swallowing
red/purple maculopapular rash
polymyositis
heliotrope rash (violet periorbital rash) shawl sign (rash of upper chest/shoulders/back) Gottron's papules (papular rash w/ scales on dorsum hand)
dermatomyositis
high CK
anti-jo-1 ab
polymyositis, dermatomyositis
anticentromere ab
CREST syndrome
Anti dsDNA, Anti-Sm, ANA
SLE NSAID - joints Corticosteroids - acute exacerbations hydroxychloroquine - skin/joints cyclophosphamide - lupus nephritis
Antinuclear, Anti-Scl-70, Antitopoisomerase 1
Scleroderma
Anti CCP, RF factor
RA Tx: methrotrexate hydroxychloroquine sulfasalazine
Complication supracondylar humerus fx
MC pediatric elbow fx
brachial artery entrapment
Alli’s/Galleazzi’s sign
knees unequal heights when hips/knees flexed = developmental dysplasia of hip
may be administered to a symptomatic pt to dx myasthenia gravis
edrophonium
Antidepressant assoc w/ HTN crisis
MAOI
mother angry at husband yells at child
displacement
pedophile enters monastery
reaction formation
pt calmly describing a grisly murder
isolation
hospitalized 10y/o begins to wet bed
regression
violent pt + vertical/horizontal nystagmus
phencyclidine hydochloride intoxication (PCP)
pupillary dilation + “cocaine bugs” (formication) + “chest pain”
haldol
sx specific meds (for HTN, tachcardia, etc)
crash w/ hypersomnolence, depression, malaise, angina, increased appetite
cocaine w/d
crash w/ anxiety, HA, stomach cramps, depression/dysphoria, hunger, fatigue
amphetamines w/d
pupillary dilation, psychomotor agitation, prolonged wakefulness
haldol
sx specific meds (antiemetics, NSAIDS)
pupillary constriction, CNS/resp depression, constipation
Naloxone
naltrexone
myalgia, fever, lacrimation, diaphoresis, DILATED pupils, yawning, piloerection, NV, diarrhea
opioid w/d
methadone
w/d not life thretening
rx for bulemia
prozac
Honeycomb pattern CXR
diffuse interstitial pulmonary fibrosis
supportive +/- steroids
non-caseating granuloma + increased ACE + hyperCa + hilar lymph
Sarcoidosis
Lung CA assoc w/ SIADH
small cell lung CA
Lung CA from cigarette exposure
small cell lung CA
ARDS
hypoxemia + pulm edema + normal pulm capillary wedge pressure (PCWP)
Silicosis increases risk of?
mycobacterium TB
Westermark’s sign, Hampton’s hump
S1Q3invT
Pulm embolism
polycystic kidneys assoc w/?
berry aneurysms
waxy casts + maltese crosses + lipiduria
nephrotic syndrome
low urine specific gravity + high serum osmolality
DI
tx SIADH
fluid restriction
demeclocycline
MC type testicular CA
seminoma (type of germ cell tumor)
Testicular CA assoc w/ bhCG, AFP
choriocarcinoma
MC histology bladder CA
transitional cell CA
complication of overly rapid correction hyponatremia
central pontine myelinolysis
Salicylate ingestion causes what type of acid-base d/o
anion gap acidosis + resp alk
3 systemic diseases that lead to nephrotic syndrome
DM, SLE, amyloidosis
tx ARDS
CPAP
acetminophen OD
N acetylcysteine
BZD overdose
flumazenil
Tx for neuroleptic malignant syndrome (muscle rigidity, hyperthermia, autonomic instability, extrapyramidal sx)
dantrolene
signs neurogenic shock
HoTN + bradycardia
sx increased ICP (Cushing’s triad)
HTN + bradycardia + abnormal respirations
low CO
HIGH PCWP
high peripheral vascular resistance
cardigenic shock
Test to r/o urethral injury
retrograde cystourethrogram
SVT tx
carotid massage
adenosine
Malignant htn tx
nitroprusside
HIGH CO
low PCWP
low peripheral vascular resistance
septic or anaphylactic shock
signs of air embolism
pt w/ chest trauma who was previously stable suddenly dies
sx cardiac tamponade
distended neck veins + HoTN + diminished heart sounds + pulsus paradoxus
absent breath sounds + dullness to percussion + shock + flat neck veins
massive hemothorax
Brown Sequard
same side motor/vib/prop
opp side pain/temp
Central cord
incomplete motor
some sensory
MCC - extension injury
Anterior cord
loss all motor
loss pain and temp
proprioception/vibration ok
Forchheimer spots
petechiae on the soft palate
rubella, measles, and scarlet fever
pattern of weight gain in kids: week 1, 6m, 12m, 3y, 4y
newborns lose 10% birth weight and back to weight at 10D 6m = 2x birth weight 12m = 3x 3y = 30lb, 30in 4y = 40lb, 40in
Barlow test
adduct + internal rotation
loud, harsh holosystolic murmur best at LLSB in child
VSD
musical/vibratory murmur at apex
Still’s murmur
staccato cough w/o fever
chlamydia pneumo
most serious complication kawasaki
aortic aneurysm
lazy eye
amblyopia
type of CXR for foreign body
expiratory view looking for hyperinflation due to air trapping
child
painful ulcers in mouth, feet and hands
coxsackie virus
MCC upper resp tract infection
rhinovirus
hyaline membrane disease on CXR
bilateral atelectasis or ground glass appearance
distal esophagus CA
adenocarcinoma
frequency screening endoscopy pernicious anemia pts
Q5y looking for gastric CA
NSAID highest rate PUD
naproxen
MC vessel blocked with intestinal ischemia
superior mesenteric artery
supplement for pts on sulfasalazine for IBD
folate
MCC folate deficiency
alcoholism
Tx for gastrinoma
PPI
hernia most likely to pass into scrotum
indirect
air fluid levels on AXR
bowel obstruction
MC location colorectal CA
cecum
normal fiber requirements in 1 day
30g
blood tests celiac dz
IgA endomysial Ab
IgA TTG ab
psoas sign
raise right leg against resistance
obturator sign
flexion + internal rotation right hip
pancreatic CA tumor marker
CA 19-9
steatorrhea
pancreatitis
Ranson’s criteria
55y+ WBC > 16k gluc > 200 LDH > 350 AST > 250
tumor marker liver CA
AFP
dysphagia to both liquids and solids
achalasia
med for hep B
lamivudine
tx hep C
pegylated interferon alpha2
hep B surface Ab?
recovery from infxn
or immunization to hep
hep B core Ab?
previous or going HIB infxn
viral hepatitis that is self limiting
Hep A and E
tx for gastric adenocarcinoma
surgery
Charcot vs Reynolds
Charcot = RUQ pain + fever + jaundice Reynolds = AMS + HoTN
PUD most common location
duodenum
tx for esophageal strictures
dilation
long term PPI
tx Mallory weiss tears
wait - typically resolve in 48H
to get Hep D must have?
Hep B
Hep B surfance antigen
active hep B infxn
MC location anal fissure
posterior midline
TLC in COPD
increases
crackles in lung fields: ddx?
pneumonia, fibrosis, CHF, bronchitis
hyperresonance to percussion: ddx?
emphysema, pneumothroax, asthma
wheezing: ddx?
asthma, COPD, bronchitis
eggshell opacities
silicosis
older pt
PNA + diarrhea
legionella pneumonia
honeycombing + tram tracks
bronchiectasis
idiopathic pulm fibrosis
what is erythema nodosum
tender red nodules usually found on the shins
erythema nodosum + enlarged parotided gland = ?
sarcoidosis
4 MC places lung CA mets to
bone, brain, adrenals, liver
centrally located lung CA
small cell
squamous cell
peripherally located lung CA
adenocacinoma
large cell
type of laxative:
polyethy glycol
bisacodyl
poly = osmotic lax bisacodyl = stimulant lax
virus assoc w/ burkitt’s lymphoma
EBV
Dx pertussis
PCR nasal secretion
tx w/ erythromycin
Premenstrual dysphoric disorder
anger/irritability
affects daily living
FB removal
rigid bronchoscopy
Rubulavirus
mumps
breakbone fever
Dengue
supportive
ARDS on CXR
diffuse infiltrates the spare costophrenic angles
MC cause bronchiectasis
CF
bullae and blebs on CXR
emphysema
FEV1 in asthma
decreases
MC cancers that mets to the lungs
breast, liver, colon
Asbestosis CXR
linear opacities at bases + pleural plaques
HACEK organisms most often cause what? list the organisms
community acquired carditis Haemophilus Actinobacillus Cardiobacerium Eikenella Kingella
Dullness to percussion
PNA
Dullness to percussion
rust colored sputum
PNA
Coal miner lung or silicosis CXR
nodular opacities in upper lung fields
Rust colored sputum
S. pneumo
MCC PNA in COPD pts
H flu
rats + PNA
yersinia pestis
aminoglycosides
college student + PNA
chlamydia or mycoplasma
gohn complex
ranke complex
caseating granuloma
TB
continue INH and RIF the longest
aerospace, nuclear plant workers
diffuse infiltrates + hilar adenopathy
berylliosis
MCC PNA in children < 1y
RSV
farsighted = ? nearsighted = ?
hyperopia; tx w/ convex lens
myopia; tx w/ concave lens
purulent d/c from eye:
2-5D after birth
up to 2wks after birth +/- PNA
2-5D = neisseria
2wks + PNA = chlamydia
hypopyon vs hyphema of the anterior chamber
hypopyon = WBC hypema = RBC
Hutchinson’s sign
HSV vesicles on nose, assoc w/ zoster in eye
sudden PAINLESS complete unilateral vision loss
opalescent retina + boxcarring
cherry red spot
CRAO
MCC viral conjunctivits
adenovirus
bilateral watery d/c w/ nontender preauricular LAD
Halos + rainbows around lights
moderate photophobia
bowing of iris
glaucoma
metamorphopsia + central blind spot
drusen deposits on fundus
distorted vision of grid lines looking wavy
macular degeneration
check w/ Amsler grid
unilateral vision blurriness
blood and thunder fundus
CVO
5 parts biophysical profile
non-stress test fetal breathing 2 gross body mvmts fetal tone amniotic fluid indix
procidentia
uterine prolapse beyond the introitus
due date for baby
1st day LMP + 1 week - 3 mon
metritis
MC infection 10D after C-section
reproductive CA that carries the highest rates of death in women
ovarian CA
when give rhogam
28 wks
mom rh-, dad rh+
bhCG positive after how many days
8 days past conception
vaginal candida on KOH
pseudophyphae
2 meds to induce labor
Cervidil (prostaglandin) for cervical ripening
Oxytocin for urterine contractions
why tell pregnant pts to avoid deli meats and soft cheese
listeria
MC type endometrial CA
adenocarcinoma
wks to do chorionic villus sampling
10-13 wks
PID vs ectopic, appendicitis, ovarian torsion, ovarian cyst
PID described as bilateral pain. others typically unilateral
preterm labor
contractions that open cervix before 37wk
wks to do amniocentesis
15-20 wks
gold standard chlamydia
nucleic acid amplification test
what dx is associated w/ thymoma
myasthenia gravis
tx acute dystonic rxn after giving neurleptic med
benztropine
diphenhydramine
(anticholinergics)
fever, hyperreflexia, tremor, sweating, dilated pupils, diarrhea
serotonin syndrome
cyproheptadine (anticholinergic/antihistamine)
tx candida intertrigio
topical econazole
painful ulceration + inguinal lymphadenopathy
H ducreyi gram- coccobacillus Azith Rocephin Cipro Erythromycin
Dx criteria or diabetes
- symptoms + random gluc > 200
- fasting plasma > 126 twice
- glucose > 200 2H after 75g glucose test
2 y/o
asx or painless rectal bleeding
Meckel’s Diverticulum
Dx w/ 99m technetium scan (nuclear med scan)
Hemophilia A vs B
A (A’ight) = factor 8
B (B-nine) = factor 9
ITCHING
fatigue
RUQ pain
AMA Ab, high liver enzymes
Primary biliary cirrhosis
Causes core pulmonale
Pulm HTN = right ventricular dilation
COPD, PE, fibrosis
MG
Sarcoid
hyperandrogenism
high LH
ovarian cysts
PCOS
same side sensorineural hearing loss + ataxia + tinnitus
poor word discrimination
Acoustic neuroma
when to check acetamiophen levels for toxicity
4H after reported time ingestion
140mg N-acetylcysteine, then 70mg Q4H = total 17 doses
Tx hypercalcemia of malignancy
bisphosphonates
loops, IV fluid
SLUDGE Salivation Lacrimation Urination Diarrhea GI cramps Emesis
Organophosphate poison
Atropine, Pralidoxime (2-PAM)
relapse/remission
15-50y
optic neuritis + fatigue
MS
Lhermitte sign
Periventricular plaques on T2 weighted MRI - demylination
Tx status epilepticus
1) IV lorazepam, diazepam, or midazolam
2) phenytoin or valproic acid
3) phenobarbital or propofol
young obese F
papilledema + diplopia (CN6 palsy) + loss peripheral visual fields
high opening pressure on LP
Idiopathic intracranial HTN (pseudotumor cerebri)
can be worsened w/ tetracycline, OCP, sulfonamides, macrobid
Diagnositic criteria gestational diabetes
1) 1h 50g glucose challened at 24-28 weeks
2) 100g glucose challenge shows (2) = 95+ fasting, 180+ 1H, 155+ 2H, 140+ 3H
HCAP
within 90 days of hospitalization
nursing home LTCF
hemodialysis
tx: cefepim, ceftazaidime, zosyn imipenem/cilastin,
gleason score
for prostate cancer (out of 10) lower number the better
Causes of transudative effusion
(intact capillaries) CHF cirrhosis Nephrotic syndrome PE
Vaccines C/I pregnancy
varicella
MMR
Zoster
any live virus
bacterial/viral infxn followed by: bilateral LE palpable non-blanching macules/patches abdominal cramps/bloody stool knee/ankle aches hematuria
IgA vasculitis
HSP
supportive tx
resolves in 6-8w
thick white curdy d/c
ph < 4.5
candida = pseudohyphae
frothy/green d/c
trich
thin, grey d/c
clue cells
BV
hx flu
fever + productive cough + bloody sputum + SOB
CXR: multiple cavitary lesions
post-viral PNA
MCC S aureus
MCC croup
parainfluenza virus
O2, IM steroids, neb epi
dx premature rupture of membranes
pooling test - amniotic fluid in fornix
nitrazine test - amniotic fluid turns paper from orange (intact) to blue
ferning (arborization)
2-6y/o child
acute post viral infxn
thrombocytopenia
petechia/purpura/gingival bleeding
ITP
corticosteroids
IVIG
splenectomy
2-10 y/o
subacute scrotal pain
dark blue dot upper pole
Torsion of appendix testis
MCC testicular pain boys 2-10
PNA + gram- coccobaccili
H flu
prophylasix menningococcal meningitis
rifampin
gram+ chains
strep
PCN, macrolides, cefs
tx toxoplasmosis
bactrim
is psudomanas gram + or gram - ?
pseudomonas = gram -
test for syphilis
dark field microsocpy/VRDL/RPR
confirm w/ Ab test (FTA-ABS)
treponema pallidum
Jarish-Herxheimer rxn to PCN
low RTC+ normal iron
anemia chronic disease
peripheral zone vs transitional zone: BPH vs prostate CA
BPH = transition
prostate CA = peripheral
MC bladder CA type
transitional cell
phren sign
lifting relieves pain = epididymitis
swelling/pain in cheek worse w/ meals
sialadenitis
s. aureus
tx epiglotitis
3rd gen ceph - cephalosporin, rocephin
most aggressive thyroid CA type
anaplastic
insulins in order of peak efficacy
lispro (1-2H)
regular (2-4H)
NPH (5-7H)
detemire/glargine (long axn - no peak)
tx dawn phenomenon
morning hyperglycemia from normal nighttime release of hormones (glucagon, cortisol, etc)
increase NPH
tx somogyi effect
rebound hyperglycemia after overnight hypoglycemia
decrease NPH
HTN, T2D, obeses, hair grown, striae, moon facies
Cushings
excess cortisol - check w/ dexamethasone suppression test and ACTH
hyperglycemia, hypoK
spironolactone or surgery
euvolemic hypoNa
SIADH - persistent ADH release, independent of serum osmolality
urinary sodium > 20
restrict fluids!
autoimmune adrenal cortical destruction
weakness, fatigue
salt craving + HoTN
hyperpigmentation
Addisons = cortical adrenal insufficiency
HoNa
HyperK, HyperCa
am cortisol < 3, confirm w/ Cosyntropin stimulation cortisol doesn’t raise >18
glucocorticoids and mineralocoritcoids (aldo)
young pt w/ HTN w/o RF or FamHx
HTN + HA + polyuria + muscle weakness
Hyperaldo - Conn's syndrome if there's an adrenal adenoma HypoK, HyperNa HypoMag aldo/renin activity ratio high CT/MRI spironolactone
Kussmal breathing
a deep and labored breathing pattern often associated with severe metabolic acidosis,
teardrop lesion after strep throat
guttate psoriasis
tx for high TG
fibric acid
left axis deviation
L1 up
AVF down
L = leaving each other
right axis deviation
L1 down
AVF up
R = heading right for each other
ddx w/ pulses paradoxus
pericarditis
pericardial effusion
obstructive lung disease
biphastic P wave
LAE
MCC subacute endocarditits
strep viridans
Balock procedure corrects what heart condition
tetralogy of fallot
Tx PDA vs VSD
PDA - indomethacin
VSD - surgery
MCC atrial septal defect
patent foramen ovale
MCC acute endocarditis
s aureus
vanc
how long to be on aspirin or clopidogrel after stent
1 yr
PMI from aortic stenosis
laterally displaced b/c LVH
tietze syndrome
costochondritis
best way to hear aortic regurge and stenosis
sitting up and leaning forwards
pulsus alternans
EKG waveform changes from beat to beat
large pericardial effusion
first line IV inotropic agent for cardiogenic shock
dopamine
INR:
mechanical valve replacement
organic valve
mechanical valve: 2.5-3.5
organic valve: 2-3
MCC CHF
coronary artery disease
after MI what med to tx HTN
BB
behavioral tx for borderline pts
dialectical behavior therapy
2 psych issues more common in M > F
autism
ADD
Cluster B
antisocial
borderline - neurotic + psychosis
histrionic
narcissistic
Cluster C
avoidant
obsessive compulsive
dependent
Cluster A
paranoid
schizoid - prefers to be alone
schizotypal - magical thinking
tx depression ok w/ breast feeding
zoloft
muscle weakness
fatigability that improves w/ rest
myasthenia gravis
ACh receptor Ab
intracranial neoplasm causing auditory illusions, olfactory hallucinations, and emotional changes: which lobe?
temporal
MC primary intracranial neoplams
glioma
tx tourette’s
haldol, fluphenazine: block DA
tx essential tremor
propanolol
primidone
stroke w/ aphasia, loss of hearing 1 hear, loss of vision 1 eye: what artery?
anterior cerebral artery
GABA and substance P
Huntington’s
3 tx cluster HA
O2
sumatriptan
stadol (butorphanol)
painful ipsilateral 3rd nerve palsy
posterior communicating artery (PCA) aneurysm
MC knee injury
medial meniscal tear
inability to extend knee after trauma
patellar fx
MC rotator cuff muscle injured
supraspinatus
elderly w/ leg shorted and externally rotated after fall
hip fx
HIV pt has severe groin pain
AVN of femoral head due to antiretroviral meds
MC fracture in a pt w/ osteoporosis
compression fx vertebral body, then hip fx
angulation Colles vs Smith
Colles = dorsal Smith = volar
hx Hep B
bilateral knee pain
fever + wt loss
polyarteritis nodosa
severe night bone pain
osteoid osteoma - benign bone tumor MC in femur and tibia
pain tx w/ ibuprofen
MCC compartment syndrome
tibia fracture
age to order DEXA scans
70 M
65 F
Austin flint murmur
low-pitched rumbling heart murmur which is best heard at the cardiac apex
mid-diastolic or presystolic murmur
assoc with severe aortic regurg
tx myasthenia gravis
pyridostigmine (anticholinesterase)
tx multiple sclerosis
steroids immunomodulators cylophosphamide IVIG plasmapheresis
nephritic ssx + coughing up blood
anti-glomerular basement membrane (Goodpasture syndrome)
tx plasmapheresis, corticosteroids, cyclophosphamide
MC primary glomerulonephritis
IgA nephropathy (Berger disease)
can be associated w/ URI
tx: ACEI/ARB or steroids
young male, black/hispanic
HTN + anemia + antiphospholipid Ab
Proetinuria > 500
lupus nephritis
Tx: ACE/ARB
7-10D after pharyngitis/impetigo
Post-infectious glomerulonephritis
Group A strep
IgG and C3 along basement membrane
ASO titers
rapid decline in kidney func
Crescents on microscopy
rapidly progressive glomerulonephritis
Types of nephritic syndromes (edema + HTN + coke/tea colored urin)
UNa > 2%
Rapidly progressive
Post-infectious
Berger disease (IgA)
Goodpasture’s
Types of nephrotic syndromes (proteinuria > 3 + hypoalbuminemia + hyperlipidemia)
minimal change disease
focal segmental glomerulosclerosis
membranous nephropathy
MC proteinuria renal disease in children
may follow URI
assoic w/ Hodkins
Minimal change disease
tx: steroids 8-16 wks
MCC nephrotic syndrome in adults that leads to ESRD
Black + overweight + HTN
Focal segmental glomerulosclerosis
tx: ACEI/ARB/statin, immunosuppressives, steroids
nephrotic syndrom associated w/ Hep B, CA, syphilis
Kidney bx = “spike and dome”
Membranous nephropathy
tx: ACE/ARB/statin, steroid, immunosuppressives
pre-renal AKI
hypoperfusion - dehydration
Na < 1%
BUN/Cr > 20
tx w/ IV saline
post-renal AKI
flow obstruction - pelvic tumors, radiation, prostate enlargement, stones
types of intrinsic renal disease
ATN
AIN
nephritc syndrome
vasculitis
Na > 2%
RF1 > 1
ATN
WBC casts (eosinophiluria) fever, rash
AIN
male child w/ infection
PALPABLE PURPURA on LE
joint aches
abdominal ssx - nausea, colic, melena
Henoch-Schonlein Purpura
(WITHOUT thrombocytopenia)
self-resolves
adenosine vs atropine
adenoSine = Slows (AV conduction via K+ channel activation) aTropine = Triggers the Ticker
rx tx for tachy in WPW
adenosine or CCB to block AV node
what med must be withheld 48H after contrast?
metformin
atrophy caudate and putamen of the basal ganglia
Huntington
tx w/ BZD, or DA antagonists (reglan)
what med class exacerbate huntingtons sx
dopamine agonists - worsens sx
erysipelas caused by?
strep pyogens
amoxicillin
keflex
rocephin
which is more sensitive: phalen vs tinel?
Phalen
imaging for congenital hip dysplasia before 6mon
US
Barlow vs Ortolani
Barlow - ADDuct = dislocate
Ortalani - ABDuct = reduction
anticholinergic sx: hot hare dry bone blind bat mad hatter red beet cause by what OD?
TCA
sudden onset unilateral (R > L) abd/pelvic pain
leukocytosis
W 15-30 or postmenopause
Ovarian Torsion
Dx TVUS
Gold standard: laparoscopy
MCC cyst or tumor
AV dissociation, wide complex, rate 150-200
VTach
pulseless: defibrilate
unstable: sync cardiovert
stable: meds
Med tx for stable V tach
amiodarone
procainamide
Bite
Neurotoxin
severe muscle cramping + CNS excitation
black widow (red hourglass) supportive (opioids, bzds)
Bite
Cytotoxin
tissue destruction
Brown recluse (brown fiddle) local wound care
MCC hyperosmolar hyperglycemic state
glucose 600+ without ketones
dehydration - tx w/ IVF
biphasic T waves V2-3
stenosis LAD
Coved ST seg elevation followed by negative T waves in V1-3
Brugada
AICD
horizontal ST depression with tall, broad R waves and upright T waves in leads V1-3
posterior MI
1) ST elevation in aVR > 1mm; or
2) aVR ST elevation > ST elevation in V1
3) ST depression in leads 1-2 and V4-6
left main coronary artery occlusion
bulge lateral to inferior epigastic vessels
can pass into scrotum or labia majora
M > F; congenital
indirect hernia
bulge thru weakened fascia of abdominal wall
behind superficial inguinal ring
medial to inferior epigastric vesels
direct hernia
Weber results
conductive loss = lateralization to affected side
sensorineural loss = lateralization to normal/better hearing side
Rinne test results
Normal = AC > BC
Conductive loss = BC > AC
difference in 1st-3rd degree burns
1st: superficial, epidermis
2nd: superficial partial - papillary dermis
2nd: deep partial - reticular dermis (white/leathery/painless)
3rd: hypodermis (subq - charred)
nephroblastoma
wilms tumor
good prognosis after surgery/chemo/radiation
what is S3 vs S4 assoc w/
CAD = systolic HF - S3 HTN = diastolic heart failure - S4
floppy ventricle
S3
stiff ventricle
S4
HTN, aortic stenosis
RF aortic aneurysm vs dissection
aneurysm - atherosclerosis
dissection - HTN, cocaine, bicuspid valve, collagen d/o
MCC bacterial trachitis
s aureus
kids 3-5y/o
looks like croup but TOXIC appearing
inverted P wave afer QRS
premature junctional contraction
flushing + diarrhea + pulm ssx
carcinoid tumor
24-hour excretion of 5-hydroxyindoleacetic acid (5-HIAA)
what is a carcinoid tumor
neuroendocrine tumors of the digestive tract, lungs, and less commonly of the kidneys and ovaries
secrete serotonin, histamine, catecholamine, prostaglandins
diastolic murmur (rumble)
left sternal border 4th
louder w/ inspiration
tricuspid stenosis
MC ekg finding in PE
sinus tachy
juvenile idiopathic arthritis tx
NSAIDs
methotrexate
steroids
diabetes insipidus lab values
low urine osmolality
high serum osmolality
tx diabetes insipidus
central: DDAVP
nephrogenic: HCTZ, amilioride, indomethacin
diarrhea, steatorrhea, gas, weight loss
IgA, anti tTG antibodies
Celiac disease
bx small bowel
dermatitis herpetiformis
