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53 Cards in this Set
- Front
- Back
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What is chalazion?
TMT? What if recurrent? |
obstructed meibomian gland eyelid
-hot compress->if fails->steroid inj or I&D -If recurrs->histo exam for possible meibomian gland carcinoma (sebaceous ca) vs. basal cell ca |
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Pt w/ chronic hep C are at risk for what?
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1. cryoglobulinemia->membranoprolif glomerulonephritis (immune-complex mediated)
2. B-Cell lymphoma 3. Autoimmune->sjogren's, thyroiditis 4. Lichen planus 5. porphyrea cutanea tarda 7. ITP |
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Tell me 4 types of familial disorders of hyperbilirubinemia
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Crigler-Najjar 1: aut rec, severe jaundice + kernicterus (bili encephalopathy) in neonate, indirect bili>20, LFTs and liver histo normal, nonresponsive to phenobarbital, TMT phototherapy or plasmapheresis, liver transplant
Crigler-Najjar 2: aut rec, milder, jaundice but survive to adult w/ no neuro prob, ibili<20, TMT improves on IV phenobarb or clofibrate (given if necessary) Gilbert: familial lack of UDP glucuronyl transferase->up ibili still <3, icterus 2/2 stress/excercise/fatigue/fasting, all normal Rotor: benign, up dbili and ibili w/ leakage to plasma and darkend urine |
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supracondylar fracture=concern for what?
How to tell? |
brachial artery
-check radial pulse (and recheck after surgery) |
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TMT of bedwetting?
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1. behavior techniques (enuresis alarms)
2.desmopressin (ADH analogue) 3. TCA imipramine |
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Describe ligamentous sprain (when is pain worse and best, is it tender?)
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painful w/ movement, feel best in morning
tender perispinal (NOT Over vertebrae) |
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Describe vertebral compression?
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This is not cord compression, so no neuro findings. It is a compression fracture usually in old pt w/ osteoporosis due to vertebral body demineralization
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Most common glomerular association w/ HepB?
What else is associated w/ this glomerular dz? |
Membranous glomerulonephritis
-solid tumor ca, NSAIDS |
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How to differentiate factitious diarrhea from IBS?
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factitious: look for pt from high socioeconomic level, medical field, mult hospital admissions, Bx w/ dark brown discolored colon w/ lymph follicles shining though pale patches (melanosis coli)->from ingesting laxatives, may also seen pigmentation in macrophages in lamina propria
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Fibromyalgia tmt?
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1. TCA-amitriptyline->restores phase 4 sleep (which is absent in fibromyalgia)
2. cyclobenzaprine 3. SSRI (if depression cooexistent) |
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What pts w/ afib get anticoagulation?
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CHADS-2 score:
CHF HTN Age>=75 DM Stroke hx =2pts 0-2: intermediate risk: aspirin or anticoag >2: anticoag w/ warf |
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What should all pts w/ STEMI get (in order of time)?
What if RV infarct? |
1. Reperfusion therapy (thrombolytic vs per angio/PCA->no thrombolytic if major bleed hx/surgery w/in2wks, severe HTN, stroke w/in6mos)
2. Aspirin vs. clopidegrel (if aspirin not tolerated) 3. Morphine, O2, Nitrates/nitrog (nitrate contraindicated in aortic stenosis, PDE5i use, RV infarct->will know since clear lungs or inferior infarct) 4. B-blocker, ACEi/ARB (at anytime in admission) 5. Heparin RV infarct: IV fluid bolus (to increase RV stroke vol and LV filling) and other tmts, but no nitrates or diuretics |
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Pt w/ refractory to med HTN, fam hx HTN, gross hematuria, bilat flank mass.
ML dx? |
Polycystic kidney dz
-aut dom, 75% have fam hx |
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How do you calculate PEEP?
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do end-expiratory hold maneuver, since plateau pressure= elastic pressure (during inspiration) + PEEP, so the plateau pressure=PEEP at end-expiration
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How do you calculate pulm compliance on ventilator?
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Do end-inspiratory hold (since PEEP is zero here), plateau pressure=elastic pressure + PEEP (0 here) and elastic pressure is inversely correlated to pulm compliance (less compliant = more elastic pressure)
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What conditions have hi peak and plateau pressure?
What have hi peak and normal plateau? |
PTX, pulm edema, PNA, atelectasis, R main intubation
-bronchospasm, mucus plug, biting ET tube (things that don't effect the lung compliance but only increase resistance) |
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What conditions typically cause anemia of CD?
TMT? |
RA, cancer, chronic infxn
-treat underlying condition (if RA: methotexate, hydroxychloroquine, anti-tnf inflximab/etanercept) |
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TMT of placental abruption during delivery?
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2 large bore IVs first w/ IV fluid and foley cath
c-section if: uncontrolled hemorrhage, rapid hemorrhage/hypOtension, fetal distress(late decels) Vaginal if: fetus doing well, mother bp is ok, baby is dead already |
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Pt w/ suspected UC toxic megacolon.
TMT? |
1st confirm w/ abd XR that colon dilated >6cm (suspect megacolon w/ fever>38, HR>120, PMN leukocytosis>10500, anemia + 1 of: volume deplete, AMS, electrolyte abn, HypOtn)
-IV prednisone and abx (if inxn suspected) |
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What is milk-alkali syndrome?
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in PUD, used to be treated by milk and nonabsrobable alkali->cause triad of hypercalcemia, met alkalosis, and renal failure
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PTH levels in sarcoid?
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down, since up extra-renal conversion of 25-h->1,24 D calcitriaol by granulomatous tissue->increaed Ca abs from GI tract and hypercalcemia->suppresses PTH
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Describe fetal hydantoin syndrome?
What causes it? |
midfacial hypoplasia, microcephaly, CLEFT LIP & PALATE, digital hypoplasia (no phalanges fingers/otes), hirsuit (lots ofhair), dev delay
-Phenytoin, carbamazepine |
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What conditions can cause pulsus paradoxus?
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1. Cardiac Tamponade
2 & 3. COPD and Asthma! surprise |
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What is the inheritance pattern of HOCM?
What pop pts get it? |
Aut Dom
-blacks>whites, young, no cardiac risk factors |
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What causes stasis dermatitis?
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Venous HTN and peripheral vasc dz->blood pooling in legs from valv incompetence->increased pressure->damages capillaries->extravasation plasma, fluids, RBCs->hemosiderin deposit, fibrin and plt aggregation
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What are electrolyte changes of subarachnoid hemorrhage?
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"cerebral salt-wasting syndrome"
inappropriate vasopressin secretion to retain water->increased secretion atria/b natriuretic peptide->HYPONATREMIA in 102wks and SIADH |
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Findings in CSF of GBS?
TMT? |
hi ptn, normal wbc/rbc/glucose=albumino-cytologic dissociation
TMT w/ IVIG and plasmapherisis |
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Describe presentation of myotonic muscular dystrophy?
Cause? Inheritance? |
normal birth, as child slow muscle weakness w/ progressive muscle wasting=face (temporal wasting, thin cheeks, inverted V upper lip), emaciated extrems(atrophy thenar and hypothenar, prox muscle weak, +gower sign, wing scapula, myotonia=stuck handshake), endocrine (DM, testicular atrophy, frontal balding, hypothyroid)
-muscular dystrophy all muscles -aut dom (also called Seinert dz) |
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How to calculate calcium correction?
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0.8mg Ca per 1g albumin (norm alb=4g)
Corrected Ca=0.8(norm albumin or 4 - measured albu)+measured Ca |
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What is cradle cap?
Describe lesion and location? TMT? Differentiate from tinea capitis |
seborrheic Dermatitis (keratosis is the "waxy stuck on")
-chronic inflammatory papulosquamous yellow and scaling plaques in infancy starting on scalp, eyebrows, nasolabial folds, base of eyelashes, paranasal skin -moisturizer, topical antifungal, anti-dandruff shampoos, topical steroid -Tinea is patchy fine WHITE adherent scales w/ ADENOPATHY on SCALP only |
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boy w/ back pain and palpable "step off" in lumbosacrum=?
Describe |
Spondylolisthesis
-developmental dz w/ forward slipping of L5 over S1 causing chronic back pain and possible neuro dysfunction if significant |
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Common GNRs? What do they infect? What abx against them?
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e.coli, staph saprophyticus, klebsiella, enterobacter, serratia, proteus, pseudomonas ("emily sees klebsiella easily swimming up her pretty parts")
-BUL: bowel (peritonitis/diverticulitis), Urine (pyelo, UTI), liver (cholecystitis, cholangitis) -Emily's QuAC PAC: quinolones, aminoglyc, carbapenems, piperac/ticarc, aztreonam, cephalosporins |
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Side effects of amikacin?
Use? |
Its an aminoglycoside: nephrotoxic, ototoxic
BUL: for GNRs in bowel, urinary, liver |
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Difference in cause of ascending vs descending aortic aneurysms?
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Ascending: cystic medial necrosis (old age) vs connective tissue dz (marfan's, ehlers-Danlos)
Descending: athersclerosis (HTN, hyperlipid, smoking) |
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Risk of cancer in PBC vs PSC?
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PBC: hepatocellular
PSC: cholangiocarcinoma and colon ca |
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Antibodies and associated labs and dz in PBC vs. PSC?
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PBC: anti-mitochondrial ab, IgM, alk phosph/bili up late in dz, dx w/ liver bx, tmt w/ ursodeoxycholic acid
PSC: P-ANCA, UC, possible IgM, hi alk phosph and bili, dx w/ ERCP seeing strictures/beeding, TMT w/ ursodeoxcholic acid/cholestyramine and dilation of strictures w/ stening->need liver transplant |
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Findings in zinc deficiency?
Where is it digested? Associated conditions that it is lacked in? Foods that have it? |
alopecia, abnormal taste, bullous pustulous lesions around body orifices, impaired wound healing, growth retardation
-jejunum -dietary deficiency, TPN formula, surgery w/ jejunal removal -animal ptn, grains, beans, nuts |
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Findings in vit A deficiency?
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blindness, dry skin, impaired immunity
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Finding in selenium deficiency?
Foods that have it? |
CARDIOMYOPATHY
same as zing (meats, nuts, grains) get this from chronic TPN or malabsorption |
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3 common hip diseases in kids and how to differentiate?q
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Congenital hip dysplasia: in infants, newborn on screening exam->ortolani and barlow "click" or "clunk", TMT w/ pavlik harness
Legg-Calve-Perthes/Avasc Necrosis fem head: 2-8yo, painful limp (antalgic gait), pain knee/groin/hip, xray w/ joint widened and effusion, TMT w/ rest/NSAIDS and surgery later SCFE: obese adolescent, painful limp, externally rotate leg, xray w/ widened joint, internal fixation w/ pinning |
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Needle shaped crystals in u/a=?
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uric acid stones (don't show up on xr)->do CT scan
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What GI dz can come from kidney stones?
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Ileus
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What regulates prolactin production?
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inhibited by dopamine and stim by serotonin and TRH
Therefore, hypothyroid->hyperprolactinemia, dopamine agonists (antipsychotics, TCAs, MAOis)->same, pituitary tumors |
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What do you use for anaerobic infxn?
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Oral (above diaphragm): penicillin/ampicillin/amoxicillin, clindamycin (PAAC your mouth)
GI: metronidazole, beta-lactam/lactamase combos 2nd line: piperacillin, carbapenems, 2nd gen cephalosporins |
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TMT of aspiration pneumonia?
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need anaerobic coverage: clindamycin
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Pt w/ smear w/ bite cells on bactrim.
ML Dx? Presentation? Labs? Pt pop? Causes? |
G6PD deficiency
back pain, hemolysis w/ dark urine,"", fatigue, pallor -NORMAL G6Pd during episode, hi ibili, hi LDH, lo haptoglobin, bite cells, heinz bodies -mediterraneion, black, asian, X-linked -primaquine, sulfas/bactrim, fava beans, infxn, dapsone) |
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Pt w/ recurrrent episode hemoptysis, 5days malaise, throat pain, dry cough, yellow sputum w/ red specks, afebrile, bilateral wheezes, CXR clear.
ML Dx? Dx Test? TMT? |
Acute bronchitis (young normal pt w/out suspicious hx w/ hemoptysis w/ negative xray)
clinical supportive w/ close observation since likely viral |
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Acute tmt of pheochromocytoma?
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Alpha blockers FIRST, then beta blockers (if you give b-blockers alone->will have unregulated alpha stimulation->rapid increase in already hi BP!)
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When is the back pain of ankylosing spondylitis worst?
TMT? |
worse w/ rest (worst in morning and night w/ morning stiffness)
TMT: excercise + NSAIDS, if fail->anti TNF ifliximab/etanercept |
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What underlying dz of restictive cardiomyopathy can actually be reversed w/ tmt?
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Hemochromatosis: phlebotomy and defuroxamine
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Focal-segmental nephrotic synd caused by?
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HIV/AIDS, 50% blacks, Heroin/IV drug use
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What is tmt of acute cholecysitis?
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cholecystectomy w/in 72hrs
in meantime: IV fluids, abx, pain meds |
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4 types of glycogen storage dz and differentiating features?
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"Very Poor Carb Metabolism"
1=glucose-6-phosphatase def=Von Gierkes: 3-4mos, sever hypoglycemia w/ seizures possible, hyperuricemia, hyperlipidema, lactic acidosis, "doll-like face"/fat cheeks, thin extrem, short stature, large kidney/liver 2=acid maltase def=Pompes: hepatomegaly, "floppy baby" w/ feeding difficulty, macroglossia, progressive hypertrophic cardiomyopathy->CHF 3=debranching enzyme=Cori's: same appearance as Von-Gierkes but labs w/ up LFTs, fasting KETOSIS, normal lactate/uric acid 4=branching enzyme/skeletal muscle glyc phosphorylase=McArdle: benign, hepatomegaly, growth retard, mild hypoglyc/hyperlipi/hyperketo, normal lactic/uric |
