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Terms in this set (997)
Type of hemangioma with purple-red on face that does not regress with age
Type of hemangioma in infant with bright red lesion that regresses over months to years
Type of hemangioma with benign small red papule that appears on skin with age
Type of hemangioma with bright red papule with radiating blanching vessels
(seen in patients with Cirrhosis)
Type of hemangioma with blue compressible mass that does not regress
Type of hemangioma with red pink nodule on a child that is often confused with melanoma
Most common type of melanoma
Superficial spreading melanoma
Dark papule on the legs or trunk that bleeds with minor trauma
Occurs on palms, soles, or beneath nail plate in patients with dark skin
Acral Lentiginous melanoma
Dark lesion larger than 6 mm with irregular, asymmetric borders
Superficial spreading melanoma
Dermatologic condition associated with obesity, DM, or malignancy (esp if over age 50)
Dermatologic condition with pigmented plaques that appear to be stuck onto the skin
Dermatologic condition with black velvety plaques on flexor surfaces and intertriginous areas
Dermatologic condition with rough lesions on sun exposed skin that are easier to feel than see
Dermatologic condition with circular rash with central clearing on the trunk or arms
Complications with fall on outstretched arm -> snuffbox tenderness
Avascular necrosis of scaphoid
What are the classic symptoms of carpal tunnel syndrome?
Wrist pain radiating up the arm
Pain worse with hand flexion and grasping
Decreased hand strength
Numbness in thumb, 2nd and 3rd digits
+ Tinels and + Phelans Tests
What is the difference between a Monteggia fracture and a Galeazzi fracture?
Monteggia = Proximal ulnar fracture with anterior dislocation of radial head
Galeazzi = Radial fracture with dislocation of the Distal Ulnar Radius Junction (DURJ)
Complications with anterior shoulder dislocation
Axillary nerve injury
Complications with fracture of the 5th metacarpal neck
Abscess from bite wound
Complications with humerus fracture
Radial nerve injury
Complications with hip fracture
DVT (acutely) then Avascular necrosis later
Complications with femur fracture
Severe blood loss and fat embolus
Complications with tibial fracture
Complications with pelvic fracture
Nerve at risk for injury with injury to shaft of the humerus
Nerve at risk for injury with injury to surgical neck of the humerus
Nerve at risk for injury with injury to the supracondylar of the humerus
Nerve at risk for injury with anterior shoulder dislocation
Nerve at risk for injury with injury to the carpal tunnel
Cause of low back pain when pain increases with passive straight leg raise
Cause of low back pain when pain lessens with flexion at the hips (bending over shopping cart)
Cause of low back pain when elderly, weight loss, pain constant but worse when supine
Cause of low back pain when acute urinary retention
Cauda equina syndrome
Cause of low back pain when pain made worse by walking and standing (aka pseudoclaudication)
Lumbar spinal stenosis
Cause of low back pain when loss of foot dorsiflexion and pain on crossed straight leg raise
Cause of low back pain when pain limited to the paraspinal region
What is the treatment for compartment syndrome?
Emergency fasciotomy of ALL compartments
What scenarios favor a posterior shoulder dislocation?
Disease: knee X-ray that reveals calcification of the menisci
Disease: Hats no longer fit + deafness
Paget's disease or Osteopetrosis
Disease: Needle-shaped, negatively birefringent crystals
Disease: Bone pain/tenderness with elevated WBC, CRP, and ESR
Disease: Narrowing of the marrow cavity results in low H & H
Disease: Child with low trauma fractures
Disease: 55 year old female that trips and sustains a distal radius fracture
Disease responsible for painful limp in a child: X-ray reveals femoral head sclerosis
Avascular necrosis with Legg-Calve-Perthes Disease
Disease responsible for painful limp in a child: Xray reveals ice cream scoop (femoral head) falling off the cone (femur)
Slipped Capital Femoral Epiphysis
Disease responsible for painful limp in a child: Obese, male adolescent with dull hip pain and inability to bear weight
Slipped Capital Femoral Epiphysis
Disease responsible for painful limp in a child: Acute onset of tibial pain, fever, malaise, elevated ESR, no joint pain
Disease responsible for painful limp in a child: Acute onset of knee pain, fever, elevated ESR, leukocytosis
Disease responsible for painful limp in a child: 7 year old with growth delay and inner thigh pain
Disease responsible for painful limp in a child: 6 year old with unilateral hip pain for 5 days, low grade fever, spontaneous resolution
Disease responsible for painful limp in a child: 13 year old male with pain and swelling at the tibial tuberosity
Disease: Proximal muscle weakness with facial rash
Disease: Pain and stiffness in the hips and shoulders
Disease: Muscle pain and tenderness in multiple distinct locations
Disease: Male in his 20s with low back pain that improves with exercise
Disease: Jaw claudication and difficulty standing from a chair
Disease: Pencil in cup deformities of the DIP and PIP joints
Disease: Bamboo spine on xray
Disease: Arthritis + oral ulcers + proteinuria
Disease: Flexed DIP and hyperextended PIP
(Swan neck deformity)
Most common cause of abnormal uterine bleeding
Cause of AUB: Positive b-hCG + intrauterine pregnancy + Close os
Cause of AUB: Enlarged uterus + menometorrhagia for months
Cause of AUB: Bleeding associated with severe menstrual pelvic pain
Cause of AUB: Menorrhagia + perimenopausal
Cause of AUB: AUB started with menarche
Cause of AUB: Positive b-hCG + severe pain + no fetus in uterus on US
Cause of AUB: Metrorrhagia especially after intercourse + no pain + normal sized uterus
Cause of AUB: Depression + Constipation + AUB
AUB: > 80mL/cycle
AUB: >7 days bleeding
AUB: < 24 day cycle
AUB: > 35 day cycle
What is the most likely cause of bloody nipple discharge?
Breast Disease: Most common breast cancer
Invasive ductal carcinoma
Breast Disease: Often presents with serous or bloody nipple discharge
Breast Disease: Most common mass in patients 35-50
Fibrocystic change of the breast
Breast Disease: Most common tumor in teen and young women
Breast Disease: Breast mass accompanied by redness, pain, and warmth
What are the most common causes of bony metastasis?
Renal Cell Carcinoma
What is the classic radiological appearance of osteosarcoma?
What is the classic appearance of Ewing's Sarcoma?
Large destructive lesion with periosteal reaction (onion skinning)
What is the treatment for Lyme disease?
What is the treatment for RMSF?
Doxycycline or chloramphenicol
What is the treatment of Nursemaid's elbow?
Forced supination and flexion
What is the treatment for slipped capital femoral epiphysis?
(non weight bearing before surgery)
What is the treatment for juvenile rheumatoid arthritis?
NSAID (try two first)
Methotrexate or Corticosteroids (if NSAIDs fail)
What is the treatment for Osgood-Schlatter disease?
*Do NOT limit sports or activity or immobilize
What is the treatment for developmental dysplasia of the hip in children younger than 6 months of age?
Which medications are FDA-approved for the treatment of fibromyalgia?
What is the appearance of molluscum contagiosum?
Painless, shiny papules with central umbilication that are less than 5 mm in size
What is the classic presentation of lichen plans?
Pruritic, purple, polygonal papules and plaques on flexor surfaces and extremities
What is the classic presentation of pityriasis rosea?
Christmas tree distribution
What medications most commonly cause erythema multiform?
What infection is commonly associated with Porphyria cutanea tarda?
What treatments are available for androgenic alopecia?
Softening and cyanosis of the cervix at 6 weeks gestation
Bluish discoloration of the vagina due to vascular congestion at 8-12 weeks gestation
Softening of the lower uterine segment at 6 weeks gestation
At what Hgb level should physiologic anemia of pregnancy be treated as iron def anemia?
1st and 3rd Trimesters: Hgb < 11 g/dL
2nd Trimester: Hgb < 10.5 g/dL
What vaccinations are contraindicated in pregnancy?
What medications are commonly used in the management of chronic hypertension in pregnancy?
What is Naegele's Rule?
LMP + 7 days - 3 months +1 year = estimated delivery date
What diagnosis would you suspect with hypertension in pregnancy prior to 20 weeks gestational age?
Chronic HTN or Molar pregnancy
Quad screen shows decreased AFP, decreased unconjugated estriol, elevated inhibin A, and elevated beta-hCG. What is the diagnosis?
Trisomy 21 (Down's Syndrome)
What supplements should be given to women on anticonvulsants during pregnancy?
Vitamin K and Folate
What additional supplements should be given to complete vegetarians during pregnancy?
Iron 30 mg
Vitamin D 400 IU/day
Vitamin B12 2 mcg/day
How much folate, iron, and calcium is needed in pregnancy?
Folate 400 mcg/day
Iron 30 mg/day
Calcium 1200 mg/day
Teratogens: Yellow or brown teeth
Teratogens: Spina bifida, hypospadias
Teratogens: Cardiac (Ebstein's) anomalies
Teratogens: Craniofacial defects, intrauterine growth retardation, central nervous system malformation, stillbirth
Teratogens: Fingernail hypoplasia, craniofacial defects
Teratogens: CNS, craniofacial, ear, and cardiovascular defects
Teratogens: Goiter, Cretinism
Teratogens: Cerebral infarcts, mental retardation
Teratogens: Clear cell vaginal cancer, adenosis, cervical imcompetence
IUP on sono + vag bleeding prior to 20 weeks + closed internal cervical os
Nonviable IUP on sono + open cervical os + no tissue passed
Nonviable IUP (fetal demise) that has not passed (lack of uterine activity)
Open cervical os + tissue at or beyond cervical os, some but not all of the POC have passed
All POC have been passed
Congenital Infection: Initially asymptomatic but later develops a unilateral hearing loss
Congenital Infection: Hydrocephalus, intracranial calcifications, chorioretinitis
Congenital Infection: Rash, deafness, cataracts
Congenital Infection: Hearing loss, chorioretinitis, intracranial calcifications
Congenital Infection: PDA or pulmonary artery stenosis
Congenital Infection: Anemia, blood-tinged nasal secretions, hepatosplenomegaly
Congenital Infection: Temporal lobe encephalitis
Definition of Oligohydramnios
AFI < 5 cm on ultrasound
Definition of Polyhydramnios
AFI > 25 cm on ultrasound
What 3 tests are used to confirm rupture of membranes?
1. Pooling Test
2. Nitrazine Paper (turns blue)
3. Ferning Test
What lab values suggest fetal lung maturity?
L:S > 2
Presence of phosphatidylglycerol (PG) in amitotic fluid
What are the signs and symptoms of magnesium toxicity?
Loss of deep tendon reflexes (9.6-1.2)
Respiratory Paralysis (12-18)
Cardiac arrest (24-30)
What is the reversal agent for magnesium toxicity?
(1g IV given over 5-10 mins for situations of cardiorespiratory compromise)
What is vasa previa?
When fetal vessels overlie the os and increase risk for fetal exsanguination
Multiple Gestations: Split between 0- 4 days
Multiple Gestations: Split between 4-8 days
Multiple Gestations: Split between 8-12 days
Multiple Gestations: Split after 12 days
What is the definition of PPROM?
Spontaneous premature rupture of membranes before 37 weeks
When should you suspect chorioamnionitis in a patient with PROM?
Fever + One of following:
Foul smelling discharge
At what gestational age is labor managed actively instead of expectantly in preterm labor?
After 34 weeks OR if there is proven fetal lung maturity
What are the risk factors for placental abruption?
Prior placental abruption
Tobacco or Cocaine use
What is typically included in an infertility work up?
Analysis of anovulatory cycles
What is considered a reactive stress test?
Two or more 15 bpm accelerations of fetal heart rate lasting at least 15 seconds, each within 20 minutes
How is amniotic fluid index measured?
Ultrasound assesses total linear measurement in centimeters of largest amniotic fluid pocket detected in each of four quadrants of the amniotic sac
What are the components of the Biophysical Profile?
1. Reactive nonstress test (2 points)
2. Amniotic fluid index = 5-23 cm
3. 1+ episode of rhythmic breathing lasting 20 seconds within a 30 minute period
4. 2+ episodes of discrete fetal movement within a 30 minute period
5. 1+ episode of spine and limb extension with return to flexion
What is the pattern of weight gain at 4 months, 12 months, and 24 months?
Doubles by 4 months
Triples by 12 months
Quadruples by 24 months
What is the pattern of height increase at 1 year, 4 years, and 13 years?
50% increase at 1 year
Doubles at 4 years
Triples at 13 years
Milestones at 2 months
Lifts head to 45 degrees
Eyes follow object to midline
Milestones at 4 months
Laughs, Aware of caregiver, localizes sound
Lifts head to 90 degrees
Eyes follow object past midline
Milestones at 6 months
Differentiates parents from others, stranger anxiety
Rolls over, holds self up with hands, sits without support
Grasps/rakes, attempts to feed self
Milestones at 9 months
Interactive games, separation anxiety (9-15 months)
Crawls, pulls to stand
Grasps with thumbs
Milestones at 12 months
Separation anxiety (9-15 months)
Walks with help
Pincer grasp, makes tower of 2 blocks
5-10 word vocabulary
Milestones at 18 months
Walks well, walks backwards
Makes tower of 4 blocks, uses cup or spoon
10-50 word vocal, 2 word sentences
Milestones at 2 years
Dresses self with help
Runs, climbs stairs
Makes tower of 6 blocks
50-75 word vocal, 3 word sentences
Milestones at 3 years
Makes tower of 9 blocks, able to draw circle
Milestones at 4 years
Plays with others
Hops on 1 foot
Able to draw line image (+), later able to draw closer line drawing (triangle)
250+ word vocal, 4 word sentences
Milestones at 6 years
Able to distinguish fantasy from reality
Draws a person
When does toilet training take place?
2 - 3 years old
Hepatitis B Vaccine
*booster at 11-12 years old
*Can be given after age 2 in asplenic patients
Hepatitis A Vaccine
2 doses between 12-18 months of age
11-12 years old
13-18 years old
3 Doses between 11-12 years old
Spider webbing or marbling of the skin
2-3 mm yellow pustule with red base (similar appearance to white-head), arising in first 24-72 hours, microscopic examination of the pustular contents reveals numerous eosinophils
Erythema toxicum neonatorum
(usually gone by 3 weeks, tell parents to leave it alone)
Intense reddening of gravity dependent side and blanching of the nondependent side with a line of demarcation between the two, lasts a few sec-min
Harlequin color change
(most common in the first few days of life, may be due to immaturity of autonomic innervation to skin vessels, completely benign, and will resolve in days to 3 weeks)
Permanent vascular malformations most commonly occurring on the nape of the neck but also upper eyelids and middle of forehead
Macular Stains (Stork bites)
Due to accumulation of sweat beneath eccrine sweat ducts that are obstructed by keratin at the stratum corneum usually develops in 1st week after birth
(usually associated with excess warmth, no treatment needed)
Bluish discoloration over buttocks and base of spine, probably present on at least one of the parents
(benign, usually fades in 1-2 years, DOCUMENT to avoid confusion!)
Treatment of neonatal acne
Mild should be left alone and will resolve in 4 months
Severe can be managed with benzoyl peroxide or topical retinoids
Yellow papules around the nose and checks at 3-4 months of age
(usually clears by age 1 but may persist until age 3, benzoyl peroxide or topical retinoids)
Superficial pustules overlying hyper pigmented macules
Superficial neonatal pustular melanosis
(tell the parents to leave it alone)
White gray spots with a red base
(Pathognomonic for Measles - Rubeola)
What are the 3 C's of Measles (Rubeola)?
How does the rash spread in Measles (rubeola)?
It appears 5 days after prodrome
Starts at the head then spreads to the feet
Lasts 4-5 days
If a patient with measles required treatment with medication, what medication would you use?
When can children begin to eat solid foods?
(typically start with iron fortified cereal)
When can children drink cows milk?
What malignancy is associated with Down Syndrome?
What GI complications are associated with Down Syndrome?
What is WAGR Syndrome?
What is the most common cause of congenital mental retardation in men?
Fragile X Syndrome
Glycogen Storage Diseases: Lactic acidosis, hyperlipidemia, hyperuricemia (gout)
Type I: Von Gierke's Disease
Glycogen Storage Diseases: Diaphragm weakness -> respiratory failure
Type II: Pompe's Disease
Glycogen Storage Diseases: Increased glycogen in liver, severe fasting hypoglycemia
Type I: Von Gierke's Disease
Glycogen Storage Diseases: Hepatomegaly, hypoglycemia, hyperlipidemia (normal kidney's, lactate, and uric acid)
Type III: Cori's Disease
Glycogen Storage Diseases: Painful muscle cramps, myoglobinuria with strenuous exercise
Type V: McArdle's Disease
Glycogen Storage Diseases: Severe hepatosplenomegaly, enlarged kidneys
Type I: Von Gierke's Disease
Immunodeficiency: congenital heart defect + low calcium + recurrent infections
Immunodeficiency: chronic mucocutaneous candidiasis + chronic diarrhea + failure to thrive
Immunodeficiency: Thrombocytopenia + eczema + recurrent infections
Immunodeficiency: Poor smooth pursuit of eyes + elevated AFP after 8 months
Immunodeficiency: Partial albinism + recurrent URIs + neurological disorders
Chediak - Higashi Disease
Genetic Disorder: cleft lip/palage, life expectancy < 1 year, polydactyly
Trisomy 13 (Patau)
Genetic Disorder: High pitched cat like cry
Cri du chat
Genetic Disorder: Elfin facial features, cardiac defects
Genetic Disorder: Tall, thin male with gynecomastia and testicular atrophy
Genetic Disorder: Obesity and overeating
Genetic Disorder: Micrognathia, life expectancy < 1 year, rocker bottom feet
Trisomy 18 (Edwards)
Genetic Disorder: Happy mood, inappropriate laughter, ataxic gait
Genetic Disorder: Large ears, MR, macroorchidism
Fragile X Syndrome
Genetic Disorder: MR, simian crease, GI and cardiac defects
Trisomy 21 (Downs)
Genetic Disorder: Short stature, infertility, coarctation of aorta
When do infections typically begin in children with immune disorders
After the first 3 months of life (after material antibodies disappear)
Vitamin Def: Increased RBC fragility
Vitamin Def: Dermatitis, Cheilosis, glossitis
Iron, B2, B3, folate, and B12
Vitamin Def: Peripheral neuropathy, angular cheilosis, glossitis
Vitamin Def: Hemorrhagic disease
Vitamin Def: Neural tube defects
Vitamin Def: Dermatitis, diarrhea, dementia
Vitamin B3 (Niacin)
Vitamin Def: Megaloblastic anemia
Vitamin B12 or Folate
Vitamin Def: Pernicious anemia
Vitamin Def: Bitot's spots, keratomalacia, xerophthalmia
Vitamin Def: Osteomalacia
Vitamin Def: Rickets
Vitamin Use: Can be used to treat acne and psoriasis
Vitamin Use: Involved in the hydroxylation of propyl residues
Vitamin Use: Requires intrinsic factor for absorption
Vitamin Use: Deficiency may result from kidney disease
Vitamin Use: Given prophylactically to newborns
Vitamin Use: Can be used to elevate HDL and lower LDL
Niacin (Vitamin B3)
Vitamin Use: Deficiency can be caused by isoniazid use
Vitamin Use: Cobalt is found within this vitamin
What is the tumor marker for granulosa cell tumors?
1st degree burn - Superficial
Painful, erythema, NO blisters, capillary refill intact
1st degree burn - Superficial partial-thickness
Epidermis and partial thickness of the dermis
Painful, erythema, DO have blisters, Capillary refill intact
2nd degree burns - Deep partial thickness
Epidermis and partial thickness of the dermis
Painful, Blisters, Does NOT blanch with pressure
3rd degree burns - Full thickness
Epidermis, entire dermis, and possibly deeper tissues
PAINLESS, white and/or charred
Does NOT blanch with pressure
4th degree burns
Additional involvement of muscle and bone
When should tetanus immune globulin be given?
In tetanus prone wounds (dirt, contamination, punctures, crush components) when it is uncertain or < 3 proper tetanus immunizations
Give with Td or DT if < 7 years old
Symptoms of organophosphate poisoning:
Excitation of skeletal muscle
What drugs are used in treating a stable, asymptomatic ventricular tachycardia?
What is the treatment for supra ventricular tachycardia?
Attempt vagal maneuvers and carotid massage
Ventricular rate control (digoxin, Ca Channel blocker or beta blocker)
What is the initial treatment for new atrial fibrillation with rapid ventricular rate of unknown duration?
Rate control: beta blockers, digoxin, verapamil, or diltiazem
Anticoagulation with heparin (then later warfarin)
What is the treatment for Pulseless Electrical Activity?
Airway, breathing, circulation
Epi 1mg IV q3-5 minutes
What are the H causes of PEA?
What are the T causes of PEA?
Toxins or Tablets
What is the treatment for lead poisoning in adults? Children?
Adults = EDTA and dimercaprol
Children = Succimer
What is the parkland formula?
4 mL X weight (kg) X %body surface area burned
What is the treatment for a black widow sider bite?
24 hour observation
+/- Oral antibiotics
What is the treatment for a skin laceration on the dorsum of the hand that resulted from a closed fist hitting a victim's mouth?
What is the next step in the management of a patient that presents to the ER with organophosphate poisoning?
Remove the clothes
What medications are used in cases of cyanide poisoning?
A COPD patient comes to the ER with tachycardia and hypotension. During the evaluation he begins to have seizures. What is the etiology?
ACLS protocol for ventricular fibrillation?
360 J -> CPR 2 mins -> 360 J -> CPR 2 mins -> Epi 1 mg IV or vasopressin
ACLS protocol for asystole
CPR, Epi or vasopression
*DO NOT SHOCK ASYSTOLE!
Labs for Iron deficiency Anemia
Low serum Iron
High TIBC (transferrin)
Low (<12%) Iron:TIBC ratio
Blood smear shows hypochromic, microcytic RBCs
Labs for lead poisoning
Normal or High serum iron
Normal TIBC (transferrin)
Blood smear shows Stippled, microcytic RBCs
Labs for Anemia of Chronic Disease
Low serum iron
Normal or High ferritin
Low TIBC (transferrin)
Normal (>18%) Iron:TIBC ratio
Blood smear shows hypo chromic, normocytic, or microcytic RBCs
Labs for Sideroblastic anemia
High serum iron
Low TIBC (transferrin)
Blood smear shows ringed sideroblasts
Labs for Thalassemia
Normal or high serum iron
Normal TIBC (transferrin)
Blood smear shows microcytic RBCs, target cells, and basophilic stippling
What is the Mentzer Index?
Used to differentiate an iron def anemia from a thalassemia anemia
>13 = Iron deficiency
< 13 = Thalassemia
3 Things associated with basophilic stippling
1. Lead poisoning
3. Alcohol use
What are the different causes of Sideroblastic anemia?
3. Lead poisoning
Sideroblastic anemia can progress to...
Besides staph aureus which organism may be responsible for osteomyelitis in a sickle cell patient?
What medication is used in the long term management of sickle cell anemia?
A teenage african american male presents to the ER with right hip pain and a hematocrit of 25%. What is the most likely diagnosis?
Sickle cell disease and osteonecrosis
(osteonecrosis is most common in humeral/femoral heads)
What is the next step in the management of a patient with febrile neutropenia due to chemotherapy?
Admit to hospital
IV broad spectrum antibiotics
What is the most common cause of anemia in elderly patients?
Iron deficiency anemia
What would you see on a blood smear of a patient with anemia due to lead poisoning?
Microcytic, hypochromic anemia with basophilic stippling
What is the cause of anemia that develops after taking a sulfa drug?
Schistocytes (fragmented RBCs)
Hemolytic, DIC, TTP, HUS
Acanthocyte (spur cell)
Basophilic stippling of RBCs
Peripheral neuropathy + sideroblastic RBCs
Vitamin B12 or Folate
Heinz Bodies (denatured Hgb in RBC)
Which vaccines are particularly important in children with sickle cell disease?
H. Influenza type B
What is the triad for HUS?
2. Uremia or acute renal failure
What is the pentad for TTP?
2. Uremia or acute renal failure
5. Altered mental status
What are the most common causes of DIC?
"STOP Making New Thrombi"
What are the criteria for SIRS
At least two of the following:
Fever > 38 C or hypothermia < 35 C
Tachypnea: RR > 20 or PaCO2 < 32 mmHg
Tachycardia: HR > 90
Leukocytosis: WBC >12000 or Leukopenia: WBC < 4000 or Bandemia: > 10% bands
What is the most common mutation in white patients that predisposes to venous thrombosis?
Factor V Leiden
MOA of Streptokinase
(Cleaves fibrin clots)
ADP receptor blocker
GP IIa/IIIb inhibitor
GP IIa/IIIb inhibitor
ADP receptor blocker
Binds factor Xa
GP IIa/IIIb inhibitor
What is the treatment for von Willebrand's disease
Cyroprecipitate or factor VIII
A patient's peripheral smear shows macrocytosis and hypogranular granulocytes with bilobed nuclei. What is the diagnosis?
What are Xanthomas and what are they associated with?
Lipid deposits in tendons
Associated with Hypercholesterolemia
*Classically found in achilles tendon!
What are Xanthelasmas?
Lipid deposits in eyelids
What are the 5 risk factors for CAD?
1. Tobacco use
2. HTN (BP > 140/90 or on meds)
3. HDL < 40
4. Fam hx of CAD in male < 55 or female < 65
5. Age (Male > 45 or female >55)
*HDL > 60 cancels one risk
LDL goal in patients with < 2 CAD risk factors
LDL goal in patients with 2 or more risk factors
LDL goal in patients with known CAD, PVD, AAA, symptomatic carotid disease, or multiple risk factors that confer a 10 year risk of CAD > 20%
Total cholesterol > 200 and LDL 130-159 without any risk factors
Total cholesterol > 200 and LDL goals NOT met
Lipid lowering medications
Leukemia: Most common neoplasm in children (peak 3-4 years)
Leukemia: Most common leukemia in adults (average age of onset 50 years)
Leukemia: Philadelphia chromosome is almost always seen
Leukemia: Smudge cells on peripheral smear
Leukemia: Peripheral blasts are PAS+ and TdT+
Leukemia: Peripheral blasts are PAS-, myeloperoxidase +, and have Auer Rods
Leukemia: Pancytopenia in a Down syndrome patient
What medication is associated with remission in 95% of patients with CML
A 21 year old male patient presents with recent weight loss, pruritus, and night sweats. Physical exam reveals hepatosplenomegaly and a contender cervical lymphadenopathy. What do you suspect?
Blood cell pathology: Associated with EBV (in Africa)
Blood cell pathology: Reed-Sternberg cells, Cervical lymphadenopathy, Night sweats
Blood cell pathology: Bence-Jones proteins, osteolytic lesions, high calcium
Blood cell pathology:Translocation 14;18
Blood cell pathology: Most common lymphoma in the US
Diffuse Large B Cell Lymphoma
Blood cell pathology: Translocation 8;14
Blood cell pathology: Translocation 9;22
Blood cell pathology: Most common form of Hodgkins Lymphoma
Blood cell pathology: Starry-sky pattern du to phagocytosis of apoptotic tumor cells
Blood cell pathology: High H&H, pruritus (especially after hot bath or shower), burning pain in hands or feet
Blood cell pathology: Blood smear (hair like projections), splenomegaly
Hairy Cell Leukemia
Antiretroviral: SE of lactic acidosis
Antiretroviral: SE of GI intolerance
Antiretroviral: SE of pancreatitis
Antiretroviral: SE of peripheral neuropathy
Antiretroviral: SE of megaloblastic anemia
Antiretroviral: SE of rash
Antiretroviral: SE of hyperglycemia, DM, and lipid abnormalities
Antiretroviral: Given to pregnant women with HIV
Zidovudine during labor (HAART)
Antiretroviral: Regimen for occupational HIV exposure
Zidovudine and Lamivudine
Antibiotic prophylaxis in HIV patients
TMP-SMX for PCP when CD4 < 200
Clarithromycin or azithromycin for MAC when CD < 100
Isoniazid for TB (when exposed)
Acute treatment of an MI
MONA had Hep B
2-4 weeks post MI:
What is the most common cause of chest paining a patient with sudden tearing chest pain radiating to the back?
What is the most common cause of death in patients with an acute MI?
Match the lipid drug: SE of facial flushing
Match the lipid drug: SE of elevated LFTs, myositis
Match the lipid drug: SE of GI discomfort, bad taste
Bile acid sequestrants
Match the lipid drug: Best effect on HDL
Match the lipid drug: Best effect on TG
Match the lipid drug: Best effect on LDL/cholesterol
Match the lipid drug: Binds C. diff toxin
How can the flushing reaction of niacin be prevented?
Give aspirin 30 mins prior
Take at bedtime
Avoid alcohol or hot beverages
Type of heart block: PR interval prolonged more than 0.2 secs (5 small boxes)
1st degree heart block
Type of heart block: No relationship between P waves and QRS
3rd degree heart block
Type of heart block: PR interval becomes progressively longer until a beat is blocked
2nd degree (Mobitz type 1, Wenckebach)
Type of heart block: PR interval fixed but with occasional blocked beats
2nd degree (Mobitz type 2)
EKG: Narrow QRS not associated with P waves, rate 60
3rd degree heart block
EKG: Chaotic erratic, wide QRS
EKG: Wide QRS not associated with p waves, rate > 40 but < 100
Accelerated ventricular rhythm
EKG: Narrow QRS not associated with p waves, rate > 100
EKG: Wide QRS, not associated with p waves, rate 20-40
EKG: Wide QRS, not associated with p waves rate > 100
EKG: Narrow QRS not associated with p waves rate > 60 but < 100
Accelerated Junctional Rhythm
EKG: Erratic QRS that varies in amplitude in a repeating pattern
Torsades de Pointes
What is the treatment for premature atrial contractions?
Which anti arrhythmic should be avoided in patients with preexisting lung disease?
What is the drug of choice for acute onset atrial fibrillation with rapid ventricular rate in a patient with WPW?
Electrocardioversion or Procainamide
An EKG shows complete independence of P waves from QRS complexes. What is the next step?
What type of heart block in which the PR interval is progressively lengthen with each beat until a ventricular beat is dropped?
2nd Degree, Mobitz Type I
What is the drug of choice in paroxysmal supra ventricular tachycardia?
Carotid massage (avoid in CAD)
Boot shaped heart on CXR
Balloon like heart on CXR
Cardiac cath shows equal pressure in ALL chambers
Chronic constrictive pericarditis
What is the classic appearance of the heart on a CXR of a patient with pericardial effusion?
Water bottle shaped heart
(enlargement of cardiac silhouette)
What would you find on physical exam of a patient with pericardial effusion?
Diminished heart sounds
Difficult to palpate apical impulse
In what scenarios might you see Kussmaul's sign?
Right ventricular infarct
What disease has signs of heart failure + DM + elevated LFTs?
In which etiology of restrictive cardiomyopathy is the pathology reversible with phlebotomy?
What is the next step in the work up of a low grade systolic murmur in an otherwise healthy asymptomatic patient?
(if loud -> echocardiogram)
What is the next step in the work up of a diastolic murmur in an otherwise healthy asymptomatic patient?
Short systolic murmur at the cardiac apex that decreases with squatting and is sometimes associated with benign chest pain and lasts only a few seconds
Mitral valve prolapse
When might subclinical mitral stenosis from rheumatic heart disease become clinically apparent?
Blood volume increase
What commonly causes heart failure in young patients?
What is the treatment for cardiac tamponade?
What is the acute treatment for exacerbations of CHF?
Diastolic murmur heard best at left lower sternum, that increases with inspiration
Late diastolic murmur with an opening snap (no change with inspiration)
Systolic murmur heard best in the second right interspace
Systolic murmur heard best in the second left interspace
Late systolic murmur heard best at the apex
Mitral valve prolapse
Diastolic murmur with a widened pulse pressure
Holosytolic murmur that is louder with inspiration at the left lower sternum
Holosystolic murmur heard at the apex and radiates to the axilla
What is the treatment for premature atrial contractions
JONES PEACE for RHD
JONES: Major Criteria
Joints (Polyarthritis, hot/swollen joints)
<3 Heart (carditis, valve damage)
Nodules (subcutaneous, extensor surface)
Erthema marginatum (painless rash)
Sydenham chorea (flinching movement disorder)
PEACE: Minor Criteria
Previous rheumatic fever
ECG with PR prolongation
CRP and ESR elevated
*2 major or 1 major with 2 minor
Noninfective endocarditis seen in SLE patients
*Negative culture endocarditis causes
FROM JANE for Endocarditits
Roth's Spots (Rentinal hemorrhages)
Osler's Nodes (tender nodules on finger/toe pads)
Janeway lesions (peripheral petechiae)
Nail bed hemorrhage (splinter hemorrhages)
Hypertension + Depression + Kidney stones?
What complications can arise from the use of vasopressor such as NE in treating shock?
Peripheral vasoconstriction -> Ischemia at fingertips and toes, mesenteric, renal failure
What intervention is most effective at reducing blood pressure?
What is the preferred initial antihypertensive in a patient with NO comorbidities?
Which antihypertensive in a patient with: DM
ACE-I or ARB
Which antihypertensive in a patient with: Heart failure (multiple)
Which antihypertensive in a patient with: BPH
Which antihypertensive in a patient with: Left ventricular hypertrophy
ACE-I or ARB
Which antihypertensive in a patient with: Hyperthyroidism
Which antihypertensive in a patient with: Osteoporosis
Which antihypertensive in a patient with: Benign essential tremor
Which antihypertensive in a patient with: Post menopausal female
Which antihypertensive in a patient with: Migraines
Antihypertensive with SE of first dose orthostatic hypotension
Antihypertensive with SE of hypertrichosis
Antihypertensive with SE of dry mouth, sedation, severe rebound HTN
Antihypertensive with SE of bradycardia, impotence, asthma exacerbation
Antihypertensive with SE of reflex tachycardia
Antihypertensive with SE of cough
Antihypertensive to avoid in patients with sulfa allergy
Thiazide and loop diuretics
Antihypertensive with SE of angioedema
Antihypertensive with SE of development of drug induced lupus
Antihypertensive with SE of cyanide toxicity
Vasodilating effects of nitroglycerin
Vasodilating effects of Dihydropyridine CCBs
Dilates both arteries and veins
Vasodilating effects of hydralazine
Vasodilating effects of nitroprusside
Dilates both veins and arteries
AAA screening recommendation
USPSTF recommends a one time screening for men ages 65 to 75 with a history of smoking
ABI < 1 indicates vascular insufficiency
ABI < 0.4 indicates severe disease
What is the treatment for superficial thrombophlebitis?
Removal of IV catheter if present
NSAIDs, heat and limb elevation
What infection is associated with polyarteritis nodosa?
Hep B or C
CRASH for Kawasaki's Disease
Fever (>104) for at least 5 days PLUS 4 of the following:
1. Conjunctivitis (Bilateral, non-exudative, painless)
2. Rash (truncal)
3. Adenopathy of the cervical lymph nodes
4. Strawberry tongue and diffuse mucus membrane erthema
5. Hands and feet have edema with induration, erythema, or desquamation
What is the treatment for Kawaski's Disease?
IVIG and high dose aspirin
A 6 week old infant presents to the Pedi ER for irritability and is found to have signs of left sided heart failure. An EKG is interpreted as a left sided MI. What is the most likely diagnosis?
Anomalous origin of the left coronary artery
(arise from the pulmonary artery rather than aorta; carries deoxygenated blood)
What class of medications is indicated in patients with a hereditary prolongation of the QT interval in order to prevent episodes of ventricular fibrillation?
Vasculitis: weak pulses in upper extremities
Vasculitis: necrotizing granulomas of the lung and necrotizing glomerulonephritis
Vasculitis: necrotizing immune complex inflammation of visceral/renal vessels
Vasculitis: Young male smokers
Vasculitis: young Asian women
Vasculitis: young asthmatics
Vasculitis: infants and young children; involved coronary arterties
Vasculitis: most common vasculitis
Vasculitis: Associated with Hep B infection
Vasculitis: Occlusion of ophthalmic artery can lead to blindness
Vasculitis: Perforation of nasal septum
Vasculitis: Unilateral headache, jaw claudication
What is the next step in management of a patient with a DVT that has a high likelihood of falling?
Place IVC filter
What are indications for operating on an AAA?
> 5.5 cm
Rate of increase > 0.5 cm in 6 months
Normal A-a gradient
5 to 15 mmHg
Signs of a peritonsilar abscess
Trismus ("lock jaw")
Displacement of uvula away from the abscess
Muffled "hot potato voice"
Patients with DM are predisposed to chronic sinusitis caused by what organism?
Most common cause of acute bronchitis in nonsmokers?
Most common causes of acute bronchitis in smokers?
Most common cause of pneumonia in children
Most common cause of pneumonia in adults
Common cause of pneumonia in immunocompromised patients?
Most common cause of atypical/walking pneumonia?
Common causative agent for pneumonia in alcoholics?
Can cause an interstitial pneumonia in bird handlers
Often the cause of pneumonia in a patient with a history of exposure to bats and bat droppings
Often the cause of pneumonia in a patient who has recently visited South California, New Mexico, or West Texas
Pneumonia associated with "currant jelly" sputum
Associated with pneumonia acquired for air conditioners
Most common cause of pneumonia in children 1 year old or younger
Most common cause of pneumonia in the neonate
Group B Strep
Most common cause of pneumonia in children and young adults (including college students, military recruits, and prison inmates)
Common cause of pneumonia in patients with other health care problems
Most common cause of viral pneumonia
Causes a Woolsorter's disease (a life threatening pneumonia)
Common bacterial cause of COPD exacerbation
Common pneumonia in ventilator patients and those with cystic fibrosis
Cause of pneumonia: Gram + cocci in clusters
Cause of pneumonia: Gram + cocci in pairs
Cause of pneumonia: Gram - rods in 80 year olds
Cause of pneumonia: Gram + cocci in neonate
Cause of pneumonia: Gram - rods in neonate
When is a 5mm PPD considered positive?
HIV positive patients
Close contact with TB infected patient
Signs of TB on CXR
When is a 10 mm PPD considered positive?
Immigrants from developing nations
Chronically ill patients
Health care workers
Patients with recent incarceration
When is a 15 mm PPD considered positive?
In a patient with pulmonary edema, how can pulmonary capillary wedge pressure distinguish ARDS from cardiogenic edema?
PCWP < 12 is a noncardiogenic pulmonary edema (ARDS)
PCWP > 18 cardiogenic edema (heart failure)
What are the diagnostic characteristics of ARDS?
Acute onset of respiratory distress
PaO2/FiO2 < 200
Bilateral pulmonary infiltrates on imaging
No evidence of cardiac origin
What is the differential diagnosis of ground glass infiltrates on CXR?
Pulmonary edema or ARDS
What causes a high A-a gradient?
Pulmonary edema/ ARDS
Right to Left shunt
What is the empiric treatment for pneumonia in a 2 month old?
What is the empiric treatment for pneumonia in a 2 year old?
Amoxicillin or Ampicillin
What are the SE of Theophylline?
What is status asthmaticus and how is it treated?
Prolonged, nonresponsive asthma attack that can be fatal
Treated with aggressive bronchodilator therapy, corticosteroids, O2, and possibly intubation
What value can you check to differentiate between chronic bronchitis and emphysema?
DLCO (Diffusing capacity of lungs)
Normal = chronic bronchitis
Decreased = emphysema
Stage 0 = Normal spirometry in smokers or those with symptoms (chronic cough)
Stage 1 = FEV1/FVC < 70% and FEV1 > 80
Stage 2 = FEV1 50-80%
Stage 3 = FEV1 30-50%
Stage 4 = FEV1 < 30%
Dextrocardia + Sinusitis + Bronchiectasis
Characteristics favoring benign solitary lung nodule
< 35 years old
No change from prior films
Central, uniform lesion with smooth margins
< 2 cm
No evidence of lymphadenopathy
*follow up chest X-ray in 3-6 months
Characteristics favoring cancerous solitary lung nodule
> 45 years old
New or progressing lesion
No calcifications or irregular calcifications
> 2 cm
Most common type of lung cancer seen in nonsmokers
Miosis + ptosis + anhidrosis
(caused by invasion of cervical ganglia)
Horner syndrome + brachial plexus involvement
Obstruction of venous drainage through superior vena caba and associated head swelling and CNS symptoms
Superior Vena Cava Syndrome
Most common sites for lung cancer metastases
What is the treatment for superior vena cava syndrome?
Endovascular stent (keep vessel open)
Asbestosis gives an increased risk of...
Malignant mesothelioma and lung cancer
*Synergistic effect with tobacco!
Silicosis gives an increased risk of...
Berylliosis is associated with what type of exposure?
Also ceramics, tool, die manufacturing
What is the next step in the workup of a patient with a solitary pulmonary nodule?
Obtain prior CXR to see if change has occured
Lung cancer associated with elevated ACTH -> glucocorticoid excess -> Cushings syndrome
Lung cancer associated with elevated PTH related peptide -> hypercalcemia
Lung cancer associated with elevated ADH -> SIADH -> hyponatremia
Lung cancer associated with antibodies to presynaptic Ca Channels -> Lambert Eaton Syndrome
What is the initial treatment of a localized non small cell lung cancer
What are the classic radiologic findings in idiopathic pulmonary fibrosis?
What is the treatment for Idiopathic pulmonary fibrosis?
Pneumoconiosis: Progressive fibrosis
Coal worker's disease
Pneumoconiosis: Increased risk of TB
Pneumoconiosis: Associated with working with electronics -> increased cancer risk
Pneumoconiosis: Malignant mesothelioma and bronchogenic carcinoma
What substances should be avoided in patients with obstructive sleep apnea?
Shortly after birth a child has stridor, wheezing, and shortness of breath despite medical therapies. What is likely to be causing this patient's symptoms?
What is the treatment for epiglottitis?
Antibiotics for 7-10 days
Intubation to protect airway
What is the treatment for croup?
What is the treatment for RSV bronchiolitis?
Trauma patient in respiratory distress -> CXR shows pleural effusion -> what is the next step in the management of this patient?
What size pneumothorax requires a chest tube placement?
> 15% of lung field
What medication is used prior to intubation in head injury patients?
Typical CXR appearance of newborn RDS
Low lung volumes
Diffuse ground glass appearance
Food poisoning as a result of mayonnaise sitting out too long
Rice water stools
Diarrhea transmitted from pet feces
Food poisoning resulting from reheated rice (chinese food)
Most common cause of "travelers diarrhea"
(E Coli Enterotoxigenic)
Diarrhea after a course of antibiotics
Diarrhea + recent ingestion of water from a stream
Giardia or E. histolytica
Mild intestinal infection that can become neurocysticercosis
Food poisoning from undercooked hamburger
(E Coli O157:H7)
Diarrhea from seafood
Bloody diarrhea from poultry
Salmonella or Campylobacter
Diarrhea + Pink eye
Blood diarrhea -> liver abscess
Diarrhea in an AIDS patient
Dehydrated child with greenish diarrhea in winter months
Most common foodborne bacterial GI infection
Second most common foodborne bacterial GI infection
What are secondary causes of achalasia?
Treatment for Entamoeba histolytica
Treatment for Giardia lamblia
Treatment for Salmonella
Fluoroquinolone (high risk only)
Treatment for Shigella
Fluoroquinolone (high risk only)
Treatment for campylobacter
Hydration and erythromycin
What is the treatment for Hep C infection?
Peg IFN alpha + Ribaviron
What is the next step after H&P in the workup of a patient complaining of dysphagia
What is the most sensitive and specific test for Chronic Pancreatitis
(it will be LOW)
Ranson Criteria on Admission
Glucose > 200
AST > 250
LDH > 350
Age > 55
WBC > 16000
Ranson Criteria during initial 48 hours after admission
" C HOBBS"
Calcium < 8
Hematocrit decreases > 10%
O2 < 60
BUN increases > 5
Base deficit > 4
Sequestration of fluid > 6L
1. Symptoms of hypoglycemia while fasting
3. Improvement in symptoms with carbohydrate load
*Associated with Insulinoma
An EGD with biopsy in a 65 year old male reveals gastric cancer. What is the next step in management?
CT scan of abdomen or pelvis for spreading and staging
What is the next step in the management of a patient with recurrent duodenal ulcers seen on at least two EGDs?
Serum gastrin level
(to check for Zollinger-Ellision Syndrome)
What is the most effective treatment of a duodenal ulcer NOT due to ZE syndrome?
PPI + Clarithromycin + Amox or Metronidazole
What Chem 7 lab abnormality is often elevated in patients with an upper GI bleed?
What is the treatment for gastric cancer?
Distal 1/3 stomach: subtotal gastrectomy
Middle or Upper stomach: total gastrectomy (chemo or radiation)
You suspect gastric cancer. What two enlarged lymph nodes will you look for?
Virchow's Node (left supraclavicular)
Sister Mary Joseph's Node (periumbilical)
What is the next step in the management of a patient that comes to the ER with severe abdominal pain and AXR shows free air in the abdomen?
(free air indicates perforation)
A recent Cuban immigrant with symptoms of malabsorption is found to also have megaloblastic anemia. What is the disease and treatment?
Dx: Tropical Sprue
Tx: Tetracycline for 3-6 months + folate
What is the treatment for Crohn's Disease?
Anti-TNF alpha agents
What is the classic characteristic of acute mesenteric ischemia?
Pain out of portion to exam
What tumors can cause a secretory diarrhea?
Medullary Thyroid Tumor
What is the most likely cause of malabsorption in a patient with a + Sudan stain in the stool sample and a normal D-xylose test?
What is the treatment for Whipple Disease?
TMP-SMX or Ceftriaxone for 12 months
What serum lab findings might help you distinguish Crohn's from UC?
ASCA in Crohn's
pANCA in Ulcerative Colitis
What are the classic features of carcinoid syndrome?
Right sided valvular disease/murmurs
Treatment for Carcinoid Syndrome
Somatostatin analog - Octreotide
What is the most common tumor of the appendix?
What is the most common location of a carcinoid tumor?
Hundreds of polyps in colon; near certain development of malignant neoplasm
Familial adenomatous polyposis (FAP)
* Prophylactic subtotal colectomy recommedned
Multiple genetic mutations; cancer arise from normal appearing mucosa; neoplasms tend to form in proximal colon
Hereditary nonpolyposis colorectal cancer (HNPCC)
aka Lynch Syndrome
Similar to FAP with addition of common bone and some tissue tumors
Polyps are hamartomas with low risk of malignancy; mucocutaneous pigmentation of mouth, hands, and genitals
Many colonic adenomas with high malignant potential; comorbid malignant CNS tumors
Polyps of colon, small bowel, and stomach that frequently are source of GI bleeding
What is the next step in the management of a patient younger than 50 with minimal bright red blood per rectum (only seen on the toilet paper after wiping)?
(look for hemorrhoids)
What is the most likely cause of acute pain and swelling of the midline sacrococcygeal skin and subcutaneous tissues?
What is the most likely cause of recurrent LLQ abdominal pain that improves after defecation?
What type of patient is at high risk for a calculous cholecystitis?
Patients getting TPN or in the ICU
A 40 year old male tells you that his father had colon cancer at age 55. When should this man's first colonoscopy be scheduled?
45 years old
How is volume status assessed in a patient with a GI bleed?
What is the treatment for hepatic encephalopathy?
What is Budd-Chiari Syndrome?
Thrombosis and occlusion of the hepatic vein or hepatic stretch of the IVC
What are the signs and symptoms of Budd-Chiari Syndrome?
Treatment for Spontaneous Bacterial Peritonitis?
Cefotaxime or Ceftriaxone
Albumin dosed IV
What is the treatment for Primary Biliary Cirrhosis?
Ursodeoxycholic Acid (UDCA)
*delays disease progression and enhances survival
Treatment for hemochromatosis
(weekly or biweekly until normal, then monthly)
Treatment for Wilson Disease
Trientine or Penicillamine
What lab value is associated with Hepatocellular carcinoma
Increased alpha fetoprotein
What antibiotic is contraindicated in neonates with hyperbilirubinemia and why?
Ceftriaxone -> it displaces bilirubin from albumin
What is the most widely used screening test for hemochromatosis?
Tumor marker for hepatocellular carcinoma
Tumor marker for colon cancer
Tumor marker for gastric cancer
Tumor marker for pancreatic cancer
Tumor marker for Ovarian cancer
Which diuretic is most useful for acute pulmonary edema?
Which diuretic is most useful for idiopathic hypercalciuria -> calcium stones?
Which diuretic is most useful for glaucoma?
Which diuretic is most useful for mild to moderate CHF with expanded ECV?
Which diuretic is most useful in conduction with loop or thiazide diuretics to retain K+?
Which diuretic is most useful for edema associated with nephrotic syndrome?
Which diuretic is most useful for increased intracranial pressure?
Which diuretic is most useful for mild to moderate hypertension?
Which diuretic is most useful for hypercalcemia?
Which diuretic is most useful for altitude sickness?
Which diuretic is most useful for Hyperaldosteronism?
What is the most common site of renal stone impaction?
What type of renal stones are radiolucent?
Uric acid stones
What type of renal stones are associated with UTIs cause by urease positive bacteria (proteus, klebsiella)
What type of renal stones are associated with idiopathic hypercalciuria?
What type of renal stones are associated with hyperparathyroidism?
Apple green birefringence with congo red stain under polarized light
EM: spike and dome pattern of the basement membrane
NOT indicative of disease
Chronic renal disease
Red cell casts
Glomerulonephritis or vasculitis
White cell casts
Tubulointerstitial disease or acute pyelonephritis
Epithelial cell casts
ATN and acute glomerulonephritis
2. Lung cavitary lesions
"Split basement membrane"
"Linear pattern of IgG antibody deposition"
"spike and dome: basement membrane thickening
"Basement membrane thickening with double layer tram track appearance"
A 60 year old male smoker is found to have a varicocele that does not empty when the patient is recumbent. What should you be suspicious of in this patient?
Renal cell carcinoma
(get CT of the abdomen)
What are the dietary recommendations in the treatment of nephrolithiasis?
Adequate dietary calcium
increased fluid intake
decreased sodium intake
decreased dietary protein and oxalate
A young black male presents with painless hematuria. What should you suspect?
sickle cell trait
What is the treatment for uric acid renal stones?
What is the most common cause of nephrotic syndrome in african amercian males?
Focal segmental glomerular sclerosis
What medications are used in the treatment of Wegener's granulomatosis?
What is the classic presentation of post streptococcal glomerulonephritis?
Child with brown urine
Strep infection 1-3 weeks ago
High ASO titer
What is the most common cause of morbidity and mortality in patients with SLE?
Fever + rash + elevated creatinine + eosinophilia
Acute interstitial nephritis (AIN)
What is the biggest risk factor for renal cell carcinoma?
What size calcium renal stone has a 50% likelihood of passing without surgical intervention?
What are the most common causes of chronic kidney disease?
Type 1 Renal tubular acidosis
Impaired H+ secretion leading to secondary hyperaldosteronism
Type 2 Renal tubular acidosis
Defect in HCO3- reabsorption
Type 4 Renal tubular acidosis
Primary or secondary hypoaldosteronism
How do you calculate the anion gap?
(Na+) - (Cl-) - (HCO3-)
What is the normal range for the anion gap?
8 - 12
What does a normal anion gap acidosis suggest?
What does an increased anion gap acidosis suggest?
What are the possible causes of a normal anion gap metabolic acidosis?
Renal tubular acidosis
What are the possible causes of an increased anion gap metabolic acidosis?
Isoniazid / Iron
Ethanol / Ethylene glycol
6 D's of Hypernatremia
Diarrhea and vomiting
Disease of kidney (hyperaldosteronism)
What is the max Na+ reduction per day?
What results from too rapid correction of hypernatremia?
Treatment for central diabetes insipid us?
What results from overly rapid correction of hyponatremia with hypertonic saline?
Central Pontine Myelinolysis
EKG change seen with hypercalcemia?
Shortened QT interval
EKG change seen with hypocalcemia?
Prolonged QT interval
Hyponatremia + low serum osmolality + high urine osmolality
What is the next step in the management of a patient with peak T waves on EKG due to hyperkalemia?
Calcium gluconate (stabilizes the myocardium)
What is the most common cause of death in dialysis patients?
What medications can be used to rapidly correct hyperkalemia by shifting K+ into cells?
Insulin + glucose
What are the causes of euvolemic hyponatremia?
What medications are necessary in patients with end stage renal disease?
A patient has signs of peritonitis and his clinical scenario favors rupture of the bladder (blunt trauma to a full distended bladder). What portion of the bladder must have been injured to allow for a chemical peritonitis to have developed?
Dome of the bladder
(ONLY part cover by peritoneum)
What is the next step in the management of a woman with an uncomplicated cystitis?
Newborn male has a distended palpable bladder and oliguria. What is the most common cause of congenital urethral obstruction?
Posterior urethral valves
What is the defining characteristic of a hydrocele?
DM Drugs: Lactic acidosis is a rare but worrisome side effect
DM Drugs: Most common side effect is hypoglycemia
DM Drugs: Oldest and cheapest of the oral agents
DM Drugs: Often used in combo with any other oral agents
DM Drugs: Also help lower TG and LDL cholesterol levels
DM Drugs: Not safe in settings of CHF
DM Drugs: Should not be used in patients with elevated serum creatinine
DM Drugs: Should not be used in patients with inflammatory bowel disease
DM Drugs: Hepatic serum transaminase levels should be carefully monitored when using these agents
DM Drugs: Not associated with weight gain, often used in overweight diabetics
DM Drugs: Metabolized by liver, excellent choice in patients with renal disease
DM Drugs: Primarily effects postprandial hyperglycemia, taken with meals
Which DM drugs inhibit the degradation of incretin?
Which newer DM drug is derived from Gila monster saliva?
Exenatide and Liraglutide (Incretin mimetics)
*agonize GLP-1 receptors
How do you diagnose diabetic gastroparesis?
Gastric emptying study
How do you treat diabetic gastroparesis?
Chronic progressive neuropathy
What increases TBG?
What decreases TBG?
Patient has exophthalmos -> What is the most likely cause?
In which of the following hyperthyroid diseases is radioactive iodine most likely to result in hypothyroidism: Graves disease, toxic multi nodular goiter, toxic adenoma?
What is the treatment of the most common cause of hyperthyroidism?
What can cause hypoglycemia in a non diabetic patient?
What are the signs and symptoms of diabetic ketoacidosis?
What lab abnormalities necessitate obtaining thyroid function testing to rule out thyroid disease?
Increased serum CPK
A patient with hypothyroidism and elevated anti-TPO antibodies is at increased risk of which type of cancer?
Cause of hyperthyroidism: Extremely tender thyroid gland
Cause of hyperthyroidism: Pretibial myxedema
Cause of hyperthyroidism: Pride in recent weight loss, medical professional
Abuse of thyroid drugs
Cause of hyperthyroidism: Palpation of single thyroid nodule
Toxic thyroid adenoma
Cause of hyperthyroidism: Palpation of multiple thyroid nodules
Toxic multinodular goiter
Cause of hyperthyroidism: Eye changes - proptosis, edema, injection
Cause of hyperthyroidism: History of thyroidectomy or radioablation of thyroid
Too much levothyroxine
What thyroid abnormalities would you expect to find during pregnancy?
Increased total T4
Normal free T4
What is the most common form of thyroid cancer?
Which type of thyroid cancer produces calcitonin?
(parafollicular C cells)
Albright Hereditary Osteodystrophy
Associated with pseudohypoparathyroidism
Shortening of 4th and 5th digits
When do you perform a surgical parathyroidectomy?
Serum Calcium > 1.0
Cr clearance reduced by 30%
Bone mineral density T score < -2.5
Age < 50
What are the symptoms of hyperprolactinemia in a premenopausal female?
Hypogonadism -> infertility
What are the symptoms of hyperprolactinemia in a post menopausal female?
None since already hypogonadal
What are the symptoms of hyperprolactinemia in a male?
Hypogonadism (low testosterone)
Infertility (low sperm counts)
How do you screen for acromegaly?
Measure serum levels of insulin-like growth factor 1 (IGF-1)
How do you confirm a dx of acromegaly?
Oral glucose suppression test
(75g of glucose, measure GH at 1hr and 2hr, if > 1ng/mL = acromegaly)
Most common cause of Cushing Syndrome?
Excess corticosteroid administration
2nd most common cause of Cushing Syndrome?
Excess ACTH production by a pituitary adenoma
Triad for hyperaldosteronism
3. Metabolic alkalosis
Excess aldosterone secretion caused by unilateral adrenal adenoma
Pancreas (or GI endocrine tumor)
*possible zollinger-ellison syndrome
Medullary thyroid cancer
Medullary thyroid cancer
*marfanoid body habitus
What is frequently the first sign of Cretinism?
*also see lethary, large fontanelles that remain open, thick tongue, constipation, poor feeding, umbilical hernia, poor growth, hypotonicity, dry skin, hypothermia
A patient with elevated BP, palpitations, headache, excessive perspiration is found to have elevated urine vanillylmandelic acid levels. What effect would giving a beta blocker have on this patient?
(need to give an alpha blocker first)
What is a lactotroph adenoma?
Prolactin secreting pituitary adenoma
What is a somatotroph?
GH secreting pituitary adenoma
Most likely cause of increased PTH + decreased serum calcium + increased serum phosphate?
Vit D deficiency
Of DHEA, DHEA-S and testosterone, which is made only by the adrenals and is more specific marker for an androgen producing adrenal tumor in a woman?
What is the most specific lab finding in making the diagnosis of primary hyperaldosteronism?
High PAC:PRA ratio
What is the next step in the management of a patient with hyperprolactinemia NOT due to an obvious drug cause?
MRI of brain
(looking for pituitary adenoma)
What test allows you to distinguish acute from chronic lead exposure?
Acute exposure can be detected with a serum lead level
Serum FEP (Free Erythrocyte Protoporphyrin) detects chronic exposure over a 3 month period
What are the components of the Glasgow Coma Scale?
Break down of Eye opening scoring for the GCS
Spontaneous = 4
To voice = 3
To pain =2
None = 1
Break down of Verbal Response scoring for the GCS
Oriented = 5
Inappropriate words = 3
Incomprehensible = 2
None = 1
Break down of Motor Response scoring for the GCS
Obeys commands = 6
Localizes pain = 5
Withdraws from pain = 4
Flexion with pain =3
Extension with pain = 2
None = 1
Associated with Increased Intracranial Pressure
Cerebral damage at the point of insult (on the same side of the head)
Cerebral damage on the opposite side of the injury to the head
What radiographic study is used to diagnose injury to the urea?
What are the symptoms of a basilar skull fracture?
Chest trauma + hypotension + JVD + distant heart sounds - what is the next step in the management of this patient?
Dx: Cardiac tamponade
Chest trauma + hypotension + JVD + respiratory distress -> next step?
Dx: Tension pneumo
Tx: needle decompression
What is the next step in the evaluation of penetrating injuries to the different zones of the neck?
Zone 1 and 3 = CTA
Zone 2 = surgery
What interventions are effective in the management of elevated intracranial pressure?
Elevate head to 30 deg
Intubate - hyperventilate
Next step when: pelvic fracture + DPL shows blood in the pelvis
Next step when: pelvic fracture + DPL shows urine in the pelvis
Next step when: pelvic fracture + DPL shows nothing + hemodynamic instability
Angiography with possible embolization
Next step when: blunt abdominal trauma + unstable vital signs + FAST shows fluid in pelvis
Next step when: blunt abdominal trauma + unstable vital signs + FAST shows no fluid in pelvis
Angiography with embolization
Next step when: blunt abdominal trauma + unstable vital signs + FAST inconclusive
Next step when: blunt abdominal trauma + stable vital signs
CT abdomen and pelvis
Next step when: abdominal stab would + hypotensive or signs of peritonitis
What can be used as a renal protectant in patients with renal insufficiency who are expected to receive intraoperative contrast?
What are the 5 W's of Postoperative fever?
Walking (DVT, PE)
Wound (wound infection)
Wonder drug (medications)
What cause of postop fever occurs after the 3rd day?
What cause of postop fever occurs between 3-5 days?
What cause of postop fever occurs between 5-8 days?
Sudden onset of severe abdominal pain (periumbilical) that is out of proportion to the exam
Acute mesenteric ischemia
What is the usual time frame for stopping warfarin prior to surgery?
3-4 days before surgery
Vasopressor: theoretically causes renal vasodilation
Vasopressor: High doses optimize the alpha-1 vasconstriction
Vasopressor: ADH analogue
Vasopressor: Best choice for anaphylactic shock
Vasopressor: Best choice for septic shock
Vasopressor: Best choice for cardiogenic shock
Vasopressor: Causes vasoconstriction but with bradycardia
What type of immunodeficiency increases the risk of anaphylactic transfusion reaction?
Which blood product should you give: severe anemia due to autoimmune hemolytic anemia
Which blood product should you give: Hemophilia
Which blood product should you give: DIC
FFP +/- platelets
Which blood product should you give: Shock due to trauma or postpartum hemorrhage
whole blood (PRBCs)
Which blood product should you give: To maintain blood pressure during large volume paracentesis
Which blood product should you give: Hemorrhage due to warfarin overdose
Which blood product should you give: Need for vWF rich blood product
Which blood product should you give: Thrombocytopenia
What are the preferred vessels in the placement of a swan-ganz catheter?
When is the greatest risk for a postop MI?
Within 48 hours
What region of the brain is supplied by the anterior cerebral artery (ACA)?
Medial and Superior Surfaces
What region of the brain is supplied by the middle cerebral artery (MCA)?
What region of the brain is supplied by the posterior cerebral artery (PCA)?
What region of the brain is supplied by the basilar artery?
What region of the brain is supplied by the AICA?
Parts of the cerebellum
What region of the brain is supplied by the PICA?
Parts of the cerebellum
Occlusion of PICA
Loss of pain and temp over contralateral body
Loss of pain and temp over ipsilateral face
Cerebellar defects (ataxia, past pointing)
Reaction in children with viral infection who are given aspirin
It is a hepatoencephalitis
Lab values for bacterial meningitis
Increased WBCs (Polymorphonuclear cells)
Lab values for Fungal /TB meningitis
Increased WBCs (Lymphocytes)
Lab values for Viral meningitis
Increased WBCs (Lymphocytes)
Increased pressure (not as high though)
When should you get a CT before performing a lumbar puncture?
Focal neurologic defects
Suspect brain tumor
Round eosinophilic inclusions in neurons
Associated with Rabies
Treatment for rabies
Rabies Immunoglobulin AND Rabies vaccine
Most likely cause of headache: Made worse by foods containing tyramine
Most likely cause of headache: Obese female with papilledema
Most likely cause of headache: Jaw muscle pain when chewing
Most likely cause of headache: Periorbital pain with ptosis and miosis
Most likely cause of headache: Photophobia and phono phobia
Most likely cause of headache: bilateral frontal/occipital pressure
Most likely cause of headache: Lacrimation and/or rhinorrhea
Most likely cause of headache: Elevated ESR
Most likely cause of headache: "Worst headache of my life"
Most likely cause of headache: Headache + extra ocular muscle palsies
Cavernous sinus thrombosis
Most likely cause of headache: scintillating scotomas prior to headache
Most likely cause of headache: headache occurring either before or after an orgasm
Most likely cause of headache: responsive to 100% oxygen supplementation
Most likely cause of headache: trauma to head -> headache begins days after the event, persists over a week and does not go away
Pharmacological treatment for pseudotumor cerebra?
Spinal cord lesion: Fasciculations but also spastic paralysis
Spinal cord lesion: Impaired proprioception + pupils do not react to light
Tabes dorsalis and Argyll roberston pupils
Spinal cord lesion: Bilateral loss of pain and temp below the lesion + hand weakness
Spinal cord lesion: Bilateral loss vibration sense + spastic paralysis of legs then arms
Vitamin B12 deficiency
Spinal cord lesion: Bilateral loss of pain/temp below lesion + bilateral spastic paralysis below lesion + bilateral flaccid paralysis at the level of the lesion
Occlusion of anterior spinal artery
Most likely cause of headache in a 40 year old woman with frontal headache that is made worse by bending over?
What would be the preferred antihypertensive in a patient with chronic hypertension and recurrent migraines?
Beta blocker: propranolol or metoprolol
Ca Channel Blocker
What medication should be given to close contacts of those with either meningococcal of HiB meningitis?
Rifampin or Ciprofloxacin
What are the four most common sequelae of meningitis in children?
1. Hear loss
2. Long term seizure disorder
3. Mental retardation
4. Spastic paralysis
What is the treatment for fungal meningitis?
Intrathecal amphotericin B
What cerebral artery infarct can cause aphasia?
Middle cerebral artery
Organism for bacterial meningitis: gram positive diplococci
Organism for bacterial meningitis: gram negative diplococci
Organism for bacterial meningitis: small pleomorphic gram negative coccobacilli
Organism for bacterial meningitis: gram positive rods and coccobacilli
Brief unilateral blindness
Associated with TIA
Convex hyperdensity compressing the brain that may appear to cross the midline
Concave hyperdensity compressing the brain that does NOT cross the midline
Weakness of the face, arm, and leg on one side of the body + ABSENT sensory or cortical signs
Pure motor hemiparesis
(MOST common lacunar stroke)
Sensory defect (numbness) of the face, arm, and leg on one side of the body + ABSENT motor or cortical signs
Pure Sensory Stroke
Ipsilateral weakness and limb ataxia out of proportion to the motor defect, possible gait deviation to the affected side + ABSENT cortical signs
Weakness AND numbness of the face, arm, and leg on one side of the body + absent cortical signs
Sensory Motor Stroke
Facial weakness, dysarthria, dysphagia, and slight weakness and clumsiness of one hand + ABSENT sensory or cortical signs
Dysarthria-Clumsy Hand Syndrome
Which seizure medication causes gingival hyperplasia?
What is the drug of choice for absence seizures?
What is the second drug of choice for absence seizures?
What is the drug of choice for trigeminal neuralgia?
Treatment for status epilepticus
IV benzos to stop seizure activity
Phenytoin to prevent recurrence
How long must a focal neurologic deficit last to qualify as a stroke?
> 24 hours
In what timeframe must thrombolytic therapy be instituted in cases of ischemic stroke?
Within 3 hours of onset
What is the treatment for an epidural hematoma or subdural hematoma?
Most common predisposing condition for an intracranial hemorrhage?
What is the principle cause of a lacunar infarct?
CT scan of the head shows a crescent shaped lesion. What event most likely caused this lesion?
Rupture of bridging veins
What is the preferred treatment for febrile seizures?
Acetominophen or Ibuprofen
A patient with a DVT develops a stroke. What study would most likely identify the underlying etiology of the stroke?
An aphastic patient has great trouble producing words but understands everything you say. What type of aphasia does he most likely have?
Although benzodiazepines are used to end a seizure in status epileptics, what is of more concern in the initial treatment?
Eosinophilic cytoplasmic inclusions in neurons
Associated with Parkinsons disease
SMART of parkinson's disease
What causes the slowing of nerve conduction velocity?
What causes fasciculations and fibrillations at rest on EMG?
What causes a silent EMG at rest (no muscle activity) and a decrease in the amplitude of muscle contraction on stimulation?
Intrinsic muscle disease
Fixed oscillation of hands or head
Benign essential tremor
Rapid flinching distal limb and facial movements
Writhing snakelike movement in extremities
Sustained proximal limb and trunk contractions
Flinging of proximal extremities
Repetitive brief involuntary movement (blinking, grimacing) or sound (grunting, sniffing, throat clearing)
What are the 3 most common primary CNS tumors in adults?
What are the 3 most common primary CNS tumors in children?
Obesity hypoventilation syndrome characterized by:
Sudden loss of muscle tone
*Diagnostic of narcolepsy
What is the treatment for narcolepsy?
Lung cancer accompanied by muscle weakness is indicative of what?
Lambert Eaton Syndrome
(small cell lung cancer)
A 66 year old woman with forgetfulness and decreased bilateral parietal lobe activity on PET scan has what form of dementia?
What is the most sensitive test for multiple sclerosis?
MRI of head and orbits
What medication decreases the frequency of relapses in patients with MS?
Interferon beta or Glatiramer
A 35 year old woman presents with ptosis and diplopia that worsens throughout the day. What is the underlying problem?
What is the mechanism of action of the preferred medication in the treatment of restless leg syndrome?
What EEG waveforms are seen in Stage 1 of sleep?
What EEG waveforms are seen in Stage 2 of sleep?
Sleep spindles and K complexes
What EEG waveforms are seen in Stage 3 and 4 of sleep?
(low frequency, high amplitude)
What EEG waveforms are seen in REM sleep?
(high frequency, low amplitude)
What test is used to confirm the most common cause of syncope?
Tilt table test
(most common cause is vasovagal)
Coma + large, nonreactive pupils
Damage below midbrain (CN III involvement), possible uncial herniation
Coma + Small, reactive pupils
Thalamic, involvement, transtentorial herniation
Coma + pinpoint pupils
Opioid overdose, toxic effect
Elbows flexed, legs extended
Cortical or thalamic compression
Elbows extended, legs extended
Accommodation to near objects, but pupils nonreactive to light
Argyll Robertson Pupil
*Cause: syphilis, SLE, DM
Light in affected pupil causes minimal bilateral constriction; light in normal pupil causes normal bilateral constriction
Marcus Gunn pupil
*Cause: afferent nerve injury
Minimally reactive dilated pupil
*Causes: abnormal innervation of iris
With lateral gaze, there is absent contralateral eye adduction
*Causes: Intracranial lesion, MS
Refracting power of eye is too great
(causing image focal point to be anterior to retina)
Refracting power of eye is insufficient
(causing image focal point to be posterior to retina)
Asymmetric cornea surface
(causing inconsistent refraction of light)
Deviation of eye unable to overcome by normal motor control
(the gaze for each eye is in different directions -> double vision and progressive blindness)
Developmental defect in neuronal pathways of eye
Inflammation of internal Meibomian sebaceous glands (eyelid swelling)
Infection of external sebaceous glands of Zeiss or Mol (tender, red swelling at the lid margin)
Infection of eyelids and lashes secondary to seborrhea
(red, swollen lid margins + dandruff on lashes)
A 10 year old boy develops worsening arm and leg weakness over a period of 3 days that has now worsened to include symmetric facial muscle weakness. DTR are absent, and sensation is intact. What is the diagnosis?
What would be the visual defect for a lesion of the optic tract?
What is the pattern of vision loss in glaucoma vs macular degeneration?
Glaucoma = peripherally to center
Macular degeneration = center to periphery
What is the differential diagnosis for dislocation of the lens of the eye?
What is the treatment for closed angle glaucoma?
The patients subjective emotional state
The way a patient expresses his or her state of mood
Patients awareness of any problems and their effect on daily life
Patient's response to a given situation
Loss of interest in previously pleasurable activity
Diagnostic features of major depressive disorder
SIG E CAPS (5 /8 for > 2 weeks)
Sleep disturbances (insomnia)
Guilt (feelings of worthlessness)
Energy reduction (fatigue)
Depression on more days than not for > 2 years with NO history of major depressive episodes
Diagnostic features of Dysthymic disorder
Depressed Mood + 2 or more
Feelings of hopelessness
Change in sleep patterns
Change in appetite
Inability to concentrate
Low self esteem
NT changes: Anxiety disorders
NT changes: Depression
NT changes: Mania
NT changes: Alzheimers
NT changes: Huntington's
NT changes: Schizophrenia
NT changes: Parkinson's
What medical conditions can cause severe depression?
What scale is used to determine a patient's risk for suicide?
Age: <19 or >45
Rational thought process
What medications work well for atypical depression
MAOI's work better than TCAs
What is the first line therapy for seasonal affective disorder?
Characteristics of Manic Episodes
Grandiosity (feelings of)
Flight of Ideas
Activity (increased in goal oriented)
*Manic > 1 week, hypomanic > 4 days
Rapid cycling of hypomania and mild depression lasting > 2 years without a period of normal mood > 2 months
Treatment of panic disorder
SSRIs and SNRIs for long term therapy
Benzos to break attacks once they have started
Personality disorder with odd thought and behaviors
Symptoms + dysfunction > 6 months
Presence of mood disorder and psychotic symptoms
Presence of psychotic symptoms during normal mood for > 2 weeks
Personality disorder with voluntary social isolation
Symptoms similar to schizophrenia but last > 1 month and < 6 months
Brief psychotic disorder
Psychosis < 1 month
A patient previously diagnosed with schizophrenia arrives at the Psych ED with a severe neck spasm that forces his head to be maintained in an unusual position. What is the treatment?
Dx: Acute dystonia (torticollis) due to antipsychotics
REALISTIC delusions lasting > 1 month
*UNrealistic delusions are classified as schizophreniform disorder or schizophrenia
What is the drug category of choice for the treatment of the negative symptoms of schizophrenia?
What is the drug of choice in the treatment for bipolar disorder in a patient with renal failure?
Vaproic acid or carbamazepine
What is the treatment of choice for OCD?
A patient on haloperidol develops fever, muscle rigidity, confusion, and diaphoresis. What is the drug of choice in the treatment of this patients condition?
(patient has neuroleptic malignant syndrome)
What is the most problematic congenital malformation associated with maternal lithium use?
What is the most common side effect of olanzapine?
Which antidepressant: SE of priapism
Which antidepressant: Lowers the seizure threshold and can be used for smoking cessation
Which antidepressant: appetite stimulant that is likely to result in weight gian
Which antidepressant: works well with SSRIs and increases REM sleep
Which antidepressant: Can be used for bedwetting in children
What is the treatment of choice of mania with psychosis?
(2nd line is haloperidol)
Personality Disorder: Excessive need to be taken care of, submissive and clinging behavior, low self confidence, fears of separation and losing support
Personality Disorder: Grandiosity, feels he is entitled to things, lacks empathy
Personality Disorder: Suicide attempts, unstable mood and behavior, sense of emptiness and loneliness, impulsiveness
Personality Disorder: Distrustful, suspicious, litigious
Personality Disorder: Lifelong voluntary social withdrawal, no psychosis, emotional expression is limited (restricted range of affect)
Personality Disorder: Feelings of inadequacy, hypersensitive to rejection or criticism, socially inhibited, shy
Personality Disorder: Constant mood of unhappiness and pessimism
Personality Disorder: Odd appearance, thoughts, and behaviors; no psychosis, social awkwardness
Personality Disorder: Controlling, perfectionistic, orderly, stubborn, indecisive
Personality Disorder: Criminality, unable to conform to social norms, disregard for others rights
Personality Disorder: Excessively dramatic, emotional and extroverted; sexually provocative behavior; unable to maintain intimate relationships
What defense mechanism is used in paranoid personality disorder?
What defense mechanism is used in borderline personality disorder?
(all good or all bad)
What defense mechanism is used in histrionic personality disorder?
What defense mechanism is used in obsessive compulsive personality disorder?
How do you screen for drug/alcohol abuse?
desire to CUT down on usage
ANNOYANCE over others suggestions to stop usage
GUILT over usage
EYE OPENER (drug use on waking)
Which substance: Post constipation and/or respiratory depression
Which substance: Severe depression, headache, fatigue, insomnia/hypersonmia, hunger
Cocaine or Amphetamine withdrawal
Which substance: pinpoint pupils, N/V, seizures
Which substance: belligerence, impulsiveness, nystagmus, homicidal ideations, psychosis
Which substance: headache, anxiety/depression, weight gain
Nicotine and Caffeine withdrawal
Which substance: Anxiety/depression, delusions, hallucinations, flashbacks
Which substance: Euphoria, social withdrawal, impaired judgement, hallucinations
Which substance: Rebound anxiety, tremors, seizures, life-threatening
Aclohol, benzos, barbs withdrawal
Which substance: anxiety, piloerection, yawning, fever, rhinorrhea, nausea, diarrhea
Hypophosphatemia, cardiovascular collapse, rhabdomyolysis, confusion and seizures
Results from sudden shift from fat to carbohydrate metabolism in severe anorexics who resume eating
Multiple recurrent physical symptoms that are unintentional and cannot be explained by any medical condition
Development of sensory or motor deficits following stress without associated medical conditions or intention
Vocal tics of repeated obscenities
What features are unique to PCP intoxication that allow you to distinguish it from LSD intoxication?
Vertical and horizontal nystagmus
A 19 year old slender female presenting with recent weight loss is found to have erythema of her turbinates and nasal septum. What is the cause of her weight loss?
What is the downside of adding bupropion to nicotine replacement in a patient trying to quit smoking?
Increase risk of severe HTN
Childhood psychiatric disorder: females only; loss of previously acquired purposeful hand skills between 6 - 30 months
Childhood psychiatric disorder: impairments in social interactions, communications, play; repetitive behaviors
Childhood psychiatric disorder: impairment in social interaction, NO language delay
Childhood psychiatric disorder: Stereotyped hand movements (midline hand wringing)
Childhood psychiatric disorder: characterized by hostility, annoyance, vindictiveness, disobedience, and resentfullness
Childhood psychiatric disorder: multiple motor and vocal tics
Childhood psychiatric disorder: impulsive and inattentive
Childhood psychiatric disorder: 7 year old that avoids going to school to stay home with parent
Separation anxiety disorder
Somatoform Disorder: unexplained pain
Somatoform Disorder: Patient with normal anatomy is convinced a part of their anatomy is abnormal
Body dysmorphic disorder
Somatoform Disorder: unexplained loss of sensory or motor function; normal exam/tests
Somatoform Disorder: unwavering complaints in multiple organ systems
Somatoform Disorder: false belief of being pregnant
Prospective comparison of experimental treatment with placebo controls and existing therapies
Randomized Clinical Trial
Examines a group of subjects exposed to a given situation or factor
(can be prospective or retrospective)
Retrospective comparison of patients with a disease with healthy controls; frequency of certain exposures in both groups in considered
Case control study
Survey of large number of people at one time to assess exposure and disease prevalence
Cross sectional survey
Report of characteristics of a disease by examining multiple cases
Pooling of multiple studies examining a given disease or exposure
Which type of study is related to relative risk?
Which type of study is related to Odds ratio?
Case control study
Type of bias: nonrandom assignment of subjects to study groups
Type of bias: subjective interpretation of data by investigator deviates toward "desired" conclusions
Type of bias: screening test provides earlier diagnosis in studied group compared with controls but has no effect on time of survival
Type of bias: screening test detects several slowly progressive cases of a disease and misses rapidly progressive cases
Type of bias: subjects may respond to subjective questions in a different way than normal because awareness of the study changes their perception of the examined issue
Type of bias: studies that show a difference between groups are more likely to be published than studies that do not show a difference
Type of bias: errors of memory within subjects because of prior confounding experiences
Type of bias: patients with a certain medical history may be more likely to participate in a study related to their condition
The number of new cases that occur at a given time within a population
Number of individuals with a certain condition at a given time
Percentage of people with a given disease who die within a certain amount of time
Case fatality rate
What is relative risk?
Risk of disease in people exposed to a given factor
A/(A + B)
C/(C + D)
What is odds ratio?
Odds of exposure among patients with a disease compared with odds of exposure among patients without a disease
What is attributable risk?
Difference in rates of disease between exposed and unexposed populations
Probability that a screening test will be positive in patients with a disease
Probability that a test will be negative in patients without the disease
Probability that a patient with a positive test has the disease
Positive predictive value
Probability that a patient with a negative test does not have a disease
Negative predictive value
What are the 4 elements of a malpractice claim?
Duty of care
Breech of duty
What are the 2 ways that the standard of care can be established in a malpractice case?
1. Expert testimony
2. Re Ipsa Loquitor (thing speaks for itself)
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