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481 Cards in this Set
- Front
- Back
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Classic EKG findings in afibb
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sawtooth P waves
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Define unstable angina
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Worsening stable angina, new angina, or resting CP
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Antihypertensive med for DM pts with proteinuria
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ACEI
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Beck's triad for cardiac tamponade
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hypotension, distant heart sounds, and JVD
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Drugs that slow the HR
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BB, CBB, digoxin, amiodarone
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HL tx that leads to flushing and pruritis
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Niacin
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Murmur: HOCM
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systolic ejection murmur heard along the lateral sternal border that increases with decrease preload (valsalva)
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Murmur: aortic insufficiency
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Austin flint murmur, a diastolic decresendo, low pitched, blowing murmur that is best heard sitting up; inc with inc afterload (handgrip maneuver)
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Murmur: AS
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A systolic crescendo/decrescendo, murmur that radiates to the neck; inc with inc preload (squatting maneuver)
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Murmur: MS
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A diastolic, mid to late low pitched murmur preceded by an opening snap
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Murmur: MR
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A holosystolic murmur that radiates to the axila; inc with inc afterload
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Tx for AF and Aflutter
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If unstalbe, cardiovert, if stable or chronic, rate control with BB or CBB
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Tx for VF
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Immediate CV
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Dresslers syndrome
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An autoimmune reaction with fever, pericarditis, and inc ESR occuring 2-4 wks post MI
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IV drug use with JVD and a holosystolic murmur at the left sternal border. Tx?
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Treat existing HF and replace the tricuspid valve
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Diagnostic test for hypertrophic CMY
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Echo (showing a thickened LV wall and outflow obstruction)
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Pulsus paradoxus
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A dec in systolic BP of >10mmHg with inspiration; seen in cardiac tamponade
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Classic EKG findings in pericarditis
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Low voltage; diffuse ST segment elevation
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Definition of HTN
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BP >140/90 on 3 separate occaisions two weeks apart
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Eight surgically correctable causes of HTN
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Renal artery stenosis, coarctation of the aorta, pheochromocytoma, conn's syndrome, cushing's syndrome, unilateral renal parenchymal disease, hyperthryoidism, hyperparathyroidism
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Evaluation of a pulsatile abd mass and bruit
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Abd u/s and CT
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Indications for surgical repair of AAA
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>5.5cm, rapidly enlarging, symptomatic, or ruptured
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Tx for acute coronary syndrome
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ASA, heparin, plavix/clopidogrel, morphine, oxygen, NTG, IV beta blocker
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Metabolic syndrome
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Abd obesity, high trig, low HDL, HTN, insulin resistance, prothrombotic or proinflammatory state
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What is the appropriate test?
1. 50M w/ stable angina can walk without problems. 2. 65F with LBBB and severe OA has unstable angina. |
1. exercise treadmill test/ETT (because pt can walk and no abnormal EKG changes to prevent interpretation)
2. pharmacologic stress test (b/c pt cannot walk due to OA and LBBB prevents EKG interpretation with ETT) |
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Target LDL in a patient with DM
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<70
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Signs of active ischemia during stress testing
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Angina, ST segment changes on EKG, or dec BP
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EKG findings suggesting MI
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ST segment elevation (depression means ischemia), flattened T waves, and Q waves
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Coronary territories in MI: ant wall, inf wall, post wall, septum
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Ant wall: LAD/diagonal
Inf wall: PDA Post wall (Left circumflex/oblique, RCA) Septum: (LAD) |
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Young pt with angina at rest and ST segment elevation with normal cardiac enzymes
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Prinzmetal angina
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Common sx's associated with silent MI
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CHF, shock, and AMS
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Diagnostic test for PE
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Spiral CT angiogram
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Protamine antidote for?
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Heparin
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Prothrombin time used to monitor what drug?
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coumadin/warfarin
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A young pt with a family Hx of sudden death collapses and dies while exercising
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hypertrophic cardiomyoipathy
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Endocarditis prophylaxis regimens
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oral surgery: amox for certain situations; GI ro GU procedures--not recommended
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Virchows triad
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Stasis, hypercoag state, endothelial damage
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most common cause of HTN in young women
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OCP
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Most common cause of HTN in young mend
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excessive ETOH
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Figure 3 sign
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aortic coartation
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Waterbottle shaped heart
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pericardial effusion.
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Derm: Stuck on appearance
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Seborrheic keratosis
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Derm: red plaques with silvery-white scales and sharp margins
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psoriasis
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Derm: most common type of skin cancer; lesion is pearly colored papule with translucent surface and telangiectasias
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BCC
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Derm: honey crusted lesions
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impetigo
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Derm: febrile pt with a hx of DM presents with a red, swollen, painful lower extremity
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cellulitis
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Derm: +nikolsky's sign
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pemphigus vulgaris
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Derm: neg nikolsky's sign
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bullous pemphigoid
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Derm: 55 yo obese pt presents with dirty, velvety patches on the back of the neck
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acanthosis nigricans. Check fasting glucose to r/o DM
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Derm: Dermatomal distribution of vesicles
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varicella zoster
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Derm: flat topped papules
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lichen planus
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Derm: Iris like target lesions
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erythema multiforme
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Derm: A lesion characteristically occuring in a linear pattern in areas where skin comes in contact with clothing or jewelry
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contact dermatitis
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Derm: presents with a hearald patch, xmas tree patter
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pityriasis rosea
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Derm: Pinkish, scaling, flat lesions on the chest and bsack; KOH prep has a "spaghetti and meatballs" appearance
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tinea versicolor
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Derm: four characteristics of nevus suggestive of melanoma
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Asymmetry; border irregular; color variation; large diameter
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Derm: a premalignant lesion from sun exposure that can lead to SCC
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actinic keratosis
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Derm: dewdrops on a rose petal
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chicken pox
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Derm: cradle cap
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seborrheic dermatitis. Tx conservatively with bathing and moisturizing agents
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Derm: associated with propionibacterium ances and changes in androgen levels
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acne vulgaris
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Derm: a painful, recurrent vesicluar eruption of mucocutaneous surfaces
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HSV
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Derm: inflammation and epithelial thinning of the anogenital area, predominantly in post menopausal women
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lichen sclerosis
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Derm: exophytic nodules on the skin with varying degree of scaling or ulceration; the 2nd most common type of cancer
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SCC
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the most common cause of hypothyroidism
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hashimoto's
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lab findings in hashimotos thyroiditis
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high TSH, low T4, and anti TPO Abs
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exophthalmos, pretibial myxedema, and low TSH
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graves' dz
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the most common cause of cushing's syndrome
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iatrogenic corticosteroid administration; the second most common cause is cushing's dz
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Pt presents with signs of hypoCa, high phos, and low PTH
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hypoparathyroidism
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"stones, bones, groans, psychiatric overtones"
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hyperCa
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Pt complains of HA, weakness, and polyuria; examination reveals HTN and tetany. Labs show hyperNa, hypoK, and metabolic alkalosis
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Primary hyperaldo (due to Conn's syndrome or bilateral adrenal hyperplasia)
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Pt presents with tachycardia, wild swings in BP, HA, diaphoresis, AMS, and sense of panic
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pheocromocytoma
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which should be used first in treating pheo, alpha or beta antagonist?
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alpha (phentolamine, phenoxybenzamine)
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Pt with hx of lithium use presents with copius amts of dilute urine
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nephrogenic DI
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Tx of central DI
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administration of DDAVP and free water restriction
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Post op pt with significant pain presents with hypoNatremia and normal volume status
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SIADH due to stress
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antiDM agent associated with lactic acidosis
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metformin
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goal HBA1c for pt with DM
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<7
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Why are beta blockers contradicted in DM?
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they can mask hypoglycemia
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How to do you interpret the following 95% confidence interval (CI) for a relative risk (RR) of 0.582: 95% CI 0.502, 0.673
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These data are consistant with RRs ranging from 0.502 to 0.673 with 95% confidence (ie, we are confidence that the true RR will be between 0.502 and 0.673 95 out of 100 times)
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True or false: Once pts signs a statement giving consent, they must cont tx?
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False. Pts may change their minds at any time. Exceptions to the requirement of informed consent include emergency situations and pts without decision making capacity
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A 15 yo pregnant girl requires hospitalization for pre eclampsia. is parental consent required?
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No. Parental consent is not necessary for the medical tx of pregnant minors
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Ethics: A doctor refers a pt for an MRI at a facility he/she owns.
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conflict of interest
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Ethics: Involuntary psychiatric hold can be done for which three reasons?
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Danger to self, others or gravely disabled due to psych issue
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True or false: It is more difficult to justify the withdrawal of futile care than to have withheld the tx in the first place
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False. Withholding a non beneficial tx is ethically similar to withholding a nonindicated one.
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ethics: A mother refuses to allow her child to be vaccinated.
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A parent has the right to refuse tx for his/her child as long as it does not pose a serious threat to the well being of the kid
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When ca a doc refuse to cont treating a pt on the grounds of futility?
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When there is no rational for tx, maximal intervention is failing, a given intervention has already failed, and tx will not achieve the goals of care
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ethics: An 8 yo child is in serious accident. She requires emergent transfusion, but her parents are not present
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treatment immediately. Consent is implied in cases of emergency.
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ethics: A 15 yo girl seeking tx for an STD asks that her parents not be told about her condition.
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Minors may consent to the care for STDS without parental consent or knowledge.
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Conditions in which confidentiality must be overridden.
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Real threat of harm to 3rd parties; suicidal intentions; certain contagious diseases; elder and child abuse
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Involutnary commitment or isolation for medical treatment may be undertaken for what reason?
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When treatment noncompliance represents a serious danger to public health (ie TB)
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A 10 yo child presents in status epilepticus, but her parents refuse tx on religious grounds.
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Treat b/c the dz represents an immediate threat to the childs life. Then seek a court order.
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ethics. A son asks that his mother not be told bout her recently discovered cancer.
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A doc can withhold info from the pt only int he rare case of therapeutic privilege or if the pt requests not to be told.
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A pt presents with sudden onset severe, diffuse abd pain. Exam reveals peritoenal signs, and abd XR reveals free air under the diaphram. Management?
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Emergent lap to repair a perforated viscuos
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The most likely cause of an acute GIB in a pt who is <40 yo.
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diverticulosis
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Diagnostic modality used when u/s is equivocal for chole?
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HIDA scan
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Risk factors for gallstones?
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Fat, female, fertile, forty, flatulant
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Inspiratory arrest during palpation ofthe RUQ?
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Murphy's signs
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The most common cause of SBO in pts with no h/o abd surgery?
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Hernia
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Most common cause of SBO in pts with h/o abd surgery?
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adhesions
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Key organism causing this diarrhea: most common organism
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campylobacter
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Key organism causing this diarrhea: recent abx use
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cdiff
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Key organism causing this diarrhea: camping
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giardia
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Key organism causing this diarrhea: travellers diarrhea
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ETEC
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Key organism causing this diarrhea: church picnics/mayo
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staph aureus
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Key organism causing this diarrhea: uncooked hamburgeusa
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ecoli 0157:h57
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Key organism causing this diarrhea: fried rice
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bacillus cereus
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Key organism causing this diarrhea: poultry/eggs
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salmonella
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Key organism causing this diarrhea: raw seafood
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vibrio, HAV
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Key organism causing this diarrhea: aids
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isospora, cryptosporidium, MAC,
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Key organism causing this diarrhea: pseudoappendicitis
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yersnia
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25 yo Jewish man presents with pain and water diarrhea after meals. Exam shows fistulas between the bowel and skin and nodular lesions on his tibia. What does he have
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chrohns
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inflammatory disease of the colon with an increase risk of colon cancer.
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UC
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Extra-GI manifestations of IBD
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Uveitis, ankylosing spondylitis, pyoderma gangrenosum, erythema nodousm, PSC
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Medical tx for IBD
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5-asa agents and steroids during acute exacerbation
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Difference between mallory weiss tear and boerhaave tears
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Mallory Weiss tears are superficial in the esophageal mucosa; boerhaave are full thickness perforations
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Charcot's triad
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RUQ pain, jaundice, and fever/chills--signs of asc cholangitis
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Reynold's pentad
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Charcot's triad plus shock and mental status changes; signs of suppurative ascending cholangitis
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Medical tx for hepatic encephalopathy
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decrease protein intake, lactulose, and rifaximin
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First step in the acute management of GIB
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Manage ABCs
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4yo child presents with oliguuria, petechiae, and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?
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HUS due to ecoli 0157:h5
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Post HBV exposure treatment
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HBV Ig
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Classic causes of drug induced hepatitis
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TB meds (INH, rifampin, pyrazinamide), tylenol, and tetracycline
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40 yo F with elevated ALP, elevate bili, pruritis, dark urine, and clay colored stool
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biliary tract obstruction
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Hernia with highest risk of incarceration: direct, indirect, or femoral?
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femoral
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50 yo male with h/o ETOH abuse p/w epigastric pain that radiates to the back and is relieved by sitting forwards. Management?
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Confirm dx of acute pancreatitis with lipase. Tx is NPO, IVF, oxygen, pain control
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Four causes of microcytic anemia
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TICS: Thalassemia, iron def, anemia of Chronic disease, Sideroblastic anemia
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An elderly man has hypochromic, microcytic anemia and is asymptomatic. Dx test?
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FOBT or colonoscopy. r/o cancer
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Precipitants of hemolytic crisis in pts with g6pd def?
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Sulfonamides, antimalarial drugs, and fava beans
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The most common inhereited cause of hypoercoagulability?
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Factor 5 leiden
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The most common inherited bleeding d/o?
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von willebrand's dz
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Most common inherited hemolytic anemia?
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hereditary spherocytosis
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Anemia associated with absent radii and thumbs, diffuse hyperpigmentation, cafe au lait spots, microcephaly, and pancytopenia
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fanconi's anemia
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Medications and viruses that leads to aplastic anemia.
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Chloramphenicol, sulfonamides, radiation, HIV, chemo, hepatitis, parvovirus b19, EBV
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How to tell the difference between polycythemia vera and secondary polycythemia
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Both have increase HCT and RBC mass, but polycythemia vera should have normal 02 sat and low EPO levels
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TTP pentad:
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FATRN: Fever, hemolytic anemia , thrombocytopenia, renal dysfunction, neuro abnormalitis
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HUS triad
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ATR: Anemia, thrombocytopenia, renal issues
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TTP tx?
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Emergent plasmapharesis, steroids, anti-plt drugs; DO NOT GIVE PLT TRANSFUSION
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Tx for ITP in kids.
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Usually self resolves; may require IVIG or steroids
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Which one of these are increased in DIC? fibrin split products, ddimer, fibrinogen, plts, HCTZ
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ddimer, fibrin split products; all others are low
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8 yo boy presents with hemarthrosis and elevated PTT but normal PT. Dx? Tx?
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Hemophilia A or B. Consider desmopressin for hemophilia A or Factor 8 or 9 supplements
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14 yo girl with prolonged bleeding time after dental surgery and with menses, normal PT, normal or elevated PTT, and elevated bleeding time. Dx? Tx?
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vonWillebrands dz; tx with desmopression, FFP, or cryo
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60 yo AA man presents with bone pain. What might a workup for multiple myeloma reveal?
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monoclonal gammopathy, bence Jones proteinuria and punched out lesions on xray of the skuss and long bones.
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Reed sternberg cells seen in:
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Hodgkin's lymphoma
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10 yo boy presetns with fever, wt loss, and nt sweats. Exam shows an ant mediastinal mass. Suspected dx?
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non hodgkins lymphoma
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Microcytic anemia with dec serum iron, dec TIBC, and nml or elevated ferritin
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anemia chronic dz
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Microcytic anemia with dec serum irin, dec ferritin, and inc tibc:
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Fe def anemia
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80 yo M p/w fatigue, LAD, splenomegally, and isolated lymphocytosis. What is the suspected 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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A late, life threatening complication of CML
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Blast crisis (fever, bone pain, splenomegally, pancytopenia)
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Auer rods on smear
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AML
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AML subtype associated with DIC. Tx?
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M3. Retinoic acid
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Electrolyte changes in tumor lysis
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dec Ca, inc K; inc phos, inc uric acid
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50 yo M with early satiety, splenomegally, and bleeding. Cytogenetic show t(9,22). Dx
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CML
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heinze bodies
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intracellular inclusions seen in thalassemia, g6pd deficiency, and postsplenectomy
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Virus associated with aplastic anemia in pts with sickle cell anemia
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parvovirus b19
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25 yo AA with sickle cell has sudden onset bone pain. Management of pain crisis?
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o2, pain medication, IVF, and if severe, transfusion
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A significant cause of morbidity in thalassemia pts? Tx?
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Iron overload from too much transfusions; use deferoxamine
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The 3 most common causes of fever of unknown origin.
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infection, cancer, and autoimmune dz
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A non suppurative complication of strep infection that is not altered by tx of the primary infection
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postinfectious GN
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The most common predisposing factor for acute sinusitis
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viral URI
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asplenic pts are susceptible to these organisms
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encapsulate organisms: pneumococcus, meningococcus, H infueanza, klebsiella
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the number of bacteria needed in an RUA to call it an infection
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ten to the 5th power/ml
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Which healthy population is susceptible to UTI's?
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pregnant women. Tx this group even if no sx's.
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A pt from CA or AZ presents with fevers, malaise, cough, and night sweats. Dx? Tx?
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cocci, amphotericin B.
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Non painful chancre
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primary syphillis
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A blueberry muffin rash is characteristic of what congential infection?
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rubella
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Meningitis in neonates. Cause? Tx?
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GBS, ecoli, listeria; tx with amp and gent
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Meningitis in infants. Cause? Tx?
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pneumo, meningococcus, H flu. Tx with cefotaxime and vanc
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What should be done prior to LP?
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Check for inc ICP; look for papilledema
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CSF findings: low glucose, PMN predominence
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bacterial meningitis
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CSF findings: nml glucose, lymphocytic predominance
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viral meningitis
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CSF findings: numerous RBC's in serial CSF samples
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SAH
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CSF findings: inc gamma globulins
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MS
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Initially presents with a pruritic papule with regional LAD; evolves into a black eschar after 7-10 days. Tx?
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cutaneous anthrax; Tx with PCN G or cipro
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Findings in tertiary syphillis
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Tabes dorsalis; general paresis; gummas; argyll robertson pupil, aortitis, aortic root aneurysm
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Characteristics of secondary lyme dz
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Arthralgias, migratory polyarthropathies, bell's palsy, myocarditis
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Cold agglutinins found in:
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mycoplasma
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24 yo M presents with soft white plaques on his tongue and the back of his throat. Dx? W/u? Tx?
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candidal thrush. Work up should include checking for HIV test. Tx with nystatin oral suspension
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At what CD4 count should you start PCP ppx?
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<200. bactrim
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At what CD4 count should you start MAC ppx?
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<50-100. azithro
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Risk factors for pyelo
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pregnancy; vesicouretral reflux; anatomic anomlalies; indwelling catheter, kidney stones
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neutropenic nadir post chemo
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7-10 days
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erythemia migrans seen in:
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lesions of primary lime dz
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Classic physical findings for endocarditis
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fever, heart murmur, osler nodes, splinter hemorrhages, janeway lesions, roths spots
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aplastic crisis in sickle cell due to:
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parvovirus
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ring enhancing lesion in head CT with seizures; caused by:
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cysticercosis
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Name the organism: branching rods in oral infection
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actinomyces israelii
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Name the organism: weakly gram +, partially acid fast lung infection
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nocardia
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Name the organism: painful chancroid
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haemophilus ducreyi
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Name the organism: dog or cat bite
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pasteurella
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Name the organism: gardener
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sprothorix schenkii
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Name the organism: raw pork and skeletal muscle cysts
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trichinella spiralis
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Name the organism: sheepherders with liver cysts
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echinococcus granulosus
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Name the organism: perianal itching
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enterobius vermicularis
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Name the organism: pregnant women with pets
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toxoplasmosis
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Name the organism: meningitis in adults
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neisseria meningitidis
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Name the organism: Meningitis in elderly:
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pneumococcus
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Name the organism: meningoencephalitis in AIDS
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crypto
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Name the organism: etoh wit pneumonia
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klebsiella
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Name the organism: currant jelly sputum
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klebsiella
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Name the organism: malignant otitis externa
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pseudonomas
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`Name the organism: infection in burn victims
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pseudonomas
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Name the organism: osteo in foot wound puncture
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pseudomonas
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Name the organism: osteo in sickle cell pt
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salmonella
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55 yo man who is a smoker and heavy drinker presents with a new cough and flu like sx's. Gram stain shows no organisms; silver stain of sputum shows gram neg rods. what is the dx?
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legionella
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middle aged man presents with acute onsent monoarticular joint pain and bilateral bell's palsy. What is the likely dx and how did her get it? Tx?
|
lyme dx; ixodes tick; tx with doxy
|
|
|
A pt develops endocarditis three weeks after receiving a prosthetic heart valve. What organism is suspected?
|
staph aureus or staph epi
|
|
|
A pt develops endocarditis after having his teeth clean. what is the organism?
|
strep viridans
|
|
|
Back pain that is made worse with walking and better with sitting and hyperflexion of the knees
|
spinal stenosis
|
|
|
Joints in the hand affected by RA.
|
MCP, PIP; DIP's are spared
|
|
|
Joint pain and stiffness that worsens throughout the day and gets better with rest
|
OA
|
|
|
Genetic d/o that is associated with multple fx's and blue sclerae and is commonly mistaken for child abuse.
|
osteogenesis imprefecta
|
|
|
Hip and back pain along with stiffness that improves with activity over the course of the day and worsens with rest. Dx test?
|
suspect ankylosing spondylitis. Check HLA b27
|
|
|
Arthritis, conjunctvitis, and urethritis in young men. Associated organism?
|
Reactive arthritis. Most commonly associated with chlamydia. Also consider campy, shigella, salmonella, and ureaplasma
|
|
|
55 yo M with sudden onset pain first MTP joint after night of drinking red wine. Dx, w/u and chronic tx?
|
Gout. Needle shaped, negatively birefringement crystals are seen on joint fluid aspirate. Chronic tx is allopurinol or probenicid
|
|
|
Rhomboid shaped, positively birefringement crystals on joint aspiration
|
pseudogout
|
|
|
Elderly woman p/w pain and stiffnesss of her shoulders and hips; she cannot lift her arms above her head. labs show anemia and elevated ESR
|
Polymyalgia rheumatica
|
|
|
An active 13 yo boy has anterior knee pain. Dx?
|
osgood schlatter dz
|
|
|
Bone fx'd in a fall with outstretched hand
|
distal radius (colles fx)
|
|
|
Complication of scaphoid fx.
|
avascular necrosis
|
|
|
signs suggesting radial nerve damage with humeral fx
|
wrist drop, loss of thumb abduction
|
|
|
Young child presents with proximal muscle weakness, waddling gait, and pronounced calf weakensss
|
duchenne muscular dystrophy
|
|
|
A first born female who was born in the breech position is found to have assymetric skin folds on a newborn exam. Dx? Tx?
|
developmental dysplaisa of the thip. If severe, consider a pavlik harness to maintain abduction
|
|
|
an 11 yo AA boy p/w sudden onset of a limp. Dx? W/u?
|
slipped capital femoral epiphysis. AP and frog leg lateral xrays
|
|
|
The most common primary malignant tumor of bone
|
multiple myeloma
|
|
|
Unilateral, severe, periorbital HA with tearing and conjunctival redness.
|
cluster HA
|
|
|
PPX tx for migraine
|
antihypertensive; antidepressants; anticonvulsants, dietary changes
|
|
|
the most common pituitary tumor and tx.
|
prolactinoma; dopamine agonist (bromocriptine)
|
|
|
55 yo pt p/w acute broken speech. What type of aphasia? What lobe and vascular distribution?
|
Broca's aphasia. Frontal lobe, left MCA distribution
|
|
|
The most common cause of SAH
|
Trauam, second most common is berry aneuyrsm
|
|
|
Crescent shaped hyperdensity on CT that does not cross the midline
|
Subdural hematoma-bridging veins torn
|
|
|
A history significant for initial AMS with an itnervening lucid interval. Dx? Most likely source? Tx?
|
epidural hematoma. Middle meningieal artery. NS evauuation
|
|
|
CSF findings with SAH
|
elevated ICP; RBC's, xanthochromia
|
|
|
Albuminocytologic dissociation
|
guillan barre syndrome (inc protein in the CSF without significant inc in cell count)
|
|
|
Cold water is flushed into the pts ear, and the fast phase of the nystagmus is toward the opposite side. Normal or pathologic?
|
nml
|
|
|
The most common primary sources of mets to the brain
|
lung, breast, skin (melanoma), kidney, GI tract
|
|
|
May be seen in children who are accused of inattention in class and confused with adhd
|
abscence sz
|
|
|
The most frequent presentation of intracranial neoplasm
|
HA. primary neoplasms are much less common the brain mets
|
|
|
Most common cause of sz in kids 2-10 years old
|
infection, febrile sz, trauma, idiopatihc
|
|
|
most common cause of seizures in 19-35
|
trauma, etoh withdrawel, brain tumor
|
|
|
first line med for status epilepticus
|
IV benzos
|
|
|
confusion, confabulation, ophthalmoplegia, ataxa
|
wernickes due to thiamine def
|
|
|
What percent lesion is an indication for CEA
|
70% if stenosis symptomatic
|
|
|
most common cause of dementia
|
alzheimers or multi infarct
|
|
|
A combined UMN and LMN d/o
|
ALS
|
|
|
Rigidity and stiffness with unilateral resting tremor and masked facies
|
parkinsons
|
|
|
tx for parkinsons
|
levodopa, carbidopa
|
|
|
Tx for guillane barre
|
IVIG or plasmapharesis. Avoid steroids
|
|
|
Rigidity and stiffness that progress to choreaform movements, then altered behavior
|
Huntingtons
|
|
|
6 yo girl presents with port wine stain in the v2 distributionas well as mental retardation, sz, and ipsilateral leptomeningeal angioma
|
sturg weber syndrome. Tx symptomatically. Possible focal cerebral resection of the affect lobe
|
|
|
multiple cafe au lait spots on the skin
|
neurofibromatosis type 1
|
|
|
Hyperphagia, hypersexuality, hyperoral, hyperdocility
|
kluver bucy
|
|
|
may be given to symptomatic pts to dx myasthenia
|
edrophonium
|
|
|
primary cause of 3rd trimester bleeding
|
placental abruption and placenta previa
|
|
|
classic u/s and gross appearance of compete hydatidiform mole
|
snowstorm on u/s. Cluster of grapes appearance on gross exam
|
|
|
chromosal pattern of complete mole
|
46, XX
|
|
|
molar pregnancy containing fetal tissue
|
partial mole
|
|
|
symptoms of placental bruption
|
continuous painful VB
|
|
|
sx's of placental previa
|
self limited, painless VB
|
|
|
When should vaginal exam be performed with suspected placental previa
|
never
|
|
|
abx with teratogenic effects
|
tetracyclne, fluoroquinolones, aminoglycosides, sulfonamides
|
|
|
medication given to accelarate fetal lung maturity
|
betamethasone or dexamethasone for 48 hrs
|
|
|
most common cause of post partum hemorrhage
|
uterine atony
|
|
|
sx's of placental previa
|
self limited, painless VB
|
|
|
When should vaginal exam be performed with suspected placental previa
|
never
|
|
|
abx with teratogenic effects
|
tetracyclne, fluoroquinolones, aminoglycosides, sulfonamides
|
|
|
medication given to accelarate fetal lung maturity
|
betamethasone or dexamethasone for 48 hrs
|
|
|
most common cause of post partum hemorrhage
|
uterine atony
|
|
|
tx for post partum hemorrhage
|
uterine massage; if that fails oxytocin
|
|
|
typical abx for GBS ppx
|
IV pcn or amp
|
|
|
a pt fails to lactate after en emergency c/s with marked blood loss
|
sheehans syndrome (post partum pituitary necrosis)
|
|
|
uterine bleeding at 18 wks gestation; no products expelled, cervical os open
|
inevitable abortion
|
|
|
uterine bleeding at 18 weeks, no products expelled, cervical os closed
|
threaten abortion
|
|
|
The first test to perform when a woman presents with amenorrhea
|
HCG; r/o pregnancy
|
|
|
Term for heavy bleeding during and inbetween your periods
|
menometromenhorrhagia
|
|
|
Cause of amenorrhea with nml prolactin, no response to estrogen/progesterone challenge, and h/o D&C`
|
asherman's syndrome
|
|
|
therapy for pcos
|
wt loss, ocp's, consider metformin
|
|
|
medication used to induce ovulation
|
clomiphene citrate
|
|
|
Dx step for women who present with post menopausal bleeding
|
emb
|
|
|
indications for medical tx of ectopic pregnancy
|
Pt is stable; unruptured ectopic pregnancy of <3.5cm at <6wks gestation
|
|
|
medical option for endometriosis
|
ocp's, danazol, and GnRH agonist
|
|
|
laprascopic findings of endometriosis
|
powder burns; chocolate cysts
|
|
|
most common location for ectopic pregnancy
|
ampulla of the oviduct
|
|
|
Hos to dx and follow leiomyoma
|
U/s
|
|
|
A pt has inc vaginal discharge and petechial patches on the upper vagina and cvx
|
trichomonas
|
|
|
Tx of bacterial vaginosis
|
oral or topical flagyl
|
|
|
the most common cause of nipple discharge
|
intraductal papilloma
|
|
|
contraceptive methods that protect against PID
|
ocps and barrier contraception
|
|
|
unnopposed estrogen is contraindicated in which cancers?
|
endometrial or estrogen receptor + breast cancer
|
|
|
Pt presents with recent PID and RUQ pain
|
consider fitz-hugh-curtis syndrome
|
|
|
Breast cancer presenting with itching, burning, and erosion of the nipple
|
paget's dz
|
|
|
Annual screening for women with a strong family history of ovairan cancer.
|
CA 125 and transvag u/s
|
|
|
50 yo F leaks urine when laughing, coughing. Non surgical options?
|
kegel exercises, estrogen, pessaries for stress incontinence
|
|
|
30F has unpredictable urine loss. Exam is nml. Medical options?
|
anticholinergics or beta adrenergics (metaproteronol) for urge incontinence
|
|
|
lab values suggestive of menopause
|
high fsh
|
|
|
most common cause of female infertility
|
endometriosis
|
|
|
Two consecutive findings of ASCUS on pap smear. Follow up eval?
|
colpo and endocervical curettage
|
|
|
Breast cancer type that inc the future risk of invasive CA in both breasts
|
lobular carcinoma in situ
|
|
|
Non tender abd mass associated with elevated VMA and HVA
|
neuroblastoma
|
|
|
The most common type of tracheoesophageal fistula (TEF). Dx?
|
esophageal atresia with distal TEF (85%). Unable to pass the NG tube
|
|
|
Not contraindications to vaccine.
|
mild illness and/or low grade fever, current abx therapy, and prematurity
|
|
|
tests to r/o shaken baby syndrome
|
eye exam, CT, and MRI
|
|
|
A neonate has meconium ileus
|
cystic fibrosis (hirschsprungs's dz is asssociated with failure to pass meconium for 48 hrs)
|
|
|
Bilious emesis within hours after first feeding
|
duodenal atresia
|
|
|
A 2 m old baby presents with non bilious projectile emesis. Dx? What are the appropriate steps in management.
|
pyloric stenosis
Correct metabolic abnormalities; then correct pyloric stenosis with pyloromyotomy |
|
|
The most common primary immunodeficiency?
|
Selective igA def
|
|
|
An infant has a high fever and onset of rash as the fever breaks. What is he at risk for?
|
febrile sz (due to roseola infantum)
|
|
|
What is the immunodeficiency?
A boy has chronic resp infections. Nitroblue terazolium test is neg. |
chronic granulomatous dz
|
|
|
What is the immunodeficiency?
a child has eczema, thrombocytopenia, and high IgA levels |
wiskott aldrich syndrome
|
|
|
What is the immunodeficiency?
a 4 month old boy has life threatening pseudomonas infxn |
bruton's xlinked agammaglobulinemia
|
|
|
acute phase treatment for kawasaki dz
|
high dose ASA for inflammation and fever; IVIG to prevent coronary artery aneurysms
|
|
|
treatment for mild and severe unconjugated hyperbili
|
mild: phototherapy
severe: exchange transfusion. Do not use phototherapy for congjugate hyperbili) |
|
|
sudden onset of mental status change, vomiting, and liver dysfunction after ASA use
|
reye's syndrome
|
|
|
A child has loss of red light reflex. Dx? The child has an increase risk of what cancer?
|
Suspect retinoblastoma. Osteosarcoma
|
|
|
Vaccine at 6m well baby visit
|
HBV, DTAP, HIB, IPV, PCV, rotavirus
|
|
|
Tanner stage 3 in a 6yo girl
|
precocious puberty
|
|
|
infection of the small airways with epidemics in winter and spring
|
RSV bronchiolitis
|
|
|
Cause of neonatal RDS
|
surfactant deficiency
|
|
|
Condition associated with red currant jelly stools, colicky abd pain, bilious emesis, and sausage shaped mass in the RUQ
|
insussuseption
|
|
|
A congenital heart disease that causes secondary HTN. What would u find on physical exam?
|
coartation of the aorta; dec femoral pulsese
|
|
|
First line tx for otitis media
|
amox for 10 days
|
|
|
The most common pathogen causing croup
|
parainfluenza virus type 1
|
|
|
homeless child is small for his age and has peeling skin and a swollen belly
|
kwashiokar (protein malnutrition)
|
|
|
Defect in an x linked syndrome with mental retardation, gout, self mutilation, and choreathetosis.
|
lesh nyhan syndrome (purine salvage problem with HGPRTase def)
|
|
|
A newborn girl has a continuous machinery murmur. What drug would you give
|
She has PDA. Give indomethacin to close it
|
|
|
A newborn with a posterior neck mass and swelling of the hands
|
turners syndrome
|
|
|
First line med for depression
|
SSRI
|
|
|
antidepressant associated with HTN crisis
|
MAOI's
|
|
|
Galactorrhea, impotence, menstrual dysfunction, and dec libido
|
DA antagonist
|
|
|
a 17 yo girl has left arm paralysis after her boyfriend dies in a car crash. No medical cause is found.
|
conversion d/o
|
|
|
Name the defense mechanism:
A mother who is angry at her husband yells at her kid |
displacement
|
|
|
Name the defense mechanism:
A pedophile enters monestary |
reaction formation
|
|
|
Name the defense mechanism:
A women calmly describes a grisly murder |
isolation
|
|
|
Name the defense mechanism:
a hospitalized 10 yo begins to wet his bed |
regression
|
|
|
Life threatening muscle rigidity, high fever, and rhabdo
|
neuroleptic malignant syndrome
|
|
|
Amenorrhea, low body wt, brady, and abnormal body image in a young woman.
|
anorexia
|
|
|
35M has recurrent episodes of palpitations, diaphoresis, and fear of going crazy
|
panic d/o
|
|
|
most serious side effect of clozapine
|
agranulocytosis
|
|
|
21 yo M has 3 months of social withdrawal, worsening grades, flattened affect, and concrete thinking
|
schizophreniform d/o (a dx of schizo needs >6m of sx's)
|
|
|
Key side effects of antipsychotics
|
wt gain, type 2 DM, QT segment prolongation
|
|
|
A young wt lifter receives IV haldaol and complains of his eyes being deviated sideways. Dx? Tx?
|
acute dystonia (oculogyric crisis). Tx with benztropine or benadryl
|
|
|
Medication to avoid in pts with a hx of etoh withdrawel sz's
|
neuroleptics
|
|
|
13 yo boy has a hx of theft, vandalism, and violence toward the family pet
|
Conduct d/o. Associated with antisocial personality d/o in adults
|
|
|
5 month old girl has dec head growth, truncal discoordination, and dec social interaction
|
Rett's d/o. Loss of milestones is commonly described
|
|
|
A pt has slept for days, lost 20K gambling, is agittated, and has pressured speech. Dx? Tx?
|
acute mania. Start mood stabilizer (ie librium)
|
|
|
After a minor fender bender, a man wears a neck brace and asks for permanent disability
|
malingering
|
|
|
A nurse presents with severe hypoglycemia; lab check shows now elevation in c-peptide
|
factitious d/o
|
|
|
A pt continues to use cocaine after losing his job, going to jail, and not paying child support
|
substance abuse
|
|
|
Medication to avoid in pts with PTSD
|
benzo's (have high addiction potential). Pts commonly have a h/o substance abuse
|
|
|
Violent pt with vertical and horizontal nystagmus
|
PCP intoxication
|
|
|
A women who was abused as a child frequently feels outside her body or detached from her body
|
depersonalization d/o
|
|
|
A schizophrenic pt takes haldol for one year and develops uncontrollable tongue movements. Dx? Tx?
|
Tardive dyskinesia.
Dec or d/c haldol and consider another antipsychotic drug |
|
|
A amn with major depressive d/o is counseled to avoid tyramine rich foods with his new medicaition
|
MAOI's
|
|
|
Risk factors for DVT
|
stasis, endothelial injury, and hypercoagulability (virchow's triad)
|
|
|
criteria for exudative effusion
|
pleural/serum protein >0.5; pleural/serum LDH>0.6
|
|
|
Causes of exudative effusion
|
Think leaky capillaries. Cancer, TB, bacterial or viral infection, PE with infarct, and pancreatitis
|
|
|
Causes of transudative
|
Think of intact capillaries. CHF, liver, renal dz; protein losing enteropathy
|
|
|
normalizing co2 in a patient with asthma exacerbation may indicate?
|
fatigue and impending respiratory failure
|
|
|
scardoidosis sx's
|
SOB, lateral hilar LAD on CXR, non caseating granulomas, inc ACE, and hypercalcemia
|
|
|
PFT's of obstructive pulm dz
|
dec FEV1/FVC
|
|
|
PFT's of restrictive pulm dz
|
inc FEV1/FVC, dec TLC
|
|
|
Honeycomb pattern on cxr. tx?
|
Diffuse interstitial pulm fibrosis. Supportive care; steroids may help
|
|
|
Tx for SVC syndrome
|
radiation
|
|
|
Tx for mild persistant asthma
|
inhaled beta agonist and inhaled steroids
|
|
|
Tx for copd exacerbation
|
o2, bronchodilators, abx, steroids, stop smoking
|
|
|
acid base d/o in PE
|
respiratory alkalosis with hypoxia and hypocarbia
|
|
|
non small cell lung cancer associated with hypercalcemia
|
squamous cell carcinoma
|
|
|
lung cancer associated with siadh
|
small cell lung cancer
|
|
|
lung cancer highly related to smoking
|
SCLC
|
|
|
A tall white man p/w acute sob. Dx? Tx?
|
spontaneous pneumo.
Spontaneous regression; supplemental o2 may be helpful |
|
|
Tx of tension pneumo
|
immediate needle thoracostomy
|
|
|
Characteristics favoring CA in an isolated pulmonary nodule
|
age >45-50; lesions new or larger in comparision to older films; abscense of calcification or irregular calcification; size >2cm; irregular margins
|
|
|
ARDS
|
hypoxemia and pulmonary edema with normal pulmonary capillary wedge pressure (PCWP)
|
|
|
sequelae of asbestos exposure
|
pulmonary fibrosis, pleural plaques, bronchogenic carcinoma (mass in lung field), mesothelioma (pleural mass)
|
|
|
inc risk fo what infection is silicosis?
|
TB
|
|
|
causes of hypoxemia
|
right to left shunt, hypoventilation, low inspired o2 tension, diffusion defect, v/q mismatch
|
|
|
Classic cxr finding of pulmonary edema
|
cardiomegally, prominent pulmonary vessels, kerley B lines, bat's wing appearance of hilar shadows, and perivascular and peribronchial cuffing
|
|
|
westermark's sign and hampton's hump
|
cxr findings suggestive of PE
|
|
|
RTA associated with abnormal H+ secretion and kidney stones
|
type 1 distal RTA
|
|
|
RTA associate with abnormal bicarb and rickets
|
Type 2 (prox) RTA
|
|
|
RTA associated with aldo defect
|
Type 4 (distal ) RTA
|
|
|
"doughy" skin
|
hypernatremia
|
|
|
Differential of hypervolemic hyponatremia
|
Cirrhosis, CHF, nephrotic syndrome
|
|
|
Chvostek's and trousseau's sign
|
hypocalcemia
|
|
|
The most common cause of hypercalcemia
|
Cancer and hyperparathyroidism
|
|
|
T wave flattenign and u waves
|
hypokalemia
|
|
|
Peaked T waves and widened QRS
|
hyperkalemia
|
|
|
first line tx for moderate hypercalcemia
|
IV hydration and lasix
|
|
|
type of ARF in patient with FENA<1%
|
pre-renal
|
|
|
A 49 yoM presents with acute onset of flank pain and hematuria
|
kidney stone
|
|
|
most common type of kidney stone
|
calcium oxalate
|
|
|
20 yo M presents with palpable flank mass and hematuria. U/S shows bilateral enlarged kidneys with cysts. associated brain anomaly?
|
berry aneurysms (autosomal dom PCKD)
|
|
|
hematuria, HTN, and oliguria
|
nephritic syndrome
|
|
|
proteinuria, hypoalbuminemia, HL, hyperlidpiduria, and edema
|
nephrotic syndrome
|
|
|
most common form of nephritic syndrome
|
membranous GN
|
|
|
most common form of glomerulonephritis
|
IGA nephropathy
|
|
|
glomerulonephritis with deafness
|
alports syndrome
|
|
|
glomerulonephritis with hemoptysis
|
wegeners granulomatosis and goodpastures syndrome
|
|
|
presence of red cell casts in urine sediment
|
glomerulonephritis/nephritic syndrome
|
|
|
eos in urine sediment
|
AIN
|
|
|
waxy casts in urine sediment and maltese crosses (see in with lipiduria)
|
nephrotic syndrome
|
|
|
drowsiness, asterixis, nausea, and pericardial friction rub
|
uremia
|
|
|
55 yo man with prostate cancer. Tx options?
|
wait; surgery to resect; radiation and or androgen suppresion
|
|
|
low urine specific gravity int he presensce of high serum osmolality
|
DI
|
|
|
tx of siadh
|
fluid restrict; demeclocyline
|
|
|
hematuria, flank pain, and palpable flank mass
|
RCC
|
|
|
testicular cancer associated with beta hcg and afp
|
choriocarcinoma
|
|
|
most common type of testicular cancer
|
seminoma, a type of germ cell tumor
|
|
|
most common histo of bladder cancer
|
transitional cell
|
|
|
complication of overly rapid correction of hyponatremia
|
central pontine myelinolysis
|
|
|
salicylate ingestion occurs in what type of acid base disorder
|
AG acidosis and primary respiratory alkalsosi due to central respiratory stimulation
|
|
|
acid base disturbance see in pregnant women
|
respiratory alk
|
|
|
3 systemic dz's that lead to nephrotic syndrome
|
DM, SLE, amyloid
|
|
|
elevated erythropoetin level, elevated HCT, adn normal o2 sat suggest?
|
RCC or other EPO producing tumor; eval with CT
|
|
|
55 M presents with irritative and obstructive urinary sx's. Tx options?
|
likelyBPH. OPtions include no tx, terazosin, finasteride, or TURP
|
|
|
class of drugs that may cuase syndrome of muscle rigidity, hyperthermia, autonomic instability, and eps
|
antipsychotics
|
|
|
side effects of steroids
|
acute mania, immunosupression, thin skin, osteoporosis, easy brusing, myopathies
|
|
|
tx for DT's
|
benzo's
|
|
|
tx for tylenol od
|
mucomyst (n acetylcysteine)
|
|
|
tx for opioid od
|
naloxone
|
|
|
tx for benzo od
|
flumazenil
|
|
|
tx for neuroleptic malignant syndrome and malignant hyperthermia
|
dantrolene
|
|
|
tx for malignant HTN
|
nitroprusside
|
|
|
tx for afib
|
rate control, rhythm conversion, and anticoagulation
|
|
|
tx of SVT
|
if stable, rate control with carotid massage or other vagal stimulation; if unssuccessful, consider adenosine
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causes of drug induced sle
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INH, penicillamine, hydralazine, procainamide, chlopromazine, methyldopa, quinidine
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macrocytic, megaloblastic anemia with neurologic sx's
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b12 def
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macrocytic, megaloblastic anemia without neuro sx's
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folate def
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burn pt presents with cherry red, flushed skin and coma. Sao2 is nml, but carboxyhemoglobin is elevated. Tx?
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treat CO poisoning with 100% o2 or with hyperbaric chamber if o2 poisoning severe or the pt is pregnant
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blood in the urethral meatus or high riding prostate
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bladder rupture or urethral injury
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test to rule out urethral injury
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retrograde cystourethrogram
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radiographic evidence of aortic disruption or dissection
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wide mediastinum (>8cm), loss of aortic knob ,pleural cap, tracheal deviation to the right, depression of left main stem bronchus
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XR indications for surgery in pts with acute abd
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free air, extravasation of contrast, severe bowel distension, space occupying lesion (CT), mesenteric occlusion (angio)
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most common organism in burn victims
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pseudomonas
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method of calculating fluid repleteion in burn patients
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parkland formula: 24hr fluids = 4 x kg x %BSA
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acceptable UOP in trauma pt
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50cc/hr
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acceptable uop in nml pts
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30cc/hr
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signs of neurogenic shock
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hypotentension and brady
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signs of inc icp
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HTN, brady, abnormal respirations
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dec CO, dec PCWP, inc PVR
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hypovolemic shock
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dec CO, inc PCWP, inc PVR
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cardiogenic shock
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inc CO, dec PCWP, dec PVR
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septic shock
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tx of septic shock
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fluids and abx
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tx of cardiogenic shock
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ID cause; pressors (ie dopamine)
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tx of hypovolemic shock
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ID cause; IVF and blood repletion
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tx of anaphylactic schock
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benadryl or epi
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supportive tx for ARDS
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cont positive airway pressure
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signs of air embolism
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a pt with chest trauma who was previously stable suddenly dies
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signs of cardiac tamponade
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JVD, hypotension, diminished heart sounds (becks triad), pulsus paradoxus
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absent breath sounds, dullness to percussion, shock , flat neck veins
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massive hemothorax
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absent breathsounds, tracheal deviation, shock distended neck veins
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tension pneumo
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tx for blunt or prenetrating abd trauma in hemodynamically unstable pts
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immediate ex alp
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inc ICP in alcoholics or the elderly following head trauma. Can be acute or chronic. crescent shape on CT
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subdural hematoma
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head trauma with immediate LOC followed by lucid interval and then rapid deterioration. Convex shape on CT
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epidural hematoma
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bias introduced into a study when a clinician is aware of the pt's treatment option
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observational bias
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bias introduced when screening detects a disease earlier and thus lengthens the time from dx to death
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lead time bias
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if you want to know if geographical location affects infant mortality rate but most vairation in infant mortality is predicted by socioeconomic status, then socioeconimic status is_____________
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counfounding variable
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the proportion of people who have the dz and test positive is
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sensitivity
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sensitive tests have few false negatives and are used to rule ______ a disease
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out
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PPD reactivity is used as a screening test b/c most people with TB (except those who are angergic) will have a +pdd. Highly sensitive or specific?
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high sensitive for TB. Screenign tests with high sensitivity are good for dz's with low prevalanece
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Chronic dz such as SLE-higher prevalance or incidence?
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HIGHER PREVALANCE
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epidemics such as influencza--higher prevalence or incidence?
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higher incidence
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what is the difference between incidence and prevalence
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Prevalence is the % of cases of dz in population at a snapshot in time. Incidence is the % of new cases of dz that develop over a given time period among the total population at risk
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cross sectional survey--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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describe at est that consistantly gives identical results, but the results are wrong
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high reliability (precision), low validity (accuracy)
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difference between a cohort and case control study
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cohort studies can be sued to calculate RR, incidcence, and/or odds ratio (OR). Case control studies can be used to calcuate an OR, which is an estimate of RR when the dz prevalnece is low
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attributable risk?
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the difference in risk in the exposed and unexposed groups (ie the risk that is attributable to the exposure)
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relative risk?
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incidence in the exposed group divided by the incidence int eh non exposed group
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the results of a hypothetical study found an association between ASA intake and risk of heart dz. How do you interpret an RR of 1.5?
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in pts who took ASA, the risk of heart dz was 1.5 times that of pts who did not take ASA
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Odds ratio?
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in cohort studies, the odds of developing the dz in the exposed group divided by the odds of developing the dz in the non exposed group
in case control studies, the odds that the cases were exposed divided by the odds that hte controls were exposed in cross sectional studies, the odds that hte exposed group has the dz divided by the odds that hte non exposed group has the dz |
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The results of the hypothetical study found an association between ASA intake and risk of heart dz. How do you interprete an OR of 1.5?
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in pts who took asa, the odds of acquiring heart dz were 1.5 times those of pts who did not take ASA
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in which pts do you initiate colorectal cancer screening early?
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pts with IBD; those with FAP/HNPCC; and those who have first degree relatives with adenomatous polyps (<60yo) or colorectal CA
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the most common cancer in men and the most common cause of death from cancer in men?
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common cancer: prostate cancer
common death: lung cancer |
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the % of cases within one SD of the mean? Two SDs? 3 SD?
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68%, 95.4%, 99.7%
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how do you calculate birth rate
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# live births per 1000 population in one yaer
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how do you calculate mortality rate
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number of deaths per 1000 population in one year
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how do you calculate neonatal mortality rate
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number of eaths from births to 28 days per 1000 live births in one year
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how do you calculate infant mortality rate
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number of deahts from birth to one yr per 1000 live births (neonate and post natal mortality) in one year
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how do you calculate maternal mortality rate
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# deaths during pregnancy to 90 days postpartum per 100,000 live births in one year
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