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Block 3 Flashcards

1
Q

Diagnostic and therapeutic (short-term) maneuver for cervical radiculopathy

A

Shoulder abduction test➡improve radicular symptoms when hand is placed on the top of the head

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2
Q

Most reliable sign of opioid intoxication. Which other clues you may find?

A

⬇Respiratory rate

  • Bradycardia
  • Acute change in mental status
  • Miosis
  • Hypotension
  • Hypothermia
  • Hypoactive bowel sounds

“BAM3H”

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3
Q

Ptosis, “down-and-out” gaze, diplopia and normal pupillary response in a patient with poorly controlled diabetes mellitus

A

Ischemic oculomotor (CN III) palsy [Diabetic ophthalmoplegia]

*Damage to the inner somatic nerve fibers while sparing the more peripheral parasympathetic fibers

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4
Q

Treatment for necrotizing (malignant) otitis externa

A
  • Intravenous antipseudomonal antibiotic (Ciprofloxacin)

- ±Surgical debridement

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5
Q

Reynolds pentad, and what does it suggest?

A

Acute cholangitis

  • Fever
  • Upper quadrant pain
  • Altered mental status
  • Jaundice
  • Hypotension
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6
Q

Medications that may precipitate myasthenic crisis

A
  • Antibiotics: aminioglycosides, fluoroquinolones
  • Beta-blockers
  • Calcium channel blockers
  • Magnesium
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7
Q

Ulnar nerve neuropathy differences between wrist and elbow level injury

A
  • Wrist➡numbness, paresthesia at medial side of the hand + intrinsic hand weakness (“clumsiness”) [hypothenar, medial lumbrical, adductor pollicis]
  • Elbow➡⬇grip strength [flexor carpi ulnaris, medial portion of flexor digitorum profundus]
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8
Q

How you may differentiate guillain-barré syndrome vs tick paralysis?

A
  • GBS➡Autonomic dysfunction in 70% of patients (tachycardia, urinary tract retention, arrhythmias). CSF with albuminocytologic dissociation (⬆proteins, ⬇cells). Ascending symmetrical paralysis over days to weeks.
  • Tick-borne paralysis➡Ascending paralysis over hours to days, may be localized or more pronunced on 1 extremity. Look for and find the tick (next best step)
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9
Q

Etiology of tick-borne paralysis

A

Neurotoxin release: tick needs 4-7 days for neurotoxin release

*Remove the tick➡improvement in an hour, complete recovery in several days (Dermacentor app, Ixodes holocyclus)

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10
Q

Most common organism causing deep infections following puncture wound (through the sole of a shoe)

A

Staphylococcus aureus and Pseudomonas aeruginosa

*Risk of osteomyelitis

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11
Q

Giant cell tumor of bone clinical presentation

A
  • Progressive knee pain + X-ray with eccentric lytic lesion (“soap bubbles”)
  • Benign, locally destructive neoplasm at epiphysis of long bones (young adults)
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12
Q

Giant cell tumor of bone association and prognosis

A
  • Associated with paget disease of bone

- It is benign but might have malignant transformation and pulmonary metastasis

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13
Q

Cause of Osteitis fibrosa cystica and clinical presentation

A
  • Primary Hyperparathyroidism➡⬆Resorption in cortical bone with subperiosteal thinning and cystic degeneration▶hypercalcemia (constipation, fatigue, etc)
  • Secondary hyperparathyroidism➡chronic renal failure

*X-ray: lytic lesions with multifocal involvement

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14
Q

Osteoid osteoma etiology and clinical presentation

A
  • Benign bone tumor prostaglandin-producer▶Nocturnal pain relieved by NSAIDs
  • X-ray: Small, round lucency
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15
Q

Clinical presentation of acute hemolytic transfusion reaction

A
  • Onset in minutes to 24 hours of transfusion
  • Fever, chills, hypotension
  • Renal tubular cell injury (may progress acute renal failure)▶Hemoglobinuria (dark urine), flank pain
  • Intravascular Hemolysis➡⬆LDH, ⬆Indirect bilirubin
  • DIC➡oozing intravenous site
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16
Q

Diagnosis test for acute hemolytic transfusion reaction

A

Direct coombs test➡antibody-coated RBCs

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17
Q

Clinical presentation of myopathy in Cushing syndrome

A
  • Painless progressive proximal muscle weakness, atrophy, no tenderness (may interfere with daily activities)
  • Lower extremity more involved
  • ESR and CK normal
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18
Q

Cause of myopathy in Cushing syndrome

A

Glucocorticoid-induced myopathy: Direct catabolic effects of cortisol on skeletal muscle➡muscle atrophy

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19
Q

What is the fetal hydantoin syndrome?

A

Teratogenic effect of phenytoin: orofacial clefts, microcephaly, nail/digit hypoplasia, cardiac defects, dysmorphic facial features

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20
Q

Radiologic feature of invasive aspergillosis in the lungs

A

Chest CT scan: Pulmonary nodules with surrounding ground-glass opacities (“halo sign”)

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21
Q

How do you suspect inhalant abuse acute intoxication?

A
  • Brief transient euphoria and loss consciousness
  • Highly lipid soluble➡immediate effects (typically last 15-45 minutes)
  • Dermatitis due chemical exposure around the mouth or nostrils▶”glue sniffer’s rash”
  • Chronic abuse of nitrous oxide➡vitamin B12 deficiency▶polyneuropathy
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22
Q

What is the most likely diagnosis in a patient with gallstone pancreatitis and fever, RUQ pain, jaundice altered mental status and hypotension? What should be the management?

A
  • Acute cholangitis
  • After strenous IV fluid resucitation and antibiotics, Endoscopic retrograde cholangiopancreatography➡relieve the biliary obstruction
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23
Q

Most common adolescent- and adult-onset muscular dystrophy and mode of genetic transmision

A
  • Classic myotonic dystrophy

- Autosomal dominant➡CTG repeat expansion on the DMPK gene

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24
Q

Main clinical presentation of classic myotonic dystrophy

A
  • Pogressive skeletal muscle weakness➡face and distal extremities (forearms, hands, ankle flexors)▶muscle wasting➡ptosis, temporal wasting, limb muscle atrophy
  • Grip myotonia (hand)
  • Dysphagia
  • Conduction anomalies
  • Testicular atrophy/infertility
25
Primary mechanism underlying the most common cytopenias in SLE
Autoantibodies➡Immune-mediated peripheral destruction (in all 3 cell lines)
26
Which clinical manifestations might raise suspicion of cervical myelopathy?
- Lower motor neuron (LMN) signs (Ex, weakness and atrophy) at the level of the lesion (arms) - Upper motor neuron (UMN) signs (Ex, hyperreflexia) below the level of the lesion (legs)
27
Most common cause of cervical myelopathy in older adults
Spondylosis➡canal narrowing➡spinal cord compression
28
Most common metals alloys that trigger allergic contact dermatitis. Mechanism of the reaction.
- Nickel (jewerly or clothing fastener)➡neck, wrists, ear lobes, umbilicus; cobalt, chromium, beryllium, zinc - Corrosion by electrolytes in sweat releases soluble metal ions➡type IV (cell-mediated) hypersensitivity reaction
29
Pulmonary function test results in a patient with amyotrophic lateral sclerosis (ALS)
- Restrictive pattern (normal or ⬆FEV1/FVC, ⬇VC)➡extrinsic limitation of lung expansion - Diaphragmatic involvement (weakness)➡⬇FVC, ⬇Maximal inspiratory pressure (reflect diaphragmatic strength), DLCO normal (pulmonar parenchyma and alveoli unaffected)
30
Best predictors of postoperative outcomes following lung resection surgery
FEV1 and DLCO
31
Screening for abdominal aortic aneurysm
Abdominal ultrasound for men age 65-75 who have ever smoked (lifetime tobacco use>100 cigarettes)
32
Ocular manifestations of Neurofibromatosis type 1
- Optic pathway glioma (15% of patients, age<6)➡asymptomatic or grow large to compress optic nerve▶⬇visual acuity, ❌color vision, optic nerve atrophy, proptosis, esotropia, optic disc pallor - Lisch nodules➡pigmented iris hamartomas
33
Primary dose-limiting side effect of first-line treatment for Sickle cell anemia with recurrent vaso-occlusive crisis
Myelosuppression (neutropenia, anemia, thrombocytopenia) *Hydroxyurea➡⬆fetal hemoglobin➡⬇sickled hb➡⬇polymerization of RBC▶⬇vaso-occlusion episodes
34
Most common site of colon cancer metastasis
Liver
35
Important difference in clinical presentation between paralytic ileus and bowel obstruction
- Paralytic ileus: hypoactive bowel sounds | - Bowel obstruction: hyperactive "tinkling" bowel sounds. Peristaltic waves on the abdominal wall
36
Musculoskeletal presentation of hereditary hemochromatosis
Arthralgia, arthropathy, chondrocalcinosis (Pseudogout)
37
How you may differentiate small cell carcinoma vs squamous cell carcinoma of the lung?
Paraneoplastic syndromes: - Small CC: ⬆ACTH (Cushing sx), ⬆ADH (SIADH), ⬆Antibodies against presynaptic Ca+2 channels (Lambert-Eaton myasthenic sx) - Squamous CC: ⬆PTHrP (hypercalcemia) * Sca++mous
38
Which conditions you must study in a patient with pseudogout?
- Hyperparathyroidism - Hypothyroidism - Hemochromatosis
39
Definition of severe aortic stenosis
- Aortic jet velocity >=4 m/sec - Mean transvalvular pressure gradient >=40 mmHg * Valve area usually <=1 cm2, but NO required
40
Indications of aortic valve replacement
Severe AS and >= of the following: - Onset of symptoms (angina, syncope) - Left ventricular ejection fraction <50% - Undergoing other cardiac surgery (CABG)
41
Common findings of chronic primary adrenal insufficiency
- Hyponatremia: hypovolemia-induced antidiuretic hormone secretion - Hypoglycemia: cortisol deficiency - Peripheral eosinophilia: normally inhibited by corticosteroids *History of weakness, fatigue, anorexia, weight loss
42
Management of small spontaneous pneumothorax
- Observation | - Supplemental oxygen (regardless of oxygen saturation)➡⬆speed of resorption
43
Best treatment for cancer-related anorexia/cachexia syndrome (CACS)
Progesterone analogs (megestrol acetate medroxyprogesterone acetate)>corticosteroids
44
Treatment for HIV cachexia
Synthetic cannabinoids (dronabinol)
45
Pathophysiologic mechanism of membranoproliferative glomerulonephritis
- Dense intramembranous deposits that stain for C3 - Deposit disease▶IgG antibodies (C3 nephritic factor) against C3 convertase➡persistent activation of the alternative complement pathway▶kidney damage
46
Most important side effects of phenytoin
* Phenytoin➡❌folic acid absorption in jejunum▶folic acid deficiency over weeks or months - Megaloblastic anemia - Gingival overgrowth/hyperplasia * Phenytoin➡❌bone and mineral metabolism (⬇bone density): calcium and vitamin D supplementation
47
Symptoms of papilledema due to increased intracranial pressure
- Momentary vision loss that varies according to changes in head position - Large blind spot in visual fields
48
Markers of Nonclassic congenital adrenal hyperplasia
- Hyperandrogenism - ⬆ 17-hydroxyprogesterone *Cause by partial ⬇ 21-hydroxylase activity
49
Most common psychiatric complication of multiple sclerosis
Depression
50
Treatment of triglyceride-induced pancreatitis
- If Glucose≥500 mg/dL: consider insulin infusion▶limits fatty-acid release from adipocytes) - If Glucose≤500 mg/dL or severe pancreatitis (lactic acidosis, hypocalcemia, etc): apheresis▶removes triglyceride-rich plasma *Always IV fluids and pain control
51
What is the difference between heat exhaustion vs exertional heat stroke?
Exertional heat stroke has CNS dysfunction, heat exhaustion not
52
Most common form of paroxysmal supraventricular tachycardia (PSVT)
Atrioventricular nodal reentrant tachycardia (AVNRT)➡reentry mechanism▶slow and fast pathways form a looped circuit *Impulses traveling in antegrade direction through the slow pathway and returning through the fast pathway
53
Most common cause of chronic mitral regurgitation in developed countries
Mitral valve prolapse: myxomatous degeneration of the mitral valve leaflets and chordae
54
How do you confirm benign paroxysmal positional vertigo (BPPV)?
Dix-Hallpike maneuver➡vertigo and nystagmus on quickly lying back into a supine position with the head rotated 45 degrees
55
Treatment for Alopecia areata
- Mild/moderate hair loss: topical or intralesional corticosteroids - Extensive hair loss: topical immunotherapy (diphenylcyclopropenone), oral corticosteroids *Autoimmune disorder involving the hair bulb cells
56
Major driver of AKI in cardiorenal syndrome?
Elevated central venous pressure *Reduced effective arterial blood volume (EABV)➡Heart failure, cirrhosis
57
Antibiotic indicated for patients undergoing splenectomy and develop fever
Amoxicillin-clavulanate *Levofloxacin (for penicillin allergy)
58
First step in evaluating solitary pulmonary nodule (SPN)
Comparison with previous x-ray➡stable lesion in 2-3 years▶malignancy ruled out, no further testing

Internal Medicine Flash Cards (3 decks)

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