Question

Id
Main
Division
Sub Division Notes
4543
Obstetrics &
Gynecology
Endocrinology
Galactorrhea can be brown, yellow and green. Bloody discharge requires mammogram as next
best step.
2925
Obstetrics &
Gynecology
Hepatology
Acute fatty liver of pregnancy - no pruritis ICP - pruritis, hand and sole involvement. J aundice is
uncommon. Puppp - no hand and sole involvement.
4472
Obstetrics &
Gynecology
ID
Tmp smx is contraindicated during first trimester pregnancy as it interferes with folate metabolism
and third trimester as it causes kernicterus. Use amox or nitrofuntoin for utis
2391
Obstetrics &
Gynecology
OBGYN
Irregular bleeding, risk factors (age >45, obesity) and negative initial work up require endometrial
biopsy.
2393
Obstetrics &
Gynecology
OBGYN
Copper iud is best way to prevent pregnancy. Inflammatory response and toxic to sperm and ova.
Ocps prevent ovulation as they contain progestin.
2394
Obstetrics &
Gynecology
OBGYN
Pelvic congestion =pain worse with standing +pain on sex. Primary dysmenorrhea - low back pain
worse during menses. Normal exam. Bulky, globular uterus =adenomyosis. Enlarged uterus =
fibroids.
2398
Obstetrics &
Gynecology
OBGYN Bethenchol and alpha blockers help with overflow incontinence.
2407
Obstetrics &
Gynecology
OBGYN Cord prolapse is painless. Placental abruption is painful b
2409
Obstetrics &
Gynecology
OBGYN
Lithium should be tApered not stopped abruptly. 2 effective forms of contraception must be used
for 1 month before starting isotretoin
2413
Obstetrics &
Gynecology
OBGYN
Pcos =lots of estrogen no progesterone =early risk of endometrial hyperplasia =high risk of
endometrial cancer
2419
Obstetrics &
Gynecology
OBGYN
Bloating, breast tenderness, headaches, anxiety =pms. Last 7-10 days. First step is menstrural
diary
2423
Obstetrics &
Gynecology
OBGYN
Thyroid stimulating antibodies in moms can travel through placenta to kid and induce
thyrotoxicosis. This happens even in hyperthyroid moms whose graves has been treated.
2524
Obstetrics &
Gynecology
OBGYN Prvia always needs c section.
2527
Obstetrics &
Gynecology
OBGYN
Accreta bleeding is often painless. Fundal placenta on US rules it out. Abruptio is always painful
and has a hypertonic uterus. Premature placental separation of placenta from uterus due to
bleeding in the decidua basalis. Primary role of ultrasound is to rule out prvia. Can't detect
abruption and accreta that well.
2528
Obstetrics &
Gynecology
OBGYN
Placental abruption should be managed with rapid vagibal delivery. C-section only if there are
other indications or if rapid fetal or maternal deterioration.
2532
Obstetrics &
Gynecology
OBGYN Loss of fetal station is a red flag for rupture.
2533
Obstetrics &
Gynecology
OBGYN Apt test distinguishes fetal from maternal blood. Treat vasa prvia with immediate c section.
2536
Obstetrics &
Gynecology
OBGYN Collapsed gestational sac =missed abortjon (dead fetus retained in uterus)
2541
Obstetrics &
Gynecology
OBGYN Suction curettage is treatment of choice for inevitable abortion.
2546
Obstetrics &
Gynecology
OBGYN
Endometriosis leads to chronic scarring which leads to chronic pelvic adhesions. Dx =direct
visualization via laparoscopy.
2549
Obstetrics &
Gynecology
OBGYN In patients With fetal demise ALWAYS iol immediately. No c-section, no watchful waiting.
2561
Obstetrics &
Gynecology
OBGYN Mag is a cns depressant and first sign of toxicity is hyporeflexia. Second sign is bradycapnia
2568
Obstetrics &
Gynecology
OBGYN First step after high/low msafp '"=ultrasound to confirm dates.
3118
Obstetrics &
Gynecology
OBGYN Breech can only be presented after 37 weeks.
3275
Obstetrics &
Gynecology
OBGYN Impending fetal demise =deliver preterm Baby without giving steroids.
3280
Obstetrics &
Gynecology
OBGYN
Asymmetric iugr due to hypertension etc. Symmetric is due to congenital anomalies or torch
infections.
3338
Obstetrics &
Gynecology
OBGYN
Lactation: sudden drop in estrogen and progesterone stops prolactin inhibition. Lactation
suppression occurs when no suckling happens, so no oxytocin, so boobs just keep seeking with
milk. Treat with ice compresses and a tight fitting bra.
3339
Obstetrics &
Gynecology
OBGYN
Progestin only pills should be used as contraception in lactating women as estrogen interferes with
regular lactation.
3370
Obstetrics &
Gynecology
OBGYN In ovulatory phase, cervical mucus is thin. Otherwise it is thick.
3639
Obstetrics &
Gynecology
OBGYN
Empiric treatment for gonhorrhea must always include treatment for chlamydia even after gram
stain shows only gonhorrhea.
3679
Obstetrics &
Gynecology
OBGYN Bacterial vaginosis (unlike trich ) does not present with erythema or pruritis
3814
Obstetrics &
Gynecology
OBGYN Chemo/radiation can cause premature ovarian failure.
3869
Obstetrics &
Gynecology
OBGYN
Recurrent variable decels: 1. Adjust position, oxygen 2. Discontinue meds that induce
contractions. Treat maternal hypotension. 3. Amnioinfusion.
3996
Obstetrics &
Gynecology
OBGYN >140 on oral glucose tolerance test =impaired glucose tolerance. Start metformin.
4050
Obstetrics &
Gynecology
OBGYN Relaxation of sacroiliac ligaments cause lumbar lordosis in pregnancy leading to back pain.
4135
Obstetrics &
Gynecology
OBGYN
Hcg is secreted by syctitiotrophoblasts. It's mAin role is to maintain the corpus luteum. Pregnancy
tests target the specific beta subunit of hcg.
4217
Obstetrics &
Gynecology
OBGYN
Breast development is present in androgen insensitivity as testosterone is converted to estrogen.
Testicular cancer can happen in 20s-30s, but balls shouldn't be cut off until after breast
Decelopment is complete.
4225
Obstetrics &
Gynecology
OBGYN Urodynamic testing is always the wrong answer.
4294
Obstetrics &
Gynecology
OBGYN Evaluate renal colic with ultrasound during pregnancy.
4767
Obstetrics &
Gynecology
OBGYN Young girls have immature hypo gonadal axis leading to low lh and fsh.
4780
Obstetrics &
Gynecology
OBGYN
Hydralazine and labetalol are fast acting so are used to treat hypertensive crises. Methyldopa has
slow onset so is not used.
4782
Obstetrics &
Gynecology
OBGYN
Preeclampsia: arterial vasospasm causes high bp, which in turn leads to pulmonary Edema.
Bronchospasm causes wheezing.
4783
Obstetrics &
Gynecology
OBGYN After eclampsia, mag is better than phenytoin and benzo b
4786
Obstetrics &
Gynecology
OBGYN Cvs before 10 weeks associated with greater risks.
4793
Obstetrics &
Gynecology
OBGYN Insulin does not cross the placenta so is good for gdm.
4795
Obstetrics &
Gynecology
OBGYN HUS -renal failure HELLP - no renal failure.
4800
Obstetrics &
Gynecology
OBGYN Endometritis is causes by a poly microbial infection (e.g. Mycoplasma and chlamydia, not just gbs).
4801
Obstetrics &
Gynecology
OBGYN Treat endometritis with clinda and genta.
4803
Obstetrics &
Gynecology
OBGYN
Complete, missed or inevitable abortion : Hemodynamically unstable =d and c. Hemodynamically
stable =prostaglandins.
4806
Obstetrics &
Gynecology
OBGYN Punched out ulcsrations or erosions =hsv
4807
Obstetrics &
Gynecology
OBGYN
Interstitial cystitis =chronic bladder infection. Triad of pelvic pain exacerbated by stress, urinary
urgency, urinary frequency. Relieved by voiding. Cystoscope shows sub mucosal petechiae.
4811
Obstetrics &
Gynecology
OBGYN Treat lichen sclerosis with topical steroids.
4812
Obstetrics &
Gynecology
OBGYN
Steroid acne =diffuse monomorphic pink papules and no comedones. Arms trunk face. Adolescent
acne =open and closed comedones. Face chest back.
4916
Obstetrics &
Gynecology
OBGYN
Transvaginal sono is gold standard for evaluating cervical insufficiency (funneling or shortening of
cervix).
8903
Obstetrics &
Gynecology
OBGYN
In post menopausal women, if an adnexal mass is found, work up must include ca-125 and
transvaginal ultrasound. If simple and low ca125, then mass can be managed conservatively.
8910
Obstetrics &
Gynecology
OBGYN Appendicitis in pregnancy: 1. Ultrasound 2. MRI.
8941
Obstetrics &
Gynecology
OBGYN Free fluid near ovarian cyst =ruptured ovarian cyst. Endometriosis =chronic pelvic pain.
8945
Obstetrics &
Gynecology
OBGYN
Ruptured ectopic pregnancy =diffuse uterine pain, cervical motion tenderness. Also leads to
shock. PID is uncommon in pregnancy as cervical mucus plug protects against upward moving
bugs.
4530
Obstetrics &
Gynecology
Preventive
Medicine
Patient should be screened for syphilis at first prenatal visit. Hep c does not need to be screened
for. Folate levels don't need to be checked. J ust go ahead and give folate in pregnancy.
2429 Pediatrics Cardiology
Harsh systolic crescendo de crescendo murmur in left upper sternal border =causes by rvot
obstruction in TOF. VSD is usually very large so does not produce a murmur. Tet spells (spasm of
rvot during exertion) are lethal and can be managed by extension of knees to chest to increase
systemic vascular resistance, this promoting blood flow into pulmonary arteries. Transposition
does not usually produce any murmurs.
3539 Pediatrics Cardiology
Complete atrial ventricular septal defect is MCC of murmur in downs sybdrome kids. Heart failure
at 6 weeks.
3910 Pediatrics Cardiology
Sotalol is the only beta blocker that prolongs the qt interval. Long qt should be treated with
propranolol and pacemaker to avoid torsades.
3991 Pediatrics Cardiology
Tricuspid atresia=decreased pulmonary markings. VSD must exist. LVH and hypo plastic Right
heart. TOF also has decreased pulmonary markings. RVH.
4497 Pediatrics Cardiology
Inspiratory stridor =croup =cough barking. vascular ring. Improves with neck extension +
associated cardiac abnormalities. Laryngomalacia: worsens in supine position improves in prone
position. Foreign body: respiratory distress.
4705 Pediatrics Cardiology VSD may have diastolic rumble due to increased flow through the mitral valve.
4842 Pediatrics Cardiology
Knee chest position increases systemic vascular resistance. Increasing pulmonary blood flow
decreases cyanosis.
4854 Pediatrics Cardiology
Myocarditis causes symptoms of heart failure (cardiomegaly, hepatomegaly, murmur). Treat with
diuretics. Rheumatic fever happens weeks after an infection. Not during.
2778 Pediatrics Dermatology
Ssss =targets desmoglein 1. There is periorAl crusting. Cultures from bullae are sterile as this is
toxin mediated. Nikolsky is negative in bullous impetigo. Patients are not ill appearing.
3122 Pediatrics Dermatology
Erythema toxicum =rash around body within a few days of being born. No treatment needed.
Varicella neonatal =vesicles. Treat with immediate acyclovir.
2831 Pediatrics ENT Cholesteatomas can occur in patients with chronic ear infections.
3972 Pediatrics ENT
Cigarette smoke, formula instead of breast milk, URI are all risk factors for otitis media. Always give
antibiotics.
4853 Pediatrics Electrolytes
1/2NS and d5w do not stay I the intra vascular space as well as isotonic solutions (like NS or LR)
do. Use the latter for volume repletion.
3867 Pediatrics Endocrinology
Premature development of sexual characteristics =<8 in girls. Adrenarche =pubic hAir and acne=
response to adrenal hormones. Elevated dhea-s. Caused only by increased insulin. Thelarche =
breast development =response to estrogen. Activated by increased Insulin or increased LH/FSH
from hpa axis.
3875 Pediatrics Endocrinology
All precocious puberty patients with elevated basal LH levels should undergo MRI brain. After
tumor has been excluded, GNRHtherapy can e initiated to clock estrogen production.
4239 Pediatrics Endocrinology
Late onset CAH manifests at 7-8 as androgen excess (acne, accelerated bone growth) and
NORMAL electrolytes. Low LH that is gonadotropin independent. Basal levels of LH are high in
idiopathic precocious puberty.
4830 Pediatrics Endocrinology Puberty is delayed in children with constitutional growth delay.
2456 Pediatrics GIT Breast feeding decreases rate of NEC
2464 Pediatrics GIT
Proctoilitis =reflux +bloody stools in response to milk or spy proteins. 2-8 weeks. Non igE
mediated. Stop dairy products. Resume @ I yo Meckels does not present in neonates.
2474 Pediatrics GIT
You don't have to be premature to get NEC. Other risks are low birth weight and Cushitic heart
diseases. NEC can lead to strictures and short bowel syndrome.
3078 Pediatrics GIT First born males at higher risk for pyloric stenosis.
3465 Pediatrics GIT Pyloric stenosis should be immediately repaired after patient is stabilized.
4183 Pediatrics GIT
Thick meconium in the ileum =meconium ilius. Also has narrowing of colon due to lack of use.
Normal viscosity meconium in the colon/rectosigmoid =hirschprung.
4817 Pediatrics GIT
Breast feeding jaundice 2/2 decreased stopping leading increased enterohepatic bilirubin
circulation. Brick red urate crystals in urine =sign of dehydration.
4839 Pediatrics GIT
Riboflavin deficiency causes seborrheix dermatitis, cheliosis, pharyngitis, edema. B6 deficiency
can cause dermatitis. Depression And elevated homocysteine, leading to dvts
8791 Pediatrics GIT
Treat foreign body ingestion leading to esophageal blockage +sx with flex endoscope. Otherwise
observe for 24 hours. Treat foreign body aspiration leading to tracheal blockage with rigid
bronchoscopy.
8955 Pediatrics GIT
Excessive milk consumption may cause anal fissures. Treat with oral laxatives =stool softeners
Encopresis =fecal in continence
2234 Pediatrics Genitourinary
Dipstick positive for protein negative for everything else should be repeated twice to call it
transient proteinuria.
2513 Pediatrics Genitourinary Enuresis: 1. Desmopressin; 2. Imipramine.
3692 Pediatrics Genitourinary
Renal and bladder us for first febrile uti in child <2yo; any recurrent uti in child of any age. If
hydrobephrosis is found, do a vcug. NEVER do a repeat urine culture.
3866 Pediatrics Genitourinary Fibromuacular dysplasia =string on beads in angiography.
4548 Pediatrics Genitourinary Potter sequence is initiated by any urinary tract abnormality; mcc is posterior urethral valves.
4870 Pediatrics Genitourinary
Small vaginal foreign objects can be removed by irrigation or with calcium Alginate swab. No need
to do a uti or urine/vag cultures.
8956 Pediatrics Genitourinary
Cryptochidism: torsion risk is lowered if affixed to scrotum. Early surgery improves sperm count,
but it still remains below average.
9566 Pediatrics Genitourinary
Primary Amenorrhea: no blood by 15 yo 1. Pelvic ultrasound to check for uterus. 2. Present=fsh -
increased fsh =karyotype - decreased FSH =cranial MRI 2. Absent =karyotype. XX =abnormal
mullerian development. XY =androgen insensitivity.
2640 Pediatrics Hem&Onc Cocaine abuse only causes bleeding, no mass.
2867 Pediatrics Hem&Onc
Lymphoblasts are pAs positive. Tdt positive =ALL Myeloblasts contain myelopwroxidase positive
material. Burkitts =ebv =starry sky appearance
2870 Pediatrics Hem&Onc
Osmotic fragility is tested with acidified glycerol test. Abnormal eosin-5. Malenimide test ( flow
cytometry).
3089 Pediatrics Hem&Onc
Vitamin k deficiency may present with isolated PT elevation. vW patients have elevated ptt, but
normal pt
3282 Pediatrics Hem&Onc Spherocytosis is autosomal dominant.
3284 Pediatrics Hem&Onc
Bone marrow biopsy with. >25% Lymphoblasts is needed to confirm leukemia. Not lymph node
biopsy. As leukemia can be diagnosed by bone marrow biopsy, lymph node biopsy is rarely
needed, unless lymphoma is suspected.
3552 Pediatrics Hem&Onc
Neuroblastoma: <2yo. CroSez midline. Systemic symptoms. Wilma tumor: wagr, beckeick withman.
No midline cross. 2-5yo. First step: abdominal US, then chest CT to look for lung mets. Hematuria.
3713 Pediatrics Hem&Onc
Sickle cell anemia =chronic intra and extra cellular hemolysis. Acute worsening May be due to
splenic sequesteration =splenomegaly.
4340 Pediatrics Hem&Onc Scd kids should get penicillin until age 5.
4438 Pediatrics Hem&Onc Fanconis is caused by chromosomal breaks.
4875 Pediatrics Hem&Onc
Thalassemia. =reduced production of alpha or beta chains. Abnormal utilization of iron =anemia
of chronic disease.
2896 Pediatrics Hepatology
Reye's =extensive fatty vacuolization of liver cells without inflammation 2/2 diffuse mitochondrial
injury. Follows URIs. Aspirin increases incidence. Treatment is glucose and mannitol and ffp
Balloon degeneration of liver cells with pmn infiltrate =alcoholic hepatitis. Pablobular mononuclear
infiltration with hepatic cell necrosis and kuppfer cells =acute viral hepatitis. Bridging necrosis =
congruent necrotic cells connecting adjacent lobes. Chronic hepatitis =
2945 Pediatrics Hepatology
Choledochoal cysts are genetic biliary tree abnormalities characterized by dilated IntrA and extra
hepatic ducts and cholangiymtis.
2193 Pediatrics ID
For suspected bacterial pharyngitis, do either throat culture or rapid strep. Can't start abx without
doing this as must distinguish bacterial from viral pharyngitis. If rapid strep is negative, get throat
culture. If rapid strep is positive no need for throat culture.
3286 Pediatrics ID
Pneumonia bugs (e.g. Strep pneumo) are MCC of bacterial rhinosinusitis, NOT staph aureus.
Treat with augmentin.
3441 Pediatrics ID Neiserria meningitides is the MCC of meningitis in children Abd young adults.
3443 Pediatrics ID
Rheumatic fever =jones (migratory joint pain, heart problem, nodules, erythema marginatum,
syndheam chorea). Rheumatic fever should be suspected in patients with new onset pericarditis.
Treat RF pericarditis with NSAIDs; chorea with steroids.
3624 Pediatrics ID
Vaccinations are emergency procedures if they are, for example, for a patient at risk for tetanus.
Normally vaccination wishes of parents respected as chances of acquiring infection in the
presence if herd immunity is low. Consent from only one parent is needed to proceed with a
procedure.
3670 Pediatrics ID Almost all toxo kids are a symptomatic until adulthood when they develop chorioretinitis
3671 Pediatrics ID Coagulase negative staph =in dwelling catheters.
3905 Pediatrics ID
Diagnosis of pertusis: lymphocyte predominant leukocytosis; pcr. Treat with macrolides. Prevent
with acellular pertussis vaccine.
4030 Pediatrics ID
In kids, staph aureus is the MCC of pneumonia in CF PATIENTS. treat empirically with vancomycin
( not an anti-pseudomonal like in adults).
4186 Pediatrics ID
Varicella post exposure prophylaxis: If immune (or past infection): do nothing. If immunocompetent:
varicella vaccine. If immunocompromised: ivig within 10 days. (Because varicella vaccine is live
virus). Acyclovir is used for treatment not prophylaxis.
4353 Pediatrics ID Treat acute cervical lymphadenitis with clindamycin to cover staph and strep plus I and D
4814 Pediatrics ID
Hydrophobia and aerophobia are paths gnomonic for Rabies ->trigger pharyngeal spasms .
Squirrel is mc reservoir in US.
4850 Pediatrics ID A viral uri is the most common reason for bacterial sinusitis. Treat with augmentin.
4852 Pediatrics ID Congenital syphilis =hepatosplebimegsky, anemia, jaundice, ulcerated lesions on Palm and soles.
4891 Pediatrics ID Widened precertebral space, inability to extend neck, muffled voice =retro pharyngeal abscess.
2279 Pediatrics Neurology Generalized symmetrical 3 hz on EEG =absence.
2443 Pediatrics Neurology
CP: Caused by prematurity. Hyperreflexia, hypertonia, resistance to passive movement 50% have
intellectual disability. No dysmorphic features. ( unlike chromosomal avnormalities).
2469 Pediatrics Neurology
Treat botulinum spore ingestion with human derives immunoglobulin. Treat food borne botulinum
toxin with equine derived antitoxin. Highest incidence in California.
2669 Pediatrics Neurology NF 1 =spots and birth defects. NF 2 =bilateral cataracts and acoustic neuromas.
2680 Pediatrics Neurology Smell =aura =seizure from specific focus. SeiZure+mental retardation =Lenox gaystat
3666 Pediatrics Neurology Steroids in premature infants can reduce incidence of ivh
3687 Pediatrics Neurology
Marfan +stroke +/- fair complexion =homocytheinuria Marfans =lens dislocated upwards
Homocytinuria =downwards. Treatment: 1. B6 supplementation 2. methionine restriction. Cysteine
supplementation.
4248 Pediatrics Neurology
ICP related to tumor increases in supine position 2/2 gravity so kids experience headaches that
are worst in the morning.
4923 Pediatrics Neurology
Epidural hematoma with signs of neuro compromise it icp must be evacuated. Steroids have no
role.
2857 Pediatrics Ophthalmology
Trachoma =neovascularozation in eye +follicular conjunctivitis. Can happen in childhood.
Gonococcal must happen right after birth. Hsv =pain, photophobia, blurred vision.
8784 Pediatrics Ophthalmology
Bacterial sinusitis is the most common predisposing factor for orbital cellulitis. This is due to
proximity of the sinuses to the retro orbital space and the valve less venous system in the orbit.
2134 Pediatrics Pediatrics
B cell defect - recurrent sinopulmonary infections. Susceptible to bacterial infection an T cell
defect: susceptible to viral and fungal infections. CGD =recurrent abscesses.
2428 Pediatrics Pediatrics Infants with meningitis are almost always burdizki and kernig negative. Hypothermia =t<96
2431 Pediatrics Pediatrics
Treat measles with vitamin A. Measles rash darkens; rubella does not. Roseola: fever, then rash.
Sixth disease. Hhv 6.
2439 Pediatrics Pediatrics Friesrichs ataxia is autosomal recessive.
2463 Pediatrics Pediatrics
Before 2 yo: random illness causes hypertrophy of peyers patches leading to a point at which
intusseception occurs. After 2yo: pathological process creates focus for intasussceptions. E.g.
small bowel (meckel) diverticulum (MCC). Surgical resection is necessary.
2479 Pediatrics Pediatrics
Premature, breast fed infants who have cow milk started before 1 yo age are at risk of iron
deficiency anemia.
2485 Pediatrics Pediatrics Instrument delivery increases risk of clavicle fracture.
2486 Pediatrics Pediatrics Rickets =costochondral joints are enlarged. Delay before skull is closed, genu Varum.
2489 Pediatrics Pediatrics
Greek helmet =wolf hirscensuon =4p deletion 13q=wide nasal bridge =13q deletion. Frog legs =
18q
2656 Pediatrics Pediatrics
Battery in esophagus ->needs immediate endoscopic removal. More distal can be followed for
spontaneous removal.
3079 Pediatrics Pediatrics
Strep pharyngitis =tonsillar exudates are required. Kawasaki rash is erythematous and may not
spare palms and soles.
3123 Pediatrics Pediatrics Guthrie test detects phenylanaline in urine. Best first step to detect PKU.
3195 Pediatrics Pediatrics Cvid has B cells. Agammahlobinemia does not have B cells.
3198 Pediatrics Pediatrics
Cgd =nadph deficiency. Susceptible to catalase positive (staph, aspergillus, serratia,
burkhoderia). Treat with tmp smx prophylaxis and gamma interferon 3x a week. Chediak higashi =
impaired leukocytosis. Treatment with tmp smx and vitamin C. LAD =persistent umbilical cord. 2/2
defective tethering. Neutrophila without polymorphs. Early loss of deciduous and permanent teeth.
J obs=chronic pruritis, recurrent staph infections.
3404 Pediatrics Pediatrics Flattened femoral head =avascular necrosis.
3418 Pediatrics Pediatrics Easier to establish Intraosseous access in kids than in adults due to softer bones.
3439 Pediatrics Pediatrics Pneumonitis intestinalis =diagnostic for NEC
3442 Pediatrics Pediatrics
Meningiococcemia causes Waterhouse. Hypotension leading to adrenal gland death. Vasomotor
distress and purpura and meningeal signs.
3541 Pediatrics Pediatrics
TOF: harsh diastolic ejection murmur on right upper to mid sternal border. For pediatrics,
squatting increases after load. Leads to more flow through the rvot, leading to a louder murmur.
3544 Pediatrics Pediatrics 3-5 =duchennes 6-12 =Becker, no gower
3545 Pediatrics Pediatrics
Digeorge causes hypocalcemia. Echo and serum calcium levels much be ordered immediately
when digeorge is suspected. Digeorge causes lymphopenia (not neutropenia).
3554 Pediatrics Pediatrics
Intasyssceptions in hsp are ileoileal. Look like target on ultrasound. Unlike ileocolic
intasussceptions, cannot be treated with air enema and require surgery.
3658 Pediatrics Pediatrics
Astrocytomas are most common infra AND supratentorial pediatric cns rumors. Medulloblastoma in
the vermis. Glioblastoma is normally seen in adults. Pinealoma =dorsal midbrain. Retraction of
eyelid, paralysis if vertical gaze.
3660 Pediatrics Pediatrics
Erythromycin ointment prophylaxis is only effective against gonhorrhea. Not effective against
chlamydia.
3664 Pediatrics Pediatrics Treat guollain barre with ivig or plasmapheresis.
3665 Pediatrics Pediatrics Pinealoma is at CNIII, midbrain, superior colliculous.
3669 Pediatrics Pediatrics Diagnose duchennes with a genetic test , NOT a muscle biopsy.
3685 Pediatrics Pediatrics Treat club foot by casting, stretching.
3721 Pediatrics Pediatrics
Large tongue , hoarse cry =congenital hypothyroidism. 85% of cases are caused by thyroid a
genesis.
3758 Pediatrics Pediatrics
Topical erythromycin prevents gonococcal conjunctivitis. IV ceftriaxone treats gonococcAl
conjunctivitis. Oral erythromycin treats chlamydial conjunctivitis. No other macrolide works as well,
though erythromycin causes congenital pyloric stenosis. Nasolacrimal duct obstruction presents
with unilateral tearing, not conjunctivitis.
3770 Pediatrics Pediatrics OI. =defective collagen. Marfan =defective fibrillin 1.
3818 Pediatrics Pediatrics
Diamond blackfan: macrocytic anemia, low retic, congenital anomalies. Due to primary defect in
erythroid precursors which trigger early apoptosis. No hyper segmentation. Elevated fetal
hemoglobin levels. Treat with steroids.
3821 Pediatrics Pediatrics
Prader willi should be screened for dm2 and OSA. Beckwith weidman =gene dysregulation on
chromosome 11. Rapid growth and macroglossia.
3835 Pediatrics Pediatrics
BW can present with umbilical hernia instead of onphalocele. 11p deregulation. Associated with
wilms and hepatoblastoma. Also causes hemihyperplasia. Surveillance: AFP, abdominal ultrasound
q3 mo for Wilms and hepatoblastoma.
3849 Pediatrics Pediatrics Vascular rings =anomalous branches of the aortic arch.
3871 Pediatrics Pediatrics
Mccune Albright: cafe au lait have irregular borders. No genital freckling. Von Recklinghausens:
genital freckling, cafe au laits have regular borders. Peutz jeger may involve estrogen secreting
tumor which may lead to precocious puberty.
3924 Pediatrics Pediatrics
Coarctation of aorta causes mild continuous murmur in chest due to collateral circulation
development between hypo and hyperperfused blood vessels.
3985 Pediatrics Pediatrics
Friedrich ataxia =scoliosis, hammer toes, concentric hypertrophic cardiomyopathy. Due to
degeneration of spinocerebellar tract.
4035 Pediatrics Pediatrics Sodium bicarbonate corrects alkalosis and narrows qrs complexes.
4260 Pediatrics Pediatrics
Decreased pulmonary flow +cyanosis: TOF, tricuspid atresia/stenosis, ebsteins anomaly.
Increased pulmonary flow +cyanosis: truncus arteriosis, transposition, TAPV Cyanosis +heart
failure: hypo plastic left heart.
4495 Pediatrics Pediatrics
In degeorge, fungal and viral infections are common. C3 deficiency predisposes to recurrent
infections with encapsulated organisms.
4764 Pediatrics Pediatrics Turners patients have generalized swelling 2/2 lymphedema
4765 Pediatrics Pediatrics Turners =increased risk of osteoporosis
4828 Pediatrics Pediatrics
Type 1 rta: impaired h+excretion. Acidotic, hypokalemic. Causing nephrolithiasis. Type 2 rta :
impaired bicarbonate reavsorption. Fanconi. Type 4: impaired sodium potassium exchange.
hyperkalemic, hypochloremic. Due to obstructive neuropathy or diabetes. Rta can lead to failure to
thrive.
4829 Pediatrics Pediatrics Thymus can be seen on cxr in kids less than 3yo. Looks like a sail.
4832 Pediatrics Pediatrics OI gives you opalescent teeth.
4846 Pediatrics Pediatrics Life saving surgery, meningitis lp, blood transfusions, intubation do not require parental consent.
4856 Pediatrics Pediatrics Infantile colic =crying infant 3 times a day. Resolves by 4 month.
4876 Pediatrics Pediatrics
Alpha thal has normal hemoglobin electrophoresis. Beta thal has abnormal hemoglobin
electrophoresis. (Elevated A2).
4889 Pediatrics Pediatrics
Sga babies are at risk for hypocalcemia, hypoglycemiA, meconium aspiration and polycythemia
(2/2 increased fetal hypoxia).
4890 Pediatrics Pediatrics
Vasoconstrictive medicines and cocaine increase risk for jejunal atresia. Presents as triple bubble
on abdominal xray.
4893 Pediatrics Pediatrics
Phenytoin causes fetal hydantoin syndrome =nail hypoplasia. +MR +dystrophic faces. Cocaine =
hyperactive reflexes , excessive sucking. Opioid withdrawal =neonatal abstinence syndrome. HIGH
PITCHED CRY.
8820 Pediatrics Pediatrics
Ppv should be started on babies with low 1 min apgar. If hr <60, start chest compressions. Apgar
scores do not correlate with prognosis. Apgar of 1 does not suggest increased risk of death.
8868 Pediatrics Pediatrics Erbs palsy: most recover on their own. Surgery considered if no improvement by 6 mo.
3906 Pediatrics
Preventive
Medicine
Pertussis contact prophylaxis: azithromycin x 5days for all household contacts and patient. Also
vaccine for those not already vaccinated. Erythromycin in neonates can cause pyloric stenosis.
4258 Pediatrics
Preventive
Medicine
Dtap contains acellular pertussis , which no longer causes seizures. Encephalopathy. (Not
seizures) are a contraindication to pertussis.
4531 Pediatrics
Preventive
Medicine
Vision screening in 0-5 yo. Lead screening in patients who live in pre-1950s houses or
occupational exposure from parents. Meningiococcus vaccine starts in 11 yo
8951 Pediatrics
Preventive
Medicine
History of Meckels and intasussceptions are contraindications to the rota virus vaccine. SCID.
4924 Pediatrics Psychiatry
Concerning sexual behavior in 2-5 year olds is touching others genitals, preoccupation with
masturbation and simulating foreplay or sex. May be indicators of sexual abuse.
2473 Pediatrics Respiratory
Bilateral perihilar streaking =ttn Bilateral granular opacities, ground glass=hyaline membrane
disease.
3285 Pediatrics Respiratory
Rhinosinusitis >10 days : treat with augmentin. Ics are good for allergic rhinitis, not for bacterial
sinusitis.
3459 Pediatrics Respiratory Absent air entry in asthmatics. =indication for ett.
4761 Pediatrics Respiratory
Toricollis =rotation of head to one side. MCC =URI, trauma, lymphadenitis. More serious =
atlanto-axial subluxation , retropharengeal abscess. C-spine X-rays should always be obtained.
4762 Pediatrics Respiratory T lymphocytes =cd3 B lymphocytes =cd 19
4584 Pediatrics Rheumatology Serum sickness =immune complex mediated hypersensitivity reaction.
4834 Pediatrics Rheumatology No conjunctivitis in scarlet fever. Conjunctivitis in Kawasaki.
4836 Pediatrics Rheumatology
Evanescent pink rash with sharp edges =erythema marginatum. Rheumatic fever. J RA arthritis is
not migratory. Rheumatic fever arthritis is migratory.
4849 Pediatrics Rheumatology Point tenderness at patella =patellar tendinitis. No point tenderness. =osgood schlatter.
4873 Pediatrics Surgery Supracindylar fractures especially prone to nv compromise and compartment syndrome.
2350 Psychiatry Psychiatry As people age, stage 4 sleep becomes shorter. People awake more.
2353 Psychiatry Psychiatry
Olazipine if anorexia doesn't respond to cbt. Hospitalize if there are electrolyte imbalances,
bradycardia or dehydration.
2354 Psychiatry Psychiatry Bulimia can be followed by large amounts of exercise and fasting instead of vomiting.
2355 Psychiatry Psychiatry First line treatment for acute agitation is antipsychotic, not benZos.
2357 Psychiatry Psychiatry High creatinine is a contraindication to lithium use.
2496 Psychiatry Psychiatry Panic disorder: Immediate treatment =benzo Long term =ssri.
2498 Psychiatry Psychiatry
Most common side effect of ect is amnesia. Anterograde amnesia disappears quickly. Retrograde
persists for some time.
2510 Psychiatry Psychiatry Cyclothymic. =fluctuating hypo manic and depressive symptoms x 2 yo
2515 Psychiatry Psychiatry Focal neurological signs should be present before making a diagnosis of vascular dementia.
2521 Psychiatry Psychiatry
Somatic Symptom disorder: preoccupation with one unexplained symptoms. Illness anxiety
disorder: fear of getting an illness despite having no reason to.
3185 Psychiatry Psychiatry
First degree relatives have 5-10% of developing bipolar disorder. Both parents have bipolar =60%
risk of bipolar. Monozygotic twins =70% chance.
3186 Psychiatry Psychiatry Antipsychotics can be used for acute mania.
3235 Psychiatry Psychiatry
Parents are no allowed to refuse life saving treatment for children. If that happens, get a court
order.
3372 Psychiatry Psychiatry
Dissociative disorders: all have memory loss and confusion. Fugue: travel. Amnesia: usually
related to trauma. Identity disorder: multiple personalities.
3375 Psychiatry Psychiatry Treat Tourette's with antipsychotics.
3378 Psychiatry Psychiatry
Autism: increased total brain volume. OCD. Increase in orbitofrontal cortex and striatum Panic
disorder: decreased amygdala volume PTSD: decreased hippocampal volume. Schizophrenia:
enlargement of ventricles.
3382 Psychiatry Psychiatry Adjustment disorder is treated with psychodynamic psychotherapy, not drugs.
3386 Psychiatry Psychiatry Setting off fire without aggression towards people =pyromania, not conduct disorder.
3615 Psychiatry Psychiatry Of severely depressed patient may become suicidal, don't divulge terminal diagnosis.
3638 Psychiatry Psychiatry Patients with psych illnesses can give consent as long as their judgement is bit impared.
3748 Psychiatry Psychiatry
Mom vs fetus; mom wins regardless of whether fetus's life is endangered (even if fetus is 40 weeks
old). e.g. Life saving c section
3759 Psychiatry Psychiatry SI w/ Plan =admit involuntarily. SI w/o plAn =outpatient therapy ok.
3839 Psychiatry Psychiatry Social anxiety: generalized =ssri; performance based =benzo or propranolol before presentation.
3845 Psychiatry Psychiatry Hypochondriacal symptoms become more prevalent with emotional stress. Ask about stressors.
3953 Psychiatry Psychiatry
Patients with previous anorexia are always at increased risk of prematurity, LGA. Anorexia also
gives prolonged qt Elevated cholesterol and carotene.
4043 Psychiatry Psychiatry Bipolar: episode 1 lithium x 1 year Episode 2: lithium for life.
4046 Psychiatry Psychiatry Sedation =2/2 antagonism at histamine receptor.
4141 Psychiatry Psychiatry Generalized anxiety disorder : first like is ssris (including escitalopram). Second line is benZos.
4192 Psychiatry Psychiatry
First trimester lithium =ebsteins 2nd or 3 rd trimester =goiter, transient neonatal neuromuscular
dysfunction.
4285 Psychiatry Psychiatry
Patients typically experience persistent worry about repeated panic attacks and become
depressed, bipolar, agoraphobic, or junkies. No associated with ibs or somatic symptom disorder.
4320 Psychiatry Psychiatry Sudden behavior or scholastic change in child =concern for physical or sexual abuse.
4881 Psychiatry Psychiatry Bereavement does not have worthlessness, SI, guilt or self loathing. Intensity decreases over time.
4885 Psychiatry Psychiatry Zidparosadone =qtc Risperadol leads to hyperprolactinoma.
4888 Psychiatry Psychiatry
Shared delusions: dominant person is responsible for delusions that are shared by non dominant
person. Individual who first had delusions needs psychiatric care, but non dominant person may
not.
8841 Psychiatry Psychiatry Overview of response, recovery etc.
8875 Psychiatry Psychiatry Treat hoarding disorder with ssris.
8915 Psychiatry Psychiatry PTSD is associated with suicide. Not substance abuse.