hammer7 Flashcards
Where is the pain of osteoarthritis usually felt? What makes it worse? What are common xray findings?
Felt in groin, buttock or pelvis and can radiate to lower thigh or knee. Pain worsens with activity and weight bearing. Xray findings are loss of joint space, osteophyte formation and subchondral sclerosis.
Which disorder has bilateral trigeminal neuralgia findings? What is the pathophysiology?
Multiple sclerosis, autoimmune demylineation of the trigeminal nerve nucleus.
What are the symptoms of pulmonary contusion and when do they develop?
Patchy alveolar infiltrates, tachypnea, tachycardia, hypoxia. PE - chest wall bruising and decreased breath sounds.
Which enzyme is deficient in Von Gierke disease (type 1 glycogen storage)? What is the presentation?
Glucose 6 phosphatase. 3-4 months of age with hypoglycemia, lactic acidosis, hyperuricemia and hyperlipidemia. Patient has a doll face with fat cheeks, thin extremities, short stature and protuberant abdomen 2/2 large liver and kidneys. Normal spleen and heart.
Which enzyme is deficient in Pompe disease(type2 glycogen storage)? What is the presentation?
Acid maltase. Hepatomegaly, floppy baby with feeding difficulties, macroglossia and HF.
Which enzyme is deficient in type 3 glycogen storage disease?
Glycogen debranching enzyme. Hepatomegaly, hypoglycemia, HLD, growth retardation, elevated LFTs, fasting ketosis ,normal blood lactate and uric acid. SPlenomegaly and normal kidneys.
What are the clinical features of Zollinger-Ellison syndrome? Diagnosis and workup?
Multiple and refractory peptic ulcers, ulcers distal to duodenum, chronic diarrhea (MEN1), malabsorption 2/2 pancreatic enzyme inactivation. Markedly elevated serum gastrin with normal gastric acid. W/u endoscopy, CT/MRI and somatostatin receptor scintigraphy for tumor localization.
What are expected findings after a postpartum period?
Transient rigors/chills, peripheral edema, lochia rubra, uterine contraction and involution, breast engorgment
What is the management of splenic trauma in a hemodynamically stable patient?
Abdominal CT
What is the expected microorganism that causes pulmonary, gastrointestinal and hepatic symptoms after a solid organ transplant?
CMV
What are the clinical features of SJS/TEN? What are common triggers?
INfluenza like prodrome, rapid onset erythematous macules, vesicles, bullae, necrosis and sloughing of epidermis, mucosal involvement. Meds such as allopurinol, sulfa, seizure meds, nsaids
What CD4 count for Pneumocystis jirovecii? Toxoplasma Gondi? Histoplasma capsulatum?
At what age is visual acuity testing in children?
3
What are indications for cystoscopy?
Gross hematuria with no evidence of glomerular disease especially in smokers, microscopi hematuria, recurrent UTIs, obstructive symptoms with suspicion for stricture, stone
Which cancer are PCOS patients susceptible to?
Endometrial hyperplasia and carcinoma
What are symptoms and risk factors for C diff colitis?
Low grade fever, acute watery diarrhea, abdominal pain and guaiac positive stool in the setting of PPIs. Prolonged gastric acid suppression with PPIs or histamine 2 receptor antagonists.
What is the clinical presentation of fibromuscular dysplasia? What is diagnosis and followup?
Resistant HTN, cerebrovascular FMD with sx of brain ischemia, sx from carotus or vertebral artery involvement (headache, pulsatile tinnitus). CT angiography/ultrasound, Cathether based digital arteriography. Medically treated pts need BP and creatinine followup every 3-4 months and renal US every 6-12 months
What is the pathophysiology of fibromuscular dysplasia? What kind of disorder is it? Which vessels does it usually target?
Abnormal cell development in arterial wall that can lead to vessel stenosis, aneurysm or dissection. It is a noninflammatory and non atherosclerotic condition. Renal, carotid and vertebral arteries.
What is the characterization of central cord syndrome? Which spinal tracts are involved?
Results from hyperextension injuries. Weakness pronounced in the upper extremties more than the lower. may be accompanies byu localized deficit in pain and temperature sensation.corticospinal tracts and decussating fibers of spinothalamic tract.
How does diabetes 1 present in toddlers?
Nocturnal enuresis
What is the presentation of serous otitis media?
Middle ear infection without signs of an active infection. Exam reveals dull tympanic membrane that is hypomobile on pneumatic otoscopy.
What is a common occurence of patients with Hodgkins lymphoma treated chemotherpy and radiation? Wher does it occur?
Secondary malignancy are lung, breast breast, thyroid, bone and GI
What is the presentation of interstitial cystitis (painful bladder syndrome)?
Bladder pain with filling, relief with voiding. Increased frequency, urgency and dyspareunia.
What are the common sideeffects of cyclosporin?
Nephrotoxicity (most common and serious), HTN, Neurotoxicity, Glucose intolerance, infection, malignancy (squamous cell carcinoma), ginvival hypertrophy adn hirsuitism, GI manifestations
What are the common sideeffects of tacrolimus?
nephrotoxicity, hyperkalemia, but no hirsuitism or gum hypertrophy
What is the mechanism and common sideeffect of Azathioprine?
Purine analog that is converted to 6-Mercatopurine that inhibits purine synthesis. Dose related diarrhea, leukopenia and hepatotoxicity
What are the common sideeffects of Mycophenolate?
Bone marrow suppression.
What are complications of aortic dissection?
Stroke, Acute aortic regurgitation, Horner syndrome, acute MI
What is a common sideeffect of the antipsychotic fluphenazine?
Hyporthermia 2/2 disrupting thermoregulation adn body’s shivering mechanism
What is the feature for Meniere disease? What is the pathophysiology?
vertigo, recurrent episodes of unilateral hearing loss and tinnitus, feeling of fullness in the ear. Disorder of the inner ear characterized by increased volume and pressure of the endolymph causing damage to teh vestibular and cochlear components of tehinner ear.
What is the feature for vestibular neuritis?
vertigo, acute single episode that can last for days, often follows viral syndrome, abnormal head thrust test
What is effect modification?
External variable positively or negatively impacts the effect of a risk factor when using stratified analysis
What type of diarrhea does Cryptosporedium cause, other symptoms and CD4 count?
Severe watery diarrhea , CD4 count
What type of diarrhea does CMV cause in AIDS patietn and CD4 count?
frequent small volume Bloody diarrhea with abdominal pain, CD4 count
What are the symptoms of MAC and CD4 count? Treatment?
Sweating, Weight loss, Fatigue, Diarrhea, Shortness of breath, Right upper quadrant abdominal pain. Chemoprophylaxis against disseminated MAC disease if they have CD4 counts
Which lung cancer presents with hypercalcemia and hilar mass? Which lung cancer presents with ACTH production and SIADH?
Squamous cell carcinoma. Small cell lung cancer
What are targets and adverse effects of Tamoxifen?
Antagonist at breast and agonsit at uterus. Hot flashes, venous thromboembolism, Endometrial hyperplasia and carcinoma
What is the management of incomplete abortion in a hemmodynamically stable patient?
Expectant management, misoprostol or Dilation adn evacuation
What is the managemetn of bine pain in patients with prostate cancer who have undergone orchiectomy?
Radiation therapy
What is a common cause of spontaneous pneumothorax? How does it present?
COPD. Acute onset of chest pain and shortness of breath.
What is the distinguisshing features of Marfan csyndrome from homosystinuria?
Marfan - AD. Normal intellect. Aortic root dilation. Upward lens dislocation.
Homocystinuria - AR. Intellectual disability. Thrombosis. Downward lens dislocation. Megalobalstic anemia. Fair complexion
What is the aldosterone level in 17 alpha hydroxylase deficiency, Cortisol level, sex hormone level, blood pressure, sex development and electrolyte abnormalities?
up, down, down, hypertension, pseudohermaphroiditism for boys, hypokalemia
What is the aldosterone level in 21 alpha hydroxylase deficiency, Cortisol level, sex hormone level, blood pressure, sex development and electrolyte abnormalities?
down, down, up, hypotension, virilized females, hyponatremia, hypochloremia, hyperkalemia
What is the aldosterone level in 11 beta hydroxylase deficiency, Cortisol level, sex hormone level, blood pressure, sex development and electrolyte abnormalities?
down, down, up, hypertension, virilized females, few electrolyte abnormalities
What are the three types of vitmain D disorders? Which values are lower in vit D-dependent rickets?
Vit D deficiency, Vit D dependet, X linked hypophosphatemia, Calcium and 1,25 (OH)2 vit D is lowered.
What are the most common organisms in neonatal sepsis and treatment?
GBS, E. coli, s. aureus, Listeria. Ampicillin and gentamicin.
What is the presentation of toxoplasmosis? Best initial test?
Chrioretinitis, hydrocephalus, multiple ring enhancing lesions. IgM to toxoplasma. Most accurate test is PCR for toxplasmosis
What is the presentation of CMV? Best initial test?
Periventricular calcifications with microcephaly, chorioretinitis, hearing loss, petechiae. Initial test - urine or saliva titers, most acccurat test is viral DNA or saliva PCR
What is the presentation of Herpes in children? Best initial test?
week 1 - shock and DIC week 2 - vesicular skin lesions week 3 - encephalitis. PCR or Tzank smear
What is the presentation of Rubella?
PDA, cataracts, deafnes, hepatosplenomegaly, thrombocytopenia, blueberry muffin rash, hyperbilirubinemia. Maternal IgM
What is the etiology and presentation of Mumps?
Paramyxovirus. Fever precedine classic parotid gland swelling and possible orchitis.
What is the etiology and presentation of scarlet fever? Treatment?
Strep pyogenes. Fever, pharyngitis, sandpaper rash, strawberry tongue, cervical LAD. Tx - penicillin, azithromycin, cephalosporin
What is the pathophysiology of Milk-alkali syndrome?
Excess intake of Calcium adn absorbable alkali. Renal vasoconstriction adn decreased GFR. INhibition of Na-K-2Cl cotransporte and impaired ADH activity leading to Renal loss of Na, H20. Increased bicarb reabsorption 2/2 hypovolemia.
What is the symptoms of Milk-alkali syndrome?
N/v/constipation. Poyuria, polydypsia, neuropsychiatric symptons
What is the labs and treatment of Milk-alkali syndrome?
Hypercalcemia, metabolic alkalosis, AKI, suppressed PTH. Discontinie causative agent. Isotonic saline followed by Furosemide.
