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1
Q

Cases

Testing for PCOS

A 
24 urine cortisol
24 urine 17-ketosteroid
serum testosterone, total and free
serum prolactin
bhcg
LH
FSH
TSH
CBC
BMP
Glucose tolerance
US Abdomen/transvag
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2
Q

Presentation of Kawasaki in <6months

A

Can be incomplete

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3
Q

Screening for celiac disease

A

anti-transglutaminase ab

anti-endomysial ab

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4
Q

Antibodies with primary biliary cirrhosis

A

Anti-mitochondrial

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5
Q

Tx scabies

A

Permethrin

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6
Q

Femur fx in nonambulating child, most likely dx?

A

Child abuse

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7
Q

First line drug therapies for obesity

A 
Orlistat
Phentermine/topomax
Lorcaserin
Wellbutrin/naltrexone
Liraglutide
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8
Q

Fx of entacapone

A

Prolongs effect of levodopa

COMT inhibitor

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9
Q

In COPD exacerbations, before intubation, always try

A

Noninvasive PP ventilation

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10
Q

Tx for nitroprusside cyanide toxicity?

A

sodium thiosulfate

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11
Q

Cases

Renal causes of renal failure

A

Toxins

Infectious

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12
Q

Cases

Lead exposure kids, order:

A

Lead pain assay at home;

follow finger stick with blood lead, quantitative

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13
Q

Cases

Postrenal causes of renal failure

A

BPH

Nephrolithiasis

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14
Q

Meningitis with gram pos cocci in clusters, use what drug?

A

IV nafcillin

10-14 days

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15
Q

Contraindications to MHT in women

A 
CAD
liver disease
hx breast cancer
venous thromboembolism
stroke
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16
Q

Sensitivity

A

a/(a+c)

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17
Q

NNT

A

1/ARR
ARR = CER - EER
Control event rate - Experimental event rate

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18
Q

TCA used in OCD

A

clomipramine

SSRIs first line w/ exposure and response therapy

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19
Q

PPV

A

a/(a+b)

TP/TP + FP

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20
Q

Restless leg syndrome association

A

Iron deficiency

Check ferritin levels

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21
Q

4x4 table

A 
DISEASE+ | -
TEST + | a | b |
             \_\_\_\_\_
TEST -  | c | d |
a = TP, b = FP, c = FN, d = TN
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22
Q

Mgmt hydrocele in infant

A

Observe, most resolve by age 1

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23
Q

Patients with severe nephrotic syndrome are predisposed to:

A

Thrombotic events, infections

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24
Q

Cases

Tx Graves disease

A

Methimazole
Propranolol
If any FH of cardiac stuff, high risk to develop VT, need Holter or inpatient monitoring

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25
Sxs of medial medullary syndrome
vertebral or anterior spinal artery occlusion contralateral paralysis of arm and leg tongue deviation TOWARD lesion
26
Drugs for Rhythm control on a-fib
Dofetilide Ibutilide Amiodarone
27
Fastest way to reverse warfarin
Prothrombin complex concentrate
28
High indirect bilirubin means
Hemolysis
29
Cases | Mgmt postrenal failure
``` Stat US Urology consult Catheterize if fever, BC, UC, start Cipro All stat ```
30
HFE genetic testing for
hereditary hemochromatosis
31
When to add antifungal therapy in neutropenic fever?
Persistent fever for 5-7 days with no response to abx
32
Tx of choice for prolonged QRS due to TCA OD
Sodium bicarb
33
Most common extraintestinal manifestation of Entaemoeba Histolytica
Liver abscess Aspirate looks like anchovy paste Aseptic/negative gram stain
34
Urine leakage with sneeze, cough etc. | Causes
Sphincter tone down | Urethral hypermobility
35
Cases | If K elevated...
D5/Insulin, EKG | and recheck
36
New atrial flutter of unknown duration, first next step
Anticoagulate | ie Xa inhibitor
37
Cutoff for cesarean delivery at 39 weeks with fetal macrosomia
>9.9lb (4.5kg)
38
Primary sclerosing cholangitis is a complication of
Ulcerative colitis | Dx w/ endoscopic cholangiography or MRCP
39
Afebrile bloody diarrhea suggests what pathogen
Enterohemorrhagic E Coli w/ shiga toxin 0157:H7 | RF undercooked beef and animal exposure
40
Drop in PTH, medical causes
Immobilization | Malignancy
41
Tx vaginosis
Metronidazole oral | Clindamycin vaginal
42
Tx pertussis
Azithromycin
43
Best tx for urine cx growing fungus
Change Foley
44
ARR | Absolute Risk Reduction
CER-EER | Control event rate - Experimental event rate
45
Mgmt pregnant patients with Parvo
Serial US Middle cerebral artery measurements correct anemia in mom
46
Case-control, what study direction
Retrospective | Compute OR
47
Cases | Remember for the ICU
``` PPI or H2 Bed rest I/Os SCDs/pneumatic CDs Stool softener ```
48
Patients with CAD should be on what dose statin?
High intensity
49
Fractures that are pathognomonic for non accidental trauma in children:
Spiral fractures metaphyseal "bucket handle" fx Posterior rib fx Fxs at various stages of healing
50
Menopausal help in pts with DVT/PE risk
Escitalopram | SNRIs
51
Confusion and shortened QT, electrolyte abnormality?
Hypercalcemia
52
Longest acting insulin
Glargine | same efficacy over 24 hrs
53
Tx prosthetic valve endocarditis
Ceftriaxone Vancomycin Gentamicin
54
Surveillance recommendations for aneurysms 3-4cm
q2-3 years | for >4cm, every 6-12 months
55
Tx for catatonia
Benzos | ECT
56
DM pt w/ no hx of HF presents with CHF sxs, drug cause?
Pioglitazone Rosiglitazone thiazolidinedione (TZD) class
57
Most dangerous complication of GPA Wegener's
Alveolar hemorrhage
58
What is a cross-sectional study?
Observational | A specific population is observed at one point in time
59
Orders with lead tox
Blood lead, quant Erythrocyte protoporphyrin LFTs Succimer for mid range, EDTA dimercaperol for high range
60
Bitemporal hemianopsia, mass?
Mass on optic chiasm
61
Recommended initial tx for head and neck cancer
combined chemo and radiation
62
Transient red cell aplasia, aplastic crisis | virus?
Parvo, B19
63
IVF bolus amt in kids
500cc
64
Pressures indicating compartment syndrome
>30 or delta pressure <20-30 delta pressure = diastolic - compartment
65
Worsening renal fx after initiation of ACEi/ARBs suggests
renal artery stenosis...if transplanted, issue w/ anastomosis is common cause also see unexplained atrophic kidney recurrent flash PE w/ HTN
66
Cohort study
2 groups chosen with and without RF and then followed -------> Prospective Compute RR
67
Tx RLS
Pramipexole, ropinirole- dopamine agonist | Gabapentin enacarbil
68
ARDS pearl
Low TV, 6-8 mg/kg
69
Shoulder pop and subsequent bruising, dx
Bicep tendon rupture
70
When to talk about renal replacement therapy
When GFR < 30
71
Mgmt neonatal hypothyroidism
Confirm TSH, T4 Immediate levothyroxine US thyroid Refer to endocrinology
72
Cases | Symptomatic tx constipation in small children
Milk of magnesia | Docusate
73
Methotrexate is what antagonist
Folate
74
Child with pallor, poor school performance, fatigue, CBC shows basophilic stippling; dx?
Lead poisoning; | Also look for constipation, asymptomatic
75
Lambert Eaton syndrome is a paraneoplastic manifestation of what cancer
Small cell lung cancer
76
If CT scan negative and high suspicion for SAH, next step
LP for xanthochromia
77
How to diagnose PCP/PJP PNA
Induced sputum, if inconclusive, bronchoalveolar lavage | Pay careful attention to ABG, if pO2 <70, need steroids with tx
78
Tx acute a-fib w/ rvr
Cardizem IV bolus, then drip | Start wafarin on ward
79
Causes of incomplete emptying and urine dribbling
Impaired detrusor contractility | Bladder outlet obstruction
80
Cases | If infant requires phototherpy, add:
Erythromycin drops
81
Most common reason for iron deficiency anemia in males
GI blood loss
82
Initial tx of prolactinoma
Bromocriptine or cabergoline (dopamine agonists)
83
Reversal for warfarin
IV Vitamin K and FFP
84
Most common 2 migraine prophylaxes
Beta blockers TCAs (Ergotamine for acute mgmt)
85
Granulomas in sarcoidosis
Noncaseating
86
When to insert defibrillator?
EF <30% and prior MI; or | LV <35% w/ moderate/severe HF
87
BUN:Cr associated with UGIB
>20:1
88
Thyroid medication recommendations in pregnancy
PTU in first trimester | then switch back to methimazole
89
What is a factorial study?
Utilizes greater than or equal to 2 interventions, and all combinations of interventions
90
Mild lead level in children
<44
91
When do patients get statin induced myositis (>10x normal CK)
First few months of taking statin | Abx/meds interactions, ie macrolides, cyclosporine
92
Most accurate measurement of iron stores
Ferritin level
93
Palpable breast mass >30 -->
Mammogram +/- US -->...
94
Restless leg syndrome first line tx
Pramipexole Ropinirole Dopamine agonists
95
Pernicious anemia involves absent rugae in the
fundus
96
Specificity
d/(c+d)
97
Tx inflammatory acne
Add topical abx ie erythromycin
98
How to make dx of Hirschsprung disease
Rectal suction biopsy | Anorectal manometry less accurate in <1 month old
99
Cases | Do what before radioiodine test
Pregnancy test
100
Cause of sudden urge to urinate
Detrusor hyperactivity
101
Infant with cyanosis and noisy breathing w/ normal heart sounds, dx
Choanal atresia Insert NG tube Requires prompt surgical repair
102
Cases | How to differentiate between prerenal and renal causes of renal failure:
``` Calculate FeNa (Fractional Excretion of Sodium) FeNa < 1 --> prerenal ```
103
Complication of nephrotic syndrome
Peritonitis
104
Antibodies with systemic sclerosis/scleroderma
Anti-centromere Velcro sound on lung auscultation Cutaneous only version - telangectasias
105
Tx of rosacea
topical metronidazole | brimonidine
106
Parotid gland enlargement in a young woman suggests
Bulimia
107
Common causes of long QT (>450 men, >470 in women)
``` Fluoroquinolones Antipsychotics Congenital Hypomagnesemia Hypokalemia ```
108
How to diagnose multiple myeloma
Monoclonal protein in urine/serum | Serum or urine 240hr protein electrophoresis
109
Ddx tachypnea in newborn
PNA/sepsis TTN hyaline membrane disease
110
``` Ipsilateral Horner's syndrome nystagmus Hoarseness Loss of P&T in contralateral limbs dx? ```
Wallenberg syndrome *facial pain can look like trigeminal neuralgia Lateral medulla from intracranial vertebral artery infarction
111
Cases | FeNa < 1
FeNa < 1 --> prerenal Bun:Cr >> 20:1 Spot urine Na < 20 meq/L
112
Common cause of transient tachypnea of the newborn
C-section
113
leukocytes x % neutrophils =
``` # neutrophils >250 = SBP ```
114
Effect of lithium on PTH
Raises
115
How to dx cryptococcus
India ink tx ampho B and flucytosine markedly elevated opening pressure *serial LPs to reduce cryptococcal burden
116
Cases | Mgmt GBS PNA neonate
``` Ampicillin Cefotaxime +/- Gentamicin when meningitis ruled out diet not oral is RR > 60 wean O2 for sat > 94% ```
117
Use DMSA succimer in children with
Moderate lead level | 45-69
118
Target cells and nucleated RBCs, | dx
Thalassemia
119
Hyperthyroid in pregnancy, failed PTU tx, next step
Surgery
120
Predictors of mortality in end stage liver disease
``` Bilirubin INR Cr Na *for 90 day survival ```
121
Tx carbuncle or skin abscess
Clindamycin, for MRSA
122
Why does cocaine cause heart attacks?
Stimulates platelet activity and encourages thrombus formation
123
Leading cause of M&M in SAH
Cerebral vasospasm, monitor likelihood with transcranial doppler
124
Mgmt cryptorchidism in infants
Wait until 6 months
125
Complication of long QT
Torsades
126
Lichen planus P's
Pruritic Planar Polygonal Purple
127
Tx of akathesia when can't reduce antipsychotic
Propranolol, Benztropine, benzos
128
Palpable breast mass <30 -->
US +/- mammogram --> simple cyst --> +/- needle aspiration complex cyst or solid mass --> image-guided core biopsy
129
Most specific finding of tamponade
Early diastolic RV collapse
130
Peaked T waves =
Hyperkalemia Also, shortened QT, lengthened PR and QRS Worst: sine wave
131
What is a crossover study?
Subjects are exposed to different treatments or exposures sequentially
132
Mgmt inguinal hernia in children
Prompt surgical correction | Patent processus vaginalis
133
High Alpha fetoprotein level suggests
Neural tube defect Next step US Amniocentesis if US is unclear
134
Complication of compartment syndrome
rhabomyolysis --> renal failure
135
Cases | Most common cause of acute renal failure
ATN - -low intravascular volume, including third spacing - -decreased CO
136
Use EDTA and dimercaperol in children with
Severe lead level | >70
137
Cases | If dehydrated
IVF bolus then continuous drip
138
First step in management of inferior wall MI w/ bradycardia
Atropine
139
Primary hyperparathyroidism carries what syndrome risks?
MEN types 1 and 2A
140
Basophilic intranuclear inclusions, renal tubular damage after kidney transplant suggest
BK virus, polyomavirus --> nephritis
141
Cases | Inpatient routine
``` Ambulate as tolerated Diet Vitals q2, q6 Daily weights I/Os Best rest with AMS Heparin 5000U SQ q12 SCDs Accuchecks q6 Out of bed to chair D/C catheter ```
142
Symptoms of long QT
``` Palpitations Presyncope Syncope Seizure Sudden cardiac arrest ```
143
Severe, sudden onset of hypercalcemia
Humoral Hypercalcemia of Malignancy | High PTHrP, low PTH
144
Tx of choice for prolonged QRS due to hypomagnesemia or torsades
Magnesium
145
Most common source of rabies in developing countries
Dogs | in US, bats
146
Causes of metabolic alkalosis w/ hypokalemia
1. Vomiting 2. Diuretics 3. Abnormal Na handling in Gitelman and Bartter syndromes
147
What is terbinafine for?
Fungal infections
148
Common sxs of hypothyroid
``` Pins and needles/carpal tunnel Mild increase in Cr Mild normocytic anemia Mild hyponatremia Hyperlipidemia Myopathy ```
149
Complications of ASD
In adulthood - decreased exercise tolerance, afib, right HF, stroke (paradoxical embolization) *left to right shunt
150
How to test for HIT
serotonin release assay
151
Most common congenital heart defects
Bicuspid aortic valve | ASD
152
Meds that decrease the effectiveness of OCPs
``` phenytoin carbamazepine ethosuximide phenobarbital topiramate ```
153
Very low risk prostate cancer =
Gleason =/< 6 with < 3 cores affected Normal DRE PSA <10
154
Another cause of hyperviscosity syndrome besides multiple myeloma
Waldenstrom's macroglobulinemia
155
Three common causes of microcytic anemia:
1. Iron deficiency 2. Anemia of chronic disease 3. Thalassemia (Lead poisoning if symptomatic, rare)
156
Tx DTs
IV lorazepam | when pt can tolerate PO, chlordiazepoxide (Librium)
157
Examples of alpha-1 adrenergic antagonists
Tamsulosin | Doxazosin
158
Xray finding in button battery ingestion
Double ring sign
159
Cases | In diabetics, order
S/S Insulin Accuchecks q6 HbA1C, routine
160
NPV
d/(c+d)
161
Location of hepatocellular carcinoma
Liver parenchyma | AFP can be normal or elevated
162
Organ donation protocol
Treating physician must be specially trained to have that conversation
163
Underlying issues that throw people into Afib
``` HF PE HTN ACS Infection Subclinical hyperthyroid ```
164
Causes of prolonged aPTT
Intrinsic pathway disorder ie | Hemophilia A, B, von Willebrand
165
If treated Pseudomonas meningitis, use what drug?
Ceftazidime 10-14 days also for suspected neutropenic fever
166
Cases | FeNa > 1
Intrinsic Renal Failure Spot urine Na > 20 meq/L Proportionate increase in BUN:Cr < 20:1
167
Most common inherites hypercoagulable condition
Factor 5 Leiden deficiency --> activated protein C resistance
168
ADHD, can doctor call school?
Yes, it's considered a disability
169
Don't use spironolactone in men bc of
side effect of gynecomastia
170
Direct thrombin inhibitor example
Argatroban
171
Tx for vaginal vulvovaginitis in pregnancy
Vaginal clotrimazole, miconazole, nystatin | Do not use oral fluconazole during 1st trimester
172
Use cell free fetal DNA test for
chromosomal things, is t21
173
Cases | Workup of infant jaundice
``` Consider hemolysis, polycythemia, TORCH, GBS CBC BMP LFTs - total and indirect bili I/Os VS q4 UA Blood type of infant and mother Coomb's test, direct CRP, stat q12 ```
174
Cases | Infant diarrhea differential
``` Rotavirus Enterovirus Adenovirus Norwalk virus Shigella Salmonella E. Coli - both Yersinia Campylobacter C/ Diff Appendicitis Intussusception Hyperconcentrated infant formula Otitis Media UTI HSP HUS Toxins: Iron, Mercury, Fluoride, Lead ```
175
HIT should be suspected when
Plt drop by >50% 5-14 days after starting heparin; | New onset unexplained thrombocytopenia or thrombosis
176
Hypercalcemia in age >50, operate?
No, unless symptomatic | Follow DXA, serum Ca and Cr
177
First line tx for Bulimia
CBT then SSRI Buproprion is contraindicated
178
Acute paralysis w/ presence of a sensory level or bowel/bladder dysfunction suggests
acute myelopathy | use MRI
179
Kind of anemia in multiple myeloma
Normocytic | MCV 80-100
180
Causes of erythema multiforme (target lesions)
``` HSV Mycoplasma pneumonia Allopurinol Abx Autoimmune Malignancy ```
181
Secondary causes of RLS
``` Iron deficiency anemia (check ferritin) DM ESRD MS, Parkinson's Pregnancy Drugs ie antidepressants ```
182
RRR | Relative Risk Reduction
(CER-EER)/CER
183
Avoid what hypertensives in patients with gout
Thiazide diuretics | Furosemide
184
Give activated charcoal for tylenol ingestion within
4 hours of ingestion | At 4 hours, get acetaminophen level and decide whether to give N-acetylcysteine
185
Cases | If renal failure w/ ACEi use...
Restrict
186
Dysphagia first test to order (pharynx and upper esophagus)
Nasopharyngeal laryngoscopy
187
Cancer found in distal esophagus
Adenocarcinoma
188
GI Bleed BMP finding
Elevated BUN:Cr

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