Questions 701- 1050 Flashcards
(238 cards)
1
Q
affective dysregulation in dependent personality disorder, if not responsive to psychotherapy, can be treated with
A
lamotrigine
2
Q
HIV pt with hx of HA, fever, neck pain
he has been working in parks/around soil
A
cryptococcal meningitis
3
Q
tx for cryptococcal meningitis
A
Amp B and flucytosine for 2 weeks, then suppression with fluconazole for 8 weeks
4
Q
when is O2 supplementation initiated in COPD pt?
A
when saturation drops to 88%
5
Q
What categories go into Bishop scoring?
A
station
cervix consistency
dilation
position
effacement
6
Q
short, plump, gram negative bacilli with capsule
A
Klebsiella
7
Q
four factors that influence AFI
A
- ureteroplacental blood flow
- fetal urination
- fetal lung fluid
- fetal swallowing
8
Q
dx gastrinoma with
A
secretin stimulation test
9
Q
ulcer located in the stomach where a large tortuous arteriole erodes and causes gastric hemorrhage
A
Dieulafoy’s ulcer
10
Q
wounds that do not heal, and especially burns, can turn into SCC, and then be considered…
A
marjolin ulcer
11
Q
biochem abnormality in bruton’s
A
abnormality in tyrosine kinase
12
Q
sexual arousal from touching or rubbing against unwilling people
A
frotteuristic disorder
13
Q
MC elevated enzymes in dermatomyositis
A
CK and aldolase
14
Q
first line tx for mild comedonal (open blackheads, closed whiteheads)
A
topical retinoid
15
Q
tx for black widow spider bite
A
antivenom
calcium gluconate no longer recommended
16
Q
rifampin MOA
A
inhibiting bacterial DNA-dependent RNA polymerase
17
Q
COBRA stands for
A
consolidated omnibus budget reconciliation act
prevents sudden loss of health coverage
18
Q
SAAG greater than 1.1 and ascitic fluid protein <2.5
A
cirrhosis
19
Q
SAAG > 1.1 and ascitic fluid protein >2.5
A
HF
constrictive pericarditis
budd chiari syndrome
20
Q
MOA of Salmonella
A
elicits host immune response that upregulate intracellular cAMP
21
Q
profuse, thick yellow green exudate from eyes within 5 days s/p birth
A
N gonorrhea
22
Q
dark specs of material and small translucent cement surrounding the hair shaft
A
louse/pediculosis
23
Q
tachypnea a/w URI, with wheezing on exam and evidence of hyperinflation on an otherwise nl CXR
A
asthma
24
Q
psych presentation but HTN and tachycardia, tactile halluciantions, aggressive behavior, poor dentention, skin excoriations
A
Methamphetamine intoxication
25
low hypocretin 1
narcolepsy
26
interviewing a psych pt, you need to ask
open ended questions
27
nystagmus in intoxicated person
PCP
28
tx for lithium toxicity
hemodialysis
29
what is the time frame with alcohol withdrawal symptoms?
mild 6-24 hrs
seizures 12-48h
hallucinosis 12-48h
DT 48-96 h
30
Buproprion MOA and indication
NE and DA reuptake inhibitor
for 2nd line for depression
no weight gain, no sexual side effects
31
schizophrenia MRI shows
enlarged ventricles with diffuse cortical atrophy
32
buproprion is contraindicated in
eating disorders and seizure disorders
33
what drug can cause a disulfuram like reaction?
metronidazole
34
first thing to give someone undergoing alcohol withdrawal
thiamine
35
tx for LV HF exacerbation
IV diuretics
36
pt has chorioamnionitis, next step?
immediate induction of labor
37
differentiate 5 alpha reductase deficiency and androgen insensitivity syndrome
5 alpha reductase will not have breast development at puberty
AIS will have breast development at puberty
38
immune mediated disorder characterized by the infiltration of inflammatory cells into a segment of the spinal cord
transverse myelitis
39
where does sensation get lost in cuada equina?
sensory loss involves thighs and buttocks
40
why is hypotension a side effect of epidural anesthesia?
redistribution to the lower extremities and venous pooling from sympathetic blockade
41
more specific findings of congenital syphilis
snuffles (copious rhinorrhea) and a maculopapular rash that may desquamate or become bullous
42
infant with cough with apnea and posttussive emesis
pertussis
43
individual puts negative feelings associated with a person or situation onto a "safer", more acceptable object or situation
displacement
44
attributing one's own feelings to someone else
projection
45
severe penicillin allergy, but pt got syphilis
doxycycline
46
dilated cardiomyopathy that develops during the last month of pregnancy or within 5 months following delivery
peripartum cardiomyopathy
47
dx cutaneous leprosy by
skin biopsy
48
acute onset of hypertension and AKI in pt with systemic sclerosis
dx?
tx?
scleroderma renal crisis
ACE inhibitors (captopril)
49
initial step in HHS tx
normal saline
50
once the normally functioning thyroid tissue is removed after cancer tx, what is used as a tumor marker?
thyroglobulin
51
pts with CIN 3 on bx require
cervical conization, excisional bx
52
extrapulmonary manifestations of sarcoidosis include
nervous system involvement, (facial nerve palsy), lymphadenopathy, hypercalcemia, and parotid gland swelling
53
in a sickle cell pt, an acute drop in Hgb with low retic ct and no splenomegaly
aplastic crisis
54
MCC of aplastic crisis
parvovirus B19 (with or without symptoms)
55
aplastic anemia affects
pancytopenia due to bone marrow failure
56
PEA... next step
chest compressions
57
classical cesarean delivery
contraindicates future vaginal
58
fetal risks associated with preeclampsia
chronic uteroplacental insufficiency
fetal growth restriction/low birth wt
59
maternal complications from preeclampsia
placental abruption
DIC
eclampsia
60
comorbidities associated with Tourette's
ADHD and OCD
61
within 2 weeks post op of CABG, fever, tachy, chest pain, leukocytosis, and wound drainage
mediastinitis
62
tx acute mediastinitis
surgical debridement and abx
63
rudy/pleothoric appearance in newborn with Hct \>65%
neonatal polycythemia
64
MRI shows ventricular enlargement and diffuse white matter changes
HIV associated neurocognitive disorder
65
symptoms with PML
subacute, AMS common, show cortical involvement (motor deficits, ataxia, vision changes)
MRI show well-delineated, asymmetric white matter lesions
66
complication of epidural anesthesia in pt who was previously taking an anticoagulant
spinal epidural hematoma
67
gross bleeding on colonoscopy, but also poor prep
angiodysplasia
68
fetal ultrasound shows double bubble sign
duodenal atresia
VACTERL
69
elevated PaCO2 causing respiratory acidosis
underlying cause?
hypoxemia
70
pulmonary embolism, atelectasis, pleural effusion, and pulmonary edema all cause
V/Q mismatch
71
pt with AIDs has progressive blurred vision, floaters, and yellow white exudates adjacent to the fovea/retinal vessels
CMV retinitis
tx with valganciclovir
72
esophagitis with oral thrush
tx with fluconazole empirically
73
resistant HTN in kidney transplant pt
added ACE-I and renal fxn declined
transplant renal artery stenosis
74
irregular, soft mass in scrotum
increases in size during valsalva and does not transluminate
varicocele
75
suspected SAH but CT non con is clean, what next?
LP
increased opening pressure, xanthochromia, and high RBC ct that does not decline with collection tubes
76
amenorrhea, signs of estrogen deficiency, and elevated FSH, \<40 yo
primary ovarian insufficiency
77
ppx options for close contacts of N. meningiditis pts
rifampin, ceftriaxone, or cipro
78
complication of cardiac cath, presenting with sudden hemodynamic instability and ipsilateral flank or back pain
retroperitoneal hematoma
79
hepatitis B is a significant risk factor for what nephrotic syndrome
membranous nephropathy
80
tx for somatic symptom disorder
regularly scheduled visits with same provider
81
pt gets flu, takes abx, gets better for a few days, then develops PNA
bug?
what does XR look like?
S. aureus (CA- MRSA)
multilobar cavitary infiltrates
82
tension type HA can present in .... when other contributing factors are also present
depression
83
indolent symptoms of HA, malaise, low grade fever, incessant cough, and nonexudative pharyngitis
Mycoplasma pneumoniae
84
decompensated heart failure in young adult
viral prodrom a few weeks ago
viral myocarditis
85
MCC nephrotic syndrome in children
dx?
tx?
minimal change disease
prednisone
86
asymmetric corneal light reflexes and asymmetric red reflexes
strabismus
87
MTX toxicities
hepatotoxicity
stomatitis
cytopenias
88
sulfasalazine toxicities
hepatotoxicity
stomatitis
hemolytic anemia
89
asthma can be diagnosed if there is at least a ....
12% increase in FEV1
90
Pulmonary arterial hypertension is a common manifestation of systemic sclerosis that results from
intimal hyperplasia of the pulmonary arteries
91
what improves mortality in pts with ARDS?
low tidal volume ventilation
results in lower pulomary pressures, decreasing the likelihood of overdistending alveoli
92
normal pleural fluid pH
transudative pH
7.6 is normal
transudative is 7.4-7.55
exudative is 7.3-7.45
93
Liver cirrhosis ends up causing hepatorenal syndrome by what method?
increase NO in splanchnic circ
systemic vasodilation, decrease BP
renal hypoperfusion
increase RAAS
increase Na retention and volume retention
94
FeNa \>2% means
intrarenal issue
95
amikacin toxicity
renal
96
contraindication for ACE-I
bilateral renal artery stenosis
97
what value do you want to shift K at?
greater than 7
98
post void residual volume of bladder \<150 in female and \<50 in male
dx? tx?
neurogenic bladder
oxybutinin/antimuscarinic
99
simple cyst tx?
asx, no follow up required
100
solid, circular, no septae in kidney mass, pain but no other symptoms
simple cyst
101
pt has varicocele that won't really go away, what do I need to think about?
left sided renal cancer
102
tacrolimus and cyclosporine casue kidney injury by
arteriolar vasoconstriction, prerenal failure
103
envelope shaped oxalate crystals - cause?
ethylene glycol poisoning
104
6-48 hours after initiating tx for syphilis
Jarisch-Herxheimer reaction
105
hx of TB, this pt now has fever, weight loss, fatigue, cough, hemoptysis and a cavitary lesion on CT
chronic pulmonary aspergillosis
106
MC GI anomaly associated with Down Syndrome
duodenal atresia
107
prenatal US of duodenal atresia
polyhydraminos, double bubble on XR, no distal intestinal gas
108
tx duodenal atresia
enteral feeds, NG tube decompression, surgical repair
109
thin, wrinkled vulvar skin resulting in hypopigmentation and increased skin sensitivity causing an intense pruritis,
can have perianal skin involvement
lichen sclerosis
110
pruritic, purple plaques that are sometimes associated with thin, white striae around the labia and vulva
vulvar lichen planus
111
develops secondary to repetitive scratching, pt develops a hyperplastic response that causes thickened, leathery skin
lichen simplex chronicus
112
pt dx'd with lichen sclerosis, next step?
punch biopsy to rule out malignancy
113
normal lab values amylase
up to 125
114
normal lab value alk phos
up to 100
115
tx of campylobacter infxn
supportive care only
116
nonbilious hungry, but projectile vomiting infant
pyloric stenosis
117
what happens to cortisol during major depressive disorder?
increased serum cortisol
due to hyperactivity of the HT-pit-adrenal axis
118
How does sleep change in MDD?
decreased REM sleep latency and decreased slow-wave sleep
119
what can cause a false positive for PCP on a UDS?
dextromethorphan, ketamine, tramadol, venlafaxine
120
first line drug for fibromyalgia?
TCAs
121
endocarditis with recent hx of pyelo
enterococci
122
two MC organisms for brain abscess
viridans streptococci
S. aureus
123
fetal US shows edematous scalp and nuchal fold
hydrops fetalis
124
hydrops fetalis and no assoicated dysmorphic features
alpha thalassemia major
125
first week of life with vomiting, jaundice, hypotonia, and hepatomegaly
develops cataracts
galactosemia
deficiency of GALT
126
tx of galactosemia
galactose free diet/soy based formula
127
soap bubble appearance in bone
giant cell tumor
128
age related loss of elastic fibers in perivascular connective tissue
senile purpura
129
MC infxn in CF kids
S. aureus
130
MC infxn of CF 20yo and older
pseudomonas
131
acquired hyperpigmentation disorder that occurs primarily on sun exposed areas of the face during pregnancy
irregularly shaped, hyperpigmented macules
dx? tx?
melasma
avoid sun
132
hearing loss that paradoxically improves in noisy environments
conductive hearing loss
possible otosclerosis
133
hemolytic anemia, thrombocytopenia
renal failure
neuro manifestations
fever
TTP
thrombotic thrombocytopenic purpura
134
tx of TTP
plasma exchange
glucocorticoids
rituximab
135
CL motor and/or sensory deficits, more pronounced in the lower limb than upper limb
urinary incontinence, gait dyspraxia, primitive reflexes, abulia, and emotional disturbances
ACA stroke
136
MCC of sudden cardiac arrest in immediate post infarction period
v fib
137
long term analgesic use with 1 or more analgesics (NSAIDs) can cause CKD due to .... and hematuria due to...
tubulointerstitial nephritis
papillary necrosis
138
loss of paternal copy of 15q11-q13
prader willi syndrome
139
loss of maternal copy of chromosome 15q11-q13
angelman syndrome
140
reticulocytes and platelets in sequestration crisis of SCD
increased retics
decreased platelets
141
mom taking DES can cause what in daughter?
clear cell adenocarcinoma of the vagina
142
histo of pseudogout
rhomboid shaped crystals with positive birefringence
143
gout histo
needle shaped crystals with negative birefringence
144
atypical squamous cells of undetermined significance (ASCUS) and LSIL should do what?
conservative mgmt, repeat cytology in 12 months
145
adverse reactions of bisphosphonate after taking them for 7 years at least
atypical femur fracture
146
adverse effects of teriparatide?
orthostatic hypotension, osteosarcoma, myalgias, nausea, arthralgias, and leg cramps
147
CAH internal sex organs
are typically normal for females, male internal sex organs may not be present
148
what is the kidney issue in alport syndrome?
what is a specific finding that goes with this?
glomerulonephritis
Red blood cell casts
149
waxy and broad casts
advanced CKD
150
granular muddy brown casts
acute tubular necrosis
151
repeated infxns, abnl cell counts, peripheral smear with immature cells and Auer rods
AML
152
Sjogren pt is at an increased risk of developing
type I, distal, RTA
hypercalciuria
increased renal stones
153
tumor markers for recurrent breast cancer
CEA, CA 15-3, CA 27-29
154
s-100 is associated with
neural crest tissue
elevated in melanoma and neural tumors such as astrocytomas
155
Drug to tx actinomyces
penicillin G
156
menieres disease is aka
idiopathic endolymphatic hydrops
157
five days high fever and rash in kid
dx?
complication?
Kawaski disease
coronary artery aneurysm
158
screening results concerning for down syndrome
decreased AFP
decreased estriol
increased bhCG
increased inhibin A
159
edwards syndrome genetic screening will show
decreaed AFP
decreased estriol
decreased bhCG
decreased Inhibin A
160
H. influ shape
gram negative coccobacillus
161
tumor marker for granulosa cell tumors
inhibin
162
septic/distributive shock
cardiac output, peripheral vascular resistance, pulm cap wedge pressure?
high cardiac output, low PVR, low PCWP
163
rupture of bicep tendon, what nerve?
musculocutaneous
164
coffin lid appearance
dx and tx
struvite stone
surgical removal 2/2 size and tx bacterial infxn
165
ppx to prevent tumor lysis syndrome
allopurinol
166
down syndrome pt complaining of fever, pallor, fatigue
myelofibrosis, early sign of acute leukemia
167
tx for E. coli prostatitis
cipro or levo
168
first step in mgmt of pt with delirium and psychomotor agitation
typical antipsychotic
169
symmetric painful swelling of the hands, feet, or both in a young child with sickle cell disease
dactylitis
170
test used to assess the degree of motion at the lumbar spine in pt with suspected ankylosing spondylitis
Schober test
171
what can COPD do to the blood
cause polycythemia
172
pts with pancreatitis are at high risk for ARDS due to the release of
phospholipase A from the pancreas, which digests surfactant in the lungs
173
HBcAb IgG positive
HBsAg positive
chronic carrier hep B
174
stage of decubitus ulcer if destruction of dermis and visulization of fat but not muscle, tendon or bone
stage III
175
stage of decubitus ulcer if area of ulceration through the dermis, or a fluid filled blister
stage II
176
contraindication to cranial OMM
increased ICP
177
what receptor positive is associated with a favorable disease outcourse in breast cancer?
progesterone receptor positive
178
high grade squamous intraepithelial lesion found on pap. next step?
colposcopy if \<25 yo
excisional procedure if \>25yo
179
periarticular bony erosions without evidence of new bone formation on XR
RA
180
psoriatic arthritis symmetry
asymmetric
181
ED but sometimes wakes up with a boner
psychological
182
is the smallpox vaccine live or killed?
live
183
asymmetric FGR is the result of
placental dysfunction during the second or third trimester
HTN, pregestational DM
184
histoplasmosis presentation can mimic the presentation of
sarcoidosis
185
pt with suspected sarcoidosis does worse after immunosuppressive therapy
histoplasmosis
186
addition of NSAIDs to lithium can cause increased lithium level and these symptoms
GI upset, confusion, ataxia, and tremor
187
nonviable fetus in breech position
allow spontaneous vaginal delivery
188
what reduces morbidity and mortality rates in kids with severe measles?
vitamin A
189
small testes, low LH, infertility
exogenous steroid use
190
imaging used for psoas abscess
CT
191
Multiple myeloma affect on kidneys
decreased renal function
bland UA, may show granular casts
192
cardioinhibitory is aka
vasovagal
193
ERCP yesterday and severe abdominal pain today, what test?
lipase
194
initial drug of choice for myasthenia gravis?
pyridostigmine
195
spinal epidural abscess, bacterial infxn of epidural space, typically arises in the setting of
bacteremia from IVDA or distant infxn
196
fever, malaise, focal back pain, and progressive neuro findings
spinal epidural abscess
197
solitary liver mass with stellate central scar and radiating fibrous bands
focal nodular hyperplasia
198
SEVERE hemorrhoid pain in initial external hemorrhoid, tx?
hemorrhoidectomy instead of conservative
199
complications of drowning injuries
ARDS, cerebral edema, arrhythmia
200
pleural fluid glucose \<60 is usually due to
exudative pleural effusion
201
how do you decrease risk of ventilator associated pna?
elevate head of bed to 45 degree angle
202
chronic granulomatous disease is caused by
impaired intracellular killing by phagocytes
203
how do you dx chronic granulomatous disease?
neutrophil function testing
dihydrorhodamine 123 or nitroblue tetrazolium testing
204
negative family hx of anemia and positive coombs test
autoimmune hemolytic anemia
205
what should be suspected in the pt with hx of malignancy who develops back pain with motor and sensory abnormalities?
epidural spinal cord compression
206
what kind of anemia do NSAIDs cause?
iron deficiency anemia
207
diagnostic test for peripheral arterial disease
ankle brachial index
208
pt recently admitted to a supervised setting
develop tremor, agitation, and elevated pulse and blood pressure
alcohol withdrawal
209
electrolytes in tumor lysis syndrome
hyperuricemia, hyperK, hyperphosphatemia, hypocalcemia
210
In pagets, what is the calcium, phosphorus, alk phos, and urine hydroxyproline levels?
normal calcium
normal phosphorus
high alk phos
high urine hydroxyproline
211
What CD4 count is the line for if it is okay for an HIV pt to receive a live attenuated vaccine?
\>200, okay for live vaccine
212
tx of MDD with psychotic features
antidepressant plus antipsychotic
213
four things/diseases that would increase the risk for preeclampsia and require screening for preeclampsia then at the first prenatal visit
T1DM, HTN, SLE, multiple gestation
214
tx for mild, asx polyhyrdaminos at term gestation
expectant mgmt
215
betamethasone is given to patients at risk for
preterm delivery to reduce the risk of neonatal respiratory distress syndrome
216
response to hypovolemia with increased cardiac index and stroke volume, leading to pulse pressure increase, can manifest as
bounding peripheral pulses
217
translucent/gray teeth in kid who always seems to be getting fx
osteogenesis imperfecta
218
what is the glomerular abnormality in HSP
mesangial deposition of IgA
219
monoarticular knee joint effusion in a kid, what else do you need to ask about for hx
accompanying rash
220
what condition is gastroschisis associated with?
isolated defect
221
changing cervix on digital exam and no fetal presenting part, next step
transabdominal US to find head
222
PTH, Ca, P in Vit D deficiency
high PTH, low Ca, low P
223
MC malignancy of the liver
mets
224
fecal occult positive and solitary liver lesion
met from colon
225
blunt abdominal trauma but symptoms start being bad 24-48 hours later
duodenal hematoma
226
pt with functional asplenia will have what on blood smear?
Howell jolly body - remnant of RBCs
227
middle mediastinum pathologic findings
bronchogenic cysts, tracheal tumors, pericardial cysts, lymphoma, lymph node enlargement, and aortic aneurysms of the arch
228
fatigue, palpable purpura, arthralgias, renal disease, peripheral neuropathies
cryoglobulinemia
get hep panel
229
tx of adjustment disorder
psychotherapy
230
contraindication to raloxifene
hx of venous thromboembolism
231
increased swelling and pain in fx that is unresponsive to escalating analgesics, what are you considered about?
compartment syndrome
232
hemarthrosis after minor trauma, next step
coagulation studies
233
weak or spraying urine flow and incomplete emptying
increased postvoid residual volume
urethral stricture
234
high energy mechanism of injury and obvious big extremity issue, next step?
CT cervical spine
235
tuberous sclerosis is characterized by distinct skin features and ...
benign tumor formation, like subependymal giant cell tumors in the brain and cardiac rhabdomyomas
236
toddler with S3
myocarditis
from viral infxn
237
super elevated AFP in fetus, next step?
get US, AFP can regress back to the mean after being elevated
238
multiloculated adnexal mass with thick walls and internal debris on US
tubo-ovarian abscess
