STEP 2 CK review

Aspiration pneumonia (Risk factors)

- *Altered consciousness* impairing cough reflex/glottic closure - *Dysphagia* due to neurologic deficits - Upper GI disorders - *NG/ET tubes* - Vomiting - *Large volume tube feeds* in recumbent position

Babesiosis (Features, Diagnosis, Treatment)

- *Anemia*, thrombocytopenia, increased bilirubin, LDH - Thin blood smear - intraerythrocytic rings - Atovaquone + erythromycin; quinine + clindamycin

Myotonic dystrophy (Complications)

- *Arrhythmias* - *Cataracts* - Balding - Testicular atrophy/infertility

Second trimester ultrasound (Timing, advantages, disadvantages)

- 18-20 weeks - Measures fetal growth, anatomy, placental position - Cannot identify all abnormalities, some findings of uncertain significance

Post partum depression usually occurs _______ after the pregnancy

- 2 weeks

Gonococcal conjunctivitis (Timing, Presentation, Prevention, Treatment)

- 2-5 days after birth - Presents with purulent exudate formation and prominent eyelid swelling - Erythromycin ointment - Ceftriaxone or Cefotaxime IM injection

At what age does p. aeruginosa surpass s. aureus as the most common cause of pneumonia in patients with cystic fibrosis?

- 20

Orthostatic hypotension involves a drop of about ______ mmHg in systolic blood pressure and _____ mmHg drop in diastolic blood pressure.

- 20 systolic - 10 diastolic

Noninflammatory arthritis synovial analysis (Upper limit for WBCs, Appearance, PMNs)

- 2000 - Clear - <25%

Pap smear results: HSIL with no CIN II or III on biopsy in a 22 year old

- 21-24 year olds can opt for repeat colposcopy every 6 months for two years (If 2 negatives, can go for routine screening)

Cushing syndrome (Full Diagnostic workup)

- 24 hour urinary free cortisol; Late night salivary cortisol; Low dose dexamethasone suppression test - ACTH level (independent/low being adrenal disease or exogenous intake) - High dose dexamethasone suppression test for ACTH dependent to differentiate pituitary (Suppression positive) or ectopic (Suppression negative)

Indomethacin is used as a tocolytic from _____________ (weeks gestation) while nifedipine is used as a tocolytic from _________________ (weeks gestation).

- 24- 32 weeks for indomethacin - 32-34 weeks for nifedipine

TDaP vaccines are provided to pregnant women between the gestational weeks ...?

- 27 and 36

Patients with a polyp removal with a colonoscopy can have f/u colonoscopies at ...?

- 3 years

Lennox gastaut syndrome (Age of onset, Features)

- 3-5 years - Variety of seizures, developmental and mental growth delay

Heart rate calculation

- 300/# of large squares between each QRS - Multiply number of QRS by 5

Labor should be managed with *tocolytics* prior to ______ weeks gestation. Labor prior to ______ weeks gestation is managed with *magnesium sulfate*.

- 34 weeks - Preterm + Steroids - 32 weeks - Magnesium

Bartholin ducts drain at the _____ o clock and ___ o clock positions.

- 4 and 8 o'clock

Hypomania lasts for ______, while mania lasts for _____

- 4 days (at least) - 7 days (at least)

Adequate treatment of syphilis is confirmed with _______________ (change) in titers collected at 6-12 months.

- 4 fold decrease

Strabismus whether intermittent or constant should be treated after the age of ____.

- 4 months

Audiometry and vision testing can begin at age ...?

- 4 years old

Patients are usually protected from significant symptoms of sickle cell anemia during the first ______ months of their lives.

- 4-6 months

In an otherwise good candidate, how much time can be allowed to pass prior to ruling out the use of thrombolytic therapy?

- 4.5 hours since onset of symptoms

Infants over the size of ________ (weight) should have planned c-sections.

- 4500 g -> Macrosomia

After ____ hours, if symptoms improve, patients with acute pyelonephritis can be discharged on oral antibiotics.

- 48 hours

The diagnosis of major depression requires _ of the SIGECAPS criteria

- 5 (including depressed mood)

Chlamydial conjunctivitis (Timing, Presentation, Prevention, Treatment)

- 5-14 days after birth - Presents with copious watery exudate and mild chemosis - Screening - Oral Erythromycin

Bowen disease and actinic keratoses may be treated with ...?

- 5-fluorouracil cream

High postvoidal volume (Men vs Women)

- 50 mL in men - 150 mL in women

Post partum hemorrhage (Definition)

- 500 ml of vaginal blood loss - 1 L blood loss from C - section

Melanoma (ABCDE rules): How large does a lesion have to be in order to qualify as suspicious?

- 6 mm or greater

Patients with alcoholic cirrhosis are recommended ultrasound every ____ in order to screen for hepatocellular carcinoma.

- 6 months

The zoster vaccine should be provided at age ...?

- 60

Screening for osteoporosis starts at age ...?

- 65 in women (DEXA of lumbar spine)

FEV1 grading of COPD

- 80+% -> SABA - 50-80% -> LABA - 30-50% -> ICS - 30% and below -> O2 therapy

First trimester combined test (Timing, advantages, disadvantages)

- 9-13 weeks - Early screening - Not diagnostic

HPV vaccine should be provided at ... (age)?

- 9-26

Primary PCI must be attempted within ____ minutes of first medical contact with a PCI capable medical hospital.

- 90 minutes (120 minutes if transferred from PCI non-capable facility)

Tuberous sclerosis (Features)

- Adenoma sebaceum (Acne like nodules around cheeks - Ash leaf spots and shagreen patches - Brain tumors (Hamartomas and GCAs causing seizures) - Cardiac rhabdomyoma and angiomyoplipomas

SVT (Medical management)

- Adenosine - Beta blocker/CCB

Viral conjunctivitis (Microbial cause, Timing, Discharge, Associated findings)

- Adenovirus - 1-2 weeks - Watery/mucoid - Viral prodrome

In addition to medications used in UC, what meds are useful for the treatment of Crohn disease?

- Antidiarrheals - Antibiotics (Metronidazole, ciprofloxacin)

Which area of the aorta is most likely to suffer forces that result in tear injury?

- Aortic isthmus

Severe aortic stenosis (Criteria)

- Aortic jet velocity *at least 4 m/sec* - Mean transvalvular pressure gradient *at least 40 mm Hg* - Valve area *at most 1 cm^2*

Ankylosing spondylitis (Cardiac association)

- Aortic regurgitation

Syringomyelia (Association)

- Arnold chiari malformation type 1

Cystine stone (Image, pH, cause)

- Associated with a lower urine pH - Caused by genetic conditions predisposing for aminoaciduria (along with ornithine, lysine, arginine)

Uric acid stone (Image, pH, cause)

- Associated with a lower urine pH - Caused by gout, hyperuricemia, hyperuricosuria

Struvite stone (Image, pH, cause)

- Associated with higher urine pH - Caused by infection with Proteus mirabilis

keratoderma blennorrhagica (Association, Image)

- Associated with reactive arthritis

HSV infection during pregnancy (Management)

- Asymptomatic individuals receive medical management to prevent active infection starting at *36 weeks gestation.*

Rickettsia (Cause, Presentation, Diagnosis, Treatment)

- Bite of Dermacentor tick transmits Rickettsia bacteria - Fever, flu-like symptoms, hepatosplenomegaly, *centripetal rash* - PCR, immunofluorescence study - Doxycycline

Disseminated blastomycosis can occur in ...?

- Both immunocompromised and immunocompetent patients

Toxic megacolon (Management)

- Bowel rest, NG suction and antibiotics - Corticosteroids to cases which are caused by IBD - Surgery if unresponsive to above

OCP (Side effects)

- Breakthrough bleeding - Amenorrhea - HTN - Thromboembolism - Hepatic adenoma - Increased triglycerides

Breast feeding reduces the occurrence of what type of cancers?

- Breast and Ovarian

What kind of casts are seen in UAs of patients with chronic kidney disease?

- Broad - Waxy

In spinal epidural abscesses, __________ should be initiated immediately.

- Broad spectrum antibiotics (Vancomycin + Ceftriaxone)

C1 esterase inhibitor deficiency (Treatment)

- C1 inhibitor concentrate

Pancoast tumors usually involve which branches of the spinal cord?

- C8-T2

CAP vs HAP treatment

- CAP - Ceftriaxone + Azithromycin - HAP - Vancomycin + Piperacillin/Tazobactam

Prenatal testing (10 weeks)

- CBC - Blood typing - Urine dipstick, culture - STIs (HIV, Hepatitis B, Syphilis, Chlamydia) - Rubella and varicella testing - PAP smear - US assessment

Delusional disorder (Treatment)

- CBT and anti-psychotic therapy

Conduct disorder (Treatment)

- CBT, parent management training

Congenital CMV vs Toxoplasmosis (Imaging difference)

- CMV presents with periventricular calcifications - Toxoplasmosis presents with diffuse calcifications

Along with TMP-SMX for PCP, patients undergoing immunosuppressive therapy also receive ...?

- CMV prophylaxis (Ganciclovir or valganciclovir)

Isopropyl alcohol ingestion (Features)

- CNS depression - Disconjugate gaze - Absent ciliary reflex

(Asthmatics/COPDers) Anticholinergics are preferred among _________ Inhaled corticosteroids are preferred among ________

- COPDers for anticholinergics - Inhaled corticosteroids for asthmatics

Gittelman's syndrome is associated with what type of arthritis?

- CPPD?

New lung nodules that are observable on chest x rays need to be evaluated with a ...?

- CT scan of the chest

What are the two chemicals that one is at most risk for coming into contact with when exposed to a house fire?

- Cyanide and Carbon monoxide

Cheyne Stokes respirations (Meaning, Cause)

- Cyclic, spindle shaped breathing with intermittent episodes of apnea - Central sleep apnea + Heart failure

Aromatase deficiency (DHEAS levels)

- DHEAS high

What is the difference between restrictive chest wall disease and interstitial lung disease in terms of the following values: TLC FEV1/FVC DLCO

- DLCO is normal in restrictive chest wall disease,* decreased in interstitial lung disease* TLC decreases in both FEV1/FVC remains normal in both

Acute Liver Failure (Features, Treatment)

- Elevated liver transaminases (>1000), hepatic encephalopathy, synthetic liver dysfunction - Liver transplantation

Nonclassical 21 hydroxylase deficiency presents with elevated ...?

- Elevated serum 17 hydroxyprogesterone

Vasa previa (Treatment)

- Emergency C-section if signs of fetal distress - Plan for c-section otherwise

When can minors provide their own consent?

- Emergency care - Sexually transmitted infection - Mental health + substance abuse - Contraception - Pregnancy - Financially independent - Parent - Married - Active military service - High school graduate

Placenta previa (Treatment)

- Emergent C- section if signs of fetal distress or active bleeding - Deliver all babies which are at 37 weeks or above

Homogenous cystic ovary with "ground glass" appearance

- Endometrioma

Immobile uterus is usually secondary to ...?

- Endometriosis

Addison's disease presents with increased ________ (WBC type)

- Eosinophils

Gustatory and olfactory hallucinations are often seen in ...?

- Epilepsy (*Temporal lobe* more associated with *olfactory*)

5-alpha reductase inhibitors (Side effects)

- Erectile dysfunction, decreased libido

Lofgren syndrome (Features)

- Erythema nodosum - Bilateral hilar adenopathy - Arthralgia associated with sarcoidosis

Acne Rosacea (Presentation, Causes)

- Erythema, edema, and telangiectasias affecting the central face - Triggered by spicy foods, emotional stressors, temperature fluctuations

Mild sunburn (Features, Treatment)

- Erythema, tenderness - Fever, vomiting, headache, blistering, systemic symptoms

Chronic bacterial prostatitis (Bacterial etiology, Treatment)

- Escherichia coli - Fluoroquinolones for 6 weeks

Esophageal wall thickening on CT scan should make one concerned for ...?

- Esophageal rupture

Pneumomediastinums are often seen in ...?

- Esophageal ruptures - Tracheobronchial ruptures

Probenecid helps with the __________ of uric acid.

- Excretion

What type of psychotherapy is used in patients with OCD?

- Exposure and response prevention (cognitive behavioral therapy)

De Quervain's tenosynovitis is due to inflammation of the ...?

- Extensor pollicis brevis and abductor pollicis longus tendons

Tuberculous/Fungal meningitis (Glucose, Protein, Cell count)

- Extremely low glucose - High protein (Usually very high) - Increased WBC with lymphocytic predominance

Prerenal azotemia (FENa, Urine osmolality, BUN/Cre ratio, Urine sodium)

- FENa <1% - Urine osmolality >500 - BUN/Cre >20:1 - Urine sodium <10

Intrinsic azotemia (FENa, Urine osmolality, BUN/Cre ratio, Urine sodium)

- FENa >1% - Urine osmolality <300 - BUN/Cre <20:1 - Urine sodium >30

Postrenal azotemia (FENa, Urine osmolality, BUN/Cre ratio, Urine Sodium)

- FENa varies - Urine osmolality 300-500 - BUN/Cre varies - Urine sodium 10-30

Obstructive lung disease (FEV1, FEV1/FVC, RV, TLC, Compliance)

- FEV1 - Decreased - FEV1/FVC - Decreased (Due to normal FVC) - RV - Increased - TLC - Increased - Compliance - Normal or Increased (Emphysema)

Restrictive lung disease (FEV1, FEV1/FVC, RV, TLC, Compliance)

- FEV1 - Decreased - FEV1/FVC - Normal or increased (Due to decreased FVC) - RV - Decreased - TLC - Decreased - Compliance - Decreased

Bicornuate uterus (Risks)

- FGR, preterm delivery

Studies for fetal anemia

- FHR (Sinusoidal tracing) - Cerebral artery doppler (MCA)

Acute onset of psoriasis may be a sign of ...?

- HIV

Focal segmental glomerulosclerosis (Associations)

- HIV, heroin - Obesity - Hispanic, African American ethnicity - Sickle cell disease

Recurrent respiratory papillomatosis (Transmission, Treatment)

- HPV 6 and 11 transmitted vertically from mother to child - Surgical debridement

Trichotillomania (Management)

- Habit reversal training

von Hippel-Lindau disease (Features)

- Hemangioblastomas - Bilateral renal cell carcinoma - Pheochromocytoma - Renal and pancreatic cysts

Miliary TB is caused by the _____________ of tuberculosis

- Hematogenous spread

4 indications for immediate exploratory laparotomy

- Hemodynamic instability - Peritonitis - Evisceration - Blood from the NG tube or on rectal examination

Cyclophosphamide (Side effects, prevention)

- Hemorrhagic cystitis (Mesna, N-acetylcysteine protects bladder)

What are the extrarenal features of ADPKD?

- Hepatic cysts - Aneurysms in the brain - Mitral valve prolapse - Hernias - Colonic diverticuli

Sulfasalazine (Side effects)

- Hepatotoxicity - Hemolytic anemia

Kernicterus can only be caused by what type of bilirubin and in what quantity?

- High (>20 mEq) of unconjugated bilirubin

Dressler syndrome (Treatment)

- High dose aspirin (first line)/Short term corticosteroids (usually avoided in patients with recent ischemic events)

Perinatal Hepatitis B infection (Risk factors, Transmission, Prevention)

- High maternal viral load + *HBeAg +* - Perinatal exposure to genital secretions + transplacental - HBV vaccine + HBIG within 12 hours of birth

Erythrocyte counts in patients with thalassemia is usually:

- High or normal (As opposed to low counts in patients with iron deficiency anemia)

Warm agglutinin disease (Antibody type, Hemolysis type, Treatment)

- IgG mediated - Extravascular hemolysis - Glucocorticoids, splenectomy/rituximab

Methemoglobinemia (Lab findings, Treatment)

- Normal PaO2, Saturation gap on pulse ox vs ABG - Methylene blue; Vitamin C

What PaCO2 values are worrisome in asthma exacerbations?

- Normal or high

Severe hypercalcemia, >14 (Treatment)

- Normal saline + calcitonin, avoid loop diuretics unless volume overloaded - Bisphosphonate (Long term)

Hypercalcemia (Initial management)

- Normal saline/Lactated Ringers

The DLCO in asthmatic patients may be __________.

- Normal/increased

In order to promote breastfeeding, birth control in the post partum period should be ...? What are the side effects of this method?

- Not estrogen based, example - > Depot shot - Weight gain, delayed return to fertility, possible bone loss

Left bundle branch block (Signs)

- Notched R wave in leads V5, V6

Allergic conjunctivitis is differentiated from viral and bacterial causes by the presence of __________ (symptom)

- Ocular pruritus

PComm aneurysms are associated with __________ nerve deficits while AComm aneurysms are associated with __________ nerve deficits.

- Oculomotor - PComm - Optic - AComm

Maternal serum AFP is *increased* in what conditions?

- Open neural tube defects - Ventral wall defects - Multiple gestation

Ethambutol (Side effects)

- Optic neuritis

Cryptorchidism (Treatment)

- Orchiopexy prior 1 year of age

Pharmacotherapy for patients with trouble losing weight with adequate diet and exercise?

- Orlistat

Alpha adrenergic antagonists (Side effects)

- Orthostatic hypotension, dizziness

Surveillance bias (Definition)

- Outcome is *diagnosed or identified more frequently in a sample* than a population due to more screening/testing/monitoring for the risk factor itself

Stopping pap smears (requirements)

- Over 65 - No history of CIN II or higher - Last 3 pap smears normal - Last 2 cotesting normal

Decompensated heart failure with hypotension (Treatment)

- Oxygen - Loop diuretics - Vasopressor

Pneumococcal vaccine for HIV patients

- PCV13 once - PPSV23 8 weeks later, 5 years later, than at age 65

Cough secondary to asthma (Management)

- PFTs

Spontaneous bacterial peritonitis (Ascitic fluid characteristics, Treatment)

- PMNs at least 250, positive culture, protein < 1 g/dL, SAAG at least 1.1 g/dL - Empiric antibiotics ->* Third generation cephalosporins*; *FQ *for SBP prophylaxis

Cough secondary to GERD (Management)

- PPI

What calcium homeostasis disorders present with increased alkaline phosphatase?

- Paget disease of the bone - Primary + secondary hyperparathyroidism - Osteomalacia/rickets

Achilles tendinopathy (Clinical presentation)

- Pain that is prominent in the posterior heel, often with palpable thickening of the tendon, and pain is reproduced clinically with *passive dorsiflexion of the ankle rather than palpation of the heel*

Cold agglutinin disease (Antibody type, Hemolysis type, Treatment)

- IgM mediated - Intravascular AND extravascular hemolysis - avoid cold temperatures, rituximab

The diagnosis of ankylosing spondylitis relies on:

- Imaging findings

Vibrio Vulnificus (Management)

- Immediate Doxycycline + Ceftriaxone

Pregnant women presenting with signs of acute appendicitis should undergo:

- Immediate surgery

NPPV is used in order to ...?

- Improve oxygenation (Not a viable option in patients who cannot breathe at all)

When should RhoGam be administered?

- In a Rh- mother with a Rh+ fetus (Possibility), it should be administered during week 28 and after delivery of a Rh+ infant (Antibody screening is appropriately screened for at first prenatal visit, 28 weeks, and after delivery) - After any invasive testing

What are some risk factors for preterm labor?

- Preterm labor in prior pregnancy - Multiple gestation - History of cervical surgery

What malaria medication has activity against hypnozoites?

- Primaquine

Which malaria medication has the potential to cause hemolytic crisis in patients with G6PD?

- Primaquine

Secondary vs Primary adrenal insufficiency

- Primary adrenal insufficiency has *aldosterone deficiency*, hyperpigmentation, and low sex hormones (More severe symptoms overall) - Secondary adrenal insufficiency has normal aldosterone and normal sex hormones (Less severe symptoms overall)

Endometrial hyperplasia can be treated with ...?

- Progestin therapy - Hysterectomy

Glucocorticoid induced myopathy (Clinical features, ESR + CK)

- Progressive *proximal muscle weakness* and atrophy without pain or tenderness; lower extremities usually more involved - Normal ESR and CK

Ataxia telangiectasia (Features)

- Progressive cerebellar ataxia - *Athetosis* - Telangiectasias on face and conjunctivae - *Decreased immunocompetence*

Prolactin ______________ the secretion of GRH.

- Prolactin *decreases* the secretion of GRH

Infantile hemangiomas (History, Management)

- Proliferation from 0-1 years and involution from 1-9 years of age - Topical beta blockers for ulcerated or cosmetically sensitive areas

Persistent complex bereavement disorder (Features)

- Prolonged (>12 month) grief, difficulty accepting the death, persistent yearning for the deceased, and avoidance of reminders of the deceased

Statin induced myopathy (Clinical features, ESR + CK)

- Prominent muscle pain and tenderness with or without weakness; rare rhabdomyolysis - Normal ESR, high CK

Pleural effusion and Atelectasis (Breath sounds, Tactile fremitus, Percussion, Mediastinal shift) How are they different?

- Mediastinal shift is away from pleural effusion and toward atelectasis

Cancer related anorexia (Treatment)

- Megestrol acetate

HAV vaccine for HIV patients (Indications)

- Men who have sex with men - IVDU - Chronic liver disease

Acoustic neuroma vs Meniere's disease

- Meniere's disease presents with *Vertigo* while acoustic neuromas present with *Dizziness*

Atrophic vaginitis (Main cause, Treatment)

- Menopause - Vaginal moisturizer + lubricant, topical vaginal estrogen

Lead poisoning in a way, presents similar to _______ (heavy metal) poisoning.

- Mercury

Neonatal thyrotoxicosis (Treatment)

- Methimazole + Beta blocker

Ectopic pregnancy (Treatment)

- Methotrexate for stable patients, then follow up hCG - Surgery for impending rupture or unstable patients

Primary Biliary Cholangitis (Clinical features, Lab findings, Treatment, Complications)

- Middle aged woman with fatigue and pruritus (*constitutional*), jaundice, hepatomegaly and cirrhosis (*cirrhosis*), along with cutaneous xanthomas and xanthelesmas (*high cholesterol*) - Very high Alk Phos, high aminotransferases; *Antimitochondrial antibody*; severe hypercholesterolemia - Ursodeoxycholic acid, liver transplantation - Malabsorption + vitamin deficiencies, Metabolic bone disease, hepatocellular carcinoma

Magnesium toxicity (Symptoms + Treatment)

- Mild - Nausea, flushing, headache, *hyporeflexia* - Moderate - *areflexia, hypocalcemia*, somnolence - Severe - *Respiratory and cardiac arrest* - Stop magnesium therapy and provide *IV calcium gluconate*

Cutis aplasia (Definition, causes)

- Missing portion of skin on an infant due to use of certain medications and conditions - *Trisomy 13*, Methimazole, carbimazole, valproate, certain ACE inhibitors

Edwards syndrome (Features, mutation)

- Prominent occiput Micrognathia Low set ears Clenched hands with overlapping fingers Heart defects Renal defects Rocker bottom feet - Trisomy 18

Pregnant women with a hx of pyelonephritis during her pregnancy need what for the duration of the pregnancy?

- Prophylactic antibiotics

Risk of developing hemarthroses in hemophilia is significantly reduced with the administration of:

- Prophylactic factor concentrates

Postpartum HIV management (Mom, Infant born to mom >1000 viral load vs <1000 viral load)

- Mom: Continue ART - Infant born to mother with *>1000 viral load*: Multi-drug ART - Infant born to mother with *<1000 viral load*: Zidovudine

Cord entanglement is a risk in what type of twins?

- Monochorionic Monoamniotic

What type of twins are vulnerable to TTTS?

- Monochorionic diamniotic twins

Atypical depression (Features)

- Mood reactivity (Pleasant responses to pleasant events) - Weight gain - Hypersomnia - Leaden paralysis - Hypersensitivity

Central cord syndrome presents with weakness that is ...?

- More pronounced in the *upper extremities*

Thyroid storm (Treatment)

4 Ps

Felty syndrome (Triad, pathophysiology)

- Rheumatoid arthritis, Splenomegaly, Neutropenia - Prolonged RA results in formation of antibodies against neutrophils, which results in destruction of neutrophils and trapping of neutrophils in the spleen

Hepatojugular reflux (Sign of?)

- Right heart disease

FB aspiration (Treatment)

- Rigid bronchoscopy

Congenital clubfoot (Clinical presentation, Treatment)

- Rigid positioning of feet with medial/upward deviation of the forefoot and hindfoot - Serial manipulation and casting

Tourette syndrome (Risks in future)

- Risk in developing *OCD* and *ADHD* in the future

Abdominal Aortic Aneurysm (Screening)

- Routine one time abdominal ultrasound for men age 65-75 who have ever smoked

What is the typical screening protocol for GBS in pregnant patients?

- Routine rectovaginal culture at 35-37 weeks gestation

Conus medullaris syndrome (Spinal level affected, Onset of pain, Motor symptoms, Sensory symptoms, Incontinence)

- S3-S5 - Sudden onset of pain - *Symmetric* + *hyperreflexic* + *spastic paralysis* of the lower limbs - *Saddle anesthesia* - *Early onset* of bowel + bladder incontinence

Intense exercise may result in the body experiencing a bout of _________.

- SIADH

If the fetus presents with heart block, the mom most likely has ...?

- SLE

Membranoproliferative glomerulonephritis (Associations)

- SLE - Hepatitis C - Monoclonal gammopathy

Mixed connective tissue disease (Which conditions?, Antibodies)

- SLE, systemic sclerosis, polymyositis - Anti-U1 RNP, RF, Anti-CCP, ANA

What class of antidepressants are known to aid with treatment of neuropathy?

- SNRIs

Diarrhea associations: Bloody diarrhea after consumption of poultry

- Salmonella

Duchenne muscular dystrophy (Complications)

- Scoliosis - Dilated Cardiomyopathy

What is the first step of evaluating the risk for preterm labor?

- Second trimester transvaginal ultrasound for measurement of cervical length

When a parent refuses life-saving treatment for a child, what is the next best step?

- Seek a court order to proceed with the necessary interventions to save their life

Attrition bias (Type of bias)

- Selection bias

Susceptibility bias (Type of bias, Definition)

- Selection bias - A first disease present in a patient predisposes to a second disease, and treatment of the first disease is mistakenly interpreted as the predisposing factor for the second one

Nonresponder bias (Type of bias, Definition)

- Selection bias - If nonresponder characteristics differ significantly from responder characteristics and *nonresponders do not return information during a study*, this is a bias

Volunteer bias (Type of bias, Definition)

- Selection bias - Individuals that volunteer to a study differ from the general population, maybe because they seek a certain reward, etc

Survival bias (Type of bias, Definition)

- Selection bias - Patients with more severe or less severe disease often get missed because those who get studied have less extreme forms of the disease

Berkson bias (Type of bias, Definition)

- Selection bias - Sample groups drawn from the hospital are *more likely to be sick* than those drawn from the general population

Healthy worker effect (Type of bias, Definition)

- Selection bias - Working population is on average healthier than the average population, so *any sample containing only the working population is not representative of the whole population*

Polymorphic eruption of pregnancy (Presentation, Treatment)

- Self resolving pruritic rash presenting in pregnant patients, usually appearing over her abdomen - Treat with topical steroids and antihistamines

Keratoacanthoma (Treatment)

- Self resolving, if not then it is surgically removed

Seminomas vs non seminomas

- Seminomas do not produce AFP, while non-seminomas do

Diethylbesterol (Teratogenicity)

- Septate uterus - Clear cell adenocarcinoma

Serotonin Syndrome (Triggers, Symptoms, Treatment)

- Serotonergic drugs - Autonomic dysfunction + *hyperreflexia, tremor, clonus, hypertonia* - Benzodiazepines/cyproheptadine

Linezolids can trigger ...?

- Serotonin syndrome

Ondansetron is a _________ receptor antagonist

- Serotonin, not dopamine!

Aortic stenosis (Indications for valve replacement)

- Severe AS and at least one of the following: 1) Onset of *symptoms* such as angina and syncope 2) Left ventricular *ejection fraction <50%* 3) Undergoing other *cardiac surgery *

What signs are a high priority when determining the risk of PE?

- Signs of DVT - Previous PE or DVT - Hemoptysis/Cancer

Polyhydramnios (Definition)

- Single deepest pocket of at least 8 cm - Amniotic fluid index of at least 24 cm

Diabetes (Diagnosis)

- Single random serum glucose 200 w/ symptoms or greater - Hemoglobin A1c of at least 6.5 - Fasting plasma glucose of 126 mg/dL or greater

Pyogenic granuloma (Features, image)

- Small bright red papule that commonly grows and bleeds

Morning sickness of pregnancy (Treatment)

- Small frequent meals - Vitamin B6 - Doxylamine

Patients presenting with seizures and suspected of TCA overdose should be treated with ...?

- Sodium bicarbonate

Unlike other vasculitides, PAN tends to ...?

- Spare the lungs

While an older patient presenting with fasciculations may point to signs of ALS, what will a young child with the same symptoms suggest?

- Spinal muscular atrophy

Congenital toxoplasmosis (Treatment)

- Spiramycin for mom - Sulfadiazine, pyrimethamine and folinic acid when confirmed in fetus

Pain caused by disc herniations tend to get better with ...?

- Standing and lying supine (Worsened with sitting)

Common microbes that cause central line associated bloodstream infections (CLABSI)

- Staphylococcus aureus - Staphylococcus epidermidis - Klebsiella pneumoniae - Pseudomonas aeruginosa

Bipolar patients with severe depression after getting started on mood stabilizers may qualify for ...?

- Starting antidepressants after mood stabilizer treatment

Mirtazipine is known to be helpful in ________ appetite.

- Stimulating (Also sleep stimulating)

Bloody diarrhea should be managed with ...?

- Stool fecal leukocyte testing

Patient presents with mania after starting an antidepressant medication. What is the next best step in management?

- Stop the antidepressant medication

Bacterial conjunctivitis (*Microbial cause*, Timing, Discharge, Associated findings)

- Streptococcus pneumoniae/ Haemophilus influenzae - 1-2 weeks - Purulent - Unremitting ocular discharge

What type of fibroids tend to cause uterine bleeding?

- Submucosal and intramural fibroids

Umbilical cord prolapse (Diagnosis, Treatment)

- Sudden change in fetal heart tracing to *variable* decelerations/ Palpable umbilical cord in pelvic exam - Push baby back in and delivery via emergency *C-section*

Thromboangiitis obliterans (Features, Treatment)

- Superficial thrombophlebitis, raynaud phenomenon; resting pain, cool extremities, trophic nail changes, ulceration - Cessation of smoking, CCBs, O2 therapy

Struvite stone treatment

- Surgery + nephrostomy

Infantile hemangiomas that compromise the airway should be treated with ...?

- Surgical resection

Performance only social anxiety disorder (Features, Treatment)

- Symptoms or fear/anxiety restricted only to public speaking or performing in front of crowds - Clonazepam or propanolol (Preferred in patients with a history of substance abuse)

HIV induced cachexia (Treatment)

- Synthetic cannabinoids

Klebsiella granulomatis vs Syphilis

- Syphilis presents with *lymphadenopathy*, while klebsiella does not

Allocation/Ascertainment/Sampling bias (Definition)

- Systematic difference in way patients are selected to a certain treatment group

What sign is seen in the ultrasound imaging of twins with potential risk for TTTS

- T sign (Thin intertwin membrane)

What are the vaccines that are safe and recommended to use during pregnancy?

- TDaP - Rho D - Inactivated influenza vaccine

PCP (Prophylaxis)

- TMP-SMX - Pentamidine - Dapsone

HIV associated conditions prophylaxis

- TMP-SMX for PCP under 200 - Itraconazole for histo under 150 - TMP-SMX for toxo under 100 - Azithromycin for MAC under 50

Young girls who are being evaluated for amenorrhea and are found to have a uterus and low FSH levels should be evaluated with ...?

- TSH, Prolactin, and cranial MRI

TTN has (Hyperinflation/Hypoinflation) while RDS causes (Hyperinflation/Hypoinflation).

- TTN -> Hyperinflation, fluid around lung lobes - RDS -> Hypoinflation, ground glass infiltrates

SNRIs are associated with __________ (cardiac side effects)

- Tachycardia and hypertension

Hyperkalemia (ECG changes)

- Tall, peaked T waves - Flattening of the P wave, lengthening of the PR interval - Shortened QT interval - Widening of the QRS complex

Valproate (Side effects)

- Teratogen - Tremor, sedation, ataxia - Hepatotoxicity - GI upset, *pancreatitis* - Skin rash, agranulocytosis

Uterine tachysystole (First line treatment, Side effects)

- Terbutaline (Short term tocolytic) - Pulmonary edema

*Physiologic jaundice* typically does not manifest until ___________ (Timing), while *pathologic jaundice* presents _____________ (Timing). When does it resolve?

- The 3rd day of life (Resolving usually by 8th day) - Less than 24 hours of life (Not resolving until 1-2 weeks)

USPSTF Recommendations: Pregnant women bacteriuria screening

- The USPSTF recommends screening for asymptomatic bacteriuria with urine culture in pregnant women at *12 to 16 weeks' gestation* or at the *first prenatal visit*, if later.

LP is only required in MS patients when ...?

- The diagnosis is not clear-cut

Rickettsial rashes start on _________ (region of body)

- The palms and soles and work *centripetally*

What happens to inhibin and progesterone levels in a patient with Turner syndrome?

- They are decreased

Why do patients with beta thal major require chelation therapy?

- They are transfusion dependent and iron removal is achieved through chelation therapy

What happens to PTH levels in Vitamin D deficiency?

- They go up (Go down in vitamin D toxicity)

What happens to coagulation factor levels in pregnancy?

- They increase (hyper coagulable state)

What is one precaution that must be considered when providing glucose to patients with hyperemesis gravidarum?

- Thiamine supplementation due to risk of WE

ICA dissections (Treatment)

- Thrombolysis within 4.5 hours - Antiplatelet therapy

What happens to *tidal volume* and *functional residual capacity* during pregnancy?

- Tidal volume increases - Functional residual capacity decreases

Acne medications

- Topical retinoids + Benzoyl peroxide - Topical antibiotics (Erythromycin/Clindamycin) - Oral antibiotics - Oral isotretinoin

Cirrhosis, nephrotic syndrome, and CHF all cause ___________ pleural effusions (exudative/transudative).

- Transudative

Irregular non-lobular infiltrates in the chest are usually secondary to ...?

- Trauma (pulmonary contusion - follow the injury pattern)

What type of CBT is used in patients with PTSD?

- Trauma focused (first line) - Exposure - response

The process of anticipation is seen in what type of chromosomal disorders?

- Trinucleotide repeat disorders

Nuchal translucency on maternal US is a sign of:

- Trisomy 18/21

Neuroleptic Malignant Syndrome (Triggers, Symptoms, Treatment)

- Typical antipsychotics, metoclopramide - Autonomic dysfunction (*Hyperthermia, hypertension, tachycardia*); *hyporeflexia/rigidity* - Stop the drug/dantrolene/bromocriptine

Hypokalemia (ECG changes)

- U wave - Flattening of the T wave - ST depression

Pediatric constipation can lead to increased propensity for ____ (pathology).

- UTIs (Due to distended colon compressing bladder and blocking complete voiding)

When suspecting a congenital diaphragmatic hernia, never do a chest x ray when the patient is ...?

- Unstable from a respiratory standpoint (Intubation always comes first)

Probenecid (Contraindications)

- Uric acid stones

Primary nocturnal enuresis can be managed with what options?

- Urinalysis to rule out secondary causes - Lifestyle changes - Enuresis alarm - Desmopressin therapy

First time seizure workup

- Urine drug screen - CT/MRI of brain or EEG - LP if needed

Porphyria cutanea tarda (Enzyme, Findings, Treatment)

- Uroporphyrinogen decarboxylase - Hypertrichosis/hyperpigmentation, fragility of sun exposed skin, - Avoid susceptibility factors + *exposure to sunlight*, *phlebotomy*, *hydroxychloroquine*

Classic causes of allergic contact dermatitis

- Urushiol - Nickel - Neomycin

Holter monitoring (Use)

- Used in patients who are likely forming arrhythmias

Uterine atony (treatment)

- Uterine massage - Oxytocin - Ergots/Prostaglandins

Uterine atony (Management)

- Uterine massage, provide tranexamic acid - Uterotonic medications - B lynch suture - Hysterectomy

Asymmetric Fetal Growth Restriction (Causes, Timing, Clinical features)

- Utero-placental insufficiency, maternal malnutrition - 2nd/3rd trimester - "Head sparing" growth lag

Extraintestinal manifestations of Crohn disease

- Uveitis - Arthritis - Ankylosing spondylitis - Erythema nodosum - Pyoderma gangrenosum - Apthous ulcers - Cholelithiasis - Nephrolithiasis

Intrauterine fetal demise (Treatment)

- Vaginal delivery if >24 weeks gestation - Dilation curettage if 20-23 weeks gestation

Fibromyalgia (Patient demographics, Prominent feature, Diagnosis)

- Young-middle aged woman - Widespread *pain with trigger points*, *fatigue* and *concentration loss *common - At least 3 months of symptoms with widespread pain index or symptom severity score; *Normal labs*

The two sample t test vs two sample z test

- Z test utilizes population means, while t test utilizes sample means

Melasma

Brownish pigmentation of the face during pregnancy; also called chloasma and "mask of pregnancy"

Central cyanosis vs Peripheral cyanosis

Central - Bluish discoloration of lips, tongue and extremities -> Usually a sign of congenital heart disease Peripheral - Bluish discoloration of the extremeties -> Usually a sign of sluggish blood flow through the extremities

Activated charcoal may be provided for patients who present within _______ of acetaminophen, salicylates, and TCA poisoning.

Few hours

Osteoarthritis vs Rheumatoid arthritis (Hands)

Osteo - Fusiform swelling of joints, Heberden's nodes (DIP), Bouchard's nodes (PIP) RA - Ulnar deviation of MCP joints, Boutonniere deformity of thumb, swan neck deformity of fingers

Preeclampsia with severe features (Definition)

Preeclampsia with: - Bp over 160/110 OR - End organ damage

Fetal Hydantoin Syndrome (Features)

small body size, microcephaly, digital hypoplasia, nail hypoplasia, midfacial hypoplasia, hirsutism, cleft palate and rib anomalies

GnRH levels in PCOS are ...?

- Elevated

What entails a reactive NST?

- 15 by 15 x 2 accelerations in 20 mins

When is autism screening routinely performed?

- 18 months and 2 years

Body dysmorphic disorder (Treatment)

- Antidepressants (SSRIs) - CBT

Variable decelerations (Image)

Short base and long nadir

High risk patients who contract varicella infections can be treated with ...?

- Acyclovir

Hypersensitivity pneumonitis (treatment)

*remove the offending antigen*; systemic steroids for patients with more severe symptoms and those with fibrosis

Short interpregnancy interval (Definition, Risks)

- *<6-18 months* from delivery to next pregnancy - *Maternal anemia*; PPROM, preterm delivery, low birth weight

Amniocentesis (Timing, advantages, disadvantages)

- 15-20 weeks - Definitive karyotypic diagnosis - Invasive, risk of membrane rupture, fetal loss

Sick sinus syndrome (Features, Diagnostics, Treatment)

- *Bradycardia *- Dizziness, syncope, lack of increasing heart rate OR *tachycardia-bradycardia* attacks leading to syncope, palpitations, etc - ECG - Pacemaker placement (Bradycardia treated with IV atropine and transvenous pacing)

Week 28 prenatal to do list

- *CBC* to check for anemia - *RhoGAM* shot - *50 g glucose challenge test* for gestational diabetes screening

What patient populations are recommended to take sequential PCV13 and PPSV23 *prior to age 65*?

- *CSF leaks, Cochlear implants* - *Sickle cell disease* - *Asplenia* - *Immunocompromised patients* - *Chronic renal failure*

The *PPSV23 vaccine alone* is recommended for what patient groups before the age of 65?

- *Current smokers * - *Chronic condition* (Heart/lung/liver disease) - *Diabetes *

IgA nephropathy vs PSGN (Complement)

- *Decreased* complement C3 in patients with *PSGN*

Fibromuscular dysplasia (Diagnosis, Treatment)

- *Duplex US*/CTA/MRA/arteriography - ACEi/ARB, percutaneous transluminal angioplasty, Surgery

Management of PPROM is typically ____________ until ________ weeks gestation.

- *Expectant *until *34* weeks gestation -> Delivery

Phenytoin (Side effects)

- *Gingival hyperplasia* - SJS - Teratogen

Ehrlichiosis (Features, Diagnosis, Treatment)

- *Leukopenia*, thrombocytopenia, increased transaminases - Giemsa stain of blood - Doxycycline

What is the main difference between malignant hyperthermia/serotonin syndrome and exertional heat stroke?

- *Muscular rigidity* is not present in patients with exertional heat strokes - note that serotonin syndrome is usually associated with hyperreflexia

Medication overuse headache (Clinical features, Treatment)

- *Near daily headache* in the setting of regular use of acute headache medications; May *present on awakening*, and *symptom relief for short periods* with medications - Remove the culprit drug

Indications for antibacterial prophylaxis for endocarditis

- *Prosthetic* heart valve - Previous *infective endocarditis* - Structural valve abnormality in *transplanted heart* - Unrepaired *cyanotic congenital heart disease* - Repaired congenital heart disease with *residual defect*

What are the recommended vaccinations for those with *chronic liver disease*?

- *TDaP* followed by *TD booster* every 10 years - *Influenza* annually - *PPSV23* once, then sequential PCV13 and PPSV23 at age 65 - *Hepatitis A* (2 doses 6 months apart if negative serology) - *Hepatitis B* (3 doses at 0 months, 1 month, and at least 4 months with initial negative serology)

IgA deficient individuals should have all blood products __________ prior to transfusion.

- *Washed* - Removes IgA and other proteins

Parvovirus B19 infection (Presentation, Diagnosis)

- 1) Asymptomatic or flulike symptoms 2) Erythema infectiosum: Fever, nausea, and slapped cheek rash that is more common in children 3) Acute symmetric arthralgia/arthritis, resembling RA 4) Transient pure red cell aplasia; aplastic crisis in patients with underlying hematologic disease - NAAT or serology

NNT equation

- 1/ARR

What is the rule of 10 for pheochromacytomas?

- 10% are bilateral - 10% are extraadrenal - 10% are malignant

Chorionic villus sampling (Timing, advantages, disadvantages)

- 10-13 weeks - Definitive karyotypic diagnosis - Invasive, risk of spontaneous abortion

The normal baseline fetal heart tracing goes from what to what?

- 110 to 160 beats per minute

When does depression screening start?

- 12 years of age

Post partum blues generally resolves within:

- 14 days (2 weeks)

Second trimester quad screen (Timing, advantages, disadvantages)

- 15 - 22 weeks - Screens for neural tube defects and aneuploidy - Not diagnostic

Reassuring nonstress test (What does it mean?)

- 15 by 15 accelerations x 2 in a 20 minute period

ECV is performed in patients who are ...? (Weeks gestation and labor status)

- >37 weeks gestation and not in active labor

Tertiary hyperparathyroidism (PTH and calcium levels)

- A result of chronic secondary hyperparathyroidism leading to stimulation and creation of parathyroid adenomas from normal tissue - High serum PTH and Ca++

Baker cyst (Formation, Risk factors, Treatment)

- A swelling of the bursa between the gastrocnemius and semimembranosus muscles that contains synovial fluid - Arthritis - Treat underlying pathology to treat cyst

What are the following amyloid subtypes caused by? AB2M AL AA ATTR

- AB2M - Secondary to *hemodialysis* - AL - Production by *clonal plasma cells* - AA - Secondary to *chronic inflammation* - ATTR - *Familial *or* hereditary *

Peripheral Artery Disease (Diagnosis, Treatment) When do we use an exercise ABI? What do we do when the ABI is too high? What is likely when the ABI is too low? What treatments are there to help these patients?

- ABI <0.9, <0.4 is resting pain and possible gangrene, >1.3 is medial sclerosis and may prevent proper diagnosis, move to imaging study; If resting ABIs are normal in a suspicious individual move to *exercise ABI.* - Smoking cessation, exercise program (Must) 1) Aspirin, Statins, Antihypertensives, Antidiabetics 2) Cilostazole

Breech presentation (Risk factors)

- AMA - Multiparity - Uterine didelphys, septate uterus - Uterine leiomyomas - Fetal anomalies - Preterm - Oligohydramnios/polyhydramnios - Placenta previa

What are the lupus antibodies?

- ANA (Sensitive) - Anti-dsDNA, anti-Smith (Specific)

What is the best diagnostic test to order for patients suspected of having toxic megacolon?

- Abdominal X ray

Acute Iron Poisoning (Features, Treatment)

- Abdominal pain, hematemesis, diarrhea, shock, liver failure - Deferoxamine, whole bowel irrigation

Indications to switch from continuous insulin to SQ insulin

- Able to eat - Glucose <200 mg/dL - Anion gap <12 mEq/L - HCO3 >15 mEq/L

Vasovagal syncope (Pathophysiology, Treatment)

- Abrupt parasympathetic activation leading to a cardioinhibitory response that manifests as bradycardia with sinus arrest - Avoid triggers, physical counterpressure maneuvers

Primary amenorrhea (Definition, Evaluation)

- Absence of menses by 15, or 13 with gynecologic abnormalities - Pelvic ultrasound - If uterus present proceed to *FSH* - If uterus absent proceed to *karyotype + serum testosterone*

Prevention of cystine stones

- Acetazolamide

What condition results from a mutation to the fibroblast growth factor receptor 3 (FGFR3) gene mutation?

- Achondroplasia

Lactose intolerance (Diagnosis)

- Acidic stool, with positive hydrogen breath test

Ewing's sarcoma (Treatment)

- Actinomycin based chemo + Surgery

Levonorgestrel implant (Contraindications)

- Active liver disease - Breast cancer - Acute pelvic infection

What are the treatment options for each of the movement disorders caused by antipsychotic medications?

- Acute dystonia - anticholinergics - Akathisia - Beta blockers, benzos - Drug induced parkinsonism - anticholinergics - TD - reduce drug, switch drug, -benazines

What are the clinical features of Reye syndrome?

- Acute liver failure - Encephalopathy - Increased ICP

Vaso-occlusive crisis (Symptoms)

- Acute, severe pain in *possibly more than 1 site * - Low grade fever - Erythema and warmth - Possibly preceded by a trigger

Primary hyperaldosteronism (Step after PAC/PRA ratio) What is the treatment for this condition?

- After the ratio reveals a value > 20, proceed to CT scan to evaluate whether it is *bilateral adrenal hyperplasia* (treated with aldosterone antagonists) or a *adenoma* (treated with surgery)

Acute epididymitis (Bacterial etiology)

- Age <35 - caused by Chlamydia and Gonorrhea - Age >35 - caused by coliform bacteria

Listeria coverage for meningitis (Patient population)

- Age > 50 - Immunocompromised

Polymyalgia Rheumatica (Clinical features, Physical exam findings, Lab studies, Treatment)

- Age >50; Bilateral pain and morning stiffness for >1 month, Involvement of certain parts of the body - Decreased active ROM in *shoulders*, *neck*, and *hip* - ESR >40, high CRP - *Low dose glucocorticoids*

Polymyalgia rheumatica (Patient demographics, Prominent feature, Diagnosis)

- Age over 50 - *Stiffness* in shoulders, hip girdle, and neck greater than pain symptoms, associated with GCA - Elevated ESR/CRP

Uterine inversion (Management)

- Aggressive fluid replacement - Manual replacement of the uterus - Placenta removal and uterotonic drugs after uterine replacement

High yield side effects of thionamides

- Agranulocytosis - Methimazole teratogenic (Use in 2nd and 3rd trimesters), propylthiouracil hepatotoxic (Use in 1st trimester)

What is a life-threatening risk of infantile hemangiomas?

- Airway compromise

Alcohol use disorder (Treatment of dependence)

- Alcoholics anonymous - Naltrexone, acamprosate, topiramate, disulfiram

RTA type 4 (Defect, Urine pH, Serum Potassium, Causes)

- Aldosterone resistance - Urine pH below 5.5 - High serum potassium - Obstructive uropathy, CAH

Treatment of uric acid stones

- Alkalinize urine with potassium citrate/bicarbonate - Allopurinol to prevent further uric acid creation

Exercise and atropine _____________ Mobitz type I heart blocks, but _______________ Mobitz type II heart blocks.

- Alleviates (Mobitz Type I) - Worsens (Mobitz Type II) Remember that vagal maneuvers make MTI worse, but MTII better

What medications are known to cause priapism?

- Alpha 1 antagonists (Prazosin) - Antidepressants - Phosphodiesterase inhibitors (Sildenafil) - Stimulants (Methylphenidate, cocaine)

Skene gland (location)

- Also called paraurethral glands, they are usually located lateral to the urethral meatus

Pulsus alternans (Meaning, Causes)

- Alternating strong and weak pulses due to alterations in stroke volume - Severe CHF

Tricuspid stenosis vs Mitral stenosis (Heart sounds)

- Although both are diastolic murmurs with opening snaps, *tricuspid stenosis* presents with jugular venous A waves

Amphetamine toxicity (Treatment)

- Ammonium, benzodiazepines

Dental procedures in patients with prosthetic valves should be prophylaxed with :

- Amoxicillin (Viridans group coverage)

GU and GI tract procedures in patients with transplanted hearts and compromised valvular flow should be treated with:

- Ampicillin (Enterococcus coverage)

Chorioamnionitis (Treatment)

- Ampicillin + Gentamycin

Neonatal sepsis (Antibiotics)

- Ampicillin and gentamicin

Polycystic ovarian syndrome (Clinical features, Pathophysiology, Comorbidities, Treatment options)

- Androgen excess, oligoovulation/anovulation, obesity, polycystic ovaries - Increased testosterone, estrogen, and LH/FSH imbalance - Metabolic syndrome, OSA, NASH, endometrial hyperplasia - Weight loss, OCPs, Clomiphene citrate

46 XY normal male testosterone levels with female characteristics - Diagnosis?

- Androgen insensitivity syndrome

Maternal serum AFP is *decreased* in what conditions?

- Aneuploidies

Hypervitaminosis A (symptoms)

- Anorexia, pruritus, irritability, arthralgias, alopecia, cutaneous lesions, fissuring of mouth, *increased ICP*, hepatomegaly

Kallmann syndrome (Features)

- Anosmia, no breast development, primary amenorrhea, small phallus and testicles, no body hair - 46 XX or 46 XY

Know the difference between anthracycline and trastuzumab induced cardiotoxicity

- Anthracyclines - Destruction, necrosis, and fibrosis - Herceptin - Myocardial stunning and hibernation

Myositis specific antibodies

- Anti Jo 1 - Anti Mi 2

Osteomyelitis (Treatment in sickle cell patients)

- Anti staph antibiotics (Nafcillin, oxacillin, vancomycin if necessary) - Third generation cephalosporin (Ceftriaxone + cefotaxime)

Which antibodies are associated with Sjogren syndrome?

- Anti-La (SSB) - Anti-Ro (SSA)

Tetanus (Treatment)

- Antibiotics, Immunoglobulin, Vaccine

Cell Free Fetal DNA (Timing, advantages, disadvantages)

- At least 10 weeks - High sensitivity and specificity for aneuploidy - Not diagnostic

Schizophrenia (Diagnosis)

- At least 2 of the following for more than 1 month 1) Delusions 2) Hallucinations 3) Disorganized speech 4) Grossly disorganized or catatonic behavior 5) Negative symptoms Signs of the illness persisting for at least *6 months*

Dysthymia (Diagnosis)

- At least 2 years with a depressed mood and 2 of the SIGECAPS symptoms

A thickened endometrial stripe presents with a measurement of thickness to be ___.

- At least 4 mm in thickness

SSRI (Adequate trial length)

- At least 6 weeks in length

Delusional disorder (Diagnosis)

- At least one delusion for at least one month

NPH presents with ______________ (feature) early on in the disease course.

- Ataxia

Amphetamine (False positives)

- Atenolol/propanolol - Buproppion - Decongestants

Heart block (Medical treatment)

- Atropine

Human bite (Treatment)

- Augmentin - Hep B and HIV prophylaxis

Aspirin-exacerbated respiratory disease (Treatment)

- Avoidance of NSAIDs, *desensitization of NSAID use* - Zileuton and Leukotriene receptor antagonists

Recall bias (Definition)

- Awareness of the condition results in changes in patients' recall of certain pieces of information

The PAIR arthritic conditions predominantly affect the ________ (region) skeleton.

- Axial

Cat scratch disease is treated with ...?

- Azithromycin

What is the empiric treatment for suspected chlamydia/gonorrhea? What about either of them alone?

- Azithromycin/ceftriaxone for empiric and gonorrhea (due to antibiotic resistance) - Azithromycin alone for chlamydia

Bariatric surgery indications

- BMI >40 - BMI >35 + complications

Bacterial vaginosis vs Trichomoniasis vs Candidiasis (pH, Treatment)

- BV - High pH, metro/clin - Trich - High pH, metro - Candida - Normal pH, fluconazole

Anaplasmosis (Cause, Features, Diagnosis, Treatment)

- Bacteria transmitted via Ixodes tick - Flu like symptoms, GI upset,

Tourette syndrome (Treatment)

- Behavioral therapy - Medical therapy (Indicated for refractory cases resistant to BT) 1) Alpha adrenergic drugs (Guanfacine + Clonidine) 2) Typical antipsychotics (Pimozide/haloperidol) 3) Atypical antipsychotics (Risperidone) 4) Benazines

ADHD (Treatment)

- Behavioral therapy (First line for < 6 years of age) - Methylphenidate (First line for > 6 years of age) - Atomoxetine (Second line for > 6 years of age, and illicit substance use)

Acute relief for panic attacks may be achieved through the use of _________ (medication)

- Benzodiazepines

Phencyclidine (Treatment)

- Benzodiazepines

Catatonia (Treatment)

- Benzodiazepines - Electroconvulsive therapy

Cocaine intoxication (Treatment)

- Benzodiazepines + alpha blockers - Aspirin - Nitroglycerin and calcium channel blockers

Graves disease (Treatment)

- Beta blockers + antithyroid drugs/RA iodine/Surgical removal

Migraine (Prophylaxis, Treatment)

- Beta blockers, TCAs - NSAIDs, Triptans, ergots

How does bilateral renal artery stenosis (RAS) present compared to unilateral RAS?

- Bilateral RAS may present with chronic kidney disease

Essential tremor

- Bilateral action tremor of the hands usually *without leg involvement* that is relieved with alcohol use, propanolol, and primidone

Leriche syndrome (Triad)

- Bilateral hip/thigh/buttock claudication; Impotence; Decreased femoral pulses w/wo atrophy

Bipolar I vs Bipolar II vs Cyclothymic disorder

- Bipolar I - 1 manic episode with or without depressive episode - Bipolar II - 1 hypomanic episode with 1 depressive episode - Cyclothymia - Persistent mood swings for at least 2 years in length

Primary amenorrhea with present uterus and decreased FSH - next best step?

- Cranial MRI

Hepatitis C (Pregnancy precautions)

- Cannot treat with ribavirin - Barrier protection does not work in protecting monogamous couples from passing infection - Hepatitis A and B vaccination must be obtained - Cesarean delivery not protective - Scalp electrodes must be avoided - Breast feeding should be encouraged unless blood products present

What cardiac pathology equalizes diastolic blood pressures in the heart?

- Cardiac tamponade

Indications for positive pressure ventilation

- Cardiogenic pulmonary edema - COPD - Acute respiratory failure - Facilitate early extubation

Beri Beri (Presentation)

- Cardiomyopathy (wet) - Symmetric and distal polyneuropathy (dry)

Anthracyclines (Side effects, Prevention)

- Cardiotoxicity (prevent with dexrazoxane)

Most common cause of death in patients with RA ...?

- Cardiovascular causes

Carotid Artery Stenosis (Diagnosis, Treatment) When do we offer CEA? Do we offer medical treatment?

- Carotid duplex ultrasonography - Aspirin, Statins, Antihypertensives, Antidiabetics 1) We CEA patients who are *symptomatic* and *at least 70% stenosed* 2) We also CEA patients who are *asymptomatic* and *at least 80% stenosed*

Case control vs Retrospective cohort study

- Case control studies evaluate for *risk factor exposures* while retrospective cohort studies evaluate for *disease incidence *

Cri du chat syndrome (Features, mutation)

- Cat like high pitched crying in infants Cardiac abnormalities Intellectual disabilities Single palmar crease Dysmorphic facial features Skeletal abnormalities - Microdeletion of 5p

Ulnar nerve compression at the wrist is unlikely to ...?

- Cause symptoms of paresthesias in the hand

Most common area in the spinal column for stenosis ...?

- Cervical

Choriocarcinoma (Treatment)

- Chemotherapy

Minimal change disease (Most common population affected)

- Children under age 10 (in fact, children above 10 with the same symptoms are candidates for biopsy)

Wernicke encephalopathy is associated with which conditions?

- Chronic alcoholism - Malnutrition - Hyperemesis gravidarum

Hepatorenal syndrome causes renal failure secondary to ____________.

- Cirrhosis and splanchnic arterial dilation (Presents with ascites and lower extremity edema)

Endometritis (Treatment)

- Clindamycin + Gentamycin

PTSD (Diagnostic criteria, Treatment)

- Clinical features relating to nightmares, flashbacks, intrusive memories, avoidance of reminders, etc should be present for *more than 1 month in duration* (Less than 1 month is acute stress disorder) - Cognitive behavioral therapy; SSRIs/SNRIs, Prazosin for nightmares

In addition to SSRIs, what medication can be used to treat OCD?

- Clomipramine

What is the main risk in patients who experience IUFD and do not have the fetus removed?

- Coagulopathy

Pygmalion effect (Type of bias, Definition)

- Cognitive bias - *Measurement of a variable* of subjects is *influenced by* the experimenter's knowledge or *expectations*

Response bias (Type of bias, Definition)

- Cognitive bias - Study participants *do not truthfully respond or accurately* because of the manner in which questions are phrased

Hawthorne effect (Type of bias, Definition)

- Cognitive bias - Study participants change their behavior once they know that *they are being observed*

Treatment of acute gout in a patient with CKD

- Colchicine/Intrarticular steroid injection

Clostridium septicum (Association)

- Colonic malignancy

Pap smear results: ASG-US (Next best step)

- Colposcopy - Endocervical curettage - Endometrial biopsy

Patients with diffuse axonal injury are usually ...? (state)

- Comatose

Autism spectrum disorder (Treatment)

- Competence training - Family support and counseling

What is the most common presentation of cardiac sarcoidosis?

- Complete AV block, with restrictive cardiomyopathy as the second most common presentation

Fanconi anemia

- Congenital aplastic anemia

Pregestational diabetes (Complications for fetus)

- Congenital heart disease - Neural tube defects - Small left colon syndrome - Spontaneous abortion

Diamond black fan anemia (Definition)

- Congenital pure red cell aplasia

Acrodermatitis enteropathica (Cause, Features, Treatment)

- Congenital zinc deficiency - Chronic recurrent *diarrhea*, *failure to thrive*, red, crusty, vesicular *skin changes*, *alopecia* - Life long *zinc supplementation*

Toxoplasmosis (Methods of transmission)

- Congenitally, cat feces, undercooked meat, unwashed fruits/vegetables

Pseudomonas aeruginosa (Associated conditions)

- Contact lens infections (Keratitis) - 'Hot tub' folliculitis - Nosocomial infections - Malignant + normal otitis externa - Adult CF pneumonia - Ecthyma gangrenosum - Puncture wounds of foot (w/ shoe) - Burn infections - Osteomyelitis (Diabetics)

Maintenance phase treatment (SSRIs)

- Continuation of the SSRI treatment past the initial 6 month phase due to risks with recurrence (at least 2 episodes, persistent residual depression)

What are some contraindications to a contraction stress test?

- Contraindications to labor (Placenta previa, prior myomectomy)

Excitatory toxicity secondary to seizures may provoke what kind of damage to the cerebral cortex?

- Cortical necrosis

Peripheral neuropathy causes (Metabolic, Toxic, Infectious, Hereditary, Other)

- DM, Hypothyroidism, Vitamin B12 deficiency - Alcohol, Medications (*phenytoin*, *disulfiram*, platinum chemotherapy) - HIV, Lyme disease - Charcot Marie Tooth, Porphyria - Idiopathic, plasma cell disorders

What is the main difference between intermittent explosive disorder and DMDD?

- DMDD is only diagnosed prior to the age of 10

What is the earliest manifestation of vaso-occlusion in sickle cell disease?

- Dactylitis

What are some factors associated with a decreased risk of gout?

- Dairy intake - Vitamin C intake - Coffee intake

Leprosy (Treatment)

- Dapsone - Rifampin - Clofazimine

Thrombotic Thrombocytopenic Purpura (Pathophysiology, Features, Management)

- Decreased ADAMTS13 level due to antibodies or hereditary component - FAT RN - *Plasma exchange*, glucocorticoids, rituximab

Euthyroid sick syndrome (Pathophysiology, Labs)

- Decreased conversion of T4 to T3 due to high endogenous cortisol, inflammatory cytokines, starvation, or glucocorticoids/amiodarone - Decreased T3, normal T4/TSH

Hypospadias (Management)

- Defer circumcision - Urologic evaluation for repair - Karyotype analysis

Pregnant patients with a* tender uterine fundus*, *leukocytosis*, *contractions*, and an *associated tender mass* most likely have a ...?

- Degenerating uterine leiomyoma

Pulsus parvus et tardus (Meaning, Causes)

- Delayed and weak carotid upstroke - Aortic stenosis

Gestational Hypertension (Definition)

- Development of hypertension > (140/90) after 20 weeks gestation *w/out proteinuria*

Preeclampsia (Definition)

- Development of hypertension after 20 weeks gestation *WITH proteinuria*

Eclampsia (Definition)

- Development of seizures in patients diagnosed with preeclampsia

PCP (False positives)

- Dextromethorphan, Tramadol - Ketamine - Diphenhydramine, doxylamine - Venlafaxine

Complicated cystitis (Causes, Management)

- Diabetes, CKD, pregnancy, immunocompromised state, hospital acquired, procedure related, obstructions - Obtain culture prior to initiating fluoroquinolone antibiotic therapy

Secondary syphilis (Symptoms)

- Diffuse rash involving palms and soles - Lymphadenopathy - Condyloma lata - Oral lesions - Hepatitis

Uterine inversion (Treatment)

- Discontinue uterotonic - Replace uterus - Stary uterotonic

Displacement vs Projection (Defense mechanisms)

- Displacement - Transferring feelings to less threatening object/person - Projection - Attributing one's own feelings to others (Blaming others for thinking the way you are actually thinking)

The donor twin often has ________amnios, while the recipient twin has ________amnios.

- Donor - oligohydramnios - Recipient - polyhydramnios

Risks for the donor twin in TTTS? Risks for the recipient twin in TTTS?

- Donor twin has oligohydramnios, renal failure, FGR, low-output heart failure - Recipient twin has polyhydramnios, cardiomegaly, high output cardiac failure, and hydrops fetalis

Echogenic bowel on maternal US is a sign of:

- Down syndrome (Duodenal atresia)

Lyme disease (Treatment)

- Doxycycline for skin and mild disease - Amoxicillin for pregnant/*nursing patients* - Ceftriaxone for neurologic and severe cardiac disease

What is the most significant side effect of lamotrigine?

- Drug rash (SJS - TEN)

Mirabegron

- Drug that is useful in the treatment of urge incontinence, (beta 3 agonist)

Routine newborn resuscitation

- Dry and stimulate, clear airway if needed, provide warmth

What are the neurologic features of friedreich ataxia?

- Dysarthria - Cerebellar ataxia - Loss of vibration or position sense - Absent DTRs

What meds are usually used for heavy metal poisoning?

- EDTA, succimer, dimercaprol

Active hematochezia is managed with a __________, while a history of hematochezia is managed with a ____________.

- EGD - Colonoscopy

STEMI/NSTEMI/Unstable angina (Management)

- EKG then troponins for all these patients 1) If EKG shows STEMI, straight to cath lab no troponins needed 2) If EKG does not show NSTEMI and troponins are elevated -> NSTEMI 3) If EKG does not show NSTEMI and troponins are not elevated -> UA

Lyme disease (Diagnosis)

- ELISA - Western blot (Confirmation)

Systems affected by GPA

- ENT - Lungs - Kidneys - Skin

Lead time bias (Definition)

- Early detection of the disease is confused with increased survival

Dawn phenomenon

- Early morning glucose elevation produced by the release of* growth hormone*, which decreases peripheral uptake of glucose resulting in elevated morning glucose levels. Admin of insulin at a later time in day will coordinate insulin peak with the hormone release.

Akinetic mutism (Presentation)

- Echolalia + Echopraxia and lack of spontaneous movement + speech

Primary sclerosing cholangitis (Clinical features, Lab findings, Treatment, Complications)

- Fatigue and pruritus in a patient with *ulcerative colitis*, symptoms of liver *cirrhosis* - p-ANCA, high Alk phos, aminotransferases, hypercholesterolemia - Liver transplantation - Cholangiocarcinoma

Umbilical artery flow velocimetry is usually performed on infants with ...?

- Fetal growth restriction

Chorioamnionitis (Diagnosis, Management)

- Fetal tachycardia (>160/min) Maternal leukocytosis (Maternal leukocytosis) Purulent amniotic fluid (Purulent amniotic fluid) - Broad spectrum antibiotics + delivery

Kawasaki disease (Features, Treatment)

- Fever for at least 5 days; 4 of the following: *conjunctivitis, mucositis, rash, extremity edema, lymphadenopathy* - High dose aspirin + IVIG (to reduce risk of aneurysm formation)

Some myxomas can present with _______(*constitutional symptom*) due to a rare propensity to produce cytokines.

- Fevers

Cough secondary to UACS (Management)

- First generation H1 blocker

Extrapyramidal side effects are most common in what type of antipsychotic medications?

- First generation typical antipsychotics (High potency) -> Haloperidol, Fluphenazine

Phases of labor

- First stage includes *latent* (onset of contractions to 6 cm of cervical dilation) to *active* (from 6 cm of dilation to full or 10 cm of dilation) phases - Second stage starts with complete cervical dilation to delivery of the infant, taking 3 hours in a primi and 2 hours in a multi - Third stage includes the period of time between the delivery of the infant and the delivery of the placenta - Fourth stage is the 2 hour post partum period

Evaluation of precocious puberty (First step, Second step, Third step)

- First step is to identify *bone age* - If bone age is normal, stop - If bone age is increased, then obtain *basal LH* - If basal LH is high, stop - If basal LH is low, do a *GnRH stimulation test*

What is the most accurate way to determine gestational age?

- First trimester crown rump length measurement

Ethylene glycol ingestion (Features)

- Flank pain, hematuria, oliguria - Cranial nerve palsies - Tetany

Light's criteria (LDH, Protein)

- Fluid/serum ratio for *protein* more than 0.5 for exudates - Fluid/serum ratio for *LDH* more than 0.6 for exudates, or more than 2/3s upper limit of normal

Chronic Pelvic Pain Syndrome (Treatment)

- Fluoroquinolones, alpha adrenergic inhibitors, 5 alpha reductase inhibitors

Temporal lobe epilepsy (Most common seizure form)

- Focal seizures with impaired consciousness (Periods of blank unconscious states that are characterized by *automatisms* and post episode *confusion*)

Is there more casein in breast milk or formula?

- Formula - makes it harder to digest

Late and Post term pregnancies (Management)

- Frequent fetal monitoring (Nonstress test) - Delivery prior to 43 weeks gestation

Gait type: Gait disequilibrium (Cause)

- Frontal lobe and multiple sensory system disorder

Patients with aldolase B deficiency must avoid ...?

- Fructose

Heinz bodies and bite cells are seen in ...?

- G6PD deficiency

What are the most common causes of meningitis in children under 1 month of age?

- GBS - E.coli - Listeria - HSV

What are indications for GBS prophy?

- GBS *bacteriuria* or GBS *UTI* in current pregnancy - GBS *positive rectovaginal culture* - Unknown GBS and *<37 weeks gestation*/*Intrapartum fever*/*ROM for over 18 hours* - Prior infant with early onset neonatal GBS infection

Diverticulitis can often present with symptoms relating to ____________.

- GU system (Sterile pyuria)

Acute arsenic poisoning (High yield finding)

- Garlic scented breath

ACLS guidelines

- Give CPR, O2, and determine if rhythm is shockable (VF/PVT) - If not shockable (Asystole/PEA) then give CPR, epinephrine, advance airway/capnography - Only give amiodarone if shockable rhythm

What should you never do when you suspect pulmonary contusions?

- Give them fluid because it will exacerbate the alveolar edema

Dysmorphic RBCs, RBC casts, and concomitant protein in the urinalysis is usually a sign of:

- Glomerular hematuria (non glomerular causes such as nephrolithiasis and *papillary necrosis* do not have protein, dysmorphic RBCs, or RBC casts in the urine)

Fibroids (Treatments)

- GnRH agonists (Leuprolide) - NSAIDs - Tranexamic acid - Androgenic agonist

The most indicative prognostic factor of brain neoplasms is their __________.

- Grade

Uterine tachysystole (Definition, Risks)

- Greater than 5 contractions every 10 minutes - Uteroplacental insufficiency

Suicidal ideation in grief vs depression

- Grief involves suicidal thoughts that revolve around the notion of joining the dead, while major depression involves the notion of hopelessness

Bupropion (Contraindications)

- H/o seizures - Anorexic/bulimic - Recent use of MAOis

Histrionic vs Narcissistic vs Obsessive compulsive personality disorders

- Histrionic - Attention seeking and need a lot of emotional connections in their lives - Narcissistic - Need for admiration, grandiosity and lack of empathy/ability to put themselves in each others' shoes - Obsessive compulsive - Perfectionists + control freaks, need to do things their way

Patau syndrome (Features, Mutation)

- Holo*p*rosence*p*haly *P*olydactyly Micro*p*hthalmia Cutis a*p*lasia Om*p*halocele cleft li*p*/*p*alate - Trisomy 13

What disorder is suspected in a patient with marfanoid habitus and thromboembolic events?

- Homocystinuria

Klumpke's palsy secondary to shoulder dystocia can often present with symptoms related to ___________ syndrome.

- Horner's

What are the adverse effects of SERMs?

- Hot flashes - Venous thromboembolism - Endometrial hyperplasia/carcinoma (Tamoxifen)

Cyanide toxicity (Treatment)

- Hydroxocobalamin - Sodium Thiosulfate - Nitrates to induce methemoglobinemia

What are the findings seen in chronic *arsenic* poisoning?

- Hyperkeratosis, Mees lines, and neuropathy

HHNS (Sodium and Potassium balance)

- Hyperosmolar hyponatremia - Total body potassium - low, serum potassium - high/normal

ACTH dependent cushing's syndrome can present with ...?

- Hyperpigmentation - Androgen excess

What are some conditions that are associated with friedreich ataxia?

- Hypertrophic cardiomyopathy - Diabetes mellitus

Pyrazinamide (Side effects)

- Hyperuricemia - Hepatoxicity

Waldenstrom's macroglobulinemia (Manifestations, Antibody, Peripheral smear, Biopsy)

- Hyperviscosity syndrome, neuropathy, bleeding, hepatosplenomegaly, lymphadenopathy - IgM - Rouleaux - >10% clonal Bs

Rhabdomyolysis (Electrolyte problems)

- Hypocalcemia - Hyperkalemia

Oxytocin toxicity (Presentation)

- Hyponatremia - Hypotension - Uterine tachysystole

What are the three signs that cardioversion is preferred over medical management of a wide complex tachycardia?

- Hypotension - Altered mental status - Respiratory distress

Right ventricular failure (Clinical findings)

- Hypotension, Clear lungs, Kussmaul sign (Distension of the jugular veins during inspiration)

Down syndrome (Features, mutation)

- Hypotonia Upward and slanted palpebral fissures Epicanthal folds Brushfield spots Cardiac malformations Intestinal atresia - Trisomy 21

Pelvic inflammatory disease (Treatment, when is metronidazole added?)

- IM ceftriaxone/cefoxitin + oral Doxycycline Add metronidazole if recent instrumentation or vaginitis present

Papillary muscle rupture vs Interventricular septum rupture (Presentation)

- ISR presents with a harsher, louder murmur and a possible thrill. If a catheter is inserted into the right ventricle, it will also yield a higher than normal oxygenation content in ISR.

Status epilepticus (Management)

- IV access, glucose, ABCs, neurologic evaluation - IV benzodiazepines and nonbenzodiazepine anticonvulsant should be administered to prevent recurrence of the seizure

Acute uterine bleeding in hemodynamically stable patients is managed with ...?

- IV estrogen or progesterone (for patients with contraindications to estrogen) - High dose OCPs

Preoperative management of esophageal perforation

- IV fluids - Antibiotics - PPIs - Restrict oral intake

What is the antibiotic used for GBS prophylaxis?

- IV penicillin intrapartum

Hemodynamically stable patients with wide complex tachycardia are usually treated with what medications?

- IV procainamide or amiodarone

Immune Thrombocytopenic Purpura (Treatment)

- IVIG and glucocorticoids below 30,000 platelets or bleeding - Splenectomy if the above doesn't work

Pancreatic cancer (Imaging diagnosis)

- If at the head (With jaundice), use *ultrasound* - If suspected to be a distal lesion, use CT

When someone is exposed to varicella, how do we determine whether or not they need treatment?

- If they have had it before or 2 doses of vaccines, they can be *observed* - If they have not had it before or did not complete the 2 doses of vaccines, and are immunocompetent, then they need the *vaccine* - If they have not had it before or did not complete the 2 doses of vaccines and are immunocompromised, they need the *VZIG*

Infertility (Definition)

- In ability to achieve pregnancy after 12 months of unprotected sexual intercourse for a couple in *which the woman is age <35* - Inability to achieve pregnancy after 6 months of unprotected sexual intercourse for a couple in *which the woman is age at least 35*

Type II osteogenesis imperfecta presents with ...?

- In utero/neonatal fractures and pulmonary failure

Delayed Sleep Phase Syndrome (Presentation)

- Inability to fall asleep at normal bedtimes, difficulty waking in the morning, excessive early daytime sleepiness

Renal cell carcinoma (Paraneoplastic effects)

- Increased EPO - Increased serum Ca

Breast milk jaundice (Pathophysiology, Timing, Treatment)

- Increased concentration of *B-glucuronidase* in mother's milk leads to the increase of bile deconjugation in the infant, leading to a *unconjugated hyperbilirubinemia* - Onset within 2 weeks of life, lasting for 4-13 weeks - Continued breastfeeding and supplementation with formula, phototherapy only if needed

Primary hypothyroidism causes ________ prolactin.

- Increased prolactin due to TRH -> Prolactin

Pediatric constipation (Treatment)

- Increasing *fluid* and *fiber* intake - Limiting milk intake to *24 oz a day* - Laxatives, suppositories

How are degenerating uterine fibroids managed?

- Indomethacin after confirmation of diagnosis with ultrasound

Tocolytics to use (<32 weeks, 32-34 weeks)

- Indomethacin if below 32 weeks gestation - Nifedipine if 32-34 weeks gestation

TNF inhibitors - Adalimumab, certolizumab, etanercept, infliximab (Side effects)

- Infection - Demyelination - Congestive heart failure - Malignancy

Membranous nephropathy (Associations)

- Infections (Hepatitis B + C) - SLE - Tumors

Reporting bias (Type of bias, Definition)

- Information bias - *Selective disclosure or suppression of information or test results* due to perceived social stigmatization by subjects, resulting in underreporting or overreporting of exposure or outcome

Rashes around patients' mouths and nostrils may be a sign of what kind of drug abuse?

- Inhalants

Some patients with hemophilia who receive factor replacement therapy can develop ...?

- Inhibitor antibodies due to exposure of factor VIII bodies to immune system

Familial adenomatous polyposis (Indications for proctocolectomy)

- Initial presentation with CRC or high grade dysplastic adenomas - Hemorrhage - Significant increase in polyp number during screening interval

Breast feeding jaundice (Pathophysiology, Timing, Treatment)

- Insufficient breast milk intake leads to inadequate bowel movements causing recirculation and deposition of bilirubin in the body - first week of life - Increase breastfeeding and rehydration

What is hospice care?

- Interdisciplinary palliative care for patients with a *life expectancy of under 6 months* that involves a patient-centered approach to emphasize quality of life, comfort, and death with dignity

Endometrial polyps (presentation)

- Intermenstrual spotting without uterine enlargement, due to presence of polypoid structures within the endometrial cavity

Acutely psychotic patients should be treated with ...?

- Intramuscular antipsychotics - Benzodiazepines - Combination of the two

Intrahepatic cholestasis of pregnancy (Risks, Management)

- Intrauterine fetal demise, preterm delivery, meconium stained amniotic fluid, NRDS - ursodeoxycholic acid, antihistamines

Malignant otitis externa (Treatment)

- Intravenous ciprofloxacin - Surgical debridement if necessary

Acute intermittent porphyria (Deficient enzyme, Labs, Treatment)

- Involves deficient *porphobilinogen deaminase* enzyme, causing GI, neurological, psychological effects + red purple urine color - Increased ALA and PBG during attacks - Hemin

Pancoast tumor (Features)

- Ipsilateral Horner's syndrome - Ipsilateral C8-T2 involvement - Ipsilateral supraclavicular lymph node enlargement - Ipsilateral hemidiaphragm paralysis

Biot respirations (Meaning, Cause)

- Irregular breathing followed by irregular periods of apnea

A positive PPD with a negative sputum culture is treated with:

- Isoniazid monotherapy + B6

Diabetic ketoacidosis (Treatment)

- Isotonic fluids - Insulin infusion - IV fluids with potassium

What happens to the PaO2 and FiO2 ratio in ARDS?

- It decreases

What happens to alkaline phosphatase in patients with rickets?

- It goes up

What does a uterus palpable above the umbilicus mean?

- It is boggy and not contracted (Atony, Adenomyosis)

Systemic Juvenile Idiopathic Arthritis (Features, Lab findings

- Joint pain, fever, rash - Thrombocytosis, leukocytosis, increased inflammatory markers

Primary amenorrhea with present uterus and increased FSH - next best step?

- Karyotyping

PMS/PMDD (Management, Treatment)

- Keep symptom/menstrual diary over 2 menstrual cycles (Shows symptoms coming 1-2 weeks prior to menses and resolution right after) - SSRIs

Cauda equina syndrome (Spinal level affected, Onset of pain, Motor symptoms, Sensory symptoms, Incontinence)

- L3-S5 - *Gradual* onset of pain - *Asymmetric* + *areflexic* + *flaccid paralysis* of the lower extremities - *Saddle anesthesia* + possible *sensory loss* in bilateral lower extremities - *Late onset* of bowel + bladder incontinence

Ovarian dysgerminomas are known to secrete:

- LDH

Small cell lung cancer (Paraneoplastic syndromes)

- LEMS (Anti calcium channel antibodies) - Paraneoplastic encephalomyelitis (Cognitive deficits, seizures, etc) - Paraneoplastic cerebellar degeneration - Cushing syndrome - SIADH - SVC syndrome

Meningitis should always be answered with __________ followed by ___________. *Pneumonia must also follow the same routine. *

- LP followed by antibiotics (Due to risk of sterilization) - Pneumonia also requires sputum collection prior to antibiotic administration

Agonal respirations (Meaning, Cause)

- Labored breathing breaths, gasping, myoclonus and grunting prior to terminal apnea and death - Cardiac arrest leading to hypoxic contractions of the diaphragm

Characteristics of lymph nodes associated with malignancies

- Large (>2 cm) - Firm - Immobile - Associated with systemic findings

What is the treatment of TTTS?

- Laser photocoagulation of the placental anastamoses

PCWP is a good approximation of?

- Left ventricular end diastolic pressure (Not helpful in determining pulmonary hypertension)

Ascites resulting from portal hypertension have protein levels ________.

- Less than 2.5g

Amniotic band sequence (Presentation

- Limb defects - Craniofacial defects - Abdominal wall defects

Granulomatosis infantisepticum (Microbial cause)

- Listeria causes multiple abscesses in the infant

CML is associated with a ____ LAP score

- Low (As opposed to high lap score in leukemoid reactions)

Beta-Thalassemia Minor (Electrophoresis patterns)

- Low A - High A2 - Normal F

Sickle cell trait (Electrophoresis patterns)

- Low A - High S - Normal F

Physiologic tremor

- Low amplitude *not visible* under normal conditions; acute onset with *increased sympathetic activity*; usually worse with *movement* and can involve the face and extremities

Serum chlorine levels are usually ______ in patients with high anion gap metabolic acidosis

- Low or Normal

Saline responsive metabolic alkalosis is characterized by what urinary chloride level?

- Low urinary chloride excretion

Air fluid levels in the chest x ray are usually caused by:

- Lung abscesses or hiatal hernias

Late term pregnancy (Risks)

- Macrosomia - Dysmaturity syndrome (Defective placental supply of nutrients to fetus) - Oligohydramnios - Demise - Severe obstetric laceration - Cesarean delivery - Postpartum hemorrhage

Acute Graft vs Host Disease (Features, Treatment)

- Maculopapular rash, Profuse watery diarrhea, Liver inflammation - Corticosteroids (Highly difficult to treat and must be cautious to start patients on immunosuppressive treatment as preventative measure)

When to use corticosteroids, magnesium, and antibiotics in pregnancy?

- Magnesium in delivery prior to 32 weeks - Corticosteroids in delivery prior to 34 weeks - Antibiotics in delivery prior to 37 weeks

What are high risk foreign bodies?

- Magnets, button batteries, sharp objects

What are important management strategies in patients with gender dysphoria?

- Maintain patient safety - Suggest counseling and psychotherapy - Referral to specialist services (Multidisciplinary mental health)

Adjustment disorder (Features, Treatment)

- Maldaptation or behavioral response to a stressor that lasts *within 6 months* following termination of the stressor; onset of symptoms has to be *within 3 months of exposure* to the stressor - CBT

Social anxiety disorder (Features, Treatment)

- Marked anxiety about certain social events for *at least 6 months*; marked impairment - SSRI/SNRI; CBT

Exercise induced bronchoconstriction (Treatment)

- Mast cell stabilizers, Beta agonists (short term prior to exercise)

IRDS (Risk factors)

- Maternal diabetes - Cesarean section w/o labor - Perinatal asphyxia - Male sex

Fetal bradycardia (causes)

- Maternal hypotension - Cord compression - Uterine tetany

Fetal cord compression (Treatment)

- Maternal repositioning - Amnioinfusion

Recurrent variable decelerations (Treatment)

- Maternal repositioning - Fluid/oxygen administration - Amnioinfusion

Osmolal gap calculation

- Measured osmolality - [(*2* x plasma *Na*) + (*glucose*/*18*) + (*BUN*/*2.8*)]

Ulcerative colitis (Features, Labs, Imaging findings, Treatment)

- Mucosal inflammation involving the rectum and commonly the sigmoid colon, possibly extending up to the ileo-colic junction - pANCA, anemia, ESR, CRP, leukocytosis - Endoscopy - pseudopolyps, colitis; contrast enema - lead pipe colon - 5-ASA (Mesalamine, sulfasalazine), TNF - a meds

46 XX normal female testosterone levels with absent uterus - Diagnosis?

- Mullerian agenesis

AST may be elevated in _________ cell injury (Name a cell other than liver)

- Muscle

Polymyositis (Prominent feature, Diagnosis)

- Muscle *weakness* proximally - *Elevated muscle enzymes* (CK, aldolase, AST)

Hypothyroid myopathy (Clinical features, ESR + CK)

- Muscle pain, cramps and weakness involving the *proximal muscles*; Delayed tendon reflexes and myoedema with occasional rhabdomyolysis; features of hypothyroidism - Normal ESR, high CK

Gait type: Waddling gait (Cause)

- Muscular dystrophy

Congenital torticollis

- Muscular injury causing contracture of the SCM muscle

Arnold Chiari malformation type II (Association)

- Myelomeningocele

Carbamazepine (Side effects)

- Myelosuppression - *SIADH* - Teratogen - SJS

Antifolates (Main organ toxicity)

- Myelosuppressive (Against bone marrow) - Hepatotoxic

What is the next best step in a patient with COPD excerbation who has respiratory failure?

- NPPV

NSAIDs _____________ the afferent arterioles, while ACEis _______________ the efferent arterioles

- NSAIDs constrict the afferent arterioles - ACEis dilate the efferent arterioles

Acute fatty liver of pregnancy (Features, Labs, Management)

- Nausea and vomiting, right upper quadrant/epigastric pain, fulminant liver failure - Profound hyperglycemia, increased aminotransferases, increased bilirubin, thrombocytopenia, DIC - Immediate delivery

Theophylline toxicity (Presentation)

- Nausea/vomiting - Arrhythmias - CNS excitation (Tremors, agitation, seizures) - *Hypotension*

Cervical motion tenderness is often ___________ (Negative/Positive) in patients with isolated cervicitis.

- Negative (It is more often a sign for PID)

Neoplastic vs inflammatory joint pain (Timing, Lab tests)

- Neoplastic joint pain tends to increase at night, while inflammatory joint pain is worse in the morning - Inflammatory joint pain tends to have an increase in inflammatory markers, while neoplastic causes do not show that same increase in inflammatory markers

Nephrosclerosis vs Glomerulosclerosis

- Nephrosclerosis is caused by *hypertrophy and intimal medial fibrosis* of renal arterioles, whereas glomerulosclerosis is characterized by progressive loss of the glomerular capillary surface area with glomerular and *peritubular fibrosis*

Carboplatin (Side effects, prevention)

- Nephrotoxicity (Amifostine protects kidneys) - Ototoxicity - Neurotoxicity

Sturge-Weber syndrome (Features)

- Nevus flammeus (Port wine stain) - Leptomeningeal angioma (Tram track calcifications, seizures)

Rh alloimmunization of a pregnant mother will affect _________ (current or next pregnancy)?

- Next pregnancy (IgG antibodies will cause anemia in next pregnancy) ABO incompatibility however can affect the very same fetus in the same pregnancy

Vitamin A deficiency

- Night blindness, photophobia, dry conjunctiva, cornea, and a wrinkled, cloudy cornea - Dry scaly skin, hyperkeratosis

Do patients with hyperkalemia and normal ECGs need calcium gluconate?

- No

Does FNH have malignant potential?

- No

Centor criteria (Scoring)

- No cough - Tender anterior cervical adenopathy - Fever - Tonsillar exudates or swelling - 3-14 - greater than age 45 is negative point Score of 1 or less - No further steps Score of 2 or 3 - Rapid strep or culture Score of 4 or more - Treat empirically

How is microscopic polyangiitis differentiated from GPA?

- No involvement of the nasopharynx

Do we ever surgically treat patients with 100% stenosis of their carotid artery and without symptoms?

- No we do not

Does avascular necrosis present with fever?

- No. It does not present with erythema and warmth either

Can pregnant patients use the nasal influenza vaccine?

- No. It is a live attenuated vaccine which is contraindicated during pregnancy.

Can gender reassignment surgery be offered prior to age 18?

- No. It is usually limited to patients beyond age 18

Patients with cardiac sarcoidosis are usually prone to developing _______________ (*pathology*) in the heart muscle

- Non caseating granulomas

What should the INR be in patients with Afib?

- Nonvalvular - 2-3 - Valvular - 2.5-3.5

Mid cycle pelvic pain is considered ___________ (Normal/Abnormal)

- Normal (Mittelschmerz)

Vaso occlusive events in SCD (Features, Treatment)

- Painful episodes of severe deep bone pain and dactylitis; can also cause acute chest syndrome, which results in chest pain and respiratory distress, which may further worsen the sickling - Hydration, nasal oxygen, pain management, thromboembolic prophylaxis

Sickle cell trait (Features)

- Painless hematuria (Renal papillary necrosis) - Hyposthenuria - Recurrent UTIs - Renal medullary carcinoma

Intussusception (Presentation, Diagnosis, Treatment)

- Palpable mass in the abdomen, currant jelly stools, colicky pain that gets better when crouching - Target sign on ultrasound - Air or saline enema, surgery for removal of lead point

Squamous cell lung cancer (Paraneoplastic syndrome)

- Pancoast symptoms - Hypercalcemia of malignancu

Seborrheic dermatitis (Associations)

- Parkinson disease - HIV

Multiple system atrophy basically has features of ______________ and autonomic instability.

- Parkinson's disease

Pulsus paradoxus (Meaning, Causes)

- Pathological *decrease* in the pulse wave amplitude and systolic blood pressure of *> 10 mmHg during inspiration* - Constrictive pericarditis, cardiac tamponade, severe asthma/COPD, *OSA*, *SVC syndrome*, *tension pneumothorax*, *croup*

Continuation phase treatment (SSRIs)

- Patients must take the SSRI for *6 months straight* if they had one episode of depression that responded well to the medication

Latent tuberculosis infection (Clinical features, Imaging findings, Contagious?, Treatment)

- Patients with latent tb infections are clinically asymptomatic, and have had a *positive PPD test* - Imaging findings are negative - They are not contagious - Treat with isoniazid monotherapy with vitamin B6 for 9 months

Acantholysis is seen in which type of pemphigoid disease?

- Pemphigus vulgaris (Acantholysis and intraepidermal cleavage)

Patients with untreated IIH are at risk for ...?

- Permanent vision loss

What is the diagnostic criteria for gender dysphoria?

- Persistent incongruence (*>6 months*) between assigned gender and felt gender - Significant distress caused by desire to be other gender, anatomical differences, etc

Plantar fasciitis (Risk factors, treatment)

- Pes planus, obesity, working or exercising on hard surfaces - Activity modification, stretching exercises, heel pads/orthotics

What congenital conditions are screened for in newborns as recommended by the USPSTF?

- Phenylketonuria, SCD, Congenital hypothyroidism

Hereditary hemochromatosis (Treatment)

- Phlebotomies, deferoxamine

MS patients who do not respond to high dose corticosteroids must be recommended:

- Plasma exchange

MS flare resistant to steroids (Treatment)

- Plasmapheresis

Pneumothorax and Emphysema (Breath sounds, Tactile fremitus, Percussion, Mediastinal shift)

- Pneumothorax (tension) causes deviation of the mediastinum away from the area involved

ADPKD is a result of a mutation of what kind of protein?

- Polycystin proteins (Prevent cystic degeneration of renal parenchyma)

Gestational diabetes (Complications for fetus)

- Polycythemia - Organomegaly - RDS - Macrosomia - Preterm delivery

RTA type 2 (Defect, Urine pH, Serum Potassium, Causes)

- Poor bicarbonate absorption - Urine pH below 5.5 - Low-normal serum potassium - Fanconi syndrome

Disruptive Mood Dysregulation Disorder (Clinical Features, Treatment)

- Poor frustration tolerance and persistent irritability that results in frequent temper outbursts out of proportion to the situation - Psychotherapy and Pharmacotherapy (Stimulants, antidepressants, etc)

RTA type 1 (Defect, Urine pH, Serum Potassium, Causes)

- Poor hydrogen secretion into the urine - Urine pH above 5.5 - Low-normal serum potassium - Genetic disorders, medication toxicity, autoimmune disorders

What are the maternal and neonatal complications of chorioamnionitis?

- Post partum hemorrhage and endometritis in the mother - Preterm birth, pneumonia, and encephalopathy in the neonate

Candida intertrigo (Diagnosis, Treatment)

- Potassium hydroxide preparation, yeast culture of skin - Fluconazole

Prader-willi syndrome vs Angelman syndrome

- Prader has no Paternal gene; AngelMan has no Maternal gene (Deletion/mutation of that gene). Note that the other gene is the one that is silenced

McCune-Albright syndrome (Features)

- Precocious puberty - Polyostotic fibrous dysplasia - Cafe-au-lait spots

Cluster headaches (Prophylaxis, Treatment)

- Prednisone for induction, verapamil, methysergide, lithium, valproate, topiramate - 100% O2, Triptans, Ergots

Preeclampsia and gestational hypertension (Labor indications) Preeclampsia with severe features, HELLP (Labor indications) Eclampsia (Labor indications)

- Preec + GH -> Deliver at 37 weeks no matter what - Preec SF + HELLP -> Deliver at 34 weeks no matter what - Eclampsia -> Deliver after seizures stop no matter what

Stretched liver capsules in pregnant women are usually secondary to ...?

- Preeclampsia

Intraventricular hemorrhage (Risk factors)

- Prematurity - Very low birth weight

Active phase of labor (Disorders, Treatment)

- Protraction - cervical changes slower than expected with inadequate contractions and oxytocin - Arrest of active phase - no cervical change for 4 hours with adequate contractions or 6 hours with inadequate contractions Protraction is treated with oxytocin, arrest is treated with cesarean delivery

Bleomycin (Side effects)

- Pulmonary fibrosis

Busulfan, Melphalan (Side effects)

- Pulmonary fibrosis

PCP (Steroid indications)

- Pulse ox less than 92% - PaO2 < 70 mmHg - Arterial - alveolar gradient at least 35 mmHg

Lichen sclerosus (Diagnosis, Treatment)

- Punch biopsy to rule out SCC - High potency topical steroids

Hypocalcemia (ECG changes)

- QT interval lengthening

Hypercalcemia (ECG changes)

- QT interval shortening

Active TB (Treatment)

- RIPE therapy for 2 months, then RI for 4 months

In children who develop DDH after 4 months, what is the best diagnostic test?

- Radiograph (Ultrasound prior to age 4 months)

Exertional heat stroke (Treatment)

- Rapid ice water immersion or water dousing/toweling

What are some clinical features associated with Sjogren syndrome?

- Raynaud phenomenon - Cutaneous vasculitis, lymphoma - Arthritis - Interstitial lung disease

Night Terrors (Treatment)

- Reassurance

What are some risk factors for intussusception?

- Recent viral illness or rotavirus vaccination, lead points (celiac disease, tumors, polyps, HSP, etc)

Crohn's disease usually spares the _________.

- Rectum

Rifampin (Side effects)

- Red orange body fluids - Hepatotoxicity

OCP (Relationship to cancer)

- Reduces risk of *endometrial* and *ovarian* cancers - Increase the risk of *cervical* cancer - Contraindicated in certain *breast* cancers

The anti-ischemic action of nitrates occurs mostly secondary to ...?

- Reduction in preload and increase in venous capacitance

Fibromyalgia (Treatment)

- Regular sleep and exercise; Relaxation (First line) - TCAs, SSRIs, Anticonvulsants

What is a common cause of magnesium toxicity?

- Renal insufficiency (Magnesium is released solely by the kidneys)

UTI's in children *under the age of 2* should be followed up with what imaging studies?

- Renal ultrasound - Voiding cystourethrogram

The captopril enhanced radionuclide renal scan is occasionally used to diagnose ...?

- Renovascular disease or RAS

Pap smear results: LSIL with colposcopy showing CIN II

- Repeat colposcopy with endocervical curettage

Pap smear: ASC-US with negative HPV

- Repeat cotesting in 3 years

Pap smear: LSIL with negative HPV

- Repeat pap smear in 12 months

How are physiological or follicular cysts managed?

- Repeat ultrasound in 6 weeks

Criteria for initiating LTOT in COPD patients

- Resting arterial oxygen tension less than or equal to *55 mmHg* or less than *88% O2* - Resting arterial oxygen tension less than or equal to *59 mmHg* or SaO2 less than or equal to *89%* in patients with *cor pulmonale, evidence of heart failure, or hematocrit greater than 55%*

Hemorrhoids can be controlled with what conservative measures?

- Restriction of fat and alcohol intake, increasing fiber and fluid intake

What types of cardiomyopathy cause right AND left sided heart failure symptoms?

- Restrictive and Dilated types

Clue: Uneven endometrial lining on ultrasound after delivery of fetus. Diagnosis? Treatment?

- Retained placental part - Dilation and curettage

Supraventricular tachycardia (Signs on EKG)

- Retrograde P waves - Retrograde P waves - R-R intervals are constant

What is the diagnostic study of choice in a patient suspected for a penile fracture?

- Retrograde cystourethrogram (when the 4 signs are present)

Vaginal progesterone is used to *decrease the risk of preterm labor* in ____________, while progesterone injections are used in ____________. Bonus: What are other methods that are also used along with progesterone injections?

- Vaginal progesterone - used in pregnant patients with short cervices and *no prior history of preterm labor* - Progesterone injections - used in *all pregnant patients* with prior history of preterm labor (Serial TVUS and cerclage if found to have a short cervix)

What type of maneuvers are patients with spontaneous mediastinum supposed to avoid?

- Valsalva maneuvers

What are the two medications used to aid in the treatment of tobacco use disorder?

- Varenicline + Bupropion

VEALCHOP mnemonic

- Variable decels caused by cord compression - Early decels caused by head compression - Accelerations mean you are Okay - Late decels caused by placental insufficiency

Medulloblastomas commonly occur in the cerebellar ...?

- Vermis

Vestibular neuritis (Symptoms)

- Vertigo and hearing loss that follows a viral upper respiratory infection

Sickle cell disease (Electrophoresis patterns)

- Very High F - Normal A2 - Very High S

Kussmaul respirations (Meaning, Cause)

- Very deep breathing at a normal or increased rate to eliminate excess CO2 - Metabolic acidosis

Beta-Thalassemia Major (Electrophoresis patterns)

- Very high A2 - Very High F

Diarrhea associations: Uncooked shellfish (Microbial cause)

- Vibrio vulnificus/hemolyticus

Nonreactive NST (Next steps)

- Vibroacoustic stimulation - Contraction stress test/Biophysical profile

A mom has a nonreactive NST. What is the best next step?

- Vibroacoustic stimulation Followed by - Contraction stress test OR Biophysical profile

Isoniazid (Side effects)

- Vitamin B6 deficiency (*polyneuropathy*, glossitis, cheilitis, etc) - Hepatotoxicity

Celiac disease (Nutrients lost)

- Vitamins ADEK - Iron - Calcium - Fat and protein

Renal+bladder ultrasounds and ______ are performed in young patients with febrile UTIs

- Voiding cystourethrograms (VCUGs)

Malignant hyperthermia (Triggers, Symptoms, Treatment)

- Volatile anesthetics - Autonomic dysfunction (*hyperthermia*, *hypertension*, *tachycardia*, livedo reticularis); *hyporeflexia/rigidity* - Stop drug/dantrolene/cooling

Eccentric hypertrophy occurs due to __________ overload, while concentric hypertrophy occurs due to ___________ overload.

- Volume - Pressure

Vaginal foreign body (Treatment)

- Warm water irrigation and swabs

Treatment for hypervolemic and euvolemic hyponatremia

- Water restriction

Microscopic colitis (Clinical findings, Triggers, Diagnosis, Management)

- Watery, nonbloody diarrhea with fecal urgency and incontinence; abdominal pain, weight loss, fatigue, arthralgias - Smoking, medications - Colonoscopic biopsy with lymphocytic infiltration of the lamina propria - collagenous and lymphocytic subtypes - Remove possible triggers, antidiarrheal medications and budesonide

High risk pregnancies (Gestational DM, preeclampsia) require NSTs ____________ (frequency).

- Weekly

What are the most common side effects of SSRIs?

- Weight gain and sexual side effects

Lifestyle changes for Gout

- Weight loss (BMI < 25%) - Limiting alcohol intake - Avoid diuretics

Treatment tree for osteoarthritis

- Weight loss and exercise - NSAIDs + acetaminophen as needed - Topical agents/intrarticular steroids/hyaluronic acid - Surgery/chronic pain management

Lifestyle modifications for HTN

- Weight loss if above 25 BMI - Diet: Reduce fat intake - Exercise - Diet: Reduce sodium intake - Reduce alcohol intake

Length time bias (Definition)

- When diseases with long intervals are more likely to be identified by screening than short interval variants, leading to erroneous belief that the screening test leads to better outcomes even though it is the long interval (less dangerous) disease that gets identified

What is the Well's criteria used for?

- Whether or not it is appropriate to start anticoagulation quickly without diagnostic testing in a patient suspected of having a PE

Placental abruption (Management)

- With *normal fetal findings* and a *hemodynamically stable mother*, we aim for a normal vaginal delivery - All acute abruptions after 36 weeks are delivered immediately - If *symptomatic*, emergency c-section is required - If fetus has died, then vaginal like IUFD

How does anti-A and anti-B antibodies affect a pregnancy?

- Women with O blood type will have IgG against A and B antigens that have a chance to cause a mild *ABO hemolytic disease* in the infant's early postpartum period

Diarrhea associations: Pork consumption (Microbial cause)

- Yersinia enterocolitica

Do patients with depersonalization/derealization disorder have intact reality testing?

- Yes

Can patients with bilateral RAS take ACEis?

- Yes, but watch their creatinine

Can colposcopy be performed during pregnancy?

- Yes, it is usually performed for LSIL/HSIL

Is the rash that develops after receiving a MMR vaccine transmissible?

- Yes, to immunocompromised individuals

Should vaginosis be treated in pregnancy?

- Yes, with metronidazole

Intrapartum HIV management (General rules, Viral load over 1000 vs less than 1000)

- avoid ROM, fetal scalp electrode, and instrumentation - if viral load *less than 1,000 copies*: ART and vaginal delivery - if viral load *more than 1,000 copies*: ART + zidovudine + cesarean delivery

What is the triad of fanconi syndrome?

- glucosuria - phosphaturia - aminoaciduria

Extubation criteria

- pH > 7.25 - FiO2 < 40% + PEEP < 5cm H2O - Mental alertness

Streptococcal agents that cause _____________ are the strains known to cause PSGN.

- pharyngitis

Tactile fremitus is usually decreased in patients with what kind of conditions?

- pleural effusions - pneumothoraces - atelectasis - emphysema

Argyll Robertson pupil

- pupil *does not react to light*; does constrict with accommodation

Right bundle branch block (Signs)

- rSR' in lead V1 , V2

The antianginal action of nitrates occurs mostly secondary to ...?

- reduction of cardiac wall stress

Three syndromes associated with pheochromacytomas

- von Hippel Lindau - Multiple endocrine neoplasia type II - Neurofibromatosis

PPD skin results: Who do we consider as positive? (>5 mm, >10 mm, >15 mm)

1) >5 mm: - HIV positive, immunosuppressed patients - Recent contact with TB infected patient - Signs of TB on X ray 2) >10 mm - IVDU - Immigrants - Healthcare workers, lab personnel - Children < 4 years of age - High risk personal settings 3) >15 mm - All of the above + healthy individuals

What are the high risk HPV strains?

16, 18, 31, 33

MUDPILES

Anion Gap Acidosis Methanol Uremia Diabetic Ketoacidosis Paraldehyde/Phenformin INH Lactic acidosis Ethylene glycol Salicylates

Secondary hyperparathyroidism (Labs)

Blood: normal or *hypocalcemia*, *hyperphosphatemia*

caput succedaneum vs cephalohematoma

Caput Succedaneum- soft tissue swelling, that *can cross suture lines* - *present at birth* Cephalohematoma- subperiosteal hemorrhag that *does NOT cross suture lines.* - usually *takes time to present*

Lichen sclerosis

Characterized by thinning of the epidermis and fibrosis (sclerosis) of the dermis; presents as a white patch (leukoplakia) with parchment-like vulvar skin (DOES NOT AFFECT VAGINA)

Complete vs incomplete mole (Difference, Treatment)

Complete - 46 XX (paternally derived) from sperm fertilizing an empty ovum; does not contain fetal tissue; *Greater hCG* than partial, resulting in *more symptoms* Incomplete - 69 XXY;XXX;XYY - when a normal ovum is fertilized by two sperm; contains fetal tissue. - Dilation and curettage

Total parenteral nutrition, TPN (Complications, Contraindications)

Complications: Venous catheter related: 1) *Thromboses* 2) *Displacement* 3) Bloodstream *infections* (CLABSI) 4) *Fluid overload* 5) *Metabolic complications* Contraindications: - Whenever enteral nutrition is feasible and *not attempted* - Serum *hyperosmolarity*, *hyperglycemia*, *electrolyte abnormalities* - *Volume overloaded state*

NOACs (Four of them)

Dabigatran Rivaroxaban Apixaban Edoxaban

What are the three components of subacute combined degeneration?

Demyelination of: - Spinocerebellar tracts - Lateral corticospinal tracts - Dorsal columns

Spontaneous abortion (Treatment)

Dilation and curettage (D&C)

Reactive Attachment Disorder

In children, a pattern of inhibited, withdrawn behavior toward adult caregivers

Henoch-Schonlein Purpura increases the risk of developing which pediatric cause of abdominal pain?

Intussusception

Ulcerative colitis (Treatment)

Mild - Mesalamine, sulfasalazine enemas; corticosteroids Moderate - Corticosteroids; anti-TNF-a meds Severe - Calcineurin antagonists (Cyclosporine, tacrolimus); thiopurines

Bipolar disorder (Treatment)

Mood stabilizers (e.g., *lithium, valproic acid, carbamazepine/lamotrigine*), *atypical antipsychotics*

Late decelerations (Image)

Nadir occurs after the peak of the contraction

Menopause (Definition)

No menstrual period for 12 mo

Internal podalic version

Performed in twin delivery to convert the second twin from a *transverse/oblique presentation* to a *breech presentation *for subsequent delivery

Nevus flammeus (Image)

Present from birth and *do not regress*

Landau Kleffner Syndrome

Regression of language skills due to severe epileptic attacks in young age

Transient hypogammaglobulinemia of infancy

Repeated bouts of upper respiratory and middle ear infections due to low IgG, IgM. *B cell* and *IgA* concentrations are however normal.

Acromegaly (treatment)

Resection of pituitary adenoma Pegvisomant/Octreotide otherwise

Hyperphosphatemia (Treatment)

Sevelamer hydrochloride

USPSTF Recommendations: Lung cancer screening

The USPSTF recommends *annual screening* for lung cancer with *low-dose computed tomography* in adults ages *55 to 80 years who have a 30 pack-year smoking history* and currently smoke or *have quit within the past 15 years*. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.

USPSTF Recommendations: Aspirin use in adults

The USPSTF recommends initiating low-dose aspirin use for the primary prevention of cardiovascular disease and colorectal cancer in adults *aged 50 to 59 years* who have a *10% or greater 10-year cardiovascular risk*, are *not at increased risk for bleeding*, have a *life expectancy of at least 10 years*, and are willing to take *low-dose aspirin daily for at least 10 years*.

USPSTF Recommendations: Diabetes screening

The USPSTF recommends screening for abnormal blood glucose as part of cardiovascular risk assessment in adults aged *40 to 70 years *who are *overweight or obese*. Clinicians should offer or refer patients with abnormal blood glucose to intensive behavioral counseling interventions to promote a healthful diet and physical activity.

USPSTF Recommendations: Chlamydia/Gonorrhea screening

The USPSTF recommends screening for chlamydia/gonorrhea in sexually active women* age 24 years or younger* and in older women who are at increased risk for infection.

USPSTF Recommendations: Hepatitis C screening

The USPSTF recommends screening for hepatitis C virus (HCV) infection in persons at *high risk for infection*. The USPSTF also recommends offering *one-time* screening for HCV infection to adults born between *1945 and 1965. *

USPSTF Recommendations: Blood pressure screening

The USPSTF recommends screening for high blood pressure in adults aged *18 years or older.* The USPSTF recommends obtaining measurements outside of the clinical setting for diagnostic confirmation before starting treatment.

USPSTF Recommendations: Mammograms

The USPSTF recommends screening mammography for women, with or without clinical breast examination, *every 1 to 2 years* for women *age 40 years and older*. (It is up to the patient and physician after the point of 75 to determine whether or not the screening is still needed)

USPSTF Recommendations: HIV screening

The USPSTF recommends that clinicians screen for HIV infection in adolescents and adults *aged 15 to 65 years*. Younger adolescents and older adults who are at increased risk of infection should also be screened.

USPSTF Recommendations: Obesity screening

The USPSTF recommends that clinicians screen for obesity in children and adolescents *6 years and older* and offer or refer them to comprehensive, intensive behavioral interventions to promote improvements in weight status.

USPSTF Recommendations: Fluoride supplementation

The USPSTF recommends the application of fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption in primary care practices. The USPSTF recommends primary care clinicians prescribe oral fluoride supplementation starting at *age 6 months for children whose water supply is fluoride deficient*.

USPSTF Recommendations: Aspirin use in pregnant women

The USPSTF recommends the use of *low-dose aspirin* (81 mg/d) as preventive medication after *12 weeks of gestation* in women who are at *high risk for preeclampsia.*

USPSTF Recommendations: Vision screening in children

The USPSTF recommends vision screening at least once in all children ages *3 to 5 years to detect amblyopia* or its risk factors

Oppositional defiant disorder (Diagnosis)

The pattern of behaviors characteristic of ODD must persist for *no less than six months*, and *at least four of the following symptoms must reveal themselves*: (1) often loses temper; (2) often argues with adults; (3) often actively defies or refuses to comply with adults' requests or rules; (4) often deliberately annoys people; (5) often blames others for his or her mistakes or behavior; (6) is often touchy or easily annoyed by others; (7) is often angry and resentful; (8) is often spiteful or vindictive *But does not break the social norms and laws established in society like conduct disorder (Breaking property, hurting people, stealing, lying)*

The artery of Adamkiewicz is prone to infarction when procedures to the ___________ (location) aorta are performed

Thoracic

Uncomplicated vs Complicated parapneumonic effusion (pH, Glucose, WBC) What is the treatment for each?

Uncomplicated: - pH at least 7.2 - Glucose at least 60 - WBC at most 50,000 - Antibiotics Complicated - pH <7.2 - Glucose <60 - WBC >50,000 - Antibiotics + drainage

Pregnant women weight gain: Underweight (18.4 or less) - Normal (18.5 - 24.9) - Overweight (25 - 29.9)- Obese (30+) -

Underweight (18.4 or less) - gain 28-40 lbs Normal (18.5 - 24.9) - Gain 25-35 Overweight (25 - 29.9)- Gain 15-25 Obese (30+) - Gain 11-20

Unsynchronized cardioversion is used for

Ventricular fibrillation and pulseless V tach

Early decelerations (Image)

Wide base and start + end points are same as the contraction

Ovarian hyperstimulation syndrome

a syndrome resulting from hyperstimulation of the ovaries by fertility drugs; results in the development of *multiple, enlarged follicular ovarian cysts* that present with increased flow on doppler US

CRVO

blood and thunder

B12 vs folate deficiency (Labs and clinical features)

both can cause megaloblastic anemia (RBCs cannot synthesize DNA) but only b12 deficiency *causes neurological problems*, and is associated with a *high MMA level*

Out of the ANCA positive vasculitides, which one is associated with c-ANCA? Which one is p-ANCA?

c-ANCA - Granulomatosis with polyangiitis p-ANCA - Eosinophilic granulomatosis, microscopic polyangiitis

Takayasu arteritis (Treatment)

corticosteroids