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127 Cards in this Set
- Front
- Back
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RTA II
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(X) proximal bicarb resorption
Urinary glucose/AA/PO4/urate Inherited 2/2 renal txp, myeloma Ifosfamide |
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RTA IV
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(X) distal ammonium excretion
Hyperkalemia, low renin, low aldosterone DM, CKD |
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Antisocial PD
Oppositional Defiant Conduct Disorder Intermittent Explosive DO |
18+ ~after conduct
Hostile to authority >6mo Violation rules & rights >1yr Assault, property destruction |
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Amphotericin Fx
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RTA I
Pancytopenia N/V |
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RTA I
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(X) H secretion
Hypokalemic, non-AG acidosis Amphotericin B Outflow obstruction AD inherited, Sjogren's, Sarcoid |
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Nonanion Gap Acidosis
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Diarrhea
RTA I |
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Hallucinate little people
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Stimulant psychosis
Amphetamines, Cocaine Tx - Benzos |
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Beta blockers & stimulants
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NEVER give to recurrent cocaine users
Unapposed beta stim = coronary spasm & MI |
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Doxycycline Uses
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Haemophilus
Strep pneumo M. pneumo Chlamydia psittaci Chlamydia trachomatis N. gonorrhea |
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Neuroblastoma
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<2 yo abdominal mass *Crosses midline
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VACTERL
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vertebral, anal, cardiac, tracheal, esophageal, renal, limb
in conjection w/TE fistulas |
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WAGR
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Wilms' tumor, aniridia, GU abnl, retardation
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Diabetic Retinopathy
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Nonproliferative (DM2) from cap leak - microaneurysms, dot hem, small infarcts "cotton wool"
#1 cause blindness in young & middle age adults Tx advanced w/laser Proliferative (DM1 ~15yrs, DM2) from hypoxia - neovasc + fibrosis , vit hem, detachment |
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DM morning hyperglycemia
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Dawn Phenomenon - 2/2 O/N insulin resistance from growth hormone, cortisol, glucagon
Somogyi Effect - 2/2 O/N insulin induced hypoglycemia |
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Alport's hereditary nephritis
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X-linked nephritis, sensorineural hearing loss, anterior lens
renal failure by 35yo (Cr and HTN) |
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Nephrotic syndrome, children
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#1) Minimal Change
#2) Focal segmental glomerular sclerosis -segmental hyaline with podocyte effacement |
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podocyte effacement
lumen cryoglobins anti-GBM with crescents tram track BM normal granulomas |
FSGS
Cryoglobinemia/IC's Goodpasture (20s M) Membranoprolif GNitis (HepC) Minimal change disease Wegener's (c-ANCA) |
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Spontaneous bacterial peritonitis (SBP)
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>250 PMN/mm3
Serum-fluid alb <1.1 Often ppt by variceal bleeding |
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Exudative ascites
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Serum-fluid alb <1.1
SBP (PMNs) TB (lymphocytes, inc adenosince deaminase) |
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mucosal and venipuncture bleeding with hypotension + increased PT, PTT, bleeding time
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DIC
Also low plt, +Ddimer, incr fibrin split, low fgen, shistocytes With sepsis, postdelivery (amniotic embolus), trauma |
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Lactulose
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Uses: hepatic encephalopathy (HE)
Mech: colon acidification (converted to SC-FAs) >> NH4+ favored, not reabsorbed |
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Colace (docusate)
Senna Bisacodyl |
Softens by mixing stool + fat
Inc peristalsis Inc peristalsis |
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Septic arthritis
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Strep, Staph aureus, N. gonorrhea
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Acute gout treatments
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NSAIDs (fx ulcers, GIB, renal pap necrosis)
Colchicine (gen GI fx) NOT allopurinol or probenecid used for chronic gout (in acute can ppt flare >> worsen pain) |
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Kidney stones
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#1 calcium oxalate -Give calcium (binds GI oxalate)
#1 in gout: urate -U alkanize >> urate salt, PO fluids, allopurinol |
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Schizophrenia spectrum
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2+ del, hall, disorg speech or behav AND neg sx THAT impair
<1mo Brief psychotic 1-6mo Schizophreniform >6mo Schizophrenia |
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Thyroid cancers
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Papillary
-#1 Medullary (MTC) -parafollicular/C cells, calcitonin (diarrhea, flushing), thyroidectomy Follicular -iodine deficiency; inc T4 |
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MEN 1, 2, 3 (1, 2a, 2b)
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"3Ps" Parathyroid, pituitary, pancreatic/enteric adenoma (Insulinoma, gastrinoma) ... also thymic carcinoid
"2Ps" MTC > Pheo > 1' PTHplasia "1P" MTC > Pheo + mucosal/GI neuromas |
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Female - CMT and RUQ tenderness
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Fitz-Hugh Curtis perihepatitis
Chlamydia > Gonorrhea Normal LFTs |
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Suicidal ideation meds
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SSRI (OD not serious)
>> NOT TCA, MAOi |
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Respirations & heart dynamics
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Inspiration: decr intrathoracic pressure (to allow air in) + RV filling *if LV decreased s.a. SBP drops 10 = tamponade/other constriction*
Expiration: incr intrathoracic pressure |
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Lung Ca: adenocarcinoma
Broncheoalverolar adenoca Large cell ca Small cell ca Squamous cell ca |
-#1 peripheral (periostosis, osteoarthropathy)
-Multiple nodules, interstitial, sputum -bHCG, gynecomastia -cigs, Cushings, SIADH, Eaton-Lambert ~mets -central, PTH, stones |
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Diagnosis:
Preeclampsia Eclampsia Severe Eclampsia |
HTN >140/90 if prev normal
Uprot twice >6hrs apart (RF: prima, >30, multiple gest) +Seizures +Uprot >5g/24hr |
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Management:
Preeclampsia Eclampsia |
Bedrest: preterm preec (w/HTN control)
Deliver w/steroids: term preec or any eclampsia |
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TOF tet spell management
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blow by O2
Magnesium sulfate (sedate and relax pulm arteries) knee to chest position |
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Schizophrenia treatments
5HT-dopamine antag |
Risperidone, olanzapine, ziprasidone
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CHF exacerbation managements
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sodium nitroprusside (decr AL)
100% O2 w/pos pressure Inotropic (dopamine/dobut) Morphine Loop diuretics (rapid) r/o: pneumonia, MI, PE, etc |
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Beta HCG trends in pregnancy
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Detect 8d after LH surge
Rises til 41d, stays 100,000 Doubles Q48hr >1500 4.5-5w = sac on US <1500 w/o sac, rpt 72hr Decreasing = failed preg |
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Hepatic masses:
Adenoma Focal nodular hyperplasia Hemangioma Hepatoblastoma HCC |
-OCPs, no capsule, periph enhancing
-arterial phase punctate enhancement central scar -30s-40s F, delayed image -<3yo, AFP sky high (100K) -h/o liver disease |
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Congenital cretinism types and pathophys
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Neurologic endemic
-iodine def early preg -deaf, spastic, gait, MR ~mute, euthyroid -amazon, SE asia Myxedematous endemic -iodine def late preg/infant -MR, short -African Congo |
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Amnioinfusion indications s/p rupture of membranes
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Premature ROM
-limit chorioamnionitis Meconium on artificial ROM -limit meconium aspiration Recurrent variable decels (cord compression w/ hypoxemic distress) |
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Live viruses
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MMR (ok HIV T4>200)
Oral polio Varicella flu mist |
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HIV T4 milestones
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350 - HAART
200 - PJP (bactrim, alt: dapsone +pyrimethamine or leucovorin; atorvaquone; pentamadine) 100 - Toxoplasma (bactrim, Alt: dapsone + pyrimethamine or leucovorin, Alt: atorvaquone) 50 - MAC (azithro- or clarithromycin; Alt: rifabutin) Prevent 2nd time: 100-200: Cryptococcus 100-150: CMV retinitis |
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CLL lymph node transformation
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Richter's syndrome
2-4 years after diagnosis Large cell ca |
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General sx, musc/joings + HepB seropositive
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Polyarteritis Nodosa
Small-medium arterial vasculitis with aneurysms 2/2 PMN destruction p-ANCA corticosteroids & cyclophosphamide |
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Recurrent oral apthous ulcers and genital ulcers
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Behcet's sydrome
Artery and vein vasculitis, also eye and skin lesions +pinprick test (turns into pustule) |
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anemia, thrombocytopenia, and acute renal failure
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Hemolytic uremic sydrome
EColi O157:H7 |
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petechiae, bruises, and mucosal bleeding
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ITP
corticosteroids If plt <10K or uncontrolled bleeding, then IV Ig and anti-Rho(D) |
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lungs and kidneys w/o granulomas
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Microscopic polyangitis
small and medium artery and vein vasculitis |
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h/o asthma w/pulmonary infiltrates, neuropathy, and eosinophils
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Churg-Strauss vasculitis
Small-some medium arterial vasculitis Requires: asthma eosinophilia, extravascular eosinophils, paranasal sinus abnormalities, pulm infiltrates, mono/polyneuropathy, |
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child with palpable purpura and hematuria
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Henoch-Schonlein pupura
Purpura unrelated to low plts Also arthritis, abdominal pain Typ s/p URI IgA deposition in cutaneous blood vessel walls |
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child with persistent fever, skin changes, and mucous membrane changes
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Kawasaki's disease
Childhood vasculitis of small and medium muscular arteries (coronaries!) fever at least 5 days + four of: rash, hands/feet, red eyes, red mucous membranes, cervical LN |
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Young adult female with claudication and abnormal pulses
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Takayasu's arteritis "pulseless disease"
Vasculitis of aorta and branches (subclavian bruit, brachial pulse, tender vessels, unequal pulses) |
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fever, anemia, low plt, ARF, neuro findings
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TTP
low platelets + shistocytes hemolysis >> LDH and indirect bilirubin |
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F >60yo coma, thyroid scar
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myxedema coma (emerg!)
draw labs then tx: - intubate - IV thyroid hormone - abx (ppt esp urosepsis, pneumonia) - passive rewarming |
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Gestational Diabetes Screening & Tx
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At risk: 24-28wk random 1-hr 50g PO challenge
If (+): 100g 3hr GTT Tx: diet first, then insulin |
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Small bowel obstruction leading causes by age group
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<2yo: intussusception
<18yo: incarcerated hernia adult: adhesions elderly ~ volvulus others: SE asia, africa, SAm w or w/o sx - ascaris lumbricoides parasite |
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Basilar vs PCA stroke
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Coma, CN palsy, apnea, vision, drop attack, dysphagia
homonymous hemianopsia, memory, dyslexia |
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Opioid wd sx & tx
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mydriasis, flu-like, anxiety, F, N/d, rhinorrhea, inc HR & BP
Mod sx: clonidine or buprenorphine Sev sx: methadone (naltrexone after 7-10d clean) |
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Lithium effects (including on fetus)
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fetus: cardiac (Ebstein's anomaly: inferior tricuspid w/TR)
adult: renal (nephrogenic polydipsia, polyuria, nephrotic); weight gain, ED, decr libido |
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Carbamazepine effects
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mild: transient leukopenia and ttp
sev: agranulocytosis and aplastic anemia |
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Clozapine effects
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leukopenia and granulocytopenia
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Valproic acid effects
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liver toxicity (esp in first 6mo or in kids)
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Chron's vs UC complications
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fistulas, abscess, oxylate kedney stones, erythema nodosum (shin nodules)
primary sclerosing cholangitis |
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PPD positive read
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>5mm: high-risk pts
- HIV, immunodef - close contact w/infected - fibrotic CXR lesion >10mm: special criteria - HCW or prevalent in work - recent seroconversion - recent immigration from HR - <4yo - teen w/recent exposure - HR setting (jail, shelter) >15mm: always + |
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Lyme dx and tx
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Biopsy rash and culture
Wks later ELISA, W blot PO doxy, amox, cefuroxime IV ceftriaxone, PCN |
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Thiazide effects
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"hyper-GLUC"
- glycemia - lipidemia - uricemia - calcemia (gout exac) |
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Causes neurogenic pulmonary edema
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SAH (symp excess)
Epileptic sz Head injury (but not subdural or epidural hematoma) |
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mammogram microcalcifications and irregular density
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ductal carcinoma in situ
if nonpalpable: stereotactic core bx |
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Kid 2-4yo painless flank mass, not crossing midline
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Wilm's tumor w/wo HTN, micro hematuria, sys sx
Stage 1 tx - nephrectomy, chemo Mets tx - add radiation Palliative - chemo w/o surg Alt: Neuroblastoma (incr. U catecholamines, no hematuria, CT mass adrenal) |
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Pos PPD tx
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w/neg CXR: 6mo isoniazid + pyridoxine (to prevent B6 deficiency: blurred vision, periph neurop)
Suspect MDR exposure: rifampin alone |
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Dyspepsia workup
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By risk of gastric cancer:
LR: <55yo - noninvasive s.a. urease breath, serology, stool antigen HR: "alarm sx" (anemia, bleeding, wt loss, early satiety, V, dysphagia, etc) - upper endoscopy w/bx |
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Serious complication of decubitus ulcer
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Marjolin ulceration
- malignant degeneration to aggressive squamous cell carcinoma |
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STEMI locations by leads and affected artery
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II, III, aVF - inferior (RCA)
- sinus brady from SN (atropine if -> hTN) I, aVL, V5-6 - lateral (LCx or diagonal branch LAD) V1 - septal (branches LAD) V2-4 - anterior (LAD) L x S A I L A L I I A L |
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Celiac complications
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Iron deficiency, ostopenia, short, delayed puberty, infertility
Skin - dermatitis herpetiformis (pruritic pap-vesic extensor) |
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Infantile spasms, delayed/regressing milestones - EEG?
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West's syndrome
high voltage, random, slow waves + diffuse cortical spikes px: spasms worsen before resolving, later seizure disorders +/- neuro impaired |
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Colon cancer screening tests
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Normal risk:
- guaiac x3 QY +/- flex sig Q5Y - double contrast barium enema Q5Y - colonoscopy Q10Y |
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Flaccid vs firm blisters from autoimmune conditions
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Anti-intraepidermal (desmogleins 1 and 3) - Pemphigus Vulgaris
- oral first, then more - painful, skin bx - middle age Antihemidesmosomal (subepidermal) - Bullous Pemphigoid - esp flexors, groin, axilla - sometimes oral - erosions and crusting - >60yo |
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Urinary sx + eosinophils in blood and urine
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Allergic reaction >> acute interstitial nephritis (AIN)
- from NSAIDS, B-lactams - also infection, AI, infiltrative |
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Histology w/Barret's esophagus and progression
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Normal distal esophagus - squamous
Barrett's - columnar Adenocarcinoma (bx may only show barrett's) |
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Scabies distribution by age, dx, tx
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Common - webbing, extensors, genitals, butt, wrists, elbows
Infants - head, palms, soles Adults - not head or neck Skin scrapings w/KOH or oil Permethrin or ivermectin |
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UTI treatment in pregnancy
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symptomatic only
7d nitrofurantoin 3-7d amox or cephalexin NOT cipro ~possible risk fetal arthropathy NOT bactrim -possible risk cleft palate |
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Histoplasmosis presentation and treatment
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Acute - often asx, mild-flu
Disseminated - F, night sweats, dry cough, HSM, LN, pancytopenia w/in 2 wks of 1' exposure amphotericin B 3-10d + itraconazole 12wk + itraconazole daily |
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Rash, round, macular, hyperpig in sun-protected, hypopig in sun-exposed
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Tinea veriscolor (KOH prep)
Antifungal +/- Selenium sulfide shampoos |
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Permethrin uses
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Scabies
Pediculosis (lice) |
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CATCH-22
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DiGeorge (22q11.2 del)
Cardiac, Abnormal facies, Thymic aplasia, Cleft palat, Hypocalcemia |
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Polymyalgia rheymatica vs. polymyositis
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Weak and stiff, systemic sx, elderly women, incr ESR, anemia
progressive prox weakness, incr Cr and CPK |
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Cushings disease vs adrenal hyperplasia
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ACTH from pituitary adenoma, cortisol suppression only with high-dose dexamethasone
complete cortisol suppression with dexamethosone |
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Pulseless VTach
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Shock, epi, shock, ACLS amiodarone (alt: lidocaine or mag sulfate)
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Dermatomyositis findings
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proximal fatigue/weakness, skin: heliotrope (periorbital), shawl sign (upper torso), gottron's papules (dorsal hands, elbows, knees)
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Causes of ARDS
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#1 sepsis, aspiration, overdose, lung/marrow txp, massive transfusion, near-drowning
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acalculous cholecystitis
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risk factors: hospitalized, immobile, esp burn patients
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Endocarditis diagnosis
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Duke Criteria
Major: several pos cultures, echo evidence or new regurg murmur |
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Hemophilia A, B, vWD
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All intrinsic only
Hemophilia mild: hemorrhage after surgery, no spontaneous bleeds Hemophilia severe: spontaneous bleed, hemarthrosis, ICH, retroperitonal, GIB vWD - mucosal and postincisional bleeding, most common inherited bleeding disorder |
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HSP
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small vessel vasculitis, palpable purpura, intermittent abd pain, arthritis (typ LE's)
+/- orchitis +/- nephritis |
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Lyme tvs RMSF and treatments
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- focal rash, central clearing
- NE US - doxy, amox, cefuroxime axetil - diffuse rash (inc. palms/ soles) - SE US - doxy + chloramphenicol |
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Children 2 - 6 yo milestones
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2yo - up/down stairs, 6cube tower, 2 word sentences
3yo - tricycle, draw circle, three word sentence 4yo - hop, skip, draw cross, count 10, sing songs, recite from memory 5yo - jump over obstacles, tie shoes, copy square, print name 6yo - bicycle, L vs R hand, talk on phone, some read/write |
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Vaginal bleeding in third trimester
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Previa - painless w/o contractions
Abruption - painful, +/- fetal distress (HR, HTN) Labor - loss of cervical plug, regular contractions |
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Lyme disease treatment
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doxycycline
Alt for pregnant and children: amoxicillin |
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Adverse effects:
- carboplatin/cisplatin - corticosteroids - cyclophosphamide - methotrexate |
- hearing loss
- cataracts (high dose) - bald, hem cystitis - bald, GI, rash |
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Rapid onset virilization + abdominal mass in adult
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Female - DHEAS adrenal mass
Female - Sertoli-Leydig ovarian tumor |
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Stages of Labor
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IA - cervix <4cm dilated
IB - cervix >4cm-10cm II - complete cervix dilation to delivery III - placenta delivered, uterus contracts |
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Gestational hypertension treatment
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Safe meds: nifedipine, methyldopa, labetalol
25% develop preeclampsia >> monitor for proteinuria |
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von hippel lindau
osler-weber-rendu tuberous sclerosis |
AD; pheo, renal cell ca, hemangioblastoma, retinal angioma
AD; telangiectasias, AV malform, aneurysms throughout body benign tumors brain, eyes, skin, kidneys w/MR and sz by 1 yo |
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Treatment of molar pregnancy
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D&C, follow bHCG
Methotrexate if: - plateau over 3wks - incr 10% over 2wks - persists 6mo - path = choriocarcinoma Double agent if mets or advanced |
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Prostatitis w/u
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urine cx before and after prostate massage
+ microscopic exam of expressed w/massage |
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Small cell lung cancer staging
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Limited
- hemithorax only - radiation indicated Extensive - beyond hemithorax - systemic chemo |
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Dysfunctional uterine bleeding (DUB)
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anovulatory cycles dx by exclusion (polyps, fibroids, etc)
Heavy, intractable bleeding: stabilize then give 25mg IV estrogens, then D&C |
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Diabetic nephropathy
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Commonly type IV RTA; hyperchloremic from relative aldosterone deficiency or resistance
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spelunking, bird/bat guano
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Histoplasma
Mississippi river valey |
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bilateral hilar lymph node calcifications
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eggshell calcifications
silicosis |
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medication induced ED
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thiazides, beta blockers
anti-androgens psych: SSRI TCA, neuroleptics |
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Fetal heart monitoring w/contractions
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Early decel - head compression
persistent nonreactive with fixed baseline - hypoxia variable decels - cord compression late decels - uteroplacental insufficiency or fetal hypoxemia late decels >50% over 20min ~ fetal acidosis |
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odds ratio
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(E+D) /(NE+D)
------------------------- (E w/o D) / (NE w/o D) |
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Drug birth defects:
ACEi Lithium Phenytoin Carbamazepine Valproate Penhobarb Sulfas |
-Renal, pulm hypoplasia, limb contracture, still birth
-Ebstein heart (low TR) -small, nails, MR -NTDs -NTDs -cardiac, bleeding (low vitK) -incr bilirubin |
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Tourette's tx
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Haldol (least fx)
Alt: pimozide, clonidine |
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Breast Cancers:
infiltrating ductal infiltrating lobular ductal papilloma |
-#1, bloody discharge, stellate
-thickened skin, diff w/MRI, freq bilateral -common bloody discharge but nonpalpable |
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LDL targets
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<70 HR w/CHD or equiv (PAD, DM, sx CAD, AAA)
<100 HR w/o CHD (HR: M>45, F>55, HTN, tob) <130: mod risk (2+) <160: low risk (0-1) |
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Intoxication:
- PCP -EtOH -Cocaine -LSD |
-unpredictable violence, paranoia, agitation, hallucination, nystagmus
-nystagmus, mood change, poor judgement -paranoid, aggressive, hallucinate, mydriasis, tremors -tachy, HTN, w/o nystagmus |
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Dx Central vs Nephrogenic DI
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Desmopressin (DDAVP) increase UOsm >50% in 1-2hrs = Central DI
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Sudden, painless unilateral vision loss
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Retinal Detachment
(flashing light, floaters) Retinal Vascular Dz Retinal Artery Occlusion (pale retina, red macula) Retinal Vein Occlusion Cataracts Optic neuropathy Giant Cell Arteritis |
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Children w/septic arthritis tx
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Empiric antibiotics + surgery for irrigate/debride
(abx only if Gm stain: GN cocci bc gonorrhea responds well to HD PCN) |
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Trigeminal neuralgia tx
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Carbamazepine
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Young overweight woman with increased ICP
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pseudotumor cerebri
-HA progressive w/blind spots, eventually peripheral visual losses -diplpia CN VI palsy |
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Recurrent daily headacye, unilateral
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Cluster headache
tx: supportive, O2, triptans |
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Positional HA (worse lying down and in morning)
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Intracranial mass
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AIDS CNS infections
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Cryptococcus
- high opening pressure, +yeast Toxoplasma -ring enhancing on MRI |
