Flashcards in hammer21 Deck (62):
What is the presentation, pathophysiology of Reye syndrome?
Hyperammonemia, transaminitis, coagulopathy, vomiting and mental status change. Microvesicular fatty infiltration and hepatic mitochondrial dysfunction. Elevated transaminases, PT, INR, PTT and ammonia
What is the presentation of carbon monoxide poisoning?
Headache, nausea, abdominal discomfort, pinkish red hue on examination confirmed by carboxyhemoglobin level.
What causes rapidly developing hyperandrogenism? What is the next step in evaluation and what do results mean?
Androgen secreting neoplasm of the ovary or adrenal glands. Measure serum testosterone and DHEAS. Elevated testosterone with normal DHEAS suggests an ovarian source, whereas elevated DHEAS suggests an adrenal source.
What is the presentation of Kallman syndrome, chromosome number?
Delayed/absent puberty and anosmia. 46 XX. Low FSH and LH 2/2 gonadotropin releasing hormone deficiency.
Where does medulloblastoma occur? What symptoms?
Posterior fossa tumor, typically arises from the cerebellar vermis, resulting in truncal and gait ataxia. Due to proximity to the fourth ventricle, obstructive hydrocephalus and signs of increased ICP.
Where is the level of Block for Mobitz type I? Response to Atropine/exercise? Vagal maneuvers (carotid sinus massage), risk of complete heart heart block?
AV node. Narrow QRS. Atropine improves it. Vagal maneuver worsens type I AV block.Low risk of heart block
Where is the level of Block for Mobitz type II? Response to Atropine/exercise? Vagal maneuvers (carotid sinus massage), risk of complete heart heart block?
Below the level of AV node. Atropine worsens type II AV block. Vagal maneuvers improve type II AV block. High risk of heart block, required pace maker.
What is the cause of NPH?
Decreased CSF absorption
What is a sensitive marker for SLE?
How long does a cough have to happen to be considered chronic? What is a suspected etiology in nocturnal cough and test do yo do?
> 8 weeks. Asthma so do spirometry
What is the treatment for Wolf-Parkinson-White patients with afib?
If hemodynamically unstable, electrocardioversion. If stable, rhythm control with anti-arrhythmic drugs like procainamide, ibutilide
What is the management in a patient who has hyperthyroidism but low RAIU uptake?
Measure serum thryoglobulin. If high, thyroiditis, iodine exposure, release of preformed hormone. If low, exogenous hormone.
What is the first step after identifying a VSD in a child?
Echocardiography to determine the location and size of defect
What is the presentation of jejunal atresia? What are risk factors?
Biolious vomiting and abdominal distension. Triple bubble sign and gaseless colon. Risk factors - prenatal exposure to cocaine and other vasoconstrictive drugs
What is the most common cause of lower GI bleeding in adults? What are associated symptoms?
Diverticulosis. Painless bleeding with lightheadedness and hemodynamic instability
What two values are lowered in cardiogenic shock?
Cardiac index and mixed venous oxygen saturation
What two values are elevated in septic shock?
Cardiac index and mixed venous oxygen saturation
What is the presentation of embolic strokes? Which patients do they occur in?
Maximal onset of symptoms at the beginning. In patients with a history of structural cardiac disease. Patients with afib PLUS existing structural cardiac heart disease have an increased risk of cardioembolic stroke.
What do acute appendicitis pateints with a classic presentation immediately have?
What is the most common cause of cardiac arrest in the immediate post MI period?
Reentrant ventricular arrhythmias like vfib
What is the management of dumping syndrome?
Small frequent meals, replace simple sugars with compex carbohydrates, incorporate high fiber-protein rich foods
What is the management of Group A strep in children?
Confirm with rapid strep antigen test before antibiotic initiation. Penicillin and amoxicillin for treatment
Which portion of brain is affected in Huntington's chorea?
What nerve controls corneal sensation?
V1 ophthalmic branch of trigeminal nerve
Which viruses case acute retinal necrosis in HIV patients? Is there pain? What are fundoscopic findings?
HSV and VZV. Pain plus peripheral pale lesions and central retinal necrosis
What is the presentation of CMV retinitis?
Painless, hemorrhages and fluffy or granular lesions around retinal vessels
What is the cause of ascending aortic aneurysm? Descending aortic aneurysm?CXR findings?
Ascending is due to cystic medial necrosis or connective tissue disorders. Descending is due to atherosclerosis. Widened mediastinal silouette, increased aortic knob and tracheal deviation
What comorbid conditions are associated with absence seizures?
ADHD and anxiety
What drugs are used to prevent recurrent nephrolithiasis?
Thiazide diuretics, urine alkalinzation, allopurinol
What is the treatement for human bite and dog bite?
What are indications for ECT?
treatment resistant depression, psychotic features present, emergency conditions )pregnancy, refusal to eat or drink, imminent suicide risk)
What are increased risk of ECT?
Severe cardiovascular disease, space occupying brian lesion, recent stroke, unstable aneurysm
Which maneuvers increase the murmur of HCM?
Valsalva, abrupt standing, amyl nitrate
What is unique about aldosterone levels in hypopituitarism?
They are normal because aldosterone release is controlled by the RAA axis and not ACTH. So K is normal too.
What is the presentation of a perforated viscus? How is it diagnosed?
Severe abdominal pain, fever, tachycardia and signs of peritonitis. Upright x-ray showing free intraperitoneal air under the diaphragm
What is the most beneficial therapy to reduce progression of diabetic nephorpathy?
Strict BP control (130/80) which helps reduce hyperfiltration
What is the presentation of vasa previa?
painless antepartum hemorrhage with rapid fetal deterioration after rupture of membranes
What is the presentation of spondylolisthesis in children?
Forward slip of vertebrae (L5 over S1). Manifests as neurological dysfunction such as urinary incontinence and back pain
What is the presentation of beta blocker overdose? Treatment?
Bradycardia, hypotension, Wheezing, hypoglycemia, delirium, seizures. IV fluids and IV glucagon if hypotension is profound
In CHF patients, what causes vasoconstriction of efferent renal arterioles? What does it lead to?
Activation of RAAS and production of angiotensin II which increases intraglomerular pressure inorder to maintain GFR
What is the presentation and treatment for food born botulism?
Acute onset within 36 hours of bilateral cranial neuropathies, symmetric DESCENDING muscle weakness, diaphragmatic weakness. Equine serum heptavalent botulinum antitoxin.
What is the presentation and treatment of polymiositis?
Symmetrical proximal muscle weakness. Systemic glucocorticoids or glucocorticoid sparing gents (MTX, azathioprine)
What medications cause phototoxic drug eruptions?
Tetracyclines, chlorpromazine, prochlorperazine, diuretics, amidarone, promethazine
What is the symptoms and treatment for BPH?
Lower urinary tract symptoms (increasd frequency, urgency, weak stream, nocturia) and incomplete sense of voiding. Alpha 1 blockers (tamsulosin) alone or in combination with 5 alpha reductase inhibitors for symptomatic relief
What is the management for TCA overdose? How does it work?
Sodium bicarbonate increaseas serum pH and extracellular sodium. Increased pH decreasesa drug avidity for sodium chanels. Elevated extracellular Na concetnration increases the electrochemical gradient across cardiac cells and affects the ability of TCA to bind fast sodium channels
What should you screen sexually active women under 24?
Chalmidya trachomatis and Neisseria gonorrhoeae
What is the presentation of erythematotelangiectatic rosacea? symptoms ,treatment?
Erythema involving central face, flushing, telangiectasias and burning discomfort. Symptoms are precipitated by hot drinks., heat, emotion and rapid changes in body temp. Tx - acoid triggers, topical metronidazole for papulopustular type
What causes straight grid lines to appear curved?
What is a consequence of arthropathy 2/2 hemophilia?
Hemosiderin derposition leading to synovitis and fibrosis within the joint.
What is the manamgement of penile fracture?
Emergent urethral imaging with retrograde urethrogram followed by surgical repair.
What is the management of patients with oliguria and acute renal failure post surgery?
Urgent bladder scan and catherization
What is the most appropriate indicator of TCA toxicity?
Duration of QRS complex
Which type of nephrotic syndrome is associated with renal vein thrombosis?
What gross motor activities does and 18 month old have?
Runs and kicks ball
What are complications of acute pancreatitis?
Pleural effusion, ARDS, ileus and renal failure
What is the presentation of bronchiectasis? What is the most sensitive/specific test?
Cough, mucopurulent sputum, hemoptysis that responds to antibiotics. CT chest over CXR
What is the most common cause of autoimmune adrenalitis? How is it different from central adrenal insufficiency?
Autoimmune adrenalitis. It has hyperpigmentation ( 2/2 melanocyte stimulating hormone with ACTH secretion) and hyperkalemia
What should you suspect in a patient with AV block and infective endocarditis? Why not tricuspid valve endocarditis?
Perivalvular abscess extending into adjacent cardiac conduction tissues. It usually has a systolic murmur which is not seen in perivalvular abscess.
What is the presentation of tracheobronchial rupture?
Persistent pneumothorax and significant air lead folllowing chest tube placement. Pneumomediastinum and subcutaneous emphysema.
What is the etiology of vascular rings and when does it present? Symptoms and improvement?
Abnormal development of aortic arch and present with respiratory (stridor, wheezing, cough) and esophageal symptoms. Stridor typically improves with neck extension. Presents before 1 year of age.
What are clinical features and treatment of paget disease of bone? Treatment?
Bone pain and deformity . Skull - hearing loss and headache. Spinal stenosis, rediculopathy. Long bone bowing, fracture, arthritis of adjacent joints. Gaint cell tumor ,osteosarcoma. Tx - Bisphosphonates