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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
HyperCa w/ high 1,25 OH VitD. Which CA?
lymphoma | MOA: increase Ca absorb
26
SCC w/ HyperCa & PTHrp. Is PTH high or low?
LOW | PTHrp is high
27
MM w/ bone mets. Are the following high or low? PTHrp PTH vitD
low low low
28
Lymphoma. Are the following high or low? - Ca - PTH - vitD
- high - low - high (MOA: increased Ca absorp)
29
Chronic D, loose, foul smelling stools. Significant w.loss, malabsorp/vit def. Tx?
Metro (tinidzole) | Dx: Giardia also abd cramps/flatus
30
sp CABG > pleural effusion. Tx?
NONE if: - <25% hemithorax - asx, L-sided Thoracentesis indicated if - >25% hemithorax - symptomatic - late (>30d sp CABG) - R-sided in absence of HF
31
Features of common/benign pleural effusion sp CABG?
- small, L-sided - asx - w/in few days of CABG *seen in 60% likely 2/2 pericardial inflammation
32
Cephalohematoma OR caput succedaneum? 1) crosses suture lines 2) +/- jaundice 3) above periosteum 4) resolves in few weeks
1) CS 2) CH 3) CS 4) CH
33
Describe disorders: 1- Conduct 2. Oppositional defiant 3. Antisocial
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
34
RFs for developmental hip dysplasia?
Female Breech tight swaddling FHx
35
Abx for asx bacteriuria in pregnancy?
1. keflex 3-7d 2. amoxi-clav 3-7d 3. fosfomycin x 1 **repeat urine cx a week after
36
Asx bacteruria in preg: Do you treat it?
YES 1. keflex 3-7d 2. amoxi-clav 3-7d 3. fosfomycin x 1
37
Why are pregnancy women at increased risk for pyelonephritis?
progesterone effect on upper urinary tract - smooth muscle dil - ureteral enlargement - vesicoureteral valve dysfunction
38
ASx bacteriuria complications in preg?
- preterm birth - low birth weight - perinatal mortality
39
Abx course duration for pyelo during pregnancy?
IV abx with following abx suppression until 6 WEEKS POSTPARTUM to prevent recurrence
40
Which abx can you use for pyelo in preg?
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
41
Which UTI abx is associated w/ the following in pregnancy: 1. NTD & kernicterus 2. hemolytic anemi
1. bactrim | 2. nitrofurantoin
42
Does drug induced lupus cause renal failure?
NO
43
Massive proteinuria in elderly pt. US renal wnl, labs w/ marked AKI on CKD. Dx?
Consider analgesic induced nephropathy- often causing florid proteinuria. (Does the pt have chronic pain?)
44
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
D) saline bolus Aggressive IVF before considering pressors
45
Mammalian bite. Abx?
amoxi-clav | GB, GN, anaerobe cover
46
Mammalian bite. Abx in PNC allergic pt?
look it up!
47
DM autonomic neuropathy unique to M, Sx?
- diminished cremasteric reflex - diminished testicular sensation - bladder dysfunction - inability to masturbate
48
Nightmare disorder VS non-REM sleep arousal disorder
Nightmare: REM, detailed dream recall non-REM sleep arousal disorder: Non-REM, sleep walking, sleep terrors, little/no recall
49
Tx for peds: persistent sleepwalking if distressing
low dose benzo prog: resolves w/in 1-2yrs
50
28yo w/ 2cm tender lump in L breast. NSIM?
US - if simple >FNA - if complex cyst/mass > core bx
51
CAP Tx | Outpatient with VS without comorbs.
Healthy: - amox OR doxy Comorbs: - FQ OR b-lactam AND macrolide
52
CAP Tx: ward VS ICU?
ward: - IV FQ (levo, moxi) - IV ceftriaxone/azi ICU: - IV ceftriaxone/azi - IV ceftriaxone/FQ
53
Elderly M w/ episodic vertigo, diplopia, dysarthria, dizziness & numbness. Dx?
vertebrobasillar insufficiency (reduced blood flow in the base of the brain 2/2 emboli, thrombi, arterial dissection) RF: DM, HTN, DLP, CAD, arrhythmia
54
First line Tx of preschool age child w/ ADHD?
behavioural therapy! If persists 6yo+, use meds (stimulants or atomoxetine)
55
Which info needs to be obtained prior to starting ADHD meds in peds?
**cardiac hx & medical exam (including FHx of sudden cardiac death etc) EKG may be needed
56
Child w/ minimal response to max dose adderall for ADHD. NSIM?
switch to atomoxetine | if that fails- clonidine
57
Reactive arthritis: Etiology? Synovial results?
"Cant see cant pee cant climb a tree" GI/GU infection - Chlamydia - Campylobacter - Salmonella - Shigella - Yersinia Synovial: high WBC but no pathogens
58
Biliteral eye pain, dysuria, oligoarthritis, dactylitis, achilles enthesitis. What do you expect from the hx?
GI/GU infection - Chlamydia - Campylobacter - Salmonella - Shigella - Yersinia Dx: Reactive arthritis ***Only 30-50% are HLA-B27+
59
Reactive arthritis suspected. Tx?
Tx underlying cause NSAID GCS if severe improves in a few weeks
60
Post-op hypercapneic/hypoxic resp acidosis. ABG w/ normal A-a gradient. Tx?
Corrects with supplemental O2 | (because A-a gas exchange is intact and hypoxemia is d/t hypoventillation_
61
Preterm labor: at 34-37wks, what do you give?
- betamethasone - PNC if GBS+ or unknown **NOT RhoD Ig (fetal Rh status is checked AFTER delivery & Ig can be administered up to 72h postpartum)
62
Define acute stress disorder?
Basically PTSD but <1 month
63
How soon after breast development do you expect menarche? If pt does not have menarche by age ___, further w/u is needed. Otherwise reassure.
2-2.5yrs 15yo
64
12yo+ girl w/ short stature, no breasts, delayed bone age. Dx?
Constitutional delay of puberty
65
Amenorrhea age 15+. NSIM?
Pelvis US & FSH. | same if 13+ w/o menses AND breast development
66
Breast development age 12 hwr still no periods age 14. NSIM?
Reassure/observe If pt does not have menarche by age 15, further w/u is needed.
67
Mother is RhD+ and father is RhD-. What is the risk of hemolytic disease in the newborn?
None. Mother would have to be RhD- and father RhD+.
68
Mother is RhD- and father RhD+. Child develops hemolytic disease of the newborn even though its the first pregnancy. How?
Mother must have either had prior - miscarriage/abortion - blood transfusions
69
MCC necrotizing fasciitis?
G.A.S (Clostridium perfringens is not as common) Other causes: - S.aureus (DM w/ poor blood flow) - Pseudomonas (immunocompromised)
70
Empiric therapy for necrotizing fasciitis?
3 meds: Zocyn or Meropen - anaerobes & GAS Vanc - S.aureus/MRSA Clinda - inhibit toxin formation by staph/strep
71
What does each abx cover in terms of empiric therapy for necrotizing fasciitis? - Zocyn or Meropen - Vanc - Clinda
Zocyn or Meropen - anaerobes & GAS Vanc - S.aureus/MRSA Clinda - inhibit toxin formation by staph/strep
72
RAPID warfarin reversal required. Tx?
prothrombin complex concentrate (INR normalizes w/in 10 mins) WITH IV vitK (Second line: FFP- high vol required & delay for blood compatibility test)
73
Tx for pt w/ VWF def & minor bleed
IV desmopressin
74
Primary dysmenorrhea in virgins. Tx?
first line: NSAIDS!! | If ineffective, then try OCP OCP is first line in sexually active patients
75
``` Which is NOT a common cause of BV? A) low E B) pregnancy C) menses D) intercourse E) recent abx F) douching ```
A) low E | high E!
76
Complications of BV in preg?
``` preterm birth PPROM spontaneous abortion chorioamnionitis postpartum-endometitis ``` (note: treating it does not decrease the risk)
77
Dose of supplements in osteoporosis? Ca+ vitD
1200mg QD | 800IU QD
78
Complete unilateral facial weakness: Bells vs CVA?
BELLS!
79
Bells VS CVA
CVA can lift eyebrow & does not have droopy/weak eye
80
30yo M severe fatigue, bells, HSM, LAD. Lyme neg. NSIM?
CXR r/o sarcoidosis
81
Two most important criteria for confirming sarcoidosis?
- 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)
82
Sarcoid suspected but no easily accessible LN. NSIM?
fiberoptic bronchoscopy w/ transbronchial lung bx
83
Likely etiology of febrile seizure?
nervous system immaturity Prognosis: - higher risk of subsequent seizures - 1% increased risk of epilepsy
84
Aortic Coractation: most commonly affected demographic?
sporadic, boys | hwr Turners is notorious for it!
85
Upper extremity HTN, lower extremity hypotension. Dx?
Aortic coarctation | also weak/delayed pulses "brachiofemoral delay"
86
Rib notching & figure 3 sign. Dx?
Aortic coarctation | also weak/delayed pulses "brachiofemoral delay"
87
Parasternal heave. Assn?
RV hypertrophy
88
Large decline in BP (>10mmHg) during inspiration is associated w/?
cardiac tamponade
89
Exercise recs to reduce CVD risk?
mod aerobic >150min/wk vigorous exercise >75min/wk
90
Review METS & RCRI pre-op risk
!
91
MS spasticity Tx? | Baclofen and _____
Tizanidine
92
Which sx of MS does amantadine tx?
fatigue | also adderall or modefenil
93
Tx MS flare?
high dose GCS
94
Cryptococcal meninginitis: high/norm/low OP: WBC: protein: glucose:
v high >250 low high low
95
Normal CSF values for: WBC protein glucose
0-5 <40 40-70
96
GBS CSF values? WBC protein glucose
normal (0-5) HIGH (45-1000) normal (40-70)
97
CSF protein >500. Dx?
GBS
98
In addition to amphotericin B & flucytosine, what is used to tx cryptococcal meningitis?
serial LPs to relieve high opening pressures
99
Cryptococcal meningitis: sx improve & CSF is clean, NSIM?
STOP amphotericin & flucytosine IV START high dose PO fluconazole x 8wks then lower dose 1yr+
100
Needle stick from HIV pt with 0 viral load. NSIM?
3 agent PEP x 1month
101
35yo obese F. Intermittent epigastric discomfort radiating to the back R shoulder w/ N/V, diaphoresis. Dx test?
ULTRASOUND per biliary colic r/o cholelithiasis
102
Best test for dx cholelithiasis?
ULTRASOUND | >95% sen/spec
103
Typical biliary colic sx w/o gallstones on imaging. NSIM?
cholecytokinin stimulated cholescintigraphy to eval for functional gallbladder disorder (cholecystectomy w/ low gallb ejection)
104
Gallstone w/ typical sx. Sx improved w/ ursodeoxycholic acid. NSIM?
***CHOLECYSTECTOMY for pts who improve w/ UDCA
105
Cholecystitis suspected but US inconclusive or neg, NSIM?
HIDA
106
Visualized choledocholithiasis pr acute cholangitis. Tx?
ERCP
107
How are diminished lower extremity DTRs related to Pancoast tumors?
tumor spread to spine
108
Parkinsons w/ recurrent R/middle lobe PNA. Test to confirm dx?
Videofluoroscopic swallowing study to eval for asp PNA
109
Tx Pagets
bisphosphonates
110
Osteoclast abnormalities > increased bone turnover & abnormal remodelling. Dx & Tx?
Pagets | Tx: bisphosphonates
111
Addisons Tx?
hydrocortisone or prendnisone AND fludrocortisone
112
Weakness, N/V/abd pain, postural hypotension, weight loss. Labs: hyperK & eosinophilia. Dx?
Addisones: | also
113
Spontaneous abortion risk
- PSA - hx spont abort - BMI extremes - advanced maternal age
114
Petechiae after BP cuff. Assn?
Dengue | aka Tourniquet test+
115
``` India fever, myalgia mucosal bleed transaminitis w HSM low WBC/PLT ``` Dx?
Dengue
116
How is dengue spread?
aedes mosquito
117
Aedes mosquito is a vector for:
Dengue Chikungunya Yellow fever Zika
118
Systemic complication of compartment syndrome?
rhabdo > AKI
119
HIV: Papules w/ central umbilication & central hemorrhage. Dx?
Cutaneous cryptococcus (Dx w/ bx!!
120
When does T3 or substantially DEcrease?
sick euthyroid syndrome | hwr rT3 is elevated!
121
Euthyroid sick syndrome. High/normal/low? T3 rT3
low | high
122
Infant w/ RSV & signs of dehydration, NSIM?
hospitalize & place on CONTACT & DROPLET precautions
123
Laxatives for peds: osmotic or stimulant?
osmotic | stimulant have associated N/V,D, cramping
124
PCOS w/ persistent infertility despite weight loss. NSIM?
LETrozole *aromatase inhibitor Then clomiphene (ovulation induction LH FSH) Then IVF
125
15yo M w/ Short stature (normal growth velocity), delated bone age. Dx?
Constitutional delay of growth and puberty (late bloomer)
126
``` Which does NOT cause digoxin toxicity? A) amiodarone B) verapamil C) quinidine D) lisinopril E) spironolactone ```
D) lisinopril | ACE ARB & BB DO NOT cause dig toxicity
127
How do you modify the insulin regimen for gestational DM after delivery?
``` 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)
128
Why is A1C not reliable during pregnancy?
high RBC turnover
129
Qualifier for home health services?
Home bound (uses cane/walker etc and cannot leave house without assistance) AND require skilled assistance (med monitoring, PT, wound care)
130
Thyroid nodule, low TSH. NSIM?
iodine 123 scintigraphy
131
MEN | Type 1, 2, 3
1: Parathyroid Pituitary Panc/NE tumors 2. Parathyroid MTC Pheo ``` 3. MTC Pheo marfanoid mucosal tumors ```
132
Parathyroid: Which MEN?
1 & 2 1: Parathyroid Pituitary Panc/NE tumors 2. Parathyroid MTC Pheo
133
Marfanoid: Which MEN?
3 ``` 3. MTC Pheo marfanoid mucosal tumors ```
134
Medullary CA: Which MEN?
2 & 3 2. Parathyroid MTC Pheo ``` 3. MTC Pheo marfanoid mucosal tumors ```
135
Pituitary tumor: Which MEN?
1 & 2 1: Parathyroid Pituitary Panc/NE tumors
136
Gastrinoma: Which MEN?
1 1: Parathyroid Pituitary Panc/NE tumors
137
Lactational mastitis. Tx?
PO dicloxacillin or keflex
138
Lactational mastitis. No improvement w/ abx. NSIM?
Ultrasound w/ FNA to r/o inflammatory breast CA. Dont go straight to I&D (abcess)
139
HIV pt w/ TB started on HAART & TB meds. 4wks later recurrent fever/cough, worsened infiltrate. NSIM?
``` Continue meds (Dx: IRIS, can give NSAIDs or short course of GCS) ```
140
Is renal US used to monitor progression of ADPKD?
NO
141
ADPKD diagnosed. Do you screen for berry aneurysms?
Only if FHx or personal hx of IC bleed
142
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?
meconium ileus r/o CF as this is pathomnemonic
143
``` LOW Hgb LOW PLT LOW haptoglobin HIGH bleed time NORM PT/PTT ``` w/ AKI & fever. Dx?
TTP
144
Tx TTP
**plasma exchange GCS rituximab
145
Rapid enlarging locally aggressive, benign tumor assd w/ FAP. Dx?
desmoid tumor | *high recurrence
146
Constrictive pericarditis causes R or L HF?
RIGHT | > edema, ascites, hepatic congestion
147
Clinical signs of constrictive pericarditis?
``` JVD ascites periph edema Kussmauls sign hepatojugular reflex pericardial knock ``` pericardial calcific low voltage QRS'
148
How to measure delta pressure in compartment synd?
DBP - compartment pressure. If <20-30 = severe Otherwise compartment pressure >30 is diagnostic
149
Arterial occlusion L foot, managed w/ thrombectomy. Few hours later foot paresthesias. Dx?
r/o compartment syndrome *post-ischemic CS due to interstitial edema and possible intracellular swelling sp tissue ischemia
150
dsDNA VS antiSMith Which is 1. More sensitive 2. More specific 3. Used for monitoring SLE 4. Assd w/ development of lupus nephritis
1. dsDNA 2. antiSmith 3. dsDNA 4. dsDNA
151
anti-mitochrondrial abs
primary biliary cirrhosis
152
First line Tx SLE
low GCS & plaquenil
153
ASP PNA Tx?
Clinda OR amoxi-clav (beta lactam w/ b lactamase inhibitor)
154
High FENa means: | Low FENa means:
>2% ATN | <1% prerenal
155
Oliguria sp hypotensive episode. High FENa. Dx?
ATN (also muddy brown casts)
156
Oliguria sp hypotensive episode. High FENa. Why is this not PRErenal AKI?
prerenal FENa is LOW
157
*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
STOP IVF. If pt is euvolemic but remains oliguric you put them at risk of fluid overload w/ continued fluids
158
LOOK UP - Pemphigoid gestationis - Pruritic folliculitis of pregnancy - pustular psoriasis of pregnancy
Note Tx of pemphigoid gestationis is topical triamcinolone & PO antihistamines
159
Definitive Tx of intrahepatic cholestasis of pregnancy
Delivery | hwr ursodeoxycholic acid improves sx
160
Tx asx bacteruria in pregnancy?
- amoxi-clav x 3-7d - keflex x 3-7d - fosfomycin x 1
161
Acute pancreatitis, TG 1000. After resolution of AP, which med do you prescribe?
Lifelong fibrate
162
Tx of TG-induced pancreatitis?
insulin (or apheresis)
163
Lichen planus disease assn?
HCV
164
Precautions for local VS dissem VZV?
Local- standard, lesion cover Dissem- contact & airbourne
165
Alcoholic w/ bloody vomiting. Why not use an NGT to aspirate stomach contents?
may cause further variceal rupture if present
166
Variceal bleed agents for management & prevention?
Tx: ligation octreotide/PPI drip PPx: nadolol or propanolol to reduce splanchnic pressure
167
When is prednisone used in Tx of Graves?
significant opthalmopathy
168
Labs used to monitor efficacy of antithyroid drugs?
Total T3 & T4 | ***TSH may be suppressed for several months (does not reliably reflect thyroid functional status)
169
HBV fingerstick. Nurse is HepB surface Ab NEGATIVE. PEP?
HBV vax and Ig
170
HBV fingerstick. Nurse is HepB surface Ab POSITIVE. PEP?
No intervention
171
5yo boy w/ focal PNA. MCC & abx?
S. pneumo high dose amoxicillin Note: if CXR w/ diffuse findings in older child MCC: Mycoplasma, Tx azithro
172
First line Tx for juvenile myoclonic epilepsy
valproate
173
Teen w/ hx poor sleep or EtOH has seizure in first hour of waking. EEG showing bilateral polyspike & slow wave activity. NSIM?
start valproate | dx: juvenile myoclonic epilepsy
174
Infantile spasms. Tx?
ACTH and vigabatrin
175
Pt on valproate w/ acute abd pain. Dx?
Valproic acid may cause life-threatening hepatitis & pancreatitis. Another known AE: THROMBOCYTOPENIA
176
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) non-dom parietal | if it was dominant: Gerstmann synd: acalculia, finger agnosia, R/L side of body confusion
177
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
B) dom parietal Gerstmann synd
178
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
C) non-dom temporal
179
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
D) dom temporal
180
90% of R-handed patients and 60% of L-handed patients have (left/right?) hemisphere dominance in speech/language functions.
LEFT
181
Leuprolide use?
Tx for endometriosis, fibroids or precocious puberty. | MOA GnRH agonist hence constant GnRH release VS pulsatile release required for release of LH/FSH
182
High Ca+ and high PTH are due to: 1. primary hyperPTH 2. ? 3. ?
familial hypercalciuric hypercalcemia lithium
183
HyperCa in teen hospitalized x 3 weeks sp MVA. Tx?
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
MOA hyperCa in TB and Sarcoidosis?
High extrarenal 1,25-vitD production
185
Chronic pelvic pain, dysmenorrhea, deep dyspareunia. Tx?
NSAIDs +/- OCPs (unless Hx infert, concern for malig, contraindications to above) Dx: Endometriosis
186
Tx lactational mastitis
PO dicloxacillin | or keflex
187
Lactational mastitis > abscess. Tx?
US then FNA | I&D is last resort! May cause milk fistulas, slower recovery time, less desirable cosmetic outcome
188
30yo F w/ hx severe mitral stenosis has acute worsening sx. NSIM?
obtain preg test as physiologic changes of preg acutely worsen MS)
189
Tx ABPA
GCS itraconazole or voriconazole (may try omalizumab, anti IgE)
190
Post partum preeclampsia Tx?
``` Mg for sz ppx HTN control diuretics O2 fluid restriction ```
191
MC drugs to interact w/ lithium & cause toxicity?
NSAIDs ACEi thiazides (lithium tox: N/V/D, confusion, ataxia, NM excitability)
192
Lithium tox Tx?
IVF & HD if - >4 - >2.5 w/ sx or AKI - increasing level despite IVF
193
Tx sulfonylurea OD
dextrose | +/- octreotide if severe
194
High suspicion of NF1. Which organ do you screen?
Eyes for optic gliomas (which cause progressive vision loss)
195
Central venous cath w/ TPN. Pt develops sudden eye pain, fever & decreased visual acuity. Dx?
Likely candida endopthalmitis | fundoscopy: focal, glistening, mound-like lesions that may extend to vitreous causing haze
196
Candida endopthalmitis Tx?
systemic amphotericin B x 4-6wks & vitrectomy
197
Depressed sx, started on SSRI. Returns w/ manic sx. NSIM?
Abruptly d/c SSRI. | Then add mood stabilizer
198
* *Abx Tx for 1. intrapartum amniotic infection VS 2. postpartum endometritis
1. ampi-genta 2. clinda, genta (or ampi sulbactam)
199
RF postpartum endometritis
- C/S - intraamniotic infection - GBS colonization - PPROM - operative vag deliv
200
Anal abscess tx?
i&d abx only if - DM - severe cellulitis - valvular hear d - immunodef
201
Biggest sequelae of anal abscess?
50% chronic fistula
202
Post-extub stridor 2/2 laryngeal edema. NSIM?
intubate
203
Pimavanserin use?
5HT-2A rec inverse agonist for tx of psych sx w/ parkinsons
204
High output HF | Common cause?
hyperthyroidism
205
``` High output HF: high or low? A) CVP B) PCWP C) C.O. D) SVR ```
high high high low
206
Pregnant woman with rubella. Tx?
supportive risk of infant born with: - SNHL - cataracts PDA
207
Congenital conditions w/ - purpuric lesions - SNHL - HSM
Rubella (measles) CMV Toxo
208
MOA of hypothyroidism in preg?
High E > increased hepatic synth of TBG
209
Name a few things that decrease synthroid absorption
cholestyramine iron fiber antacids hence take it 4+ HRS APART ALSO: - celiac - drugs that increase thyroxine met (sz) - obesity, preg, proteinuria
210
What inhibits T4 >T3?
GCS BB PTU (may be given during thyroid storm)
211
Biliary colic sx. US w/ stones but NO wall thickening, duct dilation or pain w/ compression. NSIM?
HIDA if US unclear | >90% sen/spec
212
Is there a copay for preventative tests?
NO | doesnt matter which insurance or what the deductible is
213
HyperK Tx?
Calcium gluconate B-agonist & insulin
214
Progression of EKG findings w/ severe hyperK
1. peaked T 2. loss of P 3. wide QRS
215
Who gets PFO closure?
embolic-appearing cryptogenic strokes in persons UNDER 60
216
Tx acute dystonic rxn
IV benadryl or benztropine
217
Torsades Tx?
IV Mg
218
NMS Tx?
dantroline
219
Tx & etiology of malignant hyperthermia
Dantroline (just like NMS). Caused by rxt to anesthetics
220
Which artery supplies the lateral L ventricle?
L circumfle
221
Which artery supplies the infero-post wall of the L ventricle?
RCA
222
UTI <2yo. NSIM?
US renal/bladder. If reccurent infections >voiding cystourethrogram
223
Afib: when to start AC?
CHADSVASc >2 | sometimes 1+
224
High RF for preeclampsia?
``` CKD HTN DM mult gest hx preeclampsia AI ``` (also ~~obesity, nulliparity, advanced age) (prevent w/ ASA at 12w gest)
225
Prevention of preeclampsia in high risk pts?
ASA at 12wks
226
Ventillated pt initially improving but then worsening after a few days. NSIM?
SCx from BAL or tracheobronchial aspiration | r/o ventillator assd PNA
227
Sweet spot for Tx of hypothyroidism in preg
Ideally- mild HYPERthyroid state to avoid risk of infant w/ hypothyroidism/goiter
228
LN should be bx if persistent > ___wks
>4
229
Ocular pathology in NF2
cataracts | also bunch of peripheral nerve tumors: schannomas, meningiomas
230
Caissons disease?
the bends | may cause osteonecrosis of the hip
231
MCC osteonecrosis of the hip?
>90% EtOH & GCS Rest: - SLE - Gauchers - antiPhospholipid - HIV - CKD or HD - trauma
232
When is joint decompression used?
sx relief in early stage of hip osteonecrosis (NOT late stages)
233
Suddenly stopped GCS > weight loss, fatigue, hypOTN, brady, hypOglyc. Dx?
Iatrogenic adrenal insuff
234
Do IVC filters affect overall mortality?
NO | also risk of recurrent DVT at insertion site
235
What kind of procedures can cause retroperitoneal bleeds?
cardiac cath aortic cath
236
MCC retroperitoneal bleeds
- post cardiac cath - trauma to the lower back - AC hemorrhage 2/2 malig of retroperitoneal organs
237
When to LP a febrile seizure?
- AMS - HA/V - bulging fontanelle - nuchal rigidity - petechial rash
238
Which SSRI is known to be more activating- insomnia/jitteriness: - citalopram - escitalopram - fluoxetine
- fluoxetine
239
Which is used to Tx lead <70 ``` A) DMSA, succ B) Dimercaprol C) EDTA D) British Anti Lewisite E) Calcium disodium edetate ```
A) DMSA, succ
240
``` Which is used to Tx lead >70? A) DMSA, succ B) Dimercaprol C) EDTA D) British Anti Lewisite E) Calcium disodium edetate ```
All EXCEPT A Dimercaprol (British Anti Lewisite) AND EDTA (Calcium disodium edetate)
241
Conditions requiring higher synthroid doses?
- cholestyramine - iron - fiber - antacids - celiac - drugs that increase thyroxine met (sz meds) - obesity, preg, proteinuria
242
Endocrine effects of hereditary hemochromatosis other than DM?
hypogonadism | hypothyroidism
243
Does abx tx of strep throat prevent PSGN?
NO | but it prevents RF
244
Tx strep throat (abx & duration) - no allergy - PNC allergy
- 10 days PNC - 5 days azithro (note: if cannot tolerate abx PNC IM x 1 is active for one month)
245
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
B) prevent PSGN
246
MAHA, LDH+. low PLT: | ITP ot TTP?
TTP- aslo AKI, fever, neuro sx | ITP is just isolated thrombocytopenia
247
Plasma exchange is the tx of choice for which two conditions?
TTP | HUS
248
ITP & PLT <30. Tx?
GCS!! May give IVIg or antiD if Rh+ last resort: rituximab or splenectomy (NOT plasmapheresis)
249
Test for dx pernicious anemia?
anti IF (50-80% sen, 100% spec) (schillings is more cumbersome therefore second line)
250
Autoimmune metaplstic atrophic gastritis - assd condition - features - affected parts of stomach
- pernicious anemia - glandular atrophy, intestinal metaplasia& inflamm - fundus, body (NOT antrum)
251
Hashimotos w/ rapidly growing goiter. Dx?
thyroid lymphoma
252
thyroid enlargement in teen girl w/ normal labs & neg TPO. Dx?
Colloid goiter
253
PTX. When is a chest tube preferred over needle decompression
IF NO TENSION PHYSIOLOGY IS PRESENT
254
Thalassemia major. Tx and treatment adverse effects
hypertransfusion therapy (suppresses chronic effects of severe anemia & extramedullary hematopoesis) BUT causes significant iron overload >organ damage
255
Farmer/vet w/ conjunctival suffusion, N/V/D, fever, myalgia, HA. Dx?
Leptospirosis If severe > jaundice (aka Weil synd)
256
Characteristics of the most serious dengue infection?
Dengue hemorrhagic fever: Increased vasc perm > hemoconcentration, pleural effusion, ascites >> vasc collapse
257
Normocytic anemia, next test?
retic
258
30yo hypothyroid sx. TSH 5.6, T4 wnl. NSIM?
check antiTPO | If +, likely to progress to full Hashimoto, may benefit from early tx
259
When do you tx subclinical hypothyroidism in 70yo +?
TSH >7 w/ sx
260
Complications of subclinical hypothyroidism in pregnancy
- recurrent miscarriages - severe preeclampsia - preterm birth - low birth weight - placental abruption
261
Tx eczema herpeticum?
Immediate systemic acyclovir | may spread to organs: hepatitis, encephalitis, keratitis/blindness
262
Trychophyton rubrum is the MCC of:
tinea corporis
263
Infant w/ bilateral hydronephrosis, oliguria & thick bladder. Dx?
PUV Also - weak stream - freq UTI - bladder distension Dx: voiding cystourethrogram Tx: cystoscopy w/ ablation
264
Renal US in infant showing multiple small cysts. Dx?
ARPKD | NOT dominant
265
Tx of posterior urethral valve?
cystoscopy w/ ablation | note, first use FC to relieve obstruction
266
Test of choice for: - VUR - post urethral valve
both: voiding cystourethrogram
267
Most notorious AE of valproate:
thrombocytopenia hepatotoxicity
268
Before starting a TCA, obtain:
a baseline EKG (per risk of arrhythmia)
269
Peri-infarction pericarditis occurs w/in ___ days/hours of an MI
within 4 days | DDx Dresslers which occurs several weeks later
270
Tx Peri-infarction pericarditis?
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
Tx of: 1) Prolactinomas VS 2) Nonfunctioning pituitary adenoma of gonadotropic-secreting cells
1. dopainergic meds (ie cabergoline) 2. if symptomatic > TRANSPHENOIDAL RESECTION * **dopaminergic meds have no effect on them
272
Pagets Labs? Imaging? Tx?
elevated AlkP (Ca/Ph wnl) *Bone scan is more sensitive than XR XRs mixed lytic/sclerotic Tx: bisphosphonates
273
Effect of bisphosphonates or calcitonin on HL in Pagets?
may SLOW progression but does not reverse HL
274
Amiodarone pulm disease. Tx?
STOP amio If severe > GCS
275
Which hyperPTH is assd w/ metabolic bone disease w/ pain & high alkP? A) primary B) secondary C) tertiary
C) tertiary
276
When are bisphosphonates recommended in ESRD?
theyre not
277
Indications for parathyroidectomy in CKD?
- persistently high Ca or Ph - v high PTH - soft tissue calcification or calciphylaxis - intractable bone pain
278
reverse end diastolic umbilical flow seen on doppler. NSIM?
Delivery! | sign of impending fetal hypoxia
279
Why is MgSO4 indicated in infants <32wks gestation?
Provides neuroprotection and decreases risk of cerebral palsy
280
Graves- how do you monitor response to Tx in the first 3 months?
T3 & T4 | TSH may remain suppressed for several months after starting tx
281
Burning epigastric pain, +/- N/V, epigastric fullness. NSIM?
<60yo - Hpylo - EGD if high risk >60yo - EGD
282
Maternal serum AFP screen. What does it mean if it is: Low? High?
low: T18, T21.. high: - multiple gest - omphalocele - gastroschisis - NTD (anencephaly, spina bifida)
283
HIGH Maternal serum AFP, NSIM?
detailed preg US - multiple gest - omphalocele - gastroschisis - NTD (anencephaly, spina bifida)
284
Calcium excretion in the urine: FHH vs primary hyperPTH?
FHH- LOW! <100 (unlike PTH: >300)
285
tx endometritis
clinda/genta!
286
Bilateral nipple discharge & NEG exam/imaging/labs. NSIM?
reassure, monitor
287
Infant w/ hypertonia/hyperflexia, sustained clonus, delayed motor milestones. Dx eval?
MRI: periventricular leukomalacial, basal ganglia lesions r/o cerebral palsy
288
Neonatal displaced clavicular fracture tx?
reassurance: heals w/in wks w/o sequelae gentle handling
289
Tx legionella
FQ levoflox or macrolide
290
Labs positive in drug induced lupus?
ANA | anti-histone
291
Tx hydatiform mole
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
Very severe HA, CT head negative. NSIM?
LP (for xanthochromia)
293
Which is more sensitive in Dx SAH: CT or MRI?
similar | if one is negative but suspicion is high, order LP
294
When is CT most sensitive for Dx of SAH?
2-6h after 6h, LP!
295
Lethargy, HA, V are signs of ____ during DKA Tx
cerebral edema (obtain CT)
296
Tx ABPA
itraconazole & GCS
297
** | Neonatal unconjugated hyperbili & jaundice/anemia 2nd/3rd day of life, Coombs neg. Dx?
G6PD Def | hydration & photoRx if mild/mod, exchange transfusion if more severe
298
High risk feature bite: Location? Biter? Timing?
- extremities - cat/human - >12h **tx w/ 2nd intention (leave them open to heal)
299
Which is NOT frequently transmitted through sex? HBV or HCV?
HCV
300
Caustic ingestion. NSIM?
Laryngoscopy to assess airway compromise
301
PEP for women on OCPs
Cipro or Ceft x 1 (best tx is rifampin but not for OCPs as they reduce its efficacy)
302
V hypovolemic pt w/ gluc 600 & hyperK. No peaked Ts. NSIM?
IVF then hyperK should improve
303
Indications for GCS in ITP?
PLT <30k OR | w/ bleed
304
**Tx mild VS mod/severe croup?
mild: humidified air & GCS (IV/IM) mod/severe: GCS w/ nebulized EPI
305
Child
Tx! (croup) Imaging ONLY if dx is unclear mild: humidified air & GCS (IV/IM) mod/severe: GCS w/ nebulized EPI
306
Which is NOT assd w/ gynecomastia? 1) cimetidine 2) ketoconazole 3) thiazide 4) spironolactone 5) finasteride
3) thiazide
307
MOA physiologic gynecomastia
Imbalance of E:T (esp obese, older men. high aromatase conversion)
308
Tx active TB
2 months: - Rifampin - Ethambutol - Isoniazid 7 months: - Ethambutol - Isoniazid
309
Pyridoxine AKA
Vit B 6
310
Diabetic w/ macrocytic anemia. Possible cause?
Metformin decreases B12 absorp
311
Contrast study is planned. When to stop & resume metformin?
HOLD on the day of contrast & resume 48h later if no AKI
312
``` Metformin is contraindicated in : renal failure : sepsis : ~CHF : EtOH abuse AND?? ```
Liver dysfunction
313
When to give rabies Ig?
exposure and unknown hx vaccine | otherwise, always just vaccine series
314
DEXA should begin at age:
65
315
MCC HTN in <30yo?
aortic coarctation renal parenchymal disease *GN > increased renal Na reabsorp) also ~thyroid d ~fibromuscular dysplasia
316
Dystonic blepharospasm. Tx?
Botox
317
<28do w/ sepsis. Abx?
ampicillin & cefotaxime (AVOID ceftriaxone per risk of hyperbili)
318
B sx and GIB in pt w/ celiac. Dx?
T cell lymphoma (jejunum) "enteropathy assd T-cell lymphoma"

USMLE3 (3 decks)

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