Flashcards in hammer3 Deck (55):
What is the clinical presentation of posterior limb of internal capsule (lacunar infarct)?
unliateral motor impairement w/o sensory or visual field abnormalities
What is the clinical presentation of middle cerebral artery occlusion?
1. Contralateral somatosensory and motor deficit (face, arm and leg),
2. conjugate eye deviation toward side of lesion,
3. homonymous hemianopsia, aphasia (dominant hemisphere)
4. hemineglect (nondominant hemisphere)
What is the clinical presentation of anterior cerebral artery occlusion?
1. Contralateral somatosensory and motor deficit (predominantly in lower extremity)
2. Abulia (lack of will or initiative)
3. Dyspraxia, emotional disturbances, Urinary incontinence
What is a lifethreatening complication of severe preeclampsia and what causes it?
Pulmonary edema, caused by increased systemic vascular resistance, capillary permeability, pulmonary capillary hydro static pressure and decreased albumin
What is the pathology of coarctation of the aorta? What murmur is heard?
Thickening of tunica media of teh aortc arch near teh ductus arteroisus. Systolic ejection murmur at teh left interscapular area.
What is the treatment for obsessive compulsive disorder?
CBT, high dose SSRI. If non response, use lomipramine or antipsychotic augmentation, DBS for refractory cases
What are the symptoms of congenital hypothyroidism?
weakness, hypotonia, large tongue, sluggish movement, abdominal bloating, umbilical hernia
What are the symptoms of metabolic syndrome? What is the central pathogenesis?
3/5 of the following
1. abdominal obesity
2. fasting glucose > 100
3. Blood pressure > 130/80
4. Triglycerides > 150 mg/dL
5. HDL cholesterol
What are the symptoms of pheochromocytoma?
Paroxysms of severe hypertension that can be precipitated by surgical procedures, anesthesia induction and a number of medications
What is the etiology of Wiskott-Aldrich syndrome? What are the clinical features adn what is the treatment?
XLR, impaired cytoskeleton changes in leukocytes, platelets.
Clinical - Eczema, microthrombocytopenia, recurrent infections.
Stem cell transplant
What is the treatment for migraine headaches in children?
What is the workup for primary amenorrhea?
Measure FSH if no breast development. If decreased - pituitary MRI. If increased - karyotype
What is the etiology of amyloidosis? Clinical presentation? Diagnosis?
Extracellular deposition of insoluble polymeric protein fibirils in tissues and organs. AL type - primary AA - secondary to chronic inflammatory conditions (arthritis, chronic infections, IBD, malignancy, vasculitis.
Clinical presentation - restrictive cardiomyopathy, increased ventricular wall thickness, asymptomatic proteinuria, hepatomegaly, BLEEDING diathesis, waxy thickening. Fat pad abdominal aspiration biopsy
Which medications should be withheld prior to cardiac stress testing?
BB, CCB, nitrates - which are antianginal agents
What is the treatment for cyanide poisoning?
Activated charcoal if ingested. All other exposures - give antidots - hydrocobalamin or sodium thiosulfate. No antidots - nitrites to induce methemoglobinemia to increase Fe3+ to bind cyanide
What is the difference between epidermal inclusion cyst and dermatofibroma?
EIC - benign wih normal epidermis, dome-shaped, firm, freely movable cyst/nodule with a small central punctum. VS. Dermatofibroma - firm, hyperpigmented, dimples when pinched
What is the treatment for ascited?
1. Na and water restriction 2. Spirnolactone 3. Loop diuretic 4. Paracentesis (2-4 L/day)
When do you observe a pneumothorax?
When it is small (
What is the most specific marker for dementia vs. normal aging?
Impairment of daily functioning in dementia
What is the presentation of HOCM, murmur and pathophysiolog?
Syncope in young patient wtih crescendo-decrescendo murmur at lower LEFT sternal border .Symptoms secondary to outflow obstructionfrom interventricular septal hypertrophy
What is hepatic hydrothorax and what is the pathophsiology and treatment?
Transudative pleural effusion in cirrhotc patiests leading to right sided pleural effusion not 2/2 cardiac or pulmonary abnormality. Initial treatmetn with salt restriction adn diuretics. TIPS if treatmetn is refractory.
What are preventative factors in SIDS?
Room sharing and Pacifier use
What is the appearance of a meningioma?
extra axial well circumscribed or round homogeneously enhanced dural-based mass. Can be calcified at times. Complete resection
What are the symtpms of acute iron poisoning
abdominal pain, hematemesis, metabolic acidosis. Radiopaque so can be seen on x-ray.
What are the first line treatment in acute mania?
Antipsychotics. Lithium (avoid in renal disease) and anticonvulsant mood stabilizers (valproate - avoid in liver disease)
What are the diagnostic features of acute bacterial rhinosinusitis? What causes it? TREATMENT
Persistent symptoms > 10 days w/o improvement OR severe symptoms, fever, purulent nasal dscharge or face pain > 3 days or worsenng symptoms > 5 days after initially improving viral URI. Strep pneumo and H infleunzae (30 % each) and Moraxxella (10%). AMOXICILLIN-CLAVULANIC ACID
What are the physica findings of Beckwith-Wiedemann syndrome? What are future complications/
Macrosomia, macroglossia, Hemihyperplasia, umbilical hernia/omphalocele and hypoglycemia. Monitor for Wilms tumor and hepatoblastoma.
What are teh clinical features of delusional disorder? Treatment?
More than 1 delusion for more than 1 month WITHOUT other psychotic symptoms. Can function apart from delusion. Subtypes - erotomanic, grandiose, jealous, persecutory adn somatic. Tx - anipsychotics adn CBT.
What are the diagnsotic criteria for obesity hypoventialtion syndrome?
Obese, awake daytime hypercapnia (PaCo2 > 445) leading to alveolar hypoventialtion. Do AB (normal AA gradient), restrictive pattern on PFTs.
What are the components of biophysical profile?
1. NST (reactive) 2. AFV (single pocket > 2X1 cm or AFI > 5)3. Fetal mvmt (>3 body mvmts) 4. Fetal tone (>1 episode of flexion/extension) 5. Fetal breathing mvmvts (>1 breathing for > 30 second)
What is the treatment for chronic cough with postnasal drip?
Oral first gen antihistamine (chlorpheniramine) or combined antihistamine-decongestant (eg, brompheniramine and pseudophedrine)
What is a potential complication of bronchiectasis?
What are the symptoms of infective mononucleosis? What are possible complications?
Sore throat, fever, malaise, splenomegaly, generalized lymphadenopathy. Complications include autoimmune hemolytic anemia and thrombocytopenia upto 2-3 weeks after initial symptoms.
What treatment modality is used for acute exacerbation of COPD?
Non positive pressure ventiation before intubation
What are teh renal complications of sickle cell trait?
Painless hematuria, UTO, renal medullary cancer, renal papillary necrosis
Which patients usually get acalculous cholecystitis? What is seen on imaging? Treatment?
Critically ill patients. Gallbladder wall thickening and distension and pericholecystic luid. Antibiotics and percutaneous cholecystostomy, followed by cholecystectomy.
What is the characteristic of primary dysmenorrhea and how is it treated?
Crampy lower-abdominal pain during meses adn normal physical examinaion. NSAIDs and hormonal contraception are generally effective for pain relief.
What is the most common cause of bacterial PNA in CF patients 20 year olds?How is it treated?
Staph aureus in 20
What is the most common cause of PNA in nursing home patients? How is it prevented?
Strep pneumonia. Pneumovax vaccine.
What is the treatment for acute pyelo patient who has a clear response after IV antibiotics?
Switch to oral antibiotics for a toal of 10 - 14 days (Fluoroquinolones and TMP-SMX).
What is the characteristic physical and imaging finding in pancreatic tumor of the hear of the pancreas?
Weight loss jaundice, nontnder, distended gallbladder on exam. Imaging shows - Intra and extrahepatic biliary tract dilation
What is the first intervention for patietns with acute stroke?
CT wo contrast
What is the treatment of constipation in toddlers transitioning to solid food?
Laxative therapy with polyethylene glycol or mineral oil
What are the presentation of herpes simplex virus ulcer?
multiple small, grouped ulcers with erythematous base, shallow, TENDER lymph nodes
What are the presentation of haemophilius ducreyi ulcer?
Sinlge or multiple deep ulcers, with irregular/ragged border. Base mmay be friable and have gray/yellow exudate. Mattted lymp nodes.
For how long should patients with major depressive disorder continue antidepressants after an acute response to therapy?
4 - 9 months
What type of risk is reduced with tight glycemic control? What type are NOT reduced?
Microvascular complications (retinopathy, nephropathy). Macro vascular like MI and stroke and mortality are not reduced.
What is the difference between SBO and Ileus?
SBO is old surgery with increased bowel sounds while Ileus is 2/2 recent surgery, hypokalemia or medication induced. Reduced bowel sounds with both small and large bowel dilation
What are the symptoms of necrotizing enterocolitis?
Increased gastric residual volume, vomiting, abdominal distension. X-ray findings include penumatosis intestinalis (intramural air) and portal venous air.
Which types of mutations are most severe?
Nonsense and frameshif mutations
What is the Aa gradient in hypoventilation and acid base status?
Normal A-a gradient adn respiratory acidosis
What is the diagnosis for Myasthenia gravis?
Edrohonium test, ice pack test. CT can for thymoma
What is the cause of torsde de pointes and how is it treated?
2/2 acquired or congenital QT interval prolongation. Immediate defibrilaation in hemodynamically unstable and IV magnesium in stable patients.
What is the ECG findings in Afib and initial treatment for stable patients?
No distinct p waves, irregularly irregular R waves, narrow QRS, atrial rate > 350. Rate control with BB or CCB