general questions II Flashcards
what is the godl standard treatment for bipolar
lithium
what are the SE of lithium
tremors, diabetes insipidus, hypothyropidism, weight gain
what are some of the second line therapies for bipolar
valproic acid, fcarbamezapine and atypical antipsychotics.
what are some of the atypical psychotics
risperidone, clozapine, quetiapine, ziprasidone
what are the components of rhett syndrome
incontinence, screaming fits, loss of speech, sensory problems, breath holding, stereotypic movements, chorea, bruxism, and dystonia.
diabetic nephropathy characteristics
foamy urine, proteinuria, hypertension in the setting of diabetes.
what is foamy urine a sign of>?
proteinuria
what is the treatment for diabetic nephropathy
ACEi and glycemic control
is the normal albumin/creatinine ratio of urine
less than 30. greater than 30 indicates that there is microalbuminuria
what is a technetium 99m pertechnetate study
this is looking at the GI tract and if there is ectopic uptake it strongly suggests Meckel diverticulum.
what is meckel diverticulum
patentcy of the vitelline duct. rule of 2. these are usually incidental findings unless there is blood, which indicates a lower GI tract bleed. the bleeds are caused by ulcerations of the small bowel from acid being secreted by the ectopic gastric mucosa int he diverticulum.
what is the rule of 2s for meckels diverticulum
occurs in 2% of the population, 2 inches long, 2 feet from the ileocecal valve, 2% of patients develop a complication over their life, male to female ratio is 2:1.
what metabolic disturbances will you find in bulimia nervosa
self-induced vomiting can result in hypokalemia, hypochloremic metabolic alkalosis.
what are the signs of bulimia
eroded teeth, inflammation of the esophagus, russell sign (calluses on the knuckles).
if suspected hypothyroidism what is the best test for the blood
first TSH. then look to free T4.
Do not look at T3, this is more likely to be variable.
what is highly associated with myastenia gravis and what test do you need to secure after diagnosis with edrophonium challenge
CT of the chest dumbass. this is for thymoma
what is assocaited with medulloblastoma?
nevoid basal cell carcinoma is the most common one to consider but the others are turcot and ataxia-telangiectasia
what is the mainstay of treatment for bells palsy
since this is an idiopathic peripheral lesion of the facial nerve glucocorticoid treatment is first line therapy. many cases of bells palsy can be caused by lyme disease, but watch for prodfromal symtpoms. if there are none, then glucocorticoids
also watch out for herpes voster infections. they can cause bells palsy. usually the steroids are given in conjunction with antivirals.
what is a risk factor for bell’s palsy
diabetes
what are the features of elaphantitis
low-grade fever, excessive lymphadenitis, rural china and a mosquito bite
what is the causal agent for elphantitis
wuchereria bancrofti
what is medial tibial stress syndrome
shin splints
how to diagnose a tibial stress fracture
radiographs will only pick up on it 46% of the time. bone scan within 72 hours picks up the stress fracture 96% of the time.
what is syringomyelia
fluid pocket filled with CSF forms within the spinal cord (syrinx).
what is the presentation of a syrinx or syringomyelia
selective loss of temperature and sensation in the upper extremity is very rare outside of syrinx/syringomyelia
what is associated with syringomyelia
arnold-chiari malformation type I. this causes disrupted flow through the foramen magnum and may result in the formation of a syringomyelia
what is the treatment for tuberculosis
isoniazid, rifampin, ethamutol, pyrazinamide
anisocytosis
variety in the size of erythrocytes. this is the same as red blood cell distribution width. An increased red blood cell distribution width is highly specific for iron-definiency anemia.
what is the number one cause of anemia in women of child-bearing age
menorrhagia
what is glanzmann thrombocytopenia
this is defective GpIIb/IIIa. characterized by an inability of platelets to aggregate
reaction formation is what
doing the opposite of the thought or feeling towards something
what is VACTERL congenital anomalies
vertebral anolalies, anal atresia, cardiac derfects, tracheoesophageal fistula/esophagela atresia, renal and radial (limb defects including thumbs) anomalies,
how does bladder present
80-90% of patients with bladder cancer have painless gross hematuria
what is the most common type of bladder cancer
transitional cell carcinoma
what are the risk factors for bladder cancer
smoking, aniline dyes, cyclophosphamide.
what is otosclerosis and what is it associatd with
presents as bilateral conductive hearing loss, with a positive family history. this is overgrowth of the middle ear bones, most commonly the stapes, in which it becomes fixed to the oval window and cna no longer be pulled away by the stapedius muscle in response to sounds –loss of the stapedius reflex.
what is electrical alternans
alternating amplitudes of QRS on ECG. this is indicative of pericardial effusion and cardiac tamponade.
what is the classic presntation of pericardial effusion
cough, chest pain, tachycardia, dizziness with electrical alternans
what is the next appropriate step for suspected pericardial effusion
cardiac echocardiogram
what is the definitive treatment for pericardial effusion
pericardial centesis
what causes fatty change in the liver
fatty disorders like diabetes, alcohol intoxication, obesity.
what is the difference between a sebaceous nevi and an infantile hemangioma
sebaceous nevi are there from birth, while hemagniomas develop over time.
what do we watch out for with sebaceous nevi
can develop into cancer
Hailey-Hailey disease
this is benign familial pemphigus (autosomal dominant). this usually arises in the third-fourth decades. friction areas to macerate, thicken and develop painful cracks. presents as a painful erosive skin rash. the lesions tend to come and go and leave no scars. the centers clear as the lesion spreads. heat, sweating and friction usually exacerbate the lesions.
can have malorderous drainage from secondary bacterial infections
what differentaites hailey-hailey from pemphigus vulgaris and immune mediated blistering diseases?
the immunofluorescence test for antibodies is negative.
treatment for shingles in pregnancy
no different than anyone else. oral acyclovir.
what is echinococcosis
tapeworm infection by echinococcus granulosus.
what is the disease course of echinococcosis
ingvestion of the worm egg in contaminated food with dog feces, individual will develop hydatid cysts that look like egg shells in the liver. the cysts can rupture and lead to an anaphylaxis
what is the treatment for echinococcos
abendazole and possibly surgical removal is necessary
what is a mucin positive lung tumor characterized as?
adenocarinoma
histologically will have glands and mucin
what is the presentation of lung cancer
chronic cough, hemoptysis, hoarseness, chest pain, pericardial or plural effusion and superior vena cava syndrome
what are the most common sites of metastasis for lung tumors
adrenal glands, brain, bone, and liver
what are also common in lung cancers
paraneoplastic syndromes. l
what are some paraneoplastric sydnromes
hypercalcemia from parathyroid hormone related peptide release. lambert-eaton myastenia syndrome, cushings syndrome, syndrome of inappropriate antidiuretic hormone release.
what is the therapeutic range for INR
2-3
what do you do for someone that is injured and is taking warfarin?
make sure they are hemodynamically stable and that their INR is therapeutic
what are patients with a molar pregnancy monitored for and how>?
gestational trophoblastic disease. need to take the B-hCG within 48 hours of evacuation and then 1every 1-2 weeks while the level is elevated continue to take it every 6 months. OCPs and monitoring for one year is what OB says
what is pulmonary rehabilitation
usually recommended for patients with COPD. a set of exercises that teaches them how to breath easier.
what is bird fancier’s lung and how does it present
interstitial inflammation with some fibrosis. its also called hypersensitivity pneumonitis. a disease in which the lung parenchyma becomes inflamed as a response to environmental antigens –like bird dander.
what is the most effective way to stop epistaxis
firm pressure on the cartilaginous portion of the nose for 30 min
is hypertension to blame for epistaxis
not usually
what is the next step in stopping the bleeding from epistaxis if firm pressure does not help
can cauterize with silver nitrate
why must caution be taken with silver nitrite cauterization
because there is a risk of necrosis
nikolsky’s sign
slight rubbing of the skin causes exfoliation of the outermost layer
what is a concerning biopspy result for endometrium
glands with crowding and prominent nucleoli
what is the classic triad for congenital toxoplasmosis
chorioretinitis, hydrocephalus, intracranial calcifications
how does congenital syphilis present
jaundice and hepatosplenomegaly, nasal discharge, rash on the palms and soles, saber shins and hutchingtons incisors. sensorinerual deafnes
how does congenital listeriosis present
premature birth, meningitis and sepsis, pustular skin lesions with vesicles granulomatus infantiseptica
congenital VSV
IUGR, prematurity, chorioretinitis and cataracts, encephalitis, pneumonia, CNS abnormalities, hypopl;asitc limbs
Parvovirus B19
fetal hydrops, aplastic anemia
rubella congentica
blueberry muffin baby, IUGR, sensorineural deafness, cataracts, heart defects, hepatitis
CMV congenica
jaundice, IUGR, chorioretinitis, sensorineural deafness, periventricular calcifications, microcephaly and siezures
conegnital HSV
premature birth, IUGR, vesicular lesions, keratoconjunctivitis miningitis
what do we use to treat nocturnal enuresis
imipramine
what is imipramine
a tricyclic antidepressant
what are clue cells and what do they represent
they are bacterial cells stuck to vaginal cells on a wet mount. this is indicative of garnrella vaginosis or bacterial vaginosis
how do we treat bacterial vaginosis
metronidazole
what is a side effect of the MMR vaccine
measles like rash on the trunk for 10-14 days after vaccination. this is benign and wil go away soon
what is goodpasture synfdrome
a very serious autoimmune syndrome that causes pulmonary hemorrhage, hematuria. this is due to basement membrane antibdies
what is a typical presentation for IgA nephropathy
painless hematuria after a respiratory illness. the clinical presentation is usually proteinuria, hematuria, azotemia, red blood cell casts, oliguria, hypertension
ramelteon
melatonin agonist and sleep aid.
myastenia gravis presents as
autoantibodies act against post synaptic nicotinic acetylcholine receptors. person that gets tired throughout the day and improves with rest. diplopika, muscle weakness and ptosis.
what is the test to confirm myastenia
tensilon or edriphonium
what is the treatment for myastenia
acetylcholinesterase inhibitors such as neostigmine, pyridostigmine
what do we giev to treat cholinergic crises
atropine
diamond blackfan anemia
aplastic anemia typically presents as a normo or macrocytic anemia
fanconi anemia is what type of anemia
pancytopenic anemia
narcolepsy presents how
tetrad of symptoms: cataplexy, sleep paralysis, hypenogogic hallucinations, excessive daytime sleepiness.
sudden episodes of muscle weakness ranging from slight atonia to complete paralysis and is often triggered by strong emotions like terror or crying
when is ultrasound indicatred for breast mass
in all women under 30
what are the signs of steatorrhea. what are the two sources of this
bulky and foul smelling stools
structural damage to the intestine (crohn’s, celiac) or pancratic/endocrine insiufficienchy
what is the D-xylose test for?
to test for structural damage to the small bowels.
if the d-xylose test is negative or normal then what do we look for?
endocrine insufficiency like pancreas
what is the rule pregnancy dating with ultrasounds and LMP
if the LMP and ultrasound dates differ by >7 days go with the ultrasound date
how does midgut volvulus present
with a lethargic infant that has been vomiting. duodenum is usually the culprit and emkergent laparotomy is required before the baby gets ischemic
what is psittacosis
bacterial infection transmitted from birds gram negative bacterium. treaet with tetracyclines. presents as respiratory disease with patchy infiltrates
what do we do for a nonreducible, painful inguinal hernia
surgical reduction is required because it can cause bowl strangulation
what is steven johnson syndrome
a burning skin rash usually due to medication reaction.
