Set 3 Flashcards
What are the skin manifestations of sarcoidosis?
Erythema nodosum (painful subcutaneous erythematous nodules)
What is seen on X-ray in sarcoidosis?
Bilateral hilar lymphadenopathy
&
Pulomonary reticular infiltrates
What is see on biopsy of sarcoidosis?
Noncaseating granulomas
- Headache
- Sudden loss of vision
- Elevated ESR
Dx?
Giant cell arteritis
Tx for giant cell arteririts
Giant Cell Arteritis without vision loss Tx = Intermediate to high dose oral glucocorticoids (prednisone 40-60 mg daily)
Giant Cell Arteritis With vision loss = High-dose IV glucocorticoids (e.g. methylprednisolone 1000 mg daily) for 3 days followed by intermediate to high dose oral glucocorticoids
What is the PaO2/FiO2 in Acute Respiratory Distress Syndrome?
PaO2/FiO2 < 300
What are the symptoms of digoxin toxicity?
GI (Nausea, vomiting, diarrhea)
Cardiac (Arrhythmia)
Vision
Weak and slow-rising carotid pulse. Dx?
Weak and slow-rising carotid pulse =
“pulsus parvus and tardus”
Dx = Aortic stenosis
Blood pressure differential between upper and lower extremities. Dx?
Coarctation of aorta
Cardiac auscultation demonstrates an opening snap. Dx?
Mitral stenosis
Prominant capillary pulsations in the fingertips. Dx?
Aortic regurgitation
Exertional syncope in elderly pt. What is a likely cardiac cause?
Aortic stenosis
What is the pathological view of diabetic nephropathy?
Nodular glomerulonephrosis (Kimmelstiel-Wilson nodules)
What is the difference between the hearing loss of presbycusis and osteosclerosis?
Presbycusis is sensorinural hearing loss. It is seen after the 6th decade of life. It presents with loss of high-frequency noises.
Osteosclerosis is conductive hearing loss. It is seen in middle-age. It presents with loss of low-frequency.
Morning pain and stiffness in neck, shoulders and pelvis. + Elevated ESR. Dx? Tx?
Dx = Polymyalgia rheumatica Tx = low-dose glucocorticoids
If pt develops hypocalcemia after blood transfusion. What is the mechanism?
Whole blood is stored with citrate anticoagulant.
Citrate can chelate serum calcium, causing hypocalcemia.
What is 3rd degree or complete AV block? What is the treatment?
3rd degree (complete AV block) = complete dissociation of QRS and P waves Tx = permanent pacemaker
Location of Charcot joint. Mechanism of Charcot joint.
Charcot joint = Neuropathic arthropathy
It occurs in weightbearing joints (e.g. ankle).
Patients with type 2 DM have decreased sensation in the lower extremity, unknowingly traumatize weighbearing joints, leading to joint degeneration.
Mechanism of Dupuytren contracture
Progressive fibrosis of the palmar fascia
Pt has MI with pulmonary edema. What medication to give? What medication to avoid?
Give: diuretic (Intravenous Furosemide)
Avoid beta blockers in pulmonary edema.
Claw hand. Dx? What Nerves are involved?
Dx = Klumpke palsy Nerves = C8, T1
If pediatric pt has claw hand. What other symptoms may occur? Why?
Horner’s syndrome (Miosis and Ptosis)
Sympathetics fibers run along C8, T1
“Waiter-tip” arm. Dx? What Nerves are involved?
Dx = Erb-Duchenne palsy Nerves = C5, C6
Cardiogenic shock. What is increased/decreased?
Cardiac output, SVR, PCWP
Cardiac output (decreased)
SVR (increased)
PCWP (increased)
Hypovolemic shock. What is increased/decreased?
Cardiac output, SVR, PCWP
Cardiac output (decreased)
SVR (increased)
PCWP (decreased)
Septic shock. What is increased/decreased?
Cardiac output, SVR, PCWP
Cardiac output (increased)
SVR (decreased)
PCWP (decreased)
Neurogenic shock. What is increased/decreased?
Cardiac output, SVR, PCWP
Cardiac output (decreased)
SVR (decreased)
PCWP (decreased)
What is the only type of shock that has increased cardiac output?
Septic shock
What is the only type of shock that has increased PCWP?
Cardiogenic shock
In hypovolemic shock – why does cardiac output decrease?
Decreased right ventricular preload
Which hemorrhoids are painful and which are not?
External hemorrhoids = painful
Internal hemorrhoids = less pain
What is the mechanism of graft-vs-host disease? What are the symptoms?
Mechanism = Activation of donor T-lymphocytes Symptoms = Skin (Rash on palms, soles, face) Intestine (bloody diarrhea) Liver (High LFTs, Jaundice)
Phenytoin side effect: what vitamin deficiency?
Folic acid deficiency
Inflammatory arthritis
Splenomegaly
Neutropenia
Dx?
Felty syndrome (An autoimmune conditions that is most common in patients with long-establish rheumatoid arthritis)
What type of dementia is associated with visual hallucinations?
Lewy body dementia
Key features that help to distinguish this stroke from other strokes:
Anterior Cerebral Artery Stroke
- Lower extremity more affected than upper
- Urinary incontinence
Key features that help to distinguish this stroke from other strokes:
Middle Cerebral Artery Stroke
- Homonomous hemianopsia
- Eye deviation to affected side
- Hemineglect
- IF dominant hemisphere then = Aphasia
Key features that help to distinguish this stroke from other strokes:
Posterior Cerebral Artery Stroke
- Homonomous hemianopsia
- CNIII palsy = paresis of vertical and horizontal eye movement
- Visual hallucinations
- IF dominant hemisphere then = Alexia without agraphia (can’t read, but can write)
Sudden cessation of what drug can lead to seizures?
Short acting benzodiazapines (e.g. alprazolam)
Variable decelerations. Dx? Tx?
Dx = umbilical cord compression
Tx = depends on how often the variable decels (<30 sec decels) occur
IF umbilical cord compression (variable decels) occur with <50% of contractions then NO intervention required.
IF umbilical cord compression (variable decels) occur with >50% of contraction then:
Primary Tx = maternal repositioning
Secondary Tx = amnioinfusion
What type of murmur is heard in bicuspid aortic valve?
Bicuspid aortic valve can cause aortic regurgitation.
= Diastolic decrescendo murmur
What type of murmur is heard in hypertrophic cardiomyopathy?
Systolic crescendo decrescendo murmur
Guidelines for colonoscopy for patients with ulcerative colitis.
8 yrs after initial diagnosis
AND
afterwards repeat every 1-3 yrs
Guidelines for colonoscopy for patients with family history of adenomatous polyps or colorectal cancer.
- Age 40 or 10 yrs before diagnosis of affected relative
- Repeat every 5 yrs
Guidelines for colonoscopy for patients with Hereditary Nonpolyposis Colorectal Cancer
- 1st colonoscopy at age 20-25
- Repeat every 1-2 yrs
Guidelines for colonoscopy for patients with Classic familial adenomatous polposis
- 1st colonoscopy at age 10-12
- Repeat annually
How to differentiate between erysipelas and cellulitis.
Erysipelas has a raised border.
Cellulitis has a flat border.
Timetable for alcohol withdrawal seizures.
12-48 hrs. after last drink
What heart defects are present in Marfan’s? What murmurs are heard?
Marfan’s = Aortic root dilation (aortic regurgitation) and Mitral valve prolapse (mitral regurgitation)
Aortic regurgitation = early diastolic decrescendo murmur
Mitral Regurgitation = mid-to-late systolic murmur.
Compare the sounds made by:
Mitral stenosis vs Mitral regurgitation
Mitral stenosis = opening snap + mid-diastolic rumble
Mitral regurgitation = mid-systolic click + mid-to-late systolic murmur
Pericordial friction rub. Dx?
Pericarditis
Pulsus parvus et tardus. Dx?
Pulsus parvus et tardus = weak and delayed arterial pulses
Dx = severe aortic stenosis
Categorize the types of lung cancer based on their location in the lung.
Squamous Cell Carcinoma - Central
Small Cell Carcinoma - Central
Large Cell Carcinoma - Peripheral
Adenocarcinoma - Peripheral
Clinical Associations of
Adenocarcinoma of the Lung
- Clubbing
- Hypertrophic osteoarthropathy
Clinical Association of
Squamous Cell Carcinoma of the Lung
Hypercalcemia
Clinical Associations of
Small Cell Lung Cancer
- SIADH
- ACTH (Cushing)
- Lambert-Eaton Syndrome
Clinical Association of
Large Cell Lung Cancer
- Gynecomastia
- Galactorrhea
The predominant type of lung cancer seen in nonsmokers.
Adenocarcinoma
What criteria to use to decide if patient with community acquired pneumonia should be hospitalized.
CURB-65:
- Confusion
- Urea (BUN) > 20
- Respirations > 30
- BP < 90/60
- Age > 65
- if score is >3 then hospitalize the patient
What is the treatment of community acquired pneumonia in outpatient vs inpatient?
Outpatient if patient is healthy = Macrolide OR Doxycycline
Outpatient if pt has comorbidities = Respiratory Fluoroquinolone (levofloxacin, moxifloxacin) or beta-lactam + macrolide
Inpatient =
Respiratory fluoroquinolone (IV)
OR
Beta-lactam + Macrolide (IV)
Right atrium pressure (preload) is increased in only what type of shock?
Cardiogenic shock
PCWP (preload) is increased in only what type of shock?
Cardiogenic shock
Cardiac index (pump function) is increased in only what type of shock?
Septic shock
SVR (afterload) is decreased in only what type of shock?
Septic shock
Mixed venous oxygen saturation is increased in only what type of shock?
Septic shock
IV drug user has AV block. Dx?
Dx = Perivalvular abscess (most often from aortic valve endocarditis)
NOT tricuspid if AV block
What is the animal resevoir of Ecchinococcus granulosus?
Dog tapeworm (sheep intermediate host)
Tapeworm from pigs that can cause seizures
Taenia solium
Liver cyst associated with diarrhea. What is the organism?
Entamoeba histolytica
Entamoeba histolytica and Ecchinococus granulosus both present with liver findings. Which one is associated with fever?
Liver + Fever = Entamoeba histolitica
+ diarrhea
What 2 organisms can be transmitted in undercooked fish. What are the symptoms?
Clonorchi sinesis (liver fluke) = cause biliary disesase Diphyllobothrium latum (fish tapeworm) = megaloblastic anemia due to Vit B12 deficiency
In burn patients – at what carboxyhemoglobin level is intubation warranted?
> 10 % carboxyhemoglobin = intubate
Sphincter of Oddi dysfunction presents with RUQ pain. The pain can be worsened if pt is given what medication?
Morphine
Rash after amoxicillin. Diagnosis?
Infectious Mononucleosis
Initial treatment for patient with cocaine-associated chest pain.
IV benzodiazepines
In cocaine-associated chest pain, what medication is contraindicated and why?
Beta blockers are contraindicated
because they may cause unopposed alpha adrenergic stimulation, worsening coronary vasoconstriction
Symptoms of retinal detachment
Floaters
Curtain (starting from periphery)
Both retinal artery and retinal vein occlusion can result in painless monocular vision loss. How do you differentiate them on fundoscopy?
Retinal artery occlusion = cherry red macula
Retinal vein occlusion = diffuse hemorrhages and cotton wool spots
Melanoma size.
> 6mm diameter
4 Physical findings in Trisomy 18 (Edward’s syndrome)
- Closed fists
- Overlapping fingers
- Rocker-bottom feet
- Micrognathia
4 Physical findings in Trisomy 13 (Patau)
- Cutis aplasia (absence of epidermis over skull)
- Holoprosencephaly (1 eye)
- Omphalocele (abdominal organs outside of body)
- Polydactyly (extra fingers)
Uric acid stone. Treatment?
Alkalization of urine with potassium citrate.
Unilateral cryptorchidism can be monitored until age ______. Surgery is indicated before age ______ to reduce risk of testicular torsion, infertility and testicular malignancy.
Monitor until age: 6 months
Surgery by age: 1 yr
Muscular dystrophy.
BEST TEST to confirm diagnosis
Genetic testing (for dystrophin gene)
Cellulitis in the submandibular/sublingual spaces.
Dx?
Complication?
Dx = Ludwig angina Complication = Airway obstruction due to displacement of the tongue posteriorly
TCA overdose treatment
Sodium bicarbonate
Patient less than 40 with back pain that is relieved with exercise but NOT rest. Dx?
Ankylosing spondylitis
What is the ophthalmologic complication of ankylosing spondylitis?
Anterior uveitis
What is the lung complication of ankylosing spondylitis?
Restrictive lung pathology, due to reduced chest expansion and spinal mobility
Ischemic optic neuropathy is a complication of ________
Temporal arteritris
What is episcleritis? What conditions is it associated with?
Episcleritis = inflammation at the white of the eye
Associated with Rhematoid Arthritis and Inflammatory Bowel Disease
What is the cardiac complication of ankylosing spondylitis?
Aortic regurgitation
What is the cardiac complication of Turner’s?
Aortic coarctation
Initial treatment for Rheumatoid Arthritis?
What are the side effects?
What medication is used to reduce the side effects?
Tx = Methotrexate
Side effects = Stomatitis, Hepatotoxicity, Cytopenia
Reduce side effects with Folic Acid supplementation.
Type 1 diabetic with facial pain and fever. Dx? Tx?
Dx = Mucormycosis Tx = Surgical debridement and Amphoterecin B
Lead poisoning therapy
Chelation therapy with calcium disodium EDTA
What are the symptoms of diphenhydramine overdose
Diphenhydramine causes antihistaminic and anticholinergic effects.
Antihistaminic = Drowsiness and Confusion
Anticholinergic = Dilated pupils, blurred vision, dry mouth, reduced bowel sounds, urinary retension
What is the treatment of diphenhydramine overdose
Physostigmine (a cholinesterase inhibitor), to couteract the anticholinergic effects of diphenhydramine
Salicylate intoxication symptoms and treatment.
Symptoms =
- Mixed metabolic acidosis and respiratory alkalosis
- Tinnitus
- Nausea/vomiting
- Fever
Tx = Sodium bicarbonate to alkalize urine
Theophylline overdose symptoms
Seizures
Hyperthermia
Arrhythmia
