Uworld 3 Flashcards
1
Q
pregnancy: thyroid changes
A
TG up
thyroxine up –> total thyroid hormone up
free T4 only up a little or none
TSH down (suppressed by hcg and increased T4)
2
Q
tx: hypothyroidism in preg
A
up levo 30% when find out pregnant
adjust q month
3
Q
path: HELLP syndrome
A
abnormal placentation –> systemic inflammation –> activate coags and complement –> platelet consumption and microangio hemolytic anemia –> liver problems
4
Q
tx: HELLP
A
delivery
magnesium (seizure prophylaxis)
anti-HTN
5
Q
when do you do amnioinfusion
A
variable decels from cord compression in labor
6
Q
pt w/ hashimoto’s: rapidly enlarging firm goiter –> dysphagia/hoarseness
A
think about thyroid lymphoma
7
Q
time frame: contrast induced nephropathy
A
spike within 24 hrs of contrast
return to normal in 5 - 7 days
8
Q
FTT and normal anion gap acidosis
A
thing RTA
9
Q
RTAs by urine pH
A
2 and 4: < 5.5
1: >5.5
10
Q
RTAs by K
A
1 and 2: low-normal
4: high
11
Q
path: RTAs
A
1: poor H secretion (genes, meds, AI)
2: poor bicarb resorption (fanconi)
4: aldo resistance (obstructive, CAH)
12
Q
tx: symptomatic sinus brady
A
atropine
no response –> epi or dopamine or pacing
13
Q
withdrawal from maternal E –>
A
vaginal bleeding
breast buds
genital engorgement
14
Q
recurrent infections and displaced PMI
A
kartagener syndrome
15
Q
PE finding: agammaglobulinemia
A
no tonsillar/adenoidal tissue
16
Q
ddx: stridor in babies
A
croup
foreign body
laryngomalacia
vascular ring
17
Q
baby: stridor worse when supine, improves when prone
A
laryngomalacia
18
Q
baby: biphasic stridor that improves with neck extension
A
vascular ring
19
Q
dx: infective endocarditis
A
blood cultures (3 from diff sites) before echo
20
Q
pure motor hemiparesis
A
think lacunar stroke (internal capsule)
21
Q
pure sensory stroke
A
think lacunar
22
Q
path: lacunar stroke
A
chronic HTN –> arteriolar sclerosis and occlusion
23
Q
meds –> psychosis/hallucinations
A
anti-histamines
alpha-adrenergics
dextromethorphan
glucocorticoids
24
Q
neonate: temp instability, poor feeding, lethargy
A
think sepsis (get blood, urine and CSF cultures)
25
needs to stop paps
65 or hysterectomy w/o CIN 2+
AND
3 neg paps/2 co-tests
26
stroke: contra sensory and motor mainly in lower extremity
anterior cerebral artery occlusion
27
stroke: contra hemiplegia and ipsilateral CN
vertebrobasilar
28
stroke: hemineglect
middle cerebral
29
stroke: dyspraxia, urinary incontinence
anterior cerebral
30
stroke: homonymous hemianopsia
middle cerebral artery occlusion
| BG hemorrhage
31
biliary cysts: presentation by age
classic: RUQ pain, jaundice, palpable mass
infants: jaundice, clay stools
older kids: pancreatitis
32
tx: hypovolemic hypernatremia
bolus normal saline (or LR, but has to be isotonic)
33
CF vs primary ciliary dyskinesia
PSD doesn't have pancreatic insufficiency or FTT
| PSD has situs inversus sometimes
34
polyuria and sterile pyuria in female chronically taking combined analgesics
think papillary necrosis or chronic tubulointerstitial nephritis
35
BUN/Cr > 20
prerenal
36
BUN/Cr < 15
ATN (any tubular damage)
37
a/w absence seizures
ADHD
| anxiety
38
what does anamnestic ab response -->
delayed hemolytic blood transfusion rxn
39
bleed: non reactive miotic pupils
thalamus
40
bleed: homonymous hemianopsia
occipital
41
bleed: pinpoint reactive pupils
pons
42
bleed: upgaze palsy
thalamus
43
when do kids get the meningococcal vaccine
primary @ 11 - 12
booster @ 16 - 21
(can get primary @ > 18 if high risk)
44
who gets necrotizing enterocolitis
premies
| term babies w/ congenital heart dz or hTN (--> reduced mesenteric perfusion)
45
how long does postconcussive syndrome last
usually within few weeks to months
46
things that cause up AFP in maternal serum
NTDs
abdominal wall defects (omphalocele, gastroschisis)
multiple gestations
rare: congenital nephrosis or obstructive uropathy
47
how to cool someone in heat stroke
rapid: ice bath best
| no antipyretics
48
PCOS a/w
metabolic syndrome (DM, HTN)
OSA
NASH
endometrial hyperplasia/CA
49
causes: osteomalacia
vit D def
| malabsorption, celiacs, chronic kidney/liver
50
old guy: chronic pelvic pain, voiding sx, pain w/ ejaculation
think chronic prostatitis
51
joint most often involved in RA
MCP
52
bony enlargement or PIP and DIP
OA (Bouchard + Heberden nodes)
53
sinus/face infection --> HA, papilledema
think cavernous sinus thrombosis
54
EMB: complex endometrial hyperplasia
think about unopposed estrogen
55
when do you need to give iV fluids to a kid
mod - severe (think decreased turgor, delayed cap refill, low urine output)
56
pelvic frx --> blood at meatus, scrotal ecchymosis, high riding prostate
think posterior urethral injury
57
pelvic frx --> gross hematuria, difficulty voiding
think bladder rupture
58
straddle injury -->
think anterior urethral injury
59
dx: bladder rupture
retrograde cystogram
60
dx: posterior urethral injury
retrograde urethrogram
61
dx: anterior urethral injury
retrograde urethrogram ?
62
best emergency contraceptive
copper IUD
63
which emergency contraceptives can be given > 72 hrs after
copper IUD
ulipristal - less effective than IUD
both up to 120 hrs after
64
abdominal film w/ gas filled small and large bowel and gastric dilation
paralytic ileus
65
abdominal film w/ only gastric dilation
gastric outlet obstruction
66
succussion splash over stomach
think gastric outlet obstruction
67
pseudotumor cerebri complications
blindness
68
Kallmann syndrome is what kind of hypo?
hypogonadotropic hypogonadism
69
symptomatic AFV -->
widened PP
systolic flow murmur
tachycardia
LVH
70
tx: essential HTN during pregnancy
labetalol or methyldopa (1st line)
| nifedipine and hydralazine good alternatives
71
mgmt: prego pt on lithium
taper lithium
72
schizo MRI
loss of cortical volume
| lateral ventricle enlargement
73
tx: recurrent variable decels
```
maternal repositioning (L lat)
amnioinfusion if doesnt work
```
74
proximal muscle weakness w/o pain, normal ESR, normal CK
think glucocorticoid induced or Cushing's
75
foot deformity: flexible positioning, medial deviation of forefoot, neutral position of hindfoot
metatarsus adductus
76
foot deformity: rigid positioning, medial/upward deviation of fore- and hindfoot; hyper-plantar flexion
congenital clubfoot
77
tx: metatarsus adductus
reassurance
78
tx: congenital clubfoot
serial manipulation and casting
| surgery if refractory
79
newborn: sensorineural hearing loss, cardiac defects, cataracts
congenital rubella (cardiac = PDA)
80
epigastric pain somewhat relieved by sitting upright/leaning forward
think chronic pancreatitis
81
painful genital ulcers
```
HSV
haemophilus ducreyi (has big LNs too)
```
82
painless genital ulcers
treponema pallidum
chlamydia trachomatis
granuloma inguinale (klebsiella granulomatis)
83
talk through stopping steroid treatments
ACTH is low because steroid levels have been so high in tx
| cortisol is low because steroid levels have been so high in tx
84
infertility by age
< 35 you get a year to try
| > 35, 6 months
85
theophylline tox
CNS
GI
cardiac
86
what makes theophylline tox more likely
illness (cirrhosis, infections)
| drugs (cipro, erythromycin, verapamil)
87
RA type joint pain w/ normal ESR
think parvo
88
poisoning from house fire
cyanide and carbon monoxide
89
pronator drift shows
UMN/pyramidal/corticospinal tract dz
90
sensory things affected by aminoglycosides
hearing loss
vestibulopathy (esp gentamicin)
oscillopsia (objects moving in visual field)
91
dx: vestibulopathy
head thrust (look at target, move head away, see if eyes leave and go back w/ horizontal saccade)
92
pleural effusion w/ yellow exudate and high amylase content
think esophageal perf
93
mgmt: erb-duchenne palsy
PT and massage to prevent contractures
usually clears up by 3 months
may need surgery, but doesn't really work
94
mgmt: MS flare
high dose IV glucocorticoids (methylprednisolone)
| plasma exchange if doesn't work
95
what does hCG do
preserves corpus luteum so that progesterone stays up
96
tx: radial head subluxation (nursemaid's elbow)
closed reduction: apply pressure to radial head and hyperpronate the forearm
97
when to get CA-125 for ovarian cancer dx
post meno and see a mass on U/S (it's more specific in post meno)
high --> get MRI or CT
98
high alk phos...now what
look at GGT
normal --> bone stuff
high --> biliary stuff
99
tx: afib w/ hx of WPW
stable: procainamide
unstable: cardioversion
100
cardiac RFs, DM and high TGs
still just give them a statin (it'll do both)
101
tx: exercise induced bronchoconstriction
inhaled albuterol 10 min before exercise
102
unexplained superficial venous thrombosis in weird place
Trousseau's syndrome
| usually a sign of malignancy (panc is MC, lung, prostate, stomach, colon, leukemias)
103
mgmt: PPROM
34 - 37 wks: abx, +/- corticosteroids, delivery
< 34 wks, no fetal compromise: abx, corticosteroids, fetal surveillance
< 34 wks, fetal compromise: abx, corticosteroids, delivery
< 32 wks, fetal compromise: above + Mg
104
tx: inflammatory vs nodular (cystic) acne
mod (same): topical retinoids, benzoyl peroxide, topical abx
severe (same): add oral abx
refractory severe (nodular only): add oral isotretinoin
105
everything about CML
philadelphia chromosome (translocation 9:22)
gene: BCR-ABL
tx: tyrosine kinase inhibitor (imatinib)
106
how does lead poisoning lead to anemia
mess with heme synthesis
107
HA, nausea, blurry vision, sluggish/dilated pupil
acute angle glaucoma
108
drugs that cause acute angle glaucoma
anticholinergics (eg trihexyphenidyl)
109
complications: status epilepticus
cortical necrosis --> neuro deficits, recurrent seizures
110
what goes wrong when you correct Na levels too fast
original problem: consequence of rapid correction
hypernatremia: cerebral edema
hyponatremia: osmotic demyelination
111
triple bubble sign and gasless colon on abdominal x ray
jejunal atresia
112
otitis media, mastoiditis, morning vomiting, nocturnal HA
think about temporal brain abscess
113
mgmt: penile fracture
urethrogram
| surgery
114
indications for urethrogram
possible urethral injury +
- blood @ meatus
- hematuria
- dysuria
- or urinary retention
115
non back things in ankylosing spondylitis
enthesitis
dactylitis
uveitis
aortic regurg (complication)
116
time frame: post partum blues
2 wks
117
OA signs
bony hypertrophy
crepitus
small joint effusions w/o erythema/warmth
baker cyst
118
MC orgs: bacterial pneumonia post flu -- young people
staph aureus
119
who has marfanoid habitus
marfan's
| homocystinuria
120
marfan's vs homocystinuria
homocystinuria has fair complexion, intellectual disability, hypercoag and megaloblastic anemia (and no aorta problems)
121
when do you do a diagnostic peritoneal lavage?
hemo unstable blunt trauma pt with inconclusive FAST exam
122
tx: newborn with acute hep B infected mom
hep B Ig then hep B vaccine
123
myopathy with normal ESR and CK
glucocorticoid induced
124
ddx: myopathy with elevated CK
inflammatory (myositis)
statin
hypothyroid
125
ddx: myopathy with elevated ESR
```
inflammatory (myositis)
polymyalgia rheumatica (won't have elevated CK)
```
126
vision loss, pain with eye mvmt, afferent pupil defect
think optic neuritis (a/w MS)
127
"washed out" color vision
think optic neuritis (a/w MS)
128
fundoscopy in optic neuritis
normal
129
fundoscopy: increased cup to disc ratio
open angle glaucoma
130
fundoscopy: retinal whitening, cherry red spot
central retinal artery occlusion
131
fundoscopy: yellow deposits
macular degeneration (drusen)
132
tx: cancer related anorexia/cachexia
progesterone analogues (megestrol acetate) > corticosteroids
133
tx: HIV cachexia
cannabinoids (dronabinol)
134
tx: anorexia and depression
CBT, food stuff, SSRIs
135
talk about path of spinal stenosis
MC: degenerative arthritis --> spondylosis (osteophytes) --> spinal stenosis
other: hypertrophy of ligamentum flavum, bulging disc, spondylolisthesis
136
skin cancer a/w immunosuppression
SCC
137
MC skin malignancy
basal cell
138
skin cancer w/ numbness/paresthesias
SCC
139
causes of avascular necrosis
steroids, EtOH, SLE, APS, sickle cell, osteo/HIV, renal transplant, the bends
140
hip pain: lateral, worsened with direct pressure
trochanteric bursitis
141
hip x ray: crescent sign
avascular necrosis
142
is hand foot and mouth rash itchy? painful?
neither
143
tx: endocarditis in IVDA
vanco
144
diastolic murmur
AR
| MS
145
MCC isolated AR in young person
bicuspid aortic valve
146
path and RFs: lacunar strokes
path: microatheroma and lipohyalinosis in small penetrating arteries
RFs: HTN, HLD, DM, smoking
147
erythema nodosum
strep, sarcoid, TB, coccidioidomycosis, IBD, behcet
148
workup: erythema nodosum
basic labs + ASO, TB, CXR
149
diet changes for HTN and what helps most
```
weight loss
DASH diet (high fruit/veggie, low sat fat)
exercise
low sodium
less EtOH
```
150
hyperthyroid a/ low RAIU and nontender goiter
painless (silent) thyroiditis
151
anti-thyroid peroxidase Abs
```
painless thyroiditis (hyper)
Hashimoto's (hypo)
```
152
URI then painful goiter
think subacute (de Quervain) thyroiditis
153
late term vs postterm pregnancies
late term: 41 wks
| post term: 42+ wks
154
fetal risks a/w late/post term pregnancies
```
oligohydramnios
meconium aspiration
stillbirth
macrosomia
convulsions
```
155
maternal risks a/w late/post term pregnancies
c-section
infection
postpartum hemorrhage
perineal trauma
156
drugs that up survival in LV HF pts
ACE/ARBs
BB
mineralocorticoid receptor antagonists (spironolactone/eplerenone)
hydralazine and nitrates (AAs only)
157
COPD vs alpha 1 lobes
COPD: centrilobular
| alpha-1: panacinar (lucency in basilar/lower lobes)
158
when do you irradiate blood products
bone marrow transplant recipients
cellular immunodeficiency
blood from 1st/2nd degree relatives
159
when do you use washed blood products
IgA deficiency
recurrent allergic rxn even w/ antihistamines
AI hemo-anemia (complement dependent)
160
when do you use leukoreduced blood products
previous febrile nonhemo transfusion rxn
chronic transfusers
CMV negative @ risk pts (AIDS, transplant)
potential transplant recipients
161
mgmt: find multiple liver lesions
probably mets --> do colonoscopy (MC)
162
vitiligo a/w
other AI stuff:
| SLE, thyroid, pernicious anemia, addison's
163
vitiligo vs tinea versicolor
vitiligo's lesions are completely (not partially) depigmented
vitiligo hits faces and extremities (tinea usually chest/upper back)
164
waldenstrom vs MM
monoclonal Ab: IgM (Wald) vs IgG, IgA, light chains (MM)
Wald: hyperviscosity, bleeding, neuropathy, hepatosplenomegaly
MM: lytic lesions (+HCa), renal insuff
165
hyperviscosity syndrome
```
diplopia
tinnitus
HA
dilated/segmented fundoscopy
(a/w Waldenstrom's)
```
166
what do you need B12 for
DNA synthesis
167
rewarming in hypothermia
mild (90 - 95): passive external warming
mod (82 - 90): active external
severe (< 82): active internal
168
lung things that happen in ARDS
gas exchange impaired (V/Q mismatch)
lung compliance goes down
pulmonary artery pressure goes up
169
maltese cross on blood smear
babesiosis
170
tourniquet test
shows capillary fragility
| Dengue fever
171
CSF WBCs: neutrophil vs lymphocyte predominance
neuts: bacterial
lymph: viral
172
tx: latent TB
isoniazid and pyridoxine
173
RA bone complications
a/w osteoporosis
174
kid falls with toothbrush in mouth -->
possible carotid dissection --> stroke
175
congenital calcifications: CMV vs toxo
CMV: periventricular
toxo: diffuse
176
MCC isolated increased alk phos in old people
paget
177
path: coarctation of aorta
thickening of tunica media
178
baby: leg length discrepancy and asymmetric inguinal skin folds
think developmental dysplasia of hip
179
dx: developmental dysplasia of hip
Barlow/Ortolani --> clunk
< 4 months --> U/S
> 4 months --> x ray
180
tx: developmental dysplasia of hip
pavlik's harness
181
labs: JRA
```
increased ESR, CRP
increased ferritin
increased IgG
thrombocytosis
anemia
```
182
mgmt: cocain angina
benzos
ASA
NG
CCBs (NOT BBs - unopposed alpha vasoconstriction)
183
mg tox
loss of DTRs
somnolence
resp depression
184
RF mg tox
renal insufficiency -- lower dose and observe carefully
185
tx: mg tox
calcium gluconate
186
endocarditis with new conduction abnormality
consider perivalvular abscess
187
dx: appendicitis in preg
U/S w/ graded compression
| if U/S not diagnostic you can MRI
188
fundoscopy: swollen disc, retinal hemorrhages, cotton wool spots
central retinal vein occlusion
189
AEs azathioprine
diarrhea
leukopenia
hepatotox
190
AEs mycophenolate
marrow suppression
191
AEs tacrolimus
neurotox
diarrhea
glucose intolerance
192
AEs cyclosporine
```
nephrotox
HTN
neurotox
glucose intolerance
infection
malignancy
gingival hypertrophy
hirsutism
Gi stuff
```
193
RFs for brain abscess
otitis media
sinusitis
dental infection
bacteremia from infection, cyanotic heart dz
194
CXR: elevation of L main bronchus
L atrial enlargement
195
positive thomas test
tight psoas
196
digoxin tox
n/v, abdominal pain
fatigue, weakness
confusion
vision (changes in color, scotomas, blindness)
197
drugs that up digoxin tox
amiodarone
verapamil
quinidine
198
travel: fever, polyarthralgias, maculopapular rash, lympho/thrombocytopenia
chikungunya
199
what to do when you can't find fetal HR w/ doppler
need absence of fetal cardiac activity on abdominal U/S to confirm fetal demise
200
what has to be done after a fetal demise
fetal: autopsy; examine placenta/membranes/cord; karyotype/genetics
maternal: Kleihauer-Betke test for fetomaternal hemorrhage; antiphospholipid abs; coag studies
201
increased homovanillic acid and vanillylmandelic acid
pheo
| neuroblastoma in kids
202
tx: CAP (outpatient)
healthy: macrolide of doxy
comorbidities: FQ or beta-lactam and macrolide
203
tx: CAP (inpatient)
IV FQ
IV beta-lactam + macrolide (good for ICU too)
IV beta-lactam + FQ (ICU only)
204
how does spleen kill stuff
Ab mediated phagocytosis (opsonization)
| Ab mediated complement activation
205
sepsis does what to kidneys
hypoperfusion --> prerenal AKI
| if hypoperfusion persists --> ATN
206
what to look out for when prescribing sildenafil
```
alpha blockers (doxazosin) and nitrates
--> hTN
```
207
c-section: how long after can you give anti-coags if need
6 - 12 hrs
208
when do you give heparin before imaging in a PE
no contraindications to anti-coag
PE likely (wells)
mod/severe distress
209
asterixis
hepatic encephalopathy
uremic encephalopathy
CO2 retention
210
cut off to let kidney stones just pass
< 5 mm
211
what are those little pink stains in neonate diapers
uric acid crystals (totally ok)
212
salvage therapy
treatment for a dz when the standard fails
213
neoadjuvant therapy
treatment given before the standard tx
214
consolidation therapy
tx given after induction therapy
215
maintenance therapy
tx given after induction and consolidation therapy
216
which shock has increased mixed venous O2 saturation
septic
217
fat embolism syndrome triad
resp distress
neuro dysfxn
petechial rash
218
how to open/close a PDA
open: prostaglandin E1
close: indomethacin
219
vaginal cancers (+RFs)
squamous: HPV/smoking
| clear cell adenocarcinoma: in utero exposure to diethylstilbestrol
220
tx: EtOH withdrawal
lorazepam
| chlordiazepoxide (not w/ liver problems)
221
postprandial epigastric pain, food aversion, weight loss
think chronic mesenteric ischemia
222
MC adult/adolescent onset muscular dystrophy
myotonic MD (Steinert dz)
223
myotonia
unable to relax muscle (think handshake)
224
hypovolemia: kidney effects
down renal perfusion --> renin/aldo --> upp sodium reabsorption (+ down excretion)
225
anteromedial tibial pain, ok with valgus stress
pes anserinus pain syndrome (conjoined gracilis, sartorius and semitendinosus tendons)
226
which one is dilated, which is pinpoint
dilated: mydriasis
pinpoint: miosis
227
HIV prophylaxis
< 200 (PCP): TMP-SMX
< 150 (histo in histo areas): itraconazole
< 100 (toxo): TMP-SMX
< 50 (MAC): azithromycin
228
croup aka
laryngotracheitis
229
wheezing, coughing, under 2
think RSV
230
dx: kidney stones
U/S or CT w/o contrast
231
magnetic gait
NPH
| frontal lobe degeneration
232
steppage gait
motor neuropathy
233
tx: hoarding
CBT
234
fever, night sweats, productive cough, skin lesions, lytic bone lesions
blastomycosis (yeah they're in ohio, ok)
235
heart things a/w afib
```
HTN heart dz
CAD
rheumatic/valvular
CHF
HCM
post <3 surg
```
236
pulm things a/w a fib
OSA
PE
COPD
acute hypoxia (pneumonia)
237
other things a/w a ib
obesity
hyperthyroid/DM
EtOH
druuuuuuuugs
238
ASA tox
tinnitus
fever
tachypnea
GI
239
ASA tox acid-base stuff
1st resp alkalosis
| then anion gap metabolic acidosis
240
arrest of active labor
no cervical change for > 4 hrs w/ adequate contractions
| no cervical change for > 6 w/o adequate contractions
241
crampy abdominal pain, alternating diarrhea and constipation
IBS (normal colonic mucosa)
242
vital capacity in COPD
goes down
243
tx: toxic megacolon
non-IBD: IVF, Abx, bowel rest
| IBD: IV corticosteroids
244
tx: common variable immunodeficiency
Igs
245
paresthesia @ surgical site w/ gray discharge
necrotizing surgical site infection
246
which microcytic anemia has an increased red cell distribution width
iron def
247
lambert eaton and myasthenia: path
LE: voltage gated Ca channels
MG: Ach channels
248
tx: PCN sensitive endocarditis
IV PCN or IV ceftriaxone
249
cut foot on dock, hemorrhagic bullae
vibrio vulnificus
250
path: NAFLD (NASH)
FFA: up transport in, cant oxidase in liver or don't clear
| usually related to peripheral *insulin resistance*
251
diffuse telangiectasias, recurrent epistaxis, widespread AVMs
Osler-Weber-Rendu syndrome
252
Osler-Weber-Rendu syndrome complications
AVMs in lungs --> shunt --> hypoxemia --> polycythemia
253
thyroid stuff with positive TPO
Hashimoto
| painless thyroiditis
254
withdrawal: hypersomnia, increased dreaming, hyperphagia
cocaine
255
withdrawal: GI, yawning, mydriasis
heroin
256
withdrawal: tremors, anxiety, psychosis
benzos
257
withdrawal: seizures
EtOH
| benzos
258
withdrawal: anxiety, dysphoria, increased appetite
nicotine
259
what do you do when you find gastric adenocarcinoma on EGD
CT to see how far it goes
260
expansile and eccentric lytic appearance of bone on x ray
giant cell tumor (soap bubble)
261
tx: DM neuropathy
gabapentin
amitriptyline
duloxetine (SNRI)
262
patellofemoral compression test
extend knee while compress patella
| pain --> patellofemoral syndrome
263
earliest kidney change in DM pts
glomerular hyperfiltration (--> intraglomerular HTN)
264
how do ACE-Is prevent DM nephropathy
reduce intraglomerular HTN
265
microcytic anemia with hypochromic and normochromic RBCs
sideroblastic anemia
| think B6 def (isoniazid)
266
immune complications of endocarditis
+ Rh factor
immune complex GN
osler nodes
267
herniation from epidural hematoma
uncal (transtentorial)
268
possible CN compression in uncal herniation
oculomotor
269
CA --> LE motor weakness, hyperreflexia, bladder dysfxn
think spinal cord compression
| esp prostate, lung, breast, MM
270
prolactin, LH and TSH levels in prolactinoma vs prolactin stim drugs
prolactinoma: up prolactin, down LH (down GnRH from feedback from prolactin), normal TSH
drugs: only prolactin up
271
PTU AEs
agranulocytosis (look for fever/sore throat)
272
tumor: limitation of upward gaze, eyelid retraction, argyll robertson pupils
pineal gland tumor (Parinaud syndrome)
273
tumor: opsoclonus myoclonus syndrome (dancing eyes and feet)
neuroblastomas
274
workup: secondary amenorrhea
1. beta hCG
2. prior uterine procedure? --> hysteroscopy
3. check prolactin, TSH, FSH
- up prolactin --> brain MRI
- up TSH --> hypothyroid
- up FSH --> premature ovarian failure
275
risks of parenteral nutrition
central line associated bloodstream infection
| cholelithiasis (> 2 wks)
276
TB effusion things
> 4 protein
lymphocytic WBCs
LDH > 500
(+ < 60 glucose and low pH like all infection things)
277
empyema effusion things
neutrophilic WBCs (and super high, > 50,000)
278
headaches that are worse when leaning forward
think about superior vena cava syndrome
279
how to reduce aspiration risks
```
raise head in bed
diet modification
jejunal feedings (not NG)
```
280
Ca levels in malignancy vs hyperparathyroidism
apparently its way higher in malignancy (PTrH)
281
complications post Roux-en-Y
- gallstones from quick weight loss (you can ppx with ursodeoxycholic acid)
- dumping syndrome
282
cause: dysmorphic RBCs
glomerular
283
how do you know if it's SBP
cell count x % neuts
| > 250 = SBP
284
when do you defibrillate instead of cardiovert
Vfib
285
twist your knee what do you break
meniscus
286
sickle cell sepsis orgs
strep pneumo
| H flu
287
tx: EPS things
dystonia: diphenhydramine or benztropine
akathisia: propranolol, benzos, or benztropine
parkinson: diphenhydramine or benztropine
NMS: dantrolene or bromocriptine
288
which way does ASD shunt
left to right
289
fragile x a/w
autistic behavior
290
MC orgs: septic arthritis
no IVDA: staph aureus
| IVDA: pseudomonas, E. coli
291
NG mech
venodilation
292
myelodysplastic syndrome
anemia
leukopenia
thrombocytopenia
(hypercellular marrow)
293
impetigo complication
GN (not rheumatic fever)
294
where do the ketones come from in DKA
fatty acid breakdown in the liver
295
when do you add dextrose to insulin drip in DKA
when glucose < 250
296
complication of hereditary spherocytosis
bilirubin gallstones
297
tocolytics
< 32 wks: indomethacin
| 32 - 34 wks: nifedipine
298
tx: raynaud's
CCB (nifedipine)
299
kidneys in status epilepticus
status --> rhabdo (blood on dipstick)
300
OCPs down risk of what CA
ovarian
| endometrial
301
cardiac in edward's syndrome
VSD
302
splinter hemorrhages
endocarditis
| trichinellosis, apparently
303
fluids: sepsis
normal saline
304
talk through hormones in irregular teen periods
not enough GnRH --> less GSH/LH --> not really ovulating
305
chronic cough things to treat first
ACE --> stoppit
post nasal drip (upper airway cough syndrome) --> H1 blocker
asthma --> PFTs
GERD --> PPI
306
firm, mobile skin bump with central punctum
epidermal inclusion cyst
