hammer26 Flashcards
How does tinea versicolor cause depigmentation of melanoctytes?
Inhibition of tyrosine kinase and toxicity to melanocytes caused by azelaic acid
What is Tourette disorder associated with?
OCD and ADHD
What is a presentation and treatment of tuberous sclerosis?
Neurocutaneous pigments (ash leaf spots). ACTH to suppress CRH from infantile spasms.
What are the metabolic abnormalities in Barter syndrome and which diuretics does it resemble? Which portion of the kidney is affected? Treatment?
Hypokalemia, hypocholermic metabolic alkalosis, hypovolemia, metabolic wasting, hypomagnesemia, hypercalciuria. Furosemide, mumetanide, ethacrynic acid. Thickened ascending limb. Na-K-2Cl transported. NSAID and spironolactone to block prostaglandine and aldosterone respectively.
When does NPH insulin kick in?
6 - 12 hours after dosing
Do pregnant women get tetanus vaccine?
Yes if 10 years since last one or childhood vaccination series is not complete
What are the findings in prerenal azotemia?
FeNa <1%, BUN:Cr > 20, Urine Na < 20, Urine osmolality > 500
What are findings in thromboangitis obliterans?
Normal proximal pulses with decreased distal pulses, corkscrew vessels on angiography, migrating thrombophlebitis, intermittent claudication, ischemic ulcers
What are the characteristics of hepatorenal syndrome?
Oliguria, Low mean arterial BP, hyponatremia, low urinary sodium (<5 mEq/L)
How is hepatorenal syndrome diagnosed?
Low GFR, absence of shock or bacterial infection, no renal function improvement after diuretic withdrawal and volume expansion with albumin , proteinuria less than 500 mg/d
What is the presentation and treatmetn of iridiocyclitis?
Inflammation of anterior eye structures. Presents with blurred vision, photophobia and tearing. On PE, there is ipsilateral and consensual photophobia, 360 degree perilimbal injection, hypopyon (inflammatory cells floating in aqueous humor) and miosis. Immediate opthamology referral.
What heart defects and murmmurs are heard in endocardial cushion defect?
Both ASD and VSD are present. Widely split S2, Systolic ejection murmmur at upper left sternal border and low pitched diastolic murmmur
What is the treatment for molloscum contagiosum?
Ritonavir and Cidofovir
What are EKG findings in hypokalemia?
ST depression, U wave, T wave flattening
What is the next step when a thyroid nodule has low TSH? Normal or high TSH?
Radioiodine scintigraphy. FNA
What are the fetal risk of using Valproic acid?
Craniofacial abnormalities, cardiovascular anomalies, cleft lip, meningiomyelocele,
What are the characteristics of von Hippel Landau syndrome?
AD. Multiple hemangioblastomas including retinal angiomas, clear cell RCC, endolymphatic sac tumors of the middle ear, pheochromocytomas.
What should you expect if there is no B12 in the urine after a Schilling test?
Either a malabrosption 2/2 Crohn or Celiac disease or the parasity Diphyllobotrum latum ate it
For what bleeding rate do you do a tagged red cell study?
B/n 0.5 - 2 ml/min. > 2 angiogram, less than 0.5 colonoscopy
How do bisphosphates inhibit calcium release?
By inhibiting osteoclast mediated boneresorption
What is the feared complication of supracondylar fracture in children?
Vascular or nerve injury (Median nerve ,brachial artery)
What is the management of large breast tumors affixed to the chest wall or extended nodal involvement?
Preopchemotherapy followed by palliative surgery
What are the four types of melanomas?
Superficial spreading - most common, flat, non uniform color, asymmetric, non distinct borders
Acral - dark skinned people, foot
Lentiginous - melanoma in situ, elderly sun exposed people
Nodular - dark blue/black pigmentation, rapidly develops, lack radial growth
What test should you perform in an elderly patient with frequent falls?
Get up and go test to check for gait, balance etc
What is the most common lung cancer in non smokers and where is ti located?
Adenocarcinoma. Peripherally, arising from scar tissue in the lung.
What is the treatment for benign essential tremor?
Propranolol, Primidone, Clonidine
What are the characteristics of ALS disease?
Both upper (spasticity, hypperreflection) and lower motor (weakness, atrophy, fasiculation) neuron deficits. Death from respiratory failure within a few years.
What is the first line treatment of ulcerative colitis?
5 aminosalicylic acid (5ASA) enema
When is LEEP used and what are expecte complications?
HGSIL or CIN 2 or 3. Cervical stenosis, cervical incompetence
What is the pathophysiology of alpha 1 antitrypsin deficiency?
accumulates in the hepatocytes because a mutation blocks it from leaving, and damages the liver
When is echo preferred over ECG?
When it is difficult to determine if a patient has an MI ddue to an underlying condition such as Digoxin use, LBBB, LVH, pacemaker, non specific ST segment changes and young females
When is the best time to treat thrombosed internal hemorrhoids?
Within the first three days, otherwise do conservative management
In which patients is allergic bronchopulmonary aspergillosis more common? What are common radiological findings?
CF, asthmatics, marijuana users. Parallel lines, tram lines, gloved finger shadow
What is the difference between desmopressin and democlocycline?
Desmopressin is ADH agonist, Demeclocycline is an ADH antagonist used in SIADH
Which patients should be screened for BRCA mutations?
- Women with breast/ovarian cancer including first degree relatives <35 2. B/l breast cacner 3. Cancer in multiple generations 4. Male breast cancer
What imaging modalities should be used to diagnose aortic rupture?
- Chest xray followed by spiral CT angiogram
What should you suspect if you have renal insufficiency in a diabetic?
Metformin toxicity leading to lactic acidosis.
What is the metabolic findings from pyloric stenosis induced vomiting?
Hypocholermic metabolic alkalosis
Which organisms usually cause aspiration PNA?
Mixed anerobes such as bacteroides melaninogenicus and fusiform nucleatum
What causes splenic vein thrombosis and what are the classical findings?
Acute pancreatitis, portal HTN, hypercoagulable states. Antrum varices without esophageal varices.
What causes acute pancreaitits besides alcohol and gall stones?
Hypertriglyceridemia > 500, especially if Diabetes is involved.
What is the most common cause of Creuzfeldt-Jakob disease?
Sporadic mutation in th eprion protein gene
What markers are elevated in both seminoma and non seminoma testicular cancer? WHich marker is elevated only in non seminoma?
LDH and HCG. AFP only in non seminoma
What are the two main causes of non anion gap metabolic acidosis? How can you tell which one is caused by diarrhea
Diarrhea and Renal Tubular Acidosis. Usine anoin gap (Na + K - Cl) is negative if it is diarrhea
What is ECG findings and first step in Multifocal atrial tachycardia? Which patients usually have it? Treatment?
Varying p wave morphology, irregular PP interval. Measure O2 saturation. COPD patients. Treat underlying cause such as O2 if hypoxic., then Verapamil to slow them down
What type of herniation causes an ipsilateral dialted pupil?
Uncal herniation 2/2 compression of oculomotor nerve
Which complication is not avoidalble with antibiotic treatment in acute strep pharyngitis?
Glomerulonephritis
What is the presentation of DiGeorge syndrome and how is it detected?
Cotruncal abnormalities, atypical facies, thymic hypoplasia, hypocalcemia. Genotyping via PCR for chromosome 22q11 microdeletions.
What is the cause of LLQ pain with tennesmus (rectal spasm wanting to defecate), bloody diarrhea in immunocompromised patients? What issue does CMV cause the most ? How is cryptosporidium detected?
CMV proctocolitis. Retinitis. Modified acid fast stain
What drug and mechanism reduces prostate volume in BPH?
Finasteride which is a 5 alpha reductase inhibitor blockign the formation of testosterone to dihydrotestosterone (which enlarges prostate)
What is a complication of hepatic adenoma?
Bleeding into the peritoneal cavity and also malignant .transformation.
Which vibrio species cause sepsis in patients with renal or chronic lever disease? Treatment?
Vulnificus. Treat with tetracylcine of third gen cephalosporin
