7.13.17 Flashcards
(180 cards)
1
Q
FEV1 65% of predicted
FVC 58% of predicted
FEV1/FVC 85%
what condition?
A
interstitial lung dz
2
Q
normal FEV1/FVC
A
80%
3
Q
what is arrest of active phase of labor?
A
no cervical change –> contractions:
- adeq –> >4hr
- inadeq –> >6hr
4
Q
at what cervical dilation does active phase of labor start?
A
6cm
5
Q
protracted active phase of labor –> MCC
A
inadeq contractions
6
Q
protracted active phase of labor –> tx
A
oxytocin
7
Q
what are adeq uterine contractions?
A
forceful and occur q2-3min
8
Q
pleural effusion –> Lights criteria –> exudate
A
protein (pleural:serum): >0.5
LDH: >0.6
9
Q
pleural effusion –> exudate –> common cause (3)
A
- infect
- malig
- PE
10
Q
pleural effusion –> exudate –> what 3 charact of exudate point to TB vs other etiology?
A
- high protein (always >4)
- lymphocytic leukocytosis
- low glucose (<60)
11
Q
43F –> 2 day confuse, lethargy –> h/o hepC, alcohol, IVDA –> T100.8, BP 120/70, HR 110, RR 20 –> scleral icterus, scattered spider angioma, abd distended w shifting dullness, diffuse tender –> what condition?
A
cirrhosis –> spont bact peritonitis
12
Q
tense bullae –> what condition?
A
bullous pemphigoid
13
Q
bullous pemphigoid –> bx finding
A
subepidermal cleavage –> IgG deposit at BM
14
Q
preg –> high risk pts should take how much folic acid? avg risk pts?
A
4mg vs 0.4
15
Q
preg –> who is at high risk for neural tube defects (4)
A
- methotrexate
- antiepileptic
- DM
- prior preg w NTD
16
Q
34F –> MVA –> CP, SOB –> BP 90/50, HR 118, O2 88% –> neck veins distended, trachea deviated R, L breath sounds absent –> what condition?
A
tension pneumo –> superior vena cava compression –> impede venous return
17
Q
tension pneumo –> tx? MOA?
A
needle decompress –> allow lung re-expand –> increase venous return
18
Q
DM during preg –> increased risk for what conditions in neonate (3)
A
- fetal lung immaturity
- preterm
- macrosomia
19
Q
DM during preg –> why increased risk of RDS?
A
maternal hypergly –> fetal hyperinsulin –> delay cell maturation –> immature pneumocytes –> can’t produce surfactant
20
Q
how can differentiate 1ary hyperPTH vs hyperCa of malig?
A
hyperCa of malig: rapid rise in Ca –> severe neuro ssx
1ary hyperPTH: modest hyperCa –> usu asx or mild, nonspecific ssx
21
Q
1ary hyperPTH –> Ca usu at what level?
A
<12 (modest)
22
Q
45F –> severe RUQ abd pain radiate to R shoulder, N/V –> h/o roux en Y gastric bypass –> what condition?
A
gastric bypass –> rapid wt loss –> promote gallstone formation –> symptomatic gallstones
23
Q
UA –> blood & protein vs blood & no protein –> glomerular hematuria or nonglomerular etiology?
A
glomerular: blood & protein
nonglomerular: blood, no protein
24
Q
hematuria –> gross vs microscopic blood –> glomerular or nonglom etiology?
A
glomerular: microscopic
nonglomerular: gross
25
hematuria --> dysmorphic vs normal RBC --> glomerular or nonglom etiology?
glom: dysmorphic
non: normal
26
35F --> several week severe ache in low back, hip, knees --> h/o end stage renal dz, DM1, sarcoid --> Cr 3.1, Ca 7.9, phosphorus 6.1 --> what condition?
chronic kidney dz --> decrease GFR --> decreased Ca, elevated phosphorus --> increase PTH (PTH hyperplasia & 2ary hyperPTH) --> renal osteodystrophy --> bone pain
27
chronic kidney dz --> what lab values indicate 2ary hyperPTH
elevated phosphate + low Ca
28
spont bact peritonitis --> ascitic fluid --> PMN count
>250
29
spont bact peritonitis --> tx
empiric broad spectrum abx --> 3rd gen ceph
30
62M --> 2day confuse, lethargy --> h/o cirrhosis, black stool for past few days --> moderate ascites, stool occult +, pitting edema, asterixis --> what condition?
GI bleed --> blood absorbed in small intestine --> high N loaded state --> hepatic encephalopathy
31
70F --> lethargy, decreased oral intake, SOB --> last night vomit --> h/o Parkinson w cog impair --> T 102, BP 70/60, HR 120, bronchial breath sounds in R lung base --> what condition?
aspiration pneumonia --> septic shock
32
bronchial breath sounds --> normal over trachea --> if heard elsewhere, indicates what?
no ventilation (ie consolidation) --> sound originates from bronchi and transmits to chest wall
33
septic shock --> how lead to acidosis?
septic shock --> hypotension & hypermetab state --> insuff O2 delivery to meet metab demands --> increased anaerobic metab --> lactic acid --> metab acidosis
34
38M --> 1wk fatigue, DOE, choking sensation when fall asleep supine --> h/o URI 2wk ago --> bibasilar crackles, pitting edema, PMI 6th intercostal space ant axillary line --> what condition?
coxsackie B --> myocarditis --> dilated cardiomyopathy --> heart fail
35
when (what presentation) should suspect myocarditis?
young --> recent viral ill:
- HF
- CP
- arrhythmia
36
T/F: pt w murmur needs dental prophylaxis
F
37
normal T4 5-12 --> if increase upper limit to 13 --> what happens to:
- sens
- spec
sens --> decrease
spec --> increase
38
humeral midshaft fracture --> freq comp?
radial N injury
39
radial N injury --> presentation (2)
- weak wrist/finger extend
| - loss of sens dorsal hand
40
16M --> several month nausea, watery diarrhea, bloat, wt loss --> h/o dry cough, SOB, wheeze that resolved; emigrate from Thailand --> Hb 10.4, MCV 72 --> what condition?
Thailand --> hookworm infect --> enter lung --> then intestines --> ingest blood:
- diarrhea
- malabsorption
- IDA
41
3rd trim screens (3)
- gestational DM
- alloimmunization
- maternal anemia
42
at what gestational age are 3rd trim screens done
20-28wk
43
gestational DM --> screening test? positive test?
1hr gtt >140
44
positive screen for gestation DM --> definitive test? positive test?
3hr gtt (any two):
- fasting >90
- 1hr >130
- 2hr >155
- 3hr >140
45
maternal anemia screen --> positive test?
Hb <10
46
positive screen for maternal anemia --> cause of anemia?
iron def
47
normal duration of stage 2 labor in nulliparous mother
3hr
48
what kind of mult gestation is at risk for twin twin transfusion?
monoZygotic
monoChorionic
diAmniotic
49
twin twin transfusion --> who does worse little twin or big twin?
big twin bc got too much blood
50
postpartum hemorrhage --> uterus absent --> what condition
uterine inversion
51
postpartum hemorrhage --> uterus boggy --> what condition
uterine atony
52
postpartum hemorrhage --> uterus firm --> what condition
retained placenta
53
postpartum hemorrhage --> uterus normal --> what condition
vag laceration
54
HIV preg --> tx --> preferred NRTI
tenofavir + emtircitabine
55
HIV preg --> when can vag delivery?
viral load <1000 + HAART
56
63M --> 6mo progressive fatigue, wt loss --> h/o 7mo ago pneumonia --> Hb 9.2, MCV 86, plt 150,000, WBC 9200, Ca 11.8, BUN 30, Cr 2.2 --> UA no proteinuria or hematuria --> what condition
MM
57
what presentation points to mult myeloma?
anemia + renal insuff + hyperCa
58
how does MM lead to renal insuff
monoclonal light chain --> clog renal tubule
59
fragile X --> presentation (5)
- delayed milestone
- autistic beh
- intell disability
- elongated face
- large testes
60
VSD --> how many days after MI?
3-5day
61
CP, SOB, hypotension, tachycardia, hypoxia --> what condition?
PE
62
FEV1/FVC: obstructive pattern? restrictive?
obstructive: <70%
restrictive: >70% (FVC <80%)
63
obstructive pattern --> what condition?
- low DLCO
- normal DLCO
- high DLCO
low: emphysema
normal: chronic bronchitis, asthma
low: asthma
64
33F --> sensation of severe spinning & intense nausea for 1-2hr, has lie to down w eyes closed for relief, hear mechanical humming --> tuning fork on forehead, sound more prominent in L ear --> what condition?
Meniere dz
65
Meniere dz --> pathophys
inner ear disorder --> defective resorb endolymph --> increased vol & pressure of endolymph --> damage vestibular & cochlea
66
Meniere dz --> classic triad
- tinnitis
- episodic vertigo
- sensorineural hearing loss
67
molar preg --> tx
suction curettage
68
molar preg --> f/u?
- monitor B-hCG
| - contraceptive (1yr)
69
choriocarcinoma --> initial eval
TVUS
70
choriocarcinoma --> best for dx?
bx curettage
71
63F --> 1day swelling of R 2nd MCP w guarding, tender --> h/o RA, joint deformities of b/l wrists, MCP, PIP --> R 100.8, BP 140/90, HR 90 --> what condition?
septic arthritis
72
septic arthritis --> presentation (2)
- acute monoarthritis: hot swollen, decreased ROM
| - fever
73
septic arthritis --> MC org
G+ org --> ie staph aureus
74
86F nursing home resident --> progressive lethargy, fever --> BP 75/40, HR 120, O2 85%, WBC 22000, urine >100WBC --> pt was treated appropriately --> 3day later nonblanching erythema on both heels --> what condition?
UTI --> sepsis --> ICU --> limited mobility --> pressure ulcer (early stage)
75
61M --> L pleural effusion --> 2L of yellowish fluid drained by thoracentesis --> 2hr later SBP 70, HR 130, O2 91%, dull to percussion, absent breath sounds --> what condition?
chest tube --> injure intercostal A:
- hemothorax --> impair breathing --> hypoxia
- intravasc vol deplete --> decrease LV preload
76
bacterial meningitis --> empiric tx? to cover what?
3rd gen ceph: MCC org (strep pneumo, N meningitdis, GBS, H flu)
+
vanco: S pneumo that may be resistant to B-lactams
+
dexamethasone
77
64M --> on chronic glucocorticoids --> bact meningitis --> empiric tx w 3rd gen ceph + vanco --> need what additional abx? why?
ampicillin
>50yo or immunocomp --> Listeria
78
murmur after S2 and declines in intensity until disappear suddenly before S1 --> heard along L & R sternal borders --> accentuated when sit up, lean forward, put hands behind head --> what condition?
AR
79
AR --> type of murmur?
descrendo diastolic
80
36M --> LBP, malaise, loss of sensation & motor in b/l LE --> h/o daily IVDA --> what condition?
epidural abscess
81
epidural abscess --> MC org
staph aureus
82
epidural abscess --> classic triad
- fever
- focal back pain
- neuro deficit
83
suspect epidural abscess --> next best step
broad spectrum IV abx
84
4M --> sore throat, pain when swallow food, runny nose --> erythema of pharynx w few vesicles, mild enlrg tonsils --> what condition?
viral pharyngitis
Coxsackie A --> herpangina
85
tumor lysis synd --> lab findings:
- Ca
- phosphate
- K
- uric acid
- hypoCa
- hyperPhosphate
- hyperK
- elevated uric acid
86
tumor lysis synd --> presentation (7)
- N/V
- bowel disturb
- low urine output
- acute renal insuff
- sz
- tetany
- arrhtymia
87
RF for transposition of great vessels
diabetic mother (NOT gestational DM)
88
RF for tetralogy of fallot
Down's
89
find subarachnoid hemorrhage on CT --> next step
angiography --> still bleeding?
90
suspect subarachnoid hemorrhage but CT is negative --> next step?
LP --> xanthochromia
91
early subarachnoid hemorrhage (48hr) --> should worry about and manage what 3 conditions?
- bleed
- hydrocephalus
- sz
92
SAH --> how manage bleed?
- BP <140/90
| - coil/clip
93
FND, HA, N/V, coma --> h/o HTN --> what condition?
intraparenchymal hemorrhage
94
intraparenchymal hemorrhage --> tx
craniotomy/evacuate --> decrease ICP
95
intraparenchymal hemorrhage --> monitor?
daily CT --> expanding hematoma
96
15mo M --> "turned blue" --> h/o teething trted with "numbing cream" --> BP 90/60, HR 158, RR 30, O2 86% --> supplemental O2 fail to increase pulse ox --> what condition?
topical anesthetic --> metHb --> cyanosis
97
metHb --> trigger
oxidizing subst:
- dapsone
- nitrite
- local/topical anesthetic
98
metHb --> pathophys
Hb --> 1 of 4 iron molecule --> oxidized to ferric (Fe3+) instead of ferrous (Fe2+):
- ferric site: less O2 affinity
- ferrous sites: increased O2 affinity
==> decreased O2 delivery to peripheral tissues
99
metHb --> lab findings:
- pulse ox
- PaO2
pulse ox: low --> ~85%
PaO2: normal
100
metHb --> tx
methylene blue
101
foodborne illness --> vomit predominant --> 3 MC org
- staph aureus
- bacillus cereus
- norovirus
102
1wk F --> dehydration, enlarged clitorus, BP 74/42, Na 128, K 5.8 --> what condition?
congenital adrenal hyperplasia --> 21 hydroxylase def
103
21 hydroxylase def --> lab findings:
- cortisol
- aldos
- test
- 17-hydroxyprogesterone
- cortisol: low
- aldos: low
- test: high
- 17-hydroxyprog: high
104
refeeding synd --> pathophys
carb intake --> insulin surge --> promote cell uptake of phosphorus, K, Mg
105
refeeding synd --> presentation (4)
- arrhythmia
- CHF
- sz
- Wernicke encephalopathy
106
3M --> sickle cell dz --> pallor, unable to awaken --> BP 55/30, HR 190, RR 45 --> significant splenomeg & tender LUQ --> what condition?
splenic sequestration --> hypovol shock
107
tachycardia & hypotension --> what type of shock (2)
- septic
| - hypovol
108
splenic sequestration --> pathophys
RBC pool in spleen:
- severe acute anemia
- splenic engorge
- hypovol shock
109
SCD --> splenic sequestration --> lab findings:
- retic count
- plt
- retic: elevated
| - plt: decrease
110
SCD --> splenic sequestration --> why thrombocytopenia?
plts trapped in spleen too
111
minimal change dz --> kidney bx findings:
- light microscopy
- IF
- electron microscopy
- light: normal
- IF: normal
- electron: effacement of foot processes
112
herpangina vs herpetic gingivostomatitis:
- seasonality
- location of vesicles
summer/early fall vs none
post oropharynx vs ant oropharynx
113
18mo M --> fever, facial rash --> painful clear vesicles on erythematous skin, dark-red crusting, cervical LAD --> h/o atopic dermatitis to cheeks trted w steroid cream --> what condition?
atopic dermatitis --> risk for superimposed infect --> HSV --> eczema herpeticum
114
suspect acute pancreatitis --> next step
serum amylase & lipase --> >3x normal
115
acute pancreatitis --> dx criteria (3)
- epigastric pain radiate to back
- >3x amylase, lipase
- imaging: pancreas enlrg
116
preterm labor --> expectant managemt at what gestational age?
>34wk
117
preterm labor --> <32wk gestation --> why Mg sulfate administered?
lower risk of neuro comorbidities
NOT used as tocolytic (bc it is a weak tocolytic)
118
dog/cat bite --> abx
amoxi/clav
119
human bite --> abx
amoxi/clav
120
black widow spider bite --> presentation
abd pain like pancreatitis
121
black widow spider bite --> tx
IV Ca
122
ethylene glycol ingest --> lab findings:
- anion gap
- osmolar gap
- anion gap: yes
| - osmolar gap: yes
123
methylene ingest --> lab findings:
- anion gap
- osmolar gap
- anion gap: yes
| - osmolar gap: yes
124
ethylene glycol/methylene --> tx
fomepizole or EtOH
125
ethylene glycol ingest --> comp
renal fail
126
ethylene glycol ingest --> clever way to dx?
wood's lamp --> urine fluoresce
127
salicylate toxicity --> tx
- alkalinize urine
| - diurese
128
cyanide toxicity --> tx
thiosulfate
129
reye synd --> liver bx findings
microvesicular fatty infiltration
130
prolactinoma --> tx
dopamine agonist (cabergoline, bromocriptine)
131
1day F w DiGeorge synd & truncus arteriosus in NICU --> poor feed, bloody stool, cyanotic, abd distention --> what condition?
cong heart dz --> reduced mesenteric perfusion --> necrotizing enterocolitis
132
74M --> urinary freq, nocturia, mild strain during urination, 2 episodes of bloody urine --> h/o smoke --> enlrged smooth prostate, UA 0-1WBC, 2-3RBC, trace protein --> next step?
unexplained gross/microscopic hematuria + bladder CA RF (smoke) --> cystoscopy
133
cardiac catherization --> sudden hemodynamic instability & ipsilat back pain --> what condition?
retroperitoneal hematoma
134
HSV vs CMV retinitis:
- pain
- keratitis/conjunctivitis
- fundoscopy
pain vs painless
keratitis vs no keratitis
Fundoscoppy:
- HSV: widespread pale peripheral lesions, central necrosis of retina
- CMV: fluffy or granular lesions around retinal vessels
135
30M --> something into eye while drilling --> normal penlight exam --> next step
fluroescein exam
136
prospective study --> many subjects were lost to followup by end of study --> what type of bias?
selection bias --> attrition bias
137
MC type of transfusion rxn? when does it occur?
1-6hr: febrile nonhemolytic transfusion rxn
138
febrile nonhemolytic transfusion rxn --> pathophys
during blood storage --> remaining leukocytes release cytokines:
- transient fever
- chills
- malaise
139
febrile nonhemolytic transfusion rxn --> need to use what type of blood products for future transfusions?
leukoreduced
140
postop fever --> causes & their onset
wind (1) --> water (3) --> walk (5) --> wound (7) --> wonder (10)
141
MC congenital cause of aplastic anemia
fanconi anemia
142
fanconi anemia --> pathophys
AR --> numerous genes involving DNA repair
143
fanconi anemia --> dx
genetic analysis --> chrom breaks
144
fanconi anemia --> presentation (4)
- congenital marrow fail
- poor growth
- morphologic abnormalities
- macrocytic anemia
145
when should suspect septic pelvic thrombophlebitis
postpartum:
- persistent fever unresponsive to abx
- negative infect eval (blood/urine culture)
diagnosis of exclusion
146
septic pelvic thrombophlebitis --> tx
anticoag + abx
147
zinc def --> presentation (5)
- hypogonad
- impaired taste
- impaired wound heal
- alopecia
- skin rash w perioral involvement
148
selenium def --> presentation (3)
- thyroid dysfx
- cardiomyopathy
- immune dysfx
149
copper def --> presentation (5)
- brittle hair
- skin depigment
- neuro dysfx
- sideroblastic anemia
- osteoporosis
150
indications for urgent dialysis --> mnemonic
AEIOU:
- acidosis
- electrolyte abnormal
- ingest
- overload
- uremia
151
colon cancer screen --> stop at what age
75
152
breast cancer screen --> what ages?
50-75
153
cervical cancer screen --> when stop (2)
- 65 + 3 consecutive normals
| - TAH
154
lung cancer screen --> who
55-80yo + 30ppd or quit <15yr
155
lung cancer --> how screen? how often?
low dose CT q1yr
156
AAA screen --> what age
>65
157
osteoporosis screen --> what age?
>65
158
HPV vaccine --> what ages?
9-26
159
when suspect progressive supranuclear palsy
parkinson features + limited vertical gaze
160
microcytic anemia + target cells --> what condition?
thalessemia
161
LE innervation:
- ant thigh
- post thigh/leg
- medial thigh
- ant/lat leg
- ant thigh: femoral N
- post thigh/leg: tibial N
- medial thigh: obturator N
- ant/lat leg: common peroneal/fibular N
162
sickle cell dz --> aplastic crisis --> pathophys
infect (ie parvovirus B19) --> transient arrest of erthyropoiesis
163
sickle cell dz --> when suspect aplastic crisis
acute drop in Hb + low retic + no splenomeg
164
lactose intol --> dx
lactose hydrogen breath test
165
acute bact rhinosinusitis --> MC org (2)
- strep pneumo
| - nontypable H flu
166
acute bact rhinosinusitis --> tx
amoxi/clav
167
2ary amenorrhea --> preg test neg --> next step
check prolactin, TSH, FSH
168
TTP --> tx? MOA?
plasma exchange --> remv pt plasma --> replace w donor plasma --> replenish ADAMTS13, remv autoAb
169
cryoprecipitate --> used to replace what? often used in what condition?
clotting factors, fibrinogen, vWF
DIC
170
small cell lung CA --> paraneoplastic (2)
- ACTH --> cushing
| - ADH --> SIADH
171
squamous cell CA of lung --> paraneoplastic
PTHrp --> high Ca
172
carcinoid tumor of lung --> dx
urine 5-HIAA
173
carcinoid tumor of lung --> paraneoplastic
serotonin synd
174
tumor lysis synd --> tx? MOA?
rasburicase --> break down uric acid to water-sol allantoin
175
thyroid nodule --> 1st step in eval
thyroid fx test
176
thyroid nodule --> normal thyroid fx --> next step
r/o malig --> FNA
177
stroke --> #1 RF
HTN
178
HIV pt --> molluscum contagiosum on face --> tx
curettage
179
impulsive & aggressive --> which neurotransmitter is low in CSF?
serotonin
180
mild mental retardation --> IQ range
50-70
