USAW 2 = 265 Flashcards by Amanda Compadre

Lady with Copper IUD post partum, lost 44 pounds, no periods since IUD, BMI 19, progesterone challenge no uterine bleeding. Cause?

Functional hypothalamic amenorrhea

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Male age 15-35 with unliateral painless testicular nodule, dull lower abdominal pain, metastatic symptoms (SOB, low back pain, neck mass), exam shows firm oviod mass, fixed, hard, does not transilluminate, what is it?

Testicular germ cell tumor

workup: Get tumor markers and bilateral scrotal US
tx: radical orchiectomy with LN dissection

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What tx for bulimia nervosa?

SSRI (fluoxetine), CBT, nutritional rehab

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Parameters in Cardiogenic shock

RAP, PCWP (both preload) - increased
CO/CI - Decreased
SVR - Inreased
MVO2 - Decreased

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Pruitic rash under breast, BMI 36 (also RF are excessive moisture, Immunocompromised, DM) - what is it?

Candida Intertrigo, it will culture growing pseudohyphae with budding yeast
Tx topical antifungal like nystatin, miconazole, good hygiene
(vs with tinea cruris would see septate hyphae)

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All congenital infections can have

IUGR, HSM, Jaundice, Blueberry muffin spots

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CMV also has

Periventricular calcifications, microcephaly, hearing loss

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Toxo also has

Diffuse intracerebral calcifications, chorioretinitis, hydroecphalus

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Syphilis

Rhinorrhea, notched teeth, saddle nose, short maxilla, saber shins, can have CN8 deafness, desquamating/bullous rash

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Rubella

Cataracts, heart defects PDA, deafness

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Tx sunburn

Cool compress, calamine lotion, aloe vera, NSAID

Severe: hospitalization, IV fluids, analgesia, wound care

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Tx gout

Tx Gout if someone is taking anticoagulants

NSAIDS like Indomethacin, colchicine, steriods

If on anticoagulants then colchicine

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Pregnant women with depression what do you do?

TX HER with SSRI and discuss risks and benefits

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Guy with uncontrolled HTN and Crack Cocaine use found unresponsive, Right pupil dialted and unresponsive to light, extensor posturing, DTR 4+ Left, Babinski + left, what is cause?

Basal ganglia hemorrhage causing transtentorial herniation and compression occulomotor nerve

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Tx endometritis

Clindamcin and gentamicin

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21 mo boy with recurrent otitis media, 2 PNA, eczema, thrombocytopenia, small platelet size?

Wiskott Aldrich Syndrome
XLR is WAS protein gene, impaired cytoskeleton changes in leukocytes and platelets
tx Stem cell transplant

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44 yo with fatigue, arthropathy, and hypogonadism?

Hereditary hemochromatosis

usually triad cirrhosis, DM, skin pig rare

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33 week pregnant lady with regular contractions, no cervical change, what next?

FFN test, used to determine whether a patient at <34 weeks gestation with regular uterine contractions and no cervical change is in preterm labor
+ strong predictor delivery in next week, administer bethamethasone
- FFN can resume routine prenatal care

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Labert Eaton vs MG

Labert Eaton has proximal muscle weakness L>A
Decreased or absent reflexes
Strength and reflexes improve with isometric contraction
Autonomic dysfunction
Associated with SCLC

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Man with HIV not on antiretroviral meds, with rectal pain, bleeding, 3cm ulcer, bleeds easily

ANAL CANCER

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Contraindications to Levonorgesterel IUD?

Active liver disease, breast cancer, acute pelvic infection

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Contraindications to Copper IUD?

Wilson Disease, copper allergy, heavy menstrual bleeding, acute pelvic infection

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Next step with acute mastoiditis?

Dx clinically in most cases, if needed CT scan or MRI w/contrast and IV abx and surgical drainage

Consider COPD when?

> 40, tobacco use >30 pack years, chronic cough often with sputum, progressive dyspnea on exertion
w/u with spirometry

Diabetic with nephrotic range proteinuria but has atypical features like hematuria, RBC casts, rapidly developing disease, what to do next for workup?

Kidney biopsy, looks like more GN picture

Predictive of good prognosis in schizophrenia?

Positive psychotic symptoms (hallucinations, delusions)

Predictive of poor prognosis in schizophrenia?

early onset, no clear precipitant, prodromal phase, gradual onset

Pathophysiology of chemotherapy induced cardiotoxicity?

Cardiomyocyte replacement by fibrous tissue 2/2 anthracyclines, less likely reversible VS 2/2 trastuzumab which has myocardial stuning/hibernation without myocyte destruction, more likely reversible

Local complications of cardiac catherization

1) Hematoma - +/- mass, NO BRUIT 2) Psuedoaneurysm - bulding soft pulsatile mass, systolic bruit 3) AV fistula - NO MASS, continuous bruit

Tx for patient with OA?

Exercises for strengthening the quadricep muscles

Non painful, non itchy, lower eyelid swelling with previous occurences, no Temperature

Chalazion 2/2 occlusion of meibomian tear gland, resolves on own usually, but could also benefit from warm compress

Acute inflammatory nodule from eyelash follice (stye) or from meiobomian gland under eye

Horedeolum, usually 2/2 staph a infection, usually painful and closer to lid margin

Acute infection lacrimal sac sudden onset pain and redness at the medial canthal region

Dacryocystitis

Constitutionally small infant life outcomes

Normal long term outcome

Elevated intraocular pressure, atrophy of optic nerve head, progressive loss of peripheral vision, enlargement of optic cup with an increased cup:disc ratio

chronic open angle glaucome

DRESS syndrome

drug reaction 2/2 allopurinol and antiepileptics (pheny, carba), have morbilliform eruption on face trunk and becomes diffuse and confluent, eosinophilia, systemic symtpoms, fever, malaise, LAD take 2-8 weeks between drug intiation and manifestation

Abdominal pain, distention, colonic dilation w/out radiographic evidence of an anatomic obstruction, can lead to colonic ischemia and perforation

Colonic psuedoobstruction (ogilvie syndrome)

Dominant malaria outside of africa

P viviax, can have reactivation of dormant hypnozoites, tx with primaquine and chloroquine in non resitant areas

Vaccines needed in pregnancy

TDAP, flu, RhoD IG

Onycholysis, pitting, dermal plaques...

Psoriatic arthritis

Harsh holosytolic murmur in the 4th L ICS

VSD

Watery & nocturnal diarrhea for 6 months, fecal urgency, incontinence, female >50, smoking, NSAIDS?

Mircoscopic colitis, colonoscopy shows inflammatory infitrates with a monocytic predominance

Akathisia caused by?

Antipsychotics or antiemetics (anti-DA) | Prochlorperazine, promethazine, metoclopramide (phenegran, reglan, compazine)

MDS

Hematopoetic stem cell neoplasm, risk increasing age, previous Chemo/RT, may transform to acute leukemia Pancytopenia See dysplastic red and WBC (ovalomacrocytosis, neutrophil hyposegmentation/hypogranulatino) Dx with BMBx

Myelofibrosis

Pancytopenia with massive splenomegaly due to extramedullary hematopoesis

Patients with symptomatic (exertional dyspnea, angina, presyncope/syncope) AS and valve area <1cm2 management?

Referral for valve replacement

Mechanism of testicular torsion?

twisting of spermatic cord 2/2 inadequate fixation of the lower pole of the testis to the tunica vaginalis

What to when older sibling reacts to birth of baby with regressive behavior and aggression toward infant?

Spend more time with older children

How to diagnose leiomyomata?

saline infusion US

Connection between Crohns disease and Uric acid stones?

Crohns --> chronic diarrhea --> Chronic HCO3 loss --> acidic hyper concentrated urine Manage uric acid stones with urine alkanization and KHCO3, Kcitrate

Hyperviscosity, bleeding, HSM, neuropathy, LAD

Waldenstrom macroglomulinemia IgM tx with plasma exchange

PE cauues what to happen to heart?

decreased CO 2/2 RV dysfunction

What will influence a teenager to be more adherent to using condoms?

Peer group uses them

Upper load cavitary lung lesion in 45 pack year smoker?

SCCL (85% of malignant upper cavity lessions)

1-3 weeks after viral infection child has disturbances with coordination and gait?

Acute cereballar ataxia