hammer4 Flashcards
What are the lung findings of patients with pleural effusion?
Decreased breath sounds, decreased tactile fremitus, dullness to percussion. Shift away from mediastinum
What are the lung findings of patients with lobar pneumonia with consolidation?
Increased breath sounds, increased tactile fremitus, dullness to percussion. No Shift from mediastinum
What is the hallmark damage in status epilipticus and other prolonged seizures? What is the pathophysiology?
Cortical laminar necrosis due to excitatory cytotoxicity
What are the risk factors for toxic megacolon? How is it diagnosed? Management?
IBD or C diff infection. Dx - systemic toxicity, bloody diarrhea, abdominal distension/peritonitis, marked distension of abdominal imaging. Mgmt - Bowel rest, NG suction, abx. +/- corticosteroids id IBD-associated.
When is the onset of gonococcal conjuctivitis? What are the symptoms and treatment?
2 - 5 days. Marked eye swelling, profuse purulent discharge, corneal edema/ulceration. IV/IM CTX or Cefotaxime
When is the onset of chlamidyal conjuctivitis? What are the symptoms and treatment?
5 - 14 days. Eyelid swelling; chemosis; watery, BLOODY, or mucopurulent eye discharge. Oral erythromycin.
How does NSAID cause hyperkalemia? What about K+ sparing diuretics like Amilioride?
Impaired local prostaglandin synthesis reduces renin and aldosterone secretion. Block the epithelial sodium channel or aldosterone receptor
What is the mechanism of Heparin induced thrombocytopenia and what does it lead to?
Conformational change in platelet surface antigen (platelet factor 4), forms IgG antibody that coats platelets causing thrombocytopenia 2/2 macrophage consumption and thrombus formation (arterial and venous after platelet activation)
What is sialadenosis and what causes it?
Benign, non inflammatory enlargement of the salivary glands. Seen in patients with advanced liver disease (alcoholics) as well as a variety of dietary and nutritional disorders.
What is the etiology of ascites with SAAg > 1.1? SAAG
SAAG > 1.1 indicates polar hypertension (cardiac ascites, cirrhosis) while SAAG
What is unique about a crossectional study?
Snap shot study that looks at both outcome and exposure
What is the presentation of obstructive uropathy 2/2 nephroctomy for example?
Flank pain, low voids with periods of high voids
What are the clinicial features of CLL? How is it diagnosed? What is a major complication?
Lymphadenopathy, Hepatosplenomegaly, Mild Thrombocytopenia and anemia. Severe lymphocytosis and smudge cells and flow cytometry showing clonality of mature B cells. No Bx. Infection.
What type of amnesia is associated with isolated impairment of autobiographhical memory? What is it characterized by?
Dissociative amnesia characterized by travelling or wandering in a dissociated state
What is the presentation of choriocarcinoma? Where does it usually spread to? What is seen on x-ray and how is disease diagnosed?
Irregular vaginal bleeding, enlarged uterus, pelvic pain. Irregular bleeding past 8 weeks. Mets to the lungs showing worsening pulmonary function and even hemoptysis. Multiple nodules on the lungs on CXR. Measure quantitative Bhcg.
What and where is the most common location of pediatric brain tumors? What symptoms are associated with a supratentorial tumor? What is the second most common tumor and where?
CNS tumors, astrocytoma. Seizure, weakness, sensory changes. Medulooblastoma in posterior fossa, arise from cerebellar vermis and present with vomiting, headaches and ataxia.
What complications are associated with a pneumothorax?
HYPOtension, tachycardia, absent breath sounds, JVP
What causes cyanide toxicity and what are the symptoms?
Treatment with nitroprusside especially in people with underlying renal insufficiency. AMS, lactic acidosis, seizures, coma
What class of drugs is Buproprion and when is it contraindicated?
NDRI, prior hx. of seizures, bulimia, anorexia
What symptoms are associated with acute-angle closure glaucoma?
Severe eye pain, halos, dilated pupils and poor response to light, unilateral orbitofrontal headache, unilateral eye pain with conjuctival injection
What is the most common etiology of urethritis in men ? What caused it if you can’t see it on gram culture and how would you diagnose it?
Neisseria gonorrhoeae. Chlamidya tracomatis. Nucleic acid amplification test on first catch urine sample w/o precleaning.
What is pseudocyesis?
Psychiatric illness where the patient presents with nearly all signs and symptoms of pregnancy with negative US and negative pregnancy test
What is the most common cause of conductive hearing loss in 20s and 30 year olds? What will Weber test show?
Otosclerosis. Laterizes to the affected ear when fork is placed in midline
What is the presentation of an infant with galactosemia? What enzyme is deficiency?
Failure to thrive, Bilateral cataracts, jaundice, hypoglycemia. Galactose-1-phosphate uridyl transferase deficiency.
What is the management of nephrolithiasis?
- CT abdomen w/o contrast
- NSAIDS or narcotics
- IF stone 2L/day to let it pass
- Urology if complications happen
What is a usual cause of HACEK related infections like Kingella, E. Corrodens?
Poor dental conditions
What are potential side effects of loop diuretics?
Hypokalemia, metabolic alkalosis, prerenal kidney injury (Na-K2-Cl inhibitors)
What is the presentation of supra valvular aortic stenosis? How do patients present?
Congenital left ventricular outflow obstruction - murmur best heard on the Right intercostal space higher than where AS murmur is heard. Unequal carotid pulses, differential blood pressures, palpable thrill in the suprasternal notch
What are the symptoms of opioid withdrawal for neonates?
High pitched cry, poor sleeping, tremors, seizures, sweating, SNEEzing, tachypnea, poor feeding, vomiting, diarrhea
What are the CSF findings of viral meningitis ?Which viruses are common causes in children?
WBC (100-1000) and protein
What meds are known to improve long-term survivial in patients with left ventricular systolic dysfunction? How about in AA?
BB, ACEi, ARBs, Mineralocorticoid receptor antagonists (Spirnoclactone) and in AA (hydralazine and nitrates)
What is the prognosis of constitutional growth delay?
Normal prognosis, presents with delayed growth spurt, delayed puberty and delayed bone age.
What are the findings in pseudogout? How is it treated?
Calcium PyroPhosphate Dihydrate crystals, chondrocalcinosis, inflammatory effusion (15,000 - 30,000), Intraarticular glucoocrticoids, NSAIDS, colchicine
What is the first step in evaluating a thyroid nodule?
Clinical evaluation, TSH level, US.
What is the next step if TSH is either normal or elevated in a thyroid nodule? What is the next step if TSH is low in a thyroid nodule?
FNA. If low, do Iodine 123 scintigraphy. Hot nodules get treated, cold nodules (hypofunctional) get FNA
What is the presentation of hemolytic uremic syndrome (HUS)? What are the lab findings?
Diarrhea (bloody often), Lethargy, Bruising or petichiae, Oliguria, edema.
Labs - Hemolytic anemia, thrombocytopenia, increased creatinine, hematuria, proteinuria, casts, increased bilirubin
What are the late manifestations of lyme disease?
Arthritis and neurologic (encephalomyelitis, peripheral neuropathy)
What are the manifestations of early disseminated lyme disease?
AV clock, CN VII neurologic manifestations, migratory arthlafias, conjuctivitis, multiple erythema migrans
What are treatment options for pediatric strabismus and when is it abnormal?
Before 4 months. Penalization therapy using cycloplegic drops to blur normal eye or occlusion therapy of normal eye via patch.
Which microorganisms cause alkaline urine?
Proteus, Klebsiella, Pseudomonas, Ureaplasma, Staph
How does splenic trauma present? What is the imaging modality for splenic trauma?
Delayed onset hypotension, LUQ abdominal pain, left shoulder pain. CT abdomen with IV contrast
What is the AA gradient in PE?
Elevated b/c it is a V/Q mismatch
What is the most common cause of iron deficiecny in the elderly? What is the next step?
GI blood loss. Colonoscopy and endoscopy even if FOBT is negative
What is the clinical presentation of VIPoma? What are lab findings? How is it diagnosed?
Watery diarrhea (pancreatic cholera), hypo or achlorhydria due to decreased gastric acid secretion ,associated flushing, lethargy, muscle weakness/cramps. Hypokalemia 2/2 intestinal potassium secretion, Hyper (calcemia and glycemia). Abdominal CT/MRI to localize tumor in pancreas
How is overexpression of the oncogene HER2 detected?
Immunohistochemical staining or FISH. Heps determine response to transtuzumab
What is the workup of ventilator associated PNA?
CXR, gram stain and culture if abnormal, empiric antibiotics (Gram positives, anti-pseudomonals, MRSA coverage)
How is proteinuria evaluated in preeclampsia?
Urine protein-to-creatinine ratio or a 24 hour urine collection for total protein (gold standard)
What is the pathophysiology of allergic contact dermatitis? How does it appear?
Type IV hypersensitivity, primarily on exposed skin and appears well demarcated
