Uworld Pass 2 Flashcards
ECG signs of hyperkalemia? Treatment?
Peaked t waves, PR prolongation and QRS widening, sine wave pattern
Treatment: Calcium infusion, (stabilize the cardiac myocyte)
Infectious mononucleosis complications?
autoimmune hemolytic anemia and thrombocytopenia due to cross-reactivity of EBV induced antibodies against RBCs and platelets
Fever, headache, increased intracranial pressure in HIV patient? CD4+ count? Exposure risk?
Cryptococcal meningitis
CD4+ < 100
Exposure: invasive fungal infection acquired by the inhalation of spores
Treatment for condylomata acuminata?
Trichloroacetic acid, podophyllin resin
systolic murmur over the left sternal border that increases with inspiration
Tricuspid regurgitation
Cause of the s4 heart sound?
Chronic HTN
Fractional excretion of sodium in prerenal acute kdiney injury?
<1%
If a child has more than 3 episodes of acute otitis media in 6 months, or 4 in 12 months, what actions should be considered?
myringotomy with tympanostomy tube placement
What areas produce AFP?
Fetal yolk sac, liver, GI tract
Diagnostic test for restrictive pericarditis?
Echo
TTP cause? Treatment?
Cause: uncleaved vWF multimers 0< platelet trapping and activation
Tx: plasma exchange
Role of B12 in cell metabolism?
involved in DNA synthesis
deficiency -> defective DNA synthesis -> megaloblastic anemia
Stridor with inspiration and expiration that imrpves with neck extension?
Vascular ring
Biofeedback purpose
Control over physiological reactions
Thalamus blood supple?
Posterior cerebral artery via the thalamogeniculate branches
Adenosine uses?
paroxysmal supraventricular tachycardia
Signs of pheochromocytoma?
History of HTN, frequent headaches, severe increase after induction in BO
uremic pericarditis?
BUN > 60, pericardial driction rub, sharp and pleuritic chest pain
Signs of Pons infarct
Deep coma, total paralysis withinin minutes, pinpoint reactive pupils
Active marijuana use in breas feeding causes?
decreased muscle tone, poor suckling, desation
Long-term - delayed motor development at 1 year
Middle medullary syndrome
branch occlusion of thee vertebral and/or anterior spinal artery
contralateral paralysis of the arm and let, contralateral loss of position sense, tongue deviation
Findings in benign nephrosclerosis? Causes?
arteriosclerotic lesions of afferent and efferent renal arterioles, glomerular capillary tufts
Cause: HTN
Target cells
Alpha or beta thalassemia with hypochromic, microcytic RBCs with abnormal morphology
Neotrophilic pleocytosis
bacterial CNS infections
Cause of anemia of prematurity?
Decrease EPO production, short RBC life span, Iatrogenic blood sampling
What causes diastolic and continuous murmurs?
Pathological causes
Anti-double stranded DNA
SLE
Signs of medial meniscus injury?
small joint effusion, crepitus, locking, or catching with ROM
Post-concussive syndrome
headache, confusion, amnesia, difficulty concentrating or with multitasking, vertifo, mood alteration, sleep disturbance, anxiert
OCD treatment?
SSRI, CBT
How to correct sodium?
measured sodium (mEq/L + 2 mEq/L for every 100mg glucose
Which pregnant woman should receive Haemophilus influenzae type b vaccination?
High risk (HIV, sickle cell, prior splenectomy)
Strong risk factor for vasospastic angina?
Smoking
Breath holding spell
6 months to 6 years
Often occur after some event
Problem is Graves’ disease?
Anti-TSH antibodies
Most comon cause of warts on the skin?
HPV
Methotrexate MoA
Inhibits dihydrofolate reductase
Costovertebral pain and hematuria post trauma? Work-up?
Blunt genitourinary trauma, CT scan of abdomen/pelvis
Work-up: Urinalysis, CT scan (if stable), IV pyelography (if unstable) prior to surgery
McCune-Albright Syndrome
cafef au lait spots, polyostotic fibrous dusplasia and auonomous endocrine hyperfunction (gonadotropin-independent puberty
phenylketouria diagnosis?
Newborn screenin (tandem mass spectrometry)
Quantitative amino acid analysis (increased phenylalanine levels)
Treatment for Bacillary angiomatosis?
Doxycycline, erythromycin
Then, initiate retrovirals 2-4 weeks later
intraductal papilloma
Unilateral nipple discharge, no associated mass of lymphadenopathy
Most common cause of peptic ulcer disease?
helicobacter pylori
First step addressing a patients non-adherence?
Empathize
Abx for tooth abscess?
Ampillin-sulbactam and clindamycin
Most sensitive finding for aortic injury?
X-ray
Causes of minimal change disease in adults?
NSAIDS< lymphoma
Infant contraindications to breast feeding?
Galactosemia, inpaired falactose metabolism
Soft, tender uterus?
Adenomyosis
Effects of craniopharyngioma?
Bitemporal vision loss, calcified mass on imaging
Pituitary stalk compression -> diabetes insipidus, growth hormone deficiency
What does Mallory hyaline in the liver indicate?
Liver damage
Affect of nitrates on the heart
systemic vasodilation -> decreases cardiac preload -> reduction in left ventricular end-diastolic and end-systolic volume -> reduction in left centricular systolic wall stress -> angina relief
Clopidogrel MoA
antiplatelet agent that prevent platelet activation by blocking adenosine diphophate receptors in platelet surface
Causes of medication-induced prolonation of QT interval?
fluconazole, moxifloxacin
Complication of heraprin usage?
Heparin induced thrombocytopenia
Type 1-presents within 2 days, caused by direct effect of heparin on platelet activation
Type 2- antibodies to platelet factor 3 complexed with herparin (presents 5-10 days post initiation
More sensitive test for avascular necrosis?
MRI
Fibular foot drop signs?
Unilateral foot drop, impaired ankle dorsiflexion, preserved plantar flexion, numbness over dorsal foot
CGG’ expansion disease?
Fragile X syndrome
Early-morning cortisol levels is used to deterct?
Primary adrenal insuficiency
Pruritic, ertythematous rash with vesicles and small bullae at the site of exposure
type IV hypersensitivity, allergic contact dermatitis
hypertrophic osteoarthropathy
digital clubbing and body swelling, associated with pulmonary diseases (CF, malignancy)
Cause of blueberry muffin spots?
extramedullary hemotopoiesis
Who should receive screening for AAA
Men 65-75, who have smokes cigarettes
Glucose-6-phosphatase deficiency physcial characteristics? Lab findings?
Physical exam: doll-like face with rounded cheeks, thin extremities, short stature, and protuberant abdomen
Lab values: hypoglycemia (seizures), lactic acidosis, hyperuricemia, hyperlipidemia
AKA- type glycogen storage disease
Limited sclerosis antibody?
Anticentromere antibody
Sciatic pain?
Radiation to the calf and foot
Family history of colonic polyps and osteomas should suspect?
Familial adenomatous polyposis
Uveitis is assocated with what HLA?
B27
Diagnoing mitral stenosis?
X-ray- pulmonary blood flor redistribution to upper lones, dilated pulmonary vessels, flattened left heart border
ECG: “P matrale” broad and notched P waves, atrial tachyarrhythmias, right ventricle hypertrophy
TTE: mitral valve thickening/calcification, decreased mobility, coexisting mitral regurgitation
First steps in managing suspected vericeal hemorrhage?
Place 2 large-bore IVs, IV octreotide, Abx
Treatment for cystic teratoma?
Excision
sympathetic ganglion cell tumor, abdominal mass
neuroblastomas
Intramuscular epinephrine has failed, next step?
Intravenous epinephrine
Poor prognostic factors in systolic heart failure
Resting tachycardia, s3 gallop, low blood pressure, hyponatremia, elevated pro-BNP, renal insufficiency
Treatment for Tricyclinc overdose? MoA?
intravenous sodium bicarbonate -> sodium load will alleviate depressant action of myocardial sodium channels
How does the C. difficile toxin cause diarrhea?
penetrate colonic epithelial cells, resulting in apoptosis and the loss of tight junctions
How does flattening of the diaphragm cause increased work of breathing?
decreasing intrathorasic pressure during inspiration
Initial treatment for meningitis?
Ceftriaxone, vancomycin, dexamethoason (+ ampicillin is over 50, immunocompromised)
Most sensitive test to measure B12 deficiency?
Methylmalonic acid levels
How do nitrates affect coronary blood flow in coronary stenosis?
Decrease it due to dilating other vessels (angina)
Risk associated with positive pressure mechanical ventilation in a patient with a flail chest?
Lung puncture
Causes og guillain-Barre Syndrome?
Campylobacter jejuni, herpes viruses, H. influenza, mycoplasma
Complications from acute otitis media?
Conductive hearing loss, mastoiditis, meningitis
Signs of parvo virus in adults?
Erythema infectiosum (slappe cheek, fever, nausea)m acute, symmetric arthralgia/arthritis (hands, wrists, knees, feet), transient pure red cell aplasia
Best treatment for allergic rhinitis?
Intranasal corticosteroid
First step in management of hyperthyroidism?
Beta-blocker (propranolol
Signs of Osteoarthritis?
chronic pain, stiffness, bony enlargement
When should HPV vaccinations be offered?
Up until age 26, regardless of sexual activity
Treatment for necrotizing fasciitis?
Surgical debridement and broad spectrum antibiotics
When does an S4 rount occur in most patients?
Acute phase of myocaridla ingarction due to ishcemia induced myocardial dysfunction
Dfective collagen production is associated with what disease?
Ehler-Danlos syndrome
Lab findings in kawasaki disease
Elevated CRP, ESR
leukocytosis with neutrophilia (compared to lymphocytosis in viral infections)
Reactive thrombocytosis
Sterile pyuria on urinalysis
Treatment for uremic pericarditis?
dialysis
Antidote for opiod intoxication?
Naloxone
Common causes of necrotizing fasciitis?
Streptococcus pyogenes (group A strep)
Staphylococcus aureus
Clostridium perfringens
polymicrobial
What monitoring should be done on Beckwith Wiedermann sydrome patients?
alpha-fetal protein, serial abdominal ultrasounds every 3 months from birth to four years
Afect of look diuretics on calcium?
Increased excretion
Appearance of hemorrhagic stroke on CT?
white, hyperdense regions
Management of NSTEMI?
Anticoagulation
Recommendations for sun protection
SPF 13-30 or higher, reapplied at least every 2 hours, sun avoidance is best, apply first layer 15-30 minutes prior to exposure
When to use palivizumab for infants?
Preterm birth <29 weeks
Chronic lung disease of prematurity
hemodynamically significant congenital heart disease
Affect of potassium by furiosemide?
enhanced potassium excretion
Signs of carcinoid
Diarrhea (watery), dizziness, flushing ,wheezing (bronchospasm)
Fevers associated with malaria?
Cyclic in nature
Pyridoxine deficiency?`
Vitamine B6- irratibility, depresion, dermatitis, stomatitis, elevated homocysteine concentration -> venous thromboembolic disease and atherosclerosis
How to diffentiate cushing from PCOS?
Cushings has increased bruisability, skin atrophy, muscle wasting,
Conditions associated with Fragile X disoder?
ADHD, Autism
Insulin in secreted from what cell?
Beta cell of the pancreas
Defect in marfan syndrome?
Fibrillin-1
Hemolytic anemia with schistocytes, thrombocytopenia, renal insufficiency, neurologic changes, fever
Thrombotic thrombocytopenic purpura (ADAMTS13)
Klumpke palse
claw hand
- extended wrist, hyperextended metacarpophalangeal joints, flexed interphalageal joints, absent grasp reflex
- horner synfrome
- intact moro and bicepts reflex
Lab studies for iron defiency?
decreased MCV, IRON, Ferritin, iron/TIBC (transferrin)
Increased TIBC
How does left-sided colon cancer present?
bowel obstruction, constipation, abdominal pain
Putamen infarct sign?
contralateral hemiparesis, hemianesthesia, conjugate gaze deviation (towards lesion)
AKA- Thalamus eyes deviate towards
torticollis?
dystonia of the sternocleidomastoid muscle
bone pain that increases pain that worsens at night, relieved by NSAIDs? Managment?
Osteoid osteoma
Managment: NSAIDS (symptomatic) and serial examinations and x-rays every 4-5 months
Refractory cases is surgical resection
Anterior uveitis signs?
Redness around iris, most conjunctiva spared
Treatment for avascular necrosis?
NSAIDs, decreased weight bearing
dark urine after UTI and prussian blue staining on urinalysis?
G6PD deficiency
Hirschsprung vs meconium ileus
Hirschsprung- Associated with down syndrome, positive squirt sign
Meconium ileus- associated with CG, obstruction is at the ileus, inspissated consistency, negative squirt sign
When do you start rabies prophylaxis?
If the animal is unable to be quarantined if a pet or shows signs within 10 days
High risk wild animals- if unable to test, immeidately, if able, pending test results
Livestock, or farm animal- contact public health department
Lab findings in splenc sequestration crisis in SS patients?
Increased retic count, decrease platelets
Emphysematous cholecystilit
gallbladder wall infection due to gas-producing bacteria. Characterized by right upper quadrant pain -> cause ileus (decreased, absent bowel sounds)
Fibular neuropathy diagnosis?
Electromyography and nerve conduction studies
What type of tumor causes acromegaly?
somatotroph adenoma
Gaucher disease
Glycocerebroside accumunates in macrophages of the liver, spleen, bone marrow causing pain and cytopenia
Complications associated iwth Beckwith-Wiedenmann syndrome
Wilms tumor, Hepatoblastoma
Marfans vs homocystinuria?
Marfan-aortic root dilation, upward lens dislocation
Homocystinurea-intellectual disability, thrombosis, fair complexion, downward lens dislocation
Cause of atypical glandular cells on Pap
cervical or endometrial adenocarcinoma
Tital volume?
6mL/kg
Most common pathogens in acute otitis media
Strep. pneumoniae
nontypeable H. influenza
Moraxella catarrhalis
First step in the management of a immigrant with upper lobe lung opacisty and coughing blood?
Isolation, suspected TB
Strawberry vs. Cherry Hemangioma?
Strawberry- infants
Cherry- increased frequency with age
Waldenstrom macroglobulinemia?
Hyperviscosity syndrome, neuropathy, hepatosplenomegaly, lymphadenopathy, increased IgM, rouleaux formations, >10% cloncal B cells
Diagnosis for toxic megacolon?
Three of the following: fever (>100.4), pulse (120), WBC > 10,500/u:, anemia
hypopyon, keratic precipitates “mutton fat”, iris modules
anterior uveitis
Direct renin inhibors, effects?
natriuses, decreases serum angiotensin II, decreases aldosterone production
eg: aliskiren
Treatment for tourette disorder?
Antipsychotics, alpha-2-adrenergic receptor agonist, behavioral therapy
Treatment for toxic megacolon?
antibiotics, intravenous steroids (IBD-induced)
Defects associated with increased AFP?
Open neural tube defects, ventral wall defects, multiple gestations
Amiodarone is used for…
Stable and unstable vertricular arrhythmias
Signs of selective IgA deficiency?
recurrent sinopulmonary and GI infections, normally asymptomatic, anaphylaxis during transfusions
fever 104-106, teachycarida, hypertension, agitation, lid lag? Treatment?
Thyroid storm
Treatment: beta blocker and TSH level
Choanal atresia- diagnosis?
failure to pass catheter through nares into oropharynx, confirmed by CT scan
When is alpha fetal protein measured?
15-20 weeks (16-18) ideally, elevations warrant US follow-up
What joints does rheumatiod arthritis involve?
metacarpophalangeal joints (MCP)
How to antithrobin deficiency normal occuring?
DIC, cirrhosis, nephrotic syndrome
Contraindicated imaging modalities during pregnancy include
CT, intravenous pyelogram
When is chlamydia and gonorrhea routinely screened?
All sexually active woman under 25 should be screened annually
Clincal findings of mitral stenosis?
Dyspnea, orhopnea, hemoptysis, voice horseness
Risks associated with coarctation of the aorta?
Heart failure, if the PDA is allowed to close, shock
Hemihyperplasia? Associated with?
Overgrowth of one side of the body
Associated with Beckwith-Wiedeman
Trimethoprin MoA
inhibits dihydrofolate
Bulimia nervosa
Recurrent episodes of binge eating with compensatory behaviors (vomiting, exercise, etc), with normal body weight
Werdnig-Hoffman syndrome
Degeneration of the anterior horn cells and cranial motor nuclei
causes “floppy baby”
Effects of DES exposure in utero
Clear cell adendocarcinoma of the uterus and cervix
Structural abnormalities of the reproductive tracter (T-shaped uterus, hooded cervix, baginal septae)
pregnancy problems (ectopic pregnancies, pre-term delivery)
Infertility
Signs of orbital cellulitis?
Unilateral, associated with paranasal infection
present with fever, proptosis, restriction of extraocular movements, swollen, red eyelids
Cause of lacunar infarct?
Microatheroma formation and lipohyalinosis
paradoxial splitting of S2
delayed relaxation of myocardial cells and delayed closure of aortic valve
Truncus aateriosus Examination, R-ray findings?
Single s2, systolic ejection murmur (increased flow through truncal valve)
Increased pulmonary blood flor, edema
Vaccinations for patients with HIV
Hepatitis B (unless documented immunity)
PCV13, followed 8 weeks later by PPSV23 (again 5 years later and at 65), varicella (CD4+>200
seronegative spondyloarthritis, aka?
Anklyosing spondylitis
Akathesia?
sensatio of restlessness that causes frequent movement
Neuroblastoma vs wilms tumor
Neuroblastoma crosses midline and has systemic symptoms within the first year of life
Wilms does not cross midline, 2-5 years of age
Benzotropine treatment? MoA?
MoA anticholinergic
Use: extrapryamidal side effects
Congenital clubfoot findings?
Ridit positioning, medial/upward deviation of forefoot and hindfoot, hyper-plantar flexion of foot
Diagnostic requirements to diagnose acute liver failure
Severe acute liver injury, signs of hepatic encephalopathy, synthetic liver dysfunction (INR >/= 1,5
Most common inherited thrombophilias in white people? MoA
Factor V leiden, activated protein C resistance
Leflunomide side effects
Hepatotoxicity, cytopenias
dissociative identity disorder?
2 or more distinct personalities that alternately assume control of the person’s behavior
pale follicles, conjuncativitis, tarsal inflammation?
Trachoma
When to use adenosine
supraventricular tachycardia
Signs of MEN2B?
medullary thyroid cancer, pheochromocytoma, marfanoid habitus, mucosal neuromas
Focal of CBT?
Challenges maladaptive throughts, targets avoidance with behavioral techniques
Management of central precocious puberty?
Brain imaging (CT/MRI) and GnRH analog
Orbital cellulitis? Most common predisposing factor?
Pain with eye movements, proptosis, opthalmoplegia, diplopia
Cause: Bacterial sinusitis (prevalence and location)
Recent period, lower abdominal pain, rebound tenderness in female
Ruptured ovarian cyst
Sign of avascular necrosis in imaging?
Cresent sign
First line pharmacotherapy for fibromyalgia?
Tricyclic antidepressents
Alternatives are SSRI/SNRI, pregabalin
Medial deviation of the forefoot with neutral hindfoot? Treatment?
Reassurance
Asthma PFT results
FEV1 < 80%, FEV1/FVC > 70%, FVC < 80%
Diagnosis of fibromyalgia, Treatment
normal examin, except for trigger point tenderness, lab tests are noraml
Treatment: exercise regimin
Medial medullary syndrome
alternative hypflossal hemiplegia, contralateral paralysis or arm and leg, plus deviation of tongue towards lesion
WAGR syndrome
Wilms tmor, aniridia, geritourinary anomalies, interectualy disability (retardation)
Common risk factors for C difficile infections?
Recent Abx, advanced age, gastric acid suppression
Congenital associations with ventricular septal defects?
Trisomy 13, 18, 21
LH and FSH in premature ovarian failure
FSH > 40, LH >25
How does pernicious anemia lead to increased risk of gastric cancer?
antiantibodies decrease functional instrinsic factor -> chronic atrophis gastritis -> increased risk of gastric and carcinoid
supratentorial brain tumor with cystic structures and calcification on imaging
craniopharyngiomas
Binge-eating disorder?
recurrent episodes of binge eating without inappropriate compensatory behaviors
Contraindiciation to carboprost?
Asthma, causes bronchoconstriction
Specificity
True negative over true negative plus false positive
identified people without the disease
Signs of uncomplicated lumbar strain?
radiation of pain to the buttocks or posterior thign
Different neurological complaints spaced out in time? CSF findings?
MS
CSF- oligoclonal bands
neonatal tetanus
trimus (lockjaw, feeding difficulty), spasms of muscles of mastication, respitatory failure, hypertonicity
**high risk in unvaccinated populations
Acute onset of abdominal pain, fever, hematuria, in the setting of nephrotic syndrome
Suspect renal vein thrombosis
Laboratoy findings in intravascular hemolytic anemia?
elevated reticulocyte count, increased LDH, decrease Haptoglobin
Norepinephrine-psychiatric condition?
Anxiety, altertness, learning, memory
Vaccines safe during pregnancy?
Tdap, Rho(d), inactived influenza
Requirements for EPO therapy?
chronic renal failure and hematocrit <30%, after iron deficiency has been rules out.
Atropine is used to treat?
Sinus bradycardia, AV nodal block
well-defined cyst with eggshell calcifications
Echinococcus granulosus -> transmitted by dogs
hydatid cysts
Congenital toxoplasmosis findings?
diffuse intracerebral calcifications, severe chorioretinitis
Juvenile idiopathic arthritis? Laboratory findings?
Symmetric arthritis for at least 6 weeks, (poly >5, oligo <5_
Laboratory findings: elevated inflammatory markers (ESR, CRP), hyperferritemia, hypergammaglobulinemia, thrombocytosis, anemia (most common)
Most common cause of prmary adrenal insufficiency?
Autoimmune adrenalitis
Complications from orbital cellulitis?
blindness, subperiosteal abscesses, vacernous sinus thrombosis, intracranial infection, death
What happens in megaloblastic anemia if you supplement folate
Megaloblastosis regresses, even in the presence of B12 deficiency
What is lung compliance?
Change in volume per change in pressure and is the inverse of elasticity
Most common cause of B12 deficiency? Increased risk for?
Pernicious anemia, increased risk of developing gastric cancer
Signs of methanol poisoning?
headache, nausea, vomiting, epigastric pain, vision loss, coma
Granulomatosis with polyangitis- Diagnosis
ANCA: PR3,
Biopsy: skin- leukocytoclastic vasculitis
kidney- pauci-immune GN
lung- franulomatous vasculitis
Most common pathogen in people less than 20? Treatment?
S. Aureus
Treatment: First time cefepime
Recurrent infections, hospitalization etc: Vancomycin (methcillin resistance)
Total anamalous pulmonary venous return with obstruction: Examination, X-ray
severe cyanosis, respiratory distress
Pulmonary edema, “snowstorm” sign (enlarged supracardiac veins & SVC
Features of glucagonoma?
neccrolytic migratory erythema (erythematous papules/plaques on face, perineum, extremtiies -> lesions enlarge over 7-14 days and develop central clearing and blistering, crusting, scaling @ borders
DM-mild, controlled with diet and oral agents (no insulin normally)
weight loss,
neuropsychiatric
Associated with venous thrombosis
What type of stones are Chron’s disease patients at increased risk for developing?
Oxalate, due to decreased calcium binding (preference for fat binding)
Most common primary immune deficiency?
IgA
Deficiency seen in carcinoid tumor?
Niacin (carcinoid cell use the tryptophan, instead of being used to produce niacin)
Late stages will see tryptophan deficiency
What does the p-value measure?
Random risk, not bias
When should an x-ray be ordered for back paiin? MRI? bone scan?
X-ray-osteoporosis/compression fractures, malignancy, anklyosing spondylitis
MRI: sensory/motor deficit, Cauda equina syndrome, epidural abscess/infection
Bone scan: needs MRI, but unable to get MRI
Initial management for torsades de pointes? AKA?
AKA: polymorphic centricular tachycardia
Tx: immediate defibrillation in hemodynamically unstable patients
intraveneous magnesium in conscious, stable patients
neurocysticercosis?
Taenua solium -> cysts in the brain and muscle
Signs of TCA overside?
QRS > 100 msex, hyperthermia, dilated pupils, interstinal ileus, urinary retention
Signs of infiltrating ductal carcinoma?
Breast mass, lymphadenopathy, patholigcal nipple discharge
Psychodynamic psychotherapy purpose?
Target how past experiences shapes presents situations
anti-cardiolipin detects?
antiphospholipid syndrome
How long after joint replacement do staph and pseudomonas typically present? Signs?
3 months
acute pain, fever, leukocytosis, erythema purulent drainage
Signs of osteomalacia?
bone pain, muscle weakness, muscle cramps, difficulty walking, waddling gain
ESRD is a contraindications for what type of anticoagulations?
Low molecular weight heparin (enoxaperin) and reiaxoaban -> metabolized by the kidney
Treatment for polymyalgia rheumatica?
Steroids
Workup for suspected SLE?
Anti-ana
if positive (anti-ds DNA, anti-Smith, anti-U1 rubonucleprotein)
Pathological findings of sjogren syndrome? Antibodies?
salivary gland biopsy with focal lymphocytic sialoadenitis
Antibodies: anti-Ro (SSA) and anti-La (SSB)
Signs of niacine deficiency?
Diarrhea, dermatitis, dementia
Arachnodactyly is associated with
Marfan syndrome
Aortic dissection- workup?
Initial CT angiography, if hemodynamincally stable (will show intimal flap separating the true and false lumens()
MR angiogrphy-time consuming, requires normal kidney function
Transesophageal echocariography: (Diagnostic in unstable patients)
Physical exam findings in necrotizing fasciitis?
erythema, swelling, pain out of proportion to physical exam findings
Contraindication ot the use of methylergonovine?
Hypertension
Treatment for “eggshell calcified cyst” ?
surgical resection under the cover of albendazole
Pathogenesis of exercise-induced bronchoconstriction?
mast cell degranulation triggered by the passage of high volumes of dry, cold air
Most common cause of neck pain and stiffness?
Cervical spondylosis
cysticercosis?
cysts in the brain and muscle associated with Taenia solium
Medication causes of SIADH
Carbamazapine, SSRI, NSAIDs
What movements increase murmur in hypertrophic cardiomyopathy?
Valsalve (straining phase), abrupt standing, nitroglycerine
Most common behavioral risk factor for TB?
substance abuse
VIPoma findings? Related syndrome?
watery diarrhea, hypokalemia
Order abdomainl CT or MRI to locate
Related syndrome: MEN
Stool pH in lactase deficiency?
Acidic
Normal age for urinary incontinence to regress?
less than or equal to 5
OCP vs OCPD
OCPD=preocculation with orderliness and perfectionism and control
OCD-obsessions that cause anciety and result in ritualistic behavior performed to decrease it
Most common cyanotic heart disease in the neonatal period? Management?
Transposition of the great vessels
Management: Prostaglandins (maintain PDA), and atrial septostomy (if no blood mixing)
Tricuspid atresia Examination? X-ray?
Single S2, VSD murmur
minimal pulmonary blood flow
in a patient with likely PE, what is the first step in managment?
Anticoagulation
Most sensitive test for gallstones?
Ultrasound
Non-beta cell tumor findings? Lab findings?
hypoglycemia independent of insulin -> produce IGF-II
Supressed insulin, C-peptide
Pneumonia vaccination schedule in adults
PPS (pneumococcal polysaccharide vaccine)23 along: under 65 with chronic cardiac, pulmonary, hepatic disease, diabetes, current smokers, alcoholics
PPS23 and PCV13 *pneumococcal conjugate vaccine” (very high risks)- CSF leaks, cochlear implants, sickle cell disease, asplenia, immunocompromised, chronic kidney disease
>65- PPS13 following by 26 1 year later
hypertrophic osteoarthropathy
development of clubbinf and sudden-onset joint arthropathy in a chronic smoker
hyperviscosity syndrome
diplopia, tinnitus, headdache, dilated/segmented funduscopic exam
Fatique, weakness, sclerodactyly, raynaud phenomenon? Antibody?
Systemic sclerosis
Antibody- anti-topoisomerase I (SCL-70) abd anti-RNA polymerase III *more specific)
Affect of anabolic steroid use and androgens on FSH, LH?
Negative feedback
Anemia of chronic diseases - lab findings?
Normal/decreased MCV, Transferrin
Decreased iron, TIBC
Normal/increased ferritin
Norcardia? Treatment?
nodular, cavitary lesions in the upper lung lobes, characterized as filamentous gram-positive rods weakly acid-fast
Treamtnet: Trimethoprim-sulfamethoxazole
Highest association with strokes?
Hypertension, both hemorrhagic and ischemic
Glomerulosclerosis
progressive loss of flomerular capillary surface area with flomerular and peritubular fibrosis
Rathke cleft cysts, calcification?
No association
Iron studies in thalassemia?
Markedly decreased MCV
Decreased TIBC
Increased Iron, ferrin
Markedly increased transferrin
What is the treatment for Rheumatoid arthritis?
Methotrexate
if persistent for >6 months either add sulfasalazine or hydroxychloroquine) or replace with TNF inhibitor
NSAIDS are for symptomatic relief
Sulfasalazine side effects
hepatotoxicity, stomatitis, hemolytic anemia
Dacryocystitis
iinfection of the lacrimal sac
Widened mediastinum of chest radiograph with pericardial effusion, history of hypertension, syncopy, neck pain?
Acute aortic dissection (especially ascending aorta)
Is serum alkaline phosphatase specific for anything?
No
Sympathomimetic toxcity
Hypertension, hyperthermia, mydriasis
Comorbidities associated with muscular dystrophy?
Duchenne- Cardiomyopathy, scoliosis
Becker- Cardiomyopathy
Myotonic- Arrhythmias, cataracts, balding, testicular atrophy/infertility
HIV patient with multiple ring-enhancing, spherical lesions in the basal ganglia? Treatment?
Toxoplasmosis, Trimethoprim-Sulfamethoxazole
Paraneoplastic syndromes associated with Squamous cell carcinoma of the lung?
parathyroid hormone-related protein (PTHrP
Atrial fibrillation after CABG
A fib is common within a few days post CABG. Treat with beta blockers or amiodarone. Should be self limited to less than 24 hours
If longer than 24 hours anticoagulation and elecric cardioversion
Diabetes mellitus nephropathy findings?
increased extracellular matrix, basement membrane thickening, mesangial expansion, fibrosis
Renal disease associated with solid tumors?
membranous glomerulopathy
Porcelain gallbladder, increased risk for?
gallbladder adenocarcinoma
Signs of ethylene glycol poisoning?
Anion gap acidosis, increased osmolar gap
acute onset psychosis, arthralgia, thrombocytopenia, hematuria, proteinuria in female
SLE
How to manage vasovagal syncopy?
reassurance, avoidance of triggers, counter pressure techniques (legs raised, lay down)
Screening with familial adenomatous polyposis?
yearly colonoscopies and regular screenig for upper GI tract tumors
Amiodarone uses?
atrial and ventricular tachycardia
Pharmacotherapy for monsymptomatic enuresis?
Desmopressin, tricyclics (imipramine, amitriptyline desipramine) are second-line
Treatment for acute aortic dissection?
Pain control (morphine)
Intravenous beta blckers (esmolol)
Sodium nitroprusside (if SBP > 120)
Uregent surgical repair for ascending dissection
MRI findings in progressive multifocal leukoencephalopathy?
None, no mass effects
Tetralogy of Fallot: Examination? X-ray
Harsh pulmonic stenosis murmur, VDS
x-ray “boot-shaped” heart (right ventricular hypertrophy)
inheritance of sickle cell disease?
Autosomal recessive
What factors decrease murmur in hypertrophic cardiomyopathy
sustained hand grip, squatting, passive leg raises
WHen to perform pericardiocentesis?
Pericardial effusion and cardiac tamponade with hemodynamic instability or cardiogenic shock
Chromosomal abnormality associated with Beckwith-Wiedermann syndrome
11p15, include insulin-like growth factor 2 (similar to insulin)
Substernal chest pain in an HIV patient with oral thrust management?
3-5 days oral fluconazole
If unresponsive perform esophagoscopy with biopsy, cytology, culture
hordeolum
abscess located over the upper or lower eyelid
What other lab findings can cause hypocalcemia?
hypomagnesia, hypoalbuminemia, drugs (bisphosphonates, calcium chelators, phenytoin
How to treat uric acid stones?
Potassium citrate (alkanization of the urine)
Treatment for thyrotoxicosis in infants?
Beta-blockers and methimazole
Circulating immune complexes that damage the kidney include?
SLE, post-streptococcal flomerulonephritis
Diagnosis of Parvo?
B19IgM in immunocompetent
NAAT B19 DNA for immunocompromised
Previous infection: IgG
Reactivation: NAAT for B19 DNA
Methotrexate side effects
hepatotoxicity, stomatitis, cytopenias
Ulnar nerve syndrome? Most common sitet?
Decreased ssensation of the 4th/5th fingers and weak grib due to interosseous mscule of the hand
Common site: entrapment of the medial epicondylar groove
Long-term reatment for severe calcium (>14) or symptomatic?
bisphosphonates (zoledronic acid)
Gonococcal vs Chlamydial conjunctivits
Gonococcal- copious exudate and purulence, 2-5 days post delivery, prevented with topical erythromycin
Chlamydial- milder chemosis and eyelid swelling, watery, 5-14 days post delivery (must treat systemically due to risk for pneumonia)
Location of MS lesion?
perventircular and subpial white matter of the cerebrum ( corpus callosum
chronic inflammation of the meibomian gland
chalazion
Contraindications to anticoagulation
active bleeding, hemorrhagic stoke
When does mid-forearm entrapment of the ulnar nerve occur?
Diabetes patients
Clinical features of Phenylketouria?
Severe intellectual disability, seizures, musty body odor, hypopigmentation involving skin, hair, eye, brain nuclei
Sodium bicarbonate use in apirin overdose?
Urine alkalinization
glial cell tumors that arise from the ependymal cell lining of the ventricles and spinal cord
Ependymomas
Cause for the development of gallstones during pregnancy?
Estrogen-induced increased in cholesterol secretion7
Hyperkalemia
PCP vs bath salts?
bath salts last longer (psychosis, etc)
Why do you obtain hepatitis B DNA?
chronic hepatitis B to determine candidacy for antiviral therapy or monitor response
CHF respiratory findings?
hypoxia, hypocapnia, respiratory alkalosis
Large difference in O2 saturation between hand and food, decrease capillary refill in lower extremities, left paravertebral interscapular area murmur?
Coarctation of the aorta -> increased tunica media thickeing in the aortic arch
Diagnosis of osteomalacia?
Inc. alk phos, PTH
dec. serum calcium, phosphorus, urinary calcium, 25 OH-D levels
Ulceers predisposed by peripheral neuropathy?
neglect ulcers on soles of feet
Enthesitis
tenderness at tendon insertion sites
2 year old development language milesstones
> 50 wods, understand half, 2 word sentences, turning pages in a book, throwing and kicking balls
AIDS patient with EBV DNA present and altered mental status, suspect? MRI finding?
CNS primary lymphoma
MRI- weakly ring-enhancing mass that is usually solitary and periventricular
Granulomatosis with polyangitis
Upper respiratory: sinusitis, saddle-nose deformity,,
Lower respiratory: lung nodules, cavitation
Renal: rapidly progressing glomerulonephritis
Skin: livedo reticularis, nonhealing ulcers
Test to diagnose lactose intolerance?
Positive hydrogen breath test, characterized by a rise in hydrogen in the breath after the ingestion of lactose indicating carbohydrate metabolism by bacteria
Antibodies in celiac disease
anti-transflutaminase and anti-endomysial
actinomyces
cervicofacial disease (nonpainful, chronic mandibular mass)
What are late term pregnancies at greatest risk for?
Uteroplacental insufficiency
Treatment for clubfoot?
Series manipulations and casting
Signs of cresent glomerulonephritis?
autoimmune disorders, AKI (hematuria, HTN)
Autoantibodies again acetylcholine recept in postsynaptic membrane?
Myasthenia gravis
Kidney estimate of hydration level?
BUN:Cr >20
Management of pituitary adenoma?
< 10mm and asymptomatic- no treatment
>10mm of symptomatic - Dopmine agonists (cabergoline or bromocriptine)
Resection if >3cm, or increases while on treatment
Complications from acute bacterial meningitis?
Hearing loss (most common)
intellectual disability
cerebral palsy
epilepsy
What type of infections do cushing sydrome patients have an increased risk for?
funal infections (tinea versicolor, onychomycosis
Management of shoulder dystocia?
Breathe, do not push
Elevate again abdomen (McRoberts position)
Call for help
Apply suprapublic pressure
Enlarge vaginal opening
Maneuver (delivery posterior arm, rotate 180 degrees, etc)
BE CALM!
Common bacteria in infective endocarditis from UTI?
Enterococci
HIV patient with subacute cough, inflammatory upper lung lesion
Reactivated TB
plonal proliferation of myoloid cells
Polycythemia vera
pain and redness in the medial cathal region? Organisms?
Dacryocystitis
S. aureus, beta-hemolytic strep
Associated symptoms with ankylosing spondylitis?
Low back pain (improved with exercise), hip and buttock pain, limited chest expansion, enthesitis (tendon insertion inflammation), acute anterior uveitis
SIADH laboratory findings
Hyponatremia, serum osmolarity <275mOsm/kg (hypotonic
Urine osmolatity >100mOsm/kg
Urine sodium > 40mEq/L
Stool is celiac disease?
Greasy, foul-smelling
Cor pulmonale
dyspnea, angina, syncope, anorexia, peripheral edema
Loud P2 on examination
Right heart cath (definitive) will show elevated pulmonary artery systolic pressure
uveitis presentation?
blurred vision with moderate pain, conjunctival injections and constricted pupils
Infection induced bleeding from the kidneys
white blood cells and RBC on urinalysis
cerebellar vermin, vomiting, headache, ataxia?
Medulloblastoma
Confirmatory testing for acromegaly?
Glucose suppresion test
Diagnostic tests for DM type 1?
Insulin levels and anti-flutamic acid decardocylase
Management of pancreatic cyst with symptoms?
Endoscopic drainage
Malginant biliary obstruction vs Primary biliary cirrhosis?
PBS is AMA positive
congnitive and personality changes and focal neurolofical deficits and/or seizures
HSV-1
Congenital syphillis findings?
Rhinorrhea, abnormal long-bone radiographs, desquamating or bullous rash
Chronic trachoma infection signs?
scarring of eyelids -> inversation of eyelashes -> ulcers -> blindness
When is RoGam given?
After fetal blood type has been determined (usually after deliver)
Contraindications to breast feeding?
Active untreated TB
Maternal HIV infection
Herpetic breast lesions
Active varicella infection
Chrmotherapy or radiation therapy
Active substance abuse
Signs of growth hormone abuse?
Hyperglycemia, sodium retention, hypertension, swollen hands, joint/muscle pain
bite cells and heinz bodies? Diagnosis?
Glucose-6-phosphata dehydrogenase deficiency
Acute bowel ischemia?
diminished bowel sounds and severe abdominal pain despite normal physical examination
Ovarian cysts late in a period
Corpus luteum cyst -> reputure can lead to bleeding when anticoagulated
Neonatal botulism
weakness, constipation, poor feeding, hypotonia
Manifestatios of dermatomyositis?
AC block, Gottron papules, heliotrope eruption and myalgias, proximal muscle weakness
Risk factors for syrinomyelia?
Arnold Chiari malformation, prior spinal cord injuries
What type of cancer is sjogren syndrome associated with?
non-Hodgkin lymphoma
Serotonin syndrome
muscular rigidity, significant hypertension
Examination and x-ray findings for transposition of the great vessels?
Single S2 +/- VSD,
“egg-on-a-string” (narrow mediastinum)
Signs of osteogenesis inperfecta? Inheritance?
Inheritance: Autosomal dominent
Blue sclera, recurrent fractures, hearing loss, dentinogenesis inperfectrs (opalescent blue-grey to yellow-brown discoloration of the dentin shining through the weak enamel
Congenital associations with patent ductus arteriorsus?
rubella, Char syndrome
Proptosis, ophthalmoplegia, chemosis, vision loss
Cavernous sinus thrombosis
Hawthorn effect
tendency of a study population to affect outcomes because they are aware they are being studied
Massive PE is defined as
hypotension and/or acute right heart strain (RBBB), distended neck veins
Choanal atresia? Associated syndrome?
cyanosis affrevated by feeding and releived by crying
nasal malformation caused by posterior nasal passage failing to canalize completely
Associated syndrome: CHARGE
coloboma, heart defects, atresia chonae, retardation of growth/development, genito-urinary anomalies, ear abnormalities/deafness
How to confirm cushings disease?
24-hour urinary cortisol excretion
late-night alivary cortisol assay
low-dose dexamethasone suppression test
Paraneoplastic diseases associated with small cell lung cancer?
ACTH production and SIADH
Wallenberg syndrome? Cause?
Vertifo, nystagmus, ipsilateral face and contralateral trunk and limb sensory loss, hoarseness, horner’s dundrome
Caused by intracranial vertebral artery in the lateral medulla
What causes bilateral edema and stasis dermatitis? Early common findings? Late?
Lower extremity venous valvular incompetence -> booling venous blood -> increased pressures in postcapillary venules
Early: Xerosis
Late: lipodermatosclerosis, ulcerations
hepatic hydrothorax? Treatment?
pleural effusion not due to underlying cardiac or pulmonay abnormalities in cirrhotic patients
Results in pleural effusions due to small defects in the diaphragm
Treatment:salt restriction, diuretic administration
Management of Stemi
Catherization or thrombolysis
seborrheic keratosis
> 50 years of age
solitary or multiple well-circumscribed hyperpigmented lesions
occur on trunk, face, upper extremities
20 weeks pregnant with edema, joint paint, malar rash, HTN, proteinuria, and RBC csts
systemic lupus erythematosus flaure
Treatment for Absence seizures?
First line-Ethosuxamide
Second-line- valproic acid
Hypertrophic osteoarthropathy is associated with which type of lung cancer?
Adenocarcinoma
First lone treatment for lumbosacral radiculopathy?
MSAODS amd acetaminophen, recorvery is spontanious no PT needed
What level of gastrin is diagnostic for a gastroma?
> 1000pg/mL
What type of follow-up should be done after bacterial meningitis in children?
Hearing test
How to treat sinus bradycardia after alternative diagnoses have been rules out?
IV atropine 0.5mg volus, repeat every 3-5 minutes
If no response, transcutaneous pacing, or IC dopamine, or IV epinephrine
Erb-dechenne palse
“waiter’s tip”
- Upper arm adducted, internally rotated, elbow extended, forearn pronated, wrist and fingers flexed
- decreased or absent moro reflexes, grasp reflex intact
Treatment for exertional heat stroke?
rapid cooling (water immersion) fluid resusitation, electrolyte correction, end-organ damage mediation
Signs suggestive of portal hypertension?
peripheral edema, ascities, hepatomegaly, and/or splenomegaly
Treatment for patients with acute low back pain?
continue moderate activity, nonsteroidal anti-inflammatory drugs, and/or acetaminophin
Signs of infant botulism? Treatment?
descending flacid paralysis, constipation, drooling
Treatment: infant: human-derived botulism immune globulin
foodborne: equine-derived botulism
Lab findings in polydipsia?
hyponatremia, urine osmolatity <100mOsm/kg
Congenital rubella findings?
cataracts, heart defects (PDA)
pulmonary capillary wedge pressure
Estimate of left ventricular end-diastolic pressure and is elevated in left ventricular systolic and/or diastolic dysfunction
**will show signs of pulmonary edema
Poison ivy/oak/sumac plant name
Toxicodendron, coagulase-negative staphylococci
Sensitivity
portion of positiive results over true positive plus false negative (who actually has the disease
Treatment for endophthalmitis?
intravitreal antibiotic injection or vitrectomy
Highest risk populations for developing toxic megocolon as adults?
IBD suffers
Simvastatom - MoA?
inhibiting 3-hydroxy-3-methylglutaryl coenzyme reductase
Signs of lacunar stroke?
Pure motor hemiparesis, located in internal capsule
What is releared from ventricular myocytes in response to high ventricular filling pressures and wall stress in patients with CHF?
proBNP -> active BNP and N-terminal proBNP
Next step in managment after cardiorespiratory and spine immobilization?
Insert catheter, unless there are obvious contraindications
nausea, vomiting, pneumobilia (air in biliary tree), hyperactive bowel sounds? Confirmatory test?
gallstone ileus
Confirmation: CT abdomen
Diagnosis and treatment for vasospastic angina?
Diagnosis: contiguous ST elevation on ECG
Treatment: Calcium channel blocker (dilate coronary arteries), smoking cessation
Acute hepatitis B diagnostic tests?
HBsAg and anti-HBc
Management of minimal red blood per rectum in a perason under 40?
anoscopy (if no source identified sigmoidoscopy or colonoscopy
Recurrent episodes last 20 minutes to several hours of vertigo and sensorneural hearing loss, tinnitus, feeling of fullness in the ear
Meniere disease
Cause of simple hepatic cyst?
Congenital
First step in managing hypercalcemia?
Repeat measurement, correct for albumin, then PTH measurement
Signs of mineralocorticoid production deficiency?
Hypotension, hyponatremia, hyperkalemia
Risk factors for acute otitis media?
formula intake, exposure to cigarette smoke, allergic rhinitis, upper respiratory infection
Cyanocobalamin
Vitamin B12
What else can be administered with saline to reduce calcium levels? MoA?
Calcitonin
MoA: inhibits osteoclast-mediation bone resorption
When should RhoD be administrated?
Less than 72 hour after abortion or delivery
anemia with iron defieciency, next step in management?
Locate source of belleding
pin worm, scientific name?
Treatment?
Enterobius vermicularis
Treatment: albendazole or pryantel pamoate
Risperidone side effects
Galactorrhea, orthostasis, metabolic syndrome, extrapryamidal symptoms
Pathogenesis of syrinomyelia?
CSF drainage from the central canal of the spinal cord is disrupted, leading to a fluid filled cavity that compresses the surrounding tissues
Diagnosis of peptic ulcer disease?
upper GI endoscope
Congenital adrengal hyperplasia signs?
ambiguous external genitalia, normal uterus and ovaries, and electrolyte abnormalities (hyponatremia).
When to perform breast core biopsy?
complicated or complex cysts (echogenic debris, thick septa, solid components)
Defect in sickle cell disease, thalassemia?
globin chain synthesis impairment
Peritonsillar abscess physical exam findings? Treatment?
spasms of the jaw (trismus), muffled “hot potato” voice, swelling of peritonsillar tissues with deviation of uvula to contralateral side, pooling of saliva
Treatment: needle aspiration or incision and draining plus Abx
aortic dissection that acutely preesnts with worsening pain, hypotension, pulmonary edema? murmur?
Aortic valve insufficiency
Early decrescendo diastolic murmur
When to use sodium bicarbonaet in metabolic acidosis?
pH <
What type of murmur is considered benign in adults?
midsystolic murmur
Eikenella corrodens
gram-negative anaerobe that is commonly found in oral flora of humans
Who should receive meningococcus vaccinations?
All patients 11-18, large groups in close quarters, aplenia, complement deficiency
Workup for acromegaly
- IGF-I level (if high) -> oral glucose suppression test (if inadequate) -> MRI of brain
Intubation is met with bright red blood, over 600mL or 100mL/hour?
Bronchoscopy to determine cause and treat
immune-mediated glomerulonephritis, urinalysis findings?
RBC casts and hematuria
Ebstein-barr virus? amoxicillin result?
Fatigue, exudative pharyngitis, posterior cervical lymphadenopathy
Amoxicillin leads to maculopapular rash that developed more than 24 hours after dosing
Dense intramembranous deposits that stain for C3 is a characteristic microscopic finding for? MoA?
Membranoproliferative flomerulonephritis, type 2 (dense deposit disease)
Caysed by IgG antibodies (c3 nephritis factor) directed against C3 convertase of the alternative complement pathway -> persisent activation and kidney damage)
Risk associated with hydatid cyst aspiration?
Anaphylaxis
trigeminal neuralgia?
Unilateral intermittent stabbing pain, located near the ear, radiating down the jaw, lasting several seconds, tiggered by minor stumili
EPO side effectsq
- HTN-more common in IV route (most common)
- headaches
- Flu-like syndrome
- Red cell aplasia
Characteristic x-ray findings for osteomalacia?
pseudofractures (looser zones)
Molluscum contagiosum is caused by? Transmission?
Poxvirus
Transmission: fomites, skin-to-skin
Signs of sjorgren syndrome
sicca syndome (dryness of musous membranes -> increased dental cavities), dyspareunia (painful sex), raynaud phenomenon, cutaneous vasculitis
What is osteomalacia?
defective mineralization of organic bone matrix
Enteroclysis
Diagnose small bowel tumors and other pathology
Antibodies again presynaptic voltage gated calcium channels?
Lambert-Eaton
When should adult receive TdaP
One time in place of Td as an adult
Systemic effects of PCP?
SIADH
Manfestations of esophageal rupture?
pneumomediastinum and pleural effusions
painful red eye and ulcerations of the cornea
contact lens-association keratitis due to pseudomonal and serratia
Why does TB prefer the upper lobes for reactivation?
high oxygen tension, slower lympatic elimination
Causes of fetal growth restrictions in the first trimester?
Chomosomal anomalies, congenital infection
Treatment for Trachoma?
Azithromycin
infectious mononucleosis presentation?
Prolonged fever, sore throat, malaise, jaundice
physical exam: erthematous tonsils with exudates, hepatosplenomegaly, lymphadenopathy
Heinz bodies, bite cells?
Glucose 6-phosphate dehydrogenase deficiency
Ischemia cholitis- colonoscopy findings?
cyanotic mucosa, hemorrhagic ulcerations
Cause of the hepatojugular reflux?
failing right ventricle that cannot accommodate increase in venous return
Intraparenchymas brain hemorrhage?
sudden, focal neurological deficits that worsen over minutes to hours
Diagnosis of Glucogonoma?
hyperglycemia with elevated glucogon (>500)
mornocytic, normochrominc anemia
Abdominal imaging to localize lesion
Hydroxychloroquine side efects
retinopathy
17-alpha-hydroxylase deficiency
low estrogen levels, mineralcorticoid exress (hypertension, hypokalemia)
When is cytoscope indivated?
Gross hematuria without evidence of glomerular disease
microscopic hematuria without evidence of glomerular disease or infection, but increased risk of malignancy
obstructive symptoms suggestive of stricture
irritative symptoms without urinary infection
abnormal bladder imaging or urine cytology
Environment for Taenia solium?
third world pig farmers
Medical management of children with daytime incontinence?
Desmopressin with oxybutynin
Signs of B12 deficiency
Loss of proprioception, vibration sense, mostly in lower extremities, memory deficits, irritability, dementia
Thyroid storm vs pheo
Thyroid is more acute, with increased body temperature
Treatment for acute otitis media?
Oral amoxcillin, amoxicillin-clavulanic acid
Treatment for catatonia?
Benzos, ETC
Signs of congenital hypothyroidism?
macrosomia, hypoglycemia
Adverse side effects of carbamazepine?
Leukopenia and aplastic anemia
High risk population for kawasake disease?
East Asia
Order of cardiac defects in turner’s syndrome?
Bicuspid aortic valve, coarctation of the aorta, aortic root dilation
Common genetic associations with mitral valve prolapse?
Marfan, Ehlers-Danlos, osteogenesis imperfecta
Cormorbidities with Tourettes?
ADHD, OCD
Stridor is worse during what in laryngomalacia?
Inspiration
Lobes affected in aspiration pneumonia?
Lower lung lobes
Sle with nephritis vs preexxlampsia?
SLE has joint pain, malar rash, RBC casts are not present with preecclampsia
Chest x-ray findings for granulomatosis with pokyangitis?
Pulmonary nodules with alveolar consolidation and necrotizing pulmonary vasculitis
Clincal findings in congenital cytomegalocirus infections?
periventricular calcifications
FDA approved medication for the treatment of tourettes?
First generation- haloperidol, pimozole
Second-risperidone
Beta-2-agonists: clonidine, guanfacine
Diagnosis of Wilson’s disease?
Ceruloplasmin level and slit lamp examination
Presentation of post-streptococcal glormerulonephritis? Low levels of?
10-20 days post streptococcal throat or skin infection
peiorbital swelling, hemoturia, oliguria, hypertensive, RBC casts
Have low levels of serum c2 complement
Signs of complciated small bowel obstruction?
Fever, hemodynamic instabilityy, metabolic acidosis
Hemolytic anemia, jauntice, splenomegaly , spherocytes, with family history of infants with blood transfusion? Lab findings?
Hereditary spherocytisis, caused by spectrin deficiency (a membrane protein)
Labs: spherocytes, osmotic fradility on acidified glycerol test (increased), abnormal eosin-5-maleimide binding test
Depersonalization
intact autobiographic informaiton, but experience repeated chronic feeling of unreality or detachment from ones self
CMV treatment?>
Fanciclovir
Features of chronic primary adrenal insufficiency?
Weight loss, abdominal pain, fatigue, hyperpigmentation (ACTH from malanocytes due to cortisol deficiency)
Onset is chronic
Intense episodes of vertigo triggered by changes in head position?
Benign paroxysmal positional vertigo
TNF inhibitors? Side effects
aetanercept, adalimumab, certolizumab, golimumab, inhliximab
Side effects: infection, demyelination, CHF, malignancy
A 12% increase in which value in a post-broncodilator test is diagnostic for asthma?
FEV1
What type of infection is lyme disease?
Spirochetal infections caused by Borrelia burgdorferi after zoonotic transmission from Ixodes scapularis
Drugs to reduce recurrent nephrolithiasis?
Thiazide diuretics
potassium citrate/bicard (alkalinization
Allopurinol
Whipple disease? Cause? Diagnosit method?
history of chronic malabsorptive diarrhea, protein-losing enteropathy, weight loss, migratory non-deforming arthritis, lympadenopathy, low grade fever
caused by vacillus tropheryma whippelii
Diagnosis: small intestinal biopsy showing PAS-positive macrophages in lamina propria containing non-acid-fast gram-positive bacilli
Wilson disease, findings?
neuropsychiatric disease (tremor, ataxia, rigidity, depression)-caused by Copper deposition in the basal gangilia with liver aggrevation
14-3-3 protein
Prior disease
Signs of Gilbert syndrome? cause?
increased unconjugated bilirubin, jaundice
cause: decreased UDP-glucuronosyltransferase activity
Toxoplasmosis signs? Imaging?
headache, confusion, fever, focal neyrologic deficits, serizures
MRI finds multiple ring-enhancing lesions
Carcinoid sndrome
Flushing, diarrhea, bronchospasm, mostly located in small interstine
Vasogenic angina
Hyperreactivity of intimal smooth muscle -> intermittent coronary vasospasm
Wide and fixed splitting of S2
atrial septal defect
Medial mid-pontine infarction
contralateral ataxia and hemiparesis of the face, trunk, limbs
Monoclonal gammopathy of undetermined significance
monoclonal IgM by SPEP (<3g/dL), <10% monoclonal plasma cells, no end organ damage
MoA heparin
Activated anti-thrombin III -> inactivation of factor II1 (thrombin), factor IXa, Xa
Blood smear signs of B12 deficiency?
macrocytic anemia, macro-ovalocytes, hypersegmented neutrophils
Information bias
imperfect assessment of association between the exposure and outcomes as a result of errors in the measurement and outcomes status
long-term low-grade fever, abdominal pain, bloody diarrhea, suspect?
inflammatory bowel disease
Defects associated with decreased maternal serum AFP?
Aneuploidies
Increased aggression, male pattern baldness, hynoecomastia? Side effects?
Anabolic (androgenic) steroid use
Side effects: decreased testicular volume
Cause of heinz bodies?
hemoglobin becomes oxidized and denatures in G6PD
