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45 Cards in this Set
- Front
- Back
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Name the 4 common causes of priapism?
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1. sickle cell and leukemia-kids and adolescent
2. perineal/genital trauma-laceration cavernous artery 3. neuro lesions-spinal cord injury, cauda equina 4. meds-trazodone and prazosin (Priapism in Prazosin like the Bone in trazoDone) |
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Cause of edema in Turner's Syndrome?
Other common Turner's syndrome findings? |
dysgenesis of lymphatic network=lymphedema (its nonpitting)
-webbed neck, hi palate, short 4th metacarpal, nail dysplasia, shield chest, streak gonad, horeshoe kidney, coarctation aorta, hi LH/FSH, lo estrogen, hypothyroid |
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Pt w/ RA w/ new onset swollen R knee joint w/ erythema and warmth, decreased range of motion.
Next steps? ML Dx? |
Should assume is septic arthritis until proven otherwise (could be septic A vs Gout vs trauma)
-tap for synovial fluid analysis, cx, gram stain -empiric IV abx (to prevent joint destruction->NO steroids since can worsen septic knee even though could help RA or gout) |
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Why does spleen put you at risk for encapsulated SHIN?
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dendritic cells in spleen's white pulp normally phagocytize the blood-borne antigens which are presented to Thelper cells that activate B cells creating plasma-cell reich germinal centerts that produce antibodies to systemic circulation to faciliate phagocytosis or foreign organisms via opsonization
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TMT of asymptomatic diverticulosis?
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dietary mod w/ hi fiber intake
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College footbal player in MVA now quadrapelegic laying in bed. 4 wks later, serum Ca 12.1, PO4 2.8, PTH 9, vit D lo normal.
ML Dx? Cause? TMT? |
Hypercalcemia of immobilizaiton
->4wks immobilized->increased bone turnover from increased osteoclast resorption (as early as 3days if renal failure) -hydrate, bisophosphonate |
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2mo infant to clinic w/ poor feeding, born 32wga 1200g, pallor, tachy, flow murmur, Hgb 7, wbc 7000, plt 230000, retic very low, smear w/ normocrhomic normocytic rbc.
ML Dx? Criteria? TMT? |
Anemia of prematuritiy
-suspect in premature or low weight birth in hospital (from transitions in epo production, shorter lifespan rbcs, low fetoplacental transfusion from holding baby hi fast)->hgb 7-10, usually w/ poor feeding 1.smear is normochromic normocytic (no abnromal forms) 2. low retic count 3. normal wbc, plt 4. normal tbili -give iron, check hgb periodically, transufsion if needed |
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What is hemolytic dz of newborn?
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due to Rh or ABO incompatibility->jaundice, hepatosplenomegaly, pallor, hydrops fetalis. Will have hi retic count from hemolysis
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Pt treated for temporal arteritis for 6mo, now w/ muscle weakness making it dcifficulty to get up from chair.
ML Dx? |
chronic Steroid induced myopathy (starts insidioulsy of steroid use, acute is rare) proximal muscle weakness starting in lower extrem going to upper extrem, improves after discontinuation drug
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If you suspect aortic dissection (ie. they give the BP >30 difference btwn arms and "tearing pain to back"), next dx step?
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**** the TTE->do a TEE or CT or MRI!
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TMT for night terrors?
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They spontaneously resolve as child gets oolder (occur in kids 2-12, mostly 5-7)
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Which tumors in lung are associated w/ what paraneoplastic synd?
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Squamous cell: PTHrP in smokers, central hilar mass (think "sCa++mous Central Smoking")
Small cell: ACTH, SIADH, Lambert-Eaton, central, tmt chemo (think "Siadh, Middle, Acth, Lamberteaton, Liquid chemo") Adenocarcinoma: peripheral, hypertrophic osteoarthropathy/clubbing, nonsmoker |
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Signs of pancreatic pseudocyst?
Dx Test? TMT? |
post chronic more than acute pancreatitis w/in wks, have palpable mass epigastrum w/ elevated amylase since filled w/ it and leaking out (not true cyst since no epithelium llining)
-U/S -resolves on own over wks, if persists >6wks or is >5cm or infected->drainage |
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How to clarify what type of exudative pleural effusion based on glucose?
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glucose <30: think empyema vs. rheumatic effusion
30-50: malignant, lupus, esophageal rupture, TB Glucose is from metabolic activity of WBC in fluid |
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anti-topoisomerase-I ab=?
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sleroderma (both diffuse and limited)
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SCL-70=?
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scleroderma (is same as anti-topoI)
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anti-centromer ab=?
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CREST syndrome
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Steps of Evaluation of Chest Pain Protocol for EKG nonconsistent w/ ACS and nondx CXR (ROMI)
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1. all pts get H&P, EKG, trops/ck-mb, CXR (should all be nonconsistent w/ ACS b4 this workup)
1st Pretest prob: low (<10%=asx all ages, atypical chest pain in F <50yo), Intermediate (20-80%=aytpical angina in men any age, atypical angina F>50yo, typical angina F 30-50), High (>90%: typical M >40, typical F>50) -if Low->no added testing -if Inter->normal EKG? able to excercise?->if abnormal but able to excercise->excercise echo or excercise nuclear stress, if normal ekg and able to excercise->treadmill stress test (excercise tolerance), if unable to excercise->pharm stress test->if any of those 4 positive->coronary angiography -if High->start pharm therapy->if nonresponsive->coronary angio |
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Pt postpartum 12hrs, has temp 100.4F, small blood clots and bloody discharge, but uterus firm nontender.
ML Dx? |
Normal postpartum, low grade fever, leukocytosis, and lochia rubia are normal in 1sst 24hrs postpartum (lochia rubia becomes lochia serosa after several days appearing pale->if foul smell->then think endometritis
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What is difference granulosa cell tumor vs sertoli leydig cell tumor?
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Granulosa: solid ovarian produces estrogen (bimodal usually b4 puberty) causes precocious puberty, large brests, pubic hair growth
Sertoli-Leydig: prodcues androgens causing masculinization w/ irregular menses, flattened breasts, hirsuitism, large cliteris |
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Pt w/ rheumatic fever, asymptomatic but has murmur and hx of joint pain.
Next step? |
IM penicillin ppx every 4wks to erradicate group A strep and prevent GAS pharyngitis
-if no carditis: for 5yrs or till 21yo -if w/ carditis but no residual murmur/valve dz: for 10yr or till 21yo -if w/ carditis and w/ valve/murmur now: 10yr ot till 40yo |
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port-wine stain over R side face=?
What else in this? Dx test? TMT? |
Sturge-Weber syndrome (neurocutaneous syndrome)
-congenital unilateral hemangioma (port-wine stain or nevous flammeus on territory of trigeminal nerve), intra-cranial calcification->seizure, hemianopia, hemiparesis, ipsilateral glaucoma -skull xray after 2yo show calcification (like "tramline") -control seizures and reduce intraocular pressure |
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What is SIDS?
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Sudden infant death syndrome (leading cause death infants 1mo to 1yr in USA) prevent by placing child in supine sleeping position
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What is the number 1 cause of death in gen pop?
What about in dialysis pts? What about in renal transplant pts? |
CV dz
CV dz CV dz!!! |
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Pt w/ fatigue, fever, myalgias, arthralgias, splenomegaly, no pharyngeal edema/exudate, no lymphadenomapthy, smear shows large basophilic lymphocytes w/ vacuolated appearnace.
ML Dx? |
CMV mononucleosis (no pharyngitis or post cervical lymphadenopathy->not EBV mono, but has atypical lymphocytes characteristic of mono)
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Average age of CLL? What's characterisitic of it?
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old age (60s), "smudge cells" and mature small lymphocytes
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Reliability and validity?
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Reliable = precise (how close to each try is the next)
valid = accurate (how close to the actual target) |
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Workup for child w/ discharge from vagina?
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1. exam vagina w/ child in knee to chest or frog-leg position
2. if foreign body seen, can be better visualized by vasalva 3. if foreign body, irrigate w/ warm water to flush it out (usually just TP) 4. if unsuccessful, examin and removal w/ sedation or gen anesthesia. |
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blood at end of urination =?
at beginning of urination=? throughout all urination=? |
look for bladder or prostate dz (do cystoscopy)
-urethra->urethritis possible -ureter or kidney |
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Alternate names for osteonecrosis of femoral head?
When is pain? Dx tests? Causes? |
aseptic necrosis, avascular necrosis, ischemic necrosis, osteochondritis dessicans
-initially on on activity, later w/ rest too -xray may fail to show it in 1st mos, do MRI -steroids, chronic ETOH, trauma, antiphospholid synd |
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Pain in lateral side of hip that is worse on palpation and hurts when sleeping on side=>
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trochanteric bursitis (friction btwn gluteus medius and tensor fascia lata over greater trochanter femur
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Pt w/ fall on outstretched hand now w/ pain on arc abduction and external rotation, no swelling, redness, warmth.
Diff Dx? How to differentiate? Dx Test? |
Rotator Cuff tear vs Rotator cuff tendonitis (suspect when difficulty lifting arm over head after shoulder trauma), you know its not anterior shoulder dislocation since in that the pt would hold his arm abducted and externally rotated
1. Lidocaine injection improves tendonitis, not tear 2. MRI to visualize ttear |
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Radioactive iodine poses greatest risk of hypothyroidism in tmt of what?
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Graves, since whole gland is hyperactive
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Difference Bartter vs Gittelmans?
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Barrter is the NaK2Cl so act like furosemide
Gittelman is the NaCl so act like thiazide All have normotenzive, hypokalemia, hypochloremia |
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Differential for 2ndary hyperaldosteronism?
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Diuretic Use
vomiting/hypovolemia barter/gittelman renin-secreting tumor factiti |
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Take me through the chest pain algorithm
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1. focused H&P, risk factors (smokin, fam hx, estrogen), IV access, vitals->if unstable->stabilize hemodynamics
2. if stable->EKG, CXR, ASPIRIN (if risk aortic dissection low), O2, morphine->if ekg nonconistent w/ ACS->check CXR and treat or if nondiagnostic->assess for PE, cardiac risk/markers, pericardditis, dissection 3. if EKG STEMI: PCI in 90min (give heparin or clopidogrel on way) or thrombolytic in 30min 3. if EKG NSTEMI: anticoagulate and medical optimize->routine cardiac angiography w/in 24hr |
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How to manage GERD on initial presentation?
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-if typical GERD: empiric therapy w/ PPI
-if complicated GERD (dysphagia, odynophagia, weight loss, overt/occult bleed, Fe deficiency anemia)->endoscopy/esophagoscopy and bx indicated -if fails empiric PPI: endoscopy |
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ductopenia most commonly occurs in?
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primary biliary cirrhosis (has loss of intrahepatic bile ducts, seen in vanishing bile duct syndrome)
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Findings on auscultation of consolidation
Pleural effusion PTX Emphysema Interstitial lung dz Mucus plugging |
-dull percus, bronchial breath sound (louder on expiration), egophany, Increased fremitus
-dull percus, decreased breath sound, down fremitus -hyperres percus, absent breathS, down fremitu -hyperres percus, vesicular breathS (decreased intensity), wheezing, down fremitus -resonent perccus, vesicular breathS, fine crackles end inspiration. -collapsed lung segment->no breathS |
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Any hemorrhage/blood from introitus b4 20wga w/ living fetus by U/s=?
TMT? |
threatened abortion
-after confirm fetus is alive by U/S->reassurance and outpt followup w/ U/S 1wk later (recommend bed rest and abstain from sex->not actually making difference but prevents guilty feelings if abort) |
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Signs of coarctation of aorta?
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In Turners:
Rib notching, continuous mild murmur all over chest (from collateral btwn hypertensive and hypoperfused vessels), leg muscle fatigue (poor lower body perfusion), difference BP arms, HTN, HA |
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Pt w/ down's now w/ urinary incontinence.
ML Dx? Other findings/ Dx TMT? |
Atlantoaxial instability (malformation w/ laxity posterior transverse ligament allowing motion btwn C1 C2)
-behavior change, torticollis, vertebrobasilar sx (dizzy, vertigo, diplopia), leg spastic, hyperreflexic, +babinski, clonus (normally Down's pts are hypotonic) -open mouth XR -surgical fusion C1 to C2 |
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Immediate TMT to relieve sx of pulm edema in CHF?
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1. O2
2. loop diuretic (reduce preload) 3. Nitrate/NitroG (reduce preload) 4. Morphine |
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How do nitroglycerin work to reduce anginal pain?
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dilate veins (capacitance vessels) causing venous pooling decreasing ventricular preload and thereby heart size->less O2 requirement heart
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7day old neonate brought by mother for decreased movement of arm, born w/ shoulder dystocia, arm has crepitus and bony irregularity over clavicular area w/ absent moro reflex.
ML Dx? TMT? |
Clavicle fracture (occurs usually on R during labor w/ infants of large size, shoulder dystocia, traumatic deliver)
-No tmt, will heal w/in 3-6wks |
