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Flashcards in random6 Deck (158):
1

fetal anemia presents w/?

sinusoidal fetal heart tracing w/ no variability

2

fetal head compression -->?

early decelerations

3

early decels due to?

fetal head compression

4

placental insufficiency -->?

late decelerations

5

late decels due to?

placental insufficiency

6

variable decels due to?

compression of umbilical cord

7

compression of umbilical cord --?

variable decels

8

rotavirus vax contraindicated if?

- Hx of intussusception
- Hx of uncorrected congenital malformations in GI tract (ie Meckel's)
- SCID
- anaphylaxis to vax ingredients

9

loss of pain and temp in cape distribution (along dermatomes) - think? issue where?

syringomyelia
- distrubance of crossing spinothalamic tracts at the ant commisure

10

ursodeoxycholic acid can be used for?

prophylactically prevent gallstones (esp after gastric bypass)

11

risk of esophageal variceal bleed --> med treatment?

Non-selective B-Blocker (ie propranolo or nadolol)
- reduces portal venous pressure ---> dec risk of hemorrhage

12

dec appetite, abd discomfort, abdominal fullness, now w/ painless jaundice -- think?

Pancreatic CA

- even w/ elevated bili and alk phos bc can be due to mass in panc blocking bile

13

iron toxicity --> ?

Early:
- n/v/d - hemorrhagic (BRB v and dark green stools) --> hypovolemic shock

Late:
- severe lactic acidosis
- hepatotoxicity
- organ failure

14

new onset seizures can make you worry for what?

Brain tumors

15

most common adult brain CA?

Astrocytomas (specifically glioblastoma multiforme which is type grade IV)

16

what effects prognosis of astrocytomas most?

degree of anaplasia (atypia, mitoses, neovascularity or necrosis)

17

common first line therapy for CLL?

Rituximab (monoclonal Ab against CD20 on B lymphocytes)

18

monoclonal Ab against CD20 is what med to treat what?

- Rituximab
- CLL

19

Imatinib inhibits what and is for what disease?

- Inhibits product of BCR-ABL tyrosine kinase fusion
- CML

20

BCR-ABL - think?

CML

21

arm twitching - think?

simple partial seizure

22

dx of brain abscess uses what imaging?

gadolinium enhanced brain MRI

23

nL serum osmolality?

285 - 295

24

most common bacteremia in sickle cell pts?

Strep pneumo
can cause sepsis

25

what do you use for empiric abx in febrile sickle cell pt?

1) 3rd gen cephalosporin (ie ceftriaxone)

2) add vanco if concern for meningitis or osteoarticular infx

26

who received abx prophylaxis b4 dental appts? (3)

High risk pts for bad outcomes w/ IE:
- prosthetic valves
- prior hx of IE
- unrepaired congenital heart disease

27

acute dystonic reaction treat w/?

anticholinergics
- diphenhydramine
- benztropine
- trihexyphenidyl

28

halperidol can cause what via dopamine receptor antagonism?

acute dystonia (EPS, ie torticollis)

29

treatment of epi ovarian CA?

exploratory laparotomy and tumor debulking followed by platinum based chemo

30

PCOS wants to get preggers treat?

1) weight los
2) clomiphene

and/or metformin

31

vertigo is?

sensation of spinning

32

presyncope is?

feeling like one is about to faint

33

disquilibrium is ?

sense of imbalance

34

sensation of spinning?

vertigo

35

feeling like one is about to faint?

presyncope

36

sense of imbalance?

disequilibrium

37

injury to the radial nerve may cause?

wrist drop due to weakness of the extensor muscles

38

test for intact sensation of radial nerve by?

testing dorsal surface of hand

39

oblique fracture of middle humerus most at risk of what being damaged?

radial nerve (travels in spiral groove along dorsal aspect)

40

supracondylar fracture of humerus worry what is being injured?

median n.

41

abduction and adduction of fingers controlled by?

ulnar nerve

42

weakness of elbow flexion and forearm supination - think?

injury to musculocutaneous nerve

43

palliative treatment of pancreatic adenocarcinoma causing extrahepatic cholestatis?

First line: endoscopic stent placement

2nd: surgical bypass

44

ursodeoxycholic acid is the only FDA approved treatment for what?

primary biliary cirrhosis
(doesn't change mortality, just symp help)

45

malignant pleural effusions appear how?

- exudative
- low pH (

46

absent p waves w/ irregularly, irregular QRS complexes?

atrial fibrillation

47

rate control meds for a fib?

1) beta blockers (adrenergic antagonists) - ie metoprolol or exmolol

2) non-dyhyidrophyridine Ca channel blockers - ie diltiazem or verapamil

48

dementia w/ early onset ataxia, urinary incontinence and dilation of ventricles on neuroimaging?

NPH

49

finding on neuroimaging for NPH?

dilated ventricles

50

round, eosinophilic, intracytoplasmic inclusions w/in neurons of substantia nigra - is?

Lewy body dementia

51

pt w/ multiple myeloma w/ renal issues but no proteinuria - where is kidney issue?

Renal tubular damage (from monoclonal light chains clogging tubules -> casts & toxicity)

(proteinuria would be seen if it was in the glomerulus)

52

slow rise in creatinine in pt w/ severe HTN and recurrent flash pulm edema - think?

Renal artery stenosis

53

4 big trinucleotide repeat disorders?

Fragile X
Friedrich ataxia
Huntington
Myotonic dystrophy

"X-Girlfriend's First Aid Helped Ace My Test!"

54

friedreich ataxia symp?

- kyphoscoliosis
- muscle weakness
- loss of DTR, vib and proprio
- staggering gait
- hammer toes or high instep (pes cavus)
- DM
- nystagmus
- dysarthria
--> hypertrophic cardiomyopathy

55

fragile X features?

- intellectual disability
- autistic features
- elongated face w/ large ears
- enlarged testes
- delayed milestones
- macrocephaly
- hypotonia

56

first line treatment of acute sundowning w/ agitation ?

Antipsychotic (ie haloperidol)

57

nL cardiac output?

5 L/min

58

nL RA pressure ?

0-8

59

nL RV pressure?

15-25/3-12

60

nL pulm artery pressure?

15-25/8-15

61

Right heart pressures elevated w/ nL to low PCWP in a pt w/ hypoxia, tachypnea, and tachycardia - think?

PE

62

palpable purpura, proteinuria, and hematuria -- think?

Mixed cryoglobulinemia

(can also have arthralgias, hapatosplenomegaly, and hypocomplementemia)

63

confirmatory finding for mixed cryoglobulinemia?

circulating serum cryoglobulins

64

what is a common underlying infx found w/ pts w/ mixed cryoglobulinemia?

HCV

65

what should pts w/ mixed cryoglobulinemia be tested for?

HCV Ab

66

trendelenburg sign caused by?

weakness in gluteus medius and minimus m.

(potentially bc of superior gluteal n. dysfunction)

67

superior gluteal nerve dysfunction can lead to what sign?

Trendelenburg sign
(bc of weakness of gluteus minimus and medius m.)

68

complicated diverticulitis w/

IV abx and observation

worsening symp --> surg

69

complicated diverticulitis w/ >3cm abscess treatment?

CT guided percutaneous drainage

if after 5 dys symp not controlled --> surgical drainage and debridement

70

complicated diverticulitis w/ fistuala, perforation w/ peritonitis, obstruction or recurrent attacks - treatment?

Sigmoid resection

71

med to close PDA?

Indomethacin

72

med to keep open PDA?

Prostaglandin E1

73

avoid lithium use in pts w/ what organ issues?

renal disease pts

74

avoid valproate in pts w/ what organ issues?

liver disease pts

75

most effective med to treat bipolar depressive episode?

lamotrigine

76

most significant side effect of lamotrigine?

Steven Johnson syndrome

77

Acute behavioral agitation in manic episode -- treat?

Antipsychotic (1st or 2nd gen)

- lithium, valproate, carbamazepine would take too long

78

Treatment for anorexia? (3)

- CBT
- Nutritional Rehab
- Olanzapine if no response to above

79

Treatment for Bulimia (3)?

- CBT
- Nutritional Rehab
- SSRI (fluoxetine), of in combo w/ above

80

Binge eating disorder treatment (4)?

- CBT
- Behavior weight loss therapy
- SSRI
- Lisdexamfetamine, topiramate

81

difference b/t bulimia and binge eating disorder?

Bulimia compensates for the binging w/ purging of some type --> maintenance of nL weight

Binge eating disorder just binges --> becomes overweight

82

difference b/t anorexia and bulimia?

anorexia

83

treatment of serious iron poisoning?

Deferoxamine

84

radioopaque tablets on xray in child w/ low HCO3, hypotension, hematemesis, abd pain, and cool extremities --think?

Iron poisoning --> shock

give IV resuscitation and deferoxamine

85

What is used in TCA or aspirin overdose?

Sodium bicarb

86

Torsades de points due to prolonged QT interval give?

Mag sulf

87

Severe lithium toxicity - treat?

Hemodialysis

88

moderate to severe lead poisoning give?

Calcium EDTA

89

child w/ irritability, poor appetite, headaches, abdominal pain, and anemia - toxin is?

Lead poisoning

90

mild to moderate lead poisoning treat w/?

Oral succimer

91

Acetaminophen toxicity treat w/?

N-acetylcysteine

92

abd pain, hematemesis, shock, and metabolic acidosis after a child ingests something radioopaque - think?

Iron overdose!

93

pt on TPN w/ epigastric and RUQ pain - likely?

gallstones due to gallbladder stasis

94

why does an ileal resection contribute to formation of gallstones?

Decreased enterohepatic circulation bile acids --> altered hepatic bile composition --> supersaturation w/ cholesterol --> gallstones

95

incred RBC destruction inc risk of what type of gallstone?

pigmented

96

what is cause of inc dev of cholestrol gallstones in pregnancy?

- Estrogen-induced inc in chol secretios

- Progesterone causes a) reduction in bile acid and b) slows gallbladder emptying

97

when is Anti - D immune globulin (RhoGAM) administered?

In Rh- women at:
- 28 wks
- or 2/in 72 hrs of any procedure where feto-maternal blood may mix (ie abortion, amniosentesis, delivery, trauma etc)

98

difference b/t shin splints and stress fracture?

no tibial tenderness on palpation w/ shin splints

99

shin splints aka?

medial tibial stress syndrome

100

pain at specific area that inc w/ jumping or running w/ local swelling and point tenderness to palpation - think?

stress fracture

101

best imaging for stress fracture?

MRI or bone scan

102

marfans is due to mutation of what?

fibrillin 1 gene

103

homocystinuria caused by?

cystathionine synthase deficiency

104

fibrillin 1 gene mutation -->?

marfans

105

cystathionine synthase deficiency -->?

homocystinuria

106

defective collagen production -->?

Ehlers-Danlos

107

Ehlers-Danlos due to?

collagen production defect

108

Klinefelter due to?

nondisjunction resulting in an extra X chromosome

109

upward lens dislocation - think?

marfans

110

downward lens dislocation think?

homocystinuria

111

first marker to appear in serum in acute hep B infx?

HBsAg (4-8 wks after infx)

112

2nd marker in HBV that appears around when clinical symp appear and elevation of aminotransferase levels?

IgM anti-HBc

113

what is best test to diagnose new infx of Hep B (pick 2 markers)

HBsAg
IgM anti-HBc

b/c HBsAg is first marker to dev and IgM anti-HBc may be only marker apparent during window period

114

transaminase levels >25 times nL limit w/ ALT>AST - think?

Viral Hepatitis

115

best test for HAV?

Anti-HAV (IgM)

(IgM Ab to HAV)

116

Anti-HAV (IgG) positive indicates (2)?

- Prior HAV infx
OR
- Prior HAV vaccination

117

HBsAg is and indicates?

-antigen found on surface of HBV

-Indicates HBV infx (can't tell if acute or chronic)

118

Anti-HBs is and indicates?

-Ab to HBsAg

- Indicates immunity to HBV (recovered or immunized)

119

What will you never see if you've only been vaccinated against HBV?

HBeAg

120

What may be only positive marker during infx window period of HBV?

IgM anti-HBc

121

IgM Anti-HBc indicates?

acute/recent infx

122

IgG Anti-HBc indicates?

prior exposure or chronic incx

123

Positive for: HBsAg, HBeAg, IgM Anti-HBc -- means?

acute HBV infx

124

Positive for Anti-HBe and IgM Anti-HBc - means?

Window period

125

Positive for HBsAg, HBeAg, and IgG Anti-HBc - means?

Chronic HBV w/ high infectivity (bc HBeAg pos)

126

Positive for HBsAg, Anti-HBe, and IgG-Anti HBc - means?

Chronic HBV w/ low infectivity (bc Anti-HBe pos)

127

Positive for Anti-HBs, Anti-HBe, and IgG Anti-HBc - means?

Recovered from HBV infx

128

Positive Anti-HBs only means?

HBV immunized

129

which illicit drug can cause vertical nystagmus?

PCP

130

what do you use for treatment of severe psychomotor agitation due to PCP use?

Benzo

131

Initial treatment of AOM?

10 day course of oral high dose Amoxicillin

132

If pt returns w/in 1 month w/ AOM post initial treatment, now treat w/?

Oral Amoxicillin and clavulanic acid (to fight presumably a strain w/ beta lactamase resistence)

133

common bugs --> AOM?

- Strep pneumo
- nontypeable Haemophilus
- Morazella catarrhalis

134

IE w/ nosocomial UTI - what bug?

enterococcus ( U heart trees)

135

fanconi anemia caused by?

defect in DNA repair --> chromosomal breaks

136

benzene exposure can cause what blood issue?

aplastic anemia

137

iability to palpate PMI consistent w/?

large pericardial effusion

138

pulsus bisferiens (biphasic pulse) seen with?

- AR (+/- AS)
- HOCM
- Large PDA

139

post cardiac cath worry for?

cholesterol emboli

140

cholesterol emboli post cardiac cath --> what manifestations? (3ish)

- SKIN: Livedo reticularis, blue toe syndrome
- AKI
- GI: pancreatitis, mesenteric ischemia

141

pt w/ RA has inc risk of what type of bone issues? (3)

- Osteopenia
- Osteoporosis
- Bone fractures

142

paget's disease of bone -- aka?

osteitis deformans

143

osteitis deformans - aka?

paget's disease of boen

144

osteitis fibrosa cystica aka?

Von Recklinghausen disease of bone

145

osteitis fibrosa is?

excessive osteoclastic resorption of bone --> replacement w/ fibrous tissue (brown tumors)

146

osteitis fibrosa cystica is seen in pts w/ what additional disease?

- parathyroid carcinoma
- primary, 2ndary, tertiary hyperparathyroidism (ie renal disease)

147

anti-CCP Ab -thnk?

RA

148

fibrous obliteration of small bile ducts w/ concentric replacement by connective tissue in an onion skin pattern -- think?

Primary SCLEROSING cholangitis

149

onion skin pattern in liver biopsy - think?

primary sclerosing cholangitis

150

Meniere disease due to?

excess endolymphatic fluid pressure in inner ear

151

triad in meniere disease?

- vertigo
- hearing loss
- tinnitus

152

oscillopsia?

sensation of objects moving around in visual field when looking in any direction

- seen w/ aminoglycoside toxicity esp gentamicin

153

contraindications for breastfeeding? (7)

- active untreated TB (can start post 2wks of treatment)
- Maternal HIV
- Herpetic breast lesions
- Varicella infx

154

preferred confirmatory test for giardia?

stool antigen assay (direct immunofluorescence or ELISA)

155

nitrates primary anti-ischemic effect is?

Systemic venodilation --> lower preload --> lower LVEDV --> dec myocardial O2 demand by reducing wall stress

*they also vaso dialate coronary a., but above is main effect

156

dark brown discoloration of the colon w/ lymph follicles shining through as pale patches - think?

melanosis coli
- seen w/ laxative use

157

pigment in the macrophages of the lamina propria can indicate?

melanosis coli
- seen w/ laxative use

158

alcoholism can cause what heart condition?

dilated cardiomyopathy --> SOB, S3, bibasilar cracks, low ejection fraction, etc.