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Step 2 Hi yield part 3 7-13-2016

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ruhland1's version from 2016-07-13 17:52

Section

Obstetrics
Question Answer
1o cause 3rd trim bleedplacental abrut and placenta previa
Complete mole46 XX (2 sperm 0 egg)
Placental abruptcontinuous painful bleed
Placenta previavaginal exam CONTRA
Tetracyclineteratogen
Floxteratogen
-micinteratogen
Sulfonamideteratogen
Shortest AP diamobsetric conjugate
Obstetric conjugatesacral promontory to midpoint of pubic symphisis
Accelate lung maturebetamethasone or dexamethasone 48 hr
Post partum hemmthink uterine atony
Uterine massage failsgive oxytocin
GBS ppxIV penicillin or ampicillin
Fails to lactate after major bleedSheehans synd (postpartum pit nec)
Inevitable vs threatened abortionin inevitable the cervical os is open
Women w ammenorrheaget BHCG
Ammenorrhea with normal endocrine and no response of estrogen progesterone challengeAshermanns syndrom (hx of d and c)
PCOStx is OCP and dn lb
Induce ovulationclompihene
Postmenop with vag bleedmust get endometrial bx
Indic for med use in ectopicstable, lt 3.5cm or lt 6 weeks gest
Endometriosis txOCP danazol GnRH ag
Danazola steroidogenesis inhibitor used in endometriosis
Endometriosis findingchoclate cyst, powder burn
Ectopic locationampulla of oviduct
Hx of leiomyomaregresses after menop
Vag disch and petechial patches in vag and cervixTrichomonas (pear shaped, want the peach, strawberry cervix, metro to tx)
Bact vaginosis txmetronid (clue cells) gardenella
Protects against PIDzOCP and barrier contraception
PID and RUQ pxfitz hughs curtis (violin strings)
Itching burning erosion of nipplepagets dz
Women with strong fam hx of ovarian cxget annual CA 125 and tran vag u/s
Stress incontinece intitial txkegel, estrogen, pessaries
Urge incontinece (unpredictable urine loss) txoxybutyinin or B ag (metaproterenol)
Menopauseup FSH
ASCUS guidlineshave 2 consecutive findings * need a colpo and endocervical curettage
Cx with bilateral breast cx risk in futureLCIS lobular cx in situ (vs DCIS which in unilateral)
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Pediatrics
Question Answer
Nontender abd mass with up VMA and HVAneuroblastoma
MC type of tracheoesph fistulaesophageal atresia with distal TEF. dx when unable to pass NG tube
Not contra to vaxmild ill, low F, current abx tx, prematurity
Work up for shaken baby syndoptho exam , CT, MRI
Neonate meconium ileusCystric fibrosis or Hirschsprungs
Bilious emesis with in hours after 1st feedingduodenal atresia
2 mo with projectile vomit1st correct e- then pyloric stenosis srx
MC 1o immunodefselective IgA def
Infant Hi F with rash after fever breaksat risk for febrile sz (dx is roseola infantum)
Chronic resp infxn, Nitroblue tetrazolium + or DHR test +chronic granulomatous dz (NADPH oxidase def, cannot make H2O2 so everything is like TB)
Eczema, dn pl8, high IgAWiskot Aldrich (wkATE AI Thrombocytopenic Eczema)
4 mo with serious Psueodomonas infxnBrutons X-linked agammaglobulinemia
Kawasaki acute txhi dose ASA, IVIG to dn coronary a aneursym
Tx hyperbili neonatephototherapy if mild, exch transfusion if severe
D mind, emesis, liver dyfunc after ASA useReyes synd
No red light reflexretinoblastoma
VaxBe Dr HIP. He Have 2 Very Many Pt. He Did Very, Hurt Many Teens.
Small airway epidemic in winter and springRSV bronchiolitis
Neonatal RDSsurfactant def (need lecithin-sphingomyelin ratio gt 2)
Currant stoolintussusception
2o htn in cogenitalcoarctation of aora
Otitis mediaamoxicillin 10 days, then go cephalosporin if ALL, then macrolides
Macrolideserythromycin, azithromycin, clarithromycin
Aminoglycosidesamikacin, gentamicin, tobramycin, neomycin, streptomycin
Croupsteeple sign, parainfluenza virus type 1, seal bark
Kid swollen belly poorKwashikor (protein malnutrion)
X-linked mental retard, gout, self mutilation, choreathetosisLesch Nyhan synrdome
Lesch Nyhan syndrome pathophyspurine salvage problem, HGPRTase def
Machinery murmurpatent ductur arteriosus
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Psychiatry
Question Answer
1st line MDDSSRI
MAOIup hypertensive crisis (tyramine…)
DA antag prolactin effectup galactorrhea, impotence, menstrual dysf, dn libido
Talledaga nights cant walk after experienceing very non traumatic stressconversion d/o
Mother who is angry at husband yells at kiddisplacement
Murderer becomes a buddist and enters monestaryreaction formation
Woman calmly describes a grisly murderisolation
Hospitalized 10 yo begins to wet his bedregression
M rigid, F, rhabdoNMSynd
Ammen, brady, abn body imageanorexia nervosa
Recurrent episodes of palpiations, diaphoresis, fear of going crazypanic d/o
Cloazpinewatch out for agranulocytosis (most effective antipsychotic)
21 yo 3 mo hx of social withdrawl, worsening grades, flattened affect, concrete thinkingschizophreniform (schizo needs 6 mo to dx)
AAP s//eup lb, T2DM, QT prolong (ziprasidone is worst offender)
Given IV haloperidol and up diplopliaacute dystonia (oculogyric crisis)
Oculogyric crisis txbenztropine and diphenhydramine
Hx of ETOH withdrawl szavoid neuroleptics
13 yo violence towards petsconduct d/o
5 mo old girl has dn head growth, truncal dyscoordination, hand wringing dn socialRetts d/o (dn MECP2 gene on X chromosome) poor girl syndrome
Mania sxstart mood stabilizer (Li)
Severe hypoglyemia but no elevation in C-peptidefacititous disorder (Munchausen syndrome)
Rotatory nystygPCP intox
Hx of abuse as child and adult frequently feels outside or detached from bodydepersonalization d/o
Repeated urgers to rub his body against unsuspecting passengers on busfrotteurism
Papaphiliafetish
Man unexpectedly flies across country, takes new name, has no memory of prior lifedissociative fugue
AAP for bipolar depressionLurasiodone
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Pulmonary
Question Answer
DVTthink Virchows triad (stais, endothelial injury, hypercoag)
Exudative effusionpleural/serum protein gt 0.5, pleural/serum LDH gt 0.6 (exudates have greater LDH and protein than transudates)
Causes exudative effisionthink “leaky capillaries”, cx, TB, infxn, PE w infarct, pancreatitis
Transudative effusionpleural/serum protein lt 0.5, pleural/serum LDG lt 0.6 (transudates have less protein and LDH than exudates)
Causes transudative effusionthink of “intact capillaries”. CHF, liver or kidney disea, protein losing enteropathy (not enough protein in serum to hold liquid)
Asthma exaccerbation and normalizing pCO2impending Resp failure
Resp failure stagesfollow pCO2, it is low at first due to compensating, second everything looks normal, 3 is trend for worse, 4 is worst
Dyspnea, bil hilar LAD on CXR, noncaseating granulomas, up ACE(angiotensin converting enzyme), up Ca (up 1 alpha hydroxlase * up vit D)sarcoid
Dn FEV1/FVCobstructive (find up TLC)
Up FEV1/FVCrestrictive (obese, fibrosis)
Honeycomb CXRdiffuse intersistital pulm fibrosis (tx is supportive), steroids may help
SVC syndrome txradiation
Asthma steps simplified1. SABA 2. + low ICS or Monteleukast 3. + LABA 4. Hi dose ICS 5. Oral steroids/MAB
PE lab findinghypoxia and hypocarbia
Hypoxia vs hypoxemia-emia is blood PaO2 lt 80, hypoxia is reduction of o2 supply at tissue level (hypoxemia is a cause, hypoxia is an effect)
Circulutory hypoxiaPaO2 is OK but hypoperfusion leads to hypoxia
Hypercalcemia PTH-rpsmall cell lung cx (also up SIADH)
SIADHseen post op srx, chronic stress
Small cell lung cx etiosmoking
Spontaneous pneumothoraxtx is self resolving, may need supplemental O2
Tension pneumothorax txneedle thoracostomy
Characteristics favoring cx in isolate pulmonary noduleage gt 50, lesions new or larger than previous radiographs, absence of calcifcation or irregular calcification, sive gt 2cm, irregular margins
Hypoxemia and pulm edema with normal pulm cap wedge pressureARDS
Pulm cap wedge pressureindirectly measures Left Atrial pressure , elevated pulm cap wedge suggests cardiogenic pulm 2/2 LV output failure, normal pulm (2-15) wedge cap suggests non cardiogenic like ARDS
Silicosis * up riskMycobacterium TB (places to live and hide and grow) opens walls in physical defense so its like plowing soil to sow a seed
CXR pulm edemaCardiomegaly, promient vessels, Kerly B lines, “bats wing” appearance of hilar shadows, perivascular and peribronchial cuffing
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Renal
Question Answer
Type I RTA (distal)abn H+ secretion and nephrolith
Type II RTA (proximal)abn HCO3- and rickets
Type IV RTA (distal)aldosterone defect
Doughy skinhypernatermia
Ddx hypervolemia hyponatremiacirrhosis, CHF, nephritic syndrome
T wave flat and U wavehypo K
Chvosteks (cheek tap) and Trousseaus (BP cuff)hypocalemia
Hypercalcemiamalignancy and hyperparathyroidism are MCC
Peaked T and wide QRShyper K
Hyper K txC BIG K U Di (Ca Gluconate, B ag/Bicarb, Insulin, Kayexylate, Dialyis/Diruetics)
Hyper K and d EKGuse IV calium, inhaled salbutamol and or IV insulin and glc
1st line hyper CaIV fluid and loops
ARF and Fraction excreted Na lt 1%pre-renal
49 M acute flank px and hematuriastone
20 yo palpable flank mass and hemturia. u/s shows bilateral enlarged kidney w cyst auto dom PCKD up berry aneurysms in liver and brain
Hematuria, htn, olgiurisnephritic syndrome
Prouria, hypoalb, hyperlipid,hyperlipiduria,edemanephrotic gt 3.5 g in 24 hours
MCC of nephritic syndromemembranous glomeurolnephritis
Glomnephritis w deafalport (also blindness)
Glomneph and hemoptysisWegeners and Goodpasture
Red cell castsglomnephritis/nephritic synfome
Eosinophils in urineallergic interstitial nephritis
Waxy casts and maltese crossesnephrotic syndrome
Drowsiness, asterixis, nauease, pericardial friction ruburemic syndrome 2/2 Renal Fail
55 yo with dx prostate cxoptions include wait, srx, RADs, androgen suppression
Low urine osmol with high serum osmolDiabetes Insipidus (holding e- and pissing out fluids only, Li is a nephrogenic cause)
SIADH txfluid restriction, demeclocycline
Demeclocycline MOAreduces responsiveness of collecting tubules to ADH
Hematuria, flank px, palpable flank massrenal cell cx
Testi cx up BHCG and AFPchoriocx
Mc testi cxseminoma- a germ cell tmx
MC histo of bladder cxtransitional cell cx
ASA ingestionup HAGMA 2/2 central resp stim
Pregnant womanup resp alkalosis
Nephrotic syndrome causeSLE
Nephrotic syndrome causeDM
Nephrotic syndrome causeamylodosis
Up EPO, up HCT, normal O2 satthink RCCx or other EPO making tmx, get a CT scan
Old man w irritative and obstructive urinary sxthink BPH. mx is no tx, terazosin, finasteride, or srx (TURP)
memorize

 

Emergency Medicine
Question Answer
NMSyndm rigid, hyperthermia, autonomic d, EPS sx
Corticosteroid s/eacute mania, immunosupp, think skin, osteopor, easy bruise myopathies
Delirium tremensgive benzo
Tylenol ODN-AC
Benzo odflumenazil
NMSdantrolene or bromocriptine
Malignant htnnitroprusside
A fib txrate control, rhythm conversion, anti coag
SVT txrate control w carotid massage or other vagal stim
Macrocytic, megaloblast anemia w neuro sxb12 def
Megalobasts anemia without neuro sxfolate def
CO poisoningcherry red skin and coma, give 100% O2 or hyperbaric time chamber if severe or pregnant
Blood in urethral meatus or high riding prostatebladder rupt of urethral injuly
Test to rule out urethral injuryretrograde cystourethrogram
CXR of aortic dissectionwidened mediastinum gt 8 cm, loss of aortic knob, pleural cap, tracheal deviation to the R, depression of L main stem bronchus
Radiograph of acute abdomenfree air under diaphragam, extravasation of contrast, severe bowel distention, space-occupying lesion on CT, mesenteric occlusion angiography
MC bug in burnpsuedomonas
Parkland formulato calculate fuid repletion in burn Vol=4*mass(Area*100) give 1st half in 1st 8 hours, 2nd half in next 16 hours.
Burn area9% head in adult 18% in kid
Acceptable urine output in trx pt50 cc /hr
Acceptanle urine output in stable pt30 cc /hr
Cannon ‘A” waves3rd degree heart blovk
Neurogenic shockhypotension and bradycardia
Cushing Triad of up ICPHTN, brady, abn resp (MOA up ICP so up vasocon to get blood to brain, up ICP * up pressure on vagus so dn HR, up ICP on brainstem so up abn resp)
Dn CO, dn pulm wedge pressure, up PVRall signs of hypovolemic shock
Dn CO, up Cap wdge, up PVRCardiogenic shock (up wedge d/t dn LV output)
Up CO, dn Cap wdge, dn PVRseptic or anaphylatic shock
Tx septic shockfluid and abx
Tx cardiogenic shockidentify cause and pressors (dobutamine)
Tx hypovolemic shockidentify cause, fluid and blood repletion
Tx of anaphylatic shockdiphenhydramine and epinephrine 1 1000 IM or 1 10,000 IV
ARDS supportCPAP tx
Air embolismpt with chest rx who was reviously stable and dies
Trauma SeriesAP chest, AP/Lateral C spine , AP pelvis
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