Subacute Sclerosing Panencephalitis (SSPE) Quiz
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Questions and Answers

What is the usual duration of survival for patients with SSPE?

  • 1-3 years (correct)
  • 10-15 years
  • It is highly variable
  • 5-7 years

    • What is the most effective way to prevent SSPE?

  • Palliative therapy
  • Supportive care
  • Antiviral medication
  • Vaccination (correct)

    • What is the typical timing of PSGN after a streptococcal infection?

  • 1-3 weeks (correct)
  • 1-3 years
  • 1-3 months
  • 1-3 days

    • What is the primary symptom of dumping syndrome?

    <p>Abdominal fullness</p> Signup and view all the answers

    What is the cause of late dumping syndrome?

    <p>Reactive hypoglycemia</p> Signup and view all the answers

    What is the primary treatment for hyperprolactinemia?

    <p>Dopamine agonists</p> Signup and view all the answers

    What is the primary feature of a chalazion?

    <p>chronic granulomatous lesion</p> Signup and view all the answers

    What is the usual course of treatment for PSGN?

    <p>Supportive care and monitoring</p> Signup and view all the answers

    What is the name of the disease that typically presents with hilar lymphadenopathy and granulomas of the lungs?

    <p>Sarcoidosis</p> Signup and view all the answers

    What is the name of the treatment for congestive heart failure that includes medications like BB, ACE inhibitors, and diuretics?

    <p>B.A.S.H.E.D</p> Signup and view all the answers

    What is the name of the disease that affects the spine and is characterized by destruction of vertebral bodies?

    <p>Pott's disease</p> Signup and view all the answers

    What is the name of the disease that is caused by a Factor VIII deficiency?

    <p>Hemophilia A</p> Signup and view all the answers

    What is the name of the treatment for acute asthma exacerbation that includes medications like beta-agonists and ipratropium?

    <p>BIOMES</p> Signup and view all the answers

    What is the term for a normal variation in heart rate that occurs with breathing?

    <p>Sinus arrhythmia</p> Signup and view all the answers

    What is the primary effect of chronic heavy alcohol use on the myocardium?

    <p>Direct toxicity leading to dilation and impaired contractility</p> Signup and view all the answers

    What is the name of the syndrome that is characterized by a group of symptoms, including locomotor difficulties, memory issues, and optic neuritis?

    <p>MS</p> Signup and view all the answers

    What is the term for the use of lidocaine with epinephrine, which both increases the duration of anesthesia and decreases blood flow to the area of injection?

    <p>Local anesthesia</p> Signup and view all the answers

    What is a common physical examination finding in patients with heart failure?

    <p>Distant heart sounds</p> Signup and view all the answers

    Which of the following medications is commonly used to treat heart failure?

    <p>All of the above</p> Signup and view all the answers

    What is the primary benefit of planned cesarean section delivery at 38 weeks of gestation in women with HIV?

    <p>Reduced risk of perinatal HIV transmission</p> Signup and view all the answers

    What is the typical finding on lung volume measurements in COPD?

    <p>Marked increase in lung volume</p> Signup and view all the answers

    What is the primary association of Antinuclear Antigen (ANA)?

    <p>Lupus</p> Signup and view all the answers

    What is the typical pathogen associated with Guillain-Barré syndrome?

    <p>Gram-negative bacterium</p> Signup and view all the answers

    What is the distinguishing physical examination finding in allergic rhinitis?

    <p>Pale turbinates</p> Signup and view all the answers

    What is the typical presentation of asbestosis?

    <p>Dyspnea, dry cough, inspiratory crackles</p> Signup and view all the answers

    What is the characteristic pattern on pulmonary function tests in asbestosis?

    <p>Restrictive pattern with decreased lung volumes</p> Signup and view all the answers

    What is the most common bacterium causing Malignant External Otitis?

    <p>Pseudomonas aeruginosa</p> Signup and view all the answers

    What is the primary complication of Malignant External Otitis?

    <p>Spread to the temporal bone and cranial nerves</p> Signup and view all the answers

    What is the essential component of treatment for Malignant External Otitis?

    <p>Prolonged course of antibiotics and strict glucose control</p> Signup and view all the answers

    What is the primary diagnostic tool for Malignant External Otitis?

    <p>Clinical exam and culture of ear drainage</p> Signup and view all the answers

    What is the characteristic radiographic finding in asbestosis?

    <p>Bilateral interstitial fibrosis and pleural thickening</p> Signup and view all the answers

    What is the primary goal of treatment for asbestosis?

    <p>Supportive care to alleviate symptoms</p> Signup and view all the answers

    What is a common symptom of vertebrobasilar TIAs due to the involvement of vestibular pathways?

    <p>Dizziness</p> Signup and view all the answers

    What is a symptom of retinal or ophthalmic artery ischemia, not vertebrobasilar ischemia?

    <p>Amaurosis fugax</p> Signup and view all the answers

    What is the most common congenital heart defect and can cause a holosystolic murmur in neonates?

    <p>VSD</p> Signup and view all the answers

    What is the first-line treatment for Raynaud's phenomenon?

    <p>CCBs</p> Signup and view all the answers

    What may worsen Raynaud's symptoms by reducing peripheral blood flow?

    <p>BBs</p> Signup and view all the answers

    What is the diagnostic criteria for Abdominal Aortic Aneurysm (AAA)?

    <p>Diameter &gt; 5.5cm on imaging</p> Signup and view all the answers

    What is used to measure viral load in Hepatitis C Virus (HCV) Management?

    <p>HCV RNA quantitative PCR</p> Signup and view all the answers

    What is used to treat Hepatitis C Virus (HCV)?

    <p>All of the above</p> Signup and view all the answers

    Which of the following is NOT a common cause of nephritic syndrome?

    <p>Diabetic nephropathy</p> Signup and view all the answers

    What is the hallmark of nephrotic syndrome?

    <p>Heavy proteinuria (&gt; 3.5 g/day)</p> Signup and view all the answers

    What is a key difference between nephritic and nephrotic syndromes?

    <p>Level of proteinuria</p> Signup and view all the answers

    What is the primary feature of Cushing's syndrome?

    <p>Central obesity and moon facies</p> Signup and view all the answers

    Which of the following is a common laboratory finding in nephritic syndrome?

    <p>Low complement levels</p> Signup and view all the answers

    What is the purpose of the low-dose dexamethasone suppression test?

    <p>To differentiate between pituitary and adrenal causes of Cushing's syndrome</p> Signup and view all the answers

    What is the primary treatment for severe asthma exacerbation?

    <p>Oral corticosteroids and ipratropium</p> Signup and view all the answers

    What is a characteristic of nephrotic syndrome?

    <p>Hyperlipidemia</p> Signup and view all the answers

    What is the characteristic pattern on pulmonary function tests in COPD?

    <p>Decreased FEV1 and FVC</p> Signup and view all the answers

    What is a common cause of nephrotic syndrome?

    <p>Minimal change disease</p> Signup and view all the answers

    What is a key difference between nephritic and nephrotic syndromes?

    <p>Onset of symptoms</p> Signup and view all the answers

    What is the primary benefit of planned cesarean section delivery at 38 weeks of gestation in women with HIV?

    <p>Reduced risk of vertical transmission</p> Signup and view all the answers

    What is the typical finding on lung volume measurements in COPD?

    <p>Increased total lung capacity</p> Signup and view all the answers

    Which of the following is NOT a characteristic of nephritic syndrome?

    <p>Hyperlipidemia</p> Signup and view all the answers

    What is the primary association of Antinuclear Antigen (ANA)?

    <p>Systemic lupus erythematosus</p> Signup and view all the answers

    What is the characteristic pattern on lung imaging in asbestosis?

    <p>Pleural plaques and diffuse infiltrates</p> Signup and view all the answers

    What is the typical location of a Left Ventricular Aneurysm?

    <p>Apical wall of the left ventricle</p> Signup and view all the answers

    What is the primary symptom of a Left Ventricular Aneurysm?

    <p>Heart failure</p> Signup and view all the answers

    What is the primary treatment for Malignant Hypertension?

    <p>Hydralazine</p> Signup and view all the answers

    What is the characteristic of morning stiffness in Rheumatoid Arthritis?

    <p>Lasts longer than 30 minutes</p> Signup and view all the answers

    What is a common physical examination finding in pregnant women?

    <p>Split S2</p> Signup and view all the answers

    What is the definition of Malignant Hypertension?

    <p>BP &gt; 180/110 mm Hg with either encephalopathy or nephropathy</p> Signup and view all the answers

    Which of the following is a characteristic of Essential Thrombocytosis?

    <p>Elevated platelet count</p> Signup and view all the answers

    Which mutation is commonly associated with Myelofibrosis?

    <p>Jak2 mutation</p> Signup and view all the answers

    Which of the following is a feature of Polycythemia Vera?

    <p>Elevated red blood cell count</p> Signup and view all the answers

    What is the primary difference between Acute Lymphoblastic Leukemia (ALL) and Acute Myeloid Leukemia (AML)?

    <p>Cell of origin</p> Signup and view all the answers

    What is the characteristic peripheral blood smear finding in Acute Myeloid Leukemia (AML)?

    <p>Myeloblasts</p> Signup and view all the answers

    Which of the following is a common feature of Waldenstrom's Macroglobulinemia?

    <p>Hyperviscosity syndrome</p> Signup and view all the answers

    What is the primary treatment for Chronic Myeloid Leukemia (CML)?

    <p>Tyrosine kinase inhibitors</p> Signup and view all the answers

    Which of the following is a distinguishing feature of Acute Lymphoblastic Leukemia (ALL)?

    <p>Presence of lymphoblasts</p> Signup and view all the answers

    What is the primary mechanism by which asbestos exposure leads to asbestosis?

    <p>Inflammation and fibrosis caused by the presence of asbestos fibers in the lungs</p> Signup and view all the answers

    What is the primary characteristic of the chest X-ray in asbestosis?

    <p>Bilateral pleural thickening and fibrosis</p> Signup and view all the answers

    What is the primary complication of malignant external otitis?

    <p>Cranial nerve palsies</p> Signup and view all the answers

    What is the primary diagnostic tool for malignant external otitis?

    <p>Clinical exam</p> Signup and view all the answers

    What is the primary bacterium causing malignant external otitis?

    <p>Pseudomonas aeruginosa</p> Signup and view all the answers

    What is the essential component of treatment for malignant external otitis?

    <p>All of the above</p> Signup and view all the answers

    What is the characteristic pattern on pulmonary function tests in asbestosis?

    <p>Restrictive pattern with decreased FVC</p> Signup and view all the answers

    What is the primary goal of treatment for asbestosis?

    <p>Relieve symptoms</p> Signup and view all the answers

    What is a common symptom of vertebrobasilar TIAs due to the involvement of vestibular pathways?

    <p>Vertigo</p> Signup and view all the answers

    What is a symptom of retinal or ophthalmic artery ischemia, not vertebrobasilar ischemia?

    <p>Amaurosis fugax</p> Signup and view all the answers

    What is the most common congenital heart defect and can cause a holosystolic murmur in neonates?

    <p>VSD</p> Signup and view all the answers

    What is the first-line treatment for Raynaud's phenomenon?

    <p>CCBs</p> Signup and view all the answers

    What may worsen Raynaud's symptoms by reducing peripheral blood flow?

    <p>Beta blockers</p> Signup and view all the answers

    What is the diagnostic criteria for Abdominal Aortic Aneurysm (AAA)?

    <p>Diameter &gt; 5.5cm</p> Signup and view all the answers

    What is used to measure viral load in Hepatitis C Virus (HCV) Management?

    <p>RNA</p> Signup and view all the answers

    What is used to treat Hepatitis C Virus (HCV)?

    <p>All of the above</p> Signup and view all the answers

    What is the primary characteristic of Essential Thrombocytosis?

    <p>Elevated platelet count</p> Signup and view all the answers

    What is the primary cause of Myelofibrosis?

    <p>JAK2 mutation</p> Signup and view all the answers

    What is the primary characteristic of Waldenstrom's Macroglobulinemia?

    <p>IgM monoclonal gammopathy</p> Signup and view all the answers

    What is the primary complication of Polycythemia Vera?

    <p>Thrombosis</p> Signup and view all the answers

    What is the primary difference between Acute Myeloid Leukemia (AML) and Acute Lymphoblastic Leukemia (ALL)?

    <p>Peripheral blood smear</p> Signup and view all the answers

    What is the primary treatment for Chronic Myeloid Leukemia (CML)?

    <p>Tyrosine kinase inhibitors</p> Signup and view all the answers

    What is the primary characteristic of Myelofibrosis?

    <p>Bone marrow fibrosis</p> Signup and view all the answers

    What is the primary association of the JAK2 mutation?

    <p>Myeloproliferative neoplasms</p> Signup and view all the answers

    What type of seizure is characterized by brief, shock-like muscle contractions?

    <p>Myoclonic seizure</p> Signup and view all the answers

    Which of the following medications is commonly used to treat complex partial seizures?

    <p>Oxcarbazepine</p> Signup and view all the answers

    What is the most common cause of gastroparesis?

    <p>Diabetes mellitus</p> Signup and view all the answers

    Who should undergo low-dose CT (LDCT) for lung cancer screening?

    <p>Individuals with a 30-pack-year smoking history</p> Signup and view all the answers

    What is the characteristic physical examination finding in Tetralogy of Fallot?

    <p>Palpable right ventricular heave</p> Signup and view all the answers

    What is the primary symptom of gastroparesis?

    <p>Early satiety</p> Signup and view all the answers

    Which of the following is a complication of gastroparesis?

    <p>All of the above</p> Signup and view all the answers

    What is the treatment for simple partial seizures?

    <p>Carbamazepine</p> Signup and view all the answers

    What is the recommended regimen for metronidazole in the treatment of non-severe C. difficile infection?

    <p>500 mg three times daily or 250 mg four times daily for 10 to 14 days</p> Signup and view all the answers

    What is the prevalence of G6PD deficiency in African American males in the US?

    <p>10%</p> Signup and view all the answers

    What is the characteristic of schizoid personality disorder?

    <p>All of the above</p> Signup and view all the answers

    What is the primary indication for Cervical Conization?

    <p>Cervical dysplasia</p> Signup and view all the answers

    What is the primary goal of treatment for asbestosis?

    <p>To reduce symptoms and improve quality of life</p> Signup and view all the answers

    What is the medication used for symptomatic relief of hyperthyroidism until resolved?

    <p>Propranolol</p> Signup and view all the answers

    What is the primary complication of Malignant External Otitis?

    <p>Temporal bone osteomyelitis</p> Signup and view all the answers

    What is the recommended treatment for Trigeminal Neuralgia?

    <p>Carbamazepine</p> Signup and view all the answers

    What is the test used for the diagnosis of infectious mononucleosis in children and adults?

    <p>Heterophile test</p> Signup and view all the answers

    What is the primary benefit of planned cesarean section delivery at 38 weeks of gestation in women with HIV?

    <p>Reducing the risk of vertical transmission</p> Signup and view all the answers

    What is required for mechanical valves to prevent thrombosis?

    <p>Lifelong warfarin</p> Signup and view all the answers

    What is the characteristic appearance of Terry's nails?

    <p>White discoloration with a ground glass appearance</p> Signup and view all the answers

    What can trigger hemolysis in individuals with G6PD deficiency?

    <p>All of the above</p> Signup and view all the answers

    What is the characteristic feature of nail pitting?

    <p>Punctate depressions of the nail plate</p> Signup and view all the answers

    What is the primary finding on physical examination in Guillain-Barré syndrome?

    <p>Ascending weakness</p> Signup and view all the answers

    What is the most common cause of eye foreign bodies?

    <p>Dust</p> Signup and view all the answers

    What is the characteristic finding on chest X-ray in lobar pneumonia?

    <p>Consolidation of the affected lobe</p> Signup and view all the answers

    What is Chadwick's sign?

    <p>A blue discoloration of the vagina in early pregnancy</p> Signup and view all the answers

    What is the primary site of impairing contraction in Myasthenia Gravis?

    <p>Neuromuscular junction</p> Signup and view all the answers

    What is the most common presentation of Myasthenia Gravis?

    <p>Extraocular muscle weakness</p> Signup and view all the answers

    What is the diagnostic test that shows rapid improvement in strength in Myasthenia Gravis?

    <p>Edro(phonium) test</p> Signup and view all the answers

    What is the treatment that includes medications like pred, azath, mofetil, IVIG, and thymectomy for Myasthenia Gravis?

    <p>Immunosuppressive therapy</p> Signup and view all the answers

    What is the age range for peak incidence of Myasthenia Gravis?

    <p>20-40 years old</p> Signup and view all the answers

    What is the characteristic pattern on EMG in Myasthenia Gravis?

    <p>Decrementing response to repetitive nerve stimulation</p> Signup and view all the answers

    What type of seizures are often seen in juvenile myoclonic epilepsy (JME)?

    <p>Myoclonic seizures</p> Signup and view all the answers

    What is the primary treatment for myoclonic seizures?

    <p>All of the above</p> Signup and view all the answers

    What is a characteristic symptom of complex partial seizures?

    <p>Automatisms</p> Signup and view all the answers

    What is the primary treatment for complex partial seizures?

    <p>All of the above</p> Signup and view all the answers

    What is the primary symptom of gastroparesis?

    <p>All of the above</p> Signup and view all the answers

    What is the primary cause of gastroparesis in patients with diabetes mellitus?

    <p>Autonomic neuropathy</p> Signup and view all the answers

    What is the recommended age range for lung cancer screening?

    <p>50-80 years</p> Signup and view all the answers

    What is the characteristic physical examination finding in Tetralogy of Fallot?

    <p>Palpable RV lift</p> Signup and view all the answers

    What is the key diagnostic marker for acute pancreatitis?

    <p>Elevated lipase and amylase levels</p> Signup and view all the answers

    What is the mode of inheritance of sickle cell anemia?

    <p>Autosomal recessive</p> Signup and view all the answers

    What is the most appropriate antibiotic for outpatient treatment of pyelonephritis?

    <p>Levofloxacin</p> Signup and view all the answers

    What is the characteristic rash of measles?

    <p>Koplik spots</p> Signup and view all the answers

    What is the definition of subacute sclerosing panencephalitis (SSPE)?

    <p>A progressive, fatal brain disorder caused by a viral infection</p> Signup and view all the answers

    What is the symptoms of vertebrobasilar TIAs due to the involvement of vestibular pathways?

    <p>Dizziness</p> Signup and view all the answers

    What is the primary complication of measles?

    <p>Encephalitis</p> Signup and view all the answers

    What is the primary benefit of genetic counseling for couples with sickle cell trait?

    <p>To prevent sickle cell anemia in offspring</p> Signup and view all the answers

    Which of the following is a symptom of retinal or ophthalmic artery ischemia, not vertebrobasilar ischemia?

    <p>Amaurosis fugax</p> Signup and view all the answers

    What is the most common congenital heart defect that can cause a holosystolic murmur in neonates?

    <p>VSD</p> Signup and view all the answers

    What is the primary treatment for acute pancreatitis?

    <p>Supportive care and pain management</p> Signup and view all the answers

    What is the first-line treatment for Raynaud's phenomenon?

    <p>CCBs</p> Signup and view all the answers

    What may worsen Raynaud's symptoms by reducing peripheral blood flow?

    <p>Beta blockers</p> Signup and view all the answers

    What is the diagnostic criteria for Abdominal Aortic Aneurysm (AAA)?

    <p>Diameter &gt; 5.5cm on imaging</p> Signup and view all the answers

    What is used to measure viral load in Hepatitis C Virus (HCV) Management?

    <p>RNA</p> Signup and view all the answers

    What is used to treat Hepatitis C Virus (HCV)?

    <p>All of the above</p> Signup and view all the answers

    What is the most common associated abnormality in young adults with otherwise unexplained thrombosis?

    <p>Factor 5 Leiden</p> Signup and view all the answers

    What is the primary treatment for Acute Respiratory Distress Syndrome (ARDS)?

    <p>Supportive care and treatment of underlying cause</p> Signup and view all the answers

    What is the characteristic presentation of Acute Angle-Closure Glaucoma (AACG)?

    <p>Sudden onset of severe eye pain and redness</p> Signup and view all the answers

    What is the characteristic ECG finding in Mobitz Type II 2nd degree AV block?

    <p>Constant PR interval with dropped QRS complexes</p> Signup and view all the answers

    What is the primary feature of a simple partial seizure?

    <p>Lack of altered consciousness and presence of focal motor symptoms</p> Signup and view all the answers

    What is the primary cause of viral conjunctivitis?

    <p>Adenovirus</p> Signup and view all the answers

    What is the primary treatment for Raynaud's phenomenon?

    <p>Calcium channel blockers</p> Signup and view all the answers

    What is the characteristic finding on chest X-ray in Acute Respiratory Distress Syndrome (ARDS)?

    <p>Bilateral diffuse opacities</p> Signup and view all the answers

    What is the primary risk factor for Acute Angle-Closure Glaucoma (AACG)?

    <p>Older age and hyperopia</p> Signup and view all the answers

    What is the primary complication of Acute Respiratory Distress Syndrome (ARDS)?

    <p>All of the above</p> Signup and view all the answers

    What is the characteristic of Argyll-Robertson pupils?

    <p>Irregular pupils that constrict poorly to light but accommodate normally to near vision</p> Signup and view all the answers

    What is the primary cause of amaurosis fugax?

    <p>Carotid artery atherosclerosis</p> Signup and view all the answers

    What is the characteristic of anisocoria?

    <p>Unequal pupil sizes</p> Signup and view all the answers

    What is the primary cause of Horner's syndrome?

    <p>Disruption of sympathetic innervation to the eye and face</p> Signup and view all the answers

    What is the characteristic triad of Horner's syndrome?

    <p>Miosis, ptosis, and anhidrosis</p> Signup and view all the answers

    What is the diagnostic criterion for celiac disease?

    <p>Greater than 10 grams of fecal fat in 24 hours</p> Signup and view all the answers

    What is the primary cause of unilateral vision loss in multiple sclerosis?

    <p>Optic neuritis</p> Signup and view all the answers

    What is the primary cause of lumbar radiculopathy?

    <p>Disc herniation</p> Signup and view all the answers

    Which of the following is a characteristic of constrictive pericarditis?

    <p>Pulsus paradoxus</p> Signup and view all the answers

    What is the primary etiology of Horner's syndrome?

    <p>All of the above</p> Signup and view all the answers

    What is the primary pathogen associated with pertussis?

    <p>Bordetella pertussis</p> Signup and view all the answers

    What is the primary complication of spinal stenosis?

    <p>Neurogenic claudication</p> Signup and view all the answers

    What is the primary treatment for constrictive pericarditis?

    <p>Pericardiectomy</p> Signup and view all the answers

    What is the primary feature of neurogenic claudication?

    <p>Leg symptoms with walking or standing, relieved by rest</p> Signup and view all the answers

    What is the primary diagnostic tool for pertussis?

    <p>Clinical presentation</p> Signup and view all the answers

    What is the primary association of spinal stenosis?

    <p>Age-related changes</p> Signup and view all the answers

    What is the approximate duration of action of degludec insulin?

    <p>42 hours</p> Signup and view all the answers

    What is the primary treatment for Trichomoniasis?

    <p>Tinidazole</p> Signup and view all the answers

    What is the characteristic of vaginal discharge in Trichomoniasis?

    <p>Yellow-green</p> Signup and view all the answers

    What is the diagnosis of a suspected scaphoid fracture?

    <p>X-ray</p> Signup and view all the answers

    What is the primary effect of SABAs on bronchial smooth muscle?

    <p>Relaxation</p> Signup and view all the answers

    What is the type of protozoan that causes Trichomoniasis?

    <p>Flagellated</p> Signup and view all the answers

    What is the typical pH of the vaginal discharge in Trichomoniasis?

    <p>Greater than 4.5</p> Signup and view all the answers

    Which lobe is probably injured if there is lasting depression after an acute injury?

    <p>Temporal</p> Signup and view all the answers

    What is the key diagnostic marker for acute pancreatitis?

    <p>Elevated lipase and amylase levels</p> Signup and view all the answers

    What is the genetic pattern of sickle cell anemia?

    <p>Autosomal recessive</p> Signup and view all the answers

    What is the primary antibiotic used for outpatient treatment of pyelonephritis?

    <p>Levofloxacin</p> Signup and view all the answers

    What is the characteristic rash of measles?

    <p>Koplik spots on the buccal mucosa</p> Signup and view all the answers

    What is the underlying cause of Subacute Sclerosing Panencephalitis (SSPE)?

    <p>Persistent infection with the measles virus</p> Signup and view all the answers

    What is the primary complication of measles?

    <p>Encephalitis</p> Signup and view all the answers

    What is the primary risk factor for acute pancreatitis?

    <p>Alcoholism</p> Signup and view all the answers

    What is the primary benefit of genetic counseling for couples with sickle cell trait?

    <p>Reducing the risk of sickle cell anemia in offspring</p> Signup and view all the answers

    What is the primary source of gastrin secretion in Zollinger-Ellison syndrome?

    <p>Gastrin-secreting tumor in the pancreas or duodenum</p> Signup and view all the answers

    What is the classic triad of symptoms seen in Zollinger-Ellison syndrome?

    <p>Severe ulcers, gastric acid hypersecretion, and non-beta islet cell hyperplasia of the pancreas</p> Signup and view all the answers

    What is the diagnostic criterion for Zollinger-Ellison syndrome using a secretin stimulation test?

    <p>A rise in serum gastrin &gt; 200 pg/mL after secretin administration</p> Signup and view all the answers

    What is the association between Zollinger-Ellison syndrome and MEN1 syndrome?

    <p>20-25% of Zollinger-Ellison syndrome cases are associated with MEN1 syndrome</p> Signup and view all the answers

    What is the primary tumor location in Zollinger-Ellison syndrome?

    <p>Pancreas or duodenum</p> Signup and view all the answers

    What is the primary mechanism of excessive gastric acid secretion in Zollinger-Ellison syndrome?

    <p>Gastrin-secreting tumors stimulating parietal cells</p> Signup and view all the answers

    What is the AST:ALT ratio in alcoholic hepatitis?

    <p>2:1</p> Signup and view all the answers

    What triggers Coronary Artery Spasm?

    <p>Smoking, stress, and cocaine</p> Signup and view all the answers

    What is the typical doubling time for malignant lung lesions?

    <p>60-100 days</p> Signup and view all the answers

    What is the common cause of Binasal hemianopia?

    <p>Bilateral optic nerve lesions at junction of optic nerve and chiasm</p> Signup and view all the answers

    What is the treatment of choice for Aortic Insufficiency?

    <p>Valve replacement</p> Signup and view all the answers

    What is the primary effect of lithium toxicity on the thyroid gland?

    <p>Hypothyroidism</p> Signup and view all the answers

    What is the first-line treatment for Acne Vulgaris?

    <p>Topical retinoids</p> Signup and view all the answers

    What is the characteristic physical examination finding in cardiomyopathy?

    <p>Displaced PMI</p> Signup and view all the answers

    What is the primary effect of chronic heavy alcohol use on the myocardium?

    <p>Dilated cardiomyopathy</p> Signup and view all the answers

    What is the term for the use of lidocaine with epinephrine?

    <p>Vasoconstriction</p> Signup and view all the answers

    What is the sensitive biomarker for detecting early relapse of testicular cancer?

    <p>AFP</p> Signup and view all the answers

    Which of the following is the most predominant pathogen in patients with cystic fibrosis?

    <p>Pseudomonas</p> Signup and view all the answers

    What is the primary cause of urge incontinence?

    <p>Detrusor overactivity</p> Signup and view all the answers

    What is the primary benefit of integrated screening for fetal aneuploidy?

    <p>Combination of 1st and 2nd trimester tests</p> Signup and view all the answers

    What is the characteristic hallmark of ALS?

    <p>Progressive muscle weakness + UMN signs</p> Signup and view all the answers

    What is the typical radiographic finding in asbestosis?

    <p>All of the above</p> Signup and view all the answers

    What is the primary goal of treatment for asbestosis?

    <p>Relieve symptoms</p> Signup and view all the answers

    What is the primary method of prophylaxis for recurrences of rheumatic fever?

    <p>PenG every 3 weeks</p> Signup and view all the answers

    What is the primary treatment for myoclonic seizures?

    <p>Valproic acid</p> Signup and view all the answers

    What is the typical presentation of asbestosis?

    <p>Dyspnea, dry cough, and inspiratory crackles</p> Signup and view all the answers

    What is the characteristic of simple partial seizures?

    <p>No loss of consciousness, without automatisms and sensory/autonomic symptoms</p> Signup and view all the answers

    What is the characteristic pattern on pulmonary function tests in asbestosis?

    <p>Restrictive pattern with decreased lung volumes and normal FEV1/FVC ratio</p> Signup and view all the answers

    What is the primary cause of gastroparesis in diabetes mellitus?

    <p>Autonomic neuropathy</p> Signup and view all the answers

    What is the recommended age range for lung cancer screening with low-dose CT?

    <p>50-80 years</p> Signup and view all the answers

    What is the primary complication of Malignant External Otitis?

    <p>Cranial nerve palsies</p> Signup and view all the answers

    What is the characteristic of Argyll-Robertson pupils?

    <p>Irregular pupils that constrict poorly to light but accommodate normally to near vision</p> Signup and view all the answers

    What is the characteristic physical examination finding in tetralogy of Fallot?

    <p>Palpable right ventricular lift</p> Signup and view all the answers

    What is the essential component of treatment for Malignant External Otitis?

    <p>Antibiotics and glucose control</p> Signup and view all the answers

    What is the characteristic radiographic finding in asbestosis?

    <p>Bilateral pleural plaques and thickening</p> Signup and view all the answers

    What is the primary treatment for complex partial seizures?

    <p>Valproic acid and oxcarbazepine</p> Signup and view all the answers

    What is the cause of Amaurosis fugax?

    <p>All of the above</p> Signup and view all the answers

    What is the primary goal of treatment for asbestosis?

    <p>Relieving symptoms and improving quality of life</p> Signup and view all the answers

    What is the primary complication of gastroparesis in diabetes mellitus?

    <p>Malnutrition and poor glycemic control</p> Signup and view all the answers

    What is the characteristic of Anisocoria?

    <p>Different pupil sizes</p> Signup and view all the answers

    What is the primary diagnostic tool for gastroparesis in diabetes mellitus?

    <p>Gastric emptying study</p> Signup and view all the answers

    What is the most common bacterium causing Malignant External Otitis?

    <p>Pseudomonas aeruginosa</p> Signup and view all the answers

    What is the classic triad of Horner's syndrome?

    <p>Miosis, ptosis, anhidrosis</p> Signup and view all the answers

    What is the etiology of Horner's syndrome?

    <p>All of the above</p> Signup and view all the answers

    What is the primary diagnostic tool for Malignant External Otitis?

    <p>Clinical examination</p> Signup and view all the answers

    What is the diagnosis of Horner's syndrome?

    <p>Clinical diagnosis plus imaging to identify lesion location</p> Signup and view all the answers

    What is the treatment of Horner's syndrome?

    <p>Address underlying cause, plus surgery for ptosis</p> Signup and view all the answers

    What is the diagnostic criteria for malabsorption syndrome such as celiac sprue?

    <p>Greater than 10 grams of fecal fat in 24 hours</p> Signup and view all the answers

    Study Notes

    SSPE (Subacute Sclerosing Panencephalitis)

    • Caused by chronic measles virus infection
    • Leads to progressive damage to the central nervous system
    • Presents with behavioral changes, seizures, and eventually severe neurological deterioration
    • Diagnosis based on clinical history, EEG findings, elevated antibody titers in CSF, and typical brain findings
    • Rare complication, usually fatal within 1-3 years after symptoms begin
    • Vaccination is the most effective way to prevent SSPE

    Post-Streptococcal Glomerulonephritis (PSGN)

    • Common cause of acute glomerulonephritis in children
    • Occurs 1-3 weeks after streptococcal infection (strep throat or skin infection)
    • Clinical features include edema, hypertension, and decreased urine output
    • Diagnosis confirmed by elevated ASO titers and low C3 complement levels
    • Treatment is supportive, and the condition usually resolves spontaneously within weeks to months

    Dumping Syndrome

    • Common complication after gastric surgery
    • Early dumping syndrome occurs within 30 minutes of eating and is caused by rapid gastric emptying
    • Symptoms include abdominal fullness, nausea, vasomotor symptoms (flushing, lightheadedness), and diarrhea
    • Late dumping syndrome occurs 1-3 hours after eating and is caused by reactive hypoglycemia
    • Treatment involves dietary modifications (small, frequent meals; avoiding simple sugars) and, in severe cases, somatostatin analogs (octreotide)

    Hyperprolactinemia

    • Causes amenorrhea, galactorrhea, and infertility
    • Treatment: bromocriptine, a dopamine agonist, is the first-line treatment
    • Other dopamine agonists, such as cabergoline, can also be used
    • Pituitary MRI should be performed to rule out a prolactinoma
    • Regular monitoring of prolactin levels and symptoms is necessary during treatment

    Chalazion

    • Chronic granulomatous lesion of the meibomian gland in the eyelid
    • Causes painless swelling of the eyelid
    • Treatment: incision and drainage, triamcinolone injection, and antibiotics (bacitracin, doxycycline, azithromycin)

    Vertebrobasilar Insufficiency

    • Causes symptoms of vertigo, diplopia, and bilateral visual changes
    • Diagnosis: clinical exam, imaging studies (MRI, CT), and angiography
    • Treatment: anticoagulation, antiplatelet therapy, and surgical intervention

    Raynaud's Phenomenon

    • Causes digital ischemia and vasospasm
    • Treatment: calcium channel blockers (nifedipine), peripheral vasodilators, and avoiding cold temperatures
    • Beta-blockers may worsen Raynaud's symptoms by reducing peripheral blood flow

    Congenital Heart Defects

    • VSD (Ventricular Septal Defect) is the most common congenital heart defect
    • Presents with a holosystolic murmur in neonates
    • PDA (Patent Ductus Arteriosus) typically presents with a continuous or machinery-like murmur
    • PFO (Patent Foramen Ovale) is a normal finding in neonates and typically causes a holosystolic murmur

    Abdominal Aortic Aneurysm (AAA)

    • Demographics: most common in men over 65, smokers, and those with a family history
    • Classic presentation: often asymptomatic, may have back pain, pulsatile abdominal mass, or abdominal pain
    • Treatment: surgical repair for aneurysms >5.5 cm or symptomatic, watchful waiting with regular imaging for smaller aneurysms
    • Diagnostic criteria: diameter >5.5 cm on imaging
    • Red flags: sudden severe back or abdominal pain (may indicate impending rupture)

    Hepatitis C Virus (HCV) Management

    • Demographics: risk factors include IV drug use, high-risk sexual behavior, blood transfusion before 1992
    • Classic presentation: often asymptomatic, may have fatigue, jaundice
    • Diagnostics: HCV RNA quantitative PCR to measure viral load
    • Treatment: ribavirin, sofosbuvir, ledipasvir, and sustained virologic response

    Nephrotic Syndrome

    • Causes: minimal change disease, FSGS, membranous nephropathy, amyloidosis
    • Diagnosis: clinical exam, imaging studies, and kidney biopsy

    Sarcoidosis

    • Presents with hilar lymphadenopathy and noncaseating granulomas of the lungs (and other organs)
    • May get eye involvement (uveitis)
    • Elevations of ACE, calcium, and uric acid are frequently seen

    Pott's Disease

    • TB of the spine
    • Seen on x-ray as osteopenia and vertebral body breakdown

    Hemophilia A

    • Factor VIII deficiency
    • Treatment: factor VIII replacement therapy

    CHF (Congestive Heart Failure)

    • Treatment: BB, ACE, spironolactone, hydralazine, Entresto (sacubitril/valsartan), diuretics
    • B.A.S.H.E.D. for treatment: BB, ACE, spironolactone, hydralazine, Entresto, diuretics

    Asthma

    • B.I.O.M.E.S. for treatment: beta-agonists, ipratropium, magnesium, oxygen, corticosteroids, and epi

    Multiple Sclerosis

    • L.M.N.O.P. for symptoms: locomotor, memory, nystagmus, optic neuritis, paresthesia

    Sinus Arrhythmia

    • Normal variation in heart rate that occurs with breathing
    • Heart rate increases slightly during inspiration

    Alcoholic Cardiomyopathy

    • Caused by chronic heavy alcohol use
    • Pathophysiology: alcohol is directly toxic to the myocardium, leading to dilation and impaired contractility of the left ventricle
    • Signs/symptoms: SOB, edema, JVD, S3 gallop, murmurs of mitral/tricuspid regurgitation
    • Diagnosis: echocardiogram shows dilated left ventricle with decreased ejection fraction
    • Treatment: alcohol cessation, guideline-directed medical therapy for heart failure (ACE, BB, loop diuretics)

    Guillain-Barré Syndrome

    • Usually caused by Campylobacter jejuni infection
    • Diagnosis: clinical exam, imaging studies, and electromyography

    Allergic Rhinitis

    • Physical examination finding: pale turbinate bones

    ANA (Antinuclear Antigen) Test

    • Most commonly associated with and monitors progress of lupus
    • Diagnosis: positive ANA test result

    Cesarean Section

    • Performed prior to the onset of labor and rupture of membranes to reduce perinatal HIV transmission
    • Recommended in women with a viral load >1000 copies/mL

    Asbestosis

    • Caused by inhalation of asbestos fibers
    • Presents with dyspnea, dry cough, and inspiratory crackles
    • Chest X-ray: bilateral interstitial fibrosis, pleural plaques/thickening
    • Pulmonary function tests: restrictive pattern, decreased lung volumes, and diffusing capacity of the lung for carbon monoxide
    • Diagnosis: history of asbestos exposure, imaging studies, and PFTs
    • Complications: cor pulmonale, respiratory failure, and lung cancer
    • No specific treatment; supportive care (oxygen, pulmonary rehab)

    Cushing's Syndrome

    • Causes include pituitary tumors (Cushing's disease), adrenal tumors, and ectopic ACTH secretion
    • Symptoms: central obesity, moon facies, buffalo hump, striae, easy bruising, and muscle weakness
    • Diagnosis: 24-hour urinary free cortisol, late-night salivary cortisol, and low-dose dexamethasone suppression test
    • Imaging studies (MRI, CT) are used to localize the source of excess cortisol production

    Asthma Exacerbation

    • Acute worsening of asthma symptoms, often triggered by viral infections, allergens, or irritants
    • Severity assessment based on peak expiratory flow rate (PEFR), oxygen saturation, and degree of respiratory distress
      • Mild: PEFR >70% predicted or personal best, SpO2 >95%
      • Moderate: PEFR 40-70% predicted, SpO2 90-95%
      • Severe: PEFR <40% predicted

    Heart Failure

    • NYHA Class IV: unable to carry out physical activity without discomfort
    • Symptoms: shortness of breath, fatigue, edema, and cough
    • Treatment: medications (ACE inhibitors, beta blockers, diuretics), lifestyle changes, and surgical interventions

    Nephritic and Nephrotic Syndromes

    Nephritic Syndrome

    • Glomerular inflammation causing hematuria, proteinuria, hypertension, and edema
    • Causes: post-streptococcal glomerulonephritis, IgA nephropathy, lupus, and vasculitis
    • Symptoms: hematuria, proteinuria, hypertension, and edema
    • Diagnosis: urinary sediment, kidney biopsy, and serological tests

    Nephrotic Syndrome

    • Characterized by heavy proteinuria, hypoalbuminemia, hyperlipidemia, and edema
    • Causes: minimal change disease, focal segmental glomerulosclerosis, and membranous nephropathy
    • Symptoms: heavy proteinuria, edema, and lipid abnormalities
    • Diagnosis: 24-hour urine protein, serum albumin, and lipid profile

    Hematological Disorders

    Essential Thrombocytosis

    • Elevated platelet count
    • JAK2 mutation
    • Increased risk of thrombosis and hemorrhagic complications

    Myelofibrosis

    • Bone marrow fibrosis
    • JAK2 mutation
    • Anemia, splenomegaly, and extramedullary hematopoiesis

    Waldenstrom's Macroglobulinemia

    • IgM monoclonal gammopathy
    • Hyper viscosity syndrome
    • Lymphoplasmacytic lymphoma
    • Anemia and peripheral neuropathy

    Polycythemia Vera

    • Elevated red blood cell count
    • JAK2 mutation
    • Splenomegaly and increased risk of thrombosis

    Acute Myeloid Leukemia (AML)

    • Blast cells in peripheral blood smear
    • Auer rods in blast cells
    • p53 mutation
    • Cytogenetic abnormalities (e.g., t(8;21), inv(16))
    • Bone marrow failure and frequent infections

    Cardiovascular Disorders

    Left Ventricular Aneurysm

    • Complication of myocardial infarction, usually occurring 30 days post-MI
    • Thinning and scar formation of infarcted myocardium leading to outward bulging
    • Symptoms: heart failure, ventricular arrhythmias, and thromboembolic events
    • Management: medications, anticoagulation, and surgical intervention if necessary

    Malignant Hypertension

    • Characterized by blood pressure >140/90 mmHg associated with nephropathy or encephalopathy
    • Treatment: hydralazine and other antihypertensive medications

    Asbestosis

    • Caused by inhalation of asbestos fibers
    • Presents with dyspnea, dry cough, and inspiratory crackles
    • Chest X-ray: bilateral pulmonary fibrosis and pleural thickening
    • Pulmonary function tests: restrictive pattern and decreased DLCO
    • Diagnosis: history of asbestos exposure, imaging, and PFTs
    • Complications: pulmonary hypertension, respiratory failure, and lung cancer

    Neurology

    • Vertebrobasilar TIAs are associated with symptoms such as dysarthria, hemiparesis, and sensory deficits.
    • Amaurosis fugax is a symptom of retinal or ophthalmic artery ischemia, not vertebrobasilar ischemia.
    • Raynaud's phenomenon is treated with calcium channel blockers, nifedipine, and beta blockers, which are the first-line treatment.

    Cardiology

    • Abdominal Aortic Aneurysm (AAA) is most common in men over 65, smokers, and those with a family history.
    • Classic presentation of AAA includes asymptomatic, abdominal pain, or pulsatile abdominal mass.
    • Treatment for AAA involves surgical repair for aneurysms > 5.5 cm or symptomatic, with alternatives being watchful waiting with regular imaging for smaller aneurysms.

    Infectious Diseases

    • Hepatitis C Virus (HCV) management involves demographics, classic presentation, and diagnostics.
    • Risk factors for HCV include IV drug use, high-risk sexual behavior, and blood transfusion before 1992.
    • Diagnostic criteria include HCV RNA quantitative PCR to measure viral load.

    Hematology

    • Essential Thrombocytosis is characterized by an elevated platelet count, JAK2 mutation, and increased risk of thrombosis.
    • Myelofibrosis is associated with bone marrow fibrosis, JAK2 mutation, and splenomegaly.
    • Polycythemia Vera is characterized by elevated red blood cell count, JAK2 mutation, and splenomegaly.
    • Acute Myeloid Leukemia (AML) is characterized by myeloblasts on peripheral blood smear, Auer rods, and cytogenetic abnormalities.

    Oncology

    • ALL vs CML:
      • ALL is more common in children, with an acute onset, and presents with fever, bone pain, and bleeding.
      • CML is more common in adults, with a chronic, insidious onset, and presents with fatigue, weight loss, and splenomegaly.
      • Peripheral Blood Smear: ALL shows lymphoblasts, while CML shows a full spectrum of myeloid cells.
      • Cytogenetics: Both can have the Philadelphia chromosome, but it is more common in CML.

    HIV

    • Women with 3 consecutive negative annual Pap smears may be screened every 3 years if:
      • Age ≥ 30
      • No history of CIN 2 or 3, immunosuppression, or in utero DES exposure

    Psychiatry

    • Schizoid personality disorder is characterized by:
      • Emotional coldness and detachment
      • Social isolation and aloofness
      • Prefers solitary activities
      • Lacks close relationships or confidants

    Gastroenterology

    • G6PD deficiency is more common in African Americans, Middle Easterners, and those of Mediterranean descent.
    • Prevalence in African American males in the US is ~10%.
    • Oxidative stressors can trigger hemolysis, which presents with anemia, fatigue, and dark urine.

    Pulmonology

    • Lung Cancer Screening Recommendations:
      • Low-dose CT (LDCT) for high-risk individuals
      • Ages 50-80 years
      • ≥ 30 pack-year smoking history
      • Current smoker or quit within past 15 years
      • Discontinue screening if ≥ 15 years since quitting smoking

    Miscellaneous

    • Tetralogy of Fallot is commonly associated with a palpable right ventricular lift.
    • Cervical Conization:
      • Surgical procedure to remove a cone-shaped portion of the cervix
      • Indications include diagnosis and treatment of cervical dysplasia or carcinoma in situ
    • The heterophile test is used for the diagnosis of infectious mononucleosis in children and adults.
    • Heart Valve Replacement and Anticoagulation:
      • Mechanical valves need lifelong warfarin (INR 2.5-3.5)
      • Bioprosthetic valves may only need anticoagulation for 6 months post-op
      • Bridge with heparin or LMWH when stopping warfarin for procedures
    • Nail Pitting:
      • Caused by defective layering of superficial nail plate by proximal nail matrix
      • Associated with psoriasis
    • Terry's nails:
      • Nail plate turns white with ground glass appearance
      • Distal band of brown color
      • Obliteration of lunula
      • Seen in cirrhosis
    • Nail Clubbing:
      • Bulbous swelling of soft tissue at nail base
      • Associated with lung problems, IBS, and CA
    • Chadwick's sign:
      • A blue discoloration of the vagina early in pregnancy
      • Usually appears by 6-8 weeks of gestation
    • Guillain-Barre syndrome:
      • Progressive, symmetric, ascending weakness and areflexia
      • No fever or sensory deficits
      • CSF: elevated protein, normal glucose, and normal WBCs
    • Eye Foreign Body:
      • Most common in males, 20-40 years old
      • Symptoms: pain, tearing, blurred vision, and foreign body sensation
      • Exam: check visual acuity, evert eyelids, fluorescein stain, and slit lamp exam
      • Treatment: topical anesthetic, remove foreign body, and antibiotic ointment
    • Lumbar Radiculopathy vs. Herniated Disk:
      • Compression of nerve roots
      • Unilateral, straight leg raise
      • Narrowing, degenerative disk disease
      • Bilateral, extension, claudication, and rest

    Acute Pancreatitis

    • Presents with severe, sudden-onset abdominal pain and vomiting
    • Elevated lipase and amylase levels are key diagnostic markers
    • Risk factors: alcoholism and hypertriglyceridemia
    • CT scan can reveal pancreatic inflammation and necrosis
    • Treatment: supportive care, pain management, and addressing underlying cause

    Sickle Cell Anemia

    • Autosomal recessive disorder
    • If both parents are carriers, there is a 25% chance of having a child with sickle cell anemia
    • Sickle cell trait provides some protection against malaria
    • Genetic counseling is essential for couples with sickle cell trait

    Pyelonephritis

    • Bacterial infection of the kidney
    • Levoquinolone antibiotic is the most appropriate choice for outpatient treatment
    • Other antibiotics used include ceft and tmpsmx
    • Urine culture and sensitivity guide antibiotic selection
    • Hospitalization may be necessary for severe cases or immunocompromised patients

    Measles

    • Presents with fever, cough, runny nose, and conjunctivitis
    • Koplik spots (small white spots on buccal mucosa) are pathognomonic for measles
    • Rash appears 3-5 days after onset of symptoms and spreads from head to trunk and extremities
    • Complications: pneumonia, encephalitis, and subacute sclerosing panencephalitis (SSPE)

    Subacute Sclerosing Panencephalitis (SSPE)

    • Progressive, fatal disorder caused by persistent measles virus infection
    • Memory loss, myoclonic jerks, and brain inflammation are symptoms
    • MRI and antibody testing aid diagnosis

    Raynaud's Phenomenon

    • CCBs, nifedipine, and BBs are first-line treatments
    • Beta blockers may worsen Raynaud's symptoms by reducing peripheral blood flow

    Abdominal Aortic Aneurysm (AAA)

    • Most common in men over 65, smokers, and those with a family history
    • Classic presentation: asymptomatic; may have back pain, pulsatile abdominal mass, or abdominal pain
    • Treatment: surgical repair for aneurysms >5.5cm or symptomatic; watchful waiting with regular imaging for smaller aneurysms

    Hepatitis C Virus (HCV) Management

    • Risk factors: IV drug use, high-risk sexual behavior, blood transfusion before 1992
    • Classic presentation: often asymptomatic, may have fatigue, jaundice
    • Diagnostics: HCV RNA quantitative PCR to measure viral load
    • First-line treatment: ribavirin, sofosbuvir, ledipasvir

    Myasthenia Gravis

    • Chronic autoimmune disorder affecting the neuromuscular junction
    • Antibodies against acetylcholine receptor (AChR) or muscle-specific kinase impair contraction
    • Peak incidence: 20-40 years old, women > men (2:1 ratio)
    • Clinical presentation: fatigable weakness of muscles, worsens with repetition and improves with rest
    • Diagnostic evaluation: edrophonium test, EMG, and MuSK antibody testing
    • Treatment: pyridostigmine, prednisone, azathioprine, IVIG, and thymectomy

    Viral Conjunctivitis

    • One of the most common causes of viral conjunctivitis is adenovirus type 8
    • Contaminated fomites can be a source of infection
    • No specific antiviral agent for treatment; symptomatic relief with topical antihistamine/decongestants and warm compresses

    Ovulation

    • Occurs within 1-2 days of the LH surge and at the time of elevated estrogen levels

    Factor V Leiden

    • Most common associated abnormality in young adults with otherwise unexplained thrombosis

    Acute Respiratory Distress Syndrome (ARDS)

    • Severe, acute lung injury causing noncardiogenic pulmonary edema
    • Risk factors: sepsis, pneumonia, aspiration, trauma, pancreatitis
    • Pathophysiology: alveolar-capillary membrane damage
    • Clinical presentation: acute onset dyspnea, tachypnea, hypoxemia, and bilateral diffuse opacities on chest X-ray
    • Management: supportive care, treat underlying cause, consider mechanical ventilation and prone positioning

    Acute Pancreatitis

    • Presents with severe abdominal pain and elevated lipase and amylase levels
    • Risk factors include alcoholism and gallstones
    • Diagnosis involves imaging studies to reveal pancreatic inflammation and necrosis
    • Treatment involves supportive care, pain management, and addressing the underlying cause

    Sickle Cell Anemia

    • Autosomal recessive disorder
    • If both parents are carriers, there is a 25% chance of having a child with sickle cell anemia
    • Sickle cell trait provides some protection against malaria
    • Genetic counseling is essential for couples with sickle cell trait

    Pyelonephritis

    • Bacterial infection of the kidney
    • Treatment involves antibiotics, with levofloxacin being the most appropriate choice for outpatient treatment
    • Urine culture and sensitivity should guide antibiotic selection
    • Hospitalization may be necessary for severe cases or immunocompromised patients

    Measles

    • Presents with fever, cough, runny nose, and conjunctivitis
    • Koplik spots (small white spots on the buccal mucosa) are pathognomonic for measles
    • The rash appears 2-5 days after the onset of symptoms and spreads from the head to the trunk and extremities
    • Complications include pneumonia, encephalitis, and subacute sclerosing panencephalitis (SSPE)

    Subacute Sclerosing Panencephalitis (SSPE)

    • Progressive, fatal disorder caused by persistent infection with the measles virus
    • Characterized by memory loss, myoclonic seizures, and brain inflammation
    • Diagnosis involves MRI and detection of anti-measles antibodies

    Argyll-Robertson Pupils

    • Irregular pupils that constrict poorly to light but accommodate normally to near vision
    • Seen in tabes dorsalis, neurosyphilis, and Adie's tonic pupil syndrome
    • Caused by lesions in the dorsal midbrain affecting the light reflex pathway while sparing the accommodation reflex pathway
    • Associated with loss of deep tendon reflexes, ataxia, and positive Romberg sign in tabes dorsalis

    Amaurosis Fugax

    • Transient monocular vision loss, often due to emboli from carotid artery atherosclerosis or cardiac source
    • Other causes include migraines, retinal detachment, and optic neuritis

    Anisocoria

    • Unequal pupil sizes
    • Causes include Horner's syndrome, third nerve palsy, pharmacologic dilation, physiologic anisocoria, and Adie's tonic pupil

    Horner's Syndrome

    • Caused by disruption of sympathetic innervation to the eye and face
    • Classic triad: miosis (constricted pupils), ptosis (drooping eyelids), and anhidrosis (lack of sweating on affected side of face)
    • Etiologies include stroke, tumor, dissection, and cluster headache
    • Diagnosis involves clinical evaluation, plus imaging (CT/MRI) to identify lesion location

    Celiac Disease

    • Greater than 10 grams of fecal fat in 24 hours is most consistent with a malabsorption syndrome such as celiac sprue

    Spinal Stenosis and Lumbar Radiculopathy

    • Spinal Stenosis: narrowing of the spinal canal, often due to degenerative changes
    • Lumbar Radiculopathy: nerve root compression, often due to herniated disc
    • Symptoms include leg pain, numbness, weakness, and positive straight leg raise test
    • MRI shows compression of nerve roots in lumbar radiculopathy and narrowed spinal canal in spinal stenosis

    Alcoholic Hepatitis

    • AST:ALT ratio in alcoholic hepatitis is 2:1
    • Treatment involves observing mild-moderate cases, treating severe cases, and following up in 2-3 days
    • Unreliable patients may require a higher dose of antibiotics

    Coronary Artery Spasm

    • Caused by focal constriction of coronary arteries
    • Can occur in normal or atherosclerotic vessels
    • Triggered by smoking, stress, cold, triptans, and medications (e.g., cocaine)
    • ECG shows transient ST-segment elevation during episodes
    • Treatment involves using CCBs and nitrates

    Prinzmetal Angina (Variant Angina)

    • Caused by coronary artery spasm
    • Occurs at rest, often at night or early morning
    • Not typically triggered by exertion
    • ECG shows transient ST-segment elevation during episodes
    • Treatment involves using CCBs and nitrates

    Hemochromatosis

    • Autosomal recessive inherited disorder
    • Causes cirrhosis, bronze skin pigmentation, and abnormal iron accumulation in tissues
    • Intensive phlebotomy is the treatment of choice until the iron overload is corrected

    Lung Lesions

    • Typical doubling times for lung lesions:
      • Malignant: 1-3 months
      • Hamartoma: 15-20 months
      • Inflammatory (Infectious): 20-40 days
    • Different types of lung lesions:
      • Adeno(carcinoma)
      • SCC
      • SCLC
      • Granuloma

    Visual Field Defects

    • Bitemporal hemianopia: loss of vision in the outer half of both visual fields
      • Lesion: Optic chiasm
      • Common causes: Pituitary tumor, craniopharyngioma, meningioma
    • Binasal hemianopia (rare): loss of vision in the inner half of both visual fields
      • Lesion: Bilateral optic nerve lesions at the junction of the optic nerve and chiasm
      • Common causes: Bilateral optic nerve gliomas
    • Homonymous hemianopia: loss of vision in the same half of both visual fields
      • Right homonymous hemianopia: lesion in the left optic tract or left occipital lobe
      • Left homonymous hemianopia: lesion in the right optic tract or right occipital lobe
      • Common causes: Stroke, tumor, occipital lobe

    Aortic Insufficiency

    • Definition: AoV disease causing blood regurgitation into the LV
    • Causes: Bicuspid AoV, rheumatic fever, endocarditis, Ao root disease
    • Symptoms: Dyspnea, fatigue, angina, wide pulse pressure
    • Signs: Diastolic murmur, bounding pulses, displaced PMI
    • Diagnosis: Echocardiogram
    • Treatment: Medications (vasodilators, ACE inhibitors) for mild-moderate cases, valve replacement for severe cases

    Lithium Toxicity and Thyroid Effects

    • Lithium has a narrow therapeutic index and can cause toxicity at levels above 1.5
    • Signs of toxicity: Nausea, vomiting, diarrhea, ataxia, tremors, seizures, coma
    • Lithium can cause hypothyroidism and hyperthyroidism due to inhibition of thyroid hormone release
    • Monitor lithium levels, TSH, and free T4 levels every 6-12 months in patients on lithium therapy
    • If hypothyroidism develops, treat with levothyroxine while continuing lithium

    Acne Vulgaris Treatment

    • Mild: Topical retinoids, benzoyl peroxide, or combination products
    • Moderate: Topical retinoids + oral antibiotics for 3-4 months
    • Severe: Oral isotretinoin for 4-6 months; monitor for teratogenicity and other side effects
    • Maintenance: Topical retinoids ± benzoyl peroxide to prevent recurrence

    Cardiovascular Disease

    • Dilated cardiomyopathy is often caused by chronic alcohol use
    • Argyll-Robertson pupils: irregular pupils that constrict poorly to light but accommodate normally to near vision
    • Seen in tabes dorsalis, diabetes, and Adie's tonic pupil syndrome
    • Caused by lesions in the dorsal midbrain affecting the light reflex pathway while sparing the accommodation reflex pathway

    Seizure Disorders

    • Amaurosis fugax: Transient monocular vision loss, often due to emboli from carotid artery atherosclerosis or cardiac source
    • Anisocoria: Unequal pupil sizes
    • Causes of anisocoria: Horner's syndrome, third nerve palsy, pharmacologic dilation, physiologic anisocoria, Adie's tonic pupil
    • Myoclonic seizures: Brief, shock-like muscle contractions
    • Treatment: Valproic acid, Keppra, Topamax
    • Complex partial seizures: Sxs include automatism with loss of awareness
    • Treatment: Tegretol, Lamictal
    • Simple partial seizures: Sxs include no loss of awareness, may secondarily generalize
    • Treatment: Carbamazepine, Keppra, phenytoin

    Diabetes Mellitus

    • Gastroparesis: Delayed gastric emptying, often due to autonomic neuropathy
    • Symptoms: Early satiety, bloating, nausea, vomiting, abdominal pain
    • Diagnosis: Gastric emptying study
    • Treatment: Dietary modifications, metoclopramide, erythromycin
    • Complications: Malnutrition, poor glycemic control, bezoars

    Lung Cancer Screening

    • Recommended for high-risk individuals
    • Ages 50-80 years
    • ≥30 pack-year smoking history
    • Current smoker or quit within the past 15 years
    • Discontinue screening if >15 years since quitting smoking

    Tetralogy of Fallot

    • Palpable RV lift
    • AFP

    Fetal Aneuploidy Screening

    • First trimester (11-14 weeks): Nucal translucency, PAPP-A, hCG
    • Quad screen (15-22 weeks): AFP, hCG, inhibin A, uE3
    • CVS (10-13 weeks) or amniocentesis (>15 weeks) for high-risk results
    • Ultrasound markers: NT, absent nasal bone, echogenic bowel, shortened femur/humeral bones
    • Integrated screening: 1st & 2nd trimester tests combined

    ALS

    • Characteristic hallmark: Progressive weakness + UMN signs (hyperreflexia, spasticity, positive Babinski sign) and LMN signs (muscle atrophy, fascics, sensory deficits) without sensory deficits

    Asbestosis

    • Caused by inhalation of asbestos fibers
    • Presents with dyspnea, dry cough, inspiratory crackles
    • Chest X-ray: Bilateral interstitial fibrosis, pleural thickening, and calcified pleural plaques
    • PFTs: Restrictive pattern, decreased lung volumes, normal FEV1/FVC ratio
    • Diagnosis: History of asbestos exposure + imaging + PFTs
    • Complications: COPD, lung cancer, pleural plaques, pleurisy

    Malignant External Otitis

    • Severe infection of external auditory canal, typically in elderly patients with diabetes or immunocompromised
    • Caused by Pseudomonas aeruginosa
    • Presents with severe otalgia, otorrhea, granulation tissue in ear canal
    • Can spread to temporal bone, cranial nerves, brain
    • Diagnosis: Clinical exam, culture of ear drainage, CT/MRI
    • Treatment: Prolonged course of antibiotics, strict glucose control, surgical debridement

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    Test your knowledge on Subacute Sclerosing Panencephalitis, a rare and fatal complication of measles virus infection. Learn about its symptoms, diagnosis, and prevention.

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