Miscellaneous Flashcards
Arsenic sources (3) + treatment (2)
Pesticides, contaminated water (I.e wells), pressure-treated wood; Dimercaprol British, DMSA succimer
Substances causing methemoglobinemia (3) + treatment (2)
dapsone, nitrites, local/topical anesthetics; methylene blue or vitamin C
How long after ingestion can you give activated charcoal
~1-2 hours up to 4
What is sarin, soman, and tabun?
Organophosphate chemical weapons that have a slightly fruity smell
What is a Geiger-Müller counter?
Detects radiation exposure
Snake bite treatment and indication
Crotalidae polyvalent immune Fab (FabAV); only for people with symptoms, abnormal coagulation, or cardiovascular compromise as it can cause severe anaphylaxis
Treatment for decompression sickness
IV fluids, 100% oxygen and hyperbaric oxygen therapy
Treatment of High Altitude Cerebral Edema (HACE)
Dexamethasone
When to give activated charcoal for acetaminophen OD
> 7.5g ingested, 4 hours or less of ingestion
Normal post-void residual; Post-void residual in overflow incontinence; post-void in urge incontinence
<100ml; >200ml; <50ml
Lab changes in Cushings
Hypertension, Hyperglycemia, Hypernatremia, Hypokalemia
Renal blood flow (RBF) formula
RPF/(1-Hct); RBF usually 20-25% of cardiac output
Renal plasma flow (RPF) formula
UV/P of PAH
Filtration fraction (FF) formula; Normal FF?
GFR/RPF; Normal: 20%
Filtered load (mg/min) formula
GFR x plasma concentration
Treatment for Stable Ectopic Pregnancy
Methotrexate
Treatment for unstable Ectopic pregnancy
Surgery
Other name for teratoma
Dermoid tumour
Parkland Formula for fluid resuscitation in burns
4mL x body weight (kg) x TBSA (%)= total crystalloid fluids in first 24 hours
Half total volume in first 8 hours, half given over following 16 hours
CCB that can be used in heart failure
Amlodipine
Chromium deficiency manifestation (1)
Impaired glucose control
Copper deficiency manifestation (3)
Brittle hair
Skin depigmentation
Neurological dysfunction
Selenium deficiency manifestation (3)
Thyroid dysfunction
Cardiomyopathy
Immune dysfunction
Zinc deficiency manifestation (5)
Alopecia
Pustular skin rash
Hypogonadism
Impaired wound healing
Impaired taste
Niacin deficiency manifestation (3)
Dermatitis
Diarrhea
Dementia
Entamoeba Tx
Metronidazole/Tinidazole PLUS Paromomycin
Adolescent Idiopathic Scoliosis dx tests; Risk factors for curve progression (5)
Unilateral thoracic/lumbar prominence on forward bend test. Cobb angle >10 degrees consistent with scoliosis, >25 degrees is severe.
“SAFES”
Skeletal immaturity, Age <12, Female, Early puberty, Severe curvature >25
Legionnaires Disease features
Atypical pneumonia, confusion, GI features, hyponatremia, bradycardia
Differentiation b/w Vascular Dementia and Alzheimer’s
Vascular dementia will have executive dysfunction rather than memory loss. Urinary and reflex abnormalities are moreso seen in vascular dementia
JVP Waveform correlations (A, C, x, V, y)
A: Atrial contraction
C: Ventricular contraction
x: Atrial relaxation
V: Maximal atrial filling
y: Atrial emptying
What can cause pulsus paradoxus? (3)
Decrease in Blood Pressure >10mmHg during inhalation
-Cardiac tamponade, asthma, COPD
Rituximab to treat which leukemia?
Chronic lymphocytic leukemia (CLL)
Imatinib is used to treat which leukemia?
Chronic myeloid leukemia (CML)
Cytarabine used to treat which leukemia?
Acute Myeloid Leukemia (AML)
Treatment for Acute Lymphoblastic Leukemia (ALL)
Hyper-CVAD
-Cyclophosphamide, vincristine, doxorubicin (Adriamycin), Dexamethasone
Adverse effects of each DMARD (Methotrexate, Leflunomide, Hydroxychloroquine, Sulfasalazine, TNFa-inhibitors)
Methotrexate: Hepatotoxicity, stomatitis, cytopenias
Leflunomide: Hepatotoxicity, cytopenias
Hydroxychloroquine: Retinopathy
Sulfasalazine: Hepatotoxicity, stomatitis, hemolytic anemia
TNFa-inhibitors: infection, demyelination, CHF, malignancy
Drug of choice for small intestinal bacterial overgrowth (SIBO)
Rifaximin
What is a Gastric Bezoar?
Accumulation of undigestible materials (hair, foreign objects) in stomach; leads to gastric outlet obstruction (GOO)
What is a succussion splash?
Splash sound heard when abdomen is rocked from retained food in stomach, heard in gastric outlet obstruction (GOO)
What is a trachoma?
Bacterial conjunctivitis caused by Chlamydia
Causes of Osteonecrosis (avascular necrosis)
“CAST Bent LEGS” - Corticosteroids, Alcoholism, Sickle cell, Trauma, Bend (decompression), LEgg-Calve-Perthes, Gaucher, Slipped capital femoral epiphysis
Aflatoxin increases risk of which malignancy?
Hepatocellular Carcinoma
Bordetella Pertussis Tx
Macrolide (Azithromycin, Clarithromycin)
Ogilvie Syndrome causes (6) and treatment (2)
Causes: Major surgery, injury, infection, electrolyte derangement, medication (opiates, anticholinergic), neurological disorders
Treatment: NG/rectal decompression. If signs of peritonitis/cecum >12cm, laparotomy
Neostigmine if no improvement within 48hrs
Antibody associated with Autoimmune Pancreatitis
Immunoglobulin G4 (IgG4)
Most specific antibody for Autoimmune Hepatitis
Anti-Liver Kidney Microsomal Antibody (Anti-LKM-1); other antibodies are ANA and anti-smooth muscle
Skin infection associated with Parkinson’s + Cause + Treatment
Seborrheic Dermatitis; Malassezia; Topical Ketoconazole
Chest XRay findings in pulmonary embolism (3)
Westermark sign: Peripheral hyperlucency of pulmonary arterial tree
Hampton hump: Peripheral, wedge-shaped opacity representing infarction
Fleischner sign: Enlargement of pulmonary artery
What is Hyposthenuria? What condition is it associated with
Kidneys unable to concentrate urine resulting in abnormally low specific gravity; Associated with Sickle Cell Disease
Treatment of Postherpetic Neuralgia (PHN)
-Anticonvulsants (Gabapentin, Pregabalin)
-TCAs (Amitriptyline, Desipramine, Nortriptyline)
-Topical Capsaicin
How to differentiate Biliary Colic from Acute Cholecystitis
Biliary colic has quick resolution and lack of fever, abdominal tenderness, and leukocytes which helps distinguish it from cholecystitis
Imaging modality for pancreatic tumor in head vs body/tail
Head: Ultrasound
Body/tail: Abdominal CT scan
Antibody & MSK pathology associated with PBC and treatment
Antimitochondrial antibody ; Osteoporosis/Osteomalacia ; Ursodeoxycholic acid
Cause of pill esophagitis (other than tetracycline or bisphosphanates)
NSAIDS, iron, and potassium chloride
Pancreatitis causes (11)
“I GET SMASHED”
I- Idiopathic
G- Gallstones (2nd most common cause)
E- Ethanol (most common cause)
T- Trauma
S- Steroids
M- Mumps/Malignancy
A- Autoimmune (IgG4)
S- Scorpion
H- Hypertriglyceride (>1000) or Calcium
E- ERCP
D- Drugs (HCTZ, Didanosine, Pentamidine, Bactrim, Azathioprine)
Findings on slit-lamp for keratitis (bacteria vs HSV vs fungi)
Bacteria: Central, round ulcer
HSV: Branched, dendritic ulcers
Fungi (i.e., candida): Ulcers with feathery margins
Hepatopulmonary syndrome pathology and clinical findings
Intrapulmonary vascular dilations in setting of chronic liver disease; Platypnea (dyspnea when upright) and orthodeoxia (oxygen desat when upright)
Blood transfusion-related hypocalcemia
Increased citrate levels, binding calcium
Diagnosis/treatment of Upper Airway Cough Syndrome (UACS)(postnasal drip)
First-gen H1 receptor antagonists (I.e., chlorpheniramine)
Photosensitivity-causing drugs
“SAN LIGHT”
-Sulfonamides
-Amiodarone
-NSAIDS
-Loop diuretics
-Isotretinoin
-Griseofulvin
-Hydrochlorothiazide
-Tetracyclines
SJS-causing drugs
“SANA”
-Sulfonamides
-Anticonvulsants (I.e, lamotrigine)
-NSAIDS
-Allopurinol
MMR; precautions for each
Measles: Airborne
Mumps, Rubella: Droplet
Influenza and Pertussis precaution
Droplet
Tuberculosis precaution
Airborne
Varicella precaution
Airborne
What is seen in Felty Syndrome?
Rheumatoid arthritis, Neutropenia, Splenomegaly
What is seen in Caplan Syndrome?
Rheumatoid arthritis with pneumoconiosis
Most common joint involved in OA with names of nodules
Most common: distal interphalangeal (DIP)
Nodules: Heberden (DIP), Bouchard (PIP)
Hand joint involved with RA; hand findings
-Proximal interphalangeal (PIP) common in RA
-May see Boutonnière (ulnar deviation) and Swan Neck deformities
Most common risk factors for Pseudogout (2)
Hemochromatosis and Hyperparathyroidism
Belimumab MOA & Use
B-cell inhibition to control progression of Lupus
Most dangerous complication of Sjogren syndrome
Lymphoma
Treatment for scleroderma renal crisis
ACE inhibitor
Drugs causing GOUT
“Too much seafood on your PLATE”
Pyrazinamide
Loop diuretics
Aspirin (low dose)
Thiazides
Ethambutol
Main causes of Reactive Arthritis (6)
Salmonella, Shigella, Campylobacter, CDiff, Yersinia, Chlamydia
Schirmer test
Test used in Sjogrens to measure amount of tears produced
Antibody in Limited vs Diffuse scleroderma
Limited (CREST): Anti-Centromere
Diffuse: Anti-Scl70 (Anti-topoisomerase 1), Anti-RNA polymerase III
Drug of choice for lupus + ADR
Hydroxychloroquine; Retinal toxicity
LBBB and RBBB EKG findings
-Thumbs up (I/II and aVF)
-LBBB: M-shaped V6
-RBBB: Rabbit ears V1
Differentiating CHF exacerbation vs COPD exacerbation
CHF: Low CO2, resp alkalosis 2/2 tachypnea
COPD: High CO2, resp acidosis 2/2 trapping
Causes of increased DLCO (2)
Pulmonary hemorrhage, Polycythemia
Sepsis criteria
“TPRW” (SIRS)
-Temperature >38C or <36C
-Pulse >90
-Respirations >20 or pCO2 >32mmHg
-WBC >12,000 or <4,000
+ source of infection
Wernickes Triad + Causes
Encephalopathy, Ataxia, Nystagmus
Causes: EtOH abuse, anorexia, malignancy, hyperemesis gravidarum
Prominent x & y descents on JVP tracings
Constrictive pericarditis
Causes of pulsus paradoxus
Drop in systolic blood pressure >10mmHg on inspiration
Asthma, COPD, cardiac tamponade, constrictive pericarditis, restrictive cardiomyopathy
Therapy to decrease mortality in HFpEF
SGLT2 inhibitors (Dapagliflozin, Empagliflozin)
Dx of RV dilations due to myocytes being replaced by fibrofatty tissue
Arhythmogenic right ventricular dysplasia (ARVD)
-Autosomal dominant
-2nd MCC of SCD in young adults (2nd to HOCM)
-Avoid physical activity
-Tx with ICD, b-blockers, anti-arrhythmic, anticoagulation
Pathophysiology of Refeeding Syndrome
Hypophosphatemia due to chronic malnutrition (I.e., alcohol, anorexia)-> reintroduction of carbohydrates stimulates insulin secretion-> insulin drives phosphate into cells, further depleting it-> severe phosphatemia with symptoms of muscle weakness, hyporeflexia, rhabdomyolysis, arrhythmias, CHF…
Appearance of Focal Nodular Hyperplasia (FNH) on imaging
Well-circumscribed, solitary, <5cm, hyper-dense with a central, stellate scar
Benign, asymptomatic, caused by anomalous arteries, seen in young females
Metabolic Syndrome criteria
At least 3 of the 5:
-Abdominal obesity (>40 in males, >35 in females)
-Fasting glucose (>100-110)
-BP (>130/80)
-Triglycerides (>150)
-HDL (<40 in men, <50 in women)
Lab findings in VIPoma
Hypokalemia, hypercalcemia, hyperglycemia, VIP >75pg/mL
Urine pH in each RTA
Type 1 (distal): >5.5
Type 2 (proximal): <5.5
Type 4: <5.5
Causes of each RTA
Type 1: Genetic, medication, Autoimmune >5.5
Type 2: Fanconi <5.5
Type 4: Obstructive uropathy, congenital adrenal hyperplasia <5.5
Three types of hernias
Reducible: Return to native position with gentle pressure or valsalva
Incarcerated: Trapped in hernia defect, will not return
Strangulated: Trapped hernia loses blood supply and requires groin exploration
Hepatorenal Syndrome Pathophysiology + Drug treatment (3)
Portal HTN->Local release of vasodilators->Splanchnic vasodilation->Decreased arterial blood volume->Decreased renal perfusion->Increased RAAS causing Na retention and ascites->Overwhelming renal vasoconstriction causing acute renal failure
-Octeotide, Midodrine, terlipressin
Feared outcome of heparin-induced thrombocytopenia
Arterial/Venous thrombosis
Internal vs external hordeolum (Stye)
Internal: Infectious blockage of Meibomian gland
External: Infected eyelash follicle
*both painful and
Diagnosis of painless blocked meibomian gland
Chalazion
*vs painful which is caused by hordeolum
Treatment of Hordeolum (Stye) vs Chalazion
Hordeolum: Allow spontaneous drainage, warm compress
Chalazion: Warm compress, antibiotic eyedrops, surgery if needed
Rosacea treatment, papulopustular vs erythematotelangiectatic type
Papulopustular: Topical Metronidazole
Erythematotelangiectactic: Laser or topic brimonidine (a2 agonist)
Fundoscopic findings in Glaucoma
Optic disc atrophy with cupping with elevated intra-ocular pressure (IOP)
Infectious causes s/p liver transplant <1 month, 1-6 months, and >6 months
<1 month: Bacterial
1-6 months: Opportunistic pathogens
>6 months: Community-acquired
Who would be considered low (<10%) pre test probability of coronary artery disease
-Asymptomatic people of any age
-Atypical chest pain in women <50
Who would be considered intermediate (20-80%) pre test probability of coronary artery disease
-Atypical chest pain in men all ages
-Atypical chest pain in women >50
-Typical chest pain in women 30-50
Who would be considered high (>90%) pre test probability of coronary artery disease
-Typical chest pain in men >40
-Typical chest pain in women >60
What is Samter’s Triad
Asthma, nasal polyps, sensitivity to NSAIDs.
Associated with Aspirin-exacerbated respiratory disease (AERD)
Sickle Cell Pulmonary Hypertension Pathophysiology
Chronic intravascular hemolysis releasing free heme into plasma depletes nitric oxide, leading to pulmonary vasoconstriction.
Contraindications to taking lithium vs valproate
Lithium: Avoid in renal disease
Valproate: Avoid in liver disease
Contraindications to taking Naltrexone vs Acamprosate
Naltrexone: Don’t take if taking opioids or with liver disease
Acamprosate: Don’t take with renal disease
5 P’s of Acute Intermittent Porphyria (AIP)
-Painful abdomen
-Port-wine urine
-Polyneuropathy
-Psychological disturbances
-Precipitated by drugs
Porphyria Cutanea Tarda associations and triggers
Associations: Hepatits C, HIV
Triggers: Alcohol, OCPs, Smoking
Potassium Citrate use
Urine alkalization for stones, Tx renal tubular acidosis
Memantine MOA and Use
NMDA receptor antagonist ; Alzheimer’s
What is Holiday Heart Syndrome
Afib induced by alcohol binge-drinking
All drugs causing Digoxin toxicity
Amiodarone, verapamil, quinidine, propafenone
Treatment of frequent allergic conjunctivitis
Mast cell stabilizers (e.g. Olopatadine, Azelastine)
Mixed connective tissue disease (MCTD) shows features of what? Has which marker? Most common cause of death?
Variable features of SLE, systemic sclerosis, polymyositis, rheumatoid arthritis. Anti-U1 ribonucleoprotein (anti-U1RNP). Most common of death from pulmonary hypertension
Demeclocycline off-label use
SIADH. Antagonist of ADH
What would be seen in lesion of left paramedian pontine reticular formation (PPRF)
Conjugate gaze of BOTH eyes to right side
What would be seen in lesion of left medial longitudinal fasciculus (MLF)
On attempted coordinated horizontal gaze to the right, the left eye will not be able to properly adduct and typically result in nystagmus
called Internuclear Opthalmoplegia (INO), seen in Multiple Sclerosis patients
What would be seen in lesion of left frontal eye fields
Conjugate gaze deviation of BOTH eyes toward the lesion
Multiple sclerosis treatment for acute setting, refractory, maintenance, and spasticity
Acute: IV Steroids
Maintenance: Beta interferon, fingolimod, natalizumab
Refractory: Plasmapheresis
Spasticity: Baclofen or Tizanidine
Treatment of CLL
Ibrutinib, Fludarabine
*if suspected, start with quantitative immunoglobulin assay (flow cytometry)
Adverse effect of HIV drug Abacavir
Life threatening systemic reaction (fever, rash, respiratory distress) in HLA-B5701 positive patient
Treatment of Chagas Disease
Benznidazole and Nifurtimox
Tuberous Sclerosis associations
A- Ashleaf spots
S- Shagreen patches
H- Heart rhabdomyomas
L- Lung lymphangioleiomyomatosis (LAM)
E- Epilepsy from cortical tubers
A- Angiomyolipoma in kidney
F- Facial angiofibromas
Cholangitis clinical findings
Charcot’s Triad: RUQ pain, Fever, Jaundice
Reynold’s Pentad: Triad + hypotension and AMS
VACTERL Anomalies
Vertebral (X-ray)
Anal (imperforate)
Cardiac (Echo)
Tracheal
Esophageal
Renal (ultrasound)
Limbs (thumbs in particular)
Pathophysiology of annular pancreas
Adherence of ventral bud of pancreas to duodenum causing obstruction
Which kidney stone has the highest occurrence rate
Calcium Oxalate
Shape of each type of kidney stone (6)
Calcium oxalate: Biconcave dumbbell/bipyramidal envelope
Calcium phosphate: Wedge-shaped prisms
Uric acid: Rhomboid/Rosette
Struvite: Rectangular coffin-lid
Cystine: Hexagon-shaped
Xanthine: Amorphous
What is the “law of double effect” and example in health-care
Carrying out an action that may cause harm but with a primary ethical intent
Giving pain meds to COPD patient with metastatic cancer even if the only way to relieve pain was enough opioids that breathing ends up being impaired, causing early death.
Normal pregnancy weight gain
11.4-15.9kg (25-35lbs)
*Equivalent to caloric intake increase of 350kcal/day in 2nd trimester and 450kcal/day in third semester
Most common cause of Bacterial Conjunctivitis in adults? Treatment?
Staph Aureus; Erythromycin ointment or polymixin-trimethoprim drops
*Fluoroquinolone drops in contact lens wearers
Dx in patient with maximal heel pain on first stepping out of bed. Pain/tenderness at medial plantar heel, worse with dorsiflexion
Plantar fasciitis
Dx in patient with posterior heel pain, swelling/tenderness 2-6cm proximal to tendon insertion
Achilles tendinopathy
Dx in patient with heel pain worse with activity, reproduced by medial-lateral squeezing of calcaneus
Calcaneal stress fracture
Dx in patient with pain, paresthesia, and numbness on sole of foot. Percussion tenderness over posterior tibial nerve
Tarsal tunnel
Dx in patient with pain, paresthesia, and numbness on sole of foot. Percussion tenderness over posterior tibial nerve
Tarsal tunnel
Dx in patient with episodic spastic contraction of anal sphincter unrelated to defecation
Proctalgia fugax
Treatment of lymphangitis
Cephalexin
Dx with chronic lateral hip pain that is worse with hip flexion or lying on affected side
Greater trochanteric pain syndrome (GTPS)
What is the most common congenital foot deformity
Flexible metatarsus adductus; resolved by 1 year.
*rigid type treated with casting
Dx in patient with chronic watery diarrhea, normal mucosa, and a biopsy showing mucosal subepithelial collagen deposition
Collagenous colitis
Types of strabismus
Nasal deviation (esotropia), temporal deviation (exotropia)
Von Hippel Lindau symptoms
C- Cerebellar hemangioma
A- Retinal “A”ngioblastona
R- Renal cell carcinoma
P- Pheochromocytoma
E- Epidydymal nodule and tumour
E- Endolymphatic sac tumour
P- Pancreatic tumour and cyst
Measles vs Rubella
Measles: High-grade fever with rash, generalized lymphadenopathy, common in children, conjunctivitis, cough
Rubella: Mild fever preceding rash, localized lymphadenopathy (postauricular, suboccipital), common in adolescent and young adults
*both centrifugal rash
Prognosis of congenital hydrocele
Spontaneous closure of processes vaginalis by age 1; Ligation if spontaneous closure fails to occur
Associations with Fabry disease
“HARP”
Hypohidrosis
Angiokeratomas
Renal failure
Peripheral neuropathy
What is Heyde syndrome?
Triad of aortic stenosis, vWD, and GI bleeding due to angiodysplasia
Consequence of iron poisoning within 2 days and within 2-8 weeks
Within 2 days: hepatic necrosis
Within 2-8 weeks: pyloric stenosis
Treatment of leptospirosis
Gram negative. Contact with urine of infected animals
First line Doxycycline. Alternatively Azithromycin
Dx in patient with FOOSH, anterior shoulder flattening, arm held in adduction and internal rotation
Posterior shoulder dislocation
Dx in arm drop positive and decreased abduction with intact sensation
Rotator cuff tear
Dx in axillary nerve damage, flattened deltoid, prominent acromion, abducted and externally rotated shoulder
Anterior shoulder dislocation
Dx in trauma or injury with tenderness upon adduction of arm across torso, palpable deformity at superior aspect of shoulder
Acromioclavicular joint dislocation
Amantadine MOA, Use, adverse effect
Weak NMDA receptor antagonist, improve motor symptoms in Parkinson’s. Adverse Livedo reticularis and peripheral edena in 5% of cases
Kawasaki symptoms
“CRASH and BURN”
-Conjunctival injection
-Rash (palms/soles to trunk)
-Adenopathy
-Strawberry tongue, oral fissures
-Hand/foot erythema
-Burn (Fever >5 days)
Tx: ASA + IVIG
What is Mentzer index
Used to differentiate between iron deficiency anemia and beta thalassemia
MCV divided by RBC count. Under 13 typically thalassemia, above 13 typically iron deficiency
Mastitis treatment
Continue breastfeeding, cover staph aureus with dicloxacillin or cephalexin
What is a positive Stemmer sign?
Inability to lift skin on dorsum of second toe. Highly specific for lymphedema
What is ortner syndrome?
Left atrial enlargement causing recurrent laryngeal nerve compression resulting in voice hoarseness
HLA associated with Psoriatic Arthritis
HLA-B27
What is an asthma action plan?
An Asthma Action Plan is a written, individualized worksheet that shows you the steps to take to keep your asthma from getting worse. It also provides guidance on when to call your healthcare provider or when to go to the emergency room.
Takes into account symptoms and peak flow measurement. Green=Go, Yellow=Quick-relief medicine, Red=Seek medical attention
What is the Dawn Phenomenon
Early morning (2-8AM) fasting hyperglycemia due to circadian increase in growth hormone and cortisol secretion
Diet and exercise can decrease risk of which type of heart failure
HFpEF
What is paradoxical vocal fold motion (PVFM)
Also called vocal cord dysfunction, vocal cords inappropriately adduct (close) during inspiration causing obstruction.
Diagnose with laryngoscopy
What is abdominal compartment syndrome
IAP >20mmHg associated with organ failure and IVC compressing, decreasing preload. Decompression via laparotomy/NGT needed to bring IAP <12mmHg
Dx in pregnant woman with pruritis and elevated direct bilirubin? Treatment?
Cholestasis of pregnancy. Ursodeoxycholic acid
Peutz jegher increases lifetime risk of what?
Ovarian, breast, colorectal, and pancreatic cancer
Mnemonic for reading CXR
“ABCDE”
Airway (check trachea, carina, etc…), Bones, Cardiac, Diaphragm, Everything else
NEXUS criteria for C-Spine imaging (5)
CT C-Spine if any of criteria met: Neurological deficit, spinal tenderness, AMS, intoxication, distracting injury present
“NSAID”
With low pre-test probability not meeting criteria, lateral xray used
What is Foster-Kennedy syndrome?
Triad of optic atrophy, contralateral papilledema, and anosmia, caused by olfactory meningioma or frontal lobe tumour
Drug regimen for nonseminoma treatment
BEP: Bleomycin, Etoposide, Cisplatin (platinum)
Drug treatment for BRAF+ melanoma
Vemurafenib (BRAF inh) w/ Cobimetinib (MEK inh)
What are the four types of cutaneous melanoma
Superficial spreading: seen in sun-exposed areas
Nodular: Usually in men and often with ulceration
Acral: Commonly in asians, Hispanics, African descent
Lentigo maligna: Elderly patients
Treatment of Uric Acid stones
Alkalinize urine with potassium citrate or potassium bicarb with goal pH of 6-7. Adjunct low-purine diet or allopurinol
Phlegmasia alba dolens vs Phlegmasia cerulea dolens
Alba: White leg, occlusion of deep veins
Cerulea: Blue leg, occlusion of superficial veins
Bladder ultrasound revealing how much urine confirms acute urinary retention (AUR)
> 300 mL
Estimated daily insensible fluid loss in adults vs infants
Adults: 500-700 mL
Infants: 300-400 mL
What solution is preferred for volume resuscitation in burn patients? Why?
Lactated ringer. Contains near-physiologic levels of chloride, potassium, and calcium and includes sodium lactate, a buffer that is metabolized to HCO3 to correct acidosis
What is a unicameral bone cyst?
Seen in skeletally immature children. Solitary, benign cyst with fibrous lining in medullary cavity of long bones. Usually asymptomatic. Well-defined lucent lesion, enhancing rim on MRI
Bruit in vascular pseudoaneurysm vs AF fistula
Pseudoaneurysm: Systolic bruit w/ pulsatile mass
AVF: Continuous bruit with no mass
Clinical features of Legg-Calve-Perthes disease
Limp, restricted hip abduction & internal rotation, positive trendelenburg
Treatment of Actinic Keratoses
Cryotherapy or topical fluorouracil
Stages of Decubitus Ulcer
Stage 1: Intact skin, nonblanchable erythema
Stage 2: Shallow, open ulcer
Stage 3: Full-thickness skin loss w/ possible visible subq fat
Stage 4: Exposed bone, tendon, or muscle
Unstageable: Base covered by slough or eschar
Arterial, Venous, Lymphatic drainage above vs below dentate line
Above dentate
Arterial: Superior rectal artery (from IMA)
Venous: Superior rectal vein (to portal)
Lymphatic: Internal iliac nodes
Below dentate
Arterial: Inferior rectal artery (from internal pudendal artery)
Venous: Inferior rectal vein (to internal rectal vein)
Lymphatic: Superficial inguinal nodes
Pudendal nerve causing discomfort
Retroperitoneal structures
“SAD PUCKER”
S- Suprarenal (adrenal) glands
A- Aorta/IVC
D- Duodenum (2nd/3rd parts)
P- Pancreas (head)
U- Ureters
C- Colon (ascending & descending)
K- Kidneys
E- Esophagus
R- Rectum
Small cell lung cancer Tx
Combination Cisplatin and Etoposide
Benign, rapidly expanding vascular tumour in the nose that is exclusive in males? Imaging?
Juvenile nasopharyngeal angiofibroma. Cranial CT
Timeline for performing orchiopexy in children with undescended testes
Should have spontaneous descent by 6 months. Surgical treatment between 6-12 months ideally but no later than 24 months of age
Imaging for midgut malrotation? Specific findings?
Upper GI contrast series. Misplaced ligament of treitz, duodenojejunal junction right of midline, corkscrew appearing duodenum
When is phimosis pathological? Treatment?
Full phimosis is considered normal in boys aged <5yrs. Afterwards, can treat with gentle stretching and topical corticosteroids
Actinic Keratosis treatment (3)
Cryo for small, 5-FU for multiple, imiquimod
Pt with PMH rheumatoid arthritis develops hyporeflexia and weakness following intubation
Atlantoaxial instability
Timeline of physiological congenital umbilical hernia
Typically closed spontaneously by age 5
Mutations associations with hereditary hemochromatosis? Treatment?
Homozygous C282Y, Heterozygous C282Y/H63D. Treat with phlebotomy
What does high pleural adenosine deaminase indicate?
Tuberculous pleurisy
Treatment of acute renal transplant rejection
Pulse steroid therapy (e.g., short course IV methylprednisolone)
Genes associated with hereditary pancreatitis
PRSS1
Conditions involving Psammoma bodies (calcified spheres)
“PSaMMoma”
-Papillary thyroid carcinoma
-Serous carcinoma of endometrium/ovary
-Meningioma
-Mesothelioma
What is hematobilia?
Blood from hepatic source drains into biliary tree and through sphincter of oddi into duodenum
What is the Artery of Adamkiewicz? What syndrome is it associated with?
Artery at T9-T12 branching off L posterior intercostal artery anastomosing with anterior spinal artery. Associated w Anterior Cord Syndrome
What is Argyll Robertson Pupil? Association?
Pupils that constrict with accommodation (focusing on nearby object) but do NOT constrict when exposed to light. Associated with neurosyphillis
Cauda Equina vs Conus Medullaris
Cauda Equina: Gradual/Unilateral, severe pain/paraplegia, absent knee/ankle reflex
Conus Medullaris: Sudden/Bilateral, less severe pain/paraplegia, absent ankle reflex only
Cephalohematoma vs Subgaleal hematoma
Cephalohematoma: Sub-Periosteum and does not cross suture lines self-resolves
Subgaleal hematoma: Rupture of emissary veins. Sub-aponeurosis and can cross suture lines high risk of hemorrhagic shock
Labs will show what with pertussis
Elevated WBC with lymphocytosis (often above 70%)
Difference between intention-to-treat vs per protocol
Both are methods used to analyze results in prospective randomized study
Intention-to-treat: Considering everyone in result even if some lost (died, dropped out, etc…)“Once randomized, always analyze”
Per protocol: Only consider those that are remaining at the end of the study
UBE3A allele mutation associated with?
Angelman Syndrome
Live-attenuated vaccines
“Mrr. V.Z. Mapsy”
Mumps, Rota, Rubella, Varicella Zoster, Measles, Adeno, Polio, Smallpox, Yellow fever
