5

Question 1

Paroxysmal nocturnal hemoglobinuria: pres?

flow cytometry?

Answer 1

hemolysis –> fatigue, cytopenia, venous thrombosis (abd, cerebral)

absent CD55/CD59

Question 2

PNH: tx?

Answer 2

Fe, folate, eculizumab

Question 3

Pineal mass: pres?

Answer 3

Parinaud syndr (loss of upward gaze, ptosis, upper eyelid retr, pupillary abn)
obstr hydrocephalus
central precocious puberty

Question 4

S/s CMV inf in ICH:

Answer 4

pneumonitis
UGIT/LGIT ulcers (a/w D, abdp)
BM suppr
athralgia/myalgia
esophagitis

Question 5

Shy-Drager (Multiple system atrophy) =

Answer 5

1. parkinsonism
2. autonomic dysf
3. neurological signs

(monitor for bulbar dysf/laryngeal stridor)

Question 6

Shy-Drager (Multiple system atrophy) tx?

Answer 6

increase intravasc vol with fludrocortisone, salt suppl, alpha blockers, compression stockings

Question 7

Rotator cuff impingement/tendonitis versus tear?

Answer 7

Rotator cuff impingement/tendonitis improved w lidocaine

Question 8

Amyloidosis s/s?

Answer 8

• asymp proteinuria or nephrotic syndr
• restr CM
• hepatomeg + organ enlargement
• periph (CTS) +/- autonomic neuropathy
• waxy/thickening + easy bruising skin

Question 9

Amyloidosis = a/w?

dx?

Answer 9

infl arthritis, chr inf, IBD, malig, vasculitis

tissue biopsy (abd fat pad)

Question 10

greatest risk factor for stroke?

Answer 10

htn (4x incr risk)

Question 11

Cauda equina syndrome: pres?

Answer 11

• sensory to saddle
• motor to sphincters
• parasymp (bowel/bladder) *late
• asymm motor weakness
• decr reflexes
• unilat, severe, radicular pain

Question 12

Conus medullaris syndrome: pres?

Answer 12

• sudden, severe BP
• perianal hypoanesthesia
• symm motor weakness
• increased reflexes
• early bowel/bladder dysf

Question 13

Heart defect a/w DiGeorge?

Answer 13

truncus arteriosus

Question 14

Total anamolous pulm venous return =

Answer 14

RA receives blood from pulm and systemic venous systems (causes RA/RV enlargement)

Question 15

NF1:

Answer 15

axillary freckling, cafe au lait, optic glioma (causes VL)

Question 16

Dx/tx of lead poisoning:

Answer 16

1. capillary sampling, if elevated..
2. venous lead level, if elevated…
   - mild -> recheck in 1 mo
   - mod -> DMSA
   - severe -> dimercaprol + EDTA

Question 17

indicated for tx of resistant schizophrenia with persistant suicidality

Answer 17

clozapine

Question 18

Hemorrhage at basal ganglia:

Answer 18

• contralat hemiparesis and hemisensory loss
• homonymous hemianopsia
• gaze palsy

Question 19

Hemorrhage at cerebellum:

Answer 19

• facial weakness
• ataxia
• nystagmus
• neck stiffness +/- HA

Question 20

Hemorrhage at thalamus:

Answer 20

• contralat hemiparesis and hemisensory loss
• nonreactive miotic pupils
• upwards gaze palsy
• eyes *Towards paresis

Question 21

Hemorrhage at cerebral lobe:

Answer 21

• contralat hemiparesis (if frontal)
• contralat hemisensory loss (if parietal)
• homonymous hemianopsia(if occ)
• seizures
• eyes away from paresis

Question 22

Hemorrhage at pons:

Answer 22

• coma and paralysis (in minutes)

- pinpoint, reactive pupils

Question 23

How does increased extracellular pH affect Ca?

Answer 23

decreased H binding to albumin –> Ca++ binds to albumin, decreased ionized Ca levels

Question 24

Types of drug induced chr renal failure:

pres?

Answer 24

papillary necrosis + chr tubulointerstitial nephritis

• early = sterile pyuria, polyuria
• HTN, mild proteinuria, impaired urinary conc

Question 25

Histo tx:

Answer 25

mild/mod: none or itraconazole

- severe/dissem/ICH: ampho B, then itraconazole

Question 26

S3 + clinical findings =

Answer 26

LV failure

Question 27

SIADH tx:

Answer 27

1. fluid restr
2. hypertonic saline (if needed)
3. demeclocycline (rarely needed)

Question 28

Mitral stenosis: cardiopulm effects?

Answer 28

1. LA dil –> afib and cardiac emboli

2. incr pulm vasc pressure –> dyspnea, cough, *hemoptysis