Step 2 Review

Intracerebral hemorrhage with: -pinpoint pupils -poorly reactive pupils -dilated pupils

-pons -thalamus -putamen

MCC of chronic cough

-postnasal drip -asthma -GERD

Indications for hospitalization for PID?

-pregnant -Failed outpt tx -inability to tolerate meds -noncompliant -severe sx (high fever, vomiting) -complication: abscess, perihepatitis

Vaginitis that causes: pH >4.5 pH <4.5

>4.5: Trich & gardnerella <4.5: Candida (Tx - topical azole or oral fluconazole)

If switching from MAO-I to SSRI; how many day wash-out should be done prior to starting SSRI?

At least 14 days d/t possibility of Serotonin syndrome

Loss of DNA repair Dz? S/sx?

Ataxia telangeiectasia cerecellar degeneration, risk of cancer

Post-partum hemorrhage mgmt?

Atony MCC - start with uterine massage and IV oxytocin. Look for trauma (lacs), retained produced, and coagulopathies. If uterine atony is cause and above tx failed - addition of second uterotonic medication (methylergonovine), balloon tamponade, uterine artery embolization for stable pts. In unstable pts - hysterectomy

A chronic, pruritic, superficial inflammation of the skin, usually associated with a family history of allergic disorders, is --?-- Most commonly presents on what body surface in a. infants/young children b. older children/teens c. Adults? Tx?

Atopic dermatitis a. face, wrists, neck, and dorsal hands/feet b. antecubital fossa, popliteal fossa c. eyelids, neck, nipples, hands topical steroids (low-potency on face/intertriginous areas; medium-high-potency for the body; limited to several weeks as chronic use can lead to skin atrophy) or calcineurin inhibitors/cyclosporin (for long-term tx)

Mostly asxatic: fatigue, anorexia, nausea, jaundice. Can progress to fulminant hepatic failure -Elevated AST/ALT -Hypergammaglobulinemia (*large gamma gap* = total protein - albumin) Dz? Ab? Tx?

Autoimmune hepatitis Ass w/ *anti-smooth muscle Ab*, ANA, anti-liver-kidney microsomal Ab, anti-mitochondrial Ab Steroids

Tx of Bordetella pertussis (Whooping cough)

Azithromycin

What can you do to change Paco2?

CO2 is assessed via Min vent = RR * tidal vol. If ventilation (CO2) is the issue, change tidal vol or RR.

Tremor: -action/postural tremor that worsens at the end of goal-directed activities

Essential tremor Tx: BB, self treat with alcohol.

-Blurred vision -AV nicking -Copper wiring -*Flame hemorrhages* -Cotton-wool spots -Optic disc edema

Hypertensive retinopathy

Labs to obtain in myxedema coma? Tx?

TSH, free T4, t3 (thyrotropin), and cortisol IV levothyroxine (or IV liothyronine), IV hydrocortisone

-Hair thinning in the frontal or temporal regions that are typically associated with braids

Traction alopecia Non-reversible

Next step if inability to find heart tones on dopper?

Transabd US

Blood transfusion: -Within 6 hours -Respiratory distress -*HTN*, tachycardia -pulm edema -diffuse bilat infiltrates -S3, *JVD* -Crackles/rales Which one? D/t? Tx?

Transfusion associated circulatory overload (TACO) Tx: resp support & diuresis (furosemide)

Blood transfusion: -Within 6 hours -fever, *hypoTN*, resp distress (acute dyspnea) -noncardiogenic pulm edema - diffuse bilat infiltrates -*No JVD* -Crackles/rales Which one? D/t? Tx?

Transfusion related acute lung injury (TRALI) d/t donor anti-leukocyte Ab Tx: resp support

-Acute (bilat) hip pain and decreased ROM -recent URI -Leg held in flexion, abduction, and ER and resists extension and IR. -US: small, bilat effusions -nl ESR, CRP Dz? Tx?

Transient synovitis Tx: supportive, NSAIDs, full recovery in 1-4 weeks

Newborn with: -tachypnea, increased WOB -clear breath sounds -CXR - hyperinfated lungs, perihilar streaking, & fluid in fissures -born via C-sec from diabetic mom Dz? Path? RF? Tx?

Transient tachypnea of the newborn D/t retained fetal lung fluid RF: C-sec, prematurity, maternal DM Supportive care; self-resolves in 1-3 days

Restless leg syndrome tx?

Treat IDA if possible. Dopamine agonists (pramipexole)

Subungual hematoma tx?

Trephination (nail drilling) only if painful. If asxatic - no tx necessary.

Myalgias periorbital edema/chemosis splinter hemorrhages fever elevated CK abd pain, N/V/D Dz? specific labs? Tx?

Trichinellosis d/t ingestion of undercooked meat (pork) Labs: *eosinophilia* Self-limited; albendazole

-Patchy hair loss -Uneven hair growth -No scaling/erythema Dz? Tx?

Trichotillomania Treat OCD/anxiety

Demyelinating lesion with ectopic impulse generation is the pathophysiology of what disease? Tx?

Trigeminal neuralgia Carbamazepine, Oxcarbazepine

Holoprosencephaly Omphalocele cutis aplasia (absent epidermis over skull) microphthalmia

Trisomy 13

holoprosenecephaly severe intellectual disability cranial nerve 1, 2, 8 abnlities Colobomata micropthalmia polydactyly VSD, PDA, ASD cryptorchidism omphalocele

Trisomy 13

Ompalocele IUGR Hypertonia prominent occiput microstomia micrognatia pointy ears horseshoe kidney VSD, PDA Meckel's diverticulum Clenched hands

Trisomy 18

clenched hands with overlapping fingers no palmar creases VSD/ASD/PDA micrognathia microcephaly

Trisomy 18 Others: -Rocker bottom feet -Clenched hands with overlapping fingers

Upslanting palpebral fissures Epicanthic folds Protruding tongue Short neck excessive skin at nape of neck transverse palmar crease Flat facial profile cognitive impairment ASD, VSD Duodenal atresia/stenosis Hirschsprung disease Annular pancreas imperforate anus Short stature Myeloproliferative disorder

Trisomy 21

Infant with: -decreased tone -upslanting palpebral fissures -protruding tongue -low birth weight -flattened nose

Trisomy 21 Other features: -single (transverse) palmar crease -epicanthic folds -small ears -hypotonia -increased space between first and second toes -VSD -Duodenal atresia (polyhydramnios) -Early Alzheimer's

"celiac dz of tropical farmer"

Tropical sprue -d/t bacterial overgrowth tx: abx and folic acid x6 months or more

Seizures, intellectual disability, ash-leaf spots (hypomelanotic patches), shagreen patch, adenoma sebaceum (facial angiofibroma), autism Dz?

Tuberous sclerosis

Hypopigmented macules Epilepsy Parent has features too. Dz? Other features?

Tuberous sclerosis complex. -ash-leaf spots -angiofibromas -shagreen patches -subepyendymal tumors -ID/autism -rhabdomyomas -angiomyolipomas -Periungual fibromas (koenen's tumor) -retinal hamartoma -pulmonary cysts

-Colon ca -cerebellar medulloblastoma -gliobastoma multiforme

Turcot syndrome

-young girl -high arched palate -increased carrying angle of the arms -short 4th metacarpals -horseshoe kidney -short stature Dz? Other classic s/sx? Labs? Work-up?

Turner syndrome Coarctation of the aorta, shield-chest (widely spaced nipples), streak ovaries, bicuspid aortic valve, webbed neck, no breast development, primary amenorrhea (some may have initial breast development followed by pubertal arrest or completion of puberty followed by secodnary amenrrohrea; others may have nl puberty/menarche and develop primary ovarian failure later). Decreased estrogen. Elevated FSH, LH Baseline echo, renal US, BP, hearing screen (risk of SN hearing loss)

DX of budd-chiari syndrome?

US

Dx & mgmt of venous stasis?

US elevation, compression stockings, exercise, avoid prolonged standing

Evaluation of unilateral nipple d/c?

US +/- mammography

Pt with elevated direct bili and alk phos and nl AST/ALT. What dx step is next? Differential?

US or CT +/- AMA DDx: cholestasis of pregnancy, malignancy (panc, ampullary), cholangiocarcinoma, PBC, PSC, choledocolithiasis

Dx of kidney stones?

US or noncontrast CT

Dx of VUR? Tx?

US to assess for hydroureter/nephrosis. If present, get VCUG. Abx prophylaxis, surgical correction if persistent.

dx of intussusception

US-guided air > barium contrast enema

If a woman <30 has a palpable breast mass. What is the next step following imaging?

US: tells you cyst vs mass. If *simple* cyst: FNA -If bloody or recurs: get core needle biopsy -If serous fluid and resolves: f/u in 2-4 months. If *complex* mass: core needle biopsy.

Porcelain GB -increased risk -Cause -mgmt

increased risk of GB adenocarcinoma -D/t chronic cholecystitis Cholescystecomy

Hyperalbuminemia increases or decreases lab value of calcium?

increases total calcium Ionized calcium unaffected and no hypercalcemia related sx.

Erythema nodosum associated diseases

infections - s pyogenes pharyngitis, staph aureus, fungi (coccidio, histo, blasto), chlamydia, TB IBD - C > UC sarcoidosis Malignancy Behcet disease Meds (PCN, bactrim, OCPs)

What is enthesitis? Dzs associated?

inflammation and pain at sites where tendons and ligaments attach to bone. Manifests as pain, stiffness, and tenderness of insertions, without swelling (except Achilles - often presents with swelling). Associated with Ank spond, psoriatic arth, reactive arthritis (chlamydia, yersinia, salmonella, shigella, campylobacter)

Endophthalmitis -What is it? -Exogenous vs endogenous -MCC of each? -Tx?

inflammation of the intraocular cavities (aqueous or vitreous humor); MC d/t infection Exogenous - inoculation of bacteria from an outside source - trauma, surgery. Following cataract surgery - Staph epidermidis > S. aureus. Following trauma - B. cereus, gram neg bacteria, S. epidermidism Strep Endogenous - d/t bacteremia/internal source. Associated with endocarditis MCC - S. aureus > various strep and gram neg organisms. Abx If failure to improve - evisceration (removal of all contents of the globe with the sclera and EOM intact). Enucleation (removal of the eye from the orbit while preserving all other orbital structures; primarily done for painful eyes with no useful vision - malignancies - makes room for prosthesis). Exenteration (removal of the globe and all surrounding structures - primarily for large orbital tumors)

Anal pathology with: -itching, painless bleeding, leakage of stool -Detected how?

internal hemorrhoid DRE or anoscopy

Amiodarone induced pulmonary toxicity would appear in what way on CXR? Tx?

interstitial and alveolar infiltrates; interstitial fibrosis. Stop therapy + corticosteroid therapy.

Tx for epiglottitis

intubation and antibiotics (vanc + cef)

Tx of hepatic encephalopathy

lactulose and rifaximin

In pregnancy, an epidural can increase what stage?

lengthens 2nd stage of labor (dilation to delivery)

-painless mass -rubbery, irregular

lipoma

What categorizes brain death?

loss of brainstem reflexes (corneal reflexes, water calorics, doll's eyes, pupils)

Tx *Sleep maintenance* insomnia or mixed insomnia?

low-dose dozepin or long activing Z-drugs (eszopiclone or ER Zolpidem)

Erythema multiforme How does it appear? Cause? MCC?

"Bull's eye rash" that can become bullous, painful, and pruritis. Can involve palms/soles/mouth. Skin disorder resulting from a generalized allergic reaction to an illness, infection, or medication MCC chronic HSV. Others: Mycoplasma, sulfonamides, malignancies, collagen vasc dz

major criteria for rheumatic fever Minor criteria? Sequelae? Tx?

"JONES" -Joints -Heart shaped O for pancarditis -Nodules -Erythema marginatum -Sydenham chorea Minor criteria: -fever -arthralgias -elevated ESR/CRP -Prolonged PR interval Late sequelae - mitral regurg/stenosis PCN, amox, cephalosporin, macrolides Prophylactic PCN should continue until adulthood to prevent recurrent rheumatic fever. Duration is dependent on if there is underlying heart disease. -Carditis + heart disease - continued for at least 10 years or until 40 yo (whichever is longer) -Carditis without heart dz - continued for 10 years of until 21 (whichever is longer) -No evidence of carditis - continued for 5 years of until 21 (whichever is longer).

Dx & mgmt of toxic megacolon

abd XR NPO, NG suction, steroids, broad-spectrum abx

How to calculate MAP

(SBP + 2DBP)/3

Indications for urgent dialysis?

*AEIOU* -Acidosis - metabolic acidosis w pH<7.1 refractory to medical therapy -Electrolyte abnormalities - sxatic hyperkalemia: ECG changes or ventricular arrhythmias. Sever hyperkalemia >6.5 refractory to medical therapy. -Ingestion - toxic alcohols (methanol, ethylene glycol) - salicylate - lithium - sodium valproate, carbamazepine -Overload - volume overload refractory to diuretics -Uremia - Sxatic encephalopathy (test q presented with asterixis), pericarditis, AMS, bleeding

Brown-Sequard Syndrome: which side? -Pain/temp -motor -position/vibration

*Contralat* *pain/temp* loss *2 levels below lesion* Ipsilat motor and position/vibration loss

Pathognomonic for pericarditis on EKG? What is the workup for a pt with concern on pericarditis?

*Depressed* PR interval. Diffuse ST elevation with reciprocal depressions in aVR and V1. Echo - eval for underlying effusion & trend cardiac enzymes.

Iron Deficiency Anemia -Ferritin -TIBC -Serum iron -RDW -RBCs -MCHC -Transferrin saturation -Retic count -Transferrin What is most specific?

*Elevated: TIBC, RDW, transferrin.* Low: everything else. -Ferritin low -TIBC high -Serum iron low -RDW high -Decreased RBC -MCHC low -Transferrin saturation low -Low retic count -Elevated transferrin (carrier of iron) Low transferrin sat = most specific

Causes of U waves?

*Hypokalemia*, bradycardia, antiarrhythmic drugs, intracranial hemorrhage, coronary ischemia, long QT syndrome.

Asthma dx?

*Methacholine* challenge results in >20% drop in lung function

Diagnosis of aortic dissection Tx? Complications? RF?

*TEE* - preferred in renal insuff or hemodynamic instability. *CT angiography* - preferred in hemodynamically stable pts. Ascending (A-any part of asc, II-only asc): surg repair (aortic valve) Descending (B-only desc, III-only desc): medically manage with IV BB (esmolol, labetalol) ((Debakey I - asc+desc)) aortic rupture, aortic regurgitation, cardiac tamponade, death MC - HTN; others - HLD, smoking, inc age, male, CT disorders, +FH

Oxytocin toxicity?

*hyponatremia* hypotension tachysystole neuro sx (HA, seizure)

W/u for ectopic pregnancy. RF? Tx?

+ B-hCG & hemodyn unstable - laproscopy + B-hCG & TVUS with adnexal mass & <6 weeks - treat ectopic (methotrexate for unruptured) + B-hCG & TVUS nondiagnostic: >1500 - repeat hCG and TVUS in 2 days <1500 - repeat hCG in 2 days. (B-hCG should double q 2-3 days; if ectopic present, then it will not double) -Previous ectopic, PID, h/o tubal surgery, infertility, in vitro fertilization, in utero exposure to DES, vaginal douching, increased age. -Ruptured/unstable - laparsocopy -Laproscopic surgery for non-ruptured ectopics >3.5cm -Methotrexate - Stable pts without CI to methotrexate (multiple pregnancies with viability, currently breastfeeding, abnl renal or CBC values, immunocompromised), small (<3.5cm) unruptured ectopics with close follow-up for serial B-hCGs. -Expectant - B-hCG <200 with decreasing levels at interval checks, no evidence of fetal HR on US, close follow-up, unwilling to undergo trial of methotrexate.

lactose intolerance labs

+ hydrogen breath test + stool test for reducing substances low stool pH increased stool osmotic gap

Centor Criteria What are the criteria, scoring systems, and how to apply it to diagnostics?

+1 for: Exudative pharyngitis Fever Tender anterior cervical LAD Absence of cough Modifier: <15 years old --> add 1 point >44 years old --> subtract 1 point 0-1 - no testing or abx 2-3 - rapid strep test and/or culture 4-5 - rapid strep and/or culture & epiric abx therapy

Opioids that screen: + on UDS - on UDS

+: heroin, codeine, morphine -: semisynthetic opioids (oxycodone, hydrocodone, hydromorphone) and synthetic (fentanyl, meperidine, methadone, tramadol)

Shoulder is internally rotated and forearm pronated with flexion of humerus

+Neer test: means impingment Commonly seen in rotator cuff tendinopathy.

tPA contraindications

- Acute ICH - History of ICH/intracranial neoplasm - BP above 185/110 - Unknown time of onset - Stroke/Trauma/major surgery in past 3 months - Thrombocytopenia <100,000 - Coagulopathy - Anticoagulation if INR>1.7 - Severe hypoglycemia - GI bleed in past 3 months or GI malignancy - Stroke suspected to be caused by aortic dissection or endocarditis

Osteoporosis screening? Dx? Work-up? Tx? RF?

- DEXA - women *65+* and for women <65 with equivalent risk of osteoporotic fx - if nl, repeat in 3-5 years Pt who sustained a fragility fracture is diagnostic for osteoporosis and should be started on bisphosphonates. DEXA (T score <-2.5) can be done after tx to monitor. Fragility fx = fx d/t minimal or no truma and would not otherwise be expected in those with nl bone density. Commonly seen in hip, spine, wrist, humerus, ribs, and pelvis. Calcium and vit D levels; DEXA?; Renal fx; CBC Special testing in certain populations - PTH, cortisol, TSH Calcium & Vit D Bisphosphonates (CI in renal failure) If oral bisphos CI (d/t esopahageal issues) - IV Zoledronic acid or Denosumab If severe OP or failed bisphos - Teriparatide, abaloparatide, or romosozumab Inc age, smoking, chronic steroid use, inactivity, poor intake of calcium/vit D, hyperthyroidism, low BMI, previous fx, anticonvulsant use (phenytoin), celiac disease, RA, and excessive alcohol intake.

Mgmt of unstable upper GI bleed?

- IV access with 2 large-bore IVs - IV fluid resuscitation with crystalloids - blood transfusion - CBC - PPI - Octreotide - ICU - Ceftriaxone - Plan for EGD/consult GI - Diagnostic paracentesis

Tx of pts with exercise-induced asthma?

-SABA before exercise if few times a week. -Inhaled steroids or antileukotriene agents (montelukast) for those who exercise daily.

3 major skin manifestations of SLE?

- Malar rash (erythema and edema over the cheeks and nose, sometimes forehead and chin, spares nasolabial folds; rarely presents on arms/hands, sparing knuckles; does not cause scarring or atrophy) - seen in acute cutaneous lupus erythematosus - Photosensative rash on arms, neck, and face (erythematous, annular, or cyclic lesions, often with a scale; leads to hypo or hyperpigmentation) - seen in subacute cutaneous lupus erythematosus - Discoid rash (affects face or scalp; hypo or hyperpigemented patches or plaques that can be atrophic; can lead to scarring and atrophy) - seen in chronic cutaneous lupus

Trichomoniasis - Micro findings? - Discharge/sx? - Cervix? - pH > or < 4.5? - Tx?

- Motile trichomonads with abundant PMN's in saline mount -Yellow/green frothy discharge, abnl odor, irritation, pruritis, dysuria -Cervical erythema with petechiae (strawberry cervix) - pH >4.5 -Metronidizole (+ partner)

Pts presenting with upper GI bleed in the setting of cirrhosis - mgmt?

- Restoring/maintaining hemodynamic stability. - oxygenation - control bleeding - Pantoprazole (possible PUD) - Ceftriaxone (possible SBP) - Octreotide (possible variceal bleeding) - Once stabilized, endoscopy (with banding) within 12 hours - If unstable and continued hemorrhage - balloon tamponade.

Recurrent laryngeal nerve injury - Sx? - Correct imaging/dx modality? - tx for unilateral vs bilateral involvement?

- Unilateral - affected vocal cord stuck in the paramedial or lateral position preventing complete closure of the larynx -> increased risk for aspiration and difficulty with phonation, hoarseness, breathiness - Bilat - partial airway obstruction, biphasic stridor, respiratory distress, resp distress immediately following extubation - If suspected, direct visualization with direct fiberoptic laryngoscopy - Unilateral - many go on to regain complete fx over time. -Bilat - placement of tracheostomy

Yeast Vaginitis - micro findings? - discharge/sx? - pH > or < 4.5? - Tx?

- branching/budding psuedohypahe or spores with 10% KOH - Thick, cottage cheese, white curd-like discharge with pruritis, burning, irritation, or dysuria. - pH < 4.5 - Fluconazole or miconazole

Bacterial vaginosis - micro findings? - cause? - discharge? - pH > or < 4.5? - Tx?

- clue cells - Garnerella vaginalis (fac anaerobe) - thin, homgenous, gray-white discharge with a fishy odor - >4.5 - Metronidizole (only for pt)

Osteomalacia: -cause -pathophys -labs -sx -imaging

- from vit D def d/t malabsorption, chronic liver/kidney dz, inadequate sun intake, poor dietary intake (vegans), Fanconi syndrome (hypophosphatemia), or meds (bisphosphonates) -Impaired osteoid matrix mineralization -elevated Alk phos, PTH. Decreased ca, P, vit D -Adults - nonspecific bone pain, proximal weakness -osteopenia, "looser zones" (pseudofractures) - in osteomalacia -epiphyseal widening & metaphyseal cupping/fraying; genu varum, rachitic rosary, soft skull, pigeon breast deformity - in rickets.

Peritonsillar abscess -sx -tx -complications

-*Uvular deviation*, fever, pharyngeal pain, earache, trismus, muffled voice, drooling -needle peritonsillar aspiration & IV abx -Airway obstruction, spread to parapharyngeal space/carotid sheath

In pts with aortic stenosis, who should get valve replacement?

-*severe AS* (aortic jet velocity >4m/s, valve area <1cm^2, or mean transvavular pressure gradient >40mmHg) Plus one or the following: -presence of *sx* (angina, syncope) -LV *EF <50%* -Undergoing *other cardiac surgery* If these requirements are not met, serial echo is appropriate.

Tx of scabies? S/sx?

-1st line - Permethrin cream (applied neck down, left on for 12 hours and washed off; repeated in 7-10 days; for pt and close contacts) -Oral ivermectin (cannot be used in children <6yo) severe, persistent itching; nocturnal pruritis; short elevated wavy channels on the superficial epidermis (burrows) = pathognomonic

Tx for GU syndrome of menopause (atrophic vaginitis)

-1st line: nonhormonal moisturizers, lubricants -Vaginal estrogen if no sx relief/severe sx.

Mild Intermittent asthma: -SABA/Sx frequency? -Nighttime awakening? -Tx? -PFTs?

-2 or less times per week. -2 or less times per month -SABA prn -nl PFT (FEV1 >80%; nl FEV1:FVC)

Mild persistent asthma: -SABA/sx frequency? -Nighttime awakening? -Tx? -PFTs?

-3+ a week, but not daily. -3-4 times per month (<1/wk) -SABA + *ICS* (low-dose) -nl PFT (FEV1 >80%; nl FEV1:FVC)

What conditions are considered coronary heard disease risk equivalents (same risk of having a cardiac event as someone who has already experienced one)?

-AAA -DM -PVD -CKD -Clinical coronary heart disease and CAD (??)

When is head CT indicated in children after minor head trauma?

-AMS -LOC -Severe MOI -Vomiting -Severe HA -Signs of basilar skull fx Can be observed for 4-6 hours if mental status is nl and no concerning signs.

Wernicke encephalopathy -S/Sx -Causes Korsakoff syndrome -S/Sx

-AMS, lateral-gaze palsy with horizontal nystagmus, wide-based gait/ataxia. -Chronic alcoholism (MC). Malnutrition. Hyperemesis gravidarum. -Amnesia, confabulation, intact long-term memory, lack of insight, apathy

Indications for endometrial biopsy in premenopausal women (<45)?

-Abnl uterine bleeding who failed medical therapy (OCPs) -Tamoxifen use -Obesity

1st line tx for alcohol use disorder 2nd line?

-Acamprosate - dose adjustments in pts with renal failure. -Naltrexone - CI in pts with liver dz or taking opioids Disulfuram - 2nd line - only effective in highly motivated people.

Mgmt of esophageal varices? -Active -Asxatic

-Active: IVF, IV ceftriaxone, IV octreotide. -Asxatic: nonselective BB (prop/Nadolol). If CI to BB, then ligation.

Acute vs chronic diarrhea?

-Acute: <2 weeks. MC d/t infection (viral) -Chronic: >4 weeks. MC d/t medical dz

When should the following be given in the treatment of DKA? -Dextrose? -Switching to subQ insulin? -Potassium? -Bicarb? -Phosphate?

-Add dextrose when BSG <200. -Switch to subQ insulin when able to eat, BSG <200, AG <12, and serum bicarb >15. -Add K if <5.3 -Bicarb if pH <6.9 -Phosphate if <1, cardiac dysfx, or respiratory depression

Criteria for good candidate for outpt therapy for Pulmonary Embolism? Which meds can be used?

-Age <80 -No h/o cancer -No h/o CHF or chronic lung dz -HR <110 -SBP >100 -SaO2 >90% DOACs (apixaban, rivaroxaban)

Mediastinum tumor: -ant -middle -post

-Ant: thymoma, teratoma, lymphoma, retrosternal thyroid -Middle: bronchogenic cyst, tracheal tumor, pericardial cysts, lymphoma, LN enlargement, aortic aneurysm -Post: esophageal leiomyoma, any neurologic tumor

Tamoxifen -MOA -Indications -Side effects

-Antagonist: breast -Agonist: uterus & bone -PREmenopausal women for HR+ breast cancer. -Used in postmeno women who cannot tolerate aromatse inhibitor therapy for breast cancer. -endometrial polyps in premeno women. -endometrial hyperplasia/Ca in postmeno women. -hot flashes -thromboembolism

Fetal AV Block -Ab -Timing -Fetal heart rate tracing findings -Complications

-Anti-SSA (Ro) and Anti-SSB (La) Ab -Develops ~18-24 weeks gestation -Persistent fetal bradycardia -Cardiomyopathy & hydrops fetalis

Ovarian hyperstimulation syndrome: -features -mgmt

-Ascites, resp distress, hypercoag, multiorgan failure, DIC Correct electrolyte imbalances, thoraco/paracentesis, thromboembolism prophylaxis

Scizophrenia Dx Criteria How does this differ from Delusional d/o or personality d/o?

-At least two or more of the following: delusions, hallucinations, disorganized speech, disorganized behavior, negative sx. -Continuous impairment >6 months. -Significant functional decline. Delusional disorders have delusions, but it does not alter function and there are no other sx of psychosis (hallucinations). Delusional disorder - 1 month of sx. Personality disorders also lack psychotic sx.

Indications for hospitalization in pts with anorexia?

-Bradycardia <40 -Arrhythmia -HypoTN <80/60 -Orthostasis -Hypothermia -Electrolyte disturbance/dehydration -Organ failure -BMI <15

General work-up for abnl uterine bleeding? Structural vs non-structural causes?

-CBC -ferritin studies -PT/PTT/coag studies -pregnancy test -TSH -A1C (if obese) -Androgens , testosterone (if hyperandrogenism, acne, hair growth, etc.) -Prolactin -FSH/LH -US Structural causes - polyps, adenomyosis, leiomyoma, hyperplasia, malignancy Nonstructural causes - Coagulopathy, ovulatory/endocrine, iatrogenic, endometrial

Tx of: -Central DI -Nephrogenic DI? -SIADH?

-Central: Desmopressin -Neph: Na restriction, Thiazides, amiloride -SIADH: asxatic - water restriction (first line) & Demeclocycline. If sxatic - hypertonic saline Refractory - Tolvaptan

Hypercalcemia algorithm?

-Check corrected calcium first to confirm true hypercalcemia (if albumin >4, for every 1 change there will be an increase in Ca by 0.8). -If true hypercalcemia -> Check PTH 1. High -> measure Urine Calcium/Creatinine clearance ratio a. high (>0.03) -> primary hyperparathyroidism b. low (<0.02) -> possible familial hypocalciuric hypercalcemia 2. Low -> measure PTHrP, Vit D, and 1-25-hydroxy vit D levels a. Elevated PTHrP -> Malignancy b. Elevated 1,25-hydroxy vit D -> Ectopic production (Lymphoma, sarcoidosis, granulomatous disorders) c. Elevated 25-hydroxy vit D -> Vitamin D intake d. Normal PTHrP & vit D -> Milk alkali syndrome, Vitamin A, Thyrotropin, immobilization, hyperthyroidism, metastatic bone diseases (MM)

Classes of HF Tx for HF (with reduced EF; systolic dysfx)

-Class I: sx only with vigorous activity. -Class II: sx with moderate activity -Class III: sx with daily activilities -Class IV: sx at rest -Class I & II: ACE-I/ARB + BB +/- loop diuretic if vol overload. -Class III: K-sparing diurectic (Spironolactone or Eplerenone). Can also use Isosrbide dinitrate + hydralazine -Class IV: Milrinone, Dobutamine, LVAD, or transplant. -Others: ICD implantation for EF <35%. Digoxin: for sxatic control.

Cause, dx, and tx of urge incontinence

-D/t detrusor overactivity/instability -> detrusor contractions during filling; look for strong urge to go. -urodynamic study if not responding to tx or planning for surgery(?) -bladder-training exercises; antichol (oxybutinin) and TCA (imipramine); Botox, tibial nerve stimulation, sacral neuromodulation

DM drugs - Class & effect on weight? ADR? -gliptins? -utides? -flozin?

-DPP4-i - weight neutral upper resp tract infections, nasopharyngitis, HA, pancreatitis -GLP-1 - weight loss pancreatitis, GI sx? -SGLT-2 inhibitors: WL & decrease cardiovasc mortality HypoTN, euglycemic ketoacidosis, AKI, UTI, Genital mycotic infections

Moderate persistent asthma: -SABA/sx frequency? -Nighttime awakening? -Tx? -PFTs?

-Daily -1+ times per week, not nightly -SABA + ICS (med-dose) + *LABA* -FEV1 60-80%; FEV1:FVC ratio reduced 5%

How to decreased ICP in the setting of traumatic brain injury? What is the triad seen?

-Decrease brain parenchymal volume: Hypertonic saline -Decrease cerebral blood volume: --head elevation to increase venous outflow --Sedation to decrease metabolic demand --hyperventilate to decrease Paco2, resulting in vasoconstriction -Decrease CSF volume: drain -Increase cranial volume: craniectomy -Cushing triad: HTN, bradycardia, irreg resp.

How do Benzos affect sleep stages?

-Decreased time to sleep onset (sleep latency) -Prolongation of total sleep time (primarily d/t increased stage 2 sleep) -Decreased deep/restful sleep (stage 3, REM)

Screening indicated in a pt with gestational diabetes in postpartum period? Glucose ranges for gestational DM? 1. fasting 2. 1-hour post-prandial 3. 2-hour post-prandial Therapy for gestational diabetes

-Diabetes screening at postpartum visit (6-12 weeks pp) with a *2-hour 75-g oral* glucose tolerance test 1. <95 2. <140 3. <120 Insulin = first line. Metformin and Glyburide = 2nd line

Mgmt & w/up of ascites?

-Diagnostic paracentesis to determine cause (portal HTN vs anything else) - get cell count, ascites albumin, gram stain/culture. Serum ascites albumin gradient (SAAG) >1.1 = portal HTN

When can external cephalic version be done? -CI -Risks

-Done at 37 weeks if malpresentation. -CI: prior classical C-sec or extensive myomectomy, placebta previa. -Risks: preterm labor, PROM, placental abruption

Acute limb ischemia: -Dx -Tx

-Dx: clinical, based on pain, pallor, paresthesia, pulselessness, poikilothermia, paralysis. -Tx: IV heparin infusion immediately to prevent further arterial thrombus propagation while awaiting further diagnostic procedures/awaiting surgical intervention. They may require thrombolysis or thrombectomy.

Beta-Thalassemia major vs minor -Dx -Tx

-Dx: hemoglobin electrophoresis -Major tx: packed RBC transfusion + deroxamine -Minor tx: not necessary

Complications of dialysis?

-EPO & vit D def

Changes on ABG (Paco2/Pao2) for alveolar hypoventilation? -Inc/dec/nl DLCO? -Inc/Dec/nl A-a gradient? -Causes?

-Elevated Paco2 -Low Pao2 -*Nl DLCO* -Nl A-a gradient -*Extrinsic restrictive dz* -Pulm/thoracic dz (COPD, OSA, obsesity hypovent syndrome) -Neuromusc dz (MG, LEMS, GBS) -Drugs (anesthetics, narcotics, sedatives) -Primary CNS dysfx (brainstem lesion, inf, CVA)

Cardiogenic shock: -RA P? -RV P? -PCWP? -LV EDV? -SVR? -CO? HR? SV? -JVD? -BP? -Extremities? -Dx? EKG findings? CXR findings?

-Elevated RA & RV P & PCWP, LV EDV, SVR (afterload d/t vasoconstriction) -Low CO = Inc HR x Low SV -Elevated JVD -Hypotension -Cool extremities -Dx: urgent echo: RA and ventricular collapse, plethora of IVC. -EKG: low voltage EKG, electrical alternans -CXR: enlarged cardiac silhouette, clear lungs

Pulmonary Embolism changes: -RA P -pulm a. P -PCWP -CO

-Elevated RA P & pulm a. P -nl PCWP -Dec CO

Causes of transudative effusion.

-Elevated cap pressure -decreased plasma oncotic pressure

Biliary atresia -labs -Dx -Tx

-Elevated direct/total bili. Elevated GGT. Nl/slightly elevated alk phos, AST/ALT US - small or absent GB. Definitive dx: intraoperative cholantiography or liver biopsy. HIDA after 7 days of phenobarb Hepatoportoenterostomy (Kasai) procedure

Dx & mgmt of GERD Alarm features? Gold standard dx?

-Empiric PPI (or H2blocker) x6-8 wks unless alarm sx, then start with EGD If failed initial tx or has Alarm features - EGD Alarm features - melena, hematochezia, WL, dysphagia, odynophagia, iron def anemia, elderly 24-hour esophageal pH monitoring

Empiric tx for chlamydia/gonorrhea? If PCN allergic? When can you give only one abx?

-Empiric: azith + ceftriaxone (UWorld) -Confirmed chlamydia: azith only -Confirmed Gonorrhea: azith + ceftriaxone TL - Cephalosporin (gonorrhea) + Doxy 100mg x7 days or Azithro 1gx1 (Chlamydia) + Metronidizole (trich/anaerobes) Gentamicin + Azithromycin If Gonorrhea has been ruled out - only give Doxy. If chlamydia has been ruled out - only give Ceftriaxone. or both??? For hospitalized pts = Cefoxitin or Cefotetan + Doxy or Clinda + Gent

Esophageal perforation -MCC -Dx -Tx -What is contraindicated?

-Endoscopy with adjunctive procedure (biopsy) is MCC. -Dx: esophagography or CT with water-soluble contrast -Tx: NPO, IVF, IV abx, PPI, emergent surgery CI: NG tube & EGD (EGD is dx of choice in mallory weiss tear)

Weight loss recommendations and medications and who it can be used for?

-Exercise and diet and lifestyle changes. -After 3-6 months of comprehensive changes to the pt's diet and lifestyle, medications may be considered if the pt has not lost at least 5% of their body weight. Meds can be considered if BMI >30 or 27-29 with comorbidities (HLD, HTN, DM, CAD, sleep apnea, OA) -Orlistat - inhibits pancreatic lipases ADR: cramps, flatus, dec digestion of fat-soluable vitamins, oxalate induced AKI -GLP1 agonists - stimulates glucose dependent secretion ADR: N/V/D, pancreatitis -Phentermine-topiramate - stim hypothal to release NE from phentermine with appetite suppression ADR: dry mouth, paresthesias, psych -Sympathomimetics - stim of hypothal to release NE ADR: inc HR/BP, dry mouth, constipation, abuse

Mgmt of adrenal incidentaloma?

-First r/o hyperfxing tumor -If negative, resect if >4cm or hyperfxing.

Uterine atony tx options and CI

-First: uterine massage + high-dose oxytocin -Tranexamic acid -Carboprost - CI with asthma -Methylergonovine - CI with HTN

Hemobilia -s/sx -causes -dx -tx

-GI bleed, jaundice, RUQ pain. -trauma, surgery, etc. -arteriogram, upper GI endoscopy -resuscitation

Causes of pulmonary-renal syndromes?

-Granulomatosis with Polyangiities (GPA; Wegener's) -Microscopic Polyangiitis (MPA) -Antistreptococcal -Mixed Cryoglobinemia -Systemic Lupus Erythematosus -Anti-GBM Disease (Goodpasture)

Thyroid pathology with increased RAIU:

-Graves - whole thyroid lights up -Toxic adenoma - single nodule lights up -Toxic multinodular goiter - multiple nodules light up

Antipsychotic drug with: -Greatest metabolic risk -Lowest metabolic risk -risk of QT prolongation? -increased prolactin? -Greatest EPS profile?

-Greatest: olanzapine (also clozapine) - check BMI monthly; fasting glucose, lipids, BP & waist circumference at baseline, at 3 months, then annually. -Lowest: ziprasidone (also aripiprazole, lurasidone) -QT prolongation: ziprasidone -Prolactin: risperidone -EPS: risperidone

What are the contraindications to hormone replacement therapy? What medicine can they recieve?

-breast cancer -coronary heart dz -endometrial cancer -liver dz thromboembolism SSRI (paroxetine). Others: clinidine, gabapentin

Contraindications to breastfeeding

-HIV if not on ART; CMV (+/-); HTLV -Active TB -Newly diagnosed breast CA -Infant galactosemia -Infant PKU (may partially breastfeed) -Herpes lesion on mother's breast -Mother taking medications that are contraindicated for infant (chemo drugs, drugs of abuse, primaquine if G6PD, metronidizole, sulfa, radioactive isotope) -Hep B in mom IF baby is not vaccinated

Pt with advanced HIV: -memory deficits & executive fx -apathy -loss of attention/concentration -depression Dz? Imaging?

-HIV-associated Dementia Cortical and subcortical atrophy and ventricular enlargement.

Mgmt of atypical Sq cells of undetermined significance on pap?

-HPV testing -repeat pap in 6 months. TL answer: 1. HPV testing and return in 3 years if negative or perform colposcopy if HPV testing is positive. (Preferred). 2. Repeat cytology in one year and perform colposcopy if f/up smears are abnl.

Questions to ask in a pt presenting with vertigo?

-Hearing loss -Recent infections -HA -Tinnitus -Any focal neurologic deficit (dysphagia, facial droop, difficulty speaking, diplopia, ataxia)

Sx of serotonin syndrome Tx?

-Hyperthermia -AMS -*Myoclonus*, hyperreflexia -Cardiovascular instability (HTN, tachycardia) -Flushing -Diarrhea -Seizures -Dilated pupils -Increased muscle tone, muscle rigidity -Diaphoresis -Intermittent whole body tremors ("wet dog shakes") Cooling, benzos, supportive. Cyproheptadine (controversial)

Complications of pancreatitis - soaponification. -s/sx -dx -tx

-Hypocalcemia in 1-3 days following acute pancreatitis -Ionized ca level -Give Ca

Hypokalemia -Causes -S/Sx -EKG -Tx

-Hypomag, GI/renal losses, hyperaldosteronism. -Fatigue, cramps, dizziness, weakness, dec DTR, arrhythmias (AFib, VFib, Torsades). -Flat T waves, U waves, ST depression, premature vent beats, bradycardia, AV block, QT prolongation -Oral K if asxatic. IV KCl if severe (<2.5) or sxatic.

IDA vs Thal features: -Erythrocyte count -RBC distribution width (RDW) -Mean corp Hb conc (MCHC) -TIBC

-IDA: *low erythrocyte count*, MCHC. *Elevated RDW and TIBC* -Thal: *Nl TIBC, erythrocyte count, RDW* (may be elevated). Low MCHC

tx for prolactinoma?

-If <1cm AND asxatic - no tx If >1cm or sxatic - Cabergoline > bromocriptine; resect if continues to enlarge or >3cm.

A woman undergoing breast cyst aspiration, when should they follow-up?

-If clear fluid and disappearance of mass - return in 2-4 months. At that time if no recurrance, annual f/u can be resumed.

Tx for premature atrial complexes? Premature ventricular complexes?

-If modifiable RF, advise cessation. -If asxatic - no tx. -If persistent & sxatic - low dose BB Same for PVCs

Post-exposure prophylaxis for Hep B?

-If previous vaccine and known adequate Ab response - booster vaccine -If no previous vaccine or unknown Ab response - complete hep B vaccine serries ASAP + Hep B immunoglobulin

Mgmt of Guillan-Barre Syndrome?

-In pts that have intact resp status require serial PFTs (spirometry) -Resp failure - intubation -IVIG = plasmaphoresis. DO NOT give steroids.

Dx of choanal atresia?

-Inability to pass a cath through the nares is suggestive. CT scan or nasal endoscopy confirms dx

Complications to: -inadequate WG in pregnancy? -Excessive WG in pregnancy?

-Inad: low birth weight & preterm delivery -Exessive: Gest DM, fetal macrosomia, C-sec

Insulin def causes: -inc/dec lipolysis? -which results in what?

-Inc lipolysis -Those fatty acids are taken to liver and broken down into ketones.

Changes seen in LAD occlusion: -PCWP -CO -SVR -RA P -pulm a. P

-Increased PCWP -Decreased CO -Increased SVR -Increased RA P -Increased pulm a. P

Causes of exudative effusion.

-Increased permeability of pleura. -Decreased lymphatic flow (either damage to pleural membranes or vasculature).

MDMA (ecstasy) -MOA -Intoxication signs

-increase synaptic NE, dopamine, and serotonin -HTN, hyperthermia, serotonin syndrome, hyponatremia

Mgmt of category III fetal heart tracing?

-Initial: maternal repositioning and other intrauterine resuscitative measures (O2, IVF, d/c uterotonics). If recurrent variable decels: amnioinfusion may be done. -If no improvement & not completely dilated: C-sec -If no improvement, but complete dilation: operative vag delivery.

Tinea -Dx? -MC organisms involved? -Tx?

-KOH microscopy (all except tinea capitus (i think this is actually microsporum) - wood lamp). -Pedis MC d/t Trichophytan -Capitus MC d/t Microsporum All start with topical therapy, except ochomycosis and capitus.

Lab changes with hyperemesis gravidarum? -ketones -Cl -acid-base -K -Hb -BSG Diagnosis?

-Ketonuria -Hypocloremia -Metabolic alkalosis -hypokalemia -Hemoconcentration -Hypoglycemia Sx of severe nausea and vomiting in conjunction with WL >5% prepregnancy weight.

Signs of pulm HTN

-L parasternal lift -RV heave -Loud P2 -R sided S3 -Pansystolic murmur of tricuspid regurg -JVD -Ascites -peripheral edema -hepatomegaly

Dix-Hallpike maneuver that would suggest central vertigo? Suggesting peripheral vertigo?

-Latent period <2sec -Duration >1 min or non-fatiguing -direction of nystagmus changes -Only one type of nystagmus -fatigues with repitition -duration <1min -onset 2-20sec latency

Difference between leukamoid rxn and Chronic Myelocytic Leukemia (CML). -Leuk alk phos (LAP) -Metamyelocytes compared to myelocytes -Basophilia

-Leuk rxn: elevated LAP, Metamye>myel, no basophilia. -CML: low LAP, myelo>metamye, present basophilia

Dx of HCC?

-Liver biopsy -Triple phase CT -Elevated AFP

Urethral stricture -Etiology -S/Sx -Complications -Dx -Mgmt

-MC in males. D/t trauma, infection, idiopathic, radiation. Causes fibrotic narrowing of urethra. -Weak stream, encomplete emptying, irritative voiding -Acute urinary retintion, recurrent UTI, bladder stones, hydronephrosis, fistula. -High postvoid residual volume, VCUG confirms -Urethral dilation or surgical urethroplasty.

What dz process to consider in a pt with: Fever, HA, & ___: -stiff neck -FND -AMS

-Meningitis -brain abscess -encephalitis

Size of: -microadenoma -macroadenoma

-Micro: <1cm -Macro: >1cm

Croup Tx -major difference between RSV?

-Mild (no stridor at rest) - humidified air + steroids -Mod/severe (stridor at rest) - steroids + nebulized racemic epi -Failure of steroids/epi or have signs of impending respiratory effort (AMS, poor effort) - intubation with mechanical ventilation -Croup has stridor. -RSV has wheezing.

Tx nodular (cystic) acne vulgaris -mild/mod -severe -Unresponsive severe

-Mod: topical retinoids, benzoyl peroxide, topical abx -severe: add oral abx -Unresponsive: oral isotretinoin

Child with generalized erythema turning into blisters/bullae with + Nikolsky sign. -Mucosa involved vs. -Mucosa not inolved

-Mucosal involvement - SJS/TEN. Triggered by med. -No mucosal involvement - SSSS (staph scalded skin syndrome). Tx: Naf/Vanc

Pt with HIV and toxo? How does it appear on imaging?

-Multiple ring-enhancing lesions at gray-white jx, basal ganglia, and subcortical white matter with edema

Severe persistent asthma: -SABA/sx frequency? -Nighttime awakening -Tx? -PFTs?

-Multiple times daily -4-7 nights per week -SABA + ICS (high-dose) + LABA + *oral steroid* + consider olizumab for pts with allergies -FEV1 <60%; FEV1:FVC ratio reduced >5%

Glucogonoma -s/sx -dx -tx

-Necrotizing migratory erythema (painful, pruritic, erythematous papules that coalesce for form large, indurated plaques with central clearing), glossitis, DM, hyperglycemia, WL, diarrhea, DVT -Dx: elevated glucagon levels, CT scan -Tx: resect

Hyponatremia -S/Sx -Tx

-Neuro sx and sx of elevated ICP Tx: Hypertonic 3% saline indicated for: -acute (<48 h) with Na <130 with any sx. -chronic (>48h) with Na <120, severe sx, concurrent intracranial path.

Hypernatremia -S/Sx -Tx

-Neuro sx predominate Tx: -mild: po water -mod: IV NS -severe: D5W

Diagnostic evaluation of dementia in elderly

-Neuropsych testing (moca, mini-cog, etc,) and review pts ability to perform ADLs and IADLs. -Eval for depression -Review of medicatiosn -Labs: CBC, B12, TSH, CMP, +/- RPR or HIV -Neuroimaging (CT/MRI)

1st line tx for smoking cessation?

-Nicotine replacement therapy (first line combination NRT - nicotine nasal spray + patch) -Bupropion (dec seizure threshold) -varenicline (decreases cravings. increased risk of suicide; avoid in pts with insomnia)

Abx to use for UTI in pregnancy? Mgmt?

-Nitrofurantoin -Amox or amox-clav -Fosfomycin -Bactrim only in 2nd TM. Repeat urine culture several weeks following completion of abx.

Tx of COPD exacerbation Best prognostic indicator? Improves mortabily?

-O2 -Inhaled bronchodilators -IV abx -IV steroids -NPPV vs intubation FEV1 Quit smoking & Home O2

complications of diverticulitis & mgmt?

-perforation - surgery -abscess - drain percutaneously or surgically <3cm: IV abx >3cm: Drainage -fistula formation -bowel obstruction - conservative vs surgical

Paget Disease of bone -etiology -phases -S/Sx -Labs -Imaging -Tx -Complications

-Osteoclast dysfx: increased bone turnover and disordered bone remodeling. Lytic - XR shows thinned cortex Mixed lytic and blastic Sclerotic - sclerotic appearance with coarse trabeculae and cortical thickening; "cotton wool" spots on head CT -Mostly asxatic. Deep bone pain, increased skull size, HA, bowing, fx, radiculopathy, HL (conductive - d/t osseous changes and sensorineural - d/t compression of CN VIII) -*Elevated alk phos* and urine hydroxyproline. Nl calcium/phos/PTH. -Osteolytic or mixed lytic/sclerotic kesions. Thickening of bone. Mosaic lamellar bone pattern -Asxatic - no tx -sxatic - Bisphosphonates -May develop into osteosarcoma & giant cell tumor.

Syphilis tx -If pregnant w/ allergy -Nonpregnan w/ allergy

-PCN -PCN desensitization -Doxy, Azithro

Physiologic genu varum vs rickets

-PGV: sym bowing, nl stature, no LLD, no lateral thrust when walking. Resolves by 2 yo. -Rickets: presents with short stature.

Thyroid pathology with decreased RAIU: Next step?

-Painless (silent) thyroiditis Tx: propranolol if heart sx, otherwise no tx. -Subacute (de Quervain) thyroiditis: elevated ESR -Amiodarone-induced -Exogenous thyroid intake -Struma ovarii -Iodine exposure -Extensive thyroid cancer mets Next step: measure *thyroglobulin level* -Reduced in exogenous cases -Increased in thyroiditis & iodine exposure.

These indicate what disease? -elevated fecal elastase -abnl lactose breath test -elevated fecal calprotectin

-Pancreatic insuff -Lactose intolerance -IBD

-Dz affected multiple continents? -Dz that rise to levels above expected levels in a community, population, or local region? -Dz that continues to spreak outside of a geographic area? -Two or more epidemics aggregate in a population and exacerbate the burden of dz? -Dz that regularly occurs to a particular population?

-Pandemic -Epidemic -Outbreak -Syndemic -Endemic

Criteria for ARDS?

-Pao2:Fio2 ratio <300 -XR -PCMP <18

W/u of postmenopausal bleeding?

-Pap regardless of when last test was performed and results -endometrial biopsy - can start out with transvag US. <4mm - biopsy not indicated >4mm - get biopsy Most definitive with D&C with or without hysteroscopy

Delusional Disorder Dx Criteria: Tx?

-Presence of 1 or more delusions in the absence of hallucinations or psychosis. -Able to maintain function -Types: erotomanic, grandiose, jealous, perecutory, somatic Antipsychotics, CBT

Prevention for prinzmetal angina? Tx? Dx?

-Prevent with CCB (Diltiazem > amlodipine, nifedipine, verapamil) -Tx: Nitro -Dx: transient ST elevation or depression on EKG during CP episodes; resolves with use of nitros trop negative coronary angio - spasms and no coronary artery occlusion; ergot stim

Who should get endocarditis abx prophylaxis? What procedures? What abx? When?

-Prosthetic heart valve -H/o IE -Structurally abnl valve in a transplanted heart -Certain congenital heart dz (unrepaired cyanotic CHD, repaired CHD with prosthetic material within 6 months of repair, repaired CHD with residual defects). *NOT* indicated in pts with acquired valve dysfx (MVP, Rheum fever) or relatively low-risk cong heart dz (ASD, bicuspid aortic valve). -Gingival manipulation or Resp tract incision: cover for Strep viridins with amoxicillin. -GU or GI procedure with active infection: cover for Enterococcus with ampicillin -Surgery on infected skin/muscle: cover for Staph with Vanc -Surgical plaement of prostetic cardiac material: cover for Staph with Vanc. Amoxicillin 30-60min prior to cleaning If PCN allergic, Azithromycin, cephalexin, or clindamycin

Complications of pre-eclampsia

-Pulm edema -Placental abruption -Stroke -IUGR/oligohydramnios

Reactive attachment d/o vs Disinhibited social engagement d/o

-RAD: withdraw from affection. -DSED: overly attached to affection.

Sphincter of Oddi dysfunction (biliary dyskinesia) -s/sx -dx -tx

-Recurrent sx of biliary colic without evidence of stones. -HIDA - EF low -SOD manometry is gold standard -Cholecystectomy -In pts with previous cholecystectomy, tx is sphincterotomy

Hyperkalemia -Causes -S/Sx -EKG -Tx

-Renal failure, hypoaldersterone, acidosis, rhabdo, insulin def, meds -Weakness, paralysis, Decreased DTRs. Arrhythmias. -Peaked T waves, QRS widening, PR prolongation, loss of P waves, sine wave -Severe/sxatic - IV calcium gluconate (stabilize heart), glucose + insulin, beta-agonsit, kayexalate, furosemide, hemodialysis. If asxatic - removal with Kayexalate/furosemide

Indications for home oxygen therapy? Pao2? Sao2? Sx? Hct?

-Resting Pao2 <55 or Sao2 <88% on room air -Pao2 <59 or Sao2 <89% in pts with cor pulmonale, evidence of RH failure, or hematocrit >55%

Metabolic Alkalosis - Saline-responsive vs Saline resistent. -Urine Cl -ECF contraction or expansion? -Causes -Tx

-Saline-responsive: urine Cl <20. Causes ECF contraction. D/t bicarb loss and/or RAAS activation. Tx: NS + K -Saline resistant: urine Cl >20. Causes ECF expansion. D/t increased mileralocorticoids, mostly secondary to adrenal disorders, Cushing disease, diuretic abuse. Tx: address underlying cause.

Pt diagnosed with HIV -What screening is recommended? -Vaccines? -Vaccines CI'd if CD4 <200?

-Screen for TB -Varicella serology with no h/o infection. -Hep B serology -Pneumococcal vaccine (13, followed up with 23) -Inactivated flu -Varicella if negative serology born after 1979. LAV, so only give if CD4 >200 -Hep A -Hep B if needed -Tdap once, Td q 10 years -HPV if 11-26 Varicella, MMR, Zoster

Caustic ingestion mgmt

-Secure ABC's -Decontamination -Serial chest and abd XR to evaluate for perforation. -In the absence of perforation or severe respiratory distress, endoscopy within 24 hours to assess for severity.

CHF -high sensitivity -high specificity

-Sens: elevated BNP -Spec: bilat crackles, cardiomegaly, JVD, LE edema, S3

Indications for endoscopic removal of FB?

-Sharp object in esophagus, stomach, or prox duodenum -sx of eso obstruction (drooling, inability to swallow secretions) -sx of resp compromise -Button battery in esophagus -Magnets in eso or stomach. If beyond stomach - retrieval by colonoscopy or serial XR (q4-6h)

Causes of parotid gland enlargement?

-Sialadenosis: noninflammatory swelling d/t chronic alcohol use, bulemia, malnutrition, DM, or liver dz. painless *no fluctuation* *no association with eating* bilat -Parotitis: d/t mumps *Painful* bilat -Pleomorphic adenoma: benign salivary neoplasm painless *unilat* -Sialolithiasis: salivary stones *associated with eating & fluctuating* *painful* -Sjoren's: d/t lymphoctyic infiltrate bilat *associated with dry mouth*

Tx of PTX?

-Small/asxatic - supplemental O2 & observe. -Large or sxatic - needle decompression

Carbon monoxide poisoning -Causes -S/Sx -Dx -Tx -Nl baseline levels of CO?

-Smoke inhalation, defective heating systems, gas motors in poorly ventilated areas. -HA, confusion, malaise, dizziness, nausea, seizure, syncope, coma, MI, arrhythmia, cyanosis, skin pallor (early), tachycardia, flame-shaped retinal hemorrhages. Late findings - cherry-red skin -Pulse ox is nl. ABG shows carboxyhemoglobin; nl PaO2. Metabolic acidosis d/t lactic acidosis from tissue hypoxia. -High-flow 100% O2 until asxatic or HbCO levels are <10%. Reduces carboxyhb level half-life from 5 hours to 90 min. -intubation if severe/not protecting airway -Hyperbaric O2 if levels >25% (20% if preg), pH ,7.1, LOC, or concern for end-organ damage. <3% in nonsmokers Up to 10-15% in smokers.

Bazex syndrome (Acrokeratosis neoplastica)?

-Sterile paronychia -Scaly psoriasiform lesions of acral sites, ear, nose -Palmoplantar keratoderma Ass with Sq cell carcinoma

GI bleed tx measures

-Supplemental O2 -Bowel rest -IVF -IV PPI -If Hb <7/sxatic - packed RBC transfusion

Mgmt of granulosa cell tumor?

-Surgically excise -Monitor recurrence with inhibin levels

Zollinger-Ellison Syndrome (ZES)/gastrinoma -s/sx? -dx? -tx? -Associations?

-Sx: refractory ulcers, diarrhea, WL, abd pain -Dx: 1. Endoscopy: multiple stomach/duo/jeju ulcers and thickened/prominent gastric folds 2. Serum gastrin levels (fasting; off PPI's - chronic use inc gastrin levels). -nl: <250 -250-1000 - do secretin stim test. Should suppress gastrin. If elevated, gastrinoma. ->1000: gastrinoma 3. Localization with CT/MRI, somatostatin receptor scintography (best) -tx: high-dose PPI, resect if possible MEN-1 - primary hyperparathyroidism, Gi tumors (gastrinoma, insulinoma, nonfunctioning), pituitary tumors (pit adenoma)

VIPoma -s/sx -dx -tx

-Sx: watery diarrhea, hypokal, achlorhydria, hyperglycemia, hypercalcermia, metabolic acidosis, *flushing* -Dx: VIP level (>75), abd CT/MRI for localization (MC in panc tail) -Tx: resect

Tx for lead poisoning?

-Sxatic pts - calcium disodium EDTA. -If asxatic - oral succimer.

How does thyrotoxicosis effect hemodynamics?

-Systolic HTN -Increased Pulse pressure -Increased contractility & CO -Increased myocardial O2 demand -Decreased SVR This is done by T3 increases sensitivity to circulating catecholamines - + ionotropic & chronotropic effects.

Congenital heart diseases that have a single S2?

-Transposition of the great vessels - presents immediately after birth with cyanosis. -Tricuspid atresia -Truncus arteriosus -Hypoplastic L heart syndrome - presents with neonatal shock, cyanosis several days after birth when the PDA closes Tx: supporting BP, admin of PGE to maintain PDA -TOF

When is a temporary transvenous pacemaker indicated?

-before a permanent pacemaker can be placed in pts with: -sick sinus syndrome -sxatic 2nd/3rd degree heart block

Von Willebrand disease: -bleeding time -platelet count -PT -PTT -Tx?

-bleeding time prolonged -platelet count nl -PT nl -PTT nl/elevated -Desmopressin, Factor VIII concentrate. Avoid ASA/NSAIDs. Minor bleeding - Desmopressin Major bleeding - vWF concentrates

Ascites in the setting of cirrhosis: -Initial evaluation -Mgmt -Main cause of fluid retention?

-US to confirm -> diagnositic paracentesis. -Na restriction + Furosemide + Spironolactone -Activation of the RAAS d/t percieved low-flow states. D/t peripheral vasodilation and drop in systemic vascular resistance d/t development of AVMs and decreased clearance of arterial vasodilators (NO) from impaired liver fx. Also d/t splanchnic vasodilation leading to pooling and increasedCVP which decreases renal perfusion.

Empiric tx for UTI

-Uncomplicated cystitis First-line: *Nitrofurantoin*, Bactrim, Fosfomycin, Cipro, Cephalexin -Complicated cystitis - Gram (-) coverage with: Ceftriaxone, Cipro/Levo (FQ), or Pip-tazo If foley-cath or h/o Gram (+) infection, add: Vancomycin, Daptomycin, Linezolid.

Tx for uncomplicated and complicated parapneumonic effusions?

-Uncomplicated: abx -Complicated: abx + drainage

Carotid artery dissection -S/Sx -causes? -Dx -Tx

-Unilat head/neck pain, transient vision loss, *ptosis, miosis*, focal weakness/TIA, *aphasia*, gradual-onset *hemiplegia*. Often asxatic at time of dissection; up to 50% present later with stroke. -penetrating trauma, fall with object in mouth, neck manipulation. Injury to carotid a. can result in dissection or thrombus formation, which occurs over hours to days and can extend to the middle & anterior cerebral arteries. -CT angiography -If presenting with stroke sx - CT of head without contrast and nl stroke work-up. -Thrombolysis (if <4.5 hr after sx onset). Antiplatelet therapy (ASA) +/- anticoagulation. -Cerebral angiogram with stenting and/or thrombectomy.

Esophageal cancer: -SqCC -Adeno Occurs where?

-Upper 2/3 -Lower 1/3

Cluster HA -Sx? -Abortive tx -Preventative tx

-Young male with severe HA localized around one eye lasting 15min-3hours. Ass sx - tearing, nasal congestion, red eye, reduced pupil size -Abortive: 100% O2, sumatriptan -Preventative: verapamil, lithium

Nonviable fetus -fetal dx -OB mgmt

-acardia, anencephaly, bilat renal agenesis, holoprosencephaly, IUFD, pulm hypoplasia, thanatophoric dwarfism -Vaginal delivery without fetal monitoring.

Dx of HIV

-acute phase: PCR RNA viral load -ELISA screening test. If +, get Western blot to confirm.

Major criteria for CHF? Minor criteria for CHF How many of each criteria is needed for the dx of CHF?

-acute pulmonary edema -cardiomegaly on XR -positive hepatojugular reflux -jugular vein distention -paroxysmal nocturnal dyspnea, orthopnea -pulmonary crackles/rales -S3 -hepatojugular reflex -weight loss of >4.5kg in 5 days in response to tx -Ankle edema -dyspnea on exertion -Hepatomegaly -nocturnal cough pleural effusion -tachycardia (>120) 2 major or 1 major + 2 minor.

Chronic mesenteric ischemia -S/Sx? -Dx? -Tx? -Cause?

-anorexia, dull abd postprandial pain -Mesenteric arteriogram; Angiogram (outpt) -Surgerical intervention, stent placement, medical mgmt with anticoagulation use/vasodilators. usually results from long-standing atherosclerotic disease or 2 or more mesenteric vessels.

When do you need to do additional testing of a breast cyst after fine needle aspiration? What test should be done next?

-bloody aspirate -mass does not resolve with FNA -Core needle biopsy

Indications for endotracheal intubation in the setting of burn injury?

-burn on face -singed eyebrows -oropharyngeal inflammation -blistering or carbon deposits -carbonaceous sputum -stridor -carboxyHb level >10% -h/o confinement in a burning building.

TPN: -Must be given via _______ if given for > _____ hours. -greatest risk? -other potential problems?

-central venous cath; >48 hours -Central line associated bloodstream infections. Other problems: -Cholestasis, but only if >2 weeks. -Fluid overload -Hyperglycemic events -refeeding syndrome when food is reintroduced.

Indirect inguinal hernia -old vs young -medial or lateral -d/t?

-children -lateral to inf epigastric. vessels -Patent processus vaginalis; laxity of deep inguinal ring

What happens to the DLCO in: -Chronic bronchitis -emphysema -COPD -asthma -interstitial lung disease -sarcoid -Asbestosis -HF -MSk/neuromusc dz -morbid obesity -pulm arterial HTN

-chronic bronchitis: nl -Emphysema: decreases -COPD: nl early, decreased later. -asthma - nl (increases in severe asthma) -ILD, sarcoid, asbestosis, HF - decreased -MSK/NM dz: nl -Obesity: inc -Pulm a. HTN: dec

Sinusoidal fetal heart rate pattern

-classically occurs with severe fetal anemia

Cause, dx, and tx of overflow incontinence?

-d/t bladder overdistension d/t detrusor underactivity (diabetic neuropathy, Multiple Sclerosis, spinal cord injury) or bladder outlet obstruction (BPH) -Can mimic stress or urge incontinence; Look for high post-void residual volumes! -Bladder catherization regimen and treat underlying etiology.

Cause, dx, and tx of stress incontinence

-d/t weak intraurethral pressure -> loss of urine with increased intra-abd pressure (coughing, sneezing, laughing); look for pt with multiple pregnancies, trauma, obesity, menopause, and advanced age. -Dx: clinical; cough stress test, Qtip test -Initial tx - WL. Kegal exercises, muscle training. Continences pessaries, Surgery.

Soft signs of traumatic injury

-diminished distal pulses -unexplained hypoTN -stable hematoma -documented hemorrhage at time of injury -associated neuro deficit Presence of these requires further imaging - CT angiography.

Hard signs of traumatic injury?

-distal limb ischemia (paralysis, pallor, pain, poikilothermy) -absent distal pule -active hemorrhage/rapidly expanding hematoma -bruit/thrill at site of injury Presence of these requires immediate surgery

REM sleep behavior d/o -s/sx -increased risk for what?

-dream enactment during REM -Parkinsons

Osteomylitis -dx -mgmt -tx -best lab marker to monitor tx?

-dx: start with XR, usually neg. Get MRI. Needle aspiration & bne biopsy = best. -ESR/CRP used for monitoring tx response. -tx: IV abx, surgical debridement -CRP

Signs of RV failure

-elevated JVD -RV S3 -Tricuspid regurg -Hepatomegaly with pulsatile liver -LE edema, ascites, pleural effusions -echo: elevated R heart pressures -Cath: pulm a. systolic pressure >25

Lab changes in DIC -bleeding time -thrombin time -PT -PTT -D-dimer -fibrinogen -platelet count -clotting time Treatment?

-elevated bleeding time, thrombin time, PT, PTT, D-dimer -Decreased fibrinogen (it's consumed), platelet count -Normal clotting time Underlying cause Blood Transfusion Platelet transfusion (if <50,000 with active bleeding or <20,000 if not actively bleeding) Cryoprecipitate (replaces clotting factors, vWF, & fibrinogen) or FFP (replaces clotting factors) - in pt's bleeding or high-risk to keep INR <2 and fibrinogen >50 Heparin can be started with caution in those who develop clinically evident thrombosis.

Reye Sydrome -S/Sx -Labs -Tx

-encephalopathy, seizure, acute liver failure (causes microvesicular fatty infiltrate). -Elevated AST/ALT, PT/PTT/INR, NH3 -Supportive

What are the red flags that have indications of imaging for back pain? What type of imaging for different concerns?

-h/o ca -sudden onset with spine tenderness -constitutional sx -trauma -neuro deficits -risk of spinal inf XR: osteoporosis, compression fx, suspected malignancy, ank spond. MRI: neuro deficits, suspected epidural abscess/inf.

Insulinoma -s/sx? -dx? -tx?

-hypoglycemia sx -Dx: labs showing elevated C-protein, pro-insulin, and negative sulfonurea levels. -Tx: resect

Evaluation of bilateral nipple discharge?

-if bloody/serous, US +/- mammography -If milky d/c, get pregnancy test, prolactin, TSH, +/- MRI pituitary

Prevention of kidney stones:

-increase fluid intake -decrease Na intake -Nl dietary ca intake

Giant Cell Arteritis (Temporal Arteritis) -pathophys -dx? -tx? -2 complications of giant cell arteritis

-inflammatory infiltrates, composed of macrophages and CD4 lymphocytes, in all artery layers. Temporal artery biopsy High-dose (0.5-1mg/kg) glucocorticoid taper x 3 months. blindness & aortic aneurysm

Hormone replacement therapy - who gets what?

-intact uterus: estrogen progesterone (to decrease risk of endometrial cancer) -pts without a uterus: estroogen only (preferred since progesterone has slight increased risk for breast cancer)

Causes of orthostatic hypoTN?

-intravascular volume depletion -autonomic insuff -age-related vasomotor loss -decreased baroreceptor responsiveness (part of nl aging)

Mgmt of cat/dog/human bite?

-irrigation & cleaning -Prophylactic amox/clav -Tetanus booster if not recent -avoid closure

Migratory superficial thrombophlebitis is known as ___ & is associated with ____. What diagnostic test should be done?

-known as Trousseau syndrome -visceral occult malignancy (MC is pancreatic) -CT scan of abd

Uric acid stones: -urine pH -tx

-low urine pH -Alkalization of urine with oral potassium citrate/bicarb

Meds to avoid in MG?

-mag sulfate -AG -FQ -neuromusc blocking agents -CNS depressants -muscle relaxers -CCB -BB -Opioids -Statins

How does brain mets appear on imaging? MC places of mets?

-multiple peripheral enhancing lesiosn at the gray-white jx surrounded by edema (same as toxo) MC from lung, breast, melanoma, and RCC.

CN III Palsy sx Mgmt?

-mydriasis -ptosis -down-and-out pupil If pupil is involved - concern for *aneurysm* (jx of posterior communicating artery and internal carotid). W/u with CT/MR angiogram Requires emergent eval with neuro-ophtho If pupil is nl - concern for microvascular ischemia from DM. Observation and supportive care.

Secondary adrenal insuff, changes to: -K -Na -ACTH -Aldosterone

-nl K -Dec Na -Dec ACTH -Nl Aldosterone

Direct inguinal hernia -old vs young -medial or lateral -d/t?

-older men -medial to inf epigastric vessels -weakness of transversalis fascia

In trauma what are the indications for immediate exploratory laparotomy?

-ongoing hemorrhage -Peritonitis -Evisceration -impalement

Uncomplicated parapneumonic effusion pleural fluid analysis: -pH -Glucose -WBC

-pH >7.2 -glucose >60 -WBC <50,000

Criteria for extubation How does this happen?

-pH >7.25 -Adequate oxygenation on minimal support (Fio2 <40%, PEEP <5) -Intact inspiratory effort and sufficient mental alertness to protect airway. Spontaneous breathing trial - maintains nl ABG

Complicated parapneumonic effusion pleural fluid analysis: -pH -Glucose -WBC -protein

-pH: <7.2 -glucose: <60 -WBC >50,000 -High protein

Organophosphate toxicity: -s/sx -tx?

-secretion of everything (cholinergic effects) Tx: Decontaminate, Atropine, Pralidoxime

S/Sx suspicious of renal artery stenosis Tx?

-severe HTN in pts with recurrent flash pulm edema or diffuse atherosclerosis -elevation in serum Cr >30% from baseline after starting ACE-I/ARB -onset of severe HTN >55 -HTN in pt with asymmetric kidney size of a small atrophic unilateral kidney -Abdominal bruit Tx: ACE-I/ARBs (if rise in Cr <30% then they can remain on it). Stenting/revascularization can be done if resistant HTN or recurrent flash pulm edema.

Hepatorenal syndrome occurs d/t ___. S/Sx?

-splanchnic dilation, decreased SVR, and local renal vasoconstriction. -Decreased GFR -No improvement with fluids -prerenal azotemia -low urine Na (<10) -FeNa: <1%

Pt with IUD becomes pregnant. -increased risk of what? -Mgmt?

-spontaneous abortion, placental abruption, preterm delivery. 1 - Obtain pelvic US to determine if intrauterine vs ectopic. Mgmt depends on whether the pt desires to terminate the pregnancy or not, gestational age, IUD location, and if the strings are visible on exam. If strings visible - gentle traction. Removed prior to 12 weeks if possible, otherwise risk of miscarriage increases. If strings not visualized - IUD may be left in place (understanding risks) or attemped removal under US guidance as well as hysteroscopic removal (risks of pregnancy loss with agressive IUD removal must be weighed)

Tx of inflammatory acne vulgaris (papules, pustules, nodules, cysts) -mild -mod -severe

-topical retinoids, benzoyl peroxide -add topical abx -add oral abx (tetracycline, doxycycline)

Mgmt of diverticuli bleed? Where does it occur most often?

-treat like nl GI bleed -r/o most severe things first, get *colonoscopy* once bleeding has resolved. -get arteriogram if bleeding does not stop. Diverticulosis is MC in sigmoid. Bleeds are MC in R colon.

Tx for erectile dysfx?

-underlying cause -1st line: PDE-5 inhibitors (sildenafil)

Initial fluid resusciation and bolus should be given with what?

0.9% NS

MEN-1? MEN-2A? MEN-2B?

1 - parathyroid, pancreas, pituitary 2A - pheochromocytoma, medullary thyroid ca, *parathyroid* 2B - pheochromocytoma, medullary thyroid ca, *marfanoid* habitus, *mucosal neuromas*

Dx criteria for manic episode

1+ week of elevated/irritable mood & increased energy 3+ of the following: Distractibility Impulsiveness Grandiosity Flight of ideas Activity increased/agitation Sleep (decreased need for) Talkativeness

Woman with previous pregnancy resulting in neural tube defect has what daily folic acid recommendation?

1-4mg/day initiated 1 month prior to pregnancy and continue through first TM Then can reduce to standard dosing of 0.4mg/day

Weber and Rinne test findings in: 1. sensorineural hearing loss 2. Conductive hearing loss 3. Normal hearing

1. (USA) - Weber test lateralized to the unaffected ear; Rinner test air conduction is greater. 2. (ABC) - Weber test lateralized to the affected ear; Rinne test bone conduction is greater. 3. No lateralization with Weber testing; Rinne test - air conduction is greater than air.

1. Indications for GBS prophylaxis 2. When is GBS tested? 3. Tx? 4. RF?

1. -GBS + screen during current pregnancy (regardless of tx; unless planned C-sec without ROM) -Prior infant with neonatal sepsis -Unknown GBS status PLUS: <37 weeks intrapartum fever ROM >18 hours 2. 36-37.6 week of pregnancy 3. IV PCN/amp at least 4 hours prior to delivery. If delivery occurs before 4 hours a blood culture and cbc should be obtained and monitor for signs of sepsis If PCN-allergic - Cefazolin (for low-risk anaphylaxis) or If PCN anaphyl - Clinda/Erythromycin or vanc 4. -premature delivery <37 weeks -Prolonged ROM -Chorioamnionitis -Previous delivery of an infant with GBS -Temp >100.4 during labor -GBS bacteruria during current pregnancy

When should a diabetic be put on 1. ACE-I/ARB? 2. Statin?

1. -if BP >130/80 -if alb/Cr ratio >30 2. 40-70 yo regardless of cholesterol levels

Suffix for these HIV medication categories and associated ADRs? 1. Nucleoside Reverse Transcriptase Inhibitors (NRTIs) 2. Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs) 3. Protease Inhibitors 4. Integrase Strand Transfer Inhibitors

1. -vudine, -cavir, -osine, -tabine, -fovir pancreatitis (didanosine, stavudine) anemia (zidovudine) HS rxn; requires HLA-B5701 testing (abacavir) 2. -virine, -renz, -rapine Rash 3. -navir Hyperglycemia, HLD 4. -ravir Nonspecific - nausea, diarrhea, fatigue

Bioterrorism dzs causing respiratory distress syndrome - incubation period? 1. Anthrax 2. Pneumonic Plague 3. Q fever 4. Tularemia

1. 1-6 days 2. hours to days 3. 2-3 weeks 4. 3-5 days

Pediatric milestones. 1. Cruise and walk alone 2. sit unassisted 3. crawls 4. walk backwards 5. runs 6. 2-finger pincer grasp 7. 3-finger pincer grasp 8. uses cup 9. transfer objects 10. Nonspecific mama/dada 11. Specific mama/dada 12. names common objects 13. pulls to stand 14. wave byebye 15. imitates actions 16. copies parents at tasks 17. raking grasp 18. stranger anxiety

1. 12 mo 2. 6 mo 3. 9 mo 4. 15 mo 5. 18 mo 6. 12 mo 7. 9 mo 8. 15 mo 9. 6 mo 10. 9 mo 11. 12 mo 12. 18 mo 13. 9 mo 14. 9 mo 15. 12 mo 16. 18 mo 17. 6 mo 18. 6 mo

When should these pediatric screenings take place? 1. Autism 2. Visual testing 3. Depression 4. Amblyopia 5. Blood lead level 6. Dyslipidemia 7. Iron-def anemia

1. 18 mo - 24mo 2. Starting ~4yo 3. ~12yo 4. 3-5 yo 5. universal screening at 12 and 24 mo 6. 9-11; 17-21; >2yo with risk factors 7. Universal screening at 12 months; repeat screening in those with risk factors (poor oral diet, obesity, GI tract dzs -IBD/Celiac)

Pediatric milestones 1. steps, jumps, builds tower of 6 cubes, 2-word phrases, follows 2 step commands, removes clothes, start eating adult diet 2. hops, stands on one foot, coppies cross, counts to 10, cooperative play, draw person with 2-4 body parts, sing song from memory, use cups/utensils efficiently 3. lifts head/chest when prone, tracks past midline, alert to sound, coos, recognizes parents, social smile 4. rides tricycle, climbs stairs with alternating feet, copies circle, uses utensils, 3-word sentences, brushes teeth with help, washes hands 5. rolls front to back, grasps rattle, orients to voice, looks around, laughs

1. 2 yo 2. 4 yo 3. 2 mo 4. 3 yo 5. 4-5 mo

When are these vaccines routinely given in peds? 1. Dtap 2. Hib 3. MMR 4. PCV13 5. Polio 6. Rotavirus 7. Tdap 8. Varicella 9. Influenza 10. Meningococcal

1. 4 yo 2. 2, 4, 12-15 months, +/-6 mo 3. 4 yo 4. 2,4,6,12-15mo 5. 4yo 6. 2, 4mo 7. 11-12yo 8. 4yo 9. Starting at 6mo; yearly 10. At 11-12 and booster at 16.

C. trachomatis pneumonia in newborns 1. onset? 2. sx? 3. Labs/imaging? 4. Dx? 5. Tx?

1. 4-12 weeks of age 2. initially upper respiratory - rhinitis, cough and subsequent tachypnea, staccato cough (cough with inspirations between cough), and respiratory distress. Afebrile. 3. Eosinophilia; diffuse, interstitial infiltrates on CXR; usually nl WBC count. 4. NAAT 5. Oral erythromycin or azithromycin

Classification of hypothermia: 1. mild 2. mod 3. severe What are the tx of each?

1. 90-95 (32-35) -passive external warming (cover with blankets) 2. 82-90 (28-32) -active external rewarming (heating pads, warm baths) 3. <82 (<28) -active internal rewarming (warmed IVF, warmed peritoneal irrigation)

Cervical insufficiency: 1. W/o prior preterm labor -Dx Length? Tx? 2. W/ prior preterm labor -Dx Length? Tx?

1. <2cm on transvag US. Tx: vaginal progesterone. 2. If previous h/o preterm labor, give progesterone injections IM weekly from 16-36 wks -If nl cervix length, transvaginal US. -If cervical length <2.5cm on transvag US at 24 weeks: Tx: add cerclage

Cirrhosis- paracentesis 1. SAAG 2. Total protein 3. Cell count and differential

1. >1.1 (High serum ascites albumin gradient) 2. Low total protein <2.5 3. To r/o spontaneous bacterial peritonitis (neut count <250 rules out).

These casts/'things' on UA are specific to what dz? 1. granular casts 2. hyaline casts 3. crystals 4. micro-organisms 5. RBC casts 6. WBC casts 7. Fatty casts 8. Nitrites 9. Leuk esterase

1. ATN 2. devoid of contents - seen in prerenal failure 3. stones 4. infection 5. Nephritic syndrome/glomerular dz 6. Pyelo/interstitial dz 7. nephrotic syndrome 8. presence of gram neg bacteria in urine 9. presence of WBC in urine

Evaluation of suspected ventilator-associated pneumonia

1. Abnl CXR 2. Lower resp tract endotracheal tube same (culture and microscopy) 3. empiric abx then change depending on cultures

Tx for: 1. superficial wound dehiscence 2. deep (fascial) wound dehiscence 3. evisceration

1. Absent s/sx of infection managed with regular dressing changes. 2. Abdominal binders may be used in in fascial dehiscence without evisceration in preparation for emergency surgery. 3. sterile saline gauze to cover abd contents and emergent surgery.

1. Child with fever, joint pain, rash, and cardiac complications. 2. Child with fever, sore throat, strawberry tongue, and diffuse erythematous sandpaper rash.

1. Acute rheumatic fever (erythema marginatum) 2. Scarlet fever

Screening for: 1. HTN 2. Hyperlipidemia 3. DM 4. Depression 5. HIV 6. Hep B 7. Hep C 8. Syphilis

1. All adults >18 2. Every 5 years in Men 35+, women 45+, younger for those at increased risk. Done q 5 years if nl; more frequently if they have CAD. 3. Adults 35/40-70 who are overweight/obese, those with *HTN*, anyone with BMI >25 + at least one RF. Done with A1C 4. PHQ-9; no recommendations as far as interval testing, but good for new patients, those with RF, etc. 5. Everyone 15-65 at least once; younger if RF; all pregnant women. More frequently if RF. 6. Those at high-risk (IVDU, MSM, hemodialysis) 7. adults born between *1945-1965* one time screen 8. Those with RF

Diabetes - 1. who gets screened? 2. random glucose? 3. Fasting? 4. 2-hr oral glucose tolerance test? who gets this? 5. Hb A1C? 6. When should they be evaluated by ophthalmologist? 7. How often should they recieve foot exams? 8. Dental exams? 9. Hb A1-C? Goal? 10. Urinary Albumin-Creatinine ratio? When does it start? 11. Serum Cr? 12. When do they need to see nephrology?

1. All adults >45, h/o HTN, or overweight. 2. Random >200 with sx (1 time) is diagnostic. If <200, no idea. 3. Need two measurements. <100: nl 100-125: prediabetes >126: DM 4. If fasting is 100-125 get this. Do this one time. <140: nl 141-199: prediabetes >200: DM 5. Best test. One time screen. <5.7: nl 5.8-6.4: prediabetes >6.5: DM 6. Newly diagnosed pts with type II DM & annually. All pregnant diabetic pts. Type I DM - >10yo, achieved puberty, and has had DM for 3-5 years following diagnosis 7. Annually; more if RF for neuropathy/wounds. 8. Annually 9. q 3-6 months; Goal <7%; may be higher in older/debiliated pts with goal of minimizing hypoglycemia risks 10. Annually; started at the onset of type II and 3-5 years after diagnosis of type I 11. Annually; more often if confirmed CKD. 12. GFR <30; albuminuria >300

Hereditary Nephritis 1. AKA? 2. Sx? 3. pathophys/biopsy? 4. Complement low, normal, or elevated? 5. Tx?

1. Alport Syndrome - X-linked mutation of type IV collagen (COL4A5) 2. hematuria, (sensorineural) hearing loss, renal failure, and ocular abnlities (lens protrusion, lenticonus - difficult with vision refractory to corrective lenses). Leiomyomas & arterial aneurysms. Commonly presents with hematuria after recent URI 3. X-linked inheritance of mutation to type IV collagen - longitudinal *splitting of GBM* and thinning of GBM. 4. Normal complement. 5. Monitor for proteinuria; angiotensin blockade when proteinuria occurs. Dialysis; renal transplant. Supportive measures.

For the following, which will be positive? HBsAg, HBeAg, Anti-HBc, Anti-HBe, Anti-HBs 1. Vaccinated 2. Acute infection 3. Chronic infection 4. Window period 5. Recovery

1. Anti-HBs 2. HBsAg, HBeAg, IgM Anti-HBc 3. HBsAg, IgG Anti-HBc low infectivity - Anti-Hbe high infectivity - HBeAg 4. isolated IgM Anti-HBc or Anti-HBe + IgM anti-HBc 5. Anti-Hbs, Anti-HBe, IgG Anti-HBc

Pt presents to ED with typical CP. What is the initial workup?

1. Assess stability, vitals, H&P, IV access. -if unstable, treat that. 2. Stable pts - EKG, CXR, O2, and ASA if possible ACS and low risk of aortic dissection. ASA significantly reduces rates of MI, CVA, and overall mortality in ACS. EKG: -STEMI: emergent cath vs thrombolysis -NSTEMI: anticoag

These antibodies are associated with what diseases? 1. Anti-smooth muscle Ab, anti-liver-kidney microsomal Ab, anti-mitochondrial Ab 2. Anti-CCP; anti-cyclic citrullinated peptide 3. Anti-tissue transglutaminase, anti-endomysial, anti-deamidated gliadin peptide 4. anti-SRP (signal receognition partical), anti-Mi-2 (helicase), anti-histidyl-tRNA synthetase Ab, Anti-Jo-1 Ab 5. anti-DNA topoisomerase-1 Ab, anti-RNA polymerase III, anti-Scl-70 Ab 6. anti-Centromere Ab 7. anti-U1-RNP ab (speckled ANA) 8. Anti-ribonucleoprotein Ab, Anti-Ro (SSA), Anti-La (SSB) 9. Anti-dsDNA, Anti-smith 10. Anti-histone 11. Anti-mitochondrial Ab

1. Autoimmune hepatitis 2. Rheumatoid Arthritis 3. Celiac 4. Polymyositis/dermatomyositis 5. Diffuse scleroderma 6. Limited scleroderma (CREST) 7. Mixed connective tissue disease 8. Sjoren's 9. SLE 10. Drug-induced lupus 11. Primary biliary cholangitis

Meds for HTN + comorbidities: 1. HF & CAD 2. Stroke 3. CKD 4. DM 5. First line if only HTN 6. Angina 7. AFib/AFlutter 8. BPH 9. essential tremor 10. migraine 11. Osteoporosis 12. pregnancy 13. Raynauds 14. Hemodialysis 15. no other comorbidities

1. BB, and ACE-I/ARB, aldosterone antagonist (spironolactone), +diuretic (for HF) 2. ACE-I + thiazide 3. ACE-I/ARB 4. ACE-I 5. Thiazide, CCB, ACE-I/ARB 6. CCB or BB 7. BB or Non-DHP CCB 8. Alpha-blocker (-osin) 9. BB (non-cardio selective) 10. BB or CCB 11. Thiazide diuretic 12. labetalol, hydralazine, or methyldopa 13. DHP CCB 14. 1st - BB; 2nd - DHPCCB; 3rd - ACE-I/ARB. Multidrug resistence - minoxidil, hydralazine, clonidine, methyldopa, guangacine. Aldosterone antagonists, non-DHPCCB, and thiazied are not recommended. 15. thiazide (esp if AA), ACE-I/ARB, CCB

Dx of achalasia Tx?

1. Barium swallow - birds beak 2. Manometry - failure of LES relaxation 3. EGD with biopsy (do prior to tx to r/o cancer/pseudoachalasia) Med mgmt - CCB, nitro Not surgical candidate - botulinum toxin injection Initial surg - EGD with graded pneumonic dilation (resolves 85% of time) Definitive surgery - laproscopic surgical myotomy with partial fundoplication.

Tx for: 1. Acute dystonia 2. NMS 3. Serotonin syndrome 4. Akathisia 5. Parkinsonism 6. Tardive dyskinesia

1. Benztopine, Diphenhydramine 2. Bromocriptine or Dantrolene 3. Cyproheptatine 4. Propranolol, lorazepam, benztropine 5. Benztropine, Amantadine 6. Valbenazine, Deutetrabenazine

Tumor markers with these testicular tumors: 1. Seminoma 2. Endodermal 3. Choriocarcinma 4. Yolk sac tumor 5. Leydig

1. LDH 2. AFP 3. B-hCG 4. AFP 5. Estrogen or test

IgA nephropathy 1. AKA? 2. Sx? 3. Complement low, normal, or elevated? 4. Biopsy? 5. Ab? 6. Associated with what dz?

1. Berger Disease 2. Asxatic recurrent hematuria typically *1-3 days* following GI inf or URI. 3. I think that in IgA nephropathy that C3 low, C4 nl and in IgA Vasculitis (Henoch...; systemic form) complement is nl 4. Mesangial deposition of IgA and C3 5. IgA Ab - deposits in the glomerulus 6. Henoch-Schonlein purpura

1. Tx of acute pericarditis? 2. Tx of pericarditis (acute or dressler) following MI? 3. Tx of constrictive pericarditis?

1. Best: Colchicine + NSAIDs NSAIDS CI: CKD, thrombocytopenia, PUD Colchicine limited d/t diarrhea Steroids if CI to NSAIDS (try to avoid) 2. Following MI: ASA 3. Diuretics may help; treat undlerlying cause. Pericardiectomy

These exposures lead to increased risk of what cancers? 1. textiles 2. carpenters 3. farmers 4. night shift 5. welding

1. Bladder cancer (aromatic amines) 2. sinus cavity cancer, lung ca, hodgkin lymphoma 3. non-Hodgkin lymphoma due insectaside exposure 4. breast ca 5. malig melanoma, skin ca, lung ca

Antidepressant with these ADR: 1. insomnia, WL, tachycardia, agitation, dec seizure threshold 2. sexual side effects, orthostatic hypotension, WG, HTN crisis with cheese 3. Diastolic hypertension 4. Sexual dysfx, GI distress, agitation, insomnia, fever, myoclonus, mental status changes. 5. WG, sedation 6. cardiac dysrhythmias, dry mouth, urinary retention, constipation, seizures 7. priapism, sedation

1. Bupropion 2. MAO-Is 3. SNRIs 4. SSRIs 5. Mirtazapine 6. TCAs 7. Trazodone

Translocations 1. t9:22 2. t8:14 3. t11:14 4. t11:22 5. t15:17 6. t14:18 7. BCR-ABL1 8. c-MYC 9. BCL1 10. BCL2

1. CML 2. Burkitt lymphoma 3. mantle cell lymphoma 4. ewing sarcoma 5. M3-type Acute Myelocytic Leukemia (AML) 6. follicular lymphom 7. CML 8. Burkitt lymphoma 9. Mantle cell lymphoma 10. Follicular lymphoma

Pathologic Appearance on Biopsy 1. Pseudohyphae, budding yeast 2. India ink stain with halo 3. Invasive septate hyphae with acute angle branching 4. Nonseptate hyphae with wide-angle branching 5. disc shaped yeast on Wright's stain 6. Ground glass intranuclear Cowdry type A inclusion bodies 7. Large cytomegalic cells with enlarged nuclei that contain a violacious intranurclear inclusion body surrounded by a clear halo

1. Candida 2. Cryptococcus 3. Aspergillus 4. Mucormycosis 5. Pneumocystis 6. HSV 7. CMV

Scalp edema that: 1. Does cross suture lines 2. Does NOT cross suture lines Mgmt?

1. Caput seccedaneum (immediate) & subgaleal hemorrhage (expands days later) 2. Cephalohematoma: d/t subperisoteal vessel rupture. Mgmt: reassurance and observation. Increased risk for hyperbili (d/t subperiosteal vessel rupture)

Which type of shock has: 1. elevated PCWP? 2. elevated central venous pressure/R-sided preload? 3. elevated cardiac index/LV output/myocardial contractility? 4. decreased SVR (afterload) 5. Increased mixed venous O2 sat (SvO2)?

1. Cardiogenic & sometimes in obstructive shock 2. obstructive & cardiogenic 3. Septic shock 4. Septic & neurogenic shock 5. Septic

Gram negative sepsis following severe burn. 1. S/Sx 2. Labs

1. Change in appearance of wound (partial -> full thickness) or loss of viable skin graft. Tachycardia, tachypnea, refractory hypoTN, fever/hypothermia, AMS, reduced urine output. 2. Thrombocytopenia, leukocytosis, elevated BSG.

organophosphate poisoning 1. Cholinergic or anticholinergic? 2. S/Sx? 3. Tx?

1. Cholinergic 2. Increased parasympathetic sx - SLUDGE BBB - salivation, lacrimation, urination, defecation, gastric emptying, bradycardia, bronchorrhea, bronchospasm. 3. Pralidoxime - induce rapid metabolism of organophosphate (if given early); atropine, supportive.

What asthma drugs have these mechanisms of action? 1. Mast cell degranulation inhibitors? 2. Adrenergic agonist? 3. Leukotriene rec antagonists? 4. Muscarinic antagonist? 5. Leukotriene synthesis inhibitor by inhibiting 5-lipoxygenase

1. Cromolyn 2. albuterol, etc. 3. Zafirlukast, montelukast 4. ipraptropium 5. Zileuton

Pt with HIV and diarrhea: 1. Watery with low-grade fever 2. watery with high-grade fever 3. watery without fever 4. frequent small volume +/- blood, low-grade fever

1. Crytptosporidium 2. Mycobacterium avium-intracellulare 3. Microsporidium/Isosporidium 4. CMV

Mgmt order in infective endocarditis? Which echo to get? What organism is most likely in these populations: a. IVDU b. prosthetic heart valves c. GI malignancy d. Gen population e. long-term indwelling catheters, malignancy, AIDs, organ transplant

1. Cultures x3 (if clinically stable enough to delay giving abx) 2. Empiric abx (Vanc + AG if acute; subacute treated based on culture results) 3. Intracardiac devices removed if present. TEE>TTE a. S. aureus b. S. epidermidis (in first two months) After 2 months - likely S. viridins c. S. bovis d. S. viridins e. Candida

Pleural effusion: 1. BS 2. tactile fremitus 3. percussion 4. Mediastinal shift

1. Decreased 2. Decreased 3. Dullness 4. Away

Atelectasis: 1. BS 2. Tactile fremitus 3. Percussion 4. Mediastinal shift

1. Decreased 2. Decreased 3. Dullness 4. Toward

Changes in MDD 1. Slow wave sleep 2. REM sleep latency 3. Serum cortisol concentration

1. Decreased 2. Decreased 3. Increased

PTX: 1. BS 2. Tactile fremitus 3. Percussion 4. Mediastinal shift

1. Decreased/absent 2. Decreased 3. Hyperresonant 4. Away

Paget disease of bone 1. Path 2. XR 3. Labs 4. Tx

1. Defective (overactive) osteoclasts resulting in excessive bone turnover. 2. Osteolytic lesions and expanded herpdense areas (cortical thickening) 3. Elevated alk phos & urine hydroxyproline. Nl Ca/P. 4. Bisphosphonates

Dysphagia work-up algorithm?

1. Determine if opopharyngeal or esophageal. -Oropharyngeal - difficulty in initiating swallowing, drooling, dysarthria, coughing/choking during eating, aspiration/nasopharngeal regurgitation. -Esophageal - sensation that food is getting stuck, chest discomfort, difficulty swallowing several seconds after initiation.

JNC guidelines for BP control

<60 without CKD or DM or any age with CKD or DM - target <140/90 >60 without CKD or DM - target <150/90

What type of Non-Hodkin Lymphoma? Alterations in what genetics? 1. Middle aged (60yo) pt with: -rapidly enlarging mass -diffuse LAD -Constitutional sx - fever, WL, etc. 2. Middle aged (60yo) pt with: -asxatic nodal enlargement 3. Child pt with: -rapidly growing tumor/mass often on face or abdomen

1. Diffuse Large B-cell Lymphoma (MC type); BCL-2, BCL-6 2. Follicular Lymphoma (2nd MC type); t(14:18); BCL-2 (18) 3. Burkitt Lymphoma; t(8;14) c-myc(8); "Starry sky" appearance. Jaw lesion - endemic form (Africa); abdomen lesions in sporadic form

Tx regimens of HIV

1. Dolutegravir + Tenofovir + Emtricitabine or lamivudine 2. Bictegravir + Tenofovir + Emtricitabine 3. Ritonavir + Darunavir + Tenofovir + Emtricitabine or Lamicudine

1. HIV- Pregnancy Tx - depending on viral load & medications used. 2. Infant medications postpartum.

1. During pregnancy, use ART - NRTI + protease or integrase inhibitor. -Viral load <1,000: vaginal delivery (Zidovudine not necessary). -Viral load >1,000: C-sec + Ziduvodine After delivery, mom continue ART. 2. Infant born to mom with viral load <1,000: ziduvudine. If mom's viral load >1,000: Multidrug ART. Mom's should breastfeed for 6 months, needs to be on ART.

What dz is this seen in? 1. Burr cells 2. Howell-Jolly bodies 3. Spur cells 4. Target cells

1. ESRD, liver disease 2. no spleen 3. liver disease 4. thalassemia or chronic liver dz

1. Acute onset of Round, erythematous plaque with associated pustules and small ulcers. vs: 2. Painless red macules quickly evolving into vesicles/bulla surrounded by erythema then bulla ruptured, leaving a painless, necrotic/gangrenous ulcers

1. Ecthyma - a strep skin infection related to impetigo. 2. Ecthyma gangrenosum - seen in *pseudomonal* bacteremia. Seen in pts who are immunocompromised.

Compression of radial nerve at elbow vs wrist? 1. Weak hand/finger extension; loss of sensation to post forearm/dorsolateral hand? 2. Sensory loss of lateral hand; minor motor deficits

1. Elbow d/t supracondylar humerus fx. 2. Wrist d/t repeated pronation/supination at wrist.

Dx Gastric Adenocarcinoma

1. Endoscopy and Biopsy + 2. CT scan for staging

What type of ovarian cancer based on these findings: 1. Postmenopausal women with pelvic pain. US shows: thick septations, solid & cystic component, and peritoneal free fluid (ascites). 2. Calcifications and hyperechoic nodules. 3. Following pregnancy; younger pts; aggressive 4. (Not Ca) - Complex, multicystic adnexal mass with enhancing rims.

1. Epithelial ovarian cancer (serous or mucinous) Mucinous most likely resulting in SBO 2. Mature teratoma (dermoid cyst) 3. Choriocarcinoma 4. Tubo-ovarian abscess.

Cushing syndrome Work-up Algorithm: 1. initial test(s) 2. follow up test(s)

1. Establish hypercortisolism with +2/3: -24-hour free cortisol -late night salivary cortisol test -low dose dexamethasone suppression test (fails to suppress) 2. If +2/3 from above - ACTH level. This determines if ACTH dep (elevated - Cushing dz - pit adenoma vs ectopic ACTH production - paraneo prod) or indep (low - adrenal dz or exogenous -> get CT scan of abdomen). 3. If elevated ACTH - get high-dose dexamethasone suppression test (or CRH stimulation test). -If suppresses, pituitary adenoma (Cushing Dz). -If remains elevated, this is ectopic ACTH paraneoplastic production (small cell lung cancer).

LFTs: 1. AST > ALT & inc GGT 2. ALT > AST in 1000s 3. ALT & AST >1000s with recent stressor (surg, truama, etc.) 4. Inc D. bili? 5. Inc I. bili? 6. Inc alk phos & GGT? 7. Inc alk phos. Nl GGT & nl Ca/P/PTH.

1. EtOH 2. Viral 3. Ischemic hepatitis 4. obstruction; dubin-johnson & rotor 5. Hemolysis; Rotor, Crigler-nijaar 6. Obstruction 7. Paget dz

1. Erythematous, *tender* nodule at eyelid margin. vs 2. *tender* nodule at the palpebral conjuntiva vs 3. *Nontender*, firm lid nodule; lid discomfort Dz? Tx?

1. External hordeloum (Stye) - infection of eyelash follicle. Tx: warm compress 2. Internal hordeolum (stye) - infection of meobomian gland. Tx? 3. Chalazion - d/t chronic granulomatous inflammation of meibomian gland

What abx has these ADRs? 1. Cartilage damage 2. Kernicterus 3. CN VIII damage, nephrotoxicity/ATN 4. bone damage, Fanconi syndrome 5. gray baby syndrome, aplastic anemia 6. Acute cholestatic hepatitis

1. FQ 2. Sulfa 3. AG 4. Tetracyclines 5. Chlorampenicol 6. Macrolide

Nephrotic dz associated with: 1. AA/Hispanic, obesity, HIV, heroin use 2. MCC in adults; Adenocarcinoma, NSAIDs, hepatitis, SLE, Hep B>C 3. Hep C>B/cryoglobulinemia, lipodystrophy 4. MCC in kids; NSAIDs, lymphoma 5. URI

1. FSG Biopsy shows sclerosis in the renal capillary tufts Tx: prednisone, cytotoxic meds, ACE-I/ARBs 2. Membranous glomerulonephritis 3. Membranoproliferative glomerulonephritis 4. Minimal change dz 5. IgA nephropathy (berger dz)

1. Leg that is shortened and externally rotated. 2. Leg that is shortened, internally rotated, flexed, and adducted. 3. Leg that is shortened, externally rotated, and abducted.

1. Femoral neck fx 2. Posterior hip dislocation 3. Anterior hip dislocation

Stages of labor? Timing? Timing for prolonged labor?

1. First stage a. latent phase (0-6cm dilation) no defined rate. >20 hours (nulliparous); >14 hours (multiparous) b. active phase (6-10cm dilation) nl: >1cm/2 hours >4 hours with adequate contractions; >6 hours with inadequate contractions 2. Second stage - dilation to delivery >4 hours (nulliparous); >3 hours (multiparous) 3. Third stage - delivery to placenta >30min

What syndrome is associated with these facial dysmorphisms? 1. Long, narrow face. 2. epicanthal folds 3. thin upper lip/vermilion border 4. Small palpebral fissures 5. upslanting palebral fissures 6. smooth philtrum 7. Large, protruding ears

1. Fragile X 2. Down 3. FAS 4. FAS 5. Down 6. FAS 7. Fragile X

What is this definition? 1. Rubbing one's genitals against another person who is not consenting? 2. One reveals their genitals to an unsuspecting person for shock value. 3. Act of using inaminate objects for sexual pleasure. 4. One gets sexual pleaure from engaging in sexual activity with dead bodies 5. Individuals who gain pleasure from watching other people undress or engage in sexual acitivity.

1. Frotteurism 2. Exhibitionism 3. Fetishism 4. Necrophilia 5. Voyeurism

Surgical site infections d/t what organism: 1. 1 day - 1 week 2. 1 week - 1 month 3. >1 month

1. GAS or Clostridium perfringens 2. Other organisms not in 1 3. Indolent organisms

What dz process is associated with these US findings? 1. diffuse mural thickening with a large hypoechoic foci without pericholecystic fluid 2. echogenic material with posterior acoustic shadowing and pericholcystic fluid and thickened GB wall 3. echogenic material with posterior acoustic shadowing without periocholecystic fluid and gast within the biliary tree 4. hepatomegaly with periportal edema and decreased liver echotexture 5. hypoechygenic, mobile liquid without shadowing, pericholecystic fluid, and thickened gallbladder wall

1. GB adenocarcinoma 2. Acute cholecystitis 3. Gangrenous cholecystitis 4. Acute hepatitis 5. Biliary sludge (could be indicative of acalculous cholecystitis)

Post-Streptococcal Glomerulonephritis 1. Sx? 2. Ab? 3. Immunofluor? 4. Tx? 5. Complement low, normal, or elevated?

1. GN develops 10-14 days (1-3 weeks) after strep infection with hematruria, edema, proteinuria, oliguria, HTN, smokey-brown urine. 2. Antistreptolysin-O, anti-DNase B, hyaluronidase + 3. mesangial and glomerular capillary deposition of C3 and IgG subepithelial humps ("Lumpy bumpy") or in a granular pattern. 4. Supportive 5. low complement (low serum C3)

Insulin 1. Rapid-acting? 2. Medium-acting? 3. Long-acting?

1. Glusine Aspart Lispro 2. Regular NPH 3. Detemir Glargine

Prolactin: -Inhibits: -What other hormones affect prolactin?

1. GnRH -> Decreased FSH/LH 2. TRH increases prolactin 3. Dopamine inhibits prolactin

Conjunctivitis in neonates 1. first few days (2-5 days) 2. 1-2 weeks (5-14 days) 3. First 1-2 days of life. tx? What is given as prophylaxis and what is it against?

1. Gonococcal - IM cefotaxime Often appear septic/ill-appearing, hypothermic, excessive WL 2. Chlamydial - oral azith/erythro Up to 50% of pts with chlamydia conjunctivitis will develop C. trachmatis induced pneumonia Topical erythromycin - chlamydial conjunctivitis or both?? I don't know.. everywhere says something different? 3. Chemical conjunctivitis - d/t placement of prophylactic meds (silver nitrate, not used anymore). Self-resolves. No systemic sx.

Vasculitis that is 1. c-ANCA +? 2. What is other name for c-ANCA? 3. p-ANCA? 4. Other name for P-ANCA?

1. Granulomatosis with Polyangiitis (Wegener's) 2. anti-PR3 3. Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss Syndrome) & Microscopic Polyangiitis 4. anti-MPO

1. MCC of hypothyroidism? 2. MCC of hyperthyroidism? 3. These sx are associated with which dz? a. fatigue b. lid lag c. myopathy d. generalized myxedema e. proptosis f. periorbital edema g. pretibial myxedema h. myxedema coma i. acropachy (looks like finger clubbing) j. diffuse palpable goiter with audible bruit 4. anti-TSH rec Ab 5. Germinal centers in the thyroid gland 6. Follicular hyperplasia 7. anti-thyroid peroxidase Ab, anti-microsomal Ab, anti-thyroglobulin Ab

1. Hashimoto thyroiditis 2. Graves disease a. BOTH! b. Graves c. BOTH! (Hypothyroid myopathy & thyrotoxic myopathy) d. Hashimoto e. Graves f. Graves g. Graves h. Hashimoto i. Graves j. Graves 4. Graves 5. Hashimoto 6. Graves 7. Hashimoto

1. Anti-thyroid perodidase Ab (Anti-TPO Ab) 2. TSH-rec Ab 3. Anti-thyroglobulin Ab 4. Antimicrosomal Ab 5. Antimitochondrial Ab

1. Hashimoto; can also be seen in subclinical hypothyroidism & subacute lymphcytic (silent/painless) thyroiditis 2. Graves 3. Hashimoto 4. Hashimoto 5. Primary biliary cholangitis

1. Indications for plasma exchange? 2. Indications for IVIG?

1. Hematologic - TTP, Hyperviscosity syndromes *Waldenstrom macroglobulinemia, multiple myeloma) Renal - Granulomatosis with polyangiitis (wegener), microscopic polyangiitis, anti-GBM disease (Goodpasture) Neurologic - AIDP (Guillian Barre), CIPD, MG crisis 2. Autoimmunte encephalitis, Multiple Sclerosis flares, AIDP

What disease associated with these abnormalities? 1. Nl PT. Prolonged PTT. Nl bleeding time. Nl Platelet quantity. 2. Prolonged PT/PTT. Nl bleeding time. Nl platelet quantity. 3. Nl PT. Nl/prolonged PTT. Prolonged bleeding time. Nl platelet quatity. Abnl ristocetin assay level 4. Nl PT/PTT. Prolonged bleeding time. Decreased platelet quantity. Abnl ristocetin assay level. Giant platelets. Thrombocytopenia 5. Nl PT/PTT. Prolonged bleeding time. Nl platelet quantity. 6. Nl PT/PTT. Prolonged bleeding time. Decreased platelet quantity. 7. Prolonged PT/PTT. Prolonged bleeding time. Decreased platelet quantity.

1. Hemophilia A/B 2. Vit K def 3. von Willebrand def. 4. Bernard-Soulier syndrome 5. Glanzmann thrombasthenia 6. ITP & Acquired TTP 7. DIC

Which pattern is the following higher in - Cholestatic pattern vs hepatocellular pattern: 1. AST/ALT 2. Alk phos 3. Direct bili 4. Indirect bili

1. Hepatocellular 2. Cholestatic 3. Similar 4. Hepatocellular

Tumor lysis syndrome 1. Changes in electrolytes 2. Tx 3. Prophylaxis

1. Hyperkalemia -Hyperphosphatemia -Hyperurecemia -Hypocalcemia 2. Aggressive IVF, monitor EKG 3. Allopurinol, Rasburicase, Febuxostat, IVF.

1. Bleeding into the anterior chamber of the eye? 2. WBC in the anterior chamber of the eye? Dz? Tx?

1. Hyphema Control of IOP with topical meds or surgery. Other forms of medical mgmt - protective eye shield, restricted acitivity, head elevation. 2. Hypopyon Mgmt directed at cause - autoimmune, spread of systemic infections, direct invasion of pathogen, etc.

What does BM biopsy look like for the following conditions? 1. Aplastic anemia 2. Acute Lymphocytic Leukemia (ALL)

1. Hypocellular BM with fatty infiltrate and stromal cells 2. infiltrative blasts

15 yo F with heavy menstrual bleeding and: 1. Thrombocytopenia 2. Nl platelets, prolonged bleeding time

1. ITP 2. von Willebrand Disease

Status epilepticus treatment

1. IV Lorazepan 0.1mg/kg or 4mg for termination. IM midazolam if IV access not available. If repeat seizure repeat dose of lorazepam (or diazepam if lorazepam not available.) 2. Prevent seizure recurrence with: Fosphenytoin, phenytoin, levetiracetam, valproic acid. -After stabilization - neuroimaging -Refractory and if no return to nl state of consciousness - continuous EEG, intubation with continuous infusion of medazolam, propofol, or phenobarbital

Tx of: 1. CVID? 2. CGD? 3. Bruton's agamma? 4. Wischot-Aldrich? 5. SCID? 6. DiGeorge?

1. IV immunglobulin replacement 2. Immunomodulators 3. IV immunoglobulin replacement 4. Hemato stem cell transplant 5. Hemato stem cell transplant 6. cultured Thymus transplant

Size of ureteral stone that is unlikely to pass spontaneously? Mgmt?

>10mm Urologic evaluation and hospitalization.

Tx of: 1. Aortic Regurgitation 2. Aortic Stenosis 3. Mitral Regurgitation 4. Mitral Stenosis 5. Mitral Valve Prolapse

1. If asxatic - no tx necessary. If asxatic but has severe AR and LV dysfx, medical mgmt with ACE-I/ARB to decrease afterload. If sxatic - ACE-I/ARB, diuretics, BB, aldosterone antagonists. Definitive tx is *valve replacement*. If acute AR - emergent valve replacement. If acute decompenstaed AR - Temporize prior to surgery with IV vasodilators (Nitroprusside - improves CO/forward flow and lower LC diastolic pressure and pulm venous pressure by decreasing afterload) and ionotropes (Dobutamine - increases contractility and cardiac output) 2. Valve replacement 3. For primary causes of MR: exercise program and repeat echo for chronic/severe with LVEF >60%. Surgery (*replacement*) for LVEF 30-60% regardless of sx. Secondary MR - surgery rarely indicated. Medical mgmt with ACE/ARB and BB. 4. Mild - medical tx with diuretics & BB. Severe - *valvotomy*. replacement in valvotomy is CI. 5. If asxatic - no tx. If sxatic - BB

ITP 1. tx? How does tx for children differ? 2. Other screening to include when dx suspected. 3. Etiology of ITP? 4. What should the workup include? 5. In the setting of ITP what findings are associated with increased risk of bleeding?

1. If cutaneous sx only & platelets >30,000 - observation only. -if platelets <30,000: steroids -If bleeding or platelets <10,000 - steroids, IVIG. -For chronic ITP: splenectomy, rituximab -In children, with cutaneous sx only will usually recover spontaneously regardless of platelet count - observe. However, if bleeding, give steroids, anti-D, or IVIG. 2. MC secondary causes: HIV, Hep C. If underlying autoimmune dz suspected: ANA or other depending on pt. 3. IgG autoantibodies to host platelets -> excess destruction of platelets in the spleen. 4. Peripheral smear; coag studies; HIV, Hep C; situational tests - H pylori (if GI sx), TSH, Bone marrow testing, ANA, RF, immune work-up, B12/folate, Hepatitis panel & liver testing 5. Wet purpura - petechiae and purpura in the mouth has increased risk of bleeding Dry purpura - on skin, have no increased risk of bleeding

Tx of paroxysmal supraventricular tachycardia

1. If hemodyn stable: -Adenosine -Vagal maneuvars: increase parasym stimulation and temporary slowing conduction of AV node and increase AV node refractory period. 2. If hemodyn unstable: synchronous cardioversion

Post-op fever timeline

1. Immediate - hours MI (MCC of fever and MC complication on day 0) Pre-existing inf (pna, UTI) Surgical inflammation Immune reaction Malignant hyperthermia 2. Early - first 3 days Pneumonia (MCC of fever in day 1-3) UTI (2nd MCC of fever in day 1-3) MI Early surgical site inf DVT Other non-infectious causes (EtOH withdrawal, pancreatitis, gout) 3. late - after day 3 MCC are infection-related - surgical site infection (superficial MC earlier; deep MC the further out from surgery) Nosocomial infe (Central line, urinary cath, ventilator) DVT

Screening & dx of gestational DM

1. In a pt without RF for GDM - 24-28 weeks: admin 50-g glucose load & check in 1 hr: <140: gest DM unlikely >140: move to step 2. 2. Admin 100-g glucose load and check q hr x3 h: Dx of gest DM requires 2+ abnl values: fasting: >95 1-hour postprandial: >180 2-hour postprandial: >155 3-hour postpradial: >140 In pts with RF for GDM - obesity, prior GDM, etc. screen in first TM and again 24-28 wks

AV fistula has what effect on: 1. Preload 2. Afterload 3. CO

1. Inc 2. Dec 3. Inc

Changes to preload, afterload, and CO on: 1. High-output cardiac failure? 2. Hypovolemia? 3. Cardiogenic shock? 4. sepsis? 5. Exercise? 6. Cocaine?

1. Inc preload -> inc CO. dec afterload 2. Low preload -> low CO -> compensatory inc afterload 3. Dec CO -> compens inc afterload -> inc preload 4. Dec afterload -> nl/dec preload -> compensatory inc CO 5. high CO & high afterload; low preload 6. high afterload; nl CO; nl preload

Pna/Consolidation: 1. BS 2. tactile fremitus 3. Percussion

1. Increased 2. Increased 3. Dullness

physiologic changes of pregnancy 1. CO, HR, SV 2. BP 3. Residual vol, Functional Residual Capacity, Expiratory Reserve Vol 4. Tidal Vol, Min Vent, RR 5. Met/resp acid/alk? 6. Renal plasma flow, GFR, BUN/CR 7. TG, cortisol, TSH, TBG, total T4, free T4

1. Increased CO = Increased HR * Increased SV 2. Decreased BP 3. Decreased RV, FRC, ERV 4. increased MV = increased TV * unchanged RR 5. Resp alk with metabolic compensation 6. Increased renal BF & GFR. Decreased BUN/Cr. 7. Increased TG, cortisol. TBG increases, total T4 increases, free T4 unchanged, TSH decreases (d/t hcG elevations stimulates TSH rec -> inc production of thyriod hormone and negative feedback to TSH).

HIV pt with 1. flat or raised, darkly pigmented skin lesions (plaques, papules, noodules) 2. Raised, friable, *vascular*, papules/plaques

1. Karposi sarcoma 2. Bacillary angiomatosis

What diseases are these nail findings associated with and what is the name classified as? 1. raised ridges of the nail become thin and concave. 2. depressions in the nail plates (apical nail matrix) 3. separation of the nail plate from the bed (distally) 4. brittle nails that split vertically generating a vertical ridge and gives the nail a "peeled" appearance. 5. white line or other white discoloration of the plate (middle nail matrix) 6. inflammation to proximal or lateral nail fold 7. red/pink spots within the lunula (whole nail matrix) 8. disintegration of the nail plate (whole nail matrix) 9. spots of yellow or pink color change within the nail (whole nail bed) 10. inward advance of skin over the nail plate What are the MC nail findings in pts with psoriasis?

1. Koilonychia (aka - "spoon nail") - idiopathic, acquired, or hereditary. Seen in Iron-def anemia or Plummer-Vinson syndrome. Also associated with psoriasis and lichen planus, hemochromatosis, nl finding in newborns. 2. Pitting - psoriasis 3. onycholysis - psoriasis 4. Onychorrhexis - exposure to chemical/cosmetics, malnutrition, hypothyroidism, eating disorders, psoriasis, lichen planus, atopic dermatitis, chronic graft vs host disease. 5. leukonychia - psoriasis 6. paronychia - generally d/t trauma 7. Lunular spotting - psoriasis 8. Nail plate crumbline - psoriasis 9. Oil drop discoloration/salmon patches - psoriasis 10. pterygium - usually from trauma to the nail matrix d/t surgery or a deep cut to the nail plate; systemic connective tissue disease onycholysis, oil spots, nail pitting

AR (decrescendo diastolic murmur d/t ________ is best heard where? 1. bicuspid valve 2. aortic root dilation

1. L sternal border at the 3rd and 4th ICS with the pt sitting up, leaning forward, and holding their breath in full expiration. 2. radiates toward the R side; along the R sternal border.

1. Persistent difficulties in comprehension and production of spoken and written language. 2. Stuttering 3. Articulation problems 4. Difficulty in social use of verbal and nonverbal communication

1. Language disorder. 2. Childhood-onset fluency disorder 3. Speech sound disorder 4. Social (pragmatic) communication disorder

Bipolar tx 1. long-term mgmt 2. acute psychosis 3. Acute agitation 4. pregnant

1. Lithium, typ/atyp antipsychotics (olanz, quetiapine), valproate, carb, lamotrigine. Use combination in severe mania (antipsych + lith/valp) 2. Antipsychotic - olanzapine 3. Acute agitation - benzo 4. Lamotrigine

Tumor markers associated with what malignancies? 1. Alpha-fetoprotein (AFP) 2. CA19-9 3. CA-125 4. Calcitonin 5. CEA 6. Beta-hCG 7. PSA 8. Thyroglobulin

1. Liver (HCC), germ cell tumor (ovarian or testicular) 2. Pancreatic > bowel, biliary 3. Ovarian 4. Medullary thyroid carcinoma 5. Epithelial cancers (bowel, lung, thyroid, pancreatic, cervical, bladder) 6. Prostate 7. Thryoid

What disease with these EKG findings? 1. Abnormal cardiac-ion channels, resulting in prolongation of AP 2. Accessory pathway, bundle of Kent, which directly links the atria to the ventricles, bypassing the AV node, resulting in a wide QRS 3. Accessory pathway, James bundle, which directly links the atria to the ventricles, bypassing the AV node, resulting in a narrow QRS 4. Defective myocardial-Na channels reducing Na inflow current, thereby reducing the duration of nl AP 5. Defective gain of fx mutation in K channels in an abbreviated repolarization phase during AP and shortneing of the QT interval. 6. Circular movement of electrical activity around the atrium 7. disorganized atrial contraction 8. Firing of multiple atrial pacemakers 9. reentrant circuit around the AV node

1. Long QT syndrome 2. Wolf-Parkinson White syndrome 3. Lown-Ganong-Levine Syndrome 4. Brugada Syndrome 5. Short QT syndrome 6. AFlutter 7. Atrial fibrillation 8. Multifocal atrial tachycardia 9. AVNRT

Pregnant woman with virilization: 1. bilateral ovarian cysts 2. unilateral ovarian cyst

1. Luteomas of pregnancy or theca lutein cysts. Mgmt: observation and expectant mgmt. Often spontaneously resolve following delivery. 2. Sertoli-Leydig tumor. Mgmt: surgery or oophorectomy may be indicated

Hereditary spherocytosis 1. MCHC 2. Coombs 3. retic count 4. MCV

1. MCHC increased 2. Neg coombs 3. Elevated retic 4. Nl MCV

Depression and psychotic features 1. Occurring at the same time 2. Occurring completely separate from one another

1. Major depression with psychotic features 2. Schizoaffective disorder

What's the cause? 1. Large, nonpainful, unilat pleural effusion. 2. bilat transudative pleural effusion

1. Malignant - exudative 2. CHF

SAD 1. Criteria 2. Tx

1. Marked anxiety about >1 social situations X 6 months. 2. SSRI/SNRI + CBT. BB for performance anxiety.

Eval of hyponat: 1. Serum osmol >290? 2. Urine osmol <100? 3. Urine Na <25? 4. Otherwise, consider what?

1. Marked hyperglycemia, advanced renal failure 2. Primary polydipsia, severe malnutrition (beer drinkers) 3. Vol depletion, CHF, cirrhosis 4. SIADH, adrenal insuff, hypothyroidism

Tx of: 1. BPPV 2. Meniere dz

1. Meclizine & Epley maneuver 2. Caffiene/Na restriction, diuretics (thiazides), meclizine, vestibular rehab, intratempanic steroids/gentamicin

Meds to avoid in STEMI tx in - 1. RV infarction? 2a. Bradycardia? 2b. Bradycardia temporizing measures until cath lab?

1. Meds that decrease preload - BB, nitrates, morphine 2a. BB, CCB 2b. Atropine, Dopamine

Which DMARD is assocated with these ADR: 1. hepatotox, megaloblastic anemia, stomatitis, cytopenias 2. Hepatotoxicity, cytopenias 3. retinopathy 4. Hepatotoxicity, stomatitis, hemolytic anemia 5. infection, demyelination, CHF, malignancy

1. Methotrexate 2. Leflunomide 3. Hydroxychloroquine 4. Sulfasalazine 5. TNF inhibitors (adalimumab, etanercept, etc.)

What Abx has this MOA - 1. interacts with the helical structure of DNA and causes breakdown through production of free radicals? 2. inhibition of the 50s ribosomal subunit resulting in tremination of the amino acid sequence preventing bacterial synthesis by inhibiting transpeptidation, translocation, and chain elongation? 3. inhibition of DNA topoisomerases II & IV which are required for bacteral DNA replication, transcription, repair, and recombination? 4. inhibition of bacterial cell wall synthesis by inhibiting the transpeptidase that catalyzes the final step in cell wall biosynthesis and induces bacterial autolytic effect? 5. Inhibitor of the 30S ribosomal subunit preventing bindonf of aminoacyl-tRNA to the acceptor site of the mRNA -ribosome complex. 6. Require O2 for uptake into bacterial cells 7. Inhibits the 50S peptidyl transferase enzyme in bacterial cells.

1. Metronidizole 2. Macrolide (-thromycin) 3. Fluoroquinolones (-floxacin) - bacteriocidal 4. Beta-lactams (PCN) 5. Tetracycline (-cycline) ADR - Discolored teeth & inhibition of bone growth (children). Photosensitivity, GI upset 6. Aminoglycosides 7. Chlorampenicol

Diffuse esophageal spasm -W/u -Tx

1. Mimics MI - first r/o MI 2. barium swallow (corkscrew esophagus) 3. Manometry - periodic contractions Tx: nitrates, CCB

What murmur? 1. Holosystolic blowing murmur with mid-systolic click that radiates to axilla? 2. Opening snap followed by late diastolic rumble & loud S1 with radiation to axilla? 3. Diastolic decresendo murmur with uvular pulsation, radiates to carotids at L or R sternal border, head bobbing, wide pulse pressure? 4. Cresendo-decresendo systolic murmur that radiates to carotids & soft/single S2? 5. Wide, fixed splitting of S2, mid-systolic murmur at LUSB, and mid-diastolic murmur? 6. Continuous, Machine-like murmur? 7. mid-to-late systolic click +/- followed by a high-pitched, blowing, holosyststolic crescendo-decrescendo murmur? 8. Holosystolic murmur at left sternal border that radiates to R lower sternal border and increases with inspiration? 9. Harsh crescendo-decrescendo systolic murmur without radiation?

1. Mitral Regurg 2. Mitral Stenosis 3. Aortic Regurg 4. Aortic Stenosis 5. Atrial Septal Defect 6. Patent Ductus Arteriosus 7. Mitral Valve Prolapse 8. Tricuspid Regurg 9. HOCM

Murmurs that change S sounds? 1. Loud S1? 2. single & Soft S2? 3. S4? 4. S3? 5. Soft S1?

1. Mitral Stenosis 2. Aortic Stenosis 3. Aortic Stenosis 4. Aortic Regurg & severe Mitral Regurg 5. Mitral Regurg

IUFD is characterized as fetal death at ________ weeks. Mgmt:

>20 weeks 20-23 weeks: dilation & evacuation or vaginal delivery. >24 weeks: vaginal delivery

Hypocalcemia 1. Sx 2. EKG 3. Dx 4. Tx

1. N/T, periorbital tingling; Tetany; Seizures 2. Prolonged QT 3. Check albumin to correct first (if albumin <4, for every 1 change there will be a decrease of Ca by 0.8). Check ionized Ca. Recent drug/blood transfusion or hypomag? If not, check PTH for underlying cause. 4. Severe/sxatic - IV calcium glucanate. Long-term - oral Ca

Which neurocutaneous syndrome? 1. Inguinal/axillary freckling 2. Ash-leaf spots (hypopigmented) 3. Cafe-au-lait spots (hyperpigmented) 4. Shagreen patch (Leathery texture) 5. Red papules on face/nasolabial fold (Adenoma Sebaceum; angiofibromas) 6. Lisch nodule (iris hamartoma) 7. Facial vascular nevi

1. NF-1 2. TS 3. NF1, NF-2 4. TS 5. TS 6. NF-1 7. Sturge Weber

Seizure after getting DTaP. 1. Is this an allergy? 2. Should they get any more of this vaccine? 3. What are CI to DTaP vaccine?

1. Not an allergy 2. They should get additional doses if seizure. 3. CI: -anaphylaxis (No DTaP) -encephalopathy within 1 week of vaccine or unstable neuro d/o (uncontrolled epilepsy) - no combination vaccine. Should get diphtheria and tetanus toxoids, no pertussis.

What disease? 1. Normal Ca, P, Alk phos, PTH 2. Normal Ca, P, PTH. Elevated Alk phos 3. Normal/decreased Ca, P. Elevated Alk phos, PTH 4. Decreased P. Elevated Ca, Alk phos, PTH 5. Decreased Ca. Elevated P, Alk phos, PTH

1. Osteoporosis 2. Paget disease of bone & osteopetrosis 3. Vit D def (osteomalacia, rickets) 4. Osteitis fibrosa cystica, primary hyperparathyroidism 5. Secondary hyperparathyroidism

Premature menopause 1. Definition?

1. Ovarian failure and menstrual cessation before 40 yo; must rule out medical causes of amenorrhea.

Methemoglobinemia 1. Causes 2. S/Sx 3. Labs 4. Tx

1. Oxidizing substances - dapsone, local/topical anesthetic. 2. Cyanosis. Pulse ox <85%. Dark chocolate blood 3. Saturation gap (>5% difference between oxygen sat on pulse ox and ABG). Nl PaO2 that does not improve with supplemental O2. 4. Methylene Blue (CI in G6PD def), high-dose vitamin C

TB screening In the ED in a pt who is sxatic - what tests should you get?

1. PPD 2. If + -> CXR -if CXR -, latent TB. Treat with INH + B6 x9 mo 3. If CXR +, active TB. Get AFB smear x3 -if neg, treat like latent TB. Treat with INH + B6 x9 mo -If pos, active TB. Treat with RIPE x6mo. CXR and sputum staining

Evaluation of hypoxemic pt:

1. Paco2 level? a. not elevated -> A-a gradient? -not increased: low inspired Pao2 is cause of hypoxemia. -increased: is the lower Pao2 improved with supp O2? --yes: V/Q mismatch --no: shunt b. elevated -> hypoventilation. Is the A-a gradient increased? -yes: hypoventilation alone does not account for hypoxemia. Look for another mechanism. -no: hypoventilation alone accounts fr hypoxemia.

Microbio associated with arthritis in peds & 1. trauma - animal bite 2. trauma - puncture wounds 3. Skin lesions 4. Skin/soft tissue infections 5. Recent Abx course 6. sickle cell disease 7. Travel/outdoor exposure 8. Immunizations status 9. H/o IBD 10. Recent URI

1. Pastuerella 2. Sporotrix, anaerobes 3. N. gonorrhea, N. meningitis, Lyme 4.S. aureus, S. pyogenes 5. Resistent organisms or reactive arthritis or serum sickness 6. Salmonella 7. Chikungunya, Lyme, Mycobacterium tuberculosis 8. H. influenza type B, S. pneumo, measels, mumps 9. IBD associated arthritis 10. Reactive arthritis, transient (toxic) synovitis

These mechanisms are associated with what diseases? 1. Abundant mineralization of periosteum 2. Cortical bone loss 3. Disorganized bone remodeling; mosiac lamellar bone pattern 4. Fibrous replacement of bone 5. increased deposition of poorly mineralized osteiod 6. Inc insulin-like GF-1 production 7. monoclonal plasma cell infiltration

1. Periosteal reaction. Seen in response to irritation (osteomyelitis, benign/malig tumors, excess vit A) 2. Primary hyperparathyroidism 3. Paget dz 4. Fibrous dysplasia. Occurs in children and usually involves one bone-monostotic. Polyostic form: McCune-Albright 5. Osteomalacia 6. Acromegaly 7. MM

Postcholecystectomy syndrome 1. s/sx 2. labs 3. Imaging findings 4. dx

1. Persistent ABDOMINAL PAIN OR DYSPEPSIA (nausea) that occurs Postop (early) or MONTHS TO YEARS (LATE) after CHOLECYSTECTOMY 2. increased alk phos; mild elevation in AST/ALT. 3. Dilated CBD on Abd US 4. 1st is US. Definitive dx with ERCP

Shoulder dislocations 1. aDd & IR/ER 2. aBd & ER What nerve affected? How do they appear on AP XR?

1. Posterior shoulder dislocation (PD) 2. Anterior shoulder dislocation (AB) Axillary nerve injury **Some discrepancies about abd vs add; many say both are abd. Main thing is ER=ant & IR=post Anterior - often inferior displacement of humeral head. Posterior - often appear normal on AP XR.

Female breast tanner stages

1. Prepubertal 2. breast bud below areola 3. enlargement and elevation of breast and areola 4. areola forms secondary mound above breast 5. smooth breast contour from recession of secondary mound; fully developed

Male Genital Tanner Stages

1. Prepubertal (3 cm3) 2. Enlargement of testes (5 cm3), reddening/thinning/enlargement of scrotum 3. Penile enlargement (length then diameter), testes (10 cm3); skin over scrotum is darker and more wrinkled 4. Continued enlargement of testes (15 cm3) and penis, enlargement of glans 5. Normal adult size and proportion, testes (20-25 cm3)

1. Prerenal failure 2. Intrinsic renal failure 3. Postrenal failure a. BUN/Cr ratio b. FENa c. urine sediment d. urine osmol e. urine Na f. urine-plasma Cr

1. Prerenal a. increased (>20:1) b. decreased (<1%) c. bland; +/- hyaline casts d. inc (>500) e. decreased (<20) f. increased (>40:1) 2. Intrinsic a. decreased (<20:1) b. increased (>2%) c. full brownish pigment with granular casts and epithelial casts d. decreased (<350) e. increased (>40) f. decreased (<20:1) 3. Postrenal a. BUN/Cr ratio >15 b. c. d. decreased <350 e. increased >40 f.

Pna in HIV pts: 1. MCC 2. fever, pleuritic CP, hemoptysis. Focal lesin (nodules +/- cavitation) 3. Dyspnea, nonprod cough, fever. Bilat, diffuse interstitial infiltrates. 4. pna associated with IE presenting as rapidly progressive necrotizing pna

1. S. pneumo 2. Invasive aspergillus 3. PCP 4. S. aureus

1. Hyponatremia, low urine osmol, high urine Na 2. Nl/Hypernatremia, high serum osmol, low urine osmol, low urine Na 3. Hyponatremia, low serum osmol, high urine osmol, high urine Na 4. Nl serum Na, Low urine osmol 5. Hypernatremia, increased urine osmol 6. Hyponatremia, low urine osmol, low urine Na

1. Primary polydipsia 2. DI - Central has impaired thirst so hypernatremia is worse. Nephrogenic DI has intact thirst, so Na may be nl/slightly elevated. 3. SIADH 4. Hyposthenia (Sickle cell dz/trait) - kidney is unable to concentrate urine. 5. Dehydration 6. Beer potomania - Na deficit from increased glucose/free water build up (beer).

Placenta previa: 1. RF 2. Mgmt 3. Dx 4. If presenting in 3rd TM what is mgmt? 5. when is it screened for?

1. Prior C-sec -Multiparity (grand multiparity) -smoking -Prior placenta previa -Advanced maternal age -multiple gestation 2. Pelvic rest (no sex/digital exam). Most cases resolve by 3rd TM (repeat US in 3rd TM). If persistent C-sec should be planned at 36-37 weeks. If presenting with vaginal bleeding - if pt remains stable, bleeding subsides -> expectant mgmt If hemorrage persists/worsens, signs of fetal distress - immediate delivery is warranted (C-sec) 3. Transabd US. If nondiagnostic, then transvag US. 4. Acute 3rd TM painless vaginal bleeding. First, get transabd US. Often ceases in 1-2 hours with or without uterine contractions. C-section is the method preferred for delivery. 5. screening US aroudn 18-20 wks

These drugs have what effect on EKG? 1. Non-DHP CCB 2. Digoxin

1. Prolong PR interval 2. Widen QRS; Atrial tachycardia with AV block is most specific; Short Qt interval; flattened/inverted/biphasic T waves; downslopping ST depression

Cancer: MC incidence? MCC of death?

1. Prostate/breast 2. Lung 3. Colorectal 1. Lung 2. Prostate/breast 3. Colorectal

1. Localized pulsatile mass with systolic bruit. 2. Localized tenderness/swelling without mass and continuous bruit.

1. Pseudoaneurysm 2. AV fistula

Prenatal genetic screening 1. Quad screening 2. Amniocentesis 3. Chorionic villus sampling 4. Nuchal translucency 5. Percutaneous umbilical cord smapling

1. Quad screening - done 15-20 weeks. Assesses risk for neural tube defects, trisomy 13/18/21. Measures alpha-fetoprotein, estriol, B-hCH, and inhibin. (Inhibin A is excluded in the triple marker test) 2. Amniocentesis - invasive. Can be done at any gestational age >14 weeks (15-20 weeks). Generally only done if indicated. Indications: abnl screening US, abnl 1st TM screen, abnl quad screen, or advanced maternal age. Complications - ROM, chorioamnionitis, miscarriage. 3. Chorionic Villus Sampling: taking out placenta (better for baby and can be done earlier than amniocentesis). Asses fetal karyotype. Can not detect open neural tube defects. Done 9/10-11/12 weeks. Complications: *distal limb defects*, preterm labor, PROM. Specficially <9 weeks increased risk of limb abnlities. 4. Nuchal translucency - done 11-14 weeks. Typically in conjunction with PAPP-A and B-hCG (this combo called a first screen) If pts undergo first screen, at 15 weeks alpha-fetoprotein should be drawn to determine risk for neural tube defects. 5. PUBS - invasive. Done <18 weeks Indications - fetal malformation, fetal anemia

Indicative of R vs L ventricular MI? 1. clear lungs? 2. New tricuspid regurgitation (heard at lower L or R sternal border)? 3. New mitral regurgitation? 4. 3rd or 4th heart sound? 5. pumonary congestion/edema? 6. Hypotension with JVD? 7. AV block? 8. Bradycardia? 9. Systemic hypotension? 10. Increased wedge pressure? 11. Increased R atrial pressures with nl wedge pressure?

1. R 2. R 3. L 4. L 5. L 6. R 7. R 8. R 9. R 10. L 11. R

Renal Tubular Acidosis: 1. Etiology, MCC, and tx of each one? 2. Hyperkalemia? 3. Alkaline urine? 4. Associated nephrolithiasis? 5. Associated with Fanconi syndrome?

1. RTA 1: decrease secretion of H at distal tubule. MCC: Lithium Ass w/: alkaline urine, nephrolithiasis Tx: bicarb RTA 2: decrease bicarb reabs in proximal tubule MCC: Multiple Myeloma Ass w: Fanconi anemia Tx: diuretic RTA 4: hypoald & resistance to ald MCC: DM Ass w/: adrenal insuff, hyperkal Tx: mineralocorticoid (fludricortisone) 2. Type 4 associated with hyperkal 3. Type 1 associated with alkaline urine (>5.5). 4. Type 1 associated with nephrolithiasis 5. Type 2 associated with Fanconi syndrome

Dx imaging & tx for: 1. Cholelithaisis 2. Cholecystitis 3. Choledocolithiasis 4. Cholangitis Tx

1. RUQ US elective cholecystectomy if sxatic 2. RUQ US; HIDA (cholescintography) NPO, IVF, IV abx, urgent cholecystectomy 3. RUQ US (dilated CBD); M/ERCP ERCP with f/u cholecystectomy 4. RUQ US; ERCP NPO, IVF, IV abx, emergent ERCP + urgent cholecystectomy

Renal biopsy and which disease? 1. Apple green birefringence 2. basement membrane splitting 3. linear anti-GBM deposits 4. spike and dome granular basement membrane deposits 5. tram-track double layered BM

1. Renal amyloidosis 2. Alport syndrome 3. Goodpasture syndrome 4. Membranous nephropathy 5. Membranoproliferative nephropathy

Bronchiectasis 1. Cause 2. s/sx 3. CXR findings 4. dx 5. tx 6. associated with what kind of infections?

1. Repeated pulm infections, CF, Kartrageners. 2. Similar to COPD which more sputum production. Crackles/rhonchi/wheezing. No smoking hx. Hemoptysis. WL 3. Linear atelectasis, dilated/thickened airways, irregular peripheral opacities. 4. High-res CT showing bronchial dilation, lack of airway tapering, mucous plugging, and bronchial wall thickening with tree-in-bud changes. "Signet-ring" sign - large, dilated airway is adjacent to smaller, opacified vessel. 5. bronchial hygiene; chest physiotherapy 6. Pseudomonas infections and colonization - should be empirically treated with antipseudomonal coverage (cefepime) when ill w/ lower resp tranct infection is suspected.

W/u for CAD

1. Resting EKG 2. Exercise Stress test (EKG or echo. Exercise if possible, pharm if cannot exercise) If + stress -> cardiac cath

What is the most likely cause? 1. Transudative or exudative with low glucose? 2. Exudative and bloody? 3. Transudative and bloody? 4. Transudative or exudative with elevated lymphocytes?

1. Rheumatoid Arthritis 2. Malig 3. Pulmonary Embolism 4. TB

Food poisoning: 1. vomiting predominent 2. watery diarrhea predominent 3. inflammatory diarrhea predominent

1. S. aureus, B. cereus, Norovirus 2. C. perfringens, ETEC, enteric viruses, cryptosporidium, cyclospora, intestinal tapeworms 3. Salmonella, campylobacter, Shiga-toxin E. coli, enterobacter, Vibrio, yersinia

Dx of ADPKD

Abd US or CT

Esophageal manometry: 1. hypomotility and incompetence of LES. 2. Esophageal hypercontractility 3. aperistalsis, incomplete LES relaxation 4. periodic, high-amplitude, non-peristaltic contractions

1. Scleroderma 2. Eosiniophilic esophagitis 3. Achalasia 4. Diffuse esophageal spasm.

HTN & Hypokal: 1. Elevated renin & aldosterone 2. Depressed renin & Elevated aldosterone 3. Depressed renin & aldosterone

1. Secondary hyperaldosteronism - renovasc HTN, malignant HTN, renin-secreting tumor, diuretic use. 2. Primary hyperaldosteronism (ald:renin ratio >30)- aldosterone-secreting tumor, bilat adrenal hyperplasia 3. Non-aldosterone causes - CAH, Deoxycorticosteroid-producing adrenal tumor, cushing syndrome, exogenous mineralocorticoid.

Pheochromocytoma 1. Dx 2. If surgical resection what meds to give?

1. Serum catecholamines/metanephrines or 24 hour-urine catecholamine/metanephrines Urine if suspicion is low, serum if suspicion is high. Serum has decreased specificity, and positive testing may result in unneccessary imaging. -If elevated, confirm with localization of tumor with CT/MRI. 2. Phenoxybenzamine followed by propranolol (if needed for HR control) prior to surgery.

When should the following be used? 1. Fresh frozen plasma 2. Whole blod transfusion 3. Platelet transfusion 4. Packed RBC transfusion

1. Severe coagulopathy (liver dz, DIC) with active bleeding. 2. Severe hemorrhage (major trauma) where it will assist in volume expansion. 3. Pt ct <10,000 or <50,000 with active bleeding. 4. Hb <7 or sxatic

What type of lung cancer is associated with these paraneoplastic syndromes? 1. Hyperthyroidism? 2. Polymyositis/dermatomyositis? 3. Lambert-Eaton Sydnrome? 4. Carcinoid syndrome? 5. Acanthosis nigrans? 6. Cushing's syndrome? 7. SIADH? 8. Hypercalcemia (PTHrP)? 9. Tripe palms 10. Sign of Leser-Trelat?

1. Small cell lung Ca 2. Small cell lung Ca, Sqaumous cell carcinoma 3. Small cell lung Ca 4. Neuroendocrine tumors 5. Adenocarcinoma 6. Small Cell Lung Ca 7. Small Cell lung Ca 8. Sq Cell Carcinoma 9. Adenocarcinoma 10. Adenocarcinoma

What type of lung cancer is associated with these tumor markers? 1. Keratin 2. Desmoglein 3. TTF1 4. EGFR 5. Chromogranin 6. Synatophysin 7. PD-L1

1. Small cell lung ca 2. Squamous cell ca 3. Small cell lung ca 4. Adenocarcinoma 5. Small cell lung Ca, Neuroendocrine 6. Small cell lung Ca, Neuroendocrine 7. Adenocarcinoma

Primary hyperaldosteronism w/u? -tx?

1. Start with ald:renin ratio >30 Confirm with: -saline infusion test (does not suppress ald levels) OR -oral Na load (high urine ald + high urine Na) 2. Get CT/MRI to visualize tumor 3. Confirm with adrenal vein sampling -If unilat - resect -If bilat (CAH) - spironolactone or epleronone

What cholesterol medicine changes _____ the most? 1. LDL 2. HDL 3. Triglyceride

1. Statins 2. Niacin; exercise is most reliable way to raise HDL. 3. Fenofibrate

Hypercalcemia 1. Sx 2. EKG 3. Dx 4. Tx 5. MCC?

1. Stone, bones, groans, psychiatric overtones, polydypsia/polyuria. 2. Shorted QT, prolonged PR 3. Check albumin to correct first (if albumin >4, for every 1 change there will be an increase in Ca by 0.8). Check ionized Ca. Check PTH for underlying cause. 4. Severe (>14) or sxatic - *IVF, IVF, IVF*! +/- calcitonin or loop diuretics. Long-term: bisphosphonates and calcitonin. If asxatic/mild/mod hypercalcemia, no immediate tx required. 5. Hyperparathyroidism is the MCC of hypercalcemia in an otherwise heatlhy/ambulatory pt.

1. Empiric tx for Cellulitis 2. Tx for lymphangitis?

1. Strep outpt tx - PO Amox or Cephalexin Strep inpt tx - IV Ceftriaxone or Amp -Likely Staph if: blisters, bullae, or abscess. Staph outpt tx - PO Clinda or Dicloxacillin Staph inpt tx - IV Vanc or Clinda 2. Cephalexin

1. Prominent V wave? 2. Flattened y descent? 3. Prominant A wave?

1. TR 2. Tamponade 3. TS (cannon a waves = AV dissociationl seen in 3rd degree heart block)

Dz associated with which HLA? 1. DR3 2. B27 3. DR1 4. DR4 5. HLA DR3-DQ2; HLA DR4-DQ8 6. Cw6 7. DR1 8. DQ2>DQ8

1. Thyroiditis 2. Ankylosing spondylitis, Psoriatic arthritis, IBD, ant uveitis 3. Rheumatoid Arthritis 4. Rheumatoid Arthritis 5. Celiac, TIDM 6. Early-onset psoriasis 7. Lichen Planus 8. Dermatatis herpetiformis

What's the dx? 1. Mult ring-enhancing lesions at gray-white jx & basal ganglia with edema. 2. Mult well circ lesions at gray-white jx with edema. 3. Mult lesions of various stages that are non-enhancing, enhancing, & hypodense with calcifications 4. Single, irreg, non-homogenous ring-enhancing lesion in periventricular area with edema. 5. Multiple, irreg, hypodense, non-enhancing lesions in white matter without edema

1. Toxo (HIV RF) 2. Brain mets (ca RF) 3. Neurocysticercosis (T. solium) 4. Primary CNS lymphoma 5. Progressive Multifocal Leukoenceph (PML)

Which defect? 1. Decreased alpha-fetoprotein and estriol; increased B-hCG and inhibin. 2. Decreased alpha-fetoprotein, estriol, B-hCG, and inhibin. 3. Elevated alpha-fetoprotein; decreased estriol, B-hCG, and inhibin. 4. All levels normal

1. Trisomy 21 2. Trisomy 18 3. Neural tube defect (open neural tube defect) 4. Trisomy 13 or normal fetus.

Microscopic polyangiitis 1. Sx? 2. Ab? 3. Dx? 4. Tx?

1. skin (palpable purpura), lungs (cough, dyspnea, hemoptysis, pulm HTN), kidneys (GN, hematuria). *No nasal involvement* 2. P-ANCA, anti-MPO 3. Biopsy - necrotizing vasculitis without granulomas 4. ?

CI to trial of labor?

Abdominal myomectomy with uterine cavity entry. Classical C-sec

UC or CD? 1. Crypt abscess 2. Transmural 3. skip lesions 4. Superficial 5. Fistula 6. Cobblestone 7. noncaseating granulomas 8. continuous 9. pseudopolyps 10. anterior uveitis 11. PSC 12. B12 def 13. Smoking protective 14. toxic megacolon 15. perianal disease 16. rectum involvement 17. calcium oxalate stones 18. what are some "strange" manifestations seen in both? 19. MC dermatologic manifestation of IBD? second MC? 20. Tx of Crohn's disease?

1. UC 2. CD 3. CD 4. UC 5. CD 6. CD 7. CD 8. UC 9. UC 10. CD 11. UC 12. CD 13. UC 14. UC 15. CD 16. UC 17. CD 18. increases risk of VTE d/t hypercoagulapathy; erythema/pyoderma gangrenosum; interstitial lung dz Crohn's - transmural, skip lesions, fistulas, cobblestone appearance, non-caseating granulomas, anterior uveitis, B12 def (ileum affected), perianal dz (strictures, fistulas, sinus tracts), calcium oxalate stones. *MCC of spontaneous small bowel fistula* Ulcerative colitis - crypt abscesses, superficial, continuous, pseudopolyps, primary sclerosing cholangitis, smoking protective, rectum involvement, toxic megacolon 19. MC - Erythema nodosum. 2nd MC - Pyoderma grangrenosum - nonhealing ulcer and pathergy (ulceration at a site of injury) 20. Initial therapy for mild dz - enteric coated budesonide, steroids, or 5-ASA (sulfasalazine) Mod/severe - TNF-alpha inhibitor (adalimumab), methotrexate, azathioprine, 6-mercaptopurine

Tx for incontinence types: 1. Urge 2. Stress 3. Overflow

1. Urge - bladder training, anticholinergics (oxybutinin). 2. Stress - Pelvic floor training, estrogen, pessary, surgery (sling). 3. Overflow - self-cath, cholinergic (bethanecol). Alpha blockers (tamsulosin) for BPH causes.

Which leads? Reciprocal depressions? Which artery? 1. anterior wall MI 2. septal MI 3. Lateral MI 4. Inferior MI 5. Atrial MI 6. Posterior MI

1. V1-V4, +/- aVL, I Dep II, III, aVF LAD of LCA 2. V1-2 Dep II, III, aVF 3. 4. II, III, aVF I, aVL, V5-V6 RCA 5. Elevations in PR interval (not sure if there are specific leads; reciprocal depressions; or specific artery involvement?) 6. ST dep in V1-V4; R/S wave ratio >1 in leads V1-V2; ST elevation in post leads V7-V9 RCA in a right-dominant heart; Circumflex artery from the PDA

Dementia with: 1. stepwise decline, early loss of executive dysfx, neuro findings: asym reflexes, urinary freq, gait abnlities. 2. Early personality changes, apathy, disinhibition, compulsive behavior. Primitive reflexes. 3. Early visual hallucinations, fluctuating cognition, Spontaneous parkinsonism 4. insideous short-term memory loss, language deficits/spatial disorientation, later personality changes. 5. gait instability/wide-based/shuffling gait, followed by cognitive impairment (memory, executive dysfx), and late urinary incontinence (early presents as urgency).

1. Vascular dementia - cerebral infarction & deep white matter changes on imaging. 2. Frontotemporal dementia (picks dz) - Frontotemporal atrophy on imaging & silver staining cytoplasmic inclusions within neurons in the hippocampus. 3. Dementia with Lewy Bodies 4. Alzheimer dz - medial *temporal* lobe atrophy on imaging 5. Nl pressure hydrocephalus - Ventriculomegaly on imaging. Also ass. w/ UMN signs Severity associated with neurofilament protein in CSF.

Menopause 1. Sx? 2. Definition? 3. Hormone leves - estrogen, FSH, LH, GnRH 4. Tx? 5. When is tx CI'd?

1. Vasomotor sx (hot flashes) & vaginal atrophy (pale, shiny vagina with petechiae), osteoporosis, CAD, insomnia, mood changes, loss of libido. 2. Cessation of menses for a minimum of 12 mo 3. Estrogen decreased -> GnRH increased -> increased FSH & LH. FSH >= 25 indicative 4. HRT - estrogen + progesterone if intact uterus, venlafaxine. If HRT CI'd use SSRI's, SNRI's, antiepileptics, or clonidine. Vasomotor sx - fans, avoid exacerbating factors. If severe - HRT. Vaginal atrophy - lubricants, topical estrogen therapy. 5. HRT CI in previous breast cancer, CAD, DVT/Pulmonary Embolism, smokers

Tx for: 1. MGUS 2. Multiple myeloma 3. Waldenstrom Macro

1. Watch & wait 2. chemo + hematopoetic cell transplant 3. chemo (rituximab) + plasmaphoresis

Granulomatosis with Polyangiitis 1. AKA? 2. Sx? 3. Ab? 4. CXR? 5. Tx? 6. Dx?

1. Wegener's 2. sinusitis, saddle nose deformity, hemoptysis, hematuria, rapidly progressive GN (AKI), & SLE-like sx - arthralgias, conjunctivitis, fever, WL, livdeo reticularis, non-healing ulcers 3. C-ANCA, anti-PR3 4. Pulmonary infiltrates - alveolar hemorrhage 5. Cyclophosphomide + Steroids 6. Biopsy (c-ANCA, anti-PR3 +)

Compensation in acid-base changes: 1. Metabolic acidosis? 2. Metabolic alkalosis? 3. Respiratory acidosis? 4. Respiratory alkalosis?

1. Winter's formula: Expected Paco2 = (1.5xbicarb) + 8 +/-2 2. ~7mmHg increase in Paco2 per 10mEq/L increase in bicarb 3. ~4mEq/L increase in bicarb per 10mmHg increase in Paco2 4. ~4mEq/L decrease in bicarb per 10mmHg decrease in Paco2.

Ulnar nerve compression at wrist vs elbow? 1. N/T medial hand, intrinsic hand weakness described as "clumsiness"? 2. N/T medial hand, intrinsic hand wekaness, and decreased girp strength?

1. Wrist 2. Elbow: *dec grip strength* is key for elbow.

Work-up of failure to pass meconium: What's on differential?

1. abd XR to r/o perforation 2. water-soluble (gastrograffin) contrast enema (determines meconium ileus vs. Hirshprungs) 3. If enema does not relieve, surgery is indicated. CF & Hirschsprung's

Septic arthritis associations 1. S. aureus 2. Coag-neg Staph 3. Group A Strep (Strep pyogenes) 4. Strep pneumo 5. Group B Strep 6. Kingella kingae 7. H. flu 8. N. gonorrhea 9. N. Meningitis 10. Salmonella 11. Non-salmonella gram-neg bacteria 12. Pseudomonas 13. Borrelia burgdorferi 14. Brucella

1. all ages; associated with skin/soft tissue infections; hematogenous spread 2. prosthetics (joints, hardware, heart valves) 3. Varicella zoster virus infection 4. Children <2yo; without extra-articular dz 5. Infants <3mo 6. Children 6-36mo; associated with oral ulcers 7. Unimmunized children 8. Vertical transmission; sexual; polyarticular 9. Polyarticular; petechiae/purpura, 10. sickle-cell dz; exposure to reptiles/amphibians; GI infections 11. newborns, immunocompromised 12. IVDU; water wounds 13. Lyme disease and Lyme sx 14. ingestion of unpastuerized dairy products.

Sjogren's syndrome 1. Ab associated? 2. Dx? 3. Increased risk?

1. anti SSA (Ro) , anti SSB (La) 2. Salivary gland biopsy 3. Non-Hodgkin lymphoma

Eosinophilic Granulomatosis with polyangiitis 1. Sx? 2. Ab? 3. Dx? 4. Tx? 5. AKA?

1. asthma, skin lesions (palpable purpura), eosinophilia, constitutional sx 2. P-ANCA, anti-MPO 3. Biopsy of skin or lung 4. Steroids 5. Churg-Strauss Syndrome

Acute tx of gout.

1st line: NSAIDs (Indomethacin, Naproxen) CI: bleeding; PUD; on anticoagulants 2nd line: Colchicine CI: elderly, severe renal dysfx 2/3rd line: steroids

Evaluation of precocious puberty What age is considered precocious puberty in males and females? What age is considered late/delayed puberty in males and females? First sign of puberty in females?

1. bone scan to assess for bone age. -If advanced -> basal LH to assess for central vs peripheral cause -If nl -> premature thelarche vs adrenarche Considered prcocious if puberty onset <9 in males <8 in females Considered late if puberty onset >15 for males >14 for females Thelarche - breast development occurs ~10.5 years.

Succinylcholine 1. ADR? 2. Dep or nondep?

1. cardiac arrhythmias d/t electrolyte derangements (hyperkalemia). Fasiculations 2. Depolarizing

Evaluation of precocious puberty with advanced bone age. 1. LH elevated means what? next step? 2. LH low means what? next step?

1. central cause. 2. GnRH stim test. If LH remains low: peripheral cause If LH increases: central cause. Central causes: get MRI of brain to r/o hypothal/pit tumor. Peripheral cause: get adrenal CT and pelvic US to evaluate for adrenal or gonadal tumors

RUQ pain with: 1. jaundice, afebrile, nl WBC ct, elevated/nl AST/ALT, elevated alk phos, elevated total bili, elevated direct bili 2. jaundice, febrile, leukocytosis, inc bili, increased GGT, inc alk phos. 3. leukocytosis, nl AST/ALT, alk phos, and bili

1. choledocolithiasis 2. Cholangitis 3. Acute cholecystitis

Hypovolemia has what effect on: 1. Preload 2. Afterload 3. CO

1. dec 2. inc 3. dec

ARDS - inc or dec: 1. lung compliance? 2. Elastic recoil? 3. Pulm arterial pressure? 4. Response to supplemental O2? 5. partial pressure of arterial oxygen (Pao2) 6. Fio2 requirement? 7. Pao2/Fio2 ratio? 8. A-a gradient?

1. dec 2. inc 3. inc 4. no response 5. dec 6. inc 7. <300 (dec) 8. inc

Septic shock: 1. SVR 2. RA P 3. PCWP 4. CI 5. SV 6. CO 7. EF 8. contractility 9. neck veins 10. vasodilation or vasoconstriction? 11. cool or warm extremities?

1. decrease (vasodilation) 2. decrease 3. decrease 4. increase 5. increase 6. nl/increase 7. decrease 8. decrease 9. flat 10. vasodilation 11. warm extremities

Decreased testicular size with: 1. low FSH/LH, renal failure, gynecomastia, elevated H/H. 2. elevated FSH/LH, gynecomastia, tall 3. elevated FSH/LH, gynecomastia, widespread muscle atrophy 4. Dec testosterone. Dec LH. Nl TSH & prolactin. Decreased libido. Recent opioid use

1. exogenous testosterone 2. Klinefelters 3. Myotonic dystrophy 4. ADR of opioids. They suppress GnRH and LH

MAC 1. s/sx 2. dx 3. tx 4. Prophylaxis?

1. fever, WL, abd pain, diarrhea, LAD, elevated alk phos 2. blood/LN culture 3. Macrolide + ethambutol 4. Azithromycin CD4 <50; not recommended if on ART; recommended only for those who are not on fully suppressive ART, after ruling out active disseminated MAC

Tx for: 1. Omphalocele 2. Gastroschisis 3. Congenital umbilical hernia

1. immediate surgery 2. immediate surgery 3. observe for spontaneous closure; surgery around 5 if no closure

Decompensated HF has what effect on 1. Preload 2. Afterload 3. CO

1. inc 2. inc 3. dec

Ca, P, and PTH levels in: 1. PTHrP-cancers 2. bone mets 3. Hyper vit D 4. Milk-alkali syndrome

1. inc PTH-rp -> inc Ca & P (inc abs) -> dec PTH 2. inc Ca & P (from bone reabs) -> dec PTH 3. Inc Ca -> dec PTH -> inc P (from inc abs & dec secretion) 4. Inc Ca -> Dec PTH & P (not sure why dec P?; also nl P can be seen?). Metabolic alkalosis

Tx of: 1. Internal hemorrhoids 2. External hemorrhoids 3. Anal fissures

1. increase fiber/fluid intake. rubber band ligation. 2. Increase fiber/fluid intake. Sitz baths. 3. Topical nifedipine

Breech: 1. Frank 2. Complete 3. Incomplete

1. legs up 2. legs crossed 3. one let out (footling)

Causes of 1. fetal tachycardia 2. fetal bradycardia

1. maternal infection -poorly controlled maternal hyperthyroidism -med use (terbutaline, B-agonists) -placental abruption -fetal anemia 2. maternal hypothermia, med ADR (BB), fetal hypothyroidism, fetal heart block.

Features concerning for 1. Primary amenorrhea: 2. secondary dysmenorrhea:

1. midline pelvic pain, radiation to bilat legs/back, fatigue, N/V/D. 2. Sx onset >25 yo, unilateral pelvic pain, no systemic sx during menses, abnl uterine bleeding (intermenstrual, postcoital) Work-up: hCG, TSH, prolactin, FSH, LH. If hirsutism present - androgen testing to measure DHEAS, testosterone, 17-OH progesterone (to determine organ cause - ovary vs adrenal)

parasympathetic response to the following systems: 1. pupils 2. saliva 3. heart 4. lungs 5. stomach 6. GB 7. Intestines 8. bladder

1. miosis 2. stimulates secretions 3. Decrease HR 4. bronchoconstriction 5. stimulates digestion 6. stimulates contraction 7. stimualtes digestion 8. contracts bladder

Sympathetic response to the following systems: 1. pupils 2. saliva 3. heart 4. lungs 5. stomach 6. GB 7. Intestines 8. bladder

1. mydriasis 2. inhibits secretions 3. Increase HR 4. bronchodilation 5. inhibits digestion 6. Inhibits contraction 7. Inhibits digestion 8. Relaxes bladder

How do these affect A-a gradient? 1. Hypoventilation 2. low inspired Po2 3. V/Q mismatch 4. shunting

1. nl 2. nl 3. elevated 4. elevated

Calcification locations in 1. Toxo 2. CMV

1. parenchyma 2. periventricular

Fundal height at these ages: 1. 12 weeks 2. 20 weeks 3. 36 weeks 4. 37-40 weeks 5. Postpartum (<24 hours)

1. pubic symphysis 2. umbilicus 3. xiphoid process 4. regression of fundal height between 35-42 weeks 5. umbilicus.

These fx result in what nerve problems? 1. midshaft humerus 2. surgical neck humerus 3. humerus supracondylar

1. radial nerve 2. axillary nerve 3. brachial artery & medial nerve.

Dopamine pathways: 1. Tuberoinfundibular 2. Mesolimbic 3. Nigrostriatal 4. Mesocortical

1. regulation of prolactin. 2. + sx 3. EPS/Parkinson's sx 4. - sx ("Cort = cut = negative")

Irritant contact dermatitis 1. s/sx

1. scaly, pruritic, erythematous rash with local swelling and vesicles. Chronic sx - excoriations, hyperkeratosis, and fissuring.

In pediatric with febrile seizure, who requires work-up for meningitis?

<6 months; >5 years Or s/sx of inc ICP, meningeal signs, prolonged AMS, or petechial rash

1. S/Sx & tx for papulopustular rosacea 2. S/Sx & tx for erythematotelangiectasia rosacea? 3. S/Sx & tx for phymatous rosacea? 4. S/Sx & Tx for ocular rosacea?

1. small papules and pustules without comedomes. "adult acne" 1st line: *topical metronidizole*, azeiaic acid, ivermectin 2nd line: oral tetracyclines 2. flushing, erythema, telangeictasias, exacerbated by hot drinks, heat, etc. Topical bronindine 3. Irregular thickening of skin oral isotretenoin 4. Burning/FB sensation Lid scrubs, ocular lubricants

Anticholinergic toxicity 1. sx? 2. tx?

1. sx of increased sympathetic activity - urinary retention, dry mouth, tachycardia, constipation, AMS, mydriasis (dilated pupils) 2. removal of offending agent; physostigmine when severe agitation or seizures are present.

secondary amenorrhea 1. definition? 2. Work-up? 3. Causes? 4. Tx? 5. when should progesterone/estprog challenge be done?

1. the absence of menstruation for 3 cycles after a period of normal menses 2. First step -> B-hCG If pregnancy ruled out - TSH, FSH, prolactin, etc. If labs nl - likely hypothal hypogonadism (female-athlete triad) 3. Usually in older women due to autoimmune disease, cytotoxic drugs, radiation, malignancy, or surgery. 4. Treat with full replacement dose estradiol either through patch or vaginal ring along with progesterone. Continue until age 50-51. 5. Progesterone challenge done when labs and exams are nl and there is a h/o uterine instrumentation (Ab, C-sec) -> evaluates for adhesions and withdrawal bleeding. Estrogen/progesterone challenge is done when prog challenge is negative. If this is neg then likely ueterine adhesions is cause (asherman)

In twin-twin transfusion 1. the larger twin 2. the smaller twin 3. occurs in what twin situation? 4. is what? 5. Hemoglobin differences? 6. What can be present in both? 7. Tx?

1. the recipient - plethoric, ruddy, hypervolemia, polyhydramnios, jaundice, HTN, CHF. Result of hyperperfusion 2. the donor - hypovolemia, anemia, oligohydramnios, oliguric. Result of hypoperfusion 3. monozygotic, monochorionic twins 4. result of intrauterine blood transfusion from one twin to another 5. typically >5g/dL 6. Hydrops fetalis 7. Reduction amniocentesis

Allergic contact dermatitis 1. Type of HS reaction? 2. Tx?

1. type IV HS reaction (poison ivy, nickel jewelry) 2. Steroids

Complications and treatment of: How does bite/rash appear? 1. Brown recluse spider bite 2. Black widow spider bite

1. ulcer and eschar formation 2. Muscle pain, abdominal rigidity pale area surrounded by a red ring, grossly resembling a target (sounds like Lyme dz rash) Supportive - Acetaminophen, warm compresses, elevated of affected extremities. Tetanus prophylaxis Antivenom for severe cases within several hours following bite.

What neurocut d/o is associated with these? 1. RCC 2. Capillary angiomatoses 3. Mental Retardation 4. neurofibromas 5. meningiomas 6. Astrocytomas 7. Neurofibroma 8. acoustic neuromas 9. Renal Angiomyolipomas 10. scoliosis 11. Pheochromocytoma 12. Optic nerve glioma 13. Cardiac rhabdomyomas 14. Cavernous Hemangioma 15. Seizures 16. Renal/cerebellar hemangioblastoma 17. iris hamartomas (lisch nodules)

1. vHL 2. Sturge-Weber 3. TS, Sturge-Weber, NF-1 4. NF-1 5. NF-1, NF-2 6. NF-1 7. NF-2 8. NF-2 9. TS 10. NF-1 11. NF-1, vHL 12. NF-1 13. TS 14. vHL 15. TS, Sturge-Weber, NF-1 16. vHL 17. NF-1

Compression of median nerve at wrist vs forearm? 1. N/T lateral hand 2. N/T lateral hand + thenar eminence

1. wrist 2. Forearm

1. Anaphylaxis tx 2. If unresponsive to first-line tx? 3. Risks with second-line tx?

1. •epinephrine IM •also steroids (biphasic reactions), antihistamines (itching/skin findings), bronchodilators (bronchospasm) -Airway mgmt 2. If not responding, IV epi 3. IV epi ADR - ventricular arrhythmias, refractory HTN.

Pubic hair Tanner stages in both females and males

1: prepubertal with no hair 2: sparse, lightly pigmented, straight hairs 3: darker hairs that start to curl with increased amount of hair 4: course, curly, abundant hair but not as much as adult hair 5: adult distribution of hair often with spread to medial surface of thighs

Breast mass work-up: 1. If <30 yo a. high concern for malignancy b. low concern for malignancy 2. if >30 yo 3. When is MRI used in workup? 4. What features on mammogram would be concerning for malignancy?

1a. US 1b. observe 1-2 menstrual cycles; if persists after this time, US. -> no US abnormality - observe. -> simple cyst - observe, consider therapeutic aspiration. -> solid - consider biopsy 2. Diagnostic mammogram -> if low concern malignancy - US -> if high concern for malignancy - tissue biopsy 3. Used in conjunction with mammogram in pts with high risk of developing breast cancer (BRCA gene) for screening. 4. small clusters of calcifications, spiculated masses with irregular/asymmetric borders

Perianal lac degrees -1st degree -2nd degree -3rd degree -4th degree

1st - mucosa/skin 2nd - bulbocavernosa muscle and perineal body 3rd - external/internal anal sphincter 4th - rectal mucosa

abx for open fractures?

1st gen cephalosporin In pts allergic to cephalosporins or PCN, clindamycin can be used as an alternative. If lac >10cm, add AG

Medical tx of pediatric constipation?

1st line - oral laxatives (PEG) to soften stools. If severe or oral laxatives do not help, enemas may be helpful.

Tx of panic disoder? Dx Criteria? Dz associations?

1st line: *SSRI*/SNRI + CBT Acute distress: benzo (only use when waiting for SSRI to take effect or those who cannot take SSRI) recurrent panic attacks lasting >1 month Depression, phobias

Tx of OCD Diagnostic criteria?

1st line: SSRI high dose + CBT 2nd line: clomipramine Recurrent intrusive thoughts, images, or urges (obsessions) that cause anxiety, distress, and *repetative* mental/behavioral acts (compulsions) that are *time-consuming* (>1h/day) with attempts to ignosre/resist/suppress causes significant distress or doing the action helps alleviate stress; not attributable to other causes (drugs, meds, med condition).

Tx of chronic cough following acute URI?

1st-gen antihistamine or combined antihistamine-decongestant (brompheniramine and pseudoephedrine)

Dx of acute pancreatitis?

2 of 3: -Acute epigastric pain radiating to back (partially relieved my leaning forward) w/ N/V -Elevated amylase or lipase >3 times nl limit -Abnlities on imaging consistent with acute pancreatitis Only get CT scan if 2 or 3 are not met. Most of the time nl in first 48 hours.

AV nodal reentry tachycardia results from reentrant circuit formed by _____.

2 separate conducting pathways within the AV node.

MDD criteria

2 weeks of a major depressive episode (5/9 sigecaps?) no hx of mania/hypomania

Recurrent UTI/cystitis definition? Mgmt?

2+ UTIs within 6 months or 3+ within a year. Treat current UTI and consideration for UTI prophylaxis. Decrease RF - liberal fluid intake, contraception modification (abstinence, elimination of spermacidal agents), postcoital voiding, topical estrogen for postmenopausal women. Prophylaxis - Nitrofurantoin, norfloaxin, cipro, bactrim continued for 6-12 months and then reassessed.

Postexposure prophylaxis HIV

3-drug regimen recommended. Initiate urgently and continue for 28 days. Obtain baseline serologic studies.

When to deliver in HELLP?

34 weeks

Preterm labor mgmt based on gestational age?

34-37: *PCN* if GBS unknown/+. *Betamethasone.* 32-34: ^^ + tocolytics (*Nifedipine* 1st line) <32 weeks: ^^ + *Mag* (fetal neuroprotection) Tocolytic 1st line: *indomethacin*

location of bartholin's glands

4 and 8 o'clock on the posterior lateral aspect of the vaginal orifice (base of the labia majora).

Colon cancer screening

45-75 q 10 years for nl risk. If one polyp <10mm - q 10 years; if >10mm or 2+ -> sooner. Starting at 40yo or 10 years prior to 1st-degree relative (whichever is earlier) and repeat q 3-5 years FAP - q 1-2 years beginning at puberty. UC - 8 years after dx and q 1-2 years Lynch - start ~20 yo and screen q 2 years.

Enuresis is nl until what age? What is tx?

5 If <5, reassurance only. If >5, enuresis alarm and desmopressin

-Initial female phenotype in a male -At puberty, *virilization* occurs -Female external genitalia -Male internal genitalia -Masses in labia

5-alpha reductase defiency Unable to convert testosterone to DHT.

It is nl for infants to lose how much of their original birth weight in the first _____ days? When should birth weight be regained?

7% in the first 5 days. Regined by 10-14 days.

Lung nodule - what size is considered low vs high probability for malignancy?

<0.6cm - likely benign >0.8cm - likely malignant. In a pt with RF for malignancy, excise. If low probability for malignancy, recheck CT in 3 months.

in pts with CF what is the MCC of pneumonia?

<10yo - H.flu <25-34yo - S.aureus >25-34yo - Psuedomonas

Abortion can happen at what dates?

<20 weeks

primary ovarian insufficiency occurs in women ______yo.

<40

Primary ovarian failure is in women _____ yo. Hormone changes? Mgmt?

<40 Decreased estrogen. Increased FSH Estrogen therapy if intact uterus.

what size ureteral stone will likely pass spontaneously? What is the mgmt?

<5mm likely to pass. Increase oral fluid intake Stones 6-10mm may pass. Alpha blockers or CCB may facilitate.

PPD considered + at: >5mm >10mm

>5mm: immunocompromised, transplants, chemo, close contact with someone with + TB >10mm: health care workers, prisoners/homeless shelters, travel to endemic country

Bioterrorism categories A, B, C

A - high risk - easy dissemination/transmission. C. botulinum, B. anthracis, Y. pestis, plaque, tularemia, smallpox, ebola B - Moderate ability to disseminate and moderate to low mortality rates Brucella, ricin toxin, Q fever, Salmonella, Shigella, typhus fever, Vibrio cholera infection C - Emerging pathogens that could be disseminated easily based on availability, ease or production, and potentially high mortality/morbidity. Emerging diseases - Nipah virus, Hantavirus

Pregnant woman with elevated/decreased alpha-fetoprotein than expected, next step?

A common cause is inaccurate dating, which should be ruled out prior to seeking serious pathology - do US to rule out dating error and to help rule other causes (twin gestation, placental abnlities). After dating error has been ruled out - amniocentesis

Metabolic syndrome

A syndrome marked by the presence of usually three or more of a group of factors (as high blood pressure, abdominal obesity, high triglyceride levels, low HDL levels, and high fasting levels of blood sugar) that are linked to increased risk of cardiovascular disease and Type 2 diabetes. -Abd obesity - waist circ >40in in men or 35in in women. -TG >150 or tx for TG -HDL <40 men; <50 women; drug tx -BP >130/85 or tx -Fasting plasma glucose >100 or tx

Biophysical profile - what is obtained? What is a nonstress test?

A test that assess five variables; fetal breathing, fetal movement, fetal tone, amniotic fluid volume, and fetal reaction continuous electronic fetal heart tracing over a period of at least 20 minutes Reactive - at last two accelerations over 20 minutes

Renal biopsy: -congo red positive glomerular deposits

AA amyloidosis

Components of primary survey with adjuncts?

ABCDE's FAST exam, CXR, pelvis XR

Mgmt of cocaine induced STEMI?

ABCs - secure airway if not breathing. IV access; monitors EKG/labs IV benzos IV alpha-blockers (phentolamine) if severe HTN (or IV nitro, IV nitroprusside) If QRS widening - NaBicarb

-Jaundice of newborn -anemia -elevated retic count -hyperbili -positive Coombs

ABO hemolytic disease Can only occur when mother has group O blood since thosee Ab are IgG and can cross placenta.

Meds that improve survival in CHF

ACE-I/ARBs BB (OME-met, lab, nidif. UW-met, carv, biso). Aldosterone antagonists. Combo hydralazine/nitrates Digoxin does NOT improve survival, but decreases hospitalization and sxs.

30-40 yo presenting with abd pain, flank pain, hematuria, HTN, anemia. Dz? Dx? Extrarenal features? Tx? Mutation in what?

ADPKD US Cerebral aneurysms, MVP/AR, colonic diverticuli, ventral/inguinal hernias, liver cysts Control RF, ACE-I, hemodialysis/renal transplant Mutations in PKD1 or PKD2.

When is synchronized cardioversion indicated?

AFlutter AFib Unstable SVT Unstable monomorphic VTach with pulse

Middle aged man with: -weakness in one leg, noted during ambulation -gait instability, falls, weakness -atrophy of hands bilat -Pos babinski, increased DTRs -no sensory loss -elevated CK Dz? Path? Dx?

ALS - destruction of ant horn cells (corticospinal tract and ventral horn) Dx: EMG; MRI spine/head to r/o other causes

Initial workup for pt with suspected SLE?

ANA initial screening test. If + -> then autoAb should be obtained, including anti-dsDNA, anti-Ro, anti-La, anti-smith, and anti-U1-ribonucleoprotein Abs. Also CBC, CMP, UA, ESR/CRP, complement

-Fatigue -sx of cytopenia (>1) - epistaxis, bruising, weakness, infection, etc. -Hepatosplenomegaly rare -DIC Dz? Dx?

APL BM Biopsy showing atypical promyelocytes.

Prevention of flushing with niacin?

ASA

STEMI medical treatment

ASA + P2Y12 rec blocker (clopidogrel) + statin + anticoagulant (IV heparin or enoxaparin)

-Nasal congestion and stuffiness -post-nasal drip -food tastes bland -nasal polyps Dz? D/t? Tx?

ASA-induced asthma. Non-IgE mediated reaction from prostaglanding/leukotriene misbalance. (pseudo-allergy) Tx: avoid ASA, NSAIDs. Use leukotriene rec antagonists (montelukast)

Cannon a waves? Where do you look?

AV dissociation (3rd degree heart block) Look at JVP-bounding. Problem with tricuspid (TS). where the valve is not opening in conjunction with the cardiac cycle.

Pernicious anemia is caused by ___. Increased risk of ___.

Ab to intrinsic factor -> vit B12 def -> Subacute combined degeneration of the spinal cord -> peripheral weakness, ataxia, neuropathy; may progress to spasticity, paraplegia, and incontinence. Gastric cancer

Migraine HA -Abortive tx -preventative tx -tx in pregnancy

Abortive: -Triptan -NSAIDs/Acetaminophen -Antiemetics -Ergotamine Preventive: -Topiramate; valproate -Divalproex Na -TCA; venlafaxine -BB (propranolol) Pregnancy: -Acetaminophen -If inneffective: Acetaminophen + codiene, promethazine, caffeine/butalbital. BB for prevention

Variable decels appear as what? Etiology? Mgmt?

Abrupt decrease in fetal HR ("V" shaped); variable timing in regards to contraction pattern Fetal umbilical cord compression d/t oligohydramnios or rupture of membranes. Amnioinfusion, intrauterine resus

-Painful red eyes in a pt who wears contact lenses and does not clean them or change them. Dz?

Acanthamoeba infection (rare) Tx: propamidine with polymixin ophthalmic solution

Carbonic anhydrase inhibitors drugs? ADR?

Acetazolamide Metabolic acidosis (decreased serum bicarb), increased Cl, hypokalemia

Pseudotumor cerebri tx Dx?

Acetazolamide +/- furosemide are first line. For refractory sx - shunt. Short-term steroids of serial LPs can be done while awaiting definitive tx. Dx: MRI (or CT) before LP (elevated opening P). R/out mass occupying lesion prior to prevent herniation.

"Narrowing" of visual field. Coarsening of facial features, enlargement of jaw, hands, and feet Nail/skin changes Glucose intolerance/new-onset diabetes Dz? W/up? Tx?

Acromegaly - excess production of growth hormone; MC d/t benign pituitary adenoma -Elevated IGF-1 -Glucose suppression test - fails to suppress GH -MRI -Resection, Octreotide

Areas of adherent scales on an erythematous base. Dry, Scaly plaques/ papules on face/scalp/neck. Dz? Tx? Complications?

Actinic keratosis Cryotherapy or 5-FU Progression to SqCC

Mercury poisoning sx? (Acute and chronic) Mercury poisoning tx?

Acute - cough stomatitis inflammation of gums N/V/D conjunctivitis dermatitis Chronic - Neuropsychiatric features including anxiety, irritability, insomnia, depression, tremor. Chelation - succimer, dimercaprol

Pt with nl glucose (or glucose <200) with an elevated AG with a negative ETOH level Dz? What happens to K, Na, P? Tx?

Acute Alcoholic Ketoacidosis Low Na, K, P Fluids, glucose, thiamine prior to glucose.

-N/V/D, cramping -Fever, nontender LAD, pharyngitis, arthralgias, WL, HA -Generalized macular rash (oval, pink/red macular lesions or painful oral ulcerations) -Mucositis -Positive heterophile Ab Dz? Other lab findings? Dx?

Acute HIV infection - (Antiretroviral syndrome) Presents similar to mono; however, mucositis will not be seen in mono, CMV, or syphilis. Throkmbocytopenia, leukopenia, Positive HIV Ag/Ab combination or RNA Ag(p24)/Ab (HIV1/2) testing (ELISA) + HIV RNA for viral load (PCR) Ag/Ab test positive ~24 days RNA test postive ~10 days

-Sudden onset abd pain, N/V in the setting of a very sick patient -RUQ US - biliary sludge, no calculi, GB wall 5mm, GB transverse diameter of 5.5cm with pericholecystic fluid -Leukocytosis -Elevated ALT -Nl total bili Dz? Cause? RF? -Dx? shows what? -Tx

Acute acalculous cholecystitis - inflammation of GB without evidence of calculi. D/t bile stasis and increased lithogenicity of bile. Critically ill pts, pts on TPN -US (preferred); if unclear get CT or HIDA scan US - may show stones, bile sludge, pericholecystic fluid, thickened GB wall, gas in GB Laproscopiuc cholecystectomy; if poor surgical candidate then percutaneous cholecystostomy tube. -Enteric abx coverage -Percutaneous cholecystostomy for initial drainage -Cholecystectomy when clinically stable

Child with: -recent URI -ataxia, tremor, horizontal nystagmus Dz? Tx?

Acute cerebellar ataxia (postinfectious) Self resolves in ~2weeks.

Sickle cell pt with fever, SOB, CP, and new radiographic infiltrate on CT scan Dz? Dx? Tx?

Acute chest syndrome EKG, CBC, retic ct, CXR, blood/sputum cultures, CT angio, trop O2, opiates, Abx, fluids (D5/0.45 to avoid hypernaturemia) Transfusion strategy - mild ACS - simple transfusion and hydration. moderate ACS - simple or exchange transfusion Severe ACS - *Exchange Transfusion*

Pregnant lady in 3rd TM with: -RUQ pain, jaundice, *mildly* elevated transaminases. -*thrombocytopenia*, *hypoglycemia* -Acute kidney injury Dz? Tx?

Acute fatty liver of pregnancy. Immediate delivery

Transfusion reaction: -within 1st hour -hypoTN, tachycardia -resp distress -febrile -flank pain, hemoglobinuria -*Coombs+* -can progress to *DIC* or renal failure Which one? D/t? Tx?

Acute hemolytic d/t ABO incompatibility -Resp distress, but O2 sats are nl. Tx: IV NS

-abd pain -peripheral neuropathy -Autonomic dysfx (tachy, diaphoresis, HTN) -Neuro sx -Red-urine Dz? Exacerbated by? Cause? Tx?

Acute intermittent porphyria P450 inducers, progesterone, stress (fasting, illness), alcohol/tobacco. AD d/o d/t def in porphobilinogen diaminase. Glucose & hemin

Renal biopsy: -Marked mononuclear interstitial infiltrates

Acute interstitial nephritis

Child with: -fever -bone pain -hepatosplenomegaly -bruising, pallor -leukocytosis or leukopenia. -Anemia, thrombocytopenia. -LAD Disease? Dx? Tx?

Acute lymphocytic leukemia (ALL) - disorder of B & T cells Dx: BM biopsy - replacement with immature blast cells Tx: chemo + CNS prophylaxis

Recent CABG: -dypnea, worsening retrosternal pain despite pain med use. -fever, tachycardia -cloudy fluid present in sternal wound drain -widening of mediastinum Dz? mgmt?

Acute mediastinitis Surgical debridement and abx therapy

Older adult with: -Anemia -thrombocytopenia (epistaxis, bruising) -Leukotcytosis or leukopenia -bone pain -hepatosplenomegaly rare -Pancytopenia is common Dz? Dx? Tx? -Presentation related to cytopenia (hemorrhage, petechiae, fatigue, infection) -Amenia, thrombocytopenia -Myeloblasts and blasts noted on peripheral smear -Auer rods

Acute myelocytic Leukemia (AML) Dx: BM biopsy; *+Auer rods/MPO* Tx: chemo

Pt with previous radiation: -Diarrhea, mucus d/c, tenesmus, minimal bleeding -Endoscopy: erythema, edema, ucerations Dz? Path? Tx?

Acute radiation proctitis (<8 weeks ago) D/t Direct mucosal damage Loperamide

-HypoTN, hyperpigmentation, WL, fatique, weakness, hypoglycemia, eosinophilia, hyponat, hyperkal -Dz? -What is the dx test? -Decreased levels of what hormones? Increased? -Ca high or low?

Addison's disease -Low morning cortisol level (highest between 6-8am). Values <3 = diagnostic. Values 3-19 = indeterminate and necessitate further work-up. Confirm with Coysntropin stimulation test - measures adrenal response by measuring cortisol in response to ACTH. Measuring basal ACTH levels can diff primary (high) from secondary/tertiary (low) causes. -Decreased cortisol and aldosterone -Elevated renin, ADH, ACTH -Hypercalcemia - rare finding.

Child with: -chronic nasal congestion unrelieved by antihistamines or intranasal steroids. -recurrent AOM & sinusitis -snores loudly and breathes loudly -tired throughout the day -enlarged tonsils -mucopurulent postnasal drip Dz? Mgmt?

Adenoid hypertrophy causing peds OSA Tonsillectomy, adenoidectomy

Premenopausal women with heavy, *painful* menstrual periods that are *regular*. Uterus is globular, boggy and *symmetrically enlarged*. Dx?

Adenomyosis d/t proliferation of endometrial glands inside the uterine myometrium

HIT tx? When can you bridge to warfarin? Dx? antibodies to ___. increase or decrease in platelet count?

Administer nonheparin alternatives: 1. Argatroban or Bilvalirudin (direct thrombin inhibitors) as an alternative to low molecular heparin (LMWH) 2. Fondaparinux- Factor Xa inhibitor Bridge when platelet count is >150,000 serotonin release assay or high-titer immunoassay platelet factor 4 decreased

Shingles vaccine indications?

Adults >50yo 2 doses 2-6 months apart.

corneal reflex (afferent/efferent)

Afferent: V1 (sensory) Efferent: VII (motor)

Who is considered high-risk for STI in pregnancy? What additional screening is done? What are the STI's that are routinely screened for in all pregnancies?

Age <25, prior STI, high-risk sexual activity (mult partners, commercial sex work) Initial prenatal visit, 3rd TM, and delivery: -HIV -Syphilis -Hep B *-Gonorrhea -Chlamydia* Routine: -HIV -Syphilis -Hep B

Tx for acute iron poisoning?

Aggressive volume repletion Deferoxamine

Tx of ascites in cirrhosis?

Alcohol cessation, NSAID avoidance, salt restriction. spironalacetone + furosemide -if ascites doesnt respond or diuretics -> renal failure do TIPS (complication is ENCEPHALOPATHY) -If TIPS procedure fails, surgical shunting -Liver transplant is last resort

Chemical requiring specific decontamination: 1. Chromic acid 2. Hydrofluoric acid 3. Lime (Calcium oxide) 4. Methyl mercury 5. Phenol 6. Phosphorus

All include copius irrigation initially 1. 10% ascorbic acid 2. Calcium-gluconate gel or intra-arterial calcium gluconate (because it can cause QTc prolongation) 3. brush off as much as possible prior to irrigation 4. blister debridement and blister fluid removal 5. irrigate with polyethylene glycol 400 6. Avoid exposure to air

Dx of acute liver failure? tx?

All three: -encephalopathy -elevated INR >1.5 -Elevated liver enzymes Tx - liver transfer

Pt with h/o asthma, now presenting with: -cough, fever, chills, night sweats, bilat wheezing, hepmoptysis -elevated leukocytes (inc eosinophils) -CT: infiltrates; bilat central bronchiectasis Dz? Tx?

Allergic bronchopulm aspergillosis Steroids, itraconazole

Pt presents with pruritis/rash/discomfort behind ears. Hyperpigmented, eczematous plaque with secondary lichenification Rash called what? Due to what? Tx?

Allergic contact dermatitis - nickel allergy most common from jewlery/belts/etc. Avoid nickel; steroids.

Sx of intrinsic renal failure - dysuria, N/V, fatigue, malaise, WL, hyperkalemia, metabolic acidosis, rash Eosinophilia, rash and urinary WBCs Dz? Cause? Tx?

Allergic interstitial nephritis Infections, reaction to meds (Nafcillin, methicillin, NSAIDs, rifampin, sulfa, quinolones, diuretics, allopurinol, phenytoin) Supportive; d/c offending cause

Pt with sore throat & runny nose -afebrile -swollen eyes -pale blue nasal mucosa. Dz? Tx?

Allergic rhinitis First line: Intranasal steroids Second line: oral (2nd gen) antihistamines, cromolyn (inhibits mast cell degran), leukotriene modifiers. (if signs outisde the nasal mucosa)

-Circular, smooth patch of complete devoid hair loss may progress suddenly over days to weeks; may be singular and small or multiple and extensive. -asxatic or Mild itching before hair loss -no erythema or pain -Positive hair pull test (>5 hairs) -Hairs have tapering ends (exclamation point) Dz? Path? Tx?

Alopecia areata -autoimmune (look for h/o autoimmune disease) Steroids (intralesional triamcinolone) If >50% of scalp -> topical immunotherapy and oral steroids + strategic use of intralesional steroids. Increased risk for progression to alopecia totalis or alopecia universalis.

Virus family that presents mostly with rash, arthritis, or encephalitis?

Alphavirus - Barmah Forest virus, chikungunya, Mayaro, Ross River, Sindbis, Una, Eastern equine encephalitis, Venezuelan equine encephalitis, Western equine encephalitis.

-sensorineural HL -hematuria, proteinuria -renal failure -lens protrusion Dz?

Alport syndrome X-linked mutation in type IV collagen. Longitudinal splitting on renal biopsy

-senile plaques -amyloid B-protein -neurofibrillary tangles with tau proteins -medial temporal lobe atophy -apoE -Hypocampal volume asymmetries

Alzheimer Dz

Tx of acute otitis media? If recent abx use? If allergic?

Amox If treated with amox in past 30 days, purulent conjunctivitis, or recurrent OM - give amox-clav. If allergic: clinda or azithromycin (UW) If PCN allergic - doxycycline, macrolide (TL)

Tx of Group B strep

Amp If mild PCN allergy, Cefazolin If severe PCN allergy: clinda or Vanc

Cyanide poisoning tx?

Amyl nitrite, thiosulfate

MCC of spontaneous lobar hemorrhage, particularly in pts >60

Amyloid angiopathy

Waxy skin deposition CTS S3; BLE edema fatigue WL Purpura around the eyes Peripheral neuropathy Dz?

Amyloidosis

Muir-Torre Syndrome?

An autosomal dominant syndrome related to HNPCC (Lynch). Presents with visceral (colon) and skin cancers - sebaceous adenomas and keratoacanthoma.

Anal pathology with: -small amount of bleeding, severe pain with defectaion -may have associated sentinel skin tag and white, raised edges if chronic Dz? Tx?

Anal fissure Initial: Fiber, fluid, stool softner, sitz bath, topical anesthetics, vasodilators (nifedipine, nitro) Refractory to above: lateral spinchterotomy, fissure excision

Transfusion reaction: -within minutes -hypoTN, tachycardia -respiratory distress, angioedema Which one? D/t? Tx?

Anaphylactic d/t IgA def;recipient anti-IgA Ab directed against donor blood IgA Tx: Stop transfusion, Epi Previous anaphylactic reactions necessitate pretreatment with steroids and washed RBCs or volume-reduced platelets

Thyroid cancer in elderly and rapidly fatal?

Anaplastic

-circular-patch of hairloss at crown of head Dz? Path? Tx?

Androgen allopecia D/t 5-DHT Minoxidil, Finasteride

Pt with metastatic prostate cancer - tx options? Dz limited to prostate?

Androgen deprivation therapy - orchiectomy or gonadotropnin-releasing hormone agonist therapy. Chemo - taxane; platin (2nd line) Radiation therapy for metastatic dz process. Radical prostatectomy Radiation therapy

-Female external genital and breasts -Absent pubic/axillary hair -Absent uterus/cervix -Crytorchid testes -High female range testosterone

Androgen insensitivity syndrome

-Painless, recurrent gross GI bleeding -increased risk in pts w/ von Willebrand Disease, advanced renal dz, and aortic stenosis Dz? Dx? How is this different from other cause of painless gross GI bleed?

Angiodysplasia Dx: colonoscopy (frequently missed) R colon is most common. Angiodysplasia is low-vol bleeding d/t venous blood loss. Divertuculi bleed is high-vol bleeding d/t arterial blood loss.

Pt who recieved localized radiation and resultant lymphedema now presenting years later with multiple ecchymotic/purpuric masses on skin?

Angiosarcoma Biopsy lesion

Anal pathology with: -chronic onset -soft papules, plaques, or cauliflower-shaped mass -mild itching, bleeding

Anogenital wart

Anal pathology with: -bleeding, pain/painless -ulcerating, enlarging mass -firm, painless inguinal or femoral LAD Dz? Dx? Tx?

Anorectal Ca (SqCC MC) Dx: biopsy Important to distinguish anal margin vs anal canal cancers. --Anal margin cancers - wide local excision. --Anal canal cancer - Nigro protocol - Mitomycin C + 5-FU + radiation Surgery is not the primary modality

Anal pain not with defectaion with malodorous discharge, +/- draining pus Dz? Associated with? Tx?

Anorectal fistula - tract between rectum and anus. Ass w/ Crohn's dz Abscess may be present, if so I&D. Fistulotomy.

Indurated pustule near the anal verge. Chronic Anal d/c & pruritis. intermittent rectal pain Dx? Mgmt?

Anorectal fistula: arise after anorectal abscess Surgical repair

MCC of dysfunctional uterine bleeding? Dx? Tx?

Anovulatory cycles d/t unopposed production of estradiol. Dx of exclusion that is made when other etiologies such as inflammation, tumor, and pregnancy are ruled out. -Surgery only considered in pts whom medical tx has failed. -Regardless of age, progestin therapy with levonorgestrel IUD should be considered. Contraception containing combination of estrogen and progesterone Low dose combination hormonal contraception is mainstay up to 18yo or 19-39; also consider progestrin only in 19-39yo. High-dose estrogen therapy may benefit pts with an extremely heavy flow or hemodynamic instability. -Med tx for women >40, prior to menopause, can consist of cyclic progestrin, los-dose OCPs, levonorgestrel IUD, or cyclic hormonal therapy. -If medical therapy fails - pts should undergo further testing - imaging or hysteroscopy. An in office endometrial biopsy is preferrable to D&C when examining a pt for endometrial hyperplasia or cancer. -If medical therapy fails in women in whom childbearing is complete - hysterectomy without cervical perservation may be considered. -If bleeding continues in 24 hours - D&C should be performed in all pts >35yo to r/out endometrial cancer. Dysfunctional uterine bleeding in a pt with regular menstrual periods - treat with estrogen because they typically have low estrogen state leading to heavy bleeding. Dysfunctional uterine bleeding in a pt with anovulation can be treated with progesterone.

Sensory & motor deficits to LE

Ant. cerebral artery stroke

Tamoxifen MOA Raloxifene MOA Increased risk of what? Decreased risk of what? CI?

Antagonist at breast. Agonist at bone, uterus Increased risk of endometrial cancer. Decreased risk of breast cancer. H/o endometrial ca, VTE Antagonist at breast & uterus. Agonist at bone. No increased risk of endometrial cancer. Decreased risk of breast cancer. H/o VTE

-Bilateral weakness -Decreased bilat Pain/temp -Intact prop/vibration

Anterior cord syndrome -Can be from *descending* aortic dissection resulting in thoracic spinal cord ischemia

-bilat absent pain and temp -bilat paralysis -vibration spared

Anterior spinal cord syndrome

-Significant (unilateral) eye pain -miosis -photophobia -vision loss may be present/blurred vision -floaters -redness

Anterior uveitis

-hematuria -RBC casts -hemoptysis -cough -dyspnea -rapidly progressive renal failure Dz? Ab? Dx? Tx?

Antiglomerular Basement membrane dz (Goodpasture) -anti-glomerular basement membrane Ab against collagen IV -Renal biopsy - linear pattern of IgG deposition -Plasmaphoresis (plasma exchange), cyclophosphomide, steroids

In pts with SLE, the development of venous or arterial thrombi have suspected _____. Results in increased or decreased PTT? What other situation should you suspect this syndrome? Work-up? Tx?

Antiphospholipid Syndrome Elevated PTT Recurrent prenancy losses, especially after the 1st TM. Lupus-anticoagulant, anticardiolipin Ab, and anti-beta-2-glycoprotein Ab. Lifelong anticoagulation therapy (warfarin; INR goal 2-3; if continues to have recurrent thrombosis in the setting of therapeutic INR, increase goal to 3-4 +/- addition of ASA) DOAC's cannot be used in comparison to most other pts with thrombosis.

Workup for first-febrile seizure?

Antipyretics. Reassurance.

Adjustment d/o criteria

Anxiety/depression sx developing within 3 months of an identifiable stressor and lasting <6 months. -Less sx than MDD (<5/9) -cause impairment

Dx of SLE

Any 4 of the 11 major criteria 1. ANA 2. Malar rash 3. Immunologic d/o (other Ab - anti-smith, anti-dsDNA, antiphospholipid) 4. Hematologic (anemia, leukopenia, thrombocytopenia) 5. Neurologic (seizures, psychosis) 6. Renal (proteinuria, cellular casts) 7. Serositis (pleuritis, pericarditis) 8. Arthritis (of 2+ peripheral joints with tenderness, swelling, effusion) 9. Photosensitivity (light-induced rash) 10. Oral ulcers (oral or nasopharyngeal) 11. Discoid rash (erythematous, circular, rasied patches with scaling and follicular plugging, sometimes may have atrophic scarring)

Older man with acute onset CP -Malig HTN -Early decrescendo murmur at LSB at 4th ICS -EKG: LVH, Twave inversion Dz? Dx? Tx?

Aortic dissection (murmur of AR??) Renal failure: TEE or hemodyn unstable CT angio: hemodyn stable

Ejection click followed by midsystolic murmur over RUSB. Single soft S2 Late-peaking systolic murmur and fixed, split S2 (or diminished/absent). Diminished/delayed carotid pulse (pulsus parvus et tardus) Dz? Dx? Tx?

Aortic stenosis Transthoracic echo Definitive - Valve replacement Nonsurgical candidates - medical therapy with ACE-I/diuretics

Pancytopenia with mophologically nl cells?

Aplastic anemia

-At birth, female external genitalia are ambiguous. -No breast development -delayed puberty -No estrogen -elevated FSH/LH, test, androstendione -polycystic ovaries

Aromatase deficiency. Unable to convert androgens to estrogens. Mother has transient masculinization that resolves after delivery

-garlic breath -N/V/D (watery) -Hypo/hyperpigmentation -peripheral neuropathy -hyperkeratosis -pancytopenia -mild elevation in AST/ALT Toxicity of what? Tx?

Arsenic toxicity Chelation - succimer, dimercaprol Acute sx- Severe N/V/D, abdominal pain. *Garlic breath* QTc prolongation can lead to shock, ARDS, or arrhythmia. Chronic sx- hypo and hyperpigemented skin lesions hyperkeratosis of skin symmetric sensorimotor polyneuropathy

-Navy, shipyard worker -Pleural calcifications

Asbestos exposure

-pleural plaques -barbell bodies -hazy infiltrates with bilat linear opacities -Reticular nodules in lower lobes Dz? Occupations? Inc risk?

Asbestosis Shipbuilders, construction workers, plumbers, etc. Inc risk of bronchogenic cancer > mesothelioma

Secondary amenorrhea following a miscarriage requiring D&C Dz? Dx? Estradiol, FSH, LH levels?

Asherman syndrome - bands of fibrous tissue (intrauterine adhesions) form within the endometrial cavity. Damage of the basilis layer. Hysteroscopy (definitive) Nl estradiol, FSH, LH levels.

Leading cause of pna in pts with prolonged neutropenia?

Aspergillosis

Epidural hematoma Mgmt? MCC?

Asxatic and small: serial neurochecks and serial CTs Sxatic/large: emergent neurosurgical evacuation/craniotomy Trauma d/t rupture of MMA; Non-traumatic causes - coagulopathy, vascular malformation, thrombolysis

Bipolar I Bipolar II Cyclothymia Dysthymia

At least 1 manic episode with or without major depression At least 1 hypomanic episode with a major depressive episode. Mood swings between dysthymia (less severe depression) and hypomania, but depression does not meet criteria for MDD and manic episodes do not meet threshold for manic episode. Occurs over a 2 year period without an identifiable cause. Less severe form of depression alone over a 2-year period.

Seminoma cause elevation in: Nonseminomas cause elevation in:

B-hCG AFP +/- B-hCG

Early decels appear as what? Etiology? Mgmt?

Fetal HR mirrors mothers contractions. Fetal head compression No mgmt

Optic neuropathy -> painless, progressive loss of vision and color desaturation (central or cecocentral scotomas) Ataxia Cognitive disturbances Peripheral sensory deficits Weakness Macrocytic anemia Dz? Consider in what pts? What is affected? Labs? Special test?

B12 def (hydroxycobalamin) Consider this in a person with h/o bowel resections or malnutrition (vegans, chronic pancreatitis); pt with Diphyllobathrium (tapeworms); pt with autoimmune problems (Intrinsic factor def) Dorsal columns, corticospinal tracts Increased MMA and homocysteine; hypersegmented neutrophils Schilling test - used to see if b12 def caused by pernicious anemia - radiolabeled B12 in urine will be low (because it's not absorbed)

-Cheilosis, stomatitis, glossitis -normocytic anemia -seborrheic dermatitis

B2 (riboflavin) def

-Cheilosis, stomatitis, glossitis -irritability, confusion, depression -Microcytic and hypochromic anemia with elevated iron and dec TIBC -severe - peripheral neuropathy, seborrheic dermatitis, microcytic anemia, seizures.

B6 (pyridoxine) def Can cause sideroblastic anemia

Pt with stable angina. What meds are used as prevention?

BB (1st line) - dec myocardial O2 demand, dec HR, and contractility. If CI to BB, non-DHP CCB can be used by same mechanisms. Long-acting nitrates

What medications improve mortality in CHF?

BB (dec HR -> inc cardiac filling and dec myoc O2 demand) ACE-I ARB Spironolactone Sacubitril/Valsartan (new) Hydralazine/isosorbide dinitrate (2nd line)

-Bradycardia, AV block, hypoTN -wheezing -hypoglycemia -CNS dysfx (seizures, delirium) Dz? Tx?

BB OD Tx: glucagon

BMI cutoff for anorexia nervosa

BMI < 18.5 kg/m^2 in adults. BMI <5th percentile in adolescents

Diagnosis of preeclampsia? What are "severe features" of preeclampsia?

BP >140/90 meausred on 2 occasions at least 4 hours apart after 20 weeks. Proteinuria >0.3g (300mg) or more in 24 hours Urine protein:Cr ratio >0.3 or urine dipstick reading of 2+ BP >160/110 PLT <100K LFT 2x normal Renal insufficiency RUQ pain Pulmonary edema Cerebral or visual disturbance

Dx and Mgmt of chronic HTN in pregnancy?

BP >140/90 on 2 occasions >4 hours apart prior to 20 weeks/pregnancy. Initiate aspirin Initiate/continue HTN meds Increased maternal and fetal surveillance Deliver between 37-39.6 weeks

Prognosis of pancreatitis - Greatest lab predictor of mortality is changes in ____ over the first 48 hours. What other lab value is a focus on goal-directed fluid administration? Why?

BUN Hct (not predictor of mortality; increased risk of pancreatic necrosis) These two numbers represent an overall hypovolemia and lack of adequate perfusion.

Bacterial Tracheitis vs croup?

Bacterial Vs. viral etiology Bacterial tracheitis has progressive high fever and toxic appearance Requires ABx and Tx similar to epiglottitis

Unilat eye redness, pain, & d/c with resultant both eyes affected. -thick, yellow, purulent d/c that reaccumulates quickly after wiping it. Dz? Likely organism? Tx?

Bacterial conjunctivitis. In adults MC d/t S. aureus. Often bacterial superinfection following viral conjunctivitis. Topical FQ

Pt with painful, watery, red eyes with purulent exudate and matted eyelashes upon waking up. Dz? MCC? Tx?

Bacterial conjunctivitis. S. aureus > Strep pneumo, H. flu Gatifloxain ophthalmic solution

Prophylaxis of PCP in HIV? If unable to tolerate? If unable to tolerate alternative? When is it given? Tx if they get PCP?

Bactrim Dapsone If G6PD def, Atovaquone CD4 <200 Same as above, but add steroids if hypoxic or has elevated A-a gradient Also can yse pentamidine for tx

Pts with solid organ transplant require prophylaxis against what?

Bactrim for PCP Pneumococcal and Hep B vaccines prior to transplant Gan/valganciclovir for CMV depending on status of donor Influenza given yearly

Prophylaxis of Toxo in HIV? If unable to tolerate?

Bactrim when CD4 <100 Pyramethamine + Leucovarin or sulfadiazine

Indications for bariatric surgery? When can weight loss meds be used?

Bariatric surgery candidates: -BMI >40 -BMI >35 with comorbid condition -BMI >30 with resistant type II DM or metabolic syndrome WL meds: BMI >30 or BMI 25/27-30 with comorbidities who have failed to lose 5% weight with lifestyle modifications. Meds include: orlistat, lorcaserin, naltrexone/bupropion, phentermine, liraglutide (preferred in pts with obesity and type II DM). Generally avoid because only promote short-term WL.

-Pearly, smooth papule with rolled edges -Telangiectasias -ulcerated nodule with central crusting Dz? Dx? Tx?

Basal Cell Carcinoma Excisional Biopsy: clusters of spindle cells surrounding by pallisading basal cells Surgical resection or topical imiquimod

-Contralateral hemiparesis & hemisensory loss -Homonymous hemianopsia -Conjugate gaze deviation toward lesion (away from hemiparesis) Site of hemorrhage? Complication?

Basal ganglia (putamen) Uncal herniation: compression of CN III -> dilated, nonreactive ipsilat pupil

In premature infants, when are immunizations given - based on chronological age, corrected gestational age, or depends on type of vaccine?

Based according to chronological age.

Pt presenting with hemotympanum - raise suspicion for ____. Other exam findings? Bones involved? Tx?

Basilar skull fx. Raccoon eyes (perioribital ecchymosis) Battle sign (Mastoid ecchymosis) Linear skull fx involving the temporal bone, sphenoid bone, frontal bone, or ethmoid bone. Surgery for cases complicated by intracranial bleeding, requiring decompression, vascular injury, significant cranial nerve injury, or persistent CSF leak. Theoretic risk of meningitis when CSF leak is present - prophylactically treat with abx.

Tachycardia, HTN, mydriasis, agitation, violent behavior, psychosis, myoclonus, seizures. Essentially looks like PCP intoxication, but lasts longer. Delirium & psychosis lasts several days to a week long.

Bath salt intoxication

-macroglossia -fetal hypoglycemia -fetal macrosomia -hemihyperplasia -umbilical hernia -omphalocele -ear pits Dz? What tumors are associated?

Beckwith-Wiedmann syndrome Wilms (nephroblastoma) and hepatoblastoma - monitor with abd US and AFP q few months until 4 yo, then renal US q few months from 4-8 yo

Ompalocele Gonadoblasoma Wilms tumor Hepatoblastoma macrosomia macroglossia anterior linear ear creases posterior helical pits vesceomegaly/organomegaly neonatal hypoglycemia cardiomegaly advanced bone age

Beckwith-widemann syndrome Kip 2 gene p57 mutation

-genital ulcers -painful oral ulcers -erythema nodosum -anterior uveitis -thrombosis Dz? Tx?

Behcet syndrome Acute exacerbations - prednisone Primarily skin/mucosal manifestations - Anti-TNF meds (etanercept or infliximab) Severe cases - Colchicine, thalidomide, IVIG

-prodrome of: auricular pain, dysacusis (sound distortion) -decresed tearing, hyperacusis, decreased taste over ant 2/3 of tongue -dec motor to half of face -sensation intact Dz? Tx?

Bell's Palsy Steroids/acyclovir, eye patch Do not use steroids if Lyme is suspected.

Tx for catatonia?

Benzos (Lorazepam) +/- ECT

Decompensated heart failure - what medication is contraindicated?

Beta-blockers and calcium channel blockers.

Baby with cyclic cyanosis that worsens with rest or feeding and improves with crying. Dz? Dx? W/u?

Bilateral choanal atresia. Failure to pass NG tube Part of CHARGE syndrome. (colobma, heart defects, atresia choanae, retard growth, GU anom, ear anom)

PBC imaging? S/Sx Dx? tx? complications?

Bile ducts will be nl. Fatigue, pruritis, xanthomas, jaundice. Liver biopsy Ursodeoxycholic acid, liver transplant Malabs of fat-sol vits; metabolic bone dz (osteoporosis/malacia), HCC

Stimulant laxative examples & MOA ADR?

Bisacodyl, Senna, Glycerol Intestinal contraction stimulant Melanosis coli - benign pigmentation of the wall of the colon; chronic use of antrhquinone laxatives (senna, aloe, frangula, cascara)

Dzs that cause lytic bone lesions?

Bone mets (breast, lung, thyroid, Kidney) (prostate typically blastic lesion) MM Lymphoma

Personality disorder - unstable moods high impulsivity self destructive behavior

Borderline PD Splitting defense mechanism - all good or all bad. No in between.

symmetric descending flaccid paralysis that started with dry mouth and diplopia, dysphagia, ptosis, *mydriasis*, and poorly reactive pupils.

Botulism

Diplopia, mydriasis, ptosis, dysphagia, dysphonia, muscle weakness, symmetric descending flaccid paralysis, cranial nerve palsies, respiratory failure. Dz? Tx?

Botulism toxin Trivalent antitoxin, supportive care, botulinum immunization

Lateral neck masses in children?

Branchial cleft cyst. Reactive adenopathy Mycobacterium avium lymphadenitis

Primary cancers that metastasize to bone

Breast Lung Thyroid/testes Kidney Prostate (via hematogenous spread - migration via Batson venous plexus) (BLT Kosher Pickle)

-elevated uncong bili in first week of life. -decreased urinary output and excessive WL Dz? Cause? Tx?

Breast feeding jaundice. D/t insufficient breast milk intake. Results in delayed stooling and increased enterohep circulation. Increase time/amount of feeding

-ELevated uncong bili peaking at 2 weeks of life. -no signs of dehydration or WL Dz? Cause? Tx?

Breast milk jaundive D/t high levels of B-glucoronidase in breast milk -> deconjugation f bili and increase in enterhepatic circulation. Tx?

infant/toddler with episodes of syncope/cyanosis in the setting of minor trauma and emotional upset. Dz? Age of occurrance? Workup? Associations? Types?

Breath-holding spell 6mo-6yr; first episode prior to 18 mo CBC with iron eval Iron def anemia Cyanotic or pallid Pallid is hard to differentiate from seizures because LOC will be delayed, go pale, diaphroetic, limp followed by increased muscular tone, incontinence, +/- clonus

Mgmt of chorioamnionitis

Broad spectrum IV abx (amp + erythro/azith) Immediate delivery (vaginal if reassuring fetal tracing; C-sec if nonreassuring fetal tracing); regardless of gestational age. Steroids <37 wks Magnesium <32 wks (if delivery is anticipated within 12 hours)

Pt with PTX is intubated and chest tube placed. Rapidly progressive worsening of O2 sats. Pneumomediastinum, inc subQ emphysema, and recurrent PTX. Dz? Dx? Mgmt? How does this differ from other major cause of subQ emphysema?

Bronchial rupture Bronchoscopy Operative repair Esophageal rupture is slower Diaphragmatic rupture: loss of diaphragm contour and abd viscera in thorax.

Premature neonate on mechanical ventilation. After d/c of ventilation, remains hypoxic and requires nasal O2. Increased RR & rhonchi Dz? XR?

Bronchopulmonary dysplasia (essentially RDS of newborn for >28 days) CXR: haziness bilat & decreased lung volumes

Undulating fever, fatigue, diaphoresis, arthralgias, myalgias, anorexia, malaise, HA Dz? Complications? Tx (adults vs children)?

Brucellosis Chronic fatigue, recurrent undulating fevers, hepatitis, osteoarthritis, endocarditis, respiratory diseases, CNS dysfunction, orchitis/epidydimitis Doxy + Rifampin or streptomycin x 6-8 weeks (adults) Bactrim + Rifampin or streptomycin x 6-8 weeks (children <8yo)

fever, HA, N/V, painful LAD, severe malaise, AMS, cough, buboes, eschars, pustules, necrotic lesions Dz? Microbio? Tx? Complications without tx?

Bubonic Plague (Yersinia) - MC form Zoonotic, Gram negative bacillus Transmitted via fleas/rodents Isolation, streptomycin, tetracyclines, Gentamicin +/- chlorampenicol Infection spreads resulting in Septicemic plague or pneumonic plague in 50%.

Absence or minimal presence of atheromas, segmental vascular inflammation, vasoocclusive phenomenon, and involvement of small and medium sized-arteries and veins of the upper and lower extremities. Associated with heavy tobacco use Presentation - resting pain, unremitting ischemic ulcerations, and gangrene of the digits of the hands/feet. What is the dz?

Buerger disease, a nonatherosclerotic vascular disease (aka thromboangiitis obliterans)

-tense bullae on erythematous base -elderly pt -mucosa not involved Dz? Dx? Tx?

Bullous Pemphigoid Skin biopsy - *subepidermal* (hemidesmosome) cleavage with linear IgG and C3 deposits at the dermal-epidermal junction. High-potency topical steroid (clobetasol) or oral prednisone

Rituximab is used to treat --?

Burkitt Lymphoma and a variety of B-cell dependant conditions, as it is an antibody against the B-cell surgace marker CD20, including most of the vasculitides (such as granulomatosis with polyangiitis and microscopic polyangiitis) as well as ITP.

Pneumoconiosis with exposure to cotton dust, hemp, flax brown pigmentation to lungs Sx worse at beginning of work week and gradually decrease chest tightness, SOB, fatique Dz? Tx?

Byssinosis Avoidance; supportive.

Pt will appear like post-strep glomerulonephritis but have continuation of sx (hematuria, proeinuria, elevated Cr) beyond 4-6 weeks. C3 low; C4 nl Dz?

C3 glomerulonephropathy

Tumor markers for pancreatic cancer

CA19-9 CEA

Alcohol dependence - what is considered at risk vs highly suggestive vs diagnostic?

CAGE questionnaire Cut down Annoyed when criticisizing drinking Guilt Eye opener 1 - ar risk for alcohol dep 2-3 - highly suggestive alcohol dependency 4 - diagnostic

Female with virilization and hirsuitism. Elevated 17-OHP, testosterone, and DHEAS.

CAH

Initial eval for AFib?

CBC BMP/CMP (Electrolytes, Renal fx) TSH Trop Echo

Initial work-up for AMS?

CBC CMP Head imaging ETOH level UDS UA Preg EKG CXR

Initial workup for a pt with fever and new-onset rash?

CBC (WBC - inf, platelets - purpura) CMP (renal fx - GN; liver fx) RPR (syphilis) HIV testing ANA Heterophile Ab (Mono)

Tx of hoarding disorder

CBT SSRI may be used, but CBT is best

Tx for binge eating disorder

CBT (best) 1st line: *SSRI* (sertraline) Lisdexamfetamine Topiramate

Tx of bulemia?

CBT + nutrition rehab + SSRI (fluoxetine)

Treatment for anorexia?

CBT + olanzapine

Tumor markers for colon cancer?

CEA +/- CA19-9

Chadvasc scoring system & Afib recommendations.

CHA2DS2VASc CHF-1 HTN-1 Age >75-2 DM-1 Stroke/TIA/thromboemb-2 Vasc dz (prior MI, PAD, aortic plaque)-1 Age 65-74-1 Sex category (female)-1 If 2+: anticoag with Warfarin or NOAC. If 1: nothing, ASA, or anticoag If 0: no tx

Coloboma, heart defects, choanal atresia, growth retardation, GU anomalies, ear deformity and deafness. Chr8.

CHARGE association

Newborn with: -Cyanosis at rest, improves with crying -cryptorchid testes -short, wide ears without earlobes. -cleft palate -VSD Dz? Dx? Mgmt?

CHARGE syndrome Coloboma (hole in eye structures) Heart defects (TOF, VSD) Atresia choanae Retarded growth/development GU anomalies (cryptorchid) Ear anomalies (HL) Other ass sx: anosmia, cleft lip/palate, hypotonia Dx: genetic testing Mgmt: oral airway, screening echo, renal US

RF for VTE?

CHF (generally systolic) Estrogen use Immobility Indwelling catheters Obesity Pregnancy Stroke Travel (>6 hours) Cancer Personal or family h/o VTE Clotting disorder Older age

CHF vs ARDS 1. LV fx 2. PCWP

CHF: -LV fx low becuase of increased fluid back up. -PCWP high (for above reasons) ARDS: -LV fx nl/elevated. Becuase this is non-cardiogenic pulm edema, and fluid is not backed up (no increased afterload). -PCWP nl/low

Treatment of CIN 2/3?

CIN 2/3: high-grade squamous intraepithelial lesion Tx: excision with LEEP, conization, or laser ablation. -If clear margins, repeat pap + HPV q 1-2 years. -If unclear margins or invasive cancer, repeat conization or hysterectomy.

Treatment of CIN I?

CIN I: low-grade squamous intraepithelial lesion. Repeat Pap in 6-12 months with HPV testing

Middle-aged pt with LUQ pain, fatigue, mucosal bleeding. -splenomegaly -no LAD -Anemia -Thrombocytosis -Leukocytosis -Elevated uric acid level -peripheral smear - eosinophils, neutrophils, *basophils*, mature metamyelocytes. Dz? Cell-lineage? Translocation; chromosome? BM biopsy shows what? Tx?

CML Clonal proliferation of myeloid stem cells (mature granulocutes). Translocation (*9;22*). Fusion of BCR gene on 22 with ABL gene on 9 (*BCR-ABL*) - known as the *Philidelphia* chromosome. Abdundant, hypercellular marrow; positive for BCR-ABL1 *Imatinib* a tyrosine-kinase inhibitor for stable, chronic CML. Allogeneic stem-cell transplant for the blast phase.

Conus Medullaris Syndrome vs Cauda Equina Syndrome

CMS: UMN LE signs; bilateral findings CES: LMN LE signs; unilateral findings Both: perianal anesthesia, bowel/bladder dysfx.

Bloody diarrhea in HIV + pts.

CMV if low-grade fever. Karposi sarcoma if no fever.

-HIV pt with: -progressive blurred vision -floaters -photopsia (sensation of flashing lights) -yellow-white exudates adjacent to fovea and retinal vessels with perivascular exudates and hemorrhages -*painless* Dz? Tx?

CMV retinitis Oral ganciclovir, foscarnet, cidofovir

Mgmt of ventilation in ARDS:

CO2: high RR (so you don't accumulate CO2) & low Tv (to reduce pressure). O2: *increase PEEP*. Don't want to mess with Fio2

Vasodilation or constriction in the brain: -hypercapnia Effect in COPD?

CO2: vasodilation in the brain In COPD this may induce seizures; happens d/t supplemental O2 causing loss of hypoxic respiratory drive.

Dx of chronic pancreatitis? sx?

CT abd - calcifications epigastric pain that improves with leaning forward; radiates to back diarrhea; WL DM

Diagnostic imaging for acute mesenteric ischemia: Tx?

CT angiography IV fluids, NG tube, broad-spectrum abx, Emergent laporotomy

Dx of Pulmonary Embolism? RF? EKG findings? Tx?

CT angiography best VQ scan if pt cannot recieve IC contrast (renal disease & pregnant pts) -VQ scan nl & any pretest prob -> PE excluded. -Low VQ & pretest prob -> PE excluded -High VQ scan prob & high pretest prob -> PE confirmed. -Any other combination -> further testing (CTA, etc.) RF: nephrotic syndrome, IBD, malignancy, orthopedic surgery, CHF, increased age, immobility, fracture, hospitalization, obesity, pregnancy, previous VTE, hormone therapy, smoking EKG - S1Q3T3; sinus tachy; RBBB Hemodynamically unstable - tPA Massive/Unstable + CI to anticoag therapy - pulmonary cath or embolectomy (if proximal) Stable pts - factor Xa inhibitors (first line), LMWH Anticoagulation therapy for at least 3 months or lifetime with annual reassessment of risks/benefits.

TIA work-up?

CT head -> MRI CTA/MRA Cardiac monitoring If arrhythmia is suspected - Echo EKG

Dx of RCC?

CT scan or US Do not biopsy! risk of hematoma! Resection serves as biopsy.

Dx of diverticulitis CI? Tx? Endoscopy recommendations

CT scan with IV and oral contrast XR to r/o perf -Barium enema & colonoscopy CI - do these AFTER "-itis" has resolved. IV abx regardless of complicated vs uncomplicated. If pt is hemodynamically stable with evidence of abscess -> <4cm -> IV abx alone and watch and wait for improvement. If no improvement or >4cm -> Percutaneous drainage +/- surgery. Pts who have an episode of complicated diverticulitis should undergo endoscopy within 6-8 weeks after an acute episode

Dx of pancreatic cancer? Tx? RF? Tumor marker used to monitor tx?

CT scan with IV contrast/triple phase CT = initial test of choice. Best used if *jaundice is absent*. Abd US is used as initial eval in pts with painless *jaundice*, anorexia, or WL. Debate over which is best... if concerns of obstructive process that is not cancer, US may be best initial choice, however, if cancer is concern then CT scan may be of more benefit. If mass is (not?) found on imaging -> endoscopic US or ERCP for biopsy. ERCP is the most sensitive test to idendify cancer localized in the head of the pancreas. (3-phase CT and CT+US have equal or better sensitivity) Palliative tx. If extrahepatic cholestasis is a problem (jaundice & pruritis), stent placement to relieve the obstruction is effective. Highest RF: >3 relatives with pancreatic ca, hereditary pancreatitis, Peutz-Jeghers syndrome, MEN, Lynch syndrome, von-Hippel-Lindau. Moderate RF: chronic pancreatitis, cystic fibrosis, 2+ first-degree relatives with panc ca, Lower RF: Alcohol abuse, DM, family h/o panc ca, smoking, BMI >30 CA19-9

Dx & Tx of colonic ischemia

CT with IV contrast - colonic wall thickening, fat stranding. This stratifies if pt needs colon resection. If not needed, IVF, abx, and endoscopy

Fat embolism syndrome XR findings?

CXR unremarkable at time of sx onset. Bilat pulm infiltrates within 24-48 hours.

Immunosuppression drug with these ADR: -Nephrotox -HTN -Glucose intolerance -Neurotox

Calcineurin inhibitors (tacrolimus)

-Acute onset worsening knee pain with edema, tenderness, and erythema -Elevated inflammatory markers -No fever -Nl white count -S/sx of arthritis -Chondrocalcinosis on XR Dz? Dx? Other dz associations? Other workup for new onset dz includes? Tx?

Calcium pyrophosphate Dihydrate Crystal Deposition (CPPD) aka - pseudogout. Arthrocentesis showing Rhomboid shaped, positively birefingent crystal Hemochromatosis, DM, hyperparathyroidism, hypomagnesemia, hypophosphatemia, familial hyoicalcuric hypercalcemia Screened for contributing conditions - calcium, phosphorus, magnesium, alk phos, PTH levels, and iron studies. NSAIDs, colchicine

Complication of pancreatitis - pancreatic necrosis.

Can be sterile or infected. Follows AP 1-3 weeks. CT - necrotic pancreatic tissue. If infection is suspected, get biopsy with percutanous aspiration and then treat with abx (meropenam)

Screening for lead poisoning?

Capillary (fingerstick) blood specimen is used as screening. High false-pos rate. Therefore, if elevated, venous lead measurement to confirm.

Pt with diarrhea, flushing, wheezing, right sided valvular heart dz. Dz? Dx? Biopsy findings? MC occur where? Tx?

Carcinoid syndrome - neuroendocrine cells Elevated 5-HIAA in urine, niacin def (pellegra), chromogranin A and synaptophysin rosettes -> secrete high levels of serotonin Small intestine (terminal ileum), lung Tx - octreotide, resection

S/Sx of Digoxin toxicity Tx?

Cardiac - life threatening arrhythmias GI - anorexia, N/V, abd pain Neuro - fatigue, confusion, weakness, color vision alterations. Anti-digitalis Ab, Mag, lidocaine for torsades

Cause of vasovagal (reflex) sycope? Dx? Tx?

Carotid sinus hypersensitivity causing exageratted vagal respone (parasym activation leading to cardioinhibitory resposne manifesting as brady with sinus arrest). Excess vagal tone -> rapid dec in BP with associated bradycardia. Triggered by emotional or physical stress, prolonged standing, prolonged heat exposure, fear, etc. Prodromal sx common - sweating, palpitations, yawning, nausea. Rapid recovery following syncope. -tilt table test -BB, counterpressure techniques

Opacification of lens Glare/halos with nighttime driving Muting of color vision

Cataracts

Antibiotics with pseudomonas coverage?

Cefepime Pip-tazo Levofloxacin, cipro, moxi Aztreonam (in PCN-allergic pts) Meropenam (very broad spectrum) Gentamicin (nephrotoxicity limits use)

Cephalosporins with pseudomonas coverage?

Ceftazidime Cefepime

-Diarrhea, abd distension/cramping -fractures, bone pain -microcytic anemia -WL -easy bruising -hyperkeratosis -papular/vesicular rash -loss of muscle mass & fatigue Dz? Dx? Associated with what HLA? Biopsy? What part of colon primarily affected? What Ab? Increased risk of what cancers? Screening?

Celiac dz resulting in malnutrition. Malabsorption of fats/protein (dec muscle mass, fatigue), iron (anemia), hyperparaythyroidism/Ca/vit D (fx, bone pain, osteopenia), Vit K (bruising, bleeding), vit A (hyperkeratosis), Vit E, multiple vit B def Assay of stool for fat is most sensitive initial test. Other = Ab testing and definitive with biopsy. HLA DR3-DQ2; HLA DR4-DQ8 flattened microvilli - vilious atrophy & crypt hyperplasia with intraepithelial lymphocytosis Distal duodenum and proximal jejunum *Anti-tissue transglutaminase*, anti-endomysial, anti-deamidated gliadin peptide, anti-reticulin Ab, anti-gliadin Ab. T-cell lymphoma and small bowel carcinoma Screen if sxatic; pts with 1st degree relative; pts with other autoimmune diseases; pts with chromosomal abnlities (Downs, Turnerr, WIlliams); pts with IgA def.

-Decreased sensation and motor fx in arms (with sparing of legs) after forced hyperextension (fall, whiplash). - +/- associated bladder dysfx.

Central cord syndrome Can be seen following intubation (neck hyperextension) in the setting of cervical sponylosis.

Sudden, painless unilateral vision loss -disc swelling -venous dilation & tortuosity -retinal hemorrhages -cotton wool spots

Central retinal vein occlusion

Central vs peripheral cyanosis in newborns.

Central: bluish tongue/lips/mouth. D/t low arterial O2 saturation. Peripheral: bluish distal extremities. D/t peripheral vasoconstriction & high venous prossure causing increased O2 extraction secodnary to sluggish blood flow.

Tremor: -increases as hand gets closer to target -slow, broad tremor of extremities

Cerebellar tremor

-Facial weakness -Vertigo -Occipital HA, neck stiffness -Ataxia, nystagmus -NO hemiparesis Site of hemorrhage?

Cerebellum

CT with dense, microhemorrhage and hypodense edema - dz? From what type of injury?

Cerebral contusion Coup-countercoup injury

Most serious complication if a pt gets a second concussion before he was cleared from first concussion?

Cerebral edema & death can occur from second-impact syndrome

Intramural dissections, causing luminal stenosis or occlusion is consistent with pathophysiology of what disease?

Cerebral- or cervical artery dissection.

Mgmt of high-grade cervical dysplasia. Margin assessment mgmt?

Cervical conization, LEEP, or cryoablation. If margins clear, repeat Pap/HPV in 1-2 years. If margins not clear, repeat conization or hysterectomy.

Cervix/vainga/uterus changes in early pregnancy?

Chadwick's sign - Bluish discoloration - also occurs to the vagina. Goodell's sign - softening and cyanosis of the cervix at or after 4 weeks gestation. Ladin's sign - softening of the uterus after 6 weeks gestation.

Nonpainful genital ulcer with nontender LAD?

Chancre (syphilis)

Child with prolonged bleeding times, easy bruisability, recurrent infections, peripheral neuropathy, abscesses, hypopigmentation, pancytopenia. Dz? Tx?

Chediak-Higashi syndrome - AR defect in LYST -> microtubule dysfx in phagosome-lysosome fusion. Bone marrow transplant

Chelation for lead poisoning?

Chelation - succimer, dimercaprol (EDTA) -Succimer for mild elevation (45-69) -EDTA for levels >70 Definitive - removal of offending agent.

-bilat distal n/t -bilat distal weakness & absent distal reflexes -bilat loss of pain/temp distal

Chemo-induced peripheral neuropathy - several weeks following initiation of chemo Diabetic peripheral neuropathy - motor weakness is late

Drugs that require pulmonary function testing annually?

Chemotherapy agents with lung toxicity (bleomycin, carmustine) & amiodarone

-Severe polyarthalgias -thrombocytopenia, leukopenia -macular rash -recent tropical travel

Chikungunya fever

When should children get work-up for UTI? What is work-up? Tx?

Children <2yo, with h/o febrile UTI (even first time). Work-up includes renal and bladder US. If hydronephrosis or recurrent UTI - do VCUG Empiric abx (3rd gen cephalosporin-Cefixime)

MCC of cervicitis

Chlamydia & Gonorrhea

23 yo woman with recurrent RUQ abd pain and juandice. Elevated alk phos and bilirubin Nl liver chemistry US - bile duct dilation MRCP - fusiform dilation of extrahepatic biliary tree Dz? Increased risk of what? Tx?

Choledochal cyst 6 different type...too much detail but essentially sounds like PBC(??) Malignancy Surgical removal of the cyst

-Livedo reticularis -cyanotic toes with intact pulses -acute kidney injury -ocular involvement (Hollenhorst plaques) -GI (ischemia, pancreatitis -CNS (CVA, amaurosis fugax) -decreased complement -eosinophilia Dz? MC when?

Cholesterol embolism -MC following catherization

Mineral def with: -impaired glucose control in DM?

Chromium

Smudge cells are classically associated with what disease?

Chronic Lymphocytic Leukemia (CLL)

Older adult with: mostly asxatic -painless *LAD* -*hepatosplenomegaly* -Leukocytosis >50,000 -Anemia, recurrent infections Dz? Dx? Labs? Tx?

Chronic Lymphocytic Leukemia (CLL) - disorder of B-cells -Dx: *flow cytometry*; BM biopsy confirms -Labs: lymphocytosis, anemia, thrombocytopenia, *smudge cells* -No tx if asxatic. -Inidications for tx: progressive BM failure (cytopenias), massive LAD/splenmegaly, presence of severe B sx. Tx: Rituximab - monoclonal Ab against CD20 Ag on B-lymphocytes.

Neonate with: -microcephaly -spasticity -seizures -multiple intracranial calcifications -closed ant fontanelle -contractures

Congenital zika syndrome

Adult with: -mostly asxatic -constitutional sx -hepatosplenomegaly -Leukocytosis with basophilia and eosinophilia -h/o radiation exposure -Dz? Dx? Labs? Tx?

Chronic Myelocytic Leukemia (CML) d/t BCR-ABL translocation 9:22 - *Philadelphia chr*) - clonal expansion of myeloid progenitor cells Dx: BM biopsy confirms Labs: Myelocytes, anemia, thrombocytopenia Leukocytosis (often >100,000) with excess granulocytes & basophils Tx: imatinib (tyrosine kinase inhibitor)

male with dysuria and frequency recurrent UTIs pain with ejaculation nontender prostate What's the tx?

Chronic bacterial prostatitis Different frm chronic prostatitis/chronic pelvic pain syndrome d/t *+urine culture*. FQ x 6 weeks (Bactrim may also be used)

Laxative abuse can lead to what electrolyte/acid abnlities? Vomiting causes what?

Chronic diarrhea - hypokalemia, acidosis (low bicarb) Hypokalemia and alkalosis

Loss of hydrogen peroxide production. Dz? Dx? S/Sx?

Chronic granulomatous dz Nigroblue tetrazolium test fails to turn blue; abnl dihydroohodamine test - decreased green fluorescence. Recurrent infections of catalase + organisms (fungal and bacterial infections)

Cause of finger clubbing?

Chronic hypoxia is the cause.

-Unilat LE swelling, heaviness, discomfort with firm, dry, thickened skin

Chronic lymphedema - d/t disruption of lymphatic system (recurrent cellulitis, radiation, malig obstruction, etc)

Male with: -urgency, frequency, urgency, & hesitancy -Perineal pain with ejaculation -UA: leukocytes and no growth on culture Dz?

Chronic prostatitis/chronic pelvic pain syndrome Major difference between chronic bacterial prostatitis is that culture will be + in CBP.

Pt with previous radation: -severe bloody dirrhea, strictures with fecal incontinence -Endoscopy: multiple telangiectasias, mucosal pallor & friability Dz? Path? Tx?

Chronic radiation proctitis (>3mo to years ago) D/t obliterative endarteritis and chronic mucosal ischemia; submucosal fibrosis resulting in decreased rectal compliance. Tx: endoscopic thermal coagulation; sucralfate or steroid enemas

What SSRI is associated with QT prolonation?

Citalopram

NYHA classification

Class I (mild): no sx, no limitations Monitor; BB, ACE-I/ARB Class II (mild): no sx @ rest, slight limitation, ordinary activity leads to sx Class III (moderate): no sx @ rest, marked limitation w/ physical activity, less than ordinary activity results in sx Class IV (severe): sx @ rest, unable to do any physical activity w/o discomfort

Wound Classification

Clean - uninfected operative wounds, alimentary tract not entered. Clean-contaminated - Alimentary tract is entered but under controlled conditions without unusual spillage (bowel spillage) Contaminated - open traumatic wounds, break in steril technique, gross spillage from alimentary tract Dirty - existing infection or perforated viscera present in operative field prior to surgery (colonic perf)

Dx of hepatic encephalopathy Precipitating factors?

Clinical Serum ammonia levels do not correlate. Drugs (sedatives, narcotics) Hypovolemia Electrolytes (hypokal) Increase N load (GI bleeding) Infection TIPS procedure

Post-exposure prophylaxis for Hep A?

Close contacts, child care center workers, food prep workers Give within 2 weeks <40: Hep A vaccine >40: Hep A immune globulin

Young pt with: -ataxia -limb weakness -incontinence -skin dimpling -hyperpigmentation Dz? Dx?

Closed (occult) spinal dysraphism - in the spectrum on neural tube defects. MRI entire spine

Pneumoconiosis with CXR - small nodules and large opacities in the upper lung zones; enlargement of the hilum; fibrosis and honeycombing and ground-glass opacities; gross findings - black lungs

Coal miners lung (can present similarly to Silicosis - differentiate by RF - sandblasting vs coal exposure)

-UE HTN -LE hypoTN -brachial-femoral delay -epistaxis, HA Dz? Sound?

Coarctation of the aorta Continuous rumbling murmur that radiates over the interscapular area. Systolic ejection murmur at the L interscapular area.

Insomnia, tachycardia, mydriasis, HTN, sweating, hyperalertness, aggression, delirium, psychosis, tactile hallucinations/formications (bugs crawling on them) Intoxication of what? Tx?

Cocaine intoxication -mild-mod agitation - BZD -severe agitation/psychosis - haloperidol -symptomatic support - control HTN, arrythmias

Lynch syndrome associated with what cancers? Mutation of what?

Colon (R sided) Endometrial Ovarian Germline mutation on one of several DNA-mismatch repair genes or los sof expression of MSH2 d/t a deletion in the EPCAM gene

If abnl pap, next step?

Colposcopy If + endo: get cone biopsy If + ecto: local ablation with cryo or LEEP. If unsure (ASCUS), get HPV or repeat pap in 6 months.

Atypical glandular cells of pap Next step in mgmt?

Colposcopy, Endocervical curettage, and Endometrial biopsy

-Foot drop -N/T over dorsal food/lat shin -impaired dorsiflexion and great toe extension What nerve?

Common peroneal nerve

Sensation to post/lat let and dorso/lat foot. Foot drop Weak foot eversion, dorsiflexion, and toe extension.

Common peroneal nerve

-vag bleeding <20 weeks (may present without bleeding; h/o passing tissue-like material) -closed os -US - absent products of conception

Complete Ab

Vag bleeding, malodorous d/c, ulcerated vag lesion in elderly woman. Next step?

Concern for vaginal carcinoma. Biopsy lesion.

17 yo with: -aggression towards people/animals -destruction of property -deceitfulness, lying, theft -serious violations of rules Dz?

Conduct disorder If same traits in 18 yo - antisocial personality disorder

Child who is: -shorter than peers -delayed puberty -bone age is younger than age -Nl ht/wt at birth Dz? Tx?

Constitutional growth delay. After ~6mo, the child's growth velocity slows. Reassurance. They will have nl growth spurt, it's just later than peers.

-S/sx of R HF (edema, JVD, ascites) -LV EF 65% -Calcifications of heart border -pericardial knock (middiastolic sound) Dz?

Constrictive pericarditis

Mineral def with: -neuro dysfx (ataxia, peripheral neuropathy) -subacute combined degeneration -Hypochromic microcytic anemia -osteoporosis -leukopenia -If presenting in a child with developmental delay and seizures in young child - inability to sit up, smile, find hands, brittle, kinky (pili torti) hair, and skin depig - what is this called?

Copper Nuerologic sx generally mimic B12 def, with progressive myelopathy, peripheral neuropathy. Menkes disease - these findings are generally not seen in adults.

Types of emergency contraception

Copper IUD Ulipristal Levonorgestrel OCP

Penicillamine used to treat what?

Copper chelation (Wilson disease)

Most effective emergency contraception?

Copper-IUD

-Severe eye pain and photophobia in the setting of trauma Dz? Dx? Tx? What is CI'd?

Corneal abrasion Slit-light exam with fluroscein staining Non-contact lens wearers - Bacitracin, Erythromycin ointment, trimethoprim/polymyxin B, sulfacetamide sodium For contact lens wearers - coverage for Pseudomonas is required - Cipro (FQ) or AG Steroids are contraindicated because they slow healing and reduce resistance to infection

How to correct calcium levels?

Corrected Ca = measured ca + 0.8 * (4 - albumin)

Anterior spinal artery syndrome affects what part of the spinal column? What is spared? Highly associated with what? Presents as?

Corticospinal tract spinothalamic tract ventral horn lateral fray matter Dorsal columns are spared Atherosclerotic aneurysm of the aorta bilat loss opf pain and temp below the lesion; spastic paresis below the lesion; bilat flaccid paralysis at the level of the lesion

In a pt with recent laparoscopic cholecystecomy with hyperbilirubinemia, perihepatic and peritoneal fluid collections seen on imaging - next step in mgmt?

Could be nl post-op changes, retained stone with obstruction, or biliary leak Obtain HIDA scan in stable pts. If unstable, ERCP

Smooth, nontender RUQ mass Sign? Indicative of what dx?

Courvoiseir sign Pancreatic cancer; cholangiocarcinoma

Horizontal and vertical diplopia ptosis down and out gaze Which cranial nerve?

Cranial nerve III (oculomotor)

Vertical diplopia exacerbated by a downward gaze Can reduce diplopia by turning head away from the lesion Which cranial nerve?

Cranial nerve IV (trochlear)

Horizontal diplopia Unable to abduct eye Which cranial nerve?

Cranial nerve VI (abducen)

Mineral def with: -growth retardation -flat nasal bridge -hypotonia with minimal reflexes -deaf-mutism -gross motor delay -macroglossia -diminished reflexes -large abdomen with umbilical hernia

Cretinism - d/t iodine def

Dx of imperforate anus Tx?

Cross table XR Look for VACTERL syndrome. Vertebral Anus imperf Cardiac TEF EA Renal Limb Before Surgery: US sacrum, echo, cath with XR, VCUG, & XR wrist. Mild: fix now Severe: colostomy now, fix later

Watery diarrhea in HIV pts:

Cryprosporidium: severe watery diarrhea, *low-grade fever*, WL. CD4 ct <180 Micro/Isosporidium: watery diarrhea, crampy abd pain, WL, *no fever*. CD4 ct <100 MAC: watery diarrhea, *high-grade fever*, WL. CD4 ct <50

Pt with HIV now having fever, HA, N/V, and papilledema. Cause? Prophylaxis?

Cryptococcal meningitis CD4 <100 - CHECK ON DRUG TO USE???

Periumbilical ecchymosis. Sign? Idicative of what dx?

Cullen's sign Hemorrhagic pancreatitis; retroperitoneal hemorrhage

Cushing syndrome vs Cushing disease?

Cushing Syndrome: -Excess exposure -Chronic use of corticosteroids -Iatrogenic administration of exogenous corticosteroids (e.g. prednisone) Cushing Disease: -ACTH secreting Pituitary adenoma -Adrenal tumors

HTN, bradycardia, respiratory depression What cranial nerve is likely to be affected?

Cushing reflex d/t uncal herniation CN III - down and out pupil with mydriasis and ptosis

fever, malaise, HA, painless papule/vesicle that later turns into a necrotic ulcer with characteristic 1-5cm black eschar and extensive surrounding erythema; local LAD Dz? Micro? Tx?

Cutaneous anthrax Gram-positive bacillus PCN, doxy and cipro Inhalation anthrax without meningitis is treated with Ciprofloxacin, clindamycin, + anthrax immunoglobulin or raxibacumab.

-Newborn with failure to pass meconium -Level of obstructrion at ileum -Meconium: thick, inpissated. -Colon: narrow and underdeveloped.

Cystic fibrosis meconium ileus. Tx: water enema

-hexagonal urine crystals -positive cyanide nitroprusside test -Positive familty hx

Cystinuria -impaired transport nof cystine, ornithine, lysine, and arginine (COLA)

Dx for Bladder cancer? Tx? RF?

Cystoscopy with biopsy Tx depends on the extent of spread beyond the bladder mucosa. Carcinoma in situ - transurethral resection of bladder tumor and at least one dose of intracesical chemo. Invasive cancers without mets - radical cystectomy or chemo/radiotheraphy. Invasive cancers with distant mets - oral and IV chemo. Smoking, occupational exposures to aromatic amines (mineral oils, paints, hairdressing, textiles, etc.)

Labs in a pt with SLE? In a flare what happens to complement? Ab most specific?

Cytopenias Elevated Cr Elevated ESR/CRP Sediment on UA in the setting of nephritis Hepatotoxicities Acute flare -> decreased complement d/t immune complex formation and complement activation DsDNA-Ab, anti-smith Ab

Mgmt of hydatidiform mole

D&C f/u B-hCG weekly for 1 year + contraception If B-hCG increases after D&C -> malignancy should be suspected and CXR should be obtained.

Mechanical prosthestic valve thrombosis. Features? Dx? Tx? Prevention?

D/t inadequate anticoag. Mitral > aortic risk. S/Sx: *Obstructive thrombus mimics valvular stenosis.* HF, cardiogenic shock. Systemic VTE (stroke). Dx: echo Tx: anticoag (hep), firbinolytic (try to avoid). Surgery for severe HF or large VTE. Prevention: ASA + warfarin. Target INR 2.5-3.5 (mitral) or 2-3 (aortic)

apoplexy vs Sheehan

D/t spontaneous *hemorrhage* into pituitary gland During pregnancy, lots of blood loss leads to *infarction* of pituitary

Sx of manic episode

DIG FAST Distractability Impulsivity Grandiosity Flight of Ideas Agitation (psychomotor) Sleep dec Talkativeness (pressured speech)

What joint is not involved in RA? What deformities are associated with RA? In OA - What are the nodules called involving DIP joint? PIP joint?

DIP Boutonniere deformity, swan-neck deformity, ulnar deviation of the wrists, rheumatoid nodules DIP - Heberden's nodes; PIP - Bouchard's nodes

Pt on warfarin starts eating more veggies. How does this affect PT/INR? What veggies do this? How do abx affect warfarin?

Decrease INR Spinach, brussel sprouts. Ginseng also decreases INR Abx reduce vit K production in the gut -> raise INR

Late decels appear as what? Etiology? Mgmt?

Decrease in fetal HR after contraction. Decel 30-40 bpm below baseline, then slowly returns. Uteroplacental insufficiency d/t maternal hypoTN (usually after epidural placement), maternal hemorrhage, maternal hypoxia, tachysystole, abruption Intrauterine resus - maternal repositioning (L lat decubitus), IVF bolus, maternal oxygenation, decreasing or turning off pitocin, cessation of tachysystole (terbutaline) Emergent operative vaginal devliery or C-sec as the last resort if the fetal HR variability pattern does not improve. If bradycardia or variability is lost -> emergent delivery via C-sec is warranted.

Poor sign in asthma exacerbation?

Decreased BS or Paco2 that is nl/elevated

Lab changes with Loop diuretics?

Decreased K, Ca, Mag. Ototoxicity Alkalosis

Woman (>35yo) with infertility. -Had previous pregnancy -woman has regular menstrual cycles Cause? Test?

Decreased ovarian reserve. Day 3 (early follicular phase) FSH testing can be done to assess ovarian fx.

In cardiac tamponade, what are the changes? -preload -SV -CO Physical exam findings? EKG findings? Dx? Tx?

Decreased preload, SV, CO. Beck triad - hypoTN, muffled heart sounds, elevated JVD. tachycardia (reflex), pulsus paradoxus, pericardial friction rub (if pericarditis is cause), dyspnea Electrical alternans. Echo Urgent pericardiocentesis

Dx of Wilson disease? tx?

Decreased serum ceruloplasmin. Increased urinary copper excretion Chelate with penicillamine; transplant

Cirrhosis effects on thyroid levels

Decreased synthesis of binding proteins for thyroid hormones (TBG). Decreased total T3 and T4. Free T3/T4 and TSH are unchanged.

Transfusion reaction: -within 2-10 days -asxatic -elevated uncong bili -Coombs+ -mild anemia -hyperbilirubinemia Which one? D/t? Tx?

Delayed hemolytic d/t anamestic Ab response. Tx: supportive/IVF

Oral burns (electrical) What are delayed complications? Immediate complications?

Delayed labial artery bleeding - 1-3 weeks after initial injury, necrotic tissue sloughs, potentially leading to exposure and injury to the labial artery and sometimes catastrophic hemorrhage. Tx: squeeze lips together at corners and get to ED. Airway compromise Cardiac conduction abnlitles (VFib) Deep/superficial burns Blunt injury Rhabdo

-Progressive cognitive decline, dementia -*repeated falls* -syncope/near-syncope -severe autonomic dysfx -delusions -depression/anxiety -*Fluctuating cognition* (good days and bad days) -*Visual hallucinations* -Spont *parkinsonism features* (rigidity, bradykinesia, postural instability). -REM sleep behavior disorder Dx?

Demential with Lewy Bodies Dementia then Parkinsonism. (vs. Parkinsons where parkinsonism then dementia) Deficits in attention and visual-spatial ability (clock-drawing, navigating familiar places) happen earlier than memory. (vs. Alzheimer where memory then attention & visual-spatial problems)

Defense mechanism - absolute avoidance or a painful reality?

Denial

Contraception with ADR: -weight gain -depression -alopecia -menstrual irregularities (prolonged bleeding/spotting, esp in first 6 months) - may result in amenorrhea. -breast tenderness Also, why is this not recommended for long-term use?

Depot medroxyprogesterone Not recommended for long-term use (>2 yrs) in adolescents/young women d/t signficiant risk for loss of bone mineral density.

What does muscle biopsy show in dermatomyositis or polymyositis?

Dermato: perimysial & perivascular inflammation Poly: endomysial inflammation & patchy necrosis

-firm, hyperpigmented nodule -dimpling in the center when the area is pinched.

Dermatofibroma

-Proximal muslce weakness -papules on dorsum of hand -erythematous, violacious rash around eyes Dz? What are the names of the rashes listed above? Other rash? Dx? Associated cancers? Tx?

Dermatomyositis Gottron's papules (sign when present on extensor surfaces), heloptrope rash Shawl sign - rash overlying the shoulders and upper chest Definitive with muscle biopsy - perimysial inflammation with atrophy Ovarian, cervical, lung, pancreatic, bladder, gastricp Steroids

Infant with: -small mandible -long facies -asymmetric cry -murmur -tremors -poor tone Dz?

DiGeorge syndrome Absent thymus -> hypocalcemia

-*Microaneurysms* -Hard exudates -Retinal (dot & blot) hemorrhages -Neovascularization -Patchy visual field defects -Macular edema -Cotton wools spots

Diabetic retinopathy

Child with: -pallor/cyanosis early in life -*Triphalangeal* thumbs -craniofacial abnlities -dec H/H, retic, & macrocytic anemia Dz?

Diamond blackfan anemia *Pure RBC aplasia* Tx: RBC transfusions. steroids, BM transplant.

1. HF with preserved EF vs 2. HF with reduced EF -diastolic or systolic dysfx? -What is the EF?

Diastolic HF >40% Systolic HF <40%

Eval & Tx of constipation (in elderly)?

Diet and lifestyle modification for everyone; In elderly: review of medications (opiates, antidep, anticholinergics, iron supplements); review of underlying medical problems (DM, hypothyroidism, hyperparathyroidism, chronic renal failure); eval or tx for underlying neurological disorder (Parkinson's, multiple sclerosis, dementia); eval for comorbid conditions (depression, disability, activity level) If above ineffective, then bulk laxative preferred over osmotic laxatives

dilated aberrant submucosal vessel that erodes the overlying epithelium in the absence of a primary ulcer

Dieulafoy's lesion

Pt with SLE develops acute SOB, CP, fever in the setting of significant Hb drop. CXR - bilat, fluffly infiltrates Dz? Dx? Tx?

Diffuse alveolar hemorrhage Bronchoscopy for bronchoaleolar lavage High-dose suppressive glucocorticoid therpahy with pulsed methylprednisolone and the initiation of alternate immune suppressive agents, such as cyclophosphamide.

-mediastinal mass -*CP or painful LAD with alcohol* -painless LAD -pruritis -*no hepatosplenomegaly* Disease? Male or female predominance? Age? Associated with what dz and sx? Dx? Labs? Tx? MC to least common subtype and specific buzzwords with each?

Disease: Hodgkin Lymphoma (B-cell malignancy) Male predominance; bimodal 30s & 60-90yo EBV; B-sx (fever, WL, night sweats) Dx: excisional LN biopsy - *Reed-Sternberg* cells, which care CD15+ and CD30+ Labs: leukocytosis with eosinophilia, elevated LDH Tx: chemo (ABVD - adriamycin, bleomycin, vinblastine, dacarbazine) + radiation Nodular sclerosis (Female? 20-30yo; lacunar cells; inflam infiltrate with neutrophils, eosinophils, basophils) > Mixed cellularity (eosinophilia) > lymphocytic rich (best prognosis; lymphocytic rich on biopsy) > Lymphocyte depleted (worst prognosis; 60-90yo; hypocellular d/t fibrosis and necrosis)

-Painless LAD -*Hepatosplenomegaly* -anemia, thrombocytopenia, or leukopenia Disease? Associated with what dz and sx? Dx? Labs? Tx? List some types? MC

Disease: Non-Hodgkin Lymphoma Autoimmune diseases and viral infections (HIV); B-sx (WL, fever, night sweats) Dx: Excisional LN Biopsy Labs: elevated alk phos, LFTs, bili, LDH tx: chemo (rituximab for Burkitt) B-cell types - Burkitt, Diffuse large B-cell (MC), Follicular (2nd MC), mantle cell (3rd MC), marginal zone, primary central nervous system T-cell types - Adult T-cell, Mycosis fungoides/Sezary syndrome

Oligohydramnios causes Tx?

Disorders relating to fetal renal/urinary system (Renal agenesis) ROM Aneuploidy, CNS anomalies Skeletal anomalies Based on underlying cause; fetal amnioinfusion during labor to prevent cord compression

Defense mechanism - avoided feelings transferred to another (innocent) person or object?

Displacement.

Defense mechanism - an individual mentally separates part of his or her consciousness from real-life events. Ex: someone having no recollection of being raped.

Dissociation

Stool softeners examples and MOA

Docusate Adds moisture to stools to make them softer and easier to pass.

Diabetes testing and what time in pregnancy?

Done ~24-28 weeks. Initial screening: 50g 1 hour oral glucose challenge test

Antiemetics that can cause extrapyramidal side effects?

Dopamine antagonists: prochlorperazine, promethazine, metoclopramide.

Duodenal atresia is associated with Tx?

Down syndrome VACTERL Findings of Duodenal atresia requires eval for other malformations NG tube and surgery

Tx for Lyme disease Pregant? Children? Allergy? Severe complications of dz? Who should recieve prophylaxis?

Doxycycline. Pregnant/children - amox or cefuroxime (If PCN allergic) PCN allergy - azith/erythromycin Severe complications of Lyme - IV ceftriaxone Must meet all five: -attached tick is adult -attached >36 hours -Prophylaxis within 72 hours of tick removal -local infection rate of ticks with B.burgdorferi >20% -Doxycycline is not CI'd (no other abx should be used as prophylaxis)

Pts who recieve stent or PCI should get what med?

Dual antiplatelet therapy: ASA + P2Y12 inhibitor (clopidefrel or ticagrelor) 30 days for bare metal stent 12 mo for drug eluting stent

Pt with elevated direct bili and nl alk phos, ALT/AST. Differential?

Dubin-Johnson or Rotor syndrome

3 yo male with delayed ambulation. Difficulty keeping up with other kids Pushes hands against floor to stand up Waddling gait Dz? Labs? EMG? Genetics? Tx? Complications? At risk for what other developments?

Duchenne Muscular Dystrophy Elevated CK and ALT Myopathic waveform with nl nerve conduction velocities. Mutation in Xp21 gene encoding dystrophin protein. Steroids - help slow progression; ACE-I to decrease cardiac afterload; PT; pulmonary support Death ~25 d/t respiratory/heart complications Lordosis, contractions, scoliosis, restrictive lung disease Often wheelchair bound by 7-13yo

Pt with transient monocular vision loss should be evaluated with what imaging modality?

Duplex US or CT angio of carotid arteries

Dx, Goal, & Tx for DM?

Dx: Fasting BSG >126 x2; random glucose >200 with sx; 2-hour postprandial glucose >200; A1C >6.5 Goal A1C <7% Goal preprandial glucose 90-130 Goal postprandial glucose <180 1. lifestyle + metformin (max 1000mg BID) 2. If not at goal - max out metformin; when maxed out, add 2nd agent (sulfonurea) 3. If not at goal - add insulin If A1C >9%, then start with diet modification, WL, exercise, and insulin Other indications to start out with insulin include: fasting glucose >250, random glucose >300, A1C >10% (TL), presence of ketonuria, sxatic with polyuria, polydipsia, WL. Switch to oral (metformin) when sx have resolved and glucose levels have decreased BP goal <140/90 Meds - ACE-I/ARB ASCVD considerations - add statin (high-intensity - Atorvastatin or Rosuvastatin) Yearly ophthalmology visits Yearly foot exams

Infertility in a pt with klinefelter dz d/t _____. Tx?

Dysgenesis of the seminiferous tubules -> inferfility. Testicular sperm extraction and intracytoplasmic sperm injection

Cushing dz vs syndrome?

Dz - pituitary adenoma Syndrome - everything else

Dx of PUD? Dx tests for H. pylori? RF for PUD cause of upper GI bleed?

EGD with biopsy Stool antigen test, urease breath test H. pylori, NSAID use, Stress, excess gastric acid

Who should receive traveler's diarrhea prophylaxis? What is prophylaxis?

ELderly, immunocompromised, those with chronic GI diseases Rifaximin

Common ADR of SSRI?

Early - HA, N, insomnia/sedation, anxiety, dizziness. These typically resolve with time. Long-term: Sexual dysfx, WG

Vitamin K def bleeding in newborns classification?

Early onset - within 24 hours and has a jhigh risk of intracranial hemorrhage. Classic onset - 2-7 days of life Late-onset - 3 weeks to 8 months and has a frequency of ICH of about 50%.

Basically presents like Lyme dz; -had tick bite -no rash -high fever Dz? Dx?

Ehrlichosis Tx: doxy

Child with silver hair, seizures, mental retardation, bronze-tan skin, fully functional immune system Dz?

Elejalde syndrome

-Distended GB with gas in the wall and lumen and air-fluid levels in the GB. -Fever, RUQ pain, N/V, crepitus Dx? Tx?

Emphysematous cholecystitis Emergent cholecystecomy.

What is the difference between empyema vs complicated parapneumatic effusions vs uncomplicated effusions?

Empyema: Presence of gross pus or bacteria on gram stain + WBC count >100,000, glucose <40, pH <7. Tx: chest tube drainage Complicated: exudative without presence of gross pus Uncomplicated: sterile exudative fluid

Next step when the entire squamocolumnar junction cannot be visualized on colposcopy?

Endocervical curettage

Premenopausal women with *regular* periods and *intermenstral bleeding*. Uterus is small, nontender, and mobile. Dx? Tx?

Endometrial polyp Sxatic tx - polypectomy

-Adherent, Immobile uterus -Cervical motion tenderness -Adnexal mass (unilocular) with homogenous, low level eches (ground-glass appearance) -Tenderness to posterior vaginal fornix -Thickening of uterosacral ligaments -lateral displacement of cervix What dz? S/Sx? dx? tx?

Endometriosis S/Sx: *pelvic pain* (worse with exercise/sex, 1-2 days prior to period), dysmenorrhea, infertility, dyschezia, dyspareunia, perimenstrual spotting. Dx: definitive with biopsy; laproscopy - powder burn lesions, "chocolate cysts" CA-125 Pts usually have no increased/prolonged bleeding. Periods regular. Tx: if asxatic - no tx/observation. If sxatic - NSAIDs, OCPs, GnRH agonists (leuprolide), surgical resection

In the setting of SVC syndrome d/t malignancy: pt has HA worse with leaning forward, JVD, & facial/arm swelling. How can you decrease these sx?

Endovenous stenting followed by radiation.

-Young man with dysphagia, CP, reflux, food impaction, and refractory heartburn -Associated atopy Dz? Dx?

Eosinophilic esophagitis Endoscopy + biopsy

70 yo with a form of Acute Myelocytic Leukemia (AML) presenting with pancytopenia & immature eosinophils on peripheral smear Dz? Cell line affected?

Eosinophilic leukemia Eosinophils

-nodule that can gradually increase in size and may intermittently proguce a cheezy, white discharge. -dome-shaped, firm, freely movable cyst/nodule with a central punctum (pore-like opening)

Epidermal inclusion cyst

Which hematoma is associated: 1. Lucid interval 2. Lens-shaped 3. Crosses suture lines 4. Bridging vein disruption 5. Does not cross suture lines 6. Middle meningeal artery tear 7. crescent-shape 8. Gradual deteriation

Epidural - 1, 2, 5, 6 Subdural - 3, 4, 7, 8

Difference between epiglottitis and retropharyngeal abscess? Sx? Imaging? MCC? Tx?

Epiglottitis - onset much more abrupt (2-3 days) Stridor, voice muffling, fever. Thumbprint sign MCC - Strep pneumo (adults), H.flu (children), H. parainflu, GAS Empiric tx covering H.flu type b, Strep pneumo, GAS, and S. aureus - Vancomycin + 3rd gen Ceph Retropharyngeal abscess - slower onset of sx Sore throat, fever, neck stiffness, stridor Retropharyngeal space edema on imaging manifesting as widening of the prevertebral soft tissues.

Elderly woman with: -ascites -SOB -Crampy abd pain, unrelated to meals/BM, constant, nonradiation -abd distension, obstipation -early satiety -asxatic adnexal mass Dz? Labs? Dx? Mgmt?

Epithelial ovarian carcinoma -Elevated CA-125 Pelvic US -Mgmt: exploratory laparotomy Subtle sx- ovarian cancer should be considered in elderly women with vague new-onset abd sx, particularly with nl colonoscopy.

Non-purulent, edeamtous, well-demarcated cellulitis Dz? MCC? Tx?

Erysipelas Group A Strep (S. pyogenes) Mild - oral Dicloxacillin, Cephalexin, PCN, Amox If PCN allergic - Erythro/Clarithromycin, Clindamycin, Bactrim Severe - IV Oxacillin, nafcillin, Cefazolin, Clindamycin If PCN allergic - Clindamycin, Vancomycin

Healthy neonate with: -diffuse rash on face, back, abd, chest -scattered, blanching, erythematous papules and pustules that spare palms and soles Dz? Mgmt?

Erythema toxicum neonatorum Observation and reassurance. Common in neonates in first 2 weeks of life.

Button battery FB tx?

Esophageal impaction or located in the stomach - emergent endoscopy. If in the intestines and asxatic - observation with serial imaging if clinical status changes; should pass within one week. If in intestines and sxatic - repeat imaging and (SURGERY??)

Resolution of GERD sx after years of problems and new onset dysphagia Symmetric and circumfrential narrowing of distal esophagus.

Esophageal stricture

-Platelet count >600,000 -Thrombosis, hemorrhage Dz? Tx?

Essential thrombocytopenia ASA

Tremor that increases with actions, but does not worsen/change with different movements. What's the treatment?

Essential tremor Propranolol

adjustment d/o with depressed mood Tx?

Essentially sadness/depression without enough MDD criteria and onset within 3 months of an identifiable stressor. Does cause impairment Tx: Psychotherapy

-ear fullness/discomfort -tinnitus -cond HL -popping sensation -sx occuring days following plane ride Dx?

Eustachian tube dysfx - also presents with TM retraction. TM rupture can present similarly, but would present immediately.

-Low total and free T3 -Nl T4 -*Nl TSH* Dx?

Euthyroid sick syndrome

-Lytic bone lesion with lamellated periosteal reaction and "moth-eaten" appearance on long bone *diaphysis*.

Ewing Sarcoma "Onion skinning"

Dx of lymphome?

Excisional biopsy

Marathon runner collapses following race. -no LOC -Dizziness, lightheadedness -mild elevated temp Dz? D/t? Mgmt?

Exercise-associated postural HypoTN D/t cessation of exercise resulting in sudden decrease in venous return (preload) to heart. Trendelenburg position; oral hydration

Pt experiences stridor, globus sensation, hoarseness, non-productive cough with exercise. Sx resolve within minutes of inactivity. Metacholine challenge = 3% decline in baseline PFT. Dz? Dx? Tx?

Exercise-induced laryngeal obstruction - supraglottic or glottic obstruction that is not present at rest and manifests during high intensity exercise. Symptoms similar to asthma - therefore, diagnostic workup is critical. Gold-standard - continuous laryngoscopy during exercise. Metacholine challenge for asthmatics result in >20% drop in baseline PFTs. Speech behavioral therapy.

-Temp >104 immediately following collapse -*CNS dysfx* -other organ/tissue damage Dz? Tx?

Exertional heat stroke Rapid cooling - *ice water immersion*, fluid resus, electrolyte mgmt However, these findings can also occur in elderly without exertion, Tx: evaporative cooling

Anal pathology with: -dusky purple mass -itching/bleeding -acute enlargement with pain Dz? Tx?

External hemorrhoid with thrombosis Mild hemorrhoid: conservative tx with high-fiber diet, sitz bath, stool softeners, topical analgenics/anti-inflammatories/spasmodics (lidocaine, steroid supp, nitro cream) Severe hemorrhoids or thrombosed: Hemorrhoidectomy; hemorrhoid incision with thrombus removal for temp relief.

In prerenal failure, pt on diuretic what calculation can you not use? What do you use instead?>

FENa: becuase diuretic blocks Na channels to not reliable. Use FEurea (<35%)

Best predictors of post-op outcome following lung resection?

FEV1 & DLCO

When to deliver in preeclampsia?

FIRST, stability with antihypertensive meds (hydralazine, labetolol) and seizure prophylaxis (Mag) -With severe features - deliver at 34 weeks. If 34-36.6 - antenatal corticosteroids should be given - reduces neonatal death, RDS, cerebroventricular hemorrhage, necrotizing enterocolitis, respiratory support, ICU, and systemic infections in the first 48 hours of life. -Without severe features - deliver at 37 weeks. *Induction of labor* is preferred if mom and baby are stable and no CI to vaginal delivery (breech). C-sec is done if failed induction or nonreassuring fetal stress status. <34 week and preecl w/ severe features: conservative mgmt with hospital admission and observation. <37 weeks and preec without severe features: outpt mgmt At any point if unstable/non-reassuring -> deliver.

Hemophilia A Hemophilia B Changes to PT/PTT?

Factor VIII deficiency Factor IX deficiency Prolonged PTT; nl PT

Child that has either: -weight <5th percentile -decrease in growth velocity in which weight-for-age or weight-for-height falls by at least two major percentile parkers. Dz? MCC? Eval for? RF? General and lab work-up?

Failure to thrive (weight faltering) Inadequate caloric intake Evaluation for cause of undernutrition - neglect, food insecurity, medical conditions preventing adequate intake of nutrients, etc. Rarely caused by underlying conditions which may cause increased metabolism or decreased absorption. Med conditions - prematurity, developmental delays, congenital abnlities, low birth weight, poor oral hygiene, reflux. Psychosocial disorders - disordered feeding, family stressors, FH of partner abuse, poor parenting skills, poverty, restricted diet (religious/other). Good H&P - eating habits, home life, etc. etc. Labs - considered in severe cases. Initial - CBC, BMP, VBG, lactate, ammonia, bilirubin, glucose, UA. Specialized - HIV, TB, lipase (CF), milk protein allergy, celiac panel, congenital anomaly (lung, heart, kidney, bladder), abd us (pyloric stenosis), skeletal survey (neglect), TSH (hyperthyroidism).

Child with: -cafe au lait spots and/or hypopigmented spots -short stature -abnl thumbs (*hypoplastic*) -genital anomalies -abnl ears -elevated AFP -*pancytopenia* Dz? D/t? Tx?

Fanconi anemia AR d/t BM failure. Inc risk of leukemia. Stem cell transplant

Pancytopenia myelodysplasias generalized hyper/hypopigmentation cafe-au-lait spots short stature absent/hypoplastic thumbs undescended testes microcephaly micropthalmia horseshoe kidney deafness GI atresias TEF Imperforate anus

Fanconi anemia FANC protein defects

Transfusion reaction: -within 1-6 hours -febrile -hemodym stable Which one? D/t? Tx?

Febrile nonhemolytic d/t cytokine accumulation during blood storage. Prevent with leukoreduced blood produced.

Rheumatoid Arthritis Splenomegaly Neutropenia Dz? d/t? Dx? increased risk of what?

Felty syndrome Auto-ab against neutrophil components and GCST; complication of long-standing RA BM biopsy & peripheral smear Increased risk of infection

-chronic, progressive thinning of hair -Men: vertex, frontal, and temporal areas of hair thinning in an 'M' pattern. -women: vertex, center of scalp hair thinning Dz? Path? Tx?

Female and male pattern hair loss Replacement of terminal hairs by smaller vellus hairs (follicular miniaturization) In men: driven by androgens (DHT). In women, androgen levels are usually nl. Men: minoxidil, finasteride Women: minoxidil, spironolactone

Smooth philtrum, small palpebral fissures, CNS disorders, intellectual disability, microcephaly, micrognathia, upper facial hypoplasia, ASD Dz? RF?

Fetal alcohol syndrome. RF - higher maternal age, higher G/P, H/o miscarriages/stillbirths, inadequate prenatal care, poor maternal nutrition during pregnancy, h/o FAH in previous children, Substance use (tobacco), mental health problems (depression), h/o physical/sexual abuse or IPV, social isolation (rural area), other maternal family members with IPV or substance use during pregnancy, poverty

Neonate born post-term -SGA -thin body with loose skin -meconium stained amniotic fluid Dz?

Fetal dysmaturity syndrome D/t age-related placenta changes & resultant uteroplacental insufficiency.

Cervical changes happen d/t ________.

Fetal head engagement.

Child with: -growth retardation -microcephaly -hypoplasia of distal phalanx of fingers/toes -nail hypoplasia -hirsutism -sleft lip/palate -rib anomalies -cardiac/GU anomalies Dz?

Fetal hydantoin syndrome secondary to in utero exposure to Phenytoin.

Diagnostic criteria for Kawasaki disease Mgmt?

Fever lasting 5 or more days PLUS 4 or more of the following: -conjunctivitis -mucositis ("strawberry tongue") -rash -extremity changes (edema, erythema, desquamation of hands/feet). -cervical LAD Other key features: sterile pyruia, thrombocytosis ~2-3 weeks Echo & EKG ASA + IVIGdi

31 yo Woman with breast mass US - hypoechoic solid mass with well-demarcated border Exam - firm, mobile mass Dz?

Fibroadenoma

-Young women -HTN -Recurrent HA -pulsatile tinnitus -subauricular systolic bruit -amaurosis fugax Dz? Dx? Tx?

Fibromuscular dysplasia (of internal carotid a.) Abdominal CT angiography - string of beads/pearls sign describing stenosis of the artery alternating with aneurysmal dilation Duplex US stenting, alternative revascularization, and RF modification (ASA for CVA)

Pt with painful, swollen glands, painful LAD Scrotal swelling BLE pitting edema Travel to Africa Blood smear - microfilaria with an acellular sheath, no nuclei on the tail US - movement of adult worms within the lymphatics. No rash or skin involvement. Dz? Dx? Tx? Side effect of tx? Other tx options?

Filarisis - Wuchereria bancrofti (roundworm, nematode) Blood smear Diethylcarbamazine Mazzotti reaction - rapid parasitic death; an immune hyperstimulation syndrome resulting in fever, urticaria, tachycardia, hypotension, arthralgias, edema, abdominal pain, LAD. Tx - Methylprednisolone Ivermectin + Albendazole; Doxycycline added for lymphatic dz.

Tx of BPH (benign prostatic hyperplasia)? Work-up? Histology? Occurs at what zone of the prostate?

First line: alpha-blocker (tamsulosin, doxazosin) 5-alpha-reductase inhibitors (finasteride): used in addition to alpha-blockers or as an alternative if pt cannot tolerate alpha blocker (d/t orthostatic hypoTN) and takes months to take effect. Get baseline PSA prior to starting UA - to evaluate for hematureia, glucosuria, ketonuria, infection, or alternative cause of lower urinary tract like sx. If exam has asymmetry, nodules, or very enlarged prostate with severe sx - consider PSA and urology f/u. If findings of severe urinary retention and elevated postvoid residuals (>250cc) - consider obtaining Cr and/or upper urinary tract US If elevated Cr - renal US Proliferation of glandular epithelial tissue, smooth muscle, and connective tissue within the prostatic *transitional/periurethral zone* Transition zone (vs prostatic ca - posterior, outer zones)

Tx of postnasal drip chronic cough

First-gen antihistamines.

Work up of thyroid nodule

First: TSH & thyroid US. 1. TSH *low*: means hyperfxing: get *RAIU*. -If hot - hyperfx - do not biopsy, treat hyperthyroidism. -If cold - get US and FNA 2. TSH nl/high: means euthyroid: high risk nodule - Get US for size >1cm - FNA <1cm - wait and repeat US in 6-12 weeks If FNA shows cancer, resect. If FNA is not cancer, repeat US in 6-12 months. If it grows, re-biopsy. If stable, screen q years. If FNA inconclusive, rebiopsy until you have answer.

Prophylaxis of Coccidiodomycosis in HIV pts? Histo?

Fluconazole when CD4 count <250 Itraconazole when CD4 count <150

HHS treatment algorithm?

Fluid replacement with 1-2L bolus of isotonic saline (NS) IV insulin should be administered after initial fluid bolus. If K+ <3.3 -> add K prior to insulin Following fluid bolus, corrected serum sodium calculation obtained (= Na + 1.6(glucose-100)) if value >135 -> fluids should be switched to half-NS if value <135 -> continue with NS Dextrose should be added when glucose levels reach 300 or less or when using IV insulin.

SSRI for pediatrics?

Fluoxetine

Hypermagnesemia associations Tx?

Flushing Hypocalcemia Hyperkalemia Respiratory distress (paralysis, pulmonary edema) Decreased DTRs Cardiac conduction abnormalities -> cardiac arrest Calcium Gluconate IV

Hepatic lesion in young woman with: -incidentally found solitary, hypo/iso-dense liver lesion with *central, stellate scar* and arterial enhancement Dz? Tx?

Focal nodular hyperplasia Rarely rupture, undergo malig transformation, or grow, no tx necessary.

Thyroid cancer that spreads hematogenously?

Follicular

When are foot/ankle XR indicated? (Ottawa ankle rules)

Foot: pain at midfoot AND: -tender navicular -tender base of 5th MT -unable to bear weight Ankle: pain at malleolar area AND: -tender medial malleolus or lateral malleolus -unable to bear weight

Child with: -poor muscle tone -flexible joints -delayed developmental milestones -intellectual disability -features of autism > ADHD -elongated face & large ears -large testes Dz? D/t?

Fragile X syndrome D/t CGG repeat on FMR1 gene of X chr.

~5 days to 2 weeks following MI -cardiac tamponade, shock

Free wall rupture

Flank ecchymosis. Sign? Indicative of what dx?

Grey-Turner sign Hemorrhagic pancreatitis; retroperitoneal hemorrhage

Pathologic GERD in neonates -S/Sx? -S/Sx requiring further eval? -Mgmt?

Frequent regurg/vomiting, prolonged feeding, refusal to feed, back arching, postprandial irritability. FTT, fever, persistent forceful/bilious vomiting, apnea, lethargy, seizures, neurodevelopmental delay, persistent diarrhea/constipation/GI bleeding, abdominal tenderness/distension, hepatosplenomegaly. Thickened feeds (add oatmeal) and PPI.

-Contralat hemiparesis -Eyes deviate away from hemiparesis (toward lesion) -Seizures Site of hemorrhage?

Frontal lobe

Mgmt if melanoma is suspected? Prognosis is related to what? What is an indication for sentinel LN biopsy? If +LN, next step in mgmt?

Full-thickness excisional biopsy with 1-3mm margins. Menanoma in situ (not penetrating epidermis) requires excision with margins of 5mm. Depth of tumor. Depth >0.8mm or <0.8mm with ulceration. Either complete lymphadenectomy vs serial US

-Cornea contains multiple stromal abscesses

Fungal keratitis Corneal injury in agreicultural workers or immunocompromised.

Furuncle vs. carbuncle

Furuncle = one. Carbuncle = cluster of connected furuncles (boils)

-Tonsillitis/pharyngitis -Internal jugular vein thromosis/infection -neck pain/swelling along SCM -lung nodules -fever, rigors, respiratory distress

Fusobacterium necrophorum infection resulting in Lemierre syndrme.

Explosive onset multiple, itchy siborrheic keratoses is associated with what condition?

GI malignancy

Polyhydramnios causes

GI obstruction (duodenal atresia) anencephaly multiple gestations DM Beckwith-Wiedemann TEF

Newborn with E.coli sepsis Dz? Other features? Etiology?

Galactosemia Jaundice, hepatomegaly, FTT/vomiting, cataracts, hypoglycemia, + urine reducing substances. D/t GALT def - inability to metabolize galactose -> glucose

Somatostatinoma -s/sx

Gallstones, DM, steatorrhea

-Colon ca -osteoma -soft tissue tumors (epidermoid cysts)

Gardner syndrome Mgmt: frequent colonoscopies starting in childhood.

WL, persistent abdominal pain Dysphagia Likely dz? Best next step? RF? Protective factors?

Gastric adenocarcinoma EGD with biopsy. Once confirmed, get H. pylori testing & CT for staging. If concern for metastatic or significantly locally advanced dz - staging laparoscopy. Diet high in nitrates and salts, male, smoking, +FH, gastric polyps, previous gastric resection, H.pylori infection, chronic gastritis ASA use, fruits/veggies, selenium, vit C

Asian elderly with: -persistent abd pain, WL -No relationship to food -No diarrhea, blood -Hepatomegaly -IDA, elevated alk phos, dec albumin Likely dx?

Gastric ca w/ mets to liver

-Hepatosplenomegaly -Bone pain -pancytopenia -FTT -Delayed puberty Dz? Path?

Gaucher disease D/t glucocerebrocidase def.

multiple pink/skin colored lesions ranging from smooth, flattened papules to exophytic/cauliflower-like growths in the perineum/anal area. Dz? Tx?

Genital warts (condylomata acuminata d/t HPV 6/11) Chemical: podophyllin resin, *trichloroacetic acid* (first line) Immunologic: imiquimod Surg: cryotherapy, laser, excision

-pain/aversion to attempted vaginal penetration -cannot tolerate speculum exam -no tenderness to external exam Dz? Tx?

Genito-pelvic pain/penetration d/o (vaginismus) - reflex related to contraction of pelvic floor muscles, preventing vaginal penetration. Commonly seen in pts with h/o sexual abuse. Desensitization, Kegel

Macrosomic baby d/t mom with: gestational DM or chronic DM?

Gestational Chronic DM results in baby who is SGA.

Bone tumor on epiphysis of long bones. Soap bubble appearance

Giant cell tumor

-Necrolytic migratory erythema -GI sx Dz? Association? Dx?

Glucagonoma -Also new onset DM -Glucagon level, abd imaging.

infant with doll-like face: -hypoglycemia -hyperurcemia -hyperlipidemia -seizures from lactic acidosis -thin extremities, short stature, protuberant abd -hepatomeg Dz?

Glucose-6-Phosphotase def

Mostly asxatic, -Tenesmus -Anorectal pain -Mucopurulent d/c

Gonococcal proctitis

Septic arthritis -Gonococcal vs -Staph

Gonococcal: -Common in young, sexually active adults. -person with h/o STD/urethritis/cervicitis. -Synovial fluid count <50,000 and gram negative culture. -Migratory polyarth, tenosynovitis, and dermatitis. *Pustular* rash on trunk, extremities, or *palms or soles*. Staph: -MC overall -Synovial fluid count >50,000 -Culture usually +

Which gout? 1. Needle-shaped 2. Rhomboid shaped 3. + birefringent 4. - birefringent 5. rod-shaped

Gout: 1, 4 Pseudogout: 2, 3, 5

Painless, beefy red, friable genital ulcer. No LAD. Tx?

Granuloma inguinale (Klebsiella) Azithromycin

-Painless, red genital ulcer with granulation tissue and irregular borders -No/mild LAD

Granuloma inguinale d/t Klebsiella granulomatis (or Calymmatobacterium granulomatis??) Donovan bodies

Middle aged adult with: -otalgia & hearing loss -microscopic hematuria & proteinuria. -skin ulcers; arthralgias -rhinitis Dz? Other sx? Dx? Tx?

Granulomatosis with polyangiitis (necrotizing vasculitis; Wegener's) Other sx: sinusitis, otitis, saddle-nose deformity, lung nodules/cavitation, rapidly progressive GN, livedo reticularis, leukocytoclastic angiitis (purpura on LE with ulceration), urticaria, pyoderma gangrenosum (inflam pap/pustule progressing to painful ulcer) Dx: *c-ANCA*, biopsy cutaneous, renal, lung (not nasal ulcer) Tx: steroids, methotrexate, cyclophosphomide

Child with albinism, hypotonia, peripheral faical palsy, spasticity, seizures, very ill appearing Dz?

Griscelli syndrome - require bone marrow transplant very early in life. Major difference between Chediak-Higashi is they appear more ill and with more severe neurologic features.

Symmetric LE weakness. Decreased DTRs. Paresthesia of fingers/toes & neuropathic pain. Intact sensation. Autonomic dysfx (bradycardia, dec RR) Tx?

Guillian Barre Syndrome -Tx: monitor pulm function - may require mechanical ventilation. IVIG for significant weakness. Plasmaphoresis may decrease severity. DO NOT give steroids.

Postmenopausal female with increased abd girth. -L adnexal mass -US - 6cm complex L ovarian cystic and solid mass with thick, noduler septations -CT - same ovarian mass with omental caking/nodularity and free fluid. Initial step?

Gyn onc referral for surgical exploration. Tumor markers should be ordered (CA-125); however, surgery is likely needed for diagnosis and treatment. Ovarian masses are not percutaneously biopsied. Mgmt of ovarian mass/cyst is largely drive by imaging features: -Simple cyst (anechoic, thin walls, no septations) Mgmt: f/u imaging if >1cm; MR or consider surgical eval if very large (>7cm( as US may be incompletely evaluating large lesions. -Indeterminate/Intermediate (non-simple cysts with internal echoes and thin septa without suspicious findings) Mgmt: Variable depending of pt specific RF, tumor markers, etc. -Suspicious (complex cystic mass - thick septa, solid components/nodules, color flow; solid mass; evidence of metastases - liver lesions, omental caking, peritoneal seeding, adenopathy) Mgmt: Gyn onc referral for surgical eval

-Painful genital papule/pustule/ulcer -Inguinal lymphadenitis (severe, may suppurate)

H. ducreyi

Painful genital ulcer with tender suppurative LAD? Dz? Dx? Tx?

H. ducreyi (chancroid) PCR or Gram stain - gram neg rods, sometimes described as "schools of fish" or "railroad tracks" Azithromycin or Ceftriaxone

Cerebellar hematoma s/sx; mgmt?

HA, vomiting, increased ICP, obstructive hydrocephalus d/t compression of the 4th ventricle. Surgical emergency - decompression

Causes of non-anion gap metabolic acidosis

HARDUPS Hyperailentation Acetazolamide RTA Diarrhea Uretero-pelvic shunt Post-hypocapnia Spirinolactone HARDASS - Acetazolamide Saline infusion

Major difference between HELLP and acute fatty liver of pregnancy?

HELLP: *preeclampsia*, N/V, RUQ pain, thrombocytopenia, elevated liver enzymes, MAHA AFLP: *leukocytosis, hypoglycemia, acute kidney injury,* N/V, RUQ pain, thrombocytopenia, elevation in liver enzymes

HIT 1 vs HIT 2

HIT 1 - nonimmune mediated platelet aggregation. Mild thrombocytopenia in the first 1-2 days and resolves without cessation of heparin. HIT 2 - immune-mediated platelet aggregation resuling in severe thrombocytopenia around day 5-10 (earlier if prior heparin exposure) and requires tx and cessation of heparin

Sudden onset, severe psoriasis is associated with what condition?

HIV Also recurrent herpes zoster, severe seborrheic dermatitis, and disseminated molluscum contagiosum

Pt with long standing HIV -behavioral & personality changes Dz? Imaging?

HIV-associated dementia Diffuse brain atropy, ventricular enlargement, and reduced attenuation of white matter structures

Crescendo-decrescendo murmur at apex & left sternal border that *does not radiate* to carotids Dz? Tx? Avoid? What will increase/decrease murmur? Dx? EKG?

HOCM BB (met, atenolol), non-DHP CCB. Ablation, myomectomy. AICD Avoid vol depletion, DHP-CCB, nitrates, ACE-I/ARbs. Increased with Valsalva and standing. Decreases with increased preload or increases afterload - BB, squatting Echo Septal Q waves, LVH

Painful genital ulcer with tender LAD?

HSV

Young woman with: -confusion, agitation, no sleep, twitching, not oriented -fever, supple neck -seizures -EEG: prominent high-amp slow waves over temp & frontal lobes Dz?

HSV encephalitis Other sx: anosmia, gustatory hallucinations, bizzare/psychotic behavior.

-pt with HIV -decreased vision -eye *pain* -Photophobia -conjuntivitis -fundoscopy - widespread, pale, peripheral retinal lesions and central necrosis of the retina -dendritic ulcer

HSV keratitis

Herpes simplex vs H. ducreyi

HSV: -small vesicles/ulcers on erythematous base. -mild LAD (tender) H. ducreyi (chancroid): -large, deep, multiple ulcers with gray/yellow exudate -well-demarcated borders with soft, friable base -Severe LAD (tender) that may suppurate.

Strongest RF for: ischemic stroke hemorrhagic stroke

HTN for both. It accelerates the atherosclerotic process and promotes thrombi formation.

Older adult with: mostly asxatic; weakness, fatigue, petechiae, abdominal pain, early satiety, weight loss -pancytopenia -*splenomegaly* -*LAD & hepatomegaly rare* -*TRAP stain +* Dz? Dx? Tx?

Hairy cell leukemia - Disorder of well-differentiated B-lymphocytes Pancytopenia d/t BM fibrosis. D/t clonal B-cell neoplasm & BRAF mutation. "Hairy cells" on peripheral smear - mononuclear cells with abundant pale cytoplasm and cytoplasmic projections. Dx: BM biopsy + flow cytometry (CD19, CD20; BRAF mutation) Tx: chemo if severe. otherwise, no tx If asxatic - no tx. If sxatic or cytopenic - nucleoside analogs

Tx for agitation/delirium in elderly?

Haloperidol

Fever, chills, myalgias hemorrhage, hypotension, AKI Dz?

Hantavirus - hemorrhagic fever with renal syndrome

HINTS exam

Head Impulse (VOR): ABnormal = eyes saccade back to find targe, suggesting peripheral. Normal = eyes hold on target, if pt has vertigo a normal test indicates a central problem. Nystagmus: vertical, rotary, and bi-directional Test of Skew - cover/uncover eye and look to see if it moves up or down 1/3 is +test suggesting central lesion

Causes of SIADH?

Head injury CNS surgery Certain meds (morphine, NSAIDs, oxytocin) Hypothyroidism Glucocorticoid def Small cell lung cancer Pancreatic malignancy Thymoma Hodgkin disease

Difference between heat exhaustion and heat stroke?

Heat exhaustion: overheating Heat stroke: CNS dysfx

Dimercaprol is used to treat?

Heavy metal chelation - mercury, lead, arsenic, gold

Deferoxamine is used to treat

Hemochromatosis Acute iron poisoning

Hepatic tumor associated with: -young women on OCPs -incidentally found - solitary, solid lesion in R lobe of liver Dz? Dx? Tx?

Hepatic adenoma Biopsy not recommended d/t high propensity of bleeding. -Asxatic and <5cm: stop OCPs -Sxatic or >5cm: surgical resection

Woman with hepatic mass on US appearing as a well-demarcated, homogenous, and hyperechoic lesion CT - contrast enhanced peripheral nodular enhancement in the early phase, followed by a centripital pattern or "filling in" during the late phase

Hepatic hemangioma (cavernous hemangioma) MC benign tumor of the liver.

-Hepatic mass with early arterial enhancement with early "washout" -elevated alpha-fetoprotein

Hepatocellular carcinoma

-Recurrent epistaxis -Diffuse telangiectasias -Widespread AVM's causing chronic hypoxemia and resultant digital clubbing and reactive polycythemia Dz?

Hereditary hemorrhagic telangiectasia (Osler Weber rendu syndrome)

Young pt with: -splenomegaly -jaundice -gallstones -hemolytic anemia Dz? Dx? Tx?

Hereditary spherocytosis Dx: pheripheral smear; Eosin-5 maliemide binding test; osmotic fragility test. Coombs - Tx: splenectomy

Child with albinism and amblyopia and pulmonary fibrosis. No recurrent infections Dz?

Hermansky-Pudlak

-Pain, photophobia, blurred vision, tearing, redness -corneal vesicles and dendritic ulcers Dz? Tx?

Herpes simplex keratitis (Epithelial keratitis) Topical antiviral ointment (Trifluridine)

-Fever, malaise, and a burning/itching sensation in the periorbital region -vesicular rash in the cutaneous branch of V1 -dendriform ulcers of the cornea -chemosis of conjuntiva,

Herpes zoster ophthalmicus High dose acyclovir

Tx Multiple Sclerosis exacerbation Most sensitive way to dx Multiple Sclerosis? Diagnostic criteria?

High-dose steroids. If refractory, plasmaphoresis Relapsing-remitting dz - interferon-beta, fingolimod, flatiramer acetate, monoclonal ab (ocrelizumab, daclizumab, alemtuzumab). Muscle spasticity - Baclofen MRI - Dawson's fingers = plaques scattered throughout the white matter, classically located at the angles of the lateral ventricles Only get LP or evoked potentials if dx is unclear. Two episodes of sx separated by time and space & evidence of two white matter lesions on imaging.

Best imaging for interstitial lung dz?

High-resolution CT

Who requires 24-hr urine collection for total protein at the *initial prenatal visit*? Mgmt?

High-risk pts for preeclampsia: -Type I DM -multiple gestation -chronic HTN -SLE Mgmt: ASA starting at 12 weeks.

-Erythema nodosum -non-caseating granuloma -cough -hilar adenopathy Deterioration after tx for suspected sarcoidosis. What's the dx?

Histoplasmosis Caseating granulomas are MC, but non-caseating may also be present.

Kid with CVA and: -fair skin -tall -scolioisis -intell. disability -lens dislocation (down and out) -megaloblastic anemia Dz? Tx?

Homocysteinuria B6 + folate + B12 +/- antiplatelet/anticoag therapy

Candidemia is seen in what setting? Dx? Tx?

Hospitalized pts in the ICU with intravascular catheters. Blood cultures or biopsy IV antifungals Oral cadidiasis does not cause invasive dz

N. meningitidis post-exposure prohpylaxis. Who gets it? When?

Household members/roommates, childcare center workers, directly exposed to pt, seated next to person >8 hours. *Regardless of vaccination status* Tx: Rifampin, Ceftriaxone, Cipro (adults). Given ASAP, but up to 2 weeks.

Atrophy of the caudate nucleus Dz? Repeat?

Huntington Dz CAG

Unilocular liver cyst with a thick wall (eggshell calcification). Dz? Tx? Complications?

Hydatid cyst d/t Echinococcus granulosus Tx: surgical resection + albendazole If ruptures, can result in anaphylactic shock.

First-line, Long-term mgmt of SLE? What would be a CI to this medication? ADR? Other treatments?

Hydroxychloroquine allergies, G6PD def pigment retinopathy presenting as loss of night and peripheral vision with progressively constricted visual fields; routine ophthalmology exams are recommended while on this medication. NSAIDs for pain Glucocorticoids for acute flares Steroid-sparing meds (azathioprine, methotrexate) In pts with life-threatening manifestations of lupus - high-dose, pulsed methylprednisolone and cyclophosphamide.

T-cells lack of CD40-ligand Dz? result?

Hyper-IgM syndrome cannot bind to CD40-rec on B-cells and not activate B-cells to undergo class switching

Hyperthyroidism vs hypothyroidism -effect on SVR?

Hyper: decreased SVR (systolic HTN) Hypo: increased SVR. (diastolic HTN)

Somogyi effect D/t what? Dx? Tx?

Hyperglycemia upon awakening. D/t rebound response to nocturnal hypoglycemia. Dx: 3am BSG (low) Tx: decrease evening insulin

Acanthosis nigricans is associated with

Hyperinsulinemia and visceral malignancy (gastric adenocarcinoma)

Pt with: -renal failure -atrophic kidneys -bland urine sediment & mild proteinuria -Renal biopsy: hyalinization in the arterioles and small arteries. Dz?

Hypertensive nephrosclerosis

-Sudden onset arthropathy (hands & wrists) -Digital clubbing -Skin thickening Dz? Associated with what processes?

Hypertrophic osteoarthropathy -MC d/t attributable underlying lung disease. Adenocarcinoma & SqCC of the lung. Also seen in CF pts. Essentially sudden onset clubbing. Associated with cancer -> get CXR

Beck triad? Seen in what dz?

HypoTN Muffled heart sounds Elevated JVD Cardiac tamponade

Alcoholic in withdrawal with muscular and neurologic hyperactivity -tachycardia -myoclonus -nystagmus -AMS -cardiac arrythmias -psychosis -hyperactive refelxes Deficient in what?

Hypomagnesia!! Results in refractory hypokalemia in alcoholic due to renal potassium wasting in the loop of Henle Magnesium is an important cofactor for K+

-Prox muscle weakness & pain -Nl ESR/CRP -Elevated CK -DTR decreased

Hypothyroid myopathy *Dec DTR* *Nl ESR* *Inc CK*

Hypovolemic vs Cardiogenic vs. Septic shock -CO? -PCWP? -Peripheral vascular resistance?

Hypovolemic shock: -Decreased CO, PCWP -Increased peripheral vascular resistance. Cardiogenic Shock: -Decreased CO -Increased PCWP, perip. vasc resistance Septic shock: -Increased CO -Decreased PCWP, perip. vasc resistance

Hemorrhagic shock classification - blood loss; HR; BP; RR; urine output; CNS sx? I II III IV

I - <15% (<750mL) Nl HR, BP, RR >30mL/h Nl CNS fx II - 15-30% (750-1,500mL) Mild tachycardia (100-120) Hypotensive Tachypneic (20-30) 20-30mL/h Anxious appearing III - 30-40% (1,500-2,000mL) Tachycardia (120-140) Hypotensive Tachypneic (30-40) 5-15mL/h Confused IV - >40% (>2,000mL) Tachycardia (>140) Hypotensive Tachypneic (>35) Negligible urine output Lethargic/comatose

Illness anxiety d/o vs somatic sx d/o

IAD: fear of having illness despite no sx SSD: excessive anxiety/preoccupation with >1 unexplained sx

Pyoderma gangrenosum is associated with what condition?

IBD (UC)

-Petechiae -Minor bleeding (gums, mucosal bleeding) -Decreased platelet count -splenomegaly Dz? PT/PTT, fibrinogen, D-dimer? Tx?

ITP Normal PT/PTT, fibrinogen, D-dimer Mainstay - Prednisone Others - IVIG, splenectomy, rituximab, platelet transfusions

Tx for endometritis?

IV clindamycin and gentamicin

Defense mechanism - when somone unconsciously patterns behavior after someone more powerful or influential. Ex:

Identification

Work-up for fundal height > estimated gestational age? Cut off? DDx?

If 1st TM US obtained, then assume correct dates. First step is to obtain an US to measure fetal growth and amniotic fluid (part of biophysical profile). 3cm or more requires further evaluation Fundal height > est gest age: incorrect dating, fetal macrosomia, polyhydramnios

Tx for chronic AFib Tx for acute AFib

If Cha2ds2vasc score 2+: Warfarin or NOAC (api-/edo-/rivaroxaban, dapigatran) - cannot be used in setting of renal failure. Stable pts: Non-DHP CCB, BB for rate control. After rate control -> -If <48h: cardioversion. -If >48h or unknown: cannot be cardioverted immediately. Need TTE prior then anticoag x3weeks -> TEE & cardiovert -> anticoag x4weeks. Unstable pts: electric cardioversion (synch)

Pregnant woman with: -R flank pain -fever -contractions q 2-3 min with fetal tachycardia Dx?

If absent abd rebound gaurding, likely pyelonephritis. If there were + peritoneal signs, this could be appendicitis d/t displacement of appendix in pregnancy.

Complications of pancreatitis - pleural effusion/ascites. What do you do?

If diagnosed, do not tap these unless you think they are infected.

Mgmt of avulsed tooth?

If extraoral time <60min: Handle tooth by crown (not root) gently rinse with saline reimplant tooth back into socket (within 15 min) emergent dental consult If extraoral time >60min: soak tooth in Hanks solution, milk, saline and consult with an oral surgeon

Tx for endometrial hyperplasia?

If no atypia, progestin. If atypia, hysterectomy.

Evaluation algorithm of *primary* amenorrhea? primary amenorrhea 1. definition? 2. Causes? 3. Tx?

If no menses plus: -no secondary sex characteristics by 13 -secondary sex characteristics by 15. Then do this: 1. Pelvic exam/US - determine if uterus is present. If uterus present: 2. Serum FSH - determine central (nl/low) vs peripheral (high) a. inc: karotype b. dec: cranial MRI -Other tests to consider if uterus present: 17-hydroxyprog (CAH), TSH If uterus absent: 2. Karyotype & serum testosterone levels a. XX + nl *female* test: Abnl Mull development b. XY + nl *male* test level (elevated *female* test level): Androgen insens syndrome 1. failure of menarche by age 15 WITH secondary sex characteristics -OR- by age 13 WITHOUT secondary sex characteristics 2. Usually Turner syndrome, congenital isolated GnRH def, anorexia nervosa, chronic illness, hypothyroidism, celiac, etc. 3. Treat underlying cause. If no development, start low dose 17-beta-estradiol and ramp up over 2 years to mimic normal puberty. Add progesterone once breast development is complete. If the pt experiences normal menstruation and constitutional delay of growth & puberty is diagnosed and not a primary cause of failure, then replacement can be stopped.

Pregnant pt with MDD - tx?

If severe features/active suicidality - SSRI (Citalopram) is first line. If psychotic or catatonic features - ECT.

Removal of vaginal FB in prepubertal girls?

If visualized, attempt of removal after topical anesthetic has been used with vaginal irrigation with warm fluid or swab. If unable to remove or unable to visualize, pt undergoes sedation or general anesthesia for exam with vaginoscopy. Never do speculum exam.

Nonpainful genital ulcer with tender, suppurative LAD? Tx?

Lymphogranuloma venereum (Chlamydia L1-3) Doxy

Mother Rh- and has baby that is Rh+ results in ___ antibodies that can cross the placenta and cause _________. Tx?

IgG widespread destruction of fetal RBCs and development of hydrops fetalis or hemolytic disease of the newborn. exchange transfusion, phototherapy, IVIG if given early.

Sensation to upper/med thigh & genital area. Travels with spermatic cord through supergicial inguinal ring.

Ilioinguinal nerve

Cause of pancytopenia in SLE?

Immune-mediated destruction

Newborn female with bulging vaginal introitus shortly after delivery. -No vaginal bleeding Dz? How would this present as a teen? Dx?

Imperforate hymen cyclic pelvic pain, primary amenorrhea, hematocolpos, distension of vagina resulting in back pain, pain with defecation, and difficulties with urination. Pelvic US

"honey-crusted lesions" Dz? MCC? Tx?

Impetigo Beta-hemolytic Strep or S. aureus Limited dz - topical mupriocin Extensive skin involvement - oral dicloxacillin (unless Strep has been identified then oral PCN can be used - has less MRSA coverage) If MRSA identified - DOxy, Clinda, Bactrim

First degree AV block tx and evaluation?

In asxatic pts, If QRS is nl: no tx or eval needed. However, consider cardiac and medication hx, basic labs, TSH, and metabolic panel; if pt has rf for lyme dz, consider that to be a cause as well. If QRS is prolonged: electrophysiology testing is needed to determine nature.

When should menopause be diagnosed with labs vs clinical?

In women >45 with absent menses for >12 months - clinical dx. No other w/u needed. However, in women <45, other causes should be ruled out. Get FSH & TSH.

When is amniotomy, fetal scalp electrope placement, and operative vaginal delivery contraindicated?

In women with HIV, Hep B, Hep C

Factor V Leiden mutation d/t what?

Inability to respond to activated protein C.

Serum markers for cholangiocarcinoma? RF? Dx?

Inc CEA, CA19-9 Nl AFP PSC M/ERCP: intrahepatic or CBD dilation and biliary mass

-Vag bleeding <20 weeks (may have h/o passing tissue-like material) -Dilated/closed os -US reveals some non-viable products remain in uterus Dz? Mgmt?

Incomplete Ab Expectant mgmt tends to be more successful (vs missed Ab) D&C

Crohn's dz pts are at increased risk for nephrolithiasis d/t _____.

Increased absorption of oxalate. Calcium binds fat in gut -> relative increase in oxalate absorption in comparison to Ca. Chronic GI bicarb loss can result in uric acid stones d/t resultant acidic and hyper-concentrated urine.

Activating effects of antidepressants?

Increased anxiety, insomnia, etc. after initiating/increasing dose of SSRI. Mgmt: temporary dose reduction

Scleroderma pathophysiology? Scleraderma renal crisis treatment? Types of scleroderma

Increased collagen deposition -> Inflammation and fibrosis with decreased capillary networks (HTN) ACE-I - the one time it should be given in the setting of AKI. -Diffuse cutaneous - Interstitial lung disease (bilat lung infiltrates, chronic cough, SOB), pulmonary HTN (loud P2), systemic HTN, GERD, Raynaud, and signs of cutaneous involvement. Sclerosis of the skin proximal to the wrists - Limited cutaneous (CREST) - induration/thickening of skin, soft tissue fibrosis, hypopigmentation of skin, Raynaud, GERD, calcinosis cutis, hyperpigmentation, mucocutaneous telangiectasia, systemic HTN, renal failure, pulmonary HTN, interstitial lung disease, and intestinal dysmotility. Sclerosis of the skin is typuically on the ahnds and occasionally minimally over the face/neck, but generally no other skin involvement. -Systemic Sclerosis Sine Scleroderma - presents without skin involvement CHECK ON THIS - Test 2, Q10 -

Lab changes with thiazide use?

Increased: TG, glucose, Ca, LDL, uric acid. Decreased: K, Mg, Na Metabolic alkalosis (elevated bicarc) -Sexual dysfunction

Mechanism for carotid sinus massage? What arrhythmia is it used in?

Increases parasym tone to temporarily slow conduction of AV node and increase AV node refractory period Used in SVT (AV nodal reentrant tachycardia is MC) - where two pathways exist within the AV node, so trying to slow the fast one down.

What does elevated LDH indicate?

Indicates some form of tissue damage. Causes include: -MI -Hemolytic anemia -Mono -Myopathy/muscle breakdown -Liver dz -HypoTN -Ca -Pancreatitis -Stroke

When is vaginal misoprostol indicated in pregnancy? Mifepristone indications

Induction of labor for cervical ripening. Miscarriage or termination of pregnancy (with mifepristone) Pregnancy termination - intrauterine pregnancy through 10w gestation (given with misoprostol) Miscarraige - can be given 24 hours prior to misoprostol to improve treatment efficacy for mgmt of early pregnancy loss.

-Vag bleeding <20 weeks (no h/o passing tissue-like material) -Dilated os -US reveals viable products of conception (fetal HR motion) -No passage of products of conception

Inevitable Ab Tx: expectant, medication (prostaglandin, misoprostol/mifepristone), or surgical (suction curettage) depending on preference and hemodyn stability.

Congenital diaphragmatic hernia S/Sx? Mgmt?

Infant in respiratory distress within first 24 hours of life, scaphoid abdomen, barrel chest, absent breath sounds on the left, displaced PMI to the right Intubation with cautious ventilation and gastric decompression. Urgent surgical correction.

RSV - RF for more severe illness?

Infants <6mo Premature infants born at <35 weeks Pts with Down syndrome Infants exposed to 2nd hand smoke Congenital heart/lung dz Persistent asthma Immunocompromised

If pt needs to entubated in the setting of PTX what do you do first?

Needle decompression prior to entubation.

-confusion -septic -Small painful nodes on fingers -nephritis signs on UA and complement testing -hypodensities on head CT Dz? Rash called what? What are the nephritic signs?

Infective Endocarditis Osler nodes Low complement (C3, C4); elevated Cr; elevated WBC/RBC counts

Droplet precautions are indicated for what diseases? What PPE? Vs airborne precautaions are indicated for what diseases? what PPE?

Influenza Parvo B19 Rubella Mumps From large particle droples (coughing, sneezing, etc.) Requires eye covering and mask TB Measles Disseminated shingles Requires N95

Complications of cryptorcidism? Mgmt?

Inguinal hernia Testicular torsion Testicular cancer subfertility Orchiopexy before 1 yo to decrease risk of subfertility. Does not decrease risk of Ca, but does make it palpable to be able to detect.

fever, cough, nausea, CP, night sweats, SOB Bioterrorism agent with sx 1-6 days after exposure Dz? Micro? Tx? Prophylaxis?

Inhalation anthrax Gram-positive bacillus FQ, tetracyclines, PCN At risk for inhalation anthrax 60 days of cipro or doxy

Addison's dz w/u

Initial eval: 8am cortisol and plasma ACTH level -Low cortisol & high ACTH - Primary adrenal insuff -Low cort & low ACTH - 2/3 adrenal insuff -high cortisol - r/o adrenal insuff If cortisol is nl/low - ACTH stimulation test (cosyntropin). -Nl: cortisol inc -PAI: cortisol not rise

Carotid artery stenosis tx guidelines

Initial mgmt: ASA, statin, and BP control. Sxatic pts (h/o TIA/CVA) with stenosis between 70-99% should be considered for carotid endarterectomy.

Neurogenic shock: Effects of sym/parasym status

Initially, there is massive sympathetic stimulation leading to HTN, tachycardia d/t release of NE from the adrenal glands. Quickly after, sympathetic tone plummets d/t injury to the descending spinal tracts resulting in unopposed parasympathetic stimulation, leading to hypoTN and hypothermia from peripherial vasodilation and bradycardia

Multiple skin tags are associated with what disease?

Insulin resistance Pregnancy Crohn disease (perianal) Acromegaly

Insulinoma, insulin abuse, vs sulfonurea abuse -insulin levels -C-peptide levels -Proinsulin level -Sulfonurea level

Insulinoma - elevated insulin, C-peptide, proinsulin. Low sulf. Insulin abuse - markedly elevated insulin. Low C-peptide, proinsulin, and sulf. Sulf abuse - elevated Insulin & C-peptide. Nl proinsulin. High sulf.

Tremor that increases as closer to object. Treatment?

Intention/cerebellar tremor No treatment

Most appropriate method to monitor for uterine rupture is --?

Internal fetal monitoring

-Woman in 3rd TM with pruritis worst on palms. -No rash -RUQ pain -Increased total/direct bili, alk phos, total bile acids Dz? Tx?

Intrahepatic cholestasis of pregnancy Ursodeoxycholic acid; regular fetal monitoring and delivery at 37 weeks

PTT is part of intrinsic or extrinsic clotting cascade?

Intrinsic - all except factor VII

How does OSA affect A-a gradient?

It is nl. Both alveolar and arterial oxygen content are decreased.

Pt treated for Lyme disease develops these sx withing a few hours after tx, why? Fever, chills, rigor hypotension, HA, tachycardia, hyperventilation, vasodilation with flushing, myalgias

Jarisch-Herxheimer reaction - reaction to endotoxinlike products released by the death of harmful microorganisms within the body during tx. Seen when treating spirochetes.

-myoclonic jerks immediately on wakening in adolescents

Juvenile myoclonic epilepsy About 1/3 have h/o absence seizures. Triggered by alcohol, sleep deprivation EEG: bilat polyspike and slow wave activity Tx: valproic acid.

-delayed puberty -no axillary/pubic hair -anosmia -FSH/LH absent/low Dz? D/t?

Kallman syndrome - d/t GnRH def

L shoulder tip pain while lying supine, caused by referred pain d/t diaphragmatic irritation. Sign? Indicative of what dx?

Kehr sign Ruptured spleen, ruptured ectopic pregnancy

Dome-shaped nodule with central keratin plug. very quickly growing with spontaneous regression Dz? Mgmt?

Keratoacanthoma (resembles SqCC) Concern for possible malig transformation Excisional biopsy with complete removal

Small, rough, follicular papules usually occurring on the post-lat aspect of the arms and anterior thighs

Keratosis pilaris

Pregnant trauma patient should be put in what position to avoid aortocaval compression?

L lateral decubitus Right hip wedge manual displacement of uterus.

Defective leukocyte adhesion Dz? S/Sx?

LAD recurrent infections, neurophilia, abscesses that lack pus, impaired wound healing, delayed umb cord separation.

-Prox m. weakness (legs > arms) -absent or hyporeflexia -impoves with increased use Dz? Dx?

LEMS Dx: Ab to presym Ca EMG Pts should also get CT scan of chest to look for small cell lung ca.

Anticoagulant preferred in pregnancy?

LMWH

Preferred resuscitation in burn victims? -Parkland formula?

LR -balanced fluid and does not cause hyperchloremic metabolic acidosis like NS can. Total volume in first 24 hours of resuscitation at approx 4mL/kg body weight * percentage of body surface area burned. Half the volume given in the first 8 hours; remaining half given in the following 16 hours.

Tachycardia, HTN, visual hallucinations, paranoia, pupillary dilation, flashbacks Anxiety/depression

LSD intoxication

-Severe vertigo -nausea/vomiting -hearing loss -after recent URI -sx continuous and persistent Dz? Tx?

Labyrinthitis Supportive; self-resolves

+ H breath test indicates what?

Lactose intolerance (osmotic diarrhea)

Osmotic laxative examples & MOA ADR?

Lactulose, sorbitol, Magnesium Oxide, polyethylene glycol Draws fluid into the bowel down an osmotic gradient to facilitate a BM Nausea, bloating, cramping, flatulence, rectal irritation, magnesium toxicity

Child with: -Regression of language skills d/t severe epileptic attacks -"shaking episodes" -restlessness, irritability -seizures -difficulty hearing -difficulty expressing self -lethargic -poorly responsive -hyperactive behavior Dz? Dx?

Landau-Kleffner syndrome - acquired epileptic aphasia Similar to autism, but autism typically presents by 2 yo and without seizures; this occurs between 3-6 yo. Abnl EEG - bihemispheric spike and wave; in an undifferentiated pt with neuro sx - get CT head without contrast

Kid with: -nighttime bone pain -lytic lesion on XR -macular rash on abd -hypernatremia -hepatosplenomegaly -pulm cysts/nodules

Langerhans cell histiocytosis (ass w/ central DI, eczema, LAD) Dx: skin/bone biopsy - langerhans cells Tx: chemo (prednisone + vinblastine); desmopressin for central DI

MCC of inspiratory stridor in infants. Crying/feeding/supine worsen stridor. Prone position improves. Dz? Dx>?

Laryngomalacia Flexible fiberoptic laryngoscopy

- weakness - falls - abdominal pain, constipation - poor dentition with a black line tracing the base of the teeth where the gums meet (*Burton's lines*) - bilat foot and wrist drop with preserved sensation (symmetric, isolated motor neuropathy) Dz? Lab findings? Tx? CDC considers poisoning if blood levels area greater than what level? Chelation therpy typically started when levels are what?

Lead poisoning. basophilic stippling of RBCs hypochromic, microcytic anemia Chelating agents - succimer, dimercaprol Acute sx - abdominal pain, nausea, constipation, headache, fatigue, anemia, & CNS abnormalities if significant. Chronic sx - distal motor neuropathy (wrist/foot drop) with intact sensation, tremor, Burton lines, microcytic anemia Renal failure, encephalopathy 5microg/dL 45microg/dL

-Atrophy of proximal thigh muscles. -chronic, progressive leg pain & limp (intermittent limp; abductor lurch, especially after exertion) -limited ROM (IR & abd) -Trendelenburg gait Dz? Dx? Mgmt?

Legg-Calve-Perthes disease (idiopathic osteonecrosis of femoral epiphysis) XR typically nl, get MRI. Mgmt: non-weight bearing with bracing/splinting. Surgery may be indicated if femoral head is not well contained within the acetabulum

Premenopausal woman with *heavy, prolonged* periods that are *regular*. Uterus is *irregularly* enlarged and bulky. Dz? Dx? Tx?

Leiomyoma (fibroid) d/t proliferation of smooth muscle cells within *myometrium* Pelvic US Asxatic: no tx Sxatic & no plan on becomming pregnant soon: OCPs Sxatic & desire fertility: myomectomy Sxatic and no longer desire fertility: endometrial ablation or uterine artery embolization

Severe seizures of multiple types and associated intellectual disability. EEG: slow, generalized spike and wave pattern

Lennox-Gestaut syndrome

Sudden development of numerous sebhorrheic keratoses is known as what? Thickening of palms so that they feel like velvet is known as what?

Leser-Trelat sign - concerns for adenocarcinoma Tripe palms - concerns for adenocarcinoma.

Tx of Parkinson's dz? Tx for medication-induced psychosis from Parkinson's medications? Buzzwords?

Levadopa-carbidopa, ropinirole, pramipexole, bromocriptine. Dose reduction, med substitution. Low potency antipsychotic meds (*quetiapine*) Lewy bodies (intraneuronal eosinophilic inclusions) Loss of dopaminergic neurons of the substantia nigra.

Male with: -increase in breast size -small nodule on testes -dec FSH/LH, test -elevated estrogen -undetected B-hcG & alpha-fetoprotein Dz?

Leydig cell tumor (can produce excess estrogen or testosterone, resulting in gynecomastia, acne, or precocious puberty)

Polygonal papules and plaques with white scale commonly on flexor surfaces, specifically the wrists; associated with significant pruritis What dz? What is the white scale called? Tx?

Lichen planus - inflammatory disorder. Wickham's striae Potent topical steroids

-Hypopigmented labial lesion - porcelain-white plaques (cigarette-paper) with ecchymosis and inflammation -Pruritic, erythematous -Multiple papules that converge into plaques -Thinning of skin (cigarette paper) -Involvement of perianal area -obliteration of vulvar anatomy with intriotal stnosis, fusion of labia minora, phimosis of the clitoral hood and fissures. Dz? Dx? Tx? Associations?

Lichen sclerosis Biopsy Topical steroids (clobetasol) If refractory to topical steroids -> calcineurin inhibitor (tacrolimus) Can predispose pts to vulvar SqCC

Vulvar scratching results in hyperplastic, thickened, leathery skin. -scaling and lichenified plaques -extreme pruritis Dz? Tx? Associations?

Lichen simplex chronicus. Avoidance of innocuous behaviors/irritants, barrier creams

Tx for prediabetes?

Lifestyle + metformin

Kid with this murmur: -Continuous murmur at L 2nd ICS, loud S2, bounding pulses. Best heard at L infraclavicular area.

Patent ductus arteriosus

Elderly woman with: -sudden onset abd pain -diaphoretic -hemo unstable -abd ecchymosis Dz? W/u?

Likely AAA. In hemodyn unstable pts without known AAA start with FAST exam. If known AAA, straight to surgery. In hemodyn stable pts, CT abd first.

-Elevated platelet count in the setting of infection/surgery/malignancy. What if this patient was asplenic and thrombocytosis was persistent?

Likely reactive thrombocytosis. Secondary thrombocytosis is seen in asplenic pts.

Vitiligo tx dx?

Limited disease: high-potency topical corticosteroids. Extensive/unresponsive disease: oral corticosteroids, topical calcineurin inhibitors, PUVA Wood's lamp

Psoriasis tx

Limited dz - emollients, topical high-potency steroids (betamethasone 0.05%), topical vitamin D analog (calcitriol), topical retinoids. Dz affecting >30% surface area - Phototherapy Moderate-severe or refractory dz - Calcineurin-inhibitors, TNF-inhibitors (adalimumab, etanercept, infliximab), Tazarotene, Anthralin, Methotexate, Cyclosporine

Which is better marker of pancreatitis? amylase or lipase?

Lipase

Medication toxicity sx - GI sx, confusion, ataxia, tremor, fasiculations, seizures. Other side effects not listed above? Meds that increase levels.

Lithium toxicity. CNS depression HF arrhythmias Hypercalcemia Hypothyroidism Pseudotumor cerebri diminished renal concentrating ability Serotonin syndrome Ebstein anomaly - Cardiac defects in fetus in mom who took lithium Sexual dysfx Meds that increase lithium levels - thiazides, ACE-I, NSAIDS, tetracyclines, metronidizole.

What does shunting meaning in pulmonology? D/t? Causes? Response to supplemental O2?

Little/no ventilation (Co2 exchange) in perfused (oxygenated) areas. D/t collapsed or fluid-filled alveoli resulting in venous blood shunting to arterial circulation without being oxygenated. Results in hypercapnia with secondary hypoxemia. atelectasis, fluid buildup in alveoli (pna, pulm edema), direct R->L cardiac shunt Does not respond to supplemental O2.

Dermatographism

Localized hives over an area that results from the physical trauma of rubbing. MC form of physical urticaria Pruritic, linear wheals appear after rubbing or scratching. IgE mediated. Antihistamines

-Pain to superficial touch on the vestibule/external genitalia. -Unable to tolerate touch on external exam

Localized provoked vulvodynia (vestibulodynia)

-hilar LAD -erythema nodosum -migratory polyarthritis -fever -erythema nodosum

Lofgren syndrome (a form of acute Sarcoid)

Tx of delirium tremens? Sx?

Lorazepam - long acting benzo. (or diazepam, chlordiazepoxide) tremors, diaphoresis, HTN, hallucinations, autonomic instability, agitation/combative, tachycardia, hyperthermia,

Long-acting benzos? Short-acting benzos? Benzos to use in liver disease?

Lorazepam, Diazepam, Chlordiazepoxide Alprazolam, Triazolam, Oxazepam, Midazolam (ATOM) Lorazepam, Oxazepam, Temazepam (LOT)

Mechanism of narcolepsy? Sx?

Loss of brain stem orexin signaling. Excessive daytime sleepiness, cataplexy, hypnagogic hallucinations, sleep paralysis.

Mechanism of central sleep apnea?

Loss of signaling pathways leading to repetitive cessation of airflow during sleep.

Rabies post-exposure prophylaxis

Low risk wild animal (squirrel, chipmunk, mouse, rat, rabbit): no PEP High risk wild animal (bat, racoonm skunk, fox, coyote): Is animal available for testing? -yes: euthanize & test; Start PEP if + -no: start PEP Pet: available for quarantine? -yes: observe for 10 days; no PEP if animal is healthy. -no: start PEP

Anemia of chronic disease -Serum iron -TIBC -Ferritin -percent transferrin saturation -Serum transferrin

Low serum iron, TIBC, percent transferring saturation, serum transferrin Elevated ferritin

Screening for Lung Cancer

Low-dose CT scan q year. Pts 50-80yo with: -20 pack year -Quit smokint <15 years ago.

Progressive bilat cellulitis of submandibular and sublingual spaces most often from an infected mandibular molar. Dz? S/Sx? Complications?

Ludwig angina Presents as fever, dysphagia, odynophagia, and drooling. Elevation of floor of mouth and tongue is displaced posteriorly. acute airway obstruction

Primary cancers that metastasize to the brain?

Lung Breast Skin Kidney GI

Woman with lung cancer, periphery, without smoking history. Most likely cause? Arise from? secrete what? How to get biopsy? Histology? Tx?

Lung adenocarcinoma (non-small cell lung ca) Arise from bronchial mucosal glands, secreting mucin CT guided biopsy for peripheral lung mass. Glandular formation with prominent nucleoili and mucin production; PAS+ staining. Stage I/II dz - surgical resection Locally advanced, unresectable (stage IV), LN involvement(?) - chemo (platinum based therapy) + radiation

SLE is associated with what type of nephritic/nephrotic disease?

Lupus Nephritis - immune complex deposition of dsDNA and anti-dsDNA Ab on mesangial and/or subendothelial space -> activates complement. or Lupus Nephrotic syndrome - immune complex deposition on subendothelial space (no hypocomplementemia)

-lymphocytic meningitis -cranial nerve palsies; bilat facial nerve palsy -radiculopathies These are the neurological manifestations of what?

Lyme

Erythema migrans

Lyme

-painful inguinal LAD -painless genital ulcer, may turn into buboes Dz? Stages? Tx?

Lymphogranuloma venereum d/t Clamydia trachomatis L1-3 Ulcer: primary LAD: secondary Fibrosis/stricture: tertiary Doxy x21 days or Erythromycin x21 days Partners should be treated with same if sx present. If asxatic - doxy x7 days or azithro single dose.

The MCC of appendicitis in children & young adults is ___. In mature adults & elderly ___.

Lymphoid hyperplasia (d/t viral/bacterial inf & IBD) Fecalith

RF for ovarian cancer? Protective? S/Sx concerning for ovarian cancer? Screening and evaluation?

Lynch syndrome; BRCA variants Older age Factors that lead to more ovulatory cycles -> early menses, late meopause, nulliparity Endometriosis OCPs Bilat salpinectomy Bilat oophrectomy Abdominal/pelvic pain, bloating, abdominal distension, changes in bowel/bladder habits. Screening is not recommended. In pts you are concerned about ovarian cancer - eval begins with thorough H&P. Transvaginal US and CA-125 can help support further eval. Definitive dx - biopsy during laparotomy. Ovarian lesions are not percutaneously biopsied.

Definition of pulmonary HTN? Best way to dx? Pathology?

MAP >25 mmHG at rest R heart cath Hyperplasia and hypertrophy of all three vascular layers of the pulmonary artery is the pathophys of what disease?

Pt has IUD; strings not visible on cervical exam. Next step?

MCC is retraction of strings into cervical canal; other causes include pregnancy, uterine perforation, expulsion. First step - inform pt and use cytobrush to attempt to sweep the strings out of the canal. (should be done regardless of preg status or intention to keep.remove IUD) If not successful, preg test and US to confirm IUD location If US identifies IUD - reliable contraception. If US does not identify IUD - XR abd/pelvis. -If within abdominal/pelvic cavity - surgical planning -Absent - confirms expulsion

B12 vs folate deficiency

MMA level elevated in B12 deficiency. Homocysteine levels high in BOTH B12/Folate deficiency. Folate deficiency NOT associated with neuro sx.

Causes of anion gap acidosis

MUDPILES: Methanol Uremia DKA Paraldehyde or Phenformin Iron or Isoniazid Lactic acidosis Ethylene glycol Salicylates

midsystolic click with mid- to late systolic murmur +/- followed by a high-pitched crescendo-decrescendo late systolic murmur? Worsens with standing

MVP Tx - reassurance and transthoracic echo for risk stratification regardless of sx or ausculatory findings. If sxatic - BB No abx prophylaxis

Blurred central vision with preservation of peripheral vision

Macular degeneration

-Slowly progressive central visual field defect. -Straight lines appear bent -Distorted vision. -Subretinal *drusen* and pigment abnlities -Scotoma Dz? Tx?

Macular degeneration Anti-vegF for wet

-intermittent fever -fatigue -join pain -hepatoslenomegaly -anemia

Malaria

Neonate with: -bilious vomiting -distended abd -draws up legs -XR: gasless abd -Cork-screw shaped and rightward displaced duodenum Dz? Dx? Tx? Complications?

Malrotation resulting in volvulus Upper GI series (barium swallow) Promt surgical intervention Bowel ischemia and perforation

If a woman >30 has palpable breast mass. What is treatment algorithm?

Mammogram If suspicious for malignancy, get core needle biopsy.

Screening for breast cancer

Mammogram until 74 yo Starting at: -*50 q 2 years* OR -40 q 1 year In pts with 1st degree relative - annual screening started 10 years prior to relative's age of dx.

Tx of sliding hiatal hernia?

Many are asxatic - no tx necessary. If GERD sx - PPI If resistant to PPI, then surgery

28 yo with recent international travel 1 week prior presenting with: -fever, chills, malaise, abdominal pain -previously treated patients abroad who died of multiorgan failure and coagulopathy -AKI, leukopenia, thrombocytopenia, elevated AST/ALT/PT/PTT Dz? Incubation perioed? Progression of S/Sx? Dx? Tx? Precautions?

Marburg virus (similar to Ebola; both Filovirdae) Incubation ~1 wk. Rapidly progressive febrile illness -> GI disturbances, myalgias, diffuse maculopapular rash, neuro disease, bleeding. PCR Supportive Contact precautions; if BiPAP used and risk of aerosolization -> airborne precautions indicated.

Paranoia, hallucinations, social withdrawal, anxiety, dry mouth, conjuntival injection, poor concentration, disheveled, lack of motivation Intoxication of what? How would withdrawal sx present?

Marijuana intoxication Depressed mood, lack of appetite, anger

Complications of short interpregnancy interval?

Maternal anemia PPROM Preterm delivery Low birth weight

What ovarian mass has increased risk of ovarian torsion? What does it look like on US?

Mature cystic teratoma. partially calcified mass with multiple thin, echogenic bands.

-Precocious puberty (peripheral) -cafe-au-lait spots -fibrous dysplasia of bone Dx?

McCune-Albright syndrome - hormone receptor mutation

10 hour old infant with respiratory distress; grunting, nasal flaring Post-term delivery with meconium stained amniotic fluid CXR - ground glass appearance; streaking linear densities Barrel shaped chest Dz? Tx?

Meconium aspiration syndrome - aspiration pneumonitis Supportive; suctioning; abx

Contracteption that causes weight gain?

Medroxyprogesterone injection

-Calcitonin secreting -Parafollicular C-cells What thyroid cancer?

Medullary Part of MEN2A/B syndromes. Associated with RET oncogene and pheochromocytoma (screen)

Which cancer should be monitored with calcitonin levels?

Medullary thyroid cancer

Child with: -ataxia & truncal instability -obstructive hydrocephalus

Medulloblastoma tumor of cerebellar vermis.

Renal vein thrombosis is MC seen with what type of nephrotic syndrome? Sx of renal vein thrombosis? Biopsy? Why is this important?

Membranous GN hematuria, flank pain, varicocele Deposits stain C3 (dense deposit) Peeing out protein, and clotting factors.

Screening for AAA What size is diagnostic? mgmt? Surgical intervention for what size? If pt is sxatic or have confirmed AAA - what next?

Men 65-75 who have ever smoked. One time abd US. Abd aorta >3cm = diagnostic; Annual US to evaluate for expansion. If >4.5cm - US eval q 6 months Surgical intervention recommended with diameter >5.5 in asxatic pts or less in pts with rapidly expanding aneurysms or sx concerning for impending rupture. CT scan recommended - allows to eval whole abd, complications, and surgical planning

-Vertigo -Hearing loss (SL) -tinnitus -ear fullness -Sx last few hours at a time Dz? Mgmt?

Meniere's dz - thought to be d/t increase pressure of the fluid within the cochlea and labyrinth Tx: supportive; caffiene/Na restriction, diuretics (thiazides), meclizine, vestibular rehab, intratempanic steroids/gentamicin

Infant with significant developmental delay - unable to sit up, no trunk control; does not smile or find his hands associated seizure disorder kinky, brittle hypopigmented hair microcytic anemia leukopenia Dz?

Menkes Dz d/t inborn error of copper metabolism that causes decreased uptake from the intestine resulting in severe Cu def.

Vomiting has what changes in electrolytes?

Metabolic alkalosis Decreased Cl, K Elevated bicarb d/t H loss and activation of RAAS from volume contraction

In ectopic pregnancy managed with methotrexate when should B-hCG be rechecked and what are expected levels?

Methotrexate given - day 1; B-hCG should be rechecked on day 4 & day 7. It is typical for B-hCG to increase between day 1-4. Recheck again on day 7. -If decreased from day 7 to 4 by at least 15% then B-hCG can be rechecked weekly until the level reaches 0. -If it does not decrease by at least 15%, then another dose of methotrexate is warranted if the patient remains stable and no signs of rupture.

Bulk laxative examples & MOA ADR?

Methylcellulose, psyllium Forms soft, bulky stool and promotes intestinal contraction, need good H2O intake to be effective. Impaction above strictures, fluid overload, gas/bloating

Good anaerobic coverage

Metro Clinda Amox Amox-clav Carbapenam

Microscopic hematuria: vs Gross hematuria:

Micro: glomerular Gross: non-glomerular/urologic

Middle aged pt with: -chronic, watery diarrhea unrelated to food. -fecal urgency, incontinence, nocturnal diarrhea -negative workup; colonoscopy macroscopically nl; microscopically abnl. Dz? Biopsy? RF?

Microscopic colitis Biopsy: inflammatory infiltrates and mononuclear predominance. Can be further subdivided into collagenous colitis (thickened subepithelial collagen layer) and lymphocytic colitis (more pronounced intraepithelial lymphocytic inflammatory infilatrate) RF: age >50, female, smoking, NSAID use. Mgmt: avoid triggers, antidiarrheal meds, steroids.

sensory and motor deficits to UE and face > legs homonymous hemianopia gaze preference to side of lesion

Middle cerebral artery stroke Neglect occurs with occlusion of R MCA Aphasia occurs with occlusion of L MCA

Neurogenic inflammation as a result of vasodilatory substances is the pathophysiology of what disease?

Migraine

Elderly pt with osteoporosis, dementia, and nonspecific sx - confusion, N/V -hypercalcemia -hypophosphatemia -Dec PTH -metabolic alkalosis Dz? Cause? Tx?

Milk-alkali syndrome D/t excessive calcium intake in the setting of progressive renal disease Isotonic saline

Gallstone impacted in the cystic duct with compression of adjacent common bile duct resulting in obstructive sx is ______ syndrome.

Mirizzi

-May or may not present with vag bleeding -closed os -no fetal cardiac activity -retained non-viable products of conception on US

Missed Ab Expectant (up to 4 weeks) vs medical (misoprostol) vs surgical (D&C)

Holosystolic murmur with radiation to the axilla.

Mitral Regurg

Early or mid diastolic rumble with *opening snap* and loud S1.

Mitral Stenosis. If mild, late murmur. With progression, murmur occurs earlier.

Recurrent pelvic pain ~day 10-14 of menstrual period Dz?

Mittelschmerz - d/t ruptured follicle causing irritation of peritoneum

Man with: -h/o IVDU + Hep C -malaise, fever -palp purpura -joint pain -hepatosplenomegaly -absent Achilles reflexes, peripheral neuropathy -hematuria, RBC casts, proteinuria -RF+, low complement Dz? Other associations? Other sx? Dx? Tx?

Mixed cryoglobulemia -Associated with *Hep C* > Hep B, HIV, other causes of chronic liver disease -*petechial rash/palpable purpura/livedo reticularis*, renal disease, *arthralgias*, *peripherial neuropathy*, *acrocyanosis* - blue discoloration of extremities. Pulmonary and CNS involvement is rare. -*Meltzer triad* - purpura, arthralgia, weakness -Clinical; presence of circulating cryoglobulins, biopsy - leukocytoclastic vasculitis -Depends on severity; supportive, underlying disease, steroids + cyclophosphomide. If Severe - plasmaphoresis.

Intracytoplasmic inclusion bodies (Henderson-Paterson bodies) are seen with what derm dx? Tx?

Molluscum contagiosum Typically self-limited; cryotherapy, topical cantharidin or retinoids, curettage, laser removal.

congenital dermal melanocytosis

Mongolian spots

-Mild elevation in AST/ALT -Thrombocytopenia -Autoimmune hemolytic anemia -Post LAD -fatigue -sore throat Dz? What abx given causes maculopapular rash?

Mono Amoxicillin

Numbness/pain between 3rd & 4th MT with clicking? Dz? Commonly seen in what pts?

Morton neuroma Seen in runners; sx worsened by hard surfaces or wearing tight/high-heeled shoes

Acute limb ischemia following anterior STEMI. Most likely cause? Require what?

Most likely d/t embolization of LV mural thrombus. (Nlly MC d/t plaque). These pts require echo to assess for LV aneurysm and residual thrombus

Pleural effusion following pancreatitis contain what findings? Main causes? Results? Mgmt?

Most often L-sided; contain elevated LDH and exudate; classified as exudates by Light's criteria. Often contain high levels of amylase (up to 30x upper limit of nl). blockage of the transdiaphragmatic lymphatic channels or pancreaticopleural fistulas secondary to disruption of pancreatic duct. Causes significant fluid shifts agressive tx with thoracentesis, drains, or administration of octreotide. +/- stent or srugical repair

-Female external genital and breasts -Has pubic/axillary hair -Nl ovaries -Absent uterus/cervix -Nl female range testosterone, nl FSH, nl estrogen

Mullarian agenesis Get renal US.

Pt with COPD develops: -irreg narrow complex tachy with multiple P wave morphologies and variable PR intervals with irreg pulse. Dx? Tx?

Multifocal atrial tachycardia D/t COPD exacerbation, electrolyte disturbance, catecholamine surge Tx; treat underlying cause. Verapemil if persistent.

-Irreg, narrow complex tachycardia with 3+ different P wave morphologies -Irreg RR & PR intervals Arrhthymia? RF? Tx?

Multifocal atrial tachycardia Seen in severe pulm dz Tx: underlying dz & ventialtion. If LV fx preserved, CCB, BB. No LV fx preserved, digoxin

60 yo with anemia, bone pain, lytic bone lesions, hypercalcemia (polyuria, constipation, confusion). Dz? Cell line affected? Triad? Tx?

Multiple Myeloma Clonal expansion of malignant plasma cells with excessive production of monoclonal immunoglobulins or immunoglobulin fragments >10% plasma cells in bone marrow, M protein in urine, and lytic bone lesions chemo (melphalan and prednisone) + hematopoietic cell transplant + bisphosphonates (pamidronate or zoledromic acid) if skeletal lesions

-ptosis, diplopia, blurry vision -dysarthria, dysphagia -rest improves Dz? Dx? Tx?

Myasthenia Gravis ACh-rec Ab test (most specific), muscle-specific tyrosine kinase Ab EMG: decremental response to rep. stim. CT scan to r/o thymoma Anti-striated muscle Ab (present if thymoma is cause) AChE Inhibitors (pyridostigmine) Thymectomy Steroids for acute flares, however, acute worsening occurs in 50% and should occur in hospital setting. IVIG and plasmaphoresis often used first line and prep for intubation.

Pt with MG: -resp insuff -nl DTRs -increased generalized weakness Dz? Tx?

Myasthenia crisis Intubate, plasmaphoresis = IVIG = plasma exchange, steroids

-Indolent HA, malaise, fever, dry cough -Pharyngitis -macular/vesicular rash -interstitial infiltrate -hemolytic anemia

Mycoplasma pna

Teen with: -fever, malaise, cough, pharyngitis, macular/vesicular rash -nl leuk count -elevated retic count; hemolytic anemia -interstitial infiltrate Dz? Tx?

Mycoplasma pna Tx: macrolide

Older man with: -fatigue -decreased exercise tolerance, SOB -pale -CBC shows macrocytic anemia (ovalomacrocytosis and neut with reduced segmentation), thrombocytopenia, and leukopenia. -dysplastic red & white cells on peripheral smear; bilobed neutrophils (pseudo-pelger huet) with hypogranular cytoplasm Dz? RF? Dx? tx?

Myelodysplastic syndrome RF: old age, radiation/chemo BM biopsy: hypercellular Transfusion for sxatic cytopenias, chemo, hemato stem cell transplant.

Elderly woman with h/o cancer who underwent radiation/chemo: -fatigue, weakness, scattered ecchymosis -MCV >100; dec retic count -Pancytopenia -Peripheral smear: neuts with decreased segmentation & decreased granulation Dz? Dx? Tx?

Myelodysplastic syndrome LAD and hepatosplenomegaly are *rare* Dx: *dysplastic red and white blood cells*; BM biopsy: hypercellular marrow Tx: transfusions prn, chemo, stem cell transplant

Child with: -viral prodrome -resp distress -murmur -hepatomegaly Dz? Workup?Tx?

Myocarditis MC viral (coxsackie) EKG - sinus tach CXR - cardiomegaly, pulm edema Echo - decreased EF, global hypokinesis Biopsy is gold standard, but typically given empiric tx. Supportive care with diuretics, inotropes, IVIG Monitor in ICU d/t risk of shock and fatal arrhythmia

Tx of pancreatitis?

NPO, *IVF*, pain control If gallstones, cholecystectomy and/or early ERCP

Tx of primary dysmenorrhea

NSAIDs OCPs

PD with need for admiration, entitlement, lack of empathy, and grandiosity.

Narcissistic PD.

-Nasal congestion with epistaxis -HA, facial numbness -Serous OM - ear fullness -Soft-tissue in nasopharynx Dz? -Dx test Associated with ___, which is associated with what other disease? Tx?

Nasopharyngeal carcinoma -Endoscopy guided biopsy EBV. Burkitt Lymphoma (B-cell lymphoma) Radiotherapy

Diabetic with well-demarcated area of atrophy that gradually enlarges. Primary on shins. Painless Patches initially red-brown and progress to ello, depressed, waxy, shiny atrophic plaques. Ulcerations can occur. Dz? In the setting of trauma how can they present?

Necrobiosis Lipoidica - vasculitis primarily in diabetics with ulcerations; painful

Premature neonate develops -cyanosis, dyspnea shortly after birth. CXR - diffuse haziness Dz? Pathophys? Tx? Prevention?

Neonatal respiratory distress syndrome (NRDS; hyaline membrane disease) D/t lack of surfactant (type II pneumocytes) and subsequent alveolar collapse (atelectasis) from increased surface tension. Surfact decreases surface tension. Exogenous admin of surfactant via inhalation, respiratory support (intub, supp O2, Positive pressure) Admin steroids before birth helps with fetal lung development (esp if <37 weeks).

Cafe-au-lait spots, bilateral acoustic neuromas (schwannomas of CN VIII), meningiomas, neurofibromas. Dz?

Neurofibromatosis type 2

Cafe-au-lait macules, lisch nodules (iris hamartomas), sphenoid dysplasia, neurofibromas, freckling in axillary or inguinal region (crowe sign), optic glioma, sezures Dz?

Neurofibromatosis type I

EPO ADRs

New or worsening HTN

Pneumococcal vaccine 1. > 65 2. < 65

New recommendations: Starting at 65yo - 23 (unless pt specifically wants two doses, then 13 then 23). If <65 with comorbid conditions (underlying lung dz, asthma/COPD, asplenia) - give either 13 or 23 with repeat of 23 at age of 65. Old recommendations: 1. 13 then 23 2. <65 that are very high risk (immunocompromised, asplenia, sickle cell) - 13 then 23. Repeat 23 5 years later and again at 65. <65 and high risk (lung/heart/liver dz, DM, smoker): 23 alone then 13/23 when they turn 65.

Subarachnoid hemorrhage Meds for next step in mgmt? MCC? Dx? Complications?

Nimodipine to prevent vasospasm rupture of berry aneurysm CT without contrast - high-density blood layering in the cortical sulci, cisterns, and ventricles. If CT negative and there is high index of suspicion, get LP obstructive hydrocephalus from clot formation, delayed hydrocephalus from arachnoid granulation, inability to absorb CSF, vasoaspasm

-Flushing -AMS -Metabolic acidosis -Hyperreflexia -Respiratory distress -Renal failure Medication ADR

Nitroprusside-induced cyanide poisoning.

Diabetic Glomerulosclerosis Renal biopsy?

Nodular glomerosclerosis with Kimmelstiel-Wilson nodules - nodules are spherical, laminated, PAS+, situated in the periphery of the glomerulus. May have capillary basement membrane thickening, diffuse mesangial sclerosis, renal vascular lesions (hyaline arteriosclerosis of efferent arterioles).

MC type of Hodkin lymphoma? Age of presentation? Biopsy?

Nodular sclerosing 30 M>F Reed sternberg cells (CD15+, CD30+) - with lake-like spaces (lacunar cells)

What type of cancer is associated with Lupus?

Non-Hodgkin lymphoma, especially diffuse large B-cell lymphoma secondary to underlying activation of the immune system or due to the medications which are used to control the disease

Man with: -decreased libido -test atrophy -low LH, testosterone -low TSH, free T4 -Minor Elevation prolactin

Nonfunctioning pit adenoma. Mass effect -> decreased ant pit hormones. Dopamine pathways that are nlly suppressed by ant hormones cause minor elevations in prolactin (<150).

Normal aging vs Mild cognitive impairment vs dementia?

Normal aging - decreased processing speed (normal memory and intelligence); nl functioning in all ADLs Mild cognitive impairment - decline in cognitive functionig (via testing; usually memory), but is able to compensate and still perform ADLs Major cognitive impairment - functinal impairment in ADLs.

What are the risk factors for long-term antidepressant use? When is maintenance antidepressant use indicated and what is maintenance? When is life-time antidep use indicated? How long should therapy be in first time occurrence of MDD?

Number of lifetime episodes. 2 or more episodes, young-onset MDD, greater severity, suicidality, presence of severe stressors, and persistent residual depressive sx. -Maintenance is therapy for 1-3 years. 3 or more episodes Single episode should be continued for 6 months following response to tx. Tapering and d/c may be done after that time period.

round-oval, red, erythematous, scaly, itchy patch of skin that occasionally seeps clear, yellow fluid. Worse during winter Negative skin scraping and KOH prep of lesion Does not involve face/scalp Lesions often symmetrically distributed. Dz? Tx?

Nummular eczema Topical steroids

Initial stabilization for acute STEMI?

O2 ASA Clopidogrel Nitrate (if no inf MI) BB (unless hypoTN, bradycardia, CHF, heart block) Statin Anticoag If unstable bradycardia - IV atropine If pulm edema - IV furosemide PCA within 90 min (preferred) vs Thrombolysis within 120 min

Oxygen is _____ limited. CO2 is _______ limited.

O2 - Diffusion (meaning, bigger barrier = harder to move) CO2 - Perfusion (barrier does not effect CO2 mvmt).

Hypothalamic hypogonaism and primary ovarian insuff - what should be given to decrease their risk of osteoporosis? How will their FSH, estradiol levels differ?

OCPs - preventing bone loss in the setting of amenorrhea Primary ovarian failure - elevated FSH, low estradiol Hypothal/hypogon - Low/nl FSH and estradiol

Daytime somnolence/fatigue, HA, drowsiness, difficulty concentrating, elevated HR, HTN, obese, prominant S2 (P2) on exam. Dz? Screening? Risks with untreated OSA? Dx? F/up diagnostics? Tx?

OSA - Recurrent episodes of upper airway obstruction during sleep, causing intermittent hypoxia and recurrent arousals. Screening - STOP BANG questionnaire 1. *S*nore loudly? 2. *T*ired, fatigued, sleeping during day? 3. *O*bserved you stop breathing during sleep? 4. High blood *P*ressure? 5. *B*MI >35 6. *A*ge >50 7. *N*eck circ >40cm 8. *G*ender - male 1 point for each - 3+ demonstrates high risk for OSA Drowsy driving, CAD, HF, Group 3 pulmonary HTN, metabolic syndrome, nonalcoholic fatty liver disease Sleep study - preferably *Polysomnography* - using apnea-hypopnea index; index >5 is diagnostic. Once diagnosed, modalities for identifying the site of obstruction include lateral cephalometry, endoscopy, fluoroscopy, CT/MRI, and radiography. CPAP WL and lifestyle modifications If CPAP untolerated - BiPAP can be used

Erythema marginatum

Rheumatic Fever- Small red spots w/ a center area that fades and elevated edges.

PFT changes in obstructive lung dzs vs restrictive lung dzs - 1. Total lung capacity (TLC) 2. Functional reserve capacity (FRC) 3. Residual volume (RV) 4. Forced vital capacity (FVC) 5. Forced expiratory vol in 1 sec (FEV1) 6. FEV1/FVC ratio 7. DLCO

Obstructive - Increased TLC, FRC, and RV Decreased FVC, FEV1, and FEV1/FVC ratio. DLCO - decreased in emphysema and normal in chronic bronchitis. Restrictive - Decreased TLC, FRC, RV, FVC, FEV1. Elevated FEV1/FVC ratio.

Sensory to medial thigh Motor to adductor muscles

Obturator nerve

-Homonymous hemianpsia -Eyes deviate toward lesion -Seizures Site of hemorrhage?

Occipital lobe

Ideal fetal head position?

Occiput anterior

-s/sx of obstruction -XR shows large bowel obstruction without mechanical obstruction Dz? Causes? How to differentiate from mechanical obs? Tx?

Ogilvie Syndrome (pseudo-obstruction) -electrolyte imbalance (hypokalemia), surgery, trauma -contrast enema differentiates between mechanical obst. Decompression

-Cutaneous infection of the umbilical stump -Erythema, swelling, and pus -may lead to sepsis

Omphalitis

tx of central precocious puberty

Once MRI has been done to r/o hypothal/pit tumor, GnRH agonist.

Causes of elevated AFP in pregnancy? Causes of decreased AFP in pregnancy?

Open NTDs Ventral wall defects Multiple gestation Aneuploidies (trisomy 18 & 21)

-Acute monocular vision loss -Pain with extra-ocular movements -decreased pupillary reaction to light -central scotoma (black spot in center of vision) -MRI - increased signal in the right distal optic nerve; multiple hyper-intensity signal changes representative of Dawson's fingers. Dz? Ass. with what? Tx?

Optic neuritis Multiple Sclerosis High-dose Steroids

White granular patch or plaque over the buccal mucosa without induration, erythema, or LAD in a patient with hx of smoking and alcohol use consistent with ___. Not removed by scraping.

Oral Leukoplakia

Fever painful EOM Proptosis eyelid edema HA Dz? MCC? Tx?

Orbital cellulitis Ethmoidal or frontal sinusitis; penetrating trauma Staph, strep Hospitalization and IV abx If severe proptosis, changes in visual acuity, papillary abnlities indicating optic nerve involvement - emergent surgical drainage.

osmotic vs secretory diarrhea

Osmotic: high stool osmotic gap and diarrhea occurs *only after eating*. Secretory: low stool osmotic gap and occurs during *fasting.*

Bone tumor that has small, round lucency with sclerotic margins on XR and pain resolves with NSAID use

Osteiod Osteoma

MC back tumor in children? Associated with nocturnal pain and relief with NSAIDs. Also involves long bones. Dz? Exam? dx? tx?

Osteoid osteoma Localized bone tenderness Usually plain XR, may need CT or MRI Asxatic or tolerable - observe Sxatic - resection

Back pain unrelated to activity with associated fever and systemic illness Dz? Exam? Dx? Tx?

Osteomyeltis Localized bony tenderness +/- paraspinal tenderness MRI or CT; if advanced may be apparent on plain XR Abx + surgical mgmt if needed for complications (abscess, discitis)

-Bone pain with lesion at *epiphysis* with *sunburst* pattern. -XR: medullary and cortical bone destruction with lucent areas and surrounding periosteal elevation. Localized pain over a specific bony location; often with a soft tissue mass that can be large or tender to palpation. Dz? MC location?

Osteosarcoma Metaphysis of long bones

Ear pain, edema, tenderness of the soft tissue ot ear, purulent discharge, facial nerve palsy, +/- fever Dz? Tx? MCC? Complications?

Otitis externa Topical ciprofloxacin (FQ) +/- topical steroid Pts with uncontrolled DM - Pseudomonas > mucormycosis, candida Fungal infections (Aspergillus) tend to occur more commonly after tx of bacterial infection Candida MC in pts who wear hearing aids Extension of infection to temporal bone -> osteomyelitis, cranial nerve palsies, CNS infection

Middle-aged woman with: -conductive HL that improves speech discrimination in noisy envirmonments -positive family h/o HL Dz? Etiology?

Otosclerosis - Conductive HL; AD d/t bony fusion of stapes -> loss of stapedial reflex. Can occur d/t untreated ear infections -> scarring of TM -> loss of ability to vibrate and distribute sound waves to the ossibles in the middle ear.

Empiric tx for Community acquired pna Empiric tx for Hospital acquired pna

Outpt - if healthy, macrlide or doxy. If comorbidity, FQ or Ceftriaxone + Macrolide Inpt - FQ or Ceftriaxone + macrolide. Pip-tazo + Vanc. If can't use pip-tazo, use Merapenam. If you can't use Vanc, use Linezolid.

Empiric tx for pyelonephritis

Outpt tx - Bactrim or Cipro Inpt tx - Ceftriaxone UWorld inpt tx says - Fq or AG+amp

OCPs decrease the risk of

Ovarian cancer Endometrial cancer

How to differentiate between ovarian vs adrenal tumors?

Ovarian: elevated testosterone levels Adrenal: elevated DHEAS levels

Pt with elevated indirect bili. Differential?

Overproduction (hemolysis) Reduced uptake (drugs, portosystemic shunt) Conjugation defect (Gilbert)

How can you change Po2?

Oxygenation is affected by Fio2 & PEEP. Goal is to keep Pao2 ~55-80.

Type of malaria that has dormant hepatic phase? Tx?

P. vivax Primaquine for dormant hepatic phase + Chloroquine for active erythrocyte phase

-Smoker -Pain in leg, worse with exerrcise -Relief with hanging leg off bed Dz?

PAD, arterial insufficiency - MC d/t atherosclerosis

-Mononeuritis multiplex (int motor/sensory deficit in peripheral nerve) -livedo reticularis -mesenteric ischemia -palpable purpura -renal failure -*No lung involvement* Dz? Dx? Tx?

PAN Associated with Hep B Biopsy or mesenteric angigraphy (aneurysms) Elevated ESR/p-ANCA Steroids, cyclophosphomide

-mildly elevated testosterone levels in a female -hyperandrogenism sx -LH:FSH > 2 to 3 -elevated estrogen levels

PCOS

Tachycardia, *HTN*, hyperthermia, rhabdo, agitation, violent behavior, *horizontal and vertical nystagmus*, ataxia, dissociation, *hyperthermia*, *rigidity* Intoxication of what? Tx? What would withdrawal sx present as?

PCP intoxication Benzos in the setting of agitation. Otherwise supportive similar sx of intoxication with sudden onset of severe, random violence.

Young female presenting with fever, pelvic pain, abd pain, dyspareunia, vaginal discharge, N/V. Dz? Tx?

PID (salpingitis) Stable, nonpreg pts without TOA and reliable f/u - oral abx with Ceftriaxone and Doxy. If any of above are not met - inpt treatment

If pt requests prostate cancer screening - what is done?

PSA testing +/- DRE for average risk males beginning at 50yo. If PSA >4 or nodule is felt - biopsy If PSA <4 - biopsy or serial PSA Rate of rise in PSA >0.35 per year - indication for biopsy.

Workup for a newborn with an undetermined bleeding disorder includes ___. What's on the differential?

PT, PTT, CBC, peripheral blood smear Hemophilia A/B; vit K def; platelet fx disorders.

PTSD -dx criteria -tx vs. Acute stress disorder

PTSD -Dx: >1 month + exposure to life-threatening event. Sx: intrusive thoughts, avoidance, dissociation, hypervigilence, detachment. -Tx: Early trauma focused CBT + SSRI/SNRI (paroxetine) ASD -Dx: intense fear/horror within 4 weeks of an identifiable stressor with sx lasting <4 weeks.

Which tx can be used in graves disease in pregnancy?

PTU in 1st TM If diagnosed in 2nd TM - Methimazole

Chronic, eczematous dermatitis of one breast/nipple/alveolar area. Distorted/inverted nipple Scaly, crusty, deformed nipple with multiple plaques overlying the surrounding areola. Dz? Tx?

Paget's disease of the breast- Malignancy of the epidermal layer of the nipple Mactectomy (radical or modified) with LN clearance.

Tx of chronic pancreatitis

Pain control pancreatic enzymes stop offending factors

Fibromyalgia diagnosis? Tx?

Pain in both R & L sides of body and above & below the waist. Pain is typically constant and present for >3 months. Wide-spread pain index score of 7 or higher. Diagnosis of exclusion - must be no other diagnosis for pain. Osteopathic therapy directed against tenderpoints Lifestyle modifications Low dose antidepressants NSAIDs Pregabalin

-Shoulder pain -facial edema -miosis -ptosis Dz? Associated with?

Pancoast tumor (superior sulcus tumor) Small cell carcinoma

H/o acute pancreatitis 6 weeks prior. Continued abd pain, nausea, early satiety US - hypoechoic structure near stomacg -Dz? -Dx -Tx

Pancreatic pseudocyst Dx: CT with contrast If asxatic - NPO & expectant mgmt If sxatic or >6cm - endoscopic drainage & abx

Indications to add steroids for PCP tx?

Pao2 <70 A-a gradient >35 pulse ox <92%

-Fxal MR following MI (2-7 days) -Associated with hypoTN, pulm edema -New holosystolic murmur *without thrill*

Papillary muscle rupture

Thyroid cancer with psommoma bodies What is used as a tumor marker?

Papillary thyroid cancer - MC type Thyroglobulin - used to monitor for recurrence. Associated with h/o radiation

-MC postop -continues to pass flatus -XR - uniform distribution of gas -Decreased/absent peristalsis Dz? Tx?

Paralytic ileus IVF, NPO, correct electrolytes, NG suction

-Contralateral hemisensory loss -Eyes deviate away from hemisens loss (toward lesion) -Seizures Site of hemorrhage?

Parietal lobe

Child with -conjunctivitis and FB sensation -Eye with redness and large follicles on the inferior conjunctiva -Neck - bullous adenopathy -Scratches on UE Dz? Tx?

Parinaud Oculognadular Syndrome - d/t Bartonella henselae (less common manifestation of cat-scratch fever). Adenopathy only - Azithromycin Hepatosplenic, neurologic, or ocular dz - Rifampin + doxy/azithro/bactrim + corticosteroid

Adenosine is used to treat which arrhythmia?

Paroxysmal supraventricular tachycardia (PSVT) Narrow QRS complex; no discerbable P waves. May try valsalva or carotid sinus massage first. If stable, adenosine. If unstable, cardioversion

Tx of SBO?

Partial SOB and stable: -NPO -IV fluids -Abx -NG tube Complete (no air in rectum) or s/sx of peritonitis - ex lap Other concerning features: hemo instability, leukocytosis, met acidosis (dec bicarb), changed character of pain, fever. If recent abd surgery, a tender/palpable mass is likely incisional hernia. This needs ex-lap.

Two types of eustacian tube dysfx - what are they? How do they present? Exam findings? Mgmt?

Patulous - tube is stuck open. transient autophony (hearing self louder), fluctuating sx, ear fullness. Nl exam; Nl Weber and Rinne testing. Good hydration, nasal saline drops, ENT referral. Stop decongestants and nasal steroids. Obstructive - tube is stuck closed. Chronic hearing loss, tinnitus, "plugged ears, popping, vertigo. Exam - effusion/recurrent OM; TM retracted; ass with cholesteatoma or perforated TM; Abnl Rinner/Weber testing Tx depends on underlying cause If rhinosinusitis - intranasal saline, topical/systemic steroids, abx, leukotriene inhibitors, antifungals Rhinitis - antihistamines, topical nasal steroids, cromolyn, oral leukotriene inhibitors Laryngopharyngeal reflux - avoid triggers; if GERD - PPI Mass lesions - depends on mass/cause.

Chronic, intermittent hearing loss that is worsened by exercise/head position -Nl Weber/Rinne testing -autophony (own voice/breathing is amplified) or sounding as if you were underwater/"plugged ears" Dz? Caused by? Tx?

Patulous dysfx of the eustacian tube decongestive/dehydrating effects of long speaking/exercising can result in dry mucosa around the eustacian tube, which is thought to result in pulling the eustacian tube open resulting in abnl transfer of sound and pressure from the nasopharynx into the middle ear. good oral hydration before and during exercise and using nasal saline drops.

Kid with: -fever -acute onset refusal to bear weight -leukocytosis, elevated ESR -Leg kept in ER Dz? Cause? Mgmt?

Pediatric septic arthritis - key pain with ROM. D/t hematogenous spread. MC d/t S. aureus. Blood cultures, athrocentesis, surgical drainage, cultures of fluid, empiric abx.

-rough, hyperpigmented, scaly rash that worsens with sun exposure -diarrhea -depression/dementia -glossitis

Pellegra - niacin (B3) def Can be seen in devloping countries where corn is primary food source, Carcinoid syndrome, or Hartnup dz (cong d/o of tryptophan abs), or prolong use of Isoniazid

Mgmt of severe pelvic fx (disruption of pelvic ring)?

Pelvic binder ASAP if hemodyn unstable. Indications for pelvic binder - open-book pelvic fractures, especially when there is significant hemorrhage If this does not improve pt's hemodynamic status, then pts will need laparotomy

-Dull, ill defined pelvic ache -worse with long periods of standing -Worse several days prior to menses and relieved when menses begins.

Pelvic congestion syndrome

-Flaccid bullae in elderly -Mucosa involve + Nikolski sign Dz? Path? Tx?

Pemphigus Vulgaris D/t IgG against desmoglein. IF: *intraepidermal* cleavage with "netlike", "chicken wire" appearance. steroids

What to consider in infective endocarditis with AV block?

Perivalvular abscess

Tx of lice?

Permethrin on body Pyrethrin with piperonyl butoxide in hair Fine-tooth comb to remove dead lice and nits Wash all clothing, bedding, etc

Acute bronchitis sx? Etiology? Dx? tx?

Persistent cough (with or without sputum) without sx of pna (clear lungs, afebrile, no CP/SOB). Course - nonspecific URI (rhinitis, HA), lasting 1-3 weeks Secondary to inflammation to the bronchi of the lower respiratory tract typically secondary to viral infection (influenza, parainfluenza, rhinovirus, RSV) Clinical. CXR to r/out pna; may see nonspecific, bronchial wall thickening Supportive.

Kid with this murmur: -harsh systolic murmur at LLSB, loud S1 & S2, bounding pulses

Persistent truncus arteriosus

-Ca of SI -hamartomas -pigmented spots on oral mucosa Dz? Increased risk of what?

Peutz-Jeghers 10-15x increase in GI, gonadal, and lung malignancies.

Mgmt of SCFE? MC acute, serious complication? Chronic complications?

Physis stabilization with screw fixation Avascular necrosis of the femoral head OA

Child with: -limited upward gaze; downgaze preference -upper eyelid retraction -Pupil reactive to accomodation but not to light. -obstructive hydrocephalus

Pinealoma (Parinaud syndrome)

Cholangitis Abx tx? 3 MC organism inolved?

Pip-tazo Ticarcillin-Clavulanate Ceftriaxone + Metronidizole Amp-Sulbactam If PCN allergic: Cipro + Metro Carbapenams Gentamicin + Metro E.coli > Klebsiella > Enterobacter (MC gram+)

non-pruritic, hypopigmented, scaling plaques with indistinct borders affecting the face, lateral upper amrs, and thighs

Pityriasis alba

-salmon colored macule followed by development of multiple lesions on tunk/UE -lesions are erythematous, eventually desquamate, causing itching Dz? buzzwords? Tx?

Pityriasis rosea - "herald patch", "Christmas tree pattern" Spontaneously resolves

Mgmt of placenta accreta?

Planned C-sec

Tx of vasa previa -Sx?

Planned C-sec at 34-35 weeks. If ROM, emergent C-sec Sx: painless 3rd TM bleeding. No maternal hemodyn instability, fetal HR abnlities (brady, sinusoidal)

MCC of abnl bleeding in pts with chronic kidney dz? tx?

Platelet dysfx. bleeding time is prolonged. PT/PTT/ platelet count nl. Tx: DDAVP

What type of transfusion is indicated in a pt with ITP? (what is cutoff?) Children tx? Adult tx?

Platelet transfusion; if bleeding and platelet count <30,000. Children with cutaneous sx - observation, regardless of platelet count. If mucosal bleeding -> steroids, anti-D immune globulin, IVIG Adults - if cutaneous sx *and* platelet count >30,000, observe. Otherwise, steroids, IVIG, anti-D globulin

Light's criteria

Pleura/Serum -LDH >0.6 -protein >0.5 -LDH >2/3 upper limit of nl Greater of any one: exudative

Rapidly developing pneumonia, fever, HA, SOB, pleuritic CP, cough, hemoptysis, ARDS Bioterrorism with sx hours to days after exposure Dz? Microbio? Tx?

Pneumonic Plague (Yersinia) Zoonotic, Gram negative bacillus Transmitted via fleas/rodents Isolation, streptomycin, tetracyclines, Gentamicin +/- chlorampenicol

Tay Sach's vs. Neimann-Pick's Disease hyper- or hyporeflexia?

TS: hyper NP: hypo/areflexia

Cough, CP, sudden onset dyspnea, fever, hemoptysis, myalgias, HA CXR - severe bilat pneumonia Bioterrorism causing sx 3-5 days following exposure. Dz? Micro? Incubation period? Tx?

Pneumonic Tularemia Nonspore forming, nonmotile, aerobic, Gram(-) coccobacillus. 48-72 hours Streptomycin (drug of choice), gentamicin, doxy, cipro.

Newborn of a diabetic mother within 2 hours of birth presenting with: -tremor -ruddiness (red color) -priapism in males -irritability -Hct 69% Dz? MCC? Tx?

Polycythemia of the newborn - sx d/t increased blood viscosity and decreased perfusion. Delayed clamping of the umbilical cord with increased placental transfer of blood to the newborn. 2nd MCC - increased intrauterine erythropoiesis d/y chronic intrauterine hypoxia (preeclampsia, HTN, smoking, high altitude, etc) Partial exchange transfusion using umbilical venous catheter to reduce central Hct level.

-Pregnancy woman with pruritis within abdominal striae that spreads centrifugally (spares palms/soles) and pruritic urticarial papules and plaques. Dz? Tx?

Polymorphic eruption of pregnancy Topical steroids

-Prox muscle stiffness/pain -Elevated ESR/CRP -Nl CK Dz? Other sx? Associated with what other dz? Aldolase levels? tx?

Polymyalgia rheumatica - more often presents with pain when compaired to polymyositis. Pain/stiffness worse in AM or after prolonged activity. fever, WL, fatigue, depression. *Normal strength* Temporal arteriitis Aldolase nl - differentiates it from polymyositis (increased in polymyositis) Prednisone 20mg q D.

-Prox muscle weakness -Elevated ESR/CRP -Elevated CK -Elevated LDH -DTR nl -elevated aldolase Dz? Tx?

Polymyositis *Inc ESR* - nl or minimally elevated (compared to PMR) *Inc CK* - differentiates from Polymyalgia rheumatica (nl); also PMR presents more often with pain. *nl DTR* High dose steroids

-Deep coma & total paralysis within minutes -Pinpoint, reactive pupils Site of hemorrhage?

Pons

Stroke presenting with dysarthria & clumsy hand

Pons (lacunar stroke)

MC site of DVT?

Popliteal and femoral (40%) All proximal veins (35%) Popliteal (10%) Common femoral (8%) Popliteal and common femoral (5%)

-Skin exposed to sun may develop hyperpigmentation, scleroderma-like changes, and erythematous areas including bullae. -Urine left out will turn dark Dz? Cause? Tx?

Porphyria cutanea tarda d/t reduced red cell uroporphyrinogen decarboxylase Acquired form precipitated by alcohol consumption; associated with Hep C infection Avoid sunlight

Hep C is associated with what skin conditions?

Porphyria cutanea tarda Cutaneous leukoclastic vasculitis Lichen planus

In schizophrenia what are more favorable responses to therapy? Worse prognosis?

Positive sx typically respond better to therapy. Negative sx, earlier age of onset, no precipitating stressors - poorer response/outcome.

Newborn with: -suprapubic tenderness -no urine output -Dz? -Workup? -Tx?

Post urethral valves first step: renal and bladder US to determine if hydroureter/nephrosis is present. If present, get VCUG. Tx: bladder drainage and electrolyte tx followed by cystoscopy to ablate PUV.

Most important differentiating factor of syncope vs seizure?

Post-ictal state

-HA, ischemic stroke, neck pain -loss of prop/vib

Posterior cord syndrome -can be from *ascending* aortic dissections resulting in vertebral a. dissection.

Major differences between postinfarction pericarditis vs Dressler syndrome (postpericardiotomy syndrome)?

Postinfarction - 12 hours to 10 days post large transmural MI. Less constitutional sx. No pleural rubs. Dressler - 2-4 weeks post acute MI Presents with additional constitutional sx - low grade fever, malaise, myalgias, weakness, arthralgias. Pleural rubs in addition to pericardial friction rubs. Tx: NSAIDs, Colchicine (prophylactic, but not therapeutic after onset)

RF for endometrial cancer? Protective interventions?

Postmenopausal state Obesity early menarche nulliparity h/o breast or ovarian ca Advanced age Post-menopausal estrogen use (tamoxifen) Late menopause PCOS FH of gyn malignancy Progestin-containing OCPs

Toddler with: -hyperphagia, short, ID, narrow forehead, almond eyes, down turned mouth, microphauls, dec muscle tone -As newborn: hypotonia & weak suck Dz? Dx? Complications?

Prader-Willi Deletion in paternal 15q11-q13 Sleep apnea, type II DM, gastric distension/rupture, death from choking

Infant with: -decreased tone -almond shaped eyes -hypogonadism

Prader-Willi sydrome D/t loss of paternally inherited gene on chr15

Tx for trematodes? Examples of termatodes?

Praziquantel Flukes, schistosoma, cysticercosis - taenia solium

5 yo child with: -pubic hair & axillary hair -obesity -acne -nl external genitalia -nl bone age Dx? D/t?

Premature adrenarche Nl estrogen and test levels. Elevated androgen levels d/t elevated insulin levels (from obesity) which stimulates the adrenal glands to produce sex hormones.

Older man with HL, but is able to hear, but ability to understand is impaired. Worse when there is increased background noise and improved when in a quiet room.

Presbycusis - sensorimotor HL; ass w/ aging d/t degeneration of base of cochlea. High-freq HL Hearing aids and cochlear implants may be beneficial for some pts.

In a pt with cerumen impaction what are the indications for removal? Three categories of removal? What are the contraindications of each?

Presence of sx - hearing loss, earache, fullness, itchiness. Less commonly, dizziness, tinnitus, reflex cough. If asxatic - removal not recommended. In pts who cannot express sx (children, mentally impaired) - removal indicated. cerumenolytics, irrigation, or manual removal. Cerumenolytic CI - h/o ear infections, known/suspected TM rupture, otitis externa, active ear pain, drainage or frequent ear infections, h/o ear radiation. Irrigation CI - immunosuppressive conditions (HIV, organ transplant, renal failure, DM); known/suspected TM rupture; h/o ear infections or ear surgery; h/o radiation; vertigo; otitis externa Manual removal CI - caution in pts on anticoags; inability to visualize removal. If h/o immunosuppression, prior ear surgery, previous perforated TM, typanostomy tubes, barotrauma, etc. - manual removal is indicated.

Solitary lung nodule on routine XR. Next step in mgmt?

Previous CXR for comparison. If no previous CXR, CT chest. If benign features - smooth edges, small, no smoking history, uniform shape, concentric calcifications - f/u CT scan in 3 months. If high-risk features - large (>2cm), irreg shape/edges, smoking history, changing lesions, lack of calcifications - PET vs biopsy

Middle aged woman with juandice, pruritis, fatigue, HSM, xanthomas. -elevated alk phos Dz? Associations? Dx? Tx?

Primary Biliary Cholangitis (PBC) Middle-aged women with autoimmune diseases. Positive anti-mitochondrial Ab, elevated IgM. Increased risk of developing HCC. Granulomatous (lymphocutic) infiltration with destruction of lobular bile ducts on biopsy Ursodeoxycholic acid (slows progression of dz) Cholestyramine (tx of pruritis)

Solitary irregular nonhomogenous ring-enhancing lesions in the periventricular area with surrounding erythema

Primary CNS lymphoma

Elderly with -increased optic cup to disc ratio -peripheral visual loss Dz?

Primary open angle glaucoma d/t progressive loss of nerve fiber layer in the retina.

Pt with: -fatigue, pruritis, asxatic -Dilations of both intra- and extrahepatic biliary ducts. -abd pain -jaundice -pruritis -leukocytosis -elevated alk phos -elevated total bilirubin -abd US - focal dilation of bile ducts -MRCP - multifocal stricture and dilation of intrahepatic and extrahepatic bile ducts Dz? Associations? Complications? Key words? Biopsy? Associated with what cancers? Dx? Complications? Tx?

Primary sclerosing cholangitis (PSC) Middle aged man with IBD (UC) Cirrhosis, portal HTN, liver failure "chain of lakes" or "beads on a string" appearance on MRCP "onion skin" fibrosis Cholangiocarcinoma, GB cancer, colon cancer, if cirrhosis -> HCC MRCP-multifocal stricturing/dilation of intra-/ extrahep bile ducts. Cholestatic pattern (elevated alk phos, bili). Inc ESR, IgM, p-ANCA. If MRCP nondiagnostic, get ERCP or Liver biopsy: obliteration of small bile ducts, concentric replacement in onion skin pattern. Complications: biliary stricture cholangitis; cholelithiasis, GB carcinoma, cholangiocarcinoma, colon ca, biliary ca, cholestasis (malabs of fat-sol vitamins, osteoporosis) - Screening yearly TUG US or MRCP +/- Ca-19-9 level Liver transplant, ERCP with stent placement, cholestyramine

Dx of syphilis

Primary syphilis - dark-field microscopy Nontrep tests: (RPR & VRDL) These can be negative in early infection. Trep tests: (FTA-Abs). Greatest sensitivity in early infection.

Primary vs secondary varicocele -onset -side -supine -mgmt -path

Primary: compression of L renal v. and incompetent venous valves. pubertal onset. L-sided. Decompresses when supine. Reassurance and observation. Secondary: extrinsic compression of IVC and venous thrombosis. Prepubertal onset. R-sided. Persists when supine. Abd US to r/o abd mass.

Contraception IUD that has these CI: -active liver dz -active breast ca

Progestin IUD

-Multiple, asymmetric, hypodense, non-enhancing gray-white matter jx lesions with no edema -presents with: hemisensory loss, +babinski, looks kind of like Multiple Sclerosis.

Progressive multifocal leukoencephalopathy (PML) d/t JC polyoma virus. Demyelinating

Defense mechanism - falsely accusing their own unacceptable thoughts onto someone else? (Husband accuses wife of cheating when he is)

Projection.

Renal biopsy: -glomerular immune deposits and cellular proliferation

Proliferative glomerulonephritis (associated with SLE)

HSV mgmt in pregnancy?

Prophylactic acyclovir at 36 weeks Ensure no active outbreak; if none -> vaginal delivery. If active lesions -> C-sec

Tx of AFib d/t hyperthyroidism? AFib d/t Wolff-Parkinson-White?

Propranolol (BB) Cardioversion or procainamide

Pros and cons of the patch contraception? The ring?

Pros (for both): -Periods more regular/less painful Cons the patch: -irritate skin -spotting in the first 1-2 months Cons the ring: -Increase in vaginal discharge -Spotting in the first 1-2 months

Pros and cons of copper IUD?

Pros: -Lasts 12 years -Use while breastfeeding Cons: -Cramps/heavier periods -Spotting between periods -Injury to uterusduring placement -Cannot use with Wilson dz

Pros and cons of depoprovera injection?

Pros: -decreases periods -Prevents uterine cancer -Use while breastfeeding Cons: -Spotting, no period, WG, depression, hair/skin changes, change in sex drive -Delay in getting pregnant after stopping injections -ADR may last up to 6 months after you stop

Pros and cons of Nexplanon?

Pros: -lasts 3 years -decrease cramps -use while breastfeeding Cons: -Irregular bleeding -Procedure for removal

Pros and cons of Progestin IUD?

Pros: -Lasts 5-7 years -Improve cramps/bleeding -Use while breastfeeding Cons: -Injury to uterus during placement

What cancers are not screened for?

Prostate Ca (unless requested) Ovarian Ca (unless BRCA+) Bladder Ca

Warfarin induced skin necrosis is associated with what dz?

Protein C def

Protraction disorder vs arrest disorder in pregnancy?

Protraction disorder - slow rate of cervical change <1.2cm/h (nulli) or <1.5cm/h (multi). MCC - inadequate uterine activity (contractions at least q 3-5 min??); other causes - cephalopelvic disproportion, abnl positioning of fetus Arrest disorder - complete cessation of progress -Secondary arrest of dilation - no progress in cervical dilation in more than 2 hours. -Arrest of descent - fetal heat does not descend for more than 1 hour (nulli) or 0.5 hours (multi). -failure of descent - no descent.

ACE-I angioedema mgmt?

Stop ACE-I; switch to ARB, however, angioedema can still occur up to 6 weeks after stopping ACE-I. If pt can tolerate no ARB in that 6 weeks it;s good to have a wash out period??? Admission to ICU with close airway monitoring IV steroids

Active phase protraction? Mgmt? Causes? Active phase arrest? Mgmt?

Protraction: <1cm dilation in 2 hours during the active phase (6-10cm dilation). -Mgmt: If inadequate contractions, *oxytocin* for labor augmentation Cephalopelvic disproportion (fetal head too large), *inadequate contractions* (<200 MVU), maternal obesity/excessive WG, fetal malposition (anything other than OA), nulliparity, advanced maternal age -Arrest: No cervical change in >4 hours with adequate contractions or >6 hours without adequate contractions. Mgmt: *C-sec*

Empiric tx for febrile neutropenia? What physical exam is CI? W/u?

Pseudomonas often identified. Pip-tazo should be started following blood cultures. MRSA is also common, esp if port. DRE-can induce bacteremia easily. Blood cultures Empiric abx (ceftazapime and cefepine; vanc if MRSA suspected; add ampoteracin if non-improved by 7 days)

erythematous plaques iwth silvery scaling on extensor surfaces, trunk, buttocks with associated pruritis? Dz? Other findings? Tx?

Psoriasis Nail findings -pitting - depressions in the nail plates (apical nail matrix) -onycholysis - separation of the nail plate from the bed (distally) -leukonychia - white line or other white discoloration of the plate (middle nail matrix) -Lunular spotting - red/pink spots within the lunula (whole nail matrix) -Nail plate crumbline - disintegration of the nail plate (whole nail matrix) -Oil drop discoloration/salmon patches - spots of yellow or pink color change within the nail (whole nail bed) Mild - emoliients, topical steroids (high potency - betamethasone, calcipotriol), vit D analog More severe - phototherapy, anti-TNF agents (adalimumab, etanercept, infliximab), tazarotene, anthralin, methotrexate, cyclosporine, biologic agents

Brief/Acute psychotic disorder vs Schizophreniform disorder vs Schizophrenia disorder

Psychotic disorder involving the symptoms of disorganization, hallucinations, delusions, apathy, flat affect, anhedonia, etc. Lasting *<1 month* Lasting *1-6 months.* Lasting *>6 months.*

Intermittent mandatory ventilation

Pt can initiate breaths, however, the machine does not support these breaths with a preset tidal volume. Instead, the machine supports the pt's breaths by a preset pressure and retimes the breathing rate based on the pt's own breathing pattern.

What is pressure support breaths?

Pt initiated breaths with a pressure limit. The ventilator will provide the driving pressure for each breath, which determines the maximal airflow rate. Inspiration is terminated once the inspiratory flow has decreased to a predetermined perrcentage of its max value.

Pt with decreased TSH, increased free thyroxine Most appropriate next step? Differential?

Pt with hyperthyroidism - get RAIU If pregnant - get US Graves, toxic multinodular goiter, thyroiditis, exogenous- or drug-induced thyrotoxosis, ectopic hyperthyroidism Diffuse uptake in - graves Increased localized uptake - toxic nodules Little/no uptake - thyroiditis

Red eye with irritative sx, FB sensation, lacrimation. Wing-like growth over the cornea Dz? Cause? Tx?

Pterygium D.t exposure to wind, sand, and sun can lead to an elastotic degeneration of the conjunctival stroma. Growth into the central axis can impair vision. Asxatic/mild - observation, lubrication More sxatic cases - surgical excision.

Who should receive HPV vaccine?

Pts < 26. If 11-14 -> 2 doses If >15yo -> 3 doses If benefits, possibly for pts 27-45

Tetanus prophylaxis? Tx?

Pts that have had 3+ tetanus toxoid doses - no tetanus immune globulin. -clean: If last Td dose >10 years ago, give Td. -dirty: if last Td dose >5 years ago, give Td Pts that are unimmunized -clean: Td only -dirty: Td + tetanus immune globulin. Tx: Benzos for muscle spasms, neuromuscular blockade for airway control, metronidizole. Tetanus immune globulin and/or tetanus toxoid

Who and how should screening for HCC be done?

Pts with known cirrhosis should be screened with AFP & US q 6 months.

Indications for IM hydroxyprogesterone? Vaginal progesterone?

Pts with prior spontaneous preterm delivery Cervical insuff (cerv length <2cm) in those without prior preterm labor.

Woman after delivery -painful/difficulty ambulating -radiating suprapubic pain -pubic symphesis tenderness -intact neuro exam Dz? RF? Mgmt?

Pubic symphysis diastasis Fetal macrosomia, multiparity, previpitous labor, operative vaginal delivery Conservative - NSAIDs, PT, pelvic support

New-onset RBBB can sometimes be seen in ___.

Pulmonary Embolism - indicates R heart strain

-23 yo female -progressive fatique -10lg WL -low-grade temp -joint aches -cough -hematuria -hypoxia -CXR - bilat infiltrates -proteinuria -AKI -Anemia -Negative anti-MPO and anti-PR3 Dz? What are infiltrates? Ab? Tx?

Pulmonary-renal syndrome (anti-glomerular basement membrane disease; Goodpasture disease) alveolar hemorrhage Anti-GBM Ab Plasma Exchange, immunosuppression with steroids & cyclophosphomide

Pyogenic vs amebic liver abscess is d/t ____. Imaging? Tx?

Pyogenic - d/t GI infection. Tx: abx, percutaneous drainage Amebic - d/t E. histolytica. S/Sx - fever, RUQ abd pain, WL, leukocytosis, elevated LFTs, elevated alk phos CT - hypodense avascular liver mass (RUQ) Tx: IV metronidizole, aspiration if large

Insidious or acute onset (14-26 days) of fever, chills, HA, malaise, fatigue, diaphoresis, anorexia, pneumonia, acute hepatitis, heart failure, clubbing, and splenomegaly in acute endocarditis Bioterrorism with sx 2-3 weeks after exposure. Dz? Micro? Tx?

Q fever (Coxiella burnetti) Gram-neg coccobacillus Tetracycline (drug of choice), erythromycin, azithromycin

First line tx for acute bipolar depression?

Quetiapine + Lurasidone (first line)

Murmur that worsens with inspiration?

R sided murmur

Mgmt of peripheral artery disease (PAD)? CI'd? S/Sx?

RF modification: smoking cessation, statin, treat HTN/DM. Exercise program, WL Meds: ASA, Clopidogrel Cilostazol and percutaneous/surgical revascularization reserved for persistent sx despite intial tx. Compression stockings CI. Leg pain with activity, dorsal foot ulceration, atrophic changes (cold, hair loss, thickening of nails, shiny skin). Decreased ABI

Late and post term pregnancy: -RF -Complications

RF: prior post-term delivery, obesity, increased age, nulliparity, fetal anomalies Complications: macrosomia, dysmaturity synd, oligohydramnios, demise, Ob lac, C-sec, PPH

Definition and Mgmt of PPROM

ROM prior to 37 weeks gestation. <34 weeks and reassuring - latency abx (amp + erythro/azith), steroids, expectant mgmt until 34-36 wks, deliver if signs of chorioamnionitis/decompensation. 34-37 weeks: steroids (34-37wks), deliver Never give tocolytics in the setting of PPROM, especially if signs of chorioamnionitis.

tx of bronchiolitis

RSV - supportive (nasal saline, suctioning, O2)

Loss of wrist extension. Decreased sensation of dorsoradial hand. What nerve?

Radial nerve injury - commonly d/t midshaft humerus fx.

Tx of increased sleep latency (sleep-onset) insomnia? MOA?

Ramelteon - melatonin agonist Preferred for elderly pts with gait disorders who have increased risk of falls & in pts with a h/o substance abuse. (not effective for sleep-maintenance insomnia) Other options include Z-drugs (non-benzos) - Zolpidem, Zaleplon, eszopiclone.

Defense mechanism - idea or feeling is unconsciously repaced by its opposite thought?

Reaction formation.

Tx of TM rupture?

Reassure and f/u. Usually spontaneously heal within a few weeks.l

Medications for hypertensive emergency?

Recommended IV medications: CCB (nicardipine, clevidipine), BB (labetolol, esmolol), Dopamine-1 Agonist (fenoldopam mesylate), IV vasodilators (nitroprusside, Nitroglycerin) Alternatives: enalapril, phentolamine (alpha-blocker), hydralazine (not recommended first line - d/t rebound tachycardia, coronary ischemia) Should be administered IV drip over IV push (worse outcomes - rebound ischemia and strokes)

Treatment of Hidradenitis Suppurative Staging system? What should not be done in mgmt of HS?

Regardless of stage, initial treatment begins with antibiotics. Hurley stage 1 - abscess formation without sinus tracts/scarring Topical clindamycin. If refractory - oral tetracyclines, acitretin, oral dapsone, combination of clinda/rifampin or intralesional corticosteroids. 2 - recurrent abscesses with sinus tracts & scarring Oral tetracyclines. If refractory - combination clindamycin/rifampin, oral dapsone, biologic therapy (adalimumab, infliximab), or intralesional corticosteroids. 3 - diffuse involvement, multiple interconnected isnus tracts, and abscesses across the entire area. Oral tetracyclines. If refractory - combo clinda/rifampin, oral dapsone, biologic therapy (adalimumab, infliximab), or intralesional corticosteroids. Severe refractory disease - wide surgical excision. I&D should not be performed; it worsens scarring and may promote local recurrences.

Defense mechanism - revert to patterns consistent with someone of a younger age.

Regression

Fibromuscular dysplasia typically affects what arteries?

Renal & internal carotid

Proteinuria on UA - next best step?

Repeat UA (may be transient)

When is TIPS indicated? Complication?

Reserved for bleeding that fails to be controlled endoscopically or with medical mgmt. Hepatic encephalopathy

Young woman with HTN -Nl weight; no comorbidities -BP managed with 3+ medications -Labs, TSH nl Next step?

Resistant HTN (when on 3+ HTNive meds and not controlled or 4 meds with control) Any young pt with new onset HTN, or any pt with resistant HTN, consideration need to be made for secondary cause, including - sleep apnea, alcohol/drug use, thyroid dysfx (TSH), fibromuscular dysplasia (renal US), renal disease (renal US), hyperaldosteronism (plasma aldosterone, renin), and less commonly - hypercortisolism, pheo. In children, coarctation of aorta, renal parenchymal dz.

Hyperventilation syndrome causes what acid-base/electrolyte abnlities?

Resp alkalosis -> as CO2 drops -> H ions released from binding sites on albumin -> albumin has negative charge and binds Ca -> hypocalcemia

Tremor: -at rest -inproves with outstretched arms -worse when engaged in mental tasks

Resting tremor

Pt with sickle cell dz. How do you tell the difference betweem splenic sequestration crisis and aplastic crisis?

Retic count will be elevated in splenic seq crisis. Decreased in aplastic crisis

______ count can distinguish between normocytic anemias. Causes of normocytic anemias. Would it have low, nl, or elevated haptoglobin, bilirubin, LDH?

Reticulocyte count Hemolytic and bone marrow suppression. Hemolytic anemia will have low haptoglobin elevated indirect bili & LDH.

-Burst of flashing light & floaters -amaurosis fugax -decreased visual acuity (blurred) -sluggish pupil -elevated, gray-appearing retina with folds/tear -not painful

Retinal detachment

MCC of amaurosis fugax? General approach to mgmt?

Retinal emboli that dislodge from the ipsilateral carotid a. If AFib - cardiac thrombi MRI of brain to r/out infarction Carotid a. evaluation with CT angio or MR angio - if contrast or radiation is CI - US carotids; ESR/CRP in pts >50; Ophthalmic eval; cardiac eval (EKG, echo); hypercoagable workup in pts with h/o multiple miscarriages, previous thrombi, etc. Typically require anticoagulation therapy for prevention of stroke.

Young pt with: -night blindness -progressive midperiphery visual field loss -flashing lights (photopias) adjacent to blind spot (scotoma) -dec vitual acuity (late) -fundoscopic exam: retinal vessel attentuation, optic disc pallor, abnl retinal pigmentation Dz? Etiology? Prognosis?

Retinitis pigmentosa D/t genetic mutation causing loss of photoreceptors (rods). Advanced dz leads to degen of cones (loss of bright light vision). Progressive retinal degeneration. Sx onset ~10yo through adulthood. Prog: Legally blind by ~40yo

What test should be done for concerned urethra injury? S/Sx of urethra injury? In blunt trauma - is the antior or posterior urethra MC injured? Tx?

Retrograde urethography surface exam -> retrograde urethography -> if neg then foley cath placement with retrograde cystography to eval for bladder injury. If positive -> suprapubic cath drainage with urology consult. pain, hematuria, meatal bleeding, dysuria, urinary retention, high-riding prostate, evidence of additional trauma (hematoma, lac, pelvic fx) Posterior Suprapubic catheter

-pulm nodules -insterstitial lung dz -Joint swelling/stiffness -exudative pleural effusion Dz? HLA? Ab/labs? Tx?

Rheumatoid Arthritis (other source said transudative effusion with *low glucose*) HLA-DR4, DR1 IgM Ab against Fc portion of IgG (RF), ANA, ESR/CRP, anti-CCP NSAIDs, hydroxychloroquine, sulfasalazine, methotrexate, rituximab, etanercept, inflixmab, adalimumab.

Type IV HS reaction that is characterized by linear exzematous, edematous patches and plaques that often have vesiculation & bullae. Type of dermatitis? Common causes?

Rhus Dermatitis Poison ivy, poison oak, sumac (allergic contact dermatitis)

If inhaled - Sudden onset nasopharyngeal congestion, N/V, urticaria, chest tightness, and rapidly progressive respiratory distress, pulmonary edema, multisystem organ failure, vesicular rash. If ingested - N/V/D, fever, cramps, hematochezia, shock Dz? Tx?

Ricin toxin Supportive treatment, activated charcoal and gastric lavage.

Right supraclavicular adenopathy is usually associated with what cancers? Left supraclavicular? Which is called Virchow's node?

Right - cancer in the mediastinum, lungs, esophagus Left - cancer in the stomach, GB, pancreas. Virchow's node.

what head position is best for vaginal delivery?

Right occipital anterior

Prodrome of abrupt onset fever, followed by maculopapular rash as the fever breaks. Rash begins on the trunk and spreads to the extremities.

Roseola infantum (sixth disease) caused by HSV-6

Pregnant lady with sharp abd pain that radiates to vagina?

Round ligament pain

Infant with absent red reflex, loud/harsh murmur through systole and diastole, hepatosplenomegaly, and microcephaly. What were mother's sx?

Rubella. -Joint pain and maculopapular rash.

Slow, coarse tremor that is present at rest, at posture, and with intention.

Rubral tremor

5-10 days following MI: -SOB, confusion -*hypoTN*, tachycardia -cold extremities, diaphroresis -JVD, pulm edema, Crackles -harsh, loud holosystolic murmur with *palpable thrill* -RUQ tenderness -EKG: sinus tach + deep T wave inversion in leads V1-V5 Dx?

Rupture of interventricular septum. Dx: pulm artery cath

Young female with: -Sudden onset, severe, unilat adnexal pain following strenous activity or sexual activity. -US: nl doppler flow, moderate free pelvic fluid, large adnexal mass Dz? Mgmt?

Ruptured ovarian cyst. Mass may be absent if complete rupture. Uncomplicated (no fever, hemo stable, absent signs of hemoperitoneum/infection): analgesics and outpt tx. Complicated (hemo unstable, hemoperitoneum/inf): surgical intervention

Retroperitoneal organs

S = Suprarenal (adrenal) glands A = Aorta/Inferior Vena Cava D = Duodenum (second and third segments) P = Pancreas U = Ureters C = Colon (ascending and descending only) K = Kidneys E = Esophagus R = Rectum

MCC of pneumonia complicated by lung abscess?

S. aureus

MCC of secondary bacterial pna following influenza in young? xr? In elderly? S/Sx of influenza pna and how does it appear on XR?

S. aureus alveolar infiltrates with several thin-walled cavities In elderly, S. pneumo is MCC. -Acute worsening of flu sx, leukocytosis, hypoxia. -Bilat, *diffuse, interstitial* infiltrates

MCC of sepsis in pts with sickle cell dz?

S. pneumo

Hemochromatosis S/Sx? Dx? tx? Indication for specific tx? Who cannot recieve standard tx? Increased risk of what infections? Cancer?

S/Sx: Hepatomegaly, arthritis, pseudogout, fatigue, dec testicular size/erectile dysfx, hyperpig, DM, hypothyroidism, rest/dilated CM (S3, S4), conduction defects (sick sinus syndrome), Hypermelanosis - brownish discoloration of skin (d/t hemosiderin accumulation) -Elevated serum ferritin (best) -increased transferrin saturation -elevated serum iron -decreased serum transferrin -decreased TIBC -Normal hemoglobin levels -genetic testing -tx: *phlebotomies* weekly if tolerated (nl Hb) until ferritin levels fall to 50-100 or until Hb <11, then maintenance phlebotomy can occur q 2-4 months with or without deferoxamine Indications for phlebotomy - serum ferritin >1000 or >500; tissue injury d/t iron overload (transaminitis, cardiac dysfx), increased tissue iron seen on MRI or other study or pathology Phlebotomy should not be done in pts with severe anemia, hemodynamic instability, aceruplasminemia or in pts with secondary hemochromatosis from dyserythropoiesis Increased risk of suderophilic organisms (Vibrio and Yersinia species) - should be counseled against eating undercooked seafood. Hepatocellular carcinoma

Paroxysmal nocturnal hematuria -S/Sx? -Dx? -Tx?

S/Sx: dark urine in AM; Budd-chiari syndrome Dx: flow cytometry (shows absence of CD55/59) Tx: Eculizumab (serves as complement inhibitor)

Loss of maturation of T-cells Dz?

SCID d/t ADA def Severe infections & FTT & lymphopenia

Sx of major depressive episode?

SIGECAPS (req 5/9 with at least one being depression/loss of interest) Sleep (hyper/insomnia) Interest (loss of) Guilt Energy (low) Concentration (poor) Appetite (inc or dec) Psychomotor agitation Suicidal ideations

If an adequate trial of SSRI fails, what are the other first line medications?

SNRI Bupropion Mirtazapine Sertonin modulator

Tx of PMS and PMDD?

SSRI (fluoxetine) can be continuous or luteal phase only (starting on day 14 of cycle)

tx of body dysmorphic disorder

SSRI + CBT

Tx for somatic sx disorder & illness anxiety disorder

SSRI's CBT same provider

-Bell's palsy -Heart block -erythema nodusum -*anterior uveitis* -elevated Ca -SOB/cough -hepatosplenomegaly Dz? Dx? Tx? Complications?

Sarcoidosis CXR - bilat hilar LAD, biopsy showing noncaseating granulomas, PFTs Steroids Blindness - ophthlam exam is required at the time of dx.

Child recently with pharyngitis -fever -rash that started on face and migrated to rest of body -bright red rash in the creases of the groin and underarm -bright red swollen tongue -fever resides and results in desquamation of skin Dz? Pathophys? Rash in creases called what? Tx?

Scarlet fever from GAS Erythrogenic toxin Pastia lines PCN to prevent rheumatic fever

Major difference between Scarlet fever and Kawasaki dz?

Scarlet fever: rash mainly involves skin folds; no conj injection or extremity swelling.

Personality disorder - marked detachment from others and little desire for close relationships little pleasure in activities indifferent to praise or criticism

Schizoid PD

-delusions of odd belief -paranoia, suspicious -no close relationships -flat affect -dressed oddly -formal speaking pattern Dx?

Schizotypal PD No frank delusions or hallucinations.

Woman with: -fatigue, weakness -telagiectasias, shiny skin on hands that is thickened -acute onset renal failure -Previous week with HA & intermittent vision changes -Malignant HTN Dz? Other s/sx? Dx? Tx?

Scleradermal renal crisis olidguria, thrombocytopenia, MAHA blood smear showing schistocytes *ACE-I* *DO NOT GIVE STEROIDS*

Pt with: -dyspnea -hypopigmentation of the skin over chest and back with thickening of skin over fingers with ulceration of the fingertips -GERD Dz?

Scleroderma

Diagnostic w/u for testicular mass/ca

Scrotal US Serum tumor markers Radical inginal orchiectomy (confirms dx)

multiple skin lesions with "stuck on" appearance with a well-circumscribed border Dz? Work-up? Histology Malignant potential? Tx?

Seborrheic keratosis Shave biopsy for atypical features concerning for malignancy - verrucous surface with changes in coloring. Keratinocytes, keratin-filled cysts No Cryotherapy for irritated lesions Reassurance for asxatic lesions

Second stage arrest of labor Mgmt?

Second stage of labor begins at full dilation 3+ hours (without epi) or 4+ hours (with epi) for primigravida. 2+ hours (without epi) or 3+ hours (with epi) for multigravida Operative vaginal delivery is an option in this stage since cervix is fully dilated.

-Epitrochlear LAD -Diffuse macylopapular rash -fever, malaise, HA, sore throat -raised, grey mucosal patches in the mouth Dz?

Secondary Syphilis

Pt with h/o bronchiectasis: -HTN, S4 -Hepatomegaly -Palpable kidneys -Facial puffiness, bilat LE edema Dz?

Secondary amyloidosis Other sx: cardiomyopathy, peripheral neuropathy, macroglossia, bleeding diathesis, waxy thickening of skin and easy bruising.

Those with hodgkin lymphoma treated with chemo and radiation are at increased risk for what?

Secondary malignancy: solid oran d/t radiation exposure. Hematologic malig d/t chemo exposure. Cardiovascular dz: CAD, valve damage, PVD, CM. Pulm dz: pulm fibrosis, brponchiectasis. Hypothyroidism (rad) Neuropathy (chemo)

Who requires high-statin therapy? What statins are considered high-intensity?

Secondary prevention -Vascular dz of any kind (these pts also get ASA) Primary Prevention: -LDL >190 or TG >500 -Pt with DM >40 yo -Pt >40 with 10-yr ASCVD risk >7.5-10% Atorvastatin (40 or 80mg) vs Rosuvastatin (20 or 40mg)

Mineral def with: -thyroid dysfx -cardiomegaly/cardiomyopathy (dilated) and signs of HF - rales, edema, JVD -immune def -macrocytosis -mood disorders -whitened nailbeds -hair loss -skeletal muscle dysfx

Selenium Keshan disease - an endemic cardiomyopathy d/t selenium def that is seen in certain parts of China.

Woman undergoes D&C for missed ab. Next week has fever, lower abd pain, cerv motion tenderness, thickened endometrial stripe and + preg test. Dz? Risk? tx?

Septic abortion Tx: broad spectrum abx, suction D&C Risk of intrauteirne adhesions (Asherman)

Fever (unresponsive to abx) Bilat lower abd tenderness No localizing s/sx Recent C-sec/pelvic surgery or pathology Dz? Tx?

Septic pelvic thrombophlebitis Abx + anticoag

Initially with buboes/necrotic lesions, painful LAD with progression to Febrile, toxic, GI sx, hypotension, DIC, death secondary to organ failure Dz? Microbio? Tx?

Septicemic plague Zoonotic, Gram negative bacillus Transmitted via fleas/rodents Isolation, streptomycin, tetracyclines, Gentamicin +/- chlorampenicol 10-20% present without preceding bubo.

Woman with: -markedly elevated testosterone levels -Nl DHEAS -Virilization sx (clitoromegaly) -Solid adnexal mass -S/sx of estrogen def: breast atrophy, dysparunia, vulvuvag atrophy Dz? Dx? Tx?

Sertoli-Leydig tumor Pelvic US Surgical removal

What SSRI is 1st line following acute MI?

Sertraline

-fever, hives, multiple joint pain -LAD -recent abx use -Dz? Etiology? Tx?

Serum sickness-like rxn D/t immune complex formation; abx; Hep B Hypocomplementemia; elevated ESR Tx: stop offending agent; supportive; steroids/plasmaphoresis

ADR of propofol

Severe hypoTN and myocardial depression

Plummer-Vinson Syndrome -triad -risk of what? -tx?

Severe iron deficiency anemia, esophageal web, and beefy red tongue due to atrophic glossitis Risk of SqCC Esopahgeal dilations, screening EGD's for cancer

Fever + Bloody diarrhea associated with day care?

Shigella (low infectious dose -> easily transmissible)

Impaired SA node automaticity d/t degeneration and/or fibrosis of SA node and atrial myocardium. S/Sx: fatigue, lightheadedness, palpitations, (pre)syncope. EKG: bradycardia, sinus pause/arrest, SA exit block, alternating bradycardia and atrial tachyarrhythmias (tachy-bradycardia syndrome)

Sick sinus syndrome

-Low MCV, transferrin -High iron, ferritin, percent transferrin saturation, Dz? Causes?

Sideroblastic anemia Isoniazid can cause sideroblastic anemia. BM: ringed sideroblasts

DMARD that needs PPD testing prior to use?

TNF-alpha inhibitors (infliximab, etanercept)

MCC site of volvulus in adults? S/Sx? RF? Dx? Tx?

Sigmoid colon colicky abd pain +/- obstructive sx (N/V, obstipation), distended abd, tympany RF: chronic constipation, colonic hypomotility (d/t neuro d/o) XR: loss of haustra, omega loop for sigmoid, coffee bean sign CT: dilated sigmoid colon, mesenteric twisting (whirl sign) Flex sigmoidoscopy decompression vs emergent sigmoid colectmy if perf/peritonitis

-Localized, nodular peribronchial fibrosis in upper lobes with eggshell calcifications Dz? Occupation? inc risk?

Silicosis Sandblasting, rock quarries, mining, glass manufacturing, Increased risk of TB. Need PPD annually.

Bulging mass from the umbilicus that can ulcerate and ooze. What is this nodule called? Associated with what?

Sister Mary Joseph Nodule Metastasis from GI cancers (gastric and colon MC)

-Dry eyes -Dry mouth; dental carries -bilat joint pain Dz? Ab? Extraglandular manifestations? Mgmt?

Sjoren's Anti-ribonucleoprotin Ab Anti-Ro (SSA) Anti-La (SSB) Less specific - RF, Anti-CCP Myositis, arthritis, Raynaud's, thyroid dz, cutaneous vasculitis, numerous GI complications (pancreatitis, autoimmune hepatitis, celiac dz), urogenital dz (interstitial nephritis, vulvovaginal dryness, dyspareunia), cytopenias, monoclonal gammopathy, interstitial lung dz. Artificial tears, artificial saliva. Pilocarpine

SIGECAPS

Sleep Interest Guilt Energy Concentration Appetite Psychomotor Suicide

Elderly with uncontrolled DM: -bloating, flatulence, and abd discomfort/cramping -watery diarrhea -malabs, WL, anemia, vitamin def -no association with food/defecation -abnl carbohydrate breath test using glucose & increased fecal fat Dz? Dx? Tx?

Small intestinal bacterial overgrowth Gold standard dx: jejunal aspiration - shows high bacterial concentration. Carb breath test is much easier to perform. Tx: rifamixin, neomycin

High fever, HA, rigors, vomiting, malaise, abd pain, AMS, and synchronous examthem with centrifugal distribution Dz? Tx?

Smallpox (variola) Respiratory isolation, supportive, prophylaxis with smallpox vaccine

Explain continued positive airway pressure.

Specific pressure is set, allowing the airways to remain open, and allowing spontaneous breaths by the pt. Pt can over breathe the ventilatory, but must receive the set amount of breaths that are set per minute and only receive pressure support.

Posterior epistaxis - which artery? Anterior epistaxis - which artery?

Sphenopalantine artery, arising from maxillary artery. Kiesselback plexus

-gait unsteadiness, shock sensation in spine, atrophy/weakness in UE, increase tone/reflexes in LE. Dz? Etiology? Dx? Tx?

Spinal cord compression - cervical myelopathy. D/t cervical sponylosis and associated spinal canal narrowing from osteophytes. Dx: emergent MRI Tx: immediate IV steroids to decrease vasogenic edema while getting MRI, surgical decompression

Young pt with: -preceding back pain -now with bilat LE paralysis -No sensation in bilat LE -fever -bowel/bladder dysfx Dz? Cause? Dx? Tx?

Spinal epidural abscess D/t hematologic spread from distant infection, IVDU, or direct inoculation from spinal procedure. S.aureus MCC. Dx confirmed with MRI. Labs show elevated ESR Tx: promt broad spectrum IV abx (vanc + ceftriaxone) & urgent decompression

Aldosterone diuretics names? ADR?

Spironolactone, triamterene (K-sparing diuretic) Hyperkalemia Gynecomastic

Defense mechanism - belief that people are all good or all bad - no in between.

Splitting Seen in borderline PD.

Pt with cirrhosis: -low-grade fever -abd pain -confusion, lethargy -ascites Dz? Dx? Tx?

Spontaneous bacterial peritonitis Paracentisis showing ascitic fluid neutrophil ct >250; protein <1; SAAG >1.1 Cefotaxime

Persistent nodulular, erosive, ulcerative lesion in the mouth with surrounding erythema and induration with LAD.

SqCC

Indurated, fleshy, crusted, ulcerated nodule/erosion Painbless, scaly, erythmatous plaque Dz? Dx?

SqCC of skin Biopsy - dysplastic & anaplastic keratinocytes.

O2, CO2, and pH changes in the progression of status asthmaticus?

Stage I - hyperventilation; nl PaO2; dec PaCO2; resp alk Stage 2 - hyperventilation; decreased PaO2 & PaCO2 Stage 3 - nl ventilation; false nl PaCO2; dec PaO2 Stage 4 - low PaO2; high PaCO2; acidotic

Infant with diffuse, blanching rash on buttocks & hands that spread over entire body. Febrile, irritable. +Nikolsky sign Dz? Cause? Course of rash? Tx? What else can be similar to this dx?

Staphylococcal scalded skin syndrome (SSSS, pemphigus neonatorum, Ritter dz) D/t exfoliative toxins (epidermolytic exotoxins A&B) by S. aureus. Toxins are proteases that cleave desmoglein-1 (holds stratum granulosum and spinulosum together) Typically occurs on days 3-7. Rash often begins around the mouth -> flaccid blisters appear 1-2 days later, esp in areas of mechanical stress (flexural areas, buttocks, hands, feet) Supportive, parenteral antistaph abx; often PCN resistent. Use oxacillin, nafcillin, or vanc SJS/TEN can present similarly, however, mucosal involvment in SJS/TEN and typically have a medication exposure.

-Prox muscle *pain* -May or may not have weakness -Nl ESR/CRP -Inc CK -Nl reflexes

Statin-induced myopathy

In what setting is nonbacterial thrombotic endocarditis seen?

Sterile vegetations on the cardiac valves in pts with *malignancy*

-Prox muscle weakness -Nl ESR/CRP -Nl CK

Steroid-induced myopathy (also Cushing) *nl CK & ESR*

Kid with: -Harsh, crescendo-decrescendo murmur at mid- to LUSB -Single S2

TOF

What does + fetal fibronectin test mean? When is it done? CI? What to do if + vs -?

Strong predictor of delivery within the next week. Done in pts *22-35 weeks* gestation w/ *reg contractions* and *no cervical change* is in preterm labor. CI - Gestational age <22wks or >35 wks, presence of ROM, active vaginal bleeding, anything in the vagina past 24 hours (intercourse) If +: give steroids if -: routing prenatal care and expectant mgmt - 99% sure pt will not go into preterm labor within the next 2 wks.

Epilepsy, eye abnlities (glaucoma), intellectual disability, hemiatrophy, port wine stain Dz?

Sturge-Weber syndrome

Recent viral infection Painful lump in neck for several weeks Tender, diffuse enlarged gland in the anterior aspect of neck Fatigue, malaise TSH nl Dz? Tx?

Subacute thyroiditis NSAIDs

-Nl total and free T3 -Nl T4 -*Elevated TSH*

Subclinical hypothyroidism Associated with anti-TPO & anti-thyroglobulin Ab

Thickened palpable veins or cords are seen in ______. Tx?

Superficial thrombophlebitis Supportive - NSAIDs

-pain with sex; burning -able to tolerate pelvis exam Dz? Tx?

Superficial vaginal pain d/t lack of vaginal lubrication Water-based lubricant.

Tx for viral rhinosinusitis When can you diagnose "presumed" bacterial rhinosinusitis and what is the tx?

Supportive - rest, fluids, saline nasal irrigation, decongestants, pain relievers, dextromethrophan, expectorants, glucocorticoid nasal spray Sx >10 days, double-sickening, severe presentation with high fever Tx - Amoxicillin +/- Clavulanate If PCN allergic - Doxycycline with or without Clindamycin

Procainamide indications

Supravent & vent arrhythmias Wolff-Parkinson-White syndrome

Tx of necrotizing fasciitis

Surgical debridement of all necrotic tissue (emergent) IV antibiotics - Clindamycin + ceftriaxone +/-aminoglycoside 2 sets of blood cultures (prior to abx)

Odynophagia & dysphagia work-up in pts with HIV? What do differect lesions look like?

Suspected esophagitis (dysphagia, odynophagia) 1. Mild sx, oral thrush -> Candida likely empirically treat (oral fluconazole). Endoscopy if no improvement. Candida - thick white plaques. 2. Severe sx, no improvement with empiric tx of Candida, no thrush -> endoscopy for viral cause. CMV - multiple, linear, large ulcers (Ganciclovir, Valganciclovir) HSV - well circumscribed, small ulcers, with heaped up margins "volcano-like" (Acyclovir, Valacyclovir)

ADHD Dx Criteria? Tx? Associated dz comorbidities?

Sx starting <7yo; persistent impulsiveness, inattention, hyperactivity, etc. -Stimulant (amphetamine, methylphenidate) -Non-stimulatants (atomoxetine) -Oppositional defiant disorder, conduct disorder, depression, Tourette syndrome, antisocial PD, bipolar d/o

Methanol poisoning -Sx? -Labs? -Tx?

Sx: *retinal damage* (blindness, papilledema, blurred vision, optic disc hyperemia). Labs: AG met acidosis & increased osmolar gap Treatment: Ethanol, fomepizole, dialysis Dialysis indications - 1. ingestion of methanol vol >30mL 2. serum methanol level >20 3. development of visual changes 4. lack of improvement with acidosis despite multiple NaBicarb infusions

Foreign body aspiration dx? tx?

Sxatic or asxatic pts who are stable - CXR (AP & Lat) If negative and asxatic - close monitoring with f/u in 2-3 days. Neg XR and stable -> CT chest can be considered If negative and high clinical suspicion - rigid bronch still indicated Rigid bronchoscopy - stable pts

Symmetric vs Asymmetric IUGR -onset -etiology -features

Symmetric -1st TM -Chromosomal abnlities, congenital infection, maternal drug use -global growth lag Asymmetric -2nd/3rd TM -uteroplacental insuff, maternal malnutrition -"head sparing" -Mgmt: umbilical a. Doppler US to ID who needs urgent delivery to decrease risk of fetal demise.

-Trauma to one eye leading to vision loss of that eye. -Several weeks later develop floaters and blurred vision of other eye

Sympathetic ophthalmia (AKA: spared eye injury) d/t uncovering "hidden" antigens

Tx of influenza?

Symptomatic: analgesics & cough medicine Antivirals should be used w/in 2 days of onset, may shorten course by 1-2 days -Oseltamivir - neuroaminidase inhibitor (can use in pregnancy) Baloxavir marboxil - influenza cap dependent endonuclease

Bilat shoulder/arm pain - sharp/needle-like HA decreased sensation to temp and pain in UE Nl strength in UE Dx? Dx? MCC? Tx?

Syringomyelia - fluid filled cavity in the spinal cord itself MRI Arnold-Chiari malformation (type I) - herniation of cerebellar tonsils through foramen magnum Surg decompression of the foramen magnum

55 yo with nonspecific sx of GI complaints (pain, diarrhea MC), cutaneous involvement (pruritis, flushing), anaphylactoid reaction. Dz? Cell line affected?

Systemic Mastocytosis Mast cells

Child with: -Daily spiking fevers -joint pain -pink, nonpruritic macular rash -hepatosplenomegaly -leukocytosis, thrombocytosis, anemia, hyperferritenmia, mild inc LFTs Dz? Tx? Vs other subtypes of this dz?

Systemic juvenile idiopathic arthritis (still's disease) Tx: NSAIDs, steroids Pauciarticular - MC form of JIA <5 joint involvement 2-3 yo ANA and RF negative Resolves within 6 months At risk for uveities; screen by ophthalmology. Polyarticular JIA - 2-5 yo or 10-14yo with: >4 joint involvement RF+ Mild anemia, thrombocytosis Elevated ESR/CRP ANA+ daily fever x2 weeks + arthritis Inc risk of uveitis; screen by ophtho Tx: NSAIDs + DMARDS (methotrexate, sulfasalazine)

Osteoporosis DEXA score of what? Tx? CI to tx?

T score below -2.5 Life-style changes - smoking cessation, fall prevention, avoid heavy alcohol use, increase in weight bearing activities. Adequate intake of Vit D and calcium. Post-menopausal women - bisphosphonates (alendromate, risedronate - PO forms) CI to oral bisphosphonates - esophageal abnormalities, h/o bariatric surgery, inability to sit up straight, esophagitis. IV formulation options - Zoldronic acid, ibandronate CI to IV form - hypocalcemia, severe renal dysfx. Post-menopausal women <60 - SERM (Raloxifene) CI - VTE

Neonate with: -resp distress during feeding -drooling -aspiration pna Dz? Dx? Mgmt?

TEF/EA NG tube and XR Look for VACTERL: echo, renal US, skeletal survey; then surgical repair

Pain, paresthesias, burning, and numbness in sole of foot. + tinels at the ankle Dz? What nerve?

Tarsal tunnel syndrome Tibial nerve compression Radation to calf

-*Diffuse* thinning of hair in a person undergoing increased stress. -Positive hair pull test.

Telogen effluvium

Middle-aged man with: -"odd behavior" -episodes of staring with fumbling hand movements that last about a minute. -confused after spell -forgetful Dz?

Temporal lobe epilepsy

Pre-Exposure HIV prophylaxis (PrEP)

Tenofovir + Emtricitabine For partners of HIV+ pts.

These tocolytics have what side effects? When are they indicated? 1. Terbutaline 2. Nifedipine 3. Indomethacin

Terbutaline: hypoTN, tachycardia, hyperglycemia, pulm edema. Used as short-term inpt use. CI: in maternal DM. Nifedipine: flushing, HA, nausea, tachycardia/palpitations. 1st line at 32-34 weeks. Indomethacin: gastritis, platelet dysfx. Fetal: oligo & closure of PDA. 1st line <32 weeks. CI: >32 weeks d/t possible closure f PDA.

-Difficulty walking -wide based gait -loss of proprioception and vibratory sense in BLE -dilated saccular aneurysm of the thoracic aorta -Aortic regurg Dz?

Tertiary syphilis

-Contralat hemiparesis & hemisensory loss -Nonreactive pupils -Upgaze palsy -Eyes deviate away from lesion (toward hemiparesis) Site of hemorrhage?

Thalamus (pure sensory stroke)

Large, bilateral cystic ovarian mass.

Theca lutein cyst Arise from elevated B-hCG levels (hydatidiform mole).

-Vag bleeding <20 weeks -closed os -fetal cardiac activity present Dz? Tx?

Threatened Ab Reassure and f/u US

Midline neck masses in children?

Thyroglossal duct cyst - moves with swallowing. Dermoid cyst If undergoing surgery - middle third of hyoid bone to fully excise the sinus tract +/- foramen cecum is removed.

-fever in the first few hours post-op with: -tachy, HTN, increased RR -agitation & anxious -diaphoresis -tremor -lid lag -N/V -elevated CK -absent muscle rigidity -nl DTRs Dz? Mgmt? How does this differ from other causes of post-op fever/tachy/HTN?

Thyroid storm Clinical dx. Confirm with thyroid fx studies. Tx: propranolol, PTU, iodine, steroids -Malignant hyperthermia: muscle rigidity, hyperkalemia, and significant elevations in CK

What is the ideal settings for: -tidal vol -RR -Fio2 -PEEP

Tidal vol: 4-8 RR: 10-12 Fio2: <60% PEEP: 5

-well circumscribed patch of hair loss -itching, erythema, & scaling -hair of equal length Dz? Path? Dx? Tx?

Tinea Capitus D/t Trichopytan KOH prep (?) UW says Wood's Oral griseofulvin

What tinea infection requires oral therapy?

Tinea capitus Tinea unguium

Skin infection that spares the scrotum?

Tinea cruris

-hypo/hyperpigmented lesions on trunk/UE -fine scale -pruritis Dz? Dx? Tx?

Tinea versicolor (pityriasis versicolor) KOH prep - "spaghetti & meatball" appearance of the hyphae and budding cells Selenium sulfide or topical ketoconazole Oral azoles used for recurrence and as prophylaxis.

S/sx of lidocaine toxicity? Differentiate from anaphylaxis? Amide or ester? which is more anaphylactic? Toxic dose with epi? without epi? Tx?

Tinnitus, lightheadedness, metallic taste in mouth, seizures, cardiogenic shock, bradycardia, hypotension, respiratory depression, decreased O2 sat. Differentiate from anaphylaxis d/t reflexive tachycardia with anaphylaxis + more than one system involvement. Amide; esters more anaphylactic. With - 7mg/kg Without - 4mg/kg Lipid emulsion therapy

-Multiple ring enhancing lesions in the brain

Toxo

Chronic wheezing in children; present at birth. Dz? Dx? Tx?

Tracheomalacia - dynamic collapse of upper resp tract during expiration -> airway obstruction. Bronchoscopy Routine f/u with surgery considered if airway compromise is evident (rare).

-conjunctivitis (follicular) & pannus (neovasc) -conjuntivae appear mildly thickened -nl visual acuity, no pain/itching -eyes show several pale follicles and inflammatory changes in the tarsal conjunctivae bilat dz? complications? tx?

Trachoma d/t C. trachomatis A-C lashes rub against eye and cause ulceration and can lead scarring of the cornea & blindness Azithromycin

-Frontal and temporal hair loss in a person with braids

Traction alopecia

Skin ulcer develops at the site of a tick or deer fly bite with fever, LAD, cough, malaise Dz? Tx?

Ulceroglandular Tularemia (Francisella) - nonspore forming, nonmotile, aerobic, Gram(-) coccobacillys. Streptomycin (drug of choice), Gentamicin, tetracycline, chlorampenicol

Neonate with umbilical mass that has separated with a moist, red, friable, pedunculated mass?

Umbilical granuloma Tx: silver nitrate

Pts with or h/o acute rheumatic fever. What's the mgmt?

Uncomplicated ARF: PCN x5yrs or until 21. With carditis, but no valve dysfx: PCN x10yrs or until 21. With carditis and valvular dysfx: PCN x10yrs or until 40. (which ever duration is longer) This is because they are at high risk of recurrence.

Weight gain recommendations during pregnancy Additional caloric intake based on TM? Additional caloric intake if breastfeeding?

Underweight: 28-40lbs (1lb/wk) Normal Weight: 25-35lbs (1lb/wk) Overweight: 15-25lbs (0.6lb/wk) Obese (BMI > 30): 11-20lbs (0.5lb/wk) 1st TM - no change in daily caloric intake 2nd TM - additional 340kcal/day 3rd TM - additional 450kcal/day additional 500kcal/day

Child with: -chronic unilat nasal d/c Dz? Dx?

Unilat choanal atresia Failure to pass NG tube.

Dx of gasgroparesis?

Upper GI series (watch barium as it moves through GI tract)

Speculum exam: -tender anterior vaginal wall mass that expresses a purulent urethral discharge when palpated.

Urethral diverticulum

Transfusion reaction: -within 2-3 hours -urticaria Which one? D/t? Tx?

Urticarial d/t recipient IgE against blood product component. Tx: oral diphenhydramine If no s/sx of anaphylaxis, transfusion can be resumed with diphenhydramine.

What children are at increased risk for iron def anemia? When should they be screened?

Use of cow milk, malnutrition, prematurity, low birth weight, obesity, sx of IDA, living in areas with high prev, lack of iron rich foods (fortified cereals, meats, fortified formula). In those at high risk - screening should start at 4 months and proceed through 2 years at each visit. Those who are not high risk - at least once during 4-24 months of age.

Prophylactic abx coverage to reduce surgical site infection?

Used in *clean* procedures to cover against skin flora. First line: 1st & 2nd gen cephalosporins (Cefazlin). If anaphylactic rxn, use Vanc or clinda

Controlled mechanical ventilation?

Used when the patient is making no respiratory effort. The machine does not allow spontaeous breaths or support them. This is total ventilator-dependent setting.

Middle aged woman with: -lower back/pelvic pain worsens with ambulation -"bulge" in vagina -decreased libido and unable to achieve orgasm Dz? Tx?

Uterine prolapse d/t weakening of pelvic floor muscles Most effective - strengthening of pelvic floor via Kegel exercises. Pessary insertion is temporary relief of sxatic prolapse and requires frequent follow up and monitoring.

-Wide and bizarre QRS complexes (reg, wide complex tachycardia). -What's the tx?

VTach Sustained VTach -hemo stable - IV *amiodarone*. hemo unstable - synchronous DC *cardioversion* Nonsustained VTach: -asxatic - no tx -if sxatic or underlying heart dz, electrophysiologic study. IF inducible, ICD placement (1st line). Amiodarone (2nd line)

Amiodarone is used to treat what arrhythmia?

VTach, VFib, AFib

Tx for shingles?

Valacyclovir (best if within 72 hours of rash) Postherpatic neuralgia - gabapentin, pregabalin, TCAs, topical capsaicin, lidocaine patch. If refractory pain, meds can be combined (oral + topical) or addition of valproic acid, carbamazepine, lamotrigine, duloxetine, venlafaxin.

Hypernatremia Metabolic acidosis Hypocalcemia Elevated serum ammonia mild LFT elevations Hypoglycemia Coma Small pupils Encephalopathy/coma/cerebral edema No osmolar gap Intoxication of what?

Valproic acid poisoning (presents similar to ethanol poisoning, but no osmolar gap)

HOCM gets louder with what maneuvers?

Valsalva, standing

Empiric tx for meningitis

Vanc, Ceftriaxone (Cefotaxime for <1mo) +/- Amp (if >50, immunocompromised, preg, <1mo) +/- steroids if concerns for pneumococcal meningitis +/- Acyclovir if immunocompromised

Child with noisy breathing. -biphasic stridor that improves with neck extension. Dz?

Vascular ring

What antidepressant is associated with elevated BP?

Venlafaxine

Pt suddenly becomes dyspneic during central line cannulation -BS audiblel; CXR nl -Audible, splashing murmur over precordium -Tachycardia; nl RR and bp. Dz? Other s/sx? What can develop? tx?

Venous air embolism Complication of central line placement; subsequent development of tachycardia, tachypnea, cyanosis, altered level of consciousness. Loud, churning, machine-like murmur known as "mill-wheel" murmur. Hypotension, cardiac arrest, acute cerebral ischemia (if able to pass through PFO) Place pt in Trendelburg position, left lateral side; 100% O2; immediately aspirate catheter; intubate if changes in hemodynamic status.

Swelling, increased pigmentation, and an ulcer near the medial malleolus of the leg, varicose veins. Dz? Tx? Differentiate this from other similar pathologies?

Venous stasis ulcer Gentle debridement and elevation. If it beomces secondarily infected - oral abx Differs from arterial insuff becuase it typically has ulcers on the lateral leg.

What does V/Q mismatch mean? Causes? Leads to hyper-/hypoxia? with or without hyper-/hypocapnia? Response to supplemental O2?

Ventilating, but not perfusing. i.e. CO2 exchange (vent) is working, but O2 exchange (perf) is not. alveolar hypoventilation (pulm edema, pna) or perfusion (Pulmonary Embolism) Leads to hypoxia without hypercapnia (Paco2 levels are often nl/low) Responsive to O2.

-Fxal MR following MI (6wks - 10wks) -Persistent ST elevation and deep Q waves in same leads -Nl troponin -Sx of HF or stroke (emboli form within the ventricular aneurysm) Dx? Complications?

Ventricular aneurysm - MC after anterior wall MI Complications: ventricular tachyarrhythmias, HF, refractory angina, systemic arterial embolization

Kid with this murmur: -pansystolic murmur at LLSB, loud pulm S2, apical diastolic rumble, systolic *thrill*

Ventricular septal defect

Stroke with: -opposite face & body pain/temp loss -Ataxia & nystagmus -Horner Site of lesion?

Vertebral a. or post inf cerebellar a. Lateral medullary syndrome (Wallenberg)

-paralysis of arm/leg -contralat loss of position sense -tongue deviation toward lesion Site of occlusion?

Vertebral or anterior spinal artery - Medial medullary syndrome

What are the shockable (defibrillation) rhythms? How many joules and what kind of debrillator? What rhythms can be treated with synchronized cardioversion?

Vfib Pulseless Vtach 150-200J with biphasic defibrillator; 360J with monophasic defibrillator. If stable, you could attempt chemical cardioversion with amiodarone or lidocaine. sxatic/sustained VTach with a pulse, unstable AFib with RVR, AFlutter, SVT

Pt with red, watery eyes, watery exudates, and erythematous injection of the conjunctiva with preauricular adenopathy, crusting and matting of the eyelashes upon awakening. Dz? MCC? Tx?

Viral conjunctivitis Adenovirus Supportive.

Pt with elevated direct bili and AST/ALT (with nl alk phos). Differential?

Viral hep autoimmune hep toxin/drug related hep Hemochromotosis ischemic hep alcoholic hep

-Xerophthalmia (excess dryness of cornea & conjuntiva) -Night blindness -Bitot spot on eye exam - keratinized epithelium, inflammatory cells, and coynebacterium xerosis Dz?

Vit A def

Vitamin def with: -bleeding gums -easy bruising -petechiae -perifollicular hemorrhage -corkscrew hair -gingivitis -bruising -poor wound healing

Vit C (scurvy) More sever in kids: hemorrhages, bony deformities, subperiosteal & joint hematomas.

Vitamin def: -hemolytic anemia -neuro abnlities (ataxia)

Vitamin E def

-sudden onset loss of vision and onset of floaters -fundus is hard to visualize with floating debris and dark red glow.

Vitreous hemorrhage -MCC is diabetic retinopathy

What is assist control ventilation?

Volume-cycled mode of ventilation. Setting a fixed tidal volume that the ventilator will deliver at set intervals of time or when the pt initiates a breath. Pts can over breathe the ventilator, but must receive the amount of breaths based on the set minute ventilation.

-Erythematous vulvar erosion with white striae. -Vulvar pain, pruritis, and dyspareunia. Dz? Dx? Tx?

Vulvar lichen planus Dx: clinical, confirm with vulvar biopsy Tx: high-potency topical steroids

SPEP with sharp IgM spike. Dz? Sx? Dx? Tx?

Waldenstrom macroglobulemia CBC: anemia, thrombocytopenia, leukocytosis (lymphocytosis) Peripheral smear - stacking of RBC's - rouleaux formation Hyperviscosity syndrome, hepatosplenomegaly, peripheral neuropathy, LAD Dx: SPEP-IgM; BM biopsy: >10% clonal *B cells* Tx: Plasma exchange (plasmaphoresis) - for acute hyperviscosity syndorme sx chemo (rituximab) often used in general mgmt

Elderly pt with new peripheral neuropathy -S3 -EKG low voltage -new blurry vision and HAs -HSM -Night sweats, fever -Proteinuria -Decreased anion gap -nl renal fx Dz?

Waldenstrom's macroglobulinemia Sx related to infiltrative cardiomyopathy, light chain cast nephropathy, amyloid deposition, hyperviscosity syndrome d/t large IgM proteins.

Anticoagulant preferred in end-stage renal disease? What cannot be used? What should be used as bridge?

Warfarin LMWH,fondaparinux, rivaroxaban Unfractionated heparin

Warm vs cold autoimmune hemolytic anemia. 1. IgG vs IgM 2. Causes? 3. Tx?

Warm: d/t IgG autoAb. Associated with leukemias, lymphomas, and malignancies. Tx: steroids, splenectomy, Rituximab Cold: d/t IgM autoAb. Associated with Mono and Mycoplasma. Tx: avoid cold.

Trendelenburg gait is seen in pts with weakness of what muscles? Describe the gait?

Weak hip abductors (gluteus medius) During the stance phase the contralateral hip tilts down.

First line tx for ovulatory stimulation in PCOS

Weight loss first. Letrozole (aromatase inhibitor) Clomiphene may also be used but has lower live birth rates compared to Letrozole.

In pts with acute MI, when is thrombolytic therapy indicated?

When percutaneous coronary intervention is not readily available

When is theophylline indicated in neonates?

When there is a problem with resp drive (central apnea)

-abd distension, diarrhea -WL -migratory polyarthritis -LAD -low-grade fever -rhythmic jaw and tongue movements with spontaneous convergence of eyes - oculomasticatory myorhythmia (associated with supranuclear palsy and paralysis with upward gaze) Dz? Labs? Dx?

Whipple Dz Macrocytic anemia - d/t vit B12 def Elevated INR - d/t vit K def Decreased vit A and D. Hypoalbuminemia Lymphopenia PAS-positive Gram + non-acid fast rod with biopsy of duodenum

Child with "elfin" facial features, extreme friendliness, poor social skills, supravalvular aoritic stenosis. Dz?

Williams syndrome

Pt with anxiety/neuropsychiatric sx, dysarthria/ataxia, enlarged liver, tremor. Dz? Best diagnostic test vs gold standard dx? Pathogenesis? Pathognomonic s/sx? Lab values - specific ones for dz & liver enzymes? Tx?

Wilson disease Decreased cerulopasmin = best initial diagnostic test. Liver biopsy = gold standard. MRI = useful for determining extent of brain involvement. AR disease of impaired copper transport -> copper overload. brownish-green ring visible around the corenoscleral jx (Kayser-Fleischer rings) Low Ceruloplasmin (Cu transport protein); high Cu excretion levels (24 hour urinary Cu excretion level) Elevated AST/ALT/alk phos D-penicillamine Trientine (if intolerant to above)

-Recurrent infections -Thrombocytopenia (*small platelets* & decreased platelet count) - petechiae, purpura, bleeding -Eczema Dz? D/t? Tx?

Wiskott-Aldrich Syndrome X-linked rec defect in WAS protein -> impaired cytoskeleton changes in leukocytes & platelets. Tx: Stem cell transplant

-Narrow complex tachycardia -Short PR interval -ST and T wave abnlities -wide QRS(?) -delta wave Arrhthymia? Tx? Avoid? Cause of death?

Wolff-Parkinson White syndrome Ablation (for sxatic pts or in asxtatic pts with CAD/AFib/Cong cardiac malformations/cardiomyopathy/valvular dz) Carotid massage, Valsalva, synchronized cadioversion (if unstable/AFib). Procainamide, Class Ia or Class III meds (Proc - drug of choice unless direction of depolarization - ortho vs antidromic - is known??) Observe if asxatic and low risk - if delta wave disappears with exercise - acc. pathway longer than the AV node and unlikely to experience any significant SVT and generally does not require intervention. Avoid: anything that slows AV node: dig, CCB, BB, adenosine Rapid conduction through the accessory pathway resulting in unstable ventricular rates and decreased cardiac output (AFib).

Cervical cancer screening Risk factors?

Women 21-65 Pap smear with cytology Q3 years Women 30-65 Pap smear with HPV testing Q5 years Stop at 65, or 3 nl consecutive paps, TAH RF: early age of coitus (increses risk of HPV), FH of cerv cancer (1st degree relative), DES exposure, poverty, early pregnancy, multiparity, teen pregnancy, obesity, multiple sexual partners, co-infection with other STs, immunosuppression, smoking.

Screening for chlamydia and gonorrhea?

Women 24yo and younger who are sexually active - annual screening.

-progressively worsening dysphagia, regurgitation after eating. -voice changes -halitosis -regurgitation of food Dz? Dx testing? Tx?

Zenker diverticulum Swallow study with contrast esophagography (barium swallow) Tx: cricopharyngeal myotomy

Mineral def with: -alopecia -pustular, vesiculobullous, erythematous skin rash (perioral, extremities, perineum) - "acne" -hypogonadism -impaired wound healing - ulcers, stomatitis -impaired tasted/vision -immune dysfx (frequent URI, diarrhea) -growth retardation -diarrhea -impaired cognitive function, delayed growth in children. Def in ___.

Zinc Acrodermatitis enteropathica is an AR disease with impaired absorption of zinc leading to s/sx of deficiency. Typically follows discontinuation of breastfeeding.

Penetrating neck trauma zones and mgmt?

Zone 1 - Inf to cricoid cartilage Zone 2 - between those areas Zone 3 - Superior to angle of mandible Zone 1 & 3 who are sxatic and stable - angiography, CXR, esophagoscopy, laryngoscopy. Zone 2 & anyone who is unstable - OR

Amblyopia - what is it? MCC? When should it be screened for? How is it screened?

a dimness of vision or the partial loss of sight, especially in one eye, without detectable disease of the eye Strabismus (abnl ocular alignment) Children 3-5 yo; visual acuity testing; difference >2 lines between the 2 eyes

-Conjunctival erythema -*Mid-dilated* pupil that is poorly reactive to light -Acute corneal opacification -Hard, firm eye -sudden, painful loss of vision -N/V Dz? Tx?

acute angle closure glaucoma IV acetazolamide; (timolol; pilocarpine); permanent cure: laser peripheral iridotomy

Sweet syndrome?

acute febrile neutrophilic dermatosis papillary dermal edema = juicy, erythematous papules and nodules leukocytosis bands and polys old white women paraneoplastic (AML), idiopathic

Occupations associated with berylliosis? Presents similarly to what?

aeronotics industry; welding; metal machinery, ceramics. Presents similarly to sarcoid with granulomas, skin lesions, and hypercalcemia.

Mallory bodies?

alcoholic liver disease & Wilson dz

Tx of MDD with psychotic features?

antidepressant + antipsychotic (Sertraline + risperidone) ECT (or with catatonic features)

Hypersensitivity pneumonitis d/t ____. What is common bug associated with it?

antigen mediated. Has flu-like sx when exposed. But when removed from antigen, feel better in a few days. Thermophilic actinomyces

Sx of benzo withdrawal?

anxiousness, auditory/visual hallucinations, HTN, tachycardia, tachypnea, seizures, insomnia

MCC of intracranial hemorrhage in children?

arteriovenous malformation

Hepatic angiosarcoma

assoaicted with exposure to arsenic, thorotrast, anabolic steroids, radiation, thorium, and polyvinyl chloride. Tumor cells express CD31 as a marker. MC in older men

Fetal heart tracing that reflects adequate fetal oxygenation would show what?

at least two fetal HR accelerations per 20 min -Acceleration = HR increase by 15 beats per min above the fetal HR baseline for at least 15 seconds.

Kid with this murmur: -loud S1, *wide, fixed split S2*, mid-systolic ejection murmur at LUSB, mid-diastolic flow "rumble" at LLSB

atrial septal defect

Tx of congenital QT prolongation?

avoid vigorous exercise and meds that lengthen QT interval. BB Those with h/o syncope need BB + pacemaker

-cornea appears hazy with a central ulcer and adjacent stromal abscesses. -hyppyon may be present

bacterial keratitis

Dx of diverticulosis?

barium enema

work-up of oropharyngeal dysphagia? vs esophageal dysphagia?

barium swallow +/- EGD Oropharyngeal s/sx: difficulty initiating swallowing with cough, choking, nasal regurg Esophageal dysphagia: -if solids & liquids, get barium swallow +/- manometry -if solids progressing to liquids, get EGD with biopsy +/- manometry

Osteomyelitis dx

bone biopsy

Trastuzumab is used in which type of cancer? MOA? ADR?

breast cancer Monoclonal Ab against Her-2 Cardiotoxicity

Capacity vs competence

capacity = clinical term assessed by physician competence = legal term for capacity to understand, rationally manipulate, apply info to make a reasoned decision

What is chondrocalcinosis? Dzs associated?

cartilage calcification seen on XR Associated with pseudogout. Evaluate for secondary causes - hyperparathyroidism, hypothyroidism, and hemochromatosis

-proptosis -ophthalmoplegia -chemosis -vision loss -papilledema

cavernous sinus thrombosis

Rapid correction of hypernatremia can cause

cerebral edema

Tx of multiple myeloma

chemo (melphalan and prednisone) + hematopoietic cell transplant + bisphosphonates if skeletal lesions

Who should get postexposure abx prophylaxis for pertussis? What is the abx?

close contacts within the last 21 days. Erythromycin

Cryoprecipitate contains what factors?

clotting factors, vWF, and fibrinogen

Primary cancers that metastasize to the liver?

colon stomach pancreas breast lung

Why are men with CF infertile?

congenital absence of vas deferens.

Triad of reactive arthritis? Other classic findings? Synovial fluid analysis? Tx?

conjunctivitis urethritis arthritis Other common findings: mucocutaneous lesions and enthesitis Sterile NSAIDs

Tx of bell's palsy

corticosteroids +/- (val)acyclovir.

Neurogenic orthostatic hypotension -cause -how it differs from orthostatic hypoTN?

d/t autonomic insufficiency and impaired release of NE with consequent failure of vasocontriction and increased HR. Differs from orthostatic hypoTN d/t absence of increased HR. If pt has intact autonomic NS, HR will increase with drop in BP.

Osteomalacia is d/t

decreased mineralization of osteoid.

Most sensitive test for cirrhosis on lab findings? What lab test is first to be affected?

decreased platelets PT

S/Sx of peripheral vascular disease?

decreased pulses calf pain claudication pain worse with activity Cool limb poorly healing ulcers diminished hair and nail growth on affected side.

Hammar and claw toe deformities are d/t underlying ____.

diabetic peripheral neuropathy

85% of pregnant women with pre-existing DM will have marked progression of _________, irrespective of glucose control.

diabetic retinopathy.

Tx for lactational mastitis? Breast abscess?

dicloxacillin + continue breast feeding Vanc + I&D

pulsus paradoxus

drop in SBP >20 with inspiration. Also described as thready pulses over radial arteries that disappear with deep inhalation. Cardiac tamponade Severe asthma

Initial eval of CHF?

echocardiogram - evaluate for systolic and/or diastolic dysfx, wall motion abnlities, valvular abnlities CXR EKG Labs - CMP, BNP. If signs of AVS/shock - lactic, trop, ABG

Dark urine and pale stools indicate ________ bilirubin

elevated conjugated (direct)

Assessing fluid resuscitation is best determined by examining _____.

end-organ perfusion via measureing urine output, central venous pressure, or cardiac output. CVP - 2-6mmHg CO - 4-8L/min Urine output 1mL/kg/hour for children; 0.5-1mL/kg/hour in adults.

Difference between cellulitis and erysipelas?

erysipelas has well defined margins with raised, advancing edges and sharp, demarcated borders, and typically confined to the face. Rash resembles orange peel. Cellulitis - depper subQ infection that when it spreads has more blurred edges and typically not raised.

Generalized Anxiety Disorder (GAD) criteria Tx?

excessive worry >6 months with 3 or more of the following sx: -restlessness -fatigue -difficulty concentrating -irritability -muscle tension -sleep disturbance Causes impairment SSRI/SNRI + CBT

GCS

eye opening - 1 to 4 none - 1 opens to pain - 2 opens to verbal commands - 3 spontaneous - 4 verbal - 1 to 5 none - 1 incomprehensible - 2 inappropriate response - 3 confused conversation, but answers questions -4 oriented - 5 motor - 1 to 6 none - 1 extensor (decerebrate) - 2 flexion (decorticate) - 3 withdraws from pain - 4 Purposeful movements fo pain - 5 follows commands - 6

RF for breast cancer?

female older age nulliparity early onset of menarche late onset of menses first term preg after 35 diets high in fat and low in fiber 1st degree relative with + breast cancer BRCA1/BRCA2 mutation

Pentad of TTP? Pathophys? Dx? Tx?

fever thrombocytopenia hemolytic anemia (MAHA) reanl insuff CNS symptoms low activity of ADAMTS13 - a vWF cleaving metalloprotease (either low production or inhibitor) resulting in large multimers of vWF -> platelet-rich thrombi that acculumate in small capillaries of multiple organs and cause tissue damage and failure Dx: clinical, labs (elevated indirect bili, elevated LDH - hemolysis), and peripheral smear Tx: emergent tx with plasma exchange, steorids,

Acetaminophen intoxication can be asxatic for how long? initial mgmt?

first 24 hours charcoal within 4 hours & acetaminophen levels. N-acetylcysteine if levels elevated.

Parkland formula for fluid resuscitation Rule of 9's

for first 24 hr to stabilize burn victim 4X (weight kg) X (% body surface burned)=mL Give half in first 8 hour and other half over next 16 hr This is the amount of fluid that is initially needed in addition to the maintenance fluids. Each arm = 9% Each leg = 18% Ant chest/abd = 18% Post back = 18% Head = 9% Genitals = 1%

D-xylose test

given to see if enzyme def or mucosal dz is the problem. Does not need to be degradated to be absorbed. If unabsorbed - intestinal mucosal problem (Celiac). If absorbed - enzyme def (pancreatic, lactase)

fever, cough, myalgias, pulmonary edema, bronchorrhea, arrhythmias thrombocytopenia, elevated LDH, elevated liver enzymes, leukocytosis with immunoblasts in a pt with ARDS CXR - diffuse interstitial edema involving all lung fields. Dz? Incubation time? Dx? Tx?

hantavirus cardiopulmonary syndrome 2-3 weeks Ab recognition to hantavirus Supportive; ECMO

Tx of uremic pericarditis?

hemodialysis

Mgmt of spontaneous abortion

hemodynamically unstable: surgical mgmt with suction curettage. Stable: expectant vs medical (misoprostol)

test for sickle cell dz? Elevated, normal, or decreased MVC, MCHC? Findings on blood smear?

hemoglobin electrophoresis Normocytic anemia; Decreased MCHC Sickled RBCs, Howell-Jolly bodies (after asplenia), target cells, hypochromic

Kid with previous URI and now: -abd pain -arthritis -pruritic palpable purpura -hematuria -bloody stool Dz? Tx?

henoch-schonlein purpura Supportive

What does elevated alk phos + elevated GGT indicate? Elevated alk phos + nl GGT? Isolated elevation in GGT or elevation of GGT out of proportion to other enzymes?

hepatic origin - dzs of liver, biliary tract, and pancreas. pregnancy or bone dz indicator of alcohol abuse or alcoholic liver disease

ADR - Halothane

hepatotoxicity

Primary aldosteronism has what affect on plasma ald/renin ratio?

high >20:1

Dawn Effect D/t what? Dx? Tx?

hyperglycemia upon awakening d/t increase in nocturnal secretion of GH. Dx: 3am BSG (elevated) Tx: increase evening insulin

Mechanism of pulm HTN in systemic sclerosis?

hyperplasia of intimal smooth muscle layer of the pulmonary arteries -> increased pulm vasc resistance.

Who gets varicella post-exposure prophylaxis? What is the prophylaxis?

if no prior h/o immunity (prior infection or 2 doses of vaccine) -If immuno*competent* - varicella vaccine -if immuno*compromised* or baby born to mom with active infection - varicella zoster immunoglobulin

Timeline of contrast induced nephropathy?

increase in the serum creatinine level 24 to 48 hours after contrast Recovery of normal kidney function in 1 to 2 weeks.

Achondroplasia is associated with ____. D/t mutation in ________.

increased paternal age fibroblast growth factor.

Pt diagnosed with endometrial adenocarcinoma - next step in mgmt?

low-grade histology and no sx suggestive of distant mets -> surgical staging including hysterectomy, bilat salpingo-oophrectomy, and LAD followed by radiation If concerns for distant mets, biopsy with high-grade carcinoma, or pt is poor surgical candidate - imaging for metastatic disease (CT, PET, MRI, CA-125) Progestrin IUD can be used as fertility-sparing options in pts with low-grade dz, confined to the uterus. Endometrial sampling must be done q 3 months. Advanced stage and recurrent endometrial cancer are treated with chemo (carboplatin, paclitaxel)

Hypoalbuminemia

lowers total calcium Ionized calcium unaffected and no hypocalcemia related sx.

Conn syndrome results in what acid-base changes? AKA? Low or high K? Na? Aldosterone? Renin? S/Sx? Initial screening test? next best test? Then what? Tx?

metabolic alk Primary hyperaldosteronism or adrenal adenoma - adrenal gland producing excess aldosterone (Fb loop dec renin vs secondary hyperald in renal a stenosis causes increased renin and in response inc aldosterone) Hypokal -> increases bicarb resorption & increased H secretion Hypernatremia Elevated aldosterone, low renin HTN, muscle weakness/cramping, HA Screening renin level. Plasma aldosterone:renin ratio Ratio >30 diagnostic for primary disorders (<10 diagnostic of secondary disorders). CT abdeomen to look for adrenal mass. Surgical resection of adrenal adenoma

Hemineglect syndrome is a lesion of _____.

nondominant parietal lobe

1. What are Howell-Jolly bodies?

nuclear remnants of the RBCs. Presence suggests splenectomy.

When is Rhogam given?

o Given at 28 weeks and also within 72 hours of delivery o Also given after abortion, ectopic pregnancy, amniocentesis, trauma, external cephalic version

Elevated PT can be seen in what conditions? PT is part of intrinsic or extrinsic clotting cascade?

on warfarin, vitamin K def, liver disease, altered clotting factor synthesis, DIC, fibrinogen abnlity, dilution of plasma from transfusion Extrinsic - factor VII

Gold standard dx of DM in pts with PCOS? Rotterdam criteria? General tx?

oral glucose tolerance test Any 2 of the 3: -Oligo- and/or anovulation -clinical or biochemical signs of hyperandrogenism -polycystic ovaries on US 1st line - OCPs. Metformin if DM present. WL/lifestyle changes. Iron if iron def anemia from prolonged heavy menstrual periods If no improvement of sx at 6 months - addition of antiandrogen (spironolactone).

diplopia with upward gaze

orbital floor fracture -> trapped inferior rectus muscle

Rapid correction of hyponatremia can result in Most pts end up with what? Dx?

osmotic demyelination syndrome Pontine demyleination resulting in "locked-in" syndrome MRI

Early menopause is a risk factor for ___. Late menopause is a risk factor for ___.

osteoporosis Endometrial and breast cancer

LH surge induces? What can someone see at this stage?

ovulation Physiologic leukorrhea - white, odorless mucus d/t increased estrogen

Anal pathology with: -gradual onset anal pain and pruritis -fluctuant mass, swelling with erythema -fever Dz? Tx?

perianal abscess Initially: I&D Add abx if: systemic illness (fever) or cellulitis or those at increased risk for severe infection (DM, immunosupp)

Electrical alternans

pericardial effusion & cardiac tamponade Low voltage EKG

Preferred laxative for refractory opioid induced constipation?

peripherally acting mu-opioid receptor antagonist (PAMORA) - methylnatrexone Do not cross BBB, therefore, do not induce withdrawal sx.

Placenta accreta/increta/percreta RF? Complications? Evaluation? Mgmt?

placenta attacted at: -at the myometrium -deep invasion of the myometrium -invasion of the uterine serosa and can attach to surrounding organs Advanced maternal age, multiparity Multiple gestation H/o placenta previa Leiomyomas Endometritis In vitro fertilization Smoking/cocaine use Prior uterine surgery, C-sections Uterine inversion MRI UA - as hematuria may be a sign if invasion through the bladder AFP is generally elevated in cases of abnl placental implantation. Planned C-section

Tx for TTP

plasma exchange/plasmaphoresis

Caplan syndrome

pneumoconiosis (Coal miners lung, Asbestos, silicosis) + rheumatoid nodules/arthralgias. Get RF to look for Rheumatoid Arthritis

Infants who are small for gestational age are at increased risk for what? What classifies as SGA?

polycythemia, hypoglycemia, hypothermia, hypocalcemia, hypoxia Weight <10th percentile for gestational age

Pure motor stroke

posterior limb of internal capsule (lacunar infarct)

Loss of lens elasticity due to aging

presbyopia -prohibits accomodation of lens -> loss of near vision

PPROM complications

preterm labor intraamniotic inf placental abruption umbilical cord prolapse

Primary prevention vs Secondary prevention vs Tertiary prevention

primary - dz state not present; no sx goal - prevent dz occurence ex: vaccines, dietary changes, not using tobacco secondary - precursor present; no sx goal - prevent mobidity from dz ex: all cancer screening tertiary - dz state present; sx present goal - improve morbidity from dz ex: BB after MI, chemo to prevent ca recurrence, rehab

Tx for performance-only social anxiety d/o?

prn BB or benzo +/- CBT

Reversal of heparin? Heparin tox followed by what measurement? Reversal of warfarin? Bleeding vs not actively bleeding? Followed by what measurement? Reversal of tPA and streptokinase? Toxicity is followed with what measurement?

protamine sulfate; PTT levels Vitamin K (days) - no active bleeding; FFP (8 hours) or PCC (10 minutes) - active bleeding. PT/INR Aminocaproic acid; PTT and PT levels

MC location of ectopic foci in AFib?

pulmonary veins

Reactive arthritis -s/sx -tx?

recent GI/GU infection asym arthritis +/- effusions, mucocutaneous lesions, +/- conjuntivitis/uvietis NSAIDs

Complement deficiencies

recurrent neisserial infection And encapsulated organisms (s. pneumo, H. flu)

ASA toxicity changes in acid-base? S/Sx? Tx?

respiratory alkalosis with AG met acidosis N/V, abd pain, lethargy, tinnitus, dizziness, hyperthermia, tachypnea, hypokalemia, hypoglycemia, AMS, seizure, cerebral edema, coma Supportive; correct electrolyte imbalances/metabolic derangements. Sodium bicarb for alkalinization of urine to increase rate of elimination. Severe cases - hemodialysis If acute presentation - gastric lavage/activated charcoal.

hypertensive encephalopathy

s/sx of increased ICP d/t cerebral edema (marked HTN)

Indication for oral isotreinoin?

severe, resistant nodulocystic acne.

Barrett's esophagus pathology?

simple columnar epithelium replaces rhe stratified squamous epithelium

Hypertensive brain hemorrhages affect what location? Gradual or acute onset?

small, penetrating arteries involved in lacunar strokes. -basal ganglia (putamen) > cerebellar nuclei > thalamus > pons > cerebral cortex Gradual worsening of sx (vs. embolism or subarachnoid hemorrhage which is abrupt onset of sx)

Premature Rupture of Membranes (PROM)

spontaneous rupture of the amniotic sac prior to the onset of true labor and after the 37th week of gestation

Tx of neonatal tetanus?

supportive care, antibiotics (PCN) & tetanus immune globulin

Subdural hematoma MCC? Tx?

tearing of vridging veins from trauma Depends on size of hematoma, subdural evacuation, and drain placement may be indicated for larger hematomas with significant mass effect

Pure sensory stroke

thalamus (lacunar stroke; post cerebral a.) -Thalamic pain syndrome following stroke.

Tx of non-inflammatory acne vulgaris (open and closed comedomes)

topical retinoids or salicylic acid or benzoyl peroxide

AFlutter is MC d/t reentrant circuit around _____.

tricuspid annulus

Nitrates MOA

vascular smooth muscle relaxation -> systemic venodilation and increase in peripheral vascular capacitance. -Decreased preload & LV EDV and LV ESV -> reduced LV ventricular wall stress. -Decreased myocardial O2 demand

-cerebellar & retinal hemangioblastomas -pheochromocytoma -RCC (multiple renal cysts) -hearing loss d/t endolymphatic sac tumors of the middle ear -pancreatic neuroendocrine tumors

von Hippel-Lindau disease

RCC, pheochromocytoma, hamangioblastomas Dz?

von-Hippel-Lindau syndrome

Gluteus lurch gait - what muscle are weak? Describe the gait?

weak hip extensors (gluteus maximus and majority of the hamstrings) lordotic position while walking

Interstitial lung disease path:

widespread fibroelastic proliferation & collagen deposition.