Things I need to know better...day 4

Question 1

What has to be done with a hydrocele?

Answer 1

Nothing…reassurance

Question 2

How does thyroid toxicosis cause hypertension?

Answer 2

Increased cardiac contractility…increased sensitivity to catecholamines

Question 3

A kid feels like he smelled something funny, then lost consciousness…he woke up and was really sore. What happened?

Answer 3

This is a partial seizure with secondary generalization

Aura –> partial
Tonic-clonic activity –> generalization

Question 4

What should you do if you have clinically diagnosed myasthenia gravis?

Answer 4

Chest CT –> thymus issues

Question 5

Patient has had some headaches and confusion…labs show anemia, thrombocytopenia, and renal failure…smear shows many fragmented red cells. What is going on? what should be done?

Answer 5

Consider TTP-HUS

Plasmapheresis

Question 6

Patient has s/s of Raynaud’s plus has tissue damage (ulcers) …what is going on? What should be done?

Answer 6

Secondary Raynaud’s…primary does NOT cause tissue damage

Evaluate and treat underlying cause

Question 7

A patient is started on warfarin, and within days has necrotic skin lesions on breast, trunk, extremities and/or penis. What is causing this? How is ti treated?

Answer 7

Warfarin-Induced Necrosis…often secondary to protein C deficiency

Stop warfarin and give protein C

Question 8

A person from Mississippi has a likely fungal infection, what should be considered? Where is this fungus common?

Answer 8

Histoplasmosis…rarely symptomatic

Mississippi and Ohio River valleys and Central America

Question 9

A kid has headache and vomiting + on exam he has limited upward gaze, ptosis, and upper eyelid retraction. What could be going on? What else could be seen? What should be done?

Answer 9

Pinealoma

Precocious puberty

Get an MRI

Question 10

What murmurs get louder with the valsalva maneuver? What is going on physiologically? What other maneuver does the same thing?

Answer 10

HOCM and MVP

Decreased venous return while straining

Standing

Question 11

Cardio physiologically, what happens with squatting?

Answer 11

Increased venous return
Increased afterload
Increased regurgitant fraction

Question 12

What murmurs get louder with squatting?

Answer 12

AR
MR
VSD

Question 13

What murmurs get quieter with squatting?

Answer 13

HOCM

MVP

Question 14

Cardio physiologically, what happens with hand gripping?

Answer 14

Increased afterload
Increased blood pressure
Increased regurgitant fraction

Question 15

What murmurs get louder with hand gripping?

Answer 15

AR
MR
VSD

Question 16

What murmurs get quieter with hand gripping?

Answer 16

HOCM

AS

Question 17

What are some prophylactic meds that can be used for cluster headaches?

Answer 17

Verapamil
Lithium
Ergotamine

Question 18

What kind of factors cause asymmetric growth restrictions?

Answer 18

Maternal factors: vascular disease, autoimmune, substance abuse (tobacco, alcohol, cocaine)

Question 19

What kind of factors cause symmetric growth restrictions?

Answer 19

Fetal factors: chromosome abnormalities, congenital heart disease, intrauterine infection

Question 20

Are immunizations given according to chronological age or gestational age for premies?

Answer 20

Chronological age

Question 21

A 2-5yo child has s/s of a lymphoma/leukemia. What is most likely? How is it diagnosed?

Answer 21

Acute lymphoblastic leukemia (ALL)

Bone marrow biopsy

Question 22

How is Duchenne’s muscular dystrophy diagnosed?

Answer 22

Genetic testing (X-linked recessive)

Question 23

Patient has a DVT and is found to have elevated homocysteine. Besides heparin and warfarin, what else should be given to this patient?

Answer 23

Pyridoxine (B6)

Question 24

What can cause an older patient to look at a grid of straight horizontal and vertical lines, and see the vertical lines as being bent and wavy?

Answer 24

Macular degeneration

Question 25

A patient has a burn wound that has mostly healed, but one spot that just won’t. What is a concern? What other conditions are worrisome for this?

Answer 25

Squamous cell carcinoma

Osteomyelitis, radiation scars, venous ulcers

Question 26

What is the big difference between anorexia nervosa and bulimia nervosa?

Answer 26

Anorexia BMI is LESS THAN 18.5

Bulimia BMI is GREATER THAN 18.5

Question 27

Besides loss of vision, what is another possible complication of Giant Cell Arteritis?

Answer 27

Arteritis of aortic branches

Aortic aneurysm

Question 28

Which medications can trigger acute angle-closure glaucoma?

Answer 28

Decongestants
Antiemetics
Anticholinergics

Question 29

What medication can help with delayed gastric emptying?

Answer 29

Metoclopramide