step 2 - extra cards

peds w/ periumbilicul → rlq pain, mucus stools, fever

infectious ileocolitis

campylobacter

peds w/ pain worse at night, better with nsaids

osteoid osteoma

tx for persistent pulmonary htn of newborn (ie, in meconium aspiration syndrome)?

nitrous oxide

↑ cyclic GMP in smooth muscle cells of pulmonary arteries → dilation → ↓PVR, ↓ r→l shunting through ductus arterioisis

½ life of only few seconds = only vasodilates pulm

tx for moderate-severe dehydration in children?

IV isotonic crystalloid (20mL/kg of normal saline bolus)

what’s used to diagnose vesicoureteral reflux? us is normal

voiding cystourethrogram

what is standard of care for malaria prophy?

chemoprophy before, during, and after visiting an endemic region

atovaquone, proguanil, doxy, tafenoquine, mefloquine if resistant to chloroquine (ie, india)

what is the most strongly indicated thing to improve a patient w/ copd’s ability to perform ADLs & reduce risk of copd-related hospitalizations?

pulmonary rehab!

(metabolism) copd leads to….

renal tubular compensation (metabolic alkalosis) to combat respiratory acidosis long-term

hx of dark urine & anemia, now with hemolytic anemia, jaundince, & splenomegaly and RUQ abdominal pain. does not go to doctor/never been evaluated for this

what’s the chronic condition? what does he have rn and why?

what other treatments should we start?

hereditary spherocytosis d/t deficiency in tbc scaffolding proteins (spectrin, ankyrin)

↑ mean corpuscular hemoglobin concentration due to membrane loss & rbc dehydration

RUQ pain due to pigment gallstones → cholecystitis

ggive folate (chronic hemolysis consumes it) & may require splenectomy

tx of hodgkin lympoma involves ___ and raises your risk of ____

chemoterapy & radiation therapy, secondary solid-organ malignancy & cardiovascular disease

what are the two major toxicities of methotrexate?

inhibits dihydrofolate reductase → folate deficiency → macrocytic anemia

hepatotoxicity

other ses: nausea, stomatitis, rash, ILd, alopecia, fever

give folate & avoid alcohol

AST:ALT >/= 2:1 means?

alcoholic hepatitis

if acromegaly is suspected, what do you measure?

igf-1

it is consistenly elevated throughout the day while gh fluctuates (low sens/spec)

treat gastroparesis with…

metoclopramide

heterophile antibody test is used to dx…

EBV/mono

“monospot” test

VDRL is used to dx…

syphilis (nontreponemal test)

initial screening, quantitative, high sens but low spec. ab against lipoidal antigens like cardiolipin.

RPR is used to dx…

syphilis (nontreponemal test)

initial screening, quantitative, high sens but low spec. ab against lipoidal antigens like cardiolipin.

FTA-ABS (fluorescent treponemal antibody absorption test) is used to dx…

syphilis (treponemal test)

qualitative, confirmatory. high sens & spec

TPPA )treponema pallidum particle agglutination) test is used to dx…

syphilis (treponemal test)

qualitative, confirmatory. high sens & spec

what is the abx for congenital/intrapartum syphilis?

panicillin g benzathine

you desensitive pts if allergic because its the only good drug!!!

what is the cutoff for orthostatic hypotension?

alcoholic cardiomyopathy is a (type) and (ir/reversible)

dilated & reversible w/ cessation of drinking

3 most common bugs in a brain abscess:

staph aureus

viridians strep (mutans, salivarius, anginosis, mitis, sanguinis, borivs)

anaerobes

what vitamin deficiency increases the risk for hydatidiform moles?

vitamin a

pt has postpartum uterine atony. htn. what do you avoid?

methylergonovine → potent vasoconstrictor → increased risk of stroke in hypertensive pts

how to treat postpartum uterine atony

1. bimanual uterine massafe & high-dose oxytocin

2. tranexamic acid - antifibrinolutic (best within 3 hrs of delivery, use for any PPH like retained placenta)

3. carboprost tromethamine - stimulates contractions to increase tone & decrease bleeding; synthetic prostaglandin f2a analog, CAN CAUSE BRONCHOSPASM

4. methylergonovine - potent vasoconstrictor

vwf deficiency - what are the lab results?

normal pt

normal ptt

prolonged bleeding time

what measurements mean oligohydramnios?

AFI<5cm*

DVP (deepest vertical pocket) <2cm

*aafp says this is not great, use the other one

lichen sclerosus presents in ___ and __ populations as they are _

young (prepubertal) and old (postmenopausal) vulva-havers, as they are low estrogen

decreased fetal movement & nonpainful but regular contractions, no prenatal care. mother has fatigue, joint stiffness, and erythematous, confluent facial rash

fetal AV block due to mother’s lupus

what’s the screening protocol for AAA?

what is the cutoff for latent tb with a tst?

>/= 5 mm at 48-72 hours

what tests should be done in patients taking hydroxychloroquine?

opthalmalogic eval

what are the absolute contraindications to ocps?

____ and _____ murmurs are usually pathologic and require an _____ for evaluation

diastolic & continuous, echocardiogram

aortic regurgitation murmur

early, decrescendo diastolic murmur that begins right after A2

high pitched, blowing; best heard along left sternal border at 3/4th intercostal spaces with pt sitting up & leaning forward while holding breath in full expiration

thiazides like chlorthalidone, hctz, can cause ____

dose-dependent hyperglycemia

impair insulin release & glucose utilization in peripheral tissues

(biostats) ↑ sample size = __ power

↑

(biostats) ↑ effect size = __ power

↑

(biostats) ↑ significance level = __ power

↑

(biostats) ↓ outcome variability = __ power

↑

what heart murmur is related to angiodysplasia & why?

aortic stenosis, possibly due to acquired vWF deficiency (disruption of multimers passing through turbulent valve)

angiodysplasia = dilated submucosal beins & avms, ↑ after 60y; asymptomatic require no tx, otherwise endoscopic cautery

acute rejection happens within the _____ of transplant.

first 6 months

Bk virus reactivation vs acute rejection in renal transplantation

BK virus: too much immunosuppression → tubulointerstitial nephritis, asymptomatic acute increase in cr, intranuclear inclusions & mixed lymphocutic & neutrophilic infiltrate

acute rejection: within 1st 6 months of transplant; asymptomatic or fever, decreased urine, graft tenderness, w/ ↑ cr & proteinuria; lymphocytic infiltration of intima with inflammatory tubular disruption, also intimal arteritis; reversible w/ high dose IV glucocorticoids & increasing immunosuppresion

NPV =

individuals with negative test do NOT have the disease (true negatives)

PPV =

individuals with a positive test HAVE the disease (true positives)

sensitivity =

proportion of individuals with disease for which the test was positive

TP/(TP+FN)

rules OUT disease, best for screening

specificity =

proportion of individuals without the disease with a negative test

TN/(TV+FP)

CONFIRMS disease, best used after a high-sensitivity screening test

1 - sensitivity =

false negative rate

1 - specificity =

false positive rate

( review the different stats tests )

list what hla-b27 is associated with. is it specific?

seronegative spondyloarthropathies and other autoimmune conditions:

• Ankylosing spondylitis

• Psoriatic arthritis

• Acute anterior uveitis

• IBD-associated ankylosing spondylitis

• Reactive arthritis

A-PAIR

no! not specific. it is a mhc1 allele

lead poisoning

tx for high-altitude sickness?

dexamethasone

vitiligo is associated with (autoimmune disease)

thyroid > DM1

weakness, lightheadedness, dry mucuous membranes, nausea, diffuse abdominal pain, weight loss, orthostatic changes, and hyperpigmented buccal mucosa. dx?

primary adrenal insufficiency

24h urine collection for vanillylmandelic acid and 5-hydroxyindolacetic acid is for diagnosing…..

neuroblastoma (van) or carcinoid (5-hy)

adrenal venouse sampling is for diagnosing….

primary hyperaldosteroism (ie, adrenal adenoma vs vilateral adrenal hyperplasia)

measurement of catecholamines and metanephrines is used for diagnosing….

pheochromocytoma

tx for mastitis?

dicloxacillin & continued breast feeding

hypersensitivity pneumonitis

56F with chronic fatigue

chronic myeloid leukemia

normal development - not extreme, no significant occupational or social problems

do hiv pcr

mono-like sx & leukopenia? hiv until proven otherwise

ankylosing spondylitis has a high risk of…

osteopenia/porosis due to increased osteoclast activity in the setting of chronic inflamation (il 6, tnf-a)

so have low threshhold for suspicion of vertebral fracture after a fall

conus medullaris syndrome vs cauda aquina syndrome

what is the triad of sx for disseminated gonococcal infection?

hydroxyurea has ___ as its major side effect

myelosuppression (neutropenia, anemia, thrombocytopenia)

stable patients should receive a transfusion of ___ when the hgb is ___

packed rbcs, <7 g/dL

acute coronary syndrome patients can receive a transfusion of ___ when the hgb is ___

packed rbcs, <9

uncomplicated seizure after receiving a vaccine is/is not a contraindication to future vaccination

IS NOT

give the timeline

_____ is a recreational party drug that can cause serotonin syndrom

ecstasy

what is the causative agent of refeeding syndrome?

insulin

delayed puberty is absence of breast tissue after age ___

13

intermittent dysphagia, regurg of undigested food, aspiration pna. likely dx?

zenker diverticulum

treatment for central diabetes insipidus?

subq vasopressin

alcohol use causes a ir/reversible ____ cardiomyopathy

reversible dilated cardiomyopathy

______ is a cardiac drug that can cause pulmonary fibrosis

amiodarone

what are the hormonal changes in menopause? what is the most sensitive hormone to measure?

↓ estrogen → ↓ FSH, LH

FSH is the most sensitive marker

having a unicornate uterus is associated with ____ & _____

preterm labor & having only 1 kidney

lithium tox

hemodialysis if AMS, seizures, or life-threatening arrhythmia

systolic murmurs require ____ antibiotic prophylaxis

no

what is an important value to look at when someone is hypoglycemic repeatedly?

c-peptide

low = they’re injecting themselves with insulin

hypersensitvity pneumonitis - cause, features, dx, tx

inhalation of env/occupational antigens, usually animal (birds), fungi, bacteria, or inorganic chemicals leading to interstitual lung disease

acute - constitutional, flu-like sx, leukocytosisl; or more chronic - cough, dyspnea, fatigue, weight loss

diagnosed via hx & ct of chest showing fibrosis. also lymphocytosis on bronchoaleolar lavage, noncaseating granulomas on histopathology

avoid antigen, usually resolves spontaneously. can give glucocorticoids if symptoms persist. if refractory, may eventually require lung transplant

what are the requirements for acute liver failure diagnosis?

1. severe acute liver injury (ALT, AST often >1000U)

2. signs of hepatic encephalopathy (confusion, asterixis)

3. synthetic liver dysfunction (INR >/= 1.5)

______ is a hypertension drug associated with pancreatitits

hydrochlorothiazide

sweet odor on breath + envelop-shaped crystals in urinalysis =

ethylene glycol (antifreeze) ingestion

70M here for fatigue. hasnt seen a doctor in 20 years. eats lots of fast food and takes otc pain meds for intermittent back pain. urinalysis with trace protein, no casts. s4 and strong apical impulse on exam. US of abdomen reveals bilateral small kidneys

hypertensive nephrosclerosis

recurrent respiratory infections since starting daycare?

normal. kids are nasty

pertussis. look for stepwise illness!

cephalohematoma is ____ bleeding

subperiosteal, does not cross suture lines - firm, nonfluctuant

subgaleal vein shearing is ___ (peds)

hemorrhage involving the dural sinuses & scalp, leading to massive blood accumulation between the periosteum and galea aponeurotica

diffuse, fluctuant scalp swelling that extends beyond suture lines and potentially to the neck; expands over 2-3 days, can lead to hypovolemic shock, DIC, and death → supportive care required

HIV dementia is associated with ___

UNTREATED HIV

24M with penile lesion. tender with well-demarcated, undermined borders & purulent exudate on prepuce of penis. several smaller lesions near it. no penile discharge. enlarged, tender inguinal lymph nodes. what’s the bug & how do you treat it?

haemophilus ducreyi (chancroid) - gram - rod

azithromycin

what medication can be used to help pass a kidney stone?

tamulosin (a1 antagonist)

id you suspect meningococcal meningitis, should you do an lp?

NO, START VANC & CEF ASAP!!

turner syndrome is associated with…

aortic dissection, horseshoe kidney, osteoporosis, strabismus, myopia, recurrent otitis media, celiac disease, hypothyroidism

tissue transglutaminase looks for…

celiac disease