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COMLEX Level 2 One Liners
Terms in this set (507)
Zenker's Diverticulum: Si/Sx? Dx? Tx?
Si/Sx: Dysphagia, Halitosis, Regurgitation of
Undigested Food, Throat Clearing, Neck Mass
Dx: Barium Swallow
Tx: Myotomy of Cricopharyngeus +/- Diverticulectomy
Cervical Cancer Screening
- Pap smears start at age 21
- Age 21-30: Pap q3Y
- Age 30 - 69: Pap q3Y OR Pap + HPV test q5Y
- Age 70: DC if 3 consecutive (-) and no abnormal paps in last 10 years
Breast Cancer Screening
Mammography q2Y starting at age 50 (USPSTF) or 40 (ACOG)
- GC and CHL for all sexually active non-pregnant women 24 y/o and younger
- HIV for all individuals 15-65 y/o
Colorectal Cancer Screening
- Start at 50
- FOBTx3 q1Y OR Sigmoidoscopy q5Y OR Colonoscopy q10Y
- Previous polyp: q3Y until clear, then q5Y
- Previous colon ca: 1Y after resection, then 3Y, then 5Y
- FH in single family member: 10 years earlier than age of dx or age 40
- HNPCC: start at 25, q1-2Y
- FAP: start at 12, q1Y
Men ages 65-75 who have ever smoked should undergo a one-time abdominal U/S
Guidelines for Pneumovax
All persons aged 65 y/o and older should receive a one time pneumococcal vaccination
Booster is recommended if the pt received the vaccine >=5 years previously and was age <65y/o at time of vaccination
*One time dose for Diabetic patients at time of diagnosis
- Influenza annually for all people over 6 mos
- TDaP once after 11 y/o, Td booster q 10 yrs
- VZV at 60 y/o
Mgmt of pt with FAP
Total Colectomy (100% risk of developing colonic adenocarcinoma)
COMQUEST tool for Visceral Innervation
1. Locate and Palpate TP
2. Place pt in position of optimal comfort (SHORTEN the muscle)
3. Fine tune until 70% tenderness reduction
4. Maintain position for 90 seconds
5. Slowly return to neutral
6. Recheck TP (no more than 30% tenderness should remain)
Phases of Clinical Trails
- I: Testing on a small number of healthy volunteers to determine SE, metabolism, excretion etc
- II: Testing on a small number of pts suffering from the disease to be treated
- III: Large scale trial to test against placebo
- IV: After release; surveillance
RUQ pain, jaundice, ascites...Dx? Initial test? Diagnostic test?
Budd-Chiari Syndrome: thrombosis of hepatic vein or IVC
- DX: initially Ultrasound, Venography to confirm
- TX: Thrombolytics
Most common cause of Post-Partum Fever?
Endometritis (will also have uterine tenderness)
- TX: broad spectrum abx
Contraindications for breast feeding
- Mothers with HIV, untreated TB, HSV lesions on breast, chemo, radioactive isotope administration
- Infants with galactosemia
- *Soy based formula instead
Supplementation for exclusively breast-fed infants
- Vitamin D: 400 IU daily soon after birth
- Iron: 1 mg/lg oral starting at 4 months
Woman is exclusively breast feeding, present with pain in breast...shiny skin of nipple with peeling at the areola...likely organism?
Woman presents with straw colored discharge from nipple...likely dx?
Mgmt of Lobular Carcinoma In Situ
Mgmt of Ductal Carcinoma In Situ
Excision with post op Radiation
Mgmt of Invasive Lobular/Ductal Ca.
Lumpectomy + Sentinal LN Bx + post op Radiation
Procedures requiring IE PPX
- Respiratory tract
- Major dental work
- Infected skin, tissues just under skin, musculoskeletal tissue
Who gets IE PPX?
- Artificial heart valve or heart valve repaired with articificial material
- History of endocarditis
- Heart transplant with abnormal heart fx
- Unrepaired cyanotic congenital heart dz
Thrust of Rib HVLA
For Inhaled Ribs: directly downwards
For Exhaled Ribs: 45 degrees cephalad
How to Dx BPPV
How to Tx BPPV
Intussusception: Dx? Tx?
Dx: Ultrasound in non-classic presentations
Tx: Pneumatic Enema
Sx of Opioid withdrawal
Sx of Cocaine/Amphetamine withdrawal
Dysphoria, Excessive Sleep, Hunger
Sx of Alcohol withdrawal
What is the most appropriate initial test for Urolithiasis
What is the most sensitive and specific test for Urolithiasis
Non-contrast Helical CT
Causes of Transitional Cell Carcinoma
- Aniline Dyes
Initial diagnostic test for Boerhaave's Syndrome
CXR → pneumomediastinum
Tx for Boerhaave's Syndrome
Contained Perf: NPO, NG suction, IV fluids, IV abx
Free Perf: Surgery
3 Ps: Pancreatic, Parathyroid, Pituitary Tumors
1 M 2 Ps: Medullary Thyroid Ca, Pheochromocytoma, Parathyroid Tumors
2 Ms 1 P: Medullary Thyroid Ca, Pheochromocytoma, Marfanoid Habitus/Mucosal Neuromas
Pt presents with a thyroid nodule...
1. Order TSH
2. If normal/high → FNA
If low → Scintigraphy
3. Hypofunctional → Surgery
Female of reproductive age who has been using OCPs has a hepatic tumor. Likely dx?
- Benign, associated with OCPs, anabolic steroids, and glycogen storage dz
- Surgical resection if symptomatic
Female of reproductive age has a hepatic tumor with a central scar on imaging. Dx? Tx?
Focal Nodular Hyperplasia
NOT associated with OCPs
No further management required
Mgmt of hepatic angioma (cavernous hemangioma)?
Risk of rupture
<5cm: watch expectantly, follow with imaging
>5cm or symptomatic: surgical removal
Neonate develops conjunctivitis within the first 24 hours of life...
- Usually 2/2 Erythromycin drops
- Tx: Reassurance + saline flush
Neonate develops conjunctivitis at 2-5 days
- + Purulent dc
- Tx: IM ceftriaxone + Topical Erythromycin
Neonate develops conjunctivitis at 5-14 days
- + Mucopurulent dc and palpebral erythema
- Tx: Oral +/- Topical Erythromycin
Recommended weight gain for pregnant women?
>18.5 (underweight): 28-40 lbs
18.5-24.9 (normal): 25-35 lbs
25-29.9 (overweight): 15-25 lbs
30+ (obese): 11-20lbs
Pregnant pt presents at 30 weeks gestation with PAINLESS, vaginal bleeding...
Ultrasound to r/o Placenta Previa
Pregnant pt presents with vaginal bleeding BEFORE 20 weeks. Possible dx?
Inevitable, threatened, complete, missed abortion
Pregnant pt presents with vaginal bleeding AFTER 20 weeks. Possible dx?
Placenta Previa, Placental Abruption
Indications for C/S
Placenta Previa, Vasa Previa, Placenta Accreta, active or symptomatic Herpes lesions, maternal HIV with VL 1,000, irreversible fetal distress, malpresentation
Mgmt of Placenta Previa?
- If unstable/signs of fetal distress → C-section now
- If stable and before 36 weeks → conservative mgmt. and repeat US at 36 weeks to determine route of delivery
RhoGAM should be administered...
- To all Rh negative mothers at 28 weeks
- Again within 72 hours of delivery of an Rh+ baby to an Rh- mother
- To any Rh(-) pts who have had an ectopic pregnancy, bleeding during pregnancy, amnio, CVS, abortion
- **unless dad is also Rh negative!!
Mgmt of pregnant pt with Hyperthyroidism
- 1st Trim: PTU
- 2nd, 3rd Trim: Methimazole
Best diagnostic test for neonatal hematemesis?
Apt test → differentiates fetal/neonate blood from maternal blood
Neonate presents with jitteriness, tremors, irritability, grunting...likely dx?...Tx?
Dx: Neonatal Hypoglycemia (BG<40)
Tx: If asymptomatic, feed enterally and screen in 1 hour; symptomatic, IV D10W
Si/Sx and Mgmt of neonate with...Galactosemia?...PKU?...Homocystinuria?
Galactosemia: deficiency of galactosei-1-phosphate uridyl transferase enzyme
- Si/Sx: FTT, cataracts, liver dz
- Tx: Avoid dietary glucose
PKU: deficiency of phenylalanine hydroxylase
- Si/Sx: Mental retardation, "musty odor", hypopigmentation
- Tx: Avoid dietary phenylalanine; administer tetrahydrobiopterin
Homocystinuria: disorder of methionine metabolism
- Si/Sx: Tall stature, lens subluxation, mental retardation, osteoporosis, hypercoaguability
- Tx: Vit B6 replacement for life
Universal screening of newborns include...?
PKU and congenital hypothyroidism
Mgmt of umbilical hernia in a child?
Will usually close within 2-3 years
Up to 4 y/o: Observation
Beyond 4 y/o or Incarceration: Surgical Repair
Infant with hypospadias scheduled for circumcision...what should you do?
CANCEL the circumcision
Mgmt of cleft lip? ...cleft palate?
Cleft lip: Surgery <3mos
Cleft palate: Surgery >6mos +/- special nipple for feeding
Premature neonate presents with emesis, rectal bleeding and pneumatosis intestinalis on abdominal xray...Dx?...Tx?
Dx: Necrotizing enterocolitis
Tx: Bowel rest, abx, surgical c/s
(Pneumatosis intestinalis → gas bubbles in the small bowel wall)
Neonate (5 days old) presents with bilious vomiting, blood per rectum, abdominal pain...likely dx?
What is the "double bubble sign"?... "Bird's Beak"?
Double Bubble Sign: Duodenal obstruction
Bird's Beak: tapering, compression, torsion
Most common transfusion reaction
Non-hemolytic febrile reaction
- Reaction to donor WBCs
- Mild fever, chills, dyspnea
How to prevent TRALI
Transfuse leukocyte washed RBCs (plasma/surfactant removed)
Low-dose vs. High-dose Dexamethasone suppression test
- Determines presence of ectopic source of cortisol
- Should decrease cortisol in normal person (negative feedback)
- Determines location of extra hormone
- Pituitary tumor will be suppressed
- Adrenal tumor or SSLC will not be suppressed
Most common cause of Cushing's syndrome
Most common cause of Cushing's disease
ACTH secreting pituitary adenoma
Pt presents with acute, painless monocular vision loss. Fundoscopic exam reveals pale retina with cherry red macula. Where is the occlusion?
*Ciliary artery supplies macula
Pt presents with brief, painless monocular vision loss (no cherry red macula). Where is the occlusion?
This is amaurosis fugax
Cause of Early Decelerations
Fetal Head Compression
Cause of Late Decelerations
Cause of Variable Decelerations
Umbilical Cord Compression
Mgmt of DVT in setting of intracranial bleeding, severe active bleeding, malignant HTN or recent brain, eye, spinal cord surgery?
Initial test for suspected Osteomyelitis?
How is Dermatomyositis different from Polymyositis?
Presence of unique dermatological findings:
- Heliotrope rash
- Gottron's sign: scaly papules found over dorsum of PIP and MCP
- Shawl's sign: erythema over shoulders, neck, upper chest and back
How are Polymyositis and Dermatomyositis similar?
- Symmetrical proximal muscle weakness (UE>LE), sparing the face
- Elevated CK
- Associated with Anti-Jo-1 ab and ANA
Signs of TCA overdose
- Convulsions (anti-GABA effect)
- Coma (anti-histamine effect)
- Cardiac Conduction Irregularities (sodium channel blockade → QRS prolongation)
SE of TCA
- Blurred Vision
- Dry mouth
- Sedation and Urinary Stasis
Most common cause of Otitis Externa
S. aureu, P. aeuriginosa
Tx for Otitis Externa
Cleaning of ear
Topical acidic abx (e.g. ciprofloxacin)
Topical steroids (e.g. hydrocortisone otic)
Most common thyroid cancer
Papillary Thyroid Carcinoma
Most malignant thyroid cancer
Anaplastic Thyroid Carcinoma
Thyroid cancer associated with increased calcitonin
Medullary Thyroid Carcinoma
Thyroid cancer associated with psammoma bodies
Papillary Thyroid Carcinoma
Si/Sx of Acute Intermittent Porphyria
- Abdominal pain, vomiting, constipation, muscle weakness, psychological sx
- Increased urinary aminolevulinic acid and porphobilinogen
- NO rash
Workup for Pheochromocytoma
1. Urine metanephrine
2. CT/MRI of abdomen
3. Octreotide Scan
4. MIBG Scan
Pheochromocytoma 10% Rules
- 10% Bilateral
- 10% Extra-adrenal
- 10% Familial
- 10% Malignant
- 10% Recurrence
- 10% in Children
- Most are sporadic, benign, unilateral, adrenal in adults
Diagnostic test for Meckel's diverticulum
Technetium-99m pertechnetate scan
Meckel's diverticulum Rule of 2s
Remnant of vitelline (omphalomesentaric) duct...most commone cause of large volume painless bleeding in babies
Rule of 2s:
- Occurs in 2% of the population
- Only 2% are symptomatic
- Located 2 ft proximal to ileocecal valve
- 2 in long
- Contains 2 types of tissue (gastric, pancreatic)
- Syptoms manifest at 2 y/o
Treatment of choice for acute gout
What is the most appropriate time period and tests for follow up after starting a pt on Levothyroxine for hypothyroidism
TSH in 4-6 weeks
Workup for suspected SAH
1. CT scan WITHOUT contrast
2. If (-) but still high suspicion, Lumbar puncture (xanthrochromia)
Dx and Tx of Ascites
Dx: Diagnostic paracentesis, Ultrasound
Tx: Spironolactone and/or Furosemide
Initial test of choice for dx Acromegaly
Insulin-Like Growth Factor Level (bc does not fluctuate as much as GH)
Treatment of choice for Acromegaly
1. Transsphenoidal surgical resection
2. Octreotide (if not a surgical candidate)
- Low CO
- High PCWP
- High SVR
- Low CO
- Low PCWP
- Low SVR
- High CO
- Low PCWP
- Low SVR
- Low CO
- Low PCWP
- High SVR
Tx of Shock
- Large gauge peripheral IV access
- 1-2 L bolus of NS
Sensitivity vs. Specificity
In cohort studies,
RR = Risk of Exposed / Risk of Unexposed
[a/(a+b)] / [c/(c+d)]
AKA: "Odds Ratio" in case-control studies
Pain and swelling around the knee
Hard, non-mobile mass in prox. tibia/dist. femur
MFAT vs WP? What's the difference?
Multifocal Atrial Tachycardia
- 3+ different P waves in the same lead
- HR > 100
- 3+ different P waves in the same lead
- HR < 100
BP 80/50, P 155, RR 22, O2 sat 89%...Dx? Management?
1. Check ABC and administer O2
2. Stable vs. Unstable?
- Stable → Vagal Maneuvers → Adenosine
- Unstable → Sedation → Synchronized Cardioversion
Fat Emblism: Si/Sx? Dx? Tx?
- Think in Burn pts or Trauma pts c fractures of pelvis/long bones
- Si/Sx: Neuro dysfx, respiratory distress, petechial rash of axillae/chest/arms
- Dx: Clinical; Sudan stain shows lipid deposits
- Tx: Supportive; positive pressure ventilation, diuresis
Infant with non-bilious, projectile vomiting and "olive-shaped" mass in RUQ
- Pyloric Stenosis → functional gastric outlet obstruction 2/2 hypertrophy of pylorus
- Dx: Clinical, Ultrasound can confirm
- Tx: Surgical Repair
Rule of L5 motion relative to sacrum dysfx
Rotates OPPOSITE the sacrum
Sidebends TOWARD the oblique axis
- Patau's syndrome
- Cleft lip/palate, polydactyly, microcephaly, micropthalmia, micrognathia, close-set eyes, holoprosencephaly, rocker bottom feet
- Edward's Syndrome
- Microcephaly, micrognathia, clenched fists, prominent occiput, widely spaced eyes, rocker bottom feet
- CD4 < 200: TMP/SMX (PCP)
- CD4 < 100: TMP/SMX (Toxo)
- CD4 < 50: Azithromycin (MAC)
Mom is breastfeeding her infant and develops VZV infection on face. Mgmt?
- If neonate 1-2 days old, isolate the neonate and administer lyophilized purified human IG prep containing anti-varicella ab to baby
- If neonate is older than 2 days and there are no lesions on breast, continue breast feeding
Most common cause of wound infection within 24 hours of surgery
Group A Streptococci
Most common cause of wound infection 4-10 days after surgery
Causes of post-op fever?
- Wind (pneumonia)
- Water (UTI)
- Walk (DVT)
- Wound (wound infection)
- Wonder Drugs (drug rxn)
Post op fever after 48 hours think...? After 5 days...?
48 hours: Pneumonia, UTI, phlebitis
5 days: wound infection, deep surgical space infection
<3.5g of protein in the urine over 24 hours
Protein:creatinine ratio greater than 200 mg/mmol
- Type II hypersensitivity rxn
- Anti-GBM antibodies against Type IV Collegen
- Si/Sx: Lower Resp Tract (Hemoptysis) + Renal (Glomerulonephritis)
- Bx: Linear deposit of IG
- Small - med vessel vasculitis
- + c-ANCA (anti-proteinase3)
- Si/Sx: Upper/Lower Resp Tract (sinusitis, saddle nose) + Renal (Glomerulonephritis)
- Bx: Granulomas
Screening test, dx test, and tx for Renal Amyloidosis
- Screen: Abdominal Fat Pad bx
- Dx: Renal Bx with apple green birefringence with congo red staining
- Tx: prednisone and melphalan
Mgmt of suspected Rhabdomyolysis
- Vigorous IV fluids
- Alkalization of urine with sodium bicarbonate
- EKG to check for signs of hyperkalemia
Most sensitive test for Rhabdomyolysis
Common complications of Rhabdomyolysis
- Renal Failure/Hyperuricemia
- Compartment Syndrom
First line agent for HTN in non-diabetic pt
First line agent(s) for HTN in diabetic pt
ACE-I (or ARB) + CCB or Diuretic
Mgmt of pt presenting with Eclampsia
1. Airway management
2. IV magnesium sulfate
3. Betamethasone (if <34 weeks)
4. Delivery (c-section not required)
Antidote for Magnesium toxicity
Most common cause of inherited mental impairment/retardation
Fragile X Syndrome
Look for mental impairments, elongated face, large ears, macroorchidism
DEXA T-score for Osteopenia? Osteoporosis?
Osteopenia: -1 to -2.5
Osteoporosis: below -2.5
Pleural Effusion is likely EXUDATIVE if atleast ONE of the following exists:
1. Pleural Protein : Serum Protein > 0.5
2. Pleural LDH : Serum LDH > 0.6
3. Pleural LDH is > 2/3 the upper limits of normal for serum
For diagnosis of Rheumatic Fever (2 M OR 1M+2m)
- Joints (migratory polyarthritis)
- Nodules (subcutaneous, painless)
- Erythema marginatum
- Syndenham's chorea
- Elevated ESR or CRP
- EKG showing heart block
Mgmt of PCOS
1. OCP +/- Spironolactone
2. If OGTT abnormal, add Metformin
3. If desires to become pregnant, add Clomiphene
What is the most effective single medication for allergic rhinitis?
Pt has abdominal pain, weight loss, melena...where is the tumor?
Pt has abdominal pain, weight loss, hematochezia, narrow stools...where is the tumor?
Transverse or Left Colon
What is Placenta accreta? Major RF? Tx?
Abnormal attachment of placenta to the uterine wall.
RF: Placenta Previa, previous C-Section
Tx: Prior to delivery, scheduled C-Section + Hysterectomy; after delivery, embolization and/or hysterectomy
Mgmt of Scabies?
1. Permethrin 5% neck down in 2 sessions, 1 week apart
2. Decontaminate bedding/clothing/towels 3 days before treatment by washing in hot water and drying in hot dryer
Why is Lindane not used for Scabies
Higher association with neurotoxicity
Mechanism of renal damage in cirrhosis pt?
Cirrhosis → Portal HTN → Splanchnic Vasodilation → Dec. Effective Circulatory Volume → Activation of Renin-Angiotensin-Aldosterone System → Renal Vasoconstriction
Mechanism of NSAID induced renal injury?
NSAIDS decrease PGE2 → loss of vasodilation of afferent arterioles → dec. GFR
Symptoms of Major Depression
- SLEEP: insomnia, hyper-somnia
- INTERESTS: dec. interest/pleasure in activities
- GUILT: feelings of worthlessness
- ENERGY: fatigue
- CONCENTRATION: diminished ability to think or concentrate
- APPETITE: weight loss/gain
- PSYCHOMOTOR agitation
- SUICIDAL ideation
Dx: Depressed mood OR Anhedonia + 4 more sx for TWO WEEKS
Symptoms of Mania
- Flight of ideas
- Agitation/increased Activity
- Sexual risk-taking
- Talkative/pressured speech
BP I vs BP II vs Rapid-Cycling BP vs Cyclothymic
- BP I: full blown mania +/- depression
- BP II: MDD + hypomania
- RC BP: 4+ episodes of MDD, mania, hypomania or mixed in 12 mos
- Cyclothymic: alt. hypomania and mild depression for 2 years
Dx: Depressed mood + 2 more sx for TWO YEARS
Sx: hopelessness, difficulty concentrating, appetitie changes, low self esteem, fatigue, sleep changes
Mood reactivity + weight gain, hypersomnia, leaden paralysis, sensitivity to rejection (at least 2)
Sx of Median nerve injury?
- Weakness/paralysis of thumb opposition/pronation and finger flexion
- Sensory loss to palmar surface of thumb and dorsal and palmar surface of 2nd, 3rd, and lat. ½ of 4th finger
- Thenar eminence atrophy
Sx of Axillary nerve injury
- Flat shoulder
- Loss of arm abduction
Sx of Radial nerve injury
- Wrist drop
Nerve entrapment in Guyon's Canal. Si/Sx?
Ulnar Nerve Entrapment
- Decreased adduction/abduction of digits, extension of PIP of 5th digit, opposition of 5th digit
- Numbness of 5th digit and ulnar surface of 4th digit
- Claw hand
Tx of GIST
Imatinib (tyrosine kinase inhibitor) if + c-kit mutation
Drug for GIST (c-kit+) and CML (Philadelphia chromosome+)
Pt with breast/lung cancer presents with nausea, vomiting, confusion, fatigue, muscle weakness; labs show hypercalcemia...likely dx? Mgmt?
Dx: Hypercalcemic Crisis
Mgmt: IV Fluids (NS until euvolemia) → Diuresis (furosemide) → Calcitonin → Hemodialysis → Bisphosophonates (for chronic management)
Pt s/p total thyroidectomy presents with perioral numbness, tingling of fingers, muscle cramps...likely dx? Mgmt?
Dx: Hypocalcemia due to devascularization or inadvertent removal of parathyroid glands
- Mild, oral calcium carbonate
- Refractory, add calcitriol
- Life threatening, IV calcium gluconate
Presentation of RTA
Non-anion gap hyperchloremic metabolic acidosis
1. Hyperchloremic acidosis with normal anion gap + near normal GFR + no diarrhea → RTA
2. Look at potassium:
- If High → IV
- If Low → I or II, step 3
3. Look at urine pH
- If < 5.5 → II
- If > 5.5 → step 4
4. Look at bicarb
- If normal → I
- If decreased → II
5. Confirm dx:
- I: admin ammonium chloride, confirmed if urine pH does not drop below 5.5
- II: admin bicarb, confirmed if urine pH continuously rises
- IV: salt restrict diet, confirmed if urine sodium consistently high
Type I RTA
Distal tubular defect: dec. H+ secretion
- Urinary pH > 6.0
- Predisposition for nephrolithiasis
- Common causes: Sjogren's, SLE
- Tx: Sodium Bicarbonate
Type II RTA
Proximal tubule defect: dec. HCO3- resorption
- Low bicarb
- Common causes: Fanconi's syndrome, multiple myeloma, carbonic anhydrase inhibitor use
- Tx: Sodium restriction
Type IV RTA
- Common causes: diabetic nephropathy, interstitial nephritis
- Tx: loop or thiazide diuretic +/- sodium bicarbonate
Absolute indication for hemodialysis?
- Acidosis → Metabolic acidosis
- Electrolytes → Hyperkalemia
- Intoxications → Lithium, ASA, Methanol, Ethylene Glycol
- Overload → CHF
- Uremia → Uremic pericarditis
How to distinguish Anemia of Chronic Dz from Iron Deficiency?
ACD: TIBC low, ferritin normal/high
ID: TIBC high, ferritin low
What is a Marjolin's Ulcer
Malignant transformation (usually SCC) of a chronic wound most commonly due to a burn
What is a Marginal Ulcer
Ulcer in jejunum after gastrojejunostomy
What is a Curling's Ulcer
Duodenal ulcer that occurs acutely after a burn
What is a Cushing's Ulcer
Gastric/duodenal ulcer that is caused by elevated ICP
What is a Buruli Ulcer
Manifestation of Mycobacterium ulcerans
Tx for Stress Incontinence
Urethropexy and/or sling
Tx for Urge Incontinence
Anticholinergics (e.g. oxybutynin)
Triad of Hemolytic Uremic Syndrome
29. Acute renal failure
31. Microangiopathic hemolytic anemia
*In children after infection with E coli O157:H7
Pentad of Thrombitoc Thrombocytopenic Purpura
1. Acute renal failure
3. Microangiopathic hemolytic anemia
5. Neurological syndrome
*inhibition of ADAMTS13 (protease that cleaves vWF)
Mgmt of Testicular Mass
- PE, serum markers (bHCG, AFP), US to confirm mass
- If suspect cancer → Radical orchiectomy
Mgmt of Mastitis
- Continue breast feeding
- Initiate antibiotics
- Warm and cold compresses
Paget's Disease of the Breast
Pt c/o loss of consciousness when shaving or wearing tight collard shirt...Initial test? Likely dx?
- All syncope gets EKG first
- Likely Carotid Sinus Hypersensitivity
- Confirm with f/u carotid sinus massage
First line DOC for Type II DM?
Mgmt of Type II DM pt if Hgb A1c remains elevated despite metformin tx?
- Hgb A1c 7-8.5% → add sulfonylurea
- Hgb A1c >8.5% → add insulin
Major SE of Clozapine
Agranulocytosis - weekly WBC count indicated
*Never first line
A physician's duty to exercise reasonable care arises...
When the doctor dispenses medical treatment
Mirtazapine is what kind of drug? SE? Ideal to be used in what pt?
- Atypical Antidepressant - alpha -2 receptor antagonist that increase serotining and NE
- Sedation + Weight Gain (anti-histamine)
- Use in ANOREXIC pts with depression
Major adverse side effect of Buproprion
- Lowering seizure threshold
Uses for Buproprion
- Smoking Cessation
Buproprion is contraindicated in pts with
Antidepressent with lowest risk of sexual SE
Antidepressent that can also be used for diabetic neuropathy
Major adverse side effect of Trazadone
Treatment of choice for Endometriosis
- Hgb A1c 7-8.5% → add sulfonylurea
- Hgb A1c >8.5% → add insulin
Diagnostic test for Endometriosis
Positive Nikolsky sign
Stroking of the skin causes skin to separate
Child presents with "sandpaper" like rash, positive Nikolsky sign
Staphylococcal Scalded Skin Syndrome
Newborn infant develops significant respiratory distress and cyanosis immediately after birth; PE shows diminished breath sounds on left and scaphoid abdomen; orogastric tube is in left chest cavity. Dx? Tx?
Dx: Congenital Diaphragmatic Hernia
Tx: Gastric Decompression, Intubation, Surgical Correction
Treatment of Tension Pneumothorax
Thoracotomy: large bore needle in 2nd ICS at MCL
Characteristic rash of Lichen Planus
Wickham's Striae: fine "lace-like" white lines on papules
Most common sites: flexor surface of wrist, buccal mucosa, genitals
Wickham Striae! Think Lichen Planus
Pt diagnosed with IE caused by S. bovis - what additional test should also be done?
*S. bovis associated with IE and colorectal cancer!
Most common location for Crohn's dz?
Features of Crohn's dz
- Can occur anywhere from mouth to anus
- Cobblestone mucosa
- Skip lesions/non-continuous involvement
- Creeping fat
- Non-caseating granulomas
Features of UC
- Involves rectum
- Continuous involvement
- Crypt abcesses
- *Associated with malignancy (cholangiocarcinoma, colon cancer, sclerosing cholangitis)
Tx of UC
5ASA /mesalamine or sulfasalazine
First line tx of non-severe Psoriasis
Treatment of choice for severe Psoriasis
UVB light radiation
Pt presents with "pure" psychosis (i.e. no mood disorder for 1 day - 1 month...1 month to 6 months...longer than 6 months...Dx?
- Brief psychotic disorder: < 1 month
- Schizophreniform disorder: 1-6 months
- Schozophrenia: > 6 months
Mgmt for pt presenting with unilateral and/or guiac positive nipple discharge? Likely Dx?
Surgical removal of involved duct for diagnosis and treatment
Likely dx: Intraductal Papilloma
Pt presents with enlarged cervical/supraclavicular lymph node that becomes painful with alcohol consumption
Histological characteristic of HL?
Histological characteristic of CLL?
Ann Arbor staging for HL
I: 1 LN
II: 2+ LN on SAME side of diaphragm
III: both sides of diaphragm, including 1 organ/area near the LN or spleen
IV: involvement of extralymphatic tissue (liver, BM, lungs)
Tx of HL?
Mgmt of pt with CO poisoning
- Supplemental high-flow O2 via nonrebreather
- Hyperbaric O2 for select pts
[Hypothalamus] GnRH → [Anterior Pituitary] FSH/LH
FSH → [Granulosa Cells] Aromatase → Androstenedione to Estrogen → Proliferation of Endometrium
LH → [Theca Cells] Desmolase → Cholesterol to Androstenedione
→ [Corpus Luteum] Progesterone
Female with h/o salpingitis has sausage-shaped, cystic leasion between ovary and fallopian tube on U/S...likely Dx? Likely complication?
Newborn is non-cyanotic, has a holosystolic murmur with a thrill best heard over 4th left ICS...Dx?
Newborn is non-cyanotic, has a systolic pulmonary flow murmur and diastolic rumble...fixed split S2...Dx?
Mgmt of pt with primary spontaneous pneumothorax...
- Supplemental O2 and...
- If <15% of hemithorax OR <3cm apex-to-cupola distance: Observation with repeat CXR in 24 hours
- If large: Needle Aspiration → Chest Tube Placement
Most specific test for SLE
Anti-Smith or Anti DS-DNA
Most sensitive test for SLE
Most sensitive test for drug-induced SLE
Drugs that can cause SLE
Procainamide, Isoniazid, Hydralazine, Quinidine
Which TORCH infection has... periventricular calcifications on head CT?
What are the unique characteristics of the following TORCH infections:
- Toxo: chorioretinitis, ring-enhancing lesions
- Syphilis: rash on palms/soles, snuffles, Hutchinson teeth, saddle nose
- Rubella: PDA, cataracts, deafness, blueberry muffin rash
- CMV: Periventricular calcifications, chorioretinitis, hearing loss
- Herpes: (week 1) shock, DIC; (week 2) vesicular skin lesions; (week 3) encephalitis
First line treatement for sideroblastic anemia with ringed sideroblasts
- Pyridozine (B6)
- Removal of offending agent
Initial therapy for pt with dehydration
- Mild-Mod: Oral Rehydration
- Severe or if contraindications to oral rehydration, then IV fluids
Pt presents with multiple dome-shaped papules with central umbilication on penis and inner thighs...Dx? Tx?
Dx: Molluscum Contagiosum
Tx: None (self limiting) - liquid nitrogen/curettage may be used if bothered by them cosmetically
Indications for surgical repair of AAA
- Symptomatic aneurysms of any size
- >5.5 cm in diameter
35 y/o AA female presents with large, bulky, utering tumor that extends outwardly through the cervix...Dx?
Mgmt of leiomyomas
- GnRH agonists
- Hysterectomy vs. Myomectomy (depending on desire to have children)
What kind of fibroids will lead to infertility
How to secure airway in pt with multiple facial fractures?
Woman with h/o radioactive iodine ablation of thyroid for hyperthyroidism presents with white, cloudy discharge from nipple...Dx?
Hypothyroidism (→ inc. TRH → inc. TSH AND Prolactin release)
Mgmt of Meniere's Dz
- Low sodium diet
Tumor marker for Granulosa Cell Tumor
Pt presents with allergic rhinitis, asthma, blood eosinophilia, + PANCA (anti-myeloperoxidase)...Dx?
Churg-Strauss (allergic granulomatosis)
"Floppy baby" with hypotonia, weakness, with active eye movements...Dx?
Werdnig-Hoffman Disease (spinal muscular atrophy type 1) → defect in SMN1 gene
"Floppy baby" with hypotonia, weakness, with sluggish eye movements...Dx?
Infantile Botulism → ingestion of C. botulinum spores - prevents transmission of Ach across synapse
"Floppy baby" with retinal hemorrhages or subdural hematoma...Dx?
Shaking Baby Syndrome
Pt presents with tea-colored urine, oliguria, edema, HTN...UA shows hematuria and mild proteinuria...C3 levels normal...URI 2 days ago...likely dx?
Berger's Disease (IgA Nephropathy)
Pt presents with tea-colored urine, oliguria, edema, HTN...UA shows hematuria and mild proteinuria...C3 levels low...URI 10-14 days ago...likely dx?
Pt presents with abdominal pain, hematuria, and palpable purpura on buttocks...likely dx?
Newborn s/p prolonged labor presents with firm, non-pitting edema of the occiput that crosses suture lines...likely dx?
Newborn s/p prolonged labor presents with firm, non-pitting edema of the occiput that does NOT cross suture lines...likely dx?
- Blood beneath periosteum
Newborn s/p prolonged labor presents with boggy edema of the occiput ...likely dx?
- Blood beneath epicranial aponeurosis
Nephropathy associated with analgesics, sickle cell disease, diabetes, or urinary tract obstruction?...UA will show?...Imaging will show?
Renal Papillary Necrosis
UA: Necrotic tissue (sloughed tissue can cause obstruction)
CT or IVP: Hydronephrosis, anatomical defects
Which calculi are radiolucent (i.e. will not show up on Xray)?
Uric Acid and Cystine
Algorithm for dx primary Hyperaldosteronism
- HTN + Hypernatremia + Hypokalemia
- Plasma aldosterone : Plasma renin activity
- If >25 → sodium loading test
- If ald. Not suppressed below 10 → dx
- Abdominal CT → adenoma vs hyperplasia
Neonate present with ambiguous genitalia, hypoglycemia, hyponatremia, hyperkalemia...likely Dx? Dx test? Tx?
Dx: CAH (most likely 21-alpha hydroxylase deficiency)
Text: Elevated 17-hydroxyprogesterone
Tx: Right now, IV bolus of NS + Hydrocortisone (both glucocorticoid and mineralcorticoid activity); maintenance GC and MC therapy indefinitely
Sinusoidal heart rate on FHT monitor...dx?
Severe fetal anemia (e.g. Rh isoimmunization or severe hypoxia)
Asthma Severity Mgmt
Tx for Diabetic Gastroparesis
Metaclopromide or Erythromycin
Wtf is Prune Belly Syndrome?
Congenital disorder that affects primarily males
- Bulging, thin, wrinkled abdomen
- Renal dysplasia, dilated ureters, enlarged bladder
- Pulmonary hypoplasia
- Cardiac/GI abdnormalities
- Acute hypoxemia
- PaO2/FiO2 <200
- B/L diffuse infiltrates
- Exclusion of cardiogenic pulmonary edema (r/o using BNP, echo, PCWP*)
Young, non-smoker presents with si/sx of COPD...FH of emphysema and liver failure...dx?
Pt presents with bruises/epistaxis/menorrhagia...normal PT, prolonged PTT, prolonged bleeding time, normal platelet count...Dx? Tx?
Dx: Von Willebrand Disease (vWF responsible for primary hemostasis by binding platelets/endothelium, also is a carrier for Factor VIII)
Pt presents with flushing, diarrhea, wheezing, heart murmur, abdominal pain...Dx? Tx?
Dx: Carcinoid Tumor
- Serotonin → diarrhea, cardiac damage
- Histamine → flushing, pruritis, wheezing
- Kallikrein → flushing
Tx: Surgical resection; Octreotide
Pt presents with abdominal pain and watery diarrhea after two-week course of clindamycin...Dx? Most rapid test? Diagnostic test? Tx?
Dx: C. difficile colitis
Most rapid test: Proctoscopy
Most accurate test: C. diff toxin ELISA Assay
Most common cause of meningitis in adults
Most common cause of meningitis in neonates
Most common cause of meningitis in immunocompromised or elderly
Most common cause of meningitis in AIDS with CD4 <100
Most common cause of meningitis in pt with concurrent pulmonary TB
Pt presents with signs of meningitis + petechial (pinpoint, nonblanching) rash
Pt present with signs of meningitis + target like rash
Lyme disease (Borrelia)
Pt presents with signs of meningtis + centripitally spreading petechial rash
Rocky Mountain Spotted Fever (Rickettsia)
TOC for meningitis for bacterial meningitis
Ceftriaxone + Vancomycin + Steroids (+ Ampicillin if elderly/immunocompromised)
Refinement of treatment for N. meningitidis
Ceftriaxone + Vancomycin + Rifampin OR Ciprofloxacin to close contacts
(*steroids do not reduce morality...however they are useful in S. pneumo and HIB)
Pt presents with pleuritic chest pain relieved by leaning forward...currently taking procainamide for atrial flutter...likely dx? ECG findings? Tx?
Dx: Procainamide-induced lupus pericarditis
EKG: diffuse ST elevations, PR depressions
Tx: NSAIDs + remove offending agent
Alcoholic presents with ataxia, confusion, horizontal nystagmus/double vision...Dx? Tx?
Dx: Wernicke's encephalopathy
Remember triad ACE (ataxia, confusion, eye problems)
Test to differentiate Folate vs. B12 deficiency
- Elevated: B12
- Normal: Folate
*remember that B12 will have neurological complaints (posterior columns - DProV)
*Both will have megaloblastic anemia and elevated homocysteine
What do you need to for B12 absorption?
- Parietal Cells → Intrinsic Factor
- Terminal Ileum
- Functioning pancreas
- Liver for storage
Brain lesion in Korsakoff's psychosis
Remember amnesia, confabulation
Mgmt of Hepatic encaphalopathy
Lactulose + Neomycin + Transplantation
TOC of actively bleeding esophageal varices?
Endoscopic sclerotheray or IV somatostatin/octreotide
TOC to prevent esophageal varices from bleeding?
What is a Klatskin tumor?
Cholangiocarcinoma occuring at the confluence of the hepatic ducts
What is a Krukenberg tumor?
Malignancy in the Ovary that has metastisized from a primary site (usually GI)
Pregnancy screening for Down's syndrome
- At 15-20 weeks
- Triple screen (AFP, hCG, estriol)
- Quad screen for high risk (AFP, hCG, estriol, inhibin A)
- If +, offer genetic testing (amniocentesis)
Drugs that exacerbate MG
- Beta blockers
TOC for Trigeminal Neuralgia
Complications of sleep apnea
- Pulmonary HTN
- Systemic HTN
What is Beck's Triad
- Distant heart sounds
*Also remember, Pulsus Paradoxicus and Electrical Alternans
Things to remember about St. John's Wort
- Potent inducer of cytochrome P450
- Inc. Warfarin metabolism
- Used for treatment of mild/mod depression
Things to remember about Ginko biloba
- Purported to improve memory
- Lowers seizure threshold, inc. bleeding diathesis
How do we determine to start a pt on anticoagulation for a fib?
- CHF, HTN, Age 75+, DM, Stroke
- 2 or more = anticoagualtion
CHADS2 VASc Score
- Vascular dz, Age 65-74, Female sex
Goal INR for afib/DVT/PE?...Mechanical heart valve?
- Afib/DVT/PE: 2-3
- Mechanical Valve: 2.5-3.5
Pt presents with hypopigmented macules noticed after sun exposure...Dx? Bug? Tx?
Dx: Tinea Versicolor
Bug: M. furfur (Pityrisporum ovale) - "spaghetti and meatballs" on KOH prep
Tx: Selenium sulfide, topical terbinafine or ketoconazole, oral ketoconazole
Pt presents with h/o seizures, mental retardation, hypopigmented macules, and nodules on face (below)...Dx?
- Sx: seizures, progressive retardation, psychomotor retardation
- Cutaneous findings: adenoma sebaceum, ash leaf spots, shagreen patches
- Tumors: Cardiac rhabdomyomas, renal angiomyolipomas, cortical tubers, subependymal nodules, retinal astrocytic hamartomas
Pt presents with h/o seizures and port wine stain on face
- Endoscopic decompression
- Surgery of signs of ischemia
Pt has h/o prolonged prednisone treatment...presents with hypotension, abdominal pain...likely dx? What additional findings are likely?
Dx: Adrenal Insufficiency (secondary to glucocorticoid discontinuation)
Labs: Hyponatremia, hypoglycemia (due to hypocortisolism)
**NOT hyperkalemia or hyperpigmentation (these are only present in primary adrenal insufficiency)
Full term X-week old infant presents with persistent jaundice, acholic stools, dark urine, hepatomegaly, conjugated hyperbilirubinemia ...likely Dx? Diagnostic test? Tx?
Dx: Biliary Atresia
Test: Intraoperative cholangiography
Medications that cause hypothyroidism
Methotrexate, Lithium, Amiodorone
Hospitalized pt presents with decreased TSH, decreased T3, normal T4...likely dx?
Euthyroid Sick Syndrome
J/Osborne waves → extra deflection at the end of QRS due to disturbance of repolarization
RF for endometrial carcinoma?...protective factors?
RF: Unopposed estrogen, DM, FH of breast/ovarian/endometrial ca, early menarche, late menopause, obesity, tamoxifen
PF: OCPs, multiparity, smoking
Pt presents with increased infection, anemia, thrombocytopenia, leukocytosis...BM bx stains with Sudan black and myeloperoxidase...Dx?
BM bx shows smudge cells...CD5+ lymphocytes...dx?
ME for Rib Exhalation Dysfuntion
- Rib 1: Ant/Mid Scalene → pt lift head
- Rib 2: Post Scalene → pt turns head 30 degrees away
- Rib 3-5: Pec minor → ipsilateral elbow to contralateral hip
- Rib 6-9: Serratus ant → ipsilateral elbow to ipsilateral hip
- Rib 10-11: Lat dorsi → arm adduction
- Rib 12: Quad lumborum → arm adduction
Diagnostic tests for asthma
- PFT: FEV1/FVC <75% = obstructive lung dz
- Spirometry: administration of bronchodilator increases FEV1 or FVC by atleast 12%
- PEFR: Normal 450-650 in men, 350-500 in women; exacerbation is mild (>300), mod (100-300) or severe (<100)
Dx of exercise-induced asthma
Methacholine challenge test (i.e. Bronchoprovocation Test) → if airway is hyperresponsive, pt will develop obstruction when exposed to methacholine
Pt c/o muscle weakness...PE shows muscle atrophy, fasiculations, hyperreflexia...likely dx?...tests?...Tx?
Dx: ALS (motor ONLY, UMN and LMN signs)
Tests: EMG, nerve conduction studies to r/o other dz
Tx: Riluzole (blocks Na channels associated with neurone damage) slows progression/requirement for ventilator dependent tracheostomy
Child presents with barking cough...Dx? Organism? Radiological finding? Tx?
Org: Parainfluenza virus
CXR: Steeple sign
Pt presents with testicular pain, testicular swelling and T 101.5F...likely dx? Tx?
- If <35 think CHL (#1), GC (#2) → azythromycin + ceftriaxone
- If >35 think E. coli → ciprofloxacin
The 4 Ds of Medical Malpractice
Duty, Dereliction, Damage, Direct causation
Pt presents with recurrent ulcers has elevated gastrin despite secretin injection...likely dx? Tx?
Dx: Zollinger-Ellison Syndrome
What is the most common location for peptic ulcers?
Lesser curvature of the stomach (Type I)
- Type I: lesser curvature of the stomach
- Type II: duodenal ulcer
- Type III: prepyloric ulcer
- Type IV: procimal gastroesophageal ulcer
- Type V: along gastric body
- QRS>120ms (3 small boxes)
- rSR' in V1
- Slurred S waves in I and V6
Drug used for ppx after exposure to Influenza outbreak
Oseltamivir (effective if started within 48 hours of illness onset)
Best anti-HTN drug for gout? Worst?
Best anti-HTN drug for osteopenia/osteoporosis/kidney stones?
Best anti-HTN drug for Raynaud's?
Best anti-HTN drug for essential tremor/thyrotoxicosis/migraines?
How to distinguish hematuria caused by hemolysis vs nephrolithiasis...
Urine microscopy (RBCs = nephrolithiasis, none = hemolysis)
Test of choice for gallstones?....kidney stones?
- Gallstones: U/S
- Kidney stones: noncontrast CT
Congenital disorder causing unconjugated hyperbilirubinemia
- I: No UGT1A1, fatal without transplant
- II: Very decreased UGT1A1, AD inheritence
Gilber's Syndrome (UGT1A1 only 30% active)
Congenital disorder causing conjugated hyperbilirubinemia
Dubin-Johnson Sydrome (dark liver, gallbladder cannot be visualized, normal urine corproporphyrin, 80% corproprphyrin I)
Rotor Syndrome (normal liver, gallbladder visualized, elevated total coproporphyrin, 80% coproporphyrin III)
Increased urobilinogen is caused by
Increased conjugated bilirubin
Ex: Dubin-Johnson, Rotor, hemolytic processes with normal liver
Mgmt of cluster headaches
Ppx: Verapamil, prednisone, valproic acid, topiramate, ergotamine
Abortive Tx: 100% O2, sumitriptan, intranasal lidocaine
Pt who recently had a viral infection presents with PAINFUL, diffusely enlarged thyroid gland, dec. TSH, inc. T4...Dx? Tx? Mechanism for hyperthyroidism?
Dx: Subacute GRANULOMATOUS Thyroiditis (aka DeQuervain's Thyroiditis)
MOA: Inflammatory process causes release of stored hormones (will show DECREASED uptake of radioactive iodine)
Pt who recently had a viral infection presents with PAINLESS, diffusely enlarged thyroid gland, dec. TSH, inc. T4...Dx?
Subacute LYMPHOCYTIC Thyroiditis
Pt presents with painful lumps on b/l shins following a flu infection...dx?
- septal panniculitis
- associated with infection, autoimmune dz (sarcoidosis, IBD)
Pt c/o rash on palms and soles...dx?
Erythema multiforme minor
- most commonly associated with HSV
EM Minor vs EM Major vs SJS vs TEN?
- EM minor: target lesions on extremities with no mucosal involvement
- EM major: target lesions on extremities, involvement of 1+ mucous membranes, <10% BSA
- SJS: widespread blisters involving face and trunk, <10% BSA
- TEN: widespread blisters involving face and trunk, >10% BSA
Pt with h/o varicose veins presents with painful area of cordlike, erythematous induration...Dx?...Tx?
Dx: Superficial thrombophlebitis
Tx: NSAIDS, elevation, heat, support stockings, f/u PE in 1 week to r/o progression to DVT
Child presents with acute onset of testicular pain in the superior pole of the testicle...PE reveals swollen testes with a blue dot on the superior pole...Dx?...Tx?
Dx: Torsion of appendix testis
*Blue dot sign is pathognomonic
Tx: Pain control, bed rest, scrotal support
Stages of Labor
I: Dilation of Cervix → Latent and Active Phase
- 100% effacement and dilation up to 4cm
- Up to 20 hrs in NP, 14 hrs in MP
- Cervical dilation of 4cm - 10 cm
- 1.2 cm/hr in NP, 1.5 cm/hr in MP
II: Complete Dilation to Delivery
- 2 hrs in NP, 1 hr in MP, add 1 hr if epidural
III: Delivery to Expulsion of Placenta
- 30 min
Anticoagulation method for pregnant pts?
SQ heparin (warfarin crosses placenta = teratogenic)
Pt presents with hyponatremia, low serum osmolality, and low urine volume...Dx?...Tx?
Tx: Always start with fluid restriction → 0.9% saline + furosemide → demeclocycline
Workup for Diabetes Insipidus
- Water deprivation test (normal should reduce urine output, DI will continue to have increased urine output)
- Desmopressin (response = central, no/little response = nephrogenic)
TOC for central DI?
TOC for nephrogenic DI?
Sodium restriction + Thiazide +/- Amiloride and Indomethacin
Causes of DI
Lithium, Ampho B, Demeclocycline, Hypokalemia, Hypercalcemia
Presentation of Sarcoidosis
- Hilar lymphadenopathy
- Erythema nodosum
Damage to C8-T1
- Paralysis of intrinsic hand muscles
- Ulnar N distribution numbness
- Horner's syndrome
Pt presents with hundreds of adenomatous polyps in colon, osteoma of the mandible, desmoid tumors and dental abnormalities...Dx?
Pt presents with hundreds of adenomatous polyps in colon and CNS tumor...Dx?
Pt presents with extensive FH of various cancers (colorectal/gastric/endometrial) presents with endometrial thickening (bx confirms endometrial cancer) and two adenomas on colonoscopy...Dx?
Lynch Syndrome (Hereditary Nonpolyposis Colorectal Cancer)
Mgmt of narcolepsy (daytime sleepiness, hypnagogic/hypnopompic hallucinations, cataplexy)
Daytime sleepiness: Modafinil
Cataplexy: Venlafaxine or fluoxetine
Pt presents with low calcium, low phosphate and high PTH...Dx?
Vitamin D Deficiency
Pt presents with low calcium, high phosphate and high PTH...Dx?
Pseudohypoparathyroidism (ex: Renal Failure)
Pr presents with high calcium, low phosphate, high PTH...Dx?
Pt presents with severe back pain, UMN signs, decreased sensation, incontinency...Dx?...Tx
Dx: Spinal Cord Compression
Pt presents with fever, weight loss, hematuria, flank pain, and palpable flank mass...Dx?...Lab Findings?
Dx: Renal Cell Carcinoma
Labs: Paraneoplastic syndromes → hypercalcemia (PTH-like hormone), Polycythemia (EPO), HTN (Renin), Cushing's (Cortisol)
Mgmt of pancreatic pseudocyst
<6cm: NPO, observation
>6cm or has not resolved in 8 weeks: Endoscopic cystgastrostomy/cystduodenostomy
Pt presents with jaundice, migratory thrombophlebitis, palpable gallbladder...Likely Dx?...Most sensitive dx test?...Most specific dx test?...Best next step?
Dx: Pancreatic Cancer
Best next step: Abdominal Ultrasound
Cobb angle at which there is respiratory compromise...cardiovascular compromise?
Resp: >50 degrees
CV: >75 degrees
Tests to order prior to starting a pt on Lithium?...Valproic acid?...Carbamazapine?
- BUN/Cr → nephrogenic diabetes insipidus
- TFT → hypothyroidism
- Pregnancy → Ebstein's anomaly
- Platelets → thrombocytopenia
- LFTs → hepatotoxicity
- CBC → leukopenia
- LFTs → abnormal LFT
- Watch for SJS
Pt is dx with silicosis...they are high risk for developing...?
Tuberculosis (silica is cytotoxic to alveolar macrophages)
Pt with h/o celiac disease presents with pruritic rash on elbows with erythematous papules/vesicles...Dx?...Tx?
Dx: Dermatitis herpetiformis
(complement activation due to IgA-gluten formations)
Tx: Dapsone + gluten free diet
Medication for treatment of Huntington's chorea?
Inhibits VMAT → dec. continual realease of dopamine into synaptic cleft → inc. dopamine breakdown
Difference between si/sx of Tay-Sachs vs. Niemann-Pick?
Neimann-Pick causes hepatosplenomegaly, Tay-Sachs does not involve the liver
NP - deficiency of sphingomyelinase
TS - deficiency of hexosaminidase A
Both: loss of early motor skills, mental retardation, cherry-red macular spot
Si/sx: Pain on wrist extension or supination against resistance; point tenderness on lateral epicondyle
Tx: rest, ice, counter-force brace, NSAIDS
Si/sx: Pain on wrist flexion or pronation against resistance; point tenderness on medial epicondyle
Pt presents with hypertrichosis, hyperpigmentation and painless blistering on dorsal surface of hands...likely Dx?...RF?...Tx?
Dx: Porphyria cutanea tarda
RF: Hep C, Excess Iron
Tx: Chloroquine, Phlebotomy
Treatment of choice for pruritis caused by cholestasis (e.g. Primary Biliary Cirrhosis)?
Cholestyramine or Colestipol
Portal HTN is likely with what SAAG?
Candidiasis of esophagus, lungs, trachea (NOT thrush), cryptococcal infection, intestinal isosporiasis or cryptosporidiosis, Kaposi's sarcome, cerebral lymphoma, PCP, cerebral toxo, invasive cervical cancer, HIV wasting syndrome
Pt presents with jaw pain when chewing food, scalp tenderness just above the right ear...likely Dx? Test for Dx? Tx?
Dx: Temporal (Giant Cell) Arteritis
Test: Temporal artery bx (immediately!)
Tx: High dose prednisone (immediately! X 2yrs)
Urgent - may lead to irreversible blindness
Associated with polymyalgia rheumatica (proximal muscle pain)
<100: CHD or equivalent (PAD, CAD, DM, AAA)
<130: 2+ RF
- Age 45+M, 55+F
- FH of premature CAD (55 M, 65 F)
- HDL <40
<160: 0-1 RF
When to start a statin?
CHD or Equivalent: LDL 130+
2+ RF: LDL 160+ (10yr risk 10-20%), 190+ (10yr risk <10%)
0-1 RF: LDL 190+
How do you calculate the 'number needed to treat'?
1/absolute risk reduction
How do you calculate the 'number needed to harm'?
Pt with h/o Sickle Cell disease presents with fever, chest pain, tachypnea, wheezing, hypoxia and right middle lobe infiltrate on CXR...likely Dx?...Tx?
Dx: Acute Chest Syndrome
Tx: Blood transfusion (target Hgb no greater than 10), abx (3rd gen. Cephalosporin + Macrolide), venous thromboembolism ppx, supportive tx (fluids, pain control, respiratory aids)
Mgmt of Restless Leg Syndrome
- Dopamine agonist (pramipexole, ropinirole, levodopa/carbadopa, bromocriptine)
- Iron supplementation
Which benzodiazapenes are safe to use in pts with liver disease?
Metabolism is "Outside The Liver"
TOC for Small Cell Lung ca.
Chemotherapy +/- Radiation
Child presents with a week-long fever, bilateral conjunctivitis, erythema/desquamation of palms and soles, inflamed red papillae on tongue...likely Dx?..Tx?
Kawasaki's Disease (Mucocutaneous Lymph Node Syndrome)
CRASH and Burn
- Aneurysm (Coronary Artery)
- Strawberry tongue (mucositis)
- Hand/foot desquamation and edema
- Burn = fever > 5 days
Tx: ASA + IVIG
Most specific test for Myesthenia Gravis?
ACH receptor antibody test
Remember, Ice Pack Test is the best test for pt with ptosis (sensitive/specific/inexpensive/noninvasive)
Pt presents with cough, sore throat, erythematous tonsils without exudate, T 100.1F...likely dx? Tx?
Dx: Viral pharyngitis
Streptococcal Pharyngitis will cause at least two of the following symptoms:
- Lack of cough
- Tonsillar exudates
- Tender anterior cervical lymphadenopathy
- Temperature >100.4
"Egg on a string"?
Transposition of the Great Arteries
Pt presents with generalized swelling, P 108, JVD, pericardial knock, low voltage on ECG...likely dx? Bx results? Tx?
Dx: Constrictive pericarditis
Tx: Surgical removal of pericardium
Compartment syndrome most commonly occurs in what compartment of the leg? What are the major contents of this compartment?
Tibialis anterior, extensor hallicus longus, anterior tibial arter, deep fibular nerve
Medial tibial stress syndrome involves what compartment of the leg? Dx test? Tx? Consequences if not treated?
Dx test: nuclear medicine bone scan
Tx: cessaton of inciting activity
Consequence: Stress Fractures
Pt presents with palpitations, hypoglycemia, markedly increased insulin level, decreased C-peptide level...likely Dx? Most likely additional findings?
Dx: Factitious hypoglycemia 2/2 exogenous insulin
Additionally: Antibodies to exogenous insulin, low pro-insulin
Pt presents to ER after a syncopal episode that occurred while she was chopping vegetables, BP 128/72 in R arm, 89/45 in L arm...likely Dx? Mechanism? Dx test? Tx?
Dx: Subclavian Steal Syndrome
MOA: Obstruction of subclavian artery proximal to vertebral artery; when arm is exercised, blood flows backward through vertebral artery into subclavian artery
Pt presents with muscle rigidity, tachycardia, T 102.8F, elevated end-tidal CO2 after induction of general inhalational anesthesia...likely Dx? Mgmt?
Dx: Malignant Hyperthermia
1. STOP the triggering anesthetic
2. Administer 100% O2, transition to different anesthetic
3. Once stable administer Dantrolene (2.5 mg/kg bolus, then 102 mg/kn q 5 min util normalization)
Wtf is Felty's Syndrome?
Rheumatoid arthritis, Neutropenia, Splenomegaly
Pt presents with thrombocytopenia after starting heparin...likely dx? MOA? Tx?
Dx: Heparin induced thrombocytopenia
MOA: Antibody against platelet factor 4
Tx: DC heparin, start lepirudin or argatroban
Confirm with osmotic fragility test
TOC: Splenectomy with ppx pneumococcal vaccine
Workup for gastrinoma? Most common location?
W/U: Fasting serum gastrin (elevated) → Secretin Injection Test (normal gastric cells will be inhibited; in gastrinomas gastrin levels remain elevated)
Most common location: Duodenum
Cirrhotic pt presents with abdominal pain, fever, ascites; paracentesis yeilds PMN leukocyte count of 350...likely dx? Tx?
Dx: Spontaneous Bacterial Peritonitis
Tx: 3rd Gen. Cephalosporin
(remember, PMN > 250)
Triad for Cholesterol Embolism
Livedo reticularis, acute renal failure, eosinophilia
Minimum urine output
0.5 ml/kg/hr or ~30cc/hr
Chromium deficiency causes...
Hyperglycemia → insulin requires chromium to function
Methanol or Ethylene Glycol
- TCA: NaCO3
- Beta Blocker: Glucagon
- Acetaminophen: N-Acetylcysteine
- Methanol/Ethylene Glycole: Ethanol or Fomepizole
- Organophosphate: Pralidoxime or Atropine
- Opioids: Naloxone or Naltrexone
- Warfarin: Vitamin K and FFP
- tPA: Aminocaproid Acid
- Heparin: Protamine
- Carbon Monoxide: 100% O2
- Methemoglobin: Methylene Blue
Pt (s/p vagotomy for PUD) presents with tremors, palpitations, sweating; labs show hypoglycemia, normal insulin/Cpeptide/proinsulin...likely dx?
Indications for long-term O2 therapy in COPD
- SaO2 <88
- PaO2 <55
- PaO2 55-59 + right sided heart failure or erytrhrocytosis
Si/sx of Glucagonoma
- Diabetes mellitus
- Decreased AA (due to gluconeogenesis)
Elements of Somatostatinoma Syndrome
- Diabetes mellitus
- Weight Loss
Uses of Metoclopramide
D2 Antagonist, 5HT3/4 Agonist
- Increases LES tone
- Increase breast milk production
Often the first manifestation of asbestosis...
Decreased DLCO (carbon monoxide diffusion capacity)
Pt presents with central low back pain after long car ride, stooping forward and leaning to one side...likely dx? Tx?
Tx: Treat upper lumbar spine (innervation of psoas) then the iliopsoas muscle itself
Mgmt of unstable angina
Morphine, O2, Nitro, ASA, B-blocker, Heparin
Phases of acetaminophen overdose/poisoning
I: (0-24h) N/V
II: (18-72h) Rising Transaminases, RUQ pain
III: (72-96h) Hepatic Necrosis, ATN
IV: (4d-3w) Resolution
Mgmt of acetaminophen overdose/poisoning
- Within 1 Hour: Oral Activated Charcoal
- 4, 6, 8, Hours: Serum Acetaminophen Levels drawn, plotted on Rumack-Matthew nomogram to determine hepatotoxicity
- Within 8 Hours: NAC if high likelihood of hepatotoxicity (100% hepatoprotective)
- *If pt presents 8+ hours after ingestion, administer NAC
Mechanism of renal osteodystrophy
RF → dec. GFR → inc. Phosphate → binds Calcium → dec. serum Calcium
RF → dec. Calcitriol → dec. GI Calcium absoption
Classic EKG findings for PE?
S1-Q3-T3, RBBB, sinus tachy
Pt presents with alopecia, dermatitis, central/peripheral neuropathy, depression...likely deficiency?
Pt presents with neutropenia, hypochromic anemia, osteoporosis...likely deficiency?
TOC for Akathisia ("inner restlessness")
Beta Blocker, Benzo, or Benztropine
TOC for Tardive Diskinesia
DC current med, switch to clozapine
Pt presents with lumbar back pain that radiates to buttocks and thighs and is relieved with flexion...likely Dx? Most accurate test? Tx?
Dx: Spinal Stenosis
Tx: Weight loss
Child presents with fever, conjunctivitis, coryza, cough, white/blue spots on oral mucosa...likely Dx?...PPX?...Tx shown to reduce morbidity/mortality...time period of contagiousness?
Dx: Measles (Rubeola)
TX: Vit A supplementation
Contagious: 5 days before, 4 days after rash
Rule of 9s
- Head = 9
- UE = 9 EACH
- Front Torso = 18
- Back Torso = 18
- LE = 18 EACH
- Genitalia = 1
- Head = 18 (subtract 1 for every year over 1 y/o up to 10 y/o)
- UE = 9 EACH
- Front Torso = 18
- Back Torso = 18
- LE = 14 EACH
First line treatment for Fibromyalgia
Duloxetine, Milnacipran, Pregabalin
Ab: Anti-topoisomerase I (Anti Scl-70) and Anti-centromere
Remember CREST (Caclinosis cutis, Raynaud's, Esophageal dysmotility, Sclerodactyly, Telangectasia)
Pt presents with scaly rash, axillary lymphadenopathy; bx shows abnormal T-cells...likely Dx?
Mycosis Fungoides: cutaneous T-cell lymphoma (malignant helper T-cells in skin and LN)
Pt presents with loose stools, occasional abdominal discomfort x 6 mos, iron deficiency anemia, and erythemetous vesicles on extensor surfaces of elbows...likely Dx? Most appropriate initial test? Confirmatory test? Bx?
Dx: Celiac Disease
Initial Test: Anti-tissue transglutaminase ab or anti-endomysium ab
Confirmatory Test: EGD + small bowel bx
Bx: Blunted villi, crypt hyperplasia
**Remember, Dermatitis Herpetiformis is a common extra-intestinal manifestation!!
TOC for insulinoma
Bullous Pemphidoid vs Pemphigus Vulgaris
BP: Antibodies against hemidesmosomes (BM); rarely involved mucous membranes; linear pattern of IGG/C3 along BM; (-) Nikolsky's sign; older pt
PV: Antibodies against desmosomes; involved mucous membranes; IGG between epidermal cells; (+) Nikolsky's sign; middle aged pt
Characteristics of the following spinal cord syndromes:
- Brown-Sequard: ipsilateral loss of DProV + Motor, contralateral loss of CPaT
- Ant: (think in AAA repair) loss of Motor, CPaT, urinary incontinence
- Cen: (think in whiplash or syringomyelia) loss of CPaT in "cape distribution", UE>LE
- Post: (think in MS, tabes dorsalis) loss of DProV
Obese female presents with diffuse intermittent headaches; she takes OCP and tetracycline for acne; PE shows papilledema and CN VI palsy; MRI normal...likely Dx?...next test?
Dx: Pseudotumor cerebri (increased ICP in absence of space occupying lesion)
Test: Lumbar puncture (inc. ICP, normal CSF)
Associated with: Vit A, tetracycline, OCP, corticosteroid withdrawal
Pt presents with dry cough, DOE, h/o working in [glass manufacturing, mining, sandblasting]...likely dx? CXR findings?
CXR: Nodular opacities in upper lobe
Pt presents with cough, DOE, h/o working in [nuclear power industry, aerospace induscry, electronics manufacturing]...likely dx? CXR findings?
CXR: Bilateral hilar lymphadenopathy
Pt presents with cough, DOE, h/o working in [shipyard, insulation, building demolition]...likely dx? CXR findings?
CXR: Bilateral opacities with pleural plaques
Young pt with h/o stroke and Hep B presents with flank tenderness, livedo reticularis, and foot weakness...likely dx?
Treatment options for Alzheimer's?
- First line: Supportive therapy + Cholinesterase Inhibitor (Donepezil, Rivastigmine or Galantamine)
- Mod-Sev: Memantin (NMDA glutamate receptor antagonist reduces intracellular calcium accumulation)
Treatment options for Parkinson's?
Carbidopa/Levodopa > Dopamine agonists (Bromocriptine, Pramipexole) > Selegeline (MAO-B inhibitor) > Amantadine > Anticholinergics (Benztropine, Trihexyphenidyl)
Mgmt of pt with Turner's
Estrogen/progestin replacement, HGH if heigh falls below 5th percentile, surgical consult for coarctation of aorta
BHCG discriminatory zone cutoff?
Most common type of testicular germ cell tumor? Expected labs? Histology? Tx?
Fried Egg (clear cytoplasm and round nuclei)
Testicular tumor characterized by elevated AFP?
Yolk sac tumor
5 year old presents with short stature, breast buds/TS 2 pubic hair, Café au lait spots, and frequent fractures...likely dx?
McCune-Albright syndrome: short stature, café au lait spots, precocious puberty, polyostotic fibrous dysplasia
#1 cause of mortality in men ages: 1-44, 45-54, 55-64, 65-74, 75-84?
1-44: Unintentional injuries
45-54, 65+: Cardiovascular disease
55-64, 75-84: Cancer
Main facts about Multiple Myeloma
Bence Jones proteins = nephrotoxic
UPEP: M spike of IgG or IgA
Blood smear: Rouleaux formation
BM bx: >10% plasma cells
Lytic, "punched out" bone lesions
Tumor marker: Beta 2 microglobulin
Anion gap DECREASES due to + charged immunoglobulin in plasma
Cancers that mets to bone
"BLT with Mayo and a Kosher Pickle"
Young pt presents with chronic cough productive of mucopurulent sputum and h/o [severe pulmonary infection/CF]...likely dx? Next test? Findings?
Test: High resolution computed tomography (HRCT)
Findings: dilated airways, ballooned cysts, predominantly in lower lobes ("tram-lines" on CXR)
0: None; 1: Diminished, 2: Normal, 3: Hyperactive, 4: Hyperactive + Clonus
Grading Muscle Strength
0: None; 1: Slight contractility; 2: Full without gravity; 3: Full with gravity; 4: Full with small resisitance; 5: Full with full resistance
Mgmt of CHF pt
Sodium Restriction + ACE-I + Furosemide
Best long term treatment of OA
Immigrant from India presents with night sweats, hemoptysis, hypotension, hyperkalemia...likely dx? Tx?
Dx: TB! (TB-induced adrenal insufficiency is the most common cause of adrenal insufficiency worldwide)
Tx: RIPE (Four for Two, Two for Four)
TOC for HOCM
Beta blocker or Verapamil
What murmurs will be increased with Valvsalva/Standing?
Most common cause of primary hyperparathyroidism
Localize via Sestamibi Scan
Mgmt of new onset AF
If <48 hours: TEE to look for clot in LA, if none, cardioversion
If >48 hours: anticoagulate with warfarin x 3-6 weeks (INR 2-3), then cardioversion
Mgmt of Short Leg Syndrome
Heel lift on the short leg: start 1/8 in., add 1/8 in. every 2 weeks until desired height (50-75% of deficit); ¼ in. internally, ¼ in. externally; lifts >1/2 in. should be counterbalanced with a sole lift
Mgmt of Solitary Lung Nodule
37. Look at old CXR: if nodule has changed in size within 2 yrs, or if it is new, step 2.
38. Chest CT
- Appears benign: Serial Chest CT q3 months x 2 years; no growth = benign
- Appear malignant: Biopsy (central = bronchoscopy, transthoracic needle = peripheral)
Factors that indicate possibility of malignancy in Solitary Lung Nodule
- Age > 50 y/o
- Size > 2cm
- Eccentric asymmetrical calcification
- Changing size
Delirium vs Dementia vs Psychosis
- Delirium: acute onset, altered mental status with decreased alertness
- Dementia: progressive loss of mental faculties
- Psychosis: alertness maintained, loss of contact with reality
DD for Delirium
MI WATCH DEATH
- Metabolic disturbances
- Abuse of substances
- CNS pathology
- Vitamin Deficiency (thiamine)
- Acute MI/vascular
- Heavy Metals
Newborn male with urinary tract obstruction...dx? Test?
Dx: Posterior urethral valves
Test: Voiding cystourethrogram
Mgmt of diabetic pt c/o 7am glucose of 215
Re-check glucose at 3 am before adjusting insulin
- If high, likely 2/2 Dawn effect (early morning GH secretion antagonizing insulin) → increase basal insulin at dinner
- If low, likely 2/2 Samogyi effect (overtreatment of NPH) → decrease NPH at dinner
Definition of Post Partum Hemorrhage?...Most common cause?
Blood loss >500cc in VD, 1000cc in CS
Uterine atony (treat with uterine massage + uterotonic medications like oxytocin, carbaprost, misoprostol, methylergonovine)
What is Fornier Gangrene?
Necrotizing soft tissue infection of male genitals/perineum; surgical emergency
Teres minor: ER
Diagnosis of DM
Symptoms (polyuria, polydipsia, polyphagia) + random glucose >200
2Hr SGOT: >=200
Parameters of Glucose Intolerance/Pre-Diabetes
2Hr SGOT: 145-199
Next steps after finding elevated maternal AFP? Causes?
- U/S: ensure proper dates, single uterine pregnancy
- Amnio: AFAFP + Acetycholine Esterase (both will be increased with NTD)
- Causes: Wrong dates, multiple gestation, open NTD, abdominal wall defects
What is a positive Trendelenberg Test?
Hip drop on side of gluteus muscle weakness
What is a positive Lasegue's Test?
(Straigh Leg) Reproduction of shooting leg/back pain due to sciative nerve compression
What is a positive Thomas Test?
Raising of contralateral hip during hip flesion due to tight iliopsoas (hip flexors)
What is a positive Patrick's Test?
(FABER) Hip pain during flexion, abduction, external rotation then extension due to hip joint pathology (e.g. OA)
What is the Apley Test?
Compression of the foot whil internally/externally rotating pt's leg - checks for meniscal tears, and MCL/LCL injury
Pt presents with confusion, blood glucose of 58, elevated insuline and C-peptide...likely dx? Next dx test?
Test: 72 hour fast (insulin levels will continue to be elevated)
FEV1/FVC diagnostic of obstructive lung disease? Difference between asthma and COPD?
If reversible with administration of SABA = asthma, if not = COPD
In COPD treatment, combination of what medications is associated with decreased mortality, impoved lung cunftion and decreased exacerbations?
Inhaled Glucocorticoid (budesonide, beclomethasone, flunisolide, fluticasone) + LABA (salmeterol)
Pauciarticular vs Polyarticular
Pauci = 4 or less, Poly = 5 or more
Young female pt presents with headaches, abdominal bruit and hypertension...likely dx? Dx test?
Dx: Fibromusclar dysplasia
Test: Angiography (will show beading pattern)
Laboratory findings of Primary Biliary Cirrhosis
Difference between Right-Sided vs Left-Sided colon cancers?
Right-sided: occult blood
Left-sided: hematochezia, change in bowl habits or stool caliber
Pt presents with recent onset of profuse diarrhea and vomiting, hypokalemia, hypomagnesemia, and the following EKG...Dx?...Tx?
Dx: Torsade de pointes
Ts: IV Magnesium sulfate
Post-exposure ppx for Rabies?
For Non-immunized: Irrigation + RIG + Vaccine (x4)
For Immunised: Irrigation + Vaccine (x2)
The most common sequelae after bacteria meningtis?
Sensorineural hearing loss
Neonate presents with cleft palate, facial twitching, interrupted aortic arch and VSD...likely dx? Dx test?
Dx: DiGeorge Syndrom
Test: FISH for chromosome 22q11.2 + karyotype
Characteristics: neonatal hypoglycemia, parathyroid hypoplasia → hypocalcemia, aplasia/hypoplasia of thymus → recurrent infections, congenital heart defects (Tetrology, Truncus Arteriosus, VSD), craniofacial abnormalities (cleft palate)
Neonate presents with macrosomia, hypoglycemia, Wilms tumor, hemihypertrophy...likely dx?
Folic acid recommendations for pregnancy planning
Low risk: 0.4 mg (400 mcg) per day
High risk: 4.0 mg (4000 mcg) per day
Si/sx of Neuroleptic Malignant Syndrome
Vital sign instability
Elevated enzymes (e.g. CK)
Rigidity of muscles
Mgmt of Prolactinoma
- Trial of dopamine agonist (bromocriptine, cabergoline)
- If no response, switch to other dopamine agonist
- If no response, transsphenoidal pituitary surgery
Si/sx of Hyperlipoproteinemia type I
(decreased lipoprotein lipase)
Si/sx of Hyperlipoproteinemia type IIa
(AKA Familial Hypercholesterolemia)
(Deficiency in LDL receptor, defective Apo B-100)
Si/sx of Hyperlipoproteinemia type IIb
High LDL, High VLDL → High TG
(Decreased LDL receptor, increased Apo B-100)
Si/sx of Hyperlipoproteinemia type IV
High VLDL, High TG
Si/sx of Hyperlipoproteinemia type V
High Chylomicrons, VLDL, TG
(Defect in Apo C-II gene)
Sequence of primary dentition
Central Incisors (5-8 mos), Lateral Incisors (7-10 mos), First Molars (11-18 mos), Canines (16-20 mos), Second Molars (20-30 mos)
Which blood type is associated with gastric ulcers?...Duodenal ulcers?
Gastric Ulcers: A
Duodenal Ulcers: O
Mgmt of suspected peptic ulcer
Pt <50 y/o and no alarming sx: Urea Breath Test
Pt >50 y/o and/or alarming sx: Upper Endoscopy + biopsy
Alarming sx = weight loss, dysphagia, new onset anemia, hemorrhage, early satiety
Nerve roots affected in Erb's palsy?...Klumpke's palsy?
Pt presents with fever, weight loss, bone tenderness, leukocyte count 54,000, increased alkaline phosphatase...likely dx?
Leukamoid Reaction: leukocytosis after an infection with increased LEUKOCYTE ALK PHOS
Pt with h/o spinal cord injury requiring urethral catheterization presents with diaphoresis, flushing, headache...likely dx?...Spinal level of injury?
Dx: Autonomic Hyperreflexia/Dysreflexia
Spinal Level: T6 or above
Calculation of fluid resuscitation for burn pts:
Parkland formula: 3-4 ml/kg/%BSA burned
1st ½ over the first 8 hours, 2nd ½ over the remaining 16 hours.
Benefits of breast feeding
- Decreases vaginal bleeding (milk letdown increases oxytocin release)
- Decreases allergies caused by cow's milk
- Lactoferrin: iron-binding protein found in human milk) has direct antibiotic effect by decreasing the availability of iron to intestinal bacteria
- Good source of IgA
Pt presents with chest pain and dysphagia, negative EGD, barium swallow shows "corkscrew" esophagus...likely dx?...Tx?
Dx: Diffuse esophageal spasm
Tx: CCB, Imipramine, or Nitrates
Pt presents with "Pulsus Parvus et Tardus"...likely dx?...Murmur?
Dx: Aortic Stenosis
Murmur: misystolic crescendo-decrescendo at right 2nd ICS that increases with expiration and squatting, decreases with handgrip
Pt presents with widened pulse pressure...likely dx?...Murmur?...Additional findings?
Dx: Aortic Regurgitation
Murmur: Diastolic decrescendo at lower left sternal border that increase with expiration and sqatting, increases with handgrip
Additionally: Wide pulse pressure, water-hammer pulse, Quincke pulse (pulsations in nail bed), de Musset sign (head bobbing)
Most appropriate dx test for Retropharyngeal Abscess
CT of neck (quick, helps differentiate abscess from cellulitis)
Child presents rash on abdomen and significant fatigue...PMH significant for short stature, rudimentary thumbs, café au lait spots...likely dx?...Dx test?
Dx: Fanconi anemia (pancytopenia as a result of primary bone marrow failure)
Test: Chromosome breakage test
*pts at increased risk for AML, myelodysplastic syndrome, liver tumors
Smoker presents with dyspnea, non-productive cough, fatigue, CXR shows b/l nodules, cysts, honeycombine, bony lesions of ribs...likely dx? Tx?
Dx: Langerhans Cell Histiocytosis
Tx: Smoking cessation, corticosteroids
Triad of Hirschprung's Disease
- Abdominal distension
- No passing of meconium within first 48 hours of life
- Bilious vomiting
Diagnotstic modality for Hirshprung's
Rectal bx (reveals absence of ganglionic cells)
Child presents with cough, coryza, conjunctivitis, grey spots on buccal mucosa, rash on face extending to neck...dx?
Child presents with rash on face spreading to neck, "bone pain", suboccipital/postauricular lymphadenopathy...dx?
Child presents with rash 3 days after resolution of a high fever; the rash is on the trunck spreading to the neck...dx?
HH6/Roseola Infantum/Exanthem Subitum/SixthDisease
Pt presents with oculgyric crisis 2 days after starting haloperidol...dx?...tx?
- Sustained spasm/contraciton of muscle
- Begins hours-days after initiation of antipsychotic
- Tx: anticholinergic or benzo
Pt presents with involuntary tapping/twisting of the lower extremities after taking fluphenazine for 15 months...dx?
- Involuntary movements of the lower face and extremities
- Begins months-years after initiation of antipsychotic
- Tx: switch to atypical antipsychotic
Pt presents with continous crossing/uncrossing of legs 3 days after dose of clorpromazine is increased...dx?
- Feeling of restlessness with constant movement
- Begins hours-days after initiation f typical neuroleptic drug/increase in dosage
- Tx: DC drug, anticholinergic, benzo, beta-blocker
Criteria for PTSD
- Horrifying event
- Re-experiencing (intrusive memories, nightmares, flashbacks)
- Month (1-3 = acute, >3 = chronic)
- Energy overload (hypervigilance/exaggerated startle)
Mgmt of PTSD
- First line: SSRI
- Prazosin before bed (decreases nightmares)
- Desensitization-exposure psychotherapy
Potentially reversible causes of dementia
- Vitamin B12 Deficiency
- Vascular Dementia
Mgmt of open fractures
Emergency Surgery (irrigation, debridement, wound repair)+ Abx + Tetanus Shot
What is a Boxer's Fracture?
Fracture of the shaft of the 5th metacarpal
What is Galeazzi's Fracture?
Diaphyseal fracture of the radius with derangement of the radioulnar joint (tx: ORIF, cast in supination)
What is Colle's Fracture?
Dorsally displaced fracture of the distal radius
What is a Nightstick Fracture?
Fracture of the shaft of the ulna
What is Monteggia's Fracture?
Diaphyseal fracture of the proximal ulna, resulting in displacement of the radial head
Most commonly fractured bone of the hand?...Si/sx?...Tx:Scaphoid fracture
Si/sx: Tenderness in the anatomical snuffbox, potential for avascular necrosis
Tx: Thumb spica cast for non-displaced
THIS SET IS OFTEN IN FOLDERS WITH...
COMLEX LEVEL 2 Complete (Original)
COMLEX step 2
COMLEX II High Yield
COMLEX Level 2 CE
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