IM Flashcards
What is Gamma gap?
Elevated serum protein with normal Albumin. Can be seen in MM.
Difference between MM and MGUS(monoclonal gammopathy of undetermined significance) ?
MM : Pr> 3gr
BM plasma cell> 10% of BM
B2 Microglobuline
Charactristics of Legionella?
Bradycardia inspite of high fever, GI symtoms (Diarrhea, abdominal pain), neurologic symptoms( confusion), hyponatremia, Hepatitis, negative (-) gr stain because it’s intracellular, diagnosis is based on urine test for Legionella Ag. Tx: Macrolids or Fleuroquinolon.
Respiratory and GI symptoms in a Post BMT patient, what’s the most likey cause?
CMV
Metabolic syndrome?
Hdl50 in women Bp> 130/80 TG>150 Obesity > 40 in men > 35 in women FBS>100
Tx for PBS( primary biliary cirhosis)?
Ursodeoxycolic
2 drugs that improve CHF symptoms but does not effect on mortality
Digoxin and Furosmide
Why pulse paradox in asthma and copd
Because chest expansion during inpiration in asthma and copd will cause more negative pressure in thorasic cavity and more than 10 mm hg decrease in bp during inspiration
CPPD in?
Pseudogout, Hemochromatosis
MI complications? How would you recognize them?
Ventricular free wall rupture, papillary muscle rupture, Aortic aneurysm, Pericarditis. Left ventricular aneurysm happens months after MI and there’s ST elevation and deep Q wave. Those ruptures happen early.
Preclampsia risk factors:
Maternal age, nuliparity, DM, Renal insufficiency, chronic HTN, history of preclampsia.
Charactristics of open angle and closed angles glocuma?
Open angle glucoma is painless, in african americans, cupping, peripheral vision loss. Closed angles glucoma is painfull and there is blurred vision and nausea and vomitting.
Drug induced liver diseases:
Cholestasis with: Chlorpromazine, nitrofurantoin, erythromycine, anabolic steroids.
Fatty liver with: Tetracycline, Valproat, Anti - retrovirals
Hepatitis: Halothane, Phenytoin, Isoniazide, alpha methyldopa
Fulminant hepatitis: ccl4, Acetaminophen,
Granolumatosis: Alluporinol, Phenylbutazone
Causes of gout:
1- overproduction: cancer, chemotherapy, hemolysis
2-undersecretion: ketoacidosis, Renal insufficiency, lactate acidosis
3-Meds: ASA, Thiazides
What you have in mind in DDx of gout?
Infection bcz gout can be accompanied by fever.
Tx options for gout?
Nsaids, colchicine, corticosteroids
Why Losartan is better than ASA or Thiazides for TX of gout?
Bcz of increasing risk of hyperuricemia with ASA and Thiozides.
Side effects of Colchicine?
Effect on BM and Neutropenia, Diarrhea
Mechanism of action: Allopurinol Pegloticase Febuxostat Probenecid Sulfapyrazone
Alluporinol: decrease production of uric acid
Pegloticase: Increase metabolism of uric acid
Febuxostate: inhibit Xantin Oxidase
Probenecid and Sulfipirazone: increase uric acid excretion
When do we use Alluporinol
When we can’t prescribe other meds
Alluporinol side effects:
Toxic epidermal necrolysis, Steven Johnson, Hypersensitivity reactiond ( rash, Allergy, Hemolysis)
Disease associated with CPPD:
DM, Hemochromatosis, Pseudogout, Wilson, Hypoparathyroidism
1-causes of Dopuyteren contacture
2- treatment of it?
Genetic, Cirrhosis, Alcohol
Lidocain, Collagenase, Lidocain
Felti Syndrome?
Kaplan Syndrome?
Felti Syndrom: RA+ neutropenia+ splenomegaly
Kaplan: RA+ Pneumoconiosis+ lung nodules
Med to control mild RA?
Its side effects?
Hydroxychlorokine
Retina damage
Adverse effects of Gold Salts?
Nephrotic Syndrome
Adverese effect of Rituximab?
Infection
Side effects of Sulfasalazine?
Hemolysis in G6PD, Rash, BM toxicity
Most common ocular manifestation in Giant Cell Arthritis?
Anterior ischemic optic neuropathy
What are the two organisms associated with RA?
Salmonella , Chlamydia
Lare term and post term pregnancy complications:
Fetal: oligohydroamnios, mecunium aspiration, still birth, convulsion
Mom: c-section, infection, hemorrhage, trauma
Basophilic stippling in:
1- lead poisoning
2- Alcoholism
Clinical manifestations of polycytemia vera:
- HTN
- Splenomegaly
- PUD
- Pletoric face
Vaccination in splenectomy:
14 days before or after splenectomy… Hep A hep B, Influenza, pneumococ, Meningococ, Tdap
- cancer in Hashimoto Thyroiditis?
- Lab in Hashimoto Thyroiditis?
- CT in Hashimoto Thyroiditis?
- Lymphoma
- Anti TPO
- Donut sign..Fibrotic Thyroid around the neck
Metothroxate side effects?
- Alopecia - Hepatotoxicity
- Rash - Pulmonary toxicity
- GI symptoms
- BM Suppression
- Stomatitis
Charactristics of Guilen Bare in CSF?
High Pr
Dose of vitamine B6 in TB?
100 mg/ day
Post exposure HIV meds?
2 NRT- 1 NNRT or Integrase or protease inhibitor
Tenofivir+Emtricitabine+ Raltegavir
Extra manifestations of IBD?
- Erythema Nodusom
- Pyoderma Gangronosum
- Arthritis
- Episcleritis
- Cholengitis
Complications of Maternal DM?
- Macrosomia
- Hyperviscosity and Polycytemia
- Respiratory Distress syn. Bcz of the effect of Insulin on Esphyngomyeline
- Hypoglysemia
- Hypocalcemia
- Small left colon Syn.
Tx of Raynaud Syn.:
- Ca canel blocker
- Losartan
- Avoid cold temperature
Work up plan in Raynaud:
- CBC
- U/A
- ANA
- ESR
- Complement C3C4
Mutations in Neurofibromatosis:
1-Gardner: split or missense mutation
2- Wirshart : Nonsense mutation
Electrolyte abnormality in cushing?
Hypokalemia and hypernatremia. Cortisol will attach to Aldostrone and will cause hypernatremia and hypokalemia.
Aortic Dissection treatment?
B- Blocker ( Labetolol )
Glucose test in pregnancy:
24-28 weeks
Gene mutation associated with Pancreatic Cancer?
BRCA1-BRCA2-Peutz jeger
Meds associated with y
Hyperkalemia:
1- K+ sparing Duretics
2- B Blockers
3- Digitals ( inhibition of na/k pump)
4- Trimetoprim by blocking na channels in collecting tubouls
5- Heparin ( block Aldostron production)
6-succynil cholin( leakage of K through Ach Rs)
7-Nsaids ( decrease renal perfusion)
Mechanism of Bupropione:
- inhibition of Epinephrin , Norepinephrin and Serotonin
Guidline for lipid lowering therapy:
- LDL> 190 high intensity therapy
- DM with 10 years risk > 7.5% => high intensity therapy
- DM with 10 years risk low intensity therapy
- Athrosclerosis > 75 yo => low intensity therapy
- Athrosclerosgis high intensity therapy
Side effect of Quetiapine:
Cateract
Management of Malignant Hyperthermia
- ICU
- Electrolytes
- Dantrolen
- manage Hyperthermia
What are theses therapies: 1- Supportive Psychotherapy 2- Biofeedback 3- Cognitive Behavioral therapy 4- Motivational interviewing 5- interpersonal psychotherapy 6- Psychodynamic Psychotherapy
1- Stress 2- improving health by internal signals 3- improving maladoptive thoughts 4- Addiction 5- 6- role of unconciouse conflicts in causing the patient's symptoms
Dressler syn. .?
TX?
Pericarditis after MI
TX: NSAID
Dx of peritonitis based on Neutrophils:
Neutrophils > 250 = Peritonitis
Neutrophils
How proteins and Albumine of Ascite fluid will help to dx the ethilogy of the disease?
Pr> 2.5 and SAAG> 1.1= cardiac, Budchiary, Pericarditis
Pr
Two maneuvers to treat and DX of BPPV?
1- Halpike = patient will lay down and then turn the head for 45 degree
2- Epley= turn the head for 45 degree lay down and turn the head for 90 degree to the other side
Charactristics of thyroid storm:
Thyroid storm treatment:
- thyroid or non thyroid surgery
- acute illness( trauma, infection, childbirth)
- Acute iodine load
TX:
B- blockers , Corticosteroids to decrease conversion of T4 to T3.
PTU => decrease thyroid hormone synthesis
At which level we’ll see hypokalemia signs and symptoms?
K
How to Dx gastrinoma?
PPI therapy for one week and then measure gastrin:
> 1000 is diagnostic
Lithium side effects:
- Ataxia
- Tremor
- Hyperreflexia
- Seizure
Extra hepatic manifestations of Hepatitis C
- mixed cryoglubolinemia, lichen plan, memberanoproliferative glemerulinephritis, porphyria cutanea Tarda, DM
Approach to thyroid nodule:
High risk=> FNA / low risk measure TSH , high TSH => FNA
Low TSH => idoine … => high iodine uptake FNA => low iodine uptake => treat hyperthyriodism
Manifestations of Sarcoidosis:
- Erythema Nodusome
- Prepheral Lymphodenopathy
- Ant Pos Uveitis
- Hepatomegaly, Splenomegaly
- Hypercalcemia, central DI
- Polyarthritis, chronic arthritis
Causes of proximal muscle weakness:
- eaton lambert
- Polymyositis / Dermatomyositis
- myastenia gravis
- Hypothyroidism
- Steroids
Causes of Thyrotoxicosis with low iodine reuptake?
- levothyroxin
- stroma ovarie
- subacute painless thyroiditis
- subacute granulomatosis thyroiditis
- iodine induced thyroid toxicosis
Presentation of lacunar infarct in pos. Limb of internal capsule?
Pure motor hemiparesis, mild dysarthria.
Presentation of lacunar infarct in ant. Limb of internal capsule?
Ataxic hemiparesis, weakness is more prominant in lower extremity along with ipsilateral arm leg incordination.
Presentation of lacunar stroke at the basis of pontin?
Dysartheria- clumsy hand syn. Hand weakness mikd motor aphasia no sensory abnormality.
Formula for urine calcium creatinin clearance ratio?
Urinary ca / plasma ca * plasma Cr / Urinary Cr and it’s 0.02 in primary hyperparathyroidism.
Difference between mallory weise and esophageal varices?
Malory weiss cause bleeding from submucosal A. Esophageal veins cause bleeding from submucosal veins.
Clinical presentation of Shy- drager syn.?
Parkinsonism, Autonomic dysfunction, widespread neurological signs
Clinical presentation of Riley Day syn?
Autonomic dysfunction , severe orthostatic hypotension
Causes of macrocytic anemia?
Low folic acid , low b12, Alcohol, liver disease, hypothyroidism, chemotherapy, AML, myelodysplastic syn, drugs( Hydroxy urea, Zidovudine).
Cause of Erysipelas?
Strep B hemolytic group A
Cause of prulent cellulitis?
Staph
Cause of non prulent Cellulitis?
Strep.
Differences between rotator cuff tear, rotator cuff tendinitis, rupture of long tendon of biceps?
Rotator cuff tear or tendonitis=> decrease active ROM , normal passive motion. Biceps tendon rupture=> wekness + little lump in arm.
Adheisive capsulitis=> stiffness in both passive and active ROM.
Approach to acute abdomen?
Surgery
Approach to acute Pancreatitis?
Analgesics, iv fluids, nothing by mouth
What type of toxicity in a patient with nitruprosside compsumsion?
Cyanide toxicity
Etiologies of pulmonary HTN?
Idiopathic, left heart disease, chronic lung disease, thromboemboli, hemologic disorders
Treatment of Hyponatremia?
3% Hypertonic salin at the rate no more than 0.5 meq/L/h
Indications for aortic valve replacement?
- AS
- Severe AS who underwent CABG
- patients with AS and poor LV systolic function, LV hypertrophy > 15 mm , valve area
What does it show?
- high testestrone, normal DHEAS
- high DHEAS, normal testestrone
- ovarian source
- Adrenal source
Risk of breast cancer based on size of a nodule?
- 8> low risk
- 8-2 Intermediate risk
- 8
What is HIDA scan?
It can diagnose cholecystitis. When U/S does not show the clear image HAIDA scan will help. It usually shows gall bladder after one hour if does not show anything after four hours then there is cystic duct obstruction and acute cholecystitis.
Difference between Leukomoid reaction and CML
Leukomoid reaction there is high ALKP.
Approch to pulmonary nodule?
First we should compare it to the last xrays… If it’s stable we’ll do nothing if not stable we should do serial CT Scans and risk will be low, intermediate or high.
Low risk= Serial CT scan
Intermediate risk=FNA
High risk= Surgery
Causes of high anion gap metabolic acidosis?
- CAT MUDPILES - Uremia - EthyleneGlycole
- CO/Cyanid - Diabetic ketoacidosis - Salicylates - Aminoglycoside - Para aldehyde
- Theophyline - INH
- methanol - Lactic Acidosis
Abnormalities in Down Syn.?
- DM, Hypothyroidism
- atriventricular deffect> ventricular deffect> atrial deffect
- Hypothyroidism
- Acute Leukemia
- Atlanto Axial instability
Causes of conjunctivitis in an infant?
- chemical => Lubricant
- 1 week => Gonorrhea=> Ceftriaxone/ Cefotaxim
- 2 weeks=> Chlamydia => Oral Erythromycine
Charactristics of fetal alcohol syn?
- Microcephaly
- MR
- small palpebral fissure
- thin vermillon
- small philtrum
Mechanism of Hepatorenal Syndrome?
Increased NO=> renal vasodilation=> increased NA secretion from kidneys=> Hyponatremia
What is Beckwith-Wiedmann syn?
Disregulation of 11p15 gene Hemihyperplasia Macroglossia Rapid growth Umblical Hernia Omphalocele
Treatment of Trichotilomania?
Cognitive Behavioral therapy
Definition of Menorrhagia?
Bleeding > 7 days
Bleeding> 80 ml
Treatment for acute abnormal uterin bleeding?
- estrogen
- progestron
- ocp
- Teranexamide acid
Treatment of HIV + pregnants?
Treatment of HIV+ infant?
1 Neuclotide reverse transcriptase inh.
2 NNRTI+ Protease Inh.
- Zidovudin > 6 weeks
Approach to Uterus/Cervix hyperplasia?
- regular cells => Progestrone therapy
- Atypical cells=> Hysterectomy/ wanna get pregnant=> Progestrone therapy
What are the survilance tests in high risk pregnancies?
NST, contraction stress test, umblical U/S
Arrest of labor?
- no cervical change after 4 hours inspite of adequate contractions
- no cervical change after 6 hours inspite of inadequate contractions
- > 200 montecidco unit ( number of contractions in 10 min * strength of contractions)
HTN+ Hypokalemia Dx?
Charectristics of primary hyperaldostronism?
- Primary Hyperaldostronism
- plasma Aldostrone> 15
- PAC/PRC>20
Side effect of Fluphnazine?
Hypothermia
Vaccines for cirrhotic patients:
Hep A(0-6), /Hep B, (0-1-4) Influenza, TdT, Pneuomococus
Pseudocyesis?
False pregnancy
What antibiotics are safein pregnancy?
Nitroforantoin, Amoxiciline, Amoxicilin-cavolonic acid, Cephalexin
Ant. Mediastenal mass DDX?
Thymoma
Thyroid
Lymphoma
Teratoma
What is succssion splash sound?
Retaining gastric materials > 3 hours make this sound.
Causes of increase BUN/CR?
- pre- renal
- GI bleeding
- steroids
Charectristics of cerebellar degeneration?
- nystagmus
- intention tremor
- Dysdiadocholcinesia
- gate dysfunction
- Truncal Ataxia
Charactristics of theophyline toxicity?
CNS( headache, insomnia, seizures) / GI( nausea vomitting)/ cardiac( Arrhythmia)
Etiology of Astigmatism?
non spherical cornea
Mixed cryoglubolinemia:
Low complement, Gelomeronephritis, petechia and purpura, splenomegaly, Arthralgia, Peripheral neuropathy
Two mutations in hypertrophic cardiomyopathy:
Cardiac myosin binding pr C gene
Cardiac b myosin heavy chain gene
Diet for renal calculi?
High fluid, high Ca, low Na, low Pr
Doc for idiopathic intracranial HTN?
Acetazolamide => decrease csf production / if stmptoms continue then Furosmide
Leriche syndrome?
Bilateral hip tigh and buttock cludication impotence and symmetric atrophy of the bilateral lower extremities due to chronic ischemia. The ethiology is peripheral A disease involving the biforcation of abdominal aorta as it transiotions to common illiac A.
Treatment for idiopathic intracranial HTN ?
Acetazolamide.. It decreases choroid plxus carbonic anhydrase and will decrease csf production. No improvement then=> Forusemide
Causes of meningitis in 2-50 y/o?
Causes of meningitis in > 50
Causes of meningitis in shunt?
Causes of meningitis in immunocomoromised?
2-50=> meningoccoc, Pneumoccoc=> treatment is ceftriaxone and vanco
50 meningoccoc, Pneumoccoc, Lysteria=> ceftriaxone, vanco, Ampi
Treatment for shunt is like in 2-50/ treatment in immunocompromised is like in > 50
Dx of Waterhouse Fredrichsen syn.?
Flank pain and rash and hypotension crisis
Approach to esophagyal coins?
No symptom: observation for 24 hours
Symptomatic: flexible endoscopy
Charactristics of Galactosemia?
Consequence of having Galactosemia?
Cateracts, jundice, LBW, vomitting, hepatomegaly, convulsion
E.coli sepsis
Panner disease?
Osteochondrosis of capitellum in a person who involves in throwing . It’s chronic dull pain, crepitation, loss of supination and pronation
What is pompe?
Acid Maltase defficiency. Floppy baby+ macroglossia+ HF
Two tests to diagnose hereditary spherositosis?
- Eosin 5 melamid binding test
- Acidified glycerol binding test
How to distinguish between lymphedema and other causes of edema?
Lymphedema is non pitting
What are the polymicrobial infections? Tx?
Tubo ovarian abcess, post partum endometritis. Tx: clinda genta
Contraindications of breast feeding?
- Herpes zoster - Substance abuse
- Varicella zoster - HIV
- TB
- Galactosemia
- HIv
Panner disease?
Osteochondrosis of capitullom
Fanconi syn
Pancytopenia, macrocytosis,microcephaly, microphtalmia, short stature, horse shoe kidney, cafe lait spots, absent thumbs
Disease associated with truncus arteriosus?
Di george
Tolvaptan
V2 Receptor antagonist which causes selective water loss without sodium potassium excretion. It’s good for uvolumic or hypervolemic hypernatremia.
Indications for urgent dyalisis:
- Metabolic Acidosis PH: 7.1
- Electrolyte abnormalities ( Hyperkalemia > 6.5, Hyperkalemia refractory to medical therapy, Hyperkalemia with ECG changes)
- Ingestion( Alcohol, Salicylates, Lithium, Sodium Valproat Carbamazepin)
- volume overload
- Uremia ( Encephalopathy, Preicarditis, Bleeding)
Association between HBA1C and Glucose level of the blood?
Every 35 gr => 1% increase Hb A1C
Pulmonary function test in asthma?
- Increased FEV1 more than 12% and 200 ML with the use of Albuterol
- decreased FEV1 more than 20% with the use of Methacoline or Histamine
Adverese effect of inhaled corticosteroids?
- Dysphonia , oral candidiasis
What are the diagnostic tests to evaluate asthma exacerbation?
- PFT
- ABG with increased A-a gradient
Indication of Magnesium in asthma?
It helps to relieve the symptoms of severe asthma not responsive to albuterol while waiting for corticosteroids.
Wheezing mechanism in asthma?
Loss of air movement.
How to improve mortality and delay progression of the disease in Asthma and COPD?
Smoking cessation, o2 therapy when po2
Pappenheimer body?
Iron containing inclusions found in prepheral RBC. They result from phagosomes that engulf excessive amount of iron that typically seen in sideroblastic anemia.
COPD Antibiotics:
- Macrolids
- Amoxiciline
- cephalosporines
- quinolone
Second line:
- Doxy
- trimetoprim
Tx for Bronchectasis?
- Chest physiotherapy
- rotate antibiotics one weekly
- Surgical resection
- Antibiotics are the same with COPD , the only difference is that microbiology finding should be done , M. Avium is seen
Indication for hospital addmission:
- T> 104 - RR> 30/ O2 30/ Na>130/ glucose> 250
- confusion
- pulse>125
- hypotension
In patient and outpatient treatment for pneumonia:
Outpatient: Macrolids, cipro
Inpatient: cipro, Azitro, Ceftriaxone
Varenicycline?
Partial agonist at nicotinic acetylcholin receptors
When to start Antibiotic therapy for opportunistic infections in pregnancy?
CD4
Nl QRS?
How to distinguish between Atrial flutter and Trial fibrilation?
Atrial Fibrilation the rythm is irregular but in Atrial Flutter there is a regular rythm.
What are the causes of atrial flutter, atrial fibrilation and Supraventricular tachycardia?
- hyperstimulation of sympathic
- large amount of caffein
- hyperthyriodism
- psychological distress
Treatment of SVT, Atrial Flutter, Atrial fibrilation?
Carotid massage, intravenou adenosine
What is MAT?( multifocal atrial tachycardia)
It can b seen in coronary pulmonary diseases ( COPD )
Charactristcis of Atrial fibrilation, Atrial flutter, Supraventricular tachycarida on ECG?
QRS
TX for supraventricular tachycardia?
Carotid massage and Adenosine
Charactristic of Torsade do point?
Causes of torsade do point?
QRS> 120 - Dofetilide
- Hypomagnesemia - Ibutilid
- macrolides and Quinolones
- TCA
- Amiodarone
- charactristics of Supraventricular tachycardia?
- how can it be described?
- Delta Waves
- worsen after a Ca channel blocker or Digoxin
What is CKMB used for?
It increases after 4-6 hours and will peak after 12 hours.
Reinfection
What is Dobutamin?
Beta agonist that can be used as an stress test
When is the Holter Monitoring the right answer?
When the patient is having syncope or palpitation with normal ECG.
What is Ergonovin test?
To zdx Prinzmetal angina. It’s a chestpain in patients
In Which dermatologic condition Excisional Biopse is needed?
Malignant melanoma
Indication of Transesophageal Echo?
To find out any thrombi in heart chambers before cardioversion of AF
When stress test is an answer?
- when pain is atypical
- post MI to determine the need for angiography
- patients with medications
Difference between Pemphigus Vulgaris and Bullous Pemphigoid?
Pamphigus Vulgaris there is Ig G and c3 between epidermal cells. In Bullous Pemphigoid there is IgG and C3 at dermo epidermal junction
What is Skeletal Survay indication?
When you’re suspeciouse of MM, Child abuse , metastatic bone tumor
Risk of sepsis after splenectomy?
How’s the approach to that?
10 years
What is klumpske palsy?
C8 & T1 root ( inf. Brachial) involvement which causes Ulnar injury.
Post- ischemic compartment syn?
After tissue reperfusion due to increased interacellular edema
When we’ll see nervouse system symptoms in blood loss?
when there is > 30-40% volume loss (1500-2000 cc)
First initial test to dx dermatomyositis and polymyositis?
The most accurate test to dx dermatomyositis and polymyositis?
Cpk, cr, Aldolase
Muscle biposy
Drugs causing SLE
- Procain amid - Phenytoin
- Penicillamine
- Hydralazine
- Isoniazide
- sulfanamide
What are the bite cells?
Othey formed when Heinz bodies are removed from the body
What situations will cause sideroblastic anemia?
- Lead - Myelodysplastic syn.
- Zinc
- Alcohol
- Isoniazide
- Chloramphenicol
Charactristics of MM
Rouleaux formation
Renal failure
Hypercalcemia
Anemia
The most accurate test to Dx SCD?
Hb Electrophoresis
Most accurate test to DX hereditary Espherositosis?
Osmotic fragility test
- Tear drop is the indication of ?
- what is the best diagnostic test?
- Myelofibrosis
- BM biopsy which will show reticulin fibers
When will we see target cells?
- liver disease, SCD, Thalssemia, Iron defficiency
What are the two tests to confirm perniciouse anemia?
- Anti Parietal cell antibody
- Anti intrinsic factor antibody
DX of micrangiopathic hemolytic anemia?
- dark urine in the mornings
- Pancytopenia
- large vessels thrombosis
When and how to messure BT?
What are the other follow ups?
- blod pressure cuff should inflate 40 mmhg then we’ll make small cuts.
When there is an abnormal bleeding and platelet counts are normal. - VWF level, Ristocetin, in vitro platelets study
Mechanism of Adenosine and digoxin and b-blockers?
Adenosine is ca channel blocker and inhibits AV node conductance. Digoxin and B blockers delay AV node conductance
What is the pathophysiology of CTS?
Deposition of mucopolysacharid matrix in perimisium and Endomisium of median N.
Which syndrome is associated with CTS?
Hypothyroidism
How is Antithrombothic therapy for stroke?
- within 3-4 hours=> Alteplase
- No previouse throbothic therapy=> ASA
- previouse ASA=> ASA+ chlopidogrel
- previouse ASA+ thrombosis of large Arteries=> ASA+ Chlopidogrel
- Stroke + Atrial fibrilation=> Heparin or Warfarin
What are some antiemetic medications?
- Metochloropramide( Anti dopaminergic)
- Scopolamine( Anticholinergic)
- Ondansetrone( Anti serotonergic)
What are thw two malignancies associated with SVC syn.?
- Small cell lung carcinoma
- Non Hodgkin Lymphoma
How will you define Neutropenia?
Whatkind of treatment should be considered in neutropenia fever?
ANC
What is the first approach before starting achalasia treatment?
Endoscopy
Babesiosis:
- jindice, hemolytic anemia, dark urine, tick bite
-TX: Azitromycine- Ativaquine
Clinda- quinidine
Severity of Hypoxemia is based on:?
Pio2/fio2 moderate
200
ARDS pathophysiology:
Increased pulmonary HTN
Impaired gas exchange
Decreased lung compliance
Indication of mechanical ventilation in ARDS?
- Low tidal volume ventilation 5-8 ml/kg
- inspiratory airway pressure
What should be done when based on the clinical syptoms the chances of PE islow?
D- dimer
RO PE
>500=> CT
- what is Burr cells?
- what is Spur cells?
- Bar cells or Echinocytes have lots of spicules and are seen in end stage renal and liver disease
- Spur cells or Acanthocytes have few spicules and are seen in Myelodysplasia and Hereditary Spherocytosis
- Indication of needle biopsy and Excisional biopsy of a lymph node?
- If the lymph node is hot and tender and shows an infection we should perform needle biopsy , if we are suspeciouse about Lymphoma we should do excisional biopsy.
What is philadelphia cromosome?
How to Dx CML?
How would you be suspeciouse about CML?
Tx of CML?
It can be seen in CML
PCR
When we see high WBCs but low LAP( Leukocyte Alkaline phosphatase)
Imatinib( Gleevec )
When should we do Barium Enema?
- when we are suspeciouse of Diverticulosis, omstruction, polyp, cancer, IBD
What are the initial tests we order to Dx Pancreatitis?
What is the most accurate test to dx Pancreatitis?
- Amylase & Lipase
- Abdominal CT Scan
What are anti endomysial and anti gliadine antibodies?
They used to confirm celiac disease. After Sudan black has confirmed a fat malabsorbtion.
The initial test to dx Primary Biliary Cirrhosis?
Signs and symptoms of primary biliary cirrhosis?
Most accurate test to dx primary biliary cirrhosis?
- Anti mitochondrial Antibody
- itching and increased ALKP and normal bil
- Liver Biopsy
Which antibodies are positive in Autoimmune hepatitis?
- ANA
- Anti smooth muscle antibody
- anti liver/ kidney microsome type 1
Indications of ERCP
- primary biliary cirrhosis
- biliary stones
- patient with history of ulcerative colitis aoplaining of pruritis and jundice with negative hepatitis profile and negative abdominal sono
Indication of fecal leukocytes?
To assess the etiology of acute diarrhea
Colonoscopy screening protocol?
Start at 50, every 10 years, positive family member start at 40 repeat evry 10 years
HNPCC: start at 25 , repeat every 1-2 years
What is deoxylase test?
It is a sugar which is absobed by intestine and will use to identify the source of malabsorbtion weather it’s pancrease or small intestine. If it’s small intestine then the D- Oxylase in urine wil, be low.
Benefit of FOB?
Screening test for colon cancer?
- It can detect 5-10 cc blood in stool , versus 100 cc which causes dark stool.
- colonoscopy every 10 years, sigmoidoscopy every 3 years, FOB every year
Etiologies of high gastrin?
- zollinger elison ( part of MEN 1)
- Patient use PPIs
What is Gastrografin?
What is the most accurate test?
Is water soluble form of radio opaque contrast used when we are suspeciouse of perforation like burrhave syn.
Abdominal CT Scan
What is Secretin Stimulation test?
To Dx Zolinger Elison and Pancreatitis
In zolinger elison we have high gastrin and secretin secretion would not stop gastrin secretion. In chronic pancreatitis the pancrease is so burned out and would not increase bicarbonate secretion with gastrin release.
When should we measure trypsinogen level?
When black sudan shows malabsorbtion and anti- gliadin N anti- endomysial are normal.
What is the best initial test for dysphagia?
Barium esophagram
What is the most accurate test for esophageal rings, webs and diverticuli?
Barium Esophagram
The most accurate test for achalasia, esophageal spasm and nutcracker esophagus?
Manometry
Homochromatosis charactristics?
What is the most accurate test?
Liver disease, DM, infertility, joint pain, hyperpigmentation, cardiomayopathy
Liver biopsy
What is Sudan black?
It is used to detect steatorrheah
What is the next step when sudan black is negative?
3 days stool collection to find fat malabsorbtion
What is the most sensitive test to find giardia?
What is the most accurate test to find giardia?
Stool ova and parasite
Stool giardia Ag
What is Roth spot?
A cotton wool spot( infarct ) with serrounding hemorrhage Subacute bacterial endocarditis Lekemia Anemia HTN DM HIV
What is IUFD?
In utero feath after 20 weeks
Definition of Polyhydramniose?
Single deep pocket (SDP > 8) (AFI> 24)
Single deep pocket ( SDP
Which test can be done to differenciate Gonorrhea and chlamydia?
Nucleotide amplification test
Routine vaccines in pregnancy?
Special vaccines in pregnancy?
Influenza, Tdap
Hep A, Hep B, anti Ro, pneumococ, meningococ, H. Flu
How is non-stress test(NST)?
What is Biophysical?
Contraction stress test?
- Fetal HR for 20-40 min: 2 deccleration= inactive
- biophysical: Fetal HR+ U/S: fetal movement+ fetal tone+ Fetal breathing+ Amniotic volume => 8-10 normal/
Normal contraction stress test?
Abnormal contraction stress test?
Equivocal contraction stress test?
Unsatisfactory contraction stress test?
Normal: no deccelaration
Abnormal: uterin deccelartion with >50% contractions
Equivocal: reccurent intermittent contractions
Unsatisfactory:
Which hormones alpha subunites are the same?
FSH, LH, BHCG, TSH
Which part of the fetus secret B-HCG?
Functions of BHCG?
Synsiciotrophoblast
Perservation of corpus Leteum
Promotion of sexual differences
Stimulation of maternal thyroid gland
Ehat is physiologic Leukorrhea?
Copius white or yellow discharge without burning, itching, malodorouse dircharge. There is no tenderness, or erythema or edema of cervix and vagina.
STD screening before pregnancy?
Syphilis for everybody, Gonorrhea and Chlamydia only for those at risk.
Alfa Pheto proteins secretred from which organs?
Liver- GI- Yolk sac
Low Alfa phitoprotein and high alfa phytoprotein in:
Low alfa phytoprotein in trisomies
High alfa phytoproteins in neural tube deffect, abdominal wall defect, multiple gestation
Pattern of Hemophylia inheritance?
AR
Tests in middle age woman with insomnia, night sweats, palpitations and irregular menses?
TSH, FSH
How is quadriple test in trisomy21, 18 and neural tube deffect?
Trisomy 21: high alpha fitoprotein, high inhibin and low everything else.
Trisomy18: low everything but inhibin A normal
Neural tube deffect: only high alpha-fitoprotein
HPV vaccine protocol?
Men and boys 9-21
Women and girls 9-26
Immunocompromised 9-26
Not indicated in pregnancy
Cervical cancer screening in : -> 65 no screening if there is no risk
- immunocompromised Onset of sexual intercourse every 6 month for 2 years then annualy
-
no screening
21-29=> cytology every 3 years
31-35 => cytology every 3 years or cytology + HpV every 5 years
>65 no screening if low risk
Immunocompromised: onset of sexual intercourse every 6 months for 2 years then annually
Aproach to palpable breast mass:
> 30 => mamogram+ U/S if suspeciouse => core biopsy
u/s :If there is a single cyst => needle aspiration
If there is complex cyst=> image guided core biopsy
Hormonal changes in Athelte woman with amenorrhea:
- low GnRH
- Low LH
- Low estrogen
At what BHCG level you ‘ll be able to see intauterine pregnancy?
What if BHCG is less than this amount?
1500-2000
We wait for 48 hours that BhCG will be doubled.
Causes of hyperendrogenism in pregnancy?
1) Lutheoma ( yellow or yellow brown masses often with hemorrhage of large lutein cyst
2) theca Luteom cyst( Bilateral associated with molar and multiple pregnancy)
3) Krukenberg ( Bilateral metastasis from GI)
What is Porcelain gallbladder?
It’s a calcified gallbladder and can be developed to gallbladder carcinoma.
How is sweat chloride test is being done?
Pilocarpin is given and the amount of sodium and chloride will be measured in the sweat.
Mechanism of Rasburicase and Pegloticase?
- they break down uric acid to Allantoin.
Transient sinovitis?
Most common cause of hip pain inn 7-10 years old children. After trauma or infection.
Septic Arthritis?
Fever> 38
ESR>40
CRP>2
WBC>12000
Charactristics of Hydrocephalus in neonates?
Next step?
Wide sutures, low activity, buldging fontanels, iritibility, poor feeding, vomiting, prominant scalp veins
Causes of bacterial Rhinosynovitis?
Treatment of Rhinosinovitis?
Moraxella, H Influenza, Strep
Amoxicillin+ clavolonic acid
Charactristics of prulent Rhinosinovitis?
Fever Syptoms after 10 days Prulent nasal discharge Facial pain for 3 days Worsening symptoms > 5 days after URTI
Cause of Bronchiolitis in children?
Tx of Bronchilitis in children?
Prevention of Bronchiolitis in children?
Complications of Bronchiolitis?
- RSV
- Supportive
- Palivizumab
- Apnea/ Respiratory Failure
What is sturge weber?
Neurocutaneouse disease with cavrenous hemangioma + Intracranial calcifications
Charactristics of vit B2 defficiency?
Cheilosis Stomatitis Normochrom normocytic anemia Seborrheic Dermatitis Glossitis
Only exception for scheduled vaccination?
Hep B
Complications of prematurity?
- RDS - Bronchopulmonary dysplasia
- PDA
- retinopathy of prematurity
- Necroziting entrocolitis
- intraventricular hemorrhage
Causes of QT prolongation:
Tx:
- meds
- inherited: Jerel lang nielsen & Romano ward
- Electrolyte imbalance: hypocalcemia/ hypokalemia/ hypomagnesemia
- pacemaker and b blocker
Tx for Basillary Angiomatosis:
Oral Erythromycine
Extra manifestations of UC?
- colorectal cancer
- toxic megacolon
- cholangiocarcinima
- uveitis
- Erythema nodusom
Approach to severe Hematochesia?
NG aspiration: blood? Yes-> endoscopy no-> colonoscopy
Find the source? Yes-> treat No? -> still bleeding -> surgery no bleed-> small intestin study
Different levels of HCT?
HCT 30-35 is normal
25-30 Dyspnea
20-25 angina
Under 20 chest pain and syncope
When can we see cold IG?
Mycoplasma, EBV, Waldostrome macroglubolinemia,
Iron defficiency anemia risk factors?
- Prematurity
- Lead poisoning
- toddlers>24 M on a daily milk
- infants who consume low iron formula, cow milk, soy milk, goats milk 6 M
Heart involvement in Edward syndrome and william syndrome?
Edward syndrome: VSD
William: Aortic Stenosis
Approach to lead poisoning:
5-45 nothing, 45-75 DMSA, 75
Charactristics of Macun Albright:
- Pigmentation - precocious puberty- polyostotic fibrouse dysplasia
Defect in Macun Albright?
G-protein CAMP kinase function defect
Causes of neck pain:
- trauma
- URTI
- cervicallymphadenitis
- retropharyngeal abcess
Difference between precociouse puberty in Macun-Albright and Adrenal insufficiency?
In macun albright the preciciouse puberty in homosexual in Adrenal diffiency
Ethilogy of macun Albright:
G- protein CAMP kinase function
Treatment for Impetigo?
Mupirocine topical
Contraindication of breast feeding in an infant?
Galactosemia
Which diseases are associated with intussuception?
Meckel diverticulum and Henoch Shonlein purpura
What is PANDAS?
Pediatric autoimmune neuropsychiatric disorder associated with strep.
HCT levels and its effects
30-35
Causes of sideroblastic anemia:
Alcohol, lead, isoniazide, Less B6
How much iron is needed in normal person, mensturation, pregnancy?
Nl: 1-2 mg
Mensturation: 5-6
Pregnant: 2-3
Side effect of folate and B12 replacement therapy?
Hypokalemia
Where can we see cold antibodies?
- EBV
- Waldostrom microglobolinemia
- Mycoplasma
Charactristics of Wegner?
Systemic vasculitis, upper and lowe airway granolumatose inflammation, gelomeronephritis, cutaneous leisions
Prophylaxies in :
- mycobacterium Avium - TB
- P. Cyctis jirovenji
- Toxoplasma Gondii
- Cryptococcus
- Azitromycine
- Cotrimoxazole
- Cotrimoxazole
- Fluconazole
- Isoniazide
Approach to recurrent chalazion?
Histopathology, r/o BCC and sebaceous Carcinoma
Another name for Osteitis Fibrosa cystica?
Von Rickling Hausen
- increase osteoclast activity and increasing bone resorbtion
Diseases associated with avascular necrosis?
- SCD/ Corticosteroids/ Alcohol/ SLE
Mechanism of Thrombosis in heparin induced thrombocytopenia?
Heparin will attach to PFT4 -> increase IgG -> attache to plt RS and activates platelets-> PFT4+ IgG+ platelets= > release cytokines like VWF -> induce thrombosis
What type of cancer is associated with Percelain gallbladder?
Adenocarcinoma
Most common causes of conjunctivitis right after birth, 5 days later, more than 5 days?
Right after birth is chemical, 5 days later is Gonorrhea after 5 days is chlamydia.
How would you recognize water house fridrichsen syndrome?
Flank pain + rash + Hypotension
Charactristics of Galactosemia?
Consequence of having Galactosemia?
Jundice, Cateract, LBW, Vomitting, Hepatomegaly and convulsion
E.Coli Sepsis
Charactristics of mild , moderate , severe volume loss?
Mild (2-3%) and the child is normal
Moderate (3-5%) and there is loss of skin tregor and dried mucosa
Severe (10-15%) sunken eyes, delayed capillary refill more than 35 , cool extremities.
Another name for nursemaid elbow?
Treatment for nursemail elbow?
Radial sublaxation
Hyperpronation, supination and flexion
What is Von Griek?
Glucose 6 phosphatase defficiency/ hypoglycemia/ hyperuricemia/ hyperlipidemia/ hyper lactic acidosis/ doll face, short stature, thin extremities
What is Dejernie Roussy syn.
It involves VPL nucleus and there is contralateral hemianesthesia + transient hemiparesis
Prophylaxis for ctryptococcus in HIV + patients?
Fluconasoleoo
Coplication of corniea bacterium diphteria?
Dilated cardiomyopathy
Two meds in diabetic patients that can be prescribed in renal inssuficiency?
Thiazolindiones and dipeptidyl dipeptidsse 4 inhibitiors
What alpha 2 blocker is being used to sedate patients in ICU?
Dexmedetomidine
What med can be used to treat encephalopathy if lactolose does not work?
Rifaximin
Difference between cauda equina and conus medularis?
Conus medularis is bailateral parelysis/ perianal paresthesia/ Hyperreflexia/ early onset / early bladder and bowel dysfunction
ECG changes in Hypertrophic cardiomayopathy?
Tall R in AVL and repolarization changes in avl, V4, v5, v6 and 1.
Nasal discharge+ cornea neovascularization ethiology?
Chlamydia
Which disease is associates with truncus Arteriosus?
Di george
What are the DDX of crying infant?
- colic-> > 3 hours/ day > 3 days a week > 3 weeks
- normal crying
- Milk Allergy
- GERD
- hair torniquet - corneal abraision
Charactristics of tricuspid valve atresia:
Pulmonary undercirculation and decreased pulmonary markings. Small or absent R waves
How would you distinguish between androgen insensitivity and Mullerian Agenesis?
In Androgen insensitivity there is no pubic or axillaryhair.
OI mutation?
Col 1 A1
Indication of packed RBC?
Unstable
Early complication of DM renal disease?
Gelumerolar hyperinfiltration
Gelumerular sclerosis
What are the diseases associated with erythema nodusome?
- TB
- Sarcoidosis
- IBD
- Histoplasmosis
How would you approach to atypical squamouse cell of undetermined significance?
repeat cytology in 1 year if + colposcopy if - reapaet in one year if positive colposcopy if - papsmear 2 times and routin screening
> 25 and HPV + -> colposcopy if - repeat papsmear and hpv in 3 years
Snide effects of Metimazole:
Side effect of Propylthiouracil:
Metimazole side effect: teratogen/ cholestasis
Propylthiouracil: vaculitis like diseases / Hepatic failure
Tx for the patient who cant tolerate vancomycine?
Fidaxomycine
Ulna entrapment is in :
Elbow
Tx of uncomplicated cystitis, complicated cystitis and pyelonephritis?
Uncomplicated cystitis : Nitrofurantoin, TMX, Fosfomycine
Complicated cystitis: Cipro
Pyelonephritis: Cipro
Charactristics of Leprosy?
Diagnostic test for leprosy?
Patient has cough, coriza , malaise and fatigue then hypopigmented leisions without any senses.
Skin biopsy shows T lymphocytes.
Approach to hypercalcemia?
Mechanism of Heparin induced thrombocytopenia?
Ab against platelet factor 4
Argatroban, Fundaparinox, Bivilirudin
Ddxof low pleural glucose?
- Empyema
- TB
- SLE
- Malignancy
- esophageal rupture
What are the HACEK organisms which cause endocarditis?
Hemophylus, Actinomycetem, cardiobacter, ekinella, kingella
Charactristics of HNPCC?
Side effects of Ca channel blockers? Amilodipine, Nimodipine
Tx ?
Peripheral edema,
ACE Inhibitors
Side effects of B agonists?
Tremor, hypokalemia, palpitation, headache
Connection between thyroid hormones, dopamin and prolactin?
Dopamin and thyroid hormones will supress prolactine.
Charactristics of fat necrosis:
TX:
Calcification, hypoecho mass, breast retraction
No TX is needed.
Side effects of Raloxifen and Tamoxifen?
Raloxifen: DVT
Tamoxifen: endometrial cancer
Indication of Trazodone?
Depression+Insomnia
Acute distress disorder and PTSD?
Acute distress disorder is less than a month, PTSD is more than one month.
5 drugs approved for OCD:
- Fluexetine
- Flovoxamine
- Serteraline
- Paroxetine
- Clomipramine
Charactristics of osteoid osteoma?
Round leisions with sclerotic margines.
Indication for these Antipsychotics:
- Adenosin: Supraventricular tachycardia
- Amiodarone: Vtac
- Atropin: bradycardia
- calcium gluconate: hyperkalemia
Compensation mechanisms for metabloic acidosis, metabolic alkalosis, respiratory acidosis, respiratory alkalosis:
Metabolic acidosis: paco2= 1.5 ( hco3) +8 +- 2
Metabolic alkalosis: increase pco2 by 0.7 for every 1 meq rise in Hco3
Respiratory acidosis: increase hco3 1meq for every 10 mmhg rise in paco2
Respiratory Alkalosis: decrease serum hco3 by 2 for every 10 meq decrease in paco2
Intusucception?
It happens after a gastroentritis with inflammation of lymphoid tissue, sussage shape mass, target sign in US, pain upon raising the leg toward the abdomen and TX is air enema.
Charactristics of Fabry disease:
Alpha1 galactosidase defficiency/ Angiokeratoma/ peripheral Neuropathy/ asymmetric corneal dystrophy/ renal failure/ heart failure/ thromboembolic events
Charactristics of hemocysteinuria?
It looks like Marfan/ tall stature, fair skin, dislocation of the lense inward and down, thrombosis/ megaloblastic anemia.
Most common cause of secondary HTN in children?
Fibromascular dysplasia , angiography shows strings of beads and there is a bruit in costovertebral angle.
Most common cause of Osteomyeleitis is a patient with URI?
Klebisella and pseudomona.
Clopmiphen mechanism:
It is estrogen analougue which helps to increase FSH and GnRH
Magnesium toxicity ?!
Diarrhea, nausea, vomitting, muscle weekness, decreased DTR
How would you interpret Ankle Brachial reflex?
- 9-1.30 is normal
1. 30> clacified and uncompressable vessle
Mechanisms to decrease ICP?
- head elevation
- Monitol
- shunt
- sedation
- hyperventilation
Side effect of Tacrolimus?
Neurotoxicity, Diarrhea, glucose intolerance
Side effect of micofenolate?
BM supression
Multiple trauma approach?
Fast ( U/S ) , stable see blood -> laparascopy no blood-> CT Scan
Unstable see blood-> laparatomy no blood -> DPL
Mechanism of chlomiphen?
It’s strogen Analogue and will increase GnRH and FsH.
CPPD in?
Wilson, DM, Hypothyroidism, Hyperparathyroidism, Pseudogout, Homochromatosis
Most common cause of death in young people with SLE and old people with SLE?
Young-> infection
Old-> Atherosclerosis
Charactristicsis of Hereditary Angioedema?
Differences between hereditary and aquired Angioedema?
- decreased c1 inhibitor, C4 and increased c2b,
- in hereditary form c1q is normal in aquired there is low c1q.
Mechanism of Riluzol?
Glutamate inhibitor
Charactristics of MCA stroke?
Aphasia
Eyes deviated toward the leision
Contralateral hepiparesis
Neglect if non- dominant lobe is involved
Charactristics of basal ganglia stroke?
- pure motor or sensory loss
- Dysarthria
- clammsy hand syn.
- Ataxic Hemiparesis.
Charactristics of basillar stroke?
- locked in syn - dysphagia
- coma - dysarthria
- cranial N palsy - vertigo
- Apnea - drop attacks
- visual symptoms - weakness of ipsilateral face and
Contralateral body
4 Ds of Post. Circulation stroke?
- Dysphagia
- Dysarthria
- dizziness
- Diplopia
Diseases associated with berry Aneurysm?
- Marfan - PKD
- Ehler Danlos - Familial
- SCD
- coaractation of aorta
- Athrosclerosis
Management of subarachnoid hemoorhage ?
- BP
Charactristics of MCA stroke?
1- contralateral hemiparesisi and hemisensory loss
2- Aphasia
3- neglect if non dominant lobe is involved
4- gaze toward the leision
Charactristics of basal ganglia stroke?
- clumsy hand syndrome
- ataxic hemiparesis
- pure sensory or motor loss
- Dysarthria
Charactristics of basialr Artery strokes?
- Vertigo - locked in syndrome
- cranial nerve is involved - sesonry loss in one side and weakness
- vision loss In contralateral side
- Dysphagia - Apnea
- Dysarthria - drop attacks
- coma
4 Ds of posterior circulation strokes?
- Diplopia
- Dysarthria
- Dysphagia
- Dizziness
Contraindications of TPA?
- HTN > 185/110 - Surgery in the past 2 weeks
- Glucose > 500 or 1.7
Associations with berry Aneurysm?
- SCD - Coaractation of Aeorta
- Marfan
- Ehler Danlose syn.
- PKD
- Atherosclerosis
- Familial
Basic steps in management of SAH?
- LP
- Head elevation
- Ca- channel blocker
- lowering BP
DDx of severe headache?
- primary
- increased ICP
- Angle closure Glucoma
- Thrombosis
- Hemorrhage
How to Dx headache related to cavernous sinus thrombisis?
- recent orbital facial infections
- proptosis, ptosis, red eyes
- ophtalmoplasia
- confusion, drowsiness, coma
- visual disturbance, diplopia , orbital pain
What is infantile spasm or west syn?
Generalized epilepsy 6 months after birth. It could be due to PKU, infections, Tuberouse sclerosis, hypoxic ischemic stroke.
What does protrin C do?
It inhibits factor V.
Which drugs are inhibited in Myastenia Gravis?
B-blockers and Aminoglycosides
Ddx of eaton lambert and myastenia gravis?
Eaton lambert gets better with activity but Myastenia gravis gets worse with activity.
Tx of Eaton Lambert?
- Pyridostegmine
- Guanidine
- 3,4 diamonopyrydine
What is Dawsons fingers?
Asymmetrical periventricular white matter leisions specially in corpus callusum.
Tx for Eaton Lambert?
- Guanidin
- Pyridostigimine
- 2/3 Dyamniopyridin
What is the main charactristics of ALS?
No eye or bladder is involved.
Tx for ITP?
- IVIG
- Splenectomy
- Corticosteroids
Tx for TTP?
- Plasmaphresis
- Corticosteroids
Lab tests in CML?
- low LAP
Exudate Pleural Effusion charactristics?
Ph 60%
Pr> 50%
How would you define severe PCP?
PH35
Po2
PCP treatments?
TMX/ Clinda + Primaquine or Pentamidine
Charactristic of PCP?
High LDH
Exudate pulmonary effusion charactristics?
- PH
How is sweat chloride test is being done?
Pilocarpin is given and the amount of sodium and chloride will be measured in the sweat.
Mechanism of Rasburicase and Pegloticase?
- they break down uric acid to Allantoin.
Transient sinovitis?
Most common cause of hip pain inn 7-10 years old children. After trauma or infection.
Septic Arthritis?
Fever> 38
ESR>40
CRP>2
WBC>12000
Charactristics of Hydrocephalus in neonates?
Next step?
Wide sutures, low activity, buldging fontanels, iritibility, poor feeding, vomiting, prominant scalp veins
Causes of bacterial Rhinosynovitis?
Treatment of Rhinosinovitis?
Moraxella, H Influenza, Strep
Amoxicillin+ clavolonic acid
Charactristics of prulent Rhinosinovitis?
Fever Syptoms after 10 days Prulent nasal discharge Facial pain for 3 days Worsening symptoms > 5 days after URTI
Cause of Bronchiolitis in children?
Tx of Bronchilitis in children?
Prevention of Bronchiolitis in children?
Complications of Bronchiolitis?
- RSV
- Supportive
- Palivizumab
- Apnea/ Respiratory Failure
What is sturge weber?
Neurocutaneouse disease with cavrenous hemangioma + Intracranial calcifications
Charactristics of vit B2 defficiency?
Cheilosis Stomatitis Normochrom normocytic anemia Seborrheic Dermatitis Glossitis
Only exception for scheduled vaccination?
Hep B
Exudate pulmonary effusion charactristics?
- PH
Charactristic of PCP?
High LDH
PCP treatments?
TMX/ Clinda + Primaquine or Pentamidine
How would you define severe PCP?
PH35
Po2
Exudate Pleural Effusion charactristics?
Ph 60%
Pr> 50%
Lab tests in CML?
- low LAP
Tx for TTP?
- Plasmaphresis
- Corticosteroids
Tx for ITP?
- IVIG
- Splenectomy
- Corticosteroids
What is the main charactristics of ALS?
No eye or bladder is involved.
Tx for Eaton Lambert?
- Guanidin
- Pyridostigimine
- 2/3 Dyamniopyridin
What is Dawsons fingers?
Asymmetrical periventricular white matter leisions specially in corpus callusum.
Tx of Eaton Lambert?
- Pyridostegmine
- Guanidine
- 3,4 diamonopyrydine
Ddx of eaton lambert and myastenia gravis?
Eaton lambert gets better with activity but Myastenia gravis gets worse with activity.
Which drugs are inhibited in Myastenia Gravis?
B-blockers and Aminoglycosides
What does protrin C do?
It inhibits factor V.
What is infantile spasm or west syn?
Generalized epilepsy 6 months after birth. It could be due to PKU, infections, Tuberouse sclerosis, hypoxic ischemic stroke.
How to Dx headache related to cavernous sinus thrombisis?
- recent orbital facial infections
- proptosis, ptosis, red eyes
- ophtalmoplasia
- confusion, drowsiness, coma
- visual disturbance, diplopia , orbital pain
DDx of severe headache?
- primary
- increased ICP
- Angle closure Glucoma
- Thrombosis
- Hemorrhage
Basic steps in management of SAH?
- LP
- Head elevation
- Ca- channel blocker
- lowering BP
Associations with berry Aneurysm?
- SCD - Coaractation of Aeorta
- Marfan
- Ehler Danlose syn.
- PKD
- Atherosclerosis
- Familial
Contraindications of TPA?
- HTN > 185/110 - Surgery in the past 2 weeks
- Glucose > 500 or 1.7
4 Ds of posterior circulation strokes?
- Diplopia
- Dysarthria
- Dysphagia
- Dizziness
Charactristics of basialr Artery strokes?
- Vertigo - locked in syndrome
- cranial nerve is involved - sesonry loss in one side and weakness
- vision loss In contralateral side
- Dysphagia - Apnea
- Dysarthria - drop attacks
- coma
Charactristics of basal ganglia stroke?
- clumsy hand syndrome
- ataxic hemiparesis
- pure sensory or motor loss
- Dysarthria
Charactristics of MCA stroke?
1- contralateral hemiparesisi and hemisensory loss
2- Aphasia
3- neglect if non dominant lobe is involved
4- gaze toward the leision
Management of subarachnoid hemoorhage ?
- BP
Diseases associated with berry Aneurysm?
- Marfan - PKD
- Ehler Danlos - Familial
- SCD
- coaractation of aorta
- Athrosclerosis
4 Ds of Post. Circulation stroke?
- Dysphagia
- Dysarthria
- dizziness
- Diplopia
Charactristics of basillar stroke?
- locked in syn - dysphagia
- coma - dysarthria
- cranial N palsy - vertigo
- Apnea - drop attacks
- visual symptoms - weakness of ipsilateral face and
Contralateral body
Charactristics of basal ganglia stroke?
- pure motor or sensory loss
- Dysarthria
- clammsy hand syn.
- Ataxic Hemiparesis.
Charactristics of MCA stroke?
Aphasia
Eyes deviated toward the leision
Contralateral hepiparesis
Neglect if non- dominant lobe is involved
Mechanism of Riluzol?
Glutamate inhibitor
Charactristicsis of Hereditary Angioedema?
Differences between hereditary and aquired Angioedema?
- decreased c1 inhibitor, C4 and increased c2b,
- in hereditary form c1q is normal in aquired there is low c1q.
Most common cause of death in young people with SLE and old people with SLE?
Young-> infection
Old-> Atherosclerosis
CPPD in?
Wilson, DM, Hypothyroidism, Hyperparathyroidism, Pseudogout, Homochromatosis
Mechanism of chlomiphen?
It’s strogen Analogue and will increase GnRH and FsH.
Multiple trauma approach?
Fast ( U/S ) , stable see blood -> laparascopy no blood-> CT Scan
Unstable see blood-> laparatomy no blood -> DPL
Side effect of micofenolate?
BM supression
Side effect of Tacrolimus?
Neurotoxicity, Diarrhea, glucose intolerance
Mechanisms to decrease ICP?
- head elevation
- Monitol
- shunt
- sedation
- hyperventilation
How would you interpret Ankle Brachial reflex?
- 9-1.30 is normal
1. 30> clacified and uncompressable vessle
Magnesium toxicity ?!
Diarrhea, nausea, vomitting, muscle weekness, decreased DTR
Clopmiphen mechanism:
It is estrogen analougue which helps to increase FSH and GnRH
Most common cause of Osteomyeleitis is a patient with URI?
Klebisella and pseudomona.
Most common cause of secondary HTN in children?
Fibromascular dysplasia , angiography shows strings of beads and there is a bruit in costovertebral angle.
Charactristics of hemocysteinuria?
It looks like Marfan/ tall stature, fair skin, dislocation of the lense inward and down, thrombosis/ megaloblastic anemia.
Charactristics of Fabry disease:
Alpha1 galactosidase defficiency/ Angiokeratoma/ peripheral Neuropathy/ asymmetric corneal dystrophy/ renal failure/ heart failure/ thromboembolic events
Intusucception?
It happens after a gastroentritis with inflammation of lymphoid tissue, sussage shape mass, target sign in US, pain upon raising the leg toward the abdomen and TX is air enema.
Compensation mechanisms for metabloic acidosis, metabolic alkalosis, respiratory acidosis, respiratory alkalosis:
Metabolic acidosis: paco2= 1.5 ( hco3) +8 +- 2
Metabolic alkalosis: increase pco2 by 0.7 for every 1 meq rise in Hco3
Respiratory acidosis: increase hco3 1meq for every 10 mmhg rise in paco2
Respiratory Alkalosis: decrease serum hco3 by 2 for every 10 meq decrease in paco2
Indication for these Antipsychotics:
- Adenosin: Supraventricular tachycardia
- Amiodarone: Vtac
- Atropin: bradycardia
- calcium gluconate: hyperkalemia
Charactristics of osteoid osteoma?
Round leisions with sclerotic margines.
5 drugs approved for OCD:
- Fluexetine
- Flovoxamine
- Serteraline
- Paroxetine
- Clomipramine
Acute distress disorder and PTSD?
Acute distress disorder is less than a month, PTSD is more than one month.
Indication of Trazodone?
Depression+Insomnia
Side effects of Raloxifen and Tamoxifen?
Raloxifen: DVT
Tamoxifen: endometrial cancer
Charactristics of fat necrosis:
TX:
Calcification, hypoecho mass, breast retraction
No TX is needed.
Connection between thyroid hormones, dopamin and prolactin?
Dopamin and thyroid hormones will supress prolactine.
Side effects of B agonists?
Tremor, hypokalemia, palpitation, headache
Side effects of Ca channel blockers? Amilodipine, Nimodipine
Tx ?
Peripheral edema,
ACE Inhibitors
Charactristics of HNPCC?
What are the HACEK organisms which cause endocarditis?
Hemophylus, Actinomycetem, cardiobacter, ekinella, kingella
Ddxof low pleural glucose?
- Empyema
- TB
- SLE
- Malignancy
- esophageal rupture
Mechanism of Heparin induced thrombocytopenia?
Ab against platelet factor 4
Argatroban, Fundaparinox, Bivilirudin
Approach to hypercalcemia?
Charactristics of Leprosy?
Diagnostic test for leprosy?
Patient has cough, coriza , malaise and fatigue then hypopigmented leisions without any senses.
Skin biopsy shows T lymphocytes.
Tx of uncomplicated cystitis, complicated cystitis and pyelonephritis?
Uncomplicated cystitis : Nitrofurantoin, TMX, Fosfomycine
Complicated cystitis: Cipro
Pyelonephritis: Cipro
Ulna entrapment is in :
Elbow
Tx for the patient who cant tolerate vancomycine?
Fidaxomycine
Snide effects of Metimazole:
Side effect of Propylthiouracil:
Metimazole side effect: teratogen/ cholestasis
Propylthiouracil: vaculitis like diseases / Hepatic failure
How would you approach to atypical squamouse cell of undetermined significance?
repeat cytology in 1 year if + colposcopy if - reapaet in one year if positive colposcopy if - papsmear 2 times and routin screening
> 25 and HPV + -> colposcopy if - repeat papsmear and hpv in 3 years
What are the diseases associated with erythema nodusome?
- TB
- Sarcoidosis
- IBD
- Histoplasmosis
Early complication of DM renal disease?
Gelumerolar hyperinfiltration
Gelumerular sclerosis
Indication of packed RBC?
Unstable
OI mutation?
Col 1 A1
How would you distinguish between androgen insensitivity and Mullerian Agenesis?
In Androgen insensitivity there is no pubic or axillaryhair.
Charactristics of tricuspid valve atresia:
Pulmonary undercirculation and decreased pulmonary markings. Small or absent R waves
What are the DDX of crying infant?
- colic-> > 3 hours/ day > 3 days a week > 3 weeks
- normal crying
- Milk Allergy
- GERD
- hair torniquet - corneal abraision
Which disease is associates with truncus Arteriosus?
Di george
Nasal discharge+ cornea neovascularization ethiology?
Chlamydia
ECG changes in Hypertrophic cardiomayopathy?
Tall R in AVL and repolarization changes in avl, V4, v5, v6 and 1.
Difference between cauda equina and conus medularis?
Conus medularis is bailateral parelysis/ perianal paresthesia/ Hyperreflexia/ early onset / early bladder and bowel dysfunction
What med can be used to treat encephalopathy if lactolose does not work?
Rifaximin
What alpha 2 blocker is being used to sedate patients in ICU?
Dexmedetomidine
Two meds in diabetic patients that can be prescribed in renal inssuficiency?
Thiazolindiones and dipeptidyl dipeptidsse 4 inhibitiors
Coplication of corniea bacterium diphteria?
Dilated cardiomyopathy
Prophylaxis for ctryptococcus in HIV + patients?
Fluconasoleoo
What is Dejernie Roussy syn.
It involves VPL nucleus and there is contralateral hemianesthesia + transient hemiparesis
What is Von Griek?
Glucose 6 phosphatase defficiency/ hypoglycemia/ hyperuricemia/ hyperlipidemia/ hyper lactic acidosis/ doll face, short stature, thin extremities
Another name for nursemaid elbow?
Treatment for nursemail elbow?
Radial sublaxation
Hyperpronation, supination and flexion
Charactristics of mild , moderate , severe volume loss?
Mild (2-3%) and the child is normal
Moderate (3-5%) and there is loss of skin tregor and dried mucosa
Severe (10-15%) sunken eyes, delayed capillary refill more than 35 , cool extremities.
Charactristics of Galactosemia?
Consequence of having Galactosemia?
Jundice, Cateract, LBW, Vomitting, Hepatomegaly and convulsion
E.Coli Sepsis
How would you recognize water house fridrichsen syndrome?
Flank pain + rash + Hypotension
Most common causes of conjunctivitis right after birth, 5 days later, more than 5 days?
Right after birth is chemical, 5 days later is Gonorrhea after 5 days is chlamydia.
What type of cancer is associated with Percelain gallbladder?
Adenocarcinoma
Mechanism of Thrombosis in heparin induced thrombocytopenia?
Heparin will attach to PFT4 -> increase IgG -> attache to plt RS and activates platelets-> PFT4+ IgG+ platelets= > release cytokines like VWF -> induce thrombosis
Diseases associated with avascular necrosis?
- SCD/ Corticosteroids/ Alcohol/ SLE
Another name for Osteitis Fibrosa cystica?
Von Rickling Hausen
- increase osteoclast activity and increasing bone resorbtion
Approach to recurrent chalazion?
Histopathology, r/o BCC and sebaceous Carcinoma
Prophylaxies in :
- mycobacterium Avium - TB
- P. Cyctis jirovenji
- Toxoplasma Gondii
- Cryptococcus
- Azitromycine
- Cotrimoxazole
- Cotrimoxazole
- Fluconazole
- Isoniazide
Charactristics of Wegner?
Systemic vasculitis, upper and lowe airway granolumatose inflammation, gelomeronephritis, cutaneous leisions
Where can we see cold antibodies?
- EBV
- Waldostrom microglobolinemia
- Mycoplasma
Side effect of folate and B12 replacement therapy?
Hypokalemia
How much iron is needed in normal person, mensturation, pregnancy?
Nl: 1-2 mg
Mensturation: 5-6
Pregnant: 2-3
Causes of sideroblastic anemia:
Alcohol, lead, isoniazide, Less B6
HCT levels and its effects
30-35
What is PANDAS?
Pediatric autoimmune neuropsychiatric disorder associated with strep.
Which diseases are associated with intussuception?
Meckel diverticulum and Henoch Shonlein purpura
Contraindication of breast feeding in an infant?
Galactosemia
Treatment for Impetigo?
Mupirocine topical
Ethilogy of macun Albright:
G- protein CAMP kinase function
Difference between precociouse puberty in Macun-Albright and Adrenal insufficiency?
In macun albright the preciciouse puberty in homosexual in Adrenal diffiency
Causes of neck pain:
- trauma
- URTI
- cervicallymphadenitis
- retropharyngeal abcess
Defect in Macun Albright?
G-protein CAMP kinase function defect
Charactristics of Macun Albright:
- Pigmentation - precocious puberty- polyostotic fibrouse dysplasia
Approach to lead poisoning:
5-45 nothing, 45-75 DMSA, 75
Heart involvement in Edward syndrome and william syndrome?
Edward syndrome: VSD
William: Aortic Stenosis
Iron defficiency anemia risk factors?
- Prematurity
- Lead poisoning
- toddlers>24 M on a daily milk
- infants who consume low iron formula, cow milk, soy milk, goats milk 6 M
When can we see cold IG?
Mycoplasma, EBV, Waldostrome macroglubolinemia,
Different levels of HCT?
HCT 30-35 is normal
25-30 Dyspnea
20-25 angina
Under 20 chest pain and syncope
Approach to severe Hematochesia?
NG aspiration: blood? Yes-> endoscopy no-> colonoscopy
Find the source? Yes-> treat No? -> still bleeding -> surgery no bleed-> small intestin study
Extra manifestations of UC?
- colorectal cancer
- toxic megacolon
- cholangiocarcinima
- uveitis
- Erythema nodusom
Tx for Basillary Angiomatosis:
Oral Erythromycine
Causes of QT prolongation:
Tx:
- meds
- inherited: Jerel lang nielsen & Romano ward
- Electrolyte imbalance: hypocalcemia/ hypokalemia/ hypomagnesemia
- pacemaker and b blocker
Complications of prematurity?
- RDS - Bronchopulmonary dysplasia
- PDA
- retinopathy of prematurity
- Necroziting entrocolitis
- intraventricular hemorrhage
How is sweat chloride test is being done?
Pilocarpin is given and the amount of sodium and chloride will be measured in the sweat.
Mechanism of Rasburicase and Pegloticase?
- they break down uric acid to Allantoin.
Transient sinovitis?
Most common cause of hip pain inn 7-10 years old children. After trauma or infection.
Septic Arthritis?
Fever> 38
ESR>40
CRP>2
WBC>12000
Charactristics of Hydrocephalus in neonates?
Next step?
Wide sutures, low activity, buldging fontanels, iritibility, poor feeding, vomiting, prominant scalp veins
Causes of bacterial Rhinosynovitis?
Treatment of Rhinosinovitis?
Moraxella, H Influenza, Strep
Amoxicillin+ clavolonic acid
Charactristics of prulent Rhinosinovitis?
Fever Syptoms after 10 days Prulent nasal discharge Facial pain for 3 days Worsening symptoms > 5 days after URTI
Cause of Bronchiolitis in children?
Tx of Bronchilitis in children?
Prevention of Bronchiolitis in children?
Complications of Bronchiolitis?
- RSV
- Supportive
- Palivizumab
- Apnea/ Respiratory Failure
What is sturge weber?
Neurocutaneouse disease with cavrenous hemangioma + Intracranial calcifications
Charactristics of vit B2 defficiency?
Cheilosis Stomatitis Normochrom normocytic anemia Seborrheic Dermatitis Glossitis
Only exception for scheduled vaccination?
Hep B
Complications of prematurity?
- RDS - Bronchopulmonary dysplasia
- PDA
- retinopathy of prematurity
- Necroziting entrocolitis
- intraventricular hemorrhage
Causes of QT prolongation:
Tx:
- meds
- inherited: Jerel lang nielsen & Romano ward
- Electrolyte imbalance: hypocalcemia/ hypokalemia/ hypomagnesemia
- pacemaker and b blocker
Exudate pulmonary effusion charactristics?
- PH
Charactristic of PCP?
High LDH
PCP treatments?
TMX/ Clinda + Primaquine or Pentamidine
How would you define severe PCP?
PH35
Po2
Exudate Pleural Effusion charactristics?
Ph 60%
Pr> 50%
Lab tests in CML?
- low LAP
Tx for TTP?
- Plasmaphresis
- Corticosteroids
Tx for ITP?
- IVIG
- Splenectomy
- Corticosteroids
What is the main charactristics of ALS?
No eye or bladder is involved.
Tx for Eaton Lambert?
- Guanidin
- Pyridostigimine
- 2/3 Dyamniopyridin
What is Dawsons fingers?
Asymmetrical periventricular white matter leisions specially in corpus callusum.
Tx of Eaton Lambert?
- Pyridostegmine
- Guanidine
- 3,4 diamonopyrydine
Ddx of eaton lambert and myastenia gravis?
Eaton lambert gets better with activity but Myastenia gravis gets worse with activity.
Which drugs are inhibited in Myastenia Gravis?
B-blockers and Aminoglycosides
What does protrin C do?
It inhibits factor V.
What is infantile spasm or west syn?
Generalized epilepsy 6 months after birth. It could be due to PKU, infections, Tuberouse sclerosis, hypoxic ischemic stroke.
How to Dx headache related to cavernous sinus thrombisis?
- recent orbital facial infections
- proptosis, ptosis, red eyes
- ophtalmoplasia
- confusion, drowsiness, coma
- visual disturbance, diplopia , orbital pain
DDx of severe headache?
- primary
- increased ICP
- Angle closure Glucoma
- Thrombosis
- Hemorrhage
Basic steps in management of SAH?
- LP
- Head elevation
- Ca- channel blocker
- lowering BP
Associations with berry Aneurysm?
- SCD - Coaractation of Aeorta
- Marfan
- Ehler Danlose syn.
- PKD
- Atherosclerosis
- Familial
Contraindications of TPA?
- HTN > 185/110 - Surgery in the past 2 weeks
- Glucose > 500 or 1.7
4 Ds of posterior circulation strokes?
- Diplopia
- Dysarthria
- Dysphagia
- Dizziness
Charactristics of basialr Artery strokes?
- Vertigo - locked in syndrome
- cranial nerve is involved - sesonry loss in one side and weakness
- vision loss In contralateral side
- Dysphagia - Apnea
- Dysarthria - drop attacks
- coma
Charactristics of basal ganglia stroke?
- clumsy hand syndrome
- ataxic hemiparesis
- pure sensory or motor loss
- Dysarthria
Charactristics of MCA stroke?
1- contralateral hemiparesisi and hemisensory loss
2- Aphasia
3- neglect if non dominant lobe is involved
4- gaze toward the leision
Management of subarachnoid hemoorhage ?
- BP
Diseases associated with berry Aneurysm?
- Marfan - PKD
- Ehler Danlos - Familial
- SCD
- coaractation of aorta
- Athrosclerosis
4 Ds of Post. Circulation stroke?
- Dysphagia
- Dysarthria
- dizziness
- Diplopia
Charactristics of basillar stroke?
- locked in syn - dysphagia
- coma - dysarthria
- cranial N palsy - vertigo
- Apnea - drop attacks
- visual symptoms - weakness of ipsilateral face and
Contralateral body
Charactristics of basal ganglia stroke?
- pure motor or sensory loss
- Dysarthria
- clammsy hand syn.
- Ataxic Hemiparesis.
Charactristics of MCA stroke?
Aphasia
Eyes deviated toward the leision
Contralateral hepiparesis
Neglect if non- dominant lobe is involved
Mechanism of Riluzol?
Glutamate inhibitor
Charactristicsis of Hereditary Angioedema?
Differences between hereditary and aquired Angioedema?
- decreased c1 inhibitor, C4 and increased c2b,
- in hereditary form c1q is normal in aquired there is low c1q.
Most common cause of death in young people with SLE and old people with SLE?
Young-> infection
Old-> Atherosclerosis
CPPD in?
Wilson, DM, Hypothyroidism, Hyperparathyroidism, Pseudogout, Homochromatosis
Mechanism of chlomiphen?
It’s strogen Analogue and will increase GnRH and FsH.
Multiple trauma approach?
Fast ( U/S ) , stable see blood -> laparascopy no blood-> CT Scan
Unstable see blood-> laparatomy no blood -> DPL
Side effect of micofenolate?
BM supression
Side effect of Tacrolimus?
Neurotoxicity, Diarrhea, glucose intolerance
Mechanisms to decrease ICP?
- head elevation
- Monitol
- shunt
- sedation
- hyperventilation
How would you interpret Ankle Brachial reflex?
- 9-1.30 is normal
1. 30> clacified and uncompressable vessle
Magnesium toxicity ?!
Diarrhea, nausea, vomitting, muscle weekness, decreased DTR
Clopmiphen mechanism:
It is estrogen analougue which helps to increase FSH and GnRH
Most common cause of Osteomyeleitis is a patient with URI?
Klebisella and pseudomona.
Most common cause of secondary HTN in children?
Fibromascular dysplasia , angiography shows strings of beads and there is a bruit in costovertebral angle.
Charactristics of hemocysteinuria?
It looks like Marfan/ tall stature, fair skin, dislocation of the lense inward and down, thrombosis/ megaloblastic anemia.
Charactristics of Fabry disease:
Alpha1 galactosidase defficiency/ Angiokeratoma/ peripheral Neuropathy/ asymmetric corneal dystrophy/ renal failure/ heart failure/ thromboembolic events
Intusucception?
It happens after a gastroentritis with inflammation of lymphoid tissue, sussage shape mass, target sign in US, pain upon raising the leg toward the abdomen and TX is air enema.
Compensation mechanisms for metabloic acidosis, metabolic alkalosis, respiratory acidosis, respiratory alkalosis:
Metabolic acidosis: paco2= 1.5 ( hco3) +8 +- 2
Metabolic alkalosis: increase pco2 by 0.7 for every 1 meq rise in Hco3
Respiratory acidosis: increase hco3 1meq for every 10 mmhg rise in paco2
Respiratory Alkalosis: decrease serum hco3 by 2 for every 10 meq decrease in paco2
Indication for these Antipsychotics:
- Adenosin: Supraventricular tachycardia
- Amiodarone: Vtac
- Atropin: bradycardia
- calcium gluconate: hyperkalemia
Charactristics of osteoid osteoma?
Round leisions with sclerotic margines.
5 drugs approved for OCD:
- Fluexetine
- Flovoxamine
- Serteraline
- Paroxetine
- Clomipramine
Acute distress disorder and PTSD?
Acute distress disorder is less than a month, PTSD is more than one month.
Indication of Trazodone?
Depression+Insomnia
Side effects of Raloxifen and Tamoxifen?
Raloxifen: DVT
Tamoxifen: endometrial cancer
Charactristics of fat necrosis:
TX:
Calcification, hypoecho mass, breast retraction
No TX is needed.
Connection between thyroid hormones, dopamin and prolactin?
Dopamin and thyroid hormones will supress prolactine.
Side effects of B agonists?
Tremor, hypokalemia, palpitation, headache
Side effects of Ca channel blockers? Amilodipine, Nimodipine
Tx ?
Peripheral edema,
ACE Inhibitors
Charactristics of HNPCC?
What are the HACEK organisms which cause endocarditis?
Hemophylus, Actinomycetem, cardiobacter, ekinella, kingella
Ddxof low pleural glucose?
- Empyema
- TB
- SLE
- Malignancy
- esophageal rupture
Mechanism of Heparin induced thrombocytopenia?
Ab against platelet factor 4
Argatroban, Fundaparinox, Bivilirudin
Approach to hypercalcemia?
Charactristics of Leprosy?
Diagnostic test for leprosy?
Patient has cough, coriza , malaise and fatigue then hypopigmented leisions without any senses.
Skin biopsy shows T lymphocytes.
Tx of uncomplicated cystitis, complicated cystitis and pyelonephritis?
Uncomplicated cystitis : Nitrofurantoin, TMX, Fosfomycine
Complicated cystitis: Cipro
Pyelonephritis: Cipro
Ulna entrapment is in :
Elbow
Tx for the patient who cant tolerate vancomycine?
Fidaxomycine
Snide effects of Metimazole:
Side effect of Propylthiouracil:
Metimazole side effect: teratogen/ cholestasis
Propylthiouracil: vaculitis like diseases / Hepatic failure
How would you approach to atypical squamouse cell of undetermined significance?
repeat cytology in 1 year if + colposcopy if - reapaet in one year if positive colposcopy if - papsmear 2 times and routin screening
> 25 and HPV + -> colposcopy if - repeat papsmear and hpv in 3 years
What are the diseases associated with erythema nodusome?
- TB
- Sarcoidosis
- IBD
- Histoplasmosis
Early complication of DM renal disease?
Gelumerolar hyperinfiltration
Gelumerular sclerosis
Indication of packed RBC?
Unstable
OI mutation?
Col 1 A1
How would you distinguish between androgen insensitivity and Mullerian Agenesis?
In Androgen insensitivity there is no pubic or axillaryhair.
Charactristics of tricuspid valve atresia:
Pulmonary undercirculation and decreased pulmonary markings. Small or absent R waves
What are the DDX of crying infant?
- colic-> > 3 hours/ day > 3 days a week > 3 weeks
- normal crying
- Milk Allergy
- GERD
- hair torniquet - corneal abraision
Which disease is associates with truncus Arteriosus?
Di george
Nasal discharge+ cornea neovascularization ethiology?
Chlamydia
ECG changes in Hypertrophic cardiomayopathy?
Tall R in AVL and repolarization changes in avl, V4, v5, v6 and 1.
Difference between cauda equina and conus medularis?
Conus medularis is bailateral parelysis/ perianal paresthesia/ Hyperreflexia/ early onset / early bladder and bowel dysfunction
What med can be used to treat encephalopathy if lactolose does not work?
Rifaximin
What alpha 2 blocker is being used to sedate patients in ICU?
Dexmedetomidine
Two meds in diabetic patients that can be prescribed in renal inssuficiency?
Thiazolindiones and dipeptidyl dipeptidsse 4 inhibitiors
Coplication of corniea bacterium diphteria?
Dilated cardiomyopathy
Prophylaxis for ctryptococcus in HIV + patients?
Fluconasoleoo
What is Dejernie Roussy syn.
It involves VPL nucleus and there is contralateral hemianesthesia + transient hemiparesis
What is Von Griek?
Glucose 6 phosphatase defficiency/ hypoglycemia/ hyperuricemia/ hyperlipidemia/ hyper lactic acidosis/ doll face, short stature, thin extremities
Another name for nursemaid elbow?
Treatment for nursemail elbow?
Radial sublaxation
Hyperpronation, supination and flexion
Charactristics of mild , moderate , severe volume loss?
Mild (2-3%) and the child is normal
Moderate (3-5%) and there is loss of skin tregor and dried mucosa
Severe (10-15%) sunken eyes, delayed capillary refill more than 35 , cool extremities.
Charactristics of Galactosemia?
Consequence of having Galactosemia?
Jundice, Cateract, LBW, Vomitting, Hepatomegaly and convulsion
E.Coli Sepsis
How would you recognize water house fridrichsen syndrome?
Flank pain + rash + Hypotension
Most common causes of conjunctivitis right after birth, 5 days later, more than 5 days?
Right after birth is chemical, 5 days later is Gonorrhea after 5 days is chlamydia.
What type of cancer is associated with Percelain gallbladder?
Adenocarcinoma
Mechanism of Thrombosis in heparin induced thrombocytopenia?
Heparin will attach to PFT4 -> increase IgG -> attache to plt RS and activates platelets-> PFT4+ IgG+ platelets= > release cytokines like VWF -> induce thrombosis
Diseases associated with avascular necrosis?
- SCD/ Corticosteroids/ Alcohol/ SLE
Another name for Osteitis Fibrosa cystica?
Von Rickling Hausen
- increase osteoclast activity and increasing bone resorbtion
Approach to recurrent chalazion?
Histopathology, r/o BCC and sebaceous Carcinoma
Prophylaxies in :
- mycobacterium Avium - TB
- P. Cyctis jirovenji
- Toxoplasma Gondii
- Cryptococcus
- Azitromycine
- Cotrimoxazole
- Cotrimoxazole
- Fluconazole
- Isoniazide
Charactristics of Wegner?
Systemic vasculitis, upper and lowe airway granolumatose inflammation, gelomeronephritis, cutaneous leisions
Where can we see cold antibodies?
- EBV
- Waldostrom microglobolinemia
- Mycoplasma
Side effect of folate and B12 replacement therapy?
Hypokalemia
How much iron is needed in normal person, mensturation, pregnancy?
Nl: 1-2 mg
Mensturation: 5-6
Pregnant: 2-3
Causes of sideroblastic anemia:
Alcohol, lead, isoniazide, Less B6
HCT levels and its effects
30-35
What is PANDAS?
Pediatric autoimmune neuropsychiatric disorder associated with strep.
Which diseases are associated with intussuception?
Meckel diverticulum and Henoch Shonlein purpura
Contraindication of breast feeding in an infant?
Galactosemia
Treatment for Impetigo?
Mupirocine topical
Ethilogy of macun Albright:
G- protein CAMP kinase function
Difference between precociouse puberty in Macun-Albright and Adrenal insufficiency?
In macun albright the preciciouse puberty in homosexual in Adrenal diffiency
Causes of neck pain:
- trauma
- URTI
- cervicallymphadenitis
- retropharyngeal abcess
Defect in Macun Albright?
G-protein CAMP kinase function defect
Charactristics of Macun Albright:
- Pigmentation - precocious puberty- polyostotic fibrouse dysplasia
Approach to lead poisoning:
5-45 nothing, 45-75 DMSA, 75
Heart involvement in Edward syndrome and william syndrome?
Edward syndrome: VSD
William: Aortic Stenosis
Iron defficiency anemia risk factors?
- Prematurity
- Lead poisoning
- toddlers>24 M on a daily milk
- infants who consume low iron formula, cow milk, soy milk, goats milk 6 M
When can we see cold IG?
Mycoplasma, EBV, Waldostrome macroglubolinemia,
Different levels of HCT?
HCT 30-35 is normal
25-30 Dyspnea
20-25 angina
Under 20 chest pain and syncope
Approach to severe Hematochesia?
NG aspiration: blood? Yes-> endoscopy no-> colonoscopy
Find the source? Yes-> treat No? -> still bleeding -> surgery no bleed-> small intestin study
Extra manifestations of UC?
- colorectal cancer
- toxic megacolon
- cholangiocarcinima
- uveitis
- Erythema nodusom
Tx for Basillary Angiomatosis:
Oral Erythromycine
How is sweat chloride test is being done?
Pilocarpin is given and the amount of sodium and chloride will be measured in the sweat.
How is sweat chloride test is being done?
Pilocarpin is given and the amount of sodium and chloride will be measured in the sweat.
Mechanism of Rasburicase and Pegloticase?
- they break down uric acid to Allantoin.
Transient sinovitis?
Most common cause of hip pain inn 7-10 years old children. After trauma or infection.
Septic Arthritis?
Fever> 38
ESR>40
CRP>2
WBC>12000
Charactristics of Hydrocephalus in neonates?
Next step?
Wide sutures, low activity, buldging fontanels, iritibility, poor feeding, vomiting, prominant scalp veins
Causes of bacterial Rhinosynovitis?
Treatment of Rhinosinovitis?
Moraxella, H Influenza, Strep
Amoxicillin+ clavolonic acid
Charactristics of prulent Rhinosinovitis?
Fever Syptoms after 10 days Prulent nasal discharge Facial pain for 3 days Worsening symptoms > 5 days after URTI
Cause of Bronchiolitis in children?
Tx of Bronchilitis in children?
Prevention of Bronchiolitis in children?
Complications of Bronchiolitis?
- RSV
- Supportive
- Palivizumab
- Apnea/ Respiratory Failure
What is sturge weber?
Neurocutaneouse disease with cavrenous hemangioma + Intracranial calcifications
Charactristics of vit B2 defficiency?
Cheilosis Stomatitis Normochrom normocytic anemia Seborrheic Dermatitis Glossitis
Only exception for scheduled vaccination?
Hep B
Complications of prematurity?
- RDS - Bronchopulmonary dysplasia
- PDA
- retinopathy of prematurity
- Necroziting entrocolitis
- intraventricular hemorrhage
Causes of QT prolongation:
Tx:
- meds
- inherited: Jerel lang nielsen & Romano ward
- Electrolyte imbalance: hypocalcemia/ hypokalemia/ hypomagnesemia
- pacemaker and b blocker
Tx for Basillary Angiomatosis:
Oral Erythromycine
Extra manifestations of UC?
- colorectal cancer
- toxic megacolon
- cholangiocarcinima
- uveitis
- Erythema nodusom
Approach to severe Hematochesia?
NG aspiration: blood? Yes-> endoscopy no-> colonoscopy
Find the source? Yes-> treat No? -> still bleeding -> surgery no bleed-> small intestin study
Different levels of HCT?
HCT 30-35 is normal
25-30 Dyspnea
20-25 angina
Under 20 chest pain and syncope
When can we see cold IG?
Mycoplasma, EBV, Waldostrome macroglubolinemia,
Iron defficiency anemia risk factors?
- Prematurity
- Lead poisoning
- toddlers>24 M on a daily milk
- infants who consume low iron formula, cow milk, soy milk, goats milk 6 M
Heart involvement in Edward syndrome and william syndrome?
Edward syndrome: VSD
William: Aortic Stenosis
Approach to lead poisoning:
5-45 nothing, 45-75 DMSA, 75
Lab tests in CML?
- low LAP
Tx for TTP?
- Plasmaphresis
- Corticosteroids
Tx for ITP?
- IVIG
- Splenectomy
- Corticosteroids
What is the main charactristics of ALS?
No eye or bladder is involved.
Tx for Eaton Lambert?
- Guanidin
- Pyridostigimine
- 2/3 Dyamniopyridin
What is Dawsons fingers?
Asymmetrical periventricular white matter leisions specially in corpus callusum.
Tx of Eaton Lambert?
- Pyridostegmine
- Guanidine
- 3,4 diamonopyrydine
Ddx of eaton lambert and myastenia gravis?
Eaton lambert gets better with activity but Myastenia gravis gets worse with activity.
Which drugs are inhibited in Myastenia Gravis?
B-blockers and Aminoglycosides
What does protrin C do?
It inhibits factor V.
What is infantile spasm or west syn?
Generalized epilepsy 6 months after birth. It could be due to PKU, infections, Tuberouse sclerosis, hypoxic ischemic stroke.
How to Dx headache related to cavernous sinus thrombisis?
- recent orbital facial infections
- proptosis, ptosis, red eyes
- ophtalmoplasia
- confusion, drowsiness, coma
- visual disturbance, diplopia , orbital pain
DDx of severe headache?
- primary
- increased ICP
- Angle closure Glucoma
- Thrombosis
- Hemorrhage
Basic steps in management of SAH?
- LP
- Head elevation
- Ca- channel blocker
- lowering BP
Associations with berry Aneurysm?
- SCD - Coaractation of Aeorta
- Marfan
- Ehler Danlose syn.
- PKD
- Atherosclerosis
- Familial
Contraindications of TPA?
- HTN > 185/110 - Surgery in the past 2 weeks
- Glucose > 500 or 1.7
4 Ds of posterior circulation strokes?
- Diplopia
- Dysarthria
- Dysphagia
- Dizziness
Charactristics of basialr Artery strokes?
- Vertigo - locked in syndrome
- cranial nerve is involved - sesonry loss in one side and weakness
- vision loss In contralateral side
- Dysphagia - Apnea
- Dysarthria - drop attacks
- coma
Charactristics of basal ganglia stroke?
- clumsy hand syndrome
- ataxic hemiparesis
- pure sensory or motor loss
- Dysarthria
Charactristics of MCA stroke?
1- contralateral hemiparesisi and hemisensory loss
2- Aphasia
3- neglect if non dominant lobe is involved
4- gaze toward the leision
Management of subarachnoid hemoorhage ?
- BP
Diseases associated with berry Aneurysm?
- Marfan - PKD
- Ehler Danlos - Familial
- SCD
- coaractation of aorta
- Athrosclerosis
4 Ds of Post. Circulation stroke?
- Dysphagia
- Dysarthria
- dizziness
- Diplopia
Charactristics of basillar stroke?
- locked in syn - dysphagia
- coma - dysarthria
- cranial N palsy - vertigo
- Apnea - drop attacks
- visual symptoms - weakness of ipsilateral face and
Contralateral body
Charactristics of basal ganglia stroke?
- pure motor or sensory loss
- Dysarthria
- clammsy hand syn.
- Ataxic Hemiparesis.
Charactristics of MCA stroke?
Aphasia
Eyes deviated toward the leision
Contralateral hepiparesis
Neglect if non- dominant lobe is involved
Mechanism of Riluzol?
Glutamate inhibitor
Charactristicsis of Hereditary Angioedema?
Differences between hereditary and aquired Angioedema?
- decreased c1 inhibitor, C4 and increased c2b,
- in hereditary form c1q is normal in aquired there is low c1q.
Most common cause of death in young people with SLE and old people with SLE?
Young-> infection
Old-> Atherosclerosis
CPPD in?
Wilson, DM, Hypothyroidism, Hyperparathyroidism, Pseudogout, Homochromatosis
Mechanism of chlomiphen?
It’s strogen Analogue and will increase GnRH and FsH.
Multiple trauma approach?
Fast ( U/S ) , stable see blood -> laparascopy no blood-> CT Scan
Unstable see blood-> laparatomy no blood -> DPL
Side effect of micofenolate?
BM supression
Side effect of Tacrolimus?
Neurotoxicity, Diarrhea, glucose intolerance
Mechanisms to decrease ICP?
- head elevation
- Monitol
- shunt
- sedation
- hyperventilation
How would you interpret Ankle Brachial reflex?
- 9-1.30 is normal
1. 30> clacified and uncompressable vessle
Magnesium toxicity ?!
Diarrhea, nausea, vomitting, muscle weekness, decreased DTR
Clopmiphen mechanism:
It is estrogen analougue which helps to increase FSH and GnRH
Most common cause of Osteomyeleitis is a patient with URI?
Klebisella and pseudomona.
Most common cause of secondary HTN in children?
Fibromascular dysplasia , angiography shows strings of beads and there is a bruit in costovertebral angle.
Charactristics of hemocysteinuria?
It looks like Marfan/ tall stature, fair skin, dislocation of the lense inward and down, thrombosis/ megaloblastic anemia.
Charactristics of Fabry disease:
Alpha1 galactosidase defficiency/ Angiokeratoma/ peripheral Neuropathy/ asymmetric corneal dystrophy/ renal failure/ heart failure/ thromboembolic events
Intusucception?
It happens after a gastroentritis with inflammation of lymphoid tissue, sussage shape mass, target sign in US, pain upon raising the leg toward the abdomen and TX is air enema.
Compensation mechanisms for metabloic acidosis, metabolic alkalosis, respiratory acidosis, respiratory alkalosis:
Metabolic acidosis: paco2= 1.5 ( hco3) +8 +- 2
Metabolic alkalosis: increase pco2 by 0.7 for every 1 meq rise in Hco3
Respiratory acidosis: increase hco3 1meq for every 10 mmhg rise in paco2
Respiratory Alkalosis: decrease serum hco3 by 2 for every 10 meq decrease in paco2
Indication for these Antipsychotics:
- Adenosin: Supraventricular tachycardia
- Amiodarone: Vtac
- Atropin: bradycardia
- calcium gluconate: hyperkalemia
Charactristics of osteoid osteoma?
Round leisions with sclerotic margines.
5 drugs approved for OCD:
- Fluexetine
- Flovoxamine
- Serteraline
- Paroxetine
- Clomipramine
Acute distress disorder and PTSD?
Acute distress disorder is less than a month, PTSD is more than one month.
Indication of Trazodone?
Depression+Insomnia
Side effects of Raloxifen and Tamoxifen?
Raloxifen: DVT
Tamoxifen: endometrial cancer
Charactristics of fat necrosis:
TX:
Calcification, hypoecho mass, breast retraction
No TX is needed.
Connection between thyroid hormones, dopamin and prolactin?
Dopamin and thyroid hormones will supress prolactine.
Side effects of B agonists?
Tremor, hypokalemia, palpitation, headache
Side effects of Ca channel blockers? Amilodipine, Nimodipine
Tx ?
Peripheral edema,
ACE Inhibitors
Charactristics of HNPCC?
What are the HACEK organisms which cause endocarditis?
Hemophylus, Actinomycetem, cardiobacter, ekinella, kingella
Ddxof low pleural glucose?
- Empyema
- TB
- SLE
- Malignancy
- esophageal rupture
Mechanism of Heparin induced thrombocytopenia?
Ab against platelet factor 4
Argatroban, Fundaparinox, Bivilirudin
Approach to hypercalcemia?
Charactristics of Leprosy?
Diagnostic test for leprosy?
Patient has cough, coriza , malaise and fatigue then hypopigmented leisions without any senses.
Skin biopsy shows T lymphocytes.
Tx of uncomplicated cystitis, complicated cystitis and pyelonephritis?
Uncomplicated cystitis : Nitrofurantoin, TMX, Fosfomycine
Complicated cystitis: Cipro
Pyelonephritis: Cipro
Ulna entrapment is in :
Elbow
Tx for the patient who cant tolerate vancomycine?
Fidaxomycine
Snide effects of Metimazole:
Side effect of Propylthiouracil:
Metimazole side effect: teratogen/ cholestasis
Propylthiouracil: vaculitis like diseases / Hepatic failure
How would you approach to atypical squamouse cell of undetermined significance?
repeat cytology in 1 year if + colposcopy if - reapaet in one year if positive colposcopy if - papsmear 2 times and routin screening
> 25 and HPV + -> colposcopy if - repeat papsmear and hpv in 3 years
What are the diseases associated with erythema nodusome?
- TB
- Sarcoidosis
- IBD
- Histoplasmosis
Early complication of DM renal disease?
Gelumerolar hyperinfiltration
Gelumerular sclerosis
Indication of packed RBC?
Unstable
OI mutation?
Col 1 A1
How would you distinguish between androgen insensitivity and Mullerian Agenesis?
In Androgen insensitivity there is no pubic or axillaryhair.
Charactristics of tricuspid valve atresia:
Pulmonary undercirculation and decreased pulmonary markings. Small or absent R waves
What are the DDX of crying infant?
- colic-> > 3 hours/ day > 3 days a week > 3 weeks
- normal crying
- Milk Allergy
- GERD
- hair torniquet - corneal abraision
Which disease is associates with truncus Arteriosus?
Di george
Nasal discharge+ cornea neovascularization ethiology?
Chlamydia
ECG changes in Hypertrophic cardiomayopathy?
Tall R in AVL and repolarization changes in avl, V4, v5, v6 and 1.
Difference between cauda equina and conus medularis?
Conus medularis is bailateral parelysis/ perianal paresthesia/ Hyperreflexia/ early onset / early bladder and bowel dysfunction
What med can be used to treat encephalopathy if lactolose does not work?
Rifaximin
What alpha 2 blocker is being used to sedate patients in ICU?
Dexmedetomidine
Two meds in diabetic patients that can be prescribed in renal inssuficiency?
Thiazolindiones and dipeptidyl dipeptidsse 4 inhibitiors
Coplication of corniea bacterium diphteria?
Dilated cardiomyopathy
Prophylaxis for ctryptococcus in HIV + patients?
Fluconasoleoo
What is Dejernie Roussy syn.
It involves VPL nucleus and there is contralateral hemianesthesia + transient hemiparesis
What is Von Griek?
Glucose 6 phosphatase defficiency/ hypoglycemia/ hyperuricemia/ hyperlipidemia/ hyper lactic acidosis/ doll face, short stature, thin extremities
Another name for nursemaid elbow?
Treatment for nursemail elbow?
Radial sublaxation
Hyperpronation, supination and flexion
Charactristics of mild , moderate , severe volume loss?
Mild (2-3%) and the child is normal
Moderate (3-5%) and there is loss of skin tregor and dried mucosa
Severe (10-15%) sunken eyes, delayed capillary refill more than 35 , cool extremities.
Charactristics of Galactosemia?
Consequence of having Galactosemia?
Jundice, Cateract, LBW, Vomitting, Hepatomegaly and convulsion
E.Coli Sepsis
How would you recognize water house fridrichsen syndrome?
Flank pain + rash + Hypotension
Most common causes of conjunctivitis right after birth, 5 days later, more than 5 days?
Right after birth is chemical, 5 days later is Gonorrhea after 5 days is chlamydia.
What type of cancer is associated with Percelain gallbladder?
Adenocarcinoma
Mechanism of Thrombosis in heparin induced thrombocytopenia?
Heparin will attach to PFT4 -> increase IgG -> attache to plt RS and activates platelets-> PFT4+ IgG+ platelets= > release cytokines like VWF -> induce thrombosis
Diseases associated with avascular necrosis?
- SCD/ Corticosteroids/ Alcohol/ SLE
Another name for Osteitis Fibrosa cystica?
Von Rickling Hausen
- increase osteoclast activity and increasing bone resorbtion
Approach to recurrent chalazion?
Histopathology, r/o BCC and sebaceous Carcinoma
Prophylaxies in :
- mycobacterium Avium - TB
- P. Cyctis jirovenji
- Toxoplasma Gondii
- Cryptococcus
- Azitromycine
- Cotrimoxazole
- Cotrimoxazole
- Fluconazole
- Isoniazide
Charactristics of Wegner?
Systemic vasculitis, upper and lowe airway granolumatose inflammation, gelomeronephritis, cutaneous leisions
Where can we see cold antibodies?
- EBV
- Waldostrom microglobolinemia
- Mycoplasma
Side effect of folate and B12 replacement therapy?
Hypokalemia
How much iron is needed in normal person, mensturation, pregnancy?
Nl: 1-2 mg
Mensturation: 5-6
Pregnant: 2-3
Causes of sideroblastic anemia:
Alcohol, lead, isoniazide, Less B6
HCT levels and its effects
30-35
What is PANDAS?
Pediatric autoimmune neuropsychiatric disorder associated with strep.
Which diseases are associated with intussuception?
Meckel diverticulum and Henoch Shonlein purpura
Contraindication of breast feeding in an infant?
Galactosemia
Treatment for Impetigo?
Mupirocine topical
Ethilogy of macun Albright:
G- protein CAMP kinase function
Difference between precociouse puberty in Macun-Albright and Adrenal insufficiency?
In macun albright the preciciouse puberty in homosexual in Adrenal diffiency
Causes of neck pain:
- trauma
- URTI
- cervicallymphadenitis
- retropharyngeal abcess
Defect in Macun Albright?
G-protein CAMP kinase function defect
Charactristics of Macun Albright:
- Pigmentation - precocious puberty- polyostotic fibrouse dysplasia
How is sweat chloride test is being done?
Pilocarpin is given and the amount of sodium and chloride will be measured in the sweat.
Mechanism of Rasburicase and Pegloticase?
- they break down uric acid to Allantoin.
Transient sinovitis?
Most common cause of hip pain inn 7-10 years old children. After trauma or infection.
Septic Arthritis?
Fever> 38
ESR>40
CRP>2
WBC>12000
Charactristics of Hydrocephalus in neonates?
Next step?
Wide sutures, low activity, buldging fontanels, iritibility, poor feeding, vomiting, prominant scalp veins
Causes of bacterial Rhinosynovitis?
Treatment of Rhinosinovitis?
Moraxella, H Influenza, Strep
Amoxicillin+ clavolonic acid
Charactristics of prulent Rhinosinovitis?
Fever Syptoms after 10 days Prulent nasal discharge Facial pain for 3 days Worsening symptoms > 5 days after URTI
Cause of Bronchiolitis in children?
Tx of Bronchilitis in children?
Prevention of Bronchiolitis in children?
Complications of Bronchiolitis?
- RSV
- Supportive
- Palivizumab
- Apnea/ Respiratory Failure
What is sturge weber?
Neurocutaneouse disease with cavrenous hemangioma + Intracranial calcifications
Charactristics of vit B2 defficiency?
Cheilosis Stomatitis Normochrom normocytic anemia Seborrheic Dermatitis Glossitis
Only exception for scheduled vaccination?
Hep B
Complications of prematurity?
- RDS - Bronchopulmonary dysplasia
- PDA
- retinopathy of prematurity
- Necroziting entrocolitis
- intraventricular hemorrhage
Causes of QT prolongation:
Tx:
- meds
- inherited: Jerel lang nielsen & Romano ward
- Electrolyte imbalance: hypocalcemia/ hypokalemia/ hypomagnesemia
- pacemaker and b blocker
Tx for Basillary Angiomatosis:
Oral Erythromycine
Extra manifestations of UC?
- colorectal cancer
- toxic megacolon
- cholangiocarcinima
- uveitis
- Erythema nodusom
Approach to severe Hematochesia?
NG aspiration: blood? Yes-> endoscopy no-> colonoscopy
Find the source? Yes-> treat No? -> still bleeding -> surgery no bleed-> small intestin study
Different levels of HCT?
HCT 30-35 is normal
25-30 Dyspnea
20-25 angina
Under 20 chest pain and syncope
When can we see cold IG?
Mycoplasma, EBV, Waldostrome macroglubolinemia,
Iron defficiency anemia risk factors?
- Prematurity
- Lead poisoning
- toddlers>24 M on a daily milk
- infants who consume low iron formula, cow milk, soy milk, goats milk 6 M
Heart involvement in Edward syndrome and william syndrome?
Edward syndrome: VSD
William: Aortic Stenosis
Approach to lead poisoning:
5-45 nothing, 45-75 DMSA, 75
Charactristics of Macun Albright:
- Pigmentation - precocious puberty- polyostotic fibrouse dysplasia
Defect in Macun Albright?
G-protein CAMP kinase function defect
Exudate pulmonary effusion charactristics?
- PH
Charactristic of PCP?
High LDH
PCP treatments?
TMX/ Clinda + Primaquine or Pentamidine
How would you define severe PCP?
PH35
Po2
Exudate Pleural Effusion charactristics?
Ph 60%
Pr> 50%
Lab tests in CML?
- low LAP
Tx for TTP?
- Plasmaphresis
- Corticosteroids
Tx for ITP?
- IVIG
- Splenectomy
- Corticosteroids
What is the main charactristics of ALS?
No eye or bladder is involved.
Tx for Eaton Lambert?
- Guanidin
- Pyridostigimine
- 2/3 Dyamniopyridin
What is Dawsons fingers?
Asymmetrical periventricular white matter leisions specially in corpus callusum.
Tx of Eaton Lambert?
- Pyridostegmine
- Guanidine
- 3,4 diamonopyrydine
Ddx of eaton lambert and myastenia gravis?
Eaton lambert gets better with activity but Myastenia gravis gets worse with activity.
Which drugs are inhibited in Myastenia Gravis?
B-blockers and Aminoglycosides
What does protrin C do?
It inhibits factor V.
What is infantile spasm or west syn?
Generalized epilepsy 6 months after birth. It could be due to PKU, infections, Tuberouse sclerosis, hypoxic ischemic stroke.
How to Dx headache related to cavernous sinus thrombisis?
- recent orbital facial infections
- proptosis, ptosis, red eyes
- ophtalmoplasia
- confusion, drowsiness, coma
- visual disturbance, diplopia , orbital pain
DDx of severe headache?
- primary
- increased ICP
- Angle closure Glucoma
- Thrombosis
- Hemorrhage
Basic steps in management of SAH?
- LP
- Head elevation
- Ca- channel blocker
- lowering BP
Associations with berry Aneurysm?
- SCD - Coaractation of Aeorta
- Marfan
- Ehler Danlose syn.
- PKD
- Atherosclerosis
- Familial
Contraindications of TPA?
- HTN > 185/110 - Surgery in the past 2 weeks
- Glucose > 500 or 1.7
4 Ds of posterior circulation strokes?
- Diplopia
- Dysarthria
- Dysphagia
- Dizziness
Charactristics of basialr Artery strokes?
- Vertigo - locked in syndrome
- cranial nerve is involved - sesonry loss in one side and weakness
- vision loss In contralateral side
- Dysphagia - Apnea
- Dysarthria - drop attacks
- coma
Charactristics of basal ganglia stroke?
- clumsy hand syndrome
- ataxic hemiparesis
- pure sensory or motor loss
- Dysarthria
Charactristics of MCA stroke?
1- contralateral hemiparesisi and hemisensory loss
2- Aphasia
3- neglect if non dominant lobe is involved
4- gaze toward the leision
Management of subarachnoid hemoorhage ?
- BP
Diseases associated with berry Aneurysm?
- Marfan - PKD
- Ehler Danlos - Familial
- SCD
- coaractation of aorta
- Athrosclerosis
4 Ds of Post. Circulation stroke?
- Dysphagia
- Dysarthria
- dizziness
- Diplopia
Charactristics of basillar stroke?
- locked in syn - dysphagia
- coma - dysarthria
- cranial N palsy - vertigo
- Apnea - drop attacks
- visual symptoms - weakness of ipsilateral face and
Contralateral body
Charactristics of basal ganglia stroke?
- pure motor or sensory loss
- Dysarthria
- clammsy hand syn.
- Ataxic Hemiparesis.
Charactristics of MCA stroke?
Aphasia
Eyes deviated toward the leision
Contralateral hepiparesis
Neglect if non- dominant lobe is involved
Mechanism of Riluzol?
Glutamate inhibitor
Charactristicsis of Hereditary Angioedema?
Differences between hereditary and aquired Angioedema?
- decreased c1 inhibitor, C4 and increased c2b,
- in hereditary form c1q is normal in aquired there is low c1q.
Most common cause of death in young people with SLE and old people with SLE?
Young-> infection
Old-> Atherosclerosis
CPPD in?
Wilson, DM, Hypothyroidism, Hyperparathyroidism, Pseudogout, Homochromatosis
Mechanism of chlomiphen?
It’s strogen Analogue and will increase GnRH and FsH.
Multiple trauma approach?
Fast ( U/S ) , stable see blood -> laparascopy no blood-> CT Scan
Unstable see blood-> laparatomy no blood -> DPL
Side effect of micofenolate?
BM supression
Side effect of Tacrolimus?
Neurotoxicity, Diarrhea, glucose intolerance
Mechanisms to decrease ICP?
- head elevation
- Monitol
- shunt
- sedation
- hyperventilation
How would you interpret Ankle Brachial reflex?
- 9-1.30 is normal
1. 30> clacified and uncompressable vessle
Magnesium toxicity ?!
Diarrhea, nausea, vomitting, muscle weekness, decreased DTR
Clopmiphen mechanism:
It is estrogen analougue which helps to increase FSH and GnRH
Most common cause of Osteomyeleitis is a patient with URI?
Klebisella and pseudomona.
Most common cause of secondary HTN in children?
Fibromascular dysplasia , angiography shows strings of beads and there is a bruit in costovertebral angle.
Charactristics of hemocysteinuria?
It looks like Marfan/ tall stature, fair skin, dislocation of the lense inward and down, thrombosis/ megaloblastic anemia.
Charactristics of Fabry disease:
Alpha1 galactosidase defficiency/ Angiokeratoma/ peripheral Neuropathy/ asymmetric corneal dystrophy/ renal failure/ heart failure/ thromboembolic events
Intusucception?
It happens after a gastroentritis with inflammation of lymphoid tissue, sussage shape mass, target sign in US, pain upon raising the leg toward the abdomen and TX is air enema.
Compensation mechanisms for metabloic acidosis, metabolic alkalosis, respiratory acidosis, respiratory alkalosis:
Metabolic acidosis: paco2= 1.5 ( hco3) +8 +- 2
Metabolic alkalosis: increase pco2 by 0.7 for every 1 meq rise in Hco3
Respiratory acidosis: increase hco3 1meq for every 10 mmhg rise in paco2
Respiratory Alkalosis: decrease serum hco3 by 2 for every 10 meq decrease in paco2
Indication for these Antipsychotics:
- Adenosin: Supraventricular tachycardia
- Amiodarone: Vtac
- Atropin: bradycardia
- calcium gluconate: hyperkalemia
Charactristics of osteoid osteoma?
Round leisions with sclerotic margines.
5 drugs approved for OCD:
- Fluexetine
- Flovoxamine
- Serteraline
- Paroxetine
- Clomipramine
Acute distress disorder and PTSD?
Acute distress disorder is less than a month, PTSD is more than one month.
Indication of Trazodone?
Depression+Insomnia
Side effects of Raloxifen and Tamoxifen?
Raloxifen: DVT
Tamoxifen: endometrial cancer
Charactristics of fat necrosis:
TX:
Calcification, hypoecho mass, breast retraction
No TX is needed.
Connection between thyroid hormones, dopamin and prolactin?
Dopamin and thyroid hormones will supress prolactine.
Side effects of B agonists?
Tremor, hypokalemia, palpitation, headache
Side effects of Ca channel blockers? Amilodipine, Nimodipine
Tx ?
Peripheral edema,
ACE Inhibitors
Charactristics of HNPCC?
What are the HACEK organisms which cause endocarditis?
Hemophylus, Actinomycetem, cardiobacter, ekinella, kingella
Ddxof low pleural glucose?
- Empyema
- TB
- SLE
- Malignancy
- esophageal rupture
Mechanism of Heparin induced thrombocytopenia?
Ab against platelet factor 4
Argatroban, Fundaparinox, Bivilirudin
Approach to hypercalcemia?
Charactristics of Leprosy?
Diagnostic test for leprosy?
Patient has cough, coriza , malaise and fatigue then hypopigmented leisions without any senses.
Skin biopsy shows T lymphocytes.
Tx of uncomplicated cystitis, complicated cystitis and pyelonephritis?
Uncomplicated cystitis : Nitrofurantoin, TMX, Fosfomycine
Complicated cystitis: Cipro
Pyelonephritis: Cipro
Ulna entrapment is in :
Elbow
Tx for the patient who cant tolerate vancomycine?
Fidaxomycine
Snide effects of Metimazole:
Side effect of Propylthiouracil:
Metimazole side effect: teratogen/ cholestasis
Propylthiouracil: vaculitis like diseases / Hepatic failure
How would you approach to atypical squamouse cell of undetermined significance?
repeat cytology in 1 year if + colposcopy if - reapaet in one year if positive colposcopy if - papsmear 2 times and routin screening
> 25 and HPV + -> colposcopy if - repeat papsmear and hpv in 3 years
What are the diseases associated with erythema nodusome?
- TB
- Sarcoidosis
- IBD
- Histoplasmosis
Early complication of DM renal disease?
Gelumerolar hyperinfiltration
Gelumerular sclerosis
Indication of packed RBC?
Unstable
OI mutation?
Col 1 A1
How would you distinguish between androgen insensitivity and Mullerian Agenesis?
In Androgen insensitivity there is no pubic or axillaryhair.
Charactristics of tricuspid valve atresia:
Pulmonary undercirculation and decreased pulmonary markings. Small or absent R waves
What are the DDX of crying infant?
- colic-> > 3 hours/ day > 3 days a week > 3 weeks
- normal crying
- Milk Allergy
- GERD
- hair torniquet - corneal abraision
Which disease is associates with truncus Arteriosus?
Di george
Nasal discharge+ cornea neovascularization ethiology?
Chlamydia
ECG changes in Hypertrophic cardiomayopathy?
Tall R in AVL and repolarization changes in avl, V4, v5, v6 and 1.
Difference between cauda equina and conus medularis?
Conus medularis is bailateral parelysis/ perianal paresthesia/ Hyperreflexia/ early onset / early bladder and bowel dysfunction
What med can be used to treat encephalopathy if lactolose does not work?
Rifaximin
What alpha 2 blocker is being used to sedate patients in ICU?
Dexmedetomidine
Two meds in diabetic patients that can be prescribed in renal inssuficiency?
Thiazolindiones and dipeptidyl dipeptidsse 4 inhibitiors
Coplication of corniea bacterium diphteria?
Dilated cardiomyopathy
Prophylaxis for ctryptococcus in HIV + patients?
Fluconasoleoo
What is Dejernie Roussy syn.
It involves VPL nucleus and there is contralateral hemianesthesia + transient hemiparesis
What is Von Griek?
Glucose 6 phosphatase defficiency/ hypoglycemia/ hyperuricemia/ hyperlipidemia/ hyper lactic acidosis/ doll face, short stature, thin extremities
Another name for nursemaid elbow?
Treatment for nursemail elbow?
Radial sublaxation
Hyperpronation, supination and flexion
Charactristics of mild , moderate , severe volume loss?
Mild (2-3%) and the child is normal
Moderate (3-5%) and there is loss of skin tregor and dried mucosa
Severe (10-15%) sunken eyes, delayed capillary refill more than 35 , cool extremities.
Charactristics of Galactosemia?
Consequence of having Galactosemia?
Jundice, Cateract, LBW, Vomitting, Hepatomegaly and convulsion
E.Coli Sepsis
How would you recognize water house fridrichsen syndrome?
Flank pain + rash + Hypotension
Most common causes of conjunctivitis right after birth, 5 days later, more than 5 days?
Right after birth is chemical, 5 days later is Gonorrhea after 5 days is chlamydia.
What type of cancer is associated with Percelain gallbladder?
Adenocarcinoma
Mechanism of Thrombosis in heparin induced thrombocytopenia?
Heparin will attach to PFT4 -> increase IgG -> attache to plt RS and activates platelets-> PFT4+ IgG+ platelets= > release cytokines like VWF -> induce thrombosis
Diseases associated with avascular necrosis?
- SCD/ Corticosteroids/ Alcohol/ SLE
Another name for Osteitis Fibrosa cystica?
Von Rickling Hausen
- increase osteoclast activity and increasing bone resorbtion
Approach to recurrent chalazion?
Histopathology, r/o BCC and sebaceous Carcinoma
Prophylaxies in :
- mycobacterium Avium - TB
- P. Cyctis jirovenji
- Toxoplasma Gondii
- Cryptococcus
- Azitromycine
- Cotrimoxazole
- Cotrimoxazole
- Fluconazole
- Isoniazide
Charactristics of Wegner?
Systemic vasculitis, upper and lowe airway granolumatose inflammation, gelomeronephritis, cutaneous leisions
Where can we see cold antibodies?
- EBV
- Waldostrom microglobolinemia
- Mycoplasma
Side effect of folate and B12 replacement therapy?
Hypokalemia
How much iron is needed in normal person, mensturation, pregnancy?
Nl: 1-2 mg
Mensturation: 5-6
Pregnant: 2-3
Causes of sideroblastic anemia:
Alcohol, lead, isoniazide, Less B6
HCT levels and its effects
30-35
What is PANDAS?
Pediatric autoimmune neuropsychiatric disorder associated with strep.
Which diseases are associated with intussuception?
Meckel diverticulum and Henoch Shonlein purpura
Contraindication of breast feeding in an infant?
Galactosemia
Treatment for Impetigo?
Mupirocine topical
Ethilogy of macun Albright:
G- protein CAMP kinase function
Difference between precociouse puberty in Macun-Albright and Adrenal insufficiency?
In macun albright the preciciouse puberty in homosexual in Adrenal diffiency
Causes of neck pain:
- trauma
- URTI
- cervicallymphadenitis
- retropharyngeal abcess
How is sweat chloride test is being done?
Pilocarpin is given and the amount of sodium and chloride will be measured in the sweat.
Mechanism of Rasburicase and Pegloticase?
- they break down uric acid to Allantoin.
Transient sinovitis?
Most common cause of hip pain inn 7-10 years old children. After trauma or infection.
Septic Arthritis?
Fever> 38
ESR>40
CRP>2
WBC>12000
Charactristics of Hydrocephalus in neonates?
Next step?
Wide sutures, low activity, buldging fontanels, iritibility, poor feeding, vomiting, prominant scalp veins
Causes of bacterial Rhinosynovitis?
Treatment of Rhinosinovitis?
Moraxella, H Influenza, Strep
Amoxicillin+ clavolonic acid
Charactristics of prulent Rhinosinovitis?
Fever Syptoms after 10 days Prulent nasal discharge Facial pain for 3 days Worsening symptoms > 5 days after URTI
Cause of Bronchiolitis in children?
Tx of Bronchilitis in children?
Prevention of Bronchiolitis in children?
Complications of Bronchiolitis?
- RSV
- Supportive
- Palivizumab
- Apnea/ Respiratory Failure
What is sturge weber?
Neurocutaneouse disease with cavrenous hemangioma + Intracranial calcifications
Charactristics of vit B2 defficiency?
Cheilosis Stomatitis Normochrom normocytic anemia Seborrheic Dermatitis Glossitis
Only exception for scheduled vaccination?
Hep B
Complications of prematurity?
- RDS - Bronchopulmonary dysplasia
- PDA
- retinopathy of prematurity
- Necroziting entrocolitis
- intraventricular hemorrhage
Causes of QT prolongation:
Tx:
- meds
- inherited: Jerel lang nielsen & Romano ward
- Electrolyte imbalance: hypocalcemia/ hypokalemia/ hypomagnesemia
- pacemaker and b blocker
Tx for Basillary Angiomatosis:
Oral Erythromycine
Extra manifestations of UC?
- colorectal cancer
- toxic megacolon
- cholangiocarcinima
- uveitis
- Erythema nodusom
Approach to severe Hematochesia?
NG aspiration: blood? Yes-> endoscopy no-> colonoscopy
Find the source? Yes-> treat No? -> still bleeding -> surgery no bleed-> small intestin study
Different levels of HCT?
HCT 30-35 is normal
25-30 Dyspnea
20-25 angina
Under 20 chest pain and syncope
When can we see cold IG?
Mycoplasma, EBV, Waldostrome macroglubolinemia,
Iron defficiency anemia risk factors?
- Prematurity
- Lead poisoning
- toddlers>24 M on a daily milk
- infants who consume low iron formula, cow milk, soy milk, goats milk 6 M
Heart involvement in Edward syndrome and william syndrome?
Edward syndrome: VSD
William: Aortic Stenosis
Approach to lead poisoning:
5-45 nothing, 45-75 DMSA, 75
Charactristics of Macun Albright:
- Pigmentation - precocious puberty- polyostotic fibrouse dysplasia
Defect in Macun Albright?
G-protein CAMP kinase function defect
Causes of neck pain:
- trauma
- URTI
- cervicallymphadenitis
- retropharyngeal abcess
Difference between precociouse puberty in Macun-Albright and Adrenal insufficiency?
In macun albright the preciciouse puberty in homosexual in Adrenal diffiency
Ethilogy of macun Albright:
G- protein CAMP kinase function
Treatment for Impetigo?
Mupirocine topical
Exudate pulmonary effusion charactristics?
- PH
Charactristic of PCP?
High LDH
PCP treatments?
TMX/ Clinda + Primaquine or Pentamidine
How would you define severe PCP?
PH35
Po2
Exudate Pleural Effusion charactristics?
Ph 60%
Pr> 50%
Lab tests in CML?
- low LAP
Tx for TTP?
- Plasmaphresis
- Corticosteroids
Tx for ITP?
- IVIG
- Splenectomy
- Corticosteroids
What is the main charactristics of ALS?
No eye or bladder is involved.
Tx for Eaton Lambert?
- Guanidin
- Pyridostigimine
- 2/3 Dyamniopyridin
What is Dawsons fingers?
Asymmetrical periventricular white matter leisions specially in corpus callusum.
Tx of Eaton Lambert?
- Pyridostegmine
- Guanidine
- 3,4 diamonopyrydine
Ddx of eaton lambert and myastenia gravis?
Eaton lambert gets better with activity but Myastenia gravis gets worse with activity.
Which drugs are inhibited in Myastenia Gravis?
B-blockers and Aminoglycosides
What does protrin C do?
It inhibits factor V.
What is infantile spasm or west syn?
Generalized epilepsy 6 months after birth. It could be due to PKU, infections, Tuberouse sclerosis, hypoxic ischemic stroke.
How to Dx headache related to cavernous sinus thrombisis?
- recent orbital facial infections
- proptosis, ptosis, red eyes
- ophtalmoplasia
- confusion, drowsiness, coma
- visual disturbance, diplopia , orbital pain
DDx of severe headache?
- primary
- increased ICP
- Angle closure Glucoma
- Thrombosis
- Hemorrhage
Basic steps in management of SAH?
- LP
- Head elevation
- Ca- channel blocker
- lowering BP
Associations with berry Aneurysm?
- SCD - Coaractation of Aeorta
- Marfan
- Ehler Danlose syn.
- PKD
- Atherosclerosis
- Familial
Contraindications of TPA?
- HTN > 185/110 - Surgery in the past 2 weeks
- Glucose > 500 or 1.7
4 Ds of posterior circulation strokes?
- Diplopia
- Dysarthria
- Dysphagia
- Dizziness
Charactristics of basialr Artery strokes?
- Vertigo - locked in syndrome
- cranial nerve is involved - sesonry loss in one side and weakness
- vision loss In contralateral side
- Dysphagia - Apnea
- Dysarthria - drop attacks
- coma
Charactristics of basal ganglia stroke?
- clumsy hand syndrome
- ataxic hemiparesis
- pure sensory or motor loss
- Dysarthria
Charactristics of MCA stroke?
1- contralateral hemiparesisi and hemisensory loss
2- Aphasia
3- neglect if non dominant lobe is involved
4- gaze toward the leision
Management of subarachnoid hemoorhage ?
- BP
Diseases associated with berry Aneurysm?
- Marfan - PKD
- Ehler Danlos - Familial
- SCD
- coaractation of aorta
- Athrosclerosis
4 Ds of Post. Circulation stroke?
- Dysphagia
- Dysarthria
- dizziness
- Diplopia
Charactristics of basillar stroke?
- locked in syn - dysphagia
- coma - dysarthria
- cranial N palsy - vertigo
- Apnea - drop attacks
- visual symptoms - weakness of ipsilateral face and
Contralateral body
Charactristics of basal ganglia stroke?
- pure motor or sensory loss
- Dysarthria
- clammsy hand syn.
- Ataxic Hemiparesis.
Charactristics of MCA stroke?
Aphasia
Eyes deviated toward the leision
Contralateral hepiparesis
Neglect if non- dominant lobe is involved
Mechanism of Riluzol?
Glutamate inhibitor
Charactristicsis of Hereditary Angioedema?
Differences between hereditary and aquired Angioedema?
- decreased c1 inhibitor, C4 and increased c2b,
- in hereditary form c1q is normal in aquired there is low c1q.
Most common cause of death in young people with SLE and old people with SLE?
Young-> infection
Old-> Atherosclerosis
CPPD in?
Wilson, DM, Hypothyroidism, Hyperparathyroidism, Pseudogout, Homochromatosis
Mechanism of chlomiphen?
It’s strogen Analogue and will increase GnRH and FsH.
Multiple trauma approach?
Fast ( U/S ) , stable see blood -> laparascopy no blood-> CT Scan
Unstable see blood-> laparatomy no blood -> DPL
Side effect of micofenolate?
BM supression
Side effect of Tacrolimus?
Neurotoxicity, Diarrhea, glucose intolerance
Mechanisms to decrease ICP?
- head elevation
- Monitol
- shunt
- sedation
- hyperventilation
How would you interpret Ankle Brachial reflex?
- 9-1.30 is normal
1. 30> clacified and uncompressable vessle
Magnesium toxicity ?!
Diarrhea, nausea, vomitting, muscle weekness, decreased DTR
Clopmiphen mechanism:
It is estrogen analougue which helps to increase FSH and GnRH
Most common cause of Osteomyeleitis is a patient with URI?
Klebisella and pseudomona.
Most common cause of secondary HTN in children?
Fibromascular dysplasia , angiography shows strings of beads and there is a bruit in costovertebral angle.
Charactristics of hemocysteinuria?
It looks like Marfan/ tall stature, fair skin, dislocation of the lense inward and down, thrombosis/ megaloblastic anemia.
Charactristics of Fabry disease:
Alpha1 galactosidase defficiency/ Angiokeratoma/ peripheral Neuropathy/ asymmetric corneal dystrophy/ renal failure/ heart failure/ thromboembolic events
Intusucception?
It happens after a gastroentritis with inflammation of lymphoid tissue, sussage shape mass, target sign in US, pain upon raising the leg toward the abdomen and TX is air enema.
Compensation mechanisms for metabloic acidosis, metabolic alkalosis, respiratory acidosis, respiratory alkalosis:
Metabolic acidosis: paco2= 1.5 ( hco3) +8 +- 2
Metabolic alkalosis: increase pco2 by 0.7 for every 1 meq rise in Hco3
Respiratory acidosis: increase hco3 1meq for every 10 mmhg rise in paco2
Respiratory Alkalosis: decrease serum hco3 by 2 for every 10 meq decrease in paco2
Indication for these Antipsychotics:
- Adenosin: Supraventricular tachycardia
- Amiodarone: Vtac
- Atropin: bradycardia
- calcium gluconate: hyperkalemia
Charactristics of osteoid osteoma?
Round leisions with sclerotic margines.
5 drugs approved for OCD:
- Fluexetine
- Flovoxamine
- Serteraline
- Paroxetine
- Clomipramine
Acute distress disorder and PTSD?
Acute distress disorder is less than a month, PTSD is more than one month.
Indication of Trazodone?
Depression+Insomnia
Side effects of Raloxifen and Tamoxifen?
Raloxifen: DVT
Tamoxifen: endometrial cancer
Charactristics of fat necrosis:
TX:
Calcification, hypoecho mass, breast retraction
No TX is needed.
Connection between thyroid hormones, dopamin and prolactin?
Dopamin and thyroid hormones will supress prolactine.
Side effects of B agonists?
Tremor, hypokalemia, palpitation, headache
Side effects of Ca channel blockers? Amilodipine, Nimodipine
Tx ?
Peripheral edema,
ACE Inhibitors
Charactristics of HNPCC?
What are the HACEK organisms which cause endocarditis?
Hemophylus, Actinomycetem, cardiobacter, ekinella, kingella
Ddxof low pleural glucose?
- Empyema
- TB
- SLE
- Malignancy
- esophageal rupture
Mechanism of Heparin induced thrombocytopenia?
Ab against platelet factor 4
Argatroban, Fundaparinox, Bivilirudin
Approach to hypercalcemia?
Charactristics of Leprosy?
Diagnostic test for leprosy?
Patient has cough, coriza , malaise and fatigue then hypopigmented leisions without any senses.
Skin biopsy shows T lymphocytes.
Tx of uncomplicated cystitis, complicated cystitis and pyelonephritis?
Uncomplicated cystitis : Nitrofurantoin, TMX, Fosfomycine
Complicated cystitis: Cipro
Pyelonephritis: Cipro
Ulna entrapment is in :
Elbow
Tx for the patient who cant tolerate vancomycine?
Fidaxomycine
Snide effects of Metimazole:
Side effect of Propylthiouracil:
Metimazole side effect: teratogen/ cholestasis
Propylthiouracil: vaculitis like diseases / Hepatic failure
How would you approach to atypical squamouse cell of undetermined significance?
repeat cytology in 1 year if + colposcopy if - reapaet in one year if positive colposcopy if - papsmear 2 times and routin screening
> 25 and HPV + -> colposcopy if - repeat papsmear and hpv in 3 years
What are the diseases associated with erythema nodusome?
- TB
- Sarcoidosis
- IBD
- Histoplasmosis
Early complication of DM renal disease?
Gelumerolar hyperinfiltration
Gelumerular sclerosis
Indication of packed RBC?
Unstable
OI mutation?
Col 1 A1
How would you distinguish between androgen insensitivity and Mullerian Agenesis?
In Androgen insensitivity there is no pubic or axillaryhair.
Charactristics of tricuspid valve atresia:
Pulmonary undercirculation and decreased pulmonary markings. Small or absent R waves
What are the DDX of crying infant?
- colic-> > 3 hours/ day > 3 days a week > 3 weeks
- normal crying
- Milk Allergy
- GERD
- hair torniquet - corneal abraision
Which disease is associates with truncus Arteriosus?
Di george
Nasal discharge+ cornea neovascularization ethiology?
Chlamydia
ECG changes in Hypertrophic cardiomayopathy?
Tall R in AVL and repolarization changes in avl, V4, v5, v6 and 1.
Difference between cauda equina and conus medularis?
Conus medularis is bailateral parelysis/ perianal paresthesia/ Hyperreflexia/ early onset / early bladder and bowel dysfunction
What med can be used to treat encephalopathy if lactolose does not work?
Rifaximin
What alpha 2 blocker is being used to sedate patients in ICU?
Dexmedetomidine
Two meds in diabetic patients that can be prescribed in renal inssuficiency?
Thiazolindiones and dipeptidyl dipeptidsse 4 inhibitiors
Coplication of corniea bacterium diphteria?
Dilated cardiomyopathy
Prophylaxis for ctryptococcus in HIV + patients?
Fluconasoleoo
What is Dejernie Roussy syn.
It involves VPL nucleus and there is contralateral hemianesthesia + transient hemiparesis
What is Von Griek?
Glucose 6 phosphatase defficiency/ hypoglycemia/ hyperuricemia/ hyperlipidemia/ hyper lactic acidosis/ doll face, short stature, thin extremities
Another name for nursemaid elbow?
Treatment for nursemail elbow?
Radial sublaxation
Hyperpronation, supination and flexion
Charactristics of mild , moderate , severe volume loss?
Mild (2-3%) and the child is normal
Moderate (3-5%) and there is loss of skin tregor and dried mucosa
Severe (10-15%) sunken eyes, delayed capillary refill more than 35 , cool extremities.
Charactristics of Galactosemia?
Consequence of having Galactosemia?
Jundice, Cateract, LBW, Vomitting, Hepatomegaly and convulsion
E.Coli Sepsis
How would you recognize water house fridrichsen syndrome?
Flank pain + rash + Hypotension
Most common causes of conjunctivitis right after birth, 5 days later, more than 5 days?
Right after birth is chemical, 5 days later is Gonorrhea after 5 days is chlamydia.
What type of cancer is associated with Percelain gallbladder?
Adenocarcinoma
Mechanism of Thrombosis in heparin induced thrombocytopenia?
Heparin will attach to PFT4 -> increase IgG -> attache to plt RS and activates platelets-> PFT4+ IgG+ platelets= > release cytokines like VWF -> induce thrombosis
Diseases associated with avascular necrosis?
- SCD/ Corticosteroids/ Alcohol/ SLE
Another name for Osteitis Fibrosa cystica?
Von Rickling Hausen
- increase osteoclast activity and increasing bone resorbtion
Approach to recurrent chalazion?
Histopathology, r/o BCC and sebaceous Carcinoma
Prophylaxies in :
- mycobacterium Avium - TB
- P. Cyctis jirovenji
- Toxoplasma Gondii
- Cryptococcus
- Azitromycine
- Cotrimoxazole
- Cotrimoxazole
- Fluconazole
- Isoniazide
Charactristics of Wegner?
Systemic vasculitis, upper and lowe airway granolumatose inflammation, gelomeronephritis, cutaneous leisions
Where can we see cold antibodies?
- EBV
- Waldostrom microglobolinemia
- Mycoplasma
Side effect of folate and B12 replacement therapy?
Hypokalemia
How much iron is needed in normal person, mensturation, pregnancy?
Nl: 1-2 mg
Mensturation: 5-6
Pregnant: 2-3
Causes of sideroblastic anemia:
Alcohol, lead, isoniazide, Less B6
HCT levels and its effects
30-35
What is PANDAS?
Pediatric autoimmune neuropsychiatric disorder associated with strep.
Which diseases are associated with intussuception?
Meckel diverticulum and Henoch Shonlein purpura
Contraindication of breast feeding in an infant?
Galactosemia
How is sweat chloride test is being done?
Pilocarpin is given and the amount of sodium and chloride will be measured in the sweat.
Mechanism of Rasburicase and Pegloticase?
- they break down uric acid to Allantoin.
Transient sinovitis?
Most common cause of hip pain inn 7-10 years old children. After trauma or infection.
Septic Arthritis?
Fever> 38
ESR>40
CRP>2
WBC>12000
Charactristics of Hydrocephalus in neonates?
Next step?
Wide sutures, low activity, buldging fontanels, iritibility, poor feeding, vomiting, prominant scalp veins
Causes of bacterial Rhinosynovitis?
Treatment of Rhinosinovitis?
Moraxella, H Influenza, Strep
Amoxicillin+ clavolonic acid
Charactristics of prulent Rhinosinovitis?
Fever Syptoms after 10 days Prulent nasal discharge Facial pain for 3 days Worsening symptoms > 5 days after URTI
Cause of Bronchiolitis in children?
Tx of Bronchilitis in children?
Prevention of Bronchiolitis in children?
Complications of Bronchiolitis?
- RSV
- Supportive
- Palivizumab
- Apnea/ Respiratory Failure
What is sturge weber?
Neurocutaneouse disease with cavrenous hemangioma + Intracranial calcifications
Charactristics of vit B2 defficiency?
Cheilosis Stomatitis Normochrom normocytic anemia Seborrheic Dermatitis Glossitis
Only exception for scheduled vaccination?
Hep B
Complications of prematurity?
- RDS - Bronchopulmonary dysplasia
- PDA
- retinopathy of prematurity
- Necroziting entrocolitis
- intraventricular hemorrhage
Causes of QT prolongation:
Tx:
- meds
- inherited: Jerel lang nielsen & Romano ward
- Electrolyte imbalance: hypocalcemia/ hypokalemia/ hypomagnesemia
- pacemaker and b blocker
Tx for Basillary Angiomatosis:
Oral Erythromycine
Extra manifestations of UC?
- colorectal cancer
- toxic megacolon
- cholangiocarcinima
- uveitis
- Erythema nodusom
Approach to severe Hematochesia?
NG aspiration: blood? Yes-> endoscopy no-> colonoscopy
Find the source? Yes-> treat No? -> still bleeding -> surgery no bleed-> small intestin study
Different levels of HCT?
HCT 30-35 is normal
25-30 Dyspnea
20-25 angina
Under 20 chest pain and syncope
When can we see cold IG?
Mycoplasma, EBV, Waldostrome macroglubolinemia,
Iron defficiency anemia risk factors?
- Prematurity
- Lead poisoning
- toddlers>24 M on a daily milk
- infants who consume low iron formula, cow milk, soy milk, goats milk 6 M
Heart involvement in Edward syndrome and william syndrome?
Edward syndrome: VSD
William: Aortic Stenosis
Approach to lead poisoning:
5-45 nothing, 45-75 DMSA, 75
Charactristics of Macun Albright:
- Pigmentation - precocious puberty- polyostotic fibrouse dysplasia
Defect in Macun Albright?
G-protein CAMP kinase function defect
Causes of neck pain:
- trauma
- URTI
- cervicallymphadenitis
- retropharyngeal abcess
Difference between precociouse puberty in Macun-Albright and Adrenal insufficiency?
In macun albright the preciciouse puberty in homosexual in Adrenal diffiency
Ethilogy of macun Albright:
G- protein CAMP kinase function
Treatment for Impetigo?
Mupirocine topical
Contraindication of breast feeding in an infant?
Galactosemia
Which diseases are associated with intussuception?
Meckel diverticulum and Henoch Shonlein purpura
What is PANDAS?
Pediatric autoimmune neuropsychiatric disorder associated with strep.
HCT levels and its effects
30-35
Causes of sideroblastic anemia:
Alcohol, lead, isoniazide, Less B6
How much iron is needed in normal person, mensturation, pregnancy?
Nl: 1-2 mg
Mensturation: 5-6
Pregnant: 2-3
Side effect of folate and B12 replacement therapy?
Hypokalemia
Where can we see cold antibodies?
- EBV
- Waldostrom microglobolinemia
- Mycoplasma
Charactristics of Wegner?
Systemic vasculitis, upper and lowe airway granolumatose inflammation, gelomeronephritis, cutaneous leisions
Prophylaxies in :
- mycobacterium Avium - TB
- P. Cyctis jirovenji
- Toxoplasma Gondii
- Cryptococcus
- Azitromycine
- Cotrimoxazole
- Cotrimoxazole
- Fluconazole
- Isoniazide
Approach to recurrent chalazion?
Histopathology, r/o BCC and sebaceous Carcinoma
Another name for Osteitis Fibrosa cystica?
Von Rickling Hausen
- increase osteoclast activity and increasing bone resorbtion
Diseases associated with avascular necrosis?
- SCD/ Corticosteroids/ Alcohol/ SLE
Mechanism of Thrombosis in heparin induced thrombocytopenia?
Heparin will attach to PFT4 -> increase IgG -> attache to plt RS and activates platelets-> PFT4+ IgG+ platelets= > release cytokines like VWF -> induce thrombosis
What type of cancer is associated with Percelain gallbladder?
Adenocarcinoma
Most common causes of conjunctivitis right after birth, 5 days later, more than 5 days?
Right after birth is chemical, 5 days later is Gonorrhea after 5 days is chlamydia.
How would you recognize water house fridrichsen syndrome?
Flank pain + rash + Hypotension
Charactristics of Galactosemia?
Consequence of having Galactosemia?
Jundice, Cateract, LBW, Vomitting, Hepatomegaly and convulsion
E.Coli Sepsis
Charactristics of mild , moderate , severe volume loss?
Mild (2-3%) and the child is normal
Moderate (3-5%) and there is loss of skin tregor and dried mucosa
Severe (10-15%) sunken eyes, delayed capillary refill more than 35 , cool extremities.
Another name for nursemaid elbow?
Treatment for nursemail elbow?
Radial sublaxation
Hyperpronation, supination and flexion
What is Von Griek?
Glucose 6 phosphatase defficiency/ hypoglycemia/ hyperuricemia/ hyperlipidemia/ hyper lactic acidosis/ doll face, short stature, thin extremities
What is Dejernie Roussy syn.
It involves VPL nucleus and there is contralateral hemianesthesia + transient hemiparesis
Prophylaxis for ctryptococcus in HIV + patients?
Fluconasoleoo
Coplication of corniea bacterium diphteria?
Dilated cardiomyopathy
Two meds in diabetic patients that can be prescribed in renal inssuficiency?
Thiazolindiones and dipeptidyl dipeptidsse 4 inhibitiors
What alpha 2 blocker is being used to sedate patients in ICU?
Dexmedetomidine
What med can be used to treat encephalopathy if lactolose does not work?
Rifaximin
Difference between cauda equina and conus medularis?
Conus medularis is bailateral parelysis/ perianal paresthesia/ Hyperreflexia/ early onset / early bladder and bowel dysfunction
Exudate pulmonary effusion charactristics?
- PH
Charactristic of PCP?
High LDH
PCP treatments?
TMX/ Clinda + Primaquine or Pentamidine
How would you define severe PCP?
PH35
Po2
Exudate Pleural Effusion charactristics?
Ph 60%
Pr> 50%
Lab tests in CML?
- low LAP
Tx for TTP?
- Plasmaphresis
- Corticosteroids
Tx for ITP?
- IVIG
- Splenectomy
- Corticosteroids
What is the main charactristics of ALS?
No eye or bladder is involved.
Tx for Eaton Lambert?
- Guanidin
- Pyridostigimine
- 2/3 Dyamniopyridin
What is Dawsons fingers?
Asymmetrical periventricular white matter leisions specially in corpus callusum.
Tx of Eaton Lambert?
- Pyridostegmine
- Guanidine
- 3,4 diamonopyrydine
Ddx of eaton lambert and myastenia gravis?
Eaton lambert gets better with activity but Myastenia gravis gets worse with activity.
Which drugs are inhibited in Myastenia Gravis?
B-blockers and Aminoglycosides
What does protrin C do?
It inhibits factor V.
What is infantile spasm or west syn?
Generalized epilepsy 6 months after birth. It could be due to PKU, infections, Tuberouse sclerosis, hypoxic ischemic stroke.
How to Dx headache related to cavernous sinus thrombisis?
- recent orbital facial infections
- proptosis, ptosis, red eyes
- ophtalmoplasia
- confusion, drowsiness, coma
- visual disturbance, diplopia , orbital pain
DDx of severe headache?
- primary
- increased ICP
- Angle closure Glucoma
- Thrombosis
- Hemorrhage
Basic steps in management of SAH?
- LP
- Head elevation
- Ca- channel blocker
- lowering BP
Associations with berry Aneurysm?
- SCD - Coaractation of Aeorta
- Marfan
- Ehler Danlose syn.
- PKD
- Atherosclerosis
- Familial
Contraindications of TPA?
- HTN > 185/110 - Surgery in the past 2 weeks
- Glucose > 500 or 1.7
4 Ds of posterior circulation strokes?
- Diplopia
- Dysarthria
- Dysphagia
- Dizziness
Charactristics of basialr Artery strokes?
- Vertigo - locked in syndrome
- cranial nerve is involved - sesonry loss in one side and weakness
- vision loss In contralateral side
- Dysphagia - Apnea
- Dysarthria - drop attacks
- coma
Charactristics of basal ganglia stroke?
- clumsy hand syndrome
- ataxic hemiparesis
- pure sensory or motor loss
- Dysarthria
Charactristics of MCA stroke?
1- contralateral hemiparesisi and hemisensory loss
2- Aphasia
3- neglect if non dominant lobe is involved
4- gaze toward the leision
Management of subarachnoid hemoorhage ?
- BP
Diseases associated with berry Aneurysm?
- Marfan - PKD
- Ehler Danlos - Familial
- SCD
- coaractation of aorta
- Athrosclerosis
4 Ds of Post. Circulation stroke?
- Dysphagia
- Dysarthria
- dizziness
- Diplopia
Charactristics of basillar stroke?
- locked in syn - dysphagia
- coma - dysarthria
- cranial N palsy - vertigo
- Apnea - drop attacks
- visual symptoms - weakness of ipsilateral face and
Contralateral body
Charactristics of basal ganglia stroke?
- pure motor or sensory loss
- Dysarthria
- clammsy hand syn.
- Ataxic Hemiparesis.
Charactristics of MCA stroke?
Aphasia
Eyes deviated toward the leision
Contralateral hepiparesis
Neglect if non- dominant lobe is involved
Mechanism of Riluzol?
Glutamate inhibitor
Charactristicsis of Hereditary Angioedema?
Differences between hereditary and aquired Angioedema?
- decreased c1 inhibitor, C4 and increased c2b,
- in hereditary form c1q is normal in aquired there is low c1q.
Most common cause of death in young people with SLE and old people with SLE?
Young-> infection
Old-> Atherosclerosis
CPPD in?
Wilson, DM, Hypothyroidism, Hyperparathyroidism, Pseudogout, Homochromatosis
Mechanism of chlomiphen?
It’s strogen Analogue and will increase GnRH and FsH.
Multiple trauma approach?
Fast ( U/S ) , stable see blood -> laparascopy no blood-> CT Scan
Unstable see blood-> laparatomy no blood -> DPL
Side effect of micofenolate?
BM supression
Side effect of Tacrolimus?
Neurotoxicity, Diarrhea, glucose intolerance
Mechanisms to decrease ICP?
- head elevation
- Monitol
- shunt
- sedation
- hyperventilation
How would you interpret Ankle Brachial reflex?
- 9-1.30 is normal
1. 30> clacified and uncompressable vessle
Magnesium toxicity ?!
Diarrhea, nausea, vomitting, muscle weekness, decreased DTR
Clopmiphen mechanism:
It is estrogen analougue which helps to increase FSH and GnRH
Most common cause of Osteomyeleitis is a patient with URI?
Klebisella and pseudomona.
Most common cause of secondary HTN in children?
Fibromascular dysplasia , angiography shows strings of beads and there is a bruit in costovertebral angle.
Charactristics of hemocysteinuria?
It looks like Marfan/ tall stature, fair skin, dislocation of the lense inward and down, thrombosis/ megaloblastic anemia.
Charactristics of Fabry disease:
Alpha1 galactosidase defficiency/ Angiokeratoma/ peripheral Neuropathy/ asymmetric corneal dystrophy/ renal failure/ heart failure/ thromboembolic events
Intusucception?
It happens after a gastroentritis with inflammation of lymphoid tissue, sussage shape mass, target sign in US, pain upon raising the leg toward the abdomen and TX is air enema.
Compensation mechanisms for metabloic acidosis, metabolic alkalosis, respiratory acidosis, respiratory alkalosis:
Metabolic acidosis: paco2= 1.5 ( hco3) +8 +- 2
Metabolic alkalosis: increase pco2 by 0.7 for every 1 meq rise in Hco3
Respiratory acidosis: increase hco3 1meq for every 10 mmhg rise in paco2
Respiratory Alkalosis: decrease serum hco3 by 2 for every 10 meq decrease in paco2
Indication for these Antipsychotics:
- Adenosin: Supraventricular tachycardia
- Amiodarone: Vtac
- Atropin: bradycardia
- calcium gluconate: hyperkalemia
Charactristics of osteoid osteoma?
Round leisions with sclerotic margines.
5 drugs approved for OCD:
- Fluexetine
- Flovoxamine
- Serteraline
- Paroxetine
- Clomipramine
Acute distress disorder and PTSD?
Acute distress disorder is less than a month, PTSD is more than one month.
Indication of Trazodone?
Depression+Insomnia
Side effects of Raloxifen and Tamoxifen?
Raloxifen: DVT
Tamoxifen: endometrial cancer
Charactristics of fat necrosis:
TX:
Calcification, hypoecho mass, breast retraction
No TX is needed.
Connection between thyroid hormones, dopamin and prolactin?
Dopamin and thyroid hormones will supress prolactine.
Side effects of B agonists?
Tremor, hypokalemia, palpitation, headache
Side effects of Ca channel blockers? Amilodipine, Nimodipine
Tx ?
Peripheral edema,
ACE Inhibitors
Charactristics of HNPCC?
What are the HACEK organisms which cause endocarditis?
Hemophylus, Actinomycetem, cardiobacter, ekinella, kingella
Ddxof low pleural glucose?
- Empyema
- TB
- SLE
- Malignancy
- esophageal rupture
Mechanism of Heparin induced thrombocytopenia?
Ab against platelet factor 4
Argatroban, Fundaparinox, Bivilirudin
Approach to hypercalcemia?
Charactristics of Leprosy?
Diagnostic test for leprosy?
Patient has cough, coriza , malaise and fatigue then hypopigmented leisions without any senses.
Skin biopsy shows T lymphocytes.
Tx of uncomplicated cystitis, complicated cystitis and pyelonephritis?
Uncomplicated cystitis : Nitrofurantoin, TMX, Fosfomycine
Complicated cystitis: Cipro
Pyelonephritis: Cipro
Ulna entrapment is in :
Elbow
Tx for the patient who cant tolerate vancomycine?
Fidaxomycine
Snide effects of Metimazole:
Side effect of Propylthiouracil:
Metimazole side effect: teratogen/ cholestasis
Propylthiouracil: vaculitis like diseases / Hepatic failure
How would you approach to atypical squamouse cell of undetermined significance?
repeat cytology in 1 year if + colposcopy if - reapaet in one year if positive colposcopy if - papsmear 2 times and routin screening
> 25 and HPV + -> colposcopy if - repeat papsmear and hpv in 3 years
What are the diseases associated with erythema nodusome?
- TB
- Sarcoidosis
- IBD
- Histoplasmosis
Early complication of DM renal disease?
Gelumerolar hyperinfiltration
Gelumerular sclerosis
Indication of packed RBC?
Unstable
OI mutation?
Col 1 A1
How would you distinguish between androgen insensitivity and Mullerian Agenesis?
In Androgen insensitivity there is no pubic or axillaryhair.
Charactristics of tricuspid valve atresia:
Pulmonary undercirculation and decreased pulmonary markings. Small or absent R waves
What are the DDX of crying infant?
- colic-> > 3 hours/ day > 3 days a week > 3 weeks
- normal crying
- Milk Allergy
- GERD
- hair torniquet - corneal abraision
Which disease is associates with truncus Arteriosus?
Di george
Nasal discharge+ cornea neovascularization ethiology?
Chlamydia
ECG changes in Hypertrophic cardiomayopathy?
Tall R in AVL and repolarization changes in avl, V4, v5, v6 and 1.
How is sweat chloride test is being done?
Pilocarpin is given and the amount of sodium and chloride will be measured in the sweat.
Mechanism of Rasburicase and Pegloticase?
- they break down uric acid to Allantoin.
Transient sinovitis?
Most common cause of hip pain inn 7-10 years old children. After trauma or infection.
Septic Arthritis?
Fever> 38
ESR>40
CRP>2
WBC>12000
Charactristics of Hydrocephalus in neonates?
Next step?
Wide sutures, low activity, buldging fontanels, iritibility, poor feeding, vomiting, prominant scalp veins
Causes of bacterial Rhinosynovitis?
Treatment of Rhinosinovitis?
Moraxella, H Influenza, Strep
Amoxicillin+ clavolonic acid
Charactristics of prulent Rhinosinovitis?
Fever Syptoms after 10 days Prulent nasal discharge Facial pain for 3 days Worsening symptoms > 5 days after URTI
Cause of Bronchiolitis in children?
Tx of Bronchilitis in children?
Prevention of Bronchiolitis in children?
Complications of Bronchiolitis?
- RSV
- Supportive
- Palivizumab
- Apnea/ Respiratory Failure
What is sturge weber?
Neurocutaneouse disease with cavrenous hemangioma + Intracranial calcifications
Charactristics of vit B2 defficiency?
Cheilosis Stomatitis Normochrom normocytic anemia Seborrheic Dermatitis Glossitis
Only exception for scheduled vaccination?
Hep B
Complications of prematurity?
- RDS - Bronchopulmonary dysplasia
- PDA
- retinopathy of prematurity
- Necroziting entrocolitis
- intraventricular hemorrhage
Causes of QT prolongation:
Tx:
- meds
- inherited: Jerel lang nielsen & Romano ward
- Electrolyte imbalance: hypocalcemia/ hypokalemia/ hypomagnesemia
- pacemaker and b blocker
Tx for Basillary Angiomatosis:
Oral Erythromycine
Extra manifestations of UC?
- colorectal cancer
- toxic megacolon
- cholangiocarcinima
- uveitis
- Erythema nodusom
Approach to severe Hematochesia?
NG aspiration: blood? Yes-> endoscopy no-> colonoscopy
Find the source? Yes-> treat No? -> still bleeding -> surgery no bleed-> small intestin study
Different levels of HCT?
HCT 30-35 is normal
25-30 Dyspnea
20-25 angina
Under 20 chest pain and syncope
When can we see cold IG?
Mycoplasma, EBV, Waldostrome macroglubolinemia,
Iron defficiency anemia risk factors?
- Prematurity
- Lead poisoning
- toddlers>24 M on a daily milk
- infants who consume low iron formula, cow milk, soy milk, goats milk 6 M
Heart involvement in Edward syndrome and william syndrome?
Edward syndrome: VSD
William: Aortic Stenosis
Approach to lead poisoning:
5-45 nothing, 45-75 DMSA, 75
Charactristics of Macun Albright:
- Pigmentation - precocious puberty- polyostotic fibrouse dysplasia
Defect in Macun Albright?
G-protein CAMP kinase function defect
Causes of neck pain:
- trauma
- URTI
- cervicallymphadenitis
- retropharyngeal abcess
Difference between precociouse puberty in Macun-Albright and Adrenal insufficiency?
In macun albright the preciciouse puberty in homosexual in Adrenal diffiency
Ethilogy of macun Albright:
G- protein CAMP kinase function
Treatment for Impetigo?
Mupirocine topical
Contraindication of breast feeding in an infant?
Galactosemia
Which diseases are associated with intussuception?
Meckel diverticulum and Henoch Shonlein purpura
What is PANDAS?
Pediatric autoimmune neuropsychiatric disorder associated with strep.
HCT levels and its effects
30-35
Causes of sideroblastic anemia:
Alcohol, lead, isoniazide, Less B6
How much iron is needed in normal person, mensturation, pregnancy?
Nl: 1-2 mg
Mensturation: 5-6
Pregnant: 2-3
Side effect of folate and B12 replacement therapy?
Hypokalemia
Where can we see cold antibodies?
- EBV
- Waldostrom microglobolinemia
- Mycoplasma
Charactristics of Wegner?
Systemic vasculitis, upper and lowe airway granolumatose inflammation, gelomeronephritis, cutaneous leisions
Prophylaxies in :
- mycobacterium Avium - TB
- P. Cyctis jirovenji
- Toxoplasma Gondii
- Cryptococcus
- Azitromycine
- Cotrimoxazole
- Cotrimoxazole
- Fluconazole
- Isoniazide
Approach to recurrent chalazion?
Histopathology, r/o BCC and sebaceous Carcinoma
Another name for Osteitis Fibrosa cystica?
Von Rickling Hausen
- increase osteoclast activity and increasing bone resorbtion
Diseases associated with avascular necrosis?
- SCD/ Corticosteroids/ Alcohol/ SLE
Mechanism of Thrombosis in heparin induced thrombocytopenia?
Heparin will attach to PFT4 -> increase IgG -> attache to plt RS and activates platelets-> PFT4+ IgG+ platelets= > release cytokines like VWF -> induce thrombosis
What type of cancer is associated with Percelain gallbladder?
Adenocarcinoma
Most common causes of conjunctivitis right after birth, 5 days later, more than 5 days?
Right after birth is chemical, 5 days later is Gonorrhea after 5 days is chlamydia.
How would you recognize water house fridrichsen syndrome?
Flank pain + rash + Hypotension
Charactristics of Galactosemia?
Consequence of having Galactosemia?
Jundice, Cateract, LBW, Vomitting, Hepatomegaly and convulsion
E.Coli Sepsis
Charactristics of mild , moderate , severe volume loss?
Mild (2-3%) and the child is normal
Moderate (3-5%) and there is loss of skin tregor and dried mucosa
Severe (10-15%) sunken eyes, delayed capillary refill more than 35 , cool extremities.
Another name for nursemaid elbow?
Treatment for nursemail elbow?
Radial sublaxation
Hyperpronation, supination and flexion
What is Von Griek?
Glucose 6 phosphatase defficiency/ hypoglycemia/ hyperuricemia/ hyperlipidemia/ hyper lactic acidosis/ doll face, short stature, thin extremities
What is Dejernie Roussy syn.
It involves VPL nucleus and there is contralateral hemianesthesia + transient hemiparesis
Prophylaxis for ctryptococcus in HIV + patients?
Fluconasoleoo
Coplication of corniea bacterium diphteria?
Dilated cardiomyopathy
Two meds in diabetic patients that can be prescribed in renal inssuficiency?
Thiazolindiones and dipeptidyl dipeptidsse 4 inhibitiors
What alpha 2 blocker is being used to sedate patients in ICU?
Dexmedetomidine
What med can be used to treat encephalopathy if lactolose does not work?
Rifaximin
Difference between cauda equina and conus medularis?
Conus medularis is bailateral parelysis/ perianal paresthesia/ Hyperreflexia/ early onset / early bladder and bowel dysfunction
ECG changes in Hypertrophic cardiomayopathy?
Tall R in AVL and repolarization changes in avl, V4, v5, v6 and 1.
Nasal discharge+ cornea neovascularization ethiology?
Chlamydia
Which disease is associates with truncus Arteriosus?
Di george
What are the DDX of crying infant?
- colic-> > 3 hours/ day > 3 days a week > 3 weeks
- normal crying
- Milk Allergy
- GERD
- hair torniquet - corneal abraision
Charactristics of tricuspid valve atresia:
Pulmonary undercirculation and decreased pulmonary markings. Small or absent R waves
How would you distinguish between androgen insensitivity and Mullerian Agenesis?
In Androgen insensitivity there is no pubic or axillaryhair.
OI mutation?
Col 1 A1
Indication of packed RBC?
Unstable
Early complication of DM renal disease?
Gelumerolar hyperinfiltration
Gelumerular sclerosis
What are the diseases associated with erythema nodusome?
- TB
- Sarcoidosis
- IBD
- Histoplasmosis
How would you approach to atypical squamouse cell of undetermined significance?
repeat cytology in 1 year if + colposcopy if - reapaet in one year if positive colposcopy if - papsmear 2 times and routin screening
> 25 and HPV + -> colposcopy if - repeat papsmear and hpv in 3 years
Snide effects of Metimazole:
Side effect of Propylthiouracil:
Metimazole side effect: teratogen/ cholestasis
Propylthiouracil: vaculitis like diseases / Hepatic failure
Tx for the patient who cant tolerate vancomycine?
Fidaxomycine
Ulna entrapment is in :
Elbow
Tx of uncomplicated cystitis, complicated cystitis and pyelonephritis?
Uncomplicated cystitis : Nitrofurantoin, TMX, Fosfomycine
Complicated cystitis: Cipro
Pyelonephritis: Cipro
Charactristics of Leprosy?
Diagnostic test for leprosy?
Patient has cough, coriza , malaise and fatigue then hypopigmented leisions without any senses.
Skin biopsy shows T lymphocytes.
Approach to hypercalcemia?
Mechanism of Heparin induced thrombocytopenia?
Ab against platelet factor 4
Argatroban, Fundaparinox, Bivilirudin
Ddxof low pleural glucose?
- Empyema
- TB
- SLE
- Malignancy
- esophageal rupture
What are the HACEK organisms which cause endocarditis?
Hemophylus, Actinomycetem, cardiobacter, ekinella, kingella
Charactristics of HNPCC?
Side effects of Ca channel blockers? Amilodipine, Nimodipine
Tx ?
Peripheral edema,
ACE Inhibitors
Side effects of B agonists?
Tremor, hypokalemia, palpitation, headache
Connection between thyroid hormones, dopamin and prolactin?
Dopamin and thyroid hormones will supress prolactine.
Charactristics of fat necrosis:
TX:
Calcification, hypoecho mass, breast retraction
No TX is needed.
Side effects of Raloxifen and Tamoxifen?
Raloxifen: DVT
Tamoxifen: endometrial cancer
Indication of Trazodone?
Depression+Insomnia
Acute distress disorder and PTSD?
Acute distress disorder is less than a month, PTSD is more than one month.
5 drugs approved for OCD:
- Fluexetine
- Flovoxamine
- Serteraline
- Paroxetine
- Clomipramine
Charactristics of osteoid osteoma?
Round leisions with sclerotic margines.
Indication for these Antipsychotics:
- Adenosin: Supraventricular tachycardia
- Amiodarone: Vtac
- Atropin: bradycardia
- calcium gluconate: hyperkalemia
Compensation mechanisms for metabloic acidosis, metabolic alkalosis, respiratory acidosis, respiratory alkalosis:
Metabolic acidosis: paco2= 1.5 ( hco3) +8 +- 2
Metabolic alkalosis: increase pco2 by 0.7 for every 1 meq rise in Hco3
Respiratory acidosis: increase hco3 1meq for every 10 mmhg rise in paco2
Respiratory Alkalosis: decrease serum hco3 by 2 for every 10 meq decrease in paco2
Exudate pulmonary effusion charactristics?
- PH
Charactristic of PCP?
High LDH
PCP treatments?
TMX/ Clinda + Primaquine or Pentamidine
How would you define severe PCP?
PH35
Po2
Exudate Pleural Effusion charactristics?
Ph 60%
Pr> 50%
Lab tests in CML?
- low LAP
Tx for TTP?
- Plasmaphresis
- Corticosteroids
Tx for ITP?
- IVIG
- Splenectomy
- Corticosteroids
What is the main charactristics of ALS?
No eye or bladder is involved.
Tx for Eaton Lambert?
- Guanidin
- Pyridostigimine
- 2/3 Dyamniopyridin
What is Dawsons fingers?
Asymmetrical periventricular white matter leisions specially in corpus callusum.
Tx of Eaton Lambert?
- Pyridostegmine
- Guanidine
- 3,4 diamonopyrydine
Ddx of eaton lambert and myastenia gravis?
Eaton lambert gets better with activity but Myastenia gravis gets worse with activity.
Which drugs are inhibited in Myastenia Gravis?
B-blockers and Aminoglycosides
What does protrin C do?
It inhibits factor V.
What is infantile spasm or west syn?
Generalized epilepsy 6 months after birth. It could be due to PKU, infections, Tuberouse sclerosis, hypoxic ischemic stroke.
How to Dx headache related to cavernous sinus thrombisis?
- recent orbital facial infections
- proptosis, ptosis, red eyes
- ophtalmoplasia
- confusion, drowsiness, coma
- visual disturbance, diplopia , orbital pain
DDx of severe headache?
- primary
- increased ICP
- Angle closure Glucoma
- Thrombosis
- Hemorrhage
Basic steps in management of SAH?
- LP
- Head elevation
- Ca- channel blocker
- lowering BP
Associations with berry Aneurysm?
- SCD - Coaractation of Aeorta
- Marfan
- Ehler Danlose syn.
- PKD
- Atherosclerosis
- Familial
Contraindications of TPA?
- HTN > 185/110 - Surgery in the past 2 weeks
- Glucose > 500 or 1.7
4 Ds of posterior circulation strokes?
- Diplopia
- Dysarthria
- Dysphagia
- Dizziness
Charactristics of basialr Artery strokes?
- Vertigo - locked in syndrome
- cranial nerve is involved - sesonry loss in one side and weakness
- vision loss In contralateral side
- Dysphagia - Apnea
- Dysarthria - drop attacks
- coma
Charactristics of basal ganglia stroke?
- clumsy hand syndrome
- ataxic hemiparesis
- pure sensory or motor loss
- Dysarthria
Charactristics of MCA stroke?
1- contralateral hemiparesisi and hemisensory loss
2- Aphasia
3- neglect if non dominant lobe is involved
4- gaze toward the leision
Management of subarachnoid hemoorhage ?
- BP
Diseases associated with berry Aneurysm?
- Marfan - PKD
- Ehler Danlos - Familial
- SCD
- coaractation of aorta
- Athrosclerosis
4 Ds of Post. Circulation stroke?
- Dysphagia
- Dysarthria
- dizziness
- Diplopia
Charactristics of basillar stroke?
- locked in syn - dysphagia
- coma - dysarthria
- cranial N palsy - vertigo
- Apnea - drop attacks
- visual symptoms - weakness of ipsilateral face and
Contralateral body
Charactristics of basal ganglia stroke?
- pure motor or sensory loss
- Dysarthria
- clammsy hand syn.
- Ataxic Hemiparesis.
Charactristics of MCA stroke?
Aphasia
Eyes deviated toward the leision
Contralateral hepiparesis
Neglect if non- dominant lobe is involved
Mechanism of Riluzol?
Glutamate inhibitor
Charactristicsis of Hereditary Angioedema?
Differences between hereditary and aquired Angioedema?
- decreased c1 inhibitor, C4 and increased c2b,
- in hereditary form c1q is normal in aquired there is low c1q.
Most common cause of death in young people with SLE and old people with SLE?
Young-> infection
Old-> Atherosclerosis
CPPD in?
Wilson, DM, Hypothyroidism, Hyperparathyroidism, Pseudogout, Homochromatosis
Mechanism of chlomiphen?
It’s strogen Analogue and will increase GnRH and FsH.
Multiple trauma approach?
Fast ( U/S ) , stable see blood -> laparascopy no blood-> CT Scan
Unstable see blood-> laparatomy no blood -> DPL
Side effect of micofenolate?
BM supression
Side effect of Tacrolimus?
Neurotoxicity, Diarrhea, glucose intolerance
Mechanisms to decrease ICP?
- head elevation
- Monitol
- shunt
- sedation
- hyperventilation
How would you interpret Ankle Brachial reflex?
- 9-1.30 is normal
1. 30> clacified and uncompressable vessle
Magnesium toxicity ?!
Diarrhea, nausea, vomitting, muscle weekness, decreased DTR
Clopmiphen mechanism:
It is estrogen analougue which helps to increase FSH and GnRH
Most common cause of Osteomyeleitis is a patient with URI?
Klebisella and pseudomona.
Most common cause of secondary HTN in children?
Fibromascular dysplasia , angiography shows strings of beads and there is a bruit in costovertebral angle.
Charactristics of hemocysteinuria?
It looks like Marfan/ tall stature, fair skin, dislocation of the lense inward and down, thrombosis/ megaloblastic anemia.
Charactristics of Fabry disease:
Alpha1 galactosidase defficiency/ Angiokeratoma/ peripheral Neuropathy/ asymmetric corneal dystrophy/ renal failure/ heart failure/ thromboembolic events
Intusucception?
It happens after a gastroentritis with inflammation of lymphoid tissue, sussage shape mass, target sign in US, pain upon raising the leg toward the abdomen and TX is air enema.
How is sweat chloride test is being done?
Pilocarpin is given and the amount of sodium and chloride will be measured in the sweat.
Mechanism of Rasburicase and Pegloticase?
- they break down uric acid to Allantoin.
Transient sinovitis?
Most common cause of hip pain inn 7-10 years old children. After trauma or infection.
Septic Arthritis?
Fever> 38
ESR>40
CRP>2
WBC>12000
Charactristics of Hydrocephalus in neonates?
Next step?
Wide sutures, low activity, buldging fontanels, iritibility, poor feeding, vomiting, prominant scalp veins
Causes of bacterial Rhinosynovitis?
Treatment of Rhinosinovitis?
Moraxella, H Influenza, Strep
Amoxicillin+ clavolonic acid
Charactristics of prulent Rhinosinovitis?
Fever Syptoms after 10 days Prulent nasal discharge Facial pain for 3 days Worsening symptoms > 5 days after URTI
Cause of Bronchiolitis in children?
Tx of Bronchilitis in children?
Prevention of Bronchiolitis in children?
Complications of Bronchiolitis?
- RSV
- Supportive
- Palivizumab
- Apnea/ Respiratory Failure
What is sturge weber?
Neurocutaneouse disease with cavrenous hemangioma + Intracranial calcifications
Charactristics of vit B2 defficiency?
Cheilosis Stomatitis Normochrom normocytic anemia Seborrheic Dermatitis Glossitis
Only exception for scheduled vaccination?
Hep B
Complications of prematurity?
- RDS - Bronchopulmonary dysplasia
- PDA
- retinopathy of prematurity
- Necroziting entrocolitis
- intraventricular hemorrhage
Causes of QT prolongation:
Tx:
- meds
- inherited: Jerel lang nielsen & Romano ward
- Electrolyte imbalance: hypocalcemia/ hypokalemia/ hypomagnesemia
- pacemaker and b blocker
Tx for Basillary Angiomatosis:
Oral Erythromycine
Extra manifestations of UC?
- colorectal cancer
- toxic megacolon
- cholangiocarcinima
- uveitis
- Erythema nodusom
Approach to severe Hematochesia?
NG aspiration: blood? Yes-> endoscopy no-> colonoscopy
Find the source? Yes-> treat No? -> still bleeding -> surgery no bleed-> small intestin study
Different levels of HCT?
HCT 30-35 is normal
25-30 Dyspnea
20-25 angina
Under 20 chest pain and syncope
When can we see cold IG?
Mycoplasma, EBV, Waldostrome macroglubolinemia,
Iron defficiency anemia risk factors?
- Prematurity
- Lead poisoning
- toddlers>24 M on a daily milk
- infants who consume low iron formula, cow milk, soy milk, goats milk 6 M
Heart involvement in Edward syndrome and william syndrome?
Edward syndrome: VSD
William: Aortic Stenosis
Approach to lead poisoning:
5-45 nothing, 45-75 DMSA, 75
Charactristics of Macun Albright:
- Pigmentation - precocious puberty- polyostotic fibrouse dysplasia
Defect in Macun Albright?
G-protein CAMP kinase function defect
Causes of neck pain:
- trauma
- URTI
- cervicallymphadenitis
- retropharyngeal abcess
Difference between precociouse puberty in Macun-Albright and Adrenal insufficiency?
In macun albright the preciciouse puberty in homosexual in Adrenal diffiency
Ethilogy of macun Albright:
G- protein CAMP kinase function
Treatment for Impetigo?
Mupirocine topical
Contraindication of breast feeding in an infant?
Galactosemia
Which diseases are associated with intussuception?
Meckel diverticulum and Henoch Shonlein purpura
What is PANDAS?
Pediatric autoimmune neuropsychiatric disorder associated with strep.
HCT levels and its effects
30-35
Causes of sideroblastic anemia:
Alcohol, lead, isoniazide, Less B6
How much iron is needed in normal person, mensturation, pregnancy?
Nl: 1-2 mg
Mensturation: 5-6
Pregnant: 2-3
Side effect of folate and B12 replacement therapy?
Hypokalemia
Where can we see cold antibodies?
- EBV
- Waldostrom microglobolinemia
- Mycoplasma
Charactristics of Wegner?
Systemic vasculitis, upper and lowe airway granolumatose inflammation, gelomeronephritis, cutaneous leisions
Prophylaxies in :
- mycobacterium Avium - TB
- P. Cyctis jirovenji
- Toxoplasma Gondii
- Cryptococcus
- Azitromycine
- Cotrimoxazole
- Cotrimoxazole
- Fluconazole
- Isoniazide
Approach to recurrent chalazion?
Histopathology, r/o BCC and sebaceous Carcinoma
Another name for Osteitis Fibrosa cystica?
Von Rickling Hausen
- increase osteoclast activity and increasing bone resorbtion
Diseases associated with avascular necrosis?
- SCD/ Corticosteroids/ Alcohol/ SLE
Mechanism of Thrombosis in heparin induced thrombocytopenia?
Heparin will attach to PFT4 -> increase IgG -> attache to plt RS and activates platelets-> PFT4+ IgG+ platelets= > release cytokines like VWF -> induce thrombosis
What type of cancer is associated with Percelain gallbladder?
Adenocarcinoma
Most common causes of conjunctivitis right after birth, 5 days later, more than 5 days?
Right after birth is chemical, 5 days later is Gonorrhea after 5 days is chlamydia.
How would you recognize water house fridrichsen syndrome?
Flank pain + rash + Hypotension
Charactristics of Galactosemia?
Consequence of having Galactosemia?
Jundice, Cateract, LBW, Vomitting, Hepatomegaly and convulsion
E.Coli Sepsis
Charactristics of mild , moderate , severe volume loss?
Mild (2-3%) and the child is normal
Moderate (3-5%) and there is loss of skin tregor and dried mucosa
Severe (10-15%) sunken eyes, delayed capillary refill more than 35 , cool extremities.
Another name for nursemaid elbow?
Treatment for nursemail elbow?
Radial sublaxation
Hyperpronation, supination and flexion
What is Von Griek?
Glucose 6 phosphatase defficiency/ hypoglycemia/ hyperuricemia/ hyperlipidemia/ hyper lactic acidosis/ doll face, short stature, thin extremities
What is Dejernie Roussy syn.
It involves VPL nucleus and there is contralateral hemianesthesia + transient hemiparesis
Prophylaxis for ctryptococcus in HIV + patients?
Fluconasoleoo
Coplication of corniea bacterium diphteria?
Dilated cardiomyopathy
Two meds in diabetic patients that can be prescribed in renal inssuficiency?
Thiazolindiones and dipeptidyl dipeptidsse 4 inhibitiors
What alpha 2 blocker is being used to sedate patients in ICU?
Dexmedetomidine
What med can be used to treat encephalopathy if lactolose does not work?
Rifaximin
Difference between cauda equina and conus medularis?
Conus medularis is bailateral parelysis/ perianal paresthesia/ Hyperreflexia/ early onset / early bladder and bowel dysfunction
ECG changes in Hypertrophic cardiomayopathy?
Tall R in AVL and repolarization changes in avl, V4, v5, v6 and 1.
Nasal discharge+ cornea neovascularization ethiology?
Chlamydia
Which disease is associates with truncus Arteriosus?
Di george
What are the DDX of crying infant?
- colic-> > 3 hours/ day > 3 days a week > 3 weeks
- normal crying
- Milk Allergy
- GERD
- hair torniquet - corneal abraision
Charactristics of tricuspid valve atresia:
Pulmonary undercirculation and decreased pulmonary markings. Small or absent R waves
How would you distinguish between androgen insensitivity and Mullerian Agenesis?
In Androgen insensitivity there is no pubic or axillaryhair.
OI mutation?
Col 1 A1
Indication of packed RBC?
Unstable
Early complication of DM renal disease?
Gelumerolar hyperinfiltration
Gelumerular sclerosis
What are the diseases associated with erythema nodusome?
- TB
- Sarcoidosis
- IBD
- Histoplasmosis
How would you approach to atypical squamouse cell of undetermined significance?
repeat cytology in 1 year if + colposcopy if - reapaet in one year if positive colposcopy if - papsmear 2 times and routin screening
> 25 and HPV + -> colposcopy if - repeat papsmear and hpv in 3 years
Snide effects of Metimazole:
Side effect of Propylthiouracil:
Metimazole side effect: teratogen/ cholestasis
Propylthiouracil: vaculitis like diseases / Hepatic failure
Tx for the patient who cant tolerate vancomycine?
Fidaxomycine
Ulna entrapment is in :
Elbow
Tx of uncomplicated cystitis, complicated cystitis and pyelonephritis?
Uncomplicated cystitis : Nitrofurantoin, TMX, Fosfomycine
Complicated cystitis: Cipro
Pyelonephritis: Cipro
Charactristics of Leprosy?
Diagnostic test for leprosy?
Patient has cough, coriza , malaise and fatigue then hypopigmented leisions without any senses.
Skin biopsy shows T lymphocytes.
Approach to hypercalcemia?
Mechanism of Heparin induced thrombocytopenia?
Ab against platelet factor 4
Argatroban, Fundaparinox, Bivilirudin
Ddxof low pleural glucose?
- Empyema
- TB
- SLE
- Malignancy
- esophageal rupture
What are the HACEK organisms which cause endocarditis?
Hemophylus, Actinomycetem, cardiobacter, ekinella, kingella
Charactristics of HNPCC?
Side effects of Ca channel blockers? Amilodipine, Nimodipine
Tx ?
Peripheral edema,
ACE Inhibitors
Side effects of B agonists?
Tremor, hypokalemia, palpitation, headache
Connection between thyroid hormones, dopamin and prolactin?
Dopamin and thyroid hormones will supress prolactine.
Charactristics of fat necrosis:
TX:
Calcification, hypoecho mass, breast retraction
No TX is needed.
Side effects of Raloxifen and Tamoxifen?
Raloxifen: DVT
Tamoxifen: endometrial cancer
Indication of Trazodone?
Depression+Insomnia
Acute distress disorder and PTSD?
Acute distress disorder is less than a month, PTSD is more than one month.
5 drugs approved for OCD:
- Fluexetine
- Flovoxamine
- Serteraline
- Paroxetine
- Clomipramine
Charactristics of osteoid osteoma?
Round leisions with sclerotic margines.
Indication for these Antipsychotics:
- Adenosin: Supraventricular tachycardia
- Amiodarone: Vtac
- Atropin: bradycardia
- calcium gluconate: hyperkalemia
Compensation mechanisms for metabloic acidosis, metabolic alkalosis, respiratory acidosis, respiratory alkalosis:
Metabolic acidosis: paco2= 1.5 ( hco3) +8 +- 2
Metabolic alkalosis: increase pco2 by 0.7 for every 1 meq rise in Hco3
Respiratory acidosis: increase hco3 1meq for every 10 mmhg rise in paco2
Respiratory Alkalosis: decrease serum hco3 by 2 for every 10 meq decrease in paco2
Intusucception?
It happens after a gastroentritis with inflammation of lymphoid tissue, sussage shape mass, target sign in US, pain upon raising the leg toward the abdomen and TX is air enema.
Charactristics of Fabry disease:
Alpha1 galactosidase defficiency/ Angiokeratoma/ peripheral Neuropathy/ asymmetric corneal dystrophy/ renal failure/ heart failure/ thromboembolic events
Charactristics of hemocysteinuria?
It looks like Marfan/ tall stature, fair skin, dislocation of the lense inward and down, thrombosis/ megaloblastic anemia.
Most common cause of secondary HTN in children?
Fibromascular dysplasia , angiography shows strings of beads and there is a bruit in costovertebral angle.
Most common cause of Osteomyeleitis is a patient with URI?
Klebisella and pseudomona.
Clopmiphen mechanism:
It is estrogen analougue which helps to increase FSH and GnRH
Magnesium toxicity ?!
Diarrhea, nausea, vomitting, muscle weekness, decreased DTR
How would you interpret Ankle Brachial reflex?
- 9-1.30 is normal
1. 30> clacified and uncompressable vessle
Mechanisms to decrease ICP?
- head elevation
- Monitol
- shunt
- sedation
- hyperventilation
Side effect of Tacrolimus?
Neurotoxicity, Diarrhea, glucose intolerance
Side effect of micofenolate?
BM supression
Multiple trauma approach?
Fast ( U/S ) , stable see blood -> laparascopy no blood-> CT Scan
Unstable see blood-> laparatomy no blood -> DPL
Mechanism of chlomiphen?
It’s strogen Analogue and will increase GnRH and FsH.
CPPD in?
Wilson, DM, Hypothyroidism, Hyperparathyroidism, Pseudogout, Homochromatosis
Most common cause of death in young people with SLE and old people with SLE?
Young-> infection
Old-> Atherosclerosis
Charactristicsis of Hereditary Angioedema?
Differences between hereditary and aquired Angioedema?
- decreased c1 inhibitor, C4 and increased c2b,
- in hereditary form c1q is normal in aquired there is low c1q.
Mechanism of Riluzol?
Glutamate inhibitor
Charactristics of MCA stroke?
Aphasia
Eyes deviated toward the leision
Contralateral hepiparesis
Neglect if non- dominant lobe is involved
Charactristics of basal ganglia stroke?
- pure motor or sensory loss
- Dysarthria
- clammsy hand syn.
- Ataxic Hemiparesis.
Charactristics of basillar stroke?
- locked in syn - dysphagia
- coma - dysarthria
- cranial N palsy - vertigo
- Apnea - drop attacks
- visual symptoms - weakness of ipsilateral face and
Contralateral body
4 Ds of Post. Circulation stroke?
- Dysphagia
- Dysarthria
- dizziness
- Diplopia
Diseases associated with berry Aneurysm?
- Marfan - PKD
- Ehler Danlos - Familial
- SCD
- coaractation of aorta
- Athrosclerosis
Management of subarachnoid hemoorhage ?
- BP
Charactristics of MCA stroke?
1- contralateral hemiparesisi and hemisensory loss
2- Aphasia
3- neglect if non dominant lobe is involved
4- gaze toward the leision
Charactristics of basal ganglia stroke?
- clumsy hand syndrome
- ataxic hemiparesis
- pure sensory or motor loss
- Dysarthria
Charactristics of basialr Artery strokes?
- Vertigo - locked in syndrome
- cranial nerve is involved - sesonry loss in one side and weakness
- vision loss In contralateral side
- Dysphagia - Apnea
- Dysarthria - drop attacks
- coma
4 Ds of posterior circulation strokes?
- Diplopia
- Dysarthria
- Dysphagia
- Dizziness
Contraindications of TPA?
- HTN > 185/110 - Surgery in the past 2 weeks
- Glucose > 500 or 1.7
Associations with berry Aneurysm?
- SCD - Coaractation of Aeorta
- Marfan
- Ehler Danlose syn.
- PKD
- Atherosclerosis
- Familial
Basic steps in management of SAH?
- LP
- Head elevation
- Ca- channel blocker
- lowering BP
DDx of severe headache?
- primary
- increased ICP
- Angle closure Glucoma
- Thrombosis
- Hemorrhage
How to Dx headache related to cavernous sinus thrombisis?
- recent orbital facial infections
- proptosis, ptosis, red eyes
- ophtalmoplasia
- confusion, drowsiness, coma
- visual disturbance, diplopia , orbital pain
What is infantile spasm or west syn?
Generalized epilepsy 6 months after birth. It could be due to PKU, infections, Tuberouse sclerosis, hypoxic ischemic stroke.
What does protrin C do?
It inhibits factor V.
Which drugs are inhibited in Myastenia Gravis?
B-blockers and Aminoglycosides
Ddx of eaton lambert and myastenia gravis?
Eaton lambert gets better with activity but Myastenia gravis gets worse with activity.
Tx of Eaton Lambert?
- Pyridostegmine
- Guanidine
- 3,4 diamonopyrydine
What is Dawsons fingers?
Asymmetrical periventricular white matter leisions specially in corpus callusum.
Tx for Eaton Lambert?
- Guanidin
- Pyridostigimine
- 2/3 Dyamniopyridin
What is the main charactristics of ALS?
No eye or bladder is involved.
Tx for ITP?
- IVIG
- Splenectomy
- Corticosteroids
Tx for TTP?
- Plasmaphresis
- Corticosteroids
Lab tests in CML?
- low LAP
Exudate Pleural Effusion charactristics?
Ph 60%
Pr> 50%
How would you define severe PCP?
PH35
Po2
PCP treatments?
TMX/ Clinda + Primaquine or Pentamidine
Charactristic of PCP?
High LDH
Exudate pulmonary effusion charactristics?
- PH
How is sweat chloride test is being done?
Pilocarpin is given and the amount of sodium and chloride will be measured in the sweat.
Mechanism of Rasburicase and Pegloticase?
- they break down uric acid to Allantoin.
Transient sinovitis?
Most common cause of hip pain inn 7-10 years old children. After trauma or infection.
Septic Arthritis?
Fever> 38
ESR>40
CRP>2
WBC>12000
Charactristics of Hydrocephalus in neonates?
Next step?
Wide sutures, low activity, buldging fontanels, iritibility, poor feeding, vomiting, prominant scalp veins
Causes of bacterial Rhinosynovitis?
Treatment of Rhinosinovitis?
Moraxella, H Influenza, Strep
Amoxicillin+ clavolonic acid
Charactristics of prulent Rhinosinovitis?
Fever Syptoms after 10 days Prulent nasal discharge Facial pain for 3 days Worsening symptoms > 5 days after URTI
Cause of Bronchiolitis in children?
Tx of Bronchilitis in children?
Prevention of Bronchiolitis in children?
Complications of Bronchiolitis?
- RSV
- Supportive
- Palivizumab
- Apnea/ Respiratory Failure
What is sturge weber?
Neurocutaneouse disease with cavrenous hemangioma + Intracranial calcifications
Charactristics of vit B2 defficiency?
Cheilosis Stomatitis Normochrom normocytic anemia Seborrheic Dermatitis Glossitis
Only exception for scheduled vaccination?
Hep B
Complications of prematurity?
- RDS - Bronchopulmonary dysplasia
- PDA
- retinopathy of prematurity
- Necroziting entrocolitis
- intraventricular hemorrhage
Causes of QT prolongation:
Tx:
- meds
- inherited: Jerel lang nielsen & Romano ward
- Electrolyte imbalance: hypocalcemia/ hypokalemia/ hypomagnesemia
- pacemaker and b blocker
Tx for Basillary Angiomatosis:
Oral Erythromycine
Extra manifestations of UC?
- colorectal cancer
- toxic megacolon
- cholangiocarcinima
- uveitis
- Erythema nodusom
Approach to severe Hematochesia?
NG aspiration: blood? Yes-> endoscopy no-> colonoscopy
Find the source? Yes-> treat No? -> still bleeding -> surgery no bleed-> small intestin study
Different levels of HCT?
HCT 30-35 is normal
25-30 Dyspnea
20-25 angina
Under 20 chest pain and syncope
When can we see cold IG?
Mycoplasma, EBV, Waldostrome macroglubolinemia,
Iron defficiency anemia risk factors?
- Prematurity
- Lead poisoning
- toddlers>24 M on a daily milk
- infants who consume low iron formula, cow milk, soy milk, goats milk 6 M
Heart involvement in Edward syndrome and william syndrome?
Edward syndrome: VSD
William: Aortic Stenosis
Approach to lead poisoning:
5-45 nothing, 45-75 DMSA, 75
Charactristics of Macun Albright:
- Pigmentation - precocious puberty- polyostotic fibrouse dysplasia
Defect in Macun Albright?
G-protein CAMP kinase function defect
Causes of neck pain:
- trauma
- URTI
- cervicallymphadenitis
- retropharyngeal abcess
Difference between precociouse puberty in Macun-Albright and Adrenal insufficiency?
In macun albright the preciciouse puberty in homosexual in Adrenal diffiency
Ethilogy of macun Albright:
G- protein CAMP kinase function
Treatment for Impetigo?
Mupirocine topical
Contraindication of breast feeding in an infant?
Galactosemia
Which diseases are associated with intussuception?
Meckel diverticulum and Henoch Shonlein purpura
What is PANDAS?
Pediatric autoimmune neuropsychiatric disorder associated with strep.
HCT levels and its effects
30-35
Causes of sideroblastic anemia:
Alcohol, lead, isoniazide, Less B6
How much iron is needed in normal person, mensturation, pregnancy?
Nl: 1-2 mg
Mensturation: 5-6
Pregnant: 2-3
Side effect of folate and B12 replacement therapy?
Hypokalemia
Where can we see cold antibodies?
- EBV
- Waldostrom microglobolinemia
- Mycoplasma
Charactristics of Wegner?
Systemic vasculitis, upper and lowe airway granolumatose inflammation, gelomeronephritis, cutaneous leisions
Prophylaxies in :
- mycobacterium Avium - TB
- P. Cyctis jirovenji
- Toxoplasma Gondii
- Cryptococcus
- Azitromycine
- Cotrimoxazole
- Cotrimoxazole
- Fluconazole
- Isoniazide
Approach to recurrent chalazion?
Histopathology, r/o BCC and sebaceous Carcinoma
Another name for Osteitis Fibrosa cystica?
Von Rickling Hausen
- increase osteoclast activity and increasing bone resorbtion
Diseases associated with avascular necrosis?
- SCD/ Corticosteroids/ Alcohol/ SLE
Mechanism of Thrombosis in heparin induced thrombocytopenia?
Heparin will attach to PFT4 -> increase IgG -> attache to plt RS and activates platelets-> PFT4+ IgG+ platelets= > release cytokines like VWF -> induce thrombosis
What type of cancer is associated with Percelain gallbladder?
Adenocarcinoma
Most common causes of conjunctivitis right after birth, 5 days later, more than 5 days?
Right after birth is chemical, 5 days later is Gonorrhea after 5 days is chlamydia.
How would you recognize water house fridrichsen syndrome?
Flank pain + rash + Hypotension
Charactristics of Galactosemia?
Consequence of having Galactosemia?
Jundice, Cateract, LBW, Vomitting, Hepatomegaly and convulsion
E.Coli Sepsis
Charactristics of mild , moderate , severe volume loss?
Mild (2-3%) and the child is normal
Moderate (3-5%) and there is loss of skin tregor and dried mucosa
Severe (10-15%) sunken eyes, delayed capillary refill more than 35 , cool extremities.
Another name for nursemaid elbow?
Treatment for nursemail elbow?
Radial sublaxation
Hyperpronation, supination and flexion
What is Von Griek?
Glucose 6 phosphatase defficiency/ hypoglycemia/ hyperuricemia/ hyperlipidemia/ hyper lactic acidosis/ doll face, short stature, thin extremities
What is Dejernie Roussy syn.
It involves VPL nucleus and there is contralateral hemianesthesia + transient hemiparesis
Prophylaxis for ctryptococcus in HIV + patients?
Fluconasoleoo
Coplication of corniea bacterium diphteria?
Dilated cardiomyopathy
Two meds in diabetic patients that can be prescribed in renal inssuficiency?
Thiazolindiones and dipeptidyl dipeptidsse 4 inhibitiors
What alpha 2 blocker is being used to sedate patients in ICU?
Dexmedetomidine
What med can be used to treat encephalopathy if lactolose does not work?
Rifaximin
Difference between cauda equina and conus medularis?
Conus medularis is bailateral parelysis/ perianal paresthesia/ Hyperreflexia/ early onset / early bladder and bowel dysfunction
ECG changes in Hypertrophic cardiomayopathy?
Tall R in AVL and repolarization changes in avl, V4, v5, v6 and 1.
Nasal discharge+ cornea neovascularization ethiology?
Chlamydia
Which disease is associates with truncus Arteriosus?
Di george
What are the DDX of crying infant?
- colic-> > 3 hours/ day > 3 days a week > 3 weeks
- normal crying
- Milk Allergy
- GERD
- hair torniquet - corneal abraision
Charactristics of tricuspid valve atresia:
Pulmonary undercirculation and decreased pulmonary markings. Small or absent R waves
How would you distinguish between androgen insensitivity and Mullerian Agenesis?
In Androgen insensitivity there is no pubic or axillaryhair.
OI mutation?
Col 1 A1
Indication of packed RBC?
Unstable
Early complication of DM renal disease?
Gelumerolar hyperinfiltration
Gelumerular sclerosis
What are the diseases associated with erythema nodusome?
- TB
- Sarcoidosis
- IBD
- Histoplasmosis
How would you approach to atypical squamouse cell of undetermined significance?
repeat cytology in 1 year if + colposcopy if - reapaet in one year if positive colposcopy if - papsmear 2 times and routin screening
> 25 and HPV + -> colposcopy if - repeat papsmear and hpv in 3 years
Snide effects of Metimazole:
Side effect of Propylthiouracil:
Metimazole side effect: teratogen/ cholestasis
Propylthiouracil: vaculitis like diseases / Hepatic failure
Tx for the patient who cant tolerate vancomycine?
Fidaxomycine
Ulna entrapment is in :
Elbow
Tx of uncomplicated cystitis, complicated cystitis and pyelonephritis?
Uncomplicated cystitis : Nitrofurantoin, TMX, Fosfomycine
Complicated cystitis: Cipro
Pyelonephritis: Cipro
Charactristics of Leprosy?
Diagnostic test for leprosy?
Patient has cough, coriza , malaise and fatigue then hypopigmented leisions without any senses.
Skin biopsy shows T lymphocytes.
Approach to hypercalcemia?
Mechanism of Heparin induced thrombocytopenia?
Ab against platelet factor 4
Argatroban, Fundaparinox, Bivilirudin
Ddxof low pleural glucose?
- Empyema
- TB
- SLE
- Malignancy
- esophageal rupture
What are the HACEK organisms which cause endocarditis?
Hemophylus, Actinomycetem, cardiobacter, ekinella, kingella
Charactristics of HNPCC?
Side effects of Ca channel blockers? Amilodipine, Nimodipine
Tx ?
Peripheral edema,
ACE Inhibitors
Side effects of B agonists?
Tremor, hypokalemia, palpitation, headache
Connection between thyroid hormones, dopamin and prolactin?
Dopamin and thyroid hormones will supress prolactine.
Charactristics of fat necrosis:
TX:
Calcification, hypoecho mass, breast retraction
No TX is needed.
Side effects of Raloxifen and Tamoxifen?
Raloxifen: DVT
Tamoxifen: endometrial cancer
Indication of Trazodone?
Depression+Insomnia
Acute distress disorder and PTSD?
Acute distress disorder is less than a month, PTSD is more than one month.
5 drugs approved for OCD:
- Fluexetine
- Flovoxamine
- Serteraline
- Paroxetine
- Clomipramine
Charactristics of osteoid osteoma?
Round leisions with sclerotic margines.
Indication for these Antipsychotics:
- Adenosin: Supraventricular tachycardia
- Amiodarone: Vtac
- Atropin: bradycardia
- calcium gluconate: hyperkalemia
Compensation mechanisms for metabloic acidosis, metabolic alkalosis, respiratory acidosis, respiratory alkalosis:
Metabolic acidosis: paco2= 1.5 ( hco3) +8 +- 2
Metabolic alkalosis: increase pco2 by 0.7 for every 1 meq rise in Hco3
Respiratory acidosis: increase hco3 1meq for every 10 mmhg rise in paco2
Respiratory Alkalosis: decrease serum hco3 by 2 for every 10 meq decrease in paco2
Intusucception?
It happens after a gastroentritis with inflammation of lymphoid tissue, sussage shape mass, target sign in US, pain upon raising the leg toward the abdomen and TX is air enema.
Charactristics of Fabry disease:
Alpha1 galactosidase defficiency/ Angiokeratoma/ peripheral Neuropathy/ asymmetric corneal dystrophy/ renal failure/ heart failure/ thromboembolic events
Charactristics of hemocysteinuria?
It looks like Marfan/ tall stature, fair skin, dislocation of the lense inward and down, thrombosis/ megaloblastic anemia.
Most common cause of secondary HTN in children?
Fibromascular dysplasia , angiography shows strings of beads and there is a bruit in costovertebral angle.
Most common cause of Osteomyeleitis is a patient with URI?
Klebisella and pseudomona.
Clopmiphen mechanism:
It is estrogen analougue which helps to increase FSH and GnRH
Magnesium toxicity ?!
Diarrhea, nausea, vomitting, muscle weekness, decreased DTR
How would you interpret Ankle Brachial reflex?
- 9-1.30 is normal
1. 30> clacified and uncompressable vessle
Mechanisms to decrease ICP?
- head elevation
- Monitol
- shunt
- sedation
- hyperventilation
Side effect of Tacrolimus?
Neurotoxicity, Diarrhea, glucose intolerance
Side effect of micofenolate?
BM supression
Multiple trauma approach?
Fast ( U/S ) , stable see blood -> laparascopy no blood-> CT Scan
Unstable see blood-> laparatomy no blood -> DPL
Mechanism of chlomiphen?
It’s strogen Analogue and will increase GnRH and FsH.
CPPD in?
Wilson, DM, Hypothyroidism, Hyperparathyroidism, Pseudogout, Homochromatosis
Most common cause of death in young people with SLE and old people with SLE?
Young-> infection
Old-> Atherosclerosis
Charactristicsis of Hereditary Angioedema?
Differences between hereditary and aquired Angioedema?
- decreased c1 inhibitor, C4 and increased c2b,
- in hereditary form c1q is normal in aquired there is low c1q.
Mechanism of Riluzol?
Glutamate inhibitor
Charactristics of MCA stroke?
Aphasia
Eyes deviated toward the leision
Contralateral hepiparesis
Neglect if non- dominant lobe is involved
Charactristics of basal ganglia stroke?
- pure motor or sensory loss
- Dysarthria
- clammsy hand syn.
- Ataxic Hemiparesis.
Charactristics of basillar stroke?
- locked in syn - dysphagia
- coma - dysarthria
- cranial N palsy - vertigo
- Apnea - drop attacks
- visual symptoms - weakness of ipsilateral face and
Contralateral body
4 Ds of Post. Circulation stroke?
- Dysphagia
- Dysarthria
- dizziness
- Diplopia
Diseases associated with berry Aneurysm?
- Marfan - PKD
- Ehler Danlos - Familial
- SCD
- coaractation of aorta
- Athrosclerosis
Management of subarachnoid hemoorhage ?
- BP
Charactristics of MCA stroke?
1- contralateral hemiparesisi and hemisensory loss
2- Aphasia
3- neglect if non dominant lobe is involved
4- gaze toward the leision
Charactristics of basal ganglia stroke?
- clumsy hand syndrome
- ataxic hemiparesis
- pure sensory or motor loss
- Dysarthria
Charactristics of basialr Artery strokes?
- Vertigo - locked in syndrome
- cranial nerve is involved - sesonry loss in one side and weakness
- vision loss In contralateral side
- Dysphagia - Apnea
- Dysarthria - drop attacks
- coma
4 Ds of posterior circulation strokes?
- Diplopia
- Dysarthria
- Dysphagia
- Dizziness
Contraindications of TPA?
- HTN > 185/110 - Surgery in the past 2 weeks
- Glucose > 500 or 1.7
Associations with berry Aneurysm?
- SCD - Coaractation of Aeorta
- Marfan
- Ehler Danlose syn.
- PKD
- Atherosclerosis
- Familial
Basic steps in management of SAH?
- LP
- Head elevation
- Ca- channel blocker
- lowering BP
DDx of severe headache?
- primary
- increased ICP
- Angle closure Glucoma
- Thrombosis
- Hemorrhage
How to Dx headache related to cavernous sinus thrombisis?
- recent orbital facial infections
- proptosis, ptosis, red eyes
- ophtalmoplasia
- confusion, drowsiness, coma
- visual disturbance, diplopia , orbital pain
What is infantile spasm or west syn?
Generalized epilepsy 6 months after birth. It could be due to PKU, infections, Tuberouse sclerosis, hypoxic ischemic stroke.
What does protrin C do?
It inhibits factor V.
Which drugs are inhibited in Myastenia Gravis?
B-blockers and Aminoglycosides
Ddx of eaton lambert and myastenia gravis?
Eaton lambert gets better with activity but Myastenia gravis gets worse with activity.
Tx of Eaton Lambert?
- Pyridostegmine
- Guanidine
- 3,4 diamonopyrydine
What is Dawsons fingers?
Asymmetrical periventricular white matter leisions specially in corpus callusum.
Tx for Eaton Lambert?
- Guanidin
- Pyridostigimine
- 2/3 Dyamniopyridin
What is the main charactristics of ALS?
No eye or bladder is involved.
Tx for ITP?
- IVIG
- Splenectomy
- Corticosteroids
Tx for TTP?
- Plasmaphresis
- Corticosteroids
Lab tests in CML?
- low LAP
Exudate Pleural Effusion charactristics?
Ph 60%
Pr> 50%
How would you define severe PCP?
PH35
Po2
PCP treatments?
TMX/ Clinda + Primaquine or Pentamidine
Charactristic of PCP?
High LDH
Exudate pulmonary effusion charactristics?
- PH
How is sweat chloride test is being done?
Pilocarpin is given and the amount of sodium and chloride will be measured in the sweat.
Mechanism of Rasburicase and Pegloticase?
- they break down uric acid to Allantoin.
Transient sinovitis?
Most common cause of hip pain inn 7-10 years old children. After trauma or infection.
Septic Arthritis?
Fever> 38
ESR>40
CRP>2
WBC>12000
Charactristics of Hydrocephalus in neonates?
Next step?
Wide sutures, low activity, buldging fontanels, iritibility, poor feeding, vomiting, prominant scalp veins
Causes of bacterial Rhinosynovitis?
Treatment of Rhinosinovitis?
Moraxella, H Influenza, Strep
Amoxicillin+ clavolonic acid
Charactristics of prulent Rhinosinovitis?
Fever Syptoms after 10 days Prulent nasal discharge Facial pain for 3 days Worsening symptoms > 5 days after URTI
Cause of Bronchiolitis in children?
Tx of Bronchilitis in children?
Prevention of Bronchiolitis in children?
Complications of Bronchiolitis?
- RSV
- Supportive
- Palivizumab
- Apnea/ Respiratory Failure
What is sturge weber?
Neurocutaneouse disease with cavrenous hemangioma + Intracranial calcifications
Charactristics of vit B2 defficiency?
Cheilosis Stomatitis Normochrom normocytic anemia Seborrheic Dermatitis Glossitis
Only exception for scheduled vaccination?
Hep B
Complications of prematurity?
- RDS - Bronchopulmonary dysplasia
- PDA
- retinopathy of prematurity
- Necroziting entrocolitis
- intraventricular hemorrhage
Causes of QT prolongation:
Tx:
- meds
- inherited: Jerel lang nielsen & Romano ward
- Electrolyte imbalance: hypocalcemia/ hypokalemia/ hypomagnesemia
- pacemaker and b blocker
Tx for Basillary Angiomatosis:
Oral Erythromycine
Extra manifestations of UC?
- colorectal cancer
- toxic megacolon
- cholangiocarcinima
- uveitis
- Erythema nodusom
Approach to severe Hematochesia?
NG aspiration: blood? Yes-> endoscopy no-> colonoscopy
Find the source? Yes-> treat No? -> still bleeding -> surgery no bleed-> small intestin study
Different levels of HCT?
HCT 30-35 is normal
25-30 Dyspnea
20-25 angina
Under 20 chest pain and syncope
When can we see cold IG?
Mycoplasma, EBV, Waldostrome macroglubolinemia,
Iron defficiency anemia risk factors?
- Prematurity
- Lead poisoning
- toddlers>24 M on a daily milk
- infants who consume low iron formula, cow milk, soy milk, goats milk 6 M
Heart involvement in Edward syndrome and william syndrome?
Edward syndrome: VSD
William: Aortic Stenosis
Approach to lead poisoning:
5-45 nothing, 45-75 DMSA, 75
Charactristics of Macun Albright:
- Pigmentation - precocious puberty- polyostotic fibrouse dysplasia
Defect in Macun Albright?
G-protein CAMP kinase function defect
Causes of neck pain:
- trauma
- URTI
- cervicallymphadenitis
- retropharyngeal abcess
Difference between precociouse puberty in Macun-Albright and Adrenal insufficiency?
In macun albright the preciciouse puberty in homosexual in Adrenal diffiency
Ethilogy of macun Albright:
G- protein CAMP kinase function
Treatment for Impetigo?
Mupirocine topical
Contraindication of breast feeding in an infant?
Galactosemia
Which diseases are associated with intussuception?
Meckel diverticulum and Henoch Shonlein purpura
What is PANDAS?
Pediatric autoimmune neuropsychiatric disorder associated with strep.
HCT levels and its effects
30-35
Causes of sideroblastic anemia:
Alcohol, lead, isoniazide, Less B6
How much iron is needed in normal person, mensturation, pregnancy?
Nl: 1-2 mg
Mensturation: 5-6
Pregnant: 2-3
Side effect of folate and B12 replacement therapy?
Hypokalemia
Where can we see cold antibodies?
- EBV
- Waldostrom microglobolinemia
- Mycoplasma
Charactristics of Wegner?
Systemic vasculitis, upper and lowe airway granolumatose inflammation, gelomeronephritis, cutaneous leisions
Prophylaxies in :
- mycobacterium Avium - TB
- P. Cyctis jirovenji
- Toxoplasma Gondii
- Cryptococcus
- Azitromycine
- Cotrimoxazole
- Cotrimoxazole
- Fluconazole
- Isoniazide
Approach to recurrent chalazion?
Histopathology, r/o BCC and sebaceous Carcinoma
Another name for Osteitis Fibrosa cystica?
Von Rickling Hausen
- increase osteoclast activity and increasing bone resorbtion
Diseases associated with avascular necrosis?
- SCD/ Corticosteroids/ Alcohol/ SLE
Mechanism of Thrombosis in heparin induced thrombocytopenia?
Heparin will attach to PFT4 -> increase IgG -> attache to plt RS and activates platelets-> PFT4+ IgG+ platelets= > release cytokines like VWF -> induce thrombosis
What type of cancer is associated with Percelain gallbladder?
Adenocarcinoma
Most common causes of conjunctivitis right after birth, 5 days later, more than 5 days?
Right after birth is chemical, 5 days later is Gonorrhea after 5 days is chlamydia.
How would you recognize water house fridrichsen syndrome?
Flank pain + rash + Hypotension
Charactristics of Galactosemia?
Consequence of having Galactosemia?
Jundice, Cateract, LBW, Vomitting, Hepatomegaly and convulsion
E.Coli Sepsis
Charactristics of mild , moderate , severe volume loss?
Mild (2-3%) and the child is normal
Moderate (3-5%) and there is loss of skin tregor and dried mucosa
Severe (10-15%) sunken eyes, delayed capillary refill more than 35 , cool extremities.
Another name for nursemaid elbow?
Treatment for nursemail elbow?
Radial sublaxation
Hyperpronation, supination and flexion
What is Von Griek?
Glucose 6 phosphatase defficiency/ hypoglycemia/ hyperuricemia/ hyperlipidemia/ hyper lactic acidosis/ doll face, short stature, thin extremities
What is Dejernie Roussy syn.
It involves VPL nucleus and there is contralateral hemianesthesia + transient hemiparesis
Prophylaxis for ctryptococcus in HIV + patients?
Fluconasoleoo
Coplication of corniea bacterium diphteria?
Dilated cardiomyopathy
Two meds in diabetic patients that can be prescribed in renal inssuficiency?
Thiazolindiones and dipeptidyl dipeptidsse 4 inhibitiors
What alpha 2 blocker is being used to sedate patients in ICU?
Dexmedetomidine
What med can be used to treat encephalopathy if lactolose does not work?
Rifaximin
Difference between cauda equina and conus medularis?
Conus medularis is bailateral parelysis/ perianal paresthesia/ Hyperreflexia/ early onset / early bladder and bowel dysfunction
ECG changes in Hypertrophic cardiomayopathy?
Tall R in AVL and repolarization changes in avl, V4, v5, v6 and 1.
Nasal discharge+ cornea neovascularization ethiology?
Chlamydia
Which disease is associates with truncus Arteriosus?
Di george
What are the DDX of crying infant?
- colic-> > 3 hours/ day > 3 days a week > 3 weeks
- normal crying
- Milk Allergy
- GERD
- hair torniquet - corneal abraision
Charactristics of tricuspid valve atresia:
Pulmonary undercirculation and decreased pulmonary markings. Small or absent R waves
How would you distinguish between androgen insensitivity and Mullerian Agenesis?
In Androgen insensitivity there is no pubic or axillaryhair.
OI mutation?
Col 1 A1
Indication of packed RBC?
Unstable
Early complication of DM renal disease?
Gelumerolar hyperinfiltration
Gelumerular sclerosis
What are the diseases associated with erythema nodusome?
- TB
- Sarcoidosis
- IBD
- Histoplasmosis
How would you approach to atypical squamouse cell of undetermined significance?
repeat cytology in 1 year if + colposcopy if - reapaet in one year if positive colposcopy if - papsmear 2 times and routin screening
> 25 and HPV + -> colposcopy if - repeat papsmear and hpv in 3 years
Snide effects of Metimazole:
Side effect of Propylthiouracil:
Metimazole side effect: teratogen/ cholestasis
Propylthiouracil: vaculitis like diseases / Hepatic failure
Tx for the patient who cant tolerate vancomycine?
Fidaxomycine
Ulna entrapment is in :
Elbow
Tx of uncomplicated cystitis, complicated cystitis and pyelonephritis?
Uncomplicated cystitis : Nitrofurantoin, TMX, Fosfomycine
Complicated cystitis: Cipro
Pyelonephritis: Cipro
Charactristics of Leprosy?
Diagnostic test for leprosy?
Patient has cough, coriza , malaise and fatigue then hypopigmented leisions without any senses.
Skin biopsy shows T lymphocytes.
Approach to hypercalcemia?
Mechanism of Heparin induced thrombocytopenia?
Ab against platelet factor 4
Argatroban, Fundaparinox, Bivilirudin
Ddxof low pleural glucose?
- Empyema
- TB
- SLE
- Malignancy
- esophageal rupture
What are the HACEK organisms which cause endocarditis?
Hemophylus, Actinomycetem, cardiobacter, ekinella, kingella
Charactristics of HNPCC?
Side effects of Ca channel blockers? Amilodipine, Nimodipine
Tx ?
Peripheral edema,
ACE Inhibitors
Side effects of B agonists?
Tremor, hypokalemia, palpitation, headache
Connection between thyroid hormones, dopamin and prolactin?
Dopamin and thyroid hormones will supress prolactine.
Charactristics of fat necrosis:
TX:
Calcification, hypoecho mass, breast retraction
No TX is needed.
Side effects of Raloxifen and Tamoxifen?
Raloxifen: DVT
Tamoxifen: endometrial cancer
Indication of Trazodone?
Depression+Insomnia
Acute distress disorder and PTSD?
Acute distress disorder is less than a month, PTSD is more than one month.
5 drugs approved for OCD:
- Fluexetine
- Flovoxamine
- Serteraline
- Paroxetine
- Clomipramine
Charactristics of osteoid osteoma?
Round leisions with sclerotic margines.
Indication for these Antipsychotics:
- Adenosin: Supraventricular tachycardia
- Amiodarone: Vtac
- Atropin: bradycardia
- calcium gluconate: hyperkalemia
Compensation mechanisms for metabloic acidosis, metabolic alkalosis, respiratory acidosis, respiratory alkalosis:
Metabolic acidosis: paco2= 1.5 ( hco3) +8 +- 2
Metabolic alkalosis: increase pco2 by 0.7 for every 1 meq rise in Hco3
Respiratory acidosis: increase hco3 1meq for every 10 mmhg rise in paco2
Respiratory Alkalosis: decrease serum hco3 by 2 for every 10 meq decrease in paco2
Intusucception?
It happens after a gastroentritis with inflammation of lymphoid tissue, sussage shape mass, target sign in US, pain upon raising the leg toward the abdomen and TX is air enema.
Charactristics of Fabry disease:
Alpha1 galactosidase defficiency/ Angiokeratoma/ peripheral Neuropathy/ asymmetric corneal dystrophy/ renal failure/ heart failure/ thromboembolic events
Charactristics of hemocysteinuria?
It looks like Marfan/ tall stature, fair skin, dislocation of the lense inward and down, thrombosis/ megaloblastic anemia.
Most common cause of secondary HTN in children?
Fibromascular dysplasia , angiography shows strings of beads and there is a bruit in costovertebral angle.
Most common cause of Osteomyeleitis is a patient with URI?
Klebisella and pseudomona.
Clopmiphen mechanism:
It is estrogen analougue which helps to increase FSH and GnRH
Magnesium toxicity ?!
Diarrhea, nausea, vomitting, muscle weekness, decreased DTR
How would you interpret Ankle Brachial reflex?
- 9-1.30 is normal
1. 30> clacified and uncompressable vessle
Mechanisms to decrease ICP?
- head elevation
- Monitol
- shunt
- sedation
- hyperventilation
Side effect of Tacrolimus?
Neurotoxicity, Diarrhea, glucose intolerance
Side effect of micofenolate?
BM supression
Multiple trauma approach?
Fast ( U/S ) , stable see blood -> laparascopy no blood-> CT Scan
Unstable see blood-> laparatomy no blood -> DPL
Mechanism of chlomiphen?
It’s strogen Analogue and will increase GnRH and FsH.
CPPD in?
Wilson, DM, Hypothyroidism, Hyperparathyroidism, Pseudogout, Homochromatosis
Most common cause of death in young people with SLE and old people with SLE?
Young-> infection
Old-> Atherosclerosis
Charactristicsis of Hereditary Angioedema?
Differences between hereditary and aquired Angioedema?
- decreased c1 inhibitor, C4 and increased c2b,
- in hereditary form c1q is normal in aquired there is low c1q.
Mechanism of Riluzol?
Glutamate inhibitor
Charactristics of MCA stroke?
Aphasia
Eyes deviated toward the leision
Contralateral hepiparesis
Neglect if non- dominant lobe is involved
Charactristics of basal ganglia stroke?
- pure motor or sensory loss
- Dysarthria
- clammsy hand syn.
- Ataxic Hemiparesis.
Charactristics of basillar stroke?
- locked in syn - dysphagia
- coma - dysarthria
- cranial N palsy - vertigo
- Apnea - drop attacks
- visual symptoms - weakness of ipsilateral face and
Contralateral body
4 Ds of Post. Circulation stroke?
- Dysphagia
- Dysarthria
- dizziness
- Diplopia
Diseases associated with berry Aneurysm?
- Marfan - PKD
- Ehler Danlos - Familial
- SCD
- coaractation of aorta
- Athrosclerosis
Management of subarachnoid hemoorhage ?
- BP
Charactristics of MCA stroke?
1- contralateral hemiparesisi and hemisensory loss
2- Aphasia
3- neglect if non dominant lobe is involved
4- gaze toward the leision
Charactristics of basal ganglia stroke?
- clumsy hand syndrome
- ataxic hemiparesis
- pure sensory or motor loss
- Dysarthria
Charactristics of basialr Artery strokes?
- Vertigo - locked in syndrome
- cranial nerve is involved - sesonry loss in one side and weakness
- vision loss In contralateral side
- Dysphagia - Apnea
- Dysarthria - drop attacks
- coma
4 Ds of posterior circulation strokes?
- Diplopia
- Dysarthria
- Dysphagia
- Dizziness
Contraindications of TPA?
- HTN > 185/110 - Surgery in the past 2 weeks
- Glucose > 500 or 1.7
Associations with berry Aneurysm?
- SCD - Coaractation of Aeorta
- Marfan
- Ehler Danlose syn.
- PKD
- Atherosclerosis
- Familial
Basic steps in management of SAH?
- LP
- Head elevation
- Ca- channel blocker
- lowering BP
DDx of severe headache?
- primary
- increased ICP
- Angle closure Glucoma
- Thrombosis
- Hemorrhage
How to Dx headache related to cavernous sinus thrombisis?
- recent orbital facial infections
- proptosis, ptosis, red eyes
- ophtalmoplasia
- confusion, drowsiness, coma
- visual disturbance, diplopia , orbital pain
What is infantile spasm or west syn?
Generalized epilepsy 6 months after birth. It could be due to PKU, infections, Tuberouse sclerosis, hypoxic ischemic stroke.
What does protrin C do?
It inhibits factor V.
Which drugs are inhibited in Myastenia Gravis?
B-blockers and Aminoglycosides
Ddx of eaton lambert and myastenia gravis?
Eaton lambert gets better with activity but Myastenia gravis gets worse with activity.
Tx of Eaton Lambert?
- Pyridostegmine
- Guanidine
- 3,4 diamonopyrydine
What is Dawsons fingers?
Asymmetrical periventricular white matter leisions specially in corpus callusum.
Tx for Eaton Lambert?
- Guanidin
- Pyridostigimine
- 2/3 Dyamniopyridin
What is the main charactristics of ALS?
No eye or bladder is involved.
Tx for ITP?
- IVIG
- Splenectomy
- Corticosteroids
Tx for TTP?
- Plasmaphresis
- Corticosteroids
Lab tests in CML?
- low LAP
Exudate Pleural Effusion charactristics?
Ph 60%
Pr> 50%
How would you define severe PCP?
PH35
Po2
PCP treatments?
TMX/ Clinda + Primaquine or Pentamidine
Charactristic of PCP?
High LDH
Exudate pulmonary effusion charactristics?
- PH
How is sweat chloride test is being done?
Pilocarpin is given and the amount of sodium and chloride will be measured in the sweat.
Mechanism of Rasburicase and Pegloticase?
- they break down uric acid to Allantoin.
Transient sinovitis?
Most common cause of hip pain inn 7-10 years old children. After trauma or infection.
Septic Arthritis?
Fever> 38
ESR>40
CRP>2
WBC>12000
Charactristics of Hydrocephalus in neonates?
Next step?
Wide sutures, low activity, buldging fontanels, iritibility, poor feeding, vomiting, prominant scalp veins
Causes of bacterial Rhinosynovitis?
Treatment of Rhinosinovitis?
Moraxella, H Influenza, Strep
Amoxicillin+ clavolonic acid
Charactristics of prulent Rhinosinovitis?
Fever Syptoms after 10 days Prulent nasal discharge Facial pain for 3 days Worsening symptoms > 5 days after URTI
Cause of Bronchiolitis in children?
Tx of Bronchilitis in children?
Prevention of Bronchiolitis in children?
Complications of Bronchiolitis?
- RSV
- Supportive
- Palivizumab
- Apnea/ Respiratory Failure
What is sturge weber?
Neurocutaneouse disease with cavrenous hemangioma + Intracranial calcifications
Charactristics of vit B2 defficiency?
Cheilosis Stomatitis Normochrom normocytic anemia Seborrheic Dermatitis Glossitis
Only exception for scheduled vaccination?
Hep B
Complications of prematurity?
- RDS - Bronchopulmonary dysplasia
- PDA
- retinopathy of prematurity
- Necroziting entrocolitis
- intraventricular hemorrhage
Causes of QT prolongation:
Tx:
- meds
- inherited: Jerel lang nielsen & Romano ward
- Electrolyte imbalance: hypocalcemia/ hypokalemia/ hypomagnesemia
- pacemaker and b blocker
Tx for Basillary Angiomatosis:
Oral Erythromycine
Extra manifestations of UC?
- colorectal cancer
- toxic megacolon
- cholangiocarcinima
- uveitis
- Erythema nodusom
Approach to severe Hematochesia?
NG aspiration: blood? Yes-> endoscopy no-> colonoscopy
Find the source? Yes-> treat No? -> still bleeding -> surgery no bleed-> small intestin study
Different levels of HCT?
HCT 30-35 is normal
25-30 Dyspnea
20-25 angina
Under 20 chest pain and syncope
When can we see cold IG?
Mycoplasma, EBV, Waldostrome macroglubolinemia,
Iron defficiency anemia risk factors?
- Prematurity
- Lead poisoning
- toddlers>24 M on a daily milk
- infants who consume low iron formula, cow milk, soy milk, goats milk 6 M
Heart involvement in Edward syndrome and william syndrome?
Edward syndrome: VSD
William: Aortic Stenosis
Approach to lead poisoning:
5-45 nothing, 45-75 DMSA, 75
Charactristics of Macun Albright:
- Pigmentation - precocious puberty- polyostotic fibrouse dysplasia
Defect in Macun Albright?
G-protein CAMP kinase function defect
Causes of neck pain:
- trauma
- URTI
- cervicallymphadenitis
- retropharyngeal abcess
Difference between precociouse puberty in Macun-Albright and Adrenal insufficiency?
In macun albright the preciciouse puberty in homosexual in Adrenal diffiency
Ethilogy of macun Albright:
G- protein CAMP kinase function
Treatment for Impetigo?
Mupirocine topical
Contraindication of breast feeding in an infant?
Galactosemia
Which diseases are associated with intussuception?
Meckel diverticulum and Henoch Shonlein purpura
What is PANDAS?
Pediatric autoimmune neuropsychiatric disorder associated with strep.
HCT levels and its effects
30-35
Causes of sideroblastic anemia:
Alcohol, lead, isoniazide, Less B6
How much iron is needed in normal person, mensturation, pregnancy?
Nl: 1-2 mg
Mensturation: 5-6
Pregnant: 2-3
Side effect of folate and B12 replacement therapy?
Hypokalemia
Where can we see cold antibodies?
- EBV
- Waldostrom microglobolinemia
- Mycoplasma
Charactristics of Wegner?
Systemic vasculitis, upper and lowe airway granolumatose inflammation, gelomeronephritis, cutaneous leisions
Prophylaxies in :
- mycobacterium Avium - TB
- P. Cyctis jirovenji
- Toxoplasma Gondii
- Cryptococcus
- Azitromycine
- Cotrimoxazole
- Cotrimoxazole
- Fluconazole
- Isoniazide
Approach to recurrent chalazion?
Histopathology, r/o BCC and sebaceous Carcinoma
Another name for Osteitis Fibrosa cystica?
Von Rickling Hausen
- increase osteoclast activity and increasing bone resorbtion
Diseases associated with avascular necrosis?
- SCD/ Corticosteroids/ Alcohol/ SLE
Mechanism of Thrombosis in heparin induced thrombocytopenia?
Heparin will attach to PFT4 -> increase IgG -> attache to plt RS and activates platelets-> PFT4+ IgG+ platelets= > release cytokines like VWF -> induce thrombosis
What type of cancer is associated with Percelain gallbladder?
Adenocarcinoma
Most common causes of conjunctivitis right after birth, 5 days later, more than 5 days?
Right after birth is chemical, 5 days later is Gonorrhea after 5 days is chlamydia.
How would you recognize water house fridrichsen syndrome?
Flank pain + rash + Hypotension
Charactristics of Galactosemia?
Consequence of having Galactosemia?
Jundice, Cateract, LBW, Vomitting, Hepatomegaly and convulsion
E.Coli Sepsis
Charactristics of mild , moderate , severe volume loss?
Mild (2-3%) and the child is normal
Moderate (3-5%) and there is loss of skin tregor and dried mucosa
Severe (10-15%) sunken eyes, delayed capillary refill more than 35 , cool extremities.
Another name for nursemaid elbow?
Treatment for nursemail elbow?
Radial sublaxation
Hyperpronation, supination and flexion
What is Von Griek?
Glucose 6 phosphatase defficiency/ hypoglycemia/ hyperuricemia/ hyperlipidemia/ hyper lactic acidosis/ doll face, short stature, thin extremities
What is Dejernie Roussy syn.
It involves VPL nucleus and there is contralateral hemianesthesia + transient hemiparesis
Prophylaxis for ctryptococcus in HIV + patients?
Fluconasoleoo
Coplication of corniea bacterium diphteria?
Dilated cardiomyopathy
Two meds in diabetic patients that can be prescribed in renal inssuficiency?
Thiazolindiones and dipeptidyl dipeptidsse 4 inhibitiors
What alpha 2 blocker is being used to sedate patients in ICU?
Dexmedetomidine
What med can be used to treat encephalopathy if lactolose does not work?
Rifaximin
Difference between cauda equina and conus medularis?
Conus medularis is bailateral parelysis/ perianal paresthesia/ Hyperreflexia/ early onset / early bladder and bowel dysfunction
ECG changes in Hypertrophic cardiomayopathy?
Tall R in AVL and repolarization changes in avl, V4, v5, v6 and 1.
Nasal discharge+ cornea neovascularization ethiology?
Chlamydia
Which disease is associates with truncus Arteriosus?
Di george
What are the DDX of crying infant?
- colic-> > 3 hours/ day > 3 days a week > 3 weeks
- normal crying
- Milk Allergy
- GERD
- hair torniquet - corneal abraision
Charactristics of tricuspid valve atresia:
Pulmonary undercirculation and decreased pulmonary markings. Small or absent R waves
How would you distinguish between androgen insensitivity and Mullerian Agenesis?
In Androgen insensitivity there is no pubic or axillaryhair.
OI mutation?
Col 1 A1
Indication of packed RBC?
Unstable
Early complication of DM renal disease?
Gelumerolar hyperinfiltration
Gelumerular sclerosis
What are the diseases associated with erythema nodusome?
- TB
- Sarcoidosis
- IBD
- Histoplasmosis
How would you approach to atypical squamouse cell of undetermined significance?
repeat cytology in 1 year if + colposcopy if - reapaet in one year if positive colposcopy if - papsmear 2 times and routin screening
> 25 and HPV + -> colposcopy if - repeat papsmear and hpv in 3 years
Snide effects of Metimazole:
Side effect of Propylthiouracil:
Metimazole side effect: teratogen/ cholestasis
Propylthiouracil: vaculitis like diseases / Hepatic failure
Tx for the patient who cant tolerate vancomycine?
Fidaxomycine
Ulna entrapment is in :
Elbow
Tx of uncomplicated cystitis, complicated cystitis and pyelonephritis?
Uncomplicated cystitis : Nitrofurantoin, TMX, Fosfomycine
Complicated cystitis: Cipro
Pyelonephritis: Cipro
Charactristics of Leprosy?
Diagnostic test for leprosy?
Patient has cough, coriza , malaise and fatigue then hypopigmented leisions without any senses.
Skin biopsy shows T lymphocytes.
Approach to hypercalcemia?
Mechanism of Heparin induced thrombocytopenia?
Ab against platelet factor 4
Argatroban, Fundaparinox, Bivilirudin
Ddxof low pleural glucose?
- Empyema
- TB
- SLE
- Malignancy
- esophageal rupture
What are the HACEK organisms which cause endocarditis?
Hemophylus, Actinomycetem, cardiobacter, ekinella, kingella
Charactristics of HNPCC?
Side effects of Ca channel blockers? Amilodipine, Nimodipine
Tx ?
Peripheral edema,
ACE Inhibitors
Side effects of B agonists?
Tremor, hypokalemia, palpitation, headache
Connection between thyroid hormones, dopamin and prolactin?
Dopamin and thyroid hormones will supress prolactine.
Charactristics of fat necrosis:
TX:
Calcification, hypoecho mass, breast retraction
No TX is needed.
Side effects of Raloxifen and Tamoxifen?
Raloxifen: DVT
Tamoxifen: endometrial cancer
Indication of Trazodone?
Depression+Insomnia
Acute distress disorder and PTSD?
Acute distress disorder is less than a month, PTSD is more than one month.
5 drugs approved for OCD:
- Fluexetine
- Flovoxamine
- Serteraline
- Paroxetine
- Clomipramine
Charactristics of osteoid osteoma?
Round leisions with sclerotic margines.
Indication for these Antipsychotics:
- Adenosin: Supraventricular tachycardia
- Amiodarone: Vtac
- Atropin: bradycardia
- calcium gluconate: hyperkalemia
Compensation mechanisms for metabloic acidosis, metabolic alkalosis, respiratory acidosis, respiratory alkalosis:
Metabolic acidosis: paco2= 1.5 ( hco3) +8 +- 2
Metabolic alkalosis: increase pco2 by 0.7 for every 1 meq rise in Hco3
Respiratory acidosis: increase hco3 1meq for every 10 mmhg rise in paco2
Respiratory Alkalosis: decrease serum hco3 by 2 for every 10 meq decrease in paco2
Intusucception?
It happens after a gastroentritis with inflammation of lymphoid tissue, sussage shape mass, target sign in US, pain upon raising the leg toward the abdomen and TX is air enema.
Charactristics of Fabry disease:
Alpha1 galactosidase defficiency/ Angiokeratoma/ peripheral Neuropathy/ asymmetric corneal dystrophy/ renal failure/ heart failure/ thromboembolic events
Charactristics of hemocysteinuria?
It looks like Marfan/ tall stature, fair skin, dislocation of the lense inward and down, thrombosis/ megaloblastic anemia.
Most common cause of secondary HTN in children?
Fibromascular dysplasia , angiography shows strings of beads and there is a bruit in costovertebral angle.
Most common cause of Osteomyeleitis is a patient with URI?
Klebisella and pseudomona.
Clopmiphen mechanism:
It is estrogen analougue which helps to increase FSH and GnRH
Magnesium toxicity ?!
Diarrhea, nausea, vomitting, muscle weekness, decreased DTR
How would you interpret Ankle Brachial reflex?
- 9-1.30 is normal
1. 30> clacified and uncompressable vessle
Mechanisms to decrease ICP?
- head elevation
- Monitol
- shunt
- sedation
- hyperventilation
Side effect of Tacrolimus?
Neurotoxicity, Diarrhea, glucose intolerance
Side effect of micofenolate?
BM supression
Multiple trauma approach?
Fast ( U/S ) , stable see blood -> laparascopy no blood-> CT Scan
Unstable see blood-> laparatomy no blood -> DPL
Mechanism of chlomiphen?
It’s strogen Analogue and will increase GnRH and FsH.
CPPD in?
Wilson, DM, Hypothyroidism, Hyperparathyroidism, Pseudogout, Homochromatosis
Most common cause of death in young people with SLE and old people with SLE?
Young-> infection
Old-> Atherosclerosis
Charactristicsis of Hereditary Angioedema?
Differences between hereditary and aquired Angioedema?
- decreased c1 inhibitor, C4 and increased c2b,
- in hereditary form c1q is normal in aquired there is low c1q.
Mechanism of Riluzol?
Glutamate inhibitor
Charactristics of MCA stroke?
Aphasia
Eyes deviated toward the leision
Contralateral hepiparesis
Neglect if non- dominant lobe is involved
Charactristics of basal ganglia stroke?
- pure motor or sensory loss
- Dysarthria
- clammsy hand syn.
- Ataxic Hemiparesis.
Charactristics of basillar stroke?
- locked in syn - dysphagia
- coma - dysarthria
- cranial N palsy - vertigo
- Apnea - drop attacks
- visual symptoms - weakness of ipsilateral face and
Contralateral body
4 Ds of Post. Circulation stroke?
- Dysphagia
- Dysarthria
- dizziness
- Diplopia
Diseases associated with berry Aneurysm?
- Marfan - PKD
- Ehler Danlos - Familial
- SCD
- coaractation of aorta
- Athrosclerosis
Management of subarachnoid hemoorhage ?
- BP
Charactristics of MCA stroke?
1- contralateral hemiparesisi and hemisensory loss
2- Aphasia
3- neglect if non dominant lobe is involved
4- gaze toward the leision
Charactristics of basal ganglia stroke?
- clumsy hand syndrome
- ataxic hemiparesis
- pure sensory or motor loss
- Dysarthria
Charactristics of basialr Artery strokes?
- Vertigo - locked in syndrome
- cranial nerve is involved - sesonry loss in one side and weakness
- vision loss In contralateral side
- Dysphagia - Apnea
- Dysarthria - drop attacks
- coma
4 Ds of posterior circulation strokes?
- Diplopia
- Dysarthria
- Dysphagia
- Dizziness
Contraindications of TPA?
- HTN > 185/110 - Surgery in the past 2 weeks
- Glucose > 500 or 1.7
Associations with berry Aneurysm?
- SCD - Coaractation of Aeorta
- Marfan
- Ehler Danlose syn.
- PKD
- Atherosclerosis
- Familial
Basic steps in management of SAH?
- LP
- Head elevation
- Ca- channel blocker
- lowering BP
DDx of severe headache?
- primary
- increased ICP
- Angle closure Glucoma
- Thrombosis
- Hemorrhage
How to Dx headache related to cavernous sinus thrombisis?
- recent orbital facial infections
- proptosis, ptosis, red eyes
- ophtalmoplasia
- confusion, drowsiness, coma
- visual disturbance, diplopia , orbital pain
What is infantile spasm or west syn?
Generalized epilepsy 6 months after birth. It could be due to PKU, infections, Tuberouse sclerosis, hypoxic ischemic stroke.
What does protrin C do?
It inhibits factor V.
Which drugs are inhibited in Myastenia Gravis?
B-blockers and Aminoglycosides
Ddx of eaton lambert and myastenia gravis?
Eaton lambert gets better with activity but Myastenia gravis gets worse with activity.
Tx of Eaton Lambert?
- Pyridostegmine
- Guanidine
- 3,4 diamonopyrydine
What is Dawsons fingers?
Asymmetrical periventricular white matter leisions specially in corpus callusum.
Tx for Eaton Lambert?
- Guanidin
- Pyridostigimine
- 2/3 Dyamniopyridin
What is the main charactristics of ALS?
No eye or bladder is involved.
Tx for ITP?
- IVIG
- Splenectomy
- Corticosteroids
Tx for TTP?
- Plasmaphresis
- Corticosteroids
Lab tests in CML?
- low LAP
Exudate Pleural Effusion charactristics?
Ph 60%
Pr> 50%
How would you define severe PCP?
PH35
Po2
PCP treatments?
TMX/ Clinda + Primaquine or Pentamidine
Charactristic of PCP?
High LDH
Exudate pulmonary effusion charactristics?
- PH
How is sweat chloride test is being done?
Pilocarpin is given and the amount of sodium and chloride will be measured in the sweat.
Mechanism of Rasburicase and Pegloticase?
- they break down uric acid to Allantoin.
Transient sinovitis?
Most common cause of hip pain inn 7-10 years old children. After trauma or infection.
Septic Arthritis?
Fever> 38
ESR>40
CRP>2
WBC>12000
Charactristics of Hydrocephalus in neonates?
Next step?
Wide sutures, low activity, buldging fontanels, iritibility, poor feeding, vomiting, prominant scalp veins
Causes of bacterial Rhinosynovitis?
Treatment of Rhinosinovitis?
Moraxella, H Influenza, Strep
Amoxicillin+ clavolonic acid
Charactristics of prulent Rhinosinovitis?
Fever Syptoms after 10 days Prulent nasal discharge Facial pain for 3 days Worsening symptoms > 5 days after URTI
Cause of Bronchiolitis in children?
Tx of Bronchilitis in children?
Prevention of Bronchiolitis in children?
Complications of Bronchiolitis?
- RSV
- Supportive
- Palivizumab
- Apnea/ Respiratory Failure
What is sturge weber?
Neurocutaneouse disease with cavrenous hemangioma + Intracranial calcifications
Charactristics of vit B2 defficiency?
Cheilosis Stomatitis Normochrom normocytic anemia Seborrheic Dermatitis Glossitis
Only exception for scheduled vaccination?
Hep B
Complications of prematurity?
- RDS - Bronchopulmonary dysplasia
- PDA
- retinopathy of prematurity
- Necroziting entrocolitis
- intraventricular hemorrhage
Causes of QT prolongation:
Tx:
- meds
- inherited: Jerel lang nielsen & Romano ward
- Electrolyte imbalance: hypocalcemia/ hypokalemia/ hypomagnesemia
- pacemaker and b blocker
Tx for Basillary Angiomatosis:
Oral Erythromycine
Extra manifestations of UC?
- colorectal cancer
- toxic megacolon
- cholangiocarcinima
- uveitis
- Erythema nodusom
Approach to severe Hematochesia?
NG aspiration: blood? Yes-> endoscopy no-> colonoscopy
Find the source? Yes-> treat No? -> still bleeding -> surgery no bleed-> small intestin study
Different levels of HCT?
HCT 30-35 is normal
25-30 Dyspnea
20-25 angina
Under 20 chest pain and syncope
When can we see cold IG?
Mycoplasma, EBV, Waldostrome macroglubolinemia,
Iron defficiency anemia risk factors?
- Prematurity
- Lead poisoning
- toddlers>24 M on a daily milk
- infants who consume low iron formula, cow milk, soy milk, goats milk 6 M
Heart involvement in Edward syndrome and william syndrome?
Edward syndrome: VSD
William: Aortic Stenosis
Approach to lead poisoning:
5-45 nothing, 45-75 DMSA, 75
Charactristics of Macun Albright:
- Pigmentation - precocious puberty- polyostotic fibrouse dysplasia
Defect in Macun Albright?
G-protein CAMP kinase function defect
Causes of neck pain:
- trauma
- URTI
- cervicallymphadenitis
- retropharyngeal abcess
Difference between precociouse puberty in Macun-Albright and Adrenal insufficiency?
In macun albright the preciciouse puberty in homosexual in Adrenal diffiency
Ethilogy of macun Albright:
G- protein CAMP kinase function
Treatment for Impetigo?
Mupirocine topical
Contraindication of breast feeding in an infant?
Galactosemia
Which diseases are associated with intussuception?
Meckel diverticulum and Henoch Shonlein purpura
What is PANDAS?
Pediatric autoimmune neuropsychiatric disorder associated with strep.
HCT levels and its effects
30-35
Causes of sideroblastic anemia:
Alcohol, lead, isoniazide, Less B6
How much iron is needed in normal person, mensturation, pregnancy?
Nl: 1-2 mg
Mensturation: 5-6
Pregnant: 2-3
Side effect of folate and B12 replacement therapy?
Hypokalemia
Where can we see cold antibodies?
- EBV
- Waldostrom microglobolinemia
- Mycoplasma
Charactristics of Wegner?
Systemic vasculitis, upper and lowe airway granolumatose inflammation, gelomeronephritis, cutaneous leisions
Prophylaxies in :
- mycobacterium Avium - TB
- P. Cyctis jirovenji
- Toxoplasma Gondii
- Cryptococcus
- Azitromycine
- Cotrimoxazole
- Cotrimoxazole
- Fluconazole
- Isoniazide
Approach to recurrent chalazion?
Histopathology, r/o BCC and sebaceous Carcinoma
Another name for Osteitis Fibrosa cystica?
Von Rickling Hausen
- increase osteoclast activity and increasing bone resorbtion
Diseases associated with avascular necrosis?
- SCD/ Corticosteroids/ Alcohol/ SLE
Mechanism of Thrombosis in heparin induced thrombocytopenia?
Heparin will attach to PFT4 -> increase IgG -> attache to plt RS and activates platelets-> PFT4+ IgG+ platelets= > release cytokines like VWF -> induce thrombosis
What type of cancer is associated with Percelain gallbladder?
Adenocarcinoma
Most common causes of conjunctivitis right after birth, 5 days later, more than 5 days?
Right after birth is chemical, 5 days later is Gonorrhea after 5 days is chlamydia.
How would you recognize water house fridrichsen syndrome?
Flank pain + rash + Hypotension
Charactristics of Galactosemia?
Consequence of having Galactosemia?
Jundice, Cateract, LBW, Vomitting, Hepatomegaly and convulsion
E.Coli Sepsis
Charactristics of mild , moderate , severe volume loss?
Mild (2-3%) and the child is normal
Moderate (3-5%) and there is loss of skin tregor and dried mucosa
Severe (10-15%) sunken eyes, delayed capillary refill more than 35 , cool extremities.
Another name for nursemaid elbow?
Treatment for nursemail elbow?
Radial sublaxation
Hyperpronation, supination and flexion
What is Von Griek?
Glucose 6 phosphatase defficiency/ hypoglycemia/ hyperuricemia/ hyperlipidemia/ hyper lactic acidosis/ doll face, short stature, thin extremities
What is Dejernie Roussy syn.
It involves VPL nucleus and there is contralateral hemianesthesia + transient hemiparesis
Prophylaxis for ctryptococcus in HIV + patients?
Fluconasoleoo
Coplication of corniea bacterium diphteria?
Dilated cardiomyopathy
Two meds in diabetic patients that can be prescribed in renal inssuficiency?
Thiazolindiones and dipeptidyl dipeptidsse 4 inhibitiors
What alpha 2 blocker is being used to sedate patients in ICU?
Dexmedetomidine
What med can be used to treat encephalopathy if lactolose does not work?
Rifaximin
Difference between cauda equina and conus medularis?
Conus medularis is bailateral parelysis/ perianal paresthesia/ Hyperreflexia/ early onset / early bladder and bowel dysfunction
ECG changes in Hypertrophic cardiomayopathy?
Tall R in AVL and repolarization changes in avl, V4, v5, v6 and 1.
Nasal discharge+ cornea neovascularization ethiology?
Chlamydia
Which disease is associates with truncus Arteriosus?
Di george
What are the DDX of crying infant?
- colic-> > 3 hours/ day > 3 days a week > 3 weeks
- normal crying
- Milk Allergy
- GERD
- hair torniquet - corneal abraision
Charactristics of tricuspid valve atresia:
Pulmonary undercirculation and decreased pulmonary markings. Small or absent R waves
How would you distinguish between androgen insensitivity and Mullerian Agenesis?
In Androgen insensitivity there is no pubic or axillaryhair.
OI mutation?
Col 1 A1
Indication of packed RBC?
Unstable
Early complication of DM renal disease?
Gelumerolar hyperinfiltration
Gelumerular sclerosis
What are the diseases associated with erythema nodusome?
- TB
- Sarcoidosis
- IBD
- Histoplasmosis
How would you approach to atypical squamouse cell of undetermined significance?
repeat cytology in 1 year if + colposcopy if - reapaet in one year if positive colposcopy if - papsmear 2 times and routin screening
> 25 and HPV + -> colposcopy if - repeat papsmear and hpv in 3 years
Snide effects of Metimazole:
Side effect of Propylthiouracil:
Metimazole side effect: teratogen/ cholestasis
Propylthiouracil: vaculitis like diseases / Hepatic failure
Tx for the patient who cant tolerate vancomycine?
Fidaxomycine
Ulna entrapment is in :
Elbow
Tx of uncomplicated cystitis, complicated cystitis and pyelonephritis?
Uncomplicated cystitis : Nitrofurantoin, TMX, Fosfomycine
Complicated cystitis: Cipro
Pyelonephritis: Cipro
Charactristics of Leprosy?
Diagnostic test for leprosy?
Patient has cough, coriza , malaise and fatigue then hypopigmented leisions without any senses.
Skin biopsy shows T lymphocytes.
Approach to hypercalcemia?
Mechanism of Heparin induced thrombocytopenia?
Ab against platelet factor 4
Argatroban, Fundaparinox, Bivilirudin
Ddxof low pleural glucose?
- Empyema
- TB
- SLE
- Malignancy
- esophageal rupture
What are the HACEK organisms which cause endocarditis?
Hemophylus, Actinomycetem, cardiobacter, ekinella, kingella
Charactristics of HNPCC?
Side effects of Ca channel blockers? Amilodipine, Nimodipine
Tx ?
Peripheral edema,
ACE Inhibitors
Side effects of B agonists?
Tremor, hypokalemia, palpitation, headache
Connection between thyroid hormones, dopamin and prolactin?
Dopamin and thyroid hormones will supress prolactine.
Charactristics of fat necrosis:
TX:
Calcification, hypoecho mass, breast retraction
No TX is needed.
Side effects of Raloxifen and Tamoxifen?
Raloxifen: DVT
Tamoxifen: endometrial cancer
Indication of Trazodone?
Depression+Insomnia
Acute distress disorder and PTSD?
Acute distress disorder is less than a month, PTSD is more than one month.
5 drugs approved for OCD:
- Fluexetine
- Flovoxamine
- Serteraline
- Paroxetine
- Clomipramine
Charactristics of osteoid osteoma?
Round leisions with sclerotic margines.
Indication for these Antipsychotics:
- Adenosin: Supraventricular tachycardia
- Amiodarone: Vtac
- Atropin: bradycardia
- calcium gluconate: hyperkalemia
Compensation mechanisms for metabloic acidosis, metabolic alkalosis, respiratory acidosis, respiratory alkalosis:
Metabolic acidosis: paco2= 1.5 ( hco3) +8 +- 2
Metabolic alkalosis: increase pco2 by 0.7 for every 1 meq rise in Hco3
Respiratory acidosis: increase hco3 1meq for every 10 mmhg rise in paco2
Respiratory Alkalosis: decrease serum hco3 by 2 for every 10 meq decrease in paco2
Intusucception?
It happens after a gastroentritis with inflammation of lymphoid tissue, sussage shape mass, target sign in US, pain upon raising the leg toward the abdomen and TX is air enema.
Charactristics of Fabry disease:
Alpha1 galactosidase defficiency/ Angiokeratoma/ peripheral Neuropathy/ asymmetric corneal dystrophy/ renal failure/ heart failure/ thromboembolic events
Charactristics of hemocysteinuria?
It looks like Marfan/ tall stature, fair skin, dislocation of the lense inward and down, thrombosis/ megaloblastic anemia.
Most common cause of secondary HTN in children?
Fibromascular dysplasia , angiography shows strings of beads and there is a bruit in costovertebral angle.
Most common cause of Osteomyeleitis is a patient with URI?
Klebisella and pseudomona.
Clopmiphen mechanism:
It is estrogen analougue which helps to increase FSH and GnRH
Magnesium toxicity ?!
Diarrhea, nausea, vomitting, muscle weekness, decreased DTR
How would you interpret Ankle Brachial reflex?
- 9-1.30 is normal
1. 30> clacified and uncompressable vessle
Mechanisms to decrease ICP?
- head elevation
- Monitol
- shunt
- sedation
- hyperventilation
Side effect of Tacrolimus?
Neurotoxicity, Diarrhea, glucose intolerance
Side effect of micofenolate?
BM supression
Multiple trauma approach?
Fast ( U/S ) , stable see blood -> laparascopy no blood-> CT Scan
Unstable see blood-> laparatomy no blood -> DPL
Mechanism of chlomiphen?
It’s strogen Analogue and will increase GnRH and FsH.
CPPD in?
Wilson, DM, Hypothyroidism, Hyperparathyroidism, Pseudogout, Homochromatosis
Most common cause of death in young people with SLE and old people with SLE?
Young-> infection
Old-> Atherosclerosis
Charactristicsis of Hereditary Angioedema?
Differences between hereditary and aquired Angioedema?
- decreased c1 inhibitor, C4 and increased c2b,
- in hereditary form c1q is normal in aquired there is low c1q.
Mechanism of Riluzol?
Glutamate inhibitor
Charactristics of MCA stroke?
Aphasia
Eyes deviated toward the leision
Contralateral hepiparesis
Neglect if non- dominant lobe is involved
Charactristics of basal ganglia stroke?
- pure motor or sensory loss
- Dysarthria
- clammsy hand syn.
- Ataxic Hemiparesis.
Charactristics of basillar stroke?
- locked in syn - dysphagia
- coma - dysarthria
- cranial N palsy - vertigo
- Apnea - drop attacks
- visual symptoms - weakness of ipsilateral face and
Contralateral body
4 Ds of Post. Circulation stroke?
- Dysphagia
- Dysarthria
- dizziness
- Diplopia
Diseases associated with berry Aneurysm?
- Marfan - PKD
- Ehler Danlos - Familial
- SCD
- coaractation of aorta
- Athrosclerosis
Management of subarachnoid hemoorhage ?
- BP
Charactristics of MCA stroke?
1- contralateral hemiparesisi and hemisensory loss
2- Aphasia
3- neglect if non dominant lobe is involved
4- gaze toward the leision
Charactristics of basal ganglia stroke?
- clumsy hand syndrome
- ataxic hemiparesis
- pure sensory or motor loss
- Dysarthria
Charactristics of basialr Artery strokes?
- Vertigo - locked in syndrome
- cranial nerve is involved - sesonry loss in one side and weakness
- vision loss In contralateral side
- Dysphagia - Apnea
- Dysarthria - drop attacks
- coma
4 Ds of posterior circulation strokes?
- Diplopia
- Dysarthria
- Dysphagia
- Dizziness
Contraindications of TPA?
- HTN > 185/110 - Surgery in the past 2 weeks
- Glucose > 500 or 1.7
Associations with berry Aneurysm?
- SCD - Coaractation of Aeorta
- Marfan
- Ehler Danlose syn.
- PKD
- Atherosclerosis
- Familial
Basic steps in management of SAH?
- LP
- Head elevation
- Ca- channel blocker
- lowering BP
DDx of severe headache?
- primary
- increased ICP
- Angle closure Glucoma
- Thrombosis
- Hemorrhage
How to Dx headache related to cavernous sinus thrombisis?
- recent orbital facial infections
- proptosis, ptosis, red eyes
- ophtalmoplasia
- confusion, drowsiness, coma
- visual disturbance, diplopia , orbital pain
What is infantile spasm or west syn?
Generalized epilepsy 6 months after birth. It could be due to PKU, infections, Tuberouse sclerosis, hypoxic ischemic stroke.
What does protrin C do?
It inhibits factor V.
Which drugs are inhibited in Myastenia Gravis?
B-blockers and Aminoglycosides
Ddx of eaton lambert and myastenia gravis?
Eaton lambert gets better with activity but Myastenia gravis gets worse with activity.
Tx of Eaton Lambert?
- Pyridostegmine
- Guanidine
- 3,4 diamonopyrydine
What is Dawsons fingers?
Asymmetrical periventricular white matter leisions specially in corpus callusum.
Tx for Eaton Lambert?
- Guanidin
- Pyridostigimine
- 2/3 Dyamniopyridin
What is the main charactristics of ALS?
No eye or bladder is involved.
Tx for ITP?
- IVIG
- Splenectomy
- Corticosteroids
Tx for TTP?
- Plasmaphresis
- Corticosteroids
Lab tests in CML?
- low LAP
Exudate Pleural Effusion charactristics?
Ph 60%
Pr> 50%
How would you define severe PCP?
PH35
Po2
PCP treatments?
TMX/ Clinda + Primaquine or Pentamidine
Charactristic of PCP?
High LDH
Exudate pulmonary effusion charactristics?
- PH
How is sweat chloride test is being done?
Pilocarpin is given and the amount of sodium and chloride will be measured in the sweat.
Mechanism of Rasburicase and Pegloticase?
- they break down uric acid to Allantoin.
Transient sinovitis?
Most common cause of hip pain inn 7-10 years old children. After trauma or infection.
Septic Arthritis?
Fever> 38
ESR>40
CRP>2
WBC>12000
Charactristics of Hydrocephalus in neonates?
Next step?
Wide sutures, low activity, buldging fontanels, iritibility, poor feeding, vomiting, prominant scalp veins
Causes of bacterial Rhinosynovitis?
Treatment of Rhinosinovitis?
Moraxella, H Influenza, Strep
Amoxicillin+ clavolonic acid
Charactristics of prulent Rhinosinovitis?
Fever Syptoms after 10 days Prulent nasal discharge Facial pain for 3 days Worsening symptoms > 5 days after URTI
Cause of Bronchiolitis in children?
Tx of Bronchilitis in children?
Prevention of Bronchiolitis in children?
Complications of Bronchiolitis?
- RSV
- Supportive
- Palivizumab
- Apnea/ Respiratory Failure
What is sturge weber?
Neurocutaneouse disease with cavrenous hemangioma + Intracranial calcifications
Charactristics of vit B2 defficiency?
Cheilosis Stomatitis Normochrom normocytic anemia Seborrheic Dermatitis Glossitis
Only exception for scheduled vaccination?
Hep B
Complications of prematurity?
- RDS - Bronchopulmonary dysplasia
- PDA
- retinopathy of prematurity
- Necroziting entrocolitis
- intraventricular hemorrhage
Causes of QT prolongation:
Tx:
- meds
- inherited: Jerel lang nielsen & Romano ward
- Electrolyte imbalance: hypocalcemia/ hypokalemia/ hypomagnesemia
- pacemaker and b blocker
Tx for Basillary Angiomatosis:
Oral Erythromycine
Extra manifestations of UC?
- colorectal cancer
- toxic megacolon
- cholangiocarcinima
- uveitis
- Erythema nodusom
Approach to severe Hematochesia?
NG aspiration: blood? Yes-> endoscopy no-> colonoscopy
Find the source? Yes-> treat No? -> still bleeding -> surgery no bleed-> small intestin study
Different levels of HCT?
HCT 30-35 is normal
25-30 Dyspnea
20-25 angina
Under 20 chest pain and syncope
When can we see cold IG?
Mycoplasma, EBV, Waldostrome macroglubolinemia,
Iron defficiency anemia risk factors?
- Prematurity
- Lead poisoning
- toddlers>24 M on a daily milk
- infants who consume low iron formula, cow milk, soy milk, goats milk 6 M
Heart involvement in Edward syndrome and william syndrome?
Edward syndrome: VSD
William: Aortic Stenosis
Approach to lead poisoning:
5-45 nothing, 45-75 DMSA, 75
Charactristics of Macun Albright:
- Pigmentation - precocious puberty- polyostotic fibrouse dysplasia
Defect in Macun Albright?
G-protein CAMP kinase function defect
Causes of neck pain:
- trauma
- URTI
- cervicallymphadenitis
- retropharyngeal abcess
Difference between precociouse puberty in Macun-Albright and Adrenal insufficiency?
In macun albright the preciciouse puberty in homosexual in Adrenal diffiency
Ethilogy of macun Albright:
G- protein CAMP kinase function
Treatment for Impetigo?
Mupirocine topical
Contraindication of breast feeding in an infant?
Galactosemia
Which diseases are associated with intussuception?
Meckel diverticulum and Henoch Shonlein purpura
What is PANDAS?
Pediatric autoimmune neuropsychiatric disorder associated with strep.
HCT levels and its effects
30-35
Causes of sideroblastic anemia:
Alcohol, lead, isoniazide, Less B6
How much iron is needed in normal person, mensturation, pregnancy?
Nl: 1-2 mg
Mensturation: 5-6
Pregnant: 2-3
Side effect of folate and B12 replacement therapy?
Hypokalemia
Where can we see cold antibodies?
- EBV
- Waldostrom microglobolinemia
- Mycoplasma
Charactristics of Wegner?
Systemic vasculitis, upper and lowe airway granolumatose inflammation, gelomeronephritis, cutaneous leisions
Prophylaxies in :
- mycobacterium Avium - TB
- P. Cyctis jirovenji
- Toxoplasma Gondii
- Cryptococcus
- Azitromycine
- Cotrimoxazole
- Cotrimoxazole
- Fluconazole
- Isoniazide
Approach to recurrent chalazion?
Histopathology, r/o BCC and sebaceous Carcinoma
Another name for Osteitis Fibrosa cystica?
Von Rickling Hausen
- increase osteoclast activity and increasing bone resorbtion
Diseases associated with avascular necrosis?
- SCD/ Corticosteroids/ Alcohol/ SLE
Mechanism of Thrombosis in heparin induced thrombocytopenia?
Heparin will attach to PFT4 -> increase IgG -> attache to plt RS and activates platelets-> PFT4+ IgG+ platelets= > release cytokines like VWF -> induce thrombosis
What type of cancer is associated with Percelain gallbladder?
Adenocarcinoma
Most common causes of conjunctivitis right after birth, 5 days later, more than 5 days?
Right after birth is chemical, 5 days later is Gonorrhea after 5 days is chlamydia.
How would you recognize water house fridrichsen syndrome?
Flank pain + rash + Hypotension
Charactristics of Galactosemia?
Consequence of having Galactosemia?
Jundice, Cateract, LBW, Vomitting, Hepatomegaly and convulsion
E.Coli Sepsis
Charactristics of mild , moderate , severe volume loss?
Mild (2-3%) and the child is normal
Moderate (3-5%) and there is loss of skin tregor and dried mucosa
Severe (10-15%) sunken eyes, delayed capillary refill more than 35 , cool extremities.
Another name for nursemaid elbow?
Treatment for nursemail elbow?
Radial sublaxation
Hyperpronation, supination and flexion
What is Von Griek?
Glucose 6 phosphatase defficiency/ hypoglycemia/ hyperuricemia/ hyperlipidemia/ hyper lactic acidosis/ doll face, short stature, thin extremities
What is Dejernie Roussy syn.
It involves VPL nucleus and there is contralateral hemianesthesia + transient hemiparesis
Prophylaxis for ctryptococcus in HIV + patients?
Fluconasoleoo
Coplication of corniea bacterium diphteria?
Dilated cardiomyopathy
Two meds in diabetic patients that can be prescribed in renal inssuficiency?
Thiazolindiones and dipeptidyl dipeptidsse 4 inhibitiors
What alpha 2 blocker is being used to sedate patients in ICU?
Dexmedetomidine
What med can be used to treat encephalopathy if lactolose does not work?
Rifaximin
Difference between cauda equina and conus medularis?
Conus medularis is bailateral parelysis/ perianal paresthesia/ Hyperreflexia/ early onset / early bladder and bowel dysfunction
ECG changes in Hypertrophic cardiomayopathy?
Tall R in AVL and repolarization changes in avl, V4, v5, v6 and 1.
Nasal discharge+ cornea neovascularization ethiology?
Chlamydia
Which disease is associates with truncus Arteriosus?
Di george
What are the DDX of crying infant?
- colic-> > 3 hours/ day > 3 days a week > 3 weeks
- normal crying
- Milk Allergy
- GERD
- hair torniquet - corneal abraision
Charactristics of tricuspid valve atresia:
Pulmonary undercirculation and decreased pulmonary markings. Small or absent R waves
How would you distinguish between androgen insensitivity and Mullerian Agenesis?
In Androgen insensitivity there is no pubic or axillaryhair.
OI mutation?
Col 1 A1
Indication of packed RBC?
Unstable
Early complication of DM renal disease?
Gelumerolar hyperinfiltration
Gelumerular sclerosis
What are the diseases associated with erythema nodusome?
- TB
- Sarcoidosis
- IBD
- Histoplasmosis
How would you approach to atypical squamouse cell of undetermined significance?
repeat cytology in 1 year if + colposcopy if - reapaet in one year if positive colposcopy if - papsmear 2 times and routin screening
> 25 and HPV + -> colposcopy if - repeat papsmear and hpv in 3 years
Snide effects of Metimazole:
Side effect of Propylthiouracil:
Metimazole side effect: teratogen/ cholestasis
Propylthiouracil: vaculitis like diseases / Hepatic failure
Tx for the patient who cant tolerate vancomycine?
Fidaxomycine
Ulna entrapment is in :
Elbow
Tx of uncomplicated cystitis, complicated cystitis and pyelonephritis?
Uncomplicated cystitis : Nitrofurantoin, TMX, Fosfomycine
Complicated cystitis: Cipro
Pyelonephritis: Cipro
Charactristics of Leprosy?
Diagnostic test for leprosy?
Patient has cough, coriza , malaise and fatigue then hypopigmented leisions without any senses.
Skin biopsy shows T lymphocytes.
Approach to hypercalcemia?
Mechanism of Heparin induced thrombocytopenia?
Ab against platelet factor 4
Argatroban, Fundaparinox, Bivilirudin
Ddxof low pleural glucose?
- Empyema
- TB
- SLE
- Malignancy
- esophageal rupture
What are the HACEK organisms which cause endocarditis?
Hemophylus, Actinomycetem, cardiobacter, ekinella, kingella
Charactristics of HNPCC?
Side effects of Ca channel blockers? Amilodipine, Nimodipine
Tx ?
Peripheral edema,
ACE Inhibitors
Side effects of B agonists?
Tremor, hypokalemia, palpitation, headache
Connection between thyroid hormones, dopamin and prolactin?
Dopamin and thyroid hormones will supress prolactine.
Charactristics of fat necrosis:
TX:
Calcification, hypoecho mass, breast retraction
No TX is needed.
Side effects of Raloxifen and Tamoxifen?
Raloxifen: DVT
Tamoxifen: endometrial cancer
Indication of Trazodone?
Depression+Insomnia
Acute distress disorder and PTSD?
Acute distress disorder is less than a month, PTSD is more than one month.
5 drugs approved for OCD:
- Fluexetine
- Flovoxamine
- Serteraline
- Paroxetine
- Clomipramine
Charactristics of osteoid osteoma?
Round leisions with sclerotic margines.
Indication for these Antipsychotics:
- Adenosin: Supraventricular tachycardia
- Amiodarone: Vtac
- Atropin: bradycardia
- calcium gluconate: hyperkalemia
Compensation mechanisms for metabloic acidosis, metabolic alkalosis, respiratory acidosis, respiratory alkalosis:
Metabolic acidosis: paco2= 1.5 ( hco3) +8 +- 2
Metabolic alkalosis: increase pco2 by 0.7 for every 1 meq rise in Hco3
Respiratory acidosis: increase hco3 1meq for every 10 mmhg rise in paco2
Respiratory Alkalosis: decrease serum hco3 by 2 for every 10 meq decrease in paco2
Intusucception?
It happens after a gastroentritis with inflammation of lymphoid tissue, sussage shape mass, target sign in US, pain upon raising the leg toward the abdomen and TX is air enema.
Charactristics of Fabry disease:
Alpha1 galactosidase defficiency/ Angiokeratoma/ peripheral Neuropathy/ asymmetric corneal dystrophy/ renal failure/ heart failure/ thromboembolic events
Charactristics of hemocysteinuria?
It looks like Marfan/ tall stature, fair skin, dislocation of the lense inward and down, thrombosis/ megaloblastic anemia.
Most common cause of secondary HTN in children?
Fibromascular dysplasia , angiography shows strings of beads and there is a bruit in costovertebral angle.
Most common cause of Osteomyeleitis is a patient with URI?
Klebisella and pseudomona.
Clopmiphen mechanism:
It is estrogen analougue which helps to increase FSH and GnRH
Magnesium toxicity ?!
Diarrhea, nausea, vomitting, muscle weekness, decreased DTR
How would you interpret Ankle Brachial reflex?
- 9-1.30 is normal
1. 30> clacified and uncompressable vessle
Mechanisms to decrease ICP?
- head elevation
- Monitol
- shunt
- sedation
- hyperventilation
Side effect of Tacrolimus?
Neurotoxicity, Diarrhea, glucose intolerance
Side effect of micofenolate?
BM supression
Multiple trauma approach?
Fast ( U/S ) , stable see blood -> laparascopy no blood-> CT Scan
Unstable see blood-> laparatomy no blood -> DPL
Mechanism of chlomiphen?
It’s strogen Analogue and will increase GnRH and FsH.
CPPD in?
Wilson, DM, Hypothyroidism, Hyperparathyroidism, Pseudogout, Homochromatosis
Most common cause of death in young people with SLE and old people with SLE?
Young-> infection
Old-> Atherosclerosis
Charactristicsis of Hereditary Angioedema?
Differences between hereditary and aquired Angioedema?
- decreased c1 inhibitor, C4 and increased c2b,
- in hereditary form c1q is normal in aquired there is low c1q.
Mechanism of Riluzol?
Glutamate inhibitor
Charactristics of MCA stroke?
Aphasia
Eyes deviated toward the leision
Contralateral hepiparesis
Neglect if non- dominant lobe is involved
Charactristics of basal ganglia stroke?
- pure motor or sensory loss
- Dysarthria
- clammsy hand syn.
- Ataxic Hemiparesis.
Charactristics of basillar stroke?
- locked in syn - dysphagia
- coma - dysarthria
- cranial N palsy - vertigo
- Apnea - drop attacks
- visual symptoms - weakness of ipsilateral face and
Contralateral body
4 Ds of Post. Circulation stroke?
- Dysphagia
- Dysarthria
- dizziness
- Diplopia
Diseases associated with berry Aneurysm?
- Marfan - PKD
- Ehler Danlos - Familial
- SCD
- coaractation of aorta
- Athrosclerosis
Management of subarachnoid hemoorhage ?
- BP
Charactristics of MCA stroke?
1- contralateral hemiparesisi and hemisensory loss
2- Aphasia
3- neglect if non dominant lobe is involved
4- gaze toward the leision
Charactristics of basal ganglia stroke?
- clumsy hand syndrome
- ataxic hemiparesis
- pure sensory or motor loss
- Dysarthria
Charactristics of basialr Artery strokes?
- Vertigo - locked in syndrome
- cranial nerve is involved - sesonry loss in one side and weakness
- vision loss In contralateral side
- Dysphagia - Apnea
- Dysarthria - drop attacks
- coma
4 Ds of posterior circulation strokes?
- Diplopia
- Dysarthria
- Dysphagia
- Dizziness
Contraindications of TPA?
- HTN > 185/110 - Surgery in the past 2 weeks
- Glucose > 500 or 1.7
Associations with berry Aneurysm?
- SCD - Coaractation of Aeorta
- Marfan
- Ehler Danlose syn.
- PKD
- Atherosclerosis
- Familial
Basic steps in management of SAH?
- LP
- Head elevation
- Ca- channel blocker
- lowering BP
DDx of severe headache?
- primary
- increased ICP
- Angle closure Glucoma
- Thrombosis
- Hemorrhage
How to Dx headache related to cavernous sinus thrombisis?
- recent orbital facial infections
- proptosis, ptosis, red eyes
- ophtalmoplasia
- confusion, drowsiness, coma
- visual disturbance, diplopia , orbital pain
What is infantile spasm or west syn?
Generalized epilepsy 6 months after birth. It could be due to PKU, infections, Tuberouse sclerosis, hypoxic ischemic stroke.
What does protrin C do?
It inhibits factor V.
Which drugs are inhibited in Myastenia Gravis?
B-blockers and Aminoglycosides
Ddx of eaton lambert and myastenia gravis?
Eaton lambert gets better with activity but Myastenia gravis gets worse with activity.
Tx of Eaton Lambert?
- Pyridostegmine
- Guanidine
- 3,4 diamonopyrydine
What is Dawsons fingers?
Asymmetrical periventricular white matter leisions specially in corpus callusum.
Tx for Eaton Lambert?
- Guanidin
- Pyridostigimine
- 2/3 Dyamniopyridin
What is the main charactristics of ALS?
No eye or bladder is involved.
Tx for ITP?
- IVIG
- Splenectomy
- Corticosteroids
Tx for TTP?
- Plasmaphresis
- Corticosteroids
Lab tests in CML?
- low LAP
Exudate Pleural Effusion charactristics?
Ph 60%
Pr> 50%
How would you define severe PCP?
PH35
Po2
PCP treatments?
TMX/ Clinda + Primaquine or Pentamidine
Charactristic of PCP?
High LDH
Exudate pulmonary effusion charactristics?
- PH
How is sweat chloride test is being done?
Pilocarpin is given and the amount of sodium and chloride will be measured in the sweat.
Mechanism of Rasburicase and Pegloticase?
- they break down uric acid to Allantoin.
Transient sinovitis?
Most common cause of hip pain inn 7-10 years old children. After trauma or infection.
Septic Arthritis?
Fever> 38
ESR>40
CRP>2
WBC>12000
Charactristics of Hydrocephalus in neonates?
Next step?
Wide sutures, low activity, buldging fontanels, iritibility, poor feeding, vomiting, prominant scalp veins
Causes of bacterial Rhinosynovitis?
Treatment of Rhinosinovitis?
Moraxella, H Influenza, Strep
Amoxicillin+ clavolonic acid
Charactristics of prulent Rhinosinovitis?
Fever Syptoms after 10 days Prulent nasal discharge Facial pain for 3 days Worsening symptoms > 5 days after URTI
Cause of Bronchiolitis in children?
Tx of Bronchilitis in children?
Prevention of Bronchiolitis in children?
Complications of Bronchiolitis?
- RSV
- Supportive
- Palivizumab
- Apnea/ Respiratory Failure
What is sturge weber?
Neurocutaneouse disease with cavrenous hemangioma + Intracranial calcifications
Charactristics of vit B2 defficiency?
Cheilosis Stomatitis Normochrom normocytic anemia Seborrheic Dermatitis Glossitis
Only exception for scheduled vaccination?
Hep B
Complications of prematurity?
- RDS - Bronchopulmonary dysplasia
- PDA
- retinopathy of prematurity
- Necroziting entrocolitis
- intraventricular hemorrhage
Causes of QT prolongation:
Tx:
- meds
- inherited: Jerel lang nielsen & Romano ward
- Electrolyte imbalance: hypocalcemia/ hypokalemia/ hypomagnesemia
- pacemaker and b blocker
Tx for Basillary Angiomatosis:
Oral Erythromycine
Extra manifestations of UC?
- colorectal cancer
- toxic megacolon
- cholangiocarcinima
- uveitis
- Erythema nodusom
Approach to severe Hematochesia?
NG aspiration: blood? Yes-> endoscopy no-> colonoscopy
Find the source? Yes-> treat No? -> still bleeding -> surgery no bleed-> small intestin study
Different levels of HCT?
HCT 30-35 is normal
25-30 Dyspnea
20-25 angina
Under 20 chest pain and syncope
When can we see cold IG?
Mycoplasma, EBV, Waldostrome macroglubolinemia,
Iron defficiency anemia risk factors?
- Prematurity
- Lead poisoning
- toddlers>24 M on a daily milk
- infants who consume low iron formula, cow milk, soy milk, goats milk 6 M
Heart involvement in Edward syndrome and william syndrome?
Edward syndrome: VSD
William: Aortic Stenosis
Approach to lead poisoning:
5-45 nothing, 45-75 DMSA, 75
Charactristics of Macun Albright:
- Pigmentation - precocious puberty- polyostotic fibrouse dysplasia
Defect in Macun Albright?
G-protein CAMP kinase function defect
Causes of neck pain:
- trauma
- URTI
- cervicallymphadenitis
- retropharyngeal abcess
Difference between precociouse puberty in Macun-Albright and Adrenal insufficiency?
In macun albright the preciciouse puberty in homosexual in Adrenal diffiency
Ethilogy of macun Albright:
G- protein CAMP kinase function
Treatment for Impetigo?
Mupirocine topical
Contraindication of breast feeding in an infant?
Galactosemia
Which diseases are associated with intussuception?
Meckel diverticulum and Henoch Shonlein purpura
What is PANDAS?
Pediatric autoimmune neuropsychiatric disorder associated with strep.
HCT levels and its effects
30-35
Causes of sideroblastic anemia:
Alcohol, lead, isoniazide, Less B6
How much iron is needed in normal person, mensturation, pregnancy?
Nl: 1-2 mg
Mensturation: 5-6
Pregnant: 2-3
Side effect of folate and B12 replacement therapy?
Hypokalemia
Where can we see cold antibodies?
- EBV
- Waldostrom microglobolinemia
- Mycoplasma
Charactristics of Wegner?
Systemic vasculitis, upper and lowe airway granolumatose inflammation, gelomeronephritis, cutaneous leisions
Prophylaxies in :
- mycobacterium Avium - TB
- P. Cyctis jirovenji
- Toxoplasma Gondii
- Cryptococcus
- Azitromycine
- Cotrimoxazole
- Cotrimoxazole
- Fluconazole
- Isoniazide
Approach to recurrent chalazion?
Histopathology, r/o BCC and sebaceous Carcinoma
Another name for Osteitis Fibrosa cystica?
Von Rickling Hausen
- increase osteoclast activity and increasing bone resorbtion
Diseases associated with avascular necrosis?
- SCD/ Corticosteroids/ Alcohol/ SLE
Mechanism of Thrombosis in heparin induced thrombocytopenia?
Heparin will attach to PFT4 -> increase IgG -> attache to plt RS and activates platelets-> PFT4+ IgG+ platelets= > release cytokines like VWF -> induce thrombosis
What type of cancer is associated with Percelain gallbladder?
Adenocarcinoma
Most common causes of conjunctivitis right after birth, 5 days later, more than 5 days?
Right after birth is chemical, 5 days later is Gonorrhea after 5 days is chlamydia.
How would you recognize water house fridrichsen syndrome?
Flank pain + rash + Hypotension
Charactristics of Galactosemia?
Consequence of having Galactosemia?
Jundice, Cateract, LBW, Vomitting, Hepatomegaly and convulsion
E.Coli Sepsis
Charactristics of mild , moderate , severe volume loss?
Mild (2-3%) and the child is normal
Moderate (3-5%) and there is loss of skin tregor and dried mucosa
Severe (10-15%) sunken eyes, delayed capillary refill more than 35 , cool extremities.
Another name for nursemaid elbow?
Treatment for nursemail elbow?
Radial sublaxation
Hyperpronation, supination and flexion
What is Von Griek?
Glucose 6 phosphatase defficiency/ hypoglycemia/ hyperuricemia/ hyperlipidemia/ hyper lactic acidosis/ doll face, short stature, thin extremities
What is Dejernie Roussy syn.
It involves VPL nucleus and there is contralateral hemianesthesia + transient hemiparesis
Prophylaxis for ctryptococcus in HIV + patients?
Fluconasoleoo
Coplication of corniea bacterium diphteria?
Dilated cardiomyopathy
Two meds in diabetic patients that can be prescribed in renal inssuficiency?
Thiazolindiones and dipeptidyl dipeptidsse 4 inhibitiors
What alpha 2 blocker is being used to sedate patients in ICU?
Dexmedetomidine
What med can be used to treat encephalopathy if lactolose does not work?
Rifaximin
Difference between cauda equina and conus medularis?
Conus medularis is bailateral parelysis/ perianal paresthesia/ Hyperreflexia/ early onset / early bladder and bowel dysfunction
ECG changes in Hypertrophic cardiomayopathy?
Tall R in AVL and repolarization changes in avl, V4, v5, v6 and 1.
Nasal discharge+ cornea neovascularization ethiology?
Chlamydia
Which disease is associates with truncus Arteriosus?
Di george
What are the DDX of crying infant?
- colic-> > 3 hours/ day > 3 days a week > 3 weeks
- normal crying
- Milk Allergy
- GERD
- hair torniquet - corneal abraision
Charactristics of tricuspid valve atresia:
Pulmonary undercirculation and decreased pulmonary markings. Small or absent R waves
How would you distinguish between androgen insensitivity and Mullerian Agenesis?
In Androgen insensitivity there is no pubic or axillaryhair.
OI mutation?
Col 1 A1
Indication of packed RBC?
Unstable
Early complication of DM renal disease?
Gelumerolar hyperinfiltration
Gelumerular sclerosis
What are the diseases associated with erythema nodusome?
- TB
- Sarcoidosis
- IBD
- Histoplasmosis
How would you approach to atypical squamouse cell of undetermined significance?
repeat cytology in 1 year if + colposcopy if - reapaet in one year if positive colposcopy if - papsmear 2 times and routin screening
> 25 and HPV + -> colposcopy if - repeat papsmear and hpv in 3 years
Snide effects of Metimazole:
Side effect of Propylthiouracil:
Metimazole side effect: teratogen/ cholestasis
Propylthiouracil: vaculitis like diseases / Hepatic failure
Tx for the patient who cant tolerate vancomycine?
Fidaxomycine
Ulna entrapment is in :
Elbow
Tx of uncomplicated cystitis, complicated cystitis and pyelonephritis?
Uncomplicated cystitis : Nitrofurantoin, TMX, Fosfomycine
Complicated cystitis: Cipro
Pyelonephritis: Cipro
Charactristics of Leprosy?
Diagnostic test for leprosy?
Patient has cough, coriza , malaise and fatigue then hypopigmented leisions without any senses.
Skin biopsy shows T lymphocytes.
Approach to hypercalcemia?
Mechanism of Heparin induced thrombocytopenia?
Ab against platelet factor 4
Argatroban, Fundaparinox, Bivilirudin
Ddxof low pleural glucose?
- Empyema
- TB
- SLE
- Malignancy
- esophageal rupture
What are the HACEK organisms which cause endocarditis?
Hemophylus, Actinomycetem, cardiobacter, ekinella, kingella
Charactristics of HNPCC?
Side effects of Ca channel blockers? Amilodipine, Nimodipine
Tx ?
Peripheral edema,
ACE Inhibitors
Side effects of B agonists?
Tremor, hypokalemia, palpitation, headache
Connection between thyroid hormones, dopamin and prolactin?
Dopamin and thyroid hormones will supress prolactine.
Charactristics of fat necrosis:
TX:
Calcification, hypoecho mass, breast retraction
No TX is needed.
Side effects of Raloxifen and Tamoxifen?
Raloxifen: DVT
Tamoxifen: endometrial cancer
How is sweat chloride test is being done?
Pilocarpin is given and the amount of sodium and chloride will be measured in the sweat.
Mechanism of Rasburicase and Pegloticase?
- they break down uric acid to Allantoin.
Transient sinovitis?
Most common cause of hip pain inn 7-10 years old children. After trauma or infection.
Septic Arthritis?
Fever> 38
ESR>40
CRP>2
WBC>12000
Charactristics of Hydrocephalus in neonates?
Next step?
Wide sutures, low activity, buldging fontanels, iritibility, poor feeding, vomiting, prominant scalp veins
Causes of bacterial Rhinosynovitis?
Treatment of Rhinosinovitis?
Moraxella, H Influenza, Strep
Amoxicillin+ clavolonic acid
Charactristics of prulent Rhinosinovitis?
Fever Syptoms after 10 days Prulent nasal discharge Facial pain for 3 days Worsening symptoms > 5 days after URTI
Cause of Bronchiolitis in children?
Tx of Bronchilitis in children?
Prevention of Bronchiolitis in children?
Complications of Bronchiolitis?
- RSV
- Supportive
- Palivizumab
- Apnea/ Respiratory Failure
What is sturge weber?
Neurocutaneouse disease with cavrenous hemangioma + Intracranial calcifications
Charactristics of vit B2 defficiency?
Cheilosis Stomatitis Normochrom normocytic anemia Seborrheic Dermatitis Glossitis
Only exception for scheduled vaccination?
Hep B
Complications of prematurity?
- RDS - Bronchopulmonary dysplasia
- PDA
- retinopathy of prematurity
- Necroziting entrocolitis
- intraventricular hemorrhage
Causes of QT prolongation:
Tx:
- meds
- inherited: Jerel lang nielsen & Romano ward
- Electrolyte imbalance: hypocalcemia/ hypokalemia/ hypomagnesemia
- pacemaker and b blocker
Tx for Basillary Angiomatosis:
Oral Erythromycine
Extra manifestations of UC?
- colorectal cancer
- toxic megacolon
- cholangiocarcinima
- uveitis
- Erythema nodusom
Approach to severe Hematochesia?
NG aspiration: blood? Yes-> endoscopy no-> colonoscopy
Find the source? Yes-> treat No? -> still bleeding -> surgery no bleed-> small intestin study
Different levels of HCT?
HCT 30-35 is normal
25-30 Dyspnea
20-25 angina
Under 20 chest pain and syncope
When can we see cold IG?
Mycoplasma, EBV, Waldostrome macroglubolinemia,
Iron defficiency anemia risk factors?
- Prematurity
- Lead poisoning
- toddlers>24 M on a daily milk
- infants who consume low iron formula, cow milk, soy milk, goats milk 6 M
Heart involvement in Edward syndrome and william syndrome?
Edward syndrome: VSD
William: Aortic Stenosis
Approach to lead poisoning:
5-45 nothing, 45-75 DMSA, 75
Charactristics of Macun Albright:
- Pigmentation - precocious puberty- polyostotic fibrouse dysplasia
Defect in Macun Albright?
G-protein CAMP kinase function defect
Causes of neck pain:
- trauma
- URTI
- cervicallymphadenitis
- retropharyngeal abcess
Difference between precociouse puberty in Macun-Albright and Adrenal insufficiency?
In macun albright the preciciouse puberty in homosexual in Adrenal diffiency
Ethilogy of macun Albright:
G- protein CAMP kinase function
Treatment for Impetigo?
Mupirocine topical
Contraindication of breast feeding in an infant?
Galactosemia
Which diseases are associated with intussuception?
Meckel diverticulum and Henoch Shonlein purpura
What is PANDAS?
Pediatric autoimmune neuropsychiatric disorder associated with strep.
HCT levels and its effects
30-35
Causes of sideroblastic anemia:
Alcohol, lead, isoniazide, Less B6
How much iron is needed in normal person, mensturation, pregnancy?
Nl: 1-2 mg
Mensturation: 5-6
Pregnant: 2-3
Side effect of folate and B12 replacement therapy?
Hypokalemia
Where can we see cold antibodies?
- EBV
- Waldostrom microglobolinemia
- Mycoplasma
Charactristics of Wegner?
Systemic vasculitis, upper and lowe airway granolumatose inflammation, gelomeronephritis, cutaneous leisions
Prophylaxies in :
- mycobacterium Avium - TB
- P. Cyctis jirovenji
- Toxoplasma Gondii
- Cryptococcus
- Azitromycine
- Cotrimoxazole
- Cotrimoxazole
- Fluconazole
- Isoniazide
Approach to recurrent chalazion?
Histopathology, r/o BCC and sebaceous Carcinoma
Another name for Osteitis Fibrosa cystica?
Von Rickling Hausen
- increase osteoclast activity and increasing bone resorbtion
Diseases associated with avascular necrosis?
- SCD/ Corticosteroids/ Alcohol/ SLE
Mechanism of Thrombosis in heparin induced thrombocytopenia?
Heparin will attach to PFT4 -> increase IgG -> attache to plt RS and activates platelets-> PFT4+ IgG+ platelets= > release cytokines like VWF -> induce thrombosis