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AMCMCQ - Ana > General questions 1 > Flashcards

General questions 1 Flashcards

1
Q

What is the mont common allergen that can cause allergy and asthma in children?

A

Dust mites

> Use dustproof covers for bedding
Polish floors and replace carpets
Wash bed clothes in hot water > 55º weekly
Dont use sheepsking bedding

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2
Q

What is the risk of being exposed to Asbestos?

A

Increased risk of bronchogenic carcinoma, GI cancer and asbestosis

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3
Q

What is the population most at risk for asbestos?

A

Occupationally exposed workers

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4
Q

What is the current “screening” for asbestos-relates diseases?

A

Theres is no adequate screening yet.
Current recommendations:
> Take complete history e physical exam
> Order a chest X ray for all patients with exposure
> Repeat the X ray in 3 to 5 year intervals (time that takes for asbestos exposure to be evident on X-ray)
> Simple pulmonary function tests can help recognize restrictive patterns

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5
Q

What are the symptons of tension pneumothorax besides low blood pressure and tachycardia? [3]

A
  1. Shifted trachea away from site of injury
  2. Hyper resonance
  3. Decreased chest wall movements on the affected side
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6
Q

What are the symptoms of cardiac tamponade besides low blood pressure and tachycardia?

A
  1. Decreased diastolic flow to the heart
  2. Pulsos paradoxus
  3. Hypotension
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7
Q

What is the best choice of antihypertensive therapy for a 50 year old man with CKD with decreased GFR and asthma

A

AVOID:
-Beta blockers due to ASTHMA

  • ACE inhibitors or ARBS due to decreased GFR because this drugs relax the efferent glomerular arteriole, deteriorating the GFR
  • Diuretics: the antihypertensive effects of diuretics is reduced in patients with renal disease making them inappropriate and less reliable options for hypertension control
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8
Q

In which case ACE inhibitors and ARBS are useful for patients with kidney disease?

A

Associated hypertension and proteinuria but with preserved GFR

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9
Q

Why are ACE inhibitors and BRAs contraindicated in patients with disease like bilateral renal artery stenosis, hypertensive nephroesclerosis or polycystic kidney disease ?

A

Intrarenal perfusion pressure is already reduced
Glomerular filtration rate is maintained by angiotensin II induced increase in resistance of the efferent (post glomerular) arteriole
Blocking this response will relax the efferent arteriole, lower intra glomerular pressure and reducing GFR

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10
Q

What is intersticial lung disease?

A

Chronic inflammation + fibrosis of the insterstitium and lung parenchyma

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11
Q

What are common features of intersticial lung disease? [7]

A
  1. Dyspnea: all patients with IDL will develop exertional dyspnea - MOST COMMON COMPLAINT
  2. Non productive cough
  3. Bibasal inspiratory crackles
  4. Evidence of pulmonary hypertension in advanced disease (right heart failure, etc)
  5. Clubbing (not always) especially in idiopathic pulmonary fibrosis and asbestosis
  6. Reticular or reticulonodular pattern (ground-glass appearance) on chest X ray
  7. Intrapulmonary restrictive pattern and decrease DLCO on pulmonary function testing
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12
Q

What is mesothelioma?

A

Rare malignancy of pleural and peritoneum
Highly associated with asbestos exposure (only known cause)

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13
Q

What are the main symptoms of mesothelioma?

A

Weight loss, recurrent pleural effusions and pleural thickening and calcification on imaging

Dyspneaand nonpleuriticchest pain(most common)

Fever, sweats,weight loss, fatigue

Features ofpleural effusion: dull percussion;absent or reduced breath sounds on affected side

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14
Q

What is sarcoidosis?

A

Multisystem disease characterized by non-caseating granuloma formation in different organ systems
Classified as ILD, but 90% of patients are asymptomatic

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15
Q

What are the main symptoms of sarcoidosis?

A

90% : asymptomatic
Symptoms resemble pulomary TB

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16
Q

What are the 3 main symptoms of horners syndrome?

A
  1. Miosis (an abnormally small pupil)
  2. Partial ptosis (drooping of the upper eyelid)
  3. Facial anhidrosis (absence of sweating).

Always ipsilateral as damaged nerve
SPAM: sympathetic fibers, ptosis, anhidrosis, miosis

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17
Q

What is horners syndrome?

A

Problem with sympathetic nerve supply to one side of the face (damage along the oculosympathetic pathway)

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18
Q

Describe causes for horners syndrome:

A

1st order lesion: lesion above T1 (stroke, tumors, syringomyelia)
2nd order lesion: compression from a pancoast tumor (apex of lungs)
3rd orde lesion: dissection of internal carotid artery

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19
Q

What are some tests for horner symptom?

A
  1. Eye drop test with cocaine or apraclonidine: blocks reuptake of norepinephrine, causing pupil dilatation. If the oculosympathetic pathway is blocked, midriasis wont happen
  2. CT or MRI: identifies underlying causes
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20
Q

What is vertebrobasilar insufficiency?

A

Insuficciency of the vertebrobasilar arterial systems that supplies blood to the medulla, cerebellum, pons, midbrain, thalamus and occipital cortex

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21
Q

What are features of vertebrobasilar insuficciency?

A

Vertigo, nausea, vomiting, nistagmus = vertebrobasilar strokes
Unilateral horder syndrome = brainstem lesions
Cerebellar signs = dysmetria, ataxia
Dysarthria, dysphagia
Occipital lobe lesions result in visual field loss
May affect the dorsal column of the medulla, resulting in dissociated sensory loss
!! Cortical deficits such as aphasia and cognitive impairments are absent!!

22
Q

What are symptoms of left inferior cerebellar artery (PICA) occlusion?

A

Symptoms:
Ipsilateral sensory deficits to face and cranial nerves
Contralateral sensory deficits on the trunk and extremities

Ataxia
Difference in temperature sensation between body sides
Dysphagia
Vertigo
Nystagmus
Disarthria
Horner syndrome
Palatal myoclonus
Hoarseness
Nausea and vomitng
Bradycardia and dysregulation of blood pressure

23
Q

What is PICA syndrome?

A

PICA is the largest branch of the vertebral artery, one of 3 main arteries that supply the cerebellum

PICA syndrome is also called lateral medullary syndrome or wallenberg syndrome

24
Q

What is Meniere’s disease? What is the most common age group affected?

A

Disorder of the inner ear caused by impaired endolymph resorption

Most commonly manifests in adults between 40–50 years of age.

25
Q

What causes menieres disease?

A

The exact etiology of endolymph malabsorption is unknown but viral infections, autoimmunity, and allergies are thought to play a role.

26
Q

What are the clinical findings in menieres disease? (Meniere triad)

A
  1. Vertigo
  2. Fluctuating unilateral sensorineural hearing loss (SNHL),
  3. Unilateral tinnitus (referred to as the Meniere triad);

Often associated with sensation of fullness in the ear

> Horizontal nystagmus or horizontal rotatory nystagmus may also be present.
The episodes fluctuate in severity, typically lasting from 20 minutes to 12 hours.

27
Q

What is an acoustic neuroma?

A

Intracranial tumor arising from the schwann cell, either on the vestibular or cochlear nerve

28
Q

What is the main symptom of acoustic neuroma?

A

Progressive unilateral hearing loss

Headaches and facial numbness can be present

Vertigo and disequilibrium are uncommon

!! Sudden onset symptoms are against the diagnosis !!

29
Q

What is vestibular neuronitis?

A

Inflammation of the vestibular nerve, often caused by viral infection (IVAS or herpes)

30
Q

What are the main symptoms of vestibular neuronitis?

A

Vertigo and imbalance, aggravated by change in the position of the head

NO hearing loss, tinnitus or horners syndrome

31
Q

What of the following signs mandates emergency surgical intervention in acute limb ischemia?

PALLOR / COLDNESS / PARALYSIS / PAIN AT REST / PULSELESSNESS

A

PARALYSIS - most reliable sign for emergency surgical intervention
Paresthesia and pulselessness can also be an reliable indicator

Coldness of the limb is the leat reliable sign, pain is also an unreliable sign

32
Q

What is ASPD? What are the main signs?

A

Antisocial personality disorder
Pattern of disregard for and violation of the right of others
Tipically beings by middle adolescence and continues into adulthood

33
Q

What is malingering?

A

The DSM-IV defines as the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives

34
Q

Is vaccination compulsory in Australia?

A

Vaccination is NOT compulsory and parents can choose not to vaccinate their children

35
Q

What are common causes of hyponatremia?

A

Diuretic use
Diarrhea
Heart failure
Liver disease
Renal disease
Syndrome of inappropriate ADH secretion (SIADH)

36
Q

What are common signs and symptoms of hyponatremia?

A

Nausea and vomiting
Headache
Short term memory loss, Confusion, Lethargy
Fatigue
Loss of appetite
Muscle weakness, spams or cramps
Seizures, decreased conciousness or coma

37
Q

What class is the drug indapamide, whats is the mecanism of action and what is one of the main side-effects?

A

Indapamide = THIAZIDE-LIKE DIURETIC
Excretes sodium and water via the loop of henle
Common side effect = hyponatremia

38
Q

What is budd-chiari syndrome?

A

HEPATIC VEIN OBSTRUCTION

39
Q

What are the 3 main symptoms of budd-chiari?

A

hepatomegaly, ascites, and abdominal discomfort

40
Q

What are the classical features of common bile duct obstruction (CBD)?

A

Obstructive jaundice
Often palpable mass (distended gallblader) in the right upper quadrant

41
Q

What is definition of periampullary tumors?

A

Tumors that arise within 2cm of the ampula of Vater in the duodenum

42
Q

How to distinguish between sarcoidosis and TB?

A

Sarcoidosis = non caseating epithelioid cell granuloma

> > PERFORM A MANTOUX TEST, ALSO KNOW AS TUBERCULIN SKIN TEST (TST)
* bcg vaccination can produce a false positive

43
Q

What is the gold standard method for distinguishing sarcoidosis from TB?

A

Lung biopsy with histopathology study

44
Q

What is noonan syndrome?

A

Noonan syndrome
“Male turners” - can affect both sexes
Autosomal dominant disorder of chromosome 11

45
Q

What are the clinical features of NOONAN syndrome?

A

Wide-set eyes w/ hypertelorism
Low-set ears
Short stature
Pulmonic stenosis
Hypertrophic cardiomyopathy
Webbed neck
Strabismus, amblyopia and refractive errors

46
Q

What hepatic enzyme is elevated through pregnancy?

A

Alkaline phosphatase - PLACENTAL ALP (placental alkaline phosphatase)

47
Q

How TSH levels change during pregnancy?

A

First trimester: decrease due to cross-stimulation of TSH receptor by hCG
Second trimester: returns to pre pregnancy levels
Thrid trimestrer: slight rise

Serum FREE T3 and T4 remains unchanged, but total increases due to increase in binding globulins

48
Q

What is post bone marrow transplant fever?

A

Common post-op complication of bone marrow transplant without infection
Onset 4-5 days after transplant, resolving by day 5 or 6

49
Q

How to manage post-transplant fever? (4 to 5 days after procedure)

A

Fever on day 4-5 is often cytokine-related rather than infections.
Colect blood cultures and chest X-ray before starting atbs if no clear sign of infection

50
Q

How to minimize risk of mother-to-child transmission of HIV?

A

Treatment of mother and baby with ART
Elective c-section
Not breastfeeding

Zidovudine to mom and baby reduces the risk by 2/3

51
Q

How to classify puerperal hematomas?

A

Vulvar - rapid development, painful, tense, compressible mass

Vaginal - often with rectal pressure, hemodynamic instability can be the first sign due to bleeding to the ischiorectal fossa - large mass protruding into the vagina

Retroperitoneal hematomas: can result in shock also, usually painless

52
Q

How to treat puerperal hematomas?

A

Non expanding < 3 cm can be managed with analgesics and ice packs
Expanding hematomas or greater than 3cm should be explored surgically under anethesia without suture, followed by vaginal packing for 12 to 24h

AMCMCQ - Ana (3 decks)

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