3.28.17 Flashcards
(421 cards)
1
Q
who/what conditions are at high risk for colon cancer (4)?
A
- FMHx of adenomatous polyps or colorectal cancer (CRC)
- IBD
- familial adenomatous polyposis
- hereditary nonpolyposis CRC (Lynch synd)
2
Q
IBD –> when start colon cancer screening? How often?
A
8yr after dx –> colonoscopy w bx –> every 1-2yr
3
Q
Marfanoid body habitus –> what condition?
A
- Marfan synd
- homocystinuria
4
Q
homocystinuria –> genetic disorder –> what type of heredity? enzyme def?
A
AR –> cystathionine synthase def
5
Q
distinguishing features: Marfan synd vs homocystinuria
A
- Marfan: aortic root dilation
- homocystinuria: intell disability, thrombosis
6
Q
child –> fair hair & eyes, dev delay, cerebrovasc accident –> condition?
A
homocystinuria
7
Q
homocystinuria –> tx
A
- vitB6, folate, vitB12 –> lower homocysteine levels
- antiplatelet or anticoag –> prevent stroke, CAD, VTE
8
Q
3yo F –> recurrent bact infect, severe periodontitis, marked leukocytosis –> condition?
A
leukocyte adhesion def
9
Q
leukocyte adhesion def –> CBC findings?
A
marked leukocytosis w neutrophilia
10
Q
leukocyte adhesion def –> 1st presenting sign
A
delayed umbilical cord sep
11
Q
leukocyte adhesion def –> pt presentation
A
recurrent skin & mucosal bact infect:
- no pus
- poor wound heal
12
Q
erlichiosis –> found in what part of USA?
A
- SE
- S central
13
Q
erlichiosis –> pt presentation
A
- flu-like illness
- neuro ssx (confusion)
14
Q
erlichiosis –> lab findings (4)
A
- leukopenia
- thromobcytopenia
- elevated LFT
- elevated lactate deH
15
Q
erlichiosis –> tx
A
doxycycline
16
Q
shoulder dystocia –> warning signs (2)
A
- prolonged 1st/2nd stage of labor
- turtle sign: fetal head deliver –> retract into perineum
17
Q
42yo M –> iron def anemia –> most likely cause?
A
chronic GI blood loss
18
Q
when is prosthetic joint infect early onset? delayed onset?
A
early onset: <3mo
delayed: 3-12mo
19
Q
early onset prosthetic joint infect –> org?
A
virulent org –> Staph aureus, Pseudomonas
20
Q
delayed onset prosthetic joint infect –> org?
A
less virulent org –> coag-neg staph
21
Q
delayed onset prosthetic joint infect –> presentation
A
- chronic pain
- implant loosen
- gait impair
- sinus tract form
22
Q
DM type I –> onset
A
bimodal:
- 4-6yo
- early puberty
23
Q
what is: fetal growth restriction
A
US-estimated fetal wt <10th percentile for gestational age
24
Q
symmetric fetal growth restriction –> onset?
A
1st trimester
25
symmetric fetal growth restriction --> etiology (2)
- chrom abnormal
| - congenital infect
26
asymm fetal growth restriction --> onset?
2nd-3rd trimester
27
asymmetric fetal growth restriction --> etiology
utero-placental insuff --> ie HTN
28
charcot joint --> 3 major assoc conditions
- DM
- tabes dorsalis (3ary syphilis)
- vitB12 def
29
charcot joint --> pathophys
nerve damage --> decreased proprioception, pain, temp --> pt unknowingly traumatize wt-bearing joints -->
- 2ndary degen jt dz
- jt deformation
- fxal limitation
30
charcot joint --> imaging findings
- loss of cartilage
- osteophyte
- loose bodies
31
drug-induced acne --> common side effect of what drug?
glucocorticoids
32
definition: bacteruria
>100,000 CFU/ml bact
33
preg --> why at increased risk of ascending infect (pyelonephritis)?
increased progesterone --> relax smooth muscle --> ureteral dilation
34
preg --> asymptomatic bacteriuria --> at increased risk for (2)?
- preterm labor
| - low birth wt
35
chorioamnionitis --> dx
clinical dx:
- maternal fever
- >1 of following: uterine tender, maternal/fetal tachycardia, malodorous amniotic fluid, purulent vag discharge
36
chorioamnionitis --> tx
- IV broad spectrum abx
- delivery --> oxytocin to accelerate labor
- antipyretic --> reduce maternal fever --> improve fetal tachycardia
37
bronchiectasis --> pathophys
infect + impaired bact clearance --> recurrent bact infect, inflamm, tissue damage --> bronchi thicken & dilate
38
recurrent dyspnea, fever, tenacious sputum, hemoptysis, crackles, digital clubbing --> condition?
bronchiectasis
39
succinylcholine --> type of drug?
depolarizing neuromusc blocker
40
why beware use of succinylcholine in burn pt?
burn injury, stroke, skeletal muscle trauma --> upreg postsynaptic ACh receptors --> succinylcholine --> bind ACh receptors --> K efflux --> severe hyperK --> cardiac arrythmia
41
DM --> small fiber injury --> type of ssx?
positive symptoms:
- pain
- paresthesia
- allodynia
42
DM --> large fiber injury --> type of ssx?
negative symptoms:
- numb
- loss of proprioception & vibration sense
- diminished ankle reflex
43
what is hydrogen breath test
test of lactose intolerance: ingest lactose --> measure increased breath hydrogen --> indicate bacterial carb metab
44
lactose intolerance --> test results of following:
- hydrogen breath test
- stool test for reducing subst
- stool pH
- stool osmotic gap
- hydrogen breath test: positive
- stool test for reducing subst: positive
- stool pH: low
- stool osmotic gap: increased
45
inflamm acne --> tx
topical retinoid + benzoyl peroxide
46
mod-severe inflamm acne --> tx
topical retinoid + benzoyl peroxide
| + topical abx
47
acne --> when use oral abx or isotretinoin?
severe/recalcitrant inflamm acne
48
neonate --> micrognathia, microcephaly, rocker bottom feet, overlapping fingers, absent palmar creases --> condition?
trisomy 18 (Edwards synd)
49
trisomy 18 (Edwards synd) --> cardio comp?
congenital heart dz --> #1 VSD
50
endometriosis --> definitive dx
laparoscopy --> visualize & biopsy endometrial implants
51
suspect endometriosis --> empiric tx
NSAID + oral contraceptive
52
suspect endometriosis --> empiric tx fail --> next step?
laparoscopy --> visualize & biopsy endometrial implants
53
endometriosis --> common sole presenting symptom
infertility
54
adnexal fullness on PE --> US --> ovarian cyst --> hyperechoic nodules & calcifications --> condition?
dermoid ovarian cyst (mature cystic teratoma)
55
dermoid ovarian cyst (mature cystic teratoma) --> dx
US --> ovarian cyst --> hyperechoic nodules & calcifications
56
dermoid ovarian cyst (mature cystic teratoma) --> comp
ovarian torsion
57
ovarian torsion --> typical presentation
acute onset unilat lower abd pain
possibly:
- N/V
- fever
58
when give anti-D immune globulin?
- 28-32wk gestation
| - after delivery if baby Rh+
59
STD test --> +chlamydia, -gonorrhea --> pt asymptomatic --> tx
azithromycin only
60
pt w infectious mono --> difficult swallow, labored breathing, severe tonsillar enlrg --> comp most at risk for developing?
acute airway obstruct
61
pt w infectious mono --> difficult swallow, labored breathing, severe tonsillar enlrg --> at risk for acute airway obstruct --> tx
corticosteroid
62
pts at highest risk for osteomyelitis (3)
- IVDA
- sickle cell
- immunosupp
63
vertebral osteomyelitis --> onset
chronic (>6wk) & insidious w minimal ssx
64
most reliable sign for vertebral osteomyelitis
tender to gentle percussion over spinous process
65
vertebral osteomyelitis --> characteristic back pain
not relieved by rest
66
vertebral osteomyelitis --> most sensitive dx
MRI
67
terminal deoxynucleotidyltransferase (TdT) --> positive in what cell types (2)?
pre-B & pre-T lymphoblasts
68
lymphoblast --> +Tdt --> positive for what other immunostain?
periodic acid Sciff (PAS)
69
myeloblast vs lymphoblast --> difference in immunostain?
myeloblast: +peroxidase
lymphoblast: -peroxidase --> +PAS
70
5yo M --> hip pain --> most common cause
transient synovitis
71
transient synovitis --> tx
- rest
| - NSAID
72
transient synovitis --> lab findings
usu no lab abnormalities
73
Marfan synd --> mutation?
fibrillin-1
74
sarcoidosis --> CXR findings
bilat hilar adenopathy
75
sarcoidosis --> tissue bx findings
noncaseating granuloma
76
when give HPV vaccine
- start age 11-12
| - until age 26
77
sig smoking history & hyperCa --> CXR --> hilar mass --> condition?
squamous cell Ca
78
paraneoplastic synd seen in:
- squamous cell Ca of lungs
- small cell lung CA
- squamous cell Ca of lungs: PTHrP
| - small cell lung CA: ACTH, SIADH
79
UA --> lrg amt of blood --> urine microscropy shows 0-1 RBC --> condition?
rhabdomyolysis --> myoglobinuria
80
penile fracture --> goes to ER --> pain, can't urinate, swollen penis --> next step? why?
blood at meatus, dysuria, urinary retention --> suspected urethral injury --> retrograde urethrogram
81
vitiligo --> pathophys
autoimmune --> regional destroy melanocytes
82
vitiligo --> tx
topical or systemic corticosteroid
83
HSV encephalitis --> CSF findings (3)
- lymphocytic pleocytosis
- increased erythrocytes
- elevated protein
84
7yo M --> FOOSH --> supracondylar humerus fx --> complains of increasing pain despite mult doses of pain meds --> should be concerned about what?
cmpt synd
85
40yo F --> wt loss, lid lag, hand tremor, A-fib w RVR --> condition?
hyperthyroid
86
hyperthyroid --> A-fib --> tx
BB
87
healthcare worker never got HepB vaccine --> needlestick from pt w active HepB infect --> next step?
HB vaccine & HB immune globulin ASAP
88
HIV pt --> CD4 <50 --> bloody diarrhea --> condition?
CMV colitis
89
HIV pt --> CD4 <50 --> bloody diarrhea --> next step?
colonoscopy w bx --> look for CMV colitis
90
HIV pt --> CD4 <50 --> bloody diarrhea --> CMV colitis --> r/o what other condition?
ocular exam --> r/o concurrent retinitis
91
oxytocin --> AE (3)
- hypoNa
- hypotension
- tachysystole
92
what is uterine tachysystole
abnormally freq contractions --> >5 contractions in 10min
93
premature neonate --> comp (3)
- resp distress synd
- patent ductus arteriosus
- bronchopulm dysplasia
- intraventricular hemorrhage
- necrotizing enterocolitis
- retinopathy of prematurity
94
premature neonate --> how screen for intraventricular hemorrhage? why do a screen?
screen w serial head US
25-50% asymptomatic
95
premature neonate --> intraventricular hemorrhage --> comp? pathophys?
blood accum --> irritate arachnoid villi --> impair ability to absorb CSF --> hydrocephalus
96
premature neonate --> intraventricular hemorrhage --> how prevent IVH?
- prevent preterm labor
| - antenatal corticosteroid
97
uterine fibroids --> dx
US
98
what is metatarsus adductus
congenital foot deformity --> medial deviation of forefoot
99
metatarsus adductus --> tx
resolve spontaneously
100
menstrual irreg, infertile, enlrg ovaries, acanthosis nigricans --> condition?
PCOS
101
PCOS --> tx
1st line: wt loss --> decreased peripheral estrogen conversion
wt loss unsuccessful: clomiphene citrate (SERM) --> induce ovulation
102
clomiphene citrate --> MOA
SERM
block estrogen receptor at level of hypothalamus --> inh neg feedback mech --> hypothalamus restore pulsatile GnRH secretion --> normalize LH, FSH level --> LH surge --> ovulation
103
traumatic head injury --> CT --> hyperdense football-shaped lesion --> condition?
epidural hematoma
104
traumatic head injury --> progressive lethargy --> CT --> epidural hematoma --> tx
symptomatic --> emergent neurosurg hematoma evacuation
105
52yo F --> gradual onset weakness of leg muscles --> several months can't climb stairs --> no other problems --> condition?
polymyositis
106
polymyositis --> clinical presentation
- slowly progressive proximal weakness of LE
| - no/mild muscle pain/tender
107
polymyositis --> dx? results?
muscle bx --> mononuclear infiltrate surrounding necrotic and regenerating muscle fibers
108
67yo F --> severe vulvar itch & burn --> thin, dry white plaque-like vulvar skin w loss of labia minora --> condition?
lichen sclerosus
109
lichen sclerosus --> pt presentation
vulva:
- intense pruritis
- white atrophic plaque --> "cigarette paper"
- dyspareunia
110
lichen sclerosus --> dx?
- clinical dx
| - definitive dx: punch bx --> confirm dx & r/o vulvar SCC
111
lichen sclerosus --> comp?
premalig lesion for vulvar SCC
112
Paget dz of bone --> lab findings:
- Ca
- Ph
- alk phos
- urine hydroxyproline
- Ca: normal
- Ph: normal
- alk phos: high
- urine hydroxyproline (bone turnover marker): high
113
64yo F --> worsening focal back pain, bilat LE weak, sensory loss, gait ataxia --> condition?
spinal cord compression
114
spinal cord compression --> pt presentation (4)
- worsening focal back pain
- bilat LE weak
- sensory lsos
- gait ataxia
115
spinal cord compression --> can develop what in acute phase? What is a late finding?
acute phase --> spinal shock:
- absent reflex
- flaccid paraplegia
late --> bowel/bladder disturb
116
watery diarrhea --> 3 categories
- osmotic
- secretory
- fxal
117
secretory diarrhea --> hallmark
- lrger daily stool vol (>1L/day)
| - occur even during fasting/sleep
118
how distinguish osmotic vs secretory diarrhea?
stool osmotic gap
osmotic: elevated
secretory: reduced
119
secretory diarrhea --> pathophys
luminal ion channels disrupted --> state of active secretion
120
pre-eclampsia --> definition
new onset HTN at >20wk gestation + proteinuria +/or end organ damage
121
pre-eclampsia w severe features --> what are severe features (4)
evidence of end organ damage:
- severe HA
- visual changes
- severe transaminitis
- elevated creatinine
122
HTN crisis --> 1st line drugs for BP ctrl (3)
- hydralazine
- labetalol
- nifedipine
123
what are the types of primary humor deficiencies? (5)
- X-linked agammaglobulinemia
- common variable immunodef
- IgA def
- hyper-IgM synd
- IgG subclass def
124
primary humor deficiencies --> clinical features
virus, encap bact --> sinopulm infect --> recurrent and/or severe
125
hyper-IgM synd --> lab findings:
- B cells
- IgG
- IgA
- IgM
- B cells: normal
- IgG: low
- IgA: low
- IgM: high
126
X-linked agammaglobulinemia --> lab findings:
- B cells
- IgG
- IgA
- IgM
- B cells: low or absent
| - Ig: low
127
common variable immunodef --> lab findings:
- B cells
- IgG
- IgA
- IgM
- B cells: normal
| - Ig: low
128
IgA def --> lab findings:
- B cells
- IgG
- IgA
- IgM
- B cells: normal
| - IgA: low
129
IgG subclass def --> lab findings:
- B cells
- IgG
- IgA
- IgM
- B cells: normal
| - IgG: low
130
fever & pulm ssx worsen after initial improve --> condition?
2ndary bact pneumonia after influenza
131
19yo M --> influenza --> 2ndary bact pneumonia --> org?
comm-acquired MRSA
132
19yo M --> influenza --> 2ndary bact pneumonia w comm-acquired MRSA --> clinical features (5)
rapidly progressive, necrotizing pneumonia:
- high fever
- productive cough (often hemoptysis)
- leukopenia
- multilobar cavitary infiltrates
133
greatest RF for cerebral palsy
premature birth
134
cerebral palsy --> usual cause
prenatal insult to brain development
135
cerebral palsy --> grp of synd characterized by?
nonprogressive motor dysfx
136
cerebral palsy --> #1 form seen in preterm infants
spastic diplegia
137
cerebral palsy --> 3 subtypes
- spastic
- dyskinetic
- ataxic
138
spastic diplegia --> presentation (3)
LE:
- hypertonia
- hyperreflexia
- equinovarus deformity
139
50% of cerebral palsy pts also have ___?
intell disability
140
cerebral palsy --> how are their mvmts?
voluntary mvmts:
- uncoordinated
- limited
141
suspected acromegaly --> preferred initial test
insulin-like growth factor 1
142
what is Wallenberg synd
lat medullary infarct
143
Wallenberg synd --> cause
occlusion of post inf cerebellar or vertebral A
144
Wallenberg synd --> clinical features (5)
- loss of pain/temp over ipsilat face & contralat body
- ipsilat bulbar muscle weak --> hoarse
- vestibulocerebellar impair --> vertigo, nystagmus
- Horner's synd
- motor fx of face & body spared
145
what PFT result suggests asthma?
>12% increase in FEV1
146
pt gets implantable pacemaker --> R heart fail --> should suspect what comp?
tricuspid regurg d/t direct leaflet damage or inadeq leaflet coaptation
147
tricuspid regrug --> type of murmur?
holosystolic
148
severe aortic stenosis --> PE findings (3)
- carotid pulse --> delayed & diminished
- soft S2
- mid-late systolic murmur --> max at 2nd R intercostal space
149
what is pulsus parvus and tardus? seen in what condition? what causes it?
severe aortic stenosis --> blood flow obstruct --> diminished & delayed carotid pulse
150
what causes S2 heart sound?
- mainly aortic (A2) valve closure
| - pulmonic valve (P2) closure
151
why is S2 heart sound soft in severe aortic stenosis?
aortic leaflets --> thicken & calcify --> reduce mobility
152
term neonate --> polycythemia --> definition
>65% hemotocrit
153
neonate --> polycythemia --> etiologies (3)
- excess transfer placental blood: delayed cord clamp
- in-utero hypoxia: maternal HTN, smoke
- poor placental gas exchange: maternal DM
154
neonate --> polycythemia --> ssx (4)
- usu asx
- resp distress
- hypoglycemia
- neuro ssx
155
vegans at risk for what vit def?
B12
156
vitB12 def --> ssx (2)
- anemia
| - neuro comp
157
vegan --> fatigue & pallor --> started on folic acid --> fall & forgetfulness --> why?
vegan --> B12 def --> folic acid supplementation --> correct anemia --> but rapid progress of neuro comp
158
44yo M --> H&P, labs, abd US --> found to have cirrhosis --> should look for what else?
screen EGD --> esophageal varices
159
primary prophylaxis for esophageal variceal hemorrhage
- nonselective BB --> propranolol or nadolol
| - endoscopic variceal ligation
160
who is at low (<10%) pretest probability of CAD (2)?
- any age --> asx
| - <50 F --> atypical CP
161
pt w chest pain --> at low pretest probability for CAD --> next step?
no further dx testing for CAD
162
pt w chest pain --> at high pretest probability for CAD --> next step?
- start meds for CAD
| - expert eval to consider coronary angiography
163
pt w chest pain --> at interm pretest probability for CAD --> next step?
EKG stress test
164
pericarditis --> EKG findings
diffuse ST segment elevations
165
chronic kidney dz --> chest pain --> condition?
uremic pericarditis
166
pericarditis --> what's heard on cardiac auscultation?
friction rub
167
chronic kidney dz --> uremic pericarditis --> tx
hemodialysis:
- rapid resolve chest pain
- reduce size of any assoc pericardial effusion
168
clues to correct diagnosis of AD polycystic kidney dz (3)
- HTN
- palpable bilat abd masses
- microhematuria
169
AD polycystic kidney dz --> #1 extrarenal manifestation
hepatic cysts
170
gestational DM --> 1st line tx? 2nd line?
1st line: dietary mod
| 2nd line: insulin, metformin, glyburide
171
maternal gestational DM --> delivery --> shoulder dystocia --> initial management
- McRoberts maneuver --> flex hips toward abd
- apply suprapubic pressure
--> relieve almost half of shoulder dystocias w no further intervention
172
2ndary amenorrhea --> initial eval
- B-hCG --> exclude preg
- prolactin
- TSH
- FSH
173
erythema nodosum --> assoc w what conditions (6)
- strep infect
- sarcoidosis
- TB
- coccidioidomycosis
- IBD
- Behcet dz
174
erythema nodosum --> what imaging should be done? why?
CXR --> assess for sarcoidosis
175
Rotor's synd --> pathophys
defect in hepatic secretion of conj bili into biliary system
176
positive urine bili assay --> indicates?
buildup of conj bili
177
smoker --> mild ssx --> small cell lung CA --> SIADH --> hypoNa --> tx
asx or mild symptoms --> fluid restrict
178
most accurate way to determine estimated gestational age
1st trimester US w crown-rump length
179
hereditary angioedema --> charact by (4)?
rapid onset:
- noninflamm edema --> face, limbs, genitalia
- laryngeal edema
- intestine edema --> colickly abd pain
no evidence of urticaria
180
hereditary angioedema --> pathophys
C1 inh def --> elevated edema-producing factors C2b & bradykinin
181
nasal polyps --> ssx (3)
- bilat nasal obstruct
- nasal discharge
- anosmia
182
nasal polyps --> assoc w what conditions (3)
- chronic rhinosinusitis
- asthma
- ASA-exacerbated resp dz: ASA/NSAID --> bronchospasm
183
45min ago --> ingest drain cleaner --> next step?
1st 12-24hr --> endoscopy --> assess severity of damage & guide further tx
184
uterine rupture --> presentation
- vaginal/intraabd bleed
- pain
- fetal distress/demise
185
uterine rupture --> PE findings
- abdominally palpable fetal parts at rupture site
| - no presenting fetal parts vaginally
186
iron poisoning --> presentation (3)
- abd pain
- hematemesis
- metab acid
187
somatic symptom disorder --> management
regularly scheduled visits:
- est strong physician-pt relationship
- limit dx testing, referrals
188
42 F --> intermittent blood staining left bra --> normal PE & mammogram --> condition?
intraductal papilloma
189
intraductal papilloma --> clinical features (2)
- unilat bloody nipple discharge
| - no assoc mass, LAD
190
42 F --> intermittent blood staining left bra --> normal breast exam --> next step?
mammogram --> r/o carcinoma (even w/out palpable breast mass)
191
intraductal papilloma --> mammogram finding
normal
192
#1 brain tumor in children
low-grade astrocytoma --> particularly pilocytic astrocytoma
193
supratentorial tumor --> classic presentation (3)
- sz
- weak
- sensory change
194
post fossa tumor --> typical presentation
cerebellar dysfx --> ie ataxia, dysmetria
195
bedwetting is normal before what age?
5yo
196
chronic LBP --> 6 major causes
- mechanical
- radiculopathy
- spinal stenosis
- inflamm
- metastatic cancer
- infectious
197
chronic LBP --> d/t mechanical --> 2 types of mechanical LBP?
- muscle strain
| - disc degen
198
chronic LBP --> d/t radiculopathy --> clinical features (3)
- radiate below knee
- positive SLR
- neuro deficits
199
chronic LBP --> d/t mechanical --> clinical features (2)
- normal neuro exam
| - paraspinal tender
200
chronic LBP --> d/t spinal stenosis --> clinical features (2)
- pseudoclaudication
| - relieved by leaning forward
201
chronic LBP --> d/t inflamm (ie spondyloarthropathy) --> clinical features (2)
- worse w rest, better w activity
| - sacroiliits
202
chronic LBP --> d/t metastatic cancer --> clinical features (3)
- >50yo
- worse at night
- not relieved with rest
203
chronic LBP --> d/t infectious --> clinical features (3)
- recent infect/IVDA
- fever
- focal spine tender
204
S4 heart sound --> assoc w what conditions (2)?
- V hypertrophy
| - acute MI
205
S3 heart sound --> assoc w what conditions (3)?
- heart fail
- restrictive cardiomyopathy
- high output states
206
S3 heart sound --> normal in whom?
- child
- YA
- preg
207
S4 heart sound --> normal in whom?
healthy older adult
208
what creates S3 heart sound?
turbulent blood flow to ventricles d/t increased vol
209
what creates S4 heart sound?
blood forced into stiff ventricle
210
what should raise suspicion for HIT (2)
- >50% decrease in platelets
| - new thrombus in 5-10 days
211
HIT --> pathophys
autoAb to platelet factor 4 --> coat platelets:
- spleen --> remv these platelets --> thrombocytopenia
- platelets activate --> platelet aggregation --> arterial & venous thrombus
212
26yo F --> blurry vision in L eye --> light --> dilate --> condition?
optic neuritis
213
what is optic neuritis
inflamm (immune mediated) demyelination of optic N
214
optic neuritis --> who?
young F
215
optic neuritis --> assoc w what condition?
frequently heralding ssx of mult sclerosis
216
optic neuritis --> clinical features (5)
- acute onset monocular vision loss
- central scotoma
- afferent pupil defect
- "washed out" color vision
- pain w eye mvmt
217
COPD exacerbation --> cardinal ssx (3)
- increased dyspnea
- increased cough --> more freq/severe
- sputum --> change color/vol
218
COPD exacerbation --> tx
- short acting bronchodilator --> B2 agonist & antichol
- systemic glucocorticoids
- O2 --> sat 88-92%
- abx if >2 cardinal ssx
219
what is cor pulmonale
RV fail d/t pulm HTN caused by underlying condition
220
#1 cause of cor pulmonale
COPD
221
solitary pulm nodule (SPN) --> definition
- rounded opacity
- <3cm
- completely surrounded by pulm parenchyma
- no assoc LN enlrg
222
solitary pulm nodule (SPN) --> next step for:
- lesion w high risk of malig
- low risk
- lesion w high risk of malig: surg excision
| - low risk: monitor w serial CT
223
what is ASA-exacerbated resp dz (AERD)
pseudoallergic rxn to NSAID
224
ASA-exacerbated resp dz (AERD) --> typically occur in who (2)?
pt w comorbid:
- asthma
- chronic rhinosinusitis w nasal polyposis
225
ASA-exacerbated resp dz (AERD) --> presentation (3)
- asthma ssx --> cough, wheeze, chest tight
- nasal ssx: congest, rhinorrhea
- ocular ssx: periorbital edema
226
ASA-exacerbated resp dz (AERD) --> pathophys
ASA --> inh COX1 & 2 --> inh brkdown of arachadonic acid to prostaglandins (anti-inflamm) --> LOX --> arachdonic acid to leukotrienes (pro-inflamm)
227
dermatomyosistis --> assoc w what condition?
internal malig --> must do age-approp cancer screen
228
34 F --> amenorrhea --> chemotherapy 5 yr ago for non-Hodgkin lymphoma --> all else normal --> what condition? why?
ovarian fail d/t ctx --> ctx & rad also affect proliferating granulosa & theca cells of ovary
229
mammogram --> how often?
q2y
230
pap --> how often?
q3y
231
lipid panel --> how often?
q5y
232
mammogram --> who?
50-74yo
233
young adult --> liver dz & neuropsych ssx --> condition?
Wilson's dz
234
preg at 35wk gestation --> urine leak w laugh/cough --> leakage has increased --> find nitrazine-positive fluid, low aminiotic fluid index --> condition?
preterm premature rupture of membrane
235
preterm premature rupture of membrane (PPROM) --> definition
<37 wk gestation --> rupture membranes before labor
236
preterm premature rupture of membrane (PPROM) --> management
- >34 wk --> deliver
| - <34 wk --> expectant management
237
abd succussion splash --> test for what condition?
gastric outlet obstruction
238
abd succussion splash --> how do you do this test? what is a positive test?
1) stethoscope over upper abd
2) rock pt back & forth at hips
--> splash sound --> indicate hollow viscus filled w fluid & gas
239
catatonia --> tx
- benzo
| - ECT
240
thyroid storm --> triggers (5)
- thyroid/nonthyroid surg
- trauma
- infect
- iodine contrast
- childbirth
241
thyroid storm --> ssx (7)
- tachycardia
- HTN
- cardiac arrhythmia
- high fever
- tremor
- altered MS
- lid lag
242
what org (3) can cause retinitis in HIV pt?
- VZV
- HSV
- CMV
243
how differentiate VZV/HSV retinitis vs CMV retinitis?
VZV/HSV:
- severe, acute retinal necrosis --> pain
- keratitis
- uveitis
- fundoscopy: peripheral pale lesions, central retinal necrosis
CMV:
- painless
- no keratitis/conjunctivitis
- fundoscope: hemorrhage, fluffy/granular lesions around retinal vessels
244
COPD --> criteria for initiate longterm home O2 tx
- resting PaO2 <55 mmHg
- resting O2 sat <88%
R heart fail or hematocrit >55%:
- PaO2 <59
- O2 sat <89%
245
what is cutaneous larva migrans
creeping cutaneous eruption d/t dog/cat hookworm larva
246
how does cutaneous larva migrans occur?
contaminated sand/soil --> walk barefoot
247
cutaneous larva migrans --> ssx
- portal of entry --> pruritic papular lesion
| - intensely pruritic, migrating serpiginous reddish-brown tracks
248
cutaneous larva migrans --> tx
ivermectin
249
something flew into eye while drilling --> normal penlight exam --> next step
fluorescein exam
250
toxic shock synd --> ssx (5)
- fever
- myalgia
- marked hypotension
- diffuse erythematous macular rash (erythroderma)
- can progress to multiorgan involvement
251
toxic shock synd --> assoc w (3)?
- tampon
- nasal packing
- post-surg infect
252
75 M --> routine checkup --> normal but high alk phos --> what condition?
Paget dz of bone --> #1 cause of asymptomatic elevation of alk phos in elder
253
dyspnea, S3 heart sound, bibasilar crackles, low EF --> what condition?
decompensated CHF d/t LV systolic dysfx
254
CHF ssx --> macrocytic anemia, thrombocytopenia, 2:1 AST:ALT, no CAD on angiography --> cause of CHF?
heavy alcohol --> dilated cardiomyopathy (alcoholic cardiomyopathy)
255
alcoholic cardiomyopathy --> what is most likely to reverse heart fx?
stop alcohol
256
what is malig HTN
severe HTN (>180/120) w:
- retinal hemorrhage
- exudate
- papilledema
257
76M --> substernal chest pain --> cardiac catheter shows significant coronary stenosis --> 5 hrs later --> 75/60 BP, 120 HR, diaphoresis, flat neck veins --> what condition?
retroperitoneal hematoma
258
retroperitoneal hematoma --> presentation
- sudden hemodynamic instability
| - ipsilat flank/back pain
259
retroperitoneal hematoma --> how confirm dx
noncontrast CT abd/pelvis
OR
abd US
260
retroperitoneal hematoma --> tx
supportive:
- bed rest
- intensive monitor
- IV
- blood transfusion (if needed)
261
when need to deliver bad news --> should 1st assess what?
pt's comprehension, fears, desire for info
262
premature atrial contractions found on EKG --> pt is asymptomatic --> tx
avoid precipitating factors:
- tobacco
- alcohol
- caffeine
- stress
263
premature atrial contractions found on EKG --> pt is symptomatic --> tx
BB
264
membranoprolif glomerulonephritis type 2 --> pathophys
C3 convertase Ab --> persistent activation of alt complement pathway --> kidney damage
265
membranoprolif glomerulonephritis type 2 --> microscopic finding
dense intramembranous deposits that stain for C3
266
what is mixed cryoglobulinemia synd? assoc w what condition?
immune complex deposition disorder
assoc w chronic hep C
267
mixed cryoglobulinemia synd --> presentation (5)
- fatigue
- palpable purpura
- arthralgia
- renal dz
- peripheral neuropathy
268
mixed cryoglobulinemia synd --> lab findings (5)
- serum cryoglobulin
- hypocomplement
- +RF
- elevated transaminase
- kidney injury
269
suspect mixed cryoglobulinemia --> what would be most helpful in establishing dx?
viral hep serology
270
neonate --> bilious emesis --> abd XR shows dilated bowel --> next step?
contrast enema --> determine level of obstruction
271
neonate --> bilious emesis --> d/t meconium ileus --> contrast enema will show what?
microcolon
272
status epilepticus --> what lead to what hallmark condition?
cortical laminar necrosis --> persistent neuro deficit, recurrent sz
273
6 hr postpartum --> lower abd pain --> hasn't been able to void, persistent urine dribbling --> what condition?
postpartum urinary retention & overflow incontinence
274
postpartum urinary retention --> RF (3)
- prolonged labor
- perineal trauma
- regional analgesia
275
adol --> initial menstrual cycles --> irreg & anovulatory --> pathophys
immature hypothalamic-pituitary-gonodal axis --> insuff secrete GnRH
276
hiking this morning --> tick bite, tick still attached --> next step?
remv tick w small forceps
277
hiking this morning --> tick bite, tick still attached --> does pt require prophylaxis?
no --> only if tick attached >36hr
278
what is amiloride
K+ sparing diuretic
279
CMV --> what reduces risk of transmission?
good hygiene
280
preg --> CMV infect --> tx
no tx if infect develop during preg
281
when should suspect stroke?
sudden appearance of focal neuro deficit --> >24hr
282
#1 cause of thrombotic ischemic stroke
atherosclerosis --> carotid, basilar, vertebral A
283
#1 artery involved in embolic ischemic stroke?
MCA
284
stroke --> ACA --> ssx
weak --> contralal:
- face
- LE
- trunk
285
stroke --> MCA --> ssx (7)
- contralat hemiparesis
- contralat hemisensory loss
- hyperreflexia
- bilat visual abnormal
- contralat neglect
- aphasia (if dominant hemis)
- inability to perform learned axns (if nondominant hemis)
286
stroke --> PCA --> ssx
- contralat visual abnormal --> homonymous hemianopsia
| - if bilat PCA --> blind
287
stroke --> basilar A --> ssx (7)
- CN abnormal
- contralat --> full body --> weak, decreased sensation
- vertigo
- loss of coordination
- difficult speak
- visual abnormal
- coma
288
stroke --> lacunar A --> 4 synd
- pure motor hemiparesis
- pure sensory stroke
- ataxic hemiparesis
- dysarthria clumsy hand synd
289
stroke --> lacunar A --> #1 synd
pure motor hemiparesis
290
pt has stroke --> when trt HTN? why?
do NOT trt HTN immed following stroke unless:
- >220/120
- CAD
==> maintain cerebral perfusion
291
ischemic stroke --> when can do thrombolytic tx?
w/in 3 hr
292
ischemic stroke --> acute setting --> meds?
- antiplatelet (ASA) --> prevent additional stroke
| - statin
293
pt has TIA --> what is 5yr risk of stroke?
30%
294
ischemic stroke --> 2 most important RF
- age
| - HTN
295
what is amaurosis fugax
(example of TIA) transient, curtain-like loss of sight in ipsilat eye d/t microemboli to retina
296
TIA of carotid --> presentation (4)
- loss of speech
- contralat extremity --> paralysis/paresthesia
- 1 limb --> clumsy
- amaurosis fugax
297
TIA of vertebrobasilar system --> presentation (7)
- vertigo/double vision
- ipsilat face --> numb
- contral limbs --> numb
- dysarthria
- hoarse/dysphagia/projectile vomit
- HA
- drop attack
298
lacunar stroke --> pathophys --> what causes narrowing of arterial wall?
thickening of vessel wall (not by thrombosis)
299
predisposing factor for lacunar stroke
HTN (DM also important)
300
stroke: what causes global ischemia & infarct?
nonvasc cause --> low CO, anoxia
301
subclavian steal synd --> pathophys
proximal stenosis of L subclavian A --> exercise L arm --> retrograde flow from vertebral A to supply blood to arm --> "steal" blood from vertebrobasilar system
302
subclavian steal synd --> PE findings (3)
- BP: L arm < R
- decreased pulse in L arm
- UE claudication
303
stroke --> pure motor hemiparesis --> what area was affected?
lacunar A --> internal capsule
304
stroke --> dysarthria, clumsy hand --> what area was affected?
lacunar A --> pons
305
stroke --> pure sensory deficit --> what area was affected?
lacunar A --> thalamus
306
thrombotic stroke --> onset
rapid or stepwise --> classically --> wake from sleep w neuro deficits
307
stroke --> 1st imaging test
CT w/out contrast
308
stroke --> CT non-contrast findings
- ischemia: dark area
| - hemorrhagic: white
309
stroke --> young pt (<50) --> RF (5)
- oral contraceptive
- hypercoag state --> protein C/S def, anti-PLP synd
- vasconstrictive drug use --> cocaine, amphetamine
- polycythemia vera
- sickle cell
310
carotid duplex US screen --> who?
all pts w:
- carotid bruit
- PVD
- CAD
311
what is mag resonance arteriogram for?
definitive test: head & neck vessels --> ID stenosis, aneurysms
312
stroke --> what comp can occur in 1-2 day?
cerebral edema --> mass effect
313
stroke --> cerebral edema --> tx
lower ICP:
- hypervent
- mannitol
314
ischemic stroke --> acute setting --> give antiplatelet --> what med is not given in acute setting?
anticoag --> no efficacy in acute stroke
315
ischemic stroke --> when trt w anticoag?
after acute setting if cause was emboli from cardiac source
316
lyme dz --> dx
- clinical diagnosis
| - serology to confirm: ELISA --> western to confirm
317
lyme dz --> stage 2 --> may present w what conditions (5)?
- meningitis
- encephalitis
- cranial neuritis --> bilat facial N palsy
- peripheral radiculoneuropathy --> motor or sensory
- cardiac: AV block, pericarditis, carditis
318
HIV --> CMV --> disseminate --> what organ systems usu involved (2)?
- GI
| - pulm
319
what is usu absent in CMV mononucleosis vs EBV mono (2)?
- cervical LAD
| - pharyngitis
320
comm-acq pneumonia --> tx
3rd gen ceph (ceftriaxone) + macrolide (azithro)
OR
FQ (moxifloxacin)
321
post-viral --> CAP --> what org?
S aureus
322
COPD --> CAP --> what org?
H flu
323
fever + cough --> next step?
- CXR
| - O2 sat
324
fever + cough --> cavitary lesion on CXR --> abscess --> tx?
3rd gen ceph + clindamycin
325
fever + cough --> negative CXR --> what condition?
bronchitis
326
bronchitis --> tx
- macrolide
- doxycycline
- FQ (moxi)
327
CAP --> classic presentation
sudden chill followed by:
- fever
- pleuritic pain
- productive cough
328
atypical pneumonia --> presentation
sore throat & HA -->dry cough, dyspnea
329
pt worried have pneumonia --> normal vitals --> how likely have pneumonia
<1%
330
pneumonia ssx, GI ssx, hypoNa --> what condition?
legionella pneumonia
331
legionella pneumonia --> who (4)?
- organ transplant
- renal fail
- chronic lung dz
- smoke
332
pneumonia --> comp (3)
- pleural effusion
- pleural empyema
- acute resp fail
333
heparin --> HIT --> CBC findings --> platelet count?
50% decrease
334
ankylosing spondylitis --> #1 extra-articular manifestation
eye:
- ant uveitis
- iridocyclitis
335
ankylosing spondylitis --> cardiac manifestation (2)
- AV heart block
| - aortic regurg
336
ankylosing spondylitis --> comp (5)
- restrictive lung dz
- cauda equina synd
- spine fx --> spinal cord injury
- osteoporosis
- spondylodiscitis
337
sideroblastic anemia --> cause (4)
- drug/alcohol
- lead
- B6 def
- MPD
338
sideroblastic anemia --> type of anemia?
microcytic/hypochromic
339
difference --> case ctrl vs retrospective cohort
- case ctrl: outcome --> assoc RF?
| - retrospective cohort: RF exposure --> outcome?
340
brain abscess --> classic triad
- fever
- severe HA --> nocturnal or morning
- FND
341
brain abscess --> RF (4)
- cyanotic heart dz
- recurrent sinusitis
- dental infect
- otitis media
342
MSK low back pain --> tx for acute pain?
- maintain mod activity
- NSAID/acetaminophen
- consider: muscle relaxant, spinal manipulation, brief course of opioids
343
MSK low back pain --> tx for chronic pain?
- intermittent NSAID
- exercise tx
- consider: TCA, duloxetine
344
MI --> cardiac catheter & stent --> R toe & all L toes blue --> what condition?
"blue toe synd"
345
"blue toe synd" --> pathophys
cardiac catheter & other vasc procedures --> disrupt atherosclerotic plaque --> chol crystals into circulation --> atheroembolism (cholesterol embolism) --> tissue/organ ischemia
346
atheroembolism --> clinical manifestations (6)
- blue toe synd
- livedo reticularis
- cerebral ischemia
- intestinal ischemia
- acute kidney injury
- Hollenhurst plaque
347
atheroembolism --> tx
supportive --> statin
348
what is: cell-free fetal DNA testing
maternal plasma --> test for fetal aneuploidy
349
cell-free fetal DNA testing --> who? when?
>35yo preg --> increased risk of aneuploidy --> at >10wk gestation
350
cell-free fetal DNA testing --> abnormal --> next step?
confirm results:
- if at 10-12wk --> chorionic villus sampling
- if at 15-20wk --> amniocentesis
351
B2 (riboflavin) --> source (4)
- dairy
- egg, meat
- green veg
352
B2 (riboflavin) def --> ssx (4)
- angular cheilosis
- stomatitis/glossitis
- normocytic anemia
- seborrheic dermatitis
353
baby dies --> mother comes in for lactation suppression --> how? (5)
- supportive bra
- avoid nipple stimulation
- ice
- NSAID
354
M baby --> diag w cystic fibrosis --> GU comp? pathophys?
infertility: fetal genital tract --> inspissated mucus --> obstruct developing vas deferens --> congenital absence of vas deferens --> obstructive azoospermia
355
lip --> #1 malig
SCC
356
lip SCC --> most common location?
lower lip --> vermilion
357
skin SCC --> biopsy findings
invasive cords of squamous cells w keratin pearls
358
uncomplicated preterm premature ROM --> <34wk gestation --> next step?
conservative management --> continue in utero fetal growth:
- corticosteroid --> decrease risk of neonatal resp distress synd
- abx --> increase interval bw membrane rupture & delivery
359
preterm premature ROM --> when should deliver (3)?
- >34wk gestation
- intrauterine infect
- deteriorating fetal/maternal status
360
methanol poisoning --> more severe conseq (2)
- vision loss
| - coma
361
methanol poisoning --> fundoscopic finding
optic disc hyperemia
362
sickle cell trait --> renal comp (4)
- painless hematuria
- UTI
- renal medullary cancer
- inability to concentrate urine
363
sickle cell trait --> painless hematuria --> what condition?
renal papillary necrosis
364
postop comp --> atelectasis --> postop day?
2-3
365
constrictive pericarditis --> #1 cause in developing world
TB
366
constrictive pericarditis --> MC cause in US (4)
- virus
- cardiac surg
- chest rad
- idiopathic
367
constrictive pericarditis --> CXR finding
pericardial calcification
368
what is D-xylose test
test of proximal small intestine absorption:
- small intestine mucosal dz --> impaired absorption --> less in blood --> less in urine
- malabsorption d/t enzyme def --> normal absorption of D-xylose
369
cat scratch dz --> presentation
- mild papular/nodular skin lesion
| - ipsilat regional LAD
370
62 F --> 5cm ovarian cyst found on US --> next step?
any ovarian mass in postmenopausal pt require investigation --> eval if mass is malig/benign --> CA-125 (marker for epithelial ovarian CA)
371
2 MC posterior fossa tumors in children
1) astrocytoma
| 2) medulloblastoma
372
medulloblastoma --> MC occur in what location? what does this location do?
balance & gait coordination
373
cerebellar vermis --> medulloblastoma --> ssx (3)?
- truncal or gait instability
| - obstructive hydrocephalus (d/t proximity to 4th ventricle) --> ICP ssx
374
HA, HTN, hyperreflexia, +preg test --> what condition?
preeclampsia w severe features
375
preeclampsia at <20wk gestation --> comp of what condition?
hydatidiform mole
376
preeclampsia --> likely caused by what?
abnormal placental spiral A dev
377
pruritis, fatigue, hepatomegaly, +antimito Ab --> what condition?
primary biliary cholangitis
378
primary biliary cholangitis --> skin findings (2)
- pruritis
| - xanthoma, xanthelasma
379
primary biliary cholangitis --> pathophys
autoimmune --> progressive destroy intrahep bile ducts
380
primary biliary cholangitis --> comp (3)
- malabsorption
- metabolic bone dz --> osteoporosis, osteomalacia
- hepatocell CA
381
primary biliary cholangitis --> tx? how does it help?
ursodeoxycholic acid --> delay progress
advanced dz --> liver transplant
382
LBP --> 3 MC causes
1) musculoligamentous
2) degen disc dz (osteoarthritis)
3) facet arthritis
383
disc herniation --> what worsens pain (2)?
- increase intraspinal pressure: cough, sneeze
| - forward flex: sit, drive, lift --> worse leg pain
384
lumbar disc herniation & sciatica --> most pts need what tx?
majority improve w conservative tx
385
spinal stenosis --> what worsens pain? what relieves it?
- stand, walk
- back extend --> worse leg pain
better when bend, sit
386
lumbar disc herniation & sciatica --> tx?
conservative:
- anti-inflamm
- PT
- epidural steroid inject
387
lumbar disc herniation & sciatica --> when do surg (2)?
- conservative tx fail
| - progressive neuro deficit
388
spinal stenosis --> #1 finding
neurogenic claudication
389
what is neurogenic claudication
radicular leg/butt pain --> pain, cramp, numb/paresthesia:
- worse when walk
- better when sit, forward flex
390
musculoligamentous strain --> typical HPI
episode of bend/twist --> lift heavy object --> feel back "give way" --> immed onset back pain
391
musculoligamentous strain --> referred pain?
muscle spasm --> butt --> upper post thigh --> knee level
392
vertebral compression fx --> who (2)?
- elder
| - long term steroid
393
vertebral compression fx --> location of pain
- level of fx
radiate to:
- across back
- around trunk
394
vertebral compression fx --> tx
time to heal (6-8wk):
- brace
- analgesic
395
spine infect --> who (3)?
- IVDA
- dialysis
- indwelling catheter
396
epidural abscess --> tx?
surg decompression
397
epidural abscess --> when medical manage instead of surg?
- lumbar spine
- no neuro deficits
- no sepsis
398
spine infect --> #1 imaging
MRI
399
LBP --> conservative tx for how long before MRI?
3mo
400
Motor fx:
- L2
- L3
- L4
- L5
- S1
- L2: hip flex
- L3: knee extend
- L4: ankle dorsiflex
- L5: ankle/big toe dorsiflex
- S1: ankle plantarflex
401
cauda equina synd --> presentation
- severe back/leg pain
- bladder dysfx
- saddle anesthesia
402
cauda equina synd --> cause
lumbar spine --> severe stenosis (MC d/t acute disc herniation)
403
spontaneous 2ndary (complicated pneumothorax) --> cause
comp of underlying lung dz:
- #1 COPD
- asthma
- interstitial lung dz
- neoplasm
- CF
- TB
404
spontaneous pneumothorax --> presentation
- ipsilat CP --> sudden onset
- dyspnea
- cough
405
tension pneumothorax --> cause (3)
- mech ventilation w assoc barotrauma
- CPR
- trauma
406
tension pneumothorax --> hypotension --> why?
great veins compressed --> impaired cardiac filling
407
suspect tension pneumothorax --> next step --> CXR or decompress? why?
med emergency --> can die of hemodynamic compromise --> inadeq CO, hypoxemia
==> needle aspiration ---> chest tube
408
difference bw simple vs complex sz
- simple: intact consciousness
| - complex: impaired consciousness --> postictal confusion
409
complex partial sz --> features (3)
- impaired consciousness --> postictal confusion
- automatisms
- olfactory/gustatory hallucination
410
what kind of sz has LOC?
generalized
411
what is salvage tx
tx for dz when standard tx fails
412
recurrent sinusitis & otitis, auditory canal ulceration, fatigue, anemia, microscopic hematuria --> what condition?
granulomatosis w polyangiitis
413
granulomatosis w polyangiitis --> presentation
- URTI
- LRTI
- glomerulonephritis
414
HIV pt --> altered mental status --> PCR of CSF --> EBV DNA --> what condition?
primary CNS lymphoma
415
primary CNS lymphoma --> MRI findings
solitary weakly ring-enhancing periventricular mass
416
32 F --> dyspnea, orthopnea, peripheral edema --> what condition is causing her ssx?
viral myocarditis --> dilated cardiomyopathy --> ssx of decompensated heart fail
417
hemorrhagic stroke --> putamen (basal ganglia) --> presentation? why?
injure adjacent internal capsule --> contralat hemiparesis & hemianesthesia
418
#1 cause of spontaneous deep intracerebral hemorrhage
HTN vasculopathy --> small penetrating branches of major cerebral A
419
URI --> then fever, neck pain, tender goiter --> condition?
subacute (de Quervain) thyroiditis
420
subacute (de Quervain) thyroiditis --> pathophys
URI --> postviral inflamm process
421
subacute (de Quervain) thyroiditis --> tx
BB & NSAID
