HY Review #3 part 2 Flashcards
Woman frequently has to pee & can’t get to bathroom in time
post-void residual volume is very LOW (~10s ml)
Dx/Tx
Urge incontinence
Muscarinic Antagonist (Oxybutyn)
Beta 3 agonist (Mirabegron)
Bladder muscle spastic/hyper-tonic/reflexive
Woman leaking urine
post-void residual (~100s ml)
± H/o DM or SLE
± Peripheral Neuropathy
Dx/Tx (2)
Overflow Incontinence
Muscarinic AGOnist (Bethanechol, Carbachol)
AchE inhibitor (Neostigmine)
Detrusor muscle hypotonic/ hypomobile/hyporeflexic
Chronic overflow bladder
symptomatic (tender suprapubic region)
Unable to void
Tx?
Catheterization
(scheduled if necessary)
increased intrabdominal pressure = leaking urine
weak pelvic muscles (hypermobile urethra)
BRF: multiparous or post menopausal (↓ E2) women
Dx/ Dxt/ Tx
Stress Incontinence
Q-tip test (+ if coughs & moves ≥30º )
Kegels
—-
(if not working → Mid-Urethral sling)
Pt got Botulism antitoxin or anti-venom
Or rituximab
1-2 weeks later has fever, malaise, urticarial rash and joint pain
Dx/Tx
Serum sickness (T3HSR)
discontinue offending agent
Streptococcal infection, sarcoidosis, fungal infections, pregnancy
can all cause what skin finding?
erythema nodosum
Pre-Teen or Teenager
Effects last lesson 1 hour and include:
Neuropsychiatric symptoms
(headache, ataxia, slurred speech, hallucinations, mood swings, AMS)
cardiac symptoms
( dysrhythmia, tachycardia, orthostatic hypertension)
± dermatologic, ocular, otolaryngologic, respiratory or GI symptoms
Dx?
inhalant abuse
Patient with fatigue, fever, chills, and anemia
↑ LDH, ↓ Hct/Hb
recent exposure to endemic region ( Africa or Central/ South America)
± Cyclic fevers (2-3 days)
Cx: cerebral dz/renal failure
Dx?
Malaria
Primaquine (Ovale & Vivax)
Rapid antigen testing → trophozoites and schizonts in RBCs (eggs)
(Plasmodium spp. → Anopheles mosquitoes)
40-50F Multi-gravid
heavy, painful menstrual bleeding
Smooth, enlarged, globular, boggy uterus
Dx/Tx(2)?
Adenomyosis
Mirena IUD
—
Hysterectomy
(Endometrial glands in the myometrium)
Postmenopausal woman ( or premenopausal)
abnormal uterine bleeding
prolonged exposure to estrogen
(Obese, DM, Exogenous E2, nullparity)
normal PE → Pelvic U/S: enlarged endometrial stripe
dx?
endometrial carcinoma
Monoamniotic (one amniotic sac) pregnancies may result in (2 cx)
conjoined twins
cord Entanglement
Monochorionic (one placenta) pregnancies may result in (2cx)
Twin-Twin transfusion syndrome
Selective fetal growth restriction
Ulcer found on a friable cervix
painless vaginal bleeding (with or w/o sex)
Dx?
Cervical cancer
(70% squamous cell carcinoma of ectocervix)
Soft, fleshy growths on genitals or anal canal. Generally do not ulcerate.
HPV associated
Dx?
condyloma acuminata
Female persistent nausea and vomiting
First trimester vaginal bleeding
uterine size larger than EGA
Pelvic exam → cystic clusters in the vagina
Pelvic U/S → diffuse echogenic structures + ovarian theca lutein cyst
Dx?
Hydatidiform mole
mcc (bug) of septic arthritis in children and adults
Staph A
65-year-old male with history of tobacco use.
NBSIM?
65-75 yo screening for abdominal aortic aneurysm
(Abdominal U/S)
Review following Info
Osteodystrophy: Short stature, developmental delay, round face, hypocalcemia, Short finger or toes
Primary hyperparathyroidism:
↑ PTH ↑ Calcium & ↓ phosphate, wnl Vit D → renal failure, bone reception.
Osteomalacia/Rickets: ↑ PTH ↓ Calcium ↓ phosphate, ↓ Vit D, ↑ ALP
CKD: ↑ PTH ↓ Calcium ↑ phosphate, ↓ Vit D
Osteomalacia (adults) → Bone pain
Rickets (children) → bone deformities (bowed legs/Varum)
Painless Jaundice and Weight Loss
Can’t miss dx?
Pancreatic Cancer
Acute nausea, vomiting or anorexia
RUQ abdominal pain, jaundice, and tender hepatomegaly
↑ LFTs
Recent exposure to contaminated water and food
(ex: raw shellfish, cruise ship, travel)
dx/tx?
Hepatitis A
Supportive Care
Vibrios cause diarrhea
Fever, headache, seizures, FND, and AMS.
inflammation in the temporal lobe on CT
Dx?
Herpes simplex Viral Encephalitis
Acute Decompensated CHF can cause Cardiogenic Shock
__ Cardiac Index
__ CVP, PCWP, SVR
↓ Cardiac Index
↑ CVP, PCWP, SVR
Pt with Rheumatoid Arthritis is about to get surgery.
NBSIM?
Lateral X-Ray for Cervical spine
(flex/ext)
Microcytic Anemia + Weird Hgb labs
± Weird RBCs on smear
Dx?
Thalassemia
example: ↓ HgA ↑ HgA2 ↑ HgF
(FYI: SCC = ↑ HgS & ↑ HgF)
Which Antithyroid medication is the ONLY one that can be used in pregnant patients within 12 weeks pregnancy?
PTU
Exercise stress testing is appropriate for patients with (2)
normal resting ECGs
&
ability to exercise
(contraindicated in aortic stenosis, osteoarthritis, Exertional dyspnea, etc.)
A patient who has expressed desire for end of Life Care supersedes other sources of this information such as previous advance directives or family member wishes.
As long as pt has
Capacitance
(Able to communicate verbally or nonverbally & has been making care decisions consistent with previously stated values)
Alzheimer disease initially presents with memory impairment. Neuroimaging generally demonstrates
temporal lobe atrophy
Frontotemporal dementia, age of onset 50-60s
presents with personality changes and loss of social inhibition. Neuroimaging shows atrophy of
Frontal lobe
ventriculomegaly in the absence of cortical atrophy is more suggestive of ___.
Triad of cognitive impairment, gait disturbance, and bladder incontinence
NPH
Characterized by the presence of both upper (spasticity, hyperreflexia)
and
lower (fasciculations, atrophy) motor neuron lesions.
Initially presents with bulbar weakness (difficulty swallowing, speaking, drooling, choking, tongue atrophy/fasciculations)
Amyotrophic lateral sclerosis (ALS)
stepwise/ worsening decline in executive function + memory loss
Vascular Dementia
Asymmetric Resting tremor
decreases with voluntary movement
“Pill-rolling”
shuffling gait with quick, short steps
Bradykinesia
Rigidity
Dx?
Parkinson Disease
Elderly pt with cognitive fluctuations, visual hallucinations, and parkinsonism. Dx?
Contraindications?
Dementia with Lewy bodies
(hallucinations before or with motor sxs)
Antipsychotics are c/I
The cardinal signs of Parkinson disease are (3)
Need 2/3 on physical exam to diagnose.
resting tremor
rigidity
bradykinesia
4 yo M presenting with acute onset testicular pain. PE is notable for a “bluish nodularity” and tenderness at the upper pole of the R testicle.
Dx/Tx?
Blue DOT Sign (one or many) →
Torsion of the Appendix Testes
Supportive care
Mgt of an RCA infarct II,III,aVF (what should be given)?
Normal Saline
45M obese + RUQ pain
The radiologist incidentally discovers multiple regions of signal hypoattenuation in the liver.
Negative alcohol use & hepatitis serologies
(except for HBsAb vaccination)
dx
Non-alcoholic Fatty Disease (NAFD)
Non-alcoholic Fatty Liver Disease (NAFLD)
↓ (progresses to)
Non-alcoholic steatohepatitis (NASH)
Kind that progresses to cirrhosis:
Reducing risk of progression to cirrhosis (2)
cirrhosis: NASH
Reducing risk : Weight-Loss ± vitamin E
─
Metabolic syndrome → high risk of CVD
↑ TG, HTN, Glucose
↓ HDL
Central obesity
29 yo M with hypomagnesemia, megaloblastic anemia, and an elevated GGT presents for erectile dysfunction
dx?
Alcohol use d/o
Causes ED
MCC of erectile dysfunction in these scenarios?
- 49 M recently started on therapy for angina.
- 32 M recently started on therapy for MDD.
- 23 M recently started on therapy for hallucinations.
Beta Blocker
SSRI/ SNRIs
Risperidone (↑ Prolactin)
Name sites & affected functions if lesion is present
A: LMNs (Anterior Horn) → Ipsi motor
B: STT → Contra pain/temp
C: Dorsal Column → Ipsi Propio/Vibration
D: LCST → ipsi motor (contra brain affected)
headache
blurry vision
Rock hard Pupil
Dx/contraindication?
Acute angle closure glaucoma
(beta/alpha adrenergic agonist are contraindicated bc → Dilate pupil)
shining light in R eye = no pupillary response in both R&L eye
But
shining light in L eye = Miosis in both L&R eye
Locate Lesion
R optic nerve (CN2– afferent)
shining light in R eye = no pupillary response in L & R eye
shining light in L eye = Miosis in L eye only
Locate Lesion
R optic-motor nerve (CN3–efferent)
efferent has one pupil that NEVER constricts no matter what eye you shine light on
General Region of lesion in homonymous hemianopsia (3)
Optic tract
Optic radiations
Optic MIDLINE chiasm
Sneezing, rhinorrhea for 5 days then many weeks of post-tussive emesis/syncope/conjuctival hemorrhage. Wakes up with a red eye.
± Crazy high WBCs
Dx/Tx/ppx
Pertussis (whooping cough)
Macrolide
(ppx) Treat close contacts too!
10 child with intermittent Fevers + “salmon colored” rash on the trunk + Knee pain for weeks ( ± ankle, wrist pain)
Lymphadenopathy
Dx?
Systemic juvenile rheumatoid arthritis
(Steele’s/ Stills disease)
Tx: NSAIDs
Female Child with fevers + asymmetric, multiple joints pain + eye problems
± rash on trunk & ANA (+)
Dx/Cx/screening?
Oligoarticular juvenile rheumatoid arthritis
Anterior uveitis
Annual slit lamp eye exams
Tx: NSAIDS
Good prognosis
7 M w/recent episode of AOM.
Now has fever + R hip and knee pain + painful limp
Full range of motion
Joints are not warm or erythematous
dx/tx
Transient Synovitis
Acetaminophen
━
(Recent infection + painful Limp + normal PE)
Septic arthritis vs osteomyelitis on NBMEs.
━
septic arthritis =
Osteomyelitis =
septic = JOINT tenderness
Osteomyelitis = BONE tenderness
Bugs causing Osteomyelitis
Step on Nail →
Dog/cat bite →
MCC overall →
Step on Nail osteomyelitis → Pseudomonas
Dog/cat bite osteomyelitis → Pasturella Multicida
MCC osteomyelitis → Staph A.
7M recent trip in New England, MA.
R knee pain + Red, circular rash on the RUE.
Diagnosis?
Treatment:
Treating the pregnant:
Treatment if neurologic (meningitis) disease or cardiac problems are present:
Lyme disease (>36hrs stuck)
Doxycycline
Treating the pregnant: Amoxicillin (2nd line: Doxycycline)
Neuro/Cardiac problems: CTX (not Doxy)
Bilateral conjunctival injection, fissured lips,
L sided (unilateral) anterior cervical Lymphadenopathy,
T 104, pedal/hand edema (or rash).
Plt count is 900,000.
Dx/Tx?
(HY) RUQ pain present?
Kawasaki’s disease
Aspirin + IvIg
Gallbladder hydrops
Sick child gets aspirin
becomes comatose
hypoglycemic
and dies
Dx?
Reyes syndrome
How do we treat newborns from a mom with varicella?
VZV immuneglobulin (VZIg)
given for passive immunity
(too young for VZV vaccine)
Child with Rash on face that goes down trunk
posterior auricular LND
red spots on the buccal mucosa
dx?
Rubella (Red spots)
aka German Measels
Child 3 days ago was Febrile (105ºF) has now developed a red rash on the face and trunk.
Roseola (HHV6) → Exanthem subitum
Cough, runny nose (choriza),
b/l conjunctival injection,
rash below neck going downwards
white spots on the buccal mucosa
dx/tx?
Measels (Rubiola)
Vitamin A (Reduces morbidity)
15 yo child with history of Measels becomes comatose and dies?
Dx?
SSPE (subacute sclerosis panencephalitis)
100% mortality
Child with vesicles in posterior oral cavity (Herpangina)
+ vesicles and papules on the hands and feet.
Dx/Tx?
HFM disease (Cox A virus)
Acetaminophen
Child with preceding flu like sxs later develops a bilateral lacy maculopapular rash on the cheeks.
Parvo B-19
kindergarten teacher w/joint pain OR sudden drop of Hgb with hemoglobinopathies.
dx?
Parvo B-19
Parvo B-19 in utero issues:
Hydops Fetalis → death (anemia)
9m infant is irritable + ear tugging
Mild fever and a red, bulging TYM on otoscopy.
Dx/Tx
Acute otitis media
First line: →amoxicillin
2nd line: → Amoxicillin + clauvanate (augmentin)
NBSIM for recurrent episodes of acute otitis media?
Tympanostomy tubes
White reflex in a newborn?
Dx/ Cx?
Retinoblastoma → Rb mutation
Osteosarcoma
Meniscus (fluid) behind TYM with no signs of inflammation/mild hearing loss/immobile TYM?
dx/tx?
Otitis media with effusion (aka serous otitis media)
no treatment
Sinusitis in a diabetic
Necrotic face and septic
dx/tx?
Mucormycosis (Rhizopus sp)
Tx: Amp-B +
Debride the face (surgical emergency)
Macroglossia, L side > R side of body (Hemihypertrophy), neonatal hypoglycemic seizures?
Dx?
Beckwith Weidermann Syndrome
─
Macroglossia, Seizures ± Wilm tumor/Hepatoblastoma
─
Hemihypertrophy → Pancreatic Beta Cell Hyperplasia → excessive Insulin production → hypoglycemia → Seizure
When should you introduce cow milk in a child’s diet?
Goat milk problems?
> 1 yo
─
Folate (B9) Deficiency
(child in rural area/farmer+ Macrocytic anemia)
Why are kids polycythemic at birth?
No lung use → relative hypoxia → EPO (↑) aka a lot of RBCs.
─
Once fetus in born they have a lot of RBCs and they breakdown those RBCs into INDIRECT bilirubin (jaundice)
Preemie with bilious emesis, bloody stools, and a distended abdomen.
Dx/ Classic imaging finding/ NBSIM?
Necrotizing enterocolitis
Abd XR = air in wall of bowel = Pneumatosis intestinalis
→ if perforated go to surgery
12 yo boy bedwetting with polydipsia + hyperglycemia
versus
12 yo boy bedwetting with polydipsia + Normal glucose + home/school problems.
T1DM
Psychogenic Polydipsia
Low birth weight, short palpebral fissures, flat philtrum, thin upper lip. Diagnosis & tip-off?
Philtrum problem = Fetal Alcohol Syndrome
(NBME like to mix presentations with FAS, but it is always FAS if ANYTHING is wrong with the philtrum)
Child with language delay + h/o of recurrent otitis media.
NBSIM?
perform Audiometry
─
(language delay = hearing problems on NBMEs)
Diagnosis of growth delay type:
Bone Age < Chronological Age → Dx/NBSIM
Bone Age = Chronological Age → Dx/NBSIM
Constitutional → get an X-RAY
Familial → Reassurance
(Neither ever drops from percentile lines, follow parallel)
Midline neck mass + moves with swallowing
Dx/Patho/endo or ecto derm?
Thyroglossal duct cyst
Foramen cecum (endodermal structure) doesn’t obliterate
Lateral neck mass + does not move with swallowing
Dx/Patho/endo or ecto derm?
Brachial Cleft cyst
2nd-4th pharyngeal grooves (ectodermal structure) don’t obliterate
What should a healthcare worker do when they encounter an unlabeled syringe?
Discard and report as an adverse event
A patient has severe post op respiratory depression. The anesthesiologist is finding it difficult to arouse him from the anesthetic he received. NBSIM?
Naloxone (mu antagonist)
FYI: anesthesia has opioids
23M recently treated for asthma exacerbation is now aggressive, hallucinating, and has altered mentation. Dx/Tx?
Steroid induced psychosis
Antipsychotic (Haloperidol)
The 2 HPV vaccine schedules?
<15 first dose → get 2 doses
>15 first dose→ 3 doses
How to reduce the risk of falling in elderly patients?
How to reduce the risk of falling in elderly patients on inpatient admission?
Fall Risk Assessment → Modify risk factors (drug list; walkers; bathroom rods)
Bed Alarms (inpatient)
27F with lower abdominal pain and fever 3 days after a C-section. Whiff test = fishy smell
Dx/Bug/Tx?
Endometritis
Ureaplasma Urealyticum
Doxycycline
URI 2 weeks ago now has a new S3 heart sound and lung crackles.
Dx/MCC?
Viral Myocarditis
MCC: Coxsackie B virus
─
URI then HF = COX B myocarditis
Newborn gets cyanotic hrs-days after birth. Supplemental O2 not helping.
Immediate NBSIM? :
General dx?
Alprostadil (PGE-1 analog) to open PDA before surgery
Cyanotic Congenital Heart Defect (masked by a Patent Ductus Arteriosus)
Brachial-femoral pulse delay in an infant?
Dx/Tx?
Coarctation of Aorta
Surgery
Infant with Loud P2 and cyanotic when crying.
Dx?
ToF
(TET spell)
Pulmonary vascular markings measure blood flow through pulmonary artery
(more blood = more markings)
Tetralogy of Fallot:
ASD/VSD:
TOF: ↓ Vasculature Markings ( s/t Pulmonic Stenosis)
A/VSD: ↑ Vasculature Markings (s/t L → R shunting)
Sequelae with non-treatment of VSD →
FYI: loud P2 = Pulmonary HTN
Initially: L → R acyonotic shunt
Next: Pulmonary HTN develops
Last: R→ L cyanotic shunt form
(Eisenmenger’s Syndrome)
Heart Shapes
Boot shaped heart:
Egg shaped heart/egg on a string:
Snowman heart:
Water bottle shaped heart:
Boot → ToF
Egg → TGA
Snowman → TAPVR
Water bottle → Cardiac Tamponade
Congenital heart dz mode of inheritance:
Most common congenital heart defect:
MOI → Multifactorial inheritance
MCC→ VSD
Nightmares vs night terrors?
Nightmares:
Terrors:
Nightmares: REM & Remember dreams
Terrors: N3 stage & no recollection
Round erythematous plaques with central clearing/scaly borders.
Dx/Tx?
MCC:
2nd MCC:
3rd MCC:
Tinea Corporis (Ringworm)
Topical Azole
Mcc: Trichophyton
2nd: Microsporum
3rd: Epidermalphyton
Tinea Capitis & Onychomycosis treatment:
ORAL Terbinafine
or
ORAL Griseofulvin
Formula for galactosemia:
MCCOD in galactosemia:
Formula for cow milk allergy (2):
Galactosemia → Soy milk formula
MCCOD → sepsis from E.Coli
Cow milk allergy → Soy Milk formula or Casein Hydrolysate formula
Contraindications to breastfeeding (5)
Infant w/ Galactosemia (soy milk only)
Mom on chemo
Active TB
HIV
Active substance use
Health benefits of breastfeeding.
Lowers risk of:
SIDS
Otitis media
Food allergies
Asthma
(weight loss for mom)
Rotavirus vaccine contraindications.
Disorders that cause GI bleeds (intusucception, MECKELS diverticulum, h/o Henoch Sch Purpura, h/o IgA nephropathy)
Cholinergic Toxidrome (↑ Ach)
Bradycardia, Sweaty, Drooling, Diarrhea, Miosis, Bronchocontriction/ wheezing
Ex: Pyridostigmine OD (Inhibits AchE) for Myastenia Gravis
Antidote for Cholinergic toxicity?
Atropine
(muscarinic antagonist)
