.level3 Flashcards
first line mgmt of HTN in diabetic pt
ACE or ARB
constitutional symptoms, early satiety due to splenic enlargement, gum bleeding, excessive WBC count - dx?
CML
tx of CML
imatinib
next step for acute cholangitis in setting of biliary obstruction?
ERCP
pathophys of giant cell arteritis
inflammatory infiltrates, composed of macrophages and CD4+ lymphocytes in all artery layers
repeated use of benzocaine spray
methemoglobinemia risk in anemic pt
whooping cough tx
azithro or macrolide
nonpurulent cellulitis that is “edematous and well demarcated”
erysipelas - group A strep/ S. pyogenes
wilson’s disease labs
low ceruplasmin and increased Copper urinary secretion
late decel means
uteroplacental insufficiency
variable decels are indicative of
cord compression
early decels are likely due to
head compression
separation of the nail plate from the bed
onycholysis
koilonychia seen in
iron deficiency or plummer vinson
brittle nails split vertically
onychorrhexis
hormones in secondary ammenorrhea due to asherman syndrome
normal
elevated liver enzymes, multifocal stricture and dilation on cholangiography
primary sclerosing cholangitis
majority of patients with primary sclerosing cholangitis have underlying
ulcerative colitis
Magnesium is contraindicated in pre-eclamptic women with ______
myasthenia gravis
initial manifestation of mag toxicity
decrease in DTRs, followed by respiratory paralysis, cardiac conduction abnls, cardiac arrest
pt with acute pancreatitis, what is the greatest lab predictor of mortality?
change in BUN over the first 48 hours (with adequate fluid resus)
pt with acute pancreatitis with acute rise in what may indicate pancreatic necrosis?
hematocrit
kid with fever, cervical adenopathy, polymorphous rash, hand and foot edema, cracked lips and bilateral conjunctivitis.
dx and tx
kawasaki disease, aspirin and IVIG
pain and stiffness in proximal muscles, worse in AM or prolonged activity. also fever, wt loss, fatigue, depression
polymyalgia rheumatica
differentiate PMR with polymyositis types
PMR does not have muscle weakness
tx for PMR
corticosteroids
working with artisanal mining or smelting, or with fluorescent bulbs
mercury poisoning
change in personality, anxiety, irritability, excitability, fearfulness, pathologic shyness, insomnia etc. due to mercury poisoning
erethism mercurialis
treatment of mercury poisoning?
succimer, dimercaprol, or penicillamine
category A bioterrorism agents
anthrax, plague, botulism, and tularemia
tx of ITP
prednisone
dry v wet purpura
wet includes mucous membranes and more likely to hemorrhage, indicates urgent drug therapy for decreased plt.
croup aka
laryngotracheobronchitis
bioterrorism causing undulating fever, fatigue, diaphoresis, arthralgias, myalgia, anorexia, malaise, and HA
brucellosis
tx of brucellosis
doxy and rifampin
new onset pulmonary renal syndrome and ANCA negative
anti glomerular basement membrane disease (previously goodpastures)
tx of minor bleeding in pt with von willebrand disease?
desmopressin
disease that is highly prevalent for a consistent period of time.
hyperendemic
severely decreased or absent cranial rhythmic impulse (CRI)
compression
cranial tx to increase amplitude of CRI
compression of fourth ventricle or CV4
what is the main cause of fluid retention in cirrhosis?
activation of RAAS system due to a perceived low-flow state
colorectal cancers in lynch syndrome are predominantly where?
right sided in location
lab work up in pt with ascending cholangitis reveals what 4 things?
leukocytosis, increased GGT, increased bilirubin, and increased alk phos
isolated elevation in serum GGT or GGT elevated out of proportion to other enzymes may indicate
alcohol abuse or alcoholic liver disease
biliary disease associated with UC
primary sclerosing cholangitis
eye disease seen in Crohn’s patients or IBD
anterior uveitis, associated with erythema nodosum and arthralgias
fever, RUQ pain, confusion, jaundice
ascending cholangitis
Heberdens nodes are in
OA, located on the DIP
treatment of poison ivy
oral corticosteroids
labs in GCA/PMR
elevated ESR, CRP, and plt ct. normal CPK and aldolase
Graves pt with proptosis will also likely have…
pretibial myxedema, hyperpigmentation and thickening of the skin on the anterior legs
next step up for mild persistent asthma
add daily low dose inhaled glucocorticoid
criteria for moderate persistent asthma
daily symptoms, not everyday; night awakenings more than 1/wk, not nightly; mild limitation of activity
when is surgery indicated for carpal tunnel?
evidence of axonal loss or denervation on electrodiagnostic testing
30 yo male with HTN, hematuria, proteinuria, and flank pain
ADPKD
MC isolated etiologic pathogen of lung abscess in children, following viral infection
S. aureus
what are markers indicating increased risk of scoliotic curve progression?
female, thoracic spine, larger initial curve
young woman with chronic joint pain, synovitis, mucositis/ulceration, photosensitive rash
lupus
drug treatment for lupus
oral hydroxychloroquine
most catastrophic pulmonary complication of lupus
diffuse alveolar hemorrhage
pt with SLE, development of thrombi, should be thinking underlying
antiphospholipid syndrome
antiphospholipid syndrome is associated with
an elevation in PTT
tx for pt with antiphospholipid syndrome
oral warfarin
apophysitis
inflammation of the apophysis or insertion site for tendons, normal in growing athlete
tx of spondylolysis
refrain from strenuous activity, given analgesia, and PT
MC overall cause of endocarditis
S. aureus
MC cause of transient monocular vision loss
embolism from diseased ipsilateral carotid artery
can’t look up after orbital trauma, what muscle is entrapped?
inferior rectus, cant relax/elongate when superior rectus contracts
overuse injury associated with RA, presenting with pain and tenderness at the radial styloid
de quervain tenosynovitis
MOA sulfonylureas
increase secretion of insulin from pancreatic islet cells
Side effect of sulfonylureas
weight gain, hypoglycemia without DKA, pancreatitis
high ACTH and high cortisol, next step?
dexamethasone suppression test
results of dexamethasone test… urine cortisol low
pituitary adenoma
results of dexamethasone test… results urine cortisol high
ectopic production of ACTH, small cell carcinoma, other tumor
chronically lethargic and hyperpigmented, hypotensive after acute GI illness
Addison disease/ primary adrenal insufficiency
electrolyte changes with Addison disease
hyponatremia and hyperkalemia
lab values to get in patient with myxedema coma
thyrotropin/TSH, free T4, and random serum cortisol
myxedema coma initial mgmt in stabilized pt
IV levothyroxine
IV hydrocortisone
infection with roundworms spread by black flies or misquitoes
filariasis
tx of filariasis
diethylcarbamazine (DEC)
malabsorption, chronic joint pain, weight loss, confusion/neuro ssx
whipple disease
what do you do after diverticulitis flare?
6-8 weeks later c scope
what risk increases in those with celiac disease?
fracture risk
long term tx of HTG induced pancreatitis
statin and a fibrate
virus causing hand foot mouth
enterovirus - coxsackievirus A16 and enterovirus A71
dog bite to hand
augmentin ppx for risky or large wounds
chapmans reflex point posteriorly
transverse process of T11 on the right
initial work up of acanthosis nigricans
HgbA1c, random glucose, lipids, total testosterone
tx of moderate to severe crohns
adalimumab
sympathetic viscerosomatic location of stomach
T5-9 on the left
high level of concern for acute HIV infection - what tests
HIV RNA levels
HIV antigen/antibody testing
pt suspected of having PCP, should get what tests
ABG, LDH, 1-3-beta-D-glucan, CXR, high res CT
what med to start s/p angioedema with lisinopril?
switch to ARB, angioedema can still recur for up to 6 weeks after stopping med
Most specific marker to confirm rhabdo
serum CK
chocolate brown blood
methemoglobinemia (metHb)
rigid thoracic kyphosis of more than 45 degrees, anterior wedging of 5 or more in at least 3 adjacent vertebral bodies, schmorl nodes, and degenerative endplates
Scheuermann disease
tx of scheuermann disease
conservative, PT and OMT for less than 60 degrees; ortho bracing would have to be done before skeletal maturity
tx of scheuermann disease
conservative, PT and OMT for less than 60 degrees; ortho bracing would have to be done before skeletal maturity
hypercalcemia, hypophosphatemia, metabolic alkalosis, with depressed PTH
milk alkali syndrome
milk alkali syndrome is due to
excess calcium intake in the setting of progressive renal dysfunction
tx milk alkali syndrome
isotonic saline for expanding volume and removing the offending agent
Framingham (major) criteria for CHF
acute pulm edema cardiomegaly hepatojugular reflux neck vein distention nocturnal dyspnea or orthopnea rales S3 wt loss >4.5 kg in five days in response to tx
meds that improve mortality in CHF
ACEI/ARBs aldosterone antagonists beta blockers hydralazine/nitrates sacubitril/valsartan
in lateral strain, rotation occurs around
2 vertical axes
galbreath technique is also known as
mandibular drainage
removal of the contents of the globe while leaving the sclera and extraocular muscles intact
evisceration
what is enucleation?
removal of the eye from the orbit while preserving all other orbital structures
removal of the eye and adnexa, along with part of the bony orbit
exenteration
tennis elbow affects what?
extensor carpi radialis brevis tendon
unilateral RLN injury with vocal fold stuck in paramedian or lateral position is associated with …
increased risk of aspiration
risk factors for cervical cancer
early age at coitus early child bearing multiple partners smoking immunodeficiency
young male, no family hx of bleeding disorders, but pt with prolonged PTT…
hemophilia A
hemophilia A is a deficiency in the level or function of
factor VIII, causing increased PTT, normal PT and bleeding time
newborn with continued bleeding from umbilical stump - ddx?
hemophilia A/B, vit K deficiency, platelet function disorders
newborn with continued bleeding work up
PT, PTT, CBC, consider peripheral smear
peds pt, presenting with acute onset, severe, joint pain, associated with fever or constitutional symptoms, inability to bear weight
septic arthritis
mono or polyarticular arthritis, enthesitis, dactylitis, or low back pain, multiple weeks after infection
reactive arthritis
autoimmune, noninfective, inflammatory joint disease of more than 6 weeks in duration in children less than 16 yo
juvenile rheumatoid arthritis
pleural effusion as complication of pancreatitis demonstrate
elevated LDH and protein
exudative
contain very high levels of amylase
2 high intensity statins and best in CKD
atorvastatin
rosuvastatin
when should simvastatin be used in low doses
with amlodipine, verapamil, diltiazem, and amio due to increase in simvastatin levels and increased risk for myopathy (increased P450 system)
systemic symptoms and lymphadenopathy in a 20 some year old. says alcohol causes severe pain
Hodgkins lymphoma
how to confirm dx of suspected lymphoma
excisional lymph node biopsy
when do you screen kids for Fe deficiency anemia?
for high risk pt, start at 4 months and go through 2 years
confirm dx of sickle cell anemia with
hgb electrophoresis
hypercalcemia will change EKG by
shortening of the QT
blowing systolic murmur best heard at the fifth intercostal space in the midclavicular line with radiation to the axilla
mitral regurg
MCC of significant U waves is
severe hypokalemia
how to assess adequate fluid resuscitation in a burn patient?
central venous pressure
urine output
cardiac output
how to evaluate for suspected closed spinal disraphism?
MRI whole spine
five high yield risk factors for PE
CHF IBD ortho surgery malignancy nephrotic syndrome
treatment of PE
tPA for unstable
LMWH for anticoagulation, but does not reverse clot
empiric antibiotic therapy for meningitis in elderly
vancomycin, ceftriaxone, and ampicillin
high arched palate and increased carrying angle of the arm
turner syndrome
XR of nursemaids reveal
normal study
treatment of preeclampsia
hydralazine (or labetalol) to lower BP and mag sulfate to prevent progression to eclampsia
HTN and proteinuria in pregnancy
preeclampsia
work up for incidental first degree AV block
cardiac and med hx
basic labs
TSH and BMP
consider lyme carditis
isolated antibodies to the core antigen - anti-HBc
window period
dx of acute liver failure requires 3 components
elevated aminotransferases
INR >1.5
hepatic encephalopathy
indications for ppx abx with dental procedure
prior infective endocarditis
prosthetic heart valve
unrepaired cyanotic congenital heart disease
cardiac transplant with valvulopathy
OA in knee, started having pain at night, medial aspect
pes anserine bursitis
enlarged liver, S4, S3, peripheral edema
worsening arthritis, polydipsiam and polyphagia
erectile dyfuction and shrunken testicles
hemochromatosis
lab test for dx of hemochromatosis
increased Fe, increased percentage of saturation of Fe, increased ferritin, and decreased serum-transferrin level
most sensitive diagnostic test for hemochromatosis
transferrin saturation level/test
tachypneic, normal glucose, low bicarb
alcoholic ketoacidosis
MCC of exogenous endophthalmitis
staph epidermidis
euvolemic state with increased urine osmolality and urine sodium concentration
SIADH
new neuro symptoms with hx of monoclonal gammopathy of undetermined significance
hyperviscosity syndrome
syringomyelia symptoms that come on gradually in 3rd or 4th decade?
arnold chiari malformation
IV meds to treat hypertensive emergencies
IV nitroprusside, nicardipine, clevidipine, labetalol, and fenoldopam
contraindications to oral bisphosphonates
bariatric surgery, esophageal disorders, or GI distress
drug of choice to treat tularemia
streptomycin
bugs in younger and older CF patients
pseudomonas after 25-35 years, s. aureus younger
HTN in OCP using young female
stop OCP
vagina - progressive pruritus, dyspareunia, dysuria, or genital bleeding
lichen sclerosus
IV formulation of bisphosphonate
zoledronate, zoledronic acid
how do you name nerves exiting spine
L4 nerve is above L4
MCC of septic arthritis
S. aureus
quad screen result for down syndrome
increased serum beta hcg and inhibin A, decreased estriol
markedly elevated alpha fetoprotein on quad screen
neural tube defects
decreases in a-fetoprotein, estriol, and b-hcg are associated with
trisomy 18
when to do amniocentesis v chorionic villous sampling
CVS should be done prior to 12 weeks gestation, amniocentesis after 12 weeks
new endometrial carcinoma diagnosed on bx… next step?
hysterectomy, BSO, lymphadenectomy - surgically staged malignancy
“complete claw hand” nerve injury
ulnar and median nerve
nonspecific bone pain, esp in legs and pelvis, and associated with insufficiency fx
osteomalacia
MCC of osteomalacia
vitamin D deficiency
vit D deficiency labs
mild decrease Ca, P, and an elevated PTH
contraindications to bracing for scoliosis
little growth remaining (Risser grade of 3)/skeletal maturity, cobb angle of 50 or more, and cobb angle less than 20
blood supply to extracapsular arterial network that feeds the femoral neck and head of the femur
medial and lateral circumflex arteries
dry cough, SOB, hypercalcemia, and CXR showing bilateral hilar fullness
sarcoidosis
weird complication of sarcoidosis
blindness
hypercalcemia, combined with recurrent duodenal ulcers and family hx of pituitary tumor
consider gastrinoma
BPH and renal insufficiency, next step
renal US
counterstrain positioning for posterior ribs 2-6
flexion, sidebent away, rotate away with dr thigh under patients axilla, ipsilateral
atypical glandular cells on cervical cytology, next step
colposcopy with endocervical curettage, if older than 35 also endometrial bx
endocervical curettage is abnormal, next step?
cervical cold knife cone
what is indicated following cervical intraepithelial neoplasia when endocervical curettage is negative?
loop electrosurgical excision
MC type of hodgkin lymphoma
nodular sclerosing, mixed inflammatory background with Reed Sternberg cells
lymphocyte depleted type of hodgkin lymphoma associated with
EBV positivity
amenorrhea in turner syndrome is caused by
ovarian failure, elevated FSH
breath holding spells in baby, evaluate for
iron deficiency anemia
another name for vasovagal syncope
reflex syncope
tx of DMD
glucocorticoids
bad labs with hypertensive pregnancy
pre-e with severe features
34-37 weeks, single gestation, no prior steroids, not diabetic - preterm delivery anticipated… then give
late preterm steroids
pregnant with IUD in place, how do you remove?
gentle traction on stringts, prior to 12 weeks
what is fetal fibronectin used as?
marker to assess likelihood of preterm labor between 22-34 weeks of pregnancy
CT chest shows airway dilatation, mucus plugging and bronchial wall thickening
bronchiectasis
bronchiectasis is caused by what bug and needs what abx?
pseudomonas, tx with cefepime
anti-pseudomonal abx
cefepime pip tazo fluoroquinolones aztreonam meropenem gentamicin
new S3 and low voltage, think
infiltrative cardiomyopathy
visual or neurologic changes, B symptoms, bleeding, lymphadenopathy, hepatosplenomegaly, infiltrative disease
waldenstroms macroglobulinemia
new dx of dermatomyositis, all patients should get
age appropriate cancer screening
UTI in pregnancy, tx with
cefpodoxime
mets to spine from prostate cancer - how?
hematogenous spread through Batson venous plexus
additional calorie consumption in pregnancy
340cal in second tri, then 450 cal in third tri
tx of mastitis
dicloxacillin
hypopigmentation, prolonged bleeding/bruising, recurring infections,
chediak-higashi
