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107 Cards in this Set

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Dx: adhesions and fibrosis in uterus causing secondary amenorrhea (does not respond to estrogen)
Ashermans syndrome
Dx: implantation of endometrial tissue in the myometrium, tender enlarged "boggy" uterus
adenomyosis
Diagnostic FSH value in menopause?
<30
Unopposed estrogen increases the risk of what?
endometrial cancer
Dx: firm enlarged irregular uterus, dysmenorrhea and abnormal menstrual bleeding
Leiomyomata (fibroids)
Meds which may reduce size of fibroids?
GnRH agonists
mifepristone
What types of endometrial cancer are found in younger pts? Which type in older pts?
Younger: estrogen dependent
Older: estrogen independent
Diagnosis that must be ruled out in post menopausal bleeding?
endometrial cancer
Dx: dysmenorrhea, dyspareunia, spotting, fixed uterus, associated with infertility?
endometriosis
Dx: amenorrhea, hirsutism, infertility, and insulin resistance
polycystic ovary syndrome
"String of pearls" seen on ultrasound?
polycystic ovary syndrome
HPV types associated with genital warts?
6 and 11
HPV types associated with cervical cancer?
16 and 18
Area involved in most cervical cancers?
transformation zone
Ductal carcinoma presenting with ezcematous lesion of nipple?
pagets disease
Gestational age when fundus reaches the umbilicus?
20 wks
Gestational age when fetal heart rate can be heard on doppler?
10-12 wks
Gestational age when quickening occurs?
18-20 wks
Blood levels in first trimester associated with increased risk of Trisomy 21?
low PAPP-A
high free B-hCG
Bluish discoloration of vagina and cervix?
chadwicks sign
Softening between fundus and cervix?
hagars sign
Procedure used to test for neural tube defects?
amniocentesis (15-18 wks)
Maternal Blood levels associated with increased risk of trisomy 21 in 2nd trimester?
low unconjugated estriol
low AFP
high inhibin A
What maternal blood level is abnormally high in neural tube defects?
AFP (2nd trimester)
Medication used to treat most ectopic pregnancies?
methotrexate
Criteria for using methotrexate in an ectopic pregnancy?
hCG < 5,000
ectopic mass < 3.5 cm
hemodynamically stable patient
with ability to follow up
Explain the 5 types of spontaneous abortions?
threatened: vaginal bleeding, closed cervix, no products passed

inevitable: vaginal bleeding, open cervix, no products passed

incomplete: vaginal bleeding, open cervix, some products passed

complete: vaginal bleeding, open cervix, all products passed

missed: no vaginal bleeding, closed cervix, no products passed but fetus dead
Findings on ultrasound with hydatiform moles?
"grapelike vesicles"
"snowstorm pattern"
HcG levels seen with hydatiform mole?
> 100,000
Birth defects seen in gestational diabetes?
macrosomia
prematurity
fetal demise
delated fetal lung maturity
What tocolytics are used in preterm labor?
mag sulfate
Beta agonists: ridodrine, terbutaline
CCB
Tests used to diagnose premature rupture of membranes?
nitrazine paper
fern test
What med is administered in preterm labor < 34 wks to enhance fetal lung maturity?
betamethasone
Pregnancy induced hypertension presents when?
> 20 wks
Medication treatment of choice for severe pregnancy induced hypertension?
Methyldopa
labetalol
Classic triad of preeclampsia?
hypertension
edema
proteinuria
What is HELLP syndrome?
Hemolysis
Elevated Liver enzymes
Low
Platelets

+ severe preeclampsia
Proteinuria seen in mild and severe preeclampsia?
mild: >300 mg /24 hr

severe: 5g in 24 hr
DIP and PIP joints associated with osteoarthritis?
DIP: heberdens
PIP: Bouchards
Dx: Morning stiffness lasting >1 hr, symmetric arthritis with positive RF?
rheumatoid arthritis
Dx: polyarthralgias, salmon pink rash appearing daily in the evening associated with fever, <16 yo?
Juvenile idiopathic arthritis
Uveitis that may lead to blindness is associated with what positive lab value in juvenile idiopathic arthritis?
ANA
Most common bacteria involved in septic arthritis?
staph aureus
Sausage finger appearance is seen in what type of arthritis?
psoriatic
Xray findings of psoriatic arthritis?
pencil in cup (proximal phalanx)
Tetrad of conditions in reactive arthritis (reiters syndrome)?
urethritis
conjunctivitis
oligoarthritis (asymmetric)
mucosal ulcers
Common causes of reactive arthritis?
sexually transmitted infection
(chlamydia)

gastroenteritis
(shigella, salmonella, yersinia, campylobacter)
Common positive antigen blood level in reactive arthritis?
HLA-B27 (50-80%)
Name for first MTP joint, most common site of gout?
podagra
Deposits of urate crystals adjacent to joint, seen in chronic gout?
tophi
Gout findings on fluid aspiration?
rod shaped negatively birefringent urate crystals
Causes of hyperuremia?
Primary: idiopathic overproduction or over excretion

Secondary:
-Overproduction due to purine intake, myelo/lympho proliferative, drugs, hemolytic anemia
Tx of choice for acute gout?
indomethacin 25-50mg TID

steroids if renal insufficiency
Side effects of colchicine?
n/v, diarrhea
What causes of pseudogout should be ruled out in younger patients?
Hemochromatosis
Hypothyroidism
Hyper parathyroidism
Joint aspiration findings in pseudogout?
rhomboid calcium pyrophosphate crystals, positively birefringent
Systemic sx and findings in lupus?
malar rash
discoid rash
photosensitivity
oral ulcers
arthritis
serositis (heart lungs)
renal disease
Heme disorders
Neuro disorders (seizures, psychosis)
Lab value that is very sensitive for SLE?
ANA
Besides ANA, what lab tests are very specific for SLE?
Ro
La
ds-DNA
Smith
histone (usually drug induced SLE)
U1-RNP
What meds cause SLE?
procainamide
hydralazine
penicillamine
minocycline
INH
methyldopa
quinidine
chlorpromazine
diltiazem
Dx: inflammatory disease affecting proximal limb, neck and pharynx muscles

Sx: weakness, syphagia, poyarthralgias
polymyositis
Clinical findings in dermatomyositis?
polymyositis +
malar (shawl sign) or heliotrope rash
What muscular inflammatory condition is associated with occult malignancy?
polymyositis
Scaly purple plaque found over finger/elbow joints in dermatomyositis?
gottrons papules
Elevated lab values in polymyositis?
ANA
CPK
aldolase
anti Jo1
anti Mi2
Dx: pain and stiffness in neck, shoulders, pelvic girdle. Accompanied by fever, fatigue, weight loss, depression
polymyalgia rheumatica
What condition is polymyalgia associated with?
temporal arteritis
Polyarteritis nodosa is associated with what infection?
HepB
Dx: vasculitis causing fever, wt loss, abd pain, neuropathy, arthralgias, arthritis, HTN , uremia
polyarteritis nodosa
Skin lesions seen in polyarteritis nodosa?
livedo reticularis
palpable purpura
What is CREST syndrome?
seen in limited scleroderma

Calcinosis
Raynauds
Esophageal dysfunction
Sclerodactyly
Telangiectasias
Lab value associated with Limited scleroderma?
anticentromere antibody
Lab value associated with Diffuse scleroderma?
anti-Scl-70
Dx: dry mouth, dry eyes, enlarged parotid glands
sjogrens syndrome
(autoimmune destruction of salivary and lacrimal glands)
Test to evaluate tear secretions in sjogrens syndrome?
schirmers test
(filter paper placed in lower eyelid)
Sickle cell patients are at risk for developing what kind of osteomyelitis?
salmonella
Sarcoma found in diaphyses of long bones/ribs/flat bones found in pts age 5-25?
Ewings sarcoma
Sarcoma found in metaphyseal area of long bones, ages 10-20?
osteosarcoma
Most common fracture sites in type 1 osteoporosis?
vertebrae
hip
distal radius
Classification system for childrens fractures involving the epiphyseal plate?
salter harris
Stretching or tearing of a ligament?

Injury to muscle near muscle-tendon junction?
sprain

strain
Cause of rheumatoid arthritis?
hyperplastic synovial tissue (pannus) erodes cartilage, bone, capsule and ligaments
Hand findings in rheumatoid arthritis?
ulnar deviation

subluxation of MCP joint

swan-neck deformity (flexion of DIP, extension of PIP)

boutonnieres deformity
Most common benign bone neoplasm of the hand?
enchondroma
Most common primary malignancy of bone?
multiple myeloma
Most common shoulder dislocation, fall on an outstretched arm?
anterior glenohumoral
2 Tests for shoulder impingement?
1: Neers sign: flexion to fully overhead
2: Hawkins sign: passive abduction to 90 degrees then internal rotation
Exam tests for rotator cuff problems?
apley scratch test (touch opposite scapula)

drop arm test

empty can test (thumb pointing down, raises arm against force)
Xrays findings of calcium deposits under supraspinatus?
calcific tendonitis
Inflammation of joint after injury or idiopathically, common in diabetics, pain with restricted ROM
Adhesive capsulitis
Most common nerve injured in humeral shaft fracture?
radial nerve
Xray finding in supracondylar humerus fracture?
fat pad sign (joint capsule distended with blood)
Dx: subluxation of head of radius, usually child that was lifted at wrist
nursemaids elbow
Site of lateral epicondylitis (tennis elbow)?
extensor carpi radialis brevis tendon
Site of medial epicondylitis (golfers elbow)?
flexor carpi radialis tendon
Radial shaft Fracture associated with distal radioulnar dislocation?
galeazzi
Fracture of ulnar shaft associated with radial head subluxation?
monteggia fracture
Dx: fall on outstretched hand, diner fork deformity, dorsal displacement of wrist?
colles fracture (distal radius fx)
Dx: Tenosynovitis inhibiting flexion/extension of finger joint, thickening of A1 pulley?
Trigger finger
Dx: hyperabduction and radial deiation to 1st MCP joint?
gamekeepers thumb
(skiers thumb)
Sign seen in flexor tenosynovitis:
-tendernes over sheath
-symmetric enlargement of whole finger
-pain on passive ROM
-flexed rested position
Kanavel's sign
Dx: LE pain exacerbated with walking, relieved with bending forward
neurogenic claudication (from spinal stenosis)
Dx: young male with stiffness and back/hip pain which improves with activity, associated with uveitis
ankylosing spondylitits
Lumbar film findings in ankylosing spondylitis?
bamboo spine (fusion of spine)
Condition in children associated with avascular necrosis of the femoral head?
legg-calve perthes disease
Displacement of femoral neck caused by weakening of epiphyseal plate of femur?
slipped capital femoral epiphysis
MC nerve injury in humeral shaft fracture?
radial nerve