UWorld pt2 Flashcards
(97 cards)
1
Q
Most common neuroimaging finding of schizophrenia
A
Most consistently replicated neuroimaging finding in schizophrenia = enlargement of lateral cerebral ventricles
Enlargement of cerebral ventricles in schizophrenia
2
Q
Clinical feature to distinguish middle vs. anterior cerebral artery occlusion
A
Middle cerebral artery occlusion => contralateral somatoatosensory and motor deficit in face/arm/leg
vs.
Anterior cerebral artery occlusion => contralateral somatosensory and motor deficit predominantly in LE
3
Q
First line pharmacologic agent for cancer-related anorexia/cachectic
A
Progesterone analogus
-lolz not weed (much better for HIV-associated cachexia)
4
Q
Lab values to differentiate CML from leukemoid reaction
A
CML: more immature (myelocytes > metamyelocytes), absolute basophilia, low LAP (leukocyte alkaline phosphatase)
Leukemoid rxn to severe infxn: lower (like around 50k), more mature (metamyelocytes > myelocytes), high (normal) LAP, no basophilia
5
Q
Lab tests to differentiate iron deficiency anemia from thalassemia trait
A
Both will be microcytic anemias, but iron deficiency will have high RDW and low #RBCs
While thalassemia will have normal RDW and normal number of RBCs
6
Q
Besides sedation, risk of giving benadryl to elderly M
A
Benadryl has both antihistamine and anticholinergic properties
Anticholinergic properties => detrusor hypocontractility which may cause acute urinary retentnion in elderly M w/ enlarged prostate
7
Q
5 mo old girl w/ failure to thrive and a renal tubular acidosis- which type of RTA does she likely have?
A
Type 1 (distal): not excreting enough protons -most likely to be congenitals
Others: type 2 (proximal): not reabsorbing bicarb (ex: Fanconi syndrome) vs. type 4 (aldo resistance)
8
Q
Choriocarcinoma
(a) How to make dx
(b) Tx
A
Chiocarcinoma = gestational trophoblastic tumor
(a) Diagnose w/ elevated beta-hCG way after delivery
(b) Tx w/ chemotherapy
9
Q
First line tx for VT on ECG
A
VT:
- stable: IV amiodarone
- unstable: cardiovert
10
Q
Main organ systems involved in disseminated histoplasmosis
A
Disseminated histo (usually in immunocompromised) when it spreads from lungs thru lymph into systemic
- systemic symptoms
- pulm
- mucocutaneous (papules, nodules)
- reticuloendothelial (HSM, lymphadenopathy)
11
Q
Describe the febrile nonhemolytic rxn to transfusion (MC transfusion rxn)
(a) Etiology
A
MC transfusion reaction is 2/2 (a) Cytokines that build up during storage of the blood
Clinically: w/in 1 hour of transfusion pt w/ fever and chills, but no DIC Or lab abnormalities
12
Q
Two abx classes to treat legionella pneumonia
A
Legionella pneumonia = PNA w/ hyponatremia
Tx: macrolides (azithromycin) or quinolones (levofloxacin)
13
Q
Give the typical presentation of Reye syndrome
A
Reye syndrome = acute liver failure (transaminitis, coagulopathy, hyperammonemia) and encephalopathy in child after influenza or varicella infection w/ aspirin use
14
Q
MC location of medulloblastoma
(a) Clinical symptoms
A
MC location of medulloblastoma = cerebellar vemis (and almost always in the posterior fossa)
(a) => presents w/ cerebellar symptoms, like truncal ataxia
15
Q
23 yo F w/ progressive lower back pain and stiffness x3 yrs
- relief w/ exercise
- morning stiffness x1 hr
- tenderness over lumbosacral area
(a) Dx
(b) Diagnostic test
A
(a) Dx = ankylosing spondylitis
(b) Diagnose w/ Xray of sacroiliac joints w/ characteristic bamboo spine
- can’t diagnost w/ HLA-B27: present but not specific enough for diagnosis
16
Q
Key clinical features of Chikungunya fever
A
Chikungunya fever = mosquito-borne illness in central/S America and tropical regions
High fever + severe symmetric polyarthritis (arthritis is the key here)
17
Q
Classic CXR findings of contained aortic rupture
(a) vs. CXR findings of bronchial rupture
A
- widened mediastinum
- L sided hemothorax
(a) Bronchial rupture => pneumothorax that doesn’t resolve w/ chest tube, pneumomediastinum, subcutaneous emphysema
18
Q
Ddx for exudative pleural effusion
A
- Empyema- from baceterial infxn of the pleural space (So bacterial PNA)
- Tb (AFB stain)
- Malignancy (get cytology)
- Chylothorax from thoracic duct damage (see high TG in pleural fluid)
19
Q
Workup for unexplained erythema nodosum
A
Erythema nodosum = painful lesions on shins associated w/ strep, Tb, sarcoidosis, coccidiomycosis, IBD, Behcets
- CBC, LFTS, BUN/Cr
- Anti-ASO titers
- PPD
- CXR to screen for sarcoidosis (b/l hilar lymphadenopathy, reticular opacities
20
Q
MS
(a) LP findings
(b) Classic MRI findings
A
MS
(a) Oligoclonal bands
(b) MRI findings: pericentricular and juxtacortical lesions
21
Q
Glomerulopathy MC associated w/ renal vein thrombosis
(a) Clinical presentation
A
Membranous glomerulonephrophaty
(a) Presents as progressive gradual worsening of renal fxn and proteinuria in asymptomatic pt
ex: 6 wks of periorbital edema and abdominal distention, sudden development of R sided abdominal pain fever and gross hematuria
22
Q
What is euthyroid sick syndrome
A
Euthyroid sick syndrome aka “low T3” is when T3 is low but T4/TSH normal during an acute illness
23
Q
When is MSAFP measured to screen for fetal anomalies?
(a) When is it high
(b) When is it low
A
Maternal serum alpha-fetoprotein screen measured btwn 15-20 weeks to screen for fetal anomalies
(a) High in open neural tube defects (anencephaly, open spina bifida), ventral wall defects (omphalocele, gastrocschisis), multiple gestations
- if high get ultrasound
(b) Low AFP associated w/ aneuploidies (trisomy 18, 21)
24
Q
Auer rods
A
AML
25
25 yo African American p/w nocturia x5 months
-normal UA and CBC
Explain his nocturia
Hyposthenuria = inability to concentrate urine found in SCD or sickle cell trait 2/2 RBC sickling in the vasa rectae of the inner medulla => impairs countercurrent exchange and free water reabsorption
26
Differentiate clinical features of patellofemoral syndrome and patellar tendonitis
Patellofemoral syndrome- typically young adult F athletes w/ pain on knee extension while patella is compressed (patellofemoral compression test), pain reproduced w/ squatting or stairs
Patellar tendonitis- primarily athelets, episodic pain and tenderness at the inferior patella
27
ECG changes expected from severe hyperkalemia
(a) Immediate tx when pt w/ hyperkalemia has ECG changes
ECG changes: peaked T waves, bradycardia from sinus node dysfunciton, AV block, arrhythmias (VT or VFib)
(a) IV calcium (chloride or gluconate) to stabilize cardiac myocyte
- not an anti-arrhythmic
28
15 day old boy w/ bilious emesis, breastfed, KXR w/ gasless abdomen
(a) Most likely dx
(b) First step in management
(c) Diagnostic test
(a) Midgut volvulus 2/2 malrotation: classically presents in neonate under 1mo w/ bilious vomiting
(b) NG tube decompression, IV fluids
(c) Upper GI series (Xray w/ contrast) to visualize and r/o free air in abdomen
29
Prognosis of Hodgkin lymphoma
HL is very responsive to tx: >90% 5-year survival for stage I-II disease
-recurrence uncommon
However- pts treated before 30 yoa have 18.5x increased risk of secondary malignancy from chemo/radiation
So 43 yo w/ pulmonary nodule, treated at 20 for HL w/ chemo/radiation, not recurrence on HL but a secondary malignancy
30
14-3-3 protein in CSF
Neurodegenerative prion disease (CJD)
31
Bamboo spine
Bamboo spine = fusion of vertebral bodies w/ ossification of intervertebral discs that suggests ankylosing spondylitis in young adult (under 40) w/ back pain
32
Screening guidelines for HepB vs. HepC
HIV and HepB screening in pts w/ high-risk sexual intercourse = unprotected or MSM
HepC: IVDU, high-risk needle exposure, or blood transfusion before 1992
33
Hallmark opthalmoscopy findings of
(a) Open angle glaucoma
(b) Retinal detachment
(c) Central retinal vein occlusion
(d) Simple diabetic retinopathy
(a) Pathologic cupping of the optic disc
(b) Retina hanging in the vitreous
(c) Disc swelling, venous dilation and tortuosity, retinal hemorrhages and cotton woll spots
(d) Microaneurysms, hemorrhages, exudates, retinal edema, then cotton wool spots next
34
Use of progesterone supplementation in pregnant F
Can be used in F w/ h/o preterm labor to prevent recurrence of preterm labor
35
Expected changes in the following seen in pregnancy
(a) CBC
(b) BMP
(c) UA
Pregnancy changes
(a) Mild anemia due to dilation from volume shifts
(b) BMP: reduced BUN/Cr due to increased GFR/renal blood flow
- so in nonpregnant F Cr of 1.2 may be considered ULN, while this is acute insufficiency in pregnant F
(c) Normal to have 1+ proteinuria due to expected increase in glomerular basement membrane permeability
36
34 yo HIV+ M w/ severe watery diarrhea x14 days, CD4 of 94, negative FOBT
(a) Dx
(b) Tx
(a) Cryptosporidium diarrhea: CD4 under 180 (not under 50 like when you'd see MAC or CMV diarrhea)
- severe watery diarrhea w/ low-grade fever and weight loss
(b) Treat the HIV, usually diarrhea persists until CD4 improves
37
Keywords for distinguishing the 3 systemic fungi in the US
All 3 w/ pulm and skin findings
Histo- hepatosplenomegaly (b/c intracellular in macrophages)
Blasto- ulcerated skin lesions and bony lesions (osteomyelitis, lytic lesions)
Coccidio- skin, lungs, meninges (SW US)
38
UA sediment indicative of
(a) Glomerulonephritis
(b) Pyelonephritis
(c) Chronic renal failure
(d) ATN
(e) Interstitial nephritis
(f) Nephrotic syndrome
(a) GN (causing nephrotic syndrome) = RBC casts
(b) Pyelo = WBC casts
(c) CRF => broad casts and waxy casts
(d) ATN = muddy brown, granular, casts
(e) Interstitial nephritis (AIN) = WBC casts (same as pyelo)
(f) Nephrotic syndrome (indicating glomerular injury) = fatty casts
39
MC complication of giant cell arteritis
Aortic aneurysm
-vasculitis that can involve branches of the aorta
=> pts require follow up w/ serial CXRs
40
Initial maneuvers to manage shoulder dystocia
Don't go straight to C-sxn!!!
1. McRobert's: shart hip flexion w/ mother supine
2. Suprapubic pressure to release anterior shoulder
3. Episiotomy
4. Maneuvers: mother on all 4s
41
Pregnant pt w/ hyperemesis gravidarum p/w confusion and incoherence, wt loss, nystagmus
Dx
Dx = Wernicke encephalopathy 2/2 thiamine deficiency
Not just in alcoholics!! Remember the triad: encephalopathy, oculomotor dysfunciton, ataxi
42
PSC vs. PBC buzzwords
PSC = ulcerative colitis
PBC = middle aged F w/ positive antimitochondrial antibodies
43
20 yo M w/ jaundice and dark urine
| -urine dipstick positive for bilirubin, negative for urobilinogen
Bilirubin is water soluble (can be excreted in urine), while unconjugated hyperbili is not, so urine dipstick w/ bilirubin means there is hyperbilirubinemia of CONJUGATED bilirubin
Probably Rotor's syndrome = genetic defect in hepatic secretion of bilirubin
44
37 yoM presenting in withdrawal of ?
- severe diffuse muscle aches
- abdominal cramps, 4 loose stools
- persistent nausea, no vomiting
- diaphoretic, pupils dilated
```
Opiate withdrawal (heroin): arthralgia/myalgias, GI (N/V/abd cramping)
-dilated pupils, yawning, lacrimation
```
45
Consequence of
(a) Ruptured berry aneurysm
(b) Intracerebral hypertensive vasculopathy
(a) Ruptured berry aneurysm => subarachnoid hemorrhage
| b) HTN of the small penetrating branches => deep intracerebral hemorrhage (basal ganglia
46
Differentiate the 3 uterotonic drug options to treat uterine atony
Uterotonic drugs
1st line = oxytocin
2nd line:
-methergine (methylergonovine): causes vasoconstriction, so contraindicated in pts w/ h/o HTN
-carbaprost: synthetic prostaglandin that can cause vasoconstriction => contraindicated in asthmatics
47
Gas toxicity 2/2
(a) Anesthetic/dapsone
(b) House fire
(a) Anesthetic/dapsone c/f methemoglobinemia
| (b) House fires: think cyanide or CO poisoning
48
MC comorbidity of absence seizures
Psych comorbidities- MC ADHD (inattentive subtype) and anxiety
49
Weber hearing test- explain it
Result in
(a) Sensorineural hearing loss
(b) Conductive hearing loss
Weber = vibrating tuning fork on middle of head/forehead equidistant btwn ears
-normal is hearing the same in both ears
(a) Sensorineural hearing loss: lateralize (hear sound louder) in unaffected ear (b/c affected ear can't sense the vibration
(b) Conductive hearing loss: lateralize to affected ear (b/c not distracted by ambient nose that that ear can't hear)
50
II/VI holosystolic murmur over LLSB w/ diastolic rumble over the cardiac apex
Dx = Large VSD (NOT ToF)
- diastolic rumble 2/2 increased flow across mitral valve
- II/VI b/c larger the VSD = less turbulence = softer murmur
ToF murmur = harsh systolic ejection murmur over LUSB from pulmonary stenosis
51
Differentiate etiologies of symmetric vs. asymmetric fetal growth restriction
Symmetric (both head and body small): from insult in the 1st trimester
- chromosomal abnormality
- congenital infxn
Asymmetric (head spared, only body small): from later insult
- uteroplacental insufficiency (MC 2/2 maternal HTN)
- maternal malnutrition
52
3 main features of Fanconi anemia
Fanconi anemia = autosomal recessive mutation in DNA repair enzyme (so can't repair DNA crosslinks)
1. Congenital bone marrow => asplastic anemia, pancytopenia
2. Morphologic abnormalities: short stature, microcephaly, hypo/hyperpigmented cutaneous lesions, stabismus
3. Increased risk of malignancy
53
First line tx for allergic rhinitis
Intranasal glucocorticoids
| not monteleukast or non-sedating antihistamines: those will be second line
54
Would you rather a son or daughter have Lynch syndrome?
Son!!
Lynch (mismatch repair) = increased risk of CRC, endometrial and ovarian carcinoma
Stupid question but more just getting at Lynch increases risk of other cancers besides CRC
55
Prognosis of Hodgkin lymphoma
HL is very responsive to tx: >90% 5-year survival for stage I-II disease
-recurrence uncommon
However- pts treated before 30 yoa have 18.5x increased risk of secondary malignancy from chemo/radiation
So 43 yo w/ pulmonary nodule, treated at 20 for HL w/ chemo/radiation, not recurrence on HL but a secondary malignancy
56
Effect of thiazides on calcium homeostasis
Thiazides increase calcium reabsorption
Bad: can contribute to hypercalcemia
Good: can decrease calcium urine excretion in ppl w/ recurrent radio-opaque kidney stones (calcium oxalate stones)
57
Thiazide diuretics
(a) Metabolic effects
(b) Electrolyte abnormalities
(a) Associated w/ hyperglycemia (b/c thiazides impair insulin release) and increased LDL/TGs
(b) Hyponatremia, hypokalemia, hypomag, hyPERcalcemia
58
Which dimorphic fungi most closely mimics sarcoidosis
(a) Danger of treating for sarcoid before ruling it out
Histoplasmosis (Mississippi and Ohio River basins)
(a) Don't want to start pt w/ disseminated fungal infection on an immunosuppressant (aka steroids that would be first line for sarcoid)
59
20 yo F- what type of murmur would be benign vs malignant
Benign = midsystolic murmur in otherwise healthy young, asymptomatic adults
While either diastolic or continuous murmurs = pathologic and automatically indicate TTE
60
Strawberry hemangioma vs. cherry angioma
Strawberry (capillary) hemangioma present in first week of life, can initially grow rapidly but then regress spontaneously around 5-8 yoa
Cherry angioma = senile hemangiomas- benign vascular tumor in adults present in 30/40s and can get more w/ age
-dont regress spontaneously but are benign so only remove if wanted for cosmesis
61
B/l perihilar linear streaking
CXR finding of transient tachypnea of the newborn- starts at birth resolves day 2 of life
-is 2/2 inadequate alveolar clearance at birth => mild residual pulmonary edema
62
Hereditary cancer syndrome w/ increased risk of
(a) Clear cell renal carcinoma
(b) Pheochromocytoma
(c) Endometrial carcinoma
(d) Ovarian cancer
Hereditary cancer syndromes w/ increased risk of
(a) Clear cell renal carcinoma = von-Hippel Lindau (MC is hemangioblastoma)
(b) Pheo in von-Hippel Lindau, also MEN2A/B
(c) Endometrial cancer in Lynch syndrome
(d) Ovarian cancer in Lynch syndrome, BRCA 1/2
63
Mechanism of acyclovir-induced AKI
Acyclovir causes crystaline-induced AKI (NOT AIN!!!- AIN 2/2 sulfa drugs and PPI)
Acyclovir readily excreted in urine, but then is not soluble in urine so precipitates in tubules- forming obstructive crystals
64
Mechanism of refractory hypokalemia in alcoholics
Hypomagnesemia (2/2 poor nutritional intake, EtOH-induced renal loss, diarrhea)
Low Mg => excessive K secretion by ROMK channels in collecting duct
-so hypokalemia refracotyr to IV/oral K repletion
65
47 yo on risperidone that controls refractory psychosis, develops repetitive foot tapping, tongue protrusion, lip smaking
(a) Dx
(b) Mgmt
(a) Tardive dyskinesia = abnormal involuntary mov'ts 2/2 prolonged antipsychotic use (or metoclopramide)
(b) Switch to clozapine- need to stop offending agent but if still need antipsychotic on board us the one w/ lowest risk of TD/EPS (clozapine)
66
ODD vs. conduct d/o
ODD less severe: kids are angry/irritable and argumentative/defiant towards authority, but no stealing or aggression towards other
CD: violation of major social norms and rights of others: bullying, weapons, torturing animals, destroying property, stealing
-under 18, over 18 = ASPD
67
Tetrology of Fallot murmur
ToF murmur classically = harsh, systolic ejection murmur over LUSB from pulmonary stenosis
68
Maternal HTN puts fetus at increased risk of what type of growth restriction
Maternal HTN => underdevelopment of spiral arteries in placenta => uteroplacental insufficiency that causes asymmetric fetal growth restriction (head size normal, body small)
69
3 main clinical features of lead poisoning in adults
1. Heme- anemia
2. GI- abd pain, constipation, anorexia
3. Neuro- cognitive/memory defects, peripheral neuropathy
70
Clinical features of overdose/toxicity
(a) Phenytoin
(b) Lithium
(c) Benzos
(a) Phenytoin toxicity: horizontal nystagmus, cerebellar ataxia, confusion
(b) Li toxicity: tremor, hyperreflexia, ataxia, seizures
(c) Benzos: slurred speech, unstead gait, drowsiness, normal pupils and RR (no nystagmus like EtOH and phenytoin)
71
Protocol for malaria ppx
Chemoprophylaxis- typically mefloquine beginning 2 weeks prior to travel, d/c 4 weeks after retruning
Chloroquine not used b/c most strains by now are resistant
72
Tx for isolated enuresis in child
1st line = desmopression (ADH analog) to suppress overnight urine production
Then if that doesn't work can use TCAs (kept second line due to side effect profile)
73
Explain the mechanism of infertility in PCOS
Mechanism = anovulation from failure of follicles to mature
So peripheral adipose converts androgens --> estrone, excess estrone inhibits GnRH release => dysregulated FH/LSH so ovulation and follicle maturation sucks
74
29 yo F w/ CP and dyspnea x10days, 3 mo s/p NSVD followed by frequent dark bloody vaginal discharge
- enlarged uterus on exam
- CXR: multiple b/l infiltrates of various shapes
Dx
Dx = choriocarcinoma = gestational trophoblastic tumor (so from placenta tissue that becomes malignant)
-by nature the tumor is very invasive => very invasive cancer, commonly mets to lungs => SOB/CP
Clinical features: enlarged uterus, abd pain, irregular vaginal bleeding
75
Electrolyte abnormality seen 2/2 Addisons
Addisons = primary adrenal insufficiency
MC is hyponatremia (b/c no Aldo to make you reabsorb all that Na in the collecting duct), also hypernatremia b/c aldo stimulates K+ secretion
76
Clinical manifestation of ABO incompatibility transfusion reaction
ABO incompatibility transfusion occurs w/in 1-6 hrs of transfusion w/ flank pain, renal failure, and DIC (oozing from IV sites)
77
S/p solid organ transplant pts should be put on what two prophylactic meds for ppx
Solid organ transplant require high-dose immunsuppressives to prevent organ rejection => at risk for opportunistic infxns especially PCP and CMV
So put them on Trim-Sulfa and Valganciclovir
78
# Define fetal growth restriction
(a) Differentiate symmetric vs asymmetric
FGR = ultrasound w/ fetal weight under the 10th percentile for gestational age
(a) Symmetric- both head and body (insult in the first trimester) vs. asymmetric (head sparing) from insulin in 2nd/3rd trimester
79
57 yoM p/w 2 episodes hematuria, fatigue/fever x4 weeks
- 50 pack year history
- L sided varicocele that fails to empty when pt is recumbent
- Hb 18, Plks 580k
(a) Next step
(b) Dx
(a) Abdominal CT
(b) Renal cell carcinoma- left scrotal varicocele 2/2 blockage of L renal vein
- hematuria 2/2 invasion of tumor into collecting system
80
62 yo M started on a new PO med for asthma and started acting strangely
Steroid-induced psychosissssss
81
When is amnioinfusion given
Amnioinfusion = put saline into uterine cavity, used to tx recurrent variable decels due to umbilical cord compression during labor
82
First line tx of Prinzmetal angina
CCB (Diltiazem) for prevention + sublingual nitro for abortive measures
NOT beta blockers!!! Nonselective beta-blockers (propranolol) CONTRAindicated...can make it worse
83
CVID vs. SCID
(a) Age of onset
(b) Tx
Common variable immunodeficiency = no Igs b/c of abnormal B cell maturation
- adequate cellular (T) immunity => dont need antifungals or antivirals
(a) Later, infxns in childhood
(b) Tx w/ IVIG to prevent infxns
SCID = no B or T cell activity
(a) Earlier, infancy infxns and infxn after vaccines
(b) Tx w/ ppx antivirals/antifungals or trapnsplant
84
22 yoM w/ fever, sore throat, malaise x2 wks
- s/p trip to Honduras
- tonsils enlarged and covered in white exudate
- lympahdenopathy, hepatosplenomegaly
- I/VI systolic murmur
- HB 9.4, Retic 6%, Plt 120, WBC 3.8
Dx
Mono and autoimmune hemolytic anemia and thrombocytopenia 2/2 IgM cold-agglutinin
EBV-induced antibodies form that are against RBCs and plts => anemia and thrombocytopenia
85
Define preterm premature rupture of membranes
Premature rupture of membranes = rupture of amniotic sac membrane more than an hour before onset of labor
Then preterm when PROM happens before 37 weeks
Give abx (penicillin) for either unknown or positive GBS status
86
7 yo boy p/w bleeding gums x3 mo
- WBC 3k, Hb 7.8, RBC count low, MCV 112, Plts 40k
- 5th percentile for height, thumbs slightly bent, areas of hypopigmentation on skin
(a) Dx
(b) Diagnostic test
(a) Fanconi anemia = congenital bone marrow failure => aplastic anemia, morphologic abnormalities, and increased risk of future malignancy
(b) Diagnose by chromosomal breaks on genetic analysis
87
Indication for terbutaline
Terbutaline = tocolytic to relax uterus when tachysystole (>5 contractions in 10 mins) or tetanic contractions (last >2 mins) that are causing fetal heart rate abnormalities
88
3 MC causes of acute bacterial rhinosinusitis in children
30% Strep pneumo
30% Haemophilus influenza
10% Moraxella catarhallis
89
40 yo w/ 4+ proteinuria, immunofluorescence shows C3 with no immunoglobulins
(a) Dx
(b) Mechanism
(a) Membranoproliferative glomerulonephritis => C3 deposits (w/o Igs) w/in glomerular basement membrane
(b) MPGN = IgG specifically against C3 convertase => constitutive activation of alternative complement pathway
90
45 yo HIV+ M (CD 4 22) p/w fevers, nights sweats, diarrhea/cough, 10 lb wt loss x3 wks
- clear lungs, no rashes, negative PPD, negative CMV IgG, unremarkable CXR
- splenomegaly
- serum alk phos 412
(a) Dx
(b) Diagnostic test
(c) Tx
(a) Dx = disseminated MAC
- nonspecific symptoms w/ splenomegaly and elevated alk phos (2/2 MAC hepatosplenic involvement) in pt w/ CD4 under 50 = MAC
(b) Diagnose w/ blood cultures
(c) Tx = macrolide (azithromycin or clarithromycin)
91
Elevated serum homocystine vs. methionine
Elevated methionine in only B12 deficiency
While homocystine is elevated in both b12 and folate deficiency
92
36 yo G1P0 at 38 weeks p/w sudden vaginal bleeding and severe lower abdominal pain
- uterine tenderness w/ moderate vaginal bleeding
- good fetal heart traving
- contractions q2 mins for 20 seconds
(a) Dx
(b) Risk for what maternal complications
(a) Placental abruption = premature separation of placenta from decidua
(b) Hypovolemic shock and DIC
93
10 yo boy w/ rash on LE 7-days s/p viral illness
- rash nonblanching palpable purplish lesions
- Plts 120k
- UA: moderate hematuria
(a) Dx
(b) Mgmt
(a) Henoch-Scholein Purpura = IgA mediated vasculitis characterized by palpable purpura, arthralgias, abdominal pain, hematuria, and normal platelets
(b) Mgmt- usually just supportive w/ hydration and NSAIDs, if super severe can admit and give glucocorticoids
94
Differentiate clinical manifestation of constitutional growth delay and hypothyroidism causing stunted growth
Constitutional growth delay: small drop off early (6 mo to 3 years), then maintain constant growth rate on 5th-10th percentile
-will eventually have growth spurt, just reassure
Hypothyroidism: kid moving along at normal pace then sudden drop off, also w/ fatigue, constipation, cold intolerance, dry hair/skin
95
Indication for hormone replacement therapy
For vasomotor symptoms (ex: hotflashes) in pts under 60 who have undergone menopause w/in the last 10 years
96
Features of diarrhea caused by the following in HIV pts
(a) CMV
(b) MAC
Diarrhea in HIV pts
(a) CMV diarrhea: frequent small volume bouts of diarrhea in pts w/ CD4 under 50, can have hematochezia
(b) MAC diarrhea: watery stool, febrile (very febrile, like over 102.2), only once CD4 under 50
97
What is
(a) Diclofenac
(b) Febuxostat
(c) Riluzole
(a) Diclofenac = NSAID
(b) Febuxostat = uric acid reducer
(c) Riluzole = glutamate inhibitor to prolong survival in ALS
