UW 11

Question 1

What are complement levels in SLE kidney dz and post strep GN and why?

Answer 1

Low

Immune complexes deposit in renal glomeruli - damaging - activate complement

Question 2

Goodpasture’s syndrome MOA of kidney damage

Answer 2

Cytotoxic Abs

Question 3

Harsh crescendo-decrescendo murmur begins after S1, best heard at Left lower sternal border

Answer 3

HOCM

Question 4

HOCM murmur intensifies with?

Answer 4

Valsalva - decreased preload and decreased LV filling

Question 5

What is HOCM pathophys

Answer 5

Outflow obstruction due to hypertrophied interventricualar septum
SAM = systolic anterior motion of MV leaflets

Question 6

Signs of Magnesium toxicity

Answer 6

Decreased DTRs
Respiratory depression
Death by cardiac or respiratory arrest

Question 7

Tx of Magnesium toxicity

Answer 7

Immediate discontinuation

Admin Calcium gluconate

Question 8

Down syndrome Quad screen

Answer 8

High: B-hCG and Inhibin A
Low: MSAFP and Estriol

Question 9

Limb ischemia management

Answer 9

Immediate anticoagulation w heparin - IV bolus then continuous
Referral for emergency vascular surgery

Question 10

Differ bt infectious mono (IM) and strep

Answer 10

Mono = HSM, generalized LA

Question 11

Heme complication in IM

Answer 11

AIHA
Thrombocytopenia
- Cross reactivity of EBV induced abs against RBCs and platelets
- IgM cold agglutinin abs -> complement mediated destruction of RBCs

Question 12

When does AIHA present after IM?

Answer 12

2-3 weeks after onset of sx’s

Question 13

Back pain w paravertebral tenderness

Answer 13

Lumbago

Question 14

Who is doxycycline CI in?

Answer 14

Children < 8 yoa

Pregnant women

Question 15

PCP pneumonia - cause of hypoxia

Answer 15

Increased A-a Oxygen gradient from alveolar and interstitial inflammation -> V/Q mismatch

Question 16

Presentation and TX of Nonallergic rhinitis

Answer 16

Chronic rhinitis sx’s (nasal congestion, rhinorrhea, sneezing, postnasal drainage)
Tx with intranasal antihistamine (1st G) IN glucocorticoids

Question 17

Multiple System Atrophy

Answer 17

Shy-Drager syndrome

1. Parkinsonism
2. Autonomic dysfnc
3. Neuro si’s

Question 18

Parkinsonism pt + Orthostatic HypoTN, impotence, incontinence

Answer 18

Multiple system atrophy = shy drager

Question 19

Familial dysautonomia

Answer 19

Riley-Day syndrome

• AR, Ashkenazi Jews
• Autonomic dysfnc + severe orthostatic HypoTN

Question 20

Electrolyte disturbances caused by Hypothyroidism

Answer 20

Hyperlipidemia
Hyponatremia
Elevated creatinine kinase

Question 21

Hypercholesterolemia effects in hypothyroidism

Answer 21

Decreased LDL receptor activity or receptors

Decreased lipoprotein lipase - hypertriglyceridemia

Question 22

What should be suspected in all smoke inhalation pts

Answer 22

Carbon monoxide poisoning

Question 23

Tx for CO poisoning

Answer 23

100% Oxygen nonrebreather

Question 24

Pathophysiology of cardiac tamponade

Answer 24

Fluid accumulation in pericardial cavity - increases intrapericardial pressure above diastolic ventricular pressure = restricts venous return to heart, lowers right and left ventricular filling
- Decreased Preload, SV, CO

Question 25

SBO Presentation

Answer 25

Vomiting Abdominal discomfort Mild/distal - colicky pain, delayed vomiting, abd distension, constipation-obstipation, hyperactive bowel sounds, dilaed loops of bowel on AXR

Question 26

MCC of SBO

Answer 26

Adhesions | - Think post op abdominal surgery in adult, appendectomy

Question 27

What do occasional black or tarry stools indicate

Answer 27

GI bleed above Ligament of Treitz

Question 28

Complications with severe burn pts

Answer 28

SIRS - 1st week Infx -> sepsis, septic shock Pneumonia Wound infxn

Question 29

Systemic Inflammatory Response Syndrome (SIRS)

Answer 29

Two of the four: 1. Temp > 101.3 or < 95 2. Pulse > 90 3. Respirations > 20 4. WBC > 12,000 or < 4,000 or 10% bands

Question 30

Tx for Bacillary angiomatosis

Answer 30

Oral Erythromycin

Question 31

Centrally-umbilicated dome shaped papules

Answer 31

Molluscum contagiosum

Question 32

Bright red, firm, friable exophytic nodule in HIV pt

Answer 32

Bacillary angiomatosis

Question 33

Indications for oxygen therapy in COPD

Answer 33

1. PaO2 < 88% 3. Hct >55% 4. Cor Pulmonale

Question 34

Basal Ganglia hemorrhage Presentation

Answer 34

Hemiplegia Hemi-sensory loss Homonymous hemianopsia, Gaze palsy Stupor and coma

Question 35

Cerebellum Hemorrhage Presentation

Answer 35

``` Facial weakness Neck stiffness Gaze palsy/Nystagmus Gait ataxia usually no hemiparesis Stupor/coma - brainstem herniation ```

Question 36

Thalamus hemorrhage presentation

Answer 36

``` Hemiparesis Hemi-sensory loss Upgaze palsy Nonreactive miotic pupils Eyes deviate Twd hemiparesis ```

Question 37

Cerebral lob hemorrhage presentation

Answer 37

``` Ass'd w seizures Contralateral homonymous hemianopsia (Occipital lobe) Contralateral plegia/paresis (frontal) Contralateral hemiparesis (Parietal) Eyes deviate away from hemiparesis ```

Question 38

Pons Hemorrhage presentation

Answer 38

Deep coma Total paralysis w/in mins Pinpoint reactive pupils

Question 39

MC site of hypertensive hemorrhage

Answer 39

Putamen | - Lies next to internal capsule - CL dense hemiparesis

Question 40

Presentation of cerebellar hemorrhage

Answer 40

Occipital HA Vomiting, dizziness Gait ataxia NO Hemiparesis