hammer2 Flashcards
what is the presentation of pancoast tumor a.k.a superior sulcus tumor? how is it initially evaluated?
- shoulder pain, 2. horner syndrome, 3. C8-T2 neurological involvement (hand muscle weakness/pain and paresthesia of 4th and 5th digits); 4. supraclavicular lymph node enlargement, weight loss. Chest x-ray
What is the management of ASCUS in women > 25?
- HPV test if positive - colposcopy, if negative repeat pap smear and HPV test in 3 years
What is the management of ASCUS in women
repeat cytology in 1 year
What symptoms are caused by vitamin B2 (riboflavin) and B6 (pyridoxine) deficiency?
Angular chelosis, stomatitis, glossitis. for B6 add irritability, confusion, depression
What symptoms are caused by B1 (thiamine) deficiency?
Beriberi (peripheral neuropathy, heart failure) and Wernicke-Korsakoff syndrome
What symptoms does hypervitaminosis A cause?
neuropsychiatric symptoms and cerebral edema
What is the approach to idiopathic intracranial HTN?
neuroimaging (MRI/MRV) and LP
What are the characteristics of Antiphospholipid syndrome, which antibodies are present and which parameter is raised in coag studies?
Venous thromboembolism/recurrent early miscarriage/presence of lupus anticoagulant, anticardiolipin antibody or beta 2 glycoprotein 1 antibody
PTT is prolonged
What are the 5 primary renal causes of nephrotic syndrome?
FSGS ,membranous nephropathy, MPGN, MCD, IgA nephropathy
What is the clinical association of FSGS?
AA & hispanics, HIV and Heroin use
What is the clinical association of membranous nephropathy?
adenocarcinoma, NSAIDS, hep B, SLE
What is the clinical association of MPGN?
Hep B and C; lipodystrophy
What is the clinical association of minimal change disease?
NSAIDs and LYMPHOMA for MCD
What is the clinical association of IgA nepjhropathy?
upper respiratory tract infection
What are the symptoms of post concussive syndreom?
headache, confusion, amnesia, vertigo a few hours to days after a TBI
What is the inheritance mode of hereditary spherocytosis? What are the lab findings? Tx? Complications?
AD. Increased MCHC with Negatie Coombs test. Elevated osmotic fragility on acidified glycerol lysis test andabnormal eosin-5 malemide binding test, - Tx. FA supplementation, splenectomy. Complications - Aplastic crisis from parvovirus B19 infection
What is the presentation of acute bronchitis? Treatment?
Cough more than 5 days upto 3 weeks. No systemic findings, except for wheezing or rhonchi. Symptomatic treatmnet, no abx.
What is the most common GI manifestation of CF?
Pancreatic insufficiency, ADEK malabsrption. Low K leads to mucosal bleeding and epistaxis 2/2 prolonged PT
What is the difference between acute otitis media and otitis media with effusion?
No inflammation in otitis media with effusion
What is the initial management of osteoarthrits?
Nonpharmacoloical measures including exercise, weight loss and activity modification plus NSAIDs like diclofenac for pain relief
Which organism is implicated in prosthetic joint infection within 3 months of knee replacement?
Staph aureus, gram negative rods
Which organism is implicated in prosthetic joint infection after 3 months of knee replacement?
Staph epidermidis (coagulas negative staph), propionibacterium speciess, enterococci
What is the medical treatment options for acute abnormal uterine bleeding?
High dose ESTROGEN or OCPs or progestin or tranexamic acid
What are the symtoms of zinc deficiency and what is a known cause?
Alopecia, abnormal taste, bullous, pustulous lesions, impaired wound healing. Chronic TPN or malabsotprion
What is the most important of Selenium difciency?
Cardiomyopathy
How does MM affect immunity?
Neoplastic infiltration of the bone marrow alters and impairs the normal lymphocyte population, resulting in ineffective Antibody production and hypogammaglobulinemia.
What is the pathophysiology of ARDS?
lung injury - fluid/cytokine leakage in alveoli
impaired gas exchange, decreased lung compliance, PHTN
How is ARDS diagnosed? What is the Aa gradient?
- Respiratory distress within 1 week of insult, 2. b/l lung opacities 2/2 pulmonary edema NOT due to CHF, hypoxemia with PaO2/FiO2
What are the features of glucocorticoid induced myopathy? What are the ESR and the CK values?
Progressive proximal muscle weakness and atrophy without pain or tenderness. Lower extremity muscles are more involved. Normal ESR and CK.
What are the features of gpolymyalgia rheumatica? What are the ESR and the CK values?
Muscle pain and stiffness in the shoulder and pelvic girdle. Tenderness with decreased range of motion at shoulder, neck and hip. Responds rapidly to glucocoricois. Elevated ESR with normal CK
What are the symptoms of multiple system atrophy?
Parkinsonism with orthostatic hypotension, impotence, incontinence or other autonomic symptoms
What is the most common renal malignancy in childhood? What are the associated syndromes? What is the clinical presentation?
Wilms tumor (nephroblastoma). WAR (Wilms tumor, Aniridia - absent colored part of eye, Genitourinary anomalies like Hematuria, intellectual disability). Asymptomatic, firm, smooth, abdominal mass that doesn’ tcross midline. Tx - Excision/chemo/radiation therapy
What conditions have increased Aa gradient?
Intersitial and obstructive lung disease, (intracardiac shunt, extensive ARDS) - do not corect with supplemental O2, atelectasis, pulmonary edema, PNA
What is teh presentation of Alport’s syndrome?
Recurrent episodes of heamturia, sensorineural deafness, family history of renal failure
What are the symptoms of atrophic vaginitis?
Vulvar, vaginal dryness narrow introitus, pallor, ow elasticity, low ruggae.
What is the criteria for Tourette disorder? Treatment?
Both multiple motor and one or more vocal tics, onset before age 18. Antipsychotics liek Risperidone, alpha adrenergic receptor agonists, behavioral therapy
What is the pathophysiology of bullous pemphigoid? What is seen on immunofluoresence? Treatment?
IgG autoantibodies against Hemidesmosome and basement membrae zonethat activate complement and inflammatory mediators leading to tense bullae formation. linear IgG and C3 deposts. High potency topical glucocorticoid (Clobetasol)
What are the symptoms of rotator cuff impingement or tendinopathy?
Pain with adbuction, external rotation; subacromial tenderness; positive impingmenet tests. Associated with repetitive activity above shoulder height
Which drugs casue crystal induced AKI?
acyclovir, sulfonamides, MTX, ethylene glycol, proteas inhibitors
Who should you suspect Alpha-1 antityrpsin deficiency?
Less than 45 yo, basilar lung disease, liver disease
What is the presentation of chronic tophaceous gout?
Urate crystals deposited in skin, resulting in formation of tumors with a chalky white appearance
What is the presentation of measles? Which medication increases morbidity and mortality?
high grade fever, maculopapular rash that spreads from trunk to extremities, non productive cough Vitamin AAAAA
What is the treatment for superifical infantile (strawberry) hemangiomas if they need it?
Betablockers
What are the clinical features of glucagonoma?
- Necrolytic migrathory erythema (erythematous papules/plques on face/lesions enlarge and coalesce over next 7 - 14 days with central clearing and blistering);
- Diabetes,
- GI symptoms (diarrhea, anorexia)
- neuropsychiatric symptoms
What is the immunology and examples of Type 1 (immediate) hypersensitivity reactions?
IgE-mediated. Anaphylaxis, urticaria
What is the immunology and examples of Type 2 (cytotoxic) hypersensitivity reactions?
IgG and IgM autoantibody mediated. Autoimmune hemolytic anemia and Good pasture syndrome
What is the immunology and examples of Type 3 (immune complex) hypersensitivity reactions?
Antibody-antigen complex deposition. Serum sickness/PSGN/lupus nephritis
What is the immunology and examples of Type 4 (idelayed type) hypersensitivity reactions?
T cell and macrophage mediated. Contact dermatitis and Tuberculin skin test
What testing should be done in infants with increasing head circumference and signs of ICP?
CT brain
What are the symptoms of secondary hyperparathyroidism in chrnic renal failure?
Hypocalcemia, hyperphosphatemia, increased PTH
What is the criteria for Lynch syndrome diagnosis and which cancer is it associated with?
1 case diagnosed before 50; 2 or mre generations; 3 relatives with colorectal cancer. Endometrial cancer
What causes pill eophagitis and what are the symptoms?
Tetracyclnes, KCl, bisphosphonates and NSAID. Patients experience sudden onset odynophagia and retrosternal pain
