.level3 Flashcards
(498 cards)
1
Q
first line mgmt of HTN in diabetic pt
A
ACE or ARB
2
Q
constitutional symptoms, early satiety due to splenic enlargement, gum bleeding, excessive WBC count - dx?
A
CML
3
Q
tx of CML
A
imatinib
4
Q
next step for acute cholangitis in setting of biliary obstruction?
A
ERCP
5
Q
pathophys of giant cell arteritis
A
inflammatory infiltrates, composed of macrophages and CD4+ lymphocytes in all artery layers
6
Q
repeated use of benzocaine spray
A
methemoglobinemia risk in anemic pt
7
Q
whooping cough tx
A
azithro or macrolide
8
Q
nonpurulent cellulitis that is “edematous and well demarcated”
A
erysipelas - group A strep/ S. pyogenes
9
Q
wilson’s disease labs
A
low ceruplasmin and increased Copper urinary secretion
10
Q
late decel means
A
uteroplacental insufficiency
11
Q
variable decels are indicative of
A
cord compression
12
Q
early decels are likely due to
A
head compression
13
Q
separation of the nail plate from the bed
A
onycholysis
14
Q
koilonychia seen in
A
iron deficiency or plummer vinson
15
Q
brittle nails split vertically
A
onychorrhexis
16
Q
hormones in secondary ammenorrhea due to asherman syndrome
A
normal
17
Q
elevated liver enzymes, multifocal stricture and dilation on cholangiography
A
primary sclerosing cholangitis
18
Q
majority of patients with primary sclerosing cholangitis have underlying
A
ulcerative colitis
19
Q
Magnesium is contraindicated in pre-eclamptic women with ______
A
myasthenia gravis
20
Q
initial manifestation of mag toxicity
A
decrease in DTRs, followed by respiratory paralysis, cardiac conduction abnls, cardiac arrest
21
Q
pt with acute pancreatitis, what is the greatest lab predictor of mortality?
A
change in BUN over the first 48 hours (with adequate fluid resus)
22
Q
pt with acute pancreatitis with acute rise in what may indicate pancreatic necrosis?
A
hematocrit
23
Q
kid with fever, cervical adenopathy, polymorphous rash, hand and foot edema, cracked lips and bilateral conjunctivitis.
dx and tx
A
kawasaki disease, aspirin and IVIG
24
Q
pain and stiffness in proximal muscles, worse in AM or prolonged activity. also fever, wt loss, fatigue, depression
A
polymyalgia rheumatica
25
differentiate PMR with polymyositis types
PMR does not have muscle weakness
26
tx for PMR
corticosteroids
27
working with artisanal mining or smelting, or with fluorescent bulbs
mercury poisoning
28
change in personality, anxiety, irritability, excitability, fearfulness, pathologic shyness, insomnia etc. due to mercury poisoning
erethism mercurialis
29
treatment of mercury poisoning?
succimer, dimercaprol, or penicillamine
30
category A bioterrorism agents
anthrax, plague, botulism, and tularemia
31
tx of ITP
prednisone
32
dry v wet purpura
wet includes mucous membranes and more likely to hemorrhage, indicates urgent drug therapy for decreased plt.
33
croup aka
laryngotracheobronchitis
34
bioterrorism causing undulating fever, fatigue, diaphoresis, arthralgias, myalgia, anorexia, malaise, and HA
brucellosis
35
tx of brucellosis
doxy and rifampin
36
new onset pulmonary renal syndrome and ANCA negative
anti glomerular basement membrane disease (previously goodpastures)
37
tx of minor bleeding in pt with von willebrand disease?
desmopressin
38
disease that is highly prevalent for a consistent period of time.
hyperendemic
39
severely decreased or absent cranial rhythmic impulse (CRI)
compression
40
cranial tx to increase amplitude of CRI
compression of fourth ventricle or CV4
41
what is the main cause of fluid retention in cirrhosis?
activation of RAAS system due to a perceived low-flow state
42
colorectal cancers in lynch syndrome are predominantly where?
right sided in location
43
lab work up in pt with ascending cholangitis reveals what 4 things?
leukocytosis, increased GGT, increased bilirubin, and increased alk phos
44
isolated elevation in serum GGT or GGT elevated out of proportion to other enzymes may indicate
alcohol abuse or alcoholic liver disease
45
biliary disease associated with UC
primary sclerosing cholangitis
46
eye disease seen in Crohn's patients or IBD
anterior uveitis, associated with erythema nodosum and arthralgias
47
fever, RUQ pain, confusion, jaundice
ascending cholangitis
48
Heberdens nodes are in
OA, located on the DIP
49
treatment of poison ivy
oral corticosteroids
50
labs in GCA/PMR
elevated ESR, CRP, and plt ct. normal CPK and aldolase
51
Graves pt with proptosis will also likely have...
pretibial myxedema, hyperpigmentation and thickening of the skin on the anterior legs
52
next step up for mild persistent asthma
add daily low dose inhaled glucocorticoid
53
criteria for moderate persistent asthma
daily symptoms, not everyday; night awakenings more than 1/wk, not nightly; mild limitation of activity
54
when is surgery indicated for carpal tunnel?
evidence of axonal loss or denervation on electrodiagnostic testing
55
30 yo male with HTN, hematuria, proteinuria, and flank pain
ADPKD
56
MC isolated etiologic pathogen of lung abscess in children, following viral infection
S. aureus
57
what are markers indicating increased risk of scoliotic curve progression?
female, thoracic spine, larger initial curve
58
young woman with chronic joint pain, synovitis, mucositis/ulceration, photosensitive rash
lupus
59
drug treatment for lupus
oral hydroxychloroquine
60
most catastrophic pulmonary complication of lupus
diffuse alveolar hemorrhage
61
pt with SLE, development of thrombi, should be thinking underlying
antiphospholipid syndrome
62
antiphospholipid syndrome is associated with
an elevation in PTT
63
tx for pt with antiphospholipid syndrome
oral warfarin
64
apophysitis
inflammation of the apophysis or insertion site for tendons, normal in growing athlete
65
tx of spondylolysis
refrain from strenuous activity, given analgesia, and PT
66
MC overall cause of endocarditis
S. aureus
67
MC cause of transient monocular vision loss
embolism from diseased ipsilateral carotid artery
68
can't look up after orbital trauma, what muscle is entrapped?
inferior rectus, cant relax/elongate when superior rectus contracts
69
overuse injury associated with RA, presenting with pain and tenderness at the radial styloid
de quervain tenosynovitis
70
MOA sulfonylureas
increase secretion of insulin from pancreatic islet cells
71
Side effect of sulfonylureas
weight gain, hypoglycemia without DKA, pancreatitis
72
high ACTH and high cortisol, next step?
dexamethasone suppression test
73
results of dexamethasone test... urine cortisol low
pituitary adenoma
74
results of dexamethasone test... results urine cortisol high
ectopic production of ACTH, small cell carcinoma, other tumor
75
chronically lethargic and hyperpigmented, hypotensive after acute GI illness
Addison disease/ primary adrenal insufficiency
76
electrolyte changes with Addison disease
hyponatremia and hyperkalemia
77
lab values to get in patient with myxedema coma
thyrotropin/TSH, free T4, and random serum cortisol
78
myxedema coma initial mgmt in stabilized pt
IV levothyroxine
| IV hydrocortisone
79
infection with roundworms spread by black flies or misquitoes
filariasis
80
tx of filariasis
diethylcarbamazine (DEC)
81
malabsorption, chronic joint pain, weight loss, confusion/neuro ssx
whipple disease
82
what do you do after diverticulitis flare?
6-8 weeks later c scope
83
what risk increases in those with celiac disease?
fracture risk
84
long term tx of HTG induced pancreatitis
statin and a fibrate
85
virus causing hand foot mouth
enterovirus - coxsackievirus A16 and enterovirus A71
86
dog bite to hand
augmentin ppx for risky or large wounds
87
chapmans reflex point posteriorly
transverse process of T11 on the right
88
initial work up of acanthosis nigricans
HgbA1c, random glucose, lipids, total testosterone
89
tx of moderate to severe crohns
adalimumab
90
sympathetic viscerosomatic location of stomach
T5-9 on the left
91
high level of concern for acute HIV infection - what tests
HIV RNA levels
| HIV antigen/antibody testing
92
pt suspected of having PCP, should get what tests
ABG, LDH, 1-3-beta-D-glucan, CXR, high res CT
93
what med to start s/p angioedema with lisinopril?
switch to ARB, angioedema can still recur for up to 6 weeks after stopping med
94
Most specific marker to confirm rhabdo
serum CK
95
chocolate brown blood
methemoglobinemia (metHb)
96
rigid thoracic kyphosis of more than 45 degrees, anterior wedging of 5 or more in at least 3 adjacent vertebral bodies, schmorl nodes, and degenerative endplates
Scheuermann disease
97
tx of scheuermann disease
conservative, PT and OMT for less than 60 degrees; ortho bracing would have to be done before skeletal maturity
98
tx of scheuermann disease
conservative, PT and OMT for less than 60 degrees; ortho bracing would have to be done before skeletal maturity
99
hypercalcemia, hypophosphatemia, metabolic alkalosis, with depressed PTH
milk alkali syndrome
100
milk alkali syndrome is due to
excess calcium intake in the setting of progressive renal dysfunction
101
tx milk alkali syndrome
isotonic saline for expanding volume and removing the offending agent
102
Framingham (major) criteria for CHF
```
acute pulm edema
cardiomegaly
hepatojugular reflux
neck vein distention
nocturnal dyspnea or orthopnea
rales
S3
wt loss >4.5 kg in five days in response to tx
```
103
meds that improve mortality in CHF
```
ACEI/ARBs
aldosterone antagonists
beta blockers
hydralazine/nitrates
sacubitril/valsartan
```
104
in lateral strain, rotation occurs around
2 vertical axes
105
galbreath technique is also known as
mandibular drainage
106
removal of the contents of the globe while leaving the sclera and extraocular muscles intact
evisceration
107
what is enucleation?
removal of the eye from the orbit while preserving all other orbital structures
108
removal of the eye and adnexa, along with part of the bony orbit
exenteration
109
tennis elbow affects what?
extensor carpi radialis brevis tendon
110
unilateral RLN injury with vocal fold stuck in paramedian or lateral position is associated with ...
increased risk of aspiration
111
risk factors for cervical cancer
```
early age at coitus
early child bearing
multiple partners
smoking
immunodeficiency
```
112
young male, no family hx of bleeding disorders, but pt with prolonged PTT...
hemophilia A
113
hemophilia A is a deficiency in the level or function of
factor VIII, causing increased PTT, normal PT and bleeding time
114
newborn with continued bleeding from umbilical stump - ddx?
hemophilia A/B, vit K deficiency, platelet function disorders
115
newborn with continued bleeding work up
PT, PTT, CBC, consider peripheral smear
116
peds pt, presenting with acute onset, severe, joint pain, associated with fever or constitutional symptoms, inability to bear weight
septic arthritis
117
mono or polyarticular arthritis, enthesitis, dactylitis, or low back pain, multiple weeks after infection
reactive arthritis
118
autoimmune, noninfective, inflammatory joint disease of more than 6 weeks in duration in children less than 16 yo
juvenile rheumatoid arthritis
119
pleural effusion as complication of pancreatitis demonstrate
elevated LDH and protein
exudative
contain very high levels of amylase
120
2 high intensity statins and best in CKD
atorvastatin
| rosuvastatin
121
when should simvastatin be used in low doses
with amlodipine, verapamil, diltiazem, and amio due to increase in simvastatin levels and increased risk for myopathy (increased P450 system)
122
systemic symptoms and lymphadenopathy in a 20 some year old. says alcohol causes severe pain
Hodgkins lymphoma
123
how to confirm dx of suspected lymphoma
excisional lymph node biopsy
124
when do you screen kids for Fe deficiency anemia?
for high risk pt, start at 4 months and go through 2 years
125
confirm dx of sickle cell anemia with
hgb electrophoresis
126
hypercalcemia will change EKG by
shortening of the QT
127
blowing systolic murmur best heard at the fifth intercostal space in the midclavicular line with radiation to the axilla
mitral regurg
128
MCC of significant U waves is
severe hypokalemia
129
how to assess adequate fluid resuscitation in a burn patient?
central venous pressure
urine output
cardiac output
130
how to evaluate for suspected closed spinal disraphism?
MRI whole spine
131
five high yield risk factors for PE
```
CHF
IBD
ortho surgery
malignancy
nephrotic syndrome
```
132
treatment of PE
tPA for unstable
| LMWH for anticoagulation, but does not reverse clot
133
empiric antibiotic therapy for meningitis in elderly
vancomycin, ceftriaxone, and ampicillin
134
high arched palate and increased carrying angle of the arm
turner syndrome
135
XR of nursemaids reveal
normal study
136
treatment of preeclampsia
hydralazine (or labetalol) to lower BP and mag sulfate to prevent progression to eclampsia
137
HTN and proteinuria in pregnancy
preeclampsia
138
work up for incidental first degree AV block
cardiac and med hx
basic labs
TSH and BMP
consider lyme carditis
139
isolated antibodies to the core antigen - anti-HBc
window period
140
dx of acute liver failure requires 3 components
elevated aminotransferases
INR >1.5
hepatic encephalopathy
141
indications for ppx abx with dental procedure
prior infective endocarditis
prosthetic heart valve
unrepaired cyanotic congenital heart disease
cardiac transplant with valvulopathy
142
OA in knee, started having pain at night, medial aspect
pes anserine bursitis
143
enlarged liver, S4, S3, peripheral edema
worsening arthritis, polydipsiam and polyphagia
erectile dyfuction and shrunken testicles
hemochromatosis
144
lab test for dx of hemochromatosis
increased Fe, increased percentage of saturation of Fe, increased ferritin, and decreased serum-transferrin level
145
most sensitive diagnostic test for hemochromatosis
transferrin saturation level/test
146
tachypneic, normal glucose, low bicarb
alcoholic ketoacidosis
147
MCC of exogenous endophthalmitis
staph epidermidis
148
euvolemic state with increased urine osmolality and urine sodium concentration
SIADH
149
new neuro symptoms with hx of monoclonal gammopathy of undetermined significance
hyperviscosity syndrome
150
syringomyelia symptoms that come on gradually in 3rd or 4th decade?
arnold chiari malformation
151
IV meds to treat hypertensive emergencies
IV nitroprusside, nicardipine, clevidipine, labetalol, and fenoldopam
152
contraindications to oral bisphosphonates
bariatric surgery, esophageal disorders, or GI distress
153
drug of choice to treat tularemia
streptomycin
154
bugs in younger and older CF patients
pseudomonas after 25-35 years, s. aureus younger
155
HTN in OCP using young female
stop OCP
156
vagina - progressive pruritus, dyspareunia, dysuria, or genital bleeding
lichen sclerosus
157
IV formulation of bisphosphonate
zoledronate, zoledronic acid
158
how do you name nerves exiting spine
L4 nerve is above L4
159
MCC of septic arthritis
S. aureus
160
quad screen result for down syndrome
increased serum beta hcg and inhibin A, decreased estriol
161
markedly elevated alpha fetoprotein on quad screen
neural tube defects
162
decreases in a-fetoprotein, estriol, and b-hcg are associated with
trisomy 18
163
when to do amniocentesis v chorionic villous sampling
CVS should be done prior to 12 weeks gestation, amniocentesis after 12 weeks
164
new endometrial carcinoma diagnosed on bx... next step?
hysterectomy, BSO, lymphadenectomy - surgically staged malignancy
165
"complete claw hand" nerve injury
ulnar and median nerve
166
nonspecific bone pain, esp in legs and pelvis, and associated with insufficiency fx
osteomalacia
167
MCC of osteomalacia
vitamin D deficiency
168
vit D deficiency labs
mild decrease Ca, P, and an elevated PTH
169
contraindications to bracing for scoliosis
little growth remaining (Risser grade of 3)/skeletal maturity, cobb angle of 50 or more, and cobb angle less than 20
170
blood supply to extracapsular arterial network that feeds the femoral neck and head of the femur
medial and lateral circumflex arteries
171
dry cough, SOB, hypercalcemia, and CXR showing bilateral hilar fullness
sarcoidosis
172
weird complication of sarcoidosis
blindness
173
hypercalcemia, combined with recurrent duodenal ulcers and family hx of pituitary tumor
consider gastrinoma
174
BPH and renal insufficiency, next step
renal US
175
counterstrain positioning for posterior ribs 2-6
flexion, sidebent away, rotate away with dr thigh under patients axilla, ipsilateral
176
atypical glandular cells on cervical cytology, next step
colposcopy with endocervical curettage, if older than 35 also endometrial bx
177
endocervical curettage is abnormal, next step?
cervical cold knife cone
178
what is indicated following cervical intraepithelial neoplasia when endocervical curettage is negative?
loop electrosurgical excision
179
MC type of hodgkin lymphoma
nodular sclerosing, mixed inflammatory background with Reed Sternberg cells
180
lymphocyte depleted type of hodgkin lymphoma associated with
EBV positivity
181
amenorrhea in turner syndrome is caused by
ovarian failure, elevated FSH
182
breath holding spells in baby, evaluate for
iron deficiency anemia
183
another name for vasovagal syncope
reflex syncope
184
tx of DMD
glucocorticoids
185
bad labs with hypertensive pregnancy
pre-e with severe features
186
34-37 weeks, single gestation, no prior steroids, not diabetic - preterm delivery anticipated... then give
late preterm steroids
187
pregnant with IUD in place, how do you remove?
gentle traction on stringts, prior to 12 weeks
188
what is fetal fibronectin used as?
marker to assess likelihood of preterm labor between 22-34 weeks of pregnancy
189
CT chest shows airway dilatation, mucus plugging and bronchial wall thickening
bronchiectasis
190
bronchiectasis is caused by what bug and needs what abx?
pseudomonas, tx with cefepime
191
anti-pseudomonal abx
```
cefepime
pip tazo
fluoroquinolones
aztreonam
meropenem
gentamicin
```
192
new S3 and low voltage, think
infiltrative cardiomyopathy
193
visual or neurologic changes, B symptoms, bleeding, lymphadenopathy, hepatosplenomegaly, infiltrative disease
waldenstroms macroglobulinemia
194
new dx of dermatomyositis, all patients should get
age appropriate cancer screening
195
UTI in pregnancy, tx with
cefpodoxime
196
mets to spine from prostate cancer - how?
hematogenous spread through Batson venous plexus
197
additional calorie consumption in pregnancy
340cal in second tri, then 450 cal in third tri
198
tx of mastitis
dicloxacillin
199
hypopigmentation, prolonged bleeding/bruising, recurring infections,
chediak-higashi
200
bacterial and fungal infections early in life, granulomas on skin/GI tract
chronic granulomatous disease
201
silver hair, neuro ssx/seizures, MR, bronze skin
elejalde syndrome
202
neonate with low serum calcium and possible seizures
digeorge syndrome
203
bulging vaginal introitus
imperforate hymen
204
dx tool for imperforate hymen
pelvic US
205
chronic progressive loss of the nerve fiber layer in the retina
primary open angle glaucoma
206
elevated IOP, visual field loss, changes in optic disc morphology
primary open angle gluacoma
207
carpal tunnel syndrome may be caused by severe untreated
hypothyroidism
208
amyloid precursor protein
alzheimers, specifically trisomy 21 associated
209
lithium should be avoided in severe
cardiovascular disease and renal disease
210
mineral/nutrient deficiency has been associated with glucose intolerance
chromium deficiency
211
direct tx of the sacrum, pressure during inhalation or exhalation
inhalation phase
212
renal artery stenosis may cause what electrolyte disturbances
hypokalemia and hypernatremia
213
indication for asx AAA repair
diameter greater than 5.5, rapid expansion, or a AAA associated with symptomatic PAD requiring revascularization
214
ground level fall, breaks hip
start alendronate
215
what will improve murmur of HOCM
beta blockers
216
endocarditis, going to dental cleaning
2g amoxicillin 30-60 minutes prior to procedure
217
Most specific lab test result for iron deficiency anemia
low transferrin saturation
218
antihypertensive causing hyper k
ACE I like lisinopril
219
3 vessel disease and severe LV systolic dysfunction
revascularize - CABG
220
OA mechanics
side bend and rotate in opposite
221
glomerular basement membrane splitting
alport syndrome
222
apple green birefringence
renal amyloidosis
223
linear anti-GBM
good pasture syndrome
224
spike and dome appearance
granular deposits of IgG and C3 at the basement membrane - membranous nephropathy
225
nephrotic syndrome associated with Hep B, syphilis, malaria, and exposure to gold salts
membranous nephropathy
226
tram track appearance basement membrane
subendothelial mesangial deposits, membranoproliferative nephropathy
227
flattened femoral head
legg calves perthes, AVN hip, male 4-12
228
ulnar nerve innervates
```
palmaris brevis
dorsal interosseous
palmer interosseous
adductor pollicis
third and fourth lumbricals
```
229
AA male with hx of HIV or uncontrolled HTN, what renal issue
focal segmental glomerulosclerosis
230
type III HSN rxn to intradermal injection of antigen
arthus reaction
231
dx and tx exercise induced laryngeal obstruction
continuous laryngoscopy during exercise, speech behavioral therapy
232
axis is always ...... the side of the seated flexion test
opposite
233
common associated conditions with ankylosing spondylosis
enthesitis, synovitis, dactylitis, uveitis, psoriasis, IBD
234
transferrin saturation will be increased in
hereditary hemochromatosis
235
inhalational anthrax treatment
cipro plus clinda plus anthrax immunoglobulin
236
significant developmental delay, no trunk control, smile, or find own hands
Menkes disease, inborn error of copper metabolism
237
difference in radical mastectomy and modified
modified will spare musculature
238
HIV exposure, but intact skin
reassurance
239
NPV equation
TN/ (TN +FN)
240
when do you screen for AAA?
abdominal US for men 65-75 who have ever smoked
241
metabolic syndrome 3 of 5 - list all 5
1) abd obesity >40in M, >35in F
2) triglycerides >150 or tx
3) HDL <40 M, <50 F, or tx
4) BP >130/80, or tx
5) glucose >100 or tx
242
risk factor for endometrial cancer
tamoxifen use
243
yellow white appearing lesion on conjunctiva, hx of bowel resection
bitot spot, vit A deficiency
244
decreased sensation on the lateral aspect of the lower leg and dorsum of the foot, specifically the web space between first and second digits
L5 nerve root compression
245
most important prognostic factor on bx of melanoma
tumor thickness, depth >0.8 is an indication for sentinel LN bx
246
palpable sausage like mass in kiddo
intussusception
247
nontender, small, hemorrhagic, macular or nodular lesions on palms or soles, for IE
Janeway lesions
248
tender violaceous nodules classically on pads of fingers and toes, in IE
osler nodes
249
bulimia nervosa, volume depletion 2/2 vomiting/laxative abuse can cause
secondary hyperaldosteronism, renal K loss - hypoK
250
first line tx for plantar fasciitis
better shoes
251
positive LR equation
sensitivity/ (1-specificity)
252
breast screening recommendations
USPSTF says 50
| Am.Ca society says 40
253
tx of tinea versicolor
topical ketoconazole
254
tx of lichen sclerosus
topical corticosteroids
255
action of anterior interosseous nerve
flexion of thumb at interphalangeal joint
256
action of posterior interosseous nerve
extension of thumb at interphalangeal joint
257
essential tremor treatment
propanolol, second line is clonazepam
258
what produces surfactant
type II pneumocytes
259
tx hyperthyroidism in pregnancy
PTU in first trimester, methimazole after
260
new pt, suspicious for gout, first step
joint aspiration to r/o other
261
dysfunctional uterine bleeding is likely due to
unopposed production of estradiol
262
tx of paget disease
IV zolendronic acid, PO alendronate and risedronate
263
probability that a pt with a positive test has a disease
PPV
264
bioterrorism with shortest incubation period
pneumonic plague
265
schizophreniform time frame
lasts 1-6 months
266
kid with neuro symptoms, microcytic anemia, and vomiting
lead poisoning
267
tx for pseudotumor cerebri
acetozolamide
268
flask lesions
entamoeba histolytica
269
skip lesions
crohns disease
270
increased friability of the colonic mucosa, exudates, pseudopolyps, petechia, and frank hemorrhage
UC
271
anticoagulation for patient with renal insufficiency
warfarin
272
MC bug causing cholangitis
E coli
273
res ipsa loquitur
negligence
274
bulging mass from the umbilicus that can ulcerate and ooze
Sister Mary Joseph nodule - mets from gastrointestinal cancers
275
MCC of postmenopausal bleeding
endometrial atrophy
276
secondary amenorrhea work up after negative pregnancy test
TSH, FSH, prolactin levels
277
wide splitting second heart sound with respiratory variation may be associated with
pulmonic stenosis or a RBBB
278
pt adopts the opposite attitude of personally unacceptable emotions in order to avoid them
reaction formation
279
drugs that may increase risk of osteoporosis
antiepileptic drugs
280
nonbullous impetigo tx
dicloxacillin and cephalexin
281
young female with bilateral conductive hearing loss and family hx
otosclerosis, loss of stapedial reflex
282
inappropriate growth in baby
failure to thrive
283
initial work up for failure to thrive in a baby
CBC, BMP, UA
284
cystine renal stones are caused by
a genetic defect in amino acid transport and are associated with acidic urine
285
mobitz type II occurs due to fibrotic disease of
his purkinje
286
boards response to status epilepticus
lorazepam, phenytoin, phenobarbital, propofol
287
most specific antibody to test for with lupus
anti-dsDNA antibody
288
thyroglossal duct cyst attaches to the
foramen cecum
289
possible preterm labor in pt 22-35 weeks gestation get
get fetal fibronectin test
290
cuada equina syndrome needs surgery within
48 hours
291
decrease risk of infection in pt with neurogenic bladder by
intermittent cath
292
baby with odd shaped head and poor suckling
OA compression, decreased cranial rhythmic impulse
293
septic shock - what happens to extremities
warm 2/2 vasodilation
294
unstable patient with tension pneumo
needle thoracostomy first
295
dilated intrahepatic ducts in
ascending cholangitis
296
precocious puberty, fibrous skeletal dysplasia, cafe au lait spots
mccune albright syndrome
297
MC site of vaginal injury in a sexual assault
posterior fourchette
298
first line test for osmotic demyelination syndrome
MRI
299
patient on ventilator now showing probable brain death
needs 2 physicians to confirm
300
labs in Fe deficiency anemia
low serum iron
high TIBC
low ferritin
301
haptoglobin is low in setting of
hemolytic anemia
302
TIA and negative cerebral and neck work up, next step?
echo, eval for PFO, sometimes presents with RBBB
303
rash, facial flushing, episodic nature,
| dx and tx
rosacea, tx with topical metronidazole
304
ppx for traveler's diarrhea
rifaximin
305
tx of subungual hematoma
trephination (nail drilling) to relieve the pressure - not necessary if not painful
306
Acute OM bugs in kids
s. pneumo, h influ, mor cat
307
kiddo with maculopapular rash, low grade fever, LAD
rubella
308
mimicker of squamous cell carcinoma on the skin
keratocathoma
309
macrosomia, hypoglycemia at birth and organomegaly
beckwith wiedemann syndrome
310
associated with beckwith wiedemann syndrome
macroglossia, nephroblastoma
311
MCC of fever on post-op day 4
UTI
312
blowing diastolic murmur at the left sternal border with or without a mid-diastolic rumble
aortic regurg
313
lab to confirm salicylate toxicity
ABG - mixed respiratory alkalosis and positive gap metabolic acidosis
314
what does giardia do to cause diarrhea?
decrease fat absorption
315
anterior chapmans point for myocardium
2nd intercostal space near the sternum
316
bacteremia and now effusion of joint in kid, bone looks jacked up
acute hematogenous osteomyelitis
317
what do you use to follow tx response in osteomyelitis
CRP
318
why does febrile non-hemolytic transfusion reaction occur
recipient antibodies against donor leukocytes
319
tx for anal squamous cell carcinoma
combo of chemo and radiation (Nigro protocol)
320
newborn conjunctivitis followed by pneumonia - what bug
chlamydia trachomatis
321
lateralization/Weber test shows louder vibration on the side indicating
conductive hearing loss
322
in conductive hearing loss, the sound will be detected longer in
the bone on the affected side
322
in conductive hearing loss, the sound will be detected longer in
the bone on the affected side
323
contraindicated meds in WPW
digoxin, Beta blockers, CCB
324
MC elevated enzymes in dermatomyositis
CK and aldolase
325
lymphogranuloma venereum is caused by
chlamydia trachomatis
326
what abx require oxygen for uptake into bacterial cells?
aminoglycosides
| gentamycin, neomycin, amikacin, tobramycin, and streptomycin
327
what abx can cause renal damage and CN VIII damage in both a mom and fetus?
aminoglycosides
328
when do you start ophtho exams for diabetics?
3-5 years after initial diagnosis
329
MCC of endocarditis in pt with prosthetic valve
s. epidermidis
330
emphysematous pyelonephritis bug
e coli
331
gold standard for confirming reflux
24 hr esophageal ph monitoring
332
infant initial tx of GERD
formula thickening with SMALL amount of baby cereal and upright positioning following meals
333
lofgren's syndrome is a form of
acute sarcoidosis
334
carcinoid tumor will have mets to where first?
liver
335
an estimate of the additional cost to society to increase population health by 1 year of perfect health
cost-effectiveness ratio
336
newborn with hct >65%
polycythemia
337
polycythemia of the newborn occurs in who most often
diabetic moms,
338
receiving blood transfusion, hypotension, wheezing, diaphoresis, rash
anaphylaxis, IgA deficiency
339
asymptomatic first degree block in athlete
no further work up
340
elevated megakaryocytes
ITP
341
giant platelets are associated with
bernard-soulier syndrome, abnl ristocetin assay with thrombocytopenia
342
lyme disease patient that doesn't get better with standard therapy
consider coinfection - A. phagocytophilum and babesia microti
343
kid with daily fevers for 2 weeks, arthralgias for 6 weeks, and rash
systemic juvenile idiopathic arthritis
344
lithium side effect of polyuria and polydipsia
nephrogenic diabetes insipidus
345
tx of lithium induced nephrogenic diabetes insipidis
amiloride, thiazides, low salt and low protein diet, NSAIDS
346
when should kids start an adult diet?
2 years old
347
odd lab in systemic juvenile idiopathic arthritis
hyperferritinemia
348
pt with hx of gastric bypass and now has ascedning cholangitis - next step
biliary decompression by percutaneous transhepatic cholangiography (PTC), ERCP less successful
349
MCC of epistaxis in peds
trauma
350
hypothyroidism in pregnancy
follow TSH, increased TBG that binds T4, give higher dose of levothyroxine
351
first line tx for panic disorder
SSRIs
352
up to 1/3 of panic disorder cases are associated with
depression
353
recommendations for new hypertension pt
stop smoking
DASH diet
increase exercise
weight loss
354
eczematous plaque behind ears
nickel dermatitis
355
posterior radial head is often caused by
falling on outstretched hand
356
4 yo well child vaccines if already up to date
MMR
varicella
IPV/polio
Dtap
357
when do you give Tdap
11-12 yo, or 7 yo if not fully immunized with Dtap
358
muscle rigidity, hyperthermia, AMS, tachycardia, htn
neuroleptic malignant syndrome - from psych drug use
359
shivering, hyperreflexia, myoclonus, and ataxia
serotonin syndrome
360
fenofibrate is used most often for
the control of hypertriglyceridemia
361
false positive or rejecting the null hypothesis error
type I error
362
acutely decompensated aortic regurg - tx
surgery, but nitroprusside to vasodilate and decrease afterload with dobutamine for inotrope support
363
occupational risk for bladder cancer
textiles, painters, electrical workers, miners, transport operators, excavating machine operators
364
best way to monitor for impending uterine rupture
internal fetal monitoring
365
adult with chickenpox complication
varicella pneumonia
366
retinal and CNS hemangioblastomas, pheos, multiple cysts in pancreas and kidneys, increased risk for malignant transformation of renal cysts
von hippel lindau
367
neuro and derm findings
tuberous sclerosis complex
368
best case scenario with pancreatic cancer?
involvement of gastroduodenal artery because it can be resected without significant morbidity
369
TCA toxicity will cause what in ekg
QRS prolongation due to blockade of fast sodium channels
370
goodpasture syndrome is now known as
anti-glomerular basement membrane disease
371
treatment of anti-GBM disease
plasma exchange and immunosuppression with corticosteroids and cyclophosphamide
372
notable labs in anti-GBM disease
ANA positive
C3 and C4 low
anti-dsDNA elevated
373
upper airway, eye, and ear disease along with rapidly progressive glomerulonephritis
granulomatosis with polyangiitis
374
positive C-ANCA and anti-PR3
granulomatosis with polyangiitis
375
systemic vasculitis with positive p-ANCA
microscopic polyangiitis
376
degree of calcification of the pelvis as it relates to skeletal maturity as noted on pelvic XR
Risser sign - 1 to 5
377
noncardiogenic pulmonary edema, GI hemorrhage, skin vesicles, generalized widespread multi organ system failure from bioterrorism - happens very quickly
ricin poisoning
378
from the seeds of castor oil plant
ricin toxin
379
what is ricin's MOA?
preventing protein synthesis leading to very quick cell death
380
pneumonia birth to 4 weeks of life?
GBS
381
pneumonia 4 weeks to 12 weeks?
Chlamydia trachomatis
382
young female, headaches, pulsatile tinnitus, neck pain, or flank pain
fibromuscular dysplasia
383
best imaging to diagnose FMD?
CT angio
384
normal epithelium of esophagus?
stratified squamous
385
epithelium of barrets esophagus?
metaplastic simple columnar
386
new hemolytic anemia concern, best next test for work up?
direct antiglobulin test
387
autoimmune hemolytic anemia can be idiopathic, but is often associated with
lymphoproliferative disorders like CLL or nonhodgkins lymphoma
388
unexplained thrombocytopenia and anemia in CLL requires
bone marrow biopsy
389
CLL transforming to a more aggressive and deadly lymphoma is called
Richter transformation
390
tennis elbow affects what muscle?
extensor carpi radialis brevis tendon
391
what symptoms of schizophrenia respond well to treatment?
positive symptoms (delusions, hallucinations, disordered patterns of thought)
392
initial management of trigger finger?
stretching and splinting then steroids then surgical release
393
pan systolic blowing murmur
mitral regurg
394
metronidazole side effect
disulfram like reaction
395
posterior dislocation of knee, now reduced and has normal pulses, next step?
ABI
396
new late decels noted, what do you do?
stop oxytocin, reposition patient, add IV fluids, place patient on oxygen
397
MC elevated enzymes in dermatomyositis?
CK and aldolase
398
carbon monoxide poisoning lab
metabolic acidosis
399
tx acute, uncomplicated diverticulitis?
abx - ceftriaxone and metronidazole
400
what is the only recommended pneumonia vaccine now?
PPSV23
401
how to diagnose imperforate hymen?
pelvic US
402
antibiotics that require oxygen to be taken up into bacterial cells
aminoglycosides
403
hydronephrois equals
obstructive uropathy
404
tendons in de quervain's tenosynovitis?
abductor pollicis longus and extensor pollicis brevis
405
provides information concerning malpractice payments, adverse licensure, withdrawal of clinical privileges and other negative actions taken against individual health care practitioners
National practitioner Data Bank
406
pt with shock, polydipsia, GI symptoms, excessive weight loss, dehydration and hyperpigmentation in palmar creases
Addisonian crisis
407
scabies tx
permethrin and close contacts
408
greatest lab predictor of mortality in acute pancreatitis
change in BUN over the first 48 hours
409
where do you use PT for lateral epicondylitis?
rest and PT focusing on eccentric strengthening exercises and wrist mobility
410
tx of alcoholic ketoacidosis
reverse the low insulin to glucagon ratio with dextrose and to replenish fluids
411
mgmt of suspected closed (occult) spinal dysraphism (CSD)
MRI of the whole spine
412
contraindications to bracing for scoliosis?
little growth remaining (Riser of 3)
skeletal maturity
Cobb angle 50 or more or less than 20
413
Cobb angle less than 20, treatment?
follow up every 6-12 months
414
anterior thoracic counterstrain tenderpoint for T5 (AT5) is located where
midline on the sternum at the attachment of rib 5, which is approximately 1 inch superior to the xiphisternal junction
415
inhalation dysfunction - which rib are you treating when using muscle energy?
key rib is bottom rib
416
inhalation dysfunction is also known as
an exhalation restriction
417
what drug for a heart patient can cause hyperkalemia?
ACE inhibitor
418
1-6 months of psychotic symptoms
schizophreniform
419
only antihypertensives known to be safe in pregnancy?
labetalol, methyldopa, and hydralazine
420
bizarre complication of sarcoid that actually happens about 50% of the time?
blindness
421
sudden, rapid, irregular, and aimless involuntary movments of the arms, legs, and trunk, and facial muscles
sydenham chorea (antibody mediated neuronal damage)
422
migratory arthritis and sydenham chorea?
rheumatic fever
423
what kidney stones are hereditary?
cystine - AR defect in the reabsorptive transport of cystine and the dibasic amino acids ornithine, arginine, and lysine
424
MCC of epiglottitis in adults?
S. pneumo
425
MC bug of endocarditis?
S. aureus
426
eye infection on baby 2-5 days of life?
gonococcal infection
427
iron deficiency anemia labs
serum iron low
TIBC high
ferritin low
428
porcelain white plaques on labia and peri-anal region, dx? punch biopsy does not have evidence of atypia or carcinoma
lichen sclerosis
429
minimal tx for prostate cancer?
radiation beam therapy
430
benztropine MOA?
anticholinergic
431
hemochromatosis pt, increase risk of developing
hepatocellular carcinoma
432
fluorescent bulbs - tox? dx and tx?
mercury poisoning, treat with succimer
433
drug of choice in ovulation induction for PCOS pt
letrazole, aromatase inhibitor
434
Down syndrome with AD - protein responsible?
amyloid precursor protein
435
thyroid cancer nodules are usually
cold and solid
436
MC type of thyroid cancer
papillary thyroid cancer
437
spherical concentrically laminated masses of calcium
psammomma bodies. - papillary thyroid carcinoma
438
emergent anti-hypertensive push or drip?
drip
439
high risk procedures for patient recently treated for infective endocarditis?
drainage of cutaneous, pulmonary, or dental abscess
440
valsalva causing worsening of murmur in
HCM
441
cause of acromegaly
usually benign pituitary adenoma
442
nonresolving conjunctivitis in 3rd world country
trachoma - chlymidia, tx with 1 g azithro
443
battery ingestion - when to remove and when to observe
remove in esophagus and observe in small intestine
444
what are the two high intensity statins
atorvastatin and rosuvastatin
445
HIV pt with yellow infiltrates on fundoscopic exam
CMV retinitis - CD4 <50
446
MCC of hypercalcemia?
hyperparathyroidism from adenoma
447
most sensitive and specific test for MG?
single fiber EMG
448
abx worsening MG
macrolides, fluoroquinolones, penicillin
449
severely resistant hypertension, next drug?
minoxidil
450
acid base disorder in PE
mixed metabolic acidosis and respiratory alkalosis
451
two significant risk factors for GI cancers?
smoking and alcohol
452
when do you measure serum cortisol levels?
7 am
453
C3 level decreased in this nephropathy
post streptococcal glomerulonephritis
454
most specific tests for identifying rupture of membranes
vaginal pooling, nitrazine, and fern
455
hypercalcemia with recurrent duodenal ulcers and family history of MEN1
gastrinoma
456
middle aged man, multiple enlarged lymph nodes, next step?
excisional lymph node biopsy
457
tx postherpetic neuralgia
TCAs
458
abdominal pain and recurrent cholangitis
choledochal cyst
459
MC transmitted disease acquired during blood transfusiond
hep B
460
sciatica may cause what neuro presentation?
decreased DTRs
461
lactose fermenting gram negative rod, B hemolytic
E coli
462
gram positive, coag negative, nonhemolytic
saprophyticus
463
gram negative encapsulated aerobic rod
pseudomonas
464
baby with microcephaly, short palpebral fissures, and a smooth nasal philtrum
fetal alcohol syndrome
465
psychotic symptoms accompanied by a mood disorder
schizoaffective
466
human fusion protein of TNF-a type 2 receptor that binds and inactivates soluble tumor necrosis factor
etanercept
467
MC bugs of AOM
S. pnuemoniae and H. influenza nontyable (not vaccinated against)
468
chronic diarrhea electrolyte change and ph
hypokalemia and acidosis
469
Phase IV drug trials, the drug is
already FDA approved
470
forward flexion of shoulder while scapula is stabilized
Neers test - positive > subacromial bursitis
471
the number of new cases of a disease diagnosed during a one year time period
incidence
472
the total number of cases of a disease, divided by the total population in the area
prevalence
473
gold standard for diagnosing tracheomalacia?
bronchoscopy
474
pregnant lady with controlled diabetes - still will have progression of
diabetic retinopathy
475
rib and muscle association for muscle energy tx
```
rib 1 - anterior and middle scalenes
rib 2 - posterioer scalene
rib 3-5 - pec minor
rib 6-9 - serratus anterior
rib 10-11 - lat
rib 12 - QL
```
476
abx used to treat GBS in pregnancy?
IV pen G or IV ampicillin at least 4 hours prior to delivery
477
meningitis in elderly tx
ceftriaxone, vanc, ampicillin
478
macrosomia and hypoglycemia at birth and organomegaly
Beckwith Wiedemann syndrome - nephroblastoma
479
MC malignancy of childhood
nephroblastoma/Wilms tumor
480
first line test for detecting osmotic demyelination syndrome
MRI
481
preferred anticoagulant for patient with severe renal insufficiency?
warfarin
482
recurent and persistent thoughts, urges, or images
Obsessions part of OCD
483
harsh pansystolic murmur best auscultated at the left lower sternal border
VSD
484
increased body temp, HTN, increased RR, tachy, tremulous, increased reflexes, seizures, disorientation, aroused level of consciousness or frank delirium and psychosis
benzo withdrawal
485
infant GERD tx first line
thicken formula with small amount of baby cereal
486
s/p lap chole and now has perihepatic and peritoneal fluid collections, next step?
HIDA scan
487
labs in VWD?
nl plt
nl PT
nl or slight prolonged PTT
prolonged BT
488
how long to stop MAO inhibitors before starting SSRI?
14 days
489
what will soften the murmur of HCM?
beta blockers
490
house fire patient with metabolic acidosis - dx and tx?
cyanide toxicity tx with hydroxycobalamin
491
drug for adult depression, seasonal affective disorder, and smoking cessation
buproprion
492
cefazolin will cover for
gram positive
493
common cause of elevated a-fetoprotein?
inaccurate dating - get an US
| also twin gestation and placental abnormalities
494
anti-centromere antibody
crest syndrome
495
contraindication to metformin
severe renal disease
496
osteosarcoma most commonly sends mets to
lung
497
tx malignant otitis externa?
IV cipro
