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Flashcards in random8 Deck (285):
1

CDC vax guidlines for north africa (ie Egypt)?

HAV
HBV
typhoid
polio booster

2

when is yellow fever vax recommended?

sub-saharan africa and central/south america travel

3

clubbing and sudden onset joint arthropathy in a chronic smoker is suggestive of?

hypoertrophic osteoarthropathy (pulmonary disease caused subset)

- associated w/ lung CA --> need to get CXR to rule out malignancy

4

post menopausal women w/ new onset breast tenderness and thickened endometrial stripe w/ large ovarian mass - what tumor are we thinking?

Granulosa cell tumor (secrets estrogen)

5

dopaminergic agonists used in med management of prolactinoma?

- carbergoline
- bromocriptine

6

carbergoline and bromocriptine are what and both can be used in what situation?

- dopamine agonist
- used in med management of prolactinomas

7

newborns of moms w/ active HBV should receive what at birth?

- HBIG
- HBV vax

BOTH!

8

small for gestational age infants may have what complications (5)?

- hypoxia
- polycythemia (bc inc EPO response to hypoxia)
- hypoglycemia
- hypothermia
- hypoCalcemia

9

beckwith wiedemann syndrome is due to?

deregulation of gene expression in chromosome 11p15 (which codes for insulin like growth factor 2)

10

phys findings at birth w/ beckwith wiedemann syndrome?

- macrosomia (rapid growth until late childhood)
- macroglossia
- hemihyperplasia (one side bigger than other)
- medial abdominal wall defects (ie umbilical hernia, omphalocele)

+/- visceromegaly

11

what is beckwith wiedemann syndrome?

overgrowth disorder --> predisposition to neoplasms

12

beckwith wiedemann syndrome inc risk for?

- Wilms tumor
- Hepatoblastoma

13

what is surveillance for beckwith wiedemann newborns?

at birth: monitor for hypoglycemia

birth - 4 yo: screening abd u/s and alpha-getoprotein levels from birth (looking for malignancy)

4-8yo: abd u/s every 3 mo

8- adolescence: renal u/s

14

bradycardia, AV block, hypotension, and diffuse wheezing - suggest what type of overdose?

Beta blocker overdose

15

wheezing w/ overdose -- think?

beta blocker overdose

(bc beta 2 blockade!)

16

treatment of beta blocker overdose?

1) secure airway, IV fluids
2) Atropine to treat hypotension and bradycardia
3) if hypotension profound or refractory give IV glucagon

17

Main P2y12 receptor blocker to know?

- clopidogrel

18

what is action of clopidogrel?

P2y12 receptor blocker

19

main medical therapy to improve morbidity and mortality in pts w/ CHD?

- Dual antiplatelet therapy (aspirin and clopidogrel)
- Beta blockers
- ACE-i/ARBs
- HMG-CoA reductase inhibitors (statins)
- Aldosterone antagonists (sprionolactone, eplerenone) - in pts w/ V EF

20

phosphodiesterase 5 inhibitors are used for what and do what?

- erectile dysfunc
- vasodilators

21

phosphodiesterase 5 inhib are contraindicated in pts also on what med?

nitrates (risk of hypotension)

22

milrinone is what type of med and who is it contraindicated for?

- selective phophodiesterase inhib
- contraindicated in pts w/ HF (inc mortality)

23

statins are what type of med?

HMG-CoA reducatse inhibitors

24

differences b/t the various prostatitis? (ie chronic bacterial, inflammatory, non inflammatory, acute bacterial)

Afebrile w/ irritative voiding symp (ie urgency, freq, discomfort)
- Chronic Bacterial: secretions inc WBC w/ growth on cx
- Inflammatory: secretions w/ inc WBC, cx neg
- Non-Inflammatory: nL secretions and cx

Acute bacterial: FEBRILE, exquistely tender prostate, U/A w/ bacteriuria and pyuria (+/- irritative voiding symp)

25

essential tremor + HTN - what med best?

beta blocker (ie propranolol)
- can treat both

26

aminoglycosides can cause what organ issue?

Acute renal failure

27

amikacin is what type of med?

aminoglycoside

28

multi-drug resistent pyelonephritis likely caused by what group of bugs?

gram neg rods

29

spasticity, UMN or LMN?

UMN

30

bulbar symp, UMN or LMN?

UMN

31

fasciculation, UMN or LMN?

LMN

32

hyperreflexia DTR, UMN or LMN?

UMN

33

cortical and subcortical atrophy disproportionately greater in temporal and parietal lobes -- think?

Alzheimers

34

personality changes & loss of social restraint w/ dementia --> becomes mute, immobile, and incontinent - think?

Frontotemporal lobe dementia

35

pt w/ asthma attack become hypokalemic -- why?

inhaled beta-2 agonist use (ie albuterol)
--> stim K shift into cells + release of insuline which further inc intracellular K shift

36

how long does a pt w/ mono have to refrain from sports?

>= 3 wks (regardless of symp as this is period w/ greatest splenic rupture risk)

37

common side effect of dihydropyridine CCB?

peripheral edema (due to dilated peripheral BV -- NOT allergy)

38

Triggers for SJS/TEN?

Drugs:
- allopurinol
- Abx (sulfonamides
- Antconvulsants (ie carbamazepine, lamotrigine, phenytoin)
- NSAIDs
- Sulfasalazine

- Mycoplasma pneumonia
- Vax
- Graft-vs host disease

39

clinical features of SJS/TEN?

- acute influenza like prodrome
-necrosis & sloughing of epidermis
- mucosal involvement
- rapid onset erythematous macules, vesicles, and bullae

40

adjustment disorder?

emotional or behavior symp dev w/in 3 mo of an identifiable stressor that last no longer than 6mo once stressor ends

41

prussian blue stain indicates?

prescence of hemosiderin -- found in urine during hemolytic episodes

42

common meds than can precipitate a hemolytic epi in G6PD deficiency (3)?

- sulfa drugs
- antimalarials
- nitrofurantoin

43

most common location for medulloblastoma?

cerebella vermis
- imp location for balance or gait coordination

44

common symp of medulloblastoma?

- truncal or gait instability (ie ataxia, bc most common location is in cerebellar vermis which is imp for balance and gait coordination)

*can also cause obstructive hydrocephalus

45

most common cerebral hemisphere tumors in kids?

low grade astrocytomas

46

craniopharyngiomas are found where?

suprasellar masses

47

two most common posterior fossa tumor (ie cerebellar)?

- cerebellar astrocytoma
- medulloblastoma

48

what is parinaud syndrome?

- limited upward gaze w/ downward preference
- b/l eye lid retraction
- light-near dissociation

49

what tumors cause parinaud syndrome?

pineal tumors (bc pressure on pretectal region of midbrain)

50

PNA w/ CNS and GI features -- think

legionnaires

51

PNA w/ hypOnatremia, hepatic dysfunction, diarrhea, fever and gram stain of sputum w/ a lot of PMNs but no organisms -- think?

legionella

52

most common way to confirm dx of legionella?

urine antigen testing

53

treatment for legionnaires disease?

Macrolide or fluoroquinolone

54

leuprolide is and can treat what?

- GRH agonist
- can treat symptomatic endometriosis --> but can lead to menopausal symp

55

adolescent w/ nasal obstruction, visible nasal mass w/ bony erosion, and frequent noseleeds - think?

Juvenile angiofibroma

56

chronic epigastric pain radiating to the back that improves with sitting up or leaning forward - think?

chronic pancreatitis

57

blood smear w/ RBC w/ single, round, blue inclusions on Wright stain - think?

Howell Jolly bodies (likely to due to hyposplenism)

58

hemoglobin precipitation inclusions are what and found when?

- Heinz Bodies
- G6PD deficiency under crystal violet stain

59

recurrent skin and mucosal bacterial infx w/o pus and with poor wound healing and CBC w/ neutrophilia - think?

leukocyte adhesion deficiency

60

leukocyte adhesion deficiency caused by?

defective integrins on leukocyte surface --> can't adhere to vasc endothelium --> can't migrate to site of infx/inflam

61

delayed umbilical cord separation (age>3 wks) - think?

leukocyte adhesion deficiency

62

adenosine deaminase is an AR form of what?

SCID - lack of mature B and T lymphocytes

63

pts w/ complement deficiency are at an inc risk for what?

disseminated bacterial infx esp w/ encapuslated bacteria (strep pneumo, HiB, Neisseria, etc)

64

peridontal infx w/ hx of many cellulitis and sinus infx and CBC shows very high WBC w/ neutrophilia - think?

leukocyte adhesion deficiency

65

pulm nodule w/ halo sign on CT in pt on steroids/chemo - think?

aspergillosis

66

pulm lesion w/ air crescent on CT in immuncompromised pt- think?

aspergiollosis

67

where can aspergillus be in lung?

ANYWHERE

68

histoplasmosis findings on CXR?

- hilar adenopathy
- areas of pneumonitis

69

fever, cough, SOB, hemoptysis in immunocompromised pt. CXR finds cavitary lesion and CT show pulm nodules w/ halo - think?

aspergillosis

70

tamoxifen and raloxifene are?

selective estrogen receptro modulators

(estrogen agonist)

71

side fx of SERMs?

- Hot flashes (bc estrogen agonist)
- Venous thromboembolism
- Tamoxifen ONLY: endometrial hyperplasia and CA

72

chronic steroid use has risk of what to bones (2)?

- Osteopenia/Osteoperosis
- AVN of femoral head (osteonecrosis)

73

signs of osteonecrosis of femoral head?

- pain in groin, thigh, or butt worse w/ activity and relieved by rest (eventually will progress to rest pain too)
- reduced range of motion (abduction and internal rotation)
- joint instability

74

best imaging of AVN of femoral head?

MRI most sensitive, xray can look nL

75

vision impairing opacification of the lens?

cataract

76

painless blurred vision w/ glare and often halos around lights (make night driving hard) - think?

cataract

77

acute/subacute loss of vision w/ swollen disc, venous dilation w/ tortuosity, diffuse retinal hemorrhages, +/- cotton wool spots - think?

Central retinal vein occlusion

78

Macular degeneration affects where in the vision?

central

79

2 primary forms of macular degeneration?

- atrophic (dry): slow progressive b/l vision loss

- exudative/neovascular (wet): agressive, unilateral vision loss

80

open angle glaucoma presents?

insidious onset w/ gradual loss of peripheral vision and consequent tunnel vision

81

gradual loss of peripheral vision, high intraocular pressures, and cupping of optic disc - think?

open angle glaucoma

82

open angle glaucoma finding on opthalmoscopic exam?

cupping of optic disc

(ie cup to disc ratio >0.6 - bc cup enlarged)

83

sudden unilateral loss of part or all of visual field as if "a curtain fell over the eye" - think?

retinal detachment

84

treatment of absence seizures?

- Ethosuximide
- valproate

85

initial drug for partial seizures?

Phenytoin

86

most common predisposing factor for orbital cellulitis?

bacterial sinusitis

87

pain w/ eye movements, proptosis, ophthalmoplegia, and diplopia - think?

orbital cellulitis

88

persistent depressive disorder (dysthemia) needs?

- chronic depressed mood >= 2 yrs (1 yr in kids/adolescent)
- no symptom free period for >2 mo
- at least 2 of the following:
- poor appetite/overeating
- insomnia/hypersomnia
- low energy or fatigue
- low self-esteem
- poor conc/diff making decisions
- feelings of hopelessness

89

delusional disorder is?

- >=1 delusion for >= 1 mo
- no other psychotic symp
- can function apart from delusion (behavior not obviously bizarre/odd)

90

delusions are?

fixed beliefs that are firmly held despite conflicting evidence

91

when hypothyroid pt get preg how do you adjust levothyroxine dose?

increase by approx 30%

92

ovarian mass with absent doppler flow think?

ovarian torsion

93

contraindications to radioactive iodine treatment?

- pregnancy
- very severe ophthalmopathy

94

what is henoch schnlein purpura?

IgA mediated leukocytoclastic vasculitis

95

clinical manifestations of HSP? (4)

- palpable pupura (usually lower limbs)
- arthritis/arthralgia
- abd pain, intussuceptions
- renal disease similar to IgA nephropathy

96

Treatment for HSP?

most: supportive (hydration and NSAIDs)

severe --> hospitaliztion and systemic steroids

97

HSP effecting kidneys would show what on biopsy?

deposition of IgA in mesangium (similar to IgA nephropathy)

98

palpable purpura on lower extremities, arthralgias, abdominal pain, and renal disease - think?

HSP

99

risk factors for necrotizing enterocolitis (4)?

- prematurity
- very low birth weight (breast milk)

100

clinical signs of necrotizing enterocolitis

- VS instability
- Lethargy
- Vomiting
- Bloody stools
- Abd distension/tenderness

101

most common effected site by NEC?

terminal ileum and colon

102

feeding intolerance, abd distension, bloody stools, vomiting in a full term newborn w/ congenital heart disease causign cyanosis - think?

necrotizing enterocolitis

103

xray findings w/ NEC? (3)

- pneumatosis intestinalis (gas in bowel wall)
- portal venous gas
- pneumoperitoneum (free air in abd)

104

Treatment of NEC?

- supportive care (bowel rest, parenteral hydration/nutrition)
- broad-spectrum IV abx

+/- surgery

105

elderly man w/ agitation onset around time of taking this type of med -- what is the type of med?

Benzo's
--> paradoxical agitation

106

indications that the SBO is complicated and warrants emergency abd exploration?

- change in character of the pain
- fever
- hemodynamic instability
- guarding
-leukocytosis
- significant metabolic acidosis

107

yellow-white fluffy hemorrhagic lesions along the vasculature in pt w/ HIV and CD4 count

CMV retinitis

108

CMV retinitis findings?

- full thickness retinal inflammation that moves along vasculature (--> edema & scarring)
- blurred vision
- floaters
-photopsia (sensation of flashing lights)

109

CMV retinitis can inc risk of?

- blindness (esp lesions near fovea and optic n.)

- retinal detachment (esp w/ lots of scarring)

110

newborn w/ dec lung markings on CXR and left axis deviation, tall peaked p waves, and minimal R waves in precoridal leads on ECG - think?

tricuspid atresia

111

subdural hematoma occurs when?

shearing forces tear bridging veins

112

subdural hematoma finding on CT?

crescent shaped hyperdensity (acute) or hypOdensity (chronic) crossing suture lines

113

how to tell b/t methanol and ethylene glycol poisoning?

what they hurt!

Methanol -> eye damage (think moonshine)

Ethylene glycol (antifreeze) - kidney damage

114

easiest reverisble risk factor for pancreatic CA?

stop smoking!

115

typical signs of cerebellar degeneration? (6)

- gait dysfunction
- truncal ataxia
- nystagmus
- intention tremor/dysmetria (limb-kinetic tremor when attempting to touch a target)
- impaired rapid alternating movements (dysdiadochokinesia)
- pendular knee reflex (m hypotonia --> persistent swinging)

116

clasp knife phenomenon seen in what pts?

pts w/ hypERtonia due to pyramidal tract disease

117

hypothyroidism despite high levels fo T4 and T3 and nL levels fo TSH - think?

receptor defects in peripheral tissues --> generalized resistance to TH

118

primary hypothyroidism has what T4/3 and TSH levels?

low T4/3
High TSH

issue at thyroid gland

119

secondary or tertiary hypothyroidism - where and what T4/3 and TSH levels?

low T4/3
low/inappropriately nL TSH

2ndary: pituitary gland
tertiary: issue at hypothalamus

120

amaurosis fugax is?

painless loss of vision from emboli

121

amaurosis fugax can be a sign of?

impending stroke

122

nontraumatic sub arachnoid hemorrhage usually results from?

saccular or berry aneurysm rupture

123

elevated opening pressure on MP and unexplained xanthochromia (yellowish color of CSF indicating bilirubin indicating hemolysis) - think

subarachnoid hemorrhage

124

amyloid angiopathy --> bleeding where?

intracerebral hemorrhage

125

HTN associated w/ what type of hemorrhages?

intraparenchymal or intracerebral hemorrhage

126

kaposi sarcoma associated w/ what virus?

HHV-8

127

dendritic ulcers in eye - think?

herpes simplex keratitis
or
Herpes zoster ophthalmicus

tell diff by presentation
- HSK - pain, photophobia, blurred vision, tearing, redness
- HZO: elderly, fever, malaise, burning, itching w/ periorbital rash

128

on cephalosporin, pt has fever, rash, arthralgias hematuria, sterile pyuria, eosinophilia/uria w/ WBC casts - think?

drug induced intersittial nephritis

*happens w/ penicillina, cephalosporins, NSAIDs, sulfonamides, rifampin, phenytoin, and allopurinol

129

maj difference b/t OCPD and OCD?

OCPD - ego- syntonic (thinks beliefs are good)

OCD: ego-dystonic (compulsions cause anxiety)

130

dev of new conduction abnormality in pt w/ IE -- think?

perivalvular abscess

131

early diastolic murmur - think?

AR

132

when AR is due to valvular disease best heard where?

Left sternal border (3rd and 4th intercostal space)

133

mitral valve perforation presents how?

- acute CHF
- systolic murmur of MR

134

tricuspid IE usually has what murmur?

holosystolic murmur of TR accentuated w/ inspiration

135

muddy brown cast found w/?

Acute Tubular Necrosis

136

RBC casts found w/?

Glomerulonephritis

137

WBC casts found w/?

Interstitial nephritis or pyelonephritis

138

Fatty casts found w/?

Nephrotic syndrome

139

Broad and waxy casts found w/?

Chronic renal failure

140

- BUN/CR -> 20:1
- UOsm 300-350
- UNa >20
- FeNa >2%

what is this?

ATN

141

hepatic encephalopathy likely due to?

inability to break down ammonia into urea

142

bronchoalveolar lavage very useful to work up what lung infx?

Pneumocysitis PNA

143

brochoalveolar lavage useful in evaluation of what? (2)

- malignancy
- opportunistic infx (ie PCP)

144

ethelyne glycol toxicity --> clinical findings?

- high anion gap metabolic acidosis
- hypoCalcemia
- Calcium oxlate crystal deposition in kidneys --> AKI, hematuria, flank pain

145

Fomepizole treats?

ethylene glycol overdose

146

very high anion gap w/ very low bicarb level (

- ethlyene glycol overdose
- methanol overdose

147

sodium thiosulfate treats?

cyanide poisoning

148

ethlyene glycol overdose, treat w/?

Fomepizole

149

pt w/ painful blurred vision and fixed, mid dilated eye w/ headache and nausea -- think?

Acute angle closure glaucoma

150

patchy redness on white of eye w/ mild pain and discharge in pt w/ autoimmune disorder - think?

Episcleritis

151

atopic dermatitis aka ?

eczema

152

eczema aka?

atopic dermatitis

153

PAS positive - think? (2)

- Whipple's disease
- Lymphoblasts (ie ALL)

154

rash that spreads from face to trunk to extremities w/ viral appearing prodrome and leukopenia and thrombocytopenia - think?

measles

155

what has been shown to reduce the morbidity and mortality in pts w/ measles?

Vit A

156

mag sulf toxicity findings?

- neuromuscular depression (m paralysis, dec/absent DTRs)
- dec resp effort/apnea
- somnolence
- visual distrubances

157

nL skin at birth that gradually progresses to dry scaly skin - think?

Icthyosis vulgaris

158

icthyosis vulgaris' nickname?

"lizard skin"

159

MAOI + tyramine --> what?

HTN crisis

160

PAS positive macrophages in lamina propria containing non-acid fast gram positive bacilli - think?

Whipple's disease (Tropheryma whippelii)

161

diarrhea, migratory non-deforming arthritis, lymphadenopathy, weight loss, and low grade fever w/ small intestine bx showing PAS positive macrophages - think?

Whipple's disease

162

Add abx to COPD exacerbation if?

2 or more of following:
- inc SOB
- inc cough (more freq or severe)
- Change in sputum prod (inc vol or change in color)

OR
Mechanical ventilation requirement

163

what is time frame to treat most pts w/ oseltamivir or zanamivir by?

w.in 48 hrs of influenza symptom onset

164

which pts if they presented w/ influenza you would still provide oseltamivir even if outside 48hrs? (7)

- >65yo
- pregnant or

165

1st stage of labor (active) is ?

6-10cm cervical dilation

166

1st stage of labor (latent) is?

0-6cm cerivcal dilation

167

2nd stage of labor?

complete dilation to delivery

168

3rd stage of labor is?

delivery of baby to expulsion of placenta

169

arrested labor in the first stage is diagnosed when?

>6cm dilation w/ ROM and 1 of the following:
- no cervical change >=4hrs despite adequate contractions (>=200montevideo untis for >= 2 hrs)
OR
- No cervical change for >=6hrs w/ inadequate contractions

170

adequate contractions are?

adequate contractions = >=200 Montevideo units for >=2hrs

171

contraction strength =?

peak mmHg - baseline mmHg

172

montevideo unit = ?

# of uterine contractions in 10 min x contraction strength

173

fetal renal agenesis indicates?

not compatible w/ life bc there will be severe pulm hypoplasia

174

lower back pain that is worse at night but improves w/ physical activity think?

inflammatory spondyloarthopathy

(ankylosing spondylitis, psoriatic, reactive, or IBD arthritis)

175

inflammation of ligamentous insertion?

enthesitis

176

envelope shaped kidney stones?

Calcium oxalate

177

radioopaque kidney stones?

- Calcium (oslate and phosphate)
- Struvite (ammonium, Mg, phos)
- Cystine

178

radiolucent kidney stone?

uric acid

179

precipitates at low pH kidney stones?

- Ca oxalate
- Uric acid
- Cystine

180

precipitates at high pH kidney stones?

- Ca phosphate
- Struvite

181

coffin lid shaped kidney stones?

struvite

182

rhomboid or rosette shaped kidney stones?

uric acid

183

hexagonal shaped kidney stones?

cystine

184

kidney stones cause by infx w/ urease bugs (ie proteus, klensiella, staph sapro etc)?

struvite

185

commonly form staghorn calculi?

struvite or cystine kidney stones

186

which kidney stone have a postive sodium cyanide nitroprusside test?

cystine

187

which kidney stones are related to a family inborn error?

cystine

188

treatment of infant botulism from environmental spores?

human derived botulism immune globuline

189

foodborne botulism treatment?

equine derived botulism antitoxin

190

treatment of guillain barre syndrome?

pooled human immune globulin

191

botulinum toxin does what?

blocks acetylcholine release at presynaptic NMJ

192

face and arm swelling w/ weight lost new onset SOB w/ smoking hstory and anterior wall veins engorgement - think?

SVC syndrome likely due to malignancy causing obstrution

193

bright red firm friable vascular exophytic nodule in an HIV pt - think?

bacillary angiomatosis

194

bacillary angiomatosis caused by?

bartonella - gram neg bacillus

195

treatment of bacillary angiomatosis?

oral erythromycin

196

common etiologies of crystal induced AKI? (5)

-acyclovir
-sulfonamides
-methrotrexate
-ethylene glycol
-protease inhibitors

197

preferred initial DMARD in pts w/ mod to severe RA?

methotrexate

198

indications of methotrexate toxcity?

- oral ulcers
- acute rise in serum transaminases
- bone marrow suppression (macrocytic anemia, leukopenia, thrombocytopenia)

199

felty syndrome?

clinical disorder seen in pts w/ severe long standing (>10yrs) RA that is characterized by neutropenia and splenomegaly

200

treatment of polymyalgi rheumatica?

low dose prednisone

201

treatment for giant cell artertitis?

high dose prednisone

202

treatment for fibromyalgia

initial: exercise and good sleep hygiene

next: TCAs

203

fatigue, stiffness, poor sleep w/ point tenderness at mid trapezius, lateral epicondyle, costochondral junction of chest and greater trochanter w/ otherwise nL phys exam and nL labs (incl ESR) - think?

fibromyalgia

204

bipolar pts w/ inadequate response to monotherapy and/or severe episode maintenance treatment is?

combo therapy w/:
- Lithium or valproate
AND
- a second gen antipsychotic (ie quetiapine)

205

PCV13 followed by PPSV23 6-12mo later recommended for pts

very high risk comoborbidities (ie sickle cell, HIV, CKD, etc)

206

PPSV23 alone for pts

- current smokers
- chronic med conditions (ie heart, lung, liver, DM)

207

pneumococcal conjugat vaccine is?

PCV13

208

pneumococcal polysaccharide vaccine is?

PPSV23

209

pneumococcal 23 valent vax is what type

polysaccharide

210

pneumococcal 13 valent vax is what type?

conjugate

211

pt w/ chronic headaches now w/ elevated Cr w/ painless hematuria and sterile pyuria w/ WBC casts and small kidneys b/l w/ renal papillary calcifications on CT - think?

analgesic nephropathy

212

Analgesic nephropathy causes what type of kidney injury?

tubulointerstitial nephritis

213

management of somatic symptom disorder?

- regularly scheduled visits w/ same provider
- limit unnecessary workup
- focus on stress reduction and improving coping strategies
- legitimize symp but make funtional improvement the goal

214

burning of rubber or plastic can cause?

cyanide inhalation/toxicity

215

bitter almond breath indicates?

inhaled cyanide

216

what presents similar to CO exposure but is due to burning of rubber or plastic?

cyanide inhalation

217

what is presenting physical skin findings in methemoglobinemia?

cyanosis and bluish discoloration of skin and MM

218

magnesium is solely excreted by?

Kidney

219

absolute contraindications to combined hormonal contraceptives? (8)

- migraine w/ aura
- >=15 cigs/dy & age >=35
- HTN >=160/100
- hx of venous thromboembolic disease, stroke, or ischemic heart disease
- BREAST CA
- Cirrhosis & LIVER CA
- Maj surgery w/ prolonged immobilization
-

220

common causes for priaprism (4)?

- sickle cell disease and leukemia - usual in kids/adolescents
- Perineal or genital trauma (laceration of cavernous a.)
- neurogenic lesion (cauda equina, spinal cord injury, etc)
- Meds: trazodone or prazosin

221

most common drug that causes priapism?

prazosin

222

initial hematura is?

bld at beginning of voiding cycle

223

total hermaturia is?

bld during entire voiding cycle

224

terminal hematuria is?

bld at end of voiding cycle

225

terminal hematuria suggests?

bleeding from prostate, bladder neck/trigone, or post. urethra.

(which can be concerning for CA)

226

terminal hematuria w/ clots indicates?

bleeding w/in bladder or ureters concerning for urothelial CA

227

initial hematuria causes? (2)

- urethritis
- trauma (ie catheterization)

228

Terminal hematuria causes (5)?

- Urothelial CA
- cystitis (infx/post rad)
- Urolithiasis
- BPH
- Prostate CA

229

Total hematuria causes?

- Renal mass (bening/malignant)
- Glomerulonephritis
- Urolithiasis
- PCKD
- Pyelonephritis
- Urothelial CA
- Trauma

230

bedwetting before age what is normal?

5

231

you've identified small nonbleeding varices in an alcoholic cirrhotic pt, next treatment step?

Give non-selective beta-blockers (n and below)

*dec progression and risk of hemorrhage

232

treatment for cryptococcal meningoencephalitis?

Induction therapy w/ 2 wks of amphotericin B and flucytosine

Followed by consolidation therapy of 8wks of fluconazole and maintenance w/ it for at least 1 yr

233

Antiphospholipid syndrome - clinical features?

1) Thrombotic event (venous or arterial) OR Pregnancy morbitidy (loss, severe preeclampsia, placental insufficiency)
PLUS
2) positive for at least 1 of the following Ab:
a) Anticardiolipin
b) Anti-beta2-glycoprotein-I
c) Lupus anticoagulant

234

biggest risk factor fo antiphospholipid syndrome is?

Lupus

235

antiphospholipid syndrome can cause what to be a false positive?

VDRL and RPR test --> so you mistakenly think its syphilis!

236

Single S2 - think? (3)

- Transposition of great vessels (+/- VSD)
- Tricuspid atresia (has VSD)
- Truncus Arteriosis (w/ systolic ejection murmur)

237

cyanotic baby w/ Narrow mediastinum w/ "egg on a string" heart - think?

Transposition of great vessels

238

cyanotic baby w/ Harsh pulmonic stenosis murmur and VSD murmur - think?

Tetralogy of Fallot

239

Boot shaped heart in cyanotic baby - think?

Tetralogy of Fallot

240

cyanotic baby w/ single s2 and a systolic ejcetion murmu w/ edema - think?

Truncus arteriosis

241

Severe cyanotic baby in respiratory distress w/ pulm edema on CXR and enlarged supracardiac vens and SVC - think?

Total anomalous pulm venous retun w/ obstruction

242

ice bag test is for?

Myasthenia gravis

243

place ice bags on ptosis eyes and they improve indicates?

Myasthenia gravis

(cold inhib breakdown of acetylcholine at NMJ)

244

bacterial meningitis in pt >1mo treatment?

IV vanco and ceftriaxone

(cefotaxime in pt

245

bacterial meningitis in pt

IV vanco and CEFOTAXIME

(>1mo can use ceftri)

246

when do you add dexamethasone in bacterial meningitis treatment?

when causative agent likely is HiB -- protecting against sensoriuneural hearing loss

247

HIV pt CD4 count

Progressive disseminated histoplasmosis

248

disseminated histoplasmosis hits what parts of body?

-Systemic (f/c/weight loss)
- Pulm (cough, SOB)
- Mucocutaneous lesions (mouth ulcers, nodules, papules)
- Reticuloendothelial inflammation (ie hepatosplenomegaly, lymphadenopathy)

249

CXR findings for disseminated histoplasmosis?

reticulonodular or interstitial infiltrate

250

Treat disseminated histoplasmosis?

mild/maintenance: Itraconazole

mod-sever: Ampho B

251

dx of disseminated histoplasmosis confirm most rapidly w/?

serum or urine HIstoplasma antigen immunoassay

252

congenital rubella findings?

- sensorineural hearing loss
- intellectual disability
- Cardiac anomalies
- Cataracts, glaucoma

253

kid w/ los grade fever, conjunctivitis, coryza, cervical lymphadenopathy and w/ head to body spreading erythematous blanching maculopapular rash - thnk?

Rubella

254

valgus stress test is testing what ligament in knee?

medial collateral ligament

255

knock kneed is what knee deformity?

valgus

256

bow legged is what knee deformity?

varus

257

varus laxity - what injured ligament?

lateral collateral ligament

258

chronic overuse injury characterized by ant knee pain and tenderness?

pateller tenodonitis (jumper's knee)

259

hard, immobile, non-tender boney growth on hard palate of mouth - think? caused by?

- torus palatinus
- congenital

260

gastric MALT lymphoma w/ no metastasis initial treatment?

abx to eradicate H. pylori (triple or quadruple therapy)

261

cocaine induce MI, what do you avoid?

Beta blockers (bc can make vasospasms worse)

262

cocaine induced MI, what med may you add?

CCB or alpha blockers (ie phentolamine) to help reduce vasospasms

263

most common cause of sudden cardiac arrest in the immediate post infarction period (w/in 1 hr) in pts w/ acute MI?

Reentrant ventricular arrhythmias (ie v fib)

264

down syndrome pt w/ torticollis, urinary incontinence, dizziness, diplopia, behavioral changes, hyperreflexia, positive babinski,a and ataxia - think?

atlantoaxial instability

265

young down syndrome pt w/ upper motor neuron findings - think?

atlantoaxial instability

266

infant w/ little prenatal care now w/ rhinorrhea, long bone abnlmalities, and diffuse maculopapular desquamating skin rash that can involve the palms and soles- think?

congenital syphilis

267

infant w/ little prenatal care now w/ sensorineural hearing loss, cataracts, and a PDA - think?

rubella

268

infant w/ little prenatal care now w/ periventricular calcifications -- think?

CMV

269

infant w/ little prenatal care now w/ diffuse intracranial calcifications, hydrocephalus, and severe chorioretinitis - think?

toxoplasmosis

270

crescendo decrescendo systolic murmur present at L sternal border that does NOT radiate to carotids - think?

HOCM (intervemtricular septal hypertrophy)

271

mitral regurg has what type of systolic murmu?

holosystolic

272

anterior MI now 5 days later w/ chest pain that progresse to pulseless electrical activity w/ tachy - think?

V wall rupture

273

5 days post MI w/ sudden onset hypotension, CHF symp, and a loud holosystolic murmur at LLSB - think?

Interventricular wall rupture

274

3 days post MI now w/ sudden onset hypotension and a new holosystoli cmumur at apex that radiates and pulm edema - think?

papillary muscle rupture

(---> MR)

275

TCA overdose w/ widening QRS treat w/?

sodium bicarb

276

anaphylaxis, IM or subQ epi injection?

IM! it has higher plasma and tissue levels

277

anal fissure treatment?

- high fiber diet w/ adequate fluid intake
- stool softeners
- sitz bath
- topical anesthetic
- topical vasodilators (ie nifedipine, nitroglycerin)

278

easy PAO2 formula?

PAO2 = 150 - (PaCO2/0.8)

*150 = (0.21 x [760-47]) = (FiO2 x[Patm -Ph20])

279

angina pectoris?

episodes of substernal pain provocked by emotion

280

episodes of substernal pain provoked by emotion?

angina pectoris

281

dipyrdamole and adenosine are coronary what?

coronary vasodilators

282

coronary steal is?

redistribution of coronary blood flow to "non-disease areas" and perfusion of "diseased areas" are diminshed

- can be utilized in myocardial perfusion scanning

283

how does dipyridamole help dx in myocardial perfusion scanning ?

coronary steal

284

post splenectomy pts are at inc risk for sepsis from encapsulated organisms due to?

impaired Ab-mediated opsonization in phagocytosis

285

imaging for psoas abscess?

CT scan

*u/s poor sensitivity due to deep nature and number of other organs and bones covering