Exam Missed Qs Flashcards
(152 cards)
1
Q
In HIV+ patients, what bacteria/virus is Kaposi Sarcoma assoc with
A
Human Herpesvirus 8
2
Q
In labor what does the L:S ratio represent
A
Fetal lung maturity
L:S ratio of <2:1 means lungs are immature
3
Q
Pt is lip smacking, teeth grinding, and rolling tongue
a. tardive dyskinesia
b. NMS
c. serotonin syndrome
d. acute dystonic rxn
e. akathisia
A
tardive dyskinesia
4
Q
patient started an antipsychotic med and now days later has intermittent spasms, truisms, protrusions of the tongue, facial grimacing, torticollis and diff speaking.
A
acute dystonic rxn
should include “reversible”
5
Q
the need for restlessness and constant motion
A
akathisia
6
Q
what causes NMS
A
decreased dopamine
7
Q
what are symptoms of NMS
A
hyporeflexia
urinary incontinence
hyperthermia
8
Q
what do prostaglandins and oxytocin do
A
cause increased contractions
9
Q
signs of right anterior cerebral artery occlusion
A
contralateral (left sided):
hemiparesis LEG > ARM
urinary incontinence
personality change
abulia (lack of will)
10
Q
signs of right posterior cerebral artery occlusion
A
visual hallucinations
“crossed symptoms” - ipsilateral nerve deficits, contralateral weakness, comas, drop attacks
11
Q
what is Naegeles rule with estimated delivery date
A
Day 1 of LMP - 3 months + 7 days
12
Q
what is koebner’s phenomenon
A
new skin lesions appearing along lines of trauma
nonspecific, e.g. psoriasis, vitiligo, lichen planus, infx
13
Q
what electrolyte issue is usually caused by brain bleeds
A
SIADH –> hyponatremia
14
Q
when are koplik spots seen
A
measles/rubeola
15
Q
describe the measles/rubeola rash pattern
A
brick-red
starts on face and spreads to trunk
lasts 7 days
(after a prodrome)
16
Q
describe the rubella rash pattern
A
light red to pink
spotted
lasts 3 days
17
Q
describe the 5ths disease rash
A
slapped cheek
lacy red rash on extremities
18
Q
describe the CSF findings for SAH
A
increased CSF opening pressure
xanthochromia that does not diminish
19
Q
describe CSF findings for idiopathic intracranial HTN
A
increased CSF opening pressure
otherwise normal
20
Q
describe the CSF findings for Guillain Barre syndrome
A
high protein
normal WBC
21
Q
describe the CSF findings for ms
A
increased oligoclonal IgG bands
22
Q
describe the CSF findings for viral meningitis, aseptic meningitis, or encephalitis
A
increased protein
normal glucose
increased WBC (*lymphocytes)
23
Q
describe the CSF findings for fungal meningitis and TB meningitis
A
increased protein
decreased glucose
increased WBC (lymphocytes)
24
Q
describe the CSF findings in bacterial meningitis
A
increased protein
decreased glucose
increased polymorphonuclear neutrophils
25
what is the 1st line therapy for unstable tachycardia
synchronized cardioversion
26
what is the 1st line therapy for stable narrow-complex tachycardia
adenosine
27
what is the 1st line therapy for stable wide-complex tachycardia
amiodarone (class iii anti arrhythmic)
28
unsynchronized cardioversion is aka
defibrillation
29
kidney stones: urea-splitting enzymes causing struvite stones (3)
proteus
klebsiella
pseudomonas
30
trisomy 21 vs trisomy 18 on the triple screen test
trisomy 21:
AFP: low
BHCG: high
estradiol: low
trisomy 18:
AFP: low
BHCG: low
estradiol: low
31
which cardiac med contains iodine
amiodarone
32
brief, sporadic, single repetitive jerks or twitching of 1+ muscle groups
myoclonus
33
repetitive, rhythmic, jerking that usually lasts less than 2-3 minutes
clonus
34
sustained contraction with twisting of the body and abnormal posturing
dystonia
35
repetitive, non-rhythmic movements or vocals
tics
36
rapid, involuntary, jerky, uncontrolled purposeless movements
chorea
37
what do you use as a tumor marker in medullary thyroid carcinoma / MEN2
calcitonin
| mtc arrises from the parafollicular cells which secrete calcitonin, so in this dz calcitonin is elevated
38
patient with MG: how do you tell myesthenia crisis versus cholinergic crisis
*give Edrophonium
If sx worsen --> cholinergic
If sx improve --> myastheia
39
GI: "string sign"
crohns dz
40
PE test for ACL?
Lachman
41
PE test for menisci?
McMurray
42
epigastric pain better w/ food: duodenal or gastric ulcer
duodenal
43
epigastric pain worse w food: duodenal or gastric ulcer
gastric
44
what electrolyte abnormality may be seen with B12 injections
hypokalemia
45
Bartonella; Pasteurella
| which one assoc with cat scratch, which one assoc with cat bite
bite: pasteurella
scratch: bartonella
46
FOOSH with fat pad in a kid vs. in an adult
kid: supracondylar fx
adult: radial head fx
47
what are these signs: tapping of facial nerve causes spasms, carpal spasms with inflation of BP cuff
and what electrolyte abnormality is it assoc with
hypocalcemia WHICH GOES HAND-IN-HAND WITH hypomagnesemia
| signs: Chvostek's sign and Trousseau's sign
48
pathognomonic: tetrad inclusions seen within RBCs on peripheral smear
babesiosis
49
morale clusters within WBCs on peripheral smear
ehrlichiosis
50
intracellular RBC parasites seen on peripheral smear
malaria
51
larvae in striated muscle on muscle biopsy
trichinosis
52
brain tumor occurring in the hemispheres and parasagittal regions, attached to the dura
meningioma
53
brain tumor costing the corpus collosum with butterfly appearance
glioblastoma multiforme
54
brain tumor seen in kids in 3rd or 4th ventricle
ependymoma
55
brain tumor in the cerebellopontine, assoc with unilateral senrosineural hearing loss
schwannoma (tumor of CN VIII)
56
a sterile wisp of cotton to test corneal riflex: which nerve is being tested
CN V (trigeminal)
57
name all of the cranial nerves I-XII
1: olfactory
2. optic
3. oculomotor
4. trochlear
5: trigeminal
6: abducens
7: facial
8: vestibulocochlear (auditory)
9: glossopharyngeal
10: vagus
11: spinal accessory
12: hypoglossal
58
which CN controls taste on the posterior 1/3 of tongue and swallowing
glossopharyngeal (CN 9)
59
which CN controls chewing and facial sensation
trigeminal (CN 5)
60
which CNs control eye movement (3)
oculomotor (CN 3)
trochlear (CN 4)
abducens (CN 7)
61
which CN controls pupil constriction
oculomotor (CN 3)
62
which CN controls the muscles of the tongue
hypoglossal (CN 12)
63
which CN controls taste on the anterior 2/3 of the tongue
facial (CN 7)
64
what is Boerhaave syndrome
an esophageal rupture which causes air to be absorbed into tissues --> pneumomediastinum
65
pH: 7.36
PaCO2: 68
HCO3: 36
pH = normal but on acidic side, so think ACIDOSIS.
COMPENSATED because ph is close to normal and all other values are abnormal
PRIMARY RESPIRATORY ACIDOSIS because the co2 is elevated
elevated bicarb w/ normal ph confirms this is compensated; if bicarb was normal, it would be uncompensated
66
DOC to increase HDL?
nicotinic acid
67
what is the hallmark of neurogenic shock
hypotension with bradycardia
68
hip issue: affected leg is shortened and internally rotated
hip dislocation
69
hip issue: affected leg is shortened and externally rotated
intertrochanteric fracture
70
which GI disease has decreased exacerbations with smoking
uC
71
what is the treatment for tardive dyskinesia
benadryl
72
which diabetic drug is not associated with hypoglycemia
metformin (bc it decreases the body's production of glucose)
73
irregular respirations of quick, shallow breaths of equal depth with irregular periods of apnea
Biot's breathing - common w opioids
74
periods of deep breathing alternating with periods of apnea; smooth transition between the two
Cheyne Stokes (seen with HF, resp depression and brain damage)
75
deep, rapid, continuous respirations
Kussmauls (metabolic acidosis)
76
tall male with autism, MVP, hyper extensible joints, long and narrow face, frominent forehead and chin, large ears, macroorchidism
Fragile X
77
tall, thin male with gynecomastia, testicular atrophy, difficulty understanding language, might be obese later in life
Klinefelter's syndrome
| this is XXY so usually male with poor male sex characteristics
78
short female with webbed neck, prominent ears, a broad chest with hypoplastic, widely spaced nipples. maybe isn't developing or ovulating.
turner's syndrome
79
tall male with long extremities, joint hyper mobility, arachnodactyly, precuts carinatum, pes planus, striae, MVP, ectopia lentis
marfan syndrome
80
male with skin hyper extensibility, joint hyper extensibility, easy bruising, berry aneurisms, smooth doughy skin, + Metenier's sign
Ehlers danlos syndrome
81
Auer rods
AML
82
tx for sickle cell pain crisis
hydroxyurea
83
a petechial rash is hallmark for this kind of meningitis
what does it look like on gram stain
Neisseria meningitidis
gram negative diplococci
84
what bacteria do you suspect if gram stain shows gram negative bacilli (pink staining, rod-shaped bacteria)
Staph aureus
85
coombs positive
coombs negative
+ = autoimmune hemolytic anemia
- = spherocytosis
86
which vitamin deficiency is associated with ocular - oral - genital involvement
B2 (riboflavin)
87
hyperkeratosis and hermorrhages is seen with which vitamin def
vitamin c
88
diarrhea, dementia and dermatitis is seen with which vitamin def
B3/Niacin
| "pellagra"
89
ataxia, oculomotor palsies and confusion are which vitamin def
B1/Thiamine
| "wernicke's encephalopathy"
90
looser zones are associated with what vitamin def
vitamin d (osteomalacia)
91
describe the HCM murmur
| does squatting, standing, valsalva, hand grip make it increase or decrease
```
SYStolic crescendo-decrescendo
DECREASES with squatting
INCREASES while standing
*increases with valsalva
decreases with handgrip
```
92
does Valsalva DECREASE or INCREASE the sound of all right/left sided murmurs
DECREASES
93
for which two things does Valsalva actually increase the quality of the murmur
HCM
| MVP (earlier click)
94
the hallmark of this dz is a RBBB in V1 and V2, ST elevations in V1-V3 with sharp down sloping
Brugada syndrome
95
what is the treatment for Brugada syndrome
implantation of a defibrillator to prevent sudden death
96
this disease classically presents as ST elevations on EKG and/or t wave inversion with mild elevation of troponins; but coronary arteries show no evidence of MI.
Echo classically shows L Ventricle Apical Ballooning
Takotsubo cardiomyopathy
97
MVP is the most common cause of mitral (regurg) or (stenosis)?
regurg
98
again, which one radiates to the axilla - MITRAL (regurg) or (stenosis)
regurg
99
for which kidney stones would you use
| percutaneous nephrolithotomy
large stones >10mm
struvite stones
staghorn calculi
100
for which kidney stones would you use shock wave lithotripsy
```
large stones (>7mm) that you want to break into smaller ones
Can use with fluids, metoclopromide
```
101
for which kidney stones would you use uretoscopy with stent
for immediate relief if the kidney is obstructed or at risk
102
for which kidney stones would you obvserve
small, asx
103
for which kidney stones would you use alkalinization of the urine to dissolve it
uric acid stones
104
how do you treat a myasthenia crisis
plasmapheresis or IVIG
105
with which CN is herpes zoster ophthalmic associated
CN V
106
classic physical exam findings for pleural effusion (fremitus, breath sounds, percussion?)
decreased fremitus
decreased breath sounds
dull to percussion
107
anterior or posterior shoulder dislocation: arm in abduction and external rotation, loss of deltoid prominence ("squared-off")
anterior dislocation
| MC
108
anterior or posterior shoulder dislocation: arm in adduction with a humeral head provence posteriorly
posterior dislocation
| severe trauma or seizure
109
ototoxicity and nephrotoxicity are s/e of which TB drug
streptomycin
| streptomycin is an amiNOglycoside, which treats gram NegOnly, and has s/e of Nephro/Oto-toxicity
110
hepatitis and peripheral neuropathy are s/e of which TB drug
isoniazid (INH)
111
optic neuritis is a s/e of which TB drug
ethambutol
| E for Eye
112
orange colored secretions are a s/e of which TB drug
Rifampin
113
photosensitive dermatitis and hyperuricemia are s/e of which TB drug
pyrazinamine
114
Myerson's sign is seen in parkinson's disease. what is it
a sustained blink when the bridge of the nose is tapped repetitively
115
which optho emergency causes an irregularly shaped pupil, for which you WANT to place a rigid eye shield?
globe rupture
116
```
which of the following is not seen in a patient with SIADH
a. hyponatremia
b. urine sodium >20
c. decreased serum osmolarity
d isovolemia
e. decreased urine osmolarity
```
And explain why YEEEEE
E!!! You do NOT see a decrease in urine osmolarity.
Increased ADH --> water overload --> increased URINE osmolarity because water is reabsorbed into the body.
You get isovolemic (choice D) , hypotonic (choice C) hyponatremia (choice A)
and INCREASED urine sodium with INCREASED urine osmolarity
117
what is the best drug to treat isolated hypertriglyceridemia
fibrates e.g. fenofibrate
118
what is the best drug to lower LDL
statins e.g. simvastatin
119
what drug can lower LDL but also increase trigs
cholestyramine
120
what is ezetamibe normally used for (lowering LDL, increasing HDL, or lowering trigs)?
lowering LDL
121
what is the best drug to increase HDL?
nicotinic acid
122
what is the 2nd best LDL-lowering drug, next to statins?
nicotinic acid
| ergo it DECreases LDL and INCreases HDL
123
MC presentation of sickle cell in kiddos?
dactylitis
124
what is the best treatment for kawasaki disease
aspirin and IVIG
| IVIG decreases cardiac cx
125
Barrett's esophagus is the precursor to which kind of esophageal carcinoma
ADENOCARCINOMA
126
Pt treated with Naf and Gent for endocarditis. Then he gets decreased urine output, increase BUN/Cr. Urinalysis shows epithelial cell casts, low sp gravity, FENA of 3%. What is the dx?
a. obstructive uropathy
b. acute interstitial nephritis
c. acute glomerularnephritis
d. acute tubular necrosis
e. prerenal azotemia
D!!! ATN
- MC intrinsic kidney injury, assoc with ogliuria and increased BUN/Cr
- also assoc with MUDDY BROWN casts along with epithelial
- assoc with low sp gravity (dilute) and FENA >2
- commonly caused by prolonged prerenal azotemia, DYE and AGs
127
how can you tell obstructive uropathy from intrinsic kidney injury??
IT DOESN'T HAVE CASTS
128
what kind of casts do you see with acute interstitial nephritis and how do you treat that
WBC casts
| Treat with PCN
129
what kind of casts do you see with acute glomerulonephritis?
RBC casts and dysmorphic RBC
130
how can you tell prerenal azotemia from intrinsic kidney injury in that vignette?
FENA <1
HIGH specific gravity (concentrated)
(this is because the RAAS is activated)
131
which of the following is a C/I of using MTX for an abortive drug?
1. Patient's vital signs are slightly elevated
2. BHcg > 5000
3. No fetal heart activity
4. No free fluid in the retroperitoneum
5. Gestational sac of 3cm
B!!
```
Here are MTX contraindications:
a. patient is hemodynamically unstable
b. BHcg > 5000
c. there is fetal heart activity
d. ruptured ectopic (= free fluid in the peritoneal cavity)
e. gestational sac > 4cm
also history of TB
```
132
management of choice for kidney stones <5mm that are symptomatic?
IV fluids
toradol
metoclopromide
tamsulosin
133
MOA of tamsulosin?
alpha blocker, relaxes bladder neck to promote urinary flow
134
squaring of the vertebral bodies ("bamboo spine") is assoc with???
ankylosing spondy
135
wedge shaped vertebral bodies assoc with???
vertebral fracture
136
continuous, machinery like murmur heard loudest at LUSB
PDA
137
pinguecula vs pterygium
pinguecula: painless nodule on conjunctiva that doesn't grow
pterygium: fleshy triangular mass that grows on the nasal side of the conjunctiva
138
what is the MOA of zofran
serotonin antagonist
139
what is the MOA of metoclopramide, promethazine
dopamin agonists
140
what is the definition for acute stress disorder
PTSD symptoms occurring less than 1 month from the event
141
1st line ppx treatment for cluster headaches?
verapamil
142
infectious diarrhea that gives you gray stools
vibrio cholera
143
what drug has s/e of hemorrhagic cystitis and increased risk of bladder cancer
cyclophosphamide
144
which GERD drug is assoc with cervial ripening and uterine contractions
misoprostol
145
which GERD drug is assoc with gynecomastia and impotence
cimetidine
146
which of the following is NOT classically associated with diabetes insipidus?
a. isovolemia
b. low urine sp gravity
c. increased thirst
d. decreased urine osmolarity
e. hyponatremia
E!!!! You will NOT have hyponatremia
DI patients can get HYPERnatremia unless they keep up with their increased thirst (C). They stay isovolemic (A). Because they drink so much, they have INCREASED urine production with a low specific gravity (dilute) (B) and decreased urine osmolarity (D).
147
Classic presentation if your parathyroid glands are destroyed?
a. high Ca, high PTH, low Phos
b. low Ca, high PTH, high Phos
c. low Ca, low PTH, high Phos
d. low Ca, high PTH, low Phos
e. low Ca, low PTH, low Phos
C!
Hypocalcemia so LOW CA
PTH won't be produced anymore if glands are destroyed on LOW PTH
Ca goes opposite of phosphate so HIGH PHOS
148
what is a negative Prehns test
NO relief of testicular pain with elevation of the scrotum - suggestive of testicular torsion
149
what is a negative cremasteric reflex
stroking the thigh does NOT cause the testicle to rise upward - suggestive of testicular torsion
150
what diseases are associated with a + prehns test and a + cremasteric reflex
epidiymitis and orchitis
151
which drugs exacerbate myathenia gravis (3)
beta blockers
FQs
AGs
152
what will classically be seen in post streptococcus glomerulonephritis (s/p strep illness, develops coca cola colored urine)?
a. + C-ANCA antibodies
b. + anti-streptolysin titers
c. + P-ANCA antibodies
d. + anti-glomerular basement membrane antibodies
e. + IgA deposits in the mesangium
Anti-streptolysin titers
