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200 Concepts of Amboss Flashcards

1
Q

Biostats, Epidemiology, and Social Sciences:
What is the appropriate measure of association in cohort studies?
What is the equation?

A

Relative risk
(a/a+b)/(c/c+d)

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2
Q

Biostats, Epidemiology, and Social Sciences:
What do independent, repeated measurements test for?

A

Precision or how reproducible a result is. Proportional to ‘interrater reliability.’

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3
Q

Biostats, Epidemiology, and Social Sciences:
What can you interpret from an confidence interval?

A

P-value.
If the the CI includes 1 then the study is not statistically significant, therefore the p-value can be inferred as >0.05.

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4
Q

Biostats, Epidemiology, and Social Sciences:
What is a Type 2 error?

A

(Symbolized as beta)
is the accepting of a false null hypothesis and rejecting a viable alternative hypothesis.
You want to reduce this by increasing sample size or increasing precision to increase statistical power (1 - beta)

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5
Q

Biostats, Epidemiology, and Social Sciences:
What are some risk factors to urothelial cancer?

A

Cigarette smoking is huge
Long-term occupational exposure to benzidine and alinine dyes (look for dyes, oil refining, rubber production, perfumes, and pesticides. Pharmaceutical for benzocaine.
* Carcinogenic obv. causes TCC of bladder.
*Benzene derivative (alinine and benzocaine) can result in methemoglobinemia.

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6
Q

Biostats, Epidemiology, and Social Sciences:
What is the most common complication to shaken baby syndrome?

A

Subdural Hemotomas
Upon suspicion report to Child Protective Services CPS.

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7
Q

Pregnancy and reproductive system:
Which antiepileptic medication should be avoided in pregnancy?

A

Phenytoin, Carbamazepine, and Valproate. Results in folate deficiency.
Phenytoin can cause Fetal hydantoin syndrome (cleft palate, phalanx/fingernail hypoplasia, excessive hair growth, and intrauterine growth restriction.
Carbamazepine can cause neural tube defects.
Valproate can also cause NTDs and craniofacial dysmorphism.

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8
Q

Pregnancy and reproductive system:
What antimicrobials are safe during pregnancy?

A

Avoid Cephalosporins in the first trimester.

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9
Q

Pregnancy and reproductive system:
What antimicrobials are harmful during pregnancy?

A

“Teethracycline:” teeth discoloration with tetracycline.
“A mean guy steps on baby’s ear.” Aminoglycoside can cause ototoxicity

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10
Q

Pregnancy and reproductive system:
What antivirals are safe during pregnancy?

A

.

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11
Q

Pregnancy and reproductive system:
Describe clinical features, diagnosis, treatment, and prevention for Toxoplasmosis in a newborn:

A
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12
Q

Pregnancy and reproductive system:
Describe clinical features, diagnosis, treatment, and prevention for Syphillis in a newborn:

A
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13
Q

Pregnancy and reproductive system:
Describe clinical features, diagnosis, treatment, and prevention for Listeriosis in a newborn:

A
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14
Q

Pregnancy and reproductive system:
Describe clinical features, diagnosis, treatment, and prevention for VZV in a newborn:

A
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15
Q

Pregnancy and reproductive system:
Describe clinical features, diagnosis, treatment, and prevention for Parvovirus B19 in a newborn:

A
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16
Q

Pregnancy and reproductive system:
Describe clinical features, diagnosis, treatment, and prevention for Rubella in a newborn:

A
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17
Q

Pregnancy and reproductive system:
Describe clinical features, diagnosis, treatment, and prevention for CMV in a newborn:

A
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18
Q

Pregnancy and reproductive system:
Describe clinical features, diagnosis, treatment, and prevention for HSV in a newborn:

A
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19
Q

Pregnancy and reproductive system:
Describe the developmental milestones for a 2 month old: for motor development, speech development, cognitive and social development:

A
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20
Q

Pregnancy and reproductive system:
Describe the developmental milestones for a 4 month old: for motor development, speech development, cognitive and social development:

A
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21
Q

Pregnancy and reproductive system:
Describe the developmental milestones for a 6 month old: for motor development, speech development, cognitive and social development:

A
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22
Q

Pregnancy and reproductive system:
Describe the developmental milestones for a 9 month old: for motor development, speech development, cognitive and social development:

A
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23
Q

Pregnancy and reproductive system:
Describe the developmental milestones for a 12 month old: for motor development, speech development, cognitive and social development:

A
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24
Q

Pregnancy and reproductive system:
Describe the developmental milestones for a 15 month old: for motor development, speech development, cognitive and social development:

A
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25
Pregnancy and reproductive system: Describe the developmental milestones for a 18 month old: for motor development, speech development, cognitive and social development:
26
Pregnancy and reproductive system: Describe the developmental milestones for a 2 year old: for motor development, speech development, cognitive and social development:
27
Pregnancy and reproductive system: Describe the developmental milestones for a 30 month old: for motor development, speech development, cognitive and social development:
28
Pregnancy and reproductive system: Describe the developmental milestones for a 3 year old: for motor development, speech development, cognitive and social development:
29
Pregnancy and reproductive system: Describe the developmental milestones for a 4 year old: for motor development, speech development, cognitive and social development:
30
Pregnancy and reproductive system: Describe the developmental milestones for a 5 year old: for motor development, speech development, cognitive and social development:
31
Pregnancy and reproductive system: Pts with Turner syndrome are at increased risk for developing what?
Cardiovascular anomalies like bicuspid aortic valve and coarctation of the aorta. Bicuspid arotic valve predisposes to early onset valvular calcifications, which can lead to premature aortic stenosis. BAV also increases risk for infective endocarditis.
32
Pregnancy and reproductive system: Pt with ambiguous genitalia as an infant now presents with amenorrhea, severe acne, tall stature, and possibly osteopororosis (fracture following a minor trauma). Mother hx of virilization furing pregnancy. What are the arrows for estrogen and androgen?
- Decrease estrogen, increase androgen. *Dx: Aromatase deficiency.
33
Pregnancy and reproductive system: Pts with PID are at increased risk for what?
Infertility/ectopic pregnancy
34
What is the difference between schizophrenia and schizophreniform?
Schizophrenia symptoms (delusions, hallucinations, disorganized speech, negative symptoms) last at least 1 month but less than 6 months for schizophreniform disorder.
35
What is Schizoaffective disorder?
Characterized by a continuous illness episode in which features of a major mood episode (depressive, manic, or mixed) alongside psychotic symptoms that meet the criteria for schizophrenia.
36
What is the risk with giving antidepressant medication like Venlafaxine and TCA's in a patient with undiagnosed underlying bipolar disorder?
Developing hypomania or mania. Recommended to first initiate mood stabilizers like Lithium and valproic acid before antidepressants.
37
What should be regularly assessed with a patient undergoing Lithium mono therapy?
- Serum TSH Hypothyroidism is a common side effect, as well as tremor, nephrogeneic diabetes insipidus, teratogenicity (eg Ebstein anomaly), and ECG changes (Eg T-wave depressions)
38
What is typically shown with Lysergic acid diethyl amide (LSD) intoxication?
Vivid visual hallucinations and distorted time perception, but can also experience anxiety, agitation, and paranoid delusions. In addition, LSD has mild sympathomimetic effects such as tachycardia, hypertension, and mydriasis.
39
What is typically shown with Methylenedioxymethamphetamine (MDMA) intoxication?
Increased thirst, euphoria, confusion, hyperthermia, tachycardia, hypertension, mydriasis, tremor, and hyponatremia.
40
What is typically shown with Phencyclidine PCP intoxication?
Confusion, euphoria, hyperthermia, tachycardia, and hypertension. Aggressiveness and nystagmus is also expected.
41
What is typically shown with Cocaine intoxication?
Confusion, euphoria, hyperthermia, tachycardia, hypertension, tremor, and bilateral mydriasis.
42
What is typically shown with Nitric Oxide intoxication?
Confusion, euphoria, tremor. Typically does not last very long
43
What cells are responsible for releasing surfactant and proliferate in response to lung damage?
Type 2 pneumocytes
44
What can you expect to see on PE in a pt in a severe asthma attack or severe emphysema?
- Chest percussion: hyperresonant - Chest expansion: symmetric - Tactile fremits: decreased - Chest auscultation: Decreased breath sounds
45
What can you expect to see on PE in a pt in a atelectasis or a large pleural effusion?
- Chest percussion: dull - Chest expansion: asymmetric - Tactile remits: decreased - Chest auscultation: Decreased breath sounds *Pleural effusion CXR would show costodiaphragmatic angle blunting, opacification of a lung field, tracheal shift to the opposite side *Atelectasis CXR would show lobar or lung collapse, tracheal shift to the same side *Image of pleural effusion
46
What can you expect to see on PE in a pt in a large pneumothorax?
- Chest percussion: hyperresonance - Chest expansion: asymmetric - Tactile fremits: decreased - Chest auscultation: Decreased breath sounds *Manifests acute dyspnea and increased radiolucency in the affected lung fields. CXR can also show a collapsed lung adjacent to the radiolucent region, a tracheal shift to the opposite side, and prominent outlining of the mediastinal, bronchial, and carotid arterial borders. *Image of a tension pneumothorax
47
What can you expect to see on PE in a pt with pulmonary fibrosis or pulmonary edema?
- Chest percussion: dull - Chest expansion: symmetric - Tactile fremits: normal to increased - Chest auscultation: fine inspiratory crackles *Both CXR would show pulmonary infiltrates and decreased lung volume *Image showing hydrostatic pulmonary edema
48
What can you expect to see on PE in a pt with lobar pneumonia?
- Chest percussion: hyper resonant - Chest expansion: asymmetric - Tactile fremits: normal to increased - Chest auscultation: bronchial breath sounds *also would see productive cough, fever, CXR would show consolidation *Image: Left upper lobe pneumonia
49
What are the Pulmonary function tests for restrictive lung disease?
- Decrease lung compliance - decrease TLC and VC - Normal to decrease FEV1/FVC
50
Describe the factors of spirometry:
51
Describe the different flow-volume loops for different conditions:
52
What does an FEV1:FVC ratio < 70% and a reduced FEV1 < 80% indicate?
Obstructive lung pathology
53
What is the marker for celiac disease?
Anti-endomysial antibodies - serum IgA in the layer overlying the smooth muscle cells
54
What are the clinical hallmarks of Celiac disease?
- recurrent upper respiratory infections (subsequent nasal polyposis) - pancreatic insufficiency (steatorrhea and malabsorption) - failure to thrive - 98% of males have congenital bilateral absence of the vas deferent, which results in azoospermia (lack of spermatozoa in the ejaculate) and infertility. Spermatogenesis is not affects
55
What are the hallmarks of Kartagener syndrome?
- dectrocardia (apical pulse on the right side of the sternum) - situs inversus - recurrent sinopulmonary infections - nasal polyposis - failure to thrive
56
Describe Sarcoidosis:
Reminder: Increased expression of 1-alpha-hydroxylase in macrophages leads to hypervitaminosis D with elevates calcium, resulting in low PTH via negative feedback. *ACE levels can also increase in 60% of cases
57
Describe SLE:
57
Describe COPD:
Reminder: Low ACE levels can be seen
58
Describe Tuberculosis:
59
What pathology can amiodarone cause?
Interstitial pulmonary fibrosis
60
How does Omalizumab work?
It's a monoclonal antibody that bind to free IgE. Used to treat refractory allergic asthma. Reduces serum levels of free IgE, which reduces the stimulation of mast cells and basophils and prevents inflammation. Long term use results in down regulation of FceRI on these cells.
61
How does Zileuton work?
Acts by inhibiting 5-lipoxygenase, which prevents the formation of the pro-inflammatory leukotrienes that trigger asthma attacks.
62
How does Theophylline work?
Acts by inhibiting phosphodiesterase and adenosine receptors. These two mechanisms act synergistically to relax bronchial smooth muscle, relieving bronchospasm. Due to a narrow therapeutic index and the risk of learning and behavioral disorders associated with chronic use, theophylline is not recommended in pediatric patients.
63
How does Montelukast work?
Montelukast is a leukotriene receptor antagonist used as prophylaxis in the management of asthma. By inhibiting leukotriene receptors, specifically in the bronchial smooth muscle cells, this drug inhibits the bronchospastic process initiated by proinflammatory leukotrienes. It cannot be used to reverse bronchospasm in an acute attack.
64
How does Nedocromil work?
Mast cell stabilizer that inhibits degranulation, thereby preventing bronchospasm. It is used as a prophylactic medication for asthma. ie Cromolyn.
65
What casts would you see in Acute tubular necrosis?
Muddy brown casts
66
What casts would you see in Acute interstitial nephritis?
WBC casts *also seen in pyelonephritis
67
What would you expect with Salicylate toxicity?
Aspirin (or other salicylate) overingestion that causes tinnitus, nausea, vomiting, tachypnea, and respiratory alkalosis (early) or increased anion gap metabolic acidosis (late). Can lead to nephrotoxicity because salicylates are excreted renally.
68
How does insulin cause hypokalemia?
Increased H+/K+ activity in the α-intercalated cells of the collecting tubule occurs in response to hypokalemia. H+/K+ ATPase uses the energy derived from ATP hydrolysis to excrete hydrogen ions and reabsorb potassium ions. The kidney, therefore, enhances both collecting duct hydrogen ion secretion and potassium ion absorption to counteract low serum potassium.
69
What would you expect to see on immunofluorescence in PSGN?
Granular deposits of IgG, IgM, and C3 *Lumpy bumpy starry sky," enlarged and hyper cellular glomeruli, sub epithelial immune complex deposits "humps"
70
What would you expect to see on electron microscope in membranous nephropathy?
"Spike and dome" appearance of sub epithelial deposits. - nephrotic, associated with hep B, autoimmune, or thyroid disease
71
What conditions cause splitting and alternating thickening and thinning of the GBM on light microscopy?
Alport syndrome and MPGN. Typically manifest with nephritic syndrome. However, other characteristic features of Alport syndrome include visual disturbances and sensorineural hearing loss. MPGN can either be secondary to infection (e.g., hepatitis C) or autoimmune disease, of which there is no evidence in this patient, or idiopathic
72
What is the dx? How does it occur?
Mesangial IgA-based immune complex deposits on immunofluorescence are a typical finding of IgA nephropathy. This type of glomerulonephritis may manifest with nephritic syndrome. However, IgA nephropathy most commonly occurs during or immediately following (2–5 days) an upper respiratory/gastrointestinal tract infection and not 2–4 weeks after. Also, IgA nephropathy is not typically associated with bacterial tonsillitis.
73
What is the Dx? how does it occur?
Although poststreptococcal glomerulonephritis (PSGN) can progress to RPGN, normal blood urea nitrogen, relatively mild creatinine elevation, and no changes in urinary output after 2 days of PSGN make RPGN unlikely. *Glomerular crescent moon formation of LM. Causes include anti-glomerular basement membrane antibodies (e.g., Goodpasture syndrome), immune complex deposition (e.g., in lupus nephritis), and vasculitis (e.g., granulomatosis with polyangiitis). Can cause flank pain, edema, decreased urine output, increased serum BUN and creatinine, and red blood cell casts on urinalysis.
74
Whats the diagnosis?
Hyperplasticity arteriolosclerosis Cause: Severe HTN
75
Whats the dx?
Renal amyloidosis results from the deposition of β-sheet fibrils within the mesangial matrix and glomeruli of the kidney. Renal amyloidosis can present with proteinuria and renal failure. Although amyloid deposits resemble the pink hyaline material seen here, similar deposits would also be expected in the mesangium and interstitium of the kidney.
76
What kind of kidney stone?
Magnesium ammonium phosphate
77
What kind of kidney stone?
Calcium phosphate
78
What kind of kidney stone?
Calcium oxalate Important risk factors for these stones include decreased urine volume, increased urine calcium or oxalate excretion, and decreased urine citrate excretion.
79
What kind of kidney stone?
Cystine Cystine precipitation results in the formation of radiopaque, hexagonal crystals. Cystine stones account for only 1% of kidney stones and are typically found in individuals with an autosomal recessive defect of a proximal convoluted tubule transporter responsible for reabsorption of dibasic amino acids (e.g., cystine, ornithine, arginine, and lysine). The resulting cystinuria predisposes to stone formation because cystine has low solubility in urine. Diagnosis is made by direct visualization of the stones or with a positive urine sodium cyanide nitroprusside test.
80
What kind of kidney stone?
Uric acid Uric acid precipitation results in rhomboid-shaped, radiolucent stone formation. Uric acid stones account for about 10% of kidney stones. Risk factors for uric acid crystal formation include low urine volume, high uric acid excretion, acidic urine, and hyperuricemia (e.g., gout, tumor lysis syndrome).
81
Describe the different urine incontinences:
82
Where do carbonic anhydrase inhibitors act on?
PCT Uses: glaucoma, altitude sickness, and cystine stone prophylaxis.
83
Where do osmotic diuretics ie mannitol act on?
Proximal tubule and descending limb of LOH Uses: acute cases of cerebral edema and acute angle glaucoma
84
Where do Loop diuretics act on?
Inhibit the Na+-K+2Cl- cotransporters on TAL of LOH
85
Where do potassium-sparring diuretics act on?
DCT and Collecting Ducts
86
Describe areas and lesions on the associated areas:
A- Left oftic nerve, causes ipsilateral anopia B- temporal part of the retina, lesion would cause nasal hemianopia of the left eye C- Optic chiasm. Where optic nerve decussates, causes bitemporal hemianopia. Pituitary lesions and saccular aneurysms would cause this. D- Optic tract; causes contralateral homonymous hemianopia. Stroke, tumors, surgery, and congenital defects may cause damage. E- Meyer loop; visual pathway classically produce contralateral superior homonymous quadrantanopia. Common causes include stroke of the MCA F- Dorsal optic radiation; lesion causes contralateral lower homonymous qudrantanopia. Lesions to the parietal lobe, Mc stroke of the MCA G- Central bundle of the optic radiation; lesion causes either contralateral hemianopia with macular sparing (PCA infarct) or complete contralateral homonymous hemianopia (including the macula)
87
Describe Horner syndrome:
88
Describe the clinical manifestations of a thrombus in the Cavernous Sinus:
- Horner syndrome due to compression of postganglionic sympathetic neurons - headache - photophobia - proptosis (anterior profusion of the eye, like exophthalmos) - cranial nerve palsies *Caused by an ascending infection of the face or sinuses
89
Describe an aneurysm of the Posterior cerebral artery:
- Can compress CN III, which carries parasympathetic fibers to the pupillary sphincter and ciliary muscle, and motor fibers to the levator palpebrae superioris and all extraocular muscles except for the superior oblique muscle and the lateral rectus muscle. - Ptosis as well as diplopia, a fixed and dilated pupil, and a down-and-out gaze - mydriasis (dilated pupil) - headache
90
Describe an infarction of the hypothalamus:
- Rare cause of Horner syndrome secondary to injury of centrally located sympathetic neurons - contralateral hemiparesis and hypersthesia (an increased or heightened sensitivity to touch or other sensations) - impeded homeostatic functions of the hypothalamus (e.g., thermoregulation, electrolyte balance, sleep-wake cycle).
91
Describe a dissection of the carotid artery:
- Horner syndrome by compressing the postganglionic sympathetic fibers near the internal carotid artery and damaging them directly or decreasing blood flow to their vasa nervorum. - acute onset of symptoms following some types of trauma (e.g., blunt trauma) - headache and/or neck pain

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