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Uworld Gaby > UW 2 > Flashcards

UW 2 Flashcards

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1
Q

Causes of precocious puberty

A

-central ==> high FSH & LH -peripheral ==> low FSH & LH (e.g. excess peripheral conversion, estrogen-producing ovarian cyst, CAH

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2
Q

NF1 features (7)

A

Two or more of the following

6 Cafe au lait spots

2 Neurofibromas

Freckling of the axillary or inguinal area

Optic glioma

2 Lisch nodules (Iris hamartomas)

Bone abnormality (eg. scoliosis)

First degree relative with NF1

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3
Q

Evaluation of precocious puberty

A

bone age normal ==> premature thelarche (breast development) vs. premature adrenarche (pubic hair development)

advanced ==> basal LH basal

LH high ==> central

low ==> GnRH stimulation test

low LH ==> peripheral

high LH ==> central

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4
Q

Neurologic deficits in B12 deficiency

A

loss of distal vibration sense & proprioceptive sense memory loss, irritability, dementia

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5
Q

Tx of megaloblastic anemia w/folic acid alone

A

if 2/2 B12 deficiency, folic acid will correct anemia but accelerate neurologic sx of B12 deficiency

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6
Q

Most common cause of constrictive pericarditis in Africa, India, China = ?

A

TB

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7
Q

Pagets Disease presentation

A

osteoclast dysfxn ==> increased bone turnover may be asx can lead to fx, bone pain, skeletal deformities can lead to H/As and hearing loss if bones of head/ear involved

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8
Q

Dxx for nephritic/nephrotic sd with low C3

A
  1. Postinfectious
  2. Membranoproliferative (including mixcrioglobilinemia)
  3. Lupus nephritis
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9
Q

Mixed cryoglubulinemia presentation

A

Palpable purpura

Nephritic/Nephrotic Sd

Low C3

Hep C (90%)

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10
Q

Nephritic Sd findings (6)

A

Proteinuria

Hematuria

Azotemia

RBC casts

Oliguria

Hypertension

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11
Q

Types of Nephritic Sd

A

Inmune Complex (postinfectious, igA, henoch-sholein)

Pauci-inmune (No IG deposits on inmunofluorescence)

Granulomatosis with polyangitis, microscopic polyangitis, eosinophilic granulomatosis

Anti-GMB disease Goodpasture, Alport

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12
Q

Renal disease with pulmonary symptoms (hemoptisis) dxx

A
  1. Goodpasture (no ulcers) 2. Granulomatosis with polyagitis
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13
Q

a. Kidney + lungs + sinus
b. kidney + lungs
c. kidney + asthma

A

a. granulomatosis with polyangitis
b. microscopic polyangitis / goodpasture
c. Chrug-Strauss (eosinophilic granulomatosis with polyangitis)

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14
Q

Pauci-inmune glomerulonephritis

A

a. Granulomatosis with polyangitis URT involvement (may see ulcers and polyps). Cavitary lesions (hemoptysis) PR3-ANCA/C-ANCA (antiproteinase 3)
b. Microscopic polyangitis No URT involvement. MPO-ANCA/p-ANCA (antimyeloperoxydase)
c. Eosinophilic granulomatosis with polyangitis (churg- strauss) Asthma, sinusitis, skin nodules, peripheral neuropathy MPO-ANCA/p-ANCA (antimyeloperoxydase) Eosinphilia, Elevated IgE

ALL treated with corticosteroids, cyclophosphamide or rituximab

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15
Q

Immune complex glomerulonephritis

A

a. Postinfectious: Common in kids. 2-4 weeks after infection. Low C3
b. Ig A (berger): Common in adults. During infection, Normal C3. Most common with GI infection (IgA produccing musocsa
c. Henoch-Shonlein purpura Like Berger + purpura (arthralgias, abdominal pain, IgA+)

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16
Q

Anti GMB glomerulonephritis

A

a. Goodpasture Hemoptisis, dyspnea, respiratory failure
b. Alport Fxx of renal failure. Serineural deafness

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17
Q

Treatment to consider in nephritic sd

A
  1. IECA (for all types of hypertension and/or proteinuria)
  2. Glucocorticoids
  3. Steroids, Cyclophosphamide, and rituximab
  4. Plasma exchange
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18
Q

Nephrotic sd causes

A

M and M FAN

Minimal change (most common in kids)

Membranous (highest rate of thrombosis), most common in white adults, 30% overall)

Focal segmental (most common in adults, espacially african american)

Amyloidosis

Diabetic

Lupus

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19
Q

Important complication in mebranous neprhopathy

A

Highest rate of thrombosis Renal vein trhombosis (hematuria, flank pain and scrotal edema)

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20
Q

Histology finding in MPGN

A

Tram track double layered basement mambrane/ Intermembranous dense deposits Low C3

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21
Q

Action of cyclosporin and SE

Study These Flashcards
A

Inhibits interleukin 2 transcription

nephrototoxycity (most common)

tremor

hta

gum hypertrophy

hyperkaliemia

22
Q

Mycophenolate side effects

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A

Marrow supresion

23
Q

Azathioprine

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A

diarhee leukopenia hepatotoxicity

24
Q

Calcium renal stone

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A

Radioopaque. Most common Square

Calcium phosphate: high pH

Calcium oxalate: low pH

25
Struvite stone
Mg amonium phosphate "Paralelepipedo" Radioopauqe. Urease producing organism: Proteus high pH
26
Uric acid stone
Radiolucid diamond shaped Low pH Hydrate and alkalinize urine
27
Cystine stones
Hexagonal. radiolucent Defect aminoacid transport: COLA Cystine, ornithine, lysine and arginine Family hx Hydration, Na restriction, urine alkalinization
28
Kidney stone management according to size
\<5mm: may pass spontaneously \<10mm: may pass with CCBs or Tamsulosin tx 5-20mm: shock wave lithotripsy \>20mm: percutaneous neprholithotomy
29
Young patient from developing country with progressive dyspnea, nocturnal cough and hemoptysis
Rheumatic heart disease
30
Mitral valve stenosis causes
Rheumatic fever (developing countries) Uncommon in the US
31
Presentation of Mitral stenosis
Progressive symptoms Dyspnea Orthopnea Hemoptysis =======\> Eventualy Right heart failure Left atria enlargment: Afib (thrombus formation), Stroke dysphagia and hoarness, elevation of main bronchus
32
Mitral stenosis auscultation
Opening snap with mid diastolic rumble at the apex
33
Rocky Mountain spotted fever
Riketsia Fever, malaise Maculopapular rash that starts in wrist and ankles... becomes petechial/purpuric... spreads centrally (involve hands and soles) Altered mental status and DIC may be seen in severe cases Treat with doxycycline
34
Ixodes tick is the vector of?
Babesia Lyme (Borelia) Anaplasma
35
Anemias algorithm pg 188 first aid
See algorithm Mycrocitic (5) Normocytic (14) Macrocytic (7)
36
Hereditary Spherocytosis
Autosomal Dominant Fx of splenectomy/hemolytic anemia Clasic triad: splenomegaly, hemolytic anemia, jaundice
37
Labs in Hereditary Spherocytosis
Normocytic anemia. Reticulocytosis normal MCV, elevated MCHC and RDV, Coombs - Indirect hyperbilirrubinemia May present with cholecystitis due to pigmented gall stones Diagnosis: Eosin-5 maleimide flow cytometry, acidified glycerol lysis test, osmotic fragility test
38
Autoinmune hemolytic anemia vs. Hereditary spherocytosis
Both are hemolitic anemia with spherocytes Only AIHA is direct Coombs +
39
Types of Autoinmune hemolytic anemia
Warm: IgG (SLE, CLL, lymphoma, penicillin, rifampin, phenytoin and a-methyldopa) Cold: IgM (Mycoplasma, EBV, Waldesntrom macroglobulinemia) POSITIVE: direct coombs
40
Complications of Mumps
Orchitis Can cuase aseptic meningitis and trasient sesoryneural hearing loss Pancreatitis has been described
41
Preterm premature rupture of membranes vs. premature rupture of membranes
PRM: 1hr before onset of labor (precipitated by urogenital infections, cervival incompetence,) PPRM: \<37weeks Prolonged: \>18hr (need ATB prohylaxis)
42
Agammaglobulinemia
boy (x linked recesive), starting at 6motnhs Infections with H influenza and S. neumonia and Pseudomona B cell deficiency Low Ig level Confirm with B and T-cell subsets (B absent, T high) Absent lymphoid tissue (eg. no tonsils)
43
B cell Disorders (4)
Agammaglobulinemia: H. influenzae, Pseudomona and pneumococcal infections Common variable inmunodeficiency: (both B and T defect). All Ig levels low IgA deficiency: anaphylactic reaction to blood transfusion. Recurrent GI and Resp infections Hyper IgM sd: severe recurrent sinopulmonary infection
44
Multiple Myeloma
CRAB Calcium (elevated), renal involvement, anemia/amyloidosis, Bone (lytic lesions) / back pain Multiple Myeloma: Monoclonal M protein Increased risk for infections (respiratory and UTI most common) due to impaired antibody production
45
Diagnosis of Chronic granulomatous disease
dihydrodamine 123 test nitroblue tetrazolium test
46
Chronic granulomatous disease
Increased risk of catalase + organisms (Candida, S. aureus, Serratia, Aspergillus, E. coli, Klebsiella) Severe pyogenic infections X linked or autosomal resecive
47
Treatment of Chronic granulomatous disease
Prophylaxis with TMP-SMX Interferon Bone marrow transplant
48
Obstructive pattern on spirometry
FEV1/FVC: \<70% FEV1: decreased FVC: normal/decreased FRC: increased TLC: increased
49
Managment of Neonatal respiratory distress sd
1. CPAP or intubation 2. Surfactant administration Pretreat with corticosteroids in patients with risk of preterm delivery in the next 7 days (24 to 37 weeks)
50
Xray findings in: a. NRDS b. Transient tachypnea od the new born c. Meconium aspiration
a. Ground-glass apearance, lack of focal opacities b. Due to amniotic liquid retantion. Perihiliar streaking c. Coarse, irregular infiltrates, lung expansion, pneumothoroax
51
Secondary syphilis
Fever, malaise, generalized lyphadenopaties Symetric, difuse maculo papular rash in palms and soles Condyloma lata (highly contagious) Treat with Penicillin G
52
Treatment of Multiple Sclerosis
Acute: High dose corticosteroids, plasma exchange Disease modifiying medications: * Interferon (ABC) (decrease number of relapses) * Ocrelizumab (progressive MS)

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