H I G H - Y I E L D
F A C T S
I N
RAPID REVIEW
Cardiovascular
488
Neurology
501
Dermatology
490
Obstetrics
502
Endocrinology
491
Gynecology
503
Epidemiology
492
Pediatrics
504
Ethics
493
Psychiatry
505
Gastrointestinal
494
Pulmonary
507
Hematology/Oncology
496
Renal/Genitourinary
508
Infectious Disease
498
Selected Topics In Emergency Medicine
509
Musculoskeletal
500
488
HIGH-YIELD FACTS IN
RAPID REVIEW
CARDIOVASCULAR
Classic ECG finding in atrial flutter.
“Sawtooth” P waves.
Definition of unstable angina.
Angina that is new, is worsening, or occurs at rest.
Antihypertensive for a diabetic patient with proteinuria.
ACEI.
Beck’s triad for cardiac tamponade.
Hypotension, distant heart sounds, and JVD.
Drugs that slow heart rate.
β-blockers, calcium channel blockers (CCBs), digoxin, a miodarone.
Hyperchol Hype rcholeste esterolem rolemia ia treatm treatment ent that leads to flushin flushingg and and pruritu pruritus. s.
Niacin. Niaci n.
Murmur Mur mur—hy —hyper pertro trophi phicc obs obstru tructi ctive ve car cardio diomyo myopat pathy hy (HO (HOCM) CM)..
A syst systoli olicc ejec ejectio tion n murm murmur ur hea heard rd alo along ng the lat latera erall ster sternal nal bor border der tha thatt
↑ with ↓ preload (Valsalva maneuver). Murmur—aor tic insufficiency.
Austin Flint murmur, a diastolic, decrescendo, low-pitched, blowing murmur that is best heard sitting up; ↑ with ↑ afterload (handgrip maneuver).
Murmur—aor tic stenosis.
A systolic crescendo/decrescendo murmur that radiates to the neck;
↑ with ↑ preload (squatting maneuver). Murmur—mitral regurgitation.
A holosystolic murmur that radiates to the axilla; ↑ with ↑ afterload (handgrip maneuver).
Murmur—mitral stenosis.
A diastolic, mid- to late, low-pitched murmur preceded by an opening snap.
Treatment Treat ment for atrial fibrillation fibrillation and atrial flutter. flutter.
If unstable, cardiovert. cardiovert. If stable or chronic, chronic, rate control with with CCBs or
β-blockers. Treatment Treat ment for ventricular ventricular fibrillation.
Immediate cardioversion. cardioversion.
Dressler’s syndrome.
An autoimmune reaction with fever, pericarditis, and ↑ ESR occurring 2–4 weeks post-MI.
IV drug use with JVD and a holosystolic murmur at the left sternal
Treat Tre at existing heart failure and replace the tricuspid valve.
border. Treatment? Diagnostic te test fo for hy hypert rtrrophic ca cardiomyopathy.
Echocardiogr graam (s (showing a thickened le left ve ventricular wa wall an and outflow obstruction).
Pulsus paradoxus.
A ↓ in systolic BP of > 10 mm Hg with inspiration; seen in cardiac tamponade.
Classic ECG findings in pericarditis.
Low-voltage, diffuse ST-segment elevation.
Definition of hyper tension.
BP > 140/90 mm Hg on 3 separate occasions 2 weeks apart.
Eigh Ei ghtt su surg rgic ical ally ly cor orrrec ecta tabl ble e cau cause sess of of hy hype pert rte ens nsio ion. n.
Ren Re nal ar arte tery ry st sten enos osis is,, co coar arct ctat atio ion n of of the the ao aort rta, a, phe heo och chro romo mocy cyto tom ma, Conn’s syndrome, Cushing’s syndrome, unilateral renal parenchymal disease, hyperthyroidism, hyperparathyroidism.
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489
Evaluation of a pulsatile abdominal mass and bruit.
Abdominal ultrasound and CT.
Indi In dica cati tion onss for for surgi surgica call repa repair ir of of abdo abdomi mina nall aorti aorticc aneu aneury rysm sm..
> 5.5 5.5 cm, cm, rapi rapidl dlyy enla enlargi rging ng,, symp sympto toma mati tic, c, or or rupt ruptur ured ed..
Treatment Tre atment for acute coronary syndrome.
ASA, heparin, clopidogrel, clopidogrel, morphine, O 2, sublingual nitroglycerin, IV
β-blockers. Metabolic syndrome.
Abdominal obesity, high triglycerides, low HDL, hypertension, insulin resistance, prothrombotic or proinflammatory states.
Appropriate diagnostic test? n
A 50-year-old man with stable angina can exercise exercise to 85% of
Exercise stress treadmill with ECG.
maximum predicted heart rate. n
A 65-year-old woman with left bundle bundle branch block and severe
Pharmacologic stress test (eg, dobutamine echo).
osteoarthritis has unstable angina. Target LDL in a patient with diabetes.
< 70 mg/dL. mg/dL.
Signs of active ischemia during stress testing.
Angina, ST-segment changes on ECG, or ↓ BP.
ECG findings suggesting M I.
ST-segment elevation (depression means ischemia), flattened T waves, and Q waves. waves.
Coronary territories in M I.
Anterior wall (LAD/diagonal), inferior (PDA), posterior (left circumflex/oblique, circumflex/obli que, RCA/marginal), septum (LAD/diagonal).
A young patient with angina at rest and ST-segment elevation elevation with
Prinzmetal’s angina.
normal cardiac enzymes. Common symptoms associated with silent Mls.
CHF, shock, and altered mental status.
Diagnostic test for pulmonary embolism (PE).
Spiral CT with contrast.
Protamine.
Reverses the effects of heparin.
Prothrombin time.
The coagulation parameter affected by war farin.
A young patient with a family history of sudden death collapses
Hypertrophic cardiomyopathy cardiomyopathy..
and dies while exercising. Endocarditis prophylaxis reg imens.
Oral surgery—amoxicillin for certain situations; GI or GU procedures— not recommended.
Virchow’s triad.
Stasis, hypercoagulability hypercoagulability,, endothelial damage.
The most common common cause of hypertension hypertension in young women. women.
OCPs.
The most common common cause of hypertension hypertension in young men. men.
Excessive EtOH. EtOH.
Figure 3 sign.
Aortic coarctation.
Water-bottle-shaped heart.
Pericardial effusion. Look for pulsus paradoxus.
490
HIGH-YIELD FACTS IN
RAPID REVIEW
DERMATOLOGY
“Stuck-on” appearance.
Seborrheic keratosis.
Red plaques with silvery-white scales and sh shaarp margi gin ns.
Psoriasis.
The most common common type of skin cancer; the lesion is a pearly-
Basal cell carcinoma.
colored papule with a translucent surface and telangiectasias. Honey-crusted lesions.
Impetigo.
A febrile patient with a history of diabetes presents with a red,
Cellulitis.
swollen, painful lower extremity. Nikolsky’s sign.
Pemphigus vulgaris.
N Niikolsky’s sign.
Bullous pemphigoid.
A 55-year-old obese patient presents with dirty, velvety patches on
Acanthosis nigricans. Check fasting blood glucose to rule out
the back of the neck.
diabetes.
Dermatomal distribution.
Varicella zoster.
Flat-topped papules.
Lichen planus.
Iris-like target lesions.
Erythema multiforme.
A lesion characteristically occurring in a linear pattern in areas
Contact dermatitis.
where skin comes comes into contact with with clothing or jewelry. jewelry. Presents wi with a herald pa patch, Ch Christmas-tree pa pattern.
Pityriasis ro rosea.
Pinkish, scaling, flat lesions on the chest and back; KOH prep has a
Tinea (pityriasis) versicolor. versicolor.
“spaghetti-and-meatballs” appearance. Four Fo ur ch char arac acte teri rist stic icss of a ne nevu vuss su sugg gges esti tive ve of me mela lano noma ma..
Asym As ymme metr tryy, bo bord rder er ir irre regu gula lari rity ty,, co colo lorr va vari riat atio ion, n, an and d la larg rge e di diam amet eter er..
A premalignant lesion from sun exposure that can lead to
Actinic keratosis.
squamous cell carcinoma. “Dewdrops on a rose petal.”
Lesions of 1° varicella.
“Cradle cap.”
Seborrheic dermatitis. Treat conservatively with bathing and moisturizing agents.
Associated with Propionibacterium acnes and changes in androgen
Acne vulgaris.
levels. A painful painful,, recurr recurrent ent vesi vesicul cular ar erupti eruption on of mucocu mucocutan taneou eouss surface surfaces. s.
Herpes Her pes simpl simplex. ex.
Inflammation and epithelial thinning of the anogenital area,
Lichen sclerosus.
predominantly in postmenopausal women. Exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer.
Squamous cell carcinoma.
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491
ENDOCRINOLOGY
The most common common cause of hypothyroidism. hypothyroidism.
Hashimoto’s thyroiditis.
Lab findings in Hashimoto’s thyroiditis.
High TSH, low T 4, anti-TPO antibodies.
Exophthalmos, pretibial myxedema, and ↓ T TS SH.
Graves’ disease.
The most common common cause of Cushing’s Cushing’s syndrome.
Iatrogenic corticosteroid administration. The second most common common cause is Cushing’s disease.
A patient presents with signs of hypocalcemia, high phosphorus,
Hypoparathyroidism.
and low PTH. “Stones, bo bones, gr groans, ps psychiatric overtones.”
Signs an and sy symptoms of of hypercalcemia.
A patient complains of headache, weakness, and polyuria;
1° hyperaldosteronism (due to Conn’s syndrome or bilateral adrenal
examination reveals hypertension and tetany. Labs show
hyperplasia).
hypernatremia, hypokalemia, and metabolic alkalosis. A patient presents with tachycardia, wild swings in BP, headache,
Pheochromocytoma.
diaphoresis, altered mental status, and a sense of panic. Which should be used first in treating pheochromocytoma, α- or
phenoxybenzamine). ). α-antagonists (phentolamine and phenoxybenzamine
β-antagonists? A patient with a history of lithium use presents with copious
Nephrogenic diabetes insipidus (DI).
amounts of dilute urine. Treatment Tre atment of central central DI.
Administration of DDAVP DDAVP and free-water free-water restriction. restriction.
A postoperative patient with significant pain presents with
SIADH due to stress.
hyponatremia and normal volume status. An an antidiabetic ag agent as associated wi with la lactic ac acidosis.
Metformin.
A patient presents with weakness, nausea, vomiting, weight
1° adrenal insufficiency (Addison’s disease). Treat with
loss, and new skin pigmentation. Labs show hyponatremia and
glucocorticoids, mineralocorticoids, and IV fluids.
hyperkalemia. Tre Treatment? atment? Goal HbA1c f fo or a patient with diabetes mellitus (DM).
< 7.0.
Treatment Tre atment of DKA.
Fluids, insulin, and electrolyte electrolyte repletion (eg, K + ).
Why are β-blockers co contraindicated in in di diabetics?
They ca can ma mask sy symptoms of of hy hypoglycemia.
492
HIGH-YIELD FACTS IN
RAPID REVIEW
EPIDEMIOLOGY
How do you interpret the following 95% confidence interval (CI)
These data are consistent consistent with RRs ranging from 0.502 to 0.673 0.673
for a relative risk (RR) of 0.582: 95% CI 0.502, 0.673? 0.673?
with 95% confidence confidence (ie, we are confident that that the true RR will be between 0.502 and 0.673 95 out of 100 times).
Bias introduced into a study when a clinician is aware of the
Observational bias.
patient’s treatment type. Bias introduced when screening detects a disease earlier and thus
Lead-time bias.
lengthens the time from diagnosis to death. If you want to know if geographical location affects infant
Confounding variable.
mortality rate but most variation in infant mortality is predicted by socioeconomic status, then socioeconomic status is a _____. The proportion of people people who have the disease and test
Sensitivity.
is the _____. Sensitive tests have few false s and are used to rule _____
Out.
a disease. PPD reactivity is used as a screening test because most people
Highly sensitive for TB. Screening tests with high sensitivity are good
with TB (except (except those who are anergic) will have a PPD. Highly
for diseases with low prevalence.
sensitive or specific? Chro Ch roni nicc dis disea ease sess such such as SLE SLE—h —hig ighe herr pre preva vale lenc nce e or or inc incid iden ence ce??
High Hi gher er pr prev eval alen ence ce..
Epid Ep idem emic icss such such as as influ influen enza za—h —hig ighe herr prev preval alen ence ce or or inci incide denc nce? e?
High Hi gher er inc incid iden ence ce..
What Wh at is the the di diff ffer eren ence ce be betw twee een n inc incid iden ence ce an and d pre preva vale lenc nce? e?
Prev Pr eval alen ence ce is th the e per perce cent ntage age of ca case sess of of dis disea ease se in a pop popul ulat atio ion n at 1 snapshot in time. Incidence is the percentage of new cases of disease that develop over a given time period among the total population at risk.
Cross-sectional survey—incidence or prevalence?
Prevalence.
Cohort study—incidence or prevalence?
Incidence and prevalence.
Case-control study—incidence or prevalence?
Neither.
Describe a test that consistently gives identical results, but the
High reliability (precision), low validity (accuracy).
results are wrong. Diff Di ffer eren ence ce be betw twee een n a co coho hort rt an and d a ca case se-c -con ontr trol ol st stud udyy.
Coho Co hort rt st stud udie iess can can be us used ed to ca calc lcul ulat ate e RR RR,, inc incid iden ence ce,, and and/o /orr odd oddss ratio (OR). Case-control studies can be used to calculate an OR, which is an estimate of RR when the disease prevalence is low. low.
Attributable risk?
The difference in risk in the exposed and unexposed groups (ie, the risk that is attributable to the exposure).
Relative risk?
Incidence in the exposed group divided by the incidence in the nonexposed group.
RAPID REVIEW
HIGH-YIELD FACTS IN
The results of a hypothetical study found an association between between
In patients who took ASA, the risk of heart disease was 1.5 times
ASA intake and risk of heart disease. How do you interpret an RR
that of patients who did not take ASA.
493
of 1.5? Odds ratio?
In cohort studies, the odds of developing developing the the disease in the exposed group divided by the odds of developing developing the the disease in the nonexposed group. In case-control studies, the odds that the cases were exposed divided by the odds that the controls were exposed. In cross-sectional studies, the odds that the exposed group has the disease divided by the odds that the nonexposed group has the disease.
The results of a hypothetical study found an association between between
In patients who took ASA, the odds of acquiring heart disease were
ASA intake and risk of heart disease. How do you interpret an OR
1.5 times those of patients who did not take ASA.
of 1.5? In which which patients patients do you you initiate initiate colorec colorectal tal cancer cancer screeni screening ng early? early?
Patients Pati ents with with IBD; those those with with familial familial adenomato adenomatous us polyposis polyposis (FAP)/ (FAP)/ hereditary nonpolyposis colorectal cancer (HNPCC); and those who have first-degree relatives with adenomatous polyps (< 60 years of age) or colorectal cancer.
The most common common cancer in men men and the most common common cause of
Prostate cancer is the most common cancer in men, but lung cancer
death from cancer in men.
causes more deaths.
The percentage of cases within 1 SD of the mean? Two Two SDs?
68%, 95.4%, 99.7%.
Three SDs? Birth rate?
Number of live births per 1000 population in 1 year.
Mortality rate?
Number of deaths per 1000 population in 1 year.
Neonatal mortality rate?
Number of deaths from birth to 28 days per 1000 live births in 1 year.
Infant mortality rate?
Number of deaths from birth to 1 year of age per 1000 live births (neonatal + postnatal mortality) in 1 year.
Maternal mortality rate?
Number of deaths during pregnancy to 90 days postpartum per 100,000 live births in 1 year.
ETHICS
True or false: Once patients patients sign a statement giving consent, they
False. Patients may change their minds at any time. Exceptions to the
must continue treatment.
requirement of informed consent include emergency situations and patients without decision-making capacity.
A 15-year-old pregnant girl requires hospitalization for
No. Parental consent is not necessary for the medical treatment of
preeclampsia. Is parental consent required?
pregnant minors.
A doc docto torr ref refer erss a pat patie ient nt fo forr an an MRI MRI at at a fa faci cili lity ty he he/s /she he ow owns ns..
Confl Co nflic ictt of of int inter eres est. t.
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HIGH-YIELD FACTS IN
RAPID REVIEW
Involuntary psychiatric hospitalization can be undertaken for which
The patient is a danger to self, self, a danger to others, or gravely disabled
3 reasons?
(unable to provide for basic needs).
True or false: It is more difficult to justify justify the withdrawal withdrawal of futile
False. Withdrawing a nonbeneficial treatment is ethically similar to
care than to have withheld the treatment in the first place.
withholding a nonindicated nonindicated one.
A mot mothe herr re refu fuse sess to to all allow ow her chi hild ld to be vac acci cin nat ate ed.
A par paren entt has has th the e rig right ht to re reffus use e tre treat atm ment fo forr hi his/ s/he herr ch chil ild d as as lon longg as as it does not pose a serious threat to the well-being of the child.
When can a physician refuse to continue treating a patient on the
When there is no rationale for treatment, maximal intervention is
grounds of futility?
failing, a given intervention has already failed, and treatment will not achieve the goals of care.
An 8-year-old child is in a serious accident. She requires emergent
Treat Tre at immediately. immediately. Consent is implied implied in emergency situations.
transfusion, but her parents are not present. A 15-year-old girl seeking treatment for an STD asks that her
Minors may consent to care for STDs without parental consent or
parents not be told about her condition.
knowledge.
Cond Co ndit itio ions ns in in whi which ch co confi nfide dent ntia iali lity ty mu must st be be ove overr rrid idde den. n.
Real Re al th thre reat at of ha harm rm to th thir ird d par parti ties es;; suic suicid idal al in inte tent ntio ions ns;; cer certa tain in contagious diseases; elder and child abuse.
Involuntary commitment or isolation for medical treatment may be
When treatment noncompliance represents represents a serious danger to
undertaken for what reason?
public health (eg, active TB).
A 10-year-old child presents in status epilepticus, but her parents
Treat Tre at because the disease disease represents an immediate immediate threat to the
refuse treatment on religious grounds.
child’s life. Then seek a court order.
A son asks that his mother not be told about her recently
A physician can withhold information from the patient only in the
discovered cancer.
rare case of therapeutic privilege or if the patient requests not to be told. A patient’s family cannot require the physician to withhold information from the patient.
GASTROINTESTINAL
A patient presents with sudden onset of severe, diffuse abdominal
Emergent laparotomy to repair a perforated viscus.
pain. Examination reveals peritoneal signs, and AXR reveals free air under the diaphragm. Management? The most likely cause of acute lower GI bleed in patients > 40
Diverticulosis.
years of age. Diagnostic modality used when ultrasound is equivocal for
HIDA scan.
cholecystitis. Risk factors for cholelithiasis.
Fat, female, fertile, forty, flatulent.
Inspiratory arrest during palpation of the RUQ.
Murphy’s sign, seen in acute cholecystitis.
The most common common cause of small bowel obstruction (SBO) (SBO) in
Hernia.
patients with no history of abdominal surgery.
RAPID REVIEW
The most common common cause of SBO SBO in patients with a history of
HIGH-YIELD FACTS IN
495
Adhesions.
abdominal surgery. Identify key organisms causing diarrhea: n
Most common organism
Campylobacter
n
Recent antibiotic use
Clostridium difficile
n
Camping
Giardia
n
Traveler’s diarrhea
ETEC
n
Church picnics/mayonnaise
S aureus
n
Uncooked hamburgers
O157:H7 E coli O157:H7
n
Fried rice
Bacillus cereus
n
Poultry/eggs
Salmonella
n
Raw seafood
Vibrio, HAV Vibrio, HAV
n
AIDS
Isospora, Cryptosporidium, Mycobacterium avium complex avium complex (MAC)
n
Pseudoappendicitis
Yersinia
A 25-year-old Jewish man presents with pain and watery diarrhea
Crohn’s disease.
after meals. Examination shows fistulas between the bowel and skin and nodular lesions on his tibias. Inflammatory disease of the colon with an ↑ ris riskk of col colon on can cance cerr.
Ulce Ul cera rati tive ve col colit itis is (gre (great ater er ris riskk than than Cro Crohn hn’s ’s). ).
Extraintestinal ma manifestations of of IB IBD.
Uveitis, an ankylosing sp spondylitis, py pyoderma ga gang renosum, er erythema nodosum, 1° sclerosing cholangitis.
Medical treatment for IBD.
5-ASA agents and steroids during acute exacerbations.
Diff Di ffer eren ence ce be betw twee een n Mall Mallor oryy-W Wei eiss ss an and d Boe Boerh rhaa aave ve te tear ars. s.
Mall Ma llor oryy-W Wei eiss ss—s —sup uper erfic ficia iall tea tearr in in the the es esop opha hage geal al muc mucos osa; a; Boerhaave—full-thickness Boerhaave—full-thic kness esophageal rupture.
Charcot’s triad.
RUQ pain, jaundice, and fever/chills—signs of ascending cholang itis.
Reynolds’ pentad.
Charcot’s triad plus shock and mental status changes—signs of suppurative ascending cholangitis.
Medical treatment for hepatic encephalopathy. The first step in the management of a patient with an acute GI
↓ protein intake, lactulose, rifaximin.
Manage ABCs.
bleed. A 4-year-old child presents with oliguria, petechiae, and jaundice
Hemolytic-uremic syndrome (HUS) due to E coli O157:H7. O157:H7.
following an illness with bloody diarrhea. Most likely diagnosis and cause? Post-HBV exposure treatment.
HBV immunoglobulin.
Classic causes of drug-induced hepatitis.
TB medications (INH, rifampin, pyrazinamide), acetaminophen, and tetracycline.
A 40-year-old obese woman with elevated alkaline phosphatase, elevated bilirubin, pruritus, dark urine, and clay-colored stools.
Biliary tract obstruction.
496
HIGH-YIELD FACTS IN
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Hernia with highest risk of incarceration—indirec incarceration—indirect, t, direct, or
Femoral hernia.
femoral? A 50-year-old man with a history of alcohol abuse presents with
Confirm the diagnosis of acute pancreatitis with elevated amylase
boring epigastric pain that radiates to the back and is relieved by
and lipase. Make the patient NPO and g ive IV fluids, O 2, analgesia,
sitting forward. Management?
and “tincture of time.”
HEMATOLOGY/ONCOLOGY
Four causes of microcytic anemia.
TICS–Thalassemia, Iron
deficiency, anemia of Chronic disease, and
Sideroblastic anemia.
An elderly man with hypochromic, microcytic anemia is
Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer.
asymptomatic. Diagnostic tests? Precip Pre cipita itants nts of of hemolyt hemolytic ic crisi crisiss in patie patients nts with with G6PD G6PD defici deficienc ency. y.
Sulfon Sul fonami amides des,, antima antimalar larial ial drug drugs, s, fava fava beans beans..
The most common common inherited cause of hypercoagulability. hypercoagulability.
Factor V Leiden Leiden mutation.
The most common common inherited bleeding bleeding disorder.
von Willebrand’s disease.
The most common common inherited hemolytic hemolytic anemia.
Hereditary spherocytosis. spherocytosis.
Diagnostic test for hereditary spherocytosis.
Osmotic fragility test.
Pure RBC aplasia.
Diamond-Blackfan anemia.
Anemia associated with absent radii and thumbs, diffuse
Fanconi’s anemia.
hyperpigmentation, café au lait spots, microcephaly, and pancytopenia. Medi Me dica cati tion onss an and d vi viru ruse sess th that at le lead ad to ap apla last stic ic an anem emia ia..
Chlo Ch lora ramp mphe heni nico col, l, su sulf lfon onam amid ides es,, ra radi diat atio ion, n, HI HIV V, ch chem emot othe hera rape peut utic ic agents, hepatitis, parvovirus B19, EBV.
How Ho w to to dis disttin ingu guis ish h pol polyycyt yth hem emia ia vera fro rom m 2° 2° po poly lyccyt ythe hemi mia. a.
Both Bo th ha havve ↑ hematocrit and RBC mass, but polycythemia vera should have normal O2 saturation and low erythropoietin levels.
Thrombotic thrombocytopenic thrombocytopenic purpura (TTP) pentad? pentad?
enal dysfunction, “FAT RN”: F ever, Anemia, Thrombocytopenia, R enal Neurologic abnormalities.
HUS triad?
Anemia, thrombocytopenia, and acute renal failure.
Treatment Treat ment for TTP. TTP.
Emergent large-volume large-volume plasmapheresis, corticosteroids, corticosteroids, antiplatelet drugs. Platelet transfusion is contraindicated!
Treatment Treat ment for idiopathic thrombocytopenic purpura purpura (ITP) in
Usually resolves spontaneously; may require IVIG and/or
children.
corticosteroids.
Which of the following are ↑ in DIC: fibrin split products, D-dimer,
Fibrin split products and D-dimer are elevated; platelets, fibrinogen,
fibrinogen, platelets, and hematocrit.
and hematocrit are ↓.
RAPID REVIEW
HIGH-YIELD FACTS IN
An 8-year-old boy presents with hemarthrosis and ↑ PTT with
Hemophilia A or B; consider desmopressin (for hemophilia A) or
normal PT and bleeding time. Diagnosis? Treatment? Treatment?
factor VIII or IX supplements.
A 14-year-old girl presents with prolonged bleeding after dental
von Willebrand’s Willebrand’s disease; treat with desmopressin, FFP, FFP, or
surgery and with menses, normal PT PT,, normal or ↑ PTT, and ↑
cryoprecipitate.
497
bleeding time. Diagnosis? Tre Treatment? atment? A 60-year-old African American man presents with bone pain. What
Monoclonal gammopathy, Bence Jones proteinuria, and “punched-
might a workup for multiple myeloma reveal?
out” lesions on x-ray of the skull and long bones.
Reed-Sternberg cells.
Hodgkin’s lymphoma.
A 10-year-old boy presents with fever, weight loss, and night
Non-Hodgkin’s lymphoma.
sweats. Examination shows an anterior mediastinal mass. Suspected diagnosis? Microcytic anemia with ↓ serum iron, ↓ total iron-binding capacity
Anemia of chronic disease.
(TIBC), and normal or ↑ ferritin. Microcytic anemia with ↓ serum iron, ↓ ferritin, and ↑ T TIIBC.
Iron deficiency anemia.
An 80-year-old man presents with fatigue, lymphadenopathy,
Chronic lymphocytic leukemia (CLL).
splenomegaly, and isolated lymphocytosis. What is the suspected diagnosis? The lymphoma equivalent of CLL. CLL.
Small lymphocytic lymphoma.
A late, life-threatening complication of chronic myelogenous
Blast crisis (fever, bone pain, splenomegaly, pancytopenia).
leukemia (CML). Auer rods on blood smear.
Acute myelogenous leukemia (AM L).
AM L subtype associated with DIC. Treatment?
M3. Retinoic acid.
Electrolyte changes in tumor lysis syndrome.
↓ Ca2+, ↑ K+, ↑ phosphate, ↑ uric acid.
A 50-year-old man presents with early sa tiety, splenomegaly, splenomegaly, and
CML.
bleeding. Cytogenetics show t(9,22). Diagnosis? Heinz bodies.
Intracellular inclusions seen in thalassemia, G6PD deficiency, and postsplenectomy.
Virus associated with aplastic anemia in patients with sickle cell
Parvovirus B19.
anemia. A 25-year-old African American man with sickle cell anemia has
O2, analgesia, hydration, and, if severe, transfusion.
sudden onset of bone pain. Management of pain crisis? A significant significant cause cause of morbid morbidity ity in thalasse thalassemia mia patients patients.. Treatm Treatment? ent?
Iron overloa overload; d; use deferox deferoxamine amine..
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HIGH-YIELD FACTS IN
RAPID REVIEW
INFECTIOUS DISEASE
The 3 most common common causes of fever fever of unknown unknown origin (FUO).
Infection, cancer, cancer, and autoimmune autoimmune disease.
Four Fo ur si sign gnss an and d sy symp mpto toms ms of st stre rept ptoc ococ occa call ph phar aryn yngi giti tis. s.
Feve Fe verr, ph phar aryn ynge geal al er eryt ythe hema ma,, to tons nsil illa larr ex exud udat ate, e, la lack ck of co coug ugh. h.
A nonsuppurative complication of streptococcal infection that is not
Postinfectious glomerulonephritis.
altered by treatment of 1° infection. The most common common predisposing factor for acute sinusitis.
Viral URI.
Asplenic Asplen ic patie patients nts are partic particularly ularly susce susceptibl ptible e to these organi organisms. sms.
Encapsulat Encap sulated ed organ organisms— isms—pneum pneumococ ococcus, cus, meni meningoco ngococcus ccus,, Haemophilus influenzae, Klebsiella.
The number of bacteria needed on a clean-catch specimen to
105 bacteria/mL.
diagnose a UTI. Which he healthy po population is is su susceptible to to UT UTIs?
Pregnant wo women. Tr Treat th this gr group ag aggr gre ess ssiively be because of of po potential complications.
A patient from California or Arizona presents with fever, malaise,
Coccidioidomycosis; amphotericin B.
cough, and night sweats. Diagnosis? Treatment? Nonpainful chancre.
1° syphilis.
A “blueberry muffin” rash is characteristic of what congenital
Rubella.
infection? Mening itis in neonates. Causes? Treatment?
Group B strep (GBS), E coli, Listeria. Listeria. Treat with gentamicin and ampicillin.
Mening itis in infants. Causes? Treatment?
Pneumococcus, meningococcus, H influenzae. influenzae. Treat with cefotaxime and vancomycin.
What should always be done prior to LP?
Check for ↑ ICP; look for papilledema.
CSF findings: n
Low glucose, PMN predominance
Bacterial meningitis
n
Normal glucose, lymphocytic predominance
Aseptic (viral) meningitis
n
Numerous RBCs in serial CSF samples
Subarachnoid hemorrhage (SAH)
n
↑ gamma globulins
Initially presents with a pruritic papule with regional
MS Cutaneous anthrax. Treat with penicillin G or ciprofloxacin.
lymphadenopathy; evolves into a black eschar after 7–10 days. Treatment? Treat ment? Findings in 3° syphilis.
Tabes dorsalis, general paresis, gummas, Arg yll Robertson pupil, aortitis, aortic root aneurysms.
Characteristics of 2° Lyme disease.
Arthralgias, migratory polyarthropathies, Bell’s palsy, myocarditis.
Cold agglutinins.
Mycoplasma. Mycoplasma.
A 24-year-old man presents with soft white plaques on his tongue
Candidal thrush. Workup should include an HIV test. Treat with
and the back of his throat. Diagnosis? Workup? Treatment?
nystatin oral suspension.
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At what CD4 count should Pneumocystis jiroveci pneumonia pneumonia
≤
prophylaxis be initiated in an HIV- patient? patient? Mycobacterium Mycobacterium
clarithromycin/azithromycin).
499
200 for P jiroveci (with (with TMP-SMX); ≤ 50–100 for MAI (with
avium–intracellulare (MAI) avium–intracellulare (MAI) prophylaxis? Risk factors for pyelonephritis.
Pregnancy, vesicoureteral reflux, anatomic anomalies, indwelling catheters, kidney stones.
Neutropenic nadir postchemotherapy.
7–10 days.
Erythema mig rans.
Lesion of 1° Lyme disease.
Classic physical findings for endocarditis.
Fever, heart murmur, Osler’s nodes, splinter hemorrhages, Janeway lesions, Roth’s spots.
Aplastic crisis in sickle cell disease.
Parvovirus B19.
Ring-enhancing brain lesion on CT with seizures.
Taenia solium solium (cysticercosis). (cysticercosis).
Name the organism: n
Branching rods in oral infection
n Weakly gram- , partially acid-fast in lung infection
Actinomyces israelii Nocardia asteroides
n
Painful chancroid
Haemophilus ducreyi
n
Dog or cat bite
Pasteurella multocida
n
Gardener
Sporothrix schenckii
n
Raw pork and skeletal muscle cysts
Trichinella spiralis
n
Sheepherders with liver cysts
Echinococcus granulosus
n
Perianal itching
Enterobius vermicularis
n
Pregnant women with pets
Toxoplasma gondii
n
Meningitis in adults
Neisseria meningitidis
n
Meningitis in elderly
Streptococcus pneumoniae
n
Meningoencephalitis in AIDS patients
Cryptococcus neoformans
n
Alcoholic with pneumonia
Klebsiella
n
“Currant jelly” sputum
Klebsiella
n
Malignant external otitis
Pseudomonas
n
Infection in burn victims
Pseudomonas
n
Osteomyelitis from a foot wound puncture
Pseudomonas
n
Osteomyelitis in a sickle cell patient
Salmonella
A 55-year-old man who is a smoker and a heavy drinker presents
Legionella pneumonia. Legionella pneumonia.
with a new cough and flulike symptoms. symptoms. Gram stain shows no organisms; silver stain of sputum shows gram- rods. What is the diagnosis? A middle-aged man presents with acute-onset monoarticular joint
Lyme disease, Ixodes Ixodes tick, tick, doxycycline.
pain and bilateral Bell’s palsy. What is the likely diagnosis, and how did he get it? Treatment? A patient develops endocarditis 3 weeks after receiving a prosthetic
S aureus or aureus or Staphylococcus epidermidis.
heart valve. What organism is suspected? A patient develops endocarditis in a native valve after having a dental cleaning.
Streptococcus viridans.
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MUSCULOSKELETAL
Back pain that is exacerbated by standing and walking and relieved
Spinal stenosis.
with sitting and hyperflexion hyperflexion of the hips. Joints in the hand affected affected in rheumatoid rheumatoid arthritis.
MCP and PIP joints; DIP joints are spared. spared.
Joint pain and stiffness that worsen over the course of the day and
Osteoarthritis.
are relieved by rest. A genetic disorder that is associated with multiple fractures and
Osteogenesis imperfecta.
blue sclerae and is commonly mistaken for child abuse. Hip and back pain along with stiffness that improves with activity
Suspect ankylosing spondylitis. Check HLA-B27. HLA-B27.
over the course of the day and worsens at rest. Diagnostic test? Arthritis, conjunctivitis, and urethritis in young men. Associated
Reactive (Reiter’s) arthritis. Most commonly associated with
organisms?
Chlamydia. Also Chlamydia. Also consider Campylobacter, Shigella, Salmonella, and Ureaplasma.
A 55-year-old man has sudden, excruciating first MTP joint pain
Gout. Needle-shaped, negatively birefringent crystals are seen on
after a night of drinking red wine. Diagnosis, workup, and chronic
joint fluid aspirate. Chronic Chronic treatment with allopurinol or probenecid. probenecid.
treatment? Rhomboid-shaped, positively birefringent crystals on joint fluid
Pseudogout.
aspirate. An elderly woman presents with pain and stiffness of the shoulders
Polymyalgia rheumatica.
and hips; she cannot lift her arms above her head. Labs show anemia and ↑ ESR. An act activ ive e 1313-ye year ar-o -old ld boy boy has has ant anter erio iorr knee knee pai pain. n. Dia Diagn gnos osis is??
Osgo Os good od-S -Sch chla latt tter er dis disea ease se..
Bone is fractured in a fall on an outstretched hand.
Distal radius (Colles’ fracture).
A complication of scaphoid fracture.
Avascular necrosis.
Sign Si gnss sug sugge gest stin ingg rad radia iall ner nerve ve da dama mage ge wi with th hu hume mera rall fra fract ctur ure. e.
Wri rist st dr drop op,, los losss of of thu thumb mb ab abdu duct ctio ion. n.
A young child presents with proximal muscle weakness, waddling
Duchenne muscular dystrophy.
gait, and pronounced calf muscles. A first-born female who was born in breech position is found
Developmental dysplasia of the hip. If severe, consider a Pavlik
to have asymmetric skin folds on newborn exam. Diagnosis?
harness to maintain abduction.
Treatment? Treat ment? An 11-year-old obese African American boy presents with sudden
Slipped capital femoral epiphysis. AP and frog-leg lateral x-rays.
onset of limp. Diagnosis? Workup? The most common common 1° malignant tumor of bone.
Multiple myeloma.
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NEUROLOGY
Unilateral, severe periorbital headache with tearing and
Cluster headache.
conjunctival erythema. Prophylactic treatment for mig raine.
Antihypertensives, antidepressants, anticonvulsants, dietary changes.
The most common common pituitary tumor. tumor. Treatment? Treatment?
Prolactinoma. Dopamine agonists (eg, bromocriptine). bromocriptine).
A 55-year-old patient presents with acute “broken speech.” What
Broca’s aphasia. Frontal lobe, left MCA distribution.
type of aphasia? What lobe and vascular distribution? The most common common cause of SAH. SAH.
Trauma; Traum a; the second most common is berry aneurysm.
A crescent-shaped hyperdensity on CT that does not cross the
Subdural hematoma—bridging veins torn.
midline. A history significant for initial altered mental status with an
Epidural hematoma. Middle meningeal artery. Neurosurgical
intervening lucid interval. Diagnosis? Most likely source? Tre Treatment? atment?
evacuation.
CSF findings with SAH.
Elevated ICP, RBCs, xanthochromia.
Albuminocytologic dissociation.
Guillain-Barré syndrome ( ↑ protein in CSF without a significant ↑ in cell count).
Cold water is flushed into a patient’s ear, and the fast phase of the
Normal.
nystagmus is toward the opposite side. Normal or pathologic? The most common common 1° sources of metastases to the brain. brain.
Lung, breast, skin (melanoma), (melanoma), kidney, kidney, GI tract.
May be seen in children who are accused of inattention in class
Absence seizures.
and confused with ADHD. The most frequent frequent presentation of intracranial neoplasm.
Headache. 1 neoplasms are much less common than brain °
metastases. The most common common cause of seizures seizures in children (2–10 (2–10 years).
Infection, febrile seizures, trauma, idiopathic. idiopathic.
The most common common cause of seizures seizures in young adults (18–35 (18–35
Trauma, Traum a, alcohol withdrawal, brain tumor.
years). First-line medication for status epilepticus.
IV benzodiazepine.
Conf Co nfu usi sion on,, con onffab abul ulat atio ion, n, op opht htha halm lmop ople legi gia, a, at atax axia ia..
Wern rnic icke ke’’s enc nce eph phal alop opat athy hy du due e to a de defi ficie ien ncy of th thia iami mine ne..
What Wh at % le lesi sion on is an in indi dica cati tion on fo forr ca caro roti tid d en enda darte rtere rect ctom omy? y?
Seve Se vent ntyy pe perc rcen entt if th the e st sten enos osis is is sy symp mpto toma mati tic. c.
The most common common causes of dementia. dementia.
Alzheimer’s and multi-infarct. multi-infarct.
A combined U MN and LMN disorder.
ALS.
Rigidity and stiffness with unilateral resting tremor and masked
Parkinson’s disease.
facies. The mainstay of Parkinson’s therapy. therapy.
Levodopa/carbidopa.
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HIGH-YIELD FACTS IN
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Treatment Treat ment for Guillain-Barré syndrome.
IVIG or plasmapheresis. Avoid Avoid steroids.
Rigidity and stiffness that progress to choreiform movements,
Huntington’s disease.
accompanied by moodiness and altered behavior. A 6-year-old girl presents with a port-wine stain in the V 2
Sturge-Weber syndrome. Treat symptomatically. Possible focal
distribution as well as with mental retardation, seizures, and
cerebral resection of the affected lobe.
ipsilateral leptomeningeal angioma. Multiple café au lait spots on skin.
Neurofibromatosis type 1.
Hype Hy perp rpha hagia gia,, hy hype pers rsex exua uali lity ty,, hy hype pero rora rali lity ty,, an and d hyp hyper erdo doci cili lity ty..
Klüv Kl üver er-B -Buc ucyy sy synd ndro rome me (a (amy mygd gdal ala) a)..
May be administered to a symptomatic patient to diagnose
Edrophonium.
myasthenia gravis.
OBSTETRICS
1° causes of third-trimester bleeding.
Placental abruption and placenta previa.
Classic ultrasound and g ross appearance of complete hydatidiform
Snowstorm on ultrasound. “Cluster-of-grapes” appearance on gross
mole.
examination.
Chromosomal pattern of a complete mole.
46,XX.
Molar pregnancy containing fetal tissue.
Partial mole.
Symptoms of placental abruption.
Continuous, painful vag inal bleeding.
Symptoms of placenta previa.
Self-limited, painless vaginal bleeding.
When should a vaginal exam be performed with suspected
Never.
placenta previa? Antibiotics with teratogenic effects.
Tetracycline, fluoroquinolones, aminoglycosides, sulfonamides.
Medication g iv iven to accelerate fetal lung maturity.
Betamethasone or dexamethasone
The most common common cause of postpartum hemorrhage.
Uterine atony. atony.
Treatment Treat ment for postpartum hemorrhage. hemorrhage.
Uterine massage; if that fails, give oxytocin.
Typical Typ ical antibiotics for GBS prophylaxis.
IV penicillin or ampicillin. ampicillin.
A patient fails to lactate after an emergency C-section with marked
Sheehan’s syndrome (postpartum pituitary necrosis).
blood loss. Uterine bleeding at 18 weeks’ gestation; no products expelled;
Inevitable abortion.
cervical os open. Uterine bleeding at 18 weeks’ gestation; no products expelled; cervical os closed.
Threatened abortion.
48 hours.
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GYNECOLOGY
The first test to perform when a woman presents with with amenorrhea.
β-hCG; the most common cause of a menorrhea is pregnancy.
Term Ter m for heavy bleeding bleeding during and between between menstrual periods. periods.
Menometrorrhagia.
Cause of amenorrhea with normal prolactin, no response to
Asherman’s syndrome.
estrogen-progesterone challenge, and a history of D&C. Therapy for polycystic polycystic ovarian syndrome. syndrome.
Weight loss and OCPs. OCPs. Consider metformin. metformin.
Medication used to induce ovulation.
Clomiphene citrate.
Diagnostic step required in a postmenopausal woman who
Endometrial biopsy.
presents with vaginal bleeding. Indi In dica cati tion onss for for me medi dica call tre treat atme ment nt of ec ecto topi picc pre pregn gnan ancy cy..
Pati Pa tien entt sta stabl ble; e; un unru rupt ptur ured ed ec ecto topi picc pre pregn gnan ancy cy of < 3.5 3.5 cm at < 6 weeks’ gestation.
Medical options for endometriosis.
OCPs, danazol, GnR H agonists.
Laparoscopic findings in endometriosis.
Powder burns, “chocolate cysts.”
The most common common location for an ectopic pregnancy. pregnancy.
Ampulla of the oviduct. oviduct.
How to diagnose and follow a leiomyoma.
Ultrasound.
Natural history of a leiomyoma.
Reg resses after menopause.
A patient has ↑ vaginal discharge and petechial patches in the
Trichomonal Tric homonal vaginitis.
upper vagina and cervix. Treatment Tre atment for bacterial bacterial vaginosis.
Oral or topical metronidazole. metronidazole.
The most common common cause of bloody nipple discharge.
Intraductal papilloma.
Contraceptive methods that protect against PID.
OCPs and barrier co contraception.
Unop Un oppo pose sed d es estr trog ogen en is co cont ntra rain indi dica cate ted d in wh whic ich h ca canc ncer ers? s?
Endo En dome metr tria iall or es estr trog ogen en re rece cept ptor or– – breast cancer.
A patient presents with recent PID with RUQ pain.
Consider Fitz-Hugh–Curtis syndrome.
Breast malignancy presenting as itching, burning, and erosion of
Paget’s disease.
the nipple. Annual screening for women with a strong family history of ovarian
CA-125 and transvaginal ultrasound.
cancer. A 50-year-old woman leaks urine when laughing or coughing.
Kegel exercises, estrogen, pessaries for stress incontinence.
Nonsurgical options? A 30-year-old woman has unpredictable urine loss. Examination is
Anticholinergics (oxybutynin) or β-adrenergics (metaproterenol) for
normal. Medical options?
urge incontinence.
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↑ serum FSH.
Lab values suggestive of menopause. The most common common cause of female female infertility. infertility.
Endometriosis.
Two consecutive findings findings of atypical squamous squamous cells of
Colposcopy and endocervical curettage.
undetermined significance (ASCUS) on Pap smear. Follow-up evaluation? Breast cancer type that ↑ the future risk of invasive carcinoma in
Lobular carcinoma in situ.
both breasts.
PEDIATRICS
Nontender abdominal mass associated with elevated VMA and
Neuroblastoma.
HVA. The most common common type of tracheoesophageal tracheoesophageal fistula (TEF). (TEF).
Esophageal atresia with distal TEF (85%). Unable to pass NG tube.
Diagnosis? Not co contraindications to vaccination.
Mild illness an and/or lo low-g rade fever, current antibiotic therapy, and prematurity.
Testss to rule out shaken baby syndrome. Test
Ophthalmologic exam, CT, CT, and MRI.
A neonate has meconium ileus.
Cystic fibrosis (Hirschsprung’s disease is associated with failure to pass meconium for 48 hours).
Bilious emesis within hours after the first feeding.
Duodenal atresia.
A 2-month-old baby presents with nonbilious projectile emesis.
Pyloric stenosis. Correct metabolic abnormalities; then correct pyloric
Diagnosis? What are the appropriate steps in management?
stenosis with pyloromyotomy pyloromyotomy..
The most common common 1° immunodeficiency. immunodeficiency.
Selective IgA deficiency deficiency..
An infant has a high fever and onset of rash as fever breaks. What
Febrile seizures (due to roseola infantum).
is he at risk for? What is the immunodeficienc immunodeficiency? y? n
A boy has chronic respiratory infections. Nitroblue tetrazolium test
Chronic granulomatous disease
is . n
A child has eczema, thrombocytopenia, and high levels of IgA.
Wiskott-Aldrich syndrome
n
A 4-month-old boy has life-threatening
Bruton’s X-linked agammaglobulinemia
Pseudomonas infection.
Acute-phase treatment for Kawasaki disease.
High-dose ASA for inflammation and fever; IVIG to prevent coronary artery aneurysms.
Treatment Treat ment for mild and severe unconjugated unconjugated hyperbilirubinemia.
Phototherapy (mild) or exchange transfusion transfusion (severe). (Do (Do not use phototherapy for conjugated hyperbilirubinemia.)
Sudden onset of mental status changes, emesis, and liver dysfunction after ASA intake.
Reye’s syndrome.
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A child has loss of red light reflex (white pupil). Diagnosis? The
HIGH-YIELD FACTS IN
505
Suspect retinoblastoma. Osteosarcoma.
child has an ↑ risk of what cancer? Vaccinations at a 6-month well-child visit.
HBV, DTaP, Hib, I PV, PCV, rotavirus.
Tannerr stage 3 in a 6-year-old Tanne 6-year-old girl.
Precocious puberty. puberty.
Infe In fect ctio ion n of of sma small ll ai airw rway ayss wit with h epi epide demi mics cs in wi wint nter er an and d spr sprin ing. g.
RSV br bron onch chio ioli liti tis. s.
Cause of neonatal RDS.
Surfactant deficiency.
A condition associated with red “currant-jelly” stools, colicky
Intussusception.
abdominal pain, bilious vomiting, and a sausage-shaped mass in the RUQ. A congenital heart disease that causes 2° hypertension. What
Coarctation of the aorta; ↓ femoral pulses.
would you find on physical examination? First-line treatment for otitis media.
Amoxicillin × 10 days.
The most common common pathogen causing croup. croup.
Parainfluenza virus type type 1.
A homeless child is small for his age and has peeling skin and a
Kwashiorkor (protein malnutrition).
swollen belly. Defect in an X-linked syndrome with mental retardation, gout, self-
Lesch-Nyhan syndrome (purine salvage problem with HGPRTase
mutilation, and choreoathetosis.
deficiency).
A newborn girl has a continuous “machinery murmur.” murmur.” What drug
Patent ductus arteriosus (PDA). Indomethacin is given to close the
would you give?
PDA.
A newborn with a posterior neck mass and swelling of the hands.
Turner’s Turn er’s syndrome.
PSYCHIATRY
First-line pharmacotherapy for depression.
SSRIs.
Antidepressants as associated wi with hy hypertensive cr crisis.
MAOIs.
Galactorrhea, impotence, menstrual dysfunction, and ↓ l liibido.
Dopamine antagonists.
A 17-year-old 17-year-old girl has left arm paralysis after her boyfriend dies in a
Conversion disorder.
car crash. No medical cause is found. Name the defense mechanism: n
A mother who is angry at her husband yells at her child.
Displacement
n
A pedophile enters a monastery.
Reaction formation
n
A woman calmly describes a grisly murder.
Isolation
n
A hospitalized 10-year-old begins to wet his bed.
Regression
Life-t Lif e-thre hreate atenin ningg muscl muscle e rigidi rigidity ty,, high high feve fever, r, and rha rhabdo bdomyo myolys lysis. is.
Neurol Neu rolept eptic ic mali maligna gnant nt synd syndrom rome. e.
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Amenorrhea, low body weight (< 85%), bradycardia, and abnormal
Anorexia.
body image in a young woman. A 35-year-old man has recurrent episodes of palpitations,
Panic disorder.
diaphoresis, and fear of going crazy. The most serious side effect of of clozapine.
Agranulocytosis.
A 21-year-old man has 3 months of social withdrawal, worsening
Schizophreniform disorder (a diagnosis of schizophrenia requires ≥ 6
grades, flattened affect, and concrete thinking.
months of symptoms).
Key side effects of of atypical antipsychotics.
Weight gain, type 2 DM, QT-segment prolongation.
A young weight lifter receives IV haloperidol and complains that his
Acute dystonia (oculogyric crisis). Tre Treat at with benztropine or
eyes are deviated sideways. Diagnosis? Treatment?
diphenhydramine.
Medication to avoid in patients with a history of alcohol withdrawal
Neuroleptics.
seizures. A 13-year-old boy has a history of theft, vandalism, and violence
Conduct disorder. Associated with antisocial personality disorder in
toward family pets.
adults.
A 5-month-old girl has ↓ head growth, truncal discoordination, and
Rett’s disorder. Loss of milestones is commonly described.
↓ social interaction.
A patient hasn’t slept for days, lost $20,000 gambling, is agitated,
Acute mania. Start a mood stabilizer (eg, lithium).
and has pressured speech. Diagnosis? Treatment? After a minor “fender bender,” a man wears a neck brace and
Malingering.
requests permanent disability. A nurse presents with severe hypoglycemia; blood analysis reveals
Factitious disorder (Munchausen syndrome).
no elevation in C-peptide. A patient continues to use cocaine after being in jail, losing his job,
Substance abuse.
and not paying child support. Medication to to av avoid in in pa patients wi with PT PTSD.
Benzodiazepines (h (have hi high ad addiction po potential). Pa Patients co commonly have a history of substance abuse.
A vi viol olen entt pa pati tien entt ha hass ve vert rtic ical al an and d ho hori rizo zont ntal al ny nyst stag agmu mus. s.
Phen Ph ency cycl clid idin ine e hy hydr droc ochl hlor orid ide e (P (PCP CP)) in into toxi xica cati tion on..
A woman who was abused as a child frequently feels outside of or
Depersonalization disorder.
detached from her body. A schizophrenic patient takes haloperidol for 1 year and develops
Tardive Tardiv e dyskinesia. ↓ or discontinue haloperidol and consider
uncontrollable tongue movements. Diagnosis? Tre Treatment? atment?
another antipsychotic (eg, risperidone, clozapine).
A man with major depressive disorder is counseled to avoid
MAOIs.
tyramine-rich foods with his new medication.
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PULMONARY
Risk factors for DVT.
Stasis, endothelial injury, and hypercoagulability (Virchow’s triad).
Criteria for exudative effusion.
Pleural/serum protein > 0.5; pleural/serum LDH > 0.6.
Causes of exudative effusion.
Think of leaky capillaries. Malignancy, TB, bacterial or viral infection, PE with infarct, and pancreatitis.
Causes of transudative effusion.
Think of intact capillaries. CHF, liver or kidney disease, and proteinlosing enteropathy enteropathy..
Normalizing PCO2 in a patient having an asthma exacerbation may
Fatigue and impending respiratory failure.
indicate? Sarcoidosis.
Dyspnea, lateral hilar lymphadenopathy on CXR, noncaseating granulomas, ↑ ACE, and hypercalcemia.
PFTs of obstructive pulmonary disease.
↓ FEV1 /FVC.
PFTs of restrictive pulmonary disease.
↑ FEV1 /FVC, ↓ TLC.
Honeycomb pattern on CXR. Treatment?
Diffuse interstitial pulmonary fibrosis. Suppor tive care; steroids may help.
Treatment Tre atment for SVC SVC syndrome.
Radiation.
Treatment Tre atment for mild persistent persistent asthma.
Inhaled β-agonists and inhaled corticosteroids.
Treatment Tre atment for COPD COPD exacerbation.
O 2, bronchodilators, antibiotics, corticosteroids with taper, smoking cessation.
Treatment Tre atment for chronic COPD.
Smoking cessation, home home O 2, β-agonists, anticholinergics, systemic or inhaled corticosteroids, flu and pneumococcal vaccines.
Acid-base disorder in PE.
Respiratory alkalosis with hypoxia and hypocarbia.
Non–small Non–s mall cell cell lung cancer cancer (NSCL (NSCLC) C) associated associated with with hypercal hypercalcemi cemia. a.
Squamous Squam ous cell cell carcinoma. carcinoma.
Lung cancer associated with SIADH.
Small cell lung cancer (SCLC).
Lung cancer highly related to cigarette exposure.
SCLC.
A tall Caucasian man presents with acute shortness of breath.
Spontaneous pneumothorax. Spontaneous regression; supplemental
Diagnosis? Treatment?
O2 may be helpful.
Treatment Tre atment of tension pneumothorax.
Immediate needle thoracostomy thoracostomy..
Characteri Chara cteristic sticss favoring favoring carcinoma carcinoma in an isolated isolated pulmonary pulmonary nodule. nodule.
Age > 45–50; lesions lesions new or larger larger in comparison comparison to old films; absence of calcification or irregular calcification; size > 2 cm; irregular margins.
AR DS.
Hypoxemia and pulmonary edema with normal pulmonary capillary wedge pressure (PCWP). (PCWP).
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Sequelae of asbestos exposure.
Pulmonary fibrosis, pleural plaques, bronchogenic carcinoma (mass in lung field), mesothelioma (pleural mass).
↑ risk of what infection with silicosis?
Mycobacterium tuberculosis tuberculosis..
Causes of hypoxemia.
Right-to-left shunt, hypoventilation, low inspired O 2 tension, diffusion defect, V/Q mismatch.
Classic CXR findings for pulmonary edema.
Cardiomegaly, prominent pulmonary vessels, Kerley B lines, “bat’s-wing” appearance of hilar shadows, and perivascular and peribronchial cuffing.
Westermark’s sign and Hampton’s hump.
CXR findings suggestive of PE.
RENAL/GENITOURINARY
Renal tubular acidosis (RTA) associated with abnormal H + secretion
Type Ty pe I (distal) RTA. RTA.
and nephrolithiasis. RTA RT A associated with abnormal HCO3– a an nd rickets.
Type II (proximal) RTA.
RTA associated with aldosterone defect.
Type IV (distal) RTA.
“Doughy” skin.
Hypernatremia.
Differential of hypervolemic hyponatremia.
Cirrhosis, CHF, nephritic syndrome.
Chvostek’s and Trousseau’s signs.
Hypocalcemia.
The most common common causes of hypercalcemia. hypercalcemia.
Malignancy and hyperparathyroidism. hyperparathyroidism.
T-wave flattening flattening and U waves.
Hypokalemia.
Peaked T waves and widened QRS.
Hyperkalemia.
First-line treatment for moderate hypercalcemia.
IV hydration and loop diuretics (furosemide).
Type Typ e of ARF in a patient with Fe Na < 1%.
Prerenal.
A 49-year-old man presents with acute-onset flank pain and
Nephrolithiasis.
hematuria. The most common common type of nephrolithiasis. nephrolithiasis.
Calcium oxalate.
A 20-year-old man presents with a palpable flank mass and
Cerebral berry aneurysms (autosomal dominant PCKD).
hematuria. Ultrasound shows bilateral enlarged kidneys with cysts. Associated brain anomaly? Hematuria, hypertension, and oliguria.
Nephritic syndrome.
Proteinuria, hypoalbuminemia, hyperlipidemia, hyperlipiduria, and
Nephrotic syndrome.
edema. The most common common form of nephritic nephritic syndrome.
Membranous glomerulonephritis. glomerulonephritis.
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The most common common form of glomerulonephritis. glomerulonephritis.
IgA nephropathy (Berger’s (Berger’s disease).
Glomerulonephritis with deafness.
Alport’s syndrome.
Glomerulonephritis with hemoptysis.
Wegener’s granulomatosis and Goodpasture’s syndrome.
Presence of red cell casts in urine sediment.
Glomerulonephritis/nephritic syndrome.
Eosinophils in urine sediment.
Allerg ic interstitial nephritis.
Waxy casts in urine sediment and Maltese crosses (seen with
Nephrotic syndrome.
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lipiduria). Drow Dr owsi sine ness ss,, ast aster erix ixis is,, nau nause sea, a, an and d a per peric icar ardi dial al fr fric icti tion on ru rub. b.
Urem Ur emic ic sy synd ndro rome me se seen en in pa pati tien ents ts wi with th re rena nall fai failu lure re..
A 55-year-old man is diagnosed with prostate cancer. Treatment Treatment
Wait, surgical resection, radiation and/or androgen suppression.
options? Low urin urine e specifi specificc gravity gravity in in the prese presence nce of of high seru serum m osmola osmolalit lityy.
DI.
Treatment Tre atment of SIADH.
Fluid restriction, demeclocycline. demeclocycline.
Hematuria, flank pain, and palpable flank mass.
Renal cell carcinoma (RCC).
Testicular Test icular cancer associated associated with β-hCG, AFP.
Choriocarcinoma.
The most common common type of testicular testicular cancer. cancer.
Seminoma, a type of germ cell tumor. tumor.
The most common common histology of bladder cancer.
Transitional Transit ional cell carcinoma.
Comp Co mpli lica cati tion on of ov ove erl rlyy rap rapid id cor orre reccti tion on of hyp ypon onat atre rem mia ia..
Cen enttra rall pon ponttin ine e mye myeli lino noly lysi sis. s.
Salicy Sal icylat late e inges ingestio tion n occur occurss in what what typ type e of aci acid-b d-base ase dis disord order? er?
Anion Ani on gap gap acid acidosi osiss and and 1° resp respira irator toryy alkal alkalosi osiss due to cent central ral respiratory stimulation.
Acid Ac id-b -bas ase e di dist stur urba banc nce e co comm mmon only ly se seen en in pr preg egna nant nt wo wome men. n.
Resp Re spir irat ator oryy al alka kalo losi sis. s.
Three systemic diseases that lead to nephrotic syndrome. syndrome.
DM, SLE, and amyloidosis. amyloidosis.
Elevated erythropoietin level, elevated hematocrit, and normal O 2
RCC or other erythropoietin-producing tumor; evaluate with CT scan.
saturation suggest? A 55-year-old man presents with irritative and obstructive urinary
Likely BPH. Options include no treatment, terazosin, finasteride, or
symptoms. Treatment options?
surgical intervention (TURP).
SELECTED TOPICS IN EMERGENCY MEDICINE
Class of drugs that may cause syndrome of muscle rig idity,
Antipsychotics (neuroleptic malignant syndrome).
hyperthermia, autonomic instability, and extrapyramidal symptoms. Side effects of corticosteroids.
Acute mania, immunosuppression, thin skin, osteoporosis, easy bruising, myopathies.
Treatment Tre atment for DTs. DTs.
Benzodiazepines.
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Treatment Treat ment for acetaminophen acetaminophen overdose.
-acetylcysteine. N -acetylcysteine.
Treatment Treat ment for opioid overdose. overdose.
Naloxone.
Treatment Treat ment for benzodiazepine benzodiazepine overdose.
Flumazenil.
Treatment Treat ment for neuroleptic neuroleptic malignant syndrome and malignant
Dantrolene.
hyperthermia. Treatment Treat ment for malignant hypertension. hypertension.
Nitroprusside.
Treatment Treat ment of atrial fibrillation. fibrillation.
Rate control, rhythm conversion, and anticoagulation. anticoagulation.
Treatment Treat ment of supraventricular supraventricular tachycardia.
If stable, rate control control with carotid massage massage or other vagal stimulation; stimulation; if unsuccessful, consider adenosine.
Causes of drug-induced SLE.
I NH, penicillamine, hydralazine, procainamide, chlorpromazine, methyldopa, quinidine.
Macr Ma cro ocy cyti ticc, me mega galo lobl blas asttic an ane emi miaa wit with h ne neur urol olo ogi gicc sy sympt ptom oms. s.
B 12 deficiency.
Macroc Mac rocyti ytic, c, meg megalo alobla blasti sticc anemi anemiaa with without out neu neurol rologic ogic sym sympto ptoms. ms.
Folat Fo late e defici deficienc ency. y.
A burn patient presents with cherry-red, flushed skin and coma.
Treat Tre at CO poisoning with with 100% O2 or with hyperbaric O 2 if poisoning
SaO2 is normal, but carboxyhemoglobin is elevated. Treatment? Treatment?
is severe or the patient is pregnant.
Blood in the urethral meatus or high-riding prostate.
Bladder rupture or urethral injury.
Test to rule out urethral urethral injury.
Retrograde cystourethrogram.
Radi Ra diog ogra raph phic ic ev evid iden ence ce of ao aort rtic ic di disr srup upti tion on or di diss ssec ecti tion on..
Wid iden ened ed me medi dias asti tinu num m (> (> 8 cm) cm),, los losss of ao aort rtic ic kn knob ob,, ple pleur ural al cap, tracheal deviation to the right, depression of left main stem bronchus.
Radiographic indications for surgery in patients with acute
Free air under the diaphragm, extravasation of contrast, severe
abdomen.
bowel distention, space-occupying lesion (CT), mesenteric occlusion (angiography).
The most common common organism in burn-related burn-related infections.
Pseudomonas.
Method of of ca calculating flu fluid re repletion in in bu burn pa patients.
Parklan and d fo formula: 24 24-hour flu fluids = 4 × kg × % BSA.
Acceptable urine output in a trauma patient.
50 cc/hr.
Acceptable urine output in a stable patient.
30 cc/hr.
Signs of neurogenic shock.
Hypotension and bradycardia.
Signs of ↑ I IC CP (Cushing’s triad).
Hypertension, bradycardia, and abnormal respirations.
pe eripheral vascular resistance (PVR). ↓ CO, ↓ PCWP, ↑ p
Hypovolemic shock.
PV VR. ↓ CO, ↑ PCWP, ↑ P
Cardiogenic (or obstructive) shock.
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PV VR. ↑ CO, ↓ PCWP, ↓ P
Septic or anaphylactic shock.
Treatment Tre atment of septic shock.
Fluids and antibiotics.
Treatment Tre atment of cardiogenic cardiogenic shock.
Identify cause; pressors pressors (eg, dopamine).
Treatment Tre atment of hypovolemic hypovolemic shock.
Identify cause; fluid fluid and blood repletion. repletion.
Treatment Tre atment of anaphylactic anaphylactic shock.
Diphenhydramine or or epinephrine 1:1000. 1:1000.
Supportive treatment for AR DS.
Continuous positive airway pressure.
Signs of air embolism.
A patient with chest trauma who was previously stable suddenly
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dies. Signs of cardiac tamponade.
Distended neck veins, hypotension, diminished heart sounds (Beck’s triad); pulsus paradoxus.
Absent breath sounds, dullness to percussion, shock, flat neck
Massive hemothorax.
veins. Absent breath sounds, tracheal deviation, shock, distended neck
Tension Te nsion pneumothorax.
veins. Treatment Tre atment for blunt or or penetrating abdominal trauma in
Immediate exploratory laparotomy.
hemodynamically unstable patients. ↑ ICP in alcoholics or the elderly following head trauma. Can be
Subdural hematoma.
acute or chronic; crescent shape on CT CT.. Head trauma with immediate loss of consciousness followed by a lucid interval and then rapid deterioration. Convex shape on CT.
Epidural hematoma.