HY Review #3 part 2 Flashcards by Stephanie Escobar

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

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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

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Chronic overflow bladder
symptomatic (tender suprapubic region)
Unable to void
Tx?

Catheterization

(scheduled if necessary)

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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)

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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

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Streptococcal infection, sarcoidosis, fungal infections, pregnancy
can all cause what skin finding?

erythema nodosum

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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

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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)

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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)

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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

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Monoamniotic (one amniotic sac) pregnancies may result in (2 cx)

conjoined twins
cord Entanglement

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Monochorionic (one placenta) pregnancies may result in (2cx)

Twin-Twin transfusion syndrome
Selective fetal growth restriction

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Ulcer found on a friable cervix
painless vaginal bleeding (with or w/o sex)
Dx?

Cervical cancer
(70% squamous cell carcinoma of ectocervix)

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Soft, fleshy growths on genitals or anal canal. Generally do not ulcerate.
HPV associated
Dx?

condyloma acuminata

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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

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mcc (bug) of septic arthritis in children and adults

Staph A

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65-year-old male with history of tobacco use.
NBSIM?

65-75 yo screening for abdominal aortic aneurysm
(Abdominal U/S)

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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)

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Painless Jaundice and Weight Loss

Can’t miss dx?

Pancreatic Cancer

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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

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Fever, headache, seizures, FND, and AMS.
inflammation in the temporal lobe on CT
Dx?

Herpes simplex Viral Encephalitis

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Acute Decompensated CHF can cause Cardiogenic Shock
__ Cardiac Index
__ CVP, PCWP, SVR

↓ Cardiac Index
↑ CVP, PCWP, SVR

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Pt with Rheumatoid Arthritis is about to get surgery.
NBSIM?

Lateral X-Ray for Cervical spine

(flex/ext)

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Microcytic Anemia + Weird Hgb labs
± Weird RBCs on smear
Dx?

Thalassemia

example: ↓ HgA ↑ HgA2 ↑ HgF

(FYI: SCC = ↑ HgS & ↑ HgF)

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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)