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212 Cards in this Set
- Front
- Back
What part of the bone do destructive processes affect children?
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Epiphysis - Legg Calve Perthis Disease (idiopathic avascular necrosis)
Metaphysis - osteonecrosis w/Staph Aureus Osteosarcoma - Codman's triangle of the metaphysis |
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Unilateral, intermittent bloody nipple discharge in perimenopausal woman?
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Intraductal papilloma, benign
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Anterior shoulder dislocation - mechanism and neurologic deficits?
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Forced abduction and external rotation
damage to axillary nerve - paralysis of deltoid and teres minor, paresthesia of lateral upper arm |
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Midshaft humeral fracture - neurologic deficit?
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Radial nerve
(radial nerve injury sx also occur with improperly fitted crutches) |
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Medial epicondyle fracture - neurlogic deficits?
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Ulnar nerve - ulnar claw hand and sensory loss of dorsal and ventral medial hand, paralysis of most of intrinsic muscles of the hand
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Knee injury with "pop" and swelling that develops 12-24h later?
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meniscal injury / tear
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Pain in runner w/reproduction on squeezine 3rd & 4th digits?
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Morton's neuroma
mechanically induced neuropathic degeneration |
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Tarsal tunnel syndrome?
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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 |
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How does hyperventilation change cerebral BP?
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Lowers cerebral ICP by washing out CO2, causing vasoconstriction and decreased cerebral blood flow
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Nasopharyngeal carcinoma in mediterranean or asian person caused by?
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EBV
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What happens in pulmonary contusion with intravascular expansion (volume repletion)?
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worsening hypoxemia
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What vaccines should patients undergoing splenectomy receive?
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S. pneumoniae
N. meningitidis H. influenza |
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Why would a ruptured AAA cause gross hematuria?
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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
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What is the order of MCC for otitis media in children?
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S. pneumonia (40%)
H. influenza (25-30%) Moraxella Cataralis (10-15%) ~30% viruses, ~5% other bacteria |
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Is a pediatric VSD murmur more concerning if loud or soft?
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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 |
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What are histologic findings and pathologic mechanism for Reye syndrome? What is tx?
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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% |
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How are chlamydial and gonnhococcal conjunctivitis differentiated?
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Gonnhococcal - occurs at 2-5 days, more purulent discharge, more severe complications
Chlamydial - occurs at 5-15 days, less purulent, less severe complications |
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What is most common complication of sickle cell trait? What is hemoglobin electrophoresis compisition?
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Painless, microscopic hematuria
~<40% HbS, <2% HbF |
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What is the appearance, agent, and treatment for impetigo?
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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 |
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What is Legg-Calve-Perthes disease?
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syndrome of idiopathic avascular necrosis of the hip affecting boys 5-7 years old
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What type of immunodeficiency presents at 6 months? What kind of infections prone to?
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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 |
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What type of immune deficiency predisposes children to abscesses?
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chronic granulomatous disease (CGD)
impaired oxidated mtabolism (NADPH-oxidase system defect) catalase + organisms like aspergillus and staph |
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What kind of infections seen in complement deficiency?
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Gonococcal and meningococcal
also some h. influ and s. pneumo |
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What kind of infections are ppl w/thymic hypoplasia prone to?
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T-cell deficiency --> viral and fungal infections
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What is adenosine deaminase deficiency?
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Severe combined immunodeficiency (SCID)
both B and T cell deficiency, predisposes to viral, fungal, and bacteria |
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What cranial nerves pass through cavernous sinus (and so are affected in cav sinus thrombosis)?
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CN III, IV, V, VI
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What is the MCC of nephrotic syndrome in children? Tx?
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Minimal change disease (80%)
empiric steroids (prednisone), no renal biopsy required |
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What is patellofemoral syndrome - hx and findings?
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overuse injury common in runners
pain worse going down stairs or hills pain localized to patella |
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What is Osgood-Schlatter disease - hx and findings?
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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 |
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What is Diamond-Blackfan syndrome?
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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 |
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What is lesch-nyhan syndrome - presentation and pathophys?
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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 |
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What is treatment for cat bite?
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Augmentin x5 days (covers anaerobes, which pasturella is)
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1 year old child w/thrombocytopenia, eczema, and recurrent bacterial infections?
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Wiskott-Aldrich syndrome
X-linked disorder decreased platelet production, w/small platelets clinical impact can be highly variable |
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What test can be done to differentiate complex partial from typical absence seizures?
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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 |
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What are the 3 types of renal tubular acidosis?
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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( |
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When are howell jolly bodies seen, what are they?
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in Asplenia
they are nuclear remnants of RBC which are generally removed by functional spleen |
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When are Heinz bodies seen?
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in patients w/hemolysis due to G6PD deficiency and thalassemia
they are aggregates of denatured hemoglobin phagocytes while extract this precipitate creating bite cells |
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When are helmet cells ceen?
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In traumatic hemolytic conditions such as DIC, HUS, and TTP
they are fragmented RBC |
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When is basophilic stippling seen?
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in thalassemias, lead and heavy metal poisoning
they are ribosomal precipitates which appear as blue granules of various sizes throughout cytoplasm of RBC |
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Child with precocious puberty, café au lait spots, and multiple bone defects - syndrome? Pathophys?
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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 |
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How long prior to sun exposure should sun screen be applied?
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15-60 minutes prior to exposure
sun avoidance is best method of photo-protection |
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What is Turcot syndrome?
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association between brain tumors (medulloblastomas and gliomas) and FAP or HNPCC
FAP - medulloblastomas HNPCC - gliomas (typically) |
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What are the APGAR categories and how are they scored?
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Appearance (color)
Pulse (< or > 100) Grimace/reaction Activity/mm tone Respiration (reg or irreg) 0 = not there, 2 = fully there, 1 = between |
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What syndrome is marfan features + thromboembolic events + mental retardation? What is treatment?
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Homocystinuria
autosomal recessive, cystathionine synthase deficiency Treatment - high doses Vit B6 |
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Gram positive diplococci
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streptococcus pneumoniae
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Gram positive cocci in clusters
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Staphylococcus
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Gram negative cocci
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Neisseria
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Gram positive rods
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Listeria and Bacillus
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Gram negative rods
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Pseudomonas, Haemophilus, Klebsiella, Legionella
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What is the difference between early adrenarche and pubarche?
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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 |
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Child w/umbilicated vesicles over erythematous skin following treatment for atopic dermatitis?
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Eczema herpeticum
associated with healing atopic dermatitis lesions after exposure to HSV can be lifethreatening, tx w/acyclovir |
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What distribution is atopic dermatitis seen in infants?
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face, scalp, and extensor surfaces of the extremities
erythematous excoriated papules and plaques, may weeb and become secondarily impetiginized |
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What is klumpke palsy?
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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 |
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What is pathophysiology underlying increased bleeding seen in CF kids?
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Factor VII deficiency, resulting from impaired uptake of fat-soluble vitamin K
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what is preferred antibiotic choice for pneumonia in CF child? Adult?
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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 |
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Is an LP before antibiotics ever indicated for meningitis?
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Yes, in children
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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 |
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Kawasaki disease requires 4 of 5 criteria, what are they?
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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 |
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In kids, medulloblastoma are how common and located where?
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2nd most common tmor of posterior fossa in children
~90% arise from the vermis |
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In kids, where is pinealoma located and what symptoms arise?
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dorsal aspect of midbrain
endocrine syndrome intracranial hypertension parinaud's sign (paralysis of vertical gaze) Collier's sign (retraction of eyelid) |
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In kids, where do craniopharyngeomas arise and what are sx?
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in the sella turcica
visual field defects endocrine syndrome seen as a cystic structure w/calcificaitons |
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What is the most common histology for pediatric supratentorial tumors? Infratentorial?
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Astrocytoma for both
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In children, what is most common neurovascular injury seen with supracondylar fracture?
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brachial artery entrapment
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What are typical lab findings in hemophilia?
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prolonged PTT
normal prothrombin time normal bleeding time normal fibrinogen level low serum factor VIII |
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Treatment for lyme disease in children?
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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 |
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What should be on the differential when considering scarlet fever?
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Kawasaki's disease (lymphadenopathy, changes to buccal mucosa, ad rash)
would also need changes in peripheral extremities OR bilateral conjunctival injection |
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Abx choice for kid w/infected lymph node? (what organisms)
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Dicloxacillin (or cephalexin or clindamycin)
caused by streptococcal OR staphylococcal (amoxicillin won't cover staph) |
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What stimulates prolactin production? Inhibits?
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Stimulated by serotonin and TRH
Inhibited by dopamine |
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Congenital anomalies associated w/isoretinoin?
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craniofacial dysmorphism, heart defects, deafness
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What is interstitial cystitis? What characteristics?
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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 |
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What is fetal hydantoin syndrome? What causes?
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caused by anticonvulsants during development (phenytoin, carbamazepine)
midfacial hypoplasia microcephaly cleft lip & palate digital hypoplasia hirsutism developmental delay |
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What is the main difference between bulimia and anorexia?
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Anorexia are severely underweight (<85% expected, BMI < 17) and often have 2ndary amenorrhea
both have distored body image and can have purging |
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What are the possible medical complications of tx severe anorexia?
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Bradycardia
refeeding syndrome |
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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 |
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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 |
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What are the differences between gastroschisis and omphalocele?
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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) |
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What is tx choice for acute stress disorder?
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CBT
short term benzos (< 2 wks only) for severe distress |
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What is tx for Generalized anxiety disorder?
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CBT, or
SSRI/SNRI |
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What is tx for panic disorder?
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CBT
SSRI/SNRI or both short-term benzodiazepine for severe distress |
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What is tx for PTSD?
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CBT
or SSRI/SNRI or both |
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What is tx for OCD?
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CBT
or SSRI/SNRI or both |
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What is tx for specific phobia?
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CBT - first line
SSRI/SNRI - freq exposure to stimulus & CBT not available Benzodiazepine - infreq exposure to stimulus & CBT not available |
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What is tx for social anxiety?
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CBT or SSRI/SNRI - for generalized (Freq) form
Benzo - infreq (nongeneralized) occurrence |
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What is breaking bad news mneumonic?
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SPIKES
Set up situation Perception, assess family's Invitation, obtain Knowledge, give w/information Empathetic statements Strategy and summary |
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What should you do about rest of series if kid has reaction to DTaP?
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Administer diphtheria and tetanus toxoids
avoid pertussis component (which majority of rxns are attributable to) |
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What tests are positive for lupus? Pts w/lupus have what common false positive test?
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anti-smith antibodies and/or anti-double stranded DNA antibodies
-specific and confirmatory for lupus frequent false positive RPR |
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Ashkenazi Jew adolescent w/chronic fatigue, easy bruisability, bone pain, pathologic fractures?
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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 |
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Bone marrow study - cells w/ "wrinkled paper" appearance
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Gaucher's disease
deficient acid beta-glucosidase |
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Failure to thrive, hepatosplenomegaly, rapidly progressive neurodegenerative course w/death by age 2-3?
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Nieman-pick disease
A & B result from deficient activity of sphingomyelinase |
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Hepatosplenomegaly, skeletal abnlities (anterior beaking of vertebrae, enlargement of sella turcica, thickening of calvarium)?
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GM1 gangliosidase
deficient activity of beta-galactosidase |
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Cherry red spot in retina + neurologic symptoms w/hepatosplenomegaly?
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GM2 gangliosidoses - Tay Sach's and Sandhoff's
deficiency of hexosaminidase activity lysosomal accumulation of GM2 gangliosides, particularly in CNS |
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2 drugs for tx of Tourette?
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typical antipsychotics - haloperidol or pimozide
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What are the genetic manifestations of Fanconi's anemia?
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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 |
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In cases of preterm, premature rupture of membranes, what dates indicate glucocorticoids should be given?
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Before 32 weeks give corticosteroids
Many centers give steroids between 32-34 weeks as well Typically not given after 34 weeks |
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What ion shifts does aldosterone cause in kidneys?
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acts on distal tubules to increase Na reabsorption, and secrete K and H ions
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What ECG findings are most specific for digitalis toxicity?
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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 |
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What medications should be withheld for 48 hours preceding cardiac stress testing?
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Antianginal agents
beta blockers, calcium channel blockers, nitrates these meds reduce the extend and severity of ischemia during exercise stress testing |
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What is the biggest risk factor for stroke (aside from prior stroke)?
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Hypertension - ~4x risk
greater risk than smoking or diabetes |
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What is the most common form of glomerulopathy associated with HIV?
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collapsing focal and segmental glomerulosclerosis
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What organism most likely causes cavitating lung nodules on radiography in an IV drug user?
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staph aureus - 2/2 tricuspid valve endocarditis w/septic embolism to lungs
HIV increases risk of staph aureus bacteremia |
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Young male with elevated beta-HCG and AFP?
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nonseminomatous germ cell tumor
seminoma will have elevated beta-HCG, but not AFP |
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What is the differential for an anterior mediastinal mass in young patient?
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"4 Ts"
thymoma, teratoma (& other germ cell tumors), thyroid neoplasm, and terrible lymphoma |
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Characterize cervical secretions by phase of menstrual cycle (ovulatory, pre, post)?
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Ovulatory phase - cervical mucus profuse, clear, thin, will stretch to ~6 cm, exhibit ferning on slide
Pre/post phase - scant, opaque, and thick mucus |
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What test can differentiate between hereditary spherocytosis and autoimmune hemolytic anemia?
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Direct coombs
positive - AIHA negative - hereditary spherocytosis both conditions do have spherocytes w/o central pallor (confusing!) |
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Hepatocytes that stain with periodic acid-Schiff (PAST) rxn and resist digestion by diastase?
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Alpha-1 antitrypsin
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ALS involves upper motor neurons or lower? What are sx?
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both
UMN - spasticity, bulbar sx, hyperreflexia LMN - fasciculations |
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How is gout treated w/prophylaxis and acutely?
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Prophylaxis - allopurinol (xanthine oxidase inhibitor) and probenecid (uricosuric drug)
acutely - colchicine, NSAIDs, steroids |
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HIV patients with very low CD4 counts need abx prophylaxis against respiratory infection, what count, what drug, what infection is particularly likely?
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CD4 < 50
Azithromycin Mycobacterium avium complex |
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What cancer can be correlated with B12 deficiency?
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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 |
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What monoarthritis can occur with hyperparathyroidism?
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Pseudogout - rhomboid shaped crystal with positive birefringence
|
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What vitamin deficiency causes alopecia, abnormal taste, bullous pustulous lesions surrounding body orificies and/or extremities, and impaired wound healing?
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Zinc deficiency
found in animal prtn, whole grains, beans, nuts digested primarily in the jejunum |
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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 |
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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 |
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Kid w/polyarthritis, carditis, chorea, sub-q nodules, and erythema marginatum following illness?
|
Rheumatic fever
these are the 5 major jones criteria |
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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 |
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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 |
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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 |
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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 |
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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 |
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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
|
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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 |
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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
|
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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 |
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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 |
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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?
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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 |