uworld stuff! Flashcards
(365 cards)
1
Q
infant of mother with pregestationa diabetes, presents with cyanosis and structural abnormality on second trimester ultrasound
A
hypoplastic left ventricle syndrome
2
Q
infant with weak femoral pulses and decresed postductal oxygen saturation
A
coarctation of aorta
3
Q
diaphoresis, cool extremities, JVD, pulmonary crackles, hyperdynamic impulse, apical decrescendo murmur, rapid onset pulmonary edema, heart failure
A
acute mitral valve prolapse from chordae tendinae rupture
4
Q
easy bruising, velvety skin with atrophy and scarring, MVP, scoliosis
A
ehlers-danlos syndrome
biggest give away is the velvet skin and atrophy
5
Q
mid systolic murmur at the left upper sternal boarder with right atrial and ventricular dilation
A
atrial septal defect , secundum type
wide fixed splitting of second heart sound
6
Q
heart failure patients with EF <40 should get what
A
ACE inhibitor
7
Q
trastuzumab cardiotoxicity is reversible or irreversible
A
irreversible
8
Q
nonejection click and murmur that vary in timing depending on body position
A
Mitral valve prolapse
worse with decreased venous return
9
Q
ejection crescendo-decresendo systolic murmur
A
aortic or pulmonic valve stenosis
10
Q
harsh holosystolic murmur with maximal intensity over the left thrid and fourth intercostal space with a palpable thrill
A
VSD
11
Q
SOB, fatigue, palpitations, cough while laying down, anxious, fatigue, loud fst heart sound with short apical low pitched diastolic rumble. broad notched P wave in lead II with right axis deviation
CXR showing pulmonary edema, elevaton of the left mainstem bronchus, left atrial enlargement with flattening of the left heart boarder
what is this and what can cause this 10 - 20 years after the initial event
A
mitral stenosis
rheumatic heart disease
12
Q
progressive dyspnea, fatigue, JVD, lower extremity edema
poor sign is early right ventricular collapse
A
pericardial tamponade
13
Q
person has ASCVD risk factors, ACS, angina, arterial revascularization (CABG), stroke, TIA, PAD. what do they need
A
statin
14
Q
young person, chest pain and palpitation, lightheadedness that pass out after overexertion, prolonged QT, dies of sudden cardiac death
A
anomalous aortic origin of coronary arteries
15
Q
how does bicarb work to treat TCA overdose
what about salicilate overdose
A
inhibition of fast sodium channels to decrease QRS duration and prevent arrhythmia
alkalynize urine to promote excretion
16
Q
what medication do you give to people with Afib with RVR (variable R-R) interval
A
metoprolol, do not give adenosine
17
Q
PAD disease treatment course
A
smoking cessation, comorbidity control, statin
exercise program
cilostazol
angioplasty
18
Q
treatment of cocaine overdose
A
benzodiazepine, do not give b-blockers previous studies where conducted poorly and are unreliable. can lead to unopposed alpha vasocontriction
19
Q
suspect this in cocaine overdose in patient with controlled vitals but has persistent chest pain, and new development of neurologic symptoms
A
aortic dissection
20
Q
give this medication to acute heart failure patients that are hypertensive and fluid overload
A
nitroglycerin
21
Q
what complication is the most common with compartment syndrome
A
AKI due to myoglobin release
22
Q
what pressure indicates compartment syndrome
A
30 or greater
23
Q
ekg showing narrow complex tachycardia, regular r-r interval and retrograde p waves
A
psvt
24
Q
s3 is highly specific for what
A
heart failure
25
loud harsh, holosystolic murmur in 4th left intercostal space with palpable thirll
VSD
26
polymorphic VT such as torsades is usually precipitated by what
bradycardia
27
what is contraindicated in acute decompensated heartfailure (CP, nausea, weakness, lightheadedness) due to causing decreased contractility of the heart causing worsening of pulmonary edema
b-blockers
28
edema, ascities, hepatic congestions, elevated JVP with prominent "y" decent, pericardial knock, with CXR showing pericardial thickening or calcification typically after cardiac surgery
constrictive pericarditis
29
fix this arrhythmia with treatment of underlying lung pathology
multifocal atrial tachycardia,
30
s4 with systolic murmur along left sternal boarder that increases with valsalva
HOCM
31
treatment for heart failure with LVOT obstruction
b-blocker or ccb
32
difference between acute pericarditis and dressler syndrome
dressler occurs several weeks after MI
33
treatment of peri-infarction pericarditis
aspirin
34
digoxin toxicity is caused by what four medications
verapimil, amiodarone, quinadine , spironolactone
35
aortic jet velocity, transvalvular gradient, and valve area that indicated aortic stenosis
>4 sec, >40mmHg, and <1cm
| if they have shortness of breath, angina, syncope, CABG, or EF <50 then replace
36
HOCM patients die from what and need what to prevent it
sudden cardiac death and ICD
37
what indicates severe AS as far as the sound of the murmur
loud and late peaking single sound on inspiration
38
biggest modifiable risk factor for AAA
smoking cessation
39
INR goal of mitral valve
| INR goal of aortic valve
m - 2.5 to 3.5
| a - 2 to 3
40
lower leg claudication, upper extremity HTN
| murmur can be interscapular and persistent, left sternal border with brachio-femoral delay
coarctation , associated with turners syndrome
41
syncope with no prodrome is likely related to what
cardiogenic
42
syncope triggered by prolonged standing, acute stress, or pain typically with nausea, flushing, warmth, pallor, and sweating that resolves in minutes
vasovagal syncope
43
holosystolic murmur at the apex with a click
mitral regurgitation
44
low pitch diastolic murmur over cardiac apex with emboli
atrial myxoma
45
treatment of cocaine overdose
benzos
46
bp control from acute ischemic stroke
with TPA
without TPA
<185/105 but greater >140/90
| <220/120
47
vertigo, dizziness, unable to walk, dysarthria, numbness, and visual disturbance
vertebrobasilar insufficieny
48
cognition waxes and wanes, parkinsonism like symptoms, and hallucinations in older person with frequent falls can also have delusions, depression, and autonomic dysfunction
dementia with lewy bodies, antipsychotics but this can cause things to get worse
49
bilateral polyspike and slow wave discharges, absoncse, morning myoclonus
juvinile myoclonic epilepsy, valproic acid which can cause thrombocytopenia, hepatotoxicity, and panceatitis
50
medication that causes gingival hyperplasia
phenytoin
51
dopamine agonist used for parkinsons treatment
pramipexol or bromocriptine
52
wet, wobbly, wacky
normal pressure hydrocephalus, LP then VP shunt if LP resolves symptoms
53
progressive weakness, sensory loss, urinary retention after URI
transverse myelitis
54
headache under stress, bandlike or bilateral lasting 30 minutes to 7 days
tension headache
55
patient wakes up during sleep, pain behind one eye, lacrimation, flushing, pupillary changes, and nasal congestion
cluster headache, verapamil for prevention
56
unilateral, aura, pulitile, phonophobia, photophobia, nausea
migraine headache
57
vertigo, diplopia, horizonta and vertical nystagmus, sensory loss, dysphagia, hoarsness, ipsilateral horners syndrome
wallenberg syndrome usually caused by occluded intracranial vertebral artery
58
these brain lesions affect the sensory loss in the contralateral face and body
thalamus or cortex
59
lesion associated with aphasia, neglect, and agrapesthesia
cortical lesion
60
lesions that affect the ipsilateral face and contralateral body
brainstem
61
these two drugs are disease modifying agents for relapsing and remitting MS
beta interferon, glatiramer acetate
62
pt with seizures that develops horizontal nystagmus, blurred vision, diplopia, ataxia, slurred speech, lethargy
phenytoin toxicity
63
severe, sudden onset headache with nausea, ptosis, mild anisocoria, and nuchal rigidity
SAH due to posterior communicating artery aneurysm
64
used in treatment of opioid withdrawal in hospital setting vs rehab
clonidine
| methadone
65
three acetylcholinesterase inhibitor meds and one NMDA receoptor antagonist used for dementia related cognitive impairment
ace - donepezil, rivastigimine, galantamine
nmda - memantine
66
constant tremor in arms that is worse with movement
benign essential tremor, propranolol
67
hypertonia, hyperreflexia, clonus, delayed motor milestones, MRI shows periventricualr leukomalacia, basal ganglia lesions
cerebral palsy
68
progressively worsening severe back pain, mid-thoracic level and wraps around upper abdomen in band like fashion, with weakness, numbness, and tingling in both lower extremities. can also have bowel and bladder incontinence
epidural spinal cord compression, high dose steroids
69
staring spells, preserved muscle tone, short in duration, 3Hz spike and wave discharges. associated with ADHD, anxiety, and depression
childhood absence epilepsy, ethosuximide
70
gradually progessive symptoms that impact memory and language first, while behavioral symptoms become more prominent late in disease course
Alzheimer disease, cholinesterase inhibitors slow disease
71
headache that is different form the past, often with nausea, vomiting, LOC, focal deficits, meningial signs, usually from berry anurysm
SAH, LP definitively excludes SAD if CT is negative
72
loss of pupillary light reaction, vertical gaze paralysis, loss of optokinetic nystamus, and ataxia. often cause headache due to obstructive hydrocephalus
Parinauds syndrome from pineal tumor
73
frequent headaches, rhythmic pulsating sound in ears when he bends over, when standing up his vision dims in both eyes, opthalamic exam shoes peripapillary flame hemorrhages, venous engorgement, and hard exudates
pseudotumor cerebri
74
autosomal dominant disorder with hypopigmented skin lesions "ash leaf spots", shagreen patches, CNS lesions, epilepsy, intellectual disability
tuberous sclerosis complex
75
initially presents as asymmetric weakness in one limb, cramping, then progresses over time to atrophy and fasciculations and bulbar involvement causing fasciculation of face
ALS, riluzole which is a glutamate inhibitor
76
pneumonic for OSA
```
snoring
tired
observed apnea
pressure (htn)
bmi >35
age >50
neck >17
gender male
2 - low
5 - high
```
77
what do you measure to assess muscle weakness in the lungs as it relates to neurological disease that cause difficulty breathing
vital capacity at bedside
78
fever, severe focal back pain, and neurologic deficits
spinal epidural abscess
79
stroke in the non dominant parietal lobe is called what and what cant the patient do?
construction apraxia, copy line drawings, or will get dressed on half the body
80
stroke to the dominant parietal lobe is called what and what cant the person do?
gerstmann syndrome, presents with acalculia, finger apraxia, and left vs right confusion
81
lesions of nondominant temporal lobe cause what
homonymous upper quadrantanopia
82
lesions of the dominant temporal lobe causes what
homonymous upper quadrantanopia and wernickies aphasia
83
carbamazepine causes what
bone marrow suppression
84
think about this in pts with atherosclerotic disease, present with hematochezia, diarrhea, leukocytosis, lactic acidosis. ct shows fat stranding, endoscopy shows edematous and friable mucosa. acute crampy abdominal pain with fecal urgency thats followed by bloody diarrhea
colonic ischemia, bowel rest and abx
85
acute pancreatitis patients that get worse or develop sepsis do what?
CT scan for necrotizing pancreaitis
86
decreased tone or excessive transient relaxations of LES
GERD
87
diffuse abdominal pain in ascities or pt with peritoneal dialysis cath
SBP
rocephin for tx
prophylaxsis give fluoroquinolone
88
how to calculate saag
serum albumin - ascities albumin = number
>1 infectious
<1 pressure
89
what decreases the incidence of mortality in SBP? what if that doesnt work
IV albumin
treat hepatorenal syndrome with octreotide or midodrine
90
when will you see HBV core antibody
window period, (subclinical hepatitis), years after HBV recovery
91
people who dont improve after 2-3 days after acute diverticulitis should get what
CT scan to evaluate for abscess because this would need surgical intervention
92
suboptimal breasstfeeding with signs of dehydration
breastfeeding failure jaundice
93
adequate breastfeeding with normal examination with unconjugated hyperbilirubinemia
breast milk jaundice
94
diabetic patients with recurrent hypoglycemia episodes with sweating during meals, postural dizziness, postprandial fullness, early satiety and constipation
gastroparesis, erythromycin or metoclopramide
95
person with gastric ulcer perforation should get what after a chest xray confirms the diagnosis
IV antibiotics, broad spectrum
96
nonbloody, nonbilious , projectile vomiitng immediately after feeding with the infant that is hungry following the episode of emesis, weight loss and signs of dehydration,?
what is a major risk factor for developing this
infantile hypertrophic pyloric stenosis
macrolides like azithromycin and erythromycin
97
what metabolic derangement do you see with severe pyloric stenosis
hypokalemic, hypochloremic metabolic alkalosis
98
patient has discomfort after eating typically 30-40 minutes after meals, coffee makes it worse, complains of back pain, dry cough, and constipation
GERD, consider screening EGD for barrett esophagus
99
intermittent abdominal pain for 6 months, sharp and located across his mid-abdomen, relieved with sitting upright. post prandial bloating and discomfort. pain gets worse recently. lasts minutes and then resolves. frequent large loose stools that are fatty in nature. multiple hospitalizations in the past. 15lb weight loss over the last 6 months, drinks 4-5 beers daily with some liqour occassionaly. Alk phos is elevated
chronic pancreatitis , pain may be relieved by sitting up or leaning forward.
test of choice is MRCP, alternative would be CT scan
five small frequent meals plus pancreatic enzyme supplementation
100
the presence of air in the distal colon makes the diagnosis of what less likely
complete bowel obstruction
101
what is associated with increased risk of death in a patient that presents with acute pancreatitis
BUN greater that 20
102
pt has bloody bm, urge to defecate followed by blood loss in stool but then self resolves. pts have painless hematochezia that is self liitied
diverticular bleeding,
103
pt tired, bilateral xanthelasmata, elevated alk phos, transamonitis. can also have pruritus, arthritis, hyperpigmented skin, RUQ pain?
what test confirms this
imaging shows fibrosis and obliteration of intrahepatic bile ducts
primary biliary cholangitis, ursodeoxycholic acid
anti-mitochondrial antibody
104
PBC has what issues with bones
osteopenia and osteoporosis
105
diarrhea, mucus discharge, tenesmus after radiation. can be associated with stricture, fistula formation, and rectal bleeding. sigmoidoscopy shows
pale rectal mucosa, serpinginous telangiectasisa, and small area of mucosal hemorrhage
106
high saag is related to what?
| what about low saag?
high pressure aka portal hypertension
cancer or infection
107
if the patient has sensations of food getting stuck on the esophagus or lower chest what is the best test to order
this is esaophageal dysphagia , thest is nasopharyngeal laryngoscopy due to visualization of obstruction/mass
108
angiodysplasia is associated with this
ESRD
109
untreated celiac disease can lead to what in the jejunum
enteropathy associated t-cell lymphoma
110
watery diarrhea and emesis, abdomen is otherwise benign, dehydration
viral gastroenteritis
| give a regular diet and avoid fruit juice and sugar
111
multiple bloody bowel movmeents and severe abdominal pain, what is the diagnosis and what do you have to evaluate for with a KUB
ulcerative colitis, toxic megacolon
112
UC patient with multiple air fluid levels on KUB
toxic megacolon, give glucocorticoids and consult surgery
113
triple and quad therapy for h.pylori
clarithromycin, pantoprazole, amoxicillin
quad - pantoprazole, bismuth, metro, tetracycline
114
pts with GERD over the age of 60 should get what
EDG looking for cancer because they are high risk
115
if a patient has gall stones on imaging and symptoms how are they managed
elective lap choley
116
seen with short bowel syndrome and post choley with daily diarrhea that is water
bile salt induced diarrhea, cholestyramine
117
pleural protein/ serum protgein is >0.5 or pleural LDH/serum LDH >0.6 or pleural LDH >2/3 upper limit of normal of serum LDH
exudative pleural effusion, inflammation due to infection malignancy, connective tissue disease, pulmonary embolism, pancreatitis, post cabg
118
transudative causes of pleural effusion
restrictive pericarditis, nephrotic syndrome, HF, and cirrohsis
119
treatment for decompensated cirrhosis
sodium restriction, lasix, and spironolactone
120
abdominal pain, diarrhea, nausea, vomiting, dizziness, sweating, and dyspnea after gastric sleeve or other gastic surgery
dumping syndrome, start high protein diet
121
pt with progressively increasing lower leg pain over shins, weight loss, with a normal diet and family history of hypothyroidism. pt has hypochromic and microcytic rbc. has iron deficiency and vitamin d deficiency. what is diagnosis and what is the antibody testing
celiacs disease, anti endomysia antibody and anti tissue transglutaminase
122
pt with intermittent dysphagia for months with sensation of food and water getting stuck on chest several seconds after swallowing with chest pain. also has iron deficiency anemia, . manometry shows premature and simultaneous contractions of the distal esophagus
diffuse esophageal spasm, esophageal shows corkscrew pattern treat with CCB or nitrates
123
pt with gastrointestinal hemorrhage and isolated gastric varicies, anemia, thormbocytopenia in the setting of pancreatitis likely has what
splenic vein thrombosis
124
well demarcated lesion of the liver that has peripheral enhancement likely made worse by OCP
hepatic adenoma
>5 surgery
<5 stop OCP
125
epigastric fullness and nausea with no other findings or meds, or history
dyspepsia, get h.pylori testing
126
full term infant with failure to pass meconiu, abdominal distension, poor feeding, bilious emesis, xray shows absense of rectal air and contrast enema shows transition zone
hirschsprung disease, dx with rectal mucosal suction biopsy
127
prevention of esophageal varicies
propranolol
128
enlarged liver, elevated alkaline phasphatase and ggt with hypercalcemia, and hilar adenopathy
hepatic sarcoidosis, steroids
129
pts admitted for variceal bleeding are at increased risk of what and should recieve what to treat it in order to decrease mortality
infection like spontaneous bacterial peritonitis, ceftriaxone 7 days
130
when is one of the few times to get stools studies,
chronic diarrhea
131
inguinal hernia in kids are at increased risk of what
bowel ischemia
132
acute diarrhea with visible blood or mucous
dysentery, rehydration until EHEC is suspected
133
prior to definitive treatment of a toxic thyroid nodule a patient needs what
pretreatment with antithyroid drugs like methimazole to achieve chemical euthryoidism
134
reduced 21 hydroxylase activity causing excess androgen production causing advanced bone age, acne, pubic hair development in young boys with precocious puberty.
girls with have hirsutisim and menstrual irregulaties with elevated 17 hydroxyprogesteron levels on acth stim test
nonclassic congenital adrenal hyperplasia, hydrocortisone
135
all adrenal tumors >4cm or that are functional require this
surgery
136
pt has hypercalcemia and after repeat testing you get PTH
3 things if it is high normal or elevated
if it is suppressed then measure PTHrP and vitamin d. major causes here are
primary or tertiary hyperparathyroidism, family hypercalcemia, lithim
malignancy, granulmatous diseases, thiazides, milk alkali syndrome, thyrotoxicosis, immobilization
137
hypercalcemia of malignancy
decreased PTH with increase PTHrP
decreased everything
decreased PTH and increased vitamin D
SCC, renal/blader, breast
breast, multiple myeloma,
lymphoma
138
weight loss, abdominal pain, amenorrhea, fatigue, weakness, poor appetite, muscle tenderness, decreased axillary and pubic hair, hyperpigmentation, hyponatremia, hyperkalemia, hyperchloreic metabolic acidosis
addisons disease or chronic adrenal insufficiency
139
NPH causes what more so than basal bolus insulin
hypoglycemia
140
first step in evaluating thyroid nodule is what?
when is the only time to do iodine scintigraphy?
TSH level and US
when TSH is low, all the other times do a FNA
141
hot vs cold nodule treatment
hot - treat hyperthyroidism
cold - FNA
142
goiter, HTN, tremor, hyperreflexia, proximal muscle weakness, lig lag, atrial fibrilation
long term complications, 3 in total
hyperthyroidism
arrhythmia, cardiomyopathy, osteoporosis
143
first line drugs for diabetic neuropathy
duloxetine, pregabalin, tricyclic antidepressantsw
144
what does amiodarone do to thyroid function
everything and anything if there is undetectable RAIU then give glucocorticoids because its causes destructive thyroiditis
145
bitemporal hemianopsia and hyperpigmentation following abdominal operation (bilateral adrenalectomy for cushings syndrome)
nelsons syndrome, prevention is with radiation to the pituitary but this causes hypopituitarism
146
episodic headaches, diaphoresis, tachycardia, palpitations, pallor, resistant hypertension, orthostatic hypotension, blurry vision, and weight loss
if suspicition is high what is the next step
pheochromocytoma, do preoperative alpha blockade
abdominal MRI/CT if negative do MIBG scan and if >5cm likely have extra adrenal disease
147
newborn with lethargy, poor feeding, constipation, and hypotonia, born at home with no prenatal screening. these have been progressive and werent present when born
congenital hypothyroidism
148
increased urinary cortisol level, nonsuppressible hight dose dexamethasone suppression test, and undetectable ACTH levels.
weight gain, tired, weak, difficulty climbing the stairs and in combing her hair, HTN, DM, fat distributed in the trunk, face round and plethoric, buffalo hump
cushings syndrome secondary to an adrenal etiology
149
diffuse goiter, afib rvr, bone loss with mild hypercalcemia, vasospasm, and hight output heart failure
thyrotoxicosis, bblocker first then thyroid hormone synthesis
150
young female started developing breasts, no mensturation, growth spurt, fatigue, with no pubic and axillary hair most likely diagnosis
androgen insensitivity syndrome, 46 xy
151
difference between androgen insensitivity syndrome and abnormal mullerian development
androgen insensitivity syndrome looks like a woman and is 46,xy but has no pubic hair development
abnormal mullerian development is female looking 46 xx but has pubic hair development
152
new born girl with dehydration, hypotension, and ambiguous genitalia, hyponatremia, hyperkalemia
what else will be elevated
what is the treatment
congenital adrenal hyperplasia specifically 21 hydraxylase deficiency aka salt wasting syndrome
17 hydroxyprogesterone
tx is hydrocortisone
153
hypertension with hypokalemia and ambiguous genitalia in girls
11b-hydroxylase
154
hypertension, hypokalemia, ambiguous genitalia in boys, absent puberty
17a-hydroxylase
155
mutations of calcium sensing receptor with CCCR > 0.02
familial hypocalciuric hypercalcemia
156
amenorrhea, hypogonadism, decreased LH and FSH but increased alpha subunits in someone with blurry vision
nonfunctioning pituitary adenoma, do surgery
increased alpha subunit is the give away
157
elevated calcium with suppressed PTH, in a person that is quad
parathyroid hormone independent hypercalcemia, due to immobilization give bisphosphonates
158
oral glucose control that has a risk of hypoglycemia
sulfonylureas (glyburide, glipizide, glimepirde)
| meglitinides (nateglinide, repaglinide)
159
major risk factor for untreated acromegaly
cardiovascular disease
160
elevated TSH with normal free thyroxine, irregular menses, depression, lethargy, poor sleep
when to treat?
in women can cause what
subclinical hypothyroidism, Hashimoto
goiter, high TPO antibody
recurrent spontaneous miscarrage
161
with increased levels of estrogen, what do you have to do to levothyroxine?
increase the dose because estrogen increases thyroxine binding globulin
162
is lithium induced hypothyroidism an indication to stop lithium
no, increase levothyroxine
163
delayed puberty in boys due FSH, LH, and testosterone levels
elevated FSH and LH
if they are low to normal
primary hypogonadism likely klinefelter syndrome
secondary hypogonadism any other cause essential, constituational delay, illness, hypothyroidism, kallmann syndrome, craniopharyngioma
164
lethargy, weight loss, nausea, vomiting, constipation, prolonged relaxation time to ankle reflexes, hyponatremia, hypoglycemia, low TSH, low T4, low am cortisol
if cortisol information wasnt available what would this be?
adrenal insufficiency
central hypothyroidism, if you give leveothyroxine during uncorrected adrenal insufficiency you could trigger adrenal crisis
165
amennorrhea can lead to what if untreated
osteoporosis
166
after starting antithyroid medication what do you need to follow to assess how well meds are working
t3 and t4
167
pt has early secondary sexual development
advanced bone age with high LH and then with low LH
normal bone age with isolated breast development and then with isolated pubic hair
precocious puberty
central precocious puberty then peripheral precocious puberty
premature thelarche, premature adrenarche
168
after thyroid cancer treatment how low should you titrate TSH to with meds
low normal to super low depending on the aggresiveness of cancer
169
low T3
euthyroid sick syndrome
170
loss of proprioception, brisk reflexes, loss of ankle jerk, tingling and numbness in distal lower extremities, fatigue, babinski present, romberg in someone who has hashimoto
thyroiditis
pernicious anemia, further autoimmune destruction of parietal cells
171
treating b12 deficiency can cause what
hypokalemia
172
hyperthyroidism with fever, neck pain, tender goiter, ESR elevation often after upper respiratory infection
subacute thyroiditis (de quervain) will have low radioiodine uptake on thyroid scintigraphy, give nsaids and beta blocker
173
sexual dysfuntion, no notournal erections, hx DM, dark complexion with sparse body hair, liver enlarged 1 cm below right costal margin, decreased testicular volume, alk phos elevated, transaminitis, decreased FSH and LH and low testosterone
hereditatary hemochromotosis,
| therapeutic phlebotomy
174
recurrent hypoglycemia or has symptomatic hypoglycemia, low blood glucose, resolution after glucose administration (whipple triad)
low c-peptide
positive hypoglycemic drug assay
everything elevated to normal
exogenous insulin
oral hypoglycemic agent
insulinoma
175
elevated parathyroid hormone, abdominal pain, neuro symptoms, kidney stones, elevated urinary calcium exretion
what if urine calcium was <200
primary hyperparathyroidism, parathyroidectomy
familial hypocalciuric hypercalcemia
176
thyroid symptoms with low RAIU and low thyroglobulin but has hyperthyroidism
exogenous thyrotoxicosis from supplements
177
untreated prolactinoma causes what i women long term
osteoporosis
178
oral diabetes medication that will causes orthopnea, hypoxia, pulmonary edema
pioglitazone
179
uncontrolled hypertension, DM, mood swings, hypokalemia, metabolic alkalosis with evidence of osteopenia
cushings syndrome
180
causes of hypocalcemia pt will have bilateral cataracts and basal ganglia calcifications, tetany, seizures, muscle cramping hyperreflexia,
phos low PTH high
phos High PTH low
phos and PTH high
what if they have all of the above and have dysmorphic features like short stature, round faces, short 4-5 metacarpals
vitamin d deficiency
hypoparathyroidism
seudohypoparathyroidism or hyerphosphatemia
albright hereditary osteodystrophy
181
pt has exertional dyspnea, orthopnea, PND, hemoptysis, pulomonary edema, right sided heart failure and a new murmur opening snap with middiastolic rumble at the apex
mitral stenosis , commonly seen in people with rheumatic heart disease
182
biggest difference between febrile seizures and meningitis
meningitis will have headache, vomiting, bulging fontanelle (increased ICP), nuchal rigidity, petechial rash but most importantly the post ictal state is >10 minutes
183
pt is hypocalcemic after vitamin d therapy what do you add to the treatment regimen
thiazide diuretic
184
if concerned about thyroid cancer when is the only time not to do a FNA
if you see a hyperfunctional hot nodule (TSH will be low)
185
what do you give in sulfonylurea overdose when dextrose doesnt work
octreotide
186
amenorrhea at age <40, hot flashes, increased FSH and decreased estrogen
primary ovarian insufficiency, estrogen therapy (conjugated equine estrogen with medroxyprogesterone acetate
187
back pain, low phos, high alk phos, bariatric surgery, osteomalacia, fractures
vitamin d deficiency, cholecalciferol D3
188
polyuria, polydipsia, hypertensive, hypokalemia
hyperaldosteronism
189
pt has hashimoto's thyroiditis and has acute enlargement of thyroid gland
thyroid lymphoma
190
new cases that develop in a population over a certain period of time
10,000 cases
1000 already have it
two years of follow up 200 people die and 200 people get the disease
whats the early incidence
incidence
100/9000
when calculating incidence do not take into account the number of cases that already existed in the populaton before the counting period.
then in the denominator only include the people at risk of developing disease. so in this part people that have the disease are excluded
191
total number of cases (new and old) measured at a particular point in time
prevalence
192
chronic disease treatments that prolong patient survival do what to prevalence
increase due to accumulation of cases over time, this is usually due to improved quality of care
193
improved diagnostic accuracy does what to incidence and prevalence
increased
194
how do you decreased incidence and prevalence
primary prevention
195
What do second generation antipsychotics cause
Metabolic syndrome and hyperglycemia
196
scaling of the webs of the fingers, wrists, and upper arms
scabies, permethrin
197
colitis with diarrhea, bloody stool, abdominal pain, RUQ pain, fever, liver abscess that is well defined hypoechoic mass in the right hepatic lobe.
entamoeba histolytica, diagnose with stool ova and parasites
tx metronidazole
198
man with UTI symptoms plus perineal discomfort or bladder obstruction
acute bacterial prostatitis
199
difference between coin and button battery on xray
button battery will have double ring
200
when to remove a coin that is swallowed
unknown time of ingestion, or symptomatic or >24 ingestion and lodged
201
when to do parathyroidectomy
pt <50 or has symptomatic hypercalcemia
202
circular discoid plaques, that combine together in places in spots and others as they get bigger will start to clear. typically with flu like prodrome
what is this associated with
erythema multiforme
HSV infection, mycoplasma pneumonia, abx, allopurinol
203
first step with a palpable breast mast if malignancy hasnt been excluded
ultrasound
204
pt has HCC
is AFP high or low or normal
what cells are mutated
high
liver parenchyma
205
brief transiety euphora, lethargy, poor coordination, LOC lasting 15-45 minutes typically seen in children and adolescents with rash around nostrils and mount
inhalant abuse
206
treatment of a cough that has inspiratory whoop, postussive emesis lasting weeks to months
pertussis, azithromycin which is also used as prophylaxsis despite vaccine status
207
when to fix inguinal hernia in children when asymptomatic
1-2 weeks elective surgery
208
pt started on new medication and now has muscle pain and elevated CK what is most likely cause
statin
209
normal PT and prolonged PTT is a sign of what
these are rare in women so if see in them think
hemophilia a (8) and b (9)
aqcuired coagulation inhibior
210
pt has exertional shortness of breath, decrease stamina, small joint pain, HTN, GERD, tachycardia, telangiectasias, heave along lower sternum
what antibody is associated
scleroderma, anti centromere
211
common infection in people with saphenous venectomy
tineas pedia causing cellulitis
212
HTN management in gout
losartan or ccb
213
what electrolyte causes confusion and shortened QT interval, can also lead to nephrogenic SIADH
hyperglycemia
214
how long does it take troponin to raise after STEMI chest pain
2-3 hours
215
aching pain and stiffness that involves shoulders, neck, and or hip girdle that is worse in the morning, pts have difficulty getting dressed, malaise, fatigue, weight loss. muscle strength is intact but range of motion is reduced. inflammatory markers are elevated
plymyalgia rheumatica, steroids which provides symptomatic relief
216
normocytic anemia, hypercalcemia, renal insufficiency, chronic back pain
how do you diagnosis this and what does it show
multiple myeloma
24 hour urine protein electrophoresis shows monoclonal protein
217
soft scrotal mass that decreases while supine and increased with standing or valsalva
what can this cause if not treated
varicocele, gonadal vein ligation or scrotal support in older men
infertility and testicular atrophy
218
infant with noisy breathing and cyanosis during feeding, mouth breather
how do you diagnosis this
choanal atresia (narrowing or obstruction of the posterior nasal passages), needs surgical repain
pass a samll catheter via each nostril, confirm with CT
219
coloboma, heart defects, atresia choanae, growth retardation, genital and ear abnormalities
charge syndrome
220
levels of lead toxicity
>70 severe --> dimercaprol and EDTA
<44 mild - observe and move people from home
between is moderate - DMSA (succimer)
221
indolent onset of fever, dry cough, dyspnea, weight loss in HIV pt
first line diagnostic modality
PCP pneumonia, typically requires blood gas analysis
induced sputum
222
hodgkin lymphoma places you at risk for was
secondary malignancies
223
people with prior MI and LVEF <30% or that have new york heart association class II or III heart failure and LVEF <35% should get what
implantable cardioverter-defibrillator
224
pts with moderate to severe heart failure, LVEF <35% and wide QRS complex should get what
biventricular pacer and cardiac resynchronization
225
most common inherited thrombophilia that is due to resistance of anithrombic effects of protein C
factor V leiden, look for coagulopathy in health person with no risk factors
226
normal RDW is an indication of what
what about increased
thalassemia
iron deficiency
227
nephritis in renal transplant recipient that is immunosuppressed with renal tubular damage and basophilic intranuclear insclusions
BK - virus indueced nephropathy (polyomavirus)
228
muscle pain and weakness associated with elevated CK, AST, ALT, pins and needles sensation, normocytic anemia, mild hyponatremia, HLD, creatinine elvation
hypothyroid myopathy
229
looks like healed grease burn, pruritic, planar, polygonal and purple located on flexor surfaces, lesions can have wickham stiae
lichen planus
230
pts with severe nephrotic syndrome are predisposed to what
thrombotic events typically chronic renal vein thrombi and DVT
231
pt has fever but had joint pain for several days and is now starting to notice a faint, diffuse rash (lace-like) after having son that had the same type of thing earlier in the week. can have red cell aplasia or aplastic crisis
what does this cause to a fetus
parvovirus b19
fetal demise, anemia, hydrops fetalis do ultrasound which will show fluid accumulation, can also do middle cerebral arteyr doppler
if severe do intrauterine blood transfusion
232
most dangerous complication of granulomatosis with polyangitis
diffuse alveolar hemorrhage
233
what medications causes hyperglycemia and metabolic syndrome
clozapine and olanzapine (second generation anti psychotics)
234
neonate with mild cyanosis at birth followed by rapid clinical deterioration on day of life 1 is due to what disease and process.
marked by severe cyanosis, respiratory distress, and cardiogenic shock
hypoplastic left heart syndrome which is a ductal dependent congenital heart defect PFO and PDA, give prostaglandin E1
235
pt has dyspnea, fatigue/weakness, exertional angina, syncope, abdominal pain found to have left parasternal lift and right ventricular heave, tricuspid regurgitation, JVD, ascites, right heart failure
pulmonary hypertension, get transthoracic echocardiography
236
most important factor in OSA
neck circumference
237
growing pains, pathologic fracture, splenomegaly, anemia, thrombocytopenia, FTT, delayed puberty
gaucher disease AR lysosomal storage disorder due to glucocerebrosidase deficiency
238
decompensation after protein feeding
maple syrup urine disease, PKU
239
early childhood with hypoglycemia and hepatomegaly, muscle pain and weakness with no bone pain
Von Gierke Disease, glycogen storage disorder
240
self mutilation, arthritis, immunodeficiency
nucleotide metabolism disorders, Lesch-Nyhan disease, gout, ada deficiency
241
oliogmenorrhea, hyperandrogenism, ultrasound showing enlarged ovaries
PCOS, get glucose tolerance test
242
indications for mitral valve repair
chronic primary valve issue (issue with valve itself)
| LVEF 30-60%
243
purulent monoarthritis, tenosynovitis, dermatitis, mifratory polyarthralgia
disseminated gonococcal infection, ceftriaxone
244
periarticular osteopenia, joint effusions, and symmetric joint space narrowing
RA, cytotoxic medications like methotrexate and hydroxychloroquine
245
eosinophilia and eosinophiluria
atherosclerotic embolism to kidney
246
muddy brown casts
contrast induced nephropathy
247
young female athlete with poorly localized knee pain that is worse with standing from and sitting position after extended periods of time. squatting reproduces the pain
patellofemoral pain syndrome, exercise to strengthen hip and knee muscles
248
effect of the main exposure is mixed with the effect of extraneous factors
confounding bias
249
results from inaccurate estimation of exposure and/or outcome
measurement bias
250
subjects selected for the study are not representative of the study population
selection bias
251
selecting control subjects for a case control study from hospitalized patients
Berkson fallacy
252
patients are sampled from specialized medical centers
referral bias
253
in cohort studies when people are lost to follow up
selection bias
254
incidence of disease is estimated based on prevalence and date becomes skewed by selective survival
prevalence bias or neyman bias
255
bias seen in case control studies
recall bias
256
investigators decision is adversely affected by knowledge of the exposure status
observer bias
257
how do you limit confounding bias
randomization, matching, and stratified analysis
258
this treats confounding and susceptibility bias
randomization
259
how to minimize placebo effect
single blinding
260
how to treat observer bias
double blind
261
how to deal with selective non-compliance
intention to treat approach
262
what to do if patients change treatment groups
use as treated rule
263
wrongfully concluding that there is an association between exposure and disease when there is non
type 1 error, described as alpha and p value (they are the same thing)
264
wrongfully concluding that there is no association between exposure and outcome when there is one
type II error
265
alpha level and beta level (power of the study) are inverse or converse
converse
266
how do you increase B or the power of the study
meta analysis
267
probablity of commiting type II error
1 - B which is probability of detecting an association if it exists in reality
268
error explained by chance and is unpredictable
random error
269
the reliability and reproducibility of measurements is called
precision
270
caused by flows in study design and/or analysis and is not a product of chance
systematic error which compromises the validity of the study
271
cancer patient with hodgkin lymphoma that has progressive shortness of breath with chest pain, recieved chemotherapy and radiation therapy. 2/4 diastolic murmur at left sternal border, large left atrium, EF >60%, diastolic dysfunction, mitral and aortic valves are sclerotic and calcified, aortic regurgitation, ostial narrowing of the right and left main coronaries
what causes dose dependent decline in ejection fration leading to dilated cardiomyopathy
radiation cardiotoxicity
anthracycline chemo
272
pt with frequent RBC transfusions but blood grouping and cross matching cant find a suitable blood match. what is the cause
alloantibodies typically seen in patients with sickle cell anemia or myelodysplasia
273
first step for evaluation of normocytic/normochromic anemia
reticulocyte count which is also the first thing that responds to treatment of anemia resulting in increase in reticulocyte count
274
child with pallor, microcytic anemia, elevated RDW with HbS and HbA in blood, associated with prematurity, lead exposure, exclusive breast feeding after 6 months >24 oz of cows milk per day
iron deficiency anemia although HbS with HbA is also consistent with sickle cell trait which doesnt cause anemia
275
side effect of IVC filters
recurrent DVT
276
when is the only time Rh incompatibility is possible
Rh negative mother and Rh positive father
277
presents with target cells, and appears like iron deficiency anemia but has normal RDW
how do you tell them apart
thalassemia minor, hemoglobin electrophoresis with have incrase HgA2 in b-thalassemia, alpha thalassemia will be normal
278
pt has bleeding, everything is normal except bleeding time is prolonged, what is the next best step. this is typically seen in renal failure
IV desmopressin, release of VIII:von willebrand factor multimers from endothelium.
279
autoimmune destruction of parietal cells and detected by measurement of auto-antibodies against intrinsic factor in someone with macrocytic anemia and normal serum folate but suppresed cobalamin
what would endoscopy show
pernicious anemia - b12 deficiency.
absent rugae in the fundus
280
pt with rash over her ankles that started 2 weeks ago and spread up her knees , exam shows fine petechiae and purpur around her ankles and lower legs, blood smear shows thrombocytopenia, after platelets her thrombocytopenia doesnt improve
antiplatelet antibodies caused by immune thrombocytopenia.
kids only if bleeding give steroids, IVIG, or anti D
adults >30k platelets observe or <30k same as kids
281
isolated thrombocytopenia <100,000
ITP which is platelet destruction by antiplatelet autoantibodies against membrane proteins GPiib/IIIa
282
thrombocytopenia and microangiopathic hemolytic anemia with schistocytes on peripheral smear and ELEVATED LACTATE DEHYDROGENASE, can also have renal failure, fever, and neurological abnormalities
thrombotic thrombocytopenic purpura
283
pt has elevated hemoglobin and you get EPO level
high means what
low means what
chronic hypoxia or cancer like RCC
| polycythemia vera, confirmed with Jak2 mutation,
284
osteomylitis treatment in sickle cell child
clindamycin and ceftriaxone
285
acute chest in sickle cell child
azithromycin and ceftriaxone
286
rapid reversal of warfarin
PCC
287
young child, abdominal mass, constipation, facial flushing, perspiration, weight loss, nontender, fixed mass in right mid abdomen. can cave periorbital ecchymosis (orbital metastases), spinal cord compression (dumbbell tumor), opsoclonus myoclonus syndrome, small round blue cells on cytology with N-myc gene amplification
neuroblastoma
288
unilateral painful abdominal mass with hypertension and hematuria in young children
wilms tumor
289
nasal or oral bleeding, blurry vision, confusion, headache, heart failure, other neurologic problems seen in cancers and vasculitis
hyperviscosity syndrome seen in multiple myeloma and waldenstroms macroglobulinemia (elevated IgM)
290
fatigue, poor exercise tolerance, weight loss, abdominal discomfort, leukocytosis elevated incidentally on CBC
what chromosome abnormality
CML, tyroisine kinase inhibitor
phyladelphia chromosome 9:22 bcl/abl fusion protein
291
most common cause of inherited or hereditary thrombophilia
factor V leiden
292
difference in g6pd and abo incompatibility for timing of onset in newborn
g6pd is 2-3 days negative direct combs test
abo is 24 hours with positive direct combs test
293
highest risk for colorectal cancer
alcohol
294
keratosis pilaris tx
salicylic acid or urea cream
295
what group causes tinea versicolor
malassezia species
296
post viral rash with herald patch followed by smaller pink/tan lesions
pityriasis rosea
297
painless blisters, increased skin fragility typically doral hand, facial hypertrichosis and hyperpigmentation
porphyria cutanea tarda
298
first line for onychomycosis
terbinafine, itraxonazole
299
facial flushing in response to hor or cold temps, emotion, spicy food. reddening of face, erythematous papulses on nose, telangiectasias
papulopustular rosacea, topical metronidazole, clindamycin, or peroxide
300
pea sized nodule in eyelid associated with rosacea
chalazion, optho consult
301
mild to mod plaque psoriasis tx
severe tx
facial tx
topical steroids
methotrexate
tacrolimus
302
treatment for atopic dermatitis
topical glucocorticoids like triamcinolone
303
tinea capitis tx
oral griseofulvin or terbinafine
304
shiny, discrete, intensely pruritc, polygonal shaped violaceous plaques and papules that are most frequent on flexural surfaces
lichen planus, needs biopsy for diagnosis
also associated with hep c
305
treatment for fine wrinkles, hyperpigmentation, reducing AKs, improving brown spots
tretinoin, all trans retinoic acid
306
beefy red papules and plaques with satellite lesions
what if it involves skin folds
contact dermatitis from diaper rash, barrier cream
candida dermatitis, clotrimazle or nystatin cream
307
what antihypertensive can cause sun burns to be worse
HCTZ
308
random areas of hair loss on the scalp that resolve and then return
alopecia areata, corticosteroids intralesional
309
dysuria, postvoid dribbling, dysparenunia, anterior vaginal mass, hematuria, recurrent UTI, stress incontinence . manipulation of urethra will express bloody purulent fluid
urethral diverticulum, dx with MRI or transvaginal US
310
sudden, overwhelming, or frequent need to urinate
urge incontinence, bladder training and antimuscarinic medications
311
constant dribbling of urine, incomplete bladder emptying
overflow incontinence, intermittent cath correct underlying issue
312
bilateral flank pain with gross hematuria following flu like illness 3 days ago, also has CVA tenderness bilaterally
why is this not poststrep glomerulonephritis
igA nephropathy
poststrep glomerulonephritis happens more than 10 days after
313
nighttime urinarly incontinence after age 5
primary nocturanl enuresis, enuresis alarm, desmopressing
314
vasculitis due to immune complex deposition in small and medium size vessels, typically associated with hep C. presents with palpable purpura, weakness, arthralgias, glomerulonephritis, and hypocomplementemia
mixed cryoglobulinemia, treat with viral infection therapy
315
abdominal pain, skin rashes, and joint inflammation in children with no neurologic changes
HSP
316
fever, lymphadenopathy, sore throat, headache, fatigue, myalgia, painful mucocutaneous ulcers, maculopapular rash, leukopenia, thombocytopenia
acute HIV infection
317
babys born to mothers with active Hep b should get vaccine when
at birth
318
flu-like febrile illness with marked myalgias and joint pain (bone break fever) retro-orbital pain, rash, thrombocytopenia, spontaneous bleeding with a positive tourniquet test (causes petechiae)
what bug causes this
dengue fever, supportive care
aedes mosquito
319
pt has palpitations and lightheadedness, has ventricular tachycardia, apical aneurysm. can also have biventricular heart failure, mural thrombosis, fibrosis leading ot conduction abnormalities, toxic megacolon or esophagus
what cases this
chagas disease, trypanosoma cruzi (protazoa)
320
involvement with salt water cuts, pt develops rapidly progressive ceellulitis with hemorrhagic bullae, also associated with raw oysters. can ultimately lead to septic shock quickly
vibrio vulnificus, ceftriaxone and doxycycline
321
three main causes of nec fas
group A strep (pyogenes), staph aureus, clostridium perfringens
322
fever, hypotension, swelling, erythema after a puncture wound. Notably the wound site is more painful to palpation that would be expected
what if there was crepitus on exam
nec fasciitis, broad spectrum
zosyn or carbapenem for group A strep and anaerobes
vancomycin - MRSA
clindamycin to inhibit toxin formation
clostridum perfingens
323
fever,petechiae, IV drug use, holysytolic murmur at apex
what about if they have headache, lethargy, neckstiffness
infective endocarditis
subarachnoid hemorrhage secondary to mycotic aneurysm rupture
324
acute otitis media treatment
first amoxicillin
second - augmentin
pcn allergic - clindamycin or azithromycin
325
initially pt will have erythema migrans, fatigue, headache, myalgia, arthralgia
next with have multiple erythema migrans areas, CN 7 palsy, meningitis, AV block
late can have arthritis, encephalitis, or peripheral neuropathy
lyme disease caused by borrelia burgdorferi
ixodes scapularis, deer tick
326
fever, headache, myalgia, arthralgia, macular and petechial rash, encephalitis, pulmonary edema, bleeding, shock, decreased platelets, sodium, transammonitis
rocky mountain spotted fever, doxycycline
327
abx treatment for young kids pna
amoxicillin
328
fever, sore throat, pseudomembraine and grey patches in throat with cervical lymphadenopathy, myocarditis, kidney disease
diphtheria, corynebacterium, tx is erythromycin or Pen G
329
most common cause of gastroenteritis
norovirus
330
meningitis with very high opening pressures
cryptococcal meningoencephalitis typically seen in HIV, do repeated lumbar munctures until symptoms abate
abx treatment is amphotericin B and flucytosine for >2 weeks until symptoms abate and CSF is sterilized
then high dose oral fluconazole 8 weeks
then low dose fluconazole for 1 year
331
spinal tap looks normal but might have elevated protein
guillain barre syndrome
332
tap has >500 wbc
bacterial meningitis
333
tab has low glucose
tuberculous meningitis
334
tap is just a little of normal in all catergories
viral meningitis
335
sudden sore throat, fever, abdominal pain, headache, with no cough or rhinorrhea or congestion
tonsillar erythema, anterior cervical lymphadenopathy, and palatal petechiase
strep pharyngitis, PCN or amoxicillin
pcn allergy, cephalosporin, azithromycin, or clindamycin
10 day course to prevent rheumatic fever only, others arent prevented by treatment
336
in fetus this causes sensorineural hearing loss, cataracts, and PDA
rubella aka german measles
337
child has cephalocaudal spread of maculopapular rash and a fever, adults get this as well but have arthralgia as well
rubella aka german measles
338
hepatosplenomeagly, purpuric leasions and sensorineural hearing loss in new boorn with periventricular calcifications
what about the same but with intracerebral calcifications
congenital cytomegalovirus, gangciclovir
congenital toxoplasmosis, pyrimethamine, sulfadiazine, spiramycin
339
newborn with skin, eye, mouth vesicles, severe CNS infection
HSV congenital
340
maculopapular skin rash on palsm and soles of newborn with lymphadenopathy, osteitis
syphilis, PCN
341
repeated episodes of jaundice with stressors
gilbert syndrome
342
persistent hyperbilirubinemia despite plasmapheresis and bili-light
cringar-nijar syndrome
343
cough, coryza, conjunctivities and loplic sports, srash starts on the face and spreads down 2 days after symptoms start
measles - rubeola
344
high spiking fevers for 3-5 days and then rash shows up on chest
roseola HHV 6 or 7
345
fever, malaise, headache, anorexia, parotid swelling and orchitis
mumps
346
fever, malaise, followed by vesicles on mouth, palms, and soles
HFM disease - coxsackievirus
347
symptoms begin after 6 months with repeated encapsulated organisms like pseudomonas, s pneumoniae, haemophilus, can have absent tonsils
will have absent b cells
bruton agammaglobulinemia, ivig and abx
348
all ig levels are low, decreased plasma cells, pyogenin upper and lower respiratory infections, increased risk of lymphom
common variable immunodeficieny, ivig
349
recurrent respiratory and gi infections, anaphylactic reaction to ivig infusion
igA deficiency
350
absence of CD 40 ligand, high levels of IgM, recurrent sinopulmonary infections
hyper IgM syndrome, abx and ivig
351
infected with everything, xray shows absent thymic shadow
thymic aplasia (digeorge syndroem) needs bone marrow transplantation and ivig
352
increase risk of malignancies of the blood and stomach, preogressive cerebellar ataxia, oculocutaneous telangiectasia
ataxia-telangiectasia, ivig
353
lack of b and t cells, frequent bacterial infections, chronic candidiasis
severe combined immunodeficiency aka bubble boy disease, bone marrow transplantation and IVIG
354
increase in IgE and A, decrease IgM, thrombocytopenia, bleeding, eczema, purpura
wiskott aldrich syndrome, bone marrow transplant
355
clenched overlapping hands, cardiac defects, rocker-bottom feet
trisomy 18 - edwards
356
cns malformations, polydactlyly, deafness, sloping forehead,
trisomy 13 pitau syndrome
357
congenital heart disease, thymic hypoplasia, absent parathyroid glands, hypocalcemia
digeorge syndrome
358
short female with shield chest, wide nipples, webbe neck, horseshow kidney, coarctation, hearing loss, infertility
turner syndrome, 45 XO
359
macroorchidism, tall stature ro girls with learning disability form cgg repeat in fmr1 gene
fragile x syndrome
360
hypogonadism, testicular atrophy, tall with long extremities
klinefelter 47 xxy, increase risk of breast cancer
361
cafe au lait macules, freckling inguinal and axillary folds, lisch nodules, optic glimoa, acoliosis and arthosis
NF 1
362
sensorineural hearing loss for bilateral acoustic schwannomas
NF2, peripheral nerve sheath cell
363
inhibits bacterial cell wall synthesis
```
pcn
cephalosporin
carbapenems
monobactam/aztremonam
vancyomycin
```
364
inhibits dna synthesis
fluoroquinalones, metronidazole, bactrim
365
inhibit bacterial protein syntesis
```
macrolides/azitho
aminoglycocides/gent or tobramycin
clindamycin
linezolid
tetracyclines
most of these end with mycin
```
