U world missed 7/1

Question 1

Psychogenic non-epileptic seizures explain the findings

Answer 1

this is conversion disorder with findings inconsistent with seizures.

it is characterized by forceful eye movements, side to side head off body movements and memory recall of the event.

there is no abnormal cortical activity and video electroencephalogram monitoring is the gold standard for diagnosis.

can have a history of psychiatric disorders and/or trauma.

*shaking all over, tightly closing her eyes

Question 2

caffeine intoxication can cause what ?

Answer 2

heart palpitations, anxiety, psychomotor agitation, cardiac arrhythmia, hallucinations in rare cases.

Question 3

Generalized tonic-clonic seizures explain them

Answer 3

an abrupt loss of consciousness followed by stiffening throughout the body followed by rhythmic jerking of the extremities. - typically the eyes are open during this episode and patients fall asleep after the seizure with confusion when they wakeup

Question 4

pancreatic cancer typically presents in the head of the pancreas and can what manifestations in the biliary tree on imaging

Answer 4

intra-hepatic and extra hepatic biliary duct dilation

if the tumor also compresses the pancreatic duct it can form a double duct sign

**symptoms painless jaundice, nontender enlarged gallbladder, weight loss

Question 5

what is functional hypothalamic amenhorrhea

Answer 5

this is when stress, illness, strenuous weight loss, anorexia and other causes cause secondary amenorrhea secondary to decreased GnRH release from the hypothalamus.

this decreases LH and FSH release from the pituitary and subsequent decrease in estrogen (the low estrogen will not allow withdrawal bleeding after medroxyprogesterone is initiated)

Question 6

outcomes of functional hypothalamic amenorrhea

Answer 6

amenorrhea, low estrogen state, and bone loss (decreased bone mineral density)

Question 7

In alcoholic associated liver disease early liver cirrhosis can be reversible, the steatosis and steatohepatitis (inflammation) can be reversed if you decreased portal pressure and inflammation of the liver.

what can a patient do to decrease both portal pressures and inflammation?

what can patients take to decrease portal pressures?

Answer 7

complete alcohol cessation will decrease portal pressures and inflammation

b-blockers (nonselective) can decrease portal pressures (varices) and Diuretics

Question 8

what medications are avoided in cirrhosis

Answer 8

ACE inhibitors because they can cause hypotension (they will decrease the RAS system which typically counteracts the splanchnic vasodilation that occurs in cirrhosis)

Question 9

causes of meningitis in children <1 from most common to least

Answer 9

group B strep
ECOLI
Listeria
Herpes

Question 10

most common causes of neonatal sepsis in child > 1 month old

Answer 10

Strep pneumoniae

nsisseria meningiditis

Question 11

congenital toxoplasmosis signs

Answer 11

chorioretinitis
hydrocephalus
jaundice
hepatosplenomegaly

Question 12

first line treatment of endometriosis

Answer 12

OCPs and NSAIDS

Question 13

Thoracic aortic aneurysm repair can cause spinal cord ischemia, especially of the anterior cord. Anterior cord syndrome typically presents with?

Answer 13

With distal, bilateral flaccid paralysis; loss of pain/temperature and crude touch sensation; and urinary retention.

vibratory/light touch is preserved

Question 14

Pre-eclampsia prophylaxis in high risk patients are typically started on what medication

Answer 14

low dose aspirin around 12-28 weeks gestation (continued until delivery)

Question 15

Galactosemia is what?

Answer 15

an autosomal recessive deficiency in GALT which metabolizes galactose to glucose. This deficiency presents early in life and causes galactose to accumulate in the liver and eyes.

Presents the 1st week of life with vomiting, jaundice, hepatomegaly, cataracts and increased bilirubin, and hemolytic anemia (galt deficiency in RBC, causes increased galactose in RBC and promotes RBC death)

Question 16

babies with galactosemia are at increased risk of what infection

Answer 16

Ecoli sepsis

Question 17

galactose is found in

Answer 17

breast milk, cows milk based formula

Question 18

Wiskott Aldrich syndrome

Answer 18

immunodeficiency disorder caused by loss of function in the WAS gene that leads to recurrent infections, eczema and thrombocytopenia (low platelets)

Question 19

First line treatment of ankylosing

Answer 19

spondylitis is NSAIDS and COX2 inhibitors

Question 20

ischemic stroke in patients with sickle cell is treated with

Answer 20

exchange transfusion which replaces sickles cells with healthy red blood cells to increase oxygen carrying capacity and improve hyper viscosity to limit further occlusion

if exchange tranfusion is unavailable use simple tranfusion

Question 21

under what instances should a diabetic foot ulcer be imaged for underlying osteomyelitis

Answer 21

any of the following

deep (bone exposed)
long duration >7 days
large >2 cm
ESR or CRP elevated
soft tissue infection

imaging even in the absence of signs/symptoms like erythema, streaking, pain etc.

Question 22

what is a focal seizure

Answer 22

a seizure that originates in a single hemisphere and can cause a motor, sensory or autonomic activity

*isolated right head tilt and arm twitch

focal seizures can spread to involve both cerebral hemispheres and cause an impaired awareness like a staring episode and automatism (chewing/picking)

postictal confusion and transient paralysis (todd paralysis)

Question 23

EEG results of focal seizure

Answer 23

during: abdnomral electrical activity arising from specific portion of the brian

interictal EEG is normal

Question 24

Absence seizures

Answer 24

originate from both hemispheres and present with staring spells +/- automatisms and lasts only 10-20 seconds with no postictal period.

provoked by hyperventilation

Question 25

juvenili myoclonic epilepsy

Answer 25

myoclonic jerks immediately upon wakening in adolescents

Question 26

Lennox-Gastaut syndrome

Answer 26

intellectual disability and severe seizures of varying types by age 5

interictal (between seizures) EEG shows slow spike and wave pattern

Question 27

MCC of death in patients with treated hodkins lymphoma <10 year and >10 years

Answer 27

<10 years - reoccurence

> 10 years - secondary malignancy (breast/lung) or cardiovascular disease

Question 28

the greatest risk factor for life threatening asthma is a history of?

Answer 28

prior intubation or need for mechanical ventilation

or increased/normal PaCO2 (should be decreased)

Question 29

what is the differential diagnosis for ulcerative skin lesion and suppurative regional lymphadenopathy

Answer 29

bartonella hensle- papule and lymphadenopathy
Francisella tularensis- ulcer then lymphadenpathy
sporothrix schenckii - ascending lymphagnitis

Question 30

asymptomatic BV treatment

Answer 30

no further workoup or treatment only workup/treat if there are symptoms

tx: metronidazole
dx: wet mount microscopy and KOH whiff test

Question 31

beckwith-wiedemann syndrome

Answer 31

macrosomia, macroglossia, hypoglycemia, hemihyperplasia, umbilical hernia, visceromegaly

increased risk of embryonal tumors: wilms tumors and hepatoblastoma

Question 32

BWS surviellence

Answer 32

serum a fetoprotein

abdominal ultrasound

renal ultrasound

Question 33

granulosa cell tumors secrete what?

Answer 33

Estradiol and Inhibin

post menopausal subtype will cause (breast tenderness, abnormal uterine bleeding)

juvenile subtype subtype causes precocious puberty