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MS3 > Step studying 9 > Flashcards

Step studying 9 Flashcards

1
Q

How do you calculate serum osmols and what is the normal value

A

(2 x Na) + (Gluc / 18) + (BUN / 2.8)

Normal = 280

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2
Q

How do you correct sodium in hyperglycemia

A

♣ For every 100 that glucose is above 100, you need to correct the sodium by 1.6
♣ E.g. Pt with glucose of 500, that is four 100s above 100, so correct sodium with (4 x 1.6) = 6.5
• So if measured Na was 130, then corrected sodium is 136.5

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3
Q

What is the difference between hypertensive urgency and hypertensive emergency

A

Hypertensive urgency = Severe HTN (>180/120) without symptoms of acute end-organ damage

Hypertensive emergency = Severe HTN with acute, life-threatening, end-organ complications

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4
Q

Define Malignant hypertension

A

Malignant hypertension = Severe HTN with retinal hemorrhages, exudates, or papilledema

Falls under category of HTN emergency

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5
Q

Meds that can be used to treat fibromyalgia

A

TCAs, SNRI, Gabapentin

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6
Q

What do you see histologically in diabetic nephropathy

A
  • Glycosylation of basement membrane

- Sclerosing of mesangium (Kimmelstien-Wilson nodules)

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7
Q

How does fetal alcohol syndrome present

A

o Midfacial hypoplasia, microcephaly and stunted growth
o 3 pathognomonic facial dysmorphisms
♣ Small palpebral fissures
♣ Smooth philthrum (vertical groove above the upper lip)
♣ Thin vermilion border
o CNS damage may manifest as hyperactivity, mental retardation, or learning disability

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8
Q

What lab value can help you diagnose hereditary spherocytosis

A

Elevated mean corpuscular hemoglobin concentration (MCHC) - due to membrane loss and cellular dehydration

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9
Q

Describe cause and symptoms of Meniere disease

A

• Increased pressure and volume of endolymph
• Features:
o Episodic vertigo with nausea and vomiting
o Recurrent episodes lasting 20 min to several hours
o Ear fullness/pain
o Unilateral sensorineural hearing loss
o Tinnitus

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10
Q

Tx of Meniere disease

A

o Salt restriction
o Thiazide diuretics
o Symptomatic treatment (Meclizine)

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11
Q

Pt presents with sx of URI + crackles in the setting of recent sick contact - what is next step in management

A

CXR - needed before starting abx

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12
Q

Tx of outpatient CAP

A

Macrolide (azithro) or Doxy

Fluoroquinolone or beta-lactam + macrolide if comorbidities

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13
Q

What is the leading cause of B12 deficiency

A

Pernicious anemia

Autoimmune destruction of parietal cells leads to intrinsic factor deficiency and decreased absorption of B12

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14
Q

What long-term complication should you worry about in pernicious anemia

A

Gastric cancer

♣ Recall that parietal cells produce both IF and HCl, so destruction will lead to hypochlorhydria
♣ Hypochlorhydria will lead to increased gastrin production from antral G-cells
♣ This increases risk of gastric cancer

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15
Q

What should you be worried about in fall to outstretched hand

A

Scaphoid fracture

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16
Q

Sx of rheumatic fever

A

JONES

  • Joints (migratory arthritis)
  • Cardiac (carditis)
  • Nodule (subcutaneous)
  • Erythema marginatum
  • Sydenham chorea
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17
Q

Which antibody is sensitive for SLE and which is specific

A
  • ANA is sensitive

- anti-dsDNA and ant-Smith are more specific

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18
Q

Which antibody level should be ordered first in evaluation of SLE

A

ANA

If positive then test for more specific antibodies

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19
Q

Medical treatment of aortic dissection

A
  • Pain control (Morphine)
  • IV beta blockers (want to decrease SBP and LV contractility to reduce aortic wall stress)
  • Nitroprusside only is SBP >120
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20
Q

Management of threatened abortion

A

Expectant outpatient observation

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21
Q

Management of serotonin syndrome

A
  • Discontinuation of serotenergic agents
  • Supportive (e.g. hydration)
  • Benzos for sedation
22
Q

Clinical features of Wiskott Aldrich

A

WATER - Wiskott Aldrich, microThrombocytopenia, Eczema (especially truncal), Recurrent infections

23
Q

Differentiate between manic and hypomanic episode

A

Mania
♣ Lasts at least 1 week unless hospitalized
♣ Symptoms are more severe
♣ Marked impairment in social or occupational functioning or hospitalization necessary
♣ May have psychotic features; makes episode manic by definition

Hypomania 
♣	Last at least >/=4 consecutive days
♣	Symptoms less severe
♣	Not severe enough to cause marked impairment in social or occupational function 
♣	No psychotic features
24
Q

When do you deliver in Pre-eclampsia w/o severe features

A

> 37 weeks

25
Q

When do you deliver in Pre-eclampsia with severe features

A

> 34 weeks

26
Q

Next step in management of a preterm mom with regular contractions but no cervical change

A

Check fetal fibronectin

  • If negative = expectant management
  • If positive = antenatal corticosteroids, tocolysis if <34 weeks, mag sulfate, GBS prophylaxis
27
Q

At what gestational age is mag sulfate indicated for fetal CNS protection in preterm labor

A

<32 weeks

28
Q

Describe lesion and lymph nodes in chancroid

A
  • Painful, usually multiple and deep lesions

- Painful lymphadenitis

29
Q

Describe lesion and lymph nodes in lymphogranuloma venereum

A
  • Caused by chlamydia
  • Lesion is not painful with small and shallow ulcers
  • Painful lymphadenitis (“buboes”)
30
Q

What are good prognostic factors for schizophrenia

A
  • Late onset
  • Clear precipitant
  • Positive psychotic symptoms only
  • Sudden onset
31
Q

What are the time frames of the disorders on the spectrum on schizophrenia

A
  • Brief psychotic disorder = >1 day and <1 month
  • Schizophreniform disorder = >1 month and <6 months
  • Schizophrenia = >6 months
32
Q

Describe imaging of hepatic focal nodular hyperplasia

A
  • Most common benign nonvascular livre lesion
  • Usually asymptomatic and discovered incidentally
  • Arterial flow and central scar on imaging
33
Q

Cause of weight loss in a pt with COPD and no masses of XR

A

Pulmonary cachexia secondary to COPD

- Not likely due to cancer if normal XR

34
Q

Which presents with “beaded” appearance on MRCP - PBC or PSC

A

PSC = even though it’s opposite of what you would expect with the “bitches” analogy

35
Q

What part of the bone does Ewing Sarcoma usually occur

A

Diaphysis

36
Q

What part of the bone does osteosarcoma usually occur

A

Metaphysis - distal femur or proximal tibia

37
Q

What will you see on funduscopic exam in diabetic retinopathy

A

Neovascularization

38
Q

What will you see on funduscopic exam in hypertensive retinopathy

A

♣ Arteriovenous nicking
♣ Ateriolar narrowing
♣ Cotton wool sots

39
Q

What might you see in a baby born to a diabetic mother

A
  • Macrosomia
  • Stillbirth
  • Hypoglycemia
  • Polycythemia
  • Hyperbilirubinemia
  • Hypocalcemia
  • Respiratory distress
40
Q

Whats the time frame of adjustment disorder

A

♣ Lasts < 6 months

41
Q

Medications used to treat PTSD

A
  • SSRI/SNRI

- Prazosin (alpha-1 antagonist) used for nightmares

42
Q

Diagnostic requirements for acute liver failure

A
  • Severe acute liver injury (ALT/AST often >1000)
  • Signs of hepatic encephalopathy
  • Synthetic liver dysfunction (INR > 1.5)
43
Q

Causes of acute liver failure

A
  • Viral hepatitis (e.g. HSV, CMV, hepatitis)
  • Drug toxicity (e.g. acetaminophen overdose, idiosyncratic)
  • Ischemia (e.g. shock liver, Budd-Chiari)
  • Autoimmune hepatitis
  • Wilson disease
  • Malignant infiltration
44
Q

What is a common presentation of Hemphilia other than easy bleeding

A

Hemarthrosis - joint pain or swelling followed by little to no trauma due to spontaneous bleeding into a joint

45
Q

What should you think when you see pneumobilia (air in the biliary duct)

A

Think of gallstone ileus - gallstone passing through biliary-enteric fistula in to the intestines

46
Q

Tx of dystonia

A

Antimuscarinics (Benztropine or Diphenhydramine)

47
Q

Tx of Akathisia

A

Beta blockers (Propranolol), Benzodiazepine (Lorazepam), Benztropine

48
Q

Tx of tardive dyskinesia

A

Valbenazine (vesicular monamine transporter inhibitor)

49
Q

Tx of drug-induced parkinsonsim

A

Benztropine, Amantadine

50
Q

Tx of pseudotumor cerebri

A
  1. Acetazolamide
  2. Surgery (lumboperitoneal shunt or optic nerve sheath decompression) for refractory cases
  3. Serial LP’s to bridge while waiting for surgery
51
Q

Tx of incompletely vaccinated child who is exposed to chicken pox

A

If immunocompetent - administer vaccine

If immunocompromised - administer varicella immunoglobulin

If pt was fully vaccinated (2 doses of vaccine) - then just observe

MS3 (88 decks)

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