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hammer5 Flashcards

1
Q

What are the symptoms of renal artery stenosis?

A

Systolic-dyastolic abdominal bruit, HTN, atherosclerosis

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2
Q

Which animals are the most common cause of rabies in humans? What are the clinical features and post exposure ppx?

A

BAts. Hydophobia, aerophobia, pharyngeal spasms, spastic paralysis, agitation. Rabies IG and vaccine immediately after exposure to high risk animal.

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3
Q

What are the symptoms of orbital sinusitis? What is the most common disposing factor?

A

Proptosis, opthalmoplegia, diplopia, pain with eye movements. Bacterial sinusitis is the most common predisposing factor.

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4
Q

What is the CSF finding in GBS syndrome?

A

Elevated protein level with normal cell count

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5
Q

Which form of Ca is physiologically active? What happens to Ca when the extracellular pH is high? when low?

A

Ionized Ca. When pH is high, H+ leaves Albumin and Ca binds in its spot causing a drop in ionized or unbound Ca. When pH is low, H+ goes back to Albumin causing an increased in ionized Ca.

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6
Q

What is heart failure with preserved left ventricular function and what causes it?

A

CHF symptoms with preserved EF. Diastolic hear failure 2/2 HTN, restrictive cardiomyopathy, HOCM

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7
Q

What are the symptoms of renal cell carcinoma and how is it diagnosed?

A
  1. Flank pain, hematuria, palpable abdominal renal mass

2. scrotal varices 3. paraneoplastic symptoms like anemia or erythrocytosis, thrombocytosis, fever, hyperCa. CT abdomen

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8
Q

How do follicular thyroid cancer spread?

A

Inade blood vessels and metastasize to distal organs

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9
Q

What is the cause of Membranoproliferative glomerulonephritis?

A

Caused by IgG antibodies (c# nephritic factor)directed against C3 convertase of alternative complement pathway.

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10
Q

What are the symptoms of carcinoid syndrome? How is it diagnosed?

A

Episodic flushing, secretory diarrhea, wheezing and tricuzpid murmur regurgitation 2/2 plaque deposits on the right side. Elevated 24 hour urinary 5-hydroxyindoleacetic acid

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11
Q

What are the target blood glucose levels in gestational diabetes? Treatments? When is it tested?

A

Between 24 and 28 weeks. Ingest 50 g and measure within 1 hour or give 100 g and measture for teh first three hours for glucose tolerance. Fasting >95 and 1 hour > 140. Insulin, metformin, glyburide.

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12
Q

What are the signs of a large hemothorax?

A

Hemorrhagic shock with decreased breath sounds and dullness to percussion over one hemithorax and contralateral tracheal deviation 2/2 large ipsilateral hemothorax

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13
Q

What are the presentations of neonatal sepsis? What is the managment?

A

Poor feeding, lethargy, temperature instability. Cultures for blood, urine and CSF BEFORE abx.

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14
Q

What is the symptom of patellofemoral pain syndorome? What causes it and how is it treated?

A

Anterior knee pain in young women 2/2 chronic overuse adn malalignment. Patellofemoral compression produces pain. Initial management includes modification, NSAID, stretching and strengthening exercises.

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15
Q

What is the initial evaluation for Cushing syndrome? What is the next step once hypercortisolism is confirmed?

A

late night cortisol assay, 24 hour urine free cortisol measurement or overnight low-dose dexamethasone suppression test.
ACTH levels are then measured to differentiate ACTH dependent from ACTH independent cause

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16
Q

What is the only requirement for hospice admission?

A

prognosis of less than 6 months

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17
Q

What do you do with a traumatically amputated finger?

A

Put in saline moistened gauze, palce bag on a bed of ice and bring it with patient to the ED

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18
Q

What value is increased in patients with gall stone pancreatitis and what is the intervention?

A

Elevated alanine aminotransferase > 150. Early cholecystectomy

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19
Q

When can you do external cephalic version? When is it contraindicated?

A

Breech presentation > 37 weeks. Contraindicated - placental abnormalitis, oligohydraminios, ruptured membranes, hyperextended fetal head, fetal or uterine anomaly, multiple gestation

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20
Q

What causes serum sickness like reactions? What causes it? What type of hypersensitivity? What is seen on laps?

A

Fever, urticarial rash, arthralgia and lymphadenopathy 1-2 weeks after exposure to beta lactams like penicillin and sulfa drugs. Type 3 hypersenitivity. Low complement and elevated ESR

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21
Q

What are the facial features of fetal alcohol syndrome? What are the facial features of down syndrome?

A

FAS - smooth philtrum, thin vermilion border, small palpebral fissures, microcepaly
DS - flat facial profile, slanted palpebral fissures, small low set ears

22
Q

Where is pain localized in the per anserinus pain syndrome? What do x rays look like?

A

Sharp localized pain and tenderness over the anteromedial part of tibial plateau just below the joint line of the knee. X-rays will appear normal

23
Q

What is the acid-base status after a tonic clonic seizure? What causes it?

A

Respiratory acidosis 2/2 hypoventilation. There is hypercarbia and elevated serum bicarbonate

24
Q

At what ages are meningococcal vaccination given? Which patients are high risk?

A

11 - 12 adn booster at 16. Military recruits, college students living in dorms and travelers to sub-Saharan Africa

25
Q

What is the presentation of Aortic dissection? How is it diagnosed in unstable patient? In stable patient?

A

Sudden severe chest pain radiating to the back, decrescendo diastolic murmmur, elevated creatinine, pulse difference of > 20 b/n R and L . TEE for unstable, CTA for stable. If severe kidney insufficiency, avoid CTA/MRA

26
Q

What are the exam findings in Ankylosing spondylitis? What are complicationsAnkylosing spondylitis?

A

Arthritis (sacroilitis), reduced chest expansion and spinal mobility, enthesitis (tenderness at tendon insetion sites), dactylitits, uveitis.

27
Q

What are complicationsAnkylosing spondylitis?

A

Complications - osteoporosis/vertebral fractures 2/2 increased osteoclast activitiy, aortic regurgitation, cauda equina

28
Q

What are the symptoms of Multiple myeloma? How is it screened adn diagnosed?

A

Bone pain, osteolytic lesions on X-ray. Screeingn with serum protein electrophoresis, urine protein electrophoresis, free light chain analysis. Diagnosed with bone marrow biopsy

29
Q

What are the signs of pancreatic laceration after BAT? can you pick it up on CT immediately?

A

fever, chills, deep abdominal pain suggesting a retroperitoneal abcess. No

30
Q

What are the signs of splenic rupture? Can you pick it up on CT after BAT/

A

LUQ pain and hypotension. No signs of sepsis and can be picked up on CT.

31
Q

What is common cause of low back pain during third trimester of pregnancy?

A

Increase in lumbar lordosis and relaxation of ligaments supporting the joints of the pelvic girdle

32
Q

What are the causes of non bullous Impetigo? Bullous impetigo?

A

S. aureurs and Group a strep (S pyogenes). S. aureus for bullous impetigo.

33
Q

What is the clinical feature of non bullous impetigo?

A

Painful non-pruritic pustules and honey crusted lesions

34
Q

What is the clinical feature of bullous impetigo?

A

Rapidly enlarging flaccid bullae with yellow fluid and collarette of scale at periphery of ruptured lesions

35
Q

How is impetigo treated?

A

Topical abx (mupirocin) if limited skin involvement and oral abx (Cephalexin, dicloxacillin, clindamycin) for extensive skin involvement

36
Q

What is the most common cause of congenital hypothyroidism?

A

Thyroid dysgenesis

37
Q

What lab abnormalities does Trimethoprim cause? How?

A

Hyperkalemia 2/2 blockade of epithelial sodium channel in the collecting tubule. Increased Creatinine 2/2 inhbition of renal tubular creatinine clearance without affecting GFR

38
Q

What is the criteria for PCOS diagnosis? What is the treatment?

A

> 2/3 of 1. Androgen excess 2. Oligo/anovulation 3. Polycystic ovaries on US. Tx - First line is Weight loss, OCPS. If there is DM2, Metformin. If ovulation is desired - Clomiphene citrate

39
Q

What are the symptoms of Echinococcus infection? Which layer gives rise to daughter cysts? Which animals are the definite hosts and which are intermediate hosts?

A

Hydatid cysts mostly nin liver (2/3) and lungs (1/4). Dogs are definite hosts and sheep are intermediate hosts. The inner germinal layer.

40
Q

Which risk factor has the highest associated rate of AAA expansion and rupture? What are the indications for repair?

A

Cigarette smoking. Aneurysm > 5.5 cm, rapid rate of expansion (> 0.5 cm in 6 months or 1 cm per year) and presence of symptoms regardless of aneurysm size.

41
Q

What are the clinical features of TSS? What is seen on labs?

A

Fever, hypotension, diffuse erythematous macular rash and multi system involvement liek GI, low platelets, IMMATURE Neutrophils (bands).

42
Q

What is the presentation of influenza? What organism is implicated in post influenza PNA?

A

Fever, myalgia, rhinorrhea, dry cough that remits after treatment. Staph aureus

43
Q

Which anticoagulation is favored in patients with renal insufficiency? Which anticoagulation is NOT favored in patients with renal insufficiency?

A

Unfractionated Heparin. Rivaroxaban, fondaparinaux, enoxaparin are not recommended for renal insufficiency.

44
Q

What are the causes and the signs/symptoms of myasthenic crisis? What is the treatment/

A

Infection, sergury and meds. Increased generalized and oropharyngeal weakness. Plasmapheresis or IVIG, and corticosteroids

45
Q

What are the features of essential tremor? What is it releaved by?

A

B/l action tremor of hands w/o leg involvement, possibly isolated head tremor w/o dystonia. Relived with EtOH. Treated by propranolol, or primidone and topiramate.

46
Q

What are the features of Parkinson tremor?

A

Resting tremor that decreases with movement.Usually involves legs and hands.

47
Q

What are the features of cerebellar tremor?

A

Associated with ataxia, dysmetria or gait disorder. Tremor increases steadily as hand reaches its target.

48
Q

What is the presentation of metatarsus adductus?

A

Foot deformity showing adduction of anterior aspect of foot with a convex lateral border and concave medial border, increased angle between 1st and 2nd metatarsus. Active movement of foot over-corrects the deformity into abduction.

49
Q

What is pulsus paradoxus? When does it occur?

A

Exaggerated drop in BP > 10 mmHg during inspiration. Cardiac tamponade, severe asthma exacerbation, COPD

50
Q

What is the mechanism of statins in reducing cholesterol and causing myopathy?

A

Inhibit HMG-CoA reductase which is a rate-limiting enzyme in the intracellular biosynthesis of cholesterol that converts HMG-CoA to mevalonate. This increases the # of LDL receptors on liver cell membranes. Myopathy 2/2 to decrease coenzyme Q10 synthesis

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