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hammer31 Flashcards

1
Q

What are the findings and treatment in ethylene glycol toxicity?

A

Hypocalcemia, Elevated BUN/Creatinine, Urine fluorescence under Wood’s Lamp, Elevated Anion gap. Fomepizole to block alcohol dehydrogenase so toxic metabolites are not produced or IV Ethanol if its not available.

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2
Q

What is the valve area in severe vs moderate AS?

A

Severe < 1 cm2, Moderate 1 -1 .5 cm2. Asymptomatic severe AS can get surgery.

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3
Q

What is seen in biopsy in polymyositis? Which markers are elevated?

A

CD8 positive T lymphocytes with no amyloid inclusion bodies. Anti-histydl tRNA synthetase (Jo-1),

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4
Q

What has to be ruled out before reporting to Child protective services when patient has retinal hemorhages and ecchymosis?

A

Bleeding disorders

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5
Q

What is the LFT and HR status in Legionnaires disease?

A

Abnormal LFTs and bradycardia are present in Legionnaires

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6
Q

What is the best early indicator for diabetic nephropathy?

A

Albuminuria

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7
Q

What is the history of diabetic nephropathy?

A

Stage 1 - Hyperfunction and hypertrophy (glomerular hyperfiltration)
Stage 2 - Silent Stage - Thickened BM, expanded masangium
Stage 3 - Insipeinet stage - Microalbuminuria
Stage 4 - Overt diabetic nephropathy - Macroalbuminuria
Stage 5 - Uremic - ESRD

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8
Q

What are the findings in anterior non granulmatous uveitis?

A

Unilateral eye pain, photofobia, decreased eye vision in affected eye. Small keratic precipitates and no iris nodules unlike granulomatous type. Also associated wiht inflammaotory disease like IBD, Behcet, Lyme etc

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9
Q

What are the findings and next steps in suspected cryptococcal meningitis patients?

A

Increased ICP and high opening pressure on LP. India ink is positive in 50-75%, but CSF cryptococcal antigen is more sensitive.

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10
Q

What are the thyroid lab findings in exogenous use?

A

Low (TSH, uptake, thyroglobulin)

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11
Q

What is the presentation and treatment of Tullaremia?

A

Francisella tularensis. Wild rabbits. Fever, ulceration, regional lymph node enlargment and necrosis. Streptomycin.

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12
Q

What are findings in leukemoid recation?

A

Profound leukocytosis (>50000)and elevated Leukoctye alkaline phosphatase

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13
Q

What is the Ca level in severe hypercalcemia nad what should be administered?

A

>

  1. IV fluids, Calcitonin, bisphosphonates
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14
Q

Which antibody is more specific for Sjogren syndrome?

A

anti La/SSB

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15
Q

What is the presentation of lichen simplex chronicus? Stasis dermatitis?

A

dyspigmented, thickened skin 2/2 scratching or bites.

Erythema, pruritis, hyperpigmentation, over medial ankle 2/2 venous insufficiency

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16
Q

What are lab findings in HSP?

A

Hematuria, but platelets are normal.

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17
Q

What are the diagnostic findings of CLL?

A

Leukocytosis with 80 - 90 % lymphocytes (>5000), smudge cells, CD 5 and CD 19 on flow cytometry.

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18
Q

What are the 5 stages and treatment for CLL?

A

Stage 0 - lymphocytisis
Stage 1 - lymphocytosis plus lymphadenopathy
Stage 2 lymphocytosis with splenomeglay/hepatomegaly
Stage 3 - lymphocytosis with anemia
Stage 4 - lymphocytosis and thrombocytopenia
Stage 0 and 1 no treament, other stages Fludirabine. Allogenic stem cell transplant is the only curative form but there are age restrictions so most patients do not qualify

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19
Q

What are findings and treatmetn of necrotizing fascitis?

A

WBC elevated, CPK elevated, bullae ,immobility, toxic looking patient. Air in tissue or necrosis.Surgical debridement and beta lactam/lactamase abx.

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20
Q

What is the gold standard for diagnosing urinary incontinence?

A

Urodynamic studies (cystometry) to look at bladder capacity, detrusor contractilty, voiding ability

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21
Q

What is the management of uncomplicated pyelonephritis?

A

IV abx for 24-48 hours until fever defervesance then d/c on oral antibiotics for two weeks. If fever doesnt resolve or infection with unusual organism or rapid relapse do imaging studies to r/o anatomical abnormalities

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22
Q

What is the initial treatment for hyperosmolar hyperglycemic state?

A

Half NS with potassium if K < 3.3. If K is > 5.3, start with IV insulin

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23
Q

How do Cushing syndrome cause hypercoagulability leading to DVTs?

A

Increase vWF and Factor VIII

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24
Q

What is the criteria for implantable cardiac defibrillator in HOCM patients?

A 
History of sudden cardiac arrest of ventricular tachycardia in good prognosis patients or
2 or more of the following risk factrs
1. Family history of cardiac death
2. syncope
3. asymptomatic non sustained vtach
4. abnormal BP to exercise
5. massive LVH
25
Q

What are symptoms of a manic episode?

A

Manic Episode: 1 week period of elevated or irritable mood with 4 or more of (mnemonic GST PAID)

Grandiose thoughts
Sleep, decreased need for
Talkative
Pleasurable activities with Painful consequences (gambling, spending lots of money, having lots of sex)
Activity increased
Ideas (flight of)
Distractability
26
Q

What is acanthosis nigricans associated with?

A

Obesity, insulin resistance, T2DM, gastric cancer

27
Q

What is the findings in JC virus? Treatment?

A

Demyelination in white matter with signs such as diplopia, ataxic gait, ams. HAART therapy

28
Q

How do you differentiate between acquired and congenital hemophilia?

A

Plasma mixing study (PTT corrects in congenital and doesn’t in acquired)

29
Q

What is the best initial test to diagnose GBS?

A

CSF analysis showing elevated protein. Electrophysiology and Electroconduction test are sensitive and specific

30
Q

What is the pathophysiology of adenosine deaminase deficiency?

A

Defienct enzyme leads to high levels of dATP which affects DNA synthesis particularly B and T cells. Absent thymic shadow and bony abnormalities.

31
Q

What is the most common cause of HTN in children?

A

Renovascular disease

32
Q

Which patients are recommended to get Neisseria meningitidis vaccination?

A

Adolescents 11 to 18, adults - military recruites, terminal complement deficiency, asplenic patietns, travel to endemic areas (Sub saharan Africa)

33
Q

How long does lochia last and what is the progression?

A

6 to 8 weeks. Bright red to pinkish-brown to whitish-yellow (lochia rubra - serosa-alba)

34
Q

What are the findings of acute tubular necrosis?

A

Rising BUN and creatinine levels with normal BUN:Creatinine (15:1), oliguria, high urine sodium. Granular and epithelial cast in the urine.

35
Q

What is the treatment for supraventricular tachycardia when adenosine doesn’t work?

A

Betablocker (unless asthmatic or CCB like Diltiazam)

36
Q

What mess should you also check when working our hypoglycemia?

A

Sulfonylurea and meglitinide

37
Q

What is the presentation and w/u of optic neuritis?

A

Loss of vision, eye movement pain, central scotoma, loss of color vision, afferent pupillary defect, inflammation of optic nerve with flame hemorrhages. Do MRI to exclude MS

38
Q

What is a known complication of AAA repair and presentation? Next step?

A

Ischemic colitis 2/2 IMA occlusion presenting with bloddy diarrhea and leukocytosis. Do colonoscopy or flex sigmoidoscopy

39
Q

Where is Zencker’s diverticulum located?

A

Above the upper esophageal sphincter.

40
Q

Which types of shock have elevated SVR? decreased SVR?

A

Hypovolemic and cardiogenic. Neurogenic and Septic

41
Q

What is the p/d/t of Donovanosis?

A

Painless, ulcerated lesions with beefy red granulation tissue and clean, sharp edges. Klebsiella granulomatosis. Intracellular cystic lesions in mononuclear cells. TMP/SMX or doxycyline

42
Q

What type of lung calcifications are concerning for malignancy?

A

Stippled or assymetric with irregular borders. Popcorn calcififcations are benign.

43
Q

What is sebhorric dermatitis and what disease are associated with it?

A

Waxy and red lesions in face, scalp and chest. Parkinsons and HIV.

44
Q

What levels of phosphate require treatment and how is it treatmed?

A

> 5, and binds free Ca and decreases Vitamin D leading to hypocalcemia. Since kidney excreted, P accumulates if there are kidney problems and exacerbated hypocalcemia. Oral phosphate binders, calcium acetate and calcium carbonate

45
Q

What are the T score ranges?

A

A T-score of -2.5 or lower qualifies as osteoporosis. A T-score of -1.0 to -2.5 signifies osteopenia, meaning below-normal bone density without full osteoporosis.

46
Q

What is the presentaiton and pathophysiology of ichtyosis vulgaris?

A

AD defect in profilaggrin, generalized fine white scale that spares flexures as well as keratoses. Looks like fisk scale

47
Q

What is the presentation of atypical (dysplastic melanocytic) nevi?

A

> 100 nevi, different colors, > 5mm, irregular borders. Serial monitoring with photographs every 6 months.

48
Q

What is the first step in mgmt of congenital diaphragmatic hernia?

A

NG tube suction and immediate intubation

49
Q

What is the treatment of rheumatic fever with elevated ASO?

A

Penicillin and Aspirin

50
Q

What is the pther name for Eczema herpeticum?

A

Kaposi varicelliform eruption

51
Q

Which lesion is coarctation of aorta associated with?

A

Aortic stenosis 2/2 bicuspid aortic valve.

52
Q

What medication reduces prostate size in BPH?

A

Finasteride

53
Q

Which viruses are associated with Bell’s palsy?

A

HSV, Epstein Barr, Lyme

54
Q

What should be given to hypothyroid patients prior to stressors such as surgery?

A

Steroids

55
Q

What are diagnostic features of neurofibromatosis 1?

A

Freckles, seizures, lisch nodules, optic gliomas, long bone lesion

56
Q

What are diagnostic features of tuberous sclerosis?

A

Cardiac rhabdomyomas, ash green spots, shagreen patches

57
Q

What should be done in the treatment of Lyme disease with CNS involvement such as facial droop?

A

Do LP first to determine extent as it determines treatment

58
Q

What should you consider in an infant who develops obstructive hydrocephalus?

A

Germinal matrix hemorrhages, highly vascularized structires that can obstruct teh ventricles.

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