Step studying 7 Flashcards
Diagnose and treat: vesicular lesions on the uvula and soft palate of a child
Herpangina caused by Coxsackie (hand foot and mouth
Tx = reassurance
Tx of Kawasaki
- Aspirin - to prevent thrombosis of coronary arteries
- IVIG
What part of vision is first affected in macular degeneration
Central vision
What are the options for tocolytics
Indomethacin, Nifedipine (CCB), Beta agonists (Terbutaline), Magnesium sulfate
At what age do you give the following in preterm labor
- Betamethasone
- Penicillin
- Tocolytics
- Magnesium
- Betamethasone = <37 weeks
- Penicillin = always if GBS+ or unknown
- Tocolytics = <34 weeks
- Magnesium = <32 weeks
Tx of Mallory Weiss tear
♣ Superficial tear
♣ Tear of the gastroesophageal junction caused by excessive/forceful vomiting
♣ Self-limiting
Tx of Boerhaave syndrome
♣ Transmural (esophagus ruptured into the chest), usually distal esophageal rupture
♣ Due to violent retching (alcohol or bulimia)
♣ CXR may show air in the mediastinum
♣ Surgical emergency
Pentad of sx suggestive of ascending cholangitis
- RUQ pain
- Jaundice
- Fever
- AMS
- Hypotension
Tx of ascending cholangitis
- Emergent ERCP to remove the stone so bile can flow and clear the infection
- IVF, IV abx, NPO
- Urgent cholecystectomy
Tx of choledocholithiasis
o NPO, IVF, IV abx
o Urgent ERCP
o Elective cholecystectomy
What disease is associated with migratory thrombophlebitis
Pancreatic adenocarcinoma (Troussea’s syndrome)
Erythromycin eye drops in newborns is used for prophylaxis of what bug
Gonococcal conjunctivitis (does not work against Chlamydia)
What is the difference between S3 and S4 heart sound
S3 = volume overload (rapid flow of blood from atria to ventricles)
S4 = atria contracting against stiffened ventricles
MEN1
♣ Pituitary tumors (prolactin or GH)
♣ Pancreatic endocrine tumors (Zollinger-Ellison syndrome, insulinomas, VIPomas, glucagonomas)
♣ Parathyroid adenomas
MEN2A
♣ Medullary thyroid carcinoma (neoplasm of parafollicular C cells which secrete calcitonin)
♣ Pheochromocytoma
♣ Parathyroid hyperplasia
MEN2B
♣ Medullary thyroid carcinoma
♣ Pheochromocytoma
♣ Mucosal neuromas (oral/intestinal ganglioneuromatosis) / Marfanoid habitus
Tx if someone presents with acute chest pain
MONA BASH M = morphine O = O2 N = nitro A = ASA B = BB A = ACEi S = Statin H = Heparin
Medical tx of hypertrophic cardiomyopathy
Want increased blood in the heart to stretch the ventricle and prevent obstruction
- avoid dehydration
- Beta blockers or CCBs to prolong diastole/filling
Is constrictive pericarditis a problem of systole or diastole
• Constrictive pericarditis is a problem of diastole – ventricle cannot expand against rigid pericardium
Medical tx of fast and wide arrythmia
E.g. V-tach
Amiodorone
Medical tx of fast and narrow arrythmia
E.g. SVT
Adenosine
Medical tx of slow rhythm
Atropine
Why might you see bleeding/coagulopathy in renal failure
- Uremic toxins are implicated in platelet dysfunction
- There will be normal platelet count but defect involving platelet-vessel wall and platelet-platelet interaction
How does hypothyroidism cause amenorrhea
• Low T3/T4 increases TRH (produced by hypothalamus) = increased TRH stimulates the anterior pituitary to produce prolactin = high prolactin inhibits GnRH = low GnRH causes low FSH and LH
What maneuver is for MCL vs LCL
Valgus = MCL Varus = LCL
REMEMBER: G comes before R in the alphabet and M comes before L
What will you see on pulmonary artery catheter readings in cardiac tamponade
Equalization of intracardiac diastolic pressures (RA = RV = PCWP)
Does factor VIII deficiency affect PT or PTT
PTT
Which are the vitamin K dependent clotting factors
II, VII, IX, X, C, and S
THINK: diSCo started in 1972
Does vitamin K deficiency affect PT or PTT
Both
- But mild disease will affect PT more (recall that PT measure extrinsic pathway - VII, X, and V)
How does von Willbrand disease affect BT, PT, and PTT
- Prolonged BT
- Normal PT
- May have prolonged PTT due to vWF stabilization of Factor VIII
What clotting factors are involved in intrinsic vs extrinsic pathway
Intrinsic = XII, XI, IX, X, VIII
Extrinsic = VII, X
Both = X, V, II, I
What form of anticoagulation is preferred in CKD
Warfarin
What part of the brain is affected in Huntingtons
Caudate nucleus
Remember disease of C's: • Cognitive decline • Caudate atrophy • Chorea • CAG repeat • Chromosome cuatro (4) • Cuarents (40 y/o) • Decreased AcetylCholine
Who should get low dose CT scan to screen for lung cancer
- Age 55-80
- 30 pack year smoking hx
- Quit smoking <15 years ago
Order of tx for COPD
In order – continue to add the next step until you gain control
• Short acting beta agonist (SABA)
• Long acting muscarinic antagonist (Tiotropium)
• Long acting beta agonist (LABA)
• Inhaled corticosteroids
• Phosphodiesterase 4 inhibitors
• Oral steroids
What are the 2 things that improve mortality in COPD
O2 and smoking cessation
Describe the following associated with Asbestosis
- Exposure
- Imaging findings
- Histology
- Exposure to shipbuilding, roofing, plumbing
- Imaging shows pleural plaques
- Can cause lung cancer and mesothelioma (cancer of lung pleura)
- Histology shows fusiform rods (dumbbells)
What should you look for in the eyes in PCP intoxication
Nystagmus (vertical or horizontal)
What gene is affected in Fragile X
FMR1 (THINK: Fragile Mental Retardation)
What mutation is associated with Prader Willi vs Angelman syndrome (associated with maternal vs paternal loss of gene)
Prader Willi due to 15q 11-13 deletion or mutation on paternal allele (so both genes are from mom)
Angelman due to maternal allele (so both genes are from dad)
What hormone is most responsible for sx of acromegaly
Insulin-like growth factor
♣ GH increases hepatic production of insulin-like growth factor-I (IGF-I), which causes excessive growth of bone and soft tissues
Describe work up for suspected acromegaly
Elevated IGF-1 levels –> inadequate GH suppression in oral glucose suppression test –> MRI of brain to determine if tumor is pituitary or extrapituitary
Medical tx of cancer-related anorexia syndrome (CACS)
Progesterone analogue (e.g. megestrol acetate)
Management following a recent cat bite that does not appear infected
Antibiotic prophylaxis for pasteurella (Amox-Clav)
What is a lacunar stroke
Small penetrating artery occlusion due to hypertensive arteriolar sclerosis
Affected areas usually include basal ganglia, subcortical white matter, pons
Presentation of lacunar stroke
♣ Absence of cortical signs (e.g. aphasia, agnosia, neglect, apraxia, hemianopia), seizure, or mental status change ♣ Common syndromes: • Pure motor hemiparesis • Pure sensory stroke • Ataxic hemiparesis • Dysarthria-clumsy hand
Most important risk factor for lacunar stroke
HTN - leads to arteriolar sclerosis and vessel occlusion (hypertensive vasculopathy)
Diagnosis of GERD
PPI + lifestyle modification x6 weeks with resolution/improvement of symptoms
Diagnosis and tx of eosinophilic esophagitis
♣ >15 eosinophiles per high powered field
♣ Trial PPI to r/u GERD (because GERD often causes eosinophilia)
Tx of Barrett’s esophagus
High dose PPIs + surveillance EGDs
Tx of H Pylori
• Triple therapy = PPI + clarithromycin (or metronidazole) + amoxicillin
Describe GI effect of diabetes
Gastroparesis (subtype of peripheral neuropathy)
How do you diagnose gastroparesis
Gastric emptying studying (radioactive eggs); positive if . . .
o >60% gastric contents remaining after 2 hours
o >10% gastric contents remaining after 4 hours
o Pt must be off opiate and anticholinergics with good blood glucose control in order for test to be reliable
Tx of gastroparesis
Prokinetic agents o Metaclopramide (PO) in stable disease o Erythromycin (IV) in acute flare
- Avoid opiates
- Blood glucose control
- Low fiber, small volume meals
