Smartdeck Flashcards
would a disease of bone marrow suppression also show reticulocytes in the CBC?
no
reticulocytosis is uncommon because the bone marrow cannot efficiently generate cells
ESRD, hypercalcemia, hyperphosphatemia, hyperparathyroidism, obesity, diabetes, oral anticoagulants are all risk factors for
calciphylaxis (calcific uremic arteriolopathy)
systemic arteriolar calcification and soft-tissue calcium deposition with local ischemia and necrosis
Calcific uremic arteriolopathy
what electrolyte inhibits extraosseous calcification?
magnesium
HTN, epistaxis, and HA in younger patient
coarctation of the aorta
pt with hx of HA and htn then gets anesthesia and HTN escalates immediately
catecholamine surge from pheo
type of therapy with schizophrenic pt?
family therapy
What does the initial evaluation of HTN include?
serum chem panel, UA, Hgb/Hct, lipids and glucose
defective mineralization of the bone matrix
osteomalacia
osteomalacia is MC due to
severe Vit D deficiency
will calcium be increased or decreased in multiple myeloma?
increased
hypercalcemia
codfish vertebral bodies and pseudofractures
osteomalacia
<2 yo with palpable abdominal mass, systemic symptoms, raccoon eyes, and opsoclonus-myoclonus syndrome
neuroblastoma
workup of possible nonbloody infectious diarrhea etiology
ova and parasites
nonprogressive motor dysfunction, characterized by abnormal tone, movement, and development in infant
cerebral palsy
possibly the biggest risk factor for CP
prematurity
first sign of CP?
delayed gross motor milestones
distal and facial muscle weakness with delayed muscle relaxation, (delayed release of handgrip)
myotonic dystrophy
autosomal recessive disorder associated with delayed gross motor milestones, proximal muscle weakness and hypotonia
spinal muscular atrophy
tethering of the spinal cord leads to
LE muscle atrophy and weakness with poor or absent reflexes
neonate with temperature instability and poor feeding
neonatal sepsis
2 cancers that go with elevated AFP
yolk sac tumor
hepatocellular carcinoma
lesions of multiple myeloma
osteolytic lesions only
bladder distention and hydronephrosis with oligohydraminos in utero is likely due to
posterior urethral valves
with tracheoesophogeal fistula in a fetus, would you have oligohydraminos or polyhydraminos?
polyhydraminos
most significant sequelea of posterior urethral valves?
pulmonary hypoplasia
three clinical uses of misoprostol
maintain PDA
induce labor for abortion
ppx against NSAID induced ulcers
toxicity of PPIs
C diff
osteoporosis
increased risk of aspiration PNA
triple therapy of H. pylori
clarithromycin
amoxicillin/metronidazole
PPI
octreotide indication
tx bleeding varices
VIPoma
acromegaly
carcinoid
4 drugs that could tx gastroparesis
erythromycin
metoclompramide
donparidone?
sissopride?
pills that cause esophagitis
NSAIDs
KCl
bisphosphonates
tetracyclines
3 drugs that tx hepatic encephalopathy
lactulose
rifaximin
neomycin
2 drugs that could tx chemo induced N/V
odansetron
apprepitant
first line alternative from stimulants for ADHD tx
atomoxetine (SNRI)
AMS walking into ED with unsteady gait, might as well ppx with
thiamine
sound of an AV fistula
continuous bruit with palpable thrill
sound of arterial pseudoaneurysm formation
systolic bruit
disorder that has impaired conversion of glycogen to glucose
glucose-6-phosphatase deficiency
(Type I glycogen storage disease/Von Gierke)
How do pts present with Glucose 6 phosphatase deficiency present?
3-4 mo old
hypoglycemia/seizures
Lactic acidosis
hyperuricemia
hyperlipidemia
doll like face with rounded cheeks, thin extremities, short stature, and protuberant abdomen due to hepatosplenomegaly
dx?
glucose-6 phosphatase deficiency
hypertensive end organ findings, but no HTN
masked HTN
initial step in eval of masked HTN
ambulatory BP monitoring
abdominal pain, peripheral neuropathy, positive urobilinogen
acute intermittent porphyria
Acute intermittent porphyria is autosomal dominant disorder of heme synthesis pathway that results in
reduced activity of porphobilinogen deaminase, building up neurotoxins of heme pathway intermediates
(porphobilinogen and aminolevulinic acid)
confirm dx of acute intermittent porphyria with
urinary porphyrin level
JAK2 mutations are common in myeloproliferative disorders like
polycythemia vera
4 causes of hyperandrogenism in pregnancy
placental aromatase deficiency
luteoma
theca lutein cyst
sertoli-leydig tumor
differentiate luteomas of pregnancy and theca lutein cysts in prego
- luteomas of prego
- solid, unilateral or bilateral ovarian masses
- moderate virilization risk (high fetal risk)
- spontaneous regression of masses s/p delivery
- theca lutein cyst
- cystic, bilateral ovarian masses
- moderate virilization risk (low fetal risk)
- spontaneous regression of masses s/p delivery
rubella non-immune prego lady - next step
MMR immediately pp
when do you give Rhogam?
at 28 weeks and immediately after delivery if infant is Rh(D) +
differentiate SBO and ileus on XR
SBO has a discrete transition point (ie obstruction)
ileus has uniformly dilated bowel loops due to generalized bowel paralysis throughout
post op ileus tx
conservative tx - antiemetics, bowel rest, serial examinations
what kind of iron levels is thalassemia associated with?
normal or elevated iron and ferritin levels
histopath of intestinal lymphoma
diffuse infiltrate by atypical lymphocytes
chronic malabsorptive diarrhea, wt loss, migratory non-deforming arthritis, lymphadenopathy, and a low grade fever
whipple disease
what happens to the proximal clavicle when you have an abduction somatic dysfunction?
stays up, should move down when you shrug
what happens to the proximal clavicle in an adduction somatic dysfunction
stays down
(should move upward)
rapidly expanding breast mass
dx? tx?
phyllodes tumor
wide local excision
voiding cystourethrogram can be used to dx
diverticula, obstruction, reflux, stress incontinence, and in trauma to asess for bladder and urethral injury
5 drugs you can use as mood stabilizers for severe affective dysregulation in Personality disorders
carbamazepine
lithium
lamotrigine
topiramate
valproate
pure motor stroke is likely due to occlusion where?
lenticulostriate arteries
lacunar stroke
flushing, diarrhea, R sided heart issue
carcinoid syndrome
water hammer pulse
aortic regurg
murmur with inspiration
right side of heart issue
cirrhosis and pleural effusion
hepatic hydrothorax
how does hepatic hydrothorax occur?
small defects in the diaphragm
tx of hepatic hydrothorax
salt restriction and diuretics
recommendation when you have Hep C
vaccinate against Hep A and B
Lamivudine MOA and indication
reverse transcriptase inhibitor
tx HIV and chronic Hep B co infection
tx of akathisia
reduce antipsych drug and add beta blocker
4 AIDs defining malignancies
Kaposi sarcoma
Invasive cervical carcinoma
Non Hodgkin Lymphoma
Primary CNS lymphoma
methylmalonic acid in B12 and folate deficiencies
B12 deficiency has increased MMA
folate deficiency has normal MMA
gamma tetramers aka
Hgb Barts
alpha thalassemia
lab studies in alpha thalassemia
microcytic anemia
elevated RBC ct
target cells on peripheral smear
3 gene loss in alpha thalassemia?
hemoglobin H
cervical cancer presentations
intermenstrual or postcoital bleeding
exophytic friable growth, or painless, ulcerative lesion
reverse warfarin with
IV Vit K and prothrombin complex concentrate
antifibrinolytic agent that may be used to treat heavy menstrual bleeding and prevent excessive blood loss during certain types of surgery
tranexaminc acid
hormone levels in Turner syndrome
decreased estrogen
leading to elevated FSH and LH
vision loss and HA due to retinal and CNS hemangioblastomas along with family hx
Von Hippel Lindau
manifestations of von hippel lindau
hemangioblastomas
clear cell renal cell carcinoma
pancreatic neuroendocrine tumors
endolymphatic sac tumors of the middle ear
pheochromocytomas
surge of catecholamines
pheochromocytoma
associations with anterior uveitis
infections causing systemic inflammation
spondyloarthritis
IBD
younger person with painful, red eye, tearing, and decreased visual acuity
anterior uveitis
fever, AMS, petechial rash in younger person
starts to go shocky, hyponatremia and hyperkalemia
dx?
waterhouse friedrichsen
hemorrhagic necrosis of adrenal glands (T10)
posterior margin of TFL for counterstrain tenderpoint PL4 tx
hip extension, abduction, external rotation
innominate rotation occurs around what sacral axis?
inferior transverse axis
shifting weight side to side engages what sacral axes?
oblique axes
whichever way L5 is sidebent will be the side of?
the oblique axis?
inferior or inferolateral tip of spinous process C2 is what posterior tenderpoint and what is counterstrain tx?
PC3
Flex, sidebend away, rotate away
how much time do you need between stopping an MAO-I and an SSRI
2 weeks
pt with hemochromatosis is susceptible to what bugs?
vibrio vulnificus
listeria
yersinia
hyporeflexia, hypotension, respiratory depression, drowsiness, muscle weakness is all toxicity of
magnesium sulfate OD
magnesium sulfate antidote
calcium gluconate
prior to starting infliximab, check for
TB with PPD
toxicity of calcium carbonate
hypercalcemia, hypophosphatemia, milk alkali syndrome
AE of sulfasalazine
reversible oligospermia
hepatotoxic
stomatitis
H2 blockers that decrease renal excretion of creatinine
ranitidine
cimetidine
toxicity of cimetidine
anti andronergic
impotence, decreased libido
confusion, HA, dizziness
toxicity of bismuth
black tongue, teeth, and stool
quad therapy for H. pylori
bismuth, metronidazole, tetracycline, PPI
macrolides given in early infancy can increase risk of
pyloric stenosis
first line tx for allergic rhinitis
glucocorticoid nasal spray
infants become cyanotic during feeding or crying, or older children getting cyanosis on exertion or exercise
tet spell - tetrology of falot
labs in klinefelter syndrome
elevated gonadotroping hormone (LH and FSH)
decreased Testosterone
low testosterone with elevated LH and FSH indicates… and prompts…
primary hypogonadism
karyotype analysis
pharm tx for binge eating disorder?
SSRIs, stimulants (phentermine, lisdexamfetamine), and antiepileptics (topiramate, zonisamide)
increased body temp, elevated BP, increased RR, tachycardia, tremulousness, increased reflexes, sz, disorientation, AMS or frank delirium, and psychosis are all symptoms of
benzo withdrawal
extrahepatic manifestations of Hep C
heme: mixed cryoglobulinemia syndrome
Renal: membranoproliferative GNephritis
Derm: PCT, lichen planus
MCHC and MCV in spherocytosis
MCHC will be elevated
MCV will be low or normal
restlessness, fatigue, poor concentration, irritability, muscle tension and impaired sleep
along with concern over life issues for more than 6 months
generalized anxiety disorder
scaly papules or plaques on the scalp, face, lateral neck, and dorsum of hands
actinic keratosis
mono like syndrome, generalized macular rash, GI symptoms
acute HIV infxn
focal increase in bone turnover, in which osteoclast dysfunction leads to bone breakdown and compensatory increase bone formation
Paget disease
micro findings of increased number of abnormal appearing osteoclasts with disorganized, “mosaic” pattern of bone
Paget disease of bone
what happens to osteoblast activity in Pagets disease
increase activity
3 risk factors for osteonecrosis
glucocorticoid use
sickle cell disease
heavy alcohol use
dx thromboangiitis obliterans
with arteriogram after ruling out everything else including ANA and other abs titers
giant painful chalky nodules
tophi, gout
AE of venlafaxine
dose dependent HTN
2 least likely Second Gen Antipsychotics to cause weight gain
aripiprazole and ziprasidone
pharm vasodilator stress testing causes
marked increase in blood flow in nondamaged vessels and to a lesser extent, increased blood flow in stenosed vessels
definitive tx of chronic ITP
splenctomy
spiking fevers in the evening in a kid with joint pain
systemic juvenile idiopathic arthritis
lacy white network of lines in the mouth
lichen planus
(Wickham striae)
nerve that might be injured with brachial artery cannualization
median nerve
contraindications to IUD placement
pregnancy
endometrial or cervical cancer
unexplained vaginal bleeding
gestational trophoblastic disease
distorted endometrial cavity
acute pelvic infection
Contraindications to progestin IUD specifically
active liver disease
active breast cancer
MCC of congenital hypothyroidism
thyroid dysgenesis
core feature of atypical depression
mood reactivity - positive response to pleasant events
also, wt gain, hypersomnia, leaden paralysis, and hypersensitivity to objection
persistent depressive disorder/dysthymia time frame
chronically depressed mood for >2 years
definitive test for dx of carpal tunnel
nerve conduction studies
Pleural effusion tap shows milky white fluid with high triglycerides
chylothorax
young female, generalized weakness and lightheadedness, difficulty ambulating.
fatigue, nausea, abdominal pain, weight loss
primary adrenal insufficiency
hyperpigmented mucosa in young female
primary adrenal insufficiency
peripheral eosinophilia, no parasites
primary adrenal insufficiency
finger like projections on vocal cords
HPV
anterior mediastinal masses
thymoma, teratoma, thyroid neoplasm, terrible lymphoma
untreated hyperthyroidism can lead to
rapid bone loss
tachyarrhythmias
What does the left ventricle do in hypovolemic shock?
has decreased filling so increase HR and increase EF
exaggerated fall in systemic blood pressure, greater than 10 mmHg during inspiration
pulsus paradoxus
three conditions you might see pulsus paradoxus
cardiac tamponade
severe asthma
severe COPD
decompensated heart failure is a common cause of
secondary mitral regurg
lateral papillary muscle displacement because of dilation of mitral valve annulus
is stroke 2/2 endocarditis a contraindication to thrombolytic therapy?
yes
severe HTN with onset after age 55
renovascular disease
high plasma aldosterone to renin ratio >20:1
primary aldosteronism
dx of primary adrenal insufficiency is made by
cosyntropin stimulation test
result will have low production of cortisol
tx of sternal dehisence
emergent surgery and fixation
low levels of 5 -HIAA in CSF are associated with
suicidal behavior
direct factor Xa inhibitors like rivaroxaban and apixaban are contraindicated in
severely impaired renal dysfunction or in DVT/PE secondary to malignancy
first step in work up of elevated alk phos of unknown origin
check GGT
normal = likely bone origin
elevated = likely biliary origin
d-xylose test in a celiac + pt
positive test, increased d-xylose excreted in the urine
d-xylose test in chronic pancreatitis pt
negative test, increased excretion of d-xylose in urine
ultrasound findings in congenital toxoplasmosis
bilateral ventriculomegaly
diffuse intracranial calcifications
paraplegia with severe hypertension, HA, diaphoresis, flushing, and bradycardia in the setting of urinary retention
autonomic dysreflexia
potentially fatal complication of spinal cord injury
carotid sinus hypersensitivity typically causes
bradycardia, hypotension
severe hypospadias can be indicative of
disorder of sex development
microcephaly, wide anterior fontanelle, cleft lip and palate, and distral phalange hypoplasia
fetal hydantoin syndrome
what electrolyte imbalance can precipitate ogilvie syndrome?
hypokalemia, hypomagnesemia
spiral fx of the distal tibia in ambulatory children <3 are known as
toddlers fx
tx of toddlers fx
immobilization and pain control
MC congenital heart disease, Tetralogy of Fallot has what four features
VSD
overriding aorta (over R and L ventricles)
RVOT obstruction
RVH
Clinical features of Paget disease
- most asx
- Bone pain and deformity
- skull - HA, hearing loss
- spine - spinal stenosis, radiculopathy
- long bones - bowing, fx, arthritis of adjacent joints
- Giant cell tumor, osteosarcoma
isolated, asx, elevation of alk phos in elderly pt
paget disease of bone
large mediastinal mass, elevated LDH, and eosinophilia raise strong suspiscion for
hodgkin lymphoma
recurrent forceful contraction of the eyelid muscles
blepharospasm, a form of focal dystonia
why should you avoid antidepressant monotherapy in a bipolar pt
induce mania
first line tx of bipolar depression
second gen anti psychs - quetiapine and lurasidone
what sound can be heard in most patients during the acute phase of MI
abnormal S4, atrial gallop
MEN IIb
Medullary thyroid cancer
Pheo
Mucosal neuroma/marfanoid habitus
initial mgmt of ascites
sodium restriction, spironolactone and furosemide
most cases of ludwig angina are from
dental infections
tx of unstable angina or NSTEMI initially
antiplatelets and anticoagulant therapy
beta blockers
nitrates
statins
cardiac complication in a Turner pt
aortic dissection
genotypically male, phenotypically female
breast development, absent or minimal axillary and pubic hair, female external genitalia, absent uterus, cervix, and upper one third of vagina, cryptorchid testes
androgen insensitivity syndrome
refeeding syndrome is the result of
increased insulin activity
time frame of adujstment disorder
develops within 3 months of an identifiable stressor
the anemia of lymphoproliferative disorders, such as leukemia and lymphoma, is due to
the replacement of RBC progenitor cells with cancer cells in the bone marrow
(bone marrow infiltration)
first line treatment of alcohol use disorder
naltrexone (mu opioid receptor antagonist)
acamprosate (glutamate modulator)
first line antibiotics for asx bacturia in pregnancy
cephalexin, amoxicillin-clavulanate, or nitrofurantoin
an enlarged, uclerated tonsil with ipsilateral cervical adenopathy is likely..
oropharyngeal/head and neck squamous cell carcinoma
HPV
aquagenic pruritis, facial plethora, and dramatically elevated hematocrit
polycythemia vera
classic thrombotic complication from polycythemia vera
budd chiari syndrome
how do you diagnose budd chiari
abdominal doppler US
large volume of blood is rapidly transfused into a small child or older adult with chronic anemia
transfusion associated circulatory overload
symptoms of TACO develop within …. hours of transfusion initiation and include
6 hours
respiratory distress, HTN, tachycardia, pulmonary edema
tx for TACO
respiratory support, diuresis with furosemide
Lab findings in hereditary spherocytosis
increased MCHC
negative coombs
increased osmotic fragility on acidified glycerol lysis test
abnormal eosin-5-maleimide binding test
assess RBC fragility with what tests?
eosin 5 maleimide (EMA) binding test (flow cytometry)
or acidified glycerol lysis test
on average, pt with PNH has symptoms by their fourth decade of life with what manifestations?
hemolysis
cytopenias
hypercoaguability
four things of nephrotic syndrome
- proteinuria
- hypoalbuminemia
- edema
- hyperlipidemia and lipiduria
nephrotic syndrome is frequently complicated by
hypercoagulation with a consequent risk of thromboembolic complications
pt with acute asthma exacerbation - what would be an alarming thing to see on ABG?
normal or elevated PaCO2
myalgias, proximal muscle weakness with elevated CK in young healthy woman with fatigue and delayed DTRs
hypothyroid myopathy
glucocorticoid deficiency, hypogonadism, and hypothyroidism
hypopituitarism
central adrenal insufficiency
what has decreased aldosterone, primary or 2/3 adrenal insufficiency?
aldosterone is decreased only in primary adrenal insufficiency
lab findings of milk alkali syndrome
hypercalcemia, metabolic alkalosis, AKI, suppressed PTH
low T3 levels with normal TSH and T4 in pt with acute illness
euthyroid sick syndrome
euthyroid sick syndrome is due primarily to
decreased peripheral conversion of T4 to T3
best case to improve mortality in ESRD pt
living donor related kidney transplant
HA, binocular palsies, periorbital edema, hypoesthesia, or hyperesthesia
cavernous sinus thrombosis
a limp worse in the morning in a toddler girl
oligoarticular Juvenile idiopathic arthritis
what other disorder is associated with oligoarticular JIA
uveitis, do ophthalmologic screening because it can be unsymptomatic
all infants should receive what as ppx for gonoccocal disease
topical erythromycin ppx
prematurity, very low birth weight, and enteral feeding are all risk factors for
necrotizing enterocolitis
newborn with tempurature instability, feeding intolerance, abdominal distention, and bloody stools
necrotizing enterocolitis
acute limb ischemia presents in your ED, what is first step?
heprinize
conductive hearing loos and pearly white mass behind an intact tympanic membrane
cholesteatoma
tx for MAC diarrhea
macrolide based combination therapy
systemic venodilation lowers what two things
preload and LVEDV
fever, hypotension, tachycardia, and a diffuse red, macular rash involving palms and soles
staphy toxic shock syndrome
episodes of depression, fatigue, hypersomnia, increased dreaming, hyperphagia, impaired concentration
cocaine withdrawal
plasma aldosterone to renin ratio >20
primary hyperaldosteronism
tx of primary hyperaldosteronism
surgery if unilateral is preferred, if bilateral or CI to surgery, aldosterone antagonists like spironolactone or epelrenone
chronic DIC is common in pts with
mucin producting tumors
these pts generally have palpable purpura, weakness, renal insufficiency, arthritis/arthralgias
cryoglobulinemia
continued bleeding despite contracted uterus s/p delivery
inherited coagulopathy
intrusive, reimagining traumatic event for less than 1 month
acute stress disorder
progressive ataxia in an adolescent with loss of position and vibratory senses
Friedreich ataxia
periventricular calcifications on fetal US
CMV infxn
blunt chest trauma causing hypovolemic shock is likely due to
intercostal vessel injury with rib fx
ppx for surgical site incision
clean: cefazolin, vanc, or clinda
clean-contaminated - broader coverage
fever, RUQ pain, leukocytosis, increased LFTs, with rounded hypoattenuating lesion in the liver
pyogenic liver abscess
carcinoid tumor might cause a deficiency in
niacin
sphingomyelinase deficiency and areflexia
Niemann Pick disease
beta-hexosaminidase deficiency and hyperreflexia
Tay-sachs
ppx for pt with hx of acute rheumatic fever
penicillin ppx prevents strep infxns and limits progression to the heart
invovles one or more delusions and the absence of other psych symptoms
delusional disorder
persecutory, erotomanic, grandiose, jealous, somatic
pervasive distrust and suspisciousness of others
paranoid personality disorder
pt with symptomatic sinus bradycardia should be treated initially with …
if not responding, then..
IV atropine
then consider IV epi, DA, or transcutaneous pacing
dx of granulomatosis with polyangiitis is made by
+ ANCA and tissue bx
proteinase 3 ANCA
What are the three MCC of digital clubbing?
lung malignancies, cystic fibrosis, and R to L cardiac shunts
all children less than 2 with first febrile UTI should
undergo renal and bladder US
looking for anatomic abnls
letrozole MOA
aromatase inhibitor
indication for leuprolide
endometriosis or adenomyosis
hypercalcemia, renal insufficiency, and metabolic alkalosis
milk alkali syndrome
constipation, polyuria, and possibly abdominal pain in hypercalcemic pt
primary hyperparathyroidism
diabetes drug that improves CV mortality and weight loss
SGLT2 inhibitors
increased estrogen will do what to thyroid-binding globulin?
increase
acute thyrotoxicosis with mild thyroid enlargement and suppressed TSH
scintigraphy shows decreased uptake throughout
painless thyroiditis
what does thyroid look like if pt has struma ovarii?
fibrous thyroid
EKG with broad flat T waves
hypokalemia
decrescendo, early diastolic murmur
aortic regurg
three causes of aortic regurgitation
congenital bicuspid aortic valve
postinflammatory (rheumatic, endo)
aortic root dilation (marfan, syphilis)
contraindication for OCP
migraine with aura
pt with hematoma after mild trauma and relative with hx of bleeding disorder
hemophilia
factor deficiencies of hemophilia
VIII A
IX B
recurrent hemarthrosis
hemophilia
CMV esophagitis
what does it look like and what is the tx?
linear ulcers
ganciclovir
HSV esophagitis
what does it look like and tx?
punctate, round/ovid ulcers
acyclovir
MOA of second gen antipsychotics
serotonin 2A and dopamine D2 antagonists
melanoma, shave bx or excisional bx?
excisional bx
obsese young woman, HA, vision loss, diplopia, papilledema, normal head CT
what do you do to dx?
lumbar puncture
pseudotumor cerebri
tx of pseudotumor cerebri?
weight loss
acetazolamide
more than 5 days of fever and conjunctivitis, mucositis, rash, extremity changes, cervical LAD
in a kid.
dx?
Kawasaki disease
pt with Kawasaki disease is at risk of developing…
what should you do to screen?
coronary artery aneurysms
get an echo, and repeat in 6-8 weeks
atypical glandular cells on pap…
what are the next steps?
colposcopy, endocervical curettage, and endometrial bx
systemic, descending neuro deficits, respiratory compromise, and autonomic dysfunction in the setting of contaminated puncture injury
wound botulism
tx for wound botulism
equine botulinum antitoxin
lithium toxicity
renal insufficiency
variable decels on fetal heart rate monitor is caused by
umbilical cord compression
how to tx recurrent variable decel
maternal repositioning
infants at 2-8 weeks have jaundice, acholic stools, dark urine, hepatomegaly
biliary atresia
progressive fibrosis and obliteration of extrahepatic bile ducts
biliary atresia
sudden onset, severe, HA that may be accompanied by vomiting, neck stiffness, fever, and LOC
subarachnoid hemorrhage
get a CT scan
what are reversible risk factors for PACs?
tobacco and alcohol
symptomatic PACs, what is tx?
beta blockers
renal vein thrombosis is most commonly associated with
membranous glomerulonephropathy
bullous pemphigoid tx
topical clobetasol
linear IgG and C3 deposits at the dermal-epidermal junction
bullous pemphigoid
prolonged PTT that fails to correct with a mixing study
antiphospholipid antibodies (lupus anticoagulant)
benign tumors in sellar
pituitary adenoma
craniopharyngioma
meningioma
pituicytoma (low grade glioma)
what are first line tx for Alzheimer disease?
donepezil, rivastigmine, and galantamine
(cholinesterase inhibitors)
what is the first line medical tx for idiopathic intracranial hypertension?
acetazolamide +/- furosemide
parkinsonism plus autonomic features
multiple system atrophy (Shy-Drager syndrome)
person meditating
sitting cross legged, nerve compression
sensation of the eye is controlled by what nerve?
trigeminal, ophthalmic branch (V1)
exposure to botulinum toxin, impairs the
presynaptic release of Ach at the NMJ
how will botulism present in an adult?
symmetric descending motor paresis, starting with CN
hypoventilation and resp acidosis, to diaphragmatic paralysis
autonomic dysfunction
fever, HA, and periorbital swelling
palsy of CN III, IV, and VI
cavernous sinus thrombosis
what age will you see familial dysautonomia?
infants
tx for postherpetic neuralgia
TCA, gabapentin, pregabalin
dementia pt, need to rule out what causes?
B12, TSH, folate, syphilis, vit D
Complication of idiopathic intracranial hypertension
blindness
swinging of leg like a pendulum after hit for reflex
cerebellar error
MC places for intracranial bleed
putamen, pons, thalamus, cerebellum
pt with normocytic anemia and Crohns disease with bowel resection, next step
check B12 levels
hereditary neuropathy and high arched foot
Charcot mare tooth disease
cherry red spot on macula, top 3 reasons
tay sachs, niemann pick, central retinal artery occlusion
blood and thunder appearance on fundoscopic exam
venous thrombotic occlusion
flashing lights or floaters
retinal detachment
first time seizure, CBC and labs are normal, next step
noncontrast CT brain
ER, fever, and joint pain
septic arthritis
ER, fever, and murmur
endocarditis
what is occluded in subclavian steal syndrome
subclavian artery… comon lauren
first line tx uterine atony
bimanual uterine massage, oxytocin
second line agents to tx uterine atony with noticable contraindications
carbaprost - asthma
methylergonovine - HTN
woman with hx of miscarriage believes she is pregnant and is having symptoms, but now has negative pregnancy tests
pseudocyesis
tx of pseudocyesis
psych eval and tx
lithium tox
nephrogenic DI
post op pt, significant pain, hyponatremia, normal volume status
SIADH
MCC bloody diarrhea in US
campylobacter
potato salad food posioning
s. aureus
tx for guillian barre
IVIG and plasmapheresis
Those with lupus anticoagulant will have what test that shows prolonged time?
PTT, does not improve with mixing study
Period pain that goes away after a couple of days in a young pt
primary dysmenorrhea
decreased AFP will be seen in
Edwards and Down syndrome
increased AFP in pregnancy is associated with
open neural tube defects, ventral wall defects, multiple gestation
widening of wrsits in a baby could indicate
deficiency of vitamin D
what type of kidney stone presents with urine pH <5.5
uric acid stone
serious complication after rhinoplasty that presents with whistling on respirations
nasal septal perforation
middle aged pt with progressive ambulation difficulties and extremity weakness is suggestive of
cervical myelopathy
MCC of cervical myelopathy in older adults is
spondylosis
closed fist with overlapping fingers in newborn
trisomy 18
edwards syndrome findings
FGR, microcephaly, VSD, closed fists with overlapping fingers, micrognathia, prominent occiput, rocker-bottem feet, and severe intellectual disability
medical tx of neuroleptic malignant syndrome
dantrolene, bromocriptine, amantadine
medical tx of serotonin syndrome
cyprohepatadine
hematuria, renovascular congestion, and flank pain
renal vein throm bosis
cyclic fevers and nonspecific symptoms after traveling to Africa
malaria
what can protect you from malaria?
hemoglobinopathies
how do you dx CLL
Flow cytometry - showing clonality of mature B cells
unfavorable metabolic and electrolyte side effects of thiazide diuretics
hyperglycemia, increased LDL cholesterol and plasma triglycerides, and hyperuricemia
hyponatremia, hypokalemia, hypomagnesemia, hypercalcemia
proximal muscle weakness and atrophy without pain or tenderness; LE muscles more involved.
ESR and CK are normal
Glucocorticoid induced myopathy
muscle pain and stiffness in shoulder and pelvic girdles
increased ESR, normal CK
polymyalgia rheumatica
withdrawals from what in a day 3 post op pt?
alcohol
trauma causing rib fx of RUQ might also cause
liver lac
acute or within 3-5 days of acute MI, complications include:
papillary muscle rupture, interventricular septum rupture
3 days s/p MI, get severe pulmonary edema and new holosystolic murmur
papillary muscle rupture
recurrent UTI, pain with ejaculation, and pyuria/bacteriuria
chronic bacterial prostatitis
infant with obstructive hydrocephalus and no vaccines or medications yet
vit K deficiency
painful, red eye and opacification and ulceration of the cornea while being a contact lens wearer
bug and tx
pseudomonas keratitis
topical broad spec abx
echinoccous on imaging shows a ….
while entameboa on imaging shows …
echinoccoccus cyst
entameboa abscess
medical mgmt of ventricular arrhythmia
amiodarone
some side affects of amiodarone
chronic interstitial pneumonitis, organizing pna, ARDS, alveolar hemorrhage, pulmonary nodules, and solitary masses
macrocytic anemia with postprandial abdominal pain
autoimmune gastritis
v parietal cells
rx that increases natriuresis, decreases angiotensin II concentration, and decreases aldosterone
direct renin inhibitor (aliskiren)
inspiratory stridor worsens when feeding, crying, or supine; improves when prone
laryngomalacia
biphasic stridor that improves with neck extension
vascular ring
3 causes of nocturnal cough
postnasal drip, GERD, asthma
what is the best imaging for suspected mastoiditis that is not improving
MRI, look for intracranial abscess
what is the greatest risk of completing homicide?
access to firearms
persistent difficulties in comprehension (receptive) and production (expression) of spoken and written languages
language disorder
specific learning disability dx requires what
use of standardized achievement testing
during vasovagal syncope, what happens to the heart
bradycardia and sinus arrest
abnl lipid panel in person gaining weight, next test?
TSH
what is destroyed in Huntington Disease
neostriatum’s GABA producing neurons
first line for mild to moderate HTN
DASH diet
loss to follow up is what kind of bias?
attrition bias, subtype of selection bias
when the exposed group undergoes increased monitoring relative to general population
surveillance bias
subject reluctant to report exposure due to stigma about exposure (sexual behavior, drug use)
reporting bias
cirrhosis relating to hormone changes
hypogonadism d/t primary gonadal injury or HT-pit dysfx
elevated levels of estradiol d/t increased conversion from androgens
decreased serum binding proteins for thyroid hormones. decrease total T3 and T4 in circulation (euthyroid stays)
preeclampsia with severe features may cause what due to endothelial cell damage?
acute ischemic stroke
reasons for primary polycythemia
(decreased EPO)
polycythemia vera (JAK2)
EPO receptor mutations
Reasons for secondary polycythemia
normal or elevated EPO
- hypoxemia
- CP disease, OSA, high altitude
- EPO producing tumors (renal/hepatic)
- Congenital (high affinity hgb)
- s/p renal transplant
- androgen supplementation
normal or elevated EPO, with secondary polycythemia and no signs hypoxia, next step?
get CT imaging to find tumor
low EPO, primary polycythemia suspected, how to dx?
bone marrow biopsy or JAK2 mutation testing
flat annular rash, with or without central clearing
early lyme’s disease
recurrent sinopulmonary and GI infections beginning after age 6 mo along with small tonsils
X linked agammaglobulinemia
hypocalcemia, cardiac defects, failure to thrive along with recurrent infections
DiGeorge syndrome and thymic hypoplasia
low MCV, normal RDW, normal/elevated RBC
Mentzer index (MCV/RBC) <13
thalassemia minor
RDW in Fe deficiency
elevated
jaundice, hepatomegaly, vomiting, failure to thrive, cataracts
dx?
galactosemia
GALT deficiency
inability to metabolize galactose to glucose
MCC of spinal epidural abscess
s. aureus
PTU and methimazole both cause
agranulocytosis
food stuck in throat and cough/choke as swallowing
what dx tool?
videofluoroscopic modified barium swallow
AE of benzo in elderly
paradoxical agitation
should taper and d/c
severe hypotension and shock once anesthesia comes on board, no cardio/pulm issues
primary adrenal insufficiency/crisis
what happens to A-a gradient in PE?
increase A-a gradient
obstetric complications of sickle cell disease in mom
spontaneous abortion
pre/eclampsia
placental abruption
antepartum bleeding
Fetal complications of mom with sickle cell disease
fetal growth restriction
oligohydraminos
preterm birth
baby should respond to name and babble by when…
what do you do if this has not happened yet?
6 mo
audiology testing
most common secondary factors of ITP
HIV and Hep C
how would you dx ITP?
exclusion
normal coags, platelet morphology
HIV and Hep C testing
quadripelegic with hypercalcemia - cause?
immobilization
what will be elevated in 21 hydroxylase deficiency?
17-hydroxyprogesterone
EKC finding in older adult with exacerbation of underlying pulmonary disease?
tx?
multifocal atrial tachycardia (SVT)
tx underlying lung issue
kidney compensates for respiratory alkalosis by
secreting bicarb in urine, high urine pH
tx lyme disease in pregnant woman
amoxicillin
rectus sheath hematoma usually occurs due to
rupture of inferior epigastric artery from blunt trauma or forceful abdominal contractions in those on anticoags
about 25% of pts on lithium will develop
hypothyroidism
continue to monitor TSH q6-12 mo if on chronic lithium therapy
raised nodule with rubbery texture and oily surface on skin
seborrheic keratosis
is AFP in HCC?
50%, so cant be used to rule out
Turner syndrome with decreased estrogen are at risk for
osteoporosis/fx
pleural effusion and chest tube with turbid green drainage
esophageal perforation
one of the first cranial nerves to be compressed with uncal herniation
oculomotor
how long do you do mammogram screening for?
every 2 years from 50-74 yo
pt leaving AMA, what do you do?
continue whatever tx you can as outpt
when do you give heparin in acute PE?
if likely PE and no contraindications to anticoag, start heparin prior to imaging
tx for pts who are minimally symptomatic or asx for SIADH
fluid restriction
when do you use hypertonic saline?
should be reserved for severe symptomatic hyponatremia (seizures, coma, profound confusion)
What do you need to give HIV pt for ppx?
TMP-SMX for both PCP <200, and toxo <100
itraconazole only in endemic areas of histoplasmosis
mild elevation of LFTs, chronic dyspnea, fhx of cirrhosis
alpha 1 antitrypsin deficiency
what is the breakdown product of ketones?
beta hydroxybutyrate
what will beta hydroxybutyrate level be in HHS?
normal, because negative ketones
where are craniophayngiomas?
arise within stalk of pituitary and can extend into hypothalamus
tx proliferative diabetic retinopathy with
laser photocoagulation
lab elevated with mesenteric ischemia
lactic acid
tx of TTP
plasma exchange
most affective rx to improve HDL
niacin
best med for decreasing triglycerides
fibrates
what testicular tumor is associated with Peutz-Jeghers syndrome
sertoli cell tumor
infant with convulsive seizures, developmental delay, and abnormal skin findings
tuberous sclerosis
what are the most common renal lesions found in pts with tuberous sclerosis?
angiomyolipomas
Reinke crystals are seen on histo of testicular tumor
Leydig cell tumor
ill-appearingl, febrile newborn should get
full w/u for sepsis including LP and immediate broad spec abx and acyclovir
wide complex tachycardia rx
amiodarone
MCC of pyogenic liver abscess
polymicrobial
MC benign salivary gland tumor
pleomorphic adenoma, then Warthin tumors (papillary cystadenomas)
normal plt ct, normal PT, increased PTT, increased BT, low ristocetin cofactor
von willebrand disease
most appropriate initial therapy for von willebrand disease?
desmopressin
vessel that supplies occipital lobe and medial temporal lobe
posterior cerebral artery
what happens if you combine statins and fibrates?
even higher risk for myositis, try to avoid
acute gout tx, but dude has CKD
contraindicated to NSAIDs, so use steroids
abx most likely to cause c diff
cephalosporins, fluoroquinolones, ampicillin/amoxicillin, and clindamycin
tx of lichen sclerosis et atrophicus
topical steroids first
then topical calcinuerin inhibitors (tacrolimus)
avoidant restrictive food intake disorder is associated with what else?
anxiety disorders, learning disabilities, and pervasive developmental disorders
first line drug of choice for ischemic priaprism is
intercavernosal phenylephrine
ppx for close contacts of meningococcemia pt
drug and AE?
rifampin
discoloration of body fluids
dyspnea, dysphagia, distorted vision , and orthopnea
morning HA and facial edema, JVD
superior vena cava syndrome
dequervain’s disease affects what tendon?
abductor pollicus longus (APL)
what happens to rening if HTN is occuring?
renin is decreased
systolic BP drop >10 with inspiration
pulsus paradoxus, cardiac tamponade
weak and slow rising carotid pulse
pulsus parvus et tardus
might be passing out with exertion
does bipolar disorder have to have depressive episodes?
no, can just show manic side and then later will get depressed
tx of catatonia
lorazepam
tx severe serotonin syndrome
cyprohepatdine
what will coombs test be inhereditary spherocytosis?
negative coombs test
brittle hair, skin depigmentation, neuro dysfx, anemia, osteoporosis
what mineral deficiency?
copper
thyroid dysfunction, cardiomyopathy, and immune dysfunction
what trace mineral deficiency?
selenium
alopecia, pustular skin rash (perioral region and extremities), hypogonadism, impaired wound healing, impaired taste, immune dysfunction
what trace mineral deficiency?
zinc
cat bite, next step
cats are dirty, always ppx with amox-clauv
common coinfections with gonnorrhea and chlamydia
HIV, syphilis, and Hep B
fatigue, fever, wt loss, with IVDA and incarceration hx
CXR shows diffuse reticulonodular pattern
miliary TB
when should speech be 100% intelligible?
age 4
common cause of secondary gout?
myeloproliferative disorders (like PCV)
acute febrile illness with malaise and AMS
labs show leukopenia and/or thrombocytopenia with elevated LFTs
ehrlichiosis
tick borne
tx of ehrlichiosis
doxycycline
pts with IBD have increased risk of developing what that cause diffuse colon dilation
toxic megacolon
tx toxic megacolon
IV steroids, NG tube decompression, antibiotics, and fluid mgmt
thoracic trauma and extensive extrapulmonary air (eg chest tube with peristent large air leak)
dx and confirmation?
tracheobronchial injury confirmed with bronchoscopy
what does talc pleurodesis do?
obliterates the pleural space to prevent recurrence of frequent pleural effusion or pneumothorax
what causes pseudothrombocytopenia?
laboratory error caused by platelet aggregation in vitro
exposure to oxidizing substances (eg dapsone, nitrites, local/topical anesthetics)
methemoglobinemia
diffuse telangiectasias (ruby papules), recurrent epistaxis, and widespread AV malformations
hereditary hemorrhagic telangiectasias aka
Osler Weber Rendu syndrome
Osler weber rendu pt can develop
pulmonary AV malformations a/w hemoptysis and R to L shunt physiology
asymmetric inguinal skin folds in infant
leg length discrepancy - hip dysplasia
urinary symptoms of menopause
urinary incontinence, recurrent UTIs
PBC complications
malabsorption of ADEK
metabolic bone disease (osteoporosis, osteomalacia)
HCC
tx of cocaine associated chest pain
benzos first
asa, nitro, and CCB next
dx Sjogrens with
Schirmer test showing decreased lacrimation
histo evidence of lymphocytic infiltration of salivary glands, or serum autoabs v Ro/La
tx of uric acid kidney stones
PCl, alkalinize urine
tx of actinomyces infection
penicillin
younger pt, unilateral weakness, exertional dyspnea, nocturnal cough, occasional hemoptysis.
what heart issue?
mitral stenosis
accentuated sound directly after S2
S3
ring of calcification around the heart
constrictive pericarditis
2 MC risk factors for constrictive pericarditis
TB and hx of radiation
point of maximal impulse displaced to left
fluid overload
dissection suspected, bumped creatinine, what imaging do you use?
TEE
pericarditis + kidney failure
dx? tx?
uremic pericarditis
hemodialysis
