WE3 mock SB (-6) Flashcards
WE3 blocks (50-57) Missing blocks 52-57
how do you dx obesity hypoventilation synd?
- BMI > 30
- daytime hypercapnea (paCO2 > 45)
- no alt cause of decr RR
pt notes dyspnea on exertion but has clear lungs and min LE edema. what is likely NOT causing the DOE?
L heart failure
what is the timeline for delusional disorder vs paranoid personality disorder?
delusional disorder >=1 mos
PPD = pervasive and longterm
what does HELLP stand for?
HELLP Hemolysis Elevated LFTs Low Plts
what causes the abd pain in HELLP?
liver capsule (glisson) distension 2/2 liver edema
what are the clinical features of HELLP synd?
- n/v, RUQ pain
- pre-eclampsia
how does acute fatty liver of pregnancy present?
- n/v, RUQ pain
- incr LFTs
- extrahepatic complications = incr WBC, decr BG, AKI)
what are the dx criteria for kawasaki dz?
fever >= 5 d >= 4 of the following conjunctivitis mucositis (strawberry tongue) rash (thrunk --> extremities) edema (extremities) cervical lymphadenopathy
how does the kawasaki rash differ from the measles and rubella rashes?
kawasaki: spreads trunk –> extremity
measles: spreads head –> trunk –> extremity
rubella: spreads head –> trunk –> extremity
how do you distinguish measles from rubella on clinical presentation?
measles = F + 4Cs + fine, pink, maculopap rash from face–> trunk
rubella = low F + lymphadenopathy + fine, pink, maculopap rash from face –> trunk
what are the 4Cs of measles?
- cough
- coryza
- conjunctivitis
- Koplic spots
how do you distinguish scarlet fever from kawasaki dz?
scarlet fever the rash will be concentrated over skin folds & there will be no conjunctival injection or extremity swelling
what is the most important pathogenic factor of metabolic syndrome?
insulin resistance
pt presents w/ metabolic synd + insulin resistance. what are they at risk for?
- HTN
- DM
- dyslipidemia
what are the dx criteria of metabolic synd?
- abd obesity
- fasting BG >100-110
- BP > 130/80
- TG > 150
- HDL (< 40 M or < 50 F)
* *must meet >=3/5 criteria
what are the indications for urgent ex lap?
- hemodynamic instability
- peritonitis/acute abd
- evisceration (exposed bowel)
- blood from NG tube or on rectal exam
what is the pathogenesis of PSGN?
immune complex deposition in the mesangium & BM s/p GAS impetigo or pharyngitis
what is the timeline for IgA nephropathy vs PSGN?
IgA nephropathy = during or w/in days of URI
PSGN = wks after GAS infx
what is alport synd?
inherited (MC = xlinked) T4 collagen defect –> glomerular dz
how does alport synd present?
- microscopic/gross hematuria
- sensorineural hearing loss
- occular defects
how does intracranial HTN present?
- HA (worse at night)
- n/v
- AMS
is ICP the same as intracranial HTN?
no
how do you decr ICP?
- manitol
- incr RR (induce hypocapnea)
- acetazolamide
- trendelenberg positioning
what is the cushing reflex?
HTN + low HR + AMS
what does + cushing reflex suggest?
brain stem compression
how does acute angle closed glaucoma typically present?
- age > 60
- HA + decr vision + red eye + mydriasis + poor reactivity to light
what type of heart failure can constrictive pericarditis cause?
R heart failure
how does cardiac amyloidosis look on ECHO?
- incr vent. wall thickness
- nL/nondilated LV cavity
what commonly causes non-pupil sparing CN3 palsies
compression 2/2 aneurysm
what commonly causes pupil sparing CN3 palsies?
microvasc ischemia (DM, HTN, incr lipids)
even w/ eye involvement, what will be nL in Graves dz?
pupils
pupillary constriction is controlled by ____
parasymp fibers of the outside of the CN3 fasicles
what do the diff fibers of CN3 control?
parasymp fibers = pupillary constriction (low P/high S = dilation)
symp fibers = motor control
decr sympathetic stim to the eye via CN3 will lead to what?
- ptosis
- “down and out” gaze
which eye muscles are controlled by CN4 and CN6?
- CN4 = superior oblique
- CN6 = lateral rectus
(SO4 LR6)
paralysis of what muscle leads to ptosis
levator palpebral superioris
aneurysm will more likely lead to ___ compared to ___ findings?
parasymp (mydriasis) > symp (ptosis, down and out gaze)
how are the CN3 fibers organized?
sympathetic core w/ parasymp sheath
h/o recent URI + sudden onset cardiac failure in an otherwise healthy pt suggests what?
dilated cardiomyopathy 2/2 viral myocarditis
what virus “commonly” causes dilated cardiomyopathy?
coxsackie virus B
is concentric hypertrophy of the heart seen in chronic or acute setting?
chronic (2/2 HTN or AS)
is exxentric hypertrophy of the heart seen in chronic or acute setting?
chronic (2/2 valve regurg)
what are the most important pathogenic factors in development of zenker diverticulum?
- upper esophageal sphincter dysf(x)
- esophageal dysmotility
how does parkinsonian tremor present/
- resting tremor (resolves w/ movement)
- starts in 1 extremity then spreads
bradykinesia includes what?
- festinating gate
- diff initiating movement
- hypomimia (masked facies)
- hypophonia (soft voice)
what is a festinating gait?
- broad based shuffling gait w/o arm swing
- seen in parkinson’s dz
how does the postural instability assoc w/ parkinson’s present?
- loss of balance w/ stopping/turning abruptly
- flexed atrial posture
- freq falls
- loss of balance when nudged from stationary bipedal stance
is imaging needed to dx parkinson’s?
no (can help to r/o other things though)
how do granulosa cell tumors present on histo?
call-exner bodies
GRANdma INHibited me from CALLing my EX
what do you need for clinical dx of parkinson dz?
- resting tremor
- rigidity
- bradykinesia (gate, voice, face, slow to start)
- *2/3 criteria
how does invasive vs chronic pulm aspergillosis present on imaging?
invasive = ground glass opacities (nodules + halo sign) chronic = cavity +/- fungus ball
apical ground glass opacities + triad (F + pleuritic CP + hemoptysis) = what?
invasive aspergillosis
what metabolic abns can be caused by hypothyroidism?
- hyperlipidemia
- low Na
- asymp incr CK
- asymp incr LFTs
what does erysiperlas look like?
- raised, sharply demarcated
- rapid onset
- F (early on)
what is the MCC of erysipelas?
s pyogenes
what is erysipelas vs cellulitis?
CD EF
Cellulitis = infx of Deep dermis or SUBQ fat
Erysipelas = infx of superFicial dermis or lymph
MCC of non-purulent vs purulent cellulitis = ?
non-purulent = MSSA/ s pyogenes purulent = MSSA/MRSA
how does lead poisoning present?
- neuropsych (neuropathy)
- GI (abd pain, constipation)
- general s/s (fatigue)
- *also HTN, nephropathy, hyperuricemia, microcytic anemia w/ basophilic stippling
how do you tx lead poisoning?
calcium disodium EDTA
how does acute angle closure glaucoma present?
- painful monocular vision loss
- HA
- n/v
how does amaurosis fugax present?
- painless rapid, transient, monocular vision loss
- “curtain descending”
what is a common cause of amaurosis fugax?
retinal ischemia 2/2 ipsilat CAS w/ emboli
how does optic neuritis present?
+ monocular vision loss
+pain w/ eye movement
what are the MCCs of meningitis in kids?
age < 1mos = GBS, e coli, listeria, HSV
age >= 1mos = s pneumo, n meningitidis
what is a nL ankle brachial index?
0.91 - 1.3
what do below nL and above nL ABI measures signify?
below nL (<0.91) = PAD above nL (>1.3) = calcified/non-compressible vessels
what is ABI?
SBP @ ankle / SBP @ arm
how to manage preterm labor?
< 32 wks = steroid + ABX + tocolytics + Mg
32-34 wks = steroid + ABX + tocolytics
34-36 wks = steroid + ABX
if dementia w/ lewy-bodies pt presents w/ psychosis, what do you give them?
- trial of LOW POTENCY 2ng gen antipsychotic (QUETIAPINE)
- be careful. there is a chance this will make them worse
what is the MCC of atraumatic hip pain & limp in kids?
transient synovitis
what tests are used to distinguish btwn transient synovitis and septic arthritis?
bilat U/S + arthrocentesis
what conditions lead to transudative pleural effusion?
cirrhosis, CHF, complications of peritoneal dialysis, nephrotic synd
what conditions lead to exudative pleural effusion?
infx, malig, inflam dz, CABG, PE
pt presents w/ unilat pleural effusion. what do you suspect?
malig
what are LIGHTS criteria for dx exudative pleural effusion?
- PF protein / s protein > 0.5
- PF LDH / s LDH > 0.6
- PF LDH > 2/3 ULN LDH
what is nL pleural fluid pH?
pH = 7.6
exudative pleural fluid will have what pH?
pH = 7.3-7.45 (inflam) or pH < 7.3 (empyema or tumor)
transudative pleural fluid will have what pH?
pH = 7.4 - 7.55
what are the tx options for uterine fibroids?
- OCP
- uterine myomectomy
what is the formal name for uterine fibroids?
uterine leiomyoma
how do you manage a pregnant pt found to have HSIL on pap smear mid pregnancy?
+immediate colposcopy
+/- f/u w/ loop excision
how do you manage HSIL lesions?
- immediate colposcopy
- immediate loop excision
* *can skip 1 if pt is not pregnant
how does diverticulitis present?
- LLQ pain
- n/v/d/c
- bladder s/s or sterile pyuria
what is sterile pyuria?
U/A = leuk esterase + and nitrate -
how does the pain assoc w/ diverticulitis & SBO differ?
divertic = dull, persistent LLQ pain SBO = crampy periumbilical pain
how do diverticulitis and SBO present differently on auscultation?
divertic = nL BS SBO = incr, tinkling BS
what is hemi-neglect synd?
- ignoring one side of a space
- L side ignored in a R handed indiv
what causes hemi-neglect?
damage to the non-dominant parietal lobe
R parietal lobe in R handed person
if a person is L handed which is there dominant lobe?
R lobe = dominant
what area is responsible for spatial organization?
non-dominant pariental lobe
in pts presenting w/ inf STEMI and profound HYPOtension after receiving nitrates, what underlying issue do you suspect?
RV MI
STEMI leads 2, 3, avF
how should R vent STEMI be managed?
- NO nitrates
- IV NS bollus for severe HYPOtension
- otherwise nL STEMI care
what is SOC managment of an acute STEMI?
- dual antiplatelet
- statins
- anticoag
- BB
- nitrates
- PCI w/in 90min of arrival
what is typically found on EKG in cardiac tamponade?
+/- electrical alternans
NOT 3 contig lead ST elevations
what is the 1st test for dx & risk stratification in suspected stable ischemic heart dz?
stress EKG
what are the MCC of acute bacterial rhinosinusitis?
- nontypable H influ
- S pneumo
- M catarrhalis
infants presenting in the 1st few wks of lie w/ trismus, spasms and hypertonicity likely have what?
neonatal tetanus 2/2 umbilical stump infx
how do you tx neonatal tetanus?
ABX + tetanus IgG
pt presents w/ liver abscess + recent h/o dysentary and travel abroad. what should you expect?
amebiasis
how do you tx amebiasis?
- metronidazole (= empirix for abscess)
- luminal agent (= wipe out colonization)
- cyst drainage if infx persists
when do you give rabies post-exposure ppx?
- animal is unavailable
- animal is symptomatic
- *otherwise wait and watch animal
what is included in rabies PE Ppx?
rabies vaccine + rabies IgG
what infectious dz are screened for at 1st visit (pregnancy)?
STD = HIV, HepB, Chlamydia, Syphillis
when do you screen for GBS?
35-37 wks
how will kids w/ psychosis present?
- marked changes in f(x) across mult domains (decr social skills, decr grades)
- psychoticc s/s
- neg s/s (social withdrawal, lack of motivation)
what vaccines are recommended in liver dz?
- Tdap/Td Q10yr (nL)
- influ Q1yr (nL)
- PPSV23 x1
- PCV13 –> PPSV23 @ age > 65
- HAV + titers
- HBV + titers
BPH s/s + blood or pain w/ ejaculation. dx = ?
chronic prostatitis
how do gastrinoma present?
dyspepsia + chronic diarrhea + wt loss
how does H pylori infx typically present?
- dyspepsia
- post-prandial fullness
- nausea
- *can see PM pain 2/2 circadian acid secretion
how does ethylene glycol poisoning present?
- flank pain
- hematuria/oliguria
- CN palsies
- tetany (2/2 low Ca)
what will be seen on U/A w/ ethylene glycol poisoning?
- Ca oxalate crystals
- blood
how do you tx ethylene glycol poisoning?
- fomepizole or ethanol (to inhib EtOH dehydrogenase)
- NaHCO3 (to rev. acidosis)
- Hemodialysis (to step renal failure)
pernicious anemia is associated w/ what 2 conditions?
- MCC of vit B12 def
- gastric adenoca
- gastric carcinoid
