NTK2 Flashcards
Small Cell Lung Ca
Smoking
Centrally located
ACTH
SIADH
chemo/radiation
less than 1 year old
bilateral symmetrical limb jerking
not generalized
no fever
dx?
imaging?
tx?
associated condition?
infantile spasm
EEG interictal
tx: ACTH
can be associated with tuberous sclerosis
Narcolepsy associated with low CSF levels of what?
orexin-a, hypocretin-1
UNa and FeNa in pre-renal azotemia
UNa <20
FeNa <1%
why? - usually d/t hypotension = Aldosterone release = Na reabsorption = low UNa and FeNa
Indications for bacterial endocarditis prophylaxis
prosthetic heart valve previous IE structural abnormality in TRANSPLANTED heart unrepaired cyanotic CHD repaired CHD with residual defect
Thready pulses that disappear with inspiration
pulsus paradoxus
cardiac tamponade
Characteristics of tuberculous effusions
very high protein levels (>4)
lymphocytic leukocytosis
low glucose
gallbladder wall - bluish color and brittle consistency
procelain gallbladder
gallbladder adenocarcinoma
Physical exam findings of aortic stenosis
pulsus parvus et tardus (diminished and elayed)
mid to late peaking systolic murmur
soft and single second heart sound S2
When do you add IV K with DKA
serum K less than or equal to 5.2
Right to Left shunts in peds (2)
Tetralogy
Transposition
cyanotic babies right away
Wilms tumor vs Neuroblastoma
WT - unilateral - 2 to 5 years old
Neuro - crosses midline - usually younger
What has been proven to prolong survival in COPD patients?
What hasn’t?
long term home oxygen therapy
vaccinations against influenza and pneumococcus
best preventive therapy for migraine
propranolol
Anti-social personality disorder diagnosed after what age?
18
with symptoms of conduct disorder beginning before age 15
Is metronidazole teratogenic?
No
Retinoblastoma is associated with what bone tumor?
osteosarcoma
spike differentiation between multiple myeloma and waldenstroms
waldenstroms is IgM specifically
MM - produces monoclonal IgG, IgA, or light chains
What electrolyte abnormality can occur with folate/B12 replenishment?
Hypokalemia
due to high cell production
Measles long term risk?
subacute sclerosing panencephalitis
most common pathogen of bartholin abscess
E. coli
MCC of bacterial tracheitis
staph aureus
Common murmur in infective endocarditis
Tricuspid regurgitation
Increases on inspiration
MCC of euvolemic hyponatremia
Pseudo (hyperglycemia)
Psychogenic polydipsia
Hypothyroid
SIADH
Target of Myasthenia graves
Lambert eaton
Post synaptic acetyl choline receptors
Pre synaptic Calcium channels
3 main causes of hyperbilirubinemia
pre-hepatic
intrahepatic
posthepatic
Biphasic stridor in an infant =
Vascular rings
vs
Laryngomalacia = INSPIRATORY stridor
Watery conjunctivitis 5 to 14 days after delivery
CHLAMYDIAL
two types of macular degeneration
dry - slow progressive, bilateral
wet - unilateral, aggressive
Triad of wisckott-aldrich
eczema
decreased platelets
infections
Cancers with VHL
hemangioblastoma
Clear cell renal carcinoma
Pheo
Measles = ?
infectious agent?
Prodrome?
fever and rash - timing and spread?
Rubeola
measles virus
rash on face - spreads to body (clears opposite direction)
Fever and rash at same time
Cough, Coryza, COnjunctivitis, Kopliks
What joints are NEVER involved in RA?
DIP’s
Effect of formula feeding on gastric emptying
Decreases it
Can be related to pyloric stenosis
what can differentiate transient synovitis from Legg-Calves-Perthes in a young boy who is of normal BMI?
length of pain
Months for LCP vs Up to 4 weeks for Transient synovitis
VSD murmur can be heard
Left Lower sternal border
Holosystolic
With increasing prevalence what happens to PPV?
increases
Natalizumab is associated with development of?
progressive multifocal leukoencephalopathy
What medications are associated with possibility of slowing progression of parkinsonism
MAO-B inhibitors
Ulcerative colitis associated with what gall bladder condition?
Primary sclerosing cholangitis
can have + p-ANCA
Primary adrenal insufficiency mcc?
significance of symptoms?
Autoimmune
more severe symptoms - hyperpigmentation, hypotension, hyperkalemia
Transposition of the great vessels associated with what maternal condition?
diabetes mellitus
Imiquimod
Locally applied immunostimulant
Leads to sloughing off of skin
Warts, BCC, actinic keratosis
Refractory cases of CLL tx
Cyclophosphamide
Cushing Syndrome
Initial work up tests (3)
24 hour urinary free cortisol
Late night salivary cortisol
Low dose dexamethasone suppression
High iron =
Sideroblastic anemia
alcoholic induced commonly
Triple or quad screen done when?
15-20 weeks
How logn does it take for cholestasis to develop with parenteral nutrition?
2 weeks or more
Anaphylactic egg allergy - which vaccine cannot be given?
Yellow fever
when can PUBS be done?
between 20 and 34 weeks gestation
benefit - can transfuse
Mild cases of CLL in the elderly tx?
Chlorambucil
intraplacental villous lakes
irregular placent
Placenta accreta
mechanism of decreased renal blood flow in hepatorenal syndrome
increased nitric oxide generation in splanchnic circulation secondary to portal HTN
NO reduces peripheral vascular resistance and blood pressure = decreased renal perfusion
3rd gen cephalosporins
ceftriaxone and cefotaxime
Complex vs simple seizures?
Complex = LOSS OF CONSCIOUSNESS
Where is Broca’s area located?
other associated findings with stroke?
posterior inferior FRONTAL lobe gyrus
DOMINANT side
right hemiparesis (face and upper limb)
Increasing pain, worsens at night
Relieved by NSAID’s
Osteoid osteoma
Ending -navir =?
Main adverse effect
Protease inhibitors
Hyperlipidemia, hyperglycemia
Carcinoid of the lungs
serotonin syndrome
5-HIAA in the URINE
Meds for Wolff Parkinson White
Procainamide or Ibutilide
Uncommon but specific sign of Graves Disease
digital clubbing thyroid acropathy
Specific therapy for hereditary angioedema
Ecallantide
What immunodeficiency may be associated with false negative serologic studies in celiac patients?
Selective IgA deficiency
Meckels is a remnant of what?
vitelline duct
Aldolase B deficiency =
hereditary fructose intolerance
three common causes of hyponatremia with hypervolemia
CHF
Nephrotic syndrome
Cirrhosis
Leuprolide
MOA?
GnRH agonist
given continuously suppresses estrogen
What is increased with both folate and B12 deficiency?
Homocysteine
delayed separation of cord + infections without pus?
Leukocyte adhesion deficiency
What RDW is associated with iron deficiency anemia?
> 20%
Treatment for chlamydial conjunctivits
ORAL erythromycin
Which source of vaginitis requires both partners to be treated?
Trichomonas
IgA nephropathy affects what part of the kidney?
glomerulus
Osteoarthritis is not associated with what type of anemia?
Anemia of chronic disease
Treatment of hyponatremia is based on?
Symptom severity (NOT the Na level)
Treatment for GBS
IVIG
OR
Plasmapharesis
NOT BOTH
firm hyperpigmented nodule
dimples in the center when pinched
dermatofibroma
Aplastic Anemia vs Aplastic crisis
Anemia = PANcytopenia
Crisis = ERYTHROpenia
RTA has positive or negative UAG?
Positive
Scabies treatment
Permethrin and Lindane
Treatment for Pertussis
erythromycin
4 of the most common complications of EPO therapy
Worsening of HTN
Headaches
Flu like syndrome
Red cell aplasia
Early decrescendo diastolic murmur
left sternal boarder (3rd/4th IC space)
with patient sitting up, leaning forward, and holding breath in full expiration
Aortic regurgitation
most commonly due to bicuspid aortic valve in the developed world
Increased Methylmalonic acid is associated with?
B12 deficiency
normal with folate
Complete androgen insensitivity syndrome
genetically male, phenotypically female
Cryptorchid testes
Orchiectomy after puberty
3 p’s of Mccune Albright
Precocious puberty
Pigmented spots
Polyostotic fibrous dysplasia
treatment for a-fib with RVR
beta blocker
diltiazem
digoxin
does long term use of OCP’s decrease breast cancer risk?
no , slight increase
Treatment options for non-ICU community acquired pneumonia
Fluoroquinolone
OR
Beta-lactam + Macrolide
what does mixed venous oxygen saturation tell you?
the amount of oxygen being extracted by tissues
flutamide mechanism of action
androgen blockade by binding to dihydrotestosterone receptors
Sevelamer and Lanthanum are?
phosphate binders
Diarrhea has positive or negative UAG?
Negative
Condyloma lata =
Condyloma acuminata =
Syphilis
Genital warts
When is post op atelectasis most comm?
Days 2-3
Renal changes in pregnancy
Increased risk of pyelonephritis
Increased GFR
Decreased BUN/creatinine
Methanol overdose is associated with what physical exam finding?
inflamed retina
Biliary atresia work up
U/S = no ducts
7 days of phenobarbital
HIDA scan
Patients with primary biliary cirrhosis are at increased risk of developing what?
Osteomalacia
Pulses parvus et tardus associated with what valve abnormality
Aortic stenosis
Accuracy
measures what it is supposed to measure
Periarticular osteopenia is a buzzword for?
Rheumatoid Arthritis
Tolcapone, Entacapone
MOI
COMT inhibitors
block metabolism of dopamine
Parkinsons
Most accurate imaging for adenomyosis?
MRI
Mild, irregular contractions with no cervical change =
braxton-hicks
reassure and send home
Medications that cause Acute interstitial nephritis are same drugs that cause what 4 other conditions?
Drug allergy/rash
Stevens-Johnson Syndrome
Toxic Epidermal Necrolysis
Hemolysis
Oligohydramnios
Single deepest pick of amniotic fluid <2cm or amniotic fluid index <5
MS patient with equivocal or non-diagnostic MRI
look for?
oligoclonal bands in CSF
not SPECIFIC to MS
what diuretic is associated with ototoxicity?
furosemide
damages hair cells of cochlea
Most commonly injured bronchus in chest trauma
Right main
RARE
SNRI’s
Venlafaxine
Desvenlafaxine
Duloxetine
what pharmacotherapy can be given with subarachnoid hemorrhage
CCB to prevent subsequent ischemic stroke from vasospasm
Phenytoin for seizure prophylaxis
preemie + GI bleed + air under diaphragm or pneumatosis intestinalis
NEC
NPO, IVF, TPN, IV abx
Common causes of priapism
Sickle cell Leukemia Perineal or genital trauma neurogenic lesions meds - trazodone and prazosin
Adrenal medulla produces?
catecholamines
Swelling limited to surface of one cranial bone
cephalohematoma
caput crosses suture lines
Most common cause of labial fusion
21-B Hydroxylase deficiency
TInea capitis vs seborrheic dermatitis
TC doesn’t involve face, nasolabial folds, or eyebrows
Tx to prevent renal failure from tumor lysis
allopurinol
hydration
rasburicase
Three most common underlying causes of addisons
Autoimmune
TB
Anterior pituitary
Severe features for pre eclampsia
SBP >160 or DBP >110
Thrombocytopenia
Creatinine elevation
Elevated LFT’s
Pulmonary edema
Visual or cerebral symptoms
Which treatment for graves can cause worsening ophthalmopathy
Radioactive iodine
Due to increase in thyroid receptor antibodies
Male child
Decreased or absent tonsils, adenoids, lymph nodes, spleen
Brutons agammaglobulinemia
IVIG
dorsal column is responsible for?
vibration and proprioception
includes fasciculus cuneatus and fasciculus gracilis
posterior spinal artery
Sickle cell trait commonly results in ?
inability to concentrate urine
Hemodynamics in Septic shock
RA pressure PCWP cardiac index sVR MVO2
Normal or decreased
Normal or decreased
Increased
Decreased
Increased
3 general steps of bilirubin excretion
Uptake -
Conjugation -
Excretion -
Parkinsonism due to loss of cells where?
Neurotransmitter that is low?
Substantia Nigra
Dopamine
Which skin cancer can cause neuro symptoms due to neural invasion?
Squamous cell
What cell is most distinct abnormality in myelodysplastic syndrome?
Pelger-Huet
Bilobed nucleus
barking, seal like cough
inspiratory wheeze in between
dx?
croup
parainfluenza virus
most frequent type of delusion in delusional disorder
persecutory type
Cells of Hodkgkins?
Reed Sternberg
Owl-eyed cells
Cancers with Lynch Syndrome HNPCC
Colorectal
Endometrial
Ovarian
Treatment for intrauterine fetal demise >24 weeks?
vaginal delivery with labor induction
can be delayed until mother is ready
less than 24 weeks = dilation and evacuation
What milk intake can lead to folate deficiency?
Goats milk
Schizoaffective vs Major depression with psychotic features
Mood symptoms and psychotic symptoms occur together with MDD with psychotic features
Psychotic symptoms persist for >2 weeks by themslves in schizoaffective
Brown Sequard loss of?
pain and temp OPPOSITE SIDE
position and vibratory SAME SIDE
what medication should every stroke patient be given if they aren’t already on it?
Statin
2nd line treatment for Lyme
Treatment for neurologic infxn?
Amoxicillin
IV ceftriaxone
Pinworm =
itchy butt
scotch tape test
albendazole
Severe infections in CLL tx
IVIG
Tertiary prevention =
treatment of a given disease
What condition can present with bilateral trigeminal neuralgia
MS
agent of choice for prophylaxis of pasteurella?
amoxicillin/clavulanate
Rotavirus contraindicated in?
individuals with previous intussusception
corkscrew shaped and rightward displaced duodenum +
midgut volvulus
atypical glandular cells on pap smear
next step =
endometrial biopsy
Uric acid and BUN in SIADH are?
low
4 options for emergency contraception?
most effective?
Copper IUD
Ulipristal - antiprogestin
Levonorgestrel - progestin
OCP’s - progestin
Copper IUD most effective
OCP’s least effective for EMERGENCY contraception
Initial pharmacotherapy for pseudotumor cerebri
Acetazolamide
When do children need a renal and bladder ultrasound
with a first UTI between 2 and 24 months
Subacute combined degeneration = ?
loss of?
B12 deficiency or Neurosyphilis
position and vibratory sense
Autoimmune blistering disease
no mucosal involvement
linear IgG deposits on basement membrane
Bullous pemphigoid
when can you do a trans cranial doppler?
over 20 weeks
fetal anemia
increased velocity is a positive test
Exogenous glucocorticoid induced adrenal insufficiency doesn’t have what physical finding?
hyperpigmentation
central deficiency - steroids inhibit ACTH release
What kidney disease is associated with Hodgkin Lymphoma?
Minimal Change Disease
Normal nadir of maternal anemia in pregnancy
Hgb 10/ Hct 30
Reflex iron studies if less
gross hematuria 1 TO 2 DAYS AFTER URI
IgA nephropathy
most accurate test is kidney biopsy
common cause of complex partial seizures
temporal lobe epilepsy
Autoimmune thrombocytopenia or hemolysis in association with CLL tx?
Prednisone
Can you intubate patients with cervical spine trauma?
Yes
Only contraindication is significant facial trauma
what vitamin deficiency may present with hyperemesis gravidarum?
triad?
thiamine deficiency
AMS, ataxia, nystagmus
Cyanosis in an infant relived by crying = ?
Choanal atresia
Pregnant patient and possible DVT
1st step V/Q
Only a NORMAL v/q rules out PE
low probability v/q requires further testing - CT angio
Transudates tend to be high or low protein?
low protein
What infection is associated with membranous nephropathy in children?
Hep B
Graves vs painless thyroiditis
Graves has diffuse iodine uptake
Painless has low uptake
What curious thing occurs with Lymph nodes in Hodkgins?
EtOH causes tenderness
Best initial therapy for warm hemolytic anemia
Prednisone
IVIG if prednisone fails
SN-N-OUT
Sensative test - negative - rules out disease
Don’t use copper IUD as post birth contraception in what class of patients
Hypermenorrhea
Or
Anemic
When to switch to subQ insulin in DKA
able to eat
glucose <200
anion gap <12
serum HCO3 >15
what region of the brain does toxoplasmosis have a preference for?
basal ganglia
When to do C section for labor arrest
> 6 cm dilated
arrested for 4 to 6 hours
high arches, LE wasting, decreased DTR’s
Charcot-Marie-Tooth Disease
EMG
no tx
Normal iron studies =
Thalassemia
CSF findings in Guillain-Barre
Increased protein, normal cell counts
Unconjugated hyperbilirubinemia = patho or physio?
Steps of diagnosis
1, 2, 3, 4
physiologic
- Coombs test
- Hgb level
- low = hemorrhagic
- high = transfusion (twin-twin, delayed clamping) - Retic
- Reabsorption
Contralateral somatosensory and motor deficit FACE, ARM, LEG
Eye deviation toward side of infarct
Aphasia (if dominant hemisphere)
Hemineglect (if non-dominant)
Middle Cerebral artery
Definitive diagnosis of CJD
Brain biopsy
Or
PRNP gene mutations
Type II RTA also known as?
Mechanism of impairment?
common side effect?
Proximal RTA
failure to reabsorb Bicarb in the PCT
osteomalacia (after chronic metabolic acidosis)
give bicarb then test urine
SAAG
subtract peritoneal albumin from serum albumin
ascites source determination
> 1.1 = portal
<1.1 = non-portal
First line treatment for OCD
exposure and response prevention
+/- SSRI
TYPE I RTA is also known as?
Mechanism of impairment?
common side effect?
initial step in work up?
Distal RTA
failure to generate new Bicarb in distal tubule - alkaline urine
nephrocalcinosis
UA for pH >5.5
Topical erythromycin is to prevent?
gonorrheal conjunctivits
2 to 7 days
persistent platelet elevations post infectious with a phx of abdominal trauma
splenectomy due to BAT
reactive thrombocytosis
Nontender lymphadenopathy - first step?
excisional biopsy
eosinophils on UA
what stain?
allergic or acute interstitial nephritis
Wright and Hansel
Polycythemia vera is caused by?
increased RBC production
NOT INCREASED EPO OR INCREASED EPO RESPONSIVENESS
PPV =
TP/(TP+FP)
patients want to know what a positive test means
Amniotic fluid
Ferning
Turns nitrazine paper blue
mechanism of action of hyperprolactinemia in hypothyroidism
TRH has some stimulation of lactotrophs = prolactin secretion
nipple discharge in hypothyroid patient
Sudden onset pain and redness in the MEDIAL CANTHAL region
Children or adults over 40
Dacrocystitis
Staph aureus, beta hemolytic strep
SP-P-IN
Specific test - positive - rules in disease
Bilateral pale gray nipple discharge
Guiac negative
Labs?
TSH and Prolactin level
What cbc findings can be found with EBV?
autoimmune hemolytic anemia
thrombocytopenia
elevated reticulocyte count
positive Coombs
due to IgM cold agglutinins
Work up of Addisons steps
early morning cortisol
cosyntropin stim test (no change = adrenal gland problem)
if adrenal gland - tx with cortisol + fludrocortisone
NPV =
TN/(TN+FN)
patients wants to know if the negative test is really negative
What immunosuppressant causes gingival hyperplasia and hirsutism
Cyclosporine
what is the other cause of floppy baby syndrome
Werdnig hoffman
AR degeneration of anterior horn cells and cranial nerve motor nuclei
What are the primary immune responses to PPSV23 vaccine and PCV 13 vaccine?
T-cell INDEPENDENT B cell response for PPSV23
T-cell DEPENDENT B cell response for PCV 13
Contrast induced renal failure lab values
LOW UNa
LOW FeNa
VERY HIGH spec grav
d/t spasm of afferent arteriole - renal tubular dysfunction and tremendous reabsorption of Na and Water
usual labs from toxin induced ATN would be the exact opposite
Untreated hyperthyroidism has increased risk for?
Bone loss
Osteoclast activity increased
Triple screen?
Quad?
Alpha fetoprotein
Estriol
Beta-hcg
Add inhibin A
Most common method of hep B transmission world wide
Perinatal
DTaP =
TdaP +
Kids
Adults
Proximal muscle weakness + hirsutism + weight gain
Cushing’s related MUSCULAR ATROPHY
EKG findings in tricuspid atresia
chest x ray findings
peaked P waves, Left axis deviation, small R waves
decreased pulmonary markings
headaches secondary to ICP are often worse when?
in the morning
Is BUN/Cr elevated or decreased in Upper GI Bleed?
elevated
Breast milk jaundice vs Breast feeding
Breast feeding = quanitity - not enough - bilirubin sits around due to lack of bowel movements - BEFORE DAY 7
Breast milk = quality - moms milk inhibits conjugation - AFTER DAY 7 - hydrolyzed formula
High radioactive iodine uptake scan = 3?
graves - diffuse pattern
toxic adenoma/multinodular goiter - nodular pattern
Hierarchy of growth in peds
Head
Height
Weight
(most to least important)
FTT leads to losses in the order of least to most important