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1
Q

Scleroderma renal crisis findings? (5)

A
  • Acute renal crisis (w/o previous renal disease)
  • Malignant HTN (ie headache, n/, blurry vision)
  • U/A mild proteinuria
  • Microangiopathic hemolytic anemia w/ fragmented RBCs (schistocytes)
  • Thrombocytopenia
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2
Q

Schistocyte?

A

Fragmented RBC

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3
Q

Fragmented RBC?

A

Schistocyte

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4
Q

Echinocyte is?

A

Burr cell

  • spiculated appearing RBCs
  • seen in liver disease and end-stage renal disease
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5
Q

Burr cell is?

A

Spiculated appearing RBCs w/ serrated edges seen in liver disease and end stage renal disease

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6
Q

Howell-jolly body is?

A

Basophilic remnants of the nucleus that appear as small, black pellets in RBCs
- seen in pts w/ hx of spelnectomy or functional asplenia

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7
Q

When do you see howell-jolly bodies?

A
  • Pts w/ hx of spelnectomy

- Functional asplenic pts

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8
Q

Another name for acanthocyte?

A

Spur cell

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9
Q

Another name for echinocyte?

A

Burr cell

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10
Q

Burr cells other name?

A

echinocyte

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11
Q

Spur cell other name?

A

acanthocyte

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12
Q

What is a spur cell?

A

RBCs w/ irregularly sized and spaced projections

- seen in liver disease

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13
Q

WHen are spur cells seen?

A

In liver disease

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14
Q

Spiculated RBC - think?

A

Burr cell

- liver and endstage renal disease

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15
Q

Target cells are?

A

RBCs w/ central density surrounded by pallor (bull’s eye)

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16
Q

Target cell seen w/?

A
  • Hemoglobinopathies (ie thalassemia)

- Chronic liver disease (esp obstructive liver disease)

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17
Q

Thalassemia has what type of abnl RBCs?

A

Target cells

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18
Q

Main CXR finding on aortic injury?

A

Mediastinal widening

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19
Q

Initial screening study for aortic injury?

A

CXR

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20
Q

main causes of aortic traumatic injury?

A

MVAs and falls from >10 feet

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21
Q

what is often associated finding on CXR w/ myocardial contusion?

A

rib fractures

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22
Q

How do glucocorticoids effect lymphocytes, eosinophils, and neutrophils?

A
  • Inc Neutrophils (left shift)

- Dec lymphocytes and eosinophils

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23
Q

recent cardiac cath + heparin in prep of CABG, now w/ hypotension, tachycardia, flat neck veins and back pain – think?

A

Retroperitoneal hematoma

- due to bleeding from the arterial access site

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24
Q

recent cath + hemodynamic instability + flank/back pain think?

A

retroperitoneal hematoma

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25
Q

how to confirm dx of retroperitoneal hematoma?

A

NON-contrast CT scan of abdomen and pelvis
or
abdominal u/s

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26
Q

treatment of retroperitoneal hematoma

A

supportive

  • intense monitoring
  • bed rest
  • IV fluids
  • bld transfusions as needed

*Rarely needs surgery

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27
Q

First line treatment for specific phobia?

A

Behavioral therapy (assuming enough time)

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28
Q

Treatment of specific phobia if not enough time (ie flight next week?)?

A

Benzodiazepines

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29
Q

eye movement desensitization useful in what disorder?

A

PTSD

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30
Q

industrial worker + pleural calcifications - think?

A

asbestos exposure

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31
Q

good way to distinguish b/t restrictive lung disease causes?

A

look at diffusion capacity (DLco)

  • wall issue (ie obesity, ankylosing spondylitis) –> normal diffusion capacity
  • Interstitial lung disease –> low DLco
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32
Q

Way to distinguish b/t obstructive lung diseases?

A

Bronchodilator challenge

  • If FEV1 improves - think asthma
  • if no change, think COPD
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33
Q

first line mood stabilizers for bipolar maintenance?

A
  • Lithium (renal and thyroid toxic)

- valproate (hepatotoxic, thrombocytopenia)

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34
Q

associated adverse effects of Lithium?

A
  • adverse effects on kidneys and thyroids

kidneys: nephrogenic DI or chronic tubulointerstitial nephropathy

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35
Q

Valproate adverse effects?

A
  • rare hepatotoxicity

- thrombocytopenia

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36
Q

what is bupropion?

A

Antidepressant

- NE and dopamine reuptake inhibitor (NDRI)

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37
Q

antidepressants w/ bipolar patients can cause what?

A

inducing mania (so don’t use)

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38
Q

drugs that may be useful for long term maintenance of pts w/ bipolar?

A
  • Lithium (1stline)
  • Valproate (1stline)
  • Quetiapine (antipsychotic 2nd gen)
  • Lamotrigine (anticonvulsant)
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39
Q

What is topiramate

A

anticonvulsant

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40
Q

main pharmacologic target for treatment of OCD?

A

serotonin

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41
Q

First line treatment of OCD?

A
  • SSRI
    (fluoxetine, fluvoxamine, paroxetine, citalopram, escitalopram, sertraline)
  • Cognitive-behavioral therappy
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42
Q

2nd line treatment of OCD?

A

clomipramine (tricyclic antidepressant, less well tolerated than SSRI - 1st line)

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43
Q

antipsychotics target what?

A

dopamine

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44
Q

primary target of benzodiazepines?

A

Gamma-aminobutyric acid

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45
Q

post MI few days + new pain that hurts more supine and improved on sitting up and leaning forwards - think?

A

acute pericarditis

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46
Q

ECG findings for acute pericarditis?

A
  • Diffuse ST elevations

- PR depressions

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47
Q

post MI 3-7 dys, now w/ new onset systolic murmur - think (2)?

A
  • interventricular free wall rupture

- Papillary muscle rupture (MR)

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48
Q

major depressive episode should last how long for dx?

A

> 2wks

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49
Q

Atypical depression symptoms (4)?

A
  • Hypersomnia
  • Increased appetite
  • Rejection sensitivity
  • Leaden Paralysis (heavy feeling limbs)
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50
Q

timing for adjustment disorder?

A

symp dev w/in 3 mo of stressor and last no more than 6 mo after stressor ends

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51
Q

Low mood lasting most of the day on more days than not for at least 2 years?

A

Persistent depressive disorder (dysthymia)

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52
Q

timing for persistent depressive disorder (dysthymia)

A
  • low mood lasting most of the day on more days than not

- At least 2 years

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53
Q

first line treatment for absence seizure?

A

Ethosuximide

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54
Q

EEG w/ classic 3 Hz spike wave pattern - think?

A

Absence seizure

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55
Q

1st and second line treatments for absence seizure?

A

1) Ethosuximide

2) Valproic acid (side fx)

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56
Q

Methylphenidate is?

A

stimulant used to treat ADHD

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57
Q

Atomoxetine is?

A

Nonstimulant med used to treat ADHD

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58
Q

Lorazepam is?

A

Benzodiazepine

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59
Q

Lorazepam used for?

A

Benzo used for anxiety and acute managment of prolonged seizures (ie status epilepticus)

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60
Q

Phenytoin used for as 1st line for what?

A

Generalized tonic-clonic seizures or focal seizures

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61
Q

Side fx of phenytoin? (3)

A
  • Gingival hyperplasia
  • Stevens Johnson syndrome
  • Toxic epidermal necrolysis
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62
Q

where is lesion that causes hemi-neglect syndrome

A

Lesion on non-dominant (usually R) PARIETAL lobe

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63
Q

What part of brain hurt –> hemi-neglect?

A 
Parietal lobe (non dominant side, usually R)
  - in charge of spatial organization
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64
Q

lesion on frontal cortex would cause?

A

Hemiparesis

  • w/ motor aphasia if dominant lobe involved (Broca’s, expressive aphasia)
  • maintained comprehension, but speech is stilted and effortful
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65
Q

Left temporal lobe damage –>?

A

Receptive aphasia (Wernike’s)

  • cannot comprehend written or spoken language
  • expresses fluently, although incoherently
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66
Q

occipital lobe damage results in?

A

visual distrubances

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67
Q

ansognosia?

A

pt unaware of deficit (ie unaware of hemineglect)

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68
Q

comb only R side, clock only on R side - this is?

A

hemi neglect

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69
Q

pulsus paradoxus associated w/?

A

cardiac tamponade

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70
Q

systolic murmur that increases w/ standing is?

A

Hypertrophic obstructive cardiomyopathy (HOCM)

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71
Q

good way to tell syncope vs seizure in non-witnessed pt?

A

syncope would immediately return to neurological baseline, while seizures would be delayed, sleepy, confused

72
Q

bilious vomiting + contrast from upper GI series in corkscrew appearance - think?

A

small bowel volvulus

73
Q

Ligamentz of Treitz on R side of abdomen on upper GI series - think?

A

Malrotation

74
Q

stable neonate w/ bilious vomiting + xray finding no free air or double bubble, next step?

A

Upper GI series to look for malrotation (-> volvulus)

75
Q

bilious vomiting neonate - diff dx (4)?

A
  • Malrotation (-> volvulus)
  • Duodenal atresia
  • Hirschsprung disease
  • Meconium ileus
76
Q

What procedure done to fix malrotation and prevent volvulus?

A

Ladd procedure

77
Q

bilious vomiting stable neonate + dilated loops of bowel on xray –> next step to dx b/t?

A

Next step: Contrast Enema

  • Microcolon –> Meconium ileus
  • Rectosigmoid transition zone (b/c tonically contracted distal to) –> Hirschsprung disease
78
Q

lesion in the brain + personality changes and strange behavior localize it to what area of brain?

A

frontal lobe

79
Q

brain lesion w/ butterfly appearance w/ central necrosis - think?

A

Glioblastoma multiforme

80
Q

brain metastasis usually look and are found?

A

Look:

Found in gray-white junctions or at watershed zones

81
Q

a high grade astrocytoma may also be known as?

A

Glioblastoma multiforme (grade 4 astrocytoma)

82
Q

heterogenous, serpiginous contrast enhancement can be found w/ what brain lesion?

A

High-grade astrocytoma (incl GBM)

83
Q

Liver disease w/ acute onset of kidney issues –> think?

A

Hepatorenal syndrome

84
Q

liver disease + inc creatinine + failure to respond to IV fluids + absence of shock, proteinuria, specific reason for renal disease –> think?

A

Hepatorenal syndrome

85
Q

Treatment of hepatorenal syndrome?

A

Liver transplant

86
Q

Pulsus paradoxus - diff dx (6)?

A
  • Cardiac tamponade
  • Asthma
  • Chronic COPD
  • OSA
  • Pericarditis
  • Croup
87
Q

Pulsus parvus et tardus - think?

A

aortic stenosis

88
Q

Inspiration causes what?

A

inc systemic venous return to heart

89
Q

Tic douloureux is?

A

Trigeminal neuralgia

90
Q

etiology of trigeminal neuralgia (tic douloureux)?

A

compression of the trigeminal nerve (pain along 2 & 3rd branches)

91
Q

tongue palsy results from damage to what nerve?

A

hypoglossal nerve

92
Q

facial nerve does what?

A
  • muscles of facial expression

- Taste: ant. 2/3 tongue

93
Q

jaw asymmetry can result from what nerve damage?

A

Mandibular division of the trigeminal nerve (V3) –> paralysis of muscles of mastication

94
Q

winged scapula - what nerve hurt?

A

long thoracic nerve

95
Q

MS does what to nerves?

A

autoimmune disease –> inflammatory demyelination of axons in CNS

96
Q

ocular issues + fatigable chewing + dysphagia w/ nasopharyngeal regurge + dysarthria - think

A

Myasthenia Gravis

97
Q

tall R wave in aVL + Deep S wave in V3 + repolarization changes in anterolateral leads (I, aVL, V4-6) - think?

A

Hypertrophic cardiomyopathy

- tall and deep waves indicate LVH

98
Q

violent behavior + hallucinations + nystagmus - what drug?

99
Q

Visual hallucinations + tachy/HTN - what drug?

100
Q

Chest pain + seizures + agitation + Mydriasis + tachy/HTN –> what drug?

A

Cocaine intox

101
Q

tooth decay + choreiform movements + sweating + psychosis/violence - what drug?

A

Meth intox

102
Q

increased appetite + conjunctival injection + impaired time perception - what drug?

A

marijuana intox

103
Q

Depressed mental status + Miosis + respiratory depression - what drug?

A

Heroin intox

104
Q

resp depression, pinpoint pupils, CNS depression, hypotension - think?

A

Opioid overdose

105
Q

subperiosteal hemorrhage newborn?

A

cephalohematoma

106
Q

newborn head swelling few hours later that does NOT cross suture lines - think?

A

cephalohematoma

107
Q

swelling of newborn head seen right after birth - think?

A

caput succedaneum

108
Q

diffuse swelling of newborn scalp that crosses suturelines and midline - think?

A

caput succedaneum

109
Q

good indications of cranial meningocele

A
  • pulsations
  • increased pressure upon crying
  • bony defects
110
Q

small-vessel hyalinosis - aka?

A

lacunar stroke

111
Q

kussmaul’s sign is?

A

increase in JVD w/ inspiration

112
Q

increase in JVD w/ inspiration is known as?

A

kussmaul sign

113
Q

wallenberg syndrome due to?

A

lateral medullary infarction likely due to an occluded intracranial vertebral artery

114
Q

Vestibulocerebellar symptoms in wallenberg syndrome

A
  • nystagmus (horz and rotational)
  • diplopia
  • vertigo w/ falling to side of lesion
  • difficulty sitting upright w/o support
  • Ipsilateral limb ataxia
115
Q

wallenberg syndrome findings? (6)

A
  • vertigo (fall to side of lesion)
  • nystagmus
  • ipsilateral loss of pain and temp on face
  • contralateral loss of pain and temp on trunk and limbs
  • Horner’s syndrome
  • Hoarseness
116
Q

weakness of muscles of mastication, diminished jaw jerk reflex, and impaired tactile and position sensation over face - where is lesion?

A

Lateral mid-pons

- effects ipsilateral trigeminal nerve

117
Q

Lateral mid-pons lesion would effect what nerve?

A

Ipsilateral trigeminal nerve

118
Q

lateral medullary infarct effects what nerves?

A

IX and X

–> hoarseness, dysphagia, diminished gag reflex

119
Q

paralysis of the arm and leg w/ loss of tactile and position sense + tongue deviation – think?

A

Medial medullary syndrome

120
Q

lesion on medullary pyramid causes?

A

contralateral hemiparesis

121
Q

lesion on medial lemniscus causes?

A

contralateral loss of tactile, vibratory, and position sense

122
Q

medial medullary lesion effects what cranial nerve?

A

Hypoglossal (XII)

–> ipsilateral tongue paralysis w/ deviation to side of lesion

123
Q

Alternating hypoglossal hemiplegia is also known as ?

A

medial medulary syndrome

  • contralateral hemiparesis
  • tongue deviation to ipsilateral side of lesion
124
Q

contralateral ataxia + hemiparesis of the face, trunk, and limbs - think?

A

medial mid pontine infarction

125
Q

lateral medullary infarct occurs due to?

A
  • occlusion of the post. inf cerebellar or vertebral artery

“wallenberg syndrome”

126
Q

neutrophilic cryptitis in GI - think?

A

IBD (Crohn’s or UC)

127
Q

epithelial ecrosis in GI - think?

A

Ischemic colitis

128
Q

conversion disorder is?

A

sudden onset of neurological symptom that is incompatible w/ nL neuro exam brought on by a stressor

129
Q

somatic symptom disorder is?

A

1 or more persistent physical symptoms that causes disproportionate and excessive anxiety and energy devoted to it.

  • generally symp is minor but anxiety is big
130
Q

sildenafil is?

A

phosphodiesterase 5 inhibitor

131
Q

sildenafil has cross reaction w/ what drugs (2)?

A
  • alpha blockers (-zosins)
  • nitrates

can cause hypOtension

132
Q

sildanefil first line for?

A

erectile dysfunction treatment

133
Q

IV drug user –> endocarditis think what valve?

134
Q

IV drug user + endocarditis murmur effected how w/ inspiration?

A

Increased murmur w/ inspiration (TR)

135
Q

IV drug user + endocarditis + round alverolar infiltrates on CXR - think?

A

septic emboli to lungs

136
Q

mumur best heard while sitting up – think?

137
Q

Paradoxical splitting – think?

A

LV outflow obstruction

  • AS
  • LBBB
  • R ventricular paced rhythm
138
Q

Tricuspid endocarditis –> what murmur?

139
Q

pleural plaques - think?

A

Asbestosis

140
Q

unilateral pleural abnormality w/ large pleural effusion in plumber - think?

A

pleural mesothelioma

141
Q

AST ALT levels in alcoholic liver disease?

A

AST:ALT –> 2:1

AST & ALT

142
Q

Marked elevations in AST and ALT (>25x) – think? (3)

A
  • toxin induced
  • ischemia
  • viral hepatitis
143
Q

What location in brain usually has NO hemiparesis if there is a lesion?

A

Cerebellum

144
Q

Facial weakness + ataxia + nystagmus + headache + neck stiffness + n/v – think where is lesion?

A

Cerebellum

- note: NO hemiparesis

145
Q

contralateral hemiparesis + hemianesthesia + conjugate gaze deviation toward lesion - think where is lesion (2)?

A

1) putamen + internal capsule (Basal ganglia)

2) occlusion of proximal middle cerebral artery (more acute onset)

146
Q

eyes react how when there is a hemorrhage at the thalamus?

A

eyes deviate Towards hemiparesis (contralateral to bleed)

147
Q

contralateral hemiparesis + hemisensory loss + nonreactive miotic pupils + upgaze palsy + eyes deviate towards hemiparesis - where is hemorrhage?

148
Q

Deep coma and total paralysis w/in minutes + pinpoint reactive pupils - where is hemorrhage?

149
Q

cerebral lobe bleed w/ contralateral hemiparesis + eyes deviate away from hemiparesis - location?

A

frontal lobe

150
Q

cerebral lobe bleed w/ contralteral hemisensory loss - location?

A

parietal lobe

151
Q

cerebral lobe bleed w/ homonymous hemianopsia - location?

A

occipital lobe

152
Q

Lead poisoning risk next step?

A

venous lead level

153
Q

Treatment of lead poisoning? (mild, mod, severe)

A
  • mild (5-44): no meds, repeat venous lead level in =70): Dimercaprol (BAL) + calcium disodium edtate (EDTA)
154
Q

Dimercaprol (BAL) + EDTA can treat what?

A

severe lead poisoning

155
Q

Dimercaprol + calcium disodium edetate can treat?

A

severe lead poisoning

“BAL + EDTA”

156
Q

Meso - 2,3 -Dimercaptosuccinic acid can treat?

A

moderate lead poisoning

“DMSA”

157
Q

infant w/ hypertonia and hyperreflexia in lower extremities w/ equinovarus deformity - think?

A

cerebral palsy

158
Q

pellagra?

A

Deficiency of niacin (B3) –> 3 D’s

  • Diarrhea
  • Dermatitis
  • Dementia
159
Q

watery diarrhea + tender rash similar to sunburn + beefy tongue + poor concentration - think?

A

Pellagra due to niacin (B3) deficiency

160
Q

niacin deficiency can cause?

161
Q

cyanocobalamin is?

162
Q

vit B3 is?

163
Q

vit B6 is?

A

Pyridoxine

164
Q

vit B2 is?

A

riboflavin

165
Q

vit B1 is?

166
Q

G6PD deficiency will have what findings on peripheral smear?

A

Heinz bodies and Bite cells

167
Q

maternal estrogen effects on newborns?

A
  • breast hypertrophy
  • swollen labia
  • white vaginal discharge (leukorrhea)
  • uterine withdrawal bleeding
168
Q

treatment of transplacental maternal estrogen exposure in newborns?

A

Observation and routine w/ reassurance

169
Q

Mammary gland enlargement + non-purulent vaginal discharge + mild uterine bleeding in newborn – think?

A

transplacental maternal estrogen exposure

170
Q

drug for antidepressant effect and smoking cessation?

171
Q

indications for urgent dialysis?

A 
"AEIOU"
Acidosis
Electrolyte abnl
Ingestion
Overload
Uremia
172
Q

pericarditis in a pt w/ renal failure - treat how and why?

A
  • urgent dialysis

- Uremic pericarditis

173
Q

typical paricarditis ECG findings?

A
  • Diffuse concave upwards ST segment elevation

- PR segment depression

174
Q

most common site of ulnar nerve entrapment?

A

at elbow (medial epicondylar groove)

175
Q

dec sensations at 4th and 5th fingers w/ weak grip think?

A

ulnar nerve syndrome (compression of nerve)

176
Q

papillary muscle rupture –> what murmur most commonly?

Uworld Buzz step2 (11 decks)

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