.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
bacterial and fungal infections early in life, granulomas on skin/GI tract
chronic granulomatous disease
silver hair, neuro ssx/seizures, MR, bronze skin
elejalde syndrome
neonate with low serum calcium and possible seizures
digeorge syndrome
bulging vaginal introitus
imperforate hymen
dx tool for imperforate hymen
pelvic US
chronic progressive loss of the nerve fiber layer in the retina
primary open angle glaucoma
elevated IOP, visual field loss, changes in optic disc morphology
primary open angle gluacoma
carpal tunnel syndrome may be caused by severe untreated
hypothyroidism
amyloid precursor protein
alzheimers, specifically trisomy 21 associated
lithium should be avoided in severe
cardiovascular disease and renal disease
mineral/nutrient deficiency has been associated with glucose intolerance
chromium deficiency
direct tx of the sacrum, pressure during inhalation or exhalation
inhalation phase
renal artery stenosis may cause what electrolyte disturbances
hypokalemia and hypernatremia
indication for asx AAA repair
diameter greater than 5.5, rapid expansion, or a AAA associated with symptomatic PAD requiring revascularization
ground level fall, breaks hip
start alendronate
what will improve murmur of HOCM
beta blockers
endocarditis, going to dental cleaning
2g amoxicillin 30-60 minutes prior to procedure
Most specific lab test result for iron deficiency anemia
low transferrin saturation
antihypertensive causing hyper k
ACE I like lisinopril
3 vessel disease and severe LV systolic dysfunction
revascularize - CABG
OA mechanics
side bend and rotate in opposite
glomerular basement membrane splitting
alport syndrome
apple green birefringence
renal amyloidosis
linear anti-GBM
good pasture syndrome
spike and dome appearance
granular deposits of IgG and C3 at the basement membrane - membranous nephropathy
nephrotic syndrome associated with Hep B, syphilis, malaria, and exposure to gold salts
membranous nephropathy
tram track appearance basement membrane
subendothelial mesangial deposits, membranoproliferative nephropathy
flattened femoral head
legg calves perthes, AVN hip, male 4-12
ulnar nerve innervates
palmaris brevis dorsal interosseous palmer interosseous adductor pollicis third and fourth lumbricals
AA male with hx of HIV or uncontrolled HTN, what renal issue
focal segmental glomerulosclerosis
type III HSN rxn to intradermal injection of antigen
arthus reaction
dx and tx exercise induced laryngeal obstruction
continuous laryngoscopy during exercise, speech behavioral therapy
axis is always …… the side of the seated flexion test
opposite
common associated conditions with ankylosing spondylosis
enthesitis, synovitis, dactylitis, uveitis, psoriasis, IBD
transferrin saturation will be increased in
hereditary hemochromatosis
inhalational anthrax treatment
cipro plus clinda plus anthrax immunoglobulin
significant developmental delay, no trunk control, smile, or find own hands
Menkes disease, inborn error of copper metabolism
difference in radical mastectomy and modified
modified will spare musculature
HIV exposure, but intact skin
reassurance
NPV equation
TN/ (TN +FN)
when do you screen for AAA?
abdominal US for men 65-75 who have ever smoked
metabolic syndrome 3 of 5 - list all 5
1) abd obesity >40in M, >35in F
2) triglycerides >150 or tx
3) HDL <40 M, <50 F, or tx
4) BP >130/80, or tx
5) glucose >100 or tx
risk factor for endometrial cancer
tamoxifen use
yellow white appearing lesion on conjunctiva, hx of bowel resection
bitot spot, vit A deficiency
decreased sensation on the lateral aspect of the lower leg and dorsum of the foot, specifically the web space between first and second digits
L5 nerve root compression
most important prognostic factor on bx of melanoma
tumor thickness, depth >0.8 is an indication for sentinel LN bx
palpable sausage like mass in kiddo
intussusception
nontender, small, hemorrhagic, macular or nodular lesions on palms or soles, for IE
Janeway lesions
tender violaceous nodules classically on pads of fingers and toes, in IE
osler nodes
bulimia nervosa, volume depletion 2/2 vomiting/laxative abuse can cause
secondary hyperaldosteronism, renal K loss - hypoK
first line tx for plantar fasciitis
better shoes
positive LR equation
sensitivity/ (1-specificity)
breast screening recommendations
USPSTF says 50
Am.Ca society says 40
tx of tinea versicolor
topical ketoconazole
tx of lichen sclerosus
topical corticosteroids
action of anterior interosseous nerve
flexion of thumb at interphalangeal joint
action of posterior interosseous nerve
extension of thumb at interphalangeal joint
essential tremor treatment
propanolol, second line is clonazepam
what produces surfactant
type II pneumocytes
tx hyperthyroidism in pregnancy
PTU in first trimester, methimazole after
new pt, suspicious for gout, first step
joint aspiration to r/o other
dysfunctional uterine bleeding is likely due to
unopposed production of estradiol
tx of paget disease
IV zolendronic acid, PO alendronate and risedronate
probability that a pt with a positive test has a disease
PPV
bioterrorism with shortest incubation period
pneumonic plague
schizophreniform time frame
lasts 1-6 months
kid with neuro symptoms, microcytic anemia, and vomiting
lead poisoning
tx for pseudotumor cerebri
acetozolamide
flask lesions
entamoeba histolytica
skip lesions
crohns disease
increased friability of the colonic mucosa, exudates, pseudopolyps, petechia, and frank hemorrhage
UC
anticoagulation for patient with renal insufficiency
warfarin
MC bug causing cholangitis
E coli
res ipsa loquitur
negligence
bulging mass from the umbilicus that can ulcerate and ooze
Sister Mary Joseph nodule - mets from gastrointestinal cancers
MCC of postmenopausal bleeding
endometrial atrophy
secondary amenorrhea work up after negative pregnancy test
TSH, FSH, prolactin levels
wide splitting second heart sound with respiratory variation may be associated with
pulmonic stenosis or a RBBB
pt adopts the opposite attitude of personally unacceptable emotions in order to avoid them
reaction formation
drugs that may increase risk of osteoporosis
antiepileptic drugs
nonbullous impetigo tx
dicloxacillin and cephalexin
young female with bilateral conductive hearing loss and family hx
otosclerosis, loss of stapedial reflex
inappropriate growth in baby
failure to thrive
initial work up for failure to thrive in a baby
CBC, BMP, UA
cystine renal stones are caused by
a genetic defect in amino acid transport and are associated with acidic urine
mobitz type II occurs due to fibrotic disease of
his purkinje
boards response to status epilepticus
lorazepam, phenytoin, phenobarbital, propofol
most specific antibody to test for with lupus
anti-dsDNA antibody
thyroglossal duct cyst attaches to the
foramen cecum
possible preterm labor in pt 22-35 weeks gestation get
get fetal fibronectin test
cuada equina syndrome needs surgery within
48 hours
decrease risk of infection in pt with neurogenic bladder by
intermittent cath
baby with odd shaped head and poor suckling
OA compression, decreased cranial rhythmic impulse
septic shock - what happens to extremities
warm 2/2 vasodilation
unstable patient with tension pneumo
needle thoracostomy first
dilated intrahepatic ducts in
ascending cholangitis
precocious puberty, fibrous skeletal dysplasia, cafe au lait spots
mccune albright syndrome
MC site of vaginal injury in a sexual assault
posterior fourchette
first line test for osmotic demyelination syndrome
MRI
patient on ventilator now showing probable brain death
needs 2 physicians to confirm
labs in Fe deficiency anemia
low serum iron
high TIBC
low ferritin
haptoglobin is low in setting of
hemolytic anemia
TIA and negative cerebral and neck work up, next step?
echo, eval for PFO, sometimes presents with RBBB
rash, facial flushing, episodic nature,
dx and tx
rosacea, tx with topical metronidazole
ppx for traveler’s diarrhea
rifaximin
tx of subungual hematoma
trephination (nail drilling) to relieve the pressure - not necessary if not painful
Acute OM bugs in kids
s. pneumo, h influ, mor cat
kiddo with maculopapular rash, low grade fever, LAD
rubella
mimicker of squamous cell carcinoma on the skin
keratocathoma
macrosomia, hypoglycemia at birth and organomegaly
beckwith wiedemann syndrome
associated with beckwith wiedemann syndrome
macroglossia, nephroblastoma
MCC of fever on post-op day 4
UTI
blowing diastolic murmur at the left sternal border with or without a mid-diastolic rumble
aortic regurg
lab to confirm salicylate toxicity
ABG - mixed respiratory alkalosis and positive gap metabolic acidosis
what does giardia do to cause diarrhea?
decrease fat absorption
anterior chapmans point for myocardium
2nd intercostal space near the sternum
bacteremia and now effusion of joint in kid, bone looks jacked up
acute hematogenous osteomyelitis
what do you use to follow tx response in osteomyelitis
CRP
why does febrile non-hemolytic transfusion reaction occur
recipient antibodies against donor leukocytes
tx for anal squamous cell carcinoma
combo of chemo and radiation (Nigro protocol)
newborn conjunctivitis followed by pneumonia - what bug
chlamydia trachomatis
lateralization/Weber test shows louder vibration on the side indicating
conductive hearing loss
in conductive hearing loss, the sound will be detected longer in
the bone on the affected side
in conductive hearing loss, the sound will be detected longer in
the bone on the affected side
contraindicated meds in WPW
digoxin, Beta blockers, CCB
MC elevated enzymes in dermatomyositis
CK and aldolase
lymphogranuloma venereum is caused by
chlamydia trachomatis
what abx require oxygen for uptake into bacterial cells?
aminoglycosides
gentamycin, neomycin, amikacin, tobramycin, and streptomycin
what abx can cause renal damage and CN VIII damage in both a mom and fetus?
aminoglycosides
when do you start ophtho exams for diabetics?
3-5 years after initial diagnosis
MCC of endocarditis in pt with prosthetic valve
s. epidermidis
emphysematous pyelonephritis bug
e coli
gold standard for confirming reflux
24 hr esophageal ph monitoring
infant initial tx of GERD
formula thickening with SMALL amount of baby cereal and upright positioning following meals
lofgren’s syndrome is a form of
acute sarcoidosis
carcinoid tumor will have mets to where first?
liver
an estimate of the additional cost to society to increase population health by 1 year of perfect health
cost-effectiveness ratio
newborn with hct >65%
polycythemia
polycythemia of the newborn occurs in who most often
diabetic moms,
receiving blood transfusion, hypotension, wheezing, diaphoresis, rash
anaphylaxis, IgA deficiency
asymptomatic first degree block in athlete
no further work up
elevated megakaryocytes
ITP
giant platelets are associated with
bernard-soulier syndrome, abnl ristocetin assay with thrombocytopenia
lyme disease patient that doesn’t get better with standard therapy
consider coinfection - A. phagocytophilum and babesia microti
kid with daily fevers for 2 weeks, arthralgias for 6 weeks, and rash
systemic juvenile idiopathic arthritis
lithium side effect of polyuria and polydipsia
nephrogenic diabetes insipidus
tx of lithium induced nephrogenic diabetes insipidis
amiloride, thiazides, low salt and low protein diet, NSAIDS
when should kids start an adult diet?
2 years old
odd lab in systemic juvenile idiopathic arthritis
hyperferritinemia
pt with hx of gastric bypass and now has ascedning cholangitis - next step
biliary decompression by percutaneous transhepatic cholangiography (PTC), ERCP less successful
MCC of epistaxis in peds
trauma
hypothyroidism in pregnancy
follow TSH, increased TBG that binds T4, give higher dose of levothyroxine
first line tx for panic disorder
SSRIs
up to 1/3 of panic disorder cases are associated with
depression
recommendations for new hypertension pt
stop smoking
DASH diet
increase exercise
weight loss
eczematous plaque behind ears
nickel dermatitis
posterior radial head is often caused by
falling on outstretched hand
4 yo well child vaccines if already up to date
MMR
varicella
IPV/polio
Dtap
when do you give Tdap
11-12 yo, or 7 yo if not fully immunized with Dtap
muscle rigidity, hyperthermia, AMS, tachycardia, htn
neuroleptic malignant syndrome - from psych drug use
shivering, hyperreflexia, myoclonus, and ataxia
serotonin syndrome
fenofibrate is used most often for
the control of hypertriglyceridemia
false positive or rejecting the null hypothesis error
type I error
acutely decompensated aortic regurg - tx
surgery, but nitroprusside to vasodilate and decrease afterload with dobutamine for inotrope support
occupational risk for bladder cancer
textiles, painters, electrical workers, miners, transport operators, excavating machine operators
best way to monitor for impending uterine rupture
internal fetal monitoring
adult with chickenpox complication
varicella pneumonia
retinal and CNS hemangioblastomas, pheos, multiple cysts in pancreas and kidneys, increased risk for malignant transformation of renal cysts
von hippel lindau
neuro and derm findings
tuberous sclerosis complex
best case scenario with pancreatic cancer?
involvement of gastroduodenal artery because it can be resected without significant morbidity
TCA toxicity will cause what in ekg
QRS prolongation due to blockade of fast sodium channels
goodpasture syndrome is now known as
anti-glomerular basement membrane disease
treatment of anti-GBM disease
plasma exchange and immunosuppression with corticosteroids and cyclophosphamide
notable labs in anti-GBM disease
ANA positive
C3 and C4 low
anti-dsDNA elevated
upper airway, eye, and ear disease along with rapidly progressive glomerulonephritis
granulomatosis with polyangiitis
positive C-ANCA and anti-PR3
granulomatosis with polyangiitis
systemic vasculitis with positive p-ANCA
microscopic polyangiitis
degree of calcification of the pelvis as it relates to skeletal maturity as noted on pelvic XR
Risser sign - 1 to 5
noncardiogenic pulmonary edema, GI hemorrhage, skin vesicles, generalized widespread multi organ system failure from bioterrorism - happens very quickly
ricin poisoning
from the seeds of castor oil plant
ricin toxin
what is ricin’s MOA?
preventing protein synthesis leading to very quick cell death
pneumonia birth to 4 weeks of life?
GBS
pneumonia 4 weeks to 12 weeks?
Chlamydia trachomatis
young female, headaches, pulsatile tinnitus, neck pain, or flank pain
fibromuscular dysplasia
best imaging to diagnose FMD?
CT angio
normal epithelium of esophagus?
stratified squamous
epithelium of barrets esophagus?
metaplastic simple columnar
new hemolytic anemia concern, best next test for work up?
direct antiglobulin test
autoimmune hemolytic anemia can be idiopathic, but is often associated with
lymphoproliferative disorders like CLL or nonhodgkins lymphoma
unexplained thrombocytopenia and anemia in CLL requires
bone marrow biopsy
CLL transforming to a more aggressive and deadly lymphoma is called
Richter transformation
tennis elbow affects what muscle?
extensor carpi radialis brevis tendon
what symptoms of schizophrenia respond well to treatment?
positive symptoms (delusions, hallucinations, disordered patterns of thought)
initial management of trigger finger?
stretching and splinting then steroids then surgical release
pan systolic blowing murmur
mitral regurg
metronidazole side effect
disulfram like reaction
posterior dislocation of knee, now reduced and has normal pulses, next step?
ABI
new late decels noted, what do you do?
stop oxytocin, reposition patient, add IV fluids, place patient on oxygen
MC elevated enzymes in dermatomyositis?
CK and aldolase
carbon monoxide poisoning lab
metabolic acidosis
tx acute, uncomplicated diverticulitis?
abx - ceftriaxone and metronidazole
what is the only recommended pneumonia vaccine now?
PPSV23
how to diagnose imperforate hymen?
pelvic US
antibiotics that require oxygen to be taken up into bacterial cells
aminoglycosides
hydronephrois equals
obstructive uropathy
tendons in de quervain’s tenosynovitis?
abductor pollicis longus and extensor pollicis brevis
provides information concerning malpractice payments, adverse licensure, withdrawal of clinical privileges and other negative actions taken against individual health care practitioners
National practitioner Data Bank
pt with shock, polydipsia, GI symptoms, excessive weight loss, dehydration and hyperpigmentation in palmar creases
Addisonian crisis
scabies tx
permethrin and close contacts
greatest lab predictor of mortality in acute pancreatitis
change in BUN over the first 48 hours
where do you use PT for lateral epicondylitis?
rest and PT focusing on eccentric strengthening exercises and wrist mobility
tx of alcoholic ketoacidosis
reverse the low insulin to glucagon ratio with dextrose and to replenish fluids
mgmt of suspected closed (occult) spinal dysraphism (CSD)
MRI of the whole spine
contraindications to bracing for scoliosis?
little growth remaining (Riser of 3)
skeletal maturity
Cobb angle 50 or more or less than 20
Cobb angle less than 20, treatment?
follow up every 6-12 months
anterior thoracic counterstrain tenderpoint for T5 (AT5) is located where
midline on the sternum at the attachment of rib 5, which is approximately 1 inch superior to the xiphisternal junction
inhalation dysfunction - which rib are you treating when using muscle energy?
key rib is bottom rib
inhalation dysfunction is also known as
an exhalation restriction
what drug for a heart patient can cause hyperkalemia?
ACE inhibitor
1-6 months of psychotic symptoms
schizophreniform
only antihypertensives known to be safe in pregnancy?
labetalol, methyldopa, and hydralazine
bizarre complication of sarcoid that actually happens about 50% of the time?
blindness
sudden, rapid, irregular, and aimless involuntary movments of the arms, legs, and trunk, and facial muscles
sydenham chorea (antibody mediated neuronal damage)
migratory arthritis and sydenham chorea?
rheumatic fever
what kidney stones are hereditary?
cystine - AR defect in the reabsorptive transport of cystine and the dibasic amino acids ornithine, arginine, and lysine
MCC of epiglottitis in adults?
S. pneumo
MC bug of endocarditis?
S. aureus
eye infection on baby 2-5 days of life?
gonococcal infection
iron deficiency anemia labs
serum iron low
TIBC high
ferritin low
porcelain white plaques on labia and peri-anal region, dx? punch biopsy does not have evidence of atypia or carcinoma
lichen sclerosis
minimal tx for prostate cancer?
radiation beam therapy
benztropine MOA?
anticholinergic
hemochromatosis pt, increase risk of developing
hepatocellular carcinoma
fluorescent bulbs - tox? dx and tx?
mercury poisoning, treat with succimer
drug of choice in ovulation induction for PCOS pt
letrazole, aromatase inhibitor
Down syndrome with AD - protein responsible?
amyloid precursor protein
thyroid cancer nodules are usually
cold and solid
MC type of thyroid cancer
papillary thyroid cancer
spherical concentrically laminated masses of calcium
psammomma bodies. - papillary thyroid carcinoma
emergent anti-hypertensive push or drip?
drip
high risk procedures for patient recently treated for infective endocarditis?
drainage of cutaneous, pulmonary, or dental abscess
valsalva causing worsening of murmur in
HCM
cause of acromegaly
usually benign pituitary adenoma
nonresolving conjunctivitis in 3rd world country
trachoma - chlymidia, tx with 1 g azithro
battery ingestion - when to remove and when to observe
remove in esophagus and observe in small intestine
what are the two high intensity statins
atorvastatin and rosuvastatin
HIV pt with yellow infiltrates on fundoscopic exam
CMV retinitis - CD4 <50
MCC of hypercalcemia?
hyperparathyroidism from adenoma
most sensitive and specific test for MG?
single fiber EMG
abx worsening MG
macrolides, fluoroquinolones, penicillin
severely resistant hypertension, next drug?
minoxidil
acid base disorder in PE
mixed metabolic acidosis and respiratory alkalosis
two significant risk factors for GI cancers?
smoking and alcohol
when do you measure serum cortisol levels?
7 am
C3 level decreased in this nephropathy
post streptococcal glomerulonephritis
most specific tests for identifying rupture of membranes
vaginal pooling, nitrazine, and fern
hypercalcemia with recurrent duodenal ulcers and family history of MEN1
gastrinoma
middle aged man, multiple enlarged lymph nodes, next step?
excisional lymph node biopsy
tx postherpetic neuralgia
TCAs
abdominal pain and recurrent cholangitis
choledochal cyst
MC transmitted disease acquired during blood transfusiond
hep B
sciatica may cause what neuro presentation?
decreased DTRs
lactose fermenting gram negative rod, B hemolytic
E coli
gram positive, coag negative, nonhemolytic
saprophyticus
gram negative encapsulated aerobic rod
pseudomonas
baby with microcephaly, short palpebral fissures, and a smooth nasal philtrum
fetal alcohol syndrome
psychotic symptoms accompanied by a mood disorder
schizoaffective
human fusion protein of TNF-a type 2 receptor that binds and inactivates soluble tumor necrosis factor
etanercept
MC bugs of AOM
S. pnuemoniae and H. influenza nontyable (not vaccinated against)
chronic diarrhea electrolyte change and ph
hypokalemia and acidosis
Phase IV drug trials, the drug is
already FDA approved
forward flexion of shoulder while scapula is stabilized
Neers test - positive > subacromial bursitis
the number of new cases of a disease diagnosed during a one year time period
incidence
the total number of cases of a disease, divided by the total population in the area
prevalence
gold standard for diagnosing tracheomalacia?
bronchoscopy
pregnant lady with controlled diabetes - still will have progression of
diabetic retinopathy
rib and muscle association for muscle energy tx
rib 1 - anterior and middle scalenes rib 2 - posterioer scalene rib 3-5 - pec minor rib 6-9 - serratus anterior rib 10-11 - lat rib 12 - QL
abx used to treat GBS in pregnancy?
IV pen G or IV ampicillin at least 4 hours prior to delivery
meningitis in elderly tx
ceftriaxone, vanc, ampicillin
macrosomia and hypoglycemia at birth and organomegaly
Beckwith Wiedemann syndrome - nephroblastoma
MC malignancy of childhood
nephroblastoma/Wilms tumor
first line test for detecting osmotic demyelination syndrome
MRI
preferred anticoagulant for patient with severe renal insufficiency?
warfarin
recurent and persistent thoughts, urges, or images
Obsessions part of OCD
harsh pansystolic murmur best auscultated at the left lower sternal border
VSD
increased body temp, HTN, increased RR, tachy, tremulous, increased reflexes, seizures, disorientation, aroused level of consciousness or frank delirium and psychosis
benzo withdrawal
infant GERD tx first line
thicken formula with small amount of baby cereal
s/p lap chole and now has perihepatic and peritoneal fluid collections, next step?
HIDA scan
labs in VWD?
nl plt
nl PT
nl or slight prolonged PTT
prolonged BT
how long to stop MAO inhibitors before starting SSRI?
14 days
what will soften the murmur of HCM?
beta blockers
house fire patient with metabolic acidosis - dx and tx?
cyanide toxicity tx with hydroxycobalamin
drug for adult depression, seasonal affective disorder, and smoking cessation
buproprion
cefazolin will cover for
gram positive
common cause of elevated a-fetoprotein?
inaccurate dating - get an US
also twin gestation and placental abnormalities
anti-centromere antibody
crest syndrome
contraindication to metformin
severe renal disease
osteosarcoma most commonly sends mets to
lung
tx malignant otitis externa?
IV cipro
