UWorld All Subjects 2 Flashcards
Diagnostic criteria for persistent depressive disorder (dysthymia)
- chronic depressed mood >/= 2 years
- > /= 2 of the following:
a. appetite disturbance
b. sleep disturbance
c. low energy
d. low self-esteem
e. poor concentration
f. hopelessness
Diagnostic criteria for adjustment disorder with depressed mood
- onset within 3 months of identifiable stressor
- marked distress and/or functional impairment
- does not meet criteria for another DSM-5 disorder
diagnostic criteria for normal stress response?
- not excessive or out of proportion to severity of stressor
- no significant functional impairment
What is the treatment of adjustment disorder?
psychotherapy
excessive anxiety and preoccupation with >/= 1 unexplained symptom?
somatic symptom disorder
fear of having a serious illness despite few or no symptoms and consistently negative evaluations?
illness anxiety disorder
neurologic symptom incompatible with known disease?
conversion disorder (functional neurologic symptom disorder)
intentional falsification of illness in the absence of obvious external rewards?
factitious disorder
falsification or exaggeration of symptoms to obtain external rewards?
malingering
What are common etiologies of pediatric stroke?
- sickle cell disease
- prothrombotic disorders
- congenital cardiac disease
- bacterial meningitis
- vasculitis
- focal cerebral arteriopathy
- head/neck trauma
What is the triad of Leriche syndrome?
- bilateral hip, thigh, and buttock claudication
- absent or diminished femoral pulses: from the groin distally, often with symmetric atrophy of the bilateral lower extremities due to chronic ischemia
- impotence: almost always present in men with this condition; in the absence of impotence, and alternate diagnosis should be sought
Pathophysiology pt, dx, and tx of Guillain-barre syndrome?
pathophysiology: immune-mediated demyelinating polyneuropathy; preceding GI (campylobacter) or respiratory infection
Pt:
1. paresthesia, neuropathic pain
2. symmetric, ascending weakness
3. decreased/absent DTRs
4. autonomic dysfunction (arrhythmia, ileus)
5. respiratory compromise
Dx: clinical; supportive findings: increased protein and normal leukocytes on CSF; abnormal electromyography + nerve conduction
Tx: monitoring of autonomic + respiratory function; IV immunoglobulin or plasmapheresis
What is the next step in management after diagnosis of Guillain-barre syndrome?
assess respiratory function with spirometry; FVC and negative inspiratory force monitor respiratory muscle strength
Serial PFTs should be performed given the rapid progressive of disease
A decline in FVC (= 20) indicates impending respiratory failure warranting intubation
What is the treatment for symptomatic sinus bradycardia with hypotension or signs of shock?
atropine 0.5 mg bolus, repeat every 3-5 mins up to 3.0mg max
if no response -> transcutaneous pacing OR IV dopamine infusion OR IV epinephrine infusion
If no response -> consider expert consultation or transvenous pacing
What are causes of sinus bradycardia?
sick sinus syndrome, MI, OSA, hypothyroidism, increased ICP, and medications
toddler with impaired adaption to darkness, photophobia, dry scaly skin, dry conjunctiva, dry cornea, and a wrinkled, cloudy cornea - dx?
vitamin a deficiency
characteristics of rotator cuff impingement or tendinopathy?
- pain with abduction, external rotation
- subacromial tenderness
- normal range of motion with positive impingement tests (Need, Hawkins)
characteristics of rotator cuff tear?
- similar to rotator cuff tendinopathy
- weakness with abduction and external rotation
- age > 40
characteristics of adhesive capsulitis?
- decreased passive and active range of motion
2. stiffness +/- pain
characteristics of biceps tendinopathy or rupture?
- anterior shoulder pain
- pain with lifting, carrying or overhead reaching
- weakness (less common)
characteristics of glenohumeral osteoarthritis?
- uncommon & usually caused by trauma
- gradual onset of anterior or deep shoulder pain
- decreased active and passive abduction and external rotation
supraventricular aortic stenosis path and pt
congenital left ventricular outflow tract obstruction due to discrete or diffuse narrowing of the ascending aorta
valvular murmur similar to the murmur of valvular aortic stenosis but it is best heard at the first right intercostal space
patients can also have uneven courted pulses, differential blood pressure in the upper extremities, and a palpable thrill int he suprasternal notch
path, pt, dx, and tx of biliary atresia
Path: extra hepatic bile duct fibrosis
Pt: asymptomatic at birth; infants age 2-8 weeks: jaundice, acholic stools, dark urine, hepatomegaly
dx: direct hyperbilirubinemia, elevated GGT, elevated all phos, normal or mildly elevated livery enzymes
U/S: absent/abnormal gallbladder and or CBD
Liver biopsy:
1. intrahepatic bile duct proliferation
2. portal tract edema
3. fibrosis
Intraoperative cholangiography (gold standard): biliary obstruction
Tx: surgical hepatoportoenterostomy (Kasai procedure), liver transplant
Risk factors, pt, dx and tx of chronic venous stasis
Risk factors: obesity, advanced age, varicose veins, history of DVT
Pt: leg pain (achy, heavy), edema, venous dilation (varicosities, telangiectasia), dermatitis (erythema, pruritus, scaling, weeping), chronic woody induration and brown discoloration, ulcers
Dx: clinical, can do duplex u/s to confirm and rule out venous thrombosis (ankle brachial index is used for arterial insufficiency NOT venous stasis)
Tx: elevation, compression stockings
Which medications can cause hyperkalemia?
- nonselective beta-blockers
- ACE-i, ARBs, K+ sparing diuretics
- digitalis
- cyclosporine
- heparin
- NSAIDs
- succinylcholine
How do nonselective beta blockers cause hyperkalemia?
interferes with beta-2-medicated intracellular potassium uptake
How does digitalis cause hyperkalemia?
inhibition of the Na-K-ATPase pump
How does cyclosporine cause hyperkalemia?
blocks aldosterone activity
How does heparin cause hyperkalemia?
blocks aldosterone production
How do NSAIDs cause hyperkalemia?
decreases renal perfusion resulting in decreased K+ delivery to the collecting ducts
How does succinylcholine cause hyperkalemia?
causes extracellular leakage of potassium through acetylcholine receptors
Pt, Dx, and Tx of HSV encephalitis
Pt: fever, HA, seizure, AMS (confusion, agitation), +.- focal neurologic findings (hemiparesis, cranial nerve palsies, ataxia)
Dx: CSF:
1. increased WBCs (increased lymphocytes), increased RBCs
2. Increased protein, normal glucose
3. HSV DNA on PCR
Brain MRI: temporal lobe hemorrhage/edema
Tx: IV acyclovir
What is Reye syndrome and how is it differentiated from HSV encephalitis?
encephalopathy with liver dysfunction; pt in children with AMS and generalized seizures after a viral illness
(Hepatomegaly and generalized cerebral edema without focal findings would be expected)
Pt and Dx of chronic autoimmune thyroiditis (Hashimoto)
Pt: predominant hypothyroid features, diffuse goiter
Dx: positive TPO Abx, variable radioiodine uptake
Pt and Dx of painless thyroiditis (silent thyroiditis)
Pt: variant of chronic autoimmune thyroiditis; mild, brief hyperthyroid phase; small, contender goiter, spontaneous recovery
Dx: positive TPO Abx, low radioiodine uptake
Pt and Dx of subacute thyroiditis (de Quervain thyroiditis)
Pt: likely postural inflammatory process; prominent fever + hyperthyroid symptoms, painful/tender goiter
Dx: elevated ESR + CRP, low radioiodine uptake
Epidemiology and pt of carbon monoxide poisoning
Epidemiology: 1. smoke inhalation 2. defective heating systems 3. gas motors operating in poorly ventilated areas Pt: Mild-moderate: HA, confusion, malaise, dizziness, nausea Severe Seizure, syncope, coma, MI, arrhythmias
Dx and Tx of carbon monoxide poisoning
Dx: ABG: carboxyhemoglobin level; ECG +/- cardiac enzymes
Tx: high flow 100% oxygen; intubation/hyperbaric oxygen (severe)
Complication: permanent hypoxic brain injury can occur (MRI showing bilateral hyper intensity of the globes pallidus, which is highly sensitive to hypoxic conditions)
What is a complication of antithyroid drugs in the treatment of Grave’s disease?
Both: agranulocytosis
Methimazole: 1st trimester teratogen, cholestasis
PTU: hepatic failure, ANCA-associated vasculitis
What is a complication of radioiodine ablation in the treatment of Grave’s disease?
- permanent hypothyroidism
- worsening of ophthalmopathy
- possible radiation side effects
What is a complication of surgery in the treatment of Grave’s disease?
- permanent hypothyroidism
- risk of recurrent laryngeal nerve damage
- risk of hypoparathyroidism
How is central precocious puberty differentiated from peripheral precocious puberty?
elevated LH level at baseline or following stimulation with a GnRH agonist; in contrast, elevated sex hormones in patients with peripheral PP suppress LH levels
What is the treatment of central precocious puberty?
after a CNS tumor is excluded, treat with GnRH agonist therapy, which prevents premature epiphyseal plate fusion and maximizes adult height potential
Tx of acute mania
- Antipsychotics (first and second generation)
- Lithium (avoid in renal disease)
- Valproate (avoid in liver disease)
- Combinations in severe mania (antipsychotic + lithium or valproate)
- Adjunctive benzos for insomnia, agitation
What are effects of maternal hyperglycemia on an infant during the first trimester?
- congenital heart disease
- neural tube defects
- small left colon syndrome
- spontaneous abortion
What are effects of maternal hyperglycemia on an infant in the second and third trimesters?
fetal hyperglycemia and hyperinsulinemia that leads to:
- increased metabolic demand -> fetal hypoxemia -> increased erythropoiesis -> polycythemia
- organomegaly
- neonatal hypoglycemia
- macrosomia -> shoulder dystocia -> brachial plexopathy, clavicle fracture, perinatal asphyxia
What is the difference between reactive attachment disorder (RAD) and disinhibited social engagement disorder?
Both can develop when a child has a history of neglect, abuse, prolonged institutionalization, or inconsistent care
RAD = social withdrawal, lack of positive response to attempts to comfort, and decreased emotional responsiveness, lack of positive emotions, and episodes of unexpected irritability or sadness in response to nonthreatening encounters
disinhibited social engagement disorder = overfamiliarity and an unhesitant approach to unfamiliar adults
What is the pathophys and what are etiologies of bronchiectasis?
Pathophys: infectious insult with impaired d clearance
Etiologies:
1. airway obstruction (cancer)
2. rheumatic disease (Ra, Sjogren), toxic inhalation
3. chronic or prior infection (aspergillosis, TB)
4. immunodeficiency
5. congenital (CF, alpha-1-antitrypsin def)
What is the pt and dx of bronchiectasis?
pt: cough with daily mucopurulent sputum production; rhino sinusitis, dyspnea, hemoptysis; crackles, wheezing
Dx: HR-CT scan of the chest (needed for initial diagnosis); immunoglobulin quantifications; CF testing, sputum culture; PFTs
What is the diagnostic imaging workup for UTIs in children?
Renal u/s should be performed first to rule out renal abscess.
A voiding cystourethrogram is performed after a first febrile UTI fi the patient has an abnormal renal ultrasound, high fever with unusual pathogen (ie not E. coli), or signs of chronic kidney injury.
What vessel(s) is blocked in an anterior MI? What ECG leads are involved?
vessel: LAD
ECG leads: some or all of V1-V6
What vessel(s) are blocked in an inferior MI? What ECG leads are involved?
vessels: RCA or LCX
ECG leads: ST elevation leads II, III, and aVF
What vessel(s) are blocked in a posterior MI? What ECG leads are involved?
vessels: LCX or RCA ECG leads: 1. ST depression in leads V1-V3 2. ST elevation in leads I + aVL (LCX) 3. ST depression in leads I + aVL (RCA)
What vessel(s) are blocked in a lateral MI? What ECG leads are involved?
vessels: LCX, diagonal
leads: ST elevation in leads I, aVL, V5, and V6; ST depression in leads II, III, aVF
What vessel(s) are blocked in a right ventricle MI (1/2 of inferior MIs)? What ECG leads are involved?
vessels: RCA
leads: ST elevation in leads V4-V6R
What is the medical management for a kidney stone < 10 mm?
medical management: hydration, pain control, alpha blockers, strain urine
What is medical management for a kidney stone <10 mm with uncontrolled pain or no stone passage in 4-6 weeks?
urology consult
What is the management for a kidney stone >/= 10 mm?
urology consult
blepharospasm pt and tx; what is Meige syndrome?
(form of focal dystonia)
Pt: bilateral, symmetric forceful contraction of the eyelid muscles; commonly affected by sensory input (bright lights may trigger the muscle contraction whereas touching or brushing the skin around the eye may terminate the spasm
Tx: trigger avoidance, such as wearing dark glasses, but botox injection may be needed
*When associated with spasm of the lower face (jaw, tongue), it is termed Meige syndrome
What is the path and risk factors for uric acid kidney stones?
Path: acidic urine favors formation of uric acid over rate; supersaturation of urine with uric acid precipitates crystal formation
Risk factors:
1. increased uric acid excretion: gout, myeloproliferative disorders
2. increased urine concentration: hot, arid climates; dehydration
3. low urine pH: chronic diarrhea (GI bicarb loss), metabolic syndrome/diabetes
Dx and Tx of uric acid kidney stones?
Dx: radiolucent stones (not visible on X-ray), uric acid crystal son urine microscopy urine pH usually < 5.5
Tx: alkalization of urine (potassium citrate)
Contact dermatitis as a cause of perianal dermatoses - epidemiology, visualization, and treatment
Epi: most common cause of perianal dermatoses in infants
Visual: spares creases/skinfolds
Tx: topical barrier ointment or paste
candida dermatitis as a cause of perianal dermatoses - epidemiology, visualization, and treatment
epi: second most common cause in infants
Visual: beefy-red rash involving skin folds with satellite lesions
Tx: topical antifungal therapy
perianal strep as a cause of perianal dermatoses - epidemiology, visualization, treatment
Epidemiology: school-aged children
visual: bright, sharply demarcated erythema over perianal/perineal area
Tx: oral Abx
Pt, PE, Labs, and treatment of polymyalgia rheumatica?
Pt: age >50, B/L pain and morning stiffness > 1 month; involvement of 2 of the following:
1. neck or torso
2. shoulders or proximal arms
3. proximal thigh or hip
4. constitutional (fever, malaise, weight loss)
PE: decreased active ROM in shoulders, neck, + hips
Labs:
1. ESR > 40, sometimes > 100
2. elevated CRP
3. normocytic anemia possible
Tx: response to glucocorticoids
What are the effects and side effects of alpha-adrenergic antagonists used for tx of BPH? What are the names of the drugs?
alpha-adrenergic antagonists: terzosin, tamsulosin (usual first line therapy)
MOA: relax smooth muscle in bladder neck, prostate capsule, and prostatic urethra
Side effects: orthostatic hypotension, dizziness
What are the effects and side effects of 5-alpha-reductase inhibitors used for tx of BPH? What are the names of the drugs?
5-alpha reductase inhibitors (finasteride, dutasteride)
MOA: inhibit conversion of testosterone to dihydrotestosterone; reduce prostate gland size
(effectiveness may take 6-12 months)
Side effects: decreased libido, erectile dysfunction
What are the effects and side effects of antimuscarinics used for tx of BPH? What are the names of the drugs?
antimuscarinics = tolterodine
MOA: used to treat overactive bladder (urinary frequency, urgency, incontinence)
Side effects: urine retention, dry mouth
Path, Pt and Dx of chronic granulomatous disease?
Path: majority of cases X-linked recessive
Pt: recurrent pulmonary + cutaneous infections; catalase positive pathogens (Staph aureus, Serratia, Burkholderia, Aspergillus)
Dx: neutrophil function testing:
- dihydrorhodamine 123 test
- nitroblue tetrazolium test
What is the inheritance of leukocyte adhesion deficiency? What is the defect? Presents with?
Inheritance = usually autosomal recessive defect = impaired neutrophil chemotaxis Pt = susceptible to recurrent infections (skin and mucosal) that lack pus and have poor wound healing; delayed umbilical cord separation (>21 days); marked peripheral leukocytosis with neutrophilia
What will ECG, CXR, and echo show in the diagnosis of coarctation of the aorta?
ECG: left ventricular hypertrophy
CXR: inferior notching of the 3rd-8th ribs; “3” sign due to aortic indentation
Echo: confirms diagnosis
Path, Pt, Dx, and Tx of hairy cell leukemia
Path: clonal B-cell neoplasm; middle-aged/older adults; BRAF mutation
Pt:
1. pancytopenia due to bone marrow fibrosis
a. granulocytopenia (infections)
b. anemia (fatigue, weakness)
c. thrombocytopenia (bleeding, bruising)
2. splenomegaly (early satiety)
3. hepatomegaly/LAD rare
Dx: peripheral smear - “hairy” leukocyte cells
bone marrow biopsy with flow cytometry
Tx: chemotherapy (for moderate/severe); life expectancy is often near-normal
Acute lymphoblastic leukemia path, pt, dx
path: children (not adults)
pt: symptoms related to neutropenia, anemia, or thrombocytopenia; LAD is common
Dx: peripheral smear shows lymphoblasts (small cells, scant cytoplasms)
Pt, Dx, Tx of spontaneous bacterial peritonitis
Pt:
1. temp > 100
2. AMS
3. hypotension, hypothermia, paralytic ileus with severe infection
Dx:
1. PMNs >/= 250
2. positive culture, often gram-negative organisms (E. coli, Klebsiella)
3. protein < 1 g/dL
4. SAAG >/= 1.1 g/dL
Tx: empiric Abx - third gen cephalosporin (cefotaxime); fluoroquinolones for SBP prophylaxis
Acting out - what is it? Immature or mature defense mechanism?
expressing unacceptable feelings through actions; immature
Denial - what is it? immature or mature defense mechanism?
behaving as if an aspect of reality does not exist; immature
Displacement - what is it? Immature or mature defense mechanism?
transferring feelings to less threatening object/person; immature
Intellectualization what is it? Immature or mature defense mechanism?-
focusing on nonemotional aspects to avoid distressing feelings; immature
Passive aggression - what is it? Immature or mature defense mechanism?
avoiding conflict by expressing hostility covertly; immature
Projection - what is it? Immature or mature defense mechanism?
attributing one’s own feelings to others; immature
Reaction formation - what is it? Immature or mature defense mechanism?
transforming unacceptable feelings/impulses into the opposite; immature
Regression - what is it? Immature or mature defense mechanism?
reverting to earlier developmental stage; immature
Splitting - what is it? Immature or mature defense mechanism?
experiencing a person/situation as either all positive or all negative; immature
Sublimation - what is it? Immature or mature defense mechanism?
channeling impulses into socially acceptable behaviors; mature
Suppression - what is it? Immature or mature defense mechanism?
putting unwanted feelings aside to cope with reality; mature
Pt, dx, and tx of transient synovitis
Pt: well-appearing, afebrile or low-grade fever, able to bear weight
Dx: normal or mildly elevated WBC, ESR, CRP; unilateral/bilateral joint effusion on u/s; diagnosis of exclusion
Tx: conservative
Pt, dx, and tx of septic arthritis
Pt: ill-appearing, febrile, non-weight bearing Dx: 1. modernly elevated WBCs, ESR, CRP 2. +/- positive blood culture 3. unilateral joint effusion on u/s 4. synovial fluid WBCs > 50,000 Tx: joint drainage + Abx
What antibiotics, antipsychotics, diuretics, and other drugs are associated with photosensitivity reactions?
Abx: tetracyclines (doxycycline)
Antipsychotics: chlorpromazine, prochlorperazine
Diuretics: furosemide, HCTZ
Others: amiodarone, promethazine, piroxicam
What is the dx and tx of type 2 heparin-induced thrombocytopenia?
Dx: serotonin release assay: gold standard confirmatory test
Tx: Stop ALL heparin products; start a direct thrombin inhibitor (argatroban) or fondaparinux (synthetic pentasaccharide)
**start treatment in suspected cases prior to confirmatory tests
lesion, extra dermal manifestations, and tx of plaque psoriasis
lesion: well-defined, erythematous plaques with silvery scale; extensor surfaces (knees, elbows), hands, scalp, back, nail plates
Extradermal manifestations: nail pitting; conjunctivitis, uveitis; psoriatic arthritis
Tx: topical: high-potency glucocorticoids, vit D analogs, tar, retinoids, calcineurin inhibitors, tazarotene; UV light/phototherapy
Systemic: methotrexate, calcineurin inhibitors, retinoids, apremilast, biologic agents
Etiology, Pt, and Dx of acute epididymitis
Etiology: age < 35: sexually transmitted (chlamydia, gonorrhea); age > 35: bladder outlet obstruction (coliform bacteria)
Pt:
1. unilateral, posterior testicular pain
2. epididymal edema
3. pain improved with testicular elevation
4. dysuria, frequency (with coliform infection)
Dx: NAAT for chlamydia + gonorrhea; urinalysis/culture
CVP and mechanism in hypovolemic shock
CVP is decreased because of decreased intravascular volume
CVP and mechanism in distributive shock
CVP is decreased because of decreased systemic vascular resistance
CVP and mechanism in obstructive shock
CVP is increased because of increased back pressure from obstruction cardiac filling
CVP and mechanism in cariogenic shock
CVP is increased because of back pressure from forward pump failure
Path, pt, complication of nasopharyngeal carcinoma
Path: EBV, endemic to southern china
Pt: nasal congestion with epistaxis, headache, cranial nerve palsies, and/or serous otitis media
complication - early metastatic spread to the cervical lymph nodes
gastric cancer
Path: risk is greatest for Eastern Asia (China), Eastern Europe, and Andean portion of South America; Helicobacter pylori infection, pernicious anemia, and smoking increase risk
Pt: persistent mid-epigastric abdominal pain, N/V, weight loss, microcytic anemia (likely iron deficiency)
Comp: metastases to the liver can cause hepatomegaly, elevated alk phos/transaminases, and sings of liver failure
What are the first line medications for acute bipolar depression? What other medications can be used? What medication class should be avoided?
first line (according to UWorld): second-generation antipsychotics quetiapine and lurasidone, and anticonvulsant lamotrigine
Lithium, valproate, and the combo of olanzapine and fluoxetine have also demonstrated efficacy.
Antidepressant mono therapy should be avoided in patients with bipolar I disorder due to the risk of precipitating mania.
systemic symptoms, localized symptoms, and visual symptoms of giant cell arteritis
systemic: fever, fatigue, malaise, weight loss
localized symptoms:
1. temporal headaches
2. jaw claudication (most specific symptom)
3. PMR
4. arm claudication: associated with bruits in subclavian or axillary areas
5. aortic wall thickening or aneurysms
6. CNS: TIAs/stroke, vertigo, hearing loss
Visual symptoms
1. amaurosis fugax: transient vision field defect progressing to monocular blindness
2. anterior ischemic optic neuropathy (AION): most common ocular manifestation
What are the lab results and treatments for giant cell arteritis?
labs:
1. normochromic anemia
2. elevated ESR and CRP
3. temporal artery biopsy
Tx:
- PMR only: low-dose oral glucocorticoids
- GCA: intermediate-to high-dose oral glucocorticoids
- GCA with vision loss: pulse high-dose IV glucocorticoids for 3 days followed by intermediate= to high-dose oral glucocorticoids
Pt, Dx, and Tx of angle-closure glaucoma
Pt: symptoms: HA, ocular pain, nausea, decreased visual acuity
Signs: conjunctival redness, corneal opacity, fixed mid-dilated pupil
Dx: tonometry (measure intraocular pressure; gonioscopy (measures corneal angle)
Tx: topical therapy: multidrug topical therapy (timolol, pilocarpine, apraclonidine)
systemic therapy: acetazolamide (consider mannitol)
laster iridotomy
What is the formula for calculating anion gap? What are some causes of an elevated anion gap?
AG = Na - (HCO3 + Cl)
Causes:
1. lactic acidosis: hypoxia, poor tissue perfusion, mintochondrial dysfunction
2. ketoacidosis: Type 1 DM, starvation, alcoholism
3. methanol ingestion: formic acid accumulation
4. ethylene glycol ingestion: glycolic and oxalic acid accumulation
5. salicylate poisoning (also causes concomitant respiratory alkalosis)
6. uremia (end-stage renal disease): failure to excrete H+ as NH4+
Diagnosis of idiopathic intracranial HTN/pseudotumor cerebri is considered with what 4 things?
- features of increased ICP in an alert patient
- absence of focal neurologic signs except for 6th nerve palsy
- No evidence for other causes (eg, tumors) of increased ICP on neuroimaging
- normal CSF examination except for increased CSF opening pressure
What medications can cause idiopathic intracranial HTN? What is the tx? MOA?
IIH can be caused by tetracyclines or isotretinoin
Weight loss can help with resolution of symptoms.
Tx: acetazolamide is the first-line treatment; MOA: inhibits choroid plexus carbonic anhydrase, thereby decreased CSF production and IH. Furosemide can be added for patients with continued symptoms
What is the treatment for those with idiopathic intracranial HTN with symptoms refractory to medical therapy or those with progressive vision loss?
surgical intervention with optic nerve sheath decompression or lumboperitoneal shunting
What are some drugs that are CYP450 inhibitors?
- Antibiotics (metronidazole, macrolides)
- azalea antifungals
- amiodarone
- cimetidine
- grapefruit juice
What are some drugs that are CYP450 inducers?
- carbamazepine
- phenytoin
- phenobarbital
- rifampin
- St. John’s wort
What is the MOA of warfarin? How does warfarin use change lab values? How does acetaminophen affect warfarin use?
vitamin K antagonist tha Blocks gamma carboxylation of vitamin K-dependent coagulation factors (II, VII, IX, and X) leading to partial inhibition of the extrinsic coagulation cascade. This will be reflected on laboarty evaluation as a prolonged INR (PT)
Acetaminophen can prolong INR in those on warfarin due to interruption of vitamin K recycling in the liver
disruptive mood dysregulation disorder pt/dx
characterized by an irritable or angry mood together with temper tantrums that are out of proportion to age and situation; dx is not made prior to age 6 or after age 18
How is Rett syndrome different from autism?
both present with deficits in social interaction; however, Rett syndrome also has regression in speech, loss of purposeful hand movements, and gait disturbance
How is social (pragmatic) communication disorder different than autism?
both display deficits in verbal and nonverbal communication; however, individuals with social communication disorder do not have restricted interests or demonstrate repetitive behaviors
What constitutes normal aging as the cause of cognitive impairment in the elderly?
- slight decrease in fluid intelligence (ability to process new information quickly)
- normal functioning in all activities of daily living
What constitutes mild neurocognitive disorder (mild cognitive impairment) as a cause of cognitive impairment in the elderly?
- mild decline in >/= 1 cognitive domains
2. normal functioning in all activities of daily living with compensation
What constitutes major neurocognitive disorder (dementia) as a cause of cognitive impairment in the elderly?
- significant decline in >/= 1 cognitive domains
- irreversible global cognitive impairment
- marked functional impairment
- chronic and progressive, months to years
What constitutes major depression as a cause of cognitive impairment in the elderly?
- reversible mild-moderate cognitive impairment
- features of depression (mood, interest, energy)
- episodic, weeks to months
What neurologic findings are suggestive of basal ganglia hemorrhage?
- contralateral hemiparesis + hemisensory loss
- homonymous hemianopsia
- gaze palsy
What neurologic findings are suggestive of cerebellum hemorrhage?
- usually NO hemiparesis
- facial weakness
- ataxia + nystagmus
- occipital HA + neck stiffness
What neurologic findings are suggestive of thalamus hemorrhage?
- C/L hemiparesis + hemisensory loss
- nonreactive mitotic pupils
- up gaze palsy
- eyes deviate Toward hemiparesis (T for thalamus)
What neurologic findings are suggestive of cerebral lobe hemorrhage?
- C/L hemiparesis (frontal lobe)
- C/L hemisensory loss (parietal lobe)
- homonymous hemianopsia (occipital lobe)
- eyes deviate away from hemiparesis
- high incidence of seizures
What neurologic findings are suggestive of hemorrhage in the pons?
- deep coma + total paralysis within minutes
2. pinpoint reactive pupils
What are the most common brain areas affected by hypertensive hemorrhages? (4)
- basal ganglia (putamen)
- cerebellar nuclei
- thalamus
- pons
Hyponatremia and low (<275 mOsm/kg) serum osmolality, hypovolemic ECV (extracellular volume), urine Na < 40 mEq/L -> cause?
nonrenal salt loss (eg, vomiting, diarrhea, dehydration)
Hyponatremia and low (<275mOsm/kg) serum osmolality, hypovolemic ECV, urine Na >40 -> cause?
renal salt loss (eg, diuretics, primary adrenal insufficiency)
Hyponatremia and low (<275 mOsm/kg) serum osmolality, euvolemic ECV, urine Osm < 100 -> cause?
psychogenic polydipsia
Beer potomania
Hyponatremia and low (<275 mOsm/kg), euvolemic ECV, Urine Osm > 100 and Urine Na > 40 -> cause?
SIADH (rule out hypothyroidism, secondary adrenal insufficiency)
Hyponatremia and low (<275 mOsm/kg) serum osmolality, hypervolemic ECV, variable urine findings -> cause?
CHF, hepatic failure, nephrotic syndrome
Hyponatremia and normal serum osmolality, variable ECV and urine findings -> cause?
pseudohyponatremia (eg, paraproteinemia, hyperlipidemia)
Hyponatremia and high (>295 mOsm/kg) serum osmolality, variable ECV and urine findings -> cause?
hyperglycemia, exogenous solutes (eg, mannitol)
How do you calculate serum osmolality?
2 x serum Na + (serum glucose/18) + (serum BUN/2.8) = serum osmolality
Why is therapy with an ACE inhibitor or ARB renal protective?
slows the progression of diabetic nephropathy by blocking angiotensin II-mediated renal efferent arteriole vasoconstriction thus reducing glomerular hydrostatic pressure, decelerating the development of glomerular capillary sclerosis
What dietary measures can be used to prevent recurrent nephrolithiasis? What drugs can be used?
food:
- increased fluids
- reduced sodium (<100 mEq/d)
- reduced protein
- normal calcium intake (1200 mg/day)
- increased citrate (fruits and vegetables)
- reduced exalt diet for oxalate stones (dark roughage, vitamin C)
Meds:
- thiazide diuretic
- urine alkalinization (potassium citrate/bicarbonate salt)
- allopurinol (for hyperuricuria-related stones)
What is the difference in diagnosing syphilis via nontreponemal vs treponemal
nontreponemal (RPR, VDRL):
- Abx to cardiolipid-cholesterol-lecithin antigen
- quantitative (titers)
- possible negative result in early infection
- decrease in titers confirms treatment
Treponemal (FTA-ABS, TP-EIA):
- Abx to treponemal antigens
- qualitative (reactive/nonreactive)
- greater sensitivity int arly infection)
- positive even after treatment
How is the diagnosis of paralysis due to a tick different from paralysis due to guillan barre?
Ticks:
- patients usually present with progressive ascending paralysis over hours to days (GBS days to weeks)
- paralysis may be localized or more pronounced in 1 leg or arm (GBS is symmetrical)
- fever is typically not present (or a hx of fever or prodromal illness) (GBS prodromal illness common)
- sensation is usually normal (GBS sensation is normal to mildly abnormal)
- no autonomic dysfunction (GBS has tachycardia, urinary rentaiton, and arrhythmias)
- CSF is normal (GBS CSF abnormal and may so high protein with few cells)
Path, Pt, Dx, and Tx of neonatal HSV
Path: vertical transmission: intrauterine, perinatal, post natal
Pt:
skin-eye-mouth: mucocutaneous vesicles, keratoconjunctivitis
CNS: seizures, fever, lethargy; temporal lobe hemorrhage/edema
disseminated: sepsis, hepatits, pneumonia
Dx: viral surface cultures, HSV PCR (blood, CSF)
Tx: acyclovir
management of cyanide poisoning?
Decontamination:
1. dermal exposure: removal of clothing and skin decontamination
2. Ingestion: activated charcoal
3. All exposures: Antidote: hydroxocobalamin preffered, sodium thiosulphate as alternate therapy
If antidote not available: nitrites to induce methemoglobinemia
Respiratory support:
- no mouth-to-mouth resuscitation
- supplemental o2
- airway protection (intubation)
Cardiovascular support:
IV fluids for hypotension
What are possible causes of acute hypocalcemia?
- neck surgery (parathyroidectomy)
- pancreatitis
- sepsis
- tumor lysis syndrome
- acute alkalosis
- chelation: blood (citrate) transfusion, EDTA, foscarnet
Path, Pt, Dx, Tx of atlantoaxial instability
Path: Down syndrome; excessive laxity in the posterior transverse ligament increases mobility between C1 and C2; usually asymptomatic, but symptoms can develop due to compression of the spinal cord
Pt: weakness, gait changes, urinary/fecal incontience, and verebrobasilar symptoms such as dizziness, vertigo, imbalance, and diplopia; UMN findings on exam (spasticity, hyperreflexia, and Babinski sign)
Dx: lateral X0rays of the cervical spine in flexion, extension, and in neutral position
Tx: surgical fusion of C1 to C2
Extensively explain when you might see the different hepatitis serum markers? (HBsAg, anti-HBs, HBeAg, Anti-HBc IgM and IgG)
HBsAg - present through the incubation period and infectious state
Anti-HBs - if a patient gains immunity to this virus, either due to infection of immunization, HBsAg changes to this
(neither will be present in the window phase)
HBeAg - Hep B early antigen; indicates active viral replication in the liver; always present in the acute phase and may or may not be present in the chronic stage
Anti-HBc - present during the acute, chronic, or previous hep B infections (including window phase)_
Anti-HBc IgM changes to IgG during the chronic infection
What is the gene responsible for Rett syndrome?
MECP2 gene
What is the typical presentation of Angolan syndrome?
happy disposition, jerky gait, hand flapping, delayed development
What is the presentation of Landau-Kleffner syndrome?
regression of language skills due to severe epileptic attacks (language skills typically deteriorate around age 3-6)
Pt, Dx, and Tx of cryptococcal meningoencephalitis? What would lumbar puncture show?
Pt: HA, fever, malaise; develops over 2 weeks (subacute); can be more acute + severe in HIV
Dx: transparent capsule seen with India ink stain, cryptococcal antigen positive, culture on Sabouraud agar
Tx: initial: amphotericin B with flucytosine
Maintenance: fluconazole
Lumbar puncture will show elevated opening pressure, low glucose, high protein, and a lymphocytic pleocytosis
At what CD4 count might you see CMV in an HIV patient? What does it typically present with?
CD4 <50/mm
typically causes retinitis (floaters, blurry vision)
What does HSV encephalitis present with?
cognitive and personality changes as well as neurological deficits and/or seizures
What is included in Category 1 fetal heart rate tracing patterns?
Requires all of the following criteria:
- baseline 110-160/min
- moderate variability (6-25/min)
- no late/variable decelerations
- +/- early decelerations
- +/- accelerations
What is included in Category II fetal heart rate tracing patterns?
not category I or III (indeterminate pattern)
What is included in Category III fetal heart rate tracing patterns?
> /= 1 of the following characteristics:
- absent variability + recurrent late decelerations
- absent variability + recurrent variable decelerations
- absent variability + bradycardia
- sinusoidal pattens
What is indicated by sinusoidal category III fetal heart rate tracings?
severe fetal anemia, likely due to fetal blood loss from ruptured vasa previa (bright-red amniotic fluid); requires urgent cesarean delivery
What is classical congenital adrenal hyperplasia a deficiency in? What are the symptoms?
Deficiency of 21-hydroxylase
Pt:
- inhibited conversion of progesterone to 11-deoxycorticosterone, a precursor to aldosterone: decreased aldosterone causes dehydration and salt-wasting (hypotension, hyponatremia, hyperkalemia)
- Inhibited conversion of 17-hydroxyprogesterone to 11-deoxycortisol, a procurer to cortisol: decreased cortisol results in fasting hypoglycemia
- Increased conversion of 17-hydroxyprogesterone to androstenedione, a precursor to testosterone: increased testosterone causes virilization and ambiguous genitalia in female infants; male infants typically have no abnormal newborn genital findings, but they may have an enlarged penis or scrotal hyperpigmentation
Risk factors, Pt, and Management of Transfusion-associated circulatory overload (TACO)
Risk factors: - age < 3 and >60 - underlying cardiac or renal condition - large transfusion volume or fast infusion rate Pt: (< 6 hours following transfusion initiation) - respiratory distress - increased HR - increased BP - pulmonary edema (rales) - signs of heart failure (S3 gallops and JVP) Management: - respiratory support - diuresis (furosemide)
Epidemiology, Pt, X-ray, and Tx of osteoid osteoma
Epidemiology: benign, bone-forming tumor; most common in adolescent boys
Pt:
- proximal femur most common site
- Pain: worse at night, relieved by NSAIDs, unrelated to activity
- No systemic symptoms
X-ray: small, round lucency
Tx: NSAIDs, monitor for spontaneous resolution
Onset age, findings, and tx of chemical neonatal conjunctivitis
Onset age: < 24 hours old
Findings: mild conjunctival irritation + tearing after silver nitrate ophthalmic prophylaxis
Tx: eye lubricant
Onset age, findings, and Tx of gonococcal neonatal conjunctivitis
Onset age: 2-5 days old
Findings: marked eyelid swelling, profuse purulent discharge, corneal edema/ulceration
Tx: single IM dose of 3rd-generation cephalosporin
Onset age, findings, and Tx of chlamydial neonatal conjunctivitis
Onset age: 5-14 days old
Findings: mild eyelid swelling, watery, serosanguineous, or mucopurulent eye discharge
Tx: PO macrolide
What are precipitating factors to a thyroid storm?
- thyroid or non-thyroid surgery
- acute illness (trauma, infection), childbirth
- Acute iodine load (iodine contrast)
What is the presentation and Tx of thyroid storm?
Pt:
- fever as high as 40-41.1 C (104-106F)
- tachycardia, HTN, CHF, cardiac arrhythmias (eg atrial fibrillation)
- agitation, delirium, seizure, coma
- goiter, lid lag, tremor, warm + moist skin
- N/V/D, jaundice
Tx:
- beta blocker (propranolol) to decrease adrenergic manifestations
- PTU followed by iodine solution (SSKI) to decrease hormone synthesis + release
- glucocorticoids to decrease peripheral T4 to T3 conversion + improve vasomotor stability
- identify trigger + treat, supportive care
Paget’s disease of the breast indicates what underlying pathology?
adenocarcinoma of the breast
Epidemiology, risk factors, and Pt of tinea pedis?
Epidemiology: dermatophyte fungi
Risk factors: barefoot walking in public areas
Pt:
Interdigital type: pruritus, erythema, erosions between toes
Moccasin type: scales/fissures; extension onto the sole, side, or dorsal of foot
Vesiculobullous type: painful bullae, erythema (lateral mid foot)
Complications: secondary infection, recurrence
Dx and Tx of tinea pedis?
Dx: clinical; KOH microscopy of skin scrapings
Tx: first line: topical antifungals (miconazole, tolnaftate)
Second line: oral antifungals (fluconazole)
Keep feet dry + dispose of old footwear
What is the treatment for tremor-dominant Parkinson disease in a younger person (= 65)
Trihexyphenidyl (in older patients, amantadine is sometimes use to avoid the anticholinergic effects of trihexyphenidyl)
What metabolic disturbance is caused by hyperventilation?
respiratory alkalosis (elevated pH, low pCO2)
What happens to calcium with an elevated blood pH?
elevated blood pH results in dissociation of the hydrogen ions bound to albumin, leading to increased calcium binding and a decrease in serum ionized calcium
What happens to calcium with a decreased blood pH?
Decreased blood pH results in increased hydrogen ions binding to albumin, leading to decreased calcium ion binding and an increase in serum ionized calcium
What is the MOA of adenosine? When is it used?
Adenosine induces a transient block at the AV node and is used in patients with supraventricular tachycardia in whole the diagnosis is unclear
When is dignoxin and CCB used?
rate control in patients with atrial fibrillation
What is the treatment of hyperthyroid-induced atrial fibrillation?
beta blockers
What are the two main effects of HIT antibodies?
- thrombocytopenia - the reticuloendothelial system removed HIT Ab-coted platelets, causing mild to moderate thrombocytopenia (~60,000)
- thrombus - HIT Abs activate platelets, resulting in platelet aggregation and the release of procoagulant factors, putting patients at very high risk for arterial and venous thrombus
What cancers are responsible for primarily solitary brain metastases?
breast, colon, renal cell carcinoma
What cancers are responsible for multiple brain metastases?
lung cancer, malignant melanoma
What cancers are rarely responsible for brain metastases?
prostate cancer, esophageal cancer, oropharyngeal cancer, hepatocellular carcinoma, non melanoma skin cancers
What are risk factors for cervical cancer? (8)
- infection with high-rise HPV strains (16, 18)
- History of sexually transmitted diseases
- early onset of sexual activity
- Multiple or high-risk sexual partners
- Immunosuppression
- Oral contraceptive use
- Low socioeconomic status
- Tobacco use
Pt, Triggers, and management of telogen effluvium
Pt: acute, diffuse, noninflammatory hair loss; scalp and hair fibers appear normal; hair shafts easily pulled out (hair pull test)
Triggers: severe illness, fever, surgery; pregnancy, childbirth; emotional distress; endocrine + nutritional disorders
Management: address underlying cause; reassurance (self-limited)
What is Trichorrehexis nodosa?
characterized by fragility of hair with breaking of strands; can be congenital or acquired (excessive heat, hair dyes, salt water); close inspection will show fractured strands with splitting of fibers
Path, pt, dx, and tx of hydatid cyst
Path: Echinococcus granulosus; humans contract the infection from close contact with dogs, which are the definitive host in the tapeworm’s lifecycle
Pt: E. granulosus typically causes unilocular cystic lesions that can occur in any organ (liver, lung, muscle, bone); multiple lesions are usually associated with E multilocularis instead
Dx: Eggshell calcification of a hepatic cyst on CT scan
Tx: surgical resection under the cover of albendzole
How does an amebic liver abscess usually present?
fever, RUQ pain that can develop within weeks of intestinal amebiasis
How do patients get pyogenic liver abscesses?
generally develop following surgery, GI infection, or acute appendicitis; patients typically have extreme pain, high fevers, and leukocytosis
Prominent capillary pulsations int he fingertips or nail beds, progressive dyspnea and fatigue - dx?
aortic regurgitation
In what diseases do you see pulses paradoxus? What is it?
Pulsus paradoxus is an exaggerated decrease (> 10mmHg) in systolic BP with inspiration; it is commonly seen with pericardial diseases (cardiac tamponade) and can occur with severe asthma and COPD
What are the differential diagnoses for exertional syncope?
ventricular arrhythmias (due to MI/infarction) or outflow tract obstruction (aortic stenosis, hypertrophic cardiomyopathy)
What 3 physical exam findings are suggestive of aortic stenosis?
- delayed (slow-rising) and diminished (weak) carotid pulse (pulses parvus and tradus)
- Presence of single and soft second heart sound (S2)
- Mid- to late-peaking systolic murmur with maximal intensity at the second right intercostal space radiating to the carotids
Micro and Management of cat bites
Micro: Pasteurella multocida; anaerobic bacteria Management: - copious irrigation + cleaning - prophylactic amoxicillin/clavulanate - tetanus booster as indicated - avoid closure
What 3 physical exam findings are suggestive of aortic stenosis?
- delayed (slow-rising) and diminished (weak) carotid pulse (pulses parvus and tradus)
- Presence of single and soft second heart sound (S2)
- Mid- to late-peaking systolic murmur with maximal intensity at the second right intercostal space radiating to the carotids
What are the goals of health maintenance in DM? (5)
- glycemic control - HgbA1C = 7.0% done every 3 months
- nephropathy prevention: annual random urine albumin/Cr ratio (normal <30), normal albumin excretion <30
- CV risk factor reduction: regular screening + control of lipids, BP; address lifestyle factors (diet, exercise, smoking, weight); daily aspirin if 10-year CVD risk >10%
- Retinopathy screening: ophthalmologic evaluation (every 1-3 years)
- Neuropathy screening: annual comprehensive foot examination
Path, Pt, Dx, and Tx of myotonic dystrophy
Path: autosomal dominant, CTG trinucleotide repeat expansion, repeat length inversely correlating with age of onset
Pt: myotonia (delayed muscle relaxation), progressive muscle weakness (eg, face, hands); childhood form: cognitive + behavioral problems; infantile form: hypotonia, arthrogryposis (congenital joint contracture)
Associated Sx: arrhythmias, cataracts, excessive daytime sleepiness, testicular atrophy/infertility
Dx: genetic testing
Tx: symptomatic
What are the goals of health maintenance in DM? (5)
- glycemic control - HgbA1C = 7.0% done every 3 months
- nephropathy prevention: annual random urine albumin/Cr ratio (normal <30), normal albumin excretion <30
- CV risk factor reduction: regular screening + control of lipids, BP; address lifestyle factors (diet, exercise, smoking, weight); daily aspirin if 10-year CVD risk >10%
- Retinopathy screening: ophthalmologic evaluation (every 1-3 years)
- Neuropathy screening: annual comprehensive foot examination
What is the presentation of infective endocarditis in IV drug users?
- Staph aureus is the most common organism
- Tricuspid valve involvement (right-sided) is more common than aortic valve
- holosystolic murmur increases with inspiration, indicating tricuspid involvement
- septic pulmonary emboli common
- fewer peripheral IE manifestations (splinter hemorrhages, Janeway lesions)
- HF more common in aortic involvement but rare with tricuspid valve disease
What murmur do you expect in tricuspid regurgitiation?
holosystolic murmur that increases in intensity with inspiration
In what situations would you expect an S4 heart sound?
- can be heard over the cardiac apex in the left lateral decubitus position in patient with reduced ventricular compliance
- can be heard in many healthy older adults and in patients with hypertensive heart disease, aortic stenosis, and hypertrophic cardiomyopathy (abnormal in children)
early decrescendo diastolic murmur that begins immediately after A2?
aortic regurgitation - high pitched with blowing quality best heard along the left sternal border at the third and fourth intercostal space when the patient is sitting up and leaning forward while holding the breath in full expiration
Risk factors, Pt, Tx, and complications of cryptorchidism?
Risk factors: prematurity, small for gestational age, low birth weight (< 5.5lb), genetic disorders)
Pt: empty, hypo plastic, poorly rugged scrotum or hemiscrotum, +/- inguinal fullness
Tx: orchiopexy before age 1 year
Complications: inguinal hernia, testicular torsion, sub fertility, testicular cancer (orchiopexy needs to be performed before 1 yo to avoid complications)
bradycardia, hypotension, respiratory depression, hyporeflexia that does not respond to naloxone - dx?
combined effects of alcohol and benzos
Risk factors, Pt, Tx, and complications of cryptorchidism?
Risk factors: prematurity, small for gestational age, low birth weight (< 5.5lb), genetic disorders)
Pt: empty, hypo plastic, poorly rugged scrotum or hemiscrotum, +/- inguinal fullness
Tx: orchiopexy before age 1 year
Complications: inguinal hernia, testicular torsion, sub fertility, testicular cancer
What is the pt of carpal tunnel syndrome due to idiopathic cause/overuse?
swelling + fibrosis of tendons and soft tissue
What is the pt of carpal tunnel syndrome due to hypothyroidism?
soft tissue enlargement (mucopolysaccharides)
What is the pt of carpal tunnel syndrome due to diabetes mellitus?
soft tissue enlargement; microvascular insufficiency + neovascularization
What is the pt of carpal tunnel syndrome due to rheumatoid arthritis?
extrinsic compression from joint deformity
What is the pt of carpal tunnel syndrome due to pregnancy?
edema/fluid accumulation
What is the pt of carpal tunnel syndrome due to gout?
compression from tophi
What is the pt of carpal tunnel syndrome due to acromegaly?
tendon enlargement, synovial edema
What is the pt of carpal tunnel syndrome due to gout?
compression from tophi
Path, pt, tx of mature cystic teratoma
Path: benign, ovarian germ cell tumor; endoderm, mesoderm, ectoderm tissue
Pt: most asymptomatic; ovarian torsion; struma ovarii subtype -> hyperthyroidism; unilateral adnexal mass; U/S: complex, cystic, calcifications; gross appearance: sebaceous fluid, hair, teeth
Management: ovarian cystectomy or oophorectomy
theca lutein cysts pt
appear as large, B/L cystic masses; arise from markedly elevated beta-hCG levels
Lemierre syndrome path, pt, dx, and tx
Path: young, immunocompetent patients, caused by Fusobacterium necrophorum (normal oral flora)
Pt: begins with oropharyngeal infection, usually tonsillitis, but can arise as a complication from dental work or mastoiditis -> causes internal jugular vein thrombosis and infection
Classic presentation: weeklong duration of sore throat with high fever, rigors, dysphagia, neck pain and swelling, along the SCM muscle
Dx: culture from blood or pus
Tx: supportive (airway), IV Abx, and surgery if needed
What are the steps for management of shoulder dystocia? (BE CALM)
B: breathe, do not push
E: elevate legs = flex hips, thighs against abdomen (McRoberts)
C: call for help
A: apply suprapubic pressure
L: enLarge vaginal opening with episiotomy
M: Maneuvers;
- deliver posterior arm
- rotate posterior shoulder (Woods screw) - apply pressure to anterior respect of the posterior shoulder
- Adduct posterior fetal shoulder (Rubin) - apply pressure to the posterior aspect of the posterior shoulder
- Mother on hands + knees - “all fours”
- Replace fetal head into pelvis for cesarean delivery (Zavanelli)
Lemierre syndrome path, pt, dx, and tx
Path: young, immunocompetent patients, caused by Fusobacterium necrophorum (normal oral flora)
Pt: begins with oropharyngeal infection, usually tonsillitis, but can arise as a complication from dental work or mastoiditis -> causes internal jugular vein thrombosis and infection
Classic presentation: weeklong duration of sore throat with high fever, rigors, dysphagia, neck pain and swelling, along the SCM muscle
Dx: culture from blood or pus
Tx: supportive (airway), IV Abx, and surgery if needed
Path, Pt, Dx, and Tx of hemophilia a + b
Path: X-linked recessive
Pt: delayed/prolonged bleeding after mild trauma; hemarthrosis, intramuscular hematoma, GI or GU bleeding, intracranial hemorrhage; complications: hemophilic arthropathy
Dx: increased PTT< normal platelet count + PT; absent or decreased factor VIII (hemophilia A) or factor IX (hemophilia B) activity
Tx: factor replacement; desmopressin for mild hemophilia A
Risk factors, pathogens, complications, and treatment of pyelonephritis in pregnancy?
Risk factors; asymptomatic bacteriuria, diabetes mellitus, age <20
Path: E. coli (MC), Klebsiella, Enterobacter, Group B strep
Complications: preterm labor low birth weight, ARDS
Tx: IV Abx, supportive therapy
In what areas of the world is chloroquine chemoprophylaxis used for malaria? Where is it not and what is used there?
chloroquine chemoprophylaxis is used in areas without resistance (parts of Central America, Caribbean)
Resistance is widespread in Africa, Asia (including India), and Oceania. In these areas, Mefloquine chemoprophylaxis is used
what mineral deficiency causes impaired glucose control in diabetes?
chromium
what mineral deficiency causes brittle hair, skin depigmentation, neurologic dysfunction, anemia, and osteoporosis?
copper
What mineral deficiency causes microcytic anemia?
iron
What mineral deficiency causes thyroid dysfunction, cardiomyoapthy, and immune dysfunction?
selenium
What mineral deficiency causes alopecia, pustular skin rash, hypogonadism, impaired wound healing, impaired taste, and immune dysfunction?
zinc
