4.29.17 Flashcards
(313 cards)
1
Q
preg –> hyperandrogen ssx –> 2 MC causes
A
- preg luteoma
- theca luteum cyst
2
Q
preg luteoma –> US finding
A
solid ovarian mass –> 50% bilat
3
Q
preg luteoma –> effect on fetus
A
F fetus –> virilization
4
Q
preg luteoma –> tx
A
no maternal tx warranted –> after delivery –> regress spont
5
Q
oxytocin –> how can cause sz?
A
oxytocin similar to ADH –> water retention –> hypoNa –> sz
6
Q
pt w fever –> WBC 690 –> normal CXR & UA –> what condition?
A
febrile neutropenia
7
Q
neutropenia –> definition
A
absolute neutrophil count <1500
8
Q
febrile neutropenia –> pathophys
A
ANC <1000 –> higher risk for overwhelming bact infect d/t absent/blunted neutrophil-mediated inflamm response
9
Q
febrile neutropenia –> MC org
A
G neg –> esp Pseudomonas
10
Q
febrile neutropenia –> tx
A
medical emergency –> early empiric abx –> anti-pseudomonal:
- cefepime
- meropenem
- pip/tazo
11
Q
COPD pt –> sudden onset severe dsypnea & R chest pain –> what condition?
A
2ndary spont pneumothorax
12
Q
COPD –> 2ndary spont pneumothorax –> pathophys
A
alveolar sacs –> chronic destruct –> lrg alveolar blebs –> rupture –> leak air into pleural space
13
Q
vag bleed, closed cervix, viable fetus on US –> what condition?
A
threatened abortion
14
Q
preg –> amphetamine abuse –> at risk for what conditions (5)
A
- preterm delivery
- preeclampsia
- abruptio placentae
- fetal growth restrict
- intrauterine fetal demise
15
Q
6mo F –> loss of motor milestones, hypotonic, HSM, bright red macula –> condition?
A
Neimann-Pick dz
16
Q
Neimann-Pick dz –> enzyme def?
A
sphingomyelinase
17
Q
Neimann-Pick dz –> presentation (4)
A
- areflexia
- HSM
- cherry red macula
- dev milestone regress
18
Q
difference: Niemann-Pick vs Tay Sachs
A
Tay Sachs –> similar to Niemann Pick except:
- hyperreflexia
- no HSM
19
Q
Tay Sachs –> enzyme def
A
B-hexosaminidase A
20
Q
15 F –> 1ary amenorrhea, anosmia, no pubic hair, normal uterus/ovaries –> condition?
A
Kallman synd
21
Q
Kallman synd –> pathophys
A
XR –> dysfx migration of fetal GnRH & olfactory neurons:
- hypogonadotropic hypogonad
- rhinencephalon hypoplasia
22
Q
Kallman synd –> genotype
A
normal genotype:
- 46XX
- 46XY
23
Q
Kallman synd –> presentation
A
- delayed/absent puberty
- anosmia
24
Q
Kallman synd –> LH & FSH levels
A
GnRH def –> low LH & FSH
25
58 M --> sz --> former smoker --> otherwise normal H&P --> MRI --> several lesions at gray & white matter jx --> what condition?
lung CA --> brain mets
26
lung CA --> mets to brain --> MRI finding
gray & white matter jx --> mult well-circumscribed lesions w vasogenic edema
27
pt w chronic liver dz --> vaccines same as gen population --> need what other vaccines?
- Hep A
- Hep B
- 23-valent pneumococcal
28
>65yo --> what type of pneumococcal vaccine?
13-valent --> followed by 23-valent
29
<65yo --> high risk comorbid condition --> what type of pneumococcal vaccine?
13-valent --> followed by 23-valent
30
<65yo --> chronic condition that increase risk of invasive pneumococcal dz--> what type of pneumococcal vaccine?
23-valent alone
31
<65yo --> comorbid condition at high risk for pneumococcal dz --> what are some high risk comorbid conditions? (5)
- CSF leak
- sickle cell dz
- cochlear implant
- congenital/acquired asplenia
- immunocomp
32
what are some chronic conditions that increase risk of invasive pneumococcal dz (5)
- heart dz
- lung dz
- DM
- smoke
- chronic liver dz
33
myasthenia gravis --> pathophys
autoAb --> nAChR at NM jx --> receptor degradation --> impaired AP propagation --> muscle weak
34
myasthenia gravis --> presentation (2)
- ocular --> ptosis, diplopia
| - bulbar dysfx --> fatigable chewing, dysphagia w nasopharyngeal regurg, dysarthria
35
myasthenia gravis --> chest imaging --> finding
ant mediastinal mass --> thymoma
36
went to Arizona --> CAP, arthralgia, erythema nodosum --> what condition?
coccidioides --> valley fever
37
hydroxychloroquine --> MOA
TNF & IL-1 inh
38
hydroxychloroquine --> AE (1)
retinopathy
39
DMARDS (5)
- methotrexate
- leflunomide
- hydroxychloroquine
- sulfasalazine
- TNF inh
40
Tourette synd --> 2 MC comorbid conditions
- ADHD
| - OCD
41
52 F --> morning stiffness, MCP jts involved, nontender nodule at elbow, elevated ESR --> what condition?
RA
42
early RA --> which jts? (4)
- fingers --> MCP & PIP
- toes --> MTP
- wrist
43
RA --> commonly affect what part of axial skeleton?
cervical spine
44
RA --> cervical spine involved --> comp (2)?
- spinal subluxation
| - spinal cord compression
45
what are rheumatoid nodules
firm nontender subcut nodules --> usu close to pressure pts --> ie elbow
46
33 F --> loss of pain/temp in cape-like dist --> normal vibrate/proprioception --> what condition?
syringomyelia
47
what is syringomyelia
spinal cord --> fluid filled cavity --> from:
1) dilation of central canal
2) spinal parenchyma --> separate cavity
48
syringomyelia --> MC assoc condition
Arnold Chiari malformation type 1
49
syringomyelia --> 2 MC location
- cervical
| - thoracic
50
syringomyelia --> presentation (3)
- UE --> weak, areflexia
| - sensory loss --> cape dist
51
what makes S3 heart sound
LA --> blood into LV --> hit blood already in LV --> blood reverberate
52
S3 --> indicates what pathologic medical condition?
LV fail
53
LV fail ssx --> best initial tx
IV diuretic
54
Crohn's --> small bowel resect --> now has gen bone pain --> XR --> decreased bone density, femoral neck pseudofx --> what condition?
osteomalacia
55
Crohn's --> small bowel resect --> osteomalacia --> pathophys
Crohn's & small bowel resect --> malabsorption --> vitD def
56
osteomalacia --> MC cause
vitD def
57
osteomalacia --> lab findings
- Ca
- phosphate
- PTH
- alk phos
- Ca: low
- phosphate: low
- PTH: increased
- alk phos: increased
58
osteomalacia --> characteristic XR finding
bilat & symm pseudofractures (Looser zones)
59
osteomalacia --> presentation (2)
- muscle weak
| - bone pain
60
47 F G4P4 --> low abd pain --> relieved w urination, painful intercourse, normal external genitalia, normal UA --> what condition?
interstitial cystitis (painful bladder synd)
61
interstitial cystitis --> presentation (3)
- bladder pain w filling --> relief w void
- freq, urgency
- chronic pelvic pain --> dyspareunia
62
what is interstitial cystitis
chronic painful bladder condition of uncertain etiology
63
pronator drift --> indicates what?
UMN lesion --> pyramidal/corticospinal tract dz
64
62 M --> sudden onset pain & red in L eye --> photophobia, N, severe HA --> not relieved w ibuprofen --> had used oral decongestant for cold --> nonreactive & dilated pupil --> what condition?
acute angle closure glaucoma
65
acute angle closure glaucoma --> presentation (6)
- sudden onset eye pain
- HA
- N
- conjunctival erythema
- corneal opacification
- mid-dilated pupil
66
acute angle closure glaucoma --> gold standard for dx
gonioscopy: specialized prismatic lens w slit lamp --> visualize iridocorneal angle
67
pt w suspected acute angle closure glaucoma --> next step?
- urgent ophthalmologic consultation
| - tonometry --> measure intraocular pressure
68
abnormal uterine bleed --> definition
menstrual bleed:
- prolonged --> >5day
- heavy
- irreg
69
53 M --> strange itchy rash on L nipple for 1mo --> no relief w steroid --> no periods for 2 yr --> what condition?
Mammary Paget dz
70
Mammary Paget dz --> presentation
painful, itchy, eczematous and/or ulcerating rash on nipple --> spread to areola
71
Mammary Paget dz --> assoc condition?
breast adenoCA
72
acetaminophen --> effect on warfarin
inh CYP450 --> increase warfarin effect --> increase bleed
73
what meds can increase warfarin effect (4)?
- acetaminophen
- NSAID
- amiodarone
- abx
74
preterm infant --> MC cause of anemia
anemia of prematurity
75
anemia of prematurity --> pathophys
- diminished EPO
- short RBC life span
- blood loss from phlebotomy
76
anemia of prematurity --> lab findings:
- Hb
- Hct
- retic
- Hb: decreased
- Hct: decreased
- retic: low
77
prepubertal F --> MC vaginal foreign body
toilet paper
78
prepubertal F --> vaginal foreign body --> tx
topical anesthetic:
- calcium alginate swab
OR
- irrigation w warm fluid
79
Graves ophthalmology --> pathophys
- thyrotropin receptor Ab --> retroorbital fibroblast, adipocytes
- activated T cells
80
what tx for Graves can worsen ophthalmology? why? what can be done about it?
radioactive iodine --> increase thyrotropin receptor Ab titer
glucocorticoids
81
Graves dz w mod-severe ophthalmopathy --> prefered tx
thyroidectomy
82
Graves dz --> 3 primary tx options
- radioactive iodine
- antithyroid drugs (propylthiouracil, methimazole)
- thyroidectomy
83
suspect chronic pancreatitis --> next step to dx?
CT or plain film --> pancreatic calcifications
84
suspect chronic pancreatitis --> why not amylase/lipase to dx?
can be normal & nondiagnostic
85
45 M --> HA & confusion for 2 days --> no focal weak/sensory ssx --> low Hb & platelets, elevated Cr --> fragmented RBC on blood smear -->normal prothrombin --> what condition?
thrombotic thrombocytopenic purpura
86
thrombotic thrombocytopenic purpura --> pathophys
acquired/hereditary autoAb --> low ADAMTS13 --> vWF multimers --> platelet trap & activate
87
thrombotic thrombocytopenic purpura --> presentation --> pentad
- thrombocytopenia
- microangiopathic hemolytic anemia
- renal insuff
- neuro changes
- fever
88
thrombotic thrombocytopenic purpura --> tx
emergent plasma exchange:
- replenish ADAMTS13
- remv autoAb
89
18 F --> clitoromegaly, normal uterus, amenorrhea --> undetectable estradiol, estrone --> what condition?
aromatase def
90
aromatase def --> presentation
- normal internal genitalia
- external virilization
- undetectable estrogen levels
91
aromatase def --> pathophys
prevent conversion of androgen to estrogen
92
asbestos exposure --> resulting MC malig
bronchogenic carcinoma
93
asbestosis --> pathognomic CXR finding
pleural plaques
94
53F --> G2P2 --> R pelvic pain for 3 mo --> h/o tubal ligation, C-section, smoke & EtOH --> neg B-hCG --> US --> ovarian mass --> solid components, thick septations, mod amt of peritoneal fluid --> what condition?
epithelial ovarian carcinoma
95
epithelial ovarian carcinoma --> US findings (3)
- solid mass
- thick septation
- ascites
96
epithelial ovarian carcinoma --> presentation (3)
- pelvic/abd pain
- bloat
- early satiety
97
1st trim screen --> purpose
estimate risk of trisomy 18 & 21
98
prenatal screen --> abnormal --> followup with what diag testing?
- amniocentesis
- chorionic villus sampling
depending on GA
99
1st trim screen --> components
- preg-assoc plasma protein (PAPP)
- B-hCG level
- fetal nuchal translucency
100
1st trim screen --> abnormal results that suggest aneuploidy
- B-hCG: elevated
| - nuchal translucency: increased
101
when use amniocentesis vs chorionic villus sampling
- amniocentesis: 15wk GA
| - chorionic villus sampling: 10-13 GA
102
suspect hep induced thrombocytopenia --> next step?
- stop hep
| - start direct thrombin inh (argatroban) or fondaparinux
103
newborn --> necrotizing enterocolitis --> RF (3)
- prematurity
- hypotension
- congenital heart dz
104
38F --> G1P0 --> 1st prenatal visit --> BP 141/96, no other ssx --> next visit BP 152/106 --> what condition?
primary HTN
105
preg --> chronic HTN --> definition
<20wk GA --> >140/90
106
gestational HTN --> definition
>20wk GA --> new onset elevated BP --> no proteinuria, end organ damage
107
preeclampsia --> definition
>20wk GA --> new onset elevated BP --> proteinuria or end organ damage
108
eclampsia --> definition
preeclampsia + new onset grand mal sz
109
mitral stenosis --> presentation (4)
- dsypnea
- orthopnea
- paroxsymal nocturnal dyspnea
- hemoptysis
110
mitral stenosis --> assoc comp?
LA enlrg --> A-fib --> systemic thromboembolic comp (stroke)
111
what can increase thyroglobulin (2)?
- preg
| - OCP
112
what can decrease thyroglobulin (2)?
- nephrotic synd
| - androgen use
113
preg --> lab findings:
- TBG
- total T4
- free T4
- TBG: increased
- total T4: increased
- free T4: normal
114
nephrotic synd --> lab findings:
- TBG
- total T4
- free T4
- TBG: decreased
- total T4: decreased
- free T4: normal
115
pneumothorax --> common causes (8)
A CHEST IN:
- asthma
- CF
- HIV
- emphysema
- spont trauma
- iatrogenic
- neoplasm
116
suspect tension pneumothorax --> next step
immed needle decompress
117
small pneumothorax --> tx
may resolve w suppl O2 only
118
SLE --> freq have false pos test for what?
syphilis
119
TTP --> lab results:
- PT/PTT
- fibrinogen
- D-dimer
- PT/PTT: normal
- fibrinogen: normal
- D-dimer: normal
120
myasthenia gravis --> assoc w what conditions (2)?
- thymoma
| - thyrotoxicosis
121
CHF exacerbation --> tx
LMNOP:
- lasix
- morphine
- nitrate or nesiritide
- O2
- positioning/pressor (dobutamine)
122
40 M --> car accident --> broke leg --> IV ketorolac --> pain persistent --> h/o of opioid addiction --> best analgesic choice?
acute pain management --> similar for all pts regardless of subst abuse hx
==> IV morphine is approp option
123
acute liver fail --> dx criteria triad
- elevated aminotransferases
- ssx of hep encephalopathy
- syn liver dysfx --> INR >1.5
124
acute liver fail --> MC cause
acetaminophen toxicity
125
29M --> splenectomy after MVA --> receives RBC transfusion --> min after --> wheeze --> resp distress, low BP, lose consciousness --> most likely cause of transfusion rxn?
anaphylactic rxn
126
who gets anaphylactic rxn to blood transfusion?
IgA def
has anti-IgA Ab --> attack IgA in blood transfusion
127
MEN2B --> components (3)
- medullary thyroid cancer
- pheochromocytoma
- mucosal neuroma/marfanoid habitus
128
4mo M --> harsh sound w inspiration --> esp when lie on back, improve when upright or during "tummy time" --> growing well, full term, no comp w delivery --> what condition?
laryngomalacia
129
laryngomalacia --> pathophys
"floppy" supraglottic struct --> collapse during inspiration
130
laryngomalacia --> presentation
inspiratory stridor --> worse when supine
131
laryngomalacia --> dx
- usu clinical
| - mod/severe --> confirm w flexible laryngoscopy
132
laryngomalacia --> tx
most --> reassurance d/t spont resolve
133
MC cause of vitB12 def in N Europe whites?
pernicious anemia
134
pernicious anemia --> presentation (5)
- megaloblastic anemia
- atrophic glossitis (shiny tongue)
- vitiligo
- thyroid dz
- neuro abnormal
135
34M --> recurrent episodes of acute, severe R periorbital pain --> last 30-45min --> miosis, lacrimation, nasal drainage --> no vision change --> what condition?
cluster HA
136
cluster HA --> #1 abortive tx
100% O2 by facemask
137
ASCVD --> when start statin?
40-75yo --> 10yr risk of atherosclerotic CV dz --> >7.5%
138
40M --> sudden onset odynophagia, retrosternal CP, difficult swallow --> endoscopy --> mid-3rd esophagus --> circumferential deep ulcer w relatively normal surrounding mucosa --> what condition?
pill induced esophagitis
139
pill induced esophagitis --> presentation (3)
sudden onset:
- odynophagia
- retrosternal pain
- difficult swallow
140
pill induced esophagitis --> endoscopy findings
discrete ulcer --> normal surrounding mucosa
141
pill induced esophagitis --> typically caused by what meds (4)
- tetracycline
- potassium chloride
- bisphosphonate
- NSAID
142
40F --> MVA --> hurt R leg --> reduced knee extension, decreased sensory to medial lower thigh & leg --> what nerve injured?
femoral N
143
femoral N --> motor fx
thigh --> ant cmpt:
- knee extend
- hip flex
144
femoral N --> sensory fx
- ant thigh
| - med leg
145
what branch of femoral N provide sensory to ant thigh & med leg?
saphenous
146
angiodysplasia --> assoc w what conditions (3)?
- advanced renal dz
- vWF dz
- aortic stenosis
147
39F --> diag w placenta previa --> what is contraindicated in this pt (3)
- intercourse
- digital cervical exam
- vag delivery
148
what are the 4 manifestations of alcohol withdrawal synd (4)
- mild withdrawal
- sz
- alcoholic hallucinosis
- delirium tremens
149
alcoholic hallucinosis --> presentation (3)
- intact orientation
- hallucination
- stable vital signs
150
alcoholic hallucinosis --> onset? when resolve?
12-24hr --> resolve in 24-48hr
151
hallmark of delirium tremens
disorientation and global confusion
152
38F --> obese, oligomenorrhea --> abnormal uterine bleed --> workup should include what (3)
- CBC
- pelvic US
- endometrial bx
153
38F --> obese, oligomenorrhea --> abnormal uterine bleed --> why do endometrial bx?
has RF for endometrial hyperplasia --> obesity, oligomenorrhea
154
15M --> recurrent hematuria & proteinuria, sensorineural hearing loss --> FMHx of renal dz --> what condition?
Alport's synd
155
Alport's synd --> electron microscopy findings
- capillary loops --> alternating areas of thin & thick
| - glomerular BM splitting
156
56M --> severe crushing midsternal CP, diaphoresis, dyspnea --> had drug-eluting stent placed in LAD 10 days ago --> EKG shows ST elevation in I, aVL, V1-4 --> what condition? what caused it?
MI of LAD d/t medication noncompliance
157
coronary A stent --> #1 cause of stent thrombosis
premature discontinuation of antiplatelet therapy
158
coronary A stent --> pt should be on what antiplatelet therapy?
ASA + platelet P2Y12 receptor blocker (clopidogrel, prasugrel, ticagrelor)
159
MC cause of mitral regurg in developed countries
mitral valve prolapse
160
Goodpasture's dz --> affects what organ systems
- lung
| - kidney
161
Goodpastures' dz --> how dx?
renal bx
162
Goodpasture's dz --> renal bx findings
linear IgG Ab along glomerular BM
163
6hr M --> tachycardia, irritable, warm, flushed skin --> mother had Graves' dz trted w surg resect 6mo before preg --> became hypothyroid --> trt w levothyroxine during preg --> what condition? what caused it?
neonatal thyrotoxicosis
164
6hr M --> neonatal thyrotoxicosis --> mother had Graves trted w surg resect --> became hypothyroid --> trted w levothyroxine during preg --> why is neonatal thyrotoxicosis not caused by transplacental levothyroxine?
levothyroxine (like endogenous TH) not cross placenta
165
neonatal thyrotoxicosis --> tx
methimazole + BB til self-resolve
166
neonatal thyrotoxicosis --> pathophys
TSH receptor Ab --> cross placenta
167
CURB-65 criteria used for what?
pneumonia --> risk stratification --> determine hospitalization
168
CURB-65 --> how to score?
1pt for each:
- Confusion
- Urea >20
- RR >30
- BP <90/60
- >65yo
169
CURB-65 --> how to interprete score?
- 0 --> low mortality --> outpt tx
- 1-2 --> interm mortality --> likely inpt tx
- 3-4 --> high mortality --> urgent inpt admission, possible ICU if score >4
170
CURB-65 --> how
to interprete score?
- 0 --> low mortality --> outpt tx
- 1-2 --> interm mortality --> likely inpt tx
- 3-4 --> high mortality --> urgent inpt admission, possible ICU if score >4
171
pneumonia --> must be admitted --> empiric tx?
- FQ --> moxifloxacin
| - B-lactam (ceftriaxone) + macrolide (azithromycin)
172
mult sclerosis --> lumbar puncture findings
oligoclonal IgG bands
173
mult sclerosis --> when do lumbar puncture?
when suspect mult sclerosis but clinical exam/MRI not classic
174
newborn --> IUGR, HSM, juandice, profuse rhinorrhea, desquamating skin rash --> what condition?
congenital syphilis
175
clinical findings specific to congenital syphilis (3)
- copious rhinorrhea (snuffles)
- maculopapular rash --> desquamate or become bullous
- abnormal long bone XR
176
clinical findings common to all congenital infections (4)
- IUGR
- HSM
- jaundice
- blueberry muffin spots
177
32M --> eye pain & discharge --> has not remv contact lens for 1wk --> cornea is edematous, hazy, ulcerated --> extensive scleral injection --> what condition?
contact lens assoc keratitis
178
contact lens assoc keratitis --> most common org
Gram neg --> pseudomonas
179
prolonged infusion of sodium nitroprusside can lead to what comp?
cyanide toxicity
180
cyanide toxicity --> presentation (5)
- HA
- confuse
- arrhythmia
- flushing
- resp depression
181
calc: number needed to trt
1/ARR (absolute risk reduction)
182
cancer-related anorexia/cachexia synd (CACS) --> tx
- progesterone analogue --> megestrol acetate, medroxyprogesterone acetate
- corticosteroid
183
23M --> MVA w blunt chest trauma --> JVD, tachycardia, hypotension despite aggressive fluid resuscitation --> what condition?
acute cardiac tamponade
184
bath salts --> duration
prolonged --> days to weeks
185
bath salts --> what type of drugs
amphetamine analog
186
what is endophthalmitis
infection w/in eye, particularly vitreous
187
what is potter seq
urinary tract anomaly --> anuria/oliguria in utero --> oligohydramnios --> physical anomalies --> pulm hypoplasia, flat facies, limb deformities
188
post urethral valve --> prenatal US --> classic findings (3)
- bladder distention
- bilat hydroureters
- bilat hydronephrosis
189
acute Afib --> unstable --> 1st step in management?
immed electrical cardioversion to sinus rhythm
190
acute Afib --> stable --> 1st step in management?
rate ctrl:
- BB preferred
- CCB alternative
191
acute Afib --> what can use for pharmacologic cardioversion (5)
- ibutulide
- procainamide
- flecainide
- sotalol
- amiodarone
192
acute Afib --> stable --> next step in management after rate ctrl?
cardiovert to sinus rhythm
193
does renal fail lead to hypo or hyperCa?
- usu hypo
| - can cause hyper d/t 2ndary hyperPTH
194
how does chronic renal fail lead to hypoCa?
failing kidney --> not produce enough active vitD --> not absorb Ca
195
how does chronic renal fail lead to 2ndary hyperPTH?
hypoCa --> increase secrete PTH
196
hyperCa --> EKG finding
shortened QT interval
197
hyperCa --> 1st step in management? why?
IVF --> increase urinary excretion
198
vitD intoxication --> hyperCa --> tx
glucocorticoids
199
how does pH affect serum K?
- alkalosis --> hypoK
| - acidosis --> hyperK
200
hyperCa --> classic presentation
- stones
- bones
- groans
- psych overtones
201
hyperCa --> what ssx are included in "groans" (5)
- muscle pain/weak
- pancreatitis
- PUD
- gout
- constipation
202
how does hyperPO4 lead to hypoCa?
PO4 --> bind w Ca --> insoluble precipitate
203
how does hypoMg lead to hypoCa?
low Mg --> decrease PTH secrete
204
how does blood transfusion lead to hypoCa?
citrated blood --> citrate bind Ca
205
EKG --> prolonged QT interval --> what electrolyte abnormality can cause this?
hypoCa
206
hypoCa --> should look for what other electrolyte abnormality?
hypoMg
207
Addison dz --> aka?
1ary adrenal insuff
208
1ary adrenal insuff --> #1 cause in developed country? in developing country?
- developed: idiopathic
| - developing: TB
209
2ndary adrenal insuff --> cause?
long term steroid
210
what clinical findings only found in 1ary NOT 2dnary adrenal insuff?
- hyperpigment
| - hyperK
211
long term steroid --> 2ndary adrenal insuff --> pathophys?
exogenous steroid --> chronic suppress CRH & ACTH --> ill/trauma --> can't secrete enough cortisol
212
low aldos --> seen in 1ary adrenal insuff or 2ndary or both?
only seen in 1ary adrenal insuff
chronic steroid use --> decrease ACTH --> ACTH not affect aldos secretion
213
low aldos --> clinical findings
- sodium loss --> hypoNa, hypovol --> hypotension, shock
| - retain K --> hyperK
214
low cortisol --> clinical findings (4)
- GI ssx --> anorexia, N/V, vague abd pain, wt loss
- mental ssx --> lethargy, confuse, psychosis
- hypoglycemia
- hyperpigment
215
1ary adrenal insuff --> lab findings:
- plasma cortisol
- ACTH
- aldos
- renin
- plasma cortisol: low
- ACTH: high
- aldos: low
- renin: high
216
prerenal kidney injury --> BUN:Cr ratio
>20:1
217
60M --> nausea & abd pain --> had had coronary angiogram & stent 5 days ago --> PMHx HTN, hyperchol, PAD, DM II --> painless purple mottling on both feet, elevated Cr --> what condition?
chol crystal embolism
218
chol crystal embolism --> commonly occur after what?
vasc procedure
219
chol xl embolism --> clinical features typically seen in what organ systems (5)
- derm
- renal
- CNS
- ocular
- GI
220
chol xl embolism --> classic derm findings (2)
- livedo reticularis
| - blue toe synd
221
chol xl embolism --> classic renal finding
acute/subacute kidney injury
222
chol xl embolism --> classic ocular finding
Hollenhorst plaque
223
chol xl embolism --> CBC finding
eosinophilia
224
65M --> sudden loss of vision in R eye --> PMHx of DM trted w metformin & glyburide --> exam reveals reduced light perception, floating debris, dark red glow --> what condition?
vitreous hemorrhage
225
vitreous hemorrhage --> typical presentation (2)
- sudden loss of vision
| - onset of floaters
226
vitreous hemorrhage --> MC cause
diabetic retinopathy
227
22mo F --> abd pain --> cry & scream inconsolably during episodes --> had 3 URI this winter, gastroenteritis 2wk ago --> palpable cylindrical mass on R abd --> what condition?
intussusception
228
intussusception --> MC RF
recent viral illness
229
gastroenteritis --> intussusception --> pathophys
gastroenteritis --> Peyer patch hypertrophy --> nidus for telescoping
230
intussception --> MC occur in what age grp?
<2yo
231
intussusception --> MC occur in <2yo --> if occur in older child --> should suspect what?
pathologic lead pt
232
intussusception --> how dx & tx?
sonographic/fluoroscopic guidance --> air/saline enema
233
SIADH --> charact findings:
- serum Na
- serum osmolality
- urine osmolality
- volemia
- hypoNa
- serum osm: <275
- urine osm: >100 (inapprop elevated)
- euvolemic
234
ankylosing spondylitis --> MC extraarticular manifestation
ant uveitis (iritis)
235
ant uveitis --> presentation
unilat:
- intense pain
- photophobia
236
thyroid storm --> precipitating factors
- surg
- acute illness (trauma, infect)
- childbirth
- acute iodine load
237
thyroid storm --> most serious ssx (4)
- high fever
- hemodynamic instability
- arrhythmia
- CHF
238
spinal epidural abscess --> MC org
staph aureus
239
spinal epidural abscess --> classic triad
- fever
- severe focal back pain
- neuro deficit
240
spinal epidural abscess --> pathophys
- hematologic spread: distant infect, IVDA
| - direct inoculation: spinal procedure
241
syphilis --> allergic to PCN --> alt tx?
doxycycline
242
what is:
- false labor
- latent labor
- labor
- false labor: mild, irreg contract --> no cervical change
- latent labor: reg contract --> increase freq & intensity --> gradual cervical change
- labor: reg painful contract --> cervical change
243
7M --> severe acne --> sig increase in growth, course pubic/axillary hair, normal testicle, bone age 2x higher, --> low LH, not increase after GnRH --> what condition?
21 hydroxylase def --> nonclassic (late-onset) congenital adrenal hyperplasia
244
low LH at baseline --> not increase after GnRH --> means what type of precocious puberty?
gonadotropin-indep (peripheral) precocious puberty
245
DKA --> leads to what type of respiration?
Kussmaul --> rapid & deep
246
DKA --> when give 5% glucose? why?
when blood glucose 250 --> prevent hypoglycemia
247
thionamides --> most serious SE
agranulocytosis
248
mult sclerosis --> plaques --> classic location
at angles of lat ventricles
249
22F preg --> lyme dz --> tx?
amoxicillin
250
HELLP synd --> presentation (3)
- preeclampsia
- N/V
- RUQ abd pain
251
HELLP synd --> what causes the RUQ abd pain?
serious liver problems (centrilobular necrosis, hematoma formation, thrombi in portal capillary system) --> liver swell --> distend hepatic (Glisson's) capsule --> RUQ/epigastric pain
252
23F --> nasal breathing, stuffy noise, occasional dry cough for >1yr --> ssx fluctuate in intensity w/out inciting factors --> no eye/ear ssx, itch, wheeze, or skin rash --> nasal mucosa boggy & erythematous, lungs clear --> what conditon?
nonallergic rhinitis
253
nonallergic rhinitis --> tx:
- mild
- mod-severe
- mild: intranasal antihist or glucocorticoid
| - mod-severe: combo
254
13F --> L groin mass --> tanner stage 2 breast, normal external F genitalia --> US shows cryptorchid gonads, no uterus --> karyotype 46XY --> what condition?
complete androgen insens synd
255
complete androgen insens synd --> pathophys
defective androgen receptors --> unresponsive to normal male levels of androgens --> develop phenotypically F
256
complete androgen insens synd --> gonadectomy when? why?
after completion of puberty (after attain adult height) --> decrease risk of gonadal malig
257
2nd stage arrest of labor --> MC cause
fetal malposition
258
high suspicion for epithelial ovarian CA --> next step?
exploratory laparotomy:
- cancer resect & stage
- inspect entire abd cavity
259
6M --> R shoulder pain for 2wk --> PE localized swelling --> XR single lytic lesion --> mild hyperCa --> what condition?
Langerhans histiocytosis
260
sialadenosis --> seen in what conditions? (2)
- adv liver dz (non/alcoholic cirrhosis)
| - dietary/nutritional disorders
261
LE --> progressive proximal muscle weak --> no pain/tender --> what condition?
glucocorticoid induced myopathy
262
38F --> progressive proximal muscle weak --> no muscle pain --> facial hirsutism, HTN --> what condition?
hypercortisolism (Cushing synd)
263
glucocorticoid induced myopathy --> pathophys
cortisol --> catabolic effect on skeletal muscle --> muscle atrophy
264
toxic shock synd --> presentation (3)
- fever
- hypotension
- diffuse red macular rash --> involve palms/soles
265
64M --> sharp stabbing back pain that radiate to legs --> difficult urination, pain in saddle region --> severe LE muscle weak, absent LE reflex, sensation diminished asymm --> what condition?
cauda equina synd
266
cauda equina synd --> presentation (5)
- severe LBP --> unilat radiculpathy
- saddle anesthesia
- hyporeflexia
- profound asymm motor weak
- late onset bowel/bladder dysfx
267
conus medullaris synd --> presentation (5)
- severe LBP --> less degree of radiculopathy
- perianal anesthesia
- hyperreflexia
- mild bilat motor weak
- early onset bowel/bladder dysfx
268
70M --> sudden onset R weak & urinary incontinence --> strength 4/5 R UE, 1/5 R LE, R babinski, decreased sensation in R foot/leg --> visual fields normal --> what condition?
stroke in ant cerebral A
269
stroke in ant cerebral A --> presentation
- contralat motor/sensory deficit --> more pronounced in LE than UE
- occasionally urinary incontinence
270
digital clubbing --> MC causes (3)
- lung malig
- CF
- R to L cardiac shunt
271
42M --> recent emigrate from N Africa --> 1mo of abd pain, watery diarrhea, skin rash worse w sun exposure, depressed --> PMHx latent TB trting w isoniazid & pyridoxine --> what condition?
pellagra
272
pellagra --> presentation
3 Ds:
- dermatitis
- diarrhea
- dementia
273
pellagra --> cause
niacin def
274
niacin can be synthesized from what?
tryptophan
275
what drug can cause pellagra? how?
prolonged isoniazid --> interfere w tryptophan metab
276
common cause of niacin def in developing country?
predominant corn diet
277
Duchenne muscular dystrophy --> is dystrophin absent or reduced?
absent
278
iron def anemia vs thalassemia:
- MCV
- RDW
- #RBC
- MCV: low vs low
- RDW: high vs normal
- #RBC: low vs normal
279
thalassemia --> peripheral blood smear findings (3)
- hypochromic microcytic cells
- target cells
- teardrop cells
280
46M --> MVA --> hosp day 5 --> RUQ tender, diminished bowel sounds, retention of gastric contents --> CT gaseous distention of small & lrg bowel w/out air-fluid levels, gallbladder distended w no stones --> what condition?
acalculous cholecystitis
281
acalculous cholecystitis --> most often seen in whom?
severely ill pts (ICU --> multiorgan fail, severe trauma, surg, burn, sepsis, prolonged parenteral nutrition)
282
acalculous cholecystitis --> immed tx?
abx + percut cholecystostomy
283
acalculous cholecystitis --> definitive tx?
cholecystectomy when medical condition stabilize
284
pap --> atypical glandular cells --> workup requires (3)?
- colposcopy
- endocerv curettage
- endom bx
285
pap --> atypical glandular cells --> why need to do endom bx?
atypical glandular cells may be d/t either cervical or endom adenoCA
286
45F --> 3mo of prog exertional dypsnea & nonproductive cough --> no CP, edema --> h/o Raynaud, HTN, severe GERD --> skin is thick & firm --> what condition?
systemic scleroderma --> interstitial lung dz
287
3mo M --> refuse to feed for 3 day --> head floppy, bilat ptosis, copious drool, weak suck, extremities flaccid --> recently moved to Cali, never ingested any food/honey --> what condition? how did it occur?
infant botulism
CA/PA/UT --> environ dust --> inhale soil botulism spores
288
infant botulism --> tx
human-derived botulism immune globulin
289
infant botulism --> presentation (3)
- bulbar palsies
- constipation
- hypotonia
290
IVDA --> native-valve endocarditis --> empiric abx tx? to cover what org?
vanco:
- MRSA
- strep
- enterococci
291
what abx have AE photosens?
tetracycline --> doxycycline
292
66M --> routine visit --> h/o poorly ctrl DMII, HTN --> BP 150/90, normal Na, high K, high Cl, low bicarb, high BUN, high Cr --> meds glipizide, furosemide, nifedipine, ASA --> what condition is cause of electrolyte abnormalities?
renal tubular acidosis
293
what is renal tubular acidosis
grp of disorders charact by non-anion gap metab acid w preserved kidney fx
294
impaired fx of cortical collecting tubule causes what type of RTA?
hyperK RTA (type 4)
295
hyperK RTA (type 4) --> pathophys
aldos def/resistance --> cortical collecting tubule --> H/K retention
296
hyperK RTA (type 4) --> commonly seen in what condition?
poor ctrl DM
297
hyperK RTA (type 4) --> presentation (3)
- non-anion gap metab acid
- persistent hyperK
- mild to mod renal insuff
298
16F --> HA & vision change for 1mo --> worse in AM, nausea --> h/o isotretinoin for severe acne --> papilledema, decreased visual acuity, no stiff neck, normal neuro exam, normal head CT --> LP increased opening pressure --> what condition? what caused it?
isotretinoin --> idiopathic intracranial HTN (pseudotumor cerebri)
299
idiopathic intracranial HTN --> presentation (4)
- HA
- vision change (blurry or double)
- papilledema
- CN palsy
300
idiopathic intracranial HTN --> CSF findings (2)
- increased opening pressure
| - normal studies
301
idiopathic intracranial HTN --> MC in whom?
young obese F
302
3 meds that can cause idiopathic intracranial HTN
- growth hormone
- tetracycline
- excess vitA & derivatives
303
Crohn's dz --> nephrolithiasis --> cause?
hyperoxaluria
304
Crohn's dz --> hyperoxaluria --> pathophys
Crohn's --> fat malabsorb --> Ca bind fat instead of oxalate --> increased absorb oxalate in gut
305
genital wart --> topical tx?
trichloroacetic acid
306
diabetic nephropathy --> primary intervention to slow progression?
intensive BP ctrl
307
diabetic nephropathy --> target BP
130/80
308
damage to what N causes corneal anesthesia?
trigeminal --> V1 (ophthalmic)
309
poorly ctrl DM --> oculomotor N palsy --> pathophys
ischemic neuropathy
310
30M --> 2mo LBP & stiff --> worse in AM, improve w activity --> also 3mo diarrhea & low abd pain --> anemia, thrombocytosis, sacroiliac jt inflamm --> what condition?
IBD --> arthritis
311
53F --> severe menopausal ssx --> h/o hypothyroid trt w levothyroxine --> will trt w oral estrogen replacement --> need to change hypothyroid tx in any way? why?
oral estrogen --> decrease TBG clearance --> elevated TBG --> increased TBG binding sites --> decreased free thyroxine, increased TSH --> need higher dose of levothyroxine to saturate increased # of TBG binding sites
312
26F --> 6mo lesion on L foot that gradually become firm and slight pigment --> no pain, itch --> no tobacco/alcohol --> central dimple when pinch lesion --> what condtion?
dermatofibroma
313
dermatofibroma --> pathophys
usu LE --> trauma, insect bite, unknown --> fibroblast prolif --> nontender, firm, hyperpigment <1cm nodule
