UW12 Flashcards
If you have made a dx of osteosarcoma, what is the next imaging study to be done?
CT chest to rule out pulmonary mets (it loves the lungs) DO NOT do CXR
What is a serious and fatal issue assoc with Natalizumab? MOA?
Reactivation of JC polyomavirus; binds integrins on leukocyte cell walls and prevents them from getting into the tissue where the MS is occuring
What platelet count is an indication for a pt who is actively bleeding?
50,000
T/F: Chewing Tobacco can cause Buerger’s dz
True; any kind can
What named nerve innervates the dorsum of the foot?
Common peroneal
If a pt has bleeding secondary to uterine atony and is acutely hypertensive without a hx of HTN what should you give?
Oxytocin; do not give methylergonavine to pts with high BP
What is a big difference in the presentation of EBV mononucleosis and CMV mononucleosis? What if a pregnant pt gets CMV mononucleosis?
CMV typically has much less LAD and ABSENCE of pharyngitis; baby may have calcified ventricles (CMV = Calcify My Ventricles)
How many times a day should type I DM check their blood sugar?
MULTIPLE times per day i.e. > 2
MC weak muscle in patellofemoral syndrome?
Vastus medialis obliquus
What is the major difference in labs between alcoholic ketoacidosis and DKA?
Both have anion gap acidosis with ketones but alcoholic ketoacidosis will have normal to low glucose
What is DOC for migraines in pregnancy? DOC in kids?
Acetaminophen; Ibuprofen
Describe the appearance of a pt with Beckwith-Weideman syndrome? Tests?
Hemihypertrophy with OMPHALOCELE; do renal US q 3-6 months to rule out Wilms tumor (WT1 gene on chromosome 11)
How do you tx unilateral aldosteronomas vs. bilateral?
Unilateral = adrenalectomy; bilateral = medical therapy with spironolactone or eplerenone
What are the 4 grades of internal hemorrhoids?
I = no prolapse II = prolapse with defecation but spontaneous reduction III = prolapse with defectation and manual reduction IV = prolapse and cannot be reduced
What precautions are taken in pts with Influenza, group A strep throat, epiglottiis, and mumps
Droplet precautions
What is the treatment of choice for grades II-III internal hemorrhoids?
Rubber band ligation
What are 3 important meds to give in thyroid storm?
Propanolol is most important then give PTU (not methimazole bc does not block peripheral conversion T4 to T3) then iodine 1 hour after administration of thionoamide
What named nerve innervates the medial foot?
Saphenous nerve
What is the next best step if a pt has LBP with a positive step-off sign? If neurologic sx?
Plain film with oblique view looking for pars interarticularis fx i.e. spondylolisthesis; MRI for cord compression
What is the first line tx of postherpetic neuralgia? What if they fail that?
TCA (i.e. nortryptiline) then try pregabalin (Lyrica)
What is the MOA of probenicid?
Blocks tubular reabsorption of uric acid
What ventilator setting allows the pt to take a breath on their own and then the vent gives preset tidal volume, if no spontaneous breathing occurs then it will give that breath at a backup rate?
Assist control
When is IV labetalol indicated prior to tPA in stroke?
If BP is greater than 185/110 as this is associated with increased risk of conversion to hemorrhagic stroke
If a pt is volume overloaded and isnt quite having the response you’d like to furosemide, what can you do?
Add a thiazide diuretic since they operate at different sites (TALH NKCC vs. DCT Na/Cl) they can have a synergistic effect; ultimately if you are medically refractory to volume overload that is an indication for hemodialysis
What are some risk factors for MRSA i.e. in an outpatient case of cellulitis?
Recent hospitalization, IVDA, recent incarceration or current; Tx is then TMP-SMX, clindamycin, or doxycycline; if pt is toxic then admit with IV vancomycin
What is the most specific CLINICAL test for ACL injury
Lachman test
What named nerve innervates the lateral foot?
Sural nerve
What should be suspected in any pt with conjunctival injection after sugery? Tx?
Corneal abrasion (the MC ophthalmoscopic complication of surgery) confirm dx with slit lamp; ppx broad spec abx recommended i.e. TMP and polymixin B
What is a Mallet finger
Injury to the DIP leading to inability to extend the distal phalanx
What is the dx for new HTN in a pregnat woman with 260 mg proteinuria in 24 H
Gestational HTN would need > 300 mg proteinuria to be pre-eclampsia
What is the best initial test in renal artery stenosis?
US doppler of renals
What is a strong predictor of getting diabetic retinopathy?
Presence of renal dz
What is osteonecrosis of the navicular bone?
Kohler’s dz
What is the only way to make a definitive dx of adenomyosis?
Histologic exam of a HYSTERECTOMY SPECIMEN not an endometrial bx; you need to see endometrial tissue within the myometrium at least one low power field from the endomyometrial jxn
What two dimorphic fungi often have erythema nodosum? Which has granuolmatous nodules that may be verrucous in nature?
Coccidiodes immitis and Histoplasma capsulatum; Blastomyces dermatidis
What is the tx of lead poisoning? What two populations can be seen on peripheral smear?
PO succimer or IV dimercaprol or EDTA; a normochromic and hypochromic population both microcytic
What is the name of the femoral bruit heard in pts with AR?
Duroziez’s sign
What are the two most common AE of injectable contraception with medroxyprogesterone acetate (DepoProvera)?
Irregular menstrual bleeding and breast tenderness
What is Rett syndrome? Mutation involved?
A disease only seen in girls associated with disintegration of previoulsy acquired milestones and HAND WRINGING; MECP2
What are the 4 diagnostic criteria for DM?
HbA1C > 6.5%, Fasting glucose > 126, Random glucose > 200 IF WITH Sx, 2 HR glucose tolerance test > 200 after a 75 gram load
What is the best way to CONFIRM DM neuropathy?
EMG, if just suspect in a pt without prior hx DM you should do one of the 4 tests to dx DM
What is the general mgmt for asystole and PEA?
CPR and epinephrine (pressors i.e. vasopressin is an alternative)
What is the mainstay of Tx of PNH? What is the only cure? When do you do this?
Ecluzimab (anticompliment Ab that targets CD5 compliment pathway) and prednisone; Allogeneic hematopoietic stem cell transplant but only if develop acute leukemia or aplastic anemia
What is the BP criterion for severe preeclampsia? Proteinuria?
greater than 160/110 on 2 occasions 6 hours apart, 24 hour urinary protein greater than 5 g
What is Becks syndrome
bilateral loss of pain and temp with spastic paresis below the lesion and flaccid paralysis at the lesion; more commonly known as anterior spinal artery syndrome
Where is the MC location for ureteral injury during a hysterectomy?
At the cardinal ligament where it courses below the uterine arery (i.e. you ligate the uterine artery/cardinal ligament and accidentally bag the ureter)
What is salvage therapy for failed induction tx of cryptococcal meningitis?
Intrathecal amphotericin B; i.e. if failed IV amphotericin B and flucytosine
What is renal osteodystrophy?
Essentially a form of osteoporosis that occurs in CKD due to secondary hyperparathyroidism (low to normal Ca and high PTH)
What is Kohler’s dz? What is Kahler’s dz?
Osteonecrosis of the navicular bone; Eponym for multiple myeloma
How do you tx polymyositis/dermatomyositis?
Steroids
Loss of the stapedial reflex is commonly seen in what inherited disorder?
Otosclerosis (AD genetics) presents in young ppl 20-30
Why is dicloxacillin a good drug for impetigo?
Because it covers strep and staph (MSSA) which are the 2 mc causes of impetigo? you can also do mupirocin cream
What is assoc with Anti-scl-70
Diffuse scleroderma (systemic fibrosis)
What precautions are taken with TB and SARS?
Airborne isolation precautions
What is the MC cause of an infected shunt in hydrocephalus?
CoNS
What is Frieberg’s infarction?
Osteonecrosis of the second metatarsal head
What is a fx of the neck of the 5th metacarpal? Tx?
Boxer’s fx. Ulnar gutter splint
When you calculate fluid replacement via the Parkland formula what is the timeline for giving fluids?
Occurs over 24 hours; first half of the calculated amount is in first 8 hours, second half over the ensuing 16 hours
What is the best screening test for acute cholecystitis? Confirmatory?
Abdominal US; HIDA scan
What is the most common neurological deficit after meningitis?
Deafness
Where, anatomically, does breast CA MC occur?
Upper outer quadrant of breast
How can you treat refractory depression in a pregnant pt? AE?
ECT is SAFE IN PREGNANCY; Amnesia
How do you tx scabies? Who else should be tx?
5% permethrin cream neck down or PO ivermectin; contacts
What should the initial tx be for infantile GERD? How would you technically CONFIRM the dx?
Positional changes and thickening of the formula; 24 hour esophageal pH monitoring (I mean think about how ridiculous this is)
What is the most common cause of death in kids 1-4
Unintentional injuries of which DROWNING is MC
What is an alternative to steroids in asthma in ppl who don?t want them?
Montelukast
What can be used for shock-refractory ventricular fibrillation and ventricular tachycardia?
Amiodarone