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404 Cards in this Set
- Front
- Back
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classic ECG finding in atrial flutter
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sawtooth p waves
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definition of unstable angina
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angia is new, worsening or occurs at rest
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antihypertensive for diabetic patient with protienuria
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ACEI
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beck's triad
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cardiac tamponade: muffled heart sounds, hypotension, JVD
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drugs that slow AV node transmission
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B-blockers, CCBs, digoxin
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hypercholesterolemia tx leading to flushing and pruritis
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niacin
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murmur of HOCM
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systolic ejection, lateral sternal border, increases with valsalva and standing
increases with firm handgrip |
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murmur of AS
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systolic crescendo/decrescendo radiating to neck; increases with increased preload (valsalva)
decreases with standing |
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murmur AI
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diastolic, decrescendo; high pitched and blowing
decreased with decreased preload (handgrip) |
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murmur MR
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holosystolic, radiates to axillae or carotids
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murmur MS
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diastolic, mid to late, low pitched
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treatment for afib and a flutter
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if unstable: cardioversion
stable/chronic: rate control w/CCBs or BBs |
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treatment for vfib
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immediate cardioversion
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autoimmune complication 2-4 weeks post MI
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dresslers syndrome: fever, pericarditis, high ESR
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IV drug use w/JVD, holosystolic murmur at left sternal border. Tx?
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Treat existing heart failure and replace tricuspid valve
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diagnostic test for HOCM
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echo showing thick left ventricular wall and outflow obstruction
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fall in systolic BP of >10 mmHg with inspiration
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pulsus paradoxus (in cardiac tamponade)
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classic ECG findings in pericarditis
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diffuse low voltage ST elevation
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Criteria for HTN
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>140/90 on 3 separate occasions two weeks apart
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eight surgically correctable causes of HTN
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renal artery stenosis
coarction of aorta pheochromocytoma hyperthyroidism Conn's syndrome Cushing's syndrome hyperparathyroidism unilateral renal parenchymal disease |
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evaluation of pulsatile abdominal mass and bruit
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US and CT
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indications for surgical repair of AAA
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>5.5 cm, rapidly enlarging, symptomatic or ruptured
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treatment for ACS
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morphine, O2, sublingual nitroglycerin, ASA, IV BBs, heparin
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definition of metabolic syndrome
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abdominal obesity, high triglycerides, low HDL, HTN, insulin resistance, prothrombotic or proinflammatory states
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target LDL in pt w/DM
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<70
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signs of active ischemia during stress test
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angina, ST changes, decreased BP
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ST elevation II, III, AVF
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inferior (RCA, LCA)
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ST elevation V1-V4
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anterior (LAD)
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ST elevation I, AVL, V5, V6
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lateral (LCA)
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symptoms with silent MI
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CHF, shock, AMS
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drug that reverses effects of heparin
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protamine
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coagulation parameter affected by warfarin
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PT
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endocarditis prophylaxis regimines
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oral surgery- amoxicillin
GI/GU procedures - amp and gent before, amox after |
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virchow's triad
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stasis, hypercoaguability, endothelial damage
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MCC HTN in young women
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OCPs
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MCC HTN in young men
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excessive EtOH
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plaque w/stuck on appearance
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seborrheic keratosis
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red plaques w/silvery white scales and sharp margins
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psoriasis
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MC skin cancer
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BCC - pearly lesion w/translucent surface and telangectasias
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honey crusted lesion
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impetigo
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- nikolsky's sign
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bullous pemphigoid
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+ nikolsky's sign
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pemphigus vulgaris
(rub skin and it comes off) |
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pemphigus vulgaris
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antibodies to desmosomes so separation at BM
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bullous pemphigoid
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hemidesmosome antibodies, bullae including mucous membranes
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annular patch of alopecia with broken off hairs
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alopecia areata (autoimmnue)
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inflammation and epithelial thinning of anogenital area, postmenopausal women
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linchen sclerosus
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pruritic, purple, polygonal, planar papules
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linchen planus
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MCC hypothyroidism
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hashimoto's thyroiditis
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lab findings in hashimoto's thyroiditis
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high TSH
low T4 antimicrosomal antibodies |
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exopthalmos, pretibial myxedema, low TSH
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grave's
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MCC cushing's syndrome
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iatrogenic corticosteroid administration
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hypocalcemia, hyperphosphatemia, low PTH
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hypoparathyroidism
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PTH effect on phosphate
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slightly lowers
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pt w/HA, weakness, polyuria. Exam: HTN, hypernatremia, hypokalemia, metabolic alkalosis
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primary hyperaldosteronism (Conn's syndrome or b/l adrenal hyperplasia)
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tachycardia, wild swings in BP, HA, diaphoresis, AMS, panic
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pheochromocytoma
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order of treatment for pheochromocytoma
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alpha antagonists before beta
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patient with dilute polyuria, h/o bipolar
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nephrogenic DI from lithium
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treatment of central DI
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administration of DDAVP, decrease serum osmolality
free water restriction |
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postop patient in lots of pain, p/w hyponatremia and normal volume status
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SIADH due to stress
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antidiabetic agent a/w lactic acidosis
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metformin
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patient p/w weakness, N/V, weight loss, skin pigmentation. Labs: hyponatremia, hyperkalemia. Treatment?
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primary adrenal insufficiency (addison's disease)
treat w/replacement glucocorticoids, mineralcorticoids, IVF |
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goal A1c in pt w/DM?
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<7. Normal <6.5
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treatment of DKA
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IVF, insulin, aggressive replacement of electrolytes
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why are beta blockers CI in diabetics?
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can mask symptoms of hypoglycemia
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bias when clinician is aware of patient's treatment type
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observational
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bias when screening detects a disease earlier
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lead-time bias
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# true positives / #pts with disease
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sensitivity
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chronic diseases - higher prevalence or incidence?
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prevalence
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epidemics - higher prevalence or incidence?
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incidence
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cross-sectional study: incidence or prevalence?
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prevalence
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cohort study - incidence or prevalence?
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both
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case control study - incidence or prevalence?
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neither
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test w/consistently identical results but results are wrong
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high reliability
low validity precise |
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difference b/w case control and cohort study?
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cohort can be used to calculate relative risk, and/or odds ratio
case control can be used to calculate odds ratio |
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attributable risk
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(IR of disease in exposed population) - (IR in unexposed)
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relative risk
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(IR exposed) / (IR not exposed)
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odds ratio
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(odds that diseased person was exposed) / (odds that nondiseased person was exposed)
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MC cancer in men, leading killer?
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prostate ca is MC, but lung cancer kills more
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when do you initiate colon cancer screening early?
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pt w/IBD, FAP/HNPCC, those with first degree relatives with adenomatous polyps (< 60 yo) or colorectal cancer
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% w/in 1 SD, 2 SD, and 3 SD of mean?
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68%, 95.4%, 99.7%
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birth rate?
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# live births/1000 population in 1 year
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fertility rate?
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# live births/1000 females (15-44 yo) in 1 year
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mortality rate?
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# deaths/1000 population 1 year
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neonatal mortality rate?
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# deaths 0-28 days old/1000 live birthds in 1 year
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postnatal mortality rate?
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# deaths 28 days - 1 yo/1000 live births in 1 year
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infant mortality rate?
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neonatal + postnatal mortality
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fetal mortality rate?
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# deaths 20 wks gestation - birth/1000 total births in 1 year
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perinatal mortality rate
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# deaths 20 wks gestation to 1 month of life/1000 total births in 1 year
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maternal mortality rate
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# deaths during pregnancy to 90 days postpartum/100,000 live births in 1 year
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can patients change mind after signing consent?
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yes
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15 y/o preggers requires hospitalization for preecalmpsia. Parental consent needed?
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no
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doctor refers a patient for an MRI at a facility they own. Ethical issue?
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conflict of interest
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Reasons for involuntary psychiatric hospitalization?
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danger to self, danger to others, or gravely disabled (cannot provide for basic needs)
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Is withdrawing nonbeneficial treatment ethically the same as withholding a nonindicated one?
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yes
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When can physician refuse to treat on grounds of futility?
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no rationale for treatment, maximal intervention is failing, given intervention has already failed, treatment will not achieve goals of care
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When must confidentiality be overridden?
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real threat of harm to 3rd part, SI, certain contagious diseases, elder or child abuse
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involuntary commitment or isolation when?
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treatment noncompliance represents serious danger to public health (active TB, meningitis)
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10 y/o p/w status epilepticus but parents refuse treatment for religious regions
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Treat b/c disease represents immediate threat to child's life, then seek court order
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when can physician withhold information from patient?
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therapeutic privilege (when telling patient might cause more harm, like suicide) or if patient requests not to be told
family cannot request |
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Patient p/w sudden onset severe, diffuse abdominal pain. Exam shows peritoneal signs, AXR free air under diaphragm. Management?
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emergent laparotomy to repair perforated viscus
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MCC acute lower GI bleed in patients >40 y/o?
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diverticulosis
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diagnostic modality when u/s equivocal for cholecystitis
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HIDA scan
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inspiratory arrest during palpation of RUQ
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murphy's sign (acute cholecystitis)
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MCC of SBO in patients with no history of abdominal surgery? with h/o abdominal surgery?
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hernia (w/o)
adhesions (w/) |
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MC organism causing diarrhea?
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campylobacter
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diarrhea w/recent abx use?
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clostridium difficile
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diarrhea w/recent camping?
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giardia
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travellers diarrhea?
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ETEC
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diarrhea after picnic?
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S. auerus
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diarrhea after uncooked hamburgers?
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E. coli O157:H7
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diarrhea after fried rice?
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bacillus cereus
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diarrhea after poultry/eggs?
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salmonella
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diarrhea after raw seafood?
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vibrio/HAV
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diarrhea with AIDS?
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isospora, cryptosporidium, MAC
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diarrhea w/pseudoappendicitis?
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yersinia
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25 y/o male p/w pain, watery diarrhea after meals. Exam shows fistulas b/w bowel and skin and nodular lesions on tibia?
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crohn's disease. risk of primary sclerosing cholangitis
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IBD with increased risk of colon cancer?
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UC
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extraintestinal manifestations of IBD
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uveitis, anklyosis spondylitis, pyoderma gangrenosum, erythema nodosum, primary sclerosing cholangitis
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treatment for IBD
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5-ASA agents and steroids during acute attacks
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reynold's pentad
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charcot's triad + shock and AMS, with suppurative ascending cholangitis
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medical treatment for hepatic encephalopathy
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decreased protein intake, lactulose, rifaximin (antibiotic, also used for travellers diarrhea)
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4 y/o p/w oliguria, petechiae, jaundice following illness w/bloody diarrhea. Dx and cause?
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hemolytic-uremic syndrome 2/2 E. coli O157:H7
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post HBV exposure treatment
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HBV immunoglobulin
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causes of drug induced hepatitis?
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TB meds (INH, rifampin, pyrazinamide), acetaminophen, tetracycline
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40 y/o woman w/high alk phos, elevated bili, pruritis, dark urine, clay colored stool?
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biliary tract obstruction
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hernia with highest risk of incarceration?
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femoral
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50 y/o alcoholic p/w epigastric pain, radiating to back and relieved by sitting forward. Management?
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Acute pancreatitis - confirm dx w/elevated amylase and lipase. NPO, IVF, O2, analgesia
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4 causes of microcytic anemia
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IDA
Thalassemia Anemia of Chronic disease Sideroblastic anemia |
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MC inherited cause of hypercoaguability?
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Factor V Leiden
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MC inherited bleeding d/o
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von Willebrand's disease
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MC inherited hemolytic anemia
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heriditary spherocytosis
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Dx test for spherocytosis?
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osmotic fragility test
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treatment for spherocytosis
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folic acid, splenectomy
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pure RBC aplasia
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diamond-blackfan anemia (congenital)
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anemia a/w absent radii and thumbs, diffuse hyperpigmentation, cafe-au-lait spots, microcephaly and pancytopenia?
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fanconi's anemia
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meds and viruses that lead to aplastic anemia
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choramphenicol
sulfonamides radiation HIV chemo agents hepatitis parvovirus B19 EBV |
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how to distinguish polycythemia vera from secondary polycythemia?
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vera should have normal O2 sats and low erythropoietin levels
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TTP pentad?
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fever, anemia, thrombocytopenia, renal dysfunction, neuro abnormalities
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HUS triad?
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anemia, thrombocytopenia, acute renal failure
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Treatment for TTP?
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emergent large volume plasmapheresis, corticosteroids, antiplatelet drugs
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treatment for ITP in kids?
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usually resolves spontaneously, sometimes need steroids/IVIG
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DIC labs?
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fibrin split products elevated
d-dimer elevated platelets low fibrinogen low hematocrit low |
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8 y/o boy p/w hemarthrosis, high PTT, normal PT and bleeding time. Diagnosis and treatment?
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hemophilia A or B
A: desmopressin factor VIII or IX supplements |
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14 y/o girl p/w prolonged bleeding after dental surgery and w/menses. Normal PT, nl/high PTT, high bleeding time. Dx and tx?
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vWD. Treat w/desmopressin, FFP or cryoprecipitate
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findings in multiple myeloma
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monocolonal gammopathy, bence jones proteinuria, punched out lesions on skull and long bones
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10 y/o boy p/w fever, weight loss, night sweats. Anterior mediastinal mass. Dx?
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non-hodgkins lymphoma
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microcytic anemia w/ low iron, low TIBC, nl/high ferritin
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anemia of chronic disease
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microcytic anemia with low iron, low ferratin, high TIBC
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IDA
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80 y/o male p/w fatigue, LAD, splenomegaly, isolated lymphocytosis. Dx?
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CLL
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lymphoma equivalent of CLL
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small lymphocytic lymphoma
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late life threatening complication f CML?
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blast crisis (fever, bone pain, splenomegaly, pancytopenia)
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auer rods
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AML
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AML subtype a/w DIC? Tx?
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M3
retinoic acid |
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electrolyte changes in tumor lysis syndrome
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hypocalcemia
hyperkalemia hyperphosphatemia high uric acid |
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t(9,22)
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CML
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significant cause of mortality in thalassemia patients? Tx?
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iron overload. Tx: deferoxamine
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Tx of sickle cell pain crisis
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O2, hydration, analgesia. Transfuse if severe
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AR d/o with defect in GPIIBIIIA platelt receptor and decreased platelet aggregation?
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glanzmann's thrombasthenia
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3 MCC of fever of unknown origin
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infection, cancer, autoimmune dz
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four ssx of streptococcal pharyngitis
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fever, pharyngeal erythema, tonsillar exudate, lack of cough
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nonsuppurative complication of streptococcal infection that is not altered by treatment of primary infection?
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postinfectious glomerulonephritis
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encapsulated organisms
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pneumococcus, meningococcus, h. flu, klebsiella
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# of bacteria on clean-catch specimen to dx a UTI?
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10^5 bacteria/mL
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pt from california or arizona p/w cough, malaise, fever, night sweats. dx and tx?
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coccidiodomycosis. amphotericin B
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meningitis in neonates - causes and tx
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GBS, E. coli, Listeria. Tx: amp and gent
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meningitis in infants - causes and tx
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pneumococcus, meningococcus, h. flu. Tx: cefotaxime and vanc
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Pt initially p/w pruritic papule w/regional LAD; evolves into a black eschar after 7 -10 days. Tx?
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cutaneous anthrax
tx: pen G or ciprofloxacin |
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tertiary syphilis findings
|
tabes dorsalis, general paresis, gummas, argyll robterson pupil, aortitis, aortic root aneurysms
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characteristics of secondary lyme dz
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arthralgias, migratory polyarthropathies, bells, myocarditis
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24 y/o male p/w soft white plaques on tongue and back of throat. Dx, w/u, tx?
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candidal thrush. W/u includes HIV testing. Treat w/nystatin oral suspension
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PCP and MAC prophylaxis - what CD4 count and what drugs?
|
PCP: <200, tmp-smx
MAC: <100, clarithromycin, azithromycin |
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neutropenic nadir postchemotherapy?
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7-10 days
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erythema migrans
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primary lyme
|
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endocarditis physical findings
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fever, murmur, osler's nodes, splinter hemorrhages, janeway lesions, roth spots
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ring enhancing lesion on CT w/seizures
|
t. solium (neurocysticercosis)
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branching rods in oral infection
|
actinomyces israelii
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painful chancroid
|
haemophilus ducreyi
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dog/cat bite
|
pasturella multocida
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gardner with infection
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sporothrix scheckii
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pregnant woman w/pets
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toxoplasma gondii
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meningitis in adults
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neisseria meningitidis
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meningitis in elderly
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s. pneumo
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infection in burn victims
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pseudomonas
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osteo from foot wound puncture
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pseudomonas
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osteo in sickle cell pt
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salmonella
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55 y/o male, smoker and drinker, p/w new cough and flulike sx. Gram stain shows no organisms; silver stain shows gram negative rods. Dx?
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legionella
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middle age man p/w acute onset monoarticular joint pain, b/l bell's palsy. Dx? Tx?
|
lyme disease from ixodes tick. Tx doxycycline
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pt gets endocarditis 3 weeks after getting prothetic heart valve. What organism?
|
s. aureus or s. epidermis
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back pain exacerbated by standing and walking, relieved by sitting and hyperflexion of hips
|
spinal stenosis
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joints in hand affected by rheumatoid arthritis
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MCP and PIP; DIP are spared
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joint pain/stiffness that worsens over course of day , relieved by rest
|
osteoarthritis
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hip and back pain along w/stiffness that improves with activity of course of day, worse with rest. Diagnostic test?
|
Suspect ankylosis spondylitis. Check HLA-B27
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Arthritis, conjunctivitis, urethritis in young men a/w what organisms?
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camplyobacter, shigella, salmonella, chlamydia, ureaplasma
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chronic gout tx?
|
allopurinol or probenecid
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elderly woman p/w pain and stiffness of shoulders and hips; cannot lift arms above head. Labs show anemia, high ESR
|
polymyalgia rhuematica
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active 13 yo boy w/anterior knee pain
|
osgood-schlatter disease
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bone fractured in fall on outstretched hand?
|
colle's fracture - distal radius
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complication of scaphoid fracture
|
avascular necrosis
|
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Humeral fracture - what nerve may be damaged and what will the signs be?
|
radial nerve - wrist drop and loss of thumb abduction
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young child p/w proximal muscle weakness, waddling gait, pronounced calf muscles
|
duchenne muscular dystrophy
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11 y/o obese male p/w sudden onset limp. W/u and dx?
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Slipped capital femoral epiphysis. AP and frog-leg lateral view
|
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MC primary malignant tumor of bone
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multiple myeloma
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unilateral, severe periorbital HA with tearing and conjunctival erythema
|
cluster ha, best treatment is 100% O2
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prophylactic treatment for migraine
|
antihypertensives, antidepressants, anticonvulsants
|
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MC pituitary tumor and treatment?
|
prolactinoma. bronocriptine (dopamine agonists)
|
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55 y/o pt p/w broken speech. What type of aphasia, what lobe and vascular distribution
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broca's aphasia
frontal lobe, left MCA |
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MCC of SAH
|
trauma! Berry aneurysm is 2nd MC
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albuminocytologic dissociation
|
GBS (increased protein in CSF without significant increase in cell count)
|
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cold water flushed into ear, fast phase of nystagmus is towards opposite side. Normal or abnormal?
|
normal
(COWS) |
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MC primary sources of mets to brain
|
lung, breast skin, kidney,GI
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what kind of seizures may be confused with ADHD?
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absence
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MC presentation of intracranial neoplasm
|
headache
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MCC seizures in children
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infection, fever, trauma, idiopathic
|
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MCC seziures in young adults
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trauma, alcohol w/drawl, brain tumor
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first line tx for status epilepticus
|
IV benzodiazapine
|
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confusion, confabulation, opthalmoplegia, ataxia
|
wernicke's encephalopathy
|
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when do you do a carotid endrterectomy?
|
70% if the stenosis is symptomatic
|
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treatment of GBS
|
IVIG or plasmapheresis
|
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6 y/o girl p/w port wine stain in V2 region, MR, seizures and ipsilateral leptomeningeal angioma
|
sturge-weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe
|
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hyperphagia, hypersexuality, hyperorality, hyperdocility
|
kluver-bucy syndrome (amygdala)
|
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|
how to diagnose myesthenia graivs?
|
edrophonium
|
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|
MCC causes of third trimester bleeding
|
placental abruption, placenta previa
|
|
|
u/s and gross appearance of a complete hydatidiform mole?
|
snowstorm on u/s
cluter of grapes on physical |
|
|
chromosomal pattern of complete mole?
|
46,XX
|
|
|
molar pregnancy containing fetal tissue?
|
partial mole
|
|
|
symptoms of placental abruption
|
painful continuous bleeding
|
|
|
symptoms of placenta previa
|
self limited painless bleeding
|
|
|
suspect placenta previa - when do you do a vaginal exam?
|
never
|
|
|
antibiotics w/teratogenic effects
|
tetracycline
fluoroquinolones aminoglycocides sulfonamides |
|
|
MCC postpartum hemorrhage, treatment?
|
uterine atony - massage, oxytocin
|
|
|
antibiotics for GBS prophylaxis
|
IV penicillin or ampicillin
|
|
|
patient fails to lactate after emergency C/S w/marked blood loss
|
sheehan's syndrome
|
|
|
uterine bleeding at 18 weeks gestation. No products expelled. Dx if os open? closed?
|
open - inevitable
closed - threatened |
|
|
amenorrhea w/normal prolactin, no response to estrogen-progesterone challange and h/o D&C?
|
asherman's syndrome (adhesions)
|
|
|
therapy for PCOS
|
weight loss, ocps
|
|
|
medication to induce ovulation
|
clomiphene citrate
|
|
|
indications for medical tx of ectopic pregnancy
|
stable, unruptured, <3.5 cm at <6 weeks gestation
|
|
|
medical treatment of endometriosis
|
OCPs, danazol, GnRH agonists
|
|
|
laparoscopic findings in endometriosis
|
chocolate cysts, powder burns
|
|
|
MC location of ectopic pregnancy?
|
ampulla of oviduct
|
|
|
how do you diagnose and follow a leiomyoma?
|
u/s
|
|
|
natural history of a leimyoma
|
regresses after menopause
|
|
|
MCC bloody nipple discharge
|
intraductal papilloma
|
|
|
unopposed estrogen is contraindicated in which cancers?
|
endometrial
estrogen receptor + breast cancer |
|
|
pt p/w recent PID w/RUQ pain
|
fitz-hugh-curtis syndrome
|
|
|
breast malignancy presenting as itching, burning, erosion of nipple
|
paget's disease
|
|
|
annual screening for women w/strong family history of ovarian cancer
|
CA-125 and transvaginal u/s
|
|
|
30 y/o woman has unpredictable urine loss, normal exam. Medical options?
|
anticholinergics (osybutynin) or beta adrenergics (metaproterenol) for urge incontinence
|
|
|
lab values in menopause
|
high FSH (high LH too, just not as high as FSH)
|
|
|
MCC of female infertility
|
endometriosis
|
|
|
2 consectutive findings of ASCUS on pap?
|
coloposcopy and endocervical curettage
|
|
|
breast cancer that increases future risk of invasive carcinoma in both breasts
|
lobular carcinoma in situ
|
|
|
nontender abdominal mass a/w elevated VMA/HVA
|
neuroblastoma (peds)
|
|
|
MC type of TEF? Dx?
|
esophageal atresia w/distal TEF. Dx by unable to pass NG tube
|
|
|
tests to r/o shaken baby syndrome
|
optho exam, CT, MRI
|
|
|
neonate w/meconium ileus
|
CF or Hirschsprung's disease
|
|
|
bilious emesis w/in hours after first feeding
|
duodenal atresia
|
|
|
2 mo baby p/w nonbilious projective vomiting. Management?
|
Correct metabolic abnormalities then correct pyloric stenosis w/pyloromyotomy
|
|
|
MC primary immunodeficiency
|
Selective IgA deficiency
|
|
|
infant has high fever and onset of rash as fever breaks. What are they at risk for?
|
febrile seizures
(they had roseola - HHV6/7) |
|
|
Boy w/chronic respiratory infections. Nitroblue tetrazolium test is positive
|
chronic granulomatous disease
|
|
|
child w/eczema, thrombocytopenia, and high levels of IgA?
|
wiskott-aldrich syndrome
|
|
|
4 mo boy has life-threatening pseudomonas infection
|
bruton's x-linked agammaglobulinemia
|
|
|
acute phase tx for kawasaki
|
high dose ASA
IVIG |
|
|
treatment for mild and severe unconjugated hyperbilirubinemia
|
phototherapy (mild) or exchange transfusion (severe)
|
|
|
sudden onset of mental status change, emesis, and liver dysfunction after ASA
|
reye's syndrome
|
|
|
child has loss of red light reflex
|
suspect retinoblastoma, congenital cataracts
|
|
|
vaccinations at 6 mo well child visit
|
HBV
DTaP Hib IPV PCV |
|
|
infection of small airways with epidemics in winter and spring
|
RSV bronchiolitis
|
|
|
cause of neonatal RDS
|
surfactant deficiency
|
|
|
red "currant-jelly" stools
|
intussusception
|
|
|
congenital heart disease causing HTN
|
coarction
|
|
|
first line tx for otitis media?
|
amoxicillin x 10 days
|
|
|
MC pathogen causing croup
|
parainfluenza virus type 1
|
|
|
homeless child small for age and has peeling skin and swollen belly
|
kwashikor - protein malnutrition
|
|
|
boy with MR, gout, self mutilation, and choreoathesis
|
lesch-nyhan syndrome (purine salvage problem with HGPRTase deficiency)
|
|
|
newborn girl with continuous machinery murmur
|
PDA
|
|
|
first line pharmacotherapy for depression
|
SSRIs
|
|
|
antidepressants a/w hypertensive crisis
|
MAOIs
|
|
|
galactorrhea, impotence, menstrual dysfunction, decreased libido. What med?
|
dopamine antagonist
|
|
|
17 yo girl has left arm paralysis after boyfriend dies, no medical cause
|
conversion d/o
|
|
|
mother angry at husband yells at child. defense mechanism?
|
displacement
|
|
|
pedophile enters a monestary. defense mechanism?
|
reaction formation
|
|
|
woman calmly describes a grisly murder. defense mechanism?
|
isolation
|
|
|
hospitalized 10 y/o begins to wet his bed. defense mechanism?
|
regression
|
|
|
life threatening muscle rigidity, fever, and rhabdomyolysis
|
neuroleptic malignant syndrome
|
|
|
35 yo male has recurrent episodes of palpitations, diaphoresis and fear of going crazy
|
panic d/o
|
|
|
most serious side effect of clozapine
|
agranulocytosis
|
|
|
21 yo male has 3 months of social w/drawl, worsening grades, flattened affect, and concrete thinking
|
schitzophreniform d/o (when >6 months of symptoms its schitzophrenia)
|
|
|
key SE of atypical antipsychotics
|
weight gain, type 2 DM, QT prolongation
|
|
|
young weight lifter received IV haloperidol and complains that his eyes are deviated sideways. Dx and tx?
|
acute dystonia (oculogyric crisis). Treat with benzotropine or diphenhydramine
|
|
|
medication to avoid in patients with h/o alcoholic w/drawl seizures
|
neuroleptics (antipsychotics)
|
|
|
13 yo male has h/o theft, vandalism, and violence towards family pets
|
conduct d/o (when patient reaches 18 it may be diagnosed as antisocial personality d/o)
|
|
|
5 mo girl has decreased head growth, truncal dyscoordination and decreased social interaction
|
rett's d/o
|
|
|
patient hasn't slept for days, lost $20,000 gambling, is agitated and has pressured speech. Dx and tx?
|
acute mania. start w/mood stabilizer (lithium)
|
|
|
after a minor fender bender a man wears a neck brace and requests permanent disability
|
malingering
|
|
|
nurse p/w severe hypoglycemia; blood analysis reveals no elevation in c-peptide
|
factitious d/o
|
|
|
patient continues to use cocaine after being in jail, losing job and not paying child support
|
substance abuse
|
|
|
violent patient has horizontal and vertical nystagmus
|
PCP
|
|
|
woman who was abused as a child frequently feels outside of or detached from her body
|
depersonalization d/o
|
|
|
man has repeated, intense urges to rub his body against unsuspecting passengers on a bus
|
frotteruism (a paraphilia)
|
|
|
schizophrenic patient takes haloperidol for one year and develops uncontrollable tongue movements. Dx and tx?
|
tardive dyskinesia. decrease or d/c haloperidol and consider another antipsychotic (risperidone, clozapine)
|
|
|
man unexpectedly flies across the country, takes a new name and has no memory of his prior life
|
dissociative fugue
|
|
|
criteria for exudative effusion
|
pleural/serum protein >0.5
pleural/serum LDH >0.6 |
|
|
causes of exudative effusion
|
leaky capillaries from malignancy, TB, infection, PE w/infarct, pancreatitis
|
|
|
causes of transudative effusion
|
intact capillaries - CHF, liver or kidney disease, protein losing enteropathy
|
|
|
normalizing PCO2 in a patient having an asthma exacerbation may indicate what?
|
fatigue and impending respiratory failure
|
|
|
dyspnea, lateral hilar LAD, noncaseating granulomas, increased ACE, hypercalcemia
|
sarcoidosis
|
|
|
PFTs showing decreased FEV1/FVC?
|
obstructive pulmonary dz (asthma)
|
|
|
PFTs showing increased FEV1/FVC
|
restrictive lung disease
|
|
|
honeycomb pattern on CXR. Dx and tx?
|
diffuse interstitial pulmonary fibrosis. supportive care, steroids may help
|
|
|
treatment for SVC syndrome
|
radiation
|
|
|
treatment for mild, persistant asthma
|
inhaled beta-agonists and inhaled corticosteroids
|
|
|
treatment for COPD exacerbation
|
O2, bronchodilators, antibiotics, CSTs w/taper, smoking cessation
|
|
|
treatment for chronic COPD
|
smoking cessation, home O2, beta agonists, anticholinergics, systemic or inhaled CSTs, flu and pna vaccines
|
|
|
acid-base d/o in pulmonary embolism
|
hypoxia and hypocarbia (respiratory alkalosis)
|
|
|
non-small cell lung ca a/w hypercalcemia
|
squamous cell
|
|
|
lung ca a/w SIADH
|
small cell
|
|
|
lung ca highly a/w smoking
|
small cell
|
|
|
tall white male p/w acute shortness of breath. dx and tx?
|
spontaneous pneumothorax. spontaneous regression, but supplemental o2 may be helpful
|
|
|
treatment of tension pneumothorax?
|
immediate needle thoracostomy
|
|
|
solitary pulmonary nodule - are calcifications a good thing or not?
|
yes - less likely to be malignancy
|
|
|
hypoxemia and pulmonary edema w/normal PCWP
|
ARDS
|
|
|
sequelae of asbestos exposure
|
pulmonary fibrosis, pleural plaques, bronchogenic carcinoma (mass in lung field), mesothelioma (pleural mass)
|
|
|
increased risk of what infection w/silicosis?
|
mycobacterium tuberculosis
|
|
|
causes of hypoxemia
|
right to left shunt, hypoventilation, low inspired O2 tension, diffusion defect, V/Q mismatch
|
|
|
classic CXR findings for pulmonary edema
|
cardiomegaly, prominent pulmonary essels, kerley b lines, bats wing appearance of hilar shadows, and perivascular and peribronchial cuffing
|
|
|
RTA a/w abnormal H+ secretion and nephrolithiasis
|
type 1 - distal
|
|
|
RTA a/w abnormal HCO3 and rickets
|
type 2 - proximal
|
|
|
RTA a/w aldosterone defect
|
type 4 - distal
|
|
|
"doughy" skin
|
hypernatremia
|
|
|
differential of hypervolemic hyponatremia
|
cirrhosis, CHF, nephritic syndrome
|
|
|
MCC of hypercalcemia
|
hyperPTH and malignancy
|
|
|
T wave flattening, U waves
|
hypokalemia
|
|
|
peaked T waves, wide QRS
|
hyperkalemia
|
|
|
first line tx for moderate hypercalcemia
|
IV hydration and loop diuretics
|
|
|
classic CXR findings for pulmonary edema
|
cardiomegaly, prominent pulmonary essels, kerley b lines, bats wing appearance of hilar shadows, and perivascular and peribronchial cuffing
|
|
|
RTA a/w abnormal H+ secretion and nephrolithiasis
|
type 1 - distal
|
|
|
RTA a/w abnormal HCO3 and rickets
|
type 2 - proximal
|
|
|
RTA a/w aldosterone defect
|
type 4 - distal
|
|
|
"doughy" skin
|
hypernatremia
|
|
|
differential of hypervolemic hyponatremia
|
cirrhosis, CHF, nephritic syndrome
|
|
|
MCC of hypercalcemia
|
hyperPTH and malignancy
|
|
|
T wave flattening, U waves
|
hypokalemia
|
|
|
peaked T waves, wide QRS
|
hyperkalemia
|
|
|
first line tx for moderate hypercalcemia
|
IV hydration and loop diuretics
|
|
|
FeNa <1%
|
prerenal ARF
|
|
|
49 yo male p/w acute onset flank pain and hematuria
|
nephrolithiasis
|
|
|
MC type of nephrolithiasis
|
calcium oxalate
|
|
|
20 yo male p/w palpable flank mass and hematuria. u/s shows b/l enlarged kidneyss w/cysts. what is he at risk for?
|
berry aneurysms (autosomnal dominant PCKD)
|
|
|
hematuria, HTN and oliguria
|
nephritic syndrome
|
|
|
protienuria, hypoalbuminuria, hyperlipidemia, hyperlipiduria, edema
|
nephrotic syndrome
|
|
|
MC form of nephritic syndrome
|
membranous glomerulonephritis
|
|
|
MC form of glomeruolnephritis
|
IgA nephropathy (berger's disease)
|
|
|
glomerulonephritis w/deafness
|
alport's syndrome
|
|
|
glomerulonephritis w/hemoptysis
|
wegener's granulomatosis and goodpasure's syndrome
|
|
|
presence of red cell casts in urine sediment
|
glomerulonephritis/nephritic sndrome
|
|
|
eosiniophils in urine sediment
|
allergic interstitial nephritis
|
|
|
waxy casts in urine sediment and maltese crosses
|
nephrotic syndrome
(maltese crosses seen w/lipiduria) |
|
|
drowsiness, asterixis, nausea, pericardial friction rub
|
uremic syndrome in patient w/renal failure
|
|
|
55 yo male dx w/prostate ca. treatment options?
|
wait, surgical resection, radiation and/or androgen suppression
|
|
|
low urine specific gravity in presence of high serum osmolality
|
diabetes insipidus
|
|
|
treatment of SIADH
|
fluid restriction, demeclocycline (antibiotic)
|
|
|
hematuria, flank pain, palpable flank mass
|
RCC
|
|
|
testicular cancer a/w beta-hcg, AFP
|
choriocarcinoma
|
|
|
MC type of testicular cancer
|
seminoma (germ cell tumor)
|
|
|
MC histology of bladder ca
|
transitional cell
|
|
|
complication of overly rapid correction of hyponatremia
|
central pontine myelinolysis
|
|
|
salicylate ingestion occurs in what type of acid-base d/o?
|
anion gap acidosis and primary respiratory alkalosis due to central respiratory stimulation
|
|
|
acid-base disturbance commonly seen in pregnant women
|
respiratory alkalosis
|
|
|
elevated erythropoietin level, elevated hematocrit, and normal O2 sat?
|
RCC or other erythropoietin producing tumor; evaluate w/CT
|
|
|
55 yo male p/w irritative and obstructive urinary symptoms. treatment options?
|
likely BPH - no treatment, terazosin, finasteride, or surgical intervention (TURP)
|
|
|
class of drugs that may cause muscle rigidity, hyperthermia, autonomic instability, EPS?
|
antipsychotics - neuroleptic malignant syndrome
|
|
|
side effects of CSTs?
|
acute mania, immunosuppresion, thin skin, osetoporosis, easy bruising, myopathies
|
|
|
treatment for DTs
|
benzodiazepines
|
|
|
treatment for acetaminophen OD
|
n-acetylcysteine
|
|
|
treatment for opioid OD
|
naloxone
|
|
|
treatment for benzo OD
|
flumazenil
|
|
|
treatment for NMS and malignant hyperthermia
|
dantrolene
|
|
|
treatment for malignant hypertension
|
nitroprusside
|
|
|
treatment of afib
|
rate control, rhythm conversion, anticoagulation
|
|
|
treatment of supraventricular tachycardia
|
if stable, rate control w/carotid massage or other vagal stimulation
if unsuccessful, try adenosine if unstable, cardioversion |
|
|
causes of drug induced SLE
|
INH, penicillamine, hydralazine, procainamide, chlorpromazine, methyldopa, quinidine
|
|
|
treatment of CO poisoning
|
100% O2 or hyperbaric O2 if severe or patient is pregnant
|
|
|
test to r/o urethral injury
|
retrograde cystourethrogram
|
|
|
radiographic evidence of aortic disruption or dissection
|
widened mediastium (>8 cm), loss of aortic knob, pleural cap, tracheal deviation to the right, depression of left main stem bronchus
|
|
|
radiographic indications for surgery in patients w/acute abdomen
|
free air under diaphragm, extravasation of contrast, severe bowel distention, space occupying lesion, mesenteric occlusion
|
|
|
MC organism in burn related infections
|
pseudomonas
|
|
|
method of calculating fluid replacement in burn patients
|
parkland formula
|
|
|
acceptable urine output in a trauma patient
|
50 cc/hr
|
|
|
acceptable urine output in a stable patient
|
30 cc/hr
|
|
|
cannon "a" waves
|
3rd degree heart block
|
|
|
signs of neurogenic shock
|
hypotension and bradycardia
|
|
|
signs of increased ICP (cushings triad)
|
hypertension, bradycardia, abnormal respirations
|
|
|
low cardiac output, low PCWP and increased PVR
|
hypovolemic shock
|
|
|
low cardiac output, high PCWP, high PVR
|
cardiogenic or obstructive shock
|
|
|
high cardiac output, low PCWP, low PVR
|
septic or anaphylactic shock
|
|
|
treatment of septic shock
|
fluids and abx
|
|
|
treatment of cardiogenic shock
|
identify cause; pressors (dopamine)
|
|
|
treatment of hypovolemic shock
|
identify cause; fluid and blood repletion
|
|
|
treatment of anaphylactic shock
|
diphenydramine or epinephrine 1:1000
|
|
|
supportive treatment for ARDS
|
CPAP
|
|
|
patient w/chest trauma who was previously stable suddenly dies
|
air embolism
|
|
|
trauma series
|
AP chest, AP/lateral C-spine, AP pelvis
|
