Deck 2

Question 1

What is the pathophysiology of ARDS?

Answer 1

Lung injury leads to release of proteins, cytokines, and neutrophils into the alveolar space. This leads to leakage of blood/proteinaceous fluid into the alveoli, alveolar collapse due to loss of surfactant, and diffuse alveolar damage. As a result, 1. gas exchange is impaired, 2. there is decreased lung compliance ** (due to loss of surfactant and increased elastic recoil of edematous lungs), and 3. pulmonary HTN (increased pulm arterial pressure)

Question 2

a gestational sac at the uterine cornu means….

Answer 2

ectopic pregnancy!
this type is cornual or interstitial ectopic pregnancy.
pts w/ bicornuate “heart-shaped” uteruses are at risk for this type of ectopic pregnancy.

Question 3

How do patients w/ Kawasaki disease present?

Answer 3

They must have a fever for >/= 5 days, and 4 of the following:

1. conjunctivitis
2. “strawberry tongue” (oral mucosal changes)
3. rash
4. erythema, edema, desquamation of the hands and feet
5. cervical LAD, usually unilateral

Question 4

Untreated patients with Kawasaki disease are at risk of what major complication? how do you tx Kawasaki disease?

Answer 4

coronary artery aneurysm
Tx w/ aspirin and IVIG - this decreases the risk of complications.
ECHO should be performed at the time to dx and repeated 6-8wks later.

Question 5

intrauterine fetal demise associated w/ growth restriction, multiple limb fractures, short femurs, and a hypoplastic thoracic cavity?

Answer 5

type II osteogenesis imperfecta

autosomal dominant, defective type 1 collagen synthesis

Question 6

What is the greatest risk factor for cerebral palsy? and what form is most commonly seen in these infants?

Answer 6

premature birth before 32 weeks.
spastic diplegia is most commonly seen in these preterm infants – it presents w/ hypertonia and hyperreflexia (mainly in the LEs) with both feet pointing down and inward (equinovarus deformity)

Question 7

how do you tx beta-thalassemia minor?

Answer 7

you don’t.
no specific tx is required.
usually pts are of mediterranean descent, asymptomatic w/ mild anemia, disproportionately high RBC count, low MCV, and hgb > 10.

Question 8

pts initially diagnosed w/ HTN should have a H&P, and what basic testing?

Answer 8

1. Urinalysis (for occult hematuria and urine protein/creatinine ratio)
2. chemistry panel
3. lipid profile
4. baseline ECG

Question 9

In blastomycosis, extrapulmonary dz most commonly affects the skin. What do the skin lesions look like?

Answer 9

Skin lesions in blasto characteristically present as heaped-up verrucous or nodular lesions w/ a violaceous hue that may evolve into microabscesses. wartlike lesions, may even have skin ulcers.

Question 10

HIV pt w/ CD4 < 100 has vascular cutaneous lesions that began as small reddish/purple papules and evolved into friable pedunculated/nodular lesions. Also has constitutional sxs (fever, malaise, night sweats) and may even have organ involvement (liver, CNS, bone). What do they have?

Answer 10

Bacillary angiomatosis!
a Bartonella infection – infx occurs via cat scratch (Bartonella henselae) or body/head lice bite (Bartonella quintana)
Tx = Abx (doxycycline, erythromycin), and the initiation of antiretroviral therapy

Question 11

What are the chronic symptoms of irritant contact dermatitis?

Answer 11

excoriations, hyperkeratosis, and fissuring of the skin.
this can be triggered by a variety of chemicals/cleaning products.
it is nonimmunologically mediated, but can sometimes resemble allergic contact dermatitis (pruritus, erythema, local swelling and vesicles)

Question 12

what are common symptoms of Premenstrual syndrome (PMS)? Dx? Tx?

Answer 12

common symptoms include mood swings, irritability, fatigue, bloating, hot flashes, and breast tenderness. Dx can be confirmed w/ a Symptom diary over 2 menstrual cycles, which may demonstrate recurrence of symptoms 1-2wks prior to menses during the luteal phase and resolution w/ menses. Tx = SSRIs, or OCPs.

Question 13

harsh, holosystolic murmur best heard at the left lower sternal border in a young child. what is it? Should I do anything?

Answer 13

VSD!

ECHO should be done to determine location/size and r/o other defects.

Question 14

What do you see in tricyclic antidepressant overdose?

Answer 14

mental status changes, seizures, tachycardia, hypotension, cardiac conduction delay (prolonged QRS), and anticholinergic effects (dilated pupils, hyperthermia, flushed and dry skin, intestinal ileus)

Question 15

What is bullous pemphigoid? How do you Dx and Tx it?

Answer 15

Bullous pemphigoid is an autoimmune disorder characterized by pruritus and tense bullae on an erythematous base. Common in pts >65 and those w/ malignancy or neuro disorder (parkinsons, MS).
Caused by IgG autoantibodies against the hemidesmosome and BM zone.
Dx via skin biopsy – LM shows subepidermal cleavage; immunofluorescence shows linear IgG and C3 deposits along the BM.
Tx: high-potency topical glucocorticoid – CLOBETASOL

Question 16

What do you see with laxative abuse (diarrhea characteristics, electrolyte abnormalities)? How do you dx?

Answer 16

Diarrhea is typically watery, frequent, and voluminous – nocturnal BMs and abdominal cramps are common.
Hypokalemia and metabolic alkalosis (due to increased serum bicarb from impaired chloride-bicarb exchange).
Dx via positive laxative screen or colonoscopy w/ characteristic findings of melanosis coli (dark brown discoloration w/ pale patches of lymph follicles).

Question 17

How do you tx uterine inversion?

Answer 17

immediate manual replacement of the uterus.
if the placenta is still attached, it should not be removed until after the uterus is replaced due to risk of massive hemorrhage.
Uterotonics (oxytocin, misoprostol) should be administered after uterine replacement to prevent further hemorrhage and recurrence of prolapse.

Question 18

Pt presents w/ sensory ataxia, impaired vibration/proprioception, frequent loss of balance, lancinating pains, reduced/absent DTRs, urinary incontinence, and normal pupillary constriciton w/ accommodation but not with light. What do they have and how do you tx it?

Answer 18

Tabes dorsalis and Argyll Robertson pupils, which are findings in late neurosyphilis.
Tx w/ IV penicillin

Question 19

How do you tx idiopathic intracranial HTN (IIH) or pseudotumor cerebri?

Answer 19

Acetazolamide!

it inhibits choroid plexus carbonic anhydrase, thereby decreasing CSF production and intracranial HTN.

Question 20

statins should be given to all diabetic pts between ages?

Answer 20

40-75

Question 21

When is infective endocarditis due to Eikenella corrodens seen?

Answer 21

in the setting of poor dentition and/or periodontal infection, along w/ dental procedures that involve manipulation of the gingival or oral mucosa.
ya(E. corrodens is a gram-neg anaerobe and part of normal human oral flora)

Question 22

What is Osler-Weber-Rendu syndrome?

Answer 22

aka hereditary telangiectasia.
characterized by diffuse telangiectasias, recurrent epistaxis, and widespread AV malformations.
AVMs tend to occur in the mucous membranes, skin, and GI tract, but may also occur in the liver, brain, and lung. AVMs in the lungs can shunt blood from the right to the left heart, causing chronic hypoxemia (digital clubbing) and reactive polycythemia!

Question 23

What is dacryocystitis?

Answer 23

an infection of the lacrimal gland, characterized by the sudden onset of pain and redness in the medial canthal region. Sometimes a purulent discharge is noted from the punctum.

Question 24

Describe the criteria for Schizoaffective disorder?

Answer 24

• major depressive or manic episode concurrent w/ sxs of schizophrenia
• lifetime hx of delusions or hallucinations for > 2 weeks in the absence of major depressive or manic episode
• mood sxs are present for majority of illness
• not due to substances or another medical condition

Question 25

reperfusion of a limb following arterio-occlusive ischemia for longer than 4-6 hrs can lead to what complication?

Answer 25

intracellular and interstitial edema, which may lead to compartment syndrome (acute pain and paresthesias, rapidly increasing and tense swelling, pain on passive stretch)

Question 26

For an adjustment disorder to be diagnosed, what time frame does it have to occur in?

Answer 26

an adjustment disorder involves emotional or behavior symptoms developing within *3 months* of an identifiable stressor, and lasting no longer than 6 months once the stressor ceases.

Question 27

What's the MOA of 2nd-gen antipsychotics, like risperidone?

Answer 27

serotonin 2A and dopamine D2 receptor blockers

Question 28

Pts on high dose beta-2 agonists (albuterol) for acute asthma attacks may develop what electrolyte abnormality? (sxs?)

Answer 28

hypokalemia -- may present w/ muscle weakness, arrhythmias and EKG abnormalities other common beta-2 agonist SEs include tremor, palpitations and HA

Question 29

In HIV pts, what virus causes acute retinal necrosis associated w/ pain, keratitis, uveitis, and funduscopic findings of peripheral pale lesions and central retinal necrosis?

Answer 29

Herpes simplex virus (in contrast, CMV retinitis is painless and characterized by funduscopic findings of hemorrhages and fluffy or granular lesions around the retinal vessels)

Question 30

Persistent, eczematous or ulcerating rash on the nipple that spreads to the areola. It is itchy and may hurt, and topical corticosteroids don't resolve it. What is it? What type of cancer is associated w/ it?

Answer 30

Mammary Paget disease. Adenocarcinoma (the most common type of breast cancer) is found in Paget disease.

Question 31

In dermatomyositis/polymyositis, muscle weakness is due to injury of what particularly?

Answer 31

muscle fiber injury!

Question 32

What are the specific names of the skin findings seen in dermatomyositis?

Answer 32

erythematous rash over the dorsum of the fingers = Gottron's papules; and/or on the upper eyelids = heliotrope eruption

Question 33

Pt presents w/ watery diarrhea that is tea colored, muscle weakness/cramps and hypokalemia, hypo- or achlorhydria, as well as facial flushing, lethargy, n/v, abdominal pain and weight loss. What do they have?

Answer 33

VIPoma!! this is a rare tumor affecting the pancreatic cells, VIP (vasoactive intestinal peptide) binds to intestinal epithelial cells to increase fluid and electrolyte secretion into the intestinal lumen -- most pts develop this VIPoma syndrome (pancreatic cholera) (may have hypercalcemia due to increased bone resorption, and hyperglycemia due to increased glycogenolysis) *pts may have coexisting hyperparathyroidism as part of MEN

Question 34

pt presents with a mild prodrome of fever and malaise and shows you a small area on his hand of grouped vesicles on an erythematous base. He describes a tingling, burning pain. He recently had unprotected sex. What is this rash?

Answer 34

Herpetic whitlow | caused by HSV

Question 35

all pts w/ an initial dx of rheumatic fever should be tx'd w/ Abx therapy to eradicate GAS regardless of the presence or absence of pharyngitis at the time of dx. What Abx do you use?

Answer 35

IM benzathine PENCILLIN G | continuous Abx prophylaxis to prevent recurrent GAS pharyngitis, give every 4 weeks

Question 36

What is the most common side effect of Tamoxifen? and other side effects?

Answer 36

most common = hot flashes | other side effects = venous thromboembolism, endometrial hyperplasia and carcinoma

Question 37

What is the motor and sensory function of the femoral nerve?

Answer 37

Motor: leg flexion at the hip, leg extension at the knee (innervates anterior compartment of the thigh) Sensory: anterior/medial thigh and medial leg via the saphenous branch

Question 38

What imaging study do you use to diagnose Meckel's diverticulum?

Answer 38

Technetium-99m pertechnetate scan

Question 39

What are the medications commonly used in the tx of Acute Bipolar Depression?

Answer 39

Quetiapine and Lurasidone (2nd gen antipsychotics) | Lamotrigine (anticonvulsant)

Question 40

Pt presents after blunt head trauma. They receive fluid resuscitation and develop HTN, bradycardia, and respiratory depression (Cushing's reflex)... what is going on?

Answer 40

They likely have an epidural hematoma from rupture of the middle meningeal artery. Fluid resuscitation is increasing the rate at which the hematoma expands and the sxs are caused by elevated ICP. Transtentorial (uncal) herniation is likely to occur and cause pressure on the ipsilateral oculomotor nerve (mydriasis, ptosis, down-and-out gaze of the ipsilateral pupil), ipsilateral posterior cerebral artery (contralateral homonymous hemianopsia), and contralateral cerebral peduncle against the edge of the tentorium (ipsilateral hemiparesis).

Question 41

How do you tx chorioamnionitis?

Answer 41

broad-spectrum antibiotics (ampicillin, gentamicin, clindamycin) and delivery! *chorioamnionitis is NOT an indication for c-section... oxytocin may be given to accelerate labor

Question 42

ultrasound findings of an ovarian mass with solid components, thick septations, and peritoneal free fluid (ascites) are concerning for what?

Answer 42

epithelial ovarian carcinoma the presence of peritoneal fluid in a postmenopausal woman is pathologic and is the origin of typical sxs of bloating, pain, early satiety-anorexia, and abdominal distension seen in ovarian cancer.

Question 43

How do you treat an Acute dystonic reaction (sudden, sustained contraction of the neck, mouth, tongue, or eye muscles) -- SE of antipsychotics?

Answer 43

Benztropine or Diphenhydramine benztropine is an anticholinergic med, and diphenhydramine is an antihistamine w/ significant anticholinergic activity.

Question 44

Which pts under the age of 65 is the 23-valent pneumococcal polysaccharide vaccine (PPSV23) recommended for?e

Answer 44

adults age < 65 who are current smokers, or have chronic medical conditions, including heart or lung dz, diabetes, and chronic liver dz. it is recommended to add the 13-valent pneumococcal conjugate vaccine in adults < 65 with very high risk conditions (sickle cell, HIV, CKD, etc)

Question 45

When should adults receive Tdap vs Td (which is the booster)?

Answer 45

adult pts should receive Tdap as a 1x dose in place of Td. if pts have not received Tdap as an adult, or if the pts prior vaccine hx is unknown, Tdap should be given, followed by Td every 10 years thereafter.

Question 46

how may focal seizures present in school-aged children?

Answer 46

can present with motor (head turning), sensory (paresthesias), or autonomic (sweating) sxs. Impairment of consciousness and automatisms (chewing, sucking, swallowing) may be present. absence seizures are generalized seizures that present w/ an arrest in activity w/o a postictal period. automatisms may be present. they can be provoked by hyperventilation.

Question 47

What drugs/supplements INCREASE the effects of warfarin (more bleedy) by inhibiting CYP450?

Answer 47

``` acetaminophen/NSAIDs Abx/antifungals (metronidazole) amiodarone cimetidine cranberry juice, Ginkgo biloba, vitamin E omeprazole thyroid hormone SSRIs (fluoxetine) ```

Question 48

What drugs/supplements DECREASE the effects of warfarin (less bleedy) by inducing CYP450?

Answer 48

``` carbamazepine, phenytoin Ginseng, St. John's wort OCPs phenobarbital rifampin ```

Question 49

what bacteria most common causes infective endocarditis of structurally abnormal heart valves following dental procedures (gingival manipulation; or resp tract incision or biopsy)?

Answer 49

``` Viridans group streptococci, such as STREPTOCOCCUS MUTANS (or S mitis, S oralis, S sanguinis) ``` typically presents subacutely w/ several weeks of fatigue and low-grade fever, may have a new regurgitant murmur, and SPLINTER HEMORRHAGES under the fingernails due to microemboli

Question 50

acute unilateral motor weakness w/o sensory deficits or higher cortical dysfunction is suggestive of a lacunar stroke affecting the posterior limb of the internal capsule. Lacunar infarcts are most commonly associated with what chronic condition?

Answer 50

chronic HTN! -- which leads to arteriolar sclerosis and vessel occlusion (HYPERTENSIVE VASCULOPATHY)

Question 51

How do young adults w/ Wilson's disease tend to present?

Answer 51

Wilson's dz is characterized by abnormal copper deposition in tissues as the liver, basal ganglia, and cornea young adults tend to present w/ neuropsychiatric dz (ranging from tremor and rigidity to depression, paranoia, and catatonia) (children present w/ liver dz) Dx is confirmed by the presence of low serum ceruloplasmin, increased urinary copper excretion, or Kayser-Fleischer rings on slit lamp exam

Question 52

How is central retinal artery occlusion emergently treated?

Answer 52

ocular massage and high flow oxygen

Question 53

A pt w/ undiagnosed HIV has SUBACUTE pulmonary sxs (dyspnea, dry cough, fever), tachypnea, hypoxemia, and b/l interstitial infiltrates on CXR. What does he likely have and how do you tx it?

Answer 53

Pneumocystis pneumonia Tx with Trimetoprim-sulfamethoxazole and prednisone (corticosteroids are used in pts w/ impaired oxygenation, as TMP-SMX may transiently worsen pulmonary function)

Question 54

Pt presents with chronic cough (>8 weeks) that is predominantly nocturnal and did not improve with antihistamine therapy. what do you suspect? how do you work it up?

Answer 54

Asthma evaluate with spirometry (PFTs) (an alternate approach = tx empirically w/ 2-4 wks of inhaled glucocorticoids and see if the cough improves)

Question 55

How do you tx a Bartholin gland cyst?

Answer 55

``` if asymptomatic -- observe symptomatic cysts (like Bartholin abscesses) are tx'd with incision and drainage. Placement of a Word catheter after drainage reduces the risk of recurrence. ```

Question 56

What pts are at highest risk for osteomyelitis?

Answer 56

**injection drug users**, pts w/ sickle cell anemia, and immunosuppressed pts In IV drug users, the spine is a frequent site, and Staph aureus is the most common pathogen. Most cases of vertebral osteo are chronic (>6 wks) and insidious w/ minimal sxs. Pts may have back pain unrelieved w/ rest, and <50% have fever! Exam shows tenderness to gentle percussion over spinous process of involved vertebra. Leukocytes may be high/normal, platelets are high due to inflam/stress, and ESR is elevated.

Question 57

What is the genetic mode of inheritance for myotonic dystrophy vs Duchenne and Becker muscular dystrophy?

Answer 57

Myotonic = AD (expansion of CTG trinucleotide repeat) | Duchenne and Becker = x-linked recessive (deletion of dystrophin gene)

Question 58

What are the effects of antipsychotics (D2 antagonists) on the tuberoinfundibular pathway?

Answer 58

causes hyperprolactinemia (dopamine normally inhibits prolactin release), resulting in amenorrhea, galactorrhea, gynecomastia, and sexual dysfunction

Question 59

What is the test of choice when trying to identify a Zenker's diverticulum?

Answer 59

contrast esophagram

Question 60

stable pts w/o significant comorbid conditions should receive pRBC transfusion for hemoglobin less than what?

Answer 60

hgb < 7!

Question 61

Pts with Felty syndrome typically have severe, seropositive RA w/ increased risk for extra-articular manifestations, such as?

Answer 61

vasculitis, skin ulcers! *remember Felty syndrome is triad of inflammatory arthritis (advanced RA), splenomegaly, and neutropenia

Question 62

Are phenytoin and/or valproic acid safe in pregnancy?

Answer 62

NO!! phenytoin has teratogenic effects and is known to cause fetal hydantoin syndrome (eg, orofacial clefts, microcephaly, nail/digit hypoplasia, cardiac defects, dysmorphic facial features) valproic acid has been linked to an increased risk of congenital anomalies such as neural tube defects and dysmorphic facial features

Question 63

What is the most common malignancy to spread to the brain? and how may it present/look on imaging?

Answer 63

Lung cancer! pulmonary sxs arise in the majority of pts, but up to 30% of cases present w/ manifestations of metastatic brain dz, including HA, focal deficits, cognitive changes, and seizures MRI of brain -- multiple well-circumscribed lesions w/ vasogenic edema at the gray and white matter junction!

Question 64

What medicine can be given to help pass ureteral stones <1 cm?

Answer 64

Tamsulosin, an alpha-1 blocker it relaxes ureteral muscle and decreases intraureteral pressure--this facilitates stone passage and reduces the need for analgesics.

Question 65

How do you tx TCA overdose when it causes prolongation of the QRS >100 msec?

Answer 65

Sodium bicarbonate! it increases the serum pH and extracellular sodium, thereby alleviating the cardio-depressant action on Sodium channels (TCAs can't bind to the fast sodium channels as well)

Question 66

What is a common side effect of CCBs, specifically with dihydropyridine CCBs such as amlodipine and nifedipine?

Answer 66

peripheral edema! they cause preferential dilation of precapillary ateriolar vessels, leading to peripheral edema the combination of ACE-I/ARBs + CCBs significantly lowers the risk of peripheral edema bc the ACE-I/ARBs cause post-capillary venodilation.

Question 67

What is the initial work-up for pts with secondary amenorrhea, defined as the absence of menses for >/= 3 cycles or >/= 6 months in women who menstruated previously?

Answer 67

urine pregnancy test.. if negative and there is no obvious explanation for secondary amenorrhea from the H&P, next check prolactin, TSH, and FSH -- these can differentiate between the most common causes (hyperprolactinemia, thyroid dysfunction, premature ovarian failure)

Question 68

What is the most common cause of an isolated, asymptomatic elevation of alkaline phosphatase in an elderly patient?

Answer 68

Paget disease of bone (osteitis deformans)

Question 69

irregular, soft mass in the left scrotum above and separate from the left testis, does not transilluminate, increases in size during Valsalva/with standing, decreases in size in supine position

Answer 69

Varicocele "bag of worms" description

Question 70

if you have suspicion for a stroke, what specific imaging study do you get?

Answer 70

NONCONTRAST CT scan of the head -hemorrhagic strokes appear immediately on noncontrast CT scan as white hyperdense regions in brain parenchyma (you don't use contrast bc hyperdense contrast material may be difficult to differentiate from acute blood)

Question 71

Akathisia, a type of EPS, is a subjective sense of inner restlessness that may manifest as pacing and an inability to sit still. How do you manage it?

Answer 71

reduce the antipsychotic dose (don't discontinue completely) | tx w/ a beta blocker, benztropine, or a benzo

Question 72

What is factitious disorder vs malingering?

Answer 72

Factitious disorder = intentional falsification or inducement of sxs w/ GOAL TO ASSUME SICK ROLE Malingering = falsification or exaggeration of sxs to obtain external incentives (SECONDARY GAIN)

Question 73

What are risk factors for placenta previa and how does it present?

Answer 73

Placenta previa RFs = multiparity, smoking, and previous uterine surgery (c/s) it presents with PAINLESS antepartum vaginal bleeding, fetal heart rate tracing is usually unaffected as the bleeding is maternal

Question 74

How does placental abruption present?

Answer 74

it presents with vaginal bleeding, a distended and VERY TENDER UTERUS, and fetal heart rate tracing abnormalities

Question 75

What does CSF analysis show in patients with multiple sclerosis? (remember they present w/ neuro deficits disseminated in space and time)

Answer 75

Oligoclonal IgG bands (85-95% of pts)

Question 76

What happens to thyroid levels in pregnancy in pts w/ normal thyroid function?

Answer 76

Total T3 and T4 increase, free T4 is normal (or mildly elevated), and TSH is suppressed. Pts remain clinically euthyroid. Pts with baseline hypothyroidism cannot increase thyroid hormone production during pregnancy (in response to the increase in thyroxine-binding globulin caused by estrogen) and so their replacement thyroxine dose should be increased.

Question 77

recurrent cystitis in toddlers is often caused by what?

Answer 77

constipation (causing urinary stasis) -- fecal retention can cause rectal distension, which in turn compresses the bladder and prevents complete voiding -- the residual urine is a potential breeding ground for bacteria that ascend to the urethra from the perineum

Question 78

What is the most common cause of pneumonia in infants and young children with CF?

Answer 78

Staph aureus!!!!! | pseudomonas is the most common cause of CF-related pneumonia in adults

Question 79

Pt presents w/ chronic diarrhea and abdominal pain, anal fissures, skin tags and fistulas, and canker sores (which are aphthous ulcers!), and is also a smoker. What do they have?

Answer 79

Crohn's disease extends from mouth to the anus, skip lesions, transmural bowel inflammation

Question 80

What is the quickest way to lower serum potassium concentration?

Answer 80

insulin and glucose (IV insulin moves K+ intracellularly w/in mins) Inhaled beta agonists (albuterol) also rapidly shift K+ intracellularly -- but their use in pts w/ active CAD (stable angina) can cause tachycardia and precipitate angina Sodium bicarbonate is another option for rapid tx

Question 81

how do you define Massive PE?

Answer 81

it is PE complicated by Hypotension and/or acute right heart strain -- syncope tends to only occur in massive PE JVD and right heart BBB on ECG are signs of acute right heart strain

Question 82

What are the colon cancer screening guidelines for pts w/ inflammatory bowel disease?

Answer 82

begin 8 years post dx (12-15 yrs if dz only in left colon) | Colonoscopy w/ biopsies every 1-2 years

Question 83

How do you tx V fib vs Torsades de pointes?

Answer 83

V fib -- immediate defibrillation | Torsades de pointes -- IV magnesium sulfate

Question 84

Patients with what heart defect have a 5-8x higher risk of infective endocarditis?

Answer 84

mitral valve prolapse associated w/ mitral regurgitation! pts w/ IE may present w/ a new regurgitant murmur

Question 85

what is the mechanism by which hyperventilation lowers intracranial pressure?

Answer 85

hyperventilation decreases cerebral arterial CO2, which results in rapid vasoconstriction and consequential decrease in ICP

Question 86

What neurotransmitter is the primary pharmacologic target in the tx of OCD?

Answer 86

Serotonin -- tx with SSRIs

Question 87

What form of birth control should be used in pts w/ breast cancer?

Answer 87

``` Copper IUD (hormone-containing methods of contraception are avoided in pts w/ breast cancer) ```

Question 88

``` Bleeding diathesis (easy bruising, mucosal bleeding, epistaxis) in pts w/ CF is typically from deficiency of what? this leads to deficiency of what coagulation factors? ```

Answer 88

Vitamin K deficiency this leads to low levels of vit K-dependent coagulation factors -- II, VII, IX, X, and proteins C and S. also see prolonged PT -- due predominantly to deficiency of activated factor VII (aPTT is typically normal) due to exocrine pancreatic insufficiency, pts w/ CF are unable to absorb fats and fat-soluble vitamins (A, D, E, and K)

Question 89

How do you treat Tourette disorder?

Answer 89

habit reversal training alpha-2 agonists (clonidine, guanfacine) antipsychotics (risperidone, halperidol, pimozide)

Question 90

primary hyperaldosteronism (Conn's syndrome) has what effect on bicarb?

Answer 90

increased serum bicarb! --> metabolic alkalosis also have HTN, mild hypernatremia and hypokalemia (Due to elevated aldosterone and low renin)

Question 91

What benign liver tumor is associated with young and middle-aged women who take OCPs?

Answer 91

hepatic adenoma -benign epithelial tumor US most commonly shows a well-demarcated, hyperechoic lesion possible long-term complications include growth, rupture, and malignant transformation

Question 92

What is the most common cause of megaloblastic anemia in chronic alcoholics?

Answer 92

Folate deficiency! alcoholics can develop megaloblastic anemia w/in 5 - 10 weeks, as body stores of folate are limited

Question 93

What is Friedreich ataxia?

Answer 93

``` the most common type of spinocerebellar ataxia -- AR sxs begin before 22 yrs of age neuro manifestations (gait ataxia, frequent falling, dysarthria) result from degeneration of the spinal tracts non-neuro manifestations include concentric hypertrophic cardiomyopathy, diabetes, and skeletal deformities (scoliosis, hammer toes) most common cause of death = cardiomyopathy and respiratory complications ```

Question 94

Child presents following a URI with palpable purpura on butt/legs, arthralgias, colicky abdominal pain, and mild renal dz with some hematuria. What do they have? what does renal biopsy show?

Answer 94

Henoch-Schonlein Purpura - the most common childhood systemic vasculitis Renal biopsy confirms the dx and will show Deposition of IgA in the mesangium

Question 95

How do you manage chest pain in a pt that has just done cocaine?

Answer 95

Benzos for BP and anxiety aspirin NTG and CCBs for pain NO BETA BLOCKERS!!!!

Question 96

Pt with chronic pelvic pain that is worse before the onset of menses, dysmenorrhea, and dyspareunia. On exam there is tenderness of the recto-vaginal area, tenderness w/ movement of the uterus, and thickening of the uterosacral ligaments. Lab testing is negative and US shows normal pelvic anatomy. What do they have? how do you manage it?

Answer 96

Endometriosis!! - ectopic endometrial glands and stroma cause pain due to cyclic hemorrhage and accumulating fibrosis - Tx initially with NSAIDs and/or OCPs (empiric tx) - LAPAROSCOPY is indicated after failure of empiric therapy (allows for direct visualization, biopsy, and removal of endometriotic lesions)

Question 97

What should viridans group streptococci (Strep mutans) be treated with in patients with infective endocarditis?

Answer 97

most are highly susceptible to penicillin and should be treated with IV aqueous pencillin G or IV ceftriaxone for 4 weeks.

Question 98

In a pt with lateral epicondylitis (tennis elbow), how is pain reproduced on exam?

Answer 98

pain with resisted wrist extension or supination pain with passive wrist flexion (while the elbow remains extended) also there is tenderness at the lateral epicondyle pts usually have a hx of overuse of the extensor muscles of the arm management = activity modification, NSAIDs, and counterforce bracing

Question 99

Describe Waldenstrom macroglobulinemia?

Answer 99

plasma cell malignancy characterized by excessive production of monoclonal IgM antibody --> have an M-spike of IgM (as opposed to the M-spike of multiple myeloma that is due to IgG, IgA, and light chains) pts present with hyperviscosity sydrome (diplopia, tinnitus, HA, dilated/segmented funduscopic findings), neuropathy (electric sensation), and evidence of infiltrative disease (hepatosplenomegaly, anemia, thrombocytopenia)

Question 100

pt presents after recent tooth extraction with a chronic, slow-growing, nontender indurated mass around their mandible. It has a purulent discharge with descrete yellow granules ("sulfur granules"). Eventually it will form multiple sinus tracts to the skin. What bug? how do you tx it?

Answer 100

Actinomyces -- an anaerobic bacterium of the oral cavity | Tx = high dose oral Penicillin

Question 101

When is it considered arrest of active labor? and what do you do?

Answer 101

arrest of active labor occurs at cervical dilation of >/= 6 cm when there is: - no cervical change for >/= 4 hours with adequate contractions (>/= 200 MVUs in 10-min interval) - or no cervical change for >/= 6 hours with inadequate contractions Cesarean delivery is indicated!

Question 102

In patients who habitually use combined analgesics (e.g., aspirin and naproxen) and develop analgesic nephropathy (the most common form of drug-induced chronic renal failure), what are the common pathologies seen?

Answer 102

papillary necrosis chronic tubulointerstitial nephritis early manifestations include polyuria and sterile pyuria (WBC casts may also be seen) HTN, mild proteinuria, and impaired urinary concentration commonly occur as the disease advances

Question 103

What are the major side effects of cyclosporine?

Answer 103

nephrotoxicity, hyperkalemia, HTN, gum hypertrophy, hirsutism, and tremor

Question 104

What are the major side effects of tacrolimus?

Answer 104

similar toxicities to cyclosporine, except no hirsutism or gum hypertrophy (left w/ nephrotoxicity, hyperkalemia, HTN, and tremor)

Question 105

What are the major toxicities of azathioprine?

Answer 105

dose-related diarrhea, leukopenia, and hepatotoxicity

Question 106

what are the major toxicities of mycophenolate?

Answer 106

bone *Marrow suppression

Question 107

What form of arthritis has sausage fingers?

Answer 107

P*s*oriatic arthritis! sausage fingers = dactylitis classic presentation involves the DIP joints and morning stiffness is present. There is nail pitting and onycholysis (separation of nail bed). can also see the well-demarcated red plaques with silvery scaling classic of psoriasis.

Question 108

How does porphyria cutanea tarda present? what is it associated with? how is the dx confirmed?

Answer 108

blisters, bullae, scarring, hypo/hyper-pigmentation on sun-exposed skin (back of hands, forearms, face) --(scarring and calcification similar to scleroderma) associated with Hep C!!! - also associated w/ HIV, EtOH and estrogen use, and smoking Dx is confirmed by elevated plasma or urinary porphyrin levels (due to deficiency of uroporphyrinogen decarboxylase)