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38 Cards in this Set
- Front
- Back
Findings in Different microcytic anemias? |
All have low MCV Iron: hi RDW, lo RBCs, microcytosis/hypochromia, low iron, low ferritin, hi TIBC, hgb increases w/ fe tabs, normal hgb electrophoresis alpha-thal: normal RDW, normal RBCs, target cells, normal to HIGH ferritin and iron, normal hgb electrophoresis beta-thal: same as alpha except hi hgb A2 and HgF on electrophoresis anemia chronic dz: from RA, ESRD, etc. hi ferritin, low TIBC, low FE, normal fe sat, correct underlying dz Sideroblastic anemia: ETOH, lead, isoniazid, hi Fe (in mitochondria), prussian blue stain, if major: remove toxin, if minor: pyridoxine replacement |
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Heinz body=? |
G6PD deficiency -sudden hemolysis->hemolytic anemia -X-linked in AA -get sx from oxidant stress: infxn, oxidizing drugs (sulfas, dapsone, primaquine), FAVA beans -blood smear: heinz body, BITE cells -can test for G6PD levels (but only 2 months after) -TMT: none, avoid stressor |
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24yo M bartender fatigue, fever, sweats, myalgias, sore throat, smoker, sex active, flushed, maculopap rash on face, trunk, palms, soles, well-healed puncture wounds inside forearms, general lymphadenop, neg HIV ELISA, neg heterophile, NGTD bcx=? |
Acute retroviral syndrome (HIV) will occur 2-3wks after getting infected and 2-3wks before seroconversion (acts like mono w/ maculopap rash) -test w/ HIV RNA or p24 antigen |
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Contraindications to using bupropion for quiting smoking? |
reduces seizure threshold-seizure disorders eating disorders |
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Colonoscopy screening guidelines |
General pop or single 1st degree relative age >60 w/ colon ca: start age 10 colonoscopy q10yrs or sigmoidoscopy q5yrs (w/ FOBT q3yrs) or FOBT or fecal immunochemical test YEARLY Increased risk (1st deg relative age <60 colon ca /adenomatous polyps or 2 first degree relatives any age): colonoscopy age 40 OR 10 yrs b4 age of ca dx (whichever first), rpt q3-5yrs |
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TMT of constipation in kids? |
1. diet mod (hi fiber fruits/veggies) 2. mag hydroxide (aka Milk of mag) |
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56yo F w/ met breast ca w/ tumor estrogen and prog receptor negative, started on chemo w/o response, after workup, add monoclonal ab tmt w/ good response What was it? |
HER-2/neu over expression (oncogene that has BAD prognosis), but very treatable with Trastuzumab or Herceptin, and these increase sensitivity to chemo |
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Most sig risk factor for Colon Ca? Protective factors? |
ETOH intake (more than smoking) (other than FAP, IBD, AA, fam hx -high fiber diet, regular NSAIDS, hormone replacement, exercise |
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Rules of RhD ppx in pregnancy? |
-give to ALL Rh (D) neg women at 28wks gest RhoGAM if no anti-D isoimmunizaiton detected during ab screening at 20 wks -Also, give RhoGAM after any procedure (amniocentesis) and after delivery for Rh negative moms |
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Increased AFP in 2nd trimester=? Workup? |
concern for neural tube defects -do u/s to confirm dating (if error->rpt AFP at correct date) -if correct and no detection on u/s->do amnio for amniotic fluid AFP and acetylcholinesterase levels |
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Rules of diphenhydramine with hobbies? |
Don't use before driving, operating machinery, flying planes, or DIVING |
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Mgmt of inguinal hernia in kids? |
elective repair as soon as possible |
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13yo boy was camping, came back w/ pruritic lesions R arm 2 days ago, this AM had similar on L hand, linear, erythematous, irregular=> |
poison IVY dermatitis (can occur 2-3 days later) |
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Risks with PPI long term? |
increased osteoporosis, decreased absorption of B12 and iron, hypomagnesemia, interstitial nephritis, c.diff |
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Most common causes of acute otitis media? Signs/sx TMT? Complications? |
strep pna, nontypable HiB, moraxella (pseudomonas is for EXTERNA) middle ear effusion PLUS bulging tymp membranes -Amoxicillin x10days (if rpt in same month: do amoxicillin-clavulanate) -conductive hearing loss, mastoiditis, meningitis |
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TMT for cherry angioma? Strawberry Angioma? Spider Angioma |
-in elderly: reassurance, benign vasc tmor -in childhood, conservative, can consider propranolol if ulcerated -LFTs |
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55yo w/ 1mo mild achy stiff hand joints worse in morning for 1 hour, HTN on amlodipine, multiple sharp demarcated erythematous scaly plaques on extensors both elbos, hand w/ yellow nails, erythema on distal fingers, xray w/ bony erosions and new bone formation DIP=? Dx Test? common findings? TMT? |
Psoriatic Arthritis -none -dactilytitis, psoriasis extensor surfaces, onychomycosis looking nails, DIP infolvement (RA would only be PIP and MCP!), enthesitis tendon insertion sites, nail pitting, HLA-B27 -NSAIDs first, but if extensive->methotrexate, can use topical steroids if mild or facial psoriasis) |
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39yo F w/ pscyh dz on haldol/valproate controlled, now complains of "can't sit still or relax" and gen discomfort=? TMT? |
Akathisia
-beta blocker-propranolol |
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TMT for GBS? |
Plasmapheresis and/or IVIG x2wks -plasmapheresis is better <7days onset |
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Tmt of oral thrush? What if patient uses inhaled steroids for asthma? |
nystatin suspension -then also wasthc to ensure proper technique using inhaler |
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Rules for HSV in pregnancy? |
Treat HSV if patient having an active lesion -any patient with h/o HSV: give antiviral agent acyclovir at 36wks gestation to delivery -if active genital lesions or prodrome=c-section |
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Pediatric community-acquired pna -most common cause? TMT? |
if preschool age OR focal lung findings: strep pna->give hi dose po amoxicillin if older OR well appearing w/ bilat lung findings: mycoplasma->give azithromycin |
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patient that received lots of blood now with seizures=think what? |
HYPOCALCEMIA (citrate from blood binds to calcium)->give calcium gluconate for every 500ml pRBCs given (hypokalemia happens more often with hypothermia) |
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polymyalgia rheumatica is associated with what? First dx test? |
Giant cell (temporal) arteritis (if have HA or jaw pain) -do ESR (if >50 w/ HA, very specific for GCA)->to temporal artery bx -give hi dose steroids if GCA suspected |
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In patients with some kind of chronic pain/back pain, what is the most significant predictor of likelihood to return to work? |
Patient's recovery of expectation |
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Patient on chronic steroids for lupus Next step for maintenance? |
start Calcium and vit D to decrease rate of bone loss |
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Patient with incidental finding of pituitary mass after MVA, with normal labs and tests Next step? |
rpt pituitary MRI in 6-12mos (don't need to resect unless enlarging or clinical sx) |
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Howell-Jolly bodies=? |
sickle cell anemia |
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Maintenance therapy for sickle cell? |
pneumococcal vaccination Penicillin till age 5 folate hydroxyurea if crisis >4/yr |
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What is the goal INR for mechanical heart valves? |
2-3 if aortic and no risk factors (afib, severe LV dysfunction w/ EF <30, prior DVT/PE, hypercoag state) 2.5-3.5 if mitral or aortic w/ risk factors |
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6mo old baby for well baby exam, in <5 percentile lenght and 25th percentile head circ Next step? |
Provide dietary recommendations (failure to thrive) |
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tmt of scabies? |
topical permethrin |
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tmt of chronic tinea pedis (pruritis erythema scaling between toes that may be linear and have sharp borders and acompany onychomycosis)? |
topical terbinafine, but if more extensive->po terbinafine (if also onychomycosis) |
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Patient w/ h/o HTN w/ increased Cr 2 from 1.6 a year ago Dx test? TMT? |
likely hypertensive renal failure -urine protein (if 500-1000 indicates CKD from HTN) -ACEi or ARB most effective in slowing |
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42yo F to ED w/ AMS, h/o hypoTH, depression, back pain, on levothyroxin, amytriptyline, daily oxycodone, confused, agitated, febrile, hypotensive, flushed, mydriasis, hyperreflexive, wide QRS=? TMT? |
TCA (amitriptyline overdose)-drowsy/coma/seizure/resp depression/tachy/hypotn/prolonged everything on EKG/arrythmias/dry mouth/blurred vision/midriasis/u retention (antichol stuff) -activated charcoal if w/in 2hrs of ingestion -IV sodium bicarb if QRS wide to prevent arrythmia -supplemental O2, intubate, IVF as needed |
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differentiate legionella from atypical pnas vs. strep pna? |
strep pna is most likely CAP: typical acute onset, purulent sputum, XR w/ single lobe infiltrate Atypical PCP, mycoplasma, chlamydia: gradual onset, nonproductive cough, INTERSTITIAL infiltrates on XR Legionella: CAP + diarrhea/n/v/HA/confusion (sputum w/ no organisms but many neutrophils) |
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Pregnant woman w/ acute TB TMT |
isoniazid, rifampin, ethambutol (only add pyrazinamide if it is multi-drug resistant TB since teratogenic) |
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Patient w/ HA, myalgias, lo grade fever, no CT findings CSF shows no xanthochromia, 75000rbcs, 100wbc, normal ptn, mild hi glucose=> |
traumatic LP (since no xanthochromia to indicate SAH) |