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Third 100 Flashcards

1
Q

How does TCA overdose present?

Indicator of severity? Treatment?

A

•Anticholinergic (dry, hot, crazy etc) as well as QRS PROLONGATION and hypotension with hyperthermia
– TCA: ThermiaTension, Cardiac (QRS), Antichol
•QRS is the indicator of severity - give sodium bicarb

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2
Q

Antidote for ethylene glycol poisoning? (2)

A

Ethanol OR fomepizole (foamy piss?)

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3
Q

How does beta blocker OD present?

Treatment?

A

Bradycardia, AV BLOCK, diffuse wheezing and hypotension

Give glucagon

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4
Q

How does TCAs cause QRS prolongation?

How does sodium bicarb help?

A

It inhibits cardiac fast sodium channels causing QRS prolongation

It increases extracellular sodium conc.

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5
Q

Most common cardiac congenital defect?

A

VSD

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6
Q

Cyanotic baby - list the heart defect

A 
Truncus arteriosus (1 arterial vessel for both ventricles)
Transposition of the greats (2 switched)
Tricuspid atresia (3)
Tetralogy of Fallot (tetra = 4)
Total anomalous pulm. venous return (5 words)
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7
Q

List conditions with VSD in kids

A

TORCH, FAS, Down’s, cri-du-chat

‘Torch was (fas) down, heard cat cry or something’
- also VSD = VaSDown

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8
Q

Kid with conjunctivitis and pannus (neovascularization) - mcc?

Next step to diagnose?
Treatment?

A

Chlamydia trachomatis (trachoma) A-C
Diagnose with giemsa stain
Topical tetracycline or oral azithromycin

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9
Q

Baby with wheezing, relieved by neck extension

A

Vascular ring compressing airway

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10
Q

Most common cause of congenital hypothyroidism (in the USA)?

A

Thyroid dysgenesis

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11
Q

Normal CSF values?

A

Protein <40
Glucose 40-70
Pressure 70-180

PSP 4718

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12
Q

How will viral meningitis show up in CSF?

Treatment?

A

Normal glucose, high protein, lotsa lymphocytes

Treatment - supportive. Will resolve in 7-10 days

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13
Q

Describe Kawasaki disease

A

Konjunctivitis (bilateral, non-purulent), All-over rash, Week-long fever (5days minimum), Adenopathy (cervical, unilateral), Strawberry tongue, Aspirin (high dose), Koronary artery aneurism (complication), KIvig (treatment)

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14
Q

How to differentiate between NFM1 and 2?

A

NFM-2 must have cataracts and acoustic neuromas

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15
Q

Adolescent with mass in the nose, frequent nosebleeds
MCC?
Treatment?

A

Juvenile angiofibroma

Surgical excision by a specialist

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16
Q

CAH - inheritance?
How will it present?
Deficiency?
How is it diagnosed? (2 tests)

A

Autosomal recessive
Virilization of female or over androgenization of male.
21-hydroxylase deficiency (90% of cases) - resulting in high 17-α-hydroxyprogesterone
Test for levels of 17-α, confirm with ACTH stimulation test

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17
Q

Sluggish baby with large tongue and umbilical hernia

A

Congenital hypothyroidism

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18
Q

2 causes of floppy baby

A
  1. Infant botulism (remember - NOT due to ingestion of preformed toxins, toxins formed once inside)
  2. Werdnig-Hoffman syndrome : AR syndrome with degeneration of anterior horn cells cranial nerve motor nucleii
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19
Q

Mst common cause of nephropathy in kids? Adults?

A

Kids - minimal change disease, adults - membranous glomerulonephritis
MCD - nothing, normal biopsy
Memb. G..is - diffuse thickening of BM and subepithelial spikes

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20
Q

WTF is NAS?
Caused by?
Presents how?
Treatment?

A

Neonatal abstinence syndrome
Caused by opioid withawel (2/2 mom taking them)
Presents in the first days of life with a high-pitched cry, irritability, tremors, sweating, seizures etc.
Treatment - supportive

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21
Q

Who gets screened for chlamydia?

A

24 and younger, also those with new or numerous partners or hx of STD

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22
Q

Timeframe for HPV vaccine

A

9-26

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23
Q

AAA screening?

A

65-75 yo with hx of smoking - do abd u/s

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24
Q

Timeline for mammograms?

A

Every 2 years between 50 and 75. Nothing before or after

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25
CDC guidelines for pneumococcal vaccine?
Once to pts 65+, but also to pts with chronic disease (heart, lung, liver or kidneys) and DM or immunosuppression.
26
Vaccines for newborns - according to chronological age or gestational age?
All vaccines - live and not - should be given by chronological age Remember - a baby must be 2kg before HepB vaccine!!
27
Limit of viral load for contraindication of MMR in HIV pts?
200 - less than this, no vaccine (since its live and all)
28
Pneumococcal vaccine induces immunity how ..?
T-cell independent B-cell response
29
What to give for Torsades?
Magnesium sulfate (also stop offending drug)
30
When to give amiodarone?
Ventricular and atrial tachycardia
31
When to give calcium gluconate?
Hyperkalemia
32
Wheto give sodium bicarb?
TCA and ASA overdose
33
When to give atropine?
Bradycardia, asystoly and PEA
34
When to give adenosine?
SVT (look for WPW) "AndThenYouSee ---- WPW!)
35
Name 5 drugs that can cause torsades
TCAs Amiodarone, sotalol (antiarrhythmics) Fluconazole, mixofloxacin Stop these when torsades show up, and give mag sulfate
36
How will phenytoin toxicity present?
Horizontal nystagmus, cebellar ataxia, confusion
37
How to calculate anion gap?
Sodium minus (chloride + bicarb)
38
Metabolic acidosis - what is the formula for resp compensation? What is the name of the formula?
PaCO2 = 1.5 (bicarb)+8 >> if this is the value of the CO2 in the ABG, there is resp comp. if not, think of resp. Alk/acid ontop of the metabolic. Winter's formula
39
High calcium with high/normal PTH - 2 top MCC?
``` Familial hypocalciuric hypercalcemia (look for low urine/creatinine clearance ratio) OR Primary hyperparathyroidism (this will have high urine excretion) ```
40
High calcium with low PTH?
Think of Vit. D OD, sarcoidosis, multiple myeloma, renal cell carcinoma
41
Aldosterone keeps water at the expense of..?
Hydrogen and potassium
42
Treatment for acute hyperkalemia?
1. Calcium gluconate - stabillizing the heart 2. Lower K+ quick : beta2agonists, glucose&insulin or sodium bicarb 3. Lower K+ longterm : kayexalate
43
Hyperpigmentation of the skin with fatigue etc?
Addisons - look for hypokalemia, hyponatremia
44
What factor could affect high/low calcium?
Albumin - ad/subtract 0.8 calcm for every 1 albumin above/below 4.0
45
Firstline treatment of CHF
ACEI
46
Wheezing following NSAIDs or ASA - diagnosis? | Commonly associated with?
Aspirin Exacerbation Resp Disease (AERD) Nasal polyps
47
Patient shows up with trying to lose weight and low TSH with high T3/4 - whats up? What will thyroid look like with biopsy?
Exogenous thyroid hormone Follicular atrophy
48
Pain and weakness in the hips and shoulders - diagnosis? How to differentiate between drug-induced and inflammatory? Treatment?
Inflammatory myopathy (polymyositis or dermatomyositis most common) If the ESR and CK is high - this shows inflammatory Steroids
49
Initial scan for diverticulitis?
CT scan
50
Next step with PBC patient?
Ursodeoxycholic acid
51
Pt presents with non-healing ulcer(s), lung issues and possibly renal problems - top of ddx? Lab tests show? Treatment?
Wegener's (granulomatosis with polyangiitis) Lab shows positive C-ANCA and elevated CRP Treat with cyclophosphamide
52
Treatment for cluster headache?
100% oxygen
53
Pt presents with severe pIn upon the slightest touch, together with hemianesthesia - what happened?
Thalamic stroke
54
Treatment for Alzheimer's?
Donepezil
55
Older pt with increased itching after baths, lab shows increased RBC, WBC and platelets - top of ddx? What will labs show?
Polycythemia Vera Normal ESR, hypercellular bonemarrow, high LAP, low erythropoetin (LAP > ESR > erythropoetin)
56
Which type of lung cancer causes PTHrP?
Squamous cell (SCa++mous cell)
57
``` Pt presents with spherocytes, anemia and splenomegaly Diagnosis? Hereditary type? What should this person be on? Is there a cure? ```
Hereditary spherocytosis AD Folic acid Yes - splenectomy
58
How will HIT be described?
Antibody-mediated platelet activation
59
Iron deficiency - think WHAT first?
Chronic bleeding - often GI
60
2 major macrocytic anemias - how to distinguish?
Folate and B12 | B12 will have NEUROLOGIC SIGNS, methyl malonyl CoA in urine, positive Schilling test. Folate def. will not
61
Treatment for chemo-induced nausea?
Serotonin antagonist (ondansetron)
62
B12 deficiency can lead to what long-term complication?
Gastric cancer
63
What does a positive Coombs test mean?
Hemolytic anemia
64
Bone mets with neurologic symptoms - next step? | What then?
Glucocorticoids (dexamethasone FIRST) Then MRI of spine
65
Patient with recurrent pulmonary and GI infections throughout life - cause? What else might they exhibit?
IgA deficiency Anaphylactic transfusion reactions
66
Sickle cell patient with sudden drop in H/H and low/no retic count - what is happening? What can set this off? Treatment? What else causes a sudden H/H drop, and what is different?
Aplastic crisis (NOT aplastic anemia) parvo B19 virus Blood transfusion Hyperhemolytic and splenic sequestration - retic count will be high in both, with SS also showing splenomegaly
67
What is the cause of warfarin necrosis?
Protein C inhibition/deficiency
68
Which clotting factors does warfarin bind?
Factors II, VII, IX, X, C, S (2+7=9, add 10)
69
Kid presents with exzema, multiple previous infections and low platelets - top of ddx? How will the platelets be described? Infections usually due to..? Cause of thrombocytopenia?
Wiskott-Aldrich syndrome Few (<50,000) and decreased volume (small) SHIN infections Decreased platelet production
70
Teen with polyps and a brain tumour - diagnosis? | Inheritance pattern?
Turcot's syndrome - a combo of brain tumours and either FAP or HNPCC Autosomal recessive
71
What will you see with Gardener's syndrome
Look for polyps (possibly familial) and supernumary teeth with osteonecrosis of the jaw
72
Key words - 'sunburst appearance' and 'codman's triangle' Treatment?
Osteosarcoma Surgery
73
Treatment for elevated homocysteine?
Folate & B6 (pyridoxine)
74
Key words - 'starry sky appearance'
Burkitt lymphoma
75
Kid with massive WBC count and positive PAS reaction
ALL
76
2 MCC of acquired coagulopathies in a hospital setting? What differentiates them?
Liver disease and DIC DIC has depressed levels of Factor VIII
77
Blood smear with schistocytes, low plt and high CK - diagnosis? Treatment? What is contraindicated? What else to keep in mind, and how to differentiate?
TTP Treat with steroids, plasma replaceent and plasmaphoresis Nevr give platelets!!! TTP is caused by clumping, and added plts make it worse HUS (renal failure) & HELLP (pregnant, pre-eclampsia)
78
Key word : hypersegmented neutrophil
Megaloblastic anemia
79
Hypersegmented PMN with elevated homocysteine, normal MMA What if the MMA was elevated?
Folate has normal MMA and high homocyst B12 def has elevated MMA and homocyst
80
African american male who took quinine - now at risk for?
G6PD deficiency
81
Normocytic, hemolytic anemia with neurological problems and low grade fever - what will be on labs? Diagnosis? Next step? Treatment?
Labs - high retic, high indirect bili Diagnosis - TTP Peripheral blood smear (possibly schistocytes) Plasma exchange
82
Key words - anti-Jo antibodies
Polymyositis diagnosis
83
Key words: anti-RNP antibodies
Connective tissue disease
84
Kid shows with aplastic anemia, abnormal thumbs and/or skin and ear manifestations - diagnosis? What will the ears and skin show? Treatment? What else?
Fanconi anemia Ears - lowset, middle ear comp.; skin - hypopig, cafe.., freckles Treat -stem cell transplant At risk for cancer, AR or X-linked (chromosomal breaks)
85
Exposure to what causes aplastic anemia?
Benzene
86
Side effect from isoniazid?
Pyridoxine deficiency (give B6 for sideroblastic anemia)
87
What is Zoledronic acid?
Bisphosphonate
88
Hypercalcemia in chemo setting - Probable cause? Treatment?
PTHrP secretion | Treat with bisohosphonates
89
What is Lynch syndrome? | What else should be checked?
HNPCC | Apart from colorectal cancer, also screen for endometrial cancer
90
Treatment for hairy cell leukemia? | Side effects of this treatment?
Cladribine | Neuro and kidney damage
91
Presence of cord-like veins or red streaks on arms and/or chest -think of? Also check? Pt at risk for?
Migratory thrombophlebitis (Trousseau's syndrome) CT of chest for primary tumour (prob pancreatic or lung) Pulm embolism!
92
Hard painless mass in testes - next step? | If positive, what then?
Ultrasound | If solid, hard (no hydrocele) - remove it
93
Recurrent infections with multiple myeloma - why the infections?
Decrease in total antibodiesand possible leukopenia (due to crowding of cells)
94
When seeing high calcium, think of which 2 things always? | Expand on the second one
Multiple myeloma and hyperparathyroidism With hyperpara, think of MEN1 and 2 MEN 1 (pee, papa) - pituitary, pancreas, parathyroid MEN2A - (vee met para) pheo, medullary CA, parathyroid MEN2B - (vee met almal) pheo medullary CA, neuromas
95
Diffuse telengiectasias - think of..?
CREST or OslerWeberRandau
96
Pt with high plasma homocysteine levels - treatment?
Pyridoxine (B6)
97
Pt with multiplemyeloma - next step in diagnosis?
Serum immunoelectrophoresis (will show abnormal M-spike due to IgG Ab production)
98
Breast CA - how does ER/PR and Her2 expression change prognosis?
ER+ and PR+ are good prognostic factors Her2/neu overexpression is bad
99
Treatment for CML?
Tyrosine kinase inhibitors (Imatinib)
100
What does hydroxyurea do? | Side effects?
Increases fetal hemoglobin | Bone marrow suppression

Step 2 CK (6 decks)

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