hammer3 Flashcards

1
Q

What is the clinical presentation of posterior limb of internal capsule (lacunar infarct)?

A

unliateral motor impairement w/o sensory or visual field abnormalities

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2
Q

What is the clinical presentation of middle cerebral artery occlusion?

A
  1. Contralateral somatosensory and motor deficit (face, arm and leg),
  2. conjugate eye deviation toward side of lesion,
  3. homonymous hemianopsia, aphasia (dominant hemisphere)
  4. hemineglect (nondominant hemisphere)
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3
Q

What is the clinical presentation of anterior cerebral artery occlusion?

A
  1. Contralateral somatosensory and motor deficit (predominantly in lower extremity)
  2. Abulia (lack of will or initiative)
  3. Dyspraxia, emotional disturbances, Urinary incontinence
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4
Q

What is a lifethreatening complication of severe preeclampsia and what causes it?

A

Pulmonary edema, caused by increased systemic vascular resistance, capillary permeability, pulmonary capillary hydro static pressure and decreased albumin

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5
Q

What is the pathology of coarctation of the aorta? What murmur is heard?

A

Thickening of tunica media of teh aortc arch near teh ductus arteroisus. Systolic ejection murmur at teh left interscapular area.

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6
Q

What is the treatment for obsessive compulsive disorder?

A

CBT, high dose SSRI. If non response, use lomipramine or antipsychotic augmentation, DBS for refractory cases

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7
Q

What are the symptoms of congenital hypothyroidism?

A

weakness, hypotonia, large tongue, sluggish movement, abdominal bloating, umbilical hernia

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8
Q

What are the symptoms of metabolic syndrome? What is the central pathogenesis?

A

3/5 of the following

  1. abdominal obesity
  2. fasting glucose > 100
  3. Blood pressure > 130/80
  4. Triglycerides > 150 mg/dL
  5. HDL cholesterol
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9
Q

What are the symptoms of pheochromocytoma?

A

Paroxysms of severe hypertension that can be precipitated by surgical procedures, anesthesia induction and a number of medications

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10
Q

What is the etiology of Wiskott-Aldrich syndrome? What are the clinical features adn what is the treatment?

A

XLR, impaired cytoskeleton changes in leukocytes, platelets.
Clinical - Eczema, microthrombocytopenia, recurrent infections.
Stem cell transplant

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11
Q

What is the treatment for migraine headaches in children?

A

NSAIDs

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12
Q

What is the workup for primary amenorrhea?

A

Measure FSH if no breast development. If decreased - pituitary MRI. If increased - karyotype

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13
Q

What is the etiology of amyloidosis? Clinical presentation? Diagnosis?

A

Extracellular deposition of insoluble polymeric protein fibirils in tissues and organs. AL type - primary AA - secondary to chronic inflammatory conditions (arthritis, chronic infections, IBD, malignancy, vasculitis.
Clinical presentation - restrictive cardiomyopathy, increased ventricular wall thickness, asymptomatic proteinuria, hepatomegaly, BLEEDING diathesis, waxy thickening. Fat pad abdominal aspiration biopsy

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14
Q

Which medications should be withheld prior to cardiac stress testing?

A

BB, CCB, nitrates - which are antianginal agents

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15
Q

What is the treatment for cyanide poisoning?

A

Activated charcoal if ingested. All other exposures - give antidots - hydrocobalamin or sodium thiosulfate. No antidots - nitrites to induce methemoglobinemia to increase Fe3+ to bind cyanide

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16
Q

What is the difference between epidermal inclusion cyst and dermatofibroma?

A

EIC - benign wih normal epidermis, dome-shaped, firm, freely movable cyst/nodule with a small central punctum. VS. Dermatofibroma - firm, hyperpigmented, dimples when pinched

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17
Q

What is the treatment for ascited?

A
  1. Na and water restriction 2. Spirnolactone 3. Loop diuretic 4. Paracentesis (2-4 L/day)
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18
Q

When do you observe a pneumothorax?

A

When it is small (

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19
Q

What is the most specific marker for dementia vs. normal aging?

A

Impairment of daily functioning in dementia

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20
Q

What is the presentation of HOCM, murmur and pathophysiolog?

A

Syncope in young patient wtih crescendo-decrescendo murmur at lower LEFT sternal border .Symptoms secondary to outflow obstructionfrom interventricular septal hypertrophy

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21
Q

What is hepatic hydrothorax and what is the pathophsiology and treatment?

A

Transudative pleural effusion in cirrhotc patiests leading to right sided pleural effusion not 2/2 cardiac or pulmonary abnormality. Initial treatmetn with salt restriction adn diuretics. TIPS if treatmetn is refractory.

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22
Q

What are preventative factors in SIDS?

A

Room sharing and Pacifier use

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23
Q

What is the appearance of a meningioma?

A

extra axial well circumscribed or round homogeneously enhanced dural-based mass. Can be calcified at times. Complete resection

24
Q

What are the symtpms of acute iron poisoning

A

abdominal pain, hematemesis, metabolic acidosis. Radiopaque so can be seen on x-ray.

25
Q

What are the first line treatment in acute mania?

A

Antipsychotics. Lithium (avoid in renal disease) and anticonvulsant mood stabilizers (valproate - avoid in liver disease)

26
Q

What are the diagnostic features of acute bacterial rhinosinusitis? What causes it? TREATMENT

A

Persistent symptoms > 10 days w/o improvement OR severe symptoms, fever, purulent nasal dscharge or face pain > 3 days or worsenng symptoms > 5 days after initially improving viral URI. Strep pneumo and H infleunzae (30 % each) and Moraxxella (10%). AMOXICILLIN-CLAVULANIC ACID

27
Q

What are the physica findings of Beckwith-Wiedemann syndrome? What are future complications/

A

Macrosomia, macroglossia, Hemihyperplasia, umbilical hernia/omphalocele and hypoglycemia. Monitor for Wilms tumor and hepatoblastoma.

28
Q

What are teh clinical features of delusional disorder? Treatment?

A

More than 1 delusion for more than 1 month WITHOUT other psychotic symptoms. Can function apart from delusion. Subtypes - erotomanic, grandiose, jealous, persecutory adn somatic. Tx - anipsychotics adn CBT.

29
Q

What are the diagnsotic criteria for obesity hypoventialtion syndrome?

A

Obese, awake daytime hypercapnia (PaCo2 > 445) leading to alveolar hypoventialtion. Do AB (normal AA gradient), restrictive pattern on PFTs.

30
Q

What are the components of biophysical profile?

A
  1. NST (reactive) 2. AFV (single pocket > 2X1 cm or AFI > 5)3. Fetal mvmt (>3 body mvmts) 4. Fetal tone (>1 episode of flexion/extension) 5. Fetal breathing mvmvts (>1 breathing for > 30 second)
31
Q

What is the treatment for chronic cough with postnasal drip?

A

Oral first gen antihistamine (chlorpheniramine) or combined antihistamine-decongestant (eg, brompheniramine and pseudophedrine)

32
Q

What is a potential complication of bronchiectasis?

A

Hemoptysis

33
Q

What are the symptoms of infective mononucleosis? What are possible complications?

A

Sore throat, fever, malaise, splenomegaly, generalized lymphadenopathy. Complications include autoimmune hemolytic anemia and thrombocytopenia upto 2-3 weeks after initial symptoms.

34
Q

What treatment modality is used for acute exacerbation of COPD?

A

Non positive pressure ventiation before intubation

35
Q

What are teh renal complications of sickle cell trait?

A

Painless hematuria, UTO, renal medullary cancer, renal papillary necrosis

36
Q

Which patients usually get acalculous cholecystitis? What is seen on imaging? Treatment?

A

Critically ill patients. Gallbladder wall thickening and distension and pericholecystic luid. Antibiotics and percutaneous cholecystostomy, followed by cholecystectomy.

37
Q

What is the characteristic of primary dysmenorrhea and how is it treated?

A

Crampy lower-abdominal pain during meses adn normal physical examinaion. NSAIDs and hormonal contraception are generally effective for pain relief.

38
Q

What is the most common cause of bacterial PNA in CF patients 20 year olds?How is it treated?

A

Staph aureus in 20

39
Q

What is the most common cause of PNA in nursing home patients? How is it prevented?

A

Strep pneumonia. Pneumovax vaccine.

40
Q

What is the treatment for acute pyelo patient who has a clear response after IV antibiotics?

A

Switch to oral antibiotics for a toal of 10 - 14 days (Fluoroquinolones and TMP-SMX).

41
Q

What is the characteristic physical and imaging finding in pancreatic tumor of the hear of the pancreas?

A

Weight loss jaundice, nontnder, distended gallbladder on exam. Imaging shows - Intra and extrahepatic biliary tract dilation

42
Q

What is the first intervention for patietns with acute stroke?

A

CT wo contrast

43
Q

What is the treatment of constipation in toddlers transitioning to solid food?

A

Laxative therapy with polyethylene glycol or mineral oil

44
Q

What are the presentation of herpes simplex virus ulcer?

A

multiple small, grouped ulcers with erythematous base, shallow, TENDER lymph nodes

45
Q

What are the presentation of haemophilius ducreyi ulcer?

A

Sinlge or multiple deep ulcers, with irregular/ragged border. Base mmay be friable and have gray/yellow exudate. Mattted lymp nodes.

46
Q

For how long should patients with major depressive disorder continue antidepressants after an acute response to therapy?

A

4 - 9 months

47
Q

What type of risk is reduced with tight glycemic control? What type are NOT reduced?

A

Microvascular complications (retinopathy, nephropathy). Macro vascular like MI and stroke and mortality are not reduced.

48
Q

What is the difference between SBO and Ileus?

A

SBO is old surgery with increased bowel sounds while Ileus is 2/2 recent surgery, hypokalemia or medication induced. Reduced bowel sounds with both small and large bowel dilation

49
Q

What are the symptoms of necrotizing enterocolitis?

A

Increased gastric residual volume, vomiting, abdominal distension. X-ray findings include penumatosis intestinalis (intramural air) and portal venous air.

50
Q

Which types of mutations are most severe?

A

Nonsense and frameshif mutations

51
Q

What is the Aa gradient in hypoventilation and acid base status?

A

Normal A-a gradient adn respiratory acidosis

52
Q

What is the diagnosis for Myasthenia gravis?

A

Edrohonium test, ice pack test. CT can for thymoma

53
Q

What is the cause of torsde de pointes and how is it treated?

A

2/2 acquired or congenital QT interval prolongation. Immediate defibrilaation in hemodynamically unstable and IV magnesium in stable patients.

54
Q

What is the ECG findings in Afib and initial treatment for stable patients?

A

No distinct p waves, irregularly irregular R waves, narrow QRS, atrial rate > 350. Rate control with BB or CCB

55
Q

What are the clinical feature of anaphylactic reaction?

A

Rapid onset of shock, angioedema/urticaria and respiratory distress. Within a few seconds to minutes of transfusion. Caused by recipient anti-IgA antibodies