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path facts Flashcards

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1
Q

deficiency of what :

-associated with hospitalized patients with malnutrition/short gut
-insulin resistance so require more insulin

A

chromium

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2
Q

deficiency of what :

triad =
- subacute combined degeneration**
- microcytic anemia
- leukopenia

in children : associated w hypopigmented, crimped hair +/- seizures

and what disease is this associated with

** spinal cord degeneration s/p B12 deficiency with weakness, abnormal sensations, mental problems, and vision difficulties

A

copper

menkes ds = x copper uptake

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3
Q

symptoms of wilsons disease and the etiology

A

etiology = x copper excretion

acute = renal failure, hemolysis, hepatic necrosis, encephalopathy, abdominal pain, diarrhea/vomiting,

chronic = cirrhosis, heart failure, diabetes, encephalopathy with neurologic decline

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4
Q

toxicity of what:

associated with well water and welding/steel industries

-parkinson like syndrome
-HA, confusion
-vomiting

A

manganese

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5
Q

deficiency of what:

-growth failure + dwarfism in children
-hypogonadism
-alopecia
-dysgeusia (all food tastes sour)
-impaired wound healing
-skin lesions = pustular, vesiculobullous

A

zinc

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6
Q

clinical exam finding/sign that suggests cholecystitis

A

Murphy’s sign
=abrupt cessation of inspiration with RUQ palpation

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7
Q

clinical exam finding/sign that suggests ruptured spleen/ ruptured ectopic pregnancy

A

Kehr sign
= left shoulder tip TTP while supine, due to referred pain from diaphragm irritation

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8
Q

4 clinical exam finding/sign that suggests appendicitis

A
  1. McBurney sign: TTP on RLQ (2/3 from navel to ASIS)
  2. Rovsing sign: TTP on LLQ
  3. Obturator sign: abdominal pain w flexion and IR of right hip
  4. Psoas sign: RLQ pain of extension of the right hip while patient lies on their left side
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9
Q

what are cullen’s sign and grey turner sign and what do they suggest

A

grey turner: flank ecchymosis

cullen: periumbilical ecchymosis

suggest hemorrhage pancreatitis / retroperitoneal hemorrhage

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10
Q

bullous pemphigoid vs pemphigus vulgaris

A

bullous pemphigoid = tense bullae that don’t burst with pressure, intense pruritus
= STRONG AS A BULL

pemphigus vulgaris = flaccid vesicles w positive Nikolsky sign, nonpruritic
= vulgar bc leaking

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11
Q

murmur with a mid systolic click with late systolic murmur and heard best at the apex

A

mitral valve prolapse

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12
Q

murmur that is a diastolic decrescendo blowing murmur heard at the left sternal border

A

aortic regurgitation

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13
Q

murmur that is a systolic crescendo decrescendo and radiates to the carotids

A

aortic stenosis

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14
Q

a murmur that is a mid-diastolic rumble with an opening snap heard at the apex of the heart

A

mitral stenosis

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15
Q

holosystolic murmur at the left sternal border that increased with inspiration

A

tricuspid regurgitation

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16
Q

differentiate between
- carpal tunnel syndrome
- pronator teres syndrome

A
  • carpal tunnel = median nerve entrapment in the carpal tunnel = MC NO sensory changes
    = associated w typing etc
  • pronator teres = median nerve entrapment in the pronator teres
    = commonly dc sensation
    = associated w athletes, including bicyclers
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17
Q

bioterrorism

incubation period, sx, and trx of..

-anthrax
-brucellosis
- tularemia

A

ANTHRAX
inc: 4-5 days
sx: mostly respiratory picture w resp distress, cough, Black Eschar (painless papule that turns into a necrotic ulcer)
trx: penicillin + doxycycline

BRUCELLOSIS
inc: 2-4 WEEKS
sx: systemic signs, joint + GI pain, UNDULATING FEVER (breaks, spikes, repeat)
trx: doxycycline + (streptomycin or rifampin)

TULAREMIA
inc: 2-3 days
sx: cough, CP, respiratory failure
trx: streptomycin

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18
Q

giving methotrexate for treatment of ectopic pregnancy

how do you monitor success of treatment

A

need to measure beta hcg

day you give MTX = day 1

check day 4 and day 7

-b hcg may go up days 1-4, but need to decreased by 15%+ between day 4-7…
- if don’t decrease enough, need to give another dose of MTX
- if dc 15%+, check again every week until back beta hcg = 0

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19
Q

scarlet fever vs rheumatic fever

A

both are complications of group A strep pharyngitis

rheumatic fever = body’s autoimmune response
- fever, joint pain, flat/slight raised painless rash w ragged edges, cardiac complications, syndeham chorea,

scarlet fever = toxin produced by strep
- fever, sore throat, erythematous “sand-paper” rash (flat blotches that become raised and fine bumps, strawberry tongue, tonsillar exudates

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20
Q

which vaccines are recommended and which are contraindicated in immunocompromised pateints

A

recommended: pneumococcal, HPV, flu, meningococcal, Tdap, hep B

contra-I = live attenuated vaccines = MMR, varicella, and herpes zoster

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21
Q

what pathology is the chromosome t(9;22)(q34;q11) associated with - what is this gene

A

philadelphia chromosome
makes BCR-ABL1

= chronic myeloid leukemia

trx w tyrosine-kinase inhibitors = imatinib

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22
Q

mobitz type 1 vs 2

which is wenckebach

A

mobitz type 1 = wenckebach
= PR intervals get longer leading up to the drop
= the first one you think of

mobitz type 2 = the PR interval does not change, drop a beat after every certain amount of beats

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23
Q

what are the causes of post op fever in the

  • first few hours post-op (immediate) (5)
  • first three days post-op (early)

-day 3-30 post-op (late)

A

immediate = other med stuff
- MI
- pre-existing infection
- inflammation from the surgery
- immune reaction
- malignant hyperthermia

early = infection elsewhere/ med
- pneumonia
- UTI
- MI
- early surgical site infection
- DVT
-withdrawal/gout, etc

late = surgical complications
- surgical infection (superficial earlier, deep infections more common further out)
- nosocomial infections (central line, cath, ventilator)
- DVT

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24
Q

what physical exam findings are found with
rheumatoid arthritis vs
osteoarthritis

A

RA = metacarpal and proximal interphalangeal joints
= swan neck deformities and Boutonnier deformity, ulnar deviation

OA= in the distal IPs and are Heberden’s nodes (osteophytes on DIP) and Bouchard’s nodes (osteophytes on PIP)

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25
what are the 5 groups of pulmonary hypertension
group 1 = pulmonary arterial hypertension - can be idiopathic, hereditary, or caused by drugs like CCBs, tadalafil, prostaglandins, or amphetamines - can also be caused by connective tissue ds like lupus, HIV, other vasculopathies group 2 = cardiac ds (valvular, heart failure, etc) group 3 = lung ds or chronic hypoxia - bc global hypoxia causes vasoconstriction leading to htn group 4 = chronic thromboembolic ds - clot formation, embolic --> dx with a ventilation-perfusion scan group 5 = other systemic causes - heme ds like sickle cell, metabolic ds like glycogen storage
26
JVD upon/worse with inspiration = what sign and what does it indicate
Kussmaul sign pericarditis (also relief with leaning forward)
27
MC location/cause of a posterior nose bleed and how do they present trx?
sphenopalatine artery often don't know they have epistaxis bc it is posterior - often present with hematemesis and/or melena, PE shows blood and pharynx even after/without hematemesis commonly seen in patients >40 yo TREATMENT: posterior bleeds are more likely to be severe - can try posterior packing - balloon/foley catheter to stop bleeding - may require urgent ENT eval and hospitalization
28
pleural effusion with high levels of adenosine deaminase is associated with what
TB infection
29
most commonly torn rotator cuff muscle n innervation presenting sx
supraspinatus tendon suprascapular N dec strength with ABduction of the arm especially first 20-30 degrees, with positive empty can test and the rest of the rotator cuff tests are normal
30
BP meds that cause hypokalemia sx and EKG of hypokalemia
loop diuretics (furosemide) or thiazide diuretics (HCTZ) = M wknss, bradycardia, AV block, U wave = low voltage everything especially in V2+V3, with a U wave
31
BP meds that cause hyperkalemia sx and EKG of hyperkalemia
ACE-inhibitors - presents as wkns/cardiac abnormalities in the setting of renal failure or aggressive potassium replenishing = peaked T waves, everything is large and peaked
32
meds that are associated with allergic interstitial nephritis (8) sx?
mild proteinuria w hematuria, eosinophilia, rash, WBCs in urine 1. nafcillin, methicillin 2. NSAIDS 3. rifampin 4. phenytoin 5. sulfa drugs 6. quinolone 7. diuretics 8. allopurinol
33
how do you measure adequate fluid resuscitation (3 that are validated by randomized trials)
watch for end organ perfusion - urine output - central venous pressure - cardiac output
34
blood tests showing inc Cr dec C3+C4 shows what?
nephritis caused by deposition of immune complexes = systemic cause of glomerulonephritis like lupus, sepsis, severe liver ds
35
tinnitus is associated which which cranial bone
temporal bone CN 8 vestibulocochlear N runs through it
36
patient comes in the trauma bay post MVC with a supraglottic airway and decreased but equal breath sounds first thing you do which imaging tests are part of the initial exam
- secure airway first ; this description is not secure bc decreased and the supraglottic airway is minimal - FAST exam - chest and pelvis X ray most patients will get CT but that's not the ~initial~ exam
37
what do you do if a patient has a pelvic fracture and free fluid on FAST exam
- put on a pelvic binder - laparotomy
38
where is the calcarine sulcus and what does it do
occipital lobe = where the primary visual cortex is = visual reception and interpretation
39
what does stroke of the parietal lobe look like
parietal lobe = sensory input and body orientation - MCA is in here - stroke = hemiparesis
40
what does a stroke of the temporal lobe look like
temporal lobe = auditory reception, expressed behavior, receptive speech, memory retrieval -strokes= aphasia
41
turner syndrome is associated with what cardiac abnormality
coarctation of the aorta = BP UE > BP LE
42
patients on hydroxychlorquine need what annual screening and why
- yearly optho screening because the drug concentrates in the retinal pigment epithelium and can lead to retinopathy
43
de Quervain's tenosynovitis is due to chronic stress to what
ABductor pollicis longus (muscle) and extensor pollicis brevis TENDON
44
most common cause of septic arthritis in all people (bacteria) and its histology description common cause of septic arthritis in - prosthetic joints - kids <2 yo and WITHOUT any extraarticular sx -infants < 3 mo - associated with varicella zoster infection
all ppl: stap aureus= g+ cocci in clusters prosthetics --> coagulase (-) staph kids<2yo --> strep pneumoniae infants <3mo --> GBS group b strep associated w varicella zoster --> GAS group A strep
45
what type of WBC cancer is associated with +TRAP staining and what types of cells are seen on histology of the BM associated with what gene mutation and what lymphocyte markers
= hairy cell leukemia - large lymphocytes with oval nuclei and cytoplasmic projections and pale cytoplasm associated with BRAF gene mutation B-cell markers= CD19, CD20, CD11c, CD123
46
describe the type of cells you'd see on immunohisto of the most common childhood malignancy
= acute lymphoblastic leukemia you would see lymphoblasts = immature lymphocytes with smooth chromatin
47
hypercalcemia + renal function + anemia + bone lesions is associated with what illness
multiple myeloma
48
how does HOCM change with squatting
squatting INC preload = DEC intensity of HOCM murmur inc preload = more blood in the vessel that pushes the hypertrophied septum out of the way to decrease the obstruction = less intense murmur
49
how does aortic stenosis change with squatting
squatting inc preload = more blood flowing through the stones valve = INC intensity
50
how do HOCM and aortic stenosis change with valsalva
valsalva dec preload bc you "BEARING DOWN" dec preload = - nothing to move the hypertrophied septum away so louder HOCM - less to whoosh past the stenosed valve so DEC aortic stenosis
51
lab results that suggest hemolysis
inc LDH inc INDIRECT bilirubin low haptoglobin
52
what two viruses cause hand, foot, and mouth disease
coxsackie A16 enterovirus A17
53
what virus causes roseola and what does it look like
roseola= first a spiking fever and as the fever drops a rash appears = erythematous macule on trunk and neck herpes virus 6
54
what does rubella look like
pink papules and macule spreading across the whole body, sometimes associated with posterior cervical lymphadenopathy
55
which virus class is measles in and how does it present
= a paramyxovirus in unvaccinated kids with prodrome = cough, conjunctivitis, and coryza (inflamed nasal mucosa) exanthem= erythematous raised papules spreading down from head and neck to the body and limbs
56
describe fifth's disease and which virus is it
parvovirus B19 prodrome = fever, headache, cough slapped cheek rash on face = erythema infectious on the face with a reticular maculopapular rash
57
what is galbreath's technique
an OMM lymphatic treatment that can be used for treating acute otitis media and other lymph draining of the head and neck = caudal and anterior pressure on the mandible
58
what is a negative pressure room
this is a room that allows for isolation of a possibly highly infectious and dangerous illness i.e. a patient with symptoms of a hemorrhagic virus like Ebola (fever, bleeding like hematemesis and epistaxis, hypotensive vital signs)...
59
which BP meds are known to have hypercalcemia (and hyperPh) as common side effect? how do these meds effect Na, K, glucose, lipids
thiazide diuretics = HCTZ and chlorthalidone, indapamide HYPOna HYPOk HYPERca HYPERglycemia HYPERlipidemia
60
common side effects of loop diuretics
furosemide, bumetanide hypokalemia, hypoCalcemia block Na, K, Cl reuptake in loop
61
what is a pterygium and what causes it
pterigium = a wing like growth into the cornea from the sides (like the white parts and blood vessels) due to exposure to wind, sand, and sun causing elastotic degeneration of the conjunctival stroma
62
describe presentation and most common cause of syringomyelia
person in 30s-40s w new onset headaches, neuropathy and pain of bilateral shoulders down to fingers MC cause is an arnold chiari malformation type 1 = herniation of the cerebellar tonsils through the foramen magnum --> disruption of CSF flow --> builds up during first few decades of life until onset of symptoms
63
differentiate between francisella tularemia and coxiella q fever
both potential bioterrorism (tularemia class a, q fever class b) both can cause pulmonary symptoms with fever, sob, infiltrates/nodules on CXR both are gram(-) differences: - tularemia incubation is hours-days vs q fever incubation is 14-26 days
64
von willebrand ds presentation lab findings for platelet levels, PT and PTT, bleeding time
VWD = easy bleeding i.e. bleeding gums, easily bruised, super heavy periods, gets significantly worse after giving aspirin - strong family history -n plts -n PT -n or slightly prolonged PTT -prolonged bleeding time
65
what is an appropriate fundal height what kind of testing would you do for abnormal fundal height
fundal height should be within 3 cm of the gestational age (i.e. 28 weeks = FH of 25-31) check biophysical profile = an US evaluation of the fetal wellbeing, including a measurement of amniotic fluid to check for oligo/polyhydramnios
66
which gene translation mutation is associated with chronic myeloid leukemia
t(9:22) BCR-ABL1
67
which gene translation mutation is associated with Burkitt lymphoma
t(8:14) c-MYC
68
which gene translation mutation is associated with mantle cell lymphoma
t(11:14) BCL1 cyclin D1 positive, presents mostly in elderly white males and usually presents at an advance stage, MC with lymphadenopathy as the main sx
69
which gene translation mutation is associated with Ewing Sarcoma
t(11:22)
70
which gene translation mutation is associated with acute myeloid leukemia M3 type
t(15:17) responsive to all-trans retinoic acid
71
which gene translation mutation is associated with follicular lymphoma
t(14:18) BCL2
72
in hemophilia A/B , how does it present what is the underlying mechanism how will plt count, PT, PTT, and bleeding time result
spontaneous bleeding or prolonged bleeding after a minor trauma, hemarthrosis, spontaneous/easy bruising, hematuria, menorrhagia, nosebleeds hemophilia A= the MC one = x factor 8, x linked hemophilia B= factor 9 deficiency - messes up the intrinsic pathway (12, 11, 10, 9, 8, 5, 2, 1 ) so only PTT is off n plt count, PT, bleeding time increased PTT
73
in vitamin K deficiency, how does it present how will plt count, PT, PTT, and bleeding time result
vitamin k deficiency = hemorrhage during or after birth, hemarthrosis, Gi bleeding, prolonged bleeding from minor trauma n plt, bleeding time inc PT, PTT
74
how will plt count, PT, PTT, and bleeding time result in.. ITP TTP DIC
ITP = dec plt, prolonged bleeding time, n PT/T TTP= dec plt, prolonged bleeding time, n PT/T DIC = dec plt, prolonged bleeding time, PT, PTT
75
commonly used abx regimens with anaerobic coverage
amoxicillin-clavulanate metronidazole ciprofloxacin
76
which category of diuretics could cause HYPOna, HYPOk, and metabolic alkalosis
thiazide diuretics also hypercalcemia inhibit NaCl reabsorption in the distal convoluted tubule
77
which type of diuretic is associated with hyperkalemia
potassium sparing drugs = spironolactone, aldactone also gynecomastia
78
which category of diuretics is associated with hypokalemia and metabolic acidosis
carbonic anhydrase inhibitors - inc Na, K, HCO3, and water excretion = acetazolamide
79
in knee joint injuries which ligament tears most often and how -lachman tests what - valgus test what - varus test what
MC= ACL , non contact sports injuries > contact injury -MC foot planted and turn, can hear a pop, pain on lateral side of knee lachman positive= ACL or PCL - PCL = mc with dashboard injuries or baseball player sliding into catcher valgus positive= MCL - sudden change in speed or direction or hit on the outside of the knee varus positive = LCL (super rare)
80
deficiency of what associated with nail bed abn cardiomyopathy higher insulin requirement
selenium
81
EKG changes associated with hypercalcemia vs hypocalcemia
HYPER = shortened QT interval HYPO = prolonged qt interval
82
holosystolic murmur that radiates to the axilla
mitral regurge
83
late-peaking systolic ejection murmur +/- obliteration of the second heart sound
aortic stenosis
84
when do patients need the PPSV23/PCV15 vaccine
pneumonia vaccine give once after turn 65
85
when do patients need the PPSV23/PCV15 vaccine
pneumonia vaccine give once after turn 65
86
what three lab values compose metabolic syndrome
TGs>150 HDL<40 men/<50 women fasting glucose >100 or being treated for any of those
87
empiric trx of meningitis in pt <1 mo 1mo- 50 yo >50 yo
< 1 mo = ampicillin + cefotaxime OR ampicillin + " _-micin" 1 mo-5yo = vancomycin + ceftriaxone >50 yo = vancomycin + ceftriaxone + ampicillin
88
MC causes of pneumonia in pt aged 0-20 days 3 wks-3 mo 3mo-5yr 5yr-YA
0-20 days -GBS, E.Coli, Listeria 3 wks-3 mo - viral, strep pneumo - less = chlamydia, h. flu 3mo-5yr -viral, strep pneumo -less = strep pyogenes, staph aureus 5yr-YA -virus, mycoplasma pneumonia > strep pneumo -staph aureus for post-flu pneumonia -strep pyogenes
89
what is diclofenac
an NSAID
90
5 of the most important conditions/risk factors for PE/VTE
orthopedic surgery IBD CHF malignancy nephrotic syndrome
91
3 possible EKG changes associated with a PE
S1Q3T3 RBBB sinus tachy
92
what score is needed on a DEXA scan to diagnose osteoporosis what is the other way one can be diagnosed
DEXA scan with T score of -2.5 or lower or presenting with a fragility fracture
93
most specific antibodies (2) for lupus
anti-dsDNA anti-Smith
94
anti-histone ab associate with
drug induced lupus
95
anti-ro and anti-la are associated with
sjogren
96
anticentromere ab are associated with
central CREST = limited cutaneous systemic sclerosis
97
anti-scl-70 ab is associated with
diffuse cutaneous systemic sclerosis
98
anti-jo-1 ab is associated with
inflammatory myopathy including dermatomyositis and polymyositis
99
anti-snRNP70 ab is associated with
mixed connective tissue disease
100
EKG changes associated with pericarditis
either -diffuse ST elevation with reciprocal depression in aVR and V1 OR -diffuse PR depression with with PR elevation in aVR
101
what electrolyte changes are expected with excessive vomiting
- hypokalemia -hypoMg and Ph - inc bicarb (relative to losing all the H+) and pH Na can be up, down, or normal bc Na levels are based on H2O, not actually na
102
which enzymes are elevated in dermatomyositis
= inc creatine kinase and aldolase -- both are enzymes found in muscles (CK is most sensitive and specific for myositis) **esr is NOT elevated present w progressive muscle wkns, constitutional sx including fatigue fever and weight loss, myalgia, and a heliotrope rash which is raccoon eyes aka red/purple rash of the eyelids
103
what is a positive methacholine challenge and what does it mean
positive = >20% drop in lung function with methacholine positive = asthma
104
when do you start mammography for breast cancer screening
USPSTF = 50 yo American Cancer Society = 40 or ten years before a first degree relative was diagnosed
105
what is the COBRA act
a law that prevents people from losing healthcare when transitioning between jobs or having hours cut
106
what lab level suggest ovarian insufficiency
FSH <40 x2 lab draws
107
what prenatal screening do you offer first vs second trimester
first trimester = first 12 weeks nuchal translucency + beta hcg levels , pregnancy associated second trimester= 13-24 quad screen = alpha-fetoprotein, inhibin A, beta hcg, unconjugated estriol

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