4.29.17 Flashcards
preg –> hyperandrogen ssx –> 2 MC causes
- preg luteoma
- theca luteum cyst
preg luteoma –> US finding
solid ovarian mass –> 50% bilat
preg luteoma –> effect on fetus
F fetus –> virilization
preg luteoma –> tx
no maternal tx warranted –> after delivery –> regress spont
oxytocin –> how can cause sz?
oxytocin similar to ADH –> water retention –> hypoNa –> sz
pt w fever –> WBC 690 –> normal CXR & UA –> what condition?
febrile neutropenia
neutropenia –> definition
absolute neutrophil count <1500
febrile neutropenia –> pathophys
ANC <1000 –> higher risk for overwhelming bact infect d/t absent/blunted neutrophil-mediated inflamm response
febrile neutropenia –> MC org
G neg –> esp Pseudomonas
febrile neutropenia –> tx
medical emergency –> early empiric abx –> anti-pseudomonal:
- cefepime
- meropenem
- pip/tazo
COPD pt –> sudden onset severe dsypnea & R chest pain –> what condition?
2ndary spont pneumothorax
COPD –> 2ndary spont pneumothorax –> pathophys
alveolar sacs –> chronic destruct –> lrg alveolar blebs –> rupture –> leak air into pleural space
vag bleed, closed cervix, viable fetus on US –> what condition?
threatened abortion
preg –> amphetamine abuse –> at risk for what conditions (5)
- preterm delivery
- preeclampsia
- abruptio placentae
- fetal growth restrict
- intrauterine fetal demise
6mo F –> loss of motor milestones, hypotonic, HSM, bright red macula –> condition?
Neimann-Pick dz
Neimann-Pick dz –> enzyme def?
sphingomyelinase
Neimann-Pick dz –> presentation (4)
- areflexia
- HSM
- cherry red macula
- dev milestone regress
difference: Niemann-Pick vs Tay Sachs
Tay Sachs –> similar to Niemann Pick except:
- hyperreflexia
- no HSM
Tay Sachs –> enzyme def
B-hexosaminidase A
15 F –> 1ary amenorrhea, anosmia, no pubic hair, normal uterus/ovaries –> condition?
Kallman synd
Kallman synd –> pathophys
XR –> dysfx migration of fetal GnRH & olfactory neurons:
- hypogonadotropic hypogonad
- rhinencephalon hypoplasia
Kallman synd –> genotype
normal genotype:
- 46XX
- 46XY
Kallman synd –> presentation
- delayed/absent puberty
- anosmia
Kallman synd –> LH & FSH levels
GnRH def –> low LH & FSH
58 M –> sz –> former smoker –> otherwise normal H&P –> MRI –> several lesions at gray & white matter jx –> what condition?
lung CA –> brain mets
lung CA –> mets to brain –> MRI finding
gray & white matter jx –> mult well-circumscribed lesions w vasogenic edema
pt w chronic liver dz –> vaccines same as gen population –> need what other vaccines?
- Hep A
- Hep B
- 23-valent pneumococcal
> 65yo –> what type of pneumococcal vaccine?
13-valent –> followed by 23-valent
<65yo –> high risk comorbid condition –> what type of pneumococcal vaccine?
13-valent –> followed by 23-valent
<65yo –> chronic condition that increase risk of invasive pneumococcal dz–> what type of pneumococcal vaccine?
23-valent alone
<65yo –> comorbid condition at high risk for pneumococcal dz –> what are some high risk comorbid conditions? (5)
- CSF leak
- sickle cell dz
- cochlear implant
- congenital/acquired asplenia
- immunocomp
what are some chronic conditions that increase risk of invasive pneumococcal dz (5)
- heart dz
- lung dz
- DM
- smoke
- chronic liver dz
myasthenia gravis –> pathophys
autoAb –> nAChR at NM jx –> receptor degradation –> impaired AP propagation –> muscle weak
myasthenia gravis –> presentation (2)
- ocular –> ptosis, diplopia
- bulbar dysfx –> fatigable chewing, dysphagia w nasopharyngeal regurg, dysarthria
myasthenia gravis –> chest imaging –> finding
ant mediastinal mass –> thymoma
went to Arizona –> CAP, arthralgia, erythema nodosum –> what condition?
coccidioides –> valley fever
hydroxychloroquine –> MOA
TNF & IL-1 inh
hydroxychloroquine –> AE (1)
retinopathy
DMARDS (5)
- methotrexate
- leflunomide
- hydroxychloroquine
- sulfasalazine
- TNF inh
Tourette synd –> 2 MC comorbid conditions
- ADHD
- OCD
52 F –> morning stiffness, MCP jts involved, nontender nodule at elbow, elevated ESR –> what condition?
RA
early RA –> which jts? (4)
- fingers –> MCP & PIP
- toes –> MTP
- wrist
RA –> commonly affect what part of axial skeleton?
cervical spine
RA –> cervical spine involved –> comp (2)?
- spinal subluxation
- spinal cord compression
what are rheumatoid nodules
firm nontender subcut nodules –> usu close to pressure pts –> ie elbow
33 F –> loss of pain/temp in cape-like dist –> normal vibrate/proprioception –> what condition?
syringomyelia
what is syringomyelia
spinal cord –> fluid filled cavity –> from:
1) dilation of central canal
2) spinal parenchyma –> separate cavity
syringomyelia –> MC assoc condition
Arnold Chiari malformation type 1
syringomyelia –> 2 MC location
- cervical
- thoracic
syringomyelia –> presentation (3)
- UE –> weak, areflexia
- sensory loss –> cape dist
what makes S3 heart sound
LA –> blood into LV –> hit blood already in LV –> blood reverberate
S3 –> indicates what pathologic medical condition?
LV fail
LV fail ssx –> best initial tx
IV diuretic
Crohn’s –> small bowel resect –> now has gen bone pain –> XR –> decreased bone density, femoral neck pseudofx –> what condition?
osteomalacia
Crohn’s –> small bowel resect –> osteomalacia –> pathophys
Crohn’s & small bowel resect –> malabsorption –> vitD def
osteomalacia –> MC cause
vitD def
osteomalacia –> lab findings
- Ca
- phosphate
- PTH
- alk phos
- Ca: low
- phosphate: low
- PTH: increased
- alk phos: increased
osteomalacia –> characteristic XR finding
bilat & symm pseudofractures (Looser zones)
osteomalacia –> presentation (2)
- muscle weak
- bone pain
47 F G4P4 –> low abd pain –> relieved w urination, painful intercourse, normal external genitalia, normal UA –> what condition?
interstitial cystitis (painful bladder synd)
interstitial cystitis –> presentation (3)
- bladder pain w filling –> relief w void
- freq, urgency
- chronic pelvic pain –> dyspareunia
what is interstitial cystitis
chronic painful bladder condition of uncertain etiology
pronator drift –> indicates what?
UMN lesion –> pyramidal/corticospinal tract dz
62 M –> sudden onset pain & red in L eye –> photophobia, N, severe HA –> not relieved w ibuprofen –> had used oral decongestant for cold –> nonreactive & dilated pupil –> what condition?
acute angle closure glaucoma
acute angle closure glaucoma –> presentation (6)
- sudden onset eye pain
- HA
- N
- conjunctival erythema
- corneal opacification
- mid-dilated pupil
acute angle closure glaucoma –> gold standard for dx
gonioscopy: specialized prismatic lens w slit lamp –> visualize iridocorneal angle
pt w suspected acute angle closure glaucoma –> next step?
- urgent ophthalmologic consultation
- tonometry –> measure intraocular pressure
abnormal uterine bleed –> definition
menstrual bleed:
- prolonged –> >5day
- heavy
- irreg
53 M –> strange itchy rash on L nipple for 1mo –> no relief w steroid –> no periods for 2 yr –> what condition?
Mammary Paget dz
Mammary Paget dz –> presentation
painful, itchy, eczematous and/or ulcerating rash on nipple –> spread to areola
Mammary Paget dz –> assoc condition?
breast adenoCA
acetaminophen –> effect on warfarin
inh CYP450 –> increase warfarin effect –> increase bleed
what meds can increase warfarin effect (4)?
- acetaminophen
- NSAID
- amiodarone
- abx
preterm infant –> MC cause of anemia
anemia of prematurity
anemia of prematurity –> pathophys
- diminished EPO
- short RBC life span
- blood loss from phlebotomy
anemia of prematurity –> lab findings:
- Hb
- Hct
- retic
- Hb: decreased
- Hct: decreased
- retic: low
prepubertal F –> MC vaginal foreign body
toilet paper
prepubertal F –> vaginal foreign body –> tx
topical anesthetic:
- calcium alginate swab
OR
- irrigation w warm fluid
Graves ophthalmology –> pathophys
- thyrotropin receptor Ab –> retroorbital fibroblast, adipocytes
- activated T cells
what tx for Graves can worsen ophthalmology? why? what can be done about it?
radioactive iodine –> increase thyrotropin receptor Ab titer
glucocorticoids
Graves dz w mod-severe ophthalmopathy –> prefered tx
thyroidectomy
Graves dz –> 3 primary tx options
- radioactive iodine
- antithyroid drugs (propylthiouracil, methimazole)
- thyroidectomy
suspect chronic pancreatitis –> next step to dx?
CT or plain film –> pancreatic calcifications
suspect chronic pancreatitis –> why not amylase/lipase to dx?
can be normal & nondiagnostic
45 M –> HA & confusion for 2 days –> no focal weak/sensory ssx –> low Hb & platelets, elevated Cr –> fragmented RBC on blood smear –>normal prothrombin –> what condition?
thrombotic thrombocytopenic purpura
thrombotic thrombocytopenic purpura –> pathophys
acquired/hereditary autoAb –> low ADAMTS13 –> vWF multimers –> platelet trap & activate
thrombotic thrombocytopenic purpura –> presentation –> pentad
- thrombocytopenia
- microangiopathic hemolytic anemia
- renal insuff
- neuro changes
- fever
thrombotic thrombocytopenic purpura –> tx
emergent plasma exchange:
- replenish ADAMTS13
- remv autoAb
18 F –> clitoromegaly, normal uterus, amenorrhea –> undetectable estradiol, estrone –> what condition?
aromatase def
aromatase def –> presentation
- normal internal genitalia
- external virilization
- undetectable estrogen levels
aromatase def –> pathophys
prevent conversion of androgen to estrogen
asbestos exposure –> resulting MC malig
bronchogenic carcinoma
asbestosis –> pathognomic CXR finding
pleural plaques
53F –> G2P2 –> R pelvic pain for 3 mo –> h/o tubal ligation, C-section, smoke & EtOH –> neg B-hCG –> US –> ovarian mass –> solid components, thick septations, mod amt of peritoneal fluid –> what condition?
epithelial ovarian carcinoma
epithelial ovarian carcinoma –> US findings (3)
- solid mass
- thick septation
- ascites
epithelial ovarian carcinoma –> presentation (3)
- pelvic/abd pain
- bloat
- early satiety
1st trim screen –> purpose
estimate risk of trisomy 18 & 21
prenatal screen –> abnormal –> followup with what diag testing?
- amniocentesis
- chorionic villus sampling
depending on GA
1st trim screen –> components
- preg-assoc plasma protein (PAPP)
- B-hCG level
- fetal nuchal translucency
1st trim screen –> abnormal results that suggest aneuploidy
- B-hCG: elevated
- nuchal translucency: increased
when use amniocentesis vs chorionic villus sampling
- amniocentesis: 15wk GA
- chorionic villus sampling: 10-13 GA
suspect hep induced thrombocytopenia –> next step?
- stop hep
- start direct thrombin inh (argatroban) or fondaparinux
newborn –> necrotizing enterocolitis –> RF (3)
- prematurity
- hypotension
- congenital heart dz
38F –> G1P0 –> 1st prenatal visit –> BP 141/96, no other ssx –> next visit BP 152/106 –> what condition?
primary HTN
preg –> chronic HTN –> definition
<20wk GA –> >140/90
gestational HTN –> definition
> 20wk GA –> new onset elevated BP –> no proteinuria, end organ damage
preeclampsia –> definition
> 20wk GA –> new onset elevated BP –> proteinuria or end organ damage
eclampsia –> definition
preeclampsia + new onset grand mal sz
mitral stenosis –> presentation (4)
- dsypnea
- orthopnea
- paroxsymal nocturnal dyspnea
- hemoptysis
mitral stenosis –> assoc comp?
LA enlrg –> A-fib –> systemic thromboembolic comp (stroke)
what can increase thyroglobulin (2)?
- preg
- OCP
what can decrease thyroglobulin (2)?
- nephrotic synd
- androgen use
preg –> lab findings:
- TBG
- total T4
- free T4
- TBG: increased
- total T4: increased
- free T4: normal
nephrotic synd –> lab findings:
- TBG
- total T4
- free T4
- TBG: decreased
- total T4: decreased
- free T4: normal
pneumothorax –> common causes (8)
A CHEST IN:
- asthma
- CF
- HIV
- emphysema
- spont trauma
- iatrogenic
- neoplasm
suspect tension pneumothorax –> next step
immed needle decompress
small pneumothorax –> tx
may resolve w suppl O2 only
SLE –> freq have false pos test for what?
syphilis
TTP –> lab results:
- PT/PTT
- fibrinogen
- D-dimer
- PT/PTT: normal
- fibrinogen: normal
- D-dimer: normal
myasthenia gravis –> assoc w what conditions (2)?
- thymoma
- thyrotoxicosis
CHF exacerbation –> tx
LMNOP:
- lasix
- morphine
- nitrate or nesiritide
- O2
- positioning/pressor (dobutamine)
40 M –> car accident –> broke leg –> IV ketorolac –> pain persistent –> h/o of opioid addiction –> best analgesic choice?
acute pain management –> similar for all pts regardless of subst abuse hx
==> IV morphine is approp option
acute liver fail –> dx criteria triad
- elevated aminotransferases
- ssx of hep encephalopathy
- syn liver dysfx –> INR >1.5
acute liver fail –> MC cause
acetaminophen toxicity
29M –> splenectomy after MVA –> receives RBC transfusion –> min after –> wheeze –> resp distress, low BP, lose consciousness –> most likely cause of transfusion rxn?
anaphylactic rxn
who gets anaphylactic rxn to blood transfusion?
IgA def
has anti-IgA Ab –> attack IgA in blood transfusion
MEN2B –> components (3)
- medullary thyroid cancer
- pheochromocytoma
- mucosal neuroma/marfanoid habitus
4mo M –> harsh sound w inspiration –> esp when lie on back, improve when upright or during “tummy time” –> growing well, full term, no comp w delivery –> what condition?
laryngomalacia
laryngomalacia –> pathophys
“floppy” supraglottic struct –> collapse during inspiration
laryngomalacia –> presentation
inspiratory stridor –> worse when supine
laryngomalacia –> dx
- usu clinical
- mod/severe –> confirm w flexible laryngoscopy
laryngomalacia –> tx
most –> reassurance d/t spont resolve
MC cause of vitB12 def in N Europe whites?
pernicious anemia
pernicious anemia –> presentation (5)
- megaloblastic anemia
- atrophic glossitis (shiny tongue)
- vitiligo
- thyroid dz
- neuro abnormal
34M –> recurrent episodes of acute, severe R periorbital pain –> last 30-45min –> miosis, lacrimation, nasal drainage –> no vision change –> what condition?
cluster HA
cluster HA –> #1 abortive tx
100% O2 by facemask
ASCVD –> when start statin?
40-75yo –> 10yr risk of atherosclerotic CV dz –> >7.5%
40M –> sudden onset odynophagia, retrosternal CP, difficult swallow –> endoscopy –> mid-3rd esophagus –> circumferential deep ulcer w relatively normal surrounding mucosa –> what condition?
pill induced esophagitis
pill induced esophagitis –> presentation (3)
sudden onset:
- odynophagia
- retrosternal pain
- difficult swallow
pill induced esophagitis –> endoscopy findings
discrete ulcer –> normal surrounding mucosa
pill induced esophagitis –> typically caused by what meds (4)
- tetracycline
- potassium chloride
- bisphosphonate
- NSAID
40F –> MVA –> hurt R leg –> reduced knee extension, decreased sensory to medial lower thigh & leg –> what nerve injured?
femoral N
femoral N –> motor fx
thigh –> ant cmpt:
- knee extend
- hip flex
femoral N –> sensory fx
- ant thigh
- med leg
what branch of femoral N provide sensory to ant thigh & med leg?
saphenous
angiodysplasia –> assoc w what conditions (3)?
- advanced renal dz
- vWF dz
- aortic stenosis
39F –> diag w placenta previa –> what is contraindicated in this pt (3)
- intercourse
- digital cervical exam
- vag delivery
what are the 4 manifestations of alcohol withdrawal synd (4)
- mild withdrawal
- sz
- alcoholic hallucinosis
- delirium tremens
alcoholic hallucinosis –> presentation (3)
- intact orientation
- hallucination
- stable vital signs
alcoholic hallucinosis –> onset? when resolve?
12-24hr –> resolve in 24-48hr
hallmark of delirium tremens
disorientation and global confusion
38F –> obese, oligomenorrhea –> abnormal uterine bleed –> workup should include what (3)
- CBC
- pelvic US
- endometrial bx
38F –> obese, oligomenorrhea –> abnormal uterine bleed –> why do endometrial bx?
has RF for endometrial hyperplasia –> obesity, oligomenorrhea
15M –> recurrent hematuria & proteinuria, sensorineural hearing loss –> FMHx of renal dz –> what condition?
Alport’s synd
Alport’s synd –> electron microscopy findings
- capillary loops –> alternating areas of thin & thick
- glomerular BM splitting
56M –> severe crushing midsternal CP, diaphoresis, dyspnea –> had drug-eluting stent placed in LAD 10 days ago –> EKG shows ST elevation in I, aVL, V1-4 –> what condition? what caused it?
MI of LAD d/t medication noncompliance
coronary A stent –> #1 cause of stent thrombosis
premature discontinuation of antiplatelet therapy
coronary A stent –> pt should be on what antiplatelet therapy?
ASA + platelet P2Y12 receptor blocker (clopidogrel, prasugrel, ticagrelor)
MC cause of mitral regurg in developed countries
mitral valve prolapse
Goodpasture’s dz –> affects what organ systems
- lung
- kidney
Goodpastures’ dz –> how dx?
renal bx
Goodpasture’s dz –> renal bx findings
linear IgG Ab along glomerular BM
6hr M –> tachycardia, irritable, warm, flushed skin –> mother had Graves’ dz trted w surg resect 6mo before preg –> became hypothyroid –> trt w levothyroxine during preg –> what condition? what caused it?
neonatal thyrotoxicosis
6hr M –> neonatal thyrotoxicosis –> mother had Graves trted w surg resect –> became hypothyroid –> trted w levothyroxine during preg –> why is neonatal thyrotoxicosis not caused by transplacental levothyroxine?
levothyroxine (like endogenous TH) not cross placenta
neonatal thyrotoxicosis –> tx
methimazole + BB til self-resolve
neonatal thyrotoxicosis –> pathophys
TSH receptor Ab –> cross placenta
CURB-65 criteria used for what?
pneumonia –> risk stratification –> determine hospitalization
CURB-65 –> how to score?
1pt for each:
- Confusion
- Urea >20
- RR >30
- BP <90/60
- > 65yo
CURB-65 –> how to interprete score?
- 0 –> low mortality –> outpt tx
- 1-2 –> interm mortality –> likely inpt tx
- 3-4 –> high mortality –> urgent inpt admission, possible ICU if score >4
CURB-65 –> how
to interprete score?
- 0 –> low mortality –> outpt tx
- 1-2 –> interm mortality –> likely inpt tx
- 3-4 –> high mortality –> urgent inpt admission, possible ICU if score >4
pneumonia –> must be admitted –> empiric tx?
- FQ –> moxifloxacin
- B-lactam (ceftriaxone) + macrolide (azithromycin)
mult sclerosis –> lumbar puncture findings
oligoclonal IgG bands
mult sclerosis –> when do lumbar puncture?
when suspect mult sclerosis but clinical exam/MRI not classic
newborn –> IUGR, HSM, juandice, profuse rhinorrhea, desquamating skin rash –> what condition?
congenital syphilis
clinical findings specific to congenital syphilis (3)
- copious rhinorrhea (snuffles)
- maculopapular rash –> desquamate or become bullous
- abnormal long bone XR
clinical findings common to all congenital infections (4)
- IUGR
- HSM
- jaundice
- blueberry muffin spots
32M –> eye pain & discharge –> has not remv contact lens for 1wk –> cornea is edematous, hazy, ulcerated –> extensive scleral injection –> what condition?
contact lens assoc keratitis
contact lens assoc keratitis –> most common org
Gram neg –> pseudomonas
prolonged infusion of sodium nitroprusside can lead to what comp?
cyanide toxicity
cyanide toxicity –> presentation (5)
- HA
- confuse
- arrhythmia
- flushing
- resp depression
calc: number needed to trt
1/ARR (absolute risk reduction)
cancer-related anorexia/cachexia synd (CACS) –> tx
- progesterone analogue –> megestrol acetate, medroxyprogesterone acetate
- corticosteroid
23M –> MVA w blunt chest trauma –> JVD, tachycardia, hypotension despite aggressive fluid resuscitation –> what condition?
acute cardiac tamponade
bath salts –> duration
prolonged –> days to weeks
bath salts –> what type of drugs
amphetamine analog
what is endophthalmitis
infection w/in eye, particularly vitreous
what is potter seq
urinary tract anomaly –> anuria/oliguria in utero –> oligohydramnios –> physical anomalies –> pulm hypoplasia, flat facies, limb deformities
post urethral valve –> prenatal US –> classic findings (3)
- bladder distention
- bilat hydroureters
- bilat hydronephrosis
acute Afib –> unstable –> 1st step in management?
immed electrical cardioversion to sinus rhythm
acute Afib –> stable –> 1st step in management?
rate ctrl:
- BB preferred
- CCB alternative
acute Afib –> what can use for pharmacologic cardioversion (5)
- ibutulide
- procainamide
- flecainide
- sotalol
- amiodarone
acute Afib –> stable –> next step in management after rate ctrl?
cardiovert to sinus rhythm
does renal fail lead to hypo or hyperCa?
- usu hypo
- can cause hyper d/t 2ndary hyperPTH
how does chronic renal fail lead to hypoCa?
failing kidney –> not produce enough active vitD –> not absorb Ca
how does chronic renal fail lead to 2ndary hyperPTH?
hypoCa –> increase secrete PTH
hyperCa –> EKG finding
shortened QT interval
hyperCa –> 1st step in management? why?
IVF –> increase urinary excretion
vitD intoxication –> hyperCa –> tx
glucocorticoids
how does pH affect serum K?
- alkalosis –> hypoK
- acidosis –> hyperK
hyperCa –> classic presentation
- stones
- bones
- groans
- psych overtones
hyperCa –> what ssx are included in “groans” (5)
- muscle pain/weak
- pancreatitis
- PUD
- gout
- constipation
how does hyperPO4 lead to hypoCa?
PO4 –> bind w Ca –> insoluble precipitate
how does hypoMg lead to hypoCa?
low Mg –> decrease PTH secrete
how does blood transfusion lead to hypoCa?
citrated blood –> citrate bind Ca
EKG –> prolonged QT interval –> what electrolyte abnormality can cause this?
hypoCa
hypoCa –> should look for what other electrolyte abnormality?
hypoMg
Addison dz –> aka?
1ary adrenal insuff
1ary adrenal insuff –> #1 cause in developed country? in developing country?
- developed: idiopathic
- developing: TB
2ndary adrenal insuff –> cause?
long term steroid
what clinical findings only found in 1ary NOT 2dnary adrenal insuff?
- hyperpigment
- hyperK
long term steroid –> 2ndary adrenal insuff –> pathophys?
exogenous steroid –> chronic suppress CRH & ACTH –> ill/trauma –> can’t secrete enough cortisol
low aldos –> seen in 1ary adrenal insuff or 2ndary or both?
only seen in 1ary adrenal insuff
chronic steroid use –> decrease ACTH –> ACTH not affect aldos secretion
low aldos –> clinical findings
- sodium loss –> hypoNa, hypovol –> hypotension, shock
- retain K –> hyperK
low cortisol –> clinical findings (4)
- GI ssx –> anorexia, N/V, vague abd pain, wt loss
- mental ssx –> lethargy, confuse, psychosis
- hypoglycemia
- hyperpigment
1ary adrenal insuff –> lab findings:
- plasma cortisol
- ACTH
- aldos
- renin
- plasma cortisol: low
- ACTH: high
- aldos: low
- renin: high
prerenal kidney injury –> BUN:Cr ratio
> 20:1
60M –> nausea & abd pain –> had had coronary angiogram & stent 5 days ago –> PMHx HTN, hyperchol, PAD, DM II –> painless purple mottling on both feet, elevated Cr –> what condition?
chol crystal embolism
chol crystal embolism –> commonly occur after what?
vasc procedure
chol xl embolism –> clinical features typically seen in what organ systems (5)
- derm
- renal
- CNS
- ocular
- GI
chol xl embolism –> classic derm findings (2)
- livedo reticularis
- blue toe synd
chol xl embolism –> classic renal finding
acute/subacute kidney injury
chol xl embolism –> classic ocular finding
Hollenhorst plaque
chol xl embolism –> CBC finding
eosinophilia
65M –> sudden loss of vision in R eye –> PMHx of DM trted w metformin & glyburide –> exam reveals reduced light perception, floating debris, dark red glow –> what condition?
vitreous hemorrhage
vitreous hemorrhage –> typical presentation (2)
- sudden loss of vision
- onset of floaters
vitreous hemorrhage –> MC cause
diabetic retinopathy
22mo F –> abd pain –> cry & scream inconsolably during episodes –> had 3 URI this winter, gastroenteritis 2wk ago –> palpable cylindrical mass on R abd –> what condition?
intussusception
intussusception –> MC RF
recent viral illness
gastroenteritis –> intussusception –> pathophys
gastroenteritis –> Peyer patch hypertrophy –> nidus for telescoping
intussception –> MC occur in what age grp?
<2yo
intussusception –> MC occur in <2yo –> if occur in older child –> should suspect what?
pathologic lead pt
intussusception –> how dx & tx?
sonographic/fluoroscopic guidance –> air/saline enema
SIADH –> charact findings:
- serum Na
- serum osmolality
- urine osmolality
- volemia
- hypoNa
- serum osm: <275
- urine osm: >100 (inapprop elevated)
- euvolemic
ankylosing spondylitis –> MC extraarticular manifestation
ant uveitis (iritis)
ant uveitis –> presentation
unilat:
- intense pain
- photophobia
thyroid storm –> precipitating factors
- surg
- acute illness (trauma, infect)
- childbirth
- acute iodine load
thyroid storm –> most serious ssx (4)
- high fever
- hemodynamic instability
- arrhythmia
- CHF
spinal epidural abscess –> MC org
staph aureus
spinal epidural abscess –> classic triad
- fever
- severe focal back pain
- neuro deficit
spinal epidural abscess –> pathophys
- hematologic spread: distant infect, IVDA
- direct inoculation: spinal procedure
syphilis –> allergic to PCN –> alt tx?
doxycycline
what is:
- false labor
- latent labor
- labor
- false labor: mild, irreg contract –> no cervical change
- latent labor: reg contract –> increase freq & intensity –> gradual cervical change
- labor: reg painful contract –> cervical change
7M –> severe acne –> sig increase in growth, course pubic/axillary hair, normal testicle, bone age 2x higher, –> low LH, not increase after GnRH –> what condition?
21 hydroxylase def –> nonclassic (late-onset) congenital adrenal hyperplasia
low LH at baseline –> not increase after GnRH –> means what type of precocious puberty?
gonadotropin-indep (peripheral) precocious puberty
DKA –> leads to what type of respiration?
Kussmaul –> rapid & deep
DKA –> when give 5% glucose? why?
when blood glucose 250 –> prevent hypoglycemia
thionamides –> most serious SE
agranulocytosis
mult sclerosis –> plaques –> classic location
at angles of lat ventricles
22F preg –> lyme dz –> tx?
amoxicillin
HELLP synd –> presentation (3)
- preeclampsia
- N/V
- RUQ abd pain
HELLP synd –> what causes the RUQ abd pain?
serious liver problems (centrilobular necrosis, hematoma formation, thrombi in portal capillary system) –> liver swell –> distend hepatic (Glisson’s) capsule –> RUQ/epigastric pain
23F –> nasal breathing, stuffy noise, occasional dry cough for >1yr –> ssx fluctuate in intensity w/out inciting factors –> no eye/ear ssx, itch, wheeze, or skin rash –> nasal mucosa boggy & erythematous, lungs clear –> what conditon?
nonallergic rhinitis
nonallergic rhinitis –> tx:
- mild
- mod-severe
- mild: intranasal antihist or glucocorticoid
- mod-severe: combo
13F –> L groin mass –> tanner stage 2 breast, normal external F genitalia –> US shows cryptorchid gonads, no uterus –> karyotype 46XY –> what condition?
complete androgen insens synd
complete androgen insens synd –> pathophys
defective androgen receptors –> unresponsive to normal male levels of androgens –> develop phenotypically F
complete androgen insens synd –> gonadectomy when? why?
after completion of puberty (after attain adult height) –> decrease risk of gonadal malig
2nd stage arrest of labor –> MC cause
fetal malposition
high suspicion for epithelial ovarian CA –> next step?
exploratory laparotomy:
- cancer resect & stage
- inspect entire abd cavity
6M –> R shoulder pain for 2wk –> PE localized swelling –> XR single lytic lesion –> mild hyperCa –> what condition?
Langerhans histiocytosis
sialadenosis –> seen in what conditions? (2)
- adv liver dz (non/alcoholic cirrhosis)
- dietary/nutritional disorders
LE –> progressive proximal muscle weak –> no pain/tender –> what condition?
glucocorticoid induced myopathy
38F –> progressive proximal muscle weak –> no muscle pain –> facial hirsutism, HTN –> what condition?
hypercortisolism (Cushing synd)
glucocorticoid induced myopathy –> pathophys
cortisol –> catabolic effect on skeletal muscle –> muscle atrophy
toxic shock synd –> presentation (3)
- fever
- hypotension
- diffuse red macular rash –> involve palms/soles
64M –> sharp stabbing back pain that radiate to legs –> difficult urination, pain in saddle region –> severe LE muscle weak, absent LE reflex, sensation diminished asymm –> what condition?
cauda equina synd
cauda equina synd –> presentation (5)
- severe LBP –> unilat radiculpathy
- saddle anesthesia
- hyporeflexia
- profound asymm motor weak
- late onset bowel/bladder dysfx
conus medullaris synd –> presentation (5)
- severe LBP –> less degree of radiculopathy
- perianal anesthesia
- hyperreflexia
- mild bilat motor weak
- early onset bowel/bladder dysfx
70M –> sudden onset R weak & urinary incontinence –> strength 4/5 R UE, 1/5 R LE, R babinski, decreased sensation in R foot/leg –> visual fields normal –> what condition?
stroke in ant cerebral A
stroke in ant cerebral A –> presentation
- contralat motor/sensory deficit –> more pronounced in LE than UE
- occasionally urinary incontinence
digital clubbing –> MC causes (3)
- lung malig
- CF
- R to L cardiac shunt
42M –> recent emigrate from N Africa –> 1mo of abd pain, watery diarrhea, skin rash worse w sun exposure, depressed –> PMHx latent TB trting w isoniazid & pyridoxine –> what condition?
pellagra
pellagra –> presentation
3 Ds:
- dermatitis
- diarrhea
- dementia
pellagra –> cause
niacin def
niacin can be synthesized from what?
tryptophan
what drug can cause pellagra? how?
prolonged isoniazid –> interfere w tryptophan metab
common cause of niacin def in developing country?
predominant corn diet
Duchenne muscular dystrophy –> is dystrophin absent or reduced?
absent
iron def anemia vs thalassemia:
- MCV
- RDW
- # RBC
- MCV: low vs low
- RDW: high vs normal
- # RBC: low vs normal
thalassemia –> peripheral blood smear findings (3)
- hypochromic microcytic cells
- target cells
- teardrop cells
46M –> MVA –> hosp day 5 –> RUQ tender, diminished bowel sounds, retention of gastric contents –> CT gaseous distention of small & lrg bowel w/out air-fluid levels, gallbladder distended w no stones –> what condition?
acalculous cholecystitis
acalculous cholecystitis –> most often seen in whom?
severely ill pts (ICU –> multiorgan fail, severe trauma, surg, burn, sepsis, prolonged parenteral nutrition)
acalculous cholecystitis –> immed tx?
abx + percut cholecystostomy
acalculous cholecystitis –> definitive tx?
cholecystectomy when medical condition stabilize
pap –> atypical glandular cells –> workup requires (3)?
- colposcopy
- endocerv curettage
- endom bx
pap –> atypical glandular cells –> why need to do endom bx?
atypical glandular cells may be d/t either cervical or endom adenoCA
45F –> 3mo of prog exertional dypsnea & nonproductive cough –> no CP, edema –> h/o Raynaud, HTN, severe GERD –> skin is thick & firm –> what condition?
systemic scleroderma –> interstitial lung dz
3mo M –> refuse to feed for 3 day –> head floppy, bilat ptosis, copious drool, weak suck, extremities flaccid –> recently moved to Cali, never ingested any food/honey –> what condition? how did it occur?
infant botulism
CA/PA/UT –> environ dust –> inhale soil botulism spores
infant botulism –> tx
human-derived botulism immune globulin
infant botulism –> presentation (3)
- bulbar palsies
- constipation
- hypotonia
IVDA –> native-valve endocarditis –> empiric abx tx? to cover what org?
vanco:
- MRSA
- strep
- enterococci
what abx have AE photosens?
tetracycline –> doxycycline
66M –> routine visit –> h/o poorly ctrl DMII, HTN –> BP 150/90, normal Na, high K, high Cl, low bicarb, high BUN, high Cr –> meds glipizide, furosemide, nifedipine, ASA –> what condition is cause of electrolyte abnormalities?
renal tubular acidosis
what is renal tubular acidosis
grp of disorders charact by non-anion gap metab acid w preserved kidney fx
impaired fx of cortical collecting tubule causes what type of RTA?
hyperK RTA (type 4)
hyperK RTA (type 4) –> pathophys
aldos def/resistance –> cortical collecting tubule –> H/K retention
hyperK RTA (type 4) –> commonly seen in what condition?
poor ctrl DM
hyperK RTA (type 4) –> presentation (3)
- non-anion gap metab acid
- persistent hyperK
- mild to mod renal insuff
16F –> HA & vision change for 1mo –> worse in AM, nausea –> h/o isotretinoin for severe acne –> papilledema, decreased visual acuity, no stiff neck, normal neuro exam, normal head CT –> LP increased opening pressure –> what condition? what caused it?
isotretinoin –> idiopathic intracranial HTN (pseudotumor cerebri)
idiopathic intracranial HTN –> presentation (4)
- HA
- vision change (blurry or double)
- papilledema
- CN palsy
idiopathic intracranial HTN –> CSF findings (2)
- increased opening pressure
- normal studies
idiopathic intracranial HTN –> MC in whom?
young obese F
3 meds that can cause idiopathic intracranial HTN
- growth hormone
- tetracycline
- excess vitA & derivatives
Crohn’s dz –> nephrolithiasis –> cause?
hyperoxaluria
Crohn’s dz –> hyperoxaluria –> pathophys
Crohn’s –> fat malabsorb –> Ca bind fat instead of oxalate –> increased absorb oxalate in gut
genital wart –> topical tx?
trichloroacetic acid
diabetic nephropathy –> primary intervention to slow progression?
intensive BP ctrl
diabetic nephropathy –> target BP
130/80
damage to what N causes corneal anesthesia?
trigeminal –> V1 (ophthalmic)
poorly ctrl DM –> oculomotor N palsy –> pathophys
ischemic neuropathy
30M –> 2mo LBP & stiff –> worse in AM, improve w activity –> also 3mo diarrhea & low abd pain –> anemia, thrombocytosis, sacroiliac jt inflamm –> what condition?
IBD –> arthritis
53F –> severe menopausal ssx –> h/o hypothyroid trt w levothyroxine –> will trt w oral estrogen replacement –> need to change hypothyroid tx in any way? why?
oral estrogen –> decrease TBG clearance –> elevated TBG –> increased TBG binding sites –> decreased free thyroxine, increased TSH –> need higher dose of levothyroxine to saturate increased # of TBG binding sites
26F –> 6mo lesion on L foot that gradually become firm and slight pigment –> no pain, itch –> no tobacco/alcohol –> central dimple when pinch lesion –> what condtion?
dermatofibroma
dermatofibroma –> pathophys
usu LE –> trauma, insect bite, unknown –> fibroblast prolif –> nontender, firm, hyperpigment <1cm nodule
