Set 9 Flashcards
Tx DVT/PE?
heparin bridge to warfarin. if 1st event, 6mo. If recurrent, lifelong anticoagulation
FSH, LH, FSH/LH expected in premature ovarian failure? confirmatory criteria?
- dec FSH and LH
- FSH:LH ratio >1 b/c FSH is cleared from circ slower.
Dx = FSH very elevated in woman 3 mos of amenorrhea - confirms dx
SE of dihydropyrodine CCBs
peripheral edema (especially amlodipine)
When do you get a CT in head fall? what about admission/neuro checks?
no LOC or neuro findings –> no CT, send home
If vomiting, HA or LOC –> CT, if neg send home
if severe HA, prolonged LOC or seizures, admit
Abnormal bleeding in patient with CKD due to? Tx?
platelet dysfunction, tx = DDAVP (release stores of factor 8/vWF)
3rd trimester bleeding with uterine tenderness and increased tone, contractions. Ddx?
Placental Abruption* = a/w pain, dark red bleeding
placenta previa = NO pain, bright red bleeding
HIV patient with PCP, when do you add steroids to the tx?
when PaO2 35
smelly discharge and vaginal pH of 5.5, ddx and differentiate?
trichomonas vaginITIS = gray-green frothy d/c with INFLAMMATION PRURITIS, dysuria/dyspareunia
bacterial vaginOSIS = NO inflammation or pruritis
normal vaginal pH
3.5-4.5
secondary amenorrhea + galactorrhea. next tests?
pregnancy test, THEN TSH (hypothyroidism can elevate PRL level).
also, FSH to r/o ovarian failure, PRL for hyperprolactinemia.
2 complications (NOT PE findings) of nephrotic syndromes?
hypercoagulability and dyslipidemia (leads to atherosclerosis and strokes/MI!)
Fever, dysphagia, odynophagia and drooling in an alcoholic? MCC?
Ludwig Angina = progressive b/l cellulitis of the submandibular + sublingual sapces 2/2 tooth infxn. MCC strep or anaerobes
MCC mucolpurulent cervicitis
Chlamydia trachomatis
Feared consequence of whiplash injury
central cord syndrome. damage to central portion of ant SC - central parts of CST +/- decussating fibers of lat STT.
- weakness more pronounced in upper ext b/c motor fibers for arms are nearer to the central part of the CST. +/- loss of pain and temp (STT )
(similar to syringomyelia - expansion of central canal -> fibers of STT are affected first. cape-like loss of pain/temp)
18yo girl w/ primary amenorrhea, normal breasts and pubic hair, blind vagina and no uterus, 2 ovaries, 46 XX?
Mullerian agenesis
CI succinylcholine
hyperkalemia –> depolarizing NM blocker can cause further K+ release –> arrhythmias
SE acyclovir
renal tubule obstruction 2/2 crystalluria (poorly soluble drug in urine)
TSH and T4 levels in pregnancy, MoA?
TSH and free T4 normal, increased total T4 –> due to increased E2 causing increased TBG and stimulation of TSH receptors by BhCG
chromosome findings in Kallmann Syndrome
46 XX (GnRH deficiency, anosmia)
Tactile fremitus incr/decr in: PNA, Pleural E, COPD, pneumo
increased only in PNEUMONIA b/c fluid is INSIDE the lungs –> sound transmits faster.
all others have fluid outside the lungs, therefore decreased tactile fremitus)
Tx clavicular fx
middle 3rd–> check neuroarterial injury, if OK then brace and rest, no reduction
Distal 3rd –> may require ORIF
what is plan B, how long afterwards can you take it, efficacy?
levonorgestrel, up to 120hrs, 7/8 won’t get preggers
What is pseudocyesis?
false pregnancy –> woman displays psychophysical signs of pregnancy w/o actual pregnancy. NORMAL endometrial stripe on US and negative pregnancy test in the OFFICE (regardless of home test result)
Tx duodenal hematoma 2/2 blunt trauma
NGTD and parenteral nutrition, resolves in 1-2wks
Equation for respiratory compensation for either metabolic acidosis or alkalosis
acidosis –> PaCO2 = 1.5xHCO3 + 8, +/- 2
alkalosis –>PaCO2 = 0.9xHCO3 + 16, +/-2
Causes of acute renal transplant dysfxn, dx tests?
urethral obstruction --> US acute rejection --> bx cyclosporine toxicity --> blood levels vascular obstruction --> radioisotope scan ATN
rash, arthralgias, ARF, eosinophils in urine?causes?
Drug-induced interstitial nephritis
Causes = cephalosporins, PCN, sulfonamides, NSAIDS, rifampin, phenytoin, allopurinol
H pylori is a/w what cancers?
gastric ADENOCARCINOMA
MALT lymphoma
Tx pre-eclampsia (3)?
MgS –> prevents FURTHER seizures (not abortive)
hydralazine or labetolol for HTN
deliver the baby!
clear cell carcinoma of the vagnia
DES expsoure
Bronchiectasis vs. chronic bronchitis?
bronchiectasis = irreversible dilation + destruction of bronchi leading to recurrent respiratory infxn and chronic mucopurulent daily cough
chronic bronchitis = productive cough for 3+mo in 2+yrs. PE with crackles, rhonchi, wheezing
painless blisters, hypertrichosis, hyperpigmentation. Dx? A/w?
porphyria cutanea tarda
a/w Hep C, often triggered by ethanol or E2
Endometritis, causes? Tx?
POLYMICROBIAL! MC anaerobes E coli, GBS, bacteroides
Tx = gentamicin and clindamycin until afebrile for 48hrs
2 extrarenal complications of ADPKD?
berry aneurysms and HEPATIC cysts
Role and natural history of BhCG
maintains corpus luteum (produces progesterone until placenta can)
begins 8d after fertilization, doubles every 48hrs until peaks at 6-8wks
SJS and TEN are what type of hypersensitivity reaction?
type 3 = immune-complex mediated
lightly pigmented patches on upper back that don’t tan? Tx?
tinea versicolor
Tx = topical selenium sulfide + ketoconazole shampoo
McMurrys sign indicates? what is a positive test? Tx?
Dx for meniscal tears –> positive if “snapping” upon extending leg with full knee flexion and applying tibial torsion.
Tx = NSAIDs 1st, then arthroscopic repair if necessary
When do you remove gonads in androgen insensitivity syndrome? what is the Tx needed afterwards?
AFTER puberty, decreases the risk of testicular carcinoma. MC done in 20-30s.
Tx = E2 needed to maintain female features afterwards (no progesterone bc no uterus)
When do you remove gonads in Swyer syndrome (XY gonadal dygenesis)?
IMMEDIATELY bc malignant change can occur at any time
progressive SOB, clupping and pleural plaques on CXR? Dx?
absestosis (restrictive)
decreased TLC and DLCO.
FEV1/FVC is normal (equally reduced)
immunosuppressants that can cause BM supression? (5)
mcyophenolate, 5-FU, 6-MP, methotrexate and vinBLASTine
IUFD. fibrinogen low/normal. platelets low/normal. normal PT, PTT. POA?
deliver fetus. fibrinogen levels are higher in preg, so low/normal should raise suspicious of consumptive coagulopathy due to retnetion of fetus. other signs: dec platelets, inc in PT and PTT, presence of fibrin split products.
Tx vaginal candidiasis
topical antifungals = clotrimazole, miconazole, nystatin)
OR
oral fluconazole
Tx CAP (mild vs severe)
mild = outpatient = azithro or doxy severe/inpatient = levofloxacin moxifloxacin to cover atypicals (NOT CIPROFLOXACIN)
syphilis vs granuloma inguinale vs chancroid?
- chancroid is painful. no LAD.
- syphilis - painless ulcerated chancre with punched out base and raised margins. LAD. ulcer will resolve without abx.
- granuloma inguinale (donovanosis) - painless. ulcer with red, beefy base. no LAD. req ABX to resolve!
MoA and CI of Raloxifene?
mixed E2 agonist(breast, vagina) -antagoinst(bone)
1st line Tx prevent osteoporosis and decreasing risk of BCA, but INCREASED risk of thromboembolism, CI h/o DVT/PE
post-BMT patient with lung and GI complaints?
CMV –> causes pneumonitis and GI ulcers/esophagitis
Tx precocious puberty? MoA?
GnRH AGONIST!! = leuoprolide
prevents premature fusion of epiphyseal plates
Big cyst with daughter cysts w/in it? a/w? Tx?
echinococcal cysts = liver > lung
A/w sheep and dog exposure
Tx = albendazole
immunosuppressant drug causing nephrotox, gum hypertrophy, hirsutism, tremor? similar drug?
Cyclosporine; tacrolimus does NOT have gum hypertrophy or hirsuitism tho
