Incorrects 8 Flashcards
A woman (esp. black) with RA like Sx with signs of glomerulonephritis and possibly other systems involved likely has?
SLE. ANA (sensitive), Anti-dsDNA, and anti-Sm (specific) are present often. Proteinuria and high Cr may present instead of hematuria.
A woman with advanced RA (marked morning stiffness) presents with splenomegaly and neutropenia on exam. Dx?
Felty syndrome.
Both REM sleep latency and slow-wave sleep are decreased in?
Depression.
Xray showing presence of a posterior fat pad (lucency) sign at the elbow joint in a child usually indicates?
Supracondylar fracture of the humerus. These types of fx are common in kids 2-12 and complications include compartment syndrome (5P’s) or neurovascular injury.
Length of typical Absence seizure?
<20 seconds. Can present with automatisms.
Heinz bodies are associated with?
G6PD deficiency. Oxidized Hgb precipitates to cause these crystals within the cell.
Howell-Jolly bodies are associated with?
Splenectomy. Retained nuclear remnants occurs.
What is the first step in suspected IE?
3 blood cultures from different sites must be obtained BEFORE Abx are started. In acute illness, obtain blood over 1 hour. In stable, subacute illness must obtain blood over several hours and delay Abx until blood drawn.
What is PMS?
Bloating, fatigue, HA, and breast tenderness that occur a week prior to menses and resolve within a few days after menses start. Rx: stress reduction/exercise
What is Premenstrual dysphoric disorder?
A severe form of PMS where irritability, hopelessness, and depressed mood can lead to psychosocial impairment. A detailed menstraul diary is needed for both usually over 2-3 menstrual cycles. Rx includes SSRIs.
Meniere’s disease triad?
- Low frequency tinnitus
- Episodic vertigo
- Sensorineural hearing loss
Should air conduction or bone conduction be heard longer in the Rinne test?
Air conduction. Conductive hearing loss is assessed with the Rinne test. “Rinne under the pinne (pinna of ear)”. If heard longer on mastoid than the air, then they have conductive hearing loss in that ear (eg otosclerosis).
If I strike the tuning fork and place it on the forehead, but it localizes to one side, what does this mean?
Weber test: Localizing to one ear means either there is conductive hearing loss in that ear or sensorineural hearing loss in the other ear. A normal Rinne with a right lateralized Weber indicates sensorineural in the right. If mixed, bone conduction is higher in the affected ear (conductive) and Weber lateralizes away from the affected ear (sensorineural).
Meniere’s disease leads to what kind of hearing loss?
Sensorineural.
First test in suspected subarachnoid hemorrhage?
Noncontrast head CT (90% sensitive). BUT if normal CT, must do LP to rule out definitively.
Confirmatory test in suspected subarachnoid hemorrhage?
Lumbar puncture. Xanthrochromia confirms Dx (present 6 hours after onset). Cerebral angiography will ID bleeding source AND detection of vasospasm (RX nimodipine).
Is hypoxemia the cause of acrocyanosis?
No. Acrocyanosis is due to slower cirulation of blood. Only central cyanosis after birth is associated with hypoxemia.
MCC of foot ulcers in diabetes?
Peripheral neuropathy.
MCC of neuropathic ulcers?
Diabetes.
Where do neuropathic ulcers typically occur?
Weight bearing sites (eg below the head of the first metatarsal) on the sole of the foot.
A patient comes to the office with a foot ulcer. He has no associated pain fever, chills, or rash. He is a smoker of 30 years. He walks daily. His BMI is 32. Dx?
Neuropathic (diabetic) foot ulcer. The lack of pain associated with the ulcer is classic neuropathic foot ulcer due to diabetes and loss of sensation.
Arterial ulcer typically presents where?
Tips of the digits. Diminished pulses, skin pallor, loss of hair, and intermittent claudication are common.
Venous ulcers typically present where?
Medial aspect of the leg above the malleolus. Usually present with edema and stasis dermatitis.
What is the pathologic cause of MVP?
Myxomatous valve degeneration.
A patient with SLE taking prednisone has an atraumatic hip with normal Xray findings likely has?
Osteonecrosis (AVN) of the femoral head. Microocclusion is an SLE complication and is greatly enhanced with steroids.
If Xray is normal in AVN, what is the appropriate imaging modality?
MRI. Can see boundary between normal and ischemic bone as well as zone of hypervascularity.
When are palpated lymph nodes concerning?
If firm, hard, immobile, enlarged (>2cm), or B symptoms present. Palpable supraclavicular lymph nodes are pathologic until proven otherwise.
Pt presents with elevated blood glucose levels and a skin rash. The pt reports the rash started on the left leg but is now spread to the other leg. Dx?
Glucagonoma. High BGL and a necrotic migratory erythema is classic.
Sulfonylurea overdose presentation?
Hypoglycemia. Sulfonylureas increase insulin release. Testing typically involves urine/serum sulfonylurea levels as it cannot be differentiated from insulinoma.
Time of onset of chemical, gonococcal, and chlamydial conjunctivitis in a newborn?
<24 hours in chemical. 2-5 days in gonococcal. 5-14 days in chlamydial.
A patient presenting with ptosis and fatigable proximal muscle weakness that worsens with prolonged use likely has?
Myasthenia gravis. Extraocular (diplopia, ptosis) and bulbar (dysarthria, dysphagia) weakness are common. Symetric proximal weakness in neck and UE>LE.
When do we stop pap testing?
Age 65 or hysterectomy:
AND no Hx of CIN 2+
AND 3 consecutive negative pap tests
OR 2 consecutive negative co-tests
If a 60year old patient is found to have CIN of 2 or higher, do we stop testing at 65?
No. Screening continues for 20 years after detection regardless of age (goes beyond 65 if indicated).
Proper testing for paroxysmal nocturnal hemoglobinuria?
CD55 and CD59 protein testing. Complement activation in lower oxygen tension causes lysis and early morning hematuria.
15yo girl with Tanner IV breast development and pubic hair. She has not had a period. She has no uterus on US. Dx?
Müllerian agenesis. Often short/blind vaginal pouch and no cervix. External female genitalia are normal. Müllerian duct normally develops into upper vagina, cervix, and uterus.
15yo female with amenorrhea, but normal breast development presents to the office. PE reveals normal genitalia, but no pubic hair. Dx?
Androgen insensitivity syndrome. Normal female phenotypically, but no pubic hair due to defective androgen receptor. Genetically 46XY, however.
11yo girl presents with hair growth and deepening voice. She has normal female genitalia on exam. US reveals two undescended testicles. Dx?
5-alpha-reductase deficiency. Impaired testosterone to DHT conversion leads to improper development of female external genitalia in 46XY genotype. DHT is responsible for fetal conversion to male phenotype. At puberty, these people undergo virilization.
Shared congenital infection symptoms in: CMV Toxo Syphilis Rubella
IUGR
Hepatosplenomegaly
Jaundice
Blueberry muffin rash
Congenital CMV findings?
Periventricular calcifications
Congenital Toxo findings?
Diffuse intracerebral calcifications
Severe chorioretinitis
Congenital Syphilis findings?
Rhinorrhea
Abnormal long bones on Xray
Desquamating/bullous rash
***PCN Rx prevents later sequellae (frontal bossing, saddle nose, Hutchison teeth)
Congenital Rubella findings?
Cataracts Heart defects (PDA)
Surveillance colonoscopy begins how soon after UC diagnosis?
8-10 years of initial diagnosis.
What is elevated in 21-hydroxylase deficiency?
17-hydroxyprogesterone. This is used as a screen for 21-hydroxylase deficiency in congenital adrenal hyperplasia.
What causes aminotransferase levels >1000?
Acetaminophen toxicity and viral hepatitis.
What organism causes pneumonia more in cystic fibrosis UNDER 20 years of age?
S. aureus. Infxn with S. aureus decreases with age.
What organism causes pneumonia more in cystic fibrosis OVER 20 years of age?
Pseudomonas aeruginosa.
Abrupt discontinuation of paroxetine or venlafaxine can result in?
Antidepressant discontinuation syndrome. Both have short half lives and result in dysphoria, fatigue, dizziness, GI distress, and flu-like Sx).
In HIV, which form of esophagitis is treated empirically?
Candida esophagitis. White plaques in the esophagus are characteristic. Oral thrush is present with painful swallowing, substernal burning. This suggests empiric Rx for candida. 3-5 days of oral fluconazole is Rx.
Next step if Pts with thrush fail to respond to empiric Rx?
Esophagoscopy. CMV (deep, linear lesions, distal esophagus) and HSV (ovoid lesions, oral lesions) esophagitis are possible also. Valacyclovir or acyclovir for HSV.
Anti-thyroid peroxidase antibody and antithyroidglobulin are present in?
Hashimoto’s.
Endocrine disorders at increased risk of miscarriage?
Thyroid disease
PCO
DM
Hyperprolactinemia
A Pt with symmetrically enlarged nontender thyroid with subclinical hypothyroidism (normal thyroxine and mild TSH elevation). Dx?
Chronic lymphocytic thyroiditis (aka Hashimoto Thyroiditis). Antithyroid peroxidase and antithyroglobulin antibodies present in 90%. High antiTPO assocaiuted with risk of overt hypothyroid and risk of miscarriage.
Pathophys of osteomalacia?
Defective mineralization of the organic bone matrix. Most commonly this is due to vitamin D deficiency (malabsorption, celiac sprue, bypass surgery, liver/kidney disease). RTA type 2 or inadequate calcium intake can also cause it.
Osteomalacia has low calcium levels and phosphorous. Why?
Osteomalacia, due to low Vitamin D most commonly, results in a secondary hyperPTH state. Calcium cannot be absorbed in the gut and PO4 is eliminated in the kidney. Alk phos is high due to high PTH stimulation of bone osteoclasts to increase Ca++ in serum and breakdown bone.
Diagnostics in myasthenia gravis?
Edrophonium (Tensilon) test OR ice pack test. Lab testing for ACh receptor antibodies. CT of chest for thymoma.
Rx for Myasthenia gravis (not crisis)?
ACh inhibitors (-stigmine) is first line. Immunotherapy (steroids, azathioprine) can help in addition to ACh inhibitors if still symptomatic. Thymectomy if thymoma found (result in remission).
Myasthenic crisis Rx?
IVIG or plasmapheresis are combined with steroids to treat crisis (respiratory failure due to MG).
What B vitamin deficiencies cause numbness, tingling, loss of proprioception and vibration sense?
B6 and B12. B6 (pyridoxine) is often caused by isoniazid. B12 also presents with ataxia, while B6 presents with a more “stocking-glove” neuropathy. Temperature, touch, and pain may be affected over time in B6 also. ***Remember B12 loss causes dorsal/lateral spinal column degeneration, B6 has a different mechanism.
A young female taking OCPs presents with fatigue due to difficulty getting to sleep. Her thyroid is not enlarged/no nodules. Her TSH is normal, but total T4 is high. Likely cause of lab findings?
Increased thyroid hormone-binding protein level. TBG prodxn increases in people taking estrogens, in liver disease, and with estrogen stimulating meds (tamoxifen). TBGs bind T4. The body responds by increasing T4 levels to compensate. Though the FREE T4 levels remain normal and she is euthyroid, her total T4 is up.
Membranoproliferative glomerulonephritis associated conditions?
Hep B and C; lipodystrophy.
Think: MPG HepB and C and lipodystrophy
Membranous nephropathy associated conditions?
Just Hep B (not C). SLE; NSAIDs; adenocarcinoma
Focal segmental glomerulosclerosis associations?
African american or hispanic; obesity; HIV/heroin use.
Think: F for aFrican and FSG = HIV.
Triamterene and amiloride belong to what class?
K+ sparing diuretics.
A pure sensory stroke to the thalamus usually occurs through what artery?
PCA. Affects the posterolateral thalamus nuclei causing contralateral sensory loss. Later this can cause a pain syndrome with burning in the affected side.
Damage to the internal capsule can lead to?
Contralateral pure motor or combined sensorimotor deficits.
MCA or ACA stroke can lead to what Sx?
Contralateral sensory loss and hemiapresis as well as cortical signs (aphasia, agnosia).
Atropine and pralidoxime are proper antidotes for?
Anticholinesterase toxicity as in organophosphate poisoning (bradycardia, miosis, shitty their pants).
What is the definition of tachysystole?
Abnormally frequent contractions (>5/10 minutes over 30 minute period). Caused as SE of oxytocin.
In suspected salicylate toxicity, what is the acid base disturbance and pH?
Respiratory alkalosis (resp center stim. = blow off CO2) Metabolic acidosis pH is usually normal /near normal (7.35-45)
Proper Rx for salicylate OD?
Alkalinization or dialysis.
A normal pH in an acid-base disturbance typically signifies what type of disturbance?
MIXED respiratory and metabolic disorder.
What lab abnormalities are found in hyperemesis gravidarum?
Ketonuria on UA (hypoglycemia induced), hypochloremic metabolic alkalosis, hypokalemia (K+/H+ exchange), hemoconcentration
Typical Sx of hyperemesis gravidarum?
Persistent vomiting
Loss of weight, dehydration, orthostatics
Two main causes of hyperemesis gravidarum?
Hydatidiform mole
Multifetal gestation
Best management techniques for post op atelectasis?
Exercises, coughing, mobilization, spirometry.
What condition of the breast can mimic breast cancer with its clinical/radiographic presentation?
Fat necrosis. Associated with trauma or breast surgery, they can be fixed with skin or nipple retraction and appear calcified on mammography. US may demonstrate a hyperechoic mass, which is usually benign. Biopsy may show fat globules and foamy histiocytes.
A patient taking methotrexate is at risk for what serious complications?
Pancytopenia. It is suggested by ACR to do blood counts every 3 months. Liver toxicity, stomatitis, and interstitial lung disease are other SE.
SE of azathioprine?
Pancreatitis, liver toxicity, and bone marrow suppression.
Ventricular arrhythmias commonly occur within the first hour of?
Acute MI. 50% of arrhythmias occur within the 1st hour of symptom onset. Reentry occurs often leading to ventricular arrhythmias.
