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1
Q

analgesic nephropathy

A

florid nephrotic range proteinuria

multiple myeloma protein usually not on u/a-UPEP

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2
Q

Subclinical hypothyroidism
Treat if

complications

A

Elevated TSH, normal free T4, get anti-TPO
TSH >10, symptomatic, pregnant, infertile, goiter, positive antibody
miscarriage, preeclampsia, preterm birth, pregnancy complications

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3
Q

severe bradycardia 2/2 RCA MI

A

IV atropine

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4
Q

Refeeding CHF

A

hypophosphatemia-oral phosphate (no diuretics)

also watch mg, k, thiamine

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5
Q

Sickle cell
aplastic crisis

hyperhemolytic crisis

A

dactylitis, hemolytic anemia. HgbS on electrophoresis
transient cessation of erythropoiesis due to parvovirus, low rec count, transfuse
increased rec count

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6
Q

Disseminated VZV

A

IV acyclovir (ganciclovir for local), airborne and contact precautions

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7
Q

Helminth infection

A

eosinophilia, chronic diarrhea, high risk of reinfection, treat entire family

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8
Q

Pseudotumor cerebri vs migraines

A

If fat and fertile, do eye exam

migraines can be associated with aura-vision changes, nausea, tingling

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9
Q

friable cervical lesion

A

rule out cancer

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10
Q

Hot flashes treatment

A

escitalopram/venlafaxine

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11
Q

Neonates with bilirubin >20

breastfeeding jaundice

A

exchange transfusion

supplement with formula

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12
Q

Hawthorne effect

A

change in behavior due to observation

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13
Q

GBS babies

A

observe for 2 days

if no abx >4 hours before delivery AND preterm or PROM, obtain CBC and culture

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14
Q

post op SIADH hyponatremia

A

mild-fluid restrict, salt tabs

only symptomatic, severe with seizures-hypertonic saline

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15
Q

Suppurative otitis media

A

copious drainage, feeling better after tympanic membrane ruptures

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16
Q

Diaper dermatitis

A

No powder-aspiration risk

tx: zinc oxide, petrolatum
* candida dermatitis-nystatin, miconazole

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17
Q

synthroid drug interactions

A

calcium and iron should be taken 3-4 hours later

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18
Q

45 XO

A

Turner syndrome: get TTE (cardiac defects), renal ultrasound, TSH, hearing and vision tests

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19
Q

Testicular cancer workup

A

ultrasound, CT scan, CXR, serum markers, orchiectomy

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20
Q

Indolent pna with interstitial infiltrates in immunocompromised patient
tx
steroids if

A

pcp

bactrim
o2gradient >35 or pao2 <70 (inflammation from pcp lysis)
if sputum culture is negative->bronchoalveolar lavage

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21
Q

Digoxin toxicity

induced by

A

N/V, anorexia, fatigue, confusion, cardiac abnormalities, visual disturbances
verapamil, amio, quinidine

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22
Q

burning sensation, mucoid discharge that crusts eyes shut,
infectivity

w/ itching

A

viral

over after discharge resolves bacterial-after 24 hr of topical therapy
allergic

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23
Q

TSH in history of thyroid cancer

A

Use levo to suppress TSH to low normal range

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24
Q

CAP treatment

A

Mac/doxy (healthy), mac+beta lactam/fluoroquinolone (comorbidities)
Inpt: fluoroquinolone OR beta lactam+mac
ICU: beta lactam+ mac OR beta lactam+ fluoroquinolone

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25
TP FP PPV (TP/ TP+FP) FN TN NPV (TN/TN+FN) Sens Spec (TP/TP+FN) (TN/TN +FP)
Spec, sens table
26
tuberous sclerosis testing cause of death
Imaging, EEG, skin exam (ash-leaf, hypopigmented), benign tumors epilepsy (neurologic impairment), aspiration pna, obstructive hydrocephalus
27
Lead time bias vs length time bias
Screening catches earlier vs patients who are screened have slowly progressive form of disease
28
Asthma exacerbation do not need imaging
prednisone and albuterol
29
myxedema coma pretibial myxedema
hypothyroidism *synthroid increases risk of MI in CAD, start slowly* *iodine loading is for hyperthyroidism* Grave's-hyperthyroidism
30
Essential tremor vs Parkinson's | essential tx
movement, no bradykinesia, no rigidity vs resting tremor | propranolol if necessary
31
Acute hep c
antibody may be negative, get viral load
32
clozapine risk
agranulocytosis
33
EBV mono treatment | complication
Supportive care and NSAID | aplastic anemia, airway obstruction-steroids
34
otitis externa
mild-topical acetic acid moderate-topical abx severe with edema-placement of a wick
35
uterine atony
postpartum hemorrhage-> massage uterus+ oxytocin/misoprostol/methylergonovine/carboprost
36
tetanus ppx for bite wounds
dirty: booster if last dose >5 years ago, vaccine and ig if unimmunized/not fully immunized clean: vaccine if last dose >10 years ago, vaccine if unimmunized
37
lupus nephritis | monitoring
GET BIOPSY! | anti-dsdna and complement (will be low) levels
38
Postconcussive syndrome
headache, confusion, amnesia, difficulty concentrating, vertigo, mood disorder
39
Pseudomonas pneumonia (HAP or structural lung disease)
gentamicin/zosyn/Levaquin (2 of 3 required) | *if respiratory failure-vanc to cover for MRSA*
40
Elevated PSA with urinary symptoms
observe. only workup for prostate cancer if persistent
41
multifocal atrial tachy
irregular, 3 different P morphologies-treat underlying cause | pulm disease in elderly, sepsis, electrolytes
42
bronchiectasis
recurrent infections
43
oculoglandular syndrome
conjunctivitis and ipsilateral preauricular and cervical adenopathy due to cat scratch disease, complicated by lymph node suppuration, azithromycin
44
TTP treatment (plex)
repleting ADAMST13-a metalloproteinase
45
Cyclosporine gout
decreased excretion of uric acid | * do not use colchicine with azathioprine in post-transplant patients. *
46
Tourette chronic tic provisional tic Tourette treatment
several motor with at least one vocal tic motor OR vocal >1 year <1 year habit reversal therapy, antipsychotic (Risperdal, abilify in children)
47
Status epilepticus
Benzo, if refractory-fosphenytoin/valproic acid | still refractory-continuous midazolam, phentobarb, propofol
48
Pregnant UTI
fosfomycin, cephalexin, amoxicillin-clavulanate
49
CABG for
3 vessel disease multivessel disease involving LAD DM and multivessel disease
50
pernicious anemia associated atrophic gastritis
glandular atrophy in gastric body and fundus, inflammation, intestinal metaplasia
51
Rosacea treatment | complications
topical brimonide/flagyl | ocular-chalazion (nodule on eyelid)
52
Low risk surgery preop (breast, ambulatory, endoscopy, cataracts)
If no active disease-no further workup | *otherwise, RCRI, if >=4 METS-no workup, if less-workup*
53
Intususception diagnosis Intestinal malrotation and volvulus dx
target sign on u/s-tx: air or water contrast enema (complications-perf) bilous emesis-upper GI series
54
Wallenberg syndrome
lateral medulla occlusion of PICA or vertebral artery, loss of pain and temp over opposite sides of body, bulbar muscle weakness, vertigo, nystagmus, ipsilat limb ataxia, horner's syndrome
55
tamoxifen risks
nonmetastic estrogen receptor positive breast cancer prevention in hyperplasia with history of lobular carcinoma in situ endometrial cancer, uterine sarcoma in postmenopausal women *only evaluate if symptomatic*
56
Medicare A B C D
inpatient outpatient private insurance plans prescription drugs
57
Pregnant thyroid
mildly hyperthyroid is fine
58
Opioid toxicity
pinpoint pupils, resp depression, AMS
59
Raynaud treatment
amlodipine, nifedipine
60
DM and exercise
If short-decrease preprandial | If > 60 mins-consider decreasing basal also
61
Allergic bronchopulm aspergillosis CXR treatment
Asthma/cystic fibrosis, recurrent infections with brown sputum, eosinophilia, test skin upper lobe opacities, mucous plugging, bronchial wall thickening oral prednisone, omalizumab, itraconazole/voriconazole
62
Mucormycosis tx
liposomal amphotericin B
63
Achilles tendon rupture
Thompson test-no plantar flexion when calf muscle is squeezed-MRI
64
Duchenne muscular dystrophy treatment
LE weakness in 2-3 yo boy, gowers sign, calf pseudohypertrophy, dilated cardiomyopathy, scoliosis *measure CK *testing-dystrophin deletion steroids
65
Acute bronchitis in COPD
give antibiotics
66
verification bias
when a test is only used on positive/negative screening
67
Tick paralysis
sensation intact with ascending paralysis, hyporeflexia, remove tick *hepatavalent antitoxin for botulism*
68
Pregnant acne
topical abx, azelaic acid | *retinoids/-tene*
69
Steroids can make you go crazy.
Reduce
70
To rule out a disease
Sensitivity
71
Iron def anemia
microcytic hypochromic RBCs
72
If legal guardian exists and can't be reached
proceed in emergency
73
Antipsychotics in elderly
increased mortality
74
Warts that turn white with acetic acid | treatment
HPV | trichloroacetic acid, interferon, surgical excision
75
Mammogram starting at age | Genetic testing
40 2 first degree relatives, 3 2nd degree relatives, relative with ovarian and breast cancer OR bilateral breast cancer, male relative with breast cancer Ashkenazi-just one relative
76
Erythrocytosis and hematuria in smoker
RCC-get CT scan-thickened septa/walls-no biopsy needed, refer for nephrectomy
77
bupropion CI in
seizures | *varenicline is safe-maybe cardiac effects*
78
HypoMg, HypoK EKG
Prolonged QTc
79
Licorice side effects
inhibits conversion of cortisol to cortisone. cortisol binds to mineralocorticoid receptors-hypertension, hypokalemia, metabolic alkalosis
80
Asymptomatic LV systolic dysfunction
ACEI, BB
81
Bicuspid valve screening | management
echo every 1-2 years | valvuloplasty or surgery (if aorta is involved)
82
cranial nerve III palsy (ptosis, anisocoria)
posterior communicating artery aneurysm-subarachnoid hemorrhage (headache, nausea, nuchal rigidity
83
pleuritic chest pain, loud P2, pleural friction rub, hypoxemia, small effusion
acute PE | *only a normal v/q scan rules out pe in high pretest probability*
84
Functional hypothalamic amenorrhea | treatment
exercise-induced, all hormones decreased increased calories, estrogen, calcium/vitamin d *exogenous growth hormone-hypertension, fluid retention*
85
amputated body parts
wrap in sterile gauze, moisten with saline, place in sealed, sterile plastic bag on ice mixed with saline
86
Pregnancy synthroid
increase by 25-50%
87
Paget's disease treatment
bone pain, weightbearing bones, neuro symptoms, hypercalcemia, hypercalciuria, CHF xray-cortex thickening, bone scan-increased uptake bisphosphonates *calcitriol is for the treatment of hypoparathyroidism*
88
pathologic scoliosis
back pain, neuro symptoms, rapidly progressing curvature, vertebral anomalies on x ray
89
DVT/PE treatment
If cancer-lovenox | If not-orals
90
Cervical insufficiency | short cervix
>=2 painless miscarriages in 2nd trimester-cerclage | incidental finding-serial measurement and vaginal progesterone
91
``` SGLT2 inhibitor (-gliflozin) side effect metformin ```
euglycemic DKA | lactic acidosis
92
actinic keratoses
come and go, cryodestruction, biopsy if >1cm, tender, indurated, ulcerated, growing rapidly
93
large volume foul-smelling stools, flatulence, weight loss, microcytic anemia, elevated stool osmotic gap collagenous colitis
celiac disease small bowel biopsy-villous atrophy, intraepithelial lymphocytic infiltrate, crypt hyperplasia nocturnal diarrhea, fecal urgency, decreased osmotic gap (secretory), thick subepithelial collagen band
94
NSAIDs kidney
AIN
95
hyperthyroidism complication
behavioral changes, weight loss, tachy, hyperreflexia, lid lag (sclera above irises), sweaty skin arrhythmia, cardiomyopathy, osteoporosis
96
Orthostatic hypotension caused by
diuretics, alpha blockers or nitrates
97
pulmonary contusion vs PE | fat embolism
opacification on CXR-supportive care | confusion, petechial rash
98
narcolepsy testing treatment treatment of associated cataplexy
sleep study stimulants-modafinil, methylphenidate SNRIs, SSRIs, TCAs, sodium oxybate *absence seizures-valproic acid*
99
likelihood ratio
independent of prevalence, applies to individual patient

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