ITE 2019 Flashcards
What are the presenting characteristics of alpha-one antitrypsin deficiency?
Symptoms of COPD, airflow limitation/obstruction on spirometry with FEV1/FVC <0.7, younger age, lack of tobacco smoke or occupational exposure, and panlobular basal emphysema on CXR.
What would L heart failure look like on CXR/PFT?
Bronchiectasis?
Interstitial lung disease?
Diffuse pan-bronchiolitis?
Pulmonary edema and volume restriction on PFT
Bronchial dilation and wall thickening.
Reticular or increased interstitial markings.
Diffuse small centrilobular nodular opacities and hyperinflation
What are the symptoms of low T / hypogonadism? What lab test should be next?
Fatigue, decreased libido, erectile dysfunction
FSH and LH to distinguish primary and secondary hypogonadism.
Secondary = low or inappropriately normal FSH/LH, then test prolactin and serum iron levels / total iron binding capacity to determine cause. Consider MRI pituitary.
Primary = … … karyotype for Klinefelter’s
How to treat flexible metatarsus adductus?
Rigid metatarsus adductus?
Flexible = most common congenital foot deformity, can be observed for spontaneous resolution by age 1.
Rigid should be treated with serial casting or adjustable shoes (less expensive)
Surgical correction reserved for older children who are walking or that is resistant to casting.
TREMORS!!
Describe psychogenic tremor.
Cerebellar? Which test / imaging is helpful?
Parkinsonian?
Essential?
Enhanced physiologic?
Psychogenic:
Abrupt onset, spontaneous remission, changing characteristics, and extinction with distraction.
Cerebellar:
Intention tremor with ipsilateral involvement on the side of the lesion. Testing will show past-pointing on finger-nose test -> CT or MRI brain is diagnostic.
Parkinsonian:
Resting tremor, asymmetric, decreases with voluntary movement. Bradykinesia, rigidity, and postural instability. Dx with single-photon emission CT ir OET, Tx carbidopa/levodopa.
Essential:
Symmetric, fine tremors that involves hands, wrists, head, voice, or lower extremities. May improve with small amount of EtOH. No specific test. Tx propranolol or primidone.
Enhanced physiologic:
Postural tremor of low amplitude exacerbated by medication, usually with a history of caffeine use or anxiety.
At what degree of contracture is surgical release of Dupuytren’s indicated?
30 degrees MCP, or any contracture of the PIP
What are high-risk markers that would suggest benefit from inpatient admission?
Risk of mortality increases with RR 30 or more, hypoTN, confusion/disorientation, BUN 20 or greater, age >65, male, or heart failure / COPD
Which is more sensitive, PHQ2 or PHQ9? Which is more specific?
PHQ2 has similar sensitivity to PHQ9, but PHQ9 is more specific
What are the risks associated with anemia?
Increased morbidity / mortality in older adults
What are the common causes of anemia?
nutritional deficiencies CKD occult blood loss (GI malignancies) chronic inflammation idiopathic
What lab to order with normocytic or microcytic anemia?
serum ferritin level
What problem is associated with low ferritin level?
iron deficiency, but order a serum transferrin-receptor-ferritin index if ferritin level is between 46-100 to distinguish between iron def and other types.
Which med can be added to improve antidepressant-related sexual arousal dysfunction?
Bupropion (Wellbutrin)
What is black cohosh good for?
Alternative for menopausal vasomotor symptoms.
What is the medication for dyspareunia related to vulvar / vaginal atrophy from menopause?
Ospemifene
What is Henoch-Schonlein purpura, and what does it look like?
IgA vasculitis, dx clinically, presents as palpable purpura of lower extremities without thrombocytopenia or coagulopathy.
Associated with arthralgia / arthritis, abd pain, renal dysfunction
self-limited, supportive tx only
What does erythema infectiosum (fifth disease) look like?
erythematous rash on the cheeks and a lacy reticular rash on the extremities
What does Gianotti-Crosti syndrome look like?
sudden papular or papulovesicular eruption on the extensor surfaces of arms, legs, buttocks, and face.
What does HUS look like?
Classic triad of hemolytic anemia, thrombocytopenia, and kidney injury.
Which markers are the best predictors for the severity of pancreatitis, and therefore how aggressive management should be?
Hct, BUN, and Cr levels because they reflect the degree of intravascular volume depletion.
What are the classic facial dysmorphologies associated with fetal alcohol syndrome?
smooth philtrum
shortened palpebral fissures
thin vermilion border of upper lip
What are the most common causes of HTN in preadolescent children? Best diagnostic test?
When to suspect primary hyperaldosteronism? Best diagnostic test?
When to suspect pheochromocytomas? Best dx?
When to suspect renal aa stenosis? Best dx?
Renal parenchymal diseases - glomerulonephritis - congenital abnormalities - reflux nephropathy Should be evaluated by renal US
Unexplained hypokalemia, evaluate with renin / aldosterone levels.
Rare, triad of headache / palpitations / sweating. Eval with 24-hour urinary fractionated metanephrines and normetanephrines.
Patients with coronary or peripheral atherosclerosis or young adults esp women 19-39 y/o who are more at risk for renal aa stenosis due to fibromuscular dysplasia. Eval with doppeler US of renal aa.
Which med increases risk of kidney stones?
Topiramate, carbonic anhydrase inhibitor, induces metabolic acidosis -> hypercalciuria -> calcium phosphate stones
When to treat nondisplaced tuberosity fracture with compressive dressing with weight bearing / ROM exercises as tolerated, vs ortho referral?
Minimally displaced <3mm vs >3mm
