May 12th Flashcards
What medications commonly cause urinary retention/overflow incont?
Anticholinergics, opiates, CCB
What is tolterodine? What is it used for?
Anticholinergic; indicated for urge incontinence or overactive bladder symptoms
What is superficial infantile hemangioma?
Aka strawberry hemangioma; vascular birthmark appears during first few weeks
What is a nevus flammeus?
AKA: Port wine stain
What is a nevus simplex?
“Stoke bite” or “angel kiss”; patch that most commonly occurs on eyelid and glabella and nape of neck
What is the most common cause of CF-related pneumonia in children?
S aureus
What is the most common CF-related pneumonia seen in adults?
Pseudomonas
What are Bitot spots and when do you see them?
Dry, silver-gray plaques on the bulbar conjunctiva; seen in Vit A def
What is Leriche syndrome?
Triad of bilateral hip, thigh and buttock claudication, absent or diminished femoral pulses, impotence; seen with aortoiliac occlusion
What is paroxysmal nocturnal hemoglobinuria?
Autoimmune hemolytic disorder with intra and extravascular hemolysis and hemoglobinuria; due to lack of glycosylphosphatidylinositol anchor
How is paroxysmal nocturnal hemoglobinuria diagnosed?
Flow cytometry - absence of CD55 and CD59
How is paroxysmal nocturnal hemoglobinuria treated?
Iron and folate supplementation; Eculizumab (mab that inhibits complement activation)
What is the pathophysiology of exophthalmos?
T cell activation and stimulation of orbital fibroblasts and adipocytes by TRAB, resulting in orbital tissue expansion and lymphocytic infiltration
Which vitamin can help lower homocysteine levels?
B6, folate and B12 may be helpful as well
What symptoms are seen in small fiber nerve injury of DM?
Positive sxs: pain, paresthesias, allodynia
What symptoms are seen in large fiber nerve injury in DM?
Negative sxs: numbness, loss of proprioception and vibration sense, diminished ankle reflexes
What is Legg-Calve-Perthes disease?
Idopathic avascular osteonecrosis of the femoral head; affects boys 3-12 (peak incidence is 6); dull, chronic LE pain and antalgic gait
How is acute dystonia treated?
Benztropine, diphenhydramine
How is the EPS akathisia treated?
Beta blocker, benzo, benztropine
How is parkinsonism EPS treated?
Benztropine, amantadine
What type of immune response is seen with the PPSV23 vaccine? Why?
T cell independent B cell response; vaccine contains 23 polysaccharides, which alone cannot be presented to T cells
What type of immune response is seen with PCV13 vaccine? Why?
T cell dependent B cell response; capsular polysaccharides have been covalently attached to inactivated diphtheria toxin protein
What type of vaccines produce a CD8+ T cell response?
Certain live attenuated vaccines (MMR), intranasal flu
What is a luteoma?
A benign, large ovarian mass that consists of lutein cells during pregnancy; results in hirsutism and acne during pregnancy; >10 cm in size, solid ovarian mass on US; expectant management - regress after delivery
What is a Krukenberg tumor?
Metastatic tumor to ovaries from primary GI tumor; can cause hirsutism in pregnancy
How is bronchiectasis diagnosed?
HRCT
How is vesicoureteral reflux diagnosed?
Voiding cystourethrogram
What are the characteristics of restrictive PFTs?
Decreased TLC and normal FEV1/FVC ratio; decreased DLCO
NF2 tumor suppressor gene codes for what protein?
Merlin
NF2 tumor suppressor gene is on what chromosome?
22
Nf1 tumor suppressor gene codes for what protein? And is on what chromosome?
Nuerofibromin; 17
What are the key lab findings in hereditary spherocytosis?
Increased MCHC, neg Coombs, increased osmotic fragility, abnormal eosin-5-maleimide binding test; hemolytic anemia is seen
Neonate presents with jaundice on first day of life and has persistent jaundice refractory to standard management; what should you think of?
Hereditary spherocytosis
Intensive glycemic control in t2dm reduces the risk of what complications?
Microvascular complications: nephropathy and retinopathy
Phosphodiesterase-5 inhibitors should be used with caution in what combination with what other medications?
Nitrates and alpha blockers
If a patient has h/o CIN2 or higher, what is the appropriate pap screening end point?
Continues for another 20 years after detection (past age 65 if indicated)
When is pap testing stopped?
Age 65 (with other factors met)
What is the cause of HELLP syndrome?
Systemic inflammation and activation of coagulation system and plt consumption
Mirtazapine is a good antidepressant choice when what symptoms accompany depression?
Weight loss and decreased appetite and insomnia
How is acute infection with parvovirus B19 diagnosed?
B19 IgM antibodies if immunocompetent; NAAT for B19 if immunocompromised
What are common chemotherapy-induced peripheral neuropathy drugs?
Vincristine, platinum-baed meds, taxanes
What organisms are covered by ciprofloxacin?
Gram negatives; NOT anaerobes or gram positives
What are good antibiotic options in aspiration pneumonia?
Clindamycin + azithromycin; metronidazole with amoxicillin, amoxicillin + clavulanate, or carbapenem
What organisms cause emphysematous cholecystitis?
Clostridium spp; some E coli
What is ziprasidone?
Secon gen antipsychotic with low metabolic risk profile (aripiprazole and lurasidone also have low metabolic profile)
What is fomepizole?
Competitive Alcohol dehydrogenase inhibitor; useful in methanol and ethylene glycol ingestions
Nephrotic syndrome associated with African American and Hispanic ethnicity; obesity, HIV and heroin use?
FSGS
Nephrotic syndrome associated with adenocarcinoma (breast and lung); NSAIDs, HBV, SLE?
Membranous nephropathy; HBV also associated with membranoproliferative glomerulonephritis; NSAIDs also associated with MCD
Nephrotic syndrome associated with HBV, HCV, lipodystrophy?
Membranoproliferative glomerulonephritis
Nephrotic disease associated with NSAIDs and lymphoma?
MCD; NSAIDs also associated with Membranous
Most common nephrotic syndrome in patients with Hodgkin lymphoma?
MCD
What is seen in MEN2B?
Medullary thyroid cancer, pheo, mucosal neuromas/marfanoid habitus
What is seen in MEN2A?
Medullary thyroid cancer, pheo, parathyroid hyperplasia
What is seen in MEN 1?
Primary hyperparathyroidism, pituitary tumors, pancreatic tumors
Small shallow painless genital ulcers with large, painful lymphadenopathy (buboes)
Lymphogranuloma venerum; associated with chlamydia trachomatis L1-L3
What is the next best step in a patient with suspected posterior urethral injury?
Retrograde urethrogram
What is conduct disorder?
Violation of major societal norms and rights of others (cruelty toward animals, destruction of property, lying, stealing)
How is conduct disorder treated?
CBT, family therapy
What is oppositional defiant disorder?
Angry/irritable mood, argumentative/defiant behavior toward authority; less severe and do not include stealing or aggression toward people
What is the most common GI complication of Henoch-Schonlein purpura?
Intussusception; usually ileoileal which does not response to air or contrast enema and usually needs surgical management
How is PCP treated?
TMP-SMX and glucocorticoids in patients with impaired oxygenation; treatment of PCP can cause worsening of oxygenation
What is the mechanism behind CCB causing edema?
Preferential dilation of precapillary vessels —> increased capillary hydrostatic perssure
Contact dermatitis is what type of HSR?
Type IV, delayed, T cell mediated
What is scleroderma renal crisis?
Acute onset renal failure and malignant hypertension (headache, blurry vision, nausea); can see schistocytes and thrombocytopenia
When are Burr cells seen?
Liver disease and ESRD
When are spur cells seen?
Liver disease
What is the outpatient treatment for PID?
IM ceftriaxone + doxycycline
