laracrystalo's version from 2016-07-19 21:27

Part 1

Question Answer
strawberry tonguekawasaki, scarlet fever
kawasaki vs scarlet fever?palms and soles rash specific to kawasaki
rash on palms and soles?kawasaki, 2ndary syphilis (condyloma lata), rickettsia (RMSF), coxsackie, strep/staph, neisseria meningitides and gonorhea
schistocytesDIC (abnormal Pt, PTT), HUS (diarrhea, e. coli, in kids), TTP (fever, confusion, AKI, hemolytic anemia due to overproduction of vwf), HELLP (abnormal PT and PTT), traumatic hemolysis (forced march)
tx TTPplasmapheresis
kids with leg paingrowth pains (bilateral at night); osteoid osteoma (unilateral night, relieved with aspirin), leukemia or cancer (leg pain during the day)
bilateral pain at nightgrowth pains
unilateral pain at nightosteoid osteoma
dx osteoid osteoma?Xray
tx growth pains?reassurance
tall peopleMen2B, marfans, homocysteunria
breathing difficulties in newbornterm babies think transient tachypnea of newborn, or persistent pulmonary HTN, if preterm think RDS
ground glass appearance on XRAY in neonate?RDS
fissures fluid and pleural effusion on XRAY in neonate?transient tachypnea of newborn
decreased vascularity on CXR in neonatePPHTN
parihilar linear streaking on CXR in neonateTTN
cyanotic neonate condition common in CSTTN
inspiratory stridorlaryngomalacia, croup (has cough and rhinorrhea), aspiration of foreign body, epiglottis (high fever, drooling, thumb sign)
tx epiglottitisamoxicillin, ampicillin, avoid examining oropharynx
bronchiectasisCF (failure to thrive), kartagener (primary ciliary dyskinesia), ABPA
premature baby syndromesgerminal matrix hemorrhage (periventricular leukomalacia), RDS, necrotizing enterocolitis, retinopathy of prematurity, anemia of prematurity, cerebral palsy
smooth filtrumFAS
high pitched cry in new borncocaine and opiates
cocaine vs opiates in newborn?opiates has additional sx like GI/diarrhea, tacky, yawning, sneezing
big tongue babybeck width wiedemann, congenital hypothyroidism
pre gestational DM conditionssacral genesis, transposition of great vessels, small L colon, hyperinsulinism, polycythemia
sphenoid wing bone dysplasiaNFM1
ash leaf spotstuberous sclerosis
adenoma sebaceoustuberous sclerosis
port wine stainsterge webber
neck conditions in childrentorticollis (fibromatosis colli (hypertrophied muscle/mass in SCM), cystic hygroma (fluid filled space in TURNERS), branchial cleft cyst (fluid density lateral to SCM), thyroglossal duct cyst (fluid density midline)
tx torticollismassage, conservative
X linked dominant conditionsgenetic rickets, alports
metronidazole treatsgiardia, gardnerella, entaomeba, trichomonas, bacteroides, C. diff "GET BACT CLOSE TO THE METRO"
diaper rash that affects creasescandidiasis
diaper rash that does NOT affect creasesirritant contact dermatitis
absent thymic shadowno T cells (SCID, adenosine deaminase deficiency, diGeorge
ring enhancing lesionstoxo, CNS lymphoma, brain abscess
first 4 weeks neonatal sepsisGBS, E. coli, listeria
after 4 weeks sepsiss pneumo, haemophilus, neisseria
cat scratchbartonella
bacillary angiomatosisbartonella
cat bitepasteurella (swollen abscess)
cat littertoxo
bells palsylyme and viral illnesses (EBV)
tx kid with lymeamoxicillin
tx kid with RMSFdoxycycline
lead toxicity treatmentif <45 watch and wait, if >45 without symptoms tx with SUCCIMER (DMSA), if > 70 with near sx tx with EDTA + BAL
de quervain tenosynovitis tendonsextensor pollicis braves and abductor pollicis longs
tibial tuberosityosgood schlauer = osteochondritis = traction apophysitis
baby smiles2 months
baby laughs4 months
child abuse protocolfundoscopy, CT head, skeletal survey, lab tests (CMP, CBC, coags). Report to child protective services.

Part 2

Question Answer
what is the only cause of conjugated hyperbili in a baby?biliary atresia
hyperbilirubinemia in first 24 hoursABO incompatibility if mild, RH incompatibility if severe
hyperbilirubinemia in 1day - 1wkbreast feeding jaundice or physiologic jaundice (up to 12)
hyperbilirubinemia after 1wkbreast milk jaundice (molecules in moms milk affect enterohepatic circulation
tx breast milk jaundice?stop breast milk and give formula to see if it gets better
mixed conjugated and unconjugated hyper bili in baby?neonatal hepatitis
bilious vomitingHirschsprung, malrotation with volvulus, meconium ileum, duodenal/jejunal atresia
kid with mass in abdomenneuroblastoma (adrenal, crosses midline), wilms (kidney, does NOT cross midline)
mass in kid that doesn't cross midlinewilms (kidney)
mass in kid that does cross midlineneuroblastoma (adrenal)
cataractsrubella, galactosemia, hurlers, hunters (mucopolysaccharide disease)
primary amenorrheaturners, imperforate hymen, AIS
tx mild SVTvagal maneuvers (squat, valsalva, ice bag on face, carotid massage) if vitals are stable (delay AV node conduction)
tx moderate SVTadenosine (if abnormal vitals, no pulm edema)
tx severe SVTDC cardioversion (if severe HF, pulm edema)
decrease mortality in CHFACEi, beta blockers, spironolactone
decrease mortality in COPDstop smoking, oxygen
berry aneurysmsADPCKD, ehlers dans, marfans
eosinophilsacute eosinophilic pneumonia, allergic bronchopulmonary aspergillosis (asthma, finger/cylindrical on CXR), churg-strauss (asthma, vasculitis), loffler syndrome
symmetric herniationtranstentorial, uncal
asymmetric herniationsubfalcine (shift between midline)
herniation that shows cerebellumtonsillar
CURB 65 criteriafor CAP. confusion, uremia (BUN>20), tachypnea (RR >30), hypotension (BP <90/60), age >65. 2 points or more should get inpatient treatment, and if 4 points, get ICU
outpatient CAP txmacrolide or doxycycline
inpatient CAP txfluoroquinolone or betalactam + macrolide
crescentic brain bleedsubdural
lens shaped brain bleedepidural
nuchal rigiditymeningitis and sub arachnoid hemorrhage
hearing lossmeniere (vertigo, tinnitus), acoustic neuroma (vertigo, tinnitus), chronic otitis media, otosclerosis, presbycusis (sensorineural)
mild acne txtopical antibiotics/retinoids
moderate acne txoral doxy
severe acne txisotretinoin
mild inflamed hair folliclefolliculitis
moderate inflamed hair folliclefuruncle
severe inflamed hair folliclecarbuncle
mild skin reaction to drugerythema multiforme
moderate skin reaction to drugstevens john sons syndrome
severe skin reaction to drugtoxic epidermal nerolysis
drugs that cause allergic reactionpenicillins, NSAIDS, sulfas
facial rashesSLE, slapped cheek, rosacea, dermatomyocytis (violet rash)
violacious rashdermatomyocytis
flask deformity / flaring of distal femurgaucher
small cell conditionscushing syndrome (ACTH), lambert eaton, SIADH
mild allergic rhinitis txoral antihistamines
moderate allergic rhinitis txintranasal steroids
severe allergic rhinitis txoral steroids
male cancers most commonprostate, lung, colon
male cancers most causing deathlung, prostate, colon
female cancer most commonbreast, lung, colon
female cancers most causing deathlung, breast, colon
anorexia complicationsosteoporosis, HLD, elevated carotene, amylase, long QT, euthyroid sick, HPA dysfxn, hyponatremia,
aldosterone ABGalkalosis
spironolactone ABGacidosis
acetazolamide ABGacidosis
furosemide and thiazide ABGalkalosis
mild hyponatremia txwater restriction
moderate hyponatremia txloop diuretic and IVF
severe hyponatremia txIV hypertonic saline

Part 3

Question Answer
what treats pseudomonas?ceftazadime, cefepime, piperacilin, tazobactam
cavitary lesion in lungsTB (night sweats), lung abscess (halitosis), aspergillum, cancer, septic emboli
neisseria meningitidis is common in ...asplenia, compliment deficiency, military recruits, teenagers
big kidneysAIDS nephropathy, amyloid, APCKD
signs of complicated parapneumonic effusion/empyemapH < 7.2 glucose < 60
PPD + cut offs5mm for high risk, 10mm for moderate risk, 15 mm for low risk
nephrotoxic chemocyclosporine/ tacrolimus/ cisplatin
hyperkalemia chemocyclosporine/ tacrolimus
HTN chemocyclosporine/ tacrolimus
gum hypertrophy chemocyclosporine
hirsutism chemocyclosporine
tremor chemocyclosporine
hepatotoxic chemoazathioprine
bone marrow suppression chemomycophenolate/ vinblastine
hemorrhagic cystitis chemocyclophosphamide
prevent hemorrhagic cystitis chemo with?mesna
chemo cardio toxicitydoxorubicin, trastuzumab
peripheral neuropathy chemovincristine
tx HITfondaparinox, argatroban, lepirudin
aplastic anemia causersfalconi, benzene, parvo B19, arsenic, chloramphenicol
high MCHCAIHA (+ coombs) , hereditary spherocytosis (- coombs)
tx hereditary spherocytosismild with folate, severe with splenectomy
IgM spikewaldesntroms macroglobulinemia
IgG spikeMGUS/ MM
HCG tumorshydatidiform moles, choriocarcinoma, gestational trophoblastic, seminoma, endodermal sinus, teratoma
AFP tumorsyolk sac, endodermal sinus, teratoma, HCC
estrogen and testosterone tumorleydig cell
signs of fulminant hepatic failurelow glucose, encephalopathy, high PT
tx encephalopathy?lactulose, low protein diet, rifaximin
common causes of ascites?alcohol, ovarian cancer
tx uterine atony?massage --> oxytocin --> prostaglandins
diarrhea in HIVMAC (could be bloody or watery), CMV (bloody), cryptosporidium (watery)
SBP diagnosis based on> 500 WBC or > 250 PMNs
bloody diarrheashigella, E. coli entamoeba, campylobacter, CMV, yersinia
bloody diarrhea mimics appendicitisyersinia
hypotension and JVDtamponade, CHF, massive PE
chest pain work up for person who can exercise and normal EKG?exercise treadmill/stress test
chest pain work up for person who cannot exercise and normal EKG?pharm stress test
chest pain work up for person who can exercise but abnormal EKG?exercise stress echo or exercise thallium test
chest pain work up for person who cannot exercise and abnormal EKG?thallium stress test, nuclear medicine test, stress dobutamine/adenosine echo
what do you do if someone has a + stress test?coronary angio to determine % stenosis and vessels to decide stent vs cabg
who cannot get adenosine?COPD, use dobutamine
causes of mitral stenosis5th intercostal space, diastolic rumble. rheumatic fever (high fever, foreign), atrial myxoma ( position dependent)
indication for heart procedures?need 70% occlusion
STENT/ANGIOPLASTY vs CABG?1-2 vessels, no comorbidities for stent; 2 vessels + comorbidities, or if L Main Coronary artery affected
what vessel is best to use for CABG?internal mammary artery
what artery occlusion makes you go straight to CABG?left main coronary artery
acute MI drugsASA, beta blocker, morphine, O2, nitro,
if you catch MI within 90 minutes...heparin and cath
if you catch MI within 30 minutes...TPA, heparin, and cath
home oxygen requirements< PO2 55 OR < SO2 88%
tx sleep apnea in kidsadenotonsillectomy first, then CPAP
tx sleep apnea in adultsCPAP, then uvulopalatopharyngoplasty
CT shows intra and extra hepatic biliary tract dilation?double duct sign in pancreatic cancer

Part 4

Question Answer
increase preload maneuversleg up, squat, lying down (supine)
increased preload causes most murmurs toincrease, hocm decreases
later onset of MVP clickincrease preload
hand grip isincreasing after load
handgrip increasesMR and AR
hand grip decreasesAS, HOCM
decrease preload maneuversstand up, valsalva, digoxin
decreasing preload causes most murmurs todecrease, HOCM to increase
acute pulmonary edema txoxygen, diuretics, nitrates, ASA
vision color changedigoxin, sildenafil, ethambutol
K+ and digoxin correlationlow K+ precipitates digoxin toxicity. digoxin toxicity causes high K+
tx of mild aortic stenosisACEi
tx of severe aortic stenosisreplace valve
heart block signslow BP, low HR
tx for heart block1 and 2a get atropine; 2b and 3 get pacemaker
heart block 1PR more than 1 box constantly
heart block 2aprogressively increased PR intervals
heart block 2bsometimes dropped beat with progressively increased PR intervals
heart block 3random no relation
tx these fractures with intramedullary rodslong bones (femur, humerus)
tx cartilage or ligament issuearthroscopic surgery
unstable fracturesintertrochanteric or bimalleolar tx with ORIF
use splinting forroutine fractures with risk of compartment syndrome
use traction forfractures next to strong muscle groups
rectal lymph nodesmesenteric
anal lymph nodesinguinal
hemorrhoid txWarm water (sitz), Analgesics, Stool softeners, High fiber
fissures/ hemorrhoids tend to be ...posterior (6 o'clock)
afferent loop syndromehappens shortly after surgery. blockage due to adhesions causes pain, fever, severe
tx afferent loop syndromesurgical decompression
dumping syndromehappens right away, diarrhea flushing, dizziness, anxiety
tx dumping syndromelots of small snacks instead of large meals
gastrojejunocolic fistulahappens in months after procedure. Abnormal connection to colon due to inflammation causing diarrhea and halitosis
how do you find fistulas?CT imaging
wound dehiscencepink fluid soaking through
wound dehiscence txbind and tape, avoid increases in pressure
wound evicerationwound is open and parts of abdomen coming out
tx wound evicerationimmediate OR surgery
wound infectionsred, inflamed, fever, 5 days after surgery
tx wound infectionsculture and start empiric antibiotics
pringle maneuverclamping portal triad (hepatic artery, portal vein, common bile duct)
cushing triadincreased ICP involves bradycardia, HTN, respiratory depression
tx increased ICPelevate bed --> hyperventilate (lower Co2) --> mannitol --> sedation --> burr hole/craniotomy
bx parotid tumor?NO just do superficial parotidectomy sparing facial nerve
CT with contrast indicationsinfection, cancer, vessel/vascular, inflammation
eye tumorsretinoblastoma, melanoma (mets to liver)
pancreatic cancer imagingCT
alcoholic pancreatitis imagingCT
gallstone pancreatitis imagingUS
vacuum or forceps situationsneed to be fully dilated and + 2 or below
formication conditionsalcohol withdrawal, cocaine/amphetamines toxicity
milky dischargeprolactinoma
yellow dischargephysiologic
red/copper/clear dischargeintraductal papilloma
OCPs increase these cancersCONSONANTS (breast, cervical, liver)
OCPs decrease these cancersVOWELS (endometrial, ovarian)
supra cardiac shadow with increased pulm markings?TAPVR


Question Answer
increased RAP/CVP/preloadcardiogenic
increased PCWPcardiogenic
increased mixed venous o2 satseptic/distributive
increased cardiac index (CO)septic/distributive
increased SVR (after load)hypovolemic and cardiogenic
decreased SVR (after load)septic/distributive
decreased cardiac index (CO)hypovolemic and cardiogenic