Questions 1-350 Flashcards
Posterior costal tenderpoints are typically associated with (inhalation/exhalation) somatic dysfunction (elevated/depressed) ribs.
inhalation
elevated
What is the treatment for burkitt lymphoma?
rituximab
CD20 antibody
How do you treat small cell lung cancer?
radiation and chemo
iron is absorbed in the ….
folate is absorbed in the ….
duodenum
jejunum
window period of hep B serology will show
core ab IgM then IGg positive
II, III, aVF infarct location
RV infarction
treatment for RV infarction
isotonic flusids, aspirin and cardiac cath
NO nitrates
How do you prevent infection from foley cath after surgery?
keeping urine collecting bag below the level of the bladder, ensuring good downward flow
abundance of small normal appearing lymphocytes and ruptured smudge cells
CLL
plasma cells with fried egg appearance
multiple myeloma
Dutcher bodies /PAS positive staining IgM deposits around nucleus
waldenstrom macroglobulinemia (non-hodgkin like lymphoma)
lymphoid cells with cytoplasmic projections
hairy cell leukemia
TRAP stain (tartrate resistant acid phosphatase)
hairy cell leukemia
giant cells with bilobar nuclei and eosinophilic nucleoli
Reed sternberg cells
hodgkin lymphoma
PT, PTT, and platelet count in Vit C deficiency
normal PT, normal PTT, normal platelet count
gingivitis, ecchymoses, perifollicular hemorrhage, petechiae, curly hairs
vit C deficiency/scurvy
PT, PTT, platelet count in hemophilia A
normal PT, increased PTT, normal platelet count
(factor 8 deficiency, intrinsic pathway affected)
PT, PTT, platelet count in von willebrand disease
normal PT, increased PTT, normal platelet count
(vwf carries factor 8)
PT, PTT, platelet count in ITP
normal PT, normal PTT, decreased platelet count
what type of RTA is common in sickle cell disease pts and diabetics?
type IV RTA
What medications can cause a type IV RTA
ACE-I and NSAIDs
What is the physiologic defect in type IV RTA?
hypoaldosteronism or aldosterone resistance
hyperK, urine pH <5.5, positive urine anion gap
type I RTA is (distal/proximal)
distal
type II RTA is (distal/proximal)
proximal
impaired distal acid secretion, hypoK, urine pH > 5.5, positive urine anion gap
type I RTA
impaired proximal bicarb reabsorption, hypoK, urine pH <5.5, negative urine anion gap
type II RTA
thromboangiitis obliterans aka
buerger disease
thromboangiitis obliterans is closely linked to…
tobacco use
young smoker with symptoms of claudication, extremity or digit ischemia, or superficial thrombophlebitis
thomboangiitis obliterans
granulomatous skin disorder occurring primarily in diabetics, present with well-demarcated papule or plaque that gradually enlarges; generally non painful and on shins
necrobiosis lipodica
down and out right eye with pupillary dilation
oculomotor nerve palsy due to compression by a posterior communicating artery aneurysm
overall most common site of anuerysm rupture
anterior communicating artery branching point with ACA
aneurysm spot causing bitemporal heteronymous hemianopsia
compressing optic chiasm, ACOM artery aneurysm
decreased pain and or temp of the ipsilateral face and contralateral body
wallenberg syndrome
posterior inferior cerebellar artery
First, second, and third line treatments of status epilepticus
- benzos (lorazepam)
- Antiseizure drugs (fosphenytoin)
- rapid sequence intubation with propofol
testicular tumor with AFP + and no b-hCG
prepubertal males
yolk sac tumor/endodermal sinus tumor
testicular tumor that is well-defined hypoechoic lesions in testicular parenchyma without cystic areas on US
mild elevation b-hCG, no increase of AFP
seminoma
testicular tumor characterized by areas of necrosis and hemorrhage
choriocarcinoma
testicular tumor with symptoms of gynecomastia, loss of libido, or ED in adult males/precocious puberty in children
leydig cell tumors
treatment of CAP in non-ICU inpatient setting
beta-lactam abx plus a macrolide or respiratory fluoroquinolone to cover both typical and atypical bugs
ceftriaxone and azithromycin
MC typical bug in CAP
MC atypical bug in CAP
S. pneumo
mycoplasma pneumoniae
What are two respiratory fluoroquinolones?
levofloxacin and moxifloxacin
What is CURB-65 and what is it used for?
Pneumonia severity
Confusion
Uremia (BUN >20)
Respirations (>30)
Blood pressure (<90 systolic)
65 - age 65 or greater
All HIV pts, regardless of CD4 count should receive what vaccinations?
influenza and pneumonia vax
CD4 ct <200, ppx for….. with….
PCP with TMP-SMX or dapsone
CD4 ct <100, should ppx for …. with ….
Toxoplasma with TMP-SMX
CD4 ct < 50-100 ppx for…. with …
MAC with weekly azithromycin or daily clarithromycin
formation of a biliary-enteric fistula from long-standing cholelithiasis eroding through the wall of the gallbladder will possibly cause…
gallstone ileus
where does gallstone ileus occur?
MC at ileocecal valve due to narrowing, but can be anywhere along GI tract, especially where prior surgical anastomosis is
What is the Rigler triad in gallstone ileus
radiographic findings of bowel obstruction, pneumobilia, and RLQ gallstone
what is definitive treatment of gallstone ileus?
enterolithotomy
what staging systems are used for CLL?
Rai and binet
this staging system for CLL is based on the gradual and progressive increase in the body burden of leukemic lymphocytes
- lymphocytosis
- lymphadenopathy
- organomegaly
- anemia, thrombocytopenia
Rai system
this staging system of CLL considers 5 potential sites of involvement:
cervical, axillary, inguinal lymph nodes, and spleen and liver
determined by physical exam
Binet staging
What is the Ann Arbor staging system used for?
stage lymphomas, classically associated with Hodgkin Lymphoma
What is the revised international prognostic index used for?
prognosis tool of choice for diffuse large B cell lymphoma (MC NHL) in pts receiving R-CHOP chemo
three drugs commonly causing hyperkalemia
TMP-SMX, ACE-Is/ARBs, NSAIDs
empiric therapy for adults >50 yo with bacterial meningitis
ceftriaxone, vanc, ampicillin
empiric abx for bacterial meningitis in neonates ( <1 mo)
ampicillin and cefotaxime
empiric abx for bacterial meningitis in children to adults < 50 yo
ceftriaxone and vanc
in multiple myeloma, plasma cells produce
IgG, IgA, and light chains
HIV pregnancy at 38 weeks and >1000 viral load
C section with IV zidovudine 3 hours pre op
muscle pain, depressed mood, polyuria, constipation
hypercalcemia
hydatid cyst in the liver is due to
echinococcus granulosus
eggshell calcification of a hepatic cyst on CT
hydatid cyst
treatment of hydatid cyst
surgical resection under the cover of albendazole
What is the second MCC of intracerebral hemorrhage after hypertension?
cerebral amyloid angiopathy
where will cerebral amyloid angiopathy typically be located within the brain?
lobar
What is the MCC of intracerebral hemorrhage in children?
cerebral AV malformation
on fetal heart rate tracing, this appears as persistent fetal bradycardia (ie <110)
fetal AV block
What is the most serious complication of neonatal lupus?
fetal AV block
What is a stool marker for inflammatory diarrhea? (typically elevated in pts with IBD)
fecal calprotectin
family history of sudden death, congenital sensorineural deafness, and QT interval prolongation are concerning for…
Jervell and Lange-Nielsen syndrome (AR congenital long QT syndrome)
tx of congenital long QT syndrome
beta blockers with pacemaker
MC complication of influenza
secondary bacterial pneumonia
secondary bacterial pna s/p influenza in a young person is likely…
CA-MRSA
(severe, necrotizing pneumonia)
MCC of pediatric stroke
sickle cell disease
cyanosis occurs with feeding, relieved by crying
choanal atresia
spontaneous cerebellar hemorrhage might present with (ipsilateral/contralateral) hemiataxia
ipsilateral
photosensitive rash, multisystemic symptoms (arthralgias, pancytopenia, splenomegaly)
what antibody assay do I get?
SLE
antinuclear antibody
fixed, widely split S2
atrial septal defect
large ASD or VSD is not corrected and PVR exceeds SVR due to chronic L to R shunting
Eisenmenger syndrome
wide pulse pressure and continuous machine-like murmur or loud S2 and bounding peripheral pulses
PDA
week 1: fever/chills
week 2: abdominal pain with bloddy diarrhea
week 3: faint, salmon-colored macules (rose-spots)
typhoid fever/salmonella typhi
severe enterocolitis with bloody diarrhea s/p undercooked beef
E. coli 0157:H7
2nd MC organism related to HUS
Shigella dysenteriae
bloody diarrhea possibly with proctitis, rectal prolapse, toxic megacolon, intestinal obstruction, leukemoid reaction, or neurologic symptoms
Shigella dysenteriae
vitamin B12 and folate deficiencies will show what on peripheral smears?
hypersegmented neutrophils, elevated MCV, and macroovalocytes
bilobed nuclei of neutrophils seen on peripheral smear are indicative of
Pelger-Huet anomaly
lamina B receptor gene mutation
In pts with HIV associated nephropathy, what is the prominent feature on kidney biopsy?
focal segmental glomerulosclerosis
four features of nephrotic syndrome:
proteinuria >3.5, generalized edema, hypoalbuminemia, and hyperlipidemia
what drug is contraindicated in vasospastic/Prinzmetal angina?
nonselective beta blocker
because could result in unopposed alpha-1 activity, worsening vasoconstriction, causing cardiac ischemia
Cushing triad (3 things)
widening pulse pressure, irregular respirations, and bradycardia
Cushing triad implies
impending or imminent brain herniation
grip weakness and numbness of the hand that is exacerbated by abduction and extension of the upper extremity
thoracic outlet syndrome
pain on thumb and wrist movement with focal tenderness over the radial styloid
De Quervain tenosynovitis
provocative test for dx of de quervain tenosynovitis
finkelstein test
PD pts with psychosis, if they cannot tolerate a reduction of carbidopa-levodopa can be treated with
second gen antipsychotic
quetiapine, pimavanserin
MCC of oculomotor nerve palsy
ischemic neuropathy due to poorly controlled DM
pts with ischemic CN III palsy typically have ptosis, down and out gaze, and
preserved pupillary response
What is systemic therapy for angle-closure glaucoma?
acetazolamide to reduce production of aqueous humor
child with hx of arthralgia and psychosis, together with thrombocytopenia, hematuria, and proteinuria is concerning for
SLE
anti-U1 RNP
Mixed Connective Tissue Disease (MCTD)
mixed connective tissue disease has features of …
SLE, systemic sclerosis, and polymyositis
acquired autoantibody to ADAMTS13
TTP
thrombotic thrombocytopenic purpura
plasma protease that cleaves vWF off the endothelial surface
ADAMTS13
treatment for cryptococcal meningioencephalitis
amp B with flucytosine
then maintenance with fluconazole
tx for deramtophytosis and onychomycosis
griseofulvin
tx for cerebral toxoplasmosis
sulfadiazine-pyrimethamine
new onset JVD and RBBB are indicative of…
R heart strain
(commonly associated with PE)
total T4, free T4, and TSH in pregnancy
increased, unchanged, decreased
tx for invasive pulmonary aspergillosis
1-2 weeks IV voriconazole plus an echinocandin (caspofungin)
transitioned to prolonged therapy with voriconazole PO
three common causes of exudative pleural effusion
infection (pna)
malignancy
rheumatologic disease
3 MCC of transudative pleural effusion
heart failure
cirrhosis (hepatic hydrothorax)
nephrotic syndrome
rheumatoid effusions are marked by very low …. and very high…
low glucose
high LDH
why would buproprion be a good choice after 2 failed SSRIs for depression?
NE/DA reuptake inhibitor (no serotonergic effects)
does not cause weight gain
no sexual side effects
chronic, near daily HA in setting of regular use of acute HA medications in pts with preexisiting HA disorder
medication overuse headache
the presence of a single vertebral fracture, esp cervical, in a pt with blunt trauma is an indication to
image the entire spine due to risk of a second, noncontiguous vertebral fx
wide complex tachycardia with fusion beats
sustained monomorphic ventricular tachycardia
tx for stable pt with sustained monomorphic VT
IV amiodarone
regular, narrow complex tachycardia, no fusion beats
paroxysmal supraventricular tachycardia
tx for PSVT
carotid sinus massage/vagal maneuver
MC primary cardiac neoplasm
atrial myxoma
- position dependent mitral valve obstruction
- mid diastolic murmur
- dyspnea, lightheadedness, syncope
- embolization -> stroke
- constitutional symptoms
atrial myxoma
pathologic cause of mitral valve prolapse
myxomatous valve degeneration
- high fever, malaise, throat pain
- throat PE: hyperemic yellow or grayish-white papulovesicles
herpangina
four causes of gout from increased urate production
- primary/idopathic
- myeloproliferative/lymphoproliferative disorders
- tumor lysis syndrome
- hypoxanthine guanine phosphoribosyl transferase deficiency
2 causes of gout from decreased urate clearance
- CKD
- thiazide/loop diuretics
pruritis triggered by hot baths, headaches, hepatosplenomegaly
polycythemia vera
what prolactin level correlates with symptomatic prolactinoma
>200
How is LH affected in prolactinoma in a male?
hypogonadism with low T and low or inappropriately normal LH
all preterm neonates born at <32 weeks gestation should undergo what screening?
screening head US at 1-2 weeks
what is the greatest risk factor for intraventricular hemorrhage
prematurity
first 3-4 days of life in premature neonate who has bulging fontanel, anemia, apnea, and seizures
interventricular hemorrhage
ruptured germinal matrix vessels
tx for unstable, regular, narrow complex tachycardia (SVT)
synchronized cardioversion
all pts with persistent tachyarrhythmia (narrow or wide) causing hemodynamic instability should be managed with
immediate synchronized direct current cardioversion
subacute thyroiditis is aka
de Quervain’s thyroiditis
benign, self-limited condition that classically begins after an upper respiratory infection and progresses
inflammatory process in the neck
subacute thyroiditis
subacute thyroiditis tx
NSAIDs for pain
resolves on its own
preferred method to evaluate cervical cytology in pregnant women is
colposcopy
renal failure, vision changes, neuro deficits in setting of over-consumption of fish
mercury poisoning
tx of mercury poisoning
chelating agents such as succimer, dimercaprol, penicillamine
muscle biopsy shows vacuoles and filamentous inclusions
inclusion body myositis
muscle biopsy shows lymphocytic infiltration of endomysium
polymyositis
hepatitis virus associated with injection drug abuse and with blistering in sun-exposed areas
hepatitis C
porphyria cutanea tarda
WAGR syndrome
Wilms tumor, aniridia, GU abnormalities, and intellectual disability
characteristic triangular lifting of periosteum
osteosarcoma
Turner syndrome heart defects
bicuspid aortic valve, aortic coarctation
poor feedings, constipation, low tone, large anterior fontanelle, macroglossia, and an umbilical hernia
congenital hypothyroidism
rapidly expanding multilobular breast mass
phyllodes tumor
Cobb angle between 10 and 20 in skeletally immature pt can be managed with
home exercises and observation
curves with cobb angle between 20 and 45 in skeletally immature pt can be tx’d
bracing and serial monitoring
cobb angle greater than 45
surgical fusion
is ECT safe during pregnancy?
yes
lamotrigine severe AE
SJS
irreversible, potentially fatal complication of elevated indirect bilirubin levels
kernicterus
prophylaxis of variceal bleeding
nonselective beta blockers
(propranolol or nadolol)
odansetron MOA
selective 5-HT3 antagonist
Pt with bronchiectasis, concern for infections by what organism?
Pseudomonas, TB, H. influ, mor cat, S. aureus, S. pnemo, MAC
clinical manifestations of mild bleeding (epistaxis/gingival) with petechiae or ecchymoses and isolated thrombocytopenia
ITP
What type of hypersensitivity reaction is ITP?
type II HS rxn
IgG-platelet factor 4 protein complexes
HIT
heparin induced thrombocytopenia
anticentromere antibody
CREST syndrome
antihistone antibodies
drug induced lupus
anti-Jo 1 ab
polymyositis
scl-70 antibody
anti-DNA topoisomerase I antibody
systemic sclerosis
proximal, two component, intra-articular first metacarpal fx
Bennett fx
avulsion fx off the base of the proximal phalanx of the thumb with associated injury to the ulnar collateral ligament
gamekeeper thumb fx or skier thumb
stress fx involving the base or proximal third of the fifth metatarsal
Jones fx
avulsion injury at the base of the fifth metatarsal at insertion of peroneous brevis tendon
dancer fx aka pseudo-Jones fx
why is a pregnant lady hypercoaguable?
resistance to activated protein C increases after the first tri
leukocytosis with predominance of granulocytes
peripheral smear shows basophilia and granulocytosis with neutrophils
CML
BCR- ABL1
f(22:9)
philadelphia chromosome
CML
resistant major depressive disorder - can add what drug to tx?
atypical antipsychotic in conjunction with SSRI
tx of viral labrinthitis
control symptoms of vertigo with meclizine (antihistamine)
hx of infection and CHF with evidence of acute intrinsic renal failure
acute tubular necrosis (ATN)
pts with ATN will typically have a FeUrea…
>50%
UA in ATN
muddy brown, granular casts
fatty casts, with a maltese cross
nephrotic syndrome
increased number of hyaline casts
volume depletion
tx for nasal polyps
intranasal steroid spray
if complete polypectomy is not feasible for colon lesion, you should get
multiple biopsies to get pathologic diagnosis
negligence of a physician to an established pt, which results in direct harm to the pt
breach of duty
parvovirus in pt with SCD can lead to
aplastic crisis
>10% clonal plasma cells
multiple myeloma
“dry tap”
primary myelofibrosis
EKG showing ST depression with concave-up morphology (hockey stick morphology)
digoxin toxicity
In patients with Myasthenia Gravis, what drug is contraindicated in a preeclamptic pregnant pt?
magnesium sulfate
may trigger myasthenic crisis due to inhibition of acetylcholine release at the neuromuscular junction
Seizure ppx for pregnant, preeclamptic pt with MG
valproic acid
What abx will worsen symptoms of MG?
fluoroquinolones or aminoglycosides
What most often occurs in young, athletic men who lift weights or engage in activities that have repetitive overhead arm motions?
spontaneous upper extremitiy DVT
normal creative and healthy behaviors for young children include…
imaginary friends, pretend play, and storytelling with fanciful detail
type of psychotherapy that is used to reinforce a patient’s ability to cope with stressors and is commonly used for low-functioning patients or those in crisis who are at risk of decompensating
supportive psychotherapy
This type of psychotherapy focuses on the role of unconscious conflict and gaining insight into how past experience shapes present situations
psychodynamic psychotherapy
what technique is commonly used to treat substance abuse
motivational interviewing
monoarticular arthritis of the knee that occurs in a weight-bearing, afebrile pt
Lyme arthritis part of Lyme disease
infective endocarditis due to prosthetic valves, intravascular catheters, implanted devices (PM/defib), and IV drug users
S. aureus
infective endocarditis due to nosocomial UTI
enterococci
Next step for penile fracture?
retrograde urethrography prior to surgery
dermatitis, diarrhea, dementia
pellagra
niacin deficiency
niacin deficiency is seen in populations like…
corn products diet
alcholics/chronic illness
carcinoid syndrome
Hartnup disease
prolonged isoniazid interfering with tryptophan metabolism
painless loss of monocular vision
RF: CAD, endocarditis, valvular disease, long bone fx, hypercoaguable conditions, vasculitis, atrial myxoma
central retinal artery occlusion (CRAO)
tx of central retinal artery occlusion
ocular massage and high flow oxygen
buspirone is primarily used to treat
anxiety disorders
mirtazapine antidepressant has AE of
sedation, fatigue, and weight gain
emphysema plus liver issues
alpha-1 antitrypsin deficiency
deep ST depressions in leads V1-V3, with ST elevations when leads V7-V9 are placed
isolated posterior STEMI
L circumflex artery
used in children to test vesicoureteral reflux
voiding urethrogram
What kind of poisoning is common after house fires?
AMS, elevated lactate, breath that smells like bitter almonds
cyanide poisoning
Rib inhalation somatic dysfunction is noted to have restriction in rib motion on …
the key rib being the most…
exhalation
caudal
supination of the ankle causes the fibular head to move
posteriorly
pronation of the ankle cause the fibular head to move…
anteriorly
one of the most common complaints of male patients receiving beta blockers
ED
What is the most aggressive type of lung cancer, often centrally located, and has a very strong correlation with smoking?
small cell lung vancer
peripheral lung cancer and more commonly causes superior vena cava syndrome and hoarseness
large cell carcinoma
mature appearing lymphocytes with scant cytoplasm, condensed chromatin, and clefted nuclei are commonly seen following what infxn?
bordetella pertussis
two times you might see rouleaux formation
Waldenstrom macroglobulinemia or multiple myeloma
MC leukemia that occurs after the age of 50
CLL
response to infection, drugs, or from an underlying medical condition like DKA
WBC >50k
leukemoid reaction
raloxifene acts as an estrogen receptor antagonist in …
breast, endometrial, and vaginal tissues
Raloxifene may worsen
menopausal symptoms
Organisms commonly causing bloody diarrhea
salmonella
shigella
campylobacter
EHEC
yersinia
entamoeba
acetazolamide MOA
carbonic anhydrase inhibitor
rash, GI symptoms, and liver dysfunction is the classic triad of …
acute graft v host disease
first line tx for acute GVHD
corticosteroids
MC methylprednisolone
group of AD disorders that progressively affect the cerebellum and its connections
gait unsteadiness and extremity incoordination
spinocerebellar ataxia
autosomal recessive disorder with onset in childhood with gait unsteadiness and associated cardiac and skeletal disorders
Freidrich ataxia
next step for woman beyond 20 weeks gestation presenting with vaginal bleeding
US to check for previa
What is contraindicated in any patient suspected to have a placenta previa?
digital cervical exam
upper extremity weakness in cape distribution
central cord syndrome
Which RTA has hyperkalemia?
RTA type IV
pts with nephrotic syndrome are at increased risk of infxn, particularly by …
encapsulated organisms such as S. pneumo
US after 14 weeks dating uses what measures?
biparietal diameter
head circumference
femur length
abdominal circumference
what is the single most predictive parameter of gestational age between 14 and 22 weeks?
head circumference
acute, raised, sharply demarcated area of erythema with slowly advancing margins - associated with infectious signs and symptoms
in adults in setting of stasis dermatitis and venous insufficiency
in infants, on face, dorsal hands, and scalp
erysipelas
loop diuretics (4)
bumetanide, furosemide, torsemide, and ethacrynic acid
anaphylaxis within … days of receiving any vaccine is considered an adverse effect from the vaccine and should be reported to VAERS
7
amyloid light chain amyloidosis leads to
restrictive cardiomyopathy
symmetrically thickened ventricular walls
impaired consciousness, pupillary abnormalities, neuro-ophthalmic abnormalities, especially of vertical gaze, and acute confusional state
‘top of the basilar’ syndrome
embolus lodging in rostral basilar artery
pt with saddle nose deformity and bilateral auricular inflammation who may have been treated on multiple occasions with antibiotics
relapsing polychondritis
what is removed in a Whipple procedure?
head of the pancreas, duodenum, gallbladder, and common bile duct
unilateral pure motor hemiparesis
lacunar infarct
lacunar infarct involves what arteries
lenticulostriate branches
XR shows new periosteal bone formation and osteolysis in ankle of child
osteomyelitis
Chadwick sign - during early pregnancy
bluish discoloration of the vulva, cervix, and vagina
Psoas syndrome occurs with a hypertonic psoas, which reflexively affects the contralateral…
piriformis
upper lumbar somatic dysfunctions that are flexed, side bent, and rotated …. the side of the hypertonic psoas are usually found
toward
in psoas syndrome, what should be treated first
upper lumbar segments
Posterior chapman point on the upper edge of the TP of L2
bladder
posterior chapman point on the intertransverse space of T12-L1 midway between the spinous process and tips of the transverse processes
kidney
posterior chapman point on the upper edge of the transverse process of L2 (L3)
urethra
3 MC etiologies for fever of unknown origin
collagen vascular disease
chronic infections
malignancies
milestones:
- sit momentarily propped on hands
- raking grasp
- babbling
- transfer hand to hand
6 mo
milestones
- pull to stand
- crawl
- pincer grasp
- say mama and dada
9 mo
is duchenne muscular dystrophy associated with developmental delay?
yes
DMD causes a primary …. cardiomyopathy and conduction abnormalities
dilated
person with SCD and new infiltrate on chest XR plus one of the other symptoms
Acute chest syndrome
prior to starting direct acting antivirals, a pt should be tested for
NS5A resistance-associated substitutions
4-7 days after initiation of heparin ppx and pt gets DVT
heparin induced thrombocytopenia
manifests as thrombosis and drops platelets by 50% from baseline
HIT
tx of HIT
stop all heparin products
direct thrombin inhibitor: bivalirudin or argatroban
multiple myeloma CRAB mneumonic
Calcium elevation
Renal insufficiency
Anemia
Bone lesions
stable pt, provoked DVT, tx
outpatient with apixaban
what can increase the serum levels of warfarin, leading to a higher bleeding risk?
statins
what tumor would be composed of delta cells from the head of the pancreas?
somatostatinoma
somatostatin inhibits the release of many hormones, including
TSH
GH
insulin
glucagon
gastin
CCK
deficiencies caused by a somatostatinoma lead to
mild DM
steatorrhea
gallstones
somatostatin can act in a paracrine fashion to inhibit the secretion of both
insulin and glucagon
DM, steatorrhea, gallstones
somatostatinoma
in tx of DKA, you start subQ insulin at what time in relation to turning off insulin drip
2 hours before the drip is stopped
thiazide diuretic used as a first line for HTN without comorbidities
chlorthalidone
spironolactone can be used as a first line medication in the case of
primary aldosteronism
missed ART for HIV for a sustained period, prior to restarting ART asap, you should
evaluate pt’s viral genotype to see if there are acquired mutations
two complications that can occur when restarting ART
immune reconstitution inflammatory syndrome
anti-retroviral therapy resistance
an overwhelming immune response upon initiation of ART, as the sudden increase in CD4 cells upon initiating ART tx paradoxically worsens symptoms
(strong immune response causing inflammation)
immune reconstitution inflammatory syndrome
viral mutations occuring during an interval without tx for HIV can cause
anti-retroviral therapy resistance
what should be suspected in asthmatics with poorly-controlled disease who are unable to wean themselves from corticosteroids
aspergillosis
BPP fetal breathing movements must be
one or more episodes of rhythmic fetal breathing movements of 30 seconds or more within 30 minutes
BPP fetal movement means
three or more discrete body or limb movements within 30 minutes
BPP fetal tone is
one or more episodes of extension of a fetal extremity with return to flexion, or opening and closing of a hand
BPP amniotic fluid volume must be
single deepest vertical pocket greater than 2 cm
oligohydraminos is defined as… or …
single deepest vertical pocket of amniotic fluid of 2 cm or less
AFI of 5 cm or less
golfer elbow counterstrain set up
elbow flexion, pronation with forearm adduction
What two things are strong predictors of diabetic retinopathy?
proteinuria and increased BUN/Cr levels
risk for developing post-herpetic neuralgia increases with
age
how is friedreich’s ataxia inherited?
autosomal recessive condition
3 systems of glasgow coma scale
eye response
verbal response
motor response
increasing and decreasing respiratory rate and volume followed by period of apnea
Cheyne-stokes
rapid deep respirations with short pauses
biot’s breathing
aka ataxic breathing or cluster breathing
deep increased respirations
Kussmaul’s respirations
when ROSC occurs, CO2 levels will abruptly rise to
30-40 mmHg
proficient quality CPR can be confirmed with waveform capnography with CO2 levels of
10-15 mmHg
first step in FPR
flatten the spinal curve
Facilitated positional release is an (indirect/direct) and (passive/active) technique
indirect, passive
partial or complete absence of the cerebellar vermis
Dandy-Walker Malformation
herniation of the cerebellar tonsils, cerebellar vermis, and medulla
chiari type 2 malformation
downward displacement of cerebellar tonsils through the foramen magnum
typically asymptomatic
chiari malformation type 1
chiari type 2 malformation is also associated with …
meningomyelocele or syringomyelia
chronic nonproductive cough, hypercalcemia, and decreased diffusion capacity
dad died of a ‘heart problem’
sarcoidosis
bilateral symmetric hilar and mediastinal lymphadenopathy on CXR
sarcoidosis
MC lab values in sarcoidosis
elevated ACE and hypercalciuria
what lab value can assist in dx of lead toxicity?
serum free erythrocyte protoporphyrin
hypertension, hypoK (metabolic alkalosis), hyperNa, hypoMg
Conn syndrome
primary aldosteronism
IgG and IgM mediated complement fixation
type II hypersensitivity
immune complex mediated complement fixation and subsequent cytotoxicity
type III hypersensitivity
3 major causes of delayed emergence from anesthesia
drug effect
metabolic disorder
neurologic disorder
what will not trigger a positive result on a standard UDS
semisynthetic (oxycodone, hydrocodone, hydromorphone) and synthetic (fentanyl, meperidine, methadone, and tramadol)
despite appropriate tube thoracostomy, repeat CXR shows rapid pneumothorax reaccumulation and increased subcutaneous emphysema, suggesting
tracheobronchial injury/bronchial rupture
rapid, large air leak into the chest-tube drainage system and persistent pneumothorax/pneumomediastinum despite tube thoracostomy
tracehobronchial injury
older individual witha stenotic cervical spinal canal experiences hyperextension injury to the neck (whip-lash, rear-end collision)
central cord syndrome
what modality is used to dx central cord syndrome?
cervical myelogram
complication of mediastinal irradiation and cause of R heart failure
constrictive pericarditis
progressive peripheral edema, elevated JVP, hepatomegaly, and ascites
constrictive pericarditis
lack of decrease or increase in jugular venous pressure on inspiration
Kussmaul’s sign
multiple white nodules in the hands and a hx of painful arthritis in the fingers and feet
tophaceous gout
deposition of calcium and phosphorus in the skin, presenting with scattered whitish papules, plaques, or nodules
calcinosis cutis
CXR shows widened mediastinum, abnormal aortic contour, and/or left-sided effusion due to hemothorax
blunt thoracic aortic injury
confirmation of dx of blunt thoracic aortic injury for stable and nonstable pt
stable - CTA
unstable - TEE in OR
for blunt thoracic aortic injury, what is the goal systolic blood pressure while doing repiar?
<100
first pneumonia vaccine recommended for all adults >65
PCV13
pna vaccine recommended alone for adults <65 with other chronic medical conditions
PPSV23
In an adult, do you give Td or Tdap?
Td every 10 years with Tdap as a one time dose in place of Td
stepwise illness that begins with 1-2 weeks of nonspecific symptoms and then progresses to several weeks of the classic paroxysmal cough
pertussis
adult with persistent, vigorous cough, posttussive hemoptysis, and peripheral lymphocytosis
bordetella pertussis
respiratory infection that occurs in those with underlying asthma or CF
eosinophil count is elevated
bronchial obstruction, expectoration of brownish mucous plugs, and low grade fever
aspergillosis
severe AE of PTU
agranulocytosis
how do you watch for agranulocytosis in PTU use?
once pt complains of fever and sore throat, d/c thyroid drug and measure WBC ct.
<1k warrants permanent discontinuation of the drug
if >1.5k, drug is unlikely cause
anti-mitochondrial antibodies
primary biliary cholangitis
antinuclear antibodies and anti-smooth muscle antibodies
autoimmune hepatitis
kidney histology in Alport syndrome
longitudinal splitting of the glomerular basement membrane
pt <6 yo with marked proteinuria but no hematuria, renal insufficiency, or hypertension
minimal change disease
linear IgG deposition in glomerular basement membrane
Goodpasture syndrome
mesangial and glomerular capillary deposition of C3 and IgG
poststreptococcal glomerulobnephritis
what is the MC malignancy diagnosed in pts exposed to asbestos?
bronchogenic carcinoma
almost 50% of pts with asbestosis have … which can help differentiate from other causes of pulmonary fibrosis
pleural plaques
nail and digit hypoplasia, dysmoprhic facies, and intellectual disability
exposure to phenytoin in utero
fetal hydantoin syndrome
retrograde and antegrade amnesia with intact long-term memory, confabulation, apathy, lack of insight, and hx of alcohol use disorder
Korsakoff syndrome
dementia, motor dysfunction, dysarthria
a/w severe damage to corpus callosum and surrounding white matter in the context of chronic alcohol use disorder and attendant malnutrition
marchiafava-bignami disease
greater than 2 weeks of daily fever, fixed arthritis lasting >6 weeks, and a pink macular rash that worsens during fever
systemic juvenile idiopathic arthritis
malabsorptive bowel disease complication leading to cheilosis, glossitis, and seborrheic dermatitis
riboflavin deficiency
blunt chest trauma, persistent tachycardia, new arrhythmia
blunt cardiac injury
next step to diagnose blunt cardiac injury
transthoracic echo
overloading the knee’s extensor mechanism is the fundamental role thought to play in this syndrome
patellofemoral pain syndrome
having weaker medial quadricep muscle than lateral quadricep muscles can cause the patella to be pulled…
laterally during quad contraction
callus formation on the dorsal surface of the index finger and long fingers of the hand from repetitive contact with the teeth during self-induced vomiting
Russell sign
bluish discoloration of the periumbilical area and can be seen in early pregnancy and cases of pancreatic necrosis with retroperitoneal bleeding
Cullen sign
Anterior and middle scalenes can elevate what rib?
rib 1
posterior scalene elevates rib (#) to tx an (inhalation/exhalation) somatic dysfunction
rib 2
exhalation
exhalation somatic dysfunction of ribs 3-5 will use what muscle?
ribs 6-8?
ribs 9-10?
ribs 11-12?
3-5 pec minor
6-8 serratus anterior
9-10 latissimus dorsi
11-12 quadratus lumborum
