Week 1 Flashcards
<2 year old fever, rhinorrhea (coryza), cough 18 hours and labored breathing 1 hour, exam reveals tachypnea, hypoxia, crackles, coarse breathe sounds +/- Wheezing. What is the diagnosis?
Bronchioloitis caused by RSV
Tx. Supportive
Hemochromatosis can have what complications
HCC, Cirrhosis, CM (CHF), arrythmias, DM, impotence, arthropathy, hypopituitarism
Contralateral paresis and sensory loss in the face and arm, gaze preference towards side of the lesion
MCA Stroke
Left (dominant) - Aphasia
Right (non dominant) - neglect
SOB in someone with rib fracture, no breath sounds, unstable BP 80/60, next step?
needle thoracostomy
87 year old w/dementia in nursing home with UTI, had a catheter for urinary incontinence for a week, what could have prevented this?
incontinence briefs instead of a catheter
how to treat superficial thrombophebitis
NSAIDS, warm compress
37 immigrant from pakistan, 2 week RUQ pain, fever, increased T bili 1.4, Alk phos 120, AST 40, on US see right cystic mass of the liver, what is this?
Entamoeba histolytia, diagnose with serum antibody for E histolytica, tx with metronidazole. Can also cause blood diarrhea.
Just started HCTZ feel fatigued, which electrolyte abnormality?
hypoKALEMIA, can also cause, hyponatremia, hyperglycemia, hypelipidemia, hyperuricemia, hypercalcemia, sulfa allergy
Tinea versicolor, doesn’t tan in sun, what to treat?
selenium sulfide or topical azoles, dx KOH spahgetti and meatballs
Kid with scalp scattered papules and scaly ares, and short broken hairs in patches
Tinea corpis, from sharing hat probably, Dx KOH, 2/2 tricohophyton, tx griseo or terbinafine)
6 month old chronic constipation, no stool in ampulla, next step dx
anorectal manometry detects failure of the internal sphincter to relax after distention of rectal lumen, used in atypical preso older children
4 year old with ear pain, bulging TM, edematous auditory canal, small amount MC discharge, tenderness behind ear, EAR IS LATERALLY DISPLACED, 1 CM freely mobile NT mass over L anterior neck, next step
CT scan Temporal bone … ABSCESS!
guy works as a pharmacist, advised to lose weight, high T4, very high T3, very low TSH, decreased uptake on radioactive thyroid scan and small gland, what is the cause?
EXOGENOUS ADMIN thyroid hormone
30 min after fluid resuscitation with crystalloid solution and transfusion of 4 units crossmatched PRBC, SOB and diffuse rhonchi and crackles, what is cause?
Fluid overload, Transfusion induced lung injury
prego who is vegetarian, what additional supplementation vitamin for pregnancy and lactation?
B12
47 yo male knee pain, fracture when 16, progressively worse now, can’t walk
post traumatic arthritis
What to decrease Renal Ca++ stones
- Increase fluid intake
- Decrease Na+ intake
- NL Ca++ intake
How to treat uric acid stones
- Hydration
- Alkalinize urine 6-6.5 w oral K/citrate
- Decrease pruine diet
Asthma, chronic rhinosinusitis w/nasal polyposis, and bronchospasm or nasal congestions following ASA or NSAIDS is
Aspirin exacerbated respiratory disease
How to treat recurrent variable decelerations? (occur with >50% of contractions)
Maternal repositioning, left lateral 1st line may reduce cord compression and improve blood flow to the placenta, 2nd line amnioinfusion
DiGeorge Syndrome Pathogenisis
Chromosome 22q11.2 deletion, defectiev development of pharyngeal pouches
Clinical Features DiGeorge syndrome
Conotruncal cardiac defects (truncus arteriosis)
Abnormal facies (low set ears, microagnathia)
Thymic aplasia/hypoplasia
Cleft palate
Hypocalcemia
Can also have T cell lymphpenia and increased risk viral and fungal infections
What to order if suspect DiGeorge syndrome?
Serum Ca++ and echo
Chronic granulomatous disease
-XLR
-Recurrent pulm and skin infections
-Catalase +
Dx: neutrophil function testing, dihydrorodamine 123, nitroblue tetrazolium test
Partial oculocutaneous albinism and recurrent cutaneous infections with staph a, strep pyogenes
Chediak-Higashi
AR
impaired neutrophil migration to site of infection, delayed umbilical cord separation, recurrent non purulent skin infections, sever periodontitis, neutrophilia
LAD
Eczema, thrombocytopenia, recurrent infections
Wiskott-Aldrich synfrome
Cafe-au-lait spots, multiple neurofibromas, lish nodules iris, increased risk intracranial neoplasm
NF1 (TS gene codes neurofibromin, Cr 17)
Bilateral acuostic neuromas
NF2 (TS gene codes merlin, Cr 22)
Drugs that cause megaloblastic anemia (folic acid deficiency)
Phenytoin, primidone, phenobarbital, TMP, Methotrexate
progressive visual loss, especially when driving/reading and see straight grid lines appear curvy
Macular degeneration most common cause of blindness in industrialized nations
Diffuse Telangiectasias recurrent epistaxis, wide spread AV malformations (mucous membranes, skin, GI, liver, brain, lung) AVM in lungs can shunt blood from the R to L heart causing hypoxemia and reactive polycythemia, also can preso as hemoptysis
Osler-Weber-Rendu syndrome, AD
1-2 weeks after exposure to abx (beta lactam, sulfa) or acute hep b, have fever, skin rash, urticaria, and polyarthralgia. Low Complement, elevated ESR, CRP
serum sickness like reaction type III HS reaction
tx remove offending agent, supportive care, steroids or PM if severe
What to give for a DVT in end stage renal disease?
unfractioned heparin followed by warfarin for at least 3 months
Dx Lichen sclerosus
Punch biopsy
Tx Lichen Sclerosus
Topical high potency corticosteroid
Adverse effects oxytocin
Hyponatremia (bcus like ADH)
Hypotension
Uterine Tachysystole (increased risk C section, low umbilical cord pH and neonatal intensive care unit admission)
Which antiarrhythmic agents cause use dependence?
Class IC - Flecainide and propafenone, when HR increased can cause QRS prolongation
(also verapamil and diltiazem prolong PR internval)
2 week old neonate with mucopurulent eye discharge, and what tx?
Chlamydia tx with PO macrolide (topical erythromycin effective prophylaxis for gonococcal conjuctivitis)
6mo -3yo with barky cough, stridor, hoarse voice, preceding URI sxs
CROUP parainfluenza virus tx with steroids and racemic epi for pts w/stridor @rest
Drugs that cause pancreatitis
- Anti seizure - valproate
- diuretics (furosemide, thiazides)
- IBD - sulfasalazne, 5ASA
- Azathioprine
- HIV (didanosime, pentamidine)
- Abx (metro, tetra)
Microcephaly, Micrognathia, prominent occiput, low set ears, clenched hands with overlapping fingers, renal defects, limited hip abduction, rocker bottom feet, heart defects
Trisomy 18 Edwards
Cutis aplasia, microphthalmia, midline defects like holoprosencephaly and omphalocele, rocker bottom feet
Trisomy 13
Patau
SE Cyclosporine
Nephrotox, HTN, Neurotox (HA, vision changes, seizure, mild tremors, akinetic mutism), glucose intol, infection, malignancy (SCC skin and lymphprolif dz), gingival hypertrophy and hirsutism, GI probs
Drugs that cause hyperK+
- B Blockers
- ACEi/ARBs
- K sparing diuretics
- Digoxin
- NSAID
What is Leriche Syndrome?
- Aortoiliac occlusion
- Triad 1) b/l hip, thigh, buttock claudication 2) impotence 3) symmetric atrophy of the b/l lower extremities 2/2 chronic ischemia
What is the workup for an ovarian mass in a post menopausal woman?
- Ultrasound and CA-125
- Then if ++ further imaging with CT/MRI
- Never to needle aspiration in postmeno women w/adnexal mass bcus of seeding malignant cells
Blunt Trauma to lower abodmen pelvis + peritoneal signs (peritonitis)
Rupture dome of the bladder, bcus urine spills into peritoneum, leading to peritonitis
Kehr sign
irritation to the right or left hemidiaphragm causing referred pain to the ipsilateral shoulder (C3-C5, phrenic nerve also innervated diaphragm)
What ia alcoholic hallucinosis?
Alert sensorium, visual hallucinations (auditory, tactile occur too), relatively stable vital signs developing 12-24 hours after the last drink and usually resolves within 24-48 hours. (Vs DT which occurs after 48 hours, disorientation and global confusion, hallucinations, fever, autonomic hyperactivity and potentially life threatening)
How to determine etiology of fetal demise?
Autopsy, gross and microscopic placental exam, karyotype/genetic studies. Also maternal lab testing for fetomaternal hemorrhage and antiphospholipid.
What is pemphigus vulgaris?
Antibody vs desmogleins 1 & 3, flaccid bullae and ulcers, +nikolsky sign, intraepidermal cleavage, acantholysis, IF netlike intracellular IgG and C3
Tx: steroids
2 month milestones (Gross motor, fine motor, language, social)
Gross: lifts head/chest prone
Fine: tracks past midline, unfisted 50%
Lang: alerts to voice/sound & coos
Social: social smile, rec parents
4 mo milestones (Gross motor, fine motor, language, social)
Gross: Sits with trunk support, begins rolling
Fine: Hands mostly open, reaches midline
Language: Laughs, turrns to voice
Social: enjoys looking around
6 mo milestones
gross, fine, lang, social
Gross: sits momentarily propped on hands unsupported by 7 months
Fine: Transfer objects hand to hand, raking grasp
Language: responds to name, babbles
Social: stranger anxiety
9 mo milestones
Gross: Pulls to stand, cruises
Fine: 3 finger pincer grasp, holds bottle/cup
Language: Dada, Mama
Social: Waves bye, plays pat a cake
12 mo milestone
Gross: Stands well, walks first steps, throws ball
Fine: 2 finger pincer grasp
Language: first words
Social: Separation anx, comes when called
When does moro reflex go away? Babinksi?
Moro/grasp - 4 months
Babinski - 12mo-2years
Tx urge incontinence
Antimuscarinic, oxybutinin
Tx overflow incontinence 2/2 diabetic neuropathy
Bethanechol
Painful pustules and honey crusted lesions, what is it? tx?
Non bullous impetigo, tx topical mupirocin for localized infection
Tx impetigo with extensive skin involvement or bullous?
Clinda, cephalexin, dicloxacillin
Tx Iron poisoning
Deferoxamine which binds ferric iron allowing urinary excretion (ex. radiopaque prenatal vitamins)
Probability of being disease free if the test result is negative?
NPV, varies with pretest probability of a disease
Complications of mumps?
Aseptic meningitis and orchitis
Asx gallstones t?
no treatment until symptomatic, then lap chole
How to improve oxygenation in mechanically ventilated patients?
- Increase FiO2
- Increase PEEP
Cough, coryza, conjuctiitis then maculopapular rash that spreads cephalocaudally and SPARE palms/soles
Measles (Rubeloa), transmitted airborne, tx supportive and Vit A
Acute shoulder pain after forceful abduction and ext rotation at the GH joint suggest ….
anterior shoulder dislocation, may cause injury to axillary nerve (teres minor and deltoid, weak shoulder abduction)
Most common valcular abnormality detected in pts with IE?
Mitral valve prolapse with coexisting mitral regurgitation.
44 y/o woman with hot flashes, insomnia, irregular menses, what do order?
TSH and FSH
<10 year old with triad of pain, jaundice, and palpabale mass
Biliary Cyst
Dx: US, ERCP
Tx: Surgery
Boy 13-16 yo with no constitutional sxs, tender soft tissue mass, Xray “spiculated sunburst pattern” and periosteal elevation “Codmans triangle”, also elevated AP, elevated LDH, Elevated ESR
Osteosarcoma, metaphysis long bones
Adolescent male, 20% systemic symptoms, xray shows osteolytic lesion with periosteal reaction, onion skin appearance
Ewings scarcoma
sclerotic, cortical lesion on imaging with a central nidus of lucency, pain at night, NSAID make it better
osteoid osteoma
Beta adrenergic agonists (epinephrine) cause
hypokalemia (Also poteniated by increased insulin)
Fetal hydantoin syndrome 2/2 pheytoin and carbamazepime
Midfacial hypoplasia, microcephaly, cleft lip and palate, digital hypoplasia, hirsutism, dev delay
Person w/un tx AIDS (CD4 <200) has progressive neuro sxs and imaging evidence of non enhancing/no edema white matter lesions
JC virus, progressive multifocal leukoencephalopathy
dx LP with CSF PCR for JC virus
tx. antiretroviral therapy
PCP with PaO2 <70mmHg or A-a gradient >35mmHg tx
TMP-SULF + CTS
Symptoms of CO poisoning?
HA, N/V, ab discomfort, confusion, coma, pinkish-red skin hue. Tx Hyperbaric Ox.
AKI after acyclovir, MOA?
High does acyclovir can cause crystalluria with renal tubular obstruction, give IVF with drug
Severe burn >20% BSA, hypothermia, tachyx2, refracvtory hypotension, change in burn appearance or loss of skin graft 1st sign
SEPSIS
- Soon after think gram +
- 5 days think gram - and fungi, like pseudomonas
Dermal blisters on hands and untreated hep C, painless blisters heal with scarring, increased skin fragility on dorsal surfaces of hands, hyperpigmentation
Porphyria cutanea tarda, can be hereditary or acquired disorders of heme synthesis
Generalized seizures, MR, port wine stain or nevus flammeus on TG nerve, intracranial calcifications that resemble tramline, also hemianopia, hemiparesis, glaucoma
Struge Weber, congenital unilateral cavernous hemangioma tx. argon laser
Most common cause constrictive pericarditis worldwide
TB, decreased CO, venous overload, can even see pericardial calcifications
sudden loss of vision and onset of floaters, hard to visualize floaters
vitreous hemorrhage 2/2 diabetic neuropathy
1st line tx uncomplicated BPH
alpha 1 blockers, then 5 alpha reductase inhibitors
Abdo pain, new onset psych sxs, neuropathies, anxiety, mood changes, psychosis (weeks to days)
AIP, elevated urinary porphobilinogen
S4 heart sound associated with
LVH from prolonged HTN
Asthma w/SABA use < or = 2 days week, night time awakenings same < or = 2 times a month
Intermittent, use SABA only
Asthma with >2 days a week SABA but not daily, night time awakenings 3-4/month
Add ICS low dose to SABA
Asthma Daily SABA, >1x week night time awakenings (but not nightly)
ICS med dose + SABA OR
ICS low dose, + SABA, + LABA
Recommended vaccines for pregnant women
Flu, Tdap, Rho (D)
Contraindicated vaccines in pregnancy
HPV, MMR, Live Att Influenza, Varicella
Metabolic derragnements in primary hyperaldosteronism
hypokalemia, metabolic alkalosis, HTN and increased blood volume (which leads to increased renal blood flow, GFR, ANP, and Increased NA excretion)
Anemia after total or partial gastrectomy, think …
vitamin B12 deficiency, would be megaloblastic due to loss of IF from AI gastritis or resection. Also increased IBili and LDH.
Fever, leukocytosis, LUQ abdominal pain + L sided pleuritic chest pain and L sided pleural effusion
SPLENIC ABSCESS 2/2 infections (IE, spread through blood), Sickle cell, HIV, IVDU, Trauama
tx. IV Abx and splenectomy
Infant botulism
From ingestion of Clostridium botulinum spore from envirormental dust, descending flaccid paralysis, tx with human derived botulism IG (vs Foodborne botulism from preformed toxin, Tx w/equine derived botulism antitoxin)
Preterm labor <32 weeks what to give
Betamethasone, tocolytics (CCB, PGinhibitor), Mag sulfate, penecillin if GBS + or unknown
Preterm labor 32 and 0 weeks to 33 and 6/7
Betamethasone
Tocolytics
Penecillin
Preterm labor 34-36 and 6/7
+/ Betamethasone
Penecillin
Central Retinal Artery Occlusion
Acute painless monocular vision loss. On funduscopy seewhitened retina (edema) and a cherry red macula
Metatarsus adductus
Most common congenital foot deformity; flexible positioning, medial deviation of the forefoot with a normal neutral position of hindfoot, tx reassurance
Congenital clubfoot
Rigid positioning, medial/upward deviation of forefoot and hindfoot, hyper plantar flexion foot, tx serial manipulation and casting, surgery if refractory
Tx complicated diverticulitis with abscess formation (>3cm)
CT guided percutaneous drainage, then surgical drainage if this fails
Ekinella Corrodens IE cause )
Poor dentition and/or periodontal infection along with dental procedures that involve manipulation of the gingival/oral mucosa. It is a constituent of normal human oral flora
HACEK organisms
H. Aphrophilus Aggregatibacter actinomycetemcomitans Cardiobacterium hominis E corrodens Kingella Kingae
Dx SBP
TX SBP
Proph SBP
Ascitic fluid: PMN >250, + Blood Cx, usually gram negatives, protein <1, SAAG > or = to 1.1.
Tx: Cefotaxime
Pro: FQ
Meds to discharge people after NSTEMI, shown improvement in morbidity and mortality
- DAPT (ASA + P2y12 Receptor blocker)
- ACE/ARB
- B Blocker
- Statin
- Aldo antagonist if LVEF <40% w/HF sxs of DM
64 yo w/sudden onset double vision, with DM2 poorly controlled, had ptosis R eye, R eye “Down and Out” but pupils equal and reactive to light
Oculomotor CN III palsy 2/2 ischemic neuropathy due to poorly controlled DM
Aortic regur murmur
early and decresendo diastolic, after A2, high pitched, blowing, heard on Left sternal border at the 3rd/4th ICS with pt sitting up and leaning forward while holding breath in full expiration . NEVER BENIGN. DO ECHO.
Uncomplicated pts with acute onset severe epigastric pain radiating to back. Next best step in management?
-Amylase and Lipase, CT not needed to confirm dx. Only if unclear or do not improve w/conservative mangement
Terminal hematuria, clots at the end of voiding cycle =
Bladder or prostatic damange.
Next step after Dx chorioamnioitis
- broad specturm abx, and normal delivery (oxytocin)
Liver disease, neuropsych sxs in young adult (5-35 yo)
Wilsons Dz, AR, accum copper, dx with decreased ceruloplasmin, tx with D penicillamine, trientine, and zinc
associate syndromes with WILMS
WAGR (wilms, Aniridia, GU anomalies, ID), Beckwith Wiedermann, Denys Drash?
By 12 months a childs weight should ? and height should?
weight, 2x
height, 50% increase
Dx Urethral stone
Ultrasound or non contrast spiral CT
Painless large volume rectal bleed associated with lightheadedness and hemodynamic instability
Diverticulosis
IUFD > or = 24 weeks tx? If 20-24 weeks?
> /=24 weeks vaginal delivery
< 24 weeks D&E or Vaginal delivery
Electrical alternans + sinus tachy
Pericardial effusion, 2/2 swinging of the heart in pericardial cavity that causes beat to beat variation in QRS axis and amplitude. Tx emergency pericardiocentesis
Signs Magnesium tox
loss DTR, somnolence, respiratory depression. RF could be renal insufficiency. Tx tox with Calcium gluconate.
Pts with RA have increased risk for
Osteopenia, osteoporosis, and bone fracture
Why increased incidence othrostatic hypotension in elderly?
Progressively decreasing baroreceptor sensitivity and defects in the myocardial response to this reflex
Man with low Testosterone and low FSH/LH, what is the next best step in management?
This is secondary hypogonadism (pituitary/hypothalamic), measure serum prolactin
Couple trying to get pregnant (woman<35) for 12 months, no luck, what next?
Next step semen analysis. For women >/=35 can begin after 6 months.
Adjustment d/p dx and tx?
Emotional of behavioral symptoms develop w/in 3 months of exposure to an identifiable stressor and rarely last more than 6 months after the stressor ends. Required significant distress or impairment, but doesn’t meet MDD or or d/o.
Tx: psychotherapy
Benign capillary tumor of childhood, appear in first weeks of life, initially grow rapidly in the first 1-2 years of life and then regress.
Superficial infantile hemangioma, “Strawberry hemangioma”, in some cases tx with BBlocker
RF for Respiratory distress syndrome
Prematurity #1, male, perinatal asphyxia, maternal diabetes (high levels of insulin antagonize cortisol and block maturation of sphingomyelin in surfactant), C section w/out labor
Marfanoid body habitus (pectus deformity, tall, increased arm:height ratio, decreased upper:lower ratio), arachnodactyly, joint hyperlaxity, skin hypereleasticity, scoliosis) + Normal intellect, aortic root dilation, upward lens dislocation
MARFAN (AD)
Marfanoid body habitus + ID, thrombosis, downward lens dislocation, megaloblastic anemia, fair complexion
Homocystinuria, AR (error in methionine metabolism, 2/2 cystathionine synthase deficiency)
, elevated homocysteine and methionine, tx B6, folate, B12, and antiplatelets or anticoagulants
cushing reflex
HTN, bradycardia, Respiratory depressions 2/2 brainstem compression
What meds to hold before a cardiac stress test.
48 hours, BBlocker, CCB, nitrates (vasodilator stress test als hole dipyridamole)
12 hours - caffiene
Central cord syndrome
Hyperextension injuries in elderly patients with preexisting degenerative changes, weakness more in upper than lower ext. Selective loss of pain and temperature in arms due to damage of spinothalamix tract.
Solitary pulmonary nodule, 60 yo, 2cm, irregular margins, recently quit smoking =
HIGH RISK, surgically excise. Also if growth on serial imaging, + 18 fluorodeoxyglucose PET, or suspected malignancy on tissue biopsy
Cervicofacial actinomyces
-dental infections & trauma, immunosuppression, DM, malnutrition, sinus tracts with SULFUR granules, non painful, dx FNA and culture >14 days, Tx Penicillin 2-6 months, surgery if severe
MOA that niacin causes flushing and pruritis
Prostaglandin related reaction causing peripheral vasodilation
Proliferation smooth muscle cells within the myometrium
LEIOMYOMATA UTERI, fibroids, common cause heavy menstrual bleeding (Vs Adenomyosis, prolif of endometrial glands inside the uterine myometrium)
Macrocytic anemia 1)megaloblastic
2)non megaloblastic, best next step in management?
Megaloblastics - B12/folate
Non - ETOH, hypothy, drugs, liver disease
-B12 and Folate
(also basophilic stippling can be seen in chronic ETOH)
Anterior mediastinal mass in 38 year old female who has trouble swallowing
Myasthenia Gravis - autoab mediated degradation of ACH R A NMJ
Study that involved randomization to different interventions (Ex BP drugs) with additional study of 2 or more variables (BP endpoints)
Factorial design
Asymptomatic bacteriuria in pregnancy puts you at increased risk for
- Pyelonephritis
- Preterm labor
- Low Birth weight
Tx. Cephalexin, Augemtin, Nitrofurantoin, Fosfomycin
Tx Bartholin Cyst in young women
Observation since spontaneous drainage & resolution should occur. If sxs, then I&D.
Neonate w/ jaundice, decreased activity, poor feeding, hoarse cry. Increased TSH, decreased T4.
Congenital hypothyroidism. most are asx. ID through newborn screen. Most common cause is THYROID DYSGENESIS (aplasia, hypoplasia, ectopic gland). Tx LEVO
Gait Ataxia, frequent falling, dysarthria, concentric HCM, DM, scoliosis, hammer toes
FRIEDREICH ATAXIA, AR, sxs dev before 22, 90% die from CM and respiratory complications.
Sensorineural hearing loss, cataracts (leukocoria), PDA
Congenital Rubella (german measles) from 1st semester Maternal-fetal transmission rubella
Stable pts with chest pain in the ER get
Oxygen, IV access, ECG, CXR and if low risk aortic dissection they get ASA
5 mo w/Severe ID, Seizures, musty body odor, hypopig skin, hair, eyes, brain nuceli
phenylketonuria, AR mut in phenylalanine hydroxylase, increased phenylalanine and neuro injury
dx. Newborn screen or quantitative AA analysis
What meds can benefit the slow cognitive decline of Alzheimer’s disease?
reversible Ach inhibitorys like donepezil, rivastigmine, and galantamine
FAP screen colonoscopy
begin age 10-12, every year, elective protocolectomy or protocolectomy if have CRC or adeomas with high grade dysplasia
Lynch
being 20-25, q 1-2 years
IBD
being 8 years post dx (12-15 if only in L colon), colonoscopy q 1-2years
Start oxygen on COPDers with
- PO2 <56 SaO2 <89
2. PaO2 <60 SaO2 <90 if Cor pulmonale, RHF, HCT >55
high MCHC and Red blood cell distribution width, hemolytic anemia, jaundice, splenomegaly, spherocytes on smear, negative coombs, increased osmotic fragility on acidified glycerol lysis test, abnormal eosin 5 maleimide binding
Hereditary spherocytosis, AD, N Europe descent
Multiple System Atrophy (Shy-Drager)
Parkinsonism, Autonomic dysfunction, widespread neuro signs (Parkinsonism with ortho hypotension, ED, incontinence etc)
Tx. volume expansion with fludrocortisone, salt, alpha agonists, and constrictive garments
Hyponatremia and serum osm <290, urine osm <100
primary polydipsia, malnutrition
Down syndrome pt with UMN findings
atlantoaxial instability
early diastolic murmur Left sternal border think
AR, bounding pulses
4 month old with biphasic stridor that improves with neck extension
vascular ring (Vs Laryngomalacia inspiratory stridor worse when supine, improve when prone)
Which meds contraindicated w/PDE5 Inhibitors
Alpha blockers and nitrates
PAS +, Tdt + (B and T prelymphoblasts)
ALL
Alcoholics with cerebellar dysfunction have
Gait instability, truncal ataxia, difficulty with RAM, hypotonia, intention tremor
Most common fractures in pediatric pop from fall on outstretched hand and most common complication
Supracondylar fracture of the humerus. Entrapment of the brachial artery or median nerve.
Beneficial drugs with CHF
Beta blocker
ARB/ACEi
ASA
Sprinonolactone (NYHA class II,IV)
Uterine surgeries that have a TOL contraindicated
Classical C Section, Abdomincal myomectomy with unterine cavity entry
Secondary raynauds
2/2 connective tissue disease, occlusive vascular conditions, drugs, vibrating tools, hyperviscosity, nicotine. Usually in men >40, asymmetric w/sxs underlying disease, tissue injury or digital ulcers, abnormal nail fold capillary exam. Work up: CBC, BMP, UA, ANA, RF, ESR, C3, C4
HGSIL on pap in pregnant lady, what do do next?
Means CIN 2, CIN3, so all pts need an immediate colposcopy, if inadequate colpo then endocervical curretage. Deferred in pregnancy.
A 5 year old w/incomplete immunity to varicella is exposed, what next?
if didn’t have 2 doses VSV at 1 and 4 yo then PEP w/VSV vaccine indicated for incompletely immunized children >1 who was exposed in previous 5 days. If cannot receive live vaccine (prego or IC) then PEP with varicella IG. Infacnts <1 need neither.
Young adult with pain, swelling, and decreased ROM at involved sites, presents as osteolytic lesions “soap bubble” appearance on radiographs
Giant cell tumor bone
Most common heart defect in Down syndrome
Complete AV septal defect. HF in early infancy, SEM due to increased pulmonary flow from the atrial septal defect and holosytolic murmur due to VSD. Also loud S2.
Tx Bacillary angiomatosis
2/2 gram - bartonella, tx erythromycin
HIV prophylaxis
CD4<200 - TMP/SMX for PJ
CD4<100 - TMP/SMX for TG
CD4<50- Azith for MA
CD4<150 - Itraconazole for histo in areas endemicc
Painful non itchy pustules and honey crusted lesions
non bullous impetigo, from staph a or step p, tx topical mupirocin
CHF, proteinuria, and LVH without HTN
Amyloid CM (restrictive)
pregnant woman with intense pruritis (esp soles, palms) in 2nd/3rd trimester, with elevated bile acids, LFT.
Intrahepatic cholestasis of pregnancy.
female child with precocious puberty and ovrian mass
granulosa cell tumor. malignant. secrete estrogen.
Situs inversus, recurrent sinusitis, and bronchiesctasis
Kartagener syndrome
Pancreatic pseudocyst w/symptoms (ab pain, vomiting, infections, pseudoany)
tx. Endoscopic drainage procedure (no SXS then NPO and expectant)
What is genitopelvic pain/penetration d/o (previously know as vaginismus)?
Pain w/vaginal penetration. Distress/anxiety over sxs, no other medical cause. Tx. Desensitzation or kegels.
Which treatment of graves dx can worsen eye disease in pt?
Radioactive iodine
Why graves dx treatment should not be used in pregn?
methimatzole
SE PTU in graves?
hepatic failue
CML vs leukemoid rx?
CML leuk count >100K, BCR-ABL fusion, low LAP, less mature neutrophils (myelocyes), present absolute basophilia
Caustic ingestion nxt steps
ABC
Decontaminate
CXR
Endoscopy 24 hours
Child with palpable purpura, arthritis/arhralgias, ab pain, intussusception, renal disease (+hematuria and RBC Casts +/- proetinuria)
Henoch Schonien purpura
tx. Supportive (hydration, NSAIDS), hospital with steroids if severe sxs
MIddle aged man, superficia unilateral hip pain exacerbated by external pressure to the upper lateral thigh (like when lying down on that side)
Trocanteric bursitis
Unilateral bloody nipple discharge even if on an antipyschotic
intraductal papilloma
1st line tx fibromyalgia
1st aerobic ex, good sleep, the TCA 1st line drugs
Most common predisposing factor for orbital cellulitis (proptosis, opthalmoplegia, diplopia)
bacterial sinusitis
Crescendo-decrescendo murmur at lower L sternal border
HOCM (worse with valsava, better with squat)
Tx CN tox (house fire)
Hydroxocobalamin, sodium thiosulphate, if antidote not available then nitrates to induce methemoglobinemia
Tx acute bronchitis (which can have blood)
symptomatic
thrombocytopenia in lupus 2/2
immune mediated destruction
WPW with a fib and RVR tx With
unstable: cardioversion
stable:procainamide
Note Beta blockers, CCV, dig, adeno (increase conductiON through accesory pathway)
Aortic stenosis physical exam findings
- Pulsus parvus and tardus
- Mid to late peaking systolic murmur
- Soft and single second heart sounds (S2)
48 yo with thin vulvar skin, narrowed introitus, and dry vaginal canal. Irritation and dysparenunia.
Atrophic Vaginitis vulvovaginal atrohpy from estrogen deficiency in the setting of Radioation/CMT and menopause. (Vs Lichen sclerosus does not affect vagina)
Hypomagnesemia can cause
hypocalcemia, especially in alcoholics. Low Mag causes decreased release PTH and PTH resistance. Not associated with elevated Phos.
Tx Afib 2/2 hyperthyroidsm
beta blockers
Elderly man with dysphagia, regurgitation, foul smelling breath, aspiration, occasionally a palpable fluctuant neck mass
ZENKERS, dx with contrast esophagram. tx surgery.
Symptoms/signs of orbital cellulits vs preseptal
Orbital: - Opthalmoplegia - Pain with extraocular movements - Proptosis - Vision impairment tx with iv abx
granulomas and narrow based budding yeast
histo tx. itraconazole or amph B
most common brain tumor in children
pilocytic astrocytoma, can be supratentorital (seizure, weakness, sensory changes) or in posterior fossa (increased ICP, early AM vomiting, HA/papilledema)
Changes in pregnancy
decreased serum creatinine, 2/2 increased renal blood flood, GFR, and BM permeability. Find decreased BUN, Cr, and increased renal protein excretion.
35 y/o w/ >3 tetanus toxoid doses get a clean/minor or dirty/severe wound what next?
Just give tetanus toxoid containing vaccine (last dose 10 clean, 5 non clean)
unimmunized or uncertain
then tetanus toxoid containing vaccine (No TIG if clear or minor and TIG if dirty or severe)
TCA OD tx w/
ABC’S then sodium bicarbonate to improve BP (leading cause of death) and shorten QRS to prevent arrythmia
Freidreichs Ataxia
AR, necrosis and degenration of cardiac fibers leading to mycocarditis, myocardial fibrosis, and CM, trinucleotide repeat, dgen mult spinal cord tracts, loss DTR, muscle weakness, vibration and proprioception loss, dtaggering gait, frequent falling, nystagmus, dysarthria, pes cavus, hammer toes, DM
Hyperviscosity, neuropathy, bleeding, HSM, lAD, increased IGM, rouleaux, >10% clonocal B cells
Waldenstrom macroglobulinemia
