Pearls Flashcards
Traveler’s Diarrhea
•E. coli
-<7 days, acute, self resolving
•Giardia
- >2 weeks, not bloody, watery, foul smelling
- takes about a week to manifest
•E. histolytica
- >2 weeks, bloody, mucoid
- liver involvement
•cryptosporidium
- watery, no colitis
- short lived in healthy patients
- >2 weeks in immunocompromised
bronchoconstriction + small airway inflammation
cough, wheezing
- asthma
- bronchiolitis
edema + narrowing of proximal trachea
harsh cough, inspiratory stridor
•croup
ecopresis
- sign of constipation
- leakage around impacted stool
- close proximity of bladder to rectum leads to decreased functional bladder capacity and instability of detrusor muscle
- urinary incontinence
pheochromocytoma vs. RAS
•both cause secondary HTN, but pheo has labile BP + anxiety and sweating
Target Rashes
•Tinea corporis
-itchy!
•Lyme disease
- erythema migrans
- not as itchy!
•erythema multiforme
-blistering!
Measles vs Rubella Rashes
•Rubella
- cephalocaudal
- lymphadenopathy
- mild
- Forcheimer spots
•Measles
- cephalocaudal
- coalesces and darkens
- ill appearing, fever, coryza, cough
- Vitamin A (decreases morbidity and mortality!)
In someone immunocompromised [] should never be considered a contaminant.
In someone immunocompromised candidiasis should never be considered a contaminant.
First things you do for a patient with sepsis:
1) fluids within 3 hours
2) antibiotics within 1 hour, but get blood cultures first!
Plantar puncture wounds are usually caused by []!
Plantar puncture wounds are usually caused by Pseudomonas!
NG tubes. What are they good for???
- feeding
- delivering meds
- administering radiographic contents
- removing and evaluating stomach contents (suction)
- decompressing blockages (suction)
For which thyroid cancer would you check calcitonin levels?
Medullary (parafollicular cells)
Sialadenosis
•secretory granules
- alcohol
- bulimia
- malnutrition
•fat
- DM
- liver diseases
Splenic abscess? Think [].
Splenic abscess? Think infective endocarditis.
Infective endocarditis is one of the worst complications of valvular heart disease and is sometimes life-threatening. Splenic abscess is described as a rare complication of left-sided infective endocarditis. Splenic infarctions are more common conditions and are often asymptomatic. Approximately 5% of patients with splenic infarction will eventually develop splenic abscess [1–3]. The spleen may be affected either by bacteremia seeding an infarcted splenic zone, or directly through seeding of the spleen by infected embolized vegetations of the heart valves [4]. Splenic abscesses are associated with high morbidity and mortality rates, but early recognition of the symptoms and prompt treatment should allow for a favorable outcome [5].
Symptoms and signs that could arouse suspicion of splenic abscess are nausea, vomiting, hiccups and back, left flank or left upper quadrant pain, and unexplained abdominal distension [8]. On a chest X-ray, a left-sided pleural effusion or left lower lobe infiltrate may increase suspicion [8]. However, the most common clinical presentation of splenic abscess is persistent or recurrent fever and sepsis, in spite of adequate antimicrobial treatment. The majority of patients with splenic abscesses have no localized findings on clinical examination and chest X-ray findings are nonspecific
AST/ALT in NAFLD vs alcoholism
•NAFLD
-AST/ALT <1
•alcoholism
-AST/ALT >>>1
Tracheobronchial disruption is a sign of [] .
Tracheobronchial disruption is a sign of pneumomediastinum.
•dx: bronchoscopy .
Coughing can lead to a [] .
Coughing can lead to a spontaneous pneumomediastinum.
•dx: X-ray
In the Uworld universe, unilocular adnexal mass =
endometriosis!
This is different from a cyst!
•fixed, retroverted uterus = endometriosis
and
•blue spots on posterior fornix = endometriosis
Nonspecific GI or respiratory symptoms may precede mucocutaneous findings in [] .
Nonspecific GI or respiratory symptoms may precede mucocutaneous findings in Kawasaki disease..
3 Causes of Vaginitis
- trichomoniasis pH > 4.5
- purulent, green-grey frothy discharge
- metronidazole
- trichomonads on wet mount - bacterial vaginosis pH > 4.5
- thin, malodorous, grey-white discharge
- metronidazole
- clue cells - yeast pH < 4.5
- cottage cheese discharge
- oral fluconazole or miconazole or clotrmazole cream
- hyphae and budding yeasts
First treatment for hyperkalemia?
1) calcium gluconate
then
2) insulin and glucose, sodium polystyrene sulfate, sodium bicarbonate
3) hemodialysis
“Fixed splitting of S2” almost always indicates [].
“Fixed splitting of S2” almost always indicates ASD.
“Mid-systolic click” followed by a late systolic murmur best heard at the apex is almost always [].
“Mid-systolic click” followed by a late systolic murmur best heard at the apex is almost always mitral valve prolapse.
Defects in Tetrology of Fallot
Pulmonary stenosis
Right ventricular hypertrophy
Overriding aorta
VSD
Early cyanosis
Which interventions prolong life in COPD patients?
Supplemental O2 and smoking cessation!
Iron deficiency anemia in a male is [] until proven otherwise.
Iron deficiency anemia in a male is colorectal cancer until proven otherwise.
Get an endoscopy!
Differentials for microcytic anemia
Thalessemia
Anemia of chronic disease
Iron deficiency anemia
Lead posioning
Sideroblastic anemia
Decreased haptoglobin and increased LDH indicate [].
Decreased haptoglobin and increased LDH indicate lysis of red blood cells.
Haptoglobin binds to a type of hemoglobin that’s made when red blood cells die, leading to anemia. This haptoglobin-hemoglobin complex is removed from your body by your liver. If too much hemoglobin is bound to haptoglobin, the levels of haptoglobin will drop.
What is the target HgbA1C for diabetics?
7.0%
“Rib notching” =
coarctation of the aorta
increased VMA and HVA in the urine
•neuroblastoma
- childhood tumor that can cause HTN due to catelcholamine release
- no increase in metanephrine and normetanephrine
•pheochromocytoma
- HTN
- also increased metanephrine and normetanephrine
Secretions of pheochromocytoma tumors are catecholamines, including epinephrine, norepinephrine. Secretions of neuroblastoma in the adrenals include catecholamines but not epinephrine.
After initial treatment of the acute gout, what is the next best step?
24 hour urine collection
- have to figure if the person is an undersecretor or an overproducer
- undersecretors
- probenicid or sulfinpyrazone
- block reabsorption of uric acid
•overproducers
- allopurinol
- xanthine oxidase inhibitor —> decreased production of purines and uric acid
If the TSH is normal, the patient must be euthyroid/hyperthyroid/hypothyroid.
If the TSH is normal, the patient must be euthyroid.
Rash on palms and soles of feet
- Rocky Mountain Spotted Fever
- secondary syphilis
- Kawasaki’s disease
- erythema multiforme
- coxsackie
- measles
- reactive arthritis
- Janeway lesions
- meningococcemia
Increased alpha fetal protein
- can be thought of caused by any defect in which the fetal body cavity is left open
- neural tube defects
- anencephaly
- myelomeningocele
•abdominal wall defcets
- gastroschisis
- omphalocele
•multiple gestations and an inaccurate date can throw off the test
Decreased alpha fetal protein
•chromosomal abnormalities
- trisomy 18
- trisomy 21
Differentials for an otherwise healthy person with a chronic (> 3 weeks) cough?
1) postnasal drip
2) asthma
3) GERD
Hypertensive emergency vs. urgency
•urgency is SBP >200 and DBP >120 in the absence of symptoms
- can lower BP more slowly
- give beta blocker (Labetolol if cocaine involved! It is an alpha and beta blocking properties, a pure beta –> unopposed alpha —> intense vasoconstriction, ischemia and gangrene)
•emergency is SBP >200 and DBP >120 with symptoms
-IV agents to decrease BP within minutes
CA-MRSA is susceptible to [] and [].
CA-MRSA is susceptible to clindamycin and TMP-SMX.
What can you give a patient for ED if they are taking a nitrate?
Alprostadil
A prostaglandin analog
High insulin, low C-peptide?
Think exogenous insulin!
Gait disturbance, urinary incontinence, dementia?
Normal Pressure Hydrocephalus
What is the most likely cause of bloody nipple discharge in a patient < 30 years old?
Intraductal papilloma
•If > 30 years old, may also be inflitrating ductal carcinoma
How can you tell if it is superficial vein thrombophlebitis vs. DVT?
Palpation of a cord like structure = SVT
In DVT, the thrombus is too “deep” (get it?) to palpate!
When they say “positive head thrust”, you think [].
When they say “positive head thrust”, you think vestibular neuritis aka labyrinthitis.
What test to diagnose hereditary spherocytosis?
Osmotic fragility test
Best first line treatments for GERD?
1) lifestyle modification
2) H2 , antacids
3) H2 , PPI
Young person with asymptomatic lymphadenopathy, mediastinum widening, itchy after a hot shower, in pain after drinking alcohol, with unexplained weight loss, fever, night sweats?
Hodgkins Lymphoma
Primary Sclerosing Cholangitis vs. Primary Biliary Cirrhosis (Cholangitis)
- PSC is large extrahepatic bile ducts, PBC is small intrahepatic ducts
- PSC associated with IBD, PBC associated with autoimmune (SLE, Sjogren’s)
- PSC pANCA, PBC anti-mitrochondrial
- PSC young male, PBC older female
MEN I
- Pituitary
- parathyroid ademoma
- pancreatic tumors
- ZE
- insulinomas
- glucagonomas
- VIPomas
MEN IIA
- Medullary Thyroid Cancer
- Pheochromocytoma
- Hyperparathyroidism
MEN IIB
- Pheochromocytoma
- Medullary Thyroid Cancer
- Mucosal Neuromas
- Marfan habitus
SIADH Causes
•presents with hyponatremia and euvolemia
1) cancer
- ectopic production small cell carcinoma of lung, pancreatic malignancy
2) CNS disturbances
3) drugs
- antipsychotics
- chemotherapeutics
IgA Nephropathy vs. PSGN
•IgA
- 5 days post URI
- gross hematuria
•PSGN
- 10 days post pharyngitis
- kids
Mom has mono like symptoms?
CMV
Blueberry muffin baby, deaf?
Rubella
Hydrocephalus, chorioretinitis, intracranial calcifications?
Toxoplasmosis
Rash on palms and soles, snuffles, lymphadenopathy and organomegaly?
Syphilis
Why don’t we test young children for C. difficile?
- most are carriers and asymtpomatic
- may be related to young children not having the “cellular machinery” needed for the toxin to do its thing
What are some acute phase reactants?
- ESR
- CRP
- ferritin
- fibrinogen
- hepcidin
- ceruloplasim
- haptoglobin
- C3/C4
- amyloid A
What are some negative acute phase reactants?
- serum albumin
- transferrin
- alpha fetoprotein
Which Vitamin D should you test for?
Active Vitamin D
How does magnesium sulfate help with asthma?
Competes with Ca, inhibiting smooth muscle contractility.
Used as asthma treatment.
What are the Hb differences between thalassemia major, thalassemia minor, SCT and SCD?
- thalassemia major: increased HbA2 and HbAF
- thalassemia minor: increased HbA2 and normal HbAF
- SCT: increased HbS
- SCD: increased HbS and increased HbF
Jaundice + hepatosplenomegay + FMHx of splenectomy =
Hereditary Spherocytosis!
New onset psychosis and neurologic dysfunction in an adolescent?
Consider Woilson’s Disease!
HTN + bradycardia + irregular breathing?
Cushing’s Triad
herniation imminent
Thalassemia and SCD don’t show up until 6 months old because of [].
Thalassemia and SCD don’t show up until 6 months old because of HbF.
B.henslae may have a localized papular or nodular skin lesion that may go [].
B.henslae may have a localized papular or nodular skin lesion that may go unnoticed.
Thalssemia has [] RBCs and [] RDW.
Thalssemia has normal RBCs and normal RDW.
Thalassemia and IDA may have [].
Thalassemia and IDA may have reactive thrombocytosis.
IDA has [] RBCs and [] RDW.
IDA has decreased RBCs and increased RDW.
VACTERL
Vertebral
Anal
Cardiac
Tracheal
Esophageal
Renal
Limb
Babies who have been diagnosed as having VACTERL association usually have at least three or more of these individual anomalies. There is a wide range of manifestation of VACTERL association so that the exact incidence within the population is not exactly known, but has been estimated to occur in one in 10,000 to 40,000 newborns.
The cause of VACTERL association is not well understood. VACTERL association is a complex condition that may have different causes in different people. No specific genetic or chromosome problem has been identified with VACTERL association. Multiple genetic and environmental factors likely play a part in determining the risk of developing this condition and how severe the condition will be in an individual. Some possible genetic and environmental influences are being studied.
The developmental abnormalities characteristic of VACTERL association develop before birth. The disruption to typical development that causes VACTERL association likely occurs early in development, resulting in birth defects that affect multiple body systems. It is unclear why the features characteristic of VACTERL association group together in affected individuals.
CHARGE
Coloboma
Heart defects
Atresia choanae (connection between the back of the nose and throat)
Retardation of growth
Genitourinary
Ear
CHARGE syndrome (CS) refers to a pattern of birth defects with a wide range of conditions that can differ from child to child. It is rare and affects one in each 150,000 births worldwide.
CS is a genetic condition. It is caused by a change or mutation in at least one gene. Most of the time, this is present in the child but not in the parents. It is very rare to have a family history of CS. It is not common for families to have more than one child with CS.
The CHD7 gene is the most common gene affected in children with CS. About two-thirds of children showing an abnormality (or mutation) of the CHD7 gene. This gene test is helpful to find out if a child has CS. There are other tests that are also done if this test does not show the gene mutation.
Galactosemia causes seizures due to [].
Galactosemia causes seizures due to hypoglycemia.
Glycogen storgae diseases take [] to show up, when the baby starts sleeping through the night and is feeding less often.
Glycogen storgae diseases take 3-6 months to show up, when the baby starts sleeping through the night and is feeding less often.
Does creatinine cross the placenta?
Yes; an increase in the neonate can be a reflection of maternal status.
Aplastic crisis
•a decrease in RBC precursors
- decreased reticulocytes
- normal platelets
An aplastic crisis is when the body does not make enough new red blood cells to replace the ones that are already in the blood.
Aplastic anemia
•decrease in all cell lines
- decreased platelets
- decreased RBCs
- decreased WBCs
Aplastic anemia is a condition that occurs when your body stops producing enough new blood cells.
Splenic sequestration
•trapping of RBCs and platelets
- decreased platelets (trapped in spleen)
- decreased RBCs (trapped in spleen)
- increased reticulocytes (response)
