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15 Cards in this Set
- Front
- Back
1. What are the signs and symptoms of Budd-Chiari syndrome? (B&W p73)
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Budd-Chiari syndrome is the thrombosis and occlusion of the hepatic vein or hepatic stretch of the inferior vena cava and presents with the following symptoms:
• ascites (84%) • hepatomegaly (76%) • jaundice • Acute presentation: acute RUQ pain and hepatomegaly, and rapid development of jaundice and ascites • Subacute or chronic presentation: gradual development of ascites, LE edema, cirrhosis, and portal hypertension over a few months • eventual development of liver failure and hepatic encephalopathy |
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2. What diagnostic studies are used to confirm the diagnosis of Cushing’s syndrome? (FA2 p117, B&W p87)
Screening tests |
• 24-hour urine cortisol (currently the preferred screening test)
• Overnight low-dose (1mg) dexamethasone suppression test (previously the preferred screening test) If tests are equivocal, may then use: • late evening serum cortisol level • late evening salivary cortisol level (can be collected at home) |
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3. What are the different etiologies of the syndrome of inappropriate antidiuretic hormone (SIADH)? (FA2 p442, B&W p77)
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• CNS disease: head trauma, brain tumor, stroke, CNS infection, pituitary surgery
• Pulmonary disease: pneumonia, tumor (small cell) • Drugs: NSAIDs, antidepressants, antipsychotics, antineoplastic agents, carbamazepine, ecstasy, vasopressin, dDAVP • Other: HIV/AIDS, major abdominal or thoracic surgery |
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4. What are the available treatments for atopic dermatitis (AKA eczema)? (FA2 p72, B&W p388)
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• Switching to a moisturizing soap (Dove, Aveeno) and adding an OTC emollient may be all that is needed for maintenance and mild cases.
• Hydration / Emollients: Cetaphil, Eucerin, Lubriderm, Aveeno, Aquaphor (or generic equivalents) - High water/low oil lotions will worsen xerosis and eczema, and high oil creams and ointments will reduce xerosis. • Calcineurin inhibitors: tacrolimus (Protopic) or pimecrolimus (Elidel) • Topical Steroids • Antibiotics for open lesions (cover Staph. aureus and Strep. spp.) • Antihistamines • Leukotriene inhibitors (Singulair) – theoretical efficacy supported by weak studies • UV light therapy • Systemic steroids (1-2mg/kg/d in children then taper) only in severe cases and only for short duration • For very severe cases, consider methotrexate, cyclosporin, azathioprine (Imuran) |
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5. What is the treatment for seborrheic dermatitis? (FA2 p76, B&W p389)
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• If active inflammation, treat Staph. infection (eg, azithromycin 250mg po qd x5days)
• Scalp: Derma-Smoothe FS oil (0.01% fluocinolone + peanut oil + mineral oil) qHS to scalp (for hours) then wash with Capex shampoo (0.01% fluocinolone) qd or Dawn dishwashing liquid until resolved. Once resolved, may suppress with 1-2x weekly shampoo with Head & Shoulders, Selsun Blue, T-Gel, or Capex. • Face, ears, nose: o Rosula (sulfacetamide 10% + sulfur 5%) lotion/gel qd-tid, or o Protopic or Elidil qd > 1week, or o Nizoral (ketoconazole) gel qd + Desowen (desonide) qd x2wks • Body: Rosula (sulfacetamide 10% + sulfur 5%) lotion/gel qd-tid |
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6. What are the advantages and disadvantages of combination oral contraceptives? (B&W p256)
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Advantages
• Reliable (<3% failure rate) • Reduce risk of endometrial and ovarian cancer • Decreased incidence of pelvic infections and ectopic pregnancy • Menses more predictable, lighter, less painful Disadvantages • Daily dosing • Does not protect against STDs • Breakthrough bleeding • Estrogen SE: bloating, weight gain, breast tenderness, nausea, headaches • Progesterone SE: depression, acne, hypertension • Increased risk of DVT • Elevated triglycerides |
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7. What are the treatment options for a CIN II or III lesion confirmed by colposcopy with biopsy? (B&W p259)
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Ablative Therapy
• Cryotherapy • Laser ablation Excisional Therapy • Cold knife conization • Laser conization • LEEP (loop electrosurgical excision procedure) |
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8. What is the difference between breast feeding jaundice and breast milk jaundice? (B&W p294)
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• Exaggerated physiologic jaundice (AKA breast feeding jaundice)- occurs in first wk of life, peaks at 12-15mg/dL, due to dehydration make sure baby has more than 10 feeds/day
• Breast milk jaundice- starts days 4-14 (usually after 1st wk) due to substances in breast milk. May continue for weeks to months while breastfeeding. Improvement with the substitution of formula for 48-72hrs is diagnostic. |
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9. What are the classic signs and symptoms of croup? (FA2 p373, B&W p286)
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• inflammation of larynx, trachea, and/or bronchi barking cough, resp distress, upper airway obstruction with inspiratory stridor
• symptoms are worse at night • 75% caused by parainfluenza viruses • 6% incidence annually in children under 6y/o • leading cause of hospitalization in children younger than 4y/o (esp. in fall/winter months) • Course: 12-72hrs of mild fever and coryza hoarseness and barking cough peak resp distress at 24-48 hrs resolution in 1 wk |
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10. What is the differential diagnosis of gynecomastia? (B&W p189)
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• puberty (resolves spontaneously in 6m to 2yrs)
• Medications: spironolactone, digitoxin, cimetidine, amiodarone, ketoconazole, haloperidol, HIV HAART therapy,…. • Drugs: alcohol, marijuana, heroin, anabolic steroids • Herbal agents: tea tree oil, lavender oil • Cirrhosis • Hypogonadism (eg, Klinefelter’s, hyperprolactinemia) • Testicular germ cell tumor • Hyperthyroidism • Hemodialysis patients |
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11. A 60 year old male presents to the clinic for a well male exam and on digital rectal examination a hard nodule is palpated on the prostate. Lab work-up shows an elevated PSA. What is the next step in the management of this patient? (FA2 p447, B&W p199)
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Transrectal needle biopsy in clinic (ideally ultrasound guided)
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12. What are the potential side effects of lithium use in the treatment of bipolar disorder? (FA2 p395, B&W p345)
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• CNS depression, tremor
• thyroid changes (hyper- or hypothyroidism, or euthyroid goiter) • nephrogenic diabetes insipidus (reversible on discontinuation) thirst, polydipsia, polyuria • GI side effects (nausea, vomiting, diarrhea, metallic taste changes, weight gain) |
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13. What personality disorder fits the following statement? (FA2 p397, B&W p354)
• excessive need to be taken care of, submissive and clinging behavior, low self-confidence, fears of separation and losing support • grandiosity, feels he is entitled to things, lack of empathy • suicide attempts ( 15% mortality), unstable mood and behavior, sense of emptiness and loneliness, impulsiveness • distrustful, suspicious, litigious • lifelong voluntary social withdrawal, no psychosis, emotional expression is limited (restricted range of affect) • feelings of inadequacy, hypersensitive to rejection or criticism, socially inhibited, shy |
• excessive need to be taken care of, submissive and clinging behavior, low self-confidence, fears of separation and losing support
dependent • grandiosity, feels he is entitled to things, lack of empathy narcissistic • suicide attempts ( 15% mortality), unstable mood and behavior, sense of emptiness and loneliness, impulsiveness borderline • distrustful, suspicious, litigious paranoid • lifelong voluntary social withdrawal, no psychosis, emotional expression is limited (restricted range of affect) schizoid • feelings of inadequacy, hypersensitive to rejection or criticism, socially inhibited, shy avoidant |
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14. What are the steps in the management of a femur fracture? (FA2 p245, B&W p204)
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• Maintain hemodynamic stability with IVF and PRBCs if necessary
• If closed femur shaft fracture, closed reduction and traction until able to perform ORIF in order to limit bleeding • If open fracture: copious irrigation with normal saline (at least 3 liters) then cover wound with sterile dressing, apply gentle pressure dressing to control bleeding, prophylactic antibiotics for gram (+) coverage, to OR within 6 hours for debridement, pulsatile lavage irrigation, ORIF, and delayed primary closure • Pain control with narcotics • Definite care as soon as OR can be ready: operative reduction with internal fixation (ORIF) with intramedullary nail • Tetanus prophylaxis |
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15. When are thrombolytics appropriate in the management of acute stroke? (FA2 p270, B&W p367)
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• If administered with 3 hours of the symptom onset in a CT confirmed ischemic (nonhemorrhagic) stroke (therapeutic window is 6 hours if the tPA can be given directly to the artery containing the clot)
• No contraindications to tPA (such as uncontrolled hypertension, prior intracranial hemorrhage, stroke or head trauma in the last 3 months, recent MI, current INR > 1.7, platelet count < 100K, major surgery in the last 14 days, GI/urinary bleeding in the last 21 days, seizures on stoke onset, uncontrolled blood glucose, age < 18, or improvement of symptoms as seen in TIAs) |