Mixed Flashcards
pt come in for insomnia, anxiety –> increased liver enzyme, macrocytosis –> condition?
chronic alcohol use
prolonged hypotension –> leads to what kidney condition?
acute tubular necrosis
indicates what conditon?
- muddy brown granular cast
- RBC cast
- WBC cast
- fatty cast
- broad and waxy cast
- muddy brown granular cast: acute tubular necrosis
- RBC cast: glomerulonephritis
- WBC cast: intersistial nephritis, pyelonephritis
- fatty cast: nephrotic synd
- broad and waxy cast: chronic renal fail
BUN:Cr ratio –> values and what they indicate
> 20:1 –> pre-renal
<20:1 –> intra-renal
post-menopause –> vag bleed –> next step?
think of endometrial hyperplasia or cancer:
pelvic US –> eval endometrial thickness, assess for other pelvic pathology
post-menopause –> vag bleed –> when do endometrial bx?
pelvic US –> endometrial thickness >4mm –> bx to eval for malig
whipple dz –> MC presenting ssx (5)
- chronic malabsorptive diarrhea
- wt loss
- migratory non-deforming arthritis
- LAD
- low grade fever
what meds increase risk of diverticulosis?
ASA, NSAID
cervical intraepithelial neoplasia 3 –> next step?
cervical conization (type of excisional bx)
what are howell-jolly bodies?
RBC –> nuclear remnant
howell-jolly bodies –> seen in what condition?
asplenia (ie sickle cell)
morton neuroma –> charact
- distal forefoot –> metatarsal heads to 3rd & 4th toes –> numb, ache, burn
- Mulder sign: crepitus bw 3rd & 4th toes
morton neuroma –> who? pathophys?
usu runner –> mech-induced neuropathic degen of interdigital N –> ssx worse when walk on hard surface, wear tight/high heel shoes
morton neuroma –> tx?
metatarsal support or padded shoe insert
transudate vs exudate
transudate:
- increased hydrostatic pressure
- decreased oncotic pressure
- -> low protein
exudate: inflamm –> increase vasc permeability
- -> high protein, lactate dehydrogenase
regular schedule for meningococcal vaccine
- primary vaccine –> 11-12yo
- booster at 16yo
first stage of labor –> consists of what phases?
- latent phase: gradual cervical dilation
- active phase: rapid dilation
what constitutes arrest of active labor?
cervical dilatrion >6cm:
- no cervical change for >4hr w adeq contractions
- no cervical change for >6hr w inadeq contractions
arrest of active labor –> next step?
C-section
osteoarthritis –> PE findings (3)
- bony enlrgment, tenderness
- crepitus w mvmt
- painful, decreased ROM
glasgow coma scale –> who? for what? assesses?
all trauma pt:
- estimate severity of neuro injury
- predict prognosis of coma & other conditions (bact meningitis, traumatic brain injury, subarachnoid hemorrhage)
Assess:
- eye opening
- verbal resp
- motor resp
ARDS –> pathophys? results in?
infect, trauma, other –> lung injury –> alveolar space –> release proteins, inflamm cytokines, neutrophils –> blood, proteinaceous fluid –> into alveoli –>
- lose surfactant –> alveoli collapse
- diffuse alveolar damage
Results in:
- impair gas exchange
- decreased lung compliance
- pHTN
abruptio placentae –> RF (3)
- # 1 HTN
- cocaine
- maternal trauma
abruptio placentae –> presentation
- abd/back pain
- fetal heart rate abnormal
- variable vag bleed
what is modified wells criteria?
pretest probability of PE:
<4 –> PE unlikely
>4 –> PE likely
sickle cell dz –> aplastic crisis –> pathophys? charact?
parvovirus B19 –> sudden halt in RBC production
- severe anemia
- low retic (<1%)
- no HSM
cause of ascending aortic aneurysm? descending?
ascending: cystic medial necrosis, connective tissue disorder
descending: atherosclerosis
duration of:
- brief psychotic disorder
- schizophreniform disorder
- schizophrenia
- brief psychotic disorder: 1day-1mo
- schizophreniform disorder: 1-6mo
- schizophrenia: >6mo
what is: placenta accreta
placenta attach directly to myometrium
uterine inversion –> management
1) aggressive fluid replace
2) manual replace uterus
3) remv placenta, uterotonic drug
newborn –> conjugated hyperbili + hepatomegaly –> condition?
biliary atresioa
biliary atresia –> 1st step in eval? result?
abd US –> absent/abnormal gallbladder
biliary atresia –> tx?
Kasai procedure (hepatoportoenterostomy) –> eventually liver tx
ALL –> how dx?
BM bx –> >25% lymphoblasts
gallstone + typical biliary colic ssx –> tx?
elective lap chole
acute cholecystitis –> tx?
chole in 72hr
suspect achalasia –> next step?
endoscopy to r/o malig (pseudoachalasia)
bursitis –> how affect active ROM? passive?
active: decreased or painful
passive: normal
prepatellar bursitis –> presentation (3)?
- ant knee pain, tender
- erythema
- localized swelling
acute prepatellar bursitis –> pathophys
- penetrating trauma
- repetitive friction
- local cellulitis
–> S. aureus infect bursa
acute prepatellar bursitis –> how confirm dx?
aspirate bursal fluid –> cell count & Gram stain
absence sz –> comorbidity (2)?
- ADHD
- anxiety
postmenopause –> large adnexal mass + vag bleed + endometrial hyperplasia –> condition?
granulosa cell tumor of ovary
granulosa cell tumor of ovary –> vag spot –> why?
secrete estrogen –> endometrial hyperplasia –> postmenopausal bleed
granulosa cell tumor of ovary –> endometrial hyperplasia –> next step? why?
endometrial hyperplasia –> risk of endometrial cancer –> endometrial bx
8yo M –> staring episodes –> tilt head, chew, not respond to name/touch –> confused for 20min after –> condition?
focal sz w LOC
focal sz –> presentation?
- motor (headturning), sensory (paresthesia), or autonomic ssx (sweat)
- may have LOC & automatism (chewing)
how can provoke absence sz?
hypervent
UA –> positive leukocyte esterase –> indicates?
significant pyuria
UA –> positive nitrite –> indicates?
presence of Enterobacteriaceae (E.coli –> convert nitrate in urine to nitrite)
polysaccharide vaccine –> how induce immunity?
Tcell-indep Bcell response:
polysacc –> bind Ab on Bcell –> mod level of interm-affinity Ab
conjugate vaccine –> how induce immunity?
Tcell-dep Bcell response:
polysacc-protein conjugate –> bind Ab on Bcell –> protein component activate Tcell receptor –> high levels of high-affinity Ab + memory cell formation
pneumococcal vaccine –> what kind for:
- infant
- young child
- <65yo + predisposing comorbid
- immunocomp
- > 65yo
- infant: PCV13
- young child: PCV13
- <65yo + predisposing comorbid (chronic heart/lung dz, DM, cirrhosis): PPSV23
- immunocomp: PPSV23 + PCV13
- > 65yo: PPSV23 + PCV13
tachycardia-mediated cardiomyopathy –> how to improve LV fx?
restore sinus rhythm or aggressive ctrl ventricular rate
what is: missed abortion
preg loss at <20wk gestation prior to expulsion of gestational tissue
missed abortion –> presentation
- usu asymptomatic
but can present w:
- loss of preg ssx
- light vag bleed
missed abortion –> findings (3)
- closed cervix
- decreasing B-hCG
- US: no fetal heartbeat
spherocytosis –> lab findings:
- MCHC
- MCV
- peripheral smear
- Coombs test
- acidified glycerol lysis test
- eosin-5-maleimide binding test
- MCHC: increase (d/t membrane loss & RBC dehydration)
- MCV: low
- peripheral smear: spherocytes
- Coombs test: neg
- acidified glycerol lysis test: increase osmotic fragility
- eosin-5-maleimide binding test: abnormal
spherocytosis –> increase risk for what conditions (2)?
- bilirubin gallstones
- parvovirus B19 –> aplastic crisis
spherocytosis –> presentation –> classic triad
- hemolytic anemia
- jaundice
- splenomegaly
spherocytosis –> tx
supportive: folic acid, transfusion for severe anemia
spherocytosis –> what does splenectomy do for pt? what does it not do?
- improve anemia
- reduce gallstone risk
not change increased MCHC
anti-D immune globulin –> when administered during preg?
28wk gestation + w/in 72hr of delivery
what is: Kleihauer-Betke test
determine if need higher than standard dose of anti-D immune globulin after delivery
sickle cell trait –> #1 comp
painless hematuria (d/t sickling in renal medulla)
chronic renal fail –> phlebotomy –> not stop bleed –> why?
platelet dysfx –> abnormal hemostasis
chronic renal fail –> platelet dysfx –> lab findings:
- PT
- PTT
- platelet count
- BT
- PT: normal
- PTT: normal
- platelet count: normal
- BT: prolong
chronic renal fail –> platelet dysfx –> tx? MOA?
DDAVP –> increase release of factor VIII-vWF multimers from endothelial storage sites
lung cancer –> paraneoplastic synd –> muscle weak –> what paraneoplastic synd could it be (3)?
- myasthenia gravis
- Lambert-Eaton synd
- dermatomyositis
what is: dermatomyositis
idiopathic inflamm myopathy –> immune-med muscle injury
dermatomyositis –> presentation
- symm proximal muscle weak
- erythematous rash –> Gottron’s sign, heliotrope rash
SLE –> lab findings on CBC (3)
- hemolytic anemia
- thrombocytopenia
- leukopenia
1 RF for spont preterm delivery
h/o spont preterm delivery
h/o spont preterm delivery –> how to decrease risk of spont preterm delivery w next preg
- progesterone supplementation
- serial cervical length measurements
supravalvular aortic stenosis –> exertional angina –> why?
aortic stenosis –> LV hypertrophy –> exercise –> increase myocardial O2 demand –> subendo ischemia –> angina
simple breast cyst –> aspirate clear yellow fluid –> next step?
f/u in 2-4 mo for clinical breast exam –> monitor for recurrence
ankylosing spondylitis –> exam findings (5)
- arthritis (sacroillitis)
- reduced chest expansion, spinal mobility
- enthesitis (tenderness at tendon insertion sites)
- dactylitis (swelling of fingers/toes)
- uveitis
preg –> elevated maternal serum AFP –> indicate what fetal conditions (3)?
- open neural tube defect
- ventral wall defect –> gastroschisis, omphalocele
- mult-gestation preg
preg –> elevated maternal serum AFP –> next step?
US –> eval fetal anatomy
preg –> decreased maternal serum AFP –> indicate what fetal condition?
aneuploidy
methamphetamine –> risk for what heart condition?
cardiomyopathy
milk-alkali synd –> symptoms
- N/V, constipation
- polyuria/polydipsia
- neuropsych ssx
milk-alkali synd –> pathophys
excess intake Ca & absorbable alkali –> hyperCa –>
- renal vasoconstrict –> decrease GFR
- renal lose Na & H2O –> hypovol –> increase resorb bicarb
milk-alkali synd –> lab findings (4)
- hyperCa
- metabolic alk
- acute kidney injury
- suppressed PTH
Turner synd –> CV abnormalities (3)
- bicuspid aortic valve
- coarcation of the aorta
- aortic root dilation
Turner synd –> karyotype
45, X
karyotype –> find 45, X –> next step?
eval for CV abnormalities –> 4-extremity blood pressure & echo
postpartum psychosis –> management
medical emergency –> increased risk of suicide & infanticide –> hosp –> antipsych med & trt underlying disorder
cold knife conization –> how eval risk of preterm delivery
gold standard: transvag US –> measure cervical length
nonhosp pt –> polyuria –> most likely dx (3)
- DM
- primary polydipsia
- DI
Na levels:
- primary polydipsia
- central DI
- nephrogenic DI
- primary polydipsia: low
- central DI: high
- nephrogenic DI: normal
central DI –> pathophys
pituitary –> decreased ADH –> kidney –> decrease water resorb –> water loss –> polyuria –> dilute urine & hyperNa
what is complicated cystitis
infect assoc w factors that increase risk for abx resistance or tx failure –> DM, CKD, preg, immunocomp, urinary tract obstruct, hosp-acq infect, infect assoc w procedure/indwelling foreign body
uncomplicated cystitis –> abx options (3)
- nitrofurantoin
- TMP/SMX
- fosfomycin
complicated cystitis –> next step?
urine culture –> then initiate tx
complicated cystitis –> tx
fluoroquinolone
pyelonephritis –> next step?
urine culture –> then initiate tx
cirrhotic patient on diuretic –> hepatic encephalopathy –> pathophys?
diuretic –> low intravasc vol despite total vol overload –> metab alk + hypoK –> increase NH3
cirrhotic patient on diuretic –> metab alk + hypoK –> hepatic encephalopathy –> tx?
- replete K
- replete intravasc vol
- ammonia-lowering meds: lactulose
1st trimester –> lab findings:
- total T4
- free T4
- TSH
- total T4: increased
- free T4: no change or mild increase
- TSH: decreased
preg –> increase thyroid hormone –> pathophys?
- estrogen –> stim thyroxine-binding globulin syn –> increase total TH
- hCG –> stim TSH receptor –> increase TH production
–> to cope w metabolic demands of preg
18mo M –> intussusception –> how dx?
US guided air contrast enema
primary influenza pneumonia –> CXR findings?
b/l diffuse interstitial infiltrates
dobutamine –> used to manage what condition?
severe heart fail assoc w severe LV systolic dysfx & cardiogenic shock
dobutamine –> MOA
stim B1 receptor –> increased myocardial contractility –> improve EF, reduce LV end systolic vol –> symptomatic improve decompensated heart fail
how does pneumonia cause hypoxemia?
inflamm exudate –> fill alveoli –> R to L intrapulm shunt (vent/perfusion mismatch: perfusion w/out vent)
hypoxemic –> increase FiO2 –> hypoxemia does not correct –> indicates?
absence of alveolar vent –> ie pneumonia d/t to intrapulm shunt
neonate –> <10% percentile for gestational age at birth –> comp (5)
- hypoxia
- polycythemia
- hypoglycemia
- hypothermia
- hypoCa
