8 Flashcards
(99 cards)
1
Q
low back pain w/ alarm symptoms (worsening at night, >50 yo, fever, trauma, radiculopathy)
cord compression
A
back x rays, inflammatory markers
MRI
2
Q
obese diabetic med
A
metformin
3
Q
enuresis alarm vs desmopressin therapy
A
when behavioral interventions fail
alarm has better long term success, desmopressin is short term solution has high rate of relapse
4
Q
type I
type II
treatment of type II
A
progressive elongation of PR, then drop->benign
regular PR, intermittent nonconducted Ps->progression to complete AV block->pacemaker
IV atropine if unstable (hypotension, confusion, chest pain)
long term->pacemaker
5
Q
Nursemaid’s elbow imaging
treatment
A
unnecessary
hyperpronation/ supination
6
Q
persistent and localized LAD
A
biopsy (lymphoma)
7
Q
disagreement about futile care
A
ethics committee
8
Q
optimal kidney donor
A
living, related, identical blood type
9
Q
Rotator cuff tendonitis
A
lateral shoulder/deltoid pain, aggravated by abduction and external rotation
10
Q
Amiodarone chronic interstitial pneumonitis
treatment
A
nonproductive cough, chest pain, weight loss, DOE, interstitial opacities on CXR
stop amiodarone, steroids if severe
11
Q
amaurosis fugax
A
sudden, transient monocular blindness
marker of advanced CAD, carotid bruit
12
Q
Polymyalgia rheumatica associated with
muscle weakness without pain
A
giant cell arteritis
polymyositis
13
Q
Hemophilia A genetics
A
X linked recessive
14
Q
Rash post ampicillin/amoxicillin in mono
A
discontinue and observe
15
Q
preggo tdap
A
26-36 weeks of gestation
16
Q
Unilat, spontaneous nipple d/c
A
imaging (mammogram + u/s in >30 yo)
papilloma
17
Q
splenic vein thrombosis causes — bleeding
A
variceal
18
Q
in dyspepsia, only test for h. pylori if
h. pylori diagnosis
NSAID induced
A
no history of nsaid/cox 2 or persistent symptoms after PPI
breath/stool antigen (not serum)
give PPI
19
Q
HIV associated thrombocytopenia
active bleeding
if refractory
A
give ART
steroids or IVIG
splenectomy
20
Q
In treatment naïve HIV, ART should decrease VL to
A
<50 in 6 months
<500 in 8-16 weeks
<5000 in 4 weeks
21
Q
TB meningitis
diagnosis
A
choroidal tubercles (yellow-white nodules near optic disc) basilar meningeal enchancement CSF: prot >250, gluc <10, lymphocytic pleocytosis, adenosine deaminase
serial LPs->acid fast bacilli smear and culture
22
Q
TB meningitis treatment
A
RIPE + fluoroquinolone/aminoglycoside for 2 months, then 9-12 months of rifampin and isoniazid
adjuvant steroids
23
Q
Vulvodynia treatment
A
pelvic physiotherapy, CBT->botox
24
Q
preterm labor at 34-36 weeks
A
penicillin (if positive or unknown GBS) and steroids
- tocolytics before 34 weeks*
- Rh doesn’t have to happen during labor*
25
Infant botulism
diagnosis
treatment
neurotoxin that inhibits presynaptic ach release
constipation, oculobulbar weakness, desc flaccid paralysis, hyporeflexia
stool studies
IV botulism immune globulin
26
pain out of proportion to fracture/muscular injury
physical exam
fasciotomy
compartment syndrome
tightness, weakness, pain on passive movement
pressure > 20-30
27
investigate outbreak of infectious disease
| prevalence
case-control study
| cross sectional study
28
Occupational back pain, likelihood of returning to work
recovery expectation
29
lung cancer screening with low dose CT false positive rate
96%
30
Menopausal transition bleeding
| diagnosis
>45 yo->endometrial biopsy
| clinical, no labs needed
31
EEG in AMS
nystagmus, hippus, automatism
32
Hep B serum sickness
treatment
immune complexes activate complement
fever, polyarthritis, dermatitis, fatigue, malaise
polyarteritis nodosa, glomerulonephritis
supportive care, steroids/plasmapheresis if severe
33
syncope without prodrome, structural heart disease
cardiogenic, work up, tele and echo
34
Pulm sarcoid treatment
1-2 years of steroids if symptomatic, usually resolves
35
schizotypal vs schizoid
odd vs robot
36
scrapable white lesion in mouth
ok in antibiotics, chemo, inhaled steroids
otherwise,
candida
test for HIV
37
scrapable white lesion in mouth
ok in antibiotics, chemo, inhaled steroids
otherwise,
candida
test for HIV
38
metoclopramide side effects
akathisia, dystonia, Parkinson-like
39
breastmilk jaundice management
spontaneous resolution by 3 months
f/u and check bilirubin
phototherapy only if bilirubin rises
*conjugated hyperbilirubinemia is always pathologic*
40
Monotherapy hypoglycemic that causes significant hypoglycemia
sulfonylurea, meglitinide
41
bilirubin>20 or ineffective phototherapy
plasma exchange
42
onychomycosis/ severe tinea pedis
oral terbinafine
43
Hyperkalemia EKG
| treatment
peaked Ps, prolonged PR, QRS, no P waves
| calcium
44
cervical change during active labor
if less
no cervical change for >4 hrs with adequate contractions/ >6 hours without
variable decelerations
1 cm/ 2 hr
oxytocin, amniotomy
c/section
umbilical cord compression->amnioinfusion
45
silicone breast implants morbidity
contracture, deflation, rupture
46
investigate ischemic cardiomyopathy with
stress test or cath
47
good prognosis in schizophrenia
sudden onset, later age, positive psych symptoms
48
nonmetastatic squamous cell carcinoma of one vocal cord
radiation, laser or partial vocal cordectomy
49
Cough 5 days-3 weeks
>3 months in 2 consecutive years
acute bronchitis
viral->symptomatic treatment
chronic bronchitis->PFTs
50
porcelain gallbladder
increased risk of cancer, prophylactic chole if punctuate calcifications (not curvilinear) or biliary colic
51
white spots, discoloration on teeth
decay
| prevent with fluoride
52
white spots, discoloration on teeth
decay
| prevent with fluoride
53
No fruit juice when kids have viral gastro
hypotonic fluids (not water)
54
Pulmonary cachexia syndrome
loss of lean muscle mass due to energy imbalance and inflammation
55
PCOS patient seeking pregnancy first line treatment
weight loss ->ovulation induction->IVF
| IVF first line if there's tubal obstruction
56
Acute paronychia
treatment
Chronic paronychia with loss of cuticle
localized infection of nail fold
warm soaks, antiseptics, topical antibiotics
if abscess->drain
steroids
57
penicillamine
| lead toxicity
copper chelator
| <45: nothing, 45-69: succimer, DMSA >70: EDTA, dimercaprol
58
chronic psychotic symptoms w/o mania/ depression (stable mood)
not bipolar, schizoaffective
| in bipolar/depression, psychosis always comes with mood changes.
59
Ischemic stroke prevention
blood pressure control, smoking cessation, control of blood sugar and lipids
60
Nonsuicidal self-injury (cutting)
assessment of suicidality and comprehensive psych eval
61
Nonsuicidal self-injury (cutting)
Bulimia nervosa treatment
assessment of suicidality and comprehensive psych eval
fluoxetine
62
polycythemia initial test
EPO
low: polycythemia vera
high: secondary cause such as hypoxia (rule out carbon monoxide poisoning with carboxyhemoglobin) or RCC
63
polyhydramnios
| causes
AFI > 24cm
| maternal DM, multiple gestation, congenital abnormalities
64
Drug induced lupus drugs
diagnosis
presentation
hydralazine, procainamide, minocycline, etanercept, infliximab
ANA, anti-histone antibodies
fatigue, night sweats, serositis, arthralgia, fever, organomegaly
65
phencyclidine
PCP
66
Snoring management
smoking and alcohol cessation, weight loss
67
Organophosphate poisoning treatment
atropine and pralidoxime
68
sac overlying lumbar spine
associated with
diagnosis
myelomeningocele
neurogenic bladder, bowel
elevated AFP, u/s
69
Chronic urticarial
diagnosis
treatment
prognosis
itchy wheals/rash comes and goes spontaneously
clinical
daily cetirizine->oral steroids
spontaneous resolution in 2-5 years
70
studying difference in mean values among several groups
2 paired proportions, patients as controls
analysis of variance
mcnemar test
71
hidradenitis suppurativa
treatment
intertriginous areas (axilla, groin, medial thigh, perineum)
weight loss, smoking cessation, cleaning
topical abx->oral abx (sinus tracts, scarring)->TNF alpha inhibitors and surgery
72
cherry angioma vs strawberry hemangioma
adult, increase with age, no treatment vs infant, regress with age, no treatment
73
rectocele
treatment
protrusion of posterior vaginal wall
constipation, pelvic pressure, lower back pain, fecal incontinence
pessary, surgery
74
refractory hypoglycemia
| treatment
sulfonylurea poisoning
dextrose, octreotide
*dextrose can cause transient hyperglycemia->insulin release->rebound hypoglycemia*
75
IgA nephropathy vs post strep glomerulonephritis
gross hematuria (benign) vs >10 days post infection, no hematuria, decreased complement levels
76
epiglottitis
intubate if
lateral neck x ray
Hib,
stridor, drooling, dysphonia
thumbprint sign
*racemic epi for croup (barking cough)*
77
inability to find significance
Type II error
78
sudden cardiac death in young athlete with normal ECG and echo
diagnosis
brugada and long QT
anomalous aortic origin of coronary artery
angina/lightheadedness/syncope
coronary CTA/ MRA
not exertional
79
rapid, shallow breathing with normal VS post MVA
| treatment
flail chest
| oxygen, pain control, positive pressure ventilation, surgery
80
heat stroke
| treatment
flushed, hot dry skin
| evapourative cooling
81
catatonia
treatment
treatment of anti-psychotic induced dystonia, parkinsonism
stuck
benzo
benztropine
82
Likelihood ratio
negative likelihood ratio
probability of patient with disease to have finding/ probability of patient without disease to have finding
sensitivity/ 1- specificity
1-sensitivity/ specificity
83
Preop eval METS
Even if symptomatic during performance, ability to complete is what matters?
84
Features of benign pulm nodules
malignancy
popcorn calcification, concentric/central/diffuse/laminated homogenous calcification
eccentric, reticular, punctuate
85
tibial stress fracture
x ray
management
pain, localized tenderness, swelling
normal
pneumatic splinting, reduced weightbearing, graduated exercise
86
Negative symptoms in schizo
usually don't respond to antipsychotics
| refer for social skills training
87
stool cysts, flagellated trophozoites with 2 nuclei, persistent diarrhea after camping
prevention of outbreak
treatment
giardia
treat symptomatic people (don't just treat stool), stay away from recreational water
flagyl
88
Pseudotumor cerebri not just obesity, but also
endocrine disorders, minocycline, isotretinoin
89
Salmonella in anyone more than a year old
supportive care
90
complex adnexal mass, positive B HCG, no evidence of intrauterine pregnancy
ectopic pregnancy
91
early pregnancy of undetermined location
bcg <1500, not visualized
92
chronic steroid therapy, add vitamins
D and calcium
| annual DEXA
93
lactational mastitis treatment
| breast abscess
oral dicloxacillin/ cephalexin
| fine needle aspiration
94
tertiary hyperparathyroidism
parathyroidectomy when
CKD->elevated phosphorus->binds calcium->low free calcium->elevated pth->gets out of control->remains elevated
persistent hypercal/phos, very high PTH, soft tissue calcification/calciphylaxis, intractable bone pain
95
Parkinson psychosis
can be caused by medications
carbidopa/levodopa should be last to be reduced
if refractory, start quetiapine, clozapine, pimavanserin
96
NPH vs long-acting basal
hypoglycemia
97
pear shaped motile organisms
trichomonasiasis
98
postpartum endometritis treatment
most important risk factor
PID
clindamycin+ gentamicin
c/s, chorioamnionitis, preterm, protracted labor, PROM
ceftriaxone + azithromycin
99
Analgesic nephropathy
papillary necrosis->hematuria, pyuria, renal colic, proteinuria, sterile urine
