Q Bank 3 Flashcards
(158 cards)
1
Q
viral uri syx with abrupt onset?
A
influenza like illness
2
Q
Nonthrobocytopenic palpable purpura
colicky abdominal pain
Arthritis
dx?
A
Henoch-Schonlein purpura
3
Q
At what heights should you think about Marfan’s?
A
70 - female
72 - male
+ 2 other common findings (ie myopia, long arms)
Strongly consider ECHO for MVP
4
Q
which bed wetting treatment has highest cure rate and lowest relapse rate?
A
Bed alarms
5
Q
When can you get a false positive on UDS?
A
Eating poppy seed muffins
It only takes one
6
Q
Ottawa ankle rules
A
Can’t take 4 weight bearing steps
Get Xray if pain: over malleolar zone, TTP over posterior edge of malleolus or midpoint or base of 5th metatarsal/navicular
7
Q
Parasitic disease that if untreated leads to cardiomyopathy, heart failure, fatal arrhythmia
A
American trypanosomiasis (Chagas disease)
common to Central America
vector - kissing bug
8
Q
Long term outcomes of trichomonas
A
infertility, poor birth outcomes
9
Q
Long term outcome of cysticercosis?
A
epilepsy
10
Q
Head/neck LN most likely to be cancerous?
A
Supraclavicular
11
Q
Dosing of RhoGAM
A
If < 12 wks –> 50ug
If >12 weeks –> 300 ug
Give to all Rh - pregnancies with bleeding
12
Q
most common nutritional deficiency?
A
Iron
13
Q
28 wk gravid
O-, Ab+
What does this mean?
A
Fetus is at risk of hemolytic dz but only if father is Rh+
14
Q
Most common complication after Roux-en Y bypass
A
Iron and B12 definciency
NOT dumping syndromes (rare apparently)
15
Q
1 y/o has microcytic anemia, next?
A
tx w/ po iron
NOT additional bloodwork
If failure to respond then you do a work up
16
Q
most sensitive method for identifying risk for postoperative bleeding?
A
Bleeding history
NOT coats
17
Q
Scabies are primarily transmitted through?
A
direct contact
18
Q
electrosurgical destruction in contraindicated for which type of skin lesion?
A
Melanoma
(also use of pacemaker)
Basal cell can be treated with electrosurgery
19
Q
How to drain a felon?
A
High lateral incision OR volar longitudinal incision OR high lateral incision
20
Q
young adult w/ fever, fatigue, weight loss, diarrhea x 2 months with palpable mass in RLQ. most likely dx?
A
Crohn’s
this pattern of syx is characteristic when Crohn’s affects the distal small intestine (regional enteritis)
21
Q
pt has erythroderma and fever, leukocytosis with 20% EOS, elevated LFTs. Dx?
A
Drug run with eosinophilia and systemic symptoms (DRESS syndrome)
stop offending meds - anti seizure meds, allopurinol
Start steroids
22
Q
Characteristic findings in secondary hyperaldosteronism
A
Sodium retention (decreased Ur sodium) Increased potassium secretion
23
Q
preferred imaging for dx of appendicitis?
A
spiral CT (sensitive 97%, specificity 98%) NOT US - kid was 15
24
Q
What happens if you start ACEI in a pt with renovascular HTN?
A
Increased Cr, HyperK+
25
Fancy name for target rash
erythema migrans
26
Scattered individual purple macules on ankles and wrists. Dx?
Rocky Mountain spotted fever
27
dry scaling dark red rash in groin with an active border and centra clearing. Dx?
Tinea cruris
28
migratory pruritic erythematous population eruption. dx?
uticaria
29
Pt wants to stop Pradaxa and switch to warfarin. How?
Start warfarin now and stop dabigatran in 3 days
| Dabigatran does raise INR, won't see the real INR until it has been stopped for 2 days
30
Mech of action of metformin
Inhibit glucose production by liver
31
Tx for air hunger in hospice pt
Morphine
Use haloperidol for n/v and delirium
Use scopolamine for secretions
32
hypothyroid pt gets preggo. How do you manage?
Will need more thyroid hormone
Increase to 9 doses/weekly (take extra dose on 2 days/wk)
Frequent TSH/T4 to guide dosage
33
Pt with FOOSH, + fx of radius has hyperCa and found to have hyperPTH. Now what?
Refer to surgery for parathyroidectomy
| Indicated in PTH + fragility fx
34
Factor V leiden is associated with?
DVTs
35
Infant has conjunctivitis and gram Stan is gram neg diplococci. next?
IM CTX
| NOT topicals - ppx only
36
helpful treatment in the common cold?
Ipratropium nasal spray (Atrovent)
| The only recommended tx to help with colds. Helps with cough and rhinorrhea
37
when should a preggo get live virus vaccine?
immediate post partum
38
what labs should be checked before starting reclast (bisphosphonate) for osteoporosis?
GFR
| Ca2+ (hypocalcemia is contraindication to bisphosphonate
39
pathognomonic exam finding for SCFE?
Limited internal rotation of the flexed hip
40
Osmotic demyelination (central pontine myelinolysis) occurs from too rapid correction of?
Hyponatremia
41
what can help prevent melanoma?
Avoiding hormones
| High potency broad spectrum sunscreen
42
pt presents with episodes of hypoxia, no finding on CXR. He is doing basement projects. Dx?
Hypersensitivity pneumonitis
Relapsing/remitting episodes that occur after exposure to fungus
tx - avoidance
43
What other metabolic abnormality if seen in CKD 4
HyperPTH
44
Resevoir for hantavirus?
Deer mice
45
How to calculate negative predictive value
True negative/(all those that tested negative)
46
PCOS increases risk for which carcinoma?
Endometrial
47
cardiac rhythm in anorexia?
Brady
48
Tx for gonorrhea
250mg IM CTX
49
how do you counsel laboring pt interested in regional analgesia.
Increases the risk of instrument assisted van delivery
50
Toddler w/ behavioral probs, on exam long wide protruding ears, elongated face, frontal bossing, macrocephaly. Dx?
Fragile X syndrome
| At puberty get prominent jaw and macro-orchidist
51
microbrachycephaly, maxillary hyperplasia, large mouth, prognathism
Angelman syndrome
52
Narrow distance between temples, almond shaped eyes, thin upper lip. Dx?
Trader-Wili syndrome
53
Mechanism of action of sevelamer in CKD pts
Blocks intestinal absorption of phosphate which lowers PTH hormone secretion. End goal is to prevent hypercalcemia from secondary hyperPTH
54
Tx for otitis externa
TOP cipro/dexamethasone
| this is safe to use even if you are not sure if TM is intact
55
Tx for childhood OSA
Adenotonsillectomy
| poor cpap compliance in kids
56
acidification of the urine is helpful with which type of renal stone?
calcium phosphate (struvite stone)
for all others acidic urine promotes formation
cranberry juice or betaine lower urine pH
57
10 y/o has heel pain during first few minutes of playing sport. Never at walk. No TTP over achilles. + b/l heel pain with passive dorsiflex of ankles. Dx?
Calcaneal apophysisitis (Sever disease)
Usually kids 5-11
Tight chilles is pulling on the posterior calcaneus with running/jumping causing micro trauma
NL Xray
Tx avoid painful activity, NSAIDs, ice, stretch
58
1st line study to dx endometriosis?
TVUS
59
Tx for non inflammatory acne
topical retinoids
60
Tx for mild to moderate inflammatory or mixed acne
TOP abx
61
13 y/o with limp
| R hip: decreased internal rotation. Hip externally rotates involuntarily with passive flexion. Dx?
SCFE
| Needs surgery - no weight bearing
62
pretibial myxedema is a cutaneous manifestation of?
```
Graves dz (can present in hypo or hyper thyroid phase)
Increased deposition of mucin
```
63
healthy pt, 3 mo h/o hoarseness w/o syx. Next?
Laryngoscopy
| NOT PPI trial
64
Who needs US for AAA screening?
Men 65-75 who have ever smoked
65
PNA + AMS + hyponatremia. Etiology?
Legionella
66
Pt after stenting for ACS is on statin, ASA, AACEI, HCTZ. What is missing?
beta block
67
FEV1/FVC 60%, on CT bronchial wall thickening and luminal dilation. Dx?
Bronchiectasis
68
Length of DVT ppx after hip replacement
35 days
69
Tx for mag toxicity
Calcium gluconate
| Can use calcium chloride if central line is available
70
why do we prefer methimazole over propylthiouracil for hyperthyroid?
propylthiouracil is associated with severe hepatotoxicity
71
best strategy to get long term pain relief from lateral epicondylitis?
Modify work/activity
72
GBS ppx intrapartum for pt with PCN allergy (rash, itch)
Cefazolin
| IF there is a risk of anaphylaxis may consider vanc vs. Glinda
73
CENTOR criteria
Fever
Exudate
anterior cervical N
Absence of cough
74
What pain med is contraindicated in compensated cirrhosis?
Naproxen
NOT Tylenol
NSAIDs should be avoided in cirrhosis d/t risk of precipitating hepatorenal syndrom
Tyl can be taking in cirrhosis in 2-3g/day doses
75
Tx for corynebacterium minutissimum
Erythromycin
| AKA erythrasma
76
Pt has trauma syx after an accident two weeks ago. Dx?
Acute stress disorder
| PTSD when syx present > 1 month
77
pt with exertion claudication, ABI is 1.45. Next?
Get MR or CT angio of lower extremities
Can have PAD with ABI > 1.4, this suggests the vessels are so calcified that they cannot be compressed
Need imaging to confirm if PAD is present
78
Pt has chronic cough, worked in navy ship yard for 40 years. worry for?
asbestos
79
obese M pt is concerned about increased breast tissue, no glandular tissue appreciated on palpation. Dx?
pseudogynecomastia
| Increase in subareolar fat 2/2 obesity
80
Most likely to cause hypoglycemia in elderly?
Glyburide (sulfonylurea)
| More likely to cause hypoglycemia than Glipizide
81
What is Ramsay Hunt
Shingles of the facial n.
Can present with palsy
Painful vesicles in side of palate and ipsilateral ear
Can also have vomiting, vertigo
- Tx acyclovir, pred
- HSV wouldn't typically spread to oral cavity and ear
82
Extracorporeal shock wave therapy to the shoulder is helpful with?
Calcific tendinitis
| NOT frozen shoulder
83
Risk factors for still birth
AMA
smoking > 0.5ppd
congenital anomalies
BMI >30
84
Tx for borderline personality disorder
No pharmacotherapy currently available
| Dialectic behavioral therapy (DBT) is the most promising
85
1st line for HTN in pregnancy
labetalol
| nifed (but not IR d/t hypotension)
86
Most common cause of infectious endocarditis?
Staph aureus
| 2nd - Strep viridian's
87
Kiddo has fever and knee pain with fairly normal exam. Next?
CBC, CRP, ESR
88
Tx for low libido in otherwise healthy female?
TOP testosterone
| Dx if 1) have absence of sexual desire, 2) pt is bothered by it
89
Tx for Jarisch-Herxheimer rxn?
Reassurance and antipyretics
90
When should aysx patient with no risk factors be screened for T2DM?
45 y/o
91
risk of long term tamoxifen?
Endometrial CA
92
pts on letrozole are more likely to have which syx compared to pts on tamoxifen?
Myalgias and non inflammatory arthralgia
93
Macrocytic anemia
thrombocytopenia
Neutropenia
Dx?
Myelodysplastic syndrome
| Blood malignancy with predisposition for leukemic transformation
94
asthma less than once or twice weekly, <2 nighttime awakenings a month
Intermittent
95
asthma syx > 2days/week but not daily, nighttime awakening 3-4x/month, SABA >2days/week but not daily. Minor limitation in daily acitivity
Mild persistent
96
asthma syx daily, nighttime awakenings weekly but not nightly, daily SABA with some limitations in activity. FEV1 60-80%
Moderate persistent
97
asthma syx throughout day, nightly awakenings. SABA multiple times a day
Severe persistent
98
1st line tx for depression in pregnancy
SSRI
Fluoxetine, sertraline, citalopram
avoid paroxetine
99
What is the concept behind accountable care organizations?
Deliver more efficient, high quality services by encouraging cooperation between health care providers
100
Does identifying a mallory weiss tear on EGD in pt with VSS and no active bleeding change management?
No can still d/c on PPI
101
what are the timing rules for rotavirus vx
Do not start after 15 wks of age
| do not doses after 8 months of age
102
when occiput is posterior, pt is less likely to?
have a SVD
| high risk for c-section of VBAC
103
Tx for mallet fx (unable to extend finger on exam)
Splint in full extension x 8 weeks
104
apparently this is a way you can treat depression in a patient with only 2-3 weeks to live
Methylphenidate (Ritalin)
| SSRIs will take at least 4 weeks where are Ritalin could help within days
105
Tx for bell's palsy
steroids
| Antivirals have little benefit
106
Pt given course of azithromycin for CAP. After completing abx CXR shows he still has a single thin-walled cavity in LLL. Tx?
Clindamycin
Likely PNA was caused by anaerobes that weren't covered by azithro
Flagyl isn't as good as covering pulmonary anaerobes
107
who is legally responsible for notifying a pt about a mammogram result?
The facility performing the test
108
Difference between heat exhaustion and heat stroke?
Heat stroke is more severe and has some element of CNS dysfunction
109
When does NSGY deceit a intracerebral hemorrhage?
When it is a cerebellar hemorrhage
Lower SBP if >180
Reverse INR if > 1.5
110
PNA pt rapidly deteriorates and is intubated. BNP normal. Dx?
ARDS
111
Tx for endometrial hyperplasia w/o atypia
Progestational drugs
Convert proliferative endometrium to a secretory one causing a withdrawal bleed
Most common is cyclical proverb 14 days/mo. IUDs also work
IF medical management fails then you can explore endometrial ablation or hysterectomy
112
Varicella non immune mom had varicella at 38 week gestation. has healthy infant at 40 weeks. Now what?
observe
| NO IVIG or vax
113
Tx for travelers diarrhea
Azithromycin
| Ciprofloxacin
114
Tx for delirium in hospice pt
Haldol
115
Why can't we use ACEI and ARB together?
Increases risk of HD
116
most effective drug tor tx and prevention of allergic rhinitis?
Flonase
| NOT Ipratroprium nasal spray or Zyrtec
117
Most common cause of refractory HTN in middle aged adults
Primary hyperaldosteronism
Get a plasma aldo/renin ratio
supported if pt has hypokalemia
118
Most common cause of refractory HTN in elderly adults?
Renal artery stenosis
| Dx with renal MRA
119
Psych medication associated w/ angranulocytosis
Carbamazepine (tegratol)
| Get BL CBC, CMP and monitor perodically
120
1st line tx for Alzheimers
Donepezil (Aricept)
anticholinesterase inhibitor
Memantine (Namenda) is used as an adjunct with donepezil in moderate to severe cases. Not effective as a monotheray
121
30s adult shoulder pain worse with laying on it. Pain on abduction but no weakness. ROM nl. Dx?
Subacromial bursitis
| associated with calcific deposits on the supraspinatus tendon
122
What is the benefit of static stretching before a run?
None
Slows performance in sprinters
No benefit in muscle injury or soreness
123
Celiac dz increases a pts risk of?
Iron deficiency anemia
Osteoporosis (decreased Calcium and Vitamin D absorption)
NOT at increased risk of IBS, diverticulitis or CRC
124
how do you counsel pt about a low carb diet?
Better short term weight loss than low fat diet
similar to a reduced calorie diet with normal ratio of macros
low carb does seem to be effective in reducing insulin resistance
125
Pt on antiepileptic drugs wants a contraceptive. Offer?
IUD
| Can't do combo contraception d/t antieleptic drugs inducing hepatic metabolism of hormonal contraceptives
126
Pt on Dual anti platelet is undergoing CABG. What do you do with meds?
Stop placid 5 days before surgery
127
2 m/o has a misshaped head, NL at birth. What do you do?
Counsel parents about positioning (alternate L and R) and tummy time, follow up in 1-2 months
128
Pt has EF of 35% and pHTN. What is the best way to treat her pHTN?
maximize her CHF tx
NOT vasodilation or RHC
Vasodilators could actually be harmful in L HF
129
How much time for the get up and go test?
10s
| Get up, walk 10 feet, turn around, walk back, sit
130
Tx for methanol poisoning?
Ethanol
| Slows formation of formaldehyde so it can be secreted
131
6 mo WCC only has on testicle. Now what?
Urologic referral for surgical exploration
NOT US
Tx unilateral testes at 6-12 m/oage
132
Most effective method for natural family planning
Cervical mucos monitoring
133
Stillbirth at 33wk gestation in a white preggo - most likely cause?
Placental disease
134
Pt is septic with PNA on Xray and was exposed to flu 2 days ago. Rapid flu negative. Tx?
CTX/Azithro/Vanc
oseltavivir
High false negative rate on rapids
Apparently include vanc because septic shock puts him at high risk of MRSA confection
135
1st line HTN tx for pt with CAD
Bblocker
136
vertigo + tinnitus or unilateral hearing loss
Meniere's dz
137
Pt with MDD + hypomania
Bipolar II
| Tx - depakote or Lithium mono therapy
138
Pt with T2DM and multi vessel CAD should get a
CABG
139
2 y/o with belly pain and billious vomiting x hours. Get a ?
Upper GI series
| C/f volvulus
140
Tx c. diff pt with po vanc, not getting better so can add what IV?
Flagyl
141
What vent setting is helpful in ARDS?
Lower Tidal Volume
142
1st line tx for diabetic peripheral neuropathy
TCAs (amitriptyline)
143
characteristic exam finding in pt with pericarditis
Pain improves when sitting up and leaning forward
144
Screen for T1DM in kiddos that have what other dx?
hypothyroid
| Celiac dz
145
kiddo with fever and hip pain, NL Xray, FROM. elevated WBC, ESR. Next?
HIP US, c/f septic joint
| IF negative, next step would be bone scan
146
Ppx LCC for asymptomatic gallstones is indicated in which pt population?
Sickle cell dz
d/t risk of developing pigmented stones
70% of SCD pts have gallstones
if pt develops biliary collic, it is difficult to determine if colic vs Sickling crisis and were high risk of open cases
if ppx removed - better odds they will get a LCC in a controlled way
Can be done at same time as splenectomy
NOT T2DM or Renal transplant
147
Tx for chronic fatigue syndrome
CBT
Dx if fatigue x 6 months, impaired memory, post exertion malaise, muscle pain, polyarthralgia, tender LN, sore throat, HA, unrefreshing sleep
CBT and graded exercises are helpful
NOT Ritalin
148
Which medication causes a syndrome similar to SLE (polyarthralgia, friction rub), ANA +?
hydralazine
procainamide
most pts improve within weeks with avoidance of drug
149
You extract a metal foreign body that has been present 2 days in the sclera. Rust ring present. Now?
See eye doc within 48h
| Toxic to the cornea -
150
unvax kid is exposed to kiddo with Hep A. Next?
Give hep a Vax
preferred over iVIG because effect lasts longer
Only give family PPX if there is an outbreak and if kiddo is still in diapers
151
ppx abx for ortho procedures
Cefazolin
152
Thessaly test is positive in?
Medial meniscus tear
| Pt stands on one leg and flex knee to 20degree theninteranlly and externally rotate over the knee
153
How long do you check BP when screening for orthostatic while standing?
for 3 minutes
154
erysipelas is caused by?
Group A Strep (strep progenies)
| Tx PCN
155
Which basal cell carcinomas have the highest risk of recurrence
Those that are not treated with Mohs surgery
High risk locations - in the "mask" of the face(eyelids, nose, lips, chin, mandible, periauricular, temple, ear), genitalia, hands, feet
156
Elevated AST and GGT?
Alcoholic liver dz
157
Tx for tinea wapitis?
po griseofulvin
158
skin infection associated with intertrigo?
Candida
| intertrigo = skin on skin friction --> inflammation
