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15 Cards in this Set

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1. What are the signs and symptoms of Budd-Chiari syndrome? (B&W p73)
Budd-Chiari syndrome is the thrombosis and occlusion of the hepatic vein or hepatic stretch of the inferior vena cava and presents with the following symptoms:
• ascites (84%)
• hepatomegaly (76%)
• jaundice
• Acute presentation: acute RUQ pain and hepatomegaly, and rapid development of jaundice and ascites
• Subacute or chronic presentation: gradual development of ascites, LE edema, cirrhosis, and portal hypertension over a few months
• eventual development of liver failure and hepatic encephalopathy
2. What diagnostic studies are used to confirm the diagnosis of Cushing’s syndrome? (FA2 p117, B&W p87)
Screening tests
• 24-hour urine cortisol (currently the preferred screening test)
• Overnight low-dose (1mg) dexamethasone suppression test (previously the preferred screening test)
If tests are equivocal, may then use:
• late evening serum cortisol level
• late evening salivary cortisol level (can be collected at home)
3. What are the different etiologies of the syndrome of inappropriate antidiuretic hormone (SIADH)? (FA2 p442, B&W p77)
• CNS disease: head trauma, brain tumor, stroke, CNS infection, pituitary surgery
• Pulmonary disease: pneumonia, tumor (small cell)
• Drugs: NSAIDs, antidepressants, antipsychotics, antineoplastic agents, carbamazepine, ecstasy, vasopressin, dDAVP
• Other: HIV/AIDS, major abdominal or thoracic surgery
4. What are the available treatments for atopic dermatitis (AKA eczema)? (FA2 p72, B&W p388)
• Switching to a moisturizing soap (Dove, Aveeno) and adding an OTC emollient may be all that is needed for maintenance and mild cases.
• Hydration / Emollients: Cetaphil, Eucerin, Lubriderm, Aveeno, Aquaphor (or generic equivalents)
- High water/low oil lotions will worsen xerosis and eczema, and high oil creams and ointments will reduce xerosis.
• Calcineurin inhibitors: tacrolimus (Protopic) or pimecrolimus (Elidel)
• Topical Steroids
• Antibiotics for open lesions (cover Staph. aureus and Strep. spp.)
• Antihistamines
• Leukotriene inhibitors (Singulair) – theoretical efficacy supported by weak studies
• UV light therapy
• Systemic steroids (1-2mg/kg/d in children then taper) only in severe cases and only for short duration
• For very severe cases, consider methotrexate, cyclosporin, azathioprine (Imuran)
5. What is the treatment for seborrheic dermatitis? (FA2 p76, B&W p389)
• If active inflammation, treat Staph. infection (eg, azithromycin 250mg po qd x5days)
• Scalp: Derma-Smoothe FS oil (0.01% fluocinolone + peanut oil + mineral oil) qHS to scalp (for hours) then wash with Capex shampoo (0.01% fluocinolone) qd or Dawn dishwashing liquid until resolved. Once resolved, may suppress with 1-2x weekly shampoo with Head & Shoulders, Selsun Blue, T-Gel, or Capex.
• Face, ears, nose:
o Rosula (sulfacetamide 10% + sulfur 5%) lotion/gel qd-tid, or
o Protopic or Elidil qd > 1week, or
o Nizoral (ketoconazole) gel qd + Desowen (desonide) qd x2wks
• Body: Rosula (sulfacetamide 10% + sulfur 5%) lotion/gel qd-tid
6. What are the advantages and disadvantages of combination oral contraceptives? (B&W p256)
Advantages
• Reliable (<3% failure rate)
• Reduce risk of endometrial and ovarian cancer
• Decreased incidence of pelvic infections and ectopic pregnancy
• Menses more predictable, lighter, less painful
Disadvantages
• Daily dosing
• Does not protect against STDs
• Breakthrough bleeding
• Estrogen SE: bloating, weight gain, breast tenderness, nausea, headaches
• Progesterone SE: depression, acne, hypertension
• Increased risk of DVT
• Elevated triglycerides
7. What are the treatment options for a CIN II or III lesion confirmed by colposcopy with biopsy? (B&W p259)
Ablative Therapy
• Cryotherapy
• Laser ablation
Excisional Therapy
• Cold knife conization
• Laser conization
• LEEP (loop electrosurgical excision procedure)
8. What is the difference between breast feeding jaundice and breast milk jaundice? (B&W p294)
• Exaggerated physiologic jaundice (AKA breast feeding jaundice)- occurs in first wk of life, peaks at 12-15mg/dL, due to dehydration  make sure baby has more than 10 feeds/day
• Breast milk jaundice- starts days 4-14 (usually after 1st wk) due to substances in breast milk. May continue for weeks to months while breastfeeding. Improvement with the substitution of formula for 48-72hrs is diagnostic.
9. What are the classic signs and symptoms of croup? (FA2 p373, B&W p286)
• inflammation of larynx, trachea, and/or bronchi  barking cough, resp distress, upper airway obstruction with inspiratory stridor
• symptoms are worse at night
• 75% caused by parainfluenza viruses
• 6% incidence annually in children under 6y/o
• leading cause of hospitalization in children younger than 4y/o (esp. in fall/winter months)
• Course: 12-72hrs of mild fever and coryza  hoarseness and barking cough  peak resp distress at 24-48 hrs  resolution in 1 wk
10. What is the differential diagnosis of gynecomastia? (B&W p189)
• puberty (resolves spontaneously in 6m to 2yrs)
• Medications: spironolactone, digitoxin, cimetidine, amiodarone, ketoconazole, haloperidol, HIV HAART therapy,….
• Drugs: alcohol, marijuana, heroin, anabolic steroids
• Herbal agents: tea tree oil, lavender oil
• Cirrhosis
• Hypogonadism (eg, Klinefelter’s, hyperprolactinemia)
• Testicular germ cell tumor
• Hyperthyroidism
• Hemodialysis patients
11. A 60 year old male presents to the clinic for a well male exam and on digital rectal examination a hard nodule is palpated on the prostate. Lab work-up shows an elevated PSA. What is the next step in the management of this patient? (FA2 p447, B&W p199)
Transrectal needle biopsy in clinic (ideally ultrasound guided)
12. What are the potential side effects of lithium use in the treatment of bipolar disorder? (FA2 p395, B&W p345)
• CNS depression, tremor
• thyroid changes (hyper- or hypothyroidism, or euthyroid goiter)
• nephrogenic diabetes insipidus (reversible on discontinuation)  thirst, polydipsia, polyuria
• GI side effects (nausea, vomiting, diarrhea, metallic taste changes, weight gain)
13. What personality disorder fits the following statement? (FA2 p397, B&W p354)
• excessive need to be taken care of, submissive and clinging behavior, low self-confidence, fears of separation and losing support

• grandiosity, feels he is entitled to things, lack of empathy
• suicide attempts ( 15% mortality), unstable mood and behavior, sense of emptiness and loneliness, impulsiveness

• distrustful, suspicious, litigious
• lifelong voluntary social withdrawal, no psychosis, emotional expression is limited (restricted range of affect)

• feelings of inadequacy, hypersensitive to rejection or criticism, socially inhibited, shy
• excessive need to be taken care of, submissive and clinging behavior, low self-confidence, fears of separation and losing support
dependent
• grandiosity, feels he is entitled to things, lack of empathy narcissistic
• suicide attempts ( 15% mortality), unstable mood and behavior, sense of emptiness and loneliness, impulsiveness
borderline
• distrustful, suspicious, litigious paranoid
• lifelong voluntary social withdrawal, no psychosis, emotional expression is limited (restricted range of affect)
schizoid
• feelings of inadequacy, hypersensitive to rejection or criticism, socially inhibited, shy avoidant
14. What are the steps in the management of a femur fracture? (FA2 p245, B&W p204)
• Maintain hemodynamic stability with IVF and PRBCs if necessary
• If closed femur shaft fracture, closed reduction and traction until able to perform ORIF in order to limit bleeding
• If open fracture: copious irrigation with normal saline (at least 3 liters) then cover wound with sterile dressing, apply gentle pressure dressing to control bleeding, prophylactic antibiotics for gram (+) coverage, to OR within 6 hours for debridement, pulsatile lavage irrigation, ORIF, and delayed primary closure
• Pain control with narcotics
• Definite care as soon as OR can be ready: operative reduction with internal fixation (ORIF) with intramedullary nail
• Tetanus prophylaxis
15. When are thrombolytics appropriate in the management of acute stroke? (FA2 p270, B&W p367)
• If administered with 3 hours of the symptom onset in a CT confirmed ischemic (nonhemorrhagic) stroke (therapeutic window is 6 hours if the tPA can be given directly to the artery containing the clot)
• No contraindications to tPA (such as uncontrolled hypertension, prior intracranial hemorrhage, stroke or head trauma in the last 3 months, recent MI, current INR > 1.7, platelet count < 100K, major surgery in the last 14 days, GI/urinary bleeding in the last 21 days, seizures on stoke onset, uncontrolled blood glucose, age < 18, or improvement of symptoms as seen in TIAs)