uworld Flashcards
Parenteral nutrition can provide total nutrition directly into the blood stream of patient’s who are unable to receive enteral nutrition. what is a common and serious complication?
Because it must be administered through a central venous catheter when given for >48 hrs there is risk of central line-associated bloodstream infection.
Pt with CP, signs of decreased cardiac output, and pulsus paradoxus following viral infection most likely have what resulting in what arrhythmia?
likely pericarditis resulting in cardiac tamponade
may not have any murmur and lungs remain clear.
CSF findings in HSV encephalitis?
Usually nonspecific; however classic findings are lymphocytic pleocytosis, elevated protein, elevated RBC count, and normal glucose.
the CSF RBC elevation is the result of hemorrhagic destruction of frontotemporal lobes
what will you see on spirometry of someone with ILD? specifically in regards to FEV, FEV1, and ratio?
decrease in both FEV and FEV1 with normal ratio.
pts usually have hx of smoking, and you often hear fine bibasilar “crackles” (velcro like) on exam
pt has HTN and hyperpigmentation associated with a mediastinal mass which suggests pulmonary malignancy with ectopic production of what?
ACTH
this is a polypeptide hormone - common with small cell lung cancer
pt will have manifestations of severe hypercortisolism including wide purple striae, fatigue, easy bruising, proximal muscle weakness, and central obesity (although hypermetabolic state associated with the malignancy may cause weight loss)
Describe light criteria for pleaural effusions (transudate vs exudate)
Trans: Protein less than or equal to 0.5 and LDH = 0.6 (pleural/serum), LDH is = 2/3 upper limit of normal serum LDH.
Ex: pleural/serum protein ratio >0.5 and LDH >0.6, pleural LDH > 2/3 upper limit of normal serum LDH
Common causes of trans are hypoalbuminemia (cirrhosis, nephrotic syndrome) and CHF. For Exudate think Infection (parapneumonic, TB, fungal, empyema), malignancy, and PE
What color is described with a chylothorax?
Milky white
vaccines for adults with HIV?
HAV, HBV, HPV, Influenza (inactivated), Meningococcus, Pneumococcus, Tdap
Lung malignancy pt with headache, facial swelling, and JVD without peripheral edema makes you think?
Sperior vena cava syndrome. Primary treatment is radiation therapy as a palliative measure
Measures to prevent aspiration pneumonia in hospitalized pt includes…?
why not ng tube?
oral care
diet modification for pt with dysphagia, and compensatory techniques like elevated the head of the bed to 30-45 degrees
jejunal feeding reduces risk of aspiration but simple ng or percutaneous endoscopic gastrostomy tibes predispose to aspiration pneumonia
how is SBP thought to develop? where does the infection come from?
typical treatment?
Enteric bacteria are thought to translocate across the intestinal wall and seed ascitic fluid within the peritoneal cavity.
treatment typicaly IV abx (3rd gen cephalosporins, flouroquinolones)
NOTE mental status changes common in SBP
Bullous pemphigoid vs pemphigus culgaris - which has tense vs flaccid which is hemi and which is des?
BP is hemides with tense blisters
PV is desomosomes with flaccid (usually involvement of the oral cavity too.) will not typically see ANY intact blisters because skin is so fragile.
Proximal muscle weakness (eg difficulty climbing up stairs) and pain is mild to absent with elevated muscle enzymes (CK, aldolase, AST) makes you think?
Polymyositis
confirm dx with ANA, anti-Jo-1 and biopsy showing endomysial infiltrate with patchy necrosis
Age >50, systemic signs/symptoms, stiffness > pain in shoulders hip girdle and neck, associated with giant cell arteritis makes you think?
Polymyalgia rheumatica
will see elevated ESR, CRP and rapid improvement with gluccocorticoids
combo of UMN and LMN signs is characteristic of what disease (sensation is usually intact)
ALS
Absence seizures usually occur in children but what do you think of in an adult with staring spells (and maybe automatisms like lip smacking or chewing)
these would be complex partial seizures (complex due to LOC and partial involving local area of brain
may also experience postictal state or todd paralysis after
recommended initial treatment for stable Vtach?
amiodarone
pt presents with weakness and leg cramps after initiation of thiazide diuretic suggests?
significant hypokalemia
in setting of persistent HTN think Primary hyperaldosteronism
can manage with aldo antagonists like spironolactone or eplerenone.
pt with sudden onset cholicy abdominal pain associated with eating after recent Roux-en-Y makes you think?
rapid weight loss induced gallstones with possible cholecystitis.
differences in post strep GN vs IgA nephropathy?
bacterial vs viral and delayed vs early onset of sx’s
Pt with hypocalcemia dn hyperphosphatemia in setting of CKD has typical presentation of ?
Secondary hyperparathyroidism
decreased production of VitD due to CKD leads to decreased absorption of calcium in gut. As GFR decreases kidney cant get rid of phosphate. increased phosphate binds up the circulating calcium which stimulates release of PTH which leads to parathyroid hyperplasia
what would you prescribe to a pt with neurogenic bladder?
a cholinergic agonist. (bethanechol) to aid in bladder contraction and urethral relaxation.
muscarinics are for urge incontinence (detrusor overactivity) and relax bladder
pelvic floor exercises for stress incontinence
Precipitating factors for Hepatic Encephalopathy?
Drugs (sedativesm narcs) Hypovolemia (diarrhea) Elecctrolyte changes (hypokalemia) Increased nitrogen load (GI bleed) Infection (PNA, UTI, SBP) Portosystemic shunting (TIPS)
what is restrictive cardiomyopathy?
often caused by myocardial infiltrative diseases such as amyloidosis, sarcoidosis, or hemachromatosis
Young patient presents with recent viral illness, heart failure symptoms,, chest pain, or arrhythmia should make you think?
Myocarditis
most patients have at least partial recovery of myocardial function, but some will develop dilated cardiomyopathy
64 year old pt with fever, weight loss, night sweats, cough and fatigue with cavitary lesion in lung apex on imaging and disease in the spine. Pt also has hx of smoking but quit 15 years ago. Why is this more likely to be TB than primary lung malignancy?
abstinence from smoking for 15 years makes risk of lung cancer much less and fever is not a typical feature of lung cancer.
what lab test should be ordered in all pt’s with afib particularly if they have weight loss as well?
TSH and T4
twisting knee injury with impaired extension, instability, and exacerbation of pain with squatting. on exam there is joint line tenderness and an effusion. what is likely dx?
meniscal tear.
also may have locking or catching when the joint is extended while under load.
dx with MRI
What is the best predictor of prognosis of pt with brain tumor astrocytoma of the following: size, metastatic disease, degree of anaplasia, location of tumor, or vascular invasion
degree of anaplasia (GBM is a grade IV astrocytoma with worst prognosis).
metastatic disease is rare because pt usually dies before this happens
size and location effect symptoms
neovascularity is negative prognostic factor but pt with vascular invasion does not necessarily have a worse prognosis
IL-1 receptor antagonists are useful in treatment of what?
RA
TNF-alpha inhibitors are useful in tx of what?
RA and Crohn’s
What is Imatinib and what does it treat?
it inhibits the product of the BCR-ABL tyrosine kinase fusion gene in CML
reminder: CML presents with marked leukocytosis (predominantly neutrophil) whereas CLL is multiple chain lymphadenopathy, splenomegaly, mild cytopenias (anemia/platelets) and predominent lymphocytic leukocytosis (shows smudge cells on peripheral smear)
Pt with infective endocarditis may have bacterial emboli to lungs but what about pt with neurologic symptoms?
Brain abscess is possible as it is possible to have mitral valve involved not just tricuspid valve.
How could you tell if a pt’s hyponatremia was from fluid loss or renal tubular necrosis based on labs?
hypovolemic pt with have stimulation of ADH and urine sodium of <20 whereas RTN pt will have severe hypotension and urine sodium >20
Common bugs associated with the following infections in sickle cell patients: PNA Osteomyelitis/septic arthritis Bacteremia/sepsis Meningitis
PNA-Strep pneumo
Osteo/septic arth-S. aureus and salmonella
Bacteremia/sepsis-S. pneumo and Hib
Meningitis-S. pneumo
who do you give abx prophylaxis to prevent infective endocarditis prior to invasive procedures such as dental procedures?
Those with:
- prosthetic heart valve
- Previous hx of IE
- Structurally abnormal heart valve in a transplanted heart
- Certain congenital disease (unrepaired cyannotic CHD, repaired CHD with prosthetic material within 6 mos of repair, repaired CHD with residual defects)
IT IS NOT recommended in pt with mitral valve prolapse, or other acquired valvular dysfunction (rheumatic fever), and relatively low-risk congenital heart disease( ASD, bicuspid)
How do you calculate sensitivty and specificity?
SN= TP/ (TP+FN)
SP= TN/ (TN+ FP)
What is the pharmacotherapy for acute dystonia in a pt treated with antipsychotic?
Benztropine or diphenhydramine
Injury to the radial nerve would cause what on exam?
wrist drop, decreased sensation over dorsum of hand
Which form of dementia is associated with impaired acteylcholine synthesis?
Alzheimer disease
How hypertensive would you expect to see a pt with renal artery stenosis?
severe htn >180/120
and recurrent flash pulmonary edema
young boy with trinucleotide repeat on the X chromosome makes you think?
fragile X syndrome
intellectual disability, autistic behavior, elongated face with large ear and enlarged testes
Pt with hx of breast cancer has labs that show thrombocytopenia, decreased fibrinogen, and increased INR which are indicative of what?
DIC
Pt with findings consistent with DIC (thrombocytopenia, decreased fibrinogen, and increased INR) also shows elevated LDH, reticulocyte count, and bilirubin which is consistent with what process and due to what mechanism?
consistent with hemolysis from MAHA (commonly associated with DIC, but can occur without DIC. Schistocytes on smear)
What pathology is associated with the following on cardiac auscultation: loud first heart sound, early diastolic sound after second heart sound, (opening snap) and low pitched mid-diastolic murmur best heard at apex.
Mitral Stenosis
What is the USPSTF recommendations for breast cancer screening?
Mammogram q2y for women 50-74
In adults, the most common cause of nephrotic syndrome is ?
FSGS
particularly Af Am
teen who presents with progression from absence to myoclonic to generalized tonic-clonic seizures. Typically occur upon awakening. dx?
Juvenile myoclonic epilepsy
symptoms can worsen with sleep deprivation.
Why are nitrates used in MIs and angina?
preferential venodilation treats the pain caused by cardiac ischemia
what is febuxostat?
xanthine oxidase inhibitor used in gout to decrease uric acid production. Allopurinol is preferred so febuxostat reserved for those who cannot tolerate allopurinol
what is probenacid
a gout medication to increase uric acid excretion in the kidneys
decerscendo diastolic murmur along the left sternal border at the third and fourth interspace is due to what?
Aortic regurg
What kind of murmur do you hear with aortic root dilation and where is best spot to hear it?
decrescendo diastolic murmur just like in aortic regurg but with root dilation its best heard along the right sternal border (not the left like in AR)
when will you see xanthochromia in the CSF?
with subarach hem
what is factitious disorder
making it up to assume the sick role (no secondary gain)
Do you do further workup in pediatric population with sore throat, cough, runny nose, and oral vesicles?
no. likely viral, herpangina
Pheochromocytoma arises from what cells?
neuroendocrine cells of the adrenal medulla
pt presents with poor energy, weight gain and psychosis. What lab should you order to rule out possible cause
TSH r/o hypothyroid
treatment for pt with perforated ulcer?
urgent ex-lap
What is pubic symphysis diastasis?
can occur after traumatic delivery and presents with radiating suprapubic pain exacerbated by weight-bearing. Treatment is conservative with supportive care.
What is the most common malignancy diagnosed in patients exposed to asbestos?
Bronchogenic carcinoma
especially in smokers
delayed carotid pulses and midsystolic murmur over right sternal border suggest? What else might be seen in severe cases?
Aortic stenosis
In severe dz: diminished and delayed carotid pulse (pulsus parvus and tardus) due to blood flow obstruction. Mid- to late-peaking systolic murmur from turbulence due to the stenosis. Presence of soft and single second heart sound (S2)
Mid to late diastolic murmur at apex is suggestive of?
mitral stenosis
Autoimmune hemolytic disorder characterized by intravascular and extravascular hemolysis and hemaglobinuria?
Paroxysmal nocturnal hemoglobinuria
most patients present in 4th decade with: hemolysis leading to hemoglobinuria, Cytopenias (fatigue and dyspnea from anemia), Hypercoaguable stat (portal vein thrombosis etc causing acute abdominal pain)
after 6 mos of age, inadequate dietary intake becomes the most important cause of what deficiency?
Iron
(little kid drinking only cows milk with microcytic anemia
Diagnosis requires > or = how many of the 9 symptoms of depression and for how long?
5/9 for at least 2 weeks
in addition to support groups etc you have to recommend antidepressant therapy and pyschotherapy
Tinea versicolor is the only tinea infection NOT caused by what? and what causee Tinea versicolor?
not caused by a derpatophyte infection
it is caused by Malassezia furfur or Malassezia globosa
differential for anterior mediastinal mass?
4Ts: Thymoma, Teratoma (or other germ cell tumor), thyroid neoplasm, and terrible lymphoma
What lab would be elevated in a nonseminomatous germ cell tumor that would not be elevated in seminomatous germ cell tumor?
AFP is elevated in non-seminoma and will not be elevated in seminoma
beta-hcg will be elevated in both
child with recurrent bacterial infections, severe peridontitis, and marked leukocytosis is consistent with ?
Leaukocytosis adhesion deficiency (LAD)
caused by defective integrins
exam shows inflammation with lack of purulence.
first presentation of LAD is delayed umbilical cord separation
What management do you use if endometriosis is suspected and conservative treatment with NSAIDs and OCPs isnt helping pain/ sx’s?
Laparoscopy indicated after failure of empiric therapy
What is Riluzole?
A glutamate inhibitor approved for use in ALS
Risk factors for ARDS other than intubated ICU pt?
Infection (sepsis), trauma, massive transfusion, acute pancreatitis
what is cutoff of normal thickness endometrial strip?
= 4mm
what is dactylitis?
(hand-foot syndrome) can be the earliest manifestation of vaso-occlusion in sickle cell disease pt.
usually presents at 6mos to 4 years with acute pain and severe swelling of hands and feet. Low grade fever sometimes present
what do you think of when you read endocardial cushion defect?
ASD
continuous flow murmur that is often asymptomatic and detected incidentally on routine cardiac auscultation?
PDA
What’s the treatment for iron poisoning?
deferoxamine, binds ferric iron allowing urinary excretion
How do you treat BV in a pregnant pt?
same as non pregnant pt. Metronidazole
Benign intracranial HTN has what serious possible complication if ICP is not lowered?
blindness
differential dx for pt with marfanoid body habitus?
Marfan syndrome and Homocystinuria
homocystinuria is AR error in methionine synthesis. associated with intellectual disability and thrombosis (downward lens dislocation vs marfan which is upward lens dislocation)
High dose IV acyclovir can cause what renal injury?
crystal induced AKI where crystalluria can cause renal obstruction
administering IV fluids concurrently with the drug can help reduce the risk of acute kidney injury
Microcytic anemia , disproportionately elevated RBC count and peripheral smear with hypochromia and poikilocytes including target cells is indicative of?
Beta-thalassemia minor
child age 2-5 with abnormally low platelet count (<100,000) resulting in increased bruising and bleeding following viral infection?
ITP
no treatment needed
Glucocorticoids or IV immunoglobulin (IVIG) is first line treatment with mucosal bleeding
What BUN:Cr ratio is suggestive of pre-renal AKI?
> 20:1
Which types of bacteria would you expect to see in early (<3months) vs delayed (3-12 months) prosthetic joint infection? how do the presentations differ other than timing?
acute (< 3 months) acute pain, wound infection or brreakdown, fever - S. aureus, G- rod, anaerobe
delayed (3-12mos) chronic joint pain, implant loosening, sinus tract formation - coagulase negative staph (like staph epi), propionibacterium, enterococci
pt with hx of gallstones presents with colicky pain, hyperactive bowel sounds, and peumobilia on CT, dx?
gallstome ileus
treatment is surgical
treatment of mild and severe or worsening croup?
mild-corticosteroids
severe - corticosteroids (dexamethasone) and nebulized epinepherine
Fluoxetine, Paroxetine, Sertraline, citalopram, escitalopram, and fluvoxamine are all??
SSRIs
Venlafaxine, desvenlafaxine and duloxetine are all???
SNRIs
Buproprion has what MOA?
Norepi and dopamine reuptake inhibitor
does not cause weight gain or sexual side effects
Phenelzine and Nortriptyline are ??
MAOIs
Vortioxetine is what kind of drug?
serotonin modulator
Placenta accreta typically occurs in pt’s with what hx?
Prior c-section, myomecyomy or D&C
what is immediate tx for uterine inversion?
put it back manually with your hands!
utertonic administration before replacement may make uterine replacement impossible to perform!
Symmetric decel and return to baseline of fetal HR with contraction suggests what etiology?
fetal head compression
no treatment is necessary
Late decel that mirrors conrtaction has what etiology?
uteroplacental insufficiency
Variable decels with contractions indicate?
cord compression, oligo, or cord prolapse
dysgerminomas secrete ?
LDH or beta-hcg
Mature teratomas are concerning?
they are benign and may secrete thyroid hormone (struma ovarii)
Sertoli-Leydig cell tumors secrete?
androgens (testosterone and androtestenedione typically causing virilization
amenorrhea, deep voice, clitoromegaly in females
Yolk sac tumors secrete?
AFP
tomoxifen puts women at risk for what due to its MOA?
endometrial polyps in premenopausal and endometrial hyperplasia and cancer in post menopausal women due to estrogen agonist in the uterus.
inferior wall MI is due to occlusion of what coronary artery causing damage to what area of the heart?
Right coronary causing RV infarct
RV failure leads to decreased preload and resultant hypotension
What lab findings might you see in a pt with tubo-ovarian abscess?
nonspecific (leukocytosis, CRP, CA-125)
CA-125 elevation is nonspecific and does not indicate malignancy
also pt with fever suggests infection rather than malignancy
What do you see with kawasaki disease
what is tx?
aka mucocutaneous lymph node syndrome. It’s a vasulitis characterized by FEVER >/= 5days in addition to at least 4 of the following:
Conjunctivitis (bilateral non exudative
Oral mucosal changes (erythemia, fissured lips, “strawberry tongue”)
Rash
Extremity changes (erythema, edema, desquamation of the hands and feet
Cervical lymphadenopathy: > 1.5cm node
IV immunoglobulin should be started within 10 days of fever onset to help prevent coronary artery aneurysms
Aspirin indicated to help with inflammation and antiplatelet effect (even with risk of reye still give it).
Pt’s with what hx are more susceptible to molluscum contagiosum infection?
Imparied CELLULAR immunity (HIV)
pt wit cold symptoms and cough that screams viral infection also has some crackles at one lung base. Management?
have to get chest xray to look for possible consolidation
Vaginal bleeding, malodorous discharge, and ulcerated vaginal lesion are concerning for what in post menopausal woman>
vaginal squamous cell carcinoma
need vaginal biopsy for dx
skin necrosis at injection site of a pt who recently started subQ hepain screams what?!
HIT
which biliary disease is assocaited with UC?
PSC
PBC is middle aged women with anti-mito antibodies
CKD pt with pleuritic chest pain, friction rub, and BUN 90 likely is suffering from what?
Uremic pericarditis - needs dialysis
typically happens with BUN >60
usually doesnt have the classic EKG findings associated with pericarditis
slowly developing back pain with neurologic dysfunction and palpable step off deformity in the lumbosacral area is typical for ?
spondylolisthesis
short stature, aortic coarctation, and absence of menarche in young girl likely due to?
turner syndrome 45 X
estrogen deficient risk of osteoporotic fracture
How would you differentiate a diverticular bleed from hemorrhoids?
diverticular bleeds are typically painless (hemorrhoids can also be painless) but hemorrhoids will not usually cause enough bleeding to compromise hemodynamic status (diverticular might)
Pt with itching after bathing, facial plethora and splenomegaly screams what? what is MOA of dz and what lab is characteristically DECREASED?
Polycythemia vera
JAK2 mutation for constitutive activation resulting in high erythrocytes (also high leukocytes and thrombocytes)
will have LOW EPO levels
Can a mom with HepC breast feed?
yes. Breastfeeding does not increase the risk of HCV transmission to the neonate
Are HepA and HepB vaccines safe in pregnancy?
Yes they are inactivated vaccines
Would you adjust a pt’s levothyroxine if they become pregnant?
yes. Pt’s with hypothyroidism should increase dose because in pregnancy you make more thyroid binding globulin andif you are hypothyroid you cant make extra hormone
Lithium and Valproate are first line for bipolar maintenance. In what pt population would you avoid either drug (ie what chronic disease would make you not prescribe either drug)
Lithium is avoided in pt’s with renal dysfunction because it can lead to high levels and toxicity.
Valproate needs to be monitored for hepatotocixity and thrombocytopenia
Constipation, back pain, and lab evidence of anemia, renal insufficiency and hypercalcemia indicate what malignancy?
Multiple Myeloma
(pt will have M-spike) and peripheral smear with ROULEAUX
why does excess gastric acid in ZES lead to diarrhea and steatorrhea?
because of inactivation of pancreatic enzymes and injury to the mucosal brush border
Why are ace inhibitors given to CHF patients
to lessen ventricular remodeling
which traumatic penetrating wounds require emergent ex lap?
Any penetrating injury in the thorax below the level of the nipples has potential to involve the abdomen through the diaphragm and is assumed to involve both compartments until proven otherwise
If a suicidal teenager refuses hospitalization and asks you not to tell his parents about his plans what do you do?
Inform the parents and hospitalize him immediately with or without parental consent
PAP result comes back with high grade squamous intraepithelial lesion what is next step in management?
colposcopy to evaluate and visualize lesion
Osteoarthritis of the foot usually involves what areas?
the mid foot and first metatarsophalangeal joint
A young girl who presents with primary amenorrhea and male- range testosterone levels with no cervix on exam likely has what?
Androgen insensitivity syndrome (46XY)
What is the treatment for lymes in a patient <8yo
oral amoxicillin or cefuroxime
no flouroquinolones this young
Most common cause of acute and recurrent headaches in the pediatric population?
Migraines. First line treatment is Tylenol, NSAIDs and supportive management
triptans may be tried if these are not effective
What is somatic symptom disorder?
Excessive anxiety and thoughts about the seriousness of at least 1 somatic symptom.
What causes low FSH and estradiol in females with irregular menses and infertility?
Hypogonadotropic hypogonadism via loss of GnRH pulsatile secretion precipitated by weight loss, stress, or chronic illness.
What is false labor?
Mild irregular contractions that DO NOT cause cervical change (ie braxton hicks)
What labs will you see in someone suspected to have antiphospholipid syndrome?
prolonged PTT because the lupus anticoagulant binds phospholipids
this finding is artifact and does not correlate with bleeding.
20-40% will also have thrombocytopenia even though they are hypercoagulable
what is the initial test for someone with high likelihood of DVT?
Compression US
d-dimer is more helpful to rule out and is not very specific if positive
What happens to reticulocytes and platelets in aplastic crisis?
increased reticulocytes (compensatory) and decreased platelets (they are trapped in spleen)
What differences do you see in RDW and reticulocyte count with thalessemia vs iron deficiency anemia?
Thal will have normal RDW and retics might be slightly elevated or normal
Iron def will have increased RDW and low retics
When would you typically see a drug fever after administration of drug?
1-2 weeks post admin
pt population most at risk for osteosarcoma?
where do you usually see it on the bone? what does it look like?
it is the most common primary bone tumor in children and young adults. Boys between ages 13-16 are at higher risk
seen frequently at the metaphyses of long bones such as distal femur, proximal tibia, and proximal humerus.
typically see spiculated “sunburt” pattern and peristeal elevation (Codmans triangle)
what do you see on Xray with Ewing Sarcoma?
osteolytic lesion with a periosteal reacion - “onion skin” appearance
Bortholin duct systs are found in what area?
4 and 8 ocklock positions of the labia majora
Spondyloarthropathies are characterized by what type of pain?
back pain and stiffness that worsens with rest and improves with activity
(aka ankylosing spondylitis)
Limited upward gaze, upper eyelid retraction and pupils non reactive to light but reactive to accommodation indicated what?
Parinaud syndrome (like from pineal growth in the dorsal midbrain)
can also cause obstructive hydrocephalus resulting in headache and vomiting
When do you and when do you not prescribe oral antibiotics for kid with otitis media?
when are tubes necessary?
All infants <6mos and >/=6 mos w/ high fever, severe pain, or bilateral disease.
pt =6mos with low grade fever, mild or no pain, and unilateral disease gets analgesia and observation as an option.
Recommend tubes for >/=3 episodes of otitis in 6 mos or >/=4 episodes in 12 months
What are the first line treatments for smoking cessation?
Nicotene replacement therapy, varenicline, and bupropion.
Bupropion is contraindicated in pt with seizures or any pt who may have acitve bulimia
Acute onset of psychotic symptoms (bizarre behavior, auditory hallucinations) in a child or adolescent with neurological symptoms (slurred speech, drooling, or hand tremor) and abnormal LFTs are concerning for?
Wilson disease
Sickle cell pt with acute drop in hgb, low retic count, without splenomegaly is consistent with ?
aplastic crisis
functional systolic murmur may be present due to hyperdynamic blood flow
Vaccination for medically stable preterm infants should be given according to what age (gestational or chronilogic)
Chronologic age not gestational.
All stable preterm infants should receive the first dose of HepB at birth (unless weighs <2kg) and HepB dose 2, rotavirus, tetanus, diptheria, acellular pertussis, Hib, pneumococcal, and inactivated polio at 2 mos
treatment for symptomatic 3rd degree AV block?
temporary pacemaker to look for reversible cause then permanent pacemaker if no reversible cause found.
Will ECT pt most likely experience anterograde or retrograde amnesia?
Both
Acute renal transplant rejection (days) should be treated with?
IV steroids
What do you see with digoxin toxicity?
Diarrhea, nausea, and fatigue
typically presents with N/V decreased appetite, confusion and weakness.
may also have visual symptoms of scotomata, blurry vision with color changes or blindness.
Treatment for restless legs?
Iron supplementation for deficiency, conservative measures, and pharmacotherapy with dopamine agonsits (pramipexole) or alpha-2-de;ta calcium ligands (gabapentin)
hypercalcemia with low PTH is concerning for what in a pt with non specific symptoms
malignancy
Hemiparesis and aphasia after injury to the posterior pharynx are suspicious for what type of injury?
Injury to the cervical internal carotid artery, which is located directly lateral and posterior to the tonsilar pillars
injury can result in dissection or thrombus, which occurs over hours to days and can extend into the MCA and ACA. Pt may develop thunderclap headache and sx of ischemic stroke (hemiparesis, facial droop, aphasia). confirm dx with CT or MR angiography
What is Zenker’s diverticulum?
most common in elderly patients, particularly men. occurs in posterior lower cervical esophagus near the cricopharyngeal muscle
Patients may complain of dysphagia and regurgitation often have halitosis and are at risk for aspiration pneumonia
what happens to amount of amniotic fluid if pregnancy goes past 41 weeks>
Uteroplacental insufficiency results in chronic fetal hypoxemia and CNS suppression that can lead to fetal demise. To prevent suppression, blood is preferentially distributed to the brain rather than the peripheral tissue. This redistribution can be evidenced on US as OLIGOHYDRAMNIOS as amniotic fluid is dependent on renal perfusion and urine production
What does HELLP stand for?
Hemolysis, Elevated Liver enzymes and Low Platelets
serious liver problems include centrilobular necrosis, hematoma formation, and thrombi in the portal capillary system. These processes cause swelling and distension of the hepatic (Glisson’s) capsule, resulting in RUQ or epigastric pain
Treatment for intra-amniotic infection is?
broad spectrum abx and immediate delivery via augmentation of labor
C-section is reserved for standard OB indications (non-reassuring fetal tracing, breech presentation, prior uterine surgeries)
workup of baby with asymptomtic murmur likely due to VSD?
echo to evaluate location and rule out other defects. most small VSDs close spontaneously and require no treatment
Obese boy comes in with hip or knee pain of insidious onset causing limping. PE shows loss of abduction and internal rotation of the hip as well as external rotation of the thigh while the hip is being flexed. dx?
Slipped capital femoral epiphysis
displacement of the femoral head on the femoral neck due to disruption of the proximal femoral growth plate.
should be promptly treated with surgical pinning of the slipped epiphysis to lessen risk of avascular necrosis
lymphocytic predominant leukocytosis in a kid that had bad cough that made him puke but is otherwise afebrile and VS normal?
Pertussis aka whooping cough
tx is macrolides
What are the medications used to treat alzheimer disease
Donepezil, galantamine, and rivastigmine
cholinesterase inhibitors
pt is hyponatremic to 128 and is in DKA, what fluids do you give to correct sodium?
NS -
pt’s in DKA can have pseudohyponatremia due to hyperglycemia
hypertonic saline is reserved for true (severe) hyponatremia
Pt with ESRD needs to be put on a blood thinner, what is preferred tx?
warfarin is preferred long term and to bridge use unfractionated heparin
LMWH (enoxaparin) and rivaroxaban are not recommended in ESRD because they are metabolized by the kidney and can reach toxic levels
abx tx of choice for human bite?
amoxicillin clavulanate due to good G- and G+ and beta lactamase producing organism coverage
Old man recently started on anti-depressant and cant pee, which drug was he given?
Amitriptyline (or another TCA)
a TCA with anticholinergic properties ca result in urinary retention
fever, back pain, and focal spinal tenderness suggest?
infection such as vertebral osteomyelitis
needs MRI
Most common cause of short stature and pubertal delay in adolescents?
Constitutional growth delay characterized by delayed growth spurt, delayed puberty, and delayed bone age.
GCS is scored of what three categories?
Eye opening, Verbal response, motor response
What labs do you order before starting Lithium?
BMP, UA, Calcium, pregnancy test (in women), and thyroid function tests.
first line therapy for social anxiety disorder?
SSRI or SNRI with CBT
beta blocker or benzo only for the performance subtype
60 yo female with adnexal mass and hx highly suspicious for ovarian cancer should uet what type of management>
Ex lap with surgical staging
biopsy could lead to rupture of the mass and resultant spreading of cancerous cells
What is hyposthenuia and what patients do you see it in?
Inability to concentrtae urine by the kidneys. Seen in sickle cell and sometimes sickle cell trait
In response to hypoxic, hyperosmolar conditions of the renal medulla, red blood cells sickle in the vasa recta, impairing free water reabsoprtion and countercurrent exchange. Pt typically has polyuria and nocturia despite fluid restriction. Urine osmolality is low; however, normal serum sodium is maintained due to intact ADH
Victims of smoke inhalation should be treated empirically for what kind of poisoning?
Cyanide poisoning. with an antidote such as hydroxycobalamin or sodium thiosulfite with nitrates to induce methemaglobinemia.
Hydrogen cyanide and carbon monoxide are the 2 major products of combustion in closed spaces.
How can antipsychotics contribute to infertility?
By blocking dopamine-2 receptors in the infundibular pathway, the production of prolactin increases which can result in galactorrhea, menstrual irregluarities, and infertility
Renal vein thrombosis is associated with causes of nephrotic syndrome but most commonly with which nephropathy?
Membranous glomerulopathy.
Adhesions and fibrosis of the shoulder joint synovial lining describe what pneomenon?
Adhesive capsilitis “frozen Shoulder”
persistent pain with decreased ROM in multiple planes. can be idiopathic or due to underlying pathology.
HSP is associated with what GI complication due to intestinal edema and bleeding
Intussusception
Hypercalcemia, hypophosphatemia, and elevated PTH are consistent with ?
Primary hyperparathyroidism
recommend parathyroidectomy if pt has complications such as osteoporosis, (Tscore 1mg/dL above normal, urinary excretion of calcium >400mg/day
features of cocaine withdrawal?
Predominantly psychological features: depression, fatigue, hypersomnia, increased dreaming, hyperphagia, impaired concentration, and intense drug craving
what is the most accurate method of determining gestational age?
First tri ultrasound with crown-rump length
Why do women get HELLP syndrome? MOA?
abnormal placentation, triggering systemic inflammation and activation of the coagulation system and complement cascade.
circulating platelets are rapidly consumed, MAHA it detrimental to the liver resulting in hepatocellular necrosis and trhombi in the portal system
Treatment for HELLP syndrome?
Delivery, Mg for seizure prophylaxis, and antihypertensives
What cardiac pt’s cannot receive PDE-5 inhibitors for ED? (who doesn’t get to have viagra?)
anyone on a nitrate or alpha blocker due to risk of hypotension
beta blockers are ok
Elderly pt with hypercalcemia, normocytic anemia, renal insufficiency, and protein gap (difference between total protein and albumin >4g/dL)
Multiple Myeloma
What are the contraindications to the rotavirus vaccine?
Previous anaphylaxis to ingredients, hx of intussusception, hx of uncorrected congenital malformation of GI tract (meckel’s), SCID
Causes of NORMAL anion gap mebanolic acidosis
Diarrhea, fistulat (pancreatic, ileocutaneous etc), Carbonic anhydrase inhibitors, Renal tubular acidosis, ureteral diversion (ileal loop), iatrogenic
Non-anion gap metabolic acidosis in presence of conserved kidney function indicates?
Renal Tubular acidosis
Which type of RTA is seen in porrly controlled diabetes?
hyperkalemic RTA (type 4 RTA)
damage to the juxtaglomerular apparatus, causes state of hyporenimic hypoaldosteronism
low aldo causes retention of H+ and K+
Dilation of the papiniform plexus describes what?
A varicocele
soft, irregular mass (“bag of worms”) that increases in size with standing and valsalva
more common on left side bc left spermatic vein drains to the left renal artery which then passes between the SMA and aorta prone to compression.
Most common causes of viral meningitis?
enteroviruses like coxsackievirus
An ovarian mass in a postmenopausal pt is very concerning for malignancy and should be investigated by?
pelvic US and CA-125 measurement
What is preferred option for renal transplant: living related donor, non-related donor, or cadaveric donor?
living related then living non then cadaver
Labs seen in pt with turner syndrome?
elevated FSH and LH with low estrogen, low testosterone
what is d-xylose test for?
test for intestinal malabsorption (celiac dz)
d-xylose is a monosach that can be absorbed in the proximal intestine without degradation and then excreted in urine. Pt with proximal intestinal mucosal dz (celiac) cannot absorb and urinary and serum levels of d-xylose will be low, Pt with malabsorption due to enzyme deficiency (pancreatitis) will have normal absorption.
Old person with UTI acting crazy, psychological dx?
Delirium
What is a restrictive pattern of PFTs?
what about obstructive?
reduced vital capacity and total lung capacity with normal FEV1/FVC ratio
obstructive: reduced FEV1(<80%) and FEV1/FVC (<70%)
Child with recurrent cutaneous and pulmonary infections with catalse positive bacterial and fungal organisms
Chronic granulomatous disease
Leukocyte, platelet, and B and T cell concentrations are normal
Dx made by oxidative burst testing (dihydrorhodamine or nitroblue tetrazolium testing) and confirmed by gene testing
pts should receive abx prophylaxis with TMP_SMX and itraconazole
What is Beckwith-Wiedmann syndrome?
overgrowth disorder characterized by predisposition to neoplasms. Most patients have sporadic or inherited alteration of chromosome 11p15, which includes genes that encode insulin-like growth factor 2, a growth promoting hormone similar to insulin. At birth, classic findings include
macrosomia, macroglossia, hemihyperplasia, and medial abdominal wall defects ( umbilical hernia, omphalocele)
Anorexia vs bulimia vs binge eating?
Anorexia-significantly low weight (binge/purge subtypes)
bulimia: recurrent binging with compensatory behavior like vomiting or exercise, worry about body and maintains NORMAL weight
binge-eating: no compensatory behavior just recurrent binging with lack of control
In child, viral URI followed by heart failure symptoms is most likely caused by?
Viral myocarditis (coxssackie B or adenovirus)
Because urine protein dipstick has high false-positive and false-negative during pregnancy the findings should be confirmed by?
Urine protein/creatinine ratio or 24-hour collection for total prtoein
difference in serous otitits media and acute otitis media?
Serous will not have inflammatory signs like fever tympanic membrane buldging just effusion following AOM treatment and if chronic can lead to hearing loss
In infants, areas of erythematous patches and plaques of yellow, oily scales, and mild pruritis on the scalp, eyelids, nasolabial folds, postauricular area, and umbilicus?
Seborrheic dermatitis caused by malassezia species
“cradle cap”
Why do obese people get non-alcoholic fatty liver disease? MOA?
increased transport of free fatty acides from adipose to the liver, decreased oxidation of FFA in the liver, or decreased clearance of FFA from the liver (due to decreased VLDL production).
frequently related to Insulin resistance leading to increased peripheral lipolysis, triglyceride synthesis, and hepatic uptake of fatty acides.
Hyperkeratotic papules on the soles of the feet that are painful when walking or standing most commonly in young adults and immunocomprimised
HPV
warts
overwhelming life event causes man to forget who he is or how he got to his current location, dx?
Dissociative amnesia
Pt with bad chest trauma post MVA with pneumomediastinum, and subcutaneous emphysema on physical exam despite placement of chest tube is consistent with?
Tracheobronchial rupture
esophageal rupture is more from ednoscopy or esophagitis not blunt force trauma
When does MG typically present in Males vs Females and with what sx’s? what is the ice pack test?
6th-7th decade for men
2nd to 3rd decade for women
symptoms of extraocular (ptosis, diplopia) and bulbar (dysphagia, dysarthria) muscles. Weakness can be exacerbated by meds (aminoglycodsides, magesium, beta blockers, neuromuscular blocking agents), surgery (thymectomy), pregnancy, or infections
Ice pack test is when ice pack applied to eyelids for several minutes leads to improvement of sx’s. Cold temp inhibits breakdown of ACh at neuromuscular junctionincreasing availability to nicotinic receptor. Pt with + test should get MG confirmed with AChR antibody testing.
Most common cause of unilateral bloody discharge from the breast without a coexisting breast mass?
Intraductal papilloma
What is fibromuscular dysplasia?
Non-inflammatory nonatherosclerotic condition most common in women 15-50. primarily affects renal arteries causing HTN. Involvement of the Cerebrovascular arteries (carotid, vertebral) can cause symptoms of brain ischemia (TIA, amaurosis fugax, stroke) or non specific sx’s (HA, pulsatile tinnitus, dizziness).
DX confirmed by CT or US
Adverse effects of Tomoxifen (SERMs)
Hot flashes, Cenous Thromboembolis, Endometrial hyperplasia & carcinoma
Nodular pattern of radioactive isotope uptake on thyroid scan is indicative of what vs a diffuse pattern?
Toxic adenoma or multinodular goiter
diffuse indicated Graves (usually other sx’s too like exopthalmos and pre-tibial myxedema)
Mom brings in kid concerned about possible developmental delay and pt only hx if multiple ear infections and eczema
check hearing for conductive hearing loss that is parading as developmental delay
Common symtpoms of hypertrophic cardiomyopathy include?
syncope, dyspnea, and chest pain
Peripheral neuropathy of the facial nerve is what Dx?
Bells palsy
inability to raise eyebrow or close eye, drooping of the mouth corner and disappearance of the nasolabial fold. If pt can still crinkle forehead this suggests central lesion
Atypical glandular cells on Pap testing in women >/=35 or <35 with risk factors (obesity, anovulation) requires evaluation for what? and how?
may be due to cervical or endometrial cancer
investigate with colposcopy, endocervical curettage, and endometrial biopsy to evaluate ectocervix, endocervix, and endometrium
Most commonly injured nerve with anterior shoulder dislocation? symptoms?
Axillary nerve
innervation to the teres minor and deltoid - weakness in abduction with injury
Do binge eating disorder pt’s have compensatory behavior>
no
how do you evaluate secondary amenorrhea (pt had cycles before now >/=3 cycles or >=6 months of no period)
beta hcg to r/o pregnancy, then prolactin+TSH+FSH
Pt who wear contact lenses wakes with painful, red eye and opacification and ulceration of the cornea is typical of what?
contact lens associated ketatitis - most cases due to Pseudomonas and serratia
medical emergency needs to discard the lenses and get topical abx
cornea is usually spared in bacterial conjunctivitis infections associated with contact lenses
15 yo male presents with worsening articulation and ataxia, MSK exam shows scoliosis and absent deep tendon reflexes in the lower extremities, MRI shows atrophy of the medulla and dorsal columns of the spinal cord.
Dx and usual complication that can be fatal?
Friederich ataxia
GAA
clinical features include: cerebellar ataxia, dysarthria, loss of vibration and/or position sense, absent deep tendon reflexes, Hypertrophic cardiomyopathy, skeletal deformities (scoliosis), diabetes mellitus
most common COD is cardiac dysfunction
What is avoidant/restrictive eating disorder?
lack of interest and avoidance of eating based on the sensory characteristics of food, with onset in infancy or early childhood
What is the tx for Erb-duschene palsy (brachial plexus injury - waiter tip hand)
up to 80% of patients have spontaneous recovery within 3 months.
surgical intervention for infants with no improvement 3-6 months
Osteomyelitis in sickle cell pt most likely due to?
salmonella and Saureus
Prolonged administration of high doses of oxytocin can result in what complication?
water intoxication and hyponatremia
oxytocin looks like ADH
hyponatremic sx’s include HA, abdominal pain, nausea, vomiting, lethargy, and tonic-clonic seizures.
treat with hypertonic saline
What drug therapies are used to prevent recurrent nephrolithiasis
Thiazide diuretic (less calcium excreted in urine), urine alkalinization (potassium citrate. bicarbonate salt), Allopurinol (for hyperuricosuria-related stones)
RA typically involves what area of the spine?
cervical spine
when do you start screening women with dexa scan for osteoporosis?
> =65 as well as <65 who have an equivalent risk of fx
single most important prognostic consideration in the treatment of pt with breast cancer?
Tumor burden (TMN staging)
pharmacotherapy for pagets disease?
bisphosphonates
what medications can cause pseudotumor cerebri aka IIH?
growth hormone, tetracyclines, and excessive vitamin A and its derivitives (isoretinoin, all-transretinoic acid)
what is pulsus paradoxus?
exaggerated fall in systemic BP >10 furing inspiration. it is found in carciac tamponade but also can occur in conditions without pericardial effusion such as severe asthma or COPD
key difference between dissociative amnesia and transient global amnesia>
DA: localized or selective amnesia for a particular event with inability to recall personal identity
TGA: anterograde amnesia for time and place but NO LOS OF PERSONAL IDENTITY. typically resolves in 24 hrs
Persistent pneumothorax and significant air leak following chest tube placement in pt with blunt force trauma to chest suggests? (hint pt has pneumomediastinum and subcutaneous emphysema)
tracheobronchial rupture
Delayed (slow-rising) and diminished (weak) carotid pulse (“Pulsus parvus and tardus”), presence of single and soft second heart sound (S2), Mid- to late- peaking systolic murmur with maxima intesity at the second right intercostal space ratiating to thecarotids
all suggestive of ???
Severe aortic stenosis
Pt received epidural for labor, 6 hrs later has continuous small amounts of urine since delivery, has edematous perineal area
how do you manage urinary sx’s?
urethral catheter
drainage of >=150mL confirms retention, catheterization also decompresses the bladder
presenting features of herpetic whitlow?
tingling and burning of the hand associated with localized vesicular rash. Symptoms WOULD NOT BE bilateral and symmetric.
timeline of alcoholic withdrawal symptoms from 6hrs to 96 hrs
6-24hr: mild withdrawal-anxiety, insomnia, tremors, diaphoresis, palpitations, GI upset, intract orientation
12-24hr: seizures - single or multiple generalized tonic-clonic seizure
12-48: visual, auditory, or tactile hallucinations, intact orientation, stable vital signs
48-96hr: delerium tremens
Marfan pt with acute chest pain should be evaluated for???
acute aortic dissection
exam may show >20 variation in SBP between arms. pt with dissection or progressive aortic root dilatation can develop aortic regurgitation (early crescendo decrescendo diastolic murmur.
infant with anemia, increased MCHC, indirect hyperbili, and negative coombs is indicative of >
hereditary spherocytosis
what will muscle biopsy show for pt with duschene MD? is muscle biopsy the gold standard for DX?
will show absent dystrophin,
gold standard is genetic testing
What non stimulant can be prescribed in adult ADHD?
atomoxetine
which has low complement levels post strep GN or IgA nephropathy?
PSGN
eval for pt with blunt genitourinary trauma?
UA and if hematura and stable ctrast CT
severe symptomatic hypercalcemia (>14mg/dL) can cause what sx’s?
tx?
weakness, GI upset and neuropsychiatric sx’s (confusion, stupor, coma)
treat with saline hydration and calcitonin
treatment for placenta previa?
pelvic rest until 36-37 weeks then c section
female on day x of period presents with macular rash involving hands and soles as well as hypotension - dx?
TSS Staph aureus
What compound will be elevated in the blood of B12 deficiency? (homocystein, methionin, VMA or ferritin?)
homocysteine (needs B12 to go to methionine)
most likely cause of macrocytic anemia in pt with sickle cell?
folate deficiency
what is atlantoaxial instability?
malformation in 10-15% of downs syndrome pt due to excessive laxity in the posterior transverse ligament, which causes increased mobility between the atlas (c1) and axis (c2)
what are gross motor milestones at 18 months?
running, kicking a ball
treatment for narrow complex tachycardia (SVT)
adenosine
amiodarone for wide complex tachy (VTACH
female with weight gain, proximal muscle weakness, HTN, easy bruisability, hyperpigmentation, and hyperandrogenism is indicative of?
cushings
also may see hyperglycemia, hypokalemia and alkalosis, and hypercortisolism
Any pt with UTI less than age 2 should get what as part of workup?
renal & bladder US to evaluate for anatomic abnormalities that could predispose to UTI
What do you hear on pulmonary exam of pleural effusion vs consolidation?
pleural effusion: decreased breath sounds and decreased tactile fremitus and dullness to percussion
consolidation: increased breath sounds, dullness to percussion, increased tactile fremitus
black and white rule in pediatric ethics regarding care that parent doesnt want to give?
Parent not allowed to refuse life saving treatment
Which antidepressant would you expect withdrawal symptoms from?
those with short half life like paroxetine
How do you differentiate normal grief from clinical depression?
With normal grief, sadness is typically focused on the deceased and decreases over weeks with intermittent waves mixed with positive memories
What do you expect to see as far as recurrence of symptoms in genital herpes in someone treated vs not treated?
treatment mostly makes outbreak shorter and helps reduce recurrence but even without treatment recurrence should be less frequent over time as cell mediated immunity is built up
What is a congenital melanocytic nevus?
benign proliferation of melanocytic cells. Present within the first few months of life, usually solitary with dense course hair
What is congenital dermal melanocytosis?
(mongolian spots) flat grey blue patches that are poorly circumscribed and will fade with time
Would you still be suspicious for pelvic inflammatory disease (like an abcess from ascending infection) in pt without leukocytosis or fever?
this would be very unlikely
what are modifiable risks of breast cancer?
alcohol use
nulliparity
Hormone replacement therapy
increased age at first live birth
what kind of prophylaxis should be given to people with hx of rheumatic heart disease?
Penicillin to prevent future strep A pharyngitis
inspiratory stridor and barky cough are indicative of ?
croup (parainfluenza)
What are the major and minor criteria for acute rheumatic fever?
Major: J<3NES - joints (migratory arthritis), carditis, nodules (subcutaneous, eryhtmea marginatum, syndenham chorea
Minor: fever, arthralgias, elevated ESR or CRP, prolonged PR interval
What is breast feeding jaundice?
in first week of life hyper unconjugated hyper-bili due to insufficient breast milk intake.
baby will be dehydrated
(conversely breast milk jaundice will appear with adequate intake and no sign of dehydration from 3-5 days and peak at 2 weeks)
What level of prolactin is diagnostic for prolactinoma?
> 200 ng/dL
You start CPR, give O2 and attach AED to pt in carciac arrest. monitor reads asystole/PEA, next step?
CPR x 2 min, IV access, give epi, place advanced airway
What medication can be prescribed to pt with mild grave diasese?
methimazole
most graves will require radioactive iodine and thyroidectomy.
What is PBC associated with?
xanthelasmas, severe hyperlipidemia, pruritis, anti-mito antibody, may develop osteoporosis or asteomalacia
Chronic alcohol user with gait instability, truncal ataxia, and difficulty with rapid alternating movements - due to??
cerebellar dysfunction “alcoholic cerebellar degeneration”
neonate with painless, illuminescent, scrotal swelling that fluctuates with crying - dx and management?
hydrocele
observation
which antibody shows acute hepB infection
IgM anti-HBc
child with cafe au lait macules, axillary freckling, and monocular eye protptosis with vision changes likely has?
NF1 with optic pathway glioma
What is typical presentation of retinitis pigmentosa?
bilateral tunnel vision and eventually blindness
chest/abdominal pain with subcutaneous emphysema suggests?
esophageal perf
multiparous woman >40 with dysmenorrhea and heavy mesntrual bleeding (can progress to chronic pelvic pain) and on exam boggy (soft/f;accod) tender, uniformly enlarged uterus…dx?
adenomyosis
What would a uterus with fibroids feel like on exam?
nontender, firm, and irregularly enlarged.
Pt with hematologic malignancy starts chemo and develops hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia…why? what do you do for managment?
Tumor lysis syndrome
IV fluids to flush the kidneys and uric acid metabolism inhibitors like allopurinol and rasburicase
recent URI, dyspnea, elevated JVP, clear lung sounds, and increased cardiac silhoutte on CXR is suggestive of?
early cardiac tamponade due to pericardial effusion
pt with COPD and acute onset of SOB, hypoxia and unilateral decreased breath sounds likely has ??
secondary spontaneous pneumothorax
may also see CP and hyper-resonance on percussion
what are the VitK dependent factors?
II, VII, IX, and X
In the US, the most common cause of constrictive pericarditis is idiopathic or viral (>40%), radiation therapy (30%), cardiac surgery (10%), and connective tissue disorders. What is most common cause in developing countries like Africa, India, and China?
tuberculosis
What is abx treatment for Infective endocarditis?
most likely due to viridans strep (mutans) treat empirically with vanc then depending on susceptibility give IV penicillin G or IV ceftriaxone for 4 weeks
dermal blisters that are painless and heal with scarring, increased skin fragility on tha dorsal hands, facial hypertichosis and hyperpigmentation are all indicative of what? especially in a pt with underlying HepC…
Porphyria cutanea tarda
disorder of heme synthesis
leads to photosensitivity due to accumulation of porphyrinogens that react with oxygenon excitation by UV light
Precosious puberty, irregular cafe au lait macules confined to one side of body and polyostotic fibrous dysplasia (bone fractures) is consistent with ?
McCune-Albright syndrome
constant overproduction of pituitary homrones so can also lead to thyrotixicosis, acromegaly, and cushing syndrome
What is the first few steps of evaluating precosious puberty?
bone age?
if advanced then look at LH to determine peripheral (low LH) vs central (high LH)
if normal look at breast (thelarche) and pubic hari (adrenarche)
What increases the murmur in HCM?
things that decrease preload (valsalva, abrupt standing, and nitro)
increasing afterload or preload will decrease murmur (hand grip, squatting, and passive leg raise)
Bilateral hemiparesis, Diminished bilateral pain and temp, and intact bilateral proprioception, vibratory sensation, and light touch is indicative of ?
Anterior cord syndrome.
injury to the anterior spinal artery
Life threatening complication of retropharyngeal abscess characterized by fever, chest pain, odynophagia, and requires urgent surgical intervention?
Acute necrotizing mediastinitis
