Medical Questions and Answers for University and High School Students, Exams of Nursing

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The most important risk factors for respiratory distress syndrome (RDS) is? Prematurity

• male sex, prenatal asphyxia, maternal diabetes, cesarean sec?on Maternal diabetes - > INC incidence by delaying matura?on of pulmonary surfactant produc?on (high levels insulin in fetus inhibits cor?sol and blocks matura?on sphingomyelin) Aor?c stenosis Systolic crescendo-decrescendo murmur Loudest at base and radiates to caro?ds Age related calcifica?on Puls parvus tardus

• Delayed weak pulses

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An?thyroid peroxidase and an?thyroglobulin an?bodies found in a pa?ent with an enlarged contender thyroid. What is your diagnosis, and what would you see on biopsy? Hashimoto thyroidi?s (hypothyroidism) histo findings: Hurthle cells, lymphoid aggregates with germinal centers Dysphagia MV Regurg --> large LA Congenital rubella syndrome classic triad Sensorineural deafness, eye abnormali?es (cataracts, re?nopathy, microphthalmia), congenital heart disease (PDA, pulmonary artery stenosis) Mitral Regurge Holosystolic, blowing murmur Loudest at apex and radiates to axilla Post MI, LVH, MVP Result of rhf or endocardi?s Tx RDS Antenatal preven?on w/ cor3costeroids and postnatal tx w/ exogenous surfactant Space occupying lesion in the parietal lobe in a child what is the most common tumor type?

CNS tumors most common solid tumors => Astrocytoma most common supratentorial and infratentorial groups In pediatric popula?on, infratentorial tumors are more common than supratentorial tumors, benign astrocytomas are the most common histo type Tri Regurge Holosystolic, blowing murmur Loudest at tricuspid area RVH Result of rhf or endocardi?s Pot-bellied, pale, puffy-faced child with protruding umbilicus, protuberant tongue, and poor brain development. What does this child have, and what are likely causes? Congenital hypothyroidism (cre?nism) due to maternal hypothyroidism, thyroid genesis, thyroid dysgenesis, iodine deficiency, dyshormonogene?c goiter Pulsus paradoxus Cardiac tamponade (=abnormally large P drop w/ inspira?on) HSV encephali?s loca?on

Temporal lobes Weber's syndrome Midbrain stroke with ipsilateral oculomotor palsy and contralateral hemiparesis or hemiplegia Most common cause of primary hyperparathyroidism Parathyroid adenoma (followed by parathyroid hyperplasia) Discordant RVP and LVP tracing w/ resp Constric?ve pericardi?s (--> septal bouncing) "irregularly irregular" A fib Describe the classical case in a pa?ent with subacute granulomatous thyroidi?s. Pa?ent had a viral infec?on (flu-like illness). Ini?ally was hyperthyroid, followed by hypothyroid. Pa?ent describes jaw pain, and on exam has a very tender thyroid. Atypical lymphocytes with EBV infec?on Cytotoxic T cells Define primary amenorrhea. Absence of menarche by age 15 Neonatal opioid withdrawal symptoms Uncontrolled crying, constant sucking, irritability and hyperac?ve reflexes Mitral Prolapse Mid-systolic click with crescendo Apex Common valve defect from chordae tensing

Marfans, ED, rhf, Chordae rupture May cause endocardi?s Pulsa?ng abdominal mass Abdominal aor?c aneurism Congenital dermal melocytosis, benign, flat blue-grey patches on the lower back and bu]ocks that is common in African, Asian, Hispanic, and Na?ve American ethnicity. Mongolian spots - > usually fade spontaneously

• document these as they can be mistaken for bruises III/VI Holosystolic murmur in a 1 month old with normal PE, next step? Echocardiogram, pa?ent has VSD "machine-like murmur" PDA What causes a cle^ lip?

Failed fusion of maxillary prominences and medial nasal prominences (primary palate) S Mitrial/Tricuspid closure Start Systole Best heard in mitrial area Exogenous cor?costeroids causes increased cor?sol (Cushing syndrome). What ACTH levels do you see and how does it affect the adrenal glands? Decreased ACTH (due to cor?sol nega?ve feedback on pituitary) bilateral adrenal atrophy S Aor?c and Pulm Valve closure Start Diastole Le^ upper sternal border Primary adrenal adenoma, hyperplasia, or carcinoma can cause increased cor?sol. What ACTH levels do you see and how does it affect the adrenal glands? Decreased ACTH atrophy of un-involved adrenal gland Down syndrome Endocardial cushio defects

• ASD
• AV Canal Defect

What causes a cle^ palate? Failed fusion of (1) lateral pala?ne prominences OR (2) lateral pala?ne prominences with nasal septum and/or medial pala?ne prominence (secondary palate) All sexually ac?ve women < 24 should undergo which screening? Chlamydia trachoma3s and Neisseria gonorrhoea

• recommended for any person with new partner in past 2 mo., mul?ple partners, history STI, illicit drug use, incarcera?on, contact with sex workers

• cervici?s asymptoma?c o^en can lead to PID - > infer?lity, ectopic pregnancy, chronic pelvic pain S Rapid filling Dilated ventricles - HF Mitral regurge too Normal if young ACTH-secre?ng pituitary adenoma and paraneoplas?c ACTH secre?on (small cell lung cancer) can cause increased cor?sol (Cushings). What ACTH levels do you see and how does it affect the adrenal glands? Increased ACTH bilateral adrenal hyperplasia Premature baby PDA

What types of poliovirus vaccine are available and what common immune response do they both induce? (1) Oral live a]enuated (2) injected killed poliovirus Induce neutralizing an?bodies (humoral) in circula?on *OPV also induces secretory iga an?bodies in the gut "Boot shaped Heart" Tetralogy of Fallot Hormonal changes in menopause Decreased estrogen (decline in # of ovarian follicles) Markedly increased FSH (loss of estrogen nega?ve feedback, specific) Increased LH Increased gnrh Best screening test for Chlamydia trachoma?s and Neisseria gonorrhoeae by? Nucleic acid amplifica3on tes?ng which has high sensi?vity and specificity

• can be done urine, endocervical, vaginal, or urethral specimens Findings of Cushing Syndrome HTN, weight gain, moon facies, abdominal striae, truncal obesity, buffalo hump, thinning skin, osteoporosis, hyperglycemia, amenorrhea, immunosuppression S Atrial Kick Le^ later decubitus posi?on S?ff hypertrophic Le^ Ventricle - Always abnormal High atrial pressure

Can sit momentarily on propped hands, transfer objects from hand to hand, and respond to name. Stranger anxiety develops at this age. Healthy 6 mo. Old Normal S2 Split Inspira?on causes dec ITP and Inc VR What are the results of the screening tests if a pa?ent has Cushing syndrome? Increased free cor?sol on 24-hr urinalysis increased late night salivary cor?sol inadequate suppression with overnight low-dose dexamethasone test Digeorge Syndrome Truncus Arteriosus Pulmonary silicosis/talcosis characteris?c imaging & biopsy Imaging - calcifica?ons of perihilar lung fields Biopsy - granulomatous inflamma?on surrounding foreign par?cles Posterior communica?ng artery aneurysm symptom CN III (oculomotor) palsy - eye is "down and out" "Snowman heart" Totally Anomalous Pulmonary Venous Return You measure ACTH in a pa?ent you suspect of Cushing syndrome, and results come back low. What is your likely causes? Exogenous glucocoricoids or adrenal tumor Fixed Splilng

ASD - L - > R shunt Consistent delay of pulmonic valve closure Pts with Sickle cell anemia suffer from chronic extravascular and intravascular hemolysis. Characteris?c lab findings include? Mild to moderate anemia w/ re?culocytosis + unconjugated hyperbilirubinemia, INC lactate dehydrogenase, low to absent serum haptoglobin

• Acute worsening of anemia can occur from splenic sequestra?on with manifests as splenomegaly and INC fa?gue Wide Splilng Delayed RV emptying and pulmonic closure RBBB, Pulmonic Stenosis Split increased w/ inspira?on You measure ACTH in a pa?ent you suspect of Cushing syndrome, and results come back elevated. What do you do next? Do a high dose dexamethasone suppression test and CRH s?mula?on test

"Split and fixed S2" ASD Carbon monoxide poisoning symptoms and treatment Symptoms: headache, weakness, dizziness, N/V, SOB, confusion, blurred vision Treatment: 100% O2 and hyperbaric O ___ are the an?bio?cs of choice for pertussis treatment and post-exposure prophylaxis. All close contacts should be given this an?bio?c regardless of age, immuniza?on status or symptoms. Macrolides Age < 1 mo. = Azithromycin 5 days Age > 1 mo. = Azithromycin x 5 days/Clarithromycin x 7 days/ Erythromycin x 14 days Adequate suppression of high dose dexamethasone suppression test increased ACTH and Cor?sol on CRH s?mula?on test Diagnosis, and next step? Cushing disease (ACTH pituitary adenoma) MRI of head/pituitary Chest pain relieved by leaning forward Acute pericardi?s Galactokinase deficiency symptoms AR, mild. Galactose in blood & urine, infan?le cataracts (failure to track objects or social smile) Paradoxical splilng Delayed Aor?c closure

• Stenosis, LBBB

Inspira?on pushes pulmonic closure closer to aor?c Lethargy, fever, poor oral intake, vomi?ng presenta?on, nuchal rigidity of bacterial meningi?s in infant what should be performed next? Lumbar puncture before an3bio3cs Infants cri?cally ill (status epilep?cus, sep?c shock) an?bio?cs before lumbar puncture Head CT - > comatose infants No suppression with high dose dexamethasone suppression test no increase in ACTH and cor?sol on CRH s?mula?on test diagnosis, and next step? Ectopic ACTH secre?on (small cell lung cancer) CT of chest/abdomen/pelvis Myxoid degenera?on Marfan's Galactose- 1 - phosphate uridyltransferase deficiency symptoms & treatment AR Symptoms: failure to thrive, jaundice, hepatomegaly, infan?le cataracts, intellectual disability, E. Coli sepsis Treatment: exclude galactose & lactose from diet Inspira?on

Increases R. Sided Murmurs by increasing VR and PL Indica?ons for imaging prior to LP for bacterial meningi?s suspected in children

1 mo. Hx hydrocephalus or neurosurgical procedure Hx head trauma Coma or focal neuro findings Tx Bacterial meningi?s in children age > 1 mo. IV Vanco & CeBriaxone OR Cefotaxime Dexamethasone for H. Influenzae type b meningi?s Hand grip Increases AL - > Inc TPR Increases MR, AR, and VSD Dec HOCM and AS A 3 year old child is brought to the clinic because of a firm, irregular mass that crosses its midline in his abdomen. What is your most likely diagnosis? Where does this tumor occur? What is it derived from? Diagnosis: neuroblastoma occurrence: most common tumor of adrenal medulla in children, and occurs

anywhere along sympathe?c chain derived from neural crest cells "cannon wave" on atrial P curve VT, post MI (Atrial contrac?on against closed AV valve bc early vent contrac?on) Glucose- 6 - phosphate dehydrogenase deficiency mechanism and symptoms Mechanism: X-linked recessive, enzyme defect leads to decreased RBC NADPH which leads to damage from oxidizing agents and infec?ons Symptoms: episodic dark urine, enlarged spleen, SOB, rapid heart rate, jaundice Treatment: "harsh holosystolic murmur" in ~6 wk baby Large VSD Glucose- 6 - phosphate dehydrogenase deficiency risk factors

• More common in Mediterranean males, blacks (malarial resistance)
• Induced by fava beans, sulfonamides, primaquine, an?-TB drugs Valsalva Dec PL by inc ITP Only Increases HOCM A child has increased HVA and VMA (catecholamine metabolites) in his urine. A biopsy is done and you see Homer-Wright rose]es, and the specimen stains posi?ve with Bombesin and NSE. What is the most likely diagnosis, and what gene?c altera?on is it associated with? Neuroblastoma associated with over expression of N-myc oncogene Fever, toxicity, gray-white pharyngi?s, sandpaper-like rash, circumoral pallor.

Scarlet fever - > strawberry tongue Group A strep erythrogenic exotoxin tx: Penicillin V What is herpangina? Throat infec?on caused by enteroviruses such as Cox A, high fever, sore throat complete inability to swallow, ulcera?ve lesions palate, tonsils, pharynx palms and sole rash, hand-foot-mouth disease Rapid Squalng Increases VR, PL and AL Inc AS, MR, VSD Dec HOCM A pa?ent comes to your clinic because of episodes of headaches, perspira?on and palpita?ons. He thinks he might be having panic a]acks. You look at his blood pressure and see that it is elevated currently, and he says he has a headache, and you see he is swea?ng too. He also looks a li]le pale. What is your most likely diagnosis, and what would you find on labs? Pheochromocytoma, a tumor of the adrenal medulla derived from chroma?n cells (arise from neural crest). Increased catecholamines and metanephrines in urine and plasma (due to tumor secre?ng Epi, NE, and dopamine, which causes the HTN) Rib notching Postductal Coarcta?on of Aorta Odds Ra?o

(exposed cases / unexposed cases) / (exposed non-cases / unexposed non- cases) How do you treat pheochromocytoma? Irreversible alpha antagonist (phenoxybenzamine) followed by B blockers; do this before tumor resec?on. Maternal diabetes Transposi?on of great vessels Pertussis symptoms and mechanism Symptoms: whooping cough Mechanism: (1) toxin overac?vates adenylate cyclase, leading to impaired phagocytosis and (2) produc?on of lymphocytosis-promo?ng factor leads to lymphocytosis What is the first step in the evalua?on of primary amenorrhea? Pelvic exam determine ovaries, uterus, and vagina are present or absent US is preferred imaging modality to evaluate anatomy of repro tract Ostei?s fibrosa cys?ca is a complica?on of this condi?on. Describe what this is. A complica?on of primary hyperparathyroidism (increased PTH). Cys?c bone spaces/subperiosteal bone resorp?on filled with brown fibrous ?ssue (brown tumor) consis?ng of osteoclasts and deposited hemosiderin from hemorrhages VSD Harsh, Holosystolic Tricuspid area

__ is the most common primary bone tumor in children and young adults involves metaphysis of long bones. Osteosarcoma

• large and tender mass
• sunburts poeriosteal rxn + Codman triangle Rock-hard painless goiter found on neck exam. This was found a^er the pa?ent complained of difficulty breathing and difficulty ea?ng. What is your ini?al impression, and what is this due from? Riedel thyroidi?s that's extended to local structures. A manifesta?on of igg4-related systemic disease ___ + ___ prophylaxis can prevent almost all cases of pneumonoccal sepsis in pts with sickle cell anemia. Pneumococcal vaccine + Penicillin prophylaxis Square root sign on vent tracing Constric?ve pericardi?s Familial Hypocalciuric hypercalcemia is caused by what? What are the common findings? Autosomal dominant: defec?ve G-coupled Calcium sensing receptors in mul?ple ?ssues.

Hypercalcemia, hypocalciuria (due to increased Ca uptake due to higher than normal levels of Ca needed to suppress PTH), normal PTH levels Wallenberg syndrome Posterior inferior cerebellar artery stroke (lateral medulla) - ipsilateral facial sensory deficits and contralateral body sensory deficits Viral infec?on --> bacterial infec?on --> Myocardi?s (Chagas, coxsackie, rubella) endocardi?s /valves (S. Aureus w/ IV drugs; Strep viridans w/ den?sts; Staph epidermidis w/ prosthe?c valves) Graves Disease cause An?-TSH receptor an?body (igg, type II non-cytotoxic hypersensi?vity) s?mulates TSH receptors on thyroid to cause hyperthyroidism and diffuse goiter. Also s?mulates dermal fibroblasts, which causes pretrial myxedema Gentamicin nephrotoxicity Epithelial cells in proximal tubule Kussmaul's Sign Constric?ve pericardi?s (=JVP ^ w/ expo) Increased PTH decreased Ca increased PO renal osteodystrophy Secondary hyperparathyroidism, usually due to renal disease/chronic renal disease. Dejerine-Roussy syndrome

Thalamic stroke - contralateral numbness and ?ngling becomes severe and chronic pain Commissure fusion Rheuma?c Fever --> Mitral stenosis What does US show for Turner syndrome? One of the most common causes of primary amenorrhea

• primary ovarian failure gonadal dysgenesis followed by early menopause and infer?lity - > pelvic US show an infan3le uterus and "streak ovaries" Gonorrhea virulence factors Pili Aor?c Regurge High pitched diastolic blowing decrescendo Hyperdinamic pulse, head bob, Wide PP, Aor?c root dila?on, bicuspid aor?c valve, endocard, rhf Progressive LHF "plop" (S3) Cardia myxoma What is the mechanism of exophthalmos development in a pa?ent with Graves disease?

Ac?vated T cells --> increased cytokines --> increased fibroblast secre?on of hydrophilic gags --> increased osmo?c muscle swelling, muscle inflamma?on, and adipocyte count Toxins that block electron transfer to O Cyanide, CO Diffuse ST eleva?on Acute pericardi?s (or myocardi?s if inverted T waves) Tx minor cat bite wounds due to Pasteurella multocida. Amoxicillin/clavulanate for 5 days Gerstmann syndrome Stroke affec?ng the inferior parietal lobule leading to (1) dysgraphia (2) dyscalculia (3) finger agnosia (4) le^-right disorienta?on Common presenta?on of Sheehan syndrome Failure to lactate, absent menstrua?on, cold intolerance (hypopituitarism) Mitral Stenosis Mid Diastolic Snap opening Heard best at the apex in the L. Lateral Decubi??s posi?on

• rhf main cause The shorter the interval between S2 and OS the the worse the prognosis

In acute selng, one of the primary tx for stroke in sickle cell pa?ent is ___. Exchange transfusion

• DEC % of sickle cells in bloodstream
• con?nue hydroxyurea True/False: Human milk protein absorbs be]er and improves gastric emptying. TRUE - ideal form of nutri?on for term infants un?l 6 mo. Age the major protein source is whey, which is more easily digested than casein and helps to improve gastric empty What biopsy technique is contraindicated in suspected tes?cular cancer? Transcrotal (risk spreading cancer) Polyhydramnios fetus, excessive drooling as well as chocking, coughing and regurgita?on with ini?al feeding a]empts seen immediately a^er birth. Enteric tube in the proximal esophagus on X-ray. Dx. Esophageal atresia + tranesophageal fistula

• gastric fluid can relaxes into the distal esophagus through the fistula and into the trachea and lungs, causing aspira3on pneumonia Tx mild metatarsus adductus? Reassurance, usually correct spontaneously, first-born infants a]ributed to molding effect primigravid uterus PDA Con?nous machine mike murmur

Congenital Rubella, premature le^ infraclavicular area Anterior pituitary is derived from what? Oral ectoderm (Rathke pouch) How to treat thyroid storm? Propanolol (beta blocker), propylthiouracil (thioamide), prednisolona (cor?costeroids), potassium iodide Cause of Sheehan syndrome Pituitary grows during pregnancy, but blood supply to it doesn't. So there can be ischemic infarct of pituitary following post-partum bleeding (hypo- perfusion) Holosystolic, blowing murmur increases w/ inspo Tricuspid Regurg (not mitral) "sail sign" noted child x-ray < 3 years. What can this be? Thymus

• triangular shape, scalloped border, uniform density
• anterior medias?num behind sternum + front of the heart, aor?c arch, trachea

Renal Na reabsorp?on Thick ascending loop of Henle Electrical alternans (alterna?ng amplitude on EKG) Cardiac Tamponade Which sta?s?cal test compares the means of more than two groups? ANOVA (Analysis of Variance) Which Ig predominates in Waldenstrom's macroglobulinemia? Igm Disseminated intravascular coagula?on Sep?c shock Alcoholic with cerebellar atrophy presents with Gait ataxia What dis?nguishes thyroid adenoma from follicular carcinoma? Thyroid adenoma: absence of capsular or vascular invasion follicular carcinoma: invasion of thyroid capsule and vasculature ___ and __ are the most common causes of osteomyeli?s in pts with sickle cell disease. Salmonella Staph aureus Myxoma Mitral diastolic tumor plop

5 mo. Old growth failure low serum bicarb, normal anion gap acidosis, failure to thrive, hyperchloremia. Dx. Type 1 Renal tubular acidosis (RTA)

• oral bicarbonate replacement Obese child 10-16 years common disorder hip overweight adolescents. Urgent surgical fixa?on is required to prevent avascular necrosis of the hip. Hip held passive external rota?on and DEC internal rota?on. Dx AP + flog-leg X- ray. Slipped capital femoral epiphysis - > displacement of capital femoral epiphysis from femoral neck Risk: endocrinopathies (hypothyroidism, GH deficiency), renal failure, radia?on history Small vessel disease (diffuse thickening of basement membrane) caused by non-enzyma?c glyca?on in diabetes Re?nopathy, glaucoma, neuropathy, nephropathy (progressive proteinuria), arteriosclerosis

X-linked disorder characterized by the triad of thrombocytopenia, eczema, and recurrent bacterial infec?ons. Thrombocytopenia is caused by DEC platelet produc?on and few platelets that exist are typically quite small. WiskoQ-Aldrich syndrome (WAS)

• infec?on due to step. Pneumoniae, n. Meningi?dis, and h. Influezae thrombocytopenia - > minor petechiae or purpura to life-threatening bleeding such intracranial hemorrhage, hematemesis or hematochezia What is Empty Sella Syndrome? A cause of hypopituitarism due to atrophy or compression of the pituitary, o^en idiopathic cause, but could be due to CSF in sella turica. Common in obese women Complica?ons of thyroidectomy Hoarseness --> recurrent laryngeal nerve damage hypocalcemia --> removal of parathyroid glands transec?on of recurrent and superior laryngeal nerves (due to liga?on of inferior thyroid artery and superior laryngeal artery) Giant cell tumor of bone radiograph appearance Osteoly?c lesion; "soap bubble" in epiphyseal region of long bones Pulsus parvus et tardus Aor?c stenosis (narrow PP) Preexcita?on of the atria WPW Opioid withdrawal side effects Rhinorrhea, lacrima?on, diaphoresis, piloerec?on, pupil dila?on, res?ng tremor, yawning