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212 Cards in this Set

  • Front
  • Back
What part of the bone do destructive processes affect children?
Epiphysis - Legg Calve Perthis Disease (idiopathic avascular necrosis)

Metaphysis - osteonecrosis w/Staph Aureus

Osteosarcoma - Codman's triangle of the metaphysis
Unilateral, intermittent bloody nipple discharge in perimenopausal woman?
Intraductal papilloma, benign
Anterior shoulder dislocation - mechanism and neurologic deficits?
Forced abduction and external rotation

damage to axillary nerve - paralysis of deltoid and teres minor, paresthesia of lateral upper arm
Midshaft humeral fracture - neurologic deficit?
Radial nerve

(radial nerve injury sx also occur with improperly fitted crutches)
Medial epicondyle fracture - neurlogic deficits?
Ulnar nerve - ulnar claw hand and sensory loss of dorsal and ventral medial hand, paralysis of most of intrinsic muscles of the hand
Knee injury with "pop" and swelling that develops 12-24h later?
meniscal injury / tear
Pain in runner w/reproduction on squeezine 3rd & 4th digits?
Morton's neuroma

mechanically induced neuropathic degeneration
Tarsal tunnel syndrome?
compression of tibial nerve as passes through ankle

usually results from fracture of bones around ankle

burning, numbness, aching of distal plantar surface of foot/toes, sometimes radiating up calf
How does hyperventilation change cerebral BP?
Lowers cerebral ICP by washing out CO2, causing vasoconstriction and decreased cerebral blood flow
Nasopharyngeal carcinoma in mediterranean or asian person caused by?
EBV
What happens in pulmonary contusion with intravascular expansion (volume repletion)?
worsening hypoxemia
What vaccines should patients undergoing splenectomy receive?
S. pneumoniae

N. meningitidis

H. influenza
Why would a ruptured AAA cause gross hematuria?
Aorta can rupture into retroperitoneum and cause aorto-caval fistula, resulting in venous stasis of lower organs such as bladder, distended and fragile bladder veins can then rupture resulting in hematuria
What is the order of MCC for otitis media in children?
S. pneumonia (40%)

H. influenza (25-30%)

Moraxella Cataralis (10-15%)

~30% viruses, ~5% other bacteria
Is a pediatric VSD murmur more concerning if loud or soft?
Soft is more concerning b/c corresponds to larger defect

a loud harsh murmur with other nl findings and no symptoms can be surveiled, 40% will close spontaneously
What are histologic findings and pathologic mechanism for Reye syndrome? What is tx?
liver fatty vacuolization w/o inflammation

due to diffuse mitochondrial injury in children < 15 given ASA for fever 2/2 viral syndrome

condition aka "fatty liver w/encephalopathy"

tx - glucose w/FFP and mannitol

mortality 30-35%
How are chlamydial and gonnhococcal conjunctivitis differentiated?
Gonnhococcal - occurs at 2-5 days, more purulent discharge, more severe complications

Chlamydial - occurs at 5-15 days, less purulent, less severe complications
What is most common complication of sickle cell trait? What is hemoglobin electrophoresis compisition?
Painless, microscopic hematuria

~<40% HbS, <2% HbF
What is the appearance, agent, and treatment for impetigo?
multiple vesicopustules on exposed face and upper extremities which eventually rupture and are golden-yellow and crusted

group-A beta hemolytic strept or staph aureus

tx with topical mupirocin
What is Legg-Calve-Perthes disease?
syndrome of idiopathic avascular necrosis of the hip affecting boys 5-7 years old
What type of immunodeficiency presents at 6 months? What kind of infections prone to?
abnormal B-cell maturation

prone to recurrent sinopulmonary infection w/encapsulated H. influ and s. pneumo, and to GI infect b/c IgA protects gut
What type of immune deficiency predisposes children to abscesses?
chronic granulomatous disease (CGD)

impaired oxidated mtabolism (NADPH-oxidase system defect)

catalase + organisms like aspergillus and staph
What kind of infections seen in complement deficiency?
Gonococcal and meningococcal

also some h. influ and s. pneumo
What kind of infections are ppl w/thymic hypoplasia prone to?
T-cell deficiency --> viral and fungal infections
What is adenosine deaminase deficiency?
Severe combined immunodeficiency (SCID)

both B and T cell deficiency, predisposes to viral, fungal, and bacteria
What cranial nerves pass through cavernous sinus (and so are affected in cav sinus thrombosis)?
CN III, IV, V, VI
What is the MCC of nephrotic syndrome in children? Tx?
Minimal change disease (80%)

empiric steroids (prednisone), no renal biopsy required
What is patellofemoral syndrome - hx and findings?
overuse injury common in runners

pain worse going down stairs or hills

pain localized to patella
What is Osgood-Schlatter disease - hx and findings?
knee pain in adolescent male athletes (13-14 males
10-11 females)

traction apophysitis of tibial tubercle where patellar tendon inserts

worsened by running jumping kneeling, improved by rest

pain and edema over tibial tubercle

pain reproduced by extension against resistance
What is Diamond-Blackfan syndrome?
aka congenital hypoplastic anemia

macrocytic anemia, low retic count

congenital abnormalities in ~50% (short stature, webbed neck, etc)

distinguished from megaloblastic (also macrocytic) anemia b/c no hypersegmentation of nucleus in neutrophils

tx is mainly corticosteroids, transfusion if unresponsive
What is lesch-nyhan syndrome - presentation and pathophys?
self-mutilation ~6 months w/hypotonia & persistent vomiting

deficiency in hypoxanthine-guanine phosphoribosyl transferase (HPRT), part of purine metabolism, causing uric acid to deposit in different tissues

tx w/allopurinal and fluids to reduce uric acid
What is treatment for cat bite?
Augmentin x5 days (covers anaerobes, which pasturella is)
1 year old child w/thrombocytopenia, eczema, and recurrent bacterial infections?
Wiskott-Aldrich syndrome

X-linked disorder

decreased platelet production, w/small platelets

clinical impact can be highly variable
What test can be done to differentiate complex partial from typical absence seizures?
hyperventilation while on EEG should produce a generalized 3Hz spike and wave pattern if this was typical absence seizures

also history, absence seizures last seconds and have no post-ictal state, complex partial seizures last minutes and do have post-ictal state
What are the 3 types of renal tubular acidosis?
Type 1 (distal RTA) - defect in hydrogen ion secretion, genetic disorder, paretns w/nephrolithiasis

Type 2 - decreased bicarb reabsorption in proximal tubule (Fanconi syndrome is common cause)

Type 4 - defect in Na/K exchange in distal tubule, hyperkalemia, hyperchloremic acidosis (obstructive uropathy(
When are howell jolly bodies seen, what are they?
in Asplenia

they are nuclear remnants of RBC which are generally removed by functional spleen
When are Heinz bodies seen?
in patients w/hemolysis due to G6PD deficiency and thalassemia

they are aggregates of denatured hemoglobin

phagocytes while extract this precipitate creating bite cells
When are helmet cells ceen?
In traumatic hemolytic conditions such as DIC, HUS, and TTP

they are fragmented RBC
When is basophilic stippling seen?
in thalassemias, lead and heavy metal poisoning

they are ribosomal precipitates which appear as blue granules of various sizes throughout cytoplasm of RBC
Child with precocious puberty, café au lait spots, and multiple bone defects - syndrome? Pathophys?
McCune-Albright syndrome

recently attributed to a defect in G-prtn cAMP-kinase fxn in affected tissue, resulting in autonomous activity

associated w/other endocrine disorders - hyperthyroid, prolactin, or GH secretining pituitary adenomas

3 P's - Precocious puberty, Pigmentation, Polyostotic fibrous dysplasia
How long prior to sun exposure should sun screen be applied?
15-60 minutes prior to exposure

sun avoidance is best method of photo-protection
What is Turcot syndrome?
association between brain tumors (medulloblastomas and gliomas) and FAP or HNPCC

FAP - medulloblastomas

HNPCC - gliomas

(typically)
What are the APGAR categories and how are they scored?
Appearance (color)
Pulse (< or > 100)
Grimace/reaction
Activity/mm tone
Respiration (reg or irreg)

0 = not there, 2 = fully there, 1 = between
What syndrome is marfan features + thromboembolic events + mental retardation? What is treatment?
Homocystinuria

autosomal recessive, cystathionine synthase deficiency

Treatment - high doses Vit B6
Gram positive diplococci
streptococcus pneumoniae
Gram positive cocci in clusters
Staphylococcus
Gram negative cocci
Neisseria
Gram positive rods
Listeria and Bacillus
Gram negative rods
Pseudomonas, Haemophilus, Klebsiella, Legionella
What is the difference between early adrenarche and pubarche?
Early adrenarche is development of axillary hair by age 6, not clinically significant, caused by activation of adrenals

Early pubarche is development of pubic hair before age of 8, in ~50% of cases involves CNS pathology
Child w/umbilicated vesicles over erythematous skin following treatment for atopic dermatitis?
Eczema herpeticum

associated with healing atopic dermatitis lesions after exposure to HSV

can be lifethreatening, tx w/acyclovir
What distribution is atopic dermatitis seen in infants?
face, scalp, and extensor surfaces of the extremities

erythematous excoriated papules and plaques, may weeb and become secondarily impetiginized
What is klumpke palsy?
Brachial palsy in newborns following excessive traction on arm

hand paralysis, ipsilateral Horner's syndrome (ptosis and miosis)

2/2 injury of CN 7 & 8, and 1st thoracic nn
What is pathophysiology underlying increased bleeding seen in CF kids?
Factor VII deficiency, resulting from impaired uptake of fat-soluble vitamin K
what is preferred antibiotic choice for pneumonia in CF child? Adult?
Pipercillin and tobramycin (aminoglycoside and anti-pseudomonal penicillin)

other choices: ceftazidime or cefepime and an aminoglycoside

in adult a fluoroquinolone may be used instead of aminoglycoside
Is an LP before antibiotics ever indicated for meningitis?
Yes, in children
What kind of drug is used to treat each seizure?

Absence
Partial
Primary Generalized
Absence - valproate or ethosuximide

Partial - phenytoin, alternative phenobarbital

Primary generalized - phenobarbital is alternative agent in primary generalized and partial
Kawasaki disease requires 4 of 5 criteria, what are they?
Fever > 39 for 5 days AND

1. extremity changes - erythema, edema, or desquamation
2. conjunctivities (bilateral, nonpurulent)
3. rash on trunk
4. cervical lymphadenopathy > 1.5cm, typically unilateral
5. oral changes including erythema, fissured lips, or strawberry tongue
In kids, medulloblastoma are how common and located where?
2nd most common tmor of posterior fossa in children

~90% arise from the vermis
In kids, where is pinealoma located and what symptoms arise?
dorsal aspect of midbrain

endocrine syndrome
intracranial hypertension
parinaud's sign (paralysis of vertical gaze)
Collier's sign (retraction of eyelid)
In kids, where do craniopharyngeomas arise and what are sx?
in the sella turcica

visual field defects
endocrine syndrome

seen as a cystic structure w/calcificaitons
What is the most common histology for pediatric supratentorial tumors? Infratentorial?
Astrocytoma for both
In children, what is most common neurovascular injury seen with supracondylar fracture?
brachial artery entrapment
What are typical lab findings in hemophilia?
prolonged PTT
normal prothrombin time
normal bleeding time
normal fibrinogen level

low serum factor VIII
Treatment for lyme disease in children?
Amoxicillin (equal efficacy to doxycycline)

doxycycline contraindicated in kids < 8 yo

doxy often used b/c covers for potential coexisting anaplasma phagocytophilum)

cefuroxime also effective

IV ceftriaxone if sx of heart block
What should be on the differential when considering scarlet fever?
Kawasaki's disease (lymphadenopathy, changes to buccal mucosa, ad rash)

would also need changes in peripheral extremities OR bilateral conjunctival injection
Abx choice for kid w/infected lymph node? (what organisms)
Dicloxacillin (or cephalexin or clindamycin)

caused by streptococcal OR staphylococcal

(amoxicillin won't cover staph)
What stimulates prolactin production? Inhibits?
Stimulated by serotonin and TRH

Inhibited by dopamine
Congenital anomalies associated w/isoretinoin?
craniofacial dysmorphism, heart defects, deafness
What is interstitial cystitis? What characteristics?
Triad - urinary urgency, frequency, chronic pelvic pain (in absence of other disease)

exacerbated by: sex, full bladder, exercise, spicy food, certain beverages

relieved by: voiding

cystoscopy - submucosal petechiae or ulcerations
What is fetal hydantoin syndrome? What causes?
caused by anticonvulsants during development (phenytoin, carbamazepine)

midfacial hypoplasia
microcephaly
cleft lip & palate
digital hypoplasia
hirsutism
developmental delay
What is the main difference between bulimia and anorexia?
Anorexia are severely underweight (<85% expected, BMI < 17) and often have 2ndary amenorrhea

both have distored body image and can have purging
What are the possible medical complications of tx severe anorexia?
Bradycardia

refeeding syndrome
Identify the following defense mechanisms as Immature, Neurotic, or Mature:

Idealization, Rationalization, Denial, Introjection, Altruism, Projection, Dissociation, Somatization, Suppresion, Humor, Reaction formation, Acting out, Represion, Sublimation, Denial, Projection, Displacement, Dissociation, Suppresion
Immature: -- Idealization, Projection, Somatization, Denial, Acting out

Neurotic -- Displacement, dissociation, rationalization, reaction formation, repression

Mature -- Altruism, sublimation, suppression, introjection, humor
When evaluating hirsutism in pregnancy, what is associated with the following findings on ultrasound?

No ovarian mass

Bilateral cystic ovarian masses

Bilateral solid ovarian masses

Unilateral solid ovarian masses
No ovarian mass - abdominal CT to r/o adrenal mass

Bilateral cystic - theca lutein cysts (r/o high beta-HCG states)

Bilateral solid - mostly pregnancy luteoma (benign)

Unilateral solid - surgery to r/o malignancy
What are the differences between gastroschisis and omphalocele?
Gastroschisis
-bowel protrudes thru defect on RIGHT SIDE of umbilical cord
-not covered by membrane
-looks angry and matted
-not typically associated w/other abnlities

Omphalocele
-intra-abdominal contents protrude thru umbilical ring (small bowel, sometimes large and liver)
-covered by amnioperitoneal membrane
-can be assoc w/other abnl (heart, kidney)
What is tx choice for acute stress disorder?
CBT

short term benzos (< 2 wks only) for severe distress
What is tx for Generalized anxiety disorder?
CBT, or

SSRI/SNRI
What is tx for panic disorder?
CBT

SSRI/SNRI or both

short-term benzodiazepine for severe distress
What is tx for PTSD?
CBT

or SSRI/SNRI or both
What is tx for OCD?
CBT

or SSRI/SNRI or both
What is tx for specific phobia?
CBT - first line

SSRI/SNRI - freq exposure to stimulus & CBT not available

Benzodiazepine - infreq exposure to stimulus & CBT not available
What is tx for social anxiety?
CBT or SSRI/SNRI - for generalized (Freq) form

Benzo - infreq (nongeneralized) occurrence
What is breaking bad news mneumonic?
SPIKES

Set up situation

Perception, assess family's

Invitation, obtain

Knowledge, give w/information

Empathetic statements

Strategy and summary
What should you do about rest of series if kid has reaction to DTaP?
Administer diphtheria and tetanus toxoids

avoid pertussis component (which majority of rxns are attributable to)
What tests are positive for lupus? Pts w/lupus have what common false positive test?
anti-smith antibodies and/or anti-double stranded DNA antibodies
-specific and confirmatory for lupus

frequent false positive RPR
Ashkenazi Jew adolescent w/chronic fatigue, easy bruisability, bone pain, pathologic fractures?
typer 1 Gauchers

MCC lysosomal storage disease

deficient activity of acid beta-GLUCOSIDASE (lysosomal enzyme)

anemia, thrombocytopenia, pathologic fractures

dx w/xray - Erlenmeyer flask deformity, bone marrow studies - wrinked paper apperance
Bone marrow study - cells w/ "wrinkled paper" appearance
Gaucher's disease

deficient acid beta-glucosidase
Failure to thrive, hepatosplenomegaly, rapidly progressive neurodegenerative course w/death by age 2-3?
Nieman-pick disease

A & B result from deficient activity of sphingomyelinase
Hepatosplenomegaly, skeletal abnlities (anterior beaking of vertebrae, enlargement of sella turcica, thickening of calvarium)?
GM1 gangliosidase

deficient activity of beta-galactosidase
Cherry red spot in retina + neurologic symptoms w/hepatosplenomegaly?
GM2 gangliosidoses - Tay Sach's and Sandhoff's

deficiency of hexosaminidase activity

lysosomal accumulation of GM2 gangliosides, particularly in CNS
2 drugs for tx of Tourette?
typical antipsychotics - haloperidol or pimozide
What are the genetic manifestations of Fanconi's anemia?
Bone marrow - aplastic anemia and progressive bone marrow failure

Appearance - short stature, microcephaly, abnormal thumbs, hypogonadism

skin - hypopigmented/hyperpigmented areas, café au lait spots, large freckles

Eyes/ears - strabismus, low-set ears, middle ear abnlities (hemorrhage, incomplete development, chronic infections, deafness)


Autosomal recessive or X-linked

mostly dx by 16 yo, numerous DNA repair genes implicated
In cases of preterm, premature rupture of membranes, what dates indicate glucocorticoids should be given?
Before 32 weeks give corticosteroids

Many centers give steroids between 32-34 weeks as well

Typically not given after 34 weeks
What ion shifts does aldosterone cause in kidneys?
acts on distal tubules to increase Na reabsorption, and secrete K and H ions
What ECG findings are most specific for digitalis toxicity?
Atrial tachycardia with AV block

dig can increase ectopy in atria or ventricles, can lead to atrial tachy

dig can also increase vagal tone and decrease conduction thru AV node

rare for these to occur together, so specific for digitalis
What medications should be withheld for 48 hours preceding cardiac stress testing?
Antianginal agents

beta blockers, calcium channel blockers, nitrates

these meds reduce the extend and severity of ischemia during exercise stress testing
What is the biggest risk factor for stroke (aside from prior stroke)?
Hypertension - ~4x risk

greater risk than smoking or diabetes
What is the most common form of glomerulopathy associated with HIV?
collapsing focal and segmental glomerulosclerosis
What organism most likely causes cavitating lung nodules on radiography in an IV drug user?
staph aureus - 2/2 tricuspid valve endocarditis w/septic embolism to lungs

HIV increases risk of staph aureus bacteremia
Young male with elevated beta-HCG and AFP?
nonseminomatous germ cell tumor

seminoma will have elevated beta-HCG, but not AFP
What is the differential for an anterior mediastinal mass in young patient?
"4 Ts"

thymoma, teratoma (& other germ cell tumors), thyroid neoplasm, and terrible lymphoma
Characterize cervical secretions by phase of menstrual cycle (ovulatory, pre, post)?
Ovulatory phase - cervical mucus profuse, clear, thin, will stretch to ~6 cm, exhibit ferning on slide

Pre/post phase - scant, opaque, and thick mucus
What test can differentiate between hereditary spherocytosis and autoimmune hemolytic anemia?
Direct coombs

positive - AIHA

negative - hereditary spherocytosis

both conditions do have spherocytes w/o central pallor (confusing!)
Hepatocytes that stain with periodic acid-Schiff (PAST) rxn and resist digestion by diastase?
Alpha-1 antitrypsin
ALS involves upper motor neurons or lower? What are sx?
both

UMN - spasticity, bulbar sx, hyperreflexia

LMN - fasciculations
How is gout treated w/prophylaxis and acutely?
Prophylaxis - allopurinol (xanthine oxidase inhibitor) and probenecid (uricosuric drug)

acutely - colchicine, NSAIDs, steroids
HIV patients with very low CD4 counts need abx prophylaxis against respiratory infection, what count, what drug, what infection is particularly likely?
CD4 < 50

Azithromycin

Mycobacterium avium complex
What cancer can be correlated with B12 deficiency?
Gastric cancer

pernicious anemia, autimmune d/o w/anti-intrinsic factor

atrophic gastritis increases risk of intestinal-type gastric cancer and gastric carcinoid tumors by 2-3x
What monoarthritis can occur with hyperparathyroidism?
Pseudogout - rhomboid shaped crystal with positive birefringence
What vitamin deficiency causes alopecia, abnormal taste, bullous pustulous lesions surrounding body orificies and/or extremities, and impaired wound healing?
Zinc deficiency

found in animal prtn, whole grains, beans, nuts

digested primarily in the jejunum
Bullous skin rash that began in mouth, middle aged otherwise no previous problems person?
Pemphigus vulgaris

IgG deposits intracellularly in epidermis

autoantibodies against desmoglein, an adhesion molecule

tx w/steroids, may use azathiprine w/prednisone and methotrexate
How are foot ulcers classified? (Grade 0-5)
Grade 0 - high risk, no ulcer

Grade 1 - superficial ulcer, full skin thickness, no underlying tissue

Grade 2 - penetrating to ligament/muscle, no bone involved, no abscess

Grade 3 - deep ulcer w/cellulitis, abscess, or osteomyelitis

Grade 4 - localized gangrene

Grade 5 - extensive gangrene of whole foot
Kid w/polyarthritis, carditis, chorea, sub-q nodules, and erythema marginatum following illness?
Rheumatic fever

these are the 5 major jones criteria
What is cervical mucopurulent discharge most likely resultant from? What STD do OCPs predispose to?
Chlamydia - mucopurulent discharge

N. gonorrhoeae is less common cause, but should be excluded

OCPs cause cervical ectopy which may predispose to chlamydia trachomatis
34 wk pregnant lady in MVC, becomes hypotensive, what is more likely abrupted placenta or uterine rupture? How could you tell on exam?
Uterine rupture likely to cause worse hypotension

On abdominal exam may feel fetal limbs (irregular contour of abdomen), will not be able to feel presenting part of fetus on pelvic exam
In TCA overdose, what should be administered, and what complications does this prevent?
Sodium bicarbonate

improves systolic BP (the major cause of mortality is hypotension)

narrows QRS complex

decreases incidence of ventricular arrhythmia
What is the formula used to assess for respiratory compensation in metabolic alkalosis? For metabolic acidosis?
Alkalosis: PaCO2 expected = (0.9 x bicarbonates) + 16 +/- 2

Acidosis - Winter's Formula: PaCO2 expected = (1.5 x bicarbonates) + 8 +/- 2
What pharmacotherapy is indicated for someone with hypterophic cardiomyopathy (dynamic outflow obstruction)?
Beta blockers

this increases ventricular volumes and so decreases obstruction, by decreasing rate and thus allowing more diastolic filling
What renal disease is characterized by dense deposits w/in glomerular basement membrane w/immunofluorescence positive for C3, not immunoglobulins? What is mechanism?
Membranoproliferative glomerulonephritis, type 2

persistent activation of alternative complement pathway

caused by IgG antibodies (termed C3 nephritic factor) directed against C3 convertase of alternative complement pathway, leading to persistent complement activation & kidney damage
How can HPV genital warts be treated in the office?
with trichloroacetic acid or podphyllin
HIV patient with eye infection, how do you differentiate between CMV vs HSV?
HSV - painful, b/l vision loss, widespread pale peripheral retinal lesions and central necrosis of retina, marked keratitis

CMV - painless, more common, fluffy or granular retinal lesions near retinal vessels, associated hemorrhages, does NOT cause initial conjunctivitis or keratitis
Which rash has tense bullae and urticarial plaques? Oral involvement? Immunofluorescence findings?
Bullous pemphigoid

pruritis is common

autoimmune in elderly person, often precipitating medication

NO mucous membrane involvement

caused by IgG autoantibodies against hemidesmosome and basement membrane zone, activates complement and inflamm mediators

immunofluorescence shows IgG and C3 deposits linearly along basement membrane zone
What lecithin/sphingomyelin ratio is cutoff point?
< 2.0 is concerning for fetal lung prematurity
What is a normal amniotic fluid index?
25-May
What are the components of CREST syndrome?
Calcinosis cutis
Raynauds
Esophageal dysmotility
Sclerodactyly
Telangectasias
Wisconsin adult male w/fever, night sweats, productive cough, weight loss, skin lesions, and lytic bone lesions?
Blastomycosis
Where is the most common foci for ectopic origin of signals in atrial fibrillation?
Pulmonary veins

tissue has diff electrical properties than surrounding atrial myocytes, prone to ectopic electrical foci
What are the components of the quad screen for downs? Are the levels increased or decreased? What does newer screening utilize?
beta-HCG (elevated)
maternal AFP (decreased)
estriol (decreased)
Inhibin A (elevated)

newer tests: PAPP-A (pregnancy associated plasma protein A), beta-hCG, and ultrasound measurement of fetal nuchal translucency
What is the prodrome for measles? What does the ensuing rash look like?
3 C's: coryza, conjunctivitis, cough, ~10 days

rash is erythematous maculopapular, initially on face and spreads to trunk and extremities
Knee morning stiffness of what duration is suggestive of OA vs RA?
>30 minutes suggests RA

~10 minutes suggests OA
What are treatment indications for carotid artery stenosis based on % stenosis?
if < 50 % - ASA and observe

if symptomatic
-70-99%: Carotid endarterectomy if good surgical candidate, if not then carotid angioplasty
-CEA also considered for pts w/50-69%

Asymptomatic
-CEA beneficial if stenosis 60-99%, most benefit if > 80%
-Carotid angioplasty is NOT beneficial in asymptomatic
What electrolyte and metabolic abnormalities are side effects of thiazide diuretics?
Hyponatremia
Hypokalemia
Hypercalcemia

Hyperglycemia
Unfavorable lipid metabolism effects

Uric acid retention - gout
Proximal muscle weakness? (difficulty stairs, rising chair, combing hair)

how differentiate from other similar dz?

what do mm biopsy show?
Polymyositis

-inflammatory mm dz unknown etiology
-dx w/mm biopsy

spares mm of mastication, but dysphagia can develop

differentiate from Dermatomyositis b/c no skin findings

biopsy shows mononuclear infiltrate surrounding necrotic and regenerating mm fibers
Cupping of optic discs with loss of peripheral vision?
Open angle glaucoma

african american, slow onset, high intraocular pressure

tx w/beta-blockers (timolol) eye drops
Formula for corrected calcium based on albumin?
Correced Calcium = measured calcium + [0.8 * (4.0 - measured albumin)]

or, ~ 0.8 mg calcium for ever 1 mg albumin
What are recommendations for MMR vaccine in HIV patients?
Give MMR vaccine to HIV patients with CD4 > 200, and NO prior aids defining illnesses

MMR does have live components, but is worthwhile b/c measels is such a high risk disease in HIV positive patients
What vaccines are contraindicated in HIV patients?
live vaccines

BCG
anthrax
oral typhoid
intranasal influenza
oral polia
yellow fever

if CD4 < 200 then MMR also
What nerve innervates mm of anterior compartment of thigh? Which mm are these?
Femoral nerve

quadriceps, sartorius, pectineus

responsible for knee extension and hip flexion

also does sensation to anterior thigh and medial leg (via saphenous branch)
How can you differentiate between fetal and maternal causes of intrauterine growth restriction?
Symmetric growth restriction (head and abdomen, etc) - fetal factors

Asymmetric - maternal factors (head and body may be lagging by different amounts)
Ectopic ACTH production is most commonly associated with what 2 things?
small cell lung cancer

carcinoid (bronchial, pancreatic, thymus)
How do ACE inhibitors and NSAIDs affect kidney blood flow specifically?
Normally, angiotensin constricts glomerular efferent arterioles

prostaglandins dilate glomerular afferent arteriole

this maintains GFR

these meds blunt this
When ordering prolactin level for secondary amenorrhea workup, what other lab should you order to interpret this with?
TSH to evaluate for the effects hypothyroidism has on prolactin

(posited that hyper secretion of TRH can cause increased secretion of prolactin)
What characteristic deficits are present for:

Brainstem lesions?
thalamus or cortex lesions?

cortical lesions?
Brainstem - CNs and sensory loss of 1/2 of the face, and contralateral half of body

Thalamus/cortex - sensory loss of one half of face, and SAME half of body

cortical lesions - findings specific to cerebral cortex (aphasia, neglect, abnl graphesthesia, stereognosis)
What is the medial medullary syndrome? Caused by?
caused by occlusion of vertebral arter, one or both branches

contralateral paralysis of arm and leg
contralateral loss of tactile, vibrator, and position sense
and tongue deviation to injured side

so, limbs both sensory and motor are down on contralateral side, but tongue motor is down on ipsilateral side
What is lateral midpontine syndrome? Medial midpontine syndrome?
lesion of lateral pons

impaired sensory and motor function of CN V, with accompanying limb ataxia

lesion of medial pons

ipsilateral limb ataxia, contralateral eye deviation, paralysis of face, arm, and leg

impairment of touch and position sense is variable
What is Wallenberg syndrome?
lesion of lateral medulla

ipsilateral Horner syndrome
loss of pain and temp sensation of face
weakness of palate, pharynx, and vocal cords
cerebellar ataxia

loss of pain and temp sensation of contralateral body
Which of the regional fungal infections is associated with skin lesions?
Blastomycosis

endemic in south-central and north-central US

affects lungs, skin, bones, joints, prostate

cutaneous dz either verrucous or ulcerative - can become heaped up and warty


Coccidioids can have erythema multiforme and erythema nodosum
What regions are what fungal microbes found?
Blastomycosis - south central and north central US

Histoplasmosis - southeastern, mid-atlantic, and central US

Coccidioides - southwestern US, Central and South America

has cutaneous findings of erythema multiforme and erythema nodosum
Honeycomb pattern of lungs on CXR?
Idiopathic pulmonary fibrosis

restrictive pattern with perfusion-ventilation mismatch
What diseases have low leukocyte alkaline phosphatase?
Chronic myelogenous leukemia

Hypophosphatemia

Paroxysmal nocturnal hemoglobinuria
What is the most common malignancy in asbestosis patients?
bronchogenic carcinoma

also causes peritoneal as well as pleural mesothelioma, but bronchogenic carcinoma is more likely
What vitamin should be given in the setting of DVT with elevated homocysteine?
Pyridoxine (Vitamin B6) and folate
-this is cofactor for cystathionine beta-synthase, which metabolizes homocysteine into cystathionine

B12 if deficiency is documented
In HIV patients, when is PPD positive? What is tx?
PPD positive if > 5 mm

chemoprophylaxis is Isoniazid to tx TB, + pyridoxine to prevent neuropathy

9 months
What is most common form of shoulder dislocation?
Anterior dislocations, usually caused by a direct blow or fall on outstretched arm
How do patients hold their arms with anterior vs posterior shoulder dislocation?
Anterior dislocation - holds arm slightly abducted, externally rotated

Posterior dislocation - holds arm adducted and internally rotated
Which way do ppl commonly dislocate shoulder following tonic clonic seizure?
Posterior dislocation
What is the treatment for iron overdose?
Whole bowel irrigation (sometimes)

deferoxamine

supportive care for circulation, airway & breathing
In acute coronary syndrome, what effect does lidocaine have?
Effective to control complex forms of ventricular arrhythmia (v tach)

however, increases risk of asystole so not used prophylactically
In positive vs negative skewed distribution, what does curve look like and is mean greater or less than median and mode?
Positive skew - tail on the right, mean greater than median and mode

Negative skew - tail on left, mean is less than median and mode
Characteristics of the MCC of lung cancer?
Adenocarcinoma

usually located peripherally consisting of columnar cells growing along septa

has the least association with smoking (as compared to squamous and small cell p- typically centrally located), but is still the most prevalent in smokers
What are anti-cyclic citrullinated peptides (CCP) associated with?
Rheumatoid arthritis (in adition to rheumatoid factor)
What is anti-mitochondrial antibody associated with?
Primary Biliary cirrhosis
What conditions are associated with primary biliar cirrhosis? What is treatment?
PBC (anti-mitochondrial antibodies)

Sjogren's syndrome, Raynaud's syndrome, scleroderma, autoimmune thyroid disease, hypothyroidism, celiac disease, elevated risk of hepatobiliary malignancy

ursodeoxycholic acid is drug of choice, slows dz progression and relieves sx

methotrexate and colchicine have shown moderate benefit
What are symptoms of chronic Vitamin D overdose?
can lead to hypercalcemia

constipation, abdominal pain, polyuria, polydipsia
How can you distinguish between Cushing disease and ectopic ACTH?
high dose dexamethasone suppression test

Cushing dz should have urinary cortisol secretion decreased by ~50%, as pituitary adenomas are only partially resistant to regulation

ectopic ACTH will not be suppressed
What is the location and presentation for the following 4 common lacunar syndromes?

-Pure motoer hemiparesis
-Pure sensory stroke
-Ataxic-hemiparesis
-Dysarthria-clumsy hand syndrome
Pure motor hemiparesis - lacunar infarction in posterior limb of internal capsule - unilateral motor deficit (face, arm, leg) mild dysarthria, no sensory visual or cortical dysfxn

Pure sensory stroke - stroke of ventroposterolateral nucleus of thalamus - unilateral numbness, paresthesias, and hemisensory deficit of face, arm, trunk and leg

Ataxic-hemiparesis - lacunar infarction in anterior limb of internal capsule - weakness prominent in lower extremity, with ipsilateral arm and leg incoordination

Dysarthria-clumsy hand syndrome - lacunar stroke at basis pontis - hand weakness, mild motor aphasia, no sensory abnlities
Does pulmonary embolism cause increased A-a gradient?
yes
In Inflammatory Bowel Disease, what rheumatologic marker is positive? What extra-colonic symptoms can manifest?
p-ANCA and HLA-B27

skin findings (erythema nodosum and pyoderma gangrenosum)
episcleritis
arthritis
cholangitis
What is the treatment for PCP pneumonia in HIV patient? When do you add additional drug?
IV trimethoprim-sulfamethoxazole

add oral prednisolone if PaO2 < 70
What healthy individuals should not receive the intranasal influenza vaccine?
those > 50 yo

those caring for severely immune compromised individuals
What individuals should receive the pneumococcal vaccine?
all >= 65 yo

those < 65 w/chronic CV, pulm, hepatic, renal, metabolic dz, or immunosuppression
How can you differentiate between neuroblastoma and wilm's tumor on physical exam?
Neuroblastoma will usually cross the midline, Wilm's tumor usually does not

neuroblastoma child usually < 1, wilms tumor usually 2-5 yo
Low back pain worsened by walking and standing, improved by sitting or lying down? ("neurogenic claudication")
Lumbar spinal stenosis

narrowed spinal canal compressing nerve roots

extension (standing, walking) exacerbates pain, flexion (sitting, laying down) relieves
What is Bartter's and Gitelman's syndrome? What distinguishes them from other conditions with similar presentation?
Defective sodium and chloride reabsorption in thick ascending limb (Bartter) or distal convoluted tubule (Gitelman)

presents as polyuria, polydipsia, growth & mental retardation

similar to diuretic use and surreptitious vomiting, all have elevated plasma and renin levels, hypokalemia, and metabolic alkalosis


Bartter and Gitelman syndrome have elevated URINE CHLORIDE, where the others do not
What is the prophylactic and acute treatment for cluster headache?
Acute - 100% oxygen, subQ sumatriptan

Prophylactic - verapamil, lithium, ergotamine
What findings on paracentesis are indicative of spontaneous bacterial peritonitis?
PMN > 250

positive ascities culture

SAAG (serum-ascites albumin gradient) > 1.1 indicates portal hypertension as etiology of ascities
What finding on paracentesis would indicate ascites is due to portal hypertension?
SAAG (Serum-ascites albumin gap) > 1.1 mg / dL
How do you calculate the serum osmolar gap?
Osmolar gap = measured osmolarity - calculated osmolarity

calculated osmolarity = [2Na + Glu/18 + BUN/2.8]

normal is < 10

osmolar gap metabolic acidosis indicates acute methanol, ethanol, or ethylene glycol poisoning
What is primary medical therapy for patients with aortic regurg?
Vasodilators to reduce afterload

nifedipine or ACE inhibitors
How should findings of LSIL be managed after pap smear?
If premenopausal, then all get colposcopy (10-15% are CIN II-III)

If postmenopausal, can choose between: HPV testing, repeat pap at 6 & 12 months, or colposcopy
What organism most commonly causes epididymitis?
In sexually active: chlamydia and gonococcus

Not sexually active, older men: E. Coli, and less commonly Pseudomonas
What histological cell abnormalities can be found in most women's breast if they have Paget's disease?
Adenocarcinoma in ~85%
What microbe is most likely to cause a skin infection looking as an erythematous rash with a well demarcated border?
Group A Strept
What microbe most commonly causes UTI in patients with indwelling cathethers AND alkaline urine?
Proteus species
What is the threshold for treatment of ITP in children?
If platelets < 30,000 then give corticosteroids, otherwise observe
When should kid's weight and height be doubled, tripled, etc?
Weight: 2x by 5 mos, 3x by 1 year

Height: increase 50% 1 year, double by 4 years, triple by 13 years
What is the ScVO2 in septic shock?
increased, due to hyperdynamic circulation, improper distribution of CO, inability of tissue to extract oxygen
Where is chloroquine resistant plasmodium falciparum most common? What is preferred prophylaxis in these areas?
sub-saharan Africa and the Indian subcontinent (India, Pakistan, Bangladesh)

Mefloquine is drug of choice
What is the MCC of abnormal maternal serum AFP level?
gestational age error
How is endometrial hyperplasia classified, and what is its risk for progression to uterine cancer?
Simple w/o atypia - 1%

Complex w/o atypica - 3%

Simple atypical - 8%

Complex atypical - 29%

remember by: penny, nickle, dime, quarter
Is cigarette smoking or alcohol a risk factor for pancreatic cancer?
Cigarette smoking

Alcohol is NOT a RF (tho chronic pancreatitis is)
What is Turcot's syndrome?
An association between brain tumors (medulloblastomas and gliomas) and FAP or HNPCC, mainly in teens
How do you treat neuroleptic malignant syndrome acutely? What do you follow this with?
A muscle relaxant first (dantrolene)

follow with bromocriptine (dopamine agonist) and amantadine (antiviral drug w/dopaminergic properties)
What lab changes are expected in tumor lysis syndrome for potassium, uric acid, phosphate, and calcium?
increased K+

increased phosphate (intracellular ion)

increased uric acid (prtn breakdown)

decreased calcium (bound up by phosphate)
What does EBV DNA isolated in CSF of HIV patient mean?
primary CNS lymphoma

will have a weakly ring-enhancing mass, solitary and periventricular on MRI
What is a solitary, periventricular, weakly ring enhancing mass on MRI in HIV patient?
primary CNS lymphoma, will have EBV DNA in the CSF
What is the major cause of mortality in subarrachnoid hemmorhage?
vasospasm (~30% of patients, ~7 days after event), give Nimodipine to prevent
Criteria for ARDS?
acute dyspnea

inciting condition

b/l infiltrates on CXR

PCWP < 18

PaO2/FiO2 < 200
Back pain in young-middle aged person that is worse in morning and improves gradually throughout day?
Seronegative spondyloarthropathy (ie ankylosing spondylitis)
What are the MEN syndromes?
MEN I - PTH, pituitary tumor, tneropancreatic tumor

MEN 2A - PTH hyperplasia, medullary thyroid cancer, pheo

MEN 2B - medullary thyroid, pheo, & other (mucosal & intestinal neuromas / marfanoid habitus)
What is amiloride?
A potassium sparing diuretic
What can cause chest pain following MI with ST elevation and deep Qs in the same leads as with presentation, 5 days to 3 months following MI?
Ventricular aneurysm
What is the most common sarcoma in adolescent males? What are characteristic radiographic findings?
Osteosarcoma (2nd MCC is Ewing)

Elevated periosteum Codman's triange and spiculated sunburst pattern

occurs distal femur, prox tibia or prox humerus
Maternal infection causing abnormalities of deafness, cardiac problems, and cataracts?
Rubella, transmission occurs in first 4 weeks of pregnancy

also has thrombocytopenia, growth retardation, bone dz, jaundice, hepatosplenomegaly, and purple skin lesions ("blueberry muffin spots")
What are pharmacologic treatments for Graves disease? What are the side effects of each?
Both - agranulocytosis, rash, arthralgias, hepatitis

Methimazole - teratogen in 1st trimester, cholestatic jaundice

Propylthiouracil - vasculitis
What kind of renal disease is associated with Hepatitis C?
Membranoproliferative glomerulonephritis

less freq membranous nephropathy
When is external cephalic version indicated?
If breech at 37 weeks

if fails then planned c-section
How do you managed SVT in setting of Wolf Parkinson White?
cardioversion, either electrical or with antiarrhythmics (procainamide in this question)

do NOT use beta-blockers, adenosine, etc, as anything that decreases AV node conduction will increase bypass and lead to v fib
In treating acne, what is the order treatments should be used in increasing severity of condition?
First line - topical retinoids

Moderate to severe - oral antibiotics

Severe acne w/atrophic scarring or resistant cases - oral isoretinoin
Initial management of variable decelerations?
Oxygen administration and change in maternal position
Pain in shoulder w/passive ROM above head, relieved by lidocaine injection?
Rotator cuff tendonitis ( / impingement)

no h/o trauma typically