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DIT Step 2 > Study Guide Incorrect > Flashcards

Study Guide Incorrect Flashcards

1
Q

Exercise stress test findings suggest ischemic heart dz

A

Sudden drop in BP
Reproduceable angina on exertion
Reproduceable DOE + dizzi
STEMI or NSTEMI on EKG

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2
Q

beginning stage of pathogenesis of atherosclerosis

A 
endothelial dysfxn 
(from smoking, DM, HTN, HLD)
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3
Q

lipid-lowering agent that… SE facial flushing

A

niacin

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4
Q

lipid-lowering agent that… SE elevated LFTs, myositis

A

fibrates
ezetimibe
statins

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5
Q

lipid-lowering agent that… SE GI discomfort, bad taste

A

bile acid-binding resins

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6
Q

lipid-lowering agent that… best effect on HDL

A

niacin

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7
Q

lipid-lowering agent that… best effect on TG

A

fibrates

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8
Q

lipid-lowering agent that… best effect on LDL/chol

A

statins

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9
Q

lipid-lowering agent that… binds c. difficle toxin

A

cholestyramine

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10
Q

what patients should be on statin tx?

A

ASCVD (ACS, TIA, CVA, angina, revascularization, PAD)
DM + 40-75 yo
LDL > 190
10 y ASVCD risk > 7.5 + 40-75 yo

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11
Q

pharmacologic stress test agents

A

adensoine
dipyridemol
dobutamine

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12
Q

elevated homocysteine tx

A

B12 B6 and B9

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13
Q

Medications can negatively affect lipid measurements

A

PO estrogen
BB + thiazide diuretics
antipsychotics (clozapine, olanzapine)
protease inhibitors

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14
Q

defining characteristics of Prinzmetal angina

A 
vasospasm (not atherosclerosis)
chest pain at night
5-15 m
nL caridac cath angio
smoker
younger
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15
Q

55 M report from health screening showed markedly elevated serum LDL, TG, and total chol –> most approp next step

A

fasting lipid profile

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16
Q

utility of homocysteine screening in atherosclerosis

A

increased risk for:
CVA
PAD
CAD

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17
Q

benefit of bb in pt with unstable angina?

A

decrease HR and BP
decreased O2 demand
decreased ischemia
decreased mortality

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18
Q

MC COD s/p MI

A

v fib

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19
Q

RHD valve damage

A

mitral stenosis

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20
Q

how long after onset MI does troponin I begin to rise and how long stay elevated

A

4 h to 7-14 days

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21
Q

MAP calculation

A

2/3 x DBP + 1/3 x SBP

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22
Q

type cardiomyopathy most closely associated with amyloidosis

A

restrictive cardiomyopathy

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23
Q

Rxs impt in outpt tx of cCHF

A 
ACEi
BB
spironolactone
loop diruetics
digoxin
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24
Q

two MC Rx to treat Prinzmetal angina

A 
#1 CCB (dilitazem)
#2 nitrates
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25
Q

type of shock matches: reduced venous return to left heart due to pHTN

A

obstructive shock

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26
Q

vasopressor at high doses optimizes the alpha-1 vasoCNX

A

epinephrine

dopamine

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27
Q

MC ECHO finding with myocarditis

A

impaired ventricular function

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28
Q

Janeway lesions

A

NON-tender petechiae on palms/soles

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29
Q

Osler nodes

A

tender nodules on finger/toe pads

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30
Q

Roth spots

A

retinal hemorrhages

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31
Q

Splinter hemorrhages

A

petechiae under nail beds

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32
Q

ECG findings suggestive of cardiac tamponade

A

electrical alternans

low voltage

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33
Q

Beck’s triad

A

JVD
hypoTN
muffled heart sounds

(cardiac tamponade)

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34
Q

Tx acute pericarditis

A

NSAIDs

colchicine

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35
Q

Tx chronic constrictive pericarditis

A

pericardectomy

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36
Q

pulsus paradoxus

A

drop in SBP > 10 mmHg during inspiration

cardiac tamponade

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37
Q

How do calcium channel blockers work to reduce the ischemic effects of acute angina?

A

promote coronary and peripheral vasodilation –> decreased HTN –> decrease afterload

reduce myocardial contractility and O2 demand

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38
Q

tx 3rd degree heart block

A

ventricular pacemaker

stop BB, CBB, digoxin

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39
Q

tx HOCM

A

BB
avoid volume depletion
restrict physical activity

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40
Q

MI tx inititate immediately

A

ASA
nitrates
O2 if need

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41
Q

which antiarrhythmic avoid in pt with pre-existing lung disease

A

amiodarone

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42
Q

PEx findings expected with pericardial effusion

A

deminished heart sounds

decreased apical

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43
Q

Rx to treat stable, asx ventricular tachycardia

A

amiodarone!
procainamide
sotalol

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44
Q

do not shock _____ rhythms

A

asystole

PEA

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45
Q

max number epi doses when treating cardiac arrest?

A

no max

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46
Q

ACLS protocol for ventricular fibrillation

A 
#1 shock, start CPR 2 m 
-
recheck rhythm 
- 
#2 shock, CPR 2 m, epi 1 mg Q3-5 m
-
recheck rhythm
-
#3 shock, CPR, may give amio 300
-
repeat
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47
Q

H & T causes of asystole/PEA pulseless electrical activity

A 
hypovolemia
hypoxemia
H+ (acidosis)
hyperkalemia
hypokalemia
hypogycemia
hypothermia
tamponade
tension PTX
thrombosis (MI)
thrombosis (PE)
trauma
toxins
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48
Q

Rxs that block transmission through AV node

A

adenosine
BB
CCB
digoxin

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49
Q

MC cause of 2* HTN given… high BP in UE but low in LE

A

coarctation of aorta

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50
Q

MC cause of 2* HTN given… proteinuria

A

CKD

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51
Q

MC cause of 2* HTN given… hypokalemia

A

hyperaldosteronism

renal artery stensis

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52
Q

MC cause of 2* HTN given… tachy, diarrhea, heat intol

A

hypertTHY

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53
Q

MC cause of 2* HTN given… hyperkalemia

A

renal failure

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54
Q

Tx afib of unknown duration

A

rate and anticoagulate

BB and warfarin/hep

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55
Q

2 CV dz that are biggest RF for CHF?

A

HTN

ischemic heart dz

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56
Q

JNC-8 bp guidelines 1st line rules…

A

CKD > race

DM > age

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57
Q

next step in management of pt with DVT if pt has a high likelihood of falling

A

IVC filter

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58
Q

when might subclinical mitral stenosis from RHD become clinically apparent

A

fluid overloaded (inc SV)
pregnancy
tachycardia

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59
Q

tx giant cell arteritis

A

high dose steroids

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60
Q

tx HSP

A

self-limited

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61
Q

tx thromboangiitis obliterans

A

stop smoking

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62
Q

Plummer-Vinson syndrome

A

TRIAD:
esophageal webs
dysphagia
IDA

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63
Q

most approp dx test x esophageal dysphagia to solids

A

EGD

*but if high risk perf, barium swallow

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64
Q

chest pain; uncoordinated esophageal contractions; corkscrew pattern on barium swallow dx

A

diffuse esophageal spasm

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65
Q

4 potassium-sparing diuretics

A

spironolactone (antiandrogenic)
epiplerenone
amilioride
traimterene

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66
Q

Tx Wegeners/granulomatosis with polyangiitis

A

steroids

cyclophosphamide

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67
Q

sx strongly suggest upper GI himorrhage

A

+ NG lavage
hematemesis
hemodyamic instability

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68
Q

feared complication of Kawasaki disease

A

coronary artery aneurysms

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69
Q

tx Whipple dz

A

ceftriaxone x 2 wk
THEN
TMP-SMX x 12 mo

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70
Q

chronic diarrhea + positive stool Sudan stain + normal D-xylose test –> most likely cause of malabsorption

A

pancreatic insufficiency

stool Sudan stain + = fat in stool***

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71
Q

caucasion + foul-smelling chrinc diarrhea + IDA

A

Celiac

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72
Q

immigrant DR + foul-smelling chronic diarrhea + macrocytic anemia

A

Tropical sprue

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73
Q

chronic diarrhea + arthralgias + ataxia dx

A

Whipple dz

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74
Q

SVR and HR in anaphylactic shock

A

decreased SVR

increased HR

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75
Q

SVR and HR in neurogenic shock

A

decreased SVR

decreased HR

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76
Q

food poisoning as results of mayonnaise sitting out too long

A

s. aureaus

salmonella

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77
Q

rice water stools

A

vibrio cholerae

ETEC

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78
Q

mild intestinal infection that can become neurocysticercosis

A

taenia solium

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79
Q

diarrhea from seafood

A

vibrio cholerae

vibrio parahemolyticus

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80
Q

bloody diarrhea from poutry

A

campylobacter
s. aureaus
salmonella

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81
Q

bloody diarrhea + liver abscess

A

entomoeba histolytica

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82
Q

diarrhea in AIDS pt

A

cryptosporidium

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83
Q

tx for entamoeba histolytica

A

metronidazole

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84
Q

tx giardia lamblia

A

metronidazole

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85
Q

tx salmonella spp.

A

fluoroquinolone (if immunocompromised)

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86
Q

tx shigella spp.

A

fluoroquinolone or TMP-SMX

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87
Q

tx campylobacter jejuni

A

fluoroquinolone or azithromycin

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88
Q

type esophageal cancer most prevalent in US

A

adenocarcinoma

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89
Q

vasculitis with necrotizing granulomas of lung and glomerulonephritis

A

GPA

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90
Q

next step management pt < 50 with minimal BRBPR

A

anoscope

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91
Q

vasculitis characterized by necrotizing imm complex inflammation of visceral/renal vessels

A

polyarteritis nodosa

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92
Q

next step: colonoscopy reveals colon cancer in the sigmoid colon

A

CT ab/chest/pelvis for staging

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93
Q

benign heart sounds

A 
early quiet systolic murmur
no evidence of dz
split S1
split S2 on inspiration
S3 < 40 yo
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94
Q

35 F + PUD + hypercalcemia + amenorrhea –> dx

A

MEN1
gastrinoma
PTH tumor
adenoma

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95
Q

Rx to stop insulin production in pt with insulinoma

A

octreotide

diazoxide

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96
Q

high risk acalculous cholecystitis

A

critically ill

TPN

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97
Q

Tx (medical) x UC

A

small bowel = mesalamine
large bowel = sulfasalazine (5-ASA + sulfapyridine)
stroids x acute exacerbation

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98
Q

gi infection associated with diarrhea and pseudoappendicits

A

yersinia enterocolitis

  • pork
  • puppies
  • pseudoappex
  • pharyngitis
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99
Q

hepatitis virus increase risk HCC

A

hep B > C

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100
Q

abx combinations used in outpatient tx of diverticulitis

A

metronidazole

ciproflaxacin/TMP-SMX/Augmentin

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101
Q

positive HBcAb only

A

window period of active infection

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102
Q

vaccines for cirrhotics

A

hep A
hep B
pneumo
standard

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103
Q

Rxs for ileus

A

stigmines
erythromycin
metocloperamide

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104
Q

two diuretics used in conjunction x ascites/portal HTN

A

spironolactone

furosemide

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105
Q

Budd-Chiari syndrome sx

A

jaundice
hepatomegaly
ascities
+/- RUQ pain

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106
Q

aortic stenosis - indications for valve replacement

A

syncope
CHF
dyspnea
angina

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107
Q

Paraneoplastic syndromes with polycythemia

A 
Potenially Really High Hematocrit
Pho
RCC
HCC
hemangioblastoma
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108
Q

most widely use screening test for hemochromatosis

A

ferritin

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109
Q

vasopressor theoretically causes renal vasodilation

A

dopamine

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110
Q

65 Af Am F + weakness + LE + rash on chest –> lab to establish diagnosis

A

CK, AST/ALT, aldolase
LDH
ANA
Anti-Jo 1

dermatomyositis

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111
Q

most sensitive and speciifc lab test for dx of chronic pancreatitis

A

low fecal elastase

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112
Q

“pencil-in-cup” deformities of DIP joints

A

psoriatic arthritis

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113
Q

acute gout tx

A
  1. NSAIDs
  2. glucocorticoids
  3. colchicine
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114
Q

tx 16 M bullseye ring in axilla two weeks after camping trip, dx and first-line tx

A

early localized Lyme dz

doxycycline 100 mg BID x14d

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115
Q

45 F + swollen, warm, erythematous L knoee + tender + ROM extremely limited –> best dx test and tx

A

dx: synovial fluid analysis

tx:

  1. IV abx empiric
  2. surgical I&D
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116
Q

24 F + markedly elevated BP + nL body weight, exercise, not smoker, no OCPs –> 2* cause of HTN should be considered? radiological imaging?

A

MC: OCPs
2nd: RAS 2* fibromusclar dysplasia

imaging: “beads on a string” of renal A on angiogrpahy

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117
Q

AI condition most likey seen in pt with endcarditis caused by steril vegetations of immune compex depositions

A

SLE

Libman-Sacks endocarditis

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118
Q

MC cancer of bones

A

METS

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119
Q

suspected osteomyelitis –> non-dx xray, MRI not availabe, next best test to make definitieve dx of osteomyelitis

A

bone bx and cx

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120
Q

6- M + new pt + legs bowed out + kyphosis + hearing loss + fav ht not fit anymore + most sensitive imaging tes to dx this process?

A

radionucleotide bone scan

Paget

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121
Q

medical management of PAD

A 
smoking cessation
exercise
good diet
glucose control
anti-HTN
cilostazol
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122
Q

caution for which complication of FOOSH

A

avascular necrosis

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123
Q

caution for which complication of anterior shoulder dislocation

A

axillary N

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124
Q

caution for which complication of fx of 5th metacarpal neck

A

bite inf

tendon lac

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125
Q

caution for which complication of humerus fx

A

radial N inj, wrist drop

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126
Q

caution for which complication of tibial fx

A

compartment syndrome

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127
Q

caution for which complication of pelvic fx

A

hemorrhage

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128
Q

45 obese F + pruritus + clay-colored stools + dark urine + elev ALP and bili –> most likely cause

A

biliary tract obstruction

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129
Q

pain increases with passive straight leg raise

A

herniated disc

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130
Q

29 M + alcoholism + vom + seere uper abd pain + elev lipase –> dx and tx

A

acute pancreatitis

  1. admit to ICU
  2. IV fluids
  3. correct electrolyties
  4. pain managment
  5. NPO
  6. NG for enteral feeds poss
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131
Q

microcytic anemias

A 
IDA
lead poisoning
sideroblastic anemia
thalessemia
AOCD
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132
Q

normocytic anemias

A

AOCD
hemolytic anemia
hemorrhage

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133
Q

macrocytic anemias

A

folate def
B12 def
liver dz
alcohol abuse

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134
Q

IDA iron studies vs. AOCD

A

IDA: decreased ferritin, increased TIBC
AOCD: increaed ferritin

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135
Q

pt with acute diarrheal illness, which labs should be otbtained in order to id causative organism?

A

no workup necessary (MC viral)

*if no fever or bloody diarrhea = no workup

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136
Q

imaging preferred for soft tissue?

imaging preferred for bone?

A

soft tissue - MRI

bone - CT

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137
Q

in hemolytic anemia ,why haptoglobin decreased? why LDH increased?

A

free haptoglobin decrease bc free hemoglboin released from cell lysis/hemolysis and needs to be bound up

LDH is found inside RBCs, so hemolysis = inc LDH outside the cell duh

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138
Q

most likely PUD relieved with eating and wore 2-5 hours after eating

A

duodenal

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139
Q

lose weight with which PUD?

A

gastric

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140
Q

tx for diarheal illness due to cryptosporidium parvum

A

HIV

nitazoxanide

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141
Q

tx for diarrheal illness due to trichinella spiralis

A

mabenazole

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142
Q

anemia + basophilic stippling of RBCs

A

leadpoisoning microcytic
thalessemia
EtOH use

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143
Q

degmacytes and Heinzs bodies

A

G6{D deficiency

Heinz bodies = denatured hgb in RBC

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144
Q

anemia + mintal status change + neuropathy + constipation

A

lead poisoning

microcytic

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145
Q

most likely abx tx for diarrheal illness due to salmonella

A

fluoroquinolone or TMP-SMX

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146
Q

most likely abx tx for diarrheal illness due to shigella

A

fluoroquinolone or TMP-SMX

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147
Q

most likely abx tx for diarrheal illness du eto camplylobacter jejuni

A

ciprofloxacin or azithromycin

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148
Q

thrombocytopenia while being treated with heparine for PE –> tx

A
  1. stop heparin
  2. labs to confirm HIT: hep induced agg assay, ELISA immunoassay
  3. start argatroban until PLT > 100
  4. transition to warfarin, 3 mo tx
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149
Q

classic pentad for TTP

A 
MAHA
thrombocytopenia
fever
AMS
renal failure/uremia
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150
Q

two steps to hemostasis

A
  1. temporary plug = “PLT plug”

2. permanent clot = “FIBRIN clot”

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151
Q

tx vW dz

A

DDAVP
vWF concentrate
OCPs
avoid ASA

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152
Q

MC causes of DIC acronym

A

STOP Making Thrombi

sepsis
trauma
OB complications
pancreatitis
malignancy
transfusions
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153
Q

coag changes in TTP-HUS

A

PLT dec
BT inc
PT nL
PTT nL

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154
Q

coag changes in hemophilia A or B

A

PLT nL
BT nL
PT nL
PTT inc

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155
Q

coag changes in vW dz

A

PLT nL
BT inc
PT nL
PTT inc

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156
Q

coag changes in DIC

A

PLT dec
BT inc
PT inc
PTT inc

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157
Q

coag changes in vit K def

A

PLT nL
BT nL
PT inc
PTT nL/inc

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158
Q

coag changes in ESLD

A

PLT nL/dec
BT nL/inc
PT inc
PTT inc

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159
Q

thrown from horse –> LBP + urinary retention _ dec rectal tone –> tx

A

emergent surgical decompression of cauda equinea

steroids to dec spinal cordinflammation

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160
Q

approp eval of pt susp celiac

A

lab: tissue transglucaminase IgG + anti-gliadin ab + anti-endomysial ab
img: EGD biopsy of intestine

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161
Q

MOA abciximab

A

gp IIb/IIIa i

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162
Q

MOA apixaban

A

direct Xai

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163
Q

MOA clopidogrel

A

ADP-R i

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164
Q

MOA dabigatran

A

direct thrombin i

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165
Q

MOA dalteparin

A

LMWH

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166
Q

MOA ticlopidine

A

ADP-R i

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167
Q

MOA tirofiban

A

gp IIb/IIIa i

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168
Q

safe anticaogs in pregnancy x DVT

A

heparin

LMWH

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169
Q

lab test to monitor warfarin?
heparin?
LMWH?

A

INR/PT
PTT
anti-factor Xa activity

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170
Q

why octreotide in tx GI bleed 2/2 esophageal varices?

A

somatostatin analog –> dec splanchnic blood flow + portal BP ==> dec variceal bleeding

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171
Q

management septic shock 2/2 perionitis

A
  1. ICU
  2. IV fluids BOLUS NOW
  3. norepi
  4. empiric abx
  5. Bcx/sputum/Ucx
  6. CXR
  7. insulin drip
  8. telemetry
  9. CVP/MAP
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172
Q

u wave

A

hyper Ca
hypoK
hyperTHY

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173
Q

MC leukemia in adults

A

CLL

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174
Q

philadelphia chromosome

A

CML

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175
Q

leukemia with peripheral blasts are PAS + and TdT +

A

ALL

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176
Q

leukemia wiht peripheral blasts PAS -, myeloperoxidase +, Auer rods

A

AML

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177
Q

associated with t(9;22)

A

CML*** also ALL

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178
Q

peripheral smear of asx pt reveals macrocytosis and hypogranular granulocytes with bilobed nuclei –> dx

A

myelodysplastic syndrome

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179
Q

MM findings mnemonic

A

CRAB

hyperCalcemia
Renal failure
Anemia
Back pain

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180
Q

pruitis after hot bath or shower

A

polycythemia vera

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181
Q

blurred vision after hot bath or shower

A

optic neuritis

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182
Q

spinal cord lesion: fasciculations + spastic paralysis

A

ALS

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183
Q

spinal cord lesion:bilateral loss of pain/temp sensation below the lesion + bilateral spastic paralysis below lesion + bilteral flaccid paralysis at level of lesion

A

anterior spinal artery syndrome

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184
Q

spinal cord lesion: impaired proprioception _ pupils do not react to light

A

DCML –> tabes dorsalis

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185
Q

lesion to ____ presents as agraphia and acalculia

A

dominant parietal lobe

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186
Q

ppx for close contacts of N. meningiditis meningitis

A

rifampin
cipro
ceftiaxone

(either)

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187
Q

when should CT scan be perfomred as next step instead of LP in pt suspected of having meningitis

A 
focal neuro
new onset seizures
hx CNS dz
papilledema
IC
AMS
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188
Q

skin manifestations characteristic of dermatomyositis

A 
malar rash
shawl
heliotrope eruption (violaceous eyelids)
Gottron's papules
Mechanics hands
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189
Q

HA + fever + progressive muscle weakness + CSF: inc lymphocytes, nL glucose, slightly elevated protein –> dx/pathogen

A

poliovirus

West Nile VIrus

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190
Q

27 M + progressively owrsening HA + persistent + nest step

A

MRI head

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191
Q

72 F + TIA + other imaging appropriate

A

ECHO
US of carotid arteries
MRA/CTA

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192
Q

mest diagnositc test for hereditary spherocytosis

A

osmotic fragility test

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193
Q

DVT develops stroke –> study to identify the MC undelrying etiology of stroke?

A

TEE

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194
Q

two MC locations of aneurysms in Circle of Willis

A

anterior communicating artery

posterior communicating A

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195
Q

MC causes of seizures in young adults (18-35 yo)

A

trauma
EtOH w/d
brain tumor

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196
Q

42 M + tonic-clonic + known epilepsy + seizing for past 10 minutes dx and tx

A

status epilepticus
ABCs
benzos IV diazepam
if intubated, IV barbituates (phenobarb)

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197
Q

best tx TTP

A

large volume plasmaphoresis

steroids

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198
Q

Coags with warfarin use

A

PLT nL
BT nL
PT inc
PTT inc

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199
Q

ASA coags

A

PLT nL
BT inc
PT nL
PTT nL

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200
Q

brain lesion seen in pt with PD?

in HD?

A

PD: depigmentation of substantia nigra (decreased DA)

HD: atrophy of caudate nucleus (incrased DA)

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201
Q

Treat ALS Rx

A

riluzol

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202
Q

MC rx used to tx HD

A

MC: tetrabenazine (DA antagonist)

or antipsychotics

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203
Q

cold agllutinins are classically associated with which infections

A

mycoplasma pneumoiae

mononucleosis EBV

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204
Q

recent Cuban immigrant + malabsorptive diarrhea _ megaloblastic anemia –> dx and tx

A

Tropical sprue

tx: folate, tetracycline OR sulfa x 2-6 mo

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205
Q

Most sensitive test for MS

A

MRI brain, orbits, spinal cord

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206
Q

meds decreased freq of relapses in MS

A 
interferon beta
glatiramer
natalizumab
dimethyl fumarate
teriflunomide
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207
Q

diarrhea + pink eye

A

adenovirus

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208
Q

tx Alzheimer dz

A 
anticholinesterase i (donepazil, rivastigmine, galantamine)
menantine (NMDA Rec i)
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209
Q

dementia + visual hallucinations + frequent falls

A

Lewy Body Dementia

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210
Q

type syncope consistent with type 1 DM interrupted while eating

A

hypoglycemia

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211
Q

elbows in decorticate posturing

A

flexing

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212
Q

tx first line x RLS

A

pramipexole
ropinirole

(DA agonists)

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213
Q

spinal cord lesion:bilateral loss of pain/temp sensation below the lesion + bilateral spastic paralysis below lesion + bilteral flaccid paralysis at level of lesion

A

medullary pyramids

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214
Q

obese woman + papilledema + HA

A

idiopathic intracranial HTN

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215
Q

jaw muscle pain when chewing

A

temporal arteritis

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216
Q

headache + extraocular muscle palsies

A

cavernous sinus thrombosis

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217
Q

headache occurring either befoer or after orgasm

A

postcoital cephalagia

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218
Q

frontal headache made worse by bending over

A

sinus HA

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219
Q

infarct of MCA leads to which types of aphasia

A

expressive (Broca’s)
comprehension (Wernicke’s)
conductive

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220
Q

How do sx of encephalitis differ from meningitis

A

encephalitis: focal neurologic deficits
meningitis: leptomeningeal inflammation, special tests, nuchal rigidity

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221
Q

Tx options for essential tremor

A 
propranolol
benzos
primidone
deep brain stimulation
thalamotomy
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222
Q

Characteristic features of Brown-Sequard syndrome

A

(hemisection of SC)

  • ipsilateral SPASTIC paralysis BELOW lesion
  • ipsilateral FLACCID paralysis AT LEVEL lesion
  • contralateral loss vibration and proprioception BELOW lesion
  • contralateral loss pain and temperature 1-3 levels BELOW lesion
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223
Q

upper quadrantic anopsia - where lesion?

A

temporal lobe

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224
Q

lower quadrantic anopsia - where lesion?

A

parietal lobe

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225
Q

Tx for dry age-related macular degeneration (ARMD)

A

smoking cessation

antioxidants

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226
Q

Tx for retinal detachment

A

cryotherapy
laser photocoagulation
surgery

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227
Q

4 MC sequelae of meningitis in children

A
  1. HL
  2. ID
  3. seizure disorder
  4. spastic paralysis
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228
Q

inflammation of internal Meibomian sebaceous glands

A

chalazion

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229
Q

Major exam finding in open-angle glaucoma

A

cup-to-disc ration > 50%

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230
Q

clinical features of acute angle-closure glaucoma

A 
red eye
sudden
painful
rockhard eye
pupil fixed and mid-dilated
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231
Q

tx for acute angle-closure glaucoma

A 
immediate referral to ophtho
If no ophtho in >1 hr:
- 1 drop pilocarpine
- 1 drop apraclonidine
- 1 drop timolol
ONE MINUTE APART
acetazolamide
maybe mannitol

–> surgery for laser iridotomy

232
Q

Weber test: conductive hearing loss goes to ___ear

A

damaged ear = conductive HL

WEBER HELPS LATERALIZE

233
Q

Rinne test: nL

A

AC > BC

234
Q

Triad of Meniere disease

A

HL
tinnitus
vertigo

235
Q

empiric tx fo brain abscess

A

if post-surgical (MRSA and pseudomonas):

  • vancomycin AND ceftazidime
  • drain by needle decompression
  • if mass effect, glucocorticoids
236
Q

typical presentation IIH

A 
obese female in 20-30s
HA in AM
pulsatile
papilledema
blurred vision, loss peripheral 
LP = increased opening pressure
237
Q

what is ethacrynic acid

A

loop diuretic

non-sulfa

238
Q

best diuretic for mild to moderate CHF with expanded ECV

A 
loop (furosemide)
aldosterone antagonist (spironolactone)
239
Q

best diuretic for increased intracranial pressure

A

mannitol

240
Q

renal pathology: anti-GBM antibodies, hematuria, hemoptysis

A

Goodpastures

241
Q

renal pathology: IF: linear pattern of IgG deposition

A

GBM = goodpastures

242
Q

renal pathology: crescent formation in glomeruli; p-ANCA positive

A

pauci-immune rapid progressive GN

243
Q

renal pathology: positive ANCA

A

GPA

RPGN

244
Q

renal pathology: hypercellular glomeruli and subepithelial”humps”

A

PSGN

245
Q

two meds ppx against meningococcal meningitis

A

rifampin

cipro

246
Q

Which EEG pattern is seen in cases of absence seizures

A

generealized 3/sec spike and wave pattern

247
Q

urinary casts are made of

A

Tamm-Horsfall mucoprotein (made by kidneys)

248
Q

renal pathology: multiple mesangial nodules

A

Kimmelsteil-Wilson nodules

diabetic nephropathy

249
Q

nephrotic syndrome associated with hep B

A

membranous GN

250
Q

renal pathology: EM: subendothelial “humps” and “tram track” appearance

A

MPGN

251
Q

renal pathology: EM: “Spike and dome” pattern of basement membrane

A

MGN

252
Q

apple-green birefringence with Congo red stain under polarized light

A

amyloidosis

253
Q

vasodilating effect of nitroglycerin

A

dilates veins

254
Q

vasodilating effect of dihydropyridine CCBs

A

veins and arteries

255
Q

vasodilating effect of hydralazine

A

arteries

256
Q

vasodilating effect of nitroprusside

A

veins and arteries

257
Q

2 yo develops lethargy, hypoglycemia, abnL LFTs one week after being seen for febrile URI, dx

A

Reye syndrome (hepatoencephalopathy, assuming parents gave ASA for fever)

258
Q

Greatest RF RCC

A

smoking

259
Q

cardiac abnormalities assoc with ADPKD

A

1st: MVP (mild)
2nd: aortic regurgitation

260
Q

AE of antiHTN: first dose orthostatic hypotension

A

alpha bockers - prazosin

261
Q

AE of antiHTN: hypertrichosis

A

minoxidil

262
Q

AE of antiHTN: bradycardia and asthma exacerbation

A

nonselective BB

263
Q

first-line rx for idiopathic intracranial hypertension

A

acetazolamide

264
Q

Todd’s paralysis

A

post-ictal hemiparesis
<15 minutes
not more than 24 h

265
Q

volume status expected with hyponatremia due to thiazide diuretics

A

hypovolemic or euvolemic

266
Q

volume status expected with hyponatremia due to Addison disease

A

hypovolemic

267
Q

volume status expected with hyponatremia due to hypothyroidism

A

euvolemic

268
Q

volume status expected with hyponatremia due to renal failure

A

hypervolemic

269
Q

volume status expected with hyponatremia due to psychogenic polydipsia

A

euvolemic

270
Q

MC causis of SIADH

A 
TBI and other CNS
Pulm: PNA and small cell lung cancer
Rxs
HIV
surgery
271
Q

meds can be used to rapidly correct hyperkalemia by shifting potassium into cells

A

beta-agonists - albuterol
bicarbonate
insulin and glucose

272
Q

tx for nephrogenic diabetes insipidus

A

1st: thiazide
2nd: indomethacin
amiloride for lithium induced DI

273
Q

tx lithium induced DI

A

amiloride

274
Q

meds known for causing hyperkalemia

A 
ACEi
ARB
BB
digoxin
spironolactone
epiplernone
amiloride
triamterine
275
Q

meds known for causing hypokalemia

A 
loop diuretics
thiazides
albuterol
insulin
CAi/acetazolamide
276
Q

which electrolytie abnL causes QT prolongaction

A

hypocalcemia

277
Q

MC primary sources of metastates to the brain

A 
Lots of Bad Stuff Kills Glia
lung
bone
skin/melanoma
kidney/RC
Gi/CRC
278
Q

common causes of respiratory alkalosis

A 
hyperventilation
anxiety
ASA tox
asthma
PE
high altitude
279
Q

common causes of respiratory acidosis

A

COPD
respiratory distress
NMJ
opioids

280
Q

common causes of metabolic alkalosis

A 
vomiting
NG lavage
diuretics
volume contraction
hyperaldosteronism
Cushing syndrome
281
Q

NAGMA

A

diarrhea
PTA
TPN
Addison dz/low aldosterone

282
Q

distinguishing caracteriscis of RTA type 1 - distal

A

increased urine pH >5.3
low serum K
low serum bicarb

283
Q

distinguishing characteristics of RTA IV

A

hypoaldosteronism
nL urine pH
high serum K
nL serum bicarb

284
Q

distinguishing characteristics of RTA II - proximal

A

nL urine pH
low serum K
low serum bicarb

285
Q

typical complaints of retinal detachment

A

shade covering eye
flashes of light (photopsias)
sudden onset floaters

286
Q

tx for uric acid renal stones

A

potassium citrate

bicarbonate

287
Q

type UTI most likely make pt susceptible to struvite renal stones

A

urease-positive
klebsiella
proteus
s. saprophyticus

288
Q

meds useful in pt with nephrolithiasis for passing a stone by relaixng teh smooth muscle in the distal ureters

A

tamsulosin (alpha blocker)

nifedipine

289
Q

1st line antihypertensive in LVH and HTN

A

ACEi/ARB

CCB

290
Q

1st line antihypertensive in hyperthyroidism

A

BB

291
Q

bacterial meningitis PEx signs

A

Brudinski sign - neck flexion –> knee flexion

Kernig sign - pain with straightening flexed leg

292
Q

antiHTN rx SE rxn in patient with sulf allergy

A

HCTZ

293
Q

tx epididymitis

A

<35 yo: G/C = IM ceftriazone and doxycycline PO x10d

> 35 yo or anal: enterbacteracea = fluoroquinolone or TMPSMX

294
Q

found unconscious, what administer before empiric glucose infusion?

A

thiamine before glucose

295
Q

classic sx BPH

A 
frequency
urgency
hesitancy
nocturia
weak stream
296
Q

two classes of meds tx BPH

A

5alpha reductase: finasteride, dutasteride

alpha1 antagonism: tansulosin, alfuzosin, sitodosin, terazosin, doxasosin

297
Q

hormonal meds to patients with metastatic prostate cancer

A

GnRH analogue (leuprolide, goserelin) CONTINUOUSLY

298
Q

tx for acute bacterial prostatitis

A

e. coli
- TMP-SMX
- fluoroquinolone

299
Q

AE antihypertensive: cyanide toxicity

A

sodium nitroprusside

300
Q

Most sensitive test for MS

A

MRI head and orbits

301
Q

normal puberty progression

A 
adrenarche 
conadarche
thelarche
pubarch
growth spurt
menarche
302
Q

Tx Guillain-Barre

A

IVIG OR plasmaphoresis ASAP
motility agents for ileus
mech vent if respiratory involvemenet

303
Q

classic features distinguish orbital cellulitis from periorbital cellulitis

A

orbital cellulitis:
diplopia
pain with EOM
proptosis

304
Q

tx open-angle glaucoma

A 
acetazolamide
mannitol
prostaglandins
pilocarpine (cholinergic)
timolol (BB)
apraclonidine (alpha adrenergic)
305
Q

frontotemporal dementia presentation

A

change personality
inappropriate behavior
dementia
progressive aphasia

306
Q

lewy body dementia

A

AH + VH
Parkinsonian features
dementia
falls and syncope

307
Q

tx for NPH

A

VP shunt

308
Q

tx IIH

A

acetazolamide, wt loss, serial lumbar punctures, +/- VP shunt

309
Q

dermatoligic finding of NF1

A

cafe au lait spots
neurofibromas shag sweater
axillary/inguinal freckles
hemangioblastomas

310
Q

cherry-red spot on macular ddx

A

Neiman Pick
Tay Sacks
Retinal artery occlusion

311
Q

-triptan drugs contraindicated in

A 
pregnant
just took triptan/ergotamine
CAD
prinzmetal angina
sulfa allergy
312
Q

child presents with acute-onset ear pain, otoscopy reveals large, reddish vesicles on TM, dx, org, and tx

A

bullous myringitis
mycoplasma pneumoniae
macrolide: ACE

313
Q

MC cause of sensorineural HL

A

presbycusis (high freq)

314
Q

MC cause of conductive HL

A

otosclerosis

315
Q

pt undergoes crnaiotomy and drain placemtn for evac of SDH, initally drainage is serous, HOD#3 drainage becomes thick and yellow and neuro exam deteriorates, cause?

A

subdural abscess

316
Q

tx for acute dystonia

A

EPS = benztropine or benadryl

317
Q

tract: voluntary motor commands from motor cortex to head and neck

A

corticobulbar spinal tract

318
Q

pt brough to ER with HA, vom, neck pain and fever, progressive muscle weakness, but sensation intact. CSF nL glucose and protein, but lymphocyte count is high dx

A

poliomyelitis

319
Q

67 M + ischemic stroke, BP 185/100, goal for acute management of HTN following ischemic stroke and meds MC used

A

permissive HTN: <220/120
labetalol
nicardipine

320
Q

MC organisms in neonatal bacterial meningitis and empiric abx

A

e. coli
GBS
Listeria

abx: ampicillin and gentamicin

321
Q

CSF findings in healthy

A

pressure 50-180
WBCs <5
glucose 40-70
protein 20-45

322
Q

CSF findings bacterial

A

pressure increased
WBCs increased (PMNs)
glucose decreased
protein increased

323
Q

CSF findings viral

A

pressure MAYBE increased
WBCs increased (lymphocytes)
glucose nL
protein MAYBE increased

324
Q

CSF findings TB

A

pressure VERY increased
WBCs increased (lymphocytes)
glucose decreased
protein increased

325
Q

SLE, found to have anemia, AIHA or recent menstruation…what test to distinguish?

A

Coombs test

326
Q

lesion to _____ causes coma

A

reticular activating system in pons

327
Q

test differentiates central diabetes insipidus from nephrogenic DI

A

desmopressin challenge –> urine osmolality

328
Q

elevated erythropoietin
elevated hematocrit
normal oxygen saturation

A

EPO producing tumor (RCC)

329
Q

testicular torsion next step tx

A

manual detorsion –> surgery for b/l orchiopexy

330
Q

causes of hypovolemia hyponatremia

A

diuretics/thiazides
Addison dz
loss of fluids

331
Q

segmental sclerosis and hyalinosis on light microscopy

A

FSGS

332
Q

p-ANCA associated conditions

A 
Pauci-immune glomerulonepthritis
microscopic polyangiitis
eosinophilic GPA
PSC
UC
333
Q

classic presentation of PSGN

A 
periorbital edema
cola urine
HTN
strep 1-3 w ago
increased ASO
334
Q

other name for Fitz-Hugh-Curtis

A

perihepatitis

335
Q

effect of digoxin on stroke volume

A

decrease extracellular sodium
increase intracellular calcium
= increased heart contraction

336
Q

most approp tx for PCOS

A

lose weight
OCPs
metformin
spironolactone for hirstuism

337
Q

next step in eval of pt with ASCUS

A

if 21-24 yo: repeat PAP in 1 year

if >25: HPV test, if positive colposcopy

338
Q

characteristic findings in tertiary syphilis

A 
gumma formation
tabes dorsalis
Argyll-Robertson pupils
\+ Romberg
loss proprioception
aortitis "tree-barking"
aneurysm of aortic root
aortic regurg
339
Q

cardinal movements of labor

A 
engagement
descent
flexion
internal rotation
extension
external rotation
expulsion
340
Q

EGD changes seen with Barrett esophagus

A

changed to columnar epithelium

341
Q

how expect weight to increased over first 2 years of life

A

BW at 2 weeks
double at 4 mo
triple at 12 mo
quadruple at 2 y

342
Q

spider-webbing/marbling of skin newborn rash

A

cutis marmorata

343
Q

newborn white papules caused by retention of keratin and sebaceous material in pilosebaceous follicles

A

milia

344
Q

newborn intense reddening of gravity-dependent side and blanching of nondependent side with a line of demarcation between teh two, lasts a few sec-min

A

Harlequin color change

345
Q

newborn skin vascular malformations occurring on the anpe of neck, upper eyelids, middle forehead, resolve by 18 mo, “salmon patches”

A

macular stains

“stork bites”

346
Q

newborn superficial pustules overlying hyperpigmented macules

A

transient neonatal pustular melanosis

347
Q

kilocalcories in an ounce of breast milk/in formula

A

both 20 kcal/oz

348
Q

most appropriate tx for macular degeneration

A

antioxidants: vitamines A, C, E, beta carotene, copper, zinc

349
Q

34 M rash on thigh, campking, 3 day flu like hx, oval-shaped, erythematous lesion with central clearing

A

erythema chronica migrans

Lyme disease

350
Q

cleft lip/palate, life expectancy < 1 yr, polydactyly

A

trisomy 13

351
Q

tall, thin man with gynecosmastia and testicular atrophy

A

Klinefelter

352
Q

micrognathia, life expectancy < 1 yr, rocker-bottom feet

A

trisomy 18

353
Q

happy mood, inappropriate laughter, ataxic gait

A

angelman

354
Q

MC congenital heart defect

A

VSD

355
Q

keep PDA open

A

PGE2

356
Q

trisomy 21 heart defects

A

TF
PDA
endocardial cushion defects: ASD, VSD, onechamber heart

357
Q

bony spur arising from metaphysis of long bone

A

osteochondroma

358
Q

classic presenting scenario for necrotizing enterocolitis

A

premature/low birth weight infant
started on tube feeds
develops abd distension and enterocolitis
pneumatosis intestinalis

359
Q

typical presentation intussusception

A 
colicly
current jelly stool
pallor
sweating
vom
360
Q

causes of hpysiologic jaundice

A

more blood
fragile infant RBCs
defective UDP glucuronosyltransferase
enterohepatic reabsorption of bilirubin from gut

(physiologic, breast feeding, breast milk jaundice)

361
Q

medical management of ectopic pregnancy with rx:

A

methotrexate (folate antagonist)

362
Q

tx respiratory distress of the newborn

A 
prevent preterm labor
maternal corticosteroids
CPAP
intubate if need
exogenous surfactant down ET tube
363
Q

RF meconium aspiration syndrome

A

post-term

fetal distress during labor

364
Q

tx epiglottitis

A 
keep kid calm
intubate
vanco OR clina (s. auresu)
AND
cefepime/ceftriaxone (HiB)
365
Q

how confirm pertussis

A

clinical

nasophargyneal PCR

366
Q

tx early Lyme

A

doxycycline 100 mg BID x 14 d

if kid or pregnant: amoxicillin or cefuroxime

367
Q

causes desquamation of hands and feet

A 
Kawasaki
Scarlet fever
TSS
SJS
mercury toxicity
368
Q

abx to be avoided during pregnancy

A 
tetracyclines (teeth discoloration)
fluoroquinolones (cartilage toxicity)
aminoglycosides (ototoxicity)
nitrofurantoin (avoid 1st tri)
TMP-SMX (avoid 1st tri)
369
Q

spina stenosis differ from PAD

A

spinal stenosis: worse when standing upright, better bending forward

PAD: doesn’t change with position, worse with exertion

370
Q

3 mo difficulty breathing, fatigue, pallor, heart murmur, abnormal thubs, low hemoglobin, nL WBC and PLT. dx, see on bone marrow biopsy

A

Diamond Blackfan anemia

decreased erythrocyte precursors

371
Q

presentation common to both CF and Hirschsprung

A

failure to pass meconium

372
Q

best abx for RMSF

A

doxycycline
if pregnant, chloramphenichol

*these are the only abx for RMSF!

373
Q

cause of erythroblastosis fetalis

A

maternal ab against fetal Rh-postiive RBCs

374
Q

typical prsentation osteogenesis imperfecta

A 
easy fx
fx in utero
blue sclerae
HL
teeth deformities
pliable skin
hypermobility
375
Q

tx spasticity in cerebral palsy with

A

botulinum toxin
baclofen
dantrolene
benzos

376
Q

heart defect assoc with chromosonme 22q11 deletion

A

TF
TA
(DiGeorge)

377
Q

heart defect assoc with congenital rubella

A

PDA or pulmonary stenosis

378
Q

next step aftre confirmed congenital pyloric stenosis

A
  1. correct metabolic abnormalities

2. pyloric myotomy

379
Q

next step pt aspirated object that cannot be disloged and is now having difficulty moving air, becoming hpoxic

A

Heimlich maneuver

if doesn’t work, emergency tracheotomy

380
Q

tx for black widow spider bite

A
  1. antivenin within 30 min of bite
  2. clean
  3. observe x 24 h
  4. abx if secondary infection
  5. if systmic sx: lactrodectism - give antispasmotics: benzos
381
Q

tx for skin lac on dorsum of hand that resulted from closed fist hitting victim mouth

A

irrigate
empiric abx
leave open

382
Q

definition of primary amenorrhea

A

absence of menses and secondary sexual characteristics by age 13
OR
absence of menses by 15 WITH secondary sex characteristics

383
Q

complications to watch for in pat with electrical burn

A 
compartment syndrome
bony injuries
neurologic disturbances
rhabdomyolysis
myoglobinuria
renal failure
acidosis
arrythmias
384
Q

ECG findings in hypothermia

A

j wave (elevated j point)

385
Q

primary sx theophylline toxicity

A 
hypokalemia
hyperglycemia
vomiting
seizures
hypotension
arrythmias with major toxicity
386
Q

tx for BB and CCB toxicity

A

atropine
glucagon
insulin and glucose
calcium

387
Q

tx acet toxicity

A

charcoal within 4 h injgestion
NAC within 8 h
benzos if seizure

388
Q

antidote for ASA toxicity

A

sodium bicarb
charcoal
dialysis

389
Q

antidote for TCAs

A

bicarb

diazepam if seizures

390
Q

antidote for digoxin

A

digoxin antibody fragments

391
Q

two organisms MC cause of acute cervicitis and tx for each

A

gonorrhea: ceftriaxone AND azithromycin
chlamydia: doxycycline OR azithromycin

392
Q

middle aged man, needs to buy readign glasses bc having difficulty reading fine print, alost troubl e driving at night and reading road signs, may have presbyopia, should also be examined for what

A

cataracts

393
Q

tx lead toxicity in children

A

succimer if mild

severe: succimer, calcium disodium edetate, dimercaprol

394
Q

antidote for arsenic

A

dimercaprol
succimer
penicillamine

395
Q

antidote for iron

A

deferoxamine

396
Q

antidote for mercury

A

dimercaprol

397
Q

additional studies in case of stable patient with an abd stab wound that penetrated the peritoneum

A

diagnostic laparoscopy

398
Q

pelvic fx + DPL shows blood in the pelvis next step

A

emergent laparotomy

399
Q

pelvic fx + DPL shows urine in the pelvis next step

A

urgent laparotomy (not emergent)

400
Q

pelvic fx + DPL shows nothing + hemodynamic instability next step

A

angiography with poss embolization

401
Q

blunt abd trauma + unstable + fluid in pelvis on FAST next step

A

emergent laparotomy

402
Q

blunt abd trauma + unstable + FAST no fluid in pelvis next step

A

angio with possible embolization

403
Q

blunt abd trauma + unstable + FAST inconclusive next step

A

DPL

404
Q

blunt abd trauma + stable next step

A

CT abd/pelvis

405
Q

abd stab + hypotension next step

A

emergent laparotomy

406
Q

difference between chancre and chancroid (organism, presentation, treatment)

A

chancre: treponema pallidum, “clean-based painless ulcer indurated margins”, penicillin G
chancroid: haemophilus ducreyi, “painful ulcer base covered with purulent exudate), azith or ceftriazone

407
Q

since bleeding between mother and fetus is a concern in trauma, what actions should be taken once the pt and fetus are stabilized

A

test Rh status – give RhoGAM for Rh-negative

408
Q

major causes of post-op fever in pt who just underwent neurosurgery

A

UTI
meningitis
DVT

409
Q

primary tx for malignant hyperthermia

A

stop inhaled anesthetics (stop succinyl choline)
dantrolene
100% O2 (increased ventilation)

410
Q

7 year old who avoids going to school to stay home with parent

A

separation anxiety disorder

411
Q

antidote benzo

A

flumazenil

412
Q

antidote barbituates

A

bicarbonate
HD
charcoal

413
Q

antidote CO

A

100% O2

414
Q

antidote arsenic

A

dimercaprol
succimer
penicillamine

415
Q

60 F experiences leakage of urine with laughing and coughing, nonsurgical options

A

kegel exercises
estrogen PO or vaginal
pessary

416
Q

definition mild persistent asthma and outpatient tx

A

> 3-6 day episodes in a week
3-4 night episodes in a month

tx: SABA and low ICS

417
Q

PFTs in asthma exacerbation

A

overall increased lung volumes

FEV1/FVC < 80%

418
Q

indications for chronic COPD to qualify for home O2

A

O2 sats < 88%
polycythemia
peripheral edema
pulmonary HTN

419
Q

SE from theophylline overdose

A

seizures –> hyperthermia
hypotension
tachyarrhythmias

420
Q

next step polmonary nodule

A

previous CXR

not not, then CT

421
Q

antidote for digoxin

A

activated charcoal within 1st 24 h

digoxin ab fragments

422
Q

antidote BB

A

calcium
glucagon
insulin and D5

423
Q

sarcoidosis mnemonic

A

A GRUELING Disease

increased sACE
Gamaglobulinemia
RA
Uveitis
Erythema nodosum
Lymphadenopathy (bilateral hilar)
Idiopathic
Noncaseating
Granulomas
increased vitamin D --> activated my macrophages in granulomas --> increased sCa2+ (hypercalcemia)
424
Q

tx for idiopathic pulmonary fibrosis

A

anticollagen: pirfenidone
anti-tyronsine kinase Rec: nintedanib
anti-pulmonary HTN: sildenafil

425
Q

lung disease: noncaseating granulomas and associated with aerospace manufacturing

A

berylliosis

426
Q

lung disease: noncaseating granulomas and erythemia nodosum

A

sarcoidosis

427
Q

lung disease: associated with sandblasting

A

silicosis

428
Q

lung disease: “eggshell”calcifications of hilar LNs, inc susp TB, inc rsk lung cancer

A

silicosis

429
Q

causes chronic bronchitis but not increaesed risk lung cancer

A

coal miner lung

430
Q

what is anthracosis

A

asx
city swellers
mild black lung

431
Q

small fibrotic lung nodules in coal miner

A

simple coal worsers’ disease

432
Q

lung disease: caseating granulomas and positive c-ANCA

A

GPA

433
Q

honeycombign/reticular lung imaging associated with which lung dz

A

idiopathic pulmonary fibrosis

434
Q

tx for MI due to cocaine overdose

A

no BB
benzos
CCB to inhibit vasoCNX

435
Q

common presenting features of tuberous sclerosis

A 
hamartomas
phakoma
adenoma sebaceum (facial angiofibromas)
distinctive brown fibrous plaque on forehead in infancy
shagreen patch
ash leaf sponts
sub-ependymal giant cell astrocytoma
cardiac rhabdomyoma
renal angiofibrolipoma
ID
seizures
436
Q

A-a gradient calculation and normal range

A

A-a = 700 - FiO2 - (PaCO2/0.8) - PaO2

nL 5-15 mmHg

437
Q

Increased A-a gradient with…

A

PE
pulmonary edema
R to L shunt
increased FiO2

(hard time getting O2 from alveoli to arteries)

438
Q

VQ scan: defect in venteliation = ____, defect in perfusion = ____.

A

defect in ventelation = PNA

defect in perfusion = PE

439
Q

PE on CXR

A

Hamptom’s hump (wedge)

440
Q

most appropriate next step in r/o PE in pt deemed unlikely to have PE

A

D-dimer

441
Q

vasodilators used to treat primary pulmonary HTN

A

CCB nifedipine
endotheli Recc antag (bosetan)
PDE antagones (sildenafil)
PG (traprsotanol)

442
Q

congential heart defect assoc with Li during pregnancy

A

Ebstein anomaly:

  • hypoplastic RV
  • tricuspid anterior displacement
  • TS/TR
  • 80% PFO with R to L shunt
443
Q

ER in respiratory distress frollowing MVC, CXR shows pleural effusion, next step

A

chest tube for hemothorax

444
Q

causes transudative pleural effusion

A

CHF
cirrhosis
nephrosis

445
Q

size PTX requires chest bue placement

A

> 15%

446
Q

kid, limp, asymm and sclerosis of right femoral head, widening of joint space, dx

A

Legg-Calves_perthes dz

avascular necrosis

447
Q

MC congenital neck cyst

A

thyroglossal duct cyst

448
Q

si/sx peritonsillar abscess

A

uvula deviation
muffled “hot potato” voice
trismus
drolloing

449
Q

MC causes of post-influenza bact pneum

A

s. pneumo

s. aureus

450
Q

MC cause PNA in neonates

A

GBS

451
Q

MC cause of viral pneumonia

A

flu and RSV

452
Q

antidote for tPA

A

aminocaproic acid

453
Q

antidote for mercury

A

dimercaprol
succimer
penicillamine

454
Q

sx with rifampin and insoniazid

A 
hepatotoxicity
peripheral neuropathy (i)
455
Q

first line tx for PCP in HIV patients

A

TMP-SMX x 21 d
Add sterioids if:
- RA PO2 < 70mmHg
- A-a gradient > 35 mmHg

456
Q

standard tx for latent TB

A

isoniazid QD x 9 mo
OR
isoniazid and rifampin weekly x 3 mo

457
Q

common cause of fungal PNA in immunocompromised patients

A

PCP

458
Q

PNA in spelunker

A

histoblasmosis

459
Q

induction agents commonly used in intubation

A

sedative: etomidate, propofol, midazolam, ketamine
paralytic: succinylcholine, rocuronium

460
Q

dx characteristics of ARDS

A

PaO2:FiO2 ratio < 200
no evidence cardiac origin
PCWP < 18 mmHg

461
Q

in pt with pulmonary edema, how distinguish ARDS from cardiogenic edema

A 
PCWP < 18 in ARDS
PCWP incrsed (LA presure increased) in cardiogenic edema
462
Q

hallmark CXR in pt with sarcoidosis

A

bilateral hilar lymphadenopathy

463
Q

labs help distinguish type 1 from type 2 diabetes

A

C-peptide low in T1, nL to high in T2

antibodies: Oh GAD = anti-glutamic acid decarboxylase antibodies

464
Q

two diagnositc studies to eval stable pt with suspected ectopic

A 
TVUS
quant BhCG (if <1500, repeat in 48h)
465
Q

causes exudative pleural effusion

A 
PE
TB
pancreaeatitis (amylase high)
cancer
infection
vasculitis
466
Q

goal tx DKA

A

close aniongap

467
Q

goal tx HHS

A

nL sugars

nL serum osmolality

468
Q

serum electrolyties low in KDA

A 
Na (peudohyponatremia)
K
Ca
Phos
Mg
469
Q

old man , ran out of diabets medications, electrolytes deranged, aniongap, BG 413, how further eval dx

A
  1. ABG

2. urine or serum ketones

470
Q

types diabetic retinopathy

A

non-prolierative (MC) impaired blood flow (cotton wool spots, hard exudates, microaneurysms, tortuous vessels)

prolieferative - ischemia –> neovascularization, AV nicking

471
Q

tx for prolierative diabetic retinopathy

A
  1. panretinal photocoagulation (PRP) to avoid hemorrhage

2. injectived VEGF-i

472
Q

1 COD in T2DM

A

ASCVD (cardiac)

473
Q

best tx for Goodpasture syndrome

A

steroids

plasmapheresis

474
Q

diabetes drug MOA: decreases GI absorption of starch and disaccharides

A

acarbose

475
Q

diabetes drug MOA: stimulates insulin release by inhibiting K-ATP channels

A

TZDs, meglinitides

476
Q

diabetes drug MOA: increases tissue glucose uptake and improves insuling sensitivity

A

TZDs, metformin

477
Q

diabetes drug: MC SE is hypoglycemia

A

sulfonylureas

meglitinides

478
Q

diabetes drug: not safe in setting of severe CHF

A

TZDs

SGLT-2 inhibitors

479
Q

diabets drug: acceptable choice in pt with mild-mod renal dz

A

TZDs

DPP-4i

480
Q

chemotherapeuti agent mainstay of tx for choriocarcinoma

A

methotrexate (folate antagonist)

481
Q

clinical features of strep pharyngitis

A

tender anterior cervical lymphadenopathy
fever
eudates on tonsils
no cough

482
Q

insulin used in continues influsion insulin pumps and in treatment of DKA

A

regular
OR
rapid acting

483
Q

2nd stage of labor, woman develops fever, tachy, uterine tenderness + fetal tachycardia + dx and managment

A

chorioamnionitis
IV broa-spectrum abx (amp and gent)
continue delivery

484
Q

five categories of metabolic syndrome for dx

A 
abd wasit circumference
TG
HDL
BP
BGs
485
Q

ddx hypoglycemia in patient without diabetes

A 
insulinoma
malingering
alcohol
pituiatry insufficiency
reactive 
liver dz
adrenal dz/insufficiency
gastric bypass
486
Q

examples restrictive lung dz and FEV1/FVC ratio

A

FEV1/FVC =>80%

pulmonary fibrosis
pneumonconiosis
scoliosis
Pickwickian syndrome

487
Q

19 F @ 34w GA, sudden onset painful vaginal bleeding and contractions, recurrent late decels. dx and risk factors for this complication

A

placental abruption

RF: previous abruption
HTN
trauma
smoking
cocaine***
488
Q

64 M COPD, seizure, N/V, abd pain after taking too much of one of his meds, hypotensive, tachycardic, abnL cardiac rhythm –> dx

A

theophylline OD

489
Q

medication causes of hypothyroidism

A

amiodarone (pt w/ arrhth)
lithium (bipolar)
TKi (imatinib, CML or RCC)

490
Q

goiter in Hashimoot

A

painless

491
Q

goiter in subactue thyroiditis (DeQuervain)

A

painful

492
Q

tx DeQuervain thyroiditis

A

NSAIDs

steroids

493
Q

goiter in Riedel thyroiditis

A

fixed
hard, rock-like
painless

(young pt with rockhard thryoid)

494
Q

presentation untreated congenital hypothyroidism

A 
lethargy
porr feeding
thick, protuding tongue
constipation
umbilical hernia
ID
495
Q

preferred dx test for pt with suspected PE if renal insufficiency (can’t get contrast)

A

V/Q scan

496
Q

mech of Graves dz

A

AI (antibiodies stimulate TSH receptor , TSI - thyroid stimulateing immunoglobulin)
NOT destruction of thyroid!

497
Q

thyroid changes in early pregnancy

A

TSH mildly decreased
Total T4 increased
TBG increased
Free T4 nL

498
Q

non-thyroidal manifestations fof Graves dz

A

exophthalmos

pretibial myxedema

499
Q

iatrogenic sources of iodine might cause thyrotoxicosis

A

amiodarone

IV contrast

500
Q

tx nephrogenic DI caused by Li toxicity

A
  1. stop lithium
  2. HCTZ
  3. amiloride
501
Q

FR thryoid nodule is cancer

A 
age <30, >60
neck radiation
smoker
FHx thyroid cancer
US:
-hypoechoic
irregular margins
microcalcifications
taller than wide
502
Q

next step newly identifid tyroid nodule in pt with hyperthyroidism

A

TSH

then RAIU

503
Q

medullary thyroid cancer assoc with which syndrome

A

MEN IIa and IIb

504
Q

Gene assoc with medullary carinoma

A

Ret gene

505
Q

indications for surgical PTHectomy in primary hyperparathyroidism

A 
hypercalcemia sx (bones, kidney stones, groans, psych tones)
sCa2+ >1.0 above upper limit normal
Cr clearance <60/kidney dysfxn
decrased DEXA t-score/osteoporosis
Age < 50
506
Q

medical manage primary hyperparathyroidism

A

cinacalcet (inc sensitivity of Ca rec on PTH gland)

507
Q

MC cause 2* hyperPTH

A

chronic renal disease

then vit D def
then Ca 2- def

508
Q

why PTH elevated in renal dz

A

lack phosphate secretion = hyperphosphetemia AND increased fgf-23 –> decreased vit D3 –> dec caclium reabsorption from intestine –> inc PTH

509
Q

PTH, sCa, sPhos, and VitD in pt with: primary hyperPTHN

A

PTH increased***
sCA increased
sPhos decreased
VitD nL

510
Q

PTH, sCa, sPhos, and VitD in pt with: vitamin D def (rickets in children, osteomalacia in adults) aka 2* hyperPTH

A

PTH increased
sCa decreased
sPhos decreased
VitD decreased***

511
Q

PTH, sCa, sPhos, and VitD in pt with: 2* hyperPTH from renal dz

A

PTH increased
sCa decreased
sPhos increased***
VitD decreased

512
Q

PTH, sCa, sPhos, and VitD in pt with: hypoparathyroidsim

A

PTH decreased***
sCa decreased
sPhos increased
VitD decreased

513
Q

PTH, sCa, sPhos, and VitD in pt with: Pseudohypoparathyroidism

A

PTH increased*** but receptors don’t work
sCa decreased
sPhos increased
VitD decreased

514
Q

vitamin D def labs and mech

A

malabsorption vit D
prolonged vit D def –> reduce Ca intestinal reabs –> increased PTH –> decrased sPhos and increaesed urine phos –> bones become deineralized

515
Q

pt with scoliosis higher risk of deveoping which type of infection

A

TB

516
Q

MC presentation hyperprolactinemia

A

postmeno F: asx, vision changes (bad)
premno F: hypogonadism = amenorrhea
male: hypogonadism = ED

517
Q

next step in managment of pt found to have absent pituitary on MRI (empty sellla)

A

reassure if no sx

or provide Hormones

518
Q

complications can result from acromegaly

A 
cardiac failure (cardiomyopathy, HTN)
spinal ord ompression
diabetes
compression optic N --> vision loss
oganomegaly
519
Q

tx localized non-small cell lung cancer

A

surgical resection + chemo

520
Q

s of basilar artery stroke

A

PONS

  • cranial nerve defects
  • RAS –> AMS/coma
  • contralateral full body weak
  • sensory deficits
  • poss vertigo, loss coord, defif speaking
521
Q

layers of adrenal cortex and hormones

A

GFR
Gromerulosa: SALT: mineralocorticoids (aldosterone)
Fasiculata: SUGAR: glucocorticoids (cortisol)
Reticularis: SEX: angrogens (testonsterone, DHEA-S)

522
Q

causes of Cushing syndrome

A

MC: low ACTH - exogenous steroid medications
low ACTH - adrenal adenoma or hyperplasia

high ACTH - pituitary adenoma producing ACTH (cushing disease)
high ACTH - ectopic production of ACTH (small cell lung cancer, carcinoid tumor)

523
Q

Cushing syndrome mnemonic

A 
Buffalo hump
Amenorrhea
Moon facies
Clots (thromboembolic)
Cardiac dz
Crazy (psychosis, agitation)
Ulcers (PUD)
Skin changes - striae, acne, easy bruising
Hirsutism
HTN
Hypokalemia
Infection
Necrosis of femoral head
Glaucoma and cataracts
Osteoporosis
Immune suppression
Diabetes
524
Q

tx Conn syndrome

A

surgery of adenoma OR spironolactone

525
Q

58 F cushingoid sx + low dose dex in evening and morning after there is not a decresae in cortisol –> next step

A

ACTH level (or exogenous cortisol)

526
Q

most specific lab finding in making dx of primary hyperaldoseronism

A

increased PAC:PRA ratio
PAC: aldosterone
PRA: renin (low renin because aldosterone is already high)

527
Q

55 M + hypertension, hypokalemia, metabolic alkalosis, inc alosterone, decreased renin activity –> dx? med used until definitieve

A

primary hyperalsdo

528
Q

non-aldoersone mineralocorticoid casuing HTN, hypokalemia, metabolic alkalsis

A

Cushing syndrome

Licorice!!!

529
Q

inital tx for child presnting with acute asthma attack

A

SABA
IV glucocorticoids
O2 if sat < 90%

530
Q

Adrenal isuff ciris sx

A

severe weakness, fevere, AMS, SHOCK, hyperpigmentation

531
Q

CAH: first number is 1 means…

A

HTN

532
Q

CAH: second number is 1 means…

A

increased androgen production (virilization in baby girl, precocious puberty in boy)

533
Q

CAH 21 alpha-hydroxylase deficeincy presentation

A 
increased androgen production
mineralocorticoid deficiency (aldo def) = hypotension and salt wating (dec Na and increased K)

ex: female infant with virilization of genitalia and hypotension

534
Q

17 alpha-hydroxylase def labs

A

inc na
dec K
inc aldo = HTN

535
Q

hypercalcemia
PUD
acromegaly

A

MEN1 (pituiatry, PUD/ZE, inc PTH)

536
Q

AIDS associated malignancies

A

Kaposi sarcoma (lymphatic endothelium, HHV-8) <250
Invasive cervical cancer (HPV) <200
Non-Hodgkin lymphoma (EBV, 1*CNS lymphoma) <100

537
Q

tx for septic abortion

A
  1. D&C

2. unasyn (pip/tazo) or gent/clinda

538
Q

antiretrovial HIV class SE: hyperglycemia, DM, and lipid abnormalities

A

Protease inhibitors

539
Q

rate of transmission of HIV through needle stick incident

A

0.3%

540
Q

drugs given if appreciable risk transmission HIV in needle tick incident

A

post-exposure ppx:
tenofovir (NRTI)
emtricitabine (NRTI)
raltegravie (II)

541
Q

antiretroviral drug SE - bone marrow suppression with megaloblastic anemia

A

zidovudine

542
Q

potentially fatal hypersensitivity reaction

A

abacavir

543
Q

neuropsychiatric sx

A

efavarenz

544
Q

hyperbilirubinemia, jaundice

A

atazanavir

545
Q

teratongeic

A

efavarenz

546
Q

inhibits cytochromc P450

A

ritonavir

547
Q

congenital heart defect + low calcium + recurrent infections

A

DiGeorge T cell deficiency

thymic aplasia

548
Q

chronic mucocutaneus candidiasis + chronic diarrhea + FTT

A

SCID ( and B)

549
Q

negative nitroblue tetrazolium test

A

chornic granulomatous disease (phagocyte prob)

550
Q

poor smooth pursuit of eyes + elevaeted AFT after 8 months

A

Ataxiia Telangiectasia

551
Q

Partial albinism + recurrent URIs + neurological disorders

A

Chediak Hidashi

552
Q

When do infection typially begin in children with immune disorders

A

3-6 mo

553
Q

Wiskot-Aldrick syndrome

A 
WAITER
Wiskott
Aldrich
Imuunodef
Thrombocytopenia and purpura
Eczema
Recurrent pyogenic infections
X0linked BOYS
554
Q

eczmea + recurrent cold s.aureaus abscesses + coarse facial features + two rows of teeth

A

Job syndrome (HyperIgE syndrome)

555
Q

delayed separation of umbilical cord

A

leukocyte adhesion deficiency syndrome (abnL integrins)

556
Q

no thymic shadow on newborn CXR

A 
thymic aplasia (DiGeorge 3rd and 4th pouches faill)
SCID (adenosine deaminase def)
557
Q

next steps in pt with febrile neurtopenia due to chemo

A
  1. adit to hosptial
  2. panculture
  3. start broad-sp abx (Zosyn)
558
Q

Ddx serum eosinophilia

A

CANADA-P
Collagen vascular dz (PAN, dermatomyositis)
Atopic dz (allergies, asthma, churg-strauss, alergic bronchopulomary aspergillosis)
Neoplasm
Adrenal insufficiency (Addison dz)
Drugs (NSAIDs, penicillins, cephalosporins)
Acute intersitital nephritis
Parasites (strongyloides, Ascaris – loffler esopin pneumonitis)

and HIV, hyperiGE, coccidioidomycosis

559
Q

most likely dx in pt with sx thyrotoxicosis plus history of thryoidectomy or radioablation of thyroid

A

excess thyroid replacement

560
Q

type of rejectin treated with immunosuppresive agents

A

acute

561
Q

mechansim of acute rejection

A

innate immune reaction
anti-donor T cells against transplant
6d - 1 yr

562
Q

drug do not want to combine with azathioprine

A

allopurinol

563
Q

mech of GVHD

A

graft/donor WBCs attack host

MC in bone marrow transplant

564
Q

immunosuppressant SE: hydroxychloroquine

A

visual distrubances

treats SLE and RA

565
Q

immunosuppressent SE of tacrolimus

A

nephrotoxicity when given IV

566
Q

immunosuppresssant SE of muromonab

A

leukopenia one time cytokine release

567
Q

tx for hyperPTH due to parathyroid hyperplasia

A

surgical resection of 3/5 glands, with 1/2 clip or autotransplantation

568
Q

NT derrangements in depression

A

dec NE
dec 5-HT
dec DA

569
Q

tx for acromegaly

A
  1. transphenoidal pituitary adenoma resection
  2. if no surgery: Rx
    - octreotide
    - cabergoline
    - GH Rec antagonist, pegvisomant
  3. external beam radiation
570
Q

firrstline tx for moderate hypercalcemia

A
  1. NS (pee it out)

2. loop diuretics (loops lose ca2+)

571
Q

indications for ECT

A

severe, debilitating depression refractory to antidepressants
psychotic depressoin
severes uicicidality
depression with food refusal leading to nutritional compresise
depression with catatonic stupor
rapid antidepres response if required (preganncy)
revious good repsonse
bipolar
schophernia

572
Q

SS vs. NMS

A

BOTH: utonomic instability, hypertehremia, musclr probs

S: rapid onset, hyperkinesis, clonus

NMS: gradual onset, bradykinesis, leadpiperigidity, highter fever

573
Q

GAD sx must be present for how long

A

6 months

574
Q

dx criteria for schizophrenia

A

two of following during 1 mo perid (at least one of the first three)
- delusions
-hallucinations (MC auditory)
- disorganized speech
-grossly disorganized or catatnoic behavior
- ngetative sx (flat affect, poverty of speech, lack emotional reactivity, social withdrawal, poor grooming, throught blocking)
WITH social/occupational dysfunction
For at least 6 mo

575
Q

Hashimoto thyroiditis assoc antibody

A

TPO = anti-thyroglobulin antibody

576
Q

GVHD sx

A 
maculopapular rash
abd pain
FNV diarrhea
recur infection
easy bleed
inc LFTs
decreased immunoglobulins
thrombocytoopenia
577
Q

GVHD tx

A

steroids
tacrolimus
mycophenolate

DIT Step 2 (8 decks)

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