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multisystem Flashcards

1
Q

photosensitive blistering rash associated + brown urine

dx, tx?

A

dx: porphyria cutanea tarda

tx:
1. flebotomia
2. hidroxicloroquina ( contraindicaciones: retinal disease, advanced liver disease, renal disease, psoriasis)

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2
Q

etiologia de porfiria cutanea tarda?

A

deficiencia enzima Uroporfirinógeno descarboxilasa

asociado a hep c

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3
Q

disuria+hematuria+oriente medio/africa

dx, tx?

A

dx: Schistosomiasis

tx: praziquantel

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4
Q

Sd de kawasaki sx

A

“CRASH-B”

Conjuntivitis no purulenta
Rash
Adenopatia
Strawberry tongue
Hands and feel edema

Burn > fiebre por mas de 5 dias

asociado a descamacion de los dedos y ANEURISMA CORONARIA

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5
Q

Beckwith-Wiedemann syndrome

que screenings se le hace?

A

este sd tiene riesgo aumentado de neforblastoma, hepatoblastoma, neuroblastoma, entonces se hace

US abdominal cada 3m por 8 años
medir Alfa fetoproteina cada 3 m x 4 años

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6
Q

diarrea severa que desorden acido base y electrolito?

A

met acidosis ( ph bajo, hco3 bajo)
HIPOkalemia (k bajo)
HIPERcloremia (cl alto)

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7
Q

metodo mediante el cual sarcoidosis causa hipercalcemia?

A

1,25-dihydroxyvitamin D3 increase (calcitriol) intestinal calcium absorption resulting in hypercalcemia

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8
Q

cual tipo de shock pone la piel “flushed”?

A

shock septic

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9
Q

en que parte anatomica debe estar el catater venoso central y q se hace apenas s epone?

A

vena cava superior (lower segment)

se confima su posicion con radiografiade torax

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10
Q

vomito severa que desorden acido base y electrolito?

A

alcalosis metabolica (ph alto, hco3 alto)
HIPOcloremica (Cl bajo)
HIPOkalemica (K bajo)

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11
Q

What vitamin should be orally supplemented in breastfed infants?

A

vit d

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12
Q

What electrolyte abnormality is typically the cause of hypocalcemia in a patient with alcohol use disorder?

A

Severe hypomagnesemia

↓↓ Mg2+ = ↓ PTH = ↓ Ca2+

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13
Q

Why does normocytic anemia in a patient with CKD occur y como estan los reticulocitos?

A

anemia of chronic disease in CKD due to Decreased production of EPO

retis bajos (<0,5%)

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14
Q

Mees lines (White bands across the nails of fingers and toes) + Hiperkeratosis + distal sensorimotor polyneuropathy

dx? tx?

A

arsenic poisoning

tx: dimercaprol or succimer (in children).

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15
Q

cancer anorexia-caquexia sd

tx?

A

Megestrol acetate (analogo de progesterona) o corticoesteroides

These drugs act as appetite stimulants, increase well-being, and counteract proinflammatory cytokines responsible for cachexia

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16
Q

Diffuse desquamating rash involving palms and soles

dx?

A

toxic shock syndrome

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17
Q

nexus criteria for cervical spine imaging?

A

NEXUS criteria provide indications for cervical spine imaging:

“NSAID”:

Neurologic deficit
Spinal tenderness
Altered mental status Intoxication Distracting injury

PERFORM CT SCAN

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18
Q

heterophile antibody test positive?

dx? causative agent? prevencion? tx?

A

dx: mononucleosis infecciosa

Epstein barr virus

Avoid contact sports for 1 month due to risk of splenic rupture

tx: sintomatico

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19
Q

miositis+periorbital edema+eosinofilia

dx, modo de transmission, tx?

A

dx: Trichinella spiralis (helmitio aka gusano)

modo de transmission: undercooked meat

tx: mebendazole/albendazole

recuerda: eosinophilia es eosinofilos >3%

20
Q

hemocromocitosis

que sale en el examen de sangre y diagnostico confirmatorio?

A

hx familiar de hepatocellular carcinoma + iron aumentado, transferrina aumentada >45% + ferritina aumentada >200 premenopausicas o >300 todos los demás (indica iron overload)

dx: genetic testing HFE 282Y. auto recessive

21
Q

como esta el volumen residual en una enfermedad obstructiva cronica respiratoria?

A

aumentada, debido a atrapamiento aereo

22
Q

bacilo gram +, filamentado, acido resistente

que microorganismo, tx?

A

Nocardia

causa infección pulmonar, piel, SNC en Immunocomprometido

tx: TMP-SMX (agregar imipenem si hay infecciones sec)

es una bacteria FILAMENTADA eso es muy característico

23
Q

drugs that induce lupus?

A

“SHIPP”

Sulfa
Hidralazina
Isoniazina
Phenitoina
Procainamida

Anti histone anticuerpo «< Para drug induced lupus

24
Q

agentes causales de rash in palmas y plantas de los pies?

A
  1. Coxackie (Hand, foot, and mouth disease usualmente <10 y.o)
  2. Fiebre de las Montañas Rocosas: agente causal Rickettsia rickettsii. Tx doxicilina. rash starts on the wrists and ankles and spreads to the trunk, palms, and soles. It becomes petechial and/or hemorrhagic in ∼ 50% of cases.
  3. sifilis secundaria
25
Q

porfiria aguda intermitente

sx, dx?

A

sx: 5P

Polineuropatia
Painful abdomen
Purple urine
Psicologícal abnormalities
Precipitated by medication: sulfas, barbituricos como fenobarbital y primidona y fenitoina

no hay sx dermatologicos

dx: aminolevulinic acid and porphobilinogen increased in urine

26
Q

que medicamento produce como efecto secundario intoxicación por cianuro, que acido base esta asociado y para q se usa

A

Nitroprusiato de sodio, usado en crisis hipertensivas puede causar intoxicación por cianuro y acidosis metabolica con anion gap aumentado debido a la producción de acidosis láctica

27
Q

enfisema de lobulos INFERIORES + enfermedad hepatica

dx?

A

alfa 1 antitripcina deficiencia

es importante que es enfisema de lobulos INFERIORES, ya que el enfisema de los fumadores es en lobulos superiores

usualmente pacientes jovenes, sin mayor hx de fumado

28
Q

como la apnea de sueño causa hipertension pulmonar?

A

apnea del sueno causes hypoxic pulmonary vasoconstriction&raquo_space; increase pulmonary pressure&raquo_space; RV disfunction&raquo_space; Impaired function of the right ventricle due to pulmonary hypertension resulting from a primary disorder of the respiratory or pulmonary artery system is referred to as cor pulmonale.

29
Q

restrictive cardiomyopathy+macroglossia

dx?

A

AL amyloidosis.

30
Q

en que enfermedad esta presente Low voltage QRS complexes?

A

restrictive cardiomyopathy por AL amyloidosis

31
Q

alguien que esta haciendo scuba diving asciénde a la superficie muy rapido.

tx?

A

enfermedad por descompresión

tx: camara hiperbarica 100% oxigeno

32
Q

recurrent oral ulcers+genital ulcers+uveitis

dx?

A

Behçet disease

PATHERGY:
Positive pathergy test,
Aphthous oral ulcers,
Thrombosis (arterial and venous), Hemoptysis (pulmonary artery aneurysm), Eye lesions (uveitis, retinal vasculitis), Recurrent Genital ulcers,
Young at presentation (3rd decade)

33
Q

hiperKalemia sintomatica tx?

A

gluconato de calcio + insulina +dextrosa

gluconato de calcio estabiliza la membrana cardiaca y insulina+dextrosa ayuda a intracelular K shifting

si K <6 + no sintoma: no tx, restriction of potassium intake, adequate hydration (to enhance renal potassium elimination), and discontinuation or replacement of contributing drugs;

Potassium levels should be normalized prior to surgery, as hyperkalemia increases the risk of perioperative arrhythmias.

34
Q

que es fiebre de origen desconocido y que imagenes se hacen de primera instancia?

A

> 38.3°C for > 3 weeks

imagenes:
1. Chest X ray
2. TAC abdomen y pelvis

Resolution of fevers with naproxen indicates that a malignant etiology is likely.

35
Q

anti-U1 RNP antibodies +

dx?

A

Enfermedad mixta del tejido conjuntivo

36
Q

What is the likely diagnosis in a sexually active patient that presents with fever/chills, polyarthralgia, and skin lesions on the chest and extensor surfaces of the forearms?

A

disseminated gonoccocal infection

due to gonorrhea (gram - diplococo)

triada de artritis-dermatitis sindrome:

  1. poliartralgia migratoria
  2. lesiones en piel
  3. tendosinovitis
37
Q

decreased peripheral pulses + night sweats+ joint pain

dx? cual es la población mas afectada?

A

takayasu arteritis, mujeres <40 y.o

Takayasu arteritis is associated with a(n) weak or absent pulse in the upper extremity

tambien asociado a eritema nodular de la piel

38
Q

cuales son los sx de porfiria aguda intermitente? tx?

A

5P

Painful abdomen
Polineuropatia
Psiquiatríc sx
Port urine (orina roja)
Precipitated by drugs : barfituricos, fenitoina, sulfas, alcohol, acts

tx: hemin

39
Q

artritis+vesicular, pustular, macular skin lesions

dx?

A

Arthritis-dermatitis syndrome due to gonorrea

40
Q

alopecia, diarrea, dermatitis, delayed wound healing, impaired taste

dx?

A

zinc deficiency

ocurrs due to chronic alcohol use or decreased intake

no confundir con diarrea, dermatitis, demencia x deficiencia de b3 niacina

41
Q

asociaciones de down sd?

A

The 5 A’s of Down syndrome:

  • Advanced maternal age
  • Atresia (duodenal)
  • Atrioventricular septal defect
  • Alzheimer disease (early onset)
  • Acute Mieloid Leukemia (<5 years of age)/Acute Linfocytic Leukemia (>5 years of age)
42
Q

Holoprosencephaly en que se ve?

A

Patau syndrome
fetal alcohol syndrome

43
Q

como se ve la alcalosis metabolica en acido base?

A

ph Aumentado
hco3 Aumentado

44
Q

tx atb empirico sepsis?

A

cefepime+vancomicina

45
Q

tender calves+conjunctival suffusion

dx, tx?

A

leptospirosis

tx: doxiciclina

46
Q

cherry red spots in macula de un bb

dx?

A

Tay-Sachs disease

due to deficiencia hexosaminidasa A lo cual lleva a acumulacion de gangliosido en SNC

primera etapa (27 decks)

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