Self asses 1 Flashcards
Itchy rash, inbetween fingers, worse at night
Scabies
TOP permethrin
Differentiate between MDD and grief
Grief is a normal reaction; no SSRI needed but can benefit from counseling
MDD - feelings of worthlessness, excessive sadness, low-self esteem guilt, SI; SSRI
Newborn hasn’t passed mec on DOL 3 and had aggressive expulsion on rectal exam. Dx and w/u?
c/f Hirschsprung
Caused - failure of neural crest cells to migrate to the distal colon
Dx - Rectal suction bx, demonstrates absence of ganglion cells and nerve hypertrophy
Can also use anorectal manometry as a screening test, but only acurate if >1 mo old
Recent travel w/ diarrhea about 3-4 months ago
fever
RUQ pain
Ultrasound with hypoechogenic cyst
Aspiration - thick dark brown fluid, negative gram stain
Dx?
Enatmoeba histolytica (protozoa) Fecal oral transmission 90% asymptomatic but can get colitis or liver abscess Dx - stool O&P or Serum test Tx= Flagyl and paromomycin "anchovy paste" liquid
Guy in his 40s with UTI symptoms - be suspicious for?
Prostatitis
get a prostate exam to r/o hot tender prostate
Tx - Bactrim or fluoroquinolone (cipro) x 6 weeks
Inidication for AAA repair
size > 5.5 cm
Growing faster than 0.5cm q6mo
Hyperparathyroid No constipation or urinary frequency NL DEXA Over >50 y/o how do you manage?
Regular follow up with Sr calcium, Sr Cr and DEXA
When do you recommend surgical resection of Parathyroid?
hyperparathyroid AND
- Age <50
- complication of hyperPTH (osteoporosis)
- Frequent urination, constipation
Pt had a NSTEMI, < 75 y/o. What type of statin do they need?
Hi intensity - doesn’t matter what their lipid panel is
Teenager with multiple erythematous plaques with centra clearing
Erythema multiform
HSV is the most common cause
Self limited in 1-2 weeks
When do you get an MRI of low back pain?
Neurologic deficit
suspect infection vs cancer
Pain persists 12+ weeks
Verrucocous ulcerated anal lesion
Anal carcinoma
Caused by HPV
Pt has syx c/f PE
CT shows a peripheral hemispherical consolidation near the pleura
Dx?
Pulmonary infarction
complication of a PE
can get hemoptysis d/t lung necrosis
pt with Hep B
New liver mass
Dx?
Hepatic cel carcinoma
neoplasm of hepatocytes (liver parenchyma)
AFP can be NL or elevate
teenager with a 20 min period of intoxication
Lethargy, stupor
Returns to BL within 20 min
inhalant abuse
Can have rash around mouth or nose
Tx for pertussis
Macrolides (Azithromycin)
4 months SOB
CT b/l reticular and linear opacities with irregular thickening of bronchovascular bundles in the upper lungs and enlarged mediastinal lymph nodes
Dx?
Sarcoid (Granulomatous lung disease)
How quickly should inguinal hernias be repaired in an infant?
In a few weeks, not emergent but urgent
adult with new onset easing bring
Normal PT
prolonged aPTT
Acquired hemophilia
Presence of a coagulation factor inhibitor
40ish y/o pt with new DOE, small joint pain, GERD, telangiectasis around his lips
Dx and w/u?
Scleroderma (interstitial pulmonary fibrosis, esophageal hypomotility
Anti-centromere antibodies
Rapidly progressive breast pain, erythema, edema
Failed course of abx
c/f?
Inflammatory breast cancer
Need a core biopsy of LN or breast mass
when a pt has recurrent cellulitis whites a source you should consider?
Tinea pedis
Lymphedema
What are your next options for treating acne that isn’t improving with TOP benzoyl peroxide and retinol?
moderate severe w/o scaring - po tetracycline
Severe nodulocystic w/ scaring - po isotretinoin. Need Upreg, LFTS routinely
Pt with frequent abdominal pain and diarrhea gets frequent UTIs. C/f
IBD
can cause enterovesical fistula
Typically E. coli, bactericides fragilis
Can have pneumaturia
When would you consider endometrial biopsy on a pre-menopausal female
Heavy intermenstrual bleeding to r/o endometrial cancer (especially if obese, HTN, T2DM)
Fibroids have heavy bleeding but should still be regular
Pt on AC with sudden RLQ pain and hypotensive. Scary for?
Retroperitoneal hemorrhage
Get a CT
Need rapid reversal of AC
Pt being treated for sepsis now with 2-3 loose stools and VS worsening. C/f?
C. diff
probably abdominal tenderness on exam
what should you consider for a patient that reports normal BPs at home, but always high in the office
24 hour bp readings
Syncopal episode
Electrical altercates on ekg
what caused the syncope?
Cardiac temponade
syncope d/t decreased cardiac pre-load (decreased filling of RA)
Pt >50
b/l shoulder and neck pain (apparently can even have decreased ROM)
Polymyalgia Rhematica
Can give low dose steroids for comfort
At what point should we talk about transplant vs. HD in CKD pts?
When GFR <30
Apparently step considers ACEI/ARB protective
Normocytic anemia
mild CKD
chronic back pain
Dx?
MM
Need a urine electrophoresis
Tortuous dilation of veins in pampiniform plexus
Varicocele
“bag of worms” on valsalva
Increases risk of infertility and testicular atrophy
new born (hours old) gets cyanotic with feeds and improves with crying next step in w/u?
Insert a NG tube
r/o choanal atresia
Narrowing or obstruction of posterior nasal passages preventing communication between nasal cavity and nasopharynx
So infant can’t breathe during feeds and can haver starter
If NG cannot pass into the pharynx it raises suspicion for an atresia which is then confirmed on CT
Need prompt pediatric ENT eval for surgical repair
Cancer pt
Frequent pleural effusions that are exudative
What can you offer?
Chemical pleurodesis
Palliative effort to prevent future effusion
non small cell cancers with large effusions are considered incurable dz
kiddo with lead level > 70
severe
Needs IV dimercaprol and EDTA
Kiddo with lead level 45-69
Moderate
give po DMSA (succimer)
Kiddo with lead level < 44
Mild
No need for chelating agent
Contact public health to help mitigate exposure
Repeat blood level qmonth
what increases risk of long QT
Hypo mag HypoK Fluoroquinoloes Antipsychotics Increased risk of ventricular arrhythmia
pt is s/p prostatectomy. How do you manage now?
Serial PSA’s
Level post-op should be close to 0
If it rises be concerned for recurrence
1st line diagnostic test for pulmonary source of sepsis
Induced septum with hypertonic saline
what should you get if you are thinking about adding steroids in PCP infection?
ABG
if PO2< 70 and a-a gradient > 35 should give steroids
If someone w/ a chronic foley has candida in their urine, what do you do?
Change the foley
More likely from colonization, Probably won’t need treatment
If they have urinary syx, neutropenic, or look infected can start fluconazole or amphotericin
When do you image and Anke?
Pain near the malleoli OR
Unable to bear weight
OR pain at the malleoulous
Pt w/ h/o hodgkin lymphoma and big smoking hx has a large pulmonary mass. Why?
Lung cancer
Lymphoma presents as large lymph nodes, not a discrete mass
Hodgkin lymphoma does increase your risk of other malignancies, especially solid tumors (lung, breast, thyroid, bone, GI)
Smoking + h/o chemo or radiation = lung cancer
Indications for abx prior to dental work
Prosthetic heart valve
Previous infective endocarditis
valve dz in pt with a heart transplant
Congenital heart dz (unprepared, cyanotic, anything prosthetic, or residual deficit)
kiddo tried to od on TYL 6 hours ago but she looks fine. Now what?
Give N-acetylcysteine
Activated charcoal only works in first 4 hours
IF they present >4hours after ingestion –> empirically give NAC
What is the greatest RF for pancreatic cancer?
Cigarette smoking
be suspicious with large mass in pancreases + weight loss
CHF wit EF < 35% consider what intervention?
AICD (NOT pacemaker)
When do you consider a biventricular pacemaker?
If EF < 35% and have a wide QRS (>120)
Initial Tx for a symptomatic (vision loss, low libido, hyperprolactenemia) prolactinoma?
Dopamine agonist
Surgery is only indicated if they do not improve with medication alone
Most common cause of inherited thrombophilia?
Factor V Leiden
On labs - activated protein C resistance
Will need life long AC
Pt with OD of unknown’s medication has AMS, QRS prolongation >120, dilated pupils, dry MM, + Babinski. c/f?
Tricyclic antidepressant toxicity
Corrects QRS prolongation with Sodium Bicarb
How to treat obestiy
- Dietary changes, exercise
- Orlistat
- Phentermine
Phentermine mono therapy haas high rate of re-gain
What’s the difference between delusional disorder and somatic syx disorder
Delusional - fixated on one specific delusion w/o any signs of hallucination or psychosis
Somatic symptom - anxiety about many physical symptoms, but not delusional
Illness anxiety - fear of an undiagnosed medical illness, but don’t fixate on any one thing and accept that they may not have a disease
Afebrile kiddo with blood diarrhea
EHEC
look for beef ingestion or animal exposure
Microcytic anemia, normal Hgb, NL RBC distribution width
Thalassemia
Target cells on smear
Pt on MTX gets preggo
AFP high on quad screen
What do you do next?
Ultrasound
High suspicion for NTD
Can be seen as early as 6wk GA
Recent renal transplant (weeks) present with:
Fevers, AKI, UA with RBCs
Renal bx - renal tubular damage and prominent basophilic intranuclear inclusions
BK virus
a type of polyomavirus
Well known cause of nephritis in immunosuppressed transplant recipients
Tx - reduce immunosuppression +/- antiviral therapy
Most common demographic enrolled to medicaid?
Kids approx 50% - they’re also the cheapest
When do you deliver a pt with adequately controlled DM?
39 wks
Attempts to avoid fetal respiratory stress
At what size is there risk of social dystocia?
> 4.5kg, 9.9lb
Pt presenting with proximal muscle aches exacerbated by exercise
Some weakness with ADL
non tender on exam
Elevated CK
Hypothyroid myopathy
Can look like an inflammatory myopathy (poly or dermato) but the hypothyroid pmts will not have TTP on exam
Daily prophylactic meds for migraine
Beta blockers (metoprolol, propanolol)
TCAs (amitriptyline)
Anticonvulsants (valproate)
Abortive medication for migraine
Ergotamines (Firocet)
Triptans
Best way to avoid barotrauma on a vent and improve mortality?
Low TV
6-8cc/kg of ideal weight
Middle aged adult with Flexor surface Rash that is: pruritic planar polygonal purple
Lichen plants
unk etiology
Can also have white lace like pattern on the surface (Wicham striae)
Tx: TOP steroid, antihistamines
Pt just put on a vent and gets hypotensive
2/2 increased intrathoracic pressure
Bolus her
Can also try to wean down PEEP
Severe nephrotic syndrome increases risk of?
-Thrombotic events
especially in renal veins and DVTs, loss of anticoagulant factors in urine
- Infection
Preggo gets Parvo. How does this change management?
Get periodic ultrasounds
Increased risk of fetal anemia, hydrops fetalis, fetal demise
FHx of cirrhosis
presents with fatigue, poor libido
Mild transaminitis
Hereditary hemochromatosis
Get iron studies and genetic studies
Pt taking doxycycline now with bad heart burn. Why?
Medication induced esophagitis
Common with doxycycline, NSAIDs, KCl, bisophophanates
Tx - avoid the causative medication and syx should improve in 1 week
What are the advantages of NPPV in COPD?
decreased: mortality Intubation secondary bacterial PNA Would have low threshold to give it
Pt is having an NSTEMI, what med should be started in the next 24 hours?
ACEI
Start within 1-16 days
Improves LVEF, prohibits ventricular remodeling, and improve mortality
Tx for bulimia?
CVT
If not successful SSRI, especially fluoxetine
NEVER BUPROPRION
Tx options for candidate vaginitis while preggo?
TOP clotrimazole, miconazole, and nystatin
po fluconazole is teratogenic
Causes of metabolic alkalosis w/ hypo K+ and what test can help you determine the etiology?
Vomiting - Low Urine Cl (trying to retain)
Diuretic use -High UR Na, Cl d/t receptors being blocked
Inherited salt wasting (Gitelman and Berterr) - High Ur sodium
Pt with vascular dementia is having more behavioral agitation at home. Labs normal. Consider adding?
SSRI
safe for geriatric pop and no QTcc prolongation
Tx for folliculitis (Furuncles, carbuncles)
po Clindamycin, Bactrim, doxycycline
basically the same as cellulitis
If you suspect a biceps tendon rupture how do you treat?
Refer to Ortho
IVDU with blood Cx positive for Staph aureus should raise concern for?
endocarditis
Vertebral osteomyelitis
What is the common life-threatening complication of granulomatosis with polyangiitis
Diffuse alveolar hemorrhage
Pathology: systemic vasculitis that involves the upper respiratory tract, lower respiratory tract and kidneys
Ulcerative colitis presenting with fatigue
Lab work with elevated bili, alk phos, and elevated INR
c/f?
Primary sclerosis cholangitis
Confirm dx with ERCP - multifocal strictures and dilatations of the intra and extra hepatic bile ducts
Could consider MRCP
Pt with a depression hx is c/o polydipsia, polyuria, NL Cr, elevated accucheck and HgA1c. What med caused this?
Second gen antipsychotic like olanzapine
Lithium can give similar syx but wouldn’t cause her hyperglycemia and weight gain
New born with progressive respiratory distress develops shock that is symmetric on all limbs. Dx?
Hypoplastic L heart
PDA dependent and then crash when the PDA starts closing
Tx - prostaglandin E1 to keep PDA open and maintain systemic perfusion
Aortic coarctation looks similar but shock would only be seen in the lower extremities
TNF alpha inhibitor increases risk of?
More severe infections. CAP with Staph aureus can progress to necrotizing pNA
Preggo is RhD negative on prenatal labs. Somewhere along the way her RH(D) Ab titers go from 1:2 to 1:16. What do you do?
Nothing. She underwent alloimmunization at some point and it is too late to give rhogam
Just accept babe is likely to be Coombs positive and will be at risk of hemolytic dz, hyperbili
Young pt with progressive DOE, JVD
CXR w/ enlargement of pulmonary arteries
C/f Pulmonary HTN
Get an ECHO
standard initial prenatal labs
Rheusus type and Ab screen (Rh+/-) Hgb & HCT Rubella, Varicella serology UA and culture RPR, HIV, Hep B Chlamydia Pap (if due)
Strongest correlation with OSA?
Neck circumference
young teenager Leg fracture from a simple trip hepatosplenomegaly Anemia Thrombocytopenia Dx
Gaucher dz
Lysosomal storage disorder d/t glucocerebrosidase deficiency
Diagnositic criteria for PCOS
2 orf 3:
Oligomenorrhea
Hypergonadenism
PCOS on TVUS
Co-morbidities associated with PCOS?
T2DM
NASH
OSA
Endometrial cancer
CA-125 is a tumor marker for?
Ovarian CA
alpha fetoprotein is elevated in which CA?
Yolk sac germ cell cancer
When is mitral valve repair or replacement indicated?
ECHO with severe MR and LVEF of 30-60%
LVEF is over-estimated with MR
anatomic distinction of femoral hernia?
below inguinal ligament
medial to femoral n. a. v.
Indirect inguinal hernia - pass through he inguinal ring
When to start infertility work up?
< 35 y/o F - after 12 months
>35 y/o F - after 6 months
Key findings on GBS patients on exam?
Hyporeflexia
NL Babinski
pt is hours s/p adrenalectomy (functional, elevated cortisol and low ACTH) then has adrenal crisis. Why?
adrenal gland atrophy
Leads to adrenal crisis because of the negative feedback of being in a high CRH ACTH state
what is a pituitary apoplexy?
Pituitary infarction
Can also cause and adrenal crisis
Usually have HA and visual changes
What can prevent long term disability in RA patients?
Cytotoxic medications
cause of sick sinus syndrome
chronic SA node dysfunction
alternate between tacky and bradycardia
pacemaker placement is indicated if bradycardia is symptomatic
PE findings c/w Parkinsons
Bradykinesia
Resting tremor
Rigidty
All are asymmetric and improve with dopaminergic therapy
Recent cardiac Cath
“blue toe syndrome” (lived reticular)
Blood work with eosinophilia
Atherosclerotic emboli
Tends to go to lower limbs, kidney, retina, cerebrum, GI tract
can be seen after vascular or trauma surgery
Hematuria
Flank pain
Palpable abdominal mass (firm nontender, moves with respiration)
Dx?
Renal cell carcinoma
CT to confirm
When do you let pancreatitis patients eat?
Low res diet whenever they say they’re ready
What causes hypotension after a PTX?
Decreased venous return
Formula for NNT or NNH?
(incidnce/exposed pop) subtract (incidence/unexposed)
NNH =1/the difference
Polycythemia Torturous veins Thrombocytosis low Epo Dx?
Polycythemia vera
Mutation in JAK2
Triphasic course of postpartum thyroiditis
Hyperthyroid phase
transient hypothyroidism
Recover to euthyroid state
