CK Flashcards
(854 cards)
1
Q
Hypertension in pregnancy
A
Gestational hypertension: new onset of HTN (>140/>90) at >20 wks in the absence of proteinuria or end organ damage
-no drug therapy
2
Q
Most common sequela of undescended testicle
A
INFERTILITY»_space; testicular cancer
3
Q
Treat acute flare-up of multiple sclerosis
A
Corticosteroids (methylprednisolone)
4
Q
Salmonella infection
A
From water, eggs, poultry, or seafood
Nausea, vomiting, diarrhea [+ mild blood], cramping
DO NOT TREAT ages 2-50 who are not severely ill or immunocompromised
-no benefit, and may actually prolong carriage and increase risk of relapse
DO TREAT: severe disease (high fever, severe diarrhea, need for hospitalization) or those who are immunocompromised; infants and older adults
Children: amoxicillin or TMP/SMX
Adults: fluoroquinolones
5
Q
Parameters in neurogenic shock
A
Characterized by decreased SVR (distributive shock)
RAP: decreased
CO: decreased
SVR: decreased
Causes BRADYCARDIA, while all other causes of chock lead to tachycardia
6
Q
If >30% increase in serum creatinine after starting an ACE inhibitor
A
Bilateral renal artery stenosis
If <30%, can continue ACE-i
7
Q
sJIA criteria
A
Arthritis + daily fever for 2 weeks + any one:
- evanescent red rash
- generalized lymphadenopathy
- hepatomegaly or splenomegaly
- serositis
8
Q
Medical therapy in hypertrophic cardiomyopathy
A
Beta blocker + non-dihydropyridine CCB (verapamil)
Diuretics, nitrates, and digoxin can worsen clinical status
9
Q
First step after PPROM
A
(<37 wks)
Assessment of fetal lung maturity via lamellar body count
10
Q
Treatment of gustatory rhinitis
A
Nasal ipratropium
11
Q
Treatment of essential thrombocythemia
A
Aspirin for low risk cases
Hydroxyurea for intermediate to high risk disease
Interferon for refractory cases
12
Q
Eczema herpeticum
A
A complication of severe atopic dermatitis (eczema) where superinfection of eczema with HSV causes a vesicular eruption on preexisting inflamed skin
Fever and pain
13
Q
Erythroderma (exfoliative dermatitis)
A
Erythema and scaling of >90% of body surface
14
Q
Dyslexia is classified as a
A
Specific learning disorder
15
Q
Important for ADHD diagnosis
A
In >1 setting (e.g., home AND school)
16
Q
Ascertainment (sampling) bias
A
Study population differs from target population d/t nonrandom selection methods
17
Q
Nonresponse bias
A
High nonresponse rate to surveys/questionnaries can cause errors is nonresponders differ in some way to responders
18
Q
Berkson bias
A
Disease studied using only hospital-based patients may lead to results not applicable to target population
19
Q
Prevalence (Neyman) bias
A
Exposures that happen long before disease assessment can cause study to miss deceased patients that die early or recover
20
Q
Attrition bias
A
Significant loss of stud participants may cause bias if those lost to f/u differ significantly from remaining subjects
21
Q
Recall bias
A
Common in retrospective studies
Subjects w/ negative outcomes are more likely to report certain exposures than control subjects
22
Q
Observer bias
A
Observers misclassify data d/t individual differences in interpretation or preconceived expectations regarding study
23
Q
Reporting bias
A
Subjects over- or under-report exposure history d/t perceived social stigmatization
24
Q
Surveillance (detection) bias
A
Risk factor itself causes increased monitoring in exposed group relative to unexposed group, which increases probability of identifying disease
25
In kids <3 y.o., watch out for ______ on CXR
the thymus: "sail sign" (triangular shape)
26
Osteogenesis imperfecta
- autosomal dominant
- Type I collagen gene (COLA1)
Mild-moderate:
- frequent fractures
- blue sclerae
- conductive hearing loss (and assx speech delay)
- short to normal stature
- dentinogenesis imperfecta
- joint hypermobility
Lethal (type II)
- in utero +/or neonatal fractures
- pulmonary failure
27
Posterior urethral valves
Newborn boys w/ bladder distension, decreased urine output, and respiratory distress (d/t oligohydramnios and subsequent lung hypoplasia)
Renal and bladder US and voiding cystourethrogram
28
Raynaud disease vs phenomenon
Raynaud phenomenon: presence of pain, cold intolerance, and color change of distal extremities, secondary to conditions like SLE and scleroderma
Raynaud disease: presence of isolated Raynaud phenomenon
Tx: keep warm and CCBs
29
Verruca vulgaris is caused by
HPV 1-4
NOT covered in the HPV vaccine
30
HPV strains
Verruca vulgaris: 1-4
Genital warts: 6, 11 [covered by vaccine]
Cervical cancer: 16, 18, 31, 33 [covered by vaccine]
31
Most specific EKG finding in digoxin toxicity
Inverted T waves
Bradycardia, hypotension, conduction delay, downward swooping of ST segment, inverted T wave, hyperkalemia
32
Congenital hypothyroidism vs neonatal hypothyroidism
Congenital: low or absent thyroid hormones AT BIRTH
Neonatal: aka "cretinism," postnatal tests are NORMAL
33
Pain medication in pregnancy
Cyclobenzaprine (category B)
NOT opioids because of NAS
34
Trigeminal neuralgia may be the forme fruste of
multiple sclerosis
35
Antithyroid medication side effects
- agranulocytosis
| - hepatic damage
36
Agranulocytosis classic hint
sore throat and high fever
37
Metformin and CKD
Metformin should not be used if Cr > 1.4, as potentially fatal lactic acidosis can develop
38
Initial evaluation after cystoscopy demonstrates bladder cancer
transurethral resection of the bladder tumor (TURBT)
-assesses histologic grade and depth of invasion (non-muscle invasive, muscle invasive, metastatic)
If muscle-invasive, then CT/MRI
39
Pioglitazone side effect
Fluid retention and peripheral edema, which can worsen CHF
40
Maternal vs classic hypothyroidism
Maternal: tacycardia
Classic: bradycardia
41
Biopsy of atopic dermatitis shows
spongiosis
42
Down syndrome most common cardiac defect
Complete atrioventricular septal defect
Failure of endocardial cushions to merge results in both VSD and ASD
43
If recurrent UTI symptoms but negative UA, next step is
Cystoscopy
44
First-line for cellulitis
po cephalexin
45
Treatment of dangerous hypercalcemia
IV salmon calcitonin with concurrent bisphosphonate
46
Treatment of acute cystitis in first trimester
Cefpodoxime, amoxicillin-clavulanate, or fosfomycin
Nitrofurantoin and TMP-SXM are contraindicated in first trimester and near term
47
Treatment of HPV genital warts in pregnancy
Trichloracetic acid or bichloracetic acid
48
Treatment of Torsades de pointes
IV magnesium sulfate
49
Constitutional growth delay
delayed growth spurt, delayed puberty, delayed bone age
- normal birth weight and height
- 6mo-3yo growth velocity slows and percentile drops
- 3yo regains normal velocity, tracking 5th-10th percentile
- bone age xrays delayed compared to chronological age
50
IV fluid resuscitation in children
IV ISOTONIC crystalloid (NS or LR)
51
Complications of PPROM
- preterm labor
- intraamniotic infection
- placental abruption
- umbilical cord prolapse
52
PPROM
PROM <37 wks
<34 wks (reassuring): latency abx, corticosteroids
<34 wkd (nonreassuring): delivery
>34 wks: delivery
53
If postmenopausal bleeding
TVUS or endometrial biopsy
Rule out endometrial cancer
If TVUS >4mm, need biopsy
54
Cervical displacement may be seen in
Endometriosis
d/t adhesions
55
Peripartum cardiomyopathy
Development of DCM within last month of pregnancy or w/in 5 months following delivery
Prorgessive DOE, lower extremity edema, S3
Associated w/ mitral regurgitation
Dx: transthoracic echo
Rx: like any HF
Immediate delivery only if hemodynamically unstable
56
Lichen planus association
HepC
57
Osetosarcoma vs Ewing sarcoma vs giant cell
Osteosarcoma: spiculated "sunburst" pattern, Codman triangle (periosteal elevation)
Ewing: "moth-eaten" appearance, onion skinning, Codman triangle
Giant cell (aka osteoclastoma): "soap bubble" appearance
58
If abdominal free air on XR from perforated viscus
Emergent surgery
59
Emergency contraception options and timing
- copper IUD (0-5d)
- Ulipristal pill (0-5d)
- Levonorgestrel pill (0-72h) [PLAN B]
- Progestin (0-72h)
60
Tourette syndrome treatment
- antidopamine agents
- tetrabenzine (dopamine-depleting agent)
- antipsychotics (risperidone, haloperidol)
- alpha-2-adrenergic agonists (not as good)
- guanfacine, clonidine
61
Pseudodementia
MDD in elderly can mask as cognitive impairment
REVERSIBLE
62
Bleeding disorder in patients with cystic fibrosis
Vitamin K deficiency due to exocrine pancreatic insufficiency
- prolonged PT
- easy bleeding, mucosal bleeding, epistaxis
63
First step in evaluation of severe hypospadias
Karyotype analysis, since can represent virilization of XX or undervirilization of XY
Severe hypospadias
- urethral meatus located at the perineum or scrotum
- underdeveloped penis/glans
- severe penile curvature
64
CSF in CJD
elevated 14-3-3 protein titers
65
Bordetella pertussis prophylaxis
Recommended for all close contacts
Azithomycin, erythromycin, or clarithromycin
Azithromycin in <1 mo
66
Scarlet fever
d/t Strep pyogenes
- fever and pharyngitis
- tonsillar erythema and exudates
- strawberry tongue
- tender anterior cervical nodes
- sandpaper rash
tx: penicillin (amoxicillin)
67
Staphylococcal scalded skin syndrome
d/t Staph aureus
-superficial flaccid bullae followed by extensive exfoliation of the skin
68
Potassium in DKA
Can be high or normal (since acidemia and decreased insulin cause EC shift), but total body potassium is depleted
69
Management of chorioamnionitis
Antibiotics and immediate delivery, regardless of gestational age
70
Distinguish PNES from epilepsy
-absence of self injury, incontinence, or post-ictal confusion
Suggestive features of PNES
- forceful eye closure
- side-to-side head or body movements
- rapid alerting and reorienting
- memory recall of the event
- in front of witnesses
- may model behavior off friend/family member w/ epilepsy
71
Antibiotics for epiglottitis
d/t Haemophilus influenzae type B, strep, staph
Treat empirically with: Ceftriaxone (Hib + strep) and vancomycin (staph)
72
Severe pain in areas of lymphadenopathy after small quantities of alcohol
Hodgkin lymphoma
73
Hodgkin lymphoma labs
Elevated LDH and eosinophilia
74
Endometrial polpys
Regular menstrual bleeding with additional intramenstrual bleeding
75
Claw and hammer toe deformities
Due commonly to peripheral diabetic neuropathy
76
Preseptal cellulitis vs orbital cellulitis
- eyelid erythema and swelling
- chemiosis
- rx: oral antibiotics
Not as severe as orbital cellulitis
- sx of preseptal cellulitis PLUS
- pain w/ EOM, proptosis, +/or ophthalmoplegia w/ diplopia
- needs IV abx +/- surgery
77
McCune-Albright syndrome
- café au lait spots
- precocious puberty
- fibrous dysplasia of bone
78
Causes of osteomyelitis in sickle cell disease
- Salmonella
- staph aureus
Treat w/ vancomycin and ceftriaxone
79
Post C-section mother with signs of hemorrhagic shock
Intraabdominal bleeding from uterine artery injury --> retroperitoneal hematoma
Emergency lapatotomy
80
Widening of the prevertebral space on xray
Retropharyngeal abscess
Fever, dysphagia, muffled voice, pain w/ neck extension
81
Methemoglobinemia
Excessive exposure to oxidizing agents (dapsone, nitrates, local anesthetics) results in CYANOSIS (can also get lethargy, respiratory depression, seizures, and death)
Fe++ --> Fe+++, which is unable to bind O2
Hgb changes and get a left shift (increased affinity for O2, which leads to decreased oxygen delivery to tissues)
Pulse ox of ~85% regardless of true oxygen saturation level
Supplemental O2 has no effect
ABG: falsely elevated oxygen saturation level (normal PaO2) since measures only unbound arterial oxygen (and not Hgb-bound O2)
Rx: methylene blue (or high dose ascorbic acid (vitC) if not available)
82
Cyanosis with feeding that is relieved with crying
Choanal atresia (failure of posterior nasal passage to canalize)
Dx: inability to pass catheter through nares
83
When to get a CT in bacterial sinusitis
focal HA, early morning vomiting, AMS, focal neurologic signs
CT: ring-enhancing brain abscess
84
Citalopram consideration
Dose-dependent QT prolongation
85
SSRI with the lowest risk of drug-drug interactions
Sertraline
86
Normal progression of active labor
Latent: 0-6 cm
Active: >6-10– ≥1 cm every 2 hrs
87
Rectus abdominis diastasis
Weakening of the linea alba between the rectus abdominis muscles
NO FASCIAL DEFECT
Nontender abdominal bulge (often in pregnant or postpartum patients)
Managament is conservative w/ observation and reassurance
88
Marfan syndrome gene
fibrillin-1
Autosomal dominant
89
Refeeding syndrome
Due to insulin -->
Low phosphorus, potassium, and magnesium
90
Stomal (anastamotic) stenosis post Roux-en-Y bypass
w/in the first year:
-progressive nausea, postprandial vomiting, GERD, and dysphagia to the point of not tolerating liquids
EGD w/ balloon dilatation
91
ALL vs sickle cell disease
Sickle cell disease does not have lymphadenopathy
92
Manifestations of mumps
- parotitis
- orchitis
- meningitis
93
Cephalohematoma
Subperiosteal scalp swelling w/
- firm
- nontender
- does not cross suture lines
- no skin discoloration
RF: forceps or vacuum-assisted delivery
Most resorb spontaneously, but increased risk of hyperbilirubinemia and may need phototherapy
94
Caput succedeneum
Scalp swelling superficial to the periosteum that crosses suture lines
95
When to do CTA vs D-dimer
Modified Wells criteria
PE likely: CTA
PE unlikely: D-dimer
96
Rubella
Low-grade fever, lymphadenopathy (suboccpital, posterior auricular, posterior cervical), maculopapular exanthem that spreads cephalocaudally
Forsccheimer spots (erythematous papules on the soft palate) may be seen
97
Cause of Duchenne muscular dystrophy
Deletion of the dystrophin gene
98
Treatment of neonatal conjunctivitis
Oral azithromycin
monitor for pyloric stenosis
99
Erythromycin association in neonates
pyloric stenosis
100
If rash 1-3 weeks after varicella vaccine
Mild but contagious infection from live-attenuated vaccine.
- <10 lesions
- maculopapular +/or vesicular
101
First step in workup of pediatric asymptomatic or isolated proteinuria
First morning urine protein:Cr ratio
Transient proteinuria
- fever
- exercise
- seizure
- stress
- volume depletion
Orthostatic proteinuria
-present throughout day but not first thing in the morning
102
Management of neonatal clavicle fracture
Reassurance and gentle handling
103
Alport syndrome
X-linked mutation of type IV collagen
```
Nephropathy
-hematuria (micro or gross)
-progressive renal insufficiency
-+/- proteinuria
-+/- HTN
Bilateral sensorineural hearing loss
Anterior lenticonus (lens protrusion)
```
Renal biopsy: longitudinal splitting of GBM
104
Lennox-Gastaut syndrome
presents by age 5
- intellectual disability
- severe seizures of varying types
- slow spike-and-wave pattern
105
Juvenile myoclonic epilepsy
Generalized seizures during adolescence, most commonly myoclonic jerks
Can also see absence and GTC
106
Children <2 y.o. w/ first febrile UTI
- antibiotics
| - renal and bladder US
107
Acute fatty liver of pregnancy
- nausea, vomiting
- RUQ, epigastric pai
- fulminant liver failure
- profound hypoglycemia
- elevated animotransferases (2-3x normal)
- increased bilirubin
- thrombocytopenia
- DIC
Treatment: immediate delivery
108
Fecal elastase
High SN and SP for exocrine pancreatic insufficiency
LOW in severe pancreatic insufficiency
109
Diagnosis of Budd-Chiari syndrome
abdominal Doppler US
110
Congenital rubella
- sensorineural hearing loss
- cataracts
- patent ductus arteriosus
111
Treatment of giardiasis
metronidazole
112
Chronic granulomatous disease
- Most re X-linked recessive
- abnormalities of NADPH oxidase
- recurrent pulmonary and cutaneous infections
- catalase positive pathogens (Staph aureus, Serratia, Burkholderia, Aspergillus)
Dx:
- dihidrorhodamine 123 test
- nitroblue tetrazoline test
113
Rett syndrome
- girls
- normal development until 6-18mo
- regression of speech
- loss of purposeful hand movements
- stereotypical movements
- gait abnormalities
- period breathing abnormalities
MECP2 gene mutation
114
How much cow's milk is too much for kids?
>24 oz/d
IDA
115
Mixed connective tissue disease
Features of SLE, systemic sclerosis, and polymyositis
- Raynaud phenomenon
- hand/finger swelling
- arthritis/synovitis
- inflammatory myopathy
- PHTN
- malar or discoid rash
- mild CNS and/or renal disease
```
Anti-U1 ribonucleoprotein
ANA
RF, anti-CCP
CK
Anemia/cytopenias
```
116
Most common cause of pneumonia in CF by age
<20: staph aureus
| >20: pseudomonas
117
Otosclerosis
- young (30s) Caucasian
- F>M
- AD w/ incomplete penetrance
-imbalance of bone resorption and deposition --> stiffening of stapes
- progressive and conductive hearing loss
- paradoxical speech discrimination in noisy environments
- +/- reddish hue behind TM
Treatment
- hearing aids
- surgery (stapes reconstruction)
118
Arm/forearm swelling with pain and mild erythema in the setting of PICC line
Upper extremity DVT
119
PICC infection vs UE DVT
DVT has normal appearing catheter site (no purulence)
120
Treatment of UE DVT
3 months of anticoagulation
121
Risks of short interpregnancy interval
- maternal anemia
- PPROM
- preterm delivery
- low birth weight
122
Contraindications for breastfeeding
- active untreated TB
- HIV infection
- herpetic breast lesions
- active varicella infection
- chemotherapy or radiation therapy
- active substance use
123
Infant contraindication for breastfeeding
galactosemia
124
Treatment of tinea corporis
1st line: topical antifungals (clotrimazole, terbinafine)
| 2nd line, diffuse, or tinea capitis: ORAL antifungals (griseofulvin, terbinafine)
125
Treatment of MDD w/ psychotic features
Antipsychotic + antidepressant
OR
ECT
126
Fibroids (leiomyomata uteri) during pregnancy
Can grow but then outgrow blood supply leading to fibroid infarction and necrosis
- severe abdominal pain
- uterine tenderness
- contractions (from PG release from fibroid)
- palpable, firm, tender mass
- leukocytosis (release of inflammatory cytokines)
Rx: conservative- pain control w/ indomethacin (PG inhibitor)
127
Triad of HUS
- microangiopathic hemolytic anemia
- thrombocytopenia
- AKI
d/t Shiga-toxin producing E. coli (O157:H7)
128
Why is APL a medical emergency?
DIC
Consumptive coagulopathy --> pulmonary/cerebrovascular hemorrhage
Probably d/t release of tissue factor and release of plasmin
129
If see acute onset of joint effusion after minor joint trauma, think
hemarthrosis --> hemophilia
130
Membranous nephropathy association
- SLE
- HepB
- HepC
131
Focal segmental glomerulosclerosis association
-HIV
132
Signs/sx of opioid intoxication but negative drugs screen
SEMISYNTHETIC and SYNTHETIC opioids
Semisynthetic
- oxycodone
- hydrocodone
- hydromorphone
Synthetic
- fentanyl
- meperidine
- methadone
- tramadol
Drug screen measures MORPHINE, which is a breakdown product of all natural opioids (heroin, codeine)
Use mass spec to catch false negative
133
Impetigo caused by
Staph aureus or GAS (strep pyogenes)
Bullous is caused by staph aureus
134
Treatment of impetigo
Topical antibiotics: mupirocin
Oral antibiotics for widespread non-bullous or extensive bullous: cephalexin, dicloxacillin, clindamycin
135
Most common complication of sickle cell anemia
Painless hematuria (micro or gross)
136
Active phase arrest
No cervical change in ≥4 hrs w/ adequate contractions (≥200 Montevideo units averaged over 10 min)
OR
No change in ≥6 hrs w/ inadequate contractions
Most commonly d/t cephalopelvic disproportion
C-SECTION
137
Management of active phase arrest
C-section
138
Anemia of prematurity
Etiology
- impaired EPO production
- short RBC life span
- iatrogenic blood sampling
Clinical manifestation:
- usually asymptomatic
- tachycardia, apnea, poor weight gain
Labs:
- low hgb and hct
- low reticulocyte count
- normocytic, normochromic RBCs
Treatment
- minimize blood draws
- iron supplementation
- transfusions
139
Cyanotic heart diseases of the newborn
The 5 Ts, with fingers!
1. Truncus arteriosus
2. Transposition of the great vessels
3. Tricuspid atresia
4. Tetralogy of Fallot
5. Total anomalous pulmonary venous return
140
Hereditary angioedema
Pathophys
- C1 inhibitor deficiency/dysfunction
- excesive bradykinin
Features
- swelling (face, genitals, extremities) w/o urticaria
- laryngeal edema
- colicky abdominal pain, vomiting, diarrhea
Dx
- low C4 level
- Low C1 inhibitor protein or fxn
Management
-C1 inhibitor concentrate
141
If positional headache (worse when upright, better when supine), think
postdural puncture headache
Also nausea, vomiting, neck stiffness
142
Detection of 21-hydroxylase deficiency
Dehydration, salt wasting, virilization
Elevated 17-hydroxyprogesterone levels
143
Severe aortic stenosis
valve area <1cm^2
144
Next step if think Guillain-Barré syndrome
spirometry
145
Triphalangeal thumbs
Diamond-Blackfan anemia
146
Diamond-Blackfan anemia
Congenital erythroid aplasia
- craniofacial abnormalities
- triphalangeal thumbs
- increased risk of malignancy
- MACROCYTIC anemia
- reticulocytopenia
- normal plt, WBC
- steroids
- RBC transfusions
147
Best contraception for antiphospholipid syndrome
COPPER IUD
Hormonal contraception is contraindicated in hypercoagulable states
148
Management of status epilepticus
≥5 min or ≥2 seizures in which patient does not completely regain consciousness
IV benzo + IV antiepileptic (fosphenytoin, phenytoin, leviteracetam, valproic acid)
149
Wiskott-Aldrich syndrome
X-linked recessive defect in WAS protein gene
Impaired cytoskeleton changes in leukocytes, platelets
- eczema
- microthrombocytopenia (small platelets, low platelet count)
- recurrent infections
Treatment: stem cell transplant
150
Treatment of measles
Supportive. If hospitalized, vitamin A
151
Antihypertensive class to avoid in diabetes
Beta blockers:
- weight gain
- decreased insulin sensitivity
152
Testing after HCV exposure
Anti-hepatitis C antibody
- if positive, indicates PREEXISTING infection
- if negative:
- repeat testing with either qualitative hepatitis C RNA (>3 wks post-exposure) or anti-hepatitis C antibodies (>6 months post-exposure)
153
What testing is recommended for all patients with ITP?
- HepC
| - HIV
154
Common cause of active phase protraction
(<1 cm/2hrs)
Cephalopelvic disproportion
155
Androgen insensitivity syndrome and management
XY
X-linked mutation in androgen receptor
- genotypically male but phenotypically female
- breast development [free testosterone aromatized to estrogen]
- absent or minimal pubic/axillary hair
- F external genitalia
- absent uterus, cervix, upper 1/3 of vagina
- cryptorchid testes
Management:
-elective gonadectomy d/t risk of testicular cancer from cryptorchidism
156
Praeder-Willi vs Angelman syndrome genetics
PW: deletion of PATERNAL 15q11-q13
AS: deletion of MATERNAL 15q11-q13
157
What to do if dog w/o rabies vaccine bites someone?
Quarantine for 10d. NO PEP if animal is healthy
158
Sequela of status epilepticus
cortical laminar necrosis
159
Most sensitive for diagnosis of heart failure
elevated BNP
160
HIV and delivery
viral load ≤ 1000: ART + vaginal delivery
| viral load ≥ 1000: ART + zidovudine + C-section
161
Infant treatment of mother w/ HIV
Maternal viral load ≤ 1000: zidovudine
| Maternal viral load > 1000: multidrug ART
162
HIV treatment during pregnancy
ART
163
Treatment of lung abscess
Clindamycin
164
Risk of pernicious anemia
Increases risk of intestinal-type gastric cancer and gastric carcinoid tumors
165
Thrombotic thrombocytpenic purpura
Decreased ADAMTS13 --> uncleaved vWF multimers -->plt trapping and activation
Acquired (autoantibody) or hereditary
```
Hemolytic anemia w/ schistocytes
Thrombocytopenia (increased bleeding time, normal PT/PTT)
Sometimes w/
-renal failure
-neurologic manifestations
-fever
```
Management
- plasma exchange
- glucocorticoids rituximab
166
HUS vs TTP
HUS more associated w/ E. coli O157:H7 and is primarily a renal disorder; neurologic manifestations uncommon
167
Td vs Tdap
Tdap ONCE as a substitue for Td, then 10 every 10 yrs
168
Adult pneumococcal vaccination
19-64
- Chronic heart, lung, liver disease; DM, smokers, alcoholics: PPSV23 alone
- Very high risk (CSF leaks, cochlear implants; sickle cell, asplenia; immunocompromised; CKD): PCV13 + PPSV23
≥65
-PCV13 + PPSV23
169
Methanol poisoning
Nausea, vomiting, epigastric pain
Vision loss, coma
Hyperemic optic disc
AG metabolic acidosis
170
Ethylene glycol vs methanol poisoning
AG metabolic acidosis in both
Methanol: damages eyes
EG: damages kidneys
171
Manage hyperkalemia
Stabilize myocardium: calcium gluconate
Lower serum K:
- insulin with glucose
- beta-2 agonists
- sodium bicarbonate
- diuretics
- resins
- dialysis
172
Diagnosis of aortic dissection
HD stable: CTA
| HD unstable OR renal insufficiency: TEE
173
Chikungunya fever
- high fevers and severe polyarthralgias
- headache, myalgias, conjunctivitis, maculopapular rash
- lymphopenia, thrombocytopenia, transaminitis
Chronic arthritis/arthralgias in >50%, may require methotrexate
174
Pubertal gynecomastia
BENIGN condition characterized by gradually enlarging glandular breast tissue in adolescent boys
Unilateral or bilateral
Reassurance and observation, self-resolving
175
Oxytocin toxicity
- hyponatremia
- hypotension
- tachysystole
176
VSD murmur
Holosystolic with apical diastolic rumble
177
Reye syndrome
Pediatric aspirin use during viral infection (e.g., influenza or varicella infection)
Acute liver failure
Encephalopathy
- increased ALT, AST
- increased PT, PTT, INR
- increased NH3
Treatment: supportive
178
TRetament of staphylococcal toxic shock syndrome
vancomycin + clindamycin
179
SCID
A disorder of T-cell development leading to severe B-cell dysfunction
Treatment: stem cell transplant
180
Cardiac myxoma
Benign neoplasm, 80% located in LA
```
Position-dependent mitral valve obstruction (mid diastolic murmur; dyspnea, lightheadedness, syncope)
Embolization of tumor fragments (stroke, acute limb ischemia)
Constitutional symptoms (fever, weight loss)
Increased ESR (from cytokine release)
```
Sometimes hear "tumor plop" at the end of diastole
Echo and prompt surgical resection
181
Fibromuscular dysplasia
Women <50
- resistant HTN from renal artery involvement
- cerebrovascular FMD w/ symptoms of brain ischemia (amaurosis fugax, Horner syndrome, TIA, stroke)
- nonspecific symptoms (HA, pulsatile tinnitus, dizziness) from carotid artery or vertebral artery involvement
- can also involve iliac, subclavian, and visceral arteries
182
If lateral gaze palsy (abducens nerve) and diplopia in HIV, think
Cryptococcus neoformans infection
Increases ICP
Also fever, malaise, umbilicated skin papules
LP w/ india Ink stain or capsular polysaccharide antigen testing
183
Contraindication to triptans and ergots
Coronary artery disease
184
Disseminated gonococcal infection
Triad:
- polyarthralgia
- tenosynovitis
- painless vesicopapular skin lesions
OR just purulent monoarthritis
185
Effect of angiotensin II on the kidney
Preferential vasoconstriction of the efferent arteriole (increases intraglomerular pressure)
186
Galactosemia
Galactose-1-phosphate uridyl transferase deficiency
- failure to thrive
- bilateral cataracts
- jaundice
- hypoglycemia
187
Tubo-ovarian abscess
Complication of PID
- fever
- abdominal pain
- complex, multiloculated adnexal mass with thick walls and internal debris on US
- elevated markers: leukocytosis, CRP, CA-125
188
Treatment of chlamydia vs gonorrhea
Empiric: azithromycin + ceftriaxone
Confirmed chlamydia: azithromycin
Confirmed gonorrhea: azithromycin + ceftriaxone
189
Ovarian cancer marker
CA-125
190
If new lesion on CXR, next step is
Chest CT
191
Treat PCP intoxication
Benzos
192
Analgesic nephropathy
- chronic tubulointerstitial nephritis
| - papillary necrosis
193
Diabetes drug that causes weight loss
GLP-1 agonists
194
When to involve urology for kidney stones
- ≥10 mm
- refreactory pain
- anuria
- AKI
- urosepsis
195
Duodenal vs jejeunal atresia
Duodenal: double bubble and gassless colon
Jejeunal: triple bubble and gassless colon
196
At what CD4 count should HIV patients not get live-attenuated vaccines?
<200
197
Neuroleptic malignant syndrome
```
T > 40C (104F)
Confusion
Muscle rigidity
Autonomic instability
Elevated CK
Leukocytosis
```
Dantrolene or bromocriptine if refractory
198
Congenital CMV
- microcephaly
| - periventricular calcifications
199
Bipolar drug of choice in pregnancy
Lamotrigine
Lithium can cause Ebstein anomaly
200
Type II osteogenesis imperfecta
- intrauterine demise
- multiple fractures
- limb deformities
- fetal growth restriction
- hypoplastic thoracic cavity
201
Treatment of Bell palsy
Glucocorticoids +/- acyalovir or valacyclovir
202
Benzodiazepines without active liver metabolites
LOT
Lorazepam
Oxazepam
Temazepam
203
Abnormal biophysical profile score is consistent with
fetal hypoxia
prompt delivery indicated
204
If palpable breast mass
< 30: US
| > 30: mammogram
205
Congenital toxoplasmosis
US:
- bilateral ventriculomegaly
- diffuse intracranial calcifications
Clinical features:
- chorioretinitis
- hydrocephalus
- seizures
- intellectual disability
- SN hearing loss
Rx:
- spiramycin
- pyrimethamine, sulfadiazine, folinic acid
206
First step in LUTS
UA (evaluate hematuria and infection)
207
Treatment of acute viral pericarditis
NSAIDs + colchicine
Corticosteroids are second line
Corticosteroids are used in patients w/ contraindications to NSAIDs (renal failure)
208
CVP in types of shock
Elevated: obstructive, cardiogenic
Decreased: hypovolemic, distributive
209
CVP provides an estimate of
cardiac preload (since CVP approximated RAP)
210
Spontaneous pneumomediastinum
RFs
- asthma exacerbation
- respiratory infection
- tall, thin, adolescent boy
Clinical:
- acute chest pain, SOB, cough
- subcutaneous emphysema
- Hamman sign (crunching sound over heart)
Dx:
-mediastinal gas on CXR
Tx:
- rest, analgesics
- avoid Valsalva
211
G6PD level
may be normal during an attack in G6PD deficiency
212
Most common malignancy from asbestos
Bronchogenic carcinoma, esp in smokers
213
MAO-I adverse effect
Hypertensive crisis if eat foods rich in tyramine (wine, cheese)
214
Painful vs painless bleeding
Painful: placental abruption
Painless: placenta previa
215
Light criteria
Exudative effusion:
- pleural protein / serum protein > 0.5
- pleural LDH / serum LDH > 0.6
- pleural LDH > 2/3 upper limit of normal for serum LDH
216
MEN1
- Pituitary adenoma
- Primary hyperparathyroidism
- Pancreatic/GI neuroendocrine tumors
217
MEN2A
- Parathyroid hyperplasia
- Medullary thyroid carcinoma
- Pheochromocytoma
218
MEN2B
- Medullary thyroid carcinoma
- Pheochromocytoma
- Marfanoid body habitus
- Mucosal neuromas
219
Warfarin overdose reversal
IV vitamin K and prothrombin complex concentrate
220
If depression and peripheral neuropathy
SNRI
221
Who requires penicillin for GBS prophylaxis
Women w/ unknown GBS status and
- ROM ≥18h
- intrapartum fever
- prematurity (<37 wks)
222
Primary biliary cholangitis antibody
antimitochondrial
223
Acute cholangitis
Charcot triad: fever, RUQ pain, jaundice
| Reynolds pentad: Charcot + hypotension, AMS
224
Edwards syndrome
Trisomy 18
- microcephaly
- prominent occiput
- IUGR
- micrognathia
- closed fists w/ overlapping digits
- rocker bottom feet
- cardiac defects (VSD)
225
Infected ascites
PMNs ≥ 250
226
SAAG
SAAG = serum albumin – ascites albumin
≥1.1: PORTAL HYPERTENSION
-cardiac ascites, cirrhosis, Budd-Chiari syndrome
<1.1
-TB, peritoneal carcinomatosis, pancreatic ascites, nephrotic syndrome
227
Intermittent explosive disorder vs disruptive mood dysregulation disorder
IED:
-recurrent episodes of impulsive verbal or physical aggression
DMDR:
- disproportionate physical or verbal outbursts
- persistent irritability or anger between episodes
- onset before age 10
- diagnosis NOT made after 18
228
Management of simple renal cyst
reassurance
229
Kleihauer-Betke smear
Performed prior to calculation of RhoGAM dose
Indicated in
- abortion
- ectopic pregnancy
- amniocentesis
- vaginal bleeding
- placenta previa
- placental abruption
230
Cluster headache prophylaxis
Verapamil
231
Topical treatment for condyloma accuminata (anogenital warts)
Imiquimod cream
232
Spironolactone side effects
Anti-androgen effects
- gynecomastia
- erectile dysfunction
- dizziness
- dry mouth
- thirst
- abdominal distress
233
First line therapy for vulvovaginal candidiasis
INTRAVAGINAL azoles (clotrimazole, miconazole, tioconazole)
234
Most common infectious cause of erythema multiforme
HSV
235
Inferior MI leads
II, III, avF
236
Lateral MI leads
I, avL, V5, V6
237
Anterior MI
Some or all V1-V6
238
Langerhans cell histiocytosis
- lytic bone lesions
- skin lesions (purplish papules, eczematous ras)
- lymphadenopathy, hepatosplenomegaly
- pulmonary cysts, nodules
- central diabetes insipidus
Dx: Langerhans cells on bone/skin biopsy
Tx
- chemotherapy (prednisone +/- vinblastine)
- desmopression for DI
239
When is trial of labor contraindicated?
- classical C-section (vertical incision)
- abdominal myomectomy w/ uterine cavity entry
Require laparotomy and delivery
240
Missed abortion
- no vaginal bleeding
- closed cervical os
- no fetal cardiac activity or empty sac
241
Threatened abortion
- vaginal bleeding
- closed cervical os
- fetal cardiac activity
242
Inevitable abortion
- vaginal bleeding
- dilated cervical os
- products of conception may be seen or felt at or above cervical os
243
Incomplete abortion
- vaginal bleeding
- dilated cervical os
- some products of conception expelled and some remain
244
Complete abortion
- vaginal bleeding
- closed cervical os
- products of conception completely expelled
245
Most effective nonpharmacologic approaches to lower BP
1. weight loss
| 2. DASH diet
246
WAGR syndrome
- Wilms tumor
- Aniridia
- Genitourinary abnormalities
- Intellectual disability ("r"...)
247
Treatment of minimal change disease
Corticosteroids
248
Adjustment disorder timing
- symptoms develop w/in 3 months of stressor
| - symptoms last no more than 6 months after stressor ceases
249
Generalized anxiety disorder timeline
≥ 6 mo
250
Treatment of PMR-GCA spectrum
PMR: low-dose po glucocorticoids
GCA: intermediate- to high-dose po glucocorticoids
GCA w/ vision loss: pulse high-dose IV glucocorticoids for 3d followed by intermediate- to high-dose po glucocorticoids
START STEROIDS BEFORE BIOPSY
251
Order of therapy in PMR/GCA
STEROIDS and then temporal artery biopsy
252
Confirm lead poisoning
VENOUS lead level
253
What is not affected by panhypopituitarism?
Aldosterone (since primarily regulated by RAAS
254
Hypopituitarism
Glucocorticoid deficiency, hypogonadism, and hypothyroidism
- central adrenal insufficiency (low cortisol and ACTH): fatigue, anorexia, hypoglycemia, eosinphilia, pale skin
- hypogonadotropic hypogonadism (low FSH, LH, testosterone): low libido, erectile dysfunction, testicular atrophy
- central hypothyroidism (low or inappropriately normal TSH, low free T4): cold intolerance, constipation, bradycardia
255
Primary adrenal insufficiency vs hypopituitarism
PAI: aldosterone is lost --> hyperkalemia, severe hypotension ; ACTH increased --> hyperpigmentation
256
Management of Vtach
Stable: IV amiodarone
Unstable: synchronized cardioversion
257
What EKG finding is diagnostic for sustained monomorphic ventricular tachycardia?
Fusion beats
258
Viral myocarditis
Viral prodrome followed by s/sx of heart failure (resp distress, murmur, hepatomegaly)
259
Appendicitis during pregnancy
Uterus displaces the appendix
R mid- to upper quadrant OR R flank pain
IMMEDIATE SURGERY (appy)
260
5-alpha-reductase deficiency
Impaired testosterone to DHT conversion
46, XY
Phenotypically female at birth- M internal genitalia and F external genitalia
NO breast development
Puberty- virilization (clitoromegaly, increased muscle mass, nodulocystic acne)
261
Secondary spontaneous pneumothorax
Patients w/ underlying respiratory disease (COPD, CF) w/ acute onset worsening of resp symptoms. Esp in smokers
262
Which kids should get pavalizumab for RSV bronchiolitis?
- preterm birth <29 wks
- chronic lung disease of prematurity
- hemodynamically significant congenital heart disease
263
First step in evaluating primary amenorrhea
Pelvic US
264
Labs in Turner syndrome
XO
Increased FSH and LH (d/t low estrogen so no feedback)
265
Histoplasmosis
- Mississippi and Ohio River basins
- pulmonary symptoms w/ mediastinal or hilar lymphadenopathy
- arthralgias
- erythema nodosum
-caseating or noncaseating granulomas
266
DHEAS is produced mainly in the
adrenals
267
Causes of asterixis
- hepatic encephalopathy
| - uremic encephalopathy
268
Trimethoprim electrolyte abnormality
Hyperkalemia
also may increased Cr
269
Breast fat necrosis
- fixed mass
- calcifications on mammography
- biopsy: fat globules and foamy macrophages
- no further workup
270
Medications that decrease suicide risk
- lithium
| - clozapine
271
Most common cause of sepsis in sickle cell disease
Streptococcus pneumoniae
usually from non-vaccine serotypes
Prophylax w/ penicillin
272
Primary ovarian insufficiency associations
- Turner syndrome (XO)
- Fragile X syndrome AND pre-mutation carriers
- Autoimmune oophoritis
- Anticancer drugs
- Pelvic irradiation
- Galactosemia
273
What type of anemia (MCV) does lead poisoning cause?
Microcytic
274
Treatment of BV during pregnancy
po metronidazole
275
Why might a patient undergoing laparoscopy develop bradycardia, AV block, or even asystole?
peritoneal stretch receptors --> increased vagal tone
276
HIV infection in infancy
- failure to thrive
- chronic diarrhea
- lymphadenopathy
- oppurtunistic infections: PCP pneumonia, candida
277
Antihypertensives in pregnancy
- labetalol
- methyldopa
Hydralazine and CCBs also acceptable
278
Pacemaker complication
Tricuspid regurgitation --> RHF
279
Seizures in the setting of pediatric bacterial gastroenteritis
Shigella
280
Antiphospholipid syndrome
Thrombotic event OR pregnancy morbidity in the setting of a positive antibody (either anticardiolipin, anti-beta2-glycoprotein-I, or lupus anticoagulant)
Prolonged PTT
Most important RF: SLE
281
Highest vs lowest risk second generation antipsychotics for metabolic syndrome
High risk: olanzapine, clozapine
| Low risk: aripiprazole, ziprasidone
282
Antipsychotics for bipolar depression
- quetiapine
- lurasidone
Avoid antidepressant monotherapy
283
Tetralogy of Fallot
- pulmonic stenosis (RVOT obstruction)
- RVH
- overriding aorta
- VSD
Tet spells: acute hypoxemia and cyanosis
```
Harsh, crescendo-decrescendo systolic ejection murmur (d/t pulmonic stenosis)
Single S2 (normal aortic, inaudible pulmonic)
```
284
Most common cause of megalobastic anemia in chronic alcohol use
Folic acid deficiency
285
Pulmonary artery cath results indicative of pulmonary hypertension
Elevated pulmonary artery pressure
| Elevated right atrial pressure
286
PCWP represents
LAP and L heart function
287
Elevated PCWP w/ elevated PA and RA pressures
L-sided HF leading to R-sided HF
288
Normal PCWP indicates
normal LV function
289
Normal PCWP in the setting of elevated RH pressures (PA, RA)
intrinsic pulmonary process (e.g., PE)
290
Treatment of hypernatremia
Assess volume status:
Euvolemic: FREE WATER supplementation
Hypovolemic:
Asymptomatic: 5% dextrose
Symptomatic: 0.9% saline until asymptomatic, then 5% dextrose
291
What type of fluid is 5% dextrose?
HYPOTONIC
292
Mixed cryoglobulinemia
Small vessel vasculitis
- palpable purpura
- arthralgias
- fatigue
- peripheral neuropathy
- liver involvement
- renal disease
Strongly associated w/ HepC infection
Labs
- hypocomplementemia
- polyclonal IgG
- anti-HCV antibodies
- RF
293
Lithium electrolyte abnormality
Hypercalcemia d/t hyperparathyroidism
294
Diagnosis of intra-amniotic infection
Maternal fever + ≥1
- fetal tachycardia (>160)
- maternal leukocytosis
- purulent amniotic fluid
295
Reye syndrome histology
Microvesicular steatosis (fatty infiltration)
296
Treatment of UTIs in kids
Third-generation cephalosporin (e.g., cefixime)
297
True positive, sensitivity, specificity
True positive = sensitivity
False positive = (1 - specificity)
If you increase sensitivity, you decrease specificity
298
Treatment of Paget disease of bone
Bisphosphonates
299
Decrease risk of septic embolic events in infective endocarditis
IV antibiotics
NOT heparin
300
S3 vs S4
S3: results from the sudden cessation of blood flow into a dilated LV during the passive filling phase of diastole; eccentric hypertrophy; LV volume overload (e.g. HF)
S4: caused by blood striking a stiff LV during atrial systole just before mitral valve closure (S1); concentric LV hypertrophy d/t systemic HTN or severe aortic stenosis
301
Hyperandrogenism in PCOS lab
elevated serum testosterone
302
Which hormone is increased in PCOS
LH
also testosterone
303
Types of decelerations in FHT
```
Early: fetal head compression
Late: ureteroplacental insufficiency
Variable (abrupt):
-cord compression
-oligohydramnios
-cord prolapse
```
304
Early deceleration
fetal head compression
305
Late deceleration
uteroplacental insufficiency
306
Variable deceleration
- cord compression
- oligohydramnios
- cord prolapse
307
Management of recurrent variable decelerations
-maternal repositioning (reduces cord compression)
If they still do not improve: amnioinfusion
308
Hormone levels in Turner syndrome
low estrogen and progesterone --> lack of negative feedback --> high FSH and LH
309
Tricuspid regurgitation murmur
holosystolic murmur that increases w/ inspiration
310
First step in penile fracture
retrograde urethrogram
311
Uterine tachysystole
>5 contractions in 10 min
312
HACEK organisms
~3% of infective endocarditis
```
Haemophilus aphrophilus
Aggregatibacter actinomycetemcomitans
Cardiobacterium hominis
Eikenella corrodens
Kingella kingae
```
313
Which type of glaucoma is acute?
Closed angle
Open angle is a chronic process that is often asymptomatic until gradual progression of peripheral vision loss- cupping of the optic disc
314
Treat antipsychotic-induced parkinsonism
Benztropine or amantadine
315
Kawasaki disease
Fever ≥5d +
- conjunctivitis
- rash
- adenopathy
- strawberry tongue (mucositis)
- hand/foot edema (extremity edema)
316
Antidepressants w/ short vs long half life
Short: paroxetine (paxil)
Long: fluoxetine (4-6d)
317
FSH and LH in functional hypothalamic amenorrhea
decreased
318
Treatment of prolactinoma
Asymptomatic microprolactinoma (<10 mm): no treatment
Macroprolactinoma (>1 cm) or symptomatic microprolactinoma):
- dopamine agonists (cabergoline, bromocriptine)
- surgery (transphenoidal) IF fail to respond OR large (≥3 cm)
319
Takayasu arteritis
Asian F 10-40
symptoms
- constitutional (fevers, weight loss)
- arterio-occlusive (claudication, ulcers) in UE
- arthralgias/myalgias
findings
- BP discrepancy
- pulse deficits
- arterial bruits
diagnosis
- elevated ESR, CRP
- CXR: aortic dilatation, widened mediastinum
- CT/MRI: wall thickening, narrowing of lumen
treatment
-systemic glucocorticoids
320
Acute kidney rejection most commonly occurs
w/in 6 mo of transplantation
- T-cell mediated
- asymptomatic rise in Cr
- diagnosis confirmed by renal biopsy: lymphocytic infiltration of the intima
High dose IV glucocorticoids
321
Howell-Jolly bodies
post-splenectomy or functional asplenia/hyposplenism
Retained RBC nuclear remnants (that are typically removed by the spleen)
322
Heinz bodies
G6PD deficiency
Oxidized and precipitated hemoglobin
323
Sertoli-Leydig cell tumors
Sex cord-tromal tumor of OVARY
-INCREASED TESTOSTERONE [think: "Sir"-toli]
```
Rapid-onset virilization
-voice deepening
-M pattern balding
-increased muscle mass
-clitoromegaly
Oligomenorrhea
Estrogen deficiency [T inhibits HPG axis]
Unilateral, solid adnexal mass
```
324
Most common cause of AA amyloidosis and AL amyloidosis
AA: rheumatoid arthritis
AL: multiple myeloma
325
B12 vs folate deficiency
ELEVATED MMA in B12
| NORMAL MMA in folate
326
Afib rate control options
- beta blockers (metoprolol)
- CCBs (diltiazem)
digoxin
327
Loeffler endocarditis
Restrictive cardiomyopathy presenting w/ s/sx of HF
Diastolic dysfunction
d/t EOSINOPHILIC infiltration and endocardial fibrosis
causes
- hypereosinophilic syndrome
- parasitic infection
- autoimmune
328
Threatened abortion vs inevitable abortion
Threatened: CLOSED
Inevitable: OPEN
329
Dietary advice for kidney stones
1. fluids
2. low sodium
3. normal Ca
330
Alpha thalassemia spectrum
Alpha thalassemia minima (1 gene loss): asymptomatic, silent carrier
Alpha thalassemia minor (2 gene loss): mild microcytic anemia
Hemoglobin H disease (3 gene loss): chronic hemolytic anemia
Hemoglobin Barts (4 gene loss): hydrops fetalis, high-output cardiac failure, anasarca, death in utero
331
Causes of MICROCYTIC anemia
TAILS
```
Thalassemia
Anemia of chronic disease
Iron deficiency anemia
Lead poisoning
Sideroblastic anemia
```
332
Ludwig angina
Rapidly progressive cellulitis of the submandibular and sublingual spaces
Woody or brawny neck
Most arise from DENTAL INFECTIONS (mandibular molars)
Complication: acute airway obstruction
333
Most common cause of nonreactive fetal nonstress test
fetal sleep cycle (≤ 40 min)
If so, can extend 40-120 min to ensure that fetal activity outside of sleep is captured
334
Most common cause of otitis externa
Pseudomonas aeruginosa
Tx: topical abx (fluoroquinolone) +/- topical glucocorticoid
335
If cannot distinguish between transient synovitis and septic arthritis
bilateral hip ultrasound
Unilateral effusion --> arthrocentesis
336
Best measurement to follow DKA
Anion gap OR BHOB
NOT acetoacetate
337
Most common transfusion reaction
Febrile nonhemolytic transfusion reaction
1-6h after transfusion
Fevers, chills, malaise NO hemolysis
Prevent w/ leukoreduction
338
Treatment of lithium toxicity
Dialysis
339
Nonemergency situation where patients refuse life-saving treatment for child
obtain a court order to treat
If emergency, go ahead and treat immediately
340
Most common source of rabies transmission in the US
Bats
341
Why do exudative pleural effusions have low glucose?
High metabolic activity of leukocytes and bacteria
342
Multisystem atrophy (Shy-Drager syndrome)
1. parkinsonism
2. autonomic dysfunction
3. widespread neurological signs
343
ASD vs PTSD
1 month
344
von Hippel Lindau
AUTOSOMAL DOMINANT
VHL tumor suppressor gene mutation (chromosome 3)
- cerebellar and retinal hemangioblastomas
- pheochromocytoma
- renal cell carcinoma (clear cell type)
345
Precocious puberty marker
advanced bone age
346
Hemophilia inheritance
A, B: X-linked recessive
| C: autosomal recessive
347
XLA
- recurrent sinopulmonary and gastrointestinal infections after age 6mo
- absence of lymphoid tissue on examination (e.g., tonsils, lymph nodes)
- low immunoglobulins and B cells
- normal T-cell concentration
- no response to vaccinations
Treatment
- Ig replacement therapy
- ppx abx if severe
348
Hazard ratio
< 1: more likely to occur in control group
> 1: more likely to occur in treatment group
Close to 1: little difference between groups
349
Calculate SN and SP
```
SN = TP / (TP + FN)
SP = TN / (TN + FP)
```
350
Pseudothrombocytopenia
Lab error d/t platelet aggregation in vitro
Peripheral smear: large clumps of platelets
351
CAH d/t 21-hydroxylase deficiency
- dehydration and salt wasting (hypotension, hyponatremia, hyperkalemia)
- elevated 17-hydroxyprogesterone
- virilization and ambiguous genitalia in F
352
Bedwetting is normal before age
5
353
PUD caused by
H. pylori
354
Primary hypoparathyroidism
hypocalcemia and hyperphosphatemia in the presence of normal renal function
- post-surgical (most common)
- autoimmune
- congenital absence or maldevelopment of parathyroids (e.g., DiGeorge syndrome)
- defective CaSR on parathyroids
- infiltrative: hemochromatosis, Wilson's, neck irradiation
355
Placenta previa major risk factor
Prior C-section
Also:
- prior placenta previa
- multiple gestation
- advanced maternal age
356
Painless (silent) thyroiditis
Variant of Hashimoto thyroiditis (chronic autoimmune thyroiditis)
Mild, brief HYPERTHYROID phase
Small, NONTENDER goiter
Spontaneous recovery
Positive anti-TPO antibodies
Low radioiodine uptake
Can occur postpartum, called postpartum thyroiditis
357
Subacute (de Quervain) thyroiditis
Likely postviral inflammatory process
Prominent fever and HYPERTHYROID symptoms
PAINFUL/tender goiter
Elevated ESR, CRP
Low radioiodine uptake
Treatment: beta-blockers and NSAIDs
358
Decreased radioiodine uptake in the thyroid in the setting of thyrotoxicosis
release of pre-formed thyroid hormone
359
Stimulate appetite in cancer patients
progesterone analogue (megestrol acetate, medroxyprogesterone acetate)
steroids
360
Contraindication for external cephalic version
active labor
361
Polyuria with hypernatremia
Diabetes insipidus
362
Distinguish central DI from nephrogenic DI
Central: significant hypernatremia (>150) d/t impaired thirst mechanism
Nephrogenic: normal Na (d/t intact thirst mechanism and adequate water intake)
363
Epidural prolongs which phase of labor
Second (10 cm to delivery)
364
Central vs peripheral precocious puberty
Both have advanced bone age
Low LH: peripheral
High LH: central
365
If diagnose central precocious puberty
Get MRI to evaluate for tumor
366
Pathophys of tardive dyskinesia
upregulation and supersensitivity of dopamine receptors
367
Lacunar infarct
Posterior limb of internal capsule
-unilateral MOTOR impairment
- no sensory or cortical deficits
- no visual field abnormalities
368
Anterior cerebral artery occlusion
- contralateral SOMATOSENSORY + MOTOR deficit, predominantly in the LOWER EXTREMITY
- abulia (lack of will or initiative)
- dyspraxia, emotional disturbances, urinary incontinence
369
Digitalis toxicity arrhythmia
atrial tachycardia w/ AV block
370
CLL histology
smudge cells
371
Management of congenital long-QT syndromes
Propranolol and pacemaker
372
Exception to C-section for breech
Non-viable fetus. In this case, allow vaginal delivery to decrease maternal risk
373
Anion gap calculation
AG = Na - (bicarb + Cl)
374
If no fetal HR on Doppler
Transabdominal US (diagnostic for intrauterine fetal demise)
375
Pregnancy management in patients w/ a h/o HSV
Antiviral suppression w/ acyclovir or valacyclovir beginning at 36 wks
If lesions or prodromal symptoms during labor, C-section
376
If bilateral vestibular schwannomas, think
Neurofibromatosis type II
377
Causes of lactic acidosis
MUDPILES
```
Methanol
Uremia
DKA
Propylene gycol/paraldehyde
INH/iron
Lactic acidosis
Ethylene glycol
Salicylates (aspirin)
```
378
DES exposure in utero is a risk factor for
vaginal CLEAR CELL adenocarcinoma
379
Fanconi anemia
Inherited DNA repair defect [ausotomal recessive]
Bone marrow failure
- short stature
- hypo-/hyperpigmented macules
- abnormal thumbs
- GU malformations
- pancytopenia
- positive chromosomal breakage testing
Treatment: hematopoetic stem cell transplant
380
Clues to Legionella
- pneumonia
- diarrhea
- hyponatremia
tx: macrolides or fluoroquinolones
381
Antipsychotic most likely to cause hyperprolactinemia
Risperidone
382
Sporothrichosis
```
Sporothrix shenkii (dimorphic fungus)
Gardeners and landscapers
```
Skin papule --> ulceration w/ nonpurulent, odorless drainage
Proximal lesions along lymphatic chain
LAD rare
Rx: 3-6 mo po itraconazole
383
Progression of F puberty
Thelarche --> pubarche --> growth spurt --> menarche
Premanarchal patients <15 w/ normal breast and pubic hair development require no further evaluation
384
EPO side effect
HTN
385
Kidney stones in patient w/ recurrent UTIs
Struvite stones
Urease-producing organisms: Klebsiella, Proteus
Increased urine ammonia production
Large staghorn calculi
386
Clue to milk-alkali syndrome
Hypercalcemia with METABOLIC ALKALOSIS (increased bicarb)
387
Chemotherapy-induced peripheral neuropathy
- vincristine
- cisplatin
- paclitaxel
388
Differentiate asthma from COPD
Spirometry before and after inhaled bronchodilator
Asthma is completely reversible.
COPD may be partly reversible, but not completely
389
Bullous impetigo vs SSSS
Bullous impetigo: LOCALIZED SSSS. Patients appear well. Honey-colored crusting
SSSS: systemic including fever and irritability
390
BUN:Cr ratio in pre-renal AKI
>20:1
391
Coag abnormality in antiphospholipid syndrome
Prolonged PTT
| NOT fixed w/ mixing study
392
Arsenic poisoning
Acute: garlic breath, vomiting, watery diarrhea, QTc prolongation
Chronic: hypo-/hyperpigmentation, hyperkeratosis, stocking-glove neuropathy
Rx: dimercaprol, DMSA
393
Type 4 renal tubular acidosis
- non-AG metabolic acidosis
- persistent hyperkalemia
- mild/mod renal insufficiency
Commonly occurs in patients w/ poorly controlled DM
394
REM sleep behavior disorder is a risk factor for
Parkinson disease
395
Management of congenital umbilical hernia
Observation (most resolve by 5)
396
When in pregnancy to screen for GDM
24-28 wks
397
Brown-Séquard syndrome
- ipsilateral hemiparesis
- ipsilateral diminished proprioception, vibratory sensation, and light touch
- contralateral diminished pain and temperature- 1-2 levels BELOW cord injury
398
Clozapine side effect
Neutropenia and agranulocytosis
399
Endometrial cells on Pap smear
<45: common and benign; no further workup
| ≥45: may be d/t endometrial hyperplasia/cancer; require endometrial biopsy
400
Necrotizing (malignant) otitis externa
>60, diabetes
Pseudomonas aeruginosa
Severe, unremitting ear pain (worse at night + w/ chewing)
Deficits of lower cranial nerves
Granulation tissue in external auditory canal
Elevated ESR
IV antipseudomonal abx (e.g., ciprofloxacin)
+/- surgical debridement
401
Main complication of drowning
ARDS (water washes out sufractant)
402
If multiple febrile UTIs in infants
Voiding cystourethrogram (assess for VUR)
403
Homocystinuria
- autosomal recessive
- Marfanoid
- intellectual disability
- thrombosis
- downward lens dislocation
- megaloblastic anemia
- fair complexion
rx: vitamin B6, B12, folate, and anticoagulation
404
Angioedema from ACE inhibitors
can happen ANYTIME, not just right after start of medication
405
Carboprost contraindication
asthma (can cause bronchoconstriction)
406
Methylergonovine contraindication
HTN
407
Management of uterine atony
First line: uterine massage and oxytocin
Second line: TXA
- bimanual uterine massage
- high-dose oxytocin
- misoprostol
- tranexamic acid
- carboprost
- methylergonovine
408
Tinea cruris
jock itch
topical antifungals [but NOT nystatin]
409
Kartagener syndrome
- sinus iversus
- recurrent sinusitis
- bronchiectasis
410
Most common organisms to cause brain abscess
- staph aureus
- viridans strepococci
- anaerobes
Usually from otitis media, sinusitis, or dental infection
411
Organism associated with infective endocarditis in patients w/ urinary pathology
Enterococcus
412
Which cardiac medications are contraindicated in WPW syndrome?
- digoxin
- CCBs
- beta blockers
- adenosine
413
Treatment of hyperthyroidism in pregnancy
1st trimester: PTU
| 2nd and 3rd trimesters: methimazole
414
Red, dusky plaque that always recurs in the same location
Fixed drug eruption
NSAIDs, sulfonamides, tetracycline, carbamazepine
415
Bowen disease
skin squamous cell carcinoma in situ
416
If suspect ruptured peptic ulcer
x-ray
417
Treatment of adrenal insufficiency
Prednisone (has glucocorticoid and mineralocorticoid activity)
418
Which drug is contraindicated in myasthenia gravis?
Magnesium sulfate
| -causes myasthenic crisis w/ severe respiratory depression
419
Pruritic urticarial plaques and papules of pregnancy (PUPP)
treat w/ topical steroids +/- oral antihistamines
420
Cardiac complications of sarcoidosis
- cardiac noncaseating granuloma
- conduction defects (complete AV block most common)
- restrictive cardiomyopathy (early)
- dilated cardiomyopathy (late)
- valvular dysfunction
- HF
- can get sudden cardiac death
421
How soon after OCP discontinuation do regular menses return?
1-3mo
Evaluate for secondary amenorrhea >3 mo in women w/ regular menses and >6 mo in women w/ irregular menses
422
Most common cause of splenic abscess
Infective endocarditis
423
Treatment of splenic abscess
Splenectomy
Antibiotics alone associated w/ >50% mortality
424
Splenic abscess
- fever
- leukocytosis
- LUQ pain
Can also get L-sided pleuritic chest pain, L pleural effusion, splenomegaly
Most commonly d/t infective endocarditis
Splenectomy
425
Contraindication to rotavirus vaccine
- personal history of intusussception
| - uncorrected congenital malformation of GI tract (e.g. Meckel diverticulum)
426
Latent TB
Positive PPD (>5, 10, 15) with negative imaging
9 months of isoniazid with pyridoxine
427
OCPs and migraine w/ aura
Contraindicated d/t increased risk of stroke
428
Order of steps in suspected infant meningitis
First LP then antibiotics
unless hypotension or status epilepticus
429
Upper vs lower motor neuron facial palsy
Central: FOREHEAD SPARING
Peripheral: think Bell palsy, entire face
Bell palsy may also cause decreased lacrimation, hyperacusis, reduced taste sensation over anterior tongue
430
Most common cause of infertility after 35
decreased ovarian reserve
Regular menstrual cycles but decreased oocyte number and quality
431
Treatment of acute dystonia
- benztropine
| - diphenhydramine
432
Acute rheumatic fever criteria
d/t untreated strep pharyngitis
2 major OR 1 major + 2 minor
Major: JONES
- Joints (migratory arthritis)
- ❤️ (carditis)
- nodules (subQ)
- Erythema marginatum
- Sydenham chorea
Minor
- fever
- arthralgias
- elevated ESR/CRP
- prolonged PR interval
433
Antibiotics for febrile neutropenia
- cefipime
- meropenem
- piperacillin-tazobactam
434
Cause of tinea versicolor
Malasszeia (globosa, furfur)
435
Mechanisms of action of second generation antipsychotics and consequence
Dopamine (D2) AND serotonin (2A) antagonists
The addition of serotonin antagonism decreases risk of extrapyramidal side effects
436
Aromatase deficiency
Inability to convert androgens to estrogens
-begins in utero leading to transient masculinization of the mother
- Female
- at birth, ambiguous genitalia
- adolescence: delayed puberty, osteoporosis,undetectable estrogen (no breast development), high concentrations of gonadotropins (polycystic ovaries)
- normal internal genitalia
- external virilization (clitoromegaly)
- undetectable serum estrogen
437
TXA caution
be careful in patients w/ hypercoagulabilty
438
Trisomy 21 quadruple screen
MSAFP: low
beta-hCG: high
estriol: low
inhibin A: high
439
Trisomy 18 quadruple screen
MSAFP: low
beta-hCG: low
estriol: low
inhibin A: normal
440
Neural tube or abdominal wall defect quadruple screen
MSAFP: high
beta-hCG: normal
estriol: normal
inhibin A: normal
441
Causes of Ogilvie syndrome
- electrolyte abnormalities (hypokalemia, hypomagnesemia, hypocalcemia)
- major surgery, trauma, severe infection
- medications (opioids, anticholinergics)
- neurologic disorders (dementia, stroke)
442
Treatment of Ogilvie syndrome
NPO, NG/rectal tube decompression
If no improvement in 48h: neostigmine
443
What determines severity of Tetralogy of Fallot?
the degree of RVOT obstruction
The increased PVR shunts deoxygenated blood across the VSD and into the aorta -- cyanosis, Tet spell
444
Why does knees-to-chest help Tet spell?
INCREASES SVR
Reduces right-to-left shunting (increases pulmonary blood flow and relives hypoxia)
445
Managament of COPD exacerbation
- inhaled bronchodilators (beta-2 agonist + anticholinergics)
- SYSTEMIC CORTICOSTEROIDS
- abx
- O2
446
Most common causes of acute bacterial rhinosinusitis
- nontypeable haemophilus influenzae
- streptococcus pneumoniae
- moraxella catarrhalis
Rx: amoxicillin +/- clavulanate
447
ADHD treatment in patients w/ h/o addiction
atomoxetine (non-stimulant)
448
First step in evaluating primary amenorrhea in patients w/ uterus
FSH
Distinguishes between central (lo/normal FSH) and peripheral (hi FSH) causes of amenorrhea
449
Stool osmotic gap
Elevated: osmotic diarrhea
Reduced: secretory diarrhea
450
If dilated cardiomyopathy in young adults, consider
viral myocarditis
451
Causes of unconjugated hyperbilirubinemia
- overproduction (hemolysis)
- reduced uptake (drugs, portosystemic shunt)
- conjugation defect (Gilbert)
452
Conjugated hyperbilirubinemia with normal AST, ALT, alk phos
- Dubin-Johnson syndrome
- Rotor syndrome
Defect in hepatic excretion of conjugated bilirubin
453
Causes of pseudogout
- hyperparathyroidism
- hypothyroidism
- hemochromatosis
454
Euthyroid sick syndrome mechanism
decreased peripheral conversion of T4 to T3
Low T3, NORMAL TSH and T4
455
If history of preterm delivery d/t spontaneous preterm labor or PPROM
IM progsterone during 2nd and 3rd trimesters
also serial cervical length measurements w/ cerclage placement if short cervix
456
Laxative vs diuretic abuse
Hypotension and hypovolemia, but elevated urinary sodium indicates loss from the urinary tract (diuretics)
Diuretic abuse has
- high urinary sodium
- high urinary potassium
457
Which vaccine has significant waning immunity?
pertussis
458
FHH vs primary hyperparathyroidism
FHH: LOW urine Ca
PHPT: HIGH urine Ca
459
Low basal LH in precocious puberty
do GNRH stimulation test
- low LH: peripheral precocious puberty
- high LH: central precocious puberty
460
Non-classic CAH
d/t 21-hydroxylase deficiency
Precocious puberty (gonadotropin-independent) BUT sufficient glucocorticoid and mineralocorticoid levels, so NO electrolyte abnormalities
461
Treatment of central retinal artery occlusion
ocular massage and high-flow oxygen
462
Why is there HTN in AD PCKD?
cysts --> localized renal ischemia --> increased RENIN release --> RAAS --> secondary hyperaldosteronism
Rx: ACE inhibitors
463
Buproprion is contraindicated in
- seizures
| - bullimia
464
Diagnosis of ectopic pregnancy requires
TVUS
465
S4
Stiff ventricle
466
Most effective single agents for allergic rhinitis
intranasal glucocorticoids
467
Lyme prophylaxis not needed if
tick removed before 36h
468
Two major inhalants in smoke
- carbon monoxide
- hydrogen cyanide [rx: hydroxocobalamin or sodium thiosulfate]
Treat emprically fro cyanide toxicity
469
If preeclampsia <20 weeks
hydatidiform mole
470
VIPoma
- watery diarrhea
- muscle weakness/cramps (d/t hypokalemia)
- hypo/achlorhydria
- flushing
-hypokalemia, hypercalcemia, hyperglycemia
- secretory diarrhea
- elevated VIP
May be part of MEN syndrome
471
Central retinal vein occlusion
"Blood and thunder appearance"
- optic disc swelling
- retinal hemorrhages
- dilated veins
- cotton wool spots
472
Nightmare disorder vs sleep terror disorder
Nightmare disorder (REM): recurrent episodes of awakening from sleep with recall of highly disturbing and frightening dream content. On awakening, patient is fully alert, remembers the dream, and can usually be consoled
Sleep terror disorder (non-REM): incomplete awakenings, unresponsiveness to comfort, no recall of dream content
473
Optimal fetal position at labor
occiput anterior
474
Beta blocker overdose and treatment
Bradycardia, hypotension, wheezing, hypoglycemia, delirium, seizures, cardiogenic shock
Rx:
- IV fluids, atropine
- IV glucagon (for profound or refractory hypotension)
475
Ewing sarcoma buzzwords
- onion skinning
| - moth-eaten appearance
476
Atypical melanoma
May NOT have ABCDEs of melanoma. Look instead for:
- ugly ducking sign (90% sensitive)
- palpable nodularity
- itching, bleeding, tingling
477
Uric acid stones
Form in ACIDIC URINE (low pH)
Radiolucent (NOT seen on xray)
Treat with alkalinization of the urine with potassium citrate
478
Streptococcal perianal dermatitis
Superficial infection with GAS
Bright, sharply demarcated, confluent erythema over perianal/perineal area
Perianal pruritis and pain, esp w/ stooling
Can have perirectal fissures and blood-streaked stools
May get constipation from withholding d/t pain
Clue: close contact w/ recent strep infection (cellulitis, pharyngitis)
Rx: po abx (penicillin, amoxicillin)
479
Primary vs secondary/tertiary adrenal insufficiency labs
Primary: low cortisol, high ACTH
| Secondary/tertiary: low cortisol, low ACTH
480
Cat scratch disease
d/t Bartonella henselae
- papule at scratch/bite site
- regional adenopathy (enlarged, tender, erythematous)
- +/- FUO (≥14d)
Rx: azithromycin
481
Antipsychotics should not be used in patients with
Dementia with Lewy bodies
482
Management of physiologic ovarian cysts
observation w/ repeat examination
483
Osteoid osteoma
Benign bone-forming tumor
```
Pain
-worse at night
-relieved by NSAIDs
-unrelated to activity
NO systemic symptoms
```
Xray: small, round lucency
Rx
- NSAIDs
- monitor for spontaneous resolution
484
Bright red, firm, exophytic nodules in an HIV patient
bacillary angiomatosis (d/t bartonella)
rx: po erythromycin
485
Glucose in glucagonoma
elevated
486
Any patient w/ sternal wound drainage
chest imaging to evaluate for mediastinitis (fluid collection, pneumomediastinum)
487
Timing of hematuria
Initial: URETHRA
- urethritis
- trauma (e.g., cath)
Continuous: ANYWHERE IN UT
- renal mass
- glomerulonephritis
- urolithiasis
- PCKD
- pyelonephritis
- urothelial cancer
- trauma
Terminal: BLADDER, PROSTATE
- urothelial cancer
- cystitis
- urolithiasis
- BPH
- prostate cancer
488
Neurocystercircosis caused by
tinea solium
pork tapeworm
489
Hypothyroidism and amenorrhea
Low T4 --> increased TRH --> increased TSH and PRL --> decreased GnRH --> decreased LH and FSH --> anovulation/amenorrhea
490
Anatomic origin of atrial fibrillation
pulmonary veins
491
Anatomic origin of atrial flutter
tricuspid annulus
492
Adequate trial of SSRI
≥6 WEEKS
493
When to give Rho-GAM
ONLY for Rh(D)-negative patients (where father is Rh(D)-positive), even in first pregnancy (prevent alloimmnuizatoin)
28-32 wks gestation
<72h after delivery of Rh(D)-positive infant
Others
- <72h after spontaneous abortion
- ectopic pregnancy
- threatened abortion
- hydatidiform mole
- CVS, amniocentesis
- abdominal trauma
- 2nd and 3rd trimester bleeding
- external cephalic version
494
What vaccines should NOT be given during pregnancy?
- MMR
- varicella
- HPV
- live-attenuated influenza
495
Medial vs lateral knee pain
Medial: pes anserine syndrome. Highly localized
Lateral: IT band syndrome. Poorly localized
496
Classic CAH
21-hydroxylase deficiency
AR
```
Salt wasting
-hypotension
-dehydration
-vomiting
Virilization in girls
```
```
Decreased sodium
Increased potassium
Decreased glucose
Increased 17-hydroxyprogesterone
Increased testosterone
```
497
Water bottle-shaped heart
Large pericardial effusion
498
Intermittent asthma definition
Symptoms ≤2 d/wk
Nighttime awakening ≤2d/mo
Normal spirometry
No limitation on daily activity
Manage w/ prn albuterol
499
Hemorrhagic transformation
Complication of ischemic stroke
<48h: acute deterioration of neurologic status
RFs:
- large area
- embolic stroke
- treatment w/ thrombolytics
Emergent non-con CT --> urgent surgical decompression
500
Erlichiosis
"RMSF without the spots"
- actue febrile illness w/ malaise and AMS
- leukopenia, thrombocytopenia
- elevated LFTs, LDH
Rx: doxycycline
Treat empirically
501
Treatment of postpartum endometritis
Clindamycin and gentamycin
Fever, uterine tenderness, purulent lochia
502
Bacillary angiomatosis
Bartonella (henselae, quintana) infection in HIV (CD4 <100)
Vascular cutaneous lesions (red/purple papules --> friable pedunculated or nodular lesions)
Constitutional symptoms
Organ involvement (liver, CNS, bone)
Rx:
-abx (doxycycline, erythromycin) + ART
503
Internuclear ophthalmoplegia results from damage to the
medial longitudinal fasciculus (MLF)
(mediates communication between CN III and CN VI nuclei)
Unilateral: lacunar stroke (pontine artery)
Bilateral: MS
504
Management of inevitable abortion
Based on patient preference and hemodynamic stability (anemia, tachycardia, hypotension)
HD unstable: suction curettage, Rho-GAM
HD stable: expectant management or misoprostol
505
Cortisol in depression
increased
506
Preferred fluid resuscitation in burn victims
LR
507
Treat complicated infantile (strawberry) hemangioma
propranolol
508
Acid-base effects on calcium homeostasis
Ionized calcium is physiologically active
Alkalosis: more Ca bound to ALBUMIN, making it unavailable
Acidosis: increased ionized calcium
Alkalosis: decreased ionized calcium
509
Medullary thyroid cancer comes from
calcitonin-secreting parafollicular C cells
monitor recurrence w/ calcitonin levels
510
Organ failure complication of scleroderma
Scleroderma renal crisis
- sudden onset renal failure
- malignant HTN
- microangiopathic hemolytic anemia or DIC, thrombocytopenia
511
Caution w/ heterophile (Monospot) test
25% false negative rate during first week of illness
512
If high-grade squamous intraepithelial lesion on Pap during pregnancy
colposcopy and biopsy if see concerning features
513
Most common cause of neonatal sepsis
GBS (can also be late onset, >7d)
514
Infant botulism vs foodborne botulism
Infant botulism: ingestion of C. botulinum SPORES from environmental dust or honey
-rx: human-derived botulism IG
Foodborne: ingestion of preformed C. botulinum TOXIN from canned food
-equine-derived botulism IG
515
HHS treatment
-NORMAL SALINE
- IV insulin
- careful monitoring of K
516
If recent diagnosis of diabetes, think
pancreatic cancer
abdominal CT
517
Symmetric vs asymmetric fetal growth restriction
Symmetric:
- chromosomal abnormalities
- congenital infection
Asymmetric:
- uteroplacental insufficiency (HTN, etc)
- maternal malnutrition
518
Interpretation of D-xylose test
D-xylose is absorbed in the PROXIMAL SMALL INTESTINE, without degradation by pancreatic or brush border enzymes
Abnormal: small intestinal mucosal disease (e.g., celiac)
Normal: enzyme deficiencies, pancreatic insufficiency
519
Illicit drug that causes nystagmus
PCP
520
Liver cyst with daughter cysts
Echinococcus granulosus (dog tapeworm)
Hepatic cyst w/ eggshell calcification
Rupture- fever, eosinophilia
Albendazole
Surgery if ruptured
521
Treatment of multifocal atrial tachycardia
Treat underlying cause (commonly COPD)
522
Multifocal atrial tachycardia and association
P waves of ≥3 different morphologies
Irregular RR intervals
Atrial rate >100/min
Most commonly caused by COPD
Treat underlying cause
523
Management of presumed candida esophagitis
po fluconazole
EGD if fail therapy
524
Clue for adolescent depression
May be more IRRITABLE than sad
525
Depression w/ poor sleep and appetite
Mirtazapine
526
If EBV identified in CSF, think
primary CNS lymphoma
527
Treatment of normal pressure hydrocephnalus
ventriculoperitoneal shunting
528
Continuous flow murmur
PDA
529
Most common renal manifestation of HSP
hematuria
530
Ototoxic drugs
- aminoglycoside abx (gentamycin)
- salicylates
- chemo (cisplatin)
- loop diuretics (esp hi dose)
531
Coombs test in PNH
NEGATIVE since complement-mediated
532
Spherocytes w/ negative Coombs test
Autoimmune hemolytic anemia
533
Causes of Cushing syndrome
- excess glucocorticoids
- ACTH-producing pituitary adenoma
- ectopic ACTH production
534
PPROM <34wks
If uncomplicated
- expectant management
- latency antibiotics
- corticosteroids
- magnesium if <32 wks
535
When to deliver patients w/ PPROM
34 wks
536
When to give magnesium in PPROM
<32 wks
537
Management of HIV needlestick
Draw blood and start 3-drug ART immediately
538
If SVT on EKG
Adenosine
SVT is a category that includes many different arrhytmias, so in order to identify, use adenosine to slow down
(can also use vagal maneuvers)
539
Neurofibromatosis type I
AD NF1 mutation
- café au lait spots
- multiple neurofibromas
- Lisch nodules
All features:
- café au lait spots
- clustered freckles
- Lisch nodules (tan colored lesions of the iris)
- neurofibromas
- optic glioma
540
Attributable risk
AR = (RR–1)/RR
541
Most specific sign of acute otitis media
bulging TM
542
Interventions to reduce risk of ventilator-associated pneumonia
- elevate head of bed 30-45 degrees
- suction subglottic secretions
- minimize patient transport
- limit use of gastric acid suppression
543
Therapy for bacterial prostatitis
6 wks of TMP/SMX or fluoroquinolone
544
Clues to uremic pericarditis
- BUN >60
- most do NOT have classic diffuse ST-elevation
Treat w/ hemodialysis
545
False positive VDRL
Antiphospholipid syndrome
546
Management of antiphospholipid syndrome in pregnancy to avoid pregnancy loss
- low dose aspirin
| - low molecular weight heparin
547
Anticoagulant contraindicated in pregnancy
Warfarin
548
Ages to stop screenings
Mammogram: 75
Pap: 65
Colonoscopy: 75
549
Infectious cause of primary adrenal insufficiency
TB
550
Acid-base status in primary adrenal insufficiency
Normal AG metabolic acidosis
low aldosterone --> sodium wasting --> retention of K and H+ --> normal AG, hyperkalemic and hyponatremic metabolic acidosis
551
Lynch syndrome
AD
- colorectal cancer
- endometrial cancer
- ovarian cancer
552
FAP
- colorectal cancer
- desmoids and osteomas
- brain tumors
553
Treatment of psychosis in Parkinson disease
- reduction of antiparkinsonion medications if possible
- low-potency antipsychotic: quetiapine, clozapine, pimavanserin
AVOID high-potency antipsychotics like haloperidol and risperidone which have higher risks of extrapyramidal symptoms
554
If suspect critical limb ischemia
IV heparin before evaluating with imaging
555
Management of lone AF
Nothing
556
Where do medullablastomas most commonly occur
cerebellar vermis
557
Second stage arrest criteria and management
≥3h pushing in a prima w/o epidural (≥4 w/ epidural)
OR
≥2h pushing in a multi w/o epidural (≥3 w/ epidural)
Operative vaginal delivery (e.g., vaccuum, forceps)
558
Tetanus prophylaxis
≥3 tetanus toxoid doses:
- clean: vaccine only if last ≥10 years ago
- dirty: vaccine only if last dose ≥5 years ago
Unimmunized or <3 doses:
- clean: vaccine only
- dirty: vaccine AND tetanus immune globulin
559
Most effective antipsychotic
clozapine
560
Lyme treatment for kids and pregnancy
Amoxicillin
561
Diagnosis of lactose intolerance
hydrogen breath test
562
Leukemoid reaction vs CML
LAP score HIGH in leukemoid reaction
563
Prevent oxygen toxicity in ventilation
FiO2 <60% when possible
564
Pathophys of graft-vs-host disease
Donor T-cells attack host antigens
Rash
Diarrhea
Liver dysfunction
565
Workup of bilious emesis in newborn
abdominal xray --> contrast enema
566
Pathophys of high-output HF
AVF --> shunting of blood from arterial to venous side --> increased preload --> compensatory increase in HR and SV
Also get decreased afterload (d/t decreased SVR)
567
What statistical values varies based on the pre-test probability
PPV and NPV
A patient w/ a high prbability of having a disease will have a low NPV, and a patient w/ a low probability of having a disease will have a high NPV
568
Most common cause of sudden cardiac arrest in acute MI
Ventricular fibrillation
Ventricular arrhythmias are very common in the immediate post-MI period. Re-entry is the mechanism.
569
If splenic infarction, suspect
- hypercoagulable states
- embolic disease
- hemoglobinopathy
570
Which non-germ cell cancer can express AFP?
HCC
571
Effect of hydroxyurea in sickle cell disease
Increases HbF
Dilutes the amount of sickled Hb
572
Where in the lung is the destruction of alpha-1-antitrypsin deficiency?
Lower lobes
573
If COPD symptoms in the young (or w/ no h/o smoking)
Think A1AT. May not have liver involvement...
574
When to use adjunctive steroids in PCP infection
- low PaO2 (≤70)
| - A-a gradient ≥35 on RA
575
Cavitary lesions and pulmonary symptoms in an IV drug user
septic emboli from infective endocarditis
Staph aureus
Nodular infiltrate w/ cavitation
576
Physiologic bowlegs (genu varum) resolves before
2 y.o.
577
Childhood onset fluency disorder
= stuttering
578
Language disorder
difficulties in the acquisition and use of language d/t deficits in comprehension and/or production
579
Varicella vaccine given at
1 and 4
580
Colles fracture
Distal radius
Impacts the MEDIAN nerve
- carpal tunnel- paresthesias, impaired thumb abduction (APB)
- decreased sensation over anterolateral hand
581
Triad of fat embolism syndrome
24-72h after fracture of marrow-containing bone or pancreatitis
- respiratory distress
- neurologic dysfunction (e.g., confusion)
- petechial rash (<50%)
582
Caution re dx of fat embolism syndrome
Rash is present in <50% of cases
583
Nutritional rickets
d/t vitamin D deficiency
- delayed closure of fontanelles
- wrist enlargement
- craniotabes (soft skull bones)
- progressive symmetric or asymmetric bowing of legs
- rachitic rosary (widening of the costochondral joints)- bony prominences on exam
584
Treatment of postpartum blues
reassurance and observation
assess after 2 wks
585
Urine cholride in diuretic abuse and Bartter and Gittleman
HIGH
586
Acid-base status in chronic diarrhea
metabolic acidosis (loss of bicarb) and hypokalemia
587
Acute calcineurin inhibitor renal toxicity
Tacrolimus and cyclosporine [inhibit IL-2 production]
VASOCONTRICTIVE properties
- HTN
- pre-renal AKI
Acute toxicity can be precipitated by cyt P450 inhibitors since they are hepatically cleared
588
Protective mechanism of sodium bicarbonate in TCA overdose
TCAs inhibit fast SODIUM channels in myocardium
NaHCO increases pH and extracellular sodium, thereby alleviating the cardio-depressant action on sodium channels
589
Hepatic cyst w/ eggshell calcification
hydatid cyst- Echinococcus granulosus
590
If anti-D antibody titer elevated during subsequent pregnancy
inadequate dose following delivery (common in operative, placental abruption, etc.)
Need to use K-B test to determine proper dose
591
Stevens-Johnson vs toxic epidermal necrolysis
<10%: SJS
10-30%: SJS-TEN overlap
>30%: TEN
592
Most effective treatment for depression
Combimation of SSRI/SNRI and psychotherapy (CBT or interpersonal)
593
Schizoid vs avoidant personality disorder
Schizoid: prefers to be alone
Avoidant: avoids people out of fear of rejection/embarrassment
594
Lymphadenitis
Lymphadenopathy that is tender, enlarged, and erythematous
Most commonly d/t staph aureus or GAS
595
Bloody diarrhea culprits
- E. coli (EHEC- shiga)
- Shigella
- Campylobacter
596
Do OCPs cause weight gain?
NO
597
If diagnose someone with rheumatic heart disease
penicillin prophylaxis (IM penicillin G)
598
Calcium gluconate indications
Hyperkalemia with:
- EKG changes
- K ≥7 w/o EKG changes
- rapidly rising K d/t tissue breakdown
599
First step in hypercalcemia
Normal saline
Then calcitonin, then bisphosphonates
600
Primary vs secondary/tertiary hyperparathyroidism
Primary: low phosphorus
| Secondary/tertiary: high phosphorus
601
Meningococcal vaccination schedule
11-12 and booster at 16
602
Abnormal uterine bleeding on OCPs in patients <45
endometrial biopsy
603
Cyanide toxicity
d/t nitroprusside infusion
- AMS
- lactic acidosis
- seizures
- coma
High risk in prolonged infusions, higher doses, or renal disease
604
Polymyositis
- chronic PROXIMAL muscle weakness
- elevated muscle enzymes (CK, aldolase, AST)
- autoantibodies: ANA, anti-Jo1
- muscle biopsy: endomysial infiltrate, patchy necrosis
605
Salicylate toxicity
Respiratory alkalosis + AG metabolic acidosis
- near normal pH
- low PaCO2
- low bicarb
606
PTSD in children
- distressing dreams w/ vague content (monsters, etc.)
- reenactment of traumatic themes in play
- emotional dysregulation
- behavioral difficulties
607
What is not effectie for tinea pedis?
Nystatin
608
Most common side effect of tamoxifen
hot flashes
also endometrial cancer and venous thromboembolism
609
Alopecia areata
Autoimmune attack on hair bulb cells
Genetic presidposition
- painless, patchy, nonscarring hair loss
- narrowing of hair shafts close to skin surface (exclamation point hairs)
- positive hair pull test (>5-6 hairs pulled)
Rx
- mild/mod: topical or intralesional corticosteroids
- extensive: topical immunotherapy, oral corticosteroids
610
Beta thalassemia Hb electrophoresis
Increased Hb A2 and Hb F
611
What therapy improves survival in beta thalassemia?
Chelation therapy, since they are transfusion dependent and at risk for iron overload
612
Hepatojugular reflex d/t
impaired RH function.
Helps distinguish between CARDIAC and hepatic edema
Liver disease: NO HJR
613
Which pathology is most common in native infective endocarditis?
MITRAL VALVE --> mitral regurgitation
614
If chondrocalcinosis (calcification of articular cartilage)
Calcium pyrophosphate disease- pseudogout
Rhomboid-shaped, weakly positively birefringent CPPD crystals
615
Treat SIADH
begin w/ fluid restriction +/- salt tablets
Severe hyponatremia: hypertonic (3%) saline
616
Cystinuria
Impaired transport of cystine and dibasic amino acids (COLA) in renal tubular and intestinal epithelial cells
Increased renal excretion --> cystine stone = HEXAGONAL CRYSTALS
inherited
Urinary cyanide-nitroprusside test
617
Hashimoto thyroiditis increases risk of which cancer
thyroid lymphoma
Rapidly enlarging mildly tender goiter w/ compressive symptoms, B symptoms (like all lymphoma), anti-TPO antibodies
618
If GBS asymptomatic bacteriuria or UTI during pregnancy
do not need GBS screen; do need prophylactic penicillin
619
When are tocolytics indicated
<32 wks
Indomethacin is first line
620
Babesiosis
From Ixodes tick (NE US)
- flu like: fevers, fatigue, HA, myalgias
- anemia, thrombocyropenia, elevated bilirubin, LFTs, LDH [intravascular hemolysis]
- severe: ARDS, CHF, DIC, splenic rupture
Dx: blood smear: maltese cross (intraerythrocytic rings)
rx
- atovaquone + azithromycin
- severe: quinine + clindamycin
621
Dobutamine
beta-1 agonist
Use in decompensated HF to improve ejection fraction
- positive inotrope (increased myocardial contractility)
- positive chronotrope (increased HR)
- improves forward ejection of a higher blood volume– decreased LVESV
622
Contraception in breastfeeding and postpartum
Copper IUD or progestin-only (pills or implant)
623
Location of Huntington disease pathology
caudate and putamen
624
Management of active phase arrest
C-section, because no further change is expected
Most commonly d/t cephalopelvic disproportion
625
Indication for oxytocin in labor
Augmentation of labor IF CONTRACTIONS ARE INADEQUATE (<200 Montevideo)
Used in PROTRACTED labor (dilation <1 cm/2h), but NOT arrest
626
Tumor lysis syndrome labs
- increased phosphorus, potassium, uric acid
- decreased calcium
AKI
Arrhythmias
rx
- IVF
- allopurinol or rasburicase
627
Multiple myeloma and infections
Increased risk d/t hypogammaglobulinemia from marrow infiltration
628
Management of DVT in patients w/ contraindications to anticoagulation (active bleeding, recent surgery, hemorrhagic stroke)
IVC filter
629
Pericardial knock is described as a
middiastolic sound
630
Recurrent bacterial infections in an adult should raise suspicion for
Common variable immunodeficiency
631
If cytopenias and DIC, suspect
AML/APML
632
Felty syndrome
- rheumatoid arthritis
- splenomegaly
- neutropenia
633
Erb palsy vs Klupmke palsy
Erb: waiter's tip
-C5-C6 injury
Klumpke: claw hand, Horner syndrome
-C8-T1 injury
634
Narcolepsy drug
Modafinil
635
Non-stimulant for ADHD
Atomoxetine
636
Caution w/ NPH
Not all 3 features are required- only gait dysfunction is mandatory. Go w/ MRI findings!
May also see upper motor neuron signs
637
Ventilation pressures
Peak airway pressure = airway resistance + plateau pressure
Plateau pressure = elastic pressure + PEEP
638
Relative risk interpretation
Null value is 1, so if RR = 1 NO association between exposure and outcome
RR > 1: outcome occurs more frequently in exposed group
RR < 1: outcome occurs less frequently in exposed group
639
Cardiac cath in tamponade
Elevated and equilibrated intracardiac diastolic pressures
640
Painful vs painless vision loss in HIV
Painful: HSV, VZV
Painless: CMV
641
Evaluation of an anastamotic leak
Contrast CT --> surgery
642
Microcytic anemia w/ low reticulocyte count
IDA
643
Iron in thalassemias
Elevated d/t increased RBC turnover
644
Reticulocyte count in thalassemias
Elevated
645
Bilirubin in thalassemias
Elevated d/t hemolysis
646
Tests to identify primary adrenal insufficiency
- 8am serum cortisol and plasma ACTH: low cortisol, high ACTH
- ACTH stimulation test (cosyntropin test): minimal response
647
Conduct disorder vs ASPD
≥18 y.o. = ASPD
648
Preecmalpsia with severe features
New-onset HTN ≥20 wks PLUS proteinuria &/or end-organ damage PLUS:
- BP ≥160/≥110
- thrombocytopenia
- increased creatinine
- increased transaminases
- pulmonary edema
- vision or cerebral symptoms
649
Labetalol contraindication in preecmalpsia
bradycardia
650
Herpangina
d/t Coxsackie A virus
ages 1-7, late summer-early fall
- fever
- pharyngitis
- gray vesicles/ulcers on oropharynx
tx: supportive
651
Postnatal workup of fetal growth restriction
send placenta for histopathologic examination
652
Workup of jaundice w/ choelstatic pattern
abdominal imaging (US or CT)
653
Two categories of autoimmune hemolytic anemia
WARM agglutinin AIHA
- IgG
- steroids to treat
COLD agglutinin AIHA
-IgM
Splenomegaly
NO schistocytes
654
Miliary TB
History suspicious for TB and diffuse reticulonodular appearance on X-ray
655
If a presumed Jehova's Witness without a blood transfusion card or advance directive who does not have capacity
give blood
656
Are fiancés legal next-of-kin?
NO
657
Number needed to treat
NNT = 1/ARR
ARR = absolute risk reduction
658
Ideal NNT
1
659
Presbyopia mechanism
decrease in lens elasticity --> difficulty w/ near vision
660
Treatment of drug-resistant CMV
foscarnet
661
If lack of bleeding after progesterone challenge
low estrogen (e.g., POI)
662
Crucial lab in primary ovarian insufficiency
Elevated FSH
663
POI vs Asherman syndrome
Both have no progesterone withdrawal bleeding
POI: increased FSH
664
If deep, longstanding, elevated ESR, or large diabetic ulcer
Foot imaging (xray, MRI) to assess possible osteomyelitis
665
Acute abdominal pain in young woman on anticoagulation, suspect
Ruptured ovarian cyst complicated by hemoperitoneum
666
Case control vs cohort study
Case control: OUTCOME first, look for RFs
| Cohort: RISK FACTOR first, look for outcome
667
If septic arthritis not responding to vancomycin
Likely a GN bug, so broaden coverage to ceftriaxone
e.g. Kingella kingae
668
5-alpha reductase deficiency vs androgen insensitivity syndrome
AIS: XY, phenotypically female, absent/minimal axillary/pubic hair (peripheral androgen resistance), BREAST DEVELOPMENT
5AR: XY, phenotypically female, VIRILIZATION @PUBERTY (e.g., clitoromegaly), no breast development
669
Imaging for kidney stones
US or NON-CONTRAST CT
670
Watch out for atypical presentations of MI
- women
- elderly
- DM
Epigastric pain, nausea, vomiting, diaphoresis
671
Croup
Laryngotracheitis
PARAINFLUENZA infection
- inspiratory stridor
- barking cough
- hoarseness
Mild (no stridor @rest): humidified air +/- steroids
Mod/severe (stridor @rest): steroids + racemic epinephrine
672
Pemphigus vulgaris vs bullous pemphigoid
Pemphigus vulgaris:
- painful, FLACCID bullae
- Nikolsky sign (separation of epidermis w/ light friction)
- Antibodies against desmoglein 1 and 3
Bullous pemphigoid:
-pruritis, TENSE bullae
673
Diagnosing of Cushing syndrome
1. confirm hypercortisolism
- late-night salivary cortisol assay
- 24h urine free cortisol
- overnight low-dose dexamethasone suppression test
2. If hypercortisolism confirmed:
- ACTH level (to establish Cushing disease /ectopic ACTH vs adrenal adenoma)
674
Twin classification is based on
Chorionicity: # of placentas
Amnionicity: # of amniotic sacs
675
Labor with taut bulging bag with no palpable presenting fetal part
Cannot determine presentation, so use transabdominal US
Presentation will help determine route of delivery
- cephalic --> vaginal
- breech, transverse --> CS
676
Magnesium toxicity and treatment
[Loss of DTRs, respiratory depression, cardiac arrest]
Mild: nausea, flushing, headache, hyporeflexia
Mod: areflexia, hypocalcemia, somnolence
Severe: respiratory paralysis, cardiac arrest
Rx:
- STOP mag
- give IV calcium gluconate
677
Management of ectopic pregnancy
Stable: methotrexate
Unstable: surgery
678
Paget disease of bone is a RF for
osteosarcoma
679
Chronic bacterial prostatitis caution
MAY NOT HAVE PROSTATIC TENDERNESS
- recurrent UTI symptoms
- painful ejaculation
- transient improvement w/ abx
- +/- prostatic tenderness
rx: 6 wks fluoroquinolone
680
Therapeutic window for TPA in stroke
symptom onset <4.5hrs ago
MANY exclusion criteria
681
Stroke anticoagulation
Aspirin
If already on aspirin: aspirin + clopidogrel (or dipyridamole)
682
Heparin in stroke?
NO (high risk of bleeding)
683
Most common cause of pediatric stroke
Sickle cell disease
684
Tuberous sclerosis
AD mutation in TSC1/2 genes
```
Derm
-hypopigmented macules (ash leaf spots)
-angiofibromas of the malar region
-Shagreen patches
Neuro
-CNS lesions (hamartoma)
-epilepsy
-intellectual disability
-autism and behavioral disorders (hyperactivity)
CV
-rhabdomyomas ***evaluate all pts w/ echo***
Renal
-angiolipomas
```
685
If cardiac rhabdomyoma, think
Tuberous sclerosis
686
Monoclonal IgM
Waldenström macroglobulinemia
687
Persistent ST-elevation post-MI and deep Q waves in same leads
ventricular aneurysm
Progressive LV enlargement -->
- HF
- refractory angina
- ventricular arrhythmias
- functional MR
- mural thrombus
688
Greater trochanteric pain syndrome
(aka trochanteric bursitis)
Mostly obese F >50
Chronic lateral hip pain
Pain worse w/ hip flexion or lying on affected side
Focal tenderness over trochanter
US: degeneration of tendons, tendinosis
Tx:
- exercise, PT, activity modification
- NSAIDs
- steroid injection
689
Hypocalcemia w/ elevated PTH
- vitamin D deficiency (check 25-hydroxy vitamin D)
| - CKD (check Cr)
690
Factor V Leiden
AD activated protein C resistance
PrC resistance --> decreased degradation of factor V --≥ thrombin formation --> thrombosis
PT and aPTT can be normal
691
Which types of twins are at risk for twin-twin transfusion syndrome?
MONOCHORIONIC [1 placenta]
692
Indications and contraindications for external cephalic version
Breech/transverse @ ≥37 wks
Contraindications:
- prior classical CS
- prior extensive uterine myomectomy
- placenta previa
693
Absence seizures may be accompanied by
automatisms
NO post-ictal state
694
Cause of infertility in Kleinfelter syndrome
47, XXY
Seminiferous tubule dysgenesis --> testicular fibrosis --> azospermia, hypogonadism, elevated FSH & LH (and elevated testosterone)
695
Management of uterine inversion
MANUAL REPLACEMENT OF UTERUS
Then can remove retained placenta
696
Most accurate method of determining gestational age
First trimester US w/ crown-rump length measurement
697
Vitamin deficiency in carcinoid syndrome
Niacin (diarrhea, dementia, dermatitis)
698
Rhythm control of Afib in patients w/ WPW
stable: ibutilide or procainamide
unstable: cardioversion
699
If Zollinger-Ellison syndrome, look for
MEN 1 [pituitary, parathyroid, pancreas/GI neuroendocrine]
700
What drug to avoid in acute closed angle glaucoma
Atropine [mydriatic]
[Treat w/ mannitol, acetazolamide, pilocarpine, or timolol]
701
Most PEs come from
PROXIMAL (thigh) >>> distal (calf)
Femoral and popliteal veins
702
Immediate treatment of frostbite
warm WATER (not air)
703
Toxoplasmosis can come from
- cat feces
- raw or undercooked meat
- unwashed fruits/veggies
704
Paget disease of bone is d/t
osteoCLAST dysfunction --> increased bone turnover
705
First line for chemotherapy-induced nausea
Ondansetron (serotonin receptor antagonist)
706
CREST syndrome
associated w/ limited cutaneous systemic sclerosis
```
Calcinosis cutis
Raynaud phenomenon
Esophageal dysmotility with reflux
Sclerodactyly
Telangectasia
```
Often associated with pulmonary arterial hypertension
707
Tight glucose control decreases risk of
MICROVASCULAR complications (retinopathy, nephropathy), not macrovascular or all-cause mortality
708
Cellulitis vs erisypelas
Cellulitis: deep- flat, indistinct borders
Erisypelas: superficial- raised, sharp borders and intense erythema
709
Acute interstitial nephritis
d/t drugs (penicillins, TMP/SMX, cephalosporins, NSAIDs)
- maculopapular rash
- fever
- new drug exposure
- +/- arthralgias
AKI
Hematuria, pyuria, WBC casts
Eosinophilia, urine eosinophils
710
Placental fluid volume in post-dates pregnancy
Oligohydramnios (d/t placental insufficiency)
711
Most reliable finding to distinguish epilepsy from syncope
Tongue biting (usually lateral)
712
Women with recurrentvulvuvaginal candidiasis should be tested for
Diabetes (HbA1c)
713
False positive PCP drug screen
Dextromethorphan
714
Solitary, hyperpigmented macules w/ increased density of overlying dark, coarse hair in infant
Congenital melanocytic nevus
Can transform to melanoma
715
Features suggestive of blunt cardiac injury
persistent tachycardia and new arrhythmia after blunt chest trauma
continuous cardiac monitoring and echo
716
What type of bone lesion does prostate cancer typically cause?
osteoBLASTIC
- normal or low Ca
- elevated alk phos
- focal, sclerotic bone lesions
717
Restrictive vs obstructive lung disease
Obstructive: low FEV1/FVC ratio
Restrictive: normal/high FEV1/FVC ratio; low VC
718
Empiric treatment of community-acquired pneumonia
Outpatient
- healthy: macrolide OR doxycycline
- comorbidities: fluoroquinolone OR beta-lactam + macrolide
Inpatient
- IV fluoroquinolone
- beta-lactam + IV macrolide
ICU
- beta-lactam + IV macrolide
- beta-lactam + IV fluoroquinolone
Of note, fluoroquinolone must be resipratory:
- levofloxacin
- moxifloxacin
719
Calciphylaxis
(aka calcific uremic arteriolopathy)
pathyphys
- arteriolar and soft tissue calcification
- local tissue ischemia and necrosis
RFs
- ESRD (HD, transplants)
- hypercalcemia, hyperphosphatemia
- hyperparathyroidism
- obesity, DM
- oral anticoagulants (e.g., warfarin)
clinical
- painful nodules and ulcers
- soft tissue calcification on imaging
- skin biopsy: arterial calcification/occlusion, subintimal fibrosis
Can become infected and lead to sepsis. Mortality is high.
***NORMAL CALCIUM DOES NOT EXCLUDE DIAGNOSIS***
720
Bipolar I vs bipolar II
Bipolar I: Manic episode(s)
Bipolar II: hyponamic episode(s) AND ≥ MDE
721
If elderly with severe lymphocytosis, hepatosplenomegaly, LAD, and bicytopenia (anemia and thrombocytopenia), think of
CLL
Diagnose w/ flow cytometry
722
Diagnose CLL
flow cytometry
723
Empiric treatment of meningitis in immunocompromosed patients
cefipime or ceftazidime + vancomycin + ampicillin
Also give empiric steroids (to prevent neurologic sequelae of strep pneumo meningitis, but d/c once ruled out)
724
Trichinellosis
[Triad: periorbital edema, myositis, eosinophilia]
Ingestion of undercooked meat (usually pork)
```
Intestinal stage (w/in 1wk of ingestion):
-asymptomatic OR abd pain, N/V/D
```
Muscle stage (up to 4wks after ingestion):
- myositis
- fever
- subungual splinter hemorrhages
- periorbital edema
- eosinophilia (>20%)
- elevated CK, leukocytosis
725
Hypokalemia in alcoholism d/t
hypomagnesemia [since Mg inhibits K secretion through ROMK]
726
Hawthorne effect
change behavior if know you're being studied
727
Aplastic anemia
Pancytopenia (and its sequelae) w/ normal cell morphology on peripheral spear and no splenomegaly
728
If suspect DVT (positive Wells)
Compression US BEFORE treatment (opposite of PE where you treat and then image)
729
Treat adjustemtn disorders
psychotherapy
730
Glucagonoma
- weight loss
- necrolytic migratpry erythema [erythematous papules that coalesce to form large indurated papules w/ central clearing]
- DM/hyperglycemia
- GI sx (diarrhea, anorexia, abd pain)
dx: markedly elevated glucagon level
731
Widened pulse pressure
Increased systolic, decreased diastolic
e.g., aortic regurgitation
732
Bleeding disorder in renal failure
Platelet dysfunction
Normal PT, aPTT, platelet count
Prolonged BT
Desmopressin (DDAVP) is treatment
733
Small vs large fiber neuropathy
Small fiber: positive sympotms (pain, paresthesia, allodynia)
Large fiber: negative symptoms (numbness, loss of proprioception and vibration sense, diminished ankle reflexes)
734
Isoniazid side effect and management
INH hepatitis
Increased risk in drinkers, liver disease, >50
If suspicious for INH hepatitis, STOP INH
But, if only MINOR elevations in LFTs (very common), continue INH
735
Management of first-degree AV block
Depends on QRS
Normal QRS: observation
Prolonged QRS: EP testing
736
Pericardial calcifications
Constrictive pericarditis
737
Features of constrictive pericarditis
Etiology
- idiopathic or viral
- cardiac surgery or radiation therapy
- TB
Clinical presentation
- fatigue and dyspnea on exertion
- peripheral edema and ascites
- increased JVP
- pericardial knock (early sound after S2)
- pulsus paradoxus
- Kussmaul sign (lack of inspiratory decline in CVP)
Diagnosis
- EKG: nonspecific, Afib, or low-voltage QRS
- Imaging: pericardial thickening and calcification
- JVP tracing: prominent x and y descents
738
If sudden-onset hypotension, cyanosis, and hypoxia that fails to respond to 100% O2 in a neonate, think
PDA-dependent congenital heart disease [sudden closure of the ductus has affected blood flow]
- coarctation of the aorta
- D-transposition of the great arteries
- hypoplastic LH syndrome
- TAPVR
- Tricuspid atresia
R --> L shunt of deoxygenated blood
Ductal-dependent defect requires PDA to be maintained:
-prostaglandin E1
739
Drugs that affect the ductus arteriosus
Prostaglandin E1: keeps it open
| Indomethacin: closes it
740
If suspect diaphragmatic rupture on xray
CT
741
Suppurative thyroiditis
(aka infectious thyroiditis)
Suppurative INFECTION of the thyroid gland
High-grade fever and pain at thyroid gland.
Typically euthyroid
742
Anaphylaxis during transfusions is a clue for
selective IgA deficiency
-can form IgE antibodies against IgA
Also recurrent sinopulmonary and GI infections, concommitant atopy/autoimmunity
743
Microcytic anemia w/ normal iron studies
hemoglobinopathy
744
Rifampin side effect
Red body secretions (urine, tears, etc)
745
Important coagulation adverse effect of nephrotic sybdrome
Renal vein thrombosis
- hematuria
- flank pain
- scrotal edema
due to hypercoagulability
746
Ecthyma gangrenosum
Cutaneous infection w/ Pseudomonas aeruginosa
- immunocompromised patients w/ pseudomonal bacteremia
- ischemic necrosis: painless red macule --> indurated pustules/bullae w/ punched-out gangrenous ulcers
- patients usually febrile/ill
747
Manageent of vaginal foreign body in girl
- topical anesthetic
| - vaginal irrigation w/ warm water or removal w/ a swab
748
If refractory symptoms of anaphylaxis after IM epinephrine
more epi
749
Greatest risk of parenteral nutrition
central-line associated bloodstream infection (CLABSI) since has to be given through central line
bugs
- coagulase-negative staph
- staph aureus
- GNs: Klebsiella pneumoniae, Pseudomonas aeruginosa
- candida
750
Chest pain, decreased cardiac output, and pulsus paradoxus following viral infection
viral pericarditis complicated by cardiac tamponade
751
CSF in herpes simplex encephalitis
- lymphocytic pleocytosis
- elevated protein
- normal glucose
- elevated RBCs
752
Back pain exacerbated by walking downhill but not uphill
neurogenic claudication (spinal stenosis)
shopping cart sign
753
If signs of Cushing's with HYPERPIGMENTATION
ectopic ACTH production
- pituitary ACTH secretion
- paraneoplastic ACTH secretion
754
Do NG tubes prevent aspiration pneumonia?
NO, has to be postjejeunal
Things that do:
- elevate head of bed
- limit PPIs
755
Hemodynamic effects of tension pneumothorax
high intrathoracic pressure impedes venous return by compressing vena cava
Needle decompression increases venous return
756
How to tell PTX vs tension PTX
Tension: HD unstability
757
If both upper and motor neuron signs
ALS
e.g., atrophied hand muscles
758
If hypokalemia after starting a thiazide diuretic, think
Primary hyperaldosteronism
-bilateral adrenal hypreplasia > unilateral adrenal adenoma
HTN w/ hypokalemia alkalosis, muscle weakness and paresthesias
High aldosterone, low renin
759
Treatment of primary hyperaldosteronism
Bilateral adrenal hyperplasia: spironolactone
Unilateral adrenal adenoma: excision
760
Secondary hyperparathyroidism
CKD --> low vitD --> low Ca absorption --> hypocalcemia, hyperphosphatemia --> increased PTH --> osteitis fibrosis cystica
Parathyroid hyperplasia
761
Calcium in secondary hyperparathyroidism
LOW
762
Tertiary hyperparathyroidism
chronic parathyroid stimulation --> autonomously functioning adenomas
- high PTH
- high calcium
763
Treat overflow incontinence from neurogenic bladder
cholinergic agonsit (bethanechol)
764
Precipitators of hepatic encephalopathy
- infection
- electrolyte abnormalities
- high-nitrogen states: GI bleed, diet changes
765
CML vs CLL on CBC
CML: leukocytosis of predominately neutrophil lineage
CLL: leukocytosis of premoninately lymphocyte lineage
766
Hypovolemic hyponatremia
volume loss (e.g., vomiting, diarrhea) --> ADH release --> RAAS --> hyponatremia
Rx: isotonic saline
767
What type of hyponatremia is SIADH?
euvolemic
768
Antibiotic prophylaxis for MVP before dental procedures?
NO
769
Treat acute dystonia
- benztropine
| - diphenhydramine
770
Midshaft humeral injury causes
radial nerve injury
771
What type of shunt is ASD?
Left-to-right (shunts more blood to pulmonary circulation, which is why you hear fixed split of S2)
772
Fibrinogen in DIC
decreased
773
Albuminocytologic dissociation
Guillain-Barré syndrome CSF:
- elevated protein count
- normal leukocyte count
774
Factitious disorder vs malingering
Factitious disorder: feign symptoms to assume sick role
Malingering: feign symptoms to gain external rewards
775
Management of spinal epidural abscess
Broad-spectrum antibiotics
NOT steroids, which would make worse
776
Upper/lower respiratory tract, kidney, and cutaneous involvement
Granulomatosis w/ polyangiitis
777
If withdrawing from both alcohol and opioids
Treat alcohol withdrawal [benzos], since it is life-threatening
778
If suspect PE in pregnant woman
V/Q scan
779
Interpretation of V/Q scan
based on PRE-TEST PROBABILITY for PE
Normal V/Q scan w/ any PTP: PE excluded
Low probability V/Q w/ low PTP: PE excluded
High probability V/Q w/ high PTP: PE confirmed
All other combinations of V/Q results and PTPs: additional testing needed (CTA)
780
Complication of hereditary spherocytosis
- pigment gallstones
- splenomegaly
- hemolytic anemia
781
Efavirenz side effects
Neuropsychiatric: insomnia w/ vivid dreams, depression, anxiety
782
Urge incontinence treatment
- lifestyle modification
- bladder training
- antimuscarinics (oxybutinin)
783
What do the positive and negative in blood type refer to?
Rh type
784
Next step if painless third trimester bleeding
Transabdominal US (suspect placenta previa)
785
If transabdominal US reveals placenta previa
TVUA (since TAUS has high false-positive rate for placenta previa)
786
Which beta blocker has not specifically been evaluated in HF survival benefit?
Atenolol
| instead: metoprolol, carvedilol, bisoprolol
787
Tololytics
Indomethacin (COX inhibition)
Nifedipine (CCB)
-SE: tachycardia/palpitations, nausea, flushing, HA
Terbutaline (beta agonist)
- SE: tachycardia/arrhythmias, hypotension, hypoglycemia, pulmonary edema
- not frequently used d/t risk of adverse events
788
Treatment of hypertriglyceridemia
Fibrates (e.g., fenofibrate)
789
Roseola caused by
HHV-6
790
Sudden syncope w/o prodrome most likely to be
ventricular fibrillation
sotalol can cause QT prolongation --> TdP
791
If QT prolongation and stable, give
magnesium sulfate, even if mag is normal
792
Caution in treating patients w/ RHF
Preload dependent, so be very careful with diuresis (can get prerenal AKI)
793
Pharmacotherapy for eating disorders?
Bullimia: fluoxetine
Anorexia: not effective
794
Shock after MI
Cardiogenic shock
- high preload
- low cardiac output
- high afterload [compensatory increase in SVR]
795
Treatment of acute gout in patients on anticoagulation
Colchicine or steroids
NOT indomethacin (increases bleeding)
796
Pathophysiology of urge incontinence
detrusor hyperactivity (involuntary detrusor contractions)
797
Hypertensive hemorrhages most commonly occur in the
basal ganglia
798
Pre-operative physical therapy prevents
post-operative atelectasis/pneumonia, shortens hospital stay
799
When to consider use of hypertonic saline in hyponatremia
<120 and symptomatic
800
Prosthetic valve thrombosis
Presents like HF
d/t subtherapeutic anticoagulation
MITRAL valve at higher risk d/t less flow
INR goals:
- aortic: 2-3
- mitral: 2.5-3.5
801
Fetal fibronectin
Used in <34 wks w/ regular contractions and closed cervix to determine if in preterm labor
NOT indicated after 34 wks or if cervical change (because that is definition of labor)
If positive at <34 wks, next step is give steroids
802
If ear displacement, think
mastoiditis
IV abx
803
Which gynecologic cancer is an AIDS-defining illness?
Cervical cancer
804
Unstable patients who cannot wait for type and cross should receive
type O blood
805
If trauma patient in hemorrhagic shock, next step is
transfusion (type O if don't know blood type)
If still hemorrhaging or unstable, massive transfusion protocol: pRBC, plts, FFP in 1:1:1 ratio
806
Local vascular complications of cardiac catheterization
Hematoma
- +/- mass
- no bruit
Pseudoaneurysm
- bulging, pulsatile mass
- SYSTOLIC bruit
AVF
- no mass
- CONTINUOUS bruit
807
Giant cell tumor or bone is also known as
osteoclastoma
soap-bubble appearance
808
In addition to supportive care, all patients w/ hyperemesis gravidarum should get
pelvic US to evaluate multiple gestation or mole
809
Open-angle glaucoma
chronic, progressive loss of peripheral vision
cupping of optic disc
increased cup:disc ratio
810
DRESS syndrome
Drug (often allopurinol or antiepileptic)
Rash (morbilliform)
Eosinophilia
Systemic Symptoms (fever, malaise, diffuse LAD)
Strop drug and supportive care
811
Recurrent malaria d/t
Plasmodium vivax DORMANT hepatic hypnozoites
Treat w/ chloroquine PLUS primaqine to eliminate the hepatic hypnozoites
812
Harsh holosystolic murmur w/ palpable thrill
VSD
813
Most effective prevention of herpes
consistent condom use
Most transmission occurs during asymptomatic viral shedding
814
Which antiemetics cause extrapyramidal symptoms
DOPAMINE ANTAGONISTS
- prochlorperazine
- promethazine
- metaclopramide
815
Interpretation of relative risk and odds ratio
>1: positive association
<1: negative association
1 is null, so CI including 1 is NOT significant
816
Urine sodium in SIADH
High, since kidneys do not aggressively retain sodium in euvolemia
817
Drugs that cause SIADH
- SSRIs
- carbamazepine
- NSAIDs
818
Reduce blood viscosity in Waldenström macroglobulinemia
plasma exchange to reduce IgM levels
819
Management of paraphimosis
urgent manual or surgical reduction of the prepuce
820
If mother detects decreased fetal movement
Has to be worked up- non-stress test
821
If acute exacerbation of COPD that deos not respond to initial therapy
Noninvasive positive pressure ventilation
Trial NPPV before intubation
822
Treatment of E. coli O157:H7
Supportive- antibiotics increase risk of HUS
823
Hydroxychloroquine side effect
Retinopathy- requires eye monitoring
824
Massive PE definition
PE c/b HYPOTENSION +/or acute RH STRAIN
syncope
825
Treatment of syphilis w/ penicillin allergy
Doxycycline po
826
Ethylene glycol poisoning urine finding
Envelope-shaped calcium oxalate crystals
827
Treat cocaine-associated chest pain
Benzos
DO NOT USE BETA-BLOCKERS--> unopposed alpha which worsens coronary vasoconstriction
828
Does progestin increase thromboembolism risk?
NO, so can use IUD in these patients
829
Calcineurin inhibitor adverse effects
- nephrotoxicity
- HTN
- neurotoxicity (tremor)
- impaired glucose control
830
Parapneumonic effusion vs empyema
Empyema is when parapneumonic effusion becomes colonized w/ bacteria and purulent
831
Anticoagulation in kidney disease
unfractionated heparin --> warfarin
832
Management of tardive dyskinesia
- discontinue causative medication
- switch to SGA (clozapine, quetiapine)
- valbenazine or deutetetrabenazine
833
Which test best diagnoses bronchiectasis?
High-res CT
834
GI watershed areas
- SPLENIC flexure
| - rectosigmoid junction
835
Management of enuresis
- behavioral: decreased fluids before bedtime, voiding before bed
- enuresis alarms
- DESMOPRESSIN (po) [imipramine only if DDAVP fails]
836
Cause of bacterial conjunctivitis in adults
Staph aureus
837
If suspect acromegaly
IGF-1
838
All SERMs increase risk of
VTE
839
Raloxifene MoA
Estrogen antagonist: breast, uterus
| Estrogen agonist: bone
840
Treatment of amebic liver abscess
Metronidazole, NOT drainage
| Entamoeba histolytica, solitary liver lesion
841
Pentad of TTP
- thrombocytopenia
- MAHA
- renal insufficiency
- neurologic changes
- fever
842
Vitamin A deficiency
- impaired adaptation to darkness
- photophobia
- dry scaly skin
- xerosis conjunctiva
- xerosis cornea
- keratomalacia
- Bitot spots
- follicular hyperkeratosis of the shoulders, buttocks, adn extensor surfaces
843
Pertussis treatment
Azithromycin
844
What type of heparin to use in ESRD
UNFRACTIONATED, NOT low molecular weight
845
Physiology of different murmur maneuvers
DECREASE PRELOAD
- Valsalva
- sit to stand
- nitroglycerin
INCREASE AFTERLOAD
-sustained hand grip
INCREASE PRELOAD
-passive leg raise
INCREASE AFTERLOAD AND PRELOAD
-squatting
846
Increase intensity of HCM murmur
Decrease preload (Valsalva, sit-to-stand)
847
Neonatal thyrotoxicosis d/t
Graves disease --> transplacental passage of anti-TSH-R antibody
Rx: methimazole + beta blocker
848
Hyposthenuria
The inability of the kidneys to concentrate urine
Common in patients w/ sickle cell and trait
849
Invasive aspergillosis
Triad
- fever
- pleuritic chest pain
- hemoptysis
HALO SIGN
850
What medication should all women bearing twins take?
Aspirin for preeclampsia prevention
Also:
- prior preeclampsia
- CKD
- chronic HTN
- DM
- autoimmune disease
851
Calculate PPV and NPV
PPV = TP / (TP + FP)
NPV = TN / (TN + FN)
852
Unfavorable metabolic side effects of thiazide diuretics
- hyperglycemia
- increased LDL
- increased TGs
- hyperuricemia
Also: hyponatremia, hypokalemia, hypomagnesemia, hypercalcemia
853
Caution in perioperative MI
may not have pain since analgesia...
854
Which statistical value is sensitive to outliers?
Mean
