Misc Info PANCE Flashcards
Pyloric stenosis labs
Dehydration
Hypochloremic
Hypokalemic
Metabolic alkalosis
High bicarb
What tumor in MG
Thymoma
Descending weakness
When do you see ureteropelvic junction obstruction
Peds
TX for epididymitis
Cef and doxy
Cipro if older
Primary amenorrhea
Abscence of menarche at 15
+secondary sex characteristics
Uterine leiomyomata tx
GNRH antagonist
Leuprolide
Zoster most common location
Torso
Lower limb Measurement
ASIS to Medial malleolus
Allergic rhinitis tx
2nd gen antihistamine
nasal steroid
Schwanoma location
Cerebellopontine angle
Meningioma more common in who
women
What S/S wont primary TB likely have
Dyspnea
Describe giant cell arteritis physical findings
tender, nodular, pulsless vessel
age 50-80
Epstein barr transmission
oral secretions
Acid base disorder of metformin
Lactic acidosis
Dose of amox for under 5
90mg/kg/day
cancer assosicated with lambert eaton
Small cell
Does tennis elbow need imaging
no, unless there is a complication
MCC of otitis externa
Pseudomonas
ECG change with hypercalcemia
Short QT
ECG change with hypocalcemia
Long QT
Lung tumor and hyper calcemia think what lab
PTHp
In advanced CKD what diuretic
Loop is better than HCTZ
Likely exam finding i boerhaave vs mallory weiss
Boerhaave will have chest pain
Pulse finding in Aortic stenosis
Pulsus tardus
Slow or delayed carotid upstroke
Things that make you think bone cancer
Pain at night
Alk phos up with normal ggt
Odd things about osteosarcoma
Shoe size increasse after puberty
Hearing loss
St depression numbers
0.05mv
in 2 contiguous leads
How does BB affect the heart
Reduces the effects of circulating catecholamines
Transient synovitis is worse when
worse in morning after rest
(same as JRA)
Gilberts disease
Conjugation problem
Mildly reduced UDP (poor bili conjugation)
Usually asymptomatic but can be triggered by stress
ie marathons etc
Transient jaundice
slightly high unconjugated bili (normal lft’s)
Choledocolythiasis
Common bile duct obstruction
High conjugated bili
ERCP
Ear infections and pacifiers
can increase ear infections
Acute bronchitis MCC
Virus
Lyme prophylaxis after tick bite
200mg doxy one time
ecg change associated with dig tox
av blocks
U wave
Hypokalemia
U wave
Q wave
Prior MI
T wave inversion
Ischemia
Hyperkalemia in CKD s/s
Muscle weakness,
Nausea
Arrhythmias
palpitations
What common disorders can you see hypokalemia in
Diabetes
Hypothyroid
DM Prevetion
Daily foot exam
Yearly MD foot exam
Yearly eye exam
Yearly UA
Tx for Heavy OB bleeding
TXA
Most aggressive melanoma
Nodular Melanoma
has high rate of mets
most aggressive
Bipolar treatment
Lithium first line
Carbamazepine 2nd
Disease associated with Giant cell arteritis
Polymyalgia rheumatica
Diaper rash that wont get better
zinc deficiency
Invasive lobular vs invasive ductal carcinoma breast cancer
Ductal has a palpable mass
Ductal MC (75%)
Gold standard for bladder cancer
cystoscopy
PKU foods
Avoid
Red meat, milk, grain, vegetables
(rash on flexors, knees, elbows,)
Musky urine smell
When to test TPO
Hypothyroid
Test TSH first
Then T4
Then TPO
Lyme disease stage times
Stage 1 - immediate
Stage 2 - after months (12 weeks)
Stage 3 - 1 year
Lyme disease stage 1
Mild, flu like symptoms
Single target lesion
(erythema migrans)
Lyme disease stage 2
After months
Rash with multiple lesions
Join, muscle, msk aches
HA, fatigue
Lyme disease stage 3
after a year
Neuropsych symptoms
Rheum symptoms
(MSK, joint, muscle aches remain)
Orthostatic hypotension and infection
It can increase infection
Type 1 DM can be seen in what common disorder
Thyroid
Graves or hashimoto
Where do you see a nidus
Osteoid osteoma
(gets better quick with NSAIDS
Type of picornavirus
Coxsackie
Type of flavivirus
West nile, yellow fever, dengue
Difference between tietze and costocondritis
Tietze will have palpable edema
G6PD bili labs
G6PD causes hemolysis - too much unconjugated bili in blood
UDP can only conjugate the normal amount so that keeps conjugated at a normal level but still leaves too much unconjugated in blood
Hemolysis will show increased hemoglobin in urine
Unconjugated Bilirubin up
Conjugated bilirubin down
Urine hemoglobin up
Meningitis prophylaxis for contacts
Rifampin
What can myopia lead to
(nearsightedness)
Glaucoma
Retinal Detachment
Riedel thyroiditis
Wood like, firm, hard mass, doesn’t move
Pretibial myxedema is associated with
Hyperthyroid
Viral bronchiolitis tx
Supportive
Saline flush
Nasal flush
bulb suction
Type of stone associated with UTI
Struvite
WHen is IV pyelogram used
Almost never,
outdated
When don’t we use CT urogram
Peds due to radiation
What is first line in bedwetting over 5
UA
rule out pathologic causes
First step when suspected CAUTI
Remove catheter
After cultures
OA imaging findings
Joint space narrowing
osteophytes
Sclerosis
RA imaging findings
periarticular erosions
Risk factor for neisseria meningitis
Smoking
TMS in schizophrenia works for what S/S
hallucinations
Diphenhydramine MOA
Blocks histamine receptor sites
What is PCT dysfunction (kidney)
Fanconi syndrome
SUgar and protein are lost in urine
Patho for Asthma
Chronic inflammation
superimposed bronchospasm
Where in brain does NPH occur
Corona Radiata
Drink corona, get wet wacky and wobbly
MC viral conjuntivitis
Adenovirus
MC arrhythmia after cardiac surgery
AFIB
What do SERM, aromatse and tamoxifen target
estrogen and progesterone receptors
Don’t work on trile negative
Varicose vein tx
Supportive (stockings, elevation etc)
Laser
Stripping
Pseudotumor cerebri tx
Acetazolamide
Shunt if tx fails
(idiopathic intracranial HTN)
CSF pressure increase without cause
Papilledema
Cranial nerve 6 palsy (diplopia)
Next step if UTI treatment with ABX fails even though susceptible
CT
Think obstruction (ABX cant reach bacteria)
Overdose with agitation and “bug” hallucination
think cocaine
Dubin johnson has elevated what
coproparphoryin
Increased total bili
increased Conjugated bili (mildly)
Normal LFT’s
Transport problem
Bili gets conjugated at normal rate but then builds up
Black liver on biopsy
What common meds are colorectal cancer protective
ASA
Cox 2 inhibitors
How does theophyline affect ECT
lowers seizure threshold
(contraindicated)
Meds contraindicated in ECT
Theophylline
BB
Lidocaine
DM meds
insulin
What is serous otitis media associated with
Eustachian tube dysfunction
Cell count in Appendicitis
Elevated WBC
Elevated Neutrophils
Elevated Bands
(left shift)
Gestational DM tx
Lifestyle and diet
Insulin
Glyburide
Metformin
(all 3 considered first line)
Sarcoidosis common findings
INcreased ACE
Increased Calcium
Bilateral hilar lymphadenopathy
non-Caseating granulomas
Dry cough
Lupus perino (Face rash)
Erythema nodosum
Lofgren syndrome
Sarcoidosis
Triad
Erythema nodosum
bilateral hilar lymphadenopathy
polyarthralgia with fever
Infant with painless blood in stool (flecks)
Meckles diverticulum
Tec 99 scan
Surgery
Pituitary tumor tx
Bromocriptine first (dopamine agonist)
Surgery if needed
TPA absolute contraindications (7 of them)
Prior intracranial hemorrhage
Brain AV malformations
Brain cancer/tumor
Ischemic stroke with last 3 months
Aortic dissection
Active bleed, bleeding dialysis cath
Significant trauma within 3 months
Boerhaave imaging
Water soluble esophagram
Can ECT be used on adolescents
Yes, same as adults
What can OSA lead to?
Pulmonary HTN
Decreasing what electrolyte can help with reducing calcium stones
Sodium
Brown sequard
ipsilateral (same side)
Motor, vibratory, proprioception deficiencies
contralateral
Pain and temp deficiencies
penetrating trauma to spinal cord
Deficiencies below injury
Von willebrand
MC heritable bleeding disorder
Factor 8
Young Females
Gum teeth bleeding, epistaxis, bleeding
Heavy menstruation
desmopressin
Von willie factor
Factor 8
PE tx
LMWH
Heparin
Turner syndrome
Females missing an X (normal female is XX)
Short, webbed neck,
Coarctation, horsehoe kidney, ovarian failure
Lack of secondary sex charcterisitcs
Labs - Low estrogen, High FSH, LH
45X
or 46XX, 46XY
Klinefelters
Males with extra X (normal males are XY)
Tall, thin,
Gynecomastia, small testes
high testicular cancer, breast cancer
Labs
Low testosterone,
High FSH,LH, Estradiol
Tx Testosterone may help
47XXY
Fragile X
Autism related
Males
Large ears, large testes
long narrow face
poor intellect
Down
Trisomy 21 MC genetic disorder
Flat face, epicanthal folds, simian crease
brushfield spots (spots on iris)
AV septal defects, TOF,PDA
Hirschsprung, early onset alzheimer’s
Hypersensitivity reactions
Type 1
IgE (histamine)
Anaphylaxis
insect bites, stings
allergic dermatitis
peanut allergy
Eosinophils
Hypersensitivity reactions
Type 2
Cytotoxic
Antibodies attack one place, one type of cell
MG, Graves, Goodpastures
Bullous pemphigoid, pemphigus bulgaris
Graft vs host, Transfusion reaction
IgG and IgM
Hypersensitivity reactions
Type 3
Immune complex reaction
Attack all over body, widespread
Lupus, Rheumatic fever, RA
Polyarteritis nodosa
Post strep acute glomerular nephritis
IgG and IgM
Hypersensitivity reactions
Type 4
T Helper cells
No antibodies
Delayed, takes a while to see
Anything that makes a granuloma
ie sarcoidosis, TB, Fungal pneumonia
Erythema multiform, Scarlet fever, TB skin test
Poison Ivy, Contact irritant (non allergic)
Aspergillosis
Fungal infection
Garden and house plants, soil, compost
Type 1 hypersensitivity (IgE)
occurs in Asthma, Bronchiectasis and CF patients
Coughing up brown mucous plugs
Septa hypah with 45 degree branching
Steroids
itraconazole
Chest physio
Voriconazole
Stemi elevation numbers
According to the American College of Cardiology/American Heart Association guidelines for STEMI
New ST elevation at j point in 2 contiguous leads
1 millimeter elevation in any two contiguous leads, except leads V2 or V3, where the elevation must be 2 mm in men or 1.5 mm in women.
Men
>2 mm elevation in V2,V3
>1mm in all other leads
Females
>1.5 mm elevation in V2,V3
>1mm in all other leads
New LBBB
Labs in osteoporosis
All normal
If acute fracture Alk phos up
Labs in pagets
High alk phos
Everything else normal
Calcium phospahte relationship
opposites
If calcium is up
Phos is down
Potassium and Magnesium relationship
Same
if one is down, they are both down
MC location for ectopic
Ampulla
When can resume sex after chlamydia
7 days after treatment
What is affrim test for
Vaginosis
Chlamydia first line tx
doxy
What can pathogen cause PDA at birth
TORCH viruses
WHat to look for with hyperemesis gravida
Molar pregnancy
Post partum endometriosis tx
Clinda and genta (broad spectrum)
MC risk of Placenta Previa
Multiparity
Balanitis tx
Clotrimazole
(common in diabetics)
Septic Abortion tx
Unasyn (amp/sulbac)
Evacuate uterine contents
What anti coag is best in pregnancy
LMWH
(reduces mortality)
Chorioamnionitis tx
Give ABX as soon as possible
even before birth
Lagopthalmos
Eye lid inability to close
(bells palsy)
Otosclerosis associations
Pregnancy
Women
conductive Hearing loss
Autosomal dominant disorder
Peritonsilar abscess first line
I&D
GIant cell arteritis diagnosis
Biopsy
MC otitis media bacteria
Strep Pneumo
Amoxicillin
Key difference between croup and epiglottitis exam
Epiglottitis patients appear toxic
Croup patients do not
Diarrhea with conjunctivitis think
Adenovirus
Acute angle glaucoma tx
Timilol
Apraclonidine
pilocarpine
iridotomy
Acute bacterial parotitis tx
Unasyn (ampicillin sulbactam)
Tonsillar abscess MC bacteria
Strep Pyogenes (Group A)
Conductive hearing loss findings
Bone conduction is longer than air
(sound waves can’t get in)
Weber goes towards the wax blockage
Ramsey hunt
Zoster Oticus
Facial nerve
Facial paralysis
Ear pain
vesicles in and around ear canal
Valacyclovir and prednisone
Dendritic lesion on eye
Herpes Keratitis
Oppositional defiant disorder
Bad kid (not criminal)
Conduct disorder
Criminal kid
leads to antisocial personality when older
What is avoided in anorexia/bulimia due to seizure risk
Wellbutrin (bupropion)
When do you see kidney scarring
HIV
Focal sclerosing glomerulonephritis
Primary hyperparathyroidsim
overproducing PTH
Breaking down bone
Releasing calcium
High PTH, High Calcium
Secondary Hyperparathyroidism
Chroniclly low clacium (can be due to lifestyle)
constantly producing PTH to compensate
High PTH low calcium
Tertiary Hyperparthyroidism
High PTH
High Calcium
High Phosphate
(phos should be low due to opposite of calcium but kidney isn’t working to remove it)
Primary prevention
implementing something before any evidence that a disease exists
Exercise, low fat diet,
well lit house to reduce risk of fracture
Colon cancer at 40
Secondary prevention
Have disease (diagnosed)
Make sure through screening you don’t become symptomatic
no symptoms
Osteoporosis - dexa scan, calcium, vitamin D etc
USPTF Screening tests, statins, doac with afib
DM foot exam
Tertiary Prevention
intervention after disease and symptoms
Prevent disease from worsening
Chronic HTN - ACE
Disease treatment
Hep B sero
Surface antigen positive (infected)
Acute or chronic
If core antibody is positive IgM is acute, IgG is chronic
Surface antigen negative
look at surface antibody if positive (vaccinated)
Past infection (recovered)
Surface antibody and core both positive
Surface antigen, antibody, core all neg (unvaccinated)
calcium and magnesium relationship
Same, One up both up
Rotor Syndrome
Transport problem like dubin johnson
Mild elevation in conjugated and unconjugated bili
No black liver on biopsy
GCS General numbers
Eyes 1-4
Verbal 1-5
Motor 1-6
GCS eyes
1-4
No eye opening = 1
To pain = 2
To verbal = 3
Spontaneous = 4
GCS Verbal
1-5
No response = 1
Incomprehensible sounds = 2
Inappropriate words = 3
Confused = 4
Oriented = 5
GCS motor
1-6
No motor response = 1
Extension to pain = 2
Flexion to pain = 3
Withdrawals from pain = 4
Localizes Pain = 5
Obeys commands = 6
Hyperkalemia Wave progression
Hyperacute T wave,
Widening QRS
Flattening P wave (prolonged PR)
Sine Wave
