Step studying 9 Flashcards
How do you calculate serum osmols and what is the normal value
(2 x Na) + (Gluc / 18) + (BUN / 2.8)
Normal = 280
How do you correct sodium in hyperglycemia
♣ 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
What is the difference between hypertensive urgency and hypertensive emergency
Hypertensive urgency = Severe HTN (>180/120) without symptoms of acute end-organ damage
Hypertensive emergency = Severe HTN with acute, life-threatening, end-organ complications
Define Malignant hypertension
Malignant hypertension = Severe HTN with retinal hemorrhages, exudates, or papilledema
Falls under category of HTN emergency
Meds that can be used to treat fibromyalgia
TCAs, SNRI, Gabapentin
What do you see histologically in diabetic nephropathy
- Glycosylation of basement membrane
- Sclerosing of mesangium (Kimmelstien-Wilson nodules)
How does fetal alcohol syndrome present
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
What lab value can help you diagnose hereditary spherocytosis
Elevated mean corpuscular hemoglobin concentration (MCHC) - due to membrane loss and cellular dehydration
Describe cause and symptoms of Meniere disease
• 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
Tx of Meniere disease
o Salt restriction
o Thiazide diuretics
o Symptomatic treatment (Meclizine)
Pt presents with sx of URI + crackles in the setting of recent sick contact - what is next step in management
CXR - needed before starting abx
Tx of outpatient CAP
Macrolide (azithro) or Doxy
Fluoroquinolone or beta-lactam + macrolide if comorbidities
What is the leading cause of B12 deficiency
Pernicious anemia
Autoimmune destruction of parietal cells leads to intrinsic factor deficiency and decreased absorption of B12
What long-term complication should you worry about in pernicious anemia
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
What should you be worried about in fall to outstretched hand
Scaphoid fracture
Sx of rheumatic fever
JONES
- Joints (migratory arthritis)
- Cardiac (carditis)
- Nodule (subcutaneous)
- Erythema marginatum
- Sydenham chorea
Which antibody is sensitive for SLE and which is specific
- ANA is sensitive
- anti-dsDNA and ant-Smith are more specific
Which antibody level should be ordered first in evaluation of SLE
ANA
If positive then test for more specific antibodies
Medical treatment of aortic dissection
- Pain control (Morphine)
- IV beta blockers (want to decrease SBP and LV contractility to reduce aortic wall stress)
- Nitroprusside only is SBP >120
Management of threatened abortion
Expectant outpatient observation
Management of serotonin syndrome
- Discontinuation of serotenergic agents
- Supportive (e.g. hydration)
- Benzos for sedation
Clinical features of Wiskott Aldrich
WATER - Wiskott Aldrich, microThrombocytopenia, Eczema (especially truncal), Recurrent infections
Differentiate between manic and hypomanic episode
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
When do you deliver in Pre-eclampsia w/o severe features
> 37 weeks
When do you deliver in Pre-eclampsia with severe features
> 34 weeks
Next step in management of a preterm mom with regular contractions but no cervical change
Check fetal fibronectin
- If negative = expectant management
- If positive = antenatal corticosteroids, tocolysis if <34 weeks, mag sulfate, GBS prophylaxis
At what gestational age is mag sulfate indicated for fetal CNS protection in preterm labor
<32 weeks
Describe lesion and lymph nodes in chancroid
- Painful, usually multiple and deep lesions
- Painful lymphadenitis
Describe lesion and lymph nodes in lymphogranuloma venereum
- Caused by chlamydia
- Lesion is not painful with small and shallow ulcers
- Painful lymphadenitis (“buboes”)
What are good prognostic factors for schizophrenia
- Late onset
- Clear precipitant
- Positive psychotic symptoms only
- Sudden onset
What are the time frames of the disorders on the spectrum on schizophrenia
- Brief psychotic disorder = >1 day and <1 month
- Schizophreniform disorder = >1 month and <6 months
- Schizophrenia = >6 months
Describe imaging of hepatic focal nodular hyperplasia
- Most common benign nonvascular livre lesion
- Usually asymptomatic and discovered incidentally
- Arterial flow and central scar on imaging
Cause of weight loss in a pt with COPD and no masses of XR
Pulmonary cachexia secondary to COPD
- Not likely due to cancer if normal XR
Which presents with “beaded” appearance on MRCP - PBC or PSC
PSC = even though it’s opposite of what you would expect with the “bitches” analogy
What part of the bone does Ewing Sarcoma usually occur
Diaphysis
What part of the bone does osteosarcoma usually occur
Metaphysis - distal femur or proximal tibia
What will you see on funduscopic exam in diabetic retinopathy
Neovascularization
What will you see on funduscopic exam in hypertensive retinopathy
♣ Arteriovenous nicking
♣ Ateriolar narrowing
♣ Cotton wool sots
What might you see in a baby born to a diabetic mother
- Macrosomia
- Stillbirth
- Hypoglycemia
- Polycythemia
- Hyperbilirubinemia
- Hypocalcemia
- Respiratory distress
Whats the time frame of adjustment disorder
♣ Lasts < 6 months
Medications used to treat PTSD
- SSRI/SNRI
- Prazosin (alpha-1 antagonist) used for nightmares
Diagnostic requirements for acute liver failure
- Severe acute liver injury (ALT/AST often >1000)
- Signs of hepatic encephalopathy
- Synthetic liver dysfunction (INR > 1.5)
Causes of acute liver failure
- 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
What is a common presentation of Hemphilia other than easy bleeding
Hemarthrosis - joint pain or swelling followed by little to no trauma due to spontaneous bleeding into a joint
What should you think when you see pneumobilia (air in the biliary duct)
Think of gallstone ileus - gallstone passing through biliary-enteric fistula in to the intestines
Tx of dystonia
Antimuscarinics (Benztropine or Diphenhydramine)
Tx of Akathisia
Beta blockers (Propranolol), Benzodiazepine (Lorazepam), Benztropine
Tx of tardive dyskinesia
Valbenazine (vesicular monamine transporter inhibitor)
Tx of drug-induced parkinsonsim
Benztropine, Amantadine
Tx of pseudotumor cerebri
- Acetazolamide
- Surgery (lumboperitoneal shunt or optic nerve sheath decompression) for refractory cases
- Serial LP’s to bridge while waiting for surgery
Tx of incompletely vaccinated child who is exposed to chicken pox
If immunocompetent - administer vaccine
If immunocompromised - administer varicella immunoglobulin
If pt was fully vaccinated (2 doses of vaccine) - then just observe
