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179 Cards in this Set
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Treatment phases
1) Acute phase has 2 categories 2) Continuation 3) Maintainence 4) When does recurrence fit in these 3 phases? |
1) remission (tx of acute sx) vs response (continued improvement of about 50% from baseline).
2) sustained remission 3) recovery means the sx is completely over. 4) recurrence |
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cystic fibrosis has what kind of effect on bowels?
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steatorhea due to pancreatic insuffiicency.
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If an a55hole qn makes it sound like bursitis but adds random info such as pt is smoker, has HTN, XOL... it doesn't make it PVD, it's still bursitis.
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dumba55
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Huntington is on chromosome...?
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4
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Sharp triphasic synchronous discharge on EEG is most likely which dementia?
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CJD prion etc
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Quick summary of Pregnancy changes
1) volume and pee 2) Na 3) clot 4) pulm O2/CO2 |
1) inc
2) mild hypoNa due to volume and ADH. 3) prothrombotic 4) progesterone inc tidal volume and minute ventilation |
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which of the many esophagus-dysphagia disorder is partly psychiatric so that psych counseling should be included as part of the treatment plan
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diffuse esophageal spasm!
no structural abn, just high amplitude contractions. |
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achalasia-like sx and findings can sometimes be caused by which organism?
follow up qn- describe the typical crap this organism does. |
trypanosoma cruzi
acute phase - local swelling, asx. chronic phase - infect heart, esophagus, colon, nerves. only acute cases treatable w/ benidazole and nifurtimox. |
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How does scleroderma esophagus differ from others in mechanism?
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its fibrosis and scarring that leads to weakened muscle hence increased regurgitation. achalasia is inability to relax.
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Pitting Edema dDx is due to failure of which three systems?
Non-pitting edema dDx? only one |
CHF, liver,renal
lymphedema |
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Indications for HIV tests
1) ELISA 2) western blot aka serology 3) viral load 4) CD 4 |
1) screening. 99.9% sensitivity
2) confirmation. 99.9% specificity if done w/ ELISA 3) indicator of dz progression (>100k is poor prog). 4) also dz progression. |
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Cryptorchidism complications include which 4?
After orchiopexy surgery prior to 1yr old, which complications are left? |
inguinal hernia, cancer, torsion, sub-fertility
subfertility > cancer, both at decreased risk. |
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penile cancer is NOT testicular cancer stupid.
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penile is by HPV
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When do you use BNP to dx CHF?
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when you haven't diagnosed it yet. like, when CHF is not given in the question.
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cardiac catheterization vs angio vs cabg, what??
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cath = imaging of vessels by using a cath thru groin
angioplasty/stents = good for easier stuff CABG = open heart surgery for difficult locations and stuff. |
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you always get this wrong
normal adult RR is... |
12-15
kids can go up to 25. |
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*simple topic, tricky answer choices*
1) Given recurrent pneumonia + recurrent affected lobe... dDx should include? 2) If recurrent pneumonia affects different regions..? |
anatomic obstruction (neoplasm, retained foreign body, stenosis).
vs recurrent aspiration (EtOH, sz, drug, dysphagia of any kind). 2) then it's most likely the typical infectious etiology. |
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Next step for recurrent pneumonia affecting same lobe... CT vs bronchoscopy
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CT first, bronchoscopy second if CT is negative. Needle guided biopsy if positive.
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CT w/ or w/o contrast indications?
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contrast helps you look at specific organs.
no contrast is good for bones, bleeds, stones (renal), |
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Pt has persistent AUB (abn uterine bleed) despite negative initial workup (preg test, TSH, coag study) and negative risk factors (menopause, obese, DM, PCOS, etc).
Next step? |
endometrial biopsy! still gotta check!
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Lewy Body Dementia
1) describe sx 2) affected area |
1) Parkinson + hallucination + fluctuating cognition + visuospatial failures.
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What BPP score requires a follow up in the form of contraction stress test?
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6, and only 6.
below = delievery. |
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At what AFI for oligohydramnios should delivery be considered?
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<5
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abx for G- bacteria
5 major classes |
1) 4th gen ceph (cefepime)
2) ciprofloxacin 3) gentamicin 4) imipenem 5) pip + tazo |
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Tricky Questions
> A question may lead you to think that a patient has focal deficits like an acute stroke but adds N/V, bradycardia, and progressive stupor. No prior TIA's. |
intracranial hemorrhage.
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Why does hypoT cause hypoNa?
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decreased free water clearance so more water, more swelling.
HypoT also causes XOL, up CK, LFT. |
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What does nucleated RBC tell you?
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immature RBC
stressed bone marrow. |
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Fe deficiency anemia is different from all other microcytic anemia in which lab value?
What does cow milk have to do with Fe def anemia in babies? |
RDW (red cell distribution width) only one that's increased by >20%
cow milk is low in Fe if that's the primary source. |
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When are these international travel vaccinations recommended?
1) Cholera 2) Yellow fever 3) MCV 4) Hep A 5) Typhoid |
1) never
2) South American and South Africa 3) Asia and South Africa 4) North Africa. 5) North Africa. |
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Which diet decreases BP the most?
1) fruit, vege, low fat. 2) Na restrict 3) Exercise 4) wt loss |
1.
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Small for gestational size babies are at risk for....?
1) calcium 2) O2 3) temperature 4) glucose 5) this is a heme disoder |
1) hypoCa
2) hypoxia 3) hypothermia 4) hypoglycemia 5) polycythemia due to hypoxia. |
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fk you for forgetting this all the time.
what's the mechanism for physostigimine? |
AchE inhibitor = inc cholinergic sx = for atropine poison.
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farmer and organophosphate poisoning
first 2 steps = ? |
remove cloth that has vomit so skin doesn't absorb it.
atropine |
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Drop arm test is used to dx...?
the same dx is often caused by fall on outstretched hand. |
rotator cuff tear.
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Chalazion
1) what is it? 2) what's the risk? 3) what's the next step? |
1) painful swelling that becomes painless nodular + rubbery lesion.
2) may have cancer. 3) biopsy for cancer. |
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protein c/s inc clot or dec clot?
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increases
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Special response to body dysmorphic disorder patients is....?
1) according to standard measurements... your body part is considered normal. 2) let's meet regularly to discuss this issue. |
1) no, BDD pt do not care abt normal. they see themselves differently.
2) yes |
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What is the best next step of tx for MALT lymphoma?
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omeprazole, clarithromycin, amoxicillin.
-MALT regresses as H. pylori is killed. -If doens't work, next step is chemo. |
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If fetus is suspected to be dead after 20 wks, which test do you do?
NST or real time U/S? |
real time U/S.
NST is useless if fetus is suspected to be dead. Need U/S to confirm and proceed w/ induction. |
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Young adult male. Pain and swelling over coccyx (where hair is). Dx?
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Pilonidal cyst.
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In severe croup with impending respiratory distress...
what's the first step of action? E or intubate? |
always give trial racemic epinephrine first before intubation. a-adrenergic effect reduce bronchial secretion.
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Infants with complement deficiency usually gets infected with which group of organisms?
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gonococus and meningococus.
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Adenosine deaminase deficiency gets you what kinda infxn?
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all! both T and B cell broken.
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Gradual spinal pain worse at night but better with exercise. No point tenderness, neurologic, or systemic sx.
-most likely dx? -what if pt is <40yo, young adult male? -apophyseal joint |
inflammatory etiology!
-ankylosing spondylitis. -same |
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cyclic vomiting (unclear etiology) with no other sx in kids is usually associated with what condition in parents?
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migraine.
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Variceal bleed
1) step 1 = which 2 drugs and IVF. 2) step 2 = endoscopic therapy or band ligation. 3) If no further bleed.... do what for follow-up? 4) If bleed... do what? |
1) ceftriaxone and IV octreotide
2) given 3) BB 4) balloon temponade temporary while ship to TIPS or shunt surgery. |
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Recall the flourescent eye exam in ED.
typically for pt with eye pain and feeling of foreign body despite normal gross exam. |
1) topical anesthetics + gross exam
2) flourescent eye exam 3) topical abx |
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specific food for vibrio parahemolyticus
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ANY seafood!
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stupid common mistakes.
tetracycline = doxycycline = photosensitivity |
ok
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Just gotta remember this changes in kidney dry.
***Glomerular hyperfiltration -> mesangial expansion -> nodular sclerosis = what etiology? **How is it delayed or reversed? |
DM end organ dmg of kidney.
ACEi stops the first step. |
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Primary biliary cirrhosis vs primary sclerosing cholangitis mechanism in a nutshell.
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PBC = bile duct disappearing for unknown reason. other causes could include GVHD, failed liver xplant, Hodgkins, CMV. HIV. etc.
PSC = portal tract fibrosis. bile duct stenosis. |
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Recap of a Female Ab Pain of childbearing age in the ED
Even if sx is most likely bowel related, why is the first test always preg test? |
Fetus exposed to radiation in the first 14 days after conception is pretty darn bad.
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Imaging for Ab Pain
1) what are you looking for with an x-ray? 2) CT? 3) U/S? 4) Peritoneal Lavage? |
1) air
2) if plain x-ray is negative and for selected stuff 3) if pt preg or gyn etiology. 4) trauma pt for intra-ab bleed. |
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What's a normal post-void residual volume?
1) adults 2) elderly |
1) <50
2) 50-100 |
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Mechanisms of female infertility
1) PCOS 2) Endometriosis or pelvic inflammation 3) Cervicitis or cervix inflammation |
1) anovulation
2) impaired oocyte transport thru fallopian tube 3) abn cervix mucus |
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Some mechanisms.
Polysaccharides do not get presented to T cells so these vaccines are T-cell INDEPENDENT B-cell response. |
like polyvalent polysacchardie pneumococcal vaccine
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Test Question reminders
Not every symptoms has to be found. If one of the many obscure signs/sx of a diagnosis is negative, its ok man. |
ok
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If diagnosis of a kid with fever then arhtritis sounds like transient synovitis, then what is the next step?
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X-ray to exclude bony lesion, fx, Legg-Calves-Perthes.
Ibuprofen (NOT aspirin) and home. |
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Acute Cholecystitis
1) what is involved, look at the dam word. 2) Initial Tx 3) ERCP vs cholecystectomy? 4) What does HIDA scan do? |
1) inflammed gall bladder and gallbladder only, may be due to stone obstructing outlet.
2) IVF, abx, pain med 3) Cholecystectomy within 72hrs! ** ERCP is for disease of bile ducts, not gallbladder. 4) HIDA scan is like ultrasound, to make diagnosis of gallbladder. If U/S is inconclusive, do HIDA. |
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Best type of way to cool down a heat stroke patient?
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spray lukewarm water on body and evaporate it with a fan.
-ice bath is good too but cannot monitor pt efficiently. |
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<1 yr old with sx of bacterial meningitis at the ED.
next step? |
LP then vanc + ceftriaxone then admit.
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squamous cell carcinoma treatment (of vagina or skin) all include?
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surgery at lower stages
radiation for higher stages (and if pt has too high risk for surgery). |
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We all know one of the drugs for bedwetters is desmopressin. what's the 2nd line agent that's equally potent but worse side effect profile?
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TCA's like imipramine
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Paget's dz (osteitis deforman)'s labs changes
Ca PO4 ALP hydroxyproline |
normal
normal up up |
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Membranous Glomerulonephritis is associated with Hep B.
What if it's a kid with Hep B? Should you pick membranous or minimal change? |
membranous.
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What are the sx of hypoalbuminemia in terms of calcium?
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none! ionized ca remains the same.
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Relationships
chronic EtOH -> pancreatitis -> low Vit D malabsorption -> low Ca + P. |
k
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Crohn's vs UC
which one has bloody diarrhea? which one casues toxic megacolon more often? |
UC
UC Tx w/ IVF, bowel rest, IV Abx, IV steroids then surgery. |
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Asbestosis
1) where do you work? 2) what do you hear on lung exam? |
shipyard, mine, construction, pipe, insulator.
-bibasilar crackles. -interesitial fibrosis. |
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Threshold for lead poisoning
1) which test to screen, which test to confirm? 2) what is the value to start treating? |
1) capillary blood lead to screen; venous lead to confirm
2) >5 is too high. but >45 to treat. |
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Alzheimer vs pseudodementia
how concerned are patients over their memory loss? |
1) alzheimer pt = dont' care, usually brought by family.
2) pseduodementia pt = comes in by themselves, overly concenred about their memory loss. |
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All neurogenic tumors of the mediastinum are found in which part of the mediastinum?
anterior, middle, or posterior? |
posterior
middle = bronchogenic cyst anterior = thymoma. |
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which nephrotic sx is associated w/ finding of dense C3 on glomerulus.
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membranoproliferative glomerulonephritis.
-no risk factor. -IgG atks C3 convertase and continuously activates it. |
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If pt has known chronic rheumatoid arthritis with new onset single joint red + swollen joint + motion limited by pain... consider which 2 dDx?
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crystal-induced
and **septic arthritis due to erosion of rheumatoid. |
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In Tumor Lysis Sx...what's the only ion that is decreased?
Ca, PO4, K, uric acid, etc? |
Calcium! who knew
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Consider Vit D deficiency in all bone related problems that has something to do with GI tract problem like CF, surgery for crohn/UC, pancreatitis, etc.
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will have low Ca, low PO4, high PTH.
Low vit D = low Ca + low PO4. PTH increases to reduce PO4 even lower. |
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Candida esophagitis should or should not have oral thrush as well?
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most will.
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Would viral esophagitis present with systemic sx as well?
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not usually.
common with CD4 < 50 |
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Choices of ACLS drugs
1) E 2) Adenosine 3) Amio |
1) hemodynamically unstable pt with brady
2) supraventricular tachys, not for brady 3) tachy arrythmias. |
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When to use these intubation methods?
1) Orotracheal 2) Nasal tracheal |
1) Severe trauma pt that are hypopneic (breathing but need vent support) no significant facial trauma.
2) only for pt breathing at normal rates. |
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non-allergic rhinitis is chronic rhinintis w/o any atopic sx or identifiable cause.
what is tx? specifically which class of anti-histamine? |
intranasal steroid and class I anti-histamine (must have anti-cholinergic effect) like chlorphreniramine, not loratadine (class II).
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Scaphoid fracture
> most commonly dmg'd bone due to outstretched hand during falls. > described as tenderness of snuffbox. > if bones are non-displaced, but still see radiolucent line...what is tx? |
***always tx with immobilization unless dislocated.
**open reduction and internal fixation if dislocated. |
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When is RICE used as tx (rest ice compress elevate)?
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ligamentous strains. not for bone stuff.
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When is fetal lung officially developed and can induce delivery w/o the need to administer steroids?
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34 wks.
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Tricks of Managing Acetaminophen overdose.
-When will serum acetaminophen first show up? -When is the latest you can admin N-acetycysteine? -Should you give N-acetyl before seeing serum tylenol results? |
-4 hrs
-8 hrs with no changes in outcome. -No, don't give unless it's a hepatotoxic dose. |
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Remember how you treat Kawasaki's?
2 things! why? |
IVIG
ASA (long term) dec clots since complications include coronary artery aneurysm and stroke/MI. |
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Rib notching is specific for...?
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coarctation of aorta, associated with turner's.
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ALL often has these markers.
+ Tdt + PAS AML/CML often has peroxidase + |
z
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If a pt's hand starts with numb/tingle, then is now cold + no pulse felt... then anti-coag and call vascular surgery right away.
Even if given a bunch of random sx that doesn't make sense. What's the most likely etiology? |
*Limb ischemia due to embolism esp if hx of A-fib.
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Lethargy + AMS + Fever in cirrhotic pt.
most likely dx...? next step...? |
SBP
pericentesis (> 250colonies) then abx. |
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Warfarin can cause skin necrosis due to protein C deficiency in women.
Next step...? |
1) vit K
2) stop warfarin if lesion continues 3) start heparin |
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When do EtOH withdrawawl effects occur?
1) day 1 2) 2 3) 3 |
6-24 hrs = tremor, insomnia
24-48hrs = sz 48-96hrs = delirium tremens (HTN, tachy, hallucinate, fever) |
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which 2 values are the only necessary info for any acid-base disorder
paO2, paCO2, pH, HCO3, urinary pH |
paCO2 and pH
cuz that equation |
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what do u treat acute rejection of transplant with?
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IV steroids.
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Type 4 sensitivity aka contact dermatitis is cell mediated. that's why it's slow ok? walk past branch then it gets goofy a day later.
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ok
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Pt is an alcoholic with fatiguability and a Dr gives folic acid. Pt returns with improved Hb but new onset numbness/tingling of limb.
Consider what? |
Vitamin B12 deficiency.
Folic acid will slightly improve both conditions, but B12 def still remains. |
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Breast milk has little vitamin D.
B12 supplement for vegetarian moms. Fun fact about Iron: only premmie babies will req Fe supplement. Normal babies are born with ample iron storage. |
lol k
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When can babies start cow milk?
Whats before cow milk? |
1 yr
pureed stuff. |
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ferritin is storage
transferrin is transporter. |
z
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Rupture of fetal umbilical vessel
1) classic sign in FHR? 2) changes in maternal bp? 3) dx test 4) this is also known as...? |
1) tachy then immediate brady
2) not much change. 3) apt's test diff baby vs mom blood. 4) vasa previa -> urgent c-section |
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GBS = subacute ascending paralysis usually after URI.
1) CSF stats? 2) Tx |
1) only protein is high, rest is normal.
2) IVIG or plasmapheresis. |
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Most common thyroid nodule?
Second most common? |
benign colloid nodules
follicular adenoma (not just a nodule anymore). |
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Type II Heparin-induced Thrombocytopenia
>platelet reduction >50% from baseline from asx to sx. >Confirmatory test is...? > Treatment is started before testing, what is tx? |
1) serotonin release assay
2) stop all heparin product and start thrombin inhibitor (agartroban). |
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Type I vs II Hep induced thrombocytopenia
what's diff? |
type I is not autoimmune -> will resolve. starts around day 2 of administration.
type II is autoimmune, life threatening. starts around day 5. |
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Quinolone = flurorquinolone = levofloxacin = cipro = -xacin.
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lulz.
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what is pansystolic murmur loudest at apex radiate to axilla?
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apex = mitral.
stenosis = systolic. hence pansystolic = mitral regurg. |
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Hemophilia's hemoarthritis mechanism is...?
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hemosiderin deposits and subsequent fibrosis. it might bleed into joint for joint pain but long term complication is the above (mortality).
it can affect every organ. |
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Common complications of any nephrotic sx
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hypercoagulability from protein c/s anti-thrombin loss
infxn, forgot why dec thyroxine with loss of T-globule. vit D def |
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Aortoiliac occlusion has what sx?
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impotence and symmetric atrophy of buttocks down and weakness of those things with exertion.
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Henoch Schloen Purpura
1) what kinda rash? 2) which parts of body involved? 3) mechanism? |
1) palpable nonblanching rash
2) skin, ab, arthralgia, renal 3) IgA deposition. |
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Vit D deficiency rickets of non-adults
- genu varum -delayed fontanelle closing -bones enlarged (epiphyseal widening) |
z
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Alport's Sx just remember sensorineural deafness and recurrent nephrotics lol.
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ok
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Pulmonary capillary wedge pressure
1) measures what? 2) elevated means what? 3) decreased means what? 4) normal means what? |
1) left atrium pressure
2) ? 3) hypovolemia, 4) likely pulmonary issue, including PE. |
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what is the most diagnostic test for ankylosing spondylitis?
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xray's fusing of sacroiliac joint.
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Vaccine boosters
1) TD is every 10 yrs 2) TDAP is recommended for adults, just once. 3) PCV is given to any adults with chronic dz like DM. |
kk
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Difference between transfusion rxn to cytokines vs ABO incompatibility vs anaphylaxis vs urticaria
1) cytokine 2) ABO 3) anti-IgA 4) IgE/mast |
ABO has flank pain, DIC, hemoglobinuria, etc in addition to everything cytokine rxn has.
anaphylaxis is due to host anti-IgA attack on transfusion blood. Urticaria is by IgE |
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Pulmonary lesions quiz
1) how big is it time to worry? 2) popcorn shape on xray is what? 3) bullseye is what? |
1) >3cm
2) hamartoma 3) granuloma |
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whats the only H&P difference between CN and CO2 poisoining?
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CN is burning of rubber/plastic while CO2 is burning of wood.
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If pt presents with SLE sx and you diagnose SLE, what's the next step?
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obtain renal biopsy to classify and for future reference since renal complications may alter tx.
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Cluster vs trigeminal neuralgia
1) time in min vs seconds, which? 2) tx which is which? 3) which has cholinergic sx? |
cluster HA lasts few minutes, treated with triptans and high flow O2. cluster has extra sx's.
neuralgia is in seconds, tx'd by carbamazepine (bipolar and this). |
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Cryoglobulinemia: the thing you can never rmb
1) what disease is it related to? 2) what organs are involved? 3) what type of rash? |
1) HCV
2) complement deposition, arthralgia, hepatosplenomgealy, purpura, protein/rbc-uria. 3) palpable purpura. |
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Morton's neuroma
1) History is most likely...? 2) Diagnostic test? 3) Tx |
1) like stress fx but is subacute progressive and may include numb/burning of toes
2) clicking sound when palpating b/t 3rd n 4th toe. 4) shoe inserts. if not, then surgery. |
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Requirements for HOSPICE admission
***survival prognosis < 6month!!!! Hospice is focused on quality of life, not cure! |
i hate step 2
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Question may provide overwhelming info. Just remember these points.
Fasciculation is a clue for UMN or LMN? Hyperreflex is obviously UMN. When UMN and LMN are combined w/o bowel/bladder/sensory dysfxn, think...? |
LMN.
ALS. usually starts out with symmetrically distal muscle wasting, then continues to be fatal. Superoxide dimutase stuff. |
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Tricky bast@rds:
If someone has extended FHx of thalassemia, what's the first best test? |
It is CBC, not electrophoresis. WHy? if not microcytic, pt has no problem.
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Pneumococcal vs Meningococcal meningitis
what's the one big difference? |
pneumo has no rash
bonus: rocky mt spotted fever CSF is more like viral than bacterial. |
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Acute unilateral lymphadenitis (warm tender swollen) after URI sx 1 wk ago. Few systemic sx now. dDx?
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think strep and staph (staph #1).
EBV is b/l w/ systemic sx. |
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ACL vs meniscal tear injuries
1) how does history differ? |
1) ACL = acute pop and severe swelling. Meniscal tear = pop and may or may not swell with pt ambulating pretty good.
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prophylaxis and tx against chloroquine-resistant malaria strands (African to India).
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1) mefloquine, pyrimethamine, atovaquin, and doxycycline.
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Heart Defect vs Syndromes
1) Bicuspid aortic valve 2) Coarctation or aortic root dilation 3) ASD 4) MVP 5) VSD |
1) turner
2) turner 3) Down's 4) ehlo danler, marfan, osteogenesis imperfecta 5) trisomy 13, 18, 21. |
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Recall Turner's XO has low Estrogen so it will develop osteoporosis. No breast cancer doe.
**No mental retardation! |
lol
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If you see something that looks like malignant melanoma, perform an excisional biopsy WITHOUT wide margin!
why? |
cuz if it's just pigmented basal carcinoma, you don't have to excise with wide margin. biopsy allows identification before wide margin.
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Transtentorial Hernia often presents with an accident then elevated BP with bradycardia.
-ipsilateral hemiparesis, mydriasis, strabismus -contralateral hemianopsia (CN 3) |
x
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what does prussian blue stain signify?
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there is hemosiderin
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When do you give someone Varicella IG instead vaccine? why?
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only for immunocompromised.
because VZV is live-attenuated. |
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gallstones are the #1 cause of pancreatitis in non-alcoholics. so after initial tx, schedule pt for cholecystectomy.
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uhh.... k...
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suicidal pt comes in with bradycardia, AV block, hypoTN, diffuse wheezing.
**now i know what your thinking, do ACLS right? Atropine first, then Epi if it doesn't work. **you got this question wrong, so think what caused it first. Then what would be the tx? Keyword is diffuse wheezing. |
BB overdose (wheeze)
order of tx: IVF, atropine > glucagon > E |
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Alcoholic is more likely to have folate or B12 def?
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folate since EtOH directly inhibit absorption.
B12 only if malnourished for a while. |
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if a patient presents with gastric cancer-like sx but your given a bunch of glucose numbers, consider gastroparesis by DM end-GI-organ dmg. tx w/ ?
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tx w/ metoclopromide
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what to do when suspect choking newborn with tracheo-esophageal fistula?
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first, secure ABC w/ endotracheal tube and orogastric tube. next, CXR should show you that its going into the wrong place.
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Tricky Tricky Thing
***If someone has chronic COPD, his O2 will be low, but compensated. ***If pt is treated suddenly with high-flow O2, CO2 will not be excreted, causing hyper-CO2 sz and neurologic sx. ***what is the goal for O2 tx? |
pO2 of around 90-94%. Not >95% in acute-on-chronic COPD tx.
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Diagnostic tests for post-renal etiology of oliguria
**portable bladder scan (but may be useless for obese pt) -> bladder cath. Why are post-op post-renal common? |
anesthesia may screw up voiding stuff?
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Dysthymic vs MDD
what's the one biggest diff? |
dysthymic disorder only needs 2 sx.
MDD requires 5. |
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Anorexia should be hospitalized only if what is found on physical exam?
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extreme wt loss
electrolyte disturbances bradycardia. |
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Golden diagnosis for cervical insufficiency with known short cervix is...?
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transvaginal
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metastatic squamous cell tumor of the neck.
next step is to look for primary tumor. what are the possible tests? |
chest CT
if negative, pan-endoscopy (esophogoscopy, laryngoscopy, bronchoscopy). |
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For whatever reason, hyperPTH also causes HTN, heart rhythm defects, neurologic sx (depression, mood swing).
and yeah renal stones. |
ok
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Vitamin K -> factor 2 7 9 10 C S = PT
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k
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ITP vs TTP vs DIC vs HUS
1) ITP Is unique because? 2) DIC can be r/o'd if these 2 values are normal. 3) HUS? |
1) isolated thrombocytopenia.
2) both PT and PTT should be increased. If they are not, you should r/o DIC. 3) has giant platelet (w/ thrombocytopenia) inc reticulocyte %, but normal PT/PTT. |
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Constitutional delay has normal or delayed bone age? next step.
what's typical growth velocity? |
delayed. schedule follow up.
-around 5-10th percentile, consistently. |
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Sx of leukocyte adhesion deficiency include....?
-what at birth? -recurrent infxn and ...? |
delayed separation of umbilical cord
necrotic skin lesion, gingivitis, teeth loss. |
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Histoplasmosis specifics.
Tx is which abx? |
itraconazole is #1. add amphoteracin if severe.
no flucon. |
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Human monocytic erlichiosis
1) What? Location? 2) Sx 3) Labs show...? 4) How does it differ from lyme and rocky mt? 5) Tx steps. |
1) central USA
2) flu-like sx, confusion as the only neuro sx. 3) labs = low WBC and low platelet only. order PCR testing. 4) no rash! 5) Tx = doxy while awaing confirmatory results. |
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All suspected spinal injury patients must have this fkin thing that you always fkin forget done before you fkin do any other fking thing else. what is it?
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obviously ABC then it's the fkin bladder/urinary cath to eval retention and crap before or while u wait for CT results.
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Jaundice and ALP elevation only occurs in which type of gall related crap?
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duct related problems. not gallbladder (cholecystitis).
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Acne Tx
1) when to use cream based vs water? 2) when to use diet change for acne? 3) Tx for non-inflammatory acne 4) Tx for inflammatory acne 5) Tx for severly inflammatory acne 6) Tx for crazy acne |
1) oily skin = water. dry skin = cream based.
2) no need, useless. 3) topical retinoic acid 4) topical retinoic acid + benzoyl peroxide. 5) above + topical abx. 6) oral abx, isotretinoin. |
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what is isotretinoin?
route of admin and side effects |
oral only. such sclerosing acne. wow. much severe.
ASE: teratogen + hyperTG. |
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COPD does what to hematocrit?
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increase due to O2 demand.
but abn high value of hematocrit warrants chronic O2 therapy. |
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vitiligo
1) mechanism? what kinda destruction of which type of melanocraps? 2) tx or prognosis? 3) age of onset |
1) autoimmune destruction of melanocytes.
2) slowly progressive w/o remission. 3) 20-30 |
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Renal-Pulmonary Sx
1) Goodpasture's = marker, tx? 2) Wegener's aka granulomatosis polyangiitis. 3) Polyarteritis nodosa 4) RPGN |
1) anti-GBM. Emergent plasmapheresis!
2) has eye involvement, skin, joint involvement. Ass w/ c-ANCA. Tx w/ steroid + immunosuppressant. 3) small aneurysm bead (rosary). sx of end organ dmg. associated w/ Hep B/C, p-ANCA. same tx as abv. 4) goodpasture is one type of RPGN. as are many on this list. |
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Casts
1) RBC casts 2) WBC casts 3) Epithelial casts |
1) renal injury
2) pyelo, AIN, post-strep GN. 3) ATN, toxic ingestion, CMV. |
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Spinal Cord Tricky Management
1) Which imaging to use if NO myelopathy present? 2) Which imaging if present? 3) What drug to give immediately for severe? Why? |
1) xray
2) MRI 3) IV steroid. reduce edema. |
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TIA vs stroke vs lacunar stroke
if pt only has 1 or 2 affected areas without passing out or confusion, go for lacunar stroke due to HTN. what are the 4 categories of lacunar stroke? think hard |
1) pure motor (post internal capsule)
2) pure sensory 3) motor + hemiparesis (anterior internal capsule) 4) hand + dysarthria (basis pontis). |
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key things to remember.
thalamus = sensory. |
k
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what is the mechanism behind IM E's use for anaphylaxis?
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a1-agnoist vasoconstricts and dec edema.
b2 agonist bronchodilate and reduce systemic inflammation. |
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Pt with incidentally found isolated thrombocytopenia presents for checkup. You Dx ITP. But... what must you other etiology must you exclude?
EBV? no... he has no viral sx. Which virus? |
HIV... since early HIV has no sx other than dec platelets (10-15%). fk you this is some bs.
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Exudative macular degeneration
describe 1) acute vs chronic. 2) pain vs no pain. 3) progressive or no. 4) opthal exam shows? |
slow painless progressive blurring of central vision, may even be bilateral.
-growth of abn vessels. |
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Central retinal artery occlusion
describe onset, pain, progression, opthal. Tx = steps |
sudden painless loss of vision in only 1 eye.
opthal = pall of optic disc, cherry red fovea. 1) ocular massage to dislodge emboli + high flow O2. If no such answer, go with thrombolytics within 5 hrs. |
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multiple sclerosis lesions can be seen on CT or MRI or both?
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MRI only.
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IF burn pt has signs of inhalation injury such as high carboxyhemoglobin content, blisters of throat, burns of face... what do you do?
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Intubate to protect airway.
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Scabies = think linear arrangements all over the body.
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ok
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Granuloma inguinales is painless genital ulcer with red beefy base. just remember this. No adenopathy.
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ok
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Here's how to EASILY calculate and remember positive and negative predictive value.
PPV = true positive / total positive (includes false positives). NPV = true negative / total negative. Sensitivity = true positive / total of true positives (which includes false negatives). |
lol
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Friderich Ataxia sx's
-myocarditis would manifest as EKG showing? -gait is...? -spinal atrophy shows defect in which senses? -how is it passed? |
t wave inversion
wide based vibratory and positional auto rec |
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Dx esophageal perforation with....?
Tx with...? -typical signs include air in mediastinum (crunching ascultation sounds), and widened mediastinum. |
contrast esophagography
broad spec abx, TPN, surgery. |
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Tacrolimus and Cyclosporin ASE are ....?
what's the two thing they differ on? |
nephrotox, neurotox, GI tox
no hirsutism, gum hypertrophy that cyclosporin has. |
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azathioprine ASE
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mostly GI related.
diarrhea, hepatotox, leukopenia. |
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mycophenolate ASE
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myco m mmmmmarrow suppression.
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In-depth Mechanism: How does metastatic tumors invade bones?
Premise = PTH level are normal. |
they secrete PTHrp to destroy bones!
yes PTH levels may be normal. fk q bank. |
