smartbook post class Flashcards
vascular accident in utero is likely to cause what kind of atresia?
jejunal or ileal atresia
triple bubble sign on XR
gas in stomach, dudodenum, and jejunum
jejunal atresia
indications for bariatric surgery
BMI >40
BMI > 35 with serious comorbidities
BMI > 30 with resistant DMT2 or metabolic syndrome
in chronic pancreatitis, what is the cause of pain and how do you tx it?
pancreatic exocrine insufficiency
hyperstimulation but unregulated CCK release causes pain
tx with pancreatic enzyme supplementation (lipase, protease, amylase) to reduce pancreatic hyperstimulation by CCK
what causes increased risk of sigmoid volvulus
chronic constipation
old person with progressive solid dysphagia, no other big signs, next step?
still do EGD first
what is associated with increased severity and progression of Crohn disease?
smoking
labs in biliary atresia
elevated total and direct bili
elevated GGT (2/2 bile duct destruction) and alk phos
retic ct normal (no hemolysis occuring)
abdominal US shows triangular cord sign (fibrous remnants above the porta hepatis) or a small or absent gallbladder
biliary atresia
late 20s, weeks of lower abdominal pain, bloody diarrhea, and fecal urgency - now more acutely has fever, abdominal distention, leukocytosis, hypotension, and tachycardia
dx? and what test to confirm?
IBD, now toxic megacolon
abd XR
besides surgery, what else can cause ileus?
retroperitoneal/abdominal hemorrhage, intraabdominal inflammation (pancreatitis), intestinal ischemia, and electrolyte abnormalities
abdominal distention, obstipation, abd xr shows uniformly dilated, gas-filled loops of bowel with no transition point
paralytic ileus
acute onset abdominal pain, shock, and acute anemia s/p tx for CLL sometime in the past
splenic rupture
insidious, continuous midepigastric pain that often radiates to the flanks or back and is sometimes worse with eating and lying down
dx and what test?
pancreatic cancer
CT abdomen
triad of elevated aminotransferases, signs of hepatic encephalopathy, and synthetic liver dysfunction (INR >1.5)
acute liver failure
which hepatitis is not associated with acute liver failure?
hep C
what type of ALF can be potentiated by chronic alcohol use?
acetaminophen toxicity
besides cats, how can toxo be spread?
ingestion of raw or undercooked meat from animals infected with toxo
dinner fork deformity
what is fx?
what nerve is injured?
what action will be weak?
distal radius (Colles) fx
dorsal displacement of the radius results in median n compression
motor innervation to the thenar muscles (opponens, and abductor)
fatigue and sypmtoms related to more than one cytopenia
acute myeloid leukemia
fatigue, prolonged bleeding, easy bruising, pancytopenia, coagulopathy, and elevated LDH
acute promyelocytic leukemia
important cause of hypocalcemia, particularly in alcoholics
hypomagnesemia
causes decreased release of PTH and PTH resistance
progressive peripheral edema, ascites, elevated JVP, and pericardial calcifications on chest XR
constrictive pericarditis
why might fat malabsorption occur in zollinger ellison?
inactivation of pancreatic enzymes by increased production of stomach acid may lead to malabsorption
what might make you think a parotid gland mass is malignant rather than the typical benign?
CN dysfunction - facial droop or facial numbness
ophthalmoplegia, ataxia, and areflexia; strength preserved
dx? ab?
Miller Fisher syndrome, variant of GBS
anti-GQ1b antibody
when might VDRL be a false negative
too early in disease process
what happens to LV preload, stroke volume, and cardiac output in cardiac tamponade?
decreases LV preload, SV, and CO
pattern of liver injury with elevated transaminases and normal alk phos
hepatocellular
should get viral hep panel
evaluation of adrenal insufficiency should include an
8 am serum cortisol and plasma ACTH
then cosyntropin stim test
initial tests if suspecting hypopituitarism
hormone levels (8am cortisol, free T4), testosterone, estradiol, IGF-1
diagnostic tests for acute hep B infection
HBsAg and anti-HBc
pt dx’d with Barrett’s 6 mo ago, now has symmetric, circumferential narrowing of the distal esophagus
esophageal stricture
incidental pancreatic cyst with more concerning features, next step?
endoscopic US bx
pt just had surgery, now has increased indirect bilirubin, normal LFTs, no hemolysis
Gilbert syndrome
new sexual partner, tenesmus, mucopurulent rectal discharge
gonococcal proctitis
pancreatic cancer v cholangiocarcinoma
pancreatic cancer could cause common bile duct dilation - obstruction is in the distal biliary tree
cholangiocarcinoma could cause intrahepatic duct dilation
early onset of sexual characteristics, advanced bone age, and low LH level
peripheral precocious puberty
non classical CAH
pt had MI 3 days ago, now has markedly elevated LFTs
hepatocyte ischemia
severe splenomegaly, hepatomegaly
anemia, thrombocytopenia
bony pain
failure to thrive, delayed puberty
Gaucher disease
short stature, anemia, developmental delays, pancytopenia, hypoplastic thumbs
fanconi anemia
hx of prostate cancer that has been tx’d, now having urgency and fecal incontinence
radiation proctitis
endoscopic view show multiple telangiectasias, mucosal pallor and friability in the colon
chronic radiation proctitis
chronic radiation proctitis will cause urgency and fecal incontinence due to
impaired compliance
in diabetics, intensive blood glucose control with insulin decreases the risk of
microvascular complications
(unknown affect for macrovascular)
epigastric pain and melena, pain improves with food
dx and tx?
duodenal ulcer due to H. pylori
abx and pantoprazole
age range for new onset UC
bimodal
15-40 and 50-80
infant at 99th percentile for weight and macroglossia
beckwith wiedemann syndrome
overgrowth disorder with predisposition for neoplasms
how do you do surveillance for someone with beckwith wiedemann syndrome?
serum AFP and abdominal/renal US
what are complications of beckwith wiedemann syndrome
wilms tumor
hepatoblastoma
chest XR in PJP
diffuse bilateral interstitial or alveolar infiltrates
toddler or young girl that has joint pain and stiffness that is worse in the morning
dx and tx
polyarticular juvenile idiopathic arthritis
naproxen
tx of solitary pulmonary nodule in someone who has hx of smoking
surgical excision
drugs associated with photosensitivity rxns
tetracyclines, chlorpromazine, furosemide, HCTZ, amiodarone, promethazine, piroxicam
resulting from airway obstruction and leading to mediastinal displacement toward the side of alveolar collapse
large volume atelectasis
tick disease, flu like symptoms, anemia with intravascular hemolysis and thrombocytopenia
babesiosis
maltese cross
chronic SOB, productive cough, evidence of destruction of lower lungs.
literally no other risk factors
alpha 1 antitrypsin deficiency
common finding in ankylosing spondylitis
arthritis (sacroiliitis)
reduced chest expansion/spinal mobility
enthesitis (tender on tendons)
dactylitis
uveitis
antibodies directed against nicotinic receptors on the motor end plate
dx and next step
myasthenia gravis
CT scan chest looking for thymoma
can generalized anxiety disorder be in kids?
yep
irritability, difficulty falling asleep, poor concentration
often presents with somatic symptoms
asbestos exposure, pleural plaques and cavitary lesion
bronchogenic carcinoma
croup tx order
humidified air and corticosteroids
racemic epi
intubate if prior failed
theophylline toxicity
CNS stimulation (HA, insomnia, sz), GI upset, cardiac toxicity (arrhythmia)
drug known to decrease clearance of theophylline
cipro
how early before surgery do you need to stop smoking?
at least 4 weeks prior
large volume atelectasis - whole side of lung is occluded on XR and has mediastinal shift
mucus plugging
panicking or hyperventilation tx
reassurance and deep breathing
then benzo
what happens to tactile fremitus in pleural effusion
decreased
alveolar consolidation in pneumonia causes hypoxemia due to
R to L intrapulmonary shunting
is heparin contraindicated in CKD
no
first thing to decrease on stable pt who is intubated
fiO2
hx of CAD and bibasilar crackles
CHF
intubation s/p vomiting and needing a lot of suction - what injury?
inflammatory reaction to aspirated gastric acid
tx for hoarding
CBT
tx for acute stress disorder
CBT
perferred modalities for dx’ing a ureteral stone
US or non con CT
labs in rhabdo
increased K and P, decreased Ca, increased AST>ALT
MDD in pt who just had MI, tx?
SSRI
sertraline > citalopram (QT inc)
constant and gnawing epigastric pain that is frequently worse at night, anorexia with wt loss
pancreatic cancer
psoriasis found on the back of hands
kobner phenomenon - caused by frequent minor trauma
arrhythmia most specific for digitalis toxicity
atrial tachycardia with AV block
influenza 5 days ago, now has pna, what bug?
S aureus
HIV pt with acute retinal necrosis and pain
HSV or VZV
HIV pt with painless retinitis, hemorrhages and fluffy or granular lesions around retinal vessels
CMV retitinitis
bilateral, cyclic breast pain
tx?
supportive bra and NSAIDs
pt with large or embolic ischemic stroke could be at risk for …. within 48 hours of presentation.
Dx this with…
hemorrhagic transformation
noncon CT head
What acid base disturbance will you see in a post op pancreatic leak?
nonanion gap metabolic acidosis
pancreas puts out a lof bicarb, think large volume fluid loss from pancreas or SI
UE swelling, erythema, warmth, and pain near PICC line; afebrile
DVT - get US
manic and depressive episodes, with persistence of hallucinations in between episodes
schizoaffective disorder
what cell line are you monitoring when tx’ing pt with clozapine
neutropenia
pregnant lady with intermittent leakage of fluid from vagina, but not amniotic fluid
stress urinary incontinence
infants with blood types A or B born to a mom with blood type O
ABO hemolytic disease
-mild hemolytic disease of the new born
asx at brith or mild anemia, may have neonatal jaundice that responds to phototherapy
wound ulceration after a bite
brown recluse - necrosis and eschar to follow
birth control for someone that is a heterozygous carrier of Factor V Leiden
progestin-releasing intrauterine device
exertional angina in young pt, different BP in each arm, murmur in first R intercostal space
supravalvular AS causing LVH, subendocardial ischemia when having increased O2 demand
significant decrease in GFR in the absence of another clear cause of renal dysfunction, minimal hematuria, and lack of improvement with volume resuscitation
heptorenal syndrome
how does hepatorenal syndrome start out?
cirrhosis progresses and pt develops splanchnic arterial dilation and an overall decrease in vascular resistance
isolated proteinuria in a child, next step?
first morning urine protein/Cr ratio
if still elevated, eval for glomerular/parenchymal disease
holosystolic murmur at apex
MR
acute MR within hours of an MI is likely due to
papillary muscle displacement, underlying hypokinesis
acute MR would do what to LV end diastolic pressure
increase
man with atopic disorders, refractory heartburn, now has some food stuck in his throat
eosinophilic esophagitis
esosinophilic esophagitis un tx’d can lead to
stricture formation
guy with chronic malignancy goes into the hospital for surgery. everything goes great.
couple days later, feeding tube is in, and he is weak, has hypoK, hypoPhos, and arrhythmias
refeeding syndrome
fingerstick lead level is elevated, next step
get venous lead level, capillary has a lot of false positives
tx of lead toxicity >45
tx of lead toxicity >70
first succimer/dimercaptosuccinic acid
then dimercaprol plus EDTA
what test do you get to dx TTP
peripheral blood smear
HIV and Hep C untreated, think of
TTP
tx of single brain metastasis
surgical resection if accessible
tx of multiple brain metastases
whole brain radiation
blunt trauma, mid back pain, CVA tenderness, microscopic hematuria
next step?
CT scan abd pelvis
large contributor to medical errors and adverse pt outcomes
communication failures between physicians
tool to prevent undesired medical outcomes that result from physician communication failures
check list
tx of myasthenic crisis
plasmapheresis or IVIG as well as corticosteroids
anticholinergic used in tx of symptomatic parkinsons disease?
what side effect?
trihexyphenidyl
AE: mydriasis, ppt acute angle closure glaucoma
most significant risk factor for preterm deliver
hx of spontaneous preterm delivery
soft mobile mass in unilateral breast of woman who has been breast feeding
galactocele
not fibroadenoma because estrogen decreased rn
signs of relative mineralocorticoid deficiency include
hypotension, hyperkalemia, hyponatremia, and elevated plasma renin
cancer pt can’t sleep because waking up in pain, tx?
sustained release morphine
MI causes cardiogenic shock, doing what to preload, CO, and afterload
increases preload
decreases CO
increases afterload
candida on KOH prep looks like
pseudohyphae with budding yeast forms (blastoconidia)
what skin infection has a coral red appearance under wood’s lamp?
erythrasma - corynebactrieum minutissimum
minor sunburn, tx?
NSAIDs
suburn with blisters tx?
prevent bacterial superinfection with silver sulfadiazine or mupirocin
what is the MC site of hemorrhage if spontaneous intracranial hemorrhage due to hypertensive vascuolapathy?
basal ganglia
tramadol + SSRI
serotonin syndrome
AMS, autonomic dysregulation, and neuromuscular hyperactivity
serotonin syndrome
subacute symptoms of diarrhea, bloody stools with mucus, and abdominal pain after traveling
amoebic colitis
entamoeba - get stool ova and parasites
toddler with hematuria and recurrent otitis media
Wiskott-Aldrich syndrome
hx of mechanical mitral valve, now having HF symptoms
prosthetic valve thrombosis
mechanism underlying Paget’s disease of bone
disorganized bone remodeling
fatigue and aching joints, ED, decreased libido, mild hepatomegaly, mild tenderness and swelling of the MCP joints
dx?
hereditary hemochromatosis
severe preeclampsia at 37 weeks, next step
induce vaginal delivery if all stable
MC etiology of persistent nasal obstruction during childhood
adenoid hypertrophy
what does Fetal fibronectin actually tell you?
protein found in interface of the chorion and decidua - contractions interrupt and release FFN into vaginal secretions
positive FFN = strong predictor of delivery within next week = give betamethasone
negative FFN = low likelihood delivery within next 2 weeks and can resume routine prenatal care/expectant mgmt
proximal muscle weakness, HTN, 40 pack year hx, absent DTRs
Lambert eaton myasthenic syndrome
autoantibodies v presynaptic calcium channels
small cell lung cancer - get CT
dementia characterized by fluctuating cognition/attention
lewy body dementia
impending delivery and unknown GBS status?
give penicillin
complication of MI -> ventricular aneurysm, then another complication
mural thrombus leading to systemic arterial embolization
kid with Otitis media didn’t finish abx and now has clinically dx’d mastoiditis - next step?
IV abx
SOB for a year, dyspnea with exertion, mild morning cough, hx of smoking - next step
spirometry
imaging showing colonic dilation without anatomic obstruction on imaging
colonic pseudo obstruction - ogilvie syndrome
MC dermal manifestation of antiphospholipid syndrome
livedo reticularis
what does PTT do in antiphospholipid ab syndrome?
prolongs, will not correct
beta 2 microglobulin is elevated in
lymphoproliferative disorders like multiple myeloma
iron overload would present in what systems?
affect liver (cirrhosis), heart (cardiomyopathy), pancreas (diabetes), and skin (hyperpigmentation)
basophilic stippling on peripheral blood smear
lead poisoning
cardiotoxicity of chemo (anthracyclines like doxorubicin)
cardiomyocete replacement by fibrous tissue
painless penile ulcer for several months
penile cancer
mgmt of trauma pt with hemorrhagic shock
type O blood transfusion
consider massive transfusion protocol
initial tx knee OA
PT - strengthen quads
post op dark red, sanguineous drainage and increasing incisional pain
incisional hematoma
cushing syndrome with adrenal mass
what is cortisol, ACTH and DHEA doing?
increased cortisol, decreased ACTH, decreased DHEA
all pregnant pts should get what vaccine every pregnancy in their third trimester?
Tdap - protects mom against pertussis and provides passive immunity to the infant
super high glucose level, what do you need to remember?
decrease 2 Na for every 100 excess glucose
translocational hyponatremia
generalized anxiety, but only for 2 months, make
MDD more likely
onychlysis and pitting of the nails is associated with
psoriatic arthritis
will reactive arthritis have a high fever?
no
cutting in adolescent but not suicidal
respect pt’s privacy and advocate for therapy
what antiemetics are dopamine antagonists and therefore can cause EPS?
prochlorperazine
promethazine
metoclopramide
random need to walk in someone taking dopamine antagonists
akathisia
myeloproliferative disorder that is occasionally characterized by pancytopenia but is almost always associated with massive splenomegaly due to extramedullary hematopoiesis
myelofibrosis
dysplastic red and white blood cells are on peripheral smear
myelodysplastic syndrome
SIADH will have what serum and urine osm and urine Na levels?
low serum osm
high urine osm
high urine Na
what causes an increased production of thyroid hormones in pregnancy?
hCG directly stimulates TSH receptors
hernia medial to the inferior epigastric vessels
direct inguinal hernia
hernia due to weakness of transversalis fascia
direct inguinal hernia
first line tx of HPV warts in pregnancy
topical trichloroacetic acid
imiquimod and podophyllin are CI due to potential teratogenicity
malabsorption causes of folate deficiency?
celiac
IBD
infiltrative bowel disease
short bowel syndrome
neutropenic fever abx options
pip-tazo
meropenem
imipenem-cilastatin
cefepime
what antibiotic caues sensorineural hearing loss?
what is the most potentially life threatening complication of this drug?
aminoglycosides
acute tubular necrosis
sinus tachycardia usually is not much higher than
140 bpm
narrow QRS complex and regular R-R interval
supraventricular tachycardia
MC type of hodgkin lymphoma
nodular sclerosing type
mosaic pattern of bone
Paget disease
established legal precedence for informed consent
Schloendorff v society of NY hospital
poor prognostic factor and imparts a high risk for relapse of leukemia
CSF involvement
leukoaraiosis with multiple discrete hypodense foci
vascular dementia
anaerobes
peptostreptococcus
fusobacterium
prevotella
bacteroides
initial screening test for HIV
HIV-1/2 antigen/antibody combination immunoassay followed by confirmatory HIV 1/HIV 2 antibody differentiation immunoassay
rash, fever, acute onset azotemia with hx of nsaid use
acute interstitial nephritis
inflammatory infiltrate on renal bx
tx of non classical CAH
OCPs first, then can try spironolcatone
2 day old hasn’t lost weight, decreased urination
posterior urethral valves
how do you avoid catheter associated UTI in pt with neurogenic bladder
clean intermittent catheterization (CIC)
use for tx’ing alcohol withdrawal
lorazepam
swelling in LE that worsens throughout the day and then resolves overnight
venous valvular incompetence
guy with recurrent jaw pain, worse with eating, tender mass under jaw and goes away with abx
what precipitated this?
sialolithiasis
what might still be present in someone with brain death?
DTRs
lyme carditis presentation
within first few weeks or months of infection
AV block - lightheadedness, syncope, dyspnea, chest pain, and/or palpitations
what are 4 risk factors for developing acute otitis media
young age
lack of breastfeeding
day care attendance
passive smoke exposure
TMP-SMX use and then tender, indurated lesions on the LE
erythema nodosum
this can be triggered by antibiotics, and cause presentation of painful, raised, nonblanching, palpable purpura
leukocytoclastic vasculitis
blood gas analysis in pt with aspirin intoxication
mixed respiratory alkalosis and anion gap metabolic acidosis
Sickle cell pt with increased MCV
folate deficiency
cervical spine trauma, de-satting, next step
orotracheal intubation
prior to initating trastuzumab…
get an echo
baseline assessment of cardiac function
healthy pt, shows up at prenatal and has multiple gestation. everything looks good. next step?
rx aspirin to decrease risk of preeclampsia
common cause of stroke in young pt that may occur spontaneously after mild trauma or illness
internal carotid artery dissection
Horner syndrome, unilateral head and neck pain, and TIA
ICA dissection
mgmt of migraine in pregnancy
nonpharm
acetaminophen
antiemetics (promethazine), codeine, caffeine/butalbital
NSAIDs
Opioids
HPV dosing - 2 or 3?
3 doses if older than 15
2 doses if younger than 15
diffuse atherosclerosis, recurrent flash pulm edema - next step?
get renal US doppler
pt with PAD is most at risk for
MI
then stroke
development of hemorrhagic lesions after ischemia or the exposure of gastric mucosa
acute erosive gastropathy
CHF v COPD exacerbation
CHF will have bibasilar crackles and have respiratory alkalosis
risk factors for shoulder dystocia
fetal macrosomia
maternal obesity
excessive pregnancy wt gain
DM
post term
periarticular erosions on XR with elevated inflammatory markers
RA
pt with target cells and microcytosis on blood smear
alpha thal
no specific tx
tx of acute iron poisoning
deferoxamine
protruding rectal mass that occurs with valsalva maneuver
rectal prolapse - surgical repair
a year of weakened stream and now urinary retention
bladder outlet obstruction 2/2 BPH
kid with hx of bacterial meningitis, tx’d and recovered, now doesn’t respond to questions right away
hearing loss- inflammatory damage to cochlea
nitrates action
systemic vasodilation, decrease LVEDV and decrease LV wall stress
tx radial head subluxation
hyperpronation of forearm
OR
supination of forearm and flexion of elbow
adverse effects of rivastigmine or other acetylcholinesterase inhibitors
diarrhea, vomiting, bradycardia
trimethoprim causes what electrolyte abnl?
what other lab value does TMP affect?
hyperK
creatinine
