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565 Cards in this Set

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Identify. What is the Tx?
Erythema multiforme.
Mild: Histamine blockers
Moderate: Prednisone for 1-3 weeks
If due to HSV, give acyclovir of valacylovir to decrease recurrence
What is the Tx for otitis externa?
Ampicillin/sulbactam or TMP/Sx for 10 days. If no improvement with ABx consider tympanostomy tubes.
What is the Tx for otitis externa?
Topical Oflaxacin with steroids
Identify. Presentation? Dx? Tx?
1. Pemphigus Vulgaris. Autoimmune d/o where autoantibodies destroy adhesions between epithelial cells.
2, Forms flacid bullae with erosions where previous bullae were. Nikolsky sign +.
3, Skin biopsy shows acantholysis (seperation fo epidermal cells from each other)
4. Tx: Corticosteroids and Immunosuppressive agents
What is glaucoma?
Optic neuropathy caused by increased IOP (>20mmHg) causing loss of vision
What is open angle glaucoma?
Diagnosis is made on pts who are losing there peripheral vision and who have an increased IOP; Pts have an abnormal cup to disk ratio of > 50%
What is closed angle glaucoma?
Medical Emergency!
Anterior chamber angle impairs drainage of aqueous humor; sx include eye pain, conjunctival injection, halos around lights; fixed moderately dilated pupils
What is the Tx of open angle glaucoma?
Nonselective topical betablockers (timolol, levobunolol)
Topical adrenergics (epinephrine)
Topical cholinergic agonists (pilocarpine)
What is the Tx of closed angle glaucoma?
Contact opthamologist.
Topical pilocarpine.
Acetazolamide to decrease intraocular pressure.
What is used to treat influenza?
Oseltmavir or Zanamivir. Within 48 hrs of Sx for Tx or prophylaxis.
What are the complications of influenza?
Pneumonia is the primary complication.
Others: myositis, rhabo, myocarditis, pericarditis
What are the causes of hearing loss?
Ext: foreign obj, cerumen impaction, otitis externa, growth/mass
Int: Otitis emdia, barotrauma, perforation of TM
Other: Presbycusis (age related hearing loss; high pitches first), otosclerosis, (bilat conductive hearing loss), drug induced (aminoglycosides)
What are the signs and symptoms of allergic rhinitis?
Sx: congestion, rhinorrhea, sneezing, eye irritation, postnasal drip
Sings: pale mucosa, cobblestoning pharynx, scleral injection, blue boggy turbinates
What is the tx of allergic rhinitis?
1. Antihistamines (diphenhydramine, fexofenadine)
2. Intrasnasal corticosteroids
Identify. Tx?
Atopic dermaittis. The itch that rashes.
Tx: topical steroid creams
Alt Tx:Tacrolimus (steroid sparing agent)
Identify. Tx?
Dx: Psoriasis
Limited disease Tx: topical steroids, topical retinoids
Generalized (>30% of body) Tx: UV B light exposure
Severe: Methotrexate
Identify. Tx?
Rosacea. Occurs in 30-60 y/o; flushing may be caused by emotion, spicy foods; Rhinopyma (thickened lumpy skin on nose) due to sebacous gland hyperplasia; no comedones

Tx: Mild cleanser (dove), benzoyl peroxide; metronidazole topical gel/
Persistent: Oral tetracycline, minocycline + retinoic acid cream
Mainteneance: topical metronidazole. clonidine
Identify. Sx? Dx? Tx?
Autoimmune disease where Abs against BM leading to subepidermal bulla; occurs at > 60y/o
Sx: Large tense bullae
Dx: Skin biopsy
Tx: Topical corticosteroids
Identify. Tx?
Acne Vulgaris.
Tx: Topical ABx: Erythromycin, benozyl peroxide, topical retinoids
2nd line of Tx: Minocycline + tetracycline
Severe: Isotretinoin (avoid in women as is teratogenic, or consider OCP + pregnancy test)
Identify. Tx?
Herpes Zoster.
Tx: Pain management; acylovir, valacylovir or famciclovir (can decrease duration of illness if started 72 hrs from rash onset)
Identify. Tx?
Tinea capitis.
Tx (also for corporis, pedis): Griesofulvin, itraconazole, selenium sulfide
Identify. Cause? Tx?
Onychomycosis. Caused by trichophytum rubrum and T. mentagrophytes
Tx: Terbinafine and itraconazole
Identify. Tx?
Tinea versicolor. In winter appear reddish brown.
Tx: Griesofulvin, selinium sulfide, ketoconazole
What are the preventative health screening guidelines?
Cervical CA: Pap smears start at age 21; screen annually until 3 consecutive negative results.
Breast CA: 50-74 y/o q 2years
Colon CA: Colonoscopy q 10 yrs at age 50; flex sig q3-5 years at age 50
Osteoperosis: W > 65 DEXA scan
AA: One time screening for men 65-75 y/o with smoking Hx; Do abdominal U/S
What are the indications for specific immunizations?
1. Tetanus - Childhood; q10 yrs
2. Hep B - Chronic liver disease, IVDA, HCWs
3. Pneumococcal - > 65 y/o + immunocompromised, HIV, posttransplant, recurrent infections
4. Influenza: All pts > 50 y/o + high risk pts
5. Zoster: All pts > 60 y/o
Interpret Joint Aspirate Values
Normal: Clear; High viscocity, <200 WBCs, <25% PMNs, no crystals
Non infect: xanthochromic, high visc, 200-3000 WBCs, <25% PMNs, no crystals
Inflammatory: yellow, low visc, 3000-50,000, >50% PMNs, crystals may be present (DDx: gout, pseudogout, SLE, TB)
Infectious: Opaque, low visc, > 50,000 WBCs, > 75% PMNs, no crystals (DDx: bacterial, TB)
What is the criteria for diagnosis of SLE?
DOPAMINE RASH
(need 4 criteria)
Discoid rash
Oral ulcers
Photosensitive rash
Arthritis
Malar rash
Immunologic criteria (+ antidsDNA or + antiSmith)
Neurologic or psych Sx
Renal disease
ANA +
Serositis
Hematologic d/o
Identify.
RA Hands
1. MCP + PIP involvement
2. Sparing DIP
3, Ulnar deviation
4. Symmetric
5. Swan neck deformity
6. Boutonneire's deformity
How to diagnose rheumatoid Arthritis?
Dx of Ra (Need 4 for > 6 wks)
1. Morning stiffness > 1 hr
2. Arthritis for > 3 joints
3. Symmetric arthritis
4. + RF
5. Radiographic changes: symmetric joint space narrowing with periarticular osteopenia
What is an obstructive pattern of PFTs?
Ex: COPD, chronic bronchitis, bronchiectasis, asthma
1. FEV1/FVC < 70%
2. TLC may be increased in COPD
How does a restrictive pattern appear on PFTs?
1. FEV1 and FVC may be low but the ratio is > 75%
2. TLC decreased in restrictive process
3. FVC of <80%
What pulmonary disorders is DLCO decreased?
1. COPD
2. Fibrotic disease
Dx of CO poisoning? Tx?
Dx: Normal PaO2 on ABG but decreased SpO2 on puls ox
Tx: Methylene blue
How is asthma diagnosis?
1. Obstructive pattern
2. Increase in FEV1 or FVC by 12% and at least 200 mL with bronchodilators
3. Methacholine challenge can be used to confirm diagnosis
How are acute asthma exacerbations treated?
1. Short acting beta-agonist (albuterol) nebulizer/INH
2. Systemic corticosteroid (methylprednisolone or prednisone)
3. Inhaled corticosteroids
4. Follow pts peak flow
* Check an ABG in a pt with an asthma exacerbation; a normal PCO2 suggests pt is tiring and about to crash
What is a short acting inhaled bronchodilator?
Albuterol
What is are examples of inhaled corticosteroids?
1. Flovent (Fluticasone)
2. Pulmicort (Budesonide)
3. Aerobid (Flunisolide)
What are examples of inhaled long acting beta agonists?
1. Salmeterol (Servent)
2. Formoterol (Symbicort)
What are the stages of asthma and how is each treated?
Mild intermittent: Sx <2 d/wk, < 2 n/mo, FEV1 > 80%; Tx:PRN albuterol

Mild persistent: > 2 d/wk but < 1/d, > 2 n/mo,FEV1 > 80%; Tx: PRN short acting BD + low dose inhaled CS

Moderate persistent: Daily, > 1 n/wk, FEV1 60-80%; Tx: Low to med dose inhaled CS + long acting inhaled BA + PRN short acting BD

Severe persistent: Continual, frequent, FEV1 < 60%; High dose INH CS+long acting INH BA + PO steroids+ PRN short acting BD
What is the treatment of chronic COPD?
1. Inhaled beta agonists and anticholinergics (ipratroprium)
2. O2 therpay fo those with a SpO2 < 88% or PaO2 < 55 or a PaO2 55-60 w/ cor pulmonale
3. Smoking cessation
4. O2 therapy
5. Pneumococcal vacc + influenza vacc
6. Inhaled steroids do not play a role in chronic COPD
How to Dx COPD exacerbation? Tx?
Dx: Dyspnea, chang in cough; obtain CXR to identify CHF, pneumonia as causes
Tx: Supp O2, INH BA, INH antiocholinergic, systemic CS, ABx: Azithro (cover moraxella, H. influenzae, strep)
What are the physical exam findings for pleural effusion?
Decrease breath sounds, dullness to percussion and decreased vocal fremitus
How to diagnose via thoracentesis ?
Exudate: P/S protein >0.5 or P/S LDH >0.6 or LDH >200

Transudate: P/S protein < 0.5 and P/S LDH < 0.6 or LDH < 200
What are the indications for a chest tube?
1. Pleural WBC count > 100,000 or frank pus/ gram + fluid
2. Glucose < 40 mg/dl
3. pH < 7.0
What are the features of malignant pulmonary nodules?
1. size > 2 cm
2. Spiculation (ragged edges)
3. upper lobe location
4. Smoking Hx
5. > 40 y/o
6. Cancer Hx
How should you manage an incidental pulmonary nodule seen on x-ray?
1. Eval for malignant features; if > 1 malignant feature obtain CT chest
2. If imaging points to malignancy , biopsy tissue via bronch, needle aspiration, or VATS
3. If low probability pursue serial x-rays/CT chests
How to Dx OSA?
Gold standard: Polysomnography. AHI > 5 is diagnostic
What are the Sx? Dx? Tx for bronchiolitis
sx: cough, wheezing
Dx: CXR shows hyperinflation and infiltrates; Obtain RSV via ELISA
Tx: O2, albuterol, if RSV + use Ribavarin for severe disease
Cystic Fibrosis: Sx? Dx? Tx?
Sx: recurrent pulmonary infections, pancreatic insufficiency, infertility; infants may present with meconium ileus or intussception, wheezing, clubbing
Dx: Sweat Cl tes > 60 meq on two occasions; genettic testing
Tx: Bronchodilators, chest physiotherapy, pancreatic enzymes, mucolytics; fat soluble vitamins (ADEK); antibiotics (need pseudomonal coverage), lung transplantation for severe disease
What is the DDx of monoarthritis?
1. Gout
2. Septic arthritis
3. Lyme disease
4. Pseudogout
5. Trauma
What is the difference between gout and pseudogout crystals?
Gout crystals: Urate; needle shaped; negative birefringence; yellow when parallel; good response to colchicine

Pseudogout crystals: Calcium pyrophosphate; rhomboid shape; strongly + birenfringent; blue when parallel; weak response to colchicine
How do radiographs appear as of gout affected joints?
Early: Normal

Late: Punched out erosions with overhanging cortical bone indicating rat bites
What nerve deficits result from damage to: L3,L4? L5? S1?
L3.L4: difficulty rising from chair and heel walking, numbness over anterior knee and medial calf, decreased knee jerk

L5: problems heel walking, extending the big toe or dorsiflexing the ankle; numbness over the medial aspect of the foot

S1: problems toe walking or plantar flexing the ankle, numbness over the lateral aspect of the foot, decreased ankle jerk
What is CREST syndrome?
1. Calcinosis
2. Raynaud's phenomenon
3. Esophageal dysmotility
4. Sclerodactyly
5. Telangiectasias
Define Menorrhagia
Menorrhagia is heavy or prolonged menstrual floe
Define Metrorrhagia
Metrorrhagia is bleeding between menses
Defiine metromenorrhagia
Metromenorrhagia is heavy bleeding at irregular intervals
What are the causes for uterine bleeding?
MS PDA
1. Malignancy
2.Systemic: bleeding disorders
3. Post menopausal
4. Dysfunctional: DOE; unopposed estrogen in annovulation leads to proliferative endometrium
5. Anatomic: leiomyoma, adenomyosis, polyps
What are the different types of amenorrhea and there causes?
Primary amenorrhea: no menses and no secondary sexual characteristics by age 14 or no menses with or without secondary sexual characteristics; causes include gonadal failure, congenital abnormalities

Secondary amenorrhea: lack of menses for 3 cycles or 6 months with normal menses prior to loss; etiologies include pregnancy, anorexia nervosa, stress, strenuous exercise, intrauterine adhesions, hyperthyroidism, and hyperprolactinoma
What is relative risk?
Disease No dis.
Exposure a b

No expo c d

RR + [ a/(a+b)]/[c/(c+d)]

< 1 means disease less likely with exp
> means more likely with exp
Waht is the odds ratio?
Disease No dis.
Exposure a b

No expo c d

Odds ratio = ad/bc

Compares rate of exposure among those with and without disease
What is absolute risk reduction?
Also known as attributable risk measures the absolute risk in the placebo group minus the absolute risk in the treated patients
What is relative risk reduction?
RRR = (event rate in controls - event rate in exp)/ (event rate in control pts)
What is the number needed to treat?
NNT = 1/ARR
What is a prospective study?
Prospective studies assess future outcomes relating to present or future events
What is a retrospective study?
Retrospective studies relate to outcomes of past events
What is a cohort study?
A population is observed overtime grouped on the basis of exposure to a particular factor and watched for a specific outcome
What is the workup for primary amenorrhea?
If no uterus: Karyotype; likelt testicular feminization, mullerian agenesis, gonadal dysgenesis, 46 XY

If uterus present, no patent vagina: imperforate hymen, transverse vaginal septum, vaginal agenesis

If uterus, vagina, and breasts present: workup secondary amenorrhea

if uterus, vagina present and no breasts: Work up progestin negative amenorrhea
How is secondary amenorrhea worked up?
1. Perform progestin challenge
2, No withdrawal bleed consider ruling out asherman's if necessary; otherwise obtain FSH; if FSH > 40 consider ovarian failure; if FSH < 40 likely severe hypothalamic dysfunction

If withdrawal bledd:
If hirsute consider PCOS, rule out ovarian tumor, adrenal tumor
If nonhirsute: mild hypothalamic dysfunction
What is vulvovaginitis?
Increased vaginal pruritis with discharge; can be caused by bacterial (BV), fungal (candidia), or trichomonas
What is the DDx of dysphagia with solids only?
1. Lower esophageal ring
2. Zenker's diverticulum
3. Plummer vinson syndrome
4. Peptic stricture
5. Esophagitis
6. Carcinoma
What is the DDx of dysphagia with solids and liquids?
1. Achalasia
2. Esophageal spasm
3. Scleroderma
What are the red flags of PUD?
Age > 45 y/o
Wt loss
Anemia
Heme + stools
What are the common etiologies of PUD?
H. pylori
NSAID/ASA use
Zollinger ellison syndrome
HSV
CMV
Cocaine use
What is the treatment of H. pylori?
Amoxicillin 1 g bid
Clarithromycin
Metronidazole 500 mg bid
Omeprazole or lansoprazole
What are the indications for surgery for a GI bleed?
Recurrent/refractory upper GI bleed
Gastric outlet obstruction
Recurrent/refractory ulcers
perforation
Z/E syndrome
What is the treatment of Crohn's disease?
Mild: A-ASA

Moderate: oral corticosteroids, =/- azathiopurine, 6 mercaptopurine, methotrexate

Refractory disease: IV steroids + immunomodulators (anti-TNF); imaging to r/o perforation
What immunologic markers are + in Crohn's vs. UC?
Crohn's +ASCA
UC + pANCA
What are the path findings in Crohn's versus UC?
Crohn's: Noncaseating granulomas with mononuclear cell infiltrates
UC: Crypt abcesses with micro ulcerations but no granulomas
What is the colorectal cancer screening schedule in pts with UC + Crohn's?
Surveillance colonoscopy with multiple biopsies 8-10 years after diagnosis and biannually or annually there after
What is the definitive Tx for UC?
Total colectomy
What are the Rome III criteria?
12 wks of the following Sx:
1. Improvement of pain with defecation
2. Associates with a change in frequency of bowel movements
3. Onset associates with a change in form/appearance of stool

Rome criteria for diagnosis of IBS
What us the stool osmotic gap?
SOG = 290 -(stool Na + stool K)
Normal < 50
How is the stool osmotic gap used?
If normal gap with normal weight, think IBS versus factitious

If wt is increased with a normal gap consider secretory cause or laxative use

If increased SOG + increased stool fat consider bowel malabsorption, pancreatic insufficiency, bacterial overgrowth

Normal stool fat with increased SOG: lactulose intolerance, sorbitol intolerance, laxative abuse
What skin disorder is celiac sprue associated with?
Dermatitis herpetiformis
What are the path findings of celiac sprue?
Flattening or loss of villi and inflammation
What immunological markers are associated with celiac sprue?
Anti-endomysial Ab
Anti-tissue transglutaminase
(- only with IgA deficiency)
What is the treatment of sprue?
Gluten free diet
What is the initial management of alcoholic pancreatitis?
Bowel rest, IV hydration, pain control
What are the causes of acute pancreatitis?
Gallstones, ethanol/ercp, trauma, steroids, mumps, autoimmune, scorpion bites, HLD, and drugs
How is chronic pancreatitis diagnosed?
Calcifications in pancreas on CT
72 hr fecal fat > 7g/d
When is an ERCP indicated in acute pancreatitis?
Gallstone pancreatitis with biliary obstruction
When and what antibiotics are used in prophylactic antibiotics?
ABx use prophylactically for severe pancreatitis; Imipenem or (Metronidazole + fluoroquinolone)
In what pts do you suspect acalculous cholecystitis?
Trauma pts, pts on TPN, burn pts
What is the triad and pentad of cholangitis?
Triad: RUQ pain, fever, jaundice
Pentad: RUQ pain, fever, jaundice, shock, AMS
When should a HIDA scan be ordered?
If U/S is equivocal + suspicion for acute cholecystitis is high proceed to HIDA scan
What antibiotics are used for acute cholecystitis?
3rd gen cephalosporin + metronidazole in severe cases
What is the tx of cholangitis?
NPO, pressors, hydration, ciprofloxacin, ERCP with sphincterotomy
What are the lab markers in acute vs. previous HAV?
antiHAV IGM vs. antiHAV IGM
What are the lab markers in acute HBV?
HBsAG, HBeAg, antiHBcAb IgM
What are the lab markers in acute HBV - window period?
HBcAb IgM
What are the lab markers in chronic active HBV?
HBsAg, HBcAb IgG, HBeAg
What are the lab markers in recovery from HBv?
AntiHBsAb IgG, Anti HBcAb IgG, normal ALT
What are the lab markers in a pt who was vaccinated against Hep B?
HbsAb IgG
What are the lab markers in acute HCV with recovery?
HCV RNA, anti-HCV AB, RIBA, ALT increased
What are the lab markers in acute HCV with chronic infection?
AntiHCV Ab with normal ALT
What is the treatment of HCV?
IFN with ribavarin
What is the treatment of SBP?
3rd gen cephalosporin or fluoroquinolone
What is the treatment of acetaminophen toxicity?
Acetylcysteine
What lab markers are seen in Wilson's disease?
Increased urinary copper, decreased serum ceruloplasmin, increased hepatic copper content
What is the Tx of Wilson's disease?
Chelation with penicillamine and trientine
What is the diagnostic lab work for autoimmune hepatitis?
Hypergammaglobulinemia on SPEP, + ANA, +ASMA, + LKMA
What is the tx of autoimmune hepatitis?
Corticosteroids + azathioprine
What is the diagnostic lab work of primary biliary cirrhosis?
Elevated ALP
Increased bilirubin
+ antimitochondrial Ab
What is the tx of primary biliary cirrhosis?
ursodeoxycholic acid, cholestyramine, transplantation
What is primary sclerosing cholangitis?
idiopathic intra/extra hepatic fibrosis of the bile ducts usually associated with IBD, UC
What are the diagnostic criteria for primary sclerosing cholnagitis?
Increased bilirubin + ALP
+ASMA
+ pANCA
beaded bile duct strictures on ERCP
What si the treatment of primary sclerosing cholangitis?
Ursodeoxycholic acid
Cholestyramine
Stricture stenting
liver transplantation
What is the presentation of AML?
Fatigue, easy bruising, anemia, feverl DIC, gingival hyperplasia, petechiae, purpura
What is the lab work suggestive of AML?
Prominent leukocytes; Decreased LAP in AML and CML; Hyperuricemia duet o increased cell turnover
PBS: Myeloblasts with auer rods
BM biopsy: blast with + myeloperoxidase stainin, aeur rods
What is the tx of AML?
Chemo/Induction: Cytosine-Arabinase (Ara-C) + anthracycline
For PML use all trans retinoic acid or BM transplant
What is the evaluation for a plapable breast mass?
W< 30 y/o: U/S => simple cyst vs. complex cyst/mass
- If simple cyst do needle aspiration if pt desires
- if complex cyst/mass do image guided core biopsy

W >30 y/o: mammogram and U/S; if suspicious for malignancy do a core biopsy
What is hypercalcemia of immobilization?
- seen in pts with high bone turnover
- Occurs days to weeks after immobilization
- Will have high calcium, low PTH, low 1,25 OH2 Vit D, and normal 25 OH Vit D
- Managment includes use of bisphosphonates
What are the risk factors for elder abuse?
1. Chronic physical and mental impairment
2. Old age
3. Female gender
What are the contraindications to MMR?
1. Current moderato to severe febrile illness
2. Anaphylaxis to meomycin or gelatin
3. Severe immunodeficiency
4. Thrombocytopenia after first MMR
5. Recent administration fo immunoglobulins
6. Pregnancy
What is tinea versicolor?
1. fungal infection
2. dimorphic yeast pityriosporum obicularae (malassezia furfur)
3. Multiple small circular macules that vary in color from white, pink, and brown
4. Rash is more prominent in the sumemr time as yeast prevent pigment trasnfer
5. TOC: Topical antifungal (ketoconazole); if extensive can use oral antifungals i.e. fluconazole, itraconazole, ketoconazole
What are the presenting symptoms of chordae tendinae?
1. Signs and sc of acute heart failure with no signs of acute MI on EKG
2. May hear MR murmur: systolic murmur heard at apex, radiates to axilla, increases with grip, decreases with valsalva
What are the four common causes fo acute HF?
1. Papillary muscle rupture
2. Infective endocarditis
3. Rupture of chordae tendinae (MCC of acute HF in adults)
4. Chest wall trauma w/ valve compromise
What cardiac complications can occur with Ehlers Danlos Syndrome?
1. can cause myxomatous degeneration of the mitral valve leading to rupture of chordae tendinae
2. Skin is valvity thin with cigar paper scars
3. Joint hypermobility and skin hyperextensibility
What are not contraindications to MMR?
1. Allergy to eggs
2. breast feeding
3. TB ro + PPD
What is a rectocele?
1. common in elderly
2. Displacment of rectum through the posterior wall fo the vagina
3. Caused by damage to the rectovaginal septum incurred during a vaginal birth
4. Worsened by coughing, laughing
5. Women who are symptomatic who are poor surgical candidates may be treated with a pessary (use with vaginal estrogen b/c it can cause vaginal discharge + bleeding)
6. Reccomend pelvic exercises in asymptomatic pts
7. Surgery to repair rectocele is a posterior colporrhaphy
What is compartment syndrome?
1. Severe pain out of proportion to the extent of injury
2. Pain worsened by passive movement
3. Sensory nerves affected prior to motor nerves
4. neuro deficit presents with decreased vibratory sensation and decreased two point discrimination
5. Late findings: extremity paralysis, pulseless paralysis
6. Rhabdo and ARF are common complications
7. Tissue rpessure is Dx test of choice
8. Tx: Urgent fasciotomy
What are the EKG and echocardiogram findings for PE?
EKG findings include:
1. Right bundle branch block
2. Atrial arrhythmias
3. inferior Q waves
4. ST-segment changes.

Echo findings:
1. RV dysfunction
2. Increased RV size, decreased RV function, presence of RV thrombus, and tricuspid regurgitation. Massive PE causes pulmonary hypertension, which dilates the tricuspid annulus and causes functional tricuspid regurgitation,
What should be added to chronic steroid use?
Chronic glucocorticoid therapy increases the risk of osteoporosis. For this reason, it is important to provide the lowest dose of steroids for the shortest duration, and to add vitamin D as well as calcium supplementation to the patient's therapy
What is an indication of airway hyperreactivity?
Cough induced by expiration. Consider asthma.
What is the most effective treatment of seizures in ecamplsia?
Magnesium Sulfate
What is the best way to avoid complications in eclampsia?
Speed delivery.
What are the hypertensive drugs of choice in pregnancy?
Labetalol or Hydralazine
What is the triad of wernicke's encephalopathy?
Triad: confusion, ataxia, nystagmus; always give thiamine before glucose to treat alcohol withdrawal as to prevent the progression fo the encephalopathy
What is the first drug that should be given to patient in alcohol withdrawal?
Thiamine (not benzos)
What is Korsakoff's psychosis?
1. Confabulation (pts lie in order to fill in the gaps in their memories); due to wernicke's encephalopathy.
2. Brain MRI shows abnormal enhancement of the mamillary bodies.
What is acute stress disorder?
1. Exposure to an even that was life threatening or deadly
2. Develps emotional detachment, depersonalization, dissociative amnesia
3. Relives events through dreams and illusions
4. Avoids things that remind patient of traumatic event
5. Disturbances occur within 4 weeks of the precipitating event
What is carpal tunnel syndrome?
Pain and numbness in the wrist and palmar surface of the first three fingers associated with repetitive movements of the wrist is typical for carpal tunnel syndrome.Median nerve affected.
What is the most common cause of neonatal conjunctivits?
1. Chlamydia
2. Starts a few days to weeks after delivery
3. Conjunctival congestion, edema, and discharge
4. Pneumonia appears 3-19 weeks after birth
5. While still pregnant mother and partner should be treated with erythromicin. When born neonate should be treated with erythromycin for 14 days.
If preeclampsia occurs in the 1st pregnancy will it recur in subsequent pregnancies?
1. Increased chance but is not certain to develop
What is the Tx of PVD?
Cilostazol
1. conservative treatment
2. Phosphodiesterase inhibitor that inhibit platelet aggregation and causes arterial vasodilation
3. Remember beta blockers are relatively contraindicated in PVD as they can worsen claudication
What type of bony metastases does prostate cancer create? What is the Tx of metastatic prostate cancer?
1. Osteoblastic
2. Flutamide followed by leuprolide (androgen depletion Tx)
3. Flutamide is an antiandrogen and leuprolide is a LHRH agonist (decreases LH receptors and thus decrease in testosterone)
What is allopecia areata?
1. non-scarring hair loss
2. autoimmune process
3. May see hairs at border taper as they enter into the scalp
4. Is associated with other autoimmune disorder like vitiligo, thyroid disease
What is the most common cause fo hyperthyroidism?
Graves disease
How is hyperthyroidism treated in pregnancy?
1. Propothiouracil should be used in the 1st trimester
2. Methimazol should be used in the 2nd semester
What should you think when you see several large, glistening, off-white lesions with indistinct borders on an eye exam in an immunocompromised patient?
1. Candidia endopthalmitis
2. Should do vitrectomy if vitreal involvement and systemic amphotericin B and/or fluconazole
How does and ASA overdose present? treat a aspirin overdose?
Increased gap metabolic acidosis; will devlop renal failure and elevated aminotransferases; pt can develop bleeding and encephalopathy
Tx: gastric lavage; obtain salicylate level; if > 35 alkalinize the urine
What is patello-femoral pain syndrome?
1. Most common cause of knee pain in pts younger than 45
2. Anterior knee pain worsened by climbing stairs or prolonged sitting; may see retropatellar pain and crepitus on vigorous patellar compression
What noninvasive test has the highest accuracy for diagnosing osteomyelitis?
MRI
Wht is the affect of amiodarone on the thyroid?
Amiodarone causes a decrease in conversion of T4 to T3; leads to a decrease in T3 and an increase in T4; can also cause hypothyroidism and thyrotoxicosis due to high iodine content
If a pt has high BP and BPH what medication should be used to control BP?
Alpha 1 blockers like prazosin or terazosin
What is the Tx of mucormycosis?
Amphotericin B
How does mucormycosis present and in which patient population?
1. Sinusitis, facial swelling, nasal discharge, HA
2. DKA patients
What is the Mx of LSIL with confirmed CIN 1 on a colposcopy?
Repeat pap in 6 to 12 months
What test can be done to confirm H. pylori eradication after treatment?
Urea breath test or fecal antigen test done 4 weeks after the completion of therapy
What prevents the occurrence of a fat embolism after a fracture?
early immobilization and operative correction of the fracture; prophylactic heparin is not effective
What is the most common complication of an untreated variocele?
testicular atrophy
What is the treatment of chlamydia in the pregnant patient?
Eryhromycin
What is the most common complication of sickle cell disease in children?
Splenic sequestration
What is the most common complication of gingko biloba?
Increased risk of bleeding due to platelet dysfunction
What medication can be used for smoking cessation?
Buproprion
What is a contraindication to influenza vaccination?
Egg allergy
What is complication of doxorubicin and daunaorubicin? How is it monitored?
Cardiomyopathy. Radionuclide ventriculography (MUGA) is used to monitor patients
What are the extra-renal manifestations of Adult polcystic kidney disease?
1. hepatic, pulmonary, pancreatic, and splenic cysts
2. Cerebral aneurysms
3. Aortic aneurysm
4. Colonic diverticula
5. Mitral valve prolapse
6. Inguinal and abdominal hernias
What needs to be done to clear someone for peritoneal dialysis?
Colonoscopy to rule out diverticulosis
What causes diaphragmatic paralysis of a newborn? What is it associated with?
Phrenic nerve injury. Accompanied with Erb's palsy due to shoulder traction in delivery.
What is the best diagnostic test for esophageal perforation?
Esophagogram
What is the Tx of ethylene glycol poisoning?
Fompeizole. Competitive inhibitor of Alcohol Dehydrogenase
What is a risk of chorionic villous sampling? What does the complication depend on?
1. transverse limb abnormality
2. Depends on gestational age
What is Rocky Mountain spotted fever? What are the sx? When should the patient be Treated? Tx?
1. Ticke born rickettsial infection
2. Fever, lethargy petechial rashon ankles and wrists
3. Do not need to wait on tests to start treatment
4. Doxycycline
What is the most frequent complication post-TURP?
Retrograde ejaculation
What is Latent TB infection? Treatment?
1. + PPD with no CXR findings
2. Tx with isoniazid for 6-12 months w/ B6
What is lichen planus? How does it present? Dx? Associations?
1. immunologic skin disorder that creates shiny discrete pruritic polygonal violaceous plaques on flexural surfaces and in mouth
2. Skin biopsy for diagnosis
3. Associated with liver diseases i.e. hep C
What is a common complication of bacterial conjunctivitis? Tx of bacterial conjunctivitis?
Keratitis
Erythromycin ointment with fluoroquinolones for contact wearers
What lab values are needed to rule out hyperthyroidism in a pregnant female?
T4, free T4 and TSH. If both free and total T4 are elevated then may have hyperthyroidism, but if free T4 is normal or low then may be due to normal pregnancy
What are the diagnostic criteria for hyperthyroidism in a pregnant female?
1. High serum T4
2. Serum TSH < 0.01
What is the acute treatment of sarcoidosis?
Corticosteroids
What is the Mx of Barrett's esophagus with no dysplasia?
1. Repeat EGD with biopsies in one year
What is the Tx for BV in pregnancy?
Only treat pts who are symptomatic. Tx with oral metronidazole or clindamycin
What should you consider in an elderly male with painless hematuria?
Bladder malignancy. Can do cystoscopy.
What is the most likely cause for primary hyperparathyroidism?
Parathyroid adenoma and parathyroid hyperplasia; if symptomatic perform parathyroidectomy or asymptomatic patients with a T score < -2.5 < 50 y/o, Ca > 1 above the ULN, abd CrCL < 60
What does exercise induced amenorrhea place a patient at risk for?
Osteoperosis/osteopenia
What is the criteria for diagnosis of ARDS?
1. PCWP < 18 mmHg
2. PaO2/FiO2 < 200
3. Diffuse bilateral infiltrates on CXR
What is the treatment of inner restlessness when on atypical antipsychotics or haloperidol?
1. Akathisia
2. Tx is beta blocker like propranolol
What are the characteristic findings of WPW on EKG? What is the Tx?
delta wave with a wide QRS; Tx: catheter ablation
What is the Tx fro PCP?
TMP/Sx
What are the indications for steroids in PCP pneumonia?
1. A-a gradient > 35 mmHgor a PaO2 < 70 mmHg
What is the Tx for severe bipolar mania in rpegnancy?
Electroconvulsive therapy
What is the Tx for tinea versicolor?
Topical ketoconazole
What clinical features are suggestive of cushing's syndrome?
1. HTN
2. Hyperglycemia
3. Hypokalemia
4. Metabolic acidosis
IF a child from 5 months to 6 years develops a fever with seizures what should be done?
If no meningitis signs; likely febrile seizure and reasurrance should be given
Waht does a high ALP with pruritis suggest? what test should be run? Tx? What is a common complication?
1. Primary biliary cirrhosis
2. Antimitochondrial antibodies
3. Tx: Ursodeoxycholic acid
4. Osteoperosis
What is meralgia paesthetica?
1. Entrapment fo the lateral femoral cutaneous nerve
2, Decreased sensation over the anterolateral thigh without muscle weakness or abnormal DTRs
What is the 1st and 2nd line Tc for latent TB?
1. Isoniazid
2. Rifampin
Id patient has new diabetes with elevated itchy skin rash with central clearing what is the Dx?
Glucagonoma
If HCW is exposed to Hep by pin prick what Tx should be given?
If adequately vaccinated prior then no Tx is necessary. If no immunization or poor response to vaccine provide Hep B Ig and vaccination.
What is the most likely cause of postpartum hemorrhage?
Uterine atony
What is the treatment of uterine atony?
1. Fundal massage and oxytocin - helps stimulate the uterus to contract
What is the most likely cause of postpartum hemorrhage?
Uterine atony
What is the treatment of uterine atony?
1. Fundal massage and oxytocin - helps stimulate the uterus to contract
What valve is generally affected in endocarditis to cause a conduction delay?
Aortic valve
What are the contraindications for DTaP vaccination?
1. Anaphylaxis within seven days of administration of a previous DTaP vaccine
2. Encephalopathy within seven days of a previous DTaP

Being sick is not a contraindication for vaccinations
What are medications causes fo priapism? Tx?
Trazadone
Tx:
1. Ice packs
2. Phenylephrine or epinephrine (alpha adrenergic blockade)
How is trichomoniasis treated when breast feeding?
Metronidazole for pt and partner; PO x 1 dose; d/c breastfeeding for 12-24 hrs after dose given
What medication should be used for rebound hyperglycemia after a sulfonylurea overdose?
Octreotide; dextrose is still 1st line tx
What is transverse myelitis?
- rapidly developed myelopathy
- typically follows an upper respiratory tract infection
- characterized by rapidly progressive paraplegia, sensory loss. and pelvic organ dysfunction
What is the triad of Menierie's disease?
1. Episodic dizziness
2. Unilateral hearing loss
3. Tinnitus

Note BPPV is not accompanied by hearing loss
What is the DOC for Tx of metoclopramide acute dystonic reaction?
Diphenhydramine iV
What are two causes of tinea capitis? How are they differentiated?
1. Trichophytum tonsurans
2. Microsporum canis

Microsporum appears green under Wood's UV light
What is the most common cause of pubertal delay? What is the initial workup?
1. Constitutional delay
2. Imaging to determine bone age ; bone age older or equal to chronological age warrants further testing
What is a side effect of antiparkinsonian medications?
Since they are dopaminergic they can cause psychotic symptoms
What are the cardinal features of Parkinson's disease?
1. Bradykinesia
2. Tremor
3. Cogwheel rigidity
What are the treatment medications for Parkinson's disease?
1. Levodopa
2. Pramipexole
What are the physical test for carpal tunnel syndrome?
1. Phalen's maneuver
2. Tinel's sign
3. Raise hand over the ehad
What treatment is generally provided for personality disorders?
Psychotherapy
How is GAD diagnosed?
1. Anxiety/worry on most days for at least 6 months
2. 3 or more somatic Sx like fatigue, restlessness, muscle tension, irritability
What is the difference between compulsions and obsessions?
1. Obsessions are persistent intrusive thoughts that lead to anxiety/distress and interfere with daily life i.e. contamination
2. Compulsions are conscious repetitive behaviors i.e. hand washing
What is the Tx of OCD?
SSRI + behavioral therapy
What is panic disorder?
Development of discrete periods of panic with months of worrying about the panic sx recurring
What is the Tx of panic disorder?
1. Behavioral therapy
2. SSRI
What is social phobia?
Fear of scrutiny and embarrassment in social or performance situations
What is PTSD?
1. re experiencing a traumatic life threatening event
2. Avoidance of stimuli or numbing of responsiveness
3. Hyper-arousal, hyper-vigilance, irritable, startles easily
4. Symptoms last for more than one month
What is acute stress disorder?
1. Sx are similar to PTSD but have occurred for < 1 month
2. Sx are mainly dissociative
What is adjustment disorder with anxiety?
1. Life stresssor (usually not a life threatening stressor)
2,emotional or behavior sx occurring within 3 months a a stressor and lasting less than 6 months
What is the Tx of PTSD?
1. SSRI, TCAs
2. CBT
What is the diagnostic criteria for depression?
SIG E CAPS
Sleep distubance
Interest decreases
Guilt
Energy decreases
Concentration decreases
Appetite inc or decr
Psychomotor agitation or retardation
Suicidal ideation

Must have anhedonia or depressed mood with five of the criteria in SIG E CAPS
What are the diagnostic criteria of bipolar disorder?
1. 1 week of euphoria and at least 3 of the following:
DIGS FAR
Distractability
Insomnia
Grandiosity
Speech - pressured
Flgiht of Ideas
Agitation
Reclessness/Risky behaviors
What is hypomania?
No marked functional impairment or psychosis symptoms that last less than 4 days
What is cyclothymic dosorder?
chronic cycles of depression and hypomania for > 2 years
How is acute mania treated?
Lithium, anticonvulsants
How is schizophrenia diagnosed?
One or more of the positive sx (bizarre delusions, hallucinations) + one of the negative sx (affective flattening
What is brief psychotic disorder?
1. Sx < 1 month
2. Often follows a psychosocial stressor
What is schizophreniform disorder?
Diagnostic criteria are the same as those for schizophrenia but symptoms have a duration of 1-6 months
What is schizoaffective disorder?
Mood sx are rpesent for a significant portion of the illness but psychotic symptoms have been present without a mood episode
What is delusional disorder?
Nonbizarre delusions for 1 or more months without psychotic symptoms
What is the Tx of schizophrenia?
antipsychotic medications
What is the Tx for Tourette's syndrome?
Dopamine receptor antagonists (haloperidol, pimozide)
What is the Tx for bed wetting?
Not a dx until 5; should eb treated with bed alarms; imipramine is reserved for refractory cases
What can cause NMS?
1. Use of sntipsychotics
2. Abrupt withdrawal of levodopa in parkinson's
What are the Sx of NMS?
Muscle rigidity
Dystonia
Akinesia
agitation
Rahbomyolysis
What is the Tx of NMS?
1. Stop the offending agent
2. Give dantrolene, amantidine, or bromocriptien
What causes serotonin syndrome?
1. Use of SSRIs (FECS) with MAOIs
2. MAOIs with venlafexine
What are the Sx of serotonin syndrome?
1. Delirium
2. Agitation
3. Diaphoresis
4. Diarrhea
5. Myoclonus
6. Hyperreflexia
7. Hyperthermia
7. Rhabdo
What is the Tx of serotonin syndrome?
1. Stop the offending medication
2. Give a serotonin antagonist
What is the use of buspirone? What is a contraindication?
1. Anxiety; is a partial serotonin agonist
2. Do not use with MAOIs
What are the SSRIs?
FPECS
Fluoxetine
Paroxetine
Escitalopram
Citalopram
Sertraline
What are the atypical antidepressants?
1. Buproprion
2. Venlafaxine
3. Mirtazipine
4. Trazadone
What is the use of Buproprion? SEs? Mech?
1. Depression; For pts with sexual side effects from other antidepressants, smoking cessation
2. Lowers seizure threshold
3. Dopamine reuptake inhibition
Waht is the Mech of Action for Venlafaxine? SEs?
1. 5HT and NE reuptake inhibition
2. Diastolic HTN, sexual dysfunction
What is the mech of Action for trazadone? SEs?
1. alpha 2 antagonist; Inhibits 5HT reuptake
2. Priapism, sedation
What are the tricyclic antidepressants? MOA? SEs?
DINDAC
1. Desipramine
2. Imipramine
3. Nortryptiline
4. Doxepin
5. Amitryptiline
6, Clomiparmine

Considered to be 2nd line agents; block reuptake of NE and serotonin

Cardiac conduction delays, orthostatic hypotension, anticholinergic sx
What are the sx of TCA toxicity?
TCA
Trembling
Coma
Arrythmias
What are the MAOIs?
PST
Phenylzine
Selegilline
Tranylcypromine
What are the SEs fo MAOIs?
1. Tyramine induced hypertensive crisis (restrict diet fro cheeses, sour cream, cured meats)
2. Serotonin syndrome

6 H's
Hepatoceelualr jaundice/necrosis
Hypotension (postural)
HA
Hyperreflexia
Hallucinations
Hypomania
What are the antipsychotic agents?
1. High potency: haloperidol, fluphenazine
2. Low potency (thioridazine, chlorpromazine)
What are the SEs of antipsychotic agents?
1. EPS
2. Hyperprolactinemia (amenorrhea, gynecomastia, galactorrhea)
3. NMS
What are the atypical antipsychotics and what are they sued for?
1. Resperidone, olanzapine, quetiapine, ziprasidone, aripiprazole
2. 1st line Tx for schizophrenia
What are the SEs of clozapine?
Agranulocytosis and seizures
What is the timeline of EPS?
4 hrs: Acute dsytonia
4 days: Akinesia
4 weeks: Akathisia
4 months: Tardive dyskinesia
What is the Sx and Tx of each stage of EPS?
1. Acute dystonia = involuntary muscle contractions; give benztropine or diphenhydramien
2. Dyskinesia = pseudoparkinsonism, shuffling gait cogwheel rigidity; Benztropine or amatadine and decrease neuroleptic dose or d/c completely
3. Akathisisa = restlessness; decrease neuroleptic and try propranolol
4. TD = oral/facial movements; DC neuroleptic, give BBs or benzos
What is the use of lithium?
mania of bipora disorder
What are the Sx of Li toxicity?
thirst, polyuria, fine tremor, wt gain, coarse tremor, ataxia, seizures ; teratogenic
What is the indication of valproic acid? SEs?
1. 1st line for acute mania
2. Hair loss, ataxia, pancreatitis, thrombocytopenia
What are the SEs of carbamazepine?
1. BM suppression
2. SJ syndrome
What can be used for persistent HTN after cocaine use?
Phentolazine; it is an alpha 2 agonist
What is the Tx fo N. gonorrhea?
Ceftriaxone IM x1
What other STD should pts with gonorrhea be treated for? What is the Tx?
1. Tx for chlamydia trachomatis
2. Tx with doxycycline 100 mg bid x 7 days or azithromycin 1 g PO x 1 dose
What should are clues to PBC? How should PBC be detected?
1. Elevated ALP with unexplained pruritis
2. Obtain Anti-mitochcondrial ABs
What can slow the progression pf PBC?
Ursodeoxycholic acid
What is the cause of cat scratch disease? Most common complication?
1. Baronella Henslae
2. Suppuration of cervical LNs
What is the most common cause of nongonococcal urethritis? Tx?
If Sx persist without new sexual encounters?
1. Chlamydia.
2. Tx with Azithromycin or doxycycline
3. Think Tx failure or presence of trichomonas. Tx metronidazole.
What is the tx of tension pneumothorax?
Needle thoracostomy
If patient is stabbed what should you do with the knife or object?
Keep the object in place until the patient can be taken to the OR
If a patient has breath that smells like almonds and has AMS, what substance may they have ingested? Gralic?
1. Cyanide
2. organophosphates, arsenic
What are anticholinergic Sx?
"Hot as a hare, red as a beet, dry as a bone, mad as a hatter, blind as a bat"
1. Fever
2. Skin flushing
3. Dry mucous membranes
4. Psychosis
5. Mydriasis
6. Tachycardia
7. Urinary retention
What are cholinergic Sx?
DUMBELLS
Diarrhea
Urination
Bradycardia
Bronchospasm
Emesis
Lacriamtion
Salivation
What is the triad of opiod overdose?
1. Coma
2. Respiratory depression
3. Miosis
What should be given to pts with AMS of unknown origin?
ThONG
Thiamine
Oxygen
Naloxone
Glucose
What is the Tx for tylenol voerdose?
Acetylcysteine
What is the Tx for organophosphates?
Atropine, pralidoxime
What is the Tx for benzos?
Flumazenil
What is the Tx for BBs?
Glucagon
What is the Tx for ethylene glycol or methanol?
Fomepizole; calcium gluconate for ethylene glycol
What is the Tx for lead?
1. Low levels : penicillamine and succimer
2. High levels: EDTA, Dimercaprol
What is the Tx for mehthemoglobin?
Methylene blue
What should be administered for EtOH withdrawal?
1. Benzos
2. Thiamine BEFORE Glucose
3. Folate
4. B12
What is the Tx for cat and dog bites?
Amoxicillin/clavulanate and consider tetanus prophylaxis; consider rabies in dogs
Who is given Td vs. TIG?
If unknown vacc Hx or < 3 doses of Td: give Td for clean wound; given Td and TIG for dirty wound

If had three doses but > 5 years give Td only if dirty wound

if had 3 doses > 10 years: give Td if clean or dirty wound; do not need to give TIG even if dirty
What are the symptoms of a corneal abrasion? Dx? Tx?
1. Pain out of proportion to exam; foreign body sensation, photophobia
2. Fluorescin staining
3. Gentamicin or bacitracin
What is a nonstress test? What is normal? What should you do with the results?
1. Tests fetus's response
2. Normal (Reactive) is a HR accel of > 15 bpm above baseline for > 15 seconds; must occur 2 times in a 20 minute period
3. Abnormal or nonreactive means that a biophysical profile or a contraction stress test should be done
What is a contraction stress test?
1. Used to assess uteroplacental dysfunction; FHR monitored during contractions
2. normal or negative test has no late ddecelerations and means good fetal well being
3. Abnormal or psoitive test shows late decelerations with 50% of contractions ; must have at least 3 contractions in 10 minutes to be present for an adequate CST
What is an early deceleration? What does it mean?
1. Begins and ends at the same time as a maternal contraction
2. fetal head compression but no distress
What is a variable deceleration? What does it mean?
1. variable onset of abrupt slowing of fetal heart rate in association with contractions; last < 30secs
2. umbilical cord compression
What is a late deceleration? What does it mean?
1. Deceleration begins after the start of maternal contractions and persist even after contractions are finished; from peak to nadir is > 30 secs
2. Fetal hypoxia/distress; immediate delivery is necessary if multiple late decels
What are the complications of pregestational diabetes on a fetus?
IUGR, macrosomia hypoglycemia, still birth
What are the complications of gestational diabetes on a fetus?
Hypoglycemia, macrosomia
What is preeclampsia?
HTN and proteinuria due to decreased organ perfusion because of vasospasm and endothelial activation

Defined as at least SBP > 140, diastolic > 90 and !+ on dipstick or > 300 mg in a 24 hr urine
What is ecclampsia?
Seizures in a pt with preeclampsia
What is the definitive tx of preeclampsia/eclampsia?
Delivery
What is HELLP syndrome?
Hemolytic anemia
Elevated Liver enzymes
Low Platelets
Wht is seen in the labs of hyperemesis gravidum?
Hypochloremic metabolic alkalosis; ketones in urine
What is the Tx for eclapmsia/preclampsia?
Mild preeclampsia: Deliver if near tern, fetal lungs premature or preeclampsia worsens; if far from term, treat with bed rest and conservative management

Severe preeclampsia: MgSO4 for seizure prophylaxis; hydralazine +/- labetalol for BP control, when stable then deliver

Eclampsia: MgSO4 for central seizures then deliver when stable
What are the sx of gestational trophoblastic disease?
1. 1st trimester uterine bleeding
2. Preeclampsia or eclampsia at < 24 weeks
3. Uterine size greater than GA
4. No fetal heartbeat
5. Pelvic exam may show enlarged ovaries into the vagina or blood in the cervical os
6. Pelvic US shows snowstorm appearance
What are the tx of gestational trophoblastic disease?
D&C; monitor bHCG after D&C; contraception for one year with monitoring of bHCG
What is the definition of postpartum hemorrhage?
1. Blood loss of > 500cc during vaginal delivery or > 1000 cc during C/S
What is the Tx for Sheehan's syndrome?
Lifelong hormone replacement therapy since anterior pituitary is infarcted; steroids, levothyroxine, estrogen, progesterone
What are the diagnostic Signs and Sx of uterine atony? Tx?
1. Palpation fo a soft boggy uterus
2. Vigourous bimanual massage; oxytocin infusion
What are the diagnostic Signs and Sx of genital tract trauma? Tx?
1. lacerations ro ehmatoma in GU tract
2. Surgical repair
What are the diagnostic Signs and Sx of retained placenta? Tx?
1. U/S finds retained placenta; inspection of placenta and uterine cavity
2. Removal of remaining placental tissue
What is mastitis? What are the symptoms? Dx? What is the Tx?
1. cellulitis of the preiglandular tissue in breast feeding mothers
2. Breast pain, redness, fever, fluctulance points to breast abcess
3. Breast mil cultures/CBC
4. dicloxacillin or erythromycin; continuing breast feeding;if abscess do I&D
What is chorioamionitis? Sx? Dx? Tx?
1. Infection of the chorion, amion, and amniotic fluid in labor
2. Fever with no other source and: fetal/maternal tachycardia, abd tenderness, foul smelling amiotic fluid, leukocytosis
3. Clinical; CBC
4. Delivery but not C/S; Abx until at is afebrile for 24 hrs after delivery
What is endometritis?
1. Infection fo the uterus diagnosed after delivery
2. fever 24 hrs postpartum with no source
3. Pelvic exam, CBC, UA
4. ABx for 24 hrs after vaginal delivery or 48 hrs after C/S
What are the contraindications to breastfeeding?
1. HIV
2. Active Hepatitis
3. Tetracycline
4. Chloramphenicol
5. Warfarin
A pregnant pt with acne can use what medication?
bezoyl peroxide
What are the effects of different Abx on the fetus?
1. Tetracycline - discoloration of deciduous teeth
2. Quinolones - cartilage damage
3. Sulfonamides late in pregnancy - kernicterus
4. Streptomycin - CNVIII damage/ototoxicity
What are the effects of lithium on a fetus?
1. congenital heart disease
2. Ebstein's anomaly

Avoid if mother is breast feeding
What antihypertensive should be avoided in pregnancy?
ACEI and ARBS cause fetal renal damage and oligohydramnios
What can NSAIDs lead to in the fetus?
If used for > 48 hrs can cause premature closed of PDA
What are the fetal effects of phenytoin?
1. Dysmoprhic facies
2. microcephaly
3. hypoplasia fo the nails and distal phalanges
What are the fetal effects of phenobarbital?
1. Cleft palate
2. Cardiac defects
What is IUGR?
If fetal height is < 10% for GA
When should rhogam be given?
1. prior delivery of a RH + baby to a Rh- mother
2. If baby is RH+ at delivery
3. I f father is Rh+, Rh status is unknown or paternity is uncertain
What is the MCC of infectious IUGR?
CMV
What is oligohydramnios? Dx? Tx? complications?
1. AFI < 5
2. due to fetal urinary tract abnormalities
2. U/S for anomalies; r/o ROM with ferning test and nitrazine paper
3. amnioinfusion during labor to prevent cord compression as can lead to fetal hypoxia; can lead to pulmonary hypoplasia
What is polyhydramnios?
1. AFI > 25
2. uncontrolled DM, duodenala tresia, TE fistula
3. U/S for fetal anomalies; glucose testing
4. depends on cause; can do amniocentesis
5. placental abruption, cord prolapse
What is placental abruption? RFs? Sx? Dx? Tx?
1. Placenta separates from site of uterus implantation before delivery
2. HTN, cocaine
3. Abd pain, vaginal bleeding, fetal distress
4. Clinical; U/S shows retroplacental hemorrhage
4. Mil or premature: hospitilization, fetal monitoring bed rest/ moderate to sever: Immediate delivery
What is placenta previa? RFs? Sx? Dx? Tx?
1. abnormal placental implantation near or covering the os
2. prior C/S; prev Hx
3. painless vaginal bleeding that ceases spontaneously, 2nd or 3rd trimester; no fetal distress
4. U/S for placental position
5. No cervical exams; C/S if pt or fetus in distress
What is uterine rupture? Sx? Dx? Tx?
1. Complete rupture disrupts the entire thickness of the uterine well
2. Severe abd pain, change in abd shape, fetal distress
3. Clinical
4. Immediate C/S
What is PPROM? Dx? Tx?
1. spontaneous ROM < 37 weeks
2. look for pooling of amniotic fluid in posterior vaginal vault, cervical dilation
3. Nitrazine paper test, fern test
4. Obtain Cx, if infection present treat as amionitis (ABX: ampicillin +/- gentamicin); if no signs of infection and 24-32 weeks: tx with ampicillin + erythromycin w/ steroids to promote fetal lung maturity +/- tocolytics; if no signs of infection and > 33 weeks hospitalize and treat expectantly until labor
What is preterm labor?
labor between 20-36 weeks; give steroid for fetal lung maturity, ABx. +/- tocolytics
Pencillin or ampicillim for GBS proph if preterm suspected
What is the cephalic position?
Head down. Normal position.
When can external cephalic version be done?
At 36-37 weeks
What is shoulder dystocia?
difficult delivery due to fetal shoulder entrapment
Cand o Mcroberts maneuver( alex and open maternal hips) followed by suprapubic pressure; can also deliver the posterior fetal arm or internal rotation of the fetal shoulder
What are the indications for C/S?
1. Prior C/S
2. Genital herpes
3. Cephalopelvic disproportion
4. placenta previa/abruption
5. failed vaginal delivery
6. fetal distress/malposition
7. cord prolapse
8. erythroblastosis fetalis (Rh incompatability)
What is threatened abortion? Sx? Dx? Tx?
1. minimal bleeding/cramping, no POC are expelled
2. closed os, + gestational sac
3. expectant management with pelvic rest for weeks
What are the sx of an inevitable abortion? Dx? Tx?
1. cramping with bleeding; no POC are expelled
2. Open os, normal U/S
3. D&C
What are the sx of an incomplete abortion? Dx? Tx?
1. cramping with bleeding; some POC are expelled
2. open os, normal U/S
3. D&C
What are the sx of an complete abortion? Dx? Tx?
1. some bleeding but pain has usually ceased
2. Closed os, empty uterus on U/S
3. None
What are the sx of an missed abortion? Dx? Tx?
1. No sx; No POC expelled
2. closed os, no fetal cardiac activity with retained fetal tissue
3. allow 4 weeks for POC to pass; can offer medical mx with misoprostol or D&C
What are the Sx for a septic abortion?Dx? Tx?
1. malodorous discharge, recent hx of abortion
2. cervical motion tenderness
3. ABCs, D&C, IV Abx
what are the classic symptoms of diabetes mellitus?
polyuria
polydipsia
polyphagia
how is diabetes diagnosed?
1. Random plasma glucose concentration greater than or equal to 200 with classic symptoms of diabetes
2. If fasting plasma glucose level is greater than or equal 126 on two separate occasions
3. Two hour postprandial glucose level of greater than 200 after a 75 g oral glucose tolerance test on two separate occasions
4. Hemoglobin A-1 C greater than 6.5%
what is the honeymoon period for type I diabetics?
Remission phase that is gaining type I diabetics days after initiation of insulin therapy. During this phase which may last several months patients often have decreased insulin requirements
how does metformin work? What are the side effects?space what are the contraindications?
1. Inhibits hepatic gluconeogenesis
2. Lactic acidosis, diarrhea, G.I. discomfort, metallic taste, weight loss
3. Renal insufficiency, liver disease, severe hypoxia
what are examples of sulfonylureas? what are side effects also funnel.
1. Chlorpropamide, glipizide, gltburide
2. Hypoglycemia
if the patient had depressed TSH what is the next step?
order a radioactive iodine uptake scan as well as thyroid stimulating immunoglobulin assays
if a patient has an elevated TSH what is the next step?
order in anti-thyroid peroxidase antibody assay
What is the differential for an increased uptake on radioiodine uptake scan?
1. Graves disease
2. Toxic adenoma
3. Multinodular goiter
What is the differential for decreased uptake on a radioactive iodine scan with an elevated TSH?
1. Subacute thyroiditis
2. Hashimoto's thyroiditis
3. Exogenous thyroid hormone
4. Postpartum thyroiditis
What is the DDx for an increased TSH?
1. Hashimoto's thyroiditis
2. Iatrogenic post-radiation thyroid
3. Subacute thyroiditis
4. Drugs: lithium, propylthiouracil, mehtimazole
5. Infiltrative dieseas: scleroderma, amyloidosis
6. Congenital
What is the Tx for thyroid storm?
1. IV levothyroxine
2. IV hydrocortisone
How should a thyroid nodule be managed?
1. Obtain a TSH: if low proceed to iodine thyroid scan; if normal do FNA with U/S guided biopsy
2. If TSH low and scan I123 scan done: If hot nodule ablate/resect vs. medical management; if cold nodule proceed to FNA/US guided biopsy
3. If biopsy shows follicular or malignant cells perform total/partial thyroidectomy
4. If biopsy is indeterminate or benign repeat FNA in 6 months or monitor with U/S
What are the labs of primary hyperparathyroidism?
1. Increased calcium with increased PTH
2. Low phosphate
How is osteopenia diagnosed? osteoperosis Dx?
1. DEXA scan with T score from -1 to -2.5
2. Osteoperosis: < -2.5
What is the Tx of osteoperosis?
1. Bisphosphonates (aledronate, risedronate, ibandronate)
2. Teriparatide
3. raloxifene (SERMs)
If repeat dexa is worse use combination bisphosphonate and SERM
What are the signs and sx of primary adrenal insufficiency?
1. Hyperpigmentation
2. Dehydration
3. Hyperkalemia
4. Salt craving
How is adrenal insuffiiciency diagnosed?
if AM cortisol is < 5 or cortisol < 20 after ACTH stim test or an increase < 9 after stim test
What are the sx of a prolactinoma? Labs/Dx? Tx?
1. galactorrhea and amenorrhea
2. Decreased LH and FSH with increased prolactin/Order MRI
3. Bromocriptiine or cabergoline (dopamine agonists); if medical therapy not tolerated proceed to transsphenoidal srugery
What is MEN 1 syndrome?
1. Parathyroid hyperplasia
2. Pancreatic islet cell tumor
3. Pituitary adenoma
What is MEN 2A syndrome?
1. Parathyroid Hyperplasia
2. Thyroid medullary cancer
3. Pheochormocytoma
What is MEN 2B syndrome?
1. Thyroid medullary cancer
2. Pheochromocytoma
3. Mucocutaneous neuromas
4. Ganglioneuromatosis of colon
5. Marfan like habitus
What is the definition of failure to thrive?
1. Wt < 5th percentile on more than one occasion/Wt for Ht < 10th percentile/ Decreasing wt velocity with crossing two major percentiles (90th, 75, 50 25, 10, 5) on growth chart
2.
What are the dev milestones at age 2 months?
1. Lift head/chest when prone
2. Tracks past midline
3. Recognizes parents
What are the dev milestones at age 4-5 months?
1. Rolls front ot back
2. Grasps rattle
3. Laughs
What are the dev milestones at age 6 months?
1. Sits unassisted
2. Transfers objects
3. Stranger anxiety
What are the dev milestones at age 9-10 months?
1. Crawls
2. 3 finger pincer grasp
3. Mama/Dada
What are the dev milestones at age 12 months?
1. Walks alone
2. Two finger pincer grip
3. Imitates actions
What are the dev milestones at age 15 months?
1. Walks backward
2. Uses cup
3. 4-6 words
What are the dev milestones at age 18 months?
1. Runs/kicks ball
2. Tower with 2-4 cubes
3. Names common objects
What are the dev milestones at age 2 years?
Walks up and down stairs
Jumps
Builds tower of 6 cubes
2 eord phrases
Follows two step commands
What are the dev milestones at age 3 years?
Rides tricycle
Climbs stairs with alternating feet
3 word sentences
What are the dev milestones at age 4 years?
Hops
copies a cross
counts to 10
When should rear facing car seats be used?
Until child wweighs > 20 lb and is > 1 year og age
What is meconium aspiration syndrome?
Aspiration fof meconium can cause fetal resp distress; results in chemical pneumonitis
What is congenital diaphragmatic hernia?
Leads to herniation of abdominal contents into chest; causes pulmonary hypoplasia; may lead to pulm HTN
If a baby has a fever in the 1st month of life what should be done?
Admission, full sepsis workup, and IV antibiotics (ampicillin + gentamicin or cefotaxime)
What are the Sx of toxoplasmosis in babies? Tx? Prevention?
1. hydrocephalus, seizures, intracranial calcifications, ring enhancing lesions on CT
2. Pyrimethamine
3. Avoid exposure to cats and cat feces in pregnancy; avoid raw or undercooked meats; tx women with primary infection
What are the Sx of rubella in babies? Tx? Prevention?
1. blueberry muffin rash, cataracts, hearing loss, PDA
2. None
3. Immunize mother prior to pregnancy
What are the Sx of CMV in babies? Tx? Prevention?
1. Petechial rash, periventricular calcifications, microcephaly, chorioretinitis
2. Ganciclovir
3. Avoid exposure
What are the Sx of HSV in babies? Tx? Prevention?
1. skin, eye, mouth vesicles; can progress to CNS infection
2. Acyclovir
3. C/S if mother has active infection at time of delivery
What are the Sx of syphilis in babies? Tx? Prevention?
1. Maculopapular skin rash on palms and soles, LN
2. PCN
3. Treat seropositive mothers with PCN
What is hirschprung's disease?
1. absence of ganglion cells in colon leads to narrowing of aganglionic site and dilation of prox normal colon
2. Failure to pass meconium, vomiting abd pain
3. Dx by rectal biopsy at the anal verge
4. Diverting colostomy followed by resection when infant is > 6 months of age
When does physiologic jaundice present?
First 36-48 hrs of life; peak bilirubin 10-15 at 5-7 days of life
What is breast milk jaundice? Sx? Dx? Tx?
1. delay of hepatic bilirubin conugation due to enzyme in breast milk can prolong jaundice
2. after 3-5 days fo life and peaks at 2 weeks; bili may reach 19-20 for 1-2 months
3. Dx of exclusion
4. breast feeding should continue
What is pathological jaundice? Sx? Dx? Tx?
1. If jaundice occurs in first 24 hrs or with an elevated direct component; high levels > 30 can cause kernicterus by depositing in basal ganglia; consider sepsis, HA, bruising
2. hepatomegaly, white stools, kernicterus (jaundice, poor feeding, high pitched cry, hypertonicity)
3. Coombs test, CBC
4. Photo-therapy; tx underlying condition
What is eczema in babies? Sx? Dx? Tx?
1. Chronic inflammatory skin condition aka atopic dermatitis
2. Dry, itchy erythematous skin
3. Clinical
4. Avoid triggers like heat , perspiration, maintain hydration, Tx any superinfections
What are the Sx of erythema toxicum neonatorum? Tx?
1. erythematous macules and papule s that progress to pustules ; usually appear 24-48 hrs after birth and resolve in 5-7 days
2. No Tx
What are the Sx of transient neonatal pustular melanosis? Tx?
1. pustules with a nonerythematous abse, erythematous macules with a surrounding scaly area; lesions present at birth and resolve within weeks to months
2. No Tx
What are the Sx of neomatal acne? Tx?
1. papules and pustules appearing onf ace and scalp at 3 weeks of age; resolves by 4 months
2. Gentle cleansing with soap and water; ketoconazole or hydrocortisone may help speed recovery
What are the Sx of milia? Tx?
1. White papules composed fo keratin and sebaceous material; present at birth; found on cheeks and nose; resolves within first few weeks of life
2. No Tx
What are the Sx of miliaria? Tx?
1. vesicles, papules, or pustules caused by accumalation fo sweat beneath sweat ducts blocked by keratin; common in warmer climates or in babies in incubators; appear in 1st week of life
2. cooler environment and loose clothing
What are the Sx of seborrheic dermatitis? Tx?
1. Erythema nd greasy scales on face and scalp resolve within weeks to months
2. Gentle cleansing; if does not work ketoconazole
What is the presentation fo CAH in girls?
Whether salt-losing or nonsalt losing CAH girls present with ambigious genitalia due to excess androgen production in utero
What is the presentation fo CAH in boys?
1. If salt losing variant present in first 1-2 weeks with hyponatremia, hyperkalemia, dehydration, and failure to thrive
2. If nonsalt losing variant presents with early virilization including development of pubic hair, adult body odor , and a growth spurt at 2-4 y/o
What is the Tx of CAH?
1. Glucocorticoid replacement with hydrocortisone/dexamethasone/prednisone
2. Mineralcorticoid replacement (fludrocortisone)
3. Monitoring: serum levels fo 17 hydroxypreogesterone , androstenedione, and plasma renin activity should be measure every 3 months in infants and every 4-12 months in children. obtain bone age q6 months
What is precocious puberty? causes? Dx? Tx?
1. Development of sexual characteristics in girls < 8 and boys < 9
2. Gonadotropin dependent PP: due to early activation of HPG axis, devleopment occurs in the proper interval and order but occurs early/ gonadotropin independent PP: secretion of sex hormones from the adrenals or gonads i.e. CAH, Mccune-albright syndrome (GIPP, cafe-su-lait spots, and fibrous dysplasia fo bone), androgen secreting tumors, ovarian cysts, ovarian tumors, leydig cell tumors
3. Xray of wrist to determine bone age, serum estradiol or testosterone; 17-OHP, GnRH basal and stimulated LH, DHEA
4. GDPP: GnRH agonists/GIPP: Tx underlying cause
What is the Dx for a baby with eczema, thrombocytopenia, IgEhigh, IGa high and low IGM?
Wiskott Aldrich syndrome; X-linked recessive disorder
What is Chediak-Higashi syndrome? Sx? Dx? Tx?
1. AR disorder in neutrophil chemotaxis
2. recurrent pyogenic infections and respiratory infections
3. PBS shows PMNs with giant cytoplasmic granules
4. Splenectomy, steroids, aggressive treatment of infections
What is kawasaki disease? Sx? Dx? Tx?
1. medium vessel vasculitis of childhood that predisposes to coronary artery aneurysms
2. Common in Asian heritage; acute illness; CRASH BURN ; Conjunctivitis (bilat nonpurulent), truncal rash, adenopathy, strawberry tongue, Hand/foot/ swelling or desquamation, Fever > 5 days
3. High dose ASA, IVIG to rpevent aneurysms, then switch to low dose ASA
How to diagnose juvenile idiopathic arthritis? Tx?
1. Negative infectious workup, daily fever for 2 weeks > 101.3 and arthritis
2. NSAIDs
How to diagnose pauciarticular JIA? Tx?
1. < 5 joint affected presents at 2-3 y/o; pts are ANA +
2. NSAIDs; resolves within 6 months
How to diagnose polyauticular juvenile idiopathic arthritis? Tx?
1. > 4 joints affected;occurs at 2-3 y/o
2. ANA or RF + ; anemia, elev ESR, hypergammagloulinemia
3. DMARDs
What is HSP? Sx? Dx? Tx?
1. Most common small vessel vasculitis of childhood
2. Palpable purpura, Abd pain, GN; pts ahve URI few weeks before
3. Biopsy of skin reveals IgA deposits
4. Tylenol or NSAIDs; can recur
3.
What are the sx of VSD? Dx? Tx?
1. pansystolic vibratory murmur at LLSB without radiation to axillae; if large may present with CHF sx, resp tract infection, FTT, exercise/feeding intolerance
2. EKG shows RVH and LVH, CXR shows pulmonary edema; Echo is definitive
3. Treat CHF; if large surgical repair; if untreated can progress to eisenmeger's syndrome (pulm hTN, reversal of left to right shunt, RVH)
What are the sx of ASD? Dx? Tx?
1. systolic murmur in LUSD, wide and fixed split S2; heaving cardiac impulse at LLSB; CHF, cyanosis 20-30 y/o
2. EKG shows LAD, CXR shows cardiomegaly; echo definitie
3. Surgical repair of large ASDs can progress to eisenmeger's syndrome
What is PDA? Sx? Dx? Tx?
1. Failure of PDA to close in first few days fo life; L to right shunt; RF rubella infections
2. CHF, wide pulse pressure, machinery murmur at LUSB, bounding peripheral pulses , loud S2
3. Echo left atrial and ventricular enlargement ; shunting flow
4. If diagnosed within days of birth give indomethacin but if > 6-8 months or if indomethacin fails need surgical repair; note some defects like TGA are PDA dependent do the pDA should not be closed, can use alprostadil to keep the PDA open
What are the causes of cyanotic congenital heart disease?
1. Truncus arteriosis (common srtery off both ventricles)
2. Transposition fo the great arteries
3. Tricuspid atresisa
4. Tetralogy of fallot
5. Total anomalous pulmonary venous return
What is TOF? Sx? Dx? TX?
1. Pulmonary stenosis, RVH, Overriding aorta, VSD (PROVe)
2. cyanotic spells may occur when baby is crying or eating,squatting can decrease vascular resistance, systolic ejection murmur on LSB and RV lift
3. Echo is definitive; boot shaped heart on CXR
4. Give prostaglandin to maintain PDA , surgical repair treat te spells with squatting, O2, fluids, morphine
What is Tran of the great arteries? Sx? Dx? TX?
1. aorta arises form RV and pulm artery arises from LV
2. single loud S2
3. Echo is definitive; CXR shows egg on a string
4. give prostaglandin E to keep PDA open; surgical repair necessary
Case: Baby is 3 weeks old with, projectile nonbious emesis with an olive shaped mass in epigastrium; shows hypochloremic, metabolic alkalosis. Dx? Tx?
1. Pyloric stenosis; barium study shows string sign
2. Correct dehydration and electrolytes; surgical repair
Paroxysmal abd pain, currant jelly like stool,m palpable sausage shaped mass in abdeomen. Dx? Tx?
1. Obtain abd u/s; Intussception
2. reduction via enema, supportive care, if perforation suspected or if enema ineffective proceed to surgery; associated with CF and HSP
What is volvulus? Sx? Dx? Tx?
1. malrotated gut twists around SMA
2. bowel ischemia, bilious emesis,
3. Surgical emergency
Painless rectal bleeding in child or intussception
1. Meckel's diverticulum; order a techitium scan to detect gastric mucosa; IV fluids, surgery if symptomatic
What is the rule of 2's for Meckel's ?
1. 2 feet proximal to ileocecal valve
2. 2 types of ectopic tissue
3. 2 % of the population
4. presents at age 2
5. 2 inches long
6. 2 inches in diameter
What is croup? Sx? Dx? Tx?
1. acute viral inflammatory disease by parainfluenza virus
2. fever, dyspnea, stridor, barking cough
3. Steeple sign on x-ray of neck showing subglottic narrowing
4. Mist therapy for mild croup, reacemic epi if stridor is present, systemic dexamethasone
What is epiglotittis? Sx? Dx? Tx?
1. can lead to life threating airway obstruction, rare due to Hib vaccine; cause by staph aureus or strep pneumo
2. dysphagia, drooling, muffled voice, inspiratory retractions, cyanosis, pt in sniffing position
3. Do not examine throat, lateral neck films show thumbprint sign of a swollen epiglottis
4. if unsabtle intubation with antibiotics
What is pertussis? Sx? Dx? Tx?
1+2. URI sx, severe cough
3. PCR for B pertussis
4. Erythromycin or azithromycin
What is absence seizures? Dx? Tx?
1. brief staring spells
2. 3 Hx spike and wave pattern on EEG
3. Ethosuximide
What is infantile spasms? Dx? Tx?
1. < 1 y/o; jackknife spasms and psychomotor arrest; developmental regresstion
2. Hypsarryhtmia on EEG; assoc with tuberous sclerosis
3. ACTH
What is Wilms tumor? Dx? Tx?
1. most commonr enal tumor in children; abd pain, hematuria, B symptoms
2. CT abdomen
3. Transabdominal nephrectomy followed by chemotherapy
What is trisomy 21? Sx? Dx? Px?
1. Trisomy 21
2. mental retardation, cardiac defects, throid disease, leukemia
3. Echo, basic workup
4. Develop alzheimer's at age 40
What is trisomy 18? Sx? Dx? Px?
1. Trisomy 18
2. Clenched hand, overlapping fingers, IUGR, cardiac defects, rocker bottom feet
3. FISH
4. 90% die by one eyar
What is trisomy 13? Sx? Dx? Px?
1. Trisomy 13
2. CNS malformations, polydactyly, seizures, deafness, cleft lip/palate, cardiac defects, MR
3. FISH
4. More than 70% die in one year
What is 22q11? Sx? Dx? Px?
1. Digeorge syndrome
2. MR, speech and language delay, feeding difficulty
3. FISH, renal US , lymphocyte count
4. Test parents as carriers
What is turner's syndrome? Sx? Dx? Px?
1. 45 XO
2. short female with shield chest, wide space nipples, webbed neck, and congenital lymphedema, MR, gonadal dysgenesis, coarctation of the aorta, hearing loss
4. Infertility but normal life span
3.
What is fragile x syndrome? Sx? Dx? Px?
1. fragile x
2. boys with macrocephaly, large ears, macroorchidism and talls tature; MR,
3. CCG repeat in FMR1 ,
4. Normal life span
What is marfan's? Sx? Dx? Px?
1. connective tissue disorder
2. talls tature, joint laxity, pectus excavatum, MVP, high arched palate, normal intelligence
3. slit lamp examination,
echocardiography, genetic evaluation
4.Need to correct aortic root dilation have normal life span
What is affected in a superior division MCA stroke??
1. Contralateral hemiparesis affecting face, hand, and arm
2. Contralateral hemisensory deficit in same distribution as above
3. ipsilateral gaze preference
4. facial droop
5. If dominant hemisphere is affected then broca's aphasia (nonfluent speech but good comprehension)
What is affected in a inferior division MCA stroke??
1. Contralateral homonymous hemianopsia
2. neglect of contralateral limbs
3. Apraxia
4. If dominent hemisphere is affected wernicke's aphasia (fluent speech but poor auditory comprehension, repetition, and naming
What is affected in a ACA stroke?
Leg paresis
What is affected in a PCA stroke?
1. Homonomyous hemianopsia with macular sparing, inability to recognize familiar faces
What is affected in a basilar artery stroke??
1. Coma
2. cranial nerve palsies
3. locked in syndrome
What is affected in a lacunar stroke??
pure motor or sensory deficit, clumsy hands, hemiparesis involving face arm, and elg
What are potential Tx's for myoclonic , absence, primary generalized, and partial onset strokes?
1. Valproate
2. Ethosuximide, valproate
3, Valproate, lamotrigine
4. Carbamazepine, lamotrigine, phenytoin, valproate

Rule out pregnancy before starting treatment
What is the treatment for manic episode?
Antipsychotic (olanzapine or risperidone) + Lithium ( or valproate or carbamazapine)
For all psych pts what hsould be doen?
1. psych consult
2. suicide contract
3. psychotherapy
What is the most common complication fo SCD in children?
Splenic sequestration
If a patient with pancreatitis spikes a fever what should be done next?
1. Blood culture
2. Start imipenem
What valvular abnormality is seen with acute PE?
Tricuspid indsufficiency
What is the management of extended priapism?
1. Conservative with ice
2. Phenylephrine injection or epinephrine
What should be used to treat hallucinations in parkinson's disease?
atypical neuroleptics
In a pt with SLE what markers are likely to be positive?
ANA, AntidsDNA; antidsDNA correlates with disease activity
What is psuedohypoPTH? labs?
1. Resistance of PTH on target tissues
2. Results in low calcium, high phosphorous, high pth, normal 25OHD
What is hypoPTH? labs?
1. Low pTH production
2. Low calcium, high phsophorous, low PTH and normal vitD
What is vitamin D def.? labs?
1. Lack of vitamin D
2. Low Ca, Low P, High PTH, low vit D
What is the Tx of tinea versicolor?
1. Topical ketoconazole
What are the symptoms of uretheral diverticulun
1. Dribbling, 2. Dysuria
3, Syspareunia
What are acoustic neuromas composed of?
Schwann cells
What is the most effective conservative therapy for PVD?
cilostazol; avoid BBs
What is the Dx of menopause?
Absence of period fo 12 months; FSH elevated, obtain TSH, prolactin to rule out other causes
What is the Tx of symptomatic menopause?
1. Estrogen (with progestin if uterus is still present)
What is an electrolyte complication of B12 therapy?
Hypokalemia
If an inguinal hernia is noticed in a baby what age should they have surgery?
As soon as the hernia is noticed as waiting can lead to complications
If HSIL is noted on pap what is the next step?
1. Colposcopy; can do LEEP is unavailable or colposcopy sample unsatisfactory
2. If no CIN 2 o3 on sample then repeat colposcopy in 6-12 months; if CIN 2,3 is present treat according to guidelines
What is the DDx for a young person with monoarthritis?
Gonoccal arthritis should be first thing you think of, cell count does not necessarily need to be above 50,000
What is the treatment of postpartum endometritis?
1. fever uterine tenderness, foul smelling vaginal discharge, leukocytosis
2. clindamycin and gentamicin

Note metronidazole is contraindicated in breast feeding mothers
What are the findings in TTP?
1. Thrombocytopenia
2. Hemolytic anemia
3. change in mental status
4. renal failure
5. Fever

Tx: Plasmapheresis; diffrentiate TTP from HUS as it has more neurologic sx than renal failure
What are the Sx of HSP?
1. URI Sx
2. Abd pain
3. Symmetric macular rash that changes to papules
What diabetic oral meds must be stopped in renal failure?
Metformin + glyburide or glypizide
Do not need to stop a glitazone as is metabolized by liver
What is the leading cause of encephalitis?
HSV
What is the Tx of HSV encephalitis?
Acyclovir IV
What are the Sx of HSV encephalitis?
1. bizarre behavior
2. Speech disorders
3. hallucinations
What are the organisms that cause meningitis in neonates?
GBS, E. Coli, Listeria
What are the organisms that cause meningitis in infants?
1. S. pneumoniae
2. N. meningitidis
3. H. influenzae
What are the organisms that cause meningitis in adults?
1. S. Pneumoniae
2. n. menigitidis
2. Listeria (in elderly)
What is the Tx of S. pneumoniae meningitis?
vancomycin + ceftriaxone + dexamethasone (given first)
What is the Tx of N. menigitidis meningitis?
Ceftriaxone (3rd gen ceph)
What is the Tx of listeria meningitis?
Ampicillin
What is the Tx of Hib meningitis?
Ceftriaxone
Waht is the Tx for GAS throat? Abx allergy?
1. PCN
2. Macrolide for PCN allergy
When should you use prednisone in PCP pneumonia?
When PaO2 < 70 or if Aa gradient > 35 on room air
What is bronchitis? Sx? Dx? Tx?
1. Infection of the upper airways
2. Cough with or without sputum production, dyspnea, fever, and chills
3. CXR, CBC, cultures, sputum Cx
4. If bacteria etiology is suspected give antimicrobials
What is the Tx for TB?
1. Rifampin, Isoniazid, Pryazinamide, Ethambutol for 8 wks then INH and rifampin for 16 weeks
What is the Tx of latent TB?
INH x 9 months
What is the Tx for HIV + pts with TB?
Rifabutin instead of rifampin then INH, pyrazinamide, and ethambutol
What are the SEs of the RIPE drugs?
Rifampin - red/orange blody fluids, hepatitis
INH - peripheral neuropathy, hepatitis, lupus (give pyridoxine or B6)
Pyrazinamide - hyperuricemia, hepatitis
Ethambutol - optic neuritis
What is the Tx of syphiillis?
Primary/Secondary: Penicillin G IM x1 or doxycyline of PCN allergic; idf disease course > 1 year give 3 PCN doses one week apart
Tertiary: PCN G x 14 days ; desnsitization if allergic
What is the Tx for chlamydia?
Azithromycin PO x 1
What is the Tx for gonorrhea?
COC
IM ceftriaxone x 1
PO ofloxacin x 1
PO ciprofloxacin x 1
What is PID? Sx? Dx? Tx?
1. Infection of upper genital tract due to complication of chlamydia and gonorrhea infection
2. pelvic pain, dyspareunia, vag discharge, cervical motion tenderness
3. Gram stain and endocervical smear
4. Rule out pregnancy; Tx with 2nd gen cephalosporin + doxycycline IV; check for abscessif no improvement
When should antiviral therapy be started?
1. Symptomatic pts
2. Asymptomatic with CD4 < 350
3. pregnant women
4. In setting of needle stick from HIV + pt
What are the nucleoside reverse transcriptase inhibitors and their common side effects?
DATEZL
Didanuosine - Pancreatitis
Abacavir - hypersnsitivity
Tenofovir - Renal toxicity
Emtricitabine - N/V. diarrhea
Zidovudine - Myopathy and bone marrow suppression
Lamivudine - Diarrhea, N/V. headache
What are the non-nucleoside reverse transcriptase inhibitors and their common side effects?
1. Efavirenz - CNS toxicity and teratogenicity
2. Nevirapine - rahs and hepatic failure
What is the prophylaxis used in HIV pts?
1. PCP - CD4 < 200, prev PCP, or thrush - Bactrim, dapsone, or atovaquone
2. MAC - CD4 < 50 - Azithro qwk
3. Toxo - CD4 < 100 and Toxo IgG + - Bactrim
4. Pneumovax - all HIV patients q5years
5. Hep B - chronic carriers - Hep B vacc
What is the proph for TB?
1. Chluoroquine weekly before and after trip
2. Mefloquine weekly if traveling to chuoroquine resistant areas
3. If cannot take mefloquine can use doxy qd or malranone qd

Noted nefloquine has psychiatric side effects so do not prescirbe to people with psych history
For severe Traveler's diarrhea what is the Tx?
Cipro or azithro
What is the Tx for Lyme disease? what is the rash?
1. Doxycycline or amoxicillin; if cardiac or neurological involvement give ceftriaxone
2. Erythema migrans (target lesion)
What is Ehrlichiosis? Sx? Dx? Tx?
1. Tick borne disease caused by ehrlicia in summer
2. nonspecific, no physical exam findings, HA, myalgias
3. PCR; thrombocytopenia, leukopenia, elevated LFTs
4. Doxycycline
What is the tx of neurtropenic fever?
1. Cefepime IV
2. If hypotensive, central line infection, MRSA Hx give Vanc
3. Add antifungal if 5-7 days of fevers while on antibiotics ; ampho B or voriconazole
What is the criteria for SIRS?
THRiLl
Temp > 100.4 or < 97
Heart rate > 90
Resp rate > 24 (or PCO2 < 32)
Leukocytosis > 12,000 or (bands > 10%)

Need two criteria
What is the Tx of cryptococcus?
1. Fluconazole if mild 6-12 months
2. Ampho B +/- flucytosiine then transition to fluconazole
What is the geographic locations of the various fungal infections?
1. Histo - ohio/mississippi river valley with exposure to bat, bird droppings
2. Coccidio - southwestern US (AZ)
What is the preferred Abx for cystic fibrosis lung infections?
1. Tobramycin (aminoglycoside) + 2. Ticarcillin/clavulanate or Piperacillin/clavulanate (antipseudomonal penicillin)
What are the specific neurological findings of B12 deficiency?
Impaired lower extremity vibration sensation and hyperreflexia (reflect subacute combined degeneration of the dorsal and lateral spinal columns)
What is a commpn complication of B12 deficiency (associated with mild hyperbilirubinemia)?
Ineffective erythropoiesis; so the RBC precursors that are made die in the BM
What is the Tx of Giradia? Is it assoc. with eosinophilia?
1. Metronidazole
2. No
What shoiuld you think when you see diarrhea with eosinophilia? Tx if infectious cause?
1. Helminth infection, eosinophilic gastroenteritis, or Addisson's disease
2. Albendazole or Mebendazole
What is the surveillance for polyps found on colonoscopies?
1. Hyperplastic polyps = repeat in 10 years
2. 1 or 2 small (< 1cm) tubular adenomas with no high grade dysplasia = repeat in 5 years
3. 3 or more adenomas, high grade dysplasia, villous feature, and any adenoma > 1 cm = repeat in 3 years
What is the first step in evaluating a patient with potential spondyloarthropathy?
X-ray of sacroiliac spine
What are the symptoms of reiter's syndrome?
1. Conjunctivitis
2. urethritis
3. Spondyloarthropathy
What organism increases the risk of Reiter;s in HLA B27 pts?
Chlamydia
How is hyperthyroidism diagnosed in pregnancy?
1. High free serum T4
2. Serum TSH < 0.01
How is gestational transient thyrotoxicosis Dx ?
1. Mildly increased serum T4
2. Slightly decreased TSH levels at end of 1st trimester
What is a tx of diabetic neuropathy that is not neurontin?
TCAs (i.e. duloxetine)
If you see oligodendrocytes with intranuclear inclusions, demyelination, and astrogliosis in a HIV + pt what is the cause? Tx?
1. JC virus aka progressive multifocal leukoencephalopathy
2. HAART
What is CAH?
11 hydroxylase = HTN
21 hydroxylase = hypotension
What does the SAAG ratio tell?
SAAG > 1.1 indicates portal HTN
Cirrhosis
HF
Hepatic venous occlusion (Budd Chiari)
Constrictive pericarditis

SAAG < 1.1
Cancer
Infection
Pancreatitis
Nephrotic syndrome
How to diagnose SBP?
> 250 neutrophils in paracentesis fluid
What is Light's criteria?
Exudate vs. Transudate
Exudate if any one of the following met:
1. Pleural fluid protein / serum protein > 0.5
2. Pleural fluid LDH / serum LDH > 0.6
3. Pleural fluid LDH greater 0.6 x ULN
What are the causes of exudative pleural effusions?
need additional evaluation
Can be due to pancreatitis, autoimmune, malignancy, infection, PE, viral infection
What are the causes of transudative pleural effusions?
1. LV failure
2. Cirrhosis
3. Nephrotic syndrome
Systolic murmur wide fixed split S2?
ASD
When can amniocentesis be done?
15 weeks
What is the GA at which chorionic villous sampling can be done?
9-12 weeks
What is the genotype of an incomplete mole?
69xxy
What is the screening for gestational diabetes mellitus?
1. 50 g oral glucose toelrance test; if > 140 proceed to 100 g tolerance test
2. If screening test is > 200 1 hr post and > 95 FBS then already diagnosed GDM and no further testing needed
3. If FBS > 125 then voert diabetes noted
What are some AR disorders seen in children?
CF, SCD, Tay sach's, PKU , CAH
What are the features of AR diseases?
Skips a genreation, no sex predominance passed on by both mother and father, carrier states present
What is a dermatological complication of thiazide diuretics?
Photosensitivity reaction or generalized dermatitis
What are the most common presenting sx of PML?
1. Hemiparesis
2. Disturbances in speech, vision, gait
MRI best test; see multiple demyelinating nonenhancing lesions with no mass effect; note toxo and CNS lymphoma appear as ring enhancing lesions and do cause mass effect
If a nurse is stuck with a needle from an HIV + pt what should be done ?
1. Use 2 nucleoside reverse transcriptase inhibitors for four weeks with addition of a protease inhibitor if pt has a high viral load
What is ecthyma gangrenosum?
lesions of the skin or mucous membrane that evolve into nodular patches marked by hemorrhage, ulceration, and necrosis; not pathognomonic for Pseudomonas
What is the 1st line tx for acute gout ?
NSAIDs (indomethacin) do not start hypouricemic agents like allopurinol or colchicine i a acute attack
What imaging modality is essential for all pts when working up a possible lung cancer?
CT chest
What is a common complication for paget's disease?
Hearing loss. Using bisphosphonates or calcitonin may slow rate of loss but eventually will be permanent
What imaging modality is essential for all pts when working up a possible lung cancer?
CT chest
What is a common complication for paget's disease?
Hearing loss. Using bisphosphonates or calcitonin may slow rate of loss but eventually will be permanent
What is the tx of chlamydia in pregnancy?
1. Tx partner
2. Erythromycin base (not erythromycin estolate) 500 mg po qid x 7 days or amoxicillin 500 mg PO tid x 7days (can use azithro but not well tested in pregnancy)
What intervention can decrease enlargment of an aortic aneurysm?
Smoking cessation
When does subclinical hypothyroidism require treatment?
1. Antithyroid antibodies
2. Abnormal lipid profile
3. Sx of hypothyroidism
4. Ovulatory and menstrual dysfunction
What electrolyte abnormality can occur right after surgery and cause hyperactive deep tendon reflexes and muscle cramps?
1. Hypocalcemia
2.
Who receives treatment for asymptomatic baceriuria?
1. pregnanct pts
2. urologic intervention
3. Hip arthroplasty

Do not need to tx elderly if asymptomatic
If concerned about achalasia or esophageal stricture what should be the first test ordered?
Barium swallow
In what pts is esophageal adenocarcinoma most often seen?
1. Chronic GERD
In what pts is esophageal squamous cell carcinoma most often seen?
Alcohol and tobacco users
What test should be doen when find cystic lesion in pancreas?
EUS with biopsy to differentiate malignancy vs nonmalignant
What is the Tx for squamous cell cancer?
1. Surgery
2. Radiation as an alternative
If an adrenal mass is incidentally found what is the next best step?
24 urine catecholamine levels; if functional mass, radiographic evidence of malignancy, or > 4cm the mass should be removed
What is the tx for tourette's syndrome?
Dopamine receptor blockers
1. Fluphenazine
2. pimozide
3, Tetrabenazine

SSRIs used for OCD
What infectious disease is lichen planus associated with? What does lichen planus look like?
1. Hep C
2. Involves skin, nails, mucous membranes of the mouth and ext genitalia; shiny discrete itchy polygonal violaceous papules on flexural surfaces with a characteristic whitish lacy pattern; immunologically mediated
When evaluating turner's syndrome as an outpatient what is the basic workup that should be done?
1. FAH, LH
2. UA
3. BMP
4. glucose
5. TSh
6. Echo
7. Renal U/s
7. skeletal survey
8. Pelvic U/S
9. hearing test
What is the treatment of associated disorders with Turner's syndrome?
1. GH if ht below 5th percentile
2. Estrogen + progestin at 13 y.o until menopause
3. Vit D and calcium for osteoperosis
6. Psych consult for learning disabilities
7. OB/GYN consult got possible gonadal resection
7. Counsel patient
What are the appropriate antibiotics to cover for bowel perforation?
Combination of Beta/beta-lactamase inhibitor (i.e. Zosyn) or Metronidazole

+

3rd gen cephalosporin
What orders in the cases should be written before surgery?
1. Type and cross
2. IV access
3. NPO
4. IV Abx (cefazolin or flagyl+3rd gen ceph if bowel)
5. INR
6. Chem
7. IV fluids
When concerned about PCP pneumonia what tests should be ordered?
1. PCP stain
2. LDH
3. HIV ELISA
What is ther Tx for PCP pneumonia?
Bactrim; make sure o obtain an ABG to see of steroids are necessary

Alt Tx: Dapsone, clindamycin-primaquine, atovaquone; make sure pt is not G6PD deficient
When is MAC proph indicated? What is used?
1. CD4 < 50
2. Azithromycin
If pt is having an acute gout attack and CKD what should be used?
intrauticular or systemic steroids; if steroids cannot be given start colchicine but has many side effects
What is the management of blunt abdominal trauma?
CBC, type, and cross, LFTs, amylase, lipase, UA, ABG, BMP, EKG, spine x-ray, CXR, abdominal CT, surg consult
What should be ordered with all traumas?
cervical spine immobilization until c-spine is cleared
For bronchiolitis in children what is the cause? Tx?
1. RSV
2. Albuterol, inhaled epi if no improvement , ribavirin if RSV +
What is the tx of DUB?
1. Iron supplementation
2. OCPs (progestin only if no active bleeding; combo if bleeding present)
What are the antibiotics used to cover for a septic joint?
Initial: Vanc + 3rd gen ceph (ceftriaxone, ceftazadime, cefotaxime)

Gram + cocci:
MRSA = Vanc
MSSA = nafcillin or cefazolin

Gram neg bacilli = ceftriaxone

Do joint aspiration for diagnosis but if knee does not improve do arthroscopy
What PEFR in asthma exacerbation makes one think need for admission?
< 70& of predicted
What is the Tx of asthma exacerbation?
1. albuterol/ipratroprium
2. Systemic steroids
3. O2, intubate if needed
What is the Tx for croup?
1. Inhaled cool mist + Oral dexamethasone
2. Epi inhaled if does not improved

Remember to obtain a neck x-ray
If isolated prolonged PTT is noted what should be done next and what is suspected? Tx?
1. Obtain levels of intrinsic clotting factors i.e 8,9, 11
2. Suspect hemophilia
3. Purified factor 8 for Hem A or factor 9 for for Hem B; desmopressin may also be used; proved genetic, family, and patient counseling
Pt should avoid contact sports and aspirin use
What may be the cause of drop attacks in RA pts?
Atlantoaxial instability especially if history of incontinence
What is the first study to roder when evaluating secondary HTN in a young pt?
UA, BUN, Cr
What is the next step when a pt presents with acute hep B?
Alcohol cessation and retest patient