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1
Q

HBV Tx

A

Monitor LFTs, HBV DNA

UNLESS: 
- acute liver failure
- immunosuppression
- HCV+
- cirrhosis
Tx: antiviral  entecavir, tenofovir, lamivudine , adefovir and telbivudine

Risk of chronicity
HBV: 5%
HCV: 75-85%

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2
Q

Risk of chronicity
HBV:
HCV:

A

HBV: 5%
HCV: 75-85%

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3
Q

Decrease in BP mmHg

  1. DASH
  2. W loss (per 10kg)
  3. Exercise
  4. Na <1.5-2.3g
  5. EtOH <1 F, <2 M
A
  1. 11
  2. 6
  3. 7
  4. 5-8
  5. 5
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4
Q

Catabolism effect on following:
increase/decrease

  1. Insulin
  2. Cortisol
  3. Glucagon
  4. ketone use in muscle
  5. ketone use in brain
  6. glycogenolysis
  7. lipolysis
  8. protein catabolism
A
  1. -
  2. +
  3. +
  4. -
  5. +
  6. +
  7. +
  8. +
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5
Q

Cachexia. What happens to insulin upon refeeding?

A

increases

Also: Ph, K, Mg, B1 all get used up

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6
Q

Effects of refeeding syndrome?

A

CHF >pulm edema
Arrhythmia
Seizures
Wernickes

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7
Q

Scleroderma: Systemic VS limited VS diffuse

A

Systemic Scleroderma

  1. Limited Systemic: CREST
  2. Diffuse Systemic (pulm, renal, GI)
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8
Q

RFs for amniotic fluid embolism (5)

A
  • increased maternal age
  • gravida >5
  • C/S or instrumentation
  • placenta previa/abruptio
  • preeclampsia
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9
Q

S/p C-section delivery > cardiac shock, hypoxemia, DIC. Dx?

A

r/o amniotic fluid embolism

RF

  • increased maternal age
  • gravida >5
  • C/S or instrumentation
  • placenta previa/abruptio
  • preeclampsia
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10
Q

**Indication for low dose CT chest screen.

A
  • 50-80yo
  • > 20 pack years
  • current/quit <15y ago
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11
Q

Which CA is an AIDS-defining illness?

A

Cervical CA

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12
Q

MOA of hyerCa in setting of hyperPTH?

A
  • 25OH VitD —> 1, 25OH VitD
    which DEcreases renal excretion & INcreases GI Ca absorp
  • increases release of Ca & Ph from bones
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13
Q

How sensitive is MRI for AOM?

A

very >90%

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14
Q

Tx scabies

A

permethrin cream x 1 topical

OR ivermectin x 2 PO

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15
Q

BPPV: Which is Dx & which is Tx?

  • Eply
  • Hallpike
A

Dx: hallpike
Tx: eply

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16
Q

Short term Tx for vertigo

A

dimenhydrinate (dramamine: H blocker)

meclizine (H blocker)

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17
Q

Limb or respiratory weakness in setting of multi-organ failure/sepsis. Dx?

A

critical illness neuropathy

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18
Q

Grief vs MDD

A

Grief: NO guilt, low self esteem or SI (except wishing they could join the deceased)

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19
Q

Gold standard Dx Hirschprung

A

suction bx: rectal (absent ganglion cells of affected area)

anorectal manometry: less accurate, low sen

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20
Q

Episodic abd pain & currant jelly stools. Dx?

A

Intussusception

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21
Q

Dx AND Tx for Intussusception (1)

A

contrast enema

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22
Q

Dx AND Tx for Intussusception (1)

A

contrast enema (air enema may treat but is not dx)

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23
Q

HyperCa & PTHrp. Which CA? (5)

A
  • SCC
  • renal
  • bladder
  • breast
  • ovary
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24
Q

HyperCa w/ bone mets. Which CA (2)

A

Breast
MM

(osteolysis)

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25
Q

HyperCa w/ high 1,25 OH VitD. Which CA?

A

lymphoma

MOA: increase Ca absorb

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26
Q

SCC w/ HyperCa & PTHrp. Is PTH high or low?

A

LOW

PTHrp is high

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27
Q

MM w/ bone mets. Are the following high or low?

PTHrp
PTH
vitD

A

low
low
low

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28
Q

Lymphoma. Are the following high or low?

  • Ca
  • PTH
  • vitD
A
  • high
  • low
  • high

(MOA: increased Ca absorp)

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29
Q

Chronic D, loose, foul smelling stools. Significant w.loss, malabsorp/vit def. Tx?

A

Metro (tinidzole)

Dx: Giardia
also abd cramps/flatus

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30
Q

sp CABG > pleural effusion. Tx?

A

NONE if:

  • <25% hemithorax
  • asx, L-sided

Thoracentesis indicated if

  • > 25% hemithorax
  • symptomatic
  • late (>30d sp CABG)
  • R-sided in absence of HF
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31
Q

Features of common/benign pleural effusion sp CABG?

A
  • small, L-sided
  • asx
  • w/in few days of CABG

*seen in 60% likely 2/2 pericardial inflammation

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32
Q

Cephalohematoma OR caput succedaneum?

1) crosses suture lines
2) +/- jaundice
3) above periosteum
4) resolves in few weeks

A

1) CS
2) CH
3) CS
4) CH

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33
Q

Describe disorders:
1- Conduct
2. Oppositional defiant
3. Antisocial

A
  1. Evil kid: cruelty towards animals/people, stealing, lying, bullying, property destruction
  2. Refuses to follow rules but not cruel/destructive
  3. the adult version of conduct disorder
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34
Q

RFs for developmental hip dysplasia?

A

Female
Breech
tight swaddling
FHx

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35
Q

Abx for asx bacteriuria in pregnancy?

A
  1. keflex 3-7d
  2. amoxi-clav 3-7d
  3. fosfomycin x 1

**repeat urine cx a week after

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36
Q

Asx bacteruria in preg: Do you treat it?

A

YES

  1. keflex 3-7d
  2. amoxi-clav 3-7d
  3. fosfomycin x 1
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37
Q

Why are pregnancy women at increased risk for pyelonephritis?

A

progesterone effect on upper urinary tract

  • smooth muscle dil
  • ureteral enlargement
  • vesicoureteral valve dysfunction
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38
Q

ASx bacteriuria complications in preg?

A
  • preterm birth
  • low birth weight
  • perinatal mortality
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39
Q

Abx course duration for pyelo during pregnancy?

A

IV abx with following abx suppression until 6 WEEKS POSTPARTUM to prevent recurrence

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40
Q

Which abx can you use for pyelo in preg?

A

Mild/mod

  • ceftriaxone
  • cefepime
  • cefotaxime
  • ceftazidime
  • ampi/genta

Severe
(immunocomp, incomplete urinary drainage)
- ampicillin-sulbactam
- zocyn

THEN abx suppression until 6 WEEKS POSTPARTUM to prevent recurrence

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41
Q

Which UTI abx is associated w/ the following in pregnancy:

  1. NTD & kernicterus
  2. hemolytic anemi
A
  1. bactrim

2. nitrofurantoin

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42
Q

Does drug induced lupus cause renal failure?

A

NO

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43
Q

Massive proteinuria in elderly pt. US renal wnl, labs w/ marked AKI on CKD. Dx?

A

Consider analgesic induced nephropathy- often causing florid proteinuria. (Does the pt have chronic pain?)

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44
Q

80yo M p/w sepsis. You give abx & give 500cc NS bolus w/ no improvement in BP. NSIM?

A) IV NE
B) IV dopamine
C) IV epi
D) saline bolus

A

D) saline bolus

Aggressive IVF before considering pressors

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45
Q

Mammalian bite. Abx?

A

amoxi-clav

GB, GN, anaerobe cover

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46
Q

Mammalian bite. Abx in PNC allergic pt?

A

look it up!

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47
Q

DM autonomic neuropathy unique to M, Sx?

A
  • diminished cremasteric reflex
  • diminished testicular sensation
  • bladder dysfunction
  • inability to masturbate
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48
Q

Nightmare disorder VS non-REM sleep arousal disorder

A

Nightmare: REM, detailed dream recall

non-REM sleep arousal disorder: Non-REM, sleep walking, sleep terrors, little/no recall

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49
Q

Tx for peds: persistent sleepwalking if distressing

A

low dose benzo

prog: resolves w/in 1-2yrs

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50
Q

28yo w/ 2cm tender lump in L breast. NSIM?

A

US

  • if simple >FNA
  • if complex cyst/mass > core bx
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51
Q

CAP Tx

Outpatient with VS without comorbs.

A

Healthy:
- amox OR doxy

Comorbs:
- FQ OR b-lactam
AND macrolide

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52
Q

CAP Tx: ward VS ICU?

A

ward:
- IV FQ (levo, moxi)
- IV ceftriaxone/azi

ICU:

  • IV ceftriaxone/azi
  • IV ceftriaxone/FQ
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53
Q

Elderly M w/ episodic vertigo, diplopia, dysarthria, dizziness & numbness. Dx?

A

vertebrobasillar insufficiency (reduced blood flow in the base of the brain 2/2 emboli, thrombi, arterial dissection)

RF: DM, HTN, DLP, CAD, arrhythmia

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54
Q

First line Tx of preschool age child w/ ADHD?

A

behavioural therapy!

If persists 6yo+, use meds (stimulants or atomoxetine)

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55
Q

Which info needs to be obtained prior to starting ADHD meds in peds?

A

**cardiac hx & medical exam (including FHx of sudden cardiac death etc)

EKG may be needed

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56
Q

Child w/ minimal response to max dose adderall for ADHD. NSIM?

A

switch to atomoxetine

if that fails- clonidine

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57
Q

Reactive arthritis: Etiology? Synovial results?

A

“Cant see cant pee cant climb a tree”

GI/GU infection

  • Chlamydia
  • Campylobacter
  • Salmonella
  • Shigella
  • Yersinia

Synovial: high WBC but no pathogens

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58
Q

Biliteral eye pain, dysuria, oligoarthritis, dactylitis, achilles enthesitis. What do you expect from the hx?

A

GI/GU infection

  • Chlamydia
  • Campylobacter
  • Salmonella
  • Shigella
  • Yersinia

Dx: Reactive arthritis

***Only 30-50% are HLA-B27+

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59
Q

Reactive arthritis suspected. Tx?

A

Tx underlying cause
NSAID
GCS if severe

improves in a few weeks

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60
Q

Post-op hypercapneic/hypoxic resp acidosis. ABG w/ normal A-a gradient. Tx?

A

Corrects with supplemental O2

(because A-a gas exchange is intact and hypoxemia is d/t hypoventillation_

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61
Q

Preterm labor: at 34-37wks, what do you give?

A
  • betamethasone
  • PNC if GBS+ or unknown

**NOT RhoD Ig (fetal Rh status is checked AFTER delivery & Ig can be administered up to 72h postpartum)

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62
Q

Define acute stress disorder?

A

Basically PTSD but <1 month

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63
Q

How soon after breast development do you expect menarche?

If pt does not have menarche by age ___, further w/u is needed. Otherwise reassure.

A

2-2.5yrs

15yo

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64
Q

12yo+ girl w/ short stature, no breasts, delayed bone age. Dx?

A

Constitutional delay of puberty

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65
Q

Amenorrhea age 15+. NSIM?

A

Pelvis US & FSH.

same if 13+ w/o menses AND breast development

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66
Q

Breast development age 12 hwr still no periods age 14. NSIM?

A

Reassure/observe

If pt does not have menarche by age 15, further w/u is needed.

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67
Q

Mother is RhD+ and father is RhD-. What is the risk of hemolytic disease in the newborn?

A

None. Mother would have to be RhD- and father RhD+.

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68
Q

Mother is RhD- and father RhD+. Child develops hemolytic disease of the newborn even though its the first pregnancy. How?

A

Mother must have either had prior

  • miscarriage/abortion
  • blood transfusions
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69
Q

MCC necrotizing fasciitis?

A

G.A.S
(Clostridium perfringens is not as common)

Other causes:

  • S.aureus (DM w/ poor blood flow)
  • Pseudomonas (immunocompromised)
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70
Q

Empiric therapy for necrotizing fasciitis?

A

3 meds:

Zocyn or Meropen
- anaerobes & GAS

Vanc
- S.aureus/MRSA

Clinda
- inhibit toxin formation by staph/strep

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71
Q

What does each abx cover in terms of empiric therapy for necrotizing fasciitis?

  • Zocyn or Meropen
  • Vanc
  • Clinda
A

Zocyn or Meropen
- anaerobes & GAS

Vanc
- S.aureus/MRSA

Clinda
- inhibit toxin formation by staph/strep

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72
Q

RAPID warfarin reversal required. Tx?

A

prothrombin complex concentrate (INR normalizes w/in 10 mins)

WITH IV vitK

(Second line: FFP- high vol required & delay for blood compatibility test)

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73
Q

Tx for pt w/ VWF def & minor bleed

A

IV desmopressin

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74
Q

Primary dysmenorrhea in virgins. Tx?

A

first line: NSAIDS!!

If ineffective, then try OCP
OCP is first line in sexually active patients

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75
Q 
Which is NOT a common cause of BV?
A) low E
B) pregnancy
C) menses
D) intercourse
E) recent abx
F) douching
A

A) low E

high E!

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76
Q

Complications of BV in preg?

A 
preterm birth 
PPROM
spontaneous abortion
chorioamnionitis
postpartum-endometitis

(note: treating it does not decrease the risk)

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77
Q

Dose of supplements in osteoporosis?
Ca+
vitD

A

1200mg QD

800IU QD

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78
Q

Complete unilateral facial weakness: Bells vs CVA?

A

BELLS!

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79
Q

Bells VS CVA

A

CVA can lift eyebrow & does not have droopy/weak eye

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80
Q

30yo M severe fatigue, bells, HSM, LAD. Lyme neg. NSIM?

A

CXR r/o sarcoidosis

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81
Q

Two most important criteria for confirming sarcoidosis?

A
  • LN bx: noncaseating granulomas
  • diseases w/ similar sx are ruled out

(note: even though ACE are increased in 75%, it is not specific. Also, always bx the most superficial LN if possible)

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82
Q

Sarcoid suspected but no easily accessible LN. NSIM?

A

fiberoptic bronchoscopy w/ transbronchial lung bx

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83
Q

Likely etiology of febrile seizure?

A

nervous system immaturity

Prognosis:

  • higher risk of subsequent seizures
  • 1% increased risk of epilepsy
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84
Q

Aortic Coractation: most commonly affected demographic?

A

sporadic, boys

hwr Turners is notorious for it!

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85
Q

Upper extremity HTN, lower extremity hypotension. Dx?

A

Aortic coarctation

also weak/delayed pulses “brachiofemoral delay”

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86
Q

Rib notching & figure 3 sign. Dx?

A

Aortic coarctation

also weak/delayed pulses “brachiofemoral delay”

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87
Q

Parasternal heave. Assn?

A

RV hypertrophy

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88
Q

Large decline in BP (>10mmHg) during inspiration is associated w/?

A

cardiac tamponade

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89
Q

Exercise recs to reduce CVD risk?

A

mod aerobic >150min/wk

vigorous exercise
>75min/wk

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90
Q

Review METS & RCRI pre-op risk

A

!

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91
Q

MS spasticity Tx?

Baclofen and _____

A

Tizanidine

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92
Q

Which sx of MS does amantadine tx?

A

fatigue

also adderall or modefenil

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93
Q

Tx MS flare?

A

high dose GCS

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94
Q

Cryptococcal meninginitis: high/norm/low

OP:
WBC:
protein:
glucose:

A

v high >250
low
high
low

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95
Q

Normal CSF values for:

WBC
protein
glucose

A

0-5
<40
40-70

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96
Q

GBS CSF values?

WBC
protein
glucose

A

normal (0-5)
HIGH (45-1000)
normal (40-70)

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97
Q

CSF protein >500. Dx?

A

GBS

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98
Q

In addition to amphotericin B & flucytosine, what is used to tx cryptococcal meningitis?

A

serial LPs to relieve high opening pressures

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99
Q

Cryptococcal meningitis: sx improve & CSF is clean, NSIM?

A

STOP amphotericin & flucytosine IV

START high dose PO fluconazole x 8wks

then lower dose 1yr+

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100
Q

Needle stick from HIV pt with 0 viral load. NSIM?

A

3 agent PEP x 1month

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101
Q

35yo obese F. Intermittent epigastric discomfort radiating to the back R shoulder w/ N/V, diaphoresis. Dx test?

A

ULTRASOUND per biliary colic r/o cholelithiasis

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102
Q

Best test for dx cholelithiasis?

A

ULTRASOUND

>95% sen/spec

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103
Q

Typical biliary colic sx w/o gallstones on imaging. NSIM?

A

cholecytokinin stimulated cholescintigraphy to eval for functional gallbladder disorder

(cholecystectomy w/ low gallb ejection)

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104
Q

Gallstone w/ typical sx. Sx improved w/ ursodeoxycholic acid. NSIM?

A

***CHOLECYSTECTOMY for pts who improve w/ UDCA

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105
Q

Cholecystitis suspected but US inconclusive or neg, NSIM?

A

HIDA

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106
Q

Visualized choledocholithiasis pr acute cholangitis. Tx?

A

ERCP

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107
Q

How are diminished lower extremity DTRs related to Pancoast tumors?

A

tumor spread to spine

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108
Q

Parkinsons w/ recurrent R/middle lobe PNA. Test to confirm dx?

A

Videofluoroscopic swallowing study to eval for asp PNA

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109
Q

Tx Pagets

A

bisphosphonates

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110
Q

Osteoclast abnormalities > increased bone turnover & abnormal remodelling. Dx & Tx?

A

Pagets

Tx: bisphosphonates

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111
Q

Addisons Tx?

A

hydrocortisone or prendnisone
AND
fludrocortisone

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112
Q

Weakness, N/V/abd pain, postural hypotension, weight loss.

Labs: hyperK & eosinophilia. Dx?

A

Addisones:

also

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113
Q

Spontaneous abortion risk

A
  • PSA
  • hx spont abort
  • BMI extremes
  • advanced maternal age
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114
Q

Petechiae after BP cuff. Assn?

A

Dengue

aka Tourniquet test+

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115
Q 
India
fever, myalgia
mucosal bleed
transaminitis w HSM
low WBC/PLT

Dx?

A

Dengue

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116
Q

How is dengue spread?

A

aedes mosquito

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117
Q

Aedes mosquito is a vector for:

A

Dengue
Chikungunya
Yellow fever
Zika

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118
Q

Systemic complication of compartment syndrome?

A

rhabdo > AKI

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119
Q

HIV: Papules w/ central umbilication & central hemorrhage. Dx?

A

Cutaneous cryptococcus

(Dx w/ bx!!

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120
Q

When does T3 or substantially DEcrease?

A

sick euthyroid syndrome

hwr rT3 is elevated!

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121
Q

Euthyroid sick syndrome. High/normal/low?

T3
rT3

A

low

high

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122
Q

Infant w/ RSV & signs of dehydration, NSIM?

A

hospitalize & place on CONTACT & DROPLET precautions

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123
Q

Laxatives for peds: osmotic or stimulant?

A

osmotic

stimulant have associated N/V,D, cramping

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124
Q

PCOS w/ persistent infertility despite weight loss. NSIM?

A

LETrozole *aromatase inhibitor

Then clomiphene
(ovulation induction LH FSH)

Then IVF

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125
Q

15yo M w/ Short stature (normal growth velocity), delated bone age.
Dx?

A

Constitutional delay of growth and puberty (late bloomer)

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126
Q 
Which does NOT cause digoxin toxicity?
A) amiodarone
B) verapamil 
C) quinidine
D) lisinopril 
E) spironolactone
A

D) lisinopril

ACE ARB & BB DO NOT cause dig toxicity

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127
Q

How do you modify the insulin regimen for gestational DM after delivery?

A 
STOP IT
Then order 
1. fasting gluc at 24-72h
2. OGTT at postpartum visit 6-12wks
3. then DM screen q2-3 years

(note: placenta secretes placental lactogen which is what causes insulin resistance. Once delivered, should resolve)

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128
Q

Why is A1C not reliable during pregnancy?

A

high RBC turnover

129
Q

Qualifier for home health services?

A

Home bound (uses cane/walker etc and cannot leave house without assistance)

AND
require skilled assistance
(med monitoring, PT, wound care)

130
Q

Thyroid nodule, low TSH. NSIM?

A

iodine 123 scintigraphy

131
Q

MEN

Type 1, 2, 3

A

1:
Parathyroid
Pituitary
Panc/NE tumors

  1. Parathyroid
    MTC
    Pheo
3. 
MTC 
Pheo 
marfanoid 
mucosal tumors
132
Q

Parathyroid: Which MEN?

A

1 & 2

1:
Parathyroid
Pituitary
Panc/NE tumors

  1. Parathyroid
    MTC
    Pheo
133
Q

Marfanoid: Which MEN?

A

3

3. 
MTC 
Pheo 
marfanoid 
mucosal tumors
134
Q

Medullary CA: Which MEN?

A

2 & 3

  1. Parathyroid
    MTC
    Pheo
3. 
MTC 
Pheo 
marfanoid 
mucosal tumors
135
Q

Pituitary tumor: Which MEN?

A

1 & 2

1:
Parathyroid
Pituitary
Panc/NE tumors

136
Q

Gastrinoma: Which MEN?

A

1

1:
Parathyroid
Pituitary
Panc/NE tumors

137
Q

Lactational mastitis. Tx?

A

PO dicloxacillin or keflex

138
Q

Lactational mastitis. No improvement w/ abx. NSIM?

A

Ultrasound w/ FNA to r/o inflammatory breast CA. Dont go straight to I&D (abcess)

139
Q

HIV pt w/ TB started on HAART & TB meds. 4wks later recurrent fever/cough, worsened infiltrate. NSIM?

A 
Continue meds 
(Dx: IRIS, can give NSAIDs or short course of GCS)
140
Q

Is renal US used to monitor progression of ADPKD?

A

NO

141
Q

ADPKD diagnosed. Do you screen for berry aneurysms?

A

Only if FHx or personal hx of IC bleed

142
Q

3 day old vomiting bile, abd distended. AXR: dilated loops of small bowel, no air fluid levels, R-sided ground glass mass (air bubbles/meconium in the ileum). Dx?

A

meconium ileus

r/o CF as this is pathomnemonic

143
Q 
LOW Hgb
LOW PLT
LOW haptoglobin 
HIGH bleed time
NORM PT/PTT

w/ AKI & fever. Dx?

A

TTP

144
Q

Tx TTP

A

**plasma exchange
GCS
rituximab

145
Q

Rapid enlarging locally aggressive, benign tumor assd w/ FAP. Dx?

A

desmoid tumor

*high recurrence

146
Q

Constrictive pericarditis causes R or L HF?

A

RIGHT

> edema, ascites, hepatic congestion

147
Q

Clinical signs of constrictive pericarditis?

A 
JVD
ascites 
periph edema
Kussmauls sign
hepatojugular reflex
pericardial knock

pericardial calcific
low voltage QRS’

148
Q

How to measure delta pressure in compartment synd?

A

DBP - compartment pressure. If <20-30 = severe

Otherwise compartment pressure >30 is diagnostic

149
Q

Arterial occlusion L foot, managed w/ thrombectomy. Few hours later foot paresthesias. Dx?

A

r/o compartment syndrome *post-ischemic CS due to interstitial edema and possible intracellular swelling sp tissue ischemia

150
Q

dsDNA VS antiSMith

Which is

  1. More sensitive
  2. More specific
  3. Used for monitoring SLE
  4. Assd w/ development of lupus nephritis
A
  1. dsDNA
  2. antiSmith
  3. dsDNA
  4. dsDNA
151
Q

anti-mitochrondrial abs

A

primary biliary cirrhosis

152
Q

First line Tx SLE

A

low GCS & plaquenil

153
Q

ASP PNA Tx?

A

Clinda OR
amoxi-clav
(beta lactam w/ b lactamase inhibitor)

154
Q

High FENa means:

Low FENa means:

A

> 2% ATN

<1% prerenal

155
Q

Oliguria sp hypotensive episode. High FENa. Dx?

A

ATN (also muddy brown casts)

156
Q

Oliguria sp hypotensive episode. High FENa. Why is this not PRErenal AKI?

A

prerenal FENa is LOW

157
Q

*Pt has ATN. You give her IVF and achieve euvolemia but she remains oliguric. Electrolytes grossly wnl. NSIM?

1) increase IVF
2) maintain IVF
3) stop IVF
4) HD

A

STOP IVF. If pt is euvolemic but remains oliguric you put them at risk of fluid overload w/ continued fluids

158
Q

LOOK UP

  • Pemphigoid gestationis
  • Pruritic folliculitis of pregnancy
  • pustular psoriasis of pregnancy
A

Note Tx of pemphigoid gestationis is topical triamcinolone & PO antihistamines

159
Q

Definitive Tx of intrahepatic cholestasis of pregnancy

A

Delivery

hwr ursodeoxycholic acid improves sx

160
Q

Tx asx bacteruria in pregnancy?

A
  • amoxi-clav x 3-7d
  • keflex x 3-7d
  • fosfomycin x 1
161
Q

Acute pancreatitis, TG 1000. After resolution of AP, which med do you prescribe?

A

Lifelong fibrate

162
Q

Tx of TG-induced pancreatitis?

A

insulin (or apheresis)

163
Q

Lichen planus disease assn?

A

HCV

164
Q

Precautions for local VS dissem VZV?

A

Local- standard, lesion cover

Dissem- contact & airbourne

165
Q

Alcoholic w/ bloody vomiting. Why not use an NGT to aspirate stomach contents?

A

may cause further variceal rupture if present

166
Q

Variceal bleed agents for management & prevention?

A

Tx:
ligation
octreotide/PPI drip

PPx:
nadolol or propanolol to reduce splanchnic pressure

167
Q

When is prednisone used in Tx of Graves?

A

significant opthalmopathy

168
Q

Labs used to monitor efficacy of antithyroid drugs?

A

Total T3 & T4

***TSH may be suppressed for several months (does not reliably reflect thyroid functional status)

169
Q

HBV fingerstick. Nurse is HepB surface Ab NEGATIVE. PEP?

A

HBV vax and Ig

170
Q

HBV fingerstick. Nurse is HepB surface Ab POSITIVE. PEP?

A

No intervention

171
Q

5yo boy w/ focal PNA. MCC & abx?

A

S. pneumo
high dose amoxicillin

Note: if CXR w/ diffuse findings in older child MCC: Mycoplasma, Tx azithro

172
Q

First line Tx for juvenile myoclonic epilepsy

A

valproate

173
Q

Teen w/ hx poor sleep or EtOH has seizure in first hour of waking. EEG showing bilateral polyspike & slow wave activity. NSIM?

A

start valproate

dx: juvenile myoclonic epilepsy

174
Q

Infantile spasms. Tx?

A

ACTH and vigabatrin

175
Q

Pt on valproate w/ acute abd pain. Dx?

A

Valproic acid may cause life-threatening hepatitis & pancreatitis.

Another known AE:
THROMBOCYTOPENIA

176
Q

All normal but cant copy a line drawing. (construction apraxia). Where is the infarct?

A) non-dom parietal
B) dom parietal
C) non-dom temporal
D) dom temporal

A

A) non-dom parietal

if it was dominant: Gerstmann synd: acalculia, finger agnosia, R/L side of body confusion

177
Q

Acalculia, finger agnosia, R/L side of body confusion. Where is the infarct?

A) non-dom parietal
B) dom parietal
C) non-dom temporal
D) dom temporal

A

B) dom parietal

Gerstmann synd

178
Q

Homonymous upper quadrantopia & impaired perception of complex sounds. Where is the infarct?

A) non-dom parietal
B) dom parietal
C) non-dom temporal
D) dom temporal

A

C) non-dom temporal

179
Q

Impaired comprehension of written word or spoken language. Where is the infarct?

A) non-dom parietal
B) dom parietal
C) non-dom temporal
D) dom temporal

A

D) dom temporal

180
Q

90% of R-handed patients and 60% of L-handed patients have (left/right?) hemisphere dominance in speech/language functions.

A

LEFT

181
Q

Leuprolide use?

A

Tx for endometriosis, fibroids or precocious puberty.

MOA GnRH agonist hence constant GnRH release VS pulsatile release required for release of LH/FSH

182
Q

High Ca+ and high PTH are due to:

  1. primary hyperPTH
  2. ?
  3. ?
A

familial hypercalciuric hypercalcemia

lithium

183
Q

HyperCa in teen hospitalized x 3 weeks sp MVA. Tx?

A

bisphosphonates

mech: immobilization increases Ca release from bone (esp in teens or Pagets)

In this state
HIGH Ca leads to
LOW PTH leads to
LOW vitD

184
Q

MOA hyperCa in TB and Sarcoidosis?

A

High extrarenal 1,25-vitD production

185
Q

Chronic pelvic pain, dysmenorrhea, deep dyspareunia. Tx?

A

NSAIDs +/- OCPs
(unless Hx infert, concern for malig, contraindications to above)

Dx: Endometriosis

186
Q

Tx lactational mastitis

A

PO dicloxacillin

or keflex

187
Q

Lactational mastitis > abscess. Tx?

A

US then FNA

I&D is last resort! May cause milk fistulas, slower recovery time, less desirable cosmetic outcome

188
Q

30yo F w/ hx severe mitral stenosis has acute worsening sx. NSIM?

A

obtain preg test as physiologic changes of preg acutely worsen MS)

189
Q

Tx ABPA

A

GCS
itraconazole or voriconazole

(may try omalizumab, anti IgE)

190
Q

Post partum preeclampsia Tx?

A 
Mg for sz ppx
HTN control
diuretics 
O2
fluid restriction
191
Q

MC drugs to interact w/ lithium & cause toxicity?

A

NSAIDs
ACEi
thiazides

(lithium tox: N/V/D, confusion, ataxia, NM excitability)

192
Q

Lithium tox Tx?

A

IVF & HD if

  • > 4
  • > 2.5 w/ sx or AKI
  • increasing level despite IVF
193
Q

Tx sulfonylurea OD

A

dextrose

+/- octreotide if severe

194
Q

High suspicion of NF1. Which organ do you screen?

A

Eyes for optic gliomas (which cause progressive vision loss)

195
Q

Central venous cath w/ TPN. Pt develops sudden eye pain, fever & decreased visual acuity. Dx?

A

Likely candida endopthalmitis

fundoscopy: focal, glistening, mound-like lesions that may extend to vitreous causing haze

196
Q

Candida endopthalmitis Tx?

A

systemic amphotericin B x 4-6wks & vitrectomy

197
Q

Depressed sx, started on SSRI. Returns w/ manic sx. NSIM?

A

Abruptly d/c SSRI.

Then add mood stabilizer

198
Q
  • *Abx Tx for
    1. intrapartum amniotic infection VS
    2. postpartum endometritis
A
  1. ampi-genta
  2. clinda, genta
    (or ampi sulbactam)
199
Q

RF postpartum endometritis

A
  • C/S
  • intraamniotic infection
  • GBS colonization
  • PPROM
  • operative vag deliv
200
Q

Anal abscess tx?

A

i&d

abx only if

  • DM
  • severe cellulitis
  • valvular hear d
  • immunodef
201
Q

Biggest sequelae of anal abscess?

A

50% chronic fistula

202
Q

Post-extub stridor 2/2 laryngeal edema. NSIM?

A

intubate

203
Q

Pimavanserin use?

A

5HT-2A rec inverse agonist for tx of psych sx w/ parkinsons

204
Q

High output HF

Common cause?

A

hyperthyroidism

205
Q 
High output HF: high or low?
A) CVP
B) PCWP
C) C.O.
D) SVR
A

high
high
high
low

206
Q

Pregnant woman with rubella. Tx?

A

supportive

risk of infant born with:
- SNHL
- cataracts
PDA

207
Q

Congenital conditions w/

  • purpuric lesions
  • SNHL
  • HSM
A

Rubella (measles)
CMV
Toxo

208
Q

MOA of hypothyroidism in preg?

A

High E > increased hepatic synth of TBG

209
Q

Name a few things that decrease synthroid absorption

A

cholestyramine
iron
fiber
antacids

hence take it 4+ HRS APART

ALSO:

  • celiac
  • drugs that increase thyroxine met (sz)
  • obesity, preg, proteinuria
210
Q

What inhibits T4 >T3?

A

GCS
BB
PTU

(may be given during thyroid storm)

211
Q

Biliary colic sx. US w/ stones but NO wall thickening, duct dilation or pain w/ compression. NSIM?

A

HIDA if US unclear

>90% sen/spec

212
Q

Is there a copay for preventative tests?

A

NO

doesnt matter which insurance or what the deductible is

213
Q

HyperK Tx?

A

Calcium gluconate

B-agonist & insulin

214
Q

Progression of EKG findings w/ severe hyperK

A
  1. peaked T
  2. loss of P
  3. wide QRS
215
Q

Who gets PFO closure?

A

embolic-appearing cryptogenic strokes in persons UNDER 60

216
Q

Tx acute dystonic rxn

A

IV benadryl or benztropine

217
Q

Torsades Tx?

A

IV Mg

218
Q

NMS Tx?

A

dantroline

219
Q

Tx & etiology of malignant hyperthermia

A

Dantroline (just like NMS). Caused by rxt to anesthetics

220
Q

Which artery supplies the lateral L ventricle?

A

L circumfle

221
Q

Which artery supplies the infero-post wall of the L ventricle?

A

RCA

222
Q

UTI <2yo. NSIM?

A

US renal/bladder. If reccurent infections >voiding cystourethrogram

223
Q

Afib: when to start AC?

A

CHADSVASc >2

sometimes 1+

224
Q

High RF for preeclampsia?

A 
CKD
HTN
DM
mult gest
hx preeclampsia 
AI

(also ~~obesity, nulliparity, advanced age)

(prevent w/ ASA at 12w gest)

225
Q

Prevention of preeclampsia in high risk pts?

A

ASA at 12wks

226
Q

Ventillated pt initially improving but then worsening after a few days. NSIM?

A

SCx from BAL or tracheobronchial aspiration

r/o ventillator assd PNA

227
Q

Sweet spot for Tx of hypothyroidism in preg

A

Ideally- mild HYPERthyroid state to avoid risk of infant w/ hypothyroidism/goiter

228
Q

LN should be bx if persistent > ___wks

A

> 4

229
Q

Ocular pathology in NF2

A

cataracts

also bunch of peripheral nerve tumors: schannomas, meningiomas

230
Q

Caissons disease?

A

the bends

may cause osteonecrosis of the hip

231
Q

MCC osteonecrosis of the hip?

A

> 90% EtOH & GCS

Rest:

  • SLE
  • Gauchers
  • antiPhospholipid
  • HIV
  • CKD or HD
  • trauma
232
Q

When is joint decompression used?

A

sx relief in early stage of hip osteonecrosis (NOT late stages)

233
Q

Suddenly stopped GCS > weight loss, fatigue, hypOTN, brady, hypOglyc. Dx?

A

Iatrogenic adrenal insuff

234
Q

Do IVC filters affect overall mortality?

A

NO

also risk of recurrent DVT at insertion site

235
Q

What kind of procedures can cause retroperitoneal bleeds?

A

cardiac cath aortic cath

236
Q

MCC retroperitoneal bleeds

A
  • post cardiac cath
  • trauma to the lower back
  • AC
    hemorrhage 2/2 malig of retroperitoneal organs
237
Q

When to LP a febrile seizure?

A
  • AMS
  • HA/V
  • bulging fontanelle
  • nuchal rigidity
  • petechial rash
238
Q

Which SSRI is known to be more activating- insomnia/jitteriness:

  • citalopram
  • escitalopram
  • fluoxetine
A
  • fluoxetine
239
Q

Which is used to Tx lead <70

A) DMSA, succ
B) Dimercaprol 
C) EDTA
D) British Anti Lewisite
E) Calcium disodium edetate
A

A) DMSA, succ

240
Q 
Which is used to Tx lead >70?
A) DMSA, succ
B) Dimercaprol 
C) EDTA
D) British Anti Lewisite
E) Calcium disodium edetate
A

All EXCEPT A

Dimercaprol (British Anti Lewisite)

AND

EDTA (Calcium disodium edetate)

241
Q

Conditions requiring higher synthroid doses?

A
  • cholestyramine
  • iron
  • fiber
  • antacids
  • celiac
  • drugs that increase thyroxine met (sz meds)
  • obesity, preg, proteinuria
242
Q

Endocrine effects of hereditary hemochromatosis other than DM?

A

hypogonadism

hypothyroidism

243
Q

Does abx tx of strep throat prevent PSGN?

A

NO

but it prevents RF

244
Q

Tx strep throat (abx & duration)

  • no allergy
  • PNC allergy
A
  • 10 days PNC
  • 5 days azithro

(note: if cannot tolerate abx PNC IM x 1 is active for one month)

245
Q

Which is NOT a benefit of tx strep throat?
A) prevent RF
B) prevent PSGN
C) prevent complications (peritonsillar abscess, cervical LAD)
C) prevent spread to close contacts

A

B) prevent PSGN

246
Q

MAHA, LDH+. low PLT:

ITP ot TTP?

A

TTP- aslo AKI, fever, neuro sx

ITP is just isolated thrombocytopenia

247
Q

Plasma exchange is the tx of choice for which two conditions?

A

TTP

HUS

248
Q

ITP & PLT <30. Tx?

A

GCS!!
May give IVIg or antiD if Rh+

last resort: rituximab or splenectomy

(NOT plasmapheresis)

249
Q

Test for dx pernicious anemia?

A

anti IF
(50-80% sen, 100% spec)

(schillings is more cumbersome therefore second line)

250
Q

Autoimmune metaplstic atrophic gastritis

  • assd condition
  • features
  • affected parts of stomach
A
  • pernicious anemia
  • glandular atrophy, intestinal metaplasia& inflamm
  • fundus, body (NOT antrum)
251
Q

Hashimotos w/ rapidly growing goiter. Dx?

A

thyroid lymphoma

252
Q

thyroid enlargement in teen girl w/ normal labs & neg TPO. Dx?

A

Colloid goiter

253
Q

PTX. When is a chest tube preferred over needle decompression

A

IF NO TENSION PHYSIOLOGY IS PRESENT

254
Q

Thalassemia major. Tx and treatment adverse effects

A

hypertransfusion therapy (suppresses chronic effects of severe anemia & extramedullary hematopoesis)

BUT causes significant iron overload >organ damage

255
Q

Farmer/vet w/ conjunctival suffusion, N/V/D, fever, myalgia, HA. Dx?

A

Leptospirosis

If severe > jaundice (aka Weil synd)

256
Q

Characteristics of the most serious dengue infection?

A

Dengue hemorrhagic fever: Increased vasc perm > hemoconcentration, pleural effusion, ascites&raquo_space;
vasc collapse

257
Q

Normocytic anemia, next test?

A

retic

258
Q

30yo hypothyroid sx. TSH 5.6, T4 wnl. NSIM?

A

check antiTPO

If +, likely to progress to full Hashimoto, may benefit from early tx

259
Q

When do you tx subclinical hypothyroidism in 70yo +?

A

TSH >7 w/ sx

260
Q

Complications of subclinical hypothyroidism in pregnancy

A
  • recurrent miscarriages
  • severe preeclampsia
  • preterm birth
  • low birth weight
  • placental abruption
261
Q

Tx eczema herpeticum?

A

Immediate systemic acyclovir

may spread to organs: hepatitis, encephalitis, keratitis/blindness

262
Q

Trychophyton rubrum is the MCC of:

A

tinea corporis

263
Q

Infant w/ bilateral hydronephrosis, oliguria & thick bladder. Dx?

A

PUV

Also

  • weak stream
  • freq UTI
  • bladder distension

Dx: voiding cystourethrogram

Tx: cystoscopy w/ ablation

264
Q

Renal US in infant showing multiple small cysts. Dx?

A

ARPKD

NOT dominant

265
Q

Tx of posterior urethral valve?

A

cystoscopy w/ ablation

note, first use FC to relieve obstruction

266
Q

Test of choice for:

  • VUR
  • post urethral valve
A

both: voiding cystourethrogram

267
Q

Most notorious AE of valproate:

A

thrombocytopenia

hepatotoxicity

268
Q

Before starting a TCA, obtain:

A

a baseline EKG (per risk of arrhythmia)

269
Q

Peri-infarction pericarditis occurs w/in ___ days/hours of an MI

A

within 4 days

DDx Dresslers which occurs several weeks later

270
Q

Tx Peri-infarction pericarditis?

A

HIGH DOSE ASPIRIN 650 TID
(if ineffective, may add colchicine or oxycodone)

(avoid other NSAIDs or GCS as they delay myocardial healing and are a risk for ventricular septal or free wall rupture)

271
Q

Tx of:
1) Prolactinomas

VS

2) Nonfunctioning pituitary adenoma of gonadotropic-secreting cells

A
  1. dopainergic meds (ie cabergoline)
  2. if symptomatic > TRANSPHENOIDAL RESECTION
    * **dopaminergic meds have no effect on them
272
Q

Pagets
Labs?
Imaging?
Tx?

A

elevated AlkP
(Ca/Ph wnl)

*Bone scan is more sensitive than XR

XRs mixed lytic/sclerotic

Tx: bisphosphonates

273
Q

Effect of bisphosphonates or calcitonin on HL in Pagets?

A

may SLOW progression but does not reverse HL

274
Q

Amiodarone pulm disease. Tx?

A

STOP amio

If severe > GCS

275
Q

Which hyperPTH is assd w/ metabolic bone disease w/ pain & high alkP?
A) primary
B) secondary
C) tertiary

A

C) tertiary

276
Q

When are bisphosphonates recommended in ESRD?

A

theyre not

277
Q

Indications for parathyroidectomy in CKD?

A
  • persistently high Ca or Ph
  • v high PTH
  • soft tissue calcification or calciphylaxis
  • intractable bone pain
278
Q

reverse end diastolic umbilical flow seen on doppler. NSIM?

A

Delivery!

sign of impending fetal hypoxia

279
Q

Why is MgSO4 indicated in infants <32wks gestation?

A

Provides neuroprotection and decreases risk of cerebral palsy

280
Q

Graves- how do you monitor response to Tx in the first 3 months?

A

T3 & T4

TSH may remain suppressed for several months after starting tx

281
Q

Burning epigastric pain, +/- N/V, epigastric fullness. NSIM?

A

<60yo

  • Hpylo
  • EGD if high risk

> 60yo
- EGD

282
Q

Maternal serum AFP screen. What does it mean if it is:

Low?
High?

A

low: T18, T21..

high:
- multiple gest
- omphalocele
- gastroschisis
- NTD (anencephaly, spina bifida)

283
Q

HIGH Maternal serum AFP, NSIM?

A

detailed preg US

  • multiple gest
  • omphalocele
  • gastroschisis
  • NTD (anencephaly, spina bifida)
284
Q

Calcium excretion in the urine: FHH vs primary hyperPTH?

A

FHH- LOW!
<100

(unlike PTH: >300)

285
Q

tx endometritis

A

clinda/genta!

286
Q

Bilateral nipple discharge & NEG exam/imaging/labs. NSIM?

A

reassure, monitor

287
Q

Infant w/ hypertonia/hyperflexia, sustained clonus, delayed motor milestones. Dx eval?

A

MRI: periventricular leukomalacial, basal ganglia lesions

r/o cerebral palsy

288
Q

Neonatal displaced clavicular fracture tx?

A

reassurance: heals w/in wks w/o sequelae

gentle handling

289
Q

Tx legionella

A

FQ levoflox or macrolide

290
Q

Labs positive in drug induced lupus?

A

ANA

anti-histone

291
Q

Tx hydatiform mole

A

suction/curettage, then bHCG level for baseline with monthly monitor x 6 months

(note hydatiform mole is a PRE-MALIGNANT dx (RF for choriocarcinoma)

292
Q

Very severe HA, CT head negative. NSIM?

A

LP (for xanthochromia)

293
Q

Which is more sensitive in Dx SAH: CT or MRI?

A

similar

if one is negative but suspicion is high, order LP

294
Q

When is CT most sensitive for Dx of SAH?

A

2-6h

after 6h, LP!

295
Q

Lethargy, HA, V are signs of ____ during DKA Tx

A

cerebral edema (obtain CT)

296
Q

Tx ABPA

A

itraconazole & GCS

297
Q

**

Neonatal unconjugated hyperbili & jaundice/anemia 2nd/3rd day of life, Coombs neg. Dx?

A

G6PD Def

hydration & photoRx if mild/mod, exchange transfusion if more severe

298
Q

High risk feature bite:
Location?
Biter?
Timing?

A
  • extremities
  • cat/human
  • > 12h

**tx w/ 2nd intention (leave them open to heal)

299
Q

Which is NOT frequently transmitted through sex?

HBV or HCV?

A

HCV

300
Q

Caustic ingestion. NSIM?

A

Laryngoscopy to assess airway compromise

301
Q

PEP for women on OCPs

A

Cipro or Ceft x 1 (best tx is rifampin but not for OCPs as they reduce its efficacy)

302
Q

V hypovolemic pt w/ gluc 600 & hyperK. No peaked Ts. NSIM?

A

IVF

then hyperK should improve

303
Q

Indications for GCS in ITP?

A

PLT <30k OR

w/ bleed

304
Q

**Tx mild VS mod/severe croup?

A

mild: humidified air & GCS (IV/IM)

mod/severe: GCS w/ nebulized EPI

305
Q

Child

A

Tx! (croup)
Imaging ONLY if dx is unclear

mild: humidified air & GCS (IV/IM)

mod/severe: GCS w/ nebulized EPI

306
Q

Which is NOT assd w/ gynecomastia?

1) cimetidine
2) ketoconazole
3) thiazide
4) spironolactone
5) finasteride

A

3) thiazide

307
Q

MOA physiologic gynecomastia

A

Imbalance of E:T (esp obese, older men. high aromatase conversion)

308
Q

Tx active TB

A

2 months:

  • Rifampin
  • Ethambutol
  • Isoniazid

7 months:

  • Ethambutol
  • Isoniazid
309
Q

Pyridoxine AKA

A

Vit B 6

310
Q

Diabetic w/ macrocytic anemia. Possible cause?

A

Metformin decreases B12 absorp

311
Q

Contrast study is planned. When to stop & resume metformin?

A

HOLD on the day of contrast & resume 48h later if no AKI

312
Q 
Metformin is contraindicated in : renal failure
\: sepsis
\: ~CHF 
\: EtOH abuse 
AND??
A

Liver dysfunction

313
Q

When to give rabies Ig?

A

exposure and unknown hx vaccine

otherwise, always just vaccine series

314
Q

DEXA should begin at age:

A

65

315
Q

MCC HTN in <30yo?

A

aortic coarctation

renal parenchymal disease *GN > increased renal Na reabsorp)

also
~thyroid d
~fibromuscular dysplasia

316
Q

Dystonic blepharospasm. Tx?

A

Botox

317
Q

<28do w/ sepsis. Abx?

A

ampicillin & cefotaxime (AVOID ceftriaxone per risk of hyperbili)

318
Q

B sx and GIB in pt w/ celiac. Dx?

A

T cell lymphoma (jejunum)

“enteropathy assd T-cell lymphoma”

USMLE3 (3 decks)

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