High Yield 2 Flashcards
diarrhea, vomiting , weight loss and HYPERCALCEMIA
ZES
What is the initial test for a patient with suspected celiac disease?
TgT-IgA test - most sensitive test , the alternative is the anti-endomysial antibody test
Biopsy - the gold standard
Malabsorption, arthritis + lymphadenopathy
+ PAS-positive granules in lamina propria
Whipple Disease
Treat with long term antibiotics
Best initial test for Carcinoid Syndrome
Urine levels of 5- HIAA
while the CT scan and IN-111 octreotide scan is used to localize the tumor
flushing, diarrhea, abdominal cramps, right sided cardiac valvular lesions
Carcinoid Syndrome
tx: Octreotide and Surgical resection
What Vitamin deficiency does patients with carcinoid syndrome develop?
Vitamin B3 deficiency = ie Niacin deficiency
pellagra - Diarrhea, Dermatitis, Dementia
Most common cause of SBO in adults
Adhesions
Which condition is associated with the development of ileus
Diabetes Mellitus
hypokalemia
Most accurate test for mesenteric ischemia
CT angiography - gold standard
CT scan - best initial test
significant distention, tympany and tenderness, fever and signs of shock suggest perforation/peritonitis or ischemia / necrosis
Large Bowel Obstruction
(Colon Cancer)
Most common cause of Lower GI bleed in patients > 40
Diverticulosis - most common in sigmoid colon
risk factors: low fiber and high fat diet, older age and connective tissue disorder
- outpouching of the mucosa and submucosa that herniate the colonic muscle layers
Inv:
Colonoscopy - is for diverticulosis
while CT scan is for Diverticulitis
Pt with aortic valve endocarditis - given with Iv antibiotics - culture positive for S bovis . next step?
Colonoscopy
weight loss, anorexia, blood in stool, obstruction in left sided lesions, bright red in rectal lesions
Colorectal Cancer
Most commonly affected site in the Ischemic Colitis
Left Colon
Most commonly at the splenic flexure by the watershed area
Symptoms of Ischemic Colitis
lower abdominal pain, diarrhea after meals, exertion, fever may suggest bowel necrosis
upper GI bleed is classified as one above the
Jejunum
Transmural inflammation is seen in:
skip lesions
Crohn Disease
Treatment for gallstone ileus
Laparotomy with stone extraction
Elevated ALP and bilirubin is seen in
Cholestasis
Most common causes of Chronic Viral Hepatitis are
HBV, HCV
( busy - chronic viral hepatitis)
p-ANCA and onion skinning sclerosis
Primary Sclerosing Cholangitis
Which medication slows the disease of progression of Primary Biliary cholangitis
Ursodeoxycholic acid
(cholestyramine for pruritus)
Obese, diabetic patient who develops hepatomegaly with increased LFTS and hepatitis/ alcoholism
Insulin Resistance
Most common type of Primary Liver Cancer
Hepatocellular carcinoma
Autosomal recessive disorder that results in defective copper transport and subsequent accumulation and deposition of copper in the liver and the brain (psychosis, delusions)
Wilson Disease
tx: Penicillamine
highly malignant presents with watery diarrhea, dehydration, muscle weakness and flushing
VIPOma
tx: replace fluids and electrolyte losses
surgery to resect the tumor
and consider the octreotide
Sweating, anxiety and headache
Insulinoma
Courvoisier sign, palpable nontender gallbladder
Pancreatic cancer
D-xylose test
Celiac Disease
pain to back, worse after meals, no hepatomegaly
Pancreatitits
pain several hours after a meal
no hepatomegaly
Duodenal ulcer
weight loss, fatigue, anorexia, jaundice
common bile duct dilated
Pancreatic cancer
elevated aminotransferase levels, acute RUQ pain and thrombocytopenia in 3rd trimester
Acute Fatty Liver of Pregnancy
elevated aminotransferase levels, elevated total bilirubin levels, generalized pruritus that is worse on palms and soles
Intrahepatic Cholestasis of pregnancy
Central stellate scar
Focal Nodular hyperplasia
bilateral infarcts and several microaneurysms of abdominal arteries
transmural inflammation of arterial walls, fever, joint pain , tissue ischemia affecting primarily the kidneys
Polyarteritis nodosa
persistent bloody ascites
Hepatocellular carcinoma
presents at age 3-5 weeks with non bilious vomiting after every feed
Pyloric Stenosis
a non-IgE mediated food allergy that presents in infancy with Non-bilious vomiting after ingestion of a trigger food like milk
Food protein induced enterocolitis
chronic episodic bilious vomiting
No blood in the stool
abdominal pain and irritability
Intestinal malrotation (volvulus)
A patient with cirrhosis that develops confusion and asterixis should be treated with
Lactulose
obesity, hepatomegaly, elevated AST and ALT
Non-Alcoholic Fatty Disease
self-induced vomiting _ chest / back pain + Pleural effusion
Boerhaave Syndrome
or Esophageal Perforation with pleural effusion
Proper management for a button battery lodged in the esophagus of a baby
Endoscopy
photophobia, dry skin, Bitot spots
what vit def?
Vitamin A
sore throat, cheilitis, glossitis
What vit deficieny?
Vit B12
What Vit Def if there is ecchymoses, petechiae and bleeding gums?
Vitamin C2
thickened intestinal loops floating free in the amniotic fluid
Gastroschisis
prune belly
Omphalocoele
distant infection (eg endocarditis) + high fever + tender splenomegaly
Splenic abscess
rebound and guarding
Appendicitis
Free air in the abdominal imaging
anorexia, abdominal discomfort and constipation
fever and peritonitis
Diverticular perforation
diagnostic markers most appropriate to diagnose acute hepatitis B infection
HbsAg and IgM anti-HBc
A person undergoes surgery and several days later develops RUQ pain, fever and leukocytosis
Distended gallbladder with no gallstones
Acalculous Cholecystitis
painful, erythema nodules on the shins
IBD
A pregnant woman presents with hematochieza, abdominal pain and tenesmus (fecal urgency followed by straining and an inability to defecate)
Ulcerative Colitis
porcellain gallbladder
gallbladder adenocarcinoma
crushing, substernal chest pain with ST elevations in V1, V2, V3 with shortness of breath, crackles and LE edema
STEMI
Unrestrained passenger in motor vehicle accident presents with unilateral diminished breath sounds and dullness to percussiom
Hemothorax
Young person with unilateral upper extremity swelling, pain erythema following vigorous exercise
Deep Venous thrombosis
An older man with a recent history of abdominal surgery presents with severe abdominal pain, constipation and irreducible mass in the left lower quadrant
Incarcerated Inguinal Hernia
Immediately after completing a marathon, a runner collapses without loss of consciousness and minimally elevated temperature
Exercise Associated Postural Hypotension
young patient with moderate chest pain and worsened with palpation
Costochondritis
Miner presents with ataxia, irritability, gingival inflammation and excess salivation
Mercury poisoning
Sudden onset severe headache in an elderly patient
Subarachnoid hemorrhage
Sudden-onset, severe, unilateral periorbital headache with tearing and conjunctival injection
Cluster headache
Elderly patient with extensive smoking history presents with fatigue, malaise, bilateral upper extremity edema, headache worse with supine positioning
SVC Syndrome (Pancoast Tumor)
Fall into an outstretched hand now with arm in adduction and internal rotation, Xray with widening of glenohumeral joint space
Posterior Shoulder dislocation
Repeated bilateral lower extremity pain and swelling after strenuous exercise with spontaneous resolution
Chronic Exertional compartment syndrome
Young patient with no PMH, presents with encephalopathy, anion gap metabolic acidosis, hyperglycemia
Diabetic Ketoacidosis
Fall from roof with spinal tenderness, spinal Xray with decreased vertebral height at T8
Vertebral compression fracture
Skin dimpling
Inflammatory breast carcinoma
Hx of Pcos presents with post menopausal bleeding for 1 month
Endometrial carcinoma
Beefy protrusion of tissue of the urethral meatus
Urethral prolapse
Nintendo abdominal bulge in post-partum patient with no facial defect on palpation
Rectum abdominal diastasis
Amenorrhoea and cyclic abdominal pain in each month
Impersonate hymen
Breast mass posterior to the nipple
Physi8logic thelarcge
History of multiple miscarriages, positive Vdrl and elevates PTT
Antiphospholipid syndrome
Pregnant with fever, dysuria and flank.pai n
Pyelonephritis
Treat with caftriaxone
Pregnant woman 10 wks with uterine size larger than estimated dates, severe nausea ans Vomiting BP 155/95 , elevated Bhcg
Complete hydatidiform mole
Pregnant patient with twins on ultrasound
One twin has dysmorphic limbs and a flattened face the other has polyhydramnios and polycythrmia
Twin to twin transfusion syndrome
What type of pregnancy his the previous scenario
Monochorionic diamniotic
Pregnant woman with severe nausea, Vomiting, orthosthatic hypotension, ketone in urine
Hyper3mesis gravidarum look for thiamine b1 Def
Pregnant woman with anaemia, thrombocytopenia, lfts elevated
HELLP SYNDROME
Pregnant woman with severe RUQpain, thrombocytopenia, profound hypoglycaemia, elevated LFTS, DIC
Acute fatty liver of pregnancy
Newborn male single s2 sound
Blowing holosystolic murmur
Egg ona string appearance on chest x ray
Transposition of the great vessels
Failure of aorticopulmonary septation
Associated with Digeorge syndrome
Truncus arteriosus
Displac3ment of infundibular septum
Leads to PROV abdomalities
Associated with Digeorge Syndrome
Leads ti PROV abnormalities - pulmonary stenosis, RVH , overriding of the aorta
Tetralogy of Fallot
Young person
No family hx and ischaemic stroke
PATENT FORAMEN OVALE
Holosystolic murmur at the left lower sternly border
VSD
Wide, fixed splitting S2
ASD
Double bubble sign
Duodenal atresia
Triple bubble sigb
Jejunal atresia
Corkscrew or misplaced ligament of tretz
Malrotstion + volvulis
Tonsillitis + strawberry tongue + morbiliform rash
Scarlet fever
Tx: penicillin
Crash and burn
Conjunctivitis, rash, adenopathy, strawberry tongue, hand and foot erythema + fever for 5 days
Kawasaki disease
Tx: aspirin + IVIG
Posterior lymphadenopathy
Abdominal.pain from splenomegaly
Infectious Mononucleosis
Cough absent
Exudate on tonsils
GAS pharyngitis
Fever, lovk jaw (trismus)
Ear pain, uvula deviation
Peritonsillar abscess
Anterior LAD, unable to move ecj
Retropharynge abscess
Fever, dysphagia, drooling
Epiglottitis
Harsh, cough , inspiratory stridor
Laryngotracheitis
Inspiratory chronic stridor
Improves with prone position
Laryngomalacia
Biphasic ins and ex chronic stridor
Improves with neck extension
Vascular ring
Expiratory chronic stridor
History of prolonged intubation
Tracheomalacia
Prematurity, insufficient surfactant
Alveoli collapse
Resp distress, grunting, nasal flaring
Ground glass appearance + air bronchograms
Preterm <37wks
Tx: positive pressure ventilation ,may need intubation *follow paediatric ACLS algorithm)
Neonatal Resp distress Syndrome
Rapid expulsion - inability to exhale pulmonary fluid
Brief, tachypnea, resolves by day 2
Xray findings : erihilar streaking + fluid in fissures
C section or rapid vaginal delivery
Transient Tachypnea of the newborn
Cause post -term fetus > more likely infant has passed meconium - risk to aspirate
Green coloured amniotic fluid
Treatment:intubation + suction beneath trachea
Meconium aspiration syndrome
Obese or tall adolescents 10-16yi
May have knee pain
Flexing of the hips causes external rotation
Treatment : surgical pinning
SCFE
Younger 4-10 yo child, limited to internal rotation and abduction *both cause femur -acetabulum space to narrow
Legg Calve Perthes Disease
I’ll, fever, elevated WBC count, inability to bear weight, elevated ESR and CRP
Septic arthritis
Tx,: arthrocentesis + IV antibiotics
Bloody stool
Painless
Eczema, mildly fussy but consolable, painless, hematochezia + loose stool
Treatment for breast
Milk allergic proctoenterocolitis
Bloody stool
Painless
Rule of 2s: 2yo, 2 more common in males, 2 feet from ileocecal valve + 2 inches long
Painless hematochezia or melena
Meckels diverticulum
History of straining, hard, or pellet like stools +/- anal fissures very painful
Bloody stool
Constipation
Bloody stool
Painful , intermittent episodes of painful Bloody stool in between they are seen playing normally, sausage shaped mass on RLQ or RUQ, currant jelly
Intussusception
Dilated small.bowel
Meconium.ileus
Narrow point at rectosigmoid
Hirschsprung disease
Hypotonia, jaundice, dry skin
Hypothyroidism
Slanted epicantyal folds, single pmar crews, sandal toe (gap between 1st and 2nd toe brush field spots on iris
Trisomy 21
Happy demeanour, seizures, gap between teeth, intellectual disability
Angel man
History of hypotonia as infant, obesity, short stature, behavioural problems
Prader Willi
Friendliness qith strangers, elfin face, supravalvular aortic stenosis
Williams syndrome
High oitched cry, microcephaly
Cri du chat
Midline defects, cleft lip, aphasia cuts of scalp, polydactyly,holoprosencephaly
Palau
Trisomy 13
Prominent occipital, clenched and overlapping fingers, micrognathia, or retronathia
Edward’s
Trisomy 18
Narrow epicanthal folds,smooth phltrum, thin upper vermilion bordsr
Fetal alcohol syndrome
O.phalocoele, large tongue, right arm and leg enlargement, Wilmslow tumkr
Beckwith - Wiedemann syndrome
Chordal artesian, heart defects, ear anomalies
CHARGE Syndrome
Tracheoesophageal fistula, anal abnormalities, scoliosis
VACTERL
Hypotonia, jaundice, umbilical hernia, large tongue
Congenital hypothyroidism
Self aggression, crystals found in diaper, poor tone
Lesch Nyhan Syndrome
Long head, large ears, intellectual disability
Fragile X syndrome
Nephritis syndrome gwnitourinary abnormalities
Wilms tumor
Denys Drash Syndrome
Hearing loss, microcephaly, periventricular calcifications
Congenital CMV
Hydrocephalus, microcephaly, perivwntricular calcifications
Congenital CMV
Hydrocephalus, chorioretinitis, diffuse intracranial calcifications
Toxoplasma
Soin scars, cataracts, limb hyperplasia
Varicella
Jaundice, cataracts, deafness, continuous murmur
Rua
Rhinorrhea, skinr ash, teeth and bone abnormalities
SYPHILIS
Hydrops fetalis
Parvovirus B19
Neonatal sepsis, widespread abscesses
Listeria
Encephalitis, sepsis, vesicular skin lesions
Herpes Simolex
Harsh, hilosystolic murmur at the lower left sternal border
VSD
Wide, fixed split S2 + soft systolic murmur
ASD
Continuous murmur in interscapular region
Coarctation
Continuous “machine-like” murmur in infraclavicular region
PDA
Continuous murmur in right infraclavicular region, disappears with compression of internal.jugular vein
Central venous hum
Holosystolic murmur at lower sternal border + systolic murmur at upper left sternal border in a patient with Trisomy 21
Common Av canal (endocardial cushion defect in Down syndrome)
Systolic murmur at lower left sternal border, increased intensity with Valsalva
Hypertrophic cardiomyopathy
Most sensitive Laboratory test to confirm abuse of Alcohol
GGT or
gamma Glutamyl Transferase
All of a sudden half of my vision is black
Central Retina Artery Ischemia
Placed on face mask with )2 flowing at 10 L/min, remains cyanotic and pulse oximetry reading does not chanfe.
Bilateral breath sounds are present, no murmur. breathing deeply and quickly but not retracting.
While waiting fo the transport to the nearby hospital, what will you initiate?
Prostaglandin E1 Infusion
Diagnostic imaging test to diagnose osteoporosis
DEXA scan
CMV infections may produce what retinal disturbance
Chorioretinitis
poppling sound when he bends his knees
Medial Meniscus tear
When LLQ is palpated and there is tendernes in RLQ
Rovsing Sign
Is the aign when there is an occurrence of sharp pain when the examiner presses his or her hand over the Mcburner Point and then releases the hand pressure suddenly.
Blumber Sign
Increase of pain when the psoas muscle is stretched as the patient extends his or her hips.
Psoas Sign
Elicitatiin of pain as the hip is flexed and internally rotated
Obturator Sign
is a condition marked by symmetrical cyanosis of the extremities with persistent, uneven, mottled blue or red discoloration of the skin of the digits, wrists and ankles along with profuse sweating and coldness of the fingers and toes.
Raynaud sign
Which statements about Cholangitis is true
Charcot triad: fever, jaundice and pain in the RUQ
Fracture of the left temporal lobe
Suddenly loses consiousness and dilation of the left pupil
What is the diagnosis?
An Epidural hematoma
You suspect a Meckel’s diverticulum as the possible cause what s the best test to confirm the diagnosis?
Technetium 99m pertechnetate scintigraphic study
Which HPV types are associated with benign condyloma
HPV 6 and 11
Which HPV are associated with cervical neoplasia
HPV 16, 18 and 21
How to confirm epilepsy
descibes as eye fluttering for several seconds
Electroencephalogram
Fluttering in her chest
Atrial Fibrillation
Thrombocytopenia
Eczema and increased susceptibility to infection
Wiskot Aldrich Sydnrome
The reactivation is not a risk to the fetus
Shingles
which of the ff is true with ADHD
Children diagnosed with ADHD commonly continue to have symptoms into the adulthood
several weeks of abdominal pain and black stools
inv?
Upper GI endoscopy
cough and chest pain for 2 months
she complains of coughing up hair
CXR reveals mediastinal mass
Which mediastinal tumor is most likely associated with
Cystic Teratoma
Cause phy Hypotension
Gram negative sepsis
Progressive pain in his knees
tenderness, swollen and prominent tibial tuberlcle
Osgood Schlatter disease
