Week 1 Flashcards
MELD score components and what its used for
Bili, INR, Cr, Na
Gives 90 day mortality risk liver disease
Treatment principle of acute hep B
Outpatient followup with serial labs…most cases spontaneously resolve
Rates of hep B progressing to chronic hepatitis (Adult, child, perinatal)
Adult <5%
Child 20-50%
Perinatal 90%
Best therapy for negative symptoms of schizophrenia
Social skills training
2nd generation antipsychotics are no longer recommended for negative symptoms
How do anginal symptoms differ in elderly (>80yo)?
Often present with SOB rather than chest pain
“SOB with exercise that resolves with rest” as opposed to CP with exercise that resolves with rest
Most important risk factor in AAA expansion/rupture
Smoking
Treatment of choice for localized dystonic reactions (blepharospasm)
botox
Chest pain in a SLE patient. Think…
CAD/MI
SLE leads to accelerated atherosclerosis, thus making it a HUGE risk factor for MI at early ages. (also think of pericarditis too)
3 benign calcification patterns in lung nodules
Popcorn
Concentric
Central
(all these things are mostly symmetric, which is good)
2 requirements for hospice care
Prognosis <6mo
Decided to forgoe all life prolonging tx
2 complications of scaphoid fractures if not adequately treated
Non union
Necrosis
At what gestational age should external cephalic version be offered?
> 37 weeks because most will spontaneously correct before then
3 main contraindications to ECV
Placental pathology
Multigestation
IUGR
(active herpes)
3 EGD findings associated with pernicious anemia
Atrophic rugae in FUNDUS
Glandular atrophy
Intestinal metaplasia
Triad of TTP
Hemolytic anemia (jaundice)
AMS
Petechial rash
Asthma patient develops recurrent episodes of cough, brown/bloody sputum…think:
Allergic Bronchopulmonary Aspergillosis
Treatment for ABPA
STEROIDS FIRST!!!
Then itraconoazole/Voricon (ampho if systemic)
PFTs for obstructive lung disease
FEV1 reduced
FEV1/FVC reduced
PFTs for restrictive lung disease
FEV1 decreased
FVC decreaed
FEV1/FVC normal or increaed
First step in managing shoulder dystocia
Mcroberts –> Hyperflexion of moms hips
Then add suprapubic pressure
How many kcal/kg/day is recommended for average adult getting NG feeds?
30kcal/kg/day
What infectious disase is lichun planus associated with?
Hepatitis C
Osmotic stool gap calculation
290 - 2x(StoolNa + StoolK)
Stool osmolar gap interpretation
Low <50, secretory diarrhea
High >125 osmotic diarrhea (lactose, celiac)
3 MCC of AOM
Strep pneumo > non typeable H flu»_space; moraxella
Diaphragmatic paralysis presents with:
Orthopnea
FVC is worse when laying down than it is while standing…basically, it presents with heart failure without the edema
2 ways to confirm h pylori erradicaition
Stool antigen test or urea breath 4wks after treatment
What medication must you discontinue before any procedure with large amounts of IV contrast? i.e. cardiac cath
Metformin –> risk of lactic acidosis increases dramatically with all the contrast
2 EKG findings consistent with prior MI
T wave inversion
Q waves
What meds do every post-MI patient get?
BB
ACE/Aspirin
Statin
CREST syndrome
Calcinosis Raynaud Esophageal dysmotility Sclerodactyly Telangectasias
What must all scleroderma patients be worked up for?
ILD and Pulm HTN
Schizoid
Social withdrawl..weird person. DOESNT really want friendships (vs avoidant)
Schizotypal
Eccentric, Magical thinking, weird
Antisocial
Violent, breaks rules, exploits others, fails to take responsibility
“Narcissistic + Agressive”
Borderline personality
Self harm, impuslive, LOTS OF BAD RELATIONSHIPS
Fear of abandonment
Histrionic
Excessive emotions, attention seeking, Sexual
Avoidant personality disorder
Feeling of rejection, low self esteem, loner, WANTS to have relationships (vs schizoid)
Malingering vs Factitious
Malingering - Secondary gain “work note”
Factitious - Primary gain “sick role”
4 different Diagnostic criteria for DM
A1c > 6.5
Fasting glucose >126
Random Glucose >200 w/ symptoms
GTT >200
How to differentiate neurosyphillis as being secondary or tertiary stage
Early neurosyphillis is secondary - Meningitis and ocular symptoms
Late neurosyphillis is tertiary - dementia, tabes dorsalis
What does a high C peptide mean in someone who is hypoglycemic?
They have high insulin levels that is being ENDOGNOUSLY made (not exogenous insulin injectinos)
I.e. - Insulin stimulating medications (sulfonylurea) or insulinoma
2 lab values to indicate severity of pancreatitis
BUN
Hematocrit
Endocrine side effect of SGLT2 inhibitors
Euglycemic DKA –> they have an AG acidosis, glucosiura, ketonuria, but a normal glucose level…wtf?
Preeclampsia definition
New onset HTN <140/90 with protinuria or other end organ damage (pulm edema, neuro defecits)
When to get a RAIU
Any case of primary hyperthyroidism (Low TSH, High T4)
High vs Low RAIU uptake
High = Graves Low = Thyroiditis, Stroma Ovarii
Ultrasound clue that mother has placental insufficency
Reversal of blood flow or increased vascular resistance in the umbilical arteries
(baby will also be IUGR, +/- oligohydramnios)
INDUCE DELIVERY
Etiology of symmetric vs asymmetric IUGR
Symmetric = chromosome problems, infection
Asymmetric “head sparing”= placental insuff
Which 3 groups of people need are at high risk for bacterial endocarditis?
Artificial valve
Congenital heart disease
Prior IE
3 surgical situations that a high risk cardiac patient would require abx ppx
Dental work
Respiratory tract procedures
Surgery in setting of active infection
Electrolyte triad in adrenal insufficiency
HyperK
HypoNa
Metabolic Acidosis
Someone was exposed to HIV, but test directly after exposure was negative. What do you do and why?
Repeat testing in a month, because of the WINDOW period…antibody titers will be too low within the first month you can get a false negative
Before starting HAART, what must you screen the patient for?
Hepatitis B –> some HAART meds treat both HIV and HepB, so they can be used if they are also hep b pos
Interpreting Cobb Angle
<10, normal. Observe
10-40- back brase
>40- surgery
Most important prognositc indicator in primary CNS lymphoma in HIV patients. why?
Start HAART –> improvement in CD4 count
Because the CNS lymphoma itself is secondary to severe immunosuppression
How does a hematoma in <2yo raise suspicion for TBI?
any non-frontal hematoma is suggestive of underlying TBI
Teen pregnancy is associated with what 3 complications?
Preterm delivery (preterm preg)
Low birth weight (teens are light)
Gastrochesis/Omphalocele
What is the most effective birth control method
Progestin subdermal implant…even better than an IUD!
Side effects of progestin implants
Breakthrough bleeding
Weight gain
Vaccines and patients recently recieving IVIG…what do you do?
Delay any live vaccines for 1 year after IVIG is given
2 main DDx for marfanoid habitus
marfan syndrome
homocystinuria
lens dislocation in marfan vs homocystinuria
marfan = up homocystinuria = down (cis configuration is down pointing)
management of lithium induced hypothyroid
Continue lithium, start Synthroid
UNLESS they haven’t tried any other mood stabilizers, and lithum hasn’t been working that well, then switch them
5 features of melanoma
Appearance Borders (irregular) Color (dark, different) Diameter >6mm Evolution
4 situations when pregnancy exercise is contraindicated
Risk of Preterm delivery (cervical isuff, pPROM)
Risk for antepartum bleed (previa, persistent 2nd/3rd trmester bleeding)
First step in workup of a woman >45 with AUB
Endometrial biopsy –> even though it is likely just menopause, you must rule out hyperplasia/cancer
Differentiate hand foot mouth from herpangina
HFMD- Lesions on tongue, buccal mucosa
herpangina- posterior oropharynx
HFMD vs HSV infection
HFMD lesions on bilateral hands, lips usually spared
HSV usally affects one hand, has lip/perioral involvement
What does the antibody screen tell you in a pregnant woman?
it tells you whether alloimmunization has occured…i.e. does she have Rh+ antigen exposure?
GIVE RHOGAM FOR NEGATIVE AB SCREEN
Timing for giving rhogam
28-32weeks
<72h post delivery
First line treatment for Urticaria
H1 blocker
Incidental adrenal mass- what do you do?
even if asymptomatic, must screen for hyperfunction and malignancy
ALL the tests - Electrolytes, Dex suppression test, Urine catecholamines, 17keto steroid levels
When do adrenal masses need to be removed?
1- hyperfunctioning
2- >4cm or other features of malignancy on imaging
How to interpret jones criteria
2 major criteria = Positive RF
Joint issue Cardiac issue Nodules Erythmea nodosum Sydenham chorea
2 factors in family history that increase an individuals risk for colon cancer
Any relative with Colon CA <60yo
> 2 first degree relatives with Colon CA at any age
MEN1
Pituitary
Parathyroid
Pancreatic
MEN2A
Parathyroid
Pheochromocytoma
Medullary Thyroid
MEN2B
Pheochromocytoma
Marfanoid
Medullary Thyroid
Kid with SSD comes in with acute pain crisis then develops chest pain. What do you do?
START CTX/AZITHRO…he has acute chest
How long do antidepressants take to have initial efect?
6 week
Cryoglobulinemia triad
Palpable Purpura
Renal Disease
Arthralgias
IN A PATIENT WITH HEP C
How to decrease CO2 on vent
Increase RR
Decrease TV
How to affect O2 on a vetn
PEEP > FiO2
Lights Criteria for transudate
LDH (fluid) <2/3 serum
LDHf/LDHserum <0.6
Proteinf/Protein(serum) <0.5
All 3 must be true to be a transudate
Definition of subclinical hypothyroid
Elevated TSH (on 2 measurements)
Norrmal T4
Mild or absent symptoms
MCC of restless leg syndrome
Iron deficency
First 2 meds every heart failure patient needs to be on
ACEi (AT MAXIMUM DOSE)
Beta Blocker
When is the only time you give tetanus immunoglobulin?
Dirty wound + unimmunized/unsure/<3 Td shots
How do you workup subclinical hypothyroid?
Based on TSH
If TSH >10, start levothyroixine
If TSH<10, get anti TPO ab –> if pos, start levothyroixine
Nelson Syndrome
Pituitary enlargement after removal of adrenals for adrenal cushings
Low cortisol = High ACTH = Pituitary growth
Threshold for bhcg in ectopic pregnancy
1500
If less than 1500, repeat in 48hrs
What is CURB65 and when to use it
To stratify bacterial PNA severity
Confusion
Uremia
Respiratory rate elevated
Blood pressure low
age>65
Based on CURB65 score, when should patient be admitted vs outpatient treatment
Anything 1 or greater needs admission
Greater than 3 needs ICU
Prognosis for sarcoidosis (uncomplicated)
1 year of steroids, then the majority of cases resolve and do not recur
What is CHADSVASc and when do you use it?
Determining thromboemoblism risk in Afib
CHF HTN Age >75 (2 pts) DM Stroke/TIA (2) Vascular disaese Age 65-74 (1 pt)
interpreting CHADSVASc
0 = no anticoag 1 = oral anticoag 2= Warfarin or rivoraxaban
Best med for long term treatment of varices
Beta blockers
Differentiateing acute stress disorder from PTSD
ASD is 3d-1mo
PTSD is sx >1mo
How long do you continue IV insulin in DKA?
Until BGL is <200 and the acidosis has resolved
What do you do in DKA if the BGL normalizes, but patients till has acidosis
They still need to be on IV insluin b/c of the acidosis…So you half the infusion rate and add dextrose to the fluids. Continue until acidosis resolves then stop IV and start long acting insulin
Roseaca treatemnt
Topical metronidazole
Treatment of Cdiff
Oral Vanc or Oral Fixaxomicin
NO LONGER USING METRONIDAZOLE
Management of thyroglossal duct cyst
Surgical removal (cysts have high risk of becoming infected)
Diet recommendations for gastroenteritis
Regular diet with limited sugars (sugar is osmotically active)
NO LONGER THE BRAT DIET
Ginkgo bill a major side effect
Bleeding
Single greatest risk factor for osteoporosis
Age
Sjogrens Antibodies
Anti SSA/SSB, Ro/La
MCC of cancer in Sjogren
B cell non Hodgkin lymphoma
Highly suspicous of a SAH, but CT is normal. Why? and what do you do?
CT is only good within the first few hours…patients that try to “wait out the pain” may actually have normal CT.
Get an LP to look for xanthochromia
How to differentiate 21 hydroxylase from 17 or 11 hydroxylase deficiency
21OH def has HYPOtension and hyperkalemia
The rest have HYPERtension and hypokalemia
Why doesn’t 11hydroylase deficency cause hypokalemia?
Because you still have weak mineralocorticoid activity (11deoxycortisone), which will prevent salt wasting
Patient has dermatomyositis, what should you be worried about in the big pictur?
Underlying malignancy
Dermatomyositis is heavily associated with malignancy
3 things Angiodysplasia is most commonly associated with
Aortic Stenosis
ESRD
VWD
All these things make you more likely to have bleding diathesis
Tx for first vs multiple recurrence of C.diff
Vanc again for longer period, or do fidaxomicin
Multiple- Vanc + Fidaxomicin +/- fecal transpalnt
When do you use flagyl for c.diff?
Fulminant cdiff (megacolon, hypotension, sepsis)
When is CCK stim test used?
Classic signs/symptoms of biliary colic, but no stones on ultrasound
Treatment for catatonia
Benzos
Treatment for akathesia
Propanolol
Treatment for tardive dyskinesia
Tetrabenazine
Workup for nipple discharge (3 steps)
Unilateral? NEEDS WORKUP
If <30, get ultrasound
If >30, get ultrasound + mammogram
Patient with URI symptoms, sore throat, gets amoxicillin an develops rash…think
MONO (classic rash after amoxicillin)
4 things that suggest scoliosis is pathologic
Back Pain (particularly waking up at night)
Progression (worsening cobb angle)
Neurologic Symptoms
Vertebral anomalies
MCC of death in Tuberus Sclerosis
Neurologic impairment (either tumor burden itself, or uncontrollable seizures from the tumors)
Treatment rule for cleft palate
Rule of 10s
10lbs, 10wks, 10g hemoglobin
Onset of multiple skin tags is associated with
Insullin resistence
Treatmnt for mom with HIV during pregnancy (known prior to deliver vs known at time of delivery)
Known prior - HAART for entire preg
Known at delivery- Zidovudine for mom
What role does zidovudine have in HIV pregnancy
Baby alwas gets it, mom gets it if she was HIV unknown prior to delivery
Vaginal or Csection delivery for HIV mom?
Viral load < 1000 can be viral
