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367 Cards in this Set
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Erythrocyte protoporphyrin dosage
Which clinical situation? Interpretation |
In children with high lead levels, EP becomes elevated because lead interferes with the creation of red blood cells. Screening by measuring this chemical in the blood [erythrocyte protoporphyrin (EP)] is done every time your child has a lead level drawn.
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Most common cause of mid systolic click
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Floppy mitral valve
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Auer Rods
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Pathognomonic of AML
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How to differentiate between AML and leukemoid reaction
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ALP is always elevated in leukemoid reaction.
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Surgical indications for herniated disc
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Unresponsive to treatment after 3 months
Progressive neurological deficit Cauda equina |
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Presentation and characteristics of IgA deficiency
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Selective IgA deficiency is a relatively common condition in which patients are unable to synthesize IgA.
Most patients with IgA deficiency are asymptomatic. The condition becomes clinically significant when blood transfusion is required, since they may develop anaphylaxis when exposed to blood products containing IgA. |
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Dyspnea in patient taking Bleomycin, what to suspect?
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Pulmonary Fibrosis
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Indication for excisionnal biopsy of a pigmented lesion
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Excisionnal biopsy should be carried out in any case of pigmented skin lesion that shows one or more of the following features :
- asymmetric or fuzzy border - irregular or variegated color - diameter greater than 0.6 cm |
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ABCDE mnemonic for melanoma
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Asymmetry
Border Colour Diameter > 0.6 cm Elevation |
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Presentation and characteristics of IgA deficiency
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Selective IgA deficiency is a relatively common condition in which patients are unable to synthesize IgA.
Most patients with IgA deficiency are asymptomatic. The condition becomes clinically significant when blood transfusion is required, since they may develop anaphylaxis when exposed to blood products containing IgA. |
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Dyspnea in patient taking Bleomycin, what to suspect?
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Pulmonary Fibrosis
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Indication for excisionnal biopsy of a pigmented lesion
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Excisionnal biopsy should be carried out in any case of pigmented skin lesion that shows one or more of the following features :
- asymmetric or fuzzy border - irregular or variegated color - diameter greater than 0.6 cm |
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ABCDE mnemonic for melanoma
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Asymmetry
Border Colour Diameter > 0.6 cm Elevation |
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Thrombotic Thrombocytopenic Purpura Pentad
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1- Thrombocytopenia : bruising + bleeding
2- Microangiopathic hemolytic anemia 3- Neurologic symptoms 4- Kidney failure 5- Fever |
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Blood marker for hepatocellular carcinoma
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AFP (alpha feto protein)
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Most common sites for hypertensive hemorrhage
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The caudate and the putamen are most common sites (70%).
These can lead to dangerous elevations of intracranial pressure. |
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Parkinsonian symptoms that do not respond to medical therapy, which disease should be suspected?
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Progressive supranuclear palsy
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Progressive supranuclear Palsy
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PSP is a degenerative disorder that predominantly affects the midbrain and basal ganglia. The clinical hallmarks are symmetric Parkinsonism with vertical gaze limitation and axial rigidity.
These patients tend to have falls as their earliest symptoms. There is an associated mild-to-moderate dementia that usually involves frontal lobe functions more than hippocampal/memory systems. |
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Carcinoid Syndrome
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The classic triad of this disorder is :
1- Flushing 2- Watery diarrhea 3- Valvular heart disease The first test for screening carcinoid syndrome is the determination of 5-HIAA in a 24 hr urine sample. Carcinoid syndrome is aslo associated with hypotension, bronchospasm, telangiectasia and abdominal cramps due to the release of serotonin and vasoactive peptides. Symptomatic treatment of carcinoid syndrome consists of giving Octreotide. |
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Serum marker for melanoma
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S-100
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AFP marker
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Hepatoma
Testicular and ovarian cancer with a yolk sac component. |
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CA-125
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Ovarian tumours
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LCA marker
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Marker for lymphoid neoplasms
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Wernicke-Korsakoff syndrome
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Wernicke's encephalopathy
1. Ataxia 2. Confusion ... coma... 3. Ophthalmologic manifestations - nystagmus - ophtalmoplegia - anisocoria Korsakoff's psychosis 1. Antegrade / retrograde amnesia 2. Hallucinations 3. Confabulation |
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Screening for diabetic nephropathy
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24 hour urine collection
Microalbuminuria is the earliest expression of diabetic nephropathy |
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Tumour lysis syndrome complication prevention
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Allopurinol and intensive hydration
TLS results from the acute lysis of lymphoma cells and the acute renal failure from the precipitation of uric acid and hypoxanthine in the renal collecting tubules. Patients should receive allopurinol, a xanthine oxidase inhibitor that reduces the synthetis of uric acid, and should be aggressively hydrated prior to the initiation of chemotherapy to reduce the incidence of TLS. |
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Graft versus host disease prevention in bone marrow transplant recipients
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The incidence of graft versus host disease can be reduced by removal of T cells from the donor marrow by using monoclonal antibodies, rosetting techniques, or mechanical separation.
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Idiopathic Thrombocytopenic Purpura
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ITP is most common in adults (women > men) aged 20-40 years.
Bleeding, epistaxis, oral bleeding or menorrhagia can occur and isolated thrombocytopenia (< 10 000) is characteristic. 10% of patients will have coexisting autoimmune hemolytic anemia. The first line therapy is prednisone if the patient is not actively bleeding. |
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Orphan Annie Eyes
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Papillary structures within follicles that have epithelial cells with nuclei with cleared centres indicate the presence of papillary carcinoma of the thyroid.
Of all the thyroid cancers, 60% to 70% are papillary carcinomas. The condition is more frequent in younger patients but tends to be more aggressive in the elderly. There is usually a single dominant nodule that is "cold" on thyroid scan. Among the different thyroid cancers, papillary carcinoma tends to be the one with the best prognosis overall, and smaller lesions can be treated with thyroid lobectomy alone. |
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Histologic types of esophageal cancer
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Cancers involving the upper third of the esophagus are usually squamous cell in origin. Lower oesophageal cancers may be either squamous cell carcinoma or adenocarcinoma (usually arising from Barrett Esophagus)
Predisposing factors for squamous cell carcinoma of the esophagus include: - alcohol use - tobacco use - HPV - esophageal scarring - sclerotherapy - chronic achalasia |
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Ductal carcinoma of the pancreas imaging
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Ductal carcinoma of the pancreas is often devastating because, in roughly 90% of cases , it presents late in the clinical course when it is no longer resectable.
CT-Scan is the most effective method of diagnosing and staging the disease. |
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Amaurosis fugax
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A senstation of curtain passing across the visual field can be characteristic of either amaurosis fugax or retinal detachment. If the phenomenon is transient , amaurosis fugax is more likely than retinal detachment.
Fleeting blindness is characteristically caused by retinal emboli from ipsilateral carotid disease. The visual loss is described as a curtain passing vertically across the visual field, with complete monocular visual loss lasting a few minutes Amaurosis fugax may be due to cholesterol plaque release and is a precursor of retinal artery occlusion. |
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Wich serologic marker excludes discoid lupus from the diagnosis?
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Anti-dsDNA
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MEN I
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Pituitary
Parathyroid Pancreas |
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MEN IIa
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Medullary thyroid carcinoma
Parathyroid Pheochromocytoma |
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MEN IIb
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Medullary thyroid carcinoma
Pheochromocytoma Neurofibromatosis |
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Drugs that can cause neutropenia
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Chlorpromazine
Sulfonamides Procainamide Methimazole PTU Penicillins Cephalosporins Chemoterapeutic agents |
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Complicated parapneumonic effusion
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Organisms in the fluid
Leukocyte in the fluid > 50 000 Low pH Such collections tend to loculate and form adhesions if not immediately drained with a chest tube. |
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Treatment for lyme disease
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Ceftriaxone
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Contraindications to use of anticholinergics
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Narrow angle glaucoma
Severe constipation Prostatic hyperplasia or symptoms of urinary retention |
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Causes of hepatocellular carcinoma
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HBV
HCV Aflatoxins Hemochromatosis |
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Analgesic nephropathy
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Analgesic nephropathy affects patients who consume significant amounts of aspirin, NSAIDs, phenacetin or acetaminophen for at least 3 years.
Chronic tubulointerstitial nephritis : progressive polyuria because of inability of the renal tubules to concentrate urine, hyperkalemia, presence of radiologic signs of papillary necrosis, concomitant microhematuria and proteinuria. |
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Crystals in gout and pseudogout
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Gout
- rhomboidal negatively birefringent crystals - monosodium urate Pseudogout - rhomboidal positively birefringent crystals - calcium pyrophosphate |
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Preferred imaging techniques to quickly diagnose aortic dissection
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TEE if available
CXR if not available (will show mediastinal widening) |
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Initial manifestation of gonococcal arthritis
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Acute onset tenosynovitis
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Management of solitary pulmonary nodule radiographically detected
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60% of solitary pulmonary nodules are benign, and granulomas represent the most common benign lesion.
There is no infallible clinical or radiological set of criteria that can discriminate between benign and malignant lesions. Factors favoring a benign lesion include : - young age (< 40) - small size (< 2 cm) - smooth margins of the lesion - absence of symptoms - slow growth on successive films Generally, calcifications are not a malignang malformation and presence of "popcorn-like" calcifications definitely favors hamartoma. |
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Hamartoma
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A hamartoma is a malformative lesion resulting from random admixture of tissues normally present in the lung, including cartilage, bronchial mucosa and smooth muscle. It is usually discovered incidentally.
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Hepatitis B and hives
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Up to 25 % of acute hepatitis B infections present with urticaria
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Causes of wide split S2
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RBBB
Pulmonic stenosis Pulmonary embolus Ectopic or pacemaker beats originating in the left ventricle |
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Management of asymptomatic hyperparathyroidism
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In most cases, hyperparathyroidism is asymptomatic, manifesting only with hypercalcemia incidentally in the course of routine laboratory investigations conducted for other reasons.
hypercalcemia The most common cause is parathyroid adenoma. If is the only clinical sign, without associated complications such as renal stones, bone disease or cataracts, abundant fluid intake is the only measure recommended to prevent formation of calcium stones in the urinary system. |
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False cause of depressed pancreatic enzymes level
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Type I and V hyperlipoproteinemia
They are a cause of acute pancreatitis. Look for other typical signs of acute pancreatitis. - neutrophilic leukocytosis - hyperglycemia - hypocalcemia - elevated CRP - "sentinel loop" - Typical CT-Scan |
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Colloid use
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Burns rehydration
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HIV and persistent diarrhea
Which microorganisms should be suspected |
Cryptosporidium
Isospora These organisms should be though for by examination of fresh stool sample for parasites. |
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Recurrent UTIs and kidney stones
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Urease-producing organisms create a high urinary pH, contributing to the development of struvite kidney stones.
Acetohydroxamic acid is an effective urease inhibitor. Proteus Less commonly : Pseudomonas and Providencia |
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Churg-Strauss Vs Goodpasture syndrome
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Goodpasture syndrome
- autoantibodies against a domain of type IV collagen in the basement membranes of both glomerular and alveolar capillaries - Linear deposition of IgG and complement Churg-Strauss syndrome - blood and tissue eosinophilia - circulating ANCA (p-ANCA) |
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Most common cause of status epilepticus
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Drug non compliance
2 types of status epilepticus - convulsive - non convulsive Other causes : - alcohol withdrawal - head trauma - hypoxia - intracranial infection - cranial tumour Infection is the most common cause in childhood. |
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Causes of focal segmental glomerulonephritis
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Idiopathic
HIV Heroin abuse Morbid obesity |
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Indications for cryoprecipitate use
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Hemophilia A
Hyperfibrinogenemia von Willebrand disease |
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Most common primary cardiac tumour
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Atrial myxoma
It affects women more than men and grows in the left atrium in 80% of cases. It may present with a systemic illness mimicking infective endocarditis, give rise to systemic embolism or present with signs and symptoms of mitral valve obstruction. The change of murmur when the patient changes position is suggestive of an atrial myxoma. |
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Relapsing polychondritis
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An autoimmune condition that occurs as an isolated process or together with other autoimmune disease, including rheumatoid arthritis, systemic vasculitis and SLE.
Presentations can include bilateral swelling of the external ears, nasal involvement, arthralgias to symmetric arthritis (with a predilection for the costochondral joints), and involvement of the larynx, trachea and bronchi. |
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Treatment of TCA intoxication
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Maintain an alkalemic state
- Hyperventilation - IV bicarbonates |
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ECG sign of TCA intoxication
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Prolonged QT + widening QRS
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Proper position for insertion of thoracocentesis needle? (pleural effusion)
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5th intercostal space
Posteriorly - Between the tip of the scapula and the mid axillary line Superior edge of 7th rib (in order to avoid the neurovascular bundle which runs along the inferior edge of the rib) Make sure that the effusion is free flowing by ordering a lateral decubitus CXR |
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Presentation of CLL
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Usually asymptomatic.
Increased lymphocytosis on routine bloodwork. Lymphadenopathies. Accumulation of lymphocytes in bone marrow. In the first stage, no treatment is necessary. It usually follows an indolent course and aggressive chemotherapy seems to have little impact on survival. When CLL advances, Chlorambucil is the standard treatment. - progressive fatigue and organomegaly (stage II) - severe anemia (stage III) - thrombocytopenia (stage IV) |
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HLA phenotypes of type I diabetes
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DR3 and DR4
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Hepatic enzymes in alcoholic hepatitis
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AST : ALT > 2
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Infectious causes associated with membranous glomerulonephropathy
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HBV
Syphyllis |
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Nephrotic syndrome with p-ANCA positive
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Churg Strauss syndrome
Wegener's Granulomatosis Microscopic polyangitis All these conditions are associated with sites of involvement other than the kidneys. |
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Glomerulonephritis with elevated IgA?
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Berger Disease (a.k.a IgA nephropathy)
Glomerulonephritis with recurrent hematuria and/or proteinuria + upper respiratory flu-like syndrome or interstitial infection. |
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Glomerulonephritis and elevated C3 nephritic factor?
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Type II membranoproliferative glomerulonpehritis
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Glomerulonephritis and AIDS?
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Focal segmental glomerulosclerosis
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Glomerulopathy and positive ANA
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SLE
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Renal cell carcinoma triad
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Flank pain
Abdominal mass Hematuria |
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Type of hyperbilirubinemia in Dubin-Johnson Syndrome?
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Direct
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Genetic causes of indirect hyperbilirubinemia?
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Criggler Najjar
Gilbert |
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Familial hypercholesterolemia
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Dominant autosomal disorder that affects the LDL receptor. It increases the risk of CAD (3x hetero 6x homo)
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Apolipoprotein E deficiency/mutation
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It causes hyperlipoproteinemia type I and IV.
It is characterized by recurrent pancreatitis and hyepatosplenomegaly. |
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Causes of hypophosphatemia
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Aluminum hydroxyde long term use
Hyperparathyroidism Theophylline intoxication Cushing Hypothyroidism Chronic diuretic administration Dialysis |
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Utility od carbohydrate deficient transferrin
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The serum level of this marker can be used in the follow up of patients with heavy drinking who are enrolled in specialized programs for treatment of alcoholism.
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Meniere disease
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Generalized dilation of the membranous labyrinth of the inner ear.
Associated with attacks of vertigo, tinnitus and initially fluctuating and later progressive hearing loss. |
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Vestibular neuronitis
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Presents initially with a persistent severe episode of vertigo that eventually fades to a paroxysmal form, which completely disappears within a year or two.
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Herpez Zoster Oticus
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Hearing loss, Vertigo
+ Pain sometimes facial nerve paralysis |
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Best initial treatment of hypertrophic cardiomyopathy
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Beta-Blockers or CCB
Outflow obstruction in hypertrophic cardiomyopathy causes impaired diastolic filling . |
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Most common cause of asymptomatic hypercalcemia
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Primary Hyperparathyroidism
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Three most common causes of steatosis
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Obesity
Alcoholism Diabetes Mellitus |
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Two most common causes of ketoacidosis
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Alcoholism
Starvation |
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Radial nerve palsy
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a.k.a Saturday night palsy
C5-T1 Triceps, Brachioradialis, Wrists and finger & thumb extensors Clinical features include - wrist drop - inability to extend elbow & fingers Most common causes : - saturday night palsy (alcoholism) - crutches |
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Axillary nerve
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C5-C6
Deltoid + teres minor Clinical features : - weakness in shoulder abduction |
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Median nerve palsy
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C6-T1
Abductor pollicis brevis, forearm, pronator, finger & thumb flexors Carpal tunnel syndrome Paresthesia in the ventral 2 1/2 fingers |
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PBC antibodies
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Anti-mitochondrial
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Is PBC intrahepatic or extrahepatic or both?
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intrahepatic
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PSC : intrahepatic, extrahepatic or both?
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both
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Takayasu Arteritis
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a.k.a. Pulseless disease
Inflammatory arteritis that affects the main branches originating from the aortic arch, causing sings and symptoms of ischemia to the brain and upper extremities. Young women are mostly affected. |
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Churg strauss syndrome
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Small vessel vasculitis that affects :
- lungs - kidneys - skin Usually associated with eosinophilia and p-ANCA |
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Giant cell arteritis
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Most commonly affects the brances of the external carotid artery, especially the temporal artery.
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Henoch Schonlein Purpura
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Most commonly affects :
- skin - GI tract (abdominal pain + bleeding) - joins (arthritis) - glomerulonephritis Usually associated with auto-immune complexes containing IgA |
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Kawasaki syndrome
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Usually seen in children.
Fever for 5 days associated with 4 of the following changes - Bilateral non suppurative conjunctivitis - One of more changes of the mucous membranes of the upper respiratory tract, including pharyngeal injection, dry fissured lips, injected lips, and "strawberry" tongue - One or more changes of the extremities, including peripheral erythema, peripheral edema, periungual desquamation, and generalized desquamation - Polymorphous rash, primarily truncal - Cervical lymphadenopathy >1.5 cm in diameter †A diagnosis of Kawasaki disease can be made if fever and only 3 changes are present in conjunction with coronary artery disease documented by two-dimensional echocardiography or coronary angiography. |
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nummular eczema
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Coin shaped lesions covered by uniform scaly crust
+/- itching no central clearing |
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seborrheic dermatitis
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Scaly, oily, dandruff-like rash in the scalp and eyebrows of infants (cradle cap).
Up to 50% of AIDS patients develop seborrheic dermatitis in unusual locations. Other patients predisposed to this condition are the elderly and Parkinsonnians. |
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Allergic contact dermatitis
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Mediated by type IV hypersensitivity reaction to a variety of allergens.
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Tinea corporis
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Tinea corporis is due to dermatophytes, fungal organisms that colonize the most superficial layers of the epidermis.
the most characteristic appearance of skin lesions associated with tinea corporis is a ring-like pattern. KOH treated skin scrapings examined under a microscope allow identification of spores or hyphae. |
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Dialysis indications
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Refractory hyperkalemia
Refractory acidosis Refractory fluid overload Uremic complications - pericarditis - peripheral neuropathy - encephalopathy Coagulopathy |
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Tricyclic intoxication
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Toxic effects atribuable to anticholinergic activity and "quinidine" like action
Mild overdose is principally associated with anticholinergic effects such as mydriasus, tachycardia, impaired sweating with flushed skin, dry mouth, constipation and muscle twitching. More severe intoxication leads to cardiac arrhythmias, namely ventricular tachyarrhythmias and bradycardia. Prolongation of the QRS complex (>0.1 sec) is typical and constitutes a more sensitive indicator of toxicity than serum drug levels. Seizures, coma and hypotension are the most severe manifestations. Gastric lavage in the first hour following ingestion, supportive care, anticonvulsants and appropriate antiarrhythmic drugs (sodium bicarbonate bolus, lidocaine and phenytoin) are the recommended treatments. |
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Paget disease
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Idiopathic bone disease characterized by localized areas of hyperactive bone (osteoclasts and ostebolasts).
It causes typical radiologic signs. It can also cause peripheral nerve entrapment (including hearing loss) or bone fractures. It can also cause bitemporal enlargement. It is usually accompanied with elevated of alcaline phosphatase and others are normal. + increased urinary excretion of pyridinoline links. Drug therapy (biphosphonates / calcitonine) can help. |
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Cystic Schistosomiasis
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It manifests with recurrent hematuria and predispose to squamous cell carcinoma of the bladder
Search for ova in the urine is the fundamental diagnostic test. |
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Live attenuated vaccines
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BCG
Measles Mumps Oral polio vaccine Rubella Yellow fever |
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Presentation of fat emboli
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Fat emboli occur after the introduction of neutral fat into the venous circulation, occuring most commonly after bone trauma or fracture.
After a latent period of 12-36 hours, during which the patient is asymptomatic, cardiopulmonary and neurologic deterioration occurs. Dyspnea, tachypnea and tachycardia occur with radiographic findings of diffuse bilateral infiltrates, consistent with ARDS. Treatment is supportive. Mortality is high. |
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CREST antibodies
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anti-centromere
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Scleroderma antibodies
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Scl-70 a.k.a. tropoiosomerase
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Menetrier disease
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Uncommon gastric disorder characterized by markedly thickened gastric folds.
The disorder is idiopathic and it causes reduced acid secretion (hypochlorydria) and a protein losing enteropathy with weight loss and edema secondary to hypoalbuminemia. Medical treatments are typically ineffective, and some patients require partial or complete gastric resection to control severe hypoalbuminemia. |
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Markers for CRC
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CEA
CA125 CA19-9 |
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Most common site for hypertensive hematomas?
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cerebellar
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Most common skin cancer
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Basal cell carcinoma
Squamous cell carcinoma is the 2nd most common (usually occurs on the lower lips) |
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Cold agglutinins causes
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Infectious
- EBV - Mycoplasma Pneumonia - HIV Non-infections - Lymphoma - CLL Idiopathic (auto-immune anemia) |
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Most common causes of intracerebral masses in AIDS patients
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Toxoplasmosis
Lymphoma They both show as ring enhancing lesions on imaging. Toxoplasmosis usually responds to therapy, so when the latter fails, primary brain lymphoma should be suspected. |
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Multiple Myeloma primary features
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Elevated serum proteins
Normocytic anemia Hypercalcemia CRF + Bence Jones Susceptibility to infections |
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Side effects of amiodarone
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Thyroid disorders
Pulmonary fibrosis Torsades de pointes Arrhythmias Skin discolouration |
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Oligoclonal bands in CSF
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Multiple sclerosis
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Scabies diagnosis
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The most effective way to confirm a diagnosis of scabies is to place a drop of mineral oil on a suspected area then unroof the burrow hole with a curette ring and obtain scrapings that are examined under microscope.
The ares of the body most frequently affected include the axillary and genital regions, waistline and finger webs. Pruritus tends to be particularly intense at night. |
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Aortic dissection risk factors
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Hypertension
Marfan syndrome |
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Treatment of hypertensive emergency
Treatment of hypertensive urgency |
Hypertensive emergency :
1- Nitroprusside 2- BB (if Myocardial ischemia) or nitro IV 3- Diuretic (if CHF) Hypertensive urgency : 1- Clonidine or CCB Obstetrical 1- Hydralasine |
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Hepatic adenoma usual presentation
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Hepatic adenomas are infrequent benign tumours. They are often silent and occur most frequently with OCP and anabolic steroids.
when symptomatic, its most common clinical presentation is rupture into the peritoneal cavity with consequent hemoperitoneum and shock. |
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Wegener granulomatosis sites
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Paranasal sinuses
Upper respiratory tract Lungs Kidneys Skin (subcutaneous nodules and purple papules) C-ANCA |
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Behcet disease features
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Oral ulcers
Genital ulcers Ocular disease (relapsing iridoclytis that causes pain and photophobia) skin lesiosns (papules, pustules, vesicles or folliculitis) mild arthritis of large joints Other features may include CNS involvement and migratory thrombophlebitis |
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PRICE mnemonic for sprains
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P : protect
R : rest I : ice C : compression E : elevate |
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Mixed connective tissue disease antibodies
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Anti-ribonucleosin
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Libman Saks endocarditis
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aseptic vegetations on valves associated with SLE.
No bacterial endocarditis. |
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Epidural bleed
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Epidural bleed is usually due to rupture of middle meningeal artery.
The initial concussion leads to a brief loss of consciousness, which is followed by a lucid interval lasting several hours. As the epidural hematoma progressively enlarges and pushes the underlying brain, the patient becomes comatose again and may display signs of uncal herniation. The herniating uncus pushes on the third cranial nerve, producing ipsilateral fixed pupillary dilatation. Papilledema is usually a late sign and indicates cerebral edema. |
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Nystagmus in BPPV
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Geotropic rotatory nystagmus
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Common ototoxic drugs
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ASA
Diuretics NSAIDs Aminoglycosides |
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Swimmer's ear
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Otitis externa
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Territory supplied by the right coronary artery
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Inferior and posterior segments
II, III & aVF |
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Territory supplied by the circumflex artery
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Anterolateral regions
V5-V6 and I-aVL |
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Territory supplied by the LAD artery
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Anteroseptal and ateropical regions
V1-V4 |
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Territory supplied by the LAD
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Territories of LAD and circumflex
V1-V6 and I-aVL |
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Territory supplied by the posterior descending artery
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Posterior aspect of the heart
Tall R waves in V1-V2 |
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Bleeding after antibiotic course and parenteral nutrition
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Consider vitamin K deficiency among other causes
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Polymyositis presentation
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Proximal muscle weakness and pain.
Elevated CK |
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Inclusion Body myositis
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Distal muscle weakness
Rimmed vacuoles on pathology |
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Dermatomyositis
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Mimics polymyositis on muscle but with skin involvement.
30% of cases are associated with underlying malignancy. |
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Hypocalcemina post-op of parathyroidectomy
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Caused by atrophy of the other parathyroid glands
Treat transient hypocalcemia with IV calcium gluconate followed by oral calcium and vitamin D administration. |
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Cardiomyopathy caused by chronic alcoholism
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Dilated cardiomyopathy
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Treatment of adrenal crisis
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IV hydrocortisone (100-300 mg)
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Giant platelets
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Consider essential thrombocytopenia
also : platelet aggregates and megakaryocytes fragments |
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Use of oral neomycin
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Aminoglycoside (poorly absorbed)
Adjunct to lactulose therapy in hepatic encephalopahty cases in order to reduce the bacteria load in the intestine. |
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Hemolytic anemia which may be triggered by :
- fava beans - sulfonamides - salicilates |
G6PD deficience
X linked recessive. |
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ACTH suppression test
|
Dexamethasone can inhibit ACTh secretion by the pituitary. In its simplest form, 1 mg oral dose is given at night; the following morning, a single plasma cortisol is taken, which in normal individuals will suppress to less than 5 mg/dl. Most patients with non pituitary Cushing syndrome will not have a suppression of cortisol in this setting.
A more elaborate form of the test can be given. Low dose dexamethasone can be given for 2 days (0.5 mg Q6H) which will inhibit ACTH secretion in normal subjects, but not in patients with an ACTH secreting pituitary tumour. These patients can however, be suppressed with the higher dose given on the last 2 days of the test, unlike patients with either ACTH secretion by other tumours (such as scc) or primary adrenal disease producing the cortisol. |
|
|
Pulmonary radiotherapy :
Fibrosis Vs. Pneumonitis |
Acute radiation pneumonitis develops 2-3 months after exposure and manifests with insidious onset of shortness of breath and chest pain (sharp demarcation of pulmonary infiltrate on CXR corresponds to the treated area).
Pulmonary radiation fibrosis is a delayed complication of radiation injury and manifests 6-12 months following radiation exposure. |
|
|
Three most common causes of atrial fibirillation
|
Myocardial ischemia
Mitral valve disease Hyperthyroidism |
|
|
Sporotrichosis, which occupation is linked to it?
|
Gardners or forest workers.
It is a saprophytic mold present on rose bushes, barberry bushes and other mulches and is typically introduced at a site of minor trauma. Helpful diagnostic clues are absence of systemic symptoms, subcutaneous nodules (adenopathies) in chains. Tx = itraconazole PO |
|
|
Rate of chronicity of HCV infection
|
75%
|
|
|
Rate of chronicity of HBV infection
|
5% to 10%
|
|
|
Does basal cell carcinoma have metastatic potential?
|
No.
Basal cell carcinomas are the most frequent skin malignancies. They develop on sun exposed areas, often in fair skinned individuals, grow slowly for years, and finally develop a central ulceration. |
|
|
Abdominal pain that is relieved when the patients lies quietly?
|
Consider peritonitis
|
|
|
Mutation associated with osteogenesis imperfecta?
|
Collage type I mutation
Fetal type : in utero fractures and deformities Adult type : extreme bone brittleness and frequent fractures and is also associated with characteristic constellation of signs including : bluish sclerae, bluish misshapen teeth and conductive hearing loss. Positive family history |
|
|
Marfan syndrome
|
Marfan syndrome is characterized by long limbs and fingers (arachnodactyly), ectopia lentis (dislocation of the lens), and proximal aortic dilatation resulting in aortic insufficiency, mitral valve prolapse and laxity of joints.
Patients with marfan syndrome are usually very tall : most of the height is due to the lower extremities. Pectus excavatum and pectus carinatum (pigeon breast) and protuberant forehead are frequent associated skeletal anomalies. A mutation of the fibrillin gene is the underlying molecular defect. Cardiovascular complications, particularly aortic dissection, represent the most common cause of death in marfan patients. |
|
|
ARDS
|
Virtually all patients with ARDS have reduced lung compliance.
ARDS begins with compromise of capillary integrity, which causes extravasation of fluid, fibrin and protein into the alveoli. Thus, the lungs become wet and stiff, causing reduced lung compliance. It is characterized by severe hypoxia caused by extreme V/Q imbalance and shunting of blood in the fluid filled areas of the lung. Clinical features include progressive tachypnea. Specific physical features are usually absent, except for bilateral diffuse rales. ARDS can be initiated by many different events and conditions, including shock, aspiration of fluid, DIC, sepsis trauma, blood transfusion, pancreatitis, smoke inhalation and heroin overdose. The ultimate goal of treatment is to provide adequate tissue perfusion and oxygenation while addressing the precipitating event. |
|
|
Initial treatment of polymyositis
|
Daily corticosteroids until the level of CPK normalizes in 3 months.
|
|
|
Brown pigement stones
|
infected bile
|
|
|
black pigment stones
|
chronic hemolysis
|
|
|
Test for carcinoid syndrome
|
5-HIAA urinary test
(serotonin metabolite) |
|
|
Absolute contraindication for spinal tap?
|
Increased intracranial pressure
|
|
|
Pneumovax (polysaccharide) indications
|
> 65 years olds
> 2 years olds with chronic disease or immunosuppression |
|
|
Prevmar (conjugate) indications
|
< 23 months old
< age of 5 with chronic disease or immunosuppression |
|
|
Meningococcal C conjugate vaccine indications
|
Asplenia
Complement, factor D or properdin deficieny HIV 12 months old (Quebec) |
|
|
CURB 65
|
Pneumonia treatment
Confusion Urea > 7 Respiratory rate > 30 Blood pressure <90/60 0-1 : outpatient 2 : hospitalize 3-5 : ICU |
|
|
Argyll Robertson Pupils
|
Pupils that accomodate to close objects but do no react to light.
This is pathognomonic of tertiary syphilis. |
|
|
Syphilis screening and confirmatory tests
|
Screening Tests : VDRL, RPR, EIA
Confirmatory tests : TPI, FTA-Abs, MHA-TP, TPPA |
|
|
Treatment of syphillis
|
Primary, secondary or latent (<1 year) : Pen G 2.4 million U IM x 1
Tertiary or latent (> 1 year) : Benzathine Pen G 2.4 million U IM x 3 weeks If allergic to penicillin : doxycline or tetracycline |
|
|
Classic triad of congenital toxoplasmosis
|
Chorioretinitis
Hydrocephalus Intracranial calcifications Maternal infection occurs via contact with the oocysts present in the feces of an infected house cat or by consuming undercooked meat of infected animals. The most widely accepted regimen for treatment of infected neonates is pyrimethamine, sulfadiazine and leucovorin. |
|
|
Fluoroquinolones side effects
|
GI upset
Rash Headaches and dizziness QT prolongation Tendonitis and Achilles tendon rupture |
|
|
Why shouldn't doxycycline be used in children < 8 years old?
|
Risk of tooth discolouration
|
|
|
Coxsackie Virus A infection
|
Hand-foot-and-mouth disease.
Patients typically present with a mild illness that may or may not have the presence of fever. The oropharynx is inflamed, with vesicles scattered on the tongue, buccal mucosa, posterior pharynx, gums, palate, and lips. Hands and fingers, feet, buttocks and groin may also demonstrate maculopapular, vesicular, or pustular lesions. |
|
|
Use of acyclovir in varicella infection
|
Oral acyclovir should be considered for immunocompetent patients (> 12 patients) who have an increased risk of severe varicella infection.
Oral acyclovir therapy in this population, beginning within 24 hours of symptom onset, has been shown to decrease the duration of lesions and fever and diminish the symptoms and duration of disease. |
|
|
Tubo-ovarian abscess management
|
A TOA is a result of an inadequately treated PID.
Patients with TOA will often be febrile, nauseated, tachycardic, and complain of abdominal and pelvic pain. Inpatient with IV antibiotics. |
|
|
Complications of measles
|
AOM
Pneumonia Laryngotracheitis Subacute sclerosing panencephalitis |
|
|
Hepatic side effect of INH
|
Hepatotoxicity. INH usually increases liver enzyme levels = asymptomatic hepatitis.
Concomittant iv drug use and alcohol abuse can cause symptomatic hepatitis. |
|
|
Management of needle stick injury from an HIV positive patient
|
The average risk of seroconversion following a needle stick injury is about 0.3% without prophylaxis and is reduced by 80%, when post exposure prophylaxis is administered in a timely fashion.
Recommended management of high risk exposure includes 2 anti retrovirals and a protease inhibitor. A low risk exposure involves prophylaxis with the NRTIs alone. HIV serology should be tested at baseline, 6 weeks, 12 weeks and 6 months following the exposure. |
|
|
TSS
|
Toxic shock syndrome is most often caused by S. Aureus or GAS.
Factors that increase the risk of TSS include high absorbency tampons and using a single tampon for multiple days. Non menstrual causes of TSS include a variety of infections, as well as both vaginal and cesarean childbirth. Symptoms of TSS include high fevers, headaches, GI distress, neurologic symptoms, hypotension and erythematous macular rash. Treatment is supportive with admission to ICU + removal of foreign objects. No antibiotics, IVIG or corticosteroids. |
|
|
Rifampin side effects
|
Orange discolouration of urine and tears
GI upset Hepatotoxicity |
|
|
Bartonellosis
|
The disease is bacillary angiomatosis, caused by Bartonella Henselae infection.
It is caused by vascular proliferation and neutrophilic inflammatory response to the bacteria and can look similar to Kaposi's sarcoma. Biopsy of the lesion often shows tiny clumps of bacilli on Warthin-Starry silver stain. It can be treated with antibiotics : erythromycin or doxycycline for 2-4 months. If osteomyelitis, splenitis or endocarditis : 6 months. |
|
|
Histoplasma capsulatum
|
Exposure to bird and bat droppings or soil contaminated with bird or bat droppings is a well known cause of histoplasmosis.
Histoplasmosis is an indolent fungal infection and the acute lung form of the disease usually presents with chest pain, dyspnea and dry cough. Symptoms occur within 10 days of exposure. Treatment is usually with Ketoconazole or voriconazole. |
|
|
Use of aztreonam
|
It can be used safely to replace penicillin and cephalosporin in patients who have anaphylaxis to these products.
|
|
|
Chronic granulomatous disease
|
This diagnosis shoudl be suspected in patients with recurrent lymphadenitis, multiple site osteomyelitis, cutaneous abscesses, a family history of recurrent infections, or unusual infections with catalase positive organisms such as S. Aureus or Aspergillus.
X linked inheritance pattern |
|
|
Kawasaki disease
|
Vasculitis that occurs in young children.
More common in asian children. Patients initially present with URTI symptomatology. Then, aside from fever, patients have at least 4 of the following: - adenopathies - rash - strawberry tongue - swollen hands and feet - conjunctivitis ECGs should be obtained to r/o MI and echocardiogram should be obtained to confirm the diagnosis. Dilation of the coronary arteries typically appears after 10 days. High dose ASA is given to control inflammation and fever, but has no effect on aneurysm formation. IVIG are given with ASA to reduce the risk of coronary aneurysm. |
|
|
Kaposi's sarcoma
|
KS is a low grade vascular tumor associated with infection by HHV-8.
There are 4 types, the most common one is the one associated with AIDS. Cutaneous involvement is common, but the disease can cause extracutaneous manifestations, including disease in the oral cavity, GI tract and the respiratory tract. The development and progression of KS can be halted with highly active antiretroviral therapy. |
|
|
Lymphogranuloma venerum
|
LV is caused by C. Trachomatis serotypes L1, L2 and L3.
HIV seropositivity is the strongest risk factor. Primary infection with LV is characterized by a genital ulcer that heals within a few days. Inguinal lymphadenopathy occurs 2-6 weeks later and represents direct extension of the infection to inguinal lymph nodes. Diagnosis is usually made through serologic testing. Treatment is with docycycline. |
|
|
S. Aureus Vs B. Cereus "source"
|
S. Aureus : undercooked meat, potato, eggs or dairy
B. Cereus : fried or undercooked rice Sx : acute (< 24 hrs) vomiting, nausea and GI upset. |
|
|
Which drug to give for pnemocystis jirovecii prophylaxis with Bactrim allergy
|
Dapsone
|
|
|
CML genetic mutation
|
9:22 translocation
|
|
|
Type of neuropathy associated with CRF
|
Glove and stockings
|
|
|
Back pain relieved by pushing cart?
|
Spinal stenosis pain is relieved by flexing back
|
|
|
Paronychie
|
Chronic cuticle infection by C. Albicans
|
|
|
Best treatment to reduce symptoms of PAD
|
Smoking cessation
|
|
|
Prevention of vertebral fractures
|
Raloxifene
|
|
|
Effect of biphosphonates on fracture risk
|
Biphosphonates decrease fracture risk even if they don't increase bone density
|
|
|
Vitamin that reduces the risk of falling in the elderly
|
Vitamin D
|
|
|
What treatment reduces mortality during COPD exacerbation
|
BiPAP
|
|
|
What treatment reduces mortality in COPD patients
|
OXYGEN THERAPY
SMOKING CESSATION |
|
|
Which bacteria can cause pulmonary abscesses
|
S. Pneumoniae
Klebsiella H. Influenzae S. Aureus Nocardia P. Carini |
|
|
Signs of morphine OD
|
Respiratory depression
Somnolence... coma Flaccidity Cold and clammy skin Constricted pupils |
|
|
What is the risk of thrombo embolism with AF and paroxystic FA?
|
The risk is the same.
|
|
|
Treatment of restless leg syndrome
|
Ropinirole
|
|
|
Advantage of triazolam compared to other benzodiazepines
|
Shortest half life
|
|
|
Side effects of chlorpromazine
|
Pseudo parkinsonism
Photosensitivity Hypotension + HTO Constipation Xerostomia Dyskinesia Nasal congestion Retinitis pigmentosa Prolonged QT, Torsades Ileus Agranulocytosis, cytopenias.. Cholestatic jaundince syndrome Drug induced lupus Neuroleptic malignant syndrome Priapism ...... |
|
|
Prehn's sign
|
Testicular pain relieved by supporting the testicles
Associated with epididymitis Not associated with testicular torsion |
|
|
Niacin effect on lipids and glucose
|
Increases glucose
Decreases - LDL - Triglycerides - Ratio - Total cholesterol |
|
|
Sleep pattern change in elderly
|
Healthy older adults spend fewer hours in stage of deep sleep compared to younger healthy adults
|
|
|
Benefice of simvastatin
|
Simvastatin reduces the risks of sudden death, MI and stroke regardless of lipid levels.
|
|
|
Which oils contain the highest amount of omega 3
|
1. Flaxseed
2. Canola 3. Walnut |
|
|
Best treatment for petit mal seizures
|
Ethosuximide (Zarontin)
Second line agents include valproate and lamictal |
|
|
Early treatment of parkinson
|
Dopaminergic agents
Amantadine MAOI's |
|
|
Indications for PTH surgery
|
Symptomatic hypercalcemia (i.e. nephrolithiasis)
Serum calcium 1 mg/dl higher than upper limit Age < 50 Reduced bone density |
|
|
Is there cough in acute tonsillitis?
|
no
|
|
|
Features of polycythemia vera
|
Normal SaO2
Decreased EPO Increased Hb (erythrocytes) |
|
|
Sodium homeostasis in elderly?
|
Elderly patients have tendency towards hypernatremia because they have diminished thirst response.
|
|
|
Effect of amiodarone on quinidine
|
Amiodarone reduces the clearance of quinidine.
Higher risk of arrhythmias |
|
|
EEG evidence of petit mal
|
Bilateral 3 Hz spike and wave activity during attacks
|
|
|
Bilateral 3 Hz spike and wave activity during attack.
|
Petit Mal
|
|
|
How to distinguish a pseudoseizure from a real one?
|
EEG
Prolactin measurement (Increases after true seizure) |
|
|
Normal semen analysis
|
Must be obtained after 48-72 hours of abstinence
1. Volume : 2-5 cc 2. Count > 20 million/cc 3. Motility > 50% forward progression 4. Morphology > 30% normal 5. Absence of pyospermia, hyperviscosity, agglutination NB. Does not assess sperm function |
|
|
Type 4 allergic reaction
|
Type 4 reaction are T cell mediated. These cells, sensitized after contact with a specific antigen, are activated by reexposure to the antigen.
They damage tissue by direct toxic effects or through release of cytokines, which activate eosinophils, monocytes and macrophages. Disorders involving type 4 reactions : - Contact dermatitis - Hypersensitivity pneumonitis - Allograft rejection - Tuberculosis - Many drug hypersensitivity |
|
|
Typical presentation of pneumonia with S. Pneumoniae?
|
Tachypnea + fever
Lobar consolidation infiltratre |
|
|
Typical presentation of pneumonia with H. Influenzae
|
Mainly children
Lobar consolidation infiltrate |
|
|
Typical presentation of pneumonia with M. Pneumoniae
|
Tachypnea + Fever +/- Erythema multiform
Fine interstitial pattern |
|
|
Typical presentation of pneumonia with C. Pneumoniae
|
No fever + No erythema multiform
Fine interstitial pneumonia |
|
|
Typical presentation of pneumonia with Influenzae A
|
Systemic symptoms of virus
Interstitial pneumonia |
|
|
DMARDS
|
hydroxychloroquine
sulfasalazine MTX Azathioprine Cyclosporine Etanercept |
|
|
Classification of asthma
|
Mild intermittent
- daytime symptoms no more than 2 days per week - nighttime symptoms no more than 2 nights per month - FEV1 > 80% Mild persistent asthma - daytime symptoms more than 2 days per week but less than once a day - nighttime symptoms more than 2 nights per month - FEV1 > 80% Moderate persistent asthma - daytime symptoms daily and nighttime symptoms more than one night per week. - FEV1 60-80% Severe persistent asthma - continuous daytime symptoms and frequent nighttime symptoms - FEV1 <60% |
|
|
Drugs associated with Acne
|
Anti-epileptics
Corticosteroids Lithium Androgens DHEA OCP |
|
|
Rx causes of gynecomastia
|
Hormones (androgens, anabolics, estrogen)
Antiandrogens Antibiotics (INH, Ketoconazole, metronidazole) Anti-ulcer (cimetidine) Chemotherapy Captopril Digitalis |
|
|
Characteristics of neurofibromatosis
|
> 6 café au lait spots
> 2 fibromas Axillary freckling Optic gliomas Iris hamartomas (Lisch nodules) Osseous lesions |
|
|
Lab test affected by type A hemophilia
|
Activated thromboplastin time
+ Factor VIII levels |
|
|
Treatment of phenylketonuria
|
Lifelong phenylalanine restricted diet.
Mainly due to teratogenic effect on fetus. |
|
|
Transmission pattern of Duchennes
|
Sex linked recessive
|
|
|
Transmission pattern of achondroplasia
|
Autosomal dominant
|
|
|
Transmission pattern of cystic fibrosis
|
Autosomal recessive
|
|
|
Transmission pattern of hemophlias
|
Sex linked recessive
|
|
|
ITP management
|
Usually choose to treat because recovery takes a few months, and risk of bleeding
- IV Ig or oral prednisone - IV anti-D (if blood group is +) - Splenectomy only for life threatening bleeding - Avoid ASA/NSAIDs - No contact sports |
|
|
Best position for gynaecological exam for girls < 2 years old
|
Knee Chest position
|
|
|
Antiarrhythmic to give to a patient presenting with SVT and WPW?
|
Procainamide!
Do not give adenosine, BB, CCB |
|
|
Antihypertensive associated with rebound hypertension on withdrawal?
|
Clonidine
|
|
|
Most common antibiotics associated with esophgitis
|
Tetracyclines
|
|
|
Brown Séquard Syndrome
|
Ipsilateral Weakness
Contralateral loss of sensation Loss of proprioception + spastic paralysis + hyperactive deep tendon reflexes ipsilaterally |
|
|
Transmission of huntington's
|
Autosomal dominant
|
|
|
Treatment of diabetic gastroparesis
|
Smaller more frequent meals
Improve glycemic control Metoclopramide Domperidone (less effective than metoclopramide) |
|
|
Leading cause of morbidity and mortality within the first year following cardiac transplant?
|
Infection
|
|
|
Most important test for diagnosing hepatitis A infection
|
Anti Hepatitis A IgM
|
|
|
Possible treatments of myasthenia gravis
|
Anticholinesterase drugs
Immunosuppressants Corticosteroids Thymectomy Plasmapheresis |
|
|
What imaging method should be ordered after a myasthenia gravis diagnosis?
|
Chest CT or MRI to r/o thymoma
|
|
|
What is active charcoal ineffective against?
|
Charged (ionized) chemicals and dissociated salts such as :
- iron - lithium - fluoride - cyanide - mineral acids - alkalis - inorganic compounds |
|
|
Treatment of toxic iron ingestion
|
Gastric evacuation with ipecac or lavage
Whole bowel irrigation with polyethylene glycol Chelation with deferoxamine |
|
|
Characteristic feature of secretory diarrhea
|
Persistent diarrhea despite fasting
|
|
|
Electrolytic causes of torsades de pointes
|
HypoMg
HypoK |
|
|
Main organism responsible of chronic diarrhea in HIV positive patients
|
Cryptosporidium
|
|
|
Significant side effect of PTU
|
Agranulocytosis
Liver damage |
|
|
Antihypertensive to give to patients with angina pectoris
|
Amlodipine
|
|
|
Type of hypokalemia associated with hypoMg
|
HypoK refractory to K replacement until Mg is repleted
|
|
|
What can aggravate grave's ophtalmopathy?
|
Radioactive iodine treatment
|
|
|
How to differenciate papilledema from optic neuritis?
|
Optic neuritis is usually associated with pain on eye movement and with vision loss.
|
|
|
Changes associated with papilledema
|
Blind spot enlargement
Microhemorrhages Blurring of the disk margins Hyperemia Engorgement of retinal veins |
|
|
If a patient has S. Aureus GU infection, what should be done?
|
Look for the primary infection!
|
|
|
Mechanism of action of organophosphate intoxication
|
Cholinesterase inhibition
|
|
|
Iliotibial band syndrom
|
occurs in runners and presents with stinging pain over the lateral femoral epicondyle
|
|
|
Osteitis Pubis
|
occurs in distance runners and presents with pain in the anterior pelvic area and tenderness over the symphysis pubis
|
|
|
Which Rx is more effective than epinephrine for the treatment of asystole?
|
Vasopressin
|
|
|
ddx of pulseless electrical activity?
|
Hypovolemia
Hypoxia Acidosis Hypothermia Hyperkalemia or Hypokalemia Hypoglycemia Hypocalcemia Tablets or toxins Tamponnade Tension pneumothorax Thrombosis (MI / PE) Trauma |
|
|
How is nasopharyngeal carcinoma monitored
|
Measurement of EBV antibodies
This carcinoma is more frequent in the South China Sea region and there is a hereditary predisposition. Symptoms develop late including unilateral bloody nasal discharge, obstruction and numbness. Treatment with RoRx, CoRx and rarely Chx. |
|
|
Most common symptoms of nicotine withdrawal?
|
Impaired concentration
Irritability Tension Disturbed sleep Drowsiness Intense longing for a cigarette Headaches Increased appetite which leads to weight gain |
|
|
Treatment of AMS
|
Treat very symptomatic patients
with acetazolamide or dexamethasone. Plus, recommend good hydration. Acetazolamide can be given prophylactically to patients who had AMS in the past. |
|
|
Solar eclipse retinopathy
|
|
|
|
Diagnosis of HIT
|
50% reduction in platelets 5-15 days after initiation of heparin therapy
Tests : - Carbon 14 serotonin release assay - ELISA for HIT-Ig - Flow cytometry |
|
|
Treatment of HIT
|
Stop Heparin and LMWH
Stop Warfarin (thrombotic effect) Substitute with Heparin alternatives (Fondaparinux, Hirudin, Argatroban, Danaparoid) |
|
|
Drugs that reduce both reload and afterload
|
Nitroprusside
Prazosin ACEI and ARBs |
|
|
First line vasopressors
Second line vasopressors |
First line
- Norepinephrine - Dopamine Second line - Epinephrine - Vasopressin - Phenylephrine |
|
|
Side effects of niacin
|
Myalgias
Hepatotoxicity HIgh blood sugar levels |
|
|
Causes of hypoxemia with Normal A-a gradient
|
Hypoventilation
Elevated altitude |
|
|
Causes of UPPER interstitial lung disease
|
F Farmer's lung
A Ankylosing Spondilitis S Sarcoidoisis S Silicosis T Tuberculosis E Eosinophilic Granuloma N Neurofibromatosis |
|
|
Causes of LOWER interstitial lung disease
|
B Bronchiolitis Obliterans with organizing pneumonia
A Asbestosis D Drugs (Nitrofurantoin, INH, Amiodarone, Hydralazine, Chemo) R Rheumatoid Arthritis A Aspiration S Scleroderma H Hamman Rich Syndrome (acute interstitial lung disease) |
|
|
Extrapulmonary manifestations of sarcoidoisis
|
Cardiac : arrhythmias and sudden death
Ophtalmic : anterior uveitis Arthralgia Peripheral lymphadenopathy Hepatomegaly Skin : skin papules, erythema nodosum, lupus pernio |
|
|
Acute sarcoid syndromes
|
Lofgren
Heerfordt-Waldenstrom |
|
|
Lofgren Syndrome
|
Fever
Erythema nodosum Bilateral hilar lymphadenopathy Arthralgias |
|
|
Heerfordt-Waldenstrom
|
Fever
Parotid Enlargement Anterior Uveitis Facial nerve palsy |
|
|
Hypersensitivity pneumonitis causes
|
Farmer's lung
- Thermophilic Actinomycetes Bird Breeder's lung - Chlamydia Psitacci Humidifier Lung - Aureabasidium pullulans Sauna Taker's Lung - Aureabasidium spp |
|
|
Rx that increase survival in pulmonary hypertension patients
|
Nifedipine
Diltiazem Amlodipine |
|
|
Is smoking a risk factor for bronchogenic adenocarcinoma?
|
NO
|
|
|
Centrally located bronchogenic cancers?
|
SCLS (oat cell)
SCC (squamous) |
|
|
Peripherally located bronchogenic cancers?
|
Adenocarcinoma
Large cell (anaplastic) |
|
|
Pulmonary cancer risk factors
|
Smoking
Asbestos Asbestos + Smoking (80-90x) Passive smoking Radon Uranium HIV Nickel, Chromium, Arsenic Genetic damage Parenchymal scarring Air pollution |
|
|
Mecahnism of action of warfarin
|
Inhibitor of epoxide reductase, thus depleting vitamin K stores
|
|
|
Management of nurse with accidental exposure to HBV needlestick if she received her 3 vaccines?
|
1. Test for HBsAg Antibodies
2. If > 10, reassure 3. If < 10, HBV Ig should be administered immediately as well as HBV vaccine booster If the patient never received her vaccines, she should get HBV Ig and receive HBV vaccination series (3 doses). |
|
|
Most common nutritional deficiency in Canada?
|
Iron
|
|
|
Management of nurse with accidental exposure to HBV needlestick if she received her 3 vaccines?
|
1. Test for HBsAg Antibodies
2. If > 10, reassure 3. If < 10, HBV Ig should be administered immediately as well as HBV vaccine booster If the patient never received her vaccines, she should get HBV Ig and receive HBV vaccination series (3 doses). |
|
|
Most common nutritional deficiency in Canada?
|
Iron
|
|
|
Cryptosporidiosis investigation?
|
Acid fast stain of the stool
|
|
|
West nile virus transmission and presentation
|
Mosquito Bites
Neuro Symptoms (encephalitis...) |
|
|
Parkinson Disease Risk Factors
|
Exposure to pesticides
Head injury Male gender Positive family history Rural living |
|
|
Non motor and non drug related symptoms of Parkinson's
|
Anxiety
Dementia Hypersexuality Loss of smell Orthostatic hypotension Shortness of breath Sleep disturbances |
|
|
Post MI pericarditis Vs. Dressler syndrome
|
Dressler syndrome occurs 8-10 weeks post MI, while post MI pericarditis occurs 7-10 days after (propagation of inflammation).
|
|
|
DDX of pulsus paradoxus
|
Cardiac Tamponnade
Constrictive Pericarditis Severe obstructive pulmonary disease Tension Pneumothorax Cardiogenic shock Pulmonary embolus |
|
|
Jugular venous pressure differences between constrictive pericarditis and cardiac tamponnade
|
Tamponnade : no y descent
Constrictive pericarditis : prominent y descent (Friedrich's sign) |
|
|
AAA screening guidelines
|
Men over 60 with one relative known to have AAA
Men 60-75 who have ever smoked should receive one time U>S screening |
|
|
Characteristics of hairy cell leukemia
|
Rare malignancy of B lymphocytes
Male > Female Prognosis > 10 years Pancytopenia Universal monocytopenia (predisposition to mycobacterial infections) No adenopathies Fatigue Splenomegaly Infiltration of spleen with lymphocytes with hair cell projections. |
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Why does warfarin have an initial procoagulant effect?
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Warfarin inhibits the synthesis of vitamin K by inhibition of the vitamin k epoxide reductase.
The following factors are thus reduced : 2,7,9,10, C &S. Given that the half life of proteins C and S are short, and the half life of the other factors are longer; the initial "deficiency" in proteins C and S causes a hyper coagulable state. |
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Treatment of Hodgkin's Lymphoma?
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Stage I-II : Chemotherapy followed by local RoRx
Stage III-IV : Chemotherapy with RoRx for bulky disease. Relapse : high dose chemotherapy + bone marrow transplant. |
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Complications of treatment of Hodgkin's lymphoma?
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Cardiac : post RoRx or adriamycin toxicity
Pulmonary : post RoRx fibrosis/pneumonitis or Bleomycin fibrosis Infertility Secondary malignancy in irradiated field - 2% risk MDS, AML (within 8 years) - solid tumours of lung, breast (>10 years after treatment) - non Hodgkin's lymphoma Hypothyroidism : post RoRx Infection |
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Good prognostic factors of ALL?
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Young
WBC < 30 T-cell phenotype Absence of Ph chromosome Early attainment of complete remission |
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Can be warfarin be used in cases of HIT?
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NO
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Diagnosis of HIT?
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50% reduction of platelets 4-15 days after heparin initiation
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What is post transplant lymphoproliferative disease?
Method of prevention? |
Any patient who is chronically immunosuppressed is at risk for development of a PTLPD.
Heart 4% risk Kidney 1% risk PTLDs usually occur at extra nodal locations. They may respond to reduction of immunosuppression, but since the organs are necessary, RoRx can also be used. EBV is thought to contribute to this disease. The use of Acyclovir during Tx contributes to eradicating the virus and the resolution of malignancy caused by it. |
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Sézary syndrome
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Mucosis Fungoides
Lymphadenopathy Erythroderma Presence of atypical T lymphocytes in the blood |
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Leonine Facies?
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Think of Mycocis Fungoides
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Stages of Seminoma cancer
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Stage I : testes
Stage II : retroperitoneal involvement Stage III : supradiaphragmatic nodal involvement |
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Treatment of seminomas
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Stage I : Surgery
Stage II : Surgery + radiation Stage III : Surgery + radiation Relapse : chemotherapy |
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Fungal infections after bone marrow transplant
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These usually occur after the first 7 days of transplant. These infections can even occur after resolution of neutropenia at day 45.
Candida Aspergillus CMV pneumonia Parasitic infection HHV-6 infection of skin Bacterial infection 1-4 weeks post Nocardia 30-90 days post HSV reactivation 2 weeks post |
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Stages of Mycosis Fungoides
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Stage 1 : patches (Nitrogen mustard)
Stage 2 : plaques (Nitrogen mustard) Stage 3 : Sézary (RoRx) |
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Lung cancer associated with gynecomastia?
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Large Cell Cancer
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Associations of lung adenocarcinoma?
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Clubbing
Hypertrophic pulmonary osteoarthropathy Thrombophlebitis Nonbacterial Verruous endocarditis |
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Association of lung squamous cell cancer?
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hypercalcemia by PTHrP
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Common variable immunodeficiency?
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Syndrome characterized by hypogammaglobulinemia in combination with phenotypically normal B lymphocytes.
The disease presents suddenly in the third or fourth decade after recurrent infections and lack of response to vaccines. These patients are at increased risk of lung disease, autoimmune phenomenon and chronic diarrhea. |
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What should intussusception in adults raise the suspicion of?
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Burkitt's lymphoma.
This disease is more common in people living in africa where the rate of EBV is higher and is associated with the lymphoma. It is highly associated with 8:14 translocation. High grade lymphoma responsive to chemotherapy. |
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Primary agents of osteomyleitis in sickle cell anemia patients?
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Salmonella paratyphi
S. Aureus |
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Diseases associated with ALL
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Down Syndrome
Fanconi's anemia Ataxia telangiectasia |
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What is POEMS?
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a constellation of symptoms associated with osteosclerotic multiple myeloma.
Polyneuropathy Organomegaly Endocrinopathy Multiple Myeloma Skin changes |
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Long term treatment of sickle cell anemia
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Hydroxyurea
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Treatment of acute promyelocytic leukaemia?
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Oral tretinoin if 15L17 translocation present
Reduces the risk of DIC |
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Treatment of wilm's tumour
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Surgery + chemotherapy
Painless mass that does not cross the midline. +/- hyperntension / microscopic hematuria |
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Common complaints in Walndestrom's gammaglobulinemia
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Hyperviscosity
Vision changes Raynaud Phenomenon |
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Positive myeloperoxidase test significance?
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AML
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Li-Fraumeni Syndrome
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Mutation in one copy of the p53 gene.
Predisposes patients to sarcomas, CNS tunours and carcinomas |
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Triggers for TTP and its pentad
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Clopidogrel
OCP Cyclosporine HIV infection Autoimmune disease Pentad 1. fever 2. Microangiopatic hemolytic anemia 3. Renal failure 4. Neurological symptoms 5. Thrombotic purpura |
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Wilson's disease features?
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Basal ganglia
Hemolytic anemia Cirrhosis - Portal Hypertension Arthritis Renal Failure - Fanconi syndrome Hemoyltic anemia Kayser-Fleishcer rings |
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Wilson's disease investigation
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Gold : Liver Bx
Low serum ceruloplasmin High urinary copper |
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Rule of thirds in carcinoids
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1/3 metastasize
1/3 accompanied by second malignancy 1/3 present with multiple carcinoid tumours |
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Plummer vinson syndrome
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Ferriprive anemia
Upper esophageal webs Dysphagia |
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Henoch Schnolein Tetrad
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Purpuric rash
Arthralgias Abdominal pain Glomerular renal involvement Association with numerous GI complications, most classically intussusception, pancreatitis and cholecystitis. |
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Meconium Ileus
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Pathognomonic of Cystic Fibrosis
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Omphalocele
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Herniation of abdominal viscera through the abdominal wall into the base of the umbilical cord covered by amniotic membrane and peritoneum but no skin.
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Types of E. coli
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Enterohemorragic
Enterotoxigenic Enteroinvasive Enteropathogenic |
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Bethanecol cystometry test
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Bethanecol is a parasympathetic
If detrusor does not contract = detrusor damage if spasticity = UMN lesion |
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Neurofibromatosis II
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Acoustic Neuromas
Multiple intracranial meningiomas Chromosome 22 |
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Tuberous Sclerosis
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Shagreen spots (leathery cutaneous thickening of the skin
) Facial hamartomas Seizures Mental retardation |
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Von Hippel Lindau Syndrome
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Hemangiomas
Renal cell cancer Polycythemia |
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Headache that gets better with vomitting and gets worse in the morning?
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Head tumour
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Conduction Aphasia
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Problems with repeating and naming.
Preserved fluency and comprehension Lesion : arcuate fasciculus |
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Broca's aphasia
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Problems with fluency
Preserved comprehension Naming and repetition are impaired Lesion : frontal lobe |
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Wernicke's aphasia
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Problems with comprehension
Preserved fluency Naming and repetition are impaired Lesion : temporal lobe |
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MCA stroke
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Aphasia (dominant hemisphere)
Neglect Contralateral hemiparesis Gaze preference Homonymous hemianopsia |
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ACA stroke
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Leg paresis
Amnesia Personality changes Cognitive changes Foot drop |
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Basilar Stroke
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Coma
Cranial nerve paralysis Apnea Visual symptoms .... |
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PCA stroke
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Homonymous Hemianopsia
Memory deficits Dyslexia/Alexia |
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Cluster headache
- Prevention - Abortive therapy - Prophylactic therapy |
Prevention
- Avoidance of triggers (alcohol, physical activity) Abortive - Oxygen - Triptans Prophylactic - Prednisone - Lithium - CCB |
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Serious 2nd effects of Topiramate
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Short term memory loss
Word finding difficulties Renal stones |
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Serious 2nd effects of Carbamazépine
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Diplopia
Ataxia Induction of P450 Liver toxicity Blood dyscrasias |
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Serious 2nd effects of Lamotrigine
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Stevens Johnson Syndrome
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Serious 2nd effects of Dilantin
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Gingival hyperplasia
Anemia Teratogenicity Hirsutism Nystamus |
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Possible presentation of SEVERE CO intoxication on ABG?
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Metabolic acidosis caused by lactic acid production (ischemic)
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Bartter Syndrome
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Hypokalemia
Metabolic acidosis Hypercalciuria Mental retardation |
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Thrombolytic Therapy Contra-indications
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Stroke or head trauma in the past 3 months
Active Bleeding Hemorrhagic stroke or prior hemorrhage Previous use of thrombolytic therapy Recent Myocardial infarct Major surgery in the past 14 days GI or GU bleed in the past 21 days Seizures at onset of stroke |
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Brain Death Diagnosis
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Core body temperature of at least 32 degrees
Absence of intoxication or poisoning Absence of metabolic or endocrine derangements Evidence of catastrophic cerebral event Absence of brain stem reflexes |
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Fanconi Syndrome
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Proximal renal tubular dysfunction type II
Hypophosphatemia Glycosuria (normal glycemia) |
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Type I RTA
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Distal tubule injury
Defect in urinary NH4 production Acidification of urine |
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Type IV RTA
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Hyperkalemic, Hyperchloremic metabolic acidosis
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Most common type of bladder cancer
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Transitional cell carcinoma
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Calcium oxalate stone prevention (non pharmacologic)
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Increase Calcium intake (reduces oxalate absorption)
Increase fluid intake Limiting sodium intake |
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Polycystic kidney complications
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Hypertension
Hematuria Rupture Cerebral Berry aneurysms Renal calculi Infection |
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Dominant Vs Recessive PKD
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Dominant = mainly adults > 30
Recessive = children |
