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103 Cards in this Set
- Front
- Back
When is the triple or quad screen done in pregnancy?
What do the results mean? |
15-20wga (bHCG, maternal serum AFP/MSAFP, estriol, inhibin A)
-elevated MSAFP=dating error, neural tube defect, abd wall defect -Downs=ABEI (down, up, down up) -Edwards=ABEI (down down down normal) -Patau=ABEI (all normal) |
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What murmurs need to be worked up?
What don't? Next workup step? |
diastolic, continuous, and loud systolic
-don't workup midsystolic murmur in asymptomatic pt (benign) -TTE |
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Things to consider in women complaining of hirsuitism (6)? and what to check?
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1.Meds (phenytoin, diazoxide, cyclosporine)-idiopathic
2.Family hx, ambiguous genitalis-CAH (check 17-hydroxyprogesterone) 3.Hirsuit since menarche-PCOS (check LH: FSH 2:1) 4.Rapid onset-Adrenal vs. sertoli-leydig (ovarian) tumor (check DHEA-S for adrenal and testosterone for ovarian. specifically DHEAS since DHEA only is produced in both) 5.glucose intolerance-Cushings dz (dexamethasone suppress test followed by ACTH level) |
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Pt w/ penetrating injury to L eye lost vision, now 3wks later w/ burred vision in R eye.
ML Dx? Pathophys? |
Sympathetic opthalmia (spared eye injury)
-dead eye uncovers "hidden antigens" to body that cause immune resoponse agains other eye |
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TMT for hepatic encephalopathy?
2nd line? |
Lactulose (broken down by gut flora causes conversion ammonia to ammonium that can not be absorbed)
-Rifaximin, po sodium benzoate, neomycin (short term since can cause aminoglyc side effects->oto and nephro tox) |
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Pt w/ charcot's triad->what is it?
ML Dx? Initial TMT? If still persists, next step? What about Reynold's Pentad? |
fever, jaundice, RUQ pain
-Acute Cholangitis -broad spec abx and fluid -need urgent biliary decompression->ERCP w/ sphincterotomy and stent placement (NOT SURGERY) -add AMS and HypOtn->supparative cholangitis |
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TMT for bacillus cereus?
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nothing (it's a preformed heat-stable toxin), sx usually w/in 6hrs of consuming re-heated rice
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Most common organisms in celllutlitis?
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1. Staph
2. Strep pyo (GAS) |
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PCOS puts women at risk for what?
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endometrial ca (from unaposed estrogen)
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What is the pathophys of mallory-weiss synd?
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Ruptured submucosal ARTERIES of distal esophagus and prox stomach from increased intragastric pressure during vomiting->tear in mucosa
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Pain on palp of vertebra on exam=? (2 possible)
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spinal infxn (abscess) or lytic lesion
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Initial test for pt w/ concern for compression fracture or lytic lesion vertebra?
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x-ray spine, then MRI if still concerned
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Pt postpartum 2mos ago, now w/ lethargy, weight gain, fatigue, preg was compolicated by vag bleeding needing transfucsion, no mestrual periods since, has dry skin, delayed dtrs.
ML Dx? Pathophys? Presentation? |
Sheehan's syndrome
-ischemic necrosis of pituitary -in postpartum pts w/ hx of peri-partum bleeding, lactation failure (prolactin deficiency, baby gets formula feed), secondary amenorrhea, sx of hypopituitarism (amenorrhea, down libido, down body hair, central obesity, increased LDL, less lean muscle since decreased GH) |
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Trendelenburg sign=?
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gluteus minimus/medeus weakness on contralateral side (the side of the standing leg, not the lifted leg that is drooping), since these muscles innervated by superior gluteal nerve and usually abduct the thigh
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electrolyte and acid-base disturbance of loop diuretic?
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hypokalemia and hyponatremia (since inhibits Na-K-2Cl transport in loop henle) and metabolic alkalosis (since increases aldo level leading to loss of H+)
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Pt needs to be catheterized for micturition due to thoracic vertebral fracture. Best way to do so to prevent UTI?
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Intermittent catheterizaiton
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Breastfeeding mom wants contraceptive but with option to get pregnant in 1yr.
best tmt? |
Progestin-only contraceptive (not combined OCPs since estrogen will inhibit lactation/affect volume/composition of milk), barrier, IUD, sterilization (not here since wants to get pregnant again)
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Premature infant needs vaccines. What timeline (age) do you follow to give them?
What vaccine should be given at birth? |
Baby's chronological age (not gestational age, does not depend on type of vaccine)
-HepB (all babies) |
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What vaccines given at 2mo age?
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Hep B, rotavirus, Tdap, Hib, pneumococcal, inactive polio
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How to Dx TTP?
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Clinically, but can do peripheral blood smear for confirmation
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What are the most common 2ndary malignancy after Hodgkin's dz?
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lung and breast
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How long after radiation therapy can you get radiation-induced fibrosis?
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4-24mos after, will be diffuse on CXR
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What is ichthyosis vulgaris?
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LIZARD SKIN, usually on extensor surfaces, will be increased dryness esp in winter w/ rough/dry/horny plates (spares face and diaper area)
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Where does psoriasis usually occur?
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elbows, knees, scalp trunk
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Where does atopic dermatitis usually occur? When? Sx?
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cheek, forehad, limbs, INFANTS, ITCHY
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What kind of pathophys causes drop of O2sat in consolidation (may change w/ pt positioning)?
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increased A-V shunting (since blood perfusing consolidated areas isn't ventilated, so O2Sat will be worse when pt lies on side of consolidation since more bloodflow thru the shunt)
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What is pathophys causing drop of O2sat in PE?
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increased dead space (ie. increased volume of inhaled air that cannot be used for gas exchange since no perfusion in that area)
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Compare/contrast motor deficits of anterior vs. middle cerebral artery stroke?
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Anterior=contralat lower extrem weakness w/ sensory stuff and urinary incontinencs, primitive reflexes (grasp/suckle), paratonic rigidity
Middle=more contralat UPPER extrem and homonymous hemianopia (may have aphasia if L or neglect if R) |
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Differentiate intracerebral hemorrhage from subarachnoid hemorrhage
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intracereb: hx of HTN, coagulopathy, IV drug use, sx progress over min to hour starting w/ focal sx followed by sx of increased intracranial pressure (somnolence, naus/vom/hA/bradycardia)
subarach: rupture arterial saccular berry aneurysm, sever HA onset, neck stiff (meningeal irritation), no focal deficits |
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Pt on dig and verapimil for afib, now w/ anorexia.
ML Dx? What other sx? What other causes? Dx Test? If was toxic, TMT? |
Dig-side effect from elevated level due to decreased renal clearance (due to verapimil)
-GI #1 (naus/vom/anorexia), hyperkalemia (from inhibited Na/K ATPase), confusion, visual disturbed (blurry, yellow halo), rythm (vtach, junctional arrythm, brady) -hypokalemia (since competes w/ K for binding to ATPase), any decrease renal -K level and EKG w/ downsloping ST in all leads -STOP DIG and KLAM (normalize K, lidocaine, anti-dig-Fab/dig-specific ab, Mg+) |
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Describe calculation of PPV?
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ability to identify those w/ disease (true pos) from those w/ pos results (total pos)
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Describe calc of sensitivity?
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SNOUT->ability to rule out (TP/(TP + FN)) = 1 perfect sensitive->ie you catch all the people w/ the dz
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Describe calc specifity?
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SPIN->ability to rule in (TN/TN+FP)) =1 perfect specific->ie you catch all the people w/out the dz
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S3=?
What does it sound like? TMT in these pts if symptomatic? |
enlarged ventricle w/ blood->turbulentc sound, means LV failure if sx of SOB, low O2sat
-ken-tuc-KY -diuretics |
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Pt w/ signs of atherosclerosis and resistant HTN.
THink what? look for what on physical? |
Renal artery stenosis
-bruit in periumbilical area |
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Differentiate subclavian art atherosclerosis/stenosis from coarctation of aorta on BP?
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subclav: BP in L greater than BP in R ARM
coarc: BP in upper extrem greater than BP in lower extrem (if coarc hi enough prox to L subclav->BP in R greater than BP in L->RARE condition) |
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What is normal JVD?
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<3cm
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If pt w/ scattered wheezes, JVD of 2cm, lower extrem bilat pitting edema, HTN, dilated totruous superficial leg veins.
ML Dx? Cause? TMT? |
Chronic Venous Insufficiency (not edema from CHF since JVD<3, no crackles, no ascites)
-incompetent venous valves->leg pain, edema, stasis dermatitis, skin fibrosis, ulcers (risk factors: age, female, obeses, hx lower extrem surgery, hx DVT) -leg elevation, compressing stockings, compression pneumatic devices |
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TMT of wolf-parkinson-white syndrome w/ afib?
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convert back to sinus via cardiovert or antiarrythmics like procainamide
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What type of immune response is done by pnemococcal vaccine?
What type by most others? What type by polio? |
-T-cell independent B cell response (polysaccharide w/out any attached ptn to active t cell, so no t cell)
-T-cell dependent (ie. tetanus, n meningitis, HiB, diphtheria) -IgA response (increase anti-polio IgA ab in GI tract) |
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Define central cord syndrome?
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usually hyperextension injury in elderly from degenerative change in cervical spin->weakness moreso in upper than lower extrem w/ possibel pain/temp deficit
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What makes something a confounder?
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it should be related to the exposure being looked at in a case-control study (therefore unsure which one is really causing the effect)
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What is seen on CXR in sarcoid?
Other findings? Dx Tests? TMT? |
bilateral hilar lymphadenopathy and diffuse interstitial infiltrates (but if it just says one part->still think sarcoid)
-fine rales -parotid enlargement -e nodosum -facial palsy -heart block/restrictive cardiomyopathy -CNS involved -IRITIS/UVEITIS -arthritis -TEST: CXR initial, best is lymph node bx w/ noncaseating granulomas, also up ACE, hypercalciuria/cemia, restrictive lung dz on PFTs -TMT w/ prednisone |
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Velcro-like inspiratory crackles on lung exam=?
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idiopathic pulm fibrosis
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What is the presenting sx in ankylosing spondylitis?
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back pain (don't choose w/out this)
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Pt w/ likely cirrhosis.
Managment step? |
PPx esophageal endoscopy to screen for varices->if present ppx w/ propranolol
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Metformin side effects?
Contraindications? |
none (no hypoglycemia)
-discontinue w/ renal dysfunction (also not in sepsis or liver failure)->risk of lactic acidosis |
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What drug class is glipizide?
Side effects? |
sulfonylurea (trigger insulin release from pancrease via closure of K channel in Beta cells)
-HYPOGLYCEMIA, eliminated in liver (so contraind in liver failure) |
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What drug class is pioglitazone?
side effects? |
Thiazoladinedione (increase insulin sensitivity tissues)
-HEPATOTOXIC since excreted via liver, increased fluid overload/edema (contraind in CHF) |
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What class of drug is miglitol? other drug in class?
side effects? |
alpha glucosidase inhibitor (block glucose absorption in bowel), other is acarbose
-GI disturb (flatus, diarrhea, abd pain), safe in renal failure |
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What drug class is exenatide? Other drugs?
Side effects? |
Incretin (glucose insulinotropic peptides)->all injections, sitagliptin, saxagliptin, linagliptin (decrease gastric motility, help weight loss and raise insulin
-exenatide = PANCREATITIS |
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What is pramlintide?
side effects? |
amylin analog (mimetic) increases insulin absorption
-decreased appetite, hypoglycemia, naus/diarrhea |
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Side effects of erythropoeitin therapy?
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Worsening HTN (treat w/ dialysis for fluid removal and anti-hypertensive->most common side effect
HEADACHE FLU-LIKE synd (give anti-inflammatory) Red cell aplasia (rare) |
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intra-arterial cath in radial artery showing significant variation in systolic bp related to resp cycle=?
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pulsus paradoxus->think cardiac tamponade
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DES puts you at risk for?
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clear cell adenocarcinoma of vagina and cervix
-uterine anomaly (T-shape, small) -vaginal septae In men: cryptorchidism, testicular hypoplasia, hypospadius, microphallus |
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Risk factors ovarian ca?
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family hx, nulliparity, lack of prior OCPs
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Risk factors endometrial adenoca?
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obesity, nulliparity, late menopause, HTN, DM, chronic unopposed estrogen stim, chronic tamoxifen
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TMT of nocardia?
FIrst place of manifestation dz? |
bactrim
-lungs |
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Name the drugs that have mortality benefit as secondary prevention post MI?
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1.aspirin
2. beta blockers 3. acei 4. statin (lipid lowering) |
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When should clopidogrel be used?
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pts w/ unstable MI/NSTEMI (at least 1yr)
post perc coronary invervention (at least one month to prevent stent thrombosis) |
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What are the common organisms in viral meningitis?
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Enteroviruses: echovirus and coxsackievirus
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Triphasic sharp spikes on EEG=?
Presentation? Cause? Dx test prognosis? |
Creutfeldt-Jakob Dz (prion)
-progressive rapid dementia, myoclonus, behavior change -prion (misfolded ptn that convert normal ptn to be like them) cause sspongiform encephalopathy -Dx w/ EEG showing triphasic spikes -death w/in 1yr |
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What are risk factors osteoporosis?
One that is most significant |
modifiable: low estrogen hormone, malnutrition, lo ca, lo vit D, use of steroids/anticonvulsants, immobility, cigs, ETOH use
nonmodifiable: female, aging, small body, early menopause/late menarche (estrogen is protective), caucasion/asian, fam hx -ETOH IS MOST SIGNIFICANT (dose-dependent increase osteo), obesity is protective since more estrogen, but increases risk arthritis |
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Drugs that cause macrocytic anemia?
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HYDROXYUREA (sickle cell pts need folate), PHENYTOIN (epilepsy pts), METHOREXATE (chemo pt or autoimmune pt), TRIMETHOPRIM (abx pt), ZIDOVUDINE (AIDS pt)
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Fetus in distress (late decels) + preterm labor.
TMT? |
regardless of gestational age->EMERGENT C-SECTION (anytime fetus is in distress)
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What factors is vit K needed for?
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II, VII, IX, X, ptn C, Ptn S (so any dz causing malabsorption of fat soluble vitamins: celiac, chronic pancreatitis, CF->deficiency)
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What are the first things that should be given to the disoriented pt walking into the ED?
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Thiamine-prevent Wernickes
Dextrose-prevent hypoglycemia Supplemental O2-prevent hypoxia Naloxone-prevent opiate overdose |
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Differentiate gonnococcal arthritis from reactive arthritis
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Reactive: triad of arthritis (knee, sacroiliac (apophyseal joint)->usually asymmetric), urethritis, conjunctivits, EXTRAS: mouth ulcers, enthesitis (achilles tendon pain)
Gonn: triad of dermatitis, tenosynovitis (usually wrist/hand), migratory polyarthritis assymetric->single septic arthritis |
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TMT of gout attack?
Chronic TMT? |
-NSAIDS (indomethacin)->steroid injection (oral if mult joint)->Colchicine (if the other two contraindicated, renal insufficiency contrai for nsaid)
-Chronic 1. diet (low ETOH, lose weight, low meat/purines) 2. stop thiazides, aspirin, niacin (use losartan for HTN) 3.Colchicine (SE of diarrhea/naus, agranulocytosis) 4. Allopurinol (safe w/ renal, but can cause SJS/TEN) 5. Febuxostat (same as allopurinol but no SJS) -All these can cause hypersensitivity rxn (rash, hemolysis, allergic intersitial nephriits) |
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Oddities of lupus anticoagulant/anti-phospholipid ab?
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1. slightly prolonged PTT (Immunoglobs prolong PTT by binding phospholipids in the assay->seen in Russell viper test to specifically test for lupus anticoag)
2. normal vWF, bleeding time, plt count, PT/INR 3. D-dimer hi to normal (from blood clots) |
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What is the most significant risk factor cancer?
Others? |
SMOKING
-male, >50yo, black, chronic pancreatitis, diabetes, obese, familial |
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Clubbing in COPD=?
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MALIGNANCY (not hypoxemia)->check for lung cancer!!!
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What is conn's syndrome?
What are the metabolic acid-base and electrolyte changes? |
Primary hyperaldo (likely from adrenal adenoma)
-hypokalemia, hypernatremia, HTN, metabolic alkalosis (w/ hi serum bicarb) |
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TMT for claudication?
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aspirin, smoking cessation, Cilostazol (antispasmodic antiplt w/ best efficacy)
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Pt w/ claudication sx w/ ABI 1
Next step? |
ABI after excercise
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TPN can cause what as a complication (why)?
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gall bladder stasis from lack of CCK release in GI (needed for stimulating gallbladder contraction and is secreted in dudoenum when ptn and fats present, not in TPN)->leads to gallstones and bile sludge->cholecystitis
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Elderly gets orthostatic hypotension.
What age-related change causes this? Other age related changes? |
decreased baroreceptoor sensitivity (from arterial stiffness decreases norep content nerves causes reduced sensitivity myocard to sympathetic stim)
-decreased max cardiac output/HR, increaxed contraction and relaxiation time, decreased myocytes, increased myocardial stiffness in diastole, pigmentation of myocardium, decreased GFR promoting Na retention |
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When lidocaine is used to treat anything outside of vfib/vtach, what happens?
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increased risk asystole
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When to get mammogram screening?
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50 to 75 every 2 yrs
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What is contraindication for succhinylcholine?
What to give instead? |
Hyperkalemia (since drug causes signif K release, and can lead to arrhythmia in those predisposed): crush/burn injury >8hrs old (rhabdo risk), demylinating syndromes (GBS), tumor lysis syndrome
-Give vecuronium or rocuronium (nondepolarizing agent) |
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What is the tmt for central retinal artery occlusion?
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Emergency: immediate ocular massage (to dislodge the emoblus), hyperbaric O2 (hi flow oxygen) or Carbogen therapy (5%CO2 w/ 95% O2) early on
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Name and differentiate 3 common bone tumors in kids and age?
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Osteosarcoma (malignant, most common): 13-16yo BOYS, sunburst and codman triangle at metaphysis long bones w/ soft tissue mass, up Alk phosph and LDH (higher =worse prog)->tmt surgery and chemo
Ewing Sarcomea (rare but 2nd common bone): adolescent BOYS, XR w/ osteolytic lesion and onion skin periosteal rxn, at diaphysis long bone, small blue cell on bx->CHEMO Osteochondroma (exostosis-benign): under 25 MEN, bature bony outgrowth |
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What's another name for IV NS?
For IV albumin? |
Intravenous crystalloid!
colloid=thick stuff |
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Pt took cocaine, found on floor passed out brought to ED.
CPK elevated=? risk factors this puts him at risk for? |
rhabdomyolysis
-immobillization, cocaine (vasoconstrictor) -acute renal failure |
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When pt gets pRBCs and starts to wheeze immediately in min, then resp distress and LOC
What caused this? TMT? |
Anaphylactic rxn (think IgA deficiency)
-stop infusion, give epi, IV fluids, possibly vasopressors |
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What is tmt for person comes in agitated, dilated eyes, L side chest pain, EKG w/ ST depression and T wave inversion in V4-6, negative cardiac enzymes?
ML Dx? |
Cocaine intox
-IV diazepam and supplemental O2 (relieves anxiety/agitation, reduces BP and HR) -Then aspirin (prevent thrombus), CCB and nitrates (vasodilatory for cocaine-induced vasoconstriciton) NEVER BETA BLOCKERS |
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What are lab indications to check thyroid levels?
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hyperlipidemia (esp LDL), hypOnatremia (hypothyroid->inappropriate hi ADH), hi serum muscle enzymes (myopathy), anemia (pernicious anemia from chronic autoimmune thyroiditis)
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What seen in cervical spondylosis?
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Pt >50yo, has chronic neck pain w/ limited neck rotation/lateral bending (from osteoarthritis), getting sensory deficit (osteophyte induced radiculopathy), will see bone spurs and sclerotic facet joints
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What is best diagnostic test if suspect chronic pancreatitis?
TMT? |
CT scan abdomen showing calcifications pancreas (Amylase/lipase may be low to normal)
-pain management, stop smoking and ETOH, small frequent meals, pancreatic enzyme supplement |
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Pt w/ blunt abdominal trauma initial FAST negative now hypotensive w/ L shoulder pain, epigastric discomfort, nausea
ML Dx? Dx test? |
Splenic rupture (kehr sign is pain from splenic hemorrhage irritatign diaphragm going to shoulder)
-do CT w/ VI contrast (since U/S already done) |
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Pig=?
Tell me the rest |
Cysticercosis (pork tapework Taenia solium), larvae ingested in undercooked pork->taenesis or carrying of larvae->ppop->people eat infected human feces->infect human GI wall->disseminate hematogenously to BRAIN (neurocysticercosis/NCC), MUSCLE (myositis and atrophy), EYE, subcu tissue (firm painful nodules) (now cysticercosis)
NCC=multiple small fluid filled cysts in brain parenchyma, neuro sx or 80% asymptomatic till found on brain bx) |
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Pt w/ neck and facial pain, fever, chills, inxn on neck now draining w/ erythema and induration, gram stain shows gram+ branching bacteria.
ML dx? Pathophys TMT? |
Acinomyces-anaerobic gram + branching w/ sulfur granules (the drainage will appear yellow)
-causes infxn cervicofacial thoracic or abd region w/ drainage-slow growing nontdender w/ sinus tracks causing drainage -hi dose IV penicillin 6-12wks |
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Pt s/p coronary art bypass w/ 10U pRBCs, now POD 2, develops jaundice, normal AST/ALT, alk phosph 335, tbili 9.2
ML Dx? |
POstoperative cholestasis: benign condition after surgery w/ hypotension and lots of blood loss (jaundice 2/2 increased pigment load in transuion, decreased liver function from hypotension, and decreased renal bili excretion from tubular necrosis)
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Pt w/ scaling in toe webs in foor w/ KOH prep showing hyphae, now w/ pain in calf w/ swelling warm tender not well demarcated w/ linear streaks of erythema, temp 103.1, chills, rigos
ML Dx? TMT? |
Cellulitis (staph vs. strep) caused by tinea pedia is toes (can give terbinafine or itraconazole to resolve that)
-TMT w/ IV nafcillin or cefazolin (inpatient since systemic toxic findings: rigors, chills, confusion, hi fever), if outpt give po dicloxacillin |
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Pt w/ vitamin B12 deficiency.
Concern for what long term complication? |
gastric ca, since pernicious anemia is most common cause B12 deficiency (causes by anti-IF ab and chronic atrophic gastritis decreasing IF production in gastric parietal cells->increased risk gastric cancer x3)->monitor w/ periodic stool tests for blood
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Boy w/ fever, sore throat, posterior cervcial lymph nodes, treated w/ penicillin therapy, improved, now 10days later has fever, skin rash, joint pain, scattered urticaria, and lymphadenopathy.
ML Dx? |
Serum sickness-like immune-complex mediated hypersensitivity rxn to abx (common when kids w/ viral illness treated w/ abx, esp penicillin, amoxicillin, bactrim, and cefaclor)
-NOT a true drug allergy |
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pregnant mom 18wga, has quad screen shows up MSAFP.
Next step? |
ultrasound to confirm the test, gestational age accuracy, r/o nonviable pregnancy or multiple gestations
-follow this w/ amniocentessis to confirm |
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What are risk factors for placental abruption?
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cocaine use, HTN (of any kind, gestational, chronic, pree), ETOH, smoking, diabetes, SLE
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Cutoff for symptomatic carotid stenosis and asymptomatic for surgery?
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asymptomatic >60 (men >80 best)
symtpomatic >50 |
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What is typical presentation of coarctation of aorta?
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Pt w/ unremitting HTN, epistaxis, HA, blurred vision, EKG findings of LVH (increase voltage QRS complex and ST and Twave changes in L precordial leads)
-In young pts, always do simultaneous palp of brachial and femoral pulses for brachial-femoral delay and do BP in upper and lower extrem |
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Can you give nifedipine post STEMI?
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NO: contraindicated since causes vasodilation and reflex tachy
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What meds to all pts w/ acute MI?
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Heparin, ACEi, B blocker, Aspirin
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Pt w/ hx of megacolon, now w/ prominent cardiomegaly.
ML Dx? |
Chaga dz (PROTOZOAL dz from trypanosoma cruzi)->can cause megacolon/megaesophagus/dilated dardiomegaly
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