Step 3 KaplanQ Random Set 3

1- Peripheral smear 2- Transcobalamin (neg in 30% pts)

mega-hypersegmented neutrophils, Megaloblastic= b12/folate. Macrocytic can be caused by alcohol, liver ds, meds, b12/folate def.

Chlamydia, followed by N Gono. Tx Ceftriaxone and doxycycline.

Biopsy W Granulomatosis- vasculitis of small to medium size vessels. Ulcerating granulomas of upper/lower respt.

P-Anca (Pulmonary Anca) / anti-myeloperoxidase seen in microscopic polyangiitis and Churg-Straus syndrome.

c-anca (pos 65-90%)

START ANTIBIOTICS, (abs neutros <500/mm with fever) 1- antipseudomonals ceftazidime, cefepime or imipenem along with aminoglycoside (micin/amikacin)

ADD VANCOMYCIN for MRSA

1- Gender: Female 2- Race Caucasian

Whipple's Dz, do a small bowel biopsy. ARTHRITIS NOT SEEN IN Celiac, Tropical Sprue, or Chronic Pancreatitis (do however have fat mal, diarrhea and wt loss) Brucellosis- fever/bacteremia with arthritis, n/v/d and endocarditis.

PAS positive organism, ceftriaxone followed by a year of TMP/SMX for eradication

<17.5 Consider hospitalization <15.9

wt <30% normal, continued wt loss, unstable vitals, pulse less than 40, dehydration, malnutrition (complications of), refeeding syndrome - edema or phos <2.

Indinavir not visible on xray (pts should drink 1.5L per day) Can cause renal failure in up to 30% of HIV pts.

calcium oxolate (most common) radiopaque (visible) on xray

COLA autosomal recessive in tubular reabsorption of COLA.

triple phosphate/struvite seen with bac infections: proteus, pseudomonas and klebsiella or in persistently high PH >7.2

Uric acid (10%) not visible on xray. Low volume, low ph urine. Seen in Crohns, malignancy, myeloproliferative, gout, hyperuricemia.

Avascular necrosis of the hip. 1- get an MRI. 2- start bisphosphonate. Refractory or core decompression needs surgery.

dumping symdrome, vasomotor and gastrointestinal manifestations. Eat smaller frequent meals with less carbohydrates and more protien and fats. Somatostatin may be used in refractory cases.

Spontaneous - CNS and Renal involvment. Similar: Serositis-Pericarditis, Skin Involvment, Hematological- Pancytopenia, Joint Pain.

achalasia, loss of relaxation of the lower esophogeal sphincter.

Esophageal Cancer

Plummer Vinson - Fe Def rings/webs

ODINOPHAGIA

REPLEAT POTASSIUM, it will continue to drop. DKA is a K-wasting state. Acidosis K out of cells, Initially do NaCL bolus and Insuline for hyperkalemia. Once K normal and Glucose normal, <4.5 add potassium and switch to half normal saline to prevent overshooting.

Penicillin skin allergy test, if neg give cephalosporin.

Rubella

CMV

Herpes

Toxoplasmosis

Varicella

Rule out Venous Sinus Thrombosis (sinus thrombosis peripartum). Get MRV/MRI if negative get a lumbar puncture for pseudotumor cerebri (idiopathic intercranial hypertension)

Hypophosphatemia,
Insulin skyrockets due to feeding with a highcarb meal causing increase in glycolysis that results in depletion of phosphate. Presenting with lethargy and muscle weakness.

Non invasive positive pressure ventilation. Administration of positive end-expiratory pressure splinting open airways and preventing dynamic airway colapse. And helps correct respiratory acidosis.

Nucleic acid amplification test of voided urine. used for chlamydial and gonorrheal infections.

Enterobius Vermicularis,
Vulvovaginitis can occur and can cause increased risk of UTI's
Tx albendazole, mebendazole or pyrantel pamoate.

Counsel all active smokers every visit.
ASK to identify, ADVISE to stop, ASSESS to determine willingness, ASSIST with cessation, ARRANGE follow up to monitor progress.

Drug induced lupus if negative rules it out.
Positive ANA is non-specific, positive without symptoms means nothing.

Topical steroids and phototherapy

3 doses in last 5 years - need nothing. Recieved tetanus toxoid btw 5-10 yrs contaminated wound - booste, clean - nothing.
>10 years need booster and if dirty need Tetanus IGG

1- Carbadopa/Levodopa
2- severe disease add on COMT inhibitors Tolcapone/entacapone

Use Quetiapine
if you stop levo/carbi patient will become frozen

Nodular acne is disfiguring and should be managed aggressively. Isotretinoin, requires TWO different contraceptive methods 1 month prior to, during and 1 month after treatment.

Patient believes they have and organic disorder when everything is negative. Patients require reassurance and compassion. Should be seen on a regular basis by both primary and psych

anticholinergics, benztropine

They are functionally asplenic. START ABX: ceftriaxone, levofloxacin, moxifloxacin.
Cover encapsulated organisms:
Pneumococcus, Hemophilus, Klebsiella

CSF is initially red and clear when centrifuged. RBC have yet to lyse. Normal opening pressure 100-200

Perfect 10
Appearance: 2-totally pink
Pulse: 2- >100
Grimace: 2-cough/sneeze
Activity: 2-active motion
Respiratory effort: 2-crying/good

Hematuria,
increased UTI's,
Urinary concentration defects, tubule defects leads to dehydration

Topical Intranasal Steroids
Mometasones

Then add a intranasal 2nd gent antihistamine: loratadine, cetirizine, fexofenadine

6mL/Kg

neutropenia, use clopidogrel first

Most common: Gram Positive Organisms such as Staph A, coagulase neg Staph Epi, less comon Gram Neg E Coli or Pseudomonas.
Treat with Vanco for gram positives and Cefepime for gram neg and pseudomonas

STOP VANCO
continue Cefepime

Mitral Regurge,
evaluation for valve repair are:

End-systolic left ventricular demension >45mm or

Left ventricualar ejection fraction less than 55%.

PULMONARY ALVEOLAR PROTIENOSIS

Most effective treatment is therapeutic whole lung lavage via double lumen endotracheal tube.

Atrial Fibrillation alone 5 fold increase

AF + Rheumatic Heart Disease - 17 fold increase

Spontaneous intercranial hypotension;
Brain MRI will show cerebellar tonsillar descent and diffuse pachymeningeal gadolinium enhancement.

Vaccinate against hepatitis B

One set of lips - HSV-1 55%
Two vag/penis- HSV-2 90%

Congenital diaphragmatic hernia, with defect in the left hemidiaphragm.
Heart displaced to right and pulmonary hypoplasia.
If p-hypoplasia is severe admin of O2 will result in poor imp of oxygenation.

Detection of end tidal carbon dioxide.

False positive - enough air in stomach
False negative - no circulation (HF or PE)

PROFOUND HYPOXIA
-PaO2/FiO2 ratio <200

must maintain tidal volumes less than 6cc/kg
peak inspiratory pressure limited to 35cm H2O or less
Peak expiratory pressure >10cm H2O

10-14 recheck 3mth
15-19 recheck 2mths
20-44 recheck 1wk

45 repeat 2days start succimer

70+ hospitalize - repeat lead lv and start two chelation therapies: dimercaprol and Ca EDTA

Myoglobin
(high false negative but if negative has high predictive value)
rises immediately, and peaks at 6hrs.
If negative at 4 hours can exclude infarct.

CK and Aldolase

Anti-Jo
Interstitial lung disease associated with Poly/DermM

Decreased diffusion capacity of CO

Restrictive (normal FEV1/FVC)

dipeptidyl peptidase-4 inhibitors
Sitagliptin saxagliptin and linagliptin

DDP metabolizes GLP Glucagon-like peptide which raises insulin and decreases glucagon

DO NOT INCREASE WT

Antistreptolysin O Antibody

Post-streptococcal Glomerulonephritis
MOST COMMON CAUSE OF glomerulonephritis in children.

Hematuria - red cell casts, proteinuria, hypotension and edema.
Labs show decreased complement (C3, C4) and high BUN

Double ring pelvic fractures, especially with pubic symphysis diastasis are life threatening associated with hemorrhage and visceral injury.
Pelvis can hold 2L of blood.
Treatment: fix the pelvis to prevent further instability and tamponade the bleeding.

Sideroblastic Anemia

Microcytic anemia: Anemia of CD, Fe def anemia, Thalassemia.

HgA 96%
HgA2 3%
HgF 1%

also in Alpha thal minor

Hemoglobin H disease

HgA ~85%
HgA2 ~10%
HgF ~5%

HgA 0%
HgA2 ~50%
HgF ~50%

Alkalinized intravenous crystalloid prevents renal damage from myoglobin

RULE OUT CAUSES: electrolyte, metabolic, drug related, organic.
Before you order a EEG or load with anti epileptic drugs.
Hyper/o natremia
Hypo Ca, Mg, O2, Gluc
Liver/Renal failure
Intercranial defect
Cocaine toxicity
Benzo/Barb withdrawl

mental status changes!!
risk for DIC (petechia, low plt, prolong coags) - fibrin split products
risk for rhabdo - CK >10,000 is significant enough to cause ARF
risk for ARF - UA keep a high urine output and target pH 7-8 (alkalinize)

Legionella

Pneumocystis carinii

B-hCG >1,500 with transvaginal US
B-hCG>6,000 with transabdominal US

B-hCG doubles every 2 days in first 2 mths of pregnancy

Hemodynamically stable
B-hCG <5,000
Mass <3-4cm
No fetal activity

1- Give dose
2- repeat B-hCG 4 days and 1 week (>15% dec=> DONE)
3- <15% give another dose then check in 1 week.

Chlamydia, regardless of age who has more than one sexual partner, hx of sexually transmitted dz or does not use condoms regularly.

Influenza - given routinely
Hep A/B - high risk (travel, health care worker)
Pneumo
Meningococcus
Typhoid

Given no contraindications, given within 3 hrs of symptom onset.

Hemorrhage on CT
Early ischemic changes
uncontrolled HTN
resolving symptoms
recent GI hmg
abnormal PT/PTT, platelet count or
GLUCOSE

Surgical drainage and debridement with broad spectrum abx.

male 35 female 45

1 risk factor >160
2 risk factors >130
CAD or equivalent >100

1 risk factor >190
2 risk factors >160
CAD equivalent >100

4000 grams (8 lb 13 oz)
Most commonly diabetic mothers.
Complications: HYPOGLYCEMIA - tremulousness,
clavicular fx, brachial plexus abnormalities, asphyxia

FEV1 >40: Albuterol nebs x 3 doses in 1 hr. if on steroids those too.

FEV1<40: Albuterol neb, Ipratropium neb and corticosteroids.

Resp Failure: INTUBATE

First line - ACEI if Cr rises then,
Second - Ca Ch Blocker Amlodipine
Third - anything else to get it below 120/80

ADPKD - cysts in other organs

HYPERTENSION

Aspirin, Heparin, Abciximab/Eptifibitide/Tirofiban (IIb/IIIa inhibitors), and beta blockers

only in STEMI diagnosed within 12 hrs of onset.

Hepatitis C
incubation 5-10wks
peak aminotransferase levels ~500-1000
HCV ab not detectable till 18 wks after illness onset.
70% of acute will progress to chronic