Week 3 Flashcards
A 28-year-old G2P1 woman is determined to have an amniotic fluid index (AFI) of 3 (6-19 normal) at 18 weeks gestational age on ultrasound.
Which conditions are associated with oligohydramnios, and which are associated with polyhydramnios?
What is Potter syndrome?
Oligohydramnios (< 0.5L amnionic fluid) - Placental insufficiency, Bilateral renal agenesis, Posterior urethral valves (males);
- Polyhydramnios (> 1.-2.0 L AF) - Esophageal/duodenal atresia, Anencephaly;
-
Potter syndrome - “POTTER”:
- Pulmonary hypoplasia,
- Oligohydramnios,
- Twisted skin (excessive, wrinkled skin),
- Twisted face (facial deformities),
- Extremities (limb) deformities,
- Renal agenesis
A 30-year-old man begins to develop shortness of breath and cyanosis even at rest. Exam reveals clubbing and a systolic murmur. He mentions that he has had a murmur since childhood. Further work up reveals a large ventricular septal defect and pulmonary hypertension. The patient is diagnosed with Eisenmenger syndrome. Describe how this syndrome develops.
Uncorrected VSD, ASD, PDA;
- Increased right heart pressures -> progressive pulmonary HTN;
- Flow reversal -> right-to-left shunt -> cyanosis
A 12-year-old boy is taken to the ER for confusion associated with vomiting and abdominal pain. On exam you note a fruity breath odor and that the patient is experiencing rapid deep breathing. The patient’s random blood glucose is 522mg/dL.
- What condition is the patient experiencing?
- What are the rapid, deep breaths called?
- What ketone body is the cause of the patient’s fruity breath odor?
- Which ketone body is detected by a urine test in diabetic ketoacidosis?
Diabetic ketoacdosis
Kussmaul’s breathing
Acetone (spontaneous conversion of acetoacetate);
Acetone and acetoacetate (you can’t see β-hydroxybutyrate in the urine)
A 22-year-old woman suffers from recurrent purulent upper respiratory tract infections. She is at your clinic for evaluation. Which complement protein is an opsonin? Which complement protein aids in neutrophil chemotaxis? Which complement proteins form the membrane attack complex?
Opsonins - IgG and C3b; Neutrophil chemotaxis C5a; Membrane attack complex - C5b, C6, C7, C8, C9.
A 32-year-old man ¡s in the hospital for a minor vehicle crash. Overnight, you are called by the nurse because the patient’s blood pressure went from 125/80 to 201/111, and he is now tachycardic. The patient now appears diaphoretic and reports feeling a little anxious, though, he says that this happens once or twice per week. Suspecting the diagnosis, you check his abdominal CT scan which does, in fact, show an adrenal mass. What a-adrenergic antagonists should be used to treat this patient?
Phenoxybenzamine
Phentolamine
(Beta blocker to control arrhythmia)
A 35-year-old white woman presents with a dull ache in her jaw that is made worse by chewing. She states that this pain corresponds to her recent promotion and increase in responsibilities. What is the most likely diagnosis?
(Much too young for temporal arteritis)
TMJ Syndrome -
- Young female in 3rd or 4th decade of life-
- Second most common use of facial pain
- Commonly exacerbated by stressful life events
- Nocturnal bruxism or unconscious jaw clenching.
- May or may not be a clicking of the jaw on PE (Clicking of the jaw is not diagnostic even if you feel it on PE)
bruxism - clenching of teeth
A 42year-cld obese man presents with a complaint of severe pain in his right knee He believes he injured it while dancing at his cousin’s wedding last night. You suspect gout. How would you differentiate between gout and pseudogout upon exam of synovial fluid aspirate?
Gout - Uric acid crystals, - Needle-shaped crystals, negatively birefringent and yellow under parallel light;
Pseudogout - Calcium pyrophosphate crystals Rhomboid, positively birefringent, blue under parallel like, and yellow under perpendicular light.
A 43-year-old man complains of right-sided facial drooping. When you examine the patient you notice an upper and lower face drooping. Does this patient have a lower or upper motor neuron lesion?
Lower motor neuron lesion - Ipsilateral paralysis of the lower AND upper face.
- LMN is the facial nerve, we are only hitting the nucleus which innervates the upper and lower face.
- UMN - facial region of the motor cortex innervates only the contralateral lower face and bilateral upper face. UMN lesion would only cause paralysis of the lower face.
Describe the motor innervation of the face.
What is Bell’s palsy?
What diseases are associated with Bell’s palsy?
Facial paralysis - Complete destruction of the facial nucleus it self or its branchial efferent fibers (facial nerve proper)
Diseases that cause it: “ALexander graHam Bell” with STD
- AIDS,
- Lyme disease,
- HSV,
- Sarcoidosis,
- Tumors,
- Diabetes.
A 50-year-old man crashes on a motorcycle on the highway and sustains a right anterior hip dislocation and knee trauma. Now he cannot adduct his hip or plantar flex on that side. Which nerves are injured?
Obturator nerve - hip adduction (commonly injured in anterior hip dislocation);
Tibial nerve - plantar flexion (commonly injured in knee trauma)
A 55 year-old patient is admitted for IV fluid resuscitation secondary to diarrhea. He also has gastric reflux and a peptic ulcer, which even prescription proton pump inhibitors cannot control. What drugs and endogenous hormones regulate the secretion of gastric acid?
- Proton pump inhibitors
- H2 blockers (cimetidine, famotidine, ranitidine) ; Antimuscarinic drugs
- Somatostatin analogues (octreotide) - inhibits enterochromaffin cells from stimulating the parietal cells.
Hormones:
Stimulation -
- histamine
- gastrin
- acetylcholine
Inhibition -
- prostaglandins
- somatostatin
- secretin
- GIP
A 55-year-old woman with recurrent UTIs is prescribed TMP-SMX as prophylaxis. Describe the mechanism of action of this drug combination. Which anticancer drug works in the same manner as trimethoprim?
Both inhibit tetrahydrofolate (biological active form of tetrahydrofolic acid (THF)) synthesis, bacteria can’t make Thymidine and make DNA, they can’t replicate. Bacteriostatic.
- TMP inhibits Dihydrofolate reductase
- SMX inhibits Dihydropteroate synthase
Synergistic effect wen combined.
Methotrexate - inhibits dihydrofolate reductase in cancer cells - used for leukemias, lymphomas, rare cancers, RA, ectopic pregnancies
A 67-year-old male CHF patient lost his job and medical insurance, so he stops buying and taking his digoxin, and develops dyspnea. What will this do to his cardiac output (CO)? What are the mechanisms behind his development of dyspnea?
- Stopping digoxin decreased his CO
- Blood backed up into the LA and pulmonary vasculature -> Pulmonary edema -> dyspnea.
A patient of yours with recent complaints of weakness, pallor, craving for ice chips and tachycardia has a history of chronic hemorrhoids. What do you immediately suspect is the cause of this patient’s anemia and how do you treat ¡t?
Pica - craving of non foods like ice chips or laundry detergent, dirt
Iron deficiency anemia (caused by chronic slow bleeding over time);
Treatment - Iron replacement, Possible colonoscopy.
A physician while working with a humanitarian aid organization in Africa is seeing a 30-year-old male patient with HIV. The patient complains of fever, weight loss and a cough associated with hemoptysis over the past two months. A chest X-ray reveals perihilar lymphadenopathy and a left lower lobe granulomatous formation.
- What is the name for these X-ray findings?
- What other Myco bacteria species cause pulmonary disease?
- What are the potential extrapulmonary manifestations of Mycobacterium tuberculosis?
Ghon complex - lymphadenopathy + granuloma (Ghon focus);
Other Mycobacteria - M. kansasii, M. avium
-
Extrapulmonary manifestations “(GRCVL)”
- GI manifestations;
- Renal manifestations
- CNS (parenchymal tuberculoma, meningitis)
- Vertebral body (Pott disease);
- Lymphadenitits
An 18-year-old woman is told by her boyfriend that sometimes she just “zones out” for about 15 seconds and does not respond to anything he says. He says that she picks at her shirt during this time, and that she doesn’t remember it, nor does she seem to have any decreased mental status afterward.
- What anticonvulsants are used to treat absence seizures?
- What anticonvulsants are used to treat status epilepticus?
DOC #1 Ethosuximide or #2 valproic acid;
Status epilepticus - first break the seizure:
- Acute status epilepticus - use Benzodiazepines (lorazepam, diazepam);
- Prophylaxis - phenytoin
Aztreonam and penicillins both bind to penicillin-binding proteins. Can aztreonam be used in patients with a penicillin allergy?
- In which patient populations is aztreonam a good choice?
- Against which organisms is this antibiotic effective?
Yes, Aztreonam can be used in patients with a penicillin allergy;
- Aztreonam is good for penicillin allergic patients and renal insufficiency, or someone that can’t tolerate aminoglycosides
- Effective against Gram (-) rods only
Classic presentation of granuloma annulare?
- Asymptomatic
- Non-scaly, slightly erythematous plaque
- Annular (ring-shaped)
- Edges are irregular, but well-defined
- Thick, rope-like border
- Starts small and grows outward (centrifugally);
- Usually localized
- Wrists, ankles, the dorsal surfaces of the hands or feet
Extrapulmonary causes of restrictive lung disease?
Mechanical/structural - Obesity, Scoliosis or severe kyphosis
Neuromuscular disease - Myasthenia gravis, Polio
What landmarks are used when placing an internal jugular central venous catheter?
- 30 degree angle at the angle of the triangle formed by the Sternal and clavicular heads of the sternocleidomastoid muscle
- Aim at the ipsilateral nipple
- Palpate common carotid medial to the needle. Always find the artery, even if it takes 5 minutes. Never place until you have found it. (use ultrasound guidance in a JCV)
What nutritional deficiency is associated with koilonychia?
spooning of the nails - Iron deficiency (don’t confuse with clubbing of the nails seen in oxygen deprivation) “A spoon can hold a drop of water”
A central line is often placed in the subclavian vein to administer fluids and medications or to measure central venous pressure. What landmarks are used when placing a subclavian central line?
- Thumb on the middle third of the clavicle
- Tip of index finger on the jugular notch
- Insert the needle medially, along the inferior surface of the clavicle
Sleep stages - description and EEG waveforms.
BATS Drink Blood
Awake (eyes open) - Beta (highest frequency, lowest amplitude)
Awake (eyes closed) - Alpha
1. Light sleep - Theta (5%)
2. Deeper sleep; bruxism - Sleep spindles and K complexes (45%)
3. Deepest, non-REM sleep (slow-wave); sleepwalking; night terrors; bedwetting - Delta (lowest frequency, highest amplitude) (25%)
REM - Dreaming, loss motor tone, memory processing; increased O2 brain use - Beta.
