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day 2 stuff Flashcards

0
Q

structural deformity of hypertrophic cardiomyopathy

A

asymetric septal hypertrophy and abnormal motion of mitral valve leafles- systolic anterior motion that increases the outflow obstruction.

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1
Q

HOCM murmur

A

Crescendo decrecendo murmur at the left lower sternal border that increases with valsalva due to dec preload.

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2
Q

proteinuria (>3+), hypoalbuminemia, edema, hyperlipidemia + lipiduria=

A

Nephrotic syndrome

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3
Q

Common complications of nephrotic syndrome

A

many complications due to protein loss protein malnutrition, Fe resistant microcytic hyporhcomic anemia (transferin loss), vit D defiticiency, def thyroxin levels, inc susceptibitly to infection, hypercoagulable state.

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4
Q

Most common manifestation of hypercoaglulatibility in nephrotic syndrome- esp membranous glomerulonephropathy

A

renal vein thrombosis

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5
Q

Goal oxy Hb sat in COPD?

A

90-94%

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6
Q

What happens when chronic COPD pts are over oxygenated?

A

worsening hypercapnia and CO2 narcosis- increasing CO2 retention pt will be lethargic and confused.

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7
Q

Congenital dermal melanocytosis=

A

mongolian spots

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8
Q

Male under 5 yo with proxmila muscle weakness + gower sign + bilatral calf pseudohypertrophy.

A

Duchene muscular dystrophy

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9
Q

Labs in duchene’s-

A

elevated serum creatinine phosphokinase and aldolase elevated before weakness.

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10
Q

Abnormality in Duchene’s muscular dystrophy

A

absent dystrophin gene on genetic testing
undetectable dystrophin gene with muscle bx
XR

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11
Q

long term complicatoins of duchenes muscular dystrophy

A

Cardiomypathy- often die from resp or heart failure

intellectual disability

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12
Q

Elderly person with BP 165/75- dx, pathophys, risks, and tx

A

Isolated systolic HTN due to stiffening of arteiral wall, common in elderly.
Assoc with inc risk of cardiovascular events, esp with wide pulse pressure
Tx- low dose thiazide, ACE-I, CCB

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13
Q

cancers reduced by breast feeding

A

breast and ovarian

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14
Q

benefits to infant of breast feeding

A

decreased risk of otitis media, infxns of resp/GI? and UT, as well as dec risk of necrotizing enterocolitis.
lower rates of T1DM, and childhood cancers.

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15
Q

Infant pathology that is absolute CI to breast feeding

A

Galactosemia

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16
Q

Deformed joints (especially foot) with decreased sensation, arthritis arthropathy, mild pain, fractures that are unsuspected by the pt, and degenerative joint dis and loose bodies on joint imaging=

A

Chacot Joint- a neurogenic arthropathy

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17
Q

Tx of Charcot joint

A

tx underlying neurologic condition (B12, DM, peripehral nerve or spinal cord damage, syringomyelia, tabes dorsalis).
Mechanical devices
X-rays if trauma is present

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18
Q

Congenital aromatase deficiency

A

enzyme deficiency that prevents conversion of androgens to estrogens.
gestational maternal virilization with 46 XX fetus
Normal internal genitalia w/ ambiguous external genitalia

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19
Q

Complications of congenital aromatase deficiency

A

delayed puberty ( primary amenorrhea)
osteoperosis
undetectable estrogens in the setting of high gonatropins
clitoral hypertrophy

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20
Q

pt w/ cirrhosis and ascities with low gradefever, abdominal discomfort, AMS

A

spontaenous bacterial peritonitis

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21
Q

Confirmatory tests for SBP, SAAG

A

ascitic fluid with PMN’s > 250 and positive peritoneal cutlure.
SAAG >1.1

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22
Q

MCO of SBP

A

E. Coli, Klebsiella- gram negs

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23
Q

Tx of SBP

A

3rd gen cephalosporins- Cefotaxime

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24
Q

Which children with UTIs get eval- what is it

A

Child 2-24 months get renal US with first febrile UTI

Children with recurrent febrile UTIs get voiding cystourethrogram to eval for VUR

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25
Q

Longterm complication of VUR

A

recurrent UTIs and pyelo ==> renal scarring

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26
Q

Common AE of antithyroid meds, presentation, management

A

agranulocytosis- presents with fever and sore throat normally w/in first 90 days.
Stop meds and check WBC’s- 1500 meds likely not the problem

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27
Q

Arrhthymia most specific for digitalis toxicity

A

Multifocal atrial tachycardia with AV block.

Results from inc ectopy and increased vagal tone

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28
Q

Ssx of glucocorticoid deficiency

A

Fatigue, weakness, loss of appetite, EOSINOPHILIA

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29
Q

HIV pt with dry cough, exertional dyspnea, fever.
Hypoxia out of proportion with radiographic findings
LDH?

A

PCP, LDH is elevated.

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30
Q

Indications for steroid use in treating PCP

A

PaO2 35

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31
Q

Drug to treat PCP if TMP-SMX is CI

A

Pentamidine

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32
Q

Requirements for dx of Lewy body dementia

A

1) Fluctuating cognition w/ pronouced variations in attn and alertness
2) recurrent visual hallucinations- well formed and detailed
3) spontaneous motor features of PD
Req 2/3

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33
Q

supporting features of Lewy body dementia

A 
repeated falls
Syncope
transient LOC
neuroleptic sensitivity
systematized delusoins
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34
Q

Afebrile pt with new onset blood tinged suputum w/o systemic ssx- dx and tx

A

acute bronchtitis- generally viral
tx is close clinical FU and obs
Often have wheezing

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35
Q

ddx for hemoptysis

A

Acute bronchitis- no fever, wheezing
Pneumonia- severe fever
Tb or Malignancy- constitutional signs or weight loss

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36
Q

Hypertensive pt w/ low Renin levels- suspect, labs

A

primary hyperaldosetronism
HTN, mild HyperNa, HypoK, metabolic alk
Inc Ald, dec Renin

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37
Q

When an elderly pt is on NSAIDs what type of anemai must alway be considered

A

Fe deficiency secondary to GI bleeding

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38
Q

TMP and lab changes

A

TMP can cause Hyper K bc blocks epithelial Na channels in collecting tubule.
Also causes artificial inc in serum Cr by competitive inhibition of renal tubular acid secretion w/o affecting GFR

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39
Q

Meds that inc K

A

Non selective BB- blocks Beta 2 mediated K uptake
ACE, ARB, K sparing diurectics- blocks ENaC
Digitalis- blockas Na/K ATPase
Cyclosporine- blocks aldosterone
Heparin- blocks aldosterone prod
NSAIDs- dec renal perfution–> dec K delivery to CD
Succinycholine- extracellular leakage of K via Ach receptors

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40
Q

Tx for heparin OD

A

Protamine Sulfate

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41
Q

Buspirone is used to tx

A

GAD

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42
Q

Passive aggrestion

A

Expresses aggression toward another person via repeated passive failures to meet that persons needs

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43
Q

Breast bx shows foamy macrophages and fat globules

A

Fat necrosis of the breast.
Similar findings to breast caner- skin/ nipple retraction, calcifications on mamography.
No tx, self limited

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44
Q

Parasthesias or pain in distribution of median nerve during pregnancy= ?

A

Carpal tunnel syndrome (inc incidence during preg due to E mediated depolymerization of ground substance)

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45
Q

Tx of carpal tunnel syndrome

A

NSAID’s + neutral wrist splinting –> corticosteroid injxns–> surgical decompression

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46
Q

Evaluation for uric acid stones should be prompted by

A

finding of needle shaped crystals on UA

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47
Q

How are Uric acid stones evaluated for

A

CT or IVP

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48
Q

can nephrolithiasis cause bowel ileus

A

Yes

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49
Q

Most common AE for Olanzapine

A

Sedation and weight gain
Weight gain from H1 and 5HT2c antagonism
sedation H1 antagosnism

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50
Q

Antipsychotics associated with amenorrhea

A

Paliperidone and risperidone via increase in prolactin levels (block dopamine receptors)

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51
Q

Antipsychotic associated with leukopenia and angraulocytosis

A

Clozapine

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52
Q

Olanzapine AE

A

Most common is weight gain
assoc w/ elevation in LFT, full hepatotox is rare
orthostatic hypoTN from alpha 1 antagonism

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53
Q

MC form of atypical penumoniae in ambulatory setting

A

Mycoplasma

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54
Q

Presentation of atypical pneumonia

A

Indolent course, higher incidence of extrapulm manifestations.
CXR- out of proportion to physical exam

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55
Q

Bugs responsible for atypical penumonia

A

Mycoplasma, chlamydia, legionaella, coxeilla, influenza

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56
Q

Atypical pneumonia with erythema multiforme (target lesion) and no organisms on gram stain

A

Mycoplasma

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57
Q

Atypical pneumonia assoc with environmental water sources, occurring in outbreaks

A

Legionaella

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58
Q

Screen for GBS with vaginal and rectal swab when?

A

between weeks 35-37

prophylactic Abx= penicillin or ampicillin at time of delivery

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59
Q

Which women get GBS prophylaxis

A

positive screen at 35-57 weeks
previous child that dev early onset GBS
has GBS bacteuria during the preg

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60
Q

during what weeks is amniocentesis done

A

16-18

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61
Q

what is the best test to detect chromosomal abnormalities in the first timester

A

CVS done between weeks 10 and 12

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62
Q

When is CVS indicated?

A

mother over age 35 w/ abnormal US

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63
Q

Meds to withhold 18 hours prior to stress testing (unless pt has known CAD)

A

BB, CCB, nitrates

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64
Q

Meds to be withheld 48 hrs prior to vasodilator stress testing

A

dipyridamole

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65
Q

meds to be withheld 12 hours prior to vasodilator stress testing

A

Caffeinated foods or drinks

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66
Q

Meds that can be continued

A

ACE-I, ARB
dig
statins
diuretics

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67
Q

Infants that are SGA are at increased risk for

A 
Polycythemia- inc Epo in response to hypoxia
Hypoxia
perinatal asphyxia
meconium aspiration
hypothermia
hypoglycemia
hypocalcemia
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68
Q

Definition of SGA=

A

birth weight is < 10% for GA

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69
Q

Double duct signs indicates

A

pancreatic cancer due to compression of pancreatic and common bile duct

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70
Q

Pt with abdominal pain + weight loss + jaundice + GB distention=

A

tumor in the head of the pancreas- classically presents with painless jaundice.
Imagining shows dilation of intra and extraheptaic biliary tract dilatrion

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71
Q

Pulmonary contusion- manifestations, timeline, ABG

A

Tachypnea, tachycardia, hypoxia. May have dec breath sounds
ABG will show hypoxia
CXR- unilateral patchy infiltrates
Manifests in first 24 hours

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72
Q

ARDS- timeline and presentation

A

Usually manifests in the first 24-48 hours after the trauma

bilateral lung involvement

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73
Q

Cyanotic infant with LAD + decreased pulm markings= ?

Other EKG findings

A

Tricuspid atresia

also have small absent R waves in precordial leads and peaked P waves from R. atrial enlargement

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74
Q

RF for tricuspid atresia

A

Congenital rubella
DS
maternal DM
fam hx of congenital heart dz

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75
Q

Murmur of tricuspid atresia

A

holosystolic murmur heard best at LLSB from VSD

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76
Q

Bechet syndrome- presentation

A

multi system inflammatory condition- recurrent oral and genital ulcers, skin lesions (erythema nodosum- painful), anterior or posterior uveitis, retinal vascularization

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77
Q

Tx of bechet sydrome

A

Coricosteroids

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78
Q

Long term complicatons of bechet

A

dementia or blindness- not prevented by tx with corticosteroids

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79
Q

Hypostheuria is common in what populations

A

SCD and SC trait

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80
Q

CI to Li tx, alternative tx

A

Li should not be administered to pts with renal dysfunction (elevated Cr)
use Valproic acid +/- antipsychotic for initial tx of bipolar do, manic, or mixed phase

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81
Q

Tx of mild bipolar do

A

Atypical antipsychotic

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82
Q

Tx of severe bipolar do

A

Li or valproic acid + antypical anti psychotic- has faster onset of axn

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83
Q

what does each of the hazard ratios indicate:
1
=1

A 
1= more likely in tx group
=1= equally likely in both groups
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84
Q

what does the hazard ratio tell you

A

indicate chance of an even occurring in the tx group compared to control group

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85
Q

When is rotavirus vaccine normally given

A

between 2 and 6 months

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86
Q

AE of rotavirus vaccine

A

Intussiception

87
Q

CI to rotativurs vaccine

A

anaphylaxis to a vaccine ingredient
hx of uncorrected congenital malformation of GI tract (meckels divertic)
SCID
hx of intussiception

88
Q

Presentation of achalasia

A

progressive dysphagia, chest pain, food regurgitation, aspiration

89
Q

achalasia barrium swallow

A

Birds beak deformity of LES and dilated esophagus

90
Q

Pleuritic chest pain, tachyardia, dyspnea- especially if pt is on OCP, or just had a long flight =

A

Most likely dx is PE

91
Q

Digoxin is used to tx

A

Atrial arrthmias- second line rate control in A.fib and A. flutter bc inc AV node refractory period.
Symptomatic relief in heart failure

92
Q

Lidocaine is used to tx

A 
class 1 anti arrhythmic
tx ventricular arrhythmias
93
Q

First line tx for newly dx stage 1 HTN=

A

Lifestyle modification

94
Q

Most effective life style mod to reduce BP?

A

weight loss especially via DASH diet

dec BP 5-20/ 10 kg weight loss

95
Q

broad waxy casts in UA

A

chronic renal failure

96
Q

fatty casts in UA

A

nephrotic syndrome

97
Q

WBC casts on UA

A

interstitial nephritis, pyelonephritis

98
Q

If EKG reading states “NO P waves” = A.fib- tx=

A

rate/ rhythm control

99
Q

A. fib manifestations on echo

A

Can show LV dilation w/ dec EF b/c of loss of atrial kick

Mild MR due to LV dilation

100
Q

Niacin AE- underlying mechanism, tx

A

flushing and pruritis - PGe induced peripheral vasolidation

tx= ASA

101
Q

EKG of long standing Coarc

A

LVH- high voltage QRS w/ down-sloping ST seg depression, T wave inversion in leads V5 and V6

102
Q

Coarc CXR

A

“3 sign”

ribnotching in ribs 3-8

103
Q

Treatment of coarc

A

balloon angioplasty

104
Q

Conditions assoc with Coarc

A

bicuspid AV
VSD
Turner syndrome

105
Q

Sudden onset of vertigo, vom, and occipital HA in Hypertensive pt=?
Other manifestations

A

Cerebellar hemorrhage

Also have 6th nerve paralysis, conjugate gaze deviation, blepharospasm, and coma

106
Q

High body temp (105), DEHYDRATION, CONFUSION, COMA, AND dry flushed skin=?, pathophys

A

heat stroke

caused by failure of body to thermoregulate in setting of high environmental temps

107
Q

what interventions for continuity of care when pts are moving between facilities are most effective for improving the quality of patient care?

A

interventions that target pharmacy personnel and high risk pts.

108
Q

Damage to the lateral STT causes contralateral loss of pain and temperature sensation beginning at what dermatomes

A

2 levels below the level of the lesion

109
Q

In utero abnormalities due to congenital diaphragmatic hernia

A

polyhydramnios due to esophogeal compression

110
Q

Neonate with congenital diaphragmatic hernia which with hypoxia and respiratory distress which intervientions are CI

A

bag valve mask and blow by O2 bc can pump air into stomach exacerbation condition

111
Q

After ET tube has been secured in Congenital diaphragmatic hernia what is next intervention

A

nasal or orgogastric tube to decompress the viscera.
Umbilical artery line to measure- blood gas and blood pressure
Umbilical vein line- administer fluids

112
Q

viruses that cause dilated cardiomyopathy

A

COXACKIE B
Parovirus B19, HHV6, adenovirus, enterovirus
Often preceded by viral illness

113
Q

Findings of dilated cardiomyopathy on echo

A

dilated ventricles w/ diffuse hypokinesia –> systolic dysfunction

114
Q

Tx for viral induced cardiomyopathy

A

management of CHF ssx

115
Q

mechanism of damage in viral induced dilated cardiomyopathy

A

direct viral damage from humoral or cellular immune response to persistent viral infxns

116
Q

What are the cardiac contours in acute cardiac temponade

A

normal

117
Q

early dumping syndrome

A

postgastrectomy complication
ssx- post parandial abdominal cramps, weakness, lightheadedness and diaphoresis.
tx is dietary modifications or ocretotide. if intractable- reconstructive sx

118
Q

Amphetamine intoxication-

A

SNS overload + agitaion or other beh manifestations
ie HTN, diaphoresis, mydriasis, agitation, irritability, paranoia, delerium.
Cardiac arrhythmias, seizures, hypothermia, intra cerebral hemorrhage

119
Q

Torsades de points definition

A

polymorphic ventricular tachycardia

120
Q

setting of torsades

A

prolonged QT interval ie familial long QT syndrome pts predisposed to hypoMg (alcoholics), pts taking TCA,s, amiodarone, sotalol, moxifloxacin, fluconazole

121
Q

Tx of torsades is

A

stop offending agent

initiate MgSO4

122
Q

pregnant women with surgically tx graves dz run a risk of what in the baby

A

thyrotoxicosis bc anti TSH Ab are Ig and cross placentat –> stimulate TH production

123
Q

Ssx of neonatal thyrotoxicosis

A

presents w/in 1-2 days of preg w/

tachycardia, cardiomegaly, restlessness, diarrhea + poor weight gain, goiter

124
Q

How should a tick be removed

A

ASAP with tweezers as close to the skin as possible. pull straight up with steady pressure

125
Q

Criteria for Llyme dz prophylaxis

A

Must meet all 5-

1) Tick is ixodes scapularis (deer tick)- nymph or adult
2) Tick is attached for >36 hours or engored
3) Prophylaxis is started within 72 hours of tick removal
4) Local B. burgdorpheri infxn rate is greater than or = to 20%
5) No CI to doxy- age <8, preg, lactating

126
Q

Prophylaxis for Lyme disease is

A

one dose of doxycycline

127
Q

Causes of acute pancreatitis

A

MC- alcohol or gal stones
Meds that cause acute pancreatitis- furosemide, thiazide, sulfasalazine, 5- ASA, azathioprine, didanosine, pentamidine, metronidazole, tetracycline, valproic acid

128
Q

Femoral central venouc cath vs subclavian centarl venous cath- higher rate of infxn-

A

Femoral

129
Q

Common bugs assoc with central venous line infxn

A

Staphylococci

Femoral lines can also have gram negs (enterics)

130
Q

If a mother has active uncontrolled antepartum hemorrohage, w/ unstable vital signs and unreassuring fetal monitoring requires

A

emergent C/S

131
Q

Pt’s with placenta accreta often require what to stop post partum hemorrhage

A

Hysterectomy

132
Q

MEN 1

A

Parathyroid adenoma
Pituitary tumors
Enteropancreatic tumors

133
Q

MEN type 2A

A

medullary thyroid cancer (100%)
Pheochromocytoma (60%)
Parathyroid hyperplasia (10-20%)

134
Q

MEN 2B

A

Medullary thyroid cancer- more aggressive then MTC in 2A
Pheochromocytoma
Mucosal and intestinal neuromas- tongue, eyelids, lips, GI
Marfanoid habitus- or kyphoscoliosis, lordosis

135
Q

Dysmenorrhea + heavy menses + enlarged uterus

A

Fibroids- often inc in size with OCPs or pregnancy and regress after menopause

136
Q

Pelvic congestion syndrome

A

dull/ ill defined pelvic ache, worse prior to mesntruation and relieved by menses.
assoc with hx of sexual problems

137
Q

Mucopurulent urethral dc, absent bacteuria, hx of multiple sexual partners=

A

chlamydia

138
Q

which is more common chlamydia or gonorrhea

A

chlamydia

139
Q

FEV1/FVC ratio >80% is- restictive or obstructive

A

Restrictive lung disease

140
Q

FEV1/FVC <80% is restrictive of obstructive

A

Obstructive

141
Q

Causes of restrictive lung disease-

A

interstitial lung dx, NM dz, alveolar edema, pleural fibrosis, and chest wall abnormalities

142
Q

PFT’s of ankylosing spondylitis

A

FEV1/FVC >80% bc restrictive BUT FRC is greater than predicted bc fusion of costovertebral joints –> chest wall motion restriction and maintains chest in inspiratory position.

143
Q

RIng enhancing lesion on brain MRI with fever, HA, confusion, and ataxia in HIV + pt=

A

Reactivation of toxo

should screen for toxo in new onset HIV and give TMP-SMX to any pt with toxo Ab

144
Q

What HIV opportunistic infections are prophylaxed w/ TMP SMX

A

Toxo

PCP

145
Q

X ray findings of Ewings Sarcoma

A 
Onion skinning (periosteal retraction)
lytic, central, endosteal scalloping.  
Onion skinning leads to moth eaten appearance that extends to the soft tissue
146
Q

Epidemiology of Ewing sarcoma

A

white male in 1st or second decade of life

147
Q

Extra articular manifestations of RA

A

Tenosynofitis of palm= trigger finger
TA nodules esp on elbows (non tender)
cervical joint invovlement leading to spine subluxation and SC compression

148
Q

Tx for bacterial vaginosis?

A

Metronidazole

alternatives include vaginal metronidazole and clindamycin

149
Q

Drug used to prevent acute urate nephropathy

A

Allopurinol

150
Q

causative organism assoc with pneumonia in debilitated subjects especially alcoholics, primarily affects upper lobe, mucoid colonies=

A

Klebsiella pneumonia - encapsulated gram neg bacilli

151
Q

SSx of TCA OD

A

CNS depression, hypoTN (MCC death in TCA OD), anticholinergic effects (hot has a hare, red as a beet, intestinal illeus, dilated pupils)
QRS prolongation –> increased susceptibility to vent arrhythmia’s

152
Q

TCA OD tx

A

ABC’s-secure airway

NaHCO3- improves BP, shortesn QRS, and prevents arrhythmias

153
Q

Lab studies defining anemia of prematurity

A

1) Normocytic/ normochromic anemia w/ no abnormal forms
2) Low retic count, dec RBC precursors in BM
3) normal WBC and platelet counts
4) nortal total billirubin level

154
Q

Tx of anemia of prematurity

A

Fe supplementation even though not an Fe deficiency
periodic Hb checking
blood transfusions- if needed

155
Q

who gets anemia of prematurity

A

low BW infants and premies

156
Q

cause of anemia of prematurity

A

diminished RBC prod, shortened RBC life span, blood loss

157
Q

In the setting of BPH, if renal function deteriorates next step is

A

Renal imaging ie US to assess for hydronephrosis and worsening kidney function

158
Q

Dz that causes: EOM weakness (diplopia, pitosis), symetrical proximal muscle weakness (Upper>Lower), neck (flexor/ extensor), and bulbar muscles (dysarthria, dysphagia)- and pathophys

A

Myesthnia gravis- Anti poststynaptic ACh receptors.

Characterized by fatigue-ability

159
Q

Chronic GI dz that cause steatorrhea, Celiac Dz –> effect on Ca, PO4, PTH, and vit D

A

–> lead to vit D deficiency –> hypoCa and low PO4 + inc PTH–> osteomalacia, bone pain, muscle weakness, cramps, ataxic abnormalitties

160
Q

Tx for Enterobius

A

Albendazole and mebendazole- CI in pregnancy

Alternative is Pyrantel Pamoate.

161
Q

Prader-Willi syndrome is loss of…

A

Paternal copy of 15q11-q13

162
Q

ssx of Prader-Willi syndrome and complications

A

hypotonia, hyperphagia, obesity

complications- sleep apnea, T2DM, gastric rupture

163
Q

Angleman syndrome is loss of

A

maternal copy of 15q11-q13

164
Q

Beckwith- Wiedemann syndrome

A

disregulation of imprinted gene expression of chrom 11 p15: fetal macrosomia, rapid growth until late childhood, macroglossia, hemihyperplasia, umbilical hernia, or omphalocele

165
Q

Dx criteria for DKA

A

BG >250
pH <15-20
detection of plasma ketones

166
Q

most appropriate initial management in DKA

A

rapid IV admin of NS and regular insulin

167
Q

Complications of beckwith wiedeman syndrome

A

Wilms tumor

Hepatoblastoma

168
Q

Surveillance in Beckwith- Weidemann syndrome

A

serum AFP and Abdominal/renal US q 3 months till age 4
Ab U/S q 3months Age 4-8
Renal U/s age 8-adolesence

169
Q

when should those dx with UC begin getting colonoscopies

A

8-10 years after initial dx

170
Q

Travel associated diarrhea of rotavirus and norovirus

A

brief illness w/ vom

171
Q

ETEC, EnPEC

A

contaminated food and drinking water

172
Q

Campylobacter diarrrhea

A

Prominent abdominal pain resembling a pseudoappendicitis, bloody diarrhea

173
Q

salmonella

A

frequent fever

174
Q

Shigella diarrhea

A

fever, bloody diarrhea and abdominal pain

175
Q

Diarrhea assoc with Cryptosporidium, Cystisosporia, Microsporidia

A

Chronic in immunosuppresssed, common in travelers

>2weeks

176
Q

Diarrhea assoc with cyclospora

A

> 2weeks

causes prolonged relapsing infxn

177
Q

Diarrhea assoc with Giardia

A

> 2 weeks- common in wilderness and rural areas of US, asymptomatic pts will shed for months

178
Q

Common pathology in pts that have ssx of appendicitis for >5 days

A

contained appendiceal abscess w rupture
Fever leukocytosis, anterior palpation maneuvers are negative but obturator, psoas and anal exam are more likely to be positive.
Tx of otherwise stable pts- IV Abx, bowel rest, +/- percutaneous abscess drainage, elective appendectomy in 6-8 weeks

179
Q

How long can sx be delayed in an elderly pt with femoral neck fracture and why would you delay it?

A

72 hours to ensure pt is medically stable

180
Q

MGUS vs MM

SPEP, plasma cells in BM, definitive test

A

MGUS- no ssx vs MM which does
in MGUS- SPEP 3% and MGUS >10% plasma cells in bone marrow
differentiate with metastatic skeletal bone survery- long bones and skull to r/o lytic lesions.

181
Q

MGUS rate of MM transformation / yr

A

1%

182
Q

RF for pancreatic adenocarcinoma

A

Smoking, hereditary pancreatitis, non hereditary chronic pancreatitis, obesity and lack of physical activity

183
Q

Ssx of pancreatic adenocarcinoma

A

systemic ssx
abdominal pain/ back pain- often worse at night
jaundice
recent onset of atypical DM
unexpalined migratory superficial thrombophlebitis
HSM and ascites with mets

184
Q

Labs in pancreatic adenoCa

A

cholestatic pic
elevated CA 19-9
US is jaundiced
CT w/o jaundice

185
Q

ABO rxns in newborns

A

Typically in O mothers w/ A or B child.
Generally cause minimal dz and may present in the first preg.
Can present w/ hemolytic dz of the newborn- may have absent or mild anemia and dev neonatal jaundice tx w/ phototherapy

186
Q

Langerhans cell histiocytosis/ Langerhans cell granulomatosis/ histiocytosis X

A

Causes solitary lytic long bone lesions.

and HyperCa

187
Q

Histiocytosis X- eosinophillic granuloma

A

least severe form of histiocytosis X- children/ young adulst with a solitary bone lesion +/- pain, overlying tender swelling, cause pathologic fractures.
Can be locally destructive but resolves on its own, benign and tx conservatively

188
Q

Serum sickness like rxn timeline

A

1-2 weeks after administration of drugs

189
Q

Serum sickness like rxn associated w what meds

A

penicillin, amoxicillin, cefaclor in the setting of a viral illness.

190
Q

Serum sickness like rxn prominent symptoms

A

fever, utricarrial rash, polyarthralgia, LAD

191
Q

Serum sickness like rxn tx

A

resolves w stopping offending agent

Not true drug allergy

192
Q

middle aged individual who holds books at arms length to read=

A

Presbyopsia

age related dec in lens elasticity –> difficulty with near vision.

193
Q

Infant in first 2 weeks of life w/ poor sucking and fatigue followed by rigidity, spasm and opisthotonus

A

Neonatal tetanus from clostridium tetani
infants of unimmunized mother
umbilical stump inxn

194
Q

Newborn with- webbned neck, high palate, short 4th metacarpal, and nail dysplasia

A

Turner syndrome

195
Q

HPV vaccine is recommended for

A

females age 9-26 regarless of sexual activity

males age 9-21

196
Q

dx of renal stones in pregnancy

A

US

197
Q

Immune thrombocytopenia

A

Antecedent viral infxn w/ asyptomatic petichiae and echymosis. as well as mucocutaneous bleeding ie hematuria, GI bleeding, epistaxis

198
Q

ITP lab finidngs

A

Isolated thrombocytopenia <100,000

Peripheral smear with megakaryocytes and no other abnormalitites

199
Q

ITP tx in kids

A

Obs skin manifestations

Bleeding- IVIG or glucoccorticoids

200
Q

ITP tx Adults

A

platelets > 30,000 2/o bleeding- obs

P<30,000 OR bleeding- IVIG or glucocorticoids

201
Q

Preferred initial imaging modality for suspected gynecologic tumors is

A

U/S

202
Q

Tx of ascending cholangitis

A

Start with supportive care and broad spectrum Abx

if dont respond ERCP for biliary drainage

203
Q

Development of AV block in pt w/ infective endocarditis should raise suspicion for

A

perivalvular abscess extending into adnjacent cardiac conduction tissue

204
Q

Endocarditis of which valves is most highly associated with extension of endocarditis to aabscess

A

aortic valve and IV drug abuse

205
Q

Xanthelesthemia occur in setting of what dz

A

Primary billiary cirrhosis but are most commonly idiopathic.

They are benign lesions w/ lipid filled macrophages in the dermis

206
Q

Primary pulmonary HTN- cardiac and pulm ssx, CXR, EKG

A

SSX- weakness, dyspnea, fatigue –> chest pain, hemoptysis, syncope, hoarseness.
Right vent heave, JCD, tender hepatomegaly, ascites, edema. eventual RHF/ Cor Pulmonale
CXR- enlargement of pulmonary art, rapid tapering of distal vessels (pruning), enlarged R. vent
EKG- RAD

207
Q

Rubella = German Measles

A

fever + cervical or posterior cervical LAD followed by maculopapular rash that spreads in cranio caudal fashion sparing palms and soles.
Women have have arthritis that last up to 1 month post resolution.
similar prodrome to measles- cough and coryza

208
Q

Pain with eye movement, prottosis, opthalmoplegia, diplopia=
MC RF
Dx

A

Orbital cellulitis
RF= bacterial sinusitis
dx= CT w/ contrast to look and see if there is abscess req Sx

209
Q

Complications of orbital cellulitis

A

blindness, subperiosteal abscess, cavernous sinus thrombosis, intracranial infxn, death

210
Q

newborn or young infant with FTT, bilateral cataracts, jaundice and hypoglycemia- suspect, dz and complicatoins

A

Galactosemia- galactose 1 phosphate uridyl transferase deficiency
Tx by eliminating galactose from diet
may have MR and at risk for neonatal sepsis from E. Coli

211
Q

Fibrocystic change of breast- management

A

Aspirate and obs for 4-6 weeks, if fluid is clear

212
Q

Management of acute diverticulitis

A

start with IB abx should resolve if not do CT to evaluate for abscess or perforation

213
Q

MVP pathophys and what happens when it becomes severe

A

myxomatous degeneration of mitral valve

can cause L atrial and L vent enlargement –> A.fib, L. vent dysfx, and CHF

214
Q

What should everyone about to start trastuzamab get?

A

An echo, esp those with borderline left vent function EF< 55%

215
Q

Pts with hypoTN, and acute massive increase in ALT AST, and milder increase in total billirubin and alk phos=?, prognosis?

A

Ischemic hepatic injury or shock liver

If pt survives the reasons for hypoTN, enzymes will return to normal in a few weeks

216
Q

Multiple dome shaped lesions with central umbilication

A

Mollsuscum Contagiosum

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