Amboss Flashcards
1
Q
What kind of bacteria is associated with acute infective endocarditis in someone with prosthetics?
A
Coagulase-negative staphylococci like S.epidermidis which is found on prosthetics
2
Q
What kind of bacteria is associated with subacute infective endocarditis in predamaged heart valves?
A
gram positive streptococci like strep viridians and enterococci.
3
Q
What is the next step after seeing mediastinal widening on CXR?
A
Get a chest CT with contrast
4
Q
Which drugs reduce mortality in CHF?
A
Beta blockers, ACE inhibitors, and aldosterone antagonists.
5
Q
Which drugs only improve symptoms in CHF?
A
Digoxin and diuretics
6
Q
Next management step in suspected chronic venous disease?
A
Duplex ultrasonography to help determine the underlying etiology (reflux, obstruction, or reflux and obstruction), specific sites involved (deep or superficial veins, perforators, or greater veins), the severity of the disease, and if the patient has a coexisting peripheral artery disease – all of which are needed to determine further management.
7
Q
How could a cardiac myxoma present?
A
If in the LA, will have a plopping sound followed by a low-pitched rumbling mid-diastolic murmur heard best over the apex. Might present with syncope, orthostatic hypotension, constitutional findings (fever, weight loss, anemia)
8
Q
Causes of hypomagnesemia.
A
Diarrhea, alcoholism, use of diuretics
9
Q
What kind of murmur is heard with coarctation of the aorta?
A
A systolic ejection murmur over the left paravertebral region and/or a continuous murmur below the left clavicula and between the shoulder blades.
10
Q
Symptoms of coarctation of the aorta in a child?
A
Chest pain, cold feet, and lower-extremity claudication on physical exertion, and variability in blood pressure in the upper and lower extremities
11
Q
Symptoms of coarctation of the aorta in an adult?
A
HTN, variability in blood pressure in the upper and lower extremities, headache, epistaxis, tinnitus, and claudication of the lower extremities with exertion.
12
Q
How do you diagnose pulmonary HTN?
A
Right-heart catheterization is the test of choice to confirm the diagnosis of pulmonary hypertension as well as the specific subgroup. Diagnosis is made when the mean pulmonary artery pressure is ≥ 25 mm Hg at rest and underlying pulmonary and left heart conditions (e.g., valvular heart disease, systolic dysfunction, diastolic dysfunction) are excluded
13
Q
What is used to close a PDA in a preterm infant?
A
NSAIDS (e.g indomethacin)
14
Q
What is used to close a PDA in a full term infant > 5 kg?
A
Procedural closure
15
Q
Signs and Symptoms of symptomatic PDA?
A
Poor feeding, sweating, failure to thrive, and a characteristic continuous (“machinery”) murmur
16
Q
What is used to close a PDA in a full term infant < 5 kg?
A
Digoxin and furosemide until they are >5kg and can get the procedure.
17
Q
First line tx for acute PSVT?
A
Vagal maneuver
18
Q
Second line tx for acute PSVT specifically AVNRT and orthodromic AVRT?
A
AV node blockade via adenosine. Second line: verapamil, diltiazem, and metoprolol
19
Q
Second line tx for acute PSVT specifically antidromic AVRT (WPW)?
A
Procainamide
20
Q
Which drugs are contraindicated in WPW?
A
AV node blockers like adenosine, verapamil, beta blockers, digoxin, and amiodarone.
21
Q
Patient presents with a penetrating chest wound with foreign object still in. Next step?
A
Emergency surgery to remove object under controlled conditions.
22
Q
EKG findings of AVNRT?
A
Narrow QRS complexes and an invisible P wave (as it is “buried” in the QRS complex)
23
Q
What is associated with a split pleura sign?
A
Pleural empyema
24
Q
How do you differentiate between a chylothorax and pseudochylothorax?
A
In chylothorax: cholesterol <200 and triglyceride >110 so ratio is <1. In pseudochylothorax, cholesterol >200 and triglyceride <110 so ratio >1. It will also have cholesterol crystals.
25
What causes pseudochylothorax? Examples?
Accumulation of cholesterol-rich fluid in the pleural cavity due to chronic inflammation like rheumatoid arthritis of pulmonary tuberculosis.
26
Hemothorax tx and complications?
Chest tube w. evacuation. Blood left will clot and result in a trapped lung or an empyema.
27
Glucose < 30mg/dL in pleural fluid analysis suggests what?
Rheumatoid pleurisy or empyema.
28
Glucose 30-59 mg/dL in pleural fluid analysis suggests what?
Malignant effusion, TB, empyema, pneumonia, esophageal rupture, or lupus pleuritis.
29
What kind of bacteria is associated with acute infective endocarditis?
Staph aureus, strep pyogenes, S. pneumoniae, N. gonorrhea
30
Tx of native valves in bacterial endocarditis?
| List alternatives, preferred tx for pts >65 and for penicillin susceptible pathogens.
4 week: (preferred in pts >65) penicillin G.
alternatives: ampicillin, IV ceftriaxone, IV vancomycin.
2 week: (for pts with penicillin susceptible pathogen and rapid response to abx)
- gentamicin + penicillin G
- gentamicin + ceftriaxone
31
Tx of prosthetic valves in bacterial endocarditis?
Same as native valves except at least 6 weeks.
Penicillin G.
alternatives: ampicillin, IV ceftriaxone, IV vancomycin.
(for pts with penicillin susceptible pathogen and rapid response to abx)
- gentamicin + penicillin G
- gentamicin + ceftriaxone
Exceptions for staphylococci
- Methicillin-susceptible: nafcillin (or oxacillin, cefazolin) + rifampin + gentamicin
- Methicillin-resistant: vancomycin + rifampin + gentamicin
32
Tx of in bacterial endocarditis in IV drug users?
Intravenous empiric antibiotic treatment with vancomycin.
After confirmation of a susceptible pathogen:
- IV nafcillin (2 weeks)
- PO cloxacillin (2 weeks)
33
Endocarditis ppx?
| In allergic pts?
Usually PO amoxicillin (administer 1 hour before procedure)
Patients who are unable to take oral medication: IV ampicillin
Patients with penicillin allergy: PO clarithromycin or azithromycin
34
Diagnostic criteria for Kawasaki disease?
Fever for at least 5 days in combination with at least 4 of the symptoms listed: a polymorphous rash, conjunctivitis, cervical lymphadenopathy, and erythema or edema of the hands, feet, and tongue (strawberry tongue)
35
Hemolytic anemia is a very rare complication of which childhood exanthem?
Fifth disease (Parvo B virus)
36
Describe the phases of scarlet fever.
Initial phase: acute tonsillitis: fever, sore throat, cervical LAD
Exanthem phase: 12-48 hrs after fever
- maculopapular sand-paper like erythematous rash that confluence in creases.
- Tonsillar exudate
- Strawberry tongue
- Red face with perioral pallor
Desquamation phase: 7-10 days after rash resolution
37
Digitalis toxicity symptoms?
Nausea, vomiting, diarrhea, abdominal pain, weakness, loss of appetite, and blurry vision with a yellow tint and halos.
38
Etiologies of digitalis toxicity?
- Digoxin overdose
- Hypokalemia
- Renal failure
- Volume depletion (e.g diuretics)
- Treatment with verapamil, diltiazem, amiodarone, quinidine, propafenone
39
List 2 drugs used for chemical conversion in afib?
Flecainide or propafenone
40
List a drug that is contraindicated in afib?
Adenosine
41
What other cardiac abnormality should be assessed in a pt w/ afib?
Mitral valve involvement
42
What are the 1st line med for rate control in afib?
Beta blockers (esmolol, propranolol, metoprolol or nondihydropyridine calcium channel blockers (diltiazem, verapamil)
43
What are the 2nd line meds for rate control in afib?
Digoxin
44
What are the 3rd line meds for rate control in afib?
Amiodarone or dronedarone
45
What is the 2nd line tx for rate control in afib after medication?
AV nodal ablation and implantation of a permanent ventricular pacemaker
46
What are the 1st line tx for rhythm control in afib?
Elective electrical cardioversion
47
What are the 2nd line tx for rhythm control in afib?
Pharmacologic cardioversion with antiarrhythmic drugs such as flecainide, propafenone, ibutilide, dofetilide
48
What procedure could be used as rhythm control in afib?
Catheter-based radiofrequency ablation of atrial tissue around pulmonary vein openings (pulmonary vein isolation)
49
What is the tx for unstable afib?
Immediate cardioversion
50
Tx before cardioversion in stable AF?
Warfarin with bridging therapy for 3 weeks before and up to 4 weeks after cardioversion
51
CHADS VASc score
- CHF or left-sided HF
- HTN
- A2 age >75
- DM
- S2 Stroke or TIA or thromboembolism
- Vascular disease: prior MI, PAD, or aortic plaque
- Age 65-74
- Sex - female
52
Whats CHA2DS2 VASc score corresponds to what tx of nonvalvular atrial fibrillation?
Score of 1 no anticoagulation or tx w/ oral anticoagulants
Score of 2 oral anticoagulation with either warfarin or newer oral anticoagulants (dabigatran, rivaroxaban, apixaban)
53
Tx for valvular afib?
Anticoagulation with warfarin is required regardless of the CHA2DS2-VASc score
54
First tx after infant presents with CDH?
Intubation and mechanical ventilation then gastric decompression and surgery in 24-48 hrs
55
Pre-renal BUN:creatinine? Causes?
> 20:1
- Decreased renal perfusion (e.g peripheral vasodilation due to sepsis and cirrhosis, cardiac dysfunction)
- Pre-renal uremia
- high protein intake
- After GI bleeding
56
Renal BUN:creatinine? Causes?
<10:1
- Acute tubular necrosis
- Low protein intake
- Starvation
- Severe liver disease
57
High BUN:creatinine with raised creatinine? Causes?
Like a post-renal cause.
- post renal obstruction
- post renal uremia with renal disease
- Prostate hyperplasia
58
Does type 4 RTA present with hyper or hypokalemia?
Hyperkalemia
59
How is RTA diagnosed?
With urine pH and anion gap
60
How is primary hyperaldosteronism diagnosed?
With a saline infusion test. Renin and aldosterone levels should be decreased (PAC <10 ng/dL) and if they don't then diagnosis is confirmed.
61
What is the ratio or aldosterone to renin in primary hyperaldosteronism?
> 20
62
What is the differential diagnosis of primary hyperaldosteronism?
1. Secondary hyperaldosteronism:
- Renal artery stenosis
- Renin secreting tumor
- CKD
2. Pseudohyperaldosteronism:
- Congenital adrenal hyperplasia
- Exogenous minaerlocorticoid
- Cushing's syndrome
- Liddle's syndrome
63
Symptoms of aortic stenosis?
Dyspnea on exertion, angina, or syncope.
64
Tx of symptomatic aortic stenosis?
Surgery
65
Pulmonary HTN tx?
- Diuretics
- Oxygen
- Pulmonary vasodilator therapy:
~ Ca channel blockers
~ Long-acting prostacyclin analogs
~ Endothelin receptor antagonists, Bosentan
66
Conditions where hypocomplementemia is seen?
Lupus, mixed cryoglobulinemia, membranoproliferative glomerulonephritis, hereditary angioedema, and cholesterol crystal embolism (atheroembolism).
67
Symptoms of Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)?
- Severe allergic asthma attacks (chief complaint)
- Allergic rhinitis/sinusitis
- Skin nodules; palpable purpura
- Pauci-immune glomerulonephritis
- Mononeuritis multiplex
68
Symptoms of Microscopic polyangiiti?
Similar to granulomatosis with polyangiitis, but without involvement of the nasopharynx!
- Glomerulonephritis; hypertension
- pulmonary vasculitis with hemoptysis
- palpable purpura
69
Symptoms of mixed cryoglobulinemia?
- Nonspecific systemic symptoms: fatigue, malaise, myalgia, arthralgia
- Skin lesions (nearly 100% of cases): palpable purpura, ulceration, necrosis
- Raynaud's phenomenon
- Polyneuropathy
- Hepatosplenomegaly
- Glomerulonephritis (severe cases or late complication)
70
Symptoms of Behçet disease?
- Recurrent painful aphthous ulcers
- Recurrent genital ulceration
- Ocular disease: uveitis
71
How is Behçet disease diagnosed?
Positive pathergy skin test: erythematous papule or pustule 24–48 hours after a; needle prick.
Autoantibodies (e.g., ANA, ANCA, rheumatoid factor) are usually absent
72
Are lungs involved in polyarteritis nodosa?
No they are spared
73
What medication is contraindicated in Prinzmetal angina?
Beta blockers because they inhibit dilation of smooth muscle cells.
74
Features of benign lung tumors?
“Popcorn” calcifications. Round, well-circumscribed nodules, lobulated by respiratory epithelium. 90% are peripheral, 10% are endobronchial
75
Features of infectious granulomas like TB of histoplasmosis in lung?
Round, well-defined, calcified nodule
76
Ddx of pulmonary edema?
Acute decompensated HF, ARDS, PE, transfusion-related acute lung injury, high altitude, asthma, or pneumonia.
77
What kind of arrhythmia is WPW syndrome?
A ventricular tachycardia
78
What other defect could congenital long QT syndrome be associated with?
Deafness
79
1st line tx of long QT syndrome?
Beta blockers; propranolol
80
What kind of arrhythmia is torsade de pointes?
A ventricular tachycardia
81
Is hematemesis present in Boerhaave syndrome?
Not usually
82
What is a pseudoaneurysm of the gastroduodenal artery associated with and how could it present?
Associated with recurrent pancreatitis. Pts usually have hx of pancreatic pseudocysts and can present with signs of upper GI bleed.
83
Typical findings on ECG in atrial premature beats?
- P-wave abnormalities or absent P waves
- Altered PR interval in the premature beats (compared to the normal beats)
- QRS complex may be normal, aberrant (widened), or absent
- No full compensatory pause. aka if the interval b/w pre-extrasystolic and post-extrasystolic beat is less than 2x a normal RR interval.
84
Next step after seeing atrial premature beats on ECG?
Get an echo to rule out structural heart disease
85
Tx of atrial premature beats in symptomatic pts?
Reduce triggers like caffeine, smoking, and alcohol.
| Beta blockers or catheter ablation if symptoms persist.
86
TCA overdose tx?
Activated charcoal within 2 hours of ingestion and sodium bicarbonate
87
MOA of glucagon in beta blocker overdose?
It enhances myocardial contractility.
88
Antidote for serotonin syndrome?
Cyproheptadine
89
Which antidote is used in organophosphate poisoning?
Atropine
90
What is ammonium chloride used for?
To acidify urine to help increase excretion of weak bases like amphetamines.
91
1st diagnostic step after suspecting myocarditis?
Get an ECG. Might see sinus achy, arrhythmias, ST elevation w/ concave ascending S wave, heart block, or low voltage from pericardial effusion.
92
Positive lab findings in myocarditis?
↑ Cardiac enzymes
↑ ESR
Leukocytosis
↑ BNP
93
Hypotension and tachycardia that do not respond to fluid resuscitation should raise suspicion for what?
Cardiac contusion
94
Which beta blockers are cardioselective and white receptor do they block?
Metoprolol and atenolol. They block B1 receptors
95
Which receptors does labetalol block? What other beta blocker has a similar MOA?
It blocks both beta1/2 and alpha 1 receptors. Carvedilol has a similar MOA.
96
Which alpha blocker is given first in pheochromocytoma and why?
Phenoxybenzamine. Because it is irreversible
97
How does cocaine serve as a local anesthetic?
Inhibition of Na+ channels causes local anesthetic action by blocking nerve action potential transmission.
98
Drug of choice for afib in pts w/ decompensated HF?
Digoxin
99
When is prednisone used to treat Raynaud's?
Used in patients with secondary Raynaud's phenomenon due to an underlying condition (e.g., vasculitides, connective tissue diseases).
100
What is the 1st and 2nd line tx for Raynaud?
1st: calcium channel blockers
2nd: Fluoxetine
101
Which drugs are contraindicated in Raynaud's phenomenon? why?
Beta blockers b/c they worsen the vasospasm
102
Clinical differences b/w primary and secondary Raynaud?
Primary: usually symmetrical and no ulceration
Secondary: usually asymmetrical w/ ulceration/necrosis
103
DDx of bluish/white or discoloration of fingers or toes?
- Raynaud's phenomenon
- Acrocyanosis
- Erythromelalgia
- PAD
- Acute arterial occlusion of an extremity
104
Describe ECG findings of WPW?
Shortened PR interval w/ wide monomorphic QRS and a regular rhythm. A slurred upstroke of the QRS will also be seen.
105
What is a common cause of Atrial tachycardia? What other ECG finding does it usually present with?
A common cause of AT includes digoxin poisoning which typically presents with concomitant AV block
106
ECG in AVNRT?
no P waves or atrial activity
107
ECG in AVRT?
P wave in the ST segment
108
Side effects of amiodarone (7)?
```
Cardiac: QT prolongation, TdP
Pulmonary: interstitial pneumonitis
Endocrine: Hypo or hyperthyroidism
GI: elevated transaminases, hepatitis
Ocular: corneal micro deposits, optic neuropathy
Derm: blue-gray skin
Neuro: peripheral neuropathy
```
109
Severes aortic stenosis criteria?
- Aortic jet velocity > 4.0m/sec OR
- mean transvalvular pressure gradient >40 mm Hg. OR
- Vavlve area < 1 cm2
110
Indications for AS valve replacement?
Severe AS and 1 or more of the following:
- Onset of sx (angina, syncope)
- Left EF <50%
- Undergoig other cardiac surgery
111
Can oral contraceptives cause HTN?
Yes. Most pts' HTN returns to normal after stopping it.
112
What is the 1st line medication for hypertrophic cardiomyopathy?
Beta blockers
113
First med to give for narrow QRS tachycardia? Why?
Amiodarone b/c it helps unmask any buried p waves and terminates PSVT?
114
How does constrictive pericarditis usually present?
R heart failure
115
What is the timeline requirement for diagnosis of peripartum cardiomyopathy?
Diagnosed at >36 weeks or early postpartum period.
116
How do you diagnose a retroperitoneal hematoma?
non contrast abdomen and pelvis CT. May use abdominal ultrasound.
117
How does a retroperitoneal hematoma present after catheterization?
Sudden hemodynamic instability with ipsilateral flank and back pain.
118
When is synchronized cardioversion used?
- Symptomatic or sustained monomorphic Vtach that is unresponsive to antiarrhythmics
- Afib with RVR
119
Describe the intracardiac pressures as recorded by pulmonary artery catheter in cardiac tamponade?
Elevation and equalization of intracardiac diastolic pressures: R atrial, R ventricular, and pulmonary capillary wedge pressure (L atrium).
120
Syncope associated w/ prodrome of weakness, diaphoresis, nausea, pallor, warmth, or abdominal pain. What is it?
Vasovagal syncope
121
Describe atrial premature beats on ECG?
Irregular rhythm with some of the p waves having abnormal morphology
122
Pediatric pt with hx of rheumatic fever. Next step in management?
Penicillin ppx against group A strep pharyngitis. Duration depends on severity of disease.
123
Complication in patients on TPN > 2 weeks?
Cholestasis leading to cholelithiasis
124
What chemical is found in antifreeze?
Ethylene glycol
125
What are the s&s of ethylene glycol toxicity?
Metabolic acidosis, calcium oxalate crystals in urine (due to increased oxalic acid binding Ca), high osmolar gap, flank pain, hematuria, oliguria, and altered mental status.
126
Which organism is ecthyma gangrenous associated with?
Pseudomonas aerginosa bacteremia
127
What does pulses paradoxus look like clinically?
Loss of palpable radial pulse bilaterally during inspiration
128
Describe pain from pericarditis?
Retrosternal pain that can radiate to the left arm or shoulder
129
Distinguishing feature of tamponade compared to myocarditis?
Pulsus paradoxus
130
CP + decreased CO + pulsus paradoxus following viral illness =? Describe lungs in this scenario?
Tamponade secondary to viral pericarditis. Clear
131
What are the HSV encephalitis CSF findings? Why?
Lymphocytic pleocytosis, elevated protein, normal glucose, elevated RBCs (due to hemorrhagic destruction of frontotemporal lobes.
132
What are the tuberculous meningitis CSF findings?
Markedly low glucose, elevated protein, and lymphocytic pleocytosis.
133
Alveolar hypoventilation is the pathophys behind which pulmonary disease?
Extrinsic restrictive lung disease like obesity hypoventilation or neuromuscular weakness.
134
Describe the pain of compression fx in a pt w/ osteoarthritis?
Typically starts after a minor trauma (fx) and decreases over time.
135
Back or lower extremity pain that improves with flexion of spine in someone >60?
Lumbar spinal stenosis
136
Maneuvers that cause spinal flexion?
Leaning forward or walking uphill.
137
What is active phase protraction?
Cervical dilation of <1cm per 2 hours.
138
Characteristics of pleural effusion from TB?
High protein >4, low glucose, markedly elevated LDH > 500, low pH, and lymphocytic leukocytosis
139
When are live vaccines contraindicated in HIV patients?
When CD4 is <200
140
What are 2 examples of prophylactic abx in HIV? What organisms are they used for? and when are they used?
- Azithromycin against Mycobacterium avium when CD4 <50
| - Trimethoprim-sulfamethoxazole against toxoplasmosis and Pneumocystis pneumonia when CD4 <200
141
Describe headaches associated with SVC syndrome?
They worsen with leaning forward due to decreased gravitational effects on the blood column
142
How do you diagnose SBP?
Ascitic fluid must have neutrophil count >250
143
How do you differentiate between bullous pemphigoid and pemphigus vulgaris?
The first is due to hemidesmosome autoantibodies with subepidermal blisters, liners IgG @ basement membrane and doesn't have oral/mucosal involvement. Also blisters usually remain intact.
144
Describe the clinical presentation of polymyositis?
Symmetric proximal muscle weakness. Pain is mild or not present
145
What are the lab and biopsy findings of polymyositis?
Elevated muscle enzymes: creatine kinase, aldolase, AST, ALT, and LDH.
ANA and anti-Jo-1 antibodies.
Biopst shows endomysial infiltrate (macrophages and CD8) with itchy necrosis.
146
Pt with both UMN and LMN signs. What do they have?
ALS
147
Fetal complications due to maternal DM especially new onset in the last trimesters?
- Immature lungs --> respiratory distress syndrome
- Macrosomia
- Pre-term delivery
148
Which disease is antiendomysial antibodies associated with?
Celiac disease
149
Describe lipase and liver enzyme levels in chronic pancreatitis?
They could be normal or elevated even if the etiology is alcoholic pancreatitis.
150
How does hyperthyroidism causer hypercalcemia?
Via increased bone turnover
151
Clinical features of iron overdose?
Abdominal pain, hematemesis, diarrhea (could be green or black), liver necrosis, shock, AGMA
152
What imaging modality is used to diagnose a meniscal tear?
MRI
153
Clinical features of meniscal tear?
Joint line tenderness, slow onset effusion, sensation of instability, locking or catching when joint is rotated or extended under load.
154
What are the important prognostic factors in brain tumors?
Pt age, functionality and tumor grade (degree of anaplasia, neovascularity, or necrosis)
155
Therapy in CLL targets what?
CD20 cell surface antigen
156
Clinical features of vascular dementia?
Stepwise decline in function, early executive dysfunction, cerebral infarction and/or deep white matter changes on imaging.
157
UA results in renal insufficiency in multiple myeloma caused by cast nephropathy?
Results will be normal
158
Etiologies of renal insufficiency in MM other than cast nephropathy? What are the UA results?
Amyloidosis and monoclonal immunoglobulin deposition disease. They cause glomerular injury --> nephrotic syndrome that would be reflected in the UA.
159
Gram positive cocci septic arthritis tx?
Vancomycin
160
Gram negative rod septic arthritis tx?
3rd generation cephalosporin
161
Is there increased LV end-diastolic pressure in tamponade?
No. Pressures are generally low and decreased LV preload is seen.
162
What is the primary mechanism for reducing pain in acute MI?
Venous dilation to reduce preload --> reduce myocardial oxygen demand
163
What is the typical lumbar puncture findings in GBS?
Elevated protein with normal leukocyte count and glucose
164
Lab results in epidural abscess?
They could be normal including WBC count but ESR is always elevated
165
How isa spinal epidural abscess diagnosis confirmed?
MRI of the spine
166
Describe the CF of herpangia?
Sore throat, oral ulcers or vesicles on posterior oral mucosa like uvula, soft palate, and tonsillar pillars.
167
What are the clinical manifestations of tumor lysis syndrome?
N/V, bowel disturbance, low urine output, acute renal insufficiency, seizures, tetany, or arrhythmias.
168
Lab abnormalities associated with tumor lysis syndrome?
Hypocalcemia, hyperphosphatemia, hyperkalemia, and elevated uric acid levels.
169
Describe the MOA of DKA that leads to its symptoms?
Insulin deficiency leads to increased lipolysis of peripheral fat secondary to high catecholamine levels. Those fatty acids are broken down in the liver to ketones which contribute to anion gap acidosis. Additionally, increased anaerobic metabolism releases lactic acid.
170
Where are tear-dropped shaped RBC seen?
In myelofibrosis or beta thalassemia (especially after splenectomy)
171
Which HIV drug causes neuropsychiatric effects like insomnia, vivid dreams, depression, and anxiety?
Efavirenz
172
An endocrinopathic cause of clubbing and onycholysis?
Hyperthyroidism
173
What migraine abortive should not be combined? Why?
Triptans and ergotamine because they both cause vasoconstriction and the combination could lead to HTN, MI, or stroke
174
What are the symptoms of cataracts?
Painless blurring of vision, glare and halos around lights, and worsening of distance vision initially.
175
What would be seen in ocular examination in a pt with cataracts?
Opacification and loss of red reflex and retinal details.
176
Describe symptoms of herpes simplex keratitis? What triggers it? What would be seen on examination?
Pain, photophobia, blurred vision, redness, and tearing. It is often recurrent and triggered by sun exposure, immunodeficiency, or fever. Findings include corneal vesicles w/ branching ulcers and opacities.
177
When is drusen deposits with patchy depigmentation seen in the macula? What are the features of that condition?
In dry macular degeneration which manifests with slowly progressive bilateral vision loss.
178
Hard exudates, arteriovenous nicking, 'silver wiring" of arterioles, cotton wool spots, and a flame shaped hemorrhage is seen in what condition?
Hypertensive retinopathy.
179
Retinal aneurisms are associated with what condition?
Diabetic retinopathy
180
Superolateral lens displacement (ectopia lentis) is associated with what condition?
Marfan syndrome
181
What are the 3 drugs used as tocolytics? When are they used?
Indomethacin - before <32 weeks
Nifedipine - weeks 32-34
Terbutaline - short term in-patient use
182
What are the side effects of indomethacin as a tocolytic?
Maternal: gastritis, platelet dysfunction
Fetal: oligohydramnios, closure of ductus arteriosus
183
What are the side effects of nifedipine as a tocolytic?
Hypotension, tachycardia, palpitations, nausea, flushing, headache
184
What are the side effects of terbutaline as a tocolytic?
Tachycardia, arrhythmia, hypotension, hyperglycemia, pulmonary edema
185
What are the clinical feature differences between central and peripheral cyanosis?
Central cyanosis has a low arterial oxygen saturation. Extremities are warm and patients will have bluish discoloration of lips, tongue, nail beds etc.
Peripheral cyanosis has a normal arterial oxygen saturation w/ increased O2 extraction due to sluggish blood flow thru capillaries with cold and clammy extremities. Additionally, bluish discoloration is only seen in distal extremities.
186
Striate palmar xanthomas (yellowish streaks) are associated with what condition? Other features? What is the 1st line tx?
Familial dysbetalipoproteinemia causing increased triglycerides. Blood appears milky and opalescent. 1st line tx is fenofibrate.
187
Clinical features of roseola infantum and which organism causes it?
3-5 days of high fever followed by a non-itchy, non-painful erythematous and blanching maculopapular rash. Caused by HHV-6
188
What is an absolute contraindication to OCP use?
Active liver disease
189
Clinical features of amaurosis fugax?
Painless, rapid, and transient (<10 mins) monocular vision loss
190
Fundoscopic findings in amaurosis fugax?
Often normal but may show embolic plaques and retinal whitening due to ischemia.
191
Clinical features of posterior uveitis? Pathophys? Which conditions is it associated with?
Painless vision loss and floaters. Choroidal inflammation. Associated with systemic inflammatory disorders like IBD, ankylosing spondylitis or infection e.g CMV
192
What is the Uhthoff phenomenon?
It is when neurological symptoms in MS worsen when the body overheats (e.g. exercise, hot shower, fever etc)
193
Etiology of target cells?
Liver disease, asplenia, or thalassemia
194
Pancreatitis is associated with which lipid disorder?
Hypertriglyceridemia >1000 md/dL
195
Is diarrhea is C.diff bloody or not?
Bloody
196
Clinical features of glucagonoma?
Weight loss, necrolytic migratory erythema (indurated pruritic erythematous plaques with central clearing), hyperglycemia/newly diagnosed DM, GI symptoms (diarrhea, pain, or anorexia)
197
First line Benzo for alcohol withdrawal?
Lorazepam
198
Side effects of lithium?
Hyperparathyroidism, thyroid dysfunction (usually hypo), diabetes insipidus, and CKD.
199
Signs and symptoms of benzo and alcohol overdose? How is it different from benzo overdose alone?
Benzo alone would cause altered mental status, ataxia, and slurred speech. Addition of alcohol would cause vital sign derangement with respiratory depression, bradycardia, hypotension, and hyporeflexia.
200
Which 2nd generation antipsychotics have the least metabolic effects?
Ziprasidone, aripiprazole, and lurasidone.
201
Aspirin could be a trigger for what?
Bronchoconstriction in people with asthma
202
How do glucocorticoids affect neutrophils and lymphocytes?
Decrease circulating numbers
203
What is a normal JVP range?
6-8
204
What is the nest tx after aspirin and a statin in a pt with claudication?
Exercise therapy
205
Adverse effects of methotrexate? What should be checked prior to starting it?
- Hepatotoxicity
- Stomatitis
- Cytopenias
Check liver enzymes before starting. Giving folic acid with it reduces side effects.
206
What should be regularly checked for pts on hydroxychloroquine?
Ophthalmologic evaluation for potential retinal injury
207
What are the contraindications for a contraction stress test?
The same as ones for labor: placenta previa, prior myomectomy, etc
208
What is a normal amniotic fluid volume?
Single fluid pocket of >2cm x 1cm or amniotic fluid index >5
209
What is the preferred diagnostic study for aortic dissection in a pt w/ hemodynamic compromise?
TEE
210
After thyroidectomy due to medullary thyroid cancer what should be monitored? why?
Calcitonin because of its positive correlation with recurrence.
211
Previously healthy child with 3 days fever, runny nose, cough, and visual hallucinations. Only took OTC antihistamines and decongestants. Vitals stable, physical and near exam normal. What is causing his hallucinations and agitation?
Medication side effect from antihistamines (have anticholinergic properties) and decongestants (alpha adrenergic and NMDA. antagonist)
212
Clinical features of Reye syndrome? When does it occur?
Hepatic failure, altered mental status, vomiting, seizure, and coma that develop a few days after resolution of a viral illness and risk is increased with salicylate use.
213
What are common areas of enthesitis (tenderness at tendon insertion sites) presentation? What conditions is it associated with?
Achilles heel, costosternal junction, elbows, shoulders, hips, iliac crests, tibial tuberosities, etc.
It can occur alone but is also associated with the spondyloarthropathies (ankylosing spondylitis, psoriatic arthritis, and reactive arthritis)
214
Features of medulloblastoma? Which population is it common in?
Nocturnal or morning headaches and vomiting. Incoordination and ataxia.This a pediatric tumor.
215
Indications for H. pylori screening?
Active PUD, hx of PUD, atrophic gastritis, or gastric MALT lymphomas. It is NOT indicated for GERD.
216
Clinical features of hereditary angioedema?
- Swelling of face, extremities, or genitalia without urticaria
- Laryngeal edema
- Colicky abdominal pain, vomiting, diarrhea (GI sx due to bowel wall edema)
217
When does hereditary angioedema usually present?
Late childhood or adolescence after a dental procedure, stress, or trauma
218
Which drugs can cause idiopathic intracranial hypertension?
- Retinoids
- Tetracyclines
- Growth hormone
219
What are the extra-hepatic manifestations of hepatitis C?
- Mixed cryoglobulinemia
- Membranoproliferative glomerulonephritis
- Prophyria cutanea tarda
220
Pt w/ sickle cell disease presents with macrocytic anemia and reticulocyte count on 1%? What is the cause?
Folate deficiency
221
Femoral nerve motor and sensory innervation?
Hip flexion and knee extension. Patellar reflex will be weaker with injury due to. involvement of quadriceps.
Provides sensation to anterior thigh and medial leg.
222
Common peroneal nerve motor and sensory innervation? Damage caused by which injury?
Usually caused by fx or compression at the proximal fibula. Involved in foot eversion, dorsiflexion, and toe extension. Damage causes foot drop.
Sensory includes posterolateral leg and dorsolateral foot.
223
Tibial nerve motor and sensory innervation? Caused by damage where?
Caused by injury at the popliteal fossa which results in weak plantar flexion. Compression of the nerve at the medial ankle can cause numbness and paresthesia in the sole and distal toes (Tarsal tunnel syndrome)
224
What are the lab findings in Gilbert syndrome?
Mildly elevated indirect hyperbilirubinemia. Normal CBC, no evidence of hemolysis, normal Alk phos, AST, ALT, blood smear, and reticulocytes.
225
What causes Felty syndrome?
It is a complication of long standing erosive rheumatoid arthritis.
226
Clinical features of Felty syndrome?
```
- Rheumatoid arthritis:
~ erosive joint disease and deformity
~ Rheumatoid nodules
~ Vasculitis (mononeuritis multiplex, necrotizing skin lesions)
~ LAD
- Neutropenia
- Splenomegaly (due to antibody-coated neutrophils trapped in spleen)
-
```
227
Causes of primary adrenal insufficiency?
- Autoimmune
- Infectious (TB, HIV, disseminated fungal)
- Hemorrhagic infarction (meningococcemia, anticoagulants)
- Metastatic cancer (lung)
228
Lab values associated with primary adrenal insufficiency?
- Hyponatremia
- Hyperkalemia
- Hypercalcemia
- Eosinophilia
229
What are the three categories of hyponatremia?
1. Hypotonic
2. Isotonic
3. Hypertonic
230
What are the 3 categories in hypotonic hyponatremia and list the causes of each?
1. Hypovolemic:
- Renal: diuretic, aldosterone deficiency
- Extrarenal: pancreatitis, vomiting, diarrhea, burns, bleeding
2. Euvolemic:
- SIADH
- Psychogenic polydipsia
- Hypothyroidism
- Rarely alcoholism
3. Hypervolemic:
- CHF
- Cirrhosis
- Nephrotic syndrome
231
Causes of isotonic hyponatremia?
- Psuedohyponatremia
~ Hyperlipidemia
~ Paraproteinemia (e.g multiple myeloma)
232
Causes of hypertonic hyponatremia?
- Hyperglycemia
| - Use of mannitol
233
What are the three categories of hypernatremia?
1. Hypovolemic
2. Euvolemic
3. Hypervolemic
234
What are the causes of hypovolemic hypernatremia?
1. Dehydration: poor oral intake, diarrhea
| 2. Diuretics: usually loop and osmotic diuretics
235
What are the causes of euvolemic hypernatremia?
1. Diabetes insipidus (central and renal)
| 2. Lack of access to water
236
What are the causes of hypervolemic hypernatremia?
1. Primary hyperaldosteronism
2. Cushing syndrome
3. Iatrogenic
4. Drinking sea water
237
Three main categories of hyperkalemia causes? List the different causes of each
1. Potassium excess
- Reduced excretion: acute and chronic kidney disease
- Endo: hypocortisol, hypoaldosterone
- Drugs: aldosterone antagonists, ACE, ARB, NSAIDS, TMP-SMX
- RTA IV
- Release from cells: myolysis, tumor lysis, hemolysis
2. Extracellular shifts
- Acidosis
- Insulin deficiency
- Drugs: succinylcholine, digoxin
3. Pseudohyperkalemia
- Blood draw error
- Prolonged tourniquet
238
What are the two categories of hypokalemia? List the causes under each?
1. Renal loss:
- Endo: hyperaldosterone, hypercortisol
- Drugs: diuretics, glucocorticoids, licorice (aldosterone-like)
- Hypomagnesemia
- RTA I and II
- GI loss: vomiting, diarrhea, laxatives
2. Intracellular shift:
- Alkalosis
- Insulin
- Beta agonist
239
Eosinophilia with liver cyst? Tx? Common cause?
Hydatid cyst. Albendazol if uncomplicated cyst. Petting animals or eating soiled food.
240
Clinical features of HSV retinitis (esp in HIV pts) and funduscopy findings? What other virus can cause a similar condition?
Acute retinal necrosis characterized by keratitis, uveitis, conjunctivitis followed by rapidly progressive visual loss. Funduscopy reveals widespread, pale peripheral lesions and central necrosis of the retina.
VZV.
241
How does CMV retinitis present?
Typically painless and not associated with keratitis or conjunctivitis. Funduscopy reveals fluffy or granular lesions near the retinal vessels and associated hemorrhages.
242
Chondrocalcinosis in an inflammatory joint is most likely what diagnosis?
Calcium pyrophosphate arthritis aka pseudogout
243
What is the next medication after stimulants for ADHD in children and adolescents?
Atomoxetine a selective norepinephrine reuptake inhibitor.
244
Chronically inflamed, scarred, or wounded skin can cause which skin cancer?
Squamous cell carcinoma
245
How does cutaneous T cell lymphoma appear?
Scaly, pruritic patches or plaques
246
Angiodysplasia is associated with which conditions?
- Advanced renal disease
- von Willebrand disease
- Aortic stenosis (likely due to acquired vW deficiency from shearing of vW multimers)
247
Diagnostic criteria for chorioamnionitis?
Maternal fever plus one of the following:
- Fetal tachycardia >160
- Maternal leukocytosis
- Purulent amniotic fluid
248
Signs and symptoms of rubella (German measles)?
May start with low grade fever and lymphadenopathy (especially suboccipital and posterior auricular), cephalocaudal spread of maculopapular rash. May have petechiae or erythematous papules on the soft palate.
249
1st line tx for stable angina? What is the MOA? What is an alternative?
Beta blockers. Can use non-dihydropyridines instead.
| Both medication classes work by reducing heart rate and contractility
250
Describe EPO in an infant after birth?
Circulating EPO decreases due to increased oxygen concentration in tissue. A physiologic dip in RBCs occurs at age 2-3 months. In pre-term infants this phenomenon is exacerbated and causes anemia of prematurity.
251
Herpes simplex ultrasound and fetal findings?
Placental and umbilical cord calcifications. temporal lobe involvement in the fetus.
252
Congenital defects associated with varicella zoster infection?
- Club foot
- Hypoplastic limbs
- Hydrops fetalis
253
Indications for urgent dialysis?
AEIOU
A: acidosis, pH <7.1
E: electrolyte imbalance, severe or symptomatic hyperkalemia
I: ingestion: toxic alcohols (methanol, ethylene glycol), salicylate, lithium, valproate, carbamazepine
O: overload refractory to diuretics
U: uremia symptomatic (encephalopathy, pericarditis, and bleeding)
254
Causes of asterixis?
- Hepatic encephalopathy
- Uremic encephalopathy
- Hypercapnia
255
What stain is used to visualize Howell-Jolly bodies? Heinz bodies?
- Wright staining = Howell-Jolly
| - Crystal violent = Heinz bodies
256
Ddx of hypokalemia, alkalosis, and normotension (4)?
| What is the urine finding 3 of them have in common?
- Surreptitious vomiting
- Diuretic abuse
- Bartter syndrome
- Gitelman's syndrome
Diuretic abuse and Bartter/ Gitelman results in high urine chloride concentration whereas bulimia might result in low urine chloride
257
Septic arthritis us usually caused by a gram + organism and treated with vancomycin, however some people do not improve and need additional gram - coverage. Which abx would be used?
A 3rd generation cephalosporin e.g ceftriaxone
258
CXR findings in transient tachypnea of the newborn?
Increased pulmonary vascular markings or fluid in the fissures.
259
How does Freidreich ataxia present?
Presents in adolescence with progressive ataxia, dysarthria, scoliosis, hypertrophic cardiomyopathy, and loss of vibratory/prioprioceptive sensation.
260
Which diseases are associated with erythema nodosum?
- Strep infection
- Sarcoidosis
- TB
- Endemic fungal disease (e.g histoplasmosis)
- IBD
- Behcet disease
261
How is catatonia treated?
Benzodiazepines or ECT for severe cases
262
What is a hazard ratio?
It indicates the chance of an event occurring in the treatment group compared to the chance of the event occurring in the control group.
Ratio >1 means the event is more likely to occur in the tx group
Ratio <1 = event is more likely to occur in the control group
A ratio close to 1 implies little difference between the groups.
263
Symptoms of central cord syndrome and first diagnostic test?
Usually occurs in cervical spine after trauma and causes loss of pain/temperature in upper limbs and trunk with weakness, and loss of DTR. Symptoms are usually more prominent in the hands.
First diagnostic test is MRI of the spine without contrast as well as a non contrast CT
264
When should TCAs be avoided as tx for neuropathic pain?
If a pt has hx of a cardiac condition b/c they might prolong QRS/Qt interval and causes arrhythmias.
It should also be avoided in patients with epilepsy and glaucoma.
265
How does cortisol affect ADH?
It inhibits it
266
What is the pH status in adrenal insufficiency related to corticosteroid withdrawal?
It is not associated with normal anion gap metabolic acidosis because aldosterone secretion is preserved.
267
What is the status of K in adrenal insufficiency due to corticosteroid withdrawal?
There is no hyperkalemia because aldosterone secretion is preserved.
268
What would be seen in peripheral blood smear in a pt with scleroderma renal crisis?
Schistocytes
269
Where are Burr cells (echinocytes) seen?
Liver dz and ESRD.
270
Where are spur cells (acanthocytes) seen?
Liver disease
271
How does scleroderma renal crisis present?
Presents with acute renal failure (w/o previous kidney dz), malignant HTN (HA, blurry vision, nausea), UA may show mild proteinuria, microangiopathic hemolytic anemia (schistocytes) and thrombocytopenia.
272
Clinical presentation of exztraperitoneal bladder injury and what other injury does it usually occur with?
Localized pain in lower abdomen and pelvis (due to spill of urine), gross hematuria, urinary retention, and it usually occurs with pelvic fractures.
273
What does organophosphate poisoning do and how does it present?
It inhibits acetylcholinesterase. It presents with sx of cholinergic excess like bradycardia, miosis, bronchorrhea, muscle fasciculation's, salivation, lacrimation, diarrhea, and urination.
Remove the person's clothing, wash them, and give atropine.
274
What test should be obtained in a TCA overdose?
An ECG to assess for for QRS prolongation.
275
Retinal hemorrhage in a baby is most likely due to what?
Abuse head trauma aka shaken baby syndrome
276
Which abx is most commonly used to treat UTIs in children?
3rd generation cephalosporins like cefixime.
277
What is the tx for primary CNS lymphoma?
Methotrexate and brain radiation
278
Clinical features of Legionella pneumonia?
Slowly evolving, fever, and has GI symptoms (vomiting and diarrhea).
279
What CSF findings suggest cryptococcal meningitis?
- Elevated opening pressure
- low WBC count <50
- Low glucose
- Elevated protein
280
Increase in creatinine by 30% after starting an ACE or an ARB is most likely due to what underlying cause?
Renal artery stenosis
281
The question is about psoriasis and mentions lymphoma or risk factors for lymphoma. What do you do?
Biopsy the lesion
282
How does tethered cord syndrome present and what condition is it associated with?
Presents with weakness, decreased sensation, urinary incontinence, and hyporeflexia. Because the cord is affected below T12/L1 UMN signs are not present. It is associated with spina bifida.
283
Tumor lysis syndrome prophylaxis?
- IV fluids
| - Allopurinol or rasburicase
284
What are the electrolyte abnormalities in tumor lysis syndrome and what causes them?
- Hyperuricemia: nucleic acids are released and metabolized into uric acid
- Hyperkalemia and hyperphosphatemia: these are released intracellular ions
- Hypocalcemia: precipitated by increased phosphate
285
Clinical features of sporotrichosis? Tx?
Subacute skin papule that ulcerates with nonpurulent odorless drainage and proximal lesions along the lymphatic chain. LAD is rare.
Tx is 3-6 mo of itraconazole.
286
Murmur that doesn't change with valsalva?
Systolic flow murmur
287
Causes of high output cardiac failure?
- AVF
- Thyrotoxicosis
- Paget disease
- Anemia
- Thiamine deficiency
288
Acute MS exacerbation? Next step if that doesn't work?
Glucocorticoids. Use plasmapheresis if refractory.
289
What kind of hormones does a Leydig tumor secrete?
Estrogen or testosterone
290
Seminoma features?
Painless testicular mass that does not produce hCG, AFP, or estrogen
291
Sertoli tumor features?
Occasionally secretes excessive estrogen
292
Tx for acute cocain intoxication with symptoms of sympathetic hyperactivity?
Benzodiazepines
293
Which medication is contraindicated in cocaine toxicity?
Beta blockers
294
Periumbilical pain that is disproportionate to physical exam findings?
Acute mesenteric ischemia
295
CSF findings in Creutzfeldt-Jakob disease? EEG findings?
Positive 14-3-3 CSF assay.
| Sharp wave complexes on EEG
296
What is. dermatofibroma?
It is a benign fibroblast proliferation that appears as a firm, hyperpigmented nodule, most often on the lower extremities. They have a fibrous component that causes dimpling in the center when the area is pinched (dimple or buttonhole sign)
297
What is an epidermal inclusion cyst?
A benign nodule containing epithelium that produces keratin. It presents as a dome-shaped firm and movable cyst with a central punctum. It usually regresses on its own.
298
Congenital rubella symptoms?
- Hearing loss
- Heart defects (PDA)
- Microcephaly
- Cataracts
- Blueberry muffin rash
299
Referred pain felt in the ear is coming from where?
Dental disease, TMJ, Head and neck squamous cell carcinoma like: CN IX (base of tongue tumor) and X (posterior pharyngeal wall tumor)
300
How does L5 radiculopathy present?
Back pain radiating to the foot with weakness of foot inversion and plantar flexion.
301
Dorsiflexion of the foot is caused by injury to what nerve? Where does this nerve run?
Common Peroneal nerve that runs along the lateral fibula.
302
Causes of hyperandrogenism in pregnancy and how to differentiate between them?
- Placenta aromatase deficiency: no ovarian masses
- Luteoma: uni/bilateral solid ovarian masses
- Theca lutein cyst: bilateral cystic ovarian masses. Low fetal virilization
Sertoli-Leydig tumor: solid unilateral mass. Surgery required 2nd trimester or postpartum
303
What physiologic changes happen to the kidneys during pregnancy?
Bilateral hydronephrosis with dilation of the pelvises and proximal ureters. It requires no additional management.
304
Tx of Lyme disease in pregnant and lactating women and children under <8?
Amoxicillin
305
Clinical features of osteoid osteoma and tx?
Benign bone tumor that is common in adolescent boys and occurs in the proximal femur. Pain is worse at night, unrelated to activity, and is relieved by NSAIDs.
Tx is NSAIDS and monitoring for spontaneous resolution.
306
Clinical features of Ewing sarcoma?
Typically occurs in the pelvis and femur diaphyses with pain and swelling. Pain is worse with activity and not relieved by NSAIDS. X-ray shows onion skinning.
307
Osteosarcoma presentation?
Chronic localized pain and a soft tissue mass. X-ray shows bony destruction with a "sunburst" pattern
308
Features of laxative abuse?
10-20 watery diarrhea per day that also occurs at night and has abdominal cramps. Metabolic alkalosis (usually) and melanosis coli (dark brown discoloration of the colon)
309
Causes of macrocytic anemia?
- Folate/Vit B12 deficiency
- Myelodysplastic syndromes
- AML
- Drug-induced (hydroxyurea, zidovudine, chemo)
- Liver disease
- Alcohol abuse
- Hypothyroidism
310
Peripheral smear findings in megaloblastic anemia?
- Hypersegmented neutrophils
- Anisocytosis
- Poikilocytosis
- Low reticulocyte count
311
Basophilic stippling can occur in which anemias?
- Lead poisoning
- Alcoholism
- Thalassemias
Basophilic stippling is a nonspecific finding
312
What does a pericardial knock sound like?
A mid diastolic sound
313
Imaging results of constrictive pericarditis?
Pericardial thickening with calcifications.
314
Echo results of cardiac amyloidosis?
Increased ventricular wall thickness with a normal or non dilated left ventricular cavity.
315
What can be done to reduce pain due to chronic pancreatitis? What is the next step if that doesn't work?
Pancreatic enzyme supplementation to reduce pancreatic stimulation.
Gabapentin, pregabalin, or amitriptyline.
316
Clinical presentation of thyroid lymphoma? What is a risk factor for it?
Hashimoto's is a risk factor. It presents with a rapidly enlarging diffuse firm goiter with compressive symptoms (dysphagia, hoarseness, Pemberton sign (raising arms causes distended neck veins and red face), pts also have B symptoms.
317
How does infectious cavernous venous thrombosis occur and how does it present?
It is caused by uncontrolled infection of the skin, sinuses, and orbit. It presents with HA, intracranial HTN symptoms, periorybital edema, CN II, IV, V, VI deficits, facial pain, and a low grade fever.
Features often become bilateral.
318
6 year old girl with precocious puberty, irregular cafe au lait macules, polyostotos foibrous dysplasia (recurrent long bone fractures). What does she have? What other things could this condition cause?
McCune -Albright Syndrome.
This syndrome causes overproduction of pituitary hormones so it could also cause thyrotoxicosis (TSH), acromegaly (GH) and Cushing syndrome (ACTH)
319
How is neurofibromatosis 1 different from McCune-Albright syndrome?
NF 1 also causes precocious puberty, and long-bone dysplasia (fractures), however, its cafe au lait macules are more numerous with regular borders, and is associated with axillary/inguinal freckling.
320
How does Sturge-Weber syndrome present?
- Intellectual disability
- Seizures
- Visual impairment (due to capillary-venous malformations)
- A port wine stain in the trigeminal nerve distribution
321
What do the skin lesions associated with tuberous sclerosis look like?
Hypopigmented ash leaf spots and shagreen patches.
322
Fat embolism pulmonary artery filling test results?
Arterial filling defect will not be seen because the emboli obstruct the pulmonary capillaries which are too small to be detected on CT
323
Chest imaging findings in pulmonary contusion?
Localized pulmonary edema not a diffused scattered pattern.
324
What is Langerhans cell histiocytosis and how does it present?
A rare disorder seen in children < 3 years. Presents with single or multiple punched out lytic bone lesions.
325
Possible UA findings in Wilms tumor?
Gross hematuria and RBCs on UA
326
UA and clinical features of post streptococcal glomerulonephritis?
UA: hematuria and proteinuria
| HTN and edema
327
How does erysipelas present?
This is a group A strep infection that presents with a well-demarcated warm, tender area of erythema. Overlying bullae can develop in severe cases, and pts often have constitutional symptoms (fever, chills). Diffuse rash and shedding do not occur.
328
What is another name for erythroderma and how does it present?
Exfoliative dermatitis. Pts have erythema and scaling in >90% of the body. Bright red patches coalesce and gradually peel.
329
How does salicylate intoxication present and what is the tx?
- Tinnitus
- N/V
- Fever
- Altered menta status
- Metabolic acidosis then respiratory alkalosis
Tx includes alkalization of the urine with sodium bicarbonate
330
How does graft-versus-host disease manifest?
Donor T lymphocytes attack the host's skin (macuopapular rash involving the face, palms, and soles), intestines (blood positive diarrhea), and liver (abnormal LFTs)
331
Describe the presentation of Ehrlichiosis?
A tick borne infection that starts with flu like symptoms (high fever, HA, myalgia, chills). Lab findings include luekopenia and /or thrombocytopenia, elevated liver enzymes and LDH, and neurologic symptoms.
It does not typically have a rash.
332
What is a 2nd line abx to tx Rocky Mountain spotted fever and Ehrlichiosis?
Chloramphenicol
333
What medications are used for Tourette syndrome?
- Antidopaminergic agents:
~ Tetrabenazine (dopamine depleter)
~ Antipsychotics
- Alpha 2 adrenergic receptor agonists like guanfacine
334
At what hCG level should an intrauterine pregnancy be found on intravaginal ultrasound?
>1500 IU/L
335
How does disseminated gonococcal infection present?
Triad of polyarthralgia, tenosynovitis, and painless vesiculopustular skin lesions (2-10)
336
Complications of cryptorchidism that is unfixed or fixed late?
- Testicular torsion
- Subfertility
- Testicular cancer
- Inguinal hernia
337
Lab findings in legionella pneumonia?
- Hyponatremia
- Hepatic dysfunction
- Hematuria and proteinuria
- Gram stain that shows many neutrophils but few or no microorganisms
338
Does COPD cause clubbing?
No. Its presence in patients with COPD should prompt a search for malignancy
339
Neurological deficits in uncal herniations?
Ipsilateral CN III palsy and hemiparesis
340
What kind of screening is needed for patients with cirrhosis?
Screening abdominal ultrasound every 6 months to evaluate for new-onset HCC
341
Side effects of methotrexate?
- Hepatitis
- Stomatitis
- Cytopenias
342
How do glucocorticoids affect the different WBCs?
They increase neutrophil concentration but decrease lymphocytes, eosinophils, and monocytes.
343
What other infection is Babesiosis similar to? Where is it common?
It presents similarly to Malaria but is common in northeastern and midwestern US.
344
Describe presentation of Dengue fever?
Symptoms develop 4-7 days (almost never >2 weeks) after mosquito bite. Patients present with fever, HA, marked muscle ad joint pain, retroorbital pain, rash, and leukopenia.
345
How does hepatitis A present?
- Fever
- Jaundice
- Hepatomegaly
- Dark urine
- Acholic stool
- Pruritus
346
How does typhoid fever present?
HA, GI symptoms, salmon rose spots, and relative bradycardia.
347
What is the timeframe for acute renal transplant rejection? What are the biopsy results?
Occurs within the 1st 6 months.
Biopsy shows lymphocytic infiltration of the intima with swelling and inflammatory tubular disruption.
Patients will also have an asymptomatic rise in creatinine.
348
What is bilateral nontender swelling of the submandibular glands called and what is it associated with?
Sialadenosis. It is associated with advanced liver disease (both alcoholic and non-alcoholic cirrhosis)
349
How does lichen planus present?
Pruritic purple plaques that are sometimes associated with thin white striae around the labia and vulva.
350
What is lichen simplex chronicus?
It occurs secondary to repetitive scratching. Patients develop a hyperplastic response that causes thickened leathery skin.
351
Clinical presentation and lab findings in staphylococcal toxic shock syndrome?
Fever, n/v, myalgias, widespread peeling rash involving the palms and soles as well, shock (hypotension and tachycardia), altered mental status (lethargy, coma, confusion)
Lab: decreased platelets, elevated transaminases and bilirubin
352
What are the contraindications to the use of the following uterotonics in postpartum hemorrhage:methylergonovine, carboprost, and tranexamic acid?
- Methylergonovine (methergine): HTN
- Carboprost (hemabate): asthma
- Tranexamic acid: hypercoagulability state
353
What is a unique feature of Lambert-Eaton syndrome?
Diminished or absent deep tendon reflexes
354
Cause of painless gross hematuria in someone with sickle cell trait? UA results?
Renal papillary necrosis.
| Blood with normal RBC morphology
355
UA results in acute interstitial nephritis?
| serum creatinine?
Abundant WBCs many of which are neutrophils.
Serum creatinine will be elevated
356
UA and serum findings in acute tubular necrosis?
UA: granular casts, hematuria, renal tubular epithelial cells.
Serum creatinine will be elevated
357
How do you monitor resolution of ketonemia in DKA?
By measuring anion gap or direct assay of beta-hydroxybutyrate (BH)
358
When can you switch to basal bolus insulin in DKA or HHS management?
- Able to eat
- Glucose <200 mg/dL
- Anion gap <12
- Serum HCO3 = or > 15 mEq/L
359
Symptoms of posterior urethral injury? How do you diagnose?
- Blood at urethral meatus
- Inability to void
- Perineal or scrotal hematoma
- High-riding prostate on DRE
Diagnose with aa retrograde urethrogram
360
Varicocele that fails to empty when patient is recumbent in addition to painless hematuria should raise suspicion for what?
Renal cell carcinoma
361
How do you diagnose renal cell carcinoma?
Abdominal CT
362
Symptoms of renal cell carcinoma?
- Flank pain and mass
- Hematuria
- Left sided varicocele (that fails to empty)
- Anemia or erythrocytosis
- Thrombocytosis
- Fever
- Fatigue, weight loss
- Hypercalcemia
363
Tx for strep viridans infective endocarditis that is sensitive to penicillin?
What if they have a penicillin allergy?
4 weeks of IV penicillin G or ceftriaxone.
If allergic use vancomycin.
364
Next step in patients with significant sternal wound drainage with or without systemic symptoms?
Chest and sternal imaging to look for fluid collections or pneumomediastinum
365
Describe primary infection presentation in disseminated gonococcal infection?
It is usually silent
366
UA results of cystinuria? Name a diagnostic test. What is the MOA of this disease?
Hexagonal crystals on UA
Cyanide-nitroprusside will detect elevated cystine in the urine
This condition is due to impaired transport of cystine and other amino acids like ornithine, lysine, and arginine.
367
Urine chloride level is metabolic alkalosis secondary to vomiting/nasogastric aspiration?
Low urine chloride
368
What are the acid-base findings in aspirin toxicity?
- Near normal or normal pH
- Metabolic acidosis
- Respiratory alkalosis
HCO3 and PaCO2 will both be low
369
Causes of hematuria throughout the urinary stream? Which parts of the urinary tract are involved?
Upper collecting system (kidney and upper ureters)
- Renal mass (benign/malignant)
- Glomerulonephritis
- Urolithiasis
- Polycystic kidney disease
- Urothelial cancer
- Trauma
370
Causes of hematuria at the end of the urinary stream? Which parts of the urinary tract are involved?
Lower ureter, bladder up to right below the prostatic urethra
- Urothelial cancer
- Cystitis (infectious or post-radiation)
- Urolithiasis
- Benign prostatic hyperplasia
- Prostate cancer
371
Causes of hematuria at the beginning of the urinary stream? Which parts of the urinary tract are involved?
Urethra below the prostate
- Urethritis
- Trauma (catheterizations)
372
What is the mnemonic for papillary necrosis and what does it stand for?
```
NSAID:
N: NSAIDs
S: sickle cell
A: analgesic abuse
I: infection (pyelonephritis)
D: diabetes mellitus
```
373
What would cause refractory (difficult to correct) hypokalemia in a chronic alcoholic?
Hypomagnesemia.
Intracellular magnesium inhibits K secretion by the renal outer medullary potassium (ROMK) channels in the collecting tubules.
374
Renal vein thrombosis (RVT)is a complication of nephrotic syndrome. How does it present and which of the nephrotic syndrome is it more commonly associated?
Usually presents with side abdominal pain, fever, and gross hematuria.
Associated with membranous glomerulopathy
