Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
100 Cards in this Set
- Front
- Back
fremitus def ?
- where is it most intense ? - what increases fremitus ? - what decreases fremitus ? - when is there no fremitus ? |
palpable vibrations in body
- 2RICS and interscapular region, which are closest to bronchial bifurcation. - areas of consolidation (pneumonia) - pleural effusion or bronchial obstruction - PTX |
|
arises from metanephros
|
Wilm's turmor
|
|
constitutes response to fluid resucitation ?
|
SBP > 100
|
|
VWF cleaving protease:
deficient or Ab against in ? Tx ? |
ADAMTS-13
TTP-HUS Plasma Exchange ! |
|
proximal myopathy in lung Ca where ?
|
mm membrane
|
|
Recovery in TTP-HUS indicated by:
|
LDH & Platelet normalization
|
|
TTP-HUS findings:
|
MAHA (microangiopathic h. a.)
or just hemolytic anemia neurological sx renal failure thrombocytopenia |
|
MC cause of papillary necrosis ?
|
analgesic overuse
|
|
10% of dialysis pts due to:
- anemia (pallor) due to chronic renal failure - hematuria - htn (ex 160/100) - intermittent flank pain - multiple renal cysts - nephrolithiasis (20%) - nocturia 2-3x / night - palpable kidneys - renal CA not increased - UTIs |
APKD (AHHIMNNPRU)
|
|
cardiogenic shock tx ?
|
bolus PCWP to 15-20 mmHG
if still hypotensive: - add inotropic agents |
|
obstructs venous return to right heart
|
tension PTX
|
|
pseudotumor cerebri (tx)
also called benign / idiopathic intracranial htn |
MRI to rule out mass lesion
Lumbar puncture to demonstrate increased CSF presure |
|
size of benign lymph nodes ?
|
< 1 cm in diameter
|
|
1st line for streptococcal pharyngitis
|
erythromycin
binds 23S rRNA of 50S ribo subunit bactiostatic URI, pn, STD, G+ cocci, MLCN GI discomfort, acute cholestatic hepatitis, EOSINOPHILIA, skin rash, increases concentration of theophyllines, oral anticoagulants. |
|
pneumoperitoneum on upright radiograph under the diaphragm - what next ?
|
emergent surgery
|
|
peak incidence of intussusception ?
most common location ? common finding ? |
8 months
ileocolic junction currant jelly stools |
|
kill first, investigate later
|
testicular cancer
- remove testis after hard mass + US suggest CA |
|
Chronic Hep C pt w/ nl AST/ALT but with PCR for HCV RNA.
|
Reassurance & LFT F/U.
- not even interferon or anti-viral drugs |
|
70 yo with bright red bleeding into toilet. MC cause ?
|
diverticulosis
- hemorrhoids rarely cause massive lower GI bleeding and are easily ID'd on PE. |
|
chronic occult blood loss
|
colon CA
|
|
abd pain out of proportion to physical findings
|
acute mesenteric thrombosis
thrombus - forms in vessel & does not move embolus - forms in vessel then moves |
|
peptic ulcer ds hemorrhage could be detected with:
|
NG tube suction
|
|
sudden severe pain in lower extremity:
slow, progressive arterial narrowing and pain in lower extremity - expect bilateral pulse loss: |
arterial embolism
arterial thrombosis |
|
pain and edema in lower extremity accompanied by warmth to touch - pain
is usu dull and aching vs. severe pain from an arterial origin. |
DVT (venous thrombosis)
|
|
MC cause of pancreatitis ?
- how to confirm ? |
choledocolithiasis
- confirm w/ RUQ US in a pt w/ pancreatitis |
|
GERD leads to: (ABEP)
How long for development of adenocarcinoma in GERD ? |
Adenocarcinoma, Barrett's, Erosive esophagitis, Peptic stricture
> 20 years |
|
esophageal motility disorders (2)
- describe the physical findings |
achalasia
- decreased peristaltic waves - increased LES tone (can't relax) scleroderma - decreased persistaltic wave - decreases LES tone - remember food "sticking" in her throat |
|
Ao arch vessels encircle trachea and/or esophagus.
|
vascular rings
|
|
What if my husband and I have both sickle trait ?
|
select embryos w/o the mutation for in vitro fertilization
|
|
warm Abs against RBC
MC age group ? cause ? |
positive Coomb's test - autoimmune
2-12 yo preceded by infection, usu URI |
|
these improve prognosis in CRF
- what's the big caveat ? |
ACE inhibitors
Protein restriction Caveat: in Cr >3.0 ACE inhibitors worsen CRF |
|
embryonal CA marker, GIT & lungs
seminoma choriocarcinoma |
AFP
PLAP (placental alk phos) beta-HCG |
|
decreased visual acuity
sluggish afferent response to light changes in color perception |
optic neuritis
|
|
cytotoxin assay in the stool to test for:
|
Clostridium difficile diarrhea
|
|
MC cause of Afib ?
Describe Afib on EKG (3) |
HTN
1. absent P waves 2. irregularly irregular 3. narrow QRS |
|
Lidocaine
Adenosine Carotid Massage Diltiazem which of these provides rate control ? |
Diltiazem
|
|
hemodynamically stable Afib > 48 hr tx?
hemodynamically stable Afib < 48 hr tx? hemodynamically unstable afib tx? |
rate control + anticoagulation first then cardioversion later
electrical or pharm cardioversion immediate cardioversion |
|
type Ib antiarrhythmic used in Vtac
- ischemic myocardium is the target, which are centers of abnormal automaticity. Compare to type Ia which target areas of normal automaticity. |
lidocaine (but amiodarone is first line)
|
|
carotid massage & adenosine used for:
|
SVT
- adenosine is only for dx |
|
IgM (expect hyperviscosity)
IgA or IgG (no hyperviscosity) |
Waldenstrom's macroglobulinemia
MM |
|
pregnancy test before starting:
|
sumatriptan
|
|
dopamine antagonist medication most commonly associated with NMS
|
haloperidol
|
|
begins w/in 2 weeks of initiation of precipitating drug
mortality 10-20% |
NMS
|
|
widened mediastinum DDX (AAEMMS)
|
anthrax exposure
Ao dissection esophageal rupture mediastinal hemorrhage mediastinal mass SVC syndrome (dyspnea, facial swelling) |
|
ADP inhibitors indicated in unstable angina (UA), NSTEMI & post PCI.
PCI = percutaneous coronary intervention |
clopidogrel (preferred)
ticlopidine |
|
periorbital edema
myositis eosinophilia |
trichinellosis
|
|
MC drug-induced CRF is analgesic nephropathy. Pathology ?
% of end-stage renal ds? How much drug required ? |
papillary necrosis
tubulointerstitial nephritis 3-5% 2-3kg or 4.4-6.6 LBs |
|
Granular "muddy brown" casts
acute renal failure (usu ischemic or nephrotoxic) |
acute tubular necrosis
|
|
edema
hematuria (RBC casts) htn proteinuria |
glomerulonephritis
caused by: NIM (nephritic syndromes, ischemia, malignant hypertension) |
|
premature aging
atherosclerotic vascular ds urinary tract cancer |
analgesic abuse (esp. combined as in aspirin + naproxen)
|
|
initial eval in delirium ?
|
electrolytes + urinalysis
|
|
initial test in acute pancreatitis to determine etiology in a non-drinker (that is, to find stones)
|
US for gallstones
abdominal CT to confirm pancreatitis |
|
SIRS diagnostic criteria
- need only 2 to have SIRS SIRS due to infection is Sepsis |
fever or hypothermia
tachypnea tachycardia leukocytosis, leukopenia or bandemia |
|
acanthosis nigricans think:
describe: |
DM in younger pts, GI malignancy in eldery
symmetrical hyperpigmented velvety plaques axilla, groin, neck |
|
hyposthenuria
|
impairment in kidney's ability to concentrate urine in sickle ds or sickle trait
|
|
child with macrocytic anemia
low reticulocyte count congenital anomalies (triphalangeal thumbs) etiology ? |
Diamond-Blackfan anemia (MLCT)
- defect of erythroid progenitor cells resulting in increased apoptosis |
|
no hypersegmentation of the nucleus in neutrophils, as occurs in megaloblastic anemia
|
Diamond-Blackfan anemia
(congenital hypoplastic anemia) |
|
Wiskott-Aldrich syndrome (EHTX)
Etiology: |
eczema
hypogammaglobulinemia thrombocytopenia X-linked Etiology: US Answer - It's on another card, I think. |
|
absent thumbs
autosomal recessive cafe-au-lait spots horseshoe kidney micro-cephaly & thalmia progressive pancytopenia & macrocytosis |
Fanconi's syndrome (AACHMP)
|
|
accounts for 25% of LV end-diastolic volume
|
atrial kick
|
|
CD4<40 prophylaxis for MAC
Tx for MAC |
Azithromycin
Clarithromycin + ethambutol |
|
hypertriglyceridemia definition:
hypercholesterolemia definition: optimal HDL: |
150 mg / dl
200 mg / dl > 40 mg / dl |
|
How is pulsus paradoxus measured ?
|
variation in systolic p. during expiration & inspiration
- 1st read systolic during expiration - 2nd read systolic during exp / insp. - 3rd if difference > 10 mm Hg this is PP |
|
Pulsus Paradoxus DDX: (AACCCPPST)
|
anaphylactic shock
asthma cardiac tamponade cardiogenic shock COPD pericardial effusion pulmonary embolism SVC obstruction tension PTX |
|
Obstruction of fluid drainage via lymphatic channels:
Inflammatory accumulation: |
transudate
exudate |
|
Relieved by sitting up and leaning forward and exacerbated by lying down.
|
pericardial pain
|
|
Beck triad of pericardial tamponade (JHM)
|
JVD
hypotension muffled heart sounds |
|
decorticate posturing ("mummy baby")
GCS score : disinhibtion of: fascilitaiton of: |
GCS = 3
red nucleus rubrospinal tract (flexor motor neurons) |
|
decerebrate posturing (extension)
GCS score: brain stem damage to: |
GSC = 2
red nucleus |
|
what caues transition from decorticate
to decerebrate posturing ? mech: Note: The GCS for decerebrate posturing extension is 2, for decorticate GCS is 3, so this represents worsening of the condition. |
uncal herniation (transtentorial)
or tonsillar herniation mech: activation of gamma motor neurons (A small nerve originating in the anterior horns of the spinal cord that transmits impulses through type A gamma fibers to intrafusal fibers of the muscle spindle for muscle control.) |
|
Vaccination at birth
|
Hep B
|
|
Vaccinations at 2 months: (HHIRTDAPP)
|
Hep B
Hib IPV Rota Tetanus Diphtheria Acellular Pertussis Pneumococcal |
|
Minimum weight for first vaccination:
|
2 kg (5lb 4oz)
|
|
think bradycardia
|
prolonged QRS
|
|
think tachycardia
|
prolonged QT
|
|
free of ds when study begins:
|
cohort
(retrospective or prospective) |
|
water bottle heart
|
pericardial effusion
|
|
stop AAA progression:
|
stop smoking
|
|
think hyponatremia in this type stroke:
mech: |
subarachnoid hemorrhage
mech: incr vasopression cx H20 retention atrial / brain natriuretic peptide causes Na wasting |
|
Lactase deficiency best test >
|
positive hydrogen breath test
|
|
how to cool a person in heat stroke ?
|
evaporative cooling
|
|
MC complication in PUD ?
|
hemorrhage
|
|
after cytoscopy, expect which bug in sepsis ?
|
enterococcal bacteremia
|
|
R/O pneumonia:
|
lungs CTA
|
|
when will drug fever develop ?
|
1 - 2 weeks after administration
|
|
caused by inhaled anesthetics
acidosis fever rhabdomyolysis tachycardia |
malignant hyperthermia (AFRT)
|
|
MC thyroid nodule:
2nd MC thyroid nodule: |
colloid
follicular adenoma |
|
increased LDH
increased total protein think neoplasm, TB |
exudative parapneumonic effusion
|
|
decreased LDH in the effusion
decreased total protein effusion - type of effusion ? |
transudative parapneumonic effusion
|
|
WBCs in parapneumonic effusion:
Neutrophils in parapneumonic eff: |
TB, neoplasm
infection |
|
syncope due to autonomic dysfunction or drugs is associated with:
|
postural change
|
|
febrile seizures in children expected above what temperature ?
|
39C (102.2F)
|
|
microcytic, hypochromic anemia
decreased reticulocytes increased RDW |
Fe-deficiency anemia
|
|
how to destinguish thalassemia from Fe-deficiency anemia ?
|
Thalassemia has nl RDW
|
|
Normal RDW ?
|
20%
- 21% is probably for Fe-def anemia |
|
work up for back pain:
|
R/O CES
- nl anal reflex, bowel & bladder R/I Disc Herniation - straight leg raise |
|
Disc Herniation Tx:
|
NSAIDS, early mobilization
- neither exercise nor bed rest helps - but recall the stupid Kaplan question included two days of bed rest ... |
|
Name the 3 parapneumonic effusions:
How best determine need for chest tube? |
1. uncomplicated effusion
2. complicated 3. empyema Pleural fluid pH |
|
Pleura fluid pH < 7.2 is dx for:
|
empyema
|
|
What does LDH do ?
From where does energy come ? When does this happen ? Why is LDH increased in hemolysis ? |
converts pyruvate to lactate
NADH to NAD+ decreased O2 It is in the RBC !!! |