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512 Cards in this Set
- Front
- Back
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Social Smile
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1-2months
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While prone, lifts head up 90 deg
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3-4 months
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Rolls front to back
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4-5 months
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Voluntary grasp
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5 months
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Stranger Anxiety
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6-9 months
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Cooing
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2-4 months
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Sits without support
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7 months
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Pulls to stand
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9 months
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Waves "bye-bye"
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10 months
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Plays pat-a-cake
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9-10 months
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First words
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9-12 months
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Imitates others' sounds
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9-12 months
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Voluntary grasp with voluntary release
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10 months
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Separation anxiety
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12-15 months
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Can build tower of 2 cubes
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13-15 months
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Runs well
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2 yrs
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Ties shoelaces
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5 yrs
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Good Use of cup an spoon
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15-18 months
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Understands 1 step command
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15 months
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Walks withou help
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13 months
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Risk factors for AVN
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EtOH,
Corticosteroids, Sickle cell, Lupus, Caisson dz, scfe, pancreatitis |
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SCFE
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9-13 yrs,
overweight male adolescent w/ knee, thigh, groin pain, limp tx: surgical pinning |
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LCPD
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4-10yrs,
short male w/ delayed bone age -knee, thigh, groin pain, limp tx: orthoses |
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Osgood-Schlatter
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osteochondritits of tibial tubercle.
-bilateral and in boys 10-15 yrs -knee swelling and tenderness -tx: rest, activity restriction, nsaids |
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decreased ankle jerk, weakness of plantar flexors, pain from midgluteal area to post calf, + straight-leg test
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L5-S1 herniation (S1)
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decreased biceps femoris reflex, weakness of foot extensors, pain in hip/groin
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L4-L5 herniation (L5)
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decreased triceps reflex, weakness of forearm extension
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C6-C7 herniation (C7)
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Humeral Fracture (nerve injured) + findings
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Radial nerve
(wrist drop); loss of sensation of back of forearm and 1st 3 digits of hand |
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Elbow dislocation or fracture (nerve injured) and findings
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Ulnar nerve
(claw hand); loss of finger abduction; loff of sensation of front and back of last 2 digits |
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Carpel tunnel syndrome; humeral fracture
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Median nerve:
loss of pronation; thumb opposition loss of sensation on palmar 1st 3 digits |
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Upper humeral dislocation or fracture
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Axillary nerve:
- lack of abduction/lateral rotation -lateral shoulder sensory loss |
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Knee dislocation; fibula fracture
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Peroneal nerve;
loss of dorsiflexion; loss of eversion (causes foot drop); -sensation over dorsal foot and lateral leg |
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Presbyopia
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between ages 40 or 50 lens loses accomodation
-nl part of aging |
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Corneal reflex
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CN V (afferent sensory limb)
CN VII (efferent, motor limb) |
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Central retinal vein occlusion
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painles, unilateral loss of vision;
fundo: distende, tortuous retinal veins, retinal hemorrhages congested edematous fundus Causes: leukemia, glaucoma, DM, increased blood viscosity |
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optic neuritis
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lyme, malignancy, syphillis, MS
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"blown" pupil
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emergency
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isolated CN III, IV, VI palsy
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due to HTN or DM
if less than 40, does not go away in 8 wks, or other neuro deficits, get MRI |
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herpes simplex keratitis
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conjuncctivitis and vesicular lid eruption,
---> classic dendritic keratitis (flourescien stain) -topical antivirals (idoxuridine) -corticosteroids contraindicated |
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hordeolum
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-painful red lump near lid margin
tx: warm comrpresses |
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chalazion
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painless lump away from lid margin
-warm compresses but can use steroid inj or I + D |
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number one cause of blindness in AA
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glaucoma
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conunctivitis in 1st 24 hrs of life
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chemical
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extremely purulent discharge between 2 and 5 days
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gonnorrheal conjunctivitis
tx: ceftriaxone or cefotaxime |
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mild-to-severe conjunctivitis
between 5 and 14 days |
chlamydial conjunctivitis
-oral erythromycin |
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pediatric uveitis
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juvenile rheumatoid arthritis (pauciarticular)
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UV keratitis
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snow-skiing, welding
-txx with eye patch and abx; -anticholinergica med to paralyze cialiary muscle |
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open-angle glaucoma
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painless
|
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closed-angle glaucoma tx
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pilocarpine, oral glycerin, acetazolamide
peripheral iridectomy |
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expansile, lytic lesion in proximal humerus in child/adolescent
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unicameral bone cyst
-can cause pathologic fracture |
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S-100
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melanoma
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CA27-29
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breast
|
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CA15-3
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breast
|
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beta 2-microglobulin
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MM, CLL, lymphoma
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histiocytosis
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birbeck granules, CD1
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calcified flank mass in child
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neuroblastoma
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Chadwick sign
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dark discoloration of vulva and vaginal walls
-pregnancy |
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Hegar sign
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-pregnancy
softening and compressability of lower uterine segment |
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melasma
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mask of pregnancy
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most accurate means of estimating fetal age
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biparietal diameter at 16 to 20 weeks
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preecclampsia before 3rd trimester
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mole
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46XX mole
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complete mole (father chromosomes)
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causes of IUGR
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fetal size <10th percentile for age
Maternal: -smoking, EtoH, drugs, SLE, Fetal: -TORCH, congen. anomalies Placental: -HTN, preecclampsia |
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size discrepancy >2-3cm
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US
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assessment of fetal-wellbeing
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NST
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NST
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fetal heart rate x 20 min
nl: 2+ accell lasting >15 sec w/ at least 15 bpm above baseline |
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BPP
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NST, amniotic fluid measurement, fetal breathing movements, fetal movements
-->if fails-->contraction stress test |
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contraction stress test
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-looks for uteroplacental dysfunction
-give oxytocin and monitor HR -if late decels--> C-section |
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prolonged gestation associated conditions
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anencephaly, placental sulfatase deficiency
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AFP
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15-20 weeks
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if AFP elevated:
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repeat test
|
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If AFP elevated 2x
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US to look for NTD, anomalies
-if uncertain US findings-->amniocentesis |
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First trimester combined test
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11-13 wks
-nuchal translucency via US -PAPP-A -hCG if + -->CVS |
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Quadruple test
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AFP, uE3, hCG, inhibin A
-women who present in 2nd trimester for prenateall care |
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why CVS over Amnio
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cVS: 9-12 wks (earlier)
-reserved for women with previously affected offspring -first-trimester abortion offered -CVS cannot detect NTDs |
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valproic acid
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hypospadias, spina bifida
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Diazepam
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cleft lip/palate
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DM in pregnancy adverse effects on baby
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CV malformations
cleft lip/palate Caudal regression NTD Left colon hypoplasia macrosomia microsomia incr risk of precclmapsia, polyhydramnios RDS hypoglycemia |
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TB in pregnancy
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isoniazid, rifampin, ethambutol
pyrazinamide w/ caution avoid streptomycin |
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major causes of maternal mortality associated with child-birth
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PE, pregnancy-induced HTN, hemhorrage
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Polyhydramnios
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AFI>25 or >2L
-causes: maternal DM, mult gest, NTDs, omphalocoele, esophageal atresia, hydrops -->postpartum uterine atony, maternal dyspnea |
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pseudotumor cerebri tx:
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acetazolamide, corticosteroids
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abscence seizures tx:
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ethosuxamide
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foot drop
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common peroneal nerve palsy
-L5 |
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tarsal tunnel
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entrapment of post. tibial nerve under flexor retinaculum on medial ankle
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eye adduction
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medial rectus
CN3 |
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eye elevation
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superior rectus
CN3 |
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eye depression
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inferior rectus
CN3 |
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CN3
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pupillary constriction
eyelid,opening SR MR, IR |
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Facial nerve CNVII
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ant 2/3 tongue
lacrimation, salivation, eyelid closing facial movement |
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CNX
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swallow, palate elev. talking
receptors in aortic arch |
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pseudotumor cerebri tx:
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acetazolamide, corticosteroids
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abscence seizures tx:
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ethosuxamide
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foot drop
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common peroneal nerve palsy
-L5 |
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tarsal tunnel
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entrapment of post. tibial nerve under flexor retinaculum on medial ankle
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eye adduction
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medial rectus
CN3 |
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eye elevation
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superior rectus
CN3 |
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eye depression
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inferior rectus
CN3 |
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CN3
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pupillary constriction
eyelid,opening SR MR, IR |
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Facial nerve CNVII
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ant 2/3 tongue
lacrimation, salivation, eyelid closing facial movement |
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CNX
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swallow, palate elev. talking
receptors in aortic arch |
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lateral medulla
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wallenberg
-ispi horners -losspain + temp of face -palatal weakness -cerebellar ataxia -loss pain and temp control |
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status epilepticus tx
|
lorazepam
phenytoin |
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Carotid stenosis >60%
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surg
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brainstem lesion findings
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crossed face and motor
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hemorrhage > age 75
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amyloid angiopathy
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hemorrhage <75
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htn
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DWI with stroke
CT |
dead tissue in 1- with DWI
6-12 hrs with stroke |
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ACA stroke
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slow, apathetic
L>U |
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PCA stroke (4 D's)
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-dizziness
-dysphagia -dysarthria -diploplia |
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HA and horners
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carotid dissection
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when at risk for herniation post-stroke
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edema peaks day 2-3
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cushing's triad:
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bradycardia, HTN, irregular respirations
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bell's phenomenon
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in someone faking stroke, eyeball goes up invol. when eye opened
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decorticate
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arms , legs extended
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tx of herniation
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increase head of bed
-hypervent (decr. pCO2 <25) -mannitol -neurosurg consult |
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hepatic encephalopathy on EEG
|
triphasic waves on EEG
tx: protein restriction, lactulose, abx |
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Resistance to leg extension
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Kernig's
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test to tell B12 def
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methylmalonic acid
|
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headache worsened by physical activity w/ pulsating, unilateral quality
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migraine
|
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status migranosus
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>72 hrs
-cutaneous allodynia -tx: IV steroids, valproic acid, ketorolac, prochlorperazin |
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chronic tension HA tx
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SSRI, TCA, muscle relaxant
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tension HA
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bilateral, tightening, mild-mod, no change w/ activity
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imaging for dissection
tx |
CTA, MRA w/ fat sat
tx: anticoagulation |
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eczema, thrombocytopenia, recurrent infections
decr. IgM, incr. IgA and IgE, poor resposne to polysacch antigen vaccines, -decr. plat. and lymphos |
Wiscott-Aldrich syndrome
|
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decreased granulocytes, poor chemotaxis, poor granulopoeisis, neurtopenia
-giant neutrophil lysosomes, tx: bactrim and Vitamin C |
Cheidak-Higashi Syndrome
|
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reccurring infections, tooth loss, delayed umbilical cord separation
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LAD
|
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chronic pruritic dermatitis
reccurrent staph infections, coarse facial features |
Job's (IgE) syndrome
|
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Drugs that can cause pancreatitis
|
-Valproic acid
-Diuretics: furosemide, thiazides -IDB: 5-ASA, sulphasalazine -immunosuppresants: azathioprine, L-asparaginase -AIDs: didanosine, pentamide -ABx: tetracyclines, metronidazole |
|
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mgmt of DKA
|
1) restore volume w/ NS
2) correct hyperglycemia w/ regular insulin 3) correct electrolytes w/ K+ 4) correct underlying infection with abx (can switch to D5-1/2 NS when glucose = 200-250) |
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Kidney's inferiorly displaced on exam of child
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neuroblastoma (non-palpable)
|
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SAAG>1.1
|
portal HTN
|
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Indications for dialysis
|
1) refractory hyperkalemia
2) volume overload refractory to diuretics 3) refractory metabolic acidosis w/ pH <7.2 4) uremic pericarditis, enceph, neuropathy 5) coagulation due to RF |
|
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bird's beak on barium swallow
-increased LES tone |
achalasia
|
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corkscrew on barium swallow
|
DES
|
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decreased sphincter tone on barium swallow
|
scleroderma
|
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tx for glaucoma
|
acetazolamide: inhibits production of aq humor by blocking CA
-pilocarpine: opens canal of schlemm -timolol: decreased production |
|
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reccurent infections with giardia
|
-Genetic B-cell deficiency
>6 mos of age -sinopulm. infections w/ encapsulated organisms |
|
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abscesses w/ catalase + organisms:
(staph and aspergillus) |
Chronic granulomatous disease:
def in nadph oxidase system -def. intracellular killing |
|
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recurrent gonococcal and meningococcal infxns
|
complement deficiency
|
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recurrent viral and fungal infections
|
DiGeorge syndrome
|
|
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decreased B and T cells
|
-SCID
adenosine deaminase deficiency |
|
|
transparent to yellow papules and scaling plaques
-eyebrows, nasolabial folds, eyelashes, paranasal skin |
seborrheaic dermatitis ("Cradle cap")
tx:moisturizers and antifungal shampoo |
|
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rash on flexural and extensor areas
|
atopic dermatitis
|
|
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adverse effects of thiazides
|
-decreased glucose tolerance,
-increased LDL and triglycerides -hyponatremia, hypokalemia -hypercalcemia |
|
|
causes of achalasia
|
idiopathic (most common)
-chagas disease, amyloidosis, sarcoid |
|
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Wilm's tumor
|
associated with Beckwith-weidman and
Denys-drash syndromes tx: nephrectomy |
|
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tx for rheumatic fever
|
benzathine penicillin
|
|
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nocturnal enuresis after failed conservative tx
|
ddavp-->imipramine
|
|
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recurrent respiratory and sinus problems
|
Kartagers syndrome's
|
|
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when use propylthiouracil
|
only when radioactive is contraindicated
|
|
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asymmetric polyarthritis w/ tenosynovitis, skin rash
|
gonnococcal arthritis
|
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tx of isolated brain mets
|
resection
|
|
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tx for urge incontinence
|
oxybutynin
|
|
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tx for frostbite
|
rapid rewarming in 100 degree water
|
|
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polycythemia in newborn
|
delayed clamping of cord
-peaks at 12 hrs -can lead to respiratory distress and CNS depression |
|
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tx for mucormycosis
|
amphotericin B
|
|
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angina worsened by Beta-blockers, ASA
|
printzmetal's angina
|
|
|
tx for variant anging (printzmetal's)
|
CCB
|
|
|
Focal segmental glomerulosclerosis (FSGS) causes
|
obesity, heroin, HIV
|
|
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a common cause of amyloidosis
|
RA
|
|
|
megacolon, megaesophogus, cardiac (systolic and diastolic) failure
|
trypanosoma cruzii
|
|
|
severe, recurrent pyogenic resp and sinus infections
complement def. |
C3 def
|
|
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recurrent neisseria infections
|
C5-C8 def
|
|
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hereditary angiedema
|
C1 esterase deficiency
|
|
|
Hyperglycemia, necrotizing dermatitis, weight loss
|
glucagonoma
tx: surg. |
|
|
extra-GI presentations of UC
|
erythema nodosum
-uveitis -sclerosing cholangitis -spondyloarthropathies |
|
|
milk-alkali syndrome
|
hypercalcemia caused by antacids
-metabolic alkalosis, renal insufficiency |
|
|
What document establishes the Navy's policy regarding drug and alcohol abuse, prevention, and control?
|
OPNAVINST 5350.4d, DRUG AND ALCOHOL ABUSE PREVENTION AND CONTROL
|
|
|
painless blisters on dorsal hands,
facial hypertrichosis/hyperpig -brought on by ethanol, estrogens, hep C |
uroporphryinogen decarboxylase def
poryphria cutanea tarda |
|
|
breast cancer treatment targeting her2 neu
-cardiotoxic |
trastuzumab
|
|
|
upper lobe pneumonia
-currant-jelly sputum -tissue necrosis encapsulated gram-negative baccilli mucoid colonies |
Freidlander's pneumonia
-Klebsiella |
|
|
lytic bone lesons, skin lesions, in Wisconsin wood-worker
|
blastomycosis
|
|
|
tx for blastomycosis
|
itraconazole
and amphotericin b |
|
|
walks alone;
throws; imitates |
12 months
|
|
|
stairs without help
parralel play 2-3words |
24 months
|
|
|
severe preeclampsia
|
BP >160/100
1) oliguria 2) AMS/HA/vision changes 3) edema cyanosis 4) RUQ pain 5) thrombocytopenia 6) MAHA 9) incr LFTs 10) incr cr |
|
|
jaundice in first 24-48 hrs
bili>5mg/dL/24hrs bili>12 in full-term jaundice >10-14 days |
BAD SIGNS
|
|
|
jaundice in 2nd wk of life
|
breast-milk jaundice
|
|
|
2nd week of life
|
breastmilk jaundice
|
|
|
bili @ < 12-14
from 24 hrs to first wk after birth |
physiologic jaundice
|
|
|
mild indirect hyperbili
|
GIlberts
UDP-glucuronyl |
|
|
fatal indirect hyperbili
|
Crigler-Najjar
|
|
|
umbilical hernia, sluggish
|
thyroid dysgenesis
|
|
|
degenreation of cranial nerve nuclei and anterior horn cells
floppy baby |
Werndig-hoffman syndrome
|
|
|
baldness, testicular atrophy, weakness and atrophy in distal extremities;
myotonia |
AD
myotonic myopathy |
|
|
Calcium correcte for albumin
|
0.8(nl albumin - measured albumin) + Ca 2+
|
|
|
pneumonia w/ PaO2 <70
|
PCP pneumonia
-add roids to Bactrim |
|
|
Marfan's + MR + infertior dislocation of lens
|
cystathionine synthase deficiency
|
|
|
MR, blind, deaf, paralyzed
|
Krabbe-disease
beta-galactosidase |
|
|
MR, blind, weak, cherry-red macula
|
Tay sachs
hexosaminadase A |
|
|
angiokeratomas,
peripheral neuropathy corneal dysrophy thromboembolic events HF, RF |
Fabry disease
alpha-galactosidase def |
|
|
multiufocal atrial tachycardia
|
pulmonary disease
|
|
|
HR 150-250
|
atrial tachy
|
|
|
HR 250-300
|
A fib
|
|
|
incr atopy in atria and ventricles
-AV block |
dig tox
|
|
|
acute gout
|
steroids, colchicine, nsaids
|
|
|
gradual loss of peripheral vision
tunnel vision incr intraocular pressure |
timolol
open angle glaucoma |
|
|
dilation of veins, microaneurysms, retinal hem,
edema, hard exudates |
non-proliferative retinopathy
|
|
|
straddle injury
|
ant. urethral injury
|
|
|
pelvic fracture
|
post. urethral injury
-high riding prostat suprapubic pain |
|
|
WInter's Formula
|
PaCO2 =1.5 (HCO3) + 8
|
|
|
umbilical stump infection
poor suckling, fatigue, rigidity, spaspms, opsithonus |
neonatal tetanus
1st wk: apnea 2nd wk: sepsis |
|
|
yellow sulfur granules
|
Actinomyces
-PCN |
|
|
bradycardia, miosis, fasciluations, salivlacrimation, diarrhea, urination
|
organophos
acetylchonlinesterase tox give atropine |
|
|
bone mets (where is primary)
|
lung, breast, thyroid, renal, prostate
|
|
|
supravalvular aortic stenosis
|
Williams syndroem
|
|
|
conotruncal abnormalities
(truncus, tetrology, interrupted AA) |
Catch 22, digeorge, velocardiofacial)
|
|
|
congenital heart block
|
lupus
|
|
|
PDA
|
cong. rubella
|
|
|
pancreatitis
|
lipase is more specific
|
|
|
causes of death in acromegally
|
stroke,
colon cancer renal failure adrenal failure |
|
|
barter's syndrome
|
hypokalemic metabolic alkalosis
normal BP incr Urine Cl -defective Na reabs in TALH |
|
|
Tx for CNS crypto
|
IV Amph B and Oral flucytosine
|
|
|
Tx for Histoplamosis meningitis
|
ampho B
|
|
|
3-5 words without gestures
|
15 months
|
|
|
5-20 words
|
18 months
|
|
|
1000 words, 75% intelligible
3-4 word sentences |
3 yrs
|
|
|
150-300 words
combinations |
2 yrs
|
|
|
Crystal nephropathy
|
indinavir, acyclovir, sulfonamides
|
|
|
fever, wt loss, malaise, abd pain
exophytic purpuric mass |
bacillary angiomatosis : bartonella
|
|
|
what cardiovascular problems does diptheria cause
|
dilated cardiomyopathy
|
|
|
anemia in NHL and CLL
|
warm hemolytic anemia IgG
|
|
|
If lying supine, where aspirate to:
|
posterior R upper lobe
|
|
|
If standing, where aspirate to:
|
superior and basilar lower lobes
|
|
|
babbles
|
6 months
|
|
|
2 words, 1 step command
|
1 yr
|
|
|
2-3 words, 2 step commands
|
2 yrs
|
|
|
raking grasp
|
6 months
|
|
|
builds tower of 6 blocks, turn pages
|
24 months
|
|
|
Von-Gierke's dz
|
glucose 6 phosphatase def:
"doll-like face" hypoglyc hyperlipidemia lactic acidosis hyperuricemia |
|
|
Pompe's Dz
|
acid maltase deficiency
"floppy" macroglossia HOCM |
|
|
What is difference between TI and TIII glycogen storage diseases?
|
TIII is debranching enzyme
have ketosis, NL lactate and uric acid TI (Von gierke's) lactic acidosis and hyperuricemia |
|
|
Causes of Hepatic encephalopathy in alcoholics (4)
|
1) ammonia
2) false neurotransmitters 3) incr sens. to gaba inhib 4) Zn def. delta waves (triphasic) on EEG |
|
|
Precipitators of hepatic encephalopathy (9)
|
1) incr protein
2) alkalosis 3) diuretics 4) GI bleed 5) narcotics 6) meds 7) incr vol. paracentesis 8) hepatic infection 9) portocaval shunt |
|
|
drugs that cause hyperkalemia
|
NSAIDS
ACEI K+-diuretics |
|
|
dilated pupils
blurred vision confusion dry mouth urine and stool retention |
Anticholinergic crisis
tx: physostigmine |
|
|
salicylate toxicity
|
tinnitus, fever, vomiting
metabolic acidosis respiratory acidosis tx: alkalinize urine w/ bicarb |
|
|
tachypnea
diaphoresis mydriasis HTN hyperthermia |
serotonin syndrome
|
|
|
tx for Afib w/ rapid ventricular response
|
Beta-blockers, Ca-channel blockers, dig, adenosine
if WPW, use cardioversion or procainamide |
|
|
see atypical lymphocytes with what infections
|
toxo, roseola, rubella, viral hep, mumps, CMv, HIV, IM
|
|
|
how long does it take to deplete folic acid stores?
B12? |
FOLIC ACID: 4-5 MONTHS
b12: 3-4 YRS |
|
|
painless loss of monocular vision
ischemic retinal whitening cherry red spots |
central retinal artery occlusion
tx: ocular massage |
|
|
frequent nosebleeds, visual mass
|
angiokeratoma
tx: surgical resection |
|
|
fever, malaise, wt loss,
lymphad, pancytopenia, HSM, palatal ulcers, hilar adenopathy |
histo
|
|
|
indications for surgical correction of hyperparathyroidism
|
U cal >400 mg/24hrs
<50 yrs old BMD < t-2.5 DECR gfr |
|
|
WHEN DOES Ck-mb RETurn to nl post-MI
Troponin T? |
CK-MB: 1-2 days
troponin T: 10 days |
|
|
sickle cell causes what renal pahtologies
|
hyposthenuria: cannot concentrate urine
membranoproliferative glomerulonephritis FSGS |
|
|
side-effect of ketoconazole
|
inhibits steroid synthesis
|
|
|
risk factors for pellagra (diarrhea, dermatitis, dementia)
|
niacin deficiency
1) Hartnup's Dz 2) carcinoid syndrome 3) corn-based diet |
|
|
intermittent acute attacks of abd pain, N/V, diaphoresis, parasthesias, confusion, agitation/anxiety in a female
|
acute int. poryphria
|
|
|
when is fetus most susceptible to radz
|
8-15 wks
|
|
|
how radz much is therapeutic abortion
|
5-10 cGY
|
|
|
SIRS
|
2+
1) fever or hypothermia 2) tachypnea 3) tachycardia 4) leukocytosis, bandemia, leukopenia |
|
|
Severe SIRS
|
SIRS plus end-organ damage
-oliguria -hypotension<90 syst -thrombocytopenia <80,000 met. acidodsis hypoxemia |
|
|
septic shock
|
unresponsive to fluid replacemtn
|
|
|
infected burns
|
<1 wk : S. aureus
>1wk: Pseudomonas |
|
|
Beta-blocker intox (wheezing)
|
glucagon
|
|
|
malodorous discharge
gray-green, frothy edematous, hyperemic vulva strawberry cervix pH 5.0-6.0 |
trichomonas
|
|
|
candida
|
non-malodorous, white, pH 4.0-5.0
|
|
|
gardnerella
|
incr PH, no pruritis or inflamm
|
|
|
CHD equivalents
|
DM, CAD, AAA, PAD, 10 yr risk of CHD 10% or >
|
|
|
FAP or HNPCC,
meningioblastoma, or GBM |
Turcot's syndrome
|
|
|
angiofibromas, osteomas, sebaceous cysts, lipomas, colonic polyps
|
gardner's syndrome
AD |
|
|
hamartomatous polyps
mucocutaneous melanocytic macules |
Peutz-Jeghers
AD |
|
|
Breast CA, thyroid CA, nodular gingival hyperplasia, GI tract hamartomas
|
Cowden syndrome
|
|
|
Juvenile polyps
ectodermal abnormalities (alopecia, hyperpig, onycholysis) |
cronkite-canada
|
|
|
Causes of A fib in order or commonality
|
1) HTN
2) Valvular HD 3) MI 4) Hyperthyroidism 5) EtOH |
|
|
tx: afib
|
<48 hrs cardiovert
>48 hrs: rate control w/ anticoag for 3-4 wks unstable--> cardiovert |
|
|
pneumonia w/ incr LFTs, GI sx, hyponatremia
|
Legionella
tx: quinolone/macrolide |
|
|
cavernous sinus thrombosis
|
paralysis of CN III, V1, V2, VI
tx: iv abx, anticoag, steroids, surg |
|
|
halos around eye,
red eye w/ hazy cornea |
acute angle-closure glaucoma
|
|
|
tx for nephrogenic DI
|
indomethacin and HCTZ
|
|
|
tx for Li-induced nephrogenic DI
|
amiloride
|
|
|
diploplia, weakness, blurred vision, grand mal seizures
|
insulinoma
|
|
|
episodic hypoglycemia
CNS dysfuncion reversal with glucose administration |
Whipple triad
|
|
|
QRS prolongation --> ventric arrhythmia
hyperthermia seizures hypotension dilated pupils, flushed/dry skin, intestinal ileus |
TCA OD
tx: na bicarb |
|
|
QT prolongation->torsades
deafness |
Jervell-Lange-Nielson syndrome
AR |
|
|
hydrocole
|
processus vaginalis
12 month spont resolve transilluminate |
|
|
Lithium
|
1)Nephrotoxicity
2) N/V 3) hypothyroidism 4) leuocytosis 5) tremors 6) acne 7) psoriasis |
|
|
Lithium effects on pregnancy
|
Ebstein's anomaly
|
|
|
melanosis coli (dark brown colonic discoloration w/ pale patches)
pigment in macrophages in lamina propria |
factitious diarrhea
|
|
|
MTX
|
inibits DHFR
macrocytic anemia interstitial lung dz, alopecia, fever, stomatitis |
|
|
hydroxychloquine
|
hemolysis in G6PD, visual disturbances
|
|
|
elevated urinary N telopeptide
|
Pagets
|
|
|
Fibrous replacement of bone
|
Fibrous dysplasia
|
|
|
defective H+ secretion
acidotic, hypokalemic, incr UpH stones! |
T1RTA
|
|
|
decr. bicarb reabsorption in PT
fanconi syndrome |
T2RTA
|
|
|
defective NA/K excretion in distal tubule
hyperkalemic hyperchloremic acidosis |
T4RTA
|
|
|
hemochromatosis
|
hypogonadism
arthropathy hepatomegally endocrine dysfunction cardiac conduction abnormalities |
|
|
2ndary erythrocytosis
hematuria death via cerebral aneurysm |
PKD
|
|
|
how address persistent variable decel <70bpm (fetal hypoxia)
|
1) change maternal position and give O2
2) trandellenberg 3) amnioinfusion |
|
|
MALToma
|
omeprazole, clarithromycin, amoxicillin
CHOP + bleomycin |
|
|
rsisk of OCP use
|
1) HTN
2) VTE 3) stroke 4) incr TG 5) breast ca 6) cerv ca 7) worsening of DM |
|
|
benefits of OCP use
|
decr risk of PID, ectopic preg,
ovarian and endometrial cancer |
|
|
scabies tx:
|
5% permethrin cream
steroids |
|
|
purpuric feeding spots (maculae cerulae)
|
body lice
|
|
|
bites in groups of 3s
|
bed bugs
|
|
|
charcot's triad
|
fever, RUQ pain, jaundice
|
|
|
Reynold's pentad
|
charcot's triad (fever, RUQ pain, jaundice)
+ confusion +hypotension |
|
|
Inferior MI
|
RCA: LCA
4-5:1 |
|
|
central scotoma, retinal edema, subretinal hemmhorrage, macular detachment, crescent streak
|
chroroidal rupture
|
|
|
Fanconi's anemia
|
AR
-BM failure -skin hypopigmentation -congenital anomalies (microceph, hypogonad, abnl thumbs) |
|
|
pure red cell aplasia
|
thymic tumors
|
|
|
hemosiderin pigment
|
capillary leak
|
|
|
glucocorticoid deficiency
|
weakness, eosinophilia, lymphocytosis
|
|
|
tx HEP C
|
If incr ALT, + HCV RNA-->IFN and ribavirin
|
|
|
when do fasting BS in pregnant women
|
24-28 wks
|
|
|
hepatic vein thrombosis
|
PNH
|
|
|
what SE of isoniazid is not prevented by B6
|
hepatitis
|
|
|
PPD+ in HIV
|
isoniazid + B6
or pyrazinamide + rifampin ~4months or rifampin 4 motnhs |
|
|
meningitis in those > 55, immunocomp, cancer patients, taking steroids
|
Listeria
|
|
|
tx: meningitis in those < 3months
|
IV cefotaxime + amp
|
|
|
ceftriaxone in young children
|
biliary sludging
|
|
|
post-neurosurgical meningitis
|
IV ceftaz and vanco for pseudomonas and S. aureus coverage
|
|
|
Erythema Nodosum
|
sarcoid, strep, Tb, histo, IBD
get ASO and PPD |
|
|
tx of uremic platelet dysfunction
|
DDAVP
|
|
|
rapidly progressive consolidation
"halo" sign |
aspergillosis
|
|
|
erythema multiforme
erythema nodosum |
coccidioidomycoses
|
|
|
cancers that release ectopic PTH
|
ovarian, lung, neuroectodermal
|
|
|
tx of hypercalcemia in hodgkin's dz
|
calcitriol
|
|
|
tx of cocaine-induced cardiac sichemia
|
benzos, ASA, nitrates
|
|
|
immunocompromised with:
multifocal diffuse patchy infiltrates |
CMv pneumonitis
|
|
|
decreased IgA, IgG
increased IgM lymphoid hyperplasia |
Hyper IgM syndrome
|
|
|
what infections at risk for with Bruton's aggammaglobulinemai (X-linked)
|
pseudomonas, giardia
|
|
|
middle mediastinal masses
|
bronchogenic cyst, tracheal tumor
pericardial cyst lymphoma lymphadenopathy arch aneurysms |
|
|
psoterior mediastinum
|
meningocoele
enteric cyst lymphomas diaphragmatic hernia esophageal tumors esophageal leomyomas |
|
|
what does PEEP do
|
prevents alveolar collapse @ end expiration by increasing FRC
|
|
|
what does increasing RR do
|
decreases CO2
|
|
|
MCP, PIP, Wrist arthritis
|
Parvovirus B19
|
|
|
increased testosterone and estrogen
|
Leydig cell tumor (sex cord stromal)
|
|
|
increase Beta-HCG (tumor)
|
choriocarcinoma
|
|
|
increased AFP and Beta-HCG
|
teratomas
|
|
|
decr CD19
absent tonsils and lymphoid tissue |
brutons x-linked aggammaglobulinemia
|
|
|
amyloid in ESRD
|
Beta2-microglobulin
|
|
|
synovial tendon hyperplasia
|
acromegally
|
|
|
fluid in carpal tunnel
|
pregnancy
|
|
|
common causes of death in dialysis patients
|
1) CVD
2) line infections |
|
|
increased risk for PCP, candida, paraflu, herpes
lymphopenix |
adenosine deaminase defic (SCID)
|
|
|
increased UpH, hypokalemia, nephrolithiasis
|
T1RTA
|
|
|
tamoxifen increases risk of
|
endometrial cancer
uterine sarcoma |
|
|
blunt abdominal trauma
|
1) hollow viscus rupture
2) pancreatic damage |
|
|
+ McMurray's
|
medial meniscus (effusion later)
|
|
|
locking of knee joint
|
"bucket-handle" tear
|
|
|
what leg pathology in young persons is associated with endocrine issue
|
SCFE
|
|
|
what look for on hip films with SCFE
|
femoral head is posteriorly and inferiorly displaced
|
|
|
duodenal atresia is associated with what other abnormality
|
annular pancreas
|
|
|
chloride-resistant alkalosis
|
black licorice,
barter's gittelman's primary hyperaldo |
|
|
esophageal variceal bleeds are associated with what other complication from cirrhosis
|
SBP
|
|
|
genetic mutation in CF
|
chromosome 7 - deletion
|
|
|
+ blood on Udip but no RBCs
|
rhabdo
|
|
|
Metabolic syndrome
|
1) abdominal obesity (men >40, women>35 in)
2) f glu >100-110 3) BP (>130/80) 4) trig >150 5) HDL (men< 40, women <50) insulin resitance, endocrine dysfunction, procoagulatory state, increased sympathetic activation, increased inflammation, decreased urica acid excretion |
|
|
vitiligo
|
asscotiated with addison's
|
|
|
Best test for Hep B
|
1) HbsAg
|
|
|
BW of children
|
2x by 5 months
3x by 1 year |
|
|
BH of children
|
1.5 x by 1 year
2 x by 2 years 3x by 13 |
|
|
hemmorhage affecting 1 cranial bone
|
cephalohematoma (subperiosteal)
|
|
|
diffuse, echymotic swelling of scalp
|
caput succedeaum
|
|
|
pulsatile swelling of scalp
|
cranial meningoceole
|
|
|
reasons for post-op cholestatis
|
1) increased pigment load
2) decreased liver function 3) decreased excretion (acute tubular necrosis) peaks from post-op day 2-3 can happen as alte as post-op day 10 |
|
|
doll-like face
protuberant abdomen thin ext short hypoglycemic lactic acidosis hyperuricemia |
Vongierke's
|
|
|
prussian blue stains what
|
hemosiderin
|
|
|
diabetic overflow incontinence
|
detrussor weakness
tx: catheterization, bethanecol (anticholinergic) |
|
|
back pain with decreased pain on flexion, increased on extension
neurogenic claudication |
lumbar stenosis (DJD)
|
|
|
back pain that worsens with sitting
|
herniated disk
+ straight leg test |
|
|
Kussmaul's sign
|
increased JVD with inspiration
|
|
|
what should be avoided in patients with a RVMI
|
preload reducing agents
|
|
|
UC
|
+ p-ANCA, HLA-B27
erythema nodosum episcleritis arthritis cholangitis crypt abscess |
|
|
what bias does blinding control
|
observer bias
|
|
|
what precipitates gilberts
|
fastng, fat-free
excercise fevers stress fatigue |
|
|
chest pain brought on by emotional stress, hot/cold food
|
DES
|
|
|
when do beta-blockers cause HTN
|
pheochromocytoma
|
|
|
medical management of pheo
|
alpha-blockers first
|
|
|
increase 17-alpha progetserone
|
21-hydroxylase def
|
|
|
mineralcorticoid deficiency and delayed puberty
|
17-Ohase def
|
|
|
androgen and mineralocorticoid excess
|
11-beta OHase def
|
|
|
NF type 1
|
optic glioma
slowly prog vision loss |
|
|
retinal hamartoma
|
tuberous sclerosis
|
|
|
workup for pelvic fracture
|
retrograde urethrogram (post. urethral injury)
|
|
|
workup for bladder injury
|
retrograde uretherogram and post void films
|
|
|
tx for dermatitis herpetiformis
|
dapsone!
|
|
|
hyperdynamic circulation w/ nl mix venous O2
|
septic shock
|
|
|
congen. rubella
|
sensorineural hearing loss, blueberry muffin baby
|
|
|
rat-bite lesions
|
gout
|
|
|
lupus anticoag
|
5-10%lupus patients
IgG or IgM prolongs PT prolonged russell viper venom test |
|
|
encapsulated thyroid cancer
|
follicular
|
|
|
late lyme tx
|
IV 3rd gen ceph
|
|
|
when does post-radiation lung fibrosis appear
|
4-24 months
|
|
|
restrictive cardiomyopathy
|
diastolic failure
nl LV volume -symmetric LV thickenign |
|
|
blood at beggining of urination
|
urtehral injury
|
|
|
hematuria whole cycle
|
renal or ureteral inury
|
|
|
post-infarct pericarditis
|
2-5 days post-MI
|
|
|
autoimmune pericarditis post MI
|
several wks
|
|
|
panacinar emphysema
|
apha 1 antitrypisin def
-PAS + resist diastase digestion |
|
|
protruding metropic suture
|
cri-du-chat 5 p deletion
|
|
|
hypoplastic ribs, genital anom, hypertelorism, holoprosencephaly,
polydactyly |
patau's
|
|
|
effect of glucorticoids on thyroid hormones
|
decr T4 and T3
|
|
|
reduced uptake of Iodine with thyrotoxicosis
|
1) subacute lymphocytic thyroiditis
2) levo OD 3) dequervian's (painful) subacute granulomatous 4) struma ovarii |
|
|
chronic pancratitis
|
test (stool elastase)
fibrosis and patchy inflamm may have nl panc enzymes |
|
|
acute dystonis
|
"torticollis"
4hr-4 days muslce spams/stiffness tx: antihistamines or anticholinergics |
|
|
akathasia
|
anytime
tx: betablockers |
|
|
NMS
|
any time
dantrolene |
|
|
parkinsonism
|
4 days - 4 moth
tx: anticholinergics |
|
|
AAA repair with abdominal pain
|
IMA occulsion (1-7%)
L and sigmoid colon ischemia |
|
|
what do if have 2nd VTE
|
anticoag....for life!
|
|
|
Niacin flushing
|
tx aspirin
improves after 2-4 wks |
|
|
DES exposure
|
clear cell of vagina
-cerv hypoplasia -T-shaped uterus -septated utetrus microphallus hypospadias |
|
|
risk factors for endometrial cancer
|
tamoxifen, obesity, nulliparity, late menopause
|
|
|
mycotic aneurysm
|
staph and salmonella
|
|
|
choanal atresia
|
cyanosis w/ feeding
better with crying |
|
|
mediastinal adenopathy access
|
mediastinal bronchoscopy
|
|
|
CVID
|
nl lvls of B cells
decreased IgG, IgM, IgA |
|
|
ACE and ARB affect on fetus
|
oligohydramnios
|
|
|
when tx new onset HTN in pregnancy
|
>150/95
|
|
|
what lab finding in primary polydipsia
|
dilute urine and plasma
|
|
|
imagin study for gastric cancer
|
CT
|
|
|
complete SBO
partial SBO |
complete: laparotomy
partial: NgT |
|
|
sbird's beak on barium enema
|
volvulus
tx: sigmoioscopy |
|
|
when can give MMR to HIV patients
|
CD4>400
|
|
|
blue gums, depressed sternum, thin-cortex, sharp epiphyseal plates, teners, pseudoparesis
|
scurvy
|
|
|
abdominal distension
|
duodenal atresia
|
|
|
white fluffy retinal lesions
encephalitis vitritis |
ocular toxo
|
|
|
parkinsonism and HIV are assoc. with what cutaneous manfestation
|
sebborrheic dermatitis
|
|
|
precipitators of acutee acaclculus cholecystitis
|
1) burns
2) trauma 3) prolonged TPN 4) prolonged fasting 5) mechanical ventilation |
|
|
acute epididymitis
|
fever, painful testes, dysuria
e. coli |
|
|
post-streptococcal glom
vs IgA nephropathy |
post strep: 10-12 days post
IgA <5 days nl complement lvls |
|
|
Mallory hyaline
low ceruloplasmin depression, paranoia, catatonia |
Wilson's dz
|
|
|
livedo reticularis
|
cholesterol embo. syndrome
|
|
|
tx for femoral shaft fracture
|
closed
|
|
|
subglottic narrowing on lateral x-rays
|
parainfluenza (croup)
|
|
|
obliteration of vellecula
thumb sign increased aryepiglottic folds |
epiglottitis (toxic, drooling)
|
|
|
pulses parvus et tardus
|
Aortic stenosis
|
|
|
capillary pulsations
|
aortic regurg
|
|
|
pulsus paradoxus
|
decreased systolic pressure with inspiration
tamponade |
|
|
dx of DM
|
>126 x 2
RBG > 200 75 OgTT (>200 x 2hrs) |
|
|
tx for SVT
|
adenosine
|
|
|
Acute Monocytic leukemia
|
FAB MS
+ alpha-napthyl esterase + non-specific esterase |
|
|
lymphoblasts staing
|
PAS +
|
|
|
esophagus w/
focal substernal burning with odynophagia large, shallow, superficial ulcers intracell inclusions |
CMV esophagitis
|
|
|
multiple small volcano-like appearing ulcers
ballooning degeneration eosinophilic nuclear inclusions |
HSV esophagitis
|
|
|
Central precocious puberty
|
LH is stimulated by GnRH
|
|
|
white male
pain and swelling "onion-skin" periosteal rxn lytic central w/ endomyseal scalloping "moth-eaten" |
Ewing's sarcoma
|
|
|
glomus tumor
|
subungual, palmar, wrist (painful)
|
|
|
5th and 6th decades
enchondromas hemangiomas fusiform defect w/ scalloping |
chondrosarcoma
|
|
|
envelope shaped crystals
|
calcium-oxalate
|
|
|
calcium-phosphate stones
|
PTH and RTA
|
|
|
stones associated with acidic urine
|
uric acid stones
|
|
|
Renal manifestation of Hep B
|
membranous glomerulonephritis
|
|
|
watery diarrhea in HIv + patient
|
cryptosporidium
|
|
|
workup for GI blood loss
|
colonoscopy, upper endoscopy, capsule endoscopy (pick up AVMs in small intestine)
|
|
|
labs during shunting
|
nl PaCO2
increased Aa gradient no correction with 100% O2 |
|
|
how does hypothyroidism cause HTN
|
incr SVR
|
|
|
how does hyperthyroidisim cause HTn
|
hyperdynamic circ.
|
|
|
Aa gradient equation
|
PAo2= FiO2 (760-42) - PaCO2/0.8
|
|
|
black urine
increased homogentisic acid |
alkaptonuria
|
|
|
boiled cabbage smell
|
tyrosinemia
|
|
|
how work up LSIL (CINI) in premenopausal women
|
colpo
|
|
|
how workup LSIL (CINI) in postmentopausal women
|
reflex HPv and colpo
|
|
|
acute MI w/ pulm edema
|
no beta-blockers
|
|
|
electrical alterans on ECG
|
pericardial effusion
|
|
|
cardiomyopathy in hemochromatosis
|
reversible restrictive cardiomyopathy
|
|
|
pathology with Reyes syndrome
|
brain, kidneys, liver: microvesicular steatosis
|
|
|
Intestinal granulomas with what infections
|
yersinia, tb, sarcoid
|
|
|
drugs that cause SJ syndrome
|
sulfa, nsaids, phenytoin
|
|
|
when put on home O2
|
PaO2<55
SaO2<88 pulm Htn cor pulm Hct>55% nocturnal hypoxia |
|
|
pain on light palaption of vertebrae
|
vertebral osteomyelitis
|
|
|
conditions associated with ADPKD (6)
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1) cystic kidneys
2) berry aneurysms 3) hepatic cyst 4) valvular HD (AR or MVP) 5) colonic diverticula 6) ing/abd hernia |
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stable vtach (wide complex) tx
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amiodarone or lido
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SVT tx
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carotid massage
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atrial arrhytmias tx
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diltiazem and digoxin
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sternal fractures,
BBB tachy |
myocardial contusion
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steryotyped movements appear at 6 months
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Retts syndrome
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copper deficiency
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reversible sideroblastic anemia
-celiac, gastrectomy, prolonged parenteral nutrition |
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workup for addisons
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eosinophilia
cosyntropin stim test then measure plasma ACTH lvls |
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test for SLE
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+ anti-smith
+ anti-DsDNA |
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conj bili
increased coproporphyinogen black liver w/ epiu mtabolites |
Dubin-Johnson sndrome
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drugs that cause cochlear dysfunction
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aminoglyc, cisplatin, carboplatin
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drugs that cause optic neuropathy
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ethambutol, hydroxychloroquine
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drugs that cause neuropathy
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vincristin, isoniazid, phenytoin, metals, EtOH
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pH <7.2 of pleural fluid
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chest tube
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infection tick -borne
associated with thrombocytopenia and leukopenia |
erlichiosis
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tick-borne illness associated with anemia
tx |
babesiosis
quin-clin atovquone-azithro |
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GBM splitting on electron microscopy
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Alport's syndrome
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lumpy-bumpy immunoflourescence
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postinfectious glomerulonephritis
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fusion of foot processes on electron
normal light microscopy |
minimal change disease
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sclerosis in capillary tufts on histology
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FSGS
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"spike and dome" appearance on histology
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mebranous glomerulopathy
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"tram track" double-layered basement membrane
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membranoproliferative nephropathy
HCV, cryoglobulinemia, SLE, subacute bacterial endocarditis |
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hexagonal crystals on urinalysis with stones
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cystine
tx: Na restriction, alkaqlinization of urine, penicillamine |
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testicular mass,
elevated beta-hcg |
all choriocarcinomas
10% seminomas |
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testicular mass,
elevated AFP |
nonseminomatous germ cell tumors, (endodermal sinus tumors [yolk sac])
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attributable risk
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IR exposed - IR unexposed
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Relative Risk
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IR exposed/IR not exposed
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Odds ratio
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liklihood among those exposed/liklihood among those not exposed
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NNT (number needed to treat)
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1/ (rate in untreated - rate in treated)
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who do you initiate early colorectal screening in
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IBD; FAP/HNPCC;
1st degree relatives with adenomatous polyps or CC |
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percentage of cases within one SD of mean
2 SD 3SD |
68, 95.4, 99.7%
|
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cohort studies measure?
case-control studies? |
RR, incidence and or/ OR
case-control studies: OR |
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#TP/# patients with disease
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sensitivity
|
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contraindications to HRT
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vaginal bleeding
breast cancer endometrial cancer hx VTE chronic liver dz hypertriglyceridemia |
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Follicular phase
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high inhibin B
-straight glands and thin secretions of uterine lining |
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pregression of female development
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telarche, menarche
|
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tabes dorsalis
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degen of dorsal roots and dorsal collumns
-imparied proprioception and locomotor ataxia |
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anterior dislocation @ hip
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can injure obdurator nerve
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Posterior dislovation of hip
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associated with sciatic nerve injury
AVN |
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Most common shoulder dislocation
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anterior
arm held in abduction and external rotation injury to axill art and nerve |
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dislocation assoc w/ seizures and electrocutions
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arm held in adduction and internal rotation
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fracture with tenderness in anatomical snuffbox
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scaphoid fracture
tx: with thumb spica cast displaced or navicular nonunion-->surg |
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fracture assoc with fall on outstretched hand
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Colles fracture of distal radius
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fracture assoc. with punching wall
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Boxer's fracture
fifth metacarpal neck cover Eikenella if skin is broken |
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>10% plasma cells in bM, M protein in serum or urine, lytic bone lesions
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Multiple mYeloma
skeletal survery, BM biopsy, serum and urine protein electrophoresis, CBC |
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elevated IgM
abnormal plasma cell on marrow biopsy PAS+ igM depostis around nucleus (Dutcher bodies) |
Waldenstrom's macroglobulinemia
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