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233 Cards in this Set
- Front
- Back
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Antipsychotic meds e.g. Risperidone
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Block DA and can lead to hyperprolactinemia
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Cerebellar dysfxn
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Ataxia, broad-based gait, dysmetria, intention tremor, px w/ rapid alternation, & nystagmus
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Rinne test at mastoid & EAM
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Should hear AC 2x as long as BC. Abn indicates conductive loss
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Weber test at forehead
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Should be equal bilat. Conductive loss lateralizes to affected ear. Sensorineural loss lateralizes to UNaffected ear
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Ototoxic ABX, e.g., aminoglycosides
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Usually cause sensorineural loss
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Otosclerosis
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MCC of conductive hearing loss in young adults
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Newborn w/ difficulty moving LUE & crepitus over clavicle
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Common w/ large babies seen in gest diabetes. No tx is necessary.
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Signs of intraamiotic infxn
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Maternal tachy (>100), fetal tachy (>160), maternal leukocytosis (>15), uterine tenderness, foul-smelling amniotic fluid
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Myocarditis
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Presents as flu followed by resp distress from acute heart failure. Holosystolic murmur 2/2 dilated heart & resulting fxnal mitral regurg. Big liver 2/2 passive congestion ("nutmeg liver" on path).
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Torus palatinus
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Benign congenital bony growth on midline hard palate
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Elderly man s/p surgery w/ wound that has cloudy gray d/c, decreased sensation, & dusky friable subQ
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Urgent surgical exploration
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Hyperemesis gravidarum
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Metabolic alk w/ resp comp.
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DKA
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Metabolic acidosis with ↑K: ↑K b/c of extracell shift of K in exchange for H ion to reduce acidosis
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Man w/ aids w/ upper lobe cavity w/ sputum exam of partially AF, filamentous, branching rod w/o +PPD
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Nocardia (us. N. asteroides). Tx Bactrim.
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Pneumocystis
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Does not cause cavitation
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Pneumococcus
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MCC of CA-Pna & causes lobar pna
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LDL goals
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CAD/DM: <100, meds if >130; 2+ risk factors: <130, meds if >160; 0-1 risk factor: <160, meds if >190
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Flu
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Types A&B are more troubling, C is usually minor; Amantadine & Rimantadine are active against A; Zanamivir & Oseltamivir are active against A&B but only Oseltamivir is approved for prevention; Give drugs only in first 48hrs
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Hypokalemia 2/2 PRBC tranfusion
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Due to citrate in collected blood, which can chelate serum calcium when transfused. Us. requires massive transfusion amt. Can cause paresthesias
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HypoNa w/ persistent cough, hemoptysis, & 3cm parahilar nodule in a smoker
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Likely SIADH 2/2 small cell lung CA. Tx w/ fluid restriction first. Hypertonic saline 2nd.
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DM neuropathy → detrusor weakness
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Neuropathy → denervated bladder, which results in urinary retention. Distention → overflow incontinence until pressure relieved enough to stop flow. Occurs cyclically day/night. Char. by high post-void residual volume
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Hep-induced thrombocytopenia
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Drug rxn after 5-10days of heparin that → inc risk of arterial thrombosis
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Spontaneous hemarthroses are char of
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Hemophilia
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RA
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Causes AOCD. First line txs incl MTX, hydroxychloroquine, infliximab, etanercept.
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Lyme dz
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Ehrlichiosis 2/2 tick bite. No rash. ↑ wbc/plt/ast/alt. Tx immediately w/ doxycycline w/o waiting for serology.
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Cross-sectional study
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Prevalence study char by simultaneous ("snap-shot") measure of exposure and outcome.
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To slow/reduce renal damage when microalbuminuria is found
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Rx ACEi to decrease filtration
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Cauda equina syndrome
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Spinal nerve root compression → low back pain, bowel/bladder px, saddle anesthesia, sciatica, lower extremity sensory & motor loss. Can be 2/2/ radiation.
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Normal pressure hydrocephalus
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Abn gait, incontinence, dementia (memory loss w/o focal neuro changes). 2/2 decreased CSF absorption.
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Rationalization
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Offering a rational, logical reason for an upsetting even rather than the real reason
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Dipyramidole
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Coronary vasodilator used during myocardial perfusion scanning to reveal areas of diseased vessels that can't dilate causing ischemia
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Abruptio placentae
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Painful uterine hyperactivity w/ hemorrhage 2/2 detachment of placenta. HTN increases the risk of abruption.
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Cardiac index
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Measure of cardiac output. Always ↓ in systolic heart failure.
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Signs of systolic HF
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Acrocyanosis, BLE edema, non-specific ST & T changes, + cardiac enzymes
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Gilbert's syndrome
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Predom unconj mild hyperbili 2/2 stressor
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Crigler-Najjar 1
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Severe jaundice & neuro px 2/2 kernicterus. Indirect level us 20-25mg/dl. AutoRec. Liver trnsplt only cure. If IV phenobarb given, does NOT reduce serum bili.
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Crigler-Najjar 2
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Milder jaundice (indirect <20) w/o neuro px. If IV phenobarb given, reduces serum bili. AutoRec.
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Elevated transaminases indicate
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Liver damage
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Progressive dec of transaminases
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Either 1) recover or 2) hepatocytes are dying off
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Liver fxn tests
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PT, bili, albumin, cholesterol indicate how well liver is fxning.
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Prolonged PT w/ decreasing but high transaminases
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Liver failure
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Asymptomatic bacteriuria of pregnancy
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Rx w/ nitrofurantoin, amoxicillin, or 1st gen cephalosporin
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Bactrim in prego
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NO b/c it’s a folate antagonist
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PID 2/2 gonorrhea warrants treatment for
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Chalmydia (azithro or doxy) and gonorrhea (ceftriaxone). Also test for HIV, RPR, pap smear, & hepB
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Peripheral smear of Sickle cell dz
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Sickled RBCs and reticulocytes (not Fe def)
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Beckwith-Wiedemann syndrome
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Big newborn w/ smal head, big tongue, big organs, omphalocele, hypoglycemia, hyperinsulinemia, & poor tone. May also have prominent eyes, occiput, ear creases, & hyperplasia of pancreas.
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Congenital hypothyroidism
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Infant w/ poor tone, big tongue, UMBILICAL hernia (instead of omphalocele), macrocephaly. NO hypoglycemia/hyperinsulinemia
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Parapneumonic effusion
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Get pleural fluid pH to determine if chest tube is needed. Low pH (<7.2) indicates empyema & indicates need for thoracostomy. Glucose of <60 is another indication.
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olanzapine
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Atypical antipsychotic used to tx schizophrenia and
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?
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can cause wt gain (MC), DM, postural HoTN
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HIV esophagitis
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Occurs w/ CD4 <50 & presents w/ painful swallowing, substernal burning, & unremarkable physical exam. Rx w/ fluconazole
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Medial medullary syndrome
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Occlusion of vertebral art or a branch. Contra paralysis of arm/leg, contra loss of tactile/vib/prop, & ipsi tongue deviation
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VIPoma
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Rare pancreatic cancer producing vasoactive intestinal peptide → diarrhea, hypokalemia → leg cramps, & ↓ in stomach acid (→ met alkalosis). Us in 50+yo women. Other sxs: dehydration, abd pain, cramping, wt loss, flushing. Dx by high serum VIP. CT or MRI to localize tumor.
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PosPredictValue
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TruePos/(TP+FP) aka a/a+c
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SpIn SnOut
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Sensitivity-rule out; Specificity-rule in
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Pagets dz of bone
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High serum alkphos w/ Ca/Phos WNL. Full body bone scan + xray confirmation of high uptake bones. Don't tx if asymp. Tx if bone pain, hyper Ca, neuro deficit, high output HF, prep for ortho surg, involvement of wt-bearing bones. Rx w/ IV or PO bisphosphonates.
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Edema
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Non-pitting 2/2 lymphatic obstruction; or ↑ interstitial collection of albumin/proteins w/ low-to-normal lymph flow; Pitting 2/2 ↑ fluid shift 2/2 ↑ hydro pressure, ↓ plasma oncotic press, or ↑ cap leakage
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Mono
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EBV. Fatigue, malaise, sore throat, exudative pharyngitis, a/febrile, generalized mac/pap rash, post cervical LAD, palatal petechiae, splenomegaly. Heterophile Ab very sensitive & specific but may be neg early on. CBC w/ diff: ↑ WBC w/ lymphocytosis
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Rubella
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Red mac/pap rash starts on face & progresses to trunk/extremities w/ fever, occipital & post cervical LAD, malaise. Adult women also tend to have assoc arthritis.
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Measles
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Red mac/pap rash from head to trunk/extremities. Us. has prodrome of fever, cough, coryza, conjunctivitis, & Koplik spots. Not arthritis.
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MVP
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Mid-systolic click w/ short systolic murmur if regurges. ↓ w/ squat b/c it ↑ preload by augmenting venous return, which in return ↓ or eliminates the prolapse.
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Howell Jolly bodies
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Nuclear remnants of RBCs that would be removed by fxnal spleen but not in SCD
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Heinz bodies
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Aggregates of denatured Hgb seen in pts w/ hemolysis 2/2 G6PG def & thal. When phagocytes extract this rigid precipitate, they leave Bite cells
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Helmet cells
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Fragmented RBCs suggestive of traumatic hemolytic conditions such as DIC, HUS, TTP
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Oxybutinin
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Anticholinergic for urge incontinence b/c inhibits sm muscle
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Pneumocystic jiroveci
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Atypical pna w/ bilateral diffuse insterstitial infiltrates in immuncompromised
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Acoustic neuroma
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Dx by MRI. Suspect in pt w/ café-au-lait spots & tinitis or deafness.
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MCC of congenital hypothyroid in US
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Thyroid dysgenesis
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Old person w/ osteoarthritis is anemic b/c...
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She's taking NSAIDs & likely has low grade chronic GI blood loss 2/2 peptic ulcer
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Herpetic whitlow
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Tzanck smear shows multinucleated giant cells. HSV 1 or 2 swollen, soft, tender non-purulent vesicles on fingers - think health care worker who came in direct contact w/ infected orotracheal secretions. Us. self-limited. Oral acyclovir or topical bacitracin may be used to prevent secondary infxn.
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Wt gain 2/2 OCP
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Combined OCPs are NOT assoc w/ Wt gain
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Alprazolam (Xanax) SE w/ abrupt withdrawal
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Generalized tonic-clonic sz & confusion
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ITP
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Immune-mediated isolated ↓ of platelets. Rx w/ steroids.
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Choledochal cyst
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Congenital abnormality of biliary ducts char by dilation of intra- or extra-hepatic biliary ducts or both. Us. related to anomalous pancreaticobiliary jxn, which leads to weak/dilated biliary wall 2/2 reflux of alkaline pancreatic secretions into the biliary tree. 5 types. Type 1 is MC & features dilation of entire common hepatic & common bile ducts or segments of each.
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Renal calculi recs
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↓ protein & oxalate in diet, ↓ Na, ↑ fluids, ↑ Ca
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(Lung) PFTs
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>0.7 is restrictive, < is obstructive
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Carotid dual upstroke pulse
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HCM. Midsystolic obstruction from subaortic valve hypertrophy during contraction. Left sternal border SEM worse w/ valsalva b/c ↓ preload → ↓ ventricle stretch so it is able to obstruct outflow more
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Amiodarone SEs
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Pulm fibrosis, Thyroid dysfxn, Hepatotoxicity, Corneal deposits, Blue-gray skin color
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52yo male w/ sudden photophobia, red around eye, painful eye, non-reactive mid-dilated pupil, conjunctival flushing
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Acute glaucoma. Dx w/ tonometry.
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Boggy, tender, fluctuant mass palpable anteriorly w/ tip of examining finger on rectal exam
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Rectovesical pouch. Can be 2/2 ruptured appendix and fluid drainage to dependent area.
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Cerclage is for use when
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To prevent 1st trimester abortions b/c of incompetent cervix
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Pts w/ MI should take what for secondary prevention
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ASA, Beta bl, ACEi, Statin
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Dx test of choice for 4wk old w/ non-bile/blood vomit & olive-shaped mass beside umbilicus
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Abd U/S for pyloric stenosis
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Heat stroke
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Temp > 40.5 (105) often w/ dehydration → multi-organ effects incl szs, ARDS, DIC, ARF
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Rosacea
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Red w/ teleangiectasia over cheeks, nose, & chin. Flushing 2/2 hot drinks, heat, emotion, temp changes. Can have papules & pustules. Tx w/ topical metronidazole.
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Pts w/ Strep bovis endocarditis or septicemia are at ↑ risk for ...
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Occult colorectal or upper GI CA. Evaluate w/ scopes or radiographically.
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Painless hematuria in adult.
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MCC is bladder CA, then RCC
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Elderly dehydrated post-op pt w/ painful parotid gland
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Acute bacterial parotitis us. by S. aureus that can be prevented w/ adequate hydration & oral hygiene, both pre- and post-op
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88yo man w/ h/x HTN, Afib, stroke, bleeding ulcer, DM, & nephropathy c/o severe calf pain & burning in posterior leg several hours s/p femoral art embolectomy
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Ischemia-reperfusion syndrome (a form of compartment syndrome): after more than 4-6hrs of ischemia, tissues suffer intracell & interstitial edema upon reperfusion
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Clinical sxs of compartment syndr
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Pain, Pallor, Paralysis, Paresthesia, Pulselessness
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Duodenal hematoma
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Trauma → obstruction → vomiting 2/2 failure to pass gastric secretions. Tx w/ NG suction & parenteral nutrition for 1-2wks while hematoma spontaneously resolves
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17yo monthly lower abd pain radiates to upper thighs & back
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Primary dysmenorrhea 2/2 higher level of prostaglandins which are released during the breakdown of the endometrium
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Lactating mother contraception
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Progestin only OCP
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White plaque w/ granular texture in mouth that can't be scraped off
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Leukoplakia. ↑ risk of squamous cell carcinoma
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MCC of acute bacterial sinusitis
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A. pneumo, non-typable H. flu, M. catarrhalis
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MCC of congenital intraventricular hemorrhage
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Prematurity
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Depigmented skin patches are what and are assoc w/ what
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Vitiligo - areas devloid of melanocytes. Assoc w/ Autoimmune dzs incl pernicious anemia, graves, hashimotos, DM-I, primary adrenal insuff (addisons), hypopituitarism, & alopecia areata
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Initial tx for comedomes w/ minimal inflammation
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Topical retinoids (check prego & lipids), then topical abx if mild to mod acne, then oral abx if papular & inflammatory acne, and oral isotretionoin for nodulocystic/scarring acne
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Uncontrolled DM, maxillary sinus congestion/drainage, turbinate necrosis, chemosis/proptosis of eye
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Mucormycosis of nose & maxillary sinus us/ caused by Rhizopus
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What to do for woman 9mo s/p radical mastectomy for right-sided BC w/ isolated ER+/HER2- middle lobe lung nodule
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Surgery b/c local approaches have best chance for success in metastatic BC, which has a poor prognosis
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Routine screen for chlamydia in all sexually active women age ...
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24 or younger if at risk of STI
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Routine screen for lipids at what age
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Men 35, women 45, diabetes/CAD/familial hyperlipids/↑ coronary dz risks 20
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Non-anticoagulated Afib can cause ...
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Clots to brain (stroke), bowel (ischemic bowel dz), or any other arterial supply
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Acute pancreatitis
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Assoc w/ hypertriglyceridemia, gallstones, alcoholism, epigastric pain radiating to back, Cullen's (periumbilical bruising) or Grey-Turner's (flank bruising). Other potential complications incl left-sided pleural effusion when amylase is high, abd compartment sydrome, intraabd hemorrhage, shock, DM, pancreatic pseudocyst formation, and abd pseudoaneurysm
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Nifedipine use in STEMI?
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No b/c dihydropyridine CCB cause peripheral vasodilation & reflex tachycardia which worsens cardiac ischemia. Contraindicated
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Old, bed bound woman w/ severe proximal muscle weakness, absent DTRs, & lung mass w/ medisastinal LAD. Normal CPK.
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Small cell carcinoma of lung causes Lambert-Eaton syndrome of Abs against voltage-gated Ca channels in PREsynaptic motor nerve terminal → ↓ Ach release. Dx w/ electrophysio studies to stimulate nerve → to better response. Tx is plasmapharesis & immunosuppression.
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Tx hyperthyroidism w/ radioactive iodine unless...
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Prego or very severe ophthalmopathy. Surgery is alternative & can be used for large goiter & coexisting thyroid nodule with suspicion of CA
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Common findings of anorexic pts
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Osteoporosis, ↑ cholesterol & carotene, long QT, euthyroid sick syndrome, hyponatremia 2/2 excess water intake, ↑ risk of SGA baby b/c of nutritional deficiency
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Mucopurulent urethral discharge & hx of multiple sexual partners
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Chlamydia. RUA reveals absent bacteriuria & does not grow on Cx.
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How is gonococcal STI different from chlamydial
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GC has purulent d/c (vs mucopurulent) and can be seen on gram stain.
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Acute pyelonephritis
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High fever, WBC casts, CVA tenderness, urine cx >10k colonies, bacteriuria, pyuria
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Acute hep B findings
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Sig high ALT>AST, followed by rises in bili & alk phos. Dx w/ HBsAg, IgM anti-HBc
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4 categories of hypoxemia (PaO2 <80)
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1) Hypoventilation: ↑ PaCO2 & WNL Aa gradient; 2) Low inspired O2: WNL PaCO2 & WNL Aa gradient; 3) Shunting: WNL PaCO2 & ↑ Aa gradient UNresponsive to O2; 4) V/Q mismatch: WNL PaCO2 & ↑ Aa gradient responsive to O2
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Anti-MT Abs
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Primary biliary cirrhosis - autoimmune destruction of intrahepatic bile ducts & cholestasis. Sxs pruritus, fatigue, HSM, xanthomas, jaundice, steatorrhea, portal HTN, osteopenia. Dx: ↑ alk phos (2/2 cholestasis), ↑ cholesterol, ↑ IgM. ↑ risk of hepatobiliary malignancies. Tx: ursodeoxycholic acid, MTX, cochicine, Liver transplant (only cure)
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Anti-smooth muscle Abs
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Autoimmune hepatitis
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Sxs of Systemic sclerosis
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GERD, right heart failure & HTN 2/2 involvement of esophagus, pulm arteries, & kidneys
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Talk & Die
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MMA rupture → epidural hematoma w/ biconvex shape. Can cause dilated ipsi pupil & ipsi hemiparesis
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Aromatase def
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Absence or poor fxn of enzyme that converts androgens to estrogens → normal internal genitalia w/ ambiguous external, clitoral hypertrophy, high FSH/LH, low estrogen → amenorrhea
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Painless vag bleeding in prego
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Placenta previa (abruptio is painful)
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Respiratory quotients
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The ratio of CO2 produced to O2 consumed per unit time. Carb metab 1.0; Protein metab: 0.8; Fatty acid metab 0.7
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Scarlet fever
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Group A strep (Beta hemolytic) produce erythrogenic exotoxins → strep pharyngitis → incubation for 1-7days, then rash on neck, axillae, chest, groin and generalizes in 12-48hrs w/ sandpaper-like textrure. Pharynx is red & may have gray-white exudates. Mouth appears pale vs very red cheeks ("circumoral pallor"), & desquamation of face → trunk → limbs. Tx is PenV. Erythromycin/clindamycin/1st gen ceph is allergic.
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Tx for fibromyalgia
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Amitriptyline and cyclobenzaprine b/c they are able to increase the amt of restorative phase 4 sleep a pt gets (which is a px in fibro)
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In tumor lysis syndrome, what are Ca, Phos, K, & urate levels
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Phos & K are released from cells (so they are ↑). Urate is ↑ from the breakdown of cells. Ca, an extracell ion, is bound by phos → ↓ levels
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Intoxication with what substance causes Gap acidosis, blindness, coma
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Methanol
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Intoxication with what substance causes Gap acidosis & kidney failure
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Ethylene glycol
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24yo female w/ h/o asthma (alb, inh steroid, salmeterol, cromolyn) has mod resp distress & is given alb, steroids, o2 → normal RR but scattered bilateral wheezes. WBC of 19 w/ diff shows 82% segmented neutrophils. Why?
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Steroid effect. They diminish eos& lymphocytes & demarginate (→ ↑)neutrophils
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HIV pt w/ 1mo hx of low fever, malaise, abd discomfort, cough, 10lb wt loss but not TB or CMV On zidovudine, lamivudine, efavirenz, & bactrim. CD4 is 40. Alk phos is 412. What med would have prevented this?
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Azithromycin prophylaxis b/c he has MAC.
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HIV pt prophylaxis for PCP?
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Bactrim or dapsone
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Tx for HIV pt w/ PPD >5mm
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Isoniazid
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Tx for HIV w/ MAC
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Clarithromycin w/ Ethambutol
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HIV prophylaxis & tx for CMV
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Ganciclovir, given when CD4<50
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Old woman w/ fatigue, low fevers, occ palpitations x2mo, 7lb wt loss, left sided weakness, mid-diastolic rumble at apex, mass in left atrium.
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Either thrombus or intracardiac tumor. Constitutional complaints point to tumor. Weakness likely 2/2 tumor embolus. MC primary intracardiac tumor is atrial myxoma.
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Best stats test to assess association b/t char/no char & ab/normal levels of x.
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Chi-square is used to compare proportions of a categorized outcome. 2x2 table to compare the observed vs expected outcomes
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Test to compare 2 means
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Z-tests and T-tests
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Test to compare 3 means
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ANOVA
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Difficulty gripping coffee cup & pen in the AM but fully fxnal by noon. ESR is 45. What dz & what spinal area is also affected?
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RA - difficulty w/ morning stiffness esp in hands. May also involve C spine pain, stiffness, hyperreflexia (C1-2 subluxation, too)
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How are arterial 02 & CO2 in alveolar hypoventilation diff from that of acute PE, atelectasis, pulm edema, & pleural effusion?
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Hypovent px causes hypoxemia without reflexive tachypnea to lower CO2. All the others have low O2 with low CO2 as compensation.
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Bilroth surgery for bleeding ulcer leads to chronic watery/loose BMs w/ bloating, flatulence, 20lb wt loss, abd distention w/ succusion splash . CBC shows macrocytic anemia.
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Bacterial overgrowth 2/2 small intestine stagnation . May also have nigh blindness 2/2 VitA def, neuropathy 2/2 B12def, dermatitis, arthritis, VitD def → ↓ Ca → tetany.
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HIV w/ acute fever, profuse, watery diarrhea, & abd cramps on therapy for 8mo. What to do next?
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Examine stool for ova & parasites b/c many causes of this presentation.
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MMSE of less that what suggests dementia
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Less than 24 suggests dementia
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Alzheimer dz CT scan findings
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Diffuse sub/cortical atrophy disproportionately greater in temporal & parietal lobes
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Frontotemporal dementia
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Onset 40-60s (<Alz Dz of >60). Initially less disorientation & memory loss, more personality change & loss of social restraints. Eventually, profound dementia, mute, immobile, incontinent.
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Polycythemia vera increases what
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WBC/RBC/plts
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Pituitary tumor can cause secondary adrenocortical insuff (glucocorticoid deficiency) and thyroid insuff (hypothyroid). Give sxs of each.
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Glucocorticoid def: weakness, fatigue, depression, irritability, HoTN, lymphocytosis, eosinophilia. Hypothyroid: cold intol, constipation, dry & rough skin, bradycardia.
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Weakness, fatigue, depression, irritable, HoTN, lymphocytosis, eosinophilia, & hyperpigmented skin & mucous membranes indicates...
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Primary adrenocortical deficiency (addison's)
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Hepatomegaly with smooth, round big cyst w/ daughter cysts inside it.
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Echinococcosis us. from being in sheep pastures
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Pig farmers at high risk of what parasite
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Neurocysticercosis
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Rx for absence sz
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Ethosuccimide or Valproate
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Phenytoin is used to tx what szs
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Partial szs
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Phenobarb is used for what szs
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Alternative in primary generalized & partial szs
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Child w/ repeated (often suppurative)LAD, Pna, fever. On lypmh node gram stain see numberous bacteria filled segs. Cx grows S. aureaus. What is dx?
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Chronic granulomatous dz, a genetic defect of impaired oxidative metabolism within phagocytes.
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Middle age woman w/ h/o asymp gallstones, doesn't drink, has 1st episode of acute pancreatitis which is treated and resolves. What do you do next?
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Schedule cholecystectomy
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What is the preferred screening test for HIV
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ELISA b/c its sensitivity is >99.9%
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What is the preferred confirmatory test for HIV
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Western blot
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12yo sickler w/ high grade fever & chills, tachycardic, tachypnic, high WBC w/ bandemia, & appears drowsy. MCC?
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Streptococcus pneumoniae (pneumococcus) - recall fxnal asplenia in SCD by 2-3yrs
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10yo male w/ pencil thru roof of mouth.→ hempiplegia, hemianesthesia, & motor aphasia. Cause?
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Internal carotid artery dissection
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6yo male w/ abd pain mac/pap rash on BLE, right knee TTP & passive movement. Dx:
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Henoch Schonlein Purpura, an IgA mediated vasculitis of small vessels, which freq follows URI. JARS - joints abd renal skin (purpura)
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Tx of choice for mod-to-severe acne predominantly nodulocystic form, & to those w/ scarring?
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Oral isotretinoin
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Prophylactic tx of choice s/p renal transplant?
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Bactrim - to prevent PCP. (Ganciclovir or valganciclovir to prevent CMV infxns; should also get encapsulated org vaccines)
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How do you tx essential tremor?
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Propanolol is us. first line. Can consider primidone or topirimate. Benzo's (xanax) are not rec b/c of dependence potential.
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Carbidopa/levodopa are used for tx of
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First line for Parkinson
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65yo male w/ sudden, painless loss of vision in rt eye, resolved at 5min, occurred again. MCC & tx:
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MCC: Central retinal artery occlusion 2/2 embolism (esp w/ h/o carotid art dz, endocarditis, valvular dz, long bone fx, hypercoag conditions, etc); Tx: ocular massage & high flow O2 to dislodge emboli & move downstream, thus preserving as much flow as possible
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36yo female w/ fever, malaise, cough, infiltrate on CXR, failed z pack represents w/ foul-smelling sputum. Recent h/o endoscopy for GERD/PUD. Dx: Tx:
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Most likely anaerobic pneumonia 2/2 aspiration during scope. Tx for anaerobic coverage such as Clindamycin
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Soap bubble appearance on xray in epiphysis of distal femur
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Giant cell tumor of bone. Classic pt is 20-40yo female. Tumor cells are oval or spindle intermingled w/ nultinuclear giant cells in fibrous stroma.
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New clubbing in pts w/ COPD is indicative of
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Occult malignancy
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Stevens Johnson vs Toxic Epidermal Necrolysis
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TEN has >30% surface area; SJ has <10% surface area; Both can be rxn to sulfas, barbiturates, phenytoin, & NSAIDs
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MC location for gallstone cholecystitis
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Cystic duct.
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Common bile duct obstruction (stone or CA) causes what sx and what char lab finding
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Severe icterus & very high Alk Phos
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MEN 2 A & B findings
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Med Thyroid CA, Pheo + (A has parathyroid hyperplasia - not adenoma) (B has mucosal neuroma & marfanoid habitus); both have RET-proto oncogene
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MEN 1 findings & cause
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Pit adenoma, Pacreatic islet cells, hyperParathyroidism 2/2 Menin mutation (us. a tumor suppressor gene)
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The most distinctive feature of MEN 2B is
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Mucosal neuromas, present in 90% of cases, on tongue, eyelids, lips, & GI tract
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MCC of traveler's diarrhea
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Enterotoxigenic E. coli.
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23yo man w/ occ HA, muscle weakness, fatigue, periodic numbness of extremities, HTN. Dx:
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Primary hyperaldosteronism (Conn's syndrome) us. due to adrenal hyperplasia or CA.
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Chronic inlammation 2/2 autoimmune, chronic infxn, or IV drug abuse lead to this dx which has sxs of morning facial puffiness, BLE edema, recurrent pulm infxns, chronic diarrhea & psoriasis. HIV & viral hep panel negative. UA has 4+ edema.
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Secondary amyloidosis results from the deposition of acute phase reactants, esp serum amyloid A in the setting of chronic inflammatory dz, which can cause nephrotic syndrome, hepatomegaly, cardiomyopathy, pseudohypertrophy, & peripheral neuropathy.
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46yo woman eating more, losing wt, diarrhea, thirsty, inc urination freq w/ red, scaly plaques on face & buttocks
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Glucagonoma, a malignant tumor of islet cells, causes hyperglycemia, necrolytic migratory erythema, & wt loss. Tx is surgery
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When on the vent, what 2 settings affect pO2?
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FiO2 & PEEP - influence oxygenation
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When on the vent, what 2 settings affect pCO2?
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TV & RR - influence ventilation
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7yo male w/ rapidly enlarging, fluctuant cervical LAD w/ fever. Dx: Tx:
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Likely staph or strep. Tx w/ I&D plus ABX coverage - consider B-la-ase resistant drugs like Naf/Ox/diclox-acillin for to cover staph
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How do antipsychotics work for schizophrenia
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DA receptor Antags; can cause decreased ability of DA to suppress the tuberoinfundibular pathway of Prolactin release → hyperprolactinemia, gynecomastia, & sexual dysfxn in males
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42yo woman c/o fatigue, weakness, anorexia, nausea, abd pain, syncopal episodes, HoTN, hyperpigmented palmar creases. Dx:
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HypoACTH - Addison's dz - primary adrenal failure. HoNa, 2/2 volume contraction b/c dec aldo & inc vasopressin (due to lack of cortisol suppression); ↑K 2/2 dec activation of aldo receptors (not exchanging); mild hyperchlormic acidosis
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~5days after MI, acute L→R shunt w/ Rt heart failure & new onset systolic murmur heard best at LLSternal border
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Interventricular wall rupture
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~5days after MI, acute pericardial tamponade and rapid decompensation w/ PEA
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Ventricular free wall rupture
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~3-7days after MI, acute MR & pulmonary edema
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Papillary muscle rupture
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~30days after MI, acute MR, CHF due to Left heart failure, & ST elevations
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Ventricular aneurysm
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55yo homeless alcoholic man w/ h/o chronic & recurrent abd pain presents w/ muscle cramps & perioral numbness. Lab indicates HoCa. Why?
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Pancreatitis → ↓ abs of VitD, which → ↓ abs of Ca & Phos
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47yo disheveled, malodorous, malnourished woman smiles but doesn't stay attentive to interview & says "jingle jangle, doctor, jingle jangle" when asked about being found wandering in the street. Dx: Rx:
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Disorganized schizophrenia. Rx w/ risperdone, an atypical antipsychotic (it's Atypical for Old Closets to Risper Quietly from A to Z) which has less EPS than typicals (haloperidol)
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32yo male w/ worsening low back pain & h/o smoking, drinking, IV drugs. Neuro exam & straight leg raise is WNL. Percussion on lumbar vertebrae elicits pain. Dx:
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Vertebral osteomyelitis. Common in IV drug users, sicklers, & immunosuppressed pts. S. aureaus is MCC.
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What causes Graves exopthalmos?
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Autoimmune attack on EOMs, where lymphocytes infiltrate the EOMs & orbital fat causing edema, proliferation of local interstitial fibroblasts, & deposition of GAGs. Also sympathetic mediated lid retraction.
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4mo w/ macrocytic anemia, low retic, & congenital anomalies
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Diamond-Blackfan syndrome, aka hypoplastic anemia, due to intrinsic defect of RBC progenitor cells → ↑ apoptosis. Macrocytic anemia is NOT megaloblastic as evidenced by no hypersegmented nucleoli in neutrophils. Tx w/ corticosteroids.
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Downs syndrome serum markers
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↓ AFP, ↑ BhCG, ↓ estradiol, ↑ inhibin A
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6mo w/ recurrent ear & lung infxns, oral candidiasis, & persistent rotoviral diarrhea. Low B&T cells, Absent thymic shadow. Dx:
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SCIDs: diagnostic features are absent lymph nodes & tonsils, lymphopenia, absent thymic shadow, abnormal B/T/NK cells
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Tx for chronic hep C
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Interferon & ribaviron
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40yo male c/o unusually dark urine, scleral icterus, jaundice w/ urine dipstick positive for bilirubin. Dx:
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Conjugated hyperbilirubinemia like Rotor (liver can't store conj bili so it leaks into plasma),
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PPD is positive in healthy non-healthcare workers at what size?
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>15mm
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PPD is positive at 10mm in whom?
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Immigrants from endemic TB locales, IV drug users, prisoners, homeless shelters, DM, CKD, lymphomas, leukemias, lung dz, kids under 4, teens exposed to high-risk adults
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People w/ HIV, recent contact with TB-+ person, CXR suggestive of TB, organ transplant recipients, and pts on immunosuppresants are ppd+ at what size?
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>5mm
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Female pt who is rude and belittles the nurses, quickly bonds w/ you & loves you, but hated last doctor. Dx:
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Borderline - splitting
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4+ proteinuria, microhematuria, dense deposits w/i the GBM, immunofluorescence for C3 but no Igs. Dx: Cause:
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Membranoproliferative glomerulonephritis. Caused by IgG Abs (termed C3 nephritic factor) against C3 convertase of the alternative complement pathway leading to persistent complement activation & kidney damage.
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Anti-IgM Abs are characteristic of what renal disease
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Goodpastures
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35yo febrile man w/ h/o untreated HIV & hepC brought by friends b/c acting weird. Anemic, MCV 85, retic 8.1, platelets 45k, azotemia, Tbili 3.6, conj 1, alk phos 128, AST 62, ALT 54. Dx. What would you see on smear?
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TTP (FAT RN). Schistocytes on smear.
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56yo male w/ h/o uncontrolled HTN & smoking x30yrs c/o acute onset of PND. BP 170/100, HR 120, bibasilar rales, scattered wheezes. Dx: How do you relieve his dyspnea?
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Cardiogenic pulmonary edema 2/2 diastolic dysfxn from long-standing uncontrolled HTN → left ventricular failure. Nitroglycerin rapidly reduces preload (more quickly than loops or morphine).
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18mo c/o 3day h/o fever & facial rash. H/o atopic dermatitis treated 1wk ago w/ topical steroids. PE shows numerous umbilicated vesicles or red skin of both cheeks. Submandibular LAD. Dx:
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Eczema herpeticum. Can be life-threatening. Tx w/ acyclovir.
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Outpt tx for CA-Pna
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Azithromycin or doxycycline
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Inpt tx for CA-Pna
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Levofloxacin or Moxi
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42yo obese female for routine DM f/u. Elevated AST < ALT, Alk Phos, HepBsAB positive. Denies etoh, cigs, drugs.
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NASH - metabolic syndrome w/ ALT>AST & no etoh
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12yo female w/ chronic wt loss, fatigue, bulky/floating/foul-smelling stools, anemia, low ferritin, high TIBC. Dx: Antibody assoc w/ her condition?
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Celiac dz. Anti-endomysial Ab
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Pronounced RLE weakness & sensory deficit, Babinski +, urinary incontinence, gait apraxia but RUE WNL. Where is stroke?
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Left ACA (lower ext at apex of homunculus, also affects frontal lobe personality)
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Homonymous hemianopsia w/ more pronounced upper limb motor & sensory deficit (lower limb preserved). Where is stroke?
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MCA (upper ext/face/mouth at lateral edge of homunculus)
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MCA stroke of left (dominant) lobe can cause pt to have what sx?
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Aphasia
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MCA stroke of right (non-dom) lobe can cause pt to have what sx?
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Neglect &/or anosognosia
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20yo 32wks prego w/ HTN >140/90, proteinuria >0.3g/24hr.
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Mild PreE
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Severe PreE criteria
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HTN >160/110, proteinuria > 5g/24hr, oliguria, HELPP
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1st line HTN tx in PreE?
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Methyldopa
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25yo female c/o chronic pelvic/low back pain worse w/ period. PE: tender posterior vaginal fornix & pain w/ uterine motion. Dx test: Dx:
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Laparoscopy. Endometriosis.
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At what age are meningococcal vaccines given?
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11-12yo unless SCD (asplenia), who may be as early as 2yo.
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Fight-bite ABX?
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Augmentin (amoxicillin-clavulanate) for polymicrobial coverage (amoxicillin covers G+ & G-, clavulanate adds Bl-ase inhibitor & anaerobe coverage)
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71yo male w/ back pain x 3mo which APAP has not helped. He has HTN rx w/ HCTZ. Recent hearing loss. PE shows anterolateral femoral bowing. Dx: This is a problem with what?
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Paget's disease of bone. Back pain, increasing hat size, CN8 entrapment
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Absent bowel sounds w/ gaseous distention of small & large bowels 3days s/p blunt trauma. Dx:
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Paralytic (adynamic) ileus
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Absent bowel sounds w/ massively dilated colon w/o significant small bowel dilation 3days s/p blunt trauma. Dx:
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Acute colonic pseudoobstruction
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Characteristics of nephritic syndrome
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HHA: HTN, Hematuria, Azotemia
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Characteristics of nephrotic syndrome
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HHEP: hyperlipids, hypoalbumin, edema, proteinuria
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Lymphoma is associated w/ nephrotic or nephritic?
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Nephrotic - usually minimal change dz
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MC nephropathy assoc w/ carcinoma?
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Membranous
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55yo female 1wk h/o left ear pain/itch worse at night & chewing. H/o HTN, DM, DLD, & gout. On lisinopril, allopurinol, metoformin. Febrile, 140/90, Granulation tissue in ear. Dx: Cause: Tx:
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Malignant otitis externa. Caused by Pseudomonas 2/2 poor DM control. Rx w/ IV Ciprofloxacin.
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44yo female w/ symmetrical swollen joints, stiff esp in morning, generalized weakness, low-grade fever, & jt pain. Dx: Tx: Common SE:
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RA. DMARDs like MTX. SE include stomatitis, nausea, abd pain, fever, anemia, hepatotoxicity, BM suppression.
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15yo female c/o of no menses. PE Tanner 2 w/ scant pubic hair & decreased femoral pulse. Next test? Dx:
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Karyotype. Turner's (45XO, short, webbed neck, streak ovaries, high-arched palate, congenital bicuspid aortic valve, & coarc aorta)
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47yo w/ 2mo hx of lethargy & decreased libido. H/o joint pain/swelling, DM. PE findings include big liver, small testicles. Dx: What cardiac abnormalities is most likely to be present?
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Hemochromatosis. Cardiac conduction block. (Also cirrhosis, pancreatic fibrosis (diabetes), & skin pigmentation)
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Neurofibromatosis type 2 characteristics:
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Bilateral acoustic neuromas & cataracts
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Neurofibromatosis type 1 characteristics:
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Café-au-lait spots, macrocephaly, feeding problems, short stature, & learning disabilities. Pts may develop fibromas, neurofibromas or other tumors.
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32yo female at 30wks prego w/ intense itching, elevated T & D Bili, Alk Phos, AST, ALT (516, 884), & GGT but neg Hep panel. Dx: Tx:
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Intrahepatic cholestasis of prego. Ursodeoxycholic acid.
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Nephropathy char by arteriosclerotic lesions of afferent & efferent renal arterioles & glomerular capillary tufts. This is 2/2 what chronic dz?
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HTN
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Nephropathy char by inc extracellular matrix, BM thickening, mesangial expansion, & fibrosis. This is 2/2 what chronic dz?
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DM
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53yo female w/ RA on chronic steroid & MTX tx. C/o febrile, cough, nite sweats. CXR shows LLL cavitary lesion w/ surrounding infiltrate. Blood & sputum cxs grow partially acid-fast, gram+ branching rods. Dx: Tx:
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Nocardia asteroides. Bactrim
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