uworld Flashcards
1
Q
Digoxin toxicity causes what kind of arrhythmia?
A
atrial tachycardia with AV block
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
3
Q
Unilateral lower extremity edema associated with heaviness and cramping is most likely caused by?
A
venous insufficiency (venous valve incompetence
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
5
Q
Dressler Syndrome
A
post-cardiac injury syndrome
immune-mediated pericarditis
occurs weeks to months after MI
often accompanied by pericardial effusion
6
Q
presentation of RV MI
A
hypotension, elevated jugular venous pressure, clear lung fields, ST elevation in inferior leads (II, III, aVF)
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
8
Q
ECG findings of LV aneurysm?
A
persistent ST elevations with deep Q waves
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
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)
11
Q
systolic-diastolic abdominal bruit is associated with what pathology?
A
renal artery stenosis
12
Q
MOA of adenosine
A
inhibit L-type calcium channels
decreases conduction velocity at AV node
13
Q
treatment of unstable tahyarrhythmia
A
synchronized cardioversion (consider adenosine only if regular and narrow complex)
14
Q
why do we used synchromized cardioversion?
A
if shocked during repolarization, heart can go into more dangerous ventricular fibrillation
15
Q
How does digoxin toxicity present?
A
nausea, vomiting, decreased appetite, confusion, weakness
16
Q
Leriche Syndrome
A
aortoiliac occlusion:
bilateral hip, thigh, and buttock claudication
absent or diminished femoral pulses
impotence
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
18
Q
treatment of atrial fibrillation in WPW patients
A
hemodynamically unstable, electrical cardioversion
hemodynamically stable, procainamide or ibutilide
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
20
Q
What is acetaminophen’s effect on warfarin?
A
increases it’s effetiveness
21
Q
presentation of beta-blocker overdose?
A
bradycardia, AV block, hypotension, diffuse wheezing, hypoglycemia, bronchospasm, delirium, seizures, cardiogenic shock
22
Q
treatment for beta-blocker overdose
A
- ABCs: airway and IV fluids
- atropine for hypotension and bradycardia
- refractory hypotension: give glucagon. either with or succession: IV Ca, epi/norepi, high dose insulin & glucose, IV lipid emulsion
23
Q
workup for possible secondary causes of HTN
A
urinalysis, chemistry, lipid profile, baseline ECG
24
Q
What is a cardiac complication of tuberculosis?
A
constrictive pericarditis
25
What exam maneuver increases HOCM murmur?
valsalva
26
most common congenital heart defect in down's syndrome?
complete atrioventricular septal defect
27
presentation of constrictive pericarditis
right heart failure: progressive peripheral edema, elevated JVP, ascites, pericardial knock, pericardial calcifications on CXR
28
fatal complication of coronary artery stenting
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
29
how do vagal maneuvers work?
increase parasympathetic tone -> temporary AV nodal slowing & increase AV nodal refractory period -> termination of atrioventricular nodal reentrant tachycardia
30
Most frequent underlying arrhythmia responsible for sudden cardiac death?
ventricular fibrillation with reentry being the predominant mechanism
31
immediate or phase 1a arrhythmia
ventricular arrhythmias
reentrant
within 10 minutes of MI
32
delayed or phase 1b arrhythmia
10-60 minutes after MI
| from abnormal automaticity
33
treatment for asymptomatic, bilateral, not high grade carotid stenosis
antiplatelet and statin
34
When is a carotid endarterctomy recommended?
symptomatic patients (CVA or TIA in last 6 months) with high grade carotid stenosis (70-99%)
35
hemodynamic effects of an AVF
decreases SVR
increases preload
increases CO
36
clinical presentation of AVF
```
widened pulse pressure
strong peripheral pulses
systolic flow murmur
tachycardia
flushed extremity
LVH: laterally displaced PMI & ECG changes
```
37
causes of high output heart failure
```
AV shunting
thyrotoxicosis
Paget disease
anemia
thiamine deficiency
```
38
presentation of pulmonary HTN
weakness, angina, syncope, dyspnea
| JVD, reduced carotid upstroke, RV lift, loud pulmonary heart sound, & tricuspid regurgitation
39
How do AVF causes heart failure?
AV shunting increases preload
| normal to high CO, but not meeting oxygen demand of peripheral tissues
40
preferred HTN treatment in ADPKD
ACE inhibitors
41
increased 24 hour urine cortisol is seen in what disease?
Cushing's Syndrome
42
Cushing's Syndrome presentation
central obesity, facial plethora, proximal muscle weakness, abdominal striae, ecchymosis
43
primary aldosteronism presentation
resistant HTN or HTN with unexplained hypokalemia
| NO masses palpable
44
cardiac appearance of cardiac tamponade on CXR
normal
45
How does bronchial rupture present?
JVD & tension pneumothorax
46
Presentation of Kawasaki disease?
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)
47
Complication of Kawasaki disease?
coronary artery aneurysms
48
treatment of kawasaki disease?
IV Ig within 10 days of fever onset
| Aspirin
49
Who is at highest risk of complications in Kawasaki disease?
infants and those with prolonged fevers (>14 days)
50
Measles presentations
cough, coryza, fever, conjunctivitis, cephalocaudal rash
51
How does adenosine stress the heart in a pharmacologic stress test?
dilates coronary arteries without increasing HR or BP
52
How does dobutamine stress the heart in stress echocardiography?
beta-1 receptor agonist
| increase HR & myocardial contractility
53
What is target heart rate for exercise stress test?
85% of (220-age of patient)
54
What patients require pharmacologic stress testing?
LBBB
pacemaker
cannot reach target for exercise stress test
55
What patients require stress echocardiography?
reactive airway disease
| cannot reach target fro exercise stress test
56
presentation of fibromuscular dysplasia?
internal carotid stenosis: recurrent headaches, pulsatile tinnitus, TIA, CVA
renal artery stenosis: 2nd HTN, flank pain
abdominal bruit, subauricular systolic bruit
57
Why is bowel ischemia a complication of AAA repair?
the inferior mesenteric artery is lost during aortic graft placement causing inadequate colonic arterial profusion to L & sigmoid colon
58
three most important risk factors for acute aortic dissection
HTN, Marfan's Syndrome, cocaine use
59
MOA of aliskiren
direct renin inhibitor:
| increases natriuresis, decreases serum angiotensin II concentration, decreases aldosterone production
60
first line therapy for symptomatic PVCs
escalation of beta-blocker or calcium channel blocker
| decreases symptoms, does not directly suppress PVCs
61
acute onset HF following viral illness in otherwise healthy patient?
dilated cardiomyopathy
62
Mechanism by which dobutamine improves decompensated HF?
stimulates beta-1 adrenergic receptors
increase cAMP in cardiac myocytes
increased cardiac contractility & increased HR
decreases LV EDV
increased CO, decreasing pulmonary pooling
63
laboratory poor prognostic indicators in HF
hyponatremia, elevated pro-BNP, renal insufficiency
64
treatment for new rheumatic heart disease?
PCN (prophylactic)
65
extremity vascular trauma hard signs
```
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)
```
66
extremity vascular trauma soft signs
history of hemorrhage
diminished pulses
bony injury
neurologic abnormality (paresthesias)
67
pulsus paradoxus
fall in systolic BP >10mmHg during inspiration
68
causes of pulsus paradoxus
asthma
COPD
cardiac tamponade
69
What are Burr cells and what diseases are they seen in?
spiculated RBCs with serrated edges
liver disease
ESRD
70
What are Howell-Jolly bodies and what disease do they present in?
basophilic remnants of the nucleus in RBCs
| h/o splenectomy or functional asplenia
71
What are Spur cells and what diseases are they seen in?
RBCs with irregularly sized and spaces projections
| liver disease
72
What are target cells and what disease are they seen in?
RBCs with central density surrounded by pallor
| hemoglobinopathies (thalassemias) & chronic liver disease
73
Treatment for acute mediastinitis
surgical debridement and prolonged antibiotics
| antibiotics only are not enough
74
What class of drugs has been shown to significantly reduce the risk of systemic embolization in patients with moderate to high risk?
anticoagulants, NOT antiplatelets
75
treatment for patients with "long AF"?
nothing, because CHADSVASC is low
76
tricuspid valve atresia ECG findings
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
77
risk factors for c. diff infection
hospitalization
recent antibiotic use
PPI use
78
Presentation of Reye's syndrome
vomiting and abnormal behavior
rapidly progressive to seizures and lethargy
encephalopathy, hepatic dysfunction, & cerebral edema
79
When is ERCP the appropriate treatment in gallstone pancreatitis?
when cholangitis is present
80
Almost all infants with meconium ileus have what major disorder?
cystic fibrosis (only 20% of CF pts have meconium ileus, but almost all pts with meconium ileus have CF)
81
How can meconium ileus and Hirschsprung disease be ddx in a newborn?
ileus has microcolon
| HD has megacolon
82
What screening should be done on newly diagnosed cirrhosis or alcoholic liver patients?
EGD to assess for esophageal varices
83
What the primary prophylaxis for nonbleeding esophageal varices?
endoscopic variceal ligation or nonselective beta-blocker (propanolol or nadolol)
84
infant benefits to human breastmilk
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
85
the only nutritional downside to breastmilk?
vitamin D is too low and needs to be supplemented
86
maternal benefits to breastfeeding?
rapid uterine involution
decreased postpartum bleeding
faster return to prepartum weight
reduced risk of ovarian & breast cancer
87
contraindications to breastfeeding
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
88
Differentiating factors between retrocecal appendicitis and psoas abscess
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
89
treatment for newly diagnosed asymptomatic HepC
HepA & HepB vaccines
90
medications that can cause acute pancreatitis
```
valproic acid
diuretics
IBD drugs: mesalamine, 5-ASA
immunosuppressives: azathioprine
HIV meds
antibiotics: metronidazole, tetracycline
```
91
What is melanosis coli?
dark brown discoloration of the colon w/pale patches of lymph follicles
from regular use of laxatives
92
#1 cause of painless large volume bright red blood per rectum
diverticulosis
93
anti-mitochondrial antibodies are associated with what disease?
primary biliary cirrhosis
94
What signs are caused by hyperestrinism?
spider angiomata
palmar erythema
gynecomastia, testicular atrophy, & decreased body hair in males
95
long term complication of untreated giardiasis?
lactose intolerance (not everyone, just a sub population)
96
diagnostic requirements of acute liver failure
severe acute liver injury (AST & ALT >1000)
signs of hepatic encephalopathy
synthetic liver dysfunction (INR>1.5)
97
presentation of duodenal hematoma
blunt trauma with initial pain that subsides with time then presents 2/2 obstruction 24-36 hours later as hematoma expanded
usually children
98
diagnostic test to confirm duodenal hematoma
CT abdomen
99
treatment of duodenal hematoma
resolves in 1-2 weeks
NG tube placement
TPN
drainage if non-op fails
100
most common source of liver metastases?
colorectal cancer
101
elevated AST & ALT, elevated GGT, elevated ferritin, but no signs of cirrhosis?
alcoholic hepatitis
102
pleural effusion 2/2 small diaphragmatic defects in cirrhotic patient?
hepatic hydrothorax
103
treatment for breastfeeding jaundice
increase feeding frequency to q2-3hrs instead of q4hrs
104
cause of osteogenesis imperfecta
autosomal dominant type I collagen mutation COL1A1
105
types of osteogenesis imperfecta
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
106
physical exam findings of osteonecrosis of the femoral head?
progressive hip pain
| limited internal rotation & abduction
107
xerostomia & xerophthalmia with negative ANA
age-related sicca syndrome
108
Labs in Paget disease of bone
calcium & phosphorus are NORMAL (urine calcium may be high)
alkaline phosphatase is HIGH
urine hyroxyproline is HIGH
109
treatment for Paget's disease of bone
bisphosphonates
110
benign bone-forming tumor
osteoid osteoma
111
Where are Ewing sarcomas typically found?
pelvic bone or diaphysis of long bones
112
Morton neuroma
numbness or pain between 3rd & 4th toes
| clicking sensation when palpating the space between 3rd & 4th toes while squeezing metatarsal joints
113
1-6 month old presents with preferential head tilt to one side
congenital muscular torticollis
114
knee catching or buckling is associated with injury to what structure?
meniscus
115
lab findings in juvenile idiopathic arthritis
```
elevated ESR & CRP
hyperferritinemia
hypergammaglobulinemia
thrombocytosis
anemia
```
116
common causes of lumbar spinal stenosis
degenerative arthritis (spondylosis)
degenerative disc disease
thickening of ligamentum flavum
117
presentation of ruptured popliteal cyst
acute calf/knee pain
warmth & erythema
crescent sign: ecchymosis distal to medial malleolus
118
What medications can cause methemoglobinemia?
topical anesthetics (like benzocaine)
dapsone
nitrates in infants
119
What should be suspected in a patient with large oxygen saturation gap (between pulse oximetry & blood gas)?
methemoglobinemia
| pulse oximetry is more accurate in this situation
120
What type of hematologic disease is seen in obstructive sleep apnea?
Polycythemia
| hypoapnea & apnea-> decrease blood oxygen levels-> increased EPO
121
What causes hypocalcemia after MTP?
citrate anticoagulant in blood products chelates the serum calcium (and magnesium)
122
cause of TTP (thrombotic thromobocytopenic purpura)
autoantiboies to ADAMS13 protease (to cleave vWF)
| can be genetic or acquired
123
treatment for thrombotic thrombocytopenic purpura
plasma exchange
124
presentation of pinealoma
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
treatment of hypercalcemia
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
most common congenital aplastic anemia
Fanconi anemia
| autosomal recessive DNA repair defect
127
features of fanconi anemia
```
pancytopenia
abnormal thumbs
short stature
hypo/hyperpigmented macules
genitourinary malformations
```
128
hypertensive crisis in CKD patient is suspicious for?
EPO-related hypertension (30% of patients develop new or worse HTN on EPO)
129
translocation between chromosomes 9 & 22 is associated with what cancer
CML= chronic myeloid leukemia
130
BCR-ABL gene fusion causes what pathophysiology?
leukemogenesis 2/2 constitutively active tyrosine kinase
131
treatment for CML
tyrosine kinase inhibitors, ex. imatinib
132
How does DVT treatment change in ESRD patients?
unfractionated heparin instead of LMW heparin becuase LMW heparin is metabolized in the kidneys
133
hemosiderin deposition and cartilage fibrosis of joints is caused by?
Hemophilia
134
How is CLL diagnosed?
flow cytometry of peripheral blood (clonal maturity of B cells)
135
engorged anterior chest veins are a sign of?
superior vena cava syndrome
| highly associated with malignancy (small cell lung cancer & non-Hodgkin lymphoma
136
neonatal polycythemia causes
```
excessive transfusion (delayed cord clamping, twin-to-twin)
intrauterine hypoxia (maternal DM, smoking, or HTN)
genetic conditions (trisomy 21)
```
137
treatment for cancer-related anorexia
progesterone analogues (megestrol acetate) or corticosteroids
138
treatment for HIV cachexia
synthetic cannabinoids
139
large gamma gap
large difference between total protein and albumin
| associated with Waldenstrom macroglobulinemia
140
eosin-5-maleimide binding test
fragility test for spherocytosis
141
risk factors for vitamin K deficiency
malnutrition (inadeaquate dairy)
fat malabsorption (cystic fibrosis & biliary atresia)
intestinal inflammation (celiac disease & IBD)
decreased bacterial flora (increased Abx use)
142
what labs are abnormal in vitamin K deficiency?
PT prolongation occurs first
PTT is prolonged in severe cases
low factor VII
143
Why do multiple myeloma patients have increased rates of infection?
impaired effective antibody production
144
What type of anemia is seen in hypothyroidism?
normocytic
| or macrocytic in conjunction with pernicious anemia
145
Why do newborns have low vitamin K?
poor placental transfer
absent gut flora
immature liver function
inadequate levels in breast milk
146
What lab is used to monitor heparin?
PTT
147
What lab is used to monitor warfarin?
PT
148
What lab is used to monitor LMW heparins?
none, but can use anti-factor Xa activity
149
absolute basophilia is seen in what hematologic disease?
chronic myeloid leukemia (CML)
150
What is the leukocyte alkaline phosphatase score used for?
marker of neutrophil activity
differentiate CML from leukomoid reaction
result is low in CML
151
Auer rods are seen in which hematology disease?
acute myeloid leukemia
152
target organs for GVHD
skin (maculopapular rash involving palms, soles, & face)
intestines (blood+ diarrhea)
liver (abnormal labs & jaundice)
153
Anemia with thumb anomalies
Diamond-Blackfan
154
Lab findings in Diamond-Blackfan anemia
Pure red cell aplasia:
macrocytic anemia
reticulocytopenia
normal platelets & WBCs
155
eczema, micothrombocytopenia, & hypogammaglobulinemia
Wiskott-Aldrich syndrome
156
differential diagnosis for anterior mediastinal mass
4 T's: thymoma, teratoma, thyroid neoplasm, & terrible lymphoma
157
Tumor lysis syndrome labs reveal?
elevated potassium, phosphorus, and uric acid
hypocalcemia
AKI
158
define salvage therapy
treatment for a disease when standard therapy fails
159
antipsychotic medication effects on the tuberoinfundibular pathway
hyperprolactinemia-> gynecomastia, decreased libido, amenorrhea, & galactorrhea
160
antipsychotic medication effects on the mesolimbic pathway
antipsychotic efficacy
161
antipsychotic medication effects on nigrostriatal pathway
extrapyramidal symptoms: acute dystonia, akathisia, parkinsonism
162
tremor pattern in essential tremor
worse with activity, improves at rest
163
tremor pattern in Parkinson's
improves with activity, worsens at rest
164
trihexyphenidyl use
anticholinergic
| younger patient with Parkinson's with predominantly tremor
165
treatment for trigeminal neuralgia
carbamazepine
166
Walking by age
12 months
167
running by age
18 months
168
Huntington disease mainly effects which neuronal cell group?
GABA
169
absence of galactose-1-phosphate uridyl transferase is seen in what disease?
Galactosemia
170
aldolase B deficiency is seen in what disease?
fructose intolerance
171
If not diagnosed at newborn screen, how is phenylketonuria diagnosed?
quantitative amino acid analysis
172
dementia with visual hallucinations
Dementia with Lewy bodies
173
difference between MDD & persistent depressive disorder?
MDD sxs most days for at least 2 weeks
| persistent: depressed mood for 2 years
174
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?
bladder catheterization to prevent bladder injury secondary to acute distension & to asses urinary retention
175
differentiating clinical features between Tay Sachs disease and Niemann-Pick disease
TS: hyperreflexia
NP: areflexia & hepatosplenomegaly
176
cause of Tay Sachs disease
beta-hexoaminidase A deficiency
177
cause of Niemann-Pick disease
sphingomyelinase deficiency
178
glucoerebrosidase deficiency
Gaucher disease:
| anemia, thrombocytopenia, and hepatomegaly
179
galactocerebrosidase deficiency
Krabbe disease: early infancy (2-6 months)
developmental regression
hypotonia
areflexia
180
clinical presentation of Tay Sachs disease
```
loss of motor milestones,
cherry-red macula,
hypotonia
feeding difficulty
hyperreflexia
```
181
clinical presentation of Niemann-Pick disease
```
loss of motor milestones
cherry-red macula
hypotonia
feeding difficulty
hepatosplenomegaly
areflexia
type A is fatal by 3y/o
```
182
Guillain-Barre attacks which nerves?
immune-mediated polyneuropathy
| demyelination of PERIPHERAL NERVES
183
Shy-Drager Syndrome
aka multiple system atrophy
| Parkinsonism + autonomic dysfunction + widespread neurologic signs
184
complication of untreated idiopathic intracranial hypertension
blindness
185
```
gait dysfunction
truncal ataxia
nystagmus
intention tremor
dysdiadochokinesia
pendular knee reflex (hypotonia)
```
cerebellar dysfunction
186
periodic sharp-wave complexes on EEG are seen in what disease?
Creutzfeldt-Jacob
187
rapidly progressive dementia with 2 or more:
| myoclonus, akinetic mutism, cerebellar or visual disturbance, or pyramidal dysfunction
Creuztfeldt-Jacob
188
cause of Friedreich ataxia
excessive number of trinucleotide repeats (mostly GAA)
frataxin gene
autosomal recessive
189
comorbidities seen with Friedreich ataxia
```
kyphoscoliosis
pes cavus (high arches)
hypertrophic cardiomyopathy (often cause of death in 40s)
```
190
this presents in adolescents with progressive ataxia, loss of position and vibratory sense
Friedreich ataxia
191
first line therapy for mild to moderate Alzheimer's dementia
cholinesterase inhibitors
| donepezil, galantamine, rivastigmine
192
treatment for moderate to severe dementia
Memantine
193
bilateral internuclear ophthalmoplegia
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
Where is the lesion that causes bilateral internuclear ophthalmoplegia?
medial longitudinal fasciculus
195
Effect of damage to the Edinger-Westphal nucleus
ipsilateral fixed and dilated pupil that is nonreactive to light or accommendation
196
Features of NF 1
```
optic glioma
lisch nodules
cafe-au-lait macules
scoliosis
axillary & inguinal freckling
neurofibromas
tibial pseduoarthrosis
```
197
Presents with Marfanoid body habitus, intellectual disability, thrombosis, fair complexion, cerebrovascular accident
homocystinuria
198
treatment for homocystinuria
B6, folate, B12 to lower homocysteine levels
| antiplatelet or anticoagulation
199
Most common causes of single brain abscess
staphylococcus aureus or viridans streptococci
200
myoclonus
involuntary jerking of a muscle or muscle group
201
diabetic ophthalmoplegia effects which nerve?
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
Which cranial nerve is most likely to be impinged during uncal herniation?
CN III: oculomotor, IV occurs later
203
where is the lesion in a positive pronator drift?
pyramidal tract
204
how does the ice pack test work?
cold temperature inhibits the breakdown of acetylcholine, thus strengthening muscles
seen in myasthenia gravis
205
tetanus inhibits release of
GABA & glycine
206
high risk complication of status epilepticus
cortical laminar necrosis
207
presents with hand grip myotonia, facial weakness, dysphagia at 12-30y/o
Myotonic dystrophy
208
cause of myotonic dystrophy
autosomal dominant
expansion of CTG trinucleotide repeat in DMPK gene
chromosome 19
209
comorbidities of myotonic dystrophy
arrhythmias, cataracts, balding, testicular atrophy, insulin resistance
210
#1 risk factor for neonatal intraventricular hemorrhage
prematurity
| occurs in the first 7-10 days of life
211
which parkinson's medication can cause acute closure glaucoma?
trihexyphenidyl
212
where are soil botulinum toxins highest?
California, Pennsylvania, and Utah
213
EEG findings in Creutzfeldt-Jacob disease
sharp, triphasic, synchronous discharges
214
Myasthenia gravis antibodies are directed against?
nicotinic receptors at the motor end plate
215
```
presents as:
failure to thrive
bilateral cataracts
jaundice
hypoglycemia
```
galactosemia
216
enzyme deficient in galactosemia
galactose-1-phosphate uridyl transferase
217
first line treatment for restless leg syndrome
dopamine agonists (pramipexole)
218
cause of subclavian steal syndrome
atherosclerosis of L (more commonly, but can be R) subclavian artery proximal to the origin of the vertebral artery
219
presentation of subclavian steal syndrome
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
Where is the lesion in a pure sensory stroke?
posterolateral thalamus
| VPL & VPM of contralateral side
221
What is thalamic pain syndrome?
Dejerine-Roussy syndrome
post-stroke severe paroxysmal burning pain over affected area (usually where deficits are improving)
exacerbated by light touch (allodynia)
222
When are patients with Guillain-Barre intubated?
a decline in FVC to <20mL/kg
| monitored with spirometry
223
triad of primary hyperaldosteronism?
HTN + HYPOkalemia + metabolic alkalosis
224
hyposthenuria
inability to concentrate urine
| urine will have low specific gravity
225
nephrotic syndrome puts patients at increased risk of what CVD and how?
increased risk of accelerated atherosclerosis
hypoalbuminemia -> increases hepatic lipoprotein synthesis-> elevated levels of cholesterol & triglycerides -> advancing atherosclerosis
226
What type of renal syndrome is seen in solid tumor malignancies?
membranous glomerulopathy
227
What type of renal syndrome is seen in lymphoma?
minimal change disease
228
treatment of recurrent nephrolithiasis without underlying cause?
(hypercalciuria)
| thiazide diuretic
229
What test should be ordered for a febrile UTI in a patient <2y/o?
renal & bladder ultrasound
230
What are the indications for urgent urologic consultation in the setting of ureterolithiasis?
urosepsis, anuria, AKI, refractory pain, stone >10mm
231
Appearance of renal bx in Alport syndrome?
longitudinal splitting of the basement membrane and foam cells
232
what is the mechanism of renal failure in hepatorenal disease?
splanchnic arterial dilation -> decreased SVR -> activates RAAS-> renal vasoconstriction -> decreased perfusion & GFR
233
common inciting factors of hepatorenal syndrome
spontaneous bacterial peritonitis & GI bleeding
234
treatment for hepatorenal disease?
definitive: liver recovery (EtOH abstinence) or transplant
mitigating: splanchnic vasoconstrictors (midodrine, octreotide, NE) and albumin
235
how can IgA nephropathy and PSGN be differentiated?
PSGN has low serum C3, 10-21 days after URI
| IgA neph is usually within 5 days of URI
236
pharmacotherapy for enuresis
desmopressin
237
pain with ejaculation is associated with what disease process?
chronic bacterial prostatitis
238
key factor to diagnosing psychogenic erectile dysfunction?
pt will maintain normal early-morning penile erections
239
pain is worse when the scrotum is elevated
testicular torsion
240
what testing can be needed in a penile fracture?
retrograde urethrogram if urethral injury is suspected
241
presentation: penile curvature, penile pain, and dorsal nodule or plaque
Peronie disease
242
medications that can cause priapism
alpha-1 antagonists, some SSRIs, trazadone, phosphodiesterase inhibitors, stimulants
243
Other than painful menses, what symptoms are associated with endometriosis?
dysuria, dyschezia (painful bowel movements), and dysparenia
244
how has nucleic acid amplification testing changed the treatment of chlamydia and gonorrhea?
it's very sensitive and specific, so only need to treat the positive
245
treatment for NAAT + chlamydia
azithromycin only
246
treatment for NAAT + gonorrhea
ceftriaxone only
247
genetic risk factor for premature ovarian insufficiency
FMR1 gene premutation for fragile X syndrome
248
How is primary amenorrhea evaluated?
U/S to confirm presence of uterus
| FSH (high in peripheral, low in central, normal in imperforate hymen)
249
dx of breast bx result: fat globules and foamy histocytes
fat necrosis
250
what testing should be performed before starting a patient on trastuzmab?
echocardiogram
| side effect is asymptomatic decline is LV EF
251
How to differentiate between 5alpha reductase deficiency and androgen insensitivity syndrome?
both have male internal and female external
5AR: clitoromegaly at puberty, but no breast development
AIS: breast development
252
where are the Bartholin glands located?
posterior vulvar vestibule (5 & 7 o'clock positions)
253
what is the physiology behind exercise-induced amenorrhea?
relative caloric deficiency leads to decreased GnRH, LH and estrogen causing hypothalamic amenorrhea
254
secondary amenorrhea + virilization + markedly high testosterone
NOT PCOS
sertoli-leydig cell tumor, likely of ovarian origin
those of adrenal origin have high DHEAS instead of testosterone
255
long term contraceptive that does not cause weight gain
levonorestrel or copper IUD
256
how do you differentiate between fibroids and adenomyosis?
adenomyosis: constant pelvis pain, symmetric uterine growth, boggy uterus
fibroids: asymmetric growth, no pain between periods, firm uterus
257
what condition precludes estrogen containing contraceptive use?
migraine with aura
258
What test helps confirm choriocarcinoma?
Beta-hCG
259
Where does choriocarcinoma like to metastasize?
lungs
260
```
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
```
vulvar lichen planus
261
well defined oral ulcers with necrotic base
| multiple oral and genital mucocutaneous lesions
Bechet disease
262
granulosa cell tumor presents as
precocious puberty and adnexal mass
263
peau d'orange is associated with what type of breast cancer?
inflammatory breast carcinoma
264
Why should vasomotor symptoms, insomnia, and irregular bleeding in a middle aged woman not be assumed to be menopause?
It could also be hyperthyroidism
265
timeline for postpartum blues
onset 2-3 days postpartum
| resolves within 2 weeks
266
preterm labor treatment
<32 w: betamethasone, tocolytic, and MgSO4
32-34w: betamethasone & tocolytics
>34w: +/-betamethasone
267
symmetric fetal growth restriction is caused by
congenital disorders or first trimester insults
268
asymmetric fetal growth restriction is caused by
placental insufficiency usually in 2nd or 3rd trimester (HTN, pregestational diabetes)
