Uworld review 4 Flashcards
1
Q
How can diuretic therapy lead to hepatic encephalopathy exacerbation?
A
Low intravascular volumes with hypokalemia and metabolic alkalosis
2
Q
How can hypokalemia lead to hepatic encephalopathy?
A
Hypokalemia leads to intracellular acidosis (excreted intracellular K replaced by H+) causes increased NH3 production (E conversion) in the renal tubules
3
Q
How can metabolic alkalosis exacerbate hepatic encephalopathy?
A
Promotes the conversion of NH4+, which cannot enter the CNS, into NH3, which can
4
Q
What are the three major steps in treated hepatic encephalopathy?
A
- Volume resuscitation
- K replacement
- Lactulose
5
Q
Why is proteins restriction not generally indicated for the treatment of hepatic encephalopathy 2/2 liver cirrhosis?
A
Generally, these pts are already malnourished
6
Q
What is the role of neomycin in the treatment of hepatic encephalopathy?
A
Used when lactulose is not responsive, and cannot tolerate rifaximin
7
Q
What is rifaximin used for?
A
hepatic encephalopathy
8
Q
What major heart condition can TB cause?
A
Constrictive pericarditis
9
Q
What are the s/sx of constrictive pericarditis, and why?
A
Signs of venous overload and decreased CO, since heart cannot fill properly
10
Q
What is Kussmaul’s sign?
A
Lack of JVP decline with inspiration, which can be seen in pericarditis
11
Q
What are the characteristic JVP tracings associated with constrictive pericarditis? Why?
A
Prominent X and Y descent
Loss of pressure from stiff pericardial walls during diastole**
12
Q
What can be heard on cardiac auscultation of cor pulmonale?
A
Widely S2 split with harshed S2
13
Q
What is the most important initial step in treating HONK? Why?
A
- Fluid replacement with NS
- Hyperglycemia has a diuretic effect, and can quickly lose fluid
14
Q
What is the most common cause of a macrocytic anemia in alcoholics?
A
Folate deficiency
15
Q
What lab abnormalities suggest ITP?
A
Thrombocytopenia, with normal labs otherwise
16
Q
What is a common cause of ITP?
A
HIV, Hep C, or other chronic viral infx
17
Q
What is the progression of symptoms with transverse myelitis?
A
Flaccid paralysis (spinal shock), followed by spastic hyperreflexia
18
Q
What antibody is classically found in systemic sclerosis?
A
Anti-topoisomerase 1 (aka anti-scl-70)
19
Q
What causes HTN with systemic sclerosis?
A
Renal involvement
20
Q
What antibodies are found with antiphospholipid antibody syndrome?
A
Anti cardiolipin
21
Q
Antimitochondrial antibodies are found in which disease?
A
Primary biliary cholangitis
22
Q
What is granulomatosis with polyangiitis? What antibody is classic for this?
A
Wegener’s granulomatosis
ANti-neutrophil cytoplasmic antibodies
23
Q
What is the key test to diagnosing bronchiectasis? What will it show?
A
High res CT
Bronchial wall thickening
24
Q
What is the pathophysiology of bronchiectasis?
A
Recurrent cycle of infection, inflammation, and tissue damage
25
What are the classic symptoms of bronchiectasis?
Large amounts of purulent sputum
Dyspnea
sinus congestion
Hemoptysis
26
What parts of the body does Kaposi's sarcoma classically present on?
Face
Legs
Oral cavity
Genitalia
27
What are the lesions of bacillary angiomatosis like?
Friable papules and plaques
28
What are the skin lesions of cryptococcosis like?
Multiple papules diffusely
29
What is the classic presentation of parvovirus B19 arthralgias?
Symmetric, polyarticular arthralgias, without overlying erythema, edema, or systemic symptoms.
30
True or false: in both SLE and RA, symptoms correspond to inflammatory markers like ESR
True
31
Crypt abscesses are classically found in which IBD?
UC
32
Pts with ulcerative colitis are at increased risk for developing which biliary issue?
Primary sclerosing cholangitis
33
An elevated serum alk phos in a pt with UC should be suspicious for what disease?
Primary sclerosing cholangitis
34
What cells comprise a pheochromocytoma?
Chromaffin cells
35
What drugs in particular can set off a hypertensive episode 2/2 pheochromocytoma?
Anesthetic agents
36
What is the first test in the workup of AKI in the setting of BPH?
US of the kidneys to r/o obstruction or other causes of hydronephrosis
37
What is a hepatic hydrothorax?
Pleural effusion that occurs from small defects in the diaphragm, that allow peritoneal fluid to pass into the pleural space. This is more common on the right side due to the less muscular hemidiaphragm
38
What is hepatopulmonary syndrome?
Hepatopulmonary syndrome results from the formation of microscopic intrapulmonary arteriovenous dilatations in patients with both chronic and far less common, acute liver failure. The mechanism is unknown but is thought to be due to increased liver production or decreased liver clearance of vasodilators, possibly involving nitric oxide.
39
What are the two classic symptoms of hepatopulmonary syndrome?
Platypnea (dyspnea while upright)
| Orthodeoxia (O2 desat when upright)
40
Why should atropine be avoided in pts with acute angle closure glaucoma?
dilates the eye, worsening outflow obstruction
41
What is the MOA and use of pilocarpine?
Cholinergic agent used for acute angle closure glaucoma
42
What is the difference between herpes zoster ophthalmicus and herpes simplex keratitis?
Zoster will have shingles around the eye, whilst simplex with only involve the eye, without systemic s/sx
43
Under what CD4 count does PCP occur?
200
44
What are the indications for the use of steroids in addition to bactrim in the treatment of PCP pneumonia?
- Severe s/sx
- PaO2 less than 70 mmHg
- A-a gradient over 35 mmHg
45
What is the treatment for neurosyphilis?
10-14 days of IV PCN
46
What are the s/sx of spinal cord compression?
- Pain worse in the recumbent position
- Gradually worsening, severe local back pain
- Sudden weakness and anesthesia below level of lesion
47
What is the management of spinal cord compression?
- MRI
- Corticosteroids
- Rad-onc and neurosurgery consult
48
A sensory level at what anatomic landmark exclude cauda equina syndrome?
Umbilicus (T10)
49
what are the classic findings on XR of Charcot's foot?
- effusions in several of the tarsometatarsal jts
- large osteophytes
- extra-articular bone fragments
50
How does primary sclerosing cholangitis commonly present?
- asymptomatic
| - cholestatic pattern on liver test
51
What is the gross description of primary sclerosing cholangitis?
Short annular strictures alternating with normal bile duct
52
What happens to cardiac index and PCWP with a tension pneumothorax?
CI: low
PCWP: low
53
What happens to cardiac index and PCWP with a PE
CI: low
PCWP: normal to low
54
What are the s/sx of osteonecrosis of the proximal femur?
Hip pain
| Limited internal rotation and abduction
55
How does sickle cell disease lead to osteonecrosis of the femur?
Disruption of microcirculation in the bone by sickling as well as increased intraosseous pressure d/t bone marrow hyperplasia
56
Why is the risk of femoral head necrosis increased later in life?
Initially, blood supply from ascending arteries and foveal artery. Foveal becomes obliterated later in life.
57
What labs are classically elevated in osteomyelitis? signs?
ESR
| Typical infx symptoms
58
What happens to thyroglobulin levels with exogenous levothyroxine intake?
Decreased
59
What are the s/sx of subacute (de quervain's) thyroiditis?
Fever
Neck pain
Thyroid TTP
Elevated ESR
60
What are the s/sx of Hashimoto's thyroiditis?
Palpable goiter and clinical hypothyroidism.
61
What skin condition can manifest in pts with chronic Hep C infection?
Porphyria cutanea tarda
62
What are the s/sx of Takayasu arteritis?
Vasculitis of the aorta and its branches, with arterial occlusive s/sx, including pulse deficits, bruits, BP discrepancies
63
In whom is Takayasu's arteritis most common in?
Asian Women under 40
64
What are the lab findings of Takayasu's arteritis?
Elevated ESR and CRP
65
What is the treatment for Takayasu's arteritis?
Steroids
66
What can imaging find with Takayasu's arteritis?
Thickening of large artery walls and narrowing lumen
67
What abx should be prescribed prophylactically to solid organ transplant recipients? Why?
TMP-SMX (PCP)
68
What type of nerves cause the s/sx of peripheral neuropathy in DM?
- Small nerve fiber injury causes positive symptoms (tingling, allodynia, pain)
- Large fiber injury causes negative symptoms (numbness, loss of proprioception, diminished ankle reflex)
69
What are the symptoms of Cardiac myxoma?
Fever, weight loss, raynaud's
70
What heart sound does myxomatous degeneration of the mitral valve cause?
Midsystolic click
71
What are the most common benign primary tumors of the heart? What sound does it cause?
Myxomas
| Tumor plop
72
What are the complications of Cardiac myxomas?
- Embolization
- Valvular abnormalities
- HF 2/2 obstruction
- Lung invasion causes symptoms similar to bronchogenic CA
73
What is alanine converted into top enter the kreb's cycle?
Pyruvate
74
What is lactate converted into top enter the Kreb's cycle?
Pyruvate
75
What are triacylglycerols converted into to enter the Kreb's cycle?
G3P
76
What is the treatment for gastroparesis 2/2 DM?
Metoclopramide or erythromycin
| Small, frequent meals
77
Which promotility/antiemetic agent is associated with EPS?
Metoclopramide
78
What are the s/sx of gastroparesis 2/2 DM? (4)
ANorexia
n/v
Early satiety
Impaired glycemic control
79
Stroke symptoms that are abrupt and maximal at the start is generally of what etiology?
Embolic stroke
80
Stroke symptoms that fluctuate are generally of what etiology?
Thrombosis
81
Stroke symptoms that progress over minutes to hours, with early onset focal neurologic deficits, and later on s/sx of increased ICP are generally of what etiology?
Intracerebral hemorrhage
82
What are the s/sx of a spontaneous subarachnoid hemorrhage? (3)
- Severe HA at start
- Meningeal irritation
- Focal deficits uncommon
83
What are the characteristics of the HA with idiopathic intracranial HTN?
Pulsatile HA with pulsatile tinnitus
84
What medication classically causes idiopathic intracranial HTN?
Isotretinoin
85
What are the 6 classic s/sx of idiopathic intracranial HTN?
- Papilledema
- Peripheral visual defect
- CN VI palsy
- HA
- Pulsatile tinnitus
- Diplopia
86
What type of studies produce relative risk ratios?
Cohort studies
87
What type of studies produce Odds ratio?
Case-control
88
If a disease is rare, what can be said about RR and OR?
nearly equivalent
89
What are the common s/sx of Waldenstrom's macroglobulinemia?
Hyperviscosity syndrome
| HSM
90
What is the difference between multiple myeloma and Waldenstrom's macroglobulinemia?
MM has "multiple" types of immunoglobin expansion, whereas WM has only IgM
91
What will bone marrow bx show in multiple myeloma vs Waldenstrom's macroglobulinemia?
Both have over 10% monoclonal B cells
92
What is the process of diagnosing Hep C? Why?
HCV antibody and HCV DNA. Need DNA to assess whether the pt cleared it spontaneously, or is chronically infected
93
What causes hyponatremia in severe decompensated HF?
Decreased perfusions at baroreceptors and renal afferent arterioles causes release of Renin, NE, and ADH. All of these promote free water retention
94
Describe the difference in eye involvement between viral, bacterial, and allergic conjunctivitis.
- Viral-unilateral that progresses to bilateral
- Bacterial- " "
- Allergic - bilateral
95
Which has a characteristic "eye stuck shut" in the morning symptom: viral, bacterial, and/or allergic conjunctivitis
All do
96
Describe the discharge present with viral, bacterial, and allergic conjunctivitis
```
Viral = watery with scant, stringy mucus
Bacterial = pus
Allergic = water
```
97
Which type of conjunctivitis has discharge the reappears after wiping: viral, bacterial, and/or allergic
Bacterial
98
True or false: discharge is common with anterior uveitis
False
99
What are the s/sx of anterior uveitis?
Pain
Photophobia
Miosis
Visual loss
100
What is the most significant risk factor for ischemic and hemorrhagic stroke?
HTN for both
101
What sort of neurological symptoms are present in Guillain Barre syndrome? (LMN vs UMN, sensation)
- LMN
- Weakness
- NO sensory loss
102
What is the major downside to using chem to treat Hodgkin's lymphoma?
18.5x risk for other malignancies
103
What are the CXR findings of an aspergilloma?
Mobile, intracavitary mass with an *Air Crescent* in the periphery
104
What is the treatment for actinomyces?
PCN
105
What is the classic presentation of an actinomyces infection?
```
Invasive disease (dental, sinus) in pts with DM
*Sinus tracts with sulfur granules*
```
106
What are the microscopic characteristics of actinomyces?
Filamentous Gram positive rods with rudimentary branching
107
Why are pts with Crohn's disease at increased risk of developing Calcium oxalate stones?
In pts with fat malabsorption, Ca is preferentially bound by fat, leaving oxalate unbound and free to be absorbed into the bloodstream.
108
What are the manifestations of CN toxicity?
Cherry red flushing
AMS / seizures / hyperreflexia
Arrhythmias
Metabolic acidosis
109
What is a steppage gait, and what causes it?
Weakness in foot dorsiflexion, causing a compensation of high steppage
110
What are the skin lesions like with urticaria?
well circumscribed, raised erythematous plaques with central pallor.
These can be round, oval, or serpiginous, and up to several centimeters in diameter
111
Within how many hours of symptom onset can tPA be administered?
3.5-4 hours
112
What is the only therapy that reduces the risk of early recurrent ischemic stroke?
ASA
113
What is the classic triad for a splenic abscess?
Fever
Leukocytosis
LUQ pain / pleuritic left sided chest pain
114
What will CT imaging show with a splenic abscess?
Splenic fluid collection
115
What is a major predisposing factor for the development of a splenic abscess?
Infective endocarditis
116
What bacteria commonly cause a splenic abscess? (3)
Staph aureus
Strep
Salmonella
117
What is and what is not the treatment for a splenic abscess?
Surgery
Abx alone is not sufficient
118
What is the general pathophysiology of Paget's disease?
Increased bone turnover 2/2 osteoclast dysfunction
119
What is the classic histologic appearance of Paget's disease?
Mosaic pattern of lamellar bone
120
What are the three major cardiac findings of aortic stenosis?
1. Systolic ejection murmur
2. Single and soft S2
3. Delayed and diminished carotid pulse (pulsus parvus et tardus)
121
What is pulsus paradoxus, and what it is classically seen in?
Exaggerated decrease (more than 10 mmHg) in SBP with inspiration
Pericardial disease (e.g. tamponade)
122
What is the definition of reversibility of asthma?
Increase of FEV1 over 12% post bronchodilator
123
How much protein is excreted per day in nephrotic syndrome?
More than 3.5 g/day
124
What are the associations with focal segmental glomerulosclerosis?
HIV
Heroin use
AA or hispanic ethnicity
Obesity
125
What are the associations with membranous nephropathy?
Adenocarcinoma
NSAID use
Hep B
SLE
126
What are the associations with membranoproliferative glomerulonephritis?
Hep B and C
| Lymphoma
127
What are the associations with minimal change disease?
NSAIDs
| Lymphoma
128
What are the s/sx of porphyria cutanea tarda?
Photosensitivity blisters that are pruritic, healing with scarring, increased skin fragility, hypertrichosis, and hyperpigmentation
129
What is the effect of OCPs on PCT?
Triggers it
130
What is Behcet's disease?
Rare, immune mediated small vessel systemic vasculitis that often presents with membrane ulceration (e.g. mouth, genitals) and ocular problems (anterior/posterior uveitis, retinal vasculitis)
131
What is Felty syndrome?
Advanced RA associated with splenomegaly and neutropenia
132
What are the classic s/sx of a vertebral compression fracture?
- Acute back pain after physical activity
- Pt TTP along the spine
- Worse with increased intraabdominal pressure, standing, walking, or lying on the back
133
What is the most common underlying cause of a non-traumatic vertebral compression fracture?
Osteoporosis
134
What relieves and exacerbates the pain of a ligamentous back sprain?
Worse with movement, and improves with rest
135
What is the drug of choice for treating pseudotumor cerebri? Why?
Acetazolamide
| Inhibits choroid plexus CAH, thereby decreasing CSF production, and IH
136
Which CN can be affected with idiopathic intracranial HTN?
CN VI
137
What is the role of theophylline in the treatment of acute asthma exacerbations?
No role
138
When is it okay to accept gifts from drug reps?
- Directly benefits patients
| - Of small value
139
What are a few of the differences between how allergic vs irritant contact dermatitis looks?
Allergic has papules and vesicles, and chronic lichenification
Irritant has fissures and erythema. Most commonly on hands
140
What is a common side effect of EPO?
Worsening HTN
141
How may renal stones cause an ileus?
Increased vagal tone
142
What cancer needs to be looked out for if a pt has a h/o pernicious anemia?
Gastric cancer, since atrophic gastritis that develops increase risk for intestinal type cancer
143
What is the MOA and use of eplerenone?
Aldosterone receptor antagonist
144
What is a major difference between eplerenone and spironolactone?
Spironolactone has anti androgen effects, while eplerenone does not
145
What is the drug of choice for treating hyperaldosteronism in a male?
Eplerenone
146
When is an abdominal CT scan indicated for the diagnosis of pyelonephritis? Why?
- If no improvement in 72 hours
| - Complicated pyelo may lead to corticomedullary abscess, emphysematous pyelo, or papillary necrosis
147
What is the cause of hypercalcemia d/t immobilization?
Increased osteoclast bone resorption
148
What is the treatment for hypercalcemia of malignancy? Of immobilization?
Bisphosphonates
149
What is the general MOA of bisphosphonates?
Inhibit osteoclast bone resorption
150
What is the effect on Ca levels in rhabdo?
hypocalcemia 2/2 precipitation of Ca and phosphorus in damaged muscles
151
What are the cardiac effects of sarcoidosis? (4)
Can cause AV block
Restrictive cardiomyopathy
Dilated cardiomyopathy
HF
152
What are the s/sx of disseminated gonococcal infex?
Fever
Polyarthralgia (e.g. ankle and wrist)
Pustular rash over extremities and torso
153
How do you diagnose disseminated gonococcal infex?
NAAT, as cultures are frequently negative
154
What is the age range for mammography?
[50-75)
155
How often are lipid panels checked for routine preventative care in pts without a history of hyperlipidemia?
5 years
156
What is the age range for colonoscopy?
[50-75)
157
Why are patients with RA more likely to develop osteoporosis?
- Decreased activity levels
| - local inflammation and proinflammatory cytokines around joints
158
What are the risk factors for avascular necrosis? (4)
- Prolonged corticosteroid use
- EtOH use
- SLE
- Sickle cell
159
What is osteitis fibrosa cystica?
Excessive osteoclastic resorption of bone, leading to replacement with fibrous tissue (brown tumors)
160
What are the hematologic effects of EBV? MOA?
Hemolytic anemia and thrombocytopenia
Cross reactivity of antibodies against EBV to RBCs, causing Cold agglutinins
161
What is the drug of choice to prevent cerebral vasospasm s/p coiling of ruptured cerebral vessels?
nimodipine
162
What is the most common cause of death s/p coiling for SAH?
Rebleed
163
What is the treatment for polymyalgia rheumatica?
Low dose corticosteroids
164
Why are right sided MIs preload dependent?
MI impairs RV filling, causing an increased sensitivity to decreased preload, as the ventricle cannot relax properly (relaxation is ATP driven), and need volume to stretch
165
What is the first step in treating cardiogenic shock 2/2 right sided MI? Second?
IV fluid bolus is first, then dopamine if they're crashing
166
What is the effect of Na intake on the formation of Ca stones?
Increased Na intake enhances Ca excretion, and low Na intake promotes Na and Ca absorption
167
What is the treatment for vitiligo?
Topical corticosteroids
168
Congenital patchy absence of melanocytes is characteristic of what disease?
Piebaldism
169
What is the treatment for severe causes of fulminant hepatic failure 2/2 acetaminophen poisoning?
Transfer for liver transplant
170
What type of EKG findings are diagnostic for V-tach?
fusion beats
171
What causes dupuytren's contracture in liver cirrhosis?
Increased free ROS
172
Pure motor hemiparesis is classically associated with a stroke to what part of the brain?
Lacunar
173
Pure sensory loss is classically associated with a stroke to what part of the brain?
Lacunar
174
Dysarthria-clumsy hand is classically associated with a stroke to what part of the brain?
Lacunar
175
Ataxis hemiparesis is classically associated with a stroke to what part of the brain?
Lacunar
176
What are the presenting symptoms of a middle cerebral artery stroke?
Contralateral motor and/or somatosensory deficits, and homonymous hemianopia or quadrantanopia
177
What are the s/sx of occlusion of an internal carotid artery?
Both MCA and ACA territories affected
178
What are the neurologic deficits from a posterior cerebral artery stroke?
```
Homonoymous hemianopia
Alexia without agraphia
visual hamllucinations (calcarine cortex)
Sensory symptoms (thalamus)
3rd nerve pasly
contralateral motor deficits
```
179
What part of the brain is affected in a PCA stroke, that causes visual hallucinations?
Calcarine cortex
180
What part of the brain is affected in a PCA stroke, that causes sensory symptoms?
Thalamus
181
What part of the brain is affected in a PCA stroke, that causes contralateral motor deficits?
Cerebral peduncle, midbrain
182
What are the major risk factors for acalculous cholecystitis? Why?
- Severe trauma or recent surgery
- Prolonged TPN
- Critical illness
These likely cause gallbladder stasis or ischemia with local inflammation that can lead to gallbladder distension
183
What are the labs like with acalculous cholecystitis?
Normal to elevated
184
What are the s/sx of acalculous cholecystitis?
Unexplained fever
RUQ pain
Leukocytosis
185
What usually causes a subphrenic abscess?
peritonitis
186
What is a hazard ratio, and how do you interpret it?
The chance of an event occurring in the treatment group compared to the chanced of that event occurring in the control group during a set period
If HR is less than 1, the event is more likely to occur in the control group
If HR more than 1, the event is more likely to occur in the experimental group
If = 1, then no difference
187
What is the most common pathophysiologic cause of atrial flutter?
Reentrant circuit around the tricuspid annulus, with slowing of the impulse through a region known as the cavotricuspid isthmus
188
What location is the most common source of ectopic electrical activity to produce atrial fibrillation?
Pulmonary veins
189
When is rabies PEP needed?
If exposed to high risk animal, or animal unavailable to watch.
190
What is the classic presentation of ankylosing spondylitis?
Chronic, progressive back pain and stiffness.
Pain relief with activity
Lumbosacral tenderness
191
How do you confirm the diagnosis of ankylosing spondylitis?
x-rays of the pelvis showing sacroiliitis
192
What is the role of the HLA-B27 haplotype in diagnosing ankylosing spondylitis?
No much, since most people who have the gene, do not get ankylosing spondylitis
193
What is the classic description of the vision loss with amaurosis fugax (
Curtain veil descending over the visual field
194
What is the most common site of artherosclerosic emboli that cause rentinal artery occlusion?
Carotids
195
When is carotid endarterectomy indicated for symptomatic and asymptomatic men respectively? Women?
Asymptomatic men = 60+%
Symptomatic men = 50+%
Women = 70%+
196
What are the s/sx of vertebral osteomyelitis?
Exquisite focal tenderness
| ESP and CRP elevated
197
Tight glycemic control for DM has benefits for what type of vascular problems?
Microvascular (eyes, nephropathy) NOT macrovascular (MI, stroke)
198
What is the abx of choice for HACEK group of organisms causing endocarditis?
Ampicillin-sulbactam (unasyn)
199
Native valve endocarditis caused by strep viridans group should receive what abx?
Aqueous PCN G
200
How is hereditary spherocytosis treated? Why?
Splenectomy since RBC function fine, but spleen crushes them
201
What are the three most common causes of bloody diarrhea?
- E.coli
- Shigella
- Campylobacter
202
What is the MOA and use of doxazosin?
Alpha receptor blocker, BPH
203
How does a bluish tint to the vision occur with PDE-5 inhibitors?
Cross reactivity with PDE-6 involved in color vision
204
What effect does uremia have on anion gap?
Causes an anion gap metabolic acidosis
205
What are the compensations to chronically higher levels of CO2 in the blood from COPD?
Increased bicarb
206
What is the calculation for NNT?
1/ARR
207
Will E.coli produce nitrites?
Yes
208
What are the characteristics of BCC? (5)
- Persistent open sore that bleeds, oozes, or crusts
- Reddish patch or irritated area
- Pearly or translucent nodule that is pink, red, or white
- ELevated or rolled border with central ulceration
- Pale, scar-like area with poorly defined borders
209
What are the characteristics of a keratoacanthoma?
Volcano like nodule with central keratotic plug
210
What are the characteristics of rosacea?
Flushing, erythema, telangiectasias, papules/pustules and tissue hyperplasia
211
What part of the spine is affected with ankylosing spondylitis that causes the pain?
Ligamentous insertions (enthesitis)
212
Are follicular thyroid CA usually hot or cold?
Cold
213
How does follicular thyroid CA differ from benign follicular adenomas?
Grow through capsule, and spread *hematogenously*
214
How does follicular thyroid CA spread?
Hematogenously
215
What sort of thyroid cancer has psammoma bodies?
Papillary
216
Hurthle cells are seen in which Thyroid CA?
Hashimoto's
217
How can you differentiate malpositioning of an ET tube vs tension pneumothorax?
Tension pneumothorax will have hemodynamic compromise
218
What test can be used to confirm the diagnosis of carpal tunnel syndrome?
Nerve conduction studies
219
What tendons are contained within the carpal tunnel?
Flexor digitorum profundus
Flexor digitorum superficialis
Flexor pollicis longus
220
Which is more common on the lower lip: basal cell carcinoma, or SCC?
SCC
221
What are the histological findings of SCC?
Invasive squamous cells with keratin pearls
222
What is the relation between breast tenderness and OCPs?
Increases initially with OCP use, but subsides. Shouldn't have an effect coming off of the meds.
223
Breast pain the occurs coming off of OCPs is most likely what?
Fibrocystic changes
224
What is the treatment for breast tenderness 2/2 fibrocystic changes?
NSAIDs or OCPs
225
What are the signs of cerebral salt wasting?
Hypovolemia and hyponatremia with a high urine sodium
226
What causes cerebral salt wasting?
Decreased SNS input to kidneys decrease the salt retention
227
What are the causes of hyponatremia in the setting of elevated urine Na? (4)
- Diuretic use
- Cerebral salt wasting syndrome
- Adrenal insufficiency
- AKI/CKD
228
What are the classic EKG findings of cor pulmonale?
RBBB with RAD and/or RVH, RAA
229
CXR showing enlarged pulmonary arteries is classic for what condition?
Cor pulmonale
230
What is multiple system atrophy (shy-drager syndrome)?
Degenerative disease causing
- parkinsonism
- Autonomic dysfunction (orthostatic hypotension)
- Widespread neurologic signs
231
Pt with parkinsonian symptoms + orthostatic hypotension + impotence/incontinence = ?
Multiple system atrophy
232
What parts of the brain are affected with multiple system atrophy? (4)
Neuronal degeneration in the substantia nigra, striatum, ANS and cerebellum
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What are the histologic hallmarks of multiple system atrophy?
Cell loss and gliosis, or a proliferation of astrocytes
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What is Riley-Day syndrome (familial dysautonomia)? (cause, pathophys/symptoms) Does this affect intelligence?
AR disease on chromosome 9, affecting the development and survival of sensory, sympathetic, and some PNS neurons.
This results in insensitivity to pain, inability to produce tears, poor growth, and labile BPs.
Does not affect intelligence
