Step 2 Qbank review Flashcards
1
Q
how does Crohn’s disease lead to nephrolithiasis?
A
Normally Oxalate is bound by calcium in the gut preventing its absorption, with Crohn’s and other fat malabsorption diseases, calcium is preferentially bound to fat. The unbound oxalate is then absorbed and leads to hyperoxaluria and oxalate stone formation.
2
Q
Conditions associated with formation of calcium phosphate stones
A
Hyperparathyrodism and RTA
3
Q
Cause and treatment of acute unilateral cervical adenitis
A
Typically caused by Streptococcal and staphylococcal infections. Treatment usually consist of I&D plus CLINDAMYCIN (since s. aureus produced b-lactams -MRSA- Amoxicillin is a poor choice).
4
Q
Essential tremor
A
Essential tremor is often bilateral, affects upper extremities and worsens at the end of an activity.
5
Q
Parkinson’s disease tetrad
A
Resting tremor, rigidity, postural instability, and bradykinesia.
6
Q
Definition of chronic bronchitis.
A
Chronic productive (white sputum, may have some blood tinge) for 3 months in 2 successive years. Cigarette smoking is the leading cause.
7
Q
Luteoma presentation
A
Classically presents in AA women, 30-40, during pregnancy, up to 1/3 can develop hirsutism. On U/S is appears as a multinodular solid mass on BOTH ovaries.
8
Q
Painless bloody stools in well appearing neonate
A
Milk or soy protein proctocolitis.
9
Q
Cyclical vomiting
A
Reccurent self limitign episodes of v/n in children in absence of other causes. Higher incidence in children of parents with + migraine hx. Tx: antiemetics and reassurance for the parents.
10
Q
Unusually dark urine
A
conjugated hyperbilirubinemia
11
Q
Light’s criteria transudative vs exudative
A
Any pos in LC = exudative (inflammatory process)
12
Q
Causes of Dyspepsia
A
NSAIDs, Gastric or esophageal cancer and symptomatic H. Pylori infx
13
Q
mucomycosis
A
Caused by fungus Rhizopus, most often in suceptible diabetics. Presents with low grade fever, dull facial pain, and bloody nasal discharge. Tx surgical debridement + IV AMPHOTERICIN.
14
Q
Infective endocarditis presentation and treatment.
A
Present with intermittent fever, fatigue, new holosystolic murmur and pos cultures. Start with Vancomycin, it covers staph, strep and enterococci. After cultures, if PCN sensitive, treat with IV PCN-G or IV CEFTRIAXONE.
15
Q
Pneumothorax presentation
A
tachypnea, tachycardia, DISTENDED NECK VEINS, tracheal deviation away from injury (diff in pressures)
16
Q
Pneumothorax mgt
A
needle thoracostomy, possible chest tube and intubation
17
Q
Comorbidites associated with panic disorder
A
Major depression, bipolar disorder, agoraphobia (fear of public spaces), and substance abuse.
18
Q
Holosystolic murmurs
A
TR, MR, and VSD
19
Q
CMV retinitis
A
HIV pt CD4<50, yellowish-white patches of retinal opacifications and retinal hemorrhages. Tx Valganciclovir, Ganciclovir or Forscarnet
20
Q
HIV Candidal esophagitis
A
Oral thrush and candidal esophagitis treat with 1-2 weeks of fluconazole.
21
Q
HIV esophagitis HSV
A
small, well circumscribed round/ovid ulcers and intranuclear inclusions. Tx: ACYCLOVIR
22
Q
HIV esophagitis CMV
A
Large linear ulcers and intranuclear and intracytoplasmic inclusion (Owl eyes). Tx: GANCICLOVIR
23
Q
5 common side effects of Amiodarone
A
Pulmonary fibrosis, Hypothyrodism, Hepatotoxic, Corneal deposit and Blue-gray skin discoloration
24
Q
Signs of tracheobronchial injury
A
Hemoptysis, pneumomediastinum, and air leak even after chest tube placement.
25
Galactosemia presentation and cause
infant or newborn with FTT, BILATERAL CATARACTS, jaundice and hypoglycemia. Due to Galactose 1 phosphate uridyl transferase deficiency. Pt are at increased risk of E. coli neonatal sepsis.
26
Galactokinase deficiency.
Pt only presents with cataracts. Otherwise asymptomatic.
27
what does and S4 indicate? Due to?
Indicates a stiff left ventricle, occurs in setting of restrictive cardiomyopathy or LVH from prolonged HTN.
28
Most common cause of Nephrotic syndrome in adults
Membranous glomerulonephritis. Associated with HBV, syphilis, malaria, and gold. With SPIKE AND DOME appearance due to granular deposits of IgG and C3 on BM.
29
Complication of membranous glomerulonephritis (or any nephrotic syndrome).
Renal vein thrombosis, presents sudden onset of abdominal pain, fever, and hematuria. Due to loss of antithrombin III in the urine (remember the proteinuria of nephrotic syndrome), the loss puts pts at risk of venous and arterial thrombosis.
30
Describe electrical alternans
QRS complex with variable amplitude from beat to beat, due to heart changing axis as it swings back and forth within an increased quantity of pericardial fluid.
31
Signs of pericardial effusion
muffled heart sounds, unpalpable apical pulse, dyspnea on exertion, dull chest pain, enlarged heart.
32
New onset of RBBB
consider a PE
33
chorioamnionitis
suspect in setting of PROM, maternal fever, leukocytosis, uterine tenderness, and fetal tachycardia (sign of maternal infx).
34
PROM delivery or c-section
Save the c-section for cases of evident fetal distress, eg late decelerations.
35
Cause of hypercalcemia in chronic granulomatous diseases (eg Sarcoidosis).
Elevated calcitrol (1,25 dihydroxy vit D). Treat with corticosteroids, will reduce the calcitrol levels.
36
Treatment of hypercalcemia in sarcoidosis vs malignancy.
Sarcodisosis hypercalcemia treated with corticosteroids. Malignancy hypercalcemia is treated with Zoledronic acid.
37
What do Howell-Jolly bodies indicate?
Indicates abscence of spleen, either functional, autoinfarction, infiltrative disorder, or splenic congestion. They represent nuclear remnats within RBCs, appear as single, round, blue inclusion on WRIGHT stain.
38
What are Heinz bodies?
Hemoglobin precipitation seen in G6PD deficiency. Hg becomes oxidized and forms insoluble precipitants, Heinz bodies, they appear on the periphery of RBC with blue dye (cyrstal violet)
39
most common cause of congenital hypothyrodism in the US
Thyroid dysgenesis
40
PCOS cancer risk
Endometrial hyperplasia -> carcinoma, remember PCOS is an annovulatory (thus no inc ovarian cancer risk) unbalanced estrogen secretion state.
41
Signs and symptoms of spinal cord compression.
UMN dysfunction distal to site of compression, includes weakness, hyperreflexia, and + Babinski (extensor plantar response).
42
Legg-Calve-Perthes disease
Idiopathic avascular necrosis of the femoral capital epiphysis. Commonly affects boys between 4 and 10. Presents with hip, groin, or knee pain plus antalgic gait.
43
ARDS vent goal, PaO2, PaCO2
goal: mechanical vent with low tidal volume and PEEP (between 5-15 mm Hg). PaO2: measure of oxygenation, mainly affected by FiO2 and PEEP. PaCO2: measure of ventilation, mainly affected by RR and TV.
44
Renal changes in pregnancy and lab values.
In pregnancy both renal plasma flow and glomerular filtration rate INCREASE, causing a DECREASE in serum BUN and Cr.
45
Acute Tubular Necrosis (ATN) cause and UA findings.
Due to ischemic or nephrotoxic insult. Serum Cr is elevated. Urinalysis shows GRANULAR CAST, HEMATURIA, and RENAL EPITHELIAL CELLS.
46
Renal papillary necrosis presentation and associated disease.
Painless hematuria. Look for sickle cell trait.
47
Treatment acute COPD exacerbation.
O2, inhaled bronchodialators (albuterol), inhaled anticholinergics (ipratropium), systemic glucocorticoids, consider abx (levofloxacin - respiratory FQ)
48
Infective endocarditis in pt with MVP community vs healthcare-associated (HCA).
Community most commonly due to viridans group streptococcus (s. mutuans, s. sanguis, s.??). HCA most commonly due to staph aureus.
49
Acute stress disorder
Similar to PTSD, but symptoms lasting from 3 days to 1 month post traumatic event.
50
Prosthetic joint infection early vs delay onset
Early: w/i 3 months. Erythema, swelling, drainage, fever. Staph aureus, GNR, anerobes. Delayed: > 3 months. Persistent pain, loosening implant. Coag neg staph (staph. epidermidis)
51
Syringomyelia
Areflexic weakness in upper extremities and loss of pain and temperature with preserved pos/vibration in "cape" distribution.
52
Cannabis intoxication behavioral and psychological changes.
Euphoria and relaxation. Pts have conjunctival injection, dry mouth, tachycardia, and increased appetite. Psychomotor impairment and PARANOIA may also occur.
53
Rib notching
Caused by dilatation of collateral chest wall vessels in Coarcation.
54
Stroke in child with soft palate trauma.
Either from compression of ICA leading to embolic stroke or ICA dissection leading to ischemic stroke.
55
Treatment of kawasaki disease
Aspirin + IVIG, treatment is just to prevent coronary artery aneurysm and MI/ischemia
56
Fusion beats
capture of both atrial and ventricular beats. Diagnostic of sustained monomorphic ventricular tachycardia.
57
Babesiosis
NE united states, tick bite, in immunocompromised and asplenics. Parasite enters RBCs and causes HEMOLYSIS. Jaundice, hemolytic anemia, thrombocytopenia, high ESR, NO RASH. Dx- Giemsa thin and thick smear. Tx- quinin+clinda or atovaquone+azithromycin
58
MEN TYPE 1
Parathyroid adenoma, Pituitary tumors, and Pancreatic tumors
59
MEN TYPE 2A
Medullary thyroid cancer, Pheochromocytoma, and Parathyroid hyperplasia
60
MEN TYPE 2B
Medullary thyroid cancer, Marfinoid habitus, and Pheochromocytoma
61
Recommendation for pts with renal calculi
Decreased protein and oxalate, Decreased Sodium intake (high sodium promotes Ca excretion leading to more stones), Increased fluids, and Increased Calcium dietary intake
62
BMT recipient with both lung and intestinal involvement (colitis)??
CMV pneumonitis.
63
Hallmarks of cellulitis
Warmth, erythema, edema, and tenderness.
64
Hallmarks of Necrotizing fasciitis
Purplish discoloration of skin, gangrenous changes (bullae, crepitous) and systemic toxicity.
65
Encapsulated bacteria
Some Killers Have Pretty Nice Capsules, .
66
Lactation mastitis
S. aureus (MSSA)Dicloxacillin or Cephalexin. S. aureus (MRSA) Clinda or Bactrim or Vanco.
67
Anorexia vs Bulimia
Anorexia (BMI < 18.5) give CBT and Olanzapine (Atypical) s/e is weight gain. Bulimia (normal BMI, but binge/purge) CBT/nutrional rehab, SSRI may be needed.
68
TCA overdose
CNS depression, hypotension, anticholinergic effects (dilated pupils, hyperthermia, decreased bowel sounds). Tx: NaHCO3 if hypotensive, QRS prolongation, or v-arrhythmia.
69
Diabetic gastroperesis treatment
Use a prokinetic agent, eg METOCLOPROMIDE or ERYTHROMYCIN
70
Chronic granulomatous disease
Defect of phagocytic cells due to NADPH oxidase enzyme complex dysfunction. Look for recurrent infections with Catalase positive bact (S. Aureus, Serratia, Klebsiella, and Aspergillus). Nitroblue Tetrazolium (NBT) NEGATIVE (does not turn blue, the color change means normal cell capable of making reactive oxygen species). Tx: daily TMP/SMX and gamma interferon.
71
Wiskott-Aldrich syndrome
X-linked. Presents with young boy with ECZEMA, THROMBOCYTOPENIA, AND RECURRENT ENCAPSULATED INFECTIONS. Will have LOW IgM levels with HIGH IgA/IgE
72
Chediak-Higashi syndrome
Decreased phagocytic activity because of failure of phagolysosome formation. Bacteria are not destroyed and PMN dysfunction leads to recurrent pyogenic infections (pus producing), partial albinism (light skin and hair with eye photosensitivity), and neuropathy.
73
Causes of Hypercalcemia of malignancy (solid vs lymphomas).
Due to PTHrP leading to excessive bone resorption. Lymphomas cause 1,25VitD production leading to increased gut absorption.
74
Down syndrome on quad screen
ELEVATED B-HCG and Inhibin A with a LOW MSAFP and Estriol
75
Beckwith-Wiedemann syndrome
Overgrowth disorder with predisposition for neoplasm (Wilm's tumor and hepatoblastoma) screen with U/S and alpha fetoprotein. Pts presents with big babies, with big tongues and hemihyperplasia. Can also have abdominal wall defects.
76
Use of bronchoalveolar lavage (BAL)
Suspected malignancy and opportunistic infections (eg PCP).
77
How is heart function affected in Cardiac Tamponade.
An exaggerated shift of the interventricular septum toward the left ventricular cavity reducing LV chamber volume (reducing preload/stroke volume/ CO). Beck's triad: hypotension, distended neck veins, muffled heart sounds. Also look for pulsus paradoxus.
78
Best way to reduce progression of diabetic nephropathy?
Blood pressure control.
79
G6PD Von gierkes disease
hypoglycemia, lactic acidos, hyperuricemia, and hyperlipedemia. Doll like face (fat cheeks), thin extremities, short stature, big old belly (enlarged liver and kidneys).
80
Most important prognostic indicator in ALF
PT.
81
Long term sequelae of bacterial meningitis
Hearing loss, Loss of cognitive fx,Seizures,Mental retardation, and Spasticity or paresis
82
Cerebral salt wasting syndrome
A complication of SAH. Presents with Hyponatremia. Due to an inappropriate secretion of vasopressin leading to water retention. Then an increase in atrial BNP. May also develop SiADH.
83
Definition and S/S of elevated intracranial pressure.
Elevated ICP >20 mm Hg. S/S diffuse HEADACHES (WORSE IN THE MORNING), nausea and vomiting early in the day, vision changes, papilledema, CN deficits, somnolence, confusion, unsteadiness, Cushing's reflex (HTN with bradycardia).
84
Toxoplasmosis ppx vs treatment
PPX: TMP-SMX. Treatment - Sulfadiazine and pyrimethamine + leucovorin (prevent heme tox). If pregnant treat with Spiramycin
85
How are ACEi renal protective in DM?
ACE reduce intraglomerular hypertension. In DM, renal damage comes from glomerular hyperfiltration leading to intraglomerular hypertension.
86
Delusional disorder
One or more delusions and NO psychotic symptoms in otherwise high-functioning individual.
87
Treatment of EtOH withdrawl
Benzodiazepine, Librium (chlordiazepoxide).
88
Sympathetic opthalmia
Also known as spared eye injury. Due to immune-mediated inflammation of normal eye after penetrating injury to the other. Present with anterior uveitis. Thought to be due to uncovering of hidden antigens, usually stuck in the eye and protected from immunological recognition. After penetrating injury an immune response ensues.
89
Treatment of chlamydia
Single dose Azithromycin or 7 day course of Doxycycline
90
Lennox-Gastaut Syndrome
Childhood seizures (multiple types), impaired cognitive function, and SLOW SPIKE AND WAVE ACTIVITY ON EEG.
91
Complex partial seizure
Last a few minutes, impaired consciousness, starting spells, automatisms (lip smacking, swallowing, picking movements of the hand), post-ictal confusion. Hyperventilation EEG DOES NOT show change in activity.
92
Malignant otitis externa
Seen in diabetics, usually due to Pseudommonas. Look for ear pain, drainage,, and GRANULATION TISSUE WITHIN EAR CANAL. GIve IV ciprofloxacin.
93
Hairy Cell Leukemia (B-cell lymphoma) cytochemical features and treatment
Cytochemical feature: Tartrate-resistant acid phosphatase (TRAP) stain. Treatment - Cladribine (Purine analog)
94
Treatment for CLL, NHL
CLL: Chlorambucil and prednisone, NHL: CHOP (Cyclophosphamide, Hydroxydaunorubicin, Oncovin [vincrisitine], Prednisone)
95
Lumbar spinal stenosis
Common cause of back pain, pt > 60, presents with back pain radiating to buttocks and thighs, interferes with walking and gets better with LUMBAR FLEXION. In comparison lumbar disk herniation gets worst with lumbar flexion.
96
Treatment of acute glaucoma (EM)
Mannitol, acetazolamide, pilocarpine or timolol.
97
Effects of DES exposure on offspring
Clear cell adenocarcinoma of the vagina and cervix, Cervical anomalities, and Uterine malformations.
98
Preferred study for diagnosis of melanoma.
Excisional biopsy, once confirmed 1 cm margin excision for treatment.
99
Gout acute attack vs ppx
Acute attack - NSAIDS, steroids, colchicine.
100
Herpangina
Due to Coxsackie A virus. Leads to formation of vesicles on tonsils and soft palate. Usually seen in children, presenting with sore throat, fever, and pain with swallowing.
101
Retropharyngeal abscess presentation
Neck pain, fever, limited neck mobility, inability to open mouth (Trismus) and limited cervical extension. Usually due to penetrating trauma to retropharyngeal space (chicken bones). I&D, broad spectrum abx, mediastinal spread is the worst complication.
102
Five Ps of compartment syndrome
Pain (early finding), Paresthesias (burning or tingling), Pallor, Pulselessness (late finding), and Paresis/paralysis
103
Treatment of GB
IVIG and plamapheresis.
104
Polymorphous maculopapular rash after Amoxicillin in pt with
Mono: Epstein Barr virus.
105
Compare and contrast Preseptal cellulitis and Orbital cellulitis
In common: eyelid edema, erythema, tenderness, fever, and leukocytosis. Orbital cellulitis is more severe, also presents with vision impairment, proptosis, pain with EOM, ophthalmoplegia (eye paralysis)
106
How does squatting help kid with tet spell.
The position increases systemic vascular resistance and decreased the shunting of blood from RV to LV across the VSD.
107
Immunofluorescence patterns of kidney disease
Linear Ig deposits: anti-glomerular BM dz (Goodpasture syndrome). Granular Ig deposits: Immune complex glomerulonephritis (Lupus or post strep GN)
108
Treatment of cellulitis with systemic signs (fever, tachy, etc)
IV Nafcillin or Cefazolin.
109
Pickwickian syndrome
Severely obese pt with wakeful alveolar hypoventialtion 2/2 to impaired chest wall compliance.
110
Treatment for dermatitis herpetiform
Dapsone and gluten free diet. Presents are erythematous papules, vesicles, and bullae arranged symmetrically. Group in a herpetiform pattern over extensor surfaces, upper back, and buttocks.
111
Common medications causing renal insufficiency or failure.
Chronic NSAID use (ATN or Papillary Necrosis), Cyclosporine, Aminoglycosides, and Methicillin.
112
SLE with isolated skin and joint involvement, drug of choice and s/e.
Hydroxycholoquine, main side effect is damage to eyes, most serious is retinopathy, but can also have corneal damage.
113
Tx chemotherapy induced n/v
Ondansetron, a 5HT3 serotonin antagonist.
114
Open angle glaucoma presentation and treatment
Asymptomatic in initial stages, followed by painless gradual loss of peripheral vision over year, eventually leading to tunnel vision and halos around lights. Tx: timolol.
115
Drug induced esophagitis presentation and offending agents
Direct mucosal injury to esophagus. Presents with sudden onset odynophagia and retrosternal pain with difficulty swallowing. Antibiotics (Tetracycline), Anti-inflammatories (ASA, NSAIDS), Bisphosphontes (Alendronate) and Others (Potassium Chloride, Quinidine, and Iron).
116
2 year old developmental milestones
Speak 2 word phrases, Follow 2 step commands, Walk upstairs, build tower of six cubes, help remove clothes.
117
Demeclocycline MOA and s/e
MOA: ADH antagonist used to treat SIADH (only use if fluid restriction and high salt intake fail to correct hyponatremia). Side effects: nephrogenic DI, photosensitivity, abnormalities of bone and teeth.
118
Damage to lateral spinothalamic tracts presentation.
Contralateral loss of pain and temperature sensation beginning two levels below level of lesion.
119
Brown Sequard
Hemisection of spinal cord, usually due to penetrating spinal trauma. Findings: IPSILATERAL UMN signs, ipsilateral loss of tactile, vibration, proprioception. CONTRALATERAL loss of pain and temp 2 levels BELOW lesion. LMN signs (flaccid paralysis at level of lesion). If lesion occurs above T1 => Horners syndrome.
120
Bare metal stens vs Drug eluding stents
Besides the regular regimen of ASA, BB, ACEi, Statins. Bare metal stents should get 1 month of Clopidogrel (ADP antagonist). Drug eluding stents should get 12 months of Clopidogrel.
121
Hartnup's disease
Deficiency of neutral amino acid (tryptophan) transporter. Leads to Pellagra (Niacin deficiency - 4Ds)
122
Presentation of HUS in peds
Child recently recovered from diarrheal illness (E. coli O157:H7, Shigella, Salmonella, Yersinia, and Campylobacter), now presents with purpura/multiple petichiae on exam, ACUTE RENAL FAILURE, MICROANGIOPATHIC HEMOLYTIC ANEMIA, FEVER, THROMBOCYTOPENIA. Peripheral smear with schistocytes and giant platelets 2/2 to microangiopathic hemolytic anemia and thrombocytopenia. Intravascular hemolysis -> elevated LDH/ indirect bilirubin / reticulocyte count.
123
Findings suggestive of rhabdomyolysis and treatment.
Elevated CPK and Potassium, from cell rupture and release. May lead to Acute Tubular Necrosis (ATN). On urinalysis, a + dipstick test for blood with no RBC on microscopy, suggestive of myoglobin in urine. Tx: aggressive hydration, mannitol and urine alkanization may also help.
124
Mycobacterium avium complex (MAC) HIV pos ppx vs treatment.
ppx: Azithromycin (CD4 < 50), treatment: Clarithromycin
125
Hyper-IgM syndrome
High IgM with deficiency of IgG, IgA. Presents with recurrent sinopulmonary infections and Pneumocystis carinii pneumonia. The unique susceptibility to opportunistic infection (PCP) and neutropenia with high IgM distinguish HI from XLA (Bruton's)
126
Bacillary angiomatois
Seen in immunocompromised pts. Due to Bartonella hensalae(cat scratch - Gram neg bacillus) or Bartonella quintana (tick bite). Presents with fever, weight loss, malaise, abd pain and characteristic cutaneous and visceral angioma like blood vessel growths. Dx: biopsy, but they love bleed out. Tx: ERYTHROMYCIN OR TETRACYCLINE.
127
Ethylene glycol poisoning
UA will show calcium oxalte crystal (rectangular, enveloped shaped crystals). Ethylene glycol will cause both an anion gap and osmolar gap metabolic acidosis.
128
Main 3 treatment options of Graves and s/e
Antithyroid:PTU vaculitis and MMIteratogenic. Both can cause agranulocytosis. RAI: worsening ophthalmopathy. Surgery: Laryngeal nerve damage, hypocalcemia 2/2 parathyroid damage.
129
Nerve commonly injured with anterior dislocations of shoulder
Axillary nerve, it can cause paralysis of deltoid and teres minor muscle as well as loss of sensation over lateral upper arm.
130
Phenytoin toxicity
Presents with HORIZONTAL nystagmus, cerebellar ataxia, and confusion.
131
Lithium toxicity
Presents with tremor, hyperreflexia, ataxia and seizures.
132
Alport's syndrome presentation and cause.
A familial disorder, presents in boys 5-20 y/o with recurrent gross sensorineural deafness, cataracts, hematuria, and proteinuria (hereditary nephritis).
133
MI with pulmonary edema, what to give? what to avoid?
Give Furosemide, help decrease cardiac preload and thereby decreasing pulmonary capillary pressure. Avoid beta-blockers, can worsen the pulm edema.
134
Translumination test for testicles.
Translumination POSITIVE in hydroceles, fluid in the tunica vaginalis. Translumination NEGATIVE in varicoceles, due to incompetence of testicular valve veins (often affects left testicle). Leads to dilatation of pampiniform plexus.
135
Treatment of pasteurella multocida (dog/cat bites).
Deep punctures from cat bites. Treat with Augmentin (amoxicillin/clavulanate) or Ampicillin.
136
Central retinal artery occlusion (CRAO)
Painless loss of monocular vision (2/2 embolism). Commonly associated with amaurosis fugax. Fundoscopy shows retinal whitening (diffuse ischemia). Look for hx of carotid bruit, site of clot genesis. Tx: Ocular massage and high flow oxygen.
137
Pt with hemolytic anemia and thrombocytopenia.
TTP, check peripheral smear for schistocytes.
138
Necrosis after warfarin, what happened?
Protein C deficiency in the first days creates hypercoagulable state, increased risk of thrombus.
139
Osteonecrosis (aseptic necrosis/avascular necrosis) 2/2 chronic corticosteroid use. Mechanism?
Disruption of bone vasculature.
140
Presentation of Zollinger-Ellison syndrome
Multiple duodenal ulcer and jejunal ulcers are pathognomic. Steatorrhea develops as increased stomach acid inactivates pancreatic enzymes.
141
Primary biliary cirrhosis
AUTOIMMUNE reaction (Anti-mitochondrial antibodies). MIDDLE AGED WOMEN (new pruritis), increased billirubin, jaundice.
142
Infective endocarditis following dental procedure, bugs?
Viridans group streptococci: S. mutants, S. sanguis, S. salivariu.
143
Prebyscusis
High frequency bilateral sensorineural hearing loss. Presents in old age, pt have difficulty hearing in noisy/crowded environments.
144
Hepatic encephalopathy management
Potassium repletion, Intravascular volume repletion (albumin), Lactulose (ammonia trapping), Rifaximin (nonabsorbable antibiotic if lactulose unresponsive w/i 48 hrs)
145
Presentation of lesion Middle Cerebral Artery Occlusion
CONTRALATERAL somatosensory and MOTOR WEAKNESS (face, arm, and leg), Conjugate eye deviation to infarct, Aphasia. Hemineglect (right parietal lobe)
146
Presentation of Anterior Cerebral Artery Occlusion
CONTRALATERAL somatosensory and motor weakness, mostly lower extremity. Dyspraxia (no coordinated mvts), urinary incontinency
147
Scarlet fever presentation, cause, and treatment.
Presents with prodome of fever, headache, vomiting, and sore throat. 12-48 hours later, fine pink BLANCHING papules appear on neck and trunk (feel like sandpaper). Typically due to GAS tonsilitis or pharyngitis. Tx: Penicillin G. (?)
148
Otosclerosis.
Bony overgrowth of stapes footplate, results in conductive hearing loss.
149
Cholesteatoma.
New onset of hearing loss or chronic ear drainage despite abx. On otoscopy granulation tissue and skin debris may be present.
150
Leukocoria (white reflex in eye)
Retinoblastoma.
151
Ethylene gylcol poisoning treatment
FOMEPIZOLE or Ethanol to inhibit alcohol dehydrogenase. NaHCO3 to correct acidosis or hemodialysis.
152
Myasthenia gravis acute management
Pyridostigmine (oral anticholinesterase)
153
Ebstein's anomaly
ASD, atrialized RV (from lower insertion of TV), malformed TV
154
Schizophrenia criteria
2 of the following Positive symptoms: Delusion, Hallucinations, Disorganized speech, Disorganized behavior. Negative symptoms (flat affect, decreased emotional reactivity, poverty of speech, lack of purpose, and anhedonia)
155
Torus palantinus
Congenital, benign bony growth. Presents as fleshy immobile mass on the midline hard palate, present for years. No tx unless interferes with speech or eating.
156
Furunculosis
Just good old boils. Due to S. Aureus (coagulase +). Present as inflammed boils (carbuncles).
157
Inheritance pattern muscular dystrophies + key features
Duchenne: x-linked recessive deletion of dystrophin gene on Xp21. Onset 3-5, Gower maneuver, calf pseudohypertrophy. Becker: x-linked recessive deletion of dystrophin gene on Xp21. Onset age 5-15. Milder weakness compared to Duchenne. Myotonic: AD, trinucleotide expansion on 19q. Onset age 12-30. Facial weakness, weak/delayed hand grip, dysphagia, cataracts, and testicular atrophy.
158
Charcot joint
Bone and joint destruction secondary to a neuropathy and loss of sensation.
159
Criteria for Malignant hypertension
Presence of sever HTN (> 180/120 mm Hg) associated with RETINAL HEMORRHAGES, EXUDATES, AND/OR PAPILLEDEMA.
160
Relapse-remitting MS treatment
Acute episodes with not significant disease progression between episode. Tx: Interferon-beta.
161
Patellofemoral compression test
Pain elicited by extending knee while compressing the patella (also reproducing pain with squatting). Highly suggestive of patellofemoral syndrome .
162
SSSS toxin target, presentation, illness script.
Toxin targets desmoglein 1 (keratinocyte adhesion thus + Nikolsky). Presents with prodrome of fever, irritability, and skin tenderness. Erythema start on face, spread with 48 hours.
163
Acute Rheumatic Fever
Child with pericarditis, chorea (continuous irregular, and rapid irregular jerks), subcutaneous nodules, elevated ESR and hx of untreated sore throat and fever. Due to GAS - streptococcus pyogenes pharyngitis.
164
Trousseau's syndrome presentation and disease association.
A hypercoagulability disorder presenting with recurrent and migratory superficial thrombophlebitis at unusual sites. Associated with occult visceral malignancy, most commonly pancreatic cancer.
165
Courvoisier's sign
Nontender palpable gallbladder. hallmark of pancreatic cancer.
166
Ophthalmologic problems HIV pts
VZV and HSV: PAINFUL severe, acute retinal necrosis associated with pain, keratitis, uveitis, and peripheral pale lesions and central retinal necrosis on funduscopic exam. CMV retinitis: PAINLESS, associated with keratitis or conjunctivitis. On funduscopic exam - hemorrhages and fluffy or granular lesions around the retinal vessels.
167
Presentation of cerebellar hemorrhage.
Evolves over a few hours, typically have acute onset of occipital headache, repeated vomiting, and gait ataxia. Large hemorrhage may have CN VI palsy with conjugate deviation and blepharospasm (eye lid twitch)
168
Renal failure unresponsive to fluid resuscitation in alcoholic.
Hepatorenal syndrome, only tx is liver transplant.
169
Neuroleptic Malignant Syndrome presentation and treatment.
Present 2 weeks after initiation of dopaminergic antagonist (eg typical antipsychotics - Haloperidol, Fluphenazine, Chlorpromazine). Presents with FEVER, MUSCLE RIGIDITY, AUTONOMIC INSTABILITY, AND AMS. Elevated CK is common. Treat with Dantrolene or Bromocriptine.
170
HACEK
hemophilus, actinobacillus, cardiobacterium, eikenella, kingella
171
Lemierre's syndrome
A complication of pharyngitis with jugular thrombophlebitis and septic embolus. Due to Fusobacterium (oral anaerobe).
172
Treatment of Coccidioidomycosis, Histo, and balstomycosis
Itraconazole. Severe cases, give IV Amphotericin B.
173
Malaria treatment
Chloroquine, unless in P. falciparum resitant areas where you use mefolquine. (??)
174
Centor Criteria
fever greater than 38
tender anterior cervical adenopathy
lack of cough
pharyngotonsillar exudates
3 out of 4 highly suggestive of streptococcal pharyngitis. Give PCN x 10 days. (alternatives Cephalosporins, Amoxicillin, Azythromycin). 1 out of 4 highly unlikely, 2
175
Still's disease
Spiking/recurrent high fevers, salmon-colored maculopapular rash of trunk and extremities, poly-arthritis and arthralgias. JRA subtype.
176
Presentation of occulomotor nerve injury
Ptosis and the eye looks down and out, due to unopposed actions of lateral rectus and superior oblique (CN IV).
177
Occular findings characterisitic of MS
INO, due to demyelination of medial longitudinal fasciculus.
178
Causes and imaging of choice for non-traumatic avascular (aseptic) necrosis of hip.
Chronic corticosteroid therapy, alcoholism, and hemoglobinopathies (eg SCA). Imaging study MRI.
179
Hepatitis E transmission and risk for fulminant hepatitis.
Transmission of HEV due to fecally contaminated water, RARE person to person transmission. Commonly found in India, Asia, Africa, and Central America. Abrupt s/s abd pain, hepatomegaly, n/v/anorexia, and jaundice. Beware of pregos, high risk of HEV infection -> fulminant hepatitis (specially in 3rd trimester)
180
Developmental dysplasia of hip presentation and screening studies.
Palapable clunk with Ortolani or Barlow maneuvers with palpable clunk (send to Ortho). A soft click, leg-length discrepancy, or asymmetrical inguinal folds suggestive of hip laxity. Usually resolves by 2 weeks. If infant between 2w - 6m, do U/S of hip. >6m get an xray (femoral head and acetabulum are not ossified until 6 months)
181
Ortolani maneuver and Barlow maneuver
Ortolani maneuver: abduction (away from center) with anterior lifting of hip (pulling out). Barlow maneuver: adduction (towards center) with posterior pressure of the hip (pushing in).
182
Treatment of developmental dysplasia of hip
< 6 months - try a Pavlik harness. > 6 months - reduction under anesthesia.
183
Treatment for tourette disorder.
Antipsychotics: Preferable to use 2nd generation antipsychotics: Risperidone
184
First generation antipsychotics
Pimozide, Haloperidol, Fluphenazine
185
Atypical antipsychotics
Risperidone, Olanzapine, Aripiprazole, Paliperidone, Quetiapine, Ziprasidone
186
Most common cause of isolated proteinuria in peds, work up?
Transient proteinuria, get follow up urine dipstick test x 2, to r/o persistent proteinuria indicative of underlying renal disease.
187
Pulmonary Nocardiosis: presentation, gram stain, and treatment.
Pts with deficient cell-mediated immunity (AIDS, lymphoma, or transplant) are at increased risk of pulmonary or disseminated disease. Subacute pneumonia, often leads to empyema. Gram stain: CROOKED, BRANCHING, BEADED, GRAM POSITIVE AND PARTIALLY ACID FAST FILAMENTS. Tx: TMP-SMX or Minocycline oral.
188
Cervical mucus in Follicular, Ovulatory, and Luteal Phase.
Follicular phase - Thick, scant and acidic (no sperm can survive). Ovulatory phase - clear, profuse and thin. Stretches up to 6 cm and exhibits ferning on microscope. Luteal phase - Progressively thicker (no sperm can swim through it)
189
Pediatric brain tumors
Benign astrocytomas (most common infra/supratentorial). Medulloblastoma (most common in posterior fossa, involve vermis). Pinealoma (dosal aspect of midbrain, paralysis of vertical gaze and retraction of the eye lid.
190
Pancoast tumors presentation
Commonly present with shoulder pain and horner's syndrome. Can also have weakness, atrophy of hand muscles, pain/paresthesias of arms, and enlarged supraclavicular LN. Get a CXR.
191
Horner's syndrome
Ptosis, miosis, and anhidrosis
192
Most common complication of sickle cell trait and electrophoresis pattern
Sickle cell trait - painless hematuria, due to sickling in renal medulla. HgbA - 60% HgbS - 40% HgbF - 2%
193
Test to assess infertility due to age
Early follicular phase FSH levels, a clomiphene challenge, or Inhibin B levels.
194
Hepatic hydrothorax
Results in right sided pleural effusion. Treatment is therapeutic thoracentesis, salt restriction, and diuretics. Consider TIPS placement with refractory hepatic hydrothorax.
195
Femoral nerve: Motor function and sensory areas
Motor: leg flexion at hip and leg extension at knee.
Sensory: Anterior thigh and medial leg via saphenous branch.
196
Tibial nerve: Motor function and sensory areas
Motor: Flexion of knee, plantar flexion of foot
Sensation: Leg (except medial side - femoral/saphenous) and plantar foot.
197
Obturator nerve: Motor function and sensory areas
Motor: Adduction (toward center) of thigh.
Sensation: medial thigh (small area)
198
Deep peroneal (tibial) nerve: Motor function and sensory areas
Motor: Foot dorsiflexion and toe extension
Sensory: Between first and second toe
Injury causes foot drop.
199
MOA of NaHCO3 use for TCA overdose.
Given with TCA overdose leading to QRS > 0.10 seconds. NaHCO3 reverses the prolongation of the QRS by increasing extracellular sodium concentration, this competes for the Na channels and decreases the cardio depressant action of TCA.
200
Basal cell carcinoma
Slow growing papule with pearly, rolled borders, and overlying telangiectasia.
201
Cause of death in pts with Acromegaly
Cardiovascular complications eg congestive heart failure.
202
Features of neonatal clavicular fracture
Crepitus over clavicle, asymmetric moro reflex.
203
When is a DPL indicated
Hemodynamically unstable pt with BLUNT abdominal trauma and inconclusive FAST.
204
Explain coronary steal phenomenon
Dipyridamole and adenosine cause vasodilation. In CAD, the vessels distal to obstruction are maximally dilated. The use of either will cause normal vessels to dilate and "steal" blood flow from CAD compromised blood vessels.
205
Bronchiectasis presentation
Presents with cough, mucopurulent sputum (yellow), and hemoptysis that responds to antibiotics. Need a CT for definitive diagnosis, look for bronchial dilation, lack of airway tapering, and bronchial wall thickening.
206
Trihexyphenidyl - indication, MOA
Used in early Parkinson, generally in younger patients where tremor is the primary symptom.. MOA: Anticholinergic.
207
De Quervain tensynovitis
Classically affects young mothers as they hold infants with thumb outstretched (abducted/extended). Condition is due to inflammation of abductor polis longus and extensor pollicis brevis tendons as they pass through a fibrous sheath at the radial styloid process. Pain can be elicited by direct palpation on the radial side at base of wrist base.
208
Cause of Hemolytic Uremic Syndrome
Due to toxin released by E. Coli. Toxin enters circulation and injures endothelial cells of the kidney.
209
Primidone indication and s/e
Primidone is an anticonvulsant used to treat essential tremors (BB are first line). It can precipitate acute intermittent porphyria, which manifests as abdominal pain, neurologic and psychiatric abnormalities. Diagnose by checking urine porphobilinogen.
210
Two manifestations of Chagas disease.
Megacolon 2/2 destruction of nerves controlling the GI smooth muscles. Can also cause dilated cardiomyopathy, mechanism is not known.
211
Pseudotumor cerebri presentation and complication.
A bening intracranial hypertension in YOUNG, OBESE, WOMEN with headaches suggestive of brain tumors but normal imaging. Neurological signs are usually absent but will have papilledema on fundoscopic exam. Most common complication is blindness, treat with weight reduction, or acetazolamide.
212
Carpal tunnel syndrome, various etiologies: pregnancy, amyloidosis, acromegaly, RA, and hypothyroidism.
Pregnancy: accumulation of fluid, specially in third trimester. Amyloidosis: (primary systemic amyloidosis), in setting of ESRD or hemodyalysis with beta 2 microglobulin deposition. Acromegaly: bilateral due to soft tissue enlargement, synovial edema, and tendon hyperplasia. RA: inflammation of tendons. Hypothyroidism: Deposition of mucopolysaccharide protein complexes.
213
Aphasia types as associated neurological features
Broca's sparse nonflent speech, normal comprehession. Will also show RIGHT HEMIPARESIS. Wernicke's fluent speech without meaning, poor comprehension. Will also have RIGHT SUPERIOR VISUAL FIELD DEFECT.
214
Cyclosporine MOA and s/e
Calcineurin inhibitors. Major side effects include: nephrotoxic, hyperkalemia, hypertension, gum hypertrophy, hirsutism, and tremor.
215
Gilbert's syndrome
A familial disorder of bilirubin glucorinidation, due to reduced production of UDP glucuronyl transferase. Leads to a predominantly unconjugated hyperbilirubinemia. Usually asymptomatic, but fasting, hemolysis, or fevers can trigger hyperbilirubinemia.
216
Crigler-Najjar Type 1
AR, due to UDP glucuronosyltransferase deficiency. Leads to indirect bilirubin levels are typically 20-25 mg/dL, but can go as high as 50 mg/dL. Presents as severe jaundice and kernicterus. Unresponsive to phenobarbital, but can use phototherapy and plasmapherisis short term, liver tx only definitive cure.
217
Crigler-Najjar Type 2
AR, indirect bilirubin levels are < 20 mg/dL. Survive into adulthood with no kernicterus or neurological impairment. Responsive to phenobarbital.
218
Riley-Day syndrome (Familial dysautonomia)
AR, predominantly seen in children of Ashkenazi Jews. Presents as gross dysfunction of autonomic NS with severe orthostatic hypotension.
219
Shy-Drager syndome
Parkinson pt with onset of orthostatic hypotension or any autonomic dysregulation symptom. Degenerative disease with multiple system atrophy. Presents with parkinsonism, autonomic dysfunction, and wide spread neurological signs (cerebellar, pyramidal, LMN).
220
Benefits of breast feeding mother and child.
Mother: Reduced risk of breast and ovarian cancer. No risk change for endometrial cancer. Infant: Improved GI function, prevents otitis media, gastroenteritis, respiratory illness, UTI, decreased risk of necrotizing enterocolitis.
221
Imaging findings in appendicitis with U/S, indications?
Prefer imaging technique for appendicitis during pregnancy. U/S with graded compression technique: findings of noncompression and dilation of the appendix are diagnostic.
222
Clinical manifestations of Vitamin D deficiency rickets?
Ping pong ball skull, delayed fontanel closure, genu varum, enlarged skull with frontal bossing, enlarged costochondral joints (rachitic rosary), and enlarged long bone joints (wrist widening)
223
Constitutional growth delay
Presents with delayed growth spurt, delayed puberty, and delayed bone age. Kid drops of the growth curve between 6m to 3 years, follows along the 5th-10th percentile, but will eventually have growth spurt and reach mid parental height.
224
Mixed cryoglobulinemia
Presents with IC deposition in small blood vessels, leads to endothelial injury, inflammation and end organ damage. These present as palpable purpura, proteinuria, hematuria, arthragias, and hepatosplenomegaly. IC are composed of IgM ab (similar to RF) that form complexes with IgG anti HCV antibodies, HCV RNA, and complement (this is why they will have a hypocomplementemia).
225
Cause of TTP
Decreased ADAMTS13 activity. Pt develops fever, microangiopathic hemolytic anemia, thrombocytopenia, and purpura. Renal failure and neuro findings are also possible.
226
Waldenstrom's macroglobulinemia cause.
A rare, chronic plasma cell neoplasm with terminally differentiated B cells that produce high numbers of IgM. They invade BM, LN, and spleen. Produce excessive amounts of IgM, causing a hyperviscosity thus predisposing to strokes.
227
Waldenstrom's macroglobulinemia sign and symptoms
Increased size of spleen, liver, and LN. Tired from anemia (BM invasion), easy bruising, night sweats, headaches, visual problems, and pain and numbness of extremities 2/2 demyelinating sensorimotor neuropathy.
228
C. diff colitis mild-moderate vs severe
Mild-moderate: WBC < 15K, Cr < 1.5x baseline. Treat with ORAL Metronidazole. Severe: WBC >15K, Cr > 1.5x baseline. Treat with ORAL Vancomycin.
229
Granulomatosis with polyangiitis (Wegener's) clinical triad
Systemic vasculitis, upper and lower airway granulomatous inflammation, and glomerulonephritis (RBC cast, proteinuria, and sterile pyuria). Labs will also show positive C-ANCA and elevated CRP.
230
Manifestation of cutaneous blastomycosis
Well-circumscribed verrucous nodules and plaques that progress to microabscesses.
231
Mobile cavitary mass in lung
Consider Aspergilloma, presents as a crescent radiolucency next to a rounded mass. Cavitary lesion is due to destruction of underlying lung parenchyma, debris and hyphae form fungus ball that is mobile. Pt may present with intermittent hemoptysis.
232
Management of nonbleeding esophageal varices vs bleeding esophageal varices.
Start with BB, reduces chances of progression to large varices and variceal bleeding. If BB are contraindicated to endoscopic variceal ligation. Active bleeding use Octreotide, causes splanchnic vasoconstriction and reduced portal blood flow. Can also do endoscopic sclerotherapy.
233
Causes of Idiopathic Intracranial Hypertension.
High opening pressure vision changes, papilladema, and/or CN palsies. Common in young obese women. Due to growth hormones, tetracyclines, excessive vita A (Isoretinoin).
234
MRI findings of PML
Multiple demyelinating, non-enhancing lesions, with no mass effect. Affects primarily cortical white matter.
235
Causes of increased peak pressures on I/O vent pt.
Normal plateau (increase comes from resistive pressure increase); bronchospasm, mucus plugs, biting ET tube. Increased plateau (increase comes from elastic pressure increase or decreased lung compliance): Pneumothorax, pulmonary edema, pneumonia, atelectasis, right mainstem intubation.
236
Why is aldosterone unaffected in central (tertiary) adrenal insufficiency but pt is still hyponatremic?
The principal regulators of aldosterone is angiotensin II and potassium. In central adrenal insuffiency the hyponatremia is due excessive antidiuretic hormone production form the posterior pituitary. Cortisol normally suppresses the secretion of antidiuretic hormone.
237
Choroidal rupture
BLUNT EYE TRAUMA leading to blurred vision with central scotoma, retinal edema, crescent-shaped streak concentric to the optic nerve, subretinal hemorrhage
238
Retinal detachment presentation
Sudden onset of photopsia (flashes of light) and floater, classic description of "curtain coming down over my eyes."
239
Helmet cells
Fragments of RBC, suggest traumatic hemolytic conditions, eg DIC, HUS, and TTP
240
Basophillic stippling
Ribosomal precipitates, look like blue granules dispersed throughout cytoplam. Seen in Sideroblastic anemia, Thalassemias, and lead or heavy metal poisoning.
241
Carcinoid syndrome
Bronchospasm, Flushing, Diarrhea, and right ventricular disease. High levels of 5-HIAA in urine. Tx: Octreotide
242
Glucagonoma presentation and dx study.
Suspect in pts with mild DM or hyperglycemia with NECROTIC MIGRATORY ERYTHEMA, diarrhea, anemia, and weight loss. Glucagon levels > 500 pg/mL are diagnostic.
243
Mechanism leading to right side heart failure in COPD.
Chronic hypoxemia causes constriction of pulmonary arterial system and in time leads to pulmonary hypertension. This leads to RVH and eventual right ventricular failure.
244
Gastroschisis vs Omphalocele
Gastroschisis: bowel protudes through defect on right side of umbilical ring, bowel is NOT covered by a protective membrane, bowel is angry (naked), not associated with other abnormalities outside of GI tract. Omphalocele: intraabdominal contents protude through umbilical ring, bowel is covered by peritoneal membrane, can be associated with other congenital abnormalities
245
VACTERL syndrome
Vertebrae, Anal atresia, CV tree, Tracheo-Esophageal fistula, Renal and Radial abnormalities, Limb defects
246
Anterior cord syndrome
Associated with burst fracture of vertebra, presents with total loss of motor function below level of lesion, loss of pain/temp on both sides of lesion, and intact propiception.
247
Central cord syndrome
Commonly seen in elderly 2/2 forced hyperextension type injury of the neck. Presents with burning pain and upper extremity paralysis, spares the lower extremities.
248
Malaria ppx
If traveling to chloroquine resistant areas such as Sub-saharan africa, Amazon, Souther Asia use Mefloquien, Atovaquone-Proguanil, and Doxycycline.
249
Pulsus paradoxus
> 10 mm Hg fall in systolic BP during inspiration. Associated with cardiac tamponade, but can also present in severe asthma and COPD.
250
Adjustment disorder
Development of emotional or behavioral symptoms in response to identifiable stressor w/i 3 months.
251
Generalized anxiety diosder
Excessive worry over MANY aspects of life. PT has hard time keeping worries out mind, leads to significant impairment in daily function. Unlike OCD, pts with GAD do not engage in repetitive compulsions to decrease anxiety.
252
DDX of otalgia
Acute otitis media: middle ear effusion + acute eardrum inflammation. Otitis media w/ effusion: effusion w/o inflammation. Bullous myringitis: serous liquid filled blisters on tympanic membrane, due to virus. Cerumen impaction: wax in ear canal.
253
Invasive aspergillosis
Immunocompromised patients, may present with fever, cough, dyspnea, or hemptysis. On CXR, a cavitary lesion, CT scan shows pulmonary nodules with a halo sign or lesions with air crescent.
254
Cephalohematoma vs caput succedaneum
Cephalohematoma is a subperiosteal hemorrhage, limited to surface of one cranial bone, DOES NOT CROSS MIDLINE OR SUTURES. A slow process, so may take hours to become visible. Caput succedaneum is a diffuse ecchymotic swelling of the scalp. Involves portion of the head presenting during vertex delivery, EXTENDS ACROSS MIDLINE AND SUTURES.
255
What does leukocyte esterase and nitrites signify on UA?
Leukocyte esterase indicates pyuria. Nitrates indicate presence of E. Coli which converts urinary nitrates into nitrites.
256
Serum sickness
Type III HS. Complexes deposited in membranes, fix complement, lead to tissue damage. Typically caused by drugs now. Takes 5-10 days. Fever, Urticaria, Arthralgias, proteinuria, lymphadenopathy.
257
TB ppx HIV pos
Pos PPD with neg CXR, give them INH/Pyridoxine (VitB6) 9 months. Vit B6 will not prevent INH induced hepatitis, LFT monitoring is needed.
258
Pheylketonuria presentation and screening test.
Due to phenylalanine hydroxylase deficiency, normally the enzyme break phenylalanine into tyrosine. Untreated leads to mental retardation. UA phenylalanine levels of qualitative Guthrie test are two screening test.
259
Central retinal artery vs vein occlusion
Both present with painless vision loss. CRAO: fundoscopic exam shows pallor of optic disc, cherry red fovea, and boxcar segmentation of blood in retinal arteries and veins. CRVO: fundoscopic exam shows disk swelling, venous dilation, tortuosity, retinal hemorrhages, and cotton wool spots.
260
Vitreous hemorrhage
sudden loss of vision and floaters in visual fields. Diabetic retinopathy is the most common cause. Important clue: hard to visualize fundus with obscure detials
261
Typical location of MS plaques on MRI
Periventricular regions, corpus callosum, deep white matter, and basal ganglia.
262
Cluster headache
Intense one sided retroorbital pain that starts suddenly, peaks, and last about 2 hours. Accompanied by ipsilateral Horner's syndrome, eye redness, tearing, and stuffed or runny nose. Ppx: Verapamil, lithium, ergotamine. Tx: O2 and subcutaneous sumatriptan.
263
Herceptin side effects
infusion-related hypotension, flushing, brochoconstriction, skin rashes, CARDIOTOXIC. Pts need echo before they start herceptin, < 55% EF have higher risk of cardiotoxicity.
264
Duodenal hematomas
More common in ped after BAT. Most resolve within 2 weeks, treat with NG tube and TPN. Will present with n/v and epigastric pain.
265
MOA statin induced myopathy
Decrease coenzyme Q10 synthesis, which is involved in muscle cell energy production,
266
Infective endocarditis in IV drug user
Staph, treat with Vancomycin IV to cover MSSA/MRSA.
267
Distortion of straight lines
Macular degeneration, look for yellow-white accumulation of extracellular material (Drusen deposits) in the macula.
268
Presentation and treatment of Right Ventricular Infarct.
Presents with clear lung fields, hypotension, JVD in settning of inferior wall MI (leads II, aVF, III). Avoid nitrates and diuretics, both decrease preload and exacerbate symptoms. Treat with fluid resuscitation if needed.
269
Marfan presentation + mental retardation + thromboembolic event + downward dislocation of lens.
think HOMOCYSTINURIA. Autosomal recessive disease due to cysthathionine synthase deficiency. Tx high dose Vit B6
270
Lens dislocation in Marfan's vs Homocystinuria
Marfan's the lens dislocates upwards. Homocystinuria the lends dislocates downwards.
271
Temporomandibular joint dysfunction
Typicall present with referred pain to ear that is worse when chewing. Pts usually has hx of nocturnal teeth grinding.
272
Management of PEA
CPR and vasopressor therapy (eg epinephrine) to achieve adequate cerebral and coronary perfusion. DO NOT SHOCK.
273
Psittacosis
Disease transmitted to humans by birds. Pt presents with fever, dry cough, and headache.
274
Infectious cause of constrictive pericarditis vs dilated pericarditis
TB - constrictive and Chagas - dilated
275
Treatment of nosocomial pneumonia intubated pt
Most likely due to Pseudomonas, treat with Cefepime or Piperacillin-Tazobactam. Ceftriaxone IS NOT effective against Pseudomonas.
276
Osteomyelitis in adult with hx of nail puncture.
Although Staph is the most common cause of osteomyelitis in peds and adults, pts with hx of nail puncture most likely have Pseudomonas infection.
277
Treatment Bipolar disorder manic or mixed phase.
First line is Lithium, however in pts with abnormal renal function use Valproic Acid.
278
Echinococcosis
Parasitic disease caused by tapeworm echinococcus. Associated with sheep farming or close proximity to dogs. Forms a Hydatid cyst (fluid filled) with inner germinal layer and outer acellular laminated membrane, germinal layer gives rise to numerous secondary cyst. Can also show lung involvement. Treat with Albendazole.
279
Neurocysticercosis
Caused by Tinea, look for pig exposure on question stem.
280
Bone marrow findings in acquired aplastic anemia.
BM biopsy shows profound hypocellularity with a decreased in all cell lines and fatty infiltration of the marrow. Labs will show a normocytic or macrocytic anemia with low reticulocytes.
281
Two concerns with supracondylar fractures of the humerus.
First, check distal pulse, immediate concern is for brachial artery injury. Pts can also develop compartment syndrome, presenting as severe pain, pallor, paresthesias, poikilothermia. Late findings include paralysis and pulselessness.
282
Red flags for intracranial pathology
Nocturnal headaches and morning vomiting.
283
Effect of massive PE on heart
Causes acute RV dilation and failure due to right ventricular outflow obstruction and increased pulmonary vascular resistance. The dilated RV pushes the septum towards the LV causing decrease in LV preload and CO, thus hypotension.
284
McConnell's sign
TTE: dilated RV cavity and hypokinesis of RV free wall with sparing of apex. Seen with massive PE.
285
Cancers associated with Lynch Syndrome (HNPCC).
Endometrial cancers.
286
Ehrlichiosis
Suspect in pt from endemic regions (??) with hx of tick bite, febrile illness with systemic symptoms, leukopenia, thrombocytopenia, and elevated liver trans. NO RASH. Tx: Doxycycline.
287
Preferred contraception method in lactating mothers?
Progestin only oral contraceptives, they do not affect the volume or composition of milk, there are no known side effects for baby, and no risk of DVT.
288
Key findings for Heridatary spherocytosis
Autosommal dominant inheritance, presents as hemolytic anemia, jaundice, and splenomegaly in Northern European descent pt. On labs, look for elevated MCHC, negative combs, increased osmotic fragility test (Acidified Glycerol Lysis Test). Look for low MCV if not getting supplemental folate.
289
Complications of hereditary spherocytosis
Pigmented gallstones and aplastic crisis from parvovirus B19 infection.
290
Pt with pneumonia after GI endoscopy or upper airway instrumentation, what bugs and treatment
Will present with foul smelling sputum. Most likely anaerobes, treat with Clindamycin.
291
Fribromyalgia pain locations and treatment
Point muscle tenderness in areas such as mid trapezius, lateral epicondyle, costochondral junction in chest and greater trochanter. Treatment begins with exercise, Duloxetine, TCA (amytriptaline).
292
Treatment for acute abnormal uterine bleeding moderate to severe.
High dose estrogen IV, high dose combined OCP, High dose progestin pill, Tranexamic acid (c/i to both estrogen and progesterone)
293
Weight changes in the first 2 weeks of life.
Babies can loos up to 7% of birth weight in the first 5 days of life. BW should be normal by age 10-14 days.
294
Kid with acne, goes to beach, gets a sudden onset of redness and swelling over skin over exposed areas within an hour. What medication is he/she on?
Tetracyclines (Doxycycline), due to reactive oxygen species causing direct DNA damage.
295
Tropical sprue
Pt coming back from endemic area with chronic diarrhea. Look for s/s of malabsorption (B12/folate def), glossitis, cheilosis, protuberant abdomen, and pallor.
296
Tropical sprue biopsy
Blunting of villi with infiltration of chronic inflammatory cells, such as lymphocytes, plasma cells and eosinophils.
297
List of Nephrotic syndrome
```
Minimal Change Disease
Focal Segmental Glomerulosclerosis
Membranous nephropathy
Diabetic nephropathy
Lupus Nephritis
Renal Amyloidosis
Membranoproliferative Nephropathy.
```
298
Minimal Change Disease
Seen in peds, also in adults with hematological malignancies (hogkins), or NSAID use. Tend to have infections and thrombotic events. EM shows fusion of epithelial foot process (podocytes).
299
Focal Segmental Glomerulosclerosis
Seen in African americans with uncontrolled HTN, HIV, IV drug users, and obese pts. Look for microscopic hematuria with biopsy showing sclerosis in capillary tufts. Tx: Prednisone, cytotoxic agents and ACE/ARB to decrease proteinuria.
300
Membranous nephropathy
Most common in whites, 2/2 solid tumors and IC disease. Associated with HBV, syphilis, malaria, and gold. Look for spike and dome deposits of IgG and C3 on BM.
301
Diabetic nephropathy
Can have two descriptions, diffuse hyalinization and nodular glomerulosclerosis (Kimmelstiel-Wilson lesions). Pt have long standing, poorly controlled DM, with evidence of neuropathy or retinopathy. On histology look for thickened GBM, increased mesangial matrix.
302
Lupus Nephritis
Can be both nephrotic and nephritic. Reason why every new SLE diagnosis gets a renal biopsy. On histology look for mesangial proliferation, subendothelial and /or subepithelial IC deposits.
303
Renal amyloidosis
Look for either plasma cell dyscaria or infection/inflammation. Pts usually have MM or chronic inflammatory diseases such as RA or TB. Classic apple green birefringence on congo stain, shows amyloid. Will also show nodular glomerularsclerosis.
304
Membranoproliferative nephropathy
Can be nephrotic or nephritic. Can be associated with HCV, cryoglobulinemia, SLE, and subacute bacterial endocarditis. On IF, shows tram track appearance from double layer basement membrane. All types have low C3.
305
List of Nephritic syndrome
```
Postinfectious glomerulonephritis (IC)
IgA nephropathy, aka Berger's disease (IC)
Wegner's granulomatosis (Pauci-immune)
Goodpastures syndrome (Anti GBM)
Alport's syndrome (Anti GBM)
```
306
Postinfectious glomerulosclerosis
Associated with recent (2-6 weeks) group A beta hemolytic streptococcal infection. Presents with oliguria, edema, hypertension, and TEA or COKE COLORED urine. Labs show low C3, increased ASO titers, lumpy bumpy IC.
307
IgA Nephropathy (Berger's disease)
Most common nephritic syndrome. Present after GI or URI, may also present with HSP, IC mediated small vessel vasculitis. Will have episodic or microscopic hematuria. Normal C3.
308
Wegner's granulomatosis
Granulomatous inflammation of respiratory track and kidney with necrotizing vasculitis. Presents with hematuria, respiratory symptoms, and hemoptysis from cavitary lung lesions. Presence of c-ANCA, renal biopsy shows segmental necrotizing glomerulonephritis with very few Ig deposits.
309
Goodpastures syndrome.
Rapid progression glomerulonephritis with pulmonary hemorrhage in mid 20 male. Hemptosys, with no upper tract involvement. Linear anti GBM deposits and hemosiderin filled macrophages in sputum are classic findings.
310
Alport syndrome
Hereditary, type IV collagen defect. Present in boys 5-20. Usually asymptomatic hematuria. Can be associated with sensoryneural deafness and eye disorders like cataracts. GBM splitting on EM.
311
Low risk solitary pulmonary nodule
Round opacity < 1.5 cm, 7 years prior, nodule margins are characteristically smooth. Follow up with serial CTs.
312
Drugs that cause priaprism
Trazadone, antidepressant commonly used for sleep disturbances. Prazosin, an alpha blocker used in HTN.
313
Reason for low glucose in Empyemas
These are exudative effusions with a low glucose due to high metabolic activity of leukocytes and bacteria within the pleural fluid.
314
Presentation of metastatic bone pain
Typically constant and progressive, the pain worsens with rest.
315
When and why do you discontinue metformin?
Any pt with ARF, hepatic failure, or sepsis. There is an increase risk of developing metformin induced lactic acidosis.
316
ROME diagnostic criteria for IBS
Recurrent abdominal pain/discomfort > 3 days/month for past 3 months and >2 of the following: symptoms improve with bowel movement, change in frequency of stool, change in form of stool.
317
Vitamin for any kid with Measles
Vitamin A. Reduces morbidity and mortality through immune enhancement.
318
Causes of chloride sensitive metabolic alkalosis
Presents with urinary chloride < 20 mEq/day and signs of volume depletion. Some causes include Thiazide and loop diuretics and loss of gastric secretions. Can be corrected with saline infusion to restore ECF.
319
Causes of chloride resistant metabolic alkalosis
Presents with urinary chloride level > 20 mEq/day and signs of volume expansion. Some causes include Bartter syndrome, Gitelman's syndrome, and excessive black licorice ingestion. Chloride resistant metabolic alkalosis can not be corrected with saline infusion.
320
Acute dystonic reaction
Antipsychotic EPS reaction presenting with sudden onset of sustained contraction of the neck, mouth, tongue, eye muscles. Treat with anticholinergics (Benztropine) or antihistamine (Dipehenhydramine).
321
Akathisia
Antispyschotic EPS reaction presenting with inability to sit still. Treat with Beta blockers.
322
Drug induced parkinsonism
Antipsychotic EPS reaction of gradual onset, classic PD presentation. Treat with anticholinergics or amantadine (dopamine agonist)
323
EPS risk, high and low risk antipsychotics
High risk Haloperidol, Low risk Chlorpromazine.
324
Anti HBc
IgM fraction signal acute phase disease, presents during the window period.
IgG fraction signals recovery from disease.
325
Most common symptom of vaginal cancer.
Vaginal bleeding and malodorous vaginal discharge. Usually on the upper 1/3 of vagina, posterior wall. Typically SCC.
326
Niemann Pick disease
Due to deficiency of sphingomyelinase, leads to accumulation of sphigomyeline (ceramide phosphorylcholine). Presents with cherry red spot, protruding belly, hepatomegally, lymphadenopathy, and regression of milestones.
327
Tay Sachs disease
Due to deficiency of hexosaminidase A. Presents with hyperacusis, mental retardation, seizures, cherry red macula. Unlike Niemann Pick, no hepatomegaly or lymphadenopathy.
328
Disorder suggested by gamma gap
Mulitple Myeloma, Amylodosis, Waldenstroms macroglobulinemia, and MGUS. Gap represents elevated serum protein with normal albumin.
329
Typical antipsychotic causes hypothermia
Fluphenazine, disrupts thermoregulation and shivering mechanism.
330
Warm agglutin vs cold agglutin AIHA
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Warm agglutin (IgG) more commonly due to autoimmune disease, treated with steroids, rituximab, splenectomy, or other immunosuppresants.
Cold agglutin (IgM) is due to infections or autoimmune disease and causes intravascular hemolysis. Treatment is supportive with warming pt and RBC transfusions.
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331
Spherocytosis with postive combs test
Autoimmune hemolytic anemia.
332
Only exception to scheduling vaccines by chronological age.
Must weight > 2 kg (4 lb 6 oz) before Hep B vaccine.
333
Relative risk confidence interval.
The RR must be greater than 1, indicating the risk is more present in exposed vs unexposed. Also the confidence interval can not include 1, for the confidence interval to be statistically significant.
334
Most common cause of anemia in alcoholics
Folate deficiency.
335
Low leukocyte alkaline phosphatase with leukocytosis
Classic for Chronic Myelogenous Leukemia, will also see elevated Bands. Presents as night sweats and fevers, due to increased metabolism from granulocyte turn over.
336
Diseases associated with low leukocyte alkaline phosphatase.
CML, hypophosphatemia, and Paroxysmal Nocturnal Hemoglobinuria.
337
Hypersensitivity types and examples
Type 1, IgE mediated, think atopy, uticaria, anaphylaxis.
Type 2, antibody mediated cytotoxic reaction of IgG/IgM to cell bound antigens. Think of AIHA and Rh mismatch.
Type 3, IC mediated, IgG/IgM form complex with antigen, kick of complement/inflammation cascades. Examples are serum sickness and Arthus rx.
Type 4, cell mediated delayed reaction. Allergic contact dermatitis and poison IV, PPD.
338
Drug for treatment resistant schizophrenia
Clozapine
339
Behcet's syndrome
Multisystemic inflammatory condition with recurrent oral and genital ulcers, skin lesions such as erythema nodosum, acne nodules, and papulopustar lesions. Postive pathergy test is needed for diagnosis. Treat with corticosteroids, may still progress to dementia and blindness.
340
Virus associated with Kaposi Sarcomea
HHV 8
341
Cause of post influenza pneumonia
Staph aureus.
342
Goodpasture syndrome treatment
Plasmapheresis.
343
Treatment of PSVT
Adenosine to slow down AV nodal conduction and interrupt reentry pathway. Carotid sinus massage can transiently slow down SA node and AV node activity.
344
Which thyroid nodules are benign?
Hot nodules, treat the hyperthyroidism.
345
Side effect of indinavir (protease inhibitor) therapy
Crystal induced nephropathy, due to precipitation of drug in urine and obstruction of urine flow.
346
Short term side effect of Levo/Carbidopa
Hallucinations and agitation.
347
Long term side effect of Levo/Carbidopa
Involuntary movement.
348
Mucopurulent vs purulent urethral discharge
Mucupurolent most likely due to chlamydial urethritis. Purulent most likely due to gonococcal urethritis.
349
Non caseating granulomas
Crohns disease.
350
Acquired sideroblastic anemia
Due to defective heme synthesis, most commonly due to vit B6 deficiency. Present with two groups of RBC, hypochromic and normochromic. Iron studies show a low TIBC (opposite of Iron def anemia).
351
Indications for Clozapine use
Treatment resistant schizophrenia
| Schizophrenia associated with suicidality
352
Anitbody titer indicative of alloimmunization
1:32. Woman was sensitized by previous Rh positive fetus.
353
Increased risk of alloimmunization
Placental abruption
354
Dosing schedule for Anti-D immune globulin
At 28 weeks and repeated at 72 hours. Must do Kleihauer Betke test (count number of fetal hemoglobin in mother) to dose adjust.
355
Burning smell before seizure and LOC
Partial seizure with secondary generalization. The burning tells you it was partial, the LOC shows that in generalized and crossed the midline.
356
Abortive therapy options for pt with migraine + nausea and vomiting
Antiemetics: chlorpromazine, prochlorperazine, or metoclopramide.
357
Cause of drooping of pelvis below horizontal line when standing on one foot (monopedal stance)
This is a positive Trendelenburg sign. It is due to weakness or paralysis of the gluteus medius and minimus muscles, these are innervated by the superior gluteal nerve.
358
Treatment for GAD
CBT + SSRI
359
Sturge Weber
Port wine stain, seizures, one sided neurofindings, and intra cranial calcifications resembling a tramline.
360
Tuberous sclerosis
Seizures + adenoma sebaceum.
361
Best screening test for pt with suspected adrenal insufficiency
early morning cortisol, ACTH and cosyntropin (ACTH analogue) stimulation.
362
Findings with cosyntropin test that rule out Adrenocoritcal insufficiency (Addison's disease)
An increase of > 20 ug/dL within 30-60 minutes of cosyntropin administration rule out Addison' disease
363
Test that all recently diagnosed MG pt need
CT of the chest, need to rule out coexisting Thymoma.
364
Signs suggestive of retropharyngeal abscess
Inability to extend neck and widened pervertebral spaces on lateral neck xray. Also look for fever, painful swallowing, and drooling.
365
Essenstial tremor treatment options
Propranolol or anticonvulsants such as Primidone and Topiramate.
366
Indications for cystoscopy
Gross hematuria or microhematuria with risk for bladder cancer such as cigarette smoking, occupational exposure (painters, metal workers), chronic cystitis, cyclophosphamide exposure, and pelvic radiation.
367
Varicella exposure of unvaccinated
Immunocompetent patients get Varicella vaccine.
| Immunocompromised patients get VZIG within 10 days of exposure.
368
Major cause of morbidity with SAH
With in 24 hours you worry about rebleeding.
3-10 days after initial presentation the major cause of m/m is vasospasm, most likely due to degradation of spilled blood and its metabolites. Best prevention is using Nimodipine.
369
Complications of shoulder dystocia
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Fracture clavicle
Fractured humerus
Erb-Duchenne palsy: "waiter's tip"
Klumpke palsy: "claw hand"
Perinatal asphyxia
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370
Erb Duchenne palsy
Presents with decreased moro and bicep reflex. Classic waiter's tip on PE. Grasp reflex is intact. Due to brachial plexus injury involving the 5th and 6th cervical nerves.
371
Klumpke palsy
Presents with intact moro and biceps reflex. Classic claw hand on PE, may also present with Horner's syndrome. Due to excessive traction of the 8th cervical and 1st thoracic nerve (reason for Horners).
372
Portion of spine affected by RA
Cervical spine, can cause spinal subluxation (dislocation) and spinal cord compression.
373
Smudge cells on smear
Abnormal B cells in CLL, resemble lymphocytes but are very fragile and when placed on slide the smear or smudge.
374
Advanced sleep phase syndrome vs Delayed sleep phase syndrome
Advanced sleep phase syndrome: fall at sleep really early and have morning insomnia.
Delayed sleep phase syndrome: can't fall at sleep until really late, but if allowed will have a normal sleep length.
375
Dysphagia to both liquids and solids
Motility disorder, get a Barium swallow and possible manometry.
376
Dysphagia with solids progressing to liquids
Mechanical obstruction. If any hx of neck rad/surg/cancer tx start with barium swallow, then endoscopy. Otherwise go straight to endoscopy.
377
Squatting - Increased venous return/afterload, Murmurs that get louder and softer.
Louder: AR, MR, VSD
Softer: HCM, MVP
378
Handgrip maneuver - Increased afterload/ increased blood pressure. Murmurs that get louder and softer.
Louder: AR, MR, VSD
Softer: HCM
379
Mood stabilizers
Lithium, ??
380
Description and cause of Molluscum contagiosum
Presents with multiple, dome shaped lesions with central umbilicaiton. Due to a poxvirus. In immunocompromised patients it can spread to lid margin causing conjunctivitis.
381
Defects associated with Down Syndrome
Cardiac: Complete atrioventricular defect.
GI: Duodenal atresia, Hischsprung disease
Neuro: Early Alzheimer disease
Endo: Hypothyroid, DM type 1
MSK: Atalntoaxial instability
382
Manifestations of complete atrioventricular septal defects
A combined ASD and VSD, allow for blood mixing between chambers and abnormal MV and TV allow for significant regurgitation. Excessive pulmonary blood flow results in HF by 6 weeks.
383
Asculation findings of complete atrioventricular septal defect
Loud S2 due to pulmonary HTN.
A systolic ejection murmur from left to right ASD
A holosystolic murmur from the VSD, may be soft if the defect is large.
384
Osteoid osteoma
Scleroti cortical lesion on imaging (like a hole in the bone). Pain is typically worse at night and unrelated to activity. Pain responds to NSAIDS.
385
Growing pains
Pain worst at night, responds to massage and NSAIDS
386
Cast and associated conditions
Muddy brown granular cast: ATN
RBC cast: Glomerulonephritis
WBC cast: Interstial nephritis and pyeolnephritis
Fatty cast: Nephrotic syndrome
Broad and waxy cast: Chornic renal failure.
387
Complications of small for gestational age infants
Hypoxia, Polycythemia, Hypoglycemia, Hypothermia, and Hypocalcemia.
388
Preterm infant nutrional supplementation needs
Preterm infants need Iron and Vit D supplementation until 1 year old.
389
Nutritional supplementation for all exclusively breast fed infants
Vitamin D.
390
First line antihypertensive medication in pregnancy
Methyldopa, Beta blockers (labetalol), Hydralazine, Calcium Channel Blockers (Nifedipine).
391
Antihypertensive medications contraindicated in pregnancy
ACE inhibitos, Aldosterone blockers, Direct Renin inhibitors, Furosemide, ARBs
392
Treatment for stroke in sickle cell pt
Exchange transfusion. The stroke is most likely due to sludging and occlusion of cerebral vasculature by sickling cells. Fibronolytics would not help in these cases.
393
Drop foot
L5 radiculopathy or traumatic damage to common peroneal nerve.
394
Treatment choices for diabetic neuropathy
TCA, but these can worsen urinary symptoms (due to cystopathy) and orthostatic hypotension (due to cardiovascular autonomic neuropathy). In these patients use Gabapentin.
395
Dystonia
Occurs between 4 hours to 4 days after receiving antipsychotics. Presents with muscle spasms or stiffness, tongue protrussion or twisting, opisthotonus, and oculogyric crisis. Treat with Benztropine (anticholinergic) or Diphenhydramine (antihistamine, with anticholinergic effect at high doses)
396
Tardive dyskinesias
A hyperkinetic movement disorders from medications such as dopamine receptor blockers, antipyschotics, and metoclopramide. Develops within 6 months of starting medication. Symptoms include
Oral and facial: lip smacking, chewing, tongue twisting.
Limb: foot tapping and piano playing fingers
Neck and trunk: torticollis, shoulder shrugging, rocking and swaying.
Resp: grunting noises
397
Treatment for Tardive dyskinesias
Stop offending agent, classicaly Risperidone, get a CBC and start Clozapine.
398
Trichotillomania
Recurrent hair pulling. Look out for pts who swallow hair (Tricophagia), they can develop trichobezoars presenting with abdominal pain and bowel obstruction.
399
Treatment for impetigo
Topical Muporicin or Oral Erythromycin, Dicloxacillin, and Cephalixin. Due to group A beta hemolytic streptococci or Staph aureus.
400
Phenytoin use during pregnancy, fetal abnormalities
Craniofacial anomalies, fingernail hypoplasia, growth deficiency, developmental delay, cardiac defects, and facial clefts.
401
Common Iatrogenic complication of cardiac catherization
Retroperitoneal hemorrhage from extension of local vascular hematoma in the soft tissue of the thigh.
402
Location of Thymoma
Anterior mediastinum, suspect if found in young male or female. Up to 20% of MG pts have a thymoma.
403
Location of neurogenic tumor in chest
Posterior mediastinum. MRI is the best modality to evaluate any posterior mediastinal mass.
404
Cancer associated with Pernicious anemia
Gastric cancer.
405
Treatment for acute exacerbation of MS
Corticosteroids
406
Treatment for to decrease frequency of exacerbations in pt with relapsing remitting or secondary progressive MS
Beta-interferon or Glatiramer Acetate.
407
Ulcers and cancer associated with burns
Marjolin ulcers leading to Squamous Cell Carcinoma.
408
Predisposing skin lesion leading to SCC of skin
Actinic keratosis.
409
Presenatation of Basal Cell Carcinoma
Presents in chronically sun exposed areas with pearly telangiectatic papules with central rodent ulceration and pearly rolled up borders.
410
Electrolyte abnormalities in Cushing's syndrome
Hypokalemia and hypernatremia.
411
Hypertension and hypokalemia, what to suspect?
Hyperaldosteronism, check plasma renin and aldosterone concentration.
412
Succussion splash on PE
Gastric outlet obstruction.
413
Congenital rubella (german measles) infection
Sensorineural deafness, PDA, cataracts, and glaucoma.
414
Parapneumonic effusion, indications for tube thoracostomy
Low pH (< 7.2) and low glucose (< 60 mg/dL)
415
Skin and eye findings with Sarcoidosis
Erythema nodosum and uveitis
416
Classic xray findings for sarcoidosis
Bilateral hilar adenopathy and diffuse interstitial infiltrates, can progress to fibrosis, will hear rales on auscultation.
417
PRBC transfusion thresholds, asymptomatic vs symptomatic.
Asymptomatic Hg < 7 g/dL
Symptomatic Hg < 9 g/dL
418
CT findings in Bronchiectasis
Dilated bronchi with thickened walls.
419
Testicular cancer presentation and diagnosis
Hard painless mass in testicle with suggestive ultrasound. Immediate ballectomy.
420
Presentation of early vs late congenital syphilis
Hepatosplenomegaly, cutaneous lesions on palms and soles, juandice, anemia and rhinorrhea. Imaging demostrates metaphyseal dystrophy and periostitis.
Late manifestation, about 2 years after birht, include frontal bossing, high arched palate, hutchinson teeth, interstitial keratitis, saddle nose, and perioral fissures.
421
Viral conjunctivitis presentation and treatment
Conjunctival inflammation and watery discharge in setting of URI. Common in children and caregivers in the late summer and early fall. Treat with Warm or cold compress and antihistamine decongestants.
422
Abdominal pain gets better by leaning forward
Pancreatitis.
423
Describe the Potter sequence
Urinary tract anomaly leads to anuria/oliguria in utero. The ensuing oligohydramnios causes pulmonary hypoplasia, flat facies, and limb deformities.
424
Most common urinary tract obstruction of newborns
Posterior urethral valves, presents with hydronephrosis and Potter sequence.
425
Diagnositic features of Acute Bacterial Rhinosinusitis
Persistent symptoms > 10 days without improvement. Severe symptoms such as fever > 39, purulent nasal discharge, of face pain > 3 days Or, worsening symptoms > 5 days after initially improving viral URI.
426
Treatment for acute bacterial rhinosinusitis
Amoxicillin-Clavulanic Acid.
427
Most common predisposing factor for acute bacterial rhinosinusitis
Viral URI.
428
Premature ventricular complexes
Wide QRS (>120), bizarre morphology, and compensatory pause. If asymptomatic, no treatment. Can occur in healthy individuals, more often seen in pt post MI. For symptomatic patient beta blockers are the first line therapy.
429
Increased DLCO
Interstitial lung diseases.
430
Hemolytic anemia in pt with malignant lymphoproliferative disorder.
Most likely due to warm agglutin (IgG). Treat with prednisone, if nor response jump to splenectomy.
431
Clinical features of Primary Hyperaldosteronism
Hypertension, metabolic alkalosis, hypokalemia, mild hypernatremia. No significant peripheral edema.
432
Diagnosis of Primary Hyperaldosteronism
Elevated plasma aldo, low renin. Plasma aldo/renin ration > 20.
Adrenal suppression testing after oral saline, confirmatory.
Abdominal imaging and adrenal venous sampling to distinguis between adrenal adenoma and bilateral adrenal hyperplasia.
433
Methyl alcohol poisoning
Visual changes "snowfield vision" and acute pancreatitis
434
Ethyl alcohol poisoning
Calcium oxalate crystals (enveloped shaped) with antifreeze poisoning. Look for anion gap metabolic acidosis and osmolar gap.
