6.20.17 Flashcards
(368 cards)
1
Q
PID –> outpt tx
A
ceftriaxone + doxy + metro
2
Q
PID –> inpt tx
A
- 1st: cefoxitin + doxy
- alt: clindamycin + gent
3
Q
what is courvoisier sign? seen in what condition?
A
palpable gallbladder –> pancreatic cancer
4
Q
T/F: painless jaundice is NOT common in pancreatic cancer
A
T
5
Q
jaundice in pancreatic cancer indicates?
A
obstruct intrapancreatic CBD –> sign of adv dz
6
Q
what PE finding is highly suggestive of spinal cord compression?
A
vertebra pt tenderness w percussion
7
Q
spinal cord compression –> presentation (3)
A
- vertebral tender
- sensory level
- hyperreflex
8
Q
spinal cord compression –> should start what med immed?
A
glucocorticoid –> decrease compression –> prevent permanent paralysis
9
Q
chol embolization synd –> most accurate dx test
A
bx of skin lesion –> chol xls
10
Q
chol emboli –> tx
A
supportive: no specific tx to reverse atheroembolic dz
11
Q
chol emboli –> urine finding
A
eosinophiluria
12
Q
A-fib –> initial tx
A
rate control:
- BB
- CCB –> verapamil, diltiazem –> block AV node
- digoxin
13
Q
A-fib –> rate controlled to under 100 –> next step?
A
anticoag:
- warfarin
- dabigatran
- rivaroxaban
14
Q
A fib –> goal of care (2)
A
- rate ctrl
- anticoag
15
Q
T/F: rate ctrl drugs do NOT convert pt into sinus rhythm
A
T
16
Q
CHADS score –> components
A
- CHF/cardiomyopathy
- HTN
- Age >75
- DM
- Stroke or TIA = 2pts
17
Q
CHADS score <1 –> tx
A
ASA
18
Q
CHADS score >2 –> tx
A
- warfarin
- dabigatran
- rivaroxaban, apixaba`n
19
Q
diabetic nephropathy –> earliest renal abnormality? 1st change that can be quantitated?
A
earliest abnormal: glomerular hyperfiltrate
earliest qty: glomerular BM thicken
20
Q
sz –> can lead to post or ant shoulder dislocation?
A
post
21
Q
10M –> persistent HA w no relief, daily nonbloody nonbilious emesis, eyelid retract, limited upward gaze, prefer downward gaze –> what condition?
A
pineal gland tumor:
- parinaud synd
- obstructive hydrocephalus
22
Q
parinaud synd –> presentation (3)
A
- limited upward gaze –> prefer down gaze
- eyelid retract (Collier sign)
- light-near dissoc (pupil react to accomm but not to light)
23
Q
T/F: absent/decreased achilles reflex –> normal in elderly pt
A
T
24
Q
diclofenac –> what kind of drug
A
NSAID
25
defibrillation is for what conditions (2)
- Vfib
| - pulseless V tach
26
synchronized cardioversion is for what conditions (3)
complex tachyarrythmia:
- Afib
- A flutter
- VT w pulse
27
suspect lupus --> initial test
antinuclear Ab (ANA)
28
suspect SLE --> ANA+ --> next step
ANA sens but not specific for SLE --> test for more specific Ab --> confirm dx:
- anti-dsDNA
- anti-Smith
29
suspect SLE --> why not do anti-dsDNA as initial test
anti-dsDNA is more specific for SLE but is not sens
30
73M w dementia --> low abd pain for 36hr --> refused oral intake, last bowel mvmt 2day ago --> h/o BPH, hemorrhoid, HTN, hyperlipid, chronic neck pain-started amitriptyline 8days ago --> abd full & tender at midline below umbilicus --> what condition?
amitriptyline --> antichol --> reduce detrusor contract, prevent urethral sphincter relax --> acute urinary retention
antichol + pressure from urine retention --> constipation
31
27F preg 28wk gestation --> abnormal pap high grade squamous intraepi lesion --> next step?
HSIL --> immed colposcopy w bx of abnormal lesions --> even if preg d/t high risk of progress to cancer
32
menopause --> hot flash --> tx
wt loss
33
menopause --> hot flash ssx not improve w wt loss --> next tx?
hormone replace tx
34
what is the only indication for HRT
<60yo --> menopause in past 10yr --> vasomotor ssx
35
polyarthralgia, tenosynovitis, vesiculopustular skin lesion --> classic triad for what condition?
disseminated gonococcal infect
36
use dependence --> MC seen w what kind of anti-arrhythmic?
class IC
37
class IC antiarrhythmic --> use dependence --> can cause what change in EKG w fast HR?
widened QRS
38
what is oral leukoplakia
hyperplasia of squamous epithelium --> reactive precancerous lesion
39
when should bx oral leukoplakia for malig transformation to SCC?
develop areas of induration/ulceration
40
appearance: oral leukoplakia vs SCC
leukoplakia: white patch w granular texture
SCC: areas of induration/ulceration
41
anti-histone Ab --> seen in what condition?
drug induced lupus
42
SLE --> maintenance tx
hydroxychloroquine
43
SLE --> lupus nephritis --> tx
IV cyclophosphamide --> oral mycophenolate
44
BPH --> which area/zone of prostate enlarges?
central zone
45
what herbal supplement works for BPH?
saw palmetto
46
lactose intol --> may be 2ndary to what conditions (2)
- Crohns
| - bact overgrowth
47
what is hepatorenal synd
progressive renal fail d/t adv liver dz: renal vessels vasoconstrict --> renal hypoperfusion
48
hepatorenal synd --> tx
liver transplant is only cure --> usu fatal w/out it
49
shoulder dystocia --> what are 6 steps to deliver fetus?
1) McRoberts maneuver
2) Rubin maneuver
3) Woods maneuver
4) deliver post arm
5) deliberately fracture clavicle
6) Zavanelli maneuver
50
what is McRoberts maneuver
flex knees --> suprapubic pressure
51
what do Rubin & Woods maneuvers do?
rot fetus shoulders
52
what is Zavanelli maneuver
push fetal head back into uterus --> C/S
53
difference bw spont abortion vs intrauterine fetal demise
abortion: <20wk
| fetal demise: >20wk
54
MC type of urinary incontinence in elderly
urge incontinence
55
what is urge incontinence
detrusor --> invol & uninh contract --> sudden urge to urinate --> invol loss of urine
56
urge incontinence --> 1st line tx
bladder training exercise
57
urge incontinence --> 1st line tx fail --> next tx?
- anticholinergic (oxybutynin)
| - TCA (imipramine)
58
66F --> 3mo agitation, restless, poor sleep, HA, gain 14lb --> h/o smoke --> BP 160/110, facial plethora, scattered bruises, Na 147, K 3.2, glucose 205 --> what condition?
smoke --> small cell lung cancer --> ectopic ACTH production --> hypercortisol --> Cushing synd
59
3F --> dysuria --> h/o 3 bladder infect trted w abx, constipation since start cow's milk --> suprapubic tender, anal fissures --> UA & culture show UTI w E.coli --> normal renal US, voiding cystoureterogram --> what condition?
constipation --> fecal retention --> compress bladder --> incomplete void --> urine stasis --> recurrent cystitis
60
11mo black M --> ant fontanelle wide open, pliable skull bones w/out stepoffs, bony prominences of costochondral jxs, genu varum --> what condition?
vitD def --> rickets
61
rickets --> presentation (3)
- craniotabes (softening of cranial bones)
- rachitic rosary (costochrondral jt hypertrophy)
- genu varum (femoral/tibial bowing)
62
MC 1ary bone tumor in children/YA
osteosarcoma
63
2nd MC 1ary bone tumor in children/YA
Ewing sarcoma
64
osteosarcoma --> typically involve what part of bone
long bone --> metaphyses
65
osteosarcoma --> XR finding (2)
- "sunburst" periosteal rxn
| - Codman triangle
66
Ewing sarcoma --> XR finding
"onion skin"
67
63F --> leg swelling --> h/o HTN, OSA, smoke for 30yr --> 2+ pitting edema, dilated & tortuous superficial veins, ulcer on L medial ankle --> what condition?
chronic venous insuff --> venous HTN --> varicose veins, edema, medial skin ulcer, skin discolor
68
chronic venous insuff --> initial tx
conservative:
- leg elevate
- exercise
- compression therapy
69
48M --> pain in R foot/leg after small cut while sailing --> now fever w rigors --> h/o hemochromatosis --> T 103, edema, dark bullae, streaking erythema --> what condition? causative org?
marine environ --> vibrio vulnificus --> wound contamination --> necrotizing fasciitis, septic shock
70
who is at particularly great risk for vibrio vulnificus infect?
liver dz
71
78M --> 6mo progressive b/l butt pain that radiate to thigh, calves --> worse w ambulation, improve when lean on cane, sit --> cannot walk more than 2-3blocks --> mod relief w IBU --> what condition?
spine OA --> osteophytes --> lumbar spine stenosis --> compress lumbar N roots --> neurogenic claudication
72
common causes of spinal stenosis (3)
- degen arthritis (spondlyosis)
- degen disk dz
- thickening ligamentum flavum
73
47M black farmer from Missippi --> 3wk malaise, nonproductive cough, fatigue, SOB --> h/o smoke --> erythema nodosum, CXR bilat patchy opacities, enlrg mediastinal & hilar LN --> HIV, TB neg --> LN bx noncaseating granuloma --> trted for sarcoidosis w steroid --> deteriorate rapid --> CXR progression of pulm infiltrate --> what condition?
Histoplasmosis
74
27F --> 2mo hirsutism --> acne, clitoromegaly --> abd CT L adrenal mass --> what condition?
androgen-producing neoplasm
75
intussusception --> constant or episodic pain?
episodic
76
acute resp distress --> ABG findings:
- acid-base
- O2
- CO2
- acid-base: resp alk
- O2: low
- CO2: low
77
acute resp distress --> Swan-Ganz catheterization findings during mech vent:
- wedge pressure
- PaO2:FiO2 ratio
- wedge pressure: <18mmHg
| - PaO2:FiO2 ratio: <200
78
Wegener's granulomatosis --> aka
granulomatosis w polyangiitis
79
granulomatosis w polyangiitis --> bx finding
noncaseating granuloma
80
sudden dyspnea, pleuritic CP, feeling of impending doom, loud S2, decreased breath sounds --> what condition?
PE
81
PE --> need to be on anticoag for how long
3-6mo
82
PE --> EKG findings (3)
- tachycardia
- lead I: S wave
- lead III: T wave inversion
83
suspect PE --> V/Q scan equivocal --> next step
angiography
84
29M --> copious watery diarrhea for 10day --> returned from vacation to E Europe where hiked & swam in local lakes --> what condition? causative org?
ingest contaminated water --> Cryptosporidium parvum --> prolonged traveler's diarrhea
85
traveler's diarrhea that is prolonged, profuse and watery is often caused by what type of pathogen?
parasitic
86
development of AV block in pt w infective endocarditis --> raise suspicion for what condition?
perivalvular abscess
87
bilat trigeminal neuralgia --> raise suspicion for what condition?
MS
88
pseudotumor cerebri --> most sig comp?
blind
89
26F --> microcytic anemia nonresponsive to iron supplement --> adopted from Greece --> what condition?
B-thal minor
90
fever, chill, LUQ pain, splenic fluid collection --> what condition?
splenic abscess
91
splenic abscess --> most commonly assoc w what condition
infective endocarditis
92
splenic abscess --> classic triad presentation
- fever
- leukocytosis
- LUQ abd pain
93
splenic abscess --> can also present w what other ssx (3)
- L pleuritic CP
- L pleural effusion
- splenomeg
94
70F --> fever, cough, CXR R lower lobe infiltrate --> what condition? causative org?
Strep pneumo (#1 cause of CAP) --> CAP
95
rickets --> lab findings:
- alk phos
- phos
- Ca
- PTH
- alk phos: high
- phos: low
- Ca: low
- PTH: high
96
what is Marjolin ulcer
SCC arising w/in burn wound
97
suspect acute aortic dissection --> initial dx study in hemodynamic stable pt
CT angio
98
new murmur & fever --> raise suspicion for what condition?
infective endocarditis
99
infective endocarditis --> Duke criteria --> need to meet how many criteria to dx?
- 2 major
- 1 major + 3 minor
- 5 minor
100
infective endocarditis --> Duke criteria --> what are major criteria
- bacteremia
| - new regurg murmur, echo --> vegetation
101
infective endocarditis --> Duke criteria --> what are minor criteria
- fever
- RF: IVDA, h/o endocarditis, prosthetic valve
- vasc comp: embolism, Janeway lesion, intracranial hemorrhage
- rheum comp: Roth spots, Osler nodes, glomerulonephritis
102
suspect aortic dissection --> best initial test? most accurate test?
initial: CXR
accurate: CT angiogram
103
aortic dissection --> most important goal in management
ctrl BP --> BB
104
at what age start screen for AAA?
65
105
what is Grey Turner sign
ecchymosis on back/flanks
106
what is Cullen sign
ecchymosis around umbilicus
107
Grey Turner sign, Cullen sign --> indicate what condition?
AAA --> expansion & impending rupture
108
find AAA --> at what size need surg?
5cm
109
amphetamine, cocaine, bath salt --> intox --> tx
- antipsych
- benzo
- antiHTN
110
amphetamine, cocaine, bath salt --> withdrawal --> tx
- bupropion
| - bromocriptine
111
microcytic anemias (4)
- IDA
- anemia of chronic dz
- thal
- sideroblastic
112
normocytic anemias (5)
- sickle cell
- G6PD def
- spherocytosis
- autoimmune hemolysis
- paroxysmal nocturnal Hburia
113
asx hyperCa, elevated PTH --> what condition?
1ary hyperPTH
114
infective endocarditis --> strep mutans --> tx?
IV:
- ceftriaxone
- PCN G
115
HOCM --> symptomatic --> tx
neg inotropic agent --> BB --> prolong diastole, decrease contractile --> decrease LVOT obstruct --> improve angina
116
neonate --> 1st week of life --> should have how many wet diapers a day?
equal to infant's age in days: 4day --> 4diapers
117
"brick-red" areas on diaper --> what is it? indicates what?
urate xls --> mild dehydration
118
when does breastfeed fail jaundice occur? breast milk jaundice?
breast fail: 1st week of life
breast milk: start 3-5day --> peak at 2wk
119
breastfeed fail jaundice --> cause
lactation fail:
- maternal: infreq feed, ...
- infant: poor latch, ...
120
how can distinguish bw breastfeed fail jaundice vs breast milk jaundice
dehydration vs no dehydration & no feeding problems
121
breastfeed fail jaundice --> pathophys
lactation fail --> inadeq stooling --> decrease bili elimination --> increase bili in circulation
122
breast milk jaundice --> pathophys
breast milk --> high B-glucurondinase --> deconj bili --> increase bili in circulation
123
chickenpox --> type of rash
successive crops of intensely pruritic vesicles
124
acute pancreatitis --> MCC? 2nd MC? 3rd MC?
```
#1) alcohol
#2) gallstone
#3) hyperTG
```
125
serum TG level must be what to be considered potential cause of pancreatitis?
>1,000mg/dl
126
what PaO2 shows hypoxemia?
<60mmHg
127
resp fail --> mech vent --> still hypoxemia --> increasing what values can increase oxygenation? (2)
- FiO2
| - PEEP
128
cyclosporine --> what kind of drug
calcineurin inh (immunosupp)
129
cyclosporine --> MOA
decrease production of inflamm cytokines by T-cell lymphocytes
130
calcineurin inh (2)
- cyclosporine
| - tacrolimus
131
cyclosporine --> AE (6)
- nephrotoxic
- hyperK
- HTN
- gum hypertrophy
- hirsutism
- tremor
132
tacrolimus --> AE (4)
- nephrotoxic
- hyperK
- HTN
- tremor
same as cyclosporine but not hirsutism, gum hypertrophy
133
azathioprine --> AE (3)
- diarrhea
- leukopenia
- heptatoxic
134
mycophenolate --> AE (1)
BM suppress
135
EKG --> broad flat T wave --> what condition?
hypoK
136
what is fusion beat
electrical impulse from 2 diff sources act on same region of heart at same time
137
ventricular fusion beat --> appearance on EKG
hybrid of both normal & wide QRS
138
wide complex tachycardia w fusion beats --> what condition?
sustained monomorphic ventricular tachycardia
139
sustained monomorphic ventricular tachycardia --> pt is stable --> tx
amiodarone
140
kidney stone --> obstruct ureter --> imaging of choice to dx?
abd US
141
which study design is best for determining incidence of a dz
cohort
142
pernicious anemia --> need to monitor for what longterm comp?
gastric CA
143
pernicious anemia --> why have increased risk of gastric cancer?
pernicious anemia --> chronic atrophic gastritis --> decrease produce IF
144
chronic alcohol --> cerebellar dysfx --> presentation ( 5)
- gait instability
- truncal ataxia
- difficult w rapid alt mvmt
- hypotonia
- intention tremor
145
Creutzfeldt-Jakob dz --> EEG finding
sharp, triphasic, synchronous discharges
146
18mo M --> recurrent sinopulm infect, PMI displaced to R chest --> what condition?
Kartagener synd
147
Kartagener synd --> classic triad presentation
- situs inversus
- recurrent sinusitis
- bronchiectasis
148
25F --> hair loss w receding hairline, light periods q35-50day, extensive acne, BMI 33 --> what condition?
PCOS
149
ALS --> tx? what type of drug?
riluzole (glutamate inh)
150
75M black --> h/o DM, HTN --> fundoscopy cupping of optic disc, constricted peripheral vision --> what condition?
1ary open angle glaucoma
151
open angle glaucoma --> more common in whom?
black
152
open glaucoma --> natural progression of dz
initially asx --> gradual loss of peripheral vision --> eventual tunnel vision
153
what differentiate bw heat exhaustion vs heat stroke
exhaust: >104F
stroke: >104F + CNS dysfx (confuse, irritable, sz)
154
exertional heat stroke --> tx
rapid cool --> #1 ice water immersion
155
65M --> COPD exacerbation --> started on inhaled bronchodilator, systemic steroid, high flow Ow, IV lorazepam --> 30min later lethargic, confused, gen tonic clonic --> what condition?
advanced COPD --> supplemental O2 --> CO2 retention --> acidosis:
- change level of consciousness
- cerebral vasodilate --> sz
156
advanced COPD --> how does supplemental O2 cause CO2 retention
- increase dead space perfusion --> V/Q mismatch
- decrease affinity of oxyHb for CO2
- reduce alveolar vent
157
pap smear --> atypical squamous cells of undetermined significance (ASCUS) --> management
1) HPV screen
| 2) repeat pap 6mo
158
pap smear --> abnormal (LSIL, HSIL) --> management
colposcopy --> LEEP, conization, laser ablation
159
toxic shock synd --> abx
oxacillin or nafcillin
160
24F --> 37wk gestation --> fetus is breech --> next step
external cephalic version --> if fail, schedule C/S
161
suspect Cushing's synd --> next step to confirm dx?
low dose dexamethasone test
AND
late night salivary cortisol assay
OR
24hr urine free cortisol
162
placental abruption --> maternal comp (2)
- DIC
| - hypovol shock
163
40F --> EKG to assess for CAD --> 85% sens, 80% spec, PPV 25%, NPV 96% --> test is neg --> what is probability has CAD?
1-NPV = 4%
164
Beckwith-Wiedemann synd --> comp
- Wilms tumor
| - hepatoblastoma
165
27M --> periorbital swell, dark urine --> h/o 3wk ago skin infect trted w dicloxacillin --> BP 150/90, urine RBC casts, low serum C3, BUN 40, Cr 2 --> what condition?
post strep glomerulonephritis
166
38F --> 5mo fatigue since birth of twins --> had uterine atony & bleed trted w mult transfusions --> h/o depression not taking antidep --> difficult keep track of all new responsibilities, often forget to eat, LMP before last preg, BP 85/55, BMI 18, Hb 10.1 --> what condition?
Sheehan synd
167
MC nephrotic synd assoc w Hodgkin lymphoma
minimal change dz
168
MC nephrotic synd assoc w malig
membranous nephropathy
169
Hodgkin lymphoma --> trt w ctx & rad --> comp
ctx & rad --> 2ary malig
170
glioblastoma multiforme --> CT/MRI finding
- "butterfly" appearance w central necrosis
| - heterogenous, serpiginous contrast enhancemt
171
8F --> 2 bone fx, moonlike face, 2 light brown spots w irreg contour on back, bruise on arm, breast budding and enlarged areola, course dark pubic hair --> what condition?
McCune-Albright synd
172
McCune-Albright synd --> 3 P's
- precocious puberty
- pigmentation (cafe au lait spots)
- polyostotic fibrous dysplasia
173
TCA overdose --> how does sodium bicarb help?
sodium bicarb --> increase pH, increase Na --> decrease TCA's cardio-depressant effects on Na channels
174
66M --> new dx of HTN --> CT angio reveals 80% atherosclerotic narrow of R renal A --> next step
ACEI/ARB
175
HTN & renal A stenosis --> why not trt w renal A stent or surg revasc?
not proven superior to med therapy to ctrl BP, reduce CV outcomes
==> reserve for pts w:
- resistant HTN
- recurrent flash pulm edema
- refractory HF d/t severe HTN
176
solid organ transplant --> immunosupp --> opportunistic infect --> pneumonia --> caustative org (2)?
- PCP
| - CMV
177
what meds can trigger myasthenic crisis (3)
- BB
- aminoglycoside
- FQ
178
when do quad screen ?
2nd trim (15-20wk)
179
trisomy 18 --> quad screen results:
- MSAFP
- B-hCG
- estriol
- inhA
- MSAFP: decreased
- B-hCF: decreased
- estriol: decreased
- inh A: normal
180
trisomy 21 --> quad screen results:
- MSAFP
- B-hCG
- estriol
- inh A
- MSAFP: decreased
- B-hCG: increased
- estriol: decreased
- inh A: increased
181
neural tube or abd wall defect --> quad screen results:
- MSAFP
- B-hCG
- estriol
- inh A
- MSAFP: increased
- B-hCG: normal
- estriol: normal
- inh A: normal
182
OA vs RA: how long does morning stiffness last
OA: 30min
RA: 60min
183
RA nodules --> bx finding
chol
184
RA --> XR finding
periarticular osteopenia
185
RA --> tx for everyone
NSAID + DMARD
186
RA --> tx --> preferred DMARD?
methotrexate
187
RA --> tx --> biologic for severe dz --> which biologic used?
TNFa inh (infliximab, rituximab, etanercept)
188
RA + neutropenia + splenomeg --> what condition?
Felty synd
189
episodic pounding sensation, chronic diarrhea, wt loss, tricuspid regurg --> what condition?
carcinoid synd
190
carcinoid synd --> presentation (5)
- episodic flushing (hallmark)
- secretory diarrhea
- cutaneous telangiectasia
- bronchospasm
- tricuspid regurg
191
carcinoid synd --> dx
24hr urine 5-hydroxyindoleacetic acid
192
cirrhosis + psychosis --> what condition?
Wilson dz
193
Wilson dz --> presentation (5)
- neuro: psychosis, delusion, personality change
- ataxia, chorea
- cirrhosis
- Kayser-Fleisher ring
- Coombs neg hemolytic anemia
194
Wilson dz --> best initial test
slit lamp --> Kayser-Fleisher ring
195
Wilson dz --> lab findings:
- serum ceruloplasmin
- urinary copper
- serum ceruloplasmin: decreased
| - urinary copper: increased
196
Wilson dz --> tx
penicillamine or trientine --> chelate copper --> remv from body
197
Wilson dz --> tx --> need what supplement? why?
zinc --> interfere w intestinal Cu absorption
198
stable angina --> first line tx? why?
BB --> decrease exertional HR & myocardial contractility --> reduce myocardial O2 demand --> alleviate ssx, improve exercise tolerance
199
find solid testicular mass --> next step?
radical orchiectomy
200
stable angina --> tx --> how does nitroglycerin relieve pain?
systemic vasodilate --> decrease LVEDV --> decrease wall stress --> decrease myocardial O2 demand
201
consolidation of lung:
- breath sounds
- tactile fremitus
- percussion
- breath sounds: increased (crackles, egophony)
- tactile fremitus: increased
- percussion: dull
202
Sjogren --> increased risk for what malig?
non-Hodgkin lymphoma
203
what is isolated systolic HTN? pathophys?
SBP >140, normal DBP
old age --> stiff, less elastic arterial wall
204
17F --> loss of consciousness, fall --> recent brkup w bf, stress at school, sleep poorly --> after 20min wake up, disoriented to time/place --> what condition?
LOC, loss postural tone, delayed return to baseline --> sz --> postictal state
205
how to calculate sensitivity
TP / (TP + FN)
206
how to calc specificity
TN / (TN + FP)
207
how to differentiate confounding vs effect modification
confounding: stratify pop into grps --> since confounder remved --> no sig diff bw 2 grps
effect modification: stratify grps --> sig diff bw 2 grps
208
11M --> 7mo recurrent thoughts of stabbing mother to death, must recite prayer 20times to make thoughts stop, does this 3-5times a day, feels extremely guilty, increasingly anxious and withdrawn --> what condition?
OCD
209
55F --> tender erythematous, palpable cord-like veins on L arm --> similar epsiode on chest 2wk ago that improved on own --> also several months of heartburn, mild epigastric pain --> what condition?
Trousseua's synd --> migratory superficial thrombophlebitis
210
Trousseau's synd --> usu assoc w what conditon?
occult visceral malig --> #1 pancreatic
211
cilostazol --> what kind of drug?
phosphodiesterase inh (cAMP)
212
cilostazol --> used to trt what condition?
PVD
213
pentoxyfylline --> what kind of drug?
xanthine
214
pentoxyfylline --> used to trt what condition?
PVD
215
T/F: wt gain is NOT an AE of OCP
T
216
ascending weak + loss of reflex --> next step?
LP --> high protein, few cells --> Guillain Barre
217
pt has Guillain-Barre --> next step? why?
PFT to detect impending resp fail:
- decreased FVC
- decreased peak inspiratory pressure
218
Guillain-Barre --> tx
IVIG or plasmapheresis
NEVER steroid
219
closed angle glaucoma --> tx
constrict pupil:
1) a-agonist
2) BB
220
pt w h/o closed angle glaucoma --> should never give what med?
atropine
221
chronic progressive loss of central vision --> what condition?
macular degen
222
wet macular degen --> fundoscopy findings
blood/fluid
223
dry macular degen --> fundoscopy findings
- drusen
| - pigmt change
224
macular degen --> tx:
- wet
- dry
- wet: laser
| - dry: nothing
225
acute mania --> escalating agitation --> tx
antipsych --> manage psychosis & agitation acutely --> more rapid onset than lithium, mood stabilizer
226
pharm company --> physicians may accept what kind of gifts?
nonmonetary gifts of minimal value that directly benefit pts --> unbiased ed material, drug samples
227
MC congenital heart defect in Down synd
complete AV septal defect (CAVSD)
228
neonate --> cyanosis despite supp O2 --> probable congenital heart dz --> next step?
prostaglandin E1 --> maintain PDA --> potentially life saving
229
neonate --> probable congenital heart dz --> next step after give PGE1?
echo to ID specific cardiac lesion
230
24M --> 2 day fever, sore throat, hoarse, can't swallow d/t severe pain --> T 103, drool, muffled voice, stridor, pooled secretions in oropharynx, ant neck tender --> what condition?
infectious epiglottitis
231
why is gymnastics not recommended in preg?
high fall risk
232
phlebotomist --> needlestick injury from HIV+ pt --> next step
- draw blood for HIV seroogy
| - start 3drug antiretroviral tx immed
233
folic acid/cobalamin def --> what abnormal lab finding? why?
increased homocysteine
involved in conversion of homocysteine --> methionine
234
how differentiate bw folic acid def vs cobalamin def?
cobalamin --> also involved in conversion of methylmalonyl-CoA --> succinyl CoA
==> increased methylmalonic acid
235
NSTEMI --> long term medical tx
- ASA + P2y12 receptor blocker (clopidogrel)
- BB
- ACEI
- statin
236
43M --> erectile dysfx, fatigue --> h/o alcohol, smoke --> brown skin, fasting glucose 130, AST 78, ALT 80 --> what condition?
hereditary hemochromatosis:
- elevated liver enzyme
- skin pigment
- "bronze diabetes"
- hypogonad
237
acute epididymitis --> cause:
- <35
- >35
- <35: sexually transmited --> chlamydia, gonorrhea
| - >35: bladder outlet obstruct --> coliform bact --> E.coli
238
case ctrl study --> can use odds ratio as close approximation of relative risk if what is true?
rare dz assumption: incidence of dz is low
239
immunocomp + bilat interstitial infiltrates --> what condition?
PCP pneumonia
240
PCP pneumonia --> lab finding --> LDH
elevated
241
AIDS --> PCP prophylaxis --> should use what if pt can't take TMP/SMX? and if can't take that either?
1) TMP/SMX
2) dapsone
3) atovaquone
242
PCP pneumonia --> pt experiences TMP/SMX toxicity --> alt to TMP/SMX?
- pentamidine
| - clinda + primaquine
243
septic arthritis --> arthrocentesis finding --> WBC?
>50,000
244
caustic esophageal injury --> dx?
EGD w bx --> determine severity
245
caustic esophageal injury --> when can gastric lavage?
NEVER
246
diabetes, hepatomeg, arthritis w chondrocalcinosis --> what condition?
hereditary hemochromatosis
247
what are some 2ndary causes of pseudogout? (3)
- hyperPTH
- hypothyroid
- hemochromatosis
248
hyperK --> EKG findings --> sequence
1) peaked T wave
2) prolong PR, wide QRS
3) P wave disappear
4) AV block, sine wave
249
when need to emergent trt for hyperK (3)
- serum K increase rapidly
- >6.5mEq/L
- EKG changes
250
hyperK --> need to emergent trt --> what is most immed measure?
IV Ca --> stabilize cardiac myocyte membrane --> make resistant to hyperK effects
251
mastitis --> abx tx
- dicloxacillin
| - cephalexin
252
45F --> progressive fatigue, myalgia, proximal muscle weak in LE that cramp after short distance, hyporeflex, elevated CK --> What condition?
hypothyroid myopathy
253
midgut volvulus w malrotation --> dx
upper GI series (barium swallow)
254
frostbite --> tx
rapid rewarm w warm water
255
GLP-1 agonist examples
- exenatide
| - liraglutide
256
GLP-1 agonist --> benefits to using
- induce wt loss
| - lower risk of hypoglycemia
257
sulfonylurea --> AE
- hypoglycemia
- wt gain
- sulfa allergy
258
thiazolidinedione --> examples
- rosiglitazone
| - pioglitazone
259
sulfonylurea --> examples
- glyburide
- glimerpiride
- glipizide
260
thiazolidinedione --> AE (3)
- wt gain
- fluid retention --> exacerbate CHF
- decrease bone mineral density
261
GLP-1 agonist --> AE
pancreatitis
262
celiac dz --> assoc w what Ab (2)?
- IgA anti-tissue transglutaminase
| - IgA anti-endomysial Ab
263
why some pts w celiac disease test neg for anti-ttg and anti-endomysial?
selective IgA def --> common in celiac dz
264
SIADH:
- hypo/hypertonic
- hypo/hyperNa
- hypo/eu/hypervol
hypotonic hypoNa
| euvol
265
which agents for PE should not be used in pts w renal insuff?
- LWMH (enoxaparin)
- IV factor Xa inh (fondaparinux)
- oral factor Xa inh (rivaroxaban)
266
suspect hemochromatosis --> next step?
ferritin --> >1000
| transferrin --> >50%
267
suspect hemochromatosis --> ferritin & transferrin elevated --> next step?
confirm dx --> liver bx
268
hemochromatosis --> comp (7)
- cirrhosis
- cardiomyopathy
- DM
- arthritis
- hypogonad
- hypothyroid
- hyperpigment
269
55M --> lower urinary tract ssx --> prostate is uniformly enlarged, smooth and rubbery --> next step
BPH --> UA & U culture to r/o infect
270
mechanism of dz: polymyositis vs dermatomyositis
- polymyositis: T cell mediated
| - dermatomyositis: humoral --> Ab complex deposition
271
polymyositis vs dermatomyositis --> muscle bx --> location of inflamm & muscle fiber fibrosis
- polymyositis: endomysial
| - dermatomyositis: perivascular & perimysial
272
polymyalgia rheumatica --> assoc w what condition?
temporal arteritis
273
polymyalgia rheumatica --> presentation (3)
- hip & shoulder muscle pain (bilat)
- constitutional ssx: malaise, fever, depress, wt loss, fatigue
- jt swell
274
polymyalgia rheumatica --> hip & shoulder muscle pain:
- when stiff
- when pain
- muscle strength
- stiff: morning, after inactivity
- pain w mvmt
- normal strength
275
polymyalgia rheumatica --> tx
steroid
276
Klumpke palsy --> presentation (3)
- "claw hand": ext wrist, hyperext MCP, flex IP, absent grasp reflex
- Horner synd (ptosis, miosis)
- intact Moro & biceps reflex
277
Klumpke palsy --> damage what N roots?
C8 & T1
278
serum to ascites albumin gradient (SAAG) --> how to calc
serum albumin - peritoneal albumin
279
SAAG --> how to interprete
>1.1 --> portal HTN
<1.1 --> other cause of ascites
280
what supplement is recommended to be used with methotrexate?
folic acid
281
methotrexate --> AE (3)
- hepatotoxic
- stomatitis
- cytopenia
282
Paget dz of bone --> lab findings:
- alk phos
- urine hydroxyproline
- Ca
- phosphorus
- alk phos: increased
- urine hydroxyproline: increased
- Ca: normal
- phosphorus: normal
283
Paget dz of bone --> tx
- bisphonate
| - calcitonin
284
G6PD def --> meds that commonly trigger episode (3)
- dapsone
- TMP/SMX
- nitrofurantoin
285
G6PD def --> initial test? best test?
initial: smear
best: G6PD level 6-8wk after attack
286
G6PD def --> tx
- supportive
| - avoid stress
287
what's the best statistical method to compare proportions?
chi square test
288
alcoholic hepatitis --> lab findings:
- GGT
- ferritin
- GGT: elevated
| - ferritin: elevated
289
bronchogenic cyst --> location
middle mediastinum
290
1M --> capillary (fingerstick) blood test --> lead 12ug/dl --> next step?
confirm w venous blood draw --> lead level
291
fredreich ataxia --> MC COD
- cardiomyopathy
| - resp comp
292
fredreich ataxia --> presentation (3)
- neuro: ataxia, dysrarthria
- skeletal: scoliosis, feet deform
- cardiac (concentric hypertrophic cardiomyopathy)
293
suspect infective endocarditis --> next step?
blood culture
294
18F --> disseminated maculopapular rash, malaise, Cr 2.0, white blood cell casts, T 100.4 --> h/o dysuria & increase urinary freq 1wk ago trted w TMP/SMX --> what condtiion?
allergic interstitial nephritis
295
interstitial nephritis --> presentation (3)
- fever
- maculopapular rash
- renal fail
296
new solitary pulm nodule --> next step
chest CT --> assess malig risk
297
torsades --> tx:
- unstable pt
- stable
unstable --> defib
stable --> Mg sulfate
298
newborn F --> IUGR, VSD, hypertonia, closed fists w overlapping digits --> what chrom abnormal?
trisomy 18 (Edwards)
299
trisomy 18 (Edwards) --> presentation (5)
- microcephaly --> prominent occiput
- IUGR
- micrognathia
- closed fists w overlapping digits
- rocker bottom feet
300
study to assess assoc bw L-TRP use & developmet of EMS --> EMS pts asked about L-TRP use --> ppl w/out EMS asked about L-TRP use --> what kind of study?
case ctrl
301
case ctrl study --> main measure of assoc?
exposure odds ratio
302
how can differentiate hyperemesis gravidarum from typical N/V of preg? (3)
- >5% prepreg wt loss
- electrolyte abnormal
- ketonuria
303
how deliver fetus w lethal abnormality & breech presentation? why?
spont vag delivery
#1 priority --> minimize maternal M&M rather than neonatal benefit
304
62F --> 4mo 5mm dark brown lesion on dorsal forearm, smooth border, small eccentric nodule, occasionally itch --> numerous freckles on nose, cheeks, dorsal hands --> next step
lesion is substantially different than others --> concerning for melanoma --> excisional bx
305
what is ugly duckling sign
mult pigmented lesions --> lesion that is substantially different from others --> 90% sensitive for melanoma
306
56M --> R side weak, speech difficult, difficult writing & repeating --> location of lesion?
dominant frontal lobe
307
name narrow QRS tachy (2)
- SVT
| - Afib
308
SVT --> EKG findings (3)
- no P wave
- HR >150
- reg
309
SVT --> tx for stable pt
adenosine
310
WPW synd --> pathophys
bundle of Kent --> accessory conduction pathway --> premature V excitation
311
WPW synd --> EKG findings (3)
- narrow complex tachy
- short PR
- delta wave
312
Ventricular filling --> cardiac tamponade vs constrictive pericarditis
cardiac tamponade: V filling impeded thruout diastole
constrictive pericarditis:
- early diastole: normal rapid fill
- late diastole: halted abruptly
313
constrictive pericarditis --> presentation (3)
diastolic HF:
- fluid overload: edema, ascites, pleural effusion
- decreased cardiac output: DOE, fatigue, decreased exercise tolerance, cachexia
- pericardial knock
- JVD
314
what is initial vasopressor used in cardiogenic shock?
dopamine
315
cardiogenic shock:
- cardiac output
- SVR
- PCWP
- cardiac output: decreased
- SVR: elevated
- PCWP: elevated
316
cardiogenic shock:
- SBP
- urine output
- LV filling pressure
- SBP: <90
- urine output: <20ml/hr
- LV filling pressure: adeq
317
intra-aortic balloon pump --> used for what? what effects does it have?
hemodynamic support:
- decreased afterload
- increased cardiac output
- decreased myocardial O2 demand
318
intra-aortic balloon pump --> how does it work?
- deflate in systole: reduce afterload
| - inflate in diastole: increase coronary perfusion
319
hypovol shock:
- cardiac output
- SVR
- PCWP
- cardiac output: decreased
- SVR: increased
- PCWP: decreased
320
ascites --> SAAG <1.1 --> what could be potential causes of ascites (2)?
- TB
| - cancer
321
LFTs --> mildly elevated (low 100's) --> think of what conditions (2)
- acute alcoholic hepatitis
| - chronic viral hepatitis
322
LFTs --> mod elevated (high hundreds to thousands) --> think of what condition
acute viral hepatitis
323
LFTs --> severe elevated (>10,000) --> think of what conditions (3)
extensive hepatic necrosis:
- ischemia, shock liver
- acetaminophen toxicity
- severe viral hepatitis
324
dominant frontal lobe lesion --> presentation (3)
- expressive (Broca's) aphasia
- contralat hemiparesis (involvement of 1ary motor cortex)
- contralat apraxia ( involvement of supplementary motor cortex)
325
Broca's vs Wernicke aphasia
Broca: broken speech
Wernicke: difficult comprehend, follow commands --> speak fluently
326
dominant parietal lobe lesion --> presentation (2)
- contralat sensory loss: pain, vibrate, agraphesthesia, asterognosis
- contralat inf homonymous quadrantanopsia
327
nondominant parietal lobe lesion --> presentation (2)
- anosognosia (denial of one's disabilities)
| - contralat apraxia (inability to carry out learned purposeful mvmts)
328
where is Wernicke's area located?
dominant temporal lobe
329
36M --> occasional morning HA --> BP 175/103, bilat nontender upper abd masses --> what condition?
AD polycystic kidney dz
330
organophosphate poisoning --> pathophys
inh AChE --> cholinergic excess:
- bradycardia
- miosis
- rhonchi
- muscle fasciculation
- salivation
- lacrimation
- urination
- defecation
331
organophosphate poisoning --> tx
- atropine --> reverse effects
| - remv clothes & wash skin --> prevent further transcut absorption
332
normal JVP
6-8 mmHg
333
fibromyalgia --> not respond to initial conservative tx --> 1st line drug?
TCA
334
45F --> asx --> elevated alk phos, normal AST/ALT, normal RUQ US, positive anti-mito Ab --> what condition?
1ary biliary cholangitis
335
1ary biliary cholangitis --> tx
ursodeoxycholic acid (UDCA)
336
2 classifications of dysphagia
- oropharyngeal
| - esophageal
337
oropharyngeal vs esophageal dysphagia --> presentation
oropharyngeal: difficult initiate swallow --> cough, choke, aspirate, nasal regurg
esophageal: sensation of food get stuck in esophagus few sec after swallow
338
suspect oropharyngeal dysphagia --> initial step to eval? how bout for esophageal dysphagia?
oropharyngeal: videofluoroscopic modified barium swallow study
esophageal: esophageal motility study, upper GI endoscopy
339
congenitial hypothyroid --> presentation (3)
#1 --> asx
- decreased activity
- hoarse cry
- jaundice
340
congenital hypothyroid --> MCC
thyroid dysgenesis
341
suspect lyme dz --> serology should be performed when? (2)
- early disseminated lyme dz
| - late lyme dz
342
30-50F --> pruritis, jaundice --> what condition?
1ary biliary cirrhosis
343
30-50M --> pruritis, jaundice --> what condition?
1ary sclerosing cholangitis
344
mild-mod cancer related pain --> tx
nonopioid analgesic
345
cancer pain --> not relieved w nonopioid analgesic --> tx
short acting opioid
346
T/F: active marijuana use is a CI to breastfeeding
T
347
T/F: active HepB is a CI to breastfeeding
F
348
systemic onset juvenile idiopathic arthritis --> presentation (3)
- longstanding daily fever
- arthritis >1jt
- charact pink macular rash
349
systemic onset juvenile idiopathic arthritis --> lab findings:
- WBC
- plt
- inflamm markers
- RBC
- WBC: elevated
- RBC: anemia
- plt: elevated
- inflamm markers: elevated
350
HIV pt --> bright red, firm, friable, exophytic nodule --> what condition?
bacillary angiomatosis
351
20-30's yo --> conductive hearing loss --> what condition?
otosclerosis
352
glucagonoma --> presentation (5)
- mild DM
- necrotic migratory erythema
- diarhea
- anemia
- wt loss
353
von Gierke dz --> enzyme
type 1 glycogen storage dz --> glucose 6 phosphatase def
354
von Gierke dz --> lab findings:
- glucose
- lactic acid
- uric acid
- lipid
- hypogly
- lactic acidosis
- hyperuric
- hyperlipid
355
von Gierke dz --> pt appearance (4)
- doll like face
- short stature
- thin extremities
- protuberant abd
356
tinea capitis --> tx
- griseofulvin
| - terbinafine
357
66M --> constipation, back pain, anemia, renal insuff, hyperCa --> what condition?
mult myeloma
358
how to differentiate Stevens Johnson vs toxic epidermal necrolysis
Stevens Johnson: <10% body surface area
toxic epidermal necrolysis: >30%
359
when is EPO started
Hb <10
360
EPO --> MC AE (3)
- worsening of HTN
- HA
- flu-like ssx
361
untreated hyperthyroid --> at risk for what comp? pathophys?
rapid bone loss
excess TH --> increase osteoclast activity
362
SERM --> AE (3)
- hot flash
- DVT
- endometrial hyperplasia (tamoxifen)
363
hyperNa --> assess vol status --> euvolemic --> next step
free water supplementation
364
hyperNa --> assess vol status --> hypovol --> symptomatic --> next step
1) restore vol w isotonic fluid (0.9% saline)
| 2) hypotonic fluid for free water supplementation (5% dextrose preferred over 0.45% saline)
365
leprosy --> presentation (3)
- anesthetic hypopigmented lesion w raised borders
- peripheral N --> nodular, painful deformation
- peripheral N --> loss of sensory/motor fx
366
leprosy --> dx
bx of active edge of lesion
367
AAA screen --> M or F or both? what age?
65-75 M
368
idiopathic intracranial HTN --> first line tx
acetazolamide +/- furosemide
