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What is the most common inherited form of mental retardation?
Fragile X syndrome
10 y/o M brought to ER with colicky abdominal pain and dizziness for past two hours. Seven episodes with vomiting with bright red blood in vomitus, and has also had diarrhea with dark green stools. Mother takes acetominophen, aspirin, iron supplements, and paroxetine.
Iron toxicity - Iron is toxic to GI tract - associated with hemorrhagic vomiting/diarrhea
42 y/o F twisted leg while hiking. Initially felt pain in right knee but was able to continue to walk. Next morning, noticed right knee swelling and was painful to bear weight on it. Severe pain in medial aspect of knee while squatting.
67 y/o M discovers several lumps in axilla while showering. PE: bilateral cervical and axillary lymphadenopathy. Tip of the spleen is palpable. Labs: Hb: 8.5, MCV: 89, Leukocyte count (56,000 (80% mature lymphocytes). Platelets: 90K.
Chronic lymphocytic leukemia
What cells are seen on blood smears of patients with CLL?
"Smudge cells" - fragile lymphocytes
Soft holosystolic murmur over xiphoid process in known IV drug user
Tricuspid regurgitation due to right sided endocarditis
How to differentiate loops of small bowel vs large bowel on abdominal plain film?
- Small bowel - center of abdomen
- Valvulae Conniventes extending across bowel lumen
Treatments for PCOS - first and second line
- 1. Weight loss
- 2. Clomiphene or Metformin
What is the treatment for BPPV?
Epley manuever - resposition displaced otoliths
Fracture involving middle portion of humerus - what nerve to worry about? How to tell?
Radial nerve - travels along dorsal aspect of humerus
Sensation on dorsal surface of hand
Classic EKG findings in atrial fibrillation?
- absent P waves
- irregularly irregular QRS complexes (irregular R -R intervals)
71 yo M evaluated for impaired cognition and memory loss. Family members report that suddenly 1 year ago he started to become more forgetful. About 5 months ago, he started having trouble balancing checkbook and began getting lost around neighborhood. PMH: DM, HTN, high cholesterol.
Vascular/multi infarct dementia
What test can be used to help diagnose carcinoid syndrome?
Urinary 5-HIAA excretion
What lab test to order for suspected celiac disease?
What if you see RBCs stacked together like coins?
- Rouleaux formation
- Suspect multiple myeloma - elevated proteins cover RBCs removing normal electrostatic repulsion that prevents RBCs from sticking to each other
73 y/o F hospitalized following anterior wall MI. On day 3, develops SOB and chest discomfort. BP: 80/40, HR: 120. On exam: holosystolic murmur at left sternal border.
Ventricular septal defect - secondary to rupture of interventricular septum
What is the most common coagulopathy seen in cancer patients?
Disseminated intravascular coagulation
23 y/o African American male passes out while unloading heavy packages. Has had brief episodes of light headednesss over last few years. PE: systolic murmur heard best at left sternal border that decreases in intensity when he goes from standing to supine position.
Murmur noted with mitral valve prolapse?
Midsystolic click with late systolic murmur
16 y/o M pw severe sharp right sided testicular pain. Not sexually active. PE: right sided testicular swelling and extreme tenderness. Touching inner thigh does not lead to elevation of the testes. Elevating testes does not lead to relief of pain.
Most common presentation of IgA nephropathy?
Gross hematuria following upper respiratory infection
What is the most common cause of nephrotic syndrome in adults (particularly African Americans)?
Focal segmental glomerulosclerosis
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