Secrets Flashcards
Vitamin to give w/ any patient on Isoniazid therapy
B6
Signs of end organ damage in hypertensive emergency
Headaches
Dizziness
Blurry vision
Papilledema
Cerebral edema
AMS
Seizure
Intracerebral hemorrhage (typically in the basal ganglia)
Renal failure
Angina
MI
HF
First treatment in shock
IV fluids (along w/ O2 and monitoring)
UNLESS IT IS CARDIOGENIC SHOCK
Virchow triad
Endothelial damage (surgery, trauma)
Venous Stasis (immobilization, severe HF)
Hypercoagulable state (birth control, malignancy, lupus anticoagulant)
-Increases likelihood of DVT
First thing to do on a gastric ulcer found on an upper endoscopy
Biopsy
Best initial test to distinguish upper from lower GI bleeding
Nasogastric tube
Tx for hereditary hemochromatosis
Therapeutic phlebotomy
ADRs of steroids
Weight gain
Easy bruising
Acne
Hirsutism
Emotional lability
Depression
Psychosis
Menstrual changes
Sexual dysnfnxn
Insomnia
Memory loss
Buffalo hump
Truncal/central obesity w/ wasting of extremities
Round facies
Purple skin striae
Weakness in proximal muscles
HTN
Peripheral edema
Poor wound healing
Decreased glucose tolerance
Osteoporosis
Hypokalemic metabolic acidosis
ADRs of contraception
Endometrial cancer
Hepatic adenoma
Glucose intolerance
DVT, stroke
Cholelithiasis
Depression
Weight gain
Pseudotumor cerebri
Teratogenesis
Increased risk of CAD and breast cancer
Acute laryngotracheitis
Croup
Caused by the parainfluenzae virus and commonly affects children aged 1-2 years
*X ray shows tracheal narrowing on frontal x-ray (STEEPLE SIGN)
TX: dexamethasone; epinephrine
X-rays for smokers
For pts. >55yrs old and w/ a >30 pack year history
Odds ratio
(AxD)/(BxC)
Relative risk
[A/(A+B)]/[C/(C+D)]
Attributable risk
[A/(A+B)]-[C/(C+D)]
Tx of acute dystonia
Antihistamine (Diphenhydramine)
Anticholinergic (benztropine)
MCCo decreased maternal AFP
Incorrect dates
Variable decelerations
Umbilical cord compression
Late decelerations
Uteroplacental insufficiency
-Most worrisome
Test to perform before doing a digital exam during third trimester w/ bleeding
US
-need to r/o placenta previa
Neonatal conjunctivitis
First 12-24 hours: Possibly chemical reaction to drops
2-5 days: Gonorrhea; can be prevented w/ drops
5-14 days: Chlamydia; not prevented w/ drops
6 Ps of Compartment syndrome
Pain (out of proportion to injury)
Paresthesia
Pallor
Pressure
Paralysis (late, ominous sign)
Pulselessness (very late sign; MUST TREAT NOW)
Pulsatile abdominal mass + Hypotension
Ruptured AAA
Tx: Sx.
APGAR
Color: 0- pale, blue
1- Body pink, extremities blue
2- Completely pink
HR: 0- Absent
1- <100/min
2- >100/min
Irritability: 0- None
1- Grimace
2- Grimace w/ strong cry, sneeze, or cough
Tone: 0- Limp
1- Some flexion
2- Active movement
Respiratory effort: 0- None
1- Slow, weak cry
2- Good, strong cry
Tx for BB OD
Glucagon
Tx for cholinesterase inhibitors
Atropine
Pralidoxime
Tx for digoxin toxicity
Correct K+ and other electrolytes
Digoxin ab
Deep, rapid breathing in a diabetic
Kussmaul respiration
Sign of DKA
Cherry- red spot on the macula w/o hepatosplenomegaly
Tay-Sachs Disease
Cherry-Red spot on the retina w/ hepatosplenomegaly
Niemann-Pick disease
Disease to think of when an infant has a meconium ileus
CF
Cafe-au-lait spots w/ decreased IQ
McCune-Albright
or
Tuberous sclerosis
Cafe-au-lait spots w/ a normal IQ
Neurofibromatosis
Ambigous genitalia and hypotension
21a-hydroxylase deficiency
Anaphylaxis from Ig therapy
IgA deficiency
Postpartum fever unresponsive to broad-spectrum abs
Septic pelvic thrombophlebitis
Low-grade fever in the first 24 hrs after surgery
Atelectasis
Rash that develops after administration of ampicillin or amoxicillin for sore throat
MONO
Facial port-wine stain and seizure
Sturge-Weber
Beck triad
JVD
Muffled heart sounds
Hypotension
***SIGNS OF CARDIAC TAMPONADE
Brudzinski sign
Pain on neck flexion
Charcot triad
Fever/chills
Jaundice
RUQ pain
*Cholangitis
Chvostek sign
Tapping on the facial nerve elicits tetany
***SIGN OF HYPOCALCEMIA
Cushing reflex
HTN
Bradycardia
Irregular respirations
***INCREASED ICP
Leriche syndrome
Claudication and atrophy of the butt w/ impotence
*Aortoilliac occlusive disease
Tests used to assess for abnormal karyotype after abnormal B-hCG levels
Chorionic villus sampling: Weeks 9-13
Amniocentesis: Weeks 15-20
Pneumococcal polysaccharide vaccine (PPSV23)
Contains capsular material from 23 serotypes and produces a T-cell independent B-cell response that is less effective in young children and elderly
*Given to all IC pts. and adults >65 OR <65 if they have COPD, HD, DM)
Pneumococcal conjugate vaccine (PCV13)
Contains capsular polysaccharides from 13 most common serotypes and is covalently attached to inactivated diphtheria toxin protein
=» Induces a T-cell dependent B-cell response w/ formation of memory cells and antibodies
*Recommended for all infants and young children
Pt. w/ IE who has history of heart murmur
Probably mitral regurg.
RFs for C. diff
Antibiotics
Hospitalization
PPI use
Studies that are known as a prevalence study
Cross-sectional
-These studies simultaneously measure exposure and outcome
Mammary gland enlargement, swollen labia, and white vaginal discharge in a newborn infant
NORMAL; due to maternal estrogen
Patient w/ a serum B-hCG <1500 and a negative TVUS
Repeat B-hCG level in 2 days
- Oftentimes, a intrauterine pregnancy will not be seen on a TVUS until B-hCG is >1500
- If the level is greater than 1500 and no intrauterine pregnancy is seen, begin to suspect ectopic
Cauda equina syndrome
Bilateral, severe radicular pain w/ chronic onset
Saddle anesthesia
Asymmetric motor weakness (but can be present on both sides, just greater on one of them)
Hyporeflexia
LATE onset bowel dysfnxn
***Damage is in the SPINAL NERVE ROOTS (hyporeflexia)
Conus medullaris syndrome
Pain is SUDDEN-onset and in the back
Perianal anesthesia
SYMMETRIC motor weakness
HYPERreflexia
EARLY-onset bowel dysfnxn
***DAMAGE is in the CONUS MEDULLARIS
Leads w/ ST-elevation in LAD occlusion
I, aVL (lateral)
V1-V4 (anterior)
Cardiac manifestationsof sarcoidosis
Complete AV block (most common)
Restrictive cardiomyopathy (early)
Dilated cardiomyopathy (late)
*Due to formation of cardiac noncaseating granulomas
Problems w/ vesicoureteral reflux
Recurrent UTIs
Renal scarring
Renal insufficiency
ESRD
First thing to order in a woman >30 w/ a palpable breast mass
Mammogram
“Egg on a string” heart on newborn CXR
Narrow mediastinum
-Indicative of Transposition of the Great Vessels
Hyperemesis gravidarum
RFs: Hydatiditiform mole
Multiple gestation
Hx. of HG
CFs: Severe, persistent vomiting
>5% loss of prepregnancy weight
Dehydration
Orthostatic hypotension
Labs: Ketonuria
Hypochloremic, hyopkalemic metabolic alkalosis
Hypoglycemia
Hemoconcentration
Tx: Admission; IV fluids and antiemetics
*Differentiate from normal vomiting during pregnancy by lab values
MDMA OD
Hypertension
Tachycardia
Hyperthermia
***Serotonin Syndrome (especially if the patient takes any SSRIs)
Extraperitoneal bladder injury
Contusion or rupture of the neck, anterior wall, or anterolateral wall of the bladder; presents w/ localized pain the lower abdomen and pelvis
- Cause by pelvic fracture usually
- Pts. also have hematuria and urinary retention
Reasons for baseline EKG abnormality
- LBBB
- LVH
- Pacemaker
- Digoxin
- Test for myocardial ischemia via - Thallium pickup test (abnormal shows decreased uptake)
- Echo (abnormal shows cardiac hypokinesis)
Prasugrel
P2Y-inhibitor best used alongside aspirin after coronary angioplasty or stenting
*Cannot use in pts >75yrs because of increased risk of hemorrhagic stroke
Ticlopidine
Used in pts. who are intolerant of aspirin and clopidogrel
ADRs: neutropenia, TTP
Medications to use on a pt. who does not tolerate an ACEI but has HF
Nitrates + Hydralazine
LDL goal w/ CAD
<70
Indications for cardiac revascularization
3 vessel disease
L. main disease
2 vessel disease in a diabetic
Pt w/ an acute DVT
Tx. w/ unfractionated heparin and warfarin; even if surgery has happened recently
Workup for Raynauds
CBC, BPP
Urinalysis
ANA
ESR, Complement levels
-Need to rule out sinister causes
First work-up for a palpable ovarian mass
Pelvic ultrasound
Infant w/ an elevated arterial blood level
Repeat w/ venous blood; false positives common w/ arterial blood
Granulosa cell tumor of the ovary
Malignant neoplasms that secrete ESTROGEN and can cause precocious puberty in young girls or bleeding/endometrial hyperplasia in postmenopausal women
Attrition bias
Type of SELECTION bias due to loss of patients to follow-up
Results can be skewed in certain directions depending on the populations
Factorial design
Involves 2 or more experimental interventions and measures 2 or more outcomes
Patient who has uremia and chest pain
Consider uremic pericarditis
These pts. should be started on dialysis
Tx of Torsades
IV magnesium
Pt. who is in his 50s, has a palpable retroperitoneal mass, and renal railure w/ HTN
Suspect ADPKD
Crescendo-decrescendo murmur along the left sternal border w/ no radiation
HOCM
Most important prognostic factor in breast cancer
TNM staging
Tx for cervicofacial Actinomyces
Penicillin
Clinical manifestations of hereditary hemochromatosis
Skin: Hyperpigmentation
MSK: Arthralgia, chondrocalcinosis
-IF YOU SEE THIS ON XRAY, GET A CBC TO ID THIS DISEASE
GI: Elevated hepatic enzymes =» cirrhosis and cancer
Endocrine: DM, hypogonadism, hypothyroidism
Cardiac: Restrictive or dilated cardiomyopathy
Infections: Increased susceptibility to Listeria, Vibrio, and Yersinia
Best management for preeclampsia
DELIVERY
W/o severe features =» @ 37 weeks
W/ severe features =» @34 weeks
Urine protein/creatinine ratio indicative of preeclampsia
> .3
or
24 hours urine showing >300mg protein
CHAD-VASc
CHF HTN Age >75 (score +2) DM Stroke/TIA (Score +2) Vascular disease (prior MI, PAD) Age 65-74 (score +1) Sex (female)
2 or greater requires oral anticoagulants; 1 may just need aspirin
Treatment of preeclampsia
Hydralazine
Labetalol
Nifedipine PO
JONES criteria
Joints (migratory arthritis) Carditis Nodules (subcutaneous) Erythema marginatum (looks faint, erythematous and centrifugal) Sydenham's Chorea
Minor: Fever Elevated ESR/CRP Arthralgia Prolonged PR interval
Management of postpartum urinary retention
Urethral catheterization
Treatment for Listeria
Ampicillin
Aztreonam coverage
Exclusively for gram negative bacteria
Strongest indicator other is directly correlated to the level of viral replication in HBV
HBe
Tx of chancroid
Azithromycin
Signs of peripheral Bell’s Palsy
Loss of forehead and brow movements
Inability to close eyes and drooping of both eyelids
Most accurate dating of gestational age
First trimester ultrasound with crown-rump length measurement
Cephalohematoma
Subperiosteal hemorrhage limited to the surface of one cranial bone in a newborn infant
-Swelling becomes visible a few hours after birth
Caput succedaneum
Diffuse, ecchymotic swelling of the scalp of the newborn that DOES extend over cranial suture lines
Pt w/ fat malabsorption (diarrhea, bloating) and signs of hyperparathyroidism
Probably secondary to Vitamin D deficiency
Suspect increased PTH w/ decreased Calcium and Phosphorus
Lynch Syndrome Neoplasms
Colorectal cancer
Endometrial Cancer
Ovarian Cancer
FAP Neoplasms
Colorectal cancer
Desmoids/Osteomas
Brain tumors
vHL-Syndrome Neoplasms
Hemangioblastomas
Clear cell renal carcinoma
Pheochromocytoma
MEN 1 Cancers
PTH
Pituitary Adenomas
Pancreatic adenomas
MEN 2A Cancers
Parathyroid cancer
Medullary Thryroid Cancer
Pheochromocytoma
Tx of ventricular tachycardia in a stable patient
Amiodarone
Long term O2 therapy criteria
- O2 sat <=88% on room air or PaO2 <55mmHg
2. O2 sat <=89 on room air or PaO2 <=59mmHg AND HAVE cor pulmonale, right heart failure, or Hct > 55%
Vertebral Osteomyelitis
Fever, back pain, focal spinal tenderness
*Do not need elevated WBC, fever
Joints most commonly affected by pseudogout
Ankle and knee
Manifestations of amyloidosis (primary and secondary)
Renal: Proteinuria (heavy), peripheral edema
Cardiac: Restrictive cardiomyopathy, AV block
CNS: Autonomic/peripheral neuropathy, stroke
GI: Hepatomegaly, malabsorption, GI bleed
Pulm: Nodules, effusions
MSK: ENLARGED TONGUE
Skin: Thickening (Waxy appearance), nodules, bruises
Heme: Anemia, thrombocytopenia
Other bacteria that can cause endocarditis and necessitates a colonoscopy afterwards
Clostridium septicum
When do you need surgery for endocarditis?
Rupture valve or tendinae
Prosthetic valve infxn
Fungal endocarditis
Abscess
AV block
Recurrent emboli
Tx for HACEK endocarditis
Ceftriaxone
Treatment of cardiac or neurologic Lyme disease
Ceftriaxone
Zidovudine ADR
Anemia
NRTI
Stavudine ADR
Peripheral neuropathy
Pancreatitis
(NRTI)
Didanosine ADR
Peripheral neuropathy
Pancreatitis
(NRTI)
Abacavir ADR
SJS
***TEST FOR HLA-B5701; will predict this rxn
Protease inhibitor ADRs
Hyperlipidemia, hyperglycemia
***These drugs end in -navir
Indinavir ADR
Nephrolithiasis
What class is this?
Tenofovir ADR
Renal insufficiency
Bone demineralization
(NRTI)
Anti-retroviral medication you can’t use in pregnant women
Efavirenz
Tests for Aspergillosis
Galactomannan
B-D-glucan
PCR
Chikungunya fever
Joint pain, periarticular edema, rash, fever
Box-car shaped encapsulated rods
Bacillus anthracis
Can be:
- Cutaneous (black eschar= self-limited)
- GI (diarrhea, ulcerations)
- Inhalation (widened mediastinum, pleural effusion)
Leptospirosis
Oliguria, elevated CK w/ muscle pain
Get from infected food from animal urine
Angioedema tx.
Acute: Epinephrine to stabilize airway; FFP, ecallantide, or icatibant
Chronic: Danazole; Stanazole
Manifestation of Hyper IgE Syndrome
Recurrent skin infxns w/ Staph.
Facets of a biophysical profile
Nonstress test (fetal heart rate)
Amniotic fluid volume
Fetal breathing
Fetal movement
Fetal tone
⭐️order there’s with a non reactive stress test
STDs screened for at initial pregnancy visit
Hiv
HBV
Chlamydia
Syphilis
Acute, unilateral lymphadenitis causative agent
Staph aureus
Fibromyalgia
Middle-aged women w/ widespread pain, fatigue, and mood complaints
-Point tenderness is greater at insertion points of muscles
Tx: Education; aerobic exercise
TCAs**
Malignant otitis externa (necrotizing)
Severe infxn of the external auditory canal and the base of the skull presenting w/ unrelenting ear pain, purulent drainage w/ granulation tissue, and conductive hearing loss on the affected side
Tx: IV Ciprofloxacin
Why does tucking knees into the chest fix a TOF babies problems?
It increases systemic vascular resistance causing more blood to go to the lungs
Attributable risk percent
(risk in exposed-risk in unexposed)/risk in exposed
Best test for someone w/ Addison’s
8AM serum cortisol and ACTH stimulation test
Polymyositis
Proximal muscle weakness; NO PAIN PRESENT
Dx: Elevated CK, Aldolase (muscle enzymes)
(+)ANA, (+) anti-Jo-1
Biopsy: Endomysial infiltrate w/ patchy necrosis
Polymyalgia rheumatica
Presents in >50 year wold people w/ stiffness AND PAIN in the shoulders, hip, and neck; assoc. w/ GCA
Dx: Elevated ESR, CRP
RAPID IMPROVEMENT W/ GLUCOCORTICOIDS
Pt. who started medication for tremor and has visual disturbances
Consider trihexyphenidyl precipitating Acute Angle Closure Glaucoma
Patient who prevents w/ sudden unilateral lower abdominal pain that progresses to diffuse abdominal pain, shoulder pain, decreased Hcrt and has free fluid in the pelvis
Possible ruptured ovarian cyst
***Usually occurs in the second half of the menstrual cycle after the most recent luteal cyst has formed
Medications to give women in preterm labor at <32 weeks gestation
Betamethasone
Tocolytics (indomethacin, nifedipine)
Magnesium sulfate (neuroprotective properties for the fetus)
Penicillin
Stillborn fetus w/ multiple fractures, hypoplastic thoracic cavity, short limbs
Probably Type II Osteogenesis Imperfecta
Is typically fatal during delivery
Test to order prior to starting Trastuzumab
Echocardiogram
***Drug is highly cardiotoxic, although, it is reversible following discontinuation
“Irregularly enlarged uterus”
LEIOMYOMA
-Even if you look into the OS and see a mass, the uterus is probably just trying to expel one
Febrile Neutropenia
MAKE SURE TO COVER ALL BACTERIA INCLUDING PSEUDOMONAS
-Try Pip-Tao, Meropenem, Cefepime
Myotonic Dystrophy
AD expansion of a CTG trinucleotide on Cr. 19
Presents at age 12-30 w/ facial weakness, hand grip myotonia, and dysphagia
***May also have cataracts, balding, testicular atrophy, and arrhythmia
Pulseless Electrical Activity Management
CPR
Epi
Possible Advance Airway
Manage like the patient is in asystole***
Indications for urgent dialysis
Acidosis (<7.1)
Electrolyte abnormalities (EKG probs; K>6.5)
Ingestion (alcohols, salicylate, lithium, Keppra, Carbamazepine)
Overload
Uremia (symptomatic w/ encephalopathy, pericarditis, or bleeding)
“Water bottle” shaped heart on X-ray
Pericardial effusion
Looks more like a canteen really
CML tx.
Imatinib
-TK inhibits the BCR-ABL gene product
Tx for nephrogenic DI
Tx underly cause and add..
HCTZ; amiloride; or NSAIDs (prostaglandin inhibitor)
Signs/Sx. of Acromegaly
Increased hat, ring, and shoe size
Carpal tunnel syndrome
OSA
Body odor due to sweat gland hypertrophy
Coarsened facial features
Deep voice
Macroglossia
Colonic polyps
Skin tags, hyperglycemia
Arthralgia
Best initial test for suspected acromegaly
IGF-1
Most accurate test is the glucose suppression test
=>Glucose should suppress GH levels
Tx of acromegaly
Transphenoidal resection
Meds:
Pegvisomant (GH receptor antagonist which inhibits IGF-1 release from the liver)
Octreotide/Somatostatin (inhibits GH release from pituitary)
Cabergoline (Dopamine inhibits GH release from pituitary)
CCB that can cause prolactinemia
Verapamil
Tests to run after high prolactin level
TFTs (high TRH can cause release)
Pregnancy test
BUN/Cr (kidney disease will elevate levels)
LFTs
-Afterwards, do an MRI
Subacute thyroiditis
Patient presents w/ a tender thyroid and elevated T4 but decreased TSH and RAIU
Tx: Aspirin
Thyroid storm tx
- Propanolol (blocks target organ effects and peripheral T4=>T3 conversion)
- Methimazole/PTU
- Iodine (blocks release and peripheral conversion)
- Steroids
Tx of Grave’s Opthalmopathy
Steroids
Cinacalcet
Suppresses PTH release
Used to tx. hyperparathyroidism if sx. is not an option
Calcium and albumin correlation
For every point decrease in albumin, Ca2+ drops 0.8
Tx for unresectable pituitary causing hyperadrenalism
Pasireotide
-Somatostatin analog
What should you order if a high dose dexamethasone test does not suppress ACTH secretion?
CXR
Fludrocortisone
Useful steroid replacement in that it has increased mineralcorticoid activity
-Choose this if the patient has signs of postural instability
Testing for pheo
Initial: Plasma free metanephrines
Confirm: 24 hr urine metanephrine
Diabetes diagnosis
Two fasting blood glucose levels greater than 125
Single level greater than 200 and presence of symptoms
Increased glucose level on OGTT test
Pramlinitide
Amylin analogue that decreases gastric emptying, decreases glucagon levels, and decreases APPETITE
Incretins
Exenatide, liraglutide, dulaglutide
These act like GLP and increase insulin release while slowing gastric emptying (Early satiety) and DECREASING WEIGHT
DM Health Maintenance
Pneumococcal vaccine
Eye exam
Statins if LDL >100
ACEIs/ARBs if BP >140/90 and/or if urine is (+) for microalbuminuria
Aspirin at age >30
Foot exam
Tx of diabetic gastroparesis
Metoclopromide or erythromycin (increases gastric motility)
Presents w/ nausea, bloating, constipation, abdominal discomfort
PCOS diagnostic criteria
Clinical signs of hyperandrogenism and/or high testosterone/DHEA
Irregular menstruation
10 cysts on pelvic sonogram w/ an ovary >10cm
Postpartum endometritis
RFs: C-sec, Chorioamnionitis, GBS, prolonged rupture of membranes, operative vaginal delivery
CFs: Fever >24hrs postpartum, uterine fundal tenderness, purulent lochia
Tx: Clindamycin and gentamicin
-Infxn is polymicrobial usually
Pt w/ dyspnea, chest pain, tachycardia, hypoxia, clear lungs, and syncope
COULD BE MASSIVE PE
COULD LEAD TO R.HEART FAILURE
Tx for hypotension caused by an epidural during labor
Placement of the patient on their left side to improve VR
Fluid bolus
Vasopressors
Lead points for intussusception
Kid w/ recent illness: Hypertrophied Peyer’s Patch
Normal Kid: Meckel Diverticulum
Adult: Small cell lymphoma
Asthmatic patient w/ recurrent episodes of brown-flecked sputum and transient infiltrates on x-ray
Allergic Bronchopulmonary Aspergillosis
Tx. w/ ORAL steroids
Outpatient pneumonia tx.
Azithromycin
or
Doxycycline
Comorbidities (COPD, asthma)
=»Levo or Moxi
Inpatient Pneumonia tx.
Levo; Moxi
or
Ceftriaxone + Azithromycin
CURB 65
Confusion
Uremia
Respiratory Distress
BP low
65 years or older
*Needs 2 for admission
Exudate vs. Transudate
pH <7.2
LDH >60% of serum
Protein >50% of serum
Hospital Acquired Penumonia tx.
Cefepime/Ceftazidime
Pip-Tazo
Carbapenem
***JUST MAKE SURE THERE IS PSEUD COVERAGE
Ventilator-Associated Pneumonia tx.
- Anti-pseudonomal B-lactam (ceftaz or cefepime, pip-tazo, carbapenem)
- Second antipseudomonal (gentamicin, cipro/levo)
- Vanc or Linezolid
Imipinem ADR
Seizure!
-Can occur w/ ESRD pts or pts. on meds that decrease renal fnxn
Tx for PCP if you cant use Bactrim
Clindamycin
or
Pentamadine
HIV pt. whos CD4 count rises to above 200 and stays for 6 months
You can stop medications
Patient w/ a positive PPD
Get a CXR
Only get a second PPD if they have never had a PPD before
Tx: Once active disease is ruled out w/ the CXR, tx. w/ isoniazid prophylaxis for 9 months
Interstitial Lung Disease w/ granuloma formation
Berylliosis
-Will respond to steroid tx.
Possible presentations of sarcoidosis
Erythema nodosum
Parotid gland enlargement
Facial palsy/CNS involvement
Iritis/Uveitis
Elevated ACE
Hypercalciuria/Hypercalcemia
Argatroban
Direct thrombin inhibitor
Use this if a patient has HIT
Tx for primary pulmonary HTN
Prostacyclin analogues (beraprost, iloprost)
Endothelin antagonists (bosentan)
Tx of ARDS
Low-tidal volume mechanical ventilation (6mL/kg)
PEEP (maintain plateau pressure <30cm H2O)
Pt who has a hip fracture but is medically unstable
Can delay surgery for up to 72 hrs; stabilize first
Most common cause of anemia in someone w/ SCD
Folate deficiency
BM can’t keep up with rapid hemolysis
Pt. who has clear cervical mucous and a normal period
Could just be her ovulating and leaking juice
Mongolian Spot
Benign finding of dermal melanocytosis that appears as a flat, blue-grey patch present on the lower back and butt
Typically will fade spontaneously in the first decade of life
Benign finding
First test in someone w/ back pain that is worse at night
Still get an Xray first
MRI next
Tx of Guillan-Barre
IVIG
Fanconi Anemia
BM: Aplastic anemia
Appearance: Short, microcephaly, hypoplastic thumbs, hypogonadism
Skin: Irregularly pigmented areas, large freckles
*Occurs due to chromosomal breaks
Keratitis in a pt. w/ HIV
Think HSV
Riboflavin deficiency
Angular cheilosis, stomatitis, glossitis
Normocytic anemia
Seborrheic dermatitis
Boerhaave Syndrome
Spontaneous esophageal rupture usually following excessive vomiting or retching;
S/s: Odynophagia, fever, dyspnea, septic shock, subcutaneous emphysema
Labs: Gastrografin shows leakage
CXR shows widened mediastinum
Pleural fluid will have low pH, protein, and amylase
Tx: Sx
Digoxin toxicity
N/V
Decreased appetite
Confusion
Weakness
Also the blurry vision and color changes but if a pt. has the others and is on Digoxin; CHECK BLOOD LEVELS
MC morbidities w/ TPN
<14 days =» Central-line associated bloodstream infection
> 14 days =» Cholelithiasis
Pt who was recently on chemo and now develops a dark, black legion w/ necrosis
Suspect ecthyma gangrenosum caused by Pseud.
Loss of palpable pulse during inspiration
Pulsus paradoxus (think cardiac tamponade)
TB pleural effusion
Exudative w/ increased LYMPHOCYTES
Spontaneous bacterial peritonitis
CFs: Fever, abdominal pain, AMS, hypotension, paralytic ileus
Ascitic fluid: PMNs (250, Positive culture, Protein <1, SAAG >1.1
Tx: 3rd gen. cephalosporins of FQNs
Tx of supraventricular tachycardia
Adenosine
Tx of ventricular tachycardia
Amiodarone
Pt who develops significant muscle weakness and parasthesias after being started on a thiazide
Probably has Primary Hyperaldosteronism; the thiazide made the condition worse
Pt w/ renal failure who starts developing hip and back pain
Renal osteodystrophy
Labs will show decreased Ca and increased PO4 BUT there is actually increased PTH
Pt w/ confusion and GI bleed
Probably have increased ammonia
Most important prognostic factor for astrocytoma
Tumor grade
Also, pt. age and functional states are important
Tx for CLL
Rituximab (anti-CD20)
Most common causes of infxn in SCD pts.
Pneumonia: S. pneumoniae
Osteomyelitis: S. aureus, S. enteritidis
Bactermia: S. pneumoniae, H. influenzae
Meningitis: S. pneumoniae
*Due to functional asplenia
Bacterial endocarditis prophylaxis
Prosthetic heart valvue
Hx. of IE
Structurally abnormal valve in a TRANSPLANTED HEART
***Just these
Rate control for A-fib
Metoprolol, emsolol
or
Diltiazem, Verapamil (nondihydropyridine CCBs)
Type II Membranoproliferative Glomerulonephritis
“Dense deposit disease”
Caused by anti-C3 (C3 nephritic factor) IgG targeted against C3 convertase
These complexes wind up getting deposited in the glomerular basement membrane
Pt w/ preeclampsia who becomes dyspneic and hypoxic
Likely pulmonary edema secondary to an increased workload being faced by the hear
Indications for renal/bladder US
Infants <24 months old w/ first febrile UTI
Recurrent febrile UTIs at any age
UTI in achild w/ family hx. of urologic disease, HTN, or poor growth
Children who do not respond to abx. therapy
Complete Atrioventricular septal defect
Most common congenital heart defect w/ Down Syndrome
-Failure of endocardial cushions to merge causes a VSD and ASD
Auscultation findings:
Loud S2
Systolic ejection mumur
Holosysytolic murmur from VSD
Hallmark of prolonged seizures (Status epliepticus)
Cortical laminar necrosis
Can lead to persistent neurologic defects and recurrent seizure
Alcohol withdrawal syndromes
Mild: Anxiety, insomnia, tremors, palpitations (6-24hrs)
Seizures: 12-48hrs
Alcoholic hallucinosis: 12-48hrs
DTs: 48-96hrs (confusion, agitation, fever, tachycardia, diaphoresis, hallucinations
Pt. w/ a positive Pap smear during their pregnancy
Still go ahead and perform a colposcopy
Acute cholangitis
Presents as fever, jaundice, RUQ pain, and elevated AP
Usually secondary to malignancy or gallstone
MCC of spontaneous lobar hemorrhage
Cerebral amyloid angiopathy
Normocytic anemia, thrombocytopenia, and acute renal injury following a diarrheal illness
Hemolytic Uremic Syndrome
Luteoma of pregnancy
Mom has yello-brown masses of lutein cells, ovarian mass on US, and new onset of hirsutism and acne
-Female fetus is at high risk of virilization
ADRs of cyclophosphamide
Acute hemorrhagic cystitis
Bladder carcinoma
Sterility
Myelosuppression
*****AVOID BLADDER ADRS BY DRINKING LOTS OF FLUIDS AND TAKING MESNA
Blocked vessel in inferior MI
RCA
Sometimes LCX
Solitary Pulmonary Nodule found on X-ray and it is changed from previous X-ray, what do you do?
Chest CT
Pt who has an ovarian mass and is postmenopausal, what should you do?
Get US and a CA-125
Most common cause of nephrotic syndrome in adults
Focal segmental glomerulosclerosis
- Pts. at increased risk are black, hispanics, obese ppl, HIV, and heroin users
- Pts. are at increased risk for thrombosis, infxn, and protein malnutrition
Pts. who are IC and present w/ signs of meningitis must also be covered for what organism?
Listeria monocytogenes
Spinal epidural abscess
Fever, progressive focal back pain, and neurologic deficits typically in an IV drug abuser
Labs: Elevated ESR
Child with pharnygeal erythema and some small vesicles
Probably Herpangina (Coxsackie A)
Just needs conservative management
Granulomatosis w/ polyangiitis
Sinusitis, lung nodules/cavitation, rapidly progressive GN, AND NONHEALING ULCERS OR LIVEDO RETICULARIS (4th manifestation)
Tx: Steroids; immune modulators
Insulin drips should contain what else when treating DKA?
K+
Pt. w/ elevated platelets a few months after abdominal surgery due to trauma
Likely reactive thrombocytosis which will resolve
If their spleen was removed, this could make the count even higher
In a patient w/ hyperprolactinemia but no visual sx., should you get a head CT?
No
Start off w/ lab work
Best medication to treat hypertriglyceridemia
Fibrates
Long-term benefits and risks of OCPs
Benefits: Endometrial/Ovarian cancer risk reduction
Fixed menstrual irregularities
Decreased risk of benign breast disease
Risks: DVT
HTN
Hepatic adenoma
Increased risk for cervical/breast cancer (for 10 years following discontinuation)
What should you start on a patient w/ mild bone pain probably secondary to metastatic malignancy>
Bisphosphonates
-Help to inhibit the osteoclastic activity of bone destructive tumors
ABG findings w/ postoperative atelectasis
ph: Increased
pCO2: Decreased
PO2: Decreased
-Hyperventilation gets rid of CO2; collapse of lung causes decreased O2 diffusion
Big difference b/w excess vomiting and diarrhea in labs
Vomiting =» Alkalosis
Diarrhea =» Acidosis
Fibromyalgia
Presents as chronic, widespread pain w/ fatigue and impaired concentration
***Pts. have tenderness on palpation and muscle insertion points
*Labs will be normal
Toxic Shock Syndrome
Risks: Tampon use, recent surgery, skin lesions/burns, sinusitis/nasal surgery
CFs: High fever, hypotension, diffuse macular rash involving the palms and soles, desquamation 1-3 weeks after onset, vomiting, diarrhea, AMS
Tx: Supportive; removal of any foreign bodies; antibiotics
Patients w/ palpable purpura, proteinuria, hematuria, and arthralgia should be tested for what?
HCV antibodies
- Sounds like this is mixed cryoglobulinemia
- Will also see decreased complement
How does IgA nephropathy present?
HEMATURIA
Nonclassical CAH
Can present w/ acne, irregular menses, and hirsutism
-Patients will present w/ increased 17-hydroxyprogesterone and increased testosterone and DHEA as well
Possible complications of HSP
GI hemorrhage
Intussusception
CN III palsy
Paralysis of levator muscle (ptosis)
Loss of 4 EOMs (down and out eye)
-If diabetic CN III palsy, pupillary response will be preserved because these fibers are on the outside of CN III
Why do patients w/ exudative pleural effusion have decreased glucose in the effusion?
High metabolic activity of WBCs
Felty Syndrome
RA
Splenomegaly
Neutropenia
Caplan Syndrome
RA
Pneumoconiosis
Lung nodules
MC nephrotic syndrome in SLE
Membranous glomerulonephritis
Pt. with signs of sclerosis who has a rapidly rising bp
Sclerodermic crisis
Get them ACE inhibitors yo
Dangerous complications of Sjogrens
Lymphoma; make sure to screen for this
HUS presentation
Antecedent diarrheal illness
=»Microangiopathic hemolytic anemia
- Fatigue
- Pallor
- Schistocytes
Thrombocytopenia
AKI (oliguria, edema)
Zinc deficiency
Alopecia
Pustular skin rash
Hypogonadism
Impaired wound healing
Impaired taste
immune dysfnxn
Juvenile Myoclonic seizure
Generalized seizure most commonly w/ myoclonic jerks most prominent in the first hour after awakening
Patient who has only been sick w/ respiratory illness for a few days but has focal exam findings
Still get a CXR
Pt with asthma, eosinophilia, and pulmonary/renal sx.
Churg-Strauss Syndrome
Behcet’s Syndrome
Oral and genital ulcers
Ocular lesions that can cause uveitis and/or blindness
Possible erhthema nodusm and arthritis
Septic arthritis of a prosthetic joint
Shows up as radio lucency on Radiographic imaging or it could just be a loose joint
Tx by removing joint, giving abx., and replacing it
Possible ADR to b12 or folate replacement
Hypokalemia
Secondary to rapid cell production
Management of SCD
Need folate, pneumococcal Vax, Hydroxyurea
Also give abx. Right when a fever develops or the WBC rises
Manifestation of sickle cell trait
Isosthenuria
Possible painless ️hematuria
Patient who cut foot near water source and develops septicemia, bullous lesions, and cellulitis w/ possible necrotizing fasciitis
Vibrio vulnificus (GNR)
-Increased risk in those w/ liver disease
Tx: IV ceftriaxone + doxycycline
CXR for pulmonary contusion
Patchy alveolar infiltrate; usually localized to injured area
*ARDS has the same BUT it manifests after 24-48 hours and will be diffuse
Difference b/w ovarian torsion and rupture cyst
Rupture presents w/ peritoneal signs such as rigid abdomen, pleuritic chest pain, involuntary guarding, and rebound pain
Pts. who are high risk for medications respond to what intervention the best?
Pharmacist-directed intervention
Treatment for breast engorgement for women who no longer wish to breastfeed
Supportive bra
Ice packs on nipples
NSAIDs
Vasovagal syncope
Presents in people who are subjected to stress (even emotional) or prolonged standing and is accompanied by a prodrome of pallor, nausea, and diaphoresis and is later followed by a rapid regaining of consciousness
Tx: Reassurance; counterpressure techniques
Meningococcoal vaccination
Patients get the first vax at age 11 w/ a booster at age 16-21
Wet beriberi
High output cardiac failure
Can also be “dry” presenting w/ peripheral neuropathy
Menke’s Syndrome
Copper deficiency
Presents w/ MR and kinky hair
Selenium deficiency
CArdiomyopathy
Muscle pain
Patient who has been on prolonged antibiotics and develops bleeding w/ elevated INR
Vitamin K deficiency
Abx. therapy wiped out bacteria in gut that help absorb Vit. K
Tx of superficial thrombophlebitis
Conservative (ICE, NSAIDs, REST)
No increased risk for PE so no anticoagulation
Subclavian Steal Syndrome
Left subclavian artery obstruction proximal to vertebral artery origin
***W/ exercise/stress, pts. will have CNS complaints of syncope, dizziness, vertigo, ataxia due to blood being “stolen” to supply exercising muscles
MC testicular tumor
Seminoma
BPH treatment
alpha-1 blockade (tamsulosin, doxazosin, terazosin
5a-reductase inhibitors (finasteride)
TURP if very advanced
Best donor for a kidney transplant
Living, related donor
Cadaver acceptable tho
Buerger disease
Basically Raynaud symptoms in a young person
First work up for a postmenopausal women w/ vaginal bleeding
Pelvic ultrasound
Salvage radiation therapy
Treatment when other options have failed
Neoadjuvant therapy
Radiation given before standard therapy
Induction radiation therapy
Initial dose to rapidly kill tumor cells and send a patient into immediate remission
Estrogen effects on thyroid
May have increased T4 and normal TSH
This is due to the increase in TBG
Plan B
High dose oral levonorgestrel
MC risk factor for recurrent UTIs in children
Vesicoureteral reflux
Refeeding Syndrome
Patient who has started feeding again (usually after hospital admission or maybe some tragic accident where they were lost on an island) and has a massive release of insulin on exposure to the food
CFs: Arrhythmia, CHF, Pulmonary and peripheral edema, Seizure, Wernicke’s Encephalopathy
Labs: Decreased phosphorus, K+, Mg2+, thiamine
Increased Na+
Management of meconium ileus
Abdominal X-ray (check for perfs)
Followed by contrast enema ***
Euthyroid sick syndrome
“Low T3 syndrome”
Pt. who has had caloric deprivation, severe illness, or elevated cortisol has decreased total and free T3
-Should return to normal when they get better
Top 3 lifestyle modifications for HTN
- Weight loss
- DASH diet
- Exercise
Management of inflammatory acne
- Topical retinoids + benzoyl peroxide
- Topical erythromycin/clindamycin
- Oral abx.
Quadruple screens on Trisomy 21
AFP: Decreased
b-HCG: Increased
Estriol: Decreased
Inhibin A: Increased
Ruxolitinib
JAK inhibitor used for refractory polycythemia vera
Treatment to add onto ALL tx.
Intrathecal chemo
Prevents any relapse in the CNS
Leukemia most likely to have an acute blast crisis
CML
Pelger-Huet Cell
A bilobed PMN found in MDS
-Can also see increased MCV, NRBCs, and few blasts
Non-hodgkin’s Staging
I: One lymph node group
II: 2 or more lymph node groups on the same side of the diaphragm
III: Both sides of the diaphragm
IV: Metastatic and widespread
Tx. of advance non-Hodgkin’s
Cyclophosphamide
Hydroxydaunorubicin (Adriamyacin)
Oncovin (vincristine)
Prednisone
AND Rituximab
Tx of Hodgkin’s Lymphoma
Adriamycin (doxorubicin)
Bleomycin
Vinblastine
Dacarbazine
Treat relapses w/ chemo
Tx for Waldenstrom’s
Plasmapheresis
Followed by prednisone
ITP tx.
No symptoms; greater than 30,000 =» Nothing
Severe bleeding, <10,000 =» IVIG
Mild bleeding, count greater than 30,000 =» Steroids
*Splenectomy is last resort
Tx of esophageal spasms
CCBs
Two diagnoses for a ring narrowing the distal esophagus
Plummer-Vinson Syndrome: Assoc. w/ IDE; treat w/ iron
Schatzki ring: Assoc. w/ reflux and/or hiatal hernia; tx. w/ endoscopic procedure
Orthostasis definition
10+ rise in pulse when going from lying down to sitting up
or
Systolic pressure top of >15 points when sitting up
Drug to give for esophageal variceal BLEEDING
Octreotide
Tx. of a repeat episode of C. diff
Still use repeat metronidazole
Tx for Whipple’s
Ceftriaxone; Bactrim
Tx for diarrhea-prominent IBS
Rifaximin
Tx of IBS
Increase fiber
Hyoscyamine/Dicyclomine
TCAs
Tx of constipation predominant IBS
Polyethylene glycol
Pt who has a history of osteoarthritis and has an elevated CR, mild proteinuria, and WBC casts
Suspect analgesic nephropathy
Pt. w/ syncope who has prolonged PR interval on EKG
Syncope likely due to bradyarrhythmia or intermittent AV block
Magnesium toxicity
N/V, flushing, headache, hyporeflexia, hypocalcemia, somnolence
=» Possible respiratory paralysis and cardiac arrest
tx: Calcium Gluconate
- Can occur in pts. w/ renal failure
Simple Renal Cysts
Thin, smooth, regular wall
Unilocular
Homogenous
Absence of contrast enhancement
Asymptomatic
No follow-up needed
*IF it has other qualities, work up for malignancy
Baby who presents w/ signs of meningitis but was given a C-section
Could still be GBS; has high incidence of hand-hand transmission
CXR w/ reactive nodules and surrounding ground-glass opacities
“Halo sign”
-Suspect invasive aspergillosis
Strongest RF for stroke
HTN
Pt. w/ epigastric pain and RFs for cardiac disease
Still get an EKG before amylase and lipase
Antibody positive in Crohn’s Disease
anti-saccharomyces cerevisiae ab
Peutz-Jeghers Syndrome
Multiple hamartomatous polyps
Melanotic spots on the lips and skin
Increased frequency of breast, pancreatic, and gonadal cancer
*Apparently do not need increased colonoscopy screening tho
SAAG levels of ascitic fluid
<1.1
- Infxn
- Cancer
- Nephrotic syndrome
> 1.1
- Portal HTN
- CHF
- Hepatic vein thrombosis
- Constrictive pericarditis
MCCo Spontaneous Bacterial Peritonitis
E. coli
Typically gets treated w/ ceftriaxone
What do pts. w/ variceal bleeding and ascites need?
SBP prophylaxis
-Also, anyone who’s ever had it gets lifelong prophylaxis
Hepatopulmonary Syndrome
Hypoxia due to liver failure
Pts. have orthodeoxia (hypoxia when sitting up straight)
Woman w/ fatigue, itching, elevated AP, and positive anti-mitochondrial antibody
Primary Biliary Cholangitis
Tx: Ursodeoxycholic acid
Test for suspected Primary Sclerosing Cholangitis
MRCP; will show beading of the biliary duct
AI hepatitis abs
Anit-smooth muscle antibodies
Tx: Prednisone
Med to start on an ischemic stroke when the patient is already on aspirin
Clopidogrel or dipyridamole
Cluster headache prophylaxis
Verapamil
Prednisone
CSF finding in MS
Oligoclonal banding
Pt. w/ chorioamnionitis and is having contractions
Give oxytocin; still no need for C-sec
Causes of prosthetic joint infxn
<3 months: S. aureus, GNRs, anaerobes
3-12 months: S. epidermidis, Propionibacterium, Enterococci
-May present as joint loosening or chronic pain
> 12 months: S. aureus, GNRs, Strep. pyogenes
Large, polygonal thyroid cells w/ eosinophilic cytoplasm containing large amounts of mitochondria
Hurthle Cells
NONSPECIFIC finding of follicular thyroid cancer cause they can also bee seen in benign adenomas and Hashimoto’s
MCCo Renal Vein Thrombosis
Membranous nephropathy
Presents as severe abdominal pain, fever, and gross hematuria
Management of a patient with psychosis on their Parkinson Meds
Start clozapine
Do not abruptly stop their meds
What drug is associated with the development of progressive multifocal Leukoencephalopathy
Natalizumab
a-4 integrin inhibitor sometimes used as suppressant medication for disorders like MS
CMT
Genetic denervation disorder w/ distal weakness, sensory loss, wasting in the legs, ️Decreased DTRs, and high plantar arches
Radial nerve palsy
Presents as wrist drop
Common causes are Saturday Night Palsy, crutches
Glycopyrrolate
Anticholinergic drug that inhibits the muscarinic receptors only
-Used to prevent ADRs of pyridostigmine, also for intubations to ️Decreased saliva
CSF with 14-3-3 protein
Creutzfeldt-Jakob Disease
RF of tamoxifen therapy
Endometrial carcinoma
Tx of a breast abscess from untreated mastitis
Needle drainage and abx.
IF no response, then do an Incision and drainage
Pt. who has a swollen area on the floor of his mouth and his tongue is displaced posteriorly
Ludwig angina
Rapidly progressive cellulitis of the submandibular space arising from dental infxn; infxn is typically polymicrobial in nature
IV drug abuser who presents w/ pulmonary sx., cavitary lesions on chest imaging, and systemic sx.
Probably septic emboli from IE
-Can also appear on imaging as abscesses, infarctions, or just infiltrates
Pt. who presents w/ hepatic failure following TB tx.
Likely secondary to the INH therapy
HIV pt. w/ Papilledema but has a normal MRI
Suspect Cryptococcus neoformans; organism obstructs the outflow of CSF
Difference b/w confounding and effect modification
Confounding: Both factors can cause disease possibly, but one thing certainly does
Effect modification: One thing by itself does not cause disease
Pt. w/ history of PUD and now presents w/ signs of an acute abdomn
Could be a perf.
Get an X-ray
Subcutaneous uric acid deposits that look like punched out lesions on bone radiographs
“Tophi”
Assoc. w/ gout
Disease polyarteritis nodosa is assoc. w/
HBV
Pediatric patient w/ uveitis, inflammatory arthritis, and negative RF
Rheumatoid arthritis; RF often negative in pauciarticular variant
Imaging for suspected urethral trauma
Retrograde urethrogram
Solitary lung nodule in pt. younger than 40, doesn’t smoke or live in some endemic area
Probably a hamartoma
MC bone malignancy in pediatric patients
Osteosarcoma
Baby who has pink stains in their diaper but is otherwise eating fine
Uric acid crystals; very common after birth
-Called “brick dust”
Goals of mechanical ventilation in ARDS
- Low tidal volume =» decreases likelihood of overdistending the alveoli
- Keep SpO2 >88%
Hemodynamic effects of hyperthyroidism
HTN
Increased cardiac contractility and CO
Decreased SVR
Increased myocardial O2 demand
Neonate w/ oral thrush, PCP, FTT, and diarrhea
Suspect HIV from mom
Follow-up on patient w/ amenorrhea and a negative pregnancy test
Serum prolactin, TSH, and FSH
Name of the protein that may be found on a hyaline cast
Tamm-Horsfall protein
-Normal; may present w/ dehydration causing concentrated urine and precipitation of this protein
Granular, muddy brown cast
Sign of ATN; these are collections of dead tubular cells
Best way to try to prevent contrast-induced nephropathy
Saline hydration
Urinary findings in contrast-induced nephropathy
Urine sodium (low); FENa <1%, urine SG (high)
This is because, in contrast to other forms of ATN, contrast causes afferent arteriole vasospasm and this induces the ATN w/ contrast-induced nephropathy
Pt who has cancer and is treated w/ chemo who subsequently develops renal failure
Hyperuricemia secondary to Tumor Lysis Syndrome
-Prevent w/ allopurinol, hydration, and rasburicase
Diagnostic test for cholesterol emboli affecting the kidneys
Eosinophilia
Decreased complement
Eosinophiluria
Bx. of purple skin lesion will show cholesterol crystals
Elevated ESR
Delivery for a patient w/ placenta previa
C-section at Weeks 36-37 to avoid any risks w/ labor
Vaccine refusal from a mom
Respect her decision in the test world and document that she’s a fucking idiot
Gestational HTN vs. Primary HTN during pregnancy
Gestational HTN will be only AFTER Week 20; if it was present before, probably primary
HTN RFs during pregnancy
Maternal: Superimposed preeclampsia, pospartum hemorrhage, gestational diabetes, placental abruption, C-section
Fetal: FGR, perinatal death, preterm delivery, oligohydramnios
“Triple bubble” sign on a newborn
Likely jejunal atresia
Bruton’s Agammablobulinemia
Patients have a decreased B-cell count w/ decreased Igs across ALL lines
- Typically presents w/ recurrent sinopulmonary and GI infxn after infant loses maternal antibodies at 6 months
- MAKE SURE TO TO LOOK AT B CELL COUNTS
Tx: IVIG; abx.
ADRs of Selective Estrogen Receptor Modulators (SERMs)
Tamoxifen and Raloxifene
Hot flashes
DVT
Endometrial carcinoma (w/ tamoxifen)
Tx for chemotherapy-induced nausea Odan
Odansetron (Serotonin Receptor ANTAGONIST)
Skin biopsy w/ blisters/microabscesses at the tips of the dermal papillae
Dermatitis herpetiformis
Problems not associated w/ a normal grief reaction
Feelings of worthlessness, psychomotor retardation, and suicidal ideation
Is a diagnosis of previous conduct disorder required to make a diagnosis of antisocial disorder as an adult?
Yes
If a question wants you to treat a COPD pt. w/ a beta blocker, what should you use?
Atenolol or Metoprolol
B1-selective
Pt. w/ nasal polyps and needs an NSAID
DO NOT GIVE ASPIRIN
Congenital disorders that EVERY state screens for
PKU
Hypothyroidism
Age at which you should start evaluating strabismus
3 months
Delayed puberty
Boys: Lack of testicular enlargement by 14 years
Girls: Lack of breast development or pubic hair by 12 years
Work up for cephalohematoma
Head X-ray/CT to rule out underlying fracture even tho there probably is not one
ADPKD manifestations
- Hepatic cysts
- Berry aneurysm
- MVP or Aortic regurg.
- Diverticulosis
- Abdominal/inguinal hernia
Stroke in a young person
Do a work up for PAN
Kids may also have mononeuritis complex (damage to large, peripheral nerves)
Labs: Elevated ESR and CRP; anemia and leukocytosis
Medication to give when giving vitamin D to a renal failure pt.
Phosphate binders; otherwise you can worsen their hyperphosphatemia
Symptoms present in TTP but NOT HUS
Fever
Neurologic probs (AMS)
MCCoD in ADPKD
Renal Failure
Causes of euvolemic hyponatremia
Hyperglycemia (pseudohyponatremia)
*For every 100mg/dL of glucose; there is a 1.6mEq/L drop in Na+
Psychogenic polydipsia
Hypothyroidism
SIADH
Tx for chronic SIADH
Fluid restriction
+
Demclocycline
PE findings associated w/ Aortic Stenosis
Diminished and delayed carotid pulse (pulsus parvus and tardus)
Mid-to late peaking systolic murmur
Presence of a SOFT and single second heard sound
-Due to reduced mobility of the valve
Patient who has N/V, pneumobilia, and hyperactive bowel sounds
Probably a GALLSTONE ILEUS
-Pts. have colicky pain, dilated loops of bowel, and typically have a history of gallstones
Dx: Abdominal CT
Tx: Sx.
CHARGE Syndrome
Coloboma Heart Defects Atresia chonae (baby w/ cyanosis worsened by feeds) Retardation of growth/development Genito-urinary anomalies Ear abnormalities/deafness
Adenomyosis
Endometrial glands trapped in the myometrium and cyclically shed; typically presents as dysmenorrhea w/ HEAVY menstrual bleeds that begins later in the reproductive years
CFs: Tender, UNIFORMLY enlarged uterus
Tx: OCPs; IUDs; Hysterectomy
Approach to sinus bradycardia in adults
IF UNSTABLE
-IV atropine
THEN
-IV dopamine, IV Epi, OR TRANSCUTANEOUS PACING
Missed abortion
Pregnancy loss at <20 weeks w/o expulsion of products of conception
Pts. may notice decreased pregnancy symptoms or have very light, scant vaginal bleeding
Threatened abortion
Bleeding and a closed cervix but US reveals an intrauterine gestation
Appearance of metastatic brain cancer
Several, discrete circumscribed lesions at the jnxn of the gray white matter w/ surrounding edema
Milk-alkali syndrome
Pts. have excessive calcium and absorbable alkali intake leading to renal vasoconstriction w/ decreased GRF and loss of Na+, H20, w/ reabsorption of HCO3-
CFs: N/V, constipation, polyuria, polydipsia, psych sx.
Labs: Hypercalcemia
Metabolic alkalosis
AKI
Suppressed PTH
Tx: Discontinue meds; saline + furosemide
Possible causes of lead poisoning
Battery manufacturing
Plumbing
Home restoration
Alcohol distilling
Lupus pt. w/ antiphospholipid ab syndrome and is trying to get pregnant
Get them on Heparin
-APLS actually increases likelihood of clots
Cyclic Vomiting Syndrome
Child w/ predictable pattern of vomiting that resolves spontaneously, is completely normal in b/w episodes, and has no lab abnormalities
-For some reason, parents who have migraines have kids with this
Tx: Antiemetics and hydration
How can stress fractures appear on imaging?
Sclerotic bone
Reflex sympathetic dystrophy
Pt. Who develops hyperesthesia and autonomic dysregulation in an extremely after a relatively mild injury
Dx and Tx: sympathetic nerve block (relief=diagnosis)
Ultraviolet keratitis
Pts. have a history of welding, using a tanning bed, or snow-skiing
CFs: Keratitis, foreign body sensation, tearing, red eye, and decreased bision
Tx: Eye patch and topical abx.
“Trigger words” for ALL
Pancytopenia, history of radiation therapy, Down Syndrome
Men IIB
Mucosal neuromas
Medullary Thyroid Cancer
Pheochromocytomas
Environmental RFs for Liver Cancer
Alcohol
Polyvinyl chloride (angiosarcomas)
Aflatoxins
Histological clue of serous cystadenocarcinoma
Psammoma bodies
Meigs Syndrome
Ovarian fibroma
+
Ascites
+
Right sided hydrothorax
Most common tumors in children
Cerebellar astrocytoma
Medulloblastoma
Ependymoma
Bunch of grapes coming out of the vagina of a child
Sarcoma botryoides
-Embyronal rhabdomyosarcoma
MCCo Thyroid Cancer
Papillary thyroid cancer
HHV-8
Kaposi’s Sarcoma
CT differences b/w Wilm’s Tumor and Neuroblastoma
Wilms: Arise from kidney; NO CALCIUM
Neuroblastoma: Arise from adrenals; CALCIUM
CD1
Marker for histiocytosis; will also see tennis rackets on microscopy
Management of diverticulitis complicated by abscess
CT guided percutaneous drainage
Management of endometriosis that has failed conservative management
Laparoscopy
Breastfeeding failure jaundice
Presents in the first week of life and is caused by lactation failure (can be due to mom or baby)
Path: Decreased bilirubin elimination
Increased enterohepatic circulation
CFs: Suboptimal breastfeeding
Dehydration
Brick-red urate crystals (can be normal but is a sign of dehydration)
Tx: Better breast feeding yah dingus
Breast milk jaundice
Starts at age 3-5 days and peaks at 2 weeks; due to high levels of B-glucuronidase in breast milk
CFs: Adequate breast feeding
Normal exam
Pt. who had a recent cardiac procedure and becomes hemodynamically unstable 12 hours later
Suspect retroperitoneal hematoma formation
Next thing to do: Get non-contrast CT of abdomen
Tx: Supportive
Mainstay of tx. for Polycythemia Vera
Serial phlebotomy
*This condition can also present w/ increased platelets and WBCs
CIs to OCPs
Migraine w/ aura
Cigarette smoking
HTN
HD
DM w/ end organ damage
Hx. of DVT
Anti-phospholipid antibodies (lupus)
Breast cancer
Cirrhosis/Liver Cancer
Major surgery w/ prolonged immobilization
What has the greatest mortality benefit in an asymptomatic pt with an extensive family history of breast cancer?
SERMs
Unvaccinated person gets stuck with dirty needle, what do you give them?
HBV-Ig And vaccinate
CAGE questions
Cut down
Angry
Guilty
Eye-opener
Possible causes of porphyria Cutanea Tarda
⭐️HCV
Alcoholism
Estrogen use
Hemochromatosis
Cardiac Risk factors for sx.
EF <35%
Recent MI in last 6 months
Signs of CHF (optimize pts. w/ ACEIs, BBs, and spironolactone)
Pulm Risk Assessment for Sx.
Lung disease? =» PFTs
Smoker but no disease =?? Stop smoking for 6 weeks
SIRS criteria
Body temperature <36 or >38
HR >90
RR >20 or PCO2 <32
WBC <4000 or >12000
- Must meet 2 of these
- If confirmed infxn is present, then it is sepsis
Patient who suffered from head trauma and has raccoon eyes and/or bruising behind the ears
Basal skull fracture
MC overall cause of pancreatitis
TRAUMA
DO NOT FORGET THIS W/ EPIGASTRIC PAIN AND IT CAN BE HEMORRHAGIC SO HYPOVOLEMIA CAN BE PRESENT
Best initial test for acute mesenteric ischemia
X-ray
*Will see air in the bowel wall
Median Arcuate Ligament Syndrome
External compression of the celiac trunk by the median arcuate ligament
CFs: Severe abdominal pain
Weight loss
Nausea
*Is a diagnosis of exclusion BUT US can measure flow thru the celiac artery
Tx: Surgical decompression of the celiac artery
Hamman Sign
Crunching sign on palpation of the thorax due to subcutaneous emphysema
*Seen in Boerhaave syndrome
Most common location for Boerhaave syndrome
Posterolateral aspect of the distal esophagus
MC location for a Mallory-Weiss Tear
Gastroesophageal jnxn
What should you not R/O in a pt. over 60 w/ RLQ pain?
Cecal diverticulitis
Tx of acue ascending cholangitis
IV abx. followed by ERCP to removed obstruction
Followed by cholecystectomy
When can a fetal heart first be heard on US?
10-12 weeks
If a mom gets chickenpox before delivery, what should you give the infant?
Zoster immune globulin
Lab changes in pregnancy
Increased: ESR Total T4 and TBG (free t4 is the same) Hgb and plasma volume (looks like hgb ️Decreases) AP
Decreased: BUN; Cr
Pt. who is identified to have a short cervix on TVUS
Manage w/ Vaginal progesterone
-In future pregnancies, consider a cervical cerclage beforehand
Factor V Leiden
AD mutation in factor 5 that makes it unresponsive to activated protein C
=»Thrombus formation
-Coag studies are usually normal
**If it asks why a patient is having clots and their coag studies are normal, this is a VERY LIKELY cause
Complications of Primary Biliary Cholangitis
Malabsorption and fat-soluble vitamin deficiencies
OSTEOPORSIS/OSTEOMALACIA
Hepatocellular carcinoma
Female on OCPs who has HTN
Suggest switching to a different form of BC
Tx of Nocardia
Bactrim
-Remember the sulfa eggs at the Nocardia shootout
IDE lab findings
MCV: Decreased
RDW: Increased
Can pts. w/ bronchogenic carcinoma have pleural plaques?
Yes; so do not reflexively answer mesothelioma on asbestos exposure
Injury to rule out w/ fracture of the clavicle
Subclavian artery or Brachial plexus injury
Woman who awakens in the night and has an acutely flexed and painful finger that is relief when she pops it
Trigger finger
Tx: Steroid injection
Post-op complications
Days 1-2: Atelectasis/Pneumonia (Wind)
Days 3-5: UTI (Water)
Days 5-7: DVT/Thrombophlebitis/PE (Walking)
Day 7: Wound infxn/Cellulitis (Wound)
Day 8-15: Drug fever/Deep abscess (Weird)
Most common EKG finding for PE
Non-specific ST changes
Young pt. who presents w/ recurrent candidal infxns of the skin and mucous membranes.
Chronic mucocutaneous candidiasis (T-cell dysfnxn)
