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121
Medical
Post-Graduate
11/19/2016

Additional Medical Flashcards

 


 

Cards

Term
What is the differential for HIV diarrhea?
Definition
1) Cryptosporidium: watery with acid-fast + oocytes
- Supportive and HAART

2) MAC: watery, high fever, CD4 < 50

3) CMV: Bloody diarrhea

4) Microsporidium: Afebrile, watery
Term
What are STI screening recommendations for pregnant women?
Definition
1) 21-24 or high risk, get GC/Chlamydia
2) All need HIV, Syphillis, Hep B
3) HIV or high risk: HCV
Term
Menstrual bleeding, pressure symptoms, dysmenorrhea, worsened in pregnancy

D/x and T/x?
Definition
Fibroids

Dx: Ultrasound
Tx: Observation or OCPs, embolization or surgery
Term
What is the differential for hyper-androgenism in pregnancy?
Definition
1) TL cysts: bilateral, associated with molar and multiple gestation
2) Luteoma: yellow mass, solid on US. fetal risk high
3) Krukenberg: bilateral solid masses, mets from primary GI.
4) Ovarian malignancy
Term
Pulsus paradoxes with mid-diastolic "knock" sound.
Definition
Constrictive pericarditis leading to RHF

Viral, prior surgery, radiation, TB
Term
Infant with FTT, bilateral cataracts, hypoglycemia, jaundice

D/x and T/x?
Definition
1) Galactosemia: Galactose-1 phosphate UT deficiency

2) Eliminate galactose
Term
Rapid onset hemarthrosis after knee injury.
Definition
ACL tear.

Will need surgery (vs. PCL). Get MRI
Term
Classic signs of referring syndrome?
Definition
Insulin increase leads to low K, Mg, Phos, Thiamine

Wernicke Korsakoff, Seizures and Arrhythmia
Term
HIV drug reactions

1) Didanosine
2) Indinavir
3) Abacavir
4) NRTI
5) NNRTI
6) Nevirapine
Definition
1) Pancreatitis
2) Crystal nephropathy
3) Hypersensitivity
4) Lactic acidosis
5) SJS
6) Liver failure
Term
Workup for suspected epithelial ovarian cancer
Definition
1) Pelvic US followed by CA-125 (then CT or exploratory surgery)

2) Ex-lap is definitive treatment with adjuvant chemo.

3) DO NOT perform biopsy because could spread the cancer
Term
Classic signs of Digeorge
Definition
Get Echo and Calcium level

1) Cardiac
2) Abnormal facies
3) Thymic aplasia
4) Cleft palate
5) Hypercalcemia
Term
Painful vaginal bleeding and firm tender uterus in pregnant woman with abdominal and/or back pain

What are the Res?
Definition
Placental Abruption

Smoking, HTN, Cocaine, Pre-ecclampsia
Term
Differentiate between placenta previa and vasa previa
Definition
Both are painless vaginal bleeding in pregnancy

Placenta has normal FH tracing. Vasa previa with have abnormal tracings (deceleration).
Term
Gestational maternal virilization with virilized fetus with ambiguous external genitalia, but normal internal genitalia
Definition
Aromatase Deficiency
Term
Polymyositis vs. Dermatomyositis
Definition
1) Polymyosis: biopsy with mononuclear infiltrate and necrotic/regenerating fibers.

2) Dermatomyositis: biopsy with
- Anti-jo antibodies
- Gottron papules
Term
Erythematous patches and plaques with yellow, oily scales. Usually on scalp.

D/x and T/x
Definition
Seborrheic Dermatitis: M. furfur (fungus)

Emolients and shampoos
Term
Hair loss, abnormal taste, bullous lesions and poor wound healing in patient on TPN
Definition
Zinc deficiency: Jejunum
Term
Absent lymphoid tissue (tonsils, LNs) in child with recurrent infections.

D/x and T/x
Definition
Bruton's Agammaglobulinemia

- No immunoglobulins, but normal number of B cells
- XLR disorder
- TMP/SMX, Itraconazole ppx
Term
Palpable purpura (non-blanching), hematuria, abdominal pain, arthralgias, scrotal swelling

D/x and T/x
Definition
HSP: IgA vasculitis

Ill-Ill Intussusception is risk: needs surgery

Give hydration, NSAIDs and steroids
Term
P. vulgaris vs. Bullous pemphigoid
Definition
1) P. vulgaris
- Antibody against Desmoglein
- Positive Nikoslky
- Netlike intercellular IgG on biopsy
- Systemic steroids and wound care

2) B. pemphigoid
- Antibodies against hemidesmosomes
- Negative nikolsky
- Linear IgG deposits and C3 on BM
- Topical GC (Clobestasol)
Term
Metabolic alkalosis

1) High urine chloride, saline non-responsive
2) Low urine chloride, saline responsive
Definition
1) Hyper-aldosteronism, Cushings, etc

2) Diuretics or Vomitting
Term
Autosomal Dominant expansion of CTG in DMPK gene presenting with balding, cataracts and testicular atrophy common
Definition
Myotonic Muscular dystrophy
Term
Dysmenorrhea differential

1) normal exam and crampy pain. NSAIDS and OCPs 1st line

2) dyspareunia, and dyschezia, as well as infertility risk

3) heavy menses with clots, constipation, urinary frequency, enlarged uterus on exam

4) Pelvic pain, menorrhagia, bulky, globular and tender uterus

5) Dull and ill-defined pelvic ache worse with standing
Definition
1) Primary: normal exam and crampy pain. NSAIDS and OCPs 1st line

2) Endometriosis: pain before menses (dysmenorrhea), dyspareunia, and dyschezia, as well as infertility.

3) Fibroids: heavy menses with clots, constipation, urinary frequency, enlarged uterus on exam

4) Adenomyosis: Pelvic pain, menorrhagia, bulky, globular and tender uterus. Endometrium in myometrium

5) Pelvic congestion: dull and ill-defined pelvic ache worse with standing
Term
XLR disease with pulmonary (abscess) and cutaneous infections w/ catalase-positive organisms.

Also organism filled PMNs typical

D/x and T/x?
Definition
CGD

1) Dihydrohodamine 123 test or Nitroblue tetrazolium test

2) Antimicrobial PPX with Bactrim and Itraconazole and IFN-y to boost intracellular killing.
Term
Eczema, thrombocytopenia and recurrent infections
Definition
WAS: XLR disease. Microtubule disorder
Term
EBV DNA in CSF of HIV positive patient
Definition
Primary CNS lymphoma
Term
Arrythmia Foci Locations

1) A fib
2) A flutter
Definition
1) Pulmonary veins

2) Tricuspid annulus
Term
Why/when use CS in treatment of PCP pneumonia?
Definition
Minimize antibiotic-induced worsening of respiratory function
Term
IgA Nephropathy vs. PSGN
Definition
1) IgA: 5d of URI, normal Complement and mesangial IgA deposits on biopsy

2) PSGN: 10-21d after URI, has Low C3, elevated anti-streptolysin O or anti-DNAse B with Kidney biopsy showing sub-epithelial humps of C3.
Term
Treatment of Torsaddes
Definition
Treat with MgSO4 if HDS or if HD unstable, immediate defibrillation.
Term
Digoxin Toxicity
Definition
Anorexia, N/V/AP, Hyperkalemia, color vision alterations

Atrial tachycardia with AV block (increased ectopy and vagal tone)
Term
Joint Fluid Characteristics for Normal, OA, Inflammatory and Septic joints?
Definition
1) Normal: Clear, <200 WWBC, <25% PMNs

2) OA: Clear, 200-2000 WBC, 25% PMN

3) Inflammatory (crystals, RA): Translucent or Opaque, 2k-100k WBC, >50% PMNs

4) Septic: Opaque, 50-150k WBC, 80-90% PMNs
Term
Differential for Hyperandrogenism in females
Definition
1) PCOS: oligo-ovulation, polycystic ovaries on imaging

2) Nonclassic CAH: oligo-ovulation, increased 17-OH-progesterone

3) Ovarian/Adrenal Tumor

4) Hyperprolactinemia: Amenorrhea, galactorrhea, high prolactin

5) Cushing’s’: Nonsuppressible dexamethasone suppression test,
Term
Workup for hypotension with hypokalemia
Definition
Primary Hyper-aldosteronism

1) Aldosterone/renin ratio (>20?).

2) If elevated, try adrenal suppression testing (salt loading)

3) If Suppression testing is positive, get CT
- Unilateral hyperplasia gets surgery. Bilateral gets medical
Term
What is pathophysiology of hyperthyroid bone disease?
Definition
1) Increases osteoclast activity leading to hypercalcemia

2) Hypercalcemia drives down PTH, which decreases cacium reabsorption, leads to hypercalciuria and calcium wasting.
Term
RF, specific signs and treatment for Uterine Rupture
Definition
1) Prior uterine surgery (cesariean)

2) Intense abdominal pain, loss of fetal station (pathognomonic)

3) Urgent Ex Lap
Term
Management of Chorioamnionitis
Definition
1) IV antibiotics and give Oxytocin to promote delivery.

2) NOT an indicator for cesarean.
Term
What is risk of using Erythromycin in infants?
Definition
Hypertrophic pyloric stenosis
Term
HIV positive patient develops hemiparesis, speech disturbances and CN deficits

MRI shows multiple demyelinating, non-enhancing lesions without mass effects
Definition
Progressive multifocal leukoencephalopathy (PML)

Infection caused by JC virus, a polyomavirus. No effective treatment
Term
How can you lower risk of edema when using Dihydropyridine CCBs like Amlodipine?
Definition
Add Ace inhibitor
Term
Anti-Malarial Chemoprophylaxis

1) Chloroquine-resistant P. falciparum (Africa, Southern and SE Asia)

2) Chloroquine-susceptible

3) Areas without P. falciaparum (South America, Mexico, Korea)
Definition
1)
- Mefloquine: Neuropsychiatric, but best in pregnancy
- Atovaquone prograunil: GI disturbances, expensive
- Doxycycline: cheep, but GI disturbance and teratogen

2) Chloroquine/Hydroxychloroquine: 1-2 weeks in advance

3) Primaquine: G6PD hemolysis
Term
Differential for tall patients with joint hyperlaxity and ectopic lentis
Definition
Marfinoid

1) Homocystinuria
- Elevated homocysteine and methionine levels due to cystathione synthase deficiency.
- Fair hair and eyes, AR inheritance, developmental delay and CVA.
- Give B6, folate, B 12 and anticoagulation (CVA)

2) Marfan’s: Aortic root dilation, AD inheritance, normal intellect.
Term
Painless blisters, skin fragility on dorsal surface of hands, hyperpigmentation in patient with HCV. Symptoms developed after drinking alcohol.
Definition
Porph CT

- Deficiency of uroporphyrinogen decarboxylase (heme synthesis)

- Dx: elevated urinary porphyrin levels

- Tx: Phlebotomy or hydroxychloroquine, or interferon alpha (if also have HCV)
Term
Breastfeeding is recommended exclusive feeding <6m

What are absolute contraindications?
Definition
1) Maternal Contraindications: Active substance abuse, active untreated TB, HIV
- HBV and HCV are NOT.

2) Infant Contraindications: Galactosemia
Term
Valgus (abduction) pain after knee trauma with clicking sound
Definition
MCL. Get MRI. Usually RICE management.
Term
Chemo-induced nausea. how do you manage? What about chemo-induced anorexia? What about pain?
Definition
1) Nausea: First line is Serotonin receptor antagonists (Ondansetron) that target 5HT3 receptor

2) Anorexia: Progestins

3) Pain: Short-acting opioids
Term
ypopigmented, hyperpigmented or mildly erythematous lesions
Definition
Tinea Versicolor, Malasthesia Globosa

Diagnosis: KOH prep showing hyphae and yeast cells (Spaghetti and meat balls)

Tx: Topical Ketoconazole, Terbinafine or Selenium Sulfide
Term
Management of childhood lead poisoning
Definition
- 1st step draw venous lead level (sometimes capillary finger stick for screening)

1) If mild (4-44) no meds, repeat in 1month
2) If moderate (45-69): give DMSA
3) If severe (>70): Give Dimercaprol (British Anti-Lewisite) + EDTA
Term
Workup for precocious puberty

< 8 in girls and < 9 in boys
Definition
1) Determine bone age. If advanced, get basal LH level.

2) Low LH, get GnRH stimulation test
- If high (central)
- if low (peripheral)

3) If normal bone age, think isolated breast (thelarche) or public hair (adrenarche)
Term
Management of suspected malignant OME
Definition
IV ciprofloxacin empirically
Term
Differential for neonatal respiratory distress
Definition
1) Transient tachypnea: poor alveolar fluid clearance leads to mild pulmonary edema shortly after birth with resolution by day 2
- Bilateral perihilar linear streaking

2) RDS: Surfactant deficiency leads to alveolar collapse and diffuse atelectasis
- Diffuse reticulogranular (ground-glass) appearance with low lung volumes
i- Maternal antenatal glucocorticoids and continuous PAP ventilation after birth.

3) Persistent pulmonary HTN: High pulmonary vascular resistance leading to R-L shunting and hypoxia. See Tachypnea and cyanosis
- Clear lungs with decreased pulmonary vascularity.
Term
Tick bite leading to hemolytic anemia, renal failure, NO rash
Definition
Babesiosis: Ixodes tick

- Dx: Giemsa-stained thick and thin blood smear
- Tx: Quinine-clindamycin and Atovaquone-Azithromycin
Term
Nerve-arm injury

1) Midshaft humerus
2) Supracondylar
3) Surgical neck
4) Medial epicondyle
Definition
1) Radial, axillary artery
2) Median nerve, brachial artery
3) Axillary nerve
4) Ulnar nerve
Term
Abnormal Uterine Bleeding in adolescent with no other abnormalities
Definition
1) Immature HPO axis leading to anovulatory cycles (but still evaluate for pregnancy)

2) Tx: First line is high-dose IV or oral estrogen (Conjugated equine estrokgen) combined with high-dose combined OCPs)
Term
Approach to Adult Cardiac Arrest
Definition
1) Vfib/or pulseless VT: Shock then CPR x 2min

2) Asystole/PEA: CPR x 2 min and Epi every 3-5 min. No role for defibrillation or cardioversion (QRS synchronized)
Term
Autoimmune HA: Warm vs. Cold
Definition
1) Warm agglutinin:
- Direct coombs + with anti-IgG, anti-C3 or both
- Tx: steroids and splenectomy for refractory
- Complications: VTE, lymphoproliferative

2) Cold agglutinin
- Direct coombs + with anti-IgM or anti-C3
- Avoid cold. Ritxumab.
- Complications: Ischemia, lymphoproliferative
Term
How is Pes anserinus different from MCL tear in presentation?
Definition
Both have medial knee pain and focal tenderness.

PA, however, is Not aggravated by valgus stress test
Term
First steps in evaluating infertility
Definition
1) Functional:
- Early follicular phase FSH level, Clomiphene challenge, or Inhibin-B level

3) Anatomical
- Hysterosalpingogram.
Term
Best intervention to prevent diabetic nephropathy
Definition
BP control (130/80)
Term
Medically stabilize bony metastatic lesions
Definition
Bisphosphonates
Term
Surveillance tests in Cirrhosis
Definition
1) All need Endoscopy to evaluate for esophageal varices.

2) 6 month US for HCC
Term
Bronchogenic Carcinoma vs. Mesothelioma is Asbestos exposure
Definition
1) Bronchogenic
- bibasilar reticulonodular infiltrates, honeycombing, pleural plaques

2) Mesothelioma
- unilateral pleural abnormality with large effusion.
Term
Young adults of Turkish, ME or Asian descent with recurrent painful oral ulcers, genital ulcers, eye lesions (Uveitis), skin lesions.

Major cause of morbidity?
Definition
Behchet's. Thrombosis

Dx: Pathergy (exaggerated skin ulceration with minor trauma) and Biopsy (Non-specific vasculitis of different-sized vessels
Term
Management of Congenital QT
Definition
Beta blockers and pacemaker to prevent Cardiac Arrest
Term
Types of Nephrotic Syndrome
Definition
1) Membranous glomerulopathy: most commonly see renal vein thrombosis (abdominal pain, fever and gross hematuria). Associated with malignancies (solid cancers) and HBV

2) MPGN: HBV, HCV, Lipodystrophy

3) FSGS: AA and Hispanic, obesity, HIV and heroin

4) Minimal change: Tx is steroids. Only biopsy if treatment fails. Associated with NSAIDs and lymphoma

5) Amyloidosis: associated with MM, Waldenstrom macroglobulinemia, RA, IBD
Term
T/x of umbilical chord compression
Definition
1) Variable decelerations

2) 1st line Tx for persistent decellerations (>50% of time) is Maternal repositioning

3) 2nd line is amnioinfusion
Term
Benign bone-forming tumor of adolescence affecting proximal femur. Worse at night without relation to activity
Definition
Osteogenic Osteoma: can present like growing pains

Give NSAIDs (serial X rays)
Term
PNA types in CF in children and adults
Definition
1) Staph aureus is most common in children: give Vancomycin

2) Pseudomonas is most common in adults
Term
Toxicities in house fire
Definition
1) CO: carboxyhemoglobin, 100% O2 via re-breather

2) HCN: Hydroxycobalamin, sodium thiosulfate, or induce Methemoglbinemia with Nitrates
Term
Diagnosing HIV in newborns
Definition
PCR to diagnose HIV in newborn up to 18 months b/c of maternal transferanse of antibodies.

HAART should be started immediately
Term
Treatment of Wilson's disease
Definition
d-penicillamine or trientine and oral zinc (prevent Cu absorption).
Term
AR degeneration of spinal tracts

Hypertrophic CM is commonly seen and patients die of cardiac complications.
Definition
Friedreich ataxia (spinocerebellar ataxia)
Term
Birth management of placenta previa
Definition
C-section between 36-37 weeks.
Term
T/x of Tourette Disorder
Definition
Risperidone (b/c SE of Haloperidol and Pimozide)
Term
Palpable purpura, proteinuria and hematuria, with Non-specific: arthralgias, HSM, peripheral neuropathy and hypocomplementenemia
Definition
Mixed essential cryoglobulinemia: HCV association

Look for porphyria cutanea tarda on hands as evidence of HCV

Dx: circulating cryoglobulins.
Term
ALL features
Definition
1) >25% lymphoblasts in bone marrow diagnostic. TdT (Expressed in Pre-B and Pre-T) test positive and PAS+ material.

2) Lack peroxidase positive granules seen in AML
Term
Strongest predictor of AAA expansion and rupture
Definition
cigarette smoking
Term
Gene defect leading to failure of T cell development and B cell dysfunction due to absent T cells
Definition
SCID

Tx: Stem cell transplant
Term
Management of neonatal thyrotoxicosis
Definition
self resolves in 3 months. Methimazole + Beta blocker
Term
First step in w/u of virilizing neoplasm
Definition
1st test is testosterone and DHEAS level
Term
Normal T4 and TSH, elevated free T3
Definition
Euthroid Sick Syndrome

Decreased peripheral 5’-deioindation of T4, usually in acute, severe illness.
Term
Prevention of contrast-induced nephropathy
Definition
Prevent with IV hydration with isotonic bicarb or NS with administrating of acetylcysteine
Term
Management of solid testicular mass
Definition
Remove it and cord with radical orchiectomy (no FNA b/c risk of spillage).
Term
Most common complication of sickle cell trait
Definition
painless hematuria and isosthenuria (impaired concentration)
Term
How do you diagnose condition associated with Hexagonal, radiopaque, hard crystals?
Definition
Hereditary Cystinuria: Cyanide nitroprusside test.
Term
Protozoal disease in latin America that causes megacolon and cardiac disease.
Definition
Chagas disease: T. cruzi
Term
Management of cocaine toxicity and myocardial ischemia
Definition
1) Supplemental oxygen and IV BDZ!

2) Don’t give beta blockers (worsen coronary vasoconstriction)
Term
Acute unilateral lymphadenitis in child
Definition
staph aureus (second is GAS)
Term
A/C option if GFR< 30
Definition
Unfractionated Heparin

Cannot use LMW heparin, fondaparinux or rivaroxaban
Term
Differential for gross hematuria
Definition
1) Bladder (cystitis, cancer)

2) Renal (glomerulonephritis)

3) Ureteral (nephrolithiasis)

4) Prostate (BPH)

5) Sickle Cell Trait: Renal papillary necrosis (ischemic)
Term
Toxicity of Trastuzumab for HER-2 + BC
Definition
Cardiac toxicity is issue (get echo before starting to look for baseline low EF)
Term
CM vs. CES
Definition
CM is symmetrical and UMN
CES is asymmetrical and LMN

Both need emergency MRI, steroids and NS consult
Term
Diagnostic test for Celiac Diseasse
Definition
1) D-xylose test of proximal small intestinal absorption. Celiacs cannot aborb it and low levels end up in urine.

2) If malabsorption is due to enzyme deficiencies, they will have normal D-xylose test.
Term
Severe blunt chest trauma with delayed respiratory failure that is worsened by IV expansion
Definition
Pulmonary Contusion
Term
Management of Preterm labor
Definition
1) 34-36: betamethasone and PCN if GBS unknown

2) 32-34: betamethasone and tocolytics (indomethacin and nifedipine) and PCN if GBS unknown

3) < 32: betamethasone, tocolytics, MgSO4 and PCN if GBS unknown.
Term
Cough coryza and conjunctivitis followed by exanthema sparing palms and soles.
Definition
Measles: Vitamin A for support
Term
Pathophysiology of esophageal defects of Systemic sclerosis
Definition
smooth muscle atrophy and fibrosis
Term
When are HJ bodies found?
Definition
Remnants of RBCs processed by spleen. Seen in aslpenia (SCC common).
Term
Pressure findings in Cor Pulmonale
Definition
Increased PA systolic pressure, not PCWP
Term
Diagnosis of Esophageal rupture
Definition
Get water-soluble contrast esophogram (left sided pleural effusion)
Term
Immunosuppresseur toxicity

1) Azathioprine
2) Cyclosporine
3) Tacrolimus
4) Myco Mofitil
Definition
1) GI, liver, leukopenia
2) Gingival, hirsutism, nephropathy, hyperkalemia
3) Just nephropathy and hyperkalemia
4) bone marrow suppression
Term
Complication of cardiac cath
Definition
1) Retroperitoneal hematoma: sudden hemodynamic instability and flank/back pain. Get non-contrast CT to diagnose.

2) Also Choelsterol embolism
Term
What can you use to prevent Uric Acid stones?
Definition
Potassium citrate alkalinizes urine
Term
Unimmunized mother with umbilical stump infection. Poor sucking, rigidity and spasticity.
Definition
Neonatal Tetanus
Term
Chondrocalcinosis and joint pain common in hereditary hemochromatosis
Definition
Chondrocalcinosis and joint pain common in hereditary hemochromatosis
Term
Cyanosis and loud single S2 in child
Definition
Transposition
Term
Persistent PTX after chest tube placement
Definition
bronchial rupture
Term
Which cause of hyponatremia is worsened by volume expansion with NS?
Definition
NS infusion in SIADH will worsen hyponatremia (think about in case of lung pathology).
Term
Starts with abdominal pain, N/V, then has subungual splinter hemorrhoraages, periorbital edema and chemosis. Eosinophilia and myositis common
Definition
Trichinellosis
Term
How can obesity cause amenorrhea?
Definition
because of anovulation (FSH/LH should be normal, as opposed to elevations in premature ovarian failure).
Term
How can Preeclampsia lead to IURG?
Definition
UP insufficiency (late deceleration)
Term
How do you treat ethylene glycol poisoning?
Definition
Give fomepizole or ethanol to inhibit ADH, and NaHCO3 to alleviate acidosis
Term
What neurological complication is associated with Mumps?
Definition
Mumps associated with Aseptic Meningitis
Term
Associated complications of PBC
Definition
malabsorption, metabolic bone disease (osteoporosis, osteomalacia), and HCC
Term
Pulmonary nodules with surrounding ground-glass opacity (halo sign)
Definition
pulmonary aspergilliosis
Term
Hematological findings of G6PD deficiency
Definition
bite cells and Heinz bodies
Term
Dietary recommendations for renal calculi
Definition
increase fluids, decrease sodium, normal calcium
Term
Brain and Liver (microvesicular fatty infiltration) in child starting new medication
Definition
Reye's syndrome
Term
Management of cough 2/2 PND
Definition
start with first-generation antihistamine (chlorpheniramine) or combined antihistamine/decongestant
Term
punched out erosions and hemorrhagic crusting in patient with atopic dermatitis
Definition
HSV super-infection
Term
Fever and Liver Cyst
Definition
Fever and liver cyst: think Entamoeba. Otherwise think Echinococcus
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