random8 Flashcards
CDC vax guidlines for north africa (ie Egypt)?
HAV
HBV
typhoid
polio booster
when is yellow fever vax recommended?
sub-saharan africa and central/south america travel
clubbing and sudden onset joint arthropathy in a chronic smoker is suggestive of?
hypoertrophic osteoarthropathy (pulmonary disease caused subset)
- associated w/ lung CA –> need to get CXR to rule out malignancy
post menopausal women w/ new onset breast tenderness and thickened endometrial stripe w/ large ovarian mass - what tumor are we thinking?
Granulosa cell tumor (secrets estrogen)
dopaminergic agonists used in med management of prolactinoma?
- carbergoline
- bromocriptine
carbergoline and bromocriptine are what and both can be used in what situation?
- dopamine agonist
- used in med management of prolactinomas
newborns of moms w/ active HBV should receive what at birth?
- HBIG
- HBV vax
BOTH!
small for gestational age infants may have what complications (5)?
- hypoxia
- polycythemia (bc inc EPO response to hypoxia)
- hypoglycemia
- hypothermia
- hypoCalcemia
beckwith wiedemann syndrome is due to?
deregulation of gene expression in chromosome 11p15 (which codes for insulin like growth factor 2)
phys findings at birth w/ beckwith wiedemann syndrome?
- macrosomia (rapid growth until late childhood)
- macroglossia
- hemihyperplasia (one side bigger than other)
- medial abdominal wall defects (ie umbilical hernia, omphalocele)
+/- visceromegaly
what is beckwith wiedemann syndrome?
overgrowth disorder –> predisposition to neoplasms
beckwith wiedemann syndrome inc risk for?
- Wilms tumor
- Hepatoblastoma
what is surveillance for beckwith wiedemann newborns?
at birth: monitor for hypoglycemia
birth - 4 yo: screening abd u/s and alpha-getoprotein levels from birth (looking for malignancy)
4-8yo: abd u/s every 3 mo
8- adolescence: renal u/s
bradycardia, AV block, hypotension, and diffuse wheezing - suggest what type of overdose?
Beta blocker overdose
wheezing w/ overdose – think?
beta blocker overdose
bc beta 2 blockade!
treatment of beta blocker overdose?
1) secure airway, IV fluids
2) Atropine to treat hypotension and bradycardia
3) if hypotension profound or refractory give IV glucagon
Main P2y12 receptor blocker to know?
- clopidogrel
what is action of clopidogrel?
P2y12 receptor blocker
main medical therapy to improve morbidity and mortality in pts w/ CHD?
- Dual antiplatelet therapy (aspirin and clopidogrel)
- Beta blockers
- ACE-i/ARBs
- HMG-CoA reductase inhibitors (statins)
- Aldosterone antagonists (sprionolactone, eplerenone) - in pts w/ V EF
phosphodiesterase 5 inhibitors are used for what and do what?
- erectile dysfunc
- vasodilators
phosphodiesterase 5 inhib are contraindicated in pts also on what med?
nitrates (risk of hypotension)
milrinone is what type of med and who is it contraindicated for?
- selective phophodiesterase inhib
- contraindicated in pts w/ HF (inc mortality)
statins are what type of med?
HMG-CoA reducatse inhibitors
differences b/t the various prostatitis? (ie chronic bacterial, inflammatory, non inflammatory, acute bacterial)
Afebrile w/ irritative voiding symp (ie urgency, freq, discomfort)
- Chronic Bacterial: secretions inc WBC w/ growth on cx
- Inflammatory: secretions w/ inc WBC, cx neg
- Non-Inflammatory: nL secretions and cx
Acute bacterial: FEBRILE, exquistely tender prostate, U/A w/ bacteriuria and pyuria (+/- irritative voiding symp)
essential tremor + HTN - what med best?
beta blocker (ie propranolol) - can treat both
aminoglycosides can cause what organ issue?
Acute renal failure
amikacin is what type of med?
aminoglycoside
multi-drug resistent pyelonephritis likely caused by what group of bugs?
gram neg rods
spasticity, UMN or LMN?
UMN
bulbar symp, UMN or LMN?
UMN
fasciculation, UMN or LMN?
LMN
hyperreflexia DTR, UMN or LMN?
UMN
cortical and subcortical atrophy disproportionately greater in temporal and parietal lobes – think?
Alzheimers
personality changes & loss of social restraint w/ dementia –> becomes mute, immobile, and incontinent - think?
Frontotemporal lobe dementia
pt w/ asthma attack become hypokalemic – why?
inhaled beta-2 agonist use (ie albuterol)
–> stim K shift into cells + release of insuline which further inc intracellular K shift
how long does a pt w/ mono have to refrain from sports?
> = 3 wks (regardless of symp as this is period w/ greatest splenic rupture risk)
common side effect of dihydropyridine CCB?
peripheral edema (due to dilated peripheral BV – NOT allergy)
Triggers for SJS/TEN?
Drugs:
- allopurinol
- Abx (sulfonamides
- Antconvulsants (ie carbamazepine, lamotrigine, phenytoin)
- NSAIDs
- Sulfasalazine
- Mycoplasma pneumonia
- Vax
- Graft-vs host disease
clinical features of SJS/TEN?
- acute influenza like prodrome
- necrosis & sloughing of epidermis
- mucosal involvement
- rapid onset erythematous macules, vesicles, and bullae
adjustment disorder?
emotional or behavior symp dev w/in 3 mo of an identifiable stressor that last no longer than 6mo once stressor ends
prussian blue stain indicates?
prescence of hemosiderin – found in urine during hemolytic episodes
common meds than can precipitate a hemolytic epi in G6PD deficiency (3)?
- sulfa drugs
- antimalarials
- nitrofurantoin
most common location for medulloblastoma?
cerebella vermis
- imp location for balance or gait coordination
common symp of medulloblastoma?
- truncal or gait instability (ie ataxia, bc most common location is in cerebellar vermis which is imp for balance and gait coordination)
- can also cause obstructive hydrocephalus
most common cerebral hemisphere tumors in kids?
low grade astrocytomas
craniopharyngiomas are found where?
suprasellar masses
two most common posterior fossa tumor (ie cerebellar)?
- cerebellar astrocytoma
- medulloblastoma
what is parinaud syndrome?
- limited upward gaze w/ downward preference
- b/l eye lid retraction
- light-near dissociation
what tumors cause parinaud syndrome?
pineal tumors (bc pressure on pretectal region of midbrain)
PNA w/ CNS and GI features – think
legionnaires
PNA w/ hypOnatremia, hepatic dysfunction, diarrhea, fever and gram stain of sputum w/ a lot of PMNs but no organisms – think?
legionella
most common way to confirm dx of legionella?
urine antigen testing
treatment for legionnaires disease?
Macrolide or fluoroquinolone
leuprolide is and can treat what?
- GRH agonist
- can treat symptomatic endometriosis –> but can lead to menopausal symp
adolescent w/ nasal obstruction, visible nasal mass w/ bony erosion, and frequent noseleeds - think?
Juvenile angiofibroma
chronic epigastric pain radiating to the back that improves with sitting up or leaning forward - think?
chronic pancreatitis
blood smear w/ RBC w/ single, round, blue inclusions on Wright stain - think?
Howell Jolly bodies (likely to due to hyposplenism)
hemoglobin precipitation inclusions are what and found when?
- Heinz Bodies
- G6PD deficiency under crystal violet stain
recurrent skin and mucosal bacterial infx w/o pus and with poor wound healing and CBC w/ neutrophilia - think?
leukocyte adhesion deficiency
leukocyte adhesion deficiency caused by?
defective integrins on leukocyte surface –> can’t adhere to vasc endothelium –> can’t migrate to site of infx/inflam
delayed umbilical cord separation (age>3 wks) - think?
leukocyte adhesion deficiency
adenosine deaminase is an AR form of what?
SCID - lack of mature B and T lymphocytes
pts w/ complement deficiency are at an inc risk for what?
disseminated bacterial infx esp w/ encapuslated bacteria (strep pneumo, HiB, Neisseria, etc)
peridontal infx w/ hx of many cellulitis and sinus infx and CBC shows very high WBC w/ neutrophilia - think?
leukocyte adhesion deficiency
pulm nodule w/ halo sign on CT in pt on steroids/chemo - think?
aspergillosis
pulm lesion w/ air crescent on CT in immuncompromised pt- think?
aspergiollosis
where can aspergillus be in lung?
ANYWHERE
histoplasmosis findings on CXR?
- hilar adenopathy
- areas of pneumonitis
fever, cough, SOB, hemoptysis in immunocompromised pt. CXR finds cavitary lesion and CT show pulm nodules w/ halo - think?
aspergillosis
tamoxifen and raloxifene are?
selective estrogen receptro modulators
estrogen agonist
side fx of SERMs?
- Hot flashes (bc estrogen agonist)
- Venous thromboembolism
- Tamoxifen ONLY: endometrial hyperplasia and CA
chronic steroid use has risk of what to bones (2)?
- Osteopenia/Osteoperosis
- AVN of femoral head (osteonecrosis)
signs of osteonecrosis of femoral head?
- pain in groin, thigh, or butt worse w/ activity and relieved by rest (eventually will progress to rest pain too)
- reduced range of motion (abduction and internal rotation)
- joint instability
best imaging of AVN of femoral head?
MRI most sensitive, xray can look nL
vision impairing opacification of the lens?
cataract
painless blurred vision w/ glare and often halos around lights (make night driving hard) - think?
cataract
acute/subacute loss of vision w/ swollen disc, venous dilation w/ tortuosity, diffuse retinal hemorrhages, +/- cotton wool spots - think?
Central retinal vein occlusion
Macular degeneration affects where in the vision?
central
2 primary forms of macular degeneration?
- atrophic (dry): slow progressive b/l vision loss
- exudative/neovascular (wet): agressive, unilateral vision loss
open angle glaucoma presents?
insidious onset w/ gradual loss of peripheral vision and consequent tunnel vision
gradual loss of peripheral vision, high intraocular pressures, and cupping of optic disc - think?
open angle glaucoma
open angle glaucoma finding on opthalmoscopic exam?
cupping of optic disc
ie cup to disc ratio >0.6 - bc cup enlarged
sudden unilateral loss of part or all of visual field as if “a curtain fell over the eye” - think?
retinal detachment
treatment of absence seizures?
- Ethosuximide
- valproate
initial drug for partial seizures?
Phenytoin
most common predisposing factor for orbital cellulitis?
bacterial sinusitis
pain w/ eye movements, proptosis, ophthalmoplegia, and diplopia - think?
orbital cellulitis
persistent depressive disorder (dysthemia) needs?
- chronic depressed mood >= 2 yrs (1 yr in kids/adolescent)
- no symptom free period for >2 mo
- at least 2 of the following:
- poor appetite/overeating
- insomnia/hypersomnia
- low energy or fatigue
- low self-esteem
- poor conc/diff making decisions
- feelings of hopelessness
- poor appetite/overeating
delusional disorder is?
- > =1 delusion for >= 1 mo
- no other psychotic symp
- can function apart from delusion (behavior not obviously bizarre/odd)
delusions are?
fixed beliefs that are firmly held despite conflicting evidence
when hypothyroid pt get preg how do you adjust levothyroxine dose?
increase by approx 30%
ovarian mass with absent doppler flow think?
ovarian torsion
contraindications to radioactive iodine treatment?
- pregnancy
- very severe ophthalmopathy
what is henoch schnlein purpura?
IgA mediated leukocytoclastic vasculitis
clinical manifestations of HSP? (4)
- palpable pupura (usually lower limbs)
- arthritis/arthralgia
- abd pain, intussuceptions
- renal disease similar to IgA nephropathy
Treatment for HSP?
most: supportive (hydration and NSAIDs)
severe –> hospitaliztion and systemic steroids
HSP effecting kidneys would show what on biopsy?
deposition of IgA in mesangium (similar to IgA nephropathy)
palpable purpura on lower extremities, arthralgias, abdominal pain, and renal disease - think?
HSP
risk factors for necrotizing enterocolitis (4)?
- prematurity
- very low birth weight (breast milk)
clinical signs of necrotizing enterocolitis
- VS instability
- Lethargy
- Vomiting
- Bloody stools
- Abd distension/tenderness
most common effected site by NEC?
terminal ileum and colon
feeding intolerance, abd distension, bloody stools, vomiting in a full term newborn w/ congenital heart disease causign cyanosis - think?
necrotizing enterocolitis
xray findings w/ NEC? (3)
- pneumatosis intestinalis (gas in bowel wall)
- portal venous gas
- pneumoperitoneum (free air in abd)
Treatment of NEC?
- supportive care (bowel rest, parenteral hydration/nutrition)
- broad-spectrum IV abx
+/- surgery
elderly man w/ agitation onset around time of taking this type of med – what is the type of med?
Benzo’s
–> paradoxical agitation
indications that the SBO is complicated and warrants emergency abd exploration?
- change in character of the pain
- fever
- hemodynamic instability
- guarding
- leukocytosis
- significant metabolic acidosis
yellow-white fluffy hemorrhagic lesions along the vasculature in pt w/ HIV and CD4 count
CMV retinitis
CMV retinitis findings?
- full thickness retinal inflammation that moves along vasculature (–> edema & scarring)
- blurred vision
- floaters
- photopsia (sensation of flashing lights)
CMV retinitis can inc risk of?
- blindness (esp lesions near fovea and optic n.)
- retinal detachment (esp w/ lots of scarring)
newborn w/ dec lung markings on CXR and left axis deviation, tall peaked p waves, and minimal R waves in precoridal leads on ECG - think?
tricuspid atresia
subdural hematoma occurs when?
shearing forces tear bridging veins
subdural hematoma finding on CT?
crescent shaped hyperdensity (acute) or hypOdensity (chronic) crossing suture lines
how to tell b/t methanol and ethylene glycol poisoning?
what they hurt!
Methanol -> eye damage (think moonshine)
Ethylene glycol (antifreeze) - kidney damage
easiest reverisble risk factor for pancreatic CA?
stop smoking!
typical signs of cerebellar degeneration? (6)
- gait dysfunction
- truncal ataxia
- nystagmus
- intention tremor/dysmetria (limb-kinetic tremor when attempting to touch a target)
- impaired rapid alternating movements (dysdiadochokinesia)
- pendular knee reflex (m hypotonia –> persistent swinging)
clasp knife phenomenon seen in what pts?
pts w/ hypERtonia due to pyramidal tract disease
hypothyroidism despite high levels fo T4 and T3 and nL levels fo TSH - think?
receptor defects in peripheral tissues –> generalized resistance to TH
primary hypothyroidism has what T4/3 and TSH levels?
low T4/3
High TSH
issue at thyroid gland
secondary or tertiary hypothyroidism - where and what T4/3 and TSH levels?
low T4/3
low/inappropriately nL TSH
2ndary: pituitary gland
tertiary: issue at hypothalamus
amaurosis fugax is?
painless loss of vision from emboli
amaurosis fugax can be a sign of?
impending stroke
nontraumatic sub arachnoid hemorrhage usually results from?
saccular or berry aneurysm rupture
elevated opening pressure on MP and unexplained xanthochromia (yellowish color of CSF indicating bilirubin indicating hemolysis) - think
subarachnoid hemorrhage
amyloid angiopathy –> bleeding where?
intracerebral hemorrhage
HTN associated w/ what type of hemorrhages?
intraparenchymal or intracerebral hemorrhage
kaposi sarcoma associated w/ what virus?
HHV-8
dendritic ulcers in eye - think?
herpes simplex keratitis
or
Herpes zoster ophthalmicus
tell diff by presentation
- HSK - pain, photophobia, blurred vision, tearing, redness
- HZO: elderly, fever, malaise, burning, itching w/ periorbital rash
on cephalosporin, pt has fever, rash, arthralgias hematuria, sterile pyuria, eosinophilia/uria w/ WBC casts - think?
drug induced intersittial nephritis
*happens w/ penicillina, cephalosporins, NSAIDs, sulfonamides, rifampin, phenytoin, and allopurinol
maj difference b/t OCPD and OCD?
OCPD - ego- syntonic (thinks beliefs are good)
OCD: ego-dystonic (compulsions cause anxiety)
dev of new conduction abnormality in pt w/ IE – think?
perivalvular abscess
early diastolic murmur - think?
AR
when AR is due to valvular disease best heard where?
Left sternal border (3rd and 4th intercostal space)
mitral valve perforation presents how?
- acute CHF
- systolic murmur of MR
tricuspid IE usually has what murmur?
holosystolic murmur of TR accentuated w/ inspiration
muddy brown cast found w/?
Acute Tubular Necrosis
RBC casts found w/?
Glomerulonephritis
WBC casts found w/?
Interstitial nephritis or pyelonephritis
Fatty casts found w/?
Nephrotic syndrome
Broad and waxy casts found w/?
Chronic renal failure
- BUN/CR -> 20:1
- UOsm 300-350
- UNa >20
- FeNa >2%
what is this?
ATN
hepatic encephalopathy likely due to?
inability to break down ammonia into urea
bronchoalveolar lavage very useful to work up what lung infx?
Pneumocysitis PNA
brochoalveolar lavage useful in evaluation of what? (2)
- malignancy
- opportunistic infx (ie PCP)
ethelyne glycol toxicity –> clinical findings?
- high anion gap metabolic acidosis
- hypoCalcemia
- Calcium oxlate crystal deposition in kidneys –> AKI, hematuria, flank pain
Fomepizole treats?
ethylene glycol overdose
very high anion gap w/ very low bicarb level (
- ethlyene glycol overdose
- methanol overdose
sodium thiosulfate treats?
cyanide poisoning
ethlyene glycol overdose, treat w/?
Fomepizole
pt w/ painful blurred vision and fixed, mid dilated eye w/ headache and nausea – think?
Acute angle closure glaucoma
patchy redness on white of eye w/ mild pain and discharge in pt w/ autoimmune disorder - think?
Episcleritis
atopic dermatitis aka ?
eczema
eczema aka?
atopic dermatitis
PAS positive - think? (2)
- Whipple’s disease
- Lymphoblasts (ie ALL)
rash that spreads from face to trunk to extremities w/ viral appearing prodrome and leukopenia and thrombocytopenia - think?
measles
what has been shown to reduce the morbidity and mortality in pts w/ measles?
Vit A
mag sulf toxicity findings?
- neuromuscular depression (m paralysis, dec/absent DTRs)
- dec resp effort/apnea
- somnolence
- visual distrubances
nL skin at birth that gradually progresses to dry scaly skin - think?
Icthyosis vulgaris
icthyosis vulgaris’ nickname?
“lizard skin”
MAOI + tyramine –> what?
HTN crisis
PAS positive macrophages in lamina propria containing non-acid fast gram positive bacilli - think?
Whipple’s disease (Tropheryma whippelii)
diarrhea, migratory non-deforming arthritis, lymphadenopathy, weight loss, and low grade fever w/ small intestine bx showing PAS positive macrophages - think?
Whipple’s disease
Add abx to COPD exacerbation if?
2 or more of following:
- inc SOB
- inc cough (more freq or severe)
- Change in sputum prod (inc vol or change in color)
OR
Mechanical ventilation requirement
what is time frame to treat most pts w/ oseltamivir or zanamivir by?
w.in 48 hrs of influenza symptom onset
which pts if they presented w/ influenza you would still provide oseltamivir even if outside 48hrs? (7)
- > 65yo
- pregnant or
1st stage of labor (active) is ?
6-10cm cervical dilation
1st stage of labor (latent) is?
0-6cm cerivcal dilation
2nd stage of labor?
complete dilation to delivery
3rd stage of labor is?
delivery of baby to expulsion of placenta
arrested labor in the first stage is diagnosed when?
> 6cm dilation w/ ROM and 1 of the following:
- no cervical change >=4hrs despite adequate contractions (>=200montevideo untis for >= 2 hrs)
OR
- No cervical change for >=6hrs w/ inadequate contractions
adequate contractions are?
adequate contractions = >=200 Montevideo units for >=2hrs
contraction strength =?
peak mmHg - baseline mmHg
montevideo unit = ?
of uterine contractions in 10 min x contraction strength
fetal renal agenesis indicates?
not compatible w/ life bc there will be severe pulm hypoplasia
lower back pain that is worse at night but improves w/ physical activity think?
inflammatory spondyloarthopathy
ankylosing spondylitis, psoriatic, reactive, or IBD arthritis
inflammation of ligamentous insertion?
enthesitis
envelope shaped kidney stones?
Calcium oxalate
radioopaque kidney stones?
- Calcium (oslate and phosphate)
- Struvite (ammonium, Mg, phos)
- Cystine
radiolucent kidney stone?
uric acid
precipitates at low pH kidney stones?
- Ca oxalate
- Uric acid
- Cystine
precipitates at high pH kidney stones?
- Ca phosphate
- Struvite
coffin lid shaped kidney stones?
struvite
rhomboid or rosette shaped kidney stones?
uric acid
hexagonal shaped kidney stones?
cystine
kidney stones cause by infx w/ urease bugs (ie proteus, klensiella, staph sapro etc)?
struvite
commonly form staghorn calculi?
struvite or cystine kidney stones
which kidney stone have a postive sodium cyanide nitroprusside test?
cystine
which kidney stones are related to a family inborn error?
cystine
treatment of infant botulism from environmental spores?
human derived botulism immune globuline
foodborne botulism treatment?
equine derived botulism antitoxin
treatment of guillain barre syndrome?
pooled human immune globulin
botulinum toxin does what?
blocks acetylcholine release at presynaptic NMJ
face and arm swelling w/ weight lost new onset SOB w/ smoking hstory and anterior wall veins engorgement - think?
SVC syndrome likely due to malignancy causing obstrution
bright red firm friable vascular exophytic nodule in an HIV pt - think?
bacillary angiomatosis
bacillary angiomatosis caused by?
bartonella - gram neg bacillus
treatment of bacillary angiomatosis?
oral erythromycin
common etiologies of crystal induced AKI? (5)
- acyclovir
- sulfonamides
- methrotrexate
- ethylene glycol
- protease inhibitors
preferred initial DMARD in pts w/ mod to severe RA?
methotrexate
indications of methotrexate toxcity?
- oral ulcers
- acute rise in serum transaminases
- bone marrow suppression (macrocytic anemia, leukopenia, thrombocytopenia)
felty syndrome?
clinical disorder seen in pts w/ severe long standing (>10yrs) RA that is characterized by neutropenia and splenomegaly
treatment of polymyalgi rheumatica?
low dose prednisone
treatment for giant cell artertitis?
high dose prednisone
treatment for fibromyalgia
initial: exercise and good sleep hygiene
next: TCAs
fatigue, stiffness, poor sleep w/ point tenderness at mid trapezius, lateral epicondyle, costochondral junction of chest and greater trochanter w/ otherwise nL phys exam and nL labs (incl ESR) - think?
fibromyalgia
bipolar pts w/ inadequate response to monotherapy and/or severe episode maintenance treatment is?
combo therapy w/:
- Lithium or valproate
AND
- a second gen antipsychotic (ie quetiapine)
PCV13 followed by PPSV23 6-12mo later recommended for pts
very high risk comoborbidities (ie sickle cell, HIV, CKD, etc)
PPSV23 alone for pts
- current smokers
- chronic med conditions (ie heart, lung, liver, DM)
pneumococcal conjugat vaccine is?
PCV13
pneumococcal polysaccharide vaccine is?
PPSV23
pneumococcal 23 valent vax is what type
polysaccharide
pneumococcal 13 valent vax is what type?
conjugate
pt w/ chronic headaches now w/ elevated Cr w/ painless hematuria and sterile pyuria w/ WBC casts and small kidneys b/l w/ renal papillary calcifications on CT - think?
analgesic nephropathy
Analgesic nephropathy causes what type of kidney injury?
tubulointerstitial nephritis
management of somatic symptom disorder?
- regularly scheduled visits w/ same provider
- limit unnecessary workup
- focus on stress reduction and improving coping strategies
- legitimize symp but make funtional improvement the goal
burning of rubber or plastic can cause?
cyanide inhalation/toxicity
bitter almond breath indicates?
inhaled cyanide
what presents similar to CO exposure but is due to burning of rubber or plastic?
cyanide inhalation
what is presenting physical skin findings in methemoglobinemia?
cyanosis and bluish discoloration of skin and MM
magnesium is solely excreted by?
Kidney
absolute contraindications to combined hormonal contraceptives? (8)
- migraine w/ aura
- > =15 cigs/dy & age >=35
- HTN >=160/100
- hx of venous thromboembolic disease, stroke, or ischemic heart disease
- BREAST CA
- Cirrhosis & LIVER CA
- ## Maj surgery w/ prolonged immobilization
common causes for priaprism (4)?
- sickle cell disease and leukemia - usual in kids/adolescents
- Perineal or genital trauma (laceration of cavernous a.)
- neurogenic lesion (cauda equina, spinal cord injury, etc)
- Meds: trazodone or prazosin
most common drug that causes priapism?
prazosin
initial hematura is?
bld at beginning of voiding cycle
total hermaturia is?
bld during entire voiding cycle
terminal hematuria is?
bld at end of voiding cycle
terminal hematuria suggests?
bleeding from prostate, bladder neck/trigone, or post. urethra.
(which can be concerning for CA)
terminal hematuria w/ clots indicates?
bleeding w/in bladder or ureters concerning for urothelial CA
initial hematuria causes? (2)
- urethritis
- trauma (ie catheterization)
Terminal hematuria causes (5)?
- Urothelial CA
- cystitis (infx/post rad)
- Urolithiasis
- BPH
- Prostate CA
Total hematuria causes?
- Renal mass (bening/malignant)
- Glomerulonephritis
- Urolithiasis
- PCKD
- Pyelonephritis
- Urothelial CA
- Trauma
bedwetting before age what is normal?
5
you’ve identified small nonbleeding varices in an alcoholic cirrhotic pt, next treatment step?
Give non-selective beta-blockers (n and below)
*dec progression and risk of hemorrhage
treatment for cryptococcal meningoencephalitis?
Induction therapy w/ 2 wks of amphotericin B and flucytosine
Followed by consolidation therapy of 8wks of fluconazole and maintenance w/ it for at least 1 yr
Antiphospholipid syndrome - clinical features?
1) Thrombotic event (venous or arterial) OR Pregnancy morbitidy (loss, severe preeclampsia, placental insufficiency)
PLUS
2) positive for at least 1 of the following Ab:
a) Anticardiolipin
b) Anti-beta2-glycoprotein-I
c) Lupus anticoagulant
biggest risk factor fo antiphospholipid syndrome is?
Lupus
antiphospholipid syndrome can cause what to be a false positive?
VDRL and RPR test –> so you mistakenly think its syphilis!
Single S2 - think? (3)
- Transposition of great vessels (+/- VSD)
- Tricuspid atresia (has VSD)
- Truncus Arteriosis (w/ systolic ejection murmur)
cyanotic baby w/ Narrow mediastinum w/ “egg on a string” heart - think?
Transposition of great vessels
cyanotic baby w/ Harsh pulmonic stenosis murmur and VSD murmur - think?
Tetralogy of Fallot
Boot shaped heart in cyanotic baby - think?
Tetralogy of Fallot
cyanotic baby w/ single s2 and a systolic ejcetion murmu w/ edema - think?
Truncus arteriosis
Severe cyanotic baby in respiratory distress w/ pulm edema on CXR and enlarged supracardiac vens and SVC - think?
Total anomalous pulm venous retun w/ obstruction
ice bag test is for?
Myasthenia gravis
place ice bags on ptosis eyes and they improve indicates?
Myasthenia gravis
cold inhib breakdown of acetylcholine at NMJ
bacterial meningitis in pt >1mo treatment?
IV vanco and ceftriaxone
(cefotaxime in pt
bacterial meningitis in pt
IV vanco and CEFOTAXIME
>1mo can use ceftri
when do you add dexamethasone in bacterial meningitis treatment?
when causative agent likely is HiB – protecting against sensoriuneural hearing loss
HIV pt CD4 count
Progressive disseminated histoplasmosis
disseminated histoplasmosis hits what parts of body?
- Systemic (f/c/weight loss)
- Pulm (cough, SOB)
- Mucocutaneous lesions (mouth ulcers, nodules, papules)
- Reticuloendothelial inflammation (ie hepatosplenomegaly, lymphadenopathy)
CXR findings for disseminated histoplasmosis?
reticulonodular or interstitial infiltrate
Treat disseminated histoplasmosis?
mild/maintenance: Itraconazole
mod-sever: Ampho B
dx of disseminated histoplasmosis confirm most rapidly w/?
serum or urine HIstoplasma antigen immunoassay
congenital rubella findings?
- sensorineural hearing loss
- intellectual disability
- Cardiac anomalies
- Cataracts, glaucoma
kid w/ los grade fever, conjunctivitis, coryza, cervical lymphadenopathy and w/ head to body spreading erythematous blanching maculopapular rash - thnk?
Rubella
valgus stress test is testing what ligament in knee?
medial collateral ligament
knock kneed is what knee deformity?
valgus
bow legged is what knee deformity?
varus
varus laxity - what injured ligament?
lateral collateral ligament
chronic overuse injury characterized by ant knee pain and tenderness?
pateller tenodonitis (jumper’s knee)
hard, immobile, non-tender boney growth on hard palate of mouth - think? caused by?
- torus palatinus
- congenital
gastric MALT lymphoma w/ no metastasis initial treatment?
abx to eradicate H. pylori (triple or quadruple therapy)
cocaine induce MI, what do you avoid?
Beta blockers (bc can make vasospasms worse)
cocaine induced MI, what med may you add?
CCB or alpha blockers (ie phentolamine) to help reduce vasospasms
most common cause of sudden cardiac arrest in the immediate post infarction period (w/in 1 hr) in pts w/ acute MI?
Reentrant ventricular arrhythmias (ie v fib)
down syndrome pt w/ torticollis, urinary incontinence, dizziness, diplopia, behavioral changes, hyperreflexia, positive babinski,a and ataxia - think?
atlantoaxial instability
young down syndrome pt w/ upper motor neuron findings - think?
atlantoaxial instability
infant w/ little prenatal care now w/ rhinorrhea, long bone abnlmalities, and diffuse maculopapular desquamating skin rash that can involve the palms and soles- think?
congenital syphilis
infant w/ little prenatal care now w/ sensorineural hearing loss, cataracts, and a PDA - think?
rubella
infant w/ little prenatal care now w/ periventricular calcifications – think?
CMV
infant w/ little prenatal care now w/ diffuse intracranial calcifications, hydrocephalus, and severe chorioretinitis - think?
toxoplasmosis
crescendo decrescendo systolic murmur present at L sternal border that does NOT radiate to carotids - think?
HOCM (intervemtricular septal hypertrophy)
mitral regurg has what type of systolic murmu?
holosystolic
anterior MI now 5 days later w/ chest pain that progresse to pulseless electrical activity w/ tachy - think?
V wall rupture
5 days post MI w/ sudden onset hypotension, CHF symp, and a loud holosystolic murmur at LLSB - think?
Interventricular wall rupture
3 days post MI now w/ sudden onset hypotension and a new holosystoli cmumur at apex that radiates and pulm edema - think?
papillary muscle rupture
—> MR
TCA overdose w/ widening QRS treat w/?
sodium bicarb
anaphylaxis, IM or subQ epi injection?
IM! it has higher plasma and tissue levels
anal fissure treatment?
- high fiber diet w/ adequate fluid intake
- stool softeners
- sitz bath
- topical anesthetic
- topical vasodilators (ie nifedipine, nitroglycerin)
easy PAO2 formula?
PAO2 = 150 - (PaCO2/0.8)
*150 = (0.21 x [760-47]) = (FiO2 x[Patm -Ph20])
angina pectoris?
episodes of substernal pain provocked by emotion
episodes of substernal pain provoked by emotion?
angina pectoris
dipyrdamole and adenosine are coronary what?
coronary vasodilators
coronary steal is?
redistribution of coronary blood flow to “non-disease areas” and perfusion of “diseased areas” are diminshed
- can be utilized in myocardial perfusion scanning
how does dipyridamole help dx in myocardial perfusion scanning ?
coronary steal
post splenectomy pts are at inc risk for sepsis from encapsulated organisms due to?
impaired Ab-mediated opsonization in phagocytosis
imaging for psoas abscess?
CT scan
*u/s poor sensitivity due to deep nature and number of other organs and bones covering
