IM-3

Question 1

Beau’s lines

Answer 1

horizontal lines or indentations in nails indicating catabolic event, high fever, lack of adequate nutrition or even cachexia in past 120 days (bc nails take that long to grow)

Question 2

Mee’s nails

Answer 2

Arsenic poisoning seen as single white line in each nail

Question 3

Reil’s lines

Answer 3

Single white line in each nail, indicating infection

Question 4

Banded leukodynia

Answer 4

same horizontal white lines that could be caused by a myriad of diseases like acute renal failure, chronic renal failure, malaria , psoriasis or sickle cell disease, cardiac failure, MI, pneumonia etc.

Question 5

Muehrcke’s lines

Answer 5

paired white lines “IN” each nail indicate hypoalbinemia seen in patients with liver disease, nephrotic syndrome or kwashiorkor - dissapear after albimin is restored.

Question 6

When is it indicated to use Gold therapy?

Answer 6

rheumatologic conditions like RA. Used in refractory cases and show up as single horizontal yellow band in each nail.

Question 7

Where does the conversion of pro-insulin to insulinn occur?

Answer 7

pancreatic beta islet cells

Question 8

What do low levels of C-peptide but high insulin indicate?

high c-peptide and high insulin?

Answer 8

Exogenous insulin is being injected.

Insulin is endogenously manufactured

Question 9

Bussaca nodules

Answer 9

(white nodules on iris) pathognomonic for granulomatous uveitis that can occur in any granulomatous dz like (TB, leprosy, sarcoid chronic granulomatosis, sarcoid)

Question 10

Bushfield spots

Answer 10

Down’s Syndrome (but many normal children have spots that are similar) Absence does not r/o

Question 11

Kunkmann-Wolffian bodies

Answer 11

Spots similar to brushfield spots that appear on normal iris that are less distinct, less numerous and more peripheral than Brushfield spots

Question 12

Bitoti’s spots

Answer 12

Vitamin A deficiency (pearly white to yellow foamy spots on either side of conjunctivva, not the iris) Can indicate either a previous or current vitamin A def.

Question 13

Lisch nodules

Answer 13

claer, but yellow brown pigmented dome shaped nodules that protrude from the iris.

Question 14

How to calculate total cholesterol?

Answer 14

TG/5 + LDL + HDL

Question 15

What are the top 2 secondary causes to hypercholesterolemia?

Answer 15

choledocholithiasis and hypothyroidism

Question 16

Why would choledocholithiasis cause high cholesterol?

Answer 16

obstruction of the common bile duct prevents cholesterol from leaving the liver and exiting body via stool

Question 17

Is constipation a cause or result of diverticulosis?

Answer 17

Cause of diverticuloisis. That’s why it’s reccomended to eat fiberous food when pt has diverticular disease.

Question 18

What type of medium must diptheria be cultured on?

Answer 18

Tinsdale agar

Question 19

What is the most common reason with inherited angioedema?

Answer 19

C1 esterase inhibitor deficiency. (C1 esterase is an enzyme that inhibits plasma kallikrein. Deficiency causes excess kininogen and release of excess kinin mediators causing vascular leakage –> results in edema into deeper tissues of dermis and subQ tissues.)

Question 20

What is the key player of angioadema as a result of allergic txn?

Answer 20

Histamine release from IgEmediated mast cells and basophils with consequent exudation from BVs and edema.

Question 21

Plumbism

Answer 21

aka Lead poisoning

Question 22

Any decreased metabolic state causes what kind of anemia?

Answer 22

megaloblastic

Question 23

What are the EKG findings of hypothermia?

Answer 23

J waves - appear once the body drops to a core temp of 25-30 degrees. They are characterized by notching of the junction between the QRS complex and the ST segments

Question 24

What are pts greatest risk for in severe hypothermia

Answer 24

V. tach

Question 25

How do you re-warm sombody’s core temp?

Answer 25

warm GI irrigation with saline enemas and NG tube with warmed D5NS without potassium

Question 26

What EKG finding will be caused in hypooglycemia?

Answer 26

Prolonged QT

Question 27

Best way to measure hypothermia

Answer 27

rectal temp

Question 28

What is the DDx of Fever of unknown origin after pancultures are negative?

Answer 28

1. TB
2. Sarcoid
3. Lymphoma

Question 29

Virus spread by skin to skin contact in adults usually on around genitals, sex is most common reason

Answer 29

Molluscum contagiosum - small solid individual papules with tiny central umbilication. Not specificlally associated with hair follicles, but often near.

Question 30

What type of ventillation is used to wean patients off the ventillator when pt has been on for a period of time with no respiratory muscle atrophy?

Answer 30

Intermittent mandatory ventilation

Question 31

How to wean pts with respiratory muscle atrophy?

Answer 31

Use Control/Assist vevntiallator

Question 32

What ventillatory setting to use when pt is hypoxic and refractory to O2 therapy?

Answer 32

PEEP (maintains positive pressure in alveoli even during expiration. This improves lung compliance and therefore oxygenation

Question 33

Deficiency in X linked galactosidase causing cardiac failure and renal failure, but not serious CNS problems. UA shows lipiduria and proteinuria >3.5

Answer 33

Fabry’s disease

Question 34

What are angiokeratomas?

Answer 34

Purple- maroon papular lesions often in clusters that are pathonomonic for Fabry’s disease

Question 35

Pt is of childbearing age has developed multiple fluctuant masses on the trunk and limbs. Pt also has HA and fatigue and is overweight. States the masses are painful and worse with periods.

Answer 35

Adiposis dolorosa

Question 36

What is the definition of chronic mesenteric ischemia?

Answer 36

Artherosclerosis of 2 or more of the mesenteric vessels ie celiac or SMA of IMA thus decreasing blood flow to bowel. . cornary