Second 100 Flashcards
Pt with newly diagnosed diabetes, hepatomegaly and joint complaints - think what first?
Initial test?
Hemochromatosis
Serum iron studies
Theophylline -
- which 2 abx interacts, and how?
- Toxicity symptoms?
- Stimulates release of …?
- Cipro and erythromycin decreases clearance, raising levels
- HA, insomnia, N/V and arrhythmias
- Stimulates epinephrine release
Biggest risk factor for pancreatic cancer?
Smoking
Pt with splinter hemorrhages
- Most common diagnosis
- Secondary diagnosis - what sets it apart?
- Endocarditis
2. Trichinosis - if pt also has triad of periorbital edema, myositis and eosinophilia (peomeo?) - caused by roundworm
Timeline for alcoholic hallucinations?
Starts 12-24 hrs after last drink, stops 24-48hrs after
Treatment for bipolar disease (2)?
What side effects do they have?
Lithium or valproic acid
Lithium - nephrotoxicity (DI), hypothyroidism, Ebstein’s anomaly
Also psoriasis flares, hair loss, tremors
Kid with chronic middle ear infections and worsening hearing loss, granulation tissue and skin debris
Cholesteatoma
Hypertension, dilated pupils, psychosis, tachycardia - drug?
Amphetamines
Common kidney injury following shock?
What shows on UA?
ATN (acute tubular necrosis)
Muddy brown casts
What kidney injury goes with:
1) muddy brown casts
2) RBC casts
3) WBC casts
4) fatty casts
5) broad and waxy casts
1) ATN
2) glomeluronephritis
3) interstitial nephritis & pyelonephritis
4) nephrotic syndrome
5) chronic renal failure
Older patient presenting with gradual loss of CENTRAL vision
Diagnosis?
Results from ..?
1) Macular degeneration
2) Degen and atrophy of outer retina, pigment epithelium,bruch’s membrane and choriocapillaries
Sickle cell with bone pain
1) with fever - 2 causes
2) WITHOUT fever - most common cause
1) Salmonella or Staph
2) Avascular necrosis
Bleeding in the third trimester
1) without pain
2) with pain
1) no pain - placenta previa
2) painful - abruptio placentae
Contact dermatitis is what type of reaction?
Type FOUR, IV, 4
Not type 1
What is a high LAP (leukocyte alkaline phosphatase) indicative of?
Used to steer AWAY from what?
Leukomoid reaction
Steer away from leukemias, even with blast crises
DoC for syphilils? What if pt is allergic?
Penicillin G IM
If allergic, oral doxycycline
DoC for neurosyphilis?
IV aqueous crystalline penicillin
MCV <80 with:
1) Low iron & ferritin, high TIBC
2) Normal to high iron & ferritin
3) Low TIBC, normal ferritin
1) iron deficiency anemia
2) thalassemias OR sideroblastic anemia
3) anemia of chronic disease
Anaerobic, gram-positive,branching bacteria?
Treatment?
Actinomyces israelii
IV PCN
Motor and sensory function of femoral nerve
Hip flexion, knee extension
Medial thigh and knee
Motor and sensory innervation of superficial peroneal nerve
Foot eversion
Lateral lower leg and foot
Motor and sensory innervation of deep peroneal nerve
Foot dorsiflexion, toe extension
Area between big and 2nd toe
What does tocolysis do?
Used to delay preterm delivery
TOGO = NOGO
Lower limit of hemoglobin to maintain oxygentation?
When will this be higher?
7g/L in normal people
In those with pre-existing heart disease, it is 10g/L
If the Hgb is lower than these, give packed red blood cells!
Which vitamin is used to treat measles?
Vit. A
How does mastitis differ from normal breast engorgement? (3 things)
How are plugged ducts different?
Treatment of mastitis?
Mastitis is 1. unilateral, with an 2. isolated, firm, tender erythematous area and a 3. Fever > 100
Plugged ducts are the same as mastitis, WITHOUT the fever
Treatment : anti-staph abx
How to interpret a BPP score?
<4 : immediate delivery
4 without oligohydramnios & mature lungs : consider delivery
4 without oligohydramnios and immature lungs : steroids
6 without oligo : contraction stress test
8-10 : normal
Wat skin condition is associated with parkinsons?
Seborrheic dermatitis
How does congenital rubella syndrome present? (5 things)
Deafness, cataracts, cardiac malformations, thrombocytopenia, hepatosplenomegaly
Treatment for toxoplasmosis?
Prophylactic treatment?
Treatment : Sulfadiazine-pyrimethamine
Prophylactic : TMP-SMX
HIV pt with single ring-enhancing brain lesion and NO fever - what is it? (treatment?)
What can it also be, and how would it be different?
Single without fever : CNS lymphoma (irradiation)
Multiple with fever : toxoplasmosis (sulfad-pyrim)
Most common cause of infectious neonatal conjunctivitis?
What is a positive and a negative finding?
Chlamydia
+ cough, no fever
50+ pt with mass that swells when swallowing liquids..?
Treatment?
Cause?
Zenker’s diverticulum
Surgical excision and cricopharyngeal myotomy
Motor dysfunction
Which diuretic can be used for prevention of calcium stones?
Thiazide
Iron deficiency - low or high retic count?
Low
Patient with end-stage liver disease develop kidney issues - next step?
Liver transplant 2/2 hepatorenal syndrome
Treatment for B. pertussis?
Erythromycin
Older female with painful blistering around thighs and breasts presents with some necrosis
Drug likely involved? Treatment?
Warfarin (warfarin-induced necrosis)
Stop drug, give vit. K. Use heparin in the meantime.
Purpura in kids with NO thrombocytopenia (plt > 100) - MCC?
Vsculitis - commonly HSP (look for recent infection)
Nikolsky’s sign - top diagnoses?
What differentiates them?
SSSS, TEN, SJS
Look for SSSS in kids < 6 with diffuse rash, other 2 older pts.
TEN is >30%TBSA, SJS is <10%
Baby with hx of eczema comes in with fever and overlying blisters - diagnosis? Treatment?
Eczema herpeticum
Acyclovir asap
Recurrent painless, nodular rubbery lesion on eyelid - next step? Diagnosis?
Histopathalogical exam
Chalazion - concern for meibomian gland carcinoma or basal cell CA
GVHD - pathophysiologic mechanism?
Activation of donor T-cells
Pt with new and worsening pale patches on chest and in mouth?
Cause?
Vitiligo
Autoimmune destruction of melanocytes
Pale, velvety pink macules that scale upon scratching
Lab shows?
Treatment?
- Tinea versicolor - they DO NOT TAN
- Lab shows: KOH prep - large, blunt hyphae with thick-walled budding spores (spaghetti&meatball)
- Topical antifungals, ketokonazole shampoo for scalp
Pink maculopapular rash that starts in the face and spreads down following a fever, malaise few days ago
Diagnosis?
Treatment?
Anything else?
Rubella
Symptomatic
Beware pregnancy - CRS
Key words: invasive cords of squamous cells with keratin pearls
Squamous cell carcinoma
Key words: Invasive clusters of spindle cells surrounded by palisaded basal cells
Basal cell carcinoma
Bullous impetigo - caused by?
Can evolve into?
S. aureus
SSSS
WTF is Ludwig’s angina?
Bilateral cellulitis of the submental, -lingual and -maxillary spaces.
Presents with warm, red mouth, fever, drooling.
Can lead to death by asphyxiation
Key words: Small, pink spots on trunk (‘rose spots’)
Salmonella typhi
Key words: ‘sunburn with goosebumps’ with strawberry tongue
Scarlet fever (strep pyo) – PCN
Small red patch on cheek that turns into a shiny, painful red plaque
Cause?
Treament?
Strep pyo (erysipelas)
PCN
WTF is Fournier gangrene
Necrotizing fasciitis in the perianal / genital area
2 abx that causes serious photosensitivity
Tetracycline and doxycycline
NOT erythromycin
Key words: polygonal cells with atypical nuclei at all levels (on skin)
SCC
Describe dermatitis herpitiformis
Pruritic papules
granular IgA deposits
circulating anti-endomysial antibodies
often with celiac disease
Painless blisters on the back of the hands with increased fragility of the skin
What is the MCC?
What other signs will show? Next step?
What can cause this?
Porhyria cutanea tarda - deficiency of uroporphyrinogen decarboxylase
Look for hyperpigmentation on the face
Check urinary porphyrin (elevated)
Ethanol and estrogens can cause a flare-up
Normal skin at birth, gradually becomes dryer no matter what
Ichthyosis vulgaris (lizard skin)
Key words: waxy scale on a base of mild erythema
Seborrheic dermatitis
Treatment for cellulitis with systemic signs
Nafcillin or cefazolin
Chronology of rubell
Exposure (droplets)
Fever, malaise and adenitis after 2-3 weeks
Rash appears 1-5 days later, starts on face and spreads down, lasting less than 3 days
Biopsy results with bullous pemphigoid?
IgG and C3 deposits at the dermal-epidermal junction
Describe pityrasis rosea
Starts with herald patch, then many other itchy lesions
Look for christmas tree pattern on back
Treat with reassurance
History of vomiting with crepitus in the suprasternal notch - most likely condition?
Boerhaaves - esophageal rupture
Neonate with systic scrotal mass that transilluminates with light - what is is?
Treatment?
This is located within ..?
Hydrocele
Watch and wait
Processus vaginalis
Twisting injury of the knee - most common injury?
What will show on xray?
Medial meniscus
Nothing
Burning building/smoke inhalation pt - always think of what?
What other symptoms may that have?
CO inhalation
Confusion, seizure (with toxicity), agitation, HA, nausea
When is diverticulitis complicated?
What are the treatment options?
With abscess formation, fistula, perf or obstruction
If abscess 3cm CT-guided percutaneous drainage. If this fails, surgery.
WTF is Legg-Calvé-Perthes disease?
Idiopathic avascular necrosis of the femoral capital epiphysis
Common : boys aged 4-10 (peak 5-7)
Treat with obs and bracing, surgery for fem head not contained in acetabulum
Newborn with palpable klunk in hips - next step?
Ultrasound of hips
Charcot’s triad - what is it?
Diagnosis?
Next step?
Fever, RUQ pain and jaundice !!!!! NB!!!!!
Ascending cholangitis (infection of the common bile duct)
Ultrasound and broad-spectrum abx – for unstable pts, ERCP for biliary drainage
Most common neoplasm of liver?
Mets (20x more than local)
Child with nocturnal vulvar itching - mcc?
Test?
Treatment?
Pinworm
Scotch tape
Mebedazole
Complaints of dizziness and ‘fullness of ear’ - mcc?
Pathology?
Meniere’s disease
Abnormal accumulation of endolymph in the INNER ear
How to interpret the L/S ratio of a pregnancy?
Indication of lung maturity
A ratio of less than 2:1 shows immature lungs - treat with steroids
Normal AFI?
5-25 is normal for amniotic fluid index
Less than 5 - amnioinfusion
WTF is McCune-Albright?
Look for precocious female puberty!
3 P’s - pigmentation (cafe-au-lait spots), polyostotis fibrous dysplasia (bone defects) and precocious puberty
Often assoc. with other autoimmune disorders
Amonorrhea is athletes - deficiency of proges or estrogen?
Estrogen
Turners is at risk for developing?
Osteoporosis
Trastuzumab with chemo can lead to?
Cardiotoxicity
Most sens and spec test for chronic pancreatitis?
Stool elastase
Therapy for non-bleeding varicies in stable patients?
Propranolol
Bloody discharge from nipple with no mass?
Intraductal papilloma
Most common cause of acute pancreatitis?
Diagnostic test?
Alcohol and gallstones
Ultrasound, NOT CT scan (cannot see stones)
When to give tetanus-diphteria toxoid and/or tetanus Ig?
Always give toxoid, except for minor/clean wounds with 10years
Which drug is good for anxiety, as well as an appatite stimulNt?
Mirtazapine (TCA)
Side effect of citalopram
Impotence
What are the most common complications of anorexia nervosa?
Osteoporosis #1
Also IUGR, prolonged QT interval, hypercholesterolemia, hyperemesis gravidarum,
Most significant side effect with olanzapine?
Weight gain (olifant-zapine)
Treatment for nocturnal bedwetting?
Enuresis - give desmopressin first, no dice, try imipramine
Firstline treatment for general anxiety disorders?
Buspirone
Patient is poisoned - description includes ‘optic disc hyperemia’
What is it?
What else will they have?
Methanol poisoning - it goes for the eyes
Also: metabolic acidosis, blurred vision, epigastric pain
Describe farmer’s poisoning (sluds)
Organophosphate poisoning = acetylcholinesterase inhibitor, leading to cholineric excess
Treatment = atropine & pralidoxine
Side note - atropine/pralidoxine OD treated with physostigmine, which will WORSEN sluds
What type of drug causes hypothermia?
Typical antipsychotics - fluphenazine more than others
What is naloxone used for?
Opiod OD
How does diphenhydramine (benadryl) OD show up?
Treatment?
Dilated pupils, blurred vision, decreased bowel sounds, urinary retention (anti-histamine and anti-cholinergic effects)
Treat the same as atropine OD - physostigmine
How does serotonin syndrome present?
Tachycardia, dilate pupils, HTN and hyperthermia
Look for MAOI with another serotonin drug interaction
Drug of choice for alcohol withdrawel?
Chlordiazepoxide (benzo)
Pt receives the following - what was the OD?
- Glucagon
- Flumazenil
- Naloxone
- Beta blocker OD
- Benzodiazepine OD
- Opioid OD
