Incorrects 3 Flashcards
How does obesity contribute to endometrial adenocarcinoma occurrence?
Estrogen prodxn in fat cells lead to proliferation.
Beckwith-Wiedemann Syndrome Sx?
Hypoglycemia
Fetal macrosomia (rapid growth until late childhood)
Omphalocele or umbilical hernia
Macroglossia
HEMIhyperplasia (one side of body larger than other)
***Wilms tumor and hepatoblastoma may occur as complications.
Congenital hypothyroidism Sx?
Macroglossia and umbilical hernia are common. No sugar or odd grwoth abnormalities occur.
Limbs usually affected in anterior cerebral artery stroke?
Lower»upper. Contralateral motor and/or sensory deficits.
Limbs affected in middle cerebral artery stroke?
Lower AND upper.
How does MCA infarct affect speech?
Aphasia if dominant hemisphere affected (left hemisphere in right handed and usually left hemisphere in left handed).
Hemineglect occurs if nondominant hemisphere.
MC heart defect in kids?
VSD.
VSD sound?
Holosystolic murmur. May have diastolic murmur if increased flow across mitral valve.
Widely split and fixed S2 w/ systolic ejection murmur in LUSB?
ASD.
ASD sound?
Widely split and fixed S2. Systolic ejection murmur in LSB.
Tetrollogy sound?
Harsh, systolic ejection murmur over LUSB due to pulmonary stenosis.
Dx of chronic vs gestational HTN in pregnant female?
Chronic: ≥140/90 prior to 20 weeks gestation
Gestational: New elevated BP if ≥20 weeks gestation
Dx of gestational HTN vs preeclampsia?
Gestational HTN: BP elevated ≥20 weeks gestation, but no proteinuria OR end organ damage as in preeclampsia
Pregnancy related HTN risks?
Maternal: hemorrhage, DM, abruption
Fetal: Growth restriction, preterm delivery, oligohydramnios
Uterus characteristics in Adenomyosis vs fibroids?
Adeno: uterus is uniformly enlarged
Fibroids: nonuniformly enlarged uterus
Endometrial hyperplasia with atypia is usually a cause of bleeding in what population?
Post-menopausal women.
Cauda equina Sx?
Bilateral/unilateral severe radiculopathy
Saddle anesthesia
Asymmetric motor weakness (spinal nerve roots unevenly compressed)
Hyporeflexia (LMN)
Late bladder/Bowel dysfxn
Conus medullaris syndrome Sx?
Severe back pain, but less radiculopathy Perianal anesthesia Symmetric motor weakness Hyperreflexia (UMN) Early onset bowel/bladder dysfnx
Rx if cauda equina or conus medullaris synds. suspected?
MRI
IV glucocorticoids
Neuro surgery eval
Classic triad of serum-sickness-like rxn?
Fever
Urticaria
Polyarthralgia
Serum sickness rxn commonly caused by what meds?
ß-lactams
TMP-SMX
***Rx: remove drug
Serum sickness pathology?
Immune complex formation leads to fever, rash, polyarthralgia
Rash in scarlet fever?
“sandpaper” rash following strep pharyngitis
Rash in acute rheumatic heart disease?
Erythema marginatum. Rash has a thin barrier at the margins of the rash accompanied by other “JONES” criteria.
Henoch-Schönlein rash?
Palpable purpura on lower extremities
Mononucleosis rash?
Occurs if treated with aminoPCN (eg amoxicillin). Morbilliform (measles-ike - red spots 2-10mm) rash on the trunk develops.
When should dextrose 5% be used?
Maintenance fluids only, never for initial fluid resuscitation.
What is used as initial fluid resuscitation?
Isotonic saline or ringers
Stable patients with blunt GU trauma and hematuria require what tests?
UA and contrast-enhanced CT of abd/pelvis
Unstable Pts with evidence of renal trauma (hematuria after blunt trauma) require what tests?
IV pyelography prior to surgical eval
Doctors may accept gifts from pharmacy companies only under what conditions?
The gifts are: Nonmonetary
Of small value
Directly benefit patient care
Child presents with pharyngeal pain, fever, and earache. He has trismus and a muffled voice. PE reveals deviated uvula. Dx? Rx?
Peritonsillar abscess. Needle aspiration or I&D plus ABx Rx.
Erythrocyte sedimentation rate can be used to differentiate between viral Parvo infxn joint pain and RA or SLE how?
RA and SLE have elevated ESR levels, but parvo does not.
Fetal surveillance for hypoxia begins when?
41 weeks gestation using Biophysical profile
B12 deficiency leads to destruction of what part of spinal cord?
Dorsal (vibration/point discrimination) and lateral spinal tracts (aka subacute combined degeneration).
A supratentorial white matter lesion usually leads to what dysfxn?
Contralateral hemiparesis and/or sensation changes
A patient with MS and complaining of difficulty breathing may have a lesion at what level on MRI?
C3-5 as the phrenic nerve can be involved.
An acute lesion to the brainstem would cause what dysfxn, where?
Ipsilateral cranial nerve dysfxn and contralateral motor weakness/sensory changes
First step in evaluating a thyroid nodule on PE?
TSH and US; often followed by FNA whether suspicious for cancer or not, and whether normal, low, or elevated TSH. If Low TSH do Iodine 123 scintingraphy. If “hot” treat hyperthyroid and no FNA needed.
What is the primary treatment in borderline personality disorder?
Psychotherapy (dialectical behavior therapy). Adjunctive mood stabilizers or 2nd gen antipsychotics may be used and/or SSRI for mood Sx.
Which arrhythmia is most specific to digitalis toxicity?
Atrial tachycardia with AV block. Digitalis can increase ectopy in the atria or ventricles and lead to atrial tachycardia.
Initial imaging needed in suspected cardiac tamponade?
Echocardiogram.
Luteomas result in what Sx in a pregnant female?
Virilization (hirsutism, acne, etc.) due to increased androgen prodxn. Often regress after pregnancy.
Theca luteum cysts are often associated with what during pregnancy?
Molar pregnancy and multiple gestation. Regress after pregnancy. Usually do not cause virilization of female fetus.
40s female presents with solid ovarian masses on US and is later discovered to have GI tract cancer. What are the ovarian masses called?
Krukenberg tumor. Can lead to virilization of female and fetus. As it is a cancer, often accompanied by weight loss, abd. pain, etc.
Hypercalcemia leads to what kind of intestinal symptoms?
Constipation (One of the “Groans” in hyperparathyroidism).
A female with floaty, stinky, greasy stools and diarrhea occasionally without blood or tenesmus for a year may have what Ca++, PO4-, and PTH levels?
Ca++ and PO4- low and high PTH. Chronic steatorrhea can lead to poor Vitamin D absorption and hypocalcemia and a secondary hyperparathyroidism.
Cerebellopontine angle tumor Sx?
HA
Hearing loss/tinnitus
Vertigo
GBM tumor Sx?
Progressively worsening HA
Visual changes
Motor weakness
Cognitive deficits
Pseudotumor cerebri Sx?
Usually women <45 HA Transient visual Sx Pulsatile tinnitus PE: Papilledema w/ visual field loss and sixth nerve palsy (abducens)
Temporal lobe stroke leads to what visual changes?
Homonymous superior quadrantanopsia. The inferior optic radiations of the loop of Meyer would be effected.
Two MC organisms found on brain abscess?
S. Aureus
Strep viridans
***Often from adjacent infxn (sinuses, otitis, dental infxn).
Management of brain abscess?
Emperic IV Abx (metronidazole, ceftriaxone, and vanco)
Aspiration of lesion
What is the most critical intervention with autism disorders?
Early detection and intervention at ages 2-3 can significantly improve symptoms.
Dorsal tract destruction Sx?
Position/vibratory sense loss, positive Romberg
Lateral corticospinal tract destruction Sx?
Spastic paresis
Hyperreflexia
Spinocerebellar tract damage Sx?
Ataxia
Pt presents with ascending symmetric muscle paralysis and reduced DTRs after diarrheal infxn. Dx? Rx?
Guillain-Barre. IVIG or plasmaphoresis.
Immunoflorescenece findings in Pemphigous vulgaris?
IgG and C3 deposits in netlike fashion above basement membrane.
Rx for MDD with psychotic features?
Antidepressant and antipsychotic OR ECT
What is the major difference between MDD with psychotic features and schizoaffective disorder?
MDD w/ psychotic features presents with psychotic sx that occur ONLY DURING mood disturbances. Schizoaffective presents with psychotic Sx for ≥2 weeks in the absence of mood episodes.
Doxycycline is contra’d in Early Lyme disease for which patients?
Young (<8yo)
Pregnant women
Lactating women
Appropriate Rx for Early Lyme in following: Pregnant/lactating Child <8 Child >8 Amoxicillin/doxycycline allergy
Pregnant/lactating/child<8: Amoxicillin
Child/person>8: Doxycycline
Allergies to amox/doxy: Azithromycin
SE of oxytocin?
Hyponatremia (can lead to SZ) (due to water retention - Oxytocin has crossover Fx with ADH receptors due to similarity)
Hypotension
Tachysystole
Sx of magnesium toxicity?
Sedative Fx predominate. Hyporeflexia, lethargy, HA, resp failure, cardiac arrest. No Sz.
A child with vWF disease may have what lab abnormalities?
Normal PT
Prolonged bleeding time
Normal or prolonged aPTT (due to decreased factor 8)
What is intrauterine fetal demise?
Fetal death ≥20 weeks gestation confirmed by US by absence of cardiac activity.
Management of intrauterine fetal demise?
20-23 weeks: D&C or vaginal/Csxn (if prior Hx)
≥24weeks: Vaginal/csxn
Management of mild hemophilia A?
Desmopressin (stim vWF and therefore factor VIII release)
What is CO2 narcosis?
On ABG when PaCO2>60. Hypercarbia (often from hypoventilation in COPD) can lead to retention of CO2 and lethargy.
Metabolic abnormalities expected in AKI?
Either non-anion gap metabolic acidosis from impaired acid excretion or poor bicarb reabsorption OR an anion gap acidosis from retention of uric acid.
An ethnic male appears in the ER with pneumonia. Xray shows nodular infiltrates in the upper lobes and enlarged mediastinal nodes. Bronchoalveolar lavage reveals weakly acid fast bacilli. Dx?
Nocardia. Can appear like TB, but are weakly acid fast whereas TB is strongly acid fast. Also, they are branching and filamentous, unlike TB.
Cryptosporidium Sx?
Severe watery diarrhea with weight loss and mild fever in HIV Pt with CD4 under 200.
Mycobacterium avium complex Sx?
Watery diarrhea with high fever (39°C or 102.2°F) and weight loss in HIV+ Pt with CD4<50.
Waldenström macroglobinemia Sx?
Hyperviscosity syndrome (2° to elevated IgM - diplopia, tinnitus, HA, dilated/segmented fundoscopic vessels) Abnormal bleeding Neuropathy Hepatosplenomegaly Lymphadenopathy
Multiple Myeloma Sx?
Osteolytic lesions/Fx and bone pain
Hypercalcemia
Anemia
Renal insufficiency
Monoclonal antibodies in Waldenström vs Multiple myeloma?
W: IgM (Clonal B cells)
MM: IgG, IgA, light chains (Clonal plasma cells)
Dx of Waldenström macroglobinemia?
Serum protein electrophoresis reveals monoclonal IgM (M-spike). Dx confirmed by bone marrow biopsy finding >10% clonal B cells.
Monocloncal gammopathy of undetermined significance Dx?
M-spike (usually due to IgA, IgG, or IgD - IgM only 15% cases)
Biopsy reveals<10% monoclonal plasma cells.
No end organ damage.
In what two cases is a trial of labor (TOL) contra’d?
Classic (vertical) Csxn
Abd. myomectomy WITH uterine cavity entry (if not entered it is ok to have TOL)
Variable decelerations management?
Amnioinfusion. This decreases umbilical cord compression and resolves the decelerations.
Central cord syndrome Sx?
Weak upper>lower extremities. UE motor nerves closer to central part of corticospinal tract. Usually due to hyperextension injury in elderly with degenerative changes to cervical spine.
Anterior cord syndrome Sx?
Bilateral motor paresis distal to lesion. Usually duet o occlusion of anterior spinal artery.
Posterior cord syndrome Sx?
Bilateral loss of vibratory/proprioceptive sensation w/ weakness and paresthesias and urinary Sx (incontinence or retention). MS or vascular disruption can cause it.
Cyanosis of the face or central body may raise concern for what in the neonate?
Hypoxia from respiratory or congenital cardiac problems.
Physiology of prolactin after birth leading to amenorrhea?
Prolactin secreted inhibits GnRH directly, which reduces LH and FSH secretion. This causes anovulation and amenorrhea.
Findings in transient tachypnea of newborn?
Clinical: Tachypnea (>60) shortly after birth resolving ~2 days of life
CXR: Bilateral perihilar linear streaking
Findings of respiratory distress syndrome in newborn?
Severe respiratory distress and cyanosis after PREMATURE birth
CXR: Diffuse reticulogranular opacities and low lung volumes
Findings in persistent pulmonary HTN of the newborn?
High pulmonary resistance causes R to L shunting through PFO and PDA causing hypoxia.
CXR: Clear lungs with decreased pulmonary vascularity
What vaccine is recommended in children 6mo - 11mo if they are traveling internationally?
MMR.
Route of transmission of measles?
Airborne.
What should be suspected in any Down syndrome Pt with upper motor neuron Sx (hyperreflexia, leg spasticity, clonus, etc.)?
Atlanto-occipital instability.
First imaging to be obtained in bilious emesis in newborn?
Abd Xray.
Abd. Xray in newborn shows dilated loops of bowel. Dx?
Intestinal obstrxn. Contrast enema will show either microcolon (meconium ileus) or rectosigmoid transition zone (Hirschsprung).
Abd. Xray in newborn reveals double bubble sign. Dx?
Duodenal atresia.
Abd. Xray shows free air in the abdomen. Next step?
Surgery. Pneumoperitoneum, hematemesis, unstable vitals indicate Surgery.
Abd. xray does not reveal free air, double bubble or dilated loops of bowel in child with biliary vomiting. Next step?
Upper GI series (barium swallow). This is the fastest and most accurate method to Dx malrotation of midgut volvulus. Ligament of Treitz on the right side of abdomen means malrotation and “corkscrew” pattern indicates volvulus.
Procedure used to fix bowel in non-rotated position to minimize volvulus risk in neonate?
Ladd procedure.
Dx method for suspected pyloric stenosis in neonate?
US.
What is the purpose of randomization in a clinical trial?
To evenly distribute all potential confounders between treatment and placebo groups. Thus, baseline characteristics (often found in tables in study, etc.) shows even distribution in both groups.
PE findings in bony metastasis?
Constant pain that is worse at night.
Consolidation on Xray without blunting of the costophrenic angles indicates what process?
Likely lobar pneumonia. Consolidation WITH blunting of costophrenic angle indicates pleural effusion.
What major SE of MAOIs occur?
Serotonin syndrome and hypertensive crisis. Phenelzine is an MAOI.
MAO of atomexitine?
Norepinephrine reuptake inhibition
Sx of Friedreich ataxia?
Usually <22yo
Ataxia and falls
Dysarthria
Impaired vibratory/proprioceptive senses/DTRs
May result in cardiomyopathy (90%) and musculoskeletal deformities (hammer toes, scoliosis)
What adjuvant therapy is indicated after thyroidectomy for thyroid cancer?
Radioiodine ablation to prevent recurrence and adequate thyroid hormone replacement (by suppressing TSH) will prevent recurrence also.
Name the Dx associated with each anti-Ig:
- Anticardiolipin
- Anti cyclic citrullinated peptide
- Antimitochondrial
- Anti neutrophil cytoplasmic
- Anti Smooth muscle
- Anti topoisomerase
- Antiphospholipid
- Rheumatoid arthritis (more specific than RF)
- Primary biliary cholangitis
- Granulomatosis w/ polyangiitis (Wegener’s)
- Autoimmune hepatitis
- Systemic sclerosis
Healthy neonates may lose up to how much birth weight in the first 5 days of life?
Loss of up to 7% within the first 5 days is normal. Birth weight is expected to be regained by age 10-14 days.
What is the appearance of endometrioma on the ovary via US?
Homogeneous cystic ovarian mass. Unlike cancer, which is a septated mass with solid components.
Triad of multiple system atrophy?
Shy-Drager syndrome presents with:
Parkinsonianism
Autonomic dysfxn (eg impotence, orthostatics)
Widespread neurological signs
Sx of Riley-Day syndrome?
Ashkenazi Jewish people get autonomic dysfxn with severe orthostasis.
Testing to confirm cysteinuria?
Cyanide-nitroprusside test. Helps determine elevated cystine levels.
The absence of menses by age 15 with normal growth and secondary sexual characteristics is?
Primary amenorrhea. This is usually due to anatomical/genetic anomalies that affect menstruation.
A 16 yo female without menstruation, but normal appearing outer genitalia and a testosterone level of 400ng/dL (normal female 15-75). Dx?
Androgen insensitivity syndrome. 46XY karyotype likely present and absent uterus and upper vagina with cryptorchid testes present also. PE reveals minimal to absent pubic/axillary hair. Female with high testosterone, but no virilization = androgen insensitivity.
What is secreted by the testes during development that inhibits formation of the uterus?
Anti-Müllerian hormone and testosterone. AMH stims regression of the mullerian ducts resulting in no uterus, cervix or upper vagina.
5 alpha reductase deficiency Sx?
Ambiguous genitalia at birth and a male internal urogenital tract (due to AMH). Lack of testosterone to dihydrotestosterone results in this effect.
Pregnant women require what ABx if syphilis test is positive?
PCN. If allergic, must desensitize.
Nonpregnant patients with PCN allergy can use what for syphilis Rx?
Doxycycline.
Lithium exposure can result in what fetal defects?
Ebstein’s anomaly (atrialized right ventricle due to malformed tricuspid valve).
Anticonvulsant medications can lead to what fetal defects?
Craniofacial defects
Neural tube defects
Genital anomalies
Management of slipped capital femoral epiphysis?
Immediate surgical screw fixation at the current degree of slippage. This prevents AVN from occurring.
Proper management of antiphospholipid syndrome?
Acute thromboembolic events require heparin or to prevent venous thromboembolism during pregnancy, but long-term Rx require warfarin.
MCC of tinea corporis?
Trichophyton rubrum. Any dermatophyte species can cause it however.
Rx of tinea corporis?
Topical terbinafine or clotrimazole. If they fail topics, then oral terbinafine, fluconazole, and itraconazole are preferred over griseofulvin.
Erythema nodosum pathophysiology?
Delayed hypersensitivity rxn present on bilateral anterior tibia usually. Infxn, autoimmune or inflammatory conditions cause it. Polyarthralgia, fever and malaise are common.
A cirrhotic patient with ascites that is accompanied by fever, asterixis, and lethargy is concerning for?
Spontaneous bacterial peritonitis and hepatic encephalopathy. Paracentesis is the test of choice. A positive culture and a neutrophil count ≥250 are indicative of infxn.
Hepatocellular carcinoma has what elevated tumor marker?
Alpha fetoprotein. This is a useful screen, but biopsy is gold standard.
What is Caput succedaneum?
Scalp swelling superficial to periosteum. Crosses suture lines. Usually due to edema from pressure on vaginal introitis during delivery.
What is Cephalohematoma?
Usually due to operative delivery. Bleeding deep to periosteum, thus does not cross suture lines. Usually resolves in weeks/months.
What is Subgaleal hemorrhage?
Blood outside periosteum and under scalp. Can move across suture lines and expand for days after delivery. Can lead to tachycardia/pallor from blood loss.
Calcium and potassium relative levels that prolong QT?
Hypocalcemia
Hyperkalemia
Calcium and potassium relative levels that reduce QT?
Hypercalcemia
Hypokalemia
Rx for drug-induced interstitial nephritis?
DC the offending agent. Cephalosporins, PCNs, sulfonamides, sulfonamide containing diuretics, NSAIDs, rifampin, phenytoin, and allopurinol cause 70% of cases.
Causes of HIT 1 and HIT2?
1: Heparin induces platelet aggregation
2: Neoantigen exposure from conformational change results in antibody formation and destruction of platelets
HIT 1 onset?
Under 48 hours of starting heparin
HIT 2 onset?
Over 48 hours of starting heparin
If HIT 2 is suspected, what is the next step?
DC all heparin products immediately. Start anticoagulation with alternative (eg argatroban or fondaparinux).
Next step if HIT 1 is suspected?
No intervention required. Does not cause ill effects aside from mild thrombocytopenia, which resolves w/o cessation of heparin.
Cyclothymia Dx requirement?
2+ years of mood fluctuation that does not fulfill criteria for mania, hypomania, or MDD. On the bipolar spectrum, but never meets criteria for either.
Bipolar 1 Dx requires?
Manic episode. This is with or without MDD, but must have mania.
Bipolar 2 Dx requirements?
Must have MDD AND hypomania.
Depersonalization/derealization disorder Sx?
Detachment from/observation of one’s self or the sense that one’s surroundings are not real. Reality testing is intact.
Dissociative amnesia Sx?
Cannot recall important personal information 2nd to traumatic/stressful events. Not due to PTSD/acute stress disorder, drugs, or other disorder. Now includes the Dx from DSM IV of dissociative fugue.
Dissociative identity disorder Sx?
Multiple personality disorder where identity is split into ≥2 personality states. Severe trauma/abuse.
Transient global amnesia Sx?
Anterograde amnesia for time and place (Don’t know where I am or what time it is.) No loss of identity occurs. Usually resolves in 24hrs.
Sx of chorioamnionitis in pregnant female?
>18 Hrs after ROM Fetal tachycardia >160 Maternal leukocytosis Purulent amniotic fluid Maternal tachycardia >100 Uterine fundal tenderness
Variable deceleration perimeters?
<30 seconds from onset to nadir*** Important - nadir is peak
Decrease ≥15/min
Duration ≥15 seconds, but not longer than 2 minutes
What deceleration may occur immediately after amniotomy?
Variable. Release of fluids could either compress the cord, prolapse the cord, or reduce amniotic fluid levels that result in compression of cord.
What quality of decelerations is critical to assess first to differentiate variable from early?
Variable has <15sec onset to nadir
Early has >30seconds onset to nadir (so do late). Variable appears very sharp while early and late appear very gradual and dull.
First line Rx in repeated variable decelerations?
Maternal repositioning (eg left lateral). If this fails do amnioinfusion.
When would emergent Csxn delivery be indicated based on fetal monitoring?
If loss of fetal HR variability occurred. This is usually a sign of fetal acidemia.
Which thalassemia is an elevated HbA2 expected?
Beta-thalassemia minor. This is found on Hgb electrophoresis.
Excessive consumption of cow’s milk can lead to what deficiency in kids?
> 24 ounces/day can cause blood loss from protein-induced colitis.
Fracture to the supracondylar area
of the humerus can cause damage to what structures?
Brachial artery and median nerve.
What injury pattern results in Volkmann contracture of the wrist/hand?
Compartment syndrome secondary to supracondylar fractures accompanied be forearm fractures.
Amniotic fluid embolism Sx?
Cardiogenic shock
DIC
SZ/coma
Hypoxemic respiratory failure
Causes of neonatal polycythemia?
Defined: Hct >65% in term infants.
Causes: Intrauterine hypoxia cause EPO release (maternal DM, HTN [preeclampsia], smoking). Delayed cord clamping. Thyroid up or down.
NF1 associated Sx?
Cafe au lait macules
Axillary/inguinal freckles
Lisch nodules
Peripheral nerve sheath tumors (neurofibromas)
Downs syndrome is associated with what spots on the eye?
Brushfield spots (whitish-grey spots on the iris periphery).
In order to target avoidance behavior in a Pt with panic disorder and agoraphobia who is already on an SSRI, what should be added to treatment?
CBT. CBT in combination with an SSRI will help target avoidance behavior better than increasing the dose of medicine.
Internuclear opthalmoplegia Sx?
Medial longitudinal fasciculus demyelination. Leads to impaired conjugate horizontal gaze. Ipsilateral eye to lesion cannot adduct. Contralateral eye abducts with nystagmus.
PDE5 inhibitors (sildenafil) can interact with what drug classes?
Nitrates and alpha blockers (prazosin)
Ocular SE of sildenafil?
Blue discoloration of vision
Female presents with fever, leukocytosis, and a complex multilocular mass on the ovary on US. Dx?
Tubo-ovarian abscess 2nd to PID.
Appearance of endometrioma on US?
Homogeneous cyst with internal echoes (ground glass).
A patient having received thrombolytic Rx in the hospital for ischemic stroke now presents 2 days later with worsening Sx. Likely Dx?
Hemorrhagic transformation. Often secondary to thrombolysis, presents within 2 days of initial event and with sudden neurological decline. Emergent noncontrast CT is required.
After emergent noncontrast CT finds hemorrhagic transformation of ischemic stroke, what may be needed next?
Surgical decompression.
People with spherocytosis are at increased risk for?
Bilirubin gallstones and aplastic crisis from Parvo.
Testing for spherocytosis?
Acidified glycerol lysis test shows osmotic fragility of cells. Eosin 5 maleimide binding test is abnormal.
A patient with elevated alk phos confirms either bone or biliary origin with what test?
GGT. GGT is present in the liver and biliary duct in the liver and if elevated indicates alk phos of biliary origin. If not, alk phos is likely of bone origin.
Hepatocellular injury result in elevation of what enzymes?
AST and ALT.
Cholestatic injury pattern results in elevation of what enzymes?
Alk phos and GGT. ALT and AST may be elevated also if there is damage to the liver cells.
Elevated AST and ALT with a positive antinuclear antibody (ANA) titer indicates?
Autoimmune hepatitis.
Empiric Rx for human bite wound?
Amox-clav. Coverage for polymicrobial infxn with aerobic and anaerobic oral flora is needed (S. auerus, Eikenella corrodens [gram -], H. flu, ß-lactamase producing anaerobes). Clindamycin is effective against gram positives and anaerobes, but not gram negatives.
Restriction of what substance in dietary intake is suggested in kidney stones?
Sodium. High sodium intake enhances calcium excretion into the urine (hypercalciuria) that can lead to precipitation of stones.
46yo female presents with insomnia, irregular menses and sweating at night with poor concentration at work. Her periods have been irregular for months. She smoked for many years. Next step?
TSH and FSH testing. Hyperthyroidism can present with a similar symptom set as perimenopause. It must be ruled out and can occur concurrently with menopausal Sx. If TSH normal and FSH elevated (due to low estrogen feedback), hormone replacement therapy can be given.
MCC of spontaneous abortions?
Fetal chromosomal abnormalities.
A patient with GCS of 15, but vomiting and headache and a brief LOC after falling off of his bike requires what Rx?
Either 4-6hours of observation or a head CT without contrast. This is provider dependent.
Although diarrhea usually leads to metabolic acidosis, metabolic alkalosis can result from what cause of diarrhea?
Laxative abuse. Hypokalemia from loss in stool impairs chloride reabsorption in the tubules. This decreases chloride-bicarbonate exchange resulting in increased bicarb retention.
What finding is classic for laxative abuse on colonoscopy?
Melanosis coli. Browning of the colon lymph tissues.
No growth on gram stain and urine culture in a male with urethral discharge increases concern for?
Chlamydial infxn. NAAT is used to confirm. Gonococcal infxn can be gram stained 95% of the time and find organisms, unlike Chlamydia.
Upper airway cough syndrome (UACS) (aka postnasal drip) Rx?
First-gen antihistamine (chlorpheniramine). UACS, GERD, and asthma account for 90% of chronic cough in nonsmokers w/o lung disease.
Femoral artery aneurysm (pulsatile mass below inguinal ligament) is commonly associated with what condition?
Abdominal aortic aneurysm.
Nightmare disorder Sx?
Vivid recall of horrifying dream content. No motor sx during sleep.
Sleep terror and sleepwalking common Sx?
Non-REM sleep arousal disorders often in young Pts. Do not remember dreams and are slow to become alert after awakening.
Pt experiences complex motor behaviors (kicking, pushing partner in bed) during REM sleep. Dx?
Rapid eye movement sleep behavior disorder. Quickly become alert after awakening. Can be prodrome of neurodegenerative states.
Breast cyst and fibroadenoma present as solitary, well-circumscribed, and mobile masses. They can be tender. When are they most prevalent?
Fibroadenoma often occur prior to 30 years old, but cysts occur after 30.
A female has a palpable breast mass. What is the best initial study? What is the most diagnostic study for a mass?
Initial: US if <30 - can help differentiate cystic and solid masses. Any suspicion requires FNA. If>30 then mammogram and biopsy if suspicious.
Confirmatory: Biopsy
When is MRI used to evaluate breast tissue?
Presurgical eval for breast cancer or for screening in BRCA+ women.
Wilson’s disease is confirmed with what testing?
Serum ceruloplasmin levels and slit lamp testing. In Wilson’s disease, the levels are low.
Where do copper deposits occur that result in the neurological signs of Wilson’s disease?
The basal ganglia. Resting tremor, rigidity, and other neurological sx occur.
What are Mallory bodies?
Microfilament collections associated with liver disease, most commonly alcoholic cirrhosis.
2 week old baby presents with painless bloody stools. He had a normal birth and is breastfeeding. He vomits often. Dx?
Milk or soy protein induced colitis. Resolves if breastfeeding mother eliminates milk and soy from diet. Self resolving by age 1.
A neonate with temperature instability, poor feeding, and lethargy likely has?
Neonatal sepsis. Temperature may be low or high. Blood, urine, and CSF cultures should be obtained before Abx are given if possible.
Wilson disease Rx?
Chelators: D-penacillamine
Other: Zinc (interferes with copper absorption)
A newborn presents with cyanosis shortly after birth. He does not improve with oxygen. He has a continuous heart murmur on auscultation. Next best step?
Prostaglandin E1 administration. These kids experience cyanosis as the PDA begins to close after birth. Children with a cyanotic heart disease (eg the 5 T’s, hypoplastic left heart, severe coarc) require the PDA for proper movement of blood, thus, the PGE1 will keep the PDA open.
If sensitivity is increased, what does this mean for false negatives? False positives?
False negatives decrease and false positives increase if sensitivity is increased.
If specificity is increased, what does this mean for false positives? False negatives?
False positives decrease and false negatives increase if specificity is increased.
What happens to accuracy as the area under the curve increases?
Accuracy increases as the area under the curve increases. Accuracy is the proportion of true results (true positive or true negative) out of all the results of a given diagnostic test.
What drugs can precipitate acute hemolysis in G6PD?
Sulfas (dapsone, TMP/SMX) or primaquine.
