May 10th Flashcards
Hypoketotic hypoglycemia during fasting
MCAD - inability to break down fatty acid chains
4 month old presenting with hypoglycemia, lactic acidosis, hyperuricemia, hyperlipidemia, doll-like face and hepatomegaly
Glucose 6 phosphatase def (type I glycogen storage dz, Von Gierke disease)
What cancer is associated with pernicious anemia?
Gastric cancer (due to atrophic gastritis)
Patient with HIV, presents with floaters and blurred vision of right eye, photophobia, with fundoscopy showing yellow-white exudates immediately adjacent to the fovea and retinal vessels. Diagnosis?
CMV retinitis
What is the proper work up for a palpable breast mass in a 36 yo F?
Mammogram (+/- US); mammo first in anyone >/= 30 years; if under 30 US firstline
How is lichen sclerosus definitively diagnosed?
Punch biopsy
How is lichen sclerosus treated?
Topical steroids (high potency)
What are the treatment options for chlamydia/gonorrhea in women?
Empiric: azithromycin + ceftriaxone; confirmed chlamydia: azithromycin; confirmed gonorrhea: azithromycin + ceftriaxone
Pseudogout is associated with what diseases?
Hyperparathyroidism, hypothyroidism, and hemochromatosis
What is the genetic abnormality in CML?
BCR-ABL fusion
What are the criteria for initiating long term home oxygen therapy in COPD?
Resting arterial oxygen tension (PaO2) = 55 mmHg or pulse oxy = 88% on room air; PaO2 = 59 or pulse ox = 89% in patients with cor pulmonale, RHF or Hct > 55%
MCHC in hereditary spherocytosis?
Increased
Methylmalonic acid level in B12 deficiency?
Elevated
Parkinson’s disease is due to loss of what?
Dopaminergic neurons in the basal ganglia
Prior to starting trastuzumab, patients need what type of work up?
Baseline echocardiography
What is the pathophysiology of bone loss in hyperthyroidism?
Thyroid hormones result in increased osteoclast activity, resulting in increased bone resorption
Elevated 24 hour urinary excretion of 5-HIAA is seen in what tumor?
Carcinoid
What is the treatment for carcinoid syndrome?
Octreotide for sxs/prior to surgery; surgery definitive
Patients with carcinoid syndrome can become depleted in what?
Niacin
PAS + material in laminia propria
Whipple’s disease - Tropheryma whippelii (bacillus)
What is first line treatment for tinea corporis?
Topical antifungal (eg clotrimazole, terbinafine); second line is oral antifungals (eg terbinafine and griseofulvin)
What medications cause granulomatous liver injury?
Allopurinol and phenylbutazone
What drugs cause cholestasis type drug-induced liver disease?
Chlorpromazine, nitrofurantoin, erythromycin, anabolic steroids
What medications cause fattyliver disease?
Tetracycline, valproate, anti-retrovirals
Halothane, phenytoin, isoniazid, and alpha-methyldopa cause what type of liver disease?
Hepatitis
Carbon tetrachloride and acetaminophen result in what type of liver disease?
Fulminant liver failure
Variable decels on FHR monitor are due to what?
Cord compression, oligohydramnios, cord prolapse
What are the causes of meningitis in children <3 months?
- GBS 2. E coli 3. L monocytogenes 4. HSV
What is the most common cause of meningitis in children age 3 months to 10 years?
- S pneumo 2. N meningitidis
What is the MOA of pramipexole?
Dopamine agonist
What channel does gabapentin work on?
It is a Alpha-2-delta calcium channel ligand
What is the treatment for Tourette disorder?
Antipsychotics (eg risperidone), alpha-2 adrenergic agonists (clonidine, guanfacine), habit reversal therapy
How is a dystonic reaction treated?
Dystonic reaction resulting from a dopamine antagonist - give Benztropine or diphenhydramine
What cardiac index is seen in hypovolemic shock?
Low cardiac index
What are the risk factors for placenta previa?
Prior placenta previa, prior Cesarean delivery/uterine surgery, multiple gestation, smoking
How is PAO2 calculated?
150 - (PaCO2/0.8) if at sea level breathing room air
How does a glucagonoma present?
DM (easily controlled with diet/one oral med), necrolytic migratory erythema (erythematous plaques with central clearing and eroded boarders), weight loss, diarrhea, anemia
How is MS exacerbation treated?
IV steroids; plasmapharesis if refractory to steroids
What are the prophylaxis medications for HIV opportunistic infections?
TMP SMX at CD4 200 for PCP; TMP SMX at CD4 100 for Toxo; Azithromycin at CD4 50 for MAC; itraconazole at CD4 150 for histo
What diseases are associated with erythema nodosum?
Strep infection, sarcoid, TB, endemic fungal infections (eg histo), IBD, and Behcet disease
What are the most common causes of death in Friedreich ataxia?
Cardiomyopathy (causes concentric hypertrophic cardiomyopathy) and respiratory complications
What are the common manifestations of Friedreich ataxia?
Neuro (ataxia, dysarthria), skeletal (scoliosis, hammer toes), cardiomyopathy - concentric hypertrophy
What are Howell-Jolly bodies and when do you see them?
Nuclear remnants of RBCs; seen in asplenia (eg Sickle Cell)
What is basophilic stippling and when is it seen?
Ribosomal precipitates; seen in thalassemia and lead/heavy metal poisoning
What are Heinz bodies and when are they seen?
Denatured aggregates of Hgb; seen in G6PD def (and thalassemia)
Renal vein thrombosis is most common in what nephrotic syndrome?
Membranous glomerulopathy
What is an abnormal 50 g oral glucose tolerance test?
BS >/= 140 one hour after glucose load
What is the clinical presentation of milk-protein induced entercolitis?
Age 2-8 weeks, regurgitation or vomiting, painles bloody stools, eczema
What is the treatment for milk protein induced colitis?
Mother eliminate all soy and dairy products from diet; or switch to hydrolyzed formula
Parotid gland enlargement can be seen in alcohol use, why?
Thought to be due to fatty infiltration from chronic alcohol use
How often should patients with cirrhosis have an US?
Q6 months
Urinary alkalization in a UTI is concerning for what?
Urease-producing bacteria (P mirabilis most common; K pneumo)
What thyroid nodule US findings are suspicious?
Hypoechogeneity, microcalcifications, internal vascularity
How is panic disorder treated?
Acute sxs: benzo; start SSRI and CBT for longterm management
How is the Reitan trail test useful?
Its a timed connect the numbers test that helps detect subtle mental status changes; useful with SBP
