hammer27 Flashcards
What is the difference between thoracic outlet syndrome and subclavian steal syndrome?
Subclavian steal syndrome has posterior neurological signs plus vascular symptoms
What can cause thoracic outlet syndrome?
anterior scalene muscle, Cervical rib, elongated transverse process of C7
What is the treatment of Barrett esophagus without dysplasia? With low grade dysplasia? high grade?
Endoscopy every 3-5 years. Endoscopy every 6 - 12 months. Endoscopic ablation within 3 months.
What is the treatment for a breast mass with infiltrative ductal carcinoma > 4 cm?
Mastectomy (too big for lumpectomy >4cm) and axillary node sampling
What coag profile is seen in von Willibrand disease?
Elevated bleeding time AND PTT
What are the urine findings in allergic interstitial nephritis?
WBC, RBC and white cell casts
What are specific findings for Graves disease?
Exopthalmos periorbital edema, pretibial myxedema
For which lung masses do you use bronchoscopy?
For centrally located pulmonary masses. IF not helpful, use CT
What are ocular findings to confirm brain death?
Absent corneal reflex, non responsive pupils, absent oculo cephalic or vestibulo-ocular reflex when pouring ice cold water in the ear
What is the medical treatmet for Rosacea?
Topical metronidazole and oral tetracyclines
What is the most common inherited cause of bilirubin glucoronidation?
Gilbert usually presents with mild asymtomatic unconjugated bilirubinemia
What is the most common cause of death from scleroderma? Which antibodies are elevated?
Lung fibrosis and pulmomnary HTN. Anti topoisomerase I, anti centromere, anti RNA polymerase III
WHen do you treat for Listeria in a suspected meningitis?
Age > 50
What is the treatment for septic arthritis with a negative gram stain?
Ceftriaxone plus vancomycin
What are the findings of anemia of chronic disease?
Normocytic to microcytic, high ferritin, low TIBC, low serum iron levels
What is the presenting symptom of paroxysmal nocturnal hemoglobinuria? What is found on testing?
Reddish urine in the morning from hemolysis. Flow cytometry shows deficiency of CD59 or CD55 on RBCs.
What size colonic polyp is recommended for removal?
greater than 1 cm
What should you suspect in UC patietns with elevated alkaline phosphatase? What deficiency do they have?
PSC. Bile salt deficiency leading to steattorrhea, vitamin malabsorption
WHat should you suspect in severely ill patients in the ICU who have been intubated, coagulopathy, burns, cranial trauma?
Stress gastritis leading to upper GI bleeding with large black stools. Treat prophylactically with PPIs or H2 receptor antagonist (Rantidine, Cimetidine, Famotidine)
What is the best management for sinusitis?
Do supportive treatment and observe upto 10 days, CT scan to confirm but after that you can do antibiotics, etc
Which side does the tongue deviate in hypoglossal nerve injury?
Same direction as the injury
What is the treatmetn for acute pyelonephriits?
IV ciprofloxacin or IV ceftriaxone or IV gentamicin
How is botulism different from myasthenia gravis?
INcremental muscle contraction on EMG testing adn pupillary dialtion
What disease should you suspect in a patient with hematuria and concomitant upper respiratory tract infeciton? Treatment?
IgA nephropathy. Treat with ACEi or ARBS to reduce proteinuria and HTN
What is the triad of hyperaldosteronism? Treatment?
HTN, hypokalemia, metabolic alkalosis. Spirnolactone
WHat is the w/u of thyroid nodule?
Measure TSH. If normal or high, do FNA. If low, do RAIU . IF cold nodule, suspect malignancy and have surgery. If hot nodule,
What is the presentation and treatment of lung abscess?
2 weeks of fever, cough, halitosis, chest pain, weight loss, night sweats, anemia and fatigue. Thick walled cavity lesion on CT scan, IV clindamycin for anerobes above diaphragm.
What are manometry findings of achalasia?
Decreased peristalsis and increased LES pressure
Which patients should be treated for GBS without screening?
Prior history of GBS septiciemia, premature rupture of membranes > 18 hours, unkown status, GBS infection in current pregnancy
What is a long term complication of Tetralogy of Fallot repair?
Pulmonary regurgitation, diastolic murrmur in second left intercostal space. Can present with RV failure and tricuspud regurgitation with S3 gallop
What kidney disorder is associated with sickle cell disease?
Renal papillary necrosis
What is the presentation of Mullerian agenesis?
Primary amenorrhea with fully developed secondary sexual characteristics. Lack of uterus, fallopian tube, cervix, upper vagina.
What should you suspect in brain abscess from sinusitis? from otitis?
Mixed anerobes and alpha hemolytic strep. Bacteroidis fragilis
What can infantile hepatic hemangiomas lead to ?What is the treatment?
CHF or platelet sequestration and destruction leading to coagulopathy. Steroids.But most involute within 18 months.
What organism is the most common cause of infective endocarditis? in IV users? in native valves? in prosthetic valves.
S. aureus for most common and IV. Strep viridians (s. mtans, s sanguini etc) for native valves and S. epidermidis for prosthetic valves
What is the empiric treatment for infective endocarditis? For strep viridians induced? Staph aureus? For enterococal?
Van + Gentamicin.
For Strep viridians - Ceftriaxone or Vancomycin
For Staph aureus - Naficillin or Vanc for MRSA
For enterococcal - Vanc and Gentamicine
What are Xray findings for infective endocarditis?
Multiple cavitations and nidules from septic emboli
What is first line treatment for acromegaly 2/2 growth hormone adenoma > 1 cm?
Surgical resection
What is the treatment for supraventricular tachycardia ?How does it work?
Vagal maneuver that increases delay in AV node conduction. If it doesn’t work use adenosine or other meds
Which organism causes roseala infantum (exanthema subitum) ? What are the symptoms
HHV 6 or 7. 7-13 months, high fever, lymphadenopathy, rose-pink macular rash that starts at the trunk and spreads to extremities
What causes Budd Chiari syndrome? What are the symptoms?
Polycythemia vera, myeloproliferative disorders, hypercoagulopathies. Acute cases caused by thrombosis of the heaptovenous circulation or IVC leading to acute abdominal pain, hepatomegaly, splenomegaly, elevated LFTs
What is the presentation of chlamidya PNA in children? What is seen on imaging?
Stacatto cough which are in short bursts. Hyperinflation or Ground glass opacity. Normal leukocytes with EOSINOphilia
What is the treatmet for hyperpigmentaion during pregnancy (melasma)?
Bleaching creams like hydroquinone
What is the EKG findings in posterior descending artery infarcts?
Tall, broad R in V1, V2, ST depression and tall upright T waves in V1, V2, V3
What is the EKG findings in left anteror descending artery?
ST elevation in V1-V3 for the anteroseptal wall
What is the EKG findings in circumflex artery infarct?
ST elevation in I, aVL, V5, V6 for the Lateral wall
What is prophylaxis for CD4 between 100-200? What disease
Pneumocystis jirovecii. TMP/SMZ or Dapsone or atovoquoe
What is prophylaxis for CD4 between 50 -100? What disease
Pneumocystis jirovecii + Toxoplasmosis. TMP/SMZ or Dapsone
What is prophylaxis for CD4 < 50? What disease?
Pneumocystis jirovecii + Toxoplasmosis + MAC. TMP/SMZ or Dapsone + azithromycin or clarithromycin
Which stress test is contrindicated in patients who have COPD and asthma ?
Adenosine becuase it causes bronchospasm
What congenital anomalies are associated in infants with diabetic mothers?
Small left colon, anencephaly, neural tube defects, cardiac abnormalities, sacral ageneis, GU defects (renal vein thrombosis and renal agenesis)
What can cause a decrease in hemoglobin in a chronic renal failure patient on erythropoietin therapy?
Aluminum toxicity, underlying infection, Hyperparathyroidism, Depleted iron stores
Which medications have to be lowered when taking Amiodarone?
Warfarin and Digoxin
What is the presentation of cervical spondylosis? WHen is x ray indicated?
- Increasing radicular pain by extension or lateral bending of the neck toward the lesion
- Feeling of electrical shock with neck flexion
- Reduced range of motion. In patients with non traumatic neck pain over 50
