MASTER Comlex 2

Risk factors for ectopic preg: Dx of ectopic: Mangement:

IUD, tubal ligation, previous PID, previoius ectopic preg Transvag U/S exam and serial quantitiave bhCG testing showing less than the normal doubling every 48-72 hrs Surgery if hemodynamically unstable, MTX if adnexal mass is found with ultrasound

Treat existing heart failure and replace the tricuspid valve

IV drug use with JVD and holosystolic murmur at the left sternal border. Treatment?

Isospora, Cryptosporidium, Mycobacterium avium complex (MAC)

Identify key organisms causing diarrhea: ■ AIDS

Giardia

Identify key organisms causing diarrhea: ■ Camping

S. aureus

Identify key organisms causing diarrhea: ■ Church picnics/mayonnaise

Bacillus cereus

Identify key organisms causing diarrhea: ■ Fried rice

Hepatic adenoma 2/2 OCPs - when should it be surgically resected?

If symptomatic, more than 5 cm, or do not regress after oral contraception discontinuation

Confounding variable

If you want to know if race affects infant mortality rate but most of the variation in infant mortality is predicted by socioeconomic status, then socioeconomic status is a _____.

Standing flxn tests _______

Iliosacral dysfunction

Drug for GIST (c-kit+) and CML (Philadelphia chromosome+)

Imatinib

Gastrointestinal stromal tumor (GIST), positive for c-kit mutation - tx?

Imatinib (c-kit is a tyrosine kinase mutation)

Chronic myelogenous leukemia - tx?

Imatinib (tyrosine kinase inhibitor)

Relative Risk

In cohort studies, RR = Risk of Exposed / Risk of Unexposed [a/(a+b)] / [c/(c+d)] AKA: "Odds Ratio" in case-control studies

Patients with IBD; those with familial adenomatous polyposis (FAP)/hereditary nonpolyposis colorectal cancer (HNPCC); and those who have first-degree relatives with adenomatous polyps (< 60 years of age) or colorectal cancer

In which patients do you initiate colorectal cancer screening early?

Incomplete vs. complete abortion - cervical os on physical exam?

Incomplete abortion à open cervical os, complete abortion à closed cervical os

Normal preg. changes: TBG Total and bound T4 and T3 TSH

Increase (2/2 estrogen increase) Increase ((2/2 increased TGB-binding) Decrease (slightly b/c hCG is similar to TSH nad stimulates the thyroid)

Increased urobilinogen is caused by

Increased conjugated bilirubin Ex: Dubin-Johnson, Rotor, hemolytic processes with normal liver

X-ray in PDA Diagnostic murmur

Incresed vascular markings 2/2 L -->R shunt, increased volume in the pulm system MACHINE-LIKE @ 2nd Left ICS!!!

RSV bronchiolitis

Infection of small airways with epidemics in winter and spring.

Heterophile antibodies

Infectious mononucleosis (EBV)

Lichen sclerosus

Inflammation and epithelial thinning of the anogenital area, predominantly in postmenopausal women.

Ulcerative colitis

Inflammatory disease of the colon with ↑ risk of colon cancer.

Tumor marker for Granulosa Cell Tumor

Inhibin

TTP (thrombotic thrombocytopenic purpura) - cause?

Inhibition of enzyme ADAMTS13, a protease that cleaves vWF

Cutaneous anthrax. Treat with penicillin G or ciprofloxacin

Initially presents with a pruritic papule with regional lymphadenopathy and evolves into a black eschar after 7-10 days. Treatment?

Murphy's sign, seen in acute cholecystitis

Inspiratory arrest during palpation of the RUQ.

Why is chromium important?

Insulin requires chromium to function properly

Initial test of choice for dx Acromegaly

Insulin-Like Growth Factor Level (bc does not fluctuate as much as GH)

Acromegaly - dx test; most common cause; imaging modality; tx; describe growth hormone suppression test; which other level should you check in relation to this disease?

Insulin-like growth factor level (GH level fluctuates often); anterior pituitary adenoma; MRI; transsphenoidal resection; measure fasting GH first, then give 75g glucose challenge à GH level one hour later should be < 2 µg/L (glucose suppresses GH therefore acromegaly excluded); prolactin level

Viral drugs - HBV; HCV; EBV

Interferon α-2b, lamivudine, tenofovir; interferon, ribavirin; acyclovir

Study validity - internal vs. external?

Internal validity refers to results applicable to the population being studied, external means the results are relevant to similar populations

Conjugate lateral gaze palsy, horizontal diplopia

Internuclear ophthalmoplegia (damage to MLF; bilateral [multiple sclerosis], unilateral [stroke])

Sarcoidosis - what kind of lung disease; expected spirometry findings?

Interstitial lung disease causing restrictive pattern; FEV1 and FVC are reduced in proportion to each other, FEV1/FVC is either normal or elevated, TLC and VC low

"Honeycomb lung" on x-ray or CT

Interstitial pulmonary fibrosis

Woman presents with straw colored discharge from nipple...likely dx?

Intraductal papilloma

lump, nipple retraction, microcalcifications on mammo...Dx? Tx?

Invasive ductal ca excision, +/- chemo, radiation, and tamoxifen

The patient is a danger to self, a danger to others, or gravely disabled (unable to provide for basic needs)

Involuntary psychiatric hospitalization can be undertaken for which three reasons?

Describe the legions seen in Brown Sequard

Ipsilateral losses: Proprioception, Vibratory sense Contralateral loss: Pain and temp

Erythema multiforme

Iris-like target lesions.

Hypochromic, microcytic anemia

Iron deficiency anemia, lead poisoning, thalassemia (fetal hemoglobin sometimes present)

Pt's dog bit him - tx?

Irrigate w/ saline

Rabies - if you get bit by an animal that you suspect to have rabies, what do you do with it?

Isolate it for 1 week, if it's healthy then it's unlikely to have it

Painless erythematous lesions on palms and soles

Janeway lesions (infective endocarditis, septic emboli/ microabscesses)

Fever, chills, headache, myalgia following antibiotic treatment for syphilis

Jarisch-Herxheimer reaction (rapid lysis of spirochetes results in toxin release)

Rotator cuff pathology (isolates supraspinatus muscle)

Jobe's test aka Empty can test

Osteoarthritis

Joint pain and stiffness that worsen over the course of the day and are relieved by rest.

MCP and PIP joints; DIP joints are spared

Joints in the hand affected in rheumatoid arthritis.

Dark purple skin/mouth nodules in a patient with AIDS

Kaposi sarcoma, associated with HHV-8

Weight gain, type 2 DM, QT prolongation

Key side effects of atypical antipsychotics.

Pseudohypoparathyroidism - what is it; PTH level?

Kidney unresponsiveness to PTH; high PTH

Nodular hyaline deposits in glomeruli

Kimmelstiel-Wilson nodules (diabetic nephropathy)

cholangiocarcinoma that arises at the confluence of the hepatic ducts How is it dx? Tx?

Klatskin tumor Tumor markers CEA and CA19-9 and finding a mass on U/S Tx with surgical resection and or chemo

Red "currant jelly" sputum in alcoholic or diabetic patients

Klebsiella pneumoniae

with maternal hemorrhage, before Rho(D) is given, that should be done?

Kleihauer-Betke test to quantify the severitty of fetal-maternal hemorrhage and determine the dosage of RhoGAM

Hyperphagia, hypersexuality, hyperorality, hyperdocility

Klüver-Bucy syndrome (bilateral amygdala lesion)

[OMM] Splenic dysfunction - chapman point?

L 7th intercostal space

Pt on a mechanical ventilator has his PEEP turned up in the morning, now he has hypotension, distended neck veins, and tracheal deviation to the right - dx; where would you hear diminished breath sounds?

L-sided tension pneumothorax; L side only (NOT both)

Herniation of the intervertebral disc between L2-L3 will affect: C3-C4? T3-T4?

L3 C4 T3

Leg pain on flexion, absent patellar reflex - herniated disc at what level; nerve root injured?

L3-L4; L4

Management of Lobular Carcinoma in Situ

LCIS does not require surgical excision, but should be observed with close follow up

PCOS (polycystic ovary syndrome) - characteristic lab finding; tx?

LH:FSH ratio at least 2:1; OCPs (oral contraceptive pills) +/- spironolactone

↑ serum FSH

Lab values suggestive of menopause.

Sx of Opioid withdrawal

Lacrimation, Rhinorrhea

Mgmt of Hepatic encaphalopathy

Lactulose + Neomycin + Transplantation

SOB, dry cough, bilateral nodules and cysts seen on xray and CT; a/w smoking

Langerhans cell histiocytosis

"Chocolate cysts," powder burns

Laparoscopic findings in endometriosis.

tx for LATENT TB:

Latent TB is treated with isoniazid (INH) and pyridoxine for nine months

[OMM] Prostate Chapman's point?

Lateral & posterior margin of iliotibial band (anterior iliotibial band is colon)

[OMM] Anterior Chpaman's point - eye?

Lateral humerus

Basophilic stippling of RBCs

Lead poisoning or sideroblastic anemia

Causes of left shift in the OBC Causes of right shift in the OBC

Left shifts are caused by blood transfusions (no 2,3 BPG, alkalosis, decreased temperature, fetal Hb, carbon monoxide and metHb. Right shifts in the OBC can be caused by acidosis, increased levels of 2-3-BPG, increased temperatures and high altitude.

Gout, intellectual disability, self-mutilating behavior in a boy

Lesch-Nyhan syndrome (HGPRT deficiency, X-linked recessive)

What is the most common location for peptic ulcers?

Lesser curvature of the stomach (Type I) - Type I: lesser curvature of the stomach - Type II: duodenal ulcer - Type III: prepyloric ulcer - Type IV: procimal gastroesophageal ulcer - Type V: along gastric body

Dementia w/ hallucinations, tremors and rigidity - dx?

Lewy body dementia

Pruritic, purple, polygonal planar papules and plaques (6 P's)

Lichen planus

Neuroleptic malignant syndrome

Life-threatening muscle rigidity, fever, and rhabdomyolysis.

Thrombi made of white/red layers

Lines of Zahn (arterial thrombus, layers of platelets/RBCs)

Most common cause of meningitis in immunocompromised or elderly

Listeria

Used to augment tx when MDD is resistant to monotx with antidepressants

Lithium

Causes of DI

Lithium, Ampho B, Demeclocycline, Hypokalemia, Hypercalcemia

DI

Low urine specific gravity in the presence of high serum osmolality.

Infectious mononucleosis - blood findings; lab finding with high specificity?

Lymphocytosis w/ atypical lymphocytes; heterophile antibody

Chylothraces are most commonly caused by Descripe appearence

Lymphoma Trauma by thoracic surgery white and milky with >110 TGs

Pt presents with extensive FH of various cancers (colorectal/gastric/endometrial) presents with endometrial thickening (bx confirms endometrial cancer) and two adenomas on colonoscopy...Dx?

Lynch Syndrome (Hereditary Nonpolyposis Colorectal Cancer)

Direct techniques

ME, HVLA, Soft tissue

Pancreatic, pituitary, parathyroid tumors

MEN 1 (autosomal dominant)

Thyroid and parathyroid tumors, pheochromocytoma

MEN 2A (autosomal dominant ret mutation)

Thyroid tumors, pheochromocytoma, ganglioneuromatosis

MEN 2B (autosomal dominant ret mutation)

organs involved in MEN I

MEN I: Pancreatic Parathyroid P1tuitary

organs/conditions involved in MEN IIA

MEN II A: (MAPP) Medullary thyroid ca Adrenal hyperplasia PCC Parathyroid

organs/conditions involved in MEN IIB

MEN IIB (think B for Body type: Marfanoid habitus) MMM+P Medullary thyroid ca Marfanoid habitus Mucosal neuromas PCC

Both indirect and direct

MFR and cranial Still's technique: first indirect, then direct

Describe gonococcal arthritis

MIGRATORY polyarthritis and (does not present with ulceration)

First line tx for pertussis

Macrolide (ACE)

Bloody pleural effusion - most common causes?

Malignancy & pulmonary embolism

Eosinophilic cytoplasmic inclusion in liver cell

Mallory body (alcoholic liver disease)

Brain lesion in Korsakoff's psychosis

Mamillary bodies Remember amnesia, confabulation

Pt w/ a wrist burn 30 years ago, never healed, now is associated w/ an ulcer and intermittent oozing - dx?

Marjolin's ulcer (malignant transformation of a chronic wound, esp. burns...usu. squamous cell CA)

Number of deaths during pregnancy to 90 days postpartum per 100,000 live births

Maternal mortality?

Absence seizures

May be seen in children who are accused of inattention in class and confused with ADHD.

Severe RLQ pain with rebound tenderness

McBurney sign (acute appendicitis)

Pt complains of increased morning glucose before eating breakfast and taking insulin - next step; how do you interpret low and high findings?

Measure glucose at 3am; if low à overtreatment (pt will compensate with higher glucose in morning [Somogyi effect])...if high à early morning growth hormone secretion is antagonizing insulin (dawn phenomenon)

MC type of GI bleeding not seen on endoscopy

Meckel's diverticulum

OCPs, danazol, GnRH agonists

Medical options for endometriosis.

vertigo, tinnitus, hearing loss, +/- N/V, fullness in the ear, profuse sweating, nystagmus

Menier's disease

Psammoma bodies

Meningiomas, papillary thyroid carcinoma, mesothelioma, papillary serous carcinoma of the endometrium and ovary

Pneumococcus, meningococcus, H. influenzae. Treat with cefotaxime and vancomycin

Meningitis in infants. Causes? Treatment?

Which benzodiazapenes are safe to use in pts with liver disease?

Metabolism is "Outside The Liver" - Oxazepam - Temazepam - Lorazepam

Tx for Diabetic Gastroparesis

Metaclopromide or Erythromycin

First line DOC for Type II DM?

Metformin

Dx of exercise-induced asthma

Methacholine challenge test (i.e. Bronchoprovocation Test) → if airway is hyperresponsive, pt will develop obstruction when exposed to methacholine

Exercise-induced asthma - dx test?

Methacholine-challenge test (aka bronchoprovocation test)

Parkland formula

Method of calculating fluid repletion in burn patients.

Medications that cause hypothyroidism

Methotrexate, Lithium, Amiodorone

Folate deficiency vs. vit. B12 deficiency - which test to differentiate; which level in common?

Methylmalonic acid (MMA high in B12 def., normal in folate def.); both have increased homocysteine

Diabetic gastroparesis - first line tx?

Metoclopramide

18 y.o. female had uncomplicated birth 2 weeks ago, has trouble lactating, decreased interval between feeds to no avail - tx?

Metoclopramide (dopamine antagonist)

Iron deficiency anemia

Microcytic anemia with ↓ serum iron, ↓ ferritin, and ↑ TIBC.

Neonate (5 days old) presents with bilious vomiting, blood per rectum, abdominal pain...likely dx?

Midgut Volvulus

5 day old w/ green vomiting, no solid particles, bleed per rectum, abd series shows double-bubble sign, upper GI series shows bird's beak - dx?

Midgut volvulus ("bird's beak" = compression/torsion... "double bubble" = duodenal obstruction...duodenal atresia of Trisomy 21 does not have blood per rectum)

Cobb angles in scoliosis tx

Mild: <20-OPP Mod: <20-45-OPP and brace Severe: >45-surgery

Podocyte fusion or "effacement" on electron microscopy

Minimal change disease (child with nephrotic syndrome)

Atypical Depression

Mood reactivity + weight gain, hypersomnia, leaden paralysis, sensitivity to rejection (at least 2)

Mgmt of unstable angina

Morphine, O2, Nitro, ASA, B-blocker, Heparin

Number of deaths per 1000 population

Mortality rate?

Male fetal development - which hormone is responsible: regression internal female genitalia; development male internal genitalia; development male external genitalia?

Mullerian inhibiting substance; testosterone; dihydrotestosterone

Lytic ("hole punched") bone lesions on x-ray

Multiple myeloma

Nystagmus, intention tremor, scanning speech, bilateral internuclear ophthalmoplegia

Multiple sclerosis

55 y.o. male w/ scattered, erythematous patches across the back that has progressed to raised, scaly lesions. Has axillary lymphadenopathy, bx shows abnormal T-cell infiltrates...pic of rash shown: - dx?

Mycosis fungoides (most common type of cutaneous T-cell lymphoma...plaque psoriasis would NOT have lymph node involvement)

[OMM] 2nd intercostal space chapman point - possible structures involved (4 of them)?

Myocardium, thyroid gland, esophagus & bronchi

Cutaneous/dermal edema due to connective tissue deposition

Myxedema (caused by hypothyroidism, Graves disease [pretibial])

Pt presents with signs of meningitis + petechial (pinpoint, nonblanching) rash

N. meningitidis

Physician bills an insurance company, 80% paid by company, 20% is co-pay by pt. Physician waives co-pay - OK to do?

NO (liable for fraud...if pt refuses to pay co-pay, it may be written off and not pursued)

Tx for acute gout

NSAIDs!!

Antidote for TCAs

NaCO3

tx for endometriosis

Nafarelin or lupron (GnRH analogs)

7-10 days

Neutropenic nadir postchemotherapy.

joint space narrowing, thick subchondral bone

OA

Tourette syndrome - comorbidities?

OCD, ADHD, learning disorder, conduct disorder

odds of exposure among patients with a disease compared with odds of exposure among patients without a disease

OR: (A / C) / (B / D) or (A * D) / (B * C

Mgmt of Lobular Carcinoma In Situ

Observation

2 y.o. w/ uncomplicated umbilical hernia - next step?

Observation (until age 4, elective sx at that time)

Carcinoid syndrome w/ unresectable tumors - tx?

Octreotide

Breast feeding - which of the following is a benefit: high IgG, high vit. K, high iron, high vit. D, deceases vaginal bleeding?

Only decreases vaginal bleeding (increases uterine contraction by promoting oxytocin release...breast milk is high in IgA)

Acute viral hepatitis - which ones require anti-viral tx?

Only hepatitis C

Pt presents with brief, painless monocular vision loss (no cherry red macula). Where is the occlusion?

Opthalmic Artery This is amaurosis fugax

26 y.o. pt w/ difficulty hearing in R ear, immobile tympanic membrane, image shown: - tx?

Oral Amoxicillin (AOM)

Dx modality for diverticulitis

Oral and IV contrast CT

Blue sclera

Osteogenesis imperfecta (type I collagen defect)

DEXA T-score for Osteopenia? Osteoporosis?

Osteopenia: -1 to -2.5 Osteoporosis: below -2.5

Continuous "machine-like" heart murmur

PDA (close with indomethacin; open or maintain with misoprostol)

Triple therapy for H. pylori (least resistance) If allergic to macrolides, use ______

PPI, amoxi, clarithromycin (CAP) (Bismuth can replace the PPI or added for Quadruple therapy) PPI, metronidazole, amoxi

probability that a patient with a positive test has a disease

PPV (validity of a positive test)

pencil in cup deformity

PSA

Red, itchy, swollen rash of nipple/areola

Paget disease of the breast (sign of underlying neoplasm)

...

Paget's Disease of the Breast

Osteosarcoma: Si/Sx?

Pain and swelling around the knee Hard, non-mobile mass in prox. tibia/dist. femur "Sunray/sunburst" appearance

Third degree burn - characteristics; tx?

Painless, leathery skin that can be black, white, or cherry red in color; immediate excision and skin grafting

Bronchogenic apical lung tumor on imaging

Pancoast tumor (can compress sympathetic ganglion and cause Horner syndrome)

Primary hyperparathyroidism - most likely cause?

Parathyroid adenoma (85-90%...parathyroid hyperplasia accounts for 10-15%)

Depigmentation of neurons in substantia nigra

Parkinson disease (basal ganglia disorder: rigidity, resting tremor, bradykinesia)

Resting tremor, rigidity, akinesia, postural instability

Parkinson disease (nigrostriatal dopamine depletion)

Parkinson's vs. Alzheimer's - cholinergic tx mechanism?

Parkinson's tx involves blocking ACh (benztropine / trihexyphenidyl) while Alzheimer's increases ACh (donepezil...centrally acting acetylcholinesterase inhibitor)

Shy-Drager syndrome - what is it?

Parkinson-like sxs + autonomic dysfunction

fluid resusitation for burn victims

Parkland formula= %TBSA x weight (kg) x 4 50% given in the first 8 hrs and the remainder within the next 16 hrs

Infant with cleft lip/palate, microcephaly or holoprosencephaly, polydactyly, cutis aplasia

Patau syndrome (trisomy 13)

Emergent laparotomy to repair perforated viscus, likely stomach

Patient presents with sudden onset of severe, diffuse abdominal pain. Exam reveals peritoneal signs and AXR reveals free air under the diaphragm. Management?

Hyperkalemia

Peaked T waves and widened QRS.

Causes of transitional cell bladder ca

Pee SAC: Phenacetin Smoking Aniline dyes Cyclophosphamide (chronic use) diets rich in meat and fat schistosomiasis (haematob.)

Dermatitis, dementia, diarrhea

Pellagra (niacin [vitamin B3] deficiency)

Antidesmoglein (epithelial) antibodies

Pemphigus vulgaris (blistering)

Hamartomatous GI polyps, hyperpigmentation of mouth/feet/hands

Peutz-Jeghers syndrome (inherited, benign polyposis can cause bowel obstruction; cancer risk, mainly GI)

Fibrous plaques in soft tissue of penis

Peyronie disease (connective tissue disorder)

Silver-staining spherical aggregation of tau proteins in neurons

Pick bodies (Pick disease: progressive dementia, changes in personality)

Pityriasis versicolor

Pinkish, scaling, flat lesions on the chest and back. KOH prep has a "spaghetti-and-meatballs" appearance.

Psoriasis - what is Auspitz sign?

Pinpoint bleeding upon peeling of the scale

Pregnant pt presents with vaginal bleeding AFTER 20 weeks. Possible dx?

Placenta Previa, Placental Abruption

esoph web a/w IDA

Plummer-Vinson syndrome

Dysphagia (esophageal webs), glossitis, iron deficiency anemia

Plummer-Vinson syndrome (may progress to esophageal squamous cell carcinoma)

Temporal arteritis - concomitant finding; tx?

Polymyalgia rheumatica (proximal muscle pain); 2 year-course of glucocorticoids and low dose aspirin

HBV immunoglobulin

Post-HBV exposure treatment.

Pt presents with tea-colored urine, oliguria, edema, HTN...UA shows hematuria and mild proteinuria...C3 levels low...URI 10-14 days ago...likely dx?

Post-streptococcal Glomerulonephritis

Anal fissure - most likely location; initial tx?

Posterior midline; warm sitz baths

deposits of IgG and C3 on renal basement membrane on EM (subepi), granular pattern; LOW SERUM C3, may have increased ASO titer; 10 to 14 days post infection

Postinfectious GN (nephritic) "post-step GN"

Glomerulonephritis/nephritic syndrome

Presence of red cell casts in urine sediment.

Lofgren's Syndrome?

Presentation of Sarcoidosis - Hilar lymphadenopathy - Erythema nodosum - Polyarthritis - Fever

Pr presents with high calcium, low phosphate, high PTH...Dx?

Primary Hyperparathyroidism

antimitochondrial Abs, puritis, females, fatigue, a/w other autoimmune diseases

Primary biliary cirrosis

Drugs that can cause SLE

Procainamide, Isoniazid, Hydralazine, Quinidine

Pseudomembranous colitis - fastest test to establish dx?

Proctoscopy (C difficile toxin ELISA usu. takes 24 hrs for results)

β-blockers, Ca2+ channel blockers, TCAs

Prophylactic treatment for migraine.

TOC to prevent esophageal varices from bleeding?

Propranolol

Symptomatic hypertrophic cardiomyopathy - tx?

Propranolol or verapamil

Esophageal varices - medical tx for bleeding prevention; medical tx for active bleeding?

Propranolol; octreotide (also vasopressin but not as effective)

Hyperthyroidism during pregnancy - tx during first trimester; subsequent trimesters?

Propylthiouracil; methimazole

c-ANCA is an antibody in Wegener's granulomatosis - what does it target?

Proteinase-3 (p-ANCA targets myeloperoxidase)

C-ANCA are antibodies against _____

Proteinase-3 (seen in Wegner's: will present with upper and lower resp infection)

Type II RTA

Proximal tubule defect: dec. HCO3- resorption - Low bicarb - Hypokalemia - Common causes: Fanconi's syndrome, multiple myeloma, carbonic anhydrase inhibitor use - Tx: Sodium restriction

Lichen planus - 5 P's that describe this condition?

Pruritic, polygonal, purple, papules and plaques (has white, lace-like appearance due to Wickham's striae)

Rhomboid crystals, positively birefringent

Pseudogout (calcium pyrophosphate dihydrate crystals)

Pt presents with central low back pain after long car ride, stooping forward and leaning to one side...likely dx? Tx?

Psoas Syndrome Tx: Treat upper lumbar spine (innervation of psoas) then the iliopsoas muscle itself

MDD with psychotic features

Psychotic features + 2 weeks of SIG E CAPS

Triple-blinded study - what is it?

Pt, doctor & researcher unaware of which tx pt is being given (double blind is when pt and doctor do not know, but researcher does)

Mirtazapine - what is it used for?

Pts w/ depression and eating disorder (i.e. anorexia, b/c it causes weight gain)

70 y.o. pt w/ SOB and CP w/ following EKG and clean coronary cath - dx?

Pulmonary embolism (S1Q3T3 pattern, sinus tachycardia & RBBB [S wave in lead I, Q and T waves inverted in lead III)

Diamond-Blackfan anemia

Pure RBC aplasia.

Pt w/ pyrosis and globus sensation, negative cardiac work-up - what are those sxs; likely dx?

Pyrosis = heartburn, globus sensation = lump in the throat; GERD

Inferior wall MI is caused by occlusion of

RCA

Mechanism of renal osteodystrophy

RF → dec. GFR → inc. Phosphate → binds Calcium → dec. serum Calcium RF → dec. Calcitriol → dec. GI Calcium absoption

RF for endometrial carcinoma?...protective factors?

RF: Unopposed estrogen, DM, FH of breast/ovarian/endometrial ca, early menarche, late menopause, obesity, tamoxifen PF: OCPs, multiparity, smoking

LEFT parasternal lift is a/w

RIGHT VH

Non-AG hyperchloremic metabolic acidosis, near normal GFR, no diarrhea

RTA (3 types)

Type II (proximal) RTA

RTA associated with abnormal HCO3 − and rickets.

Type IV (distal) RTA

RTA associated with aldosterone defect.

ABG pH 7.22 pCO2 15, HCO3 16, K+ 2.7, Cl- 118, Na+ 135, urine pH 5.0 - RTA type; how to confirm dx?

RTA type II; Bicarb (urine pH continually rises)

4 or more episodes of MDD, mania, hypomania, mixed in 12 months

Rapid-cycling bipolar d/o

Cellular crescents in Bowman capsule

Rapidly progressive crescentic glomerulonephritis

Painful, pale, cold fingers/toes

Raynaud phenomenon (vasospasm in extremities)

Urethritis, conjunctivitis, arthritis in a male

Reactive arthritis associated with HLA-B27

13 y.o. male pt w/ gynecomastia, denies drugs use, thyroid, BUN/Cr normal, increased estradiol - next step?

Reasurance and follow-up in 6 months (gynecomastia is common in pubertal males and will regress - hyperthyroidism, drug use, hypogonadism and renal failure must be ruled out)

Renal clearance equation

Renal clearance = (Urine flow rate x urine concentration X) / plasma concentration X * Urine fr over [plasma] times flow

[OMM] Anterior fibular head - where is restricted motion of fibular head; lateral malleolus?

Restricted posterior; restricted anterior

Pt is in navy and worked at shipyards for 18 yrs, has SOB - dx; what caused it?

Restrictive airway disease; asbestosis on ships

Pt presents with acute, painless monocular vision loss. Fundoscopic exam reveals pale retina with cherry red macula. Where is the occlusion?

Retinal Artery *Ciliary artery supplies macula

Charcot's triad plus shock and mental status changes, with suppurative ascending cholangitis

Reynolds' pentad.

sinusoidal fetal heart rate pattern bradycardia

Rh isoimmunization (severe anemia/hypoxia) congenital heart block

Anti-IgG antibodies

Rheumatoid arthritis (systemic inflammation, joint pannus, boutonnière deformity)

Wtf is Felty's Syndrome?

Rheumatoid arthritis, Neutropenia, Splenomegaly

Acne rosacea - what is the term used to identify a large, red nose; tx?

Rhinophyma (due to soft tissue and sebaceous hyperplasia of the nose); oral tetracycline and metronidazole gel

Opioid withdrawal - sxs

Rhinorrhea, lacrimation, yawning, diarrhea, diated pupils

Pseudogout

Rhomboid-shaped, positively birefringent crystals on joint fluid aspirate.

COMQUEST tool for Visceral Innervation

S 5-9 L 6-9 P 5-11 S 9-11 K 10-11 B 11-2 L 11-2

Most common cause of Otitis Externa

S. aureu, P. aeuriginosa

Antinuclear antibodies (ANAs: anti-Smith and anti-dsDNA)

SLE (type III hypersensitivity)

"Strawberry tongue"

Scarlet fever, Kawasaki disease, toxic shock syndrome

EGD shows circumferential membranous ring in distal esophagus, normal iron - dx; tx; dx if iron deficiency is present?

Schatzki's ring; esophageal dilation; Plummer-Vinson syndrome

Anticentromere antibodies

Scleroderma (CREST)

Sx of Alcohol withdrawal

Seizure

Parkinson's - MAOI tx option?

Selegiline (MAO-B inhibitor so pts do not have to restrict tyramine from their diets)

Extracellular amyloid deposition in gray matter of brain

Senile plaques (Alzheimer disease)

Pt is suspected of having an ectopic preg, however it cannot be visualized via U/S. What labs are consistent with an ectopic in this case?

Serial hCGs that show a plateau or decline

Ovarian tumor causing virilization?

Sertoli-Leydig cell tumor (androgen-secreting)

Most sensitive test for Rhabdomyolysis

Serum CK

Short leg syndrome: short leg side: long leg side:

Short leg side: sacral base is lower on this side, ant innom, lumbar spine ROTATES toward the short leg Long leg side: post innom, lumbar spine SIDEBENDS toward long leg (Lumbar spine: Type I, sidebend away, rotate towards)

Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis

Shortest AP diameter of the pelvis.

α-antagonists (phentolamine and phenoxybenzamine)

Should α- or β-antagonists be used first in treating pheochromocytoma?

Diverticulosis - most common location?

Sigmoid colon (NOT descending colon)

Angina, ST-segment changes on ECG, or ↓ BP

Signs of active ischemia during stress testing.

A patient with chest trauma who was previously stable suddenly dies

Signs of air embolism.

anti-Ro and anti-La are seen in what dz? That are they antibodies to?

Sjogren's syndrom Anti-SSA and Anti-SSB abs

Dry eyes, dry mouth, arthritis

Sjögren syndrome (autoimmune destruction of exocrine glands)

Right bundle branch block - criteria?

Slurred S wave in leads I and V6, rSR' in V1 (and usu. V2)

Histological characteristic of CLL?

Smudge cells

TOC for nephrogenic DI?

Sodium restriction + Thiazide +/- Amiloride and Indomethacin

Membranous GN has what EM pattern? Is a/w _____

Spike and dome with diffuse thickening of membranes and granular immunofluorescence a/w Syph, HBV, HCV, occult malignancy, SLE, malaria, penicillamine and gold salts

hx of cirrhosis, abd pain, fever; paracentesis shows PMNs >250...Dx?....Tx?

Spontaneous Bacterial Peritonitis (SBP) 3rd gen Ceph (Cefotaxime)

Dx? Hx of gardening or thorn puncture, nodular, possibly ulcerated lesion, tender rash on the upper extremity Tx?

Sporotrichosis (Sporothrix schenkii) Itraconazole or Ampho B if disseminated or Itra does not work

Keratin pearls on a skin biopsy

Squamous cell carcinoma

Order of Lymphatic treatments

Start at the thoracic inlet and work away from it: Thoracic inlet Diaphragms (thoracolumbar, pelvic, cranial) Lymphatic pumps Local Lymphatic tx

Pheochromocytoma - proper pre-op preparation?

Start pt on phenoxybenzamine then add propranolol one week before surgery to control blood pressure

Erythema multiforme major - name of syndrome; usual cause; which bug causes; difference between minor?

Stevens-Johnson syndrome; medications; mycoplasma pneumonia; mucous membrane ulceration w/ target lesions

Neuroleptic Malignant Syndrome - tx order?

Stop medication à IV fluids à dantrolene / bromocriptine / amantadine

[OMM] Lasegue's test - what is it?

Straight leg raise test for sciatica

exhalation dysfunction describes a rib that ______

Stuck in exhalation and resists inhalation

Pt presents with h/o seizures and port wine stain on face

Sturge-Weber Syndrome

Pt who recently had a viral infection presents with PAINLESS, diffusely enlarged thyroid gland, dec. TSH, inc. T4...Dx?

Subacute LYMPHOCYTIC Thyroiditis

Reye's syndrome

Sudden onset of mental status changes, emesis, and liver dysfunction after taking aspirin.

DeBakey Classification of Aortic dissections Stanford classification Surgical management:

Summary of DeBakey Classification of Aortic Dissection: Type I: Dissection of ascending and descending thoracic aorta (Stanford type A) Type II: Dissection of ascending aorta (Stanford type A) Type III: Dissection of descending aorta (Stanford type B) Type A usually require surgery Type B usually is tx with medical management (Beta-blockers)

[OMM] Sacral axis - what are they and what are they for?

Superior transverse = craniosacral motion, middle transverse = postural motion, inferior transverse = innominate rotation, oblique = ambulatory (dynamic) motion

Continuous positive airway pressure

Supportive treatment for ARDS.

Constrictive pericarditis w/ edema, JVD, pericardial knock, and ascites - tx; distinguishing features of constrictive pericarditis vs. restrictive cardiomyopathy?

Surgery to remove pericardium; JVD & pericardial knock are present in constrictive pericarditis only

Tx of GIST

Surgical Resection Imatinib (tyrosine kinase inhibitor) if + c-kit mutation

L testicular torsion - tx?

Surgical detorsion of L testicle AND b/l orchiopexy (fixation)

Self-limited, painless vaginal bleeding

Symptoms of placenta previa.

Continuous, painful vaginal bleeding

Symptoms of placental abruption.

cape-like distribution of pain and temp loss and b/l weakness

Syringomyelia

"Butterfly" facial rash and Raynaud phenomenon in a young female

Systemic lupus erythematosus

Normal physiological chages during preg.

Systolic murmur Increased: Blood Vol, HR, CO, SV Decreased: BP, SVR!!!

Hypokalemia

T-wave flattening and U waves.

labs for hemochromatosis

TIBC decreased Transferrin saturation very elevated (iron overload!)

PCP TX

TMP/SMX

Tourette's syndrome is treated with

TYPICAL antipsychotics (Haldol and Fluphenazine)

PT

The coagulation parameter affected by warfarin.

Levodopa/carbidopa

The mainstay of Parkinson's therapy.

Selective IgA deficiency

The most common 1° immunodeficiency.

Pseudomonas

The most common organism in burn-related infections.

Weight loss and OCPs

Therapy for polycystic ovarian syndrome.

Best anti-HTN drug for osteopenia/osteoporosis/kidney stones?

Thiazide

Tx for Nephrogenic DI

Thiazide diuretics +/- amiloride or indomethicin Chlorpropamide (off label)

this class of drugs should be avoided in gout: ____ This type of drug exacerbates gout by_____

Thiazide diuretics aggravate gout by competitively inhibiting the secretion of uric acid

Child has a febrile seizure 2/2 AOM and presents with moderate left arm weakness - dx?

Todd's paralysis

"Egg on a string"?

Transposition of the Great Arteries

AP chest, AP/lateral C-spine, AP pelvis

Trauma series.

Fluids and antibiotics

Treatment of septic shock.

Pt presents with hundreds of adenomatous polyps in colon and CNS tumor...Dx?

Turcot's Syndrome

Abx management of open fractures If allergic to the DOC, give ____

Type I: first gen ceph Type II: first gen ceph Type III: first gen ceph and AMG allergic to ceph: clinda

35 y.o female w/ duodenal ulcer - most common with which blood type; diagnostic test; most common risk factor?

Type O (gastric ulcer most common with A); urea breath test (EGD if > 50 or alarm sxs); H. pylori infxn (NSAID are risk factor for gastric ulcer)

Duodenal ulcers are more common in ________ Gastric ulcers are more common in_______

Type O bloodtype Type A bloodtype

Prerenal

Type of ARF in a patient with FeNa < 1%.

IV penicillin or ampicillin

Typical antibiotics for group B streptococcus (GBS) prophylaxis.

Missed abortion What makes this type different than the others?

U/S shows non-viable pregnancy; No vag bleeding or cpramping; CLOSED cervical os NO BLEEDING!!

Inital work-up of Budd Chiari Tx

U/S shows thrombi in hepatic (hepatic venography is more specific) Tx: thrombolytics, diuretics, anticoagulation

Flex. sig shows friable mucosa, erythema, pseudopolyps, and crypt abscesses...Dx? Tx?

UC 5-ASA, mesalamine, sulfasalasine

Hyperreflexia, hypertonia, Babinski sign present

UMN damage

Treatment of choice for severe Psoriasis

UVB light radiation

Nerve entrapment in Guyon's Canal. Si/Sx?

Ulnar Nerve Entrapment - Decreased adduction/abduction of digits, extension of PIP of 5th digit, opposition of 5th digit - Numbness of 5th digit and ulnar surface of 4th digit - Claw hand

What is the most appropriate initial test for Urolithiasis

Ultrasound

Cause of Variable Decelerations

Umbilical Cord Compression

Endometrial or estrogen receptor- breast cancer

Unopposed estrogen is contraindicated in which cancers?

Management of ectopic preg

Unruptured, <4cm (small) --> MTX >4cm--> Laproscopic surgery with possible salpingectomy or salpingostomy

Tx of psoas syndrome begins with:

Upper lumbar spine, then the psoas muscle itself

Intestinal perforation is expected - initial diagnostic test?

Upright CXR (abdominal x-ray usu. doesn't show domes of diaphragm)

Tx for Stress Incontinence

Urethropexy and/or sling

Incontinence tx - stress; urge?

Urethropexy or sling; oxybutynin (anticholingergic to relax muscle)

Which calculi are radiolucent (i.e. will not show up on Xray)?

Uric Acid and Cystine

How to distinguish hematuria caused by hemolysis vs nephrolithiasis...

Urine microscopy (RBCs = nephrolithiasis, none = hemolysis)

Threatened abortion

Uterine bleeding at 18 weeks' gestation; no products expelled; cervical os closed.

Symptomatic relief of menopause can be tx w/ What drug can exacerbate menopause sx?

Venlafaxin Clonidine Progesterone Raloxefine (SERM)

Adrenal hemorrhage, hypotension, DIC

Waterhouse-Friderichsen syndrome (meningococcemia)

Surgical treatment by tumor location w/in 5 cm on the rectal verge R or L colon Sigmoid and proximal rectum Familial adenopolyposis syndrome

abd perineal resection with permanent colostomy hemicolectomy anterior resection with anastamosis to the rectal stump total colectomy

Painless jaundice with a palpable gallbladder, wt loss,hx of smoking

adenocarcinoma of the head of the panc

low ACTH lvl and high dose dexamethasone suppression test does NOT suppress cortisol

adrenal tumor (Cushing's Syndrome)

tx for HIT

agatroban (processed by the liver) or lepirudin (processed by the kidney) *direct thrombin inhibitors

Antidote for salicylate toxicity

alkalization of urine with NaHCO3

rash seen in pt treated for mono with this drug

amoxi or ampi

how are LMWH levels monitored?

anti-Xa levels

Pap smear interval:

at age 21 and Q3 yrs after

PCP overdose is treated, but not reversed by

benzos

Posterior Chapman's points bladder kidney colon appendix vagina

bladder: TP of L2 kidney: b/w L1 and L2 colon: TP L2-4 appendix: TP 11 on the R vagina: distal to the ischial tuberosity on the posteriomedial thigh

PCWP is low in all types of shock exept:

cardiogenic shock

Beta 2 agonits have ______ effect on the uterus Name 2

cause uterine contracton 1. Terbutaline 2. Ritodrine

An anterior cerebral artery occlusion would result in

contralateral hemiparesis with the leg more affected than the arm

dysmorphic red blood cells or red blood cell casts and proteinuria on U/A, low C3/C4; a/w Hep B and C

cryoglobulinemia

tx for serotonin syndrome

cyproheptadine

Post-op fevers: day 1 day 4 day 5

day 1: atalectasis day 4: UTI day 5: superficial wound infection

labs for leukemoid rxn

elevated leukocyte alkaline phosphatase r/o CML

pathophys of B12 deficincy After gastrectomy or autoimmune After ileal resection:

gastrectomy or pernicious anemia: IF deficiency Ileal resection: Cobalamin malabsorption (B12=Cobalamin)

Risk factors for PROM/PPROM Presentation?

genital urinary infections smoking grand multiparity polyhydramnios previous PROM/PPROM Leakage of pale, yellow fluid prior to labor or prior to 37 wks in PPROM

Order of autonomic tx

gently address the symp chain from T1-L2 (rib raising) Autonomic plexus in the abdomen

HGPRTase deficiency)

gout, self-mutilation, and choreoathetosis.

large ulcerated lesions on the genitalia which are described as "beefy red" with friable granulation tissue; donovan bodies; painless

granuloma inguinale caused by calymmatobacterium granulomatis

PCA occlusion causes

homonymous hemianopsia

Beckwith-Wiedemann syndrome

hyperplasia of many tissues including the pancreas ( --> hypoglycemia) and the tongue; also a/w an omphalocele; this is a syndrome including Wilm's tumor w/ organomagaly

methergine should be avoided in _____

hypertensive pts

SE of oxytocin

hypotention

MCC of and increased or decreased AFP? What is the next test to order?

inaccurate dating! U/S

when should a karyotype be done w/ respect to amenorrhea?

increased FSH in primary amenorrhea

benzo withdrawal sx:

increased body temperature, elevated blood pressure, increased respiratory rate, tachycardia, tremulousness, increased reflexes, seizures, disorientation, aroused level of consciousness or frank delirium, and psychosis

finger placement in the vault hold

index-greater wing of the sphenoid middle-temp bone, preauricular ring finger-mastoid region of the temp bone little finger-squamous portion of the occiput

during craniosacral flxn, the dura ____

is pulled cephalad

endometriosis is dx with ________

laparoscopy

lat malleolus and fib head movement

lat malleolus glides POST, fib head moves ANT (and vis versa)

Vaccine types Live Deactivated/killed Toxoid Conjugate Subunit

live: smallpox, MMR deactivated/killed: Hep A, influenza, cholera, plague, polio, and rabies toxoid: tetanus and diptheria conjugate: Haemophilus influ b subunit: Hep B, HPV

Labs in menopause

low estrogen high FSH, LH, and GnRH

chlamydia trachomatis can cause _____

lymphogranuloma vanereum

other than "the worst h/a of my life", SAH also presents w/

meningial irritation, LOC, photophobia, N/V, diplopia

During craniosacral extention, _____

midline bones extend paired bones internally rotate

when does tardive dyskinesia arise Tx?

months to years after a typical antipsychotic med is initiated switch to an Atypical Antipsychotic

Tx for Zenker's diverticulum Dx is made with __________

myotomy or diverticulotomy Ba swallow

hypercoagulable renal disease

nephrotic syndrome!!!!

mcc of lung ca in non-smokers location w/in the lungs confirmatory tests

non-small cell ca: adenocarcinoma and large cell (*squam cell ca is common in smokiers) periphery bronchoscopy with bx

tx for hyponatremia

normal saline at a rate not in excess of 10mmol/L/24hr or 0.5mEq/L/hr

occipitomastoid sutural restriction is tx with

occipitomastoid suture direct articulatory release

PICA occlusion causes

occlusion can present with ipsilateral facial sensory loss, ataxia, nystagmus, Horner's syndrome, and contralateral loss of temperature and pain

tx for perfed TM

ofloxacin otic

Withdrawal sx: rhinorrhea, lacrimation, yawning, abd. and leg cramping, piloerection, N/V, diarrhea, dilated pupils

opioid withdrawal

pseudofractures or milkman lines are associated with

osteomalacia

increased ALP with normal vit D, calcium, posphate, PTH, and x-rays showing a mosaic pattern: Dx and Tx Initial test and most sensitive test

paget's dz No tx, usually asx X-ray -->radionucleotide bone scan

young healthy pt with intermittent palpitations EKG: narrow QRS tachycardia with p-waves at the terminal portion of the QRS complex...Dx?...Tx?

paroxysmal supraventricuar tachycardia vagal stimulation, block reentry mechanism, if unsuccessful, IV adenosine or verapamil

incomplete abortion

partional expulsion of fetal products, OPEN cervical os

gastritis in a pt with hashimoto's *what should you always consider in pts with autoimmune diseases?

pernicious anemia OTHER autoimmune conditions!!!! they often occur together

Dx of hyperaldosteronism (Algorithm)

plasma ald concentration to plasma renin activity (PAC:PRA) --> if >25, proceed to Na loading tests If PAC is not suppressed <10 --> Primary Hyperaldosteroinsm (Conn syndrome)

test used to dx hemophilia

plasma mixing study: The patients plasma is mixed with normal plasma and if this corrects the PTT a factor deficiency is likely. If the PTT does not correct the patient may have a clotting factor inhibitor.

tx for achalasia (first-line)

pneumatic dilation

Hip, shoulder, and neck pain a/w temporal arteritis

polymyalgia rheumatica

Temporal arteritis is a/w

polymyalgia rheumatica

abd pain, hallucinations, constipation, tachycardia, precipitated by stress, vomiting, urine shows aminolevulinic acid and ______; Dx?

porphobilinogen AIP (no rash!!)

with pronation, the radial head moves ______ with supination, the radial head moves ______

post ant

Indications for labor induction

post-term (42 weeks) maternal or fetal danger chorioamnionitis placental abruption PROM

post partum blues vs depression

postpartum blues: begins and ends within the first 2 weeks postpartum postpartum depression: delayed from 2 weeks to 12 months postpartum

W/u for secondary amenorrhea

preg test, thyroid function, prolactin levles, progestin challenge, E/P challenge, FSH/LH, MRI to r/o pit tumor

cows milk vs human milk prtn, vit K, Fe, and Vit C breastfed babies should be supplemented with:

protein: > in cow's milk, hard on infant kidneys vit K: > in cow's milk Fe: similar, but easier to digest Fe from human milk Vit C: > in human milk supplement Vit D

Ogilvie's syndrome

pseudo-obstruction and dilation of the COLON in the absence of any mechanical obstruction

abd pain after discharge for acute pancreatitis...Dx? Tx?

pseudocyst observation

Transrectal U/S indicated for

pt with asymmetry or hard, nodular prostate on DRE or PSA level >10 or PSA velocity >0.75

DOC for anaphalactic shock

racemic epi

Auspitz sign

removal of scaling causes pinpoint bleeding seen in psoriasis

test to dx vWF tx for hemorrhage

ristocetin cofactor assay cryoppt

measles is aka

rubeola

Blood smear in DIC

schistocytes

renal clearance <GFR, substance is _____ >GFR, substance is _____

secreted absorbed

probability that a screening test will be positive in patients with a disease

sensitivity (% of true positives)

Risk factors for spon pnx

smoking, fam hx, Marfan syn

probability that a test will be negative in patients without a disease

specificity (% of true negatives)

Tx for hereditary spherocytosis

splenectomy with ppx pneumococcal vax

raised, sharply demarcated area of erythema with slowly advancing margins; commonly seen on the face and extremities and follows a bacterial pharyngitis or trauma to the area; "streaking"; orange peel appearance usually caused by ____ seen in pt w/___

strep py (GAS) immunocomp. and pts w/ impaired lymphatic drainage

renal bx in SLE will show

subENDOthelial deposits and thickening of capillaries

guiac positive nipple discharge

surgery for dx and tx

Pregnant moms are tested for GBS during ______

the 3rd trimester

1st and 2nd line tx for lichen sclerosus et atrophicus

topical corticosteroids calcineurin inhibitors, like tacrolimus ointment

Li toxicity

tremulousness confusion dysarthria dystonia hyperreflexia ataxia

Complex regional pain syndrome I vs II

type I: no definable nerve lesion type II: idefinite peripheral nerve injury is present

G6PD vs nephrolithiasis...test to order

urine microscopy: RBCs=stones Hemolysis (blood, no RBCs)=G6PD

prolonged PTT and BT, normal PT Dx? Tx?

vWB DDAVP or desmopressin

Affect of CV4

will enhance the cranial rhythmic impulses

Dx a hemotx with ____________

x-ray

Initial study for osteomyelitis How is treatment monitored?

x-ray, but MRI if it is equivocal (more sensitive, so will rule IN the dx) Follow ESR and CRP(prognostic) (WBC is usually normal!!)

TCA overdose - antagonizes which receptors?

α-1 adrenergic, muscarinic ACh, histamine

"Hair on end" (crew-cut) appearance on x-ray

β-thalassemia, sickle cell anemia (marrow expansion)

Meningitis emperic tx by age: Neonates: Children-teens: Adults Elderly

•Neonates: ampicillin and ceftriaxone •Children to teens: ceftriaxone and vancomycin •Adults: ceftriaxone and vancomycin •Adults >65 years: ceftriaxone, vancomycin, and ampicillin (S. pneumo, N. men, Listeria)

types of open fractures

•Type I: an open fracture with a wound less than 1 cm in length, and clean •Type II: an open fracture with a laceration more than 1 cm in length, without extensive soft tissue damage, flaps, or avulsions •Type III: either an open segmental fracture, an open fracture with extensive soft tissue damage, or a traumatic amputation

Septic or anaphylactic shock

↑ CO, ↓ PCWP, ↓ PVR.

Mycobacterium tuberculosis

↑ risk of what infection with silicosis?

Cardiogenic shock

↓ CO, ↑ PCWP, ↑ PVR.

Hypovolemic shock

↓ CO, ↓ pulmonary capillary wedge pressure (PCWP), ↑ peripheral vascular resistance (PVR).

Analysis of amniotic fluid index

■Oligohydramnios — 0 to <5 cm ■Normal — 5 to 25 cm ■Polyhydramnios — greater than 25 cm

Stippled vaginal epithelial cells

"Clue cells" (Gardnerella vaginalis)

Seborrheic dermatitis. Treat with antifungals

"Cradle cap."

Sx of Axillary nerve injury

- Flat shoulder - Loss of arm abduction

Bullous pemphigoid

- Nikolsky's sign.

Treatment of choice for Endometriosis

- OCPs - NSAIDS - Hgb A1c 7-8.5% → add sulfonylurea - Hgb A1c >8.5% → add insulin

Mgmt of Testicular Mass

- PE, serum markers (bHCG, AFP), US to confirm mass - If suspect cancer → Radical orchiectomy

Things to remember about St. John's Wort

- Potent inducer of cytochrome P450 - Inc. Warfarin metabolism - Used for treatment of mild/mod depression

Major adverse side effect of Trazadone

- Priapism - Sedation

Complications of sleep apnea

- Pulmonary HTN - Systemic HTN - CVA - TIA - MI

Things to remember about Ginko biloba

- Purported to improve memory - Lowers seizure threshold, inc. bleeding diathesis

Infant with non-bilious, projectile vomiting and "olive-shaped" mass in RUQ

- Pyloric Stenosis → functional gastric outlet obstruction 2/2 hypertrophy of pylorus - Dx: Clinical, Ultrasound can confirm - Tx: Surgical Repair

Common complications of Rhabdomyolysis

- Renal Failure/Hyperuricemia - DIC - Compartment Syndrom - Hyperkalemia

RhoGAM should be administered...

- To all Rh negative mothers at 28 weeks - Again within 72 hours of delivery of an Rh+ baby to an Rh- mother - To any Rh(-) pts who have had an ectopic pregnancy, bleeding during pregnancy, amnio, CVS, abortion - **unless dad is also Rh negative!!

What are the unique characteristics of the following TORCH infections: Toxo Syphillis Rubella CMV Herpes

- Toxo: chorioretinitis, ring-enhancing lesions - Syphilis: rash on palms/soles, snuffles, Hutchinson teeth, saddle nose - Rubella: PDA, cataracts, deafness, blueberry muffin rash - CMV: Periventricular calcifications, chorioretinitis, hearing loss - Herpes: (week 1) shock, DIC; (week 2) vesicular skin lesions; (week 3) encephalitis

Mgmt of suspected Rhabdomyolysis

- Vigorous IV fluids - Alkalization of urine with sodium bicarbonate - EKG to check for signs of hyperkalemia

Sx of Radial nerve injury

- Wrist drop

Urine output - minimal guidelines?

0.5 mL/kg/hr or 30 cc/hr

Minimum urine output

0.5 ml/kg/hr or ~30cc/hr

MEN IIa

1 M 2 Ps: Medullary Thyroid Ca, Pheochromocytoma, Parathyroid Tumors

Power of statistical tests - define it; what is it's relation to type I error?

1 minus the risk of a type II error (aka the ability of a test to reject the null hypothesis); direct relationship with type I error (to increase power of a study type I error must increase - there is a tradeoff between type I and II error)

Pregnancy, folic acid recommendation - time period; low-risk dose; high-risk dose?

1 month before pregnancy through 1st trimester; 0.4 mg (400 µg) daily; 4 mg daily

The following measurements can be used by ultrasound to assess gestational age:

1) Biparietal diameter 2) Abdominal circumference 3) Crown-rump length 4) Femur length

Group A strep - how long are you contagious after initiation of abx?

1-2 days

3 ligaments of the lateral ankle: 1, 2, 3 Typing of ankle sprains: Grading system

1. ATF 2. FC 3. PTF Type I: ATF only Type II: ATF and FC Type III: ATF, FC, and PTF Grade I: damage Grade II: laxity Grade III: tear

Pentad of Thrombitoc Thrombocytopenic Purpura

1. Acute renal failure 2. Thrombocytopenia 3. Microangiopathic hemolytic anemia 4. Fever 5. Neurological syndrome *inhibition of ADAMTS13 (protease that cleaves vWF)

Mgmt of pt presenting with Eclampsia

1. Airway management 2. IV magnesium sulfate 3. Betamethasone (if <34 weeks) 4. Delivery (c-section not required)

Workup for suspected SAH

1. CT scan WITHOUT contrast 2. If (-) but still high suspicion, Lumbar puncture (xanthrochromia)

Algorithm for determining the type of RTA

1. Determine RTA: non-AG, hyperchloremic acidosis with near normal GFR and no diarrhea 2. HyperK+? Yes -->RTA IV, if lower, NOT type IV 3. Urine pH <5.5 -->RTA II if not, go to step four 4. Bicarb near normal: RTA I, if Bicarb in decreased (under 24) RTA II

Mgmt of PCOS

1. OCP +/- Spironolactone 2. If OGTT abnormal, add Metformin 3. If desires to become pregnant, add Clomiphene

Pt presents with a thyroid nodule...

1. Order TSH 2. If normal/high → FNA If low → Scintigraphy 3. Hypofunctional → Surgery

Mgmt of Scabies?

1. Permethrin 5% neck down in 2 sessions, 1 week apart 2. Decontaminate bedding/clothing/towels 3 days before treatment by washing in hot water and drying in hot dryer

Describe felty's syndrome

1. RA 2. Neutropenia 3. Splenomegaly

Workup for Pheochromocytoma

1. Urine metanephrine 2. CT/MRI of abdomen 3. Octreotide Scan 4. MIBG Scan

order of drugs for seizures including status epilepticus

1. benzos 2. phenytoin 3. phenobarb

Choledocholithiasis should be treated to prevent these 3 complications: Dx and Tx are with _________

1. pancreatitis 2. secondary sclerosing cholangitis 3. cholangitis Cholecystectomy and ERCP with sphincterotomy

SIRS criteria

1.) temperature less than 36º Celsius or greater than 38º Celsius 2.) greater than 20 breaths per minute or PaCO2 less than 32mmHg 3.) heart rate greater than 90 beats per minute and 4.) WBC count less than 4000 or greater than 12,000.

Number needed to treat

1/abs risk reduction

[OMM] Cranial rhythmic imulse - range; technique to dx craniosacral dysfunction; technique to treat CRI dysfunction?

10-14 cycles/min (CRI can ONLY be in this range...if depressed it is low and MUST be 10); vault hold; bulb decompression (aka CV4)

Pregnant lady - what is normal range of fetal heart rate?

110-160

AFP is only valid during what gestational window?

16 to 18 wks

Congenital Adrenal Hyperplasia - serum test for dx; high or low?

17-hydroxyprogesterone; high (21-hydroxylase is responsible for converting 17-hydroxyprogesterone to 11-deoxycortisol)

flushing, diarrhea, bronchospasm.....lab to order....dx

24-hr urine HIAA Carcinoid tumor

Athlete with polycythemia

2° to erythropoietin injection

Rabies - first time vaccination schedule of doses; postexposure prophylaxis for non-immunized; immunized

4 doses total on days 0, 3, 7, 14; wound cleansing (water, soap, povidine-iodine solution), Rabies immune globulin (injected around wound), 4 doses as described previously; wound cleansing, 2 doses total of vaccine on days 0, 3

Characteristic rash of Lichen Planus

5 Ps: - Pruritic - Polygonal - Purple - Papules/Plaques Wickham's Striae: fine "lace-like" white lines on papules Most common sites: flexor surface of wrist, buccal mucosa, genitals

Tx of UC

5ASA /mesalamine or sulfasalazine

Causes of post-op fever?

5Ws: - Wind (pneumonia) - Water (UTI) - Walk (DVT) - Wound (wound infection) - Wonder Drugs (drug rxn)

In order to make the dx of schizophrenia how long must the sxs be present?

6 months

COPD, cut-offs for long-term O2 therapy - SaO2; PaO2; hematocrit?

< 88%; < 55 mmHg (55-59 if right-sided heart failure or erythrocytosis present); ≥ 55%

Ankle-Brachial index: PVD:

<1.0

LDL Goals

<100: CHD or equivalent (PAD, CAD, DM, AAA) <130: 2+ RF - Age 45+M, 55+F - FH of premature CAD (55 M, 65 F) - HTN - Smoking - HDL <40 <160: 0-1 RF

Pregnant mom has HIV - at what viral load is C-section indicated?

> 1000 copies/mL

Pulsus paradoxus - how many mm Hg difference?

> 12 mm Hg

Spontaneous bacterial peritonitis - paracentesis PMN count; most likely cause; second most likely cause; how do you check response to tx?

> 250 PMN/mm3; E. coli; Klebsiella pneumonia; repeat paracentesis @ 48 hrs, re-culture and reassess neutrophil count

Rubella

A "blueberry muffin" rash is characteristic of what congenital infection?

Non-Hodgkin's lymphoma

A 10-year-old boy presents with fever, weight loss, and night sweats. Examination shows anterior mediastinal mass. Suspected diagnosis?

Conduct disorder

A 13-year-old male has a history of theft, vandalism, and violence toward family pets.

Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension

A 24-year-old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment?

Panic disorder

A 35-year-old male has recurrent episodes of palpitations, diaphoresis, and fear of going crazy.

Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids, O2, analgesia, and "tincture of time"

A 50-year-old man with a history of alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. Management?

Kegel exercises, estrogen, pessaries for stress incontinence

A 50-year-old woman leaks urine when laughing or coughing. Nonsurgical options?

Gout. Needle-shaped, negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid

A 55-year-old man has sudden, excruciating first MTP joint pain after a night of drinking red wine. Diagnosis, workup, and chronic treatment?

Wait, surgical resection, radiation and/or androgen suppression

A 55-year-old man is diagnosed with prostate cancer. Treatment options?

Likely BPH. Options include no treatment, terazosin, finasteride, or surgical intervention (TURP)

A 55-year-old man presents with irritative and obstructive urinary symptoms. Treatment options?

Treat CO poisoning with 100% O2 or with hyperbaric O2 if severe poisoning or pregnant

A burn patient presents with cherry-red flushed skin and coma. SaO2 is normal, but carboxyhemoglobin is elevated. Treatment?

Suspect retinoblastoma

A child has loss of red light reflex. Diagnosis?

Intussusception

A condition associated with red "currant-jelly" stools.

Coarctation of the aorta

A congenital heart disease that cause 2° hypertension.

Subdural hematoma—bridging veins torn

A crescent-shaped hyperdensity on CT that does not cross the midline.

Conflict of interest

A doctor refers a patient for an MRI at a facility he/she owns.

Pulsus paradoxus (seen in cardiac tamponade)

A fall in systolic BP of > 10 mmHg with inspiration.

Cellulitis

A febrile patient with a history of diabetes presents with a red, swollen, painful lower extremity.

Developmental dysplasia of the hip. If severe, consider a Pavlik harness to maintain abduction

A first-born female who was born in breech position is found to have asymmetric skin folds on her newborn exam. Diagnosis? Treatment?

Rett's disorder

A five-month-old girl has ↓ head growth, truncal dyscoordination, and ↓ social interaction.

Hemolytic-uremic syndrome (HUS) due to E. coli O157:H7

A four-year-old child presents with oliguria, petechiae, and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause?

Blast crisis (fever, bone pain, splenomegaly, pancytopenia)

A late, life-threatening complication of chronic myelogenous leukemia (CML).

Contact dermatitis

A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry.

Frotteurism (a paraphilia)

A man has repeated, intense urges to rub his body against unsuspecting passengers on a bus.

Dissociative fugue

A man unexpectedly flies across the country, takes a new name, and has no memory of his prior life.

Lyme disease, Ixodes tick, doxycycline

A middle-aged man presents with acute-onset monoarticular joint pain and bilateral Bell's palsy. What is the likely diagnosis, and how did he get it? Treatment?

CF or Hirschsprung's disease

A neonate has meconium ileus.

Patent ductus arteriosus (PDA)

A newborn female has continuous "machinery murmur."

Postinfectious glomerulonephritis

A nonsuppurative complication of streptococcal infection that is not altered by treatment of 1° infection.

Factitious disorder (Munchausen syndrome)

A nurse presents with severe hypoglycemia; blood analysis reveals no elevation in C peptide.

Herpes simplex

A painful, recurrent vesicular eruption of mucocutaneous surfaces.

Tardive dyskinesia. ↓ or discontinue haloperidol and consider another antipsychotic (e.g., risperidone, clozapine)

A schizophrenic patient takes haloperidol for one year and develops uncontrollable tongue movements. Diagnosis? Treatment?

Iron overload; use deferoxamine

A significant cause of morbidity in thalassemia patients. Treatment?

Sturge-Weber syndrome. Treat symptomatically. Possible focal cerebral resection of affected lobe

A six-year-old girl presents with a port-wine stain in the V2 distribution as well as with mental retardation, seizures, and leptomeningeal angioma.

A patient's family cannot require that a doctor withhold information from the patient

A son asks that his mother not be told about her recently discovered cancer.

Spontaneous pneumothorax. Spontaneous regression. Supplemental O2 may be helpful

A tall white male presents with acute shortness of breath. Diagnosis? Treatment?

Correct metabolic abnormalities. Then correct pyloric stenosis with pyloromyotomy

A two-month-old presents with nonbilious projectile emesis. What are the appropriate steps in management?

Phencyclidine hydrochloride (PCP) intoxication

A violent patient has vertical and horizontal nystagmus.

Depersonalization disorder

A woman who was abused as a child frequently feels outside of or detached from her body.

Duchenne muscular dystrophy

A young child presents with proximal muscle weakness, waddling gait, and pronounced calf muscles.

Absolute indications for hemodialysis

A-metabolic acidosis E-electrolytes: hyperkalemia I-intoxications (methanol, ethylene glycol, Li, ASA) O-overload (hypervolemia, CHF not otherwise managed) U-uremia (uremic pericarditis

First line agent(s) for HTN in diabetic pt

ACE-I (or ARB) + CCB or Diuretic

Anti-mitochondrial antibodies are associated with

AMA is a/w PBC

nephrotoxic drugs

AMGs Ampho B ACEi's Acyclovir Cisplatin Cyclosporine Loop diuretics NSAIDs Tacrolimus

M3

AML subtype associated with DIC.

Neonatal risks of gestational diabetes

ARDS, macrosomia, hypoglycemia (high insulin), hypOcalcemia (low PTH), polycythemia (high EPO, ruddy brown, tremor, priapism), thrombocytopenia, hypOmagnesemia, hypERbilirubinemia (2/2 hemolysis), prematurity, HOCM (high insulin)

Newborn is non-cyanotic, has a systolic pulmonary flow murmur and diastolic rumble...fixed split S2...Dx?

ASD

Abandonment

Abandonment - Medical abandonment results when the caregiver-patient relationship is terminated without making reasonable arrangements with an appropriate person so that care by others can be continued.

Pancreatic CA - most sensitive test; most specific test?

Abdominal CT; ERCP

Amyloidosis - screening test?

Abdominal fat pad bx

What is Placenta accreta? Major RF? Tx?

Abnormal attachment of placenta to the uterine wall. RF: Placenta Previa, previous C-Section Tx: Prior to delivery, scheduled C-Section + Hysterectomy; after delivery, embolization and/or hysterectomy

Osteoarthritis - long-term tx of choice?

Acetaminophen (no > than 4 g/day, chronic NSAID use causes GI side effects)

Hypoxia and hypocarbia

Acid-base disorder in pulmonary embolism.

Respiratory alkalosis

Acid-base disturbance commonly seen in pregnant women.

Branching gram-positive rods with sulfur granules

Actinomyces israelii

fever, rash, eosinophilia, wbc casts, eosinophiluria; may have hx of recent medication usage Dx? Labs?

Actute interstitial Nephritis (Tubulointerstitial neph) BUN:Cr ratio <20 UNa >40 FeNa >2% (intrinsic renal path) UOsm <350 HyperK+ ******Eosinophilia******

RBC casts in urine

Acute glomerulonephritis

45 y.o. female w/ intermittent RLQ pain, muscle weakness, and hallucinations. UA reveals high aminolevulinic acid - dx?

Acute intermittent porphyria (unlike most other porphyria does not have a rash)

severe, acute periumbilical pain with a benign abd exam

Acute mesenteric ischemia

Red "currant jelly" stools

Acute mesenteric ischemia (adults), intussusception (infants)

Henoch-Schonlein purpura has palpable purpura on the buttocks - associated problem?

Acute nephropathy

WBC casts in urine

Acute pyelonephritis

HUS - triad of sxs; what changes for TTP?

Acute renal failure, thrombocytopenia, microangiopathic anemia; add fever and neurological sxs to previous 3 sxs

Renal epithelial casts in urine

Acute toxic/viral renal injury

Skin hyperpigmentation, hypotension, fatigue

Addison disease (1° adrenocortical insufficiency causes Increased ACTH and increased α-MSH production)

hyperpigmentation, hyponatremia, hyperkalemia

Addison's disease (primary hypoadrenalism)

Edrophonium

Administer to a symptomatic patient to diagnose myasthenia gravis.

Adoption study vs. twin concordance study - what's the difference?

Adoption study looks at genetic and environmental factors; twin concordance study only looks at genetic factors

W/o tapering glucocorticoids, pt will present with

Adrenal insufficiency: HoTN, hypoglycemia, hypocortisolism, ACTH will be low and remember, aldosterone is NOT affected may also have wt loss, N/V, weakness, abd pain, arthralgia

Tests for TOS

Adson's Wright's

Pancreatitis - Ranson's criteria upon admission?

Age > 55, WBC > 16,000, glucose > 200, AST > 250, LDH > 350

Guidelines for Pneumovax

All persons aged 65 y/o and older should receive a one time pneumococcal vaccination Booster is recommended if the pt received the vaccine >=5 years previously and was age <65y/o at time of vaccination *One time dose for Diabetic patients at time of diagnosis

Young, non-smoker presents with si/sx of COPD...FH of emphysema and liver failure...dx?

Alpha-1-antitrypsin deficiency

Antidote for tPA

Aminocaproic acid

Anemia of chronic disease vs. thalassemia - iron panel differences?

Anemia of chronic disease has low iron & TIBC, while thalassemia has normal iron & TIBC

Chest pain on exertion

Angina (stable: with moderate exertion: unstable: with minimal exertion

3 y.o. child w/ Wilms tumor - associated findings?

Aniridia, GU malformations, mental retardation

"Bamboo spine" on x-ray

Ankylosing spondylitis (chronic inflammatory arthritis: HLA-B27)

Familial adenomatous polyposis - when should you start screening a pt; what percent get colorectal CA?

Annual colonoscopy or flexible sigmoidoscopy starting at puberty; 100%

40 y.o. pt newly dx'ed w/ type II diabetes - vaccine(s)?

Annual influenza & pneumococcal vaccine today (diabetics have increased morbidity w/ pneumonia)

Ribs and associated mm. to engage during tx

Anterior scalene: rib 1 Middle scalene: rib 1 Posterior scalene: rib 2 Pectoralis minor: ribs 3-5 Serratus anterior: ribs 2-8 Latissimus dorsi: ribs 9-12 Quadratus lumborum: rib 12

[OMM] Inversion sprain - talus dysfunction?

Anterior talus (when the ankle plantar flexes, the talus glides anterior)

Compartment syndrome most commonly occurs in what compartment of the leg? What are the major contents of this compartment?

Anterior! Tibialis anterior, extensor hallicus longus, anterior tibial arter, deep fibular nerve

ACEI

Antihypertensive for a diabetic patient with proteinuria.

Systolic ejection murmur (crescendo-decrescendo)

Aortic valve stenosis

Parvovirus B19

Aplastic crisis in sickle cell disease.

Apley's test Bounce home test Lachman's test Ober's test

Apley's compression test evaluates meniscus and ligamentous structures of the knee. The bounce home test is also used to evaluate mechanical injury of the knee, specifically with full knee extension. Lachman's test assesses the stability of the ACL and is more accurate than the anterior drawer test. Ober's test is used for detecting tightness in the tensor fascia lata and iliotibial band.

How is B12 deficiency distinguished from folate deficiency

B12 def: increased methylmelonic acid and neurologic sx affecting the LE Folate def: MMA is not affected *Both will have increased homocystein levels

Intrinsic renal failure - labs?

BUN/Cr < 20:1, urine sodium > 40 mEq/L, FENa > 2%, urine osmolality < 350 mosm/kg (> 500 if pre-renal)

Pre-renal due to septic shock - urinary lab findings?

BUN/Cr > 20; FE Na < 1%; Urine Na < 20

Battery

Battery - Medical battery can be defined as an intentional act on the part of the caregiver to fail to respect a patient's advance directive.

Muffled heart sounds, distended neck veins, hypotension

Beck triad of cardiac tamponade

Hypotension, distant heart sounds, and JVD

Beck's triad for cardiac tamponade.

Slow, progressive muscle weakness in boys

Becker muscular dystrophy (X-linked missense mutation in dystrophin; less severe than Duchenne)

Neonate w/ hemihypertrophy - dx; likely lab finding?

Beckwith-Wiedemann syndrome; hypoglycemia soon after birth

≤ 200 for PCP (with TMP); ≤ 50-100 for MAI (with clarithromycin/azithromycin)

Begin Pneumocystis carinii pneumonia (PCP) prophylaxis in an HIV-positive patient at what CD4 count? Mycobacterium avium-intracellulare (MAI) prophylaxis?

Meniere's dz - acute tx; chronic tx?

Benzodiazepine or meclizine; diuretic & low salt

Tx for akathisia

Benzos, beta blockers are 2nd line

Pt presents with tea-colored urine, oliguria, edema, HTN...UA shows hematuria and mild proteinuria...C3 levels normal...URI 2 days ago...likely dx?

Berger's Disease (IgA Nephropathy)

Hx of working the in the metal, nuclear power, electronics industry with wt loss, fever, cough, DOE....Dx? X-ray findings

Berylliosis Bilateral hilar adenopathy

Bladder rupture or urethral injury

Blood in the urethral meatus or high-riding prostate.

Distal radius (Colles' fracture)

Bone is fractured in fall on outstretched hand.

Tetralogy of Fallot - CXR finding?

Boot-shaped heart

Breach of duty

Breach of duty - A failure to maintain the duty that the physician owes to the patient, deviating from the "standard of care".

Lobular carcinoma in situ

Breast cancer type that ↑ the future risk of invasive carcinoma in both breasts.

Paget's disease

Breast malignancy presenting as itching, burning, and erosion of the nipple.

29 y.o. female complains of 2 cm mass in her R breast that is round and mobile - next step?

Breast ultrasound (pt is < 30, if > 30 then mammogram...if cystic then aspirate, if solid like fibroadenoma observe, if solid and suspicious bx)

2 y.o. child didn't get a toy from the store, began crying, became cyanotic and lost consciousness - dx; next step?

Breath-holding spell (usu. 2-8 yr olds); reassure

Hexagonal, double-pointed, needle-like crystals in bronchial secretions

Bronchial asthma (Charcot-Leyden crystals: eosinophilic granules)

35 y.o. pt h/o severe "lung infection" as child that required hospitalization, has progressive cough w/ green sputum, CXR shows hyperinflation and ill-defined pulmonary nodules - dx; next step?

Bronchiectasis; high-resolution CT (will see dilated airways and ballooned cysts)

The dura is attached to the cranium at these landmarks:

C2, C3, S2 (post, sup), foramen magnum

Hypochondriasis - tx?

CBT + regular visits to primary care physician

Chronic lymphocytic leukemia - which CD receptor will you find on the cells?

CD5

smudge cells goes with CD___ and in this disease

CD5 CLL

Cavernous sinus - cranial nerves that pass through it; first nerve usu. affected?

CN III, IV, V1, V2 & VI; VI (b/c it floats freely while others are attached to the wall)

Initial diagnostic test for Boerhaave's Syndrome

CXR → pneumomediastinum

Prolactinoma failed tx with bromocriptine - next tx; tx after that if it fails?

Cabergoline (another dopamine receptor agonist); transsphenoidal pituitary surgery

What is Beck's Triad

Cardiac Tamponade - Hypotension - JVD - Distant heart sounds *Also remember, Pulsus Paradoxicus and Electrical Alternans

Which type of study is good for studying rare diseases?

Case-control study

Neither

Case-control study—incidence or prevalence?

Surfactant deficiency

Cause of neonatal RDS.

INH, penicillamine, hydralazine, procainamide

Causes of drug-induced SLE.

Refinement of treatment for N. meningitidis

Ceftriaxone + Vancomycin + Rifampin OR Ciprofloxacin to close contacts (*steroids do not reduce morality...however they are useful in S. pneumo and HIB)

Child's teeth eruption - sequence?

Central incisorsà lateral incisors à 1st molars à canines à 2nd molars

Which type of DI responds to vasopressin? Urine osmolarity will ______

Central responds, Nephrogenic does not Increase with vasopressin in central DI

[OMM] Facet joints - cervical, thoracic, lumbar?

Cervical à BUM (backwards/upwards/medial), thoracic à BUL (backwards/upwards/lateral), lumbar à BUM (these apply to superior facet joints...opposite for inferior facets)

Age &gt; 45-50 years; lesions new or larger in comparison to old films; absence of calcification or irregular calcification; size &gt; 2 cm; irregular margins

Characteristics favoring carcinoma in an isolated pulmonary nodule.

Arthralgias, migratory polyarthropathies, Bell's palsy, myocarditis

Characteristics of 2° Lyme disease.

RUQ pain, jaundice, and fever/chills in the setting of ascending cholangitis

Charcot's triad.

Neonate develops conjunctivitis within the first 24 hours of life...

Chemical Conjunctivitis - Usually 2/2 Erythromycin drops - Tx: Reassurance + saline flush

Oscillating slow/fast breathing

Cheyne-Stokes respirations (central apnea in CHF or (increase) intracranial pressure)

Neonate develops conjunctivitis at 5-14 days

Chlamydial Conjunctivitis - + Mucopurulent dc and palpebral erythema - Tx: Oral +/- Topical Erythromycin

27 y.o. female w/ suicidal ideation and a plan was sexually abused 16 years ago has intrusive memories and nightmares plus hypervigilance - dx; tx?

Chronic PTSD (post-traumatic stress disorder); Inpatient admit due to suicidal behavior (PTSD can be tx w/ SSRI and desensitization-exposure psychotherapy)

Thyroid-like appearance of kidney

Chronic bacterial pyelonephritis

Higher prevalence

Chronic diseases such as SLE—higher prevalence or incidence?

"Waxy" casts with very low urine flow

Chronic end-stage renal disease

"Sawtooth" P waves

Classic ECG finding in atrial flutter.

Rib notching

Coarctation of the aorta

Periosteum raised from bone, creating triangular area

Codman triangle on x-ray (osteosarcoma, Ewing sarcoma, pyogenic osteomyelitis)

"Apple core" lesion on abdominal x-ray

Colorectal cancer (usually left-sided)

Pneumatura - likely cause?

Colovesical fistula

ALS

Combined UMN and LMN disorder.

Complete mole

Complete mole: Diploidy/Daddy's girl 46 chromosomes(all paternal) feal tissue absent choriocarcinoma risk 2 % all of chorionic villi are hydropic (edematous)

Central pontine myelinolysis

Complication of overly rapid correction of hyponatremia.

Wtf is Prune Belly Syndrome?

Congenital disorder that affects primarily males - Bulging, thin, wrinkled abdomen - Renal dysplasia, dilated ureters, enlarged bladder - Crytorchidism - Pulmonary hypoplasia - Cardiac/GI abdnormalities

Hypertension, hypokalemia, metabolic alkalosis

Conn syndrome

Infant with hypoglycemia, failure to thrive, and hepatomegaly

Cori disease (debranching enzyme deficiency) or Von Gierke disease (glucose-6-phosphatase deficiency, more severe)

Rash on palms and soles

Coxsackie A, 2° syphilis, Rocky Mountain spotted fever

How to secure airway in pt with multiple facial fractures?

Cricothyroidotomy

Congenital disorder causing unconjugated hyperbilirubinemia

Crigler-Najjar Syndrome - I: No UGT1A1, fatal without transplant - II: Very decreased UGT1A1, AD inheritence Gilber's Syndrome (UGT1A1 only 30% active)

Severe jaundice in neonate

Crigler-Najjar syndrome (congenital unconjugated hyperbilirubinemia)

Pleural/serum protein > 0.5; pleural/serum LDH > 0.6

Criteria for exudative effusion.

Prevalence

Cross-sectional survey—incidence or prevalence?

Most common cause of meningitis in AIDS with CD4 <100

Cryptococcus

2nd degree burn gives off a blue/green discharge with a fruity odor 2 weeks later - test to identify organism?

Culture and sensitivity (pseudomonas aeruginosa)

hypomania and mild depression alternating

Cyclothymic d/o

TOC for Tardive Diskinesia

DC current med, switch to clozapine

Symptoms of Mania

DIG FAST - Delusions/Distractibility - Insomnia - Grandiosity/Goal-directed - Flight of ideas - Agitation/increased Activity - Sexual risk-taking - Talkative/pressured speech

Pt w/ celiac disease develops dermatitis herpetiformis - tx for dermatitis?

Dapsone

Treatment for dermatitis herpetiformis (puritic!!) Cause of rash

Dapsone and gluten free diet Caused by C' activation due to IgA-gluten formations

Increased AFP in amniotic fluid/maternal serum

Dating error, anencephaly, spina bifida (neural tube defects)

Post-surgical fever differential:

Day 1: atelectasis (wind) Day 3: UTI (water) Day 5: DVT (walking) Day 7: Surgical site (wound) Late: drug rxn, infections a/w IV lines (wonder rx, work site)

Mgmt of narcolepsy (daytime sleepiness, hypnagogic/hypnopompic hallucinations, cataplexy)

Daytime sleepiness: Modafinil Cataplexy: Venlafaxine or fluoxetine

Factitious hypoglycemia (i.e. exogenous insulin) - lab findings?

Decreased C-peptide, decreased proinsulin, increased insulin, anti-insulin antibodies

Asbestosis - DLCO finding?

Decreased DLCO (carbon monoxide diffusing capacity...decreased total lung area means less oxygen diffusion)

Often the first manifestation of asbestosis...

Decreased DLCO (carbon monoxide diffusion capacity)

BP > 140/90 on three separate occasions two weeks apart

Definition of hypertension.

Angina is new, is worsening, or occurs at rest

Definition of unstable angina.

Major Depressive Disorder - dx criteria

Depressed mood or anhedonia (for 2 weeks) + 4 of SIGE CAPS (sleep, interest, guilt, energy, concentration, appetite, psychomotor agitation, suicidality)

Celiac disease - associated skin lesion; associated antibody tests?

Dermatitis herpetiformis; anti-gliadin, anti-transglutaminase & anti-endomysium

Varicella zoster

Dermatomal distribution.

Somatostatinoma - sxs?

Diabetes mellitus, diarrhea/steatorrhea, cholelithiasis, hypochlorhydria, and weight loss

HIDA scan

Diagnostic modality used when ultrasound is equivocal for cholecystitis.

Endometrial biopsy

Diagnostic step required in a postmenopausal woman who presents with vaginal bleeding.

Mallory-Weiss—superficial tear in the esophageal mucosa Boerhaave—full-thickness esophageal rupture

Difference between Mallory-Weiss and Boerhaave tears.

Most common location for Crohn's dz?

Distal ileum

Fractures - where are they located: Colle's, Boxer's, Monteggia's, Galeazzi's, Nightstick?

Distal radius; 5th metacarpal; proximal ulna; proximal radius; ulnar shaft

Type I RTA

Distal tubular defect: dec. H+ secretion - Urinary pH > 6.0 - Hypokalemia - Predisposition for nephrolithiasis - Common causes: Sjogren's, SLE - Tx: Sodium Bicarbonate

How to Dx BPPV

Dix-Hallpike Maneuver

Restless leg syndrome - first line tx; common mineral deficiency that can cause it?

Dopamine agonist (pramipexole, bromocriptine, levodopa/carbidopa); iron deficiency

Single palmar crease

Down syndrome

Antihistone antibodies

Drug-induced SLE (hydralazine, INH, phenytoin, procainamide)

β-blockers, digoxin, calcium channel blockers

Drugs that slow AV node transmission.

Congenital disorder causing conjugated hyperbilirubinemia

Dubin-Johnson Sydrome (dark liver, gallbladder cannot be visualized, normal urine corproporphyrin, 80% corproprphyrin I) Rotor Syndrome (normal liver, gallbladder visualized, elevated total coproporphyrin, 80% coproporphyrin III)

Antidepressent that can also be used for diabetic neuropathy

Duloxetine

Fibromyalgia - tx?

Duloxetine or amitriptyline (SNRI or TCA)

Pt presents with abdominal pain and watery diarrhea after two-week course of clindamycin...Dx? Most rapid test? Diagnostic test? Tx?

Dx: C. difficile colitis Most rapid test: Proctoscopy Most accurate test: C. diff toxin ELISA Assay Tx: Metronidazole

Pt with breast/lung cancer presents with nausea, vomiting, confusion, fatigue, muscle weakness; labs show hypercalcemia...likely dx? Mgmt?

Dx: Hypercalcemic Crisis Mgmt: IV Fluids (NS until euvolemia) → Diuresis (furosemide) → Calcitonin → Hemodialysis → Bisphosophonates (for chronic management)

Pt s/p total thyroidectomy presents with perioral numbness, tingling of fingers, muscle cramps...likely dx? Mgmt?

Dx: Hypocalcemia due to devascularization or inadvertent removal of parathyroid glands Mgmt: - Mild, oral calcium carbonate - Refractory, add calcitriol - Life threatening, IV calcium gluconate

Alcoholic presents with ataxia, confusion, horizontal nystagmus/double vision...Dx? Tx?

Dx: Wernicke's encephalopathy Tx: Thiamine Remember triad ACE (ataxia, confusion, eye problems)

ST-segment elevation (depression means ischemia), flattened T waves, and Q waves

ECG findings suggesting MI.

Syncope - initial test for ALL pts; likely cause for someone shaving or wearing tight-collared shirts?

ECG; carotid sinus hypersensitivity (vagal overactivity)

INITIAL test for any type of syncope:

EKG!!!!!!!!!!!!!!!!!!!!!!!!! Diagnostic test will be more sx specific

Withdreawal sx: seizures

ETOH

Statistic - what is lead-time bias; what is Pygmalion effect?

Early detection leading to a false sense of increased survival; researcher's belief in tx affects the results

Buproprion is contraindicated in pts with

Eating disorders

Polished, "ivory-like" appearance of bone at cartilage erosion

Eburnation (osteoarthritis resulting in bony sclerosis)

Renal artery stenosis, coarctation of the aorta, pheochromocytoma, Conn's syndrome, Cushing's syndrome, unilateral renal parenchymal disease, hyperthyroidism, hyperparathyroidism

Eight surgically correctable causes of hypertension.

↓ Ca2+ , ↑ K− , ↑ phosphate, ↑ uric acid

Electrolyte changes in tumor lysis syndrome.

RCC or other erythropoietin-producing tumor; evaluate with CT scan

Elevated erythropoietin level, elevated hematocrit, and normal O2 saturation suggest?

Eustachian tube dysfunction tx (OMM)

Engage the temporal bone with V spread of the occipitomastoid suture

Allergic interstitial nephritis

Eosinophils in urine sediment.

Higher incidence

Epidemics such as influenza—higher prevalence or incidence?

Pt presents with testicular pain, testicular swelling and T 101.5F...likely dx? Tx?

Epididymitis - If <35 think CHL (#1), GC (#2) → azythromycin + ceftriaxone - If >35 think E. coli → ciprofloxacin

Lucid interval after traumatic brain injury

Epidural hematoma (middle meningeal artery rupture)

"Thumb sign" on lateral x-ray

Epiglottitis (Haemophilus influenzae)

How to Tx BPPV

Epley Maneuver

Neonate with arm paralysis following difficult birth

Erb-Duchenne palsy (superior trunk [C5-C6] brachial plexus injury: "waiter's tip")

Circumferential burn - tx?

Escharotomy

Dysphagia that progresses from solids to liquids - dx; next step

Esophageal CA; upper endoscopy (achalasia has solid and liquid dysphagia from the beginning - requires barium swallow)

risk factors for acute pancreatitis MCC of pancreatitis is _____

Estrogens, hypertriglyceridemia, diabetes, and alcohol gallstones

Hospitalized pt presents with decreased TSH, decreased T3, normal T4...likely dx?

Euthyroid Sick Syndrome

Abdominal ultrasound and CT

Evaluation of a pulsatile abdominal mass and bruit.

"Onion skin" periosteal reaction

Ewing sarcoma (malignant round-cell tumor)

Mgmt of Ductal Carcinoma In Situ

Excision with post op Radiation

Most common cause of Cushing's syndrome

Exogenous steroids

Graves' disease

Exophthalmos, pretibial myxedema, and ↓ TSH.

Squamous cell carcinoma

Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer.

Tx for a subluxed radial head (nursemaid's elbow)

FLXN of the elbow to 90 degrees while SUPINATING the forearm

Indirect techniques

FPR, CS, BLT/LAS

Triglyceride accumulation in liver cell vacuoles

Fatty liver disease (alcoholic or metabolic syndrome)

Mammary gland ("blue domed") cyst

Fibrocystic change of the breast

Tabes dorsalis, general paresis, gummas, Argyll Robertson pupil, aortitis, aortic root aneurysms

Findings in 3° syphilis.

work up for a thyroid nodule

First TSH, if N or high (hypothyroid), then do an FNA If TSH is low (hyperthyroid), do a scintography/radioactive iodine thyroid scan --> hot or cold (more suspicious for cancer)

Establish the ABCs

First step in the management of a patient with acute GI bleed.

IV benzodiazepine

First-line medication for status epilepticus.

SSRIs

First-line pharmacotherapy for depression.

IV hydration and loop diuretics (furosemide)

First-line treatment for moderate hypercalcemia.

Thrust of Rib HVLA

For Inhaled Ribs: directly downwards For Exhaled Ribs: 45 degrees cephalad

TICS—Thalassemia, Iron deficiency, anemia of Chronic disease, and Sideroblastic anemia

Four causes of microcytic anemia.

Asymmetry, border irregularity, color variation, large diameter

Four characteristics of a nevus suggestive of melanoma.

Patient on dopamine antagonist

Galactorrhea, impotence, menstrual dysfunction, and ↓ libido.

Uterine fibroids - medical tx; surgical tx; which type of fibroid can lead to infertility?

GnRH agonist (NOT OCP b/c they have estrogen/progestin receptors so they will grow); myomectomy or hysterectomy (depending on childbearing plans); submucosal fibroid

< 7.0

Goal hemoglobin A1c for a patient with DM.

Neonate develops conjunctivitis at 2-5 days

Gonorrheal Conjunctivitis - + Purulent dc - Tx: IM ceftriaxone + Topical Erythromycin

Linear appearance of IgG deposition on glomerular basement membrane

Goodpasture syndrome

Necrotizing vasculitis (lungs) and necrotizing glomerulonephritis

Granulomatosis with polyangiitis (Wegener; PR3-ANCA/c-ANCA) and Goodpasture syndrome (anti-basement membrane antibodies)

Most common cause of wound infection within 24 hours of surgery

Group A Streptococci Clostridium spp

Surgical site infection w/in 24 hours of operation - most likely organism; only other bug?

Group A streptococci; clostridium spp. (they can infect w/ low bacterial loads [less than 105]...strep will have erythema, pain, and wound fluild w/ WBCs...clostridium will have severe pain out of proportion to other findings, brackish fluid lacking WBCs b/c exotoxins lyse them)

Ascending paralysis with minimal sensory change in a child who received the flu vaccine a week ago - dx; tx?

Guillain-Barre syndrome; IVIG and plasmapheresis, if diaphragm involved use intubation

Rapidly progressive leg weakness that ascends following GI/upper respiratory infection

Guillain-Barré syndrome (acute autoimmune inflammatory demyelinating polyneuropathy)

epiglotitis is usually caused by

H. influ

Trichomonas puts pts at greater risk for

HIV

14 y/o with palpable pupura, abd pain, arthritis- Dx? Renal Bx will show

HSP Mesangial deposits of IgA

Rotator cuff tendonitis/shoulder impingement

Hawkins, Neer's

Diabetes Mellitus type II, already taking metformin - at what HbA1C should sulfonylurea be started; insulin?

HbA1C 7-8.5%; > 8.5%

[OMM] Thoracic muscle energy - which part of the body are you using as a lever?

Head for T1-T4 & torso for T5-T12

6 month old w/ CMV infection - characteristic findings?

Hearing loss & cerebral calcifications

Miliaria - aka; sx difference vs. folliculitis?

Heat rash; folliculitis is itchy, miliaria is stinging (involves covered areas in a humid environment)

Heat stroke vs. heat exhaustion - difference?

Heat stroke has high body temperature, cutaneous vasodilation, and altered mental status, heat exhaustion does not

first time PE should be tx with

Heparin, then coumadin for 3-6 months (90-180 days)

Female of reproductive age who has been using OCPs has a hepatic tumor. Likely dx?

Hepatic Adenoma - Benign, associated with OCPs, anabolic steroids, and glycogen storage dz - Surgical resection if symptomatic

Adult polycystic kidney disease - associated complications?

Hepatic cyst, intracerebral aneurysm, thoracic aortic aneurysm

Mechanism of renal damage in cirrhosis pt?

Hepatorenal Syndrome Cirrhosis → Portal HTN → Splanchnic Vasodilation → Dec. Effective Circulatory Volume → Activation of Renin-Angiotensin-Aldosterone System → Renal Vasoconstriction

Alcoholic pt with liver failure has a creatinine of 2.7 mg/dL, 3 months ago it was 1.1 mg/dL - dx; tx?

Hepatorenal syndrome (Renal artery vasoconstriction 2/2 liver disease); liver transplant

[OMM] Singultus - what is it; omm tx?

Hiccups; myofascial diaphragm release

Why is Lindane not used for Scabies

Higher association with neurotoxicity

Suspect ankylosing spondylitis. Check HLA-B27

Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?

Pt presents with enlarged cervical/supraclavicular lymph node that becomes painful with alcohol consumption

Hodgkin's Lymphoma

65 y.o. female with a mass in her neck that is painful while drinking alcohol, CXR shows mediastinal lymphadenopathy, CT shows spleen involvement, bx of lymph node shows the following image: - dx; stage; tx?

Hodgkin's Lymphoma, Stage III (Stage I = 1 lymph node, Stage II = 2 or more nodes on same side of diaphragm [above or below], Stage III = both sides of diaphragm including one organ or area near the lymph nodes or spleen, Stage IV = extralymphatic tissue [liver, bone, lungs]), chemotherapy (Stage I/II = radiation, Stage III/IV = chemotherapy)

COPD - which tx increases survival?

Home oxygen therapy & smoking cessation

Circular grouping of dark tumor cells surrounding pale neurofibrils

Homer-Wright rosettes (neuroblastoma, medulloblastoma, retinoblastoma)

Impetigo

Honey-crusted lesions.

Diffuse interstitial pulmonary fibrosis. Supportive care. Steroids may help

Honeycomb pattern on CXR. Diagnosis? Treatment?

Ptosis, miosis, anhidrosis

Horner syndrome (sympathetic chain lesion)

Ultrasound

How to diagnose and follow a leiomyoma.

Both have ↑ hematocrit and RBC mass, but polycythemia vera should have normal O2 saturation and low erythropoietin levels

How to distinguish polycythemia vera from 2° polycythemia.

Chorea, dementia, caudate degeneration

Huntington disease (autosomal dominant CAG repeat expansion)

Newborn with insufficient surfactant - name of disease?

Hyaline membrane disease

Drug-induced lupus - 4 common drugs; test to confirm?

Hydralazine, procainamide, isoniazid, quinidine; anti-histone antibodies (100% sensitive)

First line agent for HTN in non-diabetic pt

Hydrochlorothiazide

Lactose intolerance - dx test?

Hydrogen breath test (elevated, enteric bacteria end up digesting the lactose and create hydrogen)

Afebrile 25 y.o. female w/ h/o salpingitis has sausage-shaped cystic lesions inside fallopian tube - dx?

Hydrosalpinx

EKG findings: HypERcalcemia HypOcalcemia

HypER: shortened QT HypO: prolonged QT

pts with vitiligo are at increased risk of ______

Hyper or Hypothyroid disease Addison's disease Pernicious anemia Type I diabetes

Recurrent colds, unusual eczema, high serum IgE

Hyper-IgE syndrome (Job syndrome: neutrophil chemotaxis abnormality)

Hypocalcemia & hyperphosphatemia with low normal PTH - dx?

Hypoparathyroidism

Pt undergoes total thyroidectomy for papillary carcinoma, now how perioral numbeness and tingling of fingers - dx; tx?

Hypoparathyroidism (can be transient from ischemia during surgery, or permanent b/c removal); calcium carbonate

...

Hypothermia! J/Osborne waves → extra deflection at the end of QRS due to disturbance of repolarization

Cold intolerance

Hypothyroidism

Tx of HL?

I/II: Radiation III/IV: Chemotherapy - MOPP - ABVD - BECOPP

Phases of acetaminophen overdose/poisoning

I: (0-24h) N/V II: (18-72h) Rising Transaminases, RUQ pain III: (72-96h) Hepatic Necrosis, ATN IV: (4d-3w) Resolution

Ann Arbor staging for HL

I: 1 LN II: 2+ LN on SAME side of diaphragm III: both sides of diaphragm, including 1 organ/area near the LN or spleen IV: involvement of extralymphatic tissue (liver, BM, lungs)

Surgical Terminology: Clean Clean-Contaminated

Clean: no entry into the respiratory, alimentary, genital, or urinary tract Clean-contaminated: planned entry into these tracts without usual contamination

Tx for Otitis Externa

Cleaning of ear Topical acidic abx (e.g. ciprofloxacin) Topical steroids (e.g. hydrocortisone otic)

Cleft lip vs. cleft palate - age at which surgery should be done; feeding problems?

Cleft lip surgery @ 3 months, cleft palate surgery @ 6 months; Only cleft palate needs special nipple for feeding (cleft lip still has suck)

Mgmt of cleft lip? ...cleft palate?

Cleft lip: Surgery <3mos Cleft palate: Surgery >6mos +/- special nipple for feeding

Muscle energy - what types of pts is it contraindicated?

Critically ill (i.e. ICU b/c it requires active participation), pts who have recently had a major cardiovascular event & surgery (wound dehiscence)

Desquamated epithelium casts in sputum

Curschmann spirals (bronchial asthma; can result in whorled mucous plugs)

high ACTH lvl and low dose dexamethasone suppression test restlts in 8am cortisol lvl >1.8; high dose dex reduces cortisol by another 50%

Cushing's disease (ACTH-secreting PITUITARY tumor)

Pt w/ CNS depression, respiratory/cardiac arrest and "almond-like odor in breath" - likely toxicity; tx

Cyanide; amyl nitrite

Colonies of mucoid Pseudomonas in lungs

Cystic fibrosis (autosomal recessive mutation in CFTR gene -> fat-soluble vitamin deficiency and mucous plugs)

Multifocal atrial tachycardia - describe the ECG morphology; tx; likely comorbidity?

3 or more different P-waves in the same lead, HR > 100 and irregularly irregular; verapamil; COPD

EEG pattern of an absence seizure

3 per cycle spike and wave pattern

Cavernous venous thrombosis will present with h/a and palsies of which CNs? Tx?

3-6 (minus V3) will probably present after manipulation of a skin lesion located in the central face; IV antibiotics

First time PE is tx w/ heparin followed by Coumadin - how long; if recurrent?

3-6 months; life

Candida vulvovaginitis - expected vaginal pH?

3.8 - 4.5 (normal vaginal pH, candida doesn't affect...bacterial vaginosis and trichomoniasis elevate the pH)

Metabolic syndrome (aka syndrome X)

3/5 required •abdominal obesity defined as greater than 40 inches in men or greater than 35 inches in females •triglycerides > 150mg/dL •HDL < 40mg/dL in males and < 50mg/dL in females •blood pressure > 130/85 or on hypertensive medication •fasting glucose > 100mg/dL.

prenatal testing for GBS at ______ wks Tx for + moms: if pt is allergic to the 1st line tx, use _____

35-37 Tx with ampicillin within 4 hours of delivery; if delivery occurs less than 4 hrs of administration, do a CBC and Bcx and monitor for neonatal sepsis vanco

New-onset hypothyroidism tx w/ levothyroxine - when should TSH be re-evaluated?

4-6 weeks

Post op fever after 48 hours think...? After 5 days...?

48 hours: Pneumonia, UTI, phlebitis 5 days: wound infection, deep surgical space infection

Hypoxemia, polycythemia, hypercapnia

"Blue bloater" (chronic bronchitis: hyperplasia of mucous cells)

Lesions of 1° varicella

"Dewdrop on a rose petal."

Hypernatremia

"Doughy skin."

Cyanotic babies, CXR findings - truncus arteriosus; total anomalous pulmonary venous return

"Egg-on-string"; "snowman"

Enlarged thyroid cells with ground-glass nuclei

"Orphan Annie" eyes nuclei (papillary carcinoma of the thyroid)

Enlarged cells with intranuclear inclusion bodies

"Owl eye" appearance of CMV

Causes of Transitional Cell Carcinoma

"Pee SAC" - Phenacetin - Smoking - Aniline Dyes - Cyclophosphamide

Pink complexion, dyspnea, hyperventilation

"Pink puffer" (emphysema: centriacinar [smoking], panacinar [α1-antitrypsin deficiency])

Mucin-filled cell with peripheral nucleus

"Signet ring" (gastric carcinoma)

Child with fever later develops red rash on face that spreads to body

"Slapped cheeks" (erythema infectiosum/fifth disease: parvovirus B19)

Signs and symptoms of hypercalcemia

"Stones, bones, groans, psychiatric overtones."

Narrowing of bowel lumen on barium x-ray

"String sign" (Crohn disease)

Seborrheic keratosis

"Stuck-on" appearance.

Written consent is given for release of medical records - how long do you have to comply?

5 working days

Neonatal conjunctivitis - time period for chlamydia; gonorrhea; viral; chemical?

5-14 days; 2-7 days; 6-14 days (plus b/l lid edema w/o purulent discharge); first 24 hours

management of placenta previa

<36 weeks: conservatively, U/S for planning of delivery Vag delivery may be attempted in pts with anterior marginal previa

Mgmt of pancreatic pseudocyst

<6cm: NPO, observation >6cm or has not resolved in 8 weeks: Endoscopic cystgastrostomy/cystduodenostomy

Scoliosis, Cobb angle - respiratory compromise, cardiovascular compromise?

> 50 degrees; > 75 degrees (surgery recommended for cobb angle > 50)

Endometrial CA - How thick of endometrial stripe in postmenopausal woman is abnormal; Risk factor for endo CA, True/False: Smoking, Diabetes Mellitus, Obesity, OCP, PCOS?

> 5mm; F/T/T/F/T

Pts with CHD or an equivalent should be started on a statin if LDL is >_____? If LDL is below ______, but they have a CHD equivalent, what should be done?

>130 Lifestyle modification

Obstetric Glucose Challenge Test: 1 hr 50g glucose test is abnormal if serum glucose is ______ 3 hr 100g glucose test is abnormal if serum glucose is ______

>140 Fasting >95 1 hr >180 2hrs >155 3 hrs >140

PCWP >18 indicates ______ <18 indicates ______

>18 cardiogenic <18 ARDS

Recommended weight gain for pregnant women?

>18.5 (underweight): 28-40 lbs 18.5-24.9 (normal): 25-35 lbs 25-29.9 (overweight): 15-25 lbs 30+ (obese): 11-20lbs

Management of ASCUS and LSIL

>21 y/o: HPV typing or coposcopy <21 y/o: repeat pap in 12 months

Treat because the disease represents an immediate threat to the child's life. Then seek a court order

A 10-year-old child presents in status epilepticus, but her parents refuse treatment on religious grounds.

von Willebrand's disease; treat with desmopressin, FFP, or cryoprecipitate

A 14-year-old girl presents with prolonged bleeding after dental surgery and with menses, normal PT, normal or ↑ PTT, and ↑ bleeding time. Diagnosis? Treatment?

No. Parental consent is not necessary for the medical treatment of pregnant minors

A 15-year-old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed?

Alopecia areata (autoimmune process)

A 16-year-old presents with an annular patch of alopecia with broken-off, stubby hairs.

Conversion disorder

A 17-year-old female has left arm paralysis after her boyfriend dies in a car crash. No medical cause is found.

Cerebral berry aneurysms (AD PCKD)

A 20-year-old man presents with a palpable flank mass and hematuria. Ultrasound shows bilateral enlarged kidneys with cysts. Associated brain anomaly?

Schizophreniform disorder (diagnosis of schizophrenia requires ≥ 6 months of symptoms)

A 21-year-old male has three months of social withdrawal, worsening grades, flattened affect, and concrete thinking.

O2, analgesia, hydration, and, if severe, transfusion

A 25-year-old African-American male with sickle cell anemia has sudden onset of bone pain. Management of pain crisis?

Crohn's disease

A 25-year-old Jewish male presents with pain and watery diarrhea after meals. Exam shows fistulas between the bowel and skin and nodular lesions on his tibias.

Anticholinergics (oxybutynin) or β-adrenergics (metaproterenol) for urge incontinence.

A 30-year-old woman has unpredictable urine loss. Examination is normal. Medical options?

Biliary tract obstruction

A 40-year-old obese female with elevated alkaline phosphatase, elevated bilirubin, pruritus, dark urine, and clay-colored stools.

Nephrolithiasis

A 49-year-old male presents with acute-onset flank pain and hematuria.

CML

A 50-year-old male presents with early satiety, splenomegaly, and bleeding. Cytogenetics show t(9,22). Diagnosis?

Legionella pneumonia

A 55-year-old man who is a smoker and a heavy drinker presents with a new cough and flulike symptoms. Gram stain shows no organisms; silver stain of sputum shows gram-negative rods. What is the diagnosis?

Acanthosis nigricans. Check fasting blood sugar to rule out diabetes

A 55-year-old obese patient presents with dirty, velvety patches on the back of the neck.

Broca's aphasia. Frontal lobe, left MCA distribution

A 55-year-old patient presents with acute "broken speech." What type of aphasia? What lobe and vascular distribution?

Monoclonal gammopathy, Bence Jones proteinuria, "punched-out" lesions on x-ray of the skull and long bones

A 60-year-old African-American male presents with bone pain. Workup for multiple myeloma might reveal?

Acute mania. Start a mood stabilizer (e.g., lithium)

A patient hasn't slept for days, lost $20,000 gambling, is agitated, and has pressured speech. Diagnosis? Treatment?

All-compartment fasciotomy for suspected compartment syndrome

A patient presents with pain on passive movement, pallor, poikilothermia, paresthesias, paralysis, and pulselessness. Treatment?

Consider Fitz-Hugh-Curtis syndrome

A patient presents with recent PID with RUQ pain.

Hypoparathyroidism

A patient presents with signs of hypocalcemia, high phosphorus, and low PTH.

Pheochromocytoma

A patient presents with tachycardia, wild swings in BP, headache, diaphoresis, altered mental status, and a sense of panic.

1° adrenal insufficiency (Addison's disease). Treat with replacement glucocorticoids, mineralocorticoids, and IV fluids

A patient presents with weakness, nausea, vomiting, weight loss, and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?

Nephrogenic diabetes insipidus (DI)

A patient with a history of lithium use presents with copious amounts of dilute urine.

SIADH due to stress

A postoperative patient with significant pain presents with hyponatremia and normal volume status.

Acute dystonia (oculogyric crisis). Treat with benztropine or diphenhydramine

A young weight lifter receives IV haloperidol and complains that his eyes are deviated sideways. Diagnosis? Treatment?

Most specific test for Myesthenia Gravis?

ACH receptor antibody test Remember, Ice Pack Test is the best test for pt with ptosis (sensitive/specific/inexpensive/noninvasive)

Osteomyelitis - initial test?

Always x-ray

Anorexia

Amenorrhea, bradycardia, and abnormal body image in a young female.

21 y.o. @ 18 weeks gestation has elevated maternal serum alpha fetoprotein, repeat test confirms elevation and US shows normal 18 week pregnancy - next step?

Amniocentesis for amniotic fluid level of α-fetoprotein and acetylcholinesterase activity (possible neural tube defect...trisomy has decreased levels of maternal α-fetoprotein)

Slipped capital femoral epiphyses. AP and frog-leg lateral view

An 11-year-old obese, African-American boy presents with sudden onset of limp. Diagnosis? Workup?

Chronic lymphocytic leukemia (CLL)

An 80-year-old man presents with fatigue, lymphadenopathy, splenomegaly, and isolated lymphocytosis. Suspected diagnosis?

Osgood-Schlatter disease

An active 13-year-old boy has anterior knee pain. Diagnosis?

Protamine

An agent that reverses the effects of heparin.

Metformin

An antidiabetic agent associated with lactic acidosis.

Glanzmann's thrombasthenia

An autosomal-recessive disorder with a defect in the GPIIbIIIa platelet receptor and ↓ platelet aggregation.

Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements

An eight-year-old boy presents with hemarthrosis and ↑ PTT with normal PT and bleeding time. Diagnosis? Treatment?

Treat immediately. Consent is implied in emergency situations

An eight-year-old child is in a serious accident. She requires emergent transfusion, but her parents are not present.

Polymyalgia rheumatica

An elderly female presents with pain and stiffness of the shoulders and hips; she cannot lift her arms above her head. Labs show anemia and ↑ ESR.

Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer

An elderly male with hypochromic, microcytic anemia is asymptomatic. Diagnostic tests?

Febrile seizures (roseola infantum)

An infant has a high fever and onset of rash as fever breaks. What is he at risk for?

Spinal stenosis

Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips.

60 y.o pt w/ chronic 5 week cough, R-sided hearing loss and tinnitus, no drainage, no pain when auricle is pulled - dx?

Cerumen occlusion

Cardiomegaly with apical atrophy

Chagas disease (Trypanosoma cruzi)

22 y.o. male w/ steatorrhea for several years, difficulty conceiving for 18 months, persistent cough resistant to abx, Na+ 135, K+ 4.0, ALT 20, AST 40 - dx; next test?

Cystic fibrosis; sweat chloride test

Uses of Metoclopramide

D2 Antagonist, 5HT3/4 Agonist - Antiemetic - Gastroprokinetic - Increases LES tone - Increase breast milk production

Precursor cancers: Ductal carcinoma in situ --> Tx: Lobular carconoma in situ --> Tx:

DCIS --> invasive breast ca/intraductal ca Tx: lumpectomy vs. mastectomy +/- radiation; Tamoxifen after surgery if ER+ DCIS LCIS --> not a precursor, but a/w an increased risk of invasive breast ca in either or both breasts Tx: monitory for invasive breast ca

tx for vWF

DDAVP or desmopressin

Pt presents with palpitations, hypoglycemia, markedly increased insulin level, decreased C-peptide level...likely Dx? Most likely additional findings?

Dx: Factitious hypoglycemia 2/2 exogenous insulin Additionally: Antibodies to exogenous insulin, low pro-insulin

Hemoptysis followed by nephritic syndrome, myalgias, hematuria, antialveolar basement mb abs Dx? Tx?

Dx: Goodpasture's Tx: Plasmapheresis and corticosteroids

Full term X-week old infant presents with persistent jaundice, acholic stools, dark urine, hepatomegaly, conjugated hyperbilirubinemia ...likely Dx? Diagnostic test? Tx?

Dx: Biliary Atresia Test: Intraoperative cholangiography Tx: Surgery

Neonate present with ambiguous genitalia, hypoglycemia, hyponatremia, hyperkalemia...likely Dx? Dx test? Tx?

Dx: CAH (most likely 21-alpha hydroxylase deficiency) Text: Elevated 17-hydroxyprogesterone Tx: Right now, IV bolus of NS + Hydrocortisone (both glucocorticoid and mineralcorticoid activity); maintenance GC and MC therapy indefinitely

Pt presents with flushing, diarrhea, wheezing, heart murmur, abdominal pain...Dx? Tx?

Dx: Carcinoid Tumor - Serotonin → diarrhea, cardiac damage - Histamine → flushing, pruritis, wheezing - Kallikrein → flushing Tx: Surgical resection; Octreotide

Newborn infant develops significant respiratory distress and cyanosis immediately after birth; PE shows diminished breath sounds on left and scaphoid abdomen; orogastric tube is in left chest cavity. Dx? Tx?

Dx: Congenital Diaphragmatic Hernia Tx: Gastric Decompression, Intubation, Surgical Correction

Pt presents with generalized swelling, P 108, JVD, pericardial knock, low voltage on ECG...likely dx? Bx results? Tx?

Dx: Constrictive pericarditis Bx: Normal Tx: Surgical removal of pericardium

Child presents with barking cough...Dx? Organism? Radiological finding? Tx?

Dx: Croup Org: Parainfluenza virus CXR: Steeple sign Tx: Dexamethasone

Dysthymic Disorder

Dx: Depressed mood + 2 more sx for TWO YEARS Sx: hopelessness, difficulty concentrating, appetitie changes, low self esteem, fatigue, sleep changes

Pt with h/o celiac disease presents with pruritic rash on elbows with erythematous papules/vesicles...Dx?...Tx?

Dx: Dermatitis herpetiformis (complement activation due to IgA-gluten formations) Tx: Dapsone + gluten free diet

Dx and Tx of Ascites

Dx: Diagnostic paracentesis, Ultrasound Tx: Spironolactone and/or Furosemide

Pt presents with thrombocytopenia after starting heparin...likely dx? MOA? Tx?

Dx: Heparin induced thrombocytopenia MOA: Antibody against platelet factor 4 Tx: DC heparin, start lepirudin or argatroban

Female with h/o salpingitis has sausage-shaped, cystic leasion between ovary and fallopian tube on U/S...likely Dx? Likely complication?

Dx: Hydrosalpinx Complicaton: infertility

Pt presents with muscle rigidity, tachycardia, T 102.8F, elevated end-tidal CO2 after induction of general inhalational anesthesia...likely Dx? Mgmt?

Dx: Malignant Hyperthermia Mgmt: 1. STOP the triggering anesthetic 2. Administer 100% O2, transition to different anesthetic 3. Once stable administer Dantrolene (2.5 mg/kg bolus, then 102 mg/kn q 5 min util normalization)

Child presents with fever, conjunctivitis, coryza, cough, white/blue spots on oral mucosa...likely Dx?...PPX?...Tx shown to reduce morbidity/mortality...time period of contagiousness?

Dx: Measles (Rubeola) PPX: MMR TX: Vit A supplementation Contagious: 5 days before, 4 days after rash

Pt presents with multiple dome-shaped papules with central umbilication on penis and inner thighs...Dx? Tx?

Dx: Molluscum Contagiosum Tx: None (self limiting) - liquid nitrogen/curettage may be used if bothered by them cosmetically

Premature neonate presents with emesis, rectal bleeding and pneumatosis intestinalis on abdominal xray...Dx?...Tx?

Dx: Necrotizing enterocolitis Tx: Bowel rest, abx, surgical c/s (Pneumatosis intestinalis → gas bubbles in the small bowel wall)

Neonate presents with jitteriness, tremors, irritability, grunting...likely dx?...Tx?

Dx: Neonatal Hypoglycemia (BG<40) Tx: If asymptomatic, feed enterally and screen in 1 hour; symptomatic, IV D10W

Pt presents with jaundice, migratory thrombophlebitis, palpable gallbladder...Likely Dx?...Most sensitive dx test?...Most specific dx test?...Best next step?

Dx: Pancreatic Cancer Sensitive: CT Specific: ERCP Best next step: Abdominal Ultrasound

Pt presents with hypertrichosis, hyperpigmentation and painless blistering on dorsal surface of hands...likely Dx?...RF?...Tx?

Dx: Porphyria cutanea tarda RF: Hep C, Excess Iron Tx: Chloroquine, Phlebotomy

Infant with microcephaly, rocker-bottom feet, clenched hands, and structural heart defect

Edwards syndrome (trisomy 18)

Apley's scratch test - what is if for; how do you do it?

Glenohumeral joint ROM (Adhesive capsulitis possibly); reach hand behind the back and touch opposite inferior angle of scapula & reach over head behind it to touch opposite shoulder

Pseudopalisading tumor cells on brain biopsy

Glioblastoma multiforme

Alport's syndrome

Glomerulonephritis with deafness.

Wegener's granulomatosis and Goodpasture's syndrome

Glomerulonephritis with hemoptysis.

New onset of DM, increased glucagon, stomatitis Dx? Additional finding

Glucagonoma necrotizing migratory erythema

Anti-glomerular basement membrane antibodies

Goodpasture syndrome (glomerulonephritis and hemoptysis)

Needle-shaped, negatively birefringent crystals

Gout (monosodium urate crystals)

Increased uric acid levels

Gout, Lesch-Nyhan syndrome, tumor lysis syndrome, loop and thiazide diuretics

Sudden swollen/painful big toe joint, tophi

Gout/podagra (hyperuricemia)

Spondylolisthesis - what are grades 1-4 for anterior displacement?

Grade 1 (0-25%), grade 2 (26-50%), grade 3 (51-75%), grade 4 (76-100%)

Woman with h/o radioactive iodine ablation of thyroid for hyperthyroidism presents with white, cloudy discharge from nipple...Dx?

Hypothyroidism (→ inc. TRH → inc. TSH AND Prolactin release)

ARDS

Hypoxemia and pulmonary edema with normal pulmonary capillary wedge pressure.

Female pt w/ h/o hyperthyroidism s/p radioactive iodine ablation has white breast discharge - likely etiology?

Increased TRH (stimulates both TSH and prolactin release)

Anemia of chronic disease

Microcytic anemia with ↓ serum iron, ↓ total iron-binding capacity (TIBC), and normal or ↑ ferritin.

Antiplatelet antibodies

Idiopathic thrombocytopenic purpura

Bacterial meningitis - when should prophylaxis tx be instituted; when do you add ampicillin to the tx regimen?

If Neisseria is the causative agent (rifampin or ciprofloxacin); immunocompromised hosts (including elderly) to cover Listeria

Torsade de pointes (polymorphic ventricular tachycardia that may degenerate to ventricular fibrillation) - tx?

Magnesium sulfate (hypomagnesemia and hypokalemia can cause it)

elevated Ca, normal phosphate, decreased PTH.....describe lab findings

Malignancy (maligs secrete PTH-related protein --> increase in Ca --> inhibition of PTH); phosphate will vary

What is a Krukenberg tumor?

Malignancy in the Ovary that has metastisized from a primary site (usually GI)

What is a Marjolin's Ulcer

Malignant transformation (usually SCC) of a chronic wound most commonly due to a burn

Vomiting blood following gastroesophageal lacerations

Mallory-Weiss syndrome (alcoholic and bulimic patients)

Mammogram - schedule according to U.S. Preventive Services Task Force?

Mammogram every 2 years starting at age 50

Antineutrophil cytoplasmic antibodies (ANCAs)

Microscopic polyangiitis and Churg-Strauss syndrome (MPO-ANCA/p-ANCA); granulomatosis with polyangiitis (Wegener; PR3-ANCA/c-ANCA)

Chloramphenicol, sulfonamides, radiation, HIV, chemotherapeutic agents, hepatitis, parvovirus B19, EBV

Medications and viruses that → aplastic anemia.

Thyroid cancer associated with increased calcitonin

Medullary Thyroid Carcinoma

Hypersegmented neutrophils

Megaloblastic anemia (B12 deficiency: neurologic symptoms; folate deficiency: no neurologic symptoms)

Melancholic depression vs. atypical depression?

Melancholic has weight loss & lack of mood reactivity & atypical has weight gain & mood reactivity (improved mood when something good happens)

"Tram-track" appearance of capillary loops of glomerular basement membranes on light microscopy

Membranoproliferative glomerulonephritis

IgG and C3 at the BM and spike and dome

Membranous glomerulonephritis

"Spikes" on basement membrane, "dome-like" subepithelial deposits

Membranous glomerulonephritis (may progress to nephrotic syndrome)

Membranous glomerulonephritis vs. focal segmental glomerulosclerosis - associated complications?

Membranous glomerulonephritis à syphilis, HBV, HCV, malaria, gold salts, penicillamine, SLE, malignancy...focal segmental glomerulosclerosis àHIV, IV drug abuse, sickle cell disease

AAA Screening

Men ages 65-75 who have ever smoked should undergo a one-time abdominal U/S

Group B strep, E. coli, Listeria. Treat with gentamicin and ampicillin

Meningitis in neonates. Causes? Treatment?

numbness, tingling, pain at the upper, outer thigh that is worsened with walking or standing

Meralgia paresthetica

Pacer required for these blocks

Mobitz type II (3:1 pattern of P to QRS, regular R to R) 3rd degree block (P's and QRSs are "divorced)

Narcolepsy (excessive daytime sleepiness) - tx?

Modafinil (increases histamine in hypothalamus, diff. than amphetamine, which is 2nd line)

Zollinger-Ellison Syndrome - dx test; most common site; site with higher tendency for malignancy?

Fasting serum gastrin (increased) & secretin injection test (gastrin still elevated...normally secretin suppresses gastrin); duodenum; pancreas

resp changes (dyspnea, tachypnea, cough), neurological abnormalities (AMS) petechial rash

Fat embolism, or fatty marrow entering circulation (hx should mention trauma or surgery)

Iron-containing nodules in alveolar septum

Ferruginous bodies (asbestosis: chance of mesothelioma)

Number of live births per 1000 women 15-44 years of age

Fertility rate?

Cause of Early Decelerations

Fetal Head Compression

Fetal heart rate monitor shows a sinusoidal pattern - what does that indicate?

Fetal anemia (possible Rh isoimmunization)

A study has a few outliers that are attributed to athletes - which stat will be least affected by the outliers: mode, mean, standard deviation, standard error, median?

Mode (most common number)

Pt w/ new onset asthma awakens 1-2/week b/c SOB - degree of asthma; tx

Moderate persistent asthma; inhaled low-dose corticosteroid plus long and short acting β2-agonists

Partial mole

Molar pregnancy containing fetal tissue.

Management of a cavernous hemangioma

Monitor with imaging, surgery if symptomatic or >5cm

Mortality rate vs. case fatality rate - difference?

Mortality refers to how many people die out of whole population, case fatality refers to how many people die out of those who have the disease

Regresses after menopause

Natural history of a leiomyoma.

Pt w/ sickle cell disease and naproxen use for headaches develops renal papillary necrosis - expected UA result?

Necrotic tissue

Premature baby 1-week old has rectal bleeding, abdominal x-ray shows pneumatosis intestinalis - dx; what is the x-ray finding?

Necrotizing enterocolitis; gas bubbles in the small bowel wall

Pt w/ newly dx diabetes mellitus has increased glucagon and decreased amino acid levels - likely physical finding?

Necrotizing migratory erythema (usu. w/ glucagonoma, amino acids used for gluconeogenesis)

Eosinophilic inclusion bodies in cytoplasm of hippocampal and cerebellar nerve cells

Negri bodies of rabies

Difference between si/sx of Tay-Sachs vs. Niemann-Pick?

Neimann-Pick causes hepatosplenomegaly, Tay-Sachs does not involve the liver NP - deficiency of sphingomyelinase TS - deficiency of hexosaminidase A Both: loss of early motor skills, mental retardation, cherry-red macular spot

Number of deaths from birth to 28 days per 1000 live births

Neonatal mortality?

Pt assaulted her husband and kids, is very agitated, has rotatory nystagmus, and elevated CK - intoxicated by what?

Phencyclidine hydrochloride (PCP)

Indications for C/S

Placenta Previa, Vasa Previa, Placenta Accreta, active or symptomatic Herpes lesions, maternal HIV with VL 1,000, irreversible fetal distress, malpresentation

Light's Criteria

Pleural Effusion is likely EXUDATIVE if atleast ONE of the following exists: 1. Pleural Protein : Serum Protein > 0.5 2. Pleural LDH : Serum LDH > 0.6 3. Pleural LDH is > 2/3 the upper limits of normal for serum

Tx for all types of adrenal insufficiency

Primary: glucocorticoid and fludrocortisone (ACTH increased) Secondary: glucocorticoid only (exogenous glucocort. suppresses ACTH) Tertiary: glucocorticoid ONLY (CRH is low and thus ACTH is low)

Preventative medicine Primary Seconday Tertiary Indicated

Primary: prevents development of dz Secondary: early detection Tertiary: reducing negative impact of an established dz Indicated: screening process based on specific identifiers

Nephropathy associated with analgesics, sickle cell disease, diabetes, or urinary tract obstruction?...UA will show?...Imaging will show?

Renal Papillary Necrosis UA: Necrotic tissue (sloughed tissue can cause obstruction) CT or IVP: Hydronephrosis, anatomical defects

Type I (distal) RTA

Renal tubular acidosis (RTA) associated with abnormal H+ secretion and nephrolithiasis.

Superficial thrombophlebitis - tx?

Repeat physical in 1 week to check for progression to DVT

What quality is of paramount importance in clinical trials?

Reproducibility

Cobb angle at which there is respiratory compromise...cardiovascular compromise?

Resp: >50 degrees CV: >75 degrees

Retinal artery occlusion vs. ophthalmic artery occlusion - difference on physical exam?

Retinal art occlusion has a pale retina w/ cherry-red macula (choroid artery still supplies macula), no cherry-red spot w/ oph art occlusion

Acute, painless monocular loss of vision; Fundoscopic: pale retina with a cherry-red macula

Retinal art. occlusion

ABG pH 7.22 pCO2 15, HCO3 21, K+ 2.7, Cl- 118, Na+ 135, urine pH 6.2 - RTA type; how to confirm dx?

RTA type I; Ammonium chloride (an acid...urine pH doesn't drop below 5.5)

ABG pH 7.22, pCO2 15 mmHg, HCO3 25 mEq/L, K+ 5.4 mEq/L, chloride 118 mEq/L, Na+ 125 mEq/L, urine pH 4.9 - RTA type; how to confirm dx?

RTA type IV; Salt restriction (Serum Na decreases while urine Na stays the same)

Appendicitis in pregnancy - which unusual area can it appear; first line dx test; second line dx test?

RUQ; US; MRI (preferred over CT in pregnancy)

Widened mediastinum (> 8 cm), loss of aortic knob, pleural cap, tracheal deviation to the right, depression of left main stem bronchus

Radiographic evidence of aortic disruption or dissection.

Free air under the diaphragm, extravasation of contrast, severe bowl distention, space-occupying lesion (CT), mesenteric occlusion (angiography)

Radiographic indications for surgery in patients with acute abdomen.

Pt (s/p vagotomy for PUD) presents with tremors, palpitations, sweating; labs show hypoglycemia, normal insulin/Cpeptide/proinsulin...likely dx?

Reactive Hypoglycemia

Psoriasis

Red plaques with silvery-white scales and sharp margins.

Histological characteristic of HL?

Reed-Sternberg cells

Hodgkin's lymphoma

Reed-Sternberg cells

Giant B cells with bilobed nuclei with prominent inclusions ("owl's eye")

Reed-Sternberg cells (Hodgkin lymphoma)

Indications for D&C

Refractory vag bleeding molar preg

Rectangular, crystal-like, cytoplasmic inclusions in Leydig cells

Reinke crystals (Leydig cell tumor)

The IR of a disease in a population exposed to a particular factor ÷ the IR of those not exposed

Relative risk?

Meckel's diverticulum Rule of 2s

Remnant of vitelline (omphalomesentaric) duct...most commone cause of large volume painless bleeding in babies Rule of 2s: - Occurs in 2% of the population - Only 2% are symptomatic - Located 2 ft proximal to ileocecal valve - 2 in long - Contains 2 types of tissue (gastric, pancreatic) - Syptoms manifest at 2 y/o

β-hCG; the most common cause of amenorrhea is pregnancy

The first test to perform when a woman presents with amenorrhea.

Multiple myeloma

The most common 1° malignant tumor of bone.

Lung, breast, skin (melanoma), kidney, GI tract

The most common 1° sources of metastases to the brain.

Prostate cancer is the most common cancer in men, but lung cancer causes more deaths

The most common cancer in men and the most common cause of death from cancer in men.

Iatrogenic steroid administration. The second most common cause is Cushing's disease

The most common cause of Cushing's syndrome.

Trauma; the second most common is berry aneurysm

The most common cause of SAH.

Intraductal papilloma

The most common cause of bloody nipple discharge.

Endometriosis

The most common cause of female infertility.

Excessive EtOH

The most common cause of hypertension in young men.

OCPs

The most common cause of hypertension in young women.

Hashimoto's thyroiditis

The most common cause of hypothyroidism.

Uterine atony

The most common cause of postpartum hemorrhage.

Infection, febrile seizures, trauma, idiopathic

The most common cause of seizures in children (2-10 years).

Trauma, alcohol withdrawal, brain tumor

The most common cause of seizures in young adults (18-35 years).

Alzheimer's and multi-infarct

The most common causes of dementia.

Malignancy and hyperparathyroidism

The most common causes of hypercalcemia.

IgA nephropathy (Berger's disease)

The most common form of glomerulonephritis.

Membranous glomerulonephritis

The most common form of nephritic syndrome.

Transitional cell carcinoma

The most common histology of bladder cancer.

Factor V Leiden mutation

The most common inherited cause of hypercoagulability.

Hereditary spherocytosis

The most common inherited hemolytic anemia.

Ampulla of the oviduct

The most common location for an ectopic pregnancy.

Parainfluenza virus type 1

The most common pathogen causing croup.

Prolactinoma. Dopamine agonists (e.g., bromocriptine)

The most common pituitary tumor. Treatment?

Calcium oxalate

The most common type of nephrolithiasis.

Basal cell carcinoma

The most common type of skin cancer; the lesion is a pearly-colored papule with a translucent surface and telangiectasias.

Seminoma—a type of germ cell tumor

The most common type of testicular cancer.

Esophageal atresia with distal TEF (85%). Unable to pass NG tube

The most common type of tracheoesophageal fistula (TEF). Diagnosis?

Headache

The most frequent presentation of intracranial neoplasm.

Diverticulosis

The most likely cause of acute lower GI bleed in patients > 40 years old.

Infection, cancer, and autoimmune disease

The three most common causes of fever of unknown origin (FUO).

False. Withdrawing and withholding life are the same from an ethical standpoint

True or false: Withdrawing life-sustaining care is ethically distinct from withholding sustaining care.

6 y.o. female with Tanner stage III breasts, high LH and FSH levels that increase after GnRH administration, MRI of brain and abd US are normal, skeletal age is advanced - dx; tx?

True precocious puberty (GnRH increasing LH/FSH = true, if LH/FSH are low and GnRH doesn't affect = precocious pseudopuberty); GnRH analog (leuprolide, histrelin, nafarelin, buserlin...tx helps reach desired height)

GnRH stimulation test results: True precocious puberty: Pseudopuberty: ______________________________________ Bone Age:

True: LH and FSH will be at puberty level and will INCREASE with admin of GnRH Pseudo: LH and FSH levels are low and do NOT increase after admin. of GnRH Bone age will be advanced in true precocious puberty

Pt is dx with silicosis...they are high risk for developing...?

Tuberculosis (silica is cytotoxic to alveolar macrophages)

facial angiofibromas (nasolabial folds) or forhead plaques, hypomelanotic macules, Shagreen patch (CT nevus), multiple retinal nodular hamartomas

Tuberous sclerosis

Pt presents with h/o seizures, mental retardation, hypopigmented macules, and nodules on face (below)...Dx?

Tuberous sclerosis - Sx: seizures, progressive retardation, psychomotor retardation - Cutaneous findings: adenoma sebaceum, ash leaf spots, shagreen patches - Tumors: Cardiac rhabdomyomas, renal angiomyolipomas, cortical tubers, subependymal nodules, retinal astrocytic hamartomas

Tall, long-armed pt with medullary thyroid CA, pheochromocytoma - what else should be evaluated; dx; type of genetic transmission?

Tumor of the tongue; MEN IIB (MEN IIB has marfanoid body habitus and mucosal neuromas, while MEN IIA has parathyroid tumor); autosomal dominant (all MEN II AD)

Streak ovaries, congenital heart disease, horseshoe kidney, cystic hygroma at birth, short stature, webbed neck, lymphedema

Turner syndrome (45,XO)

Colposcopy and endocervical curettage

Two consecutive findings of atypical squamous cells of undetermined significance (ASCUS) on Pap smear. Follow-up evaluation?

[OMM] Lumbar dysfunction can be treated w/rotated side up or down - what is the trick to remember which way to pull the arm?

Type 1: up/up, down/down & type 2: up/down, down/up

Group dysfunctions typically exhibit which type of mechanics?

Type I

p value represents the probability of this type of error ________

Type I (remember, the smaller the p, the better!) {Type I error being erroneously rejecting the null OR erroneously accepting the alternative hyp}

Gastric ulcer types - which type is most common; which type mostly with NSAIDs?

Type I (ulcer along lesser curve of stomach); type V (gastric body)

Neurofibromatosis type I vs. type II - differentiating characteristics?

Type I has axillary freckling and iris hamartomas (Lisch's nodules) & type II has b/l acoustic neuromas and cataracts

54 y.o. multiparous female c/o 5 month hx of urinary incontinence, she admits to urinary frequency, dribbling, and hesitancy - first step?

UA (All urinary incontinence workups should begin with UA to r/o infxn, hematuria, etc...this lady eventually has clean UA and high postvoid residual volume via cath tx'ed by self-cath [likely 2/2 diabetes or spinal cord trauma])

chronic constipation, abd pain, distention, vomiting, tympanic abd....Dx?; most common location? Best INITIAL test? Best therapeutic and diagnostic test?

Volvulus Sigmoid colon X-ray Sigmoidoscopy

...

Volvulus!! - Endoscopic decompression - Surgery of signs of ischemia

Workup for gastrinoma? Most common location?

W/U: Fasting serum gastrin (elevated) → Secretin Injection Test (normal gastric cells will be inhibited; in gastrinomas gastrin levels remain elevated) Most common location: Duodenum

21 y.o. male had a mild cough 6 weeks ago, now his coughs have been followed by vomiting, CXR is clear - dx; what could have prevented this?

Whooping cough (Bordetella pertussis); Tdap vaccination (cough is usually followed by coughing fits with sweating or vomiting)

They can mask symptoms of hypoglycemia

Why are β-blockers contraindicated in diabetics?

R vs L BBB?

WiLLiaM MaRRoW LBBB: V1: W, V6:M RBBB: V1: M, V6: W

...

Wickham Striae! Think Lichen Planus

Mgmt of umbilical hernia in a child?

Will usually close within 2-3 years Up to 4 y/o: Observation Beyond 4 y/o or Incarceration: Surgical Repair

Low serum ceruloplasmin

Wilson disease (hepatolenticular degeneration)

thrombocytopenia, immunodeficiency, eczema, X-linked (will be a male child)

Wiskott-Aldrich syndrome

Acetaminophen toxicity - tx (include timing)?

Within 1 hr of ingestion use activated charcoal...at 4, 6 and 8 hrs check serum acetaminophen levels (to determine need for N-acetylcysteine)...if after 8 hours give N-acetylcysteine while waiting for acetaminophen level

test to order for suspected PUD

X-ray

Most specific tests for RA?

X-ray and anti-CCP Abs (RF is not specific and does not rule out seronegative RA)

Spinal stenosis - initial test; most accurate test; tx that provides long-term relief?

X-ray; MRI; weight loss

Initial test for suspected Osteomyelitis?

XRay

Yellowish CSF

Xanthochromia (e.g., due to subarachnoid hemorrhage)

Tests for bicipital tenosynovitis

Yergason's Speed's

fever, chills, h/a, lymphadenopathy, a/w rodents

Yersinia pestis

Sturge-Webber syndrome manifests with _____

a port wine stain on the face, seizures, and learning disability

Motion of the talus and foot w/ Ant fib head Post fib head

ant fib head --> talus: ER, foot: dorsiflex post fib head --> talus: IR, foot: plantarflex

the majority of patients with Crohn's disease are positive for ______ UC pts are usually + for _____

anti-Saccharomyces cerevisiae (ASCA) antibodies p-ANCA

In the tx of benzo withdrawal, avoid this type of drug: ____

antipsychotics

Tx of acute mania

antipsychotics (olanzapine) mood stabilizers (Li, carbamazepine) valproic acid benzos added as adjunctive tx

test for ligamentous laxity of the shoulder

apprehension test

Initial tx for plantar fasciitis

arch supports

hx or work in the insulation industry with SOB...Dx? X-ray findings...type of pleural effusion?

asbestosis bilateral opacities and pleural plaques exudative (>0.5 prtn, >0.6 LDH, >200 LDH)

____________ is a complication of choledocholithiasis and should be treated with ____________

ascending cholangitis IV Abs, IV fluids, ERCP w/ sphincterotomy/stone removal or bile duct decompression

Pharm tx of croup always includes ______

at least one dose of dexamethasone

Mood reactivity + 2 of the following: hypersomnia, wt gain, leaden paralysis, sensitivity to rejection

atypical depression

Structures at risk with the following: Ant. shoulder dislocation Humerus fx. Scaphoid fx Supracondylar fx

ax nerve radial nerve avascular necrosis neurovascular and Volkmann contracture

Definition and causes of fetal bradycardia

baseline HR < 110; caused by prolonged cord compression, cord prolapse, fetal hypoxia, congenital heart block

diarrhea is a _____ syndrome acid-base disorder

bicarb wasting syndrome metabolic acidosis

What increases the risk of cervical ca vs. endometrial ca?

cervical ca: exposure to HSV endometrial/uterine ca: exp to estrogen

Inevitable abortion

cervical dilation, no expulsion of fetal products, OPEN cervical os

aggressive neoplasm usually in the placenta that spreads hematogenously, often to the lungs

choriocarcinoma

diabetes, steatorrhea, calcification of the pancreas; dx modality?

chronic pancreatitis, CT

MC finding on head imaging in normal pressure hydrocephalus:

dilated ventricles without cortical atrophy

most common complication of measles

dirrhea!

early post-valve endocarditis: late post-valve endocarditis: native valve endocarditis:

early (within 1 yr): S. aureus, S. epidermidis late: S. aureus HACEK: H. flu, Actinobacillus, Cardioacterium, Eikenella, Kingella

Fever + Headache: w/ confusion implies ______ w/ nuchar rigidity implies ______ w/ focal findings implies and ICS/papiledema (may also have confusion) ______

encephalitis meningitis brain abscess

The following help in diagnosing ___________: Cullen's sign Fox's sign Grey Turner's sign

hemorrhagic pancreatitis

most important feature of a randomized clinical control study is _______________

reproducibility

Procedures that require PPx in pts with a hx of infective endocarditis

resp tract MAJOR dental procedures procedures of infected skin tissues just under the skin MSK tissue

acute akathasia (timing after drug initiation)

restlessness/urge to move within hours to days of typical antipsychotic initiation

Finding in ascites caused by portal HTN

serum ascites albumin gradient (SAAG) >1.1

Hip drop tests __________

sidebending of the lumbar spine

feared complication of chronically draining sinus tract secondary to chronic osteomyelitis

squamous cell carcinoma

acute dystonia (timing after drug initiation)

starts hrs to days after initiation of antipsychotics

Pt comes in with low back pain and dermatomal/DTR neuro deficits. What test should be done next?

straight leg raising to assess for disc herniation of the lower lumbar spine

PTSD vs Acute stress disorder

sx are very similar, but Actute stress d/o lasts for a max of 4 weeks (PTSD for yrs)

painful or painless: syphilis chancroid

syph: painLESS chancroid: PAINFUL genital ulcerations

Describe polyarteritis nodosa

systemic symptoms (fatigue, weight loss, weakness, fever, arthralgias) and signs (skin lesions, hypertension, renal insufficiency, neurologic dysfunction, abdominal pain) of multisystem involvement; a/w Hep B

Tx of ZE

PPI

biliary sludge is a/w

acalculous cholecystitis (consider TPN pts, ICU pts)

molar pregnancies are consistent with:

accelerated hCG Hyperthyroidism HTN Proetinuria

tx for WPW

adenosine, amiodarone or procainamide; carotid massage or vagal maneuvers

Copper deficiency is a/w

anemia, fatigue, leukopenia, osteoperosis

How is spondylolithesis graded?

3 grades, below and above 26-50%

Campylobacter

Identify key organisms causing diarrhea: ■ Most common organism

Salmonella

Identify key organisms causing diarrhea: ■ Poultry/eggs

Yersinia

Identify key organisms causing diarrhea: ■ Pseudoappendicitis

Vibrio, HAV

Identify key organisms causing diarrhea: ■ Raw seafood

Classic EKG findings for PE?

S1-Q3-T3, RBBB, sinus tachy

polyhydramnios is a/w _____ oligohydramnios is a/w ____

neural tube defects abd wall defects renal anomaly

Hemabate is what type of drug? What is second line after oxytocin for uterine atony?

prostaglandin, aka carbaprost tromethamine Prostin (PGF-2 alpha)

What is pulsus parvus et tardus and what is it associated with

pulse is late with respect to contraction of the heart a/w aortic stenosis

HIV PPX

- CD4 < 200: TMP/SMX (PCP) - CD4 < 100: TMP/SMX (Toxo) - CD4 < 50: Azithromycin (MAC)

Toe extension/fanning upon plantar scrape

Babinski sign (UMN lesion)

ITP (Idiopathic thrombocytopenic purpura) - tx of choice?

Corticosteroids & IV IG

Eosinophilic globule in liver

Councilman body (toxic or viral hepatitis, often yellow fever)

Jaundice, palpable distended non-tender gallbladder

Courvoisier sign (distal obstruction of biliary tree)

Clostridium difficile

Identify key organisms causing diarrhea: ■ Recent antibiotic use

ETEC

Identify key organisms causing diarrhea: ■ Traveler's diarrhea

E. coli O157:H7

Identify key organisms causing diarrhea: ■ Uncooked hamburgers

Situs inversus, chronic sinusitis, bronchiectasis, infertility

Kartagener syndrome (dynein arm defect affecting cilia)

Major Depressive Disorder resistant to multiple SSRIs (monotherapy) - which drug can be added to regimen?

Lithium

Pt overdosed on a psychiatric medication presents w/ ataxia, tremulousness, and hyperreflexia - what drug?

Lithium

Betamethasone or dexamethasone × 48 hours

Medication given to accelerate fetal lung maturity.

Neuroleptics

Medication to avoid in patients with a history of alcohol withdrawal seizures.

Clomiphene citrate

Medication used to induce ovulation.

Klebsiella

Name the organism: ■ Alcoholic with pneumonia.

Actinomyces israelii

Name the organism: ■ Branching rods in oral infection.

Pasteurella multocida

Name the organism: ■ Dog or cat bite.

Sporothrix schenckii

Name the organism: ■ Gardener.

Pseudomonas

Name the organism: ■ Infection in burn victims.

Neisseria meningitidis

Name the organism: ■ Meningitis in adults.

Streptococcus pneumoniae

Name the organism: ■ Meningitis in elderly.

Pseudomonas

Name the organism: ■ Osteomyelitis from foot wound puncture.

Salmonella

Name the organism: ■ Osteomyelitis in a sickle cell patient.

Haemophilus ducreyi

Name the organism: ■ Painful chancroid.

Toxoplasma gondii

Name the organism: ■ Pregnant women with pets.

Universal screening of newborns include...?

PKU and congenital hypothyroidism

Meningitis - what age is the cutoff between mostly Group B streptococcus prevalence to Streptococcus pneumoniae?

3 months

Recommended wt gain by BMI

<25: 25-35 lbs 25-29: 15-25 >29: 11-20

[OMM] Q-angle - normal range; what dysfunction if increased; measures angle between which two functional vertical axes?

10-12; genu valgus; femur & tibia

When should infants be switched to cow's milk

12 mo

Fertility work-up - how long before intervention; first step after that?

12 months; semen analysis

A new drug for HTN has an absolute risk reduction of 0.8% in deaths - how many people must be treated to save one extra life?

125 (100/0.8)

Features of Crohn's dz

- Can occur anywhere from mouth to anus - Transmural - Cobblestone mucosa - Fistulas - Fissures/ulcerations/abscesses - Skip lesions/non-continuous involvement - Creeping fat - Non-caseating granulomas

Mgmt of Mastitis

- Continue breast feeding - Initiate antibiotics - Analgesics - Warm and cold compresses

Uses for Buproprion

- Depression - Anxiety - Smoking Cessation

Elements of Somatostatinoma Syndrome

- Diabetes mellitus - Diarrhea/Steatorrhea - Cholelithiasis - Hypochlorhydria - Weight Loss

Si/sx of Glucagonoma

- Diabetes mellitus - Glossitis/Stomatitis/Chelitis - Decreased AA (due to gluconeogenesis)

Mgmt of Restless Leg Syndrome

- Dopamine agonist (pramipexole, ropinirole, levodopa/carbadopa, bromocriptine) - Iron supplementation

Nephrotic Syndrome

<3.5g of protein in the urine over 24 hours Protein:creatinine ratio greater than 200 mg/mmol

BP I vs BP II vs Rapid-Cycling BP vs Cyclothymic

- BP I: full blown mania +/- depression - BP II: MDD + hypomania - RC BP: 4+ episodes of MDD, mania, hypomania or mixed in 12 mos - Cyclothymic: alt. hypomania and mild depression for 2 years

Acute pericarditis in SLE presents with ____

(all the normal pericarditis sx) and 1. Leukopenia 2.Thrombocytopenia

Tx for unstable angina

(same for NSTEMI): morphine, O2, nitrates, ASA, beta blockers, heperin

Pt presents with "pure" psychosis (i.e. no mood disorder for 1 day - 1 month...1 month to 6 months...longer than 6 months...Dx?

- Brief psychotic disorder: < 1 month - Schizophreniform disorder: 1-6 months - Schozophrenia: > 6 months

Describe the mm. contractions: Eccentric Concentric Isometric Plyometric

*concentric and eccentric movements are both isoTONIC mm contractions Eccentric: mm. lenghthens Concentric: mm shortens Isometric: no change in length Plyometric: short cycles of mm. loading and contracting

Pemphigus vulgaris

+ Nikolsky's sign.

Pheochromocytoma 10% Rules

- 10% Bilateral - 10% Extra-adrenal - 10% Familial - 10% Malignant - 10% Recurrence - 10% in Children - Most are sporadic, benign, unilateral, adrenal in adults

Mgmt of pregnant pt with Hyperthyroidism

- 1st Trim: PTU - 2nd, 3rd Trim: Methimazole

Tx of Shock

- ABCs - O2 - Large gauge peripheral IV access - 1-2 L bolus of NS

Si/Sx of Acute Intermittent Porphyria

- Abdominal pain, vomiting, constipation, muscle weakness, psychological sx - Increased urinary aminolevulinic acid and porphobilinogen - NO rash

ARDS criteria

- Acute hypoxemia - PaO2/FiO2 <200 - B/L diffuse infiltrates - Exclusion of cardiogenic pulmonary edema (r/o using BNP, echo, PCWP*)

Goal INR for afib/DVT/PE?...Mechanical heart valve?

- Afib/DVT/PE: 2-3 - Mechanical Valve: 2.5-3.5

Pt c/o loss of consciousness when shaving or wearing tight collard shirt...Initial test? Likely dx?

- All syncope gets EKG first - Likely Carotid Sinus Hypersensitivity - Confirm with f/u carotid sinus massage

Drugs that exacerbate MG

- Aminoglycosides - Tetracyclines - Beta blockers - Procainamide - Quinidine - Lidocaine

Mgmt of Meniere's Dz

- Antihistamines - Anticholinergics - Low sodium diet - Diuretics

Who gets IE PPX?

- Artificial heart valve or heart valve repaired with articificial material - History of endocarditis - Heart transplant with abnormal heart fx - Unrepaired cyanotic congenital heart dz

Pregnancy screening for Down's syndrome

- At 15-20 weeks - Triple screen (AFP, hCG, estriol) - Quad screen for high risk (AFP, hCG, estriol, inhibin A) - If +, offer genetic testing (amniocentesis)

Mirtazapine is what kind of drug? SE? Ideal to be used in what pt?

- Atypical Antidepressant - alpha -2 receptor antagonist that increase serotining and NE - Sedation + Weight Gain (anti-histamine) - Use in ANOREXIC pts with depression

EM Minor vs EM Major vs SJS vs TEN?

- EM minor: target lesions on extremities with no mucosal involvement - EM major: target lesions on extremities, involvement of 1+ mucous membranes, <10% BSA - SJS: widespread blisters involving face and trunk, <10% BSA - TEN: widespread blisters involving face and trunk, >10% BSA

Trisomy 18

- Edward's Syndrome - Microcephaly, micrognathia, clenched fists, prominent occiput, widely spaced eyes, rocker bottom feet

STD Screening

- GC and CHL for all sexually active non-pregnant women 24 y/o and younger - HIV for all individuals 15-65 y/o

Test of choice for gallstones?....kidney stones?

- Gallstones: U/S - Kidney stones: noncontrast CT

Mgmt of leiomyomas

- GnRH agonists - Hysterectomy vs. Myomectomy (depending on desire to have children)

Algorithm for dx primary Hyperaldosteronism

- HTN + Hypernatremia + Hypokalemia - Plasma aldosterone : Plasma renin activity - If >25 → sodium loading test - If ald. Not suppressed below 10 → dx - Abdominal CT → adenoma vs hyperplasia

Mgmt of Type II DM pt if Hgb A1c remains elevated despite metformin tx?

- Hgb A1c 7-8.5% → add sulfonylurea - Hgb A1c >8.5% → add insulin

Septic Shock

- High CO - Low PCWP - Low SVR

Phases of Clinical Trails

- I: Testing on a small number of healthy volunteers to determine SE, metabolism, excretion etc - II: Testing on a small number of pts suffering from the disease to be treated - III: Large scale trial to test against placebo - IV: After release; surveillance

Mom is breastfeeding her infant and develops VZV infection on face. Mgmt?

- If neonate 1-2 days old, isolate the neonate and administer lyophilized purified human IG prep containing anti-varicella ab to baby - If neonate is older than 2 days and there are no lesions on breast, continue breast feeding

Mgmt of Placenta Previa?

- If unstable/signs of fetal distress → C-section now - If stable and before 36 weeks → conservative mgmt. and repeat US at 36 weeks to determine route of delivery

Adult vaccines

- Influenza annually for all people over 6 mos - TDaP once after 11 y/o, Td booster q 10 yrs - VZV at 60 y/o

Features of UC

- Involves rectum - Continuous involvement - Mucosal - Crypt abcesses - *Associated with malignancy (cholangiocarcinoma, colon cancer, sclerosing cholangitis)

Streptococcal Pharyngitis will cause at least two of the following symptoms:

- Lack of cough - Tonsillar exudates - Tender anterior cervical lymphadenopathy - Temperature >100.4

Diagnostic test for Endometriosis

- Laparoscopy

Cardiogenic Shock

- Low CO - High PCWP - High SVR

Hypovolemic Shock

- Low CO - Low PCWP - High SVR

Neurogenic Shock

- Low CO - Low PCWP - Low SVR

Major adverse side effect of Buproprion

- Lowering seizure threshold

Antidotes for: TCA Beta Blocker Acetaminophen Methanol or Ethylene Glycol Organophospate Opioids Warfarin tPA Heparin Carbon Monoxide Methemoglobin

- TCA: NaCO3 - Beta Blocker: Glucagon - Acetaminophen: N-Acetylcysteine - Methanol/Ethylene Glycole: Ethanol or Fomepizole - Organophosphate: Pralidoxime or Atropine - Opioids: Naloxone or Naltrexone - Warfarin: Vitamin K and FFP - tPA: Aminocaproid Acid - Heparin: Protamine - Carbon Monoxide: 100% O2 - Methemoglobin: Methylene Blue

Initial therapy for pt with dehydration

- Mild-Mod: Oral Rehydration - Severe or if contraindications to oral rehydration, then IV fluids

Contraindications for breast feeding

- Mothers with HIV, untreated TB, HSV lesions on breast, chemo, radioactive isotope administration - Infants with galactosemia - *Soy based formula instead

Diagnostic tests for asthma

- PFT: FEV1/FVC <75% = obstructive lung dz - Spirometry: administration of bronchodilator increases FEV1 or FVC by atleast 12% - PEFR: Normal 450-650 in men, 350-500 in women; exacerbation is mild (>300), mod (100-300) or severe (<100)

Cervical Cancer Screening

- Pap smears start at age 21 - Age 21-30: Pap q3Y - Age 30 - 69: Pap q3Y OR Pap + HPV test q5Y - Age 70: DC if 3 consecutive (-) and no abnormal paps in last 10 years

What do you need to for B12 absorption?

- Parietal Cells → Intrinsic Factor - Terminal Ileum - Functioning pancreas - Liver for storage

Trisomy 13

- Patau's syndrome - Cleft lip/palate, polydactyly, microcephaly, micropthalmia, micrognathia, close-set eyes, holoprosencephaly, rocker bottom feet

First line treatement for sideroblastic anemia with ringed sideroblasts

- Pyridozine (B6) - Removal of offending agent

ME for Rib Exhalation Dysfuntion

- Rib 1: Ant/Mid Scalene → pt lift head - Rib 2: Post Scalene → pt turns head 30 degrees away - Rib 3-5: Pec minor → ipsilateral elbow to contralateral hip - Rib 6-9: Serratus ant → ipsilateral elbow to ipsilateral hip - Rib 10-11: Lat dorsi → arm adduction - Rib 12: Quad lumborum → arm adduction

Indications for long-term O2 therapy in COPD

- SaO2 <88 - PaO2 <55 - PaO2 55-59 + right sided heart failure or erytrhrocytosis

Screening test, dx test, and tx for Renal Amyloidosis

- Screen: Abdominal Fat Pad bx - Dx: Renal Bx with apple green birefringence with congo red staining - Tx: prednisone and melphalan

Wegener's Granulomatosis

- Small - med vessel vasculitis - + c-ANCA (anti-proteinase3) - Si/Sx: Upper/Lower Resp Tract (sinusitis, saddle nose) + Renal (Glomerulonephritis) - Bx: Granulomas

Colorectal Cancer Screening

- Start at 50 - FOBTx3 q1Y OR Sigmoidoscopy q5Y OR Colonoscopy q10Y - Previous polyp: q3Y until clear, then q5Y - Previous colon ca: 1Y after resection, then 3Y, then 5Y - FH in single family member: 10 years earlier than age of dx or age 40 - HNPCC: start at 25, q1-2Y - FAP: start at 12, q1Y

Mgmt of pt with primary spontaneous pneumothorax...

- Supplemental O2 and... - If <15% of hemithorax OR <3cm apex-to-cupola distance: Observation with repeat CXR in 24 hours - If large: Needle Aspiration → Chest Tube Placement

Mgmt of pt with CO poisoning

- Supplemental high-flow O2 via nonrebreather - Hyperbaric O2 for select pts

How are Polymyositis and Dermatomyositis similar?

- Symmetrical proximal muscle weakness (UE>LE), sparing the face - Elevated CK - Associated with Anti-Jo-1 ab and ANA

Indications for surgical repair of AAA

- Symptomatic aneurysms of any size - >5.5 cm in diameter

MCC of epididymitis in a pt <35? older men?

<35: Chlamydia trachomatis, then N. gon older men: E. coli

Fat Emblism: Si/Sx? Dx? Tx?

- Think in Burn pts or Trauma pts c fractures of pelvis/long bones - Si/Sx: Neuro dysfx, respiratory distress, petechial rash of axillae/chest/arms - Dx: Clinical; Sudan stain shows lipid deposits - Tx: Supportive; positive pressure ventilation, diuresis

Goodpasture's Syndrome

- Type II hypersensitivity rxn - Anti-GBM antibodies against Type IV Collegen - Si/Sx: Lower Resp Tract (Hemoptysis) + Renal (Glomerulonephritis) - Bx: Linear deposit of IG

Supplementation for exclusively breast-fed infants

- Vitamin D: 400 IU daily soon after birth - Iron: 1 mg/lg oral starting at 4 months

Workup for Diabetes Insipidus

- Water deprivation test (normal should reduce urine output, DI will continue to have increased urine output) - Desmopressin (response = central, no/little response = nephrogenic)

Sx of Median nerve injury?

- Weakness/paralysis of thumb opposition/pronation and finger flexion - Sensory loss to palmar surface of thumb and dorsal and palmar surface of 2nd, 3rd, and lat. ½ of 4th finger - Thenar eminence atrophy

Mgmt of acetaminophen overdose/poisoning

- Within 1 Hour: Oral Activated Charcoal - 4, 6, 8, Hours: Serum Acetaminophen Levels drawn, plotted on Rumack-Matthew nomogram to determine hepatotoxicity - Within 8 Hours: NAC if high likelihood of hepatotoxicity (100% hepatoprotective) - *If pt presents 8+ hours after ingestion, administer NAC

10 y.o. burn pt - percentages?

15% head, 13% anterior trunk, 18% posterior trunk, 9% for each upper extremity, 16% each lower extremity, 1% genitalia

Asthma Severity Mgmt

...

Sensitivity vs. Specificity

...

Raj staging for CLL

0 is a lymphocytosis > 15 x 10^9 I is a lymphocytosis and lymphadenopathy (LL) II is a lymphocytosis and splenomegaly (LS) III is a lymphocytosis and anemia (LA) IV is a lymphocytosis and thrombocytopenia (LT)

Trichomonas vaginitis

A patient has ↑ vaginal discharge and petechial patches in the upper vagina and cervix.

risks for placenta previa

1. C-section/uterine surgery 2. Multiparity

2 murmurs that increase with Valsalva

1. HOCM (systolic ejection murmure) 2. MVP (mid-systolic click)

Counterstrain Technique

1. Locate and Palpate TP 2. Place pt in position of optimal comfort (SHORTEN the muscle) 3. Fine tune until 70% tenderness reduction 4. Maintain position for 90 seconds 5. Slowly return to neutral 6. Recheck TP (no more than 30% tenderness should remain)

Treatment of choice for Acromegaly

1. Transsphenoidal surgical resection 2. Octreotide (if not a surgical candidate)

blood at the urethral meatus

1. retrograde urethrogram 2. suprapubic cath 3. delay surgery for 6-12 weeks

Sacral torsion rules when given L5

1.When L5 is sidebent, a sacral oblique axis is engaged on the SAME side as the sidebending. 2.When L5 is rotated, the sacrum rotates the OPPOSITE way on an oblique axis. 3.The seated flexion test is found on the opposite side of the oblique axis. ***Sidebending is the same, Rotation is reversed

How do you calculate the 'number needed to treat'?

1/absolute risk reduction

How do you calculate the 'number needed to harm'?

1/attributable risk

Acute sinusitis - days after which bacterial concern > viral; supportive tx options?

10 days; antihistamine, saline spray, NSAIDS, decongestants

Definition and causes of fetal tachycardia

10 mins+ of fetal HR >160; caused by maternal fever, infection, fetal hypoxia, fetal or maternal anemia, hyperthyroidism, prematurity, sympathomimetics

Ectopic pregnancy - what is cut-off β-hCG level that one can see gestational sac w/ transvaginal US?

1500 (usu. if suspected and < 1500, repeat US in 48 hours)

Meningitis - what age is the cutoff between mostly Neisseria meningitidis prevalence to Streptococcus pneumonia?

18 years

hypocalcemia following thyroidectomy is treated with

1st line: calcium carbonate calcitriol if refractory calcium gluconate (IV) if life-threatening

Antimitochondrial antibodies (AMAs)

1° biliary cirrhosis (female, cholestasis, portal hypertension)

Placental abruption and placenta previa

1° causes of third-trimester bleeding.

HLA associations: DR2,3, 4, 5

2 MS 3 DM 4 RA 5 JRA, kaposi, hashimoto's

MEN IIb

2 Ms 1 P: Medullary Thyroid Ca, Pheochromocytoma, Marfanoid Habitus/Mucosal Neuromas

Pregnancy - expected length of second stage of labor for nullipara; multipara; effects of epidural?

2 hours; 1 hours; epidural adds 1 hour to each

Chi-square test compares ______

2 or more proportions

Pregnancy - when will urine hCG first be positive; what about blood?

2 weeks after conception; 1 week

Glucose tolerance test is done during the ___ wk of gestation

24th-28th (not beyond)

Pregnancy recommended weight gain - underweight; normal; overweight; obese?

28-40 lbs.; 25-35 lbs.; 15-25 lbs.; 11-20 lbs.

Triad of Hemolytic Uremic Syndrome

29. Acute renal failure 30. Thrombocytopenia 31. Microangiopathic hemolytic anemia *In children after infection with E coli O157:H7

Chapman's Points

2nd ICS: myocard, thyroid, esoph, bronchi (main) 3rd ICS: upper lung and upper extremities 4th ICS: lung disease 6th ICS: Liver and GB (R); stomach peristalsis (L) 7th ICS: Pancreas (R); Spleen (L) Periumbilical: bladder

Signs of TCA overdose

3 Cs: - Convulsions (anti-GABA effect) - Coma (anti-histamine effect) - Cardiac Conduction Irregularities (sodium channel blockade → QRS prolongation)

VitB3 deficiency

3 D's: Diarrhea, Dermatitis, Dementia

MEN I

3 Ps: Pancreatic, Parathyroid, Pituitary Tumors

PPD readings are + at 5mm for ____ 10mm for ____ 15 mm for ____

5mm: + for HIV or risk factors for HIV, those who have had close contact with TB patients, evidence of TB on CXR or a history of silicosis 10mm: + for homeless or indigent, residents of developing nations, IVDAs, health care workers and residents of health and correctional facilities 15mm: + for those with no known risk

Normal bereavement lasts no longer than

6 months (some sources say 1yr, but look for 4+ of SIG E CAPS if you suspect MDD)

Lochia post-partum - normal time frame; what color is it?

6 weeks; 1st week it's red (lochia rubra), 2nd week it's pink and thin (lochia serosa), rest of time it's yellow/white (lochia alba...lochia is simply shedding of decidua and blood)

Febrile seizure - what is the age cut-off?

6 years or younger get them

Tremor - hertz range for essential; hertz range for parkinson's?

6-10 Hz; 4-6 Hz

bone mineral density testing starts at age:

65

Female, DEXA screening - what age should it begin?

65 y.o.

DM II guidelines If A1C is between ____ and ____, add _____ to the regimen If A1C is above ______, add insulin

7-8.5%, add a sulfonylurea (glyburide) 8.5%

Suspected insulinoma, pt has low glucose, high C-peptide and high insulin levels - next dx step?

72 hour fast (persistence of hyperinsulinism confirms dx, test is stopped if glucose reaches 45 mg/dL...pro-insulin level is not necessary b/c don't suspect factitious hypoglycemia)

Meningitis - what age is the cutoff between mostly Streptococcus pneumonia prevalence to Neisseria meningitidis?

9 years

Which ribs protect the following organs - spleen; liver; kidneys

9-11 on L; 7-9 on R; 11-12

HIV infection - CD4 counts & prophylaxis: toxoplasmosis; pneumocystis jirveci pneumonia; mycobacterium avium complex?

< 100, TMP-SMX (pyrimethamine/sulfadiazine is for tx of toxoplasmosis); < 200, TMP-SMX; < 50, azithromycin or clarithromycin

complete abortion

<20 weeks, passage of all tissue, bleeding and cramping that has resolved and a CLOSED cervical os

ARDS presents with PaO2/FiO2:____ Pulse ox w/ O2: _____ CXR: ____ MCC of ARDS in hosp pts: ____

<200 NOT improved Pulmonary edema Sepsis

Epidural hematoma. Middle meningeal artery. Neurosurgical evacuation

A history significant for initial altered mental status with an intervening lucid interval. Diagnosis? Most likely etiology? Treatment?

Kwashiorkor (protein malnutrition)

A homeless child is small for his age and has peeling skin and a swollen belly.

1° hyperaldosteronism (due to Conn's syndrome or bilateral adrenal hyperplasia)

A patient complains of headache, weakness, and polyuria; exam reveals hypertension and tetany. Labs reveals hypernatremia, hypokalemia, and metabolic alkalosis.

Substance abuse

A patient continues to use cocaine after being in jail, losing his job, and not paying child support.

S. aureus or S. epidermidis.

A patient develops endocarditis three weeks after receiving a prosthetic heart valve. What organism is suspected?

Sheehan's syndrome (postpartum pituitary necrosis)

A patient fails to lactate after an emergency C-section with marked blood loss.

Coccidioidomycosis. Amphotericin B

A patient from California or Arizona presents with fever, malaise, cough, and night sweats. Diagnosis? Treatment?

Prinzmetal's angina

A young patient has angina at rest with ST-segment elevation. Cardiac enzymes are normal.

Hypertrophic cardiomyopathy

A young patient with a family history of sudden death collapses and dies while exercising.

SE of TCA

ABCDS (anti-cholinergic) - Anorexia - Blurred Vision - Confusion/Constipation - Dry mouth - Sedation and Urinary Stasis

How to distinguish Anemia of Chronic Dz from Iron Deficiency?

ACD: TIBC low, ferritin normal/high ID: TIBC high, ferritin low

CHF - drug that prolongs survival; other tx in acute exacerbation for sx relief only w/ EF 35%?

ACE inhibitor; furosemide & salt restriction

tx for berger's disease

ACEi's ARBs low dose steroids

Most common cause of Cushing's disease

ACTH secreting pituitary adenoma

Absolute indication for hemodialysis?

AEIOU - Acidosis → Metabolic acidosis - Electrolytes → Hyperkalemia - Intoxications → Lithium, ASA, Methanol, Ethylene Glycol - Overload → CHF - Uremia → Uremic pericarditis

Hemodialysis - absolute indications?

AEIOU...Acidosis (metabolic acidosis), Electrolytes (severe hyperkalemia), Intoxications (lithium, aspirin, methanol, ethylene glycol), Overload (CHF), Uremia (uremic pericarditis)

Pt presents with increased infection, anemia, thrombocytopenia, leukocytosis...BM bx stains with Sudan black and myeloperoxidase...Dx?

AML (*Auer Rods)

Most sensitive test for SLE

ANA

Pt w/ psoas syndrome presents w/ back pain - things that should be ruled out; tx steps?

Abscess, cauda equina, tumor, fracture; start w/ upper lumbar then go to psoas muscle itself (b/c psoas receives innervation from upper lumbar spine)

Alzheimer's disease - some sxs; most common cause of death; mild to moderate tx; moderate to severe tx?

Acalculia, anomia, depression, confusion, apraxia; aspiration pneumonia; anticholinesterase inhibitor (donepezil, rivastigmine); memantine (NMDA glutamate receptor antagonist)

30 cc/hour

Acceptable urine output in a stable patient.

50 cc/hour

Acceptable urine output in a trauma patient.

10 y.o. male has fever and sore throat last month, did not seek medical attention, sxs resolved 3 weeks ago. Now has jerking movements of hands and feet, joint pain that started in his right wrist and moved to his left elbow and knee - dx; tx?

Acute rheumatic fever (dx w/ 2 major criteria from J<NES [joints, carditis, nodes, erythema marginatum, Syndenham's chorea] plus 1 minor like throat cx or ASO titer); ALL pts get penicillin

High-dose aspirin for inflammation and fever; IVIG to prevent coronary artery aneurysms

Acute-phase treatment for Kawasaki disease.

Hereditary nephritis, sensorineural hearing loss, cataracts

Alport syndrome (mutation in collagen IV)

Lung CA - most common type in the world; types that are peripherally located; types that are centrally located

Adenocarcinoma (not associated w/ smoking); adenocarcinoma & large cell carcinoma; squamous cell carcinoma & small cell

49 y.o. pt from India with weight loss, night sweats and blood-tinged sputum, orthostatic hypotension, mild hypoglycemia, and hyperkalemia, CXR shows caseating granuloma in upper R lung field - dx; how do you confirm dx; tx?

Adrenal insufficiency 2/2 Tuberculosis (TB is most common cause of adrenal insufficiency worldwide); low cortisol level w/ no response to cosyntropin (ACTH analog); corticosteroid

Nocturnal enuresis - age cut-off for dx; first line tx?

After 5 years of age; conditioning w/ a bed pad and alarm (alarm or vibrating device goes off once moisture is detected)

Malingering

After a minor fender bender, a man wears a neck brace and requests permanent disability.

CHD risk factors

Age: men, >45, women, >55 Family hx of premature CAD: men < 55, women <65 Low HDL: < 40 HTN Smoker

Major SE of Clozapine

Agranulocytosis - weekly WBC count indicated *Never first line

23 y.o. @ 33 weeks gestation develops eclampsia, seized a few minutes ago - tx?

Airway management, IV magnesium sulfate, induce vaginal delivery, betamethasone (for fetal lung development, fetus < 34 weeks)

A pt is placed on haloperidol and develops jitteriness and inner restlessness - side effect name; tx?

Akathisia; propranolol or benzodiazepine

Guillain-Barre syndrome - CSF findings?

Albumincytologic dissociation (elevated CSF protein, normal WBC count)

Guillain-Barré (↑ protein in CSF with only a modest ↑ in cell count)

Albuminocytologic dissociation.

Neonate with smooth philtrum, microcephaly, and midfacial hypoplasia - likely teratogen exposure?

Alcohol

Primary hyperaldosteronism - first two lab tests à next step à next step à if last step was negative, next step?

Aldosterone concentration and plasma renin activity (PRA > 25 = hyperaldosteronism) à sodium (or fludrocortisone) loading test (if plasma aldosterone is not suppressed [i.e. > 10 ng/dL] = primary hyperaldosteronism) à abdominal CT (determine adenoma vs. hyperplasia) à adrenal vein sampling (to see if condition is on one side or both sides)

...

Alopecia Areata

Most malignant thyroid cancer

Anaplastic Thyroid Carcinoma

Fanconi's anemia

Anemia associated with absent radii and thumbs, diffuse hyperpigmentation, café-au-lait spots, microcephaly, and pancytopenia.

CA-125 and transvaginal ultrasound

Annual screening for women with a strong family history of ovarian cancer.

Most common location for compartment syndrome of the leg?

Anterior compartment (contains anterior tibial artery and deep fibular nerve)

Anterior "drawer sign" (+)

Anterior cruciate ligament injury

Most specific test for SLE

Anti-Smith or Anti DS-DNA

Most sensitive test for drug-induced SLE

Anti-histone

16 y.o. female undergoes D&C for missed abortion, 2 days later vaginal bleeding and abdominal pain, BP105/70, T 100.5, P105, R18, cervix dilated 2 cm w/ uterine tenderness - tx?

Antibiotics and D&C (septic abortion, may have retained products of conception)

Tetracycline, fluoroquinolones, aminoglycosides, sulfonamides

Antibiotics with teratogenic effects.

Heparin induced thrombocytopenia - what causes it?

Antibody to platelet factor 4 (activates platelets)

Tx for Urge Incontinence

Anticholinergics (e.g. oxybutynin)

MAOIs

Antidepressants associated with hypertensive crisis.

Acute mania - tx aside from lithium?

Antipsychotic (olanzapine), carbamazepine, valproic acid

Pleural effusion, exudative vs. transudative - dx criteria; causes of exudative; causes of transudative?

Any ONE of the three: ratio of pleural protein to serum protein > 0.5, ratio of pleural LDH to serum LDH > 0.6 or LDH > 200; lung CA, TB, pneumonia, asbestosis (anything that causes dmg to lung parenchyma); CHF, cirrhosis, constrictive pericarditis, nephrotic syndrome

Bounding pulses, diastolic heart murmer, head bobbing

Aortic regurgitation

Exercise stress treadmill with ECG

Appropriate diagnostic test? ■ A 50-year-old male with angina can exercise to 85% of maximum predicted heart rate.

Pharmacologic stress test (e.g., dobutamine echo)

Appropriate diagnostic test? ■ A 65-year-old woman with left bundle branch block and severe osteoarthritis has unstable angina.

5 hours after birth a neonate vomits blood - next step?

Apt test (determines if blood is of fetal or maternal origin, it checks hemoglobin)

Best diagnostic test for neonatal hematemesis?

Apt test → differentiates fetal/neonate blood from maternal blood

Test for neonatal hematemesis

Apt test-will determine origin of the blood

Pupil accommodates but doesn't react

Argyll Robertson pupil (neurosyphilis)

Reactive (Reiter's) arthritis. Associated with Campylobacter, Shigella, Salmonella, Chlamydia, and Ureaplasma

Arthritis, conjunctivitis, and urethritis in young men. Associated organisms?

Heart nodules (granulomatous)

Aschoff bodies (rheumatic fever)

Encapsulated organisms--pneumococcus, meningococcus, Haemophilus influenzae, Klebsiella

Asplenic patients are particularly susceptible to these organisms.

Acne vulgaris

Associated with Propionibacterium acnes and changes in androgen levels.

Obstructive sleep apnea is suspected, polysomnography is performed - how do you confirm dx?

At least five obstructive breathing events (apnea or hypopnea) per hour of sleep

Wernicke Encephalopathy - triad of sxs; tx?

Ataxia, confusion, eye disorders; thiamine

...

Atrial Flutter

65 y.o. female h/o rheumatic heart disease, 3 day h/o palpitations, ECG shown: - dx?

Atrial flutter

The incidence rate (IR) of a disease in exposed − the IR of a disease in unexposed

Attributable risk?

Azurophilic peroxidase (+) granular inclusions in granulocytes and myeloblasts

Auer rods (AML, especially the promyelocytic [M3] type)

Acute myelogenous leukemia (AML)

Auer rods on blood smear.

Hamstring tendon used for reconstruction of torn anterior cruciate ligament - example of what kind of graft?

Autograft (homograft is a graft from same species but different genetic makeup)

Dressler's syndrome: fever, pericarditis, ↑ ESR

Autoimmune complication occurring 2-4 weeks post-MI.

Fever, night sweats, weight loss

B symptoms (staging) of lymphoma

Newly prescribed lithium for a female - tests to order before beginning tx?

BUN/Cr, Thyroid function, pregnancy test (SEs include nephrogenic DI, hypothyroidism, and Ebstein's anomaly in a newborn)

Splinter hemorrhages in fingernails

Bacterial endocarditis

Recurrent oral and genital ulcers; may experience ocular and CNS involvement

Behcet's syndrome (Oral mucosa -->think Buccal/Behcet's)

Increased serum IgA that is seen within days of or with upper resp infection (may even be strep, but if C3 levels are normal, it is NOT post-strep!)

Berger's disease or IgA nephropathy

Best anti-HTN drug for gout? Worst?

Best: Losartan Worst: Diuretics

TOC for Akathisia ("inner restlessness")

Beta Blocker, Benzo, or Benztropine

Prevention of bleeds from esoph varicies tx of active bleeding of esoph varicies

Beta blocker Vasopressin and Octreotide for stable pts Variceal ligation for unstable pts Transjugular intrahepatic portosystemic shunt placement (TIPS)

Best anti-HTN drug for essential tremor/thyrotoxicosis/migraines?

Beta-Blockers

How is HOCM treated?

Beta-blocker or verapamil (non-dihydro)

avoid this class of drug in aortic regurg Give this drug combo

Beta-blockers Nitro (vasodil that will dec. afterload) and DA

When can a transvag U/S detect ain intrauterine gestational sac? Abd U/S?

BhCG >1500 (5 wks) BhCG >6500

Observational bias

Bias introduced into a study when a clinician is aware of the patient's treatment type.

Lead-time bias

Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death.

Duodenal atresia

Bilious emesis within hours after the first feeding.

Pt presents with alopecia, dermatitis, central/peripheral neuropathy, depression...likely deficiency?

Biotin

Pt w/ alopecia, dermatitis, depression, central and peripheral neuropathy and nausea/vomiting - deficiency of what mineral/vitamin?

Biotin

full blown mania +/- depression

Bipolar I

MDD + hypomania

Bipolar II

"Tennis racket"-shaped cytoplasmic organelles (EM) in Langerhans cells

Birbeck granules (Langerhans cell histiocytosis or histiocytosis X: eosinophilic granuloma)

Number of live births per 1000 population

Birth rate?

40 y.o. traveled to Wisconsin, fever, chest pain, severe arthralgia and non-pruritic verrucous skin lesions on the trunk - causative organism; tx?

Blastomyces dermatitidis (broad-based budding, triad of lung, skin and bone involvement); itraconazole

Screening test for lead toxicity in children?

Blood lead level

Lyme disease - etiologic organism; tx for ages 8 and over; tx < 8; insect vector?

Borrelia burgdorferi; doxycycline; amoxicillin; Ixodes tick

Crigler vs. Gilbert

Both have Uncong bili, but Criggler-najjar is a serious problem, not just icterus. It can lead to kernicterus. Treatment is phototherapy. Gilbert's is a mild case of jaundice that can be precipited by fasting. No treatment is necessary. (Basically on the test, if they make the pt seem like he has a disastrous disease, its C-N and you have to begin phototherapy. If they make it seem benign, its gilberts and just reassure the parents)

Rotor vs. Duben

Both have elevated Congugated bili, but Rotor will have high levels of urine coproporphyrin and coproporhyrin III; Duben = black liver/pigmented liver **Urobilinogenis formed by the breakdown of conj. bili

Delirium vs. Psychosis - how to differentiate?

Both have hallucinations, but in delirium alertness is impaired, while psychosis has intact alertness

Open-angle vs Closed-angle gloucoma

Both present with INCREASED cup-to-disk ratio/optic disk cupping on fundoscopic; Open: painless, gradual visual loss; Closed: PAINFUL, acute visual loss, rock-hard eye, frontal h/a's

Amyotrophic lateral sclerosis (ALS) - unique feature; tx that slows down progression; most common cause of death?

Both upper motor neuron and lower motor neuron signs; riluzole; aspiration pneumonia

Male child, recurrent infections, no mature B cells

Bruton disease (X-linked agammaglobulinemia)

RUQ pain, jaundice, ascites...Dx? Initial test? Diagnostic test?

Budd-Chiari Syndrome: thrombosis of hepatic vein or IVC - DX: initially Ultrasound, Venography to confirm - TX: Thrombolytics

29 y.o. female w/ severe RUQ pain, jaundice and hepatomegaly. US shows obliteration of hepatic vein, large collateral vessels, and ascites - dx, tx?

Budd-Chiari syndrome (thrombosis of hepatic vein or IVC 2/2 hypercoagulable state); tissue plasminogen activator

Abdominal pain, ascites, hepatomegaly

Budd-Chiari, syndrome (postepatic venousthrombbosis)

A permanent tooth gets knocked out and you are unable to reinsert it - methods of transporting tooth to dentist?

Buffered salt solution (best), saline, milk, under the pt's tongue (water is the worst way to transport)

Antidepressent with lowest risk of sexual SE

Buproprion

Sheets of medium-sized lymphoid cells with scattered pale, tingible body-laden macrophages ("starry sky" histology)

Burkitt lymphoma (t[8:14] c-myc activation, associated with EBV; "black sky" made up of malignant cells)

Bluish line on gingiva

Burton line (lead poisoning)

Nerve roots involved: Klumpke's: Erb-Duchenne's:

C8-T1 C5-C6

Klumpke's Paralysis - injury; presentation?

C8-T1 nerves; Horner's syndrome, paralysis of intrinsic muscles of the hand & ulnar nerve distribution numbness

Herrniated disc between C7/T1 will affect which nerve root?

C8: weakness in hand grip, sensation changes in the medial aspect of the arm and into the medial hand (pinky finger)

Infant with hypospadias scheduled for circumcision...what should you do?

CANCEL the circumcision

Best anti-HTN drug for Raynaud's?

CCB

ppx for cluster h/a's

CCBs prednisone valproic acid topiramate ergotamin

How do we determine to start a pt on anticoagulation for a fib?

CHADS2 Score - CHF, HTN, Age 75+, DM, Stroke - 2 or more = anticoagualtion CHADS2 VASc Score - Vascular dz, Age 65-74, Female sex

When to start a statin?

CHD or Equivalent: LDL 130+ 2+ RF: LDL 160+ (10yr risk 10-20%), 190+ (10yr risk <10%) 0-1 RF: LDL 190+

after diagnosing and starting inital tx of a PCC, what do you do next?

CHECK FOR OTHER MEN PATHOLOGIES!!!!! CHECK A CALCIUM LEVEL!!!!!

BM bx shows smudge cells...CD5+ lymphocytes...dx?

CLL

WBCs that look "smudged"

CLL (almost always B cell)

Which TORCH infection has... periventricular calcifications on head CT?

CMV

Uncal herniation will affect __________ Central herniation will cause tonsilar herniation

CN III (ipsi dilated pupil that cannot constrict to light) AMS and possible tear of the basilar a. causing a fatal Duret hemorrhage or Cheyne-Stokes breathing (cycling between apnea and tachypnea) compression of the medulla causing cardiac and respiratory problems

Elevated ICP, RBCs, xanthochromia

CSF findings with SAH.

Bacterial meningitis

CSF findings: ■ Low glucose, PMN predominance

Aseptic (viral) meningitis

CSF findings: ■ Normal glucose, lymphocytic predominance

Subarachnoid hemorrhage (SAH)

CSF findings: ■ Numerous RBCs in serial CSF samples

MS

CSF findings: ■ ↑ gamma globulins

RCC: Dx and staging modality: ____ Most often a/w: ____ Labs: _____

CT Smokers over 50 y/o Polycythemia, hypercalcemia

Acute pancreatitis - dx test of choice?

CT scan

dx of thoracic AA

CT with contrast

Boerhaave's Syndrome - initial diagnostic test?

CXR (pneumomediastinum)

Neurofibromatosis 1

Café-au-lait spots on skin.

Antidote for Magnesium toxicity

Calcium gluconate

Disarrayed granulosa cells in eosinophilic fluid

Call-Exner bodies (granulosa-theca cell tumor of the ovary)

Newborn w/ hypospadias is scheduled for circumcision - next step?

Cancel circumcision as foreskin may be needed for urethral and penile reconstruction

Woman 40 y.o. - most common cause of death at her age?

Cancer (for men same age it's trauma...women 35-74 is cancer, 65+ is cardiovascular)

Painless jaundice

Cancer of the pancreatic head obstructing bile duct

Woman is exclusively breast feeding, present with pain in breast...shiny skin of nipple with peeling at the areola...likely organism?

Candida albicans

AIDS-defining diseases

Candidiasis of esophagus, lungs, trachea (NOT thrush), cryptococcal infection, intestinal isosporiasis or cryptosporidiosis, Kaposi's sarcome, cerebral lymphoma, PCP, cerebral toxo, invasive cervical cancer, HIV wasting syndrome

Third-degree heart block

Cannon "a" waves.

Group of physicians contract w/ an HMO for a flat fee per pt - term described?

Capitation

Newborn s/p prolonged labor presents with firm, non-pitting edema of the occiput that crosses suture lines...likely dx?

Caput succedaneum

TOC for Trigeminal Neuralgia

Carbamazapine

Otitis externa - most common organisms; tx?

S. aureus & p. aeruginosa; topical ciprofloxacin plus hydrocortisone otic

Leukocoria - which 2 conditions?

Cataracts or retinoblastoma

Drugs and preg

Category A: Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters). Category B: Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women OR animal studies which have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester. Category C: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. Category D: There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

Asherman's syndrome

Cause of amenorrhea with normal prolactin, no response to estrogen-progesterone challenge, and a history of D&C.

Think of leaky capillaries. Malignancy, TB, bacterial or viral infection, pulmonary embolism with infarct, and pancreatitis

Causes of exudative effusion.

Right-to-left shunt, hypoventilation, low inspired O2 tension, diffusion defect, V/Q mismatch

Causes of hypoxemia.

Think of intact capillaries. CHF, liver or kidney disease, and protein-losing enteropathy

Causes of transudative effusion.

TOC for meningitis for bacterial meningitis

Ceftriaxone + Vancomycin + Steroids (+ Ampicillin if elderly/immunocompromised)

Anti-transglutaminase/anti-gliadin/anti-endomysial antibodies

Celiac disease (diarrhea, distention, weight loss)

Tx for PID/salpingitis

Ceph and doxy to treat N. gon and Chlam (or any BSAs)

Newborn s/p prolonged labor presents with firm, non-pitting edema of the occiput that does NOT cross suture lines...likely dx?

Cephalhematoma - Blood beneath periosteum

Neonate delivered via vacuum-assisted delivery, edema of the head is found - cephalhematoma vs. caput succedaneum vs. subgaleal hemorrhage?

Cephalhematoma is firm, nonpitting and does NOT cross suture lines; caput succedaneum is firm, nonpitting and crosses suture lines; subgaleal hemorrhage is boggy

Timing of the following neonatal conjunctival infections: 1. Chemical 3. Inclusion/Chlamydial 3. Viral/HSV 1 and 2 2. Gonorrheal

Chemical- first 24 hrs (tx with saline flush) Inclusion/Chlamydial- 5-14 days of age (mucopurulent d/c, palpebral erythema, tx with erythromycin) Viral/HSV 1 and 2- 6-14 (clear d/c, lid edema, conjunctival erythema) Gonorrheal- 2-7 days (purulent d/c, cloudy cornea)

TOC for Small Cell Lung ca.

Chemotherapy +/- Radiation

What is a Klatskin tumor?

Cholangiocarcinoma occuring at the confluence of the hepatic ducts

Fat, female, forty, and fertile

Cholelithiasis (gallstones)

Treatment of choice for pruritis caused by cholestasis (e.g. Primary Biliary Cirrhosis)?

Cholestyramine or Colestipol

hCG elevated

Choriocarcinoma, hydatidiform mole (occurs with and without embryo, and multiple pregnancy)

46,XX

Chromosomal pattern of a complete mole.

Pt w/ h/o peripheral vascular disease, peptic ulcer disease and GERD loses 20 lbs. unintentionally in 6 months, has excruciating pain after eating, esp. fatty foods & has an abdominal bruit - dx; test to confirm dx?

Chronic intestinal ischemia (usu. in pt w/ atherosclerosis, will have abdominal bruit, loses weight by not eating to avoid pain); angiogram

Pt h/o multiple episodes of acute pancreatitis - difference between chronic pancreatitis and pseudocyst; what will you find if it is hemorrhagic pancreatitis?

Chronic pancreatitis has pancreatic insufficiency (triad of diabetes, steatorrhea and pancreatic calcifications); Cullen's and Grey Turner's sign

"Nutmeg" appearance of liver

Chronic passive congestion of liver due to right heart failure

Pt presents with allergic rhinitis, asthma, blood eosinophilia, + PANCA (anti-myeloperoxidase)...Dx?

Churg-Strauss (allergic granulomatosis)

Facial muscle spasm upon tapping

Chvostek sign (hypocalcemia)

Hypocalcemia

Chvostek's and Trousseau's signs.

Large lysosomal vesicles in phagocytes, immunodeficiency

Chédiak-Higashi disease (congenital failure of phagolysosome formation)

Medical management of PVD

Cilostazol

Epididymitis - tx > 35 y.o.; tx < 35 y.o.

Ciprofloxacin; azithromycin (or doxycycline) & ceftriaxone

Antipsychotics (neuroleptic malignant syndrome)

Class of drugs that may cause syndrome of muscle rigidity, hyperthermia, autonomic instability, and extrapyramidal symptoms.

Cardiomegaly, prominent pulmonary vessels, Kerley B lines, "bat's-wing" appearance of hilar shadows, and perivascular and peribronchial cuffing

Classic CXR findings for pulmonary edema.

Low-voltage, diffuse ST-segment elevation

Classic ECG findings in pericarditis.

TB medications (INH, rifampin, pyrazinamide), acetaminophen, and tetracycline

Classic causes of drug-induced hepatitis.

Fever, heart murmur, Osler's nodes, splinter hemorrhages, Janeway lesions, Roth's spots

Classic physical findings for endocarditis.

Snowstorm on ultrasound. "Cluster-of-grapes" appearance on gross examination

Classic ultrasound and gross appearance of complete hydatidiform mole.

[OMM] Chapman's point - middle ear?

Clavicle

Surgical wound - classification?

Clean (uninfected), clean-contaminated (controlled entry without unusual contamination), contaminated (accidental/surgical wound), dirty (pre-existing infxn)

Most common cause of meningitis in adults

S. pneumonia

28 y.o. male w/ unilateral headaches and "watery" eyes especially in the winter - dx; acute tx; prophylactic tx?

Cluster headache; 100% oxygen; verapamil, prednisone, topiramte, or valproic acid

Pt w/ headache that started yesterday, BP in both arms is 180/110, both legs 100/75, CXR shows a figure-3 sign - dx?

Coarctation of aorta distal to the L subclavian artery (NOT descending aorta...dilation of proximal and distal parts of aortic coactation create a "figure-3 sign"

Angle that defines scoliosis Management with bracing is for angles between ____ & ____ Sugery is indicated for _____

Cobb angles of >10 degrees b/w 26 and 44 degrees can be managed with bracing Angles >60 degrees (cardiopulm. compromise)

Withdreawal sx: dysphoria, excessive sleep, hunger

Cocaine and amphetamine

Pt who recently traveled to AZ has a cough and bx of erythema nodosum reveals spherules filled w/ endospores - dx?

Coccidioidomycosis (caused by Coccidioides immitis)

Cohort study vs. case-control study - which is prospective?

Cohort study (forward-looking observational study...case-control is retrospective and has recall bias)

Incidence and prevalence

Cohort study—incidence or prevalence?

Painful blue fingers/toes, hemolytic anemia

Cold agglutinin disease (autoimmune hemolytic anemia caused by Mycoplasma pneumoniae, infectious mononucleosis)

Mycoplasma

Cold agglutinins.

Normal

Cold water is flushed into a patient's ear, and the fast phase of the nystagmus is toward the opposite side. Normal or pathological?

Pt diagnosed with IE caused by S. bovis - what additional test should also be done?

Colonoscopy *S. bovis associated with IE and colorectal cancer!

CHF, shock, and altered mental status

Common symptoms associated with silent MIs.

Fugue state - what is it?

Commonly follows a stressor and includes sudden travel, amnesia, & assumption of a new identity

tx for uncomplicated diverticulitis

Coverage for G-'s and anaerobes FQ with metronidazole amoxi-clav TMP-SMX and metronidazole

Intranuclear eosinophilic droplet-like bodies

Cowdry type A bodies (HSV or CMV)

Child uses arms to stand up from squat

Cowers sign (Duchenne muscular dystrophy)

Avascular necrosis

Complication of scaphoid fracture.

Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse

Conditions in which confidentiality must be overridden.

Smooth, flat, moist, painless white lesions on genitals

Condylomata lata (2° syphilis)

Wernicke's encephalopathy due to a deficiency of thiamine

Confusion, confabulation, ophthalmoplegia, ataxia.

Benign elevated urine urobilinogen - what physiologic process is occurring?

Conjugated hyperbilirubinemia (Dubin-Johnson or Rotor syndrome, usu. asx)

Electrolyte disturbance seen in Conn syndrome?

Conn syn: Primary hyperaldosteronism, will have a metabolic alkalosis

Pericardial knock, DOE, JVD and an increase in JVP with inspiration, normal myocardial bx....Dx?....Tx?

Constrictive pericarditis Surgery

Tx for Boerhaave's Syndrome

Contained Perf: NPO, NG suction, IV fluids, IV abx Free Perf: Surgery

Surgical Terminology: Contaminated Dirty

Contaminated-open, fresh, accidental wounds or surgical wound with major break in sterile technique or spillage from GI tract Dirty-old, traumatic wounds or operative fields with pre-existing infection

OCP and barrier contraception

Contraceptive methods that protect against PID.

Retropharyngeal abscess - dx test; what does the test differentiate; tx; tx if that fails or abscess is very large

Contrast CT of the neck; retropharyngeal abscess vs. retropharyngeal cellulitis; clindamycin & ampicillin-sulbactam; surgical drainage

Neutropenia and hypochromic anemia - deficiency of which mineral can explain?

Copper

Pt presents with neutropenia, hypochromic anemia, osteoporosis...likely deficiency?

Copper

20 month old found in kitchen with unlabeled canister is drooling, has white eschars of tongue and soft palate, frequently coughs - what did the baby ingest; next step?

Corrosive akali like drain cleaner (white eschars are burns); upper endoscopy (evaluate extent of injury, i.e. esophageal perf that would require abx and surgery)

Labyrinthitis - tx?

Corticosteroids

High level of d-dimers

DVT, PE, DIC

Klumpke's paralysis?

Damage to C8-T1 - Paralysis of intrinsic hand muscles - Ulnar N distribution numbness - Horner's syndrome

Multiple Myeloma - anion gap change; why?

Decreased anion gap; 2/2 positive-charged immunoglobulin or hypoalbuminemia

Lesch-Nyhan syndrome (purine salvage problem with

Defect in an X-linked syndrome with mental retardation,

Anti-topoisomerase antibodies

Diffuse systemic scleroderma

MC location of a somatostatinoma

Delta cells of the panc and the Duodenum

Tx for SIADH

Demeclocycline (causes nephrogenic DI)

Polymyositis vs. dermatomyositis - 3 key differences?

Dermatomyositis has heliotrope rash, Gottron's sign (red papules on dorsum of PIP and MCP) & Shawl sign (red shoulder/back/neck)

High reliability, low validity

Describe a test that consistently gives identical results, but the results are wrong.

Counterstrain (indirect) Describe the location of anterior tender points

Described as either A or P for ant or post, then the region of the body is indicated: C for cervical, T for Thoracic, R for ribs, and L for lumbar AT1-6 are located on the sternum AT7-12 are located on the abd wall, about 1" to 2" lateral to midline

TOC for central DI?

Desmopressin

Tx for Central DI

Desmopressin

Diabetes Insipidus - tx central first line and second line; tx nephrogenic; abx that can induce nephrogenic DI?

Desmopressin (first line), chlorpropramide (second line); reduced Na+ intake & thiazide; demeclocycline

Pt w/ von Willebrand Disease has increased bleeding time and prolonged PTT - tx?

Desmopressin (increases circulating levels of vWF and factor VIII)

Croup - tx?

Dexamethasone

Neonate born at 29 weeks has an interrupted aortic arch, large VSD, cleft palate, twitching movements of the face and hypocalcemia - dx; what is the defect?

DiGeorge syndrome; deletion of 22q11.2

besides increased E, what increases risk of endometrial ca? what decreases it?

Diabetes Smoking

Osmotic fragility test

Diagnostic test for hereditary spherocytosis.

Echocardiogram (showing thickened left ventricular wall and outflow obstruction)

Diagnostic test for hypertrophic cardiomyopathy.

Seizure vs. syncope - good question to differentiate the two?

Did the pt lose bladder control? (yes for seizure, usu. tonic-clonic)

Cohort studies can be used to calculate relative risk (RR), incidence, and/or odds ratio (OR). Case-control studies can be used to calculate an OR

Difference between a cohort and a case-control study.

Cirrhosis, CHF, nephritic syndrome

Differential of hypervolemic hyponatremia.

Barium swallow shows: - dx; tx?

Diffuse esophageal spasm; diltiazem

[OMM] Soft tissue technique - direct or indirect; what does it entail?

Direct; employs separation of origin and insertion and deep pressure

Dx for benign paroxysmal positional vertigo: Tx: Benign positional vertigo

Dix-Hallpike maneuver Epley maneuver

What is the "double bubble sign"?... "Bird's Beak"?

Double Bubble Sign: Duodenal obstruction Bird's Beak: tapering, compression, torsion

Decreased AFP in amniotic fluid/maternal serum

Down syndrome or other chromosomal abnormality

Quad screen profile of trisomy 21? 18?

Down's: Low: AFP and Estradiol High: Inhibin A and hCG Edwards: all 4 are decreased

Chest pain, pericardial effusion/friction rub, persistent fever following MI

Dressler syndrome (autoimmune-mediated post-MI fibrinous pericarditis, 1-12 weeks after acute episode)

Uremic syndrome seen in patients with renal failure

Drowsiness, asterixis, nausea, and a pericardial friction rub.

Genetic causes of conjugated hyperbilirubinemia?

Dubin-Johnson syndrome & Rotor syndrome (DJS black liver, can't visualize gallbladder on oral cholecystography, urine coproporphyrin I 80%...reverse is true for Rotor and 80% coproporphyrin III)

What is a Curling's Ulcer

Duodenal ulcer that occurs acutely after a burn

The 4 Ds of Medical Malpractice

Duty, Dereliction, Damage, Direct causation

Adson's test - what is it for; how do you do it?

Dx thoracic outlet syndrome @ scalenes; extend elbow, abduct arm and externally rotate (positive if neurovascular bundle is compromised)

Pt c/o muscle weakness...PE shows muscle atrophy, fasiculations, hyperreflexia...likely dx?...tests?...Tx?

Dx: ALS (motor ONLY, UMN and LMN signs) Tests: EMG, nerve conduction studies to r/o other dz Tx: Riluzole (blocks Na channels associated with neurone damage) slows progression/requirement for ventilator dependent tracheostomy

Pt with h/o Sickle Cell disease presents with fever, chest pain, tachypnea, wheezing, hypoxia and right middle lobe infiltrate on CXR...likely Dx?...Tx?

Dx: Acute Chest Syndrome Tx: Blood transfusion (target Hgb no greater than 10), abx (3rd gen. Cephalosporin + Macrolide), venous thromboembolism ppx, supportive tx (fluids, pain control, respiratory aids)

Pt has h/o prolonged prednisone treatment...presents with hypotension, abdominal pain...likely dx? What additional findings are likely?

Dx: Adrenal Insufficiency (secondary to glucocorticoid discontinuation) Labs: Hyponatremia, hypoglycemia (due to hypocortisolism) **NOT hyperkalemia or hyperpigmentation (these are only present in primary adrenal insufficiency)

Pt presents with pleuritic chest pain relieved by leaning forward...currently taking procainamide for atrial flutter...likely dx? ECG findings? Tx?

Dx: Procainamide-induced lupus pericarditis EKG: diffuse ST elevations, PR depressions Tx: NSAIDs + remove offending agent

Pt presents with fever, weight loss, hematuria, flank pain, and palpable flank mass...Dx?...Lab Findings?

Dx: Renal Cell Carcinoma Labs: Paraneoplastic syndromes → hypercalcemia (PTH-like hormone), Polycythemia (EPO), HTN (Renin), Cushing's (Cortisol)

Pt presents with hyponatremia, low serum osmolality, and low urine volume...Dx?...Tx?

Dx: SIADH Tx: Always start with fluid restriction → 0.9% saline + furosemide → demeclocycline

abd pain, diarrhea, steatorrhea, cholelithiasis, DM...Dx? Tx?

Dx: Somatostatinoma causing somatostatinoma syndrome; CT Tx: surgical resection

Pt presents with severe back pain, UMN signs, decreased sensation, incontinency...Dx?...Tx

Dx: Spinal Cord Compression Tx: Steroids

Pt presents with lumbar back pain that radiates to buttocks and thighs and is relieved with flexion...likely Dx? Most accurate test? Tx?

Dx: Spinal Stenosis Test: MRI Tx: Weight loss

Cirrhotic pt presents with abdominal pain, fever, ascites; paracentesis yeilds PMN leukocyte count of 350...likely dx? Tx?

Dx: Spontaneous Bacterial Peritonitis Tx: 3rd Gen. Cephalosporin (remember, PMN > 250)

Pt who recently had a viral infection presents with PAINFUL, diffusely enlarged thyroid gland, dec. TSH, inc. T4...Dx? Tx? Mechanism for hyperthyroidism?

Dx: Subacute GRANULOMATOUS Thyroiditis (aka DeQuervain's Thyroiditis) Tx: NSAIDS MOA: Inflammatory process causes release of stored hormones (will show DECREASED uptake of radioactive iodine)

Pt presents to ER after a syncopal episode that occurred while she was chopping vegetables, BP 128/72 in R arm, 89/45 in L arm...likely Dx? Mechanism? Dx test? Tx?

Dx: Subclavian Steal Syndrome MOA: Obstruction of subclavian artery proximal to vertebral artery; when arm is exercised, blood flows backward through vertebral artery into subclavian artery

Pt with h/o varicose veins presents with painful area of cordlike, erythematous induration...Dx?...Tx?

Dx: Superficial thrombophlebitis Tx: NSAIDS, elevation, heat, support stockings, f/u PE in 1 week to r/o progression to DVT

Pt presents with jaw pain when chewing food, scalp tenderness just above the right ear...likely Dx? Test for Dx? Tx?

Dx: Temporal (Giant Cell) Arteritis Test: Temporal artery bx (immediately!) Tx: High dose prednisone (immediately! X 2yrs) Urgent - may lead to irreversible blindness Associated with polymyalgia rheumatica (proximal muscle pain)

Pt presents with hypopigmented macules noticed after sun exposure...Dx? Bug? Tx?

Dx: Tinea Versicolor Bug: M. furfur (Pityrisporum ovale) - "spaghetti and meatballs" on KOH prep Tx: Selenium sulfide, topical terbinafine or ketoconazole, oral ketoconazole

Child presents with acute onset of testicular pain in the superior pole of the testicle...PE reveals swollen testes with a blue dot on the superior pole...Dx?...Tx?

Dx: Torsion of appendix testis *Blue dot sign is pathognomonic Tx: Pain control, bed rest, scrotal support

Intussusception: Dx? Tx?

Dx: Ultrasound in non-classic presentations Tx: Pneumatic Enema

Pt presents with cough, sore throat, erythematous tonsils without exudate, T 100.1F...likely dx? Tx?

Dx: Viral pharyngitis Tx: Supportive

Pt presents with bruises/epistaxis/menorrhagia...normal PT, prolonged PTT, prolonged bleeding time, normal platelet count...Dx? Tx?

Dx: Von Willebrand Disease (vWF responsible for primary hemostasis by binding platelets/endothelium, also is a carrier for Factor VIII) Tx: Desmopressin

Pt presents with recurrent ulcers has elevated gastrin despite secretin injection...likely dx? Tx?

Dx: Zollinger-Ellison Syndrome Tx: PPI

Eclamptic pt given mag sulfate --> hypreflexia, difficulty breathing, weakness, paralysis...Dx and Tx?

Dx? Hypermagnesemia/ mag toxicity Tx: IV calcium gluconate; dialysis for renal failure pts

Pain upon defecation - term?

Dyschezia

Sx of Cocaine/Amphetamine withdrawal

Dysphoria, Excessive Sleep, Hunger

Cocaine and amphetamine withdrawal - sxs?

Dysphoria, excessive sleep, and hunger

Sarcoidosis

Dyspnea, lateral hilar lymphodenopathy on CXR, noncaseating granulomas, increased ACE, and hypercalcemia.

HIV - most sensitive test for dx; most specific test for dx; tx for cryptococcal meningitis

ELISA; Western blot; Intrathecal amphotericin B (it doesn't cross the blood-brain barrier)

ALS - dx test?

EMG (confirms lower motor neuron lesions, r/o myasthenia gravis, MS, carpal tunnel, Guillain-Barre)

Work-up for suspected ALS?

EMG and nerve conduction studies (r/o myesthenia, MS, carpal tunnel syn., and Guillain-Barre) *EMG can only confirm LMN lesiosn

Osteomyelitis, IV abx started - labs used to monitor progress?

ESR & CRP (WBC is normal in 50% of pts w/ osteomyelitis)

Elastic skin, hypermobility of joints

Ehlers-Danlos syndrome (type III collagen defect)

Oral surgery—amoxicillin; GI or GU procedures—ampicillin and gentamicin before and amoxicillin after

Endocarditis prophylaxis regimens.

"Chocolate cyst" of ovary

Endometriosis (frequently involves both ovaries)

Uterine tenderness and fever s/p C-section 2 days ago - dx?

Endometritis

Most common cause of Post-Partum Fever?

Endometritis (will also have uterine tenderness) - TX: broad spectrum abx

TOC of actively bleeding esophageal varices?

Endoscopic sclerotheray or IV somatostatin/octreotide

Large rash with bull's-eye appearance

Erythema chronicum migrans from Ixodes tick bite (Lyme disease: Borrelia)

Lesion of 1° Lyme disease

Erythema migrans.

Pt c/o rash on palms and soles...dx?

Erythema multiforme minor - target-like - most commonly associated with HSV

Pt presents with painful lumps on b/l shins following a flu infection...dx?

Erythema nodosum - septal panniculitis - associated with infection, autoimmune dz (sarcoidosis, IBD)

Pt w/ community acquired pneumonia, getting better w/ ceftriaxone and azithromycin, day 2 develops low TSH, low T3, and normal T4 - dx; tx?

Euthyroid sick syndrome; No tx necessary (goes away w/ underlying illness)

SIADH has what volume status and sodium concentration

Euvolemic hyponatremia

Mucosal bleeding and prolonged bleeding time

Glanzmann thrombasthenia (defect in platelet aggregation due to lack of GpIIb/IIIa)

Describe the temporal bone movement and associated chin placement

External rotation --> chin toward the externally rotated temporal bone Internal rotation --> chin away from the internally rotated temporal bone

Uveitis, ankylosing spondylitis, pyoderma gangrenosum, erythema nodosum, 1° sclerosing cholangitis

Extraintestinal manifestations of IBD.

Rheumatoid arthritis - characteristic pleural fluid finding?

Extremely low pleural fluid glucose level

Confirmatory labs for menopause

FSH>>LH

Unilateral facial drooping involving forehead

Facial nerve (LMN CN VII palsy)

Achilles tendon xanthoma

Familial hypercholesterolemia (Decreased LDL receptor signaling)

4 y.o. female w/ rash of 3 days has had fatigue for 3 months. She is below the 5th percentile for height, has recurrent URIs and rudimentary thumbs at birth. Physical shows multiple tan-colored macules measuring >1 cm in size and multiple, small, red spots measuring 1-2 mm on the lower abdomen - dx?

Fanconi anemia (bone marrow failure, thumb abnormalities, multiple café-au-lait spots, renal anomalies, microcephaly, and short stature)

Short stature, increased incidence of tumors/leukemia, aplastic anemia

Fanconi anemia (genetic loss of DNA crosslink repair; often progresses to AML)

Polyuria, renal tubular acidosis type II, growth failure, electrolyte imbalances, hypophosphatemic rickets

Fanconi syndrome (proximal tubular reabsorption defect)

Number of deaths from 20 weeks' gestation to birth per 1000 total births

Fetal mortality?

Blood transfusion results in acute hemolytic reaction due to ABO incompatibility - physical findings?

Fever, flank pain, red/brown urine (Hb in urine...tx IV fluids to protect kidneys)

filtration fraction

Filtration fraction = GFR / RPF

Amoxicillin × 10 days

First-line treatment for otitis media.

Lichen planus

Flat-topped papules.

[OMM] T9 ESL - setup for Muscle Energy?

Flex, sidebend R, rotate R

[OMM] Rib 3 anterior tenderpoint - tx position?

Flexed, sidebent and rotated towards (counterstrain of ribs: anterior point = "depressed," posterior point = "elevated")

[OMM] SBS movement - which motion decreases AP diameter?

Flexion of SBS

[OMM] Primary respiratory mechanism - 5 components?

Fluctuation of CSF, Inherent mobility of brain and spinal cord, Articular mobility of cranial bones, Mobility of intracranial and intraspinal membranes & involuntary mobility of sacrum between ilia

Tourette syndrome - tx?

Fluphenazine or haloperidol (typical antipsychotic)

Female of reproductive age has a hepatic tumor with a central scar on imaging. Dx? Tx?

Focal Nodular Hyperplasia NOT associated with OCPs No further management required

35 y.o. female on OCPs has a 2cm hepatic tumor, US shows a central scar - dx; tx?

Focal nodular hyperplasia; no tx (central scar differentiates it from hepatic adenoma and cavernous hemangioma, d/c of OCPs advised for both conditions)

hunters eating rabbit meat or squirrels

Francisella tularens

TNM for breast ca:

For breast cancer, the TNM staging system is used. Stage I disease involves a tumor less than 2cm in size Stage II consists of a tumor 2-5cm in size. Stage III breast cancer involves axillary lymphadenopathy Stage IV disease includes distant metastasis

Jones Criteria

For diagnosis of Rheumatic Fever (2 M OR 1M+2m) Major: J<3NES - Joints (migratory polyarthritis) - Carditis - Nodules (subcutaneous, painless) - Erythema marginatum - Syndenham's chorea Minor: - Fever - Leukocytosis - Elevated ESR or CRP - EKG showing heart block Tx: PENICILLIN

Forward sacral torsions cause Type ___ mechanics at L5 Backward sacral torsions cause Type ___ mechanics at L5

Forward w/ Type I at L5 (neutral) Backward w/ Type II at L5 (F or E)

Fever, pharyngeal erythema, tonsillar exudate, lack of cough

Four signs and symptoms of streptococcal pharyngitis.

55 y.o. male w/ severe groin pain, "pain is unbearable," recently tx'ed for perirectal abscess, has 20 yr h/o diabetes, T101.5, erythema, swelling and severe tenderness on palpation of scrotum, no fluctuance - dx?

Fournier gangrene (necrotizing soft tissue infxn of male genitals and perineum, much more painful than orchitis)

Most common cause of inherited mental impairment/retardation

Fragile X Syndrome Look for mental impairments, elongated face, large ears, macroorchidism

TTP (thrombotic thrombocytopenic purpura) - tx?

Fresh Frozen Plasma (urgent exchange)

Organism involved in: Necrotizing fasciitis and Scarlet Fever, and Erysipiles, Strep phar

GAS (Strep. pyogenes)

Most common cause of meningitis in neonates

GBS

Si/Sx and Mgmt of neonate with...Galactosemia?...PKU?...Homocystinuria?

Galactosemia: deficiency of galactosei-1-phosphate uridyl transferase enzyme - Si/Sx: FTT, cataracts, liver dz - Tx: Avoid dietary glucose PKU: deficiency of phenylalanine hydroxylase - Si/Sx: Mental retardation, "musty odor", hypopigmentation - Tx: Avoid dietary phenylalanine; administer tetrahydrobiopterin Homocystinuria: disorder of methionine metabolism - Si/Sx: Tall stature, lens subluxation, mental retardation, osteoporosis, hypercoaguability - Tx: Vit B6 replacement for life

Multiple colon polyps, osteomas/soft tissue tumors, impacted/supernumerary teeth

Gardner syndrome (subtype of FAP)

Pt presents with hundreds of adenomatous polyps in colon, osteoma of the mandible, desmoid tumors and dental abnormalities...Dx?

Gardner's Syndrome

Pt w/ 500 adenomatous polyps on colonoscopy, multiple lipomas throughout body and osteoma on the skull - dx?

Gardner's syndrome (Turcot's syndrome is FAP + CNS tumors)

What is a Cushing's Ulcer

Gastric/duodenal ulcer that is caused by elevated ICP

Dx test for suspected esoph perf (i.e. Boerhaave's syndrome)

Gastrografin swallow (H2O soluble)

Hepatosplenomegaly, osteoporosis, neurologic symptoms

Gaucher disease (glucocerebrosidase deficiency)

Buspirone - what is it used for?

Generalized anxiety disorder

Osteogenesis imperfecta

Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.

Testicular turmor markers

Germ cell tumors: Seminomas and non-seminomas Seminomas: hCG increased Non-seminomatous: Embryonal: AFP increased and hCG increased Yolk Sac: AFP only _____________________________________________ Stromal cell tumors (Leydig, sertoli, or granulosa cells)- estrogen or testosterone

Rubella is aka _______ and is caused by this virus

German measles, Togavirus

Hilar lymphadenopathy, peripheral granulomatous lesion in middle or lower lung lobes (can calcify)

Ghon complex (1° TB: Mycobacterium bacilli)

"Soap bubble" in femur or tibia on x-ray

Giant cell tumor of bone (generally benign)

post exposure ppx for Tetanus: ppx for Tetanus:

Give Tdap if wound is sever, unclean, immunization status is unknown, or it has been >5 yrs; For tetanus prone wounds (a/w soil), also give Tetanus Immune Globulin Td is given q10 yrs

target-like lesions on the hands and feet, puritic

HSV

risks for placental abruption

HTN cocaine

Anemia, thrombocytopenia, and acute renal failure

HUS triad?

Type IV RTA

HYPOaldosteronism - Hyponatremia - Hyperkalemia - Common causes: diabetic nephropathy, interstitial nephritis - Tx: loop or thiazide diuretic +/- sodium bicarbonate

amphetamine OD or delerioius pt

Haldol (vitamin "H"!!)

Adult Parkland formula

Head: 9% Upper extremities: 18% Trunk: 36% Lower extremities: 36%

Intracellular inclusions seen in thalassemia, G6PD deficiency, and postsplenectomy

Heinz bodies?

Gastric adenocarcinoma - which 2 organisms can cause it; which blood type?

Helicobacter pylori and Epstein-Barr virus; blood type A

Vascular birthmark (port-wine stain)

Hemangioma (benign, but associated with Sturge-Weber syndrome)

Renal cell carcinoma (RCC)

Hematuria, flank pain, and palpable flank mass.

Nephritic syndrome

Hematuria, hypertension, and oliguria.

Dx of HELLP syndrome

Hemolysis Elevated Liver enzymes Low Plateles

Normal platelet count, BT, and PT; increased PTT Dx? Cause of increased PTT?

Hemophilia A deficiency in factor 8

Pt present w/ stab wound to the chest, diminished breath sounds and dullness to percussion, otherwise stable - dx; next step?

Hemothorax; CXR (to confirm dx in stable pt, tube thoracostomy for drainage)

Pt presents with abdominal pain, hematuria, and palpable purpura on buttocks...likely dx?

Henoch-Schonlein Purpura

Palpable purpura on buttocks/legs, joint pain, abdominal pain (child), hematuria

Henoch-Schönlein purpura (IgA vasculitis affecting skin and kidneys)

Polyarteritis nodosa - which infxn is it closely associated with; which organ does it spare compared to other vasculitides; characteristic neurological finding?

Hepatitis B (can look like livedo reticularis); lungs; mononeuritis multiplex (multiple peripheral nerves affected)

...

Hereditary Spherocytosis! Confirm with osmotic fragility test TOC: Splenectomy with ppx pneumococcal vaccine

Femoral hernia

Hernia with highest risk of incarceration—indirect, direct, or femoral?

Sudden pruritic rash on palms and soles, no meds - causative organism; name of rash?

Herpes simplex virus; erythema multiforme minor

Basophilic nuclear remnants in RBCs

Howell-Jolly bodies (due to splenectomy or nonfunctional spleen)

Turner's syndrome - tx

Human growth hormone (until epiphyseal fusion) & estrogen/progestin replacement

Primary biliary cirrhosis - which lab study is associated with it other than antibodies and hepatic/gallbladder markers?

Hypercholesterolemia

Niacin

Hypercholesterolemia treatment that → flushing and pruritus.

Chromium deficiency causes...

Hyperglycemia → insulin requires chromium to function

Familial hypercholesterolemia - which type of hyperlipoproteinemia?

Hyperlipoproteinemia type IIa

Pregnant lady w/ preeclampsia develops seizure and is tx w/ magnesium sulfate, she now has hyporeflexia and difficulty breathing - dx; tx?

Hypermagnesemia toxicity; IV calcium gluconate

"Brown" tumor of bone

Hyperparathyroidism or osteitis fibrosa cystica (deposited hemosiderin from hemorrhage gives brown color)

Klüver-Bucy syndrome (amygdala)

Hyperphagia, hypersexuality, hyperorality, and hyperdocility.

Pt w/ Chronic Kidney Disease stage III - why do they have hypocalcemia?

Hyperphosphatemia (complexes w/ ionized Ca2+) & and decreased calcitriol production

Cord compression - physical findings; initial tx?

Hyperreflexia, loss of bowel/bladder control, back pain, muscle weakness, loss of sensation; high does corticosteroids (surgery is sometimes indicated, but steroid first)

Trousseau's sign - cause; what is it?

Hypocalcemia; blood pressure cuff on the arm causes carpopedal spasms

Chvostek's sign - cause; what is it?

Hypocalcemia; facial nerve tapping causes contraction of facial muscles

Sudden d/c of long-term glucocorticoid tx, pt has BP 90/60, hyponatremia - which of the following will be present: hyperkalemia, hyperpigmentation, hypoglycemia, increased ACTH level?

Hypoglycemia only (hyperkalemia [mineralocorticoid deficiency] and hyperpigmentation [increased proopiomelanocortin] occur only in primary adrenal insufficiency, decreased ACTH is expected due to negative feedback from exogenous corticosteroids...hyponatremia in this case likey due to increased ADH)

VIPoma - lab findings; tx?

Hypokalemia (2/2 diarrhea), hypochlorhydria & hyperglycemia; octreotide

Mgmt of DVT in setting of intracranial bleeding, severe active bleeding, malignant HTN or recent brain, eye, spinal cord surgery?

IVC Filter

Stages of Labor

I: Dilation of Cervix → Latent and Active Phase Latent: - 100% effacement and dilation up to 4cm - Up to 20 hrs in NP, 14 hrs in MP Active: - Cervical dilation of 4cm - 10 cm - 1.2 cm/hr in NP, 1.5 cm/hr in MP II: Complete Dilation to Delivery - 2 hrs in NP, 1 hr in MP, add 1 hr if epidural III: Delivery to Expulsion of Placenta - 30 min

Taking combined E and P hormone replacement tx has a(n) ____________ relative risk of breast cancer compared to women who only take estrogen or who take no hormones for replacement

INCREASED

16 y.o. female w/ 24 hr headache, palpable, purpuric rash of the lower extremities, and positive Brudzinski and Kernig signs - next best step?

IV dexamethasone and antibiotics (If petechiae and purpura are present in suspected meningococcal disease, tx before lumbar puncture...dexamethasone should be added for meningococcal)

Pt w/ painless bleeding, BP 100/70, P 95, R 18, colonoscopy shows diverticulosis - tx?

IV fluids

Sickle cell disease - tx for painful crisis; tx for aplastic crisis; what does hydroxyurea do for sickle cell?

IV fluids; blood transfusion; increases HbF

Rhabdomyolysis - initial tx; likely metabolic disturbance and screening test; tx to reduce renal failure after initial step?

IV hydration; hyperkalemia check EKG; IV NaHCO3 to alkalinize urine

Kawasaki's disease - tx?

IVIG and high-dose aspirin

Under which conditions can a minor consent to his/her own medical care

Independent: lives separately from parents armed forces financially indepenedt Significant Life status: pregnant married Victim: sexual assault or abuse Abuser: Drugs and Alc tx STD +

Stable, unruptured ectopic pregnancy of &lt; 3.5 cm at &lt; 6 weeks' gestation

Indications for medical treatment of ectopic pregnancy.

> 5.5 cm, rapidly enlarging, symptomatic, or ruptured

Indications for surgical repair of abdominal aortic aneurysm.

Pregnant pt presents with vaginal bleeding BEFORE 20 weeks. Possible dx?

Inevitable, threatened, complete, missed abortion

Number of deaths from birth to one year of age per 1000 live births (neonatal + postnatal mortality)

Infant mortality?

"Floppy baby" with hypotonia, weakness, with sluggish eye movements...Dx?

Infantile Botulism → ingestion of C. botulinum spores - prevents transmission of Ach across synapse

Child presents with a week-long fever, bilateral conjunctivitis, erythema/desquamation of palms and soles, inflamed red papillae on tongue...likely Dx?..Tx?

Kawasaki's Disease (Mucocutaneous Lymph Node Syndrome) CRASH and Burn - Conjunctivitis - Rash - Aneurysm (Coronary Artery) - Strawberry tongue (mucositis) - Hand/foot desquamation and edema - Burn = fever > 5 days Tx: ASA + IVIG

Green-yellow rings around peripheral cornea

Kayser-Fleischer rings (copper accumulation from Wilson disease)

copper deposits in this descemet's mb are called ____ and are seen in these diseases: ______

Kayser-Fleisher rings Wilson's Disease (hepatolenticular degeneration) and Primary biliary cirrhosis (hepatorenal cu deposition)

Serous or bloody nipple discharge...Dx? Tx?

Intraductal papilloma resection

What is the most effective single medication for allergic rhinitis?

Intranasal Glucocorticoids

Allergic rhinitis - most effective tx?

Intranasal glucocorticoid

When treatment noncompliance represents a serious danger to public health (e.g., active TB)

Involuntary commitment or isolation for medical treatment may be undertaken for what reason?

Dysplastic squamous cervical cells with nuclear enlargement and hyperchromasia

Koilocytes (HPV: predisposes to cervical cancer)

Small, irregular red spots on buccal/lingual mucosa with blue-white centers

Koplik spots (measles; rubeola virus)

Deep, labored breathing/hyperventilation

Kussmaul respirations (diabetic ketoacidosis)

Hyporeflexia, hypotonia, atrophy, fasciculations

LMN damage

EKG finding of ASD (and other sxs)

LVH; pt will also present in adulthood with progressive dyspnea, CP, peripheral adema, syncope, digital clubbing, wide fixed split of S2

High TSH, low T4, antimicrosomal antibodies

Lab findings in Hashimoto's thyroiditis.

Burn pt - fluid choice for 1st 24 hours?

Lactated Ringer's (need a fluid that is most similar to ECF b/c capillaries are very leaky)

[OMM] Sacral dysfunction - (+) seated flexion on right, where is oblique axis; rules for L5 sidebend and rotation?

Left axis; L5 sidebends towards axis and rotates away from sacral rotation

35 y/o AA female presents with large, bulky, utering tumor that extends outwardly through the cervix...Dx?

Leiomyosarcoma

50 y.o. pt w/ leukocytosis of 54,000/mm3 - test to differentiate between CML and leukemoid reaction?

Leukocyte alkaline phosphatase (elevated in leukemoid reaction, decreased in CML)

Emergency contraception - drug; dosing/timing?

Levonorgestrel (progestin-only); 2 pills, 12 hours apart within 72 hours

Pt is non-compliant with her medicine, has altered mental status for past 2 hours, T96.2, BP90/60, R6, sugar is normal - which med caused it: propranolol, levothyroxine, spironolactone, insulin, hydrocortisone?

Levothyroxine (myxedema coma is a complication of hypothyroidism and is often fatal...tx IV T3 and/or T4 plus IV hydrocortisone)

MC hostological finding in Parkinson's:

Lewy bodies

Eosinophilic cytoplasmic inclusion in nerve cell

Lewy body (Parkinson disease)

Tests to order prior to starting a pt on Lithium?...Valproic acid?...Carbamazapine?

Lithium: - BUN/Cr → nephrogenic diabetes insipidus - TFT → hypothyroidism - Pregnancy → Ebstein's anomaly Valproic Acid: - Platelets → thrombocytopenia - LFTs → hepatotoxicity Carbamazapine: - CBC → leukopenia - LFTs → abnormal LFT - Watch for SJS

Triad for Cholesterol Embolism

Livedo reticularis, acute renal failure, eosinophilia

You suspect child abuse - who do you contact?

Local law enforcement and Child Protective Services

Low-dose vs. High-dose Dexamethasone suppression test

Low dose: - Determines presence of ectopic source of cortisol - Should decrease cortisol in normal person (negative feedback) High Dose: - Determines location of extra hormone - Pituitary tumor will be suppressed - Adrenal tumor or SSLC will not be suppressed

Quad screen profile of Neural tube defects Amnio for NTDs will show

Low: hCG, AFP, Estradiol High: Inhibin A Increased AChE activity

Polycythemia vera - erythropoieitin level; tx?

Low; hydroxyurea and chronic phlebotomy

Secondary hypothyroidism - T4 level; TSH level

Low; low (pituitary disease is the likely culprit...high TSH and low T4 is primary hypothyroidism)

Wilson's disease - high/low: ceruloplasmin; total serum copper; free serum copper; urinary excretion of copper?

Low; low; high; high

Mgmt of Invasive Lobular/Ductal Ca.

Lumpectomy + Sentinal LN Bx + post op Radiation

Fall on dorsiflexed hand w/ pain over dorsum of wrist at level of 3rd digit & worsened by hand gripping - dx?

Lunate fx

Pt w/ seizure disorder has T102, productive cough of foul-smelling sputum, night sweats, and significant weight loss over the past 5 weeks. CXR shows cavitation with air-fluid level in R upper lobe - dx; tx?

Lung abscess (from aspiration of anaerobic bacteria); clindamycin

Small cell lung cancer (SCLC)

Lung cancer associated with SIADH.

SCLC

Lung cancer highly related to cigarette exposure.

"Wire loop" glomerular capillary appearance on light microscopy

Lupus nephropathy

Pt present with signs of meningitis + target like rash

Lyme disease (Borrelia)

Test to differentiate Folate vs. B12 deficiency

MMA - Elevated: B12 - Normal: Folate *remember that B12 will have neurological complaints (posterior columns - DProV) *Both will have megaloblastic anemia and elevated homocysteine

test of choice for ligament injuries, meniscal disease, avascular necrosis, and articular cartilage defects of the knee

MRI

Dx test for MS What test will show oligoclonal bands?

MRI LP

B12 deficiency

Macrocytic, megaloblastic anemia with neurologic symptoms.

Folate deficiency

Macrocytic, megaloblastic anemia without neurologic symptoms.

Breast Cancer Screening

Mammography q2Y starting at age 50 (USPSTF) or 40 (ACOG)

What is a Buruli Ulcer

Manifestation of Mycobacterium ulcerans

Arachnodactyly, lens dislocation, aortic dissection, hyperflexible joints

Marfan syndrome (fibrillin defect)

Chronic exercise intolerance with myalgia, fatigue, painful cramps, myoglobinuria

McArdle disease (muscle glycogen phosphorylase deficiency)

Cafe-au-lait spots, polyostotic fibrous dysplasia, precocious puberty, multiple endocrine abnormalities

McCune-Albright syndrome (mosaic G-protein signaling mutation)

Fever, cough, conjunctivitis, coryza, diffuse rash

Measles

Pt w/ acute pancreatitis respiratory distress, you want to confirm ARDS as pt does not improve w/ 100% O2 therapy, CXR shows b/l infiltrates - best test to confirm dx?

Measurement of pulmonary capillary wedge pressure (r/o cardiogenic pulmonary edema as it is indistinguishable on CXR...in practice you would probably order BNP and echo first, then go to right heart catheterization)

Coumadin - when is the therapeutic level an INR of 2.5-3.5?

Mechanical heart valves, post-MI, and antiphospholipid syndrome (INR usu. 2-3)

Medicaid is for ____

Medicaid is also available to persons who are aged, blind, disabled, or certain people in families with dependent children regardless of financial burden

5-aminosalicylic acid +/− sulfasalazine and steroids during acute exacerbations

Medical treatment for IBD.

↓ protein intake, lactulose, neomycin

Medical treatment for hepatic encephalopathy.

Medicare is for _____

Medicare is designed for 65+ year olds, people with certain disabilities, and people with end-stage renal disease.

MFAT vs WP? What's the difference?

Multifocal Atrial Tachycardia - 3+ different P waves in the same lead - HR > 100 Wandering Pacemaker - 3+ different P waves in the same lead - HR < 100

Bone pain, M-spike on SPEP and UPEP, Bence Jones prtns, periph smear shows rouleaux formation....Dx? Additional findings 1) 2) 3)

Multiple Myeloma HYPERcalcemia Renal Failure Decreased AG

Monoclonal antibody spike

Multiple myeloma (usually IgG or IgA) Monoclonal gammopathy of undetermined significance (MGUS consequence of aging) Waldenström (M protein = IgM) macroglobulinemia Primary amyloidosis

Calf pseudohypertrophy

Muscular dystrophy (most commonly Duchenne) : X-linked recessive deletion of dystrophin gene

Erythroderma, lymphadenopathy, hepatosplenomegaly, atypical T cells

Mycosis fungoides (cutaneous T-cell lymphoma) or Sézary syndrome (mycosis fungoides + malignant T cells in blood)

AMS, hypothermia, hypotention, hypoventilation, complication of thyroid disease Dx? Tx?

Myxedema coma IV T3, T4, hydrocortisone, blanket, respiratory therapy

probability that a patient with a negative test does not have a disease

NPV (validity of a negative test)

Treatment of choice for acute gout

NSAID

Mechanism of NSAID induced renal injury?

NSAIDS decrease PGE2 → loss of vasodilation of afferent arterioles → dec. GFR

tx for pericarditis tx for post-MI pericarditis

NSAIDs and colchicine ASA and colchicine

Opioid overdose - naltrexone vs. naloxone?

Naloxone is best choice in acute setting (IV and rapid acting), naltrexone is for long-term therapy and is available in oral form

Regression

Name the defense mechanism: ■ A hospitalized 10-year-old begins to wet his bed.

Displacement

Name the defense mechanism: ■ A mother who is angry at her husband yells at her child.

Reaction formation

Name the defense mechanism: ■ A pedophile enters a monastery.

Isolation

Name the defense mechanism: ■ A woman calmly describes a grisly murder.

Klebsiella

Name the organism: ■ "Currant jelly" sputum.

Periorbital and/or peripheral edema, proteinuria, hypoalbuminemia, hypercholesterolemia

Nephrotic syndrome

Protein aggregates in neurons from hyperphosphorylation of tau protein

Neurofibrillary tangles (Alzheimer disease) and Pick bodies (Pick disease)

Cafe-au-lait spots, Lisch nodules (iris hamartoma)

Neurofibromatosis type I (+pheochromocytoma, optic gliomas)

SVR is high in all types of shock except

Neurogenic Septic (fever, white count, tachy, tachypnea)

Meningitis by age: Newborn - 3months 3 months - 9yrs Teens >18

Newborn - 3months: GBS, then E. coli 3 months - 9yrs: S. pneumo Teens: N. meningitis >18: S. pneumo

Isolated hypoHDL....tx?

Niacin (ASA before!)

Infant with failure to thrive, hepatosplenomegaly, and neurodegeneration

Niemann-Pick disease (genetic sphingomyelinase deficiency)

Baby Ashkenazi Jew has cherry-red spot, hypotonia, mental retardation, and hepatosplenomegaly - dx; enzyme affected; characteristic difference between similar disorder?

Niemann-Pick disease; sphingomyelinase deficiency; Tay Sachs does NOT involved the liver (hexosaminidase deficiency)

Pt asks how many years of experience do you have performing this procedure and you say "enough" having just come out of residency - adequate?

No (you must directly answer the question b/c the pt sees this information as important for coming to informed consent)

[OMM] SBS compression - cranial findings?

No motion of the cranium

CXR findings - silicosis; berylliosis; asbestosis

Nodular opacities in the upper lobe; b/l hilar adenopathy; b/l opacities w/ pleural plaques

Presentation of RTA

Non-anion gap hyperchloremic metabolic acidosis 1. Hyperchloremic acidosis with normal anion gap + near normal GFR + no diarrhea → RTA 2. Look at potassium: - If High → IV - If Low → I or II, step 3 3. Look at urine pH - If < 5.5 → II - If > 5.5 → step 4 4. Look at bicarb - If normal → I - If decreased → II 5. Confirm dx: - I: admin ammonium chloride, confirmed if urine pH does not drop below 5.5 - II: admin bicarb, confirmed if urine pH continuously rises - IV: salt restrict diet, confirmed if urine sodium consistently high

What is the most sensitive and specific test for Urolithiasis

Non-contrast Helical CT

Most common transfusion reaction

Non-hemolytic febrile reaction - Reaction to donor WBCs - Mild fever, chills, dyspnea

Pt w/ sickle cell anemia is getting 3 units PRBC, 30 min after initiation of transfusion develops chills, mild SOB, T101 - dx; tx?

Non-hemolytic febrile reaction (most common reaction, 2/2 reaction of recipient to donor WBCs); use leukocyte washed blood products

Squamous cell carcinoma

Non-small cell lung cancer (NSCLC) associated with hypercalcemia.

1° syphilis

Nonpainful chancre.

Indurated, ulcerated genital lesion

Nonpainful: chancre (1° syphilis, Treponema pallidum) Painful, with exudate: chancroid (Haemophilus ducreyi)

Neuroblastoma

Nontender abdominal mass associated with elevated VMA and HVA.

Polycythemia vera - increases what type of cells?

Normal RBCs, granulocytes & platelets (activated JAK2 tyrosine kinase)

Candidial vaginitis pH: Tx:

Normal! (3.8-4.5) (INCREASED pH seen in Bac vag and Trich) Tx: Fluconazole (or a topical azole)

Fatigue and impending respiratory failure

Normalizing PCO2 in a patient having an asthma exacerbation may indicate?

Highly sensitive for TB

PPD reactivity is used as a screening test because most people with TB (except those who are anergic) will have a +PPD. Highly sensitive or specific?

Mild illness and/or low-grade fever, current antibiotic therapy, and prematurity

Not contraindications to vaccination.

1 ÷ (rate in untreated group − rate in treated group)

Number needed to treat?

Oral thrush in an otherwise healthy 35 y.o. male - tx?

Nystatin mouthwash or clotrimazole lozenge

Obsessive-compulsive disorder vs. obsessive-compulsive personality disorder - difference?

OCD pt recognizes own rituals as irrational. OCPD pt believes what they are doing is correct

Endometriosis and no desire to conceive - tx?

OCPs & NSAIDS (laparoscopy may be used if desires to conceive and cannot)

40 y.o. woman undergoes stereotactic bx of breast mass, which shows lobular carcinoma in situ - next step?

Observation (LCIS is not CA but a marker for breast CA development in both breasts at a rate of 1% per year...excision for ductal carcinoma in situ [DCIS] is appropriate followed by post-op radiation therapy)

The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed

Odds ratio?

40 y.o. male w/ epigastric pain, eating helps the pain, but is worse 3-4 hrs after, positive urea breath test - next step?

Omeprazole, amoxicillin, clarithromycin (upper GI w/ bx if age > 50 or troubling sxs)

Gastroschisis vs. omphalocele - covering; which one is associated w/ other congenital defects; which one requires urgent surgery?

Omphalocele is covered by peritoneum and amnion, gastrochisis lacks a covering sac; omphalocele; gastrochisis (b/c prone to drying out)

Drug used for ppx after exposure to Influenza outbreak

Oseltamivir (effective if started within 48 hours of illness onset)

Painful, raised red lesions on pad of fingers/toes

Osler nodes (infective endocarditis, immune complex deposition)

Swollen, hard, painful finger joints

Osteoarthritis (osteophytes on PIP [Bouchard nodes], DIP [Heberden nodes])

Pregnancy - what week do you start labor induction

Over 42 weeks

Pancreatic pseudocyst - when should it be tx'ed; tx?

Over 6 cm, doesn't resolve in 8 weeks, signs of infection; endoscopic cystogastrostomy (drains in stomach) or endoscopic cystoduodenostomy (needle aspiration is never used)

Causes of bloody effusion

PE malignancy

Restrictive pulmonary disease

PFT showing ↑ FEV1/FVC.

Obstructive pulmonary disease (e.g., asthma)

PFT showing ↓ FEV1/FVC.

risk factor for ectopic preg

PID

Paraneoplastic syndromes associated with lung CA - squamous cell CA; small cell CA?

PTHrP; ACTH, SIADH (also creates Lamber-Eaton syndrome)

Bone pain, bone enlargement, arthritis

Paget disease of bone (Increased osteoblastic and osteoclastic activity)

Most common thyroid cancer

Papillary Thyroid Carcinoma

Thyroid cancer associated with psammoma bodies

Papillary Thyroid Carcinoma

Management of symptomatic paraesophageal hiatal hernia vs. sliding hiatal hernia?

Paraesophageal requires surgery b/c it is fixed, sliding just treat GERD sxs

Pt w/ chronic dermatitis of the hands comes to your derm office for a third opinion, has already tried moisturizers, topical antifungals, and topical steroids, has a h/o social anxiety tx'ed moderately w/ alprazolam - tx?

Paroxetine (SSRI for OCD, likely washing his hands constantly))

Red urine in the morning, fragile RBCs

Paroxysmal nocturnal hemoglobinuria

Partial mole

Partial mole: Triploidy 69 chromosomes fetal tissue present choriocarcinoma risk is rare some of chorionic villi are hydropic (edematous)

Dog or cat bite resulting in infection

Pasteurella multocida (cellulitis at inoculation site)

Pt w/ ESRD misses a dialysis appointment and develops chest pain and a friction rub - dx; what caused it; other sxs associated w/ the cause?

Pericarditis; uremia; dysgeusia (metallic taste), pruritis, platelet dysfunction, weight loss

Number of deaths from 20 weeks' gestation to one month of life per 1000 total births

Perinatal mortality?

Drug X is being tested on several pts who have HTN - which clinical phase is it in?

Phase II (Phase II = few subjects for effectiveness, Phase III = large scale trials, Phase IV = general surveillance after drug is released)

Primary spontaneous pneumothorax in a hemodynamically stable individual - what is a small pneumothorax that only requires O2 and observation?

Pneumothorax involving <15% of the hemithorax or <3cm from the apex of the lung to the top visceral pleura (repeat CXR in 24 hrs)

Sudden onset of asymmetrical mm. weakness that leads to flaccid paralysis and absent DTRs; CSF: elevated PMNs and prtn Dx is made with _____ Tx?

Poliomyelitis Dx is confirmed with virus isolation in oral secretions Tx: supportive :(

A 45 year-old Caucasian male presents to your office complaining of periumbilical pain for one week. The patient also reports experiencing headache, weight loss, fevers, weakness, and malaise during this time (flu-like sx). His vital signs include a blood pressure of 145/100 mm Hg, a pulse of 86 bpm, and a temperature of 37.6 C. The patient also admits to taking Tylenol earlier in the day. On physical exam you note an ill-appearing male who appears older than his stated age. His abdomen is diffusely tender without peritoneal signs. Rovsing's sign and tenderness at McBurney's point are both negative. Needle tracts of various ages are visible throughout the patient's arms. Angiogram of the abdomen reveals multiple aneurysms in the mesenteric and renal arteries.

Polyarteritis nodosa (PAN) is a disease of small and medium-sized arteries that most commonly involves the skin, joints, peripheral nerves, kidneys, and the gastrointestinal (GI) tract. Although there are many manifestations of PAN, you should consider this diagnosis in all patients presenting with symptoms including fever, malaise, weight loss, and anorexia. Peripheral or central nervous symptoms, dermatologic findings (vascular purpura, subcutaneous nodules, livedo reticularis), myalgias, and orchitis are also possible presenting signs of PAN. Approximately 20% of patients with classic PAN are positive for p-ANCA. A patient is said to have PAN if he/she has 3 of the 10 following signs: 1. Weight loss greater than/equal to 4 kg 2. Livedo reticularis, which appears as a mottled, purple discoloration over the extremities or torso 3. Testicular pain in males (orchitis) 4. Myalgias or weakness 5. Elevated BUN and creatinine 6. Hepatitis-positive serology (needle tracts??) 7. Central or peripheral neuropathy 8. Diastolic blood pressure greater than 90 mm Hg 9. Arteriogram showing aneurysms in small or medium-sized vessels 10. Biopsy-positive tissue

Juvenile rheumatoid arthritis - pauciarticular vs. polyarticular; age group affected; can it include uveitis?

Polyarticular involves 5 or more joints; females under 5 y.o.; yes (Reiter's syndrome affects people > 20 y.o.)

Renal cell CA - associated paraneoplastic syndromes?

Polycythemia (EPO), Cushing's syndrome (cortisol), hypertension (renin), hypercalcemia (PTH-like hormone)

proximal mm. weakness, elevated CK, AST, ALT, aldolase, LDH...Dx? What other finding is very suggestive of the dx Tx

Polymyositis/Dermatomyositis Anti-Jo Ab Corticosteroids, MTX is adjuctive

Myopathy (infantile hypertrophic cardiomyopathy), exercise intolerance

Pompe disease (lysosomal α-1,4-glucosidase deficiency)

Wound dehiscence - what are some causes?

Poor suture placement, wound infxn, advanced age, obesity, chronic steroid use, uncontrolled diabetes, malnutrition

Painless blistering of the dorsal surface of the hands and other sun-exposed areas, increased facial hair and hyperpigmentation--Dx, labs, risk factor

Porphyria Cutanea Tarda Plasma, fecal, and urine porphyrin will be increased Supplemental Iron, alcoholism, hep C, smoking, estrogen use

65 y.o. female has outbreaks of painless blisters on the dorsum of her hand, denies abd pain, has hypertrichosis and hyperpigmentation. Serum and urine levels of porphyrin elevated - dx; risk factors; tx?

Porphyria cutanea tarda (lack of abd pain sets this aside from other porphyria); high iron, hereditary, hep c, hiv, alcohol, estrogen use; chloroquine, phlebotomy for iron overload

Paracentesis yields serum ascites albumin gradient of 1.6 g/d - what physiologic process is occurring?

Portal HTN (all ascites w/ SAAG > 1.1 g/dL...pre-hepatic [portal vein thrombosis], intra-hepatic [cirrhosis, hepatic fibrosis, hepatocellular CA] or post-hepatic [CHF, constrictive pericarditis, Budd-Chiari syndrome])

Medial tibial stress syndrome involves what compartment of the leg? Dx test? Tx? Consequences if not treated?

Posterior (superficial) Dx test: nuclear medicine bone scan Tx: cessaton of inciting activity Consequence: Stress Fractures

Number of deaths from 28 days to one year per 1000 live births

Postnatal mortality?

Postpartum blues vs. postpartum depression - difference?

Postpartum blues end by < 2 weeks after delivery and mom retains ability to care for herself and baby, postpartum depression is delayed 2 weeks to 12 months after delivery and mom loses capacity to care for herself and baby

"Lumpy bumpy" appearance of glomeruli on immunofluorescence

Poststreptococcal glomerulonephritis (immune complex deposition of IgG and C3b)

Back pain, fever, night sweats, weight loss

Pott disease (vertebral TB)

Define Power in terms of stats

Power= 1-Type II error (Beta) Beta =Type II error (null hyp. is accepted, but should not have been) Type I: null hyp is rejected, but should not have been They are inversely related

Mgmt of cluster headaches

Ppx: Verapamil, prednisone, valproic acid, topiramate, ergotamine Abortive Tx: 100% O2, sumitriptan, intranasal lidocaine

Antidote for organophosphate poisoning

Pralidoxime Atropine

Sulfonamides, antimalarial drugs, fava beans

Precipitants of hemolytic crisis in patients with G6PD deficiency.

McCune-Albright syndrome - clinical presentation?

Precocious puberty, café au lait spots, bone lesions, short stature

What is used to screen low risk women for Down's syndrome? when? When do you do a CVS?

Pregnancy-associated plasma protein A 9-14 weeks gestation CVS: 10-12 weeks gestation

Actinic keratosis

Premalignant lesion from sun exposure that can → squamous cell carcinoma.

How is Dermatomyositis different from Polymyositis?

Presence of unique dermatological findings: - Heliotrope rash - Gottron's sign: scaly papules found over dorsum of PIP and MCP - Shawl's sign: erythema over shoulders, neck, upper chest and back

Pityriasis rosea

Presents with a herald patch, Christmas-tree pattern.

Procedures requiring IE PPX

Procedures involving: - Respiratory tract - Major dental work - Infected skin, tissues just under skin, musculoskeletal tissue

Ranson criteria on admission

Prognosis of Pancreatitis on admission: glucose >200 AST >250 LDH >350 WBCs >16,000 Age >55

Nephrotic syndrome

Proteinuria, hypoalbuminemia, hyperlipidemia, hyperlipiduria, edema.

Pt comes in with chest pain to ED, insurance company will not cover charges, suddenly pt doesn't feel so bad and states he will see is own physician later today - next step?

Provide a screening exam (Emergency Medical Treatment and Active Labor Act [EMTALA] requires a medical screening exam regardless of ability to pay)

low Ca, elevated phosphate, elevated PTH (no response to PTH) Dx? disease association

Pseudohyperparathyroidism Albright's hereditary osteodystrophy (bone deformation)

Pt presents with low calcium, high phosphate and high PTH...Dx?

Pseudohypoparathyroidism (ex: Renal Failure)

Tx for Vtach Tx for SVT

Pulseless/unstable VTach: IV access, sedation, synchronized cardioversion Stable VTach: Amioderone ___________________________________________ SVT is treated with a rapid IV push of Adenosine and Vagal maneuvers

Toxoplasmosis TX

Pyrimethamine/Sulfadiazine

42 y.o. pregnant woman 15-20 weeks gestation - what screening test should be provided?

Quadruple screen (alpha-fetoprotein, unconjugated estriol, human chorionic gonadotropin, inhibin A...triple test at a minimum, if age > 35 then quad screen)

[OMM] Pancreatitis - chapman point?

R 7th intercostal space

[OMM] Lymphatic drainage - what drains through right lymphatic duct?

R arm, R head, R neck, myocardium/endocardium (but NOT the pericardium) and R lung

Newborn w/ R arm adducted, internally rotated, forearm pronated and wrist flexed - dx; nerve roots involved?

R sided Erb-Duchenne's Palsy; C5-C6 (described as "waiter's tip")

Conditions causing low glucose in pleural fluid

RA Emyema Malignancy

...

RBBB - QRS>120ms (3 small boxes) - rSR' in V1 - Slurred S waves in I and V6

Describe the defect in each type of RTA

RTA I-distal tube cannot excrete H+, so urine is pH>5.3 RTA II-prox tubes can't absorb bicarb (usually Fanconi syndrome in children), low K+. pH<5.3 RTA IV-hypoaldosteronism, so hyperK+

Pt has abdominal pain, weight loss, melena...where is the tumor?

Right Colon

Left parasternal lift - what does it indicate?

Right ventricular hypertrophy

Huntington's disease

Rigidity and stiffness that progress to choreiform movements, accompanied by moodiness and altered behavior.

Parkinson's disease

Rigidity and stiffness with resting tremor and masked facies.

Taenia solium (cysticercosis)

Ring-enhancing brain lesion on CT with seizures

Stasis, endothelial injury and hypercoagulability (Virchow's triad)

Risk factors for DVT.

Fat, female, fertile, forty, flatulent

Risk factors for cholelithiasis.

Pregnancy, vesicoureteral reflux, anatomic anomalies, indwelling catheters, kidney stones

Risk factors for pyelonephritis.

Mgmt of hepatic angioma (cavernous hemangioma)?

Risk of rupture <5cm: watch expectantly, follow with imaging >5cm or symptomatic: surgical removal

Pt presents with signs of meningtis + centripitally spreading petechial rash

Rocky Mountain Spotted Fever (Rickettsia)

Rhinophyma, facial flushing, papular lesions, telangiectasia, sebacious gland hyperplasia

Rosacea

HHV 6 is aka ________ and presents with _____

Roseola: 2-5 days of fever, THEN a maculopapular rash

Rule of L5 motion relative to sacrum dysfx

Rotates OPPOSITE the sacrum Sidebends TOWARD the oblique axis

Retinal hemorrhages with pale centers

Roth spots (bacterial endocarditis)

Stacks of RBCs

Rouleaux formation (high ESR, multiple myeloma)

Severe RLQ pain with palpation of LLQ

Rovsing sign (acute appendicitis)

1 year old w/ jaundice, hepatosplenomegaly, cataracts, heart murmur, and hearing loss - etiologic agent?

Rubella virus (cataracts, hearing loss, cardiac defects)

Viscerosomatics: (major organs)

S-stomach/spleen: 5-9 L-liver: 6-9 P-panc- 5-11 S-small bowel (j & i)- 9-11 K-kidneys- 10-11 B-bladder- 11-2 L-lower extremitis-11-2

24 y.o. female w/ 5 day old child is breast feeding and develops mastitis - causative organism; tx?

S. aureaus; continue breast feeding, abx, analgesics, warm/cold compress

Most common cause of wound infection 4-10 days after surgery

S. aureus

Portal HTN is likely with what SAAG?

SAAG>1.1

ruptured, mucinous ovarian tumors often cause ____

SBOs

Low Na, low serum osmolarity, low urine output may also see

SIADH low uric acid and decreased BUN

Symptoms of Major Depression

SIGECAPS - SLEEP: insomnia, hyper-somnia - INTERESTS: dec. interest/pleasure in activities - GUILT: feelings of worthlessness - ENERGY: fatigue - CONCENTRATION: diminished ability to think or concentrate - APPETITE: weight loss/gain - PSYCHOMOTOR agitation - SUICIDAL ideation Dx: Depressed mood OR Anhedonia + 4 more sx for TWO WEEKS

Anticoagulation method for pregnant pts?

SQ heparin (warfarin crosses placenta = teratogenic)

Panic disorder - tx?

SSRI

Tx for PTSD

SSRI

Tx for panic disorder Tx for GAD

SSRI Anxiolytic like buspirone

Post-traumatic stress disorder - tx?

SSRI and exposure therapy

First line for OCD

SSRIs

first line tx for bulimia

SSRIs

ST-elevation MI vs. non-ST elevation MI - tx difference?

ST-elevation MI gets thrombolytic therapy

JVD, morning facial and arm swelling, headache and dyspnea

SVC syndrome

BP 80/50, P 155, RR 22, O2 sat 89%...Dx? Management?

SVT! 1. Check ABC and administer O2 2. Stable vs. Unstable? - Stable → Vagal Maneuvers → Adenosine - Unstable → Sedation → Synchronized Cardioversion

AP compression and Seated flxn test ______

Sacroiliac dysfunction

Anion gap acidosis and 1° respiratory alkalosis due to central respiratory stimulation

Salicylate ingestion → in what type of acid-base disorder?

Timing of pain for the following: Salpingitis Endometriosis

Salpingitis: pain AFTER menses (in addition to purulent d/c) Endometriosis: pain 1-2 days BEFORE menses (in addition to dysmenorrhea, dysparunia, etc.)

Bilateral hilar adenopathy, uveitis

Sarcoidosis (noncaseating granulomas)

Glomerulus-like structure surrounding vessel in germ cells

Schiller-Duval bodies (yolk sac tumor)

For 9 months pt has been hearing voices telling him to quit his job. He believes they are out to get him and will probably kill him if he continues working there - dx?

Schizohrenia (delusional disorder does not have hallucinations)

Straight leg raising tests _________

Sciatic nerve compression, could be from a herniated disc

Swollen gums, mucosal bleeding, poor wound healing, petechiae

Scurvy (vitamin C deficiency: can't hydroxylate proline/lysine for collagen synthesis)

Primary vs. secondary adrenal insufficiency - tx difference?

Secondary adrenal insufficiency only requires glucocorticoid b/c pituitary has failed (primary requires prednisone + fludrocortisone b/c adrenals have failed)

Non-pruritic macules on palms and soles - most likely dx?

Secondary syphilis

Testicular tumors: seminoma vs. yolk sac (endodermal) tumor - which hormone will be elevated; histologic appearance?

Seminoma has high β-HCG, yolk sac has high AFP; seminoma à "fried egg," yolk sac à Schiller-Duvall bodies

Out

Sensitive tests have few false negatives and are used to rule _____ a disease.

Novobiocin response

Sensitive: Staphylococcus epidermidis; resistant: Staphylococcus saprophyticus

Optochin response

Sensitive: Streptococcus pneumoniae; resistant: viridans streptococci

Bacitracin response

Sensitive: Streptococcus pyogenes (group A); resistant: Streptococcus agalactiae (group B)

Bacterial meningitis in a 9 y.o. child - most common complication?

Sensorineural hearing loss

Acute pancreatitis

Sentinel loop on AXR.

High CO seen in this type of shock:

Septic, but may be normal

Vit. B 12 deficiency - what is/are most sensitive test(s)?

Serum homocysteine & methylmalonic acid (vit B12 level is usually normal in deficiency...increased MMA level by itself is not as useful b/c renal insuff can cause it)

Sinusoidal heart rate on FHT monitor...dx?

Severe fetal anemia (e.g. Rh isoimmunization or severe hypoxia)

Lesch-Nyhan - what do you see?

Severe mental retardation w/ self-mutilation. High uric acid level leads to gout and uric acid kidney stones

STD screening ages - chlamydia and gonorrhea; HIV

Sexually active females 24 and younger; 15-65 years of age

"Floppy baby" with retinal hemorrhages or subdural hematoma...Dx?

Shaking Baby Syndrome

2 pts are talking in a hospital, one states that she heard a doctor saying a pt from California has Coccidiomycosis, the other gets outraged b/c she is that pt - under what act can she sue?

She cannot sue (she can sue if a geographical subdivision smaller than a state was used)

No lactation postpartum, absent menstruation, cold intolerance

Sheehan syndrome (pituitary infarction)

autonomic sx + parkinson sx + ataxia

Shy-Drager syndrome or multiple system atrophy (degenerative)

Zenker's Diverticulum: Si/Sx? Dx? Tx?

Si/Sx: Dysphagia, Halitosis, Regurgitation of Undigested Food, Throat Clearing, Neck Mass Dx: Barium Swallow Tx: Myotomy of Cricopharyngeus +/- Diverticulectomy

Tennis Elbow...Si/sx?...Tx?

Si/sx: Pain on wrist extension or supination against resistance; point tenderness on lateral epicondyle Tx: rest, ice, counter-force brace, NSAIDS

Golfer's Elbow...Si/sx?

Si/sx: Pain on wrist flexion or pronation against resistance; point tenderness on medial epicondyle

Acute mania, immunosuppression, thin skin, osteoporosis, easy bruising, myopathies

Side effects of corticosteroids.

high Fe, high ferritin, variable TIBC, microcytosis, recent tx with isoniazid....Dx? Tx?

Sideroblastic anemia Vit B6 (pyridoxine, inhibited by INH)

What kind of fibroids will lead to infertility

Submucosal

Chronic alcohol abuser w/ fatigue, abdominal pain, and conjunctival pallor. Elevated iron, ferritin and normal TIBC. Bone marrow bx shown: - dx; first line tx; second line tx?

Sideroblastic anemia (image shows ringed sideroblasts w/ Prussian blue staining [deposits of iron in cytoplasm]); pyridoxine (vit. B6); transfusion

45 y.o. female w/ abd pain and distension, no passage of stool or flatus, no peritoneal signs, tympanitic abd, abd x-ray shown: - dx; tx?

Sigmoid volvulus; endoscopic decompression followed by elective sigmoid resection (50% recurrence)

Hypotension and bradycardia

Signs of neurogenic shock.

Hypertension, bradycardia, and abnormal respirations

Signs of ↑ ICP (Cushing's triad).

Wrist drop, loss of thumb abduction

Signs suggesting radial nerve damage with humeral fracture.

10 yr hx of working in the mining, glass, concrete, sandblasting industry with fever dry cough and DOE....Dx? X-ray findings

Silicosis Nodular opacities in the upper lobes

Silicosis vs. asbestosis - pulmonary complications?

Silicosis à TB (damages alveolar macrophages), asbestosis à mesothelioma

Sjogren's vs Sicca syndrome

Sjogren's syndrome has a classic triad of xerophthalmia, xerostomia and arthritis. It is associated with parotid enlargement, increased risk of non-hodgkins B cell lymphoma and dental caries. Patients with Sjogren's and Sicca may have autoantibodies including SS-A (Ro) and SS-B (La). SICCA SYNDROME LACKS ARTHRITIS. It may present with dry eyes, dry mouth, vaginal dryness, reflux esophagitis or chronic bronchitis

Pt started haloperidol 3 days ago now has oculogyric crisis - what is the sx; dx?

Spasm of the eyeballs into a fixed position for minutes; acute dystonia

Polio - presentation; how do you confirm dx?

Sudden onset asymmetrical muscle weakness that leads to flaccid paralysis and absent DTRs (Guillaian-Barre is symmetrical); isolate virus from oral secretions

Ascites - first line tx?

Spironolactone +/- furosemide plus Na+ restrictive diet (spironolactone is good b/c it's K+ sparing, K+ is hard to replete in cirrhotics... paracentesis if that fails)

Which dietary supplement can treat mild-moderate depression and interacts with warfarin?

St. John's wort

Pt had painless vaginal bleeding without contractions at 30 weeks gestation, pelvic US confirms placenta previa - most appropriate tx?

Stabilize pt and repeat US at 35-36 weeks to see if placenta has moved

Stages of Labor

Stage 1: Latent-cervical effacement and dilation up to 3- 4cm (1.2cm/hr for multigravid, 1.5cm/hr for prima) Active- 3-4 cm to complete dilation Stage 2: Full dilation to delivery Stage 3: Delivery to expulsion of the placenta Stage 4: unofficial, but PPH may occur immediately post-partum

Ann Arbor staging system for Hogkin's lymphoma

Stage I-1 LN Stage II-2 or more LNs on the same side of the diaphragm Stage III-both sides of the diaphragm (one organ or area near the LNs or the spleen) Stage IV-extralymphatic tissue (liver bone marrow, lungs)

Tx for Hodgkin's lymphoma

Stages I & II: radiation Stages III & IV: chemo

Standard of care

Standard of care - The level at which a professional having the same training and experience in good standing in a same or similar community would practice under the same or similar circumstances.

Child presents with "sandpaper" like rash, positive Nikolsky sign

Staphylococcal Scalded Skin Syndrome

Name the tx: Stress incontinence Urge incontinence Overflow incontinence Vesicovaginal fistula (post-pelvic surgery) incontinence:

Stress: TCAs like imiprimine (may be used for urge also) Urge: anticholinergics like oxybutynin Overflow: intermittent self-cath Fistula: Surgical correction

Positive Nikolsky sign

Stroking of the skin causes skin to separate

Pt w/ neck pain, diffusely enlarged and tender thyroid gland, had sinusitis 3 weeks ago, low TSH, high T4 and high ESR - dx; tx?

Subacute granulomatous thyroiditis (aka de Quervian's thyroiditis...NOT subacute lymphocytic thyroiditis which is painless); NSAIDs

"Worst headache of my life"

Subarachnoid hemorrhage

Bloody tap on LP

Subarachnoid hemorrhage

Worst headache of my life - dx; initial test; initial test didn't see anything, pt still has same sxs next morning, next step?

Subarachnoid hemorrhage; CT scan w/o contrast; lumbar puncture (CT scan sensitivity drops after 12 hrs)

Pt has headache unexplained by multiple diagnostic tests, lumbar puncture reveals xanthochromia - dx?

Subarachnoid hermorrhage

Newborn s/p prolonged labor presents with boggy edema of the occiput ...likely dx?

Subgaleal hemorrhage - Blood beneath epicranial aponeurosis

Mgmt for pt presenting with unilateral and/or guiac positive nipple discharge? Likely Dx?

Surgical removal of involved duct for diagnosis and treatment Likely dx: Intraductal Papilloma

[OMM] Pheochromocytoma - level of somatic dysfunction

T10-11 (adrenals/kidneys are the same)

Segmental sympathetic innervation for the mid GI/GU:

T10-11: GI: jejunum, ileum, ascending colon, prox. 2/3 of the transverse colon; GU: adrenals, kidneys, upper ureters, gonads

Segmental sympathetic innervation for the lower GI/GU

T12-L2:GI: Distal 1/3 of the transverse colon, descending colon, sigmoid, rectum; GU: lower ureter, bladder

Most common cause of meningitis in pt with concurrent pulmonary TB

TB

cause of pleural effusion with adenosine deaminase <50 (low) and >80% lymphocytes

TB

OCD - tx?

TCA or SSRI + CBT

Sonambulism - tx; what stage of sleep does this occur?

TCA or benzodiazepine; stages 3-4 (tx goal is to reduce time spent in these stages)

Sleep walking and enuresis are treated with

TCAs like Imipramine (shorten stages 3-4 of sleep)Use

Post herpetic neuralgia treatment

TCAs, topical analgesics, opioids, gabapentin, and pregabalin

What is the most appropriate time period and tests for follow up after starting a pt on Levothyroxine for hypothyroidism

TSH in 4-6 weeks

Thyroid nodule > 1cm on physical - next step; step after that?

TSH level (thyroid US for nodules no easily observed on physical); fine needle aspiration (FNA)

Degeneration of dorsal column nerves

Tabes dorsalis (3° syphilis), subacute combined degeneration (dorsal columns and lateral corticospinal tracts affected)

Precocious puberty

Tanner stage 3 in a six-year-old female.

Pt w/ erectile dysunction after tx w/ fluoxetine - tx?

Taper off fluoxetine and start bupropion

"Cherry-red spots" on macula

Tay-Sachs (ganglioside accumulation) or Niemann-Pick (sphingomyelin accumulation), central retinal artery occlusion

Diagnostic test for Meckel's diverticulum

Technetium-99m pertechnetate scan

Menometrorrhagia

Term for heavy bleeding during and between menstrual periods.

Retrograde cystourethrogram

Test to rule out urethral injury.

Choriocarcinoma

Testicular cancer associated with β-hCG, AFP.

Ophthalmologic exam, CT, and MRI

Tests to rule out shaken baby syndrome.

Medication for treatment of Huntington's chorea?

Tetrabenazine Inhibits VMAT → dec. continual realease of dopamine into synaptic cleft → inc. dopamine breakdown

Chorea of Huntington's disease - tx?

Tetrabenazine (promotes degradation of dopamine)

"Boot-shaped" heart on x-ray

Tetralogy of Fallot, RVH

Pain, pallor, pulselessness, paralysis, paresthesia, poikilothermia

The 6 P's of ischemia due to peripheral vascular disease.

[OMM] Child w/ AOM - why would V spead of the occipitomastoid suture be helpful?

The Eustachian tube traverses the temporal bone (the suture is an articulation btwn occipital bone & mastoid portion of temporal bone)

V/Q scan

The diagnostic test for pulmonary embolism.

Review of PSC

The most likely diagnosis is primary sclerosing cholangitis. PSC is caused by an obliterative fibrosis of the intrahepatic and extrahepatic bile ducts. It is predominately seen in males under the age of 45 and is associated with HLA-DR52a, HLA-Cx7, ulcerative colitis, Crohn's disease, retroperitoneal sclerosing fibrosis and mediastinal sclerosing fibrosis. HLA-DR52a has a much stronger association with PSC than HLA-Cx7 and ulcerative colitis also has a much stronger association with PSC than Crohn's disease. If left untreated PSC can lead to cirrhosis and colangiocarcinoma. It usually presents with jaundice, pruritus and hepatosplenomegaly. Lab findings include a conjugated bilirubin greater than 50%, bilirubinemia, absent urine urobilinogen, increased alkaline phosphatase and increased GGT. The diagnosis is supported with MRCP or ERCP when they show narrowing or beading of the bile ducts. Liver biopsy may show periductal sclerosis, sometimes referred to as onion skinning. Treatment for PSC consists of high-dose ursodeoxycholic acid, endoscopic dilation and stenting of bile duct strictures and immunosuppressants such as corticosteroids, azathioprine and methotrexate. Patients with invariably require a liver transplant to survive.

Agranulocytosis

The most serious side effect of clozapine.

Statistics, a new drug's effectiveness is compared with furosemide. A study shows new drug is 1.2 times effective as furosemide with a 95% confidence interval of 0.85 to 1.55 - what does this mean?

The new drug may be more effective than furosemide but the difference is not statistically significant (more than 5% chance it could be random)

105 bacteria/mL

The number of bacterial culture on a clean-catch specimen to diagnose a UTI.

Sensitivity

The number of true positives divided by the number of patients with the disease is _____.

68%, 95.5%, 99.7%

The percentage of cases within one SD of the mean? Two SDs? Three SDs?

Tests for psoas syndrome

Thomas

Test for achillis tendon rupture

Thompson

Order of tx for the thoracic cage

Thoracic spine (Neutral and non-Neutral) Structural rib dysfunction (subluxations, torsions, compressions, superior first rib, laterally flexed second rib) Respiratory rib dysfunction

[OMM] What is the order in which thoracic cage dysfunctions are treated?

Thoracic spine à structural rib dysfunctionà respiratory rib dysfunction

Treatment of Tension Pneumothorax

Thoracotomy: large bore needle in 2nd ICS at MCL

DM, SLE, and amyloidosis

Three systemic diseases → nephrotic syndrome.

Pentad of TTP—"FAT RN": Fever, Anemia, Thrombocytopenia, Renal dysfunction, Neurologic abnormalities

Thrombotic thrombocytopenic purpura (TTP) pentad?

What type of dysfunction do you expect: Tight quads: Tight hamstrings:

Tight quads: ant innominate Tight hamstrings: post innominate

[OMM] Appendix Chapman's point - anterior; posterior?

Tip of 12th rib on right; transverse process of T11

First line tx of non-severe Psoriasis

Topical corticosteroids

Psoriasis - first line tx; tx if severe; tx if that fails?

Topical corticosteroids; UVB light radiation; psoralen + UVA (improves w/ sun exposure, worsens in winter)

Quinidine toxicity - causes what; tx?

Torsade de pointes & cinchonism (tinnitus, flushed skin, CNS disturbance); IV magnesium

13 y.o. pt w/ testicular pain on the superior pole of the right testicle, there is a blue dot on the superior pole of the R testicle - dx; tx?

Torsion of the appendix testis (remanant of the paramesonephric duct); supportive (pain control, bed rest, scrotal support - typically relieved in one week)

Mgmt of pt with FAP

Total Colectomy (100% risk of developing colonic adenocarcinoma)

Ring-enhancing brain lesion in AIDS

Toxoplasma gondii, CNS lymphoma

2 day old child w/ chorioretinitis, jaundice and calcification of the basal ganglia, mom admits to eating raw meat during pregnancy - dx?

Toxoplasmosis infection (from maternal exposure to raw meat or cat feces)

Infant w/ abdominal distension, choking upon feeding, and inability to pass NG tube - dx; tx?

Tracheoesophageal fistula (NOT choanal atresia b/c abd distension; surgical repair)

How to prevent TRALI

Transfuse leukocyte washed RBCs (plasma/surfactant removed)

Painful limp after URI; afebrile, normal ESR, normal WBCs

Transient synovitis

Infant following C-section immediately develops nasal flaring, tachypnea and intercostal retractions, resolves in 48 hrs - dx; tx?

Transient tachypnea of the newborn; IV fluids and Oxygen (meconium aspiration will usu. have green urine and nails)

Pt has abdominal pain, weight loss, hematochezia, narrow stools...where is the tumor?

Transverse or Left Colon

False. Patients may change their minds at any time. Exceptions to the requirement of informed consent include emergency situations and patients without decision-making capacity

True or false: Once patients sign a statement giving consent, they must continue treatment.

Weight loss, diarrhea, arthritis, fever, adenopathy

Whipple disease (Tropheryma whipplei)

Priapism - which psychiatric drug can cause it?

Trazodone

Retinoic acid

Treatment for AML M3.

Benzodiazepines

Treatment for DTs.

IVIG or plasmapheresis

Treatment for Guillain-Barré syndrome.

Radiation

Treatment for SVC syndrome.

Emergent large-volume plasmapheresis, corticosteroids, antiplatelet drugs

Treatment for TTP.

N-acetylcysteine

Treatment for acetaminophen overdose.

Morphine, O2, sublingual nitroglycerin, ASA, IV β-blockers, heparin

Treatment for acute coronary syndrome.

Anticoagulation, rate control, cardioversion

Treatment for atrial fibrillation.

Oral or topical metronidazole

Treatment for bacterial vaginosis.

Flumazenil

Treatment for benzodiazepine overdose.

Usually resolves spontaneously; may require IVIG and/or corticosteroids

Treatment for idiopathic thrombocytopenic purpura (ITP) in children.

Nitroprusside

Treatment for malignant hypertension.

Phototherapy (mild) or exchange transfusion (severe)

Treatment for mild and severe unconjugated hyperbilirubinemia.

Inhaled β-agonists and inhaled corticosteroids

Treatment for mild, persistent asthma.

Dantrolene or bromocriptine

Treatment for neuroleptic malignant syndrome.

Naloxone

Treatment for opioid overdose.

Uterine massage; if that fails, give oxytocin

Treatment for postpartum hemorrhage.

Immediate cardioversion

Treatment for ventricular fibrillation.

Rate control, rhythm conversion, and anticoagulation

Treatment of AF.

Fluids, insulin, and aggressive replacement of electrolytes (e.g., K+)

Treatment of DKA.

Fluid restriction, demeclocycline

Treatment of SIADH?

Diphenhydramine or epinephrine 1:1000

Treatment of anaphylactic shock.

Identify cause; pressors (e.g., dobutamine)

Treatment of cardiogenic shock.

Administration of DDAVP ↓ serum osmolality and free water restriction

Treatment of central DI.

Identify cause; fluid and blood repletion

Treatment of hypovolemic shock.

Rate control with carotid massasge or other vagal stimulation

Treatment of supraventricular tachycardia (SVT).

Immediate needle thoracostomy

Treatment of tension pneumothorax.

Tx for Trich and Bac Vag

Trich: Metronidazole AND TREAT THE PARTNER Bac Vag: Metronidazole

Mitral stenosis vs. Tricuspid stenosis - what is differentiating characteristic?

Tricuspid stenosis intensifies w/ inspiration (ms doesn't)

Preg screening by maternal age and gestational age

Triple screen (hCG, uncon. estriol, AFP) to all pregos b/w 15-20 wks Quad screen (hCG, uncon. estriol, AFP, inhibin A) if >35

Newborn w/ polydactyly, meningomyelocele, and rocker-bottom feet - dx?

Trisomy 13 (rocker-bottom feet also in Trisomy 18)

Trisomy 13 vs. trimsomy 18 - distinguishing facial features?

Trisomy 13 has close-set eyes and cleft lip/palate, trisomy 18 has widely-spaced eyes and prominent occiput

Hypercoagulability (leading to migrating DVTs and vasculitis)

Trousseau syndrome (adenocarcinoma of pancreas or lung)

What is a Marginal Ulcer

Ulcer in jejunum after gastrojejunostomy

"Lead pipe" appearance of colon on barium enema x-ray

Ulcerative colitis (loss of haustra)

Pregnant pt presents at 30 weeks gestation with PAINLESS, vaginal bleeding...

Ultrasound to r/o Placenta Previa

Fetal HR monitor shown: - etiology?

Umbilical cord compression (variable decelerations)

Prevalence study for a new anti-hypertensive drug - major disadvantage?

Under-representation of acute disease

Cluster headache

Unilateral, severe periorbital headache with tearing and conjunctival erythema.

Pt w/ stable angina now has more severe chest pain with increased frequency. ECG and cardiac enzymes normal, has been stable on aspirin, metoprolol, and nitrates - dx; tx?

Unstable angina; start IV heparin (unstable angina tx is same as non-ST elevation MI: β-blocker, aspirin, oxygen, nitroglycerin, morphine, heparin)

Ranson criteria for admission: at 48 hrs:

Upon admission the criteria used include glucose >200mg/dL, age > 55 years, LDH > 350IU/L, AST >250IU/dL and WBC >16,000/mL. (glu is 2, then ast, ldh) After 48 hours the criteria include calcium <8.0mg/dL, Hct drop >10%, PaO2 <60mmHg, base excess >4mEq/L, BUN increase >5mg/dL and sequestered fluid >6L. The mortality risk correlates with the number of criteria. The mortality risk is 20% with 3-4 signs, 40% with 5-6 signs and 100% with greater than or equal to 7 signs.

Pt w/ glucose-6-phosphate deficiency develops abdominal tenderness 5 hours ago and hematuria, UA shows 2+ blood - next step?

Urine microscopy (no RBCs under microscopy means hemolysis is the cause, if RBCs present most likely nephrolithiasis)

Multiple Myeloma - how do you detect Bence Jones proteins; tumor marker; peripheral blood smear; bone marrow bx?

Urine protein electrophoresis; β2 microglobulin; rouleaux formation (stacking of RBCs); > 10% plasma cells

Awakened at night by sudden, severe flank pain that radiates to the groin. U/A shows hematuria. Dx? Dx modality?

Urolithiasis Non-contrast CT (most specific and sensitive) or U/S if woman is preg or if it asks for best INITIAL test

Inevitable abortion

Uterine bleeding at 18 weeks' gestation; no products expelled; membranes ruptured; cervical os open.

The stepwise approach to uterine atony includes:

Uterine massage with oxytocin Methylergonovine prostin (PGF2) D&C exploratory laparotomy hysterectomy

Cause of Late Decelerations

Uteroplacental insufficiency

watery diarrhia, hypochloridria, hyperglycemia, hypokalemia

VIPoma (WDHA syndrome => watery diarrhea, hypokalemia, achloridia)

productive cough that lasts up to 20 days, scattered rhonchi, and arthralgia: Dx? Tx?

VIRAL chronic bronchitis!! Tx is supportive: Ipratropium and ASA

Newborn is non-cyanotic, has a holosystolic murmur with a thrill best heard over 4th left ICS...Dx?

VSD

HBV, DTaP, Hib, IPV, PCV

Vaccinations at a six-month well-child visit.

21 y.o. male w/ painful, grouped vesicles on his penis, tender inguinal lymphadenopathy, T103 - next step?

Valacyclovir (start w/ tx if clinical suspicion is high...Tzanck smear is best initial diagnostic test)

Smoking cessation - first-line pharmacologic tx for smoking cessation?

Varenicline (Chantix) or buproprion

Generic name for Chantix

Varinicline

_______ is a potential life-threatening complication of central line placement: sudden-onset dyspnea with the presence of a "mill wheel" murmur on PE

Venous air embolism -->acute cerebral ischemia if the air passes through a patent foramen ovale

Vicarious liability

Vicarious liability - Employers are liable for negligent acts or omissions by their employees in the course of employment.

Enlarged, hard left supraclavicular node

Virchow node (abdominal metastasis)

Stasis, hypercoagulability, endothelial damage

Virchow's triad.

Parvovirus B19

Virus associated with aplastic anemia in patients with sickle cell anemia.

Low Ca, low phosphate, elevated PTH

Vit D deficiency=secondary hyperparathyroidism Low absorption of Ca and Phosphate -> PTH is elevated in response

Measles - tx that has shown to reduce morbidity and mortality; how long should kid stay out of school?

Vitamin A supplementation; return to school 4 days after onset of rash (also contagious 5 days before rash)

Pt presents with low calcium, low phosphate and high PTH...Dx?

Vitamin D Deficiency

Pt w/ low calcium, low phosphate, high PTH - dx?

Vitamin D deficiency (results in decreased calcium and phosphate absorption)

Diabetes insipidus, urine osmolarity is 250 mOsm/kg water - initial workup; test to differentiate central vs. nephrogenic?

Water deprivation test (urine osmolarity will stay around 250 mOsm/kg water, normally will increase with H2O deprivation); desmopression challenge (nephrogenic DI will still have unchanged urine osmolarity, while central will respond by increasing urine osmolarity)

test for carpal ligament injury

Watson's

Nephrotic syndrome

Waxy casts in urine sediment and Maltese crosses (seen with lipiduria).

Personality trait clusters A, B & C - what is mnemonic?

Weird, wild, worried (weird = paranoid, schizoid, schizotypal...wild = borderline, histrionic, narcissistic, antisocial...worried = OCD, avoidant, dependent)

"Floppy baby" with hypotonia, weakness, with active eye movements...Dx?

Werdnig-Hoffman Disease (spinal muscular atrophy type 1) → defect in SMN1 gene

1 month old flaccid baby w/ intact extraocular movements - dx?

Werdnig-Hoffman disease (genetic disorder similar to botulinism except botulinism does not retain extraocular movements)

Tachycardia, peripheral edema, DOE, cardiomegally, increased JVP a/w alcoholism Dx? Pathophysiology? What will the echo show? Tx?

Wet beriberi chronic thiamine deficiency DCM, decreased EF IV Thiamine, stop drinking!!

Dilated cardiomyopathy, edema, alcoholism or malnutrition

Wet beriberi (thiamine [vitamin B1] deficiency)

Seventy percent if the stenosis is symptomatic

What % lesion is an indication for carotid endarterectomy?

Chronic granulomatous disease

What is the immunodeficiency? ■ A boy has chronic respiratory infections. Nitroblue tetrazolium test is +.

Wiskott-Aldrich syndrome

What is the immunodeficiency? ■ A child has eczema, thrombocytopenia, and high levels of IgA.

Bruton's X-linked agammaglobulinemia

What is the immunodeficiency? ■ A four-month-old boy has life-threatening Pseudomonas infection.

Abdominal obesity, high triglycerides, low HDL, hypertension, insulin resistance, prothrombotic or proinflammatory states

What is the metabolic syndrome?

Pregnant women. Treat this group aggressively because of potential complications

Which healthy population is susceptible to UTIs?

Fibrin split products and D-dimer are elevated; platelets, fibrinogen, and hematocrit are ↓.

Which of the following are ↑ in DIC: fibrin split products, D-dimer, fibrinogen, platelets, and hematocrit.

Check for ↑ ICP; look for papilledema

What should always be done prior to LP?

When there is no rationale for treatment, maximal intervention is failing, a given intervention has already failed, and treatment will not achieve the goals of care

When can a physician refuse to continue treating a patient on the grounds of futility?

Never

When should a vaginal exam be performed with suspected placenta previa?

A physician's duty to exercise reasonable care arises...

When the doctor dispenses medical treatment

A physician's duty to exercise reasonable care - starts when?

When the doctor dispenses medical tx (not when an appointment is scheduled)

Pseudotumor cerebri - demographic; what is it; dx test?

Young obese female (assoc. w/ vit A, tetracyclines and oral contraceptives); increased intracranial pressure in the absence of CSF findings; lumbar puncture

Diaphragmatic compensatory pattern:

Zink's model is as follows; the *Start with L!! OA: L C-T: R T-L: L L-S: R

Menstrual Cycle...

[Hypothalamus] GnRH → [Anterior Pituitary] FSH/LH FSH → [Granulosa Cells] Aromatase → Androstenedione to Estrogen → Proliferation of Endometrium LH → [Theca Cells] Desmolase → Cholesterol to Androstenedione → [Corpus Luteum] Progesterone -

Order of Spencer technique

extension flexion circumduction with compression circumduction with traction ABduction internal rotation pump

Warfarin: pathway, factors, measured with Reversed slowly with _______ and quickly with _____

extrinsic, 2, 7, 9, 10, PT slowly with Vit K, quickly with FFP

Chapman's points for the following: eyes middle ear sinuses tonsils tounge

eyes: lateral humerus middle ear: just lateral to where the clavicles cross the ribs sinuses: first rib tonsils: 1st ICS tounge: 2nd rib

timing of GDM screening for women with risk factors: no risk factors:

first and second trimester late second trimester

1st line tx for SIADH? 2nd line tx? 3rd?

fluid restricion demeclocycline PO tolvaptan

tx for euvolemic hyponatremia 2/2 SIADH

fluid restriciton, but if refractory, then normal saline

Tx of a cerebellar edema Inital tx of cerebral edema

immediate surgery mannitol and diuretics

tx of an air embolism 2/2 a central line placement

immediately aspirate the catheter, administer 100% oxygen, and place the patient in the lateral position with left side down

DLCO is increased in ________ DLCO is decreased in _______

increased in bronchitis, mitral stenosis, polycythemia, left-sided failure decreased in emphysema, pulm. HTN, interstitial lung disease

hemochromatosis labs

increased serum iron level, increased percent saturation of iron, increased ferritin and decreased serum transferrin levels.

Human placental lactogen/ chorionic somatomammotropin cause ______

induction of lypolysis to resease fatty acids, insulin resistance -->hypergly

Tx for bladder ca in situ superficial invasive w/o mets invasive w/ mets

intravesicular chemo TURP or intravesicular chemo radical cystectomy or radiotherapy IV and oral chemo

R to R in a-fib?

irregular! (also look for p-waves that are hard to define)

During craniosacral flexion, _____ The Frontal bone is ____

midline bones match: they also flex paired bones externally rotate Paired!!!!! 2/2 the metopic suture present up until 6 yrs of age

when the ankle dorsiflexes, the talus plantarflexion?

moves posteriorly moves anteriorly

Ingesting raw meat in pregnancy is a risk factor for ______ Neonatal complications include ______

toxoplasmosis microcalcifications and microcephaly

painless nodule at the MCP joint a/w locking or catching of the digits. Dx Tx 1, 2, and 3