Incorrects 5 Flashcards
(200 cards)
1
Q
What test can differentiate achalasia and pseudoachalasia?
A
Endoscopic evaluation. Achalasia is due to nerve damage and pseudoachalasia is from cancer.
2
Q
First test when Lupus suspected?
A
Anti-Nuclear Antibody (ANA). This test is highly sensitive for SLE.
3
Q
Second test when Lupus suspected?
A
Anti-DS DNA and/or Anti-Smith. These are very specific for SLE. A positive high sensitivity test must be followed up with a positive high specificity test.
4
Q
Antihistone antibodies are present in nearly 100% of what?
A
Drug induced lupus. Minocycline is less sensitive…
5
Q
Anti cyclic citrullinated peptide antibodies are used in Dx of?
A
Rheumatoid arthritis. This is a highly specific test.
6
Q
What vaccination can lead to intussusception in children?
A
Rotavirus.
7
Q
Testing appropriate in Hirschsprung disease?
A
Anorectal monometry (analyzes motility and pressure in distal bowel). Neonates with delayed meconium passage/bilious emesis.
8
Q
Rx of leprosy with minimal lesions (paucibacillary)?
A
Dapsone and rifampin
9
Q
Rx of leprosy with extensive lesions (multibacillary)?
A
Dapsone, rifampin, and clofazimine.
10
Q
Dx test in leprosy?
A
Biopsy from active lesion edge.
11
Q
Classic hand morphology in Diamond-Blackfan anemia?
A
Triphalangeal thumbs.
12
Q
Differences in anemia between Diamond-Blackfan and Fanconi anemia?
A
DB: Pure red cell aplasia
F: Pancytopenic bone marrow failure
13
Q
Milrinone is associated with increased mortality in?
A
Heart failure. It is a PDE 5 inhibitor and leads to increased contractility.
14
Q
What antibiotic can lead to hyperkalemia due to a similar mechanism as K+ sparing diuretics?
A
Trimethoprim.
15
Q
Drugs that commonly cause hyperkalemia?
A
ß2 blockers NSAIDs ACEI, ARB, K+sparing diuretics Digitalis Cyclosporine Heparin Succinylcholine Trimethoprim
16
Q
Venous stasis ulcers most commonly occur?
A
Pretibially or above the medial malleolus.
17
Q
Diabetic foot ulcers most commonly occur with what?
A
Charcot foot deformity.
18
Q
Arterial ulcers most commonly occur where?
A
At the most distal part of the body (tips of toes/fingers).
19
Q
Pathologically what does bland urine sediment represent?
A
An absence of intrinsic renal pathology (as would RBCs, casts, or protein).
20
Q
Noninvasive positive pressure ventilation (aka CPAP) in acute COPD exacerbation is associated with a decrease in?
A
Mortality Intubation rate Treatment failure Length of hospital stay Incidence of nosocomial infxn
21
Q
Cluster HA Rx?
A
Acute: Inhaled O2
Prophylactic: Verapamil
22
Q
Migraine HA Rx?
A
Acute: DHE or Sumatriptan (both 5HT1 receptor agonists)
Prophylaxis: TCAs or propanolol
23
Q
Tension HA Rx?
A
NSAIDs.
24
Q
When is amylase found in high concentration in pleural effusions?
A
Pancreatitis effusion or esophageal rupture
25
Postoperative fever occurring within 2 hours of surgery likely due to?
- Prior infxn/trauma
- Blood products
- Malignant hyperthermia
26
Postoperative fever occurring after 24 hours of surgery up to a week likely due to?
- Nosocomial infxns
- GAS or C. perfringens infxn
- Noninfectious causes (PE, MI, DVT)
27
Postoperative fever occurring after a week from surgery but under a month likely due to?
- Catheter infxn (not GAS or C. dif)
- C. difficile
- Drug fever
- PE/DVT
28
Postoperative fever occurring after a month from surgery likely due to?
- Viral infxns
| - Indolent infxns (eg TB)
29
MC transfusion reaction?
Febrile nonhemolytic. Occurs w/in 1-6 hours of transfusion. Cytokine accumulation in blood causes fever/chills. No hemolysis.
30
Acute hemolytic transfusion reaction labs?
Occurs w/in 1 hour of transfusion. Positive direct Coombs test due to ABO incompatibility. Fever, flank pain, hemoglobinuria, renal failure, DIC.
31
Delayed hemolytic transfusion reaction labs?
W/in 2-10 days after transfusion. Positive direct Coombs w/ positive new antibody screen. Body develops new antibodies to recognized antigen (anamnestic antibody response). Mild fever and hemolysis.
32
Transfusion-related acute lung injury Sx?
W/in 6 hours of transfusion. Respiratory distress and noncardiogenic pulm edema occur due to donor anti-leukocyte antibodies.
33
How is pulmonary edema during an MI managed?
IV Furosemide. Hypotension and hypovolemia are contras.
34
Percutaneous transluminal coronary angioplasty (PTCA) is preferred within how long after admittance to ER?
90 minutes.
35
When is thrombolysis used in acute MI?
If PTCA is not available in 120 minutes, then do thrombolysis.
36
Highest risk antipsychotics for weight gain, dyslipidemia, and hyperglycemia (or even new onset DM)?
Clozapine and olanzapine. Monitoring requires BMI, fasting glucose/lipids, BP, and waist circumference.
37
Lithium requires what testing?
Kidney and thyroid fxn. Nephrogenic DI, chronic interstitial nephritis, and hypothyroidism.
38
Gestational DM treatment 1st and 2nd line?
1: Dietary modification
2: Insulin, metformin
39
2 hour postprandial blood glucose goals in pregnancy?
Fasting≤95
1hour postprandial≤140
2hour postprandial≤120
40
When to screen for gestational DM?
24-28weeks
41
Management of shoulder dystocia?
```
BE CALM:
Breathe, no pushing
Elevate legs/flex hips (McRoberts)
Call for Help
Apply suprapubic pressure
enLarge vagina (episiotomy)
Maneuvers:
Woods screw (rotative pressure on anterior part of posterior shoulder)
Rubin (adductive pressure on posterior part of posterior shoulder)
Gaskin (all 4s)
Zavanelli (replace head - do csxn)
```
42
Main clinical features of NF1?
```
Cafe au lait spots
Multiple neurofibromas (<6 may get optic pathay glioma)
Lisch nodules (in iris)
```
43
Main clinical features of NF2?
Bilateral acoustic neuromas
44
Retinitis Pigmentosa Sx?
Inherited degenerative disease of the retinal photoreceptor cells causing bilateral tunnel vision and eventually binocular blindness.
45
What is uveitis?
Inflamation of the uveal tract (iris, ciliary body, and choroid). Intense pain and photophobia in one eye is classic.
46
Triad in hemolytic uremic syndrome?
Hemolytic anemia
Thrombocytopenia
AKI (elevated creatinine, hematuria, proteinuria, oliguria/anuria, HTN)
47
Man acquires laceration on his friend's ocean yacht. In 12 hours he has rigors and dark red bullae around the wound with red streaking up the leg. What Rx is suggested?
IV ceftriaxone and doxycycline. Highly virulent Vibrio vulnificus infxn can be fatal and develops in hours (vs staph/GAS which takes days). Individuals with liver disease are at increased risk (esp. hemochromatosis). Oyster ingestion are a common vector.
48
MCC of fetal growth restriction?
Uteroplacental insufficiency.
49
What is required testing in fetal growth restriction?
Histopathologic examination of the placenta to look for infarction and/or infxn (eg spirochetes). Maternal substance abuse, genetic issues, or congenital infxn can cause fetal growth restriction.
50
Define fetal growth restriction in a newborn.
Weight <10th percentile for gestational age. May have loose skin, thin cord, and wide anterior fontanel.
51
First line medication in angioedema leading to respiratory compromise in patient taking ACEI?
Epinephrine. If still refractory do emergency tracheostomy.
52
Unusual lab findings in Antiphospholipid syndrome?
Paradoxical aPTT prolongation not reveresed on plasma mixing studies.
53
Which type of drug reaction is dose dependent?
Type A. eg respiratory depression with opioids
54
Which type of drug reaction is dose independent?
Type B. eg Stevens-Johnson syndrome with lamotrigine
55
Addition of what medication to calcium channel blocker treatment of HTN can reduce peripheral edema SE?
ACEI or ARBs.
56
Appropriate testing for Histoplasma capsulatum in HIV?
Urine or serum Histoplasma antigen testing is the test of choice for Dx (highly sensitive and rapid).
57
Both histoplasmosis and TB present with systemic symptoms (fever, chills, malaise), weight loss, cachexia, and pulmonary Sx. What PE Sx can differentiate them?
Mucocutaneous lesions (papules and nodules) are present in histoplasmosis and ARE NOT present in TB.
58
Proper management of mild or limited Histoplasmosis?
Itraconazole.
59
Proper management of severe or systemic Histoplasmosis?
Amphoteracin B. Usually switched to oral itraconazole after 1-2 weeks and stay on it for a year or more for maintenance therapy.
60
When is caspofungin used?
Second-line in aspergillosis.
61
Flucytosine is used for?
Cryptococcus.
62
Features of acute tubular necrosis?
- BUN:Cr ratio <20:1
- Urine osmolality of 300-350 (unable to concentrate urine)
- Urine Na>20
- FENa>2%
63
Casts in acute tubular necrosis?
Muddy brown casts (renal epithelial cells). Sensitive, but nonspecific for ATN.
64
Casts in chronic renal failure?
Broad casts or waxy casts.
65
Casts in nephrotic syndrome?
Fatty casts.
66
Casts in prerenal azotemia?
Hyaline casts. May be present in asymptomatic individuals also.
67
```
Name the associated renal disease:
Muddy brown cast
RBC cast
WBC cast
Fatty cast
Broad and waxy casts
```
```
MBC: ATN
RBC: Glomerulonephritis
WBC: Interstitial nephritis and pyelonephritis
Fatty: Nephrotic syndrome
Broad/waxy: Chronic renal failure
```
68
Which Rx in Graves disease can worsen ophthalmopathy?
Radioiodine ablation.
69
Methimazole and PTU SE?
Agranulocytosis. Methimazole is teratogenic in 1st trimester. PTU preferred.
70
Other PTU SE?
Hepatic failure, ANCA associated vasculitis.
71
Impaired myocardial relaxation and/or increased LV wall stiffness leads to?
An increase in LV EDP.
72
Damage to the Edinger-Westphal nucleus would result in?
Ipsilateral fixed, dilated pupil without reactivity to light/accommodation.
73
Damage to the lateral geniculate nucleus on the right would cause?
Contralateral homonymous hemianopsia. The lateral geniculate is located in the thalamus and relays visual info to the ipsilateral primary visual cortex.
74
Damage to the medial lemniscus would cause?
Contralateral vibration, proprioception, and light touch loss.
75
RFs for septic arthritis include?
```
Abnormal joints (OA, RA, prosthesis, gout)
Age>80
DM
IV drugs/etoh
Glucocorticoid injxns
```
76
MC organisms found in septic arthritis?
Gram-positive, unless IV drug use, immunosuppressed, or advanced age, then gram negatives.
77
Painless GI bleeding in a child with a positive 99mTc-pertechnetate scan identifies what Dx?
Meckel diverticulum. 99mTc-pertechnetate scan (Meckel's scan) reveals denser uptake in an area of ectopic gastric mucosa and is helpful if gastric muscosa is present in a Meckel's diverticulum which is 50% of cases.
78
MCC of coagulopathy in a patient with malignancy?
DIC. Thus, thrombocytopenia, decreased fibrinogen, and increased INR in the presence of cancer Hx likely indicate DIC.
79
Mild mitral stenosis is mostly heard in?
Late diastole (rumble at apex). But as it worsens, it gets closer and closer to the opening snap.
80
An early diastolic murmur heard at the LLB is likely?
AR. Whereas MS is heard at the apex.
81
A late systolic murmur with a click that is heard over the apex radiating to the axilla is likely?
MVP.
82
HOCM increases with murmurs that cause?
Increased outflow obstruction (eg Valsalva, standing from squatting [both reduce preload]). And is reduced by reduction of outflow obstrxn (eg handgrip [afterload up] and leg raise [preload up])
83
Management of early pressure ulcers?
Elevation/relieving the pressure on the skin
84
Management of frank pressure ulcers?
Elevation/relieve pressure and dress to maintain moist wound environment.
85
Management of infected pressure ulcer?
Utilize topical antibacterail (silver sulfadiazine)
86
A patient has thoracentesis to remove a pleural effusion. He presents within hours after with SOB and poor O2 sats with dullness to percussion in the chest wall. Dx?
Hemothorax. Rapid reaccumulation of pleural effusion with the other Sx would likely be due to bleeding into the pleural space.
87
A diabetic patient presents with severe pain in the lower anterior abdomen with pain radiating into the scrotum. PE reveals edema and crepitus. Dx?
Fournier gangrene. This is a necrotizing fasciitis affecting the perineum or genitals. Severe pain in the abd. radiating to the genitals with edema, crepitus, and blisters/bullae require emergent surgical evaluation. More common in immunodeficient.
88
Pain relief with elevation of a painful testicle indicates?
Epididymitis rather than torsion. Prehn sign. Low Dx quality.
89
Cisplatin can cause what SE?
Nephrotoxicity, ototoxicity, neurotoxicity, and electrolyte abnormalities, as well as vomiting.
90
Focal segmental glomerulosclerosis clinical associations?
African American or hispanic; obese; HIV/heroin use
91
Membranoproliferative nephropathy clinical associations?
Hep B and C; lipodystrophy
92
Minimal change disease clinical associations?
NSAIDs; lymphoma
93
IgA nephropathy clinical assocations?
URI
94
Membranous nephropathy clinical associations?
Adenocarcinomas; NSAIDs; Hep B; SLE
95
Bronchial breath sounds over the periphery of the lung space indicates?
Consolidation or fluid filling alveoli. May occur in pulmonary contusions.
96
Rx for pulmonary contusions?
Usually conservative: pain control, pulmonary hygiene, supplemental O2. Often resolve in a week.
97
Juvenile myoclonic epilepsy progression?
Progression of worsening seizures. Beginning around 10 years of age absence seizures occur and later myoclonic seizures develop (around age 15). Generalized Sz then start to occur around 16years old.
98
Pathophysiology behind virilization in Cushing syndrome?
Increase androgen prodxn in zona reticularis of adrenal cortex from ACTH stimulation. This is only present in ACTH dependent disease. ACTH indepenent does not present with this.
99
Physiology behind nitrates relief of CP in MI?
Venodilation reduces preload, reducing ventricular volume and ventricular wall stress. MI O2 demand decreases. The relief is NOT primarily due to coronary artery dilation.
100
Necrotizing enterocolitis presents with what classic sign on Xray?
Pneumoatosis or emphysematous intestinal tissue.
101
What patient population is at risk of meningitis from Listeria?
Immunocompromised or age >50. Ampicillin is the Rx of choice.
102
In suspected bacterial meningitis, what is empiric Rx?
Vanco and 3rd gen ceph (ceftriaxone)
103
Most sensitive initial test in suspected malabsorptive syndrome?
Assay of stool for fat.
104
MCC of aortic regurgitation?
Aortic root dilation or bicuspid valve (developed countries). RH is the MCC in developing countries.
105
A decrescendo diastolic murmur after S2 in the Upper LSB?
Aortic regurgitation. Commonly radiates toward the right side when due to aortic root dilation.
106
What needs to be considered with new onset aortic regurgitation and chest pain/back pain?
Ascending aortic aneurysm. This can lead to aortic root dilation and AR.
107
An IV drug user presents with fever, focal back pain, and neurologic deficits that slowly develop over days after the back pain starts. Dx?
Spinal epidural abscess.
108
Can the Centor criteria be used to Dx children?
No. They are unreliable in Dx for GAS pharyngitis in preadolescents. If suspected, do a strep test, if negative do culture. If positive, treat with PCN or ampicillin.
109
Pt presents with anemia, leukopenia, thrombocytopenia and ovalomacrocytes and neutrophil hyposegmentation, hypogranulation on smear. Dx?
Myelodysplastic syndrome. Dx is with bone marrow biopsy. This is a hematopoietic stem cell neoplasm that causes dysplasia/cytopenias. Can transform to acute leukemia.
110
Rx prior to surgery for pheochromocytoma?
Alpha and beta blockade. But first start with alpha (phenoxybenzamine), then beta blockade (propanolol) to avoid unopposed alpha.
111
A 20s female presents with diarrhea, abd. pain, fever, and stinky vaginal secretions with weight loss. No blood in the stool. NAAT is negative. Dx?
Crohn's disease. Can present with any of these Sx including rectovaginal fistula. Crohns affects mouth to anus and can cause fistulas to other hollow organs.
112
MCC of postreptococcal glomerulonephritis?
Streptococcal skin infxn>strep pharyngitis
113
A Pt starting chemotherapy presents with seizures and arrythmias. For days she complained of diarrhea and low urine output. Labs reveal hypocalcemia, hyperphosphatemia, and hyperkalemia with elevated uric acid levels. Dx?
Tumor lysis syndrome. Lysis of cells results in electrolyte release and sx.
114
What anions are reduced that cause an anion gap metabolic acidosis?
Chloride or bicarbonate. Na - [Cl- + HCO3-] = anion gap
115
Management of DKA and HHS?
0.9% saline initially with IV insulin. After glucose <200 or anion gap <12, give dextrose 5% and use SQ insulin. K+ should be given if ≤5.2. If serum K<3.3, hold insulin.
116
Why is D-dimer of no value in pregnancy to rule out VTE?
Pregnancy affects D-dimer levels making them of no value.
117
Which NNRTI can lead to CNS and psychiatric SE including bizzare, vivid dreams?
Efavirenz. Should be used cautiously in Pts with psych Hx. If severe Sx develop, stop and replace.
118
First line nonmedical therapy for urinary urgency?
Bladder training. This includes delaying micturation to stretch the bladder.
119
Pharmacologic Rx for urinary urgency?
Oxybutynin. This is an antimuscarinic. Others include Mirabegron, a ß3 agonist that relaxes the bladder in those who cannot take antimuscarinics.
120
Gold standard test for Placenta previa?
Transvaginal US. Remember previa involves painless bleeding.
121
Appropriate imaging for possible aortic rupture due to blunt chest trauma?
TEE (NOT TTE)
OR
Chest CT
122
MC organism in an infected Bartholin gland abscess?
E. coli
123
Rx for Bartholin gland abscess?
If ≥3cm, then I&D. Word catheter may reduce recurrence. Marsupialization reserved for recurrent abscesses after acute infxn resolves.
124
Onycholysis can be a pathognomonic, yet rare, sign of what disease?
Graves disease. Other odd symptoms include clubbing of the fingers.
125
Inability to extend the knee>135° when the hip is flexed is known as?
Kernig sign. This is suggestive of meningeal irritation.
126
Passive flexion of the neck resulting in flexion of the lower extremities is known as?
Brudzinsks sign. This is a sign of meningeal irritation also.
127
Abortive migraine therapies?
Triptans (sumatriptan)
NSAIDs/Tylenol
Antiemetics (promethazine, metoclopramide, prochlorperazine)
Ergots (dihydroergotamine)
***Mixing Triptans and ergots can lead to 5-HT overstimulation as they are both agonists. HTN/serotonin-like Sx occur.
128
Preventive migraine therapies?
Topiramate
Divalproex
TCAs
ß-Blockers
129
Rx administered in Kawasaki disease?
IVIG given w/in 10 days of fever onset will prevent coronary artery aneurysms. Aspirin (the only instance this is used in kids due to Reye's syndrome) will help prevent coronary artery thrombosis.
130
Superolateral displacement of the lens (ectopia lentis) is a potential complication of?
Marfan syndrome.
131
Following splenectomy, what can occur in regards to platelet numbers?
Secondary thrombocytosis may occur. Normally, this thrombocytosis resolves in weeks, but some retain their numbers for months or years after surgery.
132
Alcoholic liver disease can cause thrombocytopenia due to?
Decreased hepatic prodxn of thrombopoietin and/or direct marrow suppression from alcohol.
133
A patient with persistent elevations in platelets (>600K) can paradoxically present with?
Hemorrhage. Though thrombosis can occur also.
134
A sexually active female presents with dysuria due to urethritis and her UA reveals sterile pyuria (WBCs≥3/hpf present, but no bacteria). Dx?
Likely Chlamydia. If untreated can cause infertility/ectopic pregnancy.
135
A female presents with amenorrhea for several months. She has associated weight gain and notices bilateral milky breast discharge. She denies HA or visual changes. Next step?
TSH first. Hypothyroidism and resultant TSH elevation can lead to weight gain and amenorrhea. It can also cause hyperprolactinemia. The lack of HA or visual changes also leans away from prolactin adenoma. Other considerations are prolactin (Brain MRI) and FSH testing (premature ovarian failure).
136
First line tocolytic at 32-34 weeks gestation?
Nifedipine. Flushing, HA, and tachycardia/palpitations are SEs.
137
First line tocolytic <32 weeks?
Indomethacin. Risk of oligohydramnios and PDA closure in fetus (that's why contra'd at 32-34 wks).
138
Short-term tocolytic for inpatient use?
Terbutaline. Can cause hypotension, tachycardia, and hyperglycemia as well as pulm. edema
139
Alcohol consumption in the setting of severe hypertriglyceridemia (as in familial dysbetalipoproteinemia) can cause?
Pancreatitis. Fenofibrate is the best drug to reduce high TGs.
140
Preterm labor Rx <32 weeks?
Betamethasone, tocolytics, mag, PCN (if GBS + or unknown)
141
Preterm labor Rx b/t 32 and 34 weeks?
Betamethasone, tocolytics, PCN (if GBS + or unknown)
142
Preterm labor Rx b/t 34 and 37 weeks?
Consider betamethasone, PCN (if GBS + or unknown)
143
Initiate Rx for HTN in CKD with what BP?
≥140/>90. Goal is under this BP.
144
Initiate Rx for HTN in otherwise healthy people with what BP?
≥150/>90. Goal is under this BP.
145
Initial Rx choice in black person for HTN?
Thiazide or CCB (ACEI/ARB not first line UNLESS CKD present, then do ACEI/ARB)
146
Initial Rx choice in any ethnicity but black for HTN?
Thiazide, ACEI/ARB, or CCB
147
An US revealing an empty gestational sac without a fetal pole indicates?
Missed abortion. An empty sac without a fetal pole means there is no embryo. An embryo present without cardiac activity is also a missed abortion.
148
Typical presentation of hydatidiform mole?
Heavy bleeding, snowstorm on US, with markedly increased ß-hCG (>100K)
149
Hodgkin lymphoma Sx?
Painless lymphadenopathy and B symptoms in the setting of a normal peripheral smear and CBC.
150
BP required for preeclampsia?
Over 140/90 at at least 20 weeks gestation. Proteinuria and/or end organ damage may be present.
151
What are severe features of preeclampsia?
BP ≥160/110 (2x4hrs apart), signs of HELLP, pulmonary edema, or CNS sx
152
Rx of preeclampsia?
Without severe features: ≥37 weeks deliver
| With severe features:≥34 weeks
153
Dx for preeclampsia?
Urine protein/creatinine ratio or 24 hour urine for protein collection
154
Awake daytime hypercapnia is commonly due to?
Obesity hypoventilation syndrome. BMI ≥30.
155
The presence of what feature on PE differentiates scarlet fever from mono?
Hepatosplenomegaly.
156
Any palpable adnexal mass requires what test?
Pelvic US. Uterus, ovaries, and cul-de-sac are present on US. Tubes not present unless pathology exists.
157
Why is polyhydramnios present in esophageal atresia with tracheoesophageal fustula?
The fetus cannot swallow amniotic fluid.
158
Any newborn with tracheal and esophageal defects require workup for?
VACTERL (vertebral, anal atresia, cardiac, TEF, renal, and limb)
159
Management of worsening respiratory status in myasthenia gravis (crisis)?
Intubate. Stop pyridostygmine (to reduce secretions and avoid aspiration). Do plasmapheresis and give steroids.
160
Management of ß-thelassemia major? Minor?
Both genes mutated: Transfusions as severe anemia presents at early age.
One gene mutated: often mild Sx.
161
Both lead and arsenic toxicity are very similar, but what differentiates them?
Arsenic poisoning may present with hypo/hyperpigmentation and hyperkeratosis of skin. GI sx and stocking glove neuropathy are typical for both. Chelation (dimercaprol and DMSA) is Rx for both.
162
A study with a 95% confidence interval between 0.8 and 3.1 indicates what about that study?
The CI contains 1 and, thus, is NOT statistically significant. The p-value would be >0.05.
163
Management of placenta previa in pregnancy?
Csxn delivery at 36-37 weeks when the lungs are developed.
164
MCC of CAP is?
S. pneumoniae
165
Basic idea in SCID?
Adenosine deaminase deficiency causes severe/recurrent viral, fungal, bacterial infxns and failure to thrive.
166
Pts with complement deficiencies are at increased risk for?
Disseminated bacterial infxns (esp encapsulated)
167
Impaired oxidative burst leads to?
Chronic granulomatous disease and recurrent skin and pulmonary infxns with catalase-positive organisms.
168
Over 90% of primary adrenal insufficiency is due to?
Autoimmune adrenalitis.
169
The vast majority of medulloblastomas occur where?
In the cerebellar vermis. Thus, truncal or gait ataxia would be expected. If occurring in the lateral cerebellum, dysmetria, intention tremor and dysdiadochokinesia would result.
170
MC tumor in the cerebellum in children?
Astrocytoma. 2nd is medulloblastoma.
171
A child with medulloblastoma presents with frequent headache and vomiting. What finding is expected on MRI?
Obstructive hydrocephalus.
172
What tumor is associated with Parinaud syndrome?
Pineal tumors. Parinaud syndrome causes a limitation of upward gaze and downward gaze preference, bilateral eyelid retraction, and light-near dissociation.
173
Best initial Rx for symptomatic HOCM?
Beta blockers. They prolong diastole and decrease myocardial contractility causing reduction in outflow obstrxn.
174
MC early SE of carbidopa/levodopa?
Hallucinations, confusion, agitation. Dyskinesia can occur much later (5-10 years) in therapy.
175
What is the most important prognostic consideration in breast cancer?
TNM staging is most important. Estrogen and progesterone positivity are good prognostic features. Her-2/neu oncogene overexpression worsens prognosis, but is not as significant as TNM.
176
MCC of esophageal rupture?
Endoscopy. Dx requires water-soluble contrast esophogram to ID leak site. Surgery required to avoid mediastinitis.
177
Dysgerminomas secrete?
LDH or ß-hCG. They are cells that differentiate into syncytiotrophoblasts of the placenta.
178
What is the name of the teratoma (dermoid cyst) that produces thyroid hormone?
Struma ovarii.
179
A patient with virilization and an ovarian mass may have?
Sertoli-Leydig cell tumor. They produce testosterone.
180
Yolk sac tumors are the complement to what tumor in men?
Germ cell tumors (seminoma). They produce AFP.
181
What must be considered in any case where diffuse maculopapular rash presents with a UA with WBC casts?
Acute interstitial nephritis. Drugs like NSAIDs, PCN, TMP/SMX, cephalosporins, and diuretics are the most common causes. Legionella and strep can cause it also.
182
Sx in hypoplastic left heart syndrome?
Central cyanosis and heart failure in newborns. An underdeveloped left ventricle cannot support systemic circulation.
183
Any patient with giant cell arteritis (ESR>50, HA, jaw claudication, fatigue, etc.) requires what imaging?
Serial CXR due to possible aortic aneurysm. Giant cell arteritis is known to involve branches of the aorta.
184
In a normal distribution, where do the mean, median, and mode fall?
They are all equal at the top of the symmetrical bell curve.
185
In a positively skewed distribution, where do the mean, median, and mode fall?
Mean>median>mode. Mode is at the peak. Median is the middle number. Mean is the average.
186
In a negatively skewed distribution, where do mean, median, and mode fall?
Mode>median>mean. Again, mode is the peak. Median is the middle. Mean is the average.
187
When is ERCP indicated?
When initial US or CT indicate obstrxn due to cholelithiasis or malignancy. ERCP can be both diagnostic and therapeutic.
188
At what age are meningococcal vaccines administered?
11 and 16.
189
How does management differ in bulimia vs anorexia nervosa?
SSRIs for bulimia, but CBT and nutrition for anorexia.
190
Common SE of phenytoin?
Gingival hyperplasia, Stevens-Johnson syndrome and TEN.
191
Foot drop, sensory changes over the dorsal foot and lateral shin and impaired dorsiflexion (no heel walking). Reflexes are normal and plantar flexion is present. Likely Dx?
Common fibular neuropathy. Leg immobilization, leg crossing, or squatting for extended periods can cause fibular head dysfxn leading to peroneal nerve entrapment.
192
When is a urine anion gap calculated?
When there is a normal anion gap metabolic acidosis. The urine anion gap helps determine if the acidosis is from renal or intestinal bicarb losses. If the kidneys are responsible then RTA or carbonic anhydrase inhibitors are the cause. GI loss is usually diarrhea.
193
Anterior shoulder dislocation results in holding the arm in what position?
Abduction and external rotation. Commonly due to fall with outstretched hand.
194
Posterior shoulder dislocation results in holding the arm in what position?
Adduction and internal rotation. Commonly due to seizure or electrocution.
195
Suspect what conditions (4) in a patient presenting with hypokalemia, alkalosis, and normotension?
```
Surreptitious vomiting,
Diuretic abuse,
Bartter syndrome,
Gitelman's syndrome.
***All present with previously stated Sx, but the last three present with high urine chloride content rather than low chloride.
```
196
Pubertal boys with mild glandular tissue under the breast (considered gynecomastia) occurs as a result of?
Estrogen>testosterone prodxn during puberty by the testes. This usually resolves within months to years without intervention.
197
Which congenital aberrancy results in increased male breast cancer risk?
Klinefelter Syndrome.
198
How is lead usually absorbed in adults?
Respiratory tract. This is usually from soldering. Skin and GI tract absorb also.
199
Aside from the 10 year ASCD risk ≥7.5%, what other indications for statin therapy exist?
```
Known ASCVD (eg MI, storke, etc)
AND an LDL≥190, which usually indicates familial hypercholesterolemia.
```
200
After 48 hours of symptomatic improvement, most hospitalized patients can be transitioned to?
Culture-guided oral antimicrobials rather than continue IV antibiotics.
