hammer8 Flashcards
What is the presentation of Croup and etiology? Treatment?
Barking cough, coryza, inspiratory stridor. Presents with signs of hypoxia. Parainfluenza virus 1 and 2. RSV is also a cause. Steeple sign, narrowing of air column. Steroids for mild symptoms and racemic epinephrine for moderate to severe symptoms.
What is the presentation of Epiglottitis and etiology? Treatment?
H influenza type B. Fever, hot potato voice, drooling in tripod position, refusal to lie flat.Treat - intubate, Ceftriaxone for 7 to 10 days, Rifampin for all close contacts
What is the presentation of whooping cough and etiology? Treatment?
Bordetella pertussis (gram negative aerobic coccobacilli). Catarrhal, Paroxysmal (whooping cough) and Convalescent stage. Dx - butterfly pattern on CXR, burst blood vessels in eyes, post tussive emesis. Tx - Only in catarrhal stage - erythromycin or azithromycin. Isolate child, macrolides for close contact, DTap has decreased incidence
What is the etiology and presentation of Diphteria? Treatment?
Corynebacterium diphteriae. Gray highly vascular pseudomembranous plaques on the pharyngeal wall. Do not scrape .ANTITOXIN, not abx.
What is the xray findings of Legg-Calve-Perthe? Age range? Tx?
2-8. Joint effusions and widening. Surgery on both hips.
What is the xray findings of SCFE? Age range? Tx?
Adolescent. Widening of joint spaces. Internal fixation and pinnig
What is the presentation of Osgood Schlatter? Age range? Tx?
13 - 14. Edema, tenderness over tibial tubercule. Separation of tibial tubercule from shaft. Rest. stretching, NSAIDs.
What are the toxicity of Vitamin A?
Pseudotumor cerebri, hyperparathyroidism
What vitamin deficiency causes burning feet syndrome?
Panthothenic acid, Vitamin B5.
Which coag values are elevated in Vit K deficiency?
PT/INR
What is the sx of Vit D toxicity?
Hypercalcemia, polyuria, polydipsia
What are the symptoms of congenital varicella?
Limp hypoplasia, cutaneous scars, cataracts, chorioretinitis, cortical atrophy
What is a complication of chalmidyal conjuctivitis?
Chalmidyal PNA, cough, nasal drainage, scattered crackles, bilateral infiltrates on CXR
What are common endocrine, neuro and cancer risk in Down patients?
Hypothyroidism, alzheimer (chromosome on 21), ALL
What are characteristics of Edwards syndrome (Trisomy 18)?
Omphaolocele, rocker bottom feet, microcephaly, clenched hand
What are the symptoms of Patau syndrome (Trisomy 13)?
Holoprosencephaly, severe MR, microcephaly, cleft lip/palate
What are the symptoms of Prader willi and etiology?
Hypotonia, hypogonadism, skin picking, aggression. Deletion on paternal chromosome 15.
What are the symptoms of Angelman syndrome?
Seizures, strabismus, sociable with episodic laughter. Deletion on maternal chromosome 15
What are the symptoms of Williams syndrome?
Elfin appearance, friendly, increased empathy, deletion on chromosome 17
What are the symptoms of fragile X syndrome?
CGG repeats on X chromosome with anticipation. Macrocephaly, macroorchidism, large ears.
What are the symptoms of Waardenburg syndrome?
AD. Short palpebral fissures, white forelock, deafness.
What are lab findings of Brutons agammaglogulinemia ?
No B cells and low levels of all Igs
What are lab findings and complications of CVID?
Low levels of Ig GAME but normal B cells. Increased risk for lymphoma.
What is the most common B cell defect? Symptoms?
Selective IgA deficiency. Complications are anaphylaxis if given IgA containing blood.
What are common complications of DiGeorge syndrome? Which chromosome? What type of infections in childhood?
CATCH 22
Cardiac abnormality (commonly interrupted aortic arch, truncus arteriosus and tetralogy of Fallot)
Abnormal facies
Thymic aplasia
Cleft palate
Hypocalcemia/Hypoparathyroidism. Seizures, truncus arteriosus, micrognatia. Chromosome 22 micro deletion. Candida, viruses, PCP PNA.
What are the presentation of SCID?
Severe infections, no thymus or tonsils, severe lymphopenia. Pediatric emergency, need BM transplant by age 1.
What is the symptoms of CGD? How is it diagnosed?
Recurrent. Swollen and infected lymph nodes in groin and staph aureus skin infections. Nitrozoleum blue (yellow means disease) or flow cytometry.
What is the Ig levels in Wiskott Aldrich?
Low IgM, high IgA and IgE, slightly low IgG
When do newborns regain birth weight? Double weight? Triple weight? Increase length by 50%? Double length by?
2 weeks. 6 months. 1 year. 1 year. 5 years
How long do most primitive reflexes like Moro, grasp, rooting, placing and tonic neck last for? What about parachute reflex?What is the CNS origin of these reflex?
Birth till 4/6 months. Brain stem and vestibular nuclei. Parachute from 6-8 months till for life.
What is the treatment for urinary incontinence?
1st line is behavioral - rewards, pee before bed, bell alarm. 2nd is pharmacological - DDAVP or imipramine.
What vaccine is due at birth? At 2,4,6 months? Starting at 6 months? At 12 months? Due before age 2, due before kindergarten, due at age 12?
HepB.
Dtap, Rota, HiB, HepB, PCV.
Influenza at six months.
At 12 months, MMR, Hep A, Varicella.
Before age 2 Dtap and 2nd HepA.
Before kindergarten, last IPV, Dtap, MMR and varicella.
At age 12, Tdp booster, meningococcal vaccine and HPV for girls.
Which heart defect is associated with DiGeorge syndrome? What are the features?
Truncus arteriosus. Eisenmenger syndrome leading to increased pulmonary blood flow and bi ventricular hyper trophy.
What is the symptom of ASD?
Loud S1 with fixed and split S2. Older child with exercise intolerance.
What is the sound of endocardial cushion defects? What is the associated disease of PDA murmur?
Fix and split S2 plus SEM with diastolic rumble. Prematurity and congenital rubella syndrome for this murmur with bounding pulses and wide pulse pressure.
What are complications of anorexic patients wanting to become pregnant?
Miscarriage, IUGR, hyperemesis gravidum, premature birth, cesarean delivery, postpartum depression.
What are common findings of anorexic patients?
Osteoporosis, elevated cholesterol and carotene levels, prolonged QT interval, euthyroid sick syndrome, HPA axis dysfunction, Hyponatremia 2/2 excess H2O drinking
What is the management of patients who are pregnant less than 32 weeks?
Betamethasone, Tocolytics, Magnesium sulfate for neuro protection, Penicillin if GBS positive
What is the treatment of breastfeeding failure jaundice?
Optimizing lactation and increasing breast feeding frequency, supplement with Cow’s milk if necessary
What are the symptoms of secondary syphilis?
Diffuse rash, epitrochlear LAD, condylomata lata, Oral lesions, Hepatitis
What are the symptoms of tertiary syphilis?
Tabes Dorsalis, Argyll Robertson pupil, dementia, aortic aneurysms, aortic insufficiency, Gummas
What is the symptomatology of arterial occlusion?
5Ps - pain (severe onset), pulselessness, paresthesia, paralysis, pallor
What is the symptomatology of arterial thrombosis?
Slow, progressive narrowing of rhe vascular lumen in the affected limb. Diminished pulses b/l
What is the symptomatology of venous thrombosis
Pain, edema of the lower extremity and warmth to touch
What is the features of central adrenal insufficiency (2/2 glucocorticoid) use?
Normal aldosterone with low cortisol and low ACTH. No hyperkalemia, no hyperpigmentation.
What is the features of primary adrenal insufficiency?
Autoimmune, low cortisol, low aldosterone, elevated ACTH. Hyperpigmentation, hyperkalemia, hyponatremia, hypotension.
What meds are used after heparin induced thrombocytopenia?
Start a direct thrombin inhibitor (argatroban) or fondaparinux (synthetic pentasaccharide)
What is the EKG findings of tricuspid valve artresia?
Left axis deviation, decreased pulmonary findings on CXR
What is the most common cause of AR in young adults in developing countries? IN developed countries? What is the best way to hear the murmur?
Congenital bicuspid aortic valve. Rheumatic heart disease. Have the patient sit up, lean forward and hold breath in full expiration.
What is the symptoms of neurogenic claudication? What is seen on PE? How is it diagnosed?
Posture dependent pain, lumbar extension worsens the pain, lower extremtity numbnes and tingling. Normal pulses. Do an MRI
What is the symptoms of vascular claudication? What is seen on PE? How is it diagnosed?
Exertionally dependent pain, pain relieved with rest but not with bending forward while walking, lower-extremity cramping. Decreased pulses, cool extremities, decreased hair growth, pallor with leg elevation. Ankle-brachial index
What are the findings of Osgood-Schlatter disease?
13-14 year old, adolescent mail athletes. Traction apophysitis of the tibial tubercule. Anterior soft tissue swelling, lifting of tubercule from the shaft, irregularity or fragmentation of the tubercule
What are teh three Ps of McCune-Albright syndrome? What is the signalling behind it?
Precoccious puberty, pigmentation (2/2 cafe au lait spots) and polyostotic fibrous dysplasia (multiple bone defects). Defect in G protein cAMP-kinase function in the affected tissue, resulting in autonomous activity of that tissue.
Which tumors produce hypercalcemia 2/2 PTHrP production?
Squamous cell cancers, renal and bladder cancer, ovarian and endometrial cancer, breast cancer
Which tumors produce hypercalcemia 2/2 1,25(OH) vitamin D production?
Lymphomas
Which tumors produce hypercalcemia 2/2 bone metastasis?
Breast cancer, MM, lymphomas
Which cancers are suspected in patients with non-tender, solitary nodes in the head and neck, particularly in patients with significant smoking history?
Squamous cell cancer
What is the best initial test for head and neck quamous cell cancer?
Panendoscopy
What vaccinations should unvaccinated patients get if they get blood exposure from active HepB infections?
Hep B vaccine and hep B immune globulin
What is paradoxical agitation and what meds cause it?
Confusion and agitation shortly after taking BENZOS.
What eye complications are found in neurofibromatosis patients? How does it present?
Optic glioma. slow progressive unilateral visual loss, dyschromatopsia, exopthalmos.
What neurological symptoms develop in type 2 diabetics who have hyperosmolar hyperglycemic state without ketoacidosis?
Decreased consciousness, Blurred vision 2/2 myopic increase in lens thickness and intraocular hypotension 2/2 hyperosmolarity
What is the first test after finding a palpable adnexal mass?
Pelvic ultrasound.
What is SIRS criteria? What is leading cause of complications after hypovolemic shock in burn patients?
Temp > 38.5 or 90, Respiration > 20, WBC > 12000 or 10% bands. Bacterial infection 2/2 bronchopneumonia or burn wound infection.
What type of movements characterize tardive dyskinesia and whcih med causes it?
Biting, chewing, grimacing, tongue protrusions. Risperidone
Which abx are used for pertussis treatment and post exposure ppx?
Macrolides, for post exposure ppx - regalrdless of age, immunizaition status or symptoms.
What is the most common cause of bronchiolitis in age ? Symptoms, prevention med, complications?
RSV. Antecedent nasal congestation/discharge and cough. Wheezing/crackles and respiratory distress, Palivizumab . APNEA and respiratory failure
What are common causes of acquired torticollis and what is the management?
URI, minor trauma, cervical lymphadenitis and retro pharyngeal abscess. Cervical spine radiographs to ensure no cervical spine fracture/dislocation occurred.
What are the typical features of cerebellar degeneration in alcoholics?
Progressive gait dysfunction, truncal ataxia, nystagmus, intention tremor and impaired rapid alternating movememnts.
What are the complications of atheroembolism (cholesterol embolism)? What is the treatment?
cutaneous findings (blue toe syndrome, livedo reticularis, cerebral or intestinal ischemia, AKI and Hollenhorst plaques. Statin therapy
What are symptoms of MCL tear?
Tenderness at medial knee and valgus laxity
What is the managment of patients with acute aortic dissection who are hemodynamically stable?
CT angiography
What is the follow up of a simple breast cyst after aspiration?
Close interval followup
What is the presentation of simple/background retinopathy in diabetic retinopathy?
Microaneurysms, hemorrhages, exudates, retinal edema
What is the presentation of preproliferative retinopathy in diabetic retinopathy?
cotton wool spots
What is the presentation of proliferative/malignant retinopathy in diabetic retinopathy?
Newly formed vessels
What is the pathophysiology of graft vs host disease? ow does it present?
Donor T cells recognise host major and minor HLA antigens and launch a cell mediated response. Skin, intestine and liver are affected.
What are the clinical features of Felty syndrome? Diagnosis? Treatment?
RA, Neutropenia (ANC
