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Uworld Gaby > UW 2 > Flashcards

UW 2 Flashcards

1
Q

Causes of precocious puberty

A

-central ==> high FSH & LH -peripheral ==> low FSH & LH (e.g. excess peripheral conversion, estrogen-producing ovarian cyst, CAH

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2
Q

NF1 features (7)

A

Two or more of the following

6 Cafe au lait spots

2 Neurofibromas

Freckling of the axillary or inguinal area

Optic glioma

2 Lisch nodules (Iris hamartomas)

Bone abnormality (eg. scoliosis)

First degree relative with NF1

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3
Q

Evaluation of precocious puberty

A

bone age normal ==> premature thelarche (breast development) vs. premature adrenarche (pubic hair development)

advanced ==> basal LH basal

LH high ==> central

low ==> GnRH stimulation test

low LH ==> peripheral

high LH ==> central

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4
Q

Neurologic deficits in B12 deficiency

A

loss of distal vibration sense & proprioceptive sense memory loss, irritability, dementia

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5
Q

Tx of megaloblastic anemia w/folic acid alone

A

if 2/2 B12 deficiency, folic acid will correct anemia but accelerate neurologic sx of B12 deficiency

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6
Q

Most common cause of constrictive pericarditis in Africa, India, China = ?

A

TB

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7
Q

Pagets Disease presentation

A

osteoclast dysfxn ==> increased bone turnover may be asx can lead to fx, bone pain, skeletal deformities can lead to H/As and hearing loss if bones of head/ear involved

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8
Q

Dxx for nephritic/nephrotic sd with low C3

A
  1. Postinfectious
  2. Membranoproliferative (including mixcrioglobilinemia)
  3. Lupus nephritis
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9
Q

Mixed cryoglubulinemia presentation

A

Palpable purpura

Nephritic/Nephrotic Sd

Low C3

Hep C (90%)

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10
Q

Nephritic Sd findings (6)

A

Proteinuria

Hematuria

Azotemia

RBC casts

Oliguria

Hypertension

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11
Q

Types of Nephritic Sd

A

Inmune Complex (postinfectious, igA, henoch-sholein)

Pauci-inmune (No IG deposits on inmunofluorescence)

Granulomatosis with polyangitis, microscopic polyangitis, eosinophilic granulomatosis

Anti-GMB disease Goodpasture, Alport

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12
Q

Renal disease with pulmonary symptoms (hemoptisis) dxx

A
  1. Goodpasture (no ulcers) 2. Granulomatosis with polyagitis
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13
Q

a. Kidney + lungs + sinus
b. kidney + lungs
c. kidney + asthma

A

a. granulomatosis with polyangitis
b. microscopic polyangitis / goodpasture
c. Chrug-Strauss (eosinophilic granulomatosis with polyangitis)

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14
Q

Pauci-inmune glomerulonephritis

A

a. Granulomatosis with polyangitis URT involvement (may see ulcers and polyps). Cavitary lesions (hemoptysis) PR3-ANCA/C-ANCA (antiproteinase 3)
b. Microscopic polyangitis No URT involvement. MPO-ANCA/p-ANCA (antimyeloperoxydase)
c. Eosinophilic granulomatosis with polyangitis (churg- strauss) Asthma, sinusitis, skin nodules, peripheral neuropathy MPO-ANCA/p-ANCA (antimyeloperoxydase) Eosinphilia, Elevated IgE

ALL treated with corticosteroids, cyclophosphamide or rituximab

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15
Q

Immune complex glomerulonephritis

A

a. Postinfectious: Common in kids. 2-4 weeks after infection. Low C3
b. Ig A (berger): Common in adults. During infection, Normal C3. Most common with GI infection (IgA produccing musocsa
c. Henoch-Shonlein purpura Like Berger + purpura (arthralgias, abdominal pain, IgA+)

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16
Q

Anti GMB glomerulonephritis

A

a. Goodpasture Hemoptisis, dyspnea, respiratory failure
b. Alport Fxx of renal failure. Serineural deafness

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17
Q

Treatment to consider in nephritic sd

A
  1. IECA (for all types of hypertension and/or proteinuria)
  2. Glucocorticoids
  3. Steroids, Cyclophosphamide, and rituximab
  4. Plasma exchange
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18
Q

Nephrotic sd causes

A

M and M FAN

Minimal change (most common in kids)

Membranous (highest rate of thrombosis), most common in white adults, 30% overall)

Focal segmental (most common in adults, espacially african american)

Amyloidosis

Diabetic

Lupus

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19
Q

Important complication in mebranous neprhopathy

A

Highest rate of thrombosis Renal vein trhombosis (hematuria, flank pain and scrotal edema)

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20
Q

Histology finding in MPGN

A

Tram track double layered basement mambrane/ Intermembranous dense deposits Low C3

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21
Q

Action of cyclosporin and SE

A

Inhibits interleukin 2 transcription

nephrototoxycity (most common)

tremor

hta

gum hypertrophy

hyperkaliemia

22
Q

Mycophenolate side effects

A

Marrow supresion

23
Q

Azathioprine

A

diarhee leukopenia hepatotoxicity

24
Q

Calcium renal stone

A

Radioopaque. Most common Square

Calcium phosphate: high pH

Calcium oxalate: low pH

25
Q

Struvite stone

A

Mg amonium phosphate “Paralelepipedo” Radioopauqe. Urease producing organism: Proteus high pH

26
Q

Uric acid stone

A

Radiolucid

diamond shaped

Low pH

Hydrate and alkalinize urine

27
Q

Cystine stones

A

Hexagonal. radiolucent

Defect aminoacid transport: COLA Cystine, ornithine, lysine and arginine

Family hx

Hydration, Na restriction, urine alkalinization

28
Q

Kidney stone management according to size

A

<5mm: may pass spontaneously

<10mm: may pass with CCBs or Tamsulosin tx

5-20mm: shock wave lithotripsy

>20mm: percutaneous neprholithotomy

29
Q

Young patient from developing country with progressive dyspnea, nocturnal cough and hemoptysis

A

Rheumatic heart disease

30
Q

Mitral valve stenosis causes

A

Rheumatic fever (developing countries) Uncommon in the US

31
Q

Presentation of Mitral stenosis

A

Progressive symptoms Dyspnea Orthopnea Hemoptysis =======> Eventualy Right heart failure

Left atria enlargment: Afib (thrombus formation), Stroke dysphagia and hoarness, elevation of main bronchus

32
Q

Mitral stenosis auscultation

A

Opening snap with mid diastolic rumble at the apex

33
Q

Rocky Mountain spotted fever

A

Riketsia Fever, malaise Maculopapular rash that starts in wrist and ankles… becomes petechial/purpuric… spreads centrally (involve hands and soles)

Altered mental status and DIC may be seen in severe cases

Treat with doxycycline

34
Q

Ixodes tick is the vector of?

A

Babesia

Lyme (Borelia)

Anaplasma

35
Q

Anemias algorithm pg 188 first aid

A

See algorithm Mycrocitic (5) Normocytic (14) Macrocytic (7)

36
Q

Hereditary Spherocytosis

A

Autosomal Dominant

Fx of splenectomy/hemolytic anemia

Clasic triad: splenomegaly, hemolytic anemia, jaundice

37
Q

Labs in Hereditary Spherocytosis

A

Normocytic anemia. Reticulocytosis

normal MCV, elevated MCHC and RDV, Coombs -

Indirect hyperbilirrubinemia

May present with cholecystitis due to pigmented gall stones

Diagnosis: Eosin-5 maleimide flow cytometry, acidified glycerol lysis test, osmotic fragility test

38
Q

Autoinmune hemolytic anemia vs. Hereditary spherocytosis

A

Both are hemolitic anemia with spherocytes

Only AIHA is direct Coombs +

39
Q

Types of Autoinmune hemolytic anemia

A

Warm: IgG (SLE, CLL, lymphoma, penicillin, rifampin, phenytoin and a-methyldopa)

Cold: IgM (Mycoplasma, EBV, Waldesntrom macroglobulinemia)

POSITIVE: direct coombs

40
Q

Complications of Mumps

A

Orchitis

Can cuase aseptic meningitis and trasient sesoryneural hearing loss

Pancreatitis has been described

41
Q

Preterm premature rupture of membranes vs. premature rupture of membranes

A

PRM: 1hr before onset of labor (precipitated by urogenital infections, cervival incompetence,)

PPRM: <37weeks

Prolonged: >18hr (need ATB prohylaxis)

42
Q

Agammaglobulinemia

A

boy (x linked recesive), starting at 6motnhs

Infections with H influenza and S. neumonia and Pseudomona

B cell deficiency

Low Ig level

Confirm with B and T-cell subsets (B absent, T high)

Absent lymphoid tissue (eg. no tonsils)

43
Q

B cell Disorders (4)

A

Agammaglobulinemia: H. influenzae, Pseudomona and pneumococcal infections

Common variable inmunodeficiency: (both B and T defect). All Ig levels low

IgA deficiency: anaphylactic reaction to blood transfusion. Recurrent GI and Resp infections

Hyper IgM sd: severe recurrent sinopulmonary infection

44
Q

Multiple Myeloma

A

CRAB

Calcium (elevated), renal involvement, anemia/amyloidosis, Bone (lytic lesions) / back pain

Multiple Myeloma: Monoclonal M protein

Increased risk for infections (respiratory and UTI most common) due to impaired antibody production

45
Q

Diagnosis of Chronic granulomatous disease

A

dihydrodamine 123 test

nitroblue tetrazolium test

46
Q

Chronic granulomatous disease

A

Increased risk of catalase + organisms (Candida, S. aureus, Serratia, Aspergillus, E. coli, Klebsiella)

Severe pyogenic infections

X linked or autosomal resecive

47
Q

Treatment of Chronic granulomatous disease

A

Prophylaxis with TMP-SMX

Interferon

Bone marrow transplant

48
Q

Obstructive pattern on spirometry

A

FEV1/FVC: <70%

FEV1: decreased

FVC: normal/decreased

FRC: increased

TLC: increased

49
Q

Managment of Neonatal respiratory distress sd

A
  1. CPAP or intubation
  2. Surfactant administration

Pretreat with corticosteroids in patients with risk of preterm delivery in the next 7 days (24 to 37 weeks)

50
Q

Xray findings in:

a. NRDS
b. Transient tachypnea od the new born
c. Meconium aspiration

A

a. Ground-glass apearance, lack of focal opacities
b. Due to amniotic liquid retantion. Perihiliar streaking
c. Coarse, irregular infiltrates, lung expansion, pneumothoroax

51
Q

Secondary syphilis

A

Fever, malaise, generalized lyphadenopaties

Symetric, difuse maculo papular rash in palms and soles

Condyloma lata (highly contagious)

Treat with Penicillin G

52
Q

Treatment of Multiple Sclerosis

A

Acute: High dose corticosteroids, plasma exchange

Disease modifiying medications:

  • Interferon (ABC) (decrease number of relapses)
  • Ocrelizumab (progressive MS)

Uworld Gaby (77 decks)

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