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hammer11 Flashcards

1
Q

What is the EKG findings of complete heart block? Treatment?

A

regular P wave activity unrelated to QRS complexes, constant R-R interval independent of P waves. Pacemaker

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2
Q

What are the clinical findings of biliary cysts? How is it diagnosed and what is the treatment?

A

Pain, jaundice, palpable mass. US or ERCP. surgical resection.

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3
Q

What is the key feature of avoidant personality disorder and dependent disorder?

A

Avoids others due to fears of criticism and rejection. Dependent is clingy, submissive, needs to be taken care of.

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4
Q

What is the difference between degenerative joint disease and rheumatoid arthritis?

A

In djd, there is no inflammation, normal lab tests and duration of stiffness is short. Joint space narrowing, osteophytes, dense subchondral bone, bone cysts.

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5
Q

Which cell types are predominantly found in gout joints? What is the best initial treatment for acute attack? What is the side effect of colchicine? Consumption of what substance has to be decreased?

A

Neutrophils. NSAIDs. Superior to colchicine. Use steroids when you can’t use NSAIDs. Colchicine causes neutropenia by suppressing bone marrow and diarrhea. Alcohol, thiazides, aspirin and niacin.

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6
Q

What are the uses of Febuxostat, colchicine, pegloticase, allopurinol? What is the best drug for gout and HTN?

A

Febuxostat inhibits xanthine oxidase, allopurinol (safe with kidneys) prevents uric acid production, colchicine helps prevent a second attack of gout, pegloticase dissolves uric acid. Losartan.

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7
Q

What are the risk factors for calcium pyrophosphate deposition disease?

A

Hemochromatosis and hyperparathyroidism.

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8
Q

What is the presentation of cord compression in back pain? Treatment?

A

Point tenderness at spine, hyperreflexia, sensory level tenderness. Systemic glucocorticoids, chemotherapy for lymphoma, radiation. Then MRI.

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9
Q

What is the presentation of disk herniation? Treatment?

A

Pain or numbness of medial calf or foot, loss of knee and ankle reflexes, positive straight leg test. NSAIDS with continuation of daily activity.

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10
Q

What is the presentation of fibromyalgia and what is the treatment?

A

Tenderness with trigger points, pain at multiple sites, stiffness, numbness, headaches and sleep disorder. All lab tests are normal. Best initial test is amitriptyline. Other treatments are milnacipran and pregabalin

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11
Q

What is the pathophysiology and presentation and treatment of Dupuytren contracture?

A

Hyperplasia of palmar fascia leading to nodule formation, contracture of fourth and fifth fingers. Treat with Traimcinolone, lidocaine or collagenase injection.

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12
Q

How does Rheumatoid arthritis affect the lungs and which cervical joints?

A

Pleural effusion and nodules of lung parenchyma.cervical joint C1 and C2 leading to subluxation.

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13
Q

What is the presentation of Felty syndrome and Caplan syndrome?

A

Felty is RA, splenomegaly, neutropenia. Caplan is RA, pneumoconiosis, lung nodules.

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14
Q

What are adverse effects of methotrexate? Tnf inhibitors ( infliximab, adalimumab, etanercept)? Sulfasalazine?

A

Liver toxicity, bone marrow suppression, pulmonary toxicity. Reactivation of TB.
Bone marrow toxicity, G6PD hemolysis, rash.

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15
Q

What are the features of juvenile rheumatoid arthritis ? Treatment ?

A

High spiking fever, salmon colored rash on chest and abdomen, splenomegaly, pericardial effusion, mild joint symptoms. Aspirin or NSAIDS, if not steroids, if not TNF drugs.

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16
Q

What are some findings in SLE? What do diagnostic tests show?

A

Malar and discoid rash, photo sensitivity, oral ulcers, arthritis with normal xrayS,chest pain, membranous glomerulonephritis, red cell casts and hematuria. Decreased complement levels, antihistone in drug induced lupus, anti ds and anti sm

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17
Q

What is the most common cause of death in older patients with SLE?

A

Accelerated atherosclerosis leading to MI

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18
Q

What coagulation values are affected in antiphospholipid syndrome? What diagnostic tests are available?

A

Elevated aPTT and normal PT plus clotting. Mixing study which won’t correct if the antibodies are present. Most specific test for lupus anticoagulant is the Russell viper venom test, does not correct with mixing either.

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19
Q

What are components of CREST syndrome?ehat diagnostic tests are available and treatment?

A

Calcinosis, raynaud, esophageal dysmotility, sclerodactyly, telangiectasias. Normal ESR, scl-70(antitpooisomerase most specific), anticentromere. Methotrexate, cyclophosphamide for pulmonary fibrosis.

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20
Q

What is the difference between crest and scleroderma?

A

Scleroderma is CREST PLUS lung, heart, kidney.

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21
Q

What is the presentation of dermatomyositis? What is it associated with? What diagnostic tests and treatment?

A

Malar involvement, shawl sign, heliotrope rash, gottron papules. Associated with cancer of the ovary, lung, GI, lymphoma. CPK and aldolase are best initial tests. Anti-Jo antibodies are associated with lung fibrosis. Steroids, if not methotrexate, azathioprine, IVIG or mycophenolate.

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22
Q

What is the presentation of Sjogren syndrome? What are diagnostic tests? Treatment? What is the most dangerous complication?

A

Dry eyes, mouth, vagina, dental carries. S hirer test to test for tears, SS-A and SS-B aka ro and la. Rose Bengal stain shows abnormal corneal epithelium. Most accurate is parotid or lip biopsy. Water the mouth, use artificial tears, pilocarpine and cevimeline to increase saliva. LYMPHOMA

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23
Q

Which arteries does polyarteritis nodosa affect? Which organs does it spare? What is a common neurological sign? What is seen on angiography? Treatment? What disease should you check patients for ?

A

Small and medium sized arteries, spares lungs. Angiography shows abnormal dilation or beading. Prednisone and cyclophosphamide. Test for hepatitis B and C.

24
Q

Which antibody marker is elevated in Wegners and whcih is the best area to biopsy? What is a typical scenario?

A

C ANCA (anti proteinase 3 antibody). Lung biopsy. Unresolved pneumonia that doesn’t respond to antibiotics.

25
Q

Which antibody marker is elevated in Churg Strauss and what is the presentation?

A

P ANCA (antimyeloperoxidase antibodies). Pulmonary renal syndrome with asthma and eosinophilia.

26
Q

What is the presentation of Henoch Schonlein purpura? Treatment?

A

GI tract pain and bleeding, purpura, arthralgia and hematuria. Leukocytoclastic vasculitis. Most resolve spontaneously but steroids can help for severe abdominal pain or oreogressive renal insufficiency.

27
Q

What diseases are cryglobulins associated with? What are manifestations and treatment?

A

Hepatitis C. Joint pain, glomerulonephritis, purpuric skin lesions, neuropathy. Treatment- interferon, ribavarin, telaprevir or boceprevir. (brit)

28
Q

What diseases are cold agglutinin associated with? What are manifestations and treatment?

A

EBV, mycoplasma, lymphoma. Hemolysis. Stay warm, rituximab, cyclophosphamide, cyclosporine.

29
Q

Which complement factors are decreased in SLE AND HepC?

A

SLE has decreased C3 and hep C has decreased C4

30
Q

What are cardiac and visual findings in ankylosing spondylitis? What is the best treatment?

A

AV block and aortic insufficiency. Uveitis. Exercise and NSAIDs , if insufficient use antiTNF drugs such as etanercept, adalimumab or infliximab.

31
Q

What are characteristic findings in psoriatic arthritis? What is seen in X-ray and what is treatment?

A

Sausage digits and nail pitting. pencil Ina cup. Bony erosion and irregular bone destruction and elevated uric acid level from increased skin turnover. NSAIDs or methotrexate for severe disease. Anti tnf if methotrexate doesn’t work. NO steroids.

32
Q

What blood tests are abnormal in osteoporosis? What is a sideeffect of Bisphosphonates? What is treatment?

A

All blood tests calcium, phosphate and PTH are normal. Osteonecrosis of the jaw. Vitamin D, calcium and Bisphosphonates.

33
Q

What is the empiric treatment for septic arthritis? What is the treatment steps for infected prosthetic joint?

A

Ceftriaxone and vancomycin. Remove joint, treat with antibiotics for 6-8 weeks then replace joint.

34
Q

What should you test for if there is recurrent gonorrhea infection?

A

A terminal complement deficiency

35
Q

How does osteomyelitis spread in children? In adults? What is the first step before starting treatment? What is a typical vignette?

A

Hematogenous spread. Contiguous spread. Purulent sinus tract in a diabetic patient with an ulcer.

36
Q

What is the toxicity of fluoroqunilones?

A

Achilles’ tendon rupture and interfere with bone growth in children and pregnancy.

37
Q

What is the testing and finding for chronic glaucoma? Treatment?

A

Extremely elevated intraocular pressure with tonometry. Prostaglandins, topical beta blockers, topical carbonic anhydrase inhibitors, alpha 2 agonists, pilocarpine, laser trabeculoplasty if meds don’t work.

38
Q

What is the treatment for acute angle closure glaucoma?

A

IV acetazolamide, IV mannitol, pilocarpine, beta blockers, apraclondine, laser iridotomy.

39
Q

What medication can make herpes keratitis worse?

A

Steroids

40
Q

What is the treatment for retinal artery occlusion? Vein occlusion? What is a unique finding?

A

100% oxygen, ocular massage, acetazolamide or anterior chamber paracentesis. Ranibizumab for vein occlusion. Cherry red macula.

41
Q

What is the hallmark of HSV and VZV retinitis?

A

Severe and acute retinal necrosis with pain, keratitis, uveitis, peripheral pale lesions and central retinal necrosis.

42
Q

What is the pathology of amaurosis fugaux?

A

Transient vision loss, retinal emboli from carotids, zones of whitened retina following retinal arterioles secondary to edema.

43
Q

What is the hallmark of CMV retinitis?

A

Painless, hemorrhages and fluffy granular lesions around retinal vessels.

44
Q

What is the presentation and treatment for macular degeneration ?

A

Loss of central vision, wavy lines on a straight grid. VEGF inhibitor such as ranibizumab, bevacizumab, or aflibercept injected every 4-8 weeks.

45
Q

What are risk factors for placenta accreta? How does it present?

A

Priot c section, history of D & C, advanced maternal age. Presents with placental adherence and hemorrhage.

46
Q

What is the most effective intervention for blood pressure control?

A

Weight loss, followed by DASH diet, low Na intake

47
Q

What is the leading cause of blindness in the world? How does it present?

A

Trachoma. Follicular conjuctivitis and pannus (neovascularization) formation in the cornea.

48
Q

What is the initial treatment for patients presenting with SIADH from small cell lung cancer?

A

Fluid restriction

49
Q

What is the findings in Duchenne muscular dystrophy? What is the inheritance mode? How is it diagnosed?

A

Begins at 2-5 yo with bilateral calf pseudohypertrophy and Gower sign. XLR transmission. Genetic tesing which shows deletion of dystrophin gene on Xp21.

50
Q

What is the presentation of steppage gait? Which nerve roots are involved?

A

Footdrop, excessive hip and knee flexion while walking, slapping quality, falls. Distal sensory loss and weakness are associated signs. 2/2 motor neuropathy like common peroneal nerve. L5 radiculopathy.

51
Q

What supplementation must patients receving erythropoietin get?

A

Iron supplementation

52
Q

What is the most common site of hypertensive intraparenchymal brain hemorrhage? How does it present?

A

Basal ganglia (putamen). Internal capsule adjacent to it is always almost involved. Contralateral hemiparesis, contralateral sensory loss and conjugate eye deviation toward side of lesion (thalamus)

53
Q

Which patients should receive blood that is leukoreduced? What is the most common adverse reaction that occurs within 6 hours?

A

Chronically transfused. CMV seronegative at risk patients, previous febrile non hemolytic transfusion reaction.

54
Q

Which patients should receive irradiated blood?

A

BMT receipients, cellular immunodeficiency, blood components donated by first or second degree relatives

55
Q

Which patients should receive washed blood?

A

IgA deficient, complement dependent, continued allergic reactions with red cell transfusion despite antihistamine treatment

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