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97 Cards in this Set

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Syptoms of B12 or Folate def, what next?
1- Peripheral smear 2- Transcobalamin (neg in 30% pts)
difference btw megaloblastic/macrocytic anemia
mega-hypersegmented neutrophils, Megaloblastic= b12/folate. Macrocytic can be caused by alcohol, liver ds, meds, b12/folate def.
Most common cause of epididymitis?
Chlamydia, followed by N Gono. Tx Ceftriaxone and doxycycline.
Diagnosing Goodpastures/Wegners.
Biopsy W Granulomatosis- vasculitis of small to medium size vessels. Ulcerating granulomas of upper/lower respt.
Antibody for renopulmonary syndromes?
P-Anca (Pulmonary Anca) / anti-myeloperoxidase seen in microscopic polyangiitis and Churg-Straus syndrome.
Quick sreening for wegners?
c-anca (pos 65-90%)
neutropenic fever?
START ANTIBIOTICS, (abs neutros <500/mm with fever) 1- antipseudomonals ceftazidime, cefepime or imipenem along with aminoglycoside (micin/amikacin)
neutropenic fever with indwelling catheter?
ADD VANCOMYCIN for MRSA
Osteoporosis, most important risk factor?
1- Gender: Female 2- Race Caucasian
PECULIAR MULTIPLE ARTHRITIS: Non deforming plyarthritis that is asymmetric with diarrhea, fat mal absorption, wt loss. May have CNS abnormalities and endocarditis.
Whipple's Dz, do a small bowel biopsy. ARTHRITIS NOT SEEN IN Celiac, Tropical Sprue, or Chronic Pancreatitis (do however have fat mal, diarrhea and wt loss) Brucellosis- fever/bacteremia with arthritis, n/v/d and endocarditis.
Seen in Whipple's small bowel biopsy?
PAS positive organism, ceftriaxone followed by a year of TMP/SMX for eradication
BMI informal criterion for anorexia?
<17.5 Consider hospitalization <15.9
Anorexia: hospitalization criteria?
wt <30% normal, continued wt loss, unstable vitals, pulse less than 40, dehydration, malnutrition (complications of), refeeding syndrome - edema or phos <2.
Kidney stone: needle shaped?
Indinavir not visible on xray (pts should drink 1.5L per day) Can cause renal failure in up to 30% of HIV pts.
Kidney stone: envelope shaped?
calcium oxolate (most common) radiopaque (visible) on xray
Kidney stone: hexagonal shaped?
COLA autosomal recessive in tubular reabsorption of COLA.
Kidney stone: "coffin lid"?
triple phosphate/struvite seen with bac infections: proteus, pseudomonas and klebsiella or in persistently high PH >7.2
Kidney stone: rhombic-rosette shaped?
Uric acid (10%) not visible on xray. Low volume, low ph urine. Seen in Crohns, malignancy, myeloproliferative, gout, hyperuricemia.
Hip pain with long term steroid use?
Avascular necrosis of the hip. 1- get an MRI. 2- start bisphosphonate. Refractory or core decompression needs surgery.
Common complication of surgical treatment of peptic ulcer disease? Or any stomach surgery?
dumping symdrome, vasomotor and gastrointestinal manifestations. Eat smaller frequent meals with less carbohydrates and more protien and fats. Somatostatin may be used in refractory cases.
Difference in clinical manifestations btw Spontaneous SLE and Drug Induced?
Spontaneous - CNS and Renal involvment. Similar: Serositis-Pericarditis, Skin Involvment, Hematological- Pancytopenia, Joint Pain.
<50 dysphagia to liquids then solids?
achalasia, loss of relaxation of the lower esophogeal sphincter.
>50 dysphagia to liquids then solids?
Esophageal Cancer
dysphagia to solids only?
Plummer Vinson - Fe Def rings/webs
pain on swallowing?
ODINOPHAGIA
DKA treatment, Potassium drops to normal? What do you do?
REPLEAT POTASSIUM, it will continue to drop. DKA is a K-wasting state. Acidosis K out of cells, Initially do NaCL bolus and Insuline for hyperkalemia. Once K normal and Glucose normal, <4.5 add potassium and switch to half normal saline to prevent overshooting.
Pt allergic to penicillin, but you want to give a cephalosporin? What do you do?
Penicillin skin allergy test, if neg give cephalosporin.
Cataracts, petechia and purpura - extramedullary hematopoiesis, hemolytic anemia, intrauterine growth restriction. Newborn?
Rubella
Hepatosplenomegaly, petechia, thrombocytopenia, jaundice, microcephaly with periventricular calcifications. Newborn?
CMV
pneumonia, poor feeding that progress to hypotension, jaundice, DIC and shock. Newborn?
Herpes
Fever, hepatosplenomegaly, chorioretinitis and hydrocephalus with intercranial calcifications at birth?
Toxoplasmosis
Vesicular rash that progresses to pneumonia, hepatitis, and meningioencephalitis.
Varicella
Woman couple days post C section. With severe headache. What do you want to rule out? and if that is negative?
Rule out Venous Sinus Thrombosis (sinus thrombosis peripartum). Get MRV/MRI if negative get a lumbar puncture for pseudotumor cerebri (idiopathic intercranial hypertension)
Refeeding syndrome?
Hypophosphatemia,
Insulin skyrockets due to feeding with a highcarb meal causing increase in glycolysis that results in depletion of phosphate. Presenting with lethargy and muscle weakness.
COPD in acute exacerbation, this has been shown to decrease mortality and need for endotracheal intubation?
Non invasive positive pressure ventilation. Administration of positive end-expiratory pressure splinting open airways and preventing dynamic airway colapse. And helps correct respiratory acidosis.
Most accurate diagnostic tests for creamy urethral discharge?
Nucleic acid amplification test of voided urine. used for chlamydial and gonorrheal infections.
Perianal itching in school age children?
Enterobius Vermicularis,
Vulvovaginitis can occur and can cause increased risk of UTI's
Tx albendazole, mebendazole or pyrantel pamoate.
Active cigarette smoking comes to clinic?
Counsel all active smokers every visit.
ASK to identify, ADVISE to stop, ASSESS to determine willingness, ASSIST with cessation, ARRANGE follow up to monitor progress.
ANA has the greatest sensitivity for?
Drug induced lupus if negative rules it out.
Positive ANA is non-specific, positive without symptoms means nothing.
Vitiligo treatment?
Topical steroids and phototherapy
Tetanus Prophylaxis?
3 doses in last 5 years - need nothing. Recieved tetanus toxoid btw 5-10 yrs contaminated wound - booste, clean - nothing.
>10 years need booster and if dirty need Tetanus IGG
Parkinson's order of treatment.
1- Carbadopa/Levodopa
2- severe disease add on COMT inhibitors Tolcapone/entacapone
Severe Parkinson disease on high dose levo/carbidopa that develope psychiatric symptoms, psychosis?
Use Quetiapine
if you stop levo/carbi patient will become frozen
Multiple infammatory, deep-seated, cystic lesions on face with pitting scars wants "acne" treatment?
Nodular acne is disfiguring and should be managed aggressively. Isotretinoin, requires TWO different contraceptive methods 1 month prior to, during and 1 month after treatment.
Hypochondriasis treatment?
Patient believes they have and organic disorder when everything is negative. Patients require reassurance and compassion. Should be seen on a regular basis by both primary and psych
Neuroleptic malignant syndrome, avoid?
anticholinergics, benztropine
Sickle Cell Adult Patient with fever or WBC count that is higher than there usual level?
They are functionally asplenic. START ABX: ceftriaxone, levofloxacin, moxifloxacin.
Cover encapsulated organisms:
Pneumococcus, Hemophilus, Klebsiella
tramatic lumbar puncture? Normal opening pressure?
CSF is initially red and clear when centrifuged. RBC have yet to lyse. Normal opening pressure 100-200
APGAR mean?
Perfect 10
Appearance: 2-totally pink
Pulse: 2- >100
Grimace: 2-cough/sneeze
Activity: 2-active motion
Respiratory effort: 2-crying/good
Sickle cell trait will have what problems?
Hematuria,
increased UTI's,
Urinary concentration defects, tubule defects leads to dehydration
Allergic Rhinitis first line treatment?
Topical Intranasal Steroids
Mometasones

Then add a intranasal 2nd gent antihistamine: loratadine, cetirizine, fexofenadine
Calculate Tidal Volume?
6mL/Kg
Side effect of ticlopidine?
neutropenia, use clopidogrel first
Catheter Related Infections?
Most common: Gram Positive Organisms such as Staph A, coagulase neg Staph Epi, less comon Gram Neg E Coli or Pseudomonas.
Treat with Vanco for gram positives and Cefepime for gram neg and pseudomonas
Catheter related infection found to be gram negative?
STOP VANCO
continue Cefepime
Holosystolic radiation to axilla?
When do I get a cardiosurgeon?
Mitral Regurge,
evaluation for valve repair are:

End-systolic left ventricular demension >45mm or

Left ventricualar ejection fraction less than 55%.
Chest Xray in batwing configuration that progresses to diffuse reticulogranular pattern. CT shows patchy ground glass opacification with intralobular septal thickening and intalobular interstitial thickening. BAL - Positive PAS
PULMONARY ALVEOLAR PROTIENOSIS

Most effective treatment is therapeutic whole lung lavage via double lumen endotracheal tube.
Risk of stroke is high with?
Atrial Fibrillation alone 5 fold increase

AF + Rheumatic Heart Disease - 17 fold increase
Headache that feels better when lying down, then gets worse with getting up and resuming normal activity. Patients condition and management?
Spontaneous intercranial hypotension;
Brain MRI will show cerebellar tonsillar descent and diffuse pachymeningeal gadolinium enhancement.
Individual recently acquired STD?
Vaccinate against hepatitis B
HSV-1
HSV-2
Location and recurrence rates in genital lesions?
One set of lips - HSV-1 55%
Two vag/penis- HSV-2 90%
Newborn, subcostal and intercostal retractions, absent air entry on the left side and poor air on the right. Gurgle like sound in the left chest. Heart sound heard best in right hemithorax. Flat abdomen no organomegaly. What is going on?
Congenital diaphragmatic hernia, with defect in the left hemidiaphragm.
Heart displaced to right and pulmonary hypoplasia.
If p-hypoplasia is severe admin of O2 will result in poor imp of oxygenation.
Most sensitive method for detection of appropriatly placed tube?
Detection of end tidal carbon dioxide.

False positive - enough air in stomach
False negative - no circulation (HF or PE)
Acute Respiratory Distress
define?
PROFOUND HYPOXIA
-PaO2/FiO2 ratio <200

must maintain tidal volumes less than 6cc/kg
peak inspiratory pressure limited to 35cm H2O or less
Peak expiratory pressure >10cm H2O
Lead Levels
10-14
15-19
20-44
45-69
70+
10-14 recheck 3mth
15-19 recheck 2mths
20-44 recheck 1wk

45 repeat 2days start succimer

70+ hospitalize - repeat lead lv and start two chelation therapies: dimercaprol and Ca EDTA
Earliest test to exclude myocardial ischemia?
Myoglobin
(high false negative but if negative has high predictive value)
rises immediately, and peaks at 6hrs.
If negative at 4 hours can exclude infarct.
Best initial test in poly/dermatomyositis?
CK and Aldolase
Patient presents with poly/dermatomyositis and shortness of breath. What will determine etiology of lung disorder?
Anti-Jo
Interstitial lung disease associated with Poly/DermM

Decreased diffusion capacity of CO

Restrictive (normal FEV1/FVC)
Second line oral DM agents when concern is weight gain?
dipeptidyl peptidase-4 inhibitors
Sitagliptin saxagliptin and linagliptin

DDP metabolizes GLP Glucagon-like peptide which raises insulin and decreases glucagon

DO NOT INCREASE WT
Child with tea colored urine, eye swelling in the morning. Unremarkable physical. UA shows red cell casts.
Confirm diagnosis? expected?
Antistreptolysin O Antibody

Post-streptococcal Glomerulonephritis
MOST COMMON CAUSE OF glomerulonephritis in children.

Hematuria - red cell casts, proteinuria, hypotension and edema.
Labs show decreased complement (C3, C4) and high BUN
Pelvic Fractures?
Importance?
Treatment?
Double ring pelvic fractures, especially with pubic symphysis diastasis are life threatening associated with hemorrhage and visceral injury.
Pelvis can hold 2L of blood.
Treatment: fix the pelvis to prevent further instability and tamponade the bleeding.
Microcytic Anemia with high circulating iron?
Sideroblastic Anemia

Microcytic anemia: Anemia of CD, Fe def anemia, Thalassemia.
Normal Hgb profile?
HgA 96%
HgA2 3%
HgF 1%

also in Alpha thal minor
Microcytic anemia with an elevated retic count?
Hemoglobin H disease
B Thalassemia trait Hgb profile?
HgA ~85%
HgA2 ~10%
HgF ~5%
B Thalassemia MAJOR Hgb profile?
HgA 0%
HgA2 ~50%
HgF ~50%
Crush Injury, immediate treatment?
Alkalinized intravenous crystalloid prevents renal damage from myoglobin
Patient had a siezure, you control it with IV Lorazepam, what next?
RULE OUT CAUSES: electrolyte, metabolic, drug related, organic.
Before you order a EEG or load with anti epileptic drugs.
Hyper/o natremia
Hypo Ca, Mg, O2, Gluc
Liver/Renal failure
Intercranial defect
Cocaine toxicity
Benzo/Barb withdrawl
Heat stroke, important labs and treatment?
mental status changes!!
risk for DIC (petechia, low plt, prolong coags) - fibrin split products
risk for rhabdo - CK >10,000 is significant enough to cause ARF
risk for ARF - UA keep a high urine output and target pH 7-8 (alkalinize)
Stains silver from bronchial sputum?
Legionella

Pneumocystis carinii
When can you visualize a gestational sac?
B-hCG >1,500 with transvaginal US
B-hCG>6,000 with transabdominal US

B-hCG doubles every 2 days in first 2 mths of pregnancy
Methotrexate for ectopic pregnancy treatment?
Hemodynamically stable
B-hCG <5,000
Mass <3-4cm
No fetal activity

1- Give dose
2- repeat B-hCG 4 days and 1 week (>15% dec=> DONE)
3- <15% give another dose then check in 1 week.
Asymptomatic female <25, sexually active regardless of age. Recommended screening?
Chlamydia, regardless of age who has more than one sexual partner, hx of sexually transmitted dz or does not use condoms regularly.
Vaccinations that a pregnant woman can recieve?
Influenza - given routinely
Hep A/B - high risk (travel, health care worker)
Pneumo
Meningococcus
Typhoid
IV-tPA for acute ischemic stroke?
Given no contraindications, given within 3 hrs of symptom onset.
Contraindications for tPA?
Hemorrhage on CT
Early ischemic changes
uncontrolled HTN
resolving symptoms
recent GI hmg
abnormal PT/PTT, platelet count or
GLUCOSE
Septic Joint management?
Surgical drainage and debridement with broad spectrum abx.
Hyperlipidemia screening?
male 35 female 45
When do you start restricted diet?
1 risk factor >160
2 risk factors >130
CAD or equivalent >100
When do you start lipid lowering drug?
1 risk factor >190
2 risk factors >160
CAD equivalent >100
Macrosomic infant?
4000 grams (8 lb 13 oz)
Most commonly diabetic mothers.
Complications: HYPOGLYCEMIA - tremulousness,
clavicular fx, brachial plexus abnormalities, asphyxia
ER patient having an asthmatic attack? Treatment?
FEV1 >40: Albuterol nebs x 3 doses in 1 hr. if on steroids those too.

FEV1<40: Albuterol neb, Ipratropium neb and corticosteroids.

Resp Failure: INTUBATE
AD Polycystic Kidney Disease? Hypertension treatment?
First line - ACEI if Cr rises then,
Second - Ca Ch Blocker Amlodipine
Third - anything else to get it below 120/80

ADPKD - cysts in other organs
Single most important risk factor for STROKE?
HYPERTENSION
ACS drugs that lower mortality and morbitity?
Aspirin, Heparin, Abciximab/Eptifibitide/Tirofiban (IIb/IIIa inhibitors), and beta blockers
Role of tPA in ACS?
only in STEMI diagnosed within 12 hrs of onset.
Patient presents with signs and symptoms of hepatitis with history of transfusion. Diagnosis regardless of labs?
Hepatitis C
incubation 5-10wks
peak aminotransferase levels ~500-1000
HCV ab not detectable till 18 wks after illness onset.
70% of acute will progress to chronic