Woo studying Flashcards
1
Q
Light criteria defining exudative pleural effusion
A
At least 1 of the following:
[Pleural fluid protein]/[Serum protein] > 0.5
[Pleural fluid LDH]/[Serum LDH] > 0.6
Pleural fluid LDH > 2/3 upper limit of nml serum LDH
2
Q
Anti-AChR
A
Myasthenia gravis
3
Q
Anti-basement membrane
A
Goodpasture syndrome
4
Q
Anti-cardiolipin
A
SLE,
Antiphospholipid syndrome
5
Q
Anti-centromere
A
Limited scleroderma (CREST syndrome = Calcinosis, Raynaud’s, Esophageal dysmotility, Sclerodactyly, Telangiectasias)
6
Q
Anti-desmosome
A
Pemphigus vulgaris (Includes oral mucosa, +Nikolsky's, Intraepidermal IC deposits) PemphiguS = Superficial
7
Q
Anti-hemidesmosome
A
Bullous pemphigoid (Spares oral mucosa, -Nikolsky's, Epidermal-dermal jxn IC deposits) PemphigoiD = Deep
8
Q
Anti-dsDNA, Anti-Smith
A
SLE
9
Q
Anti-glutamic acid decarboxylase
A
T1DM
10
Q
Anti-histone
A
Drug-induced SLE
11
Q
Anti-Jo-1, Anti-SRP, Anti-Mi-2
A
Polymyositis, Dermatomyositis
12
Q
Anti-microsomal
A
Hashimoto thyroiditis (also anti-TG)
13
Q
Anti-mitochondrial
A
Primary biliary cirrhosis
14
Q
ANA
A
Nonspecific (SLE usually)
15
Q
Anti-parietal cell
A
Pernicious anemia
16
Q
Anti-Scl-70
A
(AKA anti-DNA topoisomerase I)
Diffuse scleroderma
17
Q
Anti-smooth muscle
A
Autoimmune hepatitis
18
Q
Anti-SSA/-SSB
A
Sjogren’s syndrome
19
Q
Anti-TSHR
A
Graves’ disease
20
Q
Anti-U1 RNP
A
Mixed CT disease
21
Q
IgA anti-endomysial/-tissue transglutaminase
A
Celiac disease
22
Q
p-ANCA
A
(AKA MPO-ANCA)
Micro-PAN, eosinophilic granulomatosis w/ polyangiitis (Churg-Strauss syndrome)
23
Q
c-ANCA
A
(AKA PR3-ANKA)
Wegener’s granulomatosis w/ polyangiitis
24
Q
IgM targeting IgG Fc region
A
(AKA RF)
RA
(RF is not as specific for RA as anti-CCP)
25
Febrile nonhemolytic transfusion rxn
1-6h post-transfusion
Fever/chills
Due to cytokine accumulation during storage
26
Acute hemolytic transfusion rxn
Within 1h post-transfusion
Fever, flank pain, hemoglobinuria, AKI, DIC
Due to ABO incompatibility
Positive direct Coombs
27
Delayed hemolytic transfusion rxn
2-10d post-transfusion
Mild fever, hemolytic anemia
Due to anamnestic Ab response
Positive direct Coombs, Positive new Ab response
28
Anaphylactic transfusion rxn
```
Rapid onset (sec-mins) shock, angioedema/urticaria, respiratory distress
Due to recipient anti-IgA Abs
```
29
Urticarial/allergic transfusion rxn
2-3h post-transfusion
Urticaria, flushing, angioedema, pruritus
Due to recipient IgE Abs, mast cell activation
30
Transfusion-related acute lung injury
Within 6h post-transfusion
Respiratory distress, noncardiogenic pulm edema
Due to donor anti-leukocyte Abs
31
Pleural fluid pH
Normal ~7.60
Transudative 7.4-7.55
Exudative below 7.45
32
TTP cause, symptoms, treatment
(Thrombotic thrombocytopenic purpura)
Due to acquired autoAb against ADAMTS13 (would cleave vWF from endothelium; plts get caught near endothelium and form microthrombi)
Fever, Neurologic changes, AKI, MAHA, Thrombocytopenia
Treat w/ plasma exchange; 9/10 die w/o treatment
33
HIT cause, symptoms, risk
Due to Abs against PF4-Hep complex which activates plts to cause thrombus formation and plt consumption --> thrombocytopenia, venous/arterial thrombi, necrosis at heparin sc injection site, anaphylaxis to injections
Highest risk w/ unfractionated heparin
34
Metabolic alkalosis ddx
Low (vomiting, prior diuretics) vs High urine Cl
If high urine Cl, hypervolemic (excess mineralocorticoid activity: hyperaldosteronism, Cushing's, ectopic ACTH) vs hypo-/euvolemic (Current diuretics vs Bartter, Gitelman)
Vomiting, diuretics are saline-responsive
Mineralocorticoid or renal syndromes are saline-unresponsive
35
SIADH labs
```
Serum diluted: Hyponatremia
Hypotonic serum (under 275mOsm)
```
Urine concentrated: Urine osmolarity over 100
Urine Na over 40
36
Dermatomyositis symptoms, disease associations
Proximal symmetric extremity weakness
Heliotrope rash, Gottron's papules (scales over joints), CPK over 10x ULN
Assoc w/ internal malignancies - do age appropriate screenings
37
Lactose intolerance test
Lactose hydrogen breath test
38
Leukomoid rxn vs CML
Leukomoid rxn:
WBC over 50, High LAP, Mature PMN precursors, No basophilia
CML:
WBC over 100, Low LAP, Immature PMN precursors, Basophilia
39
Trihexyphenidyl
Anticholinergic Rx for symptomatic Parkinson's
| May cause acute angle closure glaucoma
40
AIHA vs Hereditary spherocytosis
AIHA has a negative FHx and positive Coombs' test
41
Difference between case-control and retrospective cohort studies
Case-control: Determine outcome first, then look for associated risks
Retrospective cohort: First ascertain risk exposure, then determine outcome
42
Expected FEV1 change with bronchodilators in asthma
At least 12%
43
Acid-base compensations
MetAc: Winter's formula (Exp paCO2 = 1.5 * [HCO3=] + 8 +/-2)
MetAlk: Exp PaCO2 +0.7 for every +1 HCO3-
Acute RespAc: Serum HCO3- +1 for every +10 PaCO2
Acute RespAlk: Serum HCO3- -2 for every -10 PaCO2
44
D-xylose test
Monosaccharide absorbed in proximal small bowel without degradation by pancreatic or brush border enzymes before urinary excretion
Low abs = proximal small bowel disease (Celiac's)
45
Cross-sectional study
Collects data from a group of people to assess disease frequency at a particular point in time
May show risk association, but not causality
"What's happening?"
Measures prevalence
46
Case-control study
Compares group with disease to a group without disease
Looks for prior exposure/risk
Retrospective
"What happened?"
Measures odds ratio: OR = [(a/c)/(b/d)] = (ad)/(bc)
47
Cohort study
Compares initially disease-free people in two groups to see who develops disease: one with exposure/risk, and one without exposure/risk
Can show if exposure/risk increases disease likelihood
Retrospective OR prospective
"Who will develop/developed disease?"
Measures relative risk: RR = [a/(a+b)]/[c/(c+d)]
48
Twin concordance, adoption studies
Measure heritability and environmental influence
Mono- vs dizygotic twins
Siblings with biological vs adoptive parents
49
Clinical trial phase goals
I: Is it safe?
II: Does it work?
III: Is it as good or better than current treatments?
IV: Can it stay?
50
Odds ratio
Odds that a group with disease was exposed to a risk divided by the odds that the group without the disease was exposed
OR = (a/c)/(b/d) = (ad)/(bc)
Typically used for case-control studies
51
Relative risk
Risk of developing disease in the exposed group divided by risk in the unexposed group
RR = [a/(a+b)]/[c/(c+d)]
Typically used in cohort studies
If prevalence is low, OR ~ RR
52
Attributable risk
Difference in risk between exposed and unexposed groups, i.e. proportion of disease occurrences attributable to an exposure
AR = a/(a+b) - c/(c+d)
53
Relative risk reduction
Proportion of risk reduction attributable to an intervention as compared to a control
RRR = 1 - RR = 1 - [a/(a+b)]/[c/(c+d)]
54
Absolute risk reduction
Difference in risk attributable to the intervention as compared to the control
ARR = c/(c+d) - a/(a+b) = -AR
55
Number needed to treat
NNT = 1/ARR (treat has more letters than harm)
56
Number needed to harm
NNH = 1/AR
57
Recruiting biases, examples, fix
Selection, sampling, referral, allocation bias
E.g. Berkson bias - study population is from a hospital and less healthy than the general population
Healthy worker effect - (opposite of Berkson)
Non-response/differential f/u - nonrespondents may differ from participants meaningfully
Randomize to reduce
58
Procedure bias, example, fix
Subjects in different groups are not treated the same
Includes detection bias: Those with a risk factor undergo greater diagnostic scrutiny than those without the risk
Use blinding and placebos to reduce
59
Recall bias, fix
Awareness of disorder alters recall by subjects
Common in retrospective studies
Decrease time from exposure to follow-up to reduce
60
Observer-expectancy bias, example, fix
Researcher's belief in a treatment's efficacy changes outcomes
AKA Pygmalion effect or self-fulfilling prophecy
Use blinding and placebos to reduce
61
Confounding bias, fixes
Factor is related to both exposure and outcome, but not the causal pathway
Reduce with multiple/repeat studies, matching of patients with similar characteristics in both control and treatment groups, crossover studies where subjects act as their own controls
62
Lead-time bias, fix
Early detection is confused with increased survival
Especially important for studies of long-term chronic disease
Reduce by measuring back-end survival by controlling for disease severity at time of diagnosis
63
Hawthorne effect
AKA observer effect
| Subjects tend to change their behavior when they know they're being observed
64
alpha definition
Probability of making a type I error (finding a difference between control and experimental groups when one does not exist)
65
beta definition
Probability of making a type II error (stating there is no difference between control and experimental groups when one does exist)
beta increases as alpha decreases
66
Power
1 - b
| Increases as beta decreases: Increased precision, increased effect, or INCREASED SAMPLE SIZE
67
t-test
Checks differences between the MEANS OF 2 GROUPS
| E.g. BP between males/females
68
ANOVA
Checks differences between the MEANS OF AT LEAST 3 GROUPS
| E.g. BP between members of 3 ethnic groups
69
Chi-square test
Checks differences between 2 or more PERCENTAGES OR PROPORTIONS OF CATEGORICAL OUTCOMES
E.g. Percentage of members of 3 ethnic groups with HTN
70
Ordinal data
Data ordered by a position on a scale
Usually categorical - cannot perform arithmetic with these
E.g. Runners finishing in 1st, 3rd, 5th places
Qualitative - Non-parametric
71
Interval data
Data measured along a scale in which each position is equidistant
Quantitative - Parametric
Allows for distances between data points to be equivalent in a way
E.g. Happiness scale from 1-10 or Runners finishing a 5k between 18:00-18:59, 19:00-19:59, 20:00-20:59, etc.
72
Nominal data
Data differentiated by a simple naming system
Usually categorical - E.g. "employee"
May have a number assigned, but is not ordinal (E.g. Runner's ID number or an athlete's jersey number)
Qualitative - Non-parametric
73
Ratio data
Data in which numbers are multiples of each other and can be mathematically compared. Zero has a meaning on the scale used for this data
E.g. Runner's finishing time for a race
Quantitative - Parametric
74
Continuous data
Measured along a continuous scale allowing for infinitely fine subdivision
Vs. discrete where data falls into bins like with interval data
75
Parametric data
Quantitative, forms predictable distributions (e.g. normal)
| Can use arithmetic to gain insight into the datasets
76
Non-parametric data
Qualitative, does not assume any distribution
77
Likelihood ratio for a positive test
Sensitivity/(1-Specificity)
78
Likelihood ratio for a negative test
(1-Sensitivity)/Specificity
79
Sensitivity
Chance a test detects disease when it is present
(True-positive rate)
a/(a+c)
TP/(TP+FN)
80
Specificity
Chance a test indicates no disease when none is present
(True-negative rate)
d/(b+d)
TN/(TN+FP)
81
Positive predictive value
Proportion of positive test results that are true positives
a/(a+b)
TP/(TP+FP)
82
Negative predictive value
Proportion of negative test results that are true negatives
d/(c+d)
TN/(TN+FN)
83
Incidence
New cases occuring during a particular time period
| N(new cases)/N(at risk)
84
Prevalence
Number of people affected by a disease at a given point in time
N(w/disease)/N(population)
Increases w/ incidence
Decreases w/ death of affecteds and recovery
85
Standard error of the mean
Used for samples of a population
| SEM = s/sqrt(n), where s = stddev of sample
86
Correlation coefficient
r
Always between -1 and 1
More negative = stronger negative correlation, etc.
87
Coefficient of determination
r^2
Always between 0 and 1
Represents the amount of variance in the dependent variable (y) due to the independent variable (x):
y = a + bx
88
Psych Rx SEs
1st gen: Extrapyramidal symptoms, hyperprolactinemia (also risperidone)
2nd gen: Metabolic syndrome (weight gain, dyslipidemia, new T2DM) - esp. olanzapine, clozapine
Ziprasidone - Long QT
89
Clozapine indications, SE
Treatment-resistant or suicidal schizophrenia
SE: Agranulocytosis, SZ, myocarditis, metabolic syndrome
90
DSM-5 psychosis disorders
Brief psychotic - less than 1m w/ full return of fxn
Delusional - delusions over 1m w/o other psychotic symptoms and w/ nml fxn
Schizophreniform - less than 6m of schizophrenic sx
Schizophrenia - at least 6m w/ 1m active sx and functional decline
Schizoaffective - Schizophrenia + concurrent mood episode + at least 2w psychosis w/o mood sx
91
Major depression signs and symptoms
```
SIGECAPS
Sleep changes
Interest deficit (anhedonia)
Guilt
Energy deficit
Concentration deficit
Appetite changes
Psychomotor changes
Suicidality
```
92
Depressed mood ddx
Major depressive disorder - at least 2w, 5 of SIGECPAS, fxn impairment, no mania/drug/medical hx
Adjustment disorder w/ depressed mood - Within 3m of identifiable stressor
Normal stress response - Not excessive, no fxn impairment
93
Bipolar 1 vs Bipolar 2
Bipolar 1 - Manic episodes: Severe sx, over 1w, marked fxn impairment, psychotic features
Bipolar 2 - Hypomanic episodes: Less severe sx, over 4d, impairment not severe enough to be hospitalized, no psychotic features
94
Differentiating bipolar disorder and major depressive disorder w/ psychotic features vs schizophrenia vs schizoaffective disorder
Bipolar and MDD w/ psychotic features have psychosis only during mood disturbances
Schizophrenia has psychosis w/o mood disturbances
Schizoaffective has major depressive episode concurrent w/ schizophrenia sx
95
NMS management
Discontinue offending antipsychotic, supportive care
| Add dopaminergic Rx (bromocriptine, amantadine) to reverse blockade if necessary
96
Nightmare disorder vs non-REM sleep terrors
Nightmares: Full awakening from REM w/ alertness and dream recall
Non-REM: Partial arousal, unresponsiveness, no recall of dream content
97
Postinfectious glomerulonephritis vs IgA nephropathy
PIGN: 1.5-3w post-infxn, more common in kids, gross hematuria
Low C3, elevated anti-streptolysin O/anti-DNAse B, subepithelial humps of C3 deposits
IgA nephropathy: within 5d of infxn, young adult males, recurrent gross hematuria
Nml complement, mesangial IgA deposits
98
First test w/ suspected acromegaly?
IGF-1 - Responsible for most of GH effects
| GH is too variable to make decisions
99
Primary manifestations of Chagas' disease
Megacolon/megaesophagus
| Cardiac disease 2/2 prolonged protozoal myocarditis
100
Winter's formula
For determining appropriate respiratory compensation for metabolic acidosis:
Expected paCO2 = 1.5 * [HCO3-] + 8 +/- 2
101
Weber test
Tuning fork on midline skull
Conductive hearing loss: Lateralizes to affected ear
Sensorineural hearing loss: Lateralizes to unaffected ear
102
Rinne test
Normally, tuning fork over mastoid, then in outside EAM until no longer heard
Abnormal if can't hear outside EAM = Conductive hearing loss
103
Paranoid
Suspicious, distrustful, hypervigilant
104
Schizoid
Prefer loner, detached, unemotional
105
Schizotypal
Eccentric, odd thoughts/perceptions/behaviors
106
Antisocial
Disregards/violates others' rights
107
Borderline
Chaotic relationships, sensitive to abandonment, labile mood, impulsive, inner emptiness, self-harm
108
Histrionic
Dramatic, superficial, attention-seeking
109
Narcissistic
Grandiose, lacks empathy
110
Avoidant
Avoids interaction due to fear of criticism/rejection
111
Dependent
Submissive, clingy, needs to be taken care of
112
Obsessive-compulsive personality disorder
Rigid, controlling, perfectionistic (ego-syntonic)
113
Acute dystonia, treatment
(EPS from blocking D2Rs)
Sudden sustained cntrxn of neck, mouth, tongue, eye mm
Treat w/ benztropine, diphenhydramine
114
Akathisia, treatment
(EPS from blocking D2Rs)
Subjective restlessness, inability to sit still
Treat w/ b-blocker (propranolol) or BZD (lorazepam)
115
Drug-induced Parkinsonism, treatment
(EPS from blocking D2Rs)
Gradual-onset tremor, rigidity, bradykinesia
Treat w/ benztropine, amantadine
116
Tardive dyskinesia, treatment
(EPS from blocking D2Rs)
Gradual onset mouth/face/trunk/extremity dyskinesia after 6m Rx
Remove offending agent, Clozapine least likely to cause issues
117
Somatic symptom disorder
Excessive anxiety/preoccupation w/ unexplained sx
118
Illness anxiety disorder
Fear of having serious dx despite few sx, neg evals
119
Conversion disorder
Neuro sx incompatible w/ known dx
| Often acute onset assoc w/ stress
120
Factitious disorder
Intentional falsification or inducement of sx to assume sick role
121
Malingering
Falsification or exaggeration of sx to obtain external incentives
122
SSRIs, SE
Fluoxetine, paroxetine, sertraline, citalopram, escitalopram, fluvoxamine
Sexual SEs, SIADH
123
SNRIs, major SE
Venlafaxine, desvenlafaxine, duloxetine
| Discontinuation/withdrawal syndrome
124
NDRI, CIs, benefits
Bupropion
CI - SZ disorder (Lowers seizure threshold), Bulimia (Worsens electrolyte abnmlities)
No sexual SEs
125
TCAs
Amitriptyline, nortriptyline
126
MAOIs
Phenelzine, tranylcypromine
127
Social anxiety disorder
Anxiety restricted to social/performance situations, fear of scrutiny/embarrassment
128
Panic disorder
Recurrent, unexpected panic attacks
129
Specific phobia
Excessive anxiety about specific object/situation
130
Generalized anxiety disorder
Chronic multiple worries
131
Wallenberg syndrome
Lateral medullary infarction from blocked vertebral a:
Vestibulocerebellar sx (vertigo, nystagmus, IL limb ataxia)
IL loss of face + CL loss of limbs P/T/CT
Dysarthria, dysphagia
IL Horner's, loss of automatic respiration
132
Medial medullary syndrome
ASA or vertebral a occlusion
| CL limb paralysis + IL CN XII (lick your wounds)
133
Medial mid-pontine infarction
CL ataxia, hemiparesis of face+trunk+limbs, variable loss of CL tactile+position
134
Gonococcal urethritis vs chlamydial urethritis, testing, pregnancy
Gonorrhea will gram stain w/ G- cocci in vast majority of cases
Chlamydia cannot be visualized or cultured - requires DNA amplification testing
Chlamydia is in std initial prenatal screening
Gonorrhea is only indicated for high risk preg women (under 25y, multiple partners, STI hx)
135
Auer rods are specific for?
AML
136
When to start COPD patients on home oxygen?
Uncomplicated: Resting PaO2 under 55 or O2sat under 88%
| Complicated by cor pulmonale or Hct over 55%: Resting PaO2 under 59 or O2sat under 89%
137
How to assess ARDS severity
PaO2/FiO2 ratio
Under 300: ARDS
Under ~50: Severe ARDS
138
Syphilis treatment in those w/ penicillin allergies
If neurosyphilis, pregnant, or other treatment failures: Desensitize and use Pen G
If primary: Doxycycline x14d
139
Heart block and diastolic murmur in an IVDU?
Perivalvular abscess involving conducting tissues
140
Fluoxetine name, common SE
Prozac
| Weight gain, birth defects (cardiac)
141
Paroxetine name, benefit
Paxil
| Long half-life of 1-3d better for those who may have poor adherance
142
Buspirone mech
5-HT and D2R agonist
| Anxiolytic
143
Felty syndrome
Triad of inflammatory arthritis, splenomegaly, and neutropenia
Most common in those with long-standing severe RA
144
Anemia of prematurity, cause, labs
Most common anemia in preterm infants
D/t low Epo, short RBC lifespan, and blood loss
Labs: low Hb, Hct, retics
145
Beckwith-Wiedemann syndrome cause, pres, complications, monitoring
D/t gene on c11
Hemihyperplasia, macrosomia, rapid growth, macroglossia, omphalocele/umbilical hernia
Increased risk of Wilms tumor, hepatoblastoma - monitor w/ AFP, US
146
McCune-Albright syndrome
5% of female precocious puberty, assoc w/ other endocrine abnmlities
3Ps: Precocious puberty, Pigmentation (cafe-au-lait spots), Polyostotic fibrous dysplasia (bone defects)
147
ALL
Lymphoblasts on smear lack peroxidase (myeloblasts) but do stain PAS+ and contain TdT
May also have pancytopenia, LAD, splenomegaly
148
HUS
Hemolytic anemia + thrombocytopenia + AKI
| Most common in toddlers after diarrheal illness caused by Shiga-toxin producing bacteria
149
Legg-Calve-Perthes disease
Osteonecrosis of femoral head usually in boys 4-10yo
150
Slipped capital femoral epiphysis
Displaced femoral neck from femoral head
| Most often in obese adolescents (12-14yo)
151
Transient synovitis
Mild chronic hip/knee pain of insidious onset (usually post-viral illness and max 4wk) w/ uneven gait W/O PATH ON X-RAY
(Dx of exclusion)
152
Kawasaki disease sx, treatment
5d of fever
B/l nonexudative conjunctivitis
Mucositis (strawberry tongue, no exudates)
Cervical LAD (often u/l)
Rash (generalized, erythematous, polymorphous)
Extremity changes (edema)
Treat w/ ASA and IVIG to reduce coronary artery aneurysm risk
153
Scarlet fever sx
```
Complication of untreated Strep pharyngitis:
Fever
Tonsillar exudates
Cervical LAD
Rash ("sandpaper" sparing palms/soles)
```
154
Niemann-Pick disease sx, cause
```
Sphingomyelinase deficiency
2-6m
Areflexia
HSM
Cherry-red macula
Hypotonia
Dev regression
```
155
Tay-Sachs sx, cause
```
b-hexosaminidase A deficiency
2-6m
Cherry-red macula
Hypotonia
Dev regression
Hyperreflexia
```
NO HSM or areflexia
156
RTA 1 defect, cause, labs
Non-anion gap MetAcid
Poor H+ secretion into urine (distal RTA)
D/t genetic disorders, med tox, or autoimmune
Low-nml serum K
Urine pH over 5.5
157
RTA 2 defect, cause, labs
Non-anion gap MetAcid
Poor HCO3- resorption from urine (proximal RTA)
D/t Fanconi syndrome (glucosuria, phosphaturia, aminoaciduria)
Low-nml serum K
Urine pH under 5.5
158
RTA 4 defect, cause, labs
```
Non-anion gap MetAcid
Aldosterone resistance
D/t obstructive uropathy, congenital adrenal hyperplasia
High serum K
Urine pH under 5.5
```
159
Endometriosis
Pain 1-2wk prior to menses peaking before menstruation
| Triad of dysmenorrhea, dyspareunia, infertility
160
REM sleep disorder sx, assoc
Complex motor behaviors during REM due to absent muscle atonia
Usually latter part of the night (non-REM is earlier)
Assoc w/ neuro degen in PD, Lewy body dementia
161
Bereavement major depressive episode treatment
Psychotherapy + SSRI
162
First trimester screen
Screens for trisomies 18, 21 risk (not diagnostic)
| F/u w/ amniocentesis (15-20w) or CVS (10-13w) if abnml
163
Goal of HCV treatment
Limit risk for future liver damage - avoid IVDU, EtOH; HepA + B vac if not given
164
Causes of increased maternal serum AFP
Open neural tube defects
Ventral wall defects (omphalocele, gastroschisis)
Multiple gestation
165
Causes of decreased maternal serum AFP
Aneuploidy (esp. trisomies 21, 18)
166
Severe features of preeclampsia, tests
```
SBP over 160, DBP over 110
Thrombocytopenia
High Cr
High LFTs
PULM EDEMA
Visual/cerebral sx
```
Confirm proteinuria by urine protein/Cr ratio or 24h collection
167
Anemia in pregnancy, complications
Nml for dilution of Hb, but anemic if under 11 in 1/3 and 3/3, 10.5 in 2/3
Anemia can cause poor perfusion and subsequent lactic acidosis (anion gap)
168
Oxytocin SE
Hyponatremia (similar structure to ADH, can cause SZ)
Hypotension
Tachysystole
169
Signs of anterior shoulder dislocation
D/t direct blow or FOOSH
| Arm slightly abducted, externally rotated
170
Signs of posterior shoulder dislocation
D/t violent muscle contractions
| Arm adducted, internally rotated, flattened anterior shoulder aspect
171
Ovarian masses increase risk of?
Ovarian torsion
172
Missed abortion
No bleeding
Closed os
No fetal cardiac activity or empty sac
173
Threatened abortion
Vaginal bleeding
Closed os
Fetal cardiac activity
174
Inevitable abortion
Vaginal bleeding
Dilated os
Products of conception may be seen/felt at/above os
175
Incomplete abortion
Vaginal bleeding
Dilated os
Some products of conception expelled, some remain
176
Complete abortion
May or may not have vaginal bleeding
Closed os
Products of conception completely expelled
177
Protracted labor, treatment
Slower than expected cervical change w/ or w/o contractions
| Give oxytocin
178
Arrested labor, treatment
No cervical change for 4h w/ adequate ctrxns (over 200 MVUs) OR for 6h w/ inadequate ctrxns
C-section
179
Causes of asymmetric fetal growth restriction
Placental insufficiency in 2/3 or 3/3, e.g. HTN, pregestational DM
These cause hypoxemia and head-sparing growth pattern
180
Causes of symmetric fetal growth restriction
Congenital disorders (aneuploidy, 1/3 infxns)
181
Fetal hydantoin syndrome, cause
```
Small body size
Microcephaly, midfacial hypoplasia
Digital/nail hypoplasia
Hirsutism
Cleft palate
Rib anomalies
D/t anticonvulsants (e.g. phenytoin)
```
182
Congenital syphilis sx
Rhinitis
HSM
Skin lesions
Later Hutchinson teeth, saddle nose, saber shins, deafness, CNS sx
183
Cocaine in pregnancy
Placental abruption
| Can lead to fetal loss, CNS dysfxn due to hypoperfusion
184
Tamoxifen risks
Hot flashes
DVT
Endometrial hyperplasia/carcinoma (only SERM w/ this risk)
185
Age to begin Pap smears
21y
186
HPV vax schedule
Beginning at 11-12y, but can be received until 26y
187
Stress incontinence cause, sx
D/t decreased sphincter tone
| Leakage w/ straining
188
Urge incontinence cause, sx
D/t detrusor overactivity
| Sudden overwhelming urge to urinate
189
Overflow incontinence cause, sx
D/t impaired detrusor contractility or bladder outlet obstruction
Incomplete emptying w/ persistent involuntary dribbling
190
Congenital rubella syndrome
```
Deafness
Cardiac defects
HSM
Microcephaly
Cataracts
```
191
Mg SE
```
Hyporeflexia
Lethargy
Headaches
Resp failure
Cardiac arrest
Sx start above 8
```
192
Quad screen tests and timing, f/u
Performed in 2/3 (15-20w)
Maternal serum AFP, b-hCG, estriol, inhibin A are tested
F/u w/ cell-free fetal DNA testing (higher sens, spec)
193
Trisomy 18 quad screen results
Low MSAFP, b-hCG, estriol
| Nml inhibin A
194
Trisomy 21 quad screen results
Low MSAFP and estriol
| High b-hCG and inhibin
195
Neural tube/abd wall defect quad screen
High MSAFP
| Nml b-hCG, estriol, and inhibin A
196
Placenta previa management
```
Pelvic rest (no intercourse, digital exam) to decrease risk of disruption, painless bleeding
Schedule C-section for 36-37w unless resolution shown on u/s prior
```
197
Combined OCP risks and benefits
Benefits: Contraception, endometrial and ovarian CA risk reduction, menstrual regulation, benign breast disease risk reduction
Risks: DVT, HTN, hepatic adenoma, (CVA, MI - slight)
198
Hydatidiform mole pres, tests
Preeclampsia sx before 20w, enlarged uterus
| Elevated b-hCG
199
Complete mole cause, risk
D/t 1 or 2 sperm fertilizing an egg that has no DNA (46chr)
| Choriocarcinoma risk
200
Incomplete mole cause
D/t haploid egg being fertilized by a sperm that duplicates it's DNA (69chr)
Minimal choriocarcinoma risk
201
Fitz-Hugh Curtis syndrome
Perihepatitis as a sequela of PID
202
Secondary amenorrhea def, eval
```
Absence of menses for 3cyc/6m in those w/ prior periods
Exclude pregnancy (b-hCG), then serum prolactin (brain MRI), TSH (hypothyroid), FSH (premature ovarian failure)
```
203
Ovarian torsion ddx
Appendicitis, pelvic abscess, ectopic preg
Torsion may not have fever or leukocytosis, risk w/ ovarian mass hx, no b-hCG elevation
204
LBBB ECG
Widened QRS (over 120ms) w/ 2+ deflects to L leads (V6) and +/- deflects to R leads (V1)
205
RBBB ECG
Widened QRS (over 120ms) w/ 2+ deflects to R leads (V1) and +/- deflects to L leads (V6)
206
Kussmaul sign
Increased JVP w/ inspiration
| Seen in cardiac tamponade, constrictive pericarditis
207
S3 indicates? Assoc?
Fluid overload (as in CHF, MV disease) causing rapid ventricular filling
Nml in younger patients, high output states (preg)
Dilated cardiomyopathy association
208
S4 indicates? Assoc?
Decreased compliance causes sound of atrial kick
Nml in younger patients, athletes
Hypertrophic cardiomyopathy association
209
Bounding peripheral pulses may indicate?
AR, Aortic coarc, PDA,
210
Cardiac tamponade signs
```
Kussmaul sign (up JVP w/ inspiration)
Pulsus paradoxus (down sysBP w/ inspiration)
Pulsus alternans (alternating weak/strong pulse d/t impaired LV systolic fxn)
```
211
Pulsus parvus et tardus indicates?
AS
212
CHADS-VASC score
(CHA2DS2-VASc)
Estimate CVA risk in AFib - give anticoagulation for score over 2:
```
CHF - 1
HTN - 1
(Age over 75y) - 2
DM - 1
(Stroke) CVA/TIA hx - 2
Vasc disease hx - 1
Age 65-74y - 1
Sex (female) - 1
```
213
AFib management
```
ABCD
Anticoagulate
b-blockers (rate control)
Cardiovert/CCBs
Digoxin (in refractory cases)
```
214
2nd deg AV block types, signs, treatments
Mobitz I/Wenckebach - Progressive PR lengthening until dropped QRS, d/t drugs (digoxin, b-block, CCBs), increased vagal tone, or R coronary a ischemia - stop drug, periodic atropine
Mobitz II/non-Wenckebach - Random dropping of QRS, d/t fibrosis of conduction system from prior MI - Needs pacemaker d/t frequent progression to 3rd deg block
215
Sick sinus syndrome pres, treatment
Tachy-/bradycardias may induce intermittent supraventricular tachyarrhythmias or bradyarrhythmias
May present w/ syncope, palpitations, dyspnea, angina, TIA, CVA - Most common reason for pacemaker
216
Causes of acute AFib
```
PIRATES
Pulm dx
Ischemia
Rheumatic heart dx
Anemia/Atrial myxoma
Thyrotoxicosis
Ethanol
Sepsis
```
217
Chronic and acute AFib treatment
Rate control - b-blockers, CCBs, or digoxin
Anticoagulate w/ warfarin for those w/ CHA2DS2-VASc over 2
Unstable or new-onset (under 2d) - cardiovert
(Over 2d or unclear) - get TEE to rule out atrial clot
218
Multifocal atrial tachycardia cause, signs/sx, ECG, treatment
Multiple atrial pacemakers/reentrant pathways. Often d/t COPD, hypoxemia
At least 3 different P-wave morphologies, rate over 100bpm
Treat underlying disorder
Verapamil/b-blockers for rate control and suppression of atrial pacemakers (limited effectiveness)
219
AV node reentrant tachycardia (AVNRT) cause, signs/sx, ECG, treatment
D/t reentry circuit in AV node depolarizes atrium + ventricle simultaneously
Pres w/ palpitations, SOB, angina, syncope, lightheadedness
Rate 150-250bpm, BURIED P-waves
Cardiovert if unstable; Carotid massage, valsalva, or adenosine can stop arrhythmia
220
AV reentrant tachycardia (AVRT) cause, signs/sx, ECG, treatment
D/t ectopic connection between atrium + ventricle causing reentry circuit (seen in WPW)
Pres w/ palpitations, SOB, angina, syncope, lightheadedness
Retrograde P-wave seen after nml QRS (Pre-QRS delta wave in WPW)
Cardiovert if unstable
Carotid massage, valsalva, or AV nodal blockers (adenosine, b-blockers, CCBs) can stop arrhythmia
If in AFib, use procainamide/ibutilide
221
Paroxysmal atrial tachycardia cause, signs/sx, ECG, treatment
Rapid ectopic pacemaker in the atrium (not sinus node)
Pres w/ palpitations, SOB, angina, syncope, lightheadedness
Rate over 100bpm, P-wave w/ unusual axis BEFORE QRS
Adenosine to unmask underlying atrial activity by slowing rate
222
PVC causes
From ventricular foci d/t hypoxia, abnml electrolytes, hyperthyroidism
223
Acute CHF management
```
LMNOP
Lasix (furosemide)
Morphine
Nitrates
Oxygen
Position (upright)
```
224
Loop diuretics, mech, SE
Furosemide, ethacrynic acid (non-sulfa), torsemide
Block Na/K/2Cl transporter in ascending loop
Hypokalemia, hypocalcemia (Loops Lose Ca), gout flares, ototoxicity, dehydration
225
Thiazide diuretics, mech, SE
Hydrochlorothiazide, chlorothalidone
Block Na/Cl transporter in DCT -
Hypokalemic metabolic alkalosis, hyponatremia, hyperGLUC (hyperGlycemia, -Lipidemia, -Uricemia, -Calcemia)
226
K+ sparing diuretics, mechs, SE
Spironolactone, amiloride, triamterene
Block aldosterone receptor (spironolactone) or Na channels (amiloride, triamterene) in collecting tubule
Hyperkalemia, sexual dysfxn, gynecomastia
227
Carbonic anhydrase inhibitors, SE
Acetazolamide
| Hyperchloremic metabolic acidosis, neuropathy, NH3 toxicity, sulfa allergy
228
Osmotic diuretic, SE
Mannitol
| Pulm edema, dehydration
229
Angina treatment
ASA, b-blockers (shown to improve mortality)
| Nitrates
230
ACS treatment
MONA - morphine, O2, nitrates, ASA
| b-blockers as hemodynamics allow (avoid in R-sided MI)
231
Statin SE, indications
Those w/ CV hx, DM + 10y risk over 7.5%, or LDL over 190: high-intensity statin
Those w/ DM + 10y risk under 7.5%: mod-intensity statin
Those w/o DM or hx:
Over 7.5% 10y CV risk - high-intensity statin
5-7.5% 10 CV risk - mod-intensity statin
Increased LFTs, myositis, warfarin potentiation
232
HTN treatments
```
ABCD
ACEIs/ARBs
b-blockers
CCBs
Diuretics (usually thiazide)
```
233
Secondary HTN causes
```
CHAPS
Cushing syndrome
Hyperaldosteronism (Conn syndrome)
Aortic coarctation
Pheochromocytoma
Stenosis of renal aa
```
234
ST-elevations in pericarditis vs MI
MI - localized to ischemic area
| Pericarditis - global
235
AR exam, treatment
Blowing diastolic murmur, mid-diastolic rumble (Austin Flint murmur), WIDENED PULSE PRESSURE, water-hammer pulse
CCBs (DHPs) or ACEIs until severe enough to warrant valve replacement
236
Virchow Triad
DVT risk up d/t: Hemostasis, Endothelial damage, Hypercoagulability
237
Acute ischemia sx
6Ps:
| Pain, Pallor, Paralysis, Pulselessness, Paresthesias, Poikilothermia
238
How to determine severity of PVD?
Ankle-brachial index (ABI): Pleg/Parm
| Nml 1.0-1.2, Severe (rest pain) under 0.4
239
SCC vs BCC
SCC - erythematous hyperkeratotic ULCERATED papule/nodule arising from precursor AK (also: Marjolin's ulcer, As poisoning causing palmoplantar distribution) w/ faster growth, rare metastasis. More common on lower lip
BCC - most common, pearly nodule w/ umbilicated center + telangectasias, may be ulcerated/open, virtually no metastatic potential
240
DVT risk calculation, Rx
Wells score:
-2-0: Low risk, 1-2: Mod risk, 3-8: High risk
1 - Paralysis, recent LE casting
1 - Bedridden over 3d or major surgery last 4w
1 - Local tenderness
1 - Swelling of entire leg
1 - Calf swelling 3cm more than other leg 10cm below tib tuberosity
1 - Pit edema greater in symptomatic leg
1 - Collateral nonvaricose superficial vv
1 - Cancer active or within last 6m
-2 - Alt dx more likely (Baker's cyst, cellulitis, other vv stuff, etc)
If at least 2, U/S to confirm before anticoag
241
Primary hyperparathyroidism cause, labs
High PTH secreted by single adenoma (80%), diffuse hyperplasia (over 15%), or carcinoma (under 5%)
High PTH and Ca
Low PO4
242
Secondary hyperparathyroidism cause, labs
Renal insufficiency causes low production of 1-25(OH)2 vit D. Also can happen w/ vit D or Ca deficiency
High PTH
Low/nml Ca
High PO4 in setting of CKD
243
Tertiary hyperparathyroidism cause, labs
Hyperplasia of PT gland/s in dialysis patients w/ long-standing secondary hyperparathyroidism leads to autonomous PTH secretion
High PTH, Ca, PO4
244
Pseudohyperparathyroidism cause, labs
Target organs are resistant to PTH (genetic disorders)
High PTH
Low Ca
High PO4
245
Hypercalcemia sx, Rx
"Stones, bones, groans, psychiatric overtones"
IV fluids, then loop diuretics
Add bisphosphonates in malignancy +/- calcitonin
246
Hyperkalemia treatment
```
C BIG K
1st - Calcium gluconate
Bicarbonate, b-2 agonists
Insulin + Glucose
Last - Kayexalate (Na polystyrene sulfonate)
```
247
What to monitor w/ digitalis?
K+
| Hypokalemia can sensitize heart to digitalis toxicity (K+ and digitalis compete for same site on Na/K pump)
248
Factors causing K+ shift out of cells
Acidosis (exercise - lactic)
Cell lysis
Hyperosmolarity
249
If hypokalemia doesn't respond to K+ repletion, check what?
Mg levels may be low
250
Hypercalcemia causes
CHIMPANZEES
```
Calcium supplements
Hyperparathyroidism/Hyperthyroidism
Iatrogenic/Immobile
Milk-alkali syndrome
Paget disease
Adrenal insufficiency/Acromegaly
Neoplasm
Zollinger-Ellison syndrome (MEN 1)
Excess vitA
Excess vitD
Sarcoidosis/granulomatous dx
```
251
Anion-gap metabolic acidosis dx + Rx
MUDPILES
Methanol (vision loss, optic disc hyperemia) - Fomepizole (block liver conversion to toxic metabolite)
Uremia - Dialysis (aeioUy)
DKA - Insulin, IVF, K+
Paraldehyde
Iron, Isoniazid - GI lavage, charcoal (INH)
Lactic acidosis - IVF
Ethylene glycol (urine CaOx stones) - Fomepizole
Salicylates - Alkalinize urine
Use NaHCO3 in severe acidosis (under 7.2)
252
Hypomagnesemia causes, signs, Rx
Low intake - malnutrition, malabsorption, short bowel syndrome, TPN, PPIs
High loss - diuretics, diarrhea, vomiting, hypercalcemia, alcoholism (most common)
Misc - DKA, pancreatitis, ECF volume expansion
Concurrent hypocalcemia and hypokalemia
ECG - long PR + QT
IV/po supplements
Must correct low Mg to correct low K and low Ca
253
Urgent dialysis indications
AEIOU, sometimes Y
```
Acidosis
Electrolytes (high K+)
Intoxication (ASA, methanol, ethylene glycol, etc.)
Overload (fluid)
Uremia
Y not, nothing else is working
```
254
Determining acid-base status
Art pH first for acidosis/alkalosis
Acidotic + pCO2 over 40 = RespAc (hypoventilation)
Acidotic + pCO2 under 40 = MetAcid w/ compensation --> Check anion gap
Alkalotic + pCO2 over 40 = MetAlk w/ compensation --> Check urine Cl for NS responsiveness (low = yes, high = no)
Alkalotic + pCO2 under 40 = RespAlk (hyperventilation, early ASA ingestion)
255
PTH effects
PT response to low Ca
Renal: Up Ca reabs from urine, Down PO4 reabs from urine, Up vitD activation
Bones: Up Ca + PO4 reabs
256
VitD effects
GI: Up Ca + PO4 reabs
257
Calcitonin effects
Mildly lower Ca by causing deposit in bones
258
Nephritic/nephrotic syndrome w/ low C3 ddx
Postinfectious glomerulonephritis
Membranoproliferative glomerulonephritis (including mixed cryoglobulinemia)
SLE nephritis
259
Mixed cryoglobulinemia presentation
```
Palpable purpura
Arthralgias
Nephritic/nephrotic syndrome
Low C3
HCV+
```
260
Nephritic syndromes
Immune complexes:
Postinfectious glomerulonephritis
IgA nephropathy (Berger dx)
HSP
Pauci-immune (No IF):
Wegener's granulomatosis w/ PolyAngiitis
Micro-PAn
(Churg-Strauss) Eosinophilic granulomatosis w/ PAn
Anti-GBM dx:
Goodpasture syndrome
Alport syndrome
261
Postinfectious glomerulonephritis hx, labs, treat
Seen w/ 2-6w after any infxn, but usually GABHS
Tea-/Cola-colored urine, HTN, oliguria, edema
Low C3 nmlizes after 6-8w
High anti-Streptolysin O (ASO) + anti-DNase
"Lumpy-bumpy" IF
Diuretics + supportive
262
IgA nephropathy (Berger) hx, labs, treat
```
Most common nephritic syndrome
Within 5d of GI/URI, young adult males, recurrent gross hematuria - assoc w/ HSP
Nml C3, mesangial IgA deposits
Steroids
ACEIs in patients w/ proteinuria
20% progress to ESRD
```
263
HSP hx, labs, treat
Small vessel vasculitis often in childhood
Triad of: Palpable purpura, arthralgias, abdominal pain
Nml C3, mesangial IgA deposits (same as IgA nephropathy)
Steroids + supportive
264
Wegener's granulomatosis w/ poly-angiitis hx, labs, treat
Granulomatous inflammation of respiratory tract (including nasopharynx, eg septum) + kidney w/ necrotizing vasculitis
Resp + sinus sx - cavitary pulm lesions bleed and cause hemoptysis
+c-ANCA
Segmental necrotizing glomerulonephritis
High-dose steroids, cytotoxins, or rituximab - frequent relapses
265
Micro-PAN hx, labs, treat
```
Small vessel vasculitis W/O GRANULOMAS
Resp sx w/ hemoptysis, but NO SINUS SX
+p-ANCA
Necrotizing glomerulonephritis
Glucocorticoids, cyclophosphamide, or rituximab
```
266
Eosinophilic granulomatosis w/ PAN hx, labs, treat
```
AKA Churg-Strauss
Granulomatous small vessel vasculitis
ASTHMA, sinusitis, purpura/skin nodules, peripheral neuropathy
+p-ANCA, HIGH IgE
Steroids
```
267
Goodpasture syndrome hx, labs, treat
Rapidly progressive glomerulonephritis w/ pulm hemorrhage classically in young men
Hemoptysis, dyspnea, resp failure - NO UR involvement
Linear anti-GBM deposits on IF, Fe-deficiency anemia
Plasma exchange, pulsed steroids, may progress to ESRD
268
Alport syndrome hx, labs, treat
Hereditary glomerulonephritis presenting in boys 5-20y
Hematuria, sensorineural deafness, eye disorders
GBM splitting on EM
Progresses to ESRD, may recur after transplant
269
Nephrotic syndromes,
| complication
```
Minimal change disease
FSGS
Membranous nephropathy
DM nephropathy
SLE nephritis
Renal amyloidosis
Membranoproliferative nephropathy (types I, II, III)
RV thrombosis (esp. MN)
```
270
Minimal change disease hx, labs, treat
Most common nephrosis cause in children
Idiopathic or 2/2 NSAIDs, hematologic malignancies
Tendency to infxns, thrombosis; sudden onset edema
Nml light microscopy, podocyte foot effacement on EM
Steroids, good prognosis
271
FSGS hx, labs, treat
Most common nephrosis in adults
Assoc w/ black/Hispanic ethnicity, hx of IVDU (heroin), HIV, obesity
HTN, micro hematuria
Sclerosis in capillary tufts
Prednisone, cytotoxins; ACEIs/ARBs to reduce proteinuria
272
Membranous nephropathy hx, labs, treat
Assoc w/ solid-tumor malignancies, HBV, SLE, NSAIDs
Can cause RV thrombosis from AT3 loss
"Spike-and-dome" granular IgG and C3 deposits at GBM
Prednisone, cytotoxins for severe dx
273
DM nephropathy hx, labs, treat
Diffuse hyalinization + nodular glomerulosclerosis (Kimmelstiel-Wilson lesions)
Long-standing poorly controlled DM w/ neuropathy/retinopathy
Thickened GBM + increased mesangial matrix
Blood glucose control + ACEIs/ARBs
274
SLE nephritis
Nephrotic + Nephritic
Proteinuria or RBCs on UA during eval of SLE patients
Mesangial proliferation; subendothelial/subepithelial IC deposits
Prednisone, cytotoxins may slow
275
Renal amyloidosis
Primary (plasma cell dyscrasia - AL [Ab light chain] amyloid) or secondary (infectious/inflammatory - AA [serum amyloid A] amyloid) - may also deposit in HEART, LIVER
Hx of multiple myeloma or chronic inflammatory dx (RA, TB)
Nodular glomerulosclerosis, apple-green birefringence w/ Congo red
Prednison + melphalan; Bone marrow transplant in MM
276
Membranoproliferative nephropathy type I hx, labs, treat
Nephritic/nephrotic
Assoc w/ HBV, HCV, SLE, cryoglobulinemia, subacute bacterial endocarditis
"Tram-track" split GBM from subendothelial and mesangial deposits; Low C3
Steroids + cytotoxins
277
Membranoproliferative nephropathy type II/III hx, labs, treat
Nephritic/nephrotic
Idiopathic, d/t C3 nephritic factor (autoAb that stabilizes C3 convertase - LOW C3)
Intramembranous dense deposits
Steroids + cytotoxins
278
Dialysis-related amyloidosis cause
Deposition of b2-microglobulin
279
Viral exanthems
Erythema infectiosum (5th dx), Measles, Rubella, Roseola, Varicella, Hand-foot-and-mouth
280
Rubella cause, sx, complications
"3d measles"
Rubella virus
Prodrome - LAD, esp. post auricular; polyarthritis in adolescents
Rash - tender erythematous maculopapular spreading head to toe
Low-grade fever and do not appear as ill as measles
Encephalitis, neonatal triad (PDA, cataracts, deafness, +/- "Blueberry muffin" rash)
281
Roseola cause, sx, complications
HHV6, HHV7
Prodrome - 3-4d high fever (over 40C)
Rash - As fever breaks, maculopapular rash starts on trunk to face, limbs; resolves in 24h
Febrile SZ
282
Varicella cause, sx, complications
VZV
Prodrome - Mild fever, anorexia, malaise precede rash by 24h
Rash - Generalized pruritic vesicles on red base at different stages of healing. Usually start on face, spread to body, spare palms/soles
Meningoencephalitis, PNA, hepatitis if IC'd
Reactivation for shingles in dermatomal pattern w/ pain before rash
Bacterial skin infxn 2/2 lesions
Reye syndrome w/ ASA
283
Hand-foot-and-mouth dx cause, sx, complications
Coxsackie A virus
Prodrome - Fever, anorexia, oral pain
Rash - oral ulcers; maculopapular vesicular rash on hands, feet, sometimes butt
No complications (Coxsackie B may cause myocarditis)
284
Herpes transmission, maternal sx, neonate sx
Skin/mucus membrane contact
Vesicular lesions, usually asymptomatic
Vesicular lesions, encephalitis
285
Syphilis transmission, maternal sx, neonate sx
Sexual contact
Primary chancre or secondary disseminated rash (no transmission at tertiary stage)
Stillbirth, hydrops fetalis
Abnml facies (notched teeth, saddle nose, short maxilla), saber shins, CN8 deafness if neonate survives
286
Rubella transmission, maternal sx, neonate sx
Resp droplets
Rash, LAD, arthritis
Triad: PDA, cataracts, deafness, +/- "Blueberry muffin" rash
287
Erythema infectiosum cause, sx, complications
Parvovirus B19
Prodrome - none
Rash - "Slapped-cheek" pruritic, maculopapular, erythematous rash starts on arms and spreads to trunk, legs
Arthropathy, aplastic crisis (SCD, hereditary spherocytosis, Fe deficiency anemia), hydrops + death if congenital
288
Measles cause, sx, complications
Paramyxovirus
Prodrome - Low-grade fever + 3Cs (Cough, Coryza, Conjunctivits), Koplik spots on buccal mucosa after 1-2d
Rash - Erythematous maculopapular rash spreads head to toe
Common - OM, PNA, laryngotracheitis
Rare - Subacute sclerosing panencephalitis
289
Bruton agammaglobulinemia cause, infxns, dx/Rx
XR B-cell deficiency
Sx begin after 6m d/t no longer active maternal IgG
Encapsulateds - Pseudomonas, S pneumo, H flu
Quantify Ig lvls, confirm w/ B- (absent) + T-cell (high) subtypes
Absent tonsils, lymph tissue
Prophylactic abx, IVIG
290
CVID cause, infxns, dx/Rx
Combined B- and T-cell defect presenting 15-35y
Low lvls of all Ig, Nml B-cell count, Low plasma cell count
Pyogenic URIs + LRIs; Increased risk of lymphoma, autoimmune dx
Quantitative Ig lvls, confirm w/ B- + T-cell subsets
IVIG
291
IgA deficiency cause, infxns, dx/Rx
Mild, most common immunodeficiency
Low IgA only
Usually asymptomatic, but some develop recurrent respiratory or GI (Giardia) infections
Anaphylactic transfusion rxn d/t anti-IgA Abs - CAREFUL GIVING IVIG (give w/o IgA)
Quantitative IgA lvl, treat infxns
292
Thymic aplasia cause, infxns, dx/Rx
AKA DiGeorge syndrome
AD chr22 defect causing tetany 2/2 hypocalcemia in neonatal period
Variable infxn risk d/t T-cell deficiency - viral, fungal, PCP pneumonia infxns
Absent thymic shadow on CXR
Low abs T-cell count, delayed hypersensitivity skin testing
Bone marrow transplantation w/ IVIG for Ab deficiency, PCP prophylaxis, (alt - thymus transplant)
293
Ataxia-telangiectasia cause, infxns, dx/Rx
AR mutation prevents repair of dsDNA breaks
Progressive cerebellar ataxia and oculocutaneous telangiectasias, increased malignancy risk (NHL, leukemia, gastric CA)
IVIG depending on Ig deficiency
294
SCID cause, infxns, dx/Rx
Commonly XR defect in stem cell maturation and decreased adenosine deaminase causes severe lack of B- and T-cells
Severe frequent bacterial, opportunistic, Candida infxns
Bone marrow/stem cell transplant; IVIG for Ab deficiency, PCP prophylaxis
295
Wiskott-Aldrich syndrome cause, infxns, dx/Rx
XR disorder
Great risk of atopic dx, lymphoma/leukemia, encapsulated infxns d/t low IgM
WIPE: Wiskott-aldrich Infections, Purpura, Eczema
Bleeding/purpura, eczema, recurrent OM from birth
High IgE, IgA; LOW IgM, plt
IVIG + Abx (most don't reach adulthood)
296
Chronic granulomatous disease cause, infxns, dx/Rx
XR/AR deficient superoxide production in PMNs, M0s
Anemia, LAD, Hypergammaglobulinemia
Chronic skin, LN, pulm, GI, UTInfxns by CATALASE+ organisms
Abs PMN count w/ assays
Dihydrorhodamine (DHR) or nitroblue tetrazolium test (no blue = pos)
Daily TMP-SMX; IFN-g to reduce infxn severity
297
Leukocyte adhesion deficiency cause, infxns, dx/Rx
```
Defect in chemotaxis, phagocytosis
Recurrent skin, mucosal, pulm infxns
Omphalitis in newborn w/ delayed cord separation
NO PUS and minimal inflammation
High WBC count
Bone marrow transplant (BMT)
```
298
Chediak-Higashi syndrome cause, infxns, dx/Rx
AR defect in chemotaxis, microtubule polymerization
Syndrome of partial oculocutaneous albinism, peripheral neuropathy, neutropenia
High incidence of pyogenic infxns w/ Staph, Strep pyogenes, Pseudomonas
Giant granules in PMNs
BMT
299
Job syndrome cause, infxns, dx/Rx
```
AKA Hyper-IgE syndrome
Defect in PMN chemotaxis
FATED: coarse Facies, Abscesses (Staph), retained primary Teeth, hyper IgE (Eosinophilia), Dermatologic (eczema)
Staph infxns, abscesses
Penicillinase-resistant abx + IVIG
```
300
C1 esterase inhibitor deficiency cause, risk, dx/Rx
AKA hereditary angioedema
AD episodes of angioedema 2/2 stress/trauma
Risk of airway obstruction
CH50 to assess quantity, fxn of complement
Purified C1 esterase + FFP prior to surgeries
301
Terminal complement deficiency cause, infxns, dx/Rx
C5-C9 deficiency
Can't form MAC against encapsulated organisms
Recurrent Neisseria infxn (meningo- or gonococcal)
Meningococcal vaccine + appropriate abx
302
PNA hospitalization criteria
```
CURB-65:
Confusion
Uremia (BUN over 19)
RR over 30
BP under 90/ or /60
Over 65yo
```
Consider at 2-3, admit over 4
303
PNA pathogen tests
Legionella - Urine Ag
Chlamydophila - PCR, serologic testing
Strep pneumo - Urine Ag
304
Neonatal PNA causes
Group B Strep, E coli, Listeria (same as meningitis)
305
COPD PNA causes
H flu, Moraxella, Strep pneumo
306
OP CAPna w/o abx in last 3m - causes, Rx
Strep pneumo, Mycoplasma, Chlamydophila pneumo, H flu, viral
| Macrolide (Erythro-, clarithro-, azithromycin) OR doxycycline
307
OP CAPna w/ comorbidity or recent abx - causes, Rx
Strep pneumo, H flu, aerobic GNRs (E coli, Enterobacter, Klebsiella), Staph, Legionella, viral
Fluoroquinolone OR b-lactam+marcolide
308
IP CAPna - causes, Rx
Strep pneumo, H flu, anaerobes, aerobic GNRs, Mycoplasma, Pseudomonas
Fluoroquinolone OR Antipneumococcal b-lactam+macrolide
309
ICU CAPna - causes, Rx
Strep pneumo, Legionella, H flu, anaerobes, aerobic GNRs, Mycoplasma, Pseudomonas
Antipneumococcal b-lactam + azithromycin/fluoroquinolone
310
Ventilator-/HAPna - causes, Rx
```
GNRs (including Pseudomonas), Staph, Legionella, mixed flora
Extended-spectrum cephalosporin/anti-Pseudomonal carbapenem
Add aminoglycoside (gentamicin, tobramycin, streptomycin, amikacin) OR fluoroquinolone to cover resistant Pseudomonas until culture sensitivities found
```
311
Critical or worsening PNA on 1-2d of abx - cause, Rx
MRSA
| Vancomycin OR linezolid
312
Active TB Rx, SE
Active TB patients are RIPE for treatment:
Rifampin - orange body fluids
Isoniazid - peripheral neuropathy (give B6), hepatitis
Pyrazinamide
Ethambutol - optic neuritis
313
+PPD criteria
Over 5mm - HIV+, close TB contacts, or +CXR
Over 10mm - Homeless, residents of dev nations, IVDU, healthcare workers/residents
Over 15mm - Everyone else
314
GAS criteria, risk
```
1- Fever
1- Tonsillar exudate
1- Tender ant cervical LAD
1- Lack of cough
1- 3-14yo
0- 15-45yo
-1- Over 45yo
```
4-5: Treat empirically
2-3: Perform rapid Strep Ag test, culture if -test
0-1: Sx Rx only
315
Neonatal (under 1m) bacterial meningitis causes, Rx
GBS, E coli/GNRs, Listeria
| Ampicillin + cefotaxime/gentamicin
316
1-3m bacterial meningitis causes, Rx
Strep pneumo, meningococcus, H flu
| IV vancomycin + ceftriaxone/cefotaxime
317
3m-adult bacterial meningitis causes, Rx
Strep pneumo, meningococcus
| IV vancomycin + ceftriaxone/cefotaxime
318
Over 60y/alcoholic/chronic illness bacterial meningitis causes, Rx
Pneumococci, G- bacilli, Listeria, meningococci
| Ampicillin + vancomycin + cefotaxime/ceftriaxone
319
Prophylaxis for meningococci contacts
Rifampin or ciprofloxacin
320
Meningitis vs brain abscess vs encephalitis sx
Meningitis - photophobia, nuchal rigidity
Brain abscess - focal neuro defects + headache, fever
Encephalitis - AMS/confusion
321
HSV encephalitis lab, Rx
CSF nml labs + PCR
| IV acyclovir
322
CMV encephalitis lab, Rx
CSF nml labs + PCR
| IV ganciclovir +/- foscarnet
323
Lyme encephalitis Rx
Ceftriaxone
324
HIV testing
ELISA screening + Western blot confirmatory
325
HIV ART principles
2 nucleoside/nucleotide RTIs + non-nucleoside RT/protease/integrase inhibitor
326
HIV - PCP detection, prophylaxis indication, Rx
PCP found on silver sputum stain, interstitial infiltrate on CXR
CD4 under 200 or prior infxn
1x str TMP-SMX
327
HIV - MAC prophylaxis indication, Rx
CD4 under 100
| Weekly azithromycin
328
HIV - Toxoplasmosis prophylaxis indication, Rx
CD4 under 100 + anti-Toxo IgG
| 2x str TMP-SMX
329
HIV - TB prophylaxis indication, Rx
PPD over 5mm
| INH x 9m + vitB6 OR rifampin 4m
330
HIV - Candida prophylaxis indication, Rx
Multiple recurrences
Esophagitis - fluconazole
Oral - fluconazole/nystatin swish/swallow
331
HIV - HSV prophylaxis indication, Rx
Multiple recurrences
| Daily a-/fam-/valacyclovir
332
HIV - Strep pneumo prophylaxis indication, Rx
All HIV+ patients
| Pneumovax every 5y if CD4 over 200
333
HIV - Flu prophylaxis indication, Rx
All HIV+ patients
| Annual flu vaccine
334
Klebsiella granulomatis vs Haemophilus ducreyi pres, Rx
KG - Beefy-red painless ulcer w/ rolled granulation tissue edge; doxycycline/azithromycin
HD - Necrotic, irregular, painful, demarcated papules/pustules w/ inguinal LAD; azithromycin/ceftriaxone
335
Lymphogranuloma venereum cause
Chlamydia trachomatis
336
Chlamydia dx tests, Rx
Culture - gold standard
Urine DNA amplification test for rapid detection
Gram stain - PMNs w/ no bacteria (intracellular)
Doxycyline x7d or Azithromycin 1x
Azithromycin or amoxicillin in pregnant women
Treat sexual partners
337
Chlamydia complications
PID, ectopic preg, epididymitis
Reiter syndrome (reactive triad of urethritis, conjunctivitis, arthritis)
Fitz-Hugh-Curtis syndrome (perihepatic inflam/fibrosis)
338
Gonorrhea dx tests, sx
Purulent discharge, pelvic pain, swollen Bartholin glands
Disseminated - monoarticular septic arthritis, rash, tenosynovitis
Local: IM ceftriaxone + azithromycin po regardless of chlamydia status, (no fluoroquinolones d/t resistance) treat partners
Disseminated: IV ceftriaxone
339
Uncomplicated UTI Rx
po TMP-SMX/fluroquinolone (avoid d/t resistance) x3d OR nitrofurantoin x5d
340
Complicated UTI Rx
Same abx as for uncomplicated, but for x14d
341
Pregnant UTI Rx
Treat asymptomatic bacteriuria or symptomatic UTI w/ nitrofurantoin, po cephalosporin, or amoxicillin x3-7d
F/u w/ post-Rx urine culture
342
Urosepsis Rx
Hospitalize + broad IV abx
343
Pyelonephritis Rx
Mild cases - Fluoroquinolones x7-14d + po fluids
| Serious cases - admit + fluoroquinolones, 3rd/4th gen cephalosporin, b-lactam w/ b-lactamase inhibitor, or carbapenem
344
SIRS criteria
Temp over 38C or under 36C
Tachypnea over 20
Tachycardia over 90
Leukocytosis/leukopenia - Over 12k or under 4k
345
Sepsis criteria, treatment
SIRS + documented infxn
| Empiric abx + IVF + vasopressors to maintain BP and organ perfusion
346
Malaria tests, Rx
Prophylaxis - Chloroquine std, Atovaquone-proguanil/mefloquine for resistant areas
Rx - Add primaquine for P ovale/vivax cases to kill liver hypnozoites
Giemsa-/Wright-stained thick + thin blood films
Rule out hypoglycemia w/ fingerstick if AMS+malaria
347
Complication of EBV + penicillin?
Prolonged pruritic maculopapular rash
348
Neutropenic fever Rx
Empiric abx w/ anti-pseudomonal (cefepime, piperacillin-tazobactam)
Start antifungal Rx if fever persists after 3d
Colony stimulating factors not indicated generally
349
Ehrlichiosis sx, labs, Rx
Tick exposure in SC/SE US
Headache, fever, AMS, myalgias -- rash uncommon
Leukopenia, thrombocytopenia, high LFTs
Doxycycline
350
Lyme disease treatment
Doxycycline in adults, amoxicillin in children under 8y/pregnancy; Ceftriaxone for advanced dx
Prophylaxis w/ one dose doxy on initial exposure if no CI
351
RMSF cause, sx, labs, Rx
Rickettsial small vessel vasculitis
Fever, headache, rash starting at wrists/ankles that spreads to trunk, AMS, DIC
Biopsy of skin lesion w/ indirect IF
Doxycycline or chloramphenicol (pregnancy)
352
Orbital cellulits sx, Rx
General infxn sx + Restricted eye mvt, decreased visual acuity, diplopia, proptosis
Admit + IV abx + consult
IC'd/DM may need amphotericin B + surgery for Mucor/Rhizopus
353
N gonorrhoeae conjunctivitis signs, Rx
G- intracellular diplococci
| IV/IM ceftriaxone
354
Chlamydia trachomatis conjunctivitis signs, Rx
1-2w neonatal mucopurulent conjunctivitis OR trachoma (recurrent epithelial keratitis causing blindness)
Azithromycin, tetracycline, or erythromycin 3-4w in neonates
Single po dose for trachoma
355
Infective endocarditis sx, dx
Constitutional sx (fever/FUO, weight loss, fatigue), new heart murmur (esp. MV), Osler nodes, Janeway lesions, Roth spots, embolic phenomena
Diagnosed by Duke criteria: 2maj, 1maj+3min, 5min
Maj: 2+ blood cx, persistent bacteremia, +C burnetii cx OR TEE shows endocard involvement/new murmur
Min: Predisposing risks; Fever over 101F; Vasc- Septic emboli/infarcts, Janeway lesions, mycotic aneurysm; Imm- Glomerulonephritis, Osler nodes, Roth spots
356
IE Rx
Early empiric IV abx - Vancomycin + gentamicin
Tailor to cx
May need valve replacement
Pre-procedure prophylaxis in those w/ risks - amoxicillin
357
Anthrax sx, dx, Rx
Cutaneous: 1-7d post-exposure pruritic papule w/ LAD that becomes black eschar in 7-10d
Pulm: Fever, dyspnea, hypoxia, hypotension, PNA sx 1-3d post-exposure d/t HEMORRHAGIC MEDIASTINITIS w/o infiltrates
GI: dysphagia, N/V, dysentery, abd pain
Dx by culture + PCR/ELISA/Immunohistochem; CXR for pulm dx
Ciprofloxacin (also 60d ppx)/doxycycline 14d
358
Osteomyelitis sx, labs
Localized bone pain, warmth, edema, erythema, limitation of adjacent joint, fever, pus
Leukocytosis, high ESR/CRP, +blood cx
Periosteal deviation in 10-14d on XR -- prefer MRI
Bone aspiration + gram stain + cx
359
Osteomyelitis Rx
```
Surgical debridement + 4-6w IV abx
Clindamycin + cipro
Ampicillin/sulbactam
Oxacillin/nafcillin (MSSA)
Vancoymycin (MRSA)
Ceftriaxone/ciprofloxacin (G-)
```
360
Osteomyelitis causes
```
No risks - Staph
IVDU - Staph/Pseudomonas
SCD - Salmonella
Foot puncture - Pseudomonas
DM - Polymicrobial (Pseudomonas)
```
361
Obstructive pulm dx PFTs
FEV1 under 75% of FVC
| RV nml-high
362
Restrictive pulm dx PFTs
FEV1 over 75% of FVC (nml)
FVC low
RV low in severe dx
363
Small cell CA location, histo, sx, Rx
Small = Sentral
Neuroendocrine (chromogranin A+) cells
Aggressive, pos paraneoplastic syndromes from ACTH, SIADH, Lambert-Eaton
CTX only
364
Lung adeno CA location, histo, sx, Rx
```
Peripheral
Most common in nonsmokers, overall
Glandular histo, mucin+
Clubbing, CXR shows PNA-like infiltrates
Bronchioalveolar subtype = apparent thickening of alveolar walls
```
365
Pulm squamous cell CA location, histo, sx, Rx
Squamous = Sentral
Hilar mass w/ Keratin pearls, intercellular bridges
Cigarette-assoc, Cavitation, PTHrP = hyperCa
366
Pulm large cell CA location, histo, sx, Rx
Peripheral
| Anaplastic giant cells, poor prog, surgery
367
SLE criteria
DOPAMINE RASH
```
Discoid rash
Oral ulcers
Photosensitivity
Arthritis (non-deform)
Malar rash
Immune - dsDNA, anti-phospholipid autoAbs
Neuro - SZ, cerebritis
Elevated ESR
Renal dx
ANA+
Serositis - pleural, pericardial
Hem abnmlities
```
368
Behcet syndrome sx
Triad: Oral aphthous ulcers, Genital ulcers, Uveitis
| Also visceral organ small vessel vasculitis involvement
369
Avoid UTIs in AZD incontinence by?
Use Depends instead of catheter, change regularly
370
Appropriate patient management of PICC to prevent infxn?
Good hand hygiene before contact
371
Tinea versicolor pres, lab, Rx
Discrete hypopigmented patches that may become hyperpigmented on sun exposure
"Spaghetti and meatballs" on KOH prep
Selenium sulfide/Ketoconazole
372
What to do with any vaginal bleeding in a post-menopausal female?
Endometrial biopsy
373
Anticholinergic toxicity signs
Blind as a bat (miosis)
Red as a beet (flushing)
Hot as a hare (hyperthermia)
Dry as a bone (skin)
Mad as a hatter (agitation/hallucination)
Bloated as a toad (ileus/urine retention)
Heart runs alone (tachy)
374
Reporting bias
Subjects under-/over-report exposure due to perceived stigmatization
375
Detection bias
Risk factor itself causes increased monitoring in exposed group relative to unexposed, increasing likelihood of finding disease
376
b-blocker OD sx, Rx
Bradycardia, hypotension, shock, wheezing, hypoglycemia, AMS, SZ
Treat w/ IVF + atropine, followed by glucagon (up intracellular cAMP) for refractory hypotension
377
Cat-scratch disease cause, sx, Rx
Bartonella henselae
Papule at bite/scratch site 1-2w later, fever, regional LAD
Azithromycin
378
Pasteurella sx
Animal bite w/ local cellulitis, fever 1-2d later
379
Isolated systolic HTN def, cause
SBP over 140 w/ DBP under 90 - no diastolic murmur like AR
| Seen in elderly d/t rigid arterial walls
380
Follicular thyroid carcinoma characteristics
Can't diagnose on FNA - must see invasion of LNs, vessels through tumor capsule on biopsy
Heme spread
Hurthle cells may be present, but nonspecific
381
Papillary thyroid cancer
Slow LN spread
| Psammoma bodies
382
Factor V Leiden mech
Activated protein C resistance
383
Cyclosporine mech, SE
Calcineurin inhibitor
| Nephrotoxicity, hyperkalemia, HTN, gum hypertrophy, hirsutism, tremor
384
Tacrolimus mech, SE
Tacrolimus inhibitor
| Nephrotoxicity, hyperkalemia, HTN, tremor
385
Azathioprine mech, SE
Purine analog converted to 6-MP to inhibit purine synthesis
| Dose-related diarrhea, leukopenia, hepatotoxicity
386
Mycophenolate mech, SE
Reversible inhibitor of IMPDH - blocks de novo purine synth
| Bone Marrow suppression
387
Aortic dissection dx
TEE preferred (esp CKD or unstable)
CT w/ IVC if no CKD
MRI is too slow
388
Chorioamnionitis treat
Broad abx, delivery
| C/s reserved for std indications (distress, breech, multiple), not nec infxn
389
ESRD Epo indication, SE
When Hb under 10
| HTN, Headache, flu-like sx
390
Gallstone ileus sx
N/V, pneumobilia, hyperactive BS, dilated loops of bowel
| Intermittent tumbling obstruction sx, lodges in ileum
391
Toxoplasmosis sx
Congenital - macrocephaly, hydrocephalus, intracranial calc
| Chorioretinitis d/t reactivation as adults
392
BMT is used in which dx? (+Inheritance)
WAS, SCID (both XR)
393
Acute bronchitis dx, Rx
Clinical dx w/ sx Rx - no abx
394
Blastomycosis sx
Mild pulm dx
| If disseminated, may cause cutaneous verrucous nodules/plaques/microabscesses even in non-IC'd
395
Aspergillosis sx
Invasive pulm dx in IC'd
| Rare dissemination
396
Histoplasmosis sx
Asx/mild pulm dx
| Dissemination w/ IC'd - papular crusting skin lesions
397
Central vs primary adrenal insufficiency
Primary: autoimmune, high ACTH, low cort/aldo -- pigmentation, hyperkalemia
Central: d/t chronic steroids, low ACTH, low cortisol, nml aldo -- less severe sx
398
Acalculous cholecystitis sx
Acute GB inflam w/o stones in hospitalized patients
399
SC compression vs lumbar OA
Sub-/acute pain + neuro sx (incl. incontinence/retention)
| Pain d/t nerve root compression, nml neuro exam
400
Abx for anaerobes
Clindamycin OR metronidazole + (amoxicillin/amox-clav/carbapenem)
401
Ampicillin+gentamicin target
G- aerobes
| Not for anaerobes w/o b-lactamase inhibitor
402
Fluoroquinolones target
G-
403
TMP-SMX targets
Many G- and G+
| No anaerobes
404
Lyme disease sx
```
Erythema migrans
Malaise, fatigue, arthralgia
Regional LAD
Meningitis, CN palsy
AV block
```
405
Malrotation sx, dx
Neonate w/ bilious vomiting, hematochezia, peritonitis
XR to rule out free air, duodenal atresia; then upper GI series
Ligament of Treitz on R
406
Painless thyroiditis sx
Acute thyrotoxicosis, mild enlargement w/o pain, low TSH, low I uptake
407
Subacute thyroiditis sx
Hyperthyroidism, low TSH, low I uptake
| Pain
408
Tetrology of Fallot PE, CXR
Harsh PV stenosis murmur, VSD murmur, RVH
409
GV transposition PE, CXR
Single S2 +/- VSD murmur
| Narrow mediastinum
410
21-OHase def pres
Most common CAH cause
| Hyperandrogenism (acne) + high 17-OHprog in young women
411
Secretory diarrhea
| hx, labs
Large stool volumes, D during sleep/fast
| Low stool osmotic gap (under 50)
412
Cauda equina syndrome sx
```
Radicular pain
Saddle anesthesia
Asymmetric motor weakness
Hyporeflexia
Late-onset GI/GU dysfxn
```
413
Conus medullaris syndrome sx
```
Sudden-onset severe back pain
Perianal anesthesia
Symmetric motor weakness
Hyperreflexia
Early-onset GI/GU dysfxn
```
