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path facts Flashcards

1
Q

deficiency of what :

-associated with hospitalized patients with malnutrition/short gut
-insulin resistance so require more insulin

A

chromium

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2
Q

deficiency of what :

triad =
- subacute combined degeneration**
- microcytic anemia
- leukopenia

in children : associated w hypopigmented, crimped hair +/- seizures

and what disease is this associated with

** spinal cord degeneration s/p B12 deficiency with weakness, abnormal sensations, mental problems, and vision difficulties

A

copper

menkes ds = x copper uptake

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3
Q

symptoms of wilsons disease and the etiology

A

etiology = x copper excretion

acute = renal failure, hemolysis, hepatic necrosis, encephalopathy, abdominal pain, diarrhea/vomiting,

chronic = cirrhosis, heart failure, diabetes, encephalopathy with neurologic decline

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4
Q

toxicity of what:

associated with well water and welding/steel industries

-parkinson like syndrome
-HA, confusion
-vomiting

A

manganese

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5
Q

deficiency of what:

-growth failure + dwarfism in children
-hypogonadism
-alopecia
-dysgeusia (all food tastes sour)
-impaired wound healing
-skin lesions = pustular, vesiculobullous

A

zinc

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6
Q

clinical exam finding/sign that suggests cholecystitis

A

Murphy’s sign
=abrupt cessation of inspiration with RUQ palpation

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7
Q

clinical exam finding/sign that suggests ruptured spleen/ ruptured ectopic pregnancy

A

Kehr sign
= left shoulder tip TTP while supine, due to referred pain from diaphragm irritation

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8
Q

4 clinical exam finding/sign that suggests appendicitis

A
  1. McBurney sign: TTP on RLQ (2/3 from navel to ASIS)
  2. Rovsing sign: TTP on LLQ
  3. Obturator sign: abdominal pain w flexion and IR of right hip
  4. Psoas sign: RLQ pain of extension of the right hip while patient lies on their left side
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9
Q

what are cullen’s sign and grey turner sign and what do they suggest

A

grey turner: flank ecchymosis

cullen: periumbilical ecchymosis

suggest hemorrhage pancreatitis / retroperitoneal hemorrhage

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10
Q

bullous pemphigoid vs pemphigus vulgaris

A

bullous pemphigoid = tense bullae that don’t burst with pressure, intense pruritus
= STRONG AS A BULL

pemphigus vulgaris = flaccid vesicles w positive Nikolsky sign, nonpruritic
= vulgar bc leaking

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11
Q

murmur with a mid systolic click with late systolic murmur and heard best at the apex

A

mitral valve prolapse

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12
Q

murmur that is a diastolic decrescendo blowing murmur heard at the left sternal border

A

aortic regurgitation

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13
Q

murmur that is a systolic crescendo decrescendo and radiates to the carotids

A

aortic stenosis

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14
Q

a murmur that is a mid-diastolic rumble with an opening snap heard at the apex of the heart

A

mitral stenosis

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15
Q

holosystolic murmur at the left sternal border that increased with inspiration

A

tricuspid regurgitation

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16
Q

differentiate between
- carpal tunnel syndrome
- pronator teres syndrome

A
  • carpal tunnel = median nerve entrapment in the carpal tunnel = MC NO sensory changes
    = associated w typing etc
  • pronator teres = median nerve entrapment in the pronator teres
    = commonly dc sensation
    = associated w athletes, including bicyclers
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17
Q

bioterrorism

incubation period, sx, and trx of..

-anthrax
-brucellosis
- tularemia

A

ANTHRAX
inc: 4-5 days
sx: mostly respiratory picture w resp distress, cough, Black Eschar (painless papule that turns into a necrotic ulcer)
trx: penicillin + doxycycline

BRUCELLOSIS
inc: 2-4 WEEKS
sx: systemic signs, joint + GI pain, UNDULATING FEVER (breaks, spikes, repeat)
trx: doxycycline + (streptomycin or rifampin)

TULAREMIA
inc: 2-3 days
sx: cough, CP, respiratory failure
trx: streptomycin

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18
Q

giving methotrexate for treatment of ectopic pregnancy

how do you monitor success of treatment

A

need to measure beta hcg

day you give MTX = day 1

check day 4 and day 7

-b hcg may go up days 1-4, but need to decreased by 15%+ between day 4-7…
- if don’t decrease enough, need to give another dose of MTX
- if dc 15%+, check again every week until back beta hcg = 0

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19
Q

scarlet fever vs rheumatic fever

A

both are complications of group A strep pharyngitis

rheumatic fever = body’s autoimmune response
- fever, joint pain, flat/slight raised painless rash w ragged edges, cardiac complications, syndeham chorea,

scarlet fever = toxin produced by strep
- fever, sore throat, erythematous “sand-paper” rash (flat blotches that become raised and fine bumps, strawberry tongue, tonsillar exudates

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20
Q

which vaccines are recommended and which are contraindicated in immunocompromised pateints

A

recommended: pneumococcal, HPV, flu, meningococcal, Tdap, hep B

contra-I = live attenuated vaccines = MMR, varicella, and herpes zoster

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21
Q

what pathology is the chromosome t(9;22)(q34;q11) associated with - what is this gene

A

philadelphia chromosome
makes BCR-ABL1

= chronic myeloid leukemia

trx w tyrosine-kinase inhibitors = imatinib

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22
Q

mobitz type 1 vs 2

which is wenckebach

A

mobitz type 1 = wenckebach
= PR intervals get longer leading up to the drop
= the first one you think of

mobitz type 2 = the PR interval does not change, drop a beat after every certain amount of beats

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23
Q

what are the causes of post op fever in the

  • first few hours post-op (immediate) (5)
  • first three days post-op (early)

-day 3-30 post-op (late)

A

immediate = other med stuff
- MI
- pre-existing infection
- inflammation from the surgery
- immune reaction
- malignant hyperthermia

early = infection elsewhere/ med
- pneumonia
- UTI
- MI
- early surgical site infection
- DVT
-withdrawal/gout, etc

late = surgical complications
- surgical infection (superficial earlier, deep infections more common further out)
- nosocomial infections (central line, cath, ventilator)
- DVT

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24
Q

what physical exam findings are found with
rheumatoid arthritis vs
osteoarthritis

A

RA = metacarpal and proximal interphalangeal joints
= swan neck deformities and Boutonnier deformity, ulnar deviation

OA= in the distal IPs and are Heberden’s nodes (osteophytes on DIP) and Bouchard’s nodes (osteophytes on PIP)

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25
Q

what are the 5 groups of pulmonary hypertension

A

group 1 = pulmonary arterial hypertension
- can be idiopathic, hereditary, or caused by drugs like CCBs, tadalafil, prostaglandins, or amphetamines
- can also be caused by connective tissue ds like lupus, HIV, other vasculopathies

group 2 = cardiac ds (valvular, heart failure, etc)

group 3 = lung ds or chronic hypoxia
- bc global hypoxia causes vasoconstriction leading to htn

group 4 = chronic thromboembolic ds
- clot formation, embolic –> dx with a ventilation-perfusion scan

group 5 = other systemic causes
- heme ds like sickle cell, metabolic ds like glycogen storage

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26
Q

JVD upon/worse with inspiration = what sign and what does it indicate

A

Kussmaul sign

pericarditis
(also relief with leaning forward)

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27
Q

MC location/cause of a posterior nose bleed and how do they present

trx?

A

sphenopalatine artery

often don’t know they have epistaxis bc it is posterior - often present with hematemesis and/or melena, PE shows blood and pharynx even after/without hematemesis

commonly seen in patients >40 yo

TREATMENT:
posterior bleeds are more likely to be severe
- can try posterior packing
- balloon/foley catheter to stop bleeding
- may require urgent ENT eval and hospitalization

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28
Q

pleural effusion with high levels of adenosine deaminase is associated with what

A

TB infection

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29
Q

most commonly torn rotator cuff muscle

n innervation

presenting sx

A

supraspinatus tendon

suprascapular N

dec strength with ABduction of the arm especially first 20-30 degrees, with positive empty can test and the rest of the rotator cuff tests are normal

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30
Q

BP meds that cause hypokalemia

sx and EKG of hypokalemia

A

loop diuretics (furosemide) or thiazide diuretics (HCTZ)

= M wknss, bradycardia, AV block, U wave

= low voltage everything especially in V2+V3, with a U wave

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31
Q

BP meds that cause hyperkalemia

sx and EKG of hyperkalemia

A

ACE-inhibitors

  • presents as wkns/cardiac abnormalities in the setting of renal failure or aggressive potassium replenishing

= peaked T waves, everything is large and peaked

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32
Q

meds that are associated with allergic interstitial nephritis (8)

sx?

A

mild proteinuria w hematuria, eosinophilia, rash, WBCs in urine

  1. nafcillin, methicillin
  2. NSAIDS
  3. rifampin
  4. phenytoin
  5. sulfa drugs
  6. quinolone
  7. diuretics
  8. allopurinol
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33
Q

how do you measure adequate fluid resuscitation (3 that are validated by randomized trials)

A

watch for end organ perfusion

  • urine output
  • central venous pressure
  • cardiac output
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34
Q

blood tests showing
inc Cr
dec C3+C4

shows what?

A

nephritis caused by deposition of immune complexes

= systemic cause of glomerulonephritis like lupus, sepsis, severe liver ds

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35
Q

tinnitus is associated which which cranial bone

A

temporal bone
CN 8 vestibulocochlear N runs through it

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36
Q

patient comes in the trauma bay post MVC with a supraglottic airway and decreased but equal breath sounds

first thing you do
which imaging tests are part of the initial exam

A
  • secure airway first ; this description is not secure bc decreased and the supraglottic airway is minimal
  • FAST exam
  • chest and pelvis X ray

most patients will get CT but that’s not the ~initial~ exam

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37
Q

what do you do if a patient has a pelvic fracture and free fluid on FAST exam

A
  • put on a pelvic binder
  • laparotomy
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38
Q

where is the calcarine sulcus and what does it do

A

occipital lobe

= where the primary visual cortex is
= visual reception and interpretation

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39
Q

what does stroke of the parietal lobe look like

A

parietal lobe = sensory input and body orientation

  • MCA is in here
  • stroke = hemiparesis
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40
Q

what does a stroke of the temporal lobe look like

A

temporal lobe = auditory reception, expressed behavior, receptive speech, memory retrieval

-strokes= aphasia

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41
Q

turner syndrome is associated with what cardiac abnormality

A

coarctation of the aorta = BP UE > BP LE

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42
Q

patients on hydroxychlorquine need what annual screening and why

A
  • yearly optho screening because the drug concentrates in the retinal pigment epithelium and can lead to retinopathy
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43
Q

de Quervain’s tenosynovitis is due to chronic stress to what

A

ABductor pollicis longus (muscle) and extensor pollicis brevis TENDON

44
Q

most common cause of septic arthritis in all people (bacteria) and its histology description

common cause of septic arthritis in
- prosthetic joints
- kids <2 yo and WITHOUT any extraarticular sx
-infants < 3 mo
- associated with varicella zoster infection

A

all ppl: stap aureus= g+ cocci in clusters

prosthetics –> coagulase (-) staph
kids<2yo –> strep pneumoniae
infants <3mo –> GBS group b strep
associated w varicella zoster –> GAS group A strep

45
Q

what type of WBC cancer is associated with +TRAP staining and what types of cells are seen on histology of the BM

associated with what gene mutation and what lymphocyte markers

A

= hairy cell leukemia
- large lymphocytes with oval nuclei and cytoplasmic projections and pale cytoplasm

associated with BRAF gene mutation
B-cell markers= CD19, CD20, CD11c, CD123

46
Q

describe the type of cells you’d see on immunohisto of the most common childhood malignancy

A

= acute lymphoblastic leukemia

you would see lymphoblasts = immature lymphocytes with smooth chromatin

47
Q

hypercalcemia + renal function + anemia + bone lesions is associated with what illness

A

multiple myeloma

48
Q

how does HOCM change with squatting

A

squatting INC preload = DEC intensity of HOCM murmur

inc preload = more blood in the vessel that pushes the hypertrophied septum out of the way to decrease the obstruction = less intense murmur

49
Q

how does aortic stenosis change with squatting

A

squatting inc preload = more blood flowing through the stones valve = INC intensity

50
Q

how do HOCM and aortic stenosis change with valsalva

A

valsalva dec preload bc you “BEARING DOWN”

dec preload =
- nothing to move the hypertrophied septum away so louder HOCM
- less to whoosh past the stenosed valve so DEC aortic stenosis

51
Q

lab results that suggest hemolysis

A

inc LDH
inc INDIRECT bilirubin
low haptoglobin

52
Q

what two viruses cause hand, foot, and mouth disease

A

coxsackie A16
enterovirus A17

53
Q

what virus causes roseola and what does it look like

A

roseola= first a spiking fever and as the fever drops a rash appears = erythematous macule on trunk and neck

herpes virus 6

54
Q

what does rubella look like

A

pink papules and macule spreading across the whole body, sometimes associated with posterior cervical lymphadenopathy

55
Q

which virus class is measles in and how does it present

A

= a paramyxovirus
in unvaccinated kids with

prodrome = cough, conjunctivitis, and coryza (inflamed nasal mucosa)

exanthem= erythematous raised papules spreading down from head and neck to the body and limbs

56
Q

describe fifth’s disease and which virus is it

A

parvovirus B19

prodrome = fever, headache, cough

slapped cheek rash on face = erythema infectious on the face with a reticular maculopapular rash

57
Q

what is galbreath’s technique

A

an OMM lymphatic treatment that can be used for treating acute otitis media and other lymph draining of the head and neck

= caudal and anterior pressure on the mandible

58
Q

what is a negative pressure room

A

this is a room that allows for isolation of a possibly highly infectious and dangerous illness

i.e. a patient with symptoms of a hemorrhagic virus like Ebola (fever, bleeding like hematemesis and epistaxis, hypotensive vital signs)…

59
Q

which BP meds are known to have hypercalcemia (and hyperPh) as common side effect?

how do these meds effect Na, K, glucose, lipids

A

thiazide diuretics = HCTZ and chlorthalidone, indapamide

HYPOna
HYPOk
HYPERca
HYPERglycemia
HYPERlipidemia

60
Q

common side effects of loop diuretics

A

furosemide, bumetanide

hypokalemia, hypoCalcemia

block Na, K, Cl reuptake in loop

61
Q

what is a pterygium and what causes it

A

pterigium = a wing like growth into the cornea from the sides (like the white parts and blood vessels)

due to exposure to wind, sand, and sun causing elastotic degeneration of the conjunctival stroma

62
Q

describe presentation and most common cause of syringomyelia

A

person in 30s-40s w new onset headaches, neuropathy and pain of bilateral shoulders down to fingers

MC cause is an arnold chiari malformation type 1 = herniation of the cerebellar tonsils through the foramen magnum –> disruption of CSF flow –> builds up during first few decades of life until onset of symptoms

63
Q

differentiate between francisella tularemia and coxiella q fever

A

both potential bioterrorism (tularemia class a, q fever class b)

both can cause pulmonary symptoms with fever, sob, infiltrates/nodules on CXR

both are gram(-)

differences:
- tularemia incubation is hours-days
vs q fever incubation is 14-26 days

64
Q

von willebrand ds

presentation
lab findings for platelet levels, PT and PTT, bleeding time

A

VWD = easy bleeding i.e. bleeding gums, easily bruised, super heavy periods, gets significantly worse after giving aspirin
- strong family history

-n plts
-n PT
-n or slightly prolonged PTT
-prolonged bleeding time

65
Q

what is an appropriate fundal height

what kind of testing would you do for abnormal fundal height

A

fundal height should be within 3 cm of the gestational age (i.e. 28 weeks = FH of 25-31)

check biophysical profile = an US evaluation of the fetal wellbeing, including a measurement of amniotic fluid to check for oligo/polyhydramnios

66
Q

which gene translation mutation is associated with chronic myeloid leukemia

A

t(9:22) BCR-ABL1

67
Q

which gene translation mutation is associated with Burkitt lymphoma

A

t(8:14) c-MYC

68
Q

which gene translation mutation is associated with mantle cell lymphoma

A

t(11:14) BCL1

cyclin D1 positive, presents mostly in elderly white males and usually presents at an advance stage, MC with lymphadenopathy as the main sx

69
Q

which gene translation mutation is associated with Ewing Sarcoma

A

t(11:22)

70
Q

which gene translation mutation is associated with acute myeloid leukemia M3 type

A

t(15:17)

responsive to all-trans retinoic acid

71
Q

which gene translation mutation is associated with follicular lymphoma

A

t(14:18) BCL2

72
Q

in hemophilia A/B , how does it present

what is the underlying mechanism

how will plt count, PT, PTT, and bleeding time result

A

spontaneous bleeding or prolonged bleeding after a minor trauma, hemarthrosis, spontaneous/easy bruising, hematuria, menorrhagia, nosebleeds

hemophilia A= the MC one = x factor 8, x linked
hemophilia B= factor 9 deficiency
- messes up the intrinsic pathway (12, 11, 10, 9, 8, 5, 2, 1 ) so only PTT is off

n plt count, PT, bleeding time
increased PTT

73
Q

in vitamin K deficiency, how does it present

how will plt count, PT, PTT, and bleeding time result

A

vitamin k deficiency = hemorrhage during or after birth, hemarthrosis, Gi bleeding, prolonged bleeding from minor trauma

n plt, bleeding time
inc PT, PTT

74
Q

how will plt count, PT, PTT, and bleeding time result in..

ITP
TTP
DIC

A

ITP = dec plt, prolonged bleeding time, n PT/T

TTP= dec plt, prolonged bleeding time, n PT/T

DIC = dec plt, prolonged bleeding time, PT, PTT

75
Q

commonly used abx regimens with anaerobic coverage

A

amoxicillin-clavulanate

metronidazole

ciprofloxacin

76
Q

which category of diuretics could cause HYPOna, HYPOk, and metabolic alkalosis

A

thiazide diuretics

also hypercalcemia

inhibit NaCl reabsorption in the distal convoluted tubule

77
Q

which type of diuretic is associated with hyperkalemia

A

potassium sparing drugs = spironolactone, aldactone

also gynecomastia

78
Q

which category of diuretics is associated with hypokalemia and metabolic acidosis

A

carbonic anhydrase inhibitors
- inc Na, K, HCO3, and water excretion

= acetazolamide

79
Q

in knee joint injuries

which ligament tears most often and how

-lachman tests what
- valgus test what
- varus test what

A

MC= ACL , non contact sports injuries > contact injury
-MC foot planted and turn, can hear a pop, pain on lateral side of knee

lachman positive= ACL or PCL
- PCL = mc with dashboard injuries or baseball player sliding into catcher

valgus positive= MCL
- sudden change in speed or direction or hit on the outside of the knee

varus positive = LCL (super rare)

80
Q

deficiency of what associated with

nail bed abn
cardiomyopathy
higher insulin requirement

A

selenium

81
Q

EKG changes associated with hypercalcemia vs hypocalcemia

A

HYPER = shortened QT interval

HYPO = prolonged qt interval

82
Q

holosystolic murmur that radiates to the axilla

A

mitral regurge

83
Q

late-peaking systolic ejection murmur +/- obliteration of the second heart sound

A

aortic stenosis

84
Q

when do patients need the PPSV23/PCV15 vaccine

A

pneumonia vaccine

give once after turn 65

85
Q

when do patients need the PPSV23/PCV15 vaccine

A

pneumonia vaccine
give once after turn 65

86
Q

what three lab values compose metabolic syndrome

A

TGs>150
HDL<40 men/<50 women
fasting glucose >100

or being treated for any of those

87
Q

empiric trx of meningitis in pt

<1 mo
1mo- 50 yo
>50 yo

A

< 1 mo = ampicillin + cefotaxime OR ampicillin + “ _-micin”

1 mo-5yo = vancomycin + ceftriaxone

> 50 yo = vancomycin + ceftriaxone + ampicillin

88
Q

MC causes of pneumonia in pt aged

0-20 days
3 wks-3 mo
3mo-5yr
5yr-YA

A

0-20 days
-GBS, E.Coli, Listeria
3 wks-3 mo
- viral, strep pneumo
- less = chlamydia, h. flu
3mo-5yr
-viral, strep pneumo
-less = strep pyogenes, staph aureus

5yr-YA
-virus, mycoplasma pneumonia > strep pneumo
-staph aureus for post-flu pneumonia
-strep pyogenes

89
Q

what is diclofenac

A

an NSAID

90
Q

5 of the most important conditions/risk factors for PE/VTE

A

orthopedic surgery
IBD
CHF
malignancy
nephrotic syndrome

91
Q

3 possible EKG changes associated with a PE

A

S1Q3T3
RBBB
sinus tachy

92
Q

what score is needed on a DEXA scan to diagnose osteoporosis

what is the other way one can be diagnosed

A

DEXA scan with T score of -2.5 or lower

or presenting with a fragility fracture

93
Q

most specific antibodies (2) for lupus

A

anti-dsDNA
anti-Smith

94
Q

anti-histone ab associate with

A

drug induced lupus

95
Q

anti-ro and anti-la are associated with

A

sjogren

96
Q

anticentromere ab are associated with

A

central CREST = limited cutaneous systemic sclerosis

97
Q

anti-scl-70 ab is associated with

A

diffuse cutaneous systemic sclerosis

98
Q

anti-jo-1 ab is associated with

A

inflammatory myopathy including dermatomyositis and polymyositis

99
Q

anti-snRNP70 ab is associated with

A

mixed connective tissue disease

100
Q

EKG changes associated with pericarditis

A

either
-diffuse ST elevation with reciprocal depression in aVR and V1

OR

-diffuse PR depression with with PR elevation in aVR

101
Q

what electrolyte changes are expected with excessive vomiting

A
  • hypokalemia
    -hypoMg and Ph
  • inc bicarb (relative to losing all the H+) and pH

Na can be up, down, or normal bc Na levels are based on H2O, not actually na

102
Q

which enzymes are elevated in dermatomyositis

A

= inc creatine kinase and aldolase – both are enzymes found in muscles (CK is most sensitive and specific for myositis)

**esr is NOT elevated

present w progressive muscle wkns, constitutional sx including fatigue fever and weight loss, myalgia, and a heliotrope rash which is raccoon eyes aka red/purple rash of the eyelids

103
Q

what is a positive methacholine challenge and what does it mean

A

positive = >20% drop in lung function with methacholine

positive = asthma

104
Q

when do you start mammography for breast cancer screening

A

USPSTF = 50 yo
American Cancer Society = 40

or ten years before a first degree relative was diagnosed

105
Q

what is the COBRA act

A

a law that prevents people from losing healthcare when transitioning between jobs or having hours cut

106
Q

what lab level suggest ovarian insufficiency

A

FSH <40 x2 lab draws

107
Q

what prenatal screening do you offer first vs second trimester

A

first trimester = first 12 weeks
nuchal translucency + beta hcg levels , pregnancy associated

second trimester= 13-24
quad screen = alpha-fetoprotein, inhibin A, beta hcg, unconjugated estriol

trulearn questions (4 decks)

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