General Wrong Answers Flashcards
(168 cards)
1
Q
Prophylaxis after exposure to n meningitis
A
Close exposure: household members, childcare, directly exposed to oral droplets (mouth to mouth or intubation), sitting next to someone for 8 hr
Prophy regimens—> to eradicate pharyngeal carriage of organism:
- cipro 500mg single dose
- rifampin 600mg BID x2 days
- ceftriaxone 250mg single dose
2
Q
Lab tests to rule out other things when making clinical dx fibromyalgia
A
- anemia- CBC
- inflammatory Arthropothy - esr or crp
- hypothyroid - TSH
3
Q
What is imaging of choice to dx pneumothorax
A
Bedside ultrasound
4
Q
sickle cell disease in pregnancy
A
- dehydration (nausea/vomiting) is common trigger for vasoocclusive episode
- acute pain episodes more common during pregnancy
- repetitive episodes a/w increased fetal problems (growth restriction, preterm labor)
- a/w maternal complications: preE, abruption
5
Q
4 aspects of capacity
A
- comminicate a choice
- understand info provided
- appreciate consequences
- rationale about a decision (weigh risks & benefits, offer reasons for decision)
6
Q
presence of HbA:HbS in 60:40 ratio on hgb electrophoresis
A
sickle cell trait
-asymptomatic & does not cause anemia
7
Q
dx of pediatric iron deficiency anemia
A
- screening hgb at age 1yo
- hemoglobin <11 g/dL; low MCV, high RDW
8
Q
alpha thalassemias
A
presence Hg barts (4 gamma chains) seen on electrophoresis
9
Q
beta thalassemias
A
mutations in the beta globin genes
sickle beta thal: predmoinantly HbS and <30%HbA
- often HbF and HbA2 elevated
10
Q
secondary hyperpara
A
- high PTH, low/normal Ca
- can be caused by vitamin D deficiency; can see osteomalacia & hypophosphate (with normal calcium levels)
increased parathyroid hormone causes increased renal excretion of P while maintaining calcium at normal levels
11
Q
primary hyperparathyroid
A
-elevated PTH, elevated Ca
Occasionally, a person may have an elevated calcium level and a normal or minimally elevated PTH level
12
Q
treatment for catatonia
A
benzo &/or ECT
-antipsychotics can worsen catatonia
13
Q
caloric intake goal for enteral feeding
A
30kcal/kg/day ; lower for patients with severe preexisting malnutrition
1g/kg protein is approrpiate
14
Q
time period to give antiviral in flu
A
efficacy declines precipitoiusly if initiated >48hr after sx onset
aniviral=oseltevir
15
Q
management of gout in renal failure/renal transpant
A
intraarticular glucocorticoids
16
Q
tx of paryoxysmal supraventricular tachycardia
A
hemodynamically stable: vagal maneuvers (valsalva) or adenosine
hemodynamically unstable: urgen synchronized cardioversion
17
Q
EKG findings in wolf parkinson white
A
short PR interval, slurred upstroke of QRS (“delta wave,” wide QRS
18
Q
renal failure & HepC
A
think cryoglobulinemia
serum cryoglobulin levels
19
Q
antineutorphil cytoplasmic antibodies (ANCA)
A
help test for granulomatosis with polyangiitis
a/w normal or elevated complement levels & resp symptoms
20
Q
anti-dsDNA antibodies
A
usually seen with SLE
see low complement levels
21
Q
antiglomerular basement membrane antibodies
A
seen in Goodpasture disease ( glomerulonephritis & pulm sx)
22
Q
streptozyme test
A
test for strep infection
23
Q
factorial study
A
aka fully crossed study design – utilizes greater than or equal to 2 interventions and ALL COMBOS of those interventions
24
Q
crossover study
A
subjects are exposed to different treatments or exposures sequentially
(subjects crossover and serve as their own controls)
25
cross sectional study
observational study where 1 specific population is studies at one point in time
26
nested study
aka nested case-control study; retrospective observational study where subsets of controls are matched to cases & analyzed for variables of interst
27
pragmatic study
aims to determine whether intervention works in real-life
28
antipsychotic use in dementia with lewy bodies
these patients are very sensitive to antipsychotics -- may cause more confusion, worse parkinsonism, & autonimic dysfunction
29
pleural effusion that is exudative with elevated adenosine deaminase level
pathonmeumonic for TB
since TB effusion usually caused by hypersensitivity reaction to M TB, pleaural fluid smear is usually aspetic
-->pleural biopsy often required for dx of TB
30
lab findings in rocky mountain spotted fever
low platelets
low Na
elevated AST & ALT
31
treatment for pulmonary hypertension
if not type 1 (idiopathic). treat the underlying cause leading to PH (ex OSA, ILD, L heart failure)
treatment: endothelin antagonist (bosentan, ambrisentan) to dilate pulm arteries
32
physical findings in femoral nerve injury
inability to extend knee
loss of knee jerk reflex
sensory loss: anterior/medial thigh. medial shin, arch of foot
33
radiographic findings suggestive of BENIGN lung calcification
```
popcorn
concentric
laminated
central
diffuse homogenous
```
34
radiographic findings suggestive of MALIGNANT calcification
reticular
punctate
eccentric
35
character of tension type headache pain
nonthrobbing, dull, tight
while migraines are often throbbing/pulsatile
36
timeline for postpartum blues
typically peaks at 5 days postpartum, resolves within 2 weeks
37
gonococcal vs nongonococcal urethritis in men
gonococcal: PURULENT discharge; intracellular gram neg diplococci on stain
non conoccocal: WATERY duscharge; aseptic stain (leukocytes)
38
antibiotics and botulism
abx (esp aminoglycosides_ are avoided because they can cause c. botulinum to lyse in the colon -- leading to INCREASED toxin absorption
instead: give botulism immune globulin (BIG-IV)
39
technical name for GBS
strep agalactiae
40
evidence of scaphoid fx
decreased grip strength, decreased wrist ROM, tenderness of scaphoid (anatomic snuffbox)- radial/dorsal side of wrist
41
complications of poorly healed scaphoid fx
avascular necrosis & nonunion
42
tx for active TB in pregnancy
3drug therapy (INH, rifampin, ethambutol) for 2 mo, then INH + RIF for additional 7mo; plus pyridoxine throughout
43
what med may cause a utox false positive for methamphetamine?
metformin
44
treatment for severe PCP intoxication
benzo
45
Chronic Myeloid Leukemia
- results from translocation of chromosomes 9 & 22 (Philadelphia chr)
- causea production of bcr/abl fusion protein-- uninhibits tyrosine kinase
- tx: tyrosine kinase inhibors
46
ecythma gangenosum
usually associated with psuedomonas bacteremia in immunocompromised pt
- tx with double IV abx against psuedomonas (ex pip tazo.& gentamicin)
47
low serum 21 hydroxylase level
seen in congenital adrenal hyperplasia (presents with hyeperkalemic metabolic acidosis)
48
Ages for peds GI stuff
- infantile pyloric stenosis: 3-6weeks
| - intussusception: 6-26months
49
which meds cause increased risk of pyloric stenosis
azithro & erythromycin -- esp in first 2 weeks of life -- a/w with icnreased risk of infantile hypertophic pyloric stenosis
50
conditions a/w osteonecrosis
SLE, sickle cell, antiphospholipid ab syndrome, chronic rendal dz on dialysis, trauma, Gauchers dz, HIV, after renal transplant, Caissons dz
51
finding in >90% pts with sarcoidosis
>90% have hilar or mediastinal adneopathy (get a chest xray!)
52
most common bugs in orbital cellulitis
(same as sinusitis in kids, often precedes orbital cellulitis)
-stre viridans, strep pneumo, staph, h flu
53
cancers that metastasize to spinal column
prostate, breast, lung, non-hodgkins lymphoma, renal cell
54
cherry red, flat lesion on colonoscopy
angiodysplasia
| frequent cause of occult GI bleed
55
conditions a/w angiodysplasia
ESRD, von willebrand, aortic stenosis -- all cause increased bleeding rates with angiodysplasia
56
what biliary condition a/w ulcerative colitis
primary sclerosing cholangitis
57
which lipid meds worsen glycemic control
niacin
| atorvastatin
58
calories in carbs vs alcohol vs fat
4cal per gram carb
7cal per gram alcohol
9cal per gram fat
59
which DM meds help with cardiac risk
SGLT2i and GLP1
| flozins & -tides
60
which DM helps with oligomenorrhea in PCOS
metformin -- increases ovulation in PCOS
61
"Break Bone fever"
Dengue Fever - flulike isllness with market myalgias, rash, thrombocytopenia, spontaneous bleeding --> shock
tourniquet test -- petechiae after BP cuff
62
untreated celiac disease puts you at risk for ...
enteropathy associated T cell lymphoma (EATL)
| primarily affects proximal jejunum
63
gout flare with renal dz
avoid NSAIDS, so do intra-articular steroid injection, especially beneficial if the flare is only at one joint
64
initial testing for HIV+ patient
CD4 count, viral load, HIV genotype, hep B labs, HepC, TB, STIs
65
clinical picture of amniotic fluid embolism ayndrome
cardiogenic shock, hypoxemic respiratory fialure, DIC, coma, sezure
pathophys: amniotic fluid triggers massive anaphylactoid rxn resulting in vasospasm
66
aksthesia/parkisonian sx in cancer pt
think about anti-emetics; metoclopramide ia a central & peripheral D2-blocker & can result in anti-pyramidal sx
67
biggest risk of ginkgo biloba
increased bleeding/potentiating anticoagulation
68
diabetic retinopathy screening
- inT1DM: 5 years after dx
| - inT2DM: at time of dx and annual
69
actinic keratosis is premalignant for what
increased risk of squamous cell carcinoma
70
exam findings for PE
loud P2 and pleural friction rub, tachycardia
71
seborrheic keratosis
benign, "stuck on"
72
abx choice in bacterial conjunctivitis
- non contact wearers: azithromycin drops
| - contact lens wearers: fluoroquinolone drops (due to higher risk pseudomonas)
73
first line abx for lactational mastitis
dicloxacillin or cephalexin (both safe during breastfeeding)
74
PCOS tx
first line: weight loss; then OCP; if want to conceive -oetrozole for ovulation inductin
(avoid spiro if wanting to get pregnant)
75
pathophys of lupus nephritis
immune complex mediated glomerular injury (primarily of anti-DS DNA antibodies), -- this causes completment to be fixated, leading to low complement in blood
(so monitor anti DS DNA & complement)
76
anti-smith anitbodies
highly specific for SLE; may be helpful to ID pts at risk for developing renal dysfuntion (but not helpful if already have renal dysfuctnion, bc stay elevated even after dz isnt active)
77
causes of elevated gastrin
- zollinger ellison syndrome
- hypercalcemia
- use of PPI
78
adverse hospital events
- most common: related to surgery
- next most common: adverse drug events
- general care (fall, pressure ulcers)
- hospital acquired infxn
79
LV apical aneurysm in absence of coronary artery disease
pathognomonic for Chagas cardiomyopathy (2/2 T. Cruzi protozoa)
80
arthropathy a/w hemochromatosis
commonly the 2nd and 3rd MCPs (and also knees, ankles, shoulders)
-xray findings: subchondral cysts, sclerosis, osteopenia
81
oxidative stress than can trigger G6PD intra & extra vascular hemolysis
- infection
- sulfa drugs
- fava beans
82
positive RF and ant CCP antibodies
correlate with RA
83
what supplement do you have to take with methotrexate?
- folate
| MTX is a folate antimetabolite
84
GERD, raynauds, HTN with renal failure
scleroderma real crisis
tx: ace-inhibitor
85
hormonal changes in menopause
rise in FSH and LH
| ovaries can no longer respond to hormonal signals
86
definition primary amenorrhea
abscence of menses by age 15 OR absence of menses within 5 years breast development
87
definition secondary amenorrhea
absence of menses for 3 cycles (if previously regular) or six months (if previously irreg)
88
LH / FSH ratio in PCOS
elevated LH/FSH ratio is characteristic
89
Rotterdam Criteria for PCOS
requires 2 out of the 3:
- oligo or anovulation
- hyperandrogen (clinically or by elevatedf or total T)
- polycystic ovaries on u/s
90
inpatient abx for PID
```
-cefoxitin + doxy
OR
-clinda +gent
OR
amp-sulbactam + doxy
```
91
dx pregnancy of unknown location
hCG <3000 and no intrauterine preg or adnexal masses
if HDS, repeat hcg in 48hr (if doesnt double, suspect ectopic)
92
med to help with vasomotor instablity of menopause
venlafaxine and some other SSRIs
93
contraction stress test
used to ID uteroplacental dysfunction & predict how baby will tolerate labor
positive (abnml): late decels in conjunction with at least 50% ctx
94
scoring BPP
"test the baby man"
- tone
- breathing
- fetal movements
- amniotic fluid pocket
- nonstress test
score 8-10 is reassuring
less than or equal to 6 is worrisome, prompt delivery vs repeat
95
abx contraindicated in pregnancy
```
tetracycline
quinolones
sulfonamides third trimester
streptomycin
tmp (bactrim) (folic acid antagonist)
```
96
GERD meds contraindicated in pregnancy
alka seltzer & bismuth (contains NSAID)
97
why are NSAIDs contraindicated in pregnancy
may cause oligo and closure of PDA, esp in third trimester
98
timing of postpartum blues
usually resolves within 2weeks
99
definition of oligo &poly
oligohydramnios: AFI less than or equal to 5cm on u/s
poly: AFI greater than or equal to 25cm on u/s
100
additional lab to get in subclinical hypothyroid
(High TSH, normal T4)
anti TPO (antithyroid peroxidase) -- when antithyroid levels are present, high likelihood to become overtly hypohtyroid
101
complications of scleroderma
Lung- ILD, pulm HTN
Kidney: HTN, scleroderma renal crisis
Heart: fibrosis, pericarditis,
102
why no antihistamines for poison ivy?
it's a type IV (cell mediated) HSR; not histamine mediated
103
treatment for latent TB
isoniazid x 6- 9mo
- other options: isoniazid & rifampin weekly x3mo (not for HIV pts)
- rifampin x4mo
104
types of esophageal carcinoma
- adenocarcinoma -- distal to mid esophagus, usually 2/2 Gerd & Barretts
- SCC -- upper esophageal lesions, 2/2 alcohol & tobacco
105
treatment for intussusception
air or saline enema
106
henoch schonlein purpura (IgA vasculitis)
- palpable purpura/petechia on LEs, arthralgia, abd pain/intussusception, renal dz (like IgA neph)
- normal platelets & coags
- hematuria
- tx: supportive care (steroids for severe sx)
- preceding resp illness 50% of time
107
hemolytic uremic syndrome
- microangiopathic hemolytic anemia, thrombocytopenia, acute renal failure
- pts <5yo
- after a blodoy diarrheal illness
108
idiopathic thrombocytopenic purpura (ITP)
- petechia or purpura, usually after a low impact injury
| - often follows URI
109
thrombotic thrombocytopenic purpura (TTP)
serious disorder
| -pentad: fever, microangiopathic hemolytic anemia, thrombocytopenia, renal failure, neuro impairment
110
thiazolidenediones
DM Med
PPAR-y agonist (ex pioglitazone)
PPAR-y receptors are in collecting tubule of nephron --> stimulation results in increased sodium reabsorption ( this is the same channel where aldo mediates sodium retention) --> can cause fluid retention in pts esp with CHF --> pulm edema / other fluid retetion /CHF e
111
benefit of fibrates
(ex gemfibrozil)
most effective for reducing TGs, recommended with severe hyperTG to reduce risk of pancreatitis
112
dx of Duchenne muscular dystrophy
elevated CK, genetics (dystrophin deletion), muscle bx with fibrosis/fat/muscle degen
113
reversal of warfarin
- prothrombin complex concentrate (normalizes INR within 10min)
- IV vitamin K (takes 12-24hr)
(FFP only if PCC not available, requires large volume infusioN)
114
"ground glass" abdominal mass in neonate
meconium ileus -- think CF
115
medical management of hypertrophic CM
negative inotropes (beta blocker, verapamil, disopyramide) [weaken the force of contraction]
beta blocker prefered as initial therapy
116
low V/Q in COPD lugns
low V/Q regions = poorly ventilated regions undergo hypoxic vasoconstriction ==> supplemental O2 increased the Q, improving gas exchange
117
single most important risk fx for osteoporosis
age
118
anemia & indirect hyperbili in neonate
think G6PD deficiency (xlinked RBC enzymatic deficiency)
119
hypoCa sx
hyperactive DTRs
muscle cramps
convulsions
+Chvostek sign (tap facial nerve and mouth twitches)
120
endoscopic findings with pernicious anemia
(cause of vit B12 deficiency, autoantibodies against IF)
glandular atrophy (fundus & antrum), intestinal metaplasia, inflammation
121
pregnancy TSH ranges
First tri: 0.1-2.5
Second tri: 0.2-3.0
Third tri: 0.3-3.0
TSH low/suppressed due to TSH actions of B-HCG
122
common associated finding with alopecia
nail pitting
123
diaper dermatitis that involves skinfold
candida
normal contact dermatitis (treat w barrier cream) usually spares creases/ skinfold
124
what initial screening toget when you suspect dementia
TSH, vitamin B12, depression screen
125
common preceding infections for reactive arthritis
GI: salmonella, shigella, yersinia, campy, c diff
GU: chlamydia
126
how to differentiate iron deficiency anemia and thalassemia
both microcystic
mentzer indec (MCV/RBC)> 13 more likely iron deficiency
<13- more likely thalassemia
127
cephalohematoma vs caput
cephalohematoma= DOES NOT CROSS SUTURE LINES; WELL DEMARCATED; reoslves in weeks
caput= hematoma above periosteum that crosses suture lines; resolves in days
128
lowgrade fever, facial pain, nasal congestion
acute rhinosinusitis
>95% due to virus, no need for abx (even thouse with bacterial etiology will often resolve w.o abx)
129
tx of pneumomediastinum
condition usually resolves pontaneously (tx is supportive, avoid increasing pulm pressure, can give O2 to speed resorption and initiate nitrogen washout)
130
major risk fx for progression of CKD
HTN
proteinuria
Hyperglycemia
131
what amount of Cr rise is ok when starting ACEi
up to a 30% rise in serum Cr
132
lab values that predispose to calcium phosphate kidney stones
hypercalciuria & alkaline urine; hypocitraturia too
133
viral myositis findings
young boys in convalescent phase of flu
symptoms: bilateral calf pain, toe walking, elevated CK
self resolve 5-14days
134
lab findings in acute intersitial nephritis (AIN)
(commonly due to drugs)
AKI, pyruria, hematurai , WBC casts, eosinophilia & urinary eosinophils, renal bx showing inflamm & edema
135
prophy for PCP pneumonia
bactrim (Tmp sulfa)
136
enlarged cup to disc ratio of optic disc
open angle glaucoma
137
dietry changes to prevent kidney stones
increase fluids, limit dietary oxalate, increase dietary calcium (Ca binds oxalate)
138
why do transcranial doppler for kids with sickle cell?
leading cause of stroke in peds pts
139
if head trauma and >65yo
get CT scan (increased risk for occult complications following seeminglyh minor trauma)
140
what 2 ventilator settings determine ventilation (CO2 removal)
```
tidal volume (want low, 6-8ml/kg predicted weight)
and RR (want less than 35)
```
141
what 2 ventilator settings determine arterial oxygenation
PEEP ( up 15-20cm H2o) and FiO2 (less than or equal to 60%)
142
what precentage FiO2 is associated with oxygen toxicity
prolonged FiO2>60%
143
acute splenic sequestration in sickle cel
vasoccolusion within the spleen that causes trapping of RBC & platelets
- see signs of anemia & palpable spleen
- treatment- fluid resuscitation, RBC transufions, +/- splenectomy
144
meds that cause pupillary dilation (which can exacerabte angle closure glaucoma)
- nasal decongestatns
| - anticholinergics (TCAs, tolterodine)
145
protective fx against ovarian cancer
- OCPs
- multiparity
- breastfeeding
- salpingo-oophorecotmy
146
increased risk of ovarain cancer
(longer time ovulating)
early menarche
late menopause
nulliparity
147
complication of IUFD if fetus is retained
increased risk of coagulopathy (DIC due to release of TF into maternal circulation from placenta) after several weeks fo fetal retention
148
bug that cause otitis externa
pseudomonas
| staph
149
bugs that cause otitis media
strep pneumo
Hflu
moraxella
150
how to treat methemoglobinemia
methylene blue
151
buzz words for nonmalignant pulm nodule
diffuse, dense, central
popcron
concentric
target calcification pattern
152
buzz words for malignant pulm nodule
size>2cm
sunburst
spiculaiton
upper lobe
153
is biopsying erythema nodosum helpful to dx sarcoid
no-- the erythema nodosum will not show granulomas, not diagnostically helpful (although clinically it can be)
154
complications of OSA
```
HTN
LV dysfunction
arrhythmia
pulm HTN
insuling resistance
```
155
can you see pulm contusion on CXR?
yes -- irregular, localized lung opacification
156
argyll robertson pupils
in late neurosyphilis--pupillary constriction with accomodation but not with light
157
hydrophobia is hallmark symptom of what dz
rabies
158
firstline HTN med in african american
thiazide
| CCB
159
what size aortic aneursym shows increased risk of rupture
5cm
160
what is considered a rapidly expanding aortic aneurysm?
expand by 0.5cm/year (surgery is indicated)
161
anticoag after valve replacement
both aspirin + warfarin
INR goal 2-3 if aortic valve without other risk factors (low EF, AFib, hypercoag, prior clot)
INR goal 2.5-3.5 if mechanical mitral valve
162
cardiac meds that can cause digoxin toxicity when taken with dig
verapamil
quinidine
amiodarone
163
bugs causing NSTI
- in diabetes -- polymicrobial -- c perfringens
| - without diabetes - group A strep
164
high risk of developing what after kidney transplant?
diabetes
165
what medical problem is associated with restless legs?
iron deficiency anemia
166
single item screening for alcohol misuse
how many times in the past have you had 5 or more drinks in a day? (4 for women)
167
tx of choice in hepatorenal
midodrine
octreotide
albumin
168
pathophys of sickle cell dz
autosomal recessive; beta globin mutation
