UWorld 2 Flashcards
increased peak pressure a/w unchanged plateau pressure suggests…
some pathology causing increased airway resistance (bronchospasm, mucus plug, ETT obstruction)
increased peak pressure and plateau pressure suggests…
some pathology causing decreased pulmonary compliance (pulm edema, atelectasis, pneumonia, R mainstem intubation)
what is the plateau pressure
elastic pressure (compliance) + PEEP (since you set the PEEP, it's pretty much showing you compliance)
what is peak airway pressure
resistive P (flow x resistance) + plateau P (compliance + PEEP)
explain the hormones in primary ovarian insufficiency
(a type of hypogonadotropic hypogonadism)
ovaries stop functioning –> estrogen down
amps up feedback @ hypothalamus –> increased GnRH and FSH
explain the hormones in hypothalamic hypogonadism
usually they’re too skinny –> shuts down hypothalamus
less GnRH –> less FSH –> less estrogen
explain the hormones in PCOS
(i think)
the ovaries are crap and not really ovulating –> estrogen down
hypothalamus goes nuts trying to help –> GnRH up (but not pulsatile)
this makes LH go up more than FSH (which is low/normal)
then also you’re making a bunch of androgens and they get converted to estrone which is an estrogen but doesn’t help so you get high (unhelpful) estrogen
Total: GnRH up, LH up, FSH low/norm, E up
when do you get benzo withdrawal seizures
short acting benzos are more likely
24 hrs+ after abrupt stop
when can you turn a breech baby
37 weeks to onset of labor
what do leuk esterases and nitrates tell you
+ leuks = pyuria
+ nitrates = enterobacteriaceae (like E. coli)
AE of succinylcholine (who to avoid)
hyperkalemia –> cardiac arrhythmias
rhabdo, burns, guillain-barre
AE etomidate
adrenal insufficiency
AE nitrous oxide (who to avoid)
inactivates B12 –> neurotox (B12 def people)
AE propofol (who to avoid)
myocardial depression –> severe hTN
ventricular systolic dysfunction
who can’t breastfeed
active TB HIV HSV breast lesions varicella meds/chemo/drugs
walk through the hypertension/hypokalemia workup
look at the renin-aldosterone ratio
both up –> secondary hyperaldosteronism (somethings making you make renin/is making renin)
aldo up, not renin –> primary hyperaldosteronism (you’re making too much aldo in adrenals)
both down –> something else is making trouble
tx: acute CHF exacerbation
LMNOP lasix/loops morphine NG O2 position
evidence of cholecystitis vs choledocolithiasis
both can have similar sx, elevated LFTs or bilirubin
choledocolithiasis will have increased alk-phos + possibly very high bilirubin (> 4)
polymyositis vs polymyalgia rheumatica (sx)
polymyositis: proximal muscle weakness but mild pain
polymyalgia rheumatica: stiffness in same places + neck
polymyositis vs polymyalgia rheumatica (labs)
polymyositis: up CK, aldolase, AST, anti-Jo, ANA, up ESR?
polymyalgia rheumatica: up ESR, CRP
indication for HRT
hot flashes (nothing else!) women < 60 who meno'd in past 10 yrs
preterm labor definition
contractions (making cervical change!) before 37 wks
newborn CXR: egg on a string
transposition of great vessels
newborn CXR: snowman sign
total anomalous pulm venous return w/ obstruction
cyanotic newborn: single S2
transposition of great vessels
tricuspid atresia
truncus arteriosus
well circumscribed, round, dural-based mass on MRI
meningioma
tx: meningioma
resection
MSK effects of CF
osteopenia
kyphoscoliosis
tx: DM ileus
metoclopramide
erythromycin
drugs causing folate def
phenytoin
trimethoprim (TMP)
methotrexate
hydroxyurea? (–> macrocytosis)
why do you not CT infant meningitis first?
herniation is rare (fontanelles are open)
knee injury: people who kneel a lot
prepatellar bursitis
knee injury: people who jump/forcefully extend a lot
patellar tendinitis
knee injury: pain w/ active motion, normal passive ROM
think bursitis
tx: prostatitis
TMP-SMX or FQs (acute)
FQs (chronic)
MC orgs of bacterial rhinosinusitis
strep pneumo
H flu
moraxella catarrhalis (way less)
neck xray: widened prevertebral space
think retropharyngeal abscess
tylenol overdose, what ot expect
n/v
RUQ pain
LFTs up
–> liver failure
mgmt: PAD
- lifestyle (stop smoking), supervised exercise program, ASA, statins
- (if persists) Cilostazol or surgical stenting
emergency: can’t get an IV
IO
MCC pneumonia in CF pts
kids: staph aureus
> 20: pseudomonas
tx: pneumonia in CF pts
cefepime (staph + pseudomonas)
vanco (MRSA)
why is there increased CSF in NPH
decreased absorption (or obstruction)
tx: chronic LBP
exercise regimen
NSAIDs/tylenol intermittently
RFs for focal sclerosing GN
MC nephrotic syndrome in adults AA/Hispanic HIV heroin obesity
lyme/RMSF vs ehrlichiosis
ehrlichiosis has no rash
ehrlichiosis has leukopenia +/- thrombocytopenia and increased LFTs and LDH
FeNA values
> 2% = acute tubular necrosis
< 1% = acute interstitial nephritis
mgmt: variceal hemorrhage
- IVF, octreotide, Abx
- EGD
3a (stopped bleeding): start prophylaxis (BB, band 1-2 wks later)
3b (bleeding/rebleed): balloon tamponade, eventual TIPS/shunt surg
multiple myeloma: sx
weight loss
fatigue
bone pain
multiple myeloma: labs
hypercalcemia
normocytic anemia
renal insufficiency
protein gap (TP 4+ > alb)
what do you do if you see a protein gap
get serum protein electrophoresis
polyclonal = infxn, CT d/os
monoclonal = MM, Waldenstrom’s
pneumococcal vs meningococcal meningitis
pneumococcal doesn’t have rapid onset shock or skin stuff
Ca forms in the body
ionized (45%) – only physiologically active form
alb-bound (40%)
bound to other crap (15%)
Ca changes w/ acid-base stuff
acidosis –> alb holds more H+ (and less Ca) –> up ionized Ca
alkalosis –> alb releases more H+ (and holds more Ca) –> down ionized Ca
HIV pt: painless retinitis
CMV
HIV pt: rapid b/l necrotizing retinitis
HSV
signs of cyanide toxicity
AMS, lactic acidosis, seizures, coma
chorioamnionitis aka
intraamniotic infection
criteria for chorioamnionitis
maternal fever plus 1:
- uterine tenderness
- maternal or fetal tachycardia
- malodorous amniotic fluid
- purulent vaginal discharge
tx: chorioamnionitis
broad spectrum Abx
deliver (accelerate w/ oxytocin)
antipyretics
tx: disseminated GC
IV ceftriaxone, switch to oral cefixime when clinically improved
mgmt: pap –> atypical glandular cells
could be cervical or endometrial adenocarcinoma
who: > 35 or < 35 w/ RFs (obese, anovulation)
mgmt: colp, endocervical curettage and EMB
signs of acute arsenic poisoning
garlic breath
vomiting
watery diarrhea
QTc prolongation
signs of chronic arsenic poisoning
hypo/hyperpigmentation
hyperkeratosis
stocking-glove neuropathy
eyes: acute onset discomfort, photophobia, watery discharge, bulbar conjunctival injection
episcleritis
eyes: localized red, tender swelling over eyelid
hordeolum (stye) - usually staph aureus
eyes: fever, proptosis, restricted EOM, red, swollen eyelids
orbital cellulitis
eyes: sudden onset pain and redness in medial canthal region
dacryocystitis
whats that benign red thing on the baby butt called
strawberry (or superficial) hemangioma
also, they aren’t always on the butt
whats the adult hemangioma called
cherry hemangioma
mgmt: minimal BRBPR
< 40, no red flags: anoscopy (then sigmoid/colonoscopy if don’t find anything)
40 - 49, no red flags: sigmoid/colonoscopy
50+ or red flags: colonoscopy
breast: peau d’orange
inflammatory breast carcinoma
breast: firm, mobile spherical, palpable mass (young woman)
fibroadenoma (benign)
breast: unilateral nipple discharge w/o skin changes or other sx
intraductal papilloma (benign) even if discharge is bloody
breast: fever, diffuse warmth, erythema
mastitis
breast: dimpling/contour changes
infiltrating ductal carcinoma or lobular breast carcinoma
breast: diffuse erythema, edema and dimpling
inflammatory breast carcinoma
breastfeeding failure jaundice
first week of life
baby or mom fail
signs of dehydration
breast milk jaundice
peak @ 2 weeks (start at day 3-5)
adequate feeding
normal exam (besides jaundice)
how does lung infxn –> pleural effusion
cytokines released
increase capillary permeability
HIV pt: fever, headache and signs of increased ICP
think cryptococcus meningitis
tx: frostbite
rapid rewarming in a water bath (98.6 - 102.2) with tons of pain meds
newborn: cutis aplasia
trisomy 13 (Patau)
newborn: cat like cry
5p deletion
newborn: clenched fists
trisomy 18 (Edwards)
newborn: microphthalmia
trisomy 13 (Patau)
newborn: rocker bottom feet
trisomy 18 (Edwards)
newborn: polydactyly
trisomy 13 (Patau)
nephropathy a/w hep B
membranous, membranoproliferative
nephropathy a/w hep C
membranoproliferative
nephropathy a/w lipodystrophy
membranoproliferative
nephropathy a/w lymphoma
minimal change dz
nephropathy a/w URI
IgA nephropathy
things for NF-1
cafe-au-lait spots freckles in axilla/inguinal lisch nodules (iris hamartomas) neurofibromas (peripheral nerve sheath tumors) optic gliomas
daddy, where do PEs come from?
usually from proximal deep veins of LEs (iliac, femoral, popliteal) renal veins (in nephropathy) R atrium (with pacemakers)
hematuria: glomerular vs non
glomerular: blood (RBC casts, dysmorphic RBCs) and protein
non glomerular: blood (normal RBCs), no protein
lactation suppression
avoid nipple stimulation
ice packs
NSAIDs
no binding (mastitis) no bromocriptine
MCC a sudden heart attack outside the hospital
sustained v tach or vfib
most important prognosis indicator for out of hospital heart attack
time to resuscitation (CPR, defibrillator)
what not to give people with AV block
adenosine
BB
digoxin
prenatal care: when do you type and screen
initial visit
prenatal care: when do you do HIV/HBsAg/RPR/Chlamydia
initial visit
prenatal care: when do you do the 1 hr GTTT
24 - 28 wks
prenatal care: when do you get the GBS culture
35 - 37 wks
prenatal care: when do you get the Ab screen if shes Rh negative
24 - 28 wks
prenatal care: when do you check her rubella/varicella immunity
initial visit
prenatal care: when do you do a UA
initial
ataxia, dysarthria, scoliosis, foot deformities, CM
Friedreich ataxia
MCC death in Friedreich ataxia
CM/respiratory complications
hereditary thrombophilias
factor V leiden
prothrombin mutation
antithrombin def
protein C/S def
talk through protein C/S
protein C and S stop you from making clots (by inhibiting factor V)
protein C/S def –> more clots
Warfarin stops production of C and S (not on purpose!) which is why you have to bridge therapy
lung exam: when do you get increased tactile fremitus
consolidation
lung exam: when do you get dullness to percussion
consolidation
pleural effusion
atelectasis
lung exam: when do you get a mediastinal shift (away)
pneumothorax
large pleural effusion
lung exam: when do you get hyperresonant percussion
pneumothorax
emphysema
lung exam: when do you get decreased tactile fremitus
pleural effusion
pneumothorax
emphysema
atelectasis
lung exam: when do you get a mediastinal shift (toward)
large atelectasis
ABI: PAD
< 0.90
ABI > 1.3
calcified or non compressible vessels – do more tests
GI sx/complications of HSP
abdominal pain (nbd) intussusceptions (bd)
bradycardia, AV block, hypotension, wheezing
BB overdose (consider CCB, digoxin or cholinergic agents w/o wheezing)
mgmt: BB overdoes
IVF
IV atropine
IV glucagon (if still hTN)
or try calcium, pressors, insulin/glucose
tx: anemia of prematurity
stop taking all their blood
iron supplement
transfusions if bad, but it doesn’t help long term
things that up warfarin (inhibit CYP450)
tylenol/NSAIDs abx/metronidazole amiodarone cimetidine/omeprazole SSRIs
things that down warfarin (induce CYP450)
carbamazepine/phenytoin
OCPs
phenobarbital
rifampin
CHF w/ LV hypertrophy but not HTN
think about amyloidosis
waxy skin
amyloidosis
niemann pick def
sphingomyelinase
tay sachs def
beta hexosaminidase
what to do when you suspect blunt aortic injury
CXR
tx: mucormycosis
debridement and amphotericin B
loud P2
think pulm HTN
wedge shaped opacity on chest CT
think PE
EKG: broad, notched P waves
mitral stenosis
risk of cocaine in pregnancy
placental abruption
fetal hydantoin syndrome
mom on anti-seizures (phenytoin, carbamazepine)
midfacial hypoplasia, microcephaly, cleft lip/palate, little fingers, hirsutism, developmental delay
aplastic anemia vs aplastic crisis
aplastic anemia = pancytopenia
aplastic crisis is just RBCs, but super low (< 6)
aplastic crisis vs splenic sequestration crisis
aplastic has low reticulocytes (< 1%)
splenic has higher + splenomegaly
RFs for c. diff
abx, hospitalization, PPI
MC meningitis in kids by age
< 3 mo: GBS, E. coli, listeria, HSV
3 mo - 10: strep pneumo, neisseria
> 11: neisseria
PTU risks
liver injury/failure
methimazole risks
teratogen (1st TM), agranulocytosis
HIV screening test
assay for HIV p24 antigen and HIV Abs
confirmation w/ HIV-1/HIV-2 ab differentiation immunoassay
ascending paralysis in hours/days w/o autonomic dysfunction
tick-borne paralysis (find that sucker)
kidney stone: primary hyperPTH
calcium phosphate
kidney stone: small bowel dz/resection
calcium oxalate
kidney stone: recurrent UTIs
struvite
kidney stone: RTA
calcium phosphate
target cells
thalassemias
alpha vs beta thalassemia minor
Hgb electrophoresis:
alpha = normal
beta = increased Hgb A2
tx: inducible ischemia on nuclear stress test
BB and anti-platelet
measles vs rubella
rubella doesn’t have Kopliks spots and rash doesn’t darken and its milder/shorter
fundoscopy: pallor of optic disc, cherry red fovea
central retinal artery occlusion
fundoscopy: grey, elevated retina
retinal detachment
“curtain coming down over my eyes”
retinal detachment
central retinal artery occlusion
CSF: herpes encephalitis
lymphocytes
RBCs
elevated protein
where do you get colonic ischemia
splenic flexure (SMA/IMA watershed) rectosigmoid jxn (sigmoid/superior rectal watershed)
when do you use unfractionated vs LMWH
ESRD
ages for HPV vaccine
female: 11 - 26
males: 9 - 21 (9 - 26 for MSM or HIV)
tx: PCP pneumonia
TMP-SMX
if PaO2 < 70 or A-a gradient > 35: add corticosteroid
12 month old: how much should they weigh/be tall
weight x 3
height x 1.5
MC location for HTN hemorrhagic strokes
BG (putamen)
cerebellar nuclei
thalamus
pons
BG stroke –>
contra hemiparesis
contra sensory loss
conjugate gaze to side of lesion
CF infections by age
< 20: staph
> 20: pseudomonas
pneumo vaccine, who gets what + immune responses
polysaccharide (23) (< 65 w/ predisposing problems): T cell independent
conjugate (13) (kids): T-cell dependent
people > 65 and all immunocompromised get both
psych med –> infertility
dopa blockers
what else do you check when you have hypocalcemia
alb and Mg
low-> hypocalcemia
hepatojugular reflux
failing right ventricle (can’t deal with the increase in venous return)
Kussmaul’s sign
increase in jugular venous pressure on inspiration
a/w constrictive pericarditis
pregnancy liver d/os
intrahepatic cholestasis of pregnancy
HELLP
acute fatty liver of pregnancy
3rd TM: itchy papular rash around umbilicus
pruritic urticarial papules and plaques of pregnancy
pregnancy: general pruritus, worse at night, worse on palms/soles
intrahepatic cholestasis of pregnancy
acute otitis media vs otitis media w/ effusion
OMWE: middle ear effusion w/o inflammation
turns out acute otitis media has an effusion anyway
drugs a/w photosensitivity
tetracyclines chlorpromazine furosemide HCTZ amiodarone promethazine
anti-endomysial abs
celiacs
anti-cardiolipin abs
antiphospholipid syndrome
DM med that helps lose weight
GLP-1 receptor agonists (-atides)
tx: OCD
SSRI
CBT (exposure and response prevention)
definition of preeclampsia
new onset HTN (>140/+/- >90) @ > 20wks
proteinuria +/- end organ damage
RFs for pubic symphysis diastasis
macrosomia
multiparity
precipitous labor
operative delivery
McRoberts maneuver complication
mom femoral nerve damage
tx: postpartum endometritis
clindamycin + gentamicin
tx: impetigo
limited: topical mupirocin
extensive or bullous: oral cephalexin or clinda
HCM murmur
systolic
improved w/ more blood
murmur with dual upstroke of carotid pulse
HCM
CN responsible for corneal reflex
CN V (trigeminal)
indications for carotid endarterectomy
males: > 60% (asx); > 50% sx
females: > 70 %
dx: hemorrhagic stroke
CT w/o contrast
tx: TCA overdose
supportive: O2/IVF
1st 2 hrs: activated charcoal
wide QRS: IV bicarb (alleviate depression of Na channels)
dx: lactose intolerance
hydrogen breath test
stool: increased stool osmotic gap, low stool pH
talk about K levels in DKA/HHS
insulin deficiency and hyperosmolarity take K out of the cells (up K)
but you’re peeing out a million everything (down K)
so even though levels look normal, the total is low
tx: central retinal artery occlusion
ocular massage and high flow O2
when do you bx a mole (even if it’s good by ABCDE)
- person has lots, but one is diff from the others (ugly duckling)
- nodularity
- itch or bleed
contraindications to rota vaccine
past intussusception
hx of Meckel’s (or other GI malformation)
newborn CXR: diffuse reticulogranular pattern
respiratory distress syndrome
when do strawberry hemangiomas go away by
5 - 8 yo
digoxin causes what arrhythmia
atrial tachycardia w/ AV block
pain along tendon sheaths
tenosynovitis
polyarthralgia, tenosynovitis, painless vesiculopustular skin lesions
disseminated GC
workup: precocious puberty
central or peripheral?
central: high FSH/LH from high GnRH
peripheral: low FSH/LH w/ gonads or adrenals going wild
sausage digits
dactylitis
psoriatic arthritis
arthritis + nail stuff
think psoriatic arthritis
rash in fat embolism
petechiae
fat embolism time frame
12 - 24 hrs after injury
complications of SAH
rebleed (first 24 hr)
vasospasm (3 days +)
seizures
SIADH/hNa
when will you see xanthochromia
6 hr after onset
mammography: microcalcifications
ductal carcinoma in situ
breast: diffuse nodularity with b/l mastalgia
fibrocystic changes
breast: fixed, palpable mass with irregular borders
lobular breast carcinoma
corkscrew esophagram
diffuse esophageal spasm
which do you use for number needed to treat: RRR or ARR
ARR
recurrent, predictable vomiting w/ no sx between episodes
cyclic vomiting syndrome
CD4 count for HIV associated dementia
< 200
where is 0 station
midway btwn ischial spines
quick loss of fetal station
think uterine rupture
painless vaginal bleeding upon rupture of membranes
think vasa previa
tx: post nasal drip
antihistamine or antihistamine + decongestant
categories of DM retinopathy
simple
pre-proliferative
proliferative/malignant
fundoscopy for DM retinopathy (categories)
simple: microaneurysms, hemorrhages, exudates, edema
pre-proliferative: cotton wool spots
proliferative/malignant: newly formed vessels
workup: primary amenorrhea
uterus?
yes –> FSH (increased –> karyotyping; decreased –> MRI)
no –> karyotype, serum T (XX, normal –> abnormal mullerian; XY, normal –> androgen insensitivity syndrome)
tx: ringworm
local: topical clotrimazole
extensive/refractory: oral griseofulvin
infant: webbed neck, cleft lip, thumb things, macrocytic anemia
Diamond-Blackfan syndrome
infant: cafe-au-lait, microcephaly, no thumbs, pancytopenia, macrocytosis
Fanconi anemia
big, tender lymph node in kids (+ MC org)
lymphadenitis
staph aureus
GAS
lymphadenitis in older kid w/ periodontal dz
think peptostreptococcuss
skin things in cushing syndrome
striae
dermal atrophy
easy bruisability
(apparently all because CT breaks down)
what does the D-xylose test show you
shows if intestines are absorbing properly (if they are, most of it is absorbed and peed out)
only for small intestine mucosal dz (not enzymatic activity since you don’t need any enzymes to absorb D-xylose)
HMB +/- dysmenorrhea: get the uterus stuff straight
adenomyosis: HMB and dysmen
fibroids: more HMB, less dysmen
PID: no HMB yes dysmen
endometriosis: no HMB, yes dysmen
acanthosis nigricans
insulin resistance (young, fat) GI malignancy (older)
indications for parathyroidectomy
sx hypercalcemia
asx hypercalcemia w/ complications (osteoporosis, stones) or young < 50
mid diastolic sound
think pericardial knock
enzyme def: ambiguous genitalia in girls and HTN/fluid/salt retention
11 beta-hydroxylase
(low cortisol and aldo, but increased 11 stuff (which acts like a mineralocorticoid))
high T
enzyme def: ambiguous genitalia in girls and hTN/salt wasting
21-hydroxylase
low cortisol and aldo
high T
enzyme def: low cortisol, high mineralocorticoids, high T
17 alpha hydroxylase
conjunctival edema
allergic conjunctivitis
gritty feeling in eye
viral conjunctivitis
dementia w/ hallucinations
lewy body dementia
fluids (+ insulin) in DKA/HHS
initially NS (+ IV insulin) add dextrose 5% when glucose < 200 (+switch to SQ insulin)
healthy people w/o RF PPD
> 15 mm
blunt trauma: when do you FAST vs serial abd exams/CT
FAST it they’re awake/alert
contraindications for exercise in preg
amniotic fluid leak cervical incompetence multis placenta abruption/previa preeclampsia/gest HTN severe heart/lung dz also no hot yoga
MC orgs sickle cell sepsis (apparently this just like, happens)
strep pneumo
H flu
neisseria meningitidis
prevention: sickle cell sepsis
vaccinations
PCN till age 5
folic acid supplementation
tx: lichen sclerosus
topical clobetasol
MC childhood cancer
ALL
preseptal cellulitis vs orbital cellulitis
orbital has ophthalmoplegia and pain with EOM
orbital can have proptosis or vision impairment
tet spells
ToF
cohort vs case control
cohort = start with RFs, compare dz incidence
case control = start w/ dz, look at past RFs
tx: celiacs
dapsone and gluten free
epigastric pain + vomiting 24-36 hrs post abdominal trauma
think duodenal hematoma
tx: minimal change dz
corticosteroids
tx: uric acid stones
hydration
alkalinization of urine (K citrate)
low purine diet
recurrent –> add allopurinol
posterior MI: LCX or RCA
both have ST depression in V1 - V3
LCX: ST elevation in I and aVL
RCA: ST depression in I and aVL
ST elevations in some/all V1 - V6: MI (+ vessel)
anterior MI (LAD)
ST elevation in I, aVL, V5, V6: MI (+ vessel)
lateral MI (LCX, diagonal)
ST depression in II, III, aVF
lateral MI (LCX, diagonal)
water hammer pulse
AR
mass in anterior mediastinum
thymoma
mass in middle mediastinum
bronchogenic cyst tracheal tumors pericardial cysts lymphoma LN enlargement arch aortic aneurysms
mass in posterior mediastinum
all neurogenic tumors: meningocele enteric cysts lymphomas diaphragmatic hernias esophageal tumors aortic aneurysms
muddy brown casts
ATN
waxy casts
chronic renal failure
RBC casts
glomerular dz or vasculitis
fatty casts
nephrotic syndrome
broad casts
chronic renal failure
WBC casts
interstitial nephritis
pyelonephritis
hyaline casts
nephrotic syndrome
increased breath sounds
consolidation
tx: pagets
bisphosphonates
dx: amyloidosis
fat pad bx
tests before starting Li
UA
BUN, Cr
thyroid fxn
transplant a tylenol overdose?
apparently yes
head MRI: numerous minute punctate hemorrhages
think diffuse axonal injury
CT: crescentic collection
subdural
CT: biconvex collection
epidural
post MVA: pt loses consciousness instantly then –> vegetative state
think diffuse axonal injury
definition abnormal uterine bleeding
heavy > 7 days more often than every 21 days less often than every 35 any post meno bleeding
when do you do an EMB: > 45 yo
any abnormal uterine bleeding
when do you do an EMB: < 45 yo
abnormal uterine bleeding + (any of following)
- unopposed estrogen exposure
- failed medical mgmt
- lynch syndrome (HNPCC)
MCC megaloblastic anemia in alcoholics
folate def
mgmt: eclampsia
mg sulfate
anti-HTN (hydralazine, labetalol…)
deliver
when do you treat moms for GBS
+ test: during labor
unknown and < 37 wks: during labor
nephrotic syndrome complications
edema (hypoalbuminemia)
hypercoagulability (–> renal vein thrombosis, PE)
hyperlipidemia
microcytic hypochromic anemia (iron resistant)
decreased thyroxin
vit D def
infection
white reflex (aka + dz)
leukocoria
retinoblastoma
premie: lethargy, hypotonia, rapidly increasing head circumference, bulging fontanelle
intraventricular hemorrhage
why do serial head U/S in premies
screening for intraventricular hemorrhage (up to half are asx)
complications of temporal arteritis
aortic aneurysm (get serial CXRs)
vaccines for chronic liver dz
Tdap/Td
flu
pneumo (23, then 13+23 @ 65)
hep A/B
workup: low TSH, high T3/T4
- RAIU (unless clearly graves)
2a. high uptake –> graves (diffuse pattern) or toxic adenoma/multinodular (nodular)
2b. low uptake –> 3 - measure thyroglobulin
4a. high –> thyroiditis (spills pre-formed)
4b. low –> exogenous hormone, struma ovarii?
ALL cell levels
+/- leukocytosis
anemia and or thrombocytopenia
skin rash worsened by hot drinks, EtOH, sun or emotion
rosacea
what do you transfuse with for severe hemorrhage (trauma)
whole blood
what do you transfuse with for acute GI bleed
PRBCs
early onset HTN and bilateral abdominal masses
ADPKD
bilateral flaccid paralysis, loss of pain/temp, vibration/proprio in tact
anterior spinal cord syndrome (disruption of anterior spinal artery)
prophylaxis post organ transplant
TMP-SMX (PCP)
-cyclovir (CMV)
paraneoplastic lung cancers
squamous cell: PTHrP
small cell: SIADH, ACTH
MC orgs brain abscess
viridans strep
staph aureus
gram negs
CT: hypodense lesions in temporal lobe
think HSV
CT: single ring enhancing lesion w/ central necrosis
think brain abscess
signs it was prob just a febrile seizure
return to mental baseline (after post-ictal)
normal neuro exam
why do you get tardive dyskinesia
dopa receptor supersensitivity
mgmt: inevitable abortion
hemo stable: misoprostol, nothing or D&C
hemo unstable: D&C
why can’t you use oxytocin for 1 TM/2 TM abortions
there aren’t many oxytocin receptors on uterus yet
baby with retinal hemorrhages and bulging fontanelle
abusive head trauma –> subdural bleeding
sx of hypercalcemia
abdominal pain
constipation
polydipsia
tx: pinworm (+aka)
enterobius vermicularis (butthole guy) albendazole or pyrantel pamoate (esp preggers)
tx: strongyloides
ivermectin
tx: amebiasis
metronidazole
tx: chagas
benznidazole
tx: river blindness (+aka)
onchocerciasis
ivermectin
urticaria, abdominal pain, resp problems
think strongyloidiasis
thyroid and bones
hyperthyroid –> up osteoclast activity –> bone loss, osteoporosis, hypercalcemia
