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3 Flashcards

1
Q

acute painless monocular vision loss

A

central retinal artery occlusion, cherry red macula (preserved circulation via posterior ciliary arteries), retinal pallor

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2
Q

Renal failure that does not respond to fluids in cirrhotic

A

hepatorenal syndrome
midodrine, octreotide, albumin
BUN/Cr ratio >20-pre renal

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3
Q

serotonin syndrome

A

autonomic dysfunction, fever, GI, clonus, hyperreflexia, tremor, rigidity

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4
Q

disseminated gono

A

systemic symptoms, tenosynovitis, dermatitis, polyarthralgia
ceftriaxone and azithromycin

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5
Q

herpangina

A

coxsackie group A, painful vesicles on posterior oropharynx, tx: supportive care
group A pharyngitis would have cervical LAD and tonsillar exudates

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6
Q

Refractory carpal tunnel

A

Nerve conduction studies in prep for surgery

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7
Q

Chagas

A

LV apical aneurysm in absence of CAD
protozoa, trypanosome cruzi, complete heart block, ventricular tachy
lyme-AV conduction block

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8
Q

WPW arrhythmia

treatment

A

short PR, delta wave, wide QRS
tachy->syncope
catheter ablate

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9
Q

trastuzumab (chemotherapy for breast cancer, HER 2) cardiotox

A

reversible after discontinuation

anthracycline isn’t reversible

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10
Q

Lead poisoning

A

at risk with level <5: repeat level in a year
5-44: remove sources, repeat level within a month
>45: chelation with EDTA, succimer

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11
Q

Unstable angina, NSTEMI management

A

no trops vs trops

TIMI score: low risk-stress test, cath otherwise

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12
Q

cirrhosis thrombocytopenia due to

A

portal hypertension and splenic sequestration

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13
Q

Prostaglandin for baby hypoxia

A

PDA dependent conditions (transposition, hypoplastic left heart)

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14
Q

st johns wort depression

A

effective for mild to moderate, multiple drug interactions, do not use with SSRIs-serotonin syndrome

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15
Q

External cephalic version timing

A

37 weeks if still breech

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16
Q

Ischemic stroke in the setting of DVT

Diagnosis

A

Paradoxical emboli, from venous system to arterial system through intracardiac shunt
TEE or bubble study

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17
Q

multi-nutrient malabsorption in young adult
screening

skin findings

A

celiac disease, can present without GI symptoms
anti-endomysial, anti-tissue transglutaminase antibodies
vitiligo, dermatitis herpetiformis

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18
Q

patellofemoral pain syndrome

treatment
prepatellar bursitis
patellar tendonitis

A

reproduced on extension of knee with anterior pressure on patella, squatting, stairs
stretching and strengthening exercises
being on knees
inferior patella, jumping sports

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19
Q

Transfusion/volume expansion electrolyte abnormality

A

hypocalcemia- hyperactive DTRs

hypermagnesemia-hypoactive DTRs

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20
Q

tachypnea(respiratory alkalosis), tachycardia, fever, dizziness, GI symptoms, lactic acidosis

A

salicylate toxicity

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21
Q

deep dyspareunia, dysmenorrhea, chronic pelvic pain, dyschezia, rectovaginal nodularity, ovarian mass

A

endometriosis

NSAIDs and combined OCPs

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22
Q

Diabetic baby heart

A

transient HCOM - spontaneous resolution within a few weeks

hypoplastic left ventricle in second trimester ultrasound

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23
Q

pancreatitis severity assessment

A

obesity, age, hematocrit, BUN, CRP

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24
Q

hypocalcemia post parathyroidectomy

A

hungry bone syndrome, bilateral neuro symptoms

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25
Q

cremasteric reflex

A

L1-L2, can be affected by diabetic neuropathy

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26
Q

acute multiple sclerosis treatment
maintenance therapy
pregnancy
spasticity treatment

A

IV steroids, plasmapheresis if refractory
beta-interferon/ glatiramer
gets better, but increased c/s and assisted delivery
baclofen/ tinazidine

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27
Q

hemophilia A genetics

A

x linked recessive

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28
Q

nursemaid’s elbow

A

normal xray, manual reduction by flexion and supination

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29
Q

salicylate toxicity treatment

A

sodium bicarb, glucose, activated charcoal

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30
Q

aspirin at 12 weeks gestation

A

renal disease, DM, HTN, prior preeclampsia

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31
Q

postpartum eclampsia

Sheehan syndrome

A

htn, end-organ damage, edema, tx: magnesium, antihtn

post partum pituitary infarct

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32
Q

peripartum cardiomyopathy surveillance

A

serial echos

If LV dysfunction is persistent, advise against pregnancy

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33
Q

MEN 2A

MEN 2B
MEN 1

A

medullary thyroid cancer (get calcitonin, CEA, neck ultrasound, RET)
hyperparathyroid, pheo (rule out before thyroidectomy)
no hyperparathyroid
hyperparathyroid, enteropancreatic tumors, pituitary

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34
Q

HCOM medical management
Refractory
ICD if

A

beta blocker, verapamil, disopyramide
alcohol ablation
history of cardiac arrest or v tach

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35
Q

nuchal rigidity + AMS

treatment
diagnosis

A

viral meningoencephalitis
coxsackie, echo, herpes, arbo (west nile)
supportive care
CSF aseptic pleocytosis, viral serologies

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36
Q

nonallergic rhinitis

A

chronic nasal blockage, postnasal drip, rhinorrhea

tx: topical intranasal steroids, intranasal antihistamines
* eye symptoms-allergic rhinitis, same tx

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37
Q

urethral diverticulum

diagnosis

A

postvoid dribbling, dysuria, dyspareunia, anterior vaginal mass, recurrent UTIs
MRI or TVUS

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38
Q

Fat pad displacement on xray after fall on outstretched hand

A

supracondylar fracture

immobilize

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39
Q

Baby BMs

A

After the first month, okay to be 1-2 a week

40
Q

keloid treatment (can have pain and itching)

A

intralesional steroids

41
Q

Paresthesias in hands with dorsal sparing, worse at night, relieved by shaking hands

pain reproduced by

A

carpal tunnel syndrome

elevating hands above head, hyperflexion of wrist, tapping over median nerve
*dequervian tenosynovitis-sharp pain at base of thumb

42
Q

benzo withdrawal

A

autonomic instability, tremors, delirium, psychosis

43
Q

CCB edema

A

decreased when combined with ACEIs

precapillary dilation vs post capillary dilation

44
Q

scleroderma renal crisis

A

activaton of RAAS->hypertension

treat with captopril, + nitroprusside if papilledema

45
Q

Localized abdominal itching in pregnancy
treatment

intrahepatic cholestasis of pregnancy management

A

normal
oatmeal baths, UV light exposure, antihistamines

delivery at 37 weeks, urso, antihistamines

46
Q

randomization removes

A

confounding

47
Q

pancreatic mass biopsy

A

endoscopic aspiration

48
Q

Type I DM medication regimen

A

basal-bolus regimen

49
Q

scrombroid poisoning

pufferfish poisoning

A

improperly stored seafood
histamine->flushing, headache, palpitations, cramps, diarrhea, oral burning, tachy, hypotension
self-limited
neuro symptoms

50
Q

Benzo falls

A

discontinue

51
Q

Donor nephrectomy complications

A

pregnancy complications, complete childbearing before if necessary

52
Q

hormone replacement increases risk of

A

stroke ,CAD, breast cancer, VTE , higher > 60

no increased mortality if <60

53
Q

fibromyalgia, rule out

A

anemia (CBC), rheum (ESR, CRP), hypothyroid (TSH)

54
Q

igg3 deficiency

A

recurrent sinopulmonary and GI infections

55
Q

If GERD does not resolve with PPI

A

24 hour ph monitoring

56
Q

neck stiffness not only in meningitis but also

A

subarachnoid hemorrhage

57
Q

SBP prophylaxis

Advanced liver disease mortality

A

fluroquinolone

INR, creatinine, bilirubin, sodium

58
Q

Mastoiditis

treatment

A

post auricular symptoms, complication of otitis media

IV antibiotics, drainage

59
Q

multiple myeloma imaging

hyperviscosity syndrome

A

skeletal survey

CNS symptoms, mucosal bleeding, tx: plasmapheresis

60
Q

Inoperable head and neck cancers

A

chemoradiotherapy

61
Q

Dyspepsia (epigastric fullness, burning or early satiety)

A

GERD->PPI
>55->endoscopy
weight loss/vomiting/anemia->endoscopy
otherwise->h. pylori testing

62
Q

Subarachnoid hemorrhage rule out

A

CT Head, then LP

63
Q

Asthma testing

A

normal till methacholine challenge (reduced FEV1 and FEV1/FVC ratio

64
Q

Acute stress disorder vs PTSD

A

Less than a month vs more than a month

65
Q

thyroglossal duct cyst

branchial cleft cyst

A

midline, moves upward with tongue protrusion
remove because of high risk of infection
lateral neck, associated with sinus tract/fistula

66
Q

pemphigoid gestationis

treatment

A

autoimmune, abdominal itching, then rash around umbilicus and trunk, urticarial papules and plaques->bullae, no mucous involvement
topical steroids

67
Q

Depression with insomnia

A

no trazodone, it’s not a first line antidepressant and is only effective at sedating doses

68
Q

tocolysis <32 weeks

32-34 weeks

A

indomethacin

nifedipine

69
Q

PCP intoxication

A

nystagmus, lasts 8 hours

immediate benzos

70
Q

tunneled dialysis catheter related bacteremia, remove if:

A

severe sepsis, hemodynamic instability, pus, symptomatic after 72 hours, endocarditis (evidence of met infection)

71
Q

Marfans + intellectual disability+ VTE

A

homocystinuria

72
Q

Mitigating lack of power due to small sample size

A

meta analysis

73
Q

Stress testing assesses

A

risk of cardiovascular events, can’t catch nonobstructive CAD

74
Q

male breast cancer risk factors

A

BRCA mutation, klinefelter

hepatic dysfunction, marijuana, obesity

75
Q

shaken baby imaging

A

CT Head

76
Q

Wernicke

korsakoff

A

ataxia, oculomotor dysfunction, encephalopathy

mammillary body atrophy-confabulation and amnesia

77
Q

Cyanide toxicity due to nitroprusside

treatment

A

in setting of renal insufficiency, metabolic acidosis, AMS , seizures, flushing, cyanosis
sodium thiosulfate

78
Q

small rough erythematous keratotic lesions in sun exposed areas

A

actinic keratosis

if numerous-5 FU cream

79
Q

primary nocturnal enuresis

A

> 5, nighttime bedwetting

urinalysis, behavioral changes, desmopressin

80
Q

pain and numbness in wrist and palmar surfaces of first three digits

A

carpal tunnel syndrome

81
Q

scabies

treatment

A

itchy, contagious

topical permethrin, oval ivermectin

82
Q

diaper dermatitis with beefy red plaques, satellite papules, involvement of genitucrural folds

A

candida
topical nystatin/ clotrimazole
pustules/ honey crusted drainage-bacterial superinfection-mupirocin

83
Q

Stroke BPs

A

ischemic, received TPA-185/105

no TPA-<220/120

84
Q

Hirschsprung
diagnosis

malrotation with volvulus diagnosis

A

don’t pass meconium, abdominal distension
rectal suction biopsy-no innervation

upper GI series

85
Q

ectopia lentis

A

marfan’s
annual echo, beta blocker
berry aneurysm-ehlers danlos

86
Q

B12 deficiency

treatment adverse effect

A

peripheral neuropathy AND spinal cord degeneration

hypokalemia

87
Q

Normocytic anemia lab

A

Rec count

88
Q

diverticular bleeding

A

painless hematochezia due to erosion of artery

89
Q

blepharospasm

treatment

A

focal dystonia, involuntary eye closure

botox

90
Q

vasovagal syncope

A

predrome and postdrome of nausea, pallor, warmth, diaphoresis

91
Q

active preterm labor

A

IM betamethasone to prevent respiratory distress, necrotizing enterocolitis, intraventricular hemorrhage

92
Q

low T3, normal T4, normal TSH

A

euthyroid sick syndrome, recheck when patient is healthy

93
Q

sarcoid biopsy

A

most accessible spot-noncaseating granulomas

94
Q

Meningitis prophylaxis for contacts

A

Close contact, direct contact with secretions

rifampin/Cipro/IM ceftriaxone

95
Q

diaphragmatic paralysis in ALS (tongue fasciculations, muscle atrophy)
diagnosis

A

orthopnea, retraction of abdomen on inspiration,

sniff test

96
Q

spinal stenosis treatment

diagnosis

A

conservative, epidural block, laminectomy

MRI

97
Q

history of transfusion, difficulty finding cross-matched blood

A

alloantibodies

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