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uworld Flashcards

1
Q

Digoxin toxicity causes what kind of arrhythmia?

A

atrial tachycardia with AV block

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2
Q

How do you differentiate laryngomalacia and a vascular ring?

A

laryngomalacia has a more prominent inspiratory stridor, worsens supine, improves prone. vascular ring has equal inspiratory and expiratory stridor, improves with neck extension, also presence of GI complaint

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3
Q

Unilateral lower extremity edema associated with heaviness and cramping is most likely caused by?

A

venous insufficiency (venous valve incompetence

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4
Q

How do you differentiate TRALI from MI in a post-op/post-transfusion patient?

A

TRALI & MI can have hypotension and pulmonary edema.
TRALI is associated with fever, normal to increased pulmonary artery catheter cardiac index readings, normal to low PCWP.
MI will have low cardiac index and high PCWP

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5
Q

Dressler Syndrome

A

post-cardiac injury syndrome
immune-mediated pericarditis
occurs weeks to months after MI
often accompanied by pericardial effusion

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6
Q

presentation of RV MI

A

hypotension, elevated jugular venous pressure, clear lung fields, ST elevation in inferior leads (II, III, aVF)

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7
Q

When does ventricular septal defect occur after an MI?

A

3-5 days after MI, associated with sudden onset hypotension and biventricular heart failure

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8
Q

ECG findings of LV aneurysm?

A

persistent ST elevations with deep Q waves

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9
Q

standard newborn preventative care?

A 
erythromycin eye ointment (ophthalmia neonatorum from gonorrhea and chlamydia)
vitamin K (prevent hemorrhagic disease of newborn)
hepatitis B vaccine
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10
Q

standard newborn screening

A

metabolic/genetic disorders (varies by state)
hyperbilirubinemia
hearing
hypoglycemia
pre & post-ductal pulse oximetry (r/o congenital heart dz)

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11
Q

systolic-diastolic abdominal bruit is associated with what pathology?

A

renal artery stenosis

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12
Q

MOA of adenosine

A

inhibit L-type calcium channels

decreases conduction velocity at AV node

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13
Q

treatment of unstable tahyarrhythmia

A

synchronized cardioversion (consider adenosine only if regular and narrow complex)

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14
Q

why do we used synchromized cardioversion?

A

if shocked during repolarization, heart can go into more dangerous ventricular fibrillation

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15
Q

How does digoxin toxicity present?

A

nausea, vomiting, decreased appetite, confusion, weakness

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16
Q

Leriche Syndrome

A

aortoiliac occlusion:
bilateral hip, thigh, and buttock claudication
absent or diminished femoral pulses
impotence

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17
Q

Jervell & Lange-Nielson Syndrome

A

autosomal recessive congenital long QT syndrome 2/2 molecular defects in potassium channels
high risk of syncope, torsade de pointes, and sudden death
associated with congenital sensineural hearing loss
QT ~600ms
treated with beta-blocker and pacemaker

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18
Q

treatment of atrial fibrillation in WPW patients

A

hemodynamically unstable, electrical cardioversion

hemodynamically stable, procainamide or ibutilide

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19
Q

complications of PCI

A

hematoma: +/- mass, no bruit
pseudoaneurysm: bulging pulsatile mass, systolic bruit
arterivenous fistula: no mass, continuous bruit
iatrogenic (femoral) nerve injury: discomfort or paresthesias in thigh & patellar tendon hyporeflexia
femoral artery dissection: acute lower extremity ischemia, no bruit

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20
Q

What is acetaminophen’s effect on warfarin?

A

increases it’s effetiveness

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21
Q

presentation of beta-blocker overdose?

A

bradycardia, AV block, hypotension, diffuse wheezing, hypoglycemia, bronchospasm, delirium, seizures, cardiogenic shock

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22
Q

treatment for beta-blocker overdose

A
  1. ABCs: airway and IV fluids
  2. atropine for hypotension and bradycardia
  3. refractory hypotension: give glucagon. either with or succession: IV Ca, epi/norepi, high dose insulin & glucose, IV lipid emulsion
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23
Q

workup for possible secondary causes of HTN

A

urinalysis, chemistry, lipid profile, baseline ECG

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24
Q

What is a cardiac complication of tuberculosis?

A

constrictive pericarditis

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25
Q

What exam maneuver increases HOCM murmur?

A

valsalva

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26
Q

most common congenital heart defect in down’s syndrome?

A

complete atrioventricular septal defect

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27
Q

presentation of constrictive pericarditis

A

right heart failure: progressive peripheral edema, elevated JVP, ascites, pericardial knock, pericardial calcifications on CXR

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28
Q

fatal complication of coronary artery stenting

A

stent thrombosis
this is why dual anti-platelet therapy of ASA and P2Y12 receptor blocker is needed for 1 yr after drug-eluding stent placement

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29
Q

how do vagal maneuvers work?

A

increase parasympathetic tone -> temporary AV nodal slowing & increase AV nodal refractory period -> termination of atrioventricular nodal reentrant tachycardia

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30
Q

Most frequent underlying arrhythmia responsible for sudden cardiac death?

A

ventricular fibrillation with reentry being the predominant mechanism

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31
Q

immediate or phase 1a arrhythmia

A

ventricular arrhythmias
reentrant
within 10 minutes of MI

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32
Q

delayed or phase 1b arrhythmia

A

10-60 minutes after MI

from abnormal automaticity

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33
Q

treatment for asymptomatic, bilateral, not high grade carotid stenosis

A

antiplatelet and statin

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34
Q

When is a carotid endarterctomy recommended?

A

symptomatic patients (CVA or TIA in last 6 months) with high grade carotid stenosis (70-99%)

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35
Q

hemodynamic effects of an AVF

A

decreases SVR
increases preload
increases CO

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36
Q

clinical presentation of AVF

A 
widened pulse pressure
strong peripheral pulses
systolic flow murmur
tachycardia 
flushed extremity
LVH: laterally displaced PMI & ECG changes
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37
Q

causes of high output heart failure

A 
AV shunting
thyrotoxicosis
Paget disease
anemia
thiamine deficiency
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38
Q

presentation of pulmonary HTN

A

weakness, angina, syncope, dyspnea

JVD, reduced carotid upstroke, RV lift, loud pulmonary heart sound, & tricuspid regurgitation

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39
Q

How do AVF causes heart failure?

A

AV shunting increases preload

normal to high CO, but not meeting oxygen demand of peripheral tissues

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40
Q

preferred HTN treatment in ADPKD

A

ACE inhibitors

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41
Q

increased 24 hour urine cortisol is seen in what disease?

A

Cushing’s Syndrome

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42
Q

Cushing’s Syndrome presentation

A

central obesity, facial plethora, proximal muscle weakness, abdominal striae, ecchymosis

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43
Q

primary aldosteronism presentation

A

resistant HTN or HTN with unexplained hypokalemia

NO masses palpable

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44
Q

cardiac appearance of cardiac tamponade on CXR

A

normal

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45
Q

How does bronchial rupture present?

A

JVD & tension pneumothorax

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46
Q

Presentation of Kawasaki disease?

A

5 or more days of fever with 4 or more of:
bilateral, nonexudative conjunctivitis
polymorphous rash
mucositis: strawberry tongue & fissured lips
erythema, edema, desquamation of hands and feet
tender cervical lymphadenopathy (>1.5cm)

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47
Q

Complication of Kawasaki disease?

A

coronary artery aneurysms

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48
Q

treatment of kawasaki disease?

A

IV Ig within 10 days of fever onset

Aspirin

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49
Q

Who is at highest risk of complications in Kawasaki disease?

A

infants and those with prolonged fevers (>14 days)

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50
Q

Measles presentations

A

cough, coryza, fever, conjunctivitis, cephalocaudal rash

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51
Q

How does adenosine stress the heart in a pharmacologic stress test?

A

dilates coronary arteries without increasing HR or BP

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52
Q

How does dobutamine stress the heart in stress echocardiography?

A

beta-1 receptor agonist

increase HR & myocardial contractility

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53
Q

What is target heart rate for exercise stress test?

A

85% of (220-age of patient)

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54
Q

What patients require pharmacologic stress testing?

A

LBBB
pacemaker
cannot reach target for exercise stress test

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55
Q

What patients require stress echocardiography?

A

reactive airway disease

cannot reach target fro exercise stress test

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56
Q

presentation of fibromuscular dysplasia?

A

internal carotid stenosis: recurrent headaches, pulsatile tinnitus, TIA, CVA
renal artery stenosis: 2nd HTN, flank pain
abdominal bruit, subauricular systolic bruit

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57
Q

Why is bowel ischemia a complication of AAA repair?

A

the inferior mesenteric artery is lost during aortic graft placement causing inadequate colonic arterial profusion to L & sigmoid colon

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58
Q

three most important risk factors for acute aortic dissection

A

HTN, Marfan’s Syndrome, cocaine use

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59
Q

MOA of aliskiren

A

direct renin inhibitor:

increases natriuresis, decreases serum angiotensin II concentration, decreases aldosterone production

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60
Q

first line therapy for symptomatic PVCs

A

escalation of beta-blocker or calcium channel blocker

decreases symptoms, does not directly suppress PVCs

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61
Q

acute onset HF following viral illness in otherwise healthy patient?

A

dilated cardiomyopathy

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62
Q

Mechanism by which dobutamine improves decompensated HF?

A

stimulates beta-1 adrenergic receptors
increase cAMP in cardiac myocytes
increased cardiac contractility & increased HR
decreases LV EDV
increased CO, decreasing pulmonary pooling

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63
Q

laboratory poor prognostic indicators in HF

A

hyponatremia, elevated pro-BNP, renal insufficiency

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64
Q

treatment for new rheumatic heart disease?

A

PCN (prophylactic)

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65
Q

extremity vascular trauma hard signs

A 
any one is enough for surgery:
observed pulsatile bleeding
presence of bruit/thrill at injury site
expanding hematoma
signs of distal ischemia (absent pulses, cool extremity)
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66
Q

extremity vascular trauma soft signs

A

history of hemorrhage
diminished pulses
bony injury
neurologic abnormality (paresthesias)

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67
Q

pulsus paradoxus

A

fall in systolic BP >10mmHg during inspiration

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68
Q

causes of pulsus paradoxus

A

asthma
COPD
cardiac tamponade

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69
Q

What are Burr cells and what diseases are they seen in?

A

spiculated RBCs with serrated edges
liver disease
ESRD

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70
Q

What are Howell-Jolly bodies and what disease do they present in?

A

basophilic remnants of the nucleus in RBCs

h/o splenectomy or functional asplenia

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71
Q

What are Spur cells and what diseases are they seen in?

A

RBCs with irregularly sized and spaces projections

liver disease

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72
Q

What are target cells and what disease are they seen in?

A

RBCs with central density surrounded by pallor

hemoglobinopathies (thalassemias) & chronic liver disease

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73
Q

Treatment for acute mediastinitis

A

surgical debridement and prolonged antibiotics

antibiotics only are not enough

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74
Q

What class of drugs has been shown to significantly reduce the risk of systemic embolization in patients with moderate to high risk?

A

anticoagulants, NOT antiplatelets

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75
Q

treatment for patients with “long AF”?

A

nothing, because CHADSVASC is low

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76
Q

tricuspid valve atresia ECG findings

A

L axis deviation, small or absent R waves in precordial leads (infants are normally R axis)
associated atrial septal defect-> hypertrophic R atrium-> tall, peaked p waves

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77
Q

risk factors for c. diff infection

A

hospitalization
recent antibiotic use
PPI use

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78
Q

Presentation of Reye’s syndrome

A

vomiting and abnormal behavior
rapidly progressive to seizures and lethargy
encephalopathy, hepatic dysfunction, & cerebral edema

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79
Q

When is ERCP the appropriate treatment in gallstone pancreatitis?

A

when cholangitis is present

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80
Q

Almost all infants with meconium ileus have what major disorder?

A

cystic fibrosis (only 20% of CF pts have meconium ileus, but almost all pts with meconium ileus have CF)

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81
Q

How can meconium ileus and Hirschsprung disease be ddx in a newborn?

A

ileus has microcolon

HD has megacolon

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82
Q

What screening should be done on newly diagnosed cirrhosis or alcoholic liver patients?

A

EGD to assess for esophageal varices

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83
Q

What the primary prophylaxis for nonbleeding esophageal varices?

A

endoscopic variceal ligation or nonselective beta-blocker (propanolol or nadolol)

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84
Q

infant benefits to human breastmilk

A

absorbs better
improves gastric emptying
confers immunity: secretory IgA, lactoferrin, lysosyme
calcium & phosphorus are lower, but better absorbed
less reflux & colic
decreased risk of childhood cancer, DM, & NEC

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85
Q

the only nutritional downside to breastmilk?

A

vitamin D is too low and needs to be supplemented

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86
Q

maternal benefits to breastfeeding?

A

rapid uterine involution
decreased postpartum bleeding
faster return to prepartum weight
reduced risk of ovarian & breast cancer

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87
Q

contraindications to breastfeeding

A

fetal galactosemia
active untreated TB (may start after 2 weeks)
maternal untreated HIV (can if viral load is low)
herpes breast lesions
active chemo or radiation
active drug or alcohol use

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88
Q

Differentiating factors between retrocecal appendicitis and psoas abscess

A

retrocecal appendicitis will cause pain on rectal exam & less likely to cause RLQ pain
psoas abscess has more subacute presentation, h/o soft tissue infection

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89
Q

treatment for newly diagnosed asymptomatic HepC

A

HepA & HepB vaccines

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90
Q

medications that can cause acute pancreatitis

A 
valproic acid
diuretics
IBD drugs: mesalamine, 5-ASA
immunosuppressives: azathioprine
HIV meds
antibiotics: metronidazole, tetracycline
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91
Q

What is melanosis coli?

A

dark brown discoloration of the colon w/pale patches of lymph follicles
from regular use of laxatives

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92
Q

1 cause of painless large volume bright red blood per rectum

A

diverticulosis

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93
Q

anti-mitochondrial antibodies are associated with what disease?

A

primary biliary cirrhosis

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94
Q

What signs are caused by hyperestrinism?

A

spider angiomata
palmar erythema
gynecomastia, testicular atrophy, & decreased body hair in males

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95
Q

long term complication of untreated giardiasis?

A

lactose intolerance (not everyone, just a sub population)

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96
Q

diagnostic requirements of acute liver failure

A

severe acute liver injury (AST & ALT >1000)
signs of hepatic encephalopathy
synthetic liver dysfunction (INR>1.5)

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97
Q

presentation of duodenal hematoma

A

blunt trauma with initial pain that subsides with time then presents 2/2 obstruction 24-36 hours later as hematoma expanded
usually children

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98
Q

diagnostic test to confirm duodenal hematoma

A

CT abdomen

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99
Q

treatment of duodenal hematoma

A

resolves in 1-2 weeks
NG tube placement
TPN
drainage if non-op fails

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100
Q

most common source of liver metastases?

A

colorectal cancer

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101
Q

elevated AST & ALT, elevated GGT, elevated ferritin, but no signs of cirrhosis?

A

alcoholic hepatitis

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102
Q

pleural effusion 2/2 small diaphragmatic defects in cirrhotic patient?

A

hepatic hydrothorax

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103
Q

treatment for breastfeeding jaundice

A

increase feeding frequency to q2-3hrs instead of q4hrs

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104
Q

cause of osteogenesis imperfecta

A

autosomal dominant type I collagen mutation COL1A1

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105
Q

types of osteogenesis imperfecta

A

I: mild to moderate: frequent fractures, blue sclera, conductive hearing loss, short to normal stature, dentinogenesis imperfecta (gray teeth), joint hypermobility (ligamentous laxity)
II: lethal: in utero and/or neonatal fractures & pulmonary failure

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106
Q

physical exam findings of osteonecrosis of the femoral head?

A

progressive hip pain

limited internal rotation & abduction

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107
Q

xerostomia & xerophthalmia with negative ANA

A

age-related sicca syndrome

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108
Q

Labs in Paget disease of bone

A

calcium & phosphorus are NORMAL (urine calcium may be high)
alkaline phosphatase is HIGH
urine hyroxyproline is HIGH

109
Q

treatment for Paget’s disease of bone

A

bisphosphonates

110
Q

benign bone-forming tumor

A

osteoid osteoma

111
Q

Where are Ewing sarcomas typically found?

A

pelvic bone or diaphysis of long bones

112
Q

Morton neuroma

A

numbness or pain between 3rd & 4th toes

clicking sensation when palpating the space between 3rd & 4th toes while squeezing metatarsal joints

113
Q

1-6 month old presents with preferential head tilt to one side

A

congenital muscular torticollis

114
Q

knee catching or buckling is associated with injury to what structure?

A

meniscus

115
Q

lab findings in juvenile idiopathic arthritis

A 
elevated ESR & CRP
hyperferritinemia
hypergammaglobulinemia
thrombocytosis
anemia
116
Q

common causes of lumbar spinal stenosis

A

degenerative arthritis (spondylosis)
degenerative disc disease
thickening of ligamentum flavum

117
Q

presentation of ruptured popliteal cyst

A

acute calf/knee pain
warmth & erythema
crescent sign: ecchymosis distal to medial malleolus

118
Q

What medications can cause methemoglobinemia?

A

topical anesthetics (like benzocaine)
dapsone
nitrates in infants

119
Q

What should be suspected in a patient with large oxygen saturation gap (between pulse oximetry & blood gas)?

A

methemoglobinemia

pulse oximetry is more accurate in this situation

120
Q

What type of hematologic disease is seen in obstructive sleep apnea?

A

Polycythemia

hypoapnea & apnea-> decrease blood oxygen levels-> increased EPO

121
Q

What causes hypocalcemia after MTP?

A

citrate anticoagulant in blood products chelates the serum calcium (and magnesium)

122
Q

cause of TTP (thrombotic thromobocytopenic purpura)

A

autoantiboies to ADAMS13 protease (to cleave vWF)

can be genetic or acquired

123
Q

treatment for thrombotic thrombocytopenic purpura

A

plasma exchange

124
Q

presentation of pinealoma

A

mass effect with:
Parinaud Syndrome: limited upward gaze, upper eyelid retraction, pupils non-reactive to light, but do react to light
obstructive encephalitis: papilledema, headache, vomiting, ataxia

125
Q

treatment of hypercalcemia

A

asx or mild requires no treatment unless in the setting of malignancy, then use bisphosphonates. in granulomatous disease, use corticosteroids
in moderate to severe, use loop diuretics

126
Q

most common congenital aplastic anemia

A

Fanconi anemia

autosomal recessive DNA repair defect

127
Q

features of fanconi anemia

A 
pancytopenia
abnormal thumbs
short stature
hypo/hyperpigmented macules
genitourinary malformations
128
Q

hypertensive crisis in CKD patient is suspicious for?

A

EPO-related hypertension (30% of patients develop new or worse HTN on EPO)

129
Q

translocation between chromosomes 9 & 22 is associated with what cancer

A

CML= chronic myeloid leukemia

130
Q

BCR-ABL gene fusion causes what pathophysiology?

A

leukemogenesis 2/2 constitutively active tyrosine kinase

131
Q

treatment for CML

A

tyrosine kinase inhibitors, ex. imatinib

132
Q

How does DVT treatment change in ESRD patients?

A

unfractionated heparin instead of LMW heparin becuase LMW heparin is metabolized in the kidneys

133
Q

hemosiderin deposition and cartilage fibrosis of joints is caused by?

A

Hemophilia

134
Q

How is CLL diagnosed?

A

flow cytometry of peripheral blood (clonal maturity of B cells)

135
Q

engorged anterior chest veins are a sign of?

A

superior vena cava syndrome

highly associated with malignancy (small cell lung cancer & non-Hodgkin lymphoma

136
Q

neonatal polycythemia causes

A 
excessive transfusion (delayed cord clamping, twin-to-twin)
intrauterine hypoxia (maternal DM, smoking, or HTN)
genetic conditions (trisomy 21)
137
Q

treatment for cancer-related anorexia

A

progesterone analogues (megestrol acetate) or corticosteroids

138
Q

treatment for HIV cachexia

A

synthetic cannabinoids

139
Q

large gamma gap

A

large difference between total protein and albumin

associated with Waldenstrom macroglobulinemia

140
Q

eosin-5-maleimide binding test

A

fragility test for spherocytosis

141
Q

risk factors for vitamin K deficiency

A

malnutrition (inadeaquate dairy)
fat malabsorption (cystic fibrosis & biliary atresia)
intestinal inflammation (celiac disease & IBD)
decreased bacterial flora (increased Abx use)

142
Q

what labs are abnormal in vitamin K deficiency?

A

PT prolongation occurs first
PTT is prolonged in severe cases
low factor VII

143
Q

Why do multiple myeloma patients have increased rates of infection?

A

impaired effective antibody production

144
Q

What type of anemia is seen in hypothyroidism?

A

normocytic

or macrocytic in conjunction with pernicious anemia

145
Q

Why do newborns have low vitamin K?

A

poor placental transfer
absent gut flora
immature liver function
inadequate levels in breast milk

146
Q

What lab is used to monitor heparin?

A

PTT

147
Q

What lab is used to monitor warfarin?

A

PT

148
Q

What lab is used to monitor LMW heparins?

A

none, but can use anti-factor Xa activity

149
Q

absolute basophilia is seen in what hematologic disease?

A

chronic myeloid leukemia (CML)

150
Q

What is the leukocyte alkaline phosphatase score used for?

A

marker of neutrophil activity
differentiate CML from leukomoid reaction
result is low in CML

151
Q

Auer rods are seen in which hematology disease?

A

acute myeloid leukemia

152
Q

target organs for GVHD

A

skin (maculopapular rash involving palms, soles, & face)
intestines (blood+ diarrhea)
liver (abnormal labs & jaundice)

153
Q

Anemia with thumb anomalies

A

Diamond-Blackfan

154
Q

Lab findings in Diamond-Blackfan anemia

A

Pure red cell aplasia:
macrocytic anemia
reticulocytopenia
normal platelets & WBCs

155
Q

eczema, micothrombocytopenia, & hypogammaglobulinemia

A

Wiskott-Aldrich syndrome

156
Q

differential diagnosis for anterior mediastinal mass

A

4 T’s: thymoma, teratoma, thyroid neoplasm, & terrible lymphoma

157
Q

Tumor lysis syndrome labs reveal?

A

elevated potassium, phosphorus, and uric acid
hypocalcemia
AKI

158
Q

define salvage therapy

A

treatment for a disease when standard therapy fails

159
Q

antipsychotic medication effects on the tuberoinfundibular pathway

A

hyperprolactinemia-> gynecomastia, decreased libido, amenorrhea, & galactorrhea

160
Q

antipsychotic medication effects on the mesolimbic pathway

A

antipsychotic efficacy

161
Q

antipsychotic medication effects on nigrostriatal pathway

A

extrapyramidal symptoms: acute dystonia, akathisia, parkinsonism

162
Q

tremor pattern in essential tremor

A

worse with activity, improves at rest

163
Q

tremor pattern in Parkinson’s

A

improves with activity, worsens at rest

164
Q

trihexyphenidyl use

A

anticholinergic

younger patient with Parkinson’s with predominantly tremor

165
Q

treatment for trigeminal neuralgia

A

carbamazepine

166
Q

Walking by age

A

12 months

167
Q

running by age

A

18 months

168
Q

Huntington disease mainly effects which neuronal cell group?

A

GABA

169
Q

absence of galactose-1-phosphate uridyl transferase is seen in what disease?

A

Galactosemia

170
Q

aldolase B deficiency is seen in what disease?

A

fructose intolerance

171
Q

If not diagnosed at newborn screen, how is phenylketonuria diagnosed?

A

quantitative amino acid analysis

172
Q

dementia with visual hallucinations

A

Dementia with Lewy bodies

173
Q

difference between MDD & persistent depressive disorder?

A

MDD sxs most days for at least 2 weeks

persistent: depressed mood for 2 years

174
Q

In patients with possible spinal cord injury and without signs of pelvic injury or blood at the urethral meatus, what else is needed if ABCs are stable and 2 IVs placed?

A

bladder catheterization to prevent bladder injury secondary to acute distension & to asses urinary retention

175
Q

differentiating clinical features between Tay Sachs disease and Niemann-Pick disease

A

TS: hyperreflexia
NP: areflexia & hepatosplenomegaly

176
Q

cause of Tay Sachs disease

A

beta-hexoaminidase A deficiency

177
Q

cause of Niemann-Pick disease

A

sphingomyelinase deficiency

178
Q

glucoerebrosidase deficiency

A

Gaucher disease:

anemia, thrombocytopenia, and hepatomegaly

179
Q

galactocerebrosidase deficiency

A

Krabbe disease: early infancy (2-6 months)
developmental regression
hypotonia
areflexia

180
Q

clinical presentation of Tay Sachs disease

A 
loss of motor milestones, 
cherry-red macula, 
hypotonia
feeding difficulty
hyperreflexia
181
Q

clinical presentation of Niemann-Pick disease

A 
loss of motor milestones
cherry-red macula
hypotonia
feeding difficulty
hepatosplenomegaly
areflexia
type A is fatal by 3y/o
182
Q

Guillain-Barre attacks which nerves?

A

immune-mediated polyneuropathy

demyelination of PERIPHERAL NERVES

183
Q

Shy-Drager Syndrome

A

aka multiple system atrophy

Parkinsonism + autonomic dysfunction + widespread neurologic signs

184
Q

complication of untreated idiopathic intracranial hypertension

A

blindness

185
Q 
gait dysfunction
truncal ataxia
nystagmus
intention tremor
dysdiadochokinesia
pendular knee reflex (hypotonia)
A

cerebellar dysfunction

186
Q

periodic sharp-wave complexes on EEG are seen in what disease?

A

Creutzfeldt-Jacob

187
Q

rapidly progressive dementia with 2 or more:

myoclonus, akinetic mutism, cerebellar or visual disturbance, or pyramidal dysfunction

A

Creuztfeldt-Jacob

188
Q

cause of Friedreich ataxia

A

excessive number of trinucleotide repeats (mostly GAA)
frataxin gene
autosomal recessive

189
Q

comorbidities seen with Friedreich ataxia

A 
kyphoscoliosis
pes cavus (high arches)
hypertrophic cardiomyopathy (often cause of death in 40s)
190
Q

this presents in adolescents with progressive ataxia, loss of position and vibratory sense

A

Friedreich ataxia

191
Q

first line therapy for mild to moderate Alzheimer’s dementia

A

cholinesterase inhibitors

donepezil, galantamine, rivastigmine

192
Q

treatment for moderate to severe dementia

A

Memantine

193
Q

bilateral internuclear ophthalmoplegia

A

on attempted L gaze, L eye abducts with horizontal nystagmus & R remains stationary
on attempted R gaze, R eye abducts with horizontal nystagmus & L remains stationary
convergence intact

194
Q

Where is the lesion that causes bilateral internuclear ophthalmoplegia?

A

medial longitudinal fasciculus

195
Q

Effect of damage to the Edinger-Westphal nucleus

A

ipsilateral fixed and dilated pupil that is nonreactive to light or accommendation

196
Q

Features of NF 1

A 
optic glioma
lisch nodules 
cafe-au-lait macules
scoliosis
axillary & inguinal freckling
neurofibromas
tibial pseduoarthrosis
197
Q

Presents with Marfanoid body habitus, intellectual disability, thrombosis, fair complexion, cerebrovascular accident

A

homocystinuria

198
Q

treatment for homocystinuria

A

B6, folate, B12 to lower homocysteine levels

antiplatelet or anticoagulation

199
Q

Most common causes of single brain abscess

A

staphylococcus aureus or viridans streptococci

200
Q

myoclonus

A

involuntary jerking of a muscle or muscle group

201
Q

diabetic ophthalmoplegia effects which nerve?

A

ischemic neuropathy of CN III: oculomotor
eye is in down and out position & ptosis
pupils are usually spared because parasypathetic fibers are superficial and closer to blood supply

202
Q

Which cranial nerve is most likely to be impinged during uncal herniation?

A

CN III: oculomotor, IV occurs later

203
Q

where is the lesion in a positive pronator drift?

A

pyramidal tract

204
Q

how does the ice pack test work?

A

cold temperature inhibits the breakdown of acetylcholine, thus strengthening muscles
seen in myasthenia gravis

205
Q

tetanus inhibits release of

A

GABA & glycine

206
Q

high risk complication of status epilepticus

A

cortical laminar necrosis

207
Q

presents with hand grip myotonia, facial weakness, dysphagia at 12-30y/o

A

Myotonic dystrophy

208
Q

cause of myotonic dystrophy

A

autosomal dominant
expansion of CTG trinucleotide repeat in DMPK gene
chromosome 19

209
Q

comorbidities of myotonic dystrophy

A

arrhythmias, cataracts, balding, testicular atrophy, insulin resistance

210
Q

1 risk factor for neonatal intraventricular hemorrhage

A

prematurity

occurs in the first 7-10 days of life

211
Q

which parkinson’s medication can cause acute closure glaucoma?

A

trihexyphenidyl

212
Q

where are soil botulinum toxins highest?

A

California, Pennsylvania, and Utah

213
Q

EEG findings in Creutzfeldt-Jacob disease

A

sharp, triphasic, synchronous discharges

214
Q

Myasthenia gravis antibodies are directed against?

A

nicotinic receptors at the motor end plate

215
Q 
presents as:
failure to thrive
bilateral cataracts
jaundice
hypoglycemia
A

galactosemia

216
Q

enzyme deficient in galactosemia

A

galactose-1-phosphate uridyl transferase

217
Q

first line treatment for restless leg syndrome

A

dopamine agonists (pramipexole)

218
Q

cause of subclavian steal syndrome

A

atherosclerosis of L (more commonly, but can be R) subclavian artery proximal to the origin of the vertebral artery

219
Q

presentation of subclavian steal syndrome

A

ischemia of affected limb (pain, fatigue, parasthesias)
vertebrobasilar ischemia (dizziness, ataxia, dysequalibrium)
lower brachial systolic BP
systolic bruit in supraclavicular fossa
+/- 4th heart sound

220
Q

Where is the lesion in a pure sensory stroke?

A

posterolateral thalamus

VPL & VPM of contralateral side

221
Q

What is thalamic pain syndrome?

A

Dejerine-Roussy syndrome
post-stroke severe paroxysmal burning pain over affected area (usually where deficits are improving)
exacerbated by light touch (allodynia)

222
Q

When are patients with Guillain-Barre intubated?

A

a decline in FVC to <20mL/kg

monitored with spirometry

223
Q

triad of primary hyperaldosteronism?

A

HTN + HYPOkalemia + metabolic alkalosis

224
Q

hyposthenuria

A

inability to concentrate urine

urine will have low specific gravity

225
Q

nephrotic syndrome puts patients at increased risk of what CVD and how?

A

increased risk of accelerated atherosclerosis
hypoalbuminemia -> increases hepatic lipoprotein synthesis-> elevated levels of cholesterol & triglycerides -> advancing atherosclerosis

226
Q

What type of renal syndrome is seen in solid tumor malignancies?

A

membranous glomerulopathy

227
Q

What type of renal syndrome is seen in lymphoma?

A

minimal change disease

228
Q

treatment of recurrent nephrolithiasis without underlying cause?

A

(hypercalciuria)

thiazide diuretic

229
Q

What test should be ordered for a febrile UTI in a patient <2y/o?

A

renal & bladder ultrasound

230
Q

What are the indications for urgent urologic consultation in the setting of ureterolithiasis?

A

urosepsis, anuria, AKI, refractory pain, stone >10mm

231
Q

Appearance of renal bx in Alport syndrome?

A

longitudinal splitting of the basement membrane and foam cells

232
Q

what is the mechanism of renal failure in hepatorenal disease?

A

splanchnic arterial dilation -> decreased SVR -> activates RAAS-> renal vasoconstriction -> decreased perfusion & GFR

233
Q

common inciting factors of hepatorenal syndrome

A

spontaneous bacterial peritonitis & GI bleeding

234
Q

treatment for hepatorenal disease?

A

definitive: liver recovery (EtOH abstinence) or transplant
mitigating: splanchnic vasoconstrictors (midodrine, octreotide, NE) and albumin

235
Q

how can IgA nephropathy and PSGN be differentiated?

A

PSGN has low serum C3, 10-21 days after URI

IgA neph is usually within 5 days of URI

236
Q

pharmacotherapy for enuresis

A

desmopressin

237
Q

pain with ejaculation is associated with what disease process?

A

chronic bacterial prostatitis

238
Q

key factor to diagnosing psychogenic erectile dysfunction?

A

pt will maintain normal early-morning penile erections

239
Q

pain is worse when the scrotum is elevated

A

testicular torsion

240
Q

what testing can be needed in a penile fracture?

A

retrograde urethrogram if urethral injury is suspected

241
Q

presentation: penile curvature, penile pain, and dorsal nodule or plaque

A

Peronie disease

242
Q

medications that can cause priapism

A

alpha-1 antagonists, some SSRIs, trazadone, phosphodiesterase inhibitors, stimulants

243
Q

Other than painful menses, what symptoms are associated with endometriosis?

A

dysuria, dyschezia (painful bowel movements), and dysparenia

244
Q

how has nucleic acid amplification testing changed the treatment of chlamydia and gonorrhea?

A

it’s very sensitive and specific, so only need to treat the positive

245
Q

treatment for NAAT + chlamydia

A

azithromycin only

246
Q

treatment for NAAT + gonorrhea

A

ceftriaxone only

247
Q

genetic risk factor for premature ovarian insufficiency

A

FMR1 gene premutation for fragile X syndrome

248
Q

How is primary amenorrhea evaluated?

A

U/S to confirm presence of uterus

FSH (high in peripheral, low in central, normal in imperforate hymen)

249
Q

dx of breast bx result: fat globules and foamy histocytes

A

fat necrosis

250
Q

what testing should be performed before starting a patient on trastuzmab?

A

echocardiogram

side effect is asymptomatic decline is LV EF

251
Q

How to differentiate between 5alpha reductase deficiency and androgen insensitivity syndrome?

A

both have male internal and female external
5AR: clitoromegaly at puberty, but no breast development
AIS: breast development

252
Q

where are the Bartholin glands located?

A

posterior vulvar vestibule (5 & 7 o’clock positions)

253
Q

what is the physiology behind exercise-induced amenorrhea?

A

relative caloric deficiency leads to decreased GnRH, LH and estrogen causing hypothalamic amenorrhea

254
Q

secondary amenorrhea + virilization + markedly high testosterone

A

NOT PCOS
sertoli-leydig cell tumor, likely of ovarian origin
those of adrenal origin have high DHEAS instead of testosterone

255
Q

long term contraceptive that does not cause weight gain

A

levonorestrel or copper IUD

256
Q

how do you differentiate between fibroids and adenomyosis?

A

adenomyosis: constant pelvis pain, symmetric uterine growth, boggy uterus
fibroids: asymmetric growth, no pain between periods, firm uterus

257
Q

what condition precludes estrogen containing contraceptive use?

A

migraine with aura

258
Q

What test helps confirm choriocarcinoma?

A

Beta-hCG

259
Q

Where does choriocarcinoma like to metastasize?

A

lungs

260
Q 
glazed, brightly erythematous vulvar erosions
white striae (Wickham striae)
serosanginous vaginal discharge
stenosis of vaginal introitus 
lace-like reticular erosions on gingiva or palate, painful ulcers, and tongue plaques
A

vulvar lichen planus

261
Q

well defined oral ulcers with necrotic base

multiple oral and genital mucocutaneous lesions

A

Bechet disease

262
Q

granulosa cell tumor presents as

A

precocious puberty and adnexal mass

263
Q

peau d’orange is associated with what type of breast cancer?

A

inflammatory breast carcinoma

264
Q

Why should vasomotor symptoms, insomnia, and irregular bleeding in a middle aged woman not be assumed to be menopause?

A

It could also be hyperthyroidism

265
Q

timeline for postpartum blues

A

onset 2-3 days postpartum

resolves within 2 weeks

266
Q

preterm labor treatment

A

<32 w: betamethasone, tocolytic, and MgSO4
32-34w: betamethasone & tocolytics
>34w: +/-betamethasone

267
Q

symmetric fetal growth restriction is caused by

A

congenital disorders or first trimester insults

268
Q

asymmetric fetal growth restriction is caused by

A

placental insufficiency usually in 2nd or 3rd trimester (HTN, pregestational diabetes)

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