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Random Uworld 8/12 Flashcards

1
Q

Osteomyelitis without fever or leukocytosis?

A

Sure
Indolent

Tenderness is best sign

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2
Q

another urease producing bacterium that can cause alkalotic urine and struvite stones other than proteus

A

Klebsiella

also urease producing and urine alkalinizing

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3
Q

antigen 19-9 is…

A

pancreatic cancer… not sensitive enough for screening

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4
Q

TF

abstain from coitus with placenta previa, even early at 20 weeks

A

T
penile contact with cervix can disturb… cervix does not have to be dilated

no digital vaginal exams either

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5
Q

guy with history of asthma gets MI, started on aspirin metoprolol and lisinopril, gets a cough

which med responsible for cough

A

any of them

aspirin can exacerbate asthma especially with chronic rhinitis and nasal polyps

cardioselective beta1 blockers not as likely as non-selective but still can exacerbate asthma

acei angioedema you know

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6
Q

TF

need fever and guarding/rebound tenderness to suggest spontaneous bacterial peritonitis

A

F
temp ^100.0
abdominal pain/tenderness but does not have to be peritonitic

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7
Q

how can spontaneous bacterial peritonitis manifest on abdominal xr
why

A

dilated loops of large bowel with air in colon and rectum

paralytic ileus

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8
Q

sounds PID-ish but now there is pleuritic RUQ pain

think
treat

A 
perihepatitis/fitz-hugh-curtis disease
from PID (GC)

treat the PID with hospitalization and the usual (ceftri plus azythro or doxy)

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9
Q

you are thinking acute viral hepatitis for RUQ pain with recent travel… what skin and stool findings do you look for

A

jaundice

changes in stool color

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10
Q

why can get hypotension with epidural in labor

A

bock nerves including sympathetics, vasodilation, venous pooling

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11
Q

pt v40yo, low back pain worse at night improves with exercise, dyspnea on exertion, inflammation at tendon insertions, systemic fever chills weight loss fatigue, eye pain photophobia blurry vision… maybe even IBD or aortic regurge….

think
PFTs
serum marker

A

ankylosing spondylitis

sacroiliitis
limited spine mobility and chest (fixed chest but not pulmonary fibrosis usually, but sometimes)
expansion
enthesitis
uveitis

restrictive pft pattern
HLA-B27 serum marker

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12
Q 
pernicious anemia
demographic
disease association
tongue findings
neuro findings
smear
smear if severe
A

most common cause of B12 deficiency in Whites with
Northern European backgrounds especially

AI disease - eg thyroiditis and vitiligo

shiny tongue (atrophic glossitis)

shuffling broad based gate (ataxia) and position and vibratory sense abnorms

megaloblastic anemia - megaloblasts and hypersegmented neutrophils

thrombocytopenia and leukopenia too if severe

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13
Q

how many years of pure vegan diet to delete b12 stores (b12 found only in meat and dairy)

A

5 years

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14
Q

2 major side effects of isoniazid

A

peripheral neuropathy and hepatotoxicity

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15
Q 
megaloblastic anemia
atrophic glossitis (shiny tongue)
vitiligo
thyroid disease
neurologic abnormalities

think
what demo

A

pernicious anemia

whites with northern european ancestry

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16
Q

Normal post void residual (ml) male vs female

A

v50 male

v150 female

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17
Q

Preggo confusion falling nausea vomiting nystagmus low chloride high bicarb… maybe hypokalemia hypoglycemia elevated transaminases

Think
Treat

A 
Wernicke encephalopathy
-ams gait ataxia nystagmus
From thiamine deficiency
From hyperemesis gravidarum
-dehydration, hypochloremic hypokalemic metabolic alkalosis elevated transams from vomiting

Treat with fluids antiemetics Thiamine Then glucose

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18
Q

Suspect acute fatty liver of pregnancy given nausea vomiting hypoglycemia elevated transaminases starting when in pregnancy

A

3rd trimester for acute fatty liver of pregnancy… so after like 24 weeks

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19
Q

Young woman knee pain xr shows expansile and eccentrically placed lytic lesion of epiphysis of distal femur or proximal tibia aka _____ appearance

suggests
Prognosis
Treatment

A

aka “Soap bubble” appearance
(expansile and eccentrically placed lytic lesion of epiphysis of long bone)

Giant Cell Tumor of Bone
(tumor of osteoclasts)

Benign but locally aggressive

Curettage and bone grafting

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20
Q

Hyperparathyroidism from parathyroid carcinoma causing widespread bone resorption and replacement with fibrosis (brown tumors) describes this condition

A

Osteotis fribrosis cystica

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21
Q

Sclerotic cortical bone lesion with central lucency, pain worse at night not related to activity, improves with nsaids suggests

A

Osteoid osteoma

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22
Q

Fetal growth restriction defined by what weight percentile

A

v10th percentile

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23
Q

TF
well controlled hypertension in pregnancy can still cause fetal growth restriction

What pattern of fgr does hypertension cause

A

T
even well controlled can still cause spiral artery abnorms and fgr

Assymmetric fgr (abdomen relatively smaller than head… because abdominal growth happens 2nd 3rd trimesters and if htn or another placental insufficiecy blood to head and chest will be prioritized

vs Symmetric fgr in congenital disorders or infections

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24
Q

TF

Caffeine assoc with fetal growth restriction

A

F

Not caffeine… Smoking alcohol cocaine though yes

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25
Q

4 main substrates for gluconeogenesis

Where they come from

Where they enter pathway

A

Alanine from muscle breakdown, converted to pyruvate

Glutamine from muscle breakdown, enters kreb cycle

Glycerol3phosphate, from fat breakdown, enters higher up than pyruvate

Lactate from anaerobic metabolism, converted to puruvate

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26
Q

TF

Intensive bp control for diabetic nephropathy

A

T
The most important factor to slow progression
v130/80 for diabetic nephropathy
v140/90 for dm in general

So start acei arb (carefully because can acutely decrease gfr)

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27
Q

How to know large axonopathy vs small axonopathy in diabetic neuropathy

A

Small axonopathy positive symptoms pain paresthesias allodynoa

Large axonopathy Negative symptoms numbness loss of vibratory and proprioception loss of ankle reflexes

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28
Q

What serum pH to give bicarb for gap metabolic acidosis for underlying reason that has been resolved (eg seizure since stabilized)

A

v7.1 give bicarb

Otherwise recheck q2h… should resolve unless underlying reason not addressed yet

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29
Q

4 compx of epo administration

A

Worsening htn
Headaches
Flu-like symptoms
red cell aplasia rare

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30
Q

Give epo in ckd if hb and hct are

A

v10 or 30%

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31
Q

Differentiate
Hashimoto thyroiditis
Painless thyroiditis
Dequervain thyroiditis

By 
Aka
hypo vs hyperthyroid symptoms
Tenderness
TPO antigen positivity
RadioIodine uptake
ESR CRP elevation
A

Hashimoto thyroiditis - chronic autoimmune thyroiditis, hypothyroid, tpo ab positive, riu variable

Painless thyroiditis - silent thyroiditis (variant of chronic ai hashimoto thyroiditis), mild brief spontaneously recovered hyperthyroid, nontender, positive tpo ab, low riu

Dequervain thyroiditis - subacute granulomatous thyroiditis, postviral fever and hyperthyroid, tender, elevated esr crp, low riu

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32
Q

Graves is ___thyroidism

A

Graves is HYPERthyroidism

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33
Q

Strumaovarii is ___toxicosis from __ production by ___

A

Strumaovarii is THYROtoxicosis from THYROID HORMONE production by OVARIAN TERATOMA

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34
Q

How to decide if esophageal injury from caustic ingestion in hemodynamically stable patient requires supportive care or tube feeds and possible surgery (esophagectomy)

A

EGD within 12-24 hours to assess extent if damage

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35
Q

TF

Activated Charcoal for Lye ingestion

A

F
Lye (hydroxide, alkalai) causes mucosal contact damage, not systemic absorption damage

Activated charcoal prevents systemic absorption poison damage

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36
Q

Follow up atypical glandular cells on pap

What are you evaluating for

A

Colposcopy
Endometrial curettage
Endometrial biopsy

Cervical OR Endometrial Adenocarcinoma

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37
Q

LEEP is a type of ____ that removes the ____

A

LEEP is a type of Cone Biopsy that removes the Transformation Zone

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38
Q

Pork consumption or travel
Seizures
Ring enhancing, non enhancing, and calcified brain mri lesions

Think
Treat

A

NeuroCysticercosis

Albendazole

(diff brain lesions depending on stage of cyst)

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39
Q

MAC
symptoms
Treatment

A

GI and Pulm symptoms

Clarythromycin and Ethambutol

(but ppx with azythromycin…)

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40
Q

TF

TB can have a diffuse reticulonodular pattern on cxr

A

T

Miliary tb

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41
Q

Mycoplasma pna symptoms usually limited to ___ weeks

A

2-3 weeks

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42
Q

treat old guy with ams glucose 1000 normal pH bicarb gap

Stepwise, Most Important Initial Step

A

HHS

1 AGGRESSIVE NS IV FLUID REPLACEMENT
-very hyperosmolar which prob also caused tons diuresis and dehydration so THIS FIRST

2 IV IV IV IVIVIVIV INSULIN

3 Watch K supplement if v5.3

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43
Q

Follow up atypical glandular cells on pap

What are you evaluating for

A

Colposcopy
Endometrial curettage
Endometrial biopsy

Cervical OR Endometrial Adenocarcinoma

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44
Q

LEEP is a type of ____ that removes the ____

A

LEEP is a type of Cone Biopsy that removes the Transformation Zone

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45
Q

Pork consumption or travel
Seizures
Ring enhancing, non enhancing, and calcified brain mri lesions

Think
Treat

A

NeuroCysticercosis

Albendazole

(diff brain lesions depending on stage of cyst)

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46
Q

MAC
symptoms
Treatment

A

GI and Pulm symptoms

Clarythromycin and Ethambutol

(but ppx with azythromycin…)

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47
Q

TF

TB can have a diffuse reticulonodular pattern on cxr

A

T

Miliary tb

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48
Q

Mycoplasma pna symptoms usually limited to ___ weeks

A

2-3 weeks

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49
Q

treat old guy with ams glucose 1000 normal pH bicarb gap

Stepwise, Most Important Initial Step

A

HHS

1 AGGRESSIVE NS IV FLUID REPLACEMENT
-very hyperosmolar which prob also caused tons diuresis and dehydration so THIS FIRST

2 IV IV IV IVIVIVIV INSULIN

3 Watch K supplement if v5.3

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50
Q

15 yo girl concerned about what is porbably a fibroadenoma of the breast. Reassure and do nothing or follow up after next menses?

A

Follow up

If improved reassure

If persistent, ultrasound. If fibroadenoma, reassure

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51
Q

Treat woman with breast engorgement seeking lactation suppression after her baby died

A

Bra
Ice packs
Nsaids
Avoid stim

No medical suppression – engorgement provides its own negative feedback and suppression will happen
And eg bromocriptine dopamine agonism has side effects

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52
Q

What to do for kid with elevated led level oncapillary fingestick

A

Get a venous lead level to confirm elevation

fingerstick can grt false positives

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53
Q

Lead chelation therapy for kid

A

VENOUS (for confirmation after initial capillary fingerstick) lead level ^45 dimercaptosiccinate

^69 or encephalopathy dimercaptosuccinate DMSA And dimercaprol EDTA

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54
Q

Fluorourocil cream is used for

A

Actinic keratosis
Or
Bowen’s disease (SCC in situ)

And other Low Risk SCC lesions

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55
Q

TF

Falling with an object in the mouth can cause unilateral hemiplegia via carotid artery dissection

A

T

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56
Q

Marfanoid, lens dislocation, intellectual disability, arterial or venous thrombi

Think

A

Homocysteinuria

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57
Q

How does maternal diebetes cause neonatal rds

A

Insulin suppresses cortisol

So less surfactant production

58
Q

How do intrauterine growth restriction a d maternal htn affect neonatal rds

A

Decrease chance of rds…

59
Q

TF ocp’s cause htn

A

T
They can
So in 39yo nononese lady with htn consider change

60
Q

Buspirone treats

A

Buspirone treats GAD generalized anxiety disorder

61
Q

Holosystolic 2/6 llsb murmur and an apical diastolic rumble in a tired skinny kid think

A

VSD
most common congenital heart defect

Holosystolic murmur is thru vsd
Diastolic rumble is increased flow across mitral

Pulm htn from rl shunt, later tired and sob like this kid from eisenmenger rl shunt reversal

62
Q

Symptoms of cyanide poisoning

A

Headache vomiting abdominal pain flushed skin… butter almond odor if inhaled

63
Q

Symptoms of tca toxicity

A

Neuro, cardiac, anticholinergic

64
Q

Bedwetting is normal till age __ and merits no intervention before that time

A

Bedwetting is normal till age 5 and merits no intervention before that time

65
Q

Eosinophilia with gi symptoms and

Myalgias with high ck and periorbital edema
Vs
Pulmonary symptoms

Think

A

Trichinillosis
vs
Ascariasis

66
Q

Fever in first week
Abd pain and salmon rash second week
Hepatosplenomegaly and abdominal complications third week
Vs
Fever headache retroorbital pain rash myalgias arthralgias maybe skin or nose hemorrhage

Think

A

Typhoid fever
Vs
Dengue fever

67
Q

Hematuria in

Adult within 5 days of uri, mesangial deposits
Vs
Kid 2 weeks after uri, low c3 complement, anti aso and anti dnaseb titers, subepithelial humps

A

IgA nephropathy
Vs
PSGN or PIGN post strep or post infectious

68
Q

Xlinked collagen iv defect
Hearing loss, ocular abnormalities, hematuria, renal failure
Thinning of glomerular basement membrane

Think

A

Alport syndrome

69
Q

Anti glomerular basement membrane disease
Vs
Goodpasture syndrome

A

Antigbm is igs against gbm that can cause rpgn or alveolar hemorrhage

Goodpastures syndrome is subtype when both occur, pulmonary renal syndrome

70
Q

TF

Opioid withdrawal can have psulychotic delusions and resolve in a short ed stay

A

F
No delusions
3-5 day recovery

Think more amphetamine intoxication

71
Q

How does hypomagnesemia cause hypocalcemia

A

Hypomag causes resistance to pth and decreased pth release

72
Q

Schizo on mri

Atrophy of caudate think

Orbitofrontal cortex and basal ganglia abnorms think

A

Schizo on mri - ventricular enlargement, shrunk hippocampus and amygdala

Atrophy of caudate think Huntingtons

Orbitofrontal cortex and basal ganglia abnorms think OCD

73
Q

TF

Sarcoidosis causes proteinuria

A 
F
Lung heart skin eye
Hilar adenopathy 
Systolic or diastolic heart dysfunction
E nodosum
Uveiitis
74
Q

Trear old guy with meningitis vs transplant with meningitis

A

Old guy vanc ceftri amp (strep nmening list)

Immunocompromised vanc amp cefipime (strep list nmening gnrs)

Plus dexamethasone till strep pneumo (deafness risk) ruled out

Ceftri = cefotaxime = 3rd gen ceph
Amp = tmpsmx for listeria cover
Cefipime = ceftazidime or meropenem
75
Q

What cd4 count is immunocompetent enough to get live attenuated vaccines

A

^200 is good enough

76
Q

Diagnose duchenne muscular dystrophy

Muscle biopsy?

A

Genetic testing
X linked Xp21 dystrophin gene

Muscle biopsy is supportive not difinitive

77
Q

Fever malaise polyarthralgias maculopapular rash leukopenia thrombocytopenia after tropical travel think

Vector
Treatment

A

Chikengunya fever

Mosquito born virus

Supportive care

78
Q

Guy stepped on nail

How do you treat for tetanus

A

Give Tdap if last vaccine ^10 years ago anf wound clean, ^5 years ago and wound dirty, or less than 3 doses and wound clean

Add ivig if less than 3 doses and wound dirty, or to treat active tetanus infection

79
Q

What tremor does trihexyphenidyl treat

A

Parkinsons

(Anticholinergic used in young or early parkinsons

80
Q

Fetal macrosomia
Omphalocele
Macroglossia
Hemihyperplasia

Diagnosis
Pathogenesis
Complications
Surveillance

A

Beckwith wiedemann syndrome

11p15 imprintment dysregulation

Wilm’s tumor, Hepatoblastoma

AFP, abdominal/renal ultrasound

81
Q

Greater risk factor for aortic dissection

Atherosclerosis or HTN

A

HTN

82
Q

4 symptoms of Li toxicity

A

Tremor hyperreflexia ataxia seizures

83
Q

3 symptoms of phenytoin toxicity

A

NYSTAGMUS confusion ataxia

84
Q

Greatest risk for cerebral palsy

A

Premature birth

Then other prenatal neuro insults

85
Q

Disseminated gonococcus symptom triad

A

Polyarthralgia
Tenosynovitis
Vesiculopustular skin lesions

86
Q

Selection bias includes inappropriste selection Or poor ___

A

poor Retention is also included in Selection Bias

87
Q

Attrition bias is a subtype of ___ bias

A

Attrition bias is a subtype of SELECTION bias

88
Q

TF

SSRI’s can cause SIADH in elderly

A

T

89
Q

TF

SSRI’s can cause SIADH in elderly

A

T

90
Q

HIV screening test

A

HIV P24 ANTIGEN and HIV ANTIBODIES

91
Q

Benztropine is a _____ drug used to treat ____ side effects of ____ drugs

A

Benztropine is a ANTICHOLINERGIC drug used to treat EXTRAPYRAMIDAL side effects of ANTIPSYCHOTIC drugs

92
Q

Cyproheptadine is a ____ drug used to treat severe ____

A

Cyproheptadine is a SEROTONIN ANTAGONIST drug used to treat severe SEROTONIN SYNDROME

93
Q

Central retinal artery occlusion is emergently treated with

A

Ocular massage (to monilize clot more distally

And hyperbaric oxygen

94
Q

Fever sore throat malaise headache lymphadenopathy (widespread, particularly EPITROCHLEAR SAILORS HANDSHAKE)
RASH GENERALIZED INCLUDING PALMS AND SOLES
Gray mucous patches
Condyloma lata

Dx
Tx

A

Secondary syphilis
Penicillin G - 1 intramuscular dose (lasts 3 weeks)

Confirm adequacy with 4x decrease in serologic titers at 6-12 months

95
Q

Early symptomatic meningitis then Late Generalized paralysis, Dementia, Personality changes, argyll robinson pupil loss of dtr’s lost vibratory and positional sense (tabes dorsalis) Aortic aneurysm/insufficiency
Cutaneous gummas

Dx
Tx

A

Tertiary syphilis
Penicillin G - 1 intramuscular dose (lasts 3 weeks)

Confirm adequacy with 4x decrease in serologic titers at 6-12 months

96
Q

Palm and sole rashes

A

Syphilis - starts at trunk generalizes including palms and soles

Rocky mountain spotted fever - starts palms somes peripherally spreads centripitally

97
Q

LP CSF in MS

A

Oligoclonal bands

Normal cell count, t cell prediminance, total protein, but high proportion of Ig’s

98
Q

Albuminocytologic dissociation in LP CSF

Means
Think

A

Means high protein normal cell count

Think Guillan Barre syndrome

99
Q

14-3-3 protein in csf lp
Rapid dementia personality changes
Startle myoclonus

Dx

A

Prion disease (creuztfeldt jakob)

100
Q

Pruritic tense bullae on flexural surfaces groin acilla, subepidermal cleavage, IgG deposits in basement membrane on immunofluorescence

Dx

A

Bullous pemphigoid

101
Q 
Antibodies to desmosomes
Flaccid bullae and ulcers
Mucosal erosions
Nikolsky sign sloughing with rubbing
Intraepidermal cleavage Acantholysis (detached keratinocytes) Tombstone cells along basal layer
Netlike Chickenwire intercellular IgG

Dx
Tx

A

Pemphigus Vulgaris

Steroids
Wound care

102
Q 
Pruritic tense bullae on flexural surfaces groin acilla, subepidermal cleavage, IgG deposits in basement membrane on immunofluorescence
Vs
Antibodies to desmosomes
Flaccid bullae and ulcers
Mucosal erosions
Nikolsky sign sloughing with rubbing
Intraepidermal cleavage Acantholysis (detached keratinocytes) Tombstone cells along basal layer
Netlike Chickenwire intercellular IgG

Dx

A

Bullous pemphigoid
Vs
Pemphigus vulgaris

103
Q

Treat rhino orbital cerebral mucormycosis/rhizopus

A 
Debride
Amphotericin B (liposomal)
Treat dka (if present, usually that or less commonly another form of immunocompromise)
104
Q 
Chronic oligoarthritis
Daily fever
Rash, macular, with fever
Leukocytosis Thrombocytosis anemia
Elevated ESR CRP
In kid

Dx

A

Juvenile Idiopathic Arthritis

105
Q

IUD for woman with heavy menses and anemia

A

Levonorgestrel IUD
-amenorrhea causing which can be used strategically here

(Copper can cause heavy menses)

106
Q

Early short term memory loss
disorientation
Later personality changes

Early personality changes
Apathy, compulsive behavior

Visual hallucinations
Parkinsonism
Fluctuating cognition

Ataxia, urinary incontinence

Rapid progression behavioral changes, myoclonus, seizures

Cognitive decline with fnd’s

A

Alzheimers -Early short term memory loss disorientation Later personality changes

Frontotemporal dementia Picks dz - Early personality changes Apathy, compulsive behavior

Lewy Body Dementia - Visual hallucinations Parkinsonism Fluctuating cognition

Normal pressure hudrocephalus - Ataxia, urinary incontinence

Prion - Rapid progression behavioral changes, myoclonus, seizures

Vascular dementia - Cognitive decline with fnd’s

107
Q

Lithium teratogenicity

A

Cardiac defects first trimester
-septal defects, ebstein anomaly (atrialization of the ventricle)

Goiter and neuromuscular dysfunction secknd and third

108
Q

Carbemazepine and valproate teratogenicity

A

Craniofacial neurAl tube genutourinary

109
Q

Abx for EHEC

A

Avoid – can worsen HUS

110
Q

Spasticity bulbar hyperteflexia
Vs
Fasciculations

A

Umn
Vs
Lmn

111
Q

Galactosemia causes
___ hyperbilirubinemia
And ___ and ___ due to ___

A

Galactosemia causes
CONJUGATED hyperbilirubinemia
And VOMITING and GROWTH FAILURE due to INABILITY TO DIGEST GALACTOSE IN MILK

112
Q

Bili threshold for phototherapy vs exchange transfusion

A

20 for photo

25 or neuro symptoms for exchange transfusion

113
Q

Normal breast feeding frequency for newborn

A

20-60 minutes (half at each breast) at least q3 hours

114
Q

Dermatophyte tinea capitis

LAD?

Tx?

A

Yes can have lymphadenopathy

Oral griseofulvin or terbinafine

Selenium sulfide or ketoconazole shampoo for prevention

115
Q

Antidote fir methemoglobinemia

A

Methykene blue – reduces met ferric 2 hb back to ferrous 3 hb

116
Q

Dimercaprol is antidote for

A

Lead poisoning, chelating agent

117
Q

Fomepizole is antidote for

A

Methanol or Ethylene glycolr

Inhibits alc dehydrogenase and conversion to toxic metabolites

118
Q

Glucagon is antidote for

A

BB or CCB

Glucagon activated adenylate cyclase increasing intracellular ca and contractility

119
Q

Pralidoxime is antidote for

A

AchE inhibitors (eg organophosphstes)

Given with Atropine

120
Q 
Methylene blue
Dimercaprol
Fomepizole
Glucagon
Pralidoxime
A

Antidotes

Methylene blue - methemoglobinemia
Dimercaprol - lead poisoning
Fomepizole - methanol or ethylene glycol
Glucagon - BB or CCB
Pralidoxime - AchE inhibitors (eg organophosphstes) Given with Atropine
121
Q

Acetazolamide is a diuretic used to treat

A

Pseudotumor cerebri

Eg in obese women with headache and visual changes

122
Q

Associated trisomy ntd’s cardiac defects with

Gastroschisis vs Omphalocele

A

With Ophalocele yes

Gastroschisis usually isolated

123
Q

Kallman syndrome

A

Normal karyotype, x-linked recessive

Hypogonadotrophic hypogonadism
Rhinencephalon hypoplasia
Anosmia

124
Q

Iatrogenic causes of idiopathic intracranial hypertension pseudotumor ceribri

A

Tetracyclines

Hypervotaminosis A isotretinoin

125
Q

What to check before starting pt on clozapine or olanzapine

A

Fasting glucose and lipids waist circ bmi bp
-matabolic effects, weigt gain (second gen antipsychotics)

(Clozagranulocytosis only clozapine not olanzapine..follow cbcs with clozapine)

126
Q

What antipsychotic needs ekg minitoring

A

Ziprasidone

Atypical antipsychotic

127
Q

2nd line syphilis treatment

A

Doxy for 1 and 2 and latent
Ceftriaxonefor tertiary

(Benzathine Penicillin G 1st line unless allergy)

128
Q

How young with first febrile uti merits 1-2 wks abx and renal us to rule out anatomic predispositon

A

v2 years – higher risk of complication from first febrile uti

129
Q

Torus palatinus
Define/Presentation
Manage

A

Benign chronic bony growth at midline suture of hard palate, congenital/environmental, most common young female asians

Manage ntd unless symptomatic/problematic — thin epithelium easy bleeding slow healing poor vascular supply, interference within speech swallowing eating denture fitting etc

130
Q

Young patient fleshy immobile hard mass midline soft palate
Most likely diagnosis
Manage

A

Torus palatinus

Benign chronic bony growth at midline suture of hard palate, congenital/environmental, most common young female asians

Manage ntd unless symptomatic/problematic — thin epithelium easy bleeding slow healing poor vascular supply, interference within speech swallowing eating denture fitting etc

131
Q 
Normal at birth, gradual apathy weakness hypotonia sluggish movement large tongue abdominal bloatig umbilical hernia... pathalogic jaundice, difficulty breathing, noisy breathing, hypothermia, refractory macrocytic anemia
Think
Presentation
Cause
Diagnose
Treat
A

think Congenital hypothyroidism

present as Foreigner/lack of prenatal care, developes these symptoms over… weeks i think, presenting ~1 month old or so
(Neonates routinely screened in the US with serum TSH and T4, screened for other inborn errors lf metabolism galactosemia and phenylketonuria too)

caused by thyroid dysgenesis (aplasia, hypoplasia, ectopia) most often… also inborn error of thyroxine synthesis, transplacental maternal thyrotropin receptor blocking antibodies less commonly

dx with serum TSH and T4

treat with Levothyroxine 10mcg/kg then titrate as approproate

132
Q

Another cause of floppy baby syndrome other than infant botulism

A

Werdnig-Hoffman syndrome

autosomal recessive degeneration of anterior horn cells and cranial nerve nuclei

133
Q 
Congenital
Muscle weakness and atrophy especially in distal extremities
Myotonia
Testicular atrophy
Baldness

Think
Inheritance

A

Myotonic congenital myopathy

autosomal dominant

134
Q

Pediatric form of Myasthenia Gravis occurs when

A

Late childhood or adolescence

135
Q

When to get electrolyte panel for kid with allarent febrile seizure

A

If in the setting of vomiting diarrhea or dehydration

If appears well hydrated with no other symptoms, don’t worry about it

136
Q 
Febrile seizure
Risk factors
4 diagnostic criteria
Management, hospitalize?
Prognosis
A

Fever from mild viral/bacterial illness, family history of febrile seizures are risk factors

3mos-6years old
No afebrile seizures
No meningitis or encephalitis
No acute metabolic cause

Abort seizure if ^5 min
Treat cause if possible
Tylenol antipyresis for comfort
(will not impact future seizures)
Reassurance, no need to hospitalize for obs

Does Not impact development or intelligence,30% reoccur, 5% become epileptic,

137
Q

_______ is an aggressive, rapidly growing tumor that involve the distal ileum and present as intussusception and massive ascites

A

Burkitt Lymphoma
is an aggressive, rapidly growing tumor that involve the distal ileum and present as intussusception and massive ascites

138
Q

How can Henoch Schonlein Purpura cause intussusception?

What are the first manifestations of HSP usually?

A

HSP autoimmune vasculitis can cause a bowel hematoma that acts as a lead point for intussusception

Usually palpable purpura and joint pain

139
Q

Pt older than 2 with recurrent intussusception you must think

A

Pathalogical lead point (not just peyers patches hypertrophy from viral illness like less than 2yos)

140
Q

___ muscular dystrophy is injerited by ___ pattern and characterized by grip myotonia, facial weakness, foot drop, dysphagia, cardiac conduction abnorms… also baldness cataracts testicular atrophy

A

myotonic muscular dystrophy is injerited by autosomal recessive pattern and characterized by grip myotonia, facial weakness, foot drop, dysphagia, cardiac conduction abnorms… also baldness cataracts testicular atrophy

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