HWK SB3 (-5.5) Flashcards
W3 HWK blocks (39,40.5,42,43,45,46,48,49) Missing blocks 40,42,43,46,48,49
what are the anti-HTN lifestyle mods?
wt loss, exercise, DASH diet (incr fruit/veg, low fat), low salt diet, limit EtOH
if pt w/ HTN on meds presents w/ poor BP control and poor lifestyle, how do you manage their care?
- lifestye
2. adjust/add meds
when should you suspect endometriosis?
- chronic pelvic pain
- dysmenorrhea (cramps)
- deep dyspareunia (pain w/ sex)
- dyschezia (pain w/ BM)
- infertility
when should you do a laparoscopy to definitively dx endometriosis?
if NSAIDS and OCP fail to resolve s/s
what are pts w/ endometriosis @ incr risk for?
infertility
does endometriosis alter the nL menstrual cycle?
NO. will not lead to/include 2* amenorrhea in its presentation
how does AR (murmur) present on P/E
- diastolic decrescendo murmur
- widened pulse pressure (incr SBP, decr DBP)
- head bobbing
- water-hammer pulse
- pistol-shot femoral pulses
how do you position the pt to best hear AR?
- seated and leaning forward
- hold breath after full exhalation
what is the MCC of AR in young pts?
congenital bicuspid aortic valve
infant ARDS is caused by what?
decr surfactant
what are the RF for decr surfactant?
- prematurity ***
- maternal DM **
- male
- perinatal asphyxia
- csec w/o labor
what factors decr risk of ARDS in infants?
- intrauterine growth restriction
- maternal HTN
- PROM
- *incr stress on the baby –> earlier lung maturity
how do you manage uncomplicated PPROM @ <34wks?
- expectant management
- latency ABX (ampicillin & azithro)
- corticosteroids
- fetal surveillance
how do you manage PPROM @ 34-37wks?
+delivery
+GBS ppx (penicillin)
+/-corticosteroids
how do you manage complicated PPROM @ < 34wks?
- delivery
- IAI tx (ampicillin & gentamicin)
- corticosteroids
- Mg if <32 wks
when do you get erosive gastropathy?
after ischemia or gastric exposure to EtOH, ASA, cocaine, toxins/meds
will mallory-weiss tears occur w/ the first presentation of n/v
not typically
how does loperamide work?
decr H2O content of stool –> s/s relief of diarrhea
how does fecal impaction present on p/e
+/- distension
+/- diffuse tenderness
+/- palpable mass
b/c fecal impaction can be pretty benign on p/e, what should you key into to suspect this dx?
h/o constipation, impaired mobility, decr sens in rectal vault
what are the MCC of acute renal vein thrombosis?
- nephrotic synd
- malig
- trauma
how does renal vein thrombosis present?
- hematuria
- renovascular congestion
- flank pain
when do people w/ G6PD def present w/ s/s of hemolytic anemia?
when they are undergoing incr oxidative stress (think infx)
what meds should be avoided in G6PD def?
- dapsone (d…phenyl sulfone)
- isobutyl nitrate
- nitrofurantoin
- primaquine
- rasburicase
how does disseminated gonococcal infx present (triad)?
- polyarthralgias
- tenosynovitis
- vesiculo-pustular skin lesions
what can mucus plugging lead to?
large vol atalectasis (lung collapse) 2/2 airway obstruc
what is seen on CXR w/ mucus plugging?
- atalectasis (entire hemithorax)
- mediastinal shift towards atalectasis
- ribs approximate on bad side
how do you distinguish large pleural effusion from large volume atalectasis on CXR?
- pleural effusion = mediastinal shift away
- atalectasis = mediastinal shift towards
what ovarian tumor can present w/ concomittant endometrial hyperplasia/ca?
granulosa cell tumors
what are granulosa cell tumors?
estradiol-secreting ovarian sex-cord stromal tumors
what must you do prior to tx granulosa cell tumors?
check for endometrial hyperplasia/ca (endometrial bx)
why do you not use hysterosalpingogram in adnexal mass eval?
will not further define the mass or affecct the management
when do you use hysterosalpingogram?
infertility w/u
what is the most important RF for shoulder dystocia?
fetal macrosomia
apart from fetal macrosomia, what are other RF for shoulder dystocia? (hint: think what causes big babies?)
- maternal obesity
- excessive pregnancy weight gain
- gestational DM
- post-term delivery (>42wks)
how does neuroblastoma present?
- avg age < 2yrs
- abd mass
- periorbital ecchymoses
- spinal cord compression
- horner synd
- unilat facial flushing (dry side won’t flush)
how does horner synd present?
- ptosis (lid-lag)
- myosis (pupils constricted)
- anhydrosis (dry)
what are two common childhood brain tumors?
- medulloblastoma
- pilocytic astrocytoma
where do medulloblastoma and pilocytic astrocytoma typically arise?
cerebellum
presentation of medulloblastoma and pilocytic astrocytoma typically involves what?
+ataxia
+dysmetria
- (NO) horner synd
how should you deliver bad news?
- private setting
- w/ empathy (duh)
- stay to answer Qs and concerns when they are ready
- don’t offer reassurance or guarantees other than that you will be there with them
what is Felty synd?
complication of seropos RA
how does Felty synd present?
RA s/s \+neutropenia \+splenomegaly \+ incr RF \+incr anticitrullinated peptide Ab
hypocellular BM is seen in what condition?
aplastic anemia
what finding of Felty’s synd is atypical in aplastic anemia?
splenomegaly
what is a major toxicity of Mycophenolate?
bone Marrow suppression
what are the major toxicities of azatHioprine?
dose-related diarrHea, Hepatotoxicity, and leukopenia
what are the s/e of cyclosporine?
- nephrotoxic
- incr K
- HTN
- gingeval hyperplasia
- hirtuism
- tremor
what are the s/e of tacrolimus?
- nephrotoxic
- incr K
- HTN
- tremor
what two side effects are seen w/ cyclosporine use but not tacrolimus?
- gingeval hyperplasia
- hirtuism
how does Rett synd present?
- nL development until age 6-18mos
- regression of speech
- gate disturbance
- loss of purposeful hand motions + pill rolling
how does Angelman synd present?
- delayed development
- intellectual disability
- happy
- jerky gait
- hypermotoric behaviors
- hand flapping
angelman’s hand presentation?
hand flapping
Rett’s synd hand presentation?
pill rolling
how do external hemorrhoids present?
- purple/dusky color
- itching/bleeding
- thrombosed = growing and painful
what does pernicious anemia cause and how does it present?
- MCC of vit b12 def
- macrocytic anemia
- hypersegmented PMNs
- mild leukopenia
- mild thrombocytopenia
- GLOSSITIS!
pt presents w/ a smooth, shiney tongue. what is this called and what are 2 possible dx?
- glossitis
1. vitB12 def (likely 2/2 pernicious anemia)
2. vitC def (scurvy)
ADHD criteria for dx = ?
- inattentive AND/OR hyperactive s/s >= 6mos
- onset < 12 yo
- s/s occur in 2+ settings
how does hepatic adenoma present on CT?
=centripital enhancement. NO CENTRAL SCAR
what is focal nodular hyperplasia?
benign liver lesion 2/2 aberant congenital artery
what does focal nodular hyperplasia look like on imaging?
- solid mass
- STELLATE CENTRAL SCAR
- radiating fibrous bands
what is the MC malig to manifest in an upper cervical lymph node?
head and neck SCC
what is often the 1st/only apparent manifestation of head/neck SCC?
palpable painless cervical lymph node
where do the vast majority of cervical nodal SCC arise from?
mucosal surfaces of the head an neck?
what test is best to eval/dx probably SCC of the head/neck?
laryngopharynoscopy
what are the types of throid ca?
- papillary
- follicular
- medullary
- anaplastic
* *NO SCC OF THE THYROID**
if decr Ca and decr Mg, what do you do?
- tx underlying cause
- replace Mg
- IV Ca (for severe s/s)
what group of pts is @ incr risk of decr Ca and decr Mg?
alcoholics
how does decr Mg –> decr Ca?
decr Mg –> decr PTH release –> decr Ca
–> incr PTH resistance –> decr Ca
if extracellular deposition of Ca –> decr Ca 2/2 pancreatitis. how will pt present?
chronic abd pain + features of pancreatitis
how will a sertoli-leydig tumor present?
- rapid onset virilization
- oligomenorrhea
- unilat, solid adnexal mass
what are s/s of virilization?
- deepening of voice
- male pattern baldness
- incr muscle mass
- clitoromegally
what will present w/ sertoli-leydig tumors but not in PCOS that allow you to distinguish btwn the two?
SL: marked incr testosterone –> virilization
PCOS: incr testosterone isn’t high enough to cause virilization
what should you evaluate for if rapid onset (<1yr) virilization?
androgen secreting tumors in ovary or adrenal gland
how do you distinguish btwn ovarian and adrenal cause of virilization w/ labs?
- ovarian: incr T, nL DHEAS
- adrenal: nL T, incr DHEAS
how do you tx stress incontinence?
- kegels
- pessary
- sx (midurethral sling=MC)
what bladder dysf(x) is tx w/ antimuscarinics (oxybutinin)?
urge incontinence (b/c antimuscarinics tone down bladder activity by causing detrusor relaxation)
how do cholinergic agonists (bethanacol) work to tx overflow incontinence?
stimulate bladder contraction (force bladder to release urine on command)
what group of meds has the opposite effects of antimuscarinic meds?
cholinergic agonists
