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Comlex 3 3

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ruhland1's version from 2018-09-18 20:14

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Question Answer
high arched palate + increased arm carrying angleTurner
fibroblast growth factor mutationachondroplasia (molly)
Down syndshort, endo cardiocushion defects, VSD ASD ToF PDA
MarfanMVP, aortic root dilitation, aortic diss
cystic hygromawebbed neck
shield chest co-arctation of aortain turner
streak ovaries45 XO
work-up for dx of turnerecho, renal u/s, BP, hearing screen
william synd"elfin", friendly, supravavlular aortic sten
supravalvular aortic stenwilliam
aortic root dilmarfarn
MVPmarfan
VSDdown
ASDdown
Tetrology of Falotdown
Patent ductus arteriosusdown
turner incidence1 in 10,000
cogenital midline neck 1 cm cystthyroglossal duct cyst
dermoid cyst Lhas hair and teeth and stuff
branchial cleft cystlateral to midline and overlies SCM
most lymphatic malformations areslow-growing cystic cervical masses
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Question Answer
smelly vagthink chlmydia or trichomonas
accelerated hcgthink molar preg
hyperthyroid inmolar pregnancy, up HCG * up FT4
hx PIDup ecotopic, preg but u/s shows no gest sac
PID sequelaescarring of fallopian tubes
common PID etiochyamydia or gonorrhea
ectopic present1st trimester abd px N V
ectopic txsrx + remove fallopian tube
ectopic srx exceptionsstable and sac < 3.5 cm
2nd leading cause of maternal mortectopic
location of ectopic95% fallop (75% in ampulla)
prior ectopicrisk up 10x
PIDrisk up 6x
advanced maternal agerisk up 3x
sx ecabdominal pain, irreg bleed, amnorrhea, F, cervical motion tenderness, adnexal mass
b HCG in ectlower than normal, should double q24h
if sx of ectopic present but u/s neg and b hcg <1500get repeat hcg and u/s in 48 hours
stable ectopic <3 CM and hcg <5000MTX
suspect ectopic give thisRhoGAM in Rh (-)
following treatment ectopictrend hcg levels
trichomonasdx with pelvic exam and wet mount, give Flagyl
refractory vag bleed and molar pregD and C
BISHOPgrades likelihood to achieve sucessfull induction
BISHOP factorcervical position, effacement, dilatation, softness
station0 station is at ischial spine, +4 is pelvic inlet, -5 is outlet
Dilationup to 2-3cm before active labor
Effacementcervix thickness normal is 0%, 50% is thinner, 100% is ready for baby
Positionanterior > posterior
consistencysofter the better
scores6-13 is a favorable
Bishop MnemonicCall PEDS for Parturition (Cervical Position, Eff, Dil, Station)
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Question Answer
COBRA(consolidated omnibus budget reconciliation act)law that prevents people from suddenly losing health coverage if lost job or work hours are cut
ERISA(employee retirement income security act)labor act that sets minimum standards for retirement and pensions
NMHPA(Newborn Mother's Health protection act)provides rules and laws regarding length of stay in the hospital for newborn and mother under community health)
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Question Answer
tick dzrocky mountain spotted fever and lyme disease
lyme stage earlyerythema migrans (target)
disseminated lymemultip eryth migrans, neuro sx like facial nerve palsy, meningitis, carditis
late lymearthritis, enceph, polyneuropathy
lyme tickixodes
bug lymeborrelia burgdrferi
erythema migransonset 7-14 days + constiutional symptoms
lyme carditisnew AV block or myopericarditis
lyme and CNS get CSF
lyme and jointsynovial asp
lyme txdoxy or amoxicillin
lyme tx and disseminatedrocephin
RMSF bugrickettsia rickettsii
RMSF vectorAmerican Dog Tick (Dermacentor Variabilis)
RMSF locationEast Coast, North Caroline Oklahoma
RMSFup constitutional and small vessel vasculitis hence petechial rash
RMSF rashspreads centripetally
RMSF txdoxy
RMSF and preg of ALLChloramphenicol
Cat Scratch diseaseG(-) bacillus Bartonella Henselae
Cat Scratch Disease presentunexplained tender LAD present for a week, ddx is acute pyogenic LAD worsens in 24 hours, CSD is more subacute
cat fecestoxoplasmosis of pregnancy
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Question Answer
Exhalation rib dysfunctionribs stuck in exhalation * do not move while inhaling
tx rib 3-5 exhaled ribinferior traction on rib 3 while patient inhales
tx rib 3-5 inhaled ribsuperior tractiton on rib 5 while patient exhales
BITEdirect MET, bottom in inhaled rib, top in exhaled rib
bucket handleR 6 - 10
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Question Answer
DiverticulitisLLQ pain eold, wbc, no guarding
guarding, rebound tender, hemodynamic dsuspect perf get a STAT flat plate
CT findings diverticbowel-wall thickening, fat stranding, abscess formation
uncomplicated diverticulitis txNPO D5W FQ or Rocephin + Flagyl
CT finds abscess in diverticulitisCT-guided percutaneous drainage
Barium studyindic to dx achalasia or strictures
40% patientslack leukocytosis in diverticuluitis
anemia in adult maleGI until proven otherwise
colonoscopyobtain 8 weeks post resolution of diverticulitis
R sided tumorsbleed and diarrhea
L sided tumordetected later as bowel obstructions
hepatic encephalopathyNH3 dn Na dn vol dn K
Uremia2/2 renal diseas
when see uremiaCKD 4-5
CKDup normochromic normocytic anemia
CKD 5 txHD
banana bagthiamine, folic acid, magnesium, thiamine prevents seizures
best way to determine severity of DKAserum HCO3
Lactuloselowers fecal pH and inhibits diffusion of NH3
hydroxcobalamintx cyanide and B12 def
Antiparietal cell ABin pernicious anemia up MMA and homocysteine L in B12 def
B12 def risksETOH, chrons, terminal ileum resection
N-ACfor APAP, mucolytic and prevents contrast induced nephropathy
adjunct in hep encephspironolactone
spironlactone in CHFonly if NYHA III / IV
lactulosetitrate to 3 soft BM qd
significant diarrheaup metabolic acidosis
lactulose is nota cause of intestinal malabsorption and works manly in the small bowel, MOA bact turn it into lactic acid and acetic acid therefore dn NH3 diffusion
hypokalemiain diarrhea
overdosed lactulose in hep encephdn K dn Na dn Vol * up renal failure * up hepatorenal syndrome
Jaundiceseen in >2.5 bili
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Question Answer
pre-excited afibnew afib with problems due to accessory pathway like WPW of Lown-Ganon, if unstable get urgent cardioversion, if stable BB. will see irregular wide complex tachycardias.
if considering cardioversion in stable a-fibget within 7 days of new onset
MAZE procedureaka surgical compartmentalization of atria, makes a series of endocardial incisions in R and L atria and to isolate the pulm veins * dn re-entrant
if HF and dn LV funcconsider digioxin, watch for renal failure
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Question Answer
epiglottitisF , dog sniff, drool, get Nasotracheal intubation if able and IV ABx
epiglottis xray"thunbprint sign", the epiglottis looks like a thumb sticking out
VWDup PTT, ud PT, up BT
ADP recep-grel
Glanzmann thromastheniadef Gpiib/iiia rec
Gpiib/iiia inhib medsabciximab, eptifibatbe, tirofiban
GPib rec defBernard Soulier, vWF can bind and connect pl8 to sub-endothelial collagen which appears in trauma
vWF MOAbinds to sub-enothelial collagen and collagen at one end and binds to Gpib at other end, causing a pl8 to subendothelial connection
VWDAuto Dom epistaxis, white woman, main problem is not in allowing platelt adherence to enothelial lining but the vWF carries Factor VIII
dx VDWristocetin cofactor assay
ristocetin testreistocetin is an artificial endothelial surface therefore a positive test shows reduced pl8 agg
VDW txDDAVP, F VIII if refractory
especially avoidASA in VWD
DICdn Fibroingen and up Fibrinogen Degradation Products
ITP"immune", typically follows viral infection, purpura, petechiae
ITP coagswnl except dn pl8
ITP MOAIgG binds pl8 * up spleen destruction
TTPFAT RN
ITP txif pl8 < 30k with sx give 1mg/kg/qd prednisone, 2nd line is IVIG, rituximab, if refractory then splenectomy. goal is pl8 > 50k
DIC txFFP and cryoprecip
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Question Answer
crouplaryngeotrachreobronchitis MC bug parainfluenxa stridor
RSVunder 2 yo RSV MC bug
Epiglottitisback-then MC was Haemoph Influ B, now is Strepp
Steeple signcroup (subglottic narrowing)
lung hyperinflationasthma, inhaled foreign bodies
supraglottic narrowingepiglottitis (thumbprint)
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Question Answer
trigger finger txat MCP joint, 1st line is stretching and splinting then steroid then srx of A1 Pulley, DO NOT release A2 pulley
A2 Pulleyprevents bowstringing of the flexor tendons
Romberg testloss of balance is +, close eyes and hold arms out
ataxia but Romberg negativethink cerebellar dysf
Von-Hippel-Lindaudevelopment of cysts and hemangioblastiomas into retina, CNS, has Pheochromos, pancreatic and renal cysts, CNS involement, no cuataneous findings
Renal Cyst in VHLup renal cell cx
ADPKDdn renal func, up aneuryms
hepatic cystscommon in ADPKD rare in VHL
pancreatic cystscommon in VHL rare in ADPKD
Multiple Paragangliomasmutation in succinate dehydrogenase, histo equiv to pheo but occur in head and neck
Tuberous sclerosis complexrenal cyst, renal angiomyolipoma, neurocutanoues findings
neurosyphillishyporeflexia, + romberg, aniscoris, dn CN VII and VIII, charcot joint
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Question Answer
Chronic mesenteric ischemiapersistent peri-umbilical abdominal pain, old, worse with eating because increased blood flow is needed * avoid food, dx with Angiogram, if + get srx
colonoscopystart at 50yo end at 75yo
corkscrew patterndiffuse esph spasm
Chalazion(cyst)obstructed mebonium gland in eyelid, looks like a big ol' bump in eyelid tx is warm compressess and eyelid hygiene, ddx is hordeolum
hordeolumacute infection of eyelid gland
blepharitisaka low-grade eyelid inflamation
blepharitis txlow does doxy or tetra
chronic chalzion that has failed eye compresses eyelid hygienesurgical excision
do not needtopical antibiotics in chalazion
eyelid swollen and red, scaly crustsblepharitis
styeaka hordeolum
chalazion vs hordeolumhordeloum has infectious features is painful, stye is nontonder
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