SECRETS Flashcards
Common cause of wheezing in children
RSV, which classically occurs in winter and causes a fever. Asthma may be cause but usually associated with chronic hx.
When should you intubate
CO2>50 or O2
Best way to reduce pulmonary complications post op
STOP SMOKING (especially when at least 8 weeks before surgery)
Classic cause of PNA in TB pt
Pulmonary cavitation – > Aspergillus sp
Classic cause of PNA in child
RSV
Classic cause of PNA in child 2-5
Parainfluenza (croup)
Why should you get a follow up CXR in all pts >40 who develop PNA
Make sure it clears after appropriate abx treatment. If it doesn’t clear by 4-6 weeks, suspect malignancy, specifically BRONCHOALVEOLAR CA.
Complications of infant RDS
Intraventricular hemorrhage and pneumothorax or bronchopulmonary dysplasia (complications of acute or chronic mechanical ventilation)
What is the fluorescence polarization test?
Reflects ratio of surfactant to albumin in amniotic fluid and is direct measurement of surfactant concentration.
Cyanosis with attempted feedings in a neonate
TE fistula
Triglycerides in a pleural effusion
Chylous effusion
Screening for aortic aneurysm
Abdominal US
Confirmatory for aortic aneurysm
CT with contrast
Screening for aortic aneurysm should occur in?
Male smokers 65-75
Screening for aortic trauma/tear
CT with contrast
Confirmatory for aortic trauma/tear
MRA or TEE
Screening for appendicitis
US (partic in prig and children)
Confirmatory for appendicitis
CT with contrast
Screening for bowel obstruction
Abdom Xray
Confirmatory for bowel obstruction
CT with contrast
Screening for cholecystitis
US
Confirmatory for cholecystitis
HIDA
Screen for choledocholithiasis
US
Confirmatory for choledocholithiasis
ERCP or MRCP
Screen for diverticulitis
CT with contrast. No endscopy acutely as there is a risk of perforation
Screen for esophageal disease
Gastrografin or barium xray
Confirmatory test for esophageal rupture
CT with contrast.
Screen for PUD
Endoscopy
Screen for pyloric stenosis
US
Confiramtory for pyloric stenosis
Barium Xray
Confirmatory for fibroids
MRI
Confiramtory for ovarian disease
MRI
Screen for brain tumor
CT with contrast
Confirmatory for brain tumor
MRI with contrast
Screen for ICH
Non contrast CT
Screen for head trauma
Non contrast CT
Screen for acute stroke
Non contrast CT
Screen for bone mets
Bone scan
Confirmatory test for bone mets
PET scan
Screen for multiple myeloma
Plain xrays
Confirmatory test for fracture
Non contrast CT. CT can pick up many fractures not seen on X-ray.
Confirmatory test for osteomyelitis
Secrets says bone scan. NBOME said MRI.
Confirmatory test for plevic trauma
Non contrast CT
Confirmatory test for scaphoid fracture
MRI
What to do if pt with PE cannot tolerate radiation (prego) or contrast
v/q scan
Persistent and painful hematuria: screen ?
CT scan withOUT contrast
Persistent and painLESS hematuria: screen?
CT scan with contrast.
Screen for hydronephrosis
US
Screen for suspected urethral trauma
Retrograde urethrogram
3 leading causes of death in adolescents
Accidents
Homicide
Suicide
Which anti-psychotics treat positive sx of schizophrenia
Respond well to all currently used.
Which anti psychotics treat negative sx of schizophrenia
Atypical agents
Most important prognostic factor in schizophrenia
Premorbid functioning
Most schizophrenic patients in US are born in the ..
winter months.
ANS side effects are seen most in which antipsychotics?
Low potency antipsychotics like chlorpromazine
Tx of acute dystonia
Antihistamines or anticholinergics (benztropine, trihexyphenidyl)
Tx of akithisia
Beta blockers
Tx of parkinsonism in antipsychotic use
Antihistamines (diphenydramine) or anticholinergics (benztropine, trihexyphenidyl)
Neuroleptic malignant syndrome shows very high levels of what?
Creatine phosphokinase (CPK) .. more than 10x normal range.
Classic SE of thioridazine
Retinal pigment deposits, cardiac tox
Classic SE of chlorpromazine
Jaundice and photosensitivity
Antipsychotic classically associated with parkinsonism
Paliperidone
QT prolongation occurs most with which 2 antipsychotics
Paliperidone > ziprasidone
SE of valproic acid
Liver dysfunction
SE of carbamazepine
BM suppression
SE of lithium
Renal dysfunction
THYROID dysfunction
Tremor
CNS effects.
Encopresis is normal until what age
4 years
Which hallucinations are seen due to CNS issues
Visual
Which hallucinations are seen due to psych issues
Auditory
Pupils in LSD intox
Mydriasis
Start DRE exams at what age
> 40
Start PSA tests at what age in AA male
45 yr
Start PSA tests at what age
50
How often for conventional pap smears in women 30 yr or older who have had 3 negative cytology test results
every 2-3 years
how often for pelvic exam in 21-64 yr old
annually; every 2-3 yr after 3 normal exams
Breast exam by doctor in women 20-40 yrs
Every 3 years
Breast exam by doctor in women >40
Annually
Tdap recommendations
Adults 11 yrs old and older should receive single dose of Tdap to replace single dose of Td if they received last dose of Td 10 or more years earlier. Adults who anticipate having close contact with an infant
Tdap vs Td in wound ppx
Tdap
When can Tdap be given to pregos
Given to women with EVERY preg regardless of prior immunization hx, preferably in late 2nd or in 3rd trimester
Define neonatal mortality rate
Neonatal deaths (first 28 days of life)/1000 live births
Define perinatal mortality rate
Neonatal deaths + stillbirths/1000 total births
Define infant mortality rate
Deaths (0-1 y.o.)/1000 LIVE births
Maternal mortality rate definition
Maternal pregnancy-related deaths (deaths while preg or first 42 days after delivery)/100000 live births.
SE of cyclosporine
Renal toxicity
SE of sulfa drugs in neonates
Kernicterus
SE of halothane
Liver necrosis
SE of vincristine
Peripheral neuropathy
SE of quinine
Cinchonism (tinnitus, vertigo), thrombocytopenia, QT prolongation
SE of morphine
Sphincter of oddi spasm
Gray baby syndrome
Chloramphenicol. Can also cause aplastic anemia.
SE of doxorubicin
Cardiomyopathy
SE of busulfan
Pulm fibrosis
SE of chlorpropamide
SIADH
SE of oxytocin
SIADH
SE of opiates
SIADH
SE of AZT
bone marrow suppression
SE of acetazolamide
Metabolic acidosis
SE of cisplatin
Nephrotoxicity
SE of methyldopa
Hemolytic anemia (coombs test positive)
SE of Thiazides
HYPERglycemia HYPERuricemia HYPERlipidemia HYPOnatremia HYPOkalemic metabolic alkalosis
SE of loop diuretics
HYPOkalemic metabolic alkalosis
HYPOvolemia
Ototox
Calcium excretion
CAI side effect
metabolic acidosis
Which anti-HTN best known for causing depression
Methyldopa, but beta blockers can also cause.
What may happen if pt given MAOI + meperidine
Coma
Ppx in contacts of pt with Neisseria meningitis
Rifampin, cipro or ceftriaxone
3 classic meds that cause hepatic enzyme induction
Barbs, AED, rifampin
3 classic meds that cause hepatic enzyme inhibition
Cimetidine, erythromycin, ketoconazole
How is acetaminophen diff from ASA and other nsaids
Thought to inhibit COX primarily in the brain; does not act well in periphery. Thus it has analgesic and anti pyretic effects but no anti-platelet or significant anti-inflammatory
2 developments in NSAID therapy that may reduce GI and bleeding complications
COX 2 inhibitors and new combos of NSAIDS with prostaglandin E1. Normal NSAIDS inhibit type 1 cox (in addition to type 2) which is thought to be main culprit in causing GI problems. Prostaglandin E1 protects stomach by supplying what NSAIDs take away. COX2 inhibitors avoid problem altogether but are not as protective against GI bleeding as initially thought.
Give ASA to pt with aortic dissection sx?
No.
Social smile at what age
1-2 mos
Cooing at what age
2-4 mo
While prone, lifts head up 90 degrees at what age
3-4 mos
Rolls front to back at what age
4-5 months
Voluntary grasp (no release) at what age
5 months
Stranger anxiety at what age
6-9 months
Sits with no support at what age
7 months
Pulls to stand at what age
9 months
Waves bye bye at what age
10 months
Voluntary grasp with voluntary release at what age
10 months
Plays pat-a-cake at what age
9-10 months
First words at what age
9-12 months
Imitates others sounds at what age
9-12 months
Separation anxiety at what age
12-15 months
Walks without help at what age
13 months
Can build a tower of 2 cubes at what age
13-15 months
Understands 1 step commands (no gesture) at what age
15 months
Good use of cup and spoon nat what age
15-18 months
Can build tower of 6 cubes at what age
2 yr
Runs well at what age
2 yr
Ties shoelaces at what age
5 yr
Hearing and vision should be measured objectively at least once by what age?
4 years old.
At how old should strabismus be evaluated and managed?
after 3 months. before then its normal.
H&H measurement recommended at what age?
12 months but may be required at other times as dictated by history and risk assessment
When should iron supplements be started in full term infants
4-6 months
When should preterm infants be started on iron supplements
2 months
When should you recommend a child see a dentist for the first time
2-3 years of age
Define delayed puberty
Lack of testic enlargement in boys by age 14 or lack of breast dev or pubic hair in girls by age 12.
Define caput succedaneum
Diffuse swelling or edema of scalp that CROSSES the midline. Requires no further investigation.
Define cephalohematoma
subperiosteal hemorrhages that are sharply limited by sutures and do NOT ross the midline. Usually benign but rarely can indicate underlying skull fx so order radiograph or CT.
When should anterior fontanelle close and what d/o should you suspect if it fails
18 months. Delayed closure or unusually large may indicate hypothyroidism, rickets, hydrocephalus, or IUGR.
When should moro and palmar grasp reflex disappear?
6 months
Loss of finger abduction indicates which nerve njury
Ulnar
Conjunctivitis that dev in first 24 hours of life
Chemical connjunctivitis
Gonorrheal conjunctivitis
Extremely purulent discharge 2-5 days after birth. If given ppx drops should not develop this.
Chlamydial conjunctivitis
Mild to severe conjunctivitis 5-14 days after birth. Give oral erythromycin.
Sudden ocular pain, halos around lights, red eye, high IOP (>30), N/V, sudden decreased vision, and fixed mid dilated pupil
Closed angle glaucoma - - > give PILOCARPINE, oral glycerin and/or acetazolamide. Definitive surgery (peripheral iridectomy) used to prevent further attacks.
What pediatric rheum condition is commonly associated with uveitis?
JRA, especially pauciarticular form.
MCC of painless, slowly progressive loss of vision
Cataracts. Tx is surgical removal of affected lens.
Cataracts in a neonate
May indicate TORCH (toxo, other, rubella, CMV, HSV) or inherited metabolic disorder, such as galactosemia!!
Changes in retina and fundus a/w Diabetes
dot blot hemorrhages
Microaneurysms
Novas of retina
Changes in retina and fundus a/w HTN
Arteriolar narrowing
Copper/silver wiring
Cotton wool spots
Tx of proliferative diabetic retinopathy
Application of laser beam to periphery of entire retina (PANRETINAL PHOTOCOAG). Surgical or medical vitrectomy is used in some cases.
Treatment of non-proliferative diabetic retinopathy
Focal laser treatment when macular edema is present. In severe cases ,pan retinal photocoag may be used. Otherwise, treated supportively.
MCC of preorbital and orbital cellulitis
S. pneumo, H. influenzae type B, and staph aureus or strep species in pts with hx of trauma.
Which is worse, acid or alkaline burns to eye?
Alkali bc they tend to penetrate more deeply.
Eye condition that topical steroids are definitely contraindicated
HSV keratitis
MCC of central retinal artery occlusion
Emboli from carotid plaque or heart but watch for temporal arteritis.
Sudden painless unilateral loss of vision with “floaters” and flashes of light
Retinal detachment. Surgery may save patients vision!!!
What are drusen spots
Focal yellow-white deposits in and around the macula found in macular degeneration.
Left upper quadrant anopsia – where is the lesion
Right optic radiations in right TEMPORAL lobe
Left lower quadrant anopsia – where is the lesion
right optic radiations in the right parietal lobe
S-100 marker
Melanoma
Beta 2 microglobulin marker
Multiple myeloma, CLL and some lymphomas
BTA tumor marker
Bladder
Calcitonin tumor marker
Medullary thyroid carcinoma
What is a unicameral bone cyst
Expansile lytic well-demarcated benign lesion in prox humerus in children and adolescents. Although benign, may weaken bone enough to cause a pathologic fx of humerus.
Birbeck granules
Raquet shaped cytoplasmic inclusions are a marker for Langerhans cells of the skin. Other major cytologic clue is CD1 + cells.
How can you differentiate Wilms from neuroblastoma
Both present as flank masses in children. Neuroblastoma’s most commonly arise from adrenal gland and contain calcifications whereas Wilms tumors arise from kidney and rarely calcify, thus imaging with CT can distinguish the two.
Oral hairy leukoplakia
Can resemble leukoplakia but is an unrelated condition affecting HIV positive patients and is associated with EBV
Virus associated with Kaposis
HHV-8
Most common primary tumor of the liver
Hemangioma – generally benign and left alone.
Hepatic angiosarcoma
Look for industrial exposure to vinyl chloride
Most common primary liver malignancy inchildren
Hepatoblastoma
Most common thyroid cancer
Papillary
2 points about nasopharyngeal CA
Asian patients and associated with EBV.
Most common testicular cancer
Seminoma
3 MCC of brain mets
Lung CA
breast CA
melanoma
Meig’s syndrome
Ovarian fibroma that causes ascites and right hydrothorax
Krukenberg tumor
Stomach cancer with emets to ovaries
List the 3 commonly tested germ cell tumors
Teratoma/dermoid cyst.
Sertoli-leydig cell tumor
Granulosa/theca-cell tumor
Watery diarrhea, hypokalemia, achlorhydria
VIPomas
Whipple triad
Insulinaomes –hypoglycemia, CNS sx caused by hypoglycemia, and admin of glucose relieves sx.
C peptide levels in insulinoma
High
Migratory thrombophlebitis is assoc with which cancer
Pancreatic
Courvoisier sign
Palpable nontender GB found in pancreatic cancer
Cell of origin in pancreatic cancer
Ductal epithelium
What is degarelix
GnRH antagonist
What class of meds do goserelin, Mbuserelin, and triptorelin belong to
GnRH agonists
What class of med is flutamide
Androgen receptor antagonists
Cushing syndrome is seen with which lung cancer?
Small cell
Tamoxifen increases risk of which cancer
endometrium
benzene increases risk for which hcancer
leukemia
Arsenic exposure increases risk for which two cancers
lung, skin
Aflatoxins increase risk for which cancer
liver
high parity increases risk for which cancer
cervix
Inheritance of xeroderma pigmentosa
AR
NF type 1 is assoc whith which cancer
Multiple NF; cafe au last spots; increased number of pho, bone cysts, Wilms tumorr, and leukemia
Type of cancers pts with tuberous sclerosis increased risk for
Adenoma sebaceum
Glial nodules in brain
Renal angiomyolipomas
Cardiac rhabdomyomas
Retinoblastoma (inherited kind) put you at risk for which acncers
retinoblastoma obviously as well as osteogenic sarcoma
MEN type I
Parathyroid
Pituitary
Pancreas (islet cell tumors)
DIAMOND
Men Type IIa
Thyroid (medullary cancer)
Parathyroid
Pheochromocytoma
SQUARE
Men type IIb
Thyroid (medullary cancer)
Pheo
Mucosal neuromas
Peutz Jeghers at increased risk for which CA
NONCANCEROUS GI POLYPS
Increased noncolon cancer like stomach, breast and ovaries
What is major risk factor for cancer?
Age is the biggest risk factor
MCC of cancer in most organs?
Mets
Highest incidence of cancers in female 1-3
Brast
Lung
colon
Highest mortality rate of cancers in female 1-3
Lung
Breast
Colon
Highest mortality rate of cancers in male 1-3
Lung
Prostate
Colon
Highest incidence of cancers in male 1-3
Prostate
Lung
Colon
Hyperviscosity, IgM spike, cold agglutinins
Waldenstrom macroglobulinemia
Trigger words for mycosis fungoides/sezary syndrome
Plaquelike itchy skin rash that does not improve with treatment
Blood smear showing CEREBRIFORM nuclei known as butt cells
Pautrier abscesses in epidermis
Which subtype of NHL has best prognosis
Small follicular.
Large diffuse has worst.
