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254 Cards in this Set
- Front
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What is the cutoff for differentiating High albumin from Low albumin gradient in ascites?
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11g/L serum to fluid albumin ratio
High > 11g/L Low <11g/L |
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What are the most common causes of a high albumin gradient ascites?
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1. Portal hypertension (80% of pts with ascites) ie from cirrhosis or hepatitis
2. CHF (<5% of patients) particularly RHF or Budd-Chiari 3. Massive liver mets 4. Myxedema |
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What are the most common causes of a low albumin gradient ascites?
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1. Peritoneal carcinomatosis (approx. 10% of patients with ascites)
2. Peritonitis, infection 3. Pancreatitis/Serositis 4. TB 5. Nephrotic syndrome |
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What are the most common causes of mechanical bowel obstruction in the large intestine in adults?
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1. Cancer
2. Diverticulitis 3. Volvulus |
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What are the most common causes of mechanical bowel obstruction in the small intestine in adults?
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ABC
1. Adhesions 2. Bulge (hernias) 3. Volvulus 4. Cancer |
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What are the most common primary cancers which metastasize to the adrenal glands?
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- Melanoma (50%)
- Breast ca (30-40%) - Lung ca (30-40%) - Renal ca (10-20%) - GI tumors (10-20%) |
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What are some common causes of greater than normal height in childhood?
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1. Familial tall stature
2. Precocious puberty 3. Acromegaly 4. Hyperthyroidism 5. Klinefelters syndrome 6. Marfan syndrome 7. Obesity |
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Causes of short stature in children?
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ABCDEFGHIJKL
1. Abuse 2. Bad cancers 3. Chromosomal (turners) 4. Delayed (constitutional) 5. Endocrine (GH deficiency, hypothyroidism) 6. Familial short stature 7. GI disease (celiac, IBD) 8. Heart (congenital disease) 9. Immune disorders 10. Joint and bone dysplasias 11. Kidney failure 12. Lung disease (CF, asthma) |
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Causes of macrocephaly?
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1. Tay Sachs
2. Maple syrup urine disease 3. Neurocutaneous syndromes (NF, tuberous sclerosis) 4. Hydrocephalus 5. Increase ICP 6. Skeletal dysplasia 7. Acromegaly 8. Intracranial hemorrhage |
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Causes of microcephaly?
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1. Fetal toxin exposure (FAS)
2. Chromosomal trisomies 3. Congenital infections 4. Cranial anatomic abnormalities 5. Metabolic disorders 6. Neural tube defects |
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What chromsomal deletion in Di George syndrome?
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22q11
"Catch 22" |
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What are the features of Di George syndrome?
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CATCH 22
Cleft palate Abnormal facies Thymic aplasia (Tcell deficiency) Cardiac defects Hypocalcemia (secondary to parathyroid aplasia |
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What branchial embyronic (Cleft, Arch, Pouch) displays abberant growth in Di George syndrome?
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Branchial pouches 3 and 4
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What are some features of Hyper-IgM disease?
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Deftect in Tcell CD40L
Low IgG Excessive IgM increased resp and gastro infections by encapsulated bacteria |
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What are some features of common variable immunodeficiency?
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Autosomal disorder of Bcell differentiation
Low Ig levels increased resp and gastro infections beginning in second decade of life Associated with increased risk of malignant neoplasms and autoimmune disorders |
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A 2 year old boy presents with frequent infections, eczema and thrombocytopenia. What is the diagnosis?
What is the abnormal gene? What is the treatment? |
Wiskott-Aldrich syndrome
WASP gene defect Splenectomy + antibiotic prophy + IVIG, BM transplant? |
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What is the treatment for chronic granulomatous disease?
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prophylatic antibiotics
gamma-IFN corticosteriods BM transplant |
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Patient presents with chronic dermatitis, recurrent skin abcesses, coarse facial features and retained primary teeth. What is the diagnosis?
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Hyper-IgE disease
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Patient presents with abnormal platelets, albinism, neurological dysfunction and recurrent fungal, Staph aureus and streptococcal infections.
What is the diagnosis? |
Chediak-Higashi syndrome
Dysfunction of neutrophils large granules seen in granulocytes on peripheral smear |
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Patient presents with recurrent bacterial infections of URT and skin infections. Also has short stature, abnormal facies and cognitive impairment. What is the diagnosis?
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Leukocyte adhesion deficiency (types 1 and 2)
Type 1 - abnormal leukocyte integrins Type 2 - abnormal E-selectin and short stature, abnormal facies and cog impairment. |
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What is the treatment for Leukocyte adhesion deficiency type 1?
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Prophylatic antibiotics
bone marrow tx |
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What is the treatment for Leukocyte adhesion deficiency type 2?
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Prophylatic antibiotics
Fucose supplementation |
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What are some common congenital abnormalities seen in pts w/ Down syndrome?
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Duodenal atresia
Alzheimers disease Cardiac defects particularly ASD |
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What are some common congenital abnormalities seen in pts w/ Edwards syndrome?
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Severe mental retardation
Small mouth Limb abnormalities (malposition, rockerbottom feet, overlapping fingers on grasp) Cardiac defects GI abnormalities Frequently fatal within first year |
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What are some common congenital abnormalities seen in pts w/ Patau's syndrome?
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Cleft lip and palate
Cardiac defects CNS defects Severe mental retardation Rounded nose Polydactyly Rocker bottom feet Frequently fatal within 1st year |
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Male pt presents with mental retardation, large face with prominent jaw, large ears, macrorchidism, hyperactivity and seizures. What is the diagnosis?
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Fragile X syndrome
X-linked - ends of X chromosome are fragile because of an abnormal # of terminal CGG repeats |
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Patient presents with overeating, obesity, decreased muscular tone in infancy, mental retardation and small hands and feet. What is the diagnosis?
What is the genetic defect? |
Prader-Willi syndrome
15q11-15q13 inherited from father |
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Pt presents with puppet-like movements, happy mood, unprovoked laughter, mental retardation and seizures. What is the diagnosis?
What is the genetic defect? |
Angelman syndrome
15q11-15q13 inherited from mother |
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What is the approximate wt gain for a women with a BMI of 22 during pregnancy?
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13kg - 18kg
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What is the approximate wt gain for a women with a BMI of 28 during pregnancy?
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11kg - 16kg
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What is the approximate wt gain for a women with a BMI of 35 during pregnancy?
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7kg - 11
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What is the recommended daily caloric intake during pregnancy?
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2500kcal
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What gestational age is generally considered to be the earliest with a resonable chance of survival?
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24 weeks
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Low maternal pregnancy-associated plasma protein A (PAPP-A) is associated with what?
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Trisomies 18 and 21
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High levels Alpha-fetoprotein levels when performed during 16-18 weeks are associated with what?
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Neural tube defects or multiple gestations
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Low levels Alpha-fetoprotein levels when performed during 16-18 weeks are associated with what?
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Increased risk of trisomy 18 or 21
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What values in a Quad test would suggest Down syndrome?
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AFP - Decreased
hCG - Increased Unconjugated estradiol - Decreased Inhibin A - Increased |
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What values in a Quad test would suggest Edward's syndrome?
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AFP - Decreased
hCG - Decreased Unconjugated estradiol - Decreased Inhibin A - Increased |
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Risk factors for gestational DM?
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- Previous DM (gestational or otherwise)
- FHx - >25 years of age - obesity - prior polyhydramnios - recurrent abortions - prior stillbirth - African or Pacific Islander - hypertension - prior macrosomnia - corticosteroid use - PCOS |
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Which Respiratory volume Increases during pregnancy?
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Tidal volume
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What gestational age is chorionic villi sampling done?
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9-12 weeks
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What are the complications of gestational DM for the fetus?
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hypoglycemia
hypocalcemia fetal macrosomnia IUGR neural tube defects cardiac defects intrauterine fetal death |
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What are the complications of gestational DM for the mother?
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Maternal polyhydramnios
preeclampsia renal insufficiency diabetic ketoacidosis hyperosmolar hyperglycemic non ketotic coma retinopathy birth complications assoc with macrosomnia |
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What are the risk factors for preeclampsia?
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HTN
nulliparity prior Hx of preeclampsia <15 or >35 yr of age multiple gestations vascular disease chronic HTN Renal disease DM obesity African ancestry |
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What are the findings suggestive of preeclampsia?
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HELP HER!
H- HTN E - edema L - Liver enzyme elevation P - proteinuria H - headache E - eye symptoms R - renal impairment |
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What are the complications of preeclampsia?
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HELLP syndrome
Hemolysis Elevated Liver enzymes Low Platelets others include: eclampsia stroke IUGR pulmonary edema maternal organ dysfunction oligohydramnios preterm delivery hemolysis placental abruption renal insufficiency encephalopathy DIC |
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What is the treatment for hyperemesis gravidarum?
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What Shannan had...
Adequate hydration + eletrolytes Avoidance of large meals Pyridoxine Doxylamine |
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True or False?
Warfarin has teratogenic/neonatal effects and must not be used during pregnancy or when breast feeding? |
False
Can be used in breast feeding but NOT in pregnancy! |
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What are the effects of maternal cocaine use on the fetus?
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IUGR
prematurity facial abnormalities delayed intellectual development stroke |
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What are the effects of maternal ethanol use on the fetus?
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FAS
- mental retardation - IUGR - sensory and motor neuropathy - facial abnormalities (thin upper lip, smooth philtrum, small eye opening) - spontaneous abortion - intrauterine death |
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What are the effects of maternal stimulant use on the fetus?
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IUGR
congenital heart defects cleft palate |
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What are the effects of maternal tobacco use on the fetus?
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Spont abortion
prematurity IUGR intellectual impairment higher risk of neonatal resp infections |
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List some commonly used meds which CANNOT be used in pregnancy?
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Fluoroquinolones
TMP-SMX ACE-inhibitors Sulphonylureas Warfarin Valproic acid Thiazide diuretics |
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What are the common congenital infections?
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TORCHS
Toxoplasmosis Other (VZV, GBS, Chlam, Gonorr) Rubella/Rubeola CMV Hep B/HIV/HSV Syphillis |
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What are the most common causes of vaginal bleeding in early pregnancy?
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1. Ectopic pregnancy
2. Threatened or inevitable abortion 3. Physiological bleeding (related to implantation) 4. Uterine/cervical pathology 4. |
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What are the possible fetal/neonatal effects of a maternal infection with Toxoplasmosis?
What is the treatment? |
Hydrocephalus
Chorioretinitis Microcephaly Spontaneous abortion Seizures Treatment with Pyrimethaime, sulfadizaine, and folinic acid In addition mother should also avoid: gardening, raw meat, cat litter boxes, and unpasteurized milk |
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What are the possible fetal/neonatal effects of a maternal infection with VZV?
What is the treatment? |
Prematurity
Encephalitis IUGR CNS abnormalities Limb abnormalities Blindness Death Treatment with VZIG to nonimmune mother within 96hrs of exposure and to neonate if born with active infection Remember vaccine is contrainidicated in pregnancy (live vaccine) |
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What are the possible fetal/neonatal effects of a maternal infection with GBS?
What is the treatment? |
Meningitis
Sepsis Treatment with IV ampicillin or clindamycin during labour or in infected neonates |
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What are the possible fetal/neonatal effects of a maternal infection with Gonorrhea/Chlamydia?
What is the treatment? |
Spontaneous abortion
Sepsis Conjunctivitis Treatment with erythromycin given to mother or neonate |
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What are the possible fetal/neonatal effects of a maternal infection with Rubella?
What is the treatment? |
Skin lesions (blueberry muffin)
Congenital rubella syndrome which includes: IUGR, deafness, cardiovas abnormalities, vision abnorm., CNS abnorm., hepatitis Treatment: mother should be immunized before attempting to become pregnant No treatment if infection develops during pregnancy |
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What are the possible fetal/neonatal effects of a maternal infection with Rubeola (measles)?
What is the treatment? |
IUGR
High risk of neonatal death Treatment: maternal immunization before becoming pregnant, Ig given to mother if infection develops during pregnancy |
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What are the possible fetal/neonatal effects of a maternal infection with CMV?
What is the treatment? |
IUGR
CNS abnorm. Chorioretinitis mental retardation vision abnorm. hydrocephalus seizures NO treatment if infection develops during pregnancy Good hygiene decreases risk of transmission Ganciclovir may decrease effects in neonates |
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What are the possible fetal/neonatal effects of a maternal infection with HIV?
What is the treatment? |
Viral transmission in utero (5% risk)
Rapid progression of disease to AIDS in neonates Treatment: AZT significantly reduces vertical transmission risk |
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What are the possible fetal/neonatal effects of a maternal infection with Hep B?
What is the treatment? |
Prematurity
IUGR Neonatal death Treatment: Maternal vaccination, vaccination of neonate shortly after birth and Ig administration |
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What are the possible fetal/neonatal effects of a maternal infection with HSV?
What is the treatment? |
Prematurity
IUGR High risk of neonatal death CNS abnormalities Treatment is delivery by C-section Acyclovir may be beneficial in neonates |
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What are the possible fetal/neonatal effects of a maternal infection with syphilis?
What is the treatment? |
Neonatal anemia, deafness,
hepatosplenomegaly Treatment: maternal or neonatal penicillin |
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What are some common causes of spontaneous abortion?
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CUPID'S SIGHT
Coagulopathy Uterine issues (fibroids, cervical incompetence) PCOS Immunologic causes DM Substance use (tobacco, etoh) Stress Infection Genetic issues Hyperprolactinemia Thyroid disorder |
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In a THREATENED abortion:
Uterine Bleeding: Cervical os: Uterine contents expelled: Diagnosis: Treatment: |
THREATENED ABORTION
Uterine Bleeding: INITIAL 20wks OF GESTATION Cervical os: CLOSED Uterine contents expelled: NONE Diagnosis: US DETECTS VIABLE FETUS Treatment: BED REST LIMITED ACTIVITY |
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In a INEVITABLE abortion:
Uterine Bleeding: Cervical os: Uterine contents expelled: Diagnosis: Treatment: |
INEVITABLE ABORTION
Uterine Bleeding: INITIAL 20 wks + PAIN Cervical os: OPEN Uterine contents expelled: NONE Diagnosis: POSSIBLE DETECTION OF FETUS BY U/S Treatment: MISOPROSTOL OR D&C |
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In a INCOMPLETE abortion:
Uterine Bleeding: Cervical os: Uterine contents expelled: Diagnosis: Treatment: |
INCOMPLETE ABORTION
Uterine Bleeding: INITAL 20wks Cervical os: OPEN Uterine contents expelled: SOME Diagnosis: BASED ON Hx OR EXPELLED PRODUCTS OF CONCEPTION Treatment: MISOPROSTOL OR D&C |
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In a COMPLETE abortion:
Uterine Bleeding: Cervical os: Uterine contents expelled: Diagnosis: Treatment: |
COMPLETE ABORTION
Uterine Bleeding: INITIAL 20wks Cervical os: OPEN Uterine contents expelled: ALL Diagnosis: BASED ON Hx OF EXPELLED PRODUCTS OF CONCEPTION Treatment: NONE |
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In a MISSED abortion:
Uterine Bleeding: Cervical os: Uterine contents expelled: Diagnosis: Treatment: |
MISSED ABORTION
Uterine Bleeding: PRESENT OR WITH PAIN Cervical os: CLOSED Uterine contents expelled: NONE Diagnosis: U/S DETECTS UNVIABLE FETUS Treatment: MISOPROSTOL OR D&C |
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What are the causes of symmetrical IUGR?
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20% of IUGR
Congenital infection Chromosomal abnorm. Maternal drug use |
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What are the causes of Asymmetrical IUGR?
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80% of IUGR
Multiple gestation Poor maternal health placental insufficiency |
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What is the treatment of a pregnant women with PROM <32 weeks gestation?
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Give corticosteriods (lung development)
Prophylatic antibiotics (GBS) Induce labor once amniotic fluid analysis indicates fetal lung maturity |
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What is the treatment of a pregnant women with PROM 32-34 weeks gestation?
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Amniotic fluid analysis for lung maturity
If mature lungs: induce labor If nonmature lungs: corticosteriods and antibiotics Induction at 34 weeks |
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What is the treatment of a pregnant women with PROM >34 weeks gestation?
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Antibiotics administration and induction of labor
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How is fetal lung maturity determined?
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Lecithin: Sphingomyelin ratio in the amniotic fluid
Mature if L:S > 2 (+ presence of phosphatidylglycerol) Nonmature if L:S < 2 |
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T/F
A cervical length of 20mm is associated with an increased risk of premature labor? |
True
<25mm = increased risk >35mm = low risk |
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What is the management of premature labor?
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Hydration + activity restriction
Tocolytic therapy (MgSO4, ritodrine, **terbutaline**, indomethacin or nifedipine) if <34 weeks ** commonly used |
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What are the 2 most common causes of vaginal bleeding after 20weeks gestation?
How can you differentiate the 2? |
Placenta previa (painLESS bleeding)
Placental abruption (painFUL bleeding) |
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What are the common causes of abdo pain in pregnancy?
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CRUEL CRAMP
Constipation Round Ligament stretching UTI Ectopic pregnancy Labor Cholestasis Rupture (ectopic or uterine) Abruptio placenta Misscarriage Preeclampsia |
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What marks the Latent phase of Stage 1 of Labor?
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Start of Uterine contractions until 4cm dilation.
During this phase: cervical effacement and gradual dilatation |
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What marks Stage 2 of Labor?
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Full dilation (10cm) to delivery of neonate
During this phase: Fetal descent through birth canal driven by uterine contractions |
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What marks Stage 3 of Labor?
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Delivery of neonate until placental delivery
Placenta separates from uterine wall up to 30 min after delivery. Uterus normally contracts to expel placenta and prevent hemorrhage |
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What marks Stage 4 of Labor?
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Initial post-partum hr marked by hemodynamic stabilization of mother
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What marks the Active phase of Stage 1 of Labor?
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From 4cm dilation to 10cm cervical dilation
During this phase: regular uterine contractions, quick progression of cervical dilation and effacement |
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What are the components of the Apgar score?
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Appearance (blue/blue extremities/pink)
HR (>/< 100/min) RR (Regular, irregular) Tone (none/partial/active) Response to stimulus (none/grimace/strong cry) |
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Describe the genotype of a complete hydatidiform molar pregnancy?
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46XX
Formed only by fathers genetic material (empty egg fertilized by sperm) |
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Describe the genotype of a incomplete hydatidiform molar pregnancy?
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69XXY genotype
Egg fertilized by 2 sperm |
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A girl with precious puberty is administered GnRH. Labs show increased levels of LH and FSH, with an increase following GnRH admin as well. Interpret the results
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Suggests pituitary gland activation as the cause of the precocious puberty
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A girl with precious puberty is administered GnRH. Labs show low levels of LH and FSH with no response to GnRH. Interpret the results
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Excess sex steriod production
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What are the 3 causes of vaginitis (overgrowth of normal flora) and how can you differentiate them?
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Gardnerella vaginalis, Trichomonas, Candida albicans
GV - Mild vaginal inflammation, Thin white fishy odor discharge, Clue cells, +ve whiff test, pH >4.5 Trichomonas - Cervical petechiae (aka strawberry cervix) malordorous frothy green discharge, motile, pH>4.5 CA - Vaginal inflamm. thick white cottage cheese discharge, pseudohyphae, pH 3.5-4.5 |
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What is the treatment for N. gonorrhea?
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ceftriaxone
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What is the treatment for Chlamydia?
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doxycycline (bd x 10days) or azithromycin (one dose)
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What are condyloma lata?
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Are wartlike papules present typically on the genitals and indicate a secondary stage of syphilis infection
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What strains of HPV are associted with genital warts?
cervical cancer? |
Warts - types 6 and 11
Cerivical ca - types 16 and 18 |
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What organism causes Chancroid?
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Haemophilus ducreyi
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Pt presents with painless ulcer on his penis with a red "beefy" base with irregular borders. The lesion started as a smaller papule on his penis a few weeks ago. What is the treatment?
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Pt has Donovanosis or Granuloma inguinale an infection caused by Donovania granulomatis.
Treatment is with doxycycline or TMP-SMX for 3 weeks. |
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A women presents with menorrhagia, abdo pain of increaseing severity over the last 2 years. A mass is palpable on abdo exam in the hypogastric region. After appropriate imaging studies a biopsy is taken which shows well differentiated smooth muscle cells. What is the diagnosis and what are the treatment options?
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Leiomyoma
No treatment and follow with U/S GnRH agonists - reduce uterine bleeding and fibriod size. Only reccommended as a short term therapy prior to surgery or menopause. Myomectomy Hysterecotomy Uterine artery embolization (high risk of infertility) |
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What marker is useful in monitoring response to therapy in a women undergoing treatment for endometrial cancer?
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CA-125
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Women presents with pelvic discomfort. A palpable mass is found on bimanual exam in the region of one of the ovaries. Pathology reports psammoma bodies. What is the Dx?
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Mucinous or serous cystadenoma of the ovary
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What are 2 features on mammogram that are suspicious for cancer?
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1. Hyperdense regions
2. Calcifications |
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What is the most common benign breast tumor?
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Fibroadenoma
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What % of breast cancer are ductal in origin?
Lobular ? |
Ductal - 80% (more aggressive)
Lobular - 20% (less aggressive, more difficult to detect) |
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What is unique about Lobular carcinoma in situ (LCIS)
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Increased risk of contralateral malignancy
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Which type of breast cancer has a greater association with HRT?
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Infiltrating lobular carcinoma
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What are the common sites of breast metatasis?
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Bone
Lungs Pleura Liver Brain |
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What are some common causes of viral meningitis?
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Enterovirus
Echovirus HSV Lymphocytic choriomeningitis virus Mumps virus |
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In ALS what tracts are affected and what are the symptoms?
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Cst and ventral horn
Spastic and flaccid paralysis |
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In Poliomyelitis, what tracts are affected and what are the symptoms?
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Ventral horn
Flaccid paralysis |
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In Tabes dorsalis (tertiary syphillis) what tracts are affected and what are the symptoms?
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Dorsal columns
Impaired proprioception, pain |
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In spinal artery syndrome, what tracts are affected and what are the symptoms?
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Cst, StT, ventral horn, lateral gray matter. Dorsal columns are spared!!
Bilateral loss of pain and temp(one level below lesion), bilateral spastic paresis (below lesion), bilateral flaccid paralysis (level of lesion) |
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In Vit B12 deficiency, what tracts are affected and what are the symptoms?
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Dorsal columns and Cst
Bilateral loss of vibration and discrimination. Bilateral spastic paresis affecting legs before arms |
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In Syringomyelia, what tracts are affected and what are the symptoms?
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Ventral horn, ventral white commissure
Bilateral loss of pain and temperature (one level below lesion) bilateral flaccid paralysis (level of lesion) |
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In Brown-sequard syndrome, what tracts are affected and what are the symptoms?
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All tracts on one side of the cord
Ipsilateral loss of vibration and discrimination(below lesion), ipsilateral spastic paresis (below lesion), ipsilateral flaccid paralysis (level of lesion), contralateral loss of pain and temperature (below lesion) |
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What is the most common cause of bacterial meningitis in Newborns? Other common agents?
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Group B streptococcus
Also: E. coli, Listeria, H. influenzae |
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What is the most common cause of bacterial meningitis in 1month to 2 years? Other common agents?
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Most common: S. pneumoniae, N. meningitidis
Also: GBS, Listeria, H. influenzae |
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What is the most common cause of bacterial meningitis in 2-18 years? Other common agents?
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N. meningitidis
Also: S. pneumoniae, Listeria |
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What is the most common cause of bacterial meningitis in 18-60? Other common agents?
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S. pneumoniae
Also: N. meningitidis, Listeria |
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What is the most common cause of bacterial meningitis in 60+? Other common agents?
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S. pneumoniae
Also: Listeria, gram negative rods |
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What are Negri bodies?
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Round eosinophilic inclusions in neurons which are found in Rabies infection
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What is the medical treatment for trigeminal neuralgia?
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Carbamazepine, gabapentin or other anticonvulsants
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An elderly pt presents with cognitive impairment, incontinence, and gait abnormalities. What is the diagnosis and treatment?
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Normal pressure hydrocephalus
Treatment is with a ventriculoperitoneal shunt |
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What is 1st line treatment for status epilepticus?
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Benzodiazepines
Phenytoin given to prevent recurrence |
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What is 1st line treatment for absence seizures?
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Ethosuximide
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Gingival hyperplasia, lymphadenopathy, Steven-Johnson syndrome, confusion and blurred vision are side effects of which anti-convulsant?
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Phenytoin
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N/V, hyponatremia, Stevens-Johnsons, drowsiness, vertigo, blurred vision and leukopenia are side effects of which anti-convulsant?
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Carbamazepine
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Hepatotoxicity, N/V, drowsiness, tremor, wt gain, and alopecia are side effects of which anticonvulsant?
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Valproate
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What are the common signs of Parkinson's disease?
|
SMART
S-shuffling gait M-mask-like facies A-akinesia R-rigidity T-tremor (resting) |
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What are some signs of an Upper motor neuron disease?
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Spasticity, Increased DTR's, +ve Babinski
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What are some signs of an Lower motor neuron disease?
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Flaccid paralysis, decreased DTR's, Fasciculations, neg Babiniski sign, muscle wasting.
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Progressive loss of UMN and LMN in brain and spinal cord, involving degeneration of anterior horn cells and the Cst. Which neurological disorder is this statement describing?
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ALS aka Lou Gerig's
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A 40 year old pt presents with progressive rapid irregular and involuntary movement of extremities, dementia. MRI shows caudate nucleus and putamen atrophy. What is the diagnosis?
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Huntington's disease
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What medications are used to slow the progression of Alzheimers disease?
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Cholinesterase inhibitors
e.g. donepezil, rivastigmine, galantamine |
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What is Lambert-Eaton syndrome?
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a paraneoplastic disorder commonly from a SCC of the lung, with similar features as myasthenia gravis. Caused by antibodies to Ca2+ channels
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What other conditions must be investigated in a person diagnosed with myasthenia gravis?
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thymoma and thyrotoxicosis
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T/F
Tumors in adults tend to be above the tentorium? |
True
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T/F
Tumors in children tend to be below the tentorium? |
True
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What is the most common primary adult brain tumor?
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GBM
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What are the most common primary pediatric brain tumors?
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Astrocytoma > Medullablastoma > Ependymoma
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In NF type 1 where is the gene located and what is the pattern of inheiritance?
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Chromosome 17
Autosomal dominant |
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What are some clinical signs of NF type 1?
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COFFINS
C - Cafe-au-lait spots O - Optic glioma F - Freckling F - Familial Hx I - Iris hamartomas (Lisch nodules) S - Skeletal lesions |
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What stage(s) of sleep do benzodiazepines increase?
Decrease? |
Increase stage 2 (sleep spindles and k complexes)
Decrease stages 3 and 4 |
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What is the preferred treatment for narcolepsy?
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Modafinil
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What is Cerebral palsy and what are the risk factors?
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A group of disorders describing nonprogressive brain lesions involving motor or postural abnormalities resulting from CNS damage during in utero or infantile development.
Risk factors: prematurity, IUGR, birth trauma, neonatal seizures, cerebral hemorrhage, perinatal asphyxia, multiple births, intrauterine infection |
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What is medial longitudinal fasciculus syndrome and what does it suggest?
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with lateral gaze there is absent contralateral eye adduction
- Can indicate an intracranial lesion or MS |
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What are the different classes of medical treament for glaucoma?
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1. Beta blockers
2. Alpha agonists 3. Prostaglandin analogues 4. Cholinergic agents 5. Acetazolamide |
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What are some causes of a thyroid storm in a pt with pre-existing hyperthyroidism?
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Surgery
Infection Stress |
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What is the most common type of thyroid carcinoma?
What are the histological features which ID it? |
Papillary
"Ground glass" orphan Annie nuclei Psammoma bodies (round collection of calcium) |
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Which cells are affected in Medullary carcinoma of the thyroid?
What do they produce? |
parafollicular "C cells"
produces calcitonin associated w/ MEN IIA and IIB |
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What are the symptoms of hypercalcemia?
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"Bones, Stones, Groans, and Pyschiatric overtones"
Bones - bone pain Stones - renal stones Moans - N/V, constipation Psychiatric overtones - mental state changes also weakness, increased risk of fracture |
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What are some symptoms of hypocalcemia?
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Tingling
Abdo pain Tetany Possible Tachycardia Seizures Movement disorders Cataracts +ve Trousseaus sign (carpal spasm with bp cuff) +ve Chvostek's sign (tapping of facial nerve) |
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What are some complications of acromegaly?
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DM (from insulin resistance)
Heart, lungs, liver, spleen, kidneys can become enlarged Coarsening of facial features Enlargment of hands Thickened skin Increased body hair |
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In hypopituitarism, what order of hormone deficiency occurs?
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Good Luck Finding Treatment for Pituitary Accidents
1. GH 2. LH 3. FSH 4. TSH 5. Prolactin 6. ACTH |
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What are the layers of the adrenal cortex and what do they produce?
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"Great Attire And Fast Cars Are Really Sexy Attributes"
Glomerulosa - Aldosterone after ATII secretion Fasciculata - Cortisol (after ACTH Reticularis - Sex hormones (after ACTH) |
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What is the cause of Cushing's disease?
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an ACTH secreting pituitary adenoma
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What are some of the complications associated with Cushing's syndrome?
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Increased risk of cardiovascular or thromboembolic events
increased infection risk Avascular necrosis of the hip |
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What are some of the findings associated with Conn's syndrome?
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Hypertension
Polyuria Tetany Decreased K+ Mildly increased Na+ Metabolic alkalosis Decreased Renin Increased 24hr aldosterone |
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What is Addison's disease and what are some of the features?
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Primary adrenal insufficiency
Destruction of adrenal cortices (autoimmune, infection, hemorrhage) Severe weakness, fever, mental state changes, vascular collapse, N/V, myalgia, arthralgia, increased skin pigmentation (from MSH) |
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What is secondary corticoadrenal insufficiency?
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At the level of pituitary ie decreased ACTH
Due to: chronic corticosteroid use, insufficient ACTH production |
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What is tertiary corticoadrenal insufficiency?
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Level of hypothalamus
Due to insufficient CRH secretion from hypothalamus. |
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What are the common laboratory findings in Addison's disease?
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Decreased Na
Increased K Low Aldosterone Eosinophilia Decreased cortisol Increased ACTH |
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What enzyme converts testosterone to estridiol?
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Aromatase
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What H/P and Labs would you expect in someone with a 17alpha-hydroxylase deficiency?
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Leads to aldosterone excess
Amenorrhea, ambiguous genitalia in men, HTN Decreased K+, Increased Na+, decreased androgens |
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What H/P and Labs would you expect in someone with a 21alpha-hydroxylase deficiency?
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Excess testosterone, deficiency of cortisol and aldosterone
- ambiguous genitalia (female infants), virilization (women), precocious puberty in men, hypotension (severe cases), hyperkalemia, increased renin |
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What H/P and Labs would you expect in someone with a 11beta-hydroxylase deficiency?
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Excess androgens
deficiency in cortisol and aldosterone - ambiguous genitalia (female infants), virilization (women), precocious puberty in men HYPERTENSION (this one of the only features which distinguishes 11beta from 21 alpha dehydroxylase deficiency) |
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What is the most common form of congenital adrenal hyperplasia?
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21alpha-hydroxylase
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With regard to congenital adrenal hyperplasia, if the number one is in the 1st digit, then....?
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One of the features is hypertension
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With regard to congenital adrenal hyperplasia, if the number one is in the 2nd digit, then....?
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One of the features is masculinization
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What test should be performed in a pt suspected of having a phaeochromocytoma?
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24hr urinary catecholamines and metanephrines
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What is MEN type 1?
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Parathyroid, Pancreas, Pituitary
Hyperparathyroidism, hypercalcemia, Zollinger-Ellison, acromegaly, Cushings, |
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What is MEN type 2a?
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Parathyroid
Medullary thyroid carcinoma Phaeochromocytoma Hyperparathyroidism, increased calcitonin, increased catecholamines |
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What is MEN type 2b?
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Medullary thyroid carcinoma
Phaeochromocytoma Mucosal neuroma marfanoid body habitus, mucosal nodules |
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What proto-oncogene is found most cases of MEN IIa and IIb
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RET
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What is the effect of Statins on:
LDL: HDL: Triglycerides: Side effects |
LDL: dec +++
HDL: inc + Triglycerides: dec + Side effects myositis, elevated LFTs |
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What is the effect of ezetimibe on:
LDL: HDL: Triglycerides: Side effects |
LDL: dec ++
HDL: - Triglycerides: - Side effects myalgias, possible increased LFT |
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What is the effect of Fibrates on:
LDL: HDL: Triglycerides: Side effects |
LDL: dec ++
HDL: inc + Triglycerides: dec +++ Side effects myositis, increased LFTs |
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What is the effect of Bile acid sequestrants on:
LDL: HDL: Triglycerides: Side effects |
LDL: dec ++
HDL: - Triglycerides: - or inc + Side effects bad taste, GI upset |
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What is the effect of Niacin on:
LDL: HDL: Triglycerides: Side effects |
LDL: dec ++
HDL: inc ++ Triglycerides: dec + Side effects: facial flushing, N/V, parethsias, pruritis, increased LFTs, insulin resistance, gout |
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What is the characteristic pattern on ECG of unstable angina?
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ST depression
T-wave flattening or depression |
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Which serum cardiac marker is best for detection of MI in the first 24hrs?
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CK-MB
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Which serum cardiac marker is best for detection of MI after the first 3 days?
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Troponin I (sensitive up to 7 days)
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What is the medical treatment for AMI?
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BeMOAN
B- beta blocker M - morphine O - Oxygen A - ASA N - nitro |
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ECG changes in Leads V2, V3 and V4 suggest which location of infarct?
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Anterior infarct from LAD
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ECG changes in Leads V1, V2 and V3 suggest which location of infarct?
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Septal infarct from LAD
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ECG changes in Leads II, III and aVF, suggest which location of infarct?
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Inferior infarct from Posterior descending or marginal branch
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ECG changes in Leads I, aVL, V4, V5, V6, suggest which location of infarct?
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Lateral infarct from LAD or circumflex
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ECG changes in Leads V1, V2 suggest which location of infarct?
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Posterior infarct from posterior descending branch
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When is the risk greatest for ventricular wall rupture post MI?
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4-8 days post
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Give 2 examples of Class IA antiarrhythmics?
How do they work? |
Na channel inhibitor - prolongs AP
Procainamide Quinidine |
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Give 2 examples of Class IB antiarrhythmics?
How do they work? |
Na channel inhibitor - shortens AP
Lidocaine Tocainide |
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Give 2 examples of Class IC antiarrhythmics?
How do they work? |
Na channel inhibitor - no effect on AP
Flecainide Propafenone |
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Give 2 examples of Class II antiarrhythmics?
How do they work? |
Beta blockers
Propanolol Esmolol Metoprolol |
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Give 2 examples of Class III antiarrhythmics?
How do they work? |
K channel blockers
Amiodarone Sotalol Bretylium |
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Give 2 examples of Class IV antiarrhythmics?
How do they work? |
CCB
Verapamil Diltiazem |
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How does Adenosine work as an antiarrhythmics?
What types of arrthymias is it used for? |
K channel activation, decreased in intracellular cAMP.
PSVT |
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What classes of antiarrthmics can be used for PSVT?
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Nearly all except IB (eg lidocaine) and class III (K channel blockers)
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What classes of antiarrthmics can be used for Afib?
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IA
IC II III IV |
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What classes of antiarrthmics can be used for Vtach?
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IA
IB II III |
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What classes of antiarrthmics can be used for PVC?
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II (beta-blockers)
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What is a normal ejection fraction ?
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55-75%
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What are Kerley B lines and what are they a sign of?
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Increased marking of lung interlobular septa caused by pulmonary edema as seen on CXR.
Sign of CHF |
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In CHF where primary pathology is Systolic dysfunction, what is the medical treatment?
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1. Loop diuretic
2. ACEi (or ARB) 3. Add beta-blocker if needed 4. Add digoxin to improve symptoms |
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In aortic stenosis the valsalva maneuver will increase/or decrease the murmur?
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Decrease
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In hypertrophic obstructive cardiomyopathy the valsalva maneuver will increase/or decrease the murmur?
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Increase
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What systemic effects does angiotensin II have?
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1. Vasocontriction
2. Inc aldosterone secretion (inc renal absorption of Na+) 3. Facilitates release of NE 4. Inc renal tubular Na+ reabsorption 5. Sitmulates thirst and ADH section in brain 6. Enhances contractility and ventricular hypertrophy |
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What is the most common cause of sudden death in young athletes?
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Hypertrophic obstructive cardiomyopathy (HOCM)
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In what type of presentation might you see a "J" wave on ECG?
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Hypothermia
J-wave - a small wave immediately after the QRS complex but before the t wave |
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What is the treatment for a brown recluse spider bite?
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Dexamethasone
Colchicines Dapsone |
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What is the treatment for a black widow spider bite?
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Calcium gluconate
Methocarbamol |
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What causes Cat scratch fever?
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Bartonella henselae
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What is the initial protocol for the treatment of Vfib or Vtach?
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Shock, Shock, Shock, Everbody Shock!
Shock - 200J Shock - 300J Shock - 360J Epinephrine Shock - 360J |
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What is the treatment for acetaminophen poisoning?
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N-acetylcysteine
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What is the treatment for anti-cholinergic poisoning?
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Physostigmine
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What is the treatment for benzo poisoning?
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Flumazenil
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What is the treatment for Beta blocker poisoning?
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glucagon, calcium, insulin, and dextrose
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What is the treatment for CCB poisoning?
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glucagon, calcium, insulin, and dextrose
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What is the treatment for Cocaine poisoning?
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supportive care
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What is the treatment for Cyanide poisoning?
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nitrates, hydroxocobalamin
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What is the treatment for digoxin poisoning?
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digoxin Abs
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What is the treatment for Heparin poisoning?
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protamine sulfate
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What is the treatment for Isoniazid poisoning?
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Vit B6
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What is the treatment for Isopropyl alcohol poisoning?
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supportive care
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What is the treatment for methanol poisoning?
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ethanol, dialysis
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What is the treatment for opiod poisoning?
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Naloxone
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What is the treatment for Salicylate poisoning?
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Charcoal
Dialysis Sodium bicarbonate |
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What is the treatment for Sulfonylurea poisoning?
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Octreotide
Dextrose |
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What is the treatment for TCA poisoning?
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Sodium bicarbonate
Diazepam |
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What is the treatment for Warfarin poisoning?
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Vit K
FFP |
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What is the treatment for ethylene glycol poisoning?
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Ethanol
Dialysis |
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What is the treatment for organophosphates poisoning?
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Atropine
Pralidoxime Supportive care |
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What is the treatment for iron poisoning?
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Deferoximine
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What is the treatment for Lead poisoning?
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EDTA
Dimercaprol |
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What is the treatment for Mercury poisoning?
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Dimercaprol
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What is the treatment for Copper poisoning?
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Penicillamine
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What is the management of pulseless electrical activity (PEA)?
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PEA
Pulseless E - epinephrine A - atropine |
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What are the common causes of pulseless electrical activity?
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6H's and 6 T's
H- hypovolemia H- hypoxia H- hyperkalemia H- hypokalemia H- hypomagnesemia H- hydrogen ions (acidosis) T- tension pneumothorax T- thrombosis (CAD or PE) T- tablets (drugs) or toxins T- tamponade (cardiac) T- trauma |
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What are the components of a secondary survey in ATLS?
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Head to toe examination
Complete History and Examination Reassessment of vitals SAMPLE S - signs and symptoms A - allergies M - medications P - Past medical hx L - last meal E - events related to injury |
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What is hypertension with bradycardia suggestive of?
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Cushing's phenomenon aka increased intracranial pressure
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In head trauma, what does the term "coup" mean?
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cerebral damage at the point of insult
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In head trauma, what does the term "contrecoup" mean?
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cerebral damage on the opposite side of the head as the insult
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What is pulsus paradoxus?
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Exageration of normal variation of BP during inspiration.
an accentuated decrease in the bp during inspiration |
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What coverage do aminoglycosides have?
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Gram neg (including pseudomonas)
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Examples of aminoglycosides?
Mech of action? |
Gentamicin
Tobramycin Neomycin (binds 30S) |
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What coverage do tetracyclines have?
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Gram pos
anaerobes atypicals (Chlam, Myco, Rickettsia, Borelia) |
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Mechanism of action of tetracyclines?
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Blocks A site of 30s ribosome
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What coverage do macrolides have?
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Gram positives (except enterococcus and MRSA)
GN: Legionella, pertussis, atypicals |
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Mech of action of macrolides and examples?
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Inhibits 50S
Erythromycin Clarithromycin Azithromycin |
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Mech of action of fluroquinolones?
Examples? |
inhibits DNA gyrase
Cipro Norfloxacin Ofloxacin |
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What are the fluroquinolones used for?
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UTI
RTI Sinusitis (not great GP coverage) Good gram neg coverage |
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Coverage of metronidazole?
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Anaerobes
Protozoa |
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Coverage of TMP/SMX?
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UTI
RTI GI infections |
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T/F
Allergy to poison ivy is an example of a type 1 hypersensitivity rxn. |
FALSE
Contact dermatitis is a type IV hypersensitivity reaction. |
