NBME 10 Flashcards
puberty in girls
thelarche: breast development (increased produciton of estrogen and growth of mammary tissue, asymmetry is normal)
pubarche: pubic hair
growth spurt
menarche: menses (estradiol stimulation of the endometrial lining rather than ovulation and can be accompanied by prolonged vaginal spotting)
follow up in 6 months*
prolong bleeding after circumcision, eczema, thrombocytopenia (low platelets), and recurrent infections of oral thrush, otitis media, pneumococcal bacteremia
increased risk for?
Wiskott-Aldrich Syndrome
WAS gene on X chromosome – codes for actin cytoskeleton rearrangment that occurs during interaction between T lymphocytes, antigen-precenting cells, B lymphocytes
–> impaired innate and adaptive immune system
increased risk: autoimmune disease + malignancy: Leukemia*
Encapuslated bacteria + opportunistic pathogens
recurrent viral, bacterial, and fungal infections starting at birth, failure to thrive, and severe lymphopenia with impaired cellular and humoral immunity
SCID (x linked) and Adenosine deaminase deficiency (AR)
mutation in Interluekin-2 Receptor gamma chain
progressive ataxia, telangiectasias, abnormal eye movemnts, decreased immunoglobulin concentrations (leading to recurrent sinopulmonary infections)
Ataxia telangiectasia (AR) dna repair defect
somatic mutations accumulate –> lead to protein dysfunction and increased risk: Hodgkin Lymphoma
eczema and cutaneous cold abscesses
Hyper-IgE syndrome : defect in the JAK-STAT signaling pathway –> impaired Th17 cel differentiation
thymic aplasia and hypocalcemia (looks like SCID with risk of viral and fungal infections), with cardiac and craniofacial defects
DiGeorge syndrome: 22q11 deletion that leads to failure of 3rd and 4th branchial pouches to develop
recurrent BACTERIAL infection and low/absent immunoglobulin concentrations
X-linked agammaglobulinemia : mutatition in BTK gene encodes for tyrosine kinase: needed for B lymphocyte development/proliferation
next step when starting anti-TNF alpha (infliximab)
Interferon-gamma release assay (IGRA) or PPD to test for latent TB
TNF-alpha needed to fight off granuloma formation
if positive –> treat for LATENT TB with 9 months of isonizaid
sickle cell: vaso-occlusive crisis management
IV fluids and pain control
children: dactylitis, acute chest syndrome; adults diffuse pain
4 units of blood transfusion + IV crystalloids/colloids, now has dypsnea, pulmonary edema, JVD, widened pulse pressure, HTN
Transfusion-Associated Cardiac Overload TACO – fluid overload 2/2 large volume blood transfusions
STOP blood transfusion, minimize IV fluids, then give loop diuretic, O2 or positive pressure ventilation
pt thinks she has small worms underneath skin, has tried digging them out, no hx of depression/ ah. no illicit drug use
delusional parasitosis (delusional disorder)
NMDA receptor antagonist, nystagmus, agitation
next step?
complications to look out for?
PCP intoxicaiton - INHIBITS reuptake of dopamine, norepi, and serotonin
stimulates alpha-adrenergic receptors
give benzo’s for agitation
then labs for rhabdomyolysis, hyperthermia, HTN
intubate if comatose
HSV ENCEPHALITIS
how does it spread?
dx?
tx?
HSV-1 from oropharynx to CNS via trigeminal nerve
or
reactivated latent HSV-1 infection
dx: need lumbar puncture: run PCR to detect HSV1
neuroimaging: unilateral or bilateral temporal lobe
tx: IV acyclovir
STROKE workup next best step
4.5 hours
if less than –> Alteplase thrombolytic tx
if more than –> give aspirin then BP control, statins, and DVT prevention
unilateral facial paralysis with loss of right labial fold and unable to wrinkle forehead
next step?
bell palsy - likely viral-mediated inflammation, or immune reaction 2/2 to herpes or herpes zoster, or lyme disease
facial nerve – decreased taste 2/3 anterior tongue, lacrimation
dx: no further testing
tx: glucorcorticoids, or artificial tears to prevent xerophthalmia or corneal abrasion
AMS + Ophthalmoplegia (+nystagmus) + ataxia s/p gastric bypass
vitamin B-1 thiamine deficiency
can result in damage/atrophy of mamillary bodies manifests as Wernicke encephalopathy
child with unilateral cervical adenopathy with purple hue over mass, excisional biopsy showed multiple granulomas
lymphadenitis by mycobacterium avium - intracellulare M. avium common in immunocompromised children (or normal)
r/o bartonella cat scratch or Francisella tularemia
pt with diabetes + BACK PAIN + fever, malaise, fatigue
next step?
MRI of spine to confirm vertebral osteomyelitis (likely hematogenous spread from diabetic ulcer)
also do blood cultures and bone biopsy
22F with swelling on front of right ankle
next best step?
Osteosarcoma
next best step: MRI of right tibia
MCC bone cancer in under 30yo usually in LONG bones (distal femur, proximal tibia, distal tibia)
familial cases (retinoblastoma or p53 gene), body dysplasia (osteitis deformans paget disease), fibrous dysplasia nad radiation
xray: destruciton of both medullary and cortical bone as well as sunburst periosteal reaction
MRI to evaluate local invasion and staging
tx: surgical resection + chemo
muscle weakness + cramps, abdominal ileus, parasthesia, hyporeflexia
with laxative abuse
hypo-Kalemia
can also cause long QT syndrome or torsades depointe (polymorphic ventricular tachycardia)
xray: no pulmonary edema
S4 heard, no peripheral edema
what is contraindicated
ST elevation: AVF and I & II
means Right sided MI
especially with symptoms of no L sided MI (pulm edema, peripheral edema)
DO NOT GIVE nitroglycerin or opiods (they are preload-lowering meds) used to treat angina
you want to give IV fluids to maintain CO, then send to coronary reperfusion with PCI or with fibrinolytics
Diabetic nephropathy
nonenzymatic glycosylation of GBM(thickening) and efferent arterioles(mesangial expansion)
eosinophilic nodular glomerulosclerosis (kimmelstiel-wilson nodules)
initial increase in GFR with microalbuminuria
causes HTN
nonhealing ulcer medial aspect of leg
bronze discoloration
woody induration
venous insufficiency
retrograde blood flow
venous valves
hemosiderin deposition from extravasated RBCs
chronic edema
pt with HIV CD4+ 650
PPD skin test: 6mm
next step?
PPD skin test > 5mm with HIV –> treatment with LATENT TB now – 9 mo isoniazid
no active symtpoms pulmonary or dissiminated infection
if they are under 200 CD4+, then can have a false negative, retest when above 200 CD4+
Pt with asthma gets sick –> hyperinflated lungs, accessory muslces for respriation
management?
bronchospasm (acute asthma crisis)
reversible obstruction of bronchi 2/2 hyperreactivity and airway inflammation
O2 + SABA + corticosteroids
OSA risk factors
BMI >
Age >
neck circumference >
echo?
loud S2 in second left intercostal space
BMI > 35
AGE > 50
NECK > 40 cm
increased pulmonary artery pressure
pulmonic valve closure – pulmonary HTN loud S2
acute abdominal pain in setting of recent MI, bloody diarrhea
ischemic colitis
bloody diarrhea, microangiopathic hemolyic anemia, thrombocytopenia, renal failure
E coloi 0157:H7 (HUS)
pt with previous stillborn greater than 32 weeks is now pregnant
next step in management
weekly non-stress testing in the third trimester starting at 32 weeks
also serial ultrasaonography throughout gestation and screened for medical conditions
mucopurulent discharge with pruritis
’’ ^^^ “ + erythematous friable cervix and cervical motion tenderness
vaginitis
cervicitis
both can be caused by neisseria gonorrhea and chlamydia trachomatis
complications: PID or tubo ovarian or intra-abdominal abscess
cervical motion tenderness, purulent cervical discharge, uterine and adnexal tenderness –> tubo ovarian or intra-abdominal abscess
PID – can cause tubo-ovarian or intra-abdominal abscess
d/t chlaymdia or gonorrhea
dx: NAAT
chlamydia: obligate intracellular organism
tx: azithromycin or doxycycline for chlamydia
ceftriaxone for gonorrhea
fluctuant swollen cyst - caused by obstruciton of gland outflow
if erythema and tenderness to palpation:
bartholin gland cyst
bartholin gland abscess
pt with hx of pheochromocytoma, now has medullary thyroid carcinoma
what does medullary thryoid carcinoma produce ?
MEND 2A/B
medullary thryoid carcinoma arises from parafollicular C cells and produces Calcitonin
sxms: hypo-calcemia
dx: thryoid US and bx
tx: thyroidectomy and chemoradiation
pt with ulcerative colitis – severe bloody diarrhea, colonoscopy superficial ulcers, biopsy: intracellular inclusion bodies
what next?
CMV HHV-5
colitis, retinitis, esophagitis, encephalitis, pneumonia
give **ganciclovir – inhibits viral DNA polymerase (but doesnt need to phophyrlate thymidine kinase like the other -lovir’s do)
crohns manifestations
enterocutaenous fistulas, UVEITIS,
intestinal obstruction from Strictures
bowel perforatio, intra-abdominal abscess, intra-abdominal fistulas
Dx: imaging Bx
fluoroscopic small bowel follow through: narrowing of intestinal lumen usually at terminal ileum, with stricutres or fistulas
tx: NSAIDS - ANTI INFLAMMATORY FIRST
immunomodulators
glucocorticoids
pancreatic adenocarcinoma: painless obstructive jaundice
pt also has abdominal aneurysm: should they repair
no, pancreatric adenocarcinoma is poor prognosis with death within one year
walking barefoot on beach, or had oysters, shelfish, dock - gets cut
get erythema and hemorrhagic bullae (crepitus) over leg or gets diarreha
then septicemia
what next?
vibrio vulnificus gram negative
worse in pt with LIVER problems: alcoholic cirrhosis, hemochromatosis, liver transplant; or in DM or CKD
wound infection, diarrhea, sepsis
can start as mild cellulitis and turn into necrotizing fascitis with feer, pain, crepitus, hemorrhagic bullae
Dx: wound or blood cultures
Tx: IV abx: minocycline or doxycycline + cefoTax or cefTri
then undergo surgical debridement (in order to get rid of infected tissue, vs hyperbaric oxygen therapy for necrotizing soft tissue like in clostridium)
sepsis, hypovolemia, medication or substance-induced hypotension, cardiogenic shock (MI) ANY SORt of decreased perfusion leads to:
ATN
sepsis
pigmented granular, muddy brown casts
renal tubular epithelial cells – bound in a TAMM-HORSFALL (uromodulin) mucoprotein matrix
BUN:Cr < 20
NO casts but eosinophils in urine
AIN
antibiotics, NSAIDS, PPI, infections or autoimmune disorders: sarcoidosis or SLE
primary: painless chancre
secondary: fever, diffuse maculopapular rash with palms and soles, condylomata lata
tertiary: tabes dosralis, aoritis, gummas
syphillis
tx: PCN
or sensitize if allergic
ooorrr doxycycline
white-gray flat topped lesions
vs
verrucuous papules
condyloma lata – syphillis
condyloma aCUMinata verruous
pt with SLE OR Sjorgen and pregnant, fetus at risk for?
complet A-V block
antibodies: anti-Ro and anti-La cross placenta
what month baby has stranger anxiety
6 mo
peaks from 7-10mo
fever, anemia, thrombocytopenia, neuologic (AMS, confusion), renal failure (Cr elevated), Increased indirect bilirubin and jaundice
Thrombotic Thrombocytopenic Purpura TTP
inhibition: ADAMTS13: metalloprotease that degrades vWF
tx: PLASMAPHARESIS
leads to microangiopathic hemolytic anemia
renal failure from microthrombi (vWF decreased so no platelet adhesion, clumps of RBC’s floating around)
11 year old boy with 3 yr hx of increasing muscle weakness/atrophy of both shoulders and pelvic girdles + areflexia
Juvenile Spinal Muscular Dystrophy
AR mutation in SMN genes at chromosome 5q13: degeneration of motor neurons and proximal muscle weakness, resulting in hypotonia and areflexia
able to walk on their own and then slowly lose function
type 1: hoffman baby dies 2: dubowitz never able to walk 3: welander^^
pterygium
benign growth of conjunctival tissue
d/t UV radiation
tx: topical lubrication and REDUCTION OF UV light exposure – wear sunglasses
OR surgical excision
if recurrent: surgery + antimetabolite mitomycin C
Tinea Capitis
d/t Microporum Gypseum
Trichophyton Tonsurance, Epidermophyton Floccosum, Microsporum Canis
tx: oral antifungal: Griseofulvin or Terbinafine (BOTH hepatoxicity) check LFTs
older man with bloody urine, flank pain, weight loss or fever
with vague wrist pain, xray: lytic lesion of radius with pathologic fracture
Renal Cell Carcinoma
older, male smokers – may show polycythemia or hypercalcemia
paraneoplastic syndrome: Erythropoietin or Parathyroid hormone related peptide
Dx: CT
spreads hematogenously: lung brain bone metastatic diseas
osteoarthritis tx
NSAIDs (acetaminophen), intra-articular injections, joint replacement for severe
Pregnant pt with Lyme disease sxms: facial droop, ekg av block
early stage of lyme: treat with doxycycline (photosensitivity, discololartion of teeth)
later stages: nervous system (facial droop) or heart (av block) –> Ceftriaxone
pt with aortic aneurysm, livedo reticularis (dusky blue toes) petechiae, renal dysfunctions
labs: leukocytosis with Eosinophilia
skin lesions histo: biconvex needle-shaped clefts within arterial lumen left by dissolved cholesterol crystals
Cholesterol embolism
increased risk for dislodgment of atherosclerotic cholesterol plaques: cardiac catheterization and aortic dissection
tx: supportive
peritonsillar abscess: next step?
needle aspiration of peritonsillar space, to prevent airway compromise
and antibiotic to cover gram positive strep or staph (amoxicillin-sulbactam, clindamycin, vancomycin)
asthma
FEV1:FVC ratio
Peak Expiratory flow rate
Residual Volume
Total Lung Capacity
obstruction of bronchi 2/2 hyperreactivity and airway inflammation
can show decreased lung density (hyperresonance to percussion, diminished tactile fremitus, hyperinflation of chest)
FEV1:FVC ratio – decreased
Peak Expiratory flow rate – decreased (obstructed airways)
Residual Volume – increased
Total Lung Capacity – increased
CT imaging: peribronchial fibrosis, reticular opacities, subpleural thickening
Asbestosis
peripheral and basilar honeycombing
Idiopathic pulmonary fibrosis
caclicfied pleural plaque with pleural effusion
risks: asbestosis and tobacco use
Mesothelioma
purulent discharge at Stensen duct –> parotid gland
Staph Aureus
sigmoid volvulus bowel obstruction with high pitched sounds, distention, constipation, vomiting
dilation of sigmoid colon, rotates around its mesentary, air filled sigmoid colon
without sepsis or bowel necrosis: flexible sigmoidoscopy
with sepsis or bowel necrosis: surgery
pt with CKD – what should you measure to prevent further complications
measure hemoglobin to monitor for anemia
in states of hypoxia kidneys secrete epo to stimulate Bone marrow to make more erythrocytes
in CKD – kidneys dont make enough Erythropoietin so bone marrow doesnt know enough to make more, causing anemia normocytic
increases risk for exposing fetus to maternal blood in hiv + mothers
fetal scalp electrode placement
postpartum patient with fever and severe uterine tenderness
postpartum endometritis
typicaly polymicrobial infection aerobes+ anaerobes
risks: prolonged labor, premature/prolonged rupture of membranes, c-section, Bacterial Vaginosis, GBS, manual removal of placenta
tx: clindamycin or gentamicin
DKA management
**1) 0.9% Normal saline **
2) insulin + ____
3) correction of electrolyte abnormalities
Schirmer test
Sjorgen dry eyes – tests for aqueous tear deficiency
pt who takes chronic corticosteroids (prednisone), gets an infection, hypotensive, tachy, fever, and hospitalized, what shoudl you give next?
Corticosteroids
d/t adrenal crisis
exogenous corticosteroids –> b/l adrenal atrophy: diminished production of ACTH from pituitary and decrease in native production of corticosteroids
will see hypoglycemia, AMS, hyponatremia, tachycardia and vasodilation Hypotension.
child ingests drain cleaner, what next?
esophagoscopy
trying to see for any tissue perforation ulceration == chemical burns
tx: steroids
do not give charcoal and do not do gastric lavage
patient with marfans what annual checkups?
annual echocardiography for vascular complications aortic root dilation, aneurysm, dissection
annual eye exam: ectopia lentis
pt with multiple myeloma, most at risk for what infection?
Streptococcus Pneumonia
any encapsulated oraganism
Strep Pneumo, Haemophilus Influenza, Ecoli, Neisseria Meningitidis, Salmonella typhi, Klebsiella penumonia, Group B streptococcus
“multiple” small “vesicles” over inside of the mouth and posterior oropharnyx
cerivcal lymphadenopathy mouth pain, fever sore throat, what next?
HSV 1 or 2
cerivcal lymphadenopathy and vesicular eruption
Tzank smear with Giemsa stain
PCR test on open vesicle
tx: acylcovir or valacylcovir within 72 hours of symtpoms onset
infectious while sores remain open and draining
intraepithelial lympocytosis, villous atrophy, crypt hyperplasia
celiacs
gliadin protein in wheat products
tissue transflutaminase IgA Antibodies
can cuase iron deficiency anemia
normal uterus with a gestational sac and no cardiac activity
blighted ovum
d/t fetal chromosomal abnormalities
some will do D/C to look at genetic analysis
complicated, exudative pleural effusion with increased LDH and decreased pH and glucose
mangt?
empyema
strep pneumo lobar pneumonia, complicated by a parapneumonic pleural infection, infected by penuonoccal bacteria and produce pus
iv abx
thoracentesis
placement of chest tube
episodic vertigo and sensorineural hearing loss
vs
progressive vertigo and sensornieural hearing loss, also facial numbness/parasthesia
Meniere disease is episodic (d/t acumulation of pressure in endolympoh of inner ear)
Acoustic neuroma vestibular schwannoma is porgressive and with trigeminal nerve symptoms
hx of southwest asia, started off as little papule then increased in size and ulcerates, might have hyperkeratotic eschar
Leishmaniasis
wil see amastigotes within macrophages on blood smear or tissue bx
d/t sand fly
vs anthrax – 14 days small papule, ulcerates and has eschar (but no sw asia hx)
pain swelling warmth in knee
arthrocentesis: calcium pyrophosphosphate crystals
xray: chondrocalcinosis and degenerative joint disease
next step?
Pseudogout
next step: NSAIDS (anti-inflammatoin): ibuprofen, Colchicine, oral glucocorticoids
vs acetaminophen given in osteoarthritis d/t noninflammatory pain
glenohumeral joint:
internal rotation
external rotation when in adducted position
external rotation
abduction
internal rotation: subscapularis
external rotation when in adducted position: teres minor
external rotation: infraspinatus
abduction: supraspinatus most common tear
positive with drop arm test if torn
pain in shoulder with both active and passive movement
adhesive capsultitis
overhead work or throwing pain: like basketball, volleyball, baseball, football
Labral tear
Regular rhythm + narrow QRS complex, tachycardia, light headed, palpitation, diaphoresis, syncope + abrupt onset and termination + triggered by stresss, coffee, alcohol, etc.
Atrioventricular Nodal Reentrant tachychardia AVNRT
structural defects in His-Purkinje causing reentrant pathway (like in WPW)
allows impulse to go in retrograde fashion through the AV node setting up reentry circuit
mangenet:
vagal maneuvers
adenosine
CCBs or B-blockers
UNSTABLE: cardioversion
vs irregular : afib
Irregularly irregular rhythm and polymorphic P wave
associated with chronic pulmonary disease
mutlifocal atrial tachycardia
murmur becomes louder with valsalva maneuver, decreases with LV filling and worsens the outflow tract obstruction
LV hypertrophy with large amplitude Swaves in right precordial leads and increased R wave in amplitude in V6
HOCM
after insertion of central venous catheter into subclavian vein, suddenly severe ches pain, dyspnea, agitation
next step?
air embolism – place pt in trendelenburg and left lateral decubitus position, oxygen, fluids
foul smelling poop with memory decline
endoscopic biopsy: periodic acid-Schiff positive macrophages in lamina propria
Whipples
dx endoscopic bx and then lumbar puncture for PCR of CSF for CNS involvmenet
tx: ceftriaxone + trimethoprim-sulfa(1year)
achalasia
moa
dx
tx
impaired neuromuscular transmission and impaired relaxation of lower esophageal spincter
destruction of nerves in myenteric plexus impaires nitric oxide production –> prevents mooth muscle relaxation, unable to relax the LES
dysphagia, oodynophagia, wt loss, reflux, regurg food, halitosis difficulty swallowing liquids and solids
dx: first barium swallow(bird beak sign) then esophageal manometry
tx: pneumatic AIR dilation or injection of botulinism toxin to relax LES
antimitochondial antibodies positive with female, jaudnice, pruritis, hypercholesterolemia, increased alk phos, and fat solube deficiencies
primary biliary cirrhosis: destruction of intrahepatic bile ducts
tx ursodeoxycholic acid: improves biliary excretion (inhibits cholesterol secretion into bile, improving biliary excretion)
also used to tx biliary colic, PBC, intrahepatic cholestasis of pregnancy
elevated lipase with RUQ pain, bilious vomiting, periumbilical tenderness
lithogenic bile
acute pancreatitis 2/2 to eitehr gallstones or heavy alcohol consumption
lithogenic bile make gallstones –> pass through cystic duct to common bile duct and can obstruct, stopping pancreatic flow
tx: ERCP to retreive obstructing gallstone
direct hyperbilibrubinemia, pale stoole, dark urine, in baby
biliary atresia
dx: ultrasound
tx: Kasai procedure – hepato-porto-entero-ostomy
post partum bleeding, soft uterus
macrosomia, multiple gestations, uterine infection
uterine atony — failure of the myometrium to contract and compress the placental blood vessels
post partum bleeding with using forcepts, manual manipulation of the fetus
genital tract laceration
post partum bleeding with no placenta totally delivered
retaiend placenta – inabiltiy of placental bed to involute
post partum bleeding management
IV fluids and blood, uterine massage, uterotonic mediations,examination of vagina and cervix, manual extraction of retaiend prodcuct if present on u/s,
uncontrolled hemorrhage: d&c, uterine vessel embolization, hysterectomy
within one year of pregnancy hyper/hypothryoid symptoms, and antithyroid peroxidase antibodies
next step?
post partum thryoiditis
autoimmune
give metoprolol/propanolol for symtpoms
start on levothryoxine
abnormal uterine bleeding with symmetrically enalrged BOGGY uterus
adenomyosis
abnromal uterine bleeding, heavy prolonged mestrual periods, miscariage and infertility
irregular shaped uterus
Leiomyomata uteri – fibroids
estrogen responsive - get larger with pregnancy, decrease with menopause
tx: NSAIDS, COMBINED OCPS, mymoectomy or hysterectomy in severe cases
human placental lactogen
made by placenta increases insulin resistance – results in gestational diabetes
“electric like” sensation down spine, tingling, weakness, visual loss, epsidoic comes and goes
MS
treatment: corticosteroids for symptomatic flares
long term: interferon beta or monoclonal antibodies
eye symptoms: optic neuritis: central scotoma, afferent pupillary defect, pale optic disc on exam
Lhermitte sign: shock sensation with neck flexion
MRI white matter hyperintensiites in periventricular, cortex, subcortical region, cerebellum or spine
oligonclonal bands of immunolgubilins – CSF
RISK FACTOR FOR ISCHEMIC STROKE:
HTN is strongest modifiable
AGE ** is the strongest non modifyable
for every decade after age 55, stroke risk doubles
Scaly, erythematous rash around nose and eyebrows, dandruf
associated with?
seborrheic dermatitis
malessezia
tx: topical ketoconozale shapoo
or selenium sulfide or zinc pyrithione
SUDDEN ERRUPTION – CHECK FOR HIV
third trimester vaginal bleeding PAINLESS
next step
avoid
placenta previa
pelvic ultrasound
avoid digital cervical exam
risk factors: uterine scarring, previous D&C, previous C section, multiparity
if persists into trimester then must do csection
maternal diabetes or pre=eclampsia
put fetus at risk of hypoxemia
what test?
contraction stress test
child with b/l injected sclera, erythematous papular rash, erythema and tender hands and feet, fever for 5+ days
risk of:
tx:
mucocutaneous lymph node syndrome – kawasaki
risk of: MI or coronary artery aneurysm
tx: high dose aspirin or IV immunoglobulin
fuck reyes
decreased factor 8 and increased bleeding time
mucosal bleeding with normal plt count and prothrobin time
increased partial thromblastin time PTT
tx?
von willebrand disease
subendothelial lining impaired platelet adherence
tx: desmopressin (release of vwf from endothelial cells)
pregnant patient with bipolar what drug do you give them?
lamotrigine
lithium level > 2.5 what next?
hemodyalisis + IV fluids
immunedeficiency
thrombocytopenia and cutaneous bruising with no other abnormalities
Immune Thrombocytopenic purpura
platelet destruction: anti-Gp2b/3a Antibody – bind to platelet and result in their opsonization
macrophages in the spleen phagocytize the platelet-antibody complex
chronic: first with steroids, then IV IG
bone marrow: increased number of megakaryocytes
pt with hx of headaches, for 1 year takes acetaminophen (or any other headache meds) with caffeine, still has headaches
medication overuse headaches
stop taking meds
anencephaly
MCC: folate deficiency (also auses caudal neural tube defects (spina bifida)
also: trimethoprim and antiepileptics can cause anenceaphly
blunt trauma to the eye, right eye with pooling blood in the anterior chamber
Hyphema = can cause increase in intraocular pressure by clogging trabecullar meshwork
within first five days: can rebleed
Rheumatoid arthritis + new onset fevers, pleurisy, neutropenia, splenomegaly
Felty syndrome
increased risk for non-hodgkin lymphoma
tx: methotrexate + rituximab (cd20)
next step in pulmonary embolism
Spiral CT scan
CT angiography
causes of hypovolemia leading to AKI
what will see on labs?
Hypovolemia 2/2 vomiting and diarreha
sepsis
hypotension
cardiogenic shock
decreased urine fractional excretion of sodium < 1%
Increased BUN:Cr > 20
prego weeks 27-36 what vaccine ?
Tdap _ REGARDLESS with EACH pregnancy
PROMOTES PLACENTal transfer of antibodies to fetus
at 15-18 weeks gestation, abnormal prenatal quad screen
what next?
complications
amniocentesis (to detect chromosomal abnormalities)
Premature rupture of membranes, fetal injury/demise, and infection to mother/fetus
women over 45 with abnormal uterine bleeding
what nexxt?
endometrial biopsy
pt with type 1 DM
what annual screening?
lipid screening
pt with type 1 DM
what annual screening?
lipid screening
pt with lyme tic attached for less than 24 to 36 hours
what next
reassurance and follow up
if more than 36 hours –> ppx doxycline or if neuro/brain symptoms ceftriaxone
panic disorder treatment
long term: SSRI
short term mgt: benzo
neonate had umbilical artery catheter placed to monitor bp
several weeks later what expect to see on labs?
increased renin and aldosterone
umbilical artery catheter can cause renal artery thrombosis, can present up to several weeks after removed
occlusion decreases afferent blood flow to the affected kidney and increases JG renin production
most effective birth control after pregnancy safe with breast feeding:
IUD
horomonal or copper
