Smartdeck, 6.8 start Flashcards
most affective antipsychotic for treatment-resistant schizophrenia and schizoaffective disorder?
clozapine
most severe AEs of clozapine
agranulocytosis, seizures, myocarditis
compared to other antipsychotics, which one has the greatest risk of seizures?
clozapine
what actions are associated with risk reduction for long term rx opioid misuse?
state rx drug monitoring, random UDS, regular follow up
gold standard for evaluating risk in pt with hx of cervical surgery
transvaginal US
dysarthria, loss of DTRs, progressive gait and limb ataxia in adolescence
loss of position and vibratory senses
hypertrophic cardiomyopathy
friedreich ataxia
acute onset of ataxia, nystagmus, and dysarthria following an infection
acute cerebellar ataxia
musty odor urine
phenylketonuria
if PKU goes untreated…
intellectual disability and seizures
how to detect PKU
newborn screening
tandem mass spectrometry of dried blood spots
later in life - quantitative amino acid analysis
tx of PKU
dietary restriction of phenylalanine
how to differentiate hirschsprungs v meconium ileus
level of obstruction
Hirsh- rectosigmoid, normal consistency, positive squirt sign
mec ileus - ileum, inspissated consistency, negative squirt sign
bone pain and pancytopenia in a child
also fever, pallor, bruising, and hepatosplenomegaly
acute lymphoblastic leukemia
acute, unilateral cervical lymphadenitis in child is MCC by
S. aureus or S. pyogenes
pt has pna and developed signs of septic shock
airway is secure, what next?
IV normal saline
what is the MCC of community acquired bacterial meningitis
S. pneumo
can occur with or without concurrent pneumococcal pna
Vagal maneuvers will affect with node in the heart, AV or SA?
AV
High dose IV acyclovir can cause
crystalluria with renal tubular obstruction
diaphragmatic flattening in COPD caused by hyperinflation result in
increased work of breathing
intrinsic renal failure is commonly due to
acute tubular necrosis
high urine sodium
glomerulonephritis is characterized by
hematuria with RBCs
precocious puberty, normal bone age, really just increasing body hair
premature adrenarche
caused by early activation of adrenal androgens, more common in obsese children
profound hypoglycemia in pregnancy
acute fatty liver of pregnancy
management of acute fatty liver of pregnancy
immediate delivery
mucopurulent drainage with a friable cervix
acute cervicitis
management of hydatiform mole
DnC
serial bhCG post evacuation
contraception for 6 months
in adolescents, abnormal uterine bleeding is caused by
immature hypothalamic-pituitary-ovarian axis
causing irregular, heavy bleeding
in hemodynamically stable pt, acute uterine bleeding can be managed with
IV estrogen or high dose oral estrogen/progestin contraceptive pills
how long do you need pharmacotherapy for bipolar pt with multiple episodes?
likely life long
palpable lymph node, small/<2cm, soft, mobile nodes, localized to one area in a child or young adult
next step?
observation
tx for body dysmorphic disorder
SSRI and CBT
prerenal AKI is characterized by
low urinary sodium (<20)
low fractional excretion of sodium (<1%)
elevated BUN:Cr >20:1
urine sediment is bland
stable pt with wide complex tachycardia can be initially managed with
antiarrhythmics like amiodarone
daily copious mucopurulent sputum in pt with chronic cough
bronchiectasis
test to determine if Crohns or UC
colonoscopy
older adult with progressive neck pain, gait disturbances, lower motor neuron signs in UE, and UMN signs in LE
cervical spondylotic myelopathy
persistent, eczematous, and/or ulcerating rash is localized to the nipple and spreads to the areola
paget disease of the breast
what kind of cancer is associated with Paget disease of the breast?
adenocarcinoma
does primary syphilis have associated adenopathy
yes
mild to moderate LAD is often present
what causes granuloma inguinale?
klebsiella granulomatis
extensive, progressive, painless genital ulcers, usually without LAD
granuloma inguinale
infection causing vaginal pH <4
candida
normal pH is 3.8 -4.5
initial evaluation of mixed urinary incontinence
voiding diary
first line tx for primary dysmenorrhea
NSAIDs
physiologic change of pregnancy associated with insulin
increased insulin resistance due to increased levels of placental somatomammotropin
what is placental somatomammotropin?
human placental lactogen
what is the cause of labial adhesion?
if symptomatic, what is the tx?
low estrogen production
topical estrogen cream
side effect of oxytocin
similar to ADH, hyponatremia, seizure
Pts in preterm labor at <32 weeks require:
betamethasone (decrease risk neonatal RDS)
tocolytics/indomethacin
mag sulfate for fetal neuroprotection
what age can get vulvar lichen sclerosus
prepubertal girls and perimenopausal or postmenopausal women
tx vulvar lichen slcerosus
superpotent corticosteroid tx
in what age pt would you see labial adhesions?
<2 yo
high risk pts in pregnancy require what in third tri?
repeat testing for STIs
pregnant lady with pruritis worse on hands and feet; markedly elevated total bile acids
intrahepatic cholestasis of pregnancy
absent coagulation factor carboxylation
vit K deficiency
rupture of emissiary veins upon scalp traction during delivery
subgalel hemorrhage
diffuse fluctuant swelling extending beyond suture line in neonates
subgaleal hemorrhage
subperiosteal vessel rupture
cephalohematoma
firm, non fluctuant swelling, does not cross suture line in neonate
no significant blood loss
cephalohematoma
pressure of presenting part of the scalp against a dilating cervix
caput succadaneum
moderately dehydrated normal kid
IV normal saline
neonate with bruising after a home birth
vit K deficiency
reduced coagulation factor carboxylation
multiple infxns, S. aureus, Serratia, Burkholderia cepacia (catalase positive)
chronic granulomatous disease
umbilical cord fails to separate, decrease immune system
leukocyte adhesion deficiency
preterm, leukocytosis, metabolic acidosis, bilious vomiting
necrotizing enterocolitis
cyanosis in infant, bounding peripheral pulses, harsh systolic murmur at lower left sternal border, loud S2
truncus arteriosus
cyanosis, tachypnea, single loud S2
transposition of great vessels
defect in NADPH oxidase
chronic granulomatous disease
infecting organisms are catalase positive (S. aureus, E. coli, candida, klebs, pseudo, aspergillus, nocardia, serratia)
chronic granulomatous disease
diagnostic test for chronic granulomatous disease
dihydroorhodamine test
defect in neutrophil chemotaxis/microtubule polymerization
chediak higashi
oculocutaneous albinism, peripheral neuropathy, neutropenia
chediak higashi
coarse facies, abscesses, retained primary teeth, hyper IgE, dermatologic
Jobs syndrome
Hyper IgE
tx of hyper IgE syndrome
penicillinase-resistant abx and IVIG
recurrent neisseria infxns, rarely lupus or glomerulonephritis
MAC deficiency
tx for spascity of cerebral palsy
diazepam, dantrolene, baclofen
sepsis work up
CBC, UA, blood/urine/CSF culture
tongue fasiculations and symmetric proximal muscle weakness, greater in LE than UE
spinal muscular atrophy
young child with cervical paravertebral sympathetic chain LAD, droopy eyelid, constricted pupil, abdominal mass
neuroblastoma
elevated vanillylmandelic acid and homovanillic acid
neuroblastoma
3 yo presents with gross hematuria and painless right sided abdominal mass
wilms tumor
claw sign on abdominal mass imaging in kid
wilms tumor
kidney mass crossing midline on imaging
neuroblastoma
osteosarcoma (aka osteogenic sarcoma) is also associated with
Rb and Paget disease
predominantly cortical small tumor, severe nocturnal pain
dx and tx
osteoid osteoma
NSAIDs
where is osteoblastoma located?
spine
bony overgrowth of the hard palate
torus palatinus
lytic lesions in the skull, in child
langerhans cell histiocytosis
immune cells, langerhan histiocytes, tennis-raquet, bierbeck granules
most likely site of injury of clavicular fx
middle third of clavicle
overuse apophysitis
osgood schlatter
SCFE pt that is less than 10th percentile for height, get
TSH
kid with diet of mostly cheese and yogurt and drinks ridiculous amounts of milk
Fe deficiency anemia
ambiguous genitalia, super high testosterone, 46, XX
CAH
5 alpha reductase deficiency will be in what karyotype?
46 XY
aromatase deficiency will present with
virilization in both the fetus and the mom
failure to thrive, jaundice, hepatomegaly, infantile cataracts, neuro symptoms
galactosemia
excess urination in sickle cell trait
hyposthenuria
kidney cant concentrate urine
pt with friederich ataxia is most likely to die from
cardiac issue
calcified lesion in sella turcica in kid
craniopharyngioma
jaundice, pale stools, and dark urine during 2-8 weeks old
biliary atresia
amylase rich, exudative pleural effusion
pancreaticopleural fistula
decreased air flow during both inspiration and expiration, flattening the top and bottom of a flow loop is likely caused by
fixed upper airway lesion
sudden onset respiratory distress following removal of a central venous catheter
venous air embolism
tx of venous air embolism
L lateral decubitus, in order to trap VAE on the lateral wall of the R ventricle
prevents RVOT obstruction and further embolization
more than 2 years of numerous periods with hypomanic and depressive symptoms, but not meeting full criteria for hypomania or depressive symptoms
cyclothymic disorder
depressed mood lasting most days for more than 2 years
persistent depressive disorder
low urine osmolality and low urine specific gravity suggest dilute urine, as seen in
diabetes inspidus
high urine osmolality and specific gravity suggest osmotic diuresis from conditions like
diabetes mellitus
DVT following a surgery, pt has ESRD tx?
unfractionated heparin followed by warfarin
heparin would be contraindicated in what pts?
ESRD pts
respiratory distress, neuro dysfunction, and petechial rash after a femur fx
fat embolism syndrome
dx of gastric cancer is established with
EGD
patchy, nonscarring hairloss, autoimmune
alopecia areata
tx of alopecia areata
topical or intralesional corticosteroids
topical triamcinolone
laryngomalacia has an
inspiratory stridor
drug fever from antibiotics (typically beta lactams) is dx of exclusion and generally accompanied by
rash and peripheral eosinophilia
eczema, microthrombocytopenia, and recurrent infections
wiskott aldrich syndrome
why do turner syndrome babies have swollen hands and feet
lymphatic network dysgenesis
bupivacaine systemic toxicity
CNS overactivity - perioral numbness, metallic taste, tinnitus
generalized tonic clonic seizure
within 2 standard deviations of the mean is what percentage?
95% of data
greatest risk related to parenteral nutrition
central line associated bloodstream infection
thready pulses over both radial arteries that disappear with deep inspiration
pulsus paradoxus
cardiac tamponade
characteristic CSF findings in herpes simplex virus encephalitis
lymphocytic pleocytosis, increased erythrocytes, and elevated protein, normal glucose
mass causing Cushings is secreting what?
ACTH, ectopic corticotropin, polypeptide hormone
tx for nonvalvular AF
options include: rivaroxaban, dabigatran, apixaban, and endoxaban
exudative effusion with very elevated protein
Tuberculosus
flu vaccines in HIV
MMR and varicella zoster vaccines in HIV
never give LAIV
live MMR and VZ vaccines CI if <200 CD4 ct
HA worse when leaning forward, JVD but no peripheral edema
superior vena cava syndrome
fever, ascites, diffuse abdominal pain, tachycardia, AMS
spontaneous bacterial peritonitis
subepidermal blisters
bullous pemphigoid
intraepidermal cleavage
pemphigus vulgaris
what enzymes are elevated in polymyositis
CK, aldolase, AST
with a tension pneumo, the high intrathoracic pressure will
impede venous return to the R atrium by compressing the vena cava
what do you see on CT of chronic pancreatitis?
calcifications
what happens to lipase in chronic pancreatitis?
doesn’t have to be elevated
also, alcohol doesn’t always cause liver elevation
Pt just had roux en y gastric bypass, and they are likely developing symptomatic gallstones. Why does this happen?
due to rapid weight loss, promoting gallstone formation, likely from increased bile concentrations of mucin and calcium
elevated phosphate level and low calcium in setting of CKD is characteristic of …
the resulting elevation in PTH can cause…
secondary hyperparathyroidism
renal osteodystrophy
hypocalcemia and hyperphosphatemia stimulate release of PTH to maintain normal electrolyte levels. overtime, this will result in
parathyroid gland hyperplasia
high nitrogen states that could cause hepatic encephalopathy
GI bleeding or dietary changes
suicidal pt, hematemesis, green/black diarrhea, severe abdominal pain.
what did she take?
acute iron poisoning
new onset AF, unintentional wt loss
what test do you get?
TSH
the prognosis of astrocytomas is most affected by
tumor grade, with increased atypia, mitoses, neovascularity, or necrosis conveying a worse prognosis
multi-chain LAD, splenomegaly, mild cytopenias, and marked lymphocytic predominant leukocytosis
CLL
first line tx of CLL
rituximab, mab v CD20 antigen expressed on B lymphocytes
what is the relationship, generally speaking, between sensitivity and specificity?
as sensitivity increases, specificity decreases
and vice versa
tx for advanced pancreatic cancer causing jaundice an pruritis by obstructing the CBD
palliative - endoscopic CBD stent placement
amlodipine or metoprolol for controlling AF
metoprolol
amlo is DHP, causing vasodilation, not affecting conduction rate
wenckebach is a
Mobitz type I
why does renal insufficiency happen in multiple myeloma?
light chain cast nephropathy with resultant renal tubular injury
trinucleotide CGG repeat on FMR1 gene on the X chromosome
Fragile X syndrome
exhibit features of autism
3-5 days s/p MI; acute hemodynamic compromise and a holosystolic murmur at the left sternal border
ventricular septum rupture
meckel diverticulum pathophys
ectopic gastric mucosa
anemia seen in patients with DIC is often due to
microangiopathic hemolysis
mitral stenosis murmur
mid diastolic murmur at the cardiac apex
when do you monitor Lipids?
If 10 year ASCVD is >7.5%
hemothorax will do what to preload
decrease preload, blood is pooling elsewhere
nonlobular infiltrate on chest CT
pulmonary contusion
central obesity, proximal muscle weakness, HTN, and easy bruising
Cushing syndrome
upper GI series shows a cork-screw shaped duodenum that is abnormally located in the R abdomen
midgut volvulus
common bug causing immunocomprised (like on chronic glucocorticoids) pt to have bacterial meningitis in pt >50 yo
listeria
what can you tell a pt who gets a ton of gout attacks
drink less alcohol
oral vesicles in a kid
herpangina, coxsackie A
peripheral blood smear shoing signs of dysplasia, oval macrocytes, and hyposegmented/hypogranulated neutrophils
next step?
dx?
bone marrow biopsy
myelodysplastic syndrome
MC complication of neutropenia
bacterial infxn
what causes symptoms of DKA physiologically
fatty acid breakdown in the liver, generating ketones
V/Q scan can be used to rule out PE in pregnancy if…
it is normal
if low probability, get CTA
tx for urinary urgency
lifestyle mods, bladder training, antimuscarinic
vaginal bleeding in pt >20 weeks, next step?
US to find placenta location
blunt trauma, XR shows widened mediastinum, next step?
CTA chest
chronic loss of visual acuity, excessive glare, and halos around bright lights
cataracts
advanced cases of cataracts may show
loss of red reflex
what beta blockers have been shown to improve symptoms and overall long term survival in stable patients with heart failure and LV systolic dysfunction?
metoprolol succinate
carvedilol
bisoprolol
first line tocolytic at 32-34 weeks gestation
nifedipine
tocolytic to use prior to 32 weeks
indomethacin
what causes central cyanosis
low arterial oxygen saturation
urine findings in rhabdo
dark red urine
positive blood
absence of RBC
AKI
use of OCPs is associated with decreased risk of
ovarian and endometrial cancer
sotalol side effect
torasdes
low grade fever, LAD (suboccipital, posterior auriculuar, and posterior cervical), descending rash in child
rubella
carditis, chorea, and elevated ESR; also could have erythema marginatum, subcutaneous nodules, and migratory arthritis
acute rheumatic fever
best intervention to minimize AAA progression
smoking cessation
inability to recall important personal information, usually of traumatic or stressful nature; not explained by another disorder
dissociative amnesia
feelings of detachment from, or being an outside observer of, one’s self
depersonalization
experiencing surroundings as unreal
derealization
in depersonalization/derealization disorder, reality testing will be …
intact
irregular patchy hair loss, uneven hair growth and absence of other findings
trichotillomania
bloating, steatorrhea, and macrocytic anemia in setting of RYGB surgery
SIBO
test to dx symptomatic diverticulitis
abdominal CT with con
initial tx for anterior spinal cord injury
disrupted autonomic function - causing urinary retention - put in a bladder catheter
membranous nephropathy is a nephrotic syndrome and that means this person is also…
hypercoaguable
3 months constipation in older person and pain unrelated to bowel movements is suspicious for
malignancy
irregular abdominal protuberance in an acute pregnant lady
fetal parts - uterine rupture
antiemetics that are dopamine antagonists?
what are their side effects?
metoclopramide and prochlorperazine
extrapyramidal symptoms
IBD is frequently complicated by … and this can be exacerbated by NSAIDs
arthritis
how do you confirm central venous catheter placement?
chest XR
how do kidneys repsond to OSA?
increasing epo, resulting in erythrocytosis
tx of chemo related diarrhea
loperamide
tx of beta blocker toxicity
glucagon
retracted TM
eustachian tube dysfunction
tumor markers from nonseminomatous germ cell tumors
AFP and hCG both elevated
erythema of the central face, facial flushing, telangiectasias, and burning discomfort
erythematotelangiectatic rosacea
pregnant pt positive for GBS, needs intrapartum ppx, has low risk penicillin allergy
give cefazolin
tx of anaerobic/aspiration lung infection options
amoxicillin, amox-clauv, and clinda
before starting MTX, what do you need to check on the pt?
liver labs
unstable pt, unknown AAA, next step?
FAST exam
TCA overdose and is having cardiac abnormalities, tx?
sodium bicarb
sodium load will alleviate depressant action on myocardial sodium channels
short term hyperventilation helps lower ICP by causing
cerebral washout of CO2, leading to vasoconstriction and decreased cerebral blood flow
bacterial meningitis in neonate with increased ICP, next step?
LP to properly dx
why does cushing syndrome have myopathy??
due to direct catabolic effects of cortisol on skeletal muscle, leading to muscle atrophy
AIDs pt with increased ICP, progressive HA, N/V and confusion
cryptococcal meningitis
rapid onset episodes of tachycardia, hypertension, and tachypnea often associated often accompanied by fever and diaphoresis after a TBI
paroxysmal sympathetic hyperactivity
injury to hip, adduction and internal rotation at the hip
posterior hip rotation
indomethacin tocolysis can cause …. and …. although benefits outway risks
oligohydraminos and premature closure of fetal ductus arteriosus
where on the bone does pediatric acute osteomyelitis occur?
metaphysis of long bones
multiple gastric folds and thickened gastric folds on endoscopy
gastrinoma
SBO in crohns disease
fibrotic stricture
initial mgmt of frostbite
rapid rewarming in water bath
heat exhaustion v heat stroke
exhaustion - mentation remains normal
stroke - AMS
parapneumonic effusions with pH <7.2, glucose <60, neutro-predominant lymphocytes >50k
empyema
Type A aortic dissection suspected, next step?
what is contraindicated?
CT angiography
CI - anticoagulation
edema and narrowing of the proximal trachea in 18 mo old with inspiratory stridor
croup
unilateral wheezing in a kid, unresponsive to albuterol
FB ingestion
giant coffee bean on XR
sigmoid volvulus
tx of uncomplicated sigmoid volvulus
flex sig
pt with hx of breast cancer and now has mets to at least her spine; abnl labs and hypotension
dx and first test
primary adrenal insufficiency
cosyntropin stimulation test
eye complications of Sjogrens
decreased visual acuity, infection, corneal ulceration, corneal perforation
migratory, symmetric, polyarticular arthralgias, accompanied by brief morning stiffness; XR shows no evidence of joint destruction
SLE
first line tx nummular eczema
topical glucocorticoids
bright, sharply demarcated erythema over perianal/perineal area in school aged children
perianal streptococcus
beefy red rash involving skin folds with satellite lesions in kids
candida dermatitis
tx of papulopustular rosacea
topical metronidazole
tx of erythematotelangiectatic rosacea
topical brimonidine
sudden onset of psoriasis - test for?
HIV
first line tx of OCD
CBT and/or SSRI
complication of hyperemesis gravidarum, symptoms of encephalopathy, oculomotor dyfunction, and gait ataxia
wernicke encephalopathy, thiamine deficiency
oliguria definition by numbers
<250 mL urine in 12 hours
pt with oliguria and AKI, next step
urgent bladder scan and cath
elevated intraocular pressure, optic disc rim thinning, increased cup:disc ratio, otherwise asymptomatic
open angle gluacoma
first line tx open angle glaucoma
topical agent to lower IOP, topical prostaglandin (latanoprost, bimatoprost)
if prostaglandins are ineffective tx of open angle gluacoma, what is next step?
topical beta blocker like timolol
hypercalcemia in setting of metastatic cancer to bone, tx?
bisphosphonates
crescendo-decrescedno murmur along L sternal border without carotid radiation
HOCM
CXR shows extensive bilateral alveolar opacities
ARDS
ARDS pt with insufficient oxygenation, FiO2 is at 70% and PEEP is at 5, what do you change?
increase PEEP because we try to wean to <60% FiO2 as quickly as possible
tx of BCC on trunk or extremities
surgical excision bx with narrow margins
postexposure HIV ppx for high risk occupational exposure
3 drug antiretroviral therapy for 4 weeks, start ASAP
initial step in evaluation of Cushings syndrome to confirm hypercortisolism
late-night salivary cortisol
24 hour urine free cortisol
overnight low dose dexamethasone test
MC testicular malignancy in prepubertal males
yolk sac tumor
tx of MVP
reassure and echos on occasion
tx of severe mitral stenosis
percutaneous balloon valvuloplasty
status epilepticus tx
lorazepam
lorazepam
fosphenytoin
phenytoin
valproic acid
levetiracetam
travel to mexico, now has RUQ abd pain, diarrhea and weakness, next step?
RUQ ultrasound
only established risk factor for acne
family hx
new dx of HTN in pt with fhx of HTN and DM, next step?
EKG
MC long term sequelae of untreated bacterial menigitis
eighth cranial nerve/ hearing loss
dilated high output cardiomyopathy and heart failure
dx and what vitamin deficiency?
wet beri beri
thiamine
3 drugs that could tx community acquired MRSA
TMP-SMX, doxy, clinda
tx of cardiogenic shock
NE or DA
control exacerbations of Bechet disease with
prednisone
