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Low calcium, elevated phosphorus, elevated PTH - diagnosis?
Chronic renal failure
Low calcium, elevated phosphorus, low PTH - diagnosis?
What are the main affects of parathyroid hormone (PTH)?
- 1) Increase calcium resorption from bone
- 2) Increase calcium resorption at renal tubules
- 3) Enhance tubular excretion of phosphate
Low calcium, low phosphorus, elevated PTH - diagnosis?
Vitamin D deficiency or vitamin D resistent rickets
What causes vitamin D-dependent rickets?
Results from deficiency of enzyme that converts 25-D3 to 1,25-D3
How is vitamin D-dependent rickets different from vitamin D-deficiency rickets?
Labs & rads same but patient is unresponsive to 25-D; instead must treat with 1,25-D
What are the lab findings of vitamin D-resistant rickets?
Low phosphorus, normal calcium, normal PTH
What is the etiology of vitamin D-resistant rickets?
"Phosphate leak" at the proximal tubule
What are 3 maternal risk factors that would prompt intrapartum GBS prophylaxis?
- 1) Positive GBS screen at 35-37 weeks's GA
- 2) GBS urinary tract infection during current pregnancy
- 3) Previous infant treated for early-onset GBS infection
(T/F) Antibiotic treatment during pregnancy will eradicate maternal GBS.
False - cultures will become positive within days of stopping antibiotics
What is the number 1 cause of boating-related fatality in the United States?
What recommendation is most likely to decrease the risk of boating-related fatality?
Wear life jacket at all times while on the boat
(T/F) Kids infected with GABHS who younger than 3 years of age present with classic pharyngitis.
False - kids less than 3 years old have decreased attachment of GABHS to nasopharyngeal and oropharyngeal epithelial cells
List 7 symptoms (in order of presentation) of GABHS in a kid less than 3 years
- 1) Serous rhinitis
- 2) Moderate fever
- 3) Irritability
- 4) Anorexia
- 5) Purulent nasal d/c
- 6) Impetigo below nares
- 7) Scarletiniform rash
How long does it take for influenza to resolve?
Why does CCHD increase an infants risk of stroke?
Cyanosis stimulates kidneys to make more EPO, which leads to polycythemia and subsequently thromboses at lung, kidney, brain
What is the formal name of Charcot Marie Tooth disease?
Autosomal dominant hereditary sensorimotor neuropathy
Acute inflammatory demyelinating polyneuropathy is also known by what eponym?
Hereditary sensorimotor neuropathy is also known by what eponym?
Charcot Marie Tooth disease
Hypoplastic nose, depressed nasal bridge, stippling of the vertebrae on CXR - infant with these features most likely was exposed to what teratogen?
Arched eyebrows, wide-spaced eyes, short upturned nose, nail hypoplasia - infant with these features most likely was exposed to what teratogen
Phenytoin (fetal hydantoin syndrome)
Hypoplasia to absence of external ear, depressed nasal bridge, ocular hypertelorism, mottled dental enamel - infant with these features most likely was exposed to what teratogen?
Retinoic acid (Accutane)
Narrow bifrontal diameter, tall forehead, midface hypoplasia, small mouth, small chin, neural tube defect - infant with these features most likely was exposed to what teratogen?
What lab value is most likely to change in a boy going through puberty?
Hemoglobin - increases due to hematopoietic effects of testosterone
Normal calcium and low phosphorus with positive family history of rickets - diagnosis?
Familial hypophosphatemic rickets (vitamin D-resistant rickets)
What are 3 encapsulated organisms are responsible for overwhelming sepsis in asplenic patients?
- 1) Streptococcus pneumoniae
- 2) Haemophilus influenzae b
- 3) Neisseria meningitidis
What is the most common encapsulated organism to cause SBI in asplenic patients?
What are 2 special growth requirements for Campylobacter sp.?
- 1) Incubation at 42-degree C
- 2) Microaerophilic environment
Which media is needed to grow gonococci?
Which media is needed to grow Bordetella pertussis?
Bordet-Gengou or Regan-Lowe
Which media is needed to grow Corynebacterium diphtheriae?
Loeffler or Tinsdale
Name 2 slow-growing organisms that need to be held for a longer period
- 1) Brucella sp
- 2) Mycobacterium tuberculosis
What is a ureterocele?
Cystic dilation of the ureter where it inserts into bladder
Who is more likely to be born with ureteroceles, male or female?
The obstruction caused by ureteroceles classically results in what type of hydronephrosis?
Hydroureteral nephrosis of the upper renal pole of the kidney
What is vocal cord dysfunction (VCD)?
Paradoxic adduction of vocal cords during inspiration
What are 3 risk factors for subglottic stenosis?
- 1) Laryngeal trauma
- 2) Intubation
- 3) Infection (i.e. TB, diphtheria)
What are 4 risk factors for vocal cord paralysis?
- 1) CNS lesions
- 2) Heart surgery
- 3) TE fistula
- 4) Laryngitis
What electrolyte abnormality is associated with respiratory disease?
Hypocalcemia - leads to tetany-related laryngospasm
What are 5 symptoms of hypocalcemia?
- 1) Laryngospasm
- 2) Perioral/extremity paresthesia
- 3) Carpopedal spasm
- 4) Seizure
How does metabolic ALKALOSIS cause hypocalcemia?
Metabolic alkalosis leads to increased binding of calcium to albumin, thereby lowering the ionized calcium
Round, oval plaques of thick, white or silver scalelesions; pinpoint areas of hemorrhage when scale is removed - diagnosis?
How do proton pump inhibitors work?
Inhibit H-K ATPase of gastric parietal cells
What are 6 early causes of neonatal hypocalcemia?
- 1) Prematurity
- 2) Maternal diabetes
- 3) Asphyxia
- 4) IUGR
- 5) Maternal seizure meds
- 6) Maternal hyperparathyroidism
What are 10 late causes of neonatal hypocalcemia?
- 1) High P, low Mg
- 2) Primary hypoparathyroidism: 22q11
- 3) PTH resistance
- 4) Vitamin D deficiency
- 5) Disorder of vit D metabolism
- 6) Disorder of calcium receptors
- 7) Excess P intake
- 8) Alkalosis
- 9) Transfusion with citrate-containing preservatives
- 10) Malabsorption diarrhea
What are the antibiotic choices for the treatment of pinworms? (3)
- 1) Mebendazole
- 2) Pyrantel pamoate
- 3) Albendazole
Name the 4 mucopolysaccharidoses (MPS)
- 1) Hunter syndrome (MPS II)
- 2) Hurler syndrome (MPS I)
- 3) Sanfilippo syndrome (MPS III)
- 4) I-cell disease (mucolipidosis II)
How is Hunter syndrome inherited?
All MPSs have this mode of inheritance (except for Hunter syndrome)
What are late complications of asymptomatic neonatal hyperthyroidism?
Name 7 risk factors for developing a brain abscess
- 1) Right-to-left cardiac shunt
- 2) Bacterial meningitis
- 3) Penetrating head wound
- 4) Orbital cellulitis
- 5) Sinusitis
- 6) Dental infection
- 7) Chronic otitis media
What is the best antimicrobial coverage for treating brain abscess?
- Broad-spectrum covering:
- 1) Aerobic gram-positives
- 2) Gram-negatives
- 3) Anaerobes
- 4) MRSA
What is the test of cure for congenital syphilis?
Repeat RPR at 3, 6, 12 after therapy and demonstrate fourfold decrease in RPR titer or NR
What are 3 types of glomerulonephritis with normal C3 & C4?
- 1) IgA glomerulonephritis
- 2) Pauci-immune vasculitis
- 3) Familial nephritis (Alport, thin GBM)
What is the mode of inheritance of Alport syndrome?
What is the pathophysiology behind Alport syndrome?
Underlying defect in GBM resulting in disruption of glomerular capillary barrier
Which congenital lung malformation is most likely present in adolescence or adulthood (rather than in infancy)?
Which congenital lung malformation is most likely present in infancy (rather than in adolescence or adulthood)?
Congenital cystic adenomatoid malformation
Endoscopy revealing "nodular gastric antrum with gastric and duodenal ulcers" suggest what disease process?
Helicobacter pylori infection
For H. pylori that does not respond to therapy, what is the next step of evaluation?
Cultures, resistance testing, testing for CagA virulence factors
The appearance of "double bubble" on plain radiograph indicates what congenital intestinal abnormality?
AP abdominal radiograph showing dilated loops of bowel proximally but no gas distally - diagnosis?
What is another name for roseola infantum?
Human herpesvirus 6 or 7
What is another name for human herpesvirus 6 or 7?
What viral infection affects multiple systems (i.e. conjunctivitis, rhinitis, pharyngitis, otitis, gastroenteritis)?
What is "bell-clapper" deformity?
Testicle lacks normal attachment to tunica vaginalis and predisposes testicle to torsion
Infant with delayed passage of stool beyond 24 HOL, bilious emesis when fed; plain abdominal radiograph show dilated loops of bowel - diagnosis?
Cystic fibrosis - meconium ileus
Infant with delayed or absent passage of stool, progressive abdominal distention over first 48 HOL - diagnosis?
What are 4 VIRUSES that can cause exudative pharyngitis?
- 1) Adenovirus
- 2) Influenza A
- 3) Epstein-Bar Virus
- 4) Herpes Simplex Virus
What are 5 antiepileptic drugs that induce cytochrome P450 hepatic enzyme pathway?
- 1) Phenobarbital
- 2) Primidone
- 3) Hydantoin
- 4) Carbamazepine
- 5) Oxcarbazepine
What effect does the cytochrome P450 hepatic enzyme pathway have on OCPs?
Increases metabolic rate of estrogen and progestogens, thereby lowering serum levels of hormone
What is danazol?
Modified progesten with androgenic effects (i.e. fetal virilization)
What are 3 nontreponemal tests used to screen for syphilis?
- 1) VDRL venereal disease research laboratory
- 2) RPR rapid plasma reagin
- 3) ART automated reagin test
What are treponemal tests to diagnose syphilis?
- 1) FTA-ABS fluorescence treponemal antibody absorption
- 2) TPHA T. pallidum hemagglutination assay
What are 4 DSM-IV criteria for Tourette syndrome?
- 1) Multiple motor tics + one or more phonic tics
- 2) Tics are frequent or chronic (more than a year)
- 3) Onset before 21 years
- 4) Unexplained by medical condition
What is the prevalence of Tourette syndrome?
1 in 2,000
What are 3 characteristics of tics that distinguish it from other movement disorders?
- 1) Patterned
- 2) Repetitive
- 3) Decreased during purposeful movement
What are 3 characteristics of chorea that distinguish it from other movement disorders?
- 1) Nonpatterned
- 2) Continuous
- 3) Increased with purposeful movements
What are 2 methods for diagnosing Entamoeba histolytica infection?
- 1) Cysts in stool
- 2) Indirect hemagglutination assay
What are 3 complications of Ascariasis?
- 1) Pneumonitis
- 2) Acute intestinal obstruction
- 3) Bile duct obstruction (leading to cholangitis)
What parasite causes neurocysticercocis?
Taenia solium (tapeworm)
What parasite causes elephantiasis?
Wucheria bancrofti (filariasis)