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hammer4 Flashcards

1
Q

What are the lung findings of patients with pleural effusion?

A

Decreased breath sounds, decreased tactile fremitus, dullness to percussion. Shift away from mediastinum

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2
Q

What are the lung findings of patients with lobar pneumonia with consolidation?

A

Increased breath sounds, increased tactile fremitus, dullness to percussion. No Shift from mediastinum

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3
Q

What is the hallmark damage in status epilipticus and other prolonged seizures? What is the pathophysiology?

A

Cortical laminar necrosis due to excitatory cytotoxicity

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4
Q

What are the risk factors for toxic megacolon? How is it diagnosed? Management?

A

IBD or C diff infection. Dx - systemic toxicity, bloody diarrhea, abdominal distension/peritonitis, marked distension of abdominal imaging. Mgmt - Bowel rest, NG suction, abx. +/- corticosteroids id IBD-associated.

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5
Q

When is the onset of gonococcal conjuctivitis? What are the symptoms and treatment?

A

2 - 5 days. Marked eye swelling, profuse purulent discharge, corneal edema/ulceration. IV/IM CTX or Cefotaxime

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6
Q

When is the onset of chlamidyal conjuctivitis? What are the symptoms and treatment?

A

5 - 14 days. Eyelid swelling; chemosis; watery, BLOODY, or mucopurulent eye discharge. Oral erythromycin.

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7
Q

How does NSAID cause hyperkalemia? What about K+ sparing diuretics like Amilioride?

A

Impaired local prostaglandin synthesis reduces renin and aldosterone secretion. Block the epithelial sodium channel or aldosterone receptor

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8
Q

What is the mechanism of Heparin induced thrombocytopenia and what does it lead to?

A

Conformational change in platelet surface antigen (platelet factor 4), forms IgG antibody that coats platelets causing thrombocytopenia 2/2 macrophage consumption and thrombus formation (arterial and venous after platelet activation)

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9
Q

What is sialadenosis and what causes it?

A

Benign, non inflammatory enlargement of the salivary glands. Seen in patients with advanced liver disease (alcoholics) as well as a variety of dietary and nutritional disorders.

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10
Q

What is the etiology of ascites with SAAg > 1.1? SAAG

A

SAAG > 1.1 indicates polar hypertension (cardiac ascites, cirrhosis) while SAAG

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11
Q

What is unique about a crossectional study?

A

Snap shot study that looks at both outcome and exposure

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12
Q

What is the presentation of obstructive uropathy 2/2 nephroctomy for example?

A

Flank pain, low voids with periods of high voids

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13
Q

What are the clinicial features of CLL? How is it diagnosed? What is a major complication?

A

Lymphadenopathy, Hepatosplenomegaly, Mild Thrombocytopenia and anemia. Severe lymphocytosis and smudge cells and flow cytometry showing clonality of mature B cells. No Bx. Infection.

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14
Q

What type of amnesia is associated with isolated impairment of autobiographhical memory? What is it characterized by?

A

Dissociative amnesia characterized by travelling or wandering in a dissociated state

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15
Q

What is the presentation of choriocarcinoma? Where does it usually spread to? What is seen on x-ray and how is disease diagnosed?

A

Irregular vaginal bleeding, enlarged uterus, pelvic pain. Irregular bleeding past 8 weeks. Mets to the lungs showing worsening pulmonary function and even hemoptysis. Multiple nodules on the lungs on CXR. Measure quantitative Bhcg.

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16
Q

What and where is the most common location of pediatric brain tumors? What symptoms are associated with a supratentorial tumor? What is the second most common tumor and where?

A

CNS tumors, astrocytoma. Seizure, weakness, sensory changes. Medulooblastoma in posterior fossa, arise from cerebellar vermis and present with vomiting, headaches and ataxia.

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17
Q

What complications are associated with a pneumothorax?

A

HYPOtension, tachycardia, absent breath sounds, JVP

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18
Q

What causes cyanide toxicity and what are the symptoms?

A

Treatment with nitroprusside especially in people with underlying renal insufficiency. AMS, lactic acidosis, seizures, coma

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19
Q

What class of drugs is Buproprion and when is it contraindicated?

A

NDRI, prior hx. of seizures, bulimia, anorexia

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20
Q

What symptoms are associated with acute-angle closure glaucoma?

A

Severe eye pain, halos, dilated pupils and poor response to light, unilateral orbitofrontal headache, unilateral eye pain with conjuctival injection

21
Q

What is the most common etiology of urethritis in men ? What caused it if you can’t see it on gram culture and how would you diagnose it?

A

Neisseria gonorrhoeae. Chlamidya tracomatis. Nucleic acid amplification test on first catch urine sample w/o precleaning.

22
Q

What is pseudocyesis?

A

Psychiatric illness where the patient presents with nearly all signs and symptoms of pregnancy with negative US and negative pregnancy test

23
Q

What is the most common cause of conductive hearing loss in 20s and 30 year olds? What will Weber test show?

A

Otosclerosis. Laterizes to the affected ear when fork is placed in midline

24
Q

What is the presentation of an infant with galactosemia? What enzyme is deficiency?

A

Failure to thrive, Bilateral cataracts, jaundice, hypoglycemia. Galactose-1-phosphate uridyl transferase deficiency.

25
Q

What is the management of nephrolithiasis?

A
  1. CT abdomen w/o contrast
  2. NSAIDS or narcotics
  3. IF stone 2L/day to let it pass
  4. Urology if complications happen
26
Q

What is a usual cause of HACEK related infections like Kingella, E. Corrodens?

A

Poor dental conditions

27
Q

What are potential side effects of loop diuretics?

A

Hypokalemia, metabolic alkalosis, prerenal kidney injury (Na-K2-Cl inhibitors)

28
Q

What is the presentation of supra valvular aortic stenosis? How do patients present?

A

Congenital left ventricular outflow obstruction - murmur best heard on the Right intercostal space higher than where AS murmur is heard. Unequal carotid pulses, differential blood pressures, palpable thrill in the suprasternal notch

29
Q

What are the symptoms of opioid withdrawal for neonates?

A

High pitched cry, poor sleeping, tremors, seizures, sweating, SNEEzing, tachypnea, poor feeding, vomiting, diarrhea

30
Q

What are the CSF findings of viral meningitis ?Which viruses are common causes in children?

A

WBC (100-1000) and protein

31
Q

What meds are known to improve long-term survivial in patients with left ventricular systolic dysfunction? How about in AA?

A

BB, ACEi, ARBs, Mineralocorticoid receptor antagonists (Spirnoclactone) and in AA (hydralazine and nitrates)

32
Q

What is the prognosis of constitutional growth delay?

A

Normal prognosis, presents with delayed growth spurt, delayed puberty and delayed bone age.

33
Q

What are the findings in pseudogout? How is it treated?

A

Calcium PyroPhosphate Dihydrate crystals, chondrocalcinosis, inflammatory effusion (15,000 - 30,000), Intraarticular glucoocrticoids, NSAIDS, colchicine

34
Q

What is the first step in evaluating a thyroid nodule?

A

Clinical evaluation, TSH level, US.

35
Q

What is the next step if TSH is either normal or elevated in a thyroid nodule? What is the next step if TSH is low in a thyroid nodule?

A

FNA. If low, do Iodine 123 scintigraphy. Hot nodules get treated, cold nodules (hypofunctional) get FNA

36
Q

What is the presentation of hemolytic uremic syndrome (HUS)? What are the lab findings?

A

Diarrhea (bloody often), Lethargy, Bruising or petichiae, Oliguria, edema.
Labs - Hemolytic anemia, thrombocytopenia, increased creatinine, hematuria, proteinuria, casts, increased bilirubin

37
Q

What are the late manifestations of lyme disease?

A

Arthritis and neurologic (encephalomyelitis, peripheral neuropathy)

38
Q

What are the manifestations of early disseminated lyme disease?

A

AV clock, CN VII neurologic manifestations, migratory arthlafias, conjuctivitis, multiple erythema migrans

39
Q

What are treatment options for pediatric strabismus and when is it abnormal?

A

Before 4 months. Penalization therapy using cycloplegic drops to blur normal eye or occlusion therapy of normal eye via patch.

40
Q

Which microorganisms cause alkaline urine?

A

Proteus, Klebsiella, Pseudomonas, Ureaplasma, Staph

41
Q

How does splenic trauma present? What is the imaging modality for splenic trauma?

A

Delayed onset hypotension, LUQ abdominal pain, left shoulder pain. CT abdomen with IV contrast

42
Q

What is the AA gradient in PE?

A

Elevated b/c it is a V/Q mismatch

43
Q

What is the most common cause of iron deficiecny in the elderly? What is the next step?

A

GI blood loss. Colonoscopy and endoscopy even if FOBT is negative

44
Q

What is the clinical presentation of VIPoma? What are lab findings? How is it diagnosed?

A

Watery diarrhea (pancreatic cholera), hypo or achlorhydria due to decreased gastric acid secretion ,associated flushing, lethargy, muscle weakness/cramps. Hypokalemia 2/2 intestinal potassium secretion, Hyper (calcemia and glycemia). Abdominal CT/MRI to localize tumor in pancreas

45
Q

How is overexpression of the oncogene HER2 detected?

A

Immunohistochemical staining or FISH. Heps determine response to transtuzumab

46
Q

What is the workup of ventilator associated PNA?

A

CXR, gram stain and culture if abnormal, empiric antibiotics (Gram positives, anti-pseudomonals, MRSA coverage)

47
Q

How is proteinuria evaluated in preeclampsia?

A

Urine protein-to-creatinine ratio or a 24 hour urine collection for total protein (gold standard)

48
Q

What is the pathophysiology of allergic contact dermatitis? How does it appear?

A

Type IV hypersensitivity, primarily on exposed skin and appears well demarcated

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