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dx and who is at risk
|
herpetic whitlow
dental and healthcare |
|
dx
|
felon
|
|
dx
tx |
dx: cellulitis
tx: oral cephalos |
|
|
when are antibiotics needed for an abscess
|
>5cm
or at risk pts: - diabetics - corticosteroid usage |
|
dx
|
necrotizing fasciitis
|
|
|
what is the general empiric abx tx for necrotizing fasciitis
|
imipenem plus vanco
|
|
dx
|
dry gangrene
|
|
dx
tx |
dx: wet gangrene
tx: emergency debridement and amputation |
|
|
pain and swelling around surgical site, then becomes dark purple and crepitus, dx
|
gas gangrene
|
|
|
first line tx of acne
|
first line: topical retinoid
next/in combo with: benzyl peroxide |
|
|
more advanced tx of acne
|
1. topical abx
2. oral abx 3. OCP - decreases androgens 4. spironolactone - decreases androgens 5. oral retinoids |
|
|
what are the 6 side effects of oral retinoids
|
1. Depression/suidice
2. dry skin 3. pseudotumor cerebri 4. liver toxicity 5. teratogens 6. increased TG - increases panreatitis |
|
|
facial flushing provoked by hot and spicy foods, alcohol, emotions dx
|
rosacea
|
|
dx
tx |
dx: rosacea
tx: 1. sulfacetamide 2. topical metronidazole |
|
dx
|
chicken pox
|
|
|
when is acyclovir given for chickenpox
-know this |
1. >12 - increased encephalitis, pneumonia risk
2. ALL household contacts 3. taking steroids currently |
|
|
when can antivirals be given for zoster
|
<72 hours from onset
|
|
|
what meds used for post herpetic neuralgia
|
1. gabapentin
2. pregabalin 3. TCA 4. lidocaine patch |
|
|
what HPV causes skin warts
|
1,2,3,4
|
|
|
what hpv causes genital warts
|
6,11
|
|
|
salmon colored hypopigmented macules
dx |
tinea verisicolor
|
|
dx
tx |
dx: tinea versicolor
tx: 1. terbinafine 2. clotrimazole |
|
|
treatment for onchomycosis
|
1. ORAL terbinfine
2. oral itrakonazole |
|
|
treatment for pediculosis capitis
|
permethrin
|
|
|
treatment for pediculosis pubis
|
permethrin
|
|
dx
tx |
dx: carbuncle
tx: I/D |
|
dx
tx |
dx: candida
tx: 1. topical nystatin 2. oral azole |
|
dx
|
erysipelas
|
|
|
tx for folliculitis
|
- warm compress
if abx needed: muciporin |
|
dx
|
tinea corporis
|
|
dx
|
contact dermatitis
|
|
dx
|
erythema multiform
|
|
|
rash with dull red center, pale zone, dark outer ring dx
|
erythema multiform
|
|
|
what drugs can induce Erythema multiform
|
1. penicillins
2. sulfas 3. anticonvulsants |
|
|
redness scaling and flaking of eye brows, nasolabial folds dx
|
seborrheic dermititis
|
|
|
how does serborrheic dermatitis present in infants
|
cradle cap
|
|
dx
tx |
seborrheic dermatitis
tx: 1. selenium sulfide |
|
dx
|
seborrheic dermatitis, cradle cap
|
|
dx
|
atopic dermatitis aka eczema
|
|
dx
tx |
dx: psoriasis
1. topical steroids 2. Anti TNF alpha 3. salicylic acid wide spread disease ==>UV light sever widespread ==>mtx |
|
dx
tx |
dx: pityriasis rosea
tx: self limiting |
|
dx
tx |
dx: lichen planus
tx: corticosteroids |
|
|
most important treatments of decubitus ulcers
|
1. address nutrition
2. relieve the pressure |
|
|
itchy plaques with greasy yellow scales dx
|
seborrheic dermatitis
|
|
|
how to tell rosea rom syphilis
|
-rosea spares palms and soles, and is rpr negative
|
|
|
person has erythema nodosum, what test has to be done to rule out another condition
|
cxr to rule out sarcoid
|
|
|
which one, PV or BP has oral lesions
|
PV
|
|
|
which one PV or BP has tense bullae
|
BP
|
|
|
what is the tx for bp and pv
|
pb: topical steroids
pv: oral |
|
|
pct tx
|
phlebotomy
|
|
dx
tx |
melasma
hydroquinone |
|
dx
tx |
vitiligo
sunscreen and steroids if bad |
|
|
what other conditions are associated with vitiligo
|
thyroid and autoimmune
|
|
|
sharply demarcated patches of depigmentation with hyperpigmented borders
|
vitiligo
|
|
dx
tx |
actinic keratosis
5-FU |
|
dx
|
squamous cell
|
|
dx
|
basal cell
|
|
|
how to tell scalded skin syndrome from TSS
|
1. Normal blood pressure in SSS
2. no end organ damage |
|
hiv positive
|
kaposi sarcoma
|
|
|
when to suspect kawasaki
|
CRASH and Burn
Conjunctivitis Rash Adenopathy Strawberry tongue Hand foot desquamation Fever |
|
dx
|
osteosarcoma
|
|
|
soap bubble appearance on xr
|
giant cell tumor
|
|
|
cause of uti with pH >7
|
proteus
|
|
|
abx in human bite
|
amox/clav
|
|
|
treatment of dermatitis herpetiformis
|
dapsone
|
|
|
most common site of ulnar entrapment
|
elbow
|
|
|
mousy urine odor dx
|
PKU
|
|
|
initial fluid tx in hypernatremic patients that are volume depleted
|
.9 NS
|
|
|
pt cannot externally rotate arm, arm is internally rotated dx
|
posterior dislocation
|
|
|
pt is holding arm in external rotation, abduction, dx
|
anterior dislocation
|
|
|
pt hip is internally rotated, flexed, dx
|
posterior dislocation
|
|
|
clicking or locking of the knee dx
|
meniscal tear
|
|
|
tx for meniscal tears
|
NSAIDS
pt then repair |
|
|
what is compartment syndrome due to
|
referfusion injury causing swelling
|
|
|
what is the fx of a fall on outstretched hand
|
colles
|
|
|
what bones are fx in a colles fx
|
distal radius and ulna
|
|
|
snuffbox tenderness indicates
|
scaphoid fx
|
|
|
person punches another guy in face,
where is fx what complication |
boxer- 4th and 5th
bite injury |
|
|
monteggia fx
|
proximal radial dislocation
proximal ulnar fx |
|
|
galeazzi fx
|
radial fx
DRUJ dislocation |
|
|
shortened and externally rotated leg
dx and 2 complications |
hip fx
AVN DVT |
|
|
complication of tibial fx
|
compartment syndrome
|
|
|
first step in pelvic fx
|
binder
|
|
|
tx for compartment syndrome
|
fasciotomy of ALL compartments in area
|
|
|
back pain with back asymmetry
|
scoliosis
|
|
|
back pain with abnormal gait
- gait is squatted |
spondylolethesis
|
|
|
what is spondylolisthesis due to
|
anterior slip of vertebrae
L5/S1 |
|
|
low back pain with walking and standing
|
spinal stenosis
|
|
|
constant low back pain that doesnt go away or worse at night
|
neoplasm
|
|
|
pain that is better then bending over like over a shopping cart
|
spinal stenosis
|
|
|
urinary retention after trauma and saddle anesthesia
tx is surgery PLUS |
STEROIDS to reduce inflammation
|
|
|
injury to superior trunk causes what
|
erb duchenne
|
|
|
injury to ulnar nerve at medial epicondyle causes what
|
claw hand
|
|
|
injury to posterior cord causes what
|
klumpke
|
|
|
what nerve is damaged in ape hand
|
median
|
|
|
what nerve is damaged in claw hand
|
ulnar
|
|
|
what nerve is damaged when you cannot wipe bottom
|
thoracodorsal - latissmus dorsi
|
|
|
loss of forearm pronation nerve damaged
|
median
|
|
|
cannot abduct or adduct fingers nerve damage
|
ulnar
|
|
|
weak external rotation of arm nerve injury
|
suprascapular
|
|
|
loss of elbow and forearm flexion what nerve
|
msk nerve
|
|
|
trouble initiating arm abdduction, what nerve
|
suprascaular nerve to supraspinatus
|
|
|
cannot abduct arm beyond 10 degrees, what nerve and muscle
|
axillary and deltoid
|
|
|
what nerve is damaged with humeral shaft fx
|
radial
|
|
|
what nerve is damaged by:
fx of surgical neck of humerus |
axillary
|
|
|
what nerve is damaged at:
supracondylar fx of humerus |
median
|
|
|
what nerve is damaged at:
medial epicondyle |
ulnar
|
|
|
what types of fx are at risk for compartment syndrome:
|
supracondylar: kid falls on outstretched arm
tibal fx |
|
|
what is the tx for a femoral head fx
|
replace with prosthetic
|
|
|
man in army who has to march alot,
what type of injury what is tx |
tibial stress fx
cast |
|
|
treatment of de quervains tenosynovitis
|
steroids
|
|
|
diarrhea associated with mayonnaise due to
|
staph
|
|
|
ring enhancing lesion on CT with seizures
2 things |
1. brain abscess
2. neurocystercosis |
|
|
mainstay pharm tx of osteoporosis
|
bisphosphonates
|
|
|
what is osteopetrosis:
due to what mutation |
marble bone disease
impaired osteoclastic activity carbonic anhydrase |
|
dx
|
sandwich vertebrae in osteopetrosis
|
|
dx
|
tophi gout
|
|
dx
|
tophi gout
|
|
dx
|
tophi gout
|
|
dx
|
chondrocalcinosis in pseudogout
|
|
|
mcp arthritis, xr shows:
- squared off bone ends - hook like osteophytes |
hemochromatosis
|
|
|
short limbs in adult, normal head dx
|
achondroplasia
|
|
|
teenagers with persistent pain over tibial tubercle, worse when quad is contracted
tx |
osgood schlatter
- conservative tx |
|
|
steps in tx of RA
|
first line: NSAIDs
next: sulfasalazine or hydroxyquinone next: MTX next: infliximab |
|
|
medical tx options for fibromyalgia
|
1. pregabalin
2. duloxetine 3. milnacipran |
|
|
who gets screening for developmental dysplasia of hip at 6 weeks
|
1. females with family hx of dysplasia
2. female and breech |
|
|
tx of scfe
|
non weight bearing
then pinning |
|
|
what infants should receive vit d supplementation
|
all of them
|
|
|
tx of JRA
|
first line: NSAID
next: different NSAID next: corticosteroids |
|
|
can kids with osgood schlatter continue to play sports
|
yes
|
|
|
kid with abnormal gait, step off sign over L5/S1, dx
|
spondylolisthesis
|
|
|
6yo with fever, unilateral hip pain, resolves spontaneously
|
toxic synovitis
|
|
|
tx for developmental dysplasia of hips
|
pavlik harness
|
|
|
screening antibody for sle
|
ANA
|
|
|
anti scl 70 antibody
|
scleroderma
|
|
|
anti Jo
|
poly or dermatomyositis
|
|
|
type of infiltrating cell in RA
|
leukocytes
|
|
|
side effects of mtx
|
1. hepatitis
2. pneumonitis |
|
|
what drugs cause sle
|
1. Hydralzine
2. isoniazid 3. procainamide 4. quinidine |
|
|
what disease are sjogrens pts at risk for
|
Lymphoma
|
|
|
what does the shirmer test dx
|
sjogrens
|
|
|
extra articular manifestations of ankylosing spondylitis
|
1. Anterior Uveitis
2. Aortic insufficiency 3. AV block 3rd degree |
|
|
person with severe widespread psoriatic arthritis should be tested for what
|
HIV
|
|
|
kid with both feet turned inward, plantar flexion of ankle, inversion of foot
tx |
serial casts
|
|
|
what nerves are damaged when humerus is:
Anterior dislocation Surgical neck fx Shaft Supracondylar Medial Condylar |
Anterior Dislocation: Axillary Nerve/Artery
Surgical Neck: Axillary Shaft: Radial Supracondylar: Median Medial Condylar: Ulnar |
|
|
.
|
|
|
Little kid with febrile illness and then bone pain
|
hematogenous osteomyelitis
|
|
|
what nerve is damaged in anterior hip dislocation
|
obturator
|
|
|
what is at risk with posterior hip dislocation
|
medial circumflex
|
|
|
impotence, butt/sacral pain, claudication, due to what
|
vascular insufficiency
|
|
|
how to treat infertility in premature ovarian failure
|
ivf
|
|
|
how to predict fetal weight on us
|
abdominal circumference
|
|
|
alopecia, weird taste in mouth, bullae
|
zinc deficiency
|
|
|
down syndrome pt who presents with UMN lesion
|
atlanto axial instability
|
|
|
enlarged lymphocytes with glycogen and lipid deposits
|
hepatic adenoma
|
|
|
what is aspirin sensitivity due to
|
exaggerated release of vaso active stuff
|
|
|
what is the tx of aspirin sensitivty
|
leukotreine modifiers
|
|
|
increasing head circumference in new born, next step
|
CT scan
|
|
|
apgars less than __ require further intervention
|
7
|
|
|
ct scan shows lesion by liver that has calcified rim and dark center, dx
|
porcelain gallbladder
|
|
|
stages of normal female puberty
|
adrenarche: making androgens
gonadarche: activating gonads by FSH and LH thelarche: appearance of breast tissue pubarche: appearance of pubic tissue menarche |
|
|
definition of precocious puberty in boys and girls
|
girls: <8
boys: <9 |
|
|
how to tell central/true from pseudo precocious puberty in females
|
GnRH stimulation test
Central/True: have high FSH/LH, giving GnRH further increases levels Pseudo: have low FSH/LH, giving GnRH has no effect |
|
|
precocious puberty in boys most often caused by
|
CAH
|
|
|
next step if central/true precocious puberty
|
TSH
Brain imaging |
|
|
next step if pseudo precocious puberty
|
check:
- androgens/cortisol/steroid levels ABD US for: adrenal or ovarian tumor |
|
|
precocious puberty, cafe au lait spots, fibrous dysplasia of bone
|
Mcune Ablright
|
|
|
what two conditions do cafe au lait spots
|
NF
mcune albright |
|
|
how to treat central precocious puberty
|
GnRH analogues
|
|
|
definition of menopause
|
amennorrhea >1 year >45
|
|
|
what hormone induces ovulation
|
LH
|
|
|
what hormone develops the ovarian follicle
|
FSH
|
|
|
what hormone stimulates the LH surge
|
estrogen
|
|
|
what hormone increases basal body temp
|
progesterone
|
|
|
what hormone stimulates endometrial gland development
|
progesterone
|
|
|
changes to what hormone lead to menstruation
|
progesterone
|
|
|
what is the birth control choice in mentally retarded
|
depot shots
|
|
|
what is a s/e of depot shots that is lesser known
|
bone loss if used >2 years
|
|
|
what type of contraception is less effective in women >75kg
|
transdermal patch
|
|
|
what is the definition of primary amenrrhea
|
if has secondary sex characteristics: >16
if no secondary: >13 |
|
|
non hormonal tx of hot flashes
|
1. desvenlafexine
2. just wait: symptoms will get better on own 3. placebo affect/random remedies: will appear to help but is actually just getting better with time |
|
|
absolute contra indications to ocp's
|
1. pregnancy
2. hx of DVT, PE, hypercoag state 3. estrogen dependent tumor 4. stroke/mi/cad 5. poorly controlled HTN 6. smoker >35 7. hepatic dz 8. migraine with aura |
|
|
what are contraindications of IUD
|
1. current vaginal/cervical infection
2. high STD risk 3. uterine anatomy issues 4. wilsons 5. breast Ca |
|
|
15 yo girl who has never menstruated found to have bluish bulge in vaginal orifice, dx
|
imperforate hymen
|
|
|
how to tell where excess endogenous testosterone is coming from in a woman
|
DHEA-S
- DHEA-s only comes from adrenals |
|
|
honeycomb pattern on ct scan of chest
|
pulmonary fibrosis
|
|
|
what is the cause of erythroblastosis fetalis
|
Rh sensitization
|
|
|
what is the difference between
premenstrual syndrome premenstrual dysphoric disorder |
PMS: more pain
PMDD: more moody |
|
|
tx of PMS or PMDD
|
1. Excercise
2. NSAIDS 3. SSRI at the time |
|
|
most common cause of female infertility
|
endometriosis
|
|
|
what are the diagnostic labs in PCOS
|
LH:FSH >3:1
Testosterone increased |
|
|
what is PCOS due to
|
increased LH production causing excess androgens which get converted to estrogens
|
|
|
what cancer are PCOS pts at risk for
|
ENDOMETRIAL
|
|
|
thick cottage cheese like vaginal discharge
|
candida
|
|
|
motile cells on vaginal wet mount
picture |
trichomonas
|
|
|
malodorous frothy green vaginal discharge
|
trichomonas
|
|
|
thin white discharge with fishy odor
|
gardnerella
|
|
|
which vaginitis cause has to have partner treated
|
trichomonas
|
|
|
clue cell
picture |
gardnerella
|
|
|
pH >4.5 on vaginal wet mount
what 2 things |
1. gardnerella
2. trichomonas |
|
|
firm papule that evolves in painless ulcer dx
|
syphilis
|
|
|
tx of syphilis if penicillin allergic
|
doxycycline
tetracycline |
|
|
person has negative RPR/VDRL
positive FTA-ABS dx |
prior syphilis infection
- FTA-ABS remains + for life |
|
|
painful ulcer with gray base and fould odor
|
chancroid
|
|
|
painless ulcer with beefy red base and irregular borders
- donovan bodies found |
granuloma inguinale
|
|
|
treatment of endometriosis if:
want to be fertile do not care |
want to be fertile: laparoscopy
do not: 1. NSAIdS 2. OCP's |
|
|
vaginal bleeding, positive HCG, intrauterine pregnancy, closed os
|
threatened abortion
|
|
|
vaginal bleeding for months, symmetric enlarged uterus
|
fibroid
|
|
|
menorrhagia in peri menopausal, most likely dx
|
endometrial hyperplasia
|
|
|
abnormal uterine bleeding since they started menses dx
|
bleeding issue like VWF
|
|
|
bleeding only associated after intercourse, normal sized uterus
|
polyp
|
|
|
outpatient treatment for severe vaginal bleeding
|
most effective: estrogen
second line: OCP |
|
|
inpatient tx for severe vaginal bleeding beyond obvious
|
IV Premarin (conjugated estrogen)
|
|
|
treatment of PCOS
|
1. OCP
2. exercise/weight loss 3. metformin 4. clomiphene |
|
|
treatment of PID - 3 drugs
|
1. ceftriaxone
2. azythromycin/doxy 3. METROnidazole |
|
|
what is a risk for enterocele (small bowel into vaginal)
|
hysterectomy
|
|
|
treatment of fibroids:
if want to be fertile temporary therapy do not care about fertility |
want fertile: laparoscopic myomectomy
temporary: GnRh agonists do not care about fertility: hysterectomy |
|
|
most common cause of post menopausal bleeding
|
atrophic vaginitis
|
|
|
biggest risk for endometrial carcinoma
|
unopposed estrogen
|
|
|
next step if atypical cells of glandular origin
|
colpo with biopsy
|
|
|
next step if CIN1/ LSIL in:
adolescents premenopausal post menopausal |
adolescents: repeat pap in one year
pre: colpo with biopsy post: HPV or colpo |
|
|
next step if HSIL/CIN 2 or 3
|
colpo with LEEP
|
|
|
most common ovarian cyst in pregnancy
|
corpus luteum
|
|
|
ovarian cyst with psammoma body
|
cystadenocarcinoma
|
|
|
ovarian cyst plus precocious puberty in girl
|
granulosa theca
|
|
|
ovarian cyst plus virilization in girl
|
sertoli leydig
|
|
|
treatment of ductal carcinoma in situ
|
lumpectomy +/- radiation
|
|
|
treatment of lobular carcinoma in situ
|
observation
with or without tamoxifen |
|
|
firm tender breast nodule that does not change with menstruation
|
fibroadenoma
|
|
|
bilateral breast tenderness with menstruation that goes away after
|
fibrocystic changes
|
|
|
bloody nipple discharge, most common cause
|
intraductal papilloma
|
|
|
most common breast ca
|
infiltrating ductal
|
|
|
most common bilateral breast cancer
|
lobular
|
|
|
biggest risk of getting breast Ca
|
family history
|
|
|
3 month hx of progressively enlarging breast mass with erythema and edema, dx?
|
inflammatory breast ca
|
|
|
person has breast ca, goes into remission, new mass on other side what is it?
|
New primary tumor
|
|
|
next step if mastitis doesn’t improve with antibiotics
|
biopsy
|
|
|
eczematous patches on nipple
|
paget
|
|
|
treatment of splenic abscess
|
splenectomy
|
|
|
pt that rapidly virilizes, what test to order next
|
Testosterone
DHEA-S |
|
|
high mixed venous oxygen saturation in the context of hypotension
|
septic shock
|
|
|
most common heart defect in edwards
|
vsd
|
|
|
woman in labor, gets pain, bleeding, kid moves backwards in station dx
|
uterine rupture
|
|
|
one month old, abd pain, bilous vomiting, blood in stool dx
|
midgut volvulus
|
|
|
biggest risk factor for cp
|
prematurity
|
|
|
best way to slow diabetic nephropathy
|
control Blood pressure
|
|
|
post term pregnancy most associated with what finding on us
|
oligohydramnios
|
|
|
side effects of mannitol
|
1. pulmonary edema
2. pseudohyponatremia 3. hypERnatremia from excessive fluid without Na loss |
|
|
what 2 diuretics are K sparing but do not block spironolactone
|
triamterene
amiloride |
|
|
what is the treatment for pyelonephritis in pregnancy
|
1. ceftriaxone
2. amp/gent |
|
|
most common cause of kidney stones
|
idiopathic
|
|
|
what bugs can cause struvite stones
|
1. proteus
2. klebsiella |
|
|
what diseases are associated with calcium phosphate stones
|
- PO4 wasting syndromes
1. Hyper PTH 2. RTA type 1 |
|
|
treatment of uric acid stones
|
1. alkalinize urine with HCO3
2. Potassium |
|
|
treatment of hydronephrosis
|
neprhostomy tube
|
|
|
treatment of ADPKD
|
1. Vaptans
2. Amiloride will need transplant or dialysis |
|
|
complications of ADPKD
|
1. Berry aneurysms
2. LIVER CYSTS ** 3. Mitral valve prolapse |
|
|
smoker with hematuria, increased HcT, and scrotal varicies, dx
|
renal cell carcinoma
|
|
|
what cancers are associated with increased EPO
|
1. Renal cell
2. Hepatocellular |
|
|
treatment of AIN
|
corticos
|
|
|
treating strep throat will have what effect on developing:
rheumatic disease post strep gn |
rheumatic: decrease
Post strep GN: none |
|
|
P anca positive with crescents in glomeruli
|
pauci immune RPGN
|
|
|
anti double stranded DNA indicates
|
lupus nephritis
|
|
|
spike and dome basement membrane thickening
|
membranous
|
|
|
what size of kidney stones has 50% chance of passing
|
8mm
|
|
|
diuretic treatment of ascites/cirrhosis
|
1. loop
or 2. metolazone (thiazide) |
|
|
treatment of edema in nephrotic syndrome
|
Loop
or metolazone |
|
|
granular pattern of immune complex distribution, and hypercellular glomeruli dx
|
post strep
|
|
|
post strep gn
|
|
dx
|
clue cell in gardnerella
|
|
dx
|
trichonomas
|
|
dx
|
membranous
|
|
|
RPGN crescent
|
|
|
FSGS
|
|
|
klimmelsteil wilson nodules with nodular glomerulosclerosis on kidney biopsy
|
diabetic
|
|
|
treatment of RPGN
|
1. steroids
2. cyclophosphamide |
|
|
what are the 3 causes of RPGN
|
1. Goodpastures
2. wegners 3. MPA |
|
|
what causes the death in churg strauss
|
Heart disease from eosinophilic infiltrate
|
|
|
membranous GN due to what 3 things
|
1. SLE
2. NSAIDS 3. Infections |
|
|
person has hypernatremia, next step to look at
|
if making urine:
yes - Diabetes insipidus no, urine is concentrated: dehydrated/fluid loss no, urine is not concentrated: hyper aldo state |
|
|
what meds cause hyperkalemia
|
1. Digoxin
2. BB 3. ACE/ARB 4. K sparing |
|
|
what drugs cause hypokalemia
|
1. insulin
2. carbonic anhydrase inhibitors 3. loop 4. thiazide 5. albuterol |
|
|
tx of nephrogenic DI
|
1. thiazide
2. indomethiacin (potentiates ADH) |
|
|
causes of euvolemia hyponatremia
|
1. SIADH
2. Psychogenic 3. Hypothyroid 4. Post op water intox |
|
|
causes of hypovolemic hyponatremia
|
1. Burns
2. ADRENAL Insufficiency 3. |
|
|
how would you distinguish between the many different causes of hypovolemic hyponatremia
|
FENA
<1: Dehydration, vomiting, sweating, burns >1: Addisons, Diuretics, ACE |
|
|
what are the causes of hypervolemic hyponatremia
|
1. CHF
2. Cirrhosis 3. Nephrotic/renal failure |
|
|
Type 1 RTA
- due to - urine pH - serum K - radiology - tx |
due to: sporadic most often, SLE
urine pH: >5.3 k: low radiology: phosphate stones (alkaline urine) tx: HCO3, K, thiazide |
|
|
Type 2 RTA
due to urine pH serum K radiology tx |
due to: MM, fanconi, wilsons
urine pH: <5.3 serum K: low radiology: bone lesions tx: HCO3, K, thiazide |
|
|
Type 4 RTA
due to urine pH serum K tx |
due to: Diabetes
urine pH: <5.3 serum K: high tx: fludro |
|
|
man with uti symtpoms, needs to be checked for what
|
gc/chlamydia
|
|
|
immigrant form 3rd world comes in with hematuria, need to look for
|
1. schistosomiasis
2. tb |
|
|
male urethral discharge could be
|
1. gonorrhea
2. chronic prostatitis |
|
|
treatment of prostatitis
|
>35yo: 4-6 weeks of bactrim
<35: 4-6 weeks of ceftriaxone |
|
|
what are the side effects of prostate surgery
|
1. incontinence
2. impotence |
|
|
treatment of testicular torsion
|
BILATERAL orchioplexy
|
|
|
majority of testicular tumors are of what nature
|
germ cell
- seminoma |
|
|
person is on 5HT inhibitor, what do you have to do in screening test values
|
double PSA
|
|
|
testicular torsion
onset visual changes lifting testicle cremaster Ultrasound |
onset: acute
visual changes: high riding, horizontal lifting testicle: does not help pain cremaster: absent Ultrasound: No blood flow |
|
|
epididymitis
onset visual changes lifting testicle cremaster Ultrasound |
onset: sub acute/std
visual changes: normla lifting testicle: helps pain cremaster: present Ultrasound: normal blood flow |
|
|
retrograde flow to scotum on US
|
varicocele
|
|
|
wilms tumor associated with what syndrome
|
WAGR
Wilms Aniridia: no iris GU issues Retardation |
|
|
risks for bladder cancer
|
1. smoking
2. schistosomas 3. analine dyes |
|
|
god given missions what type of delusion
|
grandiosity
|
|
|
most common complication for sickle cell trait
|
painless hematuria
|
|
|
hearing loss, dull, hypomobile tympanic membrane
|
serous otitis media
|
|
|
premature infant with anemia, normocytic, low retic count, normal platelet, normal wbc
|
anemia of prematurity
|
|
|
person has gallbladder taken out, then develops similar pain months later, next step
|
ERCP
|
|
|
worst complication of sideroblastic anemia
|
ALL
|
|
|
ancanthocyte spur cell
|
a beta lipoproteinemia
|
|
|
increased 2-3 dpg does what to the o2 curve
|
shift to the right
|
|
|
treatment of autoimmune hemolytic anemia
|
corticos
avoid cold |
|
|
iron deficiency anemia
- serum iron - ferritin - TIBC/transferrin - Iron:TIBC ratio |
serum iron: low
ferritin: low TIBC/transferrin: high Iron:TIBC ratio: <12 |
|
|
lead poisoning
- serum iron - ferritin - TIBC/transferrin |
serum iron: normal or high
ferritin: normal TIBC/transferrin: normal |
|
|
anemia of chronic disease
- serum iron - ferritin - TIBC/transferrin - Iron:TIBC ratio |
serum iron: low
ferritin: high TIBC/transferrin: low Iron:TIBC ratio: >18 |
|
|
sideroblastic anemia
- serum iron - ferritin - TIBC/transferrin |
serum iron: increased
ferritin: increased TIBC/transferrin: low |
|
|
thalessemia
- serum iron - ferritin - TIBC/transferrin |
serum iron: normal/increased
ferritin: normal TIBC/transferrin: normal |
|
|
basophilic stippling ddx
|
1. lead
2. alcohol 3. thalesemmia |
|
|
microcytic anemia with wrist or foot drop
|
lead poisoning
|
|
|
microcytic anemia with neuro signs/confusion
|
iron overload
|
|
|
how to differentiate between iron deficiency and thalessemia by MCV:RBC count
|
>13: iron deficiency
<13: thalessemia |
|
|
treatment of hereditary sideroblastic anemia
|
vitamin B6
- helps as a cofactor for ALA synthase |
|
|
microcytic anemia with multiple sizes of RBC's
|
sideroblastic
|
|
|
shoulder pain in young black kid
|
osteonecrosis of humeral head
|
|
|
what is the fundamental difference between sickle cell and thalessemia
|
sickle: defective Beta chains are made
thalessemia: normal but decreased amount of beta chains made |
|
|
reversible causes of sideroblastic anemia
|
1. alcohol
2. isoniazid 3. lead |
|
|
increased HbA2
|
Thalessemia B minor
|
|
|
6 month old with growth failure, hepatospleno, bony deformities with increased HbF
|
B major cooleys anemia
|
|
|
how to tell the difference between B12 and folate on labs
|
MVA/HVA:
normal in folate increased in B12 |
|
|
what drug can be used to decrease the frequency of sickle cell attacks
|
hydroxyurea
|
|
|
what are 2 complications of hereditary spherocytosis
|
1. B19 infection/aplastic crisis
2. bilirubin gallstones |
|
|
increased MCHC
|
hereditary spherocytosis
|
|
|
pt is in septic shock, given fluids and pressors, BP is not responding, next step
|
corticosteroids
- for adrenal insufficiency which can commonly occur |
|
|
HUS/TTP
- Platelets - Bleeding time - PT - PTT |
Platelets: Decreased
Bleeding time: Increased PT: Normal PTT: Normal |
|
|
Hemophilia A or B
- Platelets - Bleeding time - PT - PTT |
Platelets: Normal
Bleeding time: Normal PT: Normal PTT: Increased |
|
|
VWF
- Platelets - Bleeding time - PT - PTT |
Platelets: Normal
Bleeding time: Increased (affects aggregation) PT: Normal PTT: Increased |
|
|
DIC
- Platelets - Bleeding time - PT - PTT |
Platelets: Decreased
Bleeding time: Increased PT: Increased PTT: Increased |
|
|
Warfarin Use
- Platelets - Bleeding time - PT - PTT |
Platelets: Normal
Bleeding time: Normal PT: Increased PTT: INCREASED *** |
|
|
End Stage Liver Disease
- Platelets - Bleeding time - PT - PTT |
Platelets: Normal or decreased
Bleeding time: Normal or increased PT: Increased PTT: Increased |
|
|
Aspirin Use
- Platelets - Bleeding time - PT - PTT |
Platelets: Normal
Bleeding time: Increased PT: Normal PTT: Normal |
|
|
person has another stroke while on aspirin, next pharm tx
|
warfarin
or dipyramidole |
|
|
safest anitcoagulant during pregnancy
|
LMWH
|
|
|
pregnant lady with htn , anemia and shistocytes, elevated AST, ALT dx
|
HELLP
|
|
|
treatment of HELLP
|
induce if >34 weeks
steroids to speed lungs up |
|
|
what is the tx of HIT
|
1. direct thrombin inhibitors (argatroban, lepirudin)
2. continue until platelets >100,000 3. once above 100,000, start transition to warfarin 4. warfarin for 3 months |
|
ddx
|
thalessemia
sickle cell |
|
|
how to dx HIV steps
|
ELISA
ELISA Western blot to confirm |
|
|
HIV drug that causes:
megaloblastic anemia |
AZT
|
|
|
HiV drug that causes:
hypersensitivity rxn |
abacavir
|
|
|
HIV drug that causes:
neuropathy and pancreatitis |
didanosine
|
|
|
HIV drug that causes:
renal stones |
indinavir
|
|
|
HIV drug class that causes lipodystrophy
|
Protease inhibitors
|
|
|
Tx of HIV during:
Pregnancy Labor After birth |
Pregnancy: Normal HAART
Labor: AZT Kid: AZT 6 weeks after birth |
|
|
How to detect if an infant has HIV
|
Viral load test
- will have antibodies from the mom |
|
|
most common lymphoma in US
|
Diffuse Large B cell
|
|
|
most leukemias are of what cell origin
|
B cell
|
|
|
abundant blasts on marrow biopsy that stain for myeloperoxidase, dx
|
AML
|
|
|
worst complication of CML
|
Blast crisis
|
|
|
thrombosis, burning pains in hands and feet, biopsy shows hypercellular marrow
|
PCV
|
|
|
side effect of ganciclovir
|
neutropenia
|
|
|
side effect of
foscarnet cidofovir |
renal tox
|
|
|
what is the only HIV med contraindicated in HIV
|
efavirenz
|
|
|
t(12,21)
|
ALL
|
|
|
PAS positive, TdT positive
|
ALL
|
|
|
why is MTX given in children with ALL
|
to prevent CNS malignancy
|
|
|
worst complication in AML
|
DIC
|
|
|
what is the staging of CLL
|
0 ==> lymphocytosis
1 ==> lymphadenopathy 2 ==> splenomegaly 3 ==> anemia 4 ==> thrombocytopenia |
|
|
what is the symptomatic tx of CLL
|
fludarabine
|
|
|
Leukemia Clues
Children Myeloblasts Auer rods DIC Elderly Splenomegaly Philly chromosome Tartrate resistant acid phosphatase HTLV 1 smudge cells |
Leukemia Clues
Children – ALL Myeloblasts – AML Auer rods - AML, PML DIC – AML Elderly – CLL Splenomegaly – CML Philly chromosome – CML Tartrate resistant acid phosphatase – Hair cell HTLV 1 – Adult T Cell smudge cells ==>cll |
|
|
t(8,14)
|
burkitt
|
|
|
t(14,18)
|
follicular
|
|
|
1. t(9,22)
2. t(8,14) 3. t(11,14) 4. t(14,18) 5. t(15,17) |
1. t(9,22) – CML, philly
2. t(8,14) – Burkitt, c-myc activation 3. t(11,14) –Mantle Cell lymphoma, cyclin d1 activation 4. t(14,18) – Follicular lymphoma, bcl 2 activation 5. t(15,17) –M3 subtype of AML – responds to all trans retinoic acid |
|
|
non tender solitary sub mandibular lymph node in elderly concerning for
|
squamous cell cancer
|
|
|
what valve murmur will be present in a native valve endocarditis not due to drugs
|
mitral regurg
mitral valve prolapse |
|
|
indications that a chest tube needs to be placed for pleural effusion
|
low glucose <60
low pH <7.2 |
|
|
how to tell the cause of sob between chf and copd exacerbation based off blood gases
|
chf: alkalosis
copd: acidotic |
|
|
woman has HCV, can she:
delivery vaginally breastfeed |
yes
yes |
|
|
what are the PaO2 and SaO2 criteria for starting home O2 in copd
|
PaO2 <55
SaO2 <88% |
|
|
what is the parkland formula
|
4ml * Kg body weight * %BSA Burned
- Half given over first 8 hours - Second half over following 16 |
|
|
what are the major complications of burns:
|
1. Pneumonia
2. Pseudomonal burn infection 3. Curling ulcers in stomach 4. Compartment syndrome 5. Rhabdo |
|
|
what percentages make up BSA in children:
head Chest/back Arms Legs |
Head: 18%
Arm: 9 each = 18 total Chest 36 Legs: 14 each = 28 total |
|
|
what percentages make up BSA in adults
head chest/back arms legs genital |
head: 9
arm: 9 each = 18 torso: 36 legs: 9 each = 18 genital: 1 |
|
|
what do all burn patients need
|
1. Tetanus ppx
2. Burn ABX 3. Pain meds ==> given IV 4. Nutrition ==> started day 3 5. skin grafts 6. rehab ==> starts day one |
|
|
when is early excision and grafting done
|
- 3rd degree burn <20% BSA
ex: iron burn |
|
|
spider bite that develops skin ulcer with necrotic center and ring of redness
what type treatment |
brown recluse
1. Dapsone 2. local wound care |
|
|
person is bit by spider, develops muscle spasms, rigid abdomen, altered mental status
dx tx |
black widow
1. calcium gluconate 2. Benzos 3. antivenom |
|
|
soot in throat or burns around mouth, have to evaluate for
|
inhalation burn injury by bronchoscopy
|
|
|
when to hospitalize for burns
|
- 2nd degree >10%
- 3rd degree >5% - Cirumfrential - Face, hand, genital - Electrical or lightening |
|
dx
|
J waves from hypothermia
|
|
|
best way to cool someone down suffering from hyperthermia
|
evaporation
|
|
|
person is a body packer and has intoxication due to rupture, what can you do to get the packets out
|
go lytely
|
|
|
antidote/treatment for:
iron lead - kids lead - adults mercury |
iron: deferoxamine
lead kids: succimer lead adults: EDTA, dimercaperol mercury: dimercaperol |
|
|
antidote/treatment for:
arsenic copper cyanide |
arsenic: Dimercap, succimer, penicillmaine
copper: penicillamine cyanide: Thiosulfate, then nitrate or hydroxycobalmin |
|
|
antidote/treatment for:
anticholinergics benzo BB CCB |
anit AcH: phygostigmine
benzo: flumazenil BB: Atropine - Glucagon - Insulin/dextrose CCB: Atropine - glucagon - insulin/dextrose |
|
|
antidote/treatment for:
cocaine Dig Heparin Isoniazid |
coke: Calcium channel blocker, benzo if agitation
Dig: digibind Heparin: protamine iso: B6 |
|
|
antidote/treatment for:
methanol/ethylene glycol sulfonylureas TCA organophosphates |
methanol - fomepizole
sulfonylureas - DEXTROSE TCA - sodium bicarb organophosphates: atropine, pralidoxime |
|
|
antidote/treatment for:
tPa/streptokinase warfarin |
tpa/strepto: aminocaproic acid
warfarin: if bleeding: FFP and vitamin K INR <5: hold dose 5-9: consider giving vit K >9: give vitamin K |
|
|
should the following bites be left open or closed
hand face |
hand - yes
face - no, has enough vascular supply |
|
|
when is tetanus Ig given in bite/injury
|
1. No prior immunization
2. tetanus prone wound + <3 immunizations |
|
|
person has received immunization against tetanus
in the past, when would the need another Td booster if clean wound/low risk dirty/contamination |
clean >10 years ago
dirty >5yrs ago |
|
|
2 complications of ingesting caustic substance
|
1. pyloric/esophageal strictures
2. esophageal squamous carcinoma |
|
|
obtunded person has almond scented breath
|
cyanide tox
|
|
|
person has yellow color change in vision
|
dig toxicity
|
|
|
person has ingestion hx, hyperthermia, tinnitus, breathing fast dx
|
aspirin overdose
|
|
|
tx of PEA
|
1. CPR
2. epi 3. atropine 4. shock |
|
|
COPD pt presents with tacycardia, hypotension, seizures, dx
|
theophylline overdose
|
|
|
biggest complication with TPN
|
infection
acalculous chole |
|
|
person has gastric bypass, what is ppx to decrease chance of getting gallstones
|
ursodeoxycholic acid
|
|
|
what monoclonal antibody can be used in CLL
|
rituximab CD20
|
|
|
petetchia and fever should indicate
|
DIC
|
|
|
treatment of agitation in delirium
|
haloperidol
|
|
|
left facial paralysis, right arm and leg weakness, where was stoke
|
pons
- cross hemiparesis |
|
|
murmur that gets louder as the patient leans forward and sits up
|
aortic regurg
|
|
|
HIV drug that causes vivid dreams and hallucinations
|
efavirenz
|
|
|
child with rose colored macules on trunk and fever
|
roseola
|
|
|
chest pain with paradoxical splitting
|
1. LBBB
2. Antero/lateral MI |
|
|
sharp tearing pain that radiates to the back/scapula
|
aortic dissection
|
|
|
when to do stress echo instead of excercise stress
|
1. prior LBBB
2. prior ST depressions 3. Digoxin |
|
|
when are 2b/3a inhibitors used in NSTEMI
|
if they need PCI
- if no PCI - can give clopidogrel |
|
|
what are the immediate EKG changes in MI
and when do they go away |
1. T waves peaked
- Hours 2. ST elevation - Weeks |
|
|
what EKG changes occur hours later after MI
|
T wave inversions
|
|
|
what EKG changes occur days later after MI
|
Q waves
|
|
|
What interventions lower mortality in a patient with ischemic heart disease
|
1. Statins
2. Aspirin 3. Beta blockers 4. CABG in pts with triple vessel or left main |
|
|
most common cause of death after MI
|
V fib
|
|
|
what is the blood supply to AV and SA node
|
RCA
|
|
|
what is the oxygen formula for CO
|
rate O2 used
______________________ arterial - venous O2 |
|
|
what is the LDL goal if no risk factors
|
<160
|
|
|
what is the LDL goal if 2 risk factors
|
<130
|
|
|
what is the LDL goal if have:
DM CAD PAD >2 risks |
<100
|
|
|
what two cholesterol meds can you not mix together
|
statins
fibrates |
|
|
A - atrial contraction
C- ventricle contraction X - atrial relaXation V - venous filling of atria Y - passive filling of ventricle from atria |
|
|
1. Mitral/Tricuspid opening
2. Ventricles filling 3. Mitral/Tricuspid close 4. Isovolumetric contraction 5. Aortic/pulmonic opening 6. Ejection 7. Aortic/pulmonic valve close 8. Isovolumetric relaxation |
|
|
when is an automated implanted cardiac defibrillator used
|
EF <35%
|
|
|
when is a biventricular pacemaker used
|
QRS >120
|
|
|
treatment of MAT
|
-same as a fib
1. BB 2. CCB |
|
|
what does short PR interval make you think of
|
WPW
|
|
|
tx of wpw if
stable unstable |
stable: procainamide
unstable: cardiovert |
|
|
what drugs cannot be given in WPW
|
1. CCB
2. Dig 3. BB - Will slow conduction through normal pathway |
|
|
upright P wave in II
upright in aVR |
ectopic atrial pacemaker
|
|
|
no P waves, slow
|
junctional rhythm
|
|
|
no P waves, tacycardia
|
AV Node reentrant tacycardia
|
|
|
3 different types of P waves, tacy
|
MAT
|
|
|
3 different types of P waves, normal rate
|
wandering pacemaker
|
|
|
3 different types of P waves, brady
|
MAB
|
|
|
what heart sound will be heard in pulmonary HTN
|
increased P2
|
|
|
PDA due to what infection
|
rubella
|
|
|
weak pulse with delayed peak
|
aortic stenosis
|
|
|
treatment of aortic regurg
|
decrease afterload
- ace/arb - ccb |
|
|
what affect does valsalva have on heart
|
decreases pre load by decreasing venous return by increasing intrathoracic pressure
|
|
|
what are the causes of pericarditis
- infectious - autoimmune - other |
infectious: coxsackie, echo, HIV
autoimmune: SLE other: radiation, uremia, dresslers |
|
|
cardiac cath shows equalization of all 4 chambers
|
pericarditis
|
|
dx
|
pericardial effusion/tamponade
- its electrical alterans |
|
|
what drug causes dilated cardiomyopathy
|
doxorubicin
|
|
|
what valvular finding can be seen with dilated cardiomyopathy
|
mitral regurg
|
|
|
3 causes of restrictive cardiomyopathy
|
1. sarcoid
2. amyloid 3. hemechromatosis |
|
|
jvd with inspiration is seen with
|
constrictive pericarditis
|
|
|
treatment of MAT
|
1. BB
2. CCB |
|
|
tx of a flutter
|
1. BB
2. CCB |
|
tx
|
shock
|
|
|
ascites, lower extremity edema, no JVD
|
occlusion of IVC
- budd chiaria |
|
|
late systolic murmur
|
MVP
|
|
|
early diastolic murmur
|
AR or PR
|
|
|
person has murmur and pulsations in nail bed
|
AR
|
|
|
weak S2 seen in
|
aortic stenosis
|
|
|
next step if
- hypotensive - JVD - distant heart sounds |
pericardiocentesis
- cardiac tamponade |
|
|
person has bone, nerve and vascular injury, what tx will they need to have
|
ppx fasciotomy
|
|
|
person has hypertension but bradycardia and breathing slowly, dx
|
elevated ICP
|
|
|
what are the levels of neck zones and how to evaluate
1 2 3 |
1: Clavicle to cricoid: 4 vessel CTA
2: Cricoid to mandible: Surgery 3: Mandible: 4 vessel CTA AND TRIPLE ENDOSCOPY |
|
|
person has neck wound and hypotension, neck step
|
surgery
|
|
|
what is the treatment of flail chest
|
1. Bipap
2. ANALGESIA 3. FLUID restriction |
|
|
what is the ppx in rape
|
1. ceftriaxone
2. doxy/azythromycin 3. HIV ppx 4. HBV if not 5. Anti emetics due to all the drugs 6. Plan B |
|
|
when does a person need to be intubated in trauma
|
1. GCS <8
2. unconscious with noisy breathing 3. potential C spine injury |
|
|
what 3 things cause shock in trauma setting
|
1. bleeding - by far most common
2. tension ptx 3. tamponade |
|
|
what is the order of tx of shock if in ED
|
1. stop source of bleeding
2. fluid resuscitate |
|
|
trauma pt is unconscious, no bleed found on CT, what is likely cause
|
Diffuse axonal injury
|
|
|
punctate hemorrhages and blurring of gray white matter on ct in unconscious person
|
Diffuse axonal injury
|
|
|
rear end collisions will cause what type of spinal cord injury
|
central cord
- syringomyelia like presentation - loss of P&T over arms only |
|
|
pt has a hemothorax, what is the normal site of bleeding
|
lung
|
|
|
when is surgery needed for hemothorax
|
1. if known internal mammary artery damage
2. >600ml in 6 hours 3. >1500ml in 24hours |
|
|
blunt trauma to the chest
- what 3 things do you have to check for |
Pulmonary contusion ==> blood gases cxr
Heart damage ==> troponins and ekg Transection of the aorta ==> sono or cta |
|
|
if person has paradoxical chest wall motion after trauma, what else has to be investigated for
|
transection of the aorta
- big time force injury |
|
|
person has trauma to chest, next day develops white out on CXR and trouble breathing,
dx tx |
pulmonary contusion
1. fluid restrict 2. diuretics |
|
|
person has car accident, is doing fine up until they die suddenly, dx
|
transection of aorta
|
|
|
sudden death in pt who had chest trauma but was intubated and on respirator
|
air emboli
|
|
|
how to prevent air emboli
|
trendeleburg position
|
|
|
person has abd surgery, then two days later abd starts to swell and sutures start to rip, dx
|
abdominal compartment syndrome
|
|
|
how to dx bladder injury
|
retrograde cystogram
|
|
|
person has blunt ABD trauma but stable, next step
|
CT abd/pelvis
|
|
|
pt has abd stab wound, but stable, next step
|
1. FAST
2. DPL 3. ABD CT |
|
|
blunt abd trauma and unstable, next step
|
1. FAST
2. DPL |
|
|
person has blunt abd trauma, is unstable, and FAST shows no fluid in pelvis, next step
|
angio for retroperitoneal bleed
|
|
|
retroperitoneal air in abd dx
|
duodenal injury
|
|
|
bladder rupture tx
|
urgent surgery not emergent
|
|
|
most common cause of congenital hypothyroid
|
thyroid dysgenesis
|
|
|
pANCA is positive in which ibd
|
UC
|
|
|
newborn, feeding intolerance, bloody diarrhea
|
necrotizing enterocolitis
|
|
|
person has surgery, on day 3 post op has decreased sensation on edges of wound, gray discharge, dx
|
necrotzing wound
|
|
|
treatment of incontinence due to epidural anesthesia
|
intermittent cath
|
|
|
tx of opioid withdraw in dependent patients
|
methadone
|
|
|
type of fluid used to treat hypernatremia or dehydration in child
|
Normal saline
|
|
|
neonate with cyanosis, left axis deviation, decreased pulmonary markings
|
tricuspid aresia
|
|
|
3 bugs that like increased iron states
|
Listeria
Yersinia Vibrio |
|
|
you are very sure someone has endocarditis, but culture is repeatedly normal
|
HACEK endocarditis
|
|
|
what is the empiric tx for endocarditis
|
vanc/gent
ceftriaxone/gent |
|
|
what drug htn drug should be avoided in gout
|
thiazides
|
|
|
woman has HTN due to OCP use, what to do
|
stop OCP
- change to progestin only - or use depot shot |
|
|
what is the best way to follow shock and perfusion status
|
mental state
urine output |
|
|
person needs ppx abx for surgery, what to give before and after if:
- oral surgery - gi/gu |
oral: amox, before and after
gi/gu: amp/gent before, amox after |
|
|
what types of shock have low peripheral resistance
|
1. Neurogenic (loss of tone)
2. Septic |
|
|
which types of shock will have low heart rate
|
1. Neurogenic
2. Cardiogenic maybe |
|
|
What types of shock have high PCWP
|
1. Cardiogenic
2. Tamponade |
|
|
Hypovolemic shock
- SVR - HR - PCWP - Tx |
SVR: High
HR: High PCWP: Low Tx: Fluids |
|
|
Cardiogenic shock
- SVR - HR - PCWP - Tx |
SVR: High
HR: High or variable PCWP: High Tx: Dobutamine (NO fluids) |
|
|
Tension PTX, hemothorax causing shock
- SVR - HR - PCWP - Tx |
SVR: High
HR: High PCWP: Low or normal (decreased venous return) Tx: Chest tube |
|
|
Cardiac Tamponade Shock
- SVR - HR - PCWP - Tx |
SVR: High
HR: High PCWP: High Tx: Pericardiocentesis |
|
|
Neurogenic Shock
- SVR - HR - PCWP - Tx |
SVR: Low
HR: Low PCWP: Low or normal Tx: Fluid, Atropine, Pressors |
|
|
Septic Shock
- SVR - HR - PCWP - Tx |
SVR: Low
HR: High PCWP: Low Tx: Fluids, ABX, Nor |
|
|
hypertension, depression, renal stones dx
|
hyper PTH
|
|
|
what type of HTN meds will have first dose hypotension
|
alpha blockes
|
|
|
best way to reduce BP
|
lose weight
|
|
|
biggest risk for AAA
|
atherosclerosis
|
|
|
biggest risk for aortic dissection
|
HTN
|
|
|
next step if widened mediastinum
|
CT
|
|
|
best tx for aortic dissection
|
Beta blocker
|
|
|
angiography that shows mutiple aneurysms
|
PAN
|
|
|
next step if a kid has early cyanosis
|
prostaglandins to keep PDA open
|
|
|
treatment for superficial thrombophlebitits
|
1. remove catheter if present
2. NSAIDS 3. heat 4. limb elevation/compression |
|
|
treatment of large VSD
|
1. ACE
2. Diuretic 3. Dig |
|
|
newborn with irritability, found to have left sided mi, dx
|
anomalous origin of left coronary artery
- will arise from pulmonary artery and give deoxygenated blood |
|
|
person becomes dizzy, nausea, tingling in arm, cold arm
dx |
subclavian steal
|
|
|
before undergoing fem pop bypass for claudication, what has to be done first
|
stress test
|
|
|
next step if person develops bloody diarrhea and fever post aorta repair
|
sigmoidoscopy
|
|
|
person has upper gi bleed, year ago had aorta surgery, dx
|
aortaenteric fistula
|
|
|
what is recommended for patients with CAD before surgery
|
Beta blocker
|
|
|
most common transfusion reaction
|
non hemolytic febrile
|
|
|
what type of transfusion reaction is due to ABO incompatibility
|
hemolytic acute
|
|
|
what type of transfusion reaction is caused by antibodies to HLA
|
non hemolytic febrile
|
|
|
what type of transfusion reaction is due to antibodies to Kidd or Rh anitbodies
|
delayed hemolytic
|
|
|
thrombocytopenia and purpura one week after receiving a transfusion
dx tx |
post transfusion purpura
ivig/plasmapheresis |
|
|
fever chills malaise hours after transfusion
dx tx |
nonhemolytic febrile
tylenol |
|
|
itching after transfusion
dx tx |
urticarial reaction
diphenhydramine |
|
|
person develops fever, chills, nausea, flushing, hypotension during transfusion
dx tx |
acute hemolytic reaction
- aggressive support |
|
|
fever, falling h/h, increased unconjugated bili, week after receiving transfusion
dx tx |
delayed hemolytic
none |
|
|
person has transplant, biopsy shows thrombosis
dx tx |
hyperacute rejection
none, should have been prevented by ABO compatibility |
|
|
person has transplant, few weeks later gets organ failure, biopsy shows T cell infiltrate
dx tx |
acute rejection
steroids |
|
|
person years after receiving transplant gets organ failure, what will appear on biopsy
|
B and T cells
- Vascular fibrosis |
|
|
worst cardiac risk factor prior to surgery
|
CHF
|
|
|
person has MI, when can they have surgery after
|
6 months
|
|
|
person has DM and is getting surgery, what should they do about their meds
|
do not take day of
|
|
|
what are the causes of post op fever on these dayss
1 3 5 7 >10 |
1: atelectasis
3: UTI, pneumonia 5: Deep thrombophlebitis 7: Wound, PE 10: Abscess |
|
|
what are the causes of post op fever and they associated days
|
Atelectasis: 1
Pneumonia: 3 UTI: 3 DVT: 5 Wound: 7 PE: 7 Abscess: 10 Meds: Any day - most commonly antibiotics Transfusion: Any day |
|
|
next step if fever >10 days post op
|
CT scan for abscess
|
|
|
person has surgery, wound looks intact but is draining red fluid, next step
|
secure wound, then surgery
|
|
|
what is the hourly maintenance fluid requirement formula
|
4 cc/kg for the first 10 kgs
2 cc/kg for the next 10 kgs 1 cc/kg for the rest |
|
|
what is the mechanism behind non hemolytic febrile transfusion reaction
|
host B cells attack donor WBC
|
|
|
Bone marrow transplant, one week later develops diarrhea, jaundice, bleeding, multi organ failure dx
|
graft vs. host
|
|
|
side effect of cyclosporin
|
nephrotoxicity
|
|
|
side effect of azathrioprine
|
leukopenia
|
|
|
side effect of tacrolimus
|
leukopenia
|
|
|
treatment of brutons agammaglobulinemia
|
life long immune globin
|
|
|
treatment for fmd
|
angioplasty with stent
|
|
|
how to differentiate RLQ pain between appendicitis and psoas abscess
|
no guarding in psoas asbcess
tenderness and guarding in appendicitis |
|
|
best way to test for histoplasmosis
|
serum antigen
urine antigen |
|
|
treatment for histoplasmosis if
severe moderate |
severe: amphotericin B then itraconazle for a year
moderate: itraconazole |
|
|
halo sign on xr
|
aspergillous
|
|
|
what nerve goes though the parotid gland
|
facial
|
|
|
first step in the management of any pleural effusion
|
thoracentesis
|
|
|
mass in pancreas with massive watery diarrhea
|
VIPoma
|
|
|
what is the cause of physiologic jaundice
|
decreased UDP activity, not level
|
|
|
most common predisposition of orbital cellulitis
|
sinusitis
|
|
|
symmetric, multiple joint arthritis in young adult
|
parvo
|
|
|
chronic headaches with painless hematuria
|
papillary necrosis
|
|
|
dark pigmented liver
|
Dubin johnson
- remember D for Dubin |
|
|
px of laryngomalacia
|
usually resolves on own
|
|
|
person is in car accident, is normotensive when they come in, then develop hypotension later, next step and dx
|
next step: ct with contrast
dx: splenic rupture late onset hypotension after trauma = splenic rupture |
|
|
how to tell septic joint from avascular necrosis in sickle cell
|
presence of fever and tenderness
- will be warm and tender in osteo |
|
|
treatment of inflammatory acne
|
topical erythromycin
|
|
|
mcc of brain abscess in immunocompetent
|
strep
bacteroides (anaerobic) |
|
|
most common cause of pneumonia in newborn
|
1. gbs
2. ecoli 3. listeria - same as meningitis |
|
|
most common cause of pneumonia in 1-4 months
|
1. RSV
2. chlamydia |
|
|
treatment of pneumonia in newborn
|
amp/gent
|
|
|
treatment of pneumonia in 1-4mo
|
macrolid
|
|
|
most common cause of pneumonia in 4mo-4yr
|
RSV
- rhino - flu - paraflu |
|
|
mcc of pneumonia 5-15yr
|
STREP
then Myocplasma |
|
|
treatment of pseudomonas pneumonia
|
at least 2 drugs
|
|
|
what are the mechanical settings for ventilation in ARDS
|
low ventilation
PEEP try to keep FiO2 low |
|
|
what are the 3 causes of high A-a gradient
|
1. PE
2. Pulmonary edema 3. Right to left shunt |
|
|
person is on chronic steroids, has trouble breathing and bilateral infiltrates on cxr
|
PCP
|
|
|
increased DLco seen in
|
pulmonary hemorrhage
ex: goodpastures |
|
|
what is the mechanism of damage behind ARDS
|
Diffuse alveolar damage leads to increased vessel permeability
|
|
|
ARDS
- pulmonary artery pressure - wedge pressure |
PAP: increased
PCWP: <18 |
|
|
person with persistent productive cough and copious sputum production
|
bronchiectasis
|
|
|
tx of svc syndrome
|
stent
|
|
|
tx of non small cell carcinoma
localized non localized |
localized: surgery
non: chemo/radiation |
|
|
honeycomb lung on cxr
|
idiopathic pulmonary fibrosis
|
|
|
most common cause of pulmonary htn
|
copd
|
|
|
person has repeated pleural effusions due to cancer, next step
|
pleurodesis
|
|
|
person has to be intubated longer than 3 weeks, what to do
|
tracheostomy to decrease pneumonia risk
|
|
|
what causes croup
|
parainfluenza
|
|
|
what is the treatment for croup
|
first: O2
next: racemic epi next: steroids |
|
|
what is the treatment for epiglottitis
|
1. Minimize child anxiety
2. intubate 3. IV abx |
|
|
what is the treatment for bronchiolitis
|
1. O2
next: albuterol or epi |
|
|
kid was rds of newborn, at increased risk for what later in life
|
asthma
|
|
|
obstructive pfts, normal dlco
|
asthma
or chronic bronchitis |
|
|
what is the pathyphys behind chronic bronchitis
|
hypertrophy of mucus secreting glands leading to airway obstruction
|
|
|
what type of infection would make you suspect bronchiectasis
|
pseudomonas
|
|
|
multiple upper lobe nodules, dx if
acute chronic |
acute: silicosis
chronic: anthracosis |
|
|
pleural plauqes on cxr
|
asbestosis
|
|
|
lung cancer with cavitation
|
squamous
|
|
|
diarrhea and pet feces
|
yersinai
|
|
|
young kid with green diarrhea in winter
|
rotavirus
|
|
|
what is the marker for infectivity in hbv
|
HBe
|
|
|
what is the most common parotid gland tumor
|
pleomorphic adenoma
- benign |
|
|
side effects of a drug
- impotence - gynecomastia - thrombocytopenia |
H2 blockers
- cimetidine |
|
|
person has confirmed GERD, no cancer, but does not respond to PPI and therapy
|
Nissen fundoplication
|
|
|
initial treatment of achalasia
|
balloon dilation
|
|
|
Baby develops stridor and respiratory distress with “crowning” respiration and hyperextended neck, dx
|
vascular ring
|
|
|
diarrhea, numbness and tingling in arms
|
ciguatera toxin
|
|
|
vomiting, diarrhea, wheezing after eating
|
scombroid
|
|
|
what is the post exposure ppx for HBV
|
ig and vaccinate
|
|
|
what is the post exposure ppx for HAV
|
ig and vaccinate
|
|
|
persons roommate has HAV what to do next
|
immune globin
|
|
|
person has previous gastric bypass, presents with epigastric pain and bilious vomiting dx
|
loop syndrome
|
|
|
low fecal elastase
|
chronic pancreatitis
|
|
|
best test for chronic pancreatitis
|
low fecal elastase
|
|
|
worse type of hiatal hernia
|
paraesophageal = stomach goes through diaphragm, ge junction is in normal spot
|
|
|
what associations are present with type A gastritis
|
1. achlorhydria
2. thyroid disease |
|
|
suspecting boerhaven, next dx step
|
GASTROGRAFFIN swallow
then barium |
|
|
what type of study knows the risk/risk reduction and wants to evaluate it
|
cohort
|
|
|
what is the conclusion of a cohort study
|
relative risk
|
|
|
what type of study looks back for an exposure or risk
|
case control
|
|
|
what is the conclusion of a case control study
|
odds ratio
|
|
|
what is the risk of a disease in people exposed to a factor
|
relative risk
(A/A+B)/(C/C+D) |
|
|
what is the odds of exposure among patients with a disease compared to those without
ex: number of ppl with lung cancer that smoked |
odds ratio
(A/B)/(C/D) |
|
|
100 patients received medication X to prevent the development of diabetes and 200 patients did not receive the medication, 10 patients in the experimental group and 40 patients patients in the control group developed diabetes, what is the absolute risk reduction and number needed to treat?
|
10/100= 0.1
40/200= 0.2 ARR= 0.2-0.1= 0.1 NNT= 1/ 0.1= 10 |
|
|
probability that a screening test will be positive in patients with a disease
|
sensitivity
|
|
|
probability that a test will be negative in patients without a disease
|
specificity
|
|
|
sensitity
|
A/A+C
|
|
|
specificity
|
D/D+B
|
|
|
odds of having positive test for those with a disease compared to those without it
|
likelihood ratio
|
|
|
postive likelihood ratio
|
sensitivity/false positive
|
|
|
negative likelihood ratio
|
false negative/specificity
|
|
|
type of error where you conclude something is true but its not
|
type 1 alpha
|
|
|
type of error where you conclude something is false when its true
|
type 2 beta
|
|
|
confidence interval crosses one
|
no association between the risk and disease
|
|
|
confidence interval crosses zero
|
no actual difference
|
|
|
treatment of mg sulfate tox
|
calcium
|
|
|
infant that cries for hours at the same time of the day
dx tx |
infantile colic
reassurance |
|
|
dilation of pampiniform plexus
|
varicocele
|
|
|
infant with bilateral cataracts and jaundice
|
galactosemia
|
|
|
person cannot balance and continues to fall to one side
|
cerebellar lesion / cerebellar tumor
|
|
|
cru di cat deletion
|
5p
|
|
|
bilateral eye edema, headache, cranial nerve deficits
|
cavernous sinus thrombosis
|
|
|
most significant complication of pseudotumor
|
blindness
|
|
|
slapping foot gait, could be due to
|
1. Large fiber neuropathy: Vitamin B12
2. Dorsal column: tabes |
|
|
1. Posture is flexed
2. Gait initiation impaired 3. Small shuffling steps that do not leave the ground |
- Frontal lobe dysfunction
1. Hydrocephalous 2. Tumor 3. Stroke 4. Neurodegen disorders |
|
|
Legs tend to cross during walking
|
demyelinating condition in spinal cord
- ms - transverse myelitis |
|
|
1. Affected leg is stiff and does not flex at hip knee or ankle
2. Leg is circumducted and tends to scrape the floor 3. Arm is held flexed and does not swing |
hemiparetic gait
|
|
|
noctural enuresis and diaper rash
|
type one diabetes
|
|
|
side effect of acylcovir
|
renal tubular obstructiont
|
|
|
treatment of inevitable abortion
|
suction curretage
rho gam |
|
|
egg shell calcifications of hepatic cysts,
due to tx |
echinococcus hydatid
leave alone - do not drain |
|
|
woman at 39 weeks, bleeding, baby's hr goes from tacycardia, to bradycardia, to sinusoidal
|
vasa previa
|
|
|
appendicitis tx if:
pain started within past couple days pain began 5 days ago |
past couple days: surgery now
>5 days: abx to calm down, surgery in 8 weeks |
|
|
px of volvulus
|
likely to recurr
- have to tack down |
|
|
latin immigrant with symptoms of malabsorption and megaloblastic anemia
tx |
dx: tropical sprue
tx: 1. folate 2. abx for months |
|
|
positive aSca
|
crohnS
|
|
|
blunting of jejunal and duodenal villi
|
celiac
|
|
|
high pitched bowel sounds, abd pain
|
small bowel obstruction
|
|
dx
|
small bowel obstruction
|
|
|
malrotation with double bubble
|
|
|
jejunal atresia triple bubble
|
|
|
birds beak in abd
|
volvulus
|
|
|
ct of abdomen shows air in bowel wall with bowel wall thickening
|
ischemic colitis
|
|
|
llq pain relieved by defecation
|
diverticulosis/diverticulitis
|
|
|
most common cause of lower gi bleed in patients >40
|
diverticulosis
|
|
|
treatmetn of colorectal cancer
|
resection of bowel
plus resection of regional lymph nodes |
|
|
what is the stage of the colorectal cancer with lymph node involvements
|
3
|
|
|
what is the screening for reoccurrence for colorectal cacner
|
CEA: every 3mo for 3 yrs
colonoscopy: at 1,3,5 yr chest/abd/pelvis ct scan: every year |
|
|
person has gi bleed but has high inr, what is the goal
|
<1.5
|
|
|
you are suspecting lower gi bleed, colonoscopy is normal though, next step
|
angiography for AVM
|
|
|
thickened gallbladder but no gallstones,
|
acalculous cholecystitis
|
|
|
what are the 2 risks for acalulous cholecystitis
|
1. TPN
2. very sick |
|
|
calcified gallbladder dx
|
cancer
|
|
|
treatment of carcinoid
|
octreotide
|
|
|
pregnant lady has pruritus that does not resolve after pregnancy
|
pbc
|
|
|
breast feeding jaundice
due to day peaks bilirubin level |
due to: dehydration
peaks at: first week bili: >10 |
|
|
physiologic jaundice
appears on bili level |
appears on: 2nd or 3rd day of life
bili: <10 |
|
|
what antibodies are seen in PBC and PSC
|
PBC: AMA
PSC: pANCA (just like ulcerative colitis) |
|
|
ercp shows stricturing and narrowing of extrahepatic and intrahepatic ducts
|
psc
|
|
|
tx of wilsons
|
1. trientine
2. penicillamine |
|
|
newborn has explosive passage of feces on rectal exam
|
hirschsprungs
|
|
|
sausage like mass in newborn on abd exam
|
intussception
|
|
|
person has chronic pancreatitis and gastritis and gastric varicies, what could the varicies be from
|
splenic vein thrombosis
|
|
|
Person with uc gets colon and rectum removed, now has fever bloody diarrhea 6 months later,
dx tx |
pouchitis
metronidazole |
|
|
best way to dx giardia
|
elisa
|
|
|
what vitamin deficiency can occur in carcinoid
|
niacin
|
|
|
most common presentation of celiac
|
iron deficiency anemia
|
|
|
what type of chemo is given in colonic cancers
|
5-FU
|
|
|
how to differentiate acute cholecystitis from cholangitis
|
ALK phos
|
|
|
person with negative pmh has had bright red blood streaks for 3 weeks,
most likely dx next step |
hemorrhoids
colonoscopy to r/o cancer |
|
|
massive dilated colon without evidence of mechanical obstruction, dx?
|
ogilvies aka pseudoobstruction
|
|
|
fibrillin one gene mutation
|
marfans
|
|
|
young kid with overlapping fingers, clenched/closed firsts, small jaw, rocker bottom feet
|
edwards
|
|
|
young kid with pliable skull bones
|
rickets
|
|
|
person has a tia what drug will they be sent out on
|
aspirin
|
|
|
infant with cyanosis that is worsened by feeding, but gets better with crying
|
choanal atresia
|
|
|
kids with hsp at risk for
|
intussception
|
|
|
hiv pt, multiple non enhancin lesions on mri
|
primary multifocal leukoencephalopathy
|
|
|
best way to intubate a patient that has c spine injury
|
orotracheal
|
|
|
majority of patients with pagets disease of the breast have what type of underlying cancer
|
adenocarcinoma
|
|
|
enlargement of pulmonary arteries, right heart enlargement on cxr
|
pulmonary htn
|
|
|
kid with sickle cell has stroke like symptoms, clear head ct, next step
|
exchange transfusion
|
|
|
first line drug therapy for fibromyalgia
|
tricyclics
|
|
|
pt with prior history of rheumatic fever and murmur
|
continuous penicillin ppx
|
|
|
initial tx of symptomatic mitral stenosis
|
preload reduction
- nitrates |
|
|
tx for bilateral breast tenderness and swelling immediately after birth
|
breast engorgement
- cold packs, nsaids |
|
|
most common cause of spinal stenosis
|
degenerative disk disease
|
|
|
management of single solitary brain met
|
resection
WHOLE brain radiation steroids |
|
|
management of multiple brain mets
|
whole brain radiation
|
|
|
spherocyte on smear with positive combs
|
autoimmune hemolytic anemia
- both hereditary spherocytois and autoimmune hemolytic anemia can have spherocytes |
|
|
rotator cuff pathology that improves with lidocaine shot
|
impingement
|
|
|
most susceptible area of colon to ischemia
|
splenic flexure
|
|
|
treatment of central precocious puberty
|
GnRH analogue
|
|
|
marfans features plus stroke/thombotic events
|
homocysteinuria
|
|
|
what surveillance must be done if a person is on hydroxychloroquine
|
eye exams
|
|
|
what are the findings on prenatal screening for down syndrome:
beta hcg afp estriol inhibin a |
beta hcg: increased
afP: decreased estriol: decreased inhibin: increased |
|
dx
|
howell jolley bodies/splenectomy
|
|
|
how to tell the difference between laryngomalacia and vascular ring
|
laryngomalacia: improves when supine, better prone
vascular: better with neck extension |
|
|
most common manifestations of polycythemia in newborn
|
respiratory distress
feeding difficulies |
|
|
what is the cause of leukopenia and thrombocytopenia in sle patients
|
autoimmune destruction
|
|
|
tenofovir and entecavir used to treat what
|
hbv
|
|
|
most common type of nephropathy associated with cancer
|
membranous
|
|
|
what nephropathy is associated with hodgkins lymphoma
|
minimal change disease
|
|
|
positive cyanide nitroprusside test
|
cysteinuria
|
|
|
best design to determine incidence
|
prospective cohort
|
|
|
type of seizure with aura, increased cpk
|
partial seizure with generalization
- yes this can have loss of consciousness |
|
|
breast mass that is biopsied and shows fat globules and foamy macrophages
|
fat necrosis
|
|
|
patients with pct need to be screened for what
|
hcv
|
|
|
next step if post menopausal woman has ovarian mass
|
ultrasound then
CA 125 |
|
|
post menopausal woman has ovarian mass, but with benign features and no elevation in CA 125
next step |
>10cm: remove
<10cm: watch |
|
|
first step in suspected diaphragmatic hernia
|
intubate
then place gastric tube to decompress |
|
|
person is in car accident is unconscious, hypotensive, and blunt abd trauma, does not respond to fluid, next step
|
ex lap
- do not do head ct |
|
|
electrolyte complication of sah
|
hyponatremia
|
|
|
hemolytic anemia, venous thrombosis, anemia
|
PNH
|
|
dx
tx |
dx: wide complex tacy
tx; amio |
|
|
initial management of myelopathy associated with cancer
|
corticos
mri right away |
|
|
what has to be test for before starting trastuzumab
|
echo
|
|
|
young kid with inflamed right eye, nasal discharge, cornea shows neovascularization
|
chlamydia
|
|
|
diabetes over 40 automatically receive what medication
|
statin
|
|
|
what type of cancer if decreased leuk alk phos and increased wbc
|
CML
|
|
|
hiv therapy that causes:
pancreatitis |
didanosine NRTI
|
|
|
hiv therapy that causes:
hypersensitivity |
abacavir NRTI
|
|
|
hiv therapy that causes:
lactic acidosis |
all NRTI
|
|
|
hiv therapy that causes:
stevens johnsons |
all NRTI
|
|
|
hiv therapy that causes:
liver failure |
nevirapine NNRTI
|
|
|
hiv therapy that causes:
needle shaped crystals |
indinavir protease
|
|
|
hematuria that occurs at end of urination
|
bladder or prostate damage
|
|
|
hematuria that appears at beginning of stream and goes away
|
urethral
|
|
|
hematuria throughout the entire stream
|
kidney or ureter damage
|
|
|
round ulcer in hiv pt on endoscopy
|
hsv
|
|
|
linear ulcer in hiv pt on endoscopy
|
cmv
|
|
|
pain and swelling on inner aspect of eye and pressure causes expression of purulent material
|
dacrocystitis
|
|
|
rsv infection in kid may predispose to what later in life
|
asthma
|
|
|
most common cause of pneumonia in child with cf
|
staph aureus
|
|
|
post op patient with new rbbb
|
massive PE
|
|
|
small palpebral fissures, thin upper lip, absent philtrum
|
fetal alcohol
|
|
|
person has repeated upper gi bleeding, what has to be done before upper endoscopy
|
intubation to protect airway
|
|
|
what is the mechanism of exudative effusions
|
increased capillary permeability
|
|
|
type of bias when study subjects change their behavior when they know they are being observed
|
hawthorne effects
|
|
|
person has mi, what drug has to started within 24 hours to prevetn remodeling
|
ace
|
|
|
px of alcoholic cirrhosis
|
reversible if they stop
|
|
|
most common cause of painless hematuria in adults
|
bladder mass
|
|
|
what effect on these cancer risks does tamoxifen have
breast endometrial |
breast: decrease
endometrial: increase |
|
|
when to give dexamethasone for meningitis and when to not
|
give: empirically or if confirmed strep pneumo
dont give: <6months or have confirmed other source |
|
|
urine ca/creatinine clearance <0.0 one
|
Familial hypocalcium urine
|
|
|
duration of lithium therapy after
first manic episode 2 manic episodes 3 manic episode |
first: for one year after remission
second: at least years, if not long term third: life long |
|
|
why are splenectomy patients at risk for encapsulated organsism
|
impaired opsonization and phagocytosis
|
|
|
closed angle glaucoma
vs open angle glaucoma |
closed: sudden acute headache and loss of vision
open: progressive peripheral loss of vision |
|
|
person has bone marrow transplant, develops cough and diarrhea dx
|
cmv
|
|
|
how to treat malignant otitis externa
|
oral cipro
|
|
|
neonatal jaundice that is conjugated suggests
|
-needs further workup
- suggests biliary atresia |
|
|
most common cause of cor pulmonale in us
|
copd
|
|
|
kid with left sided neck swelling dx as cervical adenitis, will need I&D and what abx
|
clinda
|
|
|
next step after xr in bilous vomiting
|
contrast enema
|
|
|
meconium found in ileum
|
cf
|
|
|
meconium found in sigmoid
|
hirschsprungs
|
|
|
biggest risk fo neonatal rds
|
prematurity
diabetic mother |
|
|
initial procedure for massive hemoptysis
|
bronchoscopy
|
|
|
person has suspected spleen injury based off of fluid in spleno-renal pouch, next step if responded to fluid and now stable
|
ct scan
|
|
|
what is the measure of random error in a study
|
precision
|
|
|
hazard ratio less than one
|
more likely to occur in control arm
|
|
|
hazard ratio > one
|
more likely to occur in experimental arm
|
|
|
probability of getting a disease over a certain period of time
|
risk
|
|
|
how to calcualte risk
|
A/B
|
|
|
a variable increases the chance in one group but not all, what is it
confounder or effect modifier |
effect modifier
confounder: would have affected all of them |
|
|
how to calculate ARR
|
difference in incidences
|
|
|
best type of study to determine incidence of a disease
|
cohort
|
|
|
mom develops masculin features while pregnant, goes away after delivery, what condition does the kid have
|
aromatase deficiency
|
|
|
treatment of pprom and chorioamnionitis
|
delivery
|
|
|
criteria to dx pre ecclampisa
|
bp > one 40/90
proteinuria >300mg |
|
|
mechanism behind trali
|
donor anti leukocyte antibodies
|
|
|
most common cause of AR in young ppl in developed countries
|
bicuspid
|
|
|
person experiences a pounding heart when lying down
|
aortic regurg
|
|
|
person has pe, renal insufficiency, how to treat the pe
|
unfractionated heparin
|
|
|
tx of
nocardia actinomycies |
nocardia: bactrim
actinomycies: penicillin |
|
|
itp randomly shows up, what to test for
|
hcv
hiv |
|
|
macrocytic, methyl moa coa in urine
|
b12
|
