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4 Flashcards

1
Q

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

A

Improvement of CD4 counts

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2
Q

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

A
  • echo
  • infective endocarditis
  • severe regurg/ stenosis
  • aortic root/ ascending aortic dilation
  • dissection
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3
Q

Loud S1, diastolic rumble, opening snap

A

mitral stenosis

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4
Q

most common cause of mitral stenosis

A

rheumatic heart disease

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5
Q

clinical features of mitral stenosis

A
  • dyspnea
  • hemoptysis
  • afib
  • thromboembolism
  • voice hoarseness from recurrent laryngeal compression from LAE
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6
Q

How do you diagnosis mitral stenosis

A

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

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7
Q

How do you diagnose disseminated gonococcal infection?

A

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

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8
Q

Clinical features of gonococcal infection

A

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

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9
Q

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

A
  • rectal suction biopsy will show absence of ganglion cells

- diff: meconium ileus shows narrow underused microcolon, related to CF. HD has “transition zone”

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10
Q

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

A

Barrett’s esophagus

  • no dysplasia: regular endoscopic surveillance
  • low dysplasia: surveillance or endoscopic eradication
  • high dysplasia: endoscopic eradication/surgery
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11
Q

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

A
  • hypotensive shock
  • ambiguous genitalia in 46 XX individuals
  • hyponatremia
  • hyperkalemia
  • hypoglycemia
  • vomiting, dehydration
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12
Q

clinical features of 17 alpha hydroxylase enzyme deficiency

A
  • phenotypically looks female
  • fluid, salt retention
  • hypertension
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13
Q

Treatment of CAH

A
  • glucocorticoids and mineralocorticoids
  • high salt diet
  • genital reconstruction for girls
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14
Q

best choice med for preventing cluster headache

A
  • verapamil!

- prednisone and lithium are alternatives

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15
Q

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

A
  • SNRI (venlafaxine), SSRI, TCA or sodium oxybate
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16
Q

Treatment of PE stepwise

small amount of hemoptysis is normal in PE

A
  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
17
Q

treatment of raynaud’s syndrome

A

calcium channel blockers such as nifedipine or amlodipine

18
Q

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

A

radioisotope bone scans

19
Q

Cocaine induced MI treatment regimen

A
  • nitrates/CCB, benzo, aspirin

- if no improvement, coronary angiography due to risk of coronary thrombus

20
Q

Which drugs can induce acute pancreatitis?

A
  • diuretics
  • Inflammatory bowel disease meds: sulfasalazine, 5-asa
  • immunosuppressive agents
  • bipolar/seizure meds: valproic acid
  • AIDS patient: didanosine, pentamidine
  • abx: metronidazole, tetracycline
21
Q

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

A

diencephalon: mamillary bodies, thalamus– abnormal enhancement in MRI

22
Q

Management of asthma exacerbation

A
  • 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)
23
Q

Signs of early cardiac tamponade in echo

A
  • 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)
24
Q

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

A

intestinal parasitosis/helminth infection

25
Q

Management of thyroid nodules

A
  • 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
26
Q

Treatment of acute anovulatory bleeding/dysfunctional uterine bleeding

A

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

27
Q

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

A
  • unable to perform treadmill

- resting ECG showing LBBB, ventricular pacing, or afib

28
Q

Common disease seen with primary hypothyoidism (Hashimoto’s)

A

hyperlipidemia

29
Q

Causes of pseudotumor cerebrii, and signs

A
  • obese premenopausal women
  • endocrine disorders
  • medication SE (isotretinoin, minocycline, etc)
30
Q

Diagnosing acute gout

A

arthrocentesis with monosodium urate crystals

negative birefringent, needle shaped crystals under polarizing light

31
Q

Treatment of gout

A
  • First line: NSAIDs
  • colchicine if NSAIDs contraindicated (acute or chronic renal disease, peptic ulcer disease or heart failure)
  • intrarticular glucocorticoids if contraindications to both treatments above
  • allopurinol is for prevention, avoided in acute attacks

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