WE2 mock SB (-3.5) Flashcards
WE2 mock blocks (30-37) Missing blocks 34.5-37
dopamine has what effect on prolactin?
inhibits
prolactin has what effect on GnRH?
inhibits
low dopamine –> incr prolactin. what affect does this have on sexual function and why?
decr sex f(x) + gynecomastia
incr prolactin –> decr GnRH –> decr FSH/LH
antidopaminergic effects on what pathway lead to antipsychotic efficacy?
mesolimbic
antidopaminergic effects on what pathway lead to extrapyramidal s/s?
negrostriatal
antidopaminergic effects on what pathway lead to sexual dysf(x) and gynecomastia?
tuberoindundibular
can positive superficial wound cultures reliably predict the causative organism in diabetic foot ulcers (+/- osteomyelitis)?
NO
what special test must be done to confirm the dx of diabetic foot ulcer/osteomyelitis anad guide management?
bone bx
what are some of the possible complications of BPH?
- compression of urethra
- incomplete bladder emptying
- incr UTI/polynephritis
how does intermittent testicular torsion present?
- young M w/ sudden onset testicular pain, n/v, often during exercise, s/p mild trauma, or w/ movement in sleep
- UNLIKE TESTICULAR TORSION, THE S/S WILL SELF-RESOLVE AND LATER RELAPSE
what is negative prehn sign and what does it suggest?
- negative sign = scrotal pain does not resolve w/ testicular elevation
- this suggests testicular torsion
what are the two types of breath-holding spells?
- cyanotic
2. pallid
how do cyanotic breath-holding spells present?
crying –> breath holding –> cyanosis + LOC
how do pallid breath-holding spells present?
minor trauma –> breath holding –> pallor + LOC
when are breath-holding spells concerning?
- recurrent/prolonged occurance
- famHX = + cardiac dz/death
which exhibits fistulas chron’s or UC?
chron’s
which is the most effective emergency contraceptive?
copper IUD (99%)
what is ulipristal?
= antiprogestin that delays ovulation. >= 85% effective as emergency contraception if used w/in 120 hrs after sex
what is levonorgestrel?
= progestin. 85% effective as emergency contraception if used w/in 72 hr of sex
how does ulipristal compate to levonorgestrel?
more effective and has a larger window of use (120 hrs vs 72 hrs)
how does ovarian ca present?
- asymp
- pelvic pain and bloating
- SOB, constip w/ vomiting, abd distension
how does ovarian ca look on U/S?
- solid mass + thick septations
- free fluid/ascites
what is ovarian ca?
abn proliferation of ovarian or tubal epithelium or peritoneum
what will syringomyelia most commonly present w/?
loss of pain and temp sensation in a “cape-like” distribution
how does cervical myelopathy present?
- progressive gait instability
- weakness
- LMN @ level of lesion (weak UE)
- UMN below level lesion (incr DTR LE)
what should you expect if you see a change in burn wound appearance?
infection
what infxs = common soon after burn injury vs >=5d post injury?
soon after –> G+
>=5d post –> G- and fungi
what types of infx do kids w/ xlinked agammaglobulinemia present w/ ?
recurrent sinopulmonary and GI infx @ age >6mos
what might you see on p/e of a kid w/ x-linked agammaglobulinemia?
decr lymphoid tissue (i.e. small tonsils, lymph nodes)
what types of infx do kids w/ SCID present w/ ?
severe, recurrent viral, fungal and bacterial infx
in addition to recurrent infx (all types), what will kids w/ SCID present w/ ?
failure to thrive
what renal/urinary changes are expected in nL pregnancy?
labs: decr sBUN, decr sCr, incr protenuria
physiologic: incr RBF, incr GFR, incr renal BM permeability
what change in Hgb is expected in nL pregnancy?
physiologic decr
what are the cutoffs for anemia of pregnancy by trimester?
1st = Hgb <11 2nd= Hgb <10.5 3rd = Hgb <11
what is the MCC bacterial pneumonia in young kids w/ CF (+/-co-infx w/ influ)?
s aureus
for severe PNA, freq hosppitalization, or recurrent skin infec, what med should be included in the empiric plan?
IV vancomycin
what is the MC skin malig in pts who are s/p transplant and/or are immunosupressed?
SCC
what is the MC skin malig in the general population?
BCC
which is more likely to cause neuronal invasion BCC or SCC?
SCC
what do xrays reveal in paget’s dz?
- osteolytic lesions
- mixed osteolytic/blastic lesions
- *NEVER only osteoblastic lesions
how does bone mets 2/2 to prostate ca present in the spine?
+progressive back pain
+focal tenderness over SP
+/- f(x)al impairment (weakness, incontinence)
what labs and xray results are seen for bone mets 2/2 prostate ca?
labs = nL/decr Ca, incr ALP xray = focal sclerotic lesions
how does optic neuritis present?
- monocular vision impairment
- eye pain w/ movement
- washed-out color vision
- central scotoma
- afferent pupil defect
how does macular degen present?
- bilateral and painless
- progressive loss of central vision
- drusen (yellow deposits) on retinal exam
how does open-angle glaucoma present?
- gradual, painless peripheral vision loss]
- incr cup: disk ratio on retinal exam
optic neuritis is strongly associated w/ what condition?
MS
what are PACs?
- premature atrial complexes
- initiated by a site other than the SA node
- benign arrhythmia
- usually asymp
when might you tx PACs?
- causing distress
- if pt also presents w/ SVT
avoiding what can decr the incidence of PACs?
tobacco, EtOH, caffeine, stress
what causes of amenorrhea can be dx/suggested by FSH/LH/prolactin/TSH values?
- ovarian failure
- functional hypothalamic amenorrhea
- ashermans
- polactinoma
- hypothyroidism
what labs are expected in prolactinoma?
decr FSH, decr LH, incr prolactin, nL TSH
h/o chemo + amenorrhea + estrogen def. what should you suspect?
ovarian failure
why are FSH and LH elevated in ovarian failure?
low estrogen –> no feedback inhib –> incr FSH and LH
what effect does estrogen have on T4-binding globulin?
incr –> incr T4 w/ nL TSH levels
must adjust meds during pregnancy, OCP use and HRT
HTN + incr Na + decr K. what do you suspect?
hyperaldosteronism
what is the best 1* screening test for 1* hyperaldosteronism?
plasma aldosteron:renin ratio
what is the best test for differentiating adrenal adenoma from bilat adrenal hyperplasia when imaging is neg?
adrenal venous sampling
prior to receiving test results, how do you talk to pt about ca?
- acknowledge ca as POSSIBLE outcome of test results
- DO NOT TALK PROBABILITIES
what are the C/I to attempted vaginal delivery w/ breech presentation?
- h/o classic csec ever
- placenta previa
incr cow’s milk consumption (>24 oz/d) –> ___ in young kids?
Fe def anemia
what happens to RCDW in Fe def anemia?
incr
how do you reduce the risk of vertical transmission (mom –> baby) of HIV to <1%
- maternal combo retroviral tx during pregnancy + neonatal zidovudine
if HIV dx made late in pregnancy, what should you do to decr risk of vertical transmission (mom –> baby)?
maternal combo retroviral tx + zidovudine ASAP
+neonatal zidovudine
how does neonatal zika present?
microcephaly, hypertonia, contraction, occular abn, hearing decr
what are some common examples of T1 hypersens rxn?
anaphylaxis, urticaria
what are some common examples of T2 hypersens rxn?
AI hemolytic anemia, goodpasture’s dz
what are some common examples of T3 hypersens rxn?
serum sickness, SLE, PSGN
what are some common examples of T4 hypersens rxn?
TB test, contact dermatitis
what are seen in T2 hypersensitivity rxns?
IgM and IgG antibodies
what are seen in T3 hypersensitivity rxns?
antibody-antigen complexes
what labs will be seen if a pt is abusing laxatives?
- high urine output
- dehydration
- orthostatic hypotension
- labs = decr sNa, decr sK
what is the MCC of CAP?
s pneumo
how does CO poisoning present?
mild/mod = HA, dizzy, AMS, malaise, nausea severe = syncope, siezure, coma, arrhythmia, MI
how does PCP intox present?
- agitation
- delusions of enhanced strength
- pychosis (paranoia, hallucinations)
- analgesia
- aggression
what would you find on p/e of a pt w/ PCP intoxication?
- multidirectional nystagmus
- HTN
- Tachy
- hyperthermia
- ataxia
- muscle rigidity
- seizures, coma (severe)
what class of meds is best/MC for tx of agitation 2/2 PCP use?
Benzos- lorazapam/diazepam best (IV > PO)
what is the 2nd line tx for PCP intox?
haloperidol
haloperidol is C/I for pts w/ h/o of what?
seizure disorder (lowers seizure threshold)
which antipsychotic is especially notorious for incr risk of seizure?
haloperidol
how does neonatal sepsis present?
- temp instability
- poor feeding
- jaundice
- CNS s/s (lethargy, irritability, apnea)
how to dx neonatal sepsis?
get blood, urine, and CSF cultures prior to starting emperic IV ABX
why do neonates not require CT before LP?
open fontanelles relieve incr ICP, so neonates won’t experience herniation s/p LP
what is 1* dysmenorrhea?
-period s/s that start after establishment of ovulatory cycles and generally decr w/ age
what causes 1* dysmenorrhea?
incr endometrial prostaglandin production
what are s/s of 1* dysmenorrhea?
- pain during 1st 2-3 days of menses
- n/v/d
- nL pelvic exam
how does endometriosis present?
- pain begins 2-3 days before menses and lasts through duration of period
- p/e: uterosacral ligament tenderness, culdesac nodularity and adnexal enlargement
acute pyelonephritis can lead to what?
G- sepsis
when do you get a CT in pts w/ pyelonephritis?
- s/s despite 48-72 hr tx
- h/o kidney stones
- complicated pyelonephritis
- unusual urinary findings (gross hematuria)
what might gross hematuria mean in a pyelonephritis pt?
urinary obstruction
what is one of the MC post-op complications?
atalectasis
what causes atalectasis?
- obstruction from retained secretions
- decr lung compliance
- post-op pain
- meds that decr resp drive
what ABG levels are typical w/ atalectasis?
- low paO2
- low paCO2
- resp alkalosis
what is a perilymphatic fistula?
rare complication of head injury or barotrauma
what are the presenting s/s of perilymphatic fistula?
- episodic vertigo 2/2 sudden changes in pressure and loud noises
- progressive hearing loss
how does eustacian tube dysf(x) present differently from perilymphatic fistula?
ETDysf(x) = ear pain + fullness. NO episodic vertigo or nystagmus (both seen w/ perilymphatic fistula)
how does meniere dz present differently from perilymphatic fistula?
meniere dz = episodes of vertigo + hearing loss + ear fullness + tinnitis that last 20 min - 24 hrs. NO triggers
fistula = vertigo + hearing loss. NO fullness or tinnitis. s/s triggered by sudden changes in pressure or loud noises
when should a woman w/ - Rh(D) antibody screen receive Rhogam when there is doubt as to whether baby could by Rh(D)-positive?
between 28-32 wks AND =<72hrs after possible blood mixing (trauma/birth)
what is the mode of inheritance for hemophilia A?
x-linked recessive
what inheritance patterns are seen w/ hemophilia A?
if dad has the dz:
100% F children = carriers
100% M children = nL
50% kids = nL + 50% kids = F carriers
if mom is a carrier:
50% F children = carriers
50% M children = dz
50% kids = nL + 25% kids = F carriers + 25% kids = M w/ dz
what are characteristics of Turner’s synd?
- webbed neck
- wide spaced nipples
- bicuspid aortic valve
- horseshoe kidney
- nail dysplasia
- congenital lymphedema (2/2 lymphatic network dysgenesis)
how does congenital lymphedema present in turners?
non-pitting carpal and pedal edema @ birth
what are the interstitial fluid protein levels in pitting vs nonpitting edema?
pitting = decr protein
non-pitting = incr protein
high protein - the fluid is fuller and more viscous so skin is less deformable. not sure if this is technically true but this is how i think about it
how does congenital hypothyroidism present?
6 Ps
- Potbellied
- Pale
- Puff-faced child
- Protruding umbilicus
- Protruberant tongue
- Poor brain development
what is the MCC of congenital hypothyroidism?
thyroid dysgenesis
what can/will not be elevated in panhypopituitarism?
TSH (duh!)
why must congenital hypothyroidism be tx w/ Levo ASAP?
earlier tx limits the neurodevelopmental injury
what is the 1st line tx for frostbite?
rapid rewarming w/ warm water (98.6 - 102.2*F)
when should you not start treating frostbite?
if there is any risk of refreezing before definitive care can be provided
how does Wilm’s tumor present?
- asymp
- p/e = firm, smooth abd mass that does not cross midline
- hematuria
- ages 2-5yo
how does PSGN present?
+hematuria
+proteinuria
+HTN
+edema
what is septic pelvic thrombophlebitis?
post-op or post-partum infected thrombosis of the deep pelvic or ovarian veins
how does septic pelvic thrombophlebitis present?
persistent F that DOES NOT respond to ABX
what will be seen on U/A if AIN?
- WBC casts
- WBC
- Leukocyte esterase (indicator of WBC)
what are common causes of rhabdo?
- crush injury
- prolonged immobilization
- incr muscle activity (seizure, exertion)
- drug/med toxicity (statins)
- *all cause myocyte lysis/necrosis**
in addition to back and SI joint pain + decr spine flexibility + relief w/ exercise, what are the presenting features of ankylosing spondylitis?
- reduced chest expansion
- enthesitis (tenderess @ tendon insertion sites)
- dacrolytis
- uveitis
how can ethesitis present?
- tender @ heels, iliac crests and tibial tuberosities
i. e. tenderness @ tendon insertion sites
acute cervicitis commonly presents w/ what 3 symptoms?
- post-coital bleeding
- mucopurulent discharge (thick, yellow, smelly)
- friable cervix
what are the 1* criteria for extubation?
- pH > 7.25
- adequate oxygenation on minimal vent settings
- sufficient metal alertness to protect airway
pt meets 1* criteria for extubation. what do you do?
spontaneous breathing trial to confirm that they are ready to be extubated
what causes the flushing and pruritis seening pts taking niacin?
prostagladin induced peripheral vasodilation
how to tx s/e of niacin (flushing/itching)?
low dose ASA
when will schistocytes be seen on peripheral smear?
- microangiopathic hemolytic anemias (DIC, HUS, TTP)
- mechanical destruction (+mechanical heart valve +/-stent)
what labs are seen w/ hemolytic anemias?
- incr LDH
- incr bilirubin
- decr haptoglobin
what does MCV tend to be in hemolytic anemias?
incr»_space; nL/decr
what are the microangiopathic hemolytic anemias?
- DIC
- HUS
- TTP
what is enoxaparin?
LMWH
which anticoag drugs = C/I in severe renal insufficiency?
- LMWH (enoxaparin)
2. Xa inhib (fondaparinux and rivaroxaban)
What are 2 common Xa inhib?
- fondaparinux (IV / IM)
- rivaroxaban (PO)
in the absence of underlying liver dz, what is the most-likely cause of incr LFTs?
drug-induced injury
what are the s/e of lamotrigine?
serious rashes including steven johnson synd
what is the s/e of valproate?
incr LFT –> hepatic failure (rare)
when will valproate toxicity typically occur?
w/in 1st 6 mos of initiating tx
traztuzimab s/e = ?
cardiotoxicity
what should be done prior to starting traztuzimab?
assess cardiac f(x) w/ ECHO
what class of drugs requires TB testing prior to initiation and why?
- TNF-alpha inhib
- can reactivate latent TB
p/e = mild proptosis, estropia, optic disk pallor, several large cafe au lait spots, marked axillary freckling. dx = ?
NF-1 + optic pathway glioma
mutations on which chromosomes cause NF1 and NF2 respectively?
NF 1 = chromosome 17
NF 2 = chromosome 22
what is retinitis pigmentosa?
inherited degenerative dz of retinal photoreceptor cells
what common complication of intubation –> decr lung sounds and asymmetric chest expansion?
R mainstem bronchus intubation
how does retinitis pigmentosa present?
bilat tunnel vision (binoccular blindness)
when is needle decompression used as 1st line tx?
suspect tension pneumothorax
what are some common indications for placement of a chest tube?
- pneumothorax
- hemothorax
- empyema
- malig effusion
what is autonomic dysreflexia a complication of?
spinal cord injury above T6
how does autonomic dysreflexia present?
- noxious stimuli –> unreg symp response –> incr HTN
- attempted parasymp compensation (above lesion) –> flushing, sweating, decr HR, nasal congestion
what are some noxious stimuli that can cause autonomic dysreflexia?
- urinary retention
- constipation
- pressure ulcers
how to tx autonomic dysreflexia?
REMOVE STIMULUS
sit pt upright and remove tight clothing
how do anti-cholinergic drugs cause urinary retention?
- inhib detrusor contraction
- inhib urinary sphincter relaxation
abd pain w/ exam and suprapubic fullness suggests?
urinary retention
what is amitriptyline?
a TCA w/ anti-cholinergic properties
what testing should be done to confirm blunt cardiac injury?
EKG + ECHO
when should blunt cardiac injury be suspected?
+ h/o recent blunt chest trauma
+ persistent tachy and new arrhythmias
what is a red flag for child abuse?
posterior rib fractures
what bruises are suspicious for abuse?
- patterned (hand, buckle)
- located on neck, ear, torso or butt
how can hemophilia present?
- recurrent hemarthrosis
- skeletal muscle hematoma s/p minor trauma
- famHx
how does multiple myeloma present?
CRAB Calcinosis Renal failure Anemia Bone pain (lytic lesions)
pt presents w/ back pain + anemia + nL/incr Ca + renal failure. what do you suspect?
multiple myeloma
how does vit D toxicity present?
-vomiting
-confusion
-polydipsia
-polyuria
NO ANEMIA OR RF
what is the classic triad seen in wernicke encephalopathy?
- ataxia (broad based gate)
- encephalopathy
- occulomotor dysf(x)
what does the occulomotor dysf(x) in wernicke encephalopathy present w/?
- horizontal nystagmus
- bilat abducens palsy (eyes can’t abduct)
what is associated w/ wernicke encaphalopathy?
- chronic EtOH abuse
- chronic malnourishment
- short-gut syndr
how does abducen n. palsy present?
affected eye can’t abduct, so med rectus m. pulls the eye into near permanent adduction
when can you dx MDD after the loss of a loved one?
- if meet >=5/9 criteria
- s/s will be more persistent and pervasive
- worthlessness/guilt will be worse
- thoughts of death = about ending pain (suicide) rather than rejoining loved one
what are the risk factors for cdiff infx?
- recent ABX use
- recent hospitalization
- severe comorbid illness (IBD)
- adv. age
how does 1* ovarian insufficiency present?
- amenorrhea < 40yo
- decr estrogen + associated s/s
- incr FSH
what is 2* amenorrhea?
-lack of menses for >=6mos in pt w/ previously regular cycles
what does lack of withdrawal bleeding after progesterone stim challenge suggest?
low estrogen state
how do female fragile x carriers present?
- famHx = fragile X
- neuropsych issues = GAD, autism
- 1* ovarian insufficiency
ashermans and 1* ovarian insufficiency both present w/ 2* amenorrhea + no withdrawal bleeding on PST (low estrogen). how do you tell them apart?
Asherman = nL FSH
1* Ovarian insufficiency = incr FSH
what is intrahepatic cholestasis of pregnancy?
incr estrogen/progesterone in 3rd trimester –> hepatobiliary tract stasis & low bile excretion
how does intrahepatic cholestasis of pregancy present?
- generalized pruritis
- pruritis = worse on hands and feet
- NO rash
- RUQ pain
- incr total bile acids
- incr LFTs
- incr total and direct bili
what are s/s of low estrogen?
- dry vagina
- vaginal atrophy
- thin endometrium
what is cardiac sarcoidosis?
- dz of noncaseating granuloma infiltration of the myocardium
- can see serious arrythmias, cardiomyopathy, CHF, and sudden cardiac death
when should you suspect cardiac sarcoidosis?
young pt (age < 55yo) presents w/ unexplained 2nd or 3rd degree heart block -EKG changes occur in pt w/ known sarcoidosis
what heart defects/conditions develop 2/2 cardiac sarcoidosis?
- early dz = restricted cardiomyopathy
- late dz = dialated cardiomyopathy
- can also see valvular dz, CHF, arrhythmias (3rd degree heart block = MC)
what is the MC arrhythmia seen 2/2 cardiac sarcoidosis?
3rd degree heart block
what common s/s of cardiac sarcoidosis is not generally seen in viral endocarditis?
high grade AV block
what is eczema herpeticum?
- complication of severe atopic dermatitis
- superinfx w/ HSV (you seen HSV vesicles on top/within eczematous plaques/patches)
what is atopic dermatitis?
eczema
how does atopic dermatitis present in infancy vs kids/adults?
- infancy = itchy red plaques on face, chest, and ext. surfaces
- kids/adults = like in infancy + flexural involvement
how does pneumonia cause hypoxemia?
R –> L intrapulmonary shunting
+ extreme V/Q mismatch
what is R –> L intrapulm shunting?
perfusion of lung tissue in the absence of alveolar ventilation
(i.e. blood is going to lung tissue that is not oxygenated, so it dumps its CO2 and returns to the heart w/o picking up new O2)
what are some causes of V/Q mismatch?
- R –> L shunting
- emphysema
- interstitial lung dz
- PE
when does O2 supplementation “not correct” hypoxemia?
when V/Q = 0 (R–>L shunting where O2 can’t reach part of the lung)
what is a confounder?
- an extra variable that has properties linking it to the exposure AND the outcome of interest
- b/c its linked to both, you can’t tell if it has an modifying effect on the result
what is Behcet synd?
multi-system inflammatory condition
how does Behcet syndrom present?
Recurrent:
- PAINFUL ORAL ULCERS
- genital ulcers
- eye lesions (uveitis)
- skin lesions (erythema nodosum, acneiform lesions)
SEEMS LIKE HSV BUT WILL ALSO HAVE EYE + ADDITIONAL SKIN LESIONS
what is a major cause of morbidity in Behcet’s synd?
thrombosis
are SLE aphthous ulcers typically painful or painless?
painless
what does complex pain synd typically follow?
trauma or sx
how does complex pain synd pain present?
\+severe burning or tingling pain in REGIONAL PATTERN (i.e. nerve pain NOT in a dermatomal pattern) \+/-edema \+/-redness \+/-trophic skin \+/-hair or nail changes
which is the MC form of nephrotic synd associated w/ carcinoma?
membranous nephropathy
which cause of nephrotic synd is seen in pts w/ hodgkin lymphoma?
minimal change dz
associations w/ focal segmental glomerulosclerosis (FSGS) = ?
- AA and hispanics
- obesity
- HIV
- heroin use
what causes of nephropathy are HIV, HepB, HepC and URIs associated w/ respectively?
HIV = FSGS HepB/HepC = membranoproliferative URI = IgA nephropathy
what are the s/e of theophylline?
CNS = HA, insomnia, siezure GI = n/v cardiac = arrhythmia
why must you be careful when using theophylline?
- it has a narrow therapeutic window and is metabolized by the Cyp450 system
- concomittant use of drugs that inhib cyp450 further narrow the theophylline therapeutic window
what are the s/s of delirium tremens?
- CNS = confusion, agitation, hallucinations
- Vitals = F, incr HR, HTN
- diaphoresis
what are indications for ECT for depression?
- tx resistance
- psychotic features
- emergency = pregnancy, refusal to eat/drink, imminent risk of suicide
what is the 1st line tx for MDD w/ psychotic features?
- ECT
decr ADAMTS13 activity is assoc w/ what condition?
TTP
how does TTP present?
- HUS s/s = hemolytic anemia s/s + n/v + renal injury
- FEVER
- NEURO = confusion, stroke
- non-palpable purpura
how do the purpura in TTP and mixed cryoglobulinemia differ?
TTP = non-palpable MC = palpable
what is mixed cryoglobulinemia synd?
= an immune complex deposition disorder
what is mixed cryoglobulinemia synd commonly associated w/ ?
chronic Hep C
how does mixed cryoglobulinemia synd present?
- fatigue
- arthralgias
- periph neuropathies
- palpable purpura
- renal dz,
what will labs show in mixed cryoglobulinemia?
- s cryoglobulins
- decr complement (C3/C4)
- kidney injury (incr Cr, incr BUN)
- liver damage (incr LFTs)
- risk factors
