UWOrld wrong questions part3 (3rd 200 q's) Flashcards
a) Gold standard of treatment of hot flashes? b) Tx in woman with breast cancer hx? c) with depression? d) with HTN? e) with insomnia/seizure/pain?
a) estrogen b) Desvenlafaxine or SSRI; c) venlafaxine d) clonidine e) gabapentin
what neuro problem is absolute contraindication to OCP use?
migraine with aura
what meds reduce effectiveness of combo OCPs?
RIFAMPIN! also, Guinness, Coronas, & PBRs induce chronic alcoholism: Griseofulvin, Carbamazepine, Phenytoin, Barbs, Rifampin, St Johns Wort, Chronic alcoholism
avoid progesterone IUD if you have what?
breast cancer
OCP use decreases incidence of what types of cancer?
ovarian, endometrial, colon; (NOT breast)
pulmonary cause of a) decreased PaO2 / increased PaCO2 vs b) decreased PaO2 / decreased PaCO2?
a) resp acidosis from alveolar hypoventilation, COPD, OSA, NM diseases like Lambert Eaton, Guillian-Barre, and Myasthenia gravis b/c all of these relate to KEEPING CO2 IN———- b) resp alkalosis from ANYTHING that would cause increased RR (thus blowing off CO2): atelectasis, PE, pleural effusion, pulm edema (all V/Q mismatch!!)
how to tell diff btwn esophageal perforation and aortic dissection? Next step in management, Tx for esophageal perf?
Esoph perf: mediastinal air (pneumomediastinum), pneumothorax. Dx with water soluble Gastrografin (NOT barium) contrast esophogram. Tx: broad Abx + supportive care unless significant leak.————- Aortic dissection: decreased BP, hemothorax, Dx with TEE.
succussion splash on epigastrium (placing stethoscope here and rocking patient back and forth at hips)indicates what?
gastric outlet obstruction (tumor, PUD, Crohn, strictures, caustic agents, bezoars) b/c this is sound of retained gastric material >3 hrs after meal.
ingestion of acid can cause what anatomical problem?
pyloric stricture (type of gastric outlet obstruction)
main signifier Sx of atelectasis?
shallow breathing (with increased RR, causing decreased CO2) 2-5 days after surgery
COPD and pneumothorax: what tactile fremitus, breath sounds, and percussion?
decreased tactile fremitis, decreased breath ounds, and hyperresonant to percussion
bronchial breath sounds/”bronchophony”/egophony, etc, think what lung issue?
consolidation – lobar pneumonia
pleural effusion: what is tactile fremitus, breath sounds, and percussion in this patient?
decreased tactile fremitus, decreased breath sounds, and dull percussion. Also, mediastinal shift away from effusion IF large.
bleeding varices: 1st, 2nd, and 3rd line of management?
1st: IVF, Abx, octreotide. —2nd: endoscopy within 12 h with sclerotherapy or band ligation —- 3rd: If no further bleeding, give BB + endoscopic band ligation 1-2 w later. If continued bleeding, temp balloon tamponade with eventual TIPS/shunt surgery.
the 2 main atypical signs of a massive PE? Tx?
hypotension (causing syncope) and right heart strain (causing JVD, R BBB, bradycardia). Tx: thrombolytics
what should be done in workup of achalasia?
Barium study, then manometry to confirm, plus endoscopy to r/o tumor/cancer at GE juntion
After doing physical, measuring hCG, TSH, & all hormones for amenorrhea and they turn out normal, what do you do next in workup and what does it mean?
Progesterone challenge. Give 5-10 days of progesterone, withdraw, and if she bleeds this means estrogen is normal (b/c endometrial lining was built up). If no bleeding, then low estrogen. ———— Next do estrogen-progesterone challenge and if this fails there’s an anatomical defect.
Next step if physical exam shows absence/difficulty finding uterus? 2nd step?
pelvis U/S. then karyotype and testosterone.
2 possibilities of Dz if uterus is absent?
1) Androgen insensitivity syndrome: 46XY, normal outer female development but with testes/male internals and elevated testosterone.————–2) Abnormal mullerian development: 46XX, normal outer female development but missing female internals and normal female testosterone levels.
Patient with amenorrhea – if uterus is present, what is next step? Step after that?
b-hCG and FSH. —–>Then if FSH is high do karyotype for Turner syndrome. If FSH low do cranial MRI. If FSH is normal, do prolactin and TSH.
amenorrhea in patient who had D&C might be what? Tx?
Asherman syndrome (scarring of ovaries from surgery) - do progesterone withdrawal test. Tx: lysis of adhesions + estrogen
Dix-Hallpike manuever diagnoses what? Tx?
Benign Paroxysmal Positional Vertigo. Tx: Epley maneuver
dysmenorrhea: workup? Tx?
b-HCG, vag culture, U/A. Tx: NSAIDS, OCPs
Dysmenorrhea, dyspareinua, and dyschezia (painful defecation during menses), tender adnexal masses=? Dx? Tx?
endometriosis. Dx: Bx (CA-125 too general). Tx: NSAIDS, OCPs, GnRH agonist continuous, progestin // if fertility desired, lap surgery or hysterectomy WITH B/L salpingo-oopherectomy
Patient with GERD Sx - what is 1st and 2nd step in management?
1st: if alarm sx (dysphagia, weight loss, blood, recurrent vom) or >55 then endoscopy, if esophagitis do H pylori test then Tx, if no esophagitis workup for other things like with manometry.———————— If no alarm Sx then once daily PPI for 2 months. 2nd step: if refractory switch to diff PPI or increase to 2x daily, if not working 3) do endo/pH monitoring.
Tx for cholecystitis for patients who do not want lap chole?
Tx: ursodeoxycholic acid + avoid fatty foods
aortic stenosis murmurs or ESRD + anemia + painless GI bleeding in patient >60 = what? Dx?
angiodysplasia (or AV malformations) of GI tract. Dx: colonoscopy or capsule endoscopy.
increased direct bilirubin in adult after illness + normal LFTs + dark granular pigment in hepatocytes on liver Bx = ?
Dubin Johnson syndrome. (if no pigment, then might be Rotor syndrome)
Carcinoid syndrome - what heart abnormalities? Dx? Tx?
valvular lesions (R>L). Dx: 5-HIAA, CT/MRI of abd/pelvis, octrescan, echo. Tx: octreotide for Sx; surgery for liver mets.
Tx for duodenal hematoma causing obstruction?
NG suction with parenteral nutrition. After 1-2weeks, Laparotomy/laparoscopy if this fails.
After finding gastrin level for working up ZE syndrome, what is next step? 3rd step?
If >1000, check gastric pH off PPIs for 1 week. If >4, no gastrinoma. If
a) Irregular,heavy periods suggest what? b) regular, heavy periods suggest what?
a) anovulation. b) anatomic (adenomyosis, fibroids, etc)
abnormal uterine bleeding - what workup after labs and cultures?
if >45 OR 6months, endometrial Bx. U/S pelvis; hysteroscopy.
abnormal uterine bleeding with depression, constipation, think = ?
hypothyroidism
abnormal uterine bleeding started with menarche, think = ? What are lab values?
von Willebrand Dz (increased bleeding time and PTT)
abnormal uterine bleeding in unstable patient, do what?
IVF, RBCs, intrauterine tamponade(balloon to decrease bleeding), uterine curettage. If persists —> IV high dose estrogen + antiemetic
cirrhosis or asciites + fever or change in mental status, think = ? Dx?
spontaneous bacterial peritonitis. Dx: paracentesis (BEFORE Abx) showing PMNs >250.
nonbleeding esophageal varices, how to Tx?
nonselective BBs(propranolol, nadolol); endoscopic variceal ligation if BBs contrindicated
decreased total T3 and T4, but normal free T3 and T4, normal TSH = ?
liver disease (because liver makes thyroxine-binding proteins)
acute cholangitis, what is 1st, 2nd, and 3rd step of management?
1st: IVF, broad Abx. —>2nd (if not better): biliary decompression/drainage by ERCP. 3rd:(eventual) cholecystectomy
diangosis of diverticulitis?
abdominal CT (NOT upright film/XR; NEVER -scopy)
diagnose someone with Hep C, what is 1st step in management? 2nd step? 3rd step/
1st: Liver Biopsy to stage.(b/c meds will only help if not yet cirrhotic)—— 2nd:INF, ribavirin. ——–3rd: U/S every 6 months for HCC surviellance
how to diagnose pancreatic cancer if with jaundice vs not jaundice?
Jaundice: abd U/S. ———-No jaundice: abd CT
(+) progestin challenge, LH:FSH >2:1, anovulation, increased T = ?
PCOS (need 2 of 3: anovulation, cysts on U/S, hyperandrogen Sx)
best drug for PCOS to improve fertility?
clomiphene
most common causes of steatorrhea?
chronic pancreatitis due to alcohol abuse>CF>other pancreatitis, Crohn’s, Celiac (but NOT lactose intolerance)
when to admit patient for CAP?
2 or more of the following: age>65, RR>30, hypotension, uremia(BUN>20), confusion
a)How to treat CAP outpatient? b) CAP inpatient non-iCU? c) CAP inpatient ICU?
a) macrolide or doxy (unless they mave comorbid, then just like inpatient non-ICU)————-b) FQ or b-lactam + macrolide ——————–c) b-lactam + macrolide(IV) or b-lactam + FQ
when do you put chest tube(aka tube thoracostomy) for parapneumonic effusion?
empyema: when pleural fluid pH
large anterior mediastinal mass with increased AFP and b-HCG in young man = ?
nonseminomatous germ cell tumor
what mass tends to be located in anterior mediastinum? middle mediastinum?
anterior: thymoma. Middle: bronchogenic cysts
what disease has transiently elevated LFTs over time, porphyria cutanea tarda, essential mixed cryoglobulinemia (circ Ig’s deposit in vessels, low serum complement)
hep C
a) erosions on dorsum of hands = ? b) painful nodules on anterior legs = ? c) necrotizing vasculits with rash from Ag-Ab immune complexes = ?
a) porphyria cutanea tarda (with hep C) . b) erythema nodosum (with infections/sarcoid) c) polyarteritis nodosa (with hep B)
symmetric, circumferental narrowing of esophagus with dysphagia for solids only, no weight loss? associated/causal disease?
Esophageal (peptic) stricture. Caused by GERD (or radiation, systemic sclerosis, and caustic ingestions).
Diagnostic test of choice of Zenker diverticulum?
contrast esophagram
after getting abnormal quad screen, what is next step? step after that?
1) U/S to confirm dating, etc. 2) definitive diagnosis: CVS[10-13 wks] or amniocentesis. [15-20 weeks]
What does increased ACh indicated in amniocentesis?
neural tube defects
diff between quad screen results of Down and Edwards and Patau?
Down: decreased AFP, decreased estriol, increased b-hCG, increased inhibin. / Edwards: decreased AFP, decreased estriol, decreased b-hCG, decreased inhibin (ALL DECREASED) / Patau: only decreased AFP.
Best anti-nausea meds for morning sickness?
pyridoxine (vit B6) + doxylamine (anti-hist)
when do you do screening for gestational diabetes? How do you diagnose?
24-28 wks. 50g 1 hr oral glucose tolerance test, then if (+) do 100 g 1,2,3hr oral glucose tolerance test. If 2+ of these test results are positive, it is diagnosed,
what do you do for pregnant patient with bacteria/WBCs in urine and no Sx?
this is Asymptomatic bacteruria, but must prevent from causing UTI/pyelo. Tx: nitrofurantoin, amoxicillin, cephalexin, fosfomycin, or TMP-SMX. repeat urine culture 1 wk after finishing Abx.
how to treat pyelo in pregnant patient?
ADMIT, then IV amp + genta, ceftriaxone, meropenem, or piper-tazo. Continue oral Abx for rest of pregnancy.
when to get pap smears for normal patients?
start at age 21, every 3 years till 29. 30+ can continue q3 or pap + HPV testing q5. Stop at 65.
Treatment for squamous cell carcinoma of vagina?
Stage I & 2cm: external beam radiation————– Stage II, III, IV: external beam radiation + therapy
how to treat lichen sclerosis?
punch biopsy to r/o SCC; steroids
Thayer Martin media is for what?
culture for gonorrhea
how to treat PID as outpatient? inpatient?
Outpt: ceftriaxone, doxy, or metro. / Inpt: IV cefotetan + doxy, or IV cefoxitin + doxy.
how to treat granuloma inguinale? How to distinguish it from other ulcerating STDs? what microorganism?
doxycycline. no lymphadenopathy, . From Klebsiella granulomatis.
If you have ASCUS on pap, what is next step?/
If 21-24 yrs, repeat pap in 1 year -> if repeat is (+), do colpo. ———–If 25+, do HPV testing->if (+), do colpo.
If “atypical squamous cells: cannot exclude high grade SIL” on pap, what is next step?
colposcopy
If AGUS(atypical glandular cells of undetermined signficance) on pap, what is next step?
endocervical sampling, colposcopy, & endometrial Bx if >35 or risk factors.
If LSIL (low grade squamous intraepi lesions), what is next step?
If 21-24, rpeat pap 1 yr. If 25-29, colpo. If >30, HPV testing –> if (+) colpo, if (=) repeat pap & HPV in 1 yr.
If HSIL (high grade squamous epi lesions), what next?
If 21-24, colpo, if (+) LEEP ./. If 25+, LEEP.
Cervical cancer – Tx/
If microscopic invasion, simple hysterectomy + conization. If gross invasion, radical hysterectomy + lymphadenectomy,
Tx of epithelial tumors of ovarian cancer?
TAH-BSO, peritoneal washings, lymph node dissection, omentectomy, chemo (this is BAD)
Tx of germ cell tumors of ovarian cancer?
U/L salpingo-oopherectomy
Breast absess Tx?
oral/IV Abx: diclox, cephalex, amox-clauv acid, TMP-SMX, or metro.
multiple, B/L masses in breasts that increase size and pain before menses? Tx?
fibrocystic change. Tx: reduce caffeine/fat, BC pills
woman
fibroadenoma. U/S, FNA (mamm not necessary). Tx: excise, cryotherapy
If screening mammogram is low suspicion, what is next step? high suspicision, what is next step?
low: repeat mammo in 6 months. / High: biopsy (FNA, core, or open): if nonbloody, observe closely. If bloody, better Bx. If malignant, treat.
If palpable mass on breast exam, what is next step? (and steps after)
mammogram. If high suspicion, biopsy./ If low suspicion, U/S–>if solid mass or complex cyst, biopsy. If simple cyst, repeat mammo 6 months.
How to treat LCIS?
because ALWAYS ER and PR +
When do you add radiation to a MASTectomy?(**you always do lumpectomy with rad for local solitary cancer)
when the breast cancer mass is >5cm
a)fundus at pubic symphysis is how many weeks? b) btwn umbilicus and symphysis?c) at umbilicus? d)above?
a) 12 weeks. b) 16 weeks. c) 20 weeks. d)weeks = centimeters from the pubic symphysis
when do you do fetal U/S? when do yo give anti-D if RhD(-)?
a) 18-20 wks. b)28 wks, and birth
with acute abdomen, besides exp lap why would you have to give FFP?
If patient is chronically on warfarin prior to the accident
what defines too much infant crying and what is this?
infantile colic: more than 3hrs a day, more than 3 days a week, more than 3 wks
baby with abdominal distention, X-ray showing air in bowel wall (train track/double appearance) and linear branching areas of lucency over the liver showing portal venous air = what disease?
necrotizing enterocolitis (intenstinal air = pneumatosis intestinalis)
painless hematochezia in a toddler, most common cause? Dx?
Meckel’s diverticulum. Do Tech-99, scan
baby with nonbilious vomiting, what test? with bilious vomiting, what next step?
nonbilious: abd U/S to look for pyloric stenosis. ———- bilious: stop feeds, NG, IV –>abd X-ray [if free air->ex lap. if dilated loops of bowel-> contrast enema (meconium ileus or Hirshsprung). If NG tube in misplaced duodenum, upper GI series (i.e. barium enema)->if ligament of Treitz on right side of abdomen, malrotation. If corkscrew pattern contrast, volvulus. ——–if double bubble on XR, duodenal atresia.
how to manage DVT in pregnancy?
anticoag with heparin or LMWH (not warfarin), continue until labor or 24 hrs before scheduled delivery, restart hep post-partum and do hep–>war for 6 wks post-partum
why are NSAIDs teratogenic?
premature closure of ductus arteriosis
nasal hypoplasia, epiphyseal stippling, limb hypoplasia from what teratogenic drug?
warfarin
what to you treat syphillis with in penicillin-allergic pt?
desensitize, then STILL give penicillin.
When you don’t know mother’s GBS screening status, when do you give penicillin PPx?
intrapartum fever, prolonged rupture of membranes, or preterm labor
how to treat Toxoplasmosis?
spiramycin or pyrimethamine + sulfadiazine
Mother with rash of diff ages, baby with skin scarring and limb hypoplasia, think =? Tx?
varicella zoster. Acyclovir.
flu-like Sx in mother, baby with abscesses in internal organs, think =?
Listeriosis
suspected ectopic pregnancy in stable pt, next step in management? 2nd? 3rd?
1) transvaginal U/S, quantitative hCG. 2) if bHCG >1500, confirms ectopic if you see NOTHING in TVUS. If a)if falls, monitor hCG till 0 (failed preg), b)if it goes up approp aka double, repeat TVUS when bCG>1500. c)if it goes up inapprop, its abnormal pregnancy of some kind: do D&C(no chorionic villi, ectopic. (+) chorionic villi, failed uterine pregnancy).
Tx of ectopic pregnancy?
salpingostomy, or salpingectomy. Can use methotrexate if normal renal/LFTs, bHCG
what kind of abortion: bleeding, closed cervix, no passage of POC. Tx?
threatened abortion. Expectant management/observation.
what kind of abortion: bleeding, open cervix, no passage of POC. Tx?
inevitable abortion. D&C, misoprostol, or expectant management.
what kind of abortion: bleeding, open cervix, some passage of POC. Tx?
incomplete abortion. D&C, misoprostol, or expectant management.
what kind of abortion: bleeding, closed cervix, passage of POC. Tx?
complete abortion. None.
what kind of abortion: no bleeding, closed cervix, NO passage of POC. Tx?
missed abortion. Dead but stuck in there, so D&C, misoprostol, or expectant.
how to tell the difference between cervical insufficiency and inevitable abortion? Dx, Tx of cervical insufficiency?
cervical: painless cervical dilation. abortion: painful, cramping (it’s labor!) Dx: U/S. Tx: placement of cervical cerclage (tied up to try to prevent preterm birth?
intrauterine fetal demise = ? Tx?
“stillbirth” = death after 20 wks (unlike abortion, which is
maternal diabetes, mult gestations, and fetal anemia cause poly or oligohydramnios?
polyhydramnios
what is needed to diagnose acute pancreatitis?
amylase or lipase (abd CT NOT needed)
CF can be diagnosed using what 2 methods?
quantitative pilocarpine iontophoresis or sweat Cl-.
nephritis, low complement, and increased LFTs, think what? What other nephritic syndromes have low complement?
mixed cryoglobulinemia associated with hep C….. lupus, post-strep glomerulo, and MPGN also have low complement.
how to diagnose Zenker diverticulum?
Barium esophagram. Then do manometry after.
besides post-strep GN, what other kidney disease comes after a resp infection, how shortly afterwards, and how else to distinguish with post-strep GN?
IgA nephropathy.
what STDs do you screen ALL pregnant women for, regardless of risk factors? what vaccine to always give.
syphilis (RPR), HIV, and hep B. Give flu vaccine.
1st and 2nd line treatment for stress incontinence?
1st: Kegels. 2nd: urethropexy (NOT oxybutynin; this is for urge incontinence)
what are the 2 peripartum conditions that present with painFUL vaginal bleeding?
uterine rupture(feet also palpable in this one), placental abruption
Dx of lichen sclerosis? Tx?
vulvar punch Bx. Topical steroid.
If patient is
Tocolysis (CCBs), steroids for fetal lung maturity, and MgSO4 for neuroprotection
1st line drug for fibromyalgia? 2nd line?
TCAs (amytriptyline). 2nd: SSRIs inc duloxetine and milnacipran
IE: 1st step in management? 2nd?
1st: serial(3+) blood cultures. 2nd: Abx
what is micro path of Actinomyces and Nocardia? What is basic presentation of the two diseases?
gram (+) rods. Nocardia = pneumonia in immunocomp; Actinomyces=head/neck abscesses?
most common extrapulmonary manifestation of Blastomycosis? Location (regional)?
SKIN: nodular lesions –> microabscesses. In southeast AND upper midwest
How to treat a) comedonal acne b)inflammatory acne c) cystic acne?
a) topical retinoids b)topical Abx (erythro, clinda) and if several oral Abx c) topical retinoid and if severe oral Abx; if really several ORAL retinoid
1st and 2nd line Tx of herpes zoster? how to treat the ppost-herp neuralgia?
1st: valacyclovir. 2nd: acyclovir. For neuralgia, TCAs
Tx of Tourette’s?
anitpsychotics (esp haloperidol, pimozide)
when does birth weight double? triple? quadruple? / height increase by 50%? double? triple?
W: 4 months, 1 yr, 2 yrs / H: 1 yr, 4 yrs, 13yrs
a) what age do babies have social smile, eyes follow to midline, and lifts head 45 degrees? b) what age do they laugh, lift head to 90, eyes can go past midline? c) when does stranger anxiety start?
a) 2 months b) 4 months c) 6 months
a) what age do babies grasp with thumbs? b) separation anxiety? c) make 2 block tower?
a) 9 months b) 9 months c) 12 months
a) what age do babies dress themselves? b) make 6 block tower? c) draw a circle?
a) 2 years b) 2 yrs c) 3 years
a) at what age do babies attempt to feed themselves? b) crawling + pulling selves up to stand? c) play with others, hop on 1 foot?
a) 6 months b) 9 months c) 4 yrs
at what age do babies a) parallel play b) pick things up(pincer grasp)? c) use cup and spoon? d) skip, draw stick figure?
a) 18 months b) 12 months c) 18 months d) 6 years
a) when to intro solid foods and what kind? b) when cow’s milk?(if not what happens?)
a) 4-6 mo, iron fortified cereal. b) 12 months, if not hemorrhage/iron def anemia
when do you F/U visits with babies?(first 6 visits are when)
2 days, 2 weeks, 1 month, 2 months, 4 months, 6 months (then q3months till age 2)
a) How many DTaP vaccines do you give a child? b) Hib c) PCV(pneumo)?
a) 5 b) 5 c)4
a) what vaccine do you give at birth? b) Tdap? c)Meningococcal (MCV4)? d) when do you start flu vaccines?
a) hep B b) 11-12 yrs c)11-12 yrs with booster at 16 d) 6 months
what do you use to Tx cerebral palsy to alleviate contracture?
dantrolene, baclofen, benzos, Botox. / Phys therapy, Sx, braces too.
What is first step in management of baby with single umbilical artery?
renal U/S
diff btwn caput succedanium and cephalohematoma?
caput: crosses suture lines, resolves in days. Cephalohematoma: blood, does not cross suture lines, resolves in weeks-months, can be caused by vacuum delivery.
SKIN ISSUES IN NEWBORNS(benign, no Tx needed, go away on own) - what is: a) cutus marmorata b) erythema toxicum neonatorum c) harlequin color change
a) spiderwebbing/red marbling of skin b) 2-3mm yellow pustule with red base (looks like pimples) arising in 1st 1-3 days, micro: eosinophils. c)intense redding of gravity-dep side, blanching of nondep side
SKIN ISSUES IN NEWBORNS: a) macular stains/Stork bities b) milia c) acne neonatorum? d) infantile acne?
a) red marks on back of neck and upper eyelids/mid forehead; benign but permanent b) sweat obstructed by keratin – give loose clothing, cool baths c) at 3 wks, till few months. can Tx with retinoids/benzoyl per. d)at 3-4 mo, clear by age 1-3. same Tx as above.
a) if anterior fontanelle closes early’ b) if it closes late, what are possible etiologies?
a) craniosynostosis. b) Down, achondroplasia, rickets, hypothyroidism, increased ICP
painless bleeding late in pregnancy, woman with prior C-section – what is this? Dx? Tx?
Placenta previa. Dx: U/S. Tx: C-section
what are 4 meds for tocolysis (labor suppressants)?
MgSO4, indomethacin, nifedepine, and terbutaline
How to treat choriocarcinoma?
chemo (methotrexate), surgical resection, follow hCG levels till they fall again, and avoid pregnancy for at least 1 year
How long should latent phase last in nulliparous woman? In multiparous woman? how many cm/hr does cervix dilate in active phase for nulliparous? for multiparous? 2nd stage – length for nulli? multip?
Latent, nulli: 20 hrs. multi: 14 hrs. Active, nulli: 1.2 cm/hr. multi: 1.5 cm/hr. 2nd stage, nulli: 4 hrs. multi: 3 hrs.
How to manage atonic uterus?
fundal/bimanual massage. Uterotonic agent: oxytocin, methylergonovine (except in HTN), carboprost (except in asthma).
Treatment for measles?
IVF, antipyretics, Vitamin A
fever, anorexia, and malaise for a few days then suboccipital/posterior cervical lymphadenopathy and rash = ?
rubella (German measles)
cervical lymphadenopathy, coarse red rash that blanches, starts in trunk then spreads everywhere but palms and soles; most prominent in axilla and groin, red tongue and pharynx - ?
scarlet fever from Strep pyogenes
if acute B/L cervical lymphadenopathy in a child, what is this? If acute and U/L, what is this? chronic and U/L?
B/L: prob viral i.e URIs, mono, HSV
U/L, acute: prob bacterial (S aureus, group A Strep, etc). U/L, chronic: Bartonella, Toxoplasmosis, TB, Actinomyces (sinuses drain pus)
What vitamin deficiency shows increased RBC fragility
vitamin E
diff between branchial cleft cyst vs thyroglossal duct cyst?
branchial: lateral neck, doesn’t move with swallowing / thyroglossal: midline neck, moves with swallowing.
red lips, blue fingertips but normal pulse ox –> what is this?
CO poisoning (b/c Hgb is saturated, it’s just saturated with CO)
what kind of anemia (micro, normo, macro) are the following? a) anemia of chronic disease b) thalassemia c) liver disease d) alcoholism e) lead poisoning f) hemolytic g) sideroblastic
a) normo OR micro b) micro c) macro d) macro e) micro f) normo g) micro
Coombs test - what does it do? a) direct? c) indirect?
determines if a hemolytic anemia is caused by autoimmune – if so, they’ll agglutinate. a) reagent mixed with RBCs, if agluttinates it means RBCs are coated with IgG & complement. c) type O RBCs mixed with plasma/serum, then with reagent –> shows anti-RBCs Ab’s in serum (i.e for Rh- mother)
Disease with cold agglutinins? warm?
Cold: Mycoplasma, EBV. / Warm:
Drug induced hemolytic anemia - what will you see on smear, Coombs? what drugs?
(+) Coombs test, Burr cells, spherocytes, schistocytes. Penicillin, methyl-dopa, quinidine/quinine, NSAIDs, cephalosporins.
Immune hemolytic anemia – what you see on smear, Coombs? Tx?
anti-RBCs Ab’s. (+) Coombs test, Burr cells, spherocytes, schistocytes. Tx: steroids, maybe splenectomy.
jaundice, gallstones, splenomegaly, anemia with increased reticulocytes, increased MCHC, poss increased K, smear: schistocytes, positive osmotic fragility test - what disease? Tx?
hereditary spherocytosis (defective RBC membrane). Tx: folic acid, RBC transfusions, splenectomy.
bite cells and Heinz bodies – in what Dz? Tx?
G6PD deficiency. Tx: avoid oxidants; sometimes transfusions.
In hemolytic anemia, what is the level of a) LDH b) haptoglobin c) MCV?
a) increased b) decreased c) normal
How to treat a) Salmonella/Shigella? b) Camplylobacter?
a) fluoroquinolone or TMP-SMX b) erythromycin
what anemia will have a) low MCV, normal or increased iron, normal ferritin, normal TIBC? b) low MCV, increased iron, increased ferritin, decreased TIBC? c) decreased iron, increased ferritin, decreased TIBC?
a) lead poisoning b) sideroblastic anemia (b/c it’s a problem manufacturing heme but you overproduce iron) c) anemia of chronic disease
basophilic stippling (denatured RNA granules on RBCs) on smear in what diseases?
lead poisoning, thalassemia, alcohol use
lead chelators for poisoning?
EDTA, succimer. In kids if severe, add dimercaptol.
how to treat pertussis?
azithromycin, erythro, or clarithro (macrolide), PPx for all close contacts, hospital if seizures, resp distress, cyanosis, apnea, pneumonia with it.
young child diagnosed with UTI – what other workup is needed/
renal/bladder U/S; voiding cysturethrogram if >2 febrile UTIs or Hx urologic disease/HTN/poor growth
child who can’t follow moving target with eyes well, falls over, spots on face after age 5, gets sinus/lung infections =? What lab finding for Dx?
Ataxia-Telangiectasia (IgA and T cell deficiency). Lab: increased AFP after 8 months of ago. [[[[[[acronym: ATAXIA: Ataxia, Telangiectasia, Acute leukemia/lymphoma(10% of pts), X-ray sensitivity, IgA deficiency, AFP]]]]]]]
boy with S aureus and Aspergillus infections, what is this? Dx? tx?
CGD. Dx: negative nitroblue tetrazolium test. Tx: PPx TMP-SMX and itraconazole; IFN-gamma
tricuspid regurg & widely split S2 in child born to psych patient, think what? what might be on EKG?
Ebstein’s anomaly (from lithium). EKG: SVT or WPW b/c of dilated RA
metabolic syndrome in child with lactic acidosis, hyperlipidemia, hepatomegaly, increased glycogen, severe fasting hypoglycemia, enlarged kidneys, hyperuricemia?
Type I (Von Gierke)
metabolic syndrome in child with hepatomegaly, hypoglycemia, hyperlipidemia, but normal kidneys, lactate, and acid, think=?
Type III (Cori)
where do you see spur cells (acanthocytes)?
abetalipoproteinemia
anemia with low MCV, mental status changes, neuropathy, and constipation, think =?
lead poisoning
a) HbH = ? b) Hemoglobin barts =?
a) alpha thalassemia with 3 alleles defective. Bind O2 too tightly, O2 dissociation curve all the way to left. microcytosis, hemolysis. b) all 4 messed up - erythroblastosis fetalis.
a)beta thal minor = ? b) beta thal major = ? c) main thing you see on smear with thalassemia?
a) decreased beta-globin, increased HbA2(alpha globin + delta globin) ——–b) no beta-globins, so HbA2 + HbF (alpha + gamma globin)———-c)target cells
in patient with microcytic anemia, what must you check before giving iron supplements?
r/o thalassemia. B/c otherwise you can cause iron overload. Confirm iron def with iron studies! if iron comes back normal, they may have thalassemia, so next step = Hgb electrophoresis
what PPx + vaccines do sickle cell kids need?
Pneumococcal, Hib, Meningococcal, Hep B, and annual flu. PPx penicillin till age 5.
