hammer5 Flashcards
What are the symptoms of renal artery stenosis?
Systolic-dyastolic abdominal bruit, HTN, atherosclerosis
Which animals are the most common cause of rabies in humans? What are the clinical features and post exposure ppx?
BAts. Hydophobia, aerophobia, pharyngeal spasms, spastic paralysis, agitation. Rabies IG and vaccine immediately after exposure to high risk animal.
What are the symptoms of orbital sinusitis? What is the most common disposing factor?
Proptosis, opthalmoplegia, diplopia, pain with eye movements. Bacterial sinusitis is the most common predisposing factor.
What is the CSF finding in GBS syndrome?
Elevated protein level with normal cell count
Which form of Ca is physiologically active? What happens to Ca when the extracellular pH is high? when low?
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.
What is heart failure with preserved left ventricular function and what causes it?
CHF symptoms with preserved EF. Diastolic hear failure 2/2 HTN, restrictive cardiomyopathy, HOCM
What are the symptoms of renal cell carcinoma and how is it diagnosed?
- Flank pain, hematuria, palpable abdominal renal mass
2. scrotal varices 3. paraneoplastic symptoms like anemia or erythrocytosis, thrombocytosis, fever, hyperCa. CT abdomen
How do follicular thyroid cancer spread?
Inade blood vessels and metastasize to distal organs
What is the cause of Membranoproliferative glomerulonephritis?
Caused by IgG antibodies (c# nephritic factor)directed against C3 convertase of alternative complement pathway.
What are the symptoms of carcinoid syndrome? How is it diagnosed?
Episodic flushing, secretory diarrhea, wheezing and tricuzpid murmur regurgitation 2/2 plaque deposits on the right side. Elevated 24 hour urinary 5-hydroxyindoleacetic acid
What are the target blood glucose levels in gestational diabetes? Treatments? When is it tested?
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.
What are the signs of a large hemothorax?
Hemorrhagic shock with decreased breath sounds and dullness to percussion over one hemithorax and contralateral tracheal deviation 2/2 large ipsilateral hemothorax
What are the presentations of neonatal sepsis? What is the managment?
Poor feeding, lethargy, temperature instability. Cultures for blood, urine and CSF BEFORE abx.
What is the symptom of patellofemoral pain syndorome? What causes it and how is it treated?
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.
What is the initial evaluation for Cushing syndrome? What is the next step once hypercortisolism is confirmed?
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
What is the only requirement for hospice admission?
prognosis of less than 6 months
What do you do with a traumatically amputated finger?
Put in saline moistened gauze, palce bag on a bed of ice and bring it with patient to the ED
What value is increased in patients with gall stone pancreatitis and what is the intervention?
Elevated alanine aminotransferase > 150. Early cholecystectomy
When can you do external cephalic version? When is it contraindicated?
Breech presentation > 37 weeks. Contraindicated - placental abnormalitis, oligohydraminios, ruptured membranes, hyperextended fetal head, fetal or uterine anomaly, multiple gestation
What causes serum sickness like reactions? What causes it? What type of hypersensitivity? What is seen on laps?
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
What are the facial features of fetal alcohol syndrome? What are the facial features of down syndrome?
FAS - smooth philtrum, thin vermilion border, small palpebral fissures, microcepaly
DS - flat facial profile, slanted palpebral fissures, small low set ears
Where is pain localized in the per anserinus pain syndrome? What do x rays look like?
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
What is the acid-base status after a tonic clonic seizure? What causes it?
Respiratory acidosis 2/2 hypoventilation. There is hypercarbia and elevated serum bicarbonate
At what ages are meningococcal vaccination given? Which patients are high risk?
11 - 12 adn booster at 16. Military recruits, college students living in dorms and travelers to sub-Saharan Africa
What is the presentation of Aortic dissection? How is it diagnosed in unstable patient? In stable patient?
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
What are the exam findings in Ankylosing spondylitis? What are complicationsAnkylosing spondylitis?
Arthritis (sacroilitis), reduced chest expansion and spinal mobility, enthesitis (tenderness at tendon insetion sites), dactylitits, uveitis.
What are complicationsAnkylosing spondylitis?
Complications - osteoporosis/vertebral fractures 2/2 increased osteoclast activitiy, aortic regurgitation, cauda equina
What are the symptoms of Multiple myeloma? How is it screened adn diagnosed?
Bone pain, osteolytic lesions on X-ray. Screeingn with serum protein electrophoresis, urine protein electrophoresis, free light chain analysis. Diagnosed with bone marrow biopsy
What are the signs of pancreatic laceration after BAT? can you pick it up on CT immediately?
fever, chills, deep abdominal pain suggesting a retroperitoneal abcess. No
What are the signs of splenic rupture? Can you pick it up on CT after BAT/
LUQ pain and hypotension. No signs of sepsis and can be picked up on CT.
What is common cause of low back pain during third trimester of pregnancy?
Increase in lumbar lordosis and relaxation of ligaments supporting the joints of the pelvic girdle
What are the causes of non bullous Impetigo? Bullous impetigo?
S. aureurs and Group a strep (S pyogenes). S. aureus for bullous impetigo.
What is the clinical feature of non bullous impetigo?
Painful non-pruritic pustules and honey crusted lesions
What is the clinical feature of bullous impetigo?
Rapidly enlarging flaccid bullae with yellow fluid and collarette of scale at periphery of ruptured lesions
How is impetigo treated?
Topical abx (mupirocin) if limited skin involvement and oral abx (Cephalexin, dicloxacillin, clindamycin) for extensive skin involvement
What is the most common cause of congenital hypothyroidism?
Thyroid dysgenesis
What lab abnormalities does Trimethoprim cause? How?
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
What is the criteria for PCOS diagnosis? What is the treatment?
> 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
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?
Hydatid cysts mostly nin liver (2/3) and lungs (1/4). Dogs are definite hosts and sheep are intermediate hosts. The inner germinal layer.
Which risk factor has the highest associated rate of AAA expansion and rupture? What are the indications for repair?
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.
What are the clinical features of TSS? What is seen on labs?
Fever, hypotension, diffuse erythematous macular rash and multi system involvement liek GI, low platelets, IMMATURE Neutrophils (bands).
What is the presentation of influenza? What organism is implicated in post influenza PNA?
Fever, myalgia, rhinorrhea, dry cough that remits after treatment. Staph aureus
Which anticoagulation is favored in patients with renal insufficiency? Which anticoagulation is NOT favored in patients with renal insufficiency?
Unfractionated Heparin. Rivaroxaban, fondaparinaux, enoxaparin are not recommended for renal insufficiency.
What are the causes and the signs/symptoms of myasthenic crisis? What is the treatment/
Infection, sergury and meds. Increased generalized and oropharyngeal weakness. Plasmapheresis or IVIG, and corticosteroids
What are the features of essential tremor? What is it releaved by?
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.
What are the features of Parkinson tremor?
Resting tremor that decreases with movement.Usually involves legs and hands.
What are the features of cerebellar tremor?
Associated with ataxia, dysmetria or gait disorder. Tremor increases steadily as hand reaches its target.
What is the presentation of metatarsus adductus?
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.
What is pulsus paradoxus? When does it occur?
Exaggerated drop in BP > 10 mmHg during inspiration. Cardiac tamponade, severe asthma exacerbation, COPD
What is the mechanism of statins in reducing cholesterol and causing myopathy?
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
