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929 Cards in this Set
- Front
- Back
When should you suspect Guillan Bgarre?
|
ascending paralysis after a viral illness
|
|
what is a diagnostic test for Guillan barre?
|
increased protein in CSF
|
|
what is the Rx for Guillan Barre?
|
plasmapharesis, IVIg
|
|
What is a classic sign of Impaired leukocyte adhesion?
|
delayed seperation of the umbilical cord.
normal lymphocytes, gamma globulin. Peridontal infections |
|
what organism is likely in an opsonization defect?
|
S. pneumo
|
|
What organism attacks in someone with complement deficiency?
|
neisseria
|
|
what is the diagnositic test for defective intracellular killing?
|
NBT
|
|
what drugs treat influenza A?
|
oseltamivir, zanamivir (neuroaminidase inhibitor)
Rimantidine, amantidine |
|
What is a common sign of Midpelvis contraction?
|
prominent ischial spines. Prevent expansion of the cervix
|
|
what eye tumor is seen in NF type I
|
optic glioma
|
|
what eye tumor is seen in tuberous sclerosis?
|
Retinal hamartoma
|
|
what ophthalmologic sign is seen in optic neuritis?
|
MS
|
|
What is Hehect's syndrome?
|
recurrent oral ulcer's, genital ulcers, erythema nodosum, + pathurgy
- seen in turkish, asian, middle eastern |
|
what is seen on EKG in a ventricular aneurysm?
|
ST elevation
|
|
what does a double apical beat signify?
|
ventricular aneurysm
|
|
How soon after an MI would one have Dressler's?
|
2-10 wks
|
|
what can pseudotumor lead to?
|
blindness
|
|
Define HTN retinopathy:
Grade I II III IV |
I- AV nicking
II- Copper wiring III- sliver wiring, hemorrhage IV- papilledema |
|
what does dark field microscopy test for?
|
syphilis (blood tests take a bit)
|
|
What does frei test test for?
|
chlamydia
|
|
what does wright stain test for?
|
granuloma inguinale
|
|
What does Tzanch test test for?
|
herpes
|
|
what happens to sleep when you age?
|
wake up more, shortened cycle
|
|
what can be used for continued CSF drainage (> 4 days)?
|
spinal drainage, acetazolamide to decrease ICP
|
|
when is craniotomy considered for CSF rhinorrhea?
|
>2wks
|
|
What are the findings on a stress test that indicates need for angiography?
|
faliure to increase BP, cannot complete stage 1 with bruce criteria, ST changes
|
|
at what gestational age can transiet htn be considered?
|
20 wks. b4 20 it's chronic htn or mole
|
|
when is a gunshot considered to have the abdomen involved?
|
below the 4th intercostal (nipple line). Ex lap needed.
|
|
When do u hospitalize a bulemic?
|
metabolic abnlties, medically unstable, suicide risk, failed outpt therapy
|
|
What is deQuervians tendonits?
What muscles does it effect what diagnostic PEX maneuver? What's the Rx? |
tendonitis seen post partum. Affects flexor pollicus longus, extensor pollicis brevis
+Finklestein, Rx is roids |
|
What is Dubin-Johnson?
what triggers it? what labs? |
chronic hyperbili- triggered by OCPS, Pregs, illness
conjugated bili, black liver. corophyrin? |
|
what is rotor syndrome?
labs? |
hyperbili due to defect of hepatic storage.
Unconjugated, conjugated hyperbili |
|
what is Crigler-Najar?
|
hyper bili that can cause severe neuro damage and death. Unconjugated hyperbili
Rx is phototherapy, plasma pharesis? |
|
What are the systemic findings of rheumatic fever?
|
PECCS
Polyarthralgia Erythema marginatum Chorea Carditis Subcutaneous nodules |
|
Will diuretic abuse give you high or low Cl in urine?
|
high!!
|
|
What is the blood test of choice for screening for addison's?
|
cosyntropin stim test
|
|
What is Job syndrome?
|
recurrent bacterial infections, high IgE, skin infections
|
|
What is wiskott aldrich syndrome?
|
eczema, TTP, pyogenic infections
High IgA, IgE, low IgM |
|
what is the pathomnemonic finding in chornoic eosinophilic pneumonia?
|
CXR w peripheral infiltrates, no pulm edema
|
|
When is bronchoalveolar lavage useful?
|
HIV- PCP
|
|
What is the most common cause of endocarditis?
|
viridans
|
|
How is CO2 interbeted in an ABG?
|
if high, it means a resp acidosis, or compensation for a met alk.
|
|
How is bicarb interpreted in an ABG?
|
if high,-> met alk, or compensation.
|
|
What are the common causes of resp acid?
|
COPD, Asthma, Benzos, barbs, alcohol (resp depressants), chest wall problems, sleep apnea (if you can't blow off CO2 you get acidotic)
|
|
what are the common causes of met acid?
|
ethanol, ketoacidosis, uremia, lactic acid, methanol, aspirin, diarrhea, carbonic anhydrase inhibitors
|
|
what are teh common causes of resp alk?
|
anxiety, aspirin, salicylate
|
|
what is the common metabolic disturbance w/ aspirin?
|
met acid
resp alk look for tinnitus, hypoglycemia, vomiting |
|
what are the common causes of met alk?
|
Vomiting, diuretics, volume contraction, antacid abuse, hyperaldo
|
|
what is the treatment for salicylate OD?
|
bicarb to speed up excretion
|
|
what happens to pH to peeps with chronic lung issues?
|
sleep apnea, chronic lung diseasess cause a baseline alkalosis. (normal compensatory met alk for resp acid is no longer compensitory but a primary issue)
|
|
Should you give bicarb to peeps with acidosis?
|
never, first fluids
|
|
What is the deal with a sleepy asthmatic and a normal blood gas?
|
could mean crashing. pH is normally high in asthma because they are eliminated CO2. If pt is not breathing aappropirately, CO2 will rise and pH will accumulate. If acidotic, they need intubation.
|
|
What are teh signs and symps of hyponatremia?
|
lethargy, mental status changes, anorexia, seizures, cramps, coma
|
|
What are teh hypovolemic causes of hyponatremia?
|
dehydration, diuretics, addisons, hypoaldo
|
|
what are the euvolemic causes of hyponatremia?
|
SIADH, phychogenic polydipsia, oxytocin use
|
|
what are teh hypervolemic causes of hyponatremia?
|
heart failure, nephrotic syndrome, cirrhosis, toxemia, renal failure
|
|
How do we treat hyponatremia?
|
hypovolemic = NS.
euvolemic, hypervolemic = fluid restriction. (may use diuretic for hypervolemia |
|
What med is used for SIADH if water restriction fails?
|
demeclocycline (induces nephrogenic DI)
|
|
what is the consequence of too quick a correction of hyponatremia?
|
central pontine mylinolysis.
|
|
When is hypertonic saline used?
|
only for seizures, and even then, only briefly
|
|
what can cause false hyponatremia?
|
hyperglycemia
hyperproteinemia hyperlipidemia. |
|
what is the cause of hyponatremisa in post op pts
|
narcotics (SIADH)
extra IV fluids. (adrenal insufficiency) |
|
what is a classic cause of hyponatremia in a preggers?
|
oxytocin
|
|
what are teh signs and symps of hypernatremia?
|
menstal status changes, hyperreflexia, seizure, coma
|
|
what are teh causes of hypernatremia?
|
dehydration, DI, diuretics, diarrhea, renal disease iatrogenic. sickle cell is rare. hypokalemia, hypercalcemia
|
|
how is hypernatremia treated?
|
usuall NS if dehydrated.
no D5W. |
|
what are the signs of hypokalemia?
|
muscle weakness (can lead to paralysis, vent failure, ileus, hypotension)
|
|
what are the ekg findings of hypokalemia?
|
loss of T wave, T-wave-flattening, U waves, premature ventricular and atrial complexes. Vtach, atrial tachy
|
|
what is the effect of pH on K?
|
pH can cause cellular shift
alk-> hypo acid-> hyper can give bicarb for very hyprK pts. |
|
what is the interaction between dig and serum K?
|
dig pts are very sensitive to K.
|
|
how do you replace K?
|
slowly correct.
oral preferred. IV if deranged, not greater than 20 per hr. |
|
when hypokalemia persists, what do you do?
|
check mg
if mg is low, K can't go back |
|
what are teh signs and symps of hyperK?
|
weakness and paralysis may occur, but cardiac is best studied. watch for PEA
|
|
what are the EKG effects seen in hyperK?
|
tall, peaked T waves, widened ARS, prolnged PR, loss of p waves. Sine wave EKG.
asystole and vfib. |
|
what are the causes of hyperK?
|
renal failure
tissue destruction hypoaldo meds adrenal insufficiency |
|
what is to be suspected in a nl pt with hyperK?
|
hemolyzed sample
|
|
What is the first step when hyperK comes back from a lab?
When is advanced therapy needed? |
EKG
decreased intake of K sodium polystyrene resin (K binder) >6.5 or cardiac tox IV therapy is needed CaGluc, bicarb, glucose and insulin beta2 agonists if renal failure, dialysis |
|
what are teh signs and symps of hypoCa?
|
tetany
Chvostek's (cheek tap) Trousseau's- bp cuff-> spasms |
|
what lab is the first thing that you check with low Ca?
|
check albumin. 1:.8
|
|
What causes hypocal?
|
diGeorge
renal failure (vit D) hypoparathyroidism Vit D deficiency pseudohypoparathyroid (short fingers, short stature, mental retard, nl levels of parathyroid acute pancreatitis RTA |
|
what is the relationship between low Ca and low Mg?
|
must correct hypoMg to fix hypoCa
|
|
how does pH affect Ca?
|
alk-> hypoCa (shifts Ca intracellularly)
hyperventilation, anxiety |
|
what is the relationship between Ca and Phos?
|
usually go in opposite directions.
|
|
what are teh signs and symps of hyperCa?
|
bones, stones, grones, psychiatric overtones
bones- osteoporosis stones- kidney groans- ab pain, anorexia, constipation, ileus, N/V psych- depression, psychosis, etc. |
|
what EKG change is seen in hyperCa?
|
shortened QT
|
|
what causes hyperCa?
|
hyperpara, malignancy
Vit A or D intox sarcoid thiazide famililial (low u immobilization hyperproteinemia |
|
what is seen on urine for familial hypocaliuric hypercalcemia?
|
low urinary ca
|
|
Why is asymptomatic hyperCa treated?
|
prolonged hyperCa will cause nephrocalcinosis and renal failure.
|
|
how is hyperCa treated?
|
IV fluids
furosemide oral phos calcitonin diphophonates plicamycin prednisone |
|
when is hypoMg seen?
|
alcohol?
Mg wasted by kidneys |
|
what are teh signs and symps of hypoMg?
|
hypoCa
|
|
when is hyperMg seen?
|
iatrogenic in preggers
renal failure can cause decreased deep tendons, then hypotension and resp failure |
|
how do you treat hypermg
|
ABCs. Fluids, furosemide
dialysis |
|
when do you see hypoP?
|
uncontrolled diabetes (ketoacidosis) and alcoholics
symps- neuromuscular (encephalopathy, weakness) rhabdo anemia WBC, platelet dysfunction |
|
why can't you give glucose before thiamine in an alcoholic?
|
you can cause wernicke's
|
|
what is wernicke's?
|
acute encephalopathy characterized by ophthalmoplegia, nystagmus, ataxia, and confusion. Can be fatal, reversible
|
|
what is korsakoff?
|
psychosis with anterograde amnesia, confabulation.
irreversible, 2/2 to damage to mamillary bodies and thalamic nuclei. Both are from no thiamine |
|
can alcohol w/drawal kill?
|
needs treatment on inpt basis
|
|
how do you Rx alcohol w/drawal?
|
benzos
|
|
what is acute alc w/drawal?
|
tremors, sweating, hyperreflexia, seizures 12-48hrs
|
|
what is alcoholic hallucinosis?
|
24-72 hrs
auditory and visual hallucinations and illusions w/o autonomic signs |
|
what is delirium tremens?
|
2-7 days
hallucinations, illusions, confusion, poor sleep, autonomic lability |
|
what are the physical stigmata of liver disease?
|
abdominal wall varices
esophageal varices testicular atrophy encephalopathy hemorrhoids jaundice ascites palmar erythema spider angiomas gynecomastia asterixis prolonged PTT hyperbili hypoalbumin anemia |
|
what diseases and conditioni may be caused by chronic alcohol?
|
gastritis
mallory-weiss pancreatitis peripheral neuropathy dilated cardiomyopathy rhabdo fatty change hepatitis cirrhosis wernicky cerebellar degeneration. |
|
what is the classic AST and ALT in alcohol?
|
AST:ALT is 2:1
|
|
what is the best treatment for alcoholism?
|
AA
disulfiram |
|
what are the effects of alcohol in pregs?
|
mental retardation, microcephaly, microphthalmia, short palpebral fissures, midfacial hypoplasia, cardiac defects. No alcohol is good alcohol in pregs
|
|
what kind of pneumonia is seen in alcoholics?
|
aspiration
anaerobes, e.coli, strep, staph. Klebsiella if currant jelly sputum or mucoid capsules |
|
what are the electrolyte abnlties in alcoholism?
|
low mg, K, Na, elevated uric acid
decreased folate, thiamine |
|
how are varices treated?
|
IV fluids, blood
endoscopy. sclerotherapy of the veins. mortality is high. Rebleeding is common. TIPS shunt is better than open surgical portacaval shunt. splenorenal is also teh most physiologic. |
|
what are the common causes of acute sinusitis?
|
s. pneumo
h. flu moraxella |
|
what is the Rx for BV in pregs?
|
clinda or metro cream
|
|
what is the Rx for pancreatic abscess?
|
antibiotics and drainage
|
|
ST changes in II, III, AVF, what type of MI, what artery?
|
inferior wall, RCA esp if w/ brady
|
|
what is the parkland formula?
|
4ml x kg x %
1/2 in first 8hrs |
|
what is the most common cause of back pain in 3rd trimester?
|
lordosis
|
|
what are the complications of a horseshoe kidney?
|
UPG obstructions, renal stones, chronic UTI, vesicoureteric reflux
|
|
what gives dullness to percussion and increased breath sounds?
|
consolidation
|
|
what gives dullness to percussion and decreased breath sounds?
|
effusioin
|
|
what gives hyperresonance and decreased sounds?
|
emphysema, penumothorax
|
|
are premis given vaccine's by chrono or gestational?
|
chrono, hep b > 2kgs
|
|
what causes bloody diarrhea w/ normal stool in HIV?
|
CMV- CD<50; owl's eyes
Rx is gancyclovere |
|
what type of ulcers does entamaeba give you?
|
flask-shaped
|
|
what drugs cause hearing loss?
|
furosemide, aminoglycocides, vanc, quinine, chloriquine
|
|
what labs in PKU?
|
increased phenlalanine >20
urinary phenylacetic acid nl tyrosine tetralyde |
|
what are the characteristics of a PKU kid?
|
blond, blue eyes, fair skin
musty, mouse odor urine mental retard, seizure, psychotic |
|
what is bullous pemphigoid?
|
tense blisters in flexural areas, elderly w/ uticaria
IgG, C3 at dermal-epidermal junctions - BP 230, 180 |
|
what is pemphigus vulgaris
|
IgG intercellularly in pidermus flacid bullae
|
|
what is cicatrical pemphigoid?
|
linear IgG deposits, mucosal blistering
|
|
what is herpes gestationis
|
C3 @ BM zone, 2nd trimester pregs
|
|
what is infradermal edema w/ leukocyte infiltrate a sign of?
|
uticaria
|
|
how do you treat diabetic gastroparesis?
|
1. improve glucose control
2. small, frequent meals 3. metoclopramide, domperidone 4. bethachol 5. erythro: promotes emptying 6. lisapride |
|
what lab in CML?
|
leukocyte alk phos is elevated
|
|
What is seen in AML?
|
aauer rods
|
|
what is seen in Poly vera?
|
decreased urine Epo
|
|
what is the test for c. diff?
|
cytotoxin stool assay
|
|
what is the first line in hyperCa
|
fluids, then furosemide
|
|
what is the cause of kidney failure in hodgkins?
|
minimal change
|
|
what is the cause of kidney failure in carcinomas?
|
membranous
|
|
how do you diagnose ZE?
|
gastrin serum
secretin if gastrin not indicative |
|
mycoplasma causes what skin manifestation?
|
erythema multiforme
teens. |
|
what panic disorder drug can cause seizures with w/drawal?
|
alprazolam- short acting benzo
|
|
what is the Rx for enterobius vermicularis?
how do you diagnose? |
albendazol
scotch tape test |
|
what psych disorder in kids is expressionlessness in social situations?
|
selective mutism
|
|
what arrythmia can quinidine cause?
|
torsaades
|
|
what is the Rx for epidural hematoma?
|
craniotomy
|
|
waht inhalation injureis occur in burn pts?
|
upper airway obstruction 2/2 to edema
reactive bronchospasm from aerosolized irritants small airway occlusion 2/2 edema, sloughing microatelectasis- loss of surfactant |
|
when can you not use sux?
|
hyperK
or injuries that can lead to hyperK (crush, burn) guillan barre, tumor lysis syndrome |
|
what can you use instead of sux in hyperK pts?
|
vecuronium, rocuronium
|
|
what is the mech of mitral regurg in HOCM?
|
systolic ant. motion of mitral leaflet
|
|
What organism causes eroding abscesses on the oral cavity, lungs, gi tract?
|
actinomyces israelli.
|
|
what is the microscopic finding with actinomyces?
|
yellow (sulfur) granules; Rx PCN
|
|
what is the radiologic finding on chronic pyelo?
|
blunting of calyces, focal parenchymal scarring
|
|
What are the physical exam findings in NEC?
|
abd distension, gas restriction
|
|
who will get NEC and when?
|
primis
2 wks |
|
what is marjolin's ulcer?
|
squamous cell- occurs in non-healing wounds
|
|
what diagnoses a luteal phase defect?
|
endometrial biopsy
|
|
what vitamin deficiency does INH cause?
|
b6
|
|
what causes B12 deficiency?
|
pernicious anemia
veg diet for years |
|
what causes a butterfly w/ central necrosis on head CT?
|
glioblastoma multiforme - high grade astro
|
|
what is lymphangioleiomyomatosis?
|
cystic disorder in ladies
cough, dyspnea, hemoptysis, pneumothorax, 50% goto pneumothorax |
|
what part of the brain is affected by huntingtons?
|
caudate nucleus
|
|
what elements would steer you away from MI?
|
<40, unless mad risks.
no risk factors reproducible by pain, not sharp or well locallized. not related to foods |
|
what findings on EKG make you worry about MI?
|
flipped or flattened Ts, ST elevation, q waves (II, III, AVF for inferior)
|
|
what is the Rx for MI?
|
early thrombo lysis; coronary angiography with PTCA or bipass if thrombolysis is contraindicated
2. EKG monitoring. Lidocaine or amiodorone if warranted (not prophylactic) 3. o2, sat>90% 4. morphine 5. nitrus 6. beta blocker (not w/ heart failure) 7 ASA 8 ACE, statin |
|
what drug in acute MI can relieve pulm edema?
|
morphine
|
|
when do you give heparin in an MI?
|
unstable angina. Thrombus, severe CHF on Echo
|
|
what clues suggest gERD?
|
foods, smoking, caffeine, lying down. Relieved by antacids. H. Pylori
|
|
what clues suggest chest wall?
|
localized, reprducible
|
|
what suggests esophageal problems?
|
negative MI, no risk factures. Abnl barium swallow, esophageal manometry.
|
|
what is the Rx for achalasia?
|
pneumatic dilation or botulism toxin
|
|
what is the Rx for nutcracker esophagus and espophageal spasm?
|
Ca Channel blocker.
myotomy |
|
what are clues for pericarditis?
|
recent URI, EKG with diffuse ST segment elevation
elevated ESR low grade fever pain relieved by sitting forward coxsackie tb uremia malig lupus automimmune |
|
what chest pain clues suggest PNA?
|
pleuritis, cough, fever, sputum
|
|
what suggests aortic dissection?
|
ripping pain to the back
marfans blunt chest trauma |
|
how is prinzmetal's treated?
|
ca blocker
responds to nitrus |
|
what is virchow's triad?
|
endothelial damage, venous stasis, hypercoagulable
|
|
when do you think of DVT?
|
surgery
malignancy trauma immobilization pregs OCPs DIC Lupus inherited condistions |
|
what should be considered with repeated episodes of superficial thrombophelbitis?
|
malignancy, trousseau's, migratory thrombo is classic for pancreatic cancer
|
|
what is the Rx for superficial thrombo?
|
NSAIDS, warm compresses
|
|
Give the cause of PE with each:
DVT Delivery Fracture |
thrombo
amniotic fat |
|
when would one see hemoptysis with PE?
|
lung infarct
|
|
when does HITT usually happen?
|
3-7 days post
|
|
how do you reverse aspirin bleeding?
|
platelets
|
|
Hemophelia A causes what lab test to be different?
|
prolonged PTT, low levels of 8, nl PT, bleeding time
|
|
how does vWF change labs?
|
bleedign time and PTT prolonged, nl 8 and 9; nl PT
|
|
how does DIC change labs?
|
prolongs PT, PTT, bleeding time; d-dimer
postpartum, infection, malignancy schistocytes, fragmented cells |
|
what vitamin deficiency can prolonged antibiotic use cause?
|
vit K
|
|
Left sided vs. right sided CHF
|
Left- orthopnea, paroxysmal nocturnal dyspnea; pulm congestion, kerly Bs, pulm vasc congestion and edema; bilateral pulm effuctions
Right: peripheral edema, JVD, hepatomegaly, ascites, underlying lung disease |
|
what can precipitate CHF?
|
noncompliance, MI, HTN, arrhythmias, infections, fever, pe, anemia, thyrotoxicosis, adn myocarditis
|
|
what is cor pulmonale?
|
right ventricular enlargement, hypertrophy, and failure 2/2 lung disease. COPD, PE
|
|
how do you Rx cor pulmonale?
|
ca channel blockers
|
|
What causes restrictive cardiomyopathy?
|
amyloidosis, sarcoid, hemochromatosis, myocardial fibroelastosis.
abnl biopsy |
|
what is constrictive pericarditis
|
pericardial knock, calcification of pericardicum. nl vetricular biopsy
|
|
what physical exam signs are seen in constrictive pericarditis and restrictive cardiomyopathy?
|
S4, Right sided heart failure
|
|
what is the Rx for HOCM?
|
b-blockers, verapamil for more filling time.
no competative sports NO dig, diurectics, or vasodilators |
|
what is the method for Rx of afib?
|
rate control with b-blocker, ca blocker, or dig
- acude, caardiovert w amiodarone, procainamide, or DC cardioversion - chronic, anticoagulate, then cardiovert: if it fails, leave pt on dig, and warfarin |
|
how do you treat aflutter
|
rate control- carotid massage, b-blocker, ca blocker, other
cardiovert |
|
what is the Rx for WPW?
|
procainamide or quinidine; no dig, verapamil
|
|
what is used for Vtach?
|
amiodarone, lidocaine
|
|
what is used for vfib?
|
defibrillation
|
|
what is used for sinus brady?
|
atropine if symptomatic
|
|
what is used for sinus tacy?
|
beta blocker or ca blocker
|
|
what is the presentation of WPW?
|
child becomes dizzy or dyspneic, passes out after playing. Recovers and has no symps. Delta wave
|
|
What is PDA associated with?
|
congenital rubella, high altitudes
open with E1, close with indomethacin or surgery |
|
what is the most common congenital heart defect?
|
VSD
seen in fetal alcohol, TORCH, downs |
|
when does ASD cause a problem?
|
adulthood
fixed splid S2, palpitations. |
|
what is the most common cyanotic congenital heart defect?
|
tetralogy
|
|
what is the tetralogy?
|
VSD
RVH Pulm stenosis overriding aorta "tet spells" after squatting |
|
where is the highest o2 concentration in fetal circulation?
|
umbilical vein
Lowest umbilical arteries. |
|
what is the change in infant circ when intrauterine to extrauterine life?
|
inflated lungs, decreased pulm vasc resistnace, increases blood flow to pulm arteries. Clamping of cord increases left sided heart pressures, foramen ovale closes. o2 cuts off prosta production and ductus closes
|
|
what part of the brain is affected in wilson's?
|
lenticular
|
|
what are teh typical TFTs in pregs?
|
elevated t4, nl TSH; increased thyroid binding (stimmed by BHcg and increased egen to bind to)
|
|
what the are the fundoscopic signs of DM retinopathy?
|
background or simple microaneurysms, hemorrhages, exudates, edema
- preproliferative- cotton wool spots - proliferative- new vessels |
|
what is characteristic macular degeneration?
|
distorted vision, central scotoma
|
|
what radiographic sign is seen in coarctation?
|
rib notching
|
|
what is the treatment for acute vasoocclusive crisis in sickle cell?
|
exchange transfusion
|
|
what is sclerosing pannicullitis?
|
tender lesion over medial malleolus with venostasis
|
|
what is erysipelas?
|
cheak cellulitis
|
|
what is LAP a marker for?
|
leukemoid reaction
|
|
what is haptoglobin?
|
binds hemoglobin; decreases in RBC destruction
|
|
what is the Rx for PCP?
|
TMP, conditional roids
roids if PaO2 < 70 or A-a>35 |
|
what is a frequent cause of osteo with prosthetic devices?
with sickle cell? with UTI? |
s. epidermis
salmonella kleb pseudomonas |
|
what is the hallmark of bernard soulier?
|
giant platelets, no receptor for vWF so no function with ristocetin
|
|
what is glanzman's
|
nl platelet cound, but platelets don't aggregate with ADP
|
|
what are the keys to lewy body disease diagnosis?
|
parkinsons, hallucinations
|
|
what bug causes pneumonia, abdominal pain?
|
legionella
also with headache, hyponatremia |
|
what can a buccal smear diagnosie?
|
turners
|
|
what is significant about Mammary enlargement and vaginal discharge in a newborn?
|
not much, they are transient
|
|
what is significant about recurrent chelazion
|
squamous cell carcinoma
|
|
what is the best Rx for prostate bone mets after orchiectomy?
|
rads
|
|
when should external cephalic version be performed?
|
after 37wks
|
|
how do you calculate confidence interval?
|
mean +- SD/sqrtN
|
|
what are teh common causes of contact dermatitis?
|
poison ivy, oak, sumac, gino
Nickle, formaldehyde, fragrances, polish, chemicals |
|
what is the Rx for contact dermatitis?
|
topical antihistamines, steroids
|
|
what is the murmur of HOCM?
|
harsh, diamond shaped systolic murmur, increases with valsalva
|
|
what renal failure is induced by NSAIDS?
|
tuberointerstitial nephritis, papillary necrosis
|
|
what is seen on U/A in tuberointersticial nephritis?
|
WBC casts, sterile pyuria
|
|
hat are teh characteristics of nephritic syndrome?
|
hematuria, RBC casts, edema, HTN, proteinuria
|
|
what are the hallmarks of silicosis?
|
glassmaker, pottery
small nodules in upper lung |
|
when would one suspect berrylliosis?
|
high tech jobs- aerospace, electronics
|
|
what is alveolar proteinosis
|
build up of protein in alveolar space
CXR w bilateral alveolar infiltrates impaired clearance PFTs restrictive Biopsy w PAS confirms Dx |
|
when do you supect hormone insues in 1ry amennorhea?
|
>16 w 2ry sex; >14 w/o out
the workup is FSH if increased it's peripheral so karyotype if decreased it's central so GnRH stim. |
|
when do we screen for cholesterol?
|
every 5 yrs at 20, sooner for obese or fhx
|
|
what are some signs of hypercholesterolemia?
|
xanthelasma, tenson xanhomas, corneal arcus in younger pts, milky serum.
|
|
what is the current management of chol?
|
total <200
TG < 150 LDL < 160 for no rsks (meds for >190 <100 for greated tahn 2 CHD risks (meds for >130) <100 for CAD or equivalent (meds for >100) <70 for very high risk (meds for >100) |
|
what are CHD risk factors?
|
male
age FHx Cigs HTN low HDL |
|
what are weak risk factors?
|
obesit, type a, stress and physical inactivity
hyper TG |
|
how is LDL calculated?
|
LDL=total - HDL - tg/5
|
|
what is th etreatment for hyperchol?
|
lifestyle
statins (liver, muscle damage) niacin (raises HDL) bile acid-binding resins |
|
What changes HDL
|
increased by moderate alc, exercise, egens
lowered by smoking, androgens, progesterone, hyperTG |
|
Where does Wilm's tumor originate
|
metanephros
|
|
when do you suspect wilm's tumor?
|
>3y/o
flank mass palpable kidneys |
|
when do you suspect neuroblastoma?
|
<3y/o
flank mass non-palp kidneys |
|
what are the signs of membranous GN?
|
thickened BM, supepithelial spikes
|
|
what are the signs and symps of freidrich's ataxia
|
unstable gain, difficulty speaking, falling
- concentri HCM, DM, Scoliosis, hammer toes |
|
what is affected in freidrich's ataxia?
|
spinocerebellar tracts, post columns, pyramidal tracts
|
|
What is bruton's agammaglobulinemia?
|
decresed Igs, few B cells. Affected 6-9 months old
|
|
what is common variable immunodeficiency?
|
decreased Igs, nl B cells
15-35 y/o |
|
what is the common presentation for DiGeorge?
|
hypoCa sezures
esophageal atresia, CHD, anomalies of great vessels, hypoplasia, low-set notched ears |
|
what is myotonic muscular deficiency?
|
- AD inheritance
- all muscle types involved. - thenar, hypothenar wasting - temporal wasting, ant. compartment of lwoer legs, DM, teste atrophy, frontal baldness, hypothyroid |
|
How does aspirin cause met acidosis?
|
uncouples ox phos
hyperpyrexia inhibs carb and lipid metabolism |
|
how do you manage hepatic encephalopathy?
|
deal with the precipitating factor- hypovol, GI bleed, hypoK, met alk, hypoxia, setative, hypoglycemia, infection
- decrease blood NH3 with lactulose - ornithine -asp or NaBenzoate if lactulose doesn't work |
|
what is the Rx for ankylosing spondylitis?
|
TNFalpha
|
|
what si the empiric Rx for infected diabetic ulcer?
|
cefotetan, amp/sulf, clinda/fluorquinolone
|
|
vit c causes what kidney issue?
|
oxalate stones
|
|
what valve issue can displace the R main stem bronchus?
|
MS (enlarged atria)
|
|
what is afib in pregs significant for?
|
tsh
|
|
what is the liver histology of alpha1antitrypsin?
|
PAS uptake, diastase resistant
|
|
what pulm issue is seen in alpha1antitripsin?
|
emphysema
|
|
what is the most commmon organism in joint infection?
|
s. aureus
e. coli Pseudomonas in drug users |
|
why colonoscopy in colon ischemia?
|
differectiate between ischemia and c. diff also to see if ischemia is transmural. If transmural-> OR
|
|
how do you treat superficial thrombophlebitis?
|
NSAIDS, warm compress
|
|
what is intrahepatic cholestasis in pregs?
|
2nd, 3rd trimester
genetic (seen in hisp. (bolivia)) intense pruritis increased bile acids |
|
how do you treate intrahepatic cholestasis in pregs?
|
ursodeoxycholic acid
|
|
what is the fatty liver of pregs?
|
prolonged PT, increased LFTs
microvesicular fatty deposition, no inflamm |
|
how do you suppress Lactation?
|
tight bra, ice packs.
egen and testosterone also used in combo. NO bromocriptine |
|
what is fetal hydantoin syndrom?
|
epileptic mom with anticonvulsants
- microcephaly, hypoplasia of distal phalynx, fings, toes nail hypoplasia, low nasal bridge, irsuitism, cleft palate, rib anomalies |
|
what are the signs of congenital syphilis?
|
hydrops, anemia, thrombocytopenia, leukopenia, pneumonitis, hepatitis, osteochondritis
Late- fever osteitis, osteochondritis, HSM, lymphadenopathy |
|
what is teh presentation of fetal alcohol?
|
IUGR, microcephaly, MR, renal, card defects, midfacial hypoplasia, micrognathia, flattened philthrm, short fissure, short vermillion border
|
|
what happens to cocaine babies?
|
ICH, NEC, cardiac GU
|
|
what is waterhous-frederichson syndrome?
|
acute adrenal insufficiency from DIC bleeding into adrenals (what kills in meningitis)
|
|
when should one suspect tricuspid atresia?
|
left axis deviation
hypoplastic RV, VST, TGA EKG- LVH |
|
what are teh EKG findings of tetrology?
|
right atrium dilation, RVH
|
|
what are the CXR and EKG findings of truncus?
|
increased vasc markings, r aortic arch, biventricular hypertorphy
|
|
what should you look for after Myasthenia diagnosis?
|
thymoma
|
|
what is erlichiosis?
|
tick bite
g neg bacteria fever malaise, myalgias, headache, N/V; no rash, decreased WBC, decreased platelets, increased LFTs |
|
what is the treatment for erlichiosis, RMSF, lyme disease?
|
doxy
|
|
what is the treatment for RSMV in pregs?
|
chloramphenicol
|
|
what is zenkner's diverticulum?
|
herniation of the cricopharyngeal muscles
neck bulge that increases in size with drinking liquids Rx is excision, myotomy |
|
what causes malbasorption in ZE?
|
pancreatic enzyme inactivation
|
|
what does anchovy paste signify?
|
amebic abscess
in liver caused by e. histolytica a sign is recent imigration. Rx is metronidazole |
|
what differentiates 1ry vs. secondary hyperPTH
|
Ca
if from renal, it will be low Ca stimming increased PTH |
|
what are common causes of thyrotoxicosis with decreased radioiodine uptake?
|
subacute, painless thyroiditis
subacute granulomatous thyroiditis iodine induced thyroid toxicosis levosynthroid OD struma ovarrii |
|
what Na disorder can NSAIDs cause?
|
SIADH
|
|
when are bite cells and heinz bodies seen?
|
G6PD
- x-linked |
|
what are heinz bodies?
|
update of crystal violet staining
|
|
what triggers G6PD dysfuntion?
|
drugs- sulfa, choriquine, infections, fava beans
|
|
what gene is involved in osteogenesis imprefecta?
|
type I collagen
(blue sclera, deaf, short, scoliosis) |
|
what gene is involved in marfan's?
|
fibrillin I
|
|
what is the hallmark of PCP toxicity?
|
vertical nystagmus, confusion, ataxia, decreased sensation, hallucination
|
|
how do you diagnose a stress fracture
|
CT, bone scane
|
|
how do you manage non-bleeding varices?
|
B-blocker
if they bleed-> banding or sclerotherapy if that doesn't work, then TIPS |
|
what are hallenhorst bodies?
|
cholesterol particles
|
|
what tumor is associated with Red Cell Dysplasia?
|
thymoma
|
|
what is the labs for 2ry amennorhea?
|
pregs, TSH, PRL
then estrogen then FSH |
|
what is recommended for threated ab?
|
bed rest, no sex
|
|
what congenital defect causes incrased K, decreased Na?
|
21 deficiency
increased 17, decreased gluc and mineral |
|
11 deficiency has less gluco, less mineralo or both?
|
gluco
increased mineral |
|
when a baby is cyanotic when feeding but not when crying, what do you suspect?
|
choanal atresia
|
|
what is the hallmarg of laryngomalacia?
|
insp stridor that increases w exertion
in 1st 2wks |
|
if acute pyelo does not resolve, what is needed?
|
US to look for abscess or stone
|
|
what is seen on blood smear in sideroblastic anemia?
|
dimorphic RBC population
|
|
what is seen on bone marrow biopsy in sideroblastic anemia?
|
ringed sideroblasts
|
|
what causes sideroblastic anemia?
|
decreased b6
|
|
what cancer is caused by cyclophosphamide?
|
bladder cancer from increased acrolein
to prevent, mad fluids and frequent urination |
|
what are the indications for aortic valve replacement?
|
symptomatic AS
AS and other procedure asymp w poor lVF, LVH, valve < .6cm2 |
|
what is vitiligo associated with?
|
pernicious anemia
hypothyroid addisons type I diabetes antibodies to melanin, parietal cells, thyouid |
|
what is a macule?
|
flat spot less than 1cm
freckle |
|
what is a patch?
|
large macule
|
|
what is a papule
|
solid, elevated lesion < 1cm
|
|
what is a plaque
|
large papule
|
|
what is a nodule?
|
palpable, solid lesion, no flat top
|
|
what isa vesicle
|
elevated, circumscribed lesion < 5mm with clear fluid
|
|
what is a bulla?
|
large vesicle
|
|
what is a wheal?
|
itchy edematous area
|
|
what conditions cause itching?
|
obstructive biliary disease
uremia polycythemia vera (after shower or bath) scabies, dermatitis, lichen planus |
|
what is atopic dermatitis?
|
chronic allergic condition that begins in the first year of life with red, itchy, weeping skin on head, upper extremities, diaper
can lead to bacterial infection. Rx is no dry soap and antihistamines |
|
what is seborreic dermatitis?
|
cradle cap and dandruff
blepharitis scaling skin on the scalp and eyelids treat with selenium, corticosteroids, ketoconazole |
|
tinea corporis
|
red ring-shaped lesions with raised borders, clear centrally when they expand
|
|
tinea pedis
|
macerated scaling web spasociated with thickened disorted toe nailse associated with thickened disorted toe nails
|
|
tinea unguium
|
thickened distored nails
|
|
tinea capitus
|
kids
scaly patches of hair loss, boggy granuloma of scalp kerion if florescen under wood's lamp, microsporum is the cause |
|
what is tinea cruris
|
jock itch
|
|
what are the organisms that cause fungal infections?
|
trichophyton speieas
|
|
how do you diagnose fungal infection?
|
koh prep to visualize the fungus
|
|
how to treat candidiasis?
|
nystatin, or miconazole, clotrimazole
|
|
what is the classic definition of scabies?
|
tunnels into skin, leaves visible burrows on the skin, finger web spaces and flexor surface of the wrists
|
|
how do you treat scabies
|
Dx by scraping mite out of a burrow and viewing it under a microscope.
Treat scabies with permethrin cream No lindane |
|
how do you treat tinea versicolor
|
Pityrosporum
torso of young adults areas fail to tan KOH prep sulfide shampoo or topical imidazoles |
|
what causes lice?
|
pediculosis pediculus capitis
phthirus pubis for crabs permethrin cream |
|
how do you treat warts?
|
salicylic acid, liquid nitrogen, curettage
|
|
what is molluscum?
|
poxvirus
skin colored, smooth, waxy papules, central depression inclusion bodies freeze and curettage |
|
what bacteria is involved in acne?
|
comedones
propionibacterium acnes blocks pilosebaceou glands |
|
what are the Rx for acne?
|
benzoyl peroxide
topical clinda tetracycline erythromycin Isotretinoin is a last resort, but not for pregs. |
|
what is rosacea
|
acne, but in middle age
rhinophyma 9bulbus red nose) blepharitis topical metronidazole, oral tetracycline |
|
what is a pathologic cause of baldness?
|
trichotillomania- pulling out your hair
alopecia areata- antimicrosomal antibodies |
|
what is keys to psoriasis?
|
caucasians, early onset
fhx pitting nails, arthritis |
|
what is the rx for psoriasis?
|
sunlight, lubricants, topical corticosteroids
|
|
what si the classic description and natural course of pityriasis rosea?
|
herald patch- scaly, ring-shaped patch on the trunk
followed by itch christmas tree pattern |
|
what are the four ps of lichen planus?
|
pruritic, purple, polygonal papules
wrists, lower legs |
|
what causes photosensitivity?
|
tcas
phenothiazines OCPs |
|
what is paget's disease of the nipple?
|
unilateral red, oozing nipple
underlying breast cancner invasive ductal carcinoma |
|
what is stomatitis
|
inflamation of the mucous membranes of the mouth. Corners of the mouth
b-vitamins vitamin c |
|
when do we worry about actinic keratoses?
|
nodular, warty or ulcerated
|
|
what is keratoacanthoma?
|
mimics squamous cell cancer
flesh colored, keratinous material rapid onset 1-2 months |
|
what can cause uncontrolled sweating?
|
pheo, mi, tb, hyperTSH
|
|
what is dermatitis herpetiformis?
|
celiac sprue
pruritic vesicls on elbows knees IgA deposits |
|
what is pemphigus vulgaris?
|
autoimmune disease against desmoglein III
bullae, starting in oral mucosa fishnet immunofluorescence Rx with corticosteroids |
|
what is erythema nodosum?
|
red tender nodules
pretibial with UC, sarcoid, coccidiomycosis |
|
What type of therapy do social phobias need?
|
flooding, biofeedback, relaxsation, exposure desensitization
|
|
what steps must be taken in pneumomediastinum after pneumothorax?
|
observation
air can enter via the hilum of the lung |
|
what is Hanman's sign?
|
crunching with each heart beat, heard in pneumomediastinum
|
|
when does a pneumomediastinum need needle decompression?
|
CV compromise
|
|
when does pneumomediastinum need surgical decompression?
|
when associated with mediastinitis
|
|
what infection causes nasal septum perforation?
|
3ry syph
TB leprosy cocaine |
|
when there is a midluteal progesterone defect in pregs, what are teh signs and what is the Rx?
|
signs: corups luteum doesnt' cut it and decreased prolif of endometrium (confirm by biopsy)
Rx- progestin suppositories |
|
what is the characteristic rash of rubella?
|
erythematous, maculopapular. Face-> trung, extremitis
Prodrome: fever, lymphad, malaise |
|
what is the difference in prodromes between measles and rubella?
|
measles- cough coryza, fever, conjunctiva (koplik spots)
rubella: fever, lymphad, malaise |
|
hwat causes croup?
|
paraflu
racemic epi |
|
what is the cure for hypertonic contractions?
|
morphine
|
|
with silent chest in ashtma, what's the next step?
|
intubate
|
|
what congenital disease can cause meconium ileus?
|
CF
|
|
what is Todd's paralysis?
|
post-ictal paralysis
|
|
what is a luteoma?
|
benign lesion of overy in pregs
looks like tumor suspect in multiparous AA women |
|
what can a vericocele that does not empty indicate?
|
RCC
|
|
what might cause increased Hbg, thrombocytosis in a pt with unemptying vericocele?
|
RCC-> increased epo
|
|
what is grover's disease?
|
acantholytic dermatosis
brown keratotic papules over ant chest, upper back, lower rib cage. |
|
what thyroid cancer can develope from hashimotos?
|
lymphoma
|
|
what is the role of ursodeoxycholic acid in gallstones
|
decreases chol content of bile
needed if pt does not want surgery |
|
what is the Rx for toxo?
|
sulfadiazine, pyrimidamine
|
|
what is shydragger syndrome?
|
parkinsons
autonomic dysfunction cerebellar probs Rx- fludrocortisone, salt to keep volume |
|
what is riley-day?
|
ashkenazi autonomic dysfunction
|
|
what is the common cause of esophagitis in AIDs?
|
candida-> fluconazole
if no response biopsy and look for CMV, HSV |
|
what is the best HTN drug in osteoporosis?
|
thiazide
|
|
what are the contraindications to triptans?
|
1. pregs
2. familial hemiplegic migraine 3. uncontrolled HTN 4. CAD 5. prinzmetal 5. ischemic stroke 6. basilar |
|
what are the teratogenic effects of rads?
|
preg loss, growth restriction, eye malformations, CNS defects
discuss Ab if exposed to 5-50 gray |
|
what are the major pathologies of liver disease w alcohol?
|
1. fatty liver
2. alc hepatitis 3. alc fibrosis/cirrhosis |
|
what electrolyte imbalance can occur in surgery w mult transfusions?
|
low Ca
|
|
what are the most common casues of acute pancreatitis?
|
- stone, alcohol, increased TGs, recent ERCP
- Rx- IV fluids, NG tube, NPO, analgesia |
|
If there is subcutaneous epmphysema, what must be ruled out?
|
pneumothorax
|
|
what is needed to diagnose malignant HTN?
|
papilledema
|
|
what bug makes alkaline urine?
|
proteus
|
|
what is concernting about lochia that may make you think of endometritis
|
foul smell
|
|
what drug is good for HTN and essential tremor
|
propanolol
|
|
what is a common SE of clomiphene?
|
hot flashes, breast pain
|
|
what are the Sx of reyes?
|
vomiting, agitation, irrational behavior, lethargy, stupor
increased NH3, bili, alk phos, ptt decreased sugar |
|
when do you suspect pinworm in vulvovaginitis?
|
nightime itching
other kid infected |
|
what is the Rx for fulminant hepatic failure?
|
transplant
|
|
vag bleeding with delivery then decreased pituitary is?
|
sheehans
|
|
what are teh presenting signs of lymphocytic hypophysitis?
|
headache, vision changes with decreased pituitary function
|
|
what lady cancer is associated with DES?
|
vag adenocarcinoma
clear cell |
|
when do we see retinal vein occlusion?
|
HTN, clotting disorders, DM, glaucoma
|
|
what are the sx of glaucoma?
|
red eye, hazy cornea, fixed pupil
|
|
what is the best anti HTN in LVH?
|
beta blocker
|
|
in elderly with low Fe anemia, what's first?
|
colonoscopy to rule out cancer
|
|
what is vasa previa?
|
ruptured fetal vessel.
|
|
who do you screen for dm?
|
obese, >45, fhx, minorities, pregs
|
|
what is the definition of dm?
|
>126 fasting or random >200
pregs: >200 after 2hrs, 70gm load |
|
what is the islet cell pathology in DM 1?
|
insulitis
|
|
what is the islet cell path of DM 2?
|
amyloid deposits
|
|
what are the sugar goals in DM?
|
post parandial < 200
fasting <130 |
|
what is the role of c-peptide in pt w hypoglycemia?
|
c-peptide means insulinoma
no c-peptide means abuse |
|
what are the signs of DKA?
|
kussmal breathing, dehydration, hyperglycemia, acidosis, increased ketones
|
|
what is the Rx for DKA?
|
IV fluids
insulin electrolyte replacement (K, Phos) |
|
what are teh common causes of DKA?
|
no insulin
infection |
|
what is nonketotic hyperglycemic hyperosmolar state?
|
type II w/o adequeate Rx.
hyperglycemia, increased serum osms, no ketones, or acidosis Rx- hydration, lots of it. insulin is also required |
|
what are teh classic symps of DM?
|
polydip, polyuria, candida
|
|
what is a kimmelstiel-wilson nodule?
|
golmerular change in dm.
|
|
what is the Rx for diabetic gastroparesis?
|
metoclopramide
|
|
what is the rx for diabetic retinopahty?
|
panretinal laser photocoagulation.
|
|
what is the somogyi effect?
|
body's reaction to hypoglycemia
Too much NPH at dinner will cause low sugars at 3am. this caues stress hormones-> high glucose at 7am if this is the case then decrease nighttime insulin the dawn phenomenon is what happs with GH release in the am |
|
how do you manage a diabetic who's NPO?
|
1/3rd the insuilin. Gcose is monitored closely by the anesthesia.
|
|
what happens with B-blockers in diabetics?
|
b-blockers mask the classic symps of hypoglycemia.
if there is a previous MI, use it, but otherwise, think a little omre |
|
what is the most common cause of LMN facial nerve paralysis?
|
bell's palsy. sudden, unilateral onset, usually after a URI. Possibly latent herpes. hyperacusis. Everything is loud cause of the stapedius muscle.
sever cases, pts unable to close the affected eye. Must use drops. valacyclovir may help |
|
what is ramsay hunt syndrome?
|
herpes infection, causes facial nerve paralysis.
vesicles on the pinna, inside the ear, encephalitis, meningitis may be present |
|
what are some causes of faical nerve paralysis?
|
bell's
herpes lyme's stroke middle ear or mastoid infection meningitis temporal bone fracture schwanoma |
|
what are the common causes of hearing loss?
|
aging
prolonged exposure to loud noise TORCH meniere's drugs tumor labyrinthitis- viral diabetes |
|
what is the usual cause of sudden deafness
|
viral from mumps, measles, flu, chickenpox, adnovirus.
|
|
what is the ost common cause of acquired hearing loss in kids?
|
meningitis
|
|
what are the common causes of vertigo
|
BPPV
8th nerve damage |
|
how is a deviated nasal septum treated in pts with recurrent sinusitis?
|
surgical correction
|
|
how do you treat viral rhinitis?
|
rhinovirus, influ, paraflu, coxsacki, adeno, RSV, etc. Treat symps
|
|
what is the cause of bacterial rhinitis?
|
group A strep, pneumococci, staphylococci.
|
|
what causes nosebleeds?
|
trauma (nose-picking)
tumor - angiofibroma adolescent boys leukemia thrombocytopenia |
|
what are the characteristics of a thyroglossal duct cysts?
|
midline, elevate with tongue protrusion
|
|
what is a bracnchial cleft cysts?
|
lateral, infected
|
|
what is a cystic hygroma
|
benign tumor aka lymphangioma. Turners; needs surgical rsection
|
|
what causes cervical lymphadenitis
|
strep pharyngitis, ebv, cat scratch fever
|
|
what do you think with neck mass in adult?
|
1ry tumor
mets (Scc) |
|
what is the work-up for neck cancer?
|
biopsy of nasopharynx, palatine tonsils and base of the tongue, laryngoscopy, bronchoscopy, esophagoscopy
|
|
what causes swimmer's ear?
|
pseudomonas. pain with manipulation.
Rx- neomycin, polymyxin B roids |
|
what are the complications of otitis media?
|
TM perf
mastoiditis labyrinthitis cranial nerve palsies meningitis cerebral abscess, dural sinus thrombosis, chronic otitis media. cholesteatomas |
|
what si teh problem with recurrent otitis?
|
can cause hearing loss, then speech problems
|
|
what causes infectious myringitis?
|
otoscopy reveals vesicles on the TM.
mycoplasma s. pneumo |
|
what are teh common bacterial causes of sinusitis?
|
s. pneumo, h. flu
tenderness over sinuses, purulent discharge, headache CT to diagnose |
|
what age are teh frontal sinuses well developed?
|
10
|
|
what is otosclerosis?
|
otic bones become fixed together and impede hearing.
Rx with hearing aid |
|
what is the most common cause of conductive hearing loss?
|
otosclerosis
|
|
what is the most common cause of sensorineural hearing loss?
|
presbyacusis
|
|
what causes parotid gland swelling?
|
mumps.
neoplasm (pleomorphic adenoma, Sjogren's) sialolithiasis sarcoid |
|
what is a complication of nasal fracture?
|
nasal hematoma-> septal necrosis
|
|
what is the weber test used for?
|
conduction between two ears.
if conductive hearing loss, good on affected ear if sensorineural, good on unaffected ear. |
|
what is the rinne test?
|
air conduction to bone conduction. should be able to hear once removed from mastoid.
if conductive loss, cannot hear when in the air. if sensorineural, both should be deminished. |
|
what are the three cuases of burns?
|
thermal, chemical, electrical
fluids remove clothes, irrigation low threathold for intubation 100% o2 |
|
what are the important sequelae of electrical burns?
|
muscle necrosis, myoglobinuria, acidosis, renal failure. arrhythmia
|
|
how are chemical burns managed?
|
copious irrigation
alkali burns are worse |
|
what can burned skin develop?
|
infection, S. aureus, pseudomonas.
topical prophylaxis. tetanus booster |
|
what is hypothermia?
|
<95 degrees
MS changes conscious = slow rewarming unconsious, gastric, bladder lavage with warm water, warm IV fluids Monitor EKG |
|
what is teh classic EKG finding in hypothermia?
|
J wave, small posititve deflection following QRS
|
|
what is the difference between frost nip and frost bite?
|
nip is painful
frostbite is numb warm the areas with water. Not dry heat |
|
what is hyperthermia?
|
>104, caused by meds, infection and heat stroke
cool with wet blankets, ice, cold water diazepam for convulsions CV collapse |
|
what is malignant hyperthermia?
|
general anesthesia; succs or halothate
treat with dantrolene |
|
what is neuroleptic malignant syndrome
|
antipsychotic causes hyperthermia
CPK, MS changes IV fluids dantrolene |
|
how are pts treated after near drowning?
|
intubate if unconsious, monitor ABGs
fresh water worse becasue of potential for hypervolemia, elyte disturbances, hemolysis |
|
Wegener's, what is the cause, the findings, the tip offs?
|
kidney lung disease. Peeps may have recurrent sinusitis.
c-ANCA seen CXR may show nodular cavities |
|
what is seen in good pastures?
|
antiGBM
|
|
hwo is bladder rupture classified?
|
1. contusion
2. extrapertoneal rupture (more common than intraperitoneal, lateral border or base) 3. intraperitoneal rupture (full bladder) |
|
with abdominal trauma when do u peritoneal lavage, when ex lap?
|
ex lap if obvous peritoneal irritation.
otherwise lavage |
|
when do you supect aorta rupture in MVC?
|
sternum fracture, first rip or scapula
|
|
what is the Rx for turets?
|
pimozide, haloperidol
|
|
what does and elevated DHEA point towards?
|
PCOS
|
|
what is the steps in managing pyloric stenosis?
|
correct elytes, then surgery
|
|
what can a new onset RBBB be indicative in a pt with SOB?
|
PE
|
|
what congenital malforamtion is seen with lithium use?
|
ebsteins
|
|
what is the tirad of congenital rubella?
|
deaf, cataract, pda
|
|
what congential heart defect is seen in DM moms?
|
transposition
|
|
Gastroschisis membrane or no?
|
no
|
|
what is the management for gastroschisis and omphalocele?
|
wrap, decompress, abtics and fluids
then surgery omphalo may require multiple steps omphalo also has other abnlties |
|
what is the best Rx for General anxiety disorder?
|
buspirone
|
|
what is a common SE of mono?
|
hemolytic anemia
|
|
What non GI findings are seen in whipple disease?
|
hyperpigmentation, heart murmur, arthralgia, cough
|
|
what is turcot's syndrome?
|
brain tumor with familial polyposis
|
|
what is gorduer's syndrome?
|
Autosomal dominant disease
polyps with extraintestinal lesions. |
|
What do you look for in elderly with hyper TSH?
|
toxic nodule
thyroid adenoma (lump that is "hot") subacute thyroiditis facticious struma ovarii |
|
why is free t4 better than total?
|
measures active form
pregs, egen, ocps, increase TBG nephrotic, cirrhosis, coricosteroid decrease TBG |
|
what is euthyroid sick syndrome?
|
any pt with any illness may have temporary derangements in thyroid.
|
|
what are the symptoms of cushings?
|
weight gain, changes in appearance, easy bruising, acne, hirsutism, emotional labillity, depression, psychosis, weakness
buffalo hump, hirsutism, weakness, purplish striae |
|
what causes ectopic ACTH?
|
small cell lung cancer
adrenal adenomas, carcinomas (kids) |
|
what is the test for cushings?
|
24 hr cortisol in urine
then dexamehtasone suppresion ACTH (if increased MR brain, if decreased stomach) |
|
what are the signs and symps of hypoadrenal?
|
anorexia, weight loss, weakness, apathy
hypotension, hyperK, hypoNa hyperpigmentation, N/V, diarrhea, ab pain, mild fever, hypoglycemia, eosinophilia |
|
what is the mos common typoe of hypoadrenal?
|
2/2 steroids
ACTH high, cortisol low prophylactic steroids needed |
|
wha are the other common causes of hypoadrenalism
|
autoimmune
hypothyroid, pernicious anemia, vitiligo, dm, hypopara mets infection ketoconazole |
|
who is hypoadrenal diagnosed?
|
ACTH stim test
|
|
what causes virilization in kids?
|
CAH
90% are do to 21-hydroxylase |
|
what cancer is causesd by obesity?
|
endometiral
|
|
what is precocious puberty?
|
before 8 in female
before 9 in male pseudo precocious is 2ry sex develop cause of androgen or estrogen (no pituitary) |
|
how can physical exam differentiate true precocious from pseudoprecocious?
|
teste or ovarian enlargement
|
|
what labs in precocious?
|
GnRH stim test
MRI of brain should be done |
|
what causes pseudo precocious puberty?
|
hormones, adrenal tumors, CAH, McCune Albright in females (cafe-au-lait, ovarian cysts, polyostotic firous dysplasia of bone)
|
|
how is precocious puberty treated?
|
long acting GnRH to suppress the pituitary
|
|
What are teh signs of primary hyperaldo?
|
conn's syndrome
weakness, edema htn, hypoK, hyperNa, edema low renin, high aldo CT to find, surgery |
|
what are 2ry causes of hyperaldo?
|
low kidney perfusion
k is normal or high. |
|
what is the clinical discription of a pheo
|
wild swings in bp, tachy, postural hypotension, headaches,sweating, dizziness. impending doom
metanephrines, homovanillic acid, vanillylmandelic acid |
|
what causes central DI?
|
lack of ADH production
trauma, neoplasm, sarcoid |
|
what causes nephrogenic DI?
|
lithium, methoxyflurane, demeclocycline
|
|
what diagnostic test can reveal DI
|
give ADH
|
|
what is the rx for nephrogenic DI?
|
thiazide
|
|
what causes SIADH?
|
narcotics, preggers, chlropropramide, antiepileptics
|
|
how do you treat SIADH?
|
restric water
no hypertonic saline unless seizure emeclocycline can be used. it induces nephrogenic DI. |
|
what should people with GERD avoid?
|
coffee, alcohol, tobacco, spicy and fatty foods, chocolate
|
|
what are the sequelae of GERD?
|
eophagitis, esophageal stricture, esophageal ulcer, hemorrhage, barrett's metaplasia, esophageal adenocarcinoma
|
|
what is the difference between hiatal and paraesophageal hernia?
|
paraesophageal, GE junction is below diaphragm, but stomach herniates. may strangulate the stomach
|
|
how does PUD present?
|
intermittent epigastric pain, relieved by antacids or milk.
epigastric tenderness |
|
what are the differences between gastric and duodenal ulcers?
|
duodenal- high acid, h. pylori, forites, pain gets better then worse 3 hrs later
gastric- low acid, nsaids, fifties, no pain relief with food |
|
what is the most feared complication of PUD?
|
perf
peritoneal signs, free air abitcs and laparotomy iwth repair. |
|
what is triple therapy?
|
amox, metronidazole, bismuth
|
|
what are teh complications of billroth surgery??
|
dumping syndromome (weakness, dizziness, sweating, N/V after eating
hypoglycemia afferent loop syndrome (bilious vomiting after meal) bacterial overgroath |
|
what surgical treatement is available for ulcer?
|
antrectomy, vagotomy.
|
|
what is achlorhydria?
|
absence of HCl secreation, pernicious anemia
|
|
what are the differences between upper and lower GI bleed?
|
upper- proximal to ligament of treitz; cuased by gastritis, ulcers, varices, eophagitis; stool is tarry, black; NGT is + for blood
lower- distal to ligament of treitz; caused by vascular ectasia, diverticulosis, colon cancer, colitis, IBD, hemmorhoids; BRBPR, NGT neg for blood |
|
how do you treat GI bleed?
|
IV fluids and blood products
NG tube- test aspirate for blood endoscopy first |
|
what radiologic imaging studies can be done to localize a gi bleed?
|
radionuclide scans for slow or intermittent bleeds
angiography can detect more rapid bleeds; embolization of bleeding vessels can be done during the procedure surgery is reserved for severe or resistant bleeds, involves resection of the affected bowel |
|
what causes diverticulosis?
|
low fiber, high-fat diet
|
|
what is the bad consequences of diverticulitis?
|
abscess, fistula formation, sepsis, large bowel obstruction
|
|
how do you dx diverticulitis?
|
CT
thickened walls of sigmoid, infammation of adjacent fat |
|
what is the Rx for diverticulitis?
|
floroquinolone and metronidazole
bowel rest |
|
what are the categorization of diarrhea?
|
systemic
secretory exudative functional osmotic infectious altered intestinal transit |
|
what is osmotic diarrhea?
|
nonabsorbable solutes that stay in the bowel: lactose or other sugar intolerance
|
|
what causes secretory diarrhea?
|
cholera, ecoli
VIPoma (pancreatic islet cell tumor bile acids |
|
what causes malabsorbative diarrhea?
|
celiac sprue
crohn's post gastro |
|
what is hemolytic uremic syndrome?
|
thrombocytopenia, hemolytic anemia, ARF
|
|
what are the extraintestinal manifestations of IBD?
|
uveitis, arthritis, anklylosing spondylitis, erythema nodosum, primary sclerosing cholangitis, failure to thrive, toxic megacolon, anemia of chronic disease, and fever.
|
|
how is inflammatory bowel disease treated?
|
5-asa, w or w/o sulfa
roids and azathiprine |
|
I talk to god is an example of what?
|
delusion
|
|
what is magical thinking?
|
supernatural forces
|
|
what is the DSM IV for panic disorder?
|
3 attacks a wk, no stimulus, abrupt onset
|
|
what is the first step in diaphragmatic hernia?
|
OG tube to suction
|
|
when is paracentesis necessary?
|
ascites with resp distress
|
|
How does valsalva change murmurs?
|
increases in HOCM (smaller space causes increased volume)
decreases in AS (less flow = decreased volume) |
|
when is DM screening mandatory in pregs?
|
24-28 wks
|
|
what is beckwith-wiederman syndrome?
|
macroglossia, macrosomia, omphaloceol
gene causes 2 11p genes increased risk for wilms |
|
what is WAGR syndrome?
|
Wilms, Aniridia, GU anomaly, Retardation
|
|
what is denys-Drash syndrome?
|
wilms, pseudohemphrodite, renal failure 2/2 mesangial sclerosis
|
|
what is the most frequent cause of cellulitis?
|
group A strep
s. pyogenes |
|
What is the test for a TIA in the young?
|
echo
|
|
what are teh causes of false elevated AFP?
|
fetal demise, multiple gestation, inaccurate age (most common)
|
|
What is a more common deficiency in alcoholism folate or b12?
|
folate
|
|
what must be ruled out first between head injury and neck injury?
|
neck
|
|
what is the typical skin lesion of Reiter's?
|
keratoderma Blennohagicum - clear vesicles on macules, papules
Cicinate balantis Shallow ulcers of penis |
|
When is Koilonychia seen?
|
Fe deficiency anemia
|
|
what is given in HITT for anticoag?
|
lepirudin argatroban
|
|
what is the Rx for scoliosis?
|
<20 degrees you watch
>30 degrees or change of 5 degrees get a brace >40 degrees needs surgery |
|
what is the Rx for severe decreased Na?
|
3% saline and furosemide
|
|
what heart med can cause hypothyroid?
|
amiodarone
|
|
what are teh side effects of hydralazine?
|
SLE tachy, increased Na
|
|
What are teh SEs of verapamil
|
constipation, dizzy, flush
|
|
what is the major SE to HCTZ?
|
increased glucose, LDL, TGs
decreased Na, K increased Ca |
|
what is a nl AFI?
|
>5
|
|
What are the signs of GVHD?
|
rash on palms, soles, face
diarrhea with blood increased LFTs caused by T cells |
|
What are the Rx for nephrogenic DI?
|
NSAIDs, HCTZ, amiloride for Li induced
|
|
what is the gene involved in hemochromatosis?
|
C282y
chromosome 6 |
|
what is central cord syndrome?
|
burning pain, paralysis in upper extremities
|
|
what causes a decrease in Ca and P?
|
decreased Vit D, malabsorption
|
|
what are the G+ rods?
|
listeria, bacillus
|
|
what are teh G- rods
|
pseudomonas, haemophilus, klebsiella, legionella
|
|
what are teh G- cocci?
|
neisseria
|
|
what are basal epithelial cells in vaginal discharge a symbol of?
|
atrophy of the vagina
|
|
what is the presentation of granulum inguinale?
|
inguinal lymphadenopthy, painless ulcers, + Giemsa stain
|
|
what congential error can cause stroke?
|
homocysteinuria-> cystathione, Marfan's
high dose Vit B6 |
|
What are the 3, 7 am glucose in dawn phenomenon?
|
increased
|
|
what are teh 3,7 am glucose in poor insulin doses?
|
nl, high
|
|
what is the Rx for an open Fx?
|
stabalization, and delayed closure
|
|
what needs to be done in psych pt with one broken bone?
|
look for other broken bones, due to altered pain sensation
|
|
how is preeclampsia managed at first?
|
bedreast, decreased Na diet, Roids
|
|
what is lacid acidosis-steatosis syndrome?
|
with AIDS drugs (NRTIs) zidovudine from inhibition of mitochondrial DNA synthesis cause liver failure
|
|
what is the Rx for choriooamionitis?
|
amp/gent
|
|
what does jaundice after day 5 of life suggest?
|
sepsis
|
|
when is breast milk jaundice seen?
|
>1 wk
|
|
what is painless hematuria significant for in an AA male?
|
sickle cell
|
|
what rash is seen in dermatomyositis?
|
dirty red rash
|
|
what is anti-RNP significant for?
|
MCTD
|
|
what is gottron's sign?
|
non-scaly violaceous erythematous skin over knuckles seen in dermatomyositis
|
|
What does Nocardia look like by microscope?
|
crooked, branching, beaded, G+, partially acid-fast filaments
Rx is TMP-SFX |
|
What is the best Rx for heat stroke?
|
evaporation coolign
|
|
what is buerger's disease?
|
occlusive disease, migratory thrombophlebitis, raynauds
|
|
what is a common cause of osteo in puncture wounds
|
pseudomonas
|
|
how does one correct homocysteine issues?
|
b6, b12, folate
|
|
what is a good test for lactose intolerance?
|
H+ breath test
positive clinitst for reducing substances increased osmotic gap acidic stool |
|
where is a symptomatic carcinoid seen?
|
small intestine, others are in appendix, but not symptomatic
|
|
what are the common SEs to ERCP?
|
pancreatitis, perforation, sepsis, peritnitis, hemorrhage
|
|
what is a specific test for acromegaly?
|
glucose GH test, nl patients will have decreased GH
|
|
what is the method of screenign for cadiac contusion?
|
ECG
|
|
what antimicrobial causes ARF?
|
amikacin
|
|
what antibodies seen in sprue
|
anti-endomysial, abs
|
|
what are anti-mitochondrial abs associated with?
|
PBC
|
|
what is the Rx for syphylis with PCN allergy?
|
Poxy
tetracycline, azithro |
|
what level of TGs is a risk for pancreatitis?
|
>1000
|
|
what is the cause of syncope with prolonged QRS,PR?
|
brady
|
|
what is the radiographic appeearance of osteosarcoma?
|
sunburst, codman's triangle; may need amputation
|
|
what are teh findings fo ewing sarcoma?
|
onion skinning; diaphysis
|
|
what is the xray of giant cell tumors?
|
soap bubble
|
|
when are psammoma bodies seen?
|
papillary thyroid Ca
|
|
what is a common cause of mucopurulent discharge from teh os?
|
chlamydia
|
|
what is RTA 4?
|
increased K, met acid, caused by aldosterone deficiency or insensitivity from diabetic nephropathy
|
|
what is the relationship between OCPs and Lupus?
|
it aggrivates
|
|
what is the cause of polyuria, polydipsia in phenothiazine use?
|
dry mouth causes psychogenic polydipsia
|
|
what cancer secretes pthrp
|
squamous cell
|
|
what is the Rx for prenatal itamin overdose?
|
deferoxime
|
|
what are teh signs of strangulation in SBO?
|
tenderness, guarding, no bowel sounds, SIRS, met acid
|
|
What are teh SIRS criteria?
|
T>38 or <36, HR > 90, RR > 20, WBC >12, <4, or > 10% bands
|
|
What is aspirin sensitivity syndrome?
|
persistant nasal blockage, bronchoconstriction; pseudo-allergic
Rx- leukotriene inhibitors |
|
what is done in the initial eval of bibromyalgia?
|
TSH, ESR (CK)
|
|
what vitamin deficiency occurs in carcinoid?
|
niacin
|
|
what are teh SEs of amiodarone?
|
pulm fibrosis, hypothyroid, hpatotox, corneal deposits, skin turns bluish gray
|
|
what is the Rx for cholangitis?
|
broad spectrum abtics (piperacillin with tazobactam
cholecystectomy if common duct stones, biliary stenosis if malignent. |
|
what is the Rx for diverticulitis?
|
avoid eating
broad spectrum antibiotics NG tube sigmoid colon resection if refractory |
|
what drug is good for pain control in pancreatitis?
|
meperidine over morphine
|
|
what is the hx of perfed ulcer?
|
no AA abuse or gallstones
free air, can cause an increased amylase, OR |
|
what are teh signs of LBO?
|
gradually increasing ab pain, abdominal distention, cramping, feculant vomiting (late)
|
|
what are the causes of LBO?
|
old causes are diverticulitis, colon cancer and volvulus
in kids, hirshsprungs |
|
how do you treat LBO?
|
withhold food, NG
sigmoid volvulus should be decompressed with an endoscope |
|
what are teh 3 groin hernias?
|
indirect: most common, inner and outer inguinal rings. lateral
direct: from weakness in abdominal muscles (right down the middle, medial to the vessels) Femoral: more in women, throught hte fem ring onto the ant thigh.; most susceptible to incarceration. |
|
what is an incarcerated hernia and a stragulated hernia?
|
incarcerated: trapped, swollen, edematous. needs prompt surgery
strangled: necrosis, death |
|
what is the hep b window
|
both hbsag and hbsab are neg. if hbsab appears = immune if not, chronic
|
|
what should be given to peeps exposed to hep b?
|
IgG even if vaccinated
|
|
what are teh drug induced hepatitis?
|
acetaminophen
inh rifampin pyrazinamide halothane HMG coa carbon tetrachlroide idiopathic autoimmune hepatitis anti smooth muscle, ANA Rx is steroids |
|
what are the ususal causes of chronic liver disease?
|
alc, hepatitis, metabolic disease
|
|
what si wilson's?
|
excessive copper, ceruloplasmin is low or absent
CNS mannifestations- copper in basal ganglia kayser-fleischer rings |
|
what is alpha antitrypsin
|
young adult with cirhosis, emphysema without risk factors
|
|
what is the coagulopathy in liver failure?
|
prolonged PTT
vit k doesn't help |
|
what is sbp?
|
paracentesis with wbc, gram stain, culture and sensitivity
e.coli, s. pneumo can cause 3rd generation cephalo |
|
what are the signs and symps of biliary tract obstruction?
|
elevated alk phos
elevated conjugated bilirubin. conjugated bilirubin is more than unconjugated pruritis clay stools dark urine whcih is strongly positive for conjugated bili. |
|
what are teh types of biliary tract obstruction
|
bilde duct obstruction, cholestasis, cholangitis, primary biliary cirrhosis, primary sclerosing cholangitis
|
|
what ar eth etwo major causes of bile duct obstruction?
|
gallstone (fat, female, forty, fertile)
- US Cancer- (courvoisier's sign- palpable gallbladder) |
|
what are the common causes of cholestasis?
|
meds- OCPs, phenothiazines, androgens
pregnancy |
|
what clues suggest 1ry biliary cirrhosis?
|
middle aged women with no risk factors for liver or biliary disease. marked pruritis, jaundice, +anti-mitochondral antibodies.
Rx- cholestyramine needs liver transplant |
|
what ar teht eclassic symptoms of esophageal disease?
|
dysphagia, odynophagia
|
|
what is achalasia?
|
hypertensive LES and loss of peristalsis. it is usuallly idiopathic but may be 2/2 chagas. bird-beak narrowing. Rx is Ca channel blockers, pneumatic dilation, botulism toxin injection. lastly surgery.
|
|
what are teh signs of esophageal spasm?
|
nutcracker esophagus, irregular forceful and painful contractions
|
|
what clues sugggest scleroderma?
|
aperistalsis from fibrosis, atrophy of smooth muscle
LES is incompetent, and peeps have heartburn. +ANA, mask like facies. CREST calcinosis, Raynauds, Esophagus, sclerodactyly, telangiectasias |
|
what causes acute pancreatitis?
|
alcohol, gallstones
|
|
what is grey turner's sign?
|
blue-black flanks
|
|
what is cullen's sign?
|
blue-black umbilicus
|
|
how do you treat chronic pancreatitis?
|
abstinence, oral pancreatic enzyme replacement, fat soluble vitamins
|
|
what si mallory-weiss vs. boorhave?
|
mallory weiss is superficial, boorhave need imediate surgery
|
|
what is the rule about bowel contrast when GI perf is suspected?
|
barium is preferred, no barium toxic with perf, can cause peritonitis
|
|
what are teh signs of intestial atresia?
|
double bubble, downs, bilious vomiting
|
|
what are the signs of TE fistula?
|
resp compromise with feedings, asp pneumonia inability to pass NG tube
|
|
what is henoch schonlein purpura?
|
vasculitis, GI bleeds, ab pain
URI, rash on lower extremitis, buttocks swelling in hands and feet, arthritis, hematuria and proteinuria |
|
what is the most common cause of dirreha in children?
|
norwalk
|
|
what is the first step in neonatal jaundice?
|
direct vs. indirect.
look for poor feeding, seizuer, flaccidity, opisthotonos, and apnea |
|
what is pahtologic jaundice?
|
any jaundice at birth is pathologic
breast milk: bili of 10-20 at 2 wks Illness Hemolysis Metabolic disorders: Crigler-Najjar can cuse it. Roto and dubin johnson disease cause conjugated biliary atresia: full term infants with clay or gray colored stools and high levels of conjugated bilirubin Meds: no sulfa drugs |
|
what are teh causes of peritonitis that do not require laparotomy?
|
pancreatitis, diverticulitis, spontaneous bacterial peritonitis
|
|
what is seen in URQ pain?
|
gallbladder, liver abscess
|
|
what is seen with ULQ pain?
|
spleen
|
|
what is seen with LRQ apin?
|
appendix, PID, ectopic
|
|
what is seen with LLQ pain
|
sigmoid colon, PID
|
|
what is seen in epigastric pain?
|
peptic ulcer, pancreas
|
|
what are the six fs of cholecystitis?
|
fat forty, femal flatulent, febrile
|
|
what are the common causes of post-op fever?
|
five ws- water, wind, walk, wound, weird drugs
water- UTI wind- atelectasis walk- DVT wound- infection weird drug spikes that don't respond to abtics, think abscess |
|
what is the most common cause of fever in teh first 24 hrs after sugery?
|
atlectasis- prevent and treat with early ambulation, chest physiotherapy, IS, proper pain control.
Too much pain, or too many narctoics increase the risk of atelectasis |
|
what is fascial dehiscence?
|
fascial dehiscence occurs when the surgical wound opens spontaneously. look for leakage of serosanguinous film after coughing, straining. surgical reclosure of the wound and treatment of infection are required
|
|
what are teh abcdes of trauma?
|
airwa, breathing, circulation, disability, and exposrue.
|
|
what is the difference between airway and breathing in trauma protocol.
|
airway- provision, protection, and maintenance of adquate airway at all times. if pt can answer questions, airway is fine; oropharyngeal in uncomplicated cases, oxygen. intubate if blocked, cricothyroidotomy
|
|
what is circulation, disability and exposure?
|
circ- hypovolemia, give IVF, blood products
disability- GCS, exposure- look at everything, |
|
what imaging films are routinely ordered?
|
c-spine, chest, pelvic films
|
|
what is the best choice for head trauma?
|
non-contrast CT
|
|
how do you manage pts with blunt abd trauma?
|
if the patient is a wake, stable, and exam is benign- observe
if sunstable, go to lap inwebtween-> CT with oral and IV contrast |
|
how is penetrating abdominal trauma managed?
|
gunchot-> laparotomy
knife-> lap if unstable, CT if stable |
|
how does tamponade present?
|
penetrating trauma to the L chest. hpotension from cardiac filling, distended neck veins, muffled heart sounds. normal breath sounds. Pericardiocentesis if unstable.
|
|
how is hemothorax treated?
|
decreased breath sounds, dull note on percusion, collapsed neck veins, tachycardia
chest tube and blood products. CT afterwartds. Treat supportively if bleeding does not stop-> thoracotomy |
|
how do you treat flail chest?
|
associated with pulmonary contusion, may make respiration inadequate
if not doing well, intubate and give PPV |
|
what is teh most common cause of immediate death after an automobile accident?
|
aortic rupture- widened mediastinum
|
|
What are signs of splenic rubture
|
hypo tension, tachycardia, shock Kehr's sign
|
|
what are the three zones of the neck?
|
I- base of neck from 2cm above the clavicles ot the clavicles
II- midcervical region III- top of the neck mandible to base of skill I and III-> angiogram II- OR |
|
what do you do if a tooth is knocked out?
|
put it back, stabalize.
|
|
what are the feautres of downs?
|
at birth: hypotonia, palmar crease
VSD, leukemia duodnal atresia alzheimers |
|
what is edwards?
|
18, mental retard, small size, small head with hypoplastic mandible and low-set ears
index finger overlapps the 3rd, 4th fingers |
|
what is patau's?
|
mental retard, apnea, deafness, holoprosencephaly, myelomeningocele, CV abnlties, rocker-bottom feet
|
|
what is turners?
|
XO
neck lymphedema, short stature, webed neck, wide nipps coarc, horse shoe, cystic hygroma |
|
what is the buccal smear in turners?
|
barr bodies diagnsoes
|
|
what is cri-du-chat syndrome?
|
deletion of chrom 5
severe mental retard |
|
what are teh findings in glactosemia?
|
congenital cataracts, neonatal sepsis,
vomit after breast feeding no galactose |
|
what are the clinical findings in tuberous sclerosis?
|
AD- hypopigmented skin macules, seizures, mental retard, hamartomas in CNS, rhabdomyomas, renal tumors
|
|
what is lesch-nyhan?
|
deficiency of hypoxanthine-guanine phosphoribosyltransferase-> hyperuricemia
mental retard, selfmulitaltion |
|
what do elderly pts need more of in their diet?
|
Na, b12, D, folate, iron
|
|
what is presbyopia, presbyacusis?
|
presbyopia- hardening of hte lens that decreases accommodation
presbyacusis- cannot discriminate between sounds |
|
what changes in male sex function in aging?
|
increased refractory period
increased time to achieve erection delayed ejaculation |
|
what are the normal changes in women and sex with age?
|
decreased lube
dypareneunia- atrophy of lit, labia, vag delayed orgasm |
|
what are the changes in sleep in elderly?
|
less sleep, sleep less deeply, wake up more often and earlier
less stage 3 and 4 REM |
|
what is pseudodemntia?
|
depresion in the elderly
|
|
what aer eth common dementias?
|
alzheimers (gradually progressive, neurofibrillary tnagnlees)
multi-infarct- stepwise, risks of sroke HIV Picks |
|
what is the most common cause of preventable infirtiliy?
|
PID
|
|
what is PID?
|
ascending infection from endometritis, fallps, ovaries, parametrial tissues, peritoneial
- ab pain, adnexal tenderness, cervical motion tenderness - eleveated ESR, CRp, leukocytosis, fever, or purulent cervical discharge |
|
how is PID treated?
|
cefoxitin, doxy; clinda and gent for inpatient
|
|
what is endometriosis?
|
dysmenorrhea, dyparenuria, dyschezia or perimenstrual spotting.
|
|
how do you diagnose endometritis?
|
1st line: OCPs
2nd line: danazol, GnRH |
|
candida infection in the vag?
|
cottgae, cheeze, pseudohyphae on KOH, dM, antibiotics or pregs
topical or oral antifungal |
|
stage 2 sypillis?
|
condyloma lata, maculopapular rash, serology
PCN |
|
when do you see the strawberry cervix?
|
trich
|
|
chlamydia?
|
dysuria, +culture, antibodies
doxy or azithro |
|
what is the treatment for chlamydia in pregs?
|
erythromycin
|
|
what is the treatment for adenomyosis?
|
boggy uterus on exam, D&C
hysterectomy, gnrh agonists |
|
when is dysfunctional uterine bleeding physiologic?
|
when not associated with tumor, inflammation, or pregs.
associated with anovulatory cycles. age is important. PCOS, |
|
when is d and c done in women over 35?
|
endometiral cancer first
Hb, Hct |
|
what else may causae DUB?
|
infections, endocrin coags, egen neoplasm.
if no underlying path-> Rx is nsaids, or OCPS OCPs for menorrhagia Nsaids for dymennorhea progesterone for severe bleeding |
|
what is teh ratio of LH to FSH in PCOS?
|
2:1 or greater
|
|
how is PCOS treated?
|
OCPs, progesterone
clomiphene for ovulation increased risk in endometrial cancer |
|
what is normal semen eval?
|
>1ml, >20mil/ml, >50% of sperm have initial forward motility
>60% have normal morphology |
|
what is the next step after semen eval for infertility?
|
ovulation; bbt, lluteal pahse progesterone, endometrial biopsy
|
|
what test is used to examine fallps and uterus?
|
hyesterosalpingogram
|
|
what test is teh last resort in work-up for infertility?
|
laparoscopy, LOA
|
|
what meds can be used to restore female fertility?
|
clomiphene for ovulation (needs normal egen)
if hypoegen, hMG is sued (combo of FSH and LH) |
|
what are common causes of 2ry amenorrhea?
|
PCOS, anorexia
endocrine- headaches, galactorrhea, visual field defects antipsychotics previous chemo |
|
what are the steps of eval of 2ry amenorrhea, if no obvious sign?
|
give progesterone- eval for bleeding. if bleeding, good egen, if not, no egen
then check LH TSH, PRL what if no egen?- FSH level, karyotype abnlties, |
|
when can 1ry amenorrhea be diagnosed?
|
no menstration by 16, if no 2/2 sex by 14 or w/in 2 years of 2/2 sex
|
|
what is the most likely cause of 1ry amenorrhea?
|
congenital- pheno normal, normal breast, no axillary- andro insensitivity. _look for uterus
if there is a uterus- look for pituitary issue |
|
what is teh FSH in menopause?
|
elevated
|
|
what is teh improtant questiosn in nipple discharge?
|
OCPs, hormone therapies, antipsychotic meds, hypothyroid
color of discharge unilateral vs. bilateral |
|
what is fibrocystic breast disease?
|
bilateral, multiple cystic lesions, tender to teh touch, espeical premenstrually. Most common of all disease. No work-up if <35 y/o
if >35 aspirate cyst, if bloody or rapid accumulation biopsy. OCPs, progesterone, danazol may relieve symps |
|
what is fibroadenoma of the breast?
|
painless, discrete, sharply circumscribed, unilateral, rubbery, mobile mass. Most common benign tumor fo the breast.
observe for a couple cycles. pregs and ocps may stim groth. menopause causes regression if >35 and has any risk factors, or not clinically benign, biopsy Phylloides tumors may masqureatde as fibroadenoma excision is curative, but not required |
|
breast mastitis, abscess?
|
normally postpartum
lactating wome. Cracked or fissured nipple. Rx is analgesics, continue breast feeding to prevent blockage. cephalexin or dicloxacillin given for more than mild symps. if fluxuant mass, or no response to abtics- abscess, must be drained |
|
what is fat necrosis fo the breast
|
recent trauma-> mass.
|
|
breast cancer and Step 2?
|
if not classic, no obvious trauma, or bilateral masses, biopsy, baseline mammography
|
|
what is a cystocele?
|
bladder bulges into upper ant vag.
urinary urgency, frequency, incontinence |
|
what is a rectocele?
|
rectum bulges into lower posterior vag wall- difficulty defecating
|
|
what is a enterocele?
|
bowel bulge in upper posterior vag
|
|
what is a urethrocele?
|
urethra bulges into lower ant vag wall.- urinary urgency, frequency, incontinence
|
|
what is the Rx for cystocele, rectocele, enterocele, urethrocele?
|
pelvic relaxation with pevlic strengthening excersises and or a pessary. surgery for refractory/ severe cases
|
|
from best to least was is the best form of birth control?
|
sterilization, implantable hormone pellets, injectable hormone, birth control
|
|
what are the risks of IUDs?
|
ectopics
PID- actinomyces |
|
what is adrenogenital syndrome?
|
CAH, 21-hydroxylase- low Na, hyperK, hypotension, elevated 17-hyrdoxy
|
|
what is indicated by a "bunch of grapes" protruding form the pediatric vag?
|
sarcoma botryoides- malignant tumor of embryonal rhabdomyosarcoma
|
|
what is precocious puberty?
|
girls < 8, boys less than 9.
hormone secreting tumor, or cns disorder should be ruled out. if idiopathic, treat with GnRH analog |
|
what is the cause of vaginitis in prepubescent girls?
|
foreign body, sex abuse, candida.
candida may indicate DM |
|
what are the risks and benefits of HRT after menopause?
|
risks: endometiral cancer, DVT, breast cancer, gallbladder disease
benefits: dcerasd osto, CHD, less symptoms |
|
what are teh SEs of egen therapy?
|
endometrial bleeding, breast tenderness, nausea, bloating, headaches
|
|
what are the contraindications to egen therapy?
|
unexplained vag bleeding
liver disease Hx of throbophlebitis, or embolism endometrial or breast cancer |
|
what are teh minor contraindicatiosn to egen therapy?
|
sizures
htn uteriine leiomyomas familial hyperlipidemia migraines,"", thrombophlebitis endometriosis gallbladder disease |
|
what test is needed before started egen therapy?
|
endometrial biopsy, US, or D and C
|
|
what are the absolute contraindications to OCPs?
|
smoking after 35
pregs breast feeding active liver disease hyperlipidemia uncontrolled htn DM prolonged immobilization of extremity hx of thromboembolism or thrombophlebitis CAD Hx of stroke, sickle cell, egen dependent neoplasm, liver adenoma, cholestatic jaundice of pregs |
|
what is teh relationship betwee OCPs and HTN
|
can cuse 2/2 htn
|
|
what are teh risks of ocps and sugrery
|
thromboembolism, stopped 1moth b4, 1 month after
|
|
waht are teh SEs of OCPs?
|
glucose intelerance, depression, edema, wight gain, cholelithiasis, benign liver adenomas, melasma; reduces effects of
rifampin and antiepileptics |
|
OCPs and breast, cervical cancer
|
breast is increased in long term users, cervical neoplasia may be increased.
|
|
whaat is the relationship between OCPs and ovarian, endometiral cancer?
|
reduce ovarian by 50%, reduce incidence of endometrial cancer
|
|
what are pigment gallstoens a sign of?
|
hemolytic anemia
|
|
what meds can cause anemia?
|
methydopa, PCN, sulfa-> RBC antibodies-> hemolysis
chloroquine, sulfa-> G6PD phenytoin-> megaloblastic through interference w/ folate Chloramphenicol, cancner, zidovudine-> aplastic anemia |
|
What do the following indicate?
basophicli stippling Heinz bodies Bit cells Howell-Jolly bodies Teardrop RBCs Helmet cells acanthocytes and spur cells target cells echinocytes, acanthocytes polychromasia rouleaux iron inclusions in RBCs of bone marrow |
basophilic stippling: lead
Heinz bodies: G6PD Bite celss: G6pd, hemolytic anemias howell-Jolly: asplenia teardrop: myelofibrosis helmets: hemolysis Acanthocytes and spur cells: abetalipoproteinemia Echinocytes, acanthocytes: uremia Polychromasia; reticulocytosis Rouleaux: MM Fe inclusions: sideroblastic |
|
what causes microcytic anemia with elevated retic?
|
thalassemia, hemoglobinopathy
|
|
what causes microcytic anemia with low retic?
|
lead poisoning
sideroblastic anemia of chronic disease iron deficiency |
|
what causes normocytic anemia with elevated retic?
|
acute blood loss
hemolytic meds |
|
what causes normocytic anemia with low retic?
|
cancer
anemia of hronic disease aplastic anemia/meds endocrine renal failure |
|
what causes macrocytic anemia?
|
b12
folate alcohol cirrhosis meds |
|
what clues point to hemolysis?
|
elevated LDH
elevated bili jaundice low or absent haptoglobin urobilinogen, bili and hemoglobin in urine pigmented gallstones (or at young age) |
|
what is the most common anemia?
|
fe defficiency
>40-> rule out colon cancer increased requirement in kids, pregs, breast-feeding |
|
what is plummer-vision syndrome?
|
esophageal web-> dysphagia, fe deficiency, glossitis
|
|
what are teh neurolgic deficiencies seen in b12 deficiency?
|
loss of sensation and position, paresthesias, ataxia, spasticity, hyperreflexia, + babinski, dementia
Dx is linched by a low serum b12. Schilling for the etiology |
|
what is seen on peripheral smears of thalassemia pts?
|
target cells, nucleated RBCs, diffuse basophilia, skull radiograph with crew-cut apperance.
extramedullary hematopeoisis. |
|
when do pts become symptomatic in alpha thal?
beta? |
alpha: symptomatic at birth or ftal hydrops
beta: symptomatic at 6 months |
|
what are teh clinical manifestaions of sickle cell?
|
aplastic crises- parvo
bone pain- infarcts - (classic is of femoral head) dactylitis- hand-foot syndrome renal papillary necrosis splenic sequestration autosplenectomy- increased infections with encapsulated bugs- pneumoccocus, haemophilus, neisseria acute chest pigment cholelithiasis priapism stroke |
|
how do you manage sickle cell?
|
prophy penicillin til 10y/o
vaccination against pneumonia, h. flu folate supplementation early Rx of infections, proper hydration. |
|
how do you treat a pain crisis?
|
o2, iv fluids, analgesics
|
|
what are causes of autoimmune hemolytic anemia?
|
sle, procainamide, hydralazine, isoniazid
drugs- methydopa, PCNs, cephalos, sulfa, quinidine leukemia, lymphoma infection- mycoplasmosis, EBV< syphilis |
|
what is coombs + for?
|
autoimmune anmeias; spherocytes,
|
|
what are the signs of lead poisoning?
|
hypochromic, microcytic anemia
vomiting, ataxia, colicky abdominal pain, irritability, encephalopahty, cerebral edema, seizures basophilic stippling, elevated erythrocyte protoporphyrin or pb level. |
|
what is screening for Pb poisoning?
|
6 mo, 1 and 2 ears in kids with risks- pica, old buildling, or family who work at lead smeliting, or battery recycling plant
|
|
how is pb poisoning treated?
|
chelation: succimer in kids
dimercaprol in adults in severe: dimercaprol and EDTA |
|
how is sideroblastic anemia seen on step 2?
|
microcytic, hypochromic with increased Fe. may be a sign of myelodysplasia.
can give pyridoxine for it. |
|
anemia of chronic disease?
|
low iron and low TIBC, increased ferritin
|
|
what is myelophthisic anemia?
|
anemia 2/2 to space occupying lesion in bone marrow. and myelodysplaisa or myelfibrosis. on smear look for anisocytosis, poikilocytosis, and nucleated RBCs, giant or bizarre-looking platelets, teardrop shaped RBCs.
BM may have a dry tap. |
|
how do you recognize G6PD?
|
x-linked recessive, males
blacks and mediterraneans. look for sudden hemolysis or anemia with fava beans. heinz bodies, bite cells Dx with RBC enzyme assay |
|
what signs and symps do you look for blood transfusion reaction?
|
febrile- chills, vever, headache, back pain from antibodies to WBCs
hemolytic reaction- anxiety or discomfort, dyspnea, chest pain, shock, jaundice form antibodies to RBCs allergic reaction- urticaria, edema, dizziness, dyspnea, wheezing, ananphylaxisq |
|
what are tehe common causes of DIC?
|
pregs, obstetrics, malignancy, sepsis, trauma
prolonged PT, PTT, and bleading timeoozing iv sites |
|
what conditions is eosinophilia seen?
|
allergy, eczema, atopy
angioedema drugs parasitic infections blood dyscrasias- lymphoma loffler's syndroem- pulm eos autoimmune- lupus, RA IgA deficiency adrenals |
|
what conditions is basophilia associated?
|
allergies or neoplasm/blood dyscrasia
|
|
what are the clotting test results in vWF?
|
nl pt, high ptt, high bt, nl platelts, nl RBC
Autosomal dominent |
|
what are the clotting test results in hemophilia?
|
nl pt, high Ptt, nl bt, nl platelt cound, nl rbc count
x-linked 8=a 9=b |
|
what are the clotting test results in DIC?
|
high PT, PTT, BT
low plateltes |
|
what are the clotting test results in liver failure?
|
High PT, PTT
nl BT, platelets |
|
what are the clotting test results in ITP?
|
nl PTT, PTT, high BT, low platelets
|
|
what are the clotting test results in TTP?
|
nl PT, PTT
high BT low platelets, RBCs- hemolysis on smear CNS symps plasmapharesis |
|
what are teh symps of scurvy?
|
splinter hemorrhages, gum petechiae, perifollicular or subperiosteal hemorrhages
myalgias, arthralgias, capillary fragility Rx is oral vit c |
|
how often should you scren for HTN?
|
every 2 years starting at 3y/o
|
|
what is the conservative management for HTN?
|
low salt, fat, calorie
reduce smoking, alcohol, weight loss exercise meds after 2 month trial of lifestyle if stage II or comorbid conditions start meds |
|
what is the first line for HTN
|
thiazide, beta-blockers, ACE inhibs, ARBs, Ca channel blockers
|
|
when are thiazides best as first drug?
|
Heart failure, dm, CAD, stroke, osteoporosis
|
|
who should not receive thiazides?
|
gout, hyponatremia, pregs
|
|
who should get beta-blockers?
|
stable angna, ACS, CAD, tachy, fib,
|
|
who shouldn't get beta-blockers?
|
asthma, copd, heart block, sick sinus
|
|
who shouldn't get ACe inhibs?
|
pregs, angioedea, renovascular htn
|
|
who should get Ca channels?
|
raynaud, atrial tachys
|
|
what is the difference between htn emergency and urgency?
|
emergency has symptoms angina, CP, MI, encephalopath, ARF
|
|
what causes HTN?
|
idopathic, essential
|
|
what are common causes of htn in young peeps?
|
alcohol in men
ocps or fibromuscular dysplasia in women |
|
what are the most common causes 2/2 htn?
|
peho- wild swings, anxiety, diaphresiss, confusion: screen for urine catecholamines
renal artery stenosis: young pts- fibromuscular, old- atherosclerosis; bruit PKD- flank mass, FHx, increased creatinine, BUN cushing's- stigmata of cushings conn's- aldosterone neoplasm coarc renal failure |
|
why lower pressure?
|
strokes, heart disease, MI, atherosclerosis, renal failure, aortic aneurysms
|
|
what tests should be ordered in HTN?
|
ecg
chem 7 urine |
|
What causes type I hypersensitivity?
|
I- anaphylactic- IgE
anaphylaxis, atopy, hay fever, urticaria, allergic rhinitis, asthma. bee stings, foods, PCNs, sulfa, rubber |
|
what are teh clinical findings of chronic type I?
|
eos
allergic shiners pale, bluish, edematous nasal turbinates |
|
wheat meds aren't given to pts with nasal polyps?
|
aspirin-> severe asthma attack
|
|
what are teh sigsn and Rx for anaphylaxis?
|
triggers-> itching, facial swelling, difficulty breathing
secure and areway, subcutaneous epi. |
|
what causes hereditary angioedema?
|
C1 esterase ingibitor.
diffuse swelling of lips, eyelids, and airway; unrealted to allergen exposure. AD, low C4, androgens for long term treatment, increase liver production of C1 esterase |
|
what causes type II hypersensitivity?
|
cytotoxic-> IgG, IgM
autoimmune hemolytic anemia transfusion reactions erythroblastosis fetalis goodpastures MG Graves Pernicious anemia Pemphigus |
|
what lab test is + with type II hypersensitivity?
|
coombs
|
|
what causes type III hypersensitivity?
|
immune complex from antigen-antibody
serum sickness lupus, RA, polyarteritis nodosa, cryoglobulinemia glomerulonephritis |
|
what causes type IV
|
cell-mediated, elayed from t lymphos
PPD contact dermatitis chronic rejection granulomas |
|
how is HIV diagnosed and how long after expsure?
|
ELISA-> western blot
1 mnth for antibodies |
|
what is a control test in context of PPD and HIV?
|
PPD for candida and mumps to see if an immune response can occur.
|
|
what are teh signs of PCP?
|
severe hypoxia with normla radiographs, diffuse bilateral infiltrates.
dry nonproductive cough silver stains (wright-giemsa) bronchoscopy LDH |
|
what is the most common 1ry immunodeficiency?
|
IgA-> recurrent respiratory gi infections
IgA levels are always low, levels of IgG are low. (if Ig given, then anaphylaxis think IgA cause of IgA antibodies) |
|
what is bruton's agammaglobulinemia
|
X-linked recessive. Low or absent Bs. lung, sinus with strep hemophilus
|
|
what is DiGeorge's?
|
hypoplasia of 3rd,4th pouch
hypocalcemia thymus may be absent |
|
what causes severe combined immunodeficiency?
|
adenosine deaminase deficiency: AR inheritance
b and t cell defects |
|
what triad is the dx of wiskott-aldrich?
|
excema, thrombocytopenia, infections
|
|
what is chediak higashi?
|
giant granules in neutrophils, albinism
|
|
what is the pathophys of chronic granulomatous disease?
|
no burst-> staph, pseudomonas
nitroblue tetrazolium dye reaction |
|
how often do you check a cd4 count?
|
6 months
|
|
when do you start antiretrovirals
|
<500
|
|
when do you start PCP prophy?
|
<200
bactrim |
|
what is used in sulfa alergy for PCP prophy in aids?
|
dapsone, penamidine
|
|
what is used for MAC prophy?
|
<100, azithro, clarithro, rifabutin
|
|
AIDS patients get:
MMR? annual flu? annual PPD? pneumococcal hepatitis? oral polio? |
MMR- yes
annual flu- yes annual ppd- yes oral polio- no, give inactive pneumococcal- yes Hep- yes |
|
what cancer in aids?
|
kaposi's
non-hodgkin's |
|
what causes chronic diarrhea only in AIDS?
|
cryptosporidium, isospora
|
|
what is the cause of a false positive HIV in newborns?
|
mom's antibodies for 6 months
|
|
what complicment defieciency of C5-9 can cause?
|
neisseria
|
|
chronic mucocutaneous candidiasis is what?
|
can't fight candida.
associated with hypothyroid |
|
what is hyper-IgE syndrome?
|
job-buckly
recurrent staph infections high IgE fiar skin, red hair eczema. |
|
what is the major cause of bronchitis and how do you treat?
|
virus
h flu moraxella amox, erythro |
|
what is the common cause of pneumonia classically?
|
s. peumo
|
|
what causess osteo
|
staph
|
|
what causes cellulitis
|
strep, staph
|
|
what causes meningitis in teh neonate? child/adult?
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GBS, e coli, listeria- amp, aminoglycoside, cephalo
S. pneumo, n. mening- cephalo, vanc, dxa |
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what bugs cause sepsis?
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g-
strep third gen penicillin, ceph, aminoglycoside, imipenem |
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what causes spetic arthritis?
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staph
gonorrhe if sexually active |
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what causes sendocarditis?
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staph, strep
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what is the drug for strep a or b
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penicillin
|
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what is the drug for s pneumo?
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cephalo, levoflox
|
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enterococcus is treated with?
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penicillin and aminoclycoside
|
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what treats staph aurreus
|
methicillin
|
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what treats gonococcus?
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ceftrixone, fluroquinolone
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what treats haemophilus?
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cephalo
|
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what is a plump g- rod with thick capsule?
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klebsiella
|
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what is a G_ with spores?
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clostridium, bacillus
|
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what bug is gram positive with sulfur granules?
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actinomyces
|
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what is silver staining (bug)?
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pcp
|
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what are the hallmarks of staph pneumonia?
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nosocomial, cf, iv drugs, chronic granulomatous disease, empyema and lung abscesses are common with s. aureus
|
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when do you see G- pneumonias?
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pseudomonas with cf
klbsiella with skid-row- currant jelly sputum e.coli with aspiration, neutropenia, hospital acquired. |
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how do you recognize mycoplasma pneumonia?
|
most common in adolescents and young adults
long prodrome. CXR- pachy, diffuse bronchopneumonia- looks bad _cold-agglutinin antibody titiers-> hemolysis, anemia |
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how do you recognize chlamydia pneumonia
|
negative cold-agglutinin
azithro or levo |
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what is an alternative to bactrim in HIV?
|
pentamidine
|
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what bug when stuck with a thorn?
|
schenckii- K or ketoconazole
|
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aplastic in sickle cell?
|
parvo
|
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penumonia in southwest?
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coccidiodes- itraconazole or fluconazole
|
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sepsis after splenectomy?
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s. pneumo, h. flu, n. meningitis
|
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pneumonia after exposure to parrot or bird?
|
chlamydia psittaci
|
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pneumonia in ohio or mississippi river valleys?
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histo
|
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fungus ball hemoptysis after tuberculosis?
|
aspergillus
|
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penumoia in pt with silicosis
|
TB
|
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diarrhea after hikin/drining?
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giardia
stool cysts- metronidazole |
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prenant and cats?
|
toxo
|
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b12 and ab pain
|
diphyllobothrium
|
|
what seizures with ring enhancing lesion
|
taenia solium, toxo
|
|
squamous cell bladdder cancer in middle east
|
schistosoma
|
|
worm in kids
|
enterobius
|
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fever, muscle pain, eos, periorbital edema after raw meat?
|
trichinosis
|
|
slaughterhouse woith fever?
|
brucellosis
|
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when is lumbar puncture contraindicated?
|
if acute head trauma or igns of ICH.
|
|
what is the classic description of the multiple sclerosis?
|
insidious onset, neurologic symps in white women, parasthesias, numbness, weakness, clumsiness, visual disturbances, gait disturbances, incontinence, urgency
|
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what is seen on CSF in MS?
|
oligoclonal bands
|
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what is the pathology in guillan barre?
|
demyelination, slowed nerve conduction
|
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what causes an EMG study with no muscle activity?
|
intrinsic muscle disease
|
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what causes EMG to show fascics or fibs at rest?
|
lower motor neuron lesion
|
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What manifests as decreased reflexes, fascics, atrophy?
|
LMN disease
|
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what causes hyperreflexia, clonus, increased muscle tone?
|
UMN lesion
|
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what causes apathy, inattentin, disinhibition labile affect?
|
frontal lobes
|
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what causes broca's aphasia?
|
dominant frontal lobe
|
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what causes wernicke's?
|
dominant temporal lobe.
|
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what causes the inability to read, write, name or do math?
|
dominant parietal lobe
|
|
hemispatial neglect?
|
nondominant parietal lobe
|
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what causes visual hallucinations/illusions
|
occipital lobes
|
|
what treatable causes of dementia must be ruled out?
|
b12, thyroid, parathyroid, uremia, syphilis, brain tumors, NPH, Parkinsons
|
|
what is pseudotumor
|
benign, seems like a tumor
young obese females can result in vision loss Rx is weight loss, repeated lumbar punctiorse or CSF shunt vit A, tetracyclines corticos may cause it. |
|
How do you recognize a headache from meningitis?
|
fever, brudzinski's, kernig's
|
|
what are extracranial causes of headache
|
eye
middle ear sinus pain oral cavity pain herpes zoster nonspecific headache |
|
Where is the lesion with the following visual field deficits?
Right anopsia Bitemporal hemianopsia left homonymous hemianopsia left upper quadrant anopsia left lower quadrant anopsia left homonymous hemianopsia |
right anopsia- right optic nerve
bitemporal hemianopsia- opitcchiasm left homonymous hemianopsia- right optic tract |
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what is a nonsuppurative complication of strep infection that is not altered by treatment of 1ry infection?
|
postinfection glomerulonephritis
|
|
what asplenic patients are sucseptable?
|
pneumoccoccus, meningococcus, h. flu, klebsiella
|
|
what drug causes gray baby?
|
chloramphenicol
|
|
what is a major side effect of clonidine?
|
rebound headache
|
|
what are the criteria for exudative effusion?
|
pleural to serum protein >.5, >.6
|
|
what caues exudative effusions?
|
leaky
malig, tb, bacterial, viral infection pe, pnacreatitis. |
|
what causes transudative?
|
intact capillaries chf, liver, kidney, protein losing enteropathy
|
|
what are the symps associated with silent MI?
|
CHF, shock, altered mental status
|
|
what is endocarditis prophy regimens?
|
oral- amox
GI- or GU- amp and gent, amox after |
|
what derm lesion has a stuck on appearance?
|
seborrheic keratosis
|
|
what gives a +nikolsky's sign?
|
pemphigus
bullous pemphigoid is neg |
|
what presents with a herald patch, christman-tree pattern?
|
pityriasis rosea
|
|
what presents with a 16 y/o who presents with alopesia and broken-off, stubby hairs?
|
alopecia areata
|
|
what has a KOH stain with spaghetti and meatballs?
|
pityriasis versicolor
|
|
what is significant about low Ca, high P, low PTH?
|
hypoPTH
|
|
what are the drugs for pheo?
|
phentolamine, pneoxybenzamine
|
|
what is a sentinal loop on Ab XR?
|
pancreatitis
|
|
what is the most common cause of diarrhea?
|
capmylobacter
|
|
what are teh diarheas of aid?
|
isospora, crypto, mAC
|
|
what causes pseudoappendicitis?
|
yersinia
|
|
what is the treatmetn for high NH3?
|
decrease protein, give lactulose, neomycin
|
|
what is the rx for vW
|
despmopressin FFP, cryoprecipitate
|
|
what is a 10 y/o boy who presents with fever, weight loss, and night sweats. ant mediastinal mass?
|
non-hodgkin's
|
|
microcytic anemia with decreased iron, iron binding, and normal or increased ferritin?
|
anemia of chronic disease
|
|
an 80y/o man wiht fatigue, lymphadenopathy, splenomegaly, isolated lymphocytosis
|
CLL
|
|
a late life-threatening complication of CML?
|
blast crissi- fever, bone pain, splenomegaly pancytopenia
|
|
what are auer rods?
|
AML
|
|
what is an AML subtype associated with DIC?
|
M3
|
|
what changes in tumor lysis syndrome
|
decreased Ca, increased K, phosphate, uric acid
|
|
what is the treatment for AML M3?
|
retinoic acid
|
|
what causes a blueberry muffin rash?
|
rubella
|
|
what causes cold agglutinins?
|
mycoplasma
|
|
what are teh findings in 2ry lyme disease?
|
polyarthropathies, arthralgias, bell's palsy, myocarditis
|
|
what is erythema migrans?
|
lesion of lyme disease
|
|
what is prophylactic treatment for migraine?
|
b-blockers, ca channel blockers, Tcas
|
|
what is the most common pit tumor?
|
prolactinoma
|
|
cold water in the ear goes towards or opposite?
|
opposite
|
|
what are the indications for medical treatment of ectopic?
|
stable, unruptured ectopic pregs of < 3.5 cm at <6wks
|
|
what is the most common cause of bloddy nipple?
|
intraductal papilloma
|
|
how does paget's disease of the breast present?
|
itching, buringin and erosion of nipple
|
|
what is fitz hugh curtis syndrome?
|
recent PID, RUQ pain.
|