Step 2 Rapid Review

Front 1

Vitamin A deficiency

Back 1

night blindness, dry skin

Front 2

Vitamin B1 (thiamine) def

Back 2

beriberi (polyneuritis, dilated cardiomyopathy, high output CHF, edema), Wernicke-Korsakoff syndrom

Front 3

Vitamin B2 (riboflavin) def

Back 3

angular stomatitis, cheilosis, corneal vascularization

Front 4

Vitamin B3 (niacin) def

Back 4

pellagra (diarrhea, dermatitis, dementia)

Front 5

Vitamin B5 (pantothenate) def

Back 5

dermatitis, enteritis, alopecia, adrenal insufficiency

Front 6

Vitamin B6 (pyridoxine) def

Back 6

convulsions, hyperirritability; required during administration of INH

Front 7

Vitamin B12 (cobalamin) def

Back 7

macrocytic, megaloblastic anemia, neurologic symptoms (optic neuropathy, subacute combined degneration, paresthesias), glossitis

Front 8

Vitamin C def

Back 8

scurvy (swollen gums, bruising, anemia, poor wound healing)

Front 9

Vitamin D def

Back 9

rickets in children, osteomalacia in adults (soft bones), hypocalcemic tetany

Front 10

Vitamin E def

Back 10

increased fragility of RBCs

Front 11

Vitamin K def

Back 11

neonatal hemorrhage, increase PT and aPP, normal BT

Front 12

biotin def

Back 12

dermatitis, enteritis, can be caused by ingestion of raw eggs or antibiotic use

Front 13

Folic acid def

Back 13

MOST COMMON VIT DEFICIENCY IN US; sprue, macrocytic, megaloblastic anemia without neuro signs

Front 14

Mg def

Back 14

weakness, muscle cramps, exacerbation of hypocalcemic tetany, CNS hyperirritability leading to tremors and choreoathetoid movement

Front 15

Selenium def

Back 15

Keshan disease (cardiomyopathy)

Front 16

unstable angina

Back 16

angina is new, worsening or occurs at rest

Front 17

Antihypertensive for a diabetic pt with proteinuria

Back 17

ACE I

Front 18

Beck's triad for cardiac tamponade

Back 18

hypotension, distant heart sounds and elevated JVD

Front 19

drugs that slow AV transmission

Back 19

beta blockers, digoxin, calcium channel blockers

Front 20

hypercholesterolemia tx that causes flushing and pruritis

Back 20

niacin

Front 21

tx for a-fib

Back 21

anticoagulation, rate control, cardioversion

Front 22

tx for v-fib

Back 22

immediate cardioversion

Front 23

autoimmune complication occurring 2-4 weeks post MI

Back 23

Dressler's syndrome: fever, pericarditis, increased ESR

Front 24

IV drug use with JVD and holosystolic murmur at left sternal border...tx?

Back 24

tx existing heart failure and replace tricuspid valve

Front 25

Diagnostic test for hypertrophic cardiomyopathy

Back 25

echocardiogram (showing thickened left ventricular wall and outflow obstruction)

Front 26

a fall in systolic BP of > 10mmHg with inspiration

Back 26

pulsus paradoxus (seen in cardiac tamponade)

Front 27

low-voltage, diffuse ST segment elevation

Back 27

classic ECG finding in pericarditis

Front 28

HTN =

Back 28

BP > 140/0 on three separate occasions two weeks apart

Front 29

8 surgically correctable causes of HTN

Back 29

renal artery stenosis, coarctation of the aorta, pheochromocytoma, Conn's syndrome, Cushings, unilateral renal parenchymal disease, hyperthyroidism and hyperparathyroidism

Front 30

indications for surgical repair of abd aortic aneurysm

Back 30

> 5.5 cm, rapidly enlarging, symptomatic, or ruptured

Front 31

Tx for acute coronary syndrome

Back 31

morphine, O2, sublingual nitroglycerin, AA, IV beta blockers, heparin

Front 32

metabolic syndrome

Back 32

abd obesity, high TGs, low HDL, HTN, insulin resistance, prothrombotic or pro-inflam states

Front 33

target LDL in pt with diabetes

Back 33

< 70

Front 34

signs of active ischemia during stress testing

Back 34

angina, ST-segment changes on EKG or decreased BP

Front 35

ECG findings suggesting MI

Back 35

ST elevation (depression means ischemia), flattened T waves and Q waves

Front 36

young pt has angina at rest with ST segment elevation, cardiac enzymes are nl

Back 36

prinzmetals angina

Front 37

common symptoms with silent MIs

Back 37

CHF, shock, and altered mental status

Front 38

diagnostic test for pulm embolus

Back 38

V/Q scan

Front 39

reverses effects of heparin

Back 39

protamine

Front 40

coagulation parameter affected by warfarin

Back 40

PT

Front 41

endocarditis prophylaxis regimens

Back 41

oral surgery - amoxicillin
GI/GU procedures: ampicillin and gentamicin before and amoxicillin after

Front 42

6 P's of ischemia due to peripheral vascular disease

Back 42

pain, pallor, pulselessness, paralysis, parethesia and poikilothermia (cold)

Front 43

Virchow's triad

Back 43

stasis, hypercoagulability and endothelial damage

Front 44

most common cause of HTN in young women

Back 44

OCPs

Front 45

most common cause of HTN in young men

Back 45

excessive EtOH

Front 46

"stuck on" appearance

Back 46

seborrheic keratosis

Front 47

red plaques with silvery-white scales and sharp margins

Back 47

psoriasis

Front 48

most common type of skin cancer; lesion is pearly colored papule with a translucent surface and telangiectasias

Back 48

basal cell carcinoma

Front 49

honey crusted lesions

Back 49

impetigo

Front 50

febrile patient with history of diabetes presents with a red, swollen, painful lower extremity

Back 50

cellulitis

Front 51

+ Nikolsky's sign

Back 51

pemphigus vulgaris

Front 52

- Nikolsky's sign

Back 52

bullous pemphigoid

Front 53

55 year old obese pt presents with dirty, velvety patches on back of neck

Back 53

acanthosis nigricans; check fasting blood sugar to r/o diabetes

Front 54

Dermatomal distribution

Back 54

varicella zoster

Front 55

flat-topped papules

Back 55

lichen planus

Front 56

iris-like target lesions

Back 56

erythema multiforme

Front 57

presents with a herald patch, Christmas-tree pattern

Back 57

pityriasis rosea

Front 58

16 yo presents with an annular patch of alopecia with broken-off, stubby hairs

Back 58

alopecia areata (autoimmune process)

Front 59

pinkish, scaling, flat lesions on the chest and back; KOH prep has a "spaghetti and meatballs" appearance

Back 59

pityriasis versicolor

Front 60

four characteristics of nevus suggestive of melanoma

Back 60

asymmetry, border irregularity, color variation, large diameter

Front 61

premalignant lesion from sun exposure that can lead to squamous cell carcinoma

Back 61

actinic keratosis

Front 62

"dewdrop on a rose petal"

Back 62

lesions of primary varicella

Front 63

"cradle cap"

Back 63

seborrheic dermatitis...treat with antifungals

Front 64

associated with Propionibacterium acnes and changes in androgen level

Back 64

acne vulgaris

Front 65

painful, recurrent vesicular eruption of mucocutaneous surfaces

Back 65

herpes simplex

Front 66

inflammation and epithelial thinning of anogenital area, predominantly in postmenopausal women

Back 66

lichen sclerosus

Front 67

exophytic nodules on skin with varying degrees of scaling or ulceration; second most common type of skin cancer

Back 67

squamous cell carcinoma

Front 68

induction of p450 enzymes

Back 68

barbiturates, phenytoin, carbamazepine, rifampin, quinidine, griseofulvin

Front 69

inhibition of p450 enzymes

Back 69

cimetidine, ketoconazole, INH, grapefruit, erythromycin, sulfonamides

Front 70

Metabolism by p450 enzymes

Back 70

benzos, amide anesthetics, metoprolol, propranolol, nifedipine, phenytoin, quinidine, theophylline, warfarin, barbiturates

Front 71

increase risk of digoxin toxicity

Back 71

quinidine, cimetidine, amiodarone, calcium channel blockers

Front 72

competition for albumin binding sites

Back 72

warfarin, asa, phenytoin

Front 73

blood dyscrasias

Back 73

ibuprofen, quinidine, methyldopa, chemo agents

Front 74

hemolysis in G6PD deficient patients

Back 74

sulfonamides, INH, ASA, ibuprofen, nitrofurantoin, primaquine, pyrimethamine, chloramphenicol

Front 75

Gynecomastia

Back 75

spironolactone, estrogens, digitalis, cimetidine, chronic alcohol use, ketoconazole

Front 76

stevens johnson syndrome

Back 76

ethosuximide, sulfonamide

Front 77

photosensitivity

Back 77

tetracycline, amiodarone, sulfonamides

Front 78

drug induced SLE

Back 78

procainamide, hydralazine, INH, penicillamine, chlorpromazine, methyldopa, quinidine

Front 79

three most common causes of fever of unknown origin

Back 79

infection, cancer, and autoimmune disease

Front 80

four signs and symptoms of streptococcal pharyngitis

Back 80

fever, pharyngeal erythema, tonsillar exudate, lack of cough

Front 81

a nonsuppurative complication of strep infection that is not altered by treatment of primary infection

Back 81

postinfectious glomerulonephritis

Front 82

asplenic pts are particularly susceptible to these organisms

Back 82

encapsulated organisms - pneumococcus, meningococcus, H. flu and Klebsiella

Front 83

number of bacteria on a clean-catch specimen to diagnose UTI

Back 83

10 x 5 bacteria/mL

Front 84

health population susceptible to UTI?

Back 84

pregnant women...treat aggressively because of potential complications

Front 85

pt from california or arizona presents with fever, malaise, cough and night sweats...

Back 85

coccidiodomycosis, Amphotericin B

Front 86

nonpainful chancre

Back 86

primary syphilis

Front 87

"blueberry muffin" rash

Back 87

rubella

Front 88

meningitis in neonates...causes? tx?

Back 88

group B strep, E. coli, Listeria...tx with gentamycin and ampicillin

Front 89

meningitis in infants...causes? tx?

Back 89

pneumococcus, meningococcus, H. flu...
tx with cefotaxime and vanco

Front 90

CSF - nl glucose and lymphocytic predominance

Back 90

aseptic (viral) meningitis

Front 91

numerous RBCs in serial CSF samples

Back 91

subarachnoid hemorrhage

Front 92

initially presents with pruritic papule with regional lymphadenopathy and evolves into black eschar after 7-10 days...

Back 92

cutaneous anthrax, tx with penicillin G or ciprofloxacin

Front 93

findings in tertiary syphilis

Back 93

tabes dorsalis, general paresis, gummas, argyll robertson pupils, aortitis, aortic root aneurysms

Front 94

cold agglutinins

Back 94

mycoplasma

Front 95

24 year old male with soft white plaques on tongue and back of throat

Back 95

candidal thrush...workup should include HIV...treat with nystatin oral suspension

Front 96

begin PCP proph in HIV + patient at what CD4 count?
MAC prophylaxis?

Back 96

PCP - < 200 (with TMP-SMX)
MAC - <50-100 (with clarithromycin/azithromycin)

Front 97

risk factors for pyelonephritis

Back 97

pregnancy, vesicoureteral reflux, anatomic anomalies, indwelling catheters, kidney stones

Front 98

neutropenic nadir postchemo

Back 98

7-10 days

Front 99

classic physical findings of endocarditis

Back 99

fever, heart murmur, Osler's nodes, splinter hemorrhages, Janeway lesions, Roth's spots

Front 100

aplastic crisis in sickle cell disease

Back 100

Parvovirus B19

Front 101

ring-enhancing brain lesions on CT with seizures

Back 101

taenia solium (cysticercosis)

Front 102

branching rods in oral infection

Back 102

actinomyces israelii

Front 103

painful chancroid

Back 103

haemophilus ducreyi

Front 104

dog or cat bite

Back 104

pasteurella multocida

Front 105

gardener

Back 105

sporothrix schenckii

Front 106

pregnant women with pets

Back 106

toxoplasma gondii

Front 107

meningitis in adults

Back 107

neisseria meningitidis

Front 108

meningitis in elderly

Back 108

strep pneumo

Front 109

alcoholic with pneumonia

Back 109

klebsiella

Front 110

'currant jelly' sputum

Back 110

klebsiella

Front 111

infection in burn victims

Back 111

pseudomonas

Front 112

osteomyelitis from foot wound puncture

Back 112

pseudomonas

Front 113

osteomyelitis in sickel cell patients

Back 113

salmonella

Front 114

55 year old man who is a smoker and a heavy drinker presents with new cough and flulike symptoms...gram stain shows no organisms; silver stain of sputum shows gram neg rods...dx?

Back 114

legionella pneumonia

Front 115

middle aged man presents with acute-onset monoarticular joint pain and bilateral Bell's palsy...dx, tx?

Back 115

Lyme disease, Ixodes tick, doxycycline

Front 116

pt develops endocarditis 3 weeks after receiving prosthetic heart valve...organism?

Back 116

staph aureus or staph epidermidis

Front 117

Xeroderma pigmentosum (a/cancer)

Back 117

squamous cell and basal cell carinoma of the skin

Front 118

Gastric adenocarcinoma is a/w

Back 118

chronic atrophic gastritis, pernicious anemia, postsurgical gastric remnants

Front 119

Astrocytoma and cardiac rhabdomyoma a/w

Back 119

tuberous sclerosis (facial angiofibroma, seizures, mental retardation)

Front 120

Actinic keratosis a/w

Back 120

squamous cell carcinoma of the skin

Front 121

Barret's esophagus (chronic GI reflux)

Back 121

a/w esophagel adenocarcinoma

Front 122

Plummer Vinson Syndrome a/w

Back 122

first: Plummer Vinson syndrome is atrophic glossitis, eophageal webs, anemia...all due to iron deficiency

a/w squamous cell carcinoma of the esophagus

Front 123

ulcerative colitis a/w

Back 123

colonic adenocarcinoma

Front 124

paget's disease of the bone a/w

Back 124

secondary osteosarcoma and fibrosarcoma

Front 125

immunodeficiency states a/w

Back 125

malignant lymphomas

Front 126

AIDS a/w (neoplasm)

Back 126

aggressive malignant NHLs and Kaposi's sarcoma

Front 127

autoimmune diseases (like myastenia) a/w

Back 127

benign and malignant thymomas

Front 128

acanthosis nigricans a/w

Back 128

visceral malignancy (stomach, lung, breast and uterus)

Front 129

dysplastic nevus a/w

Back 129

malignant melanoma

Front 130

four causes of microcytic anemia

Back 130

thalassemia, iron deficiency, anemia of chronic disease and sideroblastic anemia

Front 131

precipitants of hemolytic crisis in patients with G6PD deficiency

Back 131

sulfonamides, antimalarial drugs and fava beans

Front 132

most common inherited cause of hypercoagulability

Back 132

factor V Leiden mutation

Front 133

most common inherited hemolytic anemia

Back 133

hereditary spherocytosis

Front 134

diagnostic test for hereditary spherocytosis

Back 134

osmotic fragility test

Front 135

pure RBC aplasia

Back 135

diamond-blackfan anemia

Front 136

Fanconi's anemia

Back 136

anemia a/w absent radii and thumbs, diffuse hyperpigmentation, cafe-au-lait spots, microcephaly and pancytopenia

Front 137

meds and viruses that lead to aplastic anemia

Back 137

chloramphenicol, sulfonamides, radiation, HIV, chemotherpeutic drugs, hepatitis, parvo B19 and EBV

Front 138

how to distinguish polycythemia vera from secondary polycythemia

Back 138

both have increased hematocrit and RBC mass, but polycythemia vera has normal O2 sats and low EPO levels

Front 139

TTP pentad!!!

Back 139

fever, renal failure, anemia, thrombocytopenia and neurologic abnls

Front 140

HUS triad

Back 140

anemia, thrombocytopenia and acute renal failure

Front 141

treatment for TTP

Back 141

emergent large volume plasmapheresis, corticosteroids and antiplatelet drugs

Front 142

tx for ITP in kids

Back 142

usually resolves spontaneously, may require IVIG and/or corticosteroids

Front 143

changes in DIC

Back 143

elevated fibrin split products and D-dimer
decreased platelets, fibrinogen and hematocrit

Front 144

14 year old girl with prolonged bleeding after dental surgery and with menses...nl PT, nl or increased PTT, increased bleeding time...dx?

Back 144

von Willebrand's disease, treat with desmopressin, FFP or cryoprecipitate

Front 145

60 year old AA male with bone pain...w/u for MM may reveal?

Back 145

monoclonal gammopathy, bence jones proteinuria, "punched out" lesions on x-ray of skull and long bones

Front 146

reed sternberg cells

Back 146

hodgkins lymphoma

Front 147

microcytic anemia with decreased serum iron, decreased TIBC and normal or increased ferritin

Back 147

anemia of chronic disease

Front 148

microcytic anemia with decreased serum iron, decreased ferritin and increased TIBC

Back 148

iron deficiency anemia

Front 149

80 yo male with fatigue, lymphadenopathy, splenomegaly and isolated lymphocytosis...wtf?

Back 149

CLL

Front 150

late, life-threatening complication of CML

Back 150

blast crisis (fever, bone pain, splenomegaly, pancytopenia)

Front 151

auer rods on blood smear

Back 151

AML

Front 152

AML subtype associated with DIC

Back 152

M3

Front 153

elec changes in tumor lysis syndrome

Back 153

dec calcium, increased K, increased phosphate and increased uric acid

Front 154

treatment for AML M3

Back 154

retinoic acid

Front 155

heinz bodies?

Back 155

intracellular inclusions seen in thalassemia, G6PD def and post-splenectomy

Front 156

Glanzmann's thrombasthenia

Back 156

AR disorder with defect in GPIIb/IIIa platelet receptor and decreased platelet aggregation

Front 157

virus associated with aplastic anemia in pts with sickle cell

Back 157

parvovirus B19

Front 158

25 year old AA male with sickle cell anemia has sudden onset bone pain...management?

Back 158

O2, analgesia, hydration, and, if severe, transfusion

Front 159

significant cause of morbidity in thalassemia patients...tx?

Back 159

iron overload; use deferoxamine

Front 160

elevated alpha feto protein

Back 160

open neural tube defects (anencephaly, spina bifida), abdominal wall defects (gastroschisis, omphalocele), multiple gestation, incorrect gestational age, fetal death and placental abnormalities (placental abruption)

Front 161

abnormally low alpha fetoprotein

Back 161

should do amniocentesis and karyotyping to rule out chromosomal abnormalities

Front 162

quad screen

Back 162

alpha fetoprotein, inhibin A, estriol and beta-hCG

Front 163

decreased AFP, decreased estriol, decreased beta-hCG and decreased inhibin A

Back 163

trisomy 18

Front 164

decreased AFP, decreased estriol, increased beta-hCG and increased inhibin A

Back 164

trisomy 21

Front 165

reasons for amniocentesis

Back 165

>35 years old, conjuction with abnl quad screen, Rh-sensitized pregnancy to obtain fetal blood type or detect fetal hemolysis, to evaluate fetal lung maturity via a lecithin-sphingomyelin ratio >2.5 or to detect presence of phosphatidylglycerol (done during 3rd trimester)

Front 166

chorionic villous sampling

Back 166

can be done earlier - 10-12 weeks gestation...better diagnostic accuracy

dis: risk of fetal loss and inability to diagnose neural tube defects is 0.5% - 1% higher than with amnio

limb defects a/w CVS performed earlier than 9 weeks

Front 167

percutaneous umbilical blood sampling

Back 167

gett blood from umbilical vessels...used to diagnose fetal hemolytic disease and fetal infection

Front 168

category A drugs (preg)

Back 168

fine...no harm...ex: vit C

Front 169

cat B drugs (preg)

Back 169

no risk in animal studies...ampicillin

Front 170

cat C drugs (preg)

Back 170

drugs given only if potential benefit justifies potential risk to fetus...zidovudine

Front 171

Cat D drugs (preg)

Back 171

there are risks, but benefits from use in pregnant women may be acceptable despite the risk...PHENYTOIN

Front 172

cat X drugs (preg)

Back 172

just dont do it...no way.

isoretinoin

Front 173

fetal alcohol syndrome

Back 173

growth restriction before and after birth, MR, midfacial hypoplasia, renal and cardiac defects...6 drinks/day have 40% risk

Front 174

androgens/test der in pregnancy

Back 174

virilization of females, advanced genital dev in males

Front 175

ACE-I in preg

Back 175

can cause fetal renal tubular dysplasia and neonatal renal failure, oligohydramnios, IUGR, lack of cranial ossification

Front 176

coumadin in preg

Back 176

BAD

nasal hypoplasia and stippled bone epiphyses, develop delay, IUGR, opthalmologic abnl

Front 177

Carbamazepine in preg

Back 177

neural tube defects, fingernal hypoplasia, microcephaly, DD and IUGR

Front 178

folic acid antagonists in preg (methotrexate, aminopterin)

Back 178

increased spontaneous abortion

Front 179

cocaine in preg

Back 179

bowel atresias in fetus, congenital malfms of heart, limbs, face and GU tract; microcephaly; IUGR, cerebral infarction

Front 180

DES in preg

Back 180

clear cell adenocarcinoma of vagina or cervix, vaginal adenosis, abnl of cervix and uterus or testes, possible infertility

Front 181

Lead in preg

Back 181

increase spont abortion rates, stillbirths

Front 182

Lithium in preg

Back 182

congenital heart disease (Ebsteins anomaly)

Front 183

organic mercury in preg

Back 183

cerebral atrophy, microcephaly, MR, spasticity, seizures and blindness

Front 184

Phenytoin in preg

Back 184

IUGR, MR, microcephaly, dysmorphic craniofacial features, cardiac defects fingernail hypoplasia

Front 185

Radiation in preg

Back 185

microcephaly, MR, < 0.05 Gy to the fetus has no teratogenic risk

Front 186

Streptomycin and kanamycin in preg

Back 186

hearing loss, CN VIII damage

Front 187

tetracycline in preg

Back 187

permanent yellow-brown discoloration of deciduous teeth, hypoplasia of tooth enamel

Front 188

Thalidomide in preg

Back 188

bilateral limb deficiencies, anotio and microtia, cardiac and GI abnormalities

Front 189

Trimethadione and paramethadione in preg

Back 189

cleft lip and cleft palate, cardiac defects, microcephaly, MR

Front 190

Valproic acid in preg

Back 190

neural tube defects (spina bifida), minor craniofacial defects

Front 191

Vitamin A in preg

Back 191

increased SAB rate, microtia, thymic agenesis, CV defects, craniofacial dysmorphism, microphthalmia, cleft lip or cleft palate, MR

Front 192

CMV in preg

Back 192

can cause in fetus: microcephaly, hydrocephaly, chorioretinitis, cerebral calcifications, IUGR, microphthalmos, MR and hearing loss

THE MOST COMMON CONGENITAL INFECTION

Front 193

Rubella in preg

Back 193

to fetus: microcephaly, MR, cataracts, hearing loss, congenital heart disease

do NOT give immunization in pregnancy...live attenuated vaccine (no evidence of it doing sh*t, but dont give it still)

Front 194

Syphilis in preg

Back 194

to fetus: fetal hydrops (severe), abnormalities of skin, teeth and bones (mild)

Front 195

Toxo in preg

Back 195

to fetus: microcephaly, hydrocephaly, cerebral calcifications, chorioretinitis

transmitted via raw meat or through exposure to infected cat feces

Front 196

Varicella in preg

Back 196

to fetus: skin scarring, chorioretinitis, cataracts, microcephaly, hypoplasia of hands and feet, muscle atrophy

Front 197

Bishop score

Back 197

to see if cervix is favorable for both spontaneous and induced labor

dilation, effacement, station, cervical position and cervical consistency...> 8 is ready.

Front 198

early deceleration

Back 198

apparent, gradual (onset to nadir less than 30sec) decrease in FHR with return to baseline that mirrors uterine contraction

causes: head compression from uterine contraction

Front 199

late deceleration

Back 199

gradual onset decrease in FHR with return to baseline whose onset, nadir and recovery occur after the beg, peak and end of uterine ctx.

causes: uteroplacental insufficiency and fetal hypoxemia

Front 200

variable deceleration

Back 200

an abrupt decrease in FHR below baseline lasting more than 15 sec but less than 2 min

cause: umbilical cord compression (most often secondary to oligohydramnios)

Front 201

bradycardia baseline

Back 201

FHR below 110

causes: congenital heart malformations, severe hypoxia (2/2 uterine hyperstimulation, cord prolapse and rapid fetal descent)

Front 202

Tachycardia, FHR

Back 202

FHR > 160...

causes: hypoxia, maternal fever and anemia

Front 203

BPP (biophysical profile)

Back 203

5 parameters: breathing, fetal tone, movement, amniotic fluid volume and NST

8-10 is reassuring for fetal well being

6 is equivocal (most term preg)

0-4 is extremely worrisome for fetal asphyxia and strong consideration should be given for immediate delivery

Front 204

modified BPP

Back 204

combines NST with the amniotic fluid index...considered normal with reactive NST and an AFI > 5cm

Front 205

contraindications for regional anesthesia in preggers

Back 205

refractory mat hypotension, maternal coagulopathy, mat use of heparin within 12 hours, untreated maternal bacteremia, skin infection over needle site and increased ICP caused by a mass lesion

Front 206

maternal complications of pregestationl DM

Back 206

DKA (1) and HHNK (2), preeclampsia/eclampsia, cephalopelvic disproportion, preterm labor, infection, polyhydramnios, postpartum hemorrhage, maternal mortality

Front 207

fetal complications of maternal pregestational DM

Back 207

macrosomia, cardiac and renal defects, neural tube defects (sacral agenesis), hypocalcemia, polycythemia, hyperbilirubinemia, IUGR, hypoglycemia with hyperinsulinemia, RDS, birth injury (shoulder dystocia), perinatal mortality

Front 208

BP meds NOT to give in pregnancy

Back 208

ACE-I or diuretics...

ACE-I can lead to uterine ischemia and diuretics can aggravate low plasma volume to the point of uterine ischemia

Front 209

complications a/w preeclampsia

Back 209

prematurity, fetal distress, stillbirth, placental abruption, seizure, DIC, cerebral hemorrhage, serour retinal detachment, fetal/maternal death

Front 210

severe preeclampsia

Back 210

BP > 160/110
renal: proteinuria, >5gm/24hr
cerebral: HA, somnolence
Visual changes: blurred vision, scotomata
hyperactive reflexes/clonus
Hemolysis, elevated liver enzymes, thrombocytopenia (HELLP syndrome)

give mag sulfate for prevention of seizures...watch out for toxicity - loss of DTRs, resp paralysis, coma...tx toxicity with IV calcium gluconate

Front 211

risk factors for placenta previa

Back 211

prior C-sections, grand multiparous, advanced maternal age, multiple gestation, prior placenta previa

Front 212

complications of placenta previa

Back 212

increased risk of placenta accreta, vasa previa (fetal vessels crossing internal os)

preterm delivery, premature rupture of membranes, IUGR and congenital anomalies

recurrence risk 4-6%

Front 213

oligohydramnios

Back 213

AFI < 5cm

etiologies: fetal urinary tract abnl (renal agenesis, GU obstruction), chronic uteroplacental insufficiency and ROM

a/w 40-fold increase in perinatal mortality; other complications include musculoskeletal abnormalities (eg clubfoot, facial distortion), pulmonary hypoplasia, umbilical cord compression and IUGR

Front 214

polyhydramnios

Back 214

AFI >20

etiologies include: maternal DM, multiple gestation, isoimmunization, pulmonary abnormalities (eg cystic lung abnl), fetal anomalies (eg duodenal atresia, tracheoesophageal fistula, anencephaly) and twin-twin transfusion syndrome

complications: preterm labor, fetal malpresentation, cord prolapse

Front 215

gestational trophoblastic disease

COMPLETE MOLES

Back 215

usually result from sperm fertilization of an empty ovum

46XX - paternally derived

Front 216

Incomplete moles

Back 216

occur when normal ovum is fertilized by two sperm (or a haploid sperm that duplicates its chromosomes), contains fetal tissue

69XXY

Front 217

history of ladies with gestational troph. dz

Back 217

first trimester uterine bleeding, hyperemesis gravidum, preeclampsia/eclampsia at < 24 weeks, uterine size greater than dates

no fetal HB detected, pelvic exam with enlarged ovaries (bilateral theca-lutein cysts) or expulsion of grapelike molar clusters

risk factors: extremes of age, less than 20, more than 40, deficient in folate or beta-carotene and blood group

Front 218

diagnosis of GTD

Back 218

markedly increased b-hCG (greater than 100,000)..."snowstorm" on US...

CXR: may have lung mets; D&C reveals cluster of grapes tissue

Front 219

tx of GTD

Back 219

follow beta hCG, prevent pregnancy for one year

tx malignancy with chemo (methotrexate or dactinomycin) and residual uterine disease with hysterectomy; chemo and irradiation are cool/good

Front 220

complications of GTD

Back 220

molar pregnancy may progress to malignant GTD...including invasive moles (10-15%) and choriocarcinoma (2-5%) with pulm mets or CNS mets

may see trophoblastic pulm nodules

Front 221

to diagnose premature rupture of membranes

Back 221

sterile speculum exam shows pooling of amniotic fluid in vaginal vault, + Nitrazine paper test (paper turns blue in alkaline amniotic fluid)
+ fern test - ferning pattern is seen under a microscope after amniotic fluid dries on glass slide

U/S to assess AFI

do NOT perform digital vaginal exams in women who are not in labor or for whom labor in not immediately planned

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to tx PROM

Back 222

term: check GBS and fetal presentation, can induce or wait 24-72 hrs

>34-36 wks: labor induction

<32 wks: expectant management with bed rest and pelvic rest

antibxs to prevent infxt prolong latency period in absence of infection

antenatal corticosteroids: to promote fetal lung maturity in absence of intraamniotic infection prior to 32 weeks GA

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uterine atony

Back 223

risk factors: uterine overdistention, exhausted myometrium, uterine infection, conditions interfering with contractions

dx: soft, enlarged, BOGGY uterus (most common cause of PPH...90%)

tx: bimanual uterine massage, oxytocin, methergine (methylergonovine) if not hypertensive, Prostin (PGF2alpha) if not asthmatic

Front 224

retained placental tissue

Back 224

another cause of PPH

risk factors: placenta accreta/increta/percreta, placenta previa, uterine leiomyomas, preterm delivery, previous c-section/curettage

Front 225

primary syphilis

Back 225

10-60 days post exposure

chancre

can tx primary or secondary: best is penicillin G, if allergic, can use tetracycline and doxycycline

Front 226

secondary syphilis

Back 226

4-8wks after appearance of chancre, maculopapular rash (palms and soles); condylomata lata

Front 227

tertiary syphilis

Back 227

1-10 years after infection

granulomas (gummas) of the skin and bones, aortitis, neurosyphilis with meningovascular disease, paresis and tabes dorsalis

must tx with penicillin...if allergice, desensitize pt.

Front 228

herpes genitalis

Back 228

primary: malaise, myalgias and fever with vulvar burning/pruritis (2-5 days post exposure) followed by vesicular genital lesions (3-7 days post exposure)...shallow, painful ulcers with a red border

HSV 2 (85% genital lesions)

Tzanck smear...presence of multinucleated giant cells with eosinophilic inclusion...viral culture is most sensitive

tx: sitz baths and dryer...acyclovir, famciclovir or valacyclovir for primary or for suppressive tx for frequent recurrences

Front 229

chancroid

Back 229

painful, nonindurated, purulent, hemorrhagic ulcers with painful inguinal lymphadenopathy

h. ducreyi

tx: ceftriaxone, azithromycin, erythromycin or cipro

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lymphogranuloma venereum

Back 230

primary: presents with painless, transient papule or shallow ulcer that can go unnoticed

secondary: inguinal syndrome - painful enlargement and inflammation of inguinal nodes with fever, malaise, HA and loss of appetite

tertiary: anogenital syndrome, anal pruritis with discharge, proctocolitis, rectal stricture, rectovaginal fistula and elephantiasis

L-serotype Chlamydia trachomatis

tx: doxycycline 100mg BID x 21 days

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granuloma inguinale

Back 231

raised, firm lesions

Calymmato-bacterium granulomatis

tx: doxy, bactrim or cipro

Front 232

condylomata acuminata (genital warts)

Back 232

raised cauliflower like lesions...in immunocompromised pts

HPV, HPV 6 and HPV 11

tx: surgical, chemical (TCA, podophyllin, 5-FU, podofilox), immunologic imiquimod)

Front 233

molluscum

Back 233

poxviridae

tx with desiccation, cryotherapy, curettage or imiquimod

Front 234

inpt antibiotics for PID

Back 234

1. cefoxitin or cefotetan and doxycycline x 14 days
2. clinda and gent x 14 days

Front 235

outpt tx for PID

Back 235

1. cefoxitin with probenecid x 1 dose
2. ceftriaxone IM and doxycycline
3. ofloxacin and metronidazole

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trichomonas

Back 236

protozoal flagellates affect the vagina, skene's duct and lower urinary tract...

STRAWBERRY PETECHIAE in upper vagina/cervix

d/c: profuse, malodorous, yellow-green, frothy

wet mount: motile trichomonads (slightly larger than WBCs)

tx: single dose PO metronidazole or tinidazole

complications: chorioamnionitis/endometritis, infection, preterm delivery, miscarriage, PID, cellulitis when invasive procedures done

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risk factors for yeast infections

Back 237

diabetes, broad-spectrum antibiotic use, pregnancy steroids, HIV, OCP use, IUD use, young age at first intercourse, increased freq of intercourse

(avoid oral azoles in pregnancy)

Front 238

vulvar cancer

Back 238

a/w HPV types 16, 18 and 31, diabetes, obesity, HTN, CV dz and immunosuppression

VIN (vulvar intraepithelial neoplasia)...dx with punch biopsy

VIN III: carcinoma in situ

about 87% are squamous cell carcinomas and 6% malignant melanomas...remainder are basal cell carcinoma and Paget's disease

safe sex can help prevent this

Front 239

ovarian cancer

Back 239

nulliparity, breast cancer, family history...

OCP use is protective.

CA-125 for epithelial cancers
AFP and b-hCG for germ cell cancers

tx: TAH/BSO and peritoneal washing for cytology w or w/o pelvic and aortic node sampling, tumor debulking, chemo

prevention: OCPs, prophylactic BSO with fm history

most common cause of death is bowel obstruction

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more on ovarian tumors

Back 240

pats with first-deg relative have 5% lifetime risk...with >2 relatives, risk is 7%

BRCA1 has 45% lifetime risk
BRCA2 has 25% lifetime risk

OCPs decrease risk!!!

tumor marker CA-125...used only for progression and recurrence

Front 241

Lynch II syndrome

Back 241

hereditary nonpolyposis colorectal cancer (HNPCC) is associated with increased risk of colon, ovarian, endometrial and breast cancer

Front 242

CA-125 in ovarian tumors

Back 242

premenopausal women: increased CA-125 may point to benign such as endometriosis

postmenopausal women: increased indicates an increased likelihood that the ovarian tumor is malignant

any palpable ovarian or adnexal mass in a premenarchal or postmenopausal patient is suggestive of ovarian neoplasm

Front 243

marker for ovarian epithelial tumor

Back 243

CA-125

Front 244

marker for endodermal sinue ovarian tumor

Back 244

AFP

Front 245

marker for ovarian tumor embryonal carcinoma

Back 245

AFP, hCG

Front 246

marker for ovarian tumor choriocarcinoma

Back 246

hCG

Front 247

marker for ovarian tumor dysgerminoma

Back 247

LDH

Front 248

marker for ovarian tumor granulosa cell

Back 248

inhibin!

Front 249

stress incontinence

Back 249

activities that increase intra-abd pressure

etiology: urethral sphincteric insufficiency due to laxity of pelvic floor musculature; common in multiparous women or after pelvic surgery

tx: surgery places bladder neck into app anatomical location;

swab test: greater than 30 degrees with increased intra-abd pressure

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urge incontinence

Back 250

unexpected urge to void, unrelated to position or activity

etiology: detrussor hyperreflexia or sphincter dysfunction 2/2 inflammatory conditions or neurogenic d/o of bladder...

tx: anticholinergics or TCAs

oxybutynin

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overflow incontinence

Back 251

chronic urinary retention

etiology: chronically distended bladder; increased intravesical pressure that just exceeds outlet resistance, allowing small amt of urine to dribble out

tx: place urethral catheter in acute settings

bethanecol and alpha blockers

Front 252

primary causes of third trimester bleeding

Back 252

placental abruption and placenta previa

Front 253

classic U/S and gross appearance of complete hydatidiform mole

Back 253

snowstorm on U/S, "cluster of grapes" on gross exam

Front 254

molar pregnancy containing fetal tissue

Back 254

partial mole

Front 255

antibiotics with teratogenic effects

Back 255

tetracycline, fluoroquinolones, aminoglycosides and sulfonamide

Front 256

shortest AP diameter in pelvis

Back 256

obstetric conjugate: between sacral promontory and midpoint of symphysis pubis

Front 257

tx for postpartum hem

Back 257

uterine massage, if fails, oxytocin

Front 258

typical antibiotics for group B strep prophylaxis

Back 258

IV penicillin or ampicillin

Front 259

term for heaving bleeding during and between menstrual periods

Back 259

menometrorrhagia

Front 260

cause of amenorrhea with normal prolactin, no response to estrogen-progesterone challenge, history D&C

Back 260

Asherman's syndrome

Front 261

indications for med tx of ectopic preg

Back 261

stable, unruptured ectopic of <3.5cm at <6wks gestation

Front 262

med options for endometriosis

Back 262

OCPs, danazol, GnRH agonists

Front 263

lap findings in endometriosis

Back 263

chocolate cysts, powder burns

Front 264

most common location of ectopic preg

Back 264

ampulla of oviduct

Front 265

patient has increased vaginal discharge and petechial patches in upper vagina and cervix

Back 265

trichomonas vaginitis

Front 266

most common cause of bloody nipple discharge

Back 266

intraductal papilloma

Front 267

breast malignancy presenting as itching, burning and erosion of nipple

Back 267

Paget's

Front 268

annual screening for women with strong fm history of ovarian cancer

Back 268

CA-125 and transvaginal US

Front 269

30 year old has unpredictable urine loss...med options?

Back 269

anticholinergics (oxybutynin) or beta-adrenergics (metaproterenol) for urge incontinence

Front 270

most common cause of female infertility

Back 270

endometriosis

Front 271

two consecutive findings of atypical squamous cells of undet significance on pap...f/u?

Back 271

colposcopy and endocervical curettage

Front 272

breast cancer type that increases future risk of invasive carcinoma in both breasts

Back 272

lobular carcinoma in situ

Front 273

five thoracic causes of immediate death

Back 273

tension pneumo, cardiac tamponade, open pneumo, massive hemothorax and airway obstruction

Front 274

always suspect aortic disruption with...

Back 274

scapular, sternal or first and second rib fractures

CXR: widened mediastinum (>8cm), loss of aortic knob, pleural cap, deviation of trachia and esophagus to the right, depression of left main stem bronchus

get CT or TEE before surgery

aortography is gold standard

Front 275

asystole

Back 275

give epinephrine and atropine

Front 276

v-fib or v-tach

Back 276

desyn shock then epi then shock then amio or lidocaine then shock then epi

if stable, amiodarone

vasopressin can be given in place of 1st or 2nd dose of epi

Front 277

pulseless electrical activity

Back 277

give epi and atropine

causes: hypovolemia, hypoxia, acidosis, hyper/hypokalemia, hypothermia, tablets, tamponade, thromobosis

Front 278

emergent SVT

Back 278

unstable: electrical cardioversion

stable: control rate with maneuvers (valsalva, carotid sinus massage or cold stimulus)

if resistant to maneuvers: adenosine

Front 279

a-fib/flutter tx (ER)

Back 279

unstable: shock at 100J
stable: rate control with diltiazem or beta blockers, convert rhythm (<48 elect or chemical, >48 need to anticoagulate or do TEE)

dont give nodal blockers if pt has WPW

Front 280

bradycardia (ER)

Back 280

symptomatic: atropine and consider dopamine, epi or glucagon

if mobitz II or 3rd degree block present, place transvenous pacemaker

Front 281

suspect smoke inhalation in...

Back 281

singed nose hairs, facial burns, hoarseness, wheezing or carbonaceous sputum

Front 282

fevers before POD 3 are unlikely to be infectious unless...

Back 282

clostridium or beta-hemolytic streptococci are involved

Front 283

CATCH 22

Back 283

cardiac abnormalities
abnormal facies
thymic aplasia
cleft palate
hypocalcemia
22q11 deletion

Front 284

tetralogy of fallot

Back 284

pulmonary stenosis, RVH, overriding aorta and VSD

most common cyanotic congenital heart disease in children

risk factors: maternal PKU and CATCH 22 syndromes

"tet spells" - hypoxemic episodes...children often squat for relief (increases systemic vascular resistance)

CXR: "boot shaped" heart with decreased pulmonary vascular markings...EKG with right-axis deviation

Front 285

breast bud dev age

testicular enlargment age

Back 285

breast bud dev: btw 8 and 13 years

testicular enlargement btw 9 and 11 years

Front 286

Trisomy 21

Back 286

Downs

a/w duodenal atresia, Hirschsprung's and congenital heart disease (most common malformation is AV canal, which includes an ASD and VSD with mitral and tricuspid valve abnormalities 2/2 endocardial cushion defects)

increased risk of ALL and early onset Alzheimer's, increased risk for atlantoaxial (C1-C2) instability

Front 287

Edward's Syndrome

Back 287

Trisomy 18

severe MR, rocker-bottom feet, low-set ears, micrognathia, clenched hands and prominent occiput

a/w congenital heart disease, may have horseshoe kidneys

death usually occurs within one year of birth

Front 288

Patau's syndrome

Back 288

Trisomy 13

severe MR, microphthalmia, microcephaly, cleft lip/palate, abnormal forebrain structures (holoprosencephaly), "punched out" scalp lesions and polydacyly

a/w congenital heart disease

death usually occurs within one year of birth

Front 289

Klinefelter's

Back 289

45, XXY

inactivated X chromosome (Barr body)

one of most common causes of hypogonadism in males

presents with testicular atrophy; eunuchoid body shape; tall, long extremities; gynecomastia and female hair distributions

Front 290

Turner's

Back 290

45, XO

most common cause of primary amenorrhea

no barr body

short stature, webbed neck, ovarian dysgenesis and coarctation of aorta...lymphedema of hands and feet in neonatal period

may have horseshoe kidney

buccal smear helpful

normally Turners is 45 XO, but if 45 XY with turners, increased risk of gonadoblastoma - needs prophylactic bilateral gonadectomy

Front 291

Phenylketonuria

Back 291

decreased phenylalanine hydroxylase or decreased tetrahydrobiopterin cofactor

screened for at birth - valid only after baby has had protein meal

tyrosine becomes essential and phenylalanine builds up excess phenyl ketones

MR, fair skin, eczema and a musty or mousy urine odor

blonde-haired, blue-eyed infants

a/w increased heart disease

tx: decreased phenylalanine and increased tyrosine in diet, if mom with PKU wants to become pregnant, must restrict diet before conception

Front 292

Fragile X syndrome

Back 292

an x-linked defect affecting the methylation and expression of FMR1 gene

second most common cause of genetic mental retardation

presents with macro-orchidism; long face with large jaw; large everted ears and autism

triplet repeat disorder that may show genetic anticipation

Front 293

Fabry's

Back 293

x-linked recessive

deficiency of alpha-galactosidase A leads to accumulation of ceramide trihexoside in heart, brain and kidneys...renal failure and increased risk of stroke and MI

Front 294

Krabbe's dz

Back 294

autosomal recessive

NO galactosylceramide and galactoside (due to galactosylceramidase deficiency) leads to accumulation of galactocerebroside in brain

optic atrophy, spasticity and early death

Front 295

Gaucher's dz

Back 295

AR

deficiency of glucocerebrosidase leads to glucocerebroside accumulation in the brain, liver, spleen and bone marrow (Gaucher's cells have characteristic "crinkled paper" enlarged cytoplasm)

may have hepatosplenomegaly, anemia and thrombocytopenia

type I more compatible with life...does not affect brain

Front 296

Niemann-Pick dz

Back 296

AR

deficiency of sphingomyelinase which leads to buildup of sphingomyelin cholesterol in reticuloendothelial and parenchymal cells and tissues

patients with type A die by age of 3

Front 297

Tay Sachs dz

Back 297

TAY SAX LACKS HEXOSAMINIDASE

no hexosaminidase leads to GM2 ganglioside accumulation, may appear nl until 3-6 months of age, weakness begins and development slows

exaggerated startle response, death by age 3

cherry red spot on macula

carrier rate is 1/30 Jews of European descent

Front 298

Metachromatic leukodystrophy

Back 298

AR

deficiency of arylsulfatase A, accumulation of sulfatide in the brain, kidney, liver and peripheral nerves

Front 299

Hurler's syndrome

Back 299

AR

def of alpha-L-iduronidase leads to corneal clouding and MR

Front 300

Hunter's syndrome

Back 300

X-linked recessive (hunters need to see...no corneal clouding...to aim at the X.

def of iduronate sulfatase, milder form of Hurler's with no corneal clouding and mild MR

Front 301

cystic fibrosis

Back 301

autosomal recessive

mutation in CFTR gene (chloride channel) on chromosome 7 with widespread exocrine gland dysfunction

15% infants have meconium ileus, other GI symptoms include greasy stools and flatulence, pancreatitis, rectal prolapse, esophageal varices and biliary cirrhosis

other sym: type 2 DM, "salty taste", male infertility and unexplained hyponatremia

at risk for fat-soluble vitamin def (vit A, D, E and K) 2/2 malabsorption...may have bleeding symptoms with vit K def

Front 302

B cell deficiencies (peds)

Back 302

most common 50%

typicall present AFTER 6 months of age with recurrent sinopulmonary, GI and UTIs with encapsulated organisms (H flu, Strep pneumo, N. meningitidis); treat with IVIG

X-linked agammaglobulinemia (Brutons), common variable immunodeficiency and IgA def

Front 303

T cell def (peds)

Back 303

tends to present earlier (1-3 months) with opportunistic and low-grade fungal, viral and intracellular bacterial infections

Front 304

phagocytic def (peds)

Back 304

mucous mem infections, abscesses and poor wound healing

infections with catalase + organisms (staph aureus), fungi and gram - enteric org

Front 305

X-linked agamma-globulinemia (Brutons)

Back 305

b cell deficiency only in boys

infections with encapsulated pseudomonas, strep pneumo and h. flu

dx/tx: quantitative immunoglobulin levels; if low confirm with B and T cell subsets (no b cells, t cells often high)

absent tonsils and other lymphoid tissues may be a clue

tx with prophylactic antibodies and IVIG

Front 306

common variable immunodeficiency

Back 306

immunoglobulin levels drop in 20s and 30s, usually combined B and T cell defect

increase pyogenic upper and lower respiratory infections; increased risk of lymphoma and autoimmune disease

dx/tx: quantitative Ig levels; confirm with B and T cell subsets; treat with IVIG

Front 307

IgA deficiency

Back 307

mild, the most common immunodeficiency

usually asymptomatic, recurrent infections

anaphylactic transfusion rxt due to anti-IgA antibodies is a common presentation

sinopulmonary and GI (giardia) - consequence of IgA's role in mucosal barrier protection

dx: quantitative IgA levels; tx infections

Front 308

Thymic aplasia (DiGeorge)

Back 308

cardiac, abnl facies, thymic aplasia, cleft palate, hypocalcemia and 22q11 del
defect in dev of 3rd/4th pharyngeal pouch, low set ears, anomolies of great vessels
can present with tetany 2/2 hypocalcemia in first days of life

way increased risk of infections with fungi and PCP

dx: abs lymphocyte count, mitogen stim response, delayed hypersensitivity skin testing

tx: bone marrow transplant and IVIG, PCP prophylaxis, thymus transplantation

Front 309

Ataxia telangiectasia

Back 309

combined B and T cell messed up

oculocutaneous telangiectasias and progressive cerebellar ataxia - caused by DNA repair defect

increased incidence of non-Hodgkin's lymphoma, leukemia and gastric carcinoma

no spec tx; may require IVIG, depending on severity of Ig deficiency

Front 310

Severe combined immunodeficiency (SCID)

Back 310

severe lack of B and T cells - adenosine deaminase deficiency

severe, frequent bacterial infections, chronic candidiasis and opportunistic infections

tx with bone marrow transplant or stem cell transplant, IVIG...NEEDS PCP PROPHYLAXIS

Front 311

Wiskott-Aldrich syndrome

Back 311

x-linked

(think twins at CHOC)

less severe T and B cell dysfunction

ECZEMA, increased IgE/IgA, decreased IgM and THROMBOCYTOPENIA

classic presentation: bleeding, eczema and recurrent otitis media

very increased risk of atopic disorders, lymphoma/leukemia and infection from strep pneu, staph aureus and H flu type b

supportive tx, if severe, bone marrow transplant

Front 312

Chronic Granulomatous Disease

Back 312

phagocytic defect

x-linked (2/3) or AR (1/3) with deficient superoxide production by PMNs and macrophages (mutation which causes loss or inactivation of NADPH oxidase)

anemia, lymphadenopathy and hypergammaglobulinemia

intracellular killing is deficient

chronic skin, pulmonary, GI and UTIs; osteomyelitis and hepatitis

infecting organisms are catalase +, increased risk of infection with aspergillus; may have granulomas of the skin and GI/GU tracts

gm stain neutrophils filled with bacteria

dx: abs neutrophil count with neutrophil assays

NITROBLUE TETRAZOLIUM TEST

treat with DAILY TMP-SMX

IFN-gamma can decrease incidence of serious infection; poss bone marrow transplant and gene therapy

Front 313

newborm with omphalitis with delayed separation of umbilical cord

Back 313

leukocyte adhesion deficiency

defect in chemotaxis of leukocytes

recurrent skin, mucosal and pulmonary infections

no pus with minimal inflammation in wounds (due to chemotaxis defect); high WBCs in blood; bone marrow transplant is curative

Front 314

Chediak-Higashi syndrome

Back 314

phagocytic defect

AR d/o...defect in neutrophil chemotaxis

THIS INCLUDES OCULOCUTANEOUS ALBINISM, NEUROPATHY AND NEUTROPENIA

waaaay increased incidence of overwhelming infections with strep pyogenes, staph aureus and pseudomonas

bone marrow is tx of choice

Front 315

complement deficiencies

Back 315

present in children with congenital asplenia or splenic dysfunction (sickle cell disease)...recurrent bacterial infections with encapsulated organisms

Front 316

C1 esterase deficiency

Back 316

hereditary angioedema

AD d/o with recurrent episodes of angioedema lasting 2-72 hrs and provoked by stress or trauma

can be life threatening if have airway edema

dx/tx: total hemolytic complement to assess quantity and function of complement...purified C1 esterase and FFP can be used prior to surgery

Front 317

Terminal complement def (C5-C9)

Back 317

inability to form membrane attack complex

recurrent meningococcal or gonococcal infections; rarely lupus or glomerulonephritis

give men vaccine and app antibxs

Front 318

conjunctivitis, rash, adenopathy, strawberry tongue, hands and feet (red, swollen, flaky skin) and fever > 40 for > 5 days

Back 318

KAWASAKI.

tx with high dose aspirin and IVIG (to prevent aneurysms)

low dose aspirin is then continued, usually for 6 weeks (may use corticosteroids in IVIG refractory cases, not routinely used)

Front 319

avoid live vaccines in immunocompromised and pregnant pts...

Back 319

live vaccine: oral polio vaccine, varicella, MMR

(exception: may give MMR and varicella in HIV peeps)

Front 320

Croup

Back 320

3 months to 3 years
acute viral inflammatory disease, primarily subglottic space

parainfluenza 1 (most common), 2 and 3, RSV; influenza and adenovirus

bacterial superinfection may progress to tracheitis

hx: prodromal URI symptoms, low-grade fever, mild dyspnea, inspiratory stridor that worsens with agitation, hoarse voice and characteristic barking cough (usually at night)

dx: CLASSIC STEEPLE SIGN FROM SUBGLOTTIC NARROWING - not sens or spec

may need nebulized RACEMIC EPINEPHRINE!

Front 321

Epiglottitis

Back 321

supraglottic infection

used to be H. flu, now strep pneumo, nontypable H flu and viral agents

CAN BE LIFE THREATENING

hx: acute-onset high fever, dysphagia, drooling, muffled voice, insp retractions, cyanosis and soft stridor

pts sit with neck hyperextended and chin protruding, leaning forward

must secure airway before looking in!! will see cherry red swollen epiglottis and arytenoids

thumbprint sign

TRUE EMERGENCY - endotracheal intubation or tracheostomy and IV antibiotics (ceftriaxone or cefuroxime)

Front 322

most common organisms in childhood bact meningitis

Back 322

Strep pneumo, N. meningitidis (will give petechial rash) and E. coli

(enteroviruses are most common agents in viral meningitis - all ages, risk factors are sinofacial infections, trauma and sepsis)

can give empiric tx: ceftriaxone, vancomycin and ampicillin

neonates should get ampicillin and cefotaxime or gentamycin

older: ceftriaxone and vanco

Front 323

erythema infectiosum (5th disease)

Back 323

parvovirus B19

fever absent or low grade

slapped cheek, erythematous, pruritic, maculopapular rash starts on arms and spreads to trunk and legs, WORSENS WITH FEVER AND SUN EXPOSURE

complications: arthritis, hemolytic anemia, encephalopathy, congenital infection a/w fetal hydrops and death

aplastic crisis may be precipitated in children with increased RBC turnover (sickle cell anemia, hereditary spherocytosis) or in those with decreased RBC production (severe iron def)

Front 324

measles

Back 324

paramyxovirus

prodrome: low grade fever with cough, coryza and conjunctivitis...koplik's spots on buccal mucosa

rash: head towards feet

complications: otitis media, pneumonia, laryngotracheitis, subacute sclerosing panencephalitis

Front 325

Rubella

Back 325

prodrome: asymptomatic...
rash: also starts on face and goes downwards; in contrast with pts with measles, rubella often have low grade fever and do not seem ill

Front 326

Roseola

Back 326

HHV 6 (herpes)!

prodrome: acute onset of high fever, no other symptoms for 3-4 days

rash: MACULOPAPULAR RASH APPEARS AS FEVER BREAKS, begins on trunk and spreads to face and extremities

comp: FEBRILE SEIZURES

Front 327

Hand-foot-and-mouth disease

Back 327

Coxsackie A

oral ulcers, maculopapular vesicular rash on hands and feet, sometimes on buttocks

Front 328

duodenal atresia

Back 328

completel or partial failure of the duodenal lumen to recanalize during gestational weeks 8-10

polyhydramnios in utero; bilious emesis within hours after first feeding; a/w Down syndrome and other cardiac/GI abnormalities (like annular pancreas, malrotation and imperforate anus)

double bubble sign

surgery to repair

Front 329

AML can present with a chloroma

Back 329

-- greenish soft-tissue tumor of the skin or spinal cord

Front 330

neuroblastoma

Back 330

embryonal tumor of neural crest origin

<1year old...70% have distant mets at presentation

a/w neurofibromatosis, Hirschsprung's and N-myc oncogene

NONTENDER abd mass (may cross midline), horners syndrome, HTN or cord compression (from paraspinal tumor)

elevated 24 hr urinary catecholamines (VMA and HVA)

Front 331

Wilms tumor

Back 331

renal tumor of embryonal origin, 2-5 years old

a/w Beckwith Wiedemann syndrome (hemihypertrophy, macroglossia, visceromegaly), neurofibromatosis and WAGR (wilms, aniridia, GU and MR)

ASYMPTOMATIC, NONTENDER, smooth abd mass

abd pain, fever, HTN and microscopic/gross hematuria are seen

Front 332

Ewing's sarcoma

Back 332

neuroectodermal origin...from bone

mostly in Caucasian male adolescents

a/w chrom 11:22 translocation

local pain and swelling

commonly target midshaft of long bones - femur, pelvis, fibula and humerus (descen order)

systemic stuff: fever, anorexia, fatigue

LYTIC BONE LESION (ONION SKIN IF TUMOR PENETRATES THROUGH CORTEX)

Front 333

"sunburst" lytic bone lesions

Back 333

osteosarcoma - from osteoblasts of mesenchymal origin

male adolescents

systemic symptoms are RARE (as compared with Ewings)

METAPHYSES OF LONG BONES (ewings is midshaft)...distal femur, proximal tibia and proximal humerus...mets to lungs in 20% pts

increased LDH is worse prognosis

increaed alk phosp

Front 334

most common type of tracheoesophageal fistula

Back 334

esophageal atresia with distal TEF (85%)...cannot pass NG tube

Front 335

not contraindications to vaccines

Back 335

mild illness and/or low grade fever, current antibiotic therapy and prematurity

Front 336

neonate has meconium ileus

Back 336

CF or Hirschsprung's

Front 337

bilious emesis within hours after first feeding

Back 337

duodenal atresia

Front 338

infant has high fever and onset of rash as fever breaks...babys at risk for what?

Back 338

febrile seizures (roseola infantum)

Front 339

chronic resp infections, nitroblue tetrazolium test is positive

Back 339

chronic granulomatous disease

Front 340

child has eczema, thrombocytopenia and high levels of IgA

Back 340

Wiskott-Aldrich syndrome

Front 341

4 month old infant has life-threatening Pseudomonas infection

Back 341

bruton's x-linked agammaglobulinemia

Front 342

sudden onsent of mental status changes, emesis and liver dysfunction after taking aspirin

Back 342

Reye's syndrome

Front 343

child has loss of red light reflex...

Back 343

suspect retinoblastoma

Front 344

vaccines at 6 month visit

Back 344

HBV, DTaP, IPV, PCV

Front 345

cause of neonatal RDS

Back 345

surfactant deficiency

Front 346

red "currant jelly" stools

Back 346

intussusception

Front 347

congenital heart disease that causes secondary HTN

Back 347

coarctation of the aorta

Front 348

first line tx for otitis media

Back 348

amoxicillin x 10 days

Front 349

most common pathogen causing croup

Back 349

parainfluenza virus 1

Front 350

homeless child small for his age, peeling skin and swollen belly

Back 350

Kwashiorkor

Front 351

defect in x-linked syndrome with MR, gout, self mutilation and choreoathetosis

Back 351

Lesch-Nyhan syndrome (purine salvage problem with HGPRTase deficiency)

Front 352

machinery murmur in newbord

Back 352

PDA

Front 353

farmer's lung

Back 353

spores of actinomycetes from moldy hay

Front 354

bird fancier's lung

Back 354

antigens from feathers, excreta, serum

Front 355

mushroom worker's lung

Back 355

spores of actinomycetes from compost

Front 356

malt worker's lung

Back 356

spores of Aspergillus clavatus in grain

Front 357

Grain handler's lung

Back 357

grain weevil dust

Front 358

Bagassosis

Back 358

spores of actinomycetes from sugarcane

Front 359

Air condition lung

Back 359

spores of actinomycetes from air conditioners

Front 360

Asbestosis

Back 360

work involving SHIPBUILDING, tile or brake linings, insulation, construction...presents 15-20yrs after initial exposure

CXR: linear opacities of lung bases and interstitial fibrosis, CALCIFIED PLEURAL PLAQUES indicative of benign pleural disease

comp: increased risk of mesothelioma (rare) and lung cancer; risk of lung cancer is higher in smokers

Front 361

Coal mine disease

Back 361

CXR: small nodular opacities (<1cm) in upper lung zones; restrictive lung disease

progressive massive fibrosis

Front 362

Silicosis

Back 362

works in mines or quarries with glass, pottery or silica

CXR: small (<1cm) nodular opacities in upper lung zones; EGGSHELL CALCIFICATIONS

restrictive lung disease

increased risk of TB, annual skin test

progressive massive fibrosis

Front 363

Berylliosis

Back 363

work in high-tech fields such as aerospace, nuclear and electronic plants; ceramic industries; foundries; plating facilities; dental material sites, dye manufacturing

CXR: diffuse infiltrates, hilar adenopathy

requires chronic steroid treatments

Front 364

usual interstitial pneumonia

Back 364

most common form of interstital pneumonia

Front 365

causes of obstructive pulmonary disease

Back 365

asthma, bronchiectasis, cystic fibrosis and tracheal or bronchial obstruction

Front 366

asthma

Back 366

REVERSIBLE airway obstruction 2/2 bronchial hyperreactivity, airway inflammation, mucous plugging and SM hypertrophy

peak flow is diminished; FEV/FVC is decreased, residual volume and TLC increased

CXR: hyperinflation

methacholine challenge: test for bronchial hyperresponsiveness; useful when PFTs are normal

Front 367

Isoproterenol

Back 367

nonspecific beta agonist

relaxes bronchial SM (beta 2); tachycardia (beta 1) is an adverse effect

Front 368

beta 2 agonists

Back 368

albuterol: relaxes bronchial SM, used in acute attacks

Salmeterol: long acting agent for prophylaxis

Front 369

methylxanthines

Back 369

Theophylline

likely causes bronchodilation by inhibiting phosphodiesterase, thereby decreasing cAMP hydrolysis

usage is limited due to narrow therapeutic index (cardiotoxicity and neurotoxicity)

Front 370

Ipratropium

Back 370

muscarinic antagonists

competitive block of muscarinic receptors, prevents bronchoconstriction

Front 371

Cromolyn

Back 371

prevents release of mediators from mast cells; useful for exercise-induced bronchospasm, effective only in prophylaxis of asthma; not effective during an acute asthmatic attach...toxicity is rare

Front 372

Beclomethasone

Back 372

corticosteroid used in asthma

inhibits synthesis of virtually all cytokines; inactivate NF-kB, transcription factor that induces production of TNF-alpha, among other inflammatory agents

inhaled corticosteroids are first line tx for long term control of asthma

Front 373

Zileuton

Zafirlukast

Back 373

antileukotrienes

zileuton: 5-lipoxygenase pathway inhibitor; blocks conversion of arachidonic acid to leukotrienes

zafirlukast: blocks leukotriene receptors

Front 374

Bronchiectasis

Back 374

DILATION OF BRONCHI, permanent fibrosis, remodeling...caused by cycles of infection and inflammation of bronchi/bronchioles...

hx: cough with frequent bouts of yellow or green sputum production...a/w hx of pulm infections (pseudo, h flu and TB), and lots of other stuff...

CXR: TRAM LINES (parallel lines outlining dilated bronchi as a result of peribronchial inflammation and fibrosis), increased bronchovascular markings and HONEYCOMBING

high res CT: DILATED AIRWAYS...and ballooned cysts at end of bronchus

Front 375

Chronic bronchitis

Back 375

productive cough for > 3 months per year for 2 consecutive years

BLUE BLOATER - PRODUCTIVE COUGH, cyanosis with mild dyspnea; pts often overweight with peripheral edema...barrel chest, use of acc chest muscles, JVD, end-exp WHEEZING or muffled breath sounds

Front 376

Emphysema

Back 376

terminal airway destruction and dilation that may be due to SMOKING (centrilobular) or to alpha-1-antitrypsin deficiency (panlobular)

PINK PUFFER - dyspnea, pursed lips, thin wasted appearance

parenchymal bullae or subpleural blebs

Front 377

an increased A-a gradient indicates...

Back 377

V/Q mismatch or a diffusion impairment.

(random...in hypercapnic pts, increase minute ventilation...if give more O2, may suppress hypoxic resp drive)

Front 378

ARDS

Back 378

ACUTE ONSET, ratio PaO2/FiO2 < 200, diffuse infiltration, swan ganz wedge pressure < 18mmHg (non-cardiogenic pulm edema)

2/2 endothelial injury, common causes are sepsis, pneumonia, aspiration, multiple blood transfusions, inhaled/ingested toxins and trauma...overall mortality is 30-40%

minimize injury induced by mechanical ventilation by ventilating with low tidal volumes...use PEEP to recruit collapsed alveoli and titrate PEEP and FiO2 to achieve adequate oxygenation

Front 379

pulmonary HTN

Back 379

mean pulmonary art pressure > 25mmHg (nl 15mmHg)

causes: left sided heart failure, mitral valve disease, congenital heart disease with L to R shunt, hypoxic vasoconstriction (2/2 chronic lung disease), increased resistance in pulm veins, thromboembolic disease...remodeling 2/2 structural lung disease

loud, palpable S2 (often split)...systolic ejection murmur, S4 or parasternal heave

Front 380

CXR for PE

Back 380

may show atelectasis, pleural effusion...HAMPTONS HUMP: wedge shaped infarct, WESTERMARKS SIGN: oligemia in embolized lung zone

Front 381

EKG in PE

Back 381

not diagnostic, sinus tach

classic triad of S1Q3T3 - acute right heart strain with an S wave in lead I, a Q wave in lead III and inverted T in III - uncommon!

Front 382

lung nodules...char favoring malignancy

Back 382

age > 45-50; smoking history, history of malignancy, new or larger lesions, absence of calcifications or irregular calcifications, > 2cm, irregular margins

Front 383

Characteristics favoring benign lung nodule

Back 383

age < 35, no change from old films, central/uniform/laminated/popcorn calcifications, size < 2cm, smooth margins

Front 384

lung cancer NOT associated with smoking

Back 384

bronchoalveolar carcinoma

(an adenocarcinoma)

Front 385

small cell lung cancer

Back 385

highly correlated with cigarette exposure

central location

neuroendocrine origin; a/w paraneoplastic syndromes

commonly presents with mets (intrathoracic and extrathoracic sites such as brain, liver and bone)

paraneoplastic processes a/w small cell lung cancer: Cushing's (ACTH), SIADH leading to hyponatremia, peripheral neuropathy, subacute cerebellar degeneration, myasthenia (eaton-lambert syndrome)

Front 386

non small cell lung cancer

Back 386

less propensity to metastasize

paraneoplastic: hypertrophic pulmonary osteoarthropathy, digital clubbing

Front 387

adenocarinoma of the lung

Back 387

MOST COMMON TYPE OF LUNG CANCER

PERIPHERAL location

includes bronchoalveolar carcinoma which is a/w multiple nodules, interstitial infiltration and prolifer sputum production

paraneo: thrombophlebitis, nonbacterial verrucous endocarditis, hypercoagulability

Front 388

squamous cell carcinoma of the lung

Back 388

central location; 98% are in smokers

paraneoplastic: HYPERCALCEMIA (PTHrP)

Front 389

large cell/neuroendocrine carcinomas of the lung

Back 389

least common; a/w poor prognosis

a/w gynecomastia

Front 390

lung cancer can present with...

Back 390

Horner's: miosis, ptosis and anhidrosis in patients with Pancoast's tumor at apex of the lung

superior vena cava syndrome: obstruction of SVC with supraclavicular venous engorgement

Hoarseness: due to recurrent laryngeal nerve involvement

Paraneoplastic syndromes

Front 391

tx of small cell lung cancer

Back 391

unresectable

chemotherapy is mainstay of tx.

usually metastasized at time of diagnosis

Front 392

tx of non-small cell lung cancer

Back 392

surgical resection in early stages (IA, IB, IIA, IIB and poss IIIA)

supplement surgery with radiation and chemo

palliation for symptomatic but unresectable disease

Front 393

causes of transudate pleural effusion

Back 393

CHF, cirrhosis or nephrotic syndrome

(increased pulm cap wedge pressure, dec oncotic pressure)

Front 394

exudative pleural effusion

Back 394

causes: pneumonia (parapneumonic effusion), TB, malignancy, pulmonary embolism, collagen vascular disease (RA, SLE), pancreatitis, trauma

2/2 increased pleural vascular permeability

ratio of pleural to serum protein is >0.5

ratio of pleural to serum LDH is >0.6

pleural fluid LDH is more than 2/3 of upper normal limit of serum LDH

Front 395

parapneumonic effusion

Back 395

complicated in setting of + gram stain or culture OR pH < 7.2 OR a glucose level of <60

presence of PUS indicates an EMPYEMA

Front 396

primary spontaneous pneumothorax

Back 396

due to rupture of subpleural apical blebs

usually found in tall, thin young males

Front 397

secondary pneumothorax

Back 397

due to COPD, TB, trauma, PCP and iatrogenic factors (thoracentesis, subclavian line placement, positive pressure mechanical ventilation, bronchoscopy)

Front 398

tension pneumo

Back 398

pulmonary or chest wall defect that acts as a one-way valve, drawing air into the pleural space including penetrating trauma, infection and positive pressure mechanical ventilation

immediate needle decompression (2nd intercostal space at midclavicular line), then chest tube

presents with respiratory distress, falling O2 sats, hypotension, distended neck veins and tracheal deviation

Front 399

normalizing PCO2 in patient with asthma exacerbation

Back 399

fatigue and impending respiratory failure

Front 400

dyspnea, lateral hilar lymphodenopathy on CXR, noncaseating granulomas, increased ACE and hypercalcemia

Back 400

sarcoidosis

Front 401

honeycomb pattern on CXR

Back 401

diffuse interstitial pulmonary fibrosis; supportive care, steroids may help

Front 402

treatment for SVC syndrome

Back 402

radiation

Front 403

tall white male presents with acute shortness of breath

Back 403

spontaneous pneumothorax, spontaneous regression, supplemental O2 may be helpful

Front 404

hypoxemia and pulmonary edema with normal pulmonary cap wedge pressure

Back 404

ARDS

Front 405

increased risk of what infection with silicosis?

Back 405

TB

Front 406

classic CXR findings for pulmonary edema

Back 406

cardiomegaly, prominent pulmonary vessels, Kerley B lines, 'bats-wing' appearance of hilar shadows and perivascular and peribronchial cuffing

Front 407

causes of hyperkalemia

Back 407

1. spurious: hemolysis of blood samples, fist clenching in blood draws, rhabdo

2. decreased excretion - renal insufficiciency, drugs (spironolactone, triamterene, ACEIs, trimethoprin, NSAIDs, mineralocorticoid def/type IV RTA)

3. cellular shifts: tissue injury, insulin deficiency, acidosis, drugs (succinylcholine, digitalis, arginine, beta blockers)

Front 408

hx of hyperkalemia

Back 408

N/V, intesintal colic, areflexia, weakness, flaccid paralysis and paresthesias

Front 409

EKG: peaked T waves, PR prolongation, wide QRS and loss of P waves

can progress to sine waves, ventricular fibrillation and cardiac arrest

Back 409

HYPERKALEMIA, biotch.

Front 410

tx of hyperkalemia

Back 410

C BIG K

calcium gluconate!!! (for cardiac cell membrane stabilization)

bicarbonate and/or insulin + glucose to temporarily shift potassium into cells

kayexalate and loop diuretics to remove potassium from the body

beta agonists - promotes cellular reuptake of potassium

Front 411

causes of hypokalemia

Back 411

1. transcellular shifts - insulin, beta 2 agonists, alkalosis, familial hypokalemic periodic paralysis

2. GI losses - diarrhea, chronic laxative abuse, vomiting, NG suction

3. renal losses - diuretics (loop or thiazide), primary mineralocorticoid excess or secondary hyperaldosteronism, decreased circulating volume, Bartter's syndrome, drugs (eg gentamycin, amphotericin), DKA, hypomagnesemia, type I RTA (defective distal H+ secretion)

consider RTA in setting of metabolic acidosis

Front 412

hx of hypokalemia

Back 412

muscle weakness, cramps, fatigue, hyporeflexia, paresthesias, rhabdomyolysis and ascending paralysis

Front 413

EKG- T wave flattening, U wave (additional wave after the T wave) and ST segment depression can lead to AV block and subsequent cardiac arrest

Back 413

hypokalemia

Front 414

tx of hypokalemia

Back 414

replete K and also magnesium - as hypomagnesia complicates potassium repletion

Front 415

cause of hypercalcemia

Back 415

calcium supplementation, hyperparathyroidism, iatrogenic (thiazides), immobility, milk-alkali syndrome, paget's disease, addisons disease/acromegaly, neoplasm, zollinger-ellison syndrome (MEN 1), excess vitamin A, excess vitamin D, sarcoidosis

(can see short QT with hypercalcemia)

Front 416

abd muscle cramps, dyspnea, tetany, perioral and acral paresthesias and convulsions

Back 416

hypocalcemia

Chvostek's sign - tapping of facial nerve

Trousseau's sign - carpal spasm after arterial occlusion of BP cuff

may show PROLONGED QT INTERVAL...

Front 417

causes of increased anion gap

Back 417

methanol.

uremia.

DKA.

Paraldehyde.

Intoxication.

Lactic acidosis.

Ethylene glycol.

Salicylates.

if normal anion gap: diarrhea, glue sniffing, RTA or hyperchloremia

Front 418

early aspirin ingestion can cause...

Back 418

respiratory alkalosis

Front 419

causes of metabolic alkalosis with compensation

Back 419

vomiting, diuretic use, antacid use or hyperaldosteronism

Front 420

renal tubular acidosis

Back 420

net decrease in either tubular H+ secretion or HCO3- reabsorption that leads to a NON-ANION GAP METABOLIC ACIDOSIS

three main types of RTA, type IV (distal) is the MOST COMMON FORM!!!

Front 421

type I RTA

Back 421

distal - defect in H+ secretion

etiologies: hereditary, amphotericin, cirrhosis, autoimmune disorders, sickle cell disease and lithium

Tx: potassium citrate

complications: nephrolithiasis

Front 422

type II (proximal) RTA

Back 422

defect in HCO3- resorption

etiologies: hereditary, carbonic anhydrase inhibitors, Fanconi's syndrome, MM

Tx: potassium citrate

Complications: rickets, osteomalacia

Front 423

Type IV (distal) RTA

Back 423

defect is aldosterone deficiency or resistance leads to defects in sodium reabsorption and H+/K+ excretion

etiologies: hyporeninemic hypoaldosteronism; chronic kidney disease from DM, HTN and HIV

tx: furosemide, fludrocortisone, and low potassium diet in pts with aldosterone def

complications: hyperkalemia

Front 424

acute interstitial nephritis

Back 424

fever, arthralgias, and a pruritic, erythematous rash...methicillin is the classic association

Front 425

FeNa < 1%, Urine sodium < 20, urine specific gravity > 1.020 or a BUN/Creatinine ratio > 20 suggest...

Back 425

pre-renal etiology of acute renal failure

Front 426

indications for urgent dialysis

Back 426

acidosis

electrolyte abnormalities (hyperkalemia)

ingestions - salicylates, theophylline, methanol, barbiturates, lithium, ethylene glycol

overload - fluid

uremic symptoms - pericarditis, encephalopathy, bleeding, nausea, pruritis and myoclonus

Front 427

hyaline casts (urine sediment)

Back 427

normal finding, but increased amount suggests volume depletion

prerenal

Front 428

red cell casts, dysmorphic red cells

Back 428

glomerulonephritis

intrinsic renal disease

Front 429

white cells, eosinophils

(urine sediment)

Back 429

allergic interstitial nephritis, atheroembolic disease

intrinsic

Front 430

granular casts, renal tubular cells, "muddy-brown cast"

Back 430

ATN

intrinsic

Front 431

white cells, white cell casts

Back 431

pyelonephritis

postrenal etiology

Front 432

carbonic anhydrase inhibitor

Back 432

acetazolamide

acts on proximal convuluted tubule

mech: inhibits carbonic anhydrase, increases H+ reabsorption, blocks Na/H exchange

side effects: hyperchloremic metabolic acidosis, sulfa allergy

Front 433

osmotic agents

(ie. mannitol, urea)

Back 433

acts on entire tubule

increases tubular fluid osmolarity

side effects: pulmonary edema 2/2 CHF and anuria

Front 434

Loop agents

(furosemide, ethacrynic acid, bumetanide, torsemide)

Back 434

acts on ascending loop of henle

inhibits Na/K/Cl transporter

side effects: water loss, metabolic alkalosis, decreases potassium, decreases calcium, OTOTOXICITY, sulfa allergy (not ethacrynic acid - hyperuricemia)

Front 435

thiazide agents

(HCTZ, chlorothiazide)

Back 435

acts on distal convoluted tubule

inhibits Na/Cl transporter

side effects: water loss, metabolic alkalosis, decreases sodium, decreases potassium, increases glucose, increases CALCIUM, increases uric acid, sulfa allergy, pancreatitis

Front 436

K sparing agents

Back 436

spironolactone, triamterene, amiloride

acts on cortical collecting tubule

mech: aldosterone receptor antagonist (spironolactone)
blocks sodium channels (triamterene, amiloride)

side effects: metabolic acidosis, increases potassium, antiandrogenic effects - including gynecomastia (spironolactone)

Front 437

nephritic syndrome in general

Back 437

d/o of glomerular inflammation, aka glomerulonephritis

classic findings: oliguria, macroscopic/microscopic hematuria (smoky-brown urine), HTN and EDEMA!!! (may have small amt of proteinuria)

pts have decreased GFR with elevated BUN and creatinine; measure complement, ANA, ANCA and anti-GBM antibody levels...

tx: HTN, fluid overload and uremia; corticosteroids are useful in reducing glomerular inflammation in some cases

Front 438

nephrotic syndrome in general

Back 438

PROTEINURIA (> 3.5 g/day), generalized EDEMA, HYPOALBUMINEMIA and HYPERLIPIDEMIA

about 1/3 cases from systemic diseases like DM, SLE or amyloidosis

hx: generalized edema, FOAMY URINE, increased susceptibility to infection and predisposition to hypercoagulable states...increased risk of venous thrombosis and pulmonary embolism

tx: protein and salt restriction, ACE inhibitors decrease proteinuria and diminish progression...

vaccinate with 23-polyvalent pneumococcus vaccine (PPV23) - patients at increased risk of Strep pneumo

Front 439

list of causes of nephritic syndrome

Back 439

Immune complex - postinfectious glomerulonephritis, IgA nephropathy (Berger's dz)

Pauci immune - Wegener's granulomatosis

Anti-GBM disease - Goodpasture's syndrome and Alport's syndrome

Front 440

list of causes of nephrotic syndrome

Back 440

minimal change, focal segmental glomerular sclerosis, membranous nephropathy, diabetic nephropathy, lupus nephritis, renal amyloidosis, membranoproliferative nephropathy

Front 441

post infectious glomerulonephritis

Back 441

NEPHRITIC

a/w recent group A beta hemolytic streptococcal infection (within 2 weeks)

hx: oliguria, edema, HTN, smoky brown urine

LOW SERUM C3!!!!, increased ASO titer, lumpy-bumpy immunofluorescence

Front 442

IgA nephropathy (Berger's disease)

Back 442

MOST COMMON TYPE
NEPHRITIC

a/w upper resp or GI infections, commonly seen in young men; may be seen in HSP

episodic gross hematuria or persistent microscopic hematuria

NORMAL C3

tx: glucocorticoids for select pts, ACEIs in pts with proteinuria

20% progress to ESRD

Front 443

Wegener's granulomatosis

Back 443

NEPHRITIC (pauci-immune)

granulomatous inflammation of the respiratory tract and kidney with necrotizing vasculitis

hx: fever, weight loss, hematuria, hearing disturbances, resp and sinus symptoms, cavitary pulmonary lesions bleed and lead to HEMOPTYSIS

C-ANCA!!! (cell mediated immune response)...renal biopsy shows segmental necrotizing glomerulonephritis with few immunoglobulin deposits on immuno-fluorescence

tx: high dose corticosteroids and cytotoxic agents; pts have frequent relapses

Front 444

Goodpasture's

Back 444

Nephritic

Anti-GBM disease

glomerulonephritis with pulmonary hemorrhage; peak incidence in men in their mid-20s

HEMOPTYSIS, dyspnea, possible resp failure

LINEAR ANTI-GBM DEPOSITS on immunofluorescence; iron def anemia; hemosiderin-filled macrophages in sputum; pulm infiltrates on CXR

tx: plasma exchange tx, pulsed steroids, may progress to ESRD

Front 445

Alport's syndrome

Back 445

nephritic

hereditary glomerulonephritis; presents in boys 5-20 yrs of age

asymptomatic hematuria a/w NERVE DEAFNESS and eye disorders

GBM splitting on EM

tx: progresses to renal failure; anti-GBM nephritis may recur s/p transplant

Front 446

minimal change disease

Back 446

most common nephrotic syn in children, idiopathic, 2' causes include NSAIDs and hematologic malignancies

tendency towards infections and thrombotic events

light mic is NORMAL

EM: FUSION of EPITHELIAL FOOT PROCESSES with lipid laden renal cortices

tx: steroids - excellent prognosis

Front 447

focal segmental glomerular sclerosis

Back 447

nephritic

idiopathic, IV drug use, HIV infection, obesity

typical pt is young black male with uncontrolled HTN

microscopic hematuria; biopsy - sclerosis in capillary tufts

tx: prednisone, cytotoxic tx

Front 448

most common nephropathy in caucasian adults

Back 448

MEMBRANOUS NEPHROPATHY

2' causes includes solid tumor malignancies (esp in pts > 60 yrs old) and immune complex disease

a/w HBV, syphilis, malaria and gold

SPIKE AND DOME 2/2 granular deposits of IgG and C3 at BM

tx: prednisone and cytotoxic therapy for severe disease

Front 449

Kimmelstiel-Wilson lesions

increased mesangial matrix

Back 449

diabetic nephropathy

two forms: diffuse hyalinization and nodular glomerulosclerosis

long standing, poorly controlled DM with evidence of retionpathy or neuropathy

tx: tight control of blood sugars; ACEIs for type I and ARBs for type 2

Front 450

Lupus nephritis

Back 450

WHO types I-IV

both nephrotic and nephritic

severity of renal disease often determines overall prognosis...

proteinuria or RBCs on UA ma be found during evaluation of SLE patients

mesangial proliferation, subendothelial immune complex deposition

tx: prednisone and cytotoxic therapy may decrease disease progression

Front 451

Renal amyloidosis

Back 451

primary (plasma cell dyscrasias) and secondary (infectious or inflammatory) are most common

pts with MM or chronic inflam dz (RA, TB)

CONGO RED STAIN; APPLE GREEN birefringence under polarized light

tx: prednisone and melphalan; bone marrow transplant may be used for MM

Front 452

membranoproliferative nephropathy

Back 452

a/w HCV, dammit!!! cryoglobulinemia, lupus and subacute bacterial endocarditis

slow progression to renal failure

TRAM TRACK, double layered BM; type I has subendothelial deposits and mesangial deposits; all three types have low serum C3

tx: corticosteroids and cytotoxic agents may help

Front 453

calcium oxalate/calcium phosphate stones

Back 453

most common stones (most common are calcium oxalate)

etiology: idiopathic hypercalciuria, elevated urine acid 2/2 to diet and 1' hyperparathyroidism, alkaline urine

radiopaque!

tx: hydration and thiazide diuretic

Front 454

Struvite stones

Back 454

9%

triple phosphate stones

a/w urease-producing organisms (Proteus, Klebsiella), form staghorn calculi, alkaline urine, radiopaque, increased ammonia

tx: hydration, tx UTI if present

Front 455

Uric acid stones

Back 455

7%

a/w gout and high purine turnover states

acidic urine (pH < 5.5)

RADIOLUCENT (cannot see on x-ray)

tx: hydration, alkalinize urine with citrate, which is converted to HCO3 in the liver; dietary purine restriction and allopurinol

Front 456

Cystine stones

Back 456

least common

hexagonal crystals

2/2 defect in renal transport of certain amino acids (COLA - cystine, ornithine, lysine and arginine)

HEXAGONAL CRYSTALS

radiopaque

tx: hydration, alkalinize urine, penicillamine

Front 457

AR PCKD

Back 457

less common but more severe

infants and young children with renal failure, liver fibrosis and portal hypertension; may lead to death in first few years of life

Front 458

AD PCKD

Back 458

most common

starts to be sympt > 30 yrs old

a/w increased risk of cerebral aneurysm, especially in pts with + fm history

extrarenal complications: hepatic cysts, valvular heart disease, colonic diverticula, abd wall and ing hernia

hx: PAIN AND HEMATURIA, other findings - HTN, hepatic cysts, cerebral berry aneurysms, diverticulosis and mitral valve prolapse

Front 459

cryptorchidism

Back 459

failure of testes to descend into scrotum

prematurity is a huge risk factor

bilateral cryptorchidism is a/w oligospermia and infertility

tx: orchiopexy after age one (in all but 1% of males, testes will descend by that age) but before age 5 (to preserve fertility)

if discovered later, tx with orchiectomy to avoid risk of testicular cancer

Front 460

risk factors for erectile dysfunction

Back 460

DM, atherosclerosis, meds (beta-blockers, SSRIs), HTN, heart disease, surgery or radiation for prostate cancer and spinal cord injury

Front 461

tx of erectile dysfunction

Back 461

Sildenafil (Viagra), Vardenafil (Levitra) and Tadalafil (Cialis)

phosphodiesterase-5 inhibitors that prolong action of cGMP-mediated SM relaxation and increase blood flow in the corpora cavernosa...effective but contraindicated in pts taking nitroglycerin

testosterone is useful for pts with hypogonadism of testicular or pituitary origin; discouraged for pts with normal testosterone levels

Front 462

tx of BPH

Back 462

medical therapy with alpha-blockers (terazosin) and 5-alpha-reductase inhibitors (finasteride) to reduce mild to moderate symptoms

TURP (transurethral resection of the prostate) or open prostatectomy for pts with moderate to severe symptoms

Front 463

major side effect of alpha blockers (for BPH)

Back 463

orthostatic hypotension

Front 464

leading causes of cancer death in men

Back 464

1. lung cancer
2. prostate cancer
3. colorectal cancer
4. pancreatic cancer
5. leukemia

Front 465

tx of metastatic prostate cancer

Back 465

androgen ablation (eg. GnRH agonists, orchiectomy, flutamide) and chemotherapy

Front 466

differential for hematuria

Back 466

strictures, stones, infection, inflammation, infarction, tumor, trauma and TB

Front 467

lets talk about bladder cancer

Back 467

most frequent malignant tumor of urinary tract

transitional cell carcinoma

risk factors: smoking, diets rich in meat and fat, schistosomiasis, chronic tx with cyclophosphamide and exposure to aniline dyes (benzene derivative)

hx: GROSS HEMATURIA - most common presenting symptom

dx: CYSTOSCOPY WITH BX IS DIAGNOSTIC..IVP

tx: depends on extent of spread beyond the bladder mucosa...

superficial cancers: complete transurethral resection or intravesicular chemo with mitomycin C or BCG (TB vaccine)

Front 468

renal cell carinoma...whhhatt.

Back 468

adenocarcinoma from tubular epithelial cells

tumors can spread along renal vein to the IVC and can metastasize to lung and bone

risk factors: male gender, smoking, obesity, acquired cystic kidney disease in ESRD and von Hippel-Lindau disease

Front 469

classic triad of RCC

Back 469

hematuria, flank pain and palpable flank mass

many have fever...varicocele is common

ANEMIA IS COMMON AT PRESENTATION, BUT POLYCYTHEMIA 2/2 increased EPO production may be seen in 5-10% pts

Front 470

testicular cancer shiznit.

Back 470

95% derive from germ cells and virtually all are malignant

cryptorchidism a/w increased risk of neoplasm in both testes

Klinefelter's also risk factor

most common malignancy in men 25-34

hx: painless enlargement of testes

seminomas peak b/t 40-50yo

Front 471

beta-hCG in test. cancer

Back 471

always elevated in choriocarcinoma and elevated in 10% seminomas

Front 472

alpha-fetoprotein in test. cancer

Back 472

often elevated in nonseminomatous germ cell tumors, particularly endodermal sinus (yolk sac) tumors

Front 473

testicular seminomas

Back 473

exquisitely radiosensitive and also respond to chemotherapy

(platinum based chemo for nonseminomatous germ cell tumors)

Front 474

renal tubular acidosis a/w abnormal H+ secretion and nephrolithiasis

Back 474

Type I (distal) RTA

Front 475

RTA a/w abnormal HCO3 and rickets

Back 475

Type II (proximal) RTA

Front 476

RTA a/w aldosterone defect

Back 476

Type IV (distal) RTA

Front 477

"doughy skin"

Back 477

hypernatremia

Front 478

differential of hypervolemic hyponatremia

Back 478

cirrhosis, CHF, nephritic syndrome

Front 479

most common causes of hypercalcemia

Back 479

malignancy and hyperparathyroidism

Front 480

hematuria, hypertension and oliguria

Back 480

nephritic syndrome

Front 481

proteinuria, hypoalbuminemia, hyperlipidemia, hyperlipiduria and edema

Back 481

nephrotic syndrome

Front 482

presence of red cell casts in urine sediment

Back 482

glomerulonephritis/nephritic syndrome

Front 483

waxy casts in urine sediment and Maltese crosses (seen with lipiduria)

Back 483

nephrotic syndrome

Front 484

drowsiness, asterixis, nausea and pericardial friction rub

Back 484

uremic syndrome seen in pts with renal failure

Front 485

low urine specific gravity in presence of high serum osmolality

Back 485

DI

Front 486

testicular cancer a/w beta-hCG and alpha fetoprotein

Back 486

choriocarcinoma

Front 487

salicylate ingestion - what type of acid-base d/o?

Back 487

anion gap acidosis and primary respiratory alkalosis due to central respiratory stimulation

Front 488

acid-base disturbance commonly seen in pregnant women

Back 488

respiratory alkalosis

Front 489

three systemic diseases that lead to nephrotic syndrome

Back 489

DM, SLE and amyloidosis

Front 490

elevated EPO, elevated Hct and normal O2 sats suggest?

Back 490

RCC or other EPO-producing tumor; evaluate with CT scan

Front 491

L4 nerve root

Back 491

motor: foot dorsiflexion (tibialis anterior)

reflex: patellar

sensory: medial aspect of lower leg

Front 492

L5 nerve root

Back 492

motor: big toe dorsiflexion (extensor hallucis longus), foot eversion (peroneu muscles)

no reflex a/w L5

sensory: dorsum of the foot and lateral aspect of the lower leg

Front 493

S1 nerve root

Back 493

Motor: plantar flexion (gastrocnemius/soleus), gluteus maximus (hip extension)

Reflex: achilles

Sensory: plantar and lateral aspects of the foot

Front 494

most common spot for Herniated Disk

Back 494

L4-L5 and L5-S1

Front 495

cauda equina syndrome

Back 495

bowel or bladder dysfunction (urinary overflow incontinence), impotence and saddle-area anesthesia

surgical emergency!!

Front 496

spinal stenosis

Back 496

usually 2/2 degenerative joint disease

leg cramping worse at rest, with standing and with walking (pseudo or neurogenic claudication)

symptoms improve with flexion at the hips and bending forward

if refractory to med tx, may do surgical laminectomy - achieves significant short term success, but many have recurrence of symptoms

Front 497

anterior dislocation of the shoulder

Back 497

most common

AXILLARY ARTERY AND NERVE are at risk

patients hold arm in external rotation

tx: reduction followed by sling and swath; recurrent dislocations may need surgical repair

Front 498

posterior dislocation of the shoulder

Back 498

a/w seizure and electrocusions

can injure RADIAL ARTERY

pts hold arm in internal rotation

Front 499

posterior hip dislocation

Back 499

MOST COMMON!! (>90%)

occurs via posteriorly directed force on an internally rotated, flexed, adducted hip (dashboard injury)

a/w risk of sciatic nerve injury and avascular necrosis

tx: closed reduction followed by abduction pillow/bracing...evaluate with CT scan after reduction

Front 500

anterior hip dislocation

Back 500

not that common

can injury obturator nerve

Front 501

Colles' fracture

Back 501

distal radius...fall on outstretched hand...dorsally displaced, dorsally angulated fracture

tx: closed reduction by application of long-arm cast

open reduction if fracture is intra-articular

Front 502

Scaphoid (carpal navicular) fracture

Back 502

MOST COMMONLY FRACTURED CARPAL BONE

may take two weeks for radiographs to show fracture...

assume fracture if tenderness in ANATOMICAL SNUFF BOX

tx: thumb spica cast; if displacement or navicular nonunion present - tx with open reduction (if displacement)

with proximal 3rd scaphoid fractures, AVN may result from disruption of blood flow

Front 503

boxer's fracture

Back 503

5th metacarpal neck fracture

2/2 trauma of closed fist

tx: closed reduction with ulnar gutter splint; percutaneous pinning if fracture is excessively angulated

if skin is broken - assume infection by human oral pathogens...surgical irrigation, debridement and IV antibiotics (covering Eikenella)

Front 504

Humerus fracture

Back 504

RADIAL NERVE PALSY - wrist drop and loss of thumb abduction

tx: hanging arm cast vs. coaptation splint and sling

functional bracing

Front 505

Nightstick fracture

Back 505

ulnar shaft fracture resulting from self defense

tx: open reduction and internal fixation (ORIF) if significanly displaced

Front 506

Monteggia's fracture

Back 506

diaphyseal fracture of proximal ulna with subluxation or radial head

tx: ORIF of the shaft fracture (due to poor fracture diaphyseal blood supply) and closed reduction of radial head

Front 507

Galeazzi's fracture

Back 507

diaphyseal fracture of radias with dislocation of distal radioulnar joint

from direct blow to radius

tx: ORIF of radius and casting of fracture forearm in supination to reduce distal radioulnar joint

Front 508

hip fracture

Back 508

increased risk with osteoporosis...presents with shortened and externally rotated leg

DISPLACED FEMORAL NECK FRACTURES: a/w increased risk of AVN, nonunion and DVTs

tx: ORIF with parallel pinning of femoral neck; displaced fractures in elderly pts ma require hip hemiarthroplasty

anticoagulate to decrease likelihood of DVTs

Front 509

femoral fracture

Back 509

direct trauma...beware of fat emboli - fever, change in mental status, dyspnea, hypoxia, petechiae and decreased platelets

tx: intramedullary nailing of the femur; irrigate and debride open fractures

Front 510

achilles tendon rupture

Back 510

sudden "pop" like a rifle shot; more likely with decreased physical deconditioning

exam: limited plantar flexion and a + Thompson's test (pressure on the gastrocnemius leads to absent foot plantar flexion)

tx: surgically followed by long leg cast for 6 weeks

Front 511

ACL injury

Back 511

results from noncontact twisting mechanism, forced hyperextension or impact to an extended knee, + anterior drawer and Lachman tests; r/o meniscal or MCL injury

tx: generally surgical with graft from patellar or hamstring tendons

Front 512

PCL injury

Back 512

from forced hyperextension
+ posterior drawer test

tx: operative for highly competitive athletes

Front 513

Meniscal tears

Back 513

from acute twisting injury or degenerative tear in elderly pts

clicking or locking may be present

joint line tenderness and + McMurray's test

operative for younger pts with significant tears or older pts whose symptoms did not respond to conservative management

Front 514

Nursemaid's elbow

Back 514

radial head subluxation that typically occurs as a result of being pulled or lifted by the hand

presents with pain and refusal to bend the elbow

tx: manual reduction by gentle supination of the elbow at 90 degrees of flexion; no immobilization

Front 515

Supracondylar humerus fracture

Back 515

tends to occur at 5-8 yrs old

proximity to brachial artery increases risk of Volkmann's contracture (results from compartment syndrome of the forearm)

tx: cast immobilization; closed reduction with percutaneous pinning if significantly displaced

Front 516

Osgood-Schlatter dz

Back 516

overuse apophysitis of tibial tubercle, localized pain, especially with quadriceps contraction, in active young boys

tx: decrease activity for 2-3 months or until asymptomatic; neoprene brace may provide symptomatic relief

Front 517

salter-harris fracture

Back 517

fractures of growth plates in children

5 different types

types III-V: surgical repair to prevent complications such as leg length inequality

Front 518

Developmental dysplasia of the hip

Back 518

aka: congenital hip dislocation

can result in subluxed, dislocatable or dislocated femoral heads...can lead to early degenerative joint disease of the hips

dislocations result from poor development of the acetabulum and hip 2/2 lax musculature and EXCESSIVE UTERINE PACKING in the flexed and adducted position (eg. breech presentation) --> excessive stretching of the posterior hip capsule and adductor muscle contracture

Front 519

History of developmental dysplasia of hips

Back 519

FIRST BORN FEMALES in BREECH POSITION

Front 520

Barlow's maneuver

Back 520

DDH

pressure placed on inner aspect of abducted thigh and hip is then adducted - audible "clunk" as femoral head dislocates posteriorly

Front 521

Ortolani's maneuver

Back 521

thighs are gently abducted from midline with ant pressure on greater trochanter...SOFT CLICK signifies reduction of femoral head into acetabulum

Front 522

other stuff with DHH (rando)

Back 522

Allis (Galeazzi's) sign: knees are at unequal heights when hips and knees are flexed (dislocated side is lower)

Asymmetric skin folds and limited abduction of the affected hip

Front 523

Tx of DDH

Back 523

early detection is critical

u/s may be helpful, esp after 10 weeks of age

radiographs unreliable until pts > 4months because of radiolucency of neonatal femoral head

< 6months: splint with PAVLIK HARNESS (maintains hip flexed and abducted)...dont flex hips >60 degrees to prevent AVN

6-15months: spica cast

15-24 months: open reduction followed by spica cast

complications: joint contractures and AVN of femoral head

without tx, significant defect is likely in patients < 2 yrs of age

Front 524

Legg-Calve Perthes Disease

Back 524

idiopathic AVN of the femoral head

most commonly in boys 4-10yo

usually self-limited with symptoms lasting < 18 months

history/PE: asymptomatic at first, but pts can develop painless limp; if there is pain - groin or anterior thigh, or referred to the knee

LIMITED ABDUCTION AND INTERNAL ROTATION, atrophy of affected leg; usually unilateral - 85-90%

tx: OBSERVATION if limited femoral head involvement or full ROM

if extensive or decrease ROM - consider bracing, petrie cast or an osteotomy

prognosis good if pt < 5yo and has full ROM, decreased fem head involvement and stable joint

Front 525

Slipped Capital Femoral Epiphysis (SCFE)

Back 525

separation of proximal femoral epiphysis through growth plate --> medial and posterior displacement of femoral head (relative to femoral neck)

may be 2/2 imbalance btw growth hormone and sex hormones

risk factors: obesity, age, 11-13 yrs old, male gender and african american ethnicity

a/w hypothyroidism

hx: acute or insidious THIGH or KNEE PAIN and a PAINFUL LIMP

acute cases present with restricted ROM and commonly INABILITY TO BEAR WEIGHT

bilateral in 40-50% cases

limited internal rotation and abduction of hip...on flexion of hip, obligatory external rotation 2/2 physical displacement...further loss of internal rotation with hip flexion

Dx: BOTH hips in AP and FROG-LEG LATERAL VIEWS reveal POSTERIOR AND MEDIAL DISPLACEMENT of femoral heads

r/o hypothroidism with TSH

tx: no weight bearing; gentle closed reduction in acute slips

ext fixation - surgical pinning where it lays...lesseens risk of AVN and chondrolysis

complications: ANV of fem head, chondrolysis and premature hip osteoarthritis --> hip arthroplasty

Front 526

Osteosarcoma

Back 526

2nd most common primary malignant tumor of bone (1st is MM)

METAPHYSEAL areas of DISTAL FEMUR, PROXIMAL TIBIA and proximal humerus...often mets to lungs

some cases preceeded by Paget's; risk factors include male gender and age 20-30

presents as progressive and eventually intractable PAIN THAT IS WORSE AT NIGHT

dx: CODMANS TRIANGLE (periosteal new bone fmt at diaphyseal end of lesion)

SUNBURST PATTERN of osteosarcoma

(Ewing's has onion skinng)

tx: limb sparing surgical procedures and pre/post-op chemo (methotrexate, doxorubicin, cisplatin and ifosfamide), may need amputation

Front 527

Colchicine

Back 527

inhibits chemotaxis and is most effective when used early during a gout flare (use is limited by a narrow therapeutic window)

Front 528

causes of hyperuricemia

Back 528

increased cell turnover (hemolysis, blast crisis, tumor lysis, myelodysplasia, psoriasis)

cyclosporine, dehydration, diabetes insipidus, diet (increased red meat, alcohol), diuretics, lead poisoning, Lesch Nyhan syndrome, salicylates (low dose), starvation

Front 529

Reactive arthritis

Back 529

Reiter's syndrome

disease of young men, characteristic arthritis, uveitis, conjunctivitis and urethritis...

usuall follows infection with Campylobacter, Shigella, Salmonella, Chlamydia or Ureaplasma

Front 530

ank spon

Back 530

HLA B27

tx: NSAIDs (indomethacin) or for refractory cases - tumor necrosis factor inhibitors

may have anterior uveitis and heart block

Front 531

dermatomyositis

Back 531

may have heliotrope rash, "shawl sign" - rash involving shoulders, upper chest and back, Gottron's papules - papular rash with scales located on the dorsa of the hands, over bony prominences

Front 532

Felty's syndrome

Back 532

RA, splenomegaly and neutropenia

Front 533

Rheumatoid Arthritis

Back 533

chronic, destructive inflammatory arthritis with SYMMETRIC involvement of both large and small joints...causes synovial hypertrophy and pannus formation...leads to erosion of adjacent cartilage, bone and tendons...

risk factors: female, age 35-50 and HLA-DR4!!

hx: insidious onset of morning stiffness for > 1 hr with painful, warm swelling of multiple symmetric joints wrists, MCP and PIP joints)...

ulnar deviation

BAKERS CYSTS (palpable popliteal mass), vasculitis, atlantoaxial subluxation, carpal tunnel syndrome, rheumatoid nodules, keratoconjunctivitis sicca, pulm nodules, inflam endocarditis

Front 534

tx of RA

Back 534

NSAIDS - reduced or d/c'ed if tx successful with DMARDS (disease modifying antirheumatic drugs)

DMARDS should be started early...first line are hydroxychloroquine, sulfasalazine, methotrexate and azithioprine...2nd line include rituximab (anti-CD20) and leflunomide

Front 535

anticentromere antibodies

Back 535

CREST

Front 536

anti-Scl 70 antibodies

Back 536

a/w with poor prognosis of scleroderma

Front 537

CREST

Back 537

calcinosis, Raynaud's, esophageal dysmotility, sclerodactyly and telangiectasias

(diffuse form - pulmonary fibrosis)

can tx Raynaud's with calcium channel blockers

mortality 2/2 pulmonary hypertension and complications of pulmonary HTN

Front 538

criteria for SLE

Back 538

DOPAMINE RASH

discoid rash, oral ulcers, photosensitivity, arthritis, malar rash, immunologic criteria, neurologic symptoms (lupus cerebritis, seizures), elevated ESR, renal disease, + ANA, serositis, hematologic abnormalities

Front 539

anti-ds DNA and anti-Sm antibodies

Back 539

LUPUS

Front 540

+ antihistone antibodies

Back 540

drug induced SLE

Front 541

neonatal SLE

Back 541

+ anti-Ro antibodies

Front 542

drugs that cause a lupus syndrome

Back 542

chlorpromazine, hydralazine, INH, methyldopa, penicillamine, procainamide, quinidine

Front 543

hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest

Back 543

suspect ankylosing spondylitis

check HLA-B27

Front 544

arthritis, conjunctivitis and urethritis in young men...dx?
associated organisms?

Back 544

Reactive (reiter's) arthritis

a/w Campylobacter, Shigella, Salmonella, Chlamydia and Ureaplasma

Front 545

active 13 year old boy with anterior knee pain...

Back 545

Osgood Schlatter disease

Front 546

complication of scaphoid fracture

Back 546

avascular necrosis

Front 547

signs of radial nerve damage

Back 547

wrist drop, loss of thumb abduction

Front 548

first born female who was born in breech position found to have asymmetric skin folds on her newborn exam...whats up?

Back 548

developmental dysplasia of the hip

if severe, consider a Pavlik harness to maintain abduction

Front 549

11 year old obese, African American boy presents with sudden onset of limp...dx, w/u?

Back 549

slipped capital femoral epiphyses

AP and frog-leg lateral view

Front 550

most common primary malignant tumor of bone

Back 550

multiple myeloma

Front 551

pemphigus

Back 551

pemphigus vulgaris

intraepidermal blister that leads to widespread painful erosions

MUCOUS MEMBRANE

antibodies against desmoglein molecules responsible for keratinocyte adherence leading to loss of cellular attachment

MIDDLE AGED (40-60)

+ Nikolsky's sign

ACANTHOLYIS - intraepidermal split with free-floating keratinocytes in blister

Front 552

Bullous pemphigoid

Back 552

separation at epidermal BM

60-80 years old

antibodies against bullous pemphigoid antigen, superficially in BM zone

BLISTERS ARE STABLE - roof consists of nearly normal epidermis

IgG and C3 at dermal-epidermal junctions

autoantibodies against BM glycoproteins BP230 and BP 180

- Nikolsky's sign

mucous membranes NOT involved

Front 553

HSV 1

Back 553

oral labial lesions

primary: typically presents in infancy with widespread, severe herpetic gingivostomatitis with oral erosions

Front 554

HSV 2

Back 554

genital lesions

often presents in adults with bilateral, erosive vesicular lesions with edema and lymphadenopathy

Front 555

verrucae (warts)

Back 555

many different types of HPV

usually benign, some subtypes of HPV (especially 16 and 18) can lead to squamous malignancies

cauliflower like...grows downward

dx: acetowhitening...

tx: destruction of tissue by curettage, cryotherapy or acid keratolytics...

genital warts tx locally with podophyllin, trichloroacetic acid, imiquimod or 5-FU

Front 556

Pityrosporum orbiculare

Back 556

yeast that causes Tinea Versicolor

normal on skin...pathogenic type called Malassezia furfur

KOH preparation of scale that reveals "spaghetti and meatballs" pattern of hyphae and spores

tx: selenium sulfide daily for one week, followed by application once weekly for prophylaxis

Front 557

pyrethrin

Back 557

aka: RID

tx of head and pubic lice

Front 558

Scabies

Back 558

Sarcoptes scabiei - tiny arthropod mates on skin surface

female digs passage into stratum corneum and lays eggs...burrowing leads to pruritis...

hx: intense pruritis especially at night; hands, axillae and genitals...exam: mite's track can sometimes be seen along with erythematous, excoriated papules

Tx: 1-2 applications of PERMETHRIN

oral IVERMECTIN also effective...

pruritis may persist for two weeks after treatment...symptomatic tx should be used after this

Front 559

Lichen planus

Back 559

violaceous, flat-topped, polygonal papules

may have Wickham's striae (white stripes), especially on mucous membranes

Koebner's phenomenon - lesions that appear at the site of trauma...initially on genitalia

histology: "lichenoid pattern" - band of T lymphocytes at the epidermal-dermal junction with damage to the basal layer

tx: mild cases with corticosteroids

P disease: planar, purple, pruritic, persistent, polygonal, penile, perioral, puzzling and Koebner's phenomenon

Front 560

"christmas tree pattern"

Back 560

Pityriasis Rosea

acute dermatitis that is pink and scaly

etiology unknown, may be due to viral infection with human herpesvirus 7 (HHV7)

HERALD PATCH

"cigarette paper"

asymptomatic...heal without tx in 2-3 weeks...can use skin lubrication, topical antipruritics and systemic antihistamines

Front 561

class of drugs that may cause syndrome of muscle rigidity, hyperthermia, autonomic instability and EPS

Back 561

antipsychotics (neuroleptic malignant syndrome)

Front 562

side effects of corticosteroids

Back 562

acute mania, immunosuppression, thin skin, osteoporosis, easy bruising, myopathies

Front 563

treatment for DTs

Back 563

benzodiazepines

Front 564

tx for acetaminophen OD

Back 564

N-acetylcysteine

Front 565

Tx for opiod overdose

Back 565

Naloxone

Front 566

Tx for benzo overdose

Back 566

Flumazenil

Front 567

Tx for neuroleptic malignant syndrome

Back 567

Dantrolene or bromocriptine

Front 568

Tx for malignant hypertension

Back 568

nitroprusside

Front 569

Tx of AF

Back 569

rate control rhythm conversion and anticoagulation

Front 570

Tx of SVT

Back 570

if stable, rate control with carotid massage or other vagal stimulation...if unsuccessful, consider adenosine

Front 571

causes of drug induced SLE

Back 571

INH, penicillamine, hydralazine, procainamide, chlorpromazine, methyldopa and quinidine

Front 572

blood in the urethral meatus or high-riding prostate

Back 572

bladder rupture or urethral injury

Front 573

test to rule out urethral injury

Back 573

retrograde cystourethrogram

Front 574

radiologic evidence of aortic rupture or dissection

Back 574

widened mediastinum (>8cm), loss of aortic knob, pleural cap, tracheal deviation to the right, depression of left main stem bronchus

Front 575

acceptable urine output in trauma pt

Back 575

50cc/hr

Front 576

acceptable urine output in stable patient

Back 576

30cc/hr

Front 577

cannon "a" waves

Back 577

third degree heart block

Front 578

signs of neurogenic shock

Back 578

hypotension and bradycardia

Front 579

signs of increased ICP

Back 579

Cushings triad...

hypertension, bradycardia and abnormal respirations

Front 580

decreased CO, decreased pulmonary capillary wedge pressure, increased peripheral vascular resistance

Back 580

hypovolemic shock

Front 581

increased CO, decreased PCWP, decreased PVR

Back 581

septic or anaphylactic shock

Front 582

tx of cardiogenic shock

Back 582

identify cause; pressors (eg dopamine)

Front 583

tx of anaphylactic shock

Back 583

diphenhydramine or epinephrine 1:1000

Front 584

supportive tx for ARDS

Back 584

continuous positive airway pressure

Front 585

signs of air embolism

Back 585

pt with chest trauma who was previously stable suddenly dies

Front 586

trauma series

Back 586

AP chest, AP/lateral C-spine, AP pelvis

Front 587

4 D's of posterior circulation strokes

Back 587

Diplopia

Dizziness

Dysphagia

Dysarthria

Front 588

MCA strokes

Back 588

aphasia (dominant hemisphere), neglect (nondominant hemisphere), contralateral paresis and sensory loss in the FACE and ARM, gaze preference toward the side of the lesion, homonymous hemianopia

Front 589

ACA stroke

Back 589

contralateral paresis and sensory loss in the LEG, amnesia, personality changes, foot drop, gait dysfunction, cognitive changes

Front 590

PCA stroke

Back 590

homonymous hemianopia, memory deficits, dyslexia/alexia

Front 591

Basilar artery stroke

Back 591

coma, "locked in" syndrome, cranial nerve palsies, apnea, visual crap, drop attacks, dysphagia, dysarthria, vertigo, "crossed" weakness and sensory loss affecting the ipsilateral face and contralateral body

Front 592

neuro deficients in polio and Werdnig Hoffman

Back 592

LMN lesions only 2/2 destruction of anterior horns; flaccid paralysis

Front 593

multiple sclerosis

Back 593

demyelination

scanning speech, intention tremor and nystagmus

Front 594

ALS

Back 594

combined upper and lower motor neuron lesions with no sensory deficits

Front 595

tabes dorsalis

Back 595

tertiary syphilis

degeneration of dorsal roots and dorsal columns; impaired proprioception, locomotor ataxia

Front 596

subarachnoid hemorrhages

Back 596

2/2 trauma, berry aneurysms, AVM or trauma in circle of willis (often at the MCA)

Front 597

hx of subarachnoid hemorrhage

Back 597

acute onset, intensely painful "thunderclap" headache often followed by neck stiffness

may have had sentinel bleed days to weeks earlier marked by HA, neck stiffness and N/V 2/2 leaking aneurysm

LP if CT - to look for RBCs, xanthochromia (yellowish CSF due to breakdown of RBCs), increased protein from RBCs and increased ICP

Front 598

tx of subarachnoid hemorrhage

Back 598

prevent rebleeding, keep SBP <150

prevent vasospasm and associated neurologic deterioration by giving calcium channel blockers, IV fluids and pressors to maintain BP

give phenytoin for seizure prophylaxis

decrease ICP

(CN III palsy with pupil involvement is a/w Berry aneurysms)

Front 599

subdural hematomas

Back 599

typically follows head trauma leading to rupture of bridging veins and accumulation of blood btw dura and arachnoid membranes...common in elderly and alcoholics

hx: headache, changes in mental status, contralateral hemiparesis and ipsilateral pupillary dilation

CT: Crescent shaped, concave hyperdensity that does NOT cross suture midline

tx: surgical evacuation if symptomatic

Front 600

epidural hematomas

Back 600

usually 2/2 lateral skull fracture --> tear of middle meningeal artery

hx: immediate loss of consciousness leads to a lucid interval (minutes to hours) then to a coma with hemiparesis...ultimately a "blown pupil" (watch out for impending brain stem compression)...

CT: lens-shaped CONVEX hyperdensity limited by sutures

Front 601

Tx of migraine headaches

Back 601

abortive therapy: triptans - 1st line, metoclopramide; consider symptomatic tx for nausea

prophylactic: beta-blockers (propranolol), TCAs (amitriptyline), CCBs and valproic acid

Front 602

tx of cluster HA

Back 602

acute: high flow O2, ergots, sumatriptans, intranasal lidocaine, corticosteroids

prophylactic: ergots, CCBs, prednisone, lithium, valproic acid and topiramate

Front 603

Lambert-Eaton Myasthenic Syndrome

Back 603

small cell lung carcinoma risk factor (60%)

Dx: repetitive nerve stimulation shows incremental response, autoantibodies to presynaptic calcium channels and a chest CT indicative of lung neoplasm

Tx: tx small cell lung carcinoma; tumor resection may reverse symptoms; Guanidine hydrochloride is mainstay of tx; anticholinesterases may also improve symptoms

Front 604

scanning speech, intranuclear ophthalmoplegia and nystagmus

Back 604

MS

Front 605

MS

Back 605

can have optic neuritis (painful loss of vision)

Lhermittes sign may be present - sharp pain traveling up and down neck with flexion

MRI: multiple, asymmetric, periventricular white matter lesions (Dawsons fingers), esp in corpus callosum

increase IgG in CSF

tx: steroids, avonex/rebif (interferon alpha), betaseron (interferon alpha 1b) and copaxone (copolymer 1)

mitoxantrone...

alt tx: cyclophosphamide, IVIG and plasmapharesis

symptomatic therapy: baclofen for spasticity, cholinergics for urinary retention, anti-cholinergics for urinary incontinenct or amitriptyline for painful paresthesias

glatiramer acetate - suppresses T-cells against myelin

Front 606

ropinirole or pramipexole

Back 606

dopamine agonists

side effect of pramipexole: uncontrolled gambling

Front 607

selegiline

Back 607

MAO-B inhibitor...may be neuroprotective and may decrease need for levodopa

Front 608

Dural tails

Back 608

meningioma

from dura mater or arachnoid

Front 609

Medulloblastoma

Back 609

primitive neuroectodermal tumor

common in children

arises from 4th ventricle and increases ICP

HIGHLY MALIGNANT; may seed the subarachnoid space

posterior vermis sign - truncal dystaxia

Front 610

Neurofibromatosis 1

Back 610

AD, chromosome 17

aka: von Recklinghausen's syndrome

cafe au lait spots, freckling in axillary or inguinal area, optic glioma, two lisch nodules (pigmented iris hamartomas), bone abnormality, first degree relative with NF1

clinically evident by age 15

Front 611

NF 2

Back 611

AD, chromosome 22

BILATERAL ACOUSTIC NEUROMAS

first degree relative with NF2

unilateral acoustic neuromas

neurofibromas, meningiomas, gliomas or schwannomas

seizures, skin nodules, cafe au lait spots

clinically evident by age 20

Front 612

tuberous sclerosis

Back 612

AD

convulsive seizures, "ash leaf" hypopigmented lesions, MR

sebaceous adenomas (small red nodules on nose and cheeks in butterfly shapes)

shagreen patch (rough papule in lumbosacral region with an orange-peel consistency)

two retinal lesions: mulberry tumors and phakomas (round, flat, gray lesions)

lots of systems can be involved...CHF from rhabdomyoma...renal involvement may include hamartomas, angiomyolipomas or rarely, RCC

head CT: calcified tubers within cerebrum in the periventricular area

renal CT: angiomyolipomas (causing cystic or fibrous pulmonary changes)

Front 613

Brocas

Back 613

d/o of language production, including writing with intact comprehension

posterior inferior frontal gyrus is messed...often 2/2 left superior MCA stroke

impaired repetition, frustration, arm and face hemiparesis

Front 614

Wernickes

Back 614

d/o of language comprehension with intact yet nonsensical production

sensory aphasia

left posterior superior temporal (perisylvian) lobe...2/2 inferior/posterior MCA

preserved fluency, impaired repitition and comprehension..."word salad"...lack of awareness...

may have right upper homonymous quadrantanopia 2/2 involvement of Meyer's loop

Front 615

Locked in syndrome

Back 615

pts awake and alert but can move only eyes and eyelids

a/w central pontine myelinolysis, brain stem stroke and advanced ALS

Front 616

persistent vegatative state

Back 616

normal sleep-wake cycles but lack of awareness of self or the environment

most commonly caused by trauma with diffuse cortical injury or hypoxic ischmic injury

Front 617

Wernicke's encephalopathy

Back 617

encephalopathy, ophthalmoplegia (nystagmus, lateral rectus palsy, conjugate gaze palsy) and ataxia

pts: alcoholics, hyperemesis, starvation, renal dialysis and AIDS

can be elicited by high dose glucose administration

Front 618

closed angle glaucoma

Back 618

risk factors: PUPILLARY DILATION (prolonged time in darkened area, stress, meds), anterior uveitis and lens dislocation

hx: presents with EXTREME PAIN and blurred vision

HARD, RED EYE seen...pupil dilated and nonreactive to light

MEDICAL EMERGENCY that may lead to blindness...need to decrease intraocular pressure with acetazolamide and then pilocarpine...laser iridotomy

Front 619

open angle glaucoma

Back 619

risk factors: age > 40, african american ethnicity, diabetes and myopia

hx/PE: initially asymptomatic; frequent lens changes...defect in peripheral visual fields...CUPPING of optic disk

almost always bilateral

dx: tonometry, look at optic nerve...diseased trabecular meshwork that obstructs proper drainage of the eye...gradulal loss of vision...tunnel vision

tx: frequent optho exams...topical beta blockers - timolol, betaxolol to decrease aqueous humor production or with pilocarpine to increase aqueous outflow

can use carbonic anhydrase inhibitors...

Front 620

Central retinal artery occlusion

Back 620

sudden, painless unilateral blindness...cherry-red spot on the fovea, retinal swelling and retinal arteries that may appear bloodless

tx: THROMBOLYSIS within 8 hrs of symptom onset...decrease intraocular pressure through drainage of anterior chamber...may use IV acetazolamide to improve retinal perfusion...if no tx, may have retinal infarction and permanent blindess may result

Front 621

Central retinal vein occlusion

Back 621

subacute monocular visula loss..."blood and thunder", cotton wool spots...edema/optic disk swelling...dilated veins

tx: laser photocoagulation has variable results

Front 622

most common primary sources of mets to the brain

Back 622

lung, breast, skin (melanoma), kidney and GI tract

Front 623

most common cause of seizures in children (2-10yo)

Back 623

infection, febrile seizures, trauma and idiopathic

Front 624

most common cause of seizures in adults (18-35)

Back 624

trauma, alcohol withdrawal and brain tumor

Front 625

Kluver-Bucy syndrome (amygdala)

Back 625

hyperphagia, hypersexuality, hyperorality and hyperdocility

Front 626

SSRIs

(fluoxetine, sertraline, paroxetine, citalopram, escitalopram)

Back 626

indications: depression and anxiety; first line for generalized anxiety disorder, OCD and PTSD

side effects: nausea, GI upset, somnolence, sexual dysfunction, tremor, diarrhea, and agitation

SEROTONIN SYNDROME: if SSRIs are used with MAOIs - fever, myoclonus, mental status changes, cardiovascular collapse

Front 627

buspirone

Back 627

indications: generalized anxiety disorder, OCD and PTSD

side effects: seizures with chronic use, no tolerance, dependence or withdrawal

Front 628

TCA toxicity

Back 628

convulsions, coma and cardiac arrythmias

Front 629

Atypicals (for psych)

Buproprion, venlafaxine, Mirtazapine, Nefazodone and Trazodone

Back 629

indications: depression, anxiety and chronic pain

Front 630

side effect of Bupropion

Back 630

decreased seizure threshold; minimal sexual side effects; CONTRAINDICATED IN BULIMICS

Front 631

side effects of venlafaxine

Back 631

diastolic hypertension

Front 632

side effect of Mirtazapine

Back 632

atypical

weight gain, sedation

Front 633

side effects of Nefazodone

Back 633

atypical

sedation, HA and dry mouth

Front 634

side effects of Trazodone

Back 634

aytpical

highly sedating, priapism

Front 635

TCAs

nortriptyline, desipramine, amitriptyline and imipramine

Back 635

indications: depression, anxiety disorder, chronic pain, migraine and enuresis (imipramine)

side effects:

LETHAL with OD owing to cardiac arrhythmias...monitor for 3-4 days in the ICU after OD

ANTICHOLINERGIC EFFECTS - dry mouth, constipation, urinary retention and sedation

Front 636

phenelzine and tranylcypromine

Back 636

MAOIs

indication: depression, especially atypical

Side effects - hypertensive crisis if taken with high-TYRAMINE foods (cheese, red wine)

sexual side effects, orthostatic hypotension, weight gain

Front 637

chronic lithium use...

Back 637

hypothyroidism and nephrotoxicity

Front 638

lamotrigine can lead to a...

Back 638

life threatening skin rash

Front 639

Typical antipsychotics

haloperidol, droperidol, fluphenazine, thioridazine, chlorpromazine

Back 639

indications: psychotic d/o, acute agitation, acute mania and Tourette's syndrome

side effects:

EPS!!!
HYPERPROLACTINEMIA
ANTICHOLINERGIC EFFECTS - drug mouth, urinary retention and constipation

seizures, hypotension, sedation and QTc prolongation

Front 640

side effect of Thioridazine

Back 640

typical antipsychotic

irreversible retinal pigmentation

Front 641

Neuroleptic malignant syndrome

Back 641

fever, muscle rigidity, autonomic instability, clouded consciousness

stop medication, go to ICU

Dantrolene or bromocriptine

Front 642

Atypical antipsychotics

clozapine, risperidone, quetiapine, olanzapine, ziprasidone and aripiprazole

Back 642

indicaitons: 1st line for schizophrenia - fewer EPS and anticholinergic effects

Clozapine is reserved for severe tx resistance and severe tardive dyskinesia; AGRANULOCYTOSIS

side effects of atypicals: weight gain, Type 2 DM, somnolence, sedation and QTc prolongation

Front 643

Lithium toxicity

Back 643

ataxia, dysarthria and delirium

Front 644

Lithium

Back 644

mood stabilizer, used for acute mania (in combo with antipsychotics); prophylaxis in bipolar disorders and augmentation in depression tx

side effects: thirst, polyuria, diabetes insipidus, tremors, weight gain, hypothyroidism, nausea, diarrhea, seizures, teratogenicity (if used in first trimer), acne and vomiting

Front 645

Carbamazepine

Back 645

2nd line mood stabilizer; anticonvulsant

side effects: nausea, skin rash, leukopenia, AV block

rarely, aplastic anemia (monitor CBC biweekly), Stevens-Johnson syndrome

Front 646

Valproic acid

Back 646

bipolar d/o and anticonvulsant

side effects: GI (N/V), tremor, sedation, alopecia, weight gain

rarely - pancreatitis, thrombocytopenia, fatal hepatotoxicity and agranulocytosis

Front 647

Lamotrigine

Back 647

2nd line mood stabilizer; anticonvulsant

side effects: blurred vision, GI distress, Steven Johnson syndrome

Front 648

acute dystonia

Back 648

involuntary muscle contraction or spasm (eg. torticollis, oculogyric crisis)

tx: anticholinergics (benztropine or diphenhydramine); to prevent, administer these meds prophylactically

Front 649

akathisia

Back 649

subjective/objective restlessness - perceived as being distressing

tx: decrease neuroleptics and try beta-blockers (propranolol)

benzos or anticholinergics may help

Front 650

Dyskinesia

Back 650

pseudoparkinsonism (eg. shuffling gait, cogwheel rigidity)

tx: give an anticholinergic (benztropine) or a dopamine agnost (amantadine); decrease dose of neuroleptic or d/c

Front 651

Tardive dyskinesia

Back 651

stereotypic oral facial movements...likely from dopamine receptor sensitization...often irreversible (50%)

tx: d/c or decrease dose of neuroleptic; consider changing neuroleptic (to clozapine or risperidone)

GIVING ANTICHOLINERGICS OR DECREASING NEUROLEPTICS MAY INITIALLY WORSEN TARDIVE DYSKINESIA

Front 652

evolution of EPS

Back 652

4 hours: acute dystonia

4 days: akinesia

4 weeks: akathisia

4 months: tardive dyskinesia

Front 653

Cluster A personality d/o

Back 653

weird...

paranoid, schizoid (loner) and schizotypal

Front 654

Cluster B pers d/o

Back 654

wild...

Borderline, histrionic, narcissistic and antisocial

Front 655

Cluster C pers d/o

Back 655

worried and wimpy

obsessive compulsive, avoidant and dependent

Front 656

Rett's disorder

Back 656

genetic neurodegenerative d/o of FEMALES with progressive impairment (language, head growth, coordination, ataxia, seizures, MR) AFTER 5 MONTHS NORMAL DEVELOPMENT

Front 657

Childhood disintegrative disorder

Back 657

severe developmental REGRESSION after > 2 years of normal development (eg. language, motor skills, social skills, bladder/bowel control, play)

males > females

Front 658

Tourette's syndrome

Back 658

a/w ADHD, learning disorders and OCD

multiple motor tics (blinking, grimacing) and vocal tics, occurring many times a day, recurrently for > 1 year with social or occupational impairment

tx: dopamine receptor antagonists (haloperidol, pimozide) or clonidine...stimulants can worsen or precipitate tics

Front 659

substance dependence

Back 659

tolerance

withdrawal symptoms

attempts to cut down use or abstain - fails

(dependence differs from abuse b/c has physical manifestations)

Front 660

alcohol withdrawal

Back 660

tremor, tachycardia, hypertension, malaise, nausea, seizures, DTs and agitation

Front 661

opiod intoxication

Back 661

euphoria leading to apathy, CNS depression, constipation

PUPILLARY CONSTRICTION and respiratory depression (life-threatening OD)

naloxone/naltrexone will block opioid receptors and reverse effects (beware of antagonist clearing before opioids...particularly long-acting opioids like methadone)

Front 662

opioid withdrawal

Back 662

dysphoria, insomnia, anorexia, myalgias, fever, lacrimation, diaphoresis, dilated pupils, rhinorrhea, piloerection, nausea, vomiting, stomach cramps, diarrhea and yawning

Front 663

amphetamine intoxication

Back 663

PUPILLARY DILATION, psychomotor agitation, impaired judgment, HTN, tachycardia, fever, diaphoresis, anxiety, angina, euphoria...arrhythmias, hallucinations, seizures

can give haldol for severe agitation and symptom targeted meds (like antiemetics, NSAIDs)

Front 664

amphetamine withdrawal

Back 664

postuse "crash" with anxiety, lethargy, HA, stomach cramps, hunger, fatigue, depression/dysphoria, sleep disturbance, nightmares

Front 665

PCP intoxication

Back 665

ASSAULTIVENESS
VERTICAL/HORIZONTAL NYSTAGMUS

belligerence, psychosis, violence, impulsiveness, psychomotor agitation, HTN, impaired judgement, ataxia, seizures, delirium

give benzos or haldol for severe symptoms

Front 666

PCP withdrawal

Back 666

may have recurrence of intoxication symptoms due to reabsorption in the GI tract; udden onset of severe, random violence

Front 667

galactorrhea, impotence, menstrual dysfunction and decreased libido

Back 667

patient on dopamine antagonist

Front 668

key side effects of atypical antipsychotics

Back 668

weight gain, type 2 DM and QT prolongation

Front 669

a young wt lifter receive IV haldol and complaints that his eyes are deviated sideways...dx? tx?

Back 669

acute dystonia (oculogyric crisis); tx with benztropine or diphenhydramine

Front 670

med to avoid in pts with history of alcohol withdrawal seizure

Back 670

neuroleptics

Front 671

5 month old girl has decreased head growth, truncal dyscoordination and decreased social interaction

Back 671

Rett's disorder

Front 672

violent patient with horizontal and vertical nystagmus

Back 672

phencyclidine hydrochloride intoxication (PCP)

Front 673

man has repeated, intense urges to rub his body against unsuspected passengers on a bus

Back 673

frotteurism (a paraphilia)

Front 674

live, attenuated vaccines

Back 674

MMR, polio (sabin), yellow fever

Front 675

Inactivated (killed) vaccines

Back 675

cholera, influenza, HAV, polio (Salk) and rabies

Front 676

Toxoid vaccine

Back 676

diphtheria, tetanus

Front 677

Subunit vaccines

Back 677

HBV, pertussis, Streptococcus pneumoniae, HPV, meningococcus

Front 678

Conjugate vaccines

Back 678

Hib, Strep pneumoniae

Front 679

number of true positives divided by number of patients with the disease

Back 679

sensitivity

Front 680

sensitive tests have few false negatives and are thus used to...

Back 680

rule OUT a disease

Front 681

cross sectional survey - incidence or prevalence?

Back 681

prevalence

Front 682

cohort study - incidence or prevalence

Back 682

incidence and prevalence

Front 683

case control study - incidence or prevalence?

Back 683

neither

Front 684

difference btw cohort and case-control study

Back 684

cohorts can be used to calculate relative risk, incidence and odds ratio

case control studies used to calculate odds ratio

Front 685

attributable risk?

Back 685

incidence ratio of a disease in exposed minus IR of disease in unexposed

Front 686

Relative risk?

Back 686

incidence rate of disease in population exposed to facor divided by incidence rate of those not exposed

Front 687

Odds ratio?

Back 687

likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed

Front 688

number needed to treat?

Back 688

1 / (rate in untreated group - rate in treated group)

Front 689

patients where screening for colorectal cancer is initiated early...

Back 689

patients with IBD, those with FAP/hereditary nonpolyposis colorectal cancer, and those who have first degree relatives with adenomatous polyps (< 60 years old) or colorectal cancer

Front 690

percentage of cases within one SD of the mean? two SDs? three SDs?

Back 690

68%

95.5%

99.7%

Front 691

postnatal mortality?

Back 691

number of death from 28 days to one year per 1000 live births

Front 692

infant mortality?

Back 692

number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)

Front 693

perinatal mortality?

Back 693

number of deaths from 20 weeks' gestation to one month of life per 1000 total births

Front 694

maternal mortality?

Back 694

number of deaths during pregnancy to 90 days postpartum per 100,000 live births

Front 695

involuntary psychiatric hospitalization can be undertaken for which three reasons?

Back 695

danger to self, danger to others or gravely disturbed (unable to provide for basic needs)

Front 696

when can a physician refuse to continue treating a pt on grounds of futility?

Back 696

no rationale for treatment, maximal intervention is failing, given intervention has already failed and tx will not achieve goals of care

Front 697

conditions where confidentiality can be overriden...

Back 697

real threat of harm to third parties, suicidal intentions, certain contagious diseases; elder and child abuse

Front 698

10 yr old child presents in status epilepticus, but parents refuse tx on religious grounds...

Back 698

tx because disease represents immediate threat to the child's life...then seek a court order