Week 4 Flashcards
Mechanism of action of clopidogrel?
P2y12 receptor blocker
NSTEMI drug eluting stent rec?
Dual anticoagulation therapy for 12 months
Mechanism of action of colchicine and role in cardio?
Tubulin inhibitor - can be involved with pericarditis treatment
Hip pain mostly with pressure while sleeping in middle age man?
Trochanteric bursitis
Elevations of transaminases with skin findings of PCT?
Suspect HCV
Diagnosis of suspected PCT
increased plasma and urine porphyrins
Extrapulmonary TB sites?
Lymph nodes, liver, bones, CNS
Most common cause of viral meningitis?
Enterovirus (coxackie B)
After getting high level of fingerstick lead in child, what follow up test?
Venous lead - high false positive in fingerstick
When to chelate for lead?
> 45 ug/dL
Pink stains or brick dust in neonatal diapers
uric acid crystals, normal in newborn
Normal amount of weight ot lose in first 5 days of life?
Up to 7%
Brick urine with other abnormalities
Lesch Nyan syndrome
AD characteristic neuroimaging finding?
Medial temporal lobe atrophy
Altered mental status, oculomotor dysfunction, and gait ataxia with hyperemesis gravidarum?
wernicke’s encephalopathy - thiamine
Major blood finding of hyperemesis gravidarum?
Hypochloremic metabolic alkalosis, hypoglycemia, elevated liver enzymes
Effusion with highly elevated triglycerides?
Chylothorax from dysruption of lymph flow - lymph has T cell lymphocytes, immunoglobulins, and lipi-transporting chylomicrons
How does glucagon counteract too much b-blockade or calcium channel blockade?
Increases intracellular levels of cAMP
Treatment of over b-blockagde
First IV fluids and atropine, then IV glucagon
Liver cyst and bloody diarrhea after travel?
E. histolyica - treat with metronidazole and paromycin
What labor related drug can cause seizures?
Oxytocin, related to ADH in structure and can cause water toxicity
How to treat organophosphate toxicity
atropine and remove clothing as organophosphate can be absorbed through skin
First line for treatment of PCP intoxication?
Benzodiazepines
Huntington’s chorea MRI finding?
Atrophy of the caudate nucleus
Retinoblastoma path?
Inactivation of RB1 - tumor suppressor gene
Adult onset seizure or increased ICP with cystic lesion with surrounding enhancement and edema at various stages of development (D/Tr)
Neurocystercosis due to ingested eggs hatching and invading - treat with antiepileptics, albendazole, and corticosteroids
Rapid pain relief from cancerous bony mets?
Radiation therapy
Fever >39 in child <3?
Think occult UTI - do a straight cath
CURB-65?
Confusion, Urea Nitrogen >20, respirations >30, Blood pressure hypotensive, >65 yo, >3 hospitalized for pneumonia with fluoroquinolone or beta-lactam and macrolide
Outpatient treatment of CAP?
Macrolide or doxy for healthy, fluoroquinolone or betalactam + macrolide in comorbidity
Distinguish primary adrenal insufficiency from steroid use -
PAI usually has hyperkalemia due to concurrent mineralocorticoid deficiency
Dosage of steroids needed for adrenal suppression?
> =20mg/day
On top of CAP with CNS or GI dysfunction, what other findings are classic for Legionaire’s disease?
Hyponatremia, brady relative to fever, and mild hepatits
Treatment for Legionairre’s
macrolide or fluoroquinolone
Hyposthenuria?
Inability of the kidneys to concentrate urine
Hyposthenuria in SCD path?
Blood cells sickle in the vasa recta, impairing free water reabsorption and countercurrent exchange
Distinguish hyposthenuria from DI?
Normal serum sodium in hyposthenuria due to intact function of ADH
Trimethoprin electrolyte deregulation in HIV patient?
Hyperkalemia by blocking ENaC (and also causes non-AKI Cr bump) - check potassium serially
Acute shortness of breath, obstipation, abdominal distension, with pelvic/abdominal pain with a firm, nonmobile pelvic mass with nodularity and BRCA positive?
Suspect epithelial ovarianc cancer, needs exploratory laporotamy and CA125 levels - don’t biopsy due to possible rupture and spread
How to prevent preterm delivery in hx of preterm labor or rupture of membranes?
Intramuscular progesterone, serial cervical length measurements, potentially cerclage
Blue bulging vaginal mass and cyclical lower abdominal pain in a girl who has not yet menstruated?
Imperforate hymen
Associated neoplasms of Lynch syndrome?
Colorectal, endometrial, ovarian
Associated neoplsasms of FAP?
Colorectal, desmoids/osteomas, brain tumors
A1ssociated neoplasms of von Hippel-Lindau?
Hemangioblastomas, clear cell renal carcinoma, pheochromocytoma
Cause of Lynch syndrome
DNA mismatch repair gene
Assymptomatic scattered erythematous macules, papules, and pustules on a neonate?
Erythema toxcicum neonatorum - bening and no treatment
Do OCP’s cause weight gain?
No, can cause hypertension, venous thromboembolism, or cervical cancer
Treatment of choice for adjustment disorder?
Psychotherapy
Acute MS exacerbation?
First glucocorticoids - plasmapheresis only if refractory
Infectious hepatic cyst if patient is afebrile with daughter cysts to initial cys?
Echinococcus grandulosum - treat with albendezole, dx with IgG serology
Signs of renovascular disease?
Diffuse atherosclerosis, asymmetric kidney size, recurrent flash pulmonary edema, elevation in serum Cr >30%
Erythema of nasal mucosa with increased energy and mood changes as well as weight loss?
Cocaine
Neuro deficits and palpable step off in a kid with back pain?
Spondylolisthesis - forward slip of vertebrae, usually L5 over S1
Who should be screenied for chlamydia and gonorrhoeae?
All sexually active women <24 yrs old
Neck pain and limited rotation with sensory deficit in arms?n
Cervical sponylosis - sensory deficits caused by osteophye-induced radiculopahty
Mass causing precocious puberty? Probably granulosa cell tumor -
Look for estrogen and inhibi
Cardiomyopathy in the face of persistent tachycardia?
Aggressive rate control or restoration of sinus rhythm
Why is there signs of hemolysis on B12 deficiency?
INcreased intramedullary hemolysis of megaloblasts
How does clubbing occur?
Megakaryocytes that skip pulmonary circulation - trapped in distal fingers and release VEGF and PDGF
Keep a PDA open? close it?
PGE1 to keep it open, indomethacin to close
How does supplement O2 cause seizures in chronic COPD?
Loss of compenatory vasocontriction of lungs - increased oxyhemoglobin reduces uptake of CO2, decreased respiratory drive - causes cerebral vasodialtion and can alter consciousness level via upreg of GABA/glutamine
Main risk factors of aneurysm expansion?
Cigarette smoking, hypertension only has weak association with AAA
Indeterminate TVUS for elevated B-hCG -
Check B-hCG in 2 days - should be approx 1500-2000
Atypical glandular cells on a Pap test?
Cervical or endometrial adenocarcinoma - colposcopy, endocervical currettage, and endometrial biopsy
Back pain during testicular cancer?
Retroperitoneal lymph nodes
Interstitial infiltrates, serous pleural effusion, and a rash (D/Tr)
Mycoplasma pneumoniae - azithromycin
Persistent ST-segment elevations in the months following an MI with symtoms of heart failure?
Ventricular aneurysm
Side effect of malabsorption like Crohn’s?
Increased oxalate absorbtion due to decreased fat absorbtion as calcium binds the fat and oxalate is free to be absorbed
Complication of mono?
Airway obstruction
Hawthorne effect
tendency of a study population to affect the outcome due to being studied
Normal at birth but then develop apathy, weakness, hypotonia, large tongue, abdominal bloating?
Hypothyroidism, screened for in all states
Therapy for central precocious puberty that has no findings on MRI?
GnRH
Percentage of hypothyroid patients presenting with myalgias/myopathy
1/3
Lithium exposure to infant?
Ebsteins abnormality (atrialization of right ventricle) in first trimester, goiter and transient neuromuscular dysfunction in 2nd and 3rd
Abdominal pain, lower extremity purpura, arthritis, and hematuria in a kid -
Henoch-Schonlein purpura, IgA medited vasculitis of small vessels
Antipsychotic with highest potential to increase prolactin?
Risperidone
Painful and painless genital ulcers?
Painful and small - herpes
Painful and large - h. ducreyi
Painless and single - syphilis
Painless and small shallow - chlamydia L1-L3 (lymphogranuloma venereum, can progress to buboes)
Med to help pass a kidney stone?
Alpha blocker
Reduce risk of microvascular complications -
macrovascular not firmly established
Closed fists with overlapping fingers?
Edwards syndrome
Absence of epidermis over skull, holoprosencephaly, microopthalmia, omphalocele?
Trisomy 13
Mortality rate in edwards first year
95%
Hyperviscosity, neuropathy, and infiltrative disease (end organ damage) with a monoclonal M-spike of IgM?
Waldenstom’s macroglobulinemia - need to see >10% clonal B cells on bone marrow biopsy
What are examples of tissue infiltration symptoms?
Hepatosplenomegaly, lymphadenopathy, cytopenias
P/F in ARDS
<300 mmHg
Are PAC’s a big deal?
No, stop stimulation and only work up in absence of obvious precipitants
Mono symptoms with leukocytosis and variant lymphocytes with a large vacuolated cytoplasm?
Mono - heterophile antibodies specific b ut not sensative in early course of illness
Leukmoid vs leukemia?
High leukocyte alkaline phosphatase score suggests leukmoid - also more late neutrophils and lack of absolute basophilia
Why does follicular thyroid cancer typically mets?
Key feature is invasivenes to blood vessels
Exogenous thyroid hormone finding?
Decreased serum thyroglobulin
After reprefusion of a limb, what should you be watching for?
Compartment syndrome
Source of exophtalmos in Grave’s?
T cell activation and stimulation of orbital fibroblasts by TRAB
Use dependence of class 1C antiarryhtmic drug
flecainide used in afib blocks sodium channels inhibiting phase 0 - with faster heart rates, drug has less time to dissociate so it blocks more channels and widens QRS complex - mechanism of efficacy controlling supraventicular arryhtmias
Risk factor for achilles tendonopathy?
Fluoroquinolone use, corticosteroids, organ transplant
Fluoroquinolone mechanism of action?
Direct inhibition of DNA synthesis
When to get CA-125 level?
With the pelvic ultrasonography
Pain and knee crepitus with overuse in young female?
Patellofemoral pain syndrome - quad strengthening exercises
Chronic oligoarthritis, daily fever, and rash in a young child?
Systemic-onset juvenile idiopathyic arthritis
Findings of juvenile arthritis?
Leukocytosis, thrombocytosis, elevated ESR and CRP and anemia
When to do chorionic villus sampling vs. fetal karyotyping?
CVS - 10-13 weeks, after, fetal karyoptyping, both DIAGNOSTIC tests
Intolerable itching during pregnancy? Lab findings? Treatment?
Intrahepatic cholestasis of pregnancy - highly elevated liver enzymes and total bile acid - treat with ursodeoxycholic acid and early delivery - still need to rule out hepatitis
Severe liver issues with nausea and vomitting, hypoglycemia, and encephalopahty in third trimester of pregnancy?
Acute fatty liver of pregnancy
Red papules with striae sparing the umbillicus in third trimester of pregnancy?
Pruitic urticarial papules and plaques of pregnancy
Distinguish Bruton’s agammaglobulinemia from common variable immunodeficiency?
B cells levels - Bruton’s low due to tyrosine kinase defect
Genetics of Brutons
X-linked
Post-exposure prophylaxis for pertussis?
Macrolides
Endocarditis prothestic most likely colonization?
Staph aureus or epidermidis
Endocarditis gingival manipulation?
Strep viridans
Endocarditis with uti?
Enterococcus
Who gets prophylaxed for dental procedures?
Past IE
Cause of folate deficiency in alcoholics?
Disrupts enterohepatic cycle and inhibits absorbtion
Effect of estrogen on thyroid
Increase T4-binding globulin - increased total T4
Effect of estrogen on thyroid?
Increase T4-binding globulin - increased total T4
Cirrhosis effect on hormones
Hypogonadism
Pancreatitis path after stenting?
Cholesterol emboli
Path of Kallmann syndrome?
Disorder of migration of fetal olfactory and GnRH celsl
TSH in pregnancy?
Down - hCG stimulates TSH on its own
First line treatment for diffuse esophageal spasm?
Calcium channel blockers
What if intramuscular epinephrine does not fully control anaphylaxis?
Give it again
Intermittent claudication is a strong predictor of future what?
Cardiovascular morbidity and mortality
Drug for treating urge incontinence?
Antimuscarinics like oxybutynin
First line treatment for chemotherapy induced nausea?
Serotonin receptor antagonists like odansetron
Complications of subarachnoid hemmorhage by timing:
24 hours- Rebleeding
3-10 days: Vasospasms
Prevention of vasospasm after SAH
Nimodipine
Diagnostic criteria of acute liver failure?
Severe acute liver injury evidenced by elevated denzymes, signs of hepatic encephalopathy, and impaired synthetic function (INR>=1.5)
Differentiate ALF from acute hepatitis?
Presence of epatic encephalopathy
Liver mass in old man with exposure to toxins
Hepatic angiosarcoma
Biliary obstruction, jaundice, pruritus, light-colored stool, and liver mass
Cholangiocarcinoma
Most common primary liver cancer?
Hepatocellular carcinoma in chronically inflamed liver
Low grade fever, violaceous water skin lesions, and moderate pulmonary infection. Other sites of infection?
Blastomyces dermatiditis. Bone, prostate, CNS
Can disseminated infection occur in blasto in immunocompoetent patients?
Yes
Dx of fetal arrest?
No cervical change for >= 4 hours with adequate contractions, no cervical change >=6 hours with inadequate contractions
Empiric prophylaxis for bacterial meningitis per age group:
2-50 - strep pneumo and neisseria - vanc and cefepime
>50 - add amp for listeria
Immunocompromised - add amp - also suspect GNR’s
Neurosurgery/penetrating trauma - vanc and cefepijme
First line for narcolepsy?
Modafinil - nonamphetamine wakefulness drug
Causes of secondary hypogonadism?
Mass lesions (prolactinemia), long term use of glucocorticoids or opiods, or severe systemic illness
Most common cause of constrictive pericarditis in developing countries?
TB
Refractory hypokalemia
check magnesium - mg inhibits renal secretion via ROMK channels and low levels leads to excess secretion
Normal growth by 1 year?
Triple weight, height increase by 50%
Bright, sharply demarkated erythema in the perianal region
Streptococcal perianala dermatitis from GAS
Differentiate GBS from tick nuerotoxin disease?
GBS usually has autonomic dysfunction
Treatment for EPS effects of antipsychotics by type:
Dystonia: Benztropine or diphenhydramine
Akasthisia: B-blocker, benzo, or benztropine
Parkinsons: Benztropine or amantadine
Tardize: Valbenazine
First line for neuropathic pain control in patient >65?
Pregabalin, less side effects
First line for generalized anxiety disorder:
SSRI’s OR SNRI’s like venlafaxine
How does the kidney adapt to pregnancy?
How does the kidney adapt to pregnancy?
Pentad of TTP?
Thrombocytopenia, MAHA, renal insufficiency, neuro changes, fevers
Stork bite in infant?
Nevus simplex
Type of hemangioma that gets bigger in first year of life? Treatment if in a bad spot?
Superficial, infantile hemangioma, b-blockers
Why are MM patients prone to infection?
Hypogammaglobulinemia due to bonemarrow infiltration of neoplastic cells
Dx of gram negative sepsis in burn patient?
Quantitative wound culture and biopsy for histopathology
Snuffles, maculopapular rash, and abnormal long-bone radiographs in neonate with hepatosplenomegaly?
Congenital syphillis
Differentiate Giant cell arteritis from Takayatsu’s?
Age >50 for giant, <50 for takayasu’s
Constitutional symptoms and cardio complications with mass in right atrium?
Cardio myxoma
Preterm labor management by week:
<32 weeks - betamethasone, tocolytics, magnesium sulfate
32-34.0 - betamethasone and tocolytics
Patient is prematurely in labor, what to give?
Magnesium sulfate - reduces incidence of CP
Tocolytics?
Indomethicin first line, nifedipine second line
Dx of malaria?
Thick and thin blood smears with Giemsa stains
Vascular cuntaneous lesions in HIV+ homeless person?
Bacilliary angiomatosis from bartonella due to lice
Kind of Cushing’s that produce hypokalemia?
Ectopic ACTH producing tumors
Hepatic hydrothorax
Pleural effusions from small defect in diaphram
Isoniazid hepatitis management?
If it looks bad, d/c immediately, if not too bad, don’t worry about it
After stroke, give what?
Aspirin, plus clopidogrel if recurrent stroke (or dipyridamole)
Treating symptomatic polycythemia in infant?
NS trasfusion
Length of cervix, visa vi preterm labor risk, is established by what test?
Transvaginal ultrasound
Most common hematologic finding in polyarticular juvenile idiopathic arthritis?
Anemia
Can neisseria gonorrhoeae cause pharyngitis?
Yes
Antithyroid immune side effects?
Agranulocytosis due to immune destruction of granulocytes
Testing for a child post bacterial meningitis?
Audiologic testing for common damage to cochlea
pyloric stenosis workup?
Ultrasonography
Symptoms of hypocalcemia during repiratory alkalosis?
Due to increased binding of calcium on albumin as hydrogen dissocaites
Advise patients with recurrent kidney stones to do what?
Lower salt in diet
Why do SS patients get hematuria?
Renal papillary necrosis
Injury for hemicord with sensory loss to belly button?
T8, remember that spinothalamic tract decussates 1-2 levels before crossing
How do CCB’s cause edema?
Preferential dilation of precapillary vessels
What can be given with CCB’s to reduce risk of edema?
ACEi’s, postcapitallary venodilation
Expansile and eccentric lytic area of bone (“soap bubble”)
Giant cell tumor
Multiple “brown” tumors and cysts
osteitis fibrosa cystica
Bloody diarrhea with no fever? Best test
E. Coli, stool assay for Shiga toxin
Prolonged diffuse diarrhea causes?
Giardia, cryptosporidium parvum, and cyclospora
Prolonged, profuse travellers diarrhea?
Cryptosporidium parvum
Cafe au lait spots, bone fractures, and precocious puberty?
McCune-Albright - G protein activiation
Pronator drift indication?
Pyramidal/corticospinal tract disease - UMN’s cause more weakness in supinators than pronators
