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Comlex 3 4

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ruhland1's version from 2018-09-19 19:21

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Question Answer
berger's dznephritic syndrome, proteinuria <1.5g qd
bergers dz akaIgA nephropathy
MC type of nephritic syndrome assoc w GI or URIIgA Nephropathy (Berger's disease)
syndrome assoc with IgA nephropathyHenoch Schonlein Purpurpura
IgA Nephropathy txsteroids + ACEi
Focal Segmental Glomsclerosisprouria > 3.5g/qd + edema
Focal seg glomscler riskidio, IVDU, HIV
FSG dxbx shows sclerosis in renal capillary tufts
FSG rxprednisone, cytotoxics, ACEi
Acute interstitial nephritismany drug etios, sx of intrinsic renal failure, Classic is rash eosinophilia urinary wbc
AIN txsupportive, dicontinue offender
MCC of ARF in hospitalizedATN
ATN etioishemia "muddy brown"
ATN urineosmololaity <350 Urine Na >20, FeNa >2%, tx is tx renal ischemia
Alport<1.5g/qd, boys age 5-20, bx basement membrane splitting, assoc deaf and eye d/o
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Question Answer
late decelerationsutero-placental insuff, late means decel starts after peak of contraction
term preg accelerations2 per 20 minutes
variable deccelerationscord compression, makes sense since UP insuff is general and not variable
head compressionearly deccel
tachysystole>5 contractions in 10 min over 30 min
tx late decelerations1st line is to turn pt on left side, place on O2, discontinue oxytocin, if does not woek or unstable FHR then C-section
variable decelerationsgive amnioinfusion, more fluid less rate of cord compression
chorionic villi samplingassesses fetal karyotype, done between 9-11 weeks
chorioinc villous is done too earlyup risk limb defect
amiocentesis15-20weeks with u/s eval fetal genes
sheehan syndromepost-partum hypopituitaryism, signs are failure to lactate and amennorrhea, tx is lifelong hormone replacement
springing at both sacral sulcibilateral sacral flexion, deep b/l sulci, shallow ILA
abominal compartment syndromecomplic of post-partum hemmorrhage
Asheman synduterine adhesions and scaring etios in d and c and endometrial ablation
prolactinomacan decrease amount of milk
third trimester painless bleedplacenta previa, risk is prior c-sections
up risk placental abruptioncocaine use due to up BP
gest HTNup risk placental abrupt
MCC of post-partum hemmuterine atony, massage uterus and give pitocin
pelvic examcontraindicated in placenta previa, so do transabd u/s
inital tx of pre-eclamspiamag sulfate and hydralizene
OA compressionseen after prolonged child-birth, causes poor suckling due to compression of CN XII, findings includ dn CRI and dn ext lfex amplitude
c5-c6 injury childbirtherb duchenne, waiter's tip
if abnormal alpha-feto protein levelfirst suspect dating error
Neural tube defectselevated alpha fetal protein
amniocenteisif abn alpha fetoprotein and dating error is ruled outt
non-stress testsassess FHR and movement, do during 3rd trimester
if Rh negative and have complete abortiongive RhoGam within 72 hours of abortion
Rh neg mom Rh positive neonategive RhoGam at 28-29wks gest and within 72 hours of delivery
untreated allo-immunized Rh motherfuture pregs with develop HDFN leading to attack fetal rbc * up anemia * up hydrops fetalis
hydrops fetalisaccumulations of fluid in 2 compartments like pleural effusion ascites pericardial effusion
when able to see gest sacBHCG is 1500-2000
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Question Answer
meningiomaforms attached to meninges(dura), duh!
astrocytomawell-differentiated if WHO grade II-IV * called glioblastoma multiforme, appears "infiltrative"
GBM"butterfly" appearance, crosses midline, sz focals
intra-cranial abscesslook for focal rim-enhancing lesions
brain tumor in kidsinfratentoria
brain tumor in adultssupra-tentorial
meningioma mxsurveillance in asx
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Question Answer
ascending cholangitisCharcots triad
dx ascending cholangitis specificERCP
charcot + shock + amsreynald pentade
ascending cholang mxICU admit, emergent bile duct compression via pecut drainage, srx, of ERCP sphincterotomy
MCC of spontaneous small intestine fistualchrons
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Question Answer
nummular eczemaround scaly patches/plaques, KOH (-)
bullous pemphigoidAI, tense blisters, immunofluorescene shows IgG and C3 in a "linear band" on basement mem
bullous pemph txprednisone
sebrrheic kertosis"stuck on ", mx is nothing or cryotherapy
KOH preprules in or out fungal
tinea corporis txlotrisone
nummular eczema txtopical steroid
desonide"low potency" * can be used on face/axilla/groin
trimcinolone"medium potency" body use
clobetasol"high potency" indic in thick lz like psoriasis
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Question Answer
L2 sidebent right in scolipsoslevoscoliosis
shape of levoscoliosisC
right sided rib humpdextroscoliosis "named for side of convexity"
functional spinal curvescorrect of sidebending in opposite direction, scoliotic curves do not
exercise induced asthmainstruct kid to take albuterol just prior to exercise
OMT to help asthmarib raising, normalizes hyper SNS
T2-T7respiratory system
T1-T4head and neck
T1-T5heart
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Question Answer
acute stress disorderdsx of PTSD max of 4 weeks
schizophreniformsx for 1-6mo
surgical contaminatedspill bile from GB into abd cavity
surgical clean-contaminateda hollow viscous (like poking a hole in the GB) is entered under controlled effort, so not an acident
dirtycontain necrotic tissue, includes wounds with stool
bug in acute cholecystitisE Coli is #1, kleb is #2,
MC G+ in acute choleEnterococcus, but not MC organism overall
MC anerobe in colonB Fragilis
post GB removal and 1 week later has jaundicethink retained CBD stone, 1st get US
when suspect retained stone on CBDif >6mm
HIDA scanuseful in bili tract physiology
biliary systemCT scan is not too useful
acute cholangitisgive Zosyn or cipro + flagyl or rocephin + flgayl
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Question Answer
septic shockeven if BP is low initially extremities are warm because of lack of vasocon, as seen in hypovolemic shock
greyturnerecchymosis of flanks in acute pancreatitis
cardiac ouputincreased in septic shock as compensenatory
Janeway lesionsendocarditis
breast hematoma2/2 trauma, management is heated compresses, pain meds and breast u/s to track resolution
mammogramstart at 40yo and every 1-2 years, screen until age 74
why breast hematomas need to be monitoredmay evolve into scar or fat necrosis or breast seroma, follow up in 8 weeks, drain hematoms if large and cause discomfort
de quervainsdo finklestein
CKD IVavoid NSAOD
ASA toxic phase 1hypervent compensatory alkauria (weird) last 12 hours
ASA tox phase 2paradoxic aciduria with resp alk 12-24 hr
ASA tox phase 3dn H20, dn K, further dn pH, 24hr +
mixed metabolic acid and resp acidCOPD
ASA tox txICU and bicarb, if early ingestion give charcoal and gastric lavage, tinnitus and confusion indicates late ingestion
parental consentnot needed in STD, OCP, detox, psych
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