random / exam master questions Flashcards
sarcoidosis pres
30-40 year old african american female
constituional (fever, malaise), dyspnea, erythema nedosum, parotid gland enlargement, hepatosplenomegaly, arthritis, neuropathy, lymphadenopathy
sarcoid labs
elevated ESR, hypercalcemia, hypercalciuria, elevated ACE and leukopenia
sarcoid diagnosis
bilateral hilar adenoapthy and diagnostic biopsy of NONCASEATING GRANULOMAS!
sarcoid tx
- lots resolve spontaneously
- more severe: prednisone
tuberculosis - pres
- CASEATING GRANULOMAS w/ fever, night sweats, malaise, fatigue, weight loss
- w/ progression, productive cough, dsypnea, hemoptysis,, pleuritic chest pain
TB - high risk pop
-homeless, immigrants, alcoholics, drug abusers, elderly, HIV pos
CXR w/ TB
UPPER LOBE cavitation or superior segment of lower lobe
alcoholic given D5W becomes confused, ataxic w/ nystagmus and internuclear opthalmoplegia…
WERNICKES ENCEPHALOPATHY!
-d/t acute thiamine def!
dz d/t chronic thiamine deficiency…
KORSAKOFFS ENCEPHALOPATHY! - have presevered long-term memory, language and socially appropriate but have profound short-term memory loss, confabulation
what test is associated w/ recurrent thyroid malignancy post ablation or incomplete thyroidectomy…
rising serum thyroglobulin levels - w/ baseline and stimulated thyroglobulin levels >2 ng/ml need repeat u/s and scan to r/o malignancy
requirement before using I131 for hyperthyroidism…
pregnancy test! contraindicated in prego!
3 y/o boy who uses hands to push himself upright w/ waddling gait, bilateral calf hypertrophy, lumbar lordosis and hyporeflexia and increased CK levels suggests…
duchenne MD - most common type, onset b/n 3-5 in boys
gower’s sign = pushing self upright w/ hands
-see increased CK
trichostatis spinulosa
little black dots around nose - can pull out = keratin plug w/ vellous hair
oral hairy leukoplakia suggests…
HIV or immunosuppression! rarely seen in immunocompetent!!
farmer presents w/ rigid paralysis after getting puncture wound on foot - drained to find motile rods w/ terminal endospores that look like tennis rackets…
c. tetani! (endospores are terminal, look like tennis racket / drumstick)
crepitant cellulitis w/ gas…
c. perfringens - central endospores, nonmotile
73 y/o AA w/ lower back and shoulder pain who is anemic w/ hypercalcemia and multiple spots of bony tenderness…expect what on xray and dx?
Multiple myeloma!!! lytic bone lesions!
-tx w/ chemo first bortezomib then bone marrow transplant
35 y/o w/ nonproductive cough and dyspnea on exertion x 1 week. some weight loss and night sweats, white plaques in mouth w/ dysphagia. hx iv heroin. clear lungs on exam. wbc 2800, pmn 79%……dx and tx
AIDS W/ PCP! IV bactrim!!!
- think AIDS w/ hx drug use, low white count and high ldh w/ esophageal candidiasis
- CXR may be negative, dx w/ bronchoscopy showing trophozoites or yeast
unilateral sharply demarcated scaling lesion on breast….
PAGET’S! r/o mammary duct carcinoma (tx would be mastectomy if carcinoma present)
types of melanoma…
superficial spreading - black/blue plaques
nodular - black/blue rapidly growing papule
acral - most in AA, on fingers/subungal, soles, palms, mucous membranes
lentigo - brown/tan spots on sun exposed skin
BCC…
-shiny pearly nodule or scaling plaque or solitary flat yellow plaque
SCC…
red papule / crusted plaque on lips, ears, hands, neck / face
kaposis
purple plaques on lower limbs or widely disseminated in AIDS
high prolactin levels - cause? non-adenoma…
chronic renal failure d/t decreased clearance - get kidney function testing then pituitary mri for prolactinoma
std initial test for kidney stone…
non contrast CT!!
cholinergic crisis symptoms…
SLUDGE: salivation, lacrimation, urination, defacation, gi pain, E?, rhinorrhea
*muscle fasisculations! not seen w/ MG
triad of colicky abd pain + vomiting + rectal bleeding in baby suggests…..
intussuseption. ..CURRANT JELLY STOOL AND TELESCOPING!
- most d/t viral infection w/ hypertrophy of peyer’s patches! in young
eruptive and tendinous xanthomas…d/t?
high chylomicrons and VLDL w/ hyperlipidemia! yellow-red papules on butt and tendons
case: pt w/ nausea, anorexia, weakness, constipated, thirst, muscle pain and h/o kidney stones…think about?
hypercalcemia!
expect shortened QRS on ekg! can also see J waves and arrest w/ severe!!
common complications of aortic coarctation after correction….
htn!
treatment of cardiogenic shock d/t MI
- *avoid phenylephrine (alpha agonist - pure vasoconstrictor - will increase afterload), BB, no CCB, no crystalloids w/ pulmonary edema
- w/o pulmonary edema - oxygen, asa, heparin, fluid challenge (250 cc NS) over 5 min
- w/ severe (MAP <80
dose-dependent dopamine effects:
<5 mcg/kg = vasodilation
5-10 = beta 1 activity - increase contractility and HR
10 = alpha adrenergic - arterial vasoconstriction
drug of choice to prevent cluster headaches…
VERAPAMIL!
boy who ate pork 3-4 weeks ago, now with watery diarrhea, periorbital edema and muscle pain. has blood eosinophilia and muscle biopsy shows edematous fibers w/ worm…tx?
mebendazole! 200-400 TID x 3 d then 400-500 TID x 10 days!
broad spectrum antihelminthic!
best diagnostic test for CF?
sweat chloride! >60 mmol/L
40 y/o man w/ RUQ pain, weight loss, weakness. on exam has ascites, hepatomegaly and h/o hep b. think about? best marker?
hepatocellular carcinoma!! order alphafetoprotein (elevated in over 70%)
gram negative intracellular diplococci? tx?
GONORRHEA!
always cover for chlamydia too - ceftriaxone 125 mg IM + azithromycin 1 g
tx for cholinergic crisis
stop agent, give atropine. can distinguish from myasthenic crisis w/ edrophonium testing
bronchoalveolar lavage of enlarged cells w/ intranuclear inclusions in immunosupp pt w/ acute resp failure…
CMV! tx immunosupp only w/ ganciclovir
intermittent jaundice and elevated unconjugated bilirubin…dx?
gilbert’s syndrome! benign condition! no treatment
codman triangle…
area of new bone growth d/t lesion at metaphysis - often d/t tumor
time for transmission of lyme dz w/ tick bite
must feed 24-36 hours
