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1
Q

analgesic nephropathy

A

florid nephrotic range proteinuria

multiple myeloma protein usually not on u/a-UPEP

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2
Q

Subclinical hypothyroidism
Treat if

complications

A

Elevated TSH, normal free T4, get anti-TPO
TSH >10, symptomatic, pregnant, infertile, goiter, positive antibody
miscarriage, preeclampsia, preterm birth, pregnancy complications

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3
Q

severe bradycardia 2/2 RCA MI

A

IV atropine

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4
Q

Refeeding CHF

A

hypophosphatemia-oral phosphate (no diuretics)

also watch mg, k, thiamine

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5
Q

Sickle cell
aplastic crisis

hyperhemolytic crisis

A

dactylitis, hemolytic anemia. HgbS on electrophoresis
transient cessation of erythropoiesis due to parvovirus, low rec count, transfuse
increased rec count

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6
Q

Disseminated VZV

A

IV acyclovir (ganciclovir for local), airborne and contact precautions

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7
Q

Helminth infection

A

eosinophilia, chronic diarrhea, high risk of reinfection, treat entire family

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8
Q

Pseudotumor cerebri vs migraines

A

If fat and fertile, do eye exam

migraines can be associated with aura-vision changes, nausea, tingling

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9
Q

friable cervical lesion

A

rule out cancer

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10
Q

Hot flashes treatment

A

escitalopram/venlafaxine

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11
Q

Neonates with bilirubin >20

breastfeeding jaundice

A

exchange transfusion

supplement with formula

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12
Q

Hawthorne effect

A

change in behavior due to observation

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13
Q

GBS babies

A

observe for 2 days

if no abx >4 hours before delivery AND preterm or PROM, obtain CBC and culture

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14
Q

post op SIADH hyponatremia

A

mild-fluid restrict, salt tabs

only symptomatic, severe with seizures-hypertonic saline

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15
Q

Suppurative otitis media

A

copious drainage, feeling better after tympanic membrane ruptures

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16
Q

Diaper dermatitis

A

No powder-aspiration risk

tx: zinc oxide, petrolatum
* candida dermatitis-nystatin, miconazole

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17
Q

synthroid drug interactions

A

calcium and iron should be taken 3-4 hours later

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18
Q

45 XO

A

Turner syndrome: get TTE (cardiac defects), renal ultrasound, TSH, hearing and vision tests

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19
Q

Testicular cancer workup

A

ultrasound, CT scan, CXR, serum markers, orchiectomy

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20
Q

Indolent pna with interstitial infiltrates in immunocompromised patient
tx
steroids if

A

pcp

bactrim
o2gradient >35 or pao2 <70 (inflammation from pcp lysis)
if sputum culture is negative->bronchoalveolar lavage

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21
Q

Digoxin toxicity

induced by

A

N/V, anorexia, fatigue, confusion, cardiac abnormalities, visual disturbances
verapamil, amio, quinidine

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22
Q

burning sensation, mucoid discharge that crusts eyes shut,
infectivity

w/ itching

A

viral

over after discharge resolves bacterial-after 24 hr of topical therapy
allergic

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23
Q

TSH in history of thyroid cancer

A

Use levo to suppress TSH to low normal range

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24
Q

CAP treatment

A

Mac/doxy (healthy), mac+beta lactam/fluoroquinolone (comorbidities)
Inpt: fluoroquinolone OR beta lactam+mac
ICU: beta lactam+ mac OR beta lactam+ fluoroquinolone

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25
Q

TP FP PPV (TP/ TP+FP)
FN TN NPV (TN/TN+FN)
Sens Spec
(TP/TP+FN) (TN/TN +FP)

A

Spec, sens table

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26
Q

tuberous sclerosis testing

cause of death

A

Imaging, EEG, skin exam (ash-leaf, hypopigmented), benign tumors
epilepsy (neurologic impairment), aspiration pna, obstructive hydrocephalus

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27
Q

Lead time bias vs length time bias

A

Screening catches earlier vs patients who are screened have slowly progressive form of disease

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28
Q

Asthma exacerbation do not need imaging

A

prednisone and albuterol

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29
Q

myxedema coma

pretibial myxedema

A

hypothyroidism
synthroid increases risk of MI in CAD, start slowly
iodine loading is for hyperthyroidism
Grave’s-hyperthyroidism

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30
Q

Essential tremor vs Parkinson’s

essential tx

A

movement, no bradykinesia, no rigidity vs resting tremor

propranolol if necessary

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31
Q

Acute hep c

A

antibody may be negative, get viral load

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32
Q

clozapine risk

A

agranulocytosis

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33
Q

EBV mono treatment

complication

A

Supportive care and NSAID

aplastic anemia, airway obstruction-steroids

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34
Q

otitis externa

A

mild-topical acetic acid
moderate-topical abx
severe with edema-placement of a wick

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35
Q

uterine atony

A

postpartum hemorrhage-> massage uterus+ oxytocin/misoprostol/methylergonovine/carboprost

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36
Q

tetanus ppx for bite wounds

A

dirty: booster if last dose >5 years ago, vaccine and ig if unimmunized/not fully immunized
clean: vaccine if last dose >10 years ago, vaccine if unimmunized

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37
Q

lupus nephritis

monitoring

A

GET BIOPSY!

anti-dsdna and complement (will be low) levels

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38
Q

Postconcussive syndrome

A

headache, confusion, amnesia, difficulty concentrating, vertigo, mood disorder

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39
Q

Pseudomonas pneumonia (HAP or structural lung disease)

A

gentamicin/zosyn/Levaquin (2 of 3 required)

if respiratory failure-vanc to cover for MRSA

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40
Q

Elevated PSA with urinary symptoms

A

observe. only workup for prostate cancer if persistent

41
Q

multifocal atrial tachy

A

irregular, 3 different P morphologies-treat underlying cause

pulm disease in elderly, sepsis, electrolytes

42
Q

bronchiectasis

A

recurrent infections

43
Q

oculoglandular syndrome

A

conjunctivitis and ipsilateral preauricular and cervical adenopathy due to cat scratch disease, complicated by lymph node suppuration, azithromycin

44
Q

TTP treatment (plex)

A

repleting ADAMST13-a metalloproteinase

45
Q

Cyclosporine gout

A

decreased excretion of uric acid

* do not use colchicine with azathioprine in post-transplant patients. *

46
Q

Tourette
chronic tic
provisional tic
Tourette treatment

A

several motor with at least one vocal tic
motor OR vocal >1 year
<1 year
habit reversal therapy, antipsychotic (Risperdal, abilify in children)

47
Q

Status epilepticus

A

Benzo, if refractory-fosphenytoin/valproic acid

still refractory-continuous midazolam, phentobarb, propofol

48
Q

Pregnant UTI

A

fosfomycin, cephalexin, amoxicillin-clavulanate

49
Q

CABG for

A

3 vessel disease
multivessel disease involving LAD
DM and multivessel disease

50
Q

pernicious anemia associated atrophic gastritis

A

glandular atrophy in gastric body and fundus, inflammation, intestinal metaplasia

51
Q

Rosacea treatment

complications

A

topical brimonide/flagyl

ocular-chalazion (nodule on eyelid)

52
Q

Low risk surgery preop (breast, ambulatory, endoscopy, cataracts)

A

If no active disease-no further workup

otherwise, RCRI, if >=4 METS-no workup, if less-workup

53
Q

Intususception diagnosis

Intestinal malrotation and volvulus dx

A

target sign on u/s-tx: air or water contrast enema (complications-perf)
bilous emesis-upper GI series

54
Q

Wallenberg syndrome

A

lateral medulla
occlusion of PICA or vertebral artery, loss of pain and temp over opposite sides of body, bulbar muscle weakness, vertigo, nystagmus, ipsilat limb ataxia, horner’s syndrome

55
Q

tamoxifen

risks

A

nonmetastic estrogen receptor positive breast cancer
prevention in hyperplasia with history of lobular carcinoma in situ
endometrial cancer, uterine sarcoma in postmenopausal women
only evaluate if symptomatic

56
Q

Medicare A
B
C
D

A

inpatient
outpatient
private insurance plans
prescription drugs

57
Q

Pregnant thyroid

A

mildly hyperthyroid is fine

58
Q

Opioid toxicity

A

pinpoint pupils, resp depression, AMS

59
Q

Raynaud treatment

A

amlodipine, nifedipine

60
Q

DM and exercise

A

If short-decrease preprandial

If > 60 mins-consider decreasing basal also

61
Q

Allergic bronchopulm aspergillosis

CXR

treatment

A

Asthma/cystic fibrosis, recurrent infections with brown sputum, eosinophilia, test skin
upper lobe opacities, mucous plugging, bronchial wall thickening
oral prednisone, omalizumab, itraconazole/voriconazole

62
Q

Mucormycosis tx

A

liposomal amphotericin B

63
Q

Achilles tendon rupture

A

Thompson test-no plantar flexion when calf muscle is squeezed-MRI

64
Q

Duchenne muscular dystrophy

treatment

A

LE weakness in 2-3 yo boy, gowers sign, calf pseudohypertrophy, dilated cardiomyopathy, scoliosis
*measure CK
*testing-dystrophin deletion
steroids

65
Q

Acute bronchitis in COPD

A

give antibiotics

66
Q

verification bias

A

when a test is only used on positive/negative screening

67
Q

Tick paralysis

A

sensation intact with ascending paralysis, hyporeflexia, remove tick
hepatavalent antitoxin for botulism

68
Q

Pregnant acne

A

topical abx, azelaic acid

retinoids/-tene

69
Q

Steroids can make you go crazy.

A

Reduce

70
Q

To rule out a disease

A

Sensitivity

71
Q

Iron def anemia

A

microcytic hypochromic RBCs

72
Q

If legal guardian exists and can’t be reached

A

proceed in emergency

73
Q

Antipsychotics in elderly

A

increased mortality

74
Q

Warts that turn white with acetic acid

treatment

A

HPV

trichloroacetic acid, interferon, surgical excision

75
Q

Mammogram starting at age

Genetic testing

A

40
2 first degree relatives, 3 2nd degree relatives, relative with ovarian and breast cancer OR bilateral breast cancer, male relative with breast cancer
Ashkenazi-just one relative

76
Q

Erythrocytosis and hematuria in smoker

A

RCC-get CT scan-thickened septa/walls-no biopsy needed, refer for nephrectomy

77
Q

bupropion CI in

A

seizures

varenicline is safe-maybe cardiac effects

78
Q

HypoMg, HypoK EKG

A

Prolonged QTc

79
Q

Licorice side effects

A

inhibits conversion of cortisol to cortisone. cortisol binds to mineralocorticoid receptors-hypertension, hypokalemia, metabolic alkalosis

80
Q

Asymptomatic LV systolic dysfunction

A

ACEI, BB

81
Q

Bicuspid valve screening

management

A

echo every 1-2 years

valvuloplasty or surgery (if aorta is involved)

82
Q

cranial nerve III palsy (ptosis, anisocoria)

A

posterior communicating artery aneurysm-subarachnoid hemorrhage (headache, nausea, nuchal rigidity

83
Q

pleuritic chest pain, loud P2, pleural friction rub, hypoxemia, small effusion

A

acute PE

only a normal v/q scan rules out pe in high pretest probability

84
Q

Functional hypothalamic amenorrhea

treatment

A

exercise-induced, all hormones decreased
increased calories, estrogen, calcium/vitamin d
exogenous growth hormone-hypertension, fluid retention

85
Q

amputated body parts

A

wrap in sterile gauze, moisten with saline, place in sealed, sterile plastic bag on ice mixed with saline

86
Q

Pregnancy synthroid

A

increase by 25-50%

87
Q

Paget’s disease

treatment

A

bone pain, weightbearing bones, neuro symptoms, hypercalcemia, hypercalciuria, CHF
xray-cortex thickening, bone scan-increased uptake
bisphosphonates
calcitriol is for the treatment of hypoparathyroidism

88
Q

pathologic scoliosis

A

back pain, neuro symptoms, rapidly progressing curvature, vertebral anomalies on x ray

89
Q

DVT/PE treatment

A

If cancer-lovenox

If not-orals

90
Q

Cervical insufficiency

short cervix

A

> =2 painless miscarriages in 2nd trimester-cerclage

incidental finding-serial measurement and vaginal progesterone

91
Q 
SGLT2 inhibitor (-gliflozin) side effect
metformin
A

euglycemic DKA

lactic acidosis

92
Q

actinic keratoses

A

come and go, cryodestruction, biopsy if >1cm, tender, indurated, ulcerated, growing rapidly

93
Q

large volume foul-smelling stools, flatulence, weight loss, microcytic anemia, elevated stool osmotic gap

collagenous colitis

A

celiac disease
small bowel biopsy-villous atrophy, intraepithelial lymphocytic infiltrate, crypt hyperplasia
nocturnal diarrhea, fecal urgency, decreased osmotic gap (secretory), thick subepithelial collagen band

94
Q

NSAIDs kidney

A

AIN

95
Q

hyperthyroidism

complication

A

behavioral changes, weight loss, tachy, hyperreflexia, lid lag (sclera above irises), sweaty skin
arrhythmia, cardiomyopathy, osteoporosis

96
Q

Orthostatic hypotension caused by

A

diuretics, alpha blockers or nitrates

97
Q

pulmonary contusion vs PE

fat embolism

A

opacification on CXR-supportive care

confusion, petechial rash

98
Q

narcolepsy testing
treatment
treatment of associated cataplexy

A

sleep study
stimulants-modafinil, methylphenidate
SNRIs, SSRIs, TCAs, sodium oxybate
absence seizures-valproic acid

99
Q

likelihood ratio

A

independent of prevalence, applies to individual patient

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