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1
Q

pt come in for insomnia, anxiety –> increased liver enzyme, macrocytosis –> condition?

A

chronic alcohol use

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2
Q

prolonged hypotension –> leads to what kidney condition?

A

acute tubular necrosis

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3
Q

indicates what conditon?

  • muddy brown granular cast
  • RBC cast
  • WBC cast
  • fatty cast
  • broad and waxy cast
A
  • muddy brown granular cast: acute tubular necrosis
  • RBC cast: glomerulonephritis
  • WBC cast: intersistial nephritis, pyelonephritis
  • fatty cast: nephrotic synd
  • broad and waxy cast: chronic renal fail
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4
Q

BUN:Cr ratio –> values and what they indicate

A

> 20:1 –> pre-renal

<20:1 –> intra-renal

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5
Q

post-menopause –> vag bleed –> next step?

A

think of endometrial hyperplasia or cancer:

pelvic US –> eval endometrial thickness, assess for other pelvic pathology

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6
Q

post-menopause –> vag bleed –> when do endometrial bx?

A

pelvic US –> endometrial thickness >4mm –> bx to eval for malig

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7
Q

whipple dz –> MC presenting ssx (5)

A
  • chronic malabsorptive diarrhea
  • wt loss
  • migratory non-deforming arthritis
  • LAD
  • low grade fever
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8
Q

what meds increase risk of diverticulosis?

A

ASA, NSAID

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9
Q

cervical intraepithelial neoplasia 3 –> next step?

A

cervical conization (type of excisional bx)

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10
Q

what are howell-jolly bodies?

A

RBC –> nuclear remnant

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11
Q

howell-jolly bodies –> seen in what condition?

A

asplenia (ie sickle cell)

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12
Q

morton neuroma –> charact

A
  • distal forefoot –> metatarsal heads to 3rd & 4th toes –> numb, ache, burn
  • Mulder sign: crepitus bw 3rd & 4th toes
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13
Q

morton neuroma –> who? pathophys?

A

usu runner –> mech-induced neuropathic degen of interdigital N –> ssx worse when walk on hard surface, wear tight/high heel shoes

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14
Q

morton neuroma –> tx?

A

metatarsal support or padded shoe insert

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15
Q

transudate vs exudate

A

transudate:
- increased hydrostatic pressure
- decreased oncotic pressure
- -> low protein

exudate: inflamm –> increase vasc permeability
- -> high protein, lactate dehydrogenase

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16
Q

regular schedule for meningococcal vaccine

A
  • primary vaccine –> 11-12yo

- booster at 16yo

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17
Q

first stage of labor –> consists of what phases?

A
  • latent phase: gradual cervical dilation

- active phase: rapid dilation

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18
Q

what constitutes arrest of active labor?

A

cervical dilatrion >6cm:

  • no cervical change for >4hr w adeq contractions
  • no cervical change for >6hr w inadeq contractions
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19
Q

arrest of active labor –> next step?

A

C-section

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20
Q

osteoarthritis –> PE findings (3)

A
  • bony enlrgment, tenderness
  • crepitus w mvmt
  • painful, decreased ROM
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21
Q

glasgow coma scale –> who? for what? assesses?

A

all trauma pt:

  • estimate severity of neuro injury
  • predict prognosis of coma & other conditions (bact meningitis, traumatic brain injury, subarachnoid hemorrhage)

Assess:

  • eye opening
  • verbal resp
  • motor resp
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22
Q

ARDS –> pathophys? results in?

A

infect, trauma, other –> lung injury –> alveolar space –> release proteins, inflamm cytokines, neutrophils –> blood, proteinaceous fluid –> into alveoli –>

  • lose surfactant –> alveoli collapse
  • diffuse alveolar damage

Results in:

  • impair gas exchange
  • decreased lung compliance
  • pHTN
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23
Q

abruptio placentae –> RF (3)

A
  • # 1 HTN
  • cocaine
  • maternal trauma
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24
Q

abruptio placentae –> presentation

A
  • abd/back pain
  • fetal heart rate abnormal
  • variable vag bleed
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25
what is modified wells criteria?
pretest probability of PE: <4 --> PE unlikely >4 --> PE likely
26
sickle cell dz --> aplastic crisis --> pathophys? charact?
parvovirus B19 --> sudden halt in RBC production - severe anemia - low retic (<1%) - no HSM
27
cause of ascending aortic aneurysm? descending?
ascending: cystic medial necrosis, connective tissue disorder descending: atherosclerosis
28
duration of: - brief psychotic disorder - schizophreniform disorder - schizophrenia
- brief psychotic disorder: 1day-1mo - schizophreniform disorder: 1-6mo - schizophrenia: >6mo
29
what is: placenta accreta
placenta attach directly to myometrium
30
uterine inversion --> management
1) aggressive fluid replace 2) manual replace uterus 3) remv placenta, uterotonic drug
31
newborn --> conjugated hyperbili + hepatomegaly --> condition?
biliary atresioa
32
biliary atresia --> 1st step in eval? result?
abd US --> absent/abnormal gallbladder
33
biliary atresia --> tx?
Kasai procedure (hepatoportoenterostomy) --> eventually liver tx
34
ALL --> how dx?
BM bx --> >25% lymphoblasts
35
gallstone + typical biliary colic ssx --> tx?
elective lap chole
36
acute cholecystitis --> tx?
chole in 72hr
37
suspect achalasia --> next step?
endoscopy to r/o malig (pseudoachalasia)
38
bursitis --> how affect active ROM? passive?
active: decreased or painful passive: normal
39
prepatellar bursitis --> presentation (3)?
- ant knee pain, tender - erythema - localized swelling
40
acute prepatellar bursitis --> pathophys
- penetrating trauma - repetitive friction - local cellulitis --> S. aureus infect bursa
41
acute prepatellar bursitis --> how confirm dx?
aspirate bursal fluid --> cell count & Gram stain
42
absence sz --> comorbidity (2)?
- ADHD | - anxiety
43
postmenopause --> large adnexal mass + vag bleed + endometrial hyperplasia --> condition?
granulosa cell tumor of ovary
44
granulosa cell tumor of ovary --> vag spot --> why?
secrete estrogen --> endometrial hyperplasia --> postmenopausal bleed
45
granulosa cell tumor of ovary --> endometrial hyperplasia --> next step? why?
endometrial hyperplasia --> risk of endometrial cancer --> endometrial bx
46
8yo M --> staring episodes --> tilt head, chew, not respond to name/touch --> confused for 20min after --> condition?
focal sz w LOC
47
focal sz --> presentation?
- motor (headturning), sensory (paresthesia), or autonomic ssx (sweat) - may have LOC & automatism (chewing)
48
how can provoke absence sz?
hypervent
49
UA --> positive leukocyte esterase --> indicates?
significant pyuria
50
UA --> positive nitrite --> indicates?
presence of Enterobacteriaceae (E.coli --> convert nitrate in urine to nitrite)
51
polysaccharide vaccine --> how induce immunity?
Tcell-indep Bcell response: | polysacc --> bind Ab on Bcell --> mod level of interm-affinity Ab
52
conjugate vaccine --> how induce immunity?
Tcell-dep Bcell response: polysacc-protein conjugate --> bind Ab on Bcell --> protein component activate Tcell receptor --> high levels of high-affinity Ab + memory cell formation
53
pneumococcal vaccine --> what kind for: - infant - young child - <65yo + predisposing comorbid - immunocomp - >65yo
- infant: PCV13 - young child: PCV13 - <65yo + predisposing comorbid (chronic heart/lung dz, DM, cirrhosis): PPSV23 - immunocomp: PPSV23 + PCV13 - >65yo: PPSV23 + PCV13
54
tachycardia-mediated cardiomyopathy --> how to improve LV fx?
restore sinus rhythm or aggressive ctrl ventricular rate
55
what is: missed abortion
preg loss at <20wk gestation prior to expulsion of gestational tissue
56
missed abortion --> presentation
- usu asymptomatic but can present w: - loss of preg ssx - light vag bleed
57
missed abortion --> findings (3)
- closed cervix - decreasing B-hCG - US: no fetal heartbeat
58
spherocytosis --> lab findings: - MCHC - MCV - peripheral smear - Coombs test - acidified glycerol lysis test - eosin-5-maleimide binding test
- MCHC: increase (d/t membrane loss & RBC dehydration) - MCV: low - peripheral smear: spherocytes - Coombs test: neg - acidified glycerol lysis test: increase osmotic fragility - eosin-5-maleimide binding test: abnormal
59
spherocytosis --> increase risk for what conditions (2)?
- bilirubin gallstones | - parvovirus B19 --> aplastic crisis
60
spherocytosis --> presentation --> classic triad
- hemolytic anemia - jaundice - splenomegaly
61
spherocytosis --> tx
supportive: folic acid, transfusion for severe anemia
62
spherocytosis --> what does splenectomy do for pt? what does it not do?
- improve anemia - reduce gallstone risk not change increased MCHC
63
anti-D immune globulin --> when administered during preg?
28wk gestation + w/in 72hr of delivery
64
what is: Kleihauer-Betke test
determine if need higher than standard dose of anti-D immune globulin after delivery
65
sickle cell trait --> #1 comp
painless hematuria (d/t sickling in renal medulla)
66
chronic renal fail --> phlebotomy --> not stop bleed --> why?
platelet dysfx --> abnormal hemostasis
67
chronic renal fail --> platelet dysfx --> lab findings: - PT - PTT - platelet count - BT
- PT: normal - PTT: normal - platelet count: normal - BT: prolong
68
chronic renal fail --> platelet dysfx --> tx? MOA?
DDAVP --> increase release of factor VIII-vWF multimers from endothelial storage sites
69
lung cancer --> paraneoplastic synd --> muscle weak --> what paraneoplastic synd could it be (3)?
- myasthenia gravis - Lambert-Eaton synd - dermatomyositis
70
what is: dermatomyositis
idiopathic inflamm myopathy --> immune-med muscle injury
71
dermatomyositis --> presentation
- symm proximal muscle weak | - erythematous rash --> Gottron's sign, heliotrope rash
72
SLE --> lab findings on CBC (3)
- hemolytic anemia - thrombocytopenia - leukopenia
73
#1 RF for spont preterm delivery
h/o spont preterm delivery
74
h/o spont preterm delivery --> how to decrease risk of spont preterm delivery w next preg
- progesterone supplementation | - serial cervical length measurements
75
supravalvular aortic stenosis --> exertional angina --> why?
aortic stenosis --> LV hypertrophy --> exercise --> increase myocardial O2 demand --> subendo ischemia --> angina
76
simple breast cyst --> aspirate clear yellow fluid --> next step?
f/u in 2-4 mo for clinical breast exam --> monitor for recurrence
77
ankylosing spondylitis --> exam findings (5)
- arthritis (sacroillitis) - reduced chest expansion, spinal mobility - enthesitis (tenderness at tendon insertion sites) - dactylitis (swelling of fingers/toes) - uveitis
78
preg --> elevated maternal serum AFP --> indicate what fetal conditions (3)?
- open neural tube defect - ventral wall defect --> gastroschisis, omphalocele - mult-gestation preg
79
preg --> elevated maternal serum AFP --> next step?
US --> eval fetal anatomy
80
preg --> decreased maternal serum AFP --> indicate what fetal condition?
aneuploidy
81
methamphetamine --> risk for what heart condition?
cardiomyopathy
82
milk-alkali synd --> symptoms
- N/V, constipation - polyuria/polydipsia - neuropsych ssx
83
milk-alkali synd --> pathophys
excess intake Ca & absorbable alkali --> hyperCa --> - renal vasoconstrict --> decrease GFR - renal lose Na & H2O --> hypovol --> increase resorb bicarb
84
milk-alkali synd --> lab findings (4)
- hyperCa - metabolic alk - acute kidney injury - suppressed PTH
85
Turner synd --> CV abnormalities (3)
- bicuspid aortic valve - coarcation of the aorta - aortic root dilation
86
Turner synd --> karyotype
45, X
87
karyotype --> find 45, X --> next step?
eval for CV abnormalities --> 4-extremity blood pressure & echo
88
postpartum psychosis --> management
medical emergency --> increased risk of suicide & infanticide --> hosp --> antipsych med & trt underlying disorder
89
cold knife conization --> how eval risk of preterm delivery
gold standard: transvag US --> measure cervical length
90
nonhosp pt --> polyuria --> most likely dx (3)
- DM - primary polydipsia - DI
91
Na levels: - primary polydipsia - central DI - nephrogenic DI
- primary polydipsia: low - central DI: high - nephrogenic DI: normal
92
central DI --> pathophys
pituitary --> decreased ADH --> kidney --> decrease water resorb --> water loss --> polyuria --> dilute urine & hyperNa
93
what is complicated cystitis
infect assoc w factors that increase risk for abx resistance or tx failure --> DM, CKD, preg, immunocomp, urinary tract obstruct, hosp-acq infect, infect assoc w procedure/indwelling foreign body
94
uncomplicated cystitis --> abx options (3)
- nitrofurantoin - TMP/SMX - fosfomycin
95
complicated cystitis --> next step?
urine culture --> then initiate tx
96
complicated cystitis --> tx
fluoroquinolone
97
pyelonephritis --> next step?
urine culture --> then initiate tx
98
cirrhotic patient on diuretic --> hepatic encephalopathy --> pathophys?
diuretic --> low intravasc vol despite total vol overload --> metab alk + hypoK --> increase NH3
99
cirrhotic patient on diuretic --> metab alk + hypoK --> hepatic encephalopathy --> tx?
- replete K - replete intravasc vol - ammonia-lowering meds: lactulose
100
1st trimester --> lab findings: - total T4 - free T4 - TSH
- total T4: increased - free T4: no change or mild increase - TSH: decreased
101
preg --> increase thyroid hormone --> pathophys?
- estrogen --> stim thyroxine-binding globulin syn --> increase total TH - hCG --> stim TSH receptor --> increase TH production --> to cope w metabolic demands of preg
102
18mo M --> intussusception --> how dx?
US guided air contrast enema
103
primary influenza pneumonia --> CXR findings?
b/l diffuse interstitial infiltrates
104
dobutamine --> used to manage what condition?
severe heart fail assoc w severe LV systolic dysfx & cardiogenic shock
105
dobutamine --> MOA
stim B1 receptor --> increased myocardial contractility --> improve EF, reduce LV end systolic vol --> symptomatic improve decompensated heart fail
106
how does pneumonia cause hypoxemia?
inflamm exudate --> fill alveoli --> R to L intrapulm shunt (vent/perfusion mismatch: perfusion w/out vent)
107
hypoxemic --> increase FiO2 --> hypoxemia does not correct --> indicates?
absence of alveolar vent --> ie pneumonia d/t to intrapulm shunt
108
neonate --> <10% percentile for gestational age at birth --> comp (5)
- hypoxia - polycythemia - hypoglycemia - hypothermia - hypoCa

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