UWorld 2 Flashcards
Clinical presentation of a popliteal (Baker) cyst
- Asymptomatic bulge behind knee that diminishes with flexion
- Posterior knee pain, swelling, stiffness
Complications that can accompany a Popliteal (Baker) cyst
- Venous compression (leg/ankle swelling)
- Dissection into calf (erythema, edema, positive Homan sign)
- Cyst rupture (acute calf pain, warmth, erythema, ecchymosis)
A popliteal cyst is due to what
extrusion of synovial fluid from the knee joint into the gastrocnemius or semimembranosus bursa through a communication between the joint and the bursa
Risk factors for popliteal cyst
- Trauma (e.g. meniscal tear)
- Underlying joint dx (RA or OA)
What is the crescent sign in terms of popliteal cysts
-An arc of ecchymosis visible distal to the medial malleolus when popliteal cyst ruptures
This presents with subacute medial knee pain and exam shows a well-defined area of tenderness over the medial tibial plateau below the joint line
Pes anserinus pain syndrome (anserine bursitis)
patient with progressive dyspnea, decreased exercise tolerance, Afib with rvr and LV systolic dysfunction is consistent with what
tachycardia-mediated cardiomyopathy
Treatment of tachycardia-mediated cardiomyopathy
-Aggressive rate control or restoration of normal sinus rhythm
effect of albumin on calcium
- approximately 40-45% of total blood calcium is bound to albumin and other plasma proteins, the remainder is transported in the blood as ionized calcium or complexed with phosphate and other anions
- Patients with hypoalbuminemia may have significant deficit in total blood calcium . However, the ionized plasma calcium (physiologic active form) is hormonally regulated and remains stable
what is the corrected calcium equation
CC = (measured total calcium) + .8 (4.0 - serum albumin)
Untreated hyperthyroidism and bone health?
risk for rapid bone loss from increased osteoclastic activity in the bone cells
Lab findings in Hereditary spherocytosis
- Increased corpuscular hemoglobin concentration (due to membrane loss and RBC dehydration)
- Spherocytes on peripheral smear
- Negative Coombs test
- Increased osmotic fragility on acidified glycerol lysis test
- Abnormal eosin-5-maleimide binding test
Treatment of Hereditary spherocytosis
- Folic acid supplementation
- Blood transfusions
- Splenectomy
Complications of Hereditary Spherocytosis
- Pigment gallstones
- Aplastic crises from parvovirus B19 infection
Absent CD55 molecule causes hemolytic anemia induced by the complement system, which is the mechanism of what disorder
Paroxysmal nocturnal hemoglobinuria
A patient with end-stage Renal disease has severe HTN, headache, and retinal hemorrhages consistent with acute hypertensive crisis. This should raise suspicion for what
-erythropoietin-related hypertension
CSF findings in Herpes encephalitis
- Lymphocytic pleocytosis
- increase in erythrocytes (due to hemorrhagic destruction of temporal lobes)
- elevated proteins
- Low CSF glucose is NOT SEEN
imaging for herpes encephalitis
-MRI preferred over CT (which may be normal in up to 50% of patients)
This is a circadian rhythm disorder characterized by the inability to stay awake in the evening (usually after 7:00 p.m.), making social functioning difficult
Advanced sleep phase syndrome
This is a circadian rhythm disorder characterized by the inability to fall asleep at “normal” bedtimes, resulting in sleep-onset insomnia and excessive daytime sleepiness. Patients sleep normally if allowed to follow their internal circadian rhythm and sleep until late morning
Delayed sleep phase syndrome
what testing can help confirm a suspected ankylosing spondylitis
- Xrays of SI joints
- HLA-B27 is not specific and is not necessary for diagnosis
Exam findings in Ankylosing Spondylitis
- Arthritis (sacroiliitis)
- Reduced chest expansion and spinal mobility
- Enthesitis (tenderness at tendon insertion sites)
- Dactylitis (swelling of fingers and toes)
- Uveitis
Most common extraarticular manifestation of ankylosing spondylitis
-Anterior uveitis
definition of excessive alcohol intake
- > 2 drinks a day
- or binge drinking (5 or more drinks in a row)
- both associated with increased incidence of HTN compared to nondrinkers