Panda fam med: 4 Flashcards
How to differentiate between Waldenstrom’s and MGUS?
Both may have monoclonal expansion of IgM, but only MGUS has Bence Jones Proteinuria
Management of Fight Bite (2)
- Radiograph (r/o Boxer’s Fracture)
2. ABx with ANY TEAR IN SKIn
MCC Syncope
- Pathophys
- Presentation
- Diagnosis
Neurocardiogenic / Vasovagal
- Pathophys: increase SNS tone —> sudden withdrawal (fear / emotion).
- Alternative: excess PaNS stimulation (blood rush to head / carotid)
- Diagnosis: Tilt Table test to recreate hyptension / bradycarda
Only alternative medicine to work for migraines?
Biofeedback
Best treatment for nerve gas toxicity (2)
nerve gas = sarin = increase AcH Like organophosphates
- Atropine
- Pralidoxine
Rx for EtOH Dependence (3)
Naltrexone, Acamprosate, Disulfram
Autonomic Hyperreflexia
- Common in spinal trauma above T6
- Lack of SNS inhibition = increase SNS tone
- P/w HA, HTN, Flushing, Dilated Pupils and Goosebumps
Child of jehovas witness who needs blood?
- Give the blood (emergency situation, parent’s religious belief ≠ child)
Child with treatable ALL with parents refusing chemo?
Court order to overturn the parents; this is treatable condition and it parent’s do not understand the disease process
Child with ALL with poor prognosis refusing chemo?
Respect parent’s wishes
Which anti-psych Rx causes agranulocytosis?
Clozapine
Live Flu Vaccine
- Who can get it?
- Who requires 2 doses?
Live Flu = Intranasal Flu Vaccine
- All healthy / non-pregnant persons can get it (before 50, then switch to typical protocol)
- 2 doses for t ever been vaccinated
MCC of Blindness
- ≥65
- <65
- AA
- Worldwide
- ≥65: ARMD
- <65: Diabetes
- AA: Glaucoma (non-reversible)
- Worldwide: CT A-C
MCC Galactorrhea in Women of Reproductive Age?
OCP (E –> increase Prolactin)
Management of Fibroids:
- Pregnancy Desired (1)
- Pregnancy Not Desired (3 Sx / 3 Rx)
- Preg: Myomectomy
- No Preg: TAH, UAE, Endometrial Ablation, OCP, Danazol (Androgen PA) and GnRH Analogue
3 CI to E-containing OCP
- Smokers >35
- H/o DVT / VTE
- CHD / CHF
Diaphragm in Sex
- How long to keep in?
- When to take out?
Keep in 6-24 hours after intercourse, take out after 24 to decrease risk of Toxic Shock
Best test for ectopic pregnancy?
hCG Level (1500-2000) @classic 6 week with TVUSG showing nothing inside uterus
4 Protective Things Agst Endometrial Cancer
- Late Menarche (decrease E)
- Early Menopause (same)
- OCP - regulate E exposure
- Mulliparity - decrease estrogen during the pregnancy
Normal Progressive of Female Puberty
Thelarche —> Adrenarche —> Growth Spurt —> Menache
Trich Cervicitis Treatment
- First time
- Relapse
- First time: 2g Flagyl in Single PO Dose
- Relapse: 500 mg BID x 7 days
Postterm pregnancy is ≥_____
42 weeks
During PNC a patient is found to be CT positive.Next best step?
Normally would treat with doxy, but this is CI in pregnancy. Give arithryomycin / amoxicillin. Remember, no doxy in pregnancy or children <8 y/o.
2 CI to Electrosurgical Destruction of a skin lesion
Pacemaker
Melanoma
Max Tyelnol Dose / Day
4000 mg
Define:
- Pre-eclampsia (Mild vs. Severe)
Pre-E: >20 weeks HTN and Proteinuria (recall edema removed b/c 2+ LE edema is common in pregnancy)
- HTN: 140/90 is mild, 160/110 is severe
- Proteinuria: >0.3g/24 hr (mild) –> 5g/24 hr (severe)
- Gestational HTN
Gestational HTN: >20 weeks HTN
Chronic HTN in Pregnancy
Chronic HTN: <20 weeks HTN
<20 weeks HTN + Proteinuria
GTN
Early Decelerations
mirror uterine contractions = head compression
Variable Decelerations
cord compression
Late Decelerations
2/2 fetal hypoxemia / acidosis (placental problems)
SVT Management (3)
- Vagal Maneuvers
- Adenosine
- Beta Blockers / CCB
HTN Based on Ethnicity
- Caucasian (2)
- AA
Caucasian = ACE I / Beta Blockers
AA = HCTZ / CCB (as less RAAS dependent)
Upper Extremity DVT
- MCC Inpatient
- MCC Outpatient
Most commonly affects axillo-subclavian system
- MCC Inpatient = Central Venous Lines
- MCC Outpatient = structural abnormalities of the thoracic outlet associated with strenuous exercise
ECT Therapy
- Indications
- Contraindications
- Patients at high risk for getting complications
- Indications: Severe refractory depression, pregnancy, catatonia, NMS
- NO CONTRAINDICATIONS (including pregnancy / pacemakers)
- Patients high risk for complications from ECT = increased ICP / recent hemorrhagic or ischemic CVA
Age to Begin Solid Foods
Why (2)
4-6 months
Why?
- Extrusion Reflex (pushing material out of mouth) exists until 4 months
- No benefit from solid food until this age
Best SCREENING test for hypogonadism?
Next best test if abnormal screening test?
TOTAL Testosterone (≠Free, too expensive)
FSH / LH, to determine if primary / secondary testicular
When to operate on AAA?
> 5.5 cm
Aortic Stenosis
- When to operative in asymptomatic patients?
- How to tell if older pt with CHD’s symptoms are from CHD or AS?
- NO OPERATIVES FOR ASX PATIENTS = Watchful Waiting; operate only when symptomatic
- ECHO, findings s/o Surgery for AS
1. Pressure Gradient >50
2. Aortic Valve Area <1.0 cm2
Definition of COPD
Diagnosis of COPD
COPD = Chronic Bronchitis (>3 months of productive cough for 2 years) and Emphysema (dilation of post-terminal bronchiole 2/2 loss of elastase)
Diagnosis of COPD = SPIROMETRY with decrease FEV1»_space;> decrease FVC = low ratio
Diagnosis of Peripheral Arterial Disease
- Clinical Diagnosis vs. Neurogenic Claudication
- Diagnostic Tests (3)
- Clinical: leg pain worse with walking, relieved by rest. Neurogenic claudication occurs at rest and is often better with walking.
- Diagnostics
1. ABI <20 mmHg upon walking / exercise
Woman with signs / symptoms of UTI:
- DDx if Acute Onset
- DDx if Progressive Onset
- UA with pyuria but no growth on UCx =
Acute = classic UTI with GNR > S. Saprophyticus Gradual = STI Urethritis (CT / GC, HSV)
*UA with Pyuria and No growth on UCx = Chlamydia
Gait Abnormalities
- Best Screening Test
- Interpretation of Findings
- Best Screening Test = Get Up and Go: patient gets up without using arms and walks 3 m and then back
- Interpretation of Findings
14 seconds = high fall risk
>20 seconds = severe gait imbalance
“Walking on Ice Gait”
Visual Impairment (Cataracts)
Short-stepped Shuffling Gait
PD
Steppage Gait
Neuropathy
Pregnant woman (or Newborn) is found to be anemic based off of Hb/HCT on CBC. What is the next best step?
Trial of Fe. DO NOT order more serum studies / Hb Electrophoresis as 9/10 these are caused by Fe Deficiency Anemia.
MCC of Acute Interstitial Nephritis
Abx
Primary vs. Secondary Hypothyroidism
- TSH / T4 Levels in Both
- How to follow Synthroid Dosing in Both
Primary
- HIGH TSH with LOW T4
- Follow Synthroid dosing with TSH levels
Secondary
- LOW TSH with LOW T4
- Can’t use TSH to follow Synthroid b/c of pituitary failure, use T4 levels
Patient presents with stones, bones, moans and groans.
- MCC (specifically!)
- Next best serum test?
- Finding on EKG
MCC = Parathyroid Adenoma
Next Best Serum Test = PTH
Short QT interval
When to order a SPOT U_Protein/Creatinine Ratio
Order when +Proteinuria on dipstick without clear etiology. Best would be a 24 hour urine protein, but in KIDS and NON-COMPLIANT adult patients, this is a good estimate.
Cervical Radiculopathy
- Physical Exam Test
- Work Up
- Management
PE Test = Spurling Maneuver (Rotate + extend head) = worsens radiculopathy pain
Work Up = need C-Spine Imaging
Mgmt: if no pathology on C-Spine Imaging = conservative + NSAID
Indications for Trial of CSx without SVD Attempt
Fetal Macrosomia (Defined as 4500-5000)
>4500 in Diabetic Mothers
>5000 in Non-Diabetic Mothers
Comment on Vacuum Delivery vs. Forceps / SVD
- Risk of fetal trauma
- Maternal soft tissue trauma
- Risk of Shoulder Dystocia
- Increased risk of fetal cephalophematoma / retinal hemorrhage
- Decrease risk of maternal soft tissue vs. forces
- Decrease risk of Dystocia vs. SVD
Pertussis
- Microbiology
- Transmission
- Pathophysiology
- Presentation (3 Stages)
- Common PE findings
- Common Lab Findings
- Gold Standard Diagnosis
- Treatment
- Microbiology: gram- coccobaccilus B. Pertussis
- Transmission: respiratory droplets
- Pathophysiology: infects respiratory epithelium
- Presentation (3 Stages): Catarrhal (URI Sx) —> Paroxysmal (Cough) —> Convalescent
- Common PE findings: Conjunctival Hemorrhage, UE Petechia and Post-tussive emesis
- Common Lab Findings: lymphocytosis
- Gold Standard Diagnosis: Nasopharyngeal swab
- Treatment: Azithromycin > Erythromycin for patient and family
Patellofemoral Pain
- Epidemiology
- Presentation (3)
- Management
- Epidemiology: young female athletes; associated with low core strength
- Presentation: anterior knee pain worse with CLIMBING / DESCENDING stairs, popping sensation and positive J sign (lateral patellar deviation during extension)
- Build up surrounding leg muscles
Patient presents with locking of the knee. DDx?
Loose Body / Meniscal Tear
Serum Tumor Markers
- PSA / PAP
- CEA
- AFP
- HCG
- CA-125
- CA-19-9
PSA: prostatic hypertrophy / cancer
PAP: definite for prostatic cancer
CEA: sensitive for COLON, ESOPHAGEAL and LIVER
HCG: Hydaditiform Mole, Choriocarcinoma, GTND
CA-125: Ovarian
CA-19-9: Pancreas
