4 Flashcards Preview

step3 > 4 > Flashcards

Flashcards in 4 Deck (31)
Loading flashcards...

Best prognostic sign in patients with primary CNS lymphoma with HIV?

Improvement of CD4 counts


Complications of bicuspid aortic valve (in 30% of turner syndrome), best screening test for pt and family members?

- echo
- infective endocarditis
- severe regurg/ stenosis
- aortic root/ ascending aortic dilation
- dissection


Loud S1, diastolic rumble, opening snap

mitral stenosis


most common cause of mitral stenosis

rheumatic heart disease


clinical features of mitral stenosis

- voice hoarseness from recurrent laryngeal compression from LAE


How do you diagnosis mitral stenosis

CXR: flattened left heart border, LAE, dilated pulmonary arteries
EKG: broad and notched p waves/ P mitrale


How do you diagnose disseminated gonococcal infection?

culture joint fluid, mucosal surfaces (urethral, rectal, oral, cervical)


Clinical features of gonococcal infection

joint pain
tenosynovitis (painful tendons around ankle and toe)
transient pustular skin rash


Gold standard diagnostic test for Hirschsprung's disease, and difference with meconium ileus on imaging

- rectal suction biopsy will show absence of ganglion cells
- diff: meconium ileus shows narrow underused microcolon, related to CF. HD has "transition zone"


Endoscopy showing red velvety colored squamous epithelium with pale and glossy appearance with intestinal metaplasia. Ddx and management?

Barrett's esophagus
- no dysplasia: regular endoscopic surveillance
- low dysplasia: surveillance or endoscopic eradication
- high dysplasia: endoscopic eradication/surgery


clinical features of 21 hydroxylase enzyme deficiency (most common cause of congenital adrenal hyperplasia)

- hypotensive shock
- ambiguous genitalia in 46 XX individuals
- hyponatremia
- hyperkalemia
- hypoglycemia
- vomiting, dehydration


clinical features of 17 alpha hydroxylase enzyme deficiency

- phenotypically looks female
- fluid, salt retention
- hypertension


Treatment of CAH

- glucocorticoids and mineralocorticoids
- high salt diet
- genital reconstruction for girls


best choice med for preventing cluster headache

- verapamil!
- prednisone and lithium are alternatives


Treatment of cataplexy (sudden loss of muscle tone) in narcolepsy

- SNRI (venlafaxine), SSRI, TCA or sodium oxybate


Treatment of PE stepwise

small amount of hemoptysis is normal in PE

1. low molecular weight heparin or unfractionated heparin
2. early initiation of warfarin
3. fibrinolytic therapy with hypotension (no antiplatelet therapy!)
4. Last if all fails-- IVC filter


treatment of raynaud's syndrome

calcium channel blockers such as nifedipine or amlodipine


what test is good to look for osteoblastic lesions in prostate cancer?

radioisotope bone scans


Cocaine induced MI treatment regimen

- nitrates/CCB, benzo, aspirin
- if no improvement, coronary angiography due to risk of coronary thrombus


Which drugs can induce acute pancreatitis?

- diuretics
- Inflammatory bowel disease meds: sulfasalazine, 5-asa
- immunosuppressive agents
- bipolar/seizure meds: valproic acid
- AIDS patient: didanosine, pentamidine
- abx: metronidazole, tetracycline


Which areas of the brain is affected by Wernicke's-Korsakoff's syndrome?

diencephalon: mamillary bodies, thalamus-- abnormal enhancement in MRI


Management of asthma exacerbation

- mild to moderate (40-69%): SABA, PO steroids
- moderate to severe (<40%): SABA and ipratropium, PO/IV steroids
- impending respiratory arrest: SABA and ipratropium, IV steroids and magnesium sulfate, SQ terbutaline or epinephrine, intubation (last resort)


Signs of early cardiac tamponade in echo

- right atrial and ventricular collapse during diastole
- exaggerated respiratory variation of cardiac and venous flow
- IVC plethora (dilation and <50% decrease in IVC size during inspiration)


chronic diarrhea, weight loss, iron deficiency anemia, eosinophilia, and pt is from developing countries. Likely ddx?

intestinal parasitosis/helminth infection


Management of thyroid nodules

- suspicious US findings/nodule >1cm: FNA
- suspicious US/ no cancer risk, normal or elevated TSH: FNA
- suspicious US/ no cancer risk, low TSH: iodine scan--> if hyperfunctional, then treat with meds. hypofunctional or indeterminate then FNA


Treatment of acute anovulatory bleeding/dysfunctional uterine bleeding

oral contraceptives with high estrogen to stop bleeding and stabilize the endometrium (estrogen promotes hemostasis)


When should low to intermediate risk pts with CHD undergo vasodilator stress imaging instead of treadmill stress test?

- unable to perform treadmill
- resting ECG showing LBBB, ventricular pacing, or afib


Common disease seen with primary hypothyoidism (Hashimoto's)



Causes of pseudotumor cerebrii, and signs

- obese premenopausal women
- endocrine disorders
- medication SE (isotretinoin, minocycline, etc)


Diagnosing acute gout

arthrocentesis with monosodium urate crystals
negative birefringent, needle shaped crystals under polarizing light