hammer30 Flashcards
What are the electrolyte abnormalities in RTA4? What is the etiology?
Hyponatrima, hyperkalemia, hypercholeremia, non anion gap metabolic acidosis. DIabetes, primary adrenal insufficiency, renal insuficiency and NSAIDS
What is the presentation and most common etiology of SVC syndrome?
Dyspnea and edema of upper face, neck ,chest. Lung cancer
Which antibody is specific for dermatomyositis?
Anti Jo 1
What are the findings in acalculos cholecystitis? What are risk factors?
New onset RUQ pain, elevated WBC, Elevated LFTs (elevated alk phos). Long illness and TPN
Which patients have germinal matrix hemorrhage?
Premature infants with hydrocephalus
What do you use to treat GBS in patients allergic to penicillinanaphylacticaly?
Vancomycin. If mild allergy, use Cefazolin
What should you suspect when Ca levels drop rapidly after parathyroidectomy?
Hungry bone syndrome (metabolic)
What is the most common cardiac defect in infants of diabetic mothers?
Asymmetric septal hypertrophy presenting with low BP, weak pulse, prolonged cap refill. Will improve byitself
What is first and second line treatment of hyperemesis gravidum (HEG)?
Pyridoxine-doxylamine. Promethazine and/or ondansetron.
What is the presentation of femoral pseudoaneurysm?
Cool lower extremities, absent DP pulses, pulsatile groin mass usually after femoral catheterization
What should you worry about in silicosis patients?
30X risk of TB
What is the first step after discovering prolactinoma?
MRI to assess tumor
What is the first step after discovering gastroparesis?
ENdoscopy
What is the histologic presentation and elevated markers of embyonic carcinoma?
Sheets of undifferentiated cells with scant cytoplasm, indistinct cell borders, crowded nuclei, Elevated serum AFP
What is the histologic presentation and elevated markers of choriocarcinoma?
Cytotrophoblastic and syncitiotrophoblastic cells resembling papillary villi. Serum bHCG
What is the histologic presentation and elevated markers of seminoma?
Large round clear cells with centrally placed nuclei and obvious nucleoli resembling primary spermatocytes. placental alkaline phosphatase
What is the histologic presentation and elevated markers of yolk sac carcinoma?
Looks like glomeruli (Schiller Duval bodies)
What is the treatment for patients with hyperkalemia and EKG changes?
IV calcium gluconate
What is the first step in managing patients with acute pulmonary edema?
100% Oxygen
What is the presentation of acute laryngotracheobronchitis (viral croup)
<3 yo, barking cough, inspiratory stridor
What is the treatment of PID in pregnant women?
IV clindamycin and gentamycin
What prophylaxis for malaria to Africa travellers?
Mefloquine (contraindicated in cardiac and neuropsychiatric patients) or doxycycline.
What vaccines for COPD patients?
Pneumococcal and influenza vaccine
When do you attempt external cephalic version?
Breech presentation after 36 weeks
Treatment for acute COPD exacerbation?
Systemic steroids, inhaled albuterol and ipratropium, antibiotics against Strep and HIB
What is the treatment for emphysematous cholecysttis which can also reflect sound waves 2/2 air presence?
Chloecystectomy followed by IV ciprofloxacin and metronidazole
What is the imaging modality of choice in AAA in an obese patient or patient with bowel gas?
Abdominal CT with contrast
What are the indications for hemodyalysis?
Potassium > 6.5, profound metabolic acidosis < 7.1, signs of uremia, ams, pericarditis, refractory fluid overload
What are the symptoms of Pyridoxine (Vitamin B6 deficiency) and what hematologic disorder is it associated with?
Glossitis, angular chelitis, peripheral neuropathy, sideroblastic anemia with low MCV and high serum ferritin. Myelodysplastic syndrome.
What are the findings of IgA heavy chain type disease? What is seen in serum electrophoresisi?
Abdominal mass and malabsorption syndomre. Decreased gamma and broad alpha 2 and beta chains.
Which class of BP medications are useful in treating patients with multiple BP risk factors who are undergoing non cardiac surgery?
Betablockers particularly (which is mied alpha and beta blocker) labetalol
What are the findings of membranous nephropathy in imaging? Most common etiologies?
subepithelial intramembranous IgG and C3 deposits. Chronic infections and drugs.
What are the findings of membranoproliferative glomerulonephritis? Which is common etiology?
Thickened basement membrane with dense deposits and mesangial cell proliferation. Classic train track and Hep C.
When does a dirty wound require a tetanus vaccine?
If last one was more than 5 years ago. If it is clean, can wait upto 10 years.
What is the recommnede surveillance in ulcerative colitis patients?
Annual Colonoscopy with multiple biopsies starting 8 years from diagnosis
What is the presentation of Whipple disease and treatment?
Diarrhea, arthralgia, endocarditis, CNS dysfunction. Penicillin, ampicillin, TMP/SMX or doxycylcine
What are EKG findings of supraventricular tachycardia? Treatment steps?
Sinus Tachy > 100 and P waves before QRS complexes. 1. Vagal maneuvers such as Carotid massage (contraindicated if b/l carotid stenosis) .2 Valsalva 3. Drug therapy
What are presenting symptoms and signs of good prognosis in juvenile rheumatoid arthritis?
Morning stiffness, joint pain and lethargy. Positive Anti Nuclear Antibody
What is the treatment for infants with poorly formed loose stools?
May have low bile acids 2/2 excretion in stool. Use MC triglycerides instead of long chain because they don’t require bile for absorption
What are the two common sites for endometriosis?
Ovaries followed by cul-de-sac
What is the presentation adn treatmetn of nevus sebaceous?
Hamartomatous warty area on scalp . Excise at early age 2/2 malignancy concerns
What is the best initial test in subclavian steal syndrome?
Measure BP in both arms b/c there is a 15 - 20 mm Hg difference. There are also neurologic signs since the subclavian steals from the vertebral artery.
What is the presentation of polyarteritis nodosa? What diseases is it associated with?
Constitutional symptoms, arthritis, abdominal pain worsened by eating, CNS changes, skin nodules. Spares lungs. Bx shows focal necrotizing arteritis. Hepatitis B and C.
What is second line treatmetn for animal bites?
Clindamycin plus (doxicycline or fluoroquinoone or TMP/SMX)
Which infections are associated with Reiter’s syndrome?
Chalmidya, Yersinia, Salmonella, Shigella, Campylobacter. Treat underlying infection particularly Chlamidya with doxycycline.
What is the characteristics and treatmetn of ALS?
Upper (motor cranial nuclei) and lower (anterior horn cells of spinal cord) motor neuron deficits. Riluzole
What test is done in patietns with coronary disease if the baseline EKG has abnormalities?
Stress echo or exercise thallium test
How do hepatic adenomas appear on sulfur colloid liver scan? Why? How many of turn malignant?
Appear Cold because of lack of Kuppfer cells. 10-15%. Rupture has 20% mortality rate.
What are risk factors for cholangiocarcinoma?
PSC, chronic parasitic infections, IBD especially UC, chronic cholecystitis, chronic pyogenic cholangitis
What is the initial treatmetn for ankylosing spondylitis?
NSAIDS such as Indomethacin. TNF alpha antagonists (Etanercept, Inflximab, aldalimumab) are used in advanced disease
What is the difference between moderate and severe placental abruption?
Moderate - fetal tachycardia, decreased variability, mild/late decelerations, moderate bleeding
Severe - knife like uterine pain with severe bradycardia, severe late deceleration, or fetal death. DIC in 10 - 20 % of cases.
What is the initial treatment and EKG finding for Wolf Parkinson White?
Procainamide or Amiodarone. Short PR, delta wave and wide QRS.
What are the hormone abnormalities in Klinefelter syndomre?
Low testosterone, increased FSH and LH
What is a subsitiute med if there is HIT?
Lepiuridin
What are common symptoms in order of frequency in Premenstrual dysphoric disorder?
- Bloating 2. Breast tenderness 3. Headaches
What is the workup of asymptomatic hematochezia in a person < 45 years?
Ansocopy and flexible sigmoidoscopy because source is usually distant colon, rectum or anus
