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Flashcards in Secrets Deck (1142):
1

Vitamin to give w/ any patient on Isoniazid therapy

B6

2

Signs of end organ damage in hypertensive emergency

Headaches

Dizziness

Blurry vision

Papilledema

Cerebral edema

AMS

Seizure

Intracerebral hemorrhage (typically in the basal ganglia)

Renal failure

Angina

MI

HF

3

First treatment in shock

IV fluids (along w/ O2 and monitoring)

UNLESS IT IS CARDIOGENIC SHOCK

4

Virchow triad

Endothelial damage (surgery, trauma)

Venous Stasis (immobilization, severe HF)

Hypercoagulable state (birth control, malignancy, lupus anticoagulant)

-Increases likelihood of DVT

5

First thing to do on a gastric ulcer found on an upper endoscopy

Biopsy

6

Best initial test to distinguish upper from lower GI bleeding

Nasogastric tube

7

Tx for hereditary hemochromatosis

Therapeutic phlebotomy

8

ADRs of steroids

Weight gain

Easy bruising

Acne

Hirsutism

Emotional lability

Depression

Psychosis

Menstrual changes

Sexual dysnfnxn

Insomnia

Memory loss

Buffalo hump

Truncal/central obesity w/ wasting of extremities

Round facies

Purple skin striae

Weakness in proximal muscles

HTN

Peripheral edema

Poor wound healing

Decreased glucose tolerance

Osteoporosis

Hypokalemic metabolic acidosis

9

ADRs of contraception

Endometrial cancer

Hepatic adenoma

Glucose intolerance

DVT, stroke

Cholelithiasis

Depression

Weight gain

Pseudotumor cerebri

Teratogenesis

Increased risk of CAD and breast cancer

10

Acute laryngotracheitis

Croup

Caused by the parainfluenzae virus and commonly affects children aged 1-2 years

*X ray shows tracheal narrowing on frontal x-ray (STEEPLE SIGN)

TX: dexamethasone; epinephrine

11

X-rays for smokers

For pts. >55yrs old and w/ a >30 pack year history

12

Odds ratio

(AxD)/(BxC)

13

Relative risk

[A/(A+B)]/[C/(C+D)]

14

Attributable risk

[A/(A+B)]-[C/(C+D)]

15

Tx of acute dystonia

Antihistamine (Diphenhydramine)

Anticholinergic (benztropine)

16

MCCo decreased maternal AFP

Incorrect dates

17

Variable decelerations

Umbilical cord compression

18

Late decelerations

Uteroplacental insufficiency

-Most worrisome

19

Test to perform before doing a digital exam during third trimester w/ bleeding

US

-need to r/o placenta previa

20

Neonatal conjunctivitis

First 12-24 hours: Possibly chemical reaction to drops

2-5 days: Gonorrhea; can be prevented w/ drops

5-14 days: Chlamydia; not prevented w/ drops

21

6 Ps of Compartment syndrome

Pain (out of proportion to injury)

Paresthesia

Pallor

Pressure

Paralysis (late, ominous sign)

Pulselessness (very late sign; MUST TREAT NOW)

22

Pulsatile abdominal mass + Hypotension

Ruptured AAA

Tx: Sx.

23

APGAR

Color: 0- pale, blue
1- Body pink, extremities blue
2- Completely pink

HR: 0- Absent
1- <100/min
2- >100/min

Irritability: 0- None
1- Grimace
2- Grimace w/ strong cry, sneeze, or cough

Tone: 0- Limp
1- Some flexion
2- Active movement

Respiratory effort: 0- None
1- Slow, weak cry
2- Good, strong cry

24

Tx for BB OD

Glucagon

25

Tx for cholinesterase inhibitors

Atropine

Pralidoxime

26

Tx for digoxin toxicity

Correct K+ and other electrolytes

Digoxin ab

27

Deep, rapid breathing in a diabetic

Kussmaul respiration

Sign of DKA

28

Cherry- red spot on the macula w/o hepatosplenomegaly

Tay-Sachs Disease

29

Cherry-Red spot on the retina w/ hepatosplenomegaly

Niemann-Pick disease

30

Disease to think of when an infant has a meconium ileus

CF

31

Cafe-au-lait spots w/ decreased IQ

McCune-Albright

or

Tuberous sclerosis

32

Cafe-au-lait spots w/ a normal IQ

Neurofibromatosis

33

Ambigous genitalia and hypotension

21a-hydroxylase deficiency

34

Anaphylaxis from Ig therapy

IgA deficiency

35

Postpartum fever unresponsive to broad-spectrum abs

Septic pelvic thrombophlebitis

36

Low-grade fever in the first 24 hrs after surgery

Atelectasis

37

Rash that develops after administration of ampicillin or amoxicillin for sore throat

MONO

38

Facial port-wine stain and seizure

Sturge-Weber

39

Beck triad

JVD

Muffled heart sounds

Hypotension

***SIGNS OF CARDIAC TAMPONADE

40

Brudzinski sign

Pain on neck flexion

41

Charcot triad

Fever/chills

Jaundice

RUQ pain

*Cholangitis

42

Chvostek sign

Tapping on the facial nerve elicits tetany

***SIGN OF HYPOCALCEMIA

43

Cushing reflex

HTN

Bradycardia

Irregular respirations

***INCREASED ICP

44

Leriche syndrome

Claudication and atrophy of the butt w/ impotence

*Aortoilliac occlusive disease

45

Tests used to assess for abnormal karyotype after abnormal B-hCG levels

Chorionic villus sampling: Weeks 9-13

Amniocentesis: Weeks 15-20

46

Pneumococcal polysaccharide vaccine (PPSV23)

Contains capsular material from 23 serotypes and produces a T-cell independent B-cell response that is less effective in young children and elderly

*Given to all IC pts. and adults >65 OR <65 if they have COPD, HD, DM)

47

Pneumococcal conjugate vaccine (PCV13)

Contains capsular polysaccharides from 13 most common serotypes and is covalently attached to inactivated diphtheria toxin protein

=>> Induces a T-cell dependent B-cell response w/ formation of memory cells and antibodies

*Recommended for all infants and young children

48

Pt. w/ IE who has history of heart murmur

Probably mitral regurg.

49

RFs for C. diff

Antibiotics

Hospitalization

PPI use

50

Studies that are known as a prevalence study

Cross-sectional

-These studies simultaneously measure exposure and outcome

51

Mammary gland enlargement, swollen labia, and white vaginal discharge in a newborn infant

NORMAL; due to maternal estrogen

52

Patient w/ a serum B-hCG <1500 and a negative TVUS

Repeat B-hCG level in 2 days

-Oftentimes, a intrauterine pregnancy will not be seen on a TVUS until B-hCG is >1500

-If the level is greater than 1500 and no intrauterine pregnancy is seen, begin to suspect ectopic

53

Cauda equina syndrome

Bilateral, severe radicular pain w/ chronic onset

Saddle anesthesia

Asymmetric motor weakness (but can be present on both sides, just greater on one of them)

Hyporeflexia

LATE onset bowel dysfnxn

***Damage is in the SPINAL NERVE ROOTS (hyporeflexia)

54

Conus medullaris syndrome

Pain is SUDDEN-onset and in the back

Perianal anesthesia

SYMMETRIC motor weakness

HYPERreflexia

EARLY-onset bowel dysfnxn

***DAMAGE is in the CONUS MEDULLARIS

55

Leads w/ ST-elevation in LAD occlusion

I, aVL (lateral)

V1-V4 (anterior)

56

Cardiac manifestationsof sarcoidosis

Complete AV block (most common)

Restrictive cardiomyopathy (early)

Dilated cardiomyopathy (late)

*Due to formation of cardiac noncaseating granulomas

57

Problems w/ vesicoureteral reflux

Recurrent UTIs

Renal scarring

Renal insufficiency

ESRD

58

First thing to order in a woman >30 w/ a palpable breast mass

Mammogram

59

"Egg on a string" heart on newborn CXR

Narrow mediastinum

-Indicative of Transposition of the Great Vessels

60

Hyperemesis gravidarum

RFs: Hydatiditiform mole
Multiple gestation
Hx. of HG

CFs: Severe, persistent vomiting
>5% loss of prepregnancy weight
Dehydration
Orthostatic hypotension

Labs: Ketonuria
Hypochloremic, hyopkalemic metabolic alkalosis
Hypoglycemia
Hemoconcentration

Tx: Admission; IV fluids and antiemetics

*Differentiate from normal vomiting during pregnancy by lab values

61

MDMA OD

Hypertension

Tachycardia

Hyperthermia

***Serotonin Syndrome (especially if the patient takes any SSRIs)

62

Extraperitoneal bladder injury

Contusion or rupture of the neck, anterior wall, or anterolateral wall of the bladder; presents w/ localized pain the lower abdomen and pelvis

-Cause by pelvic fracture usually

*Pts. also have hematuria and urinary retention

63

Reasons for baseline EKG abnormality

1. LBBB

2. LVH

3. Pacemaker

4. Digoxin

-Test for myocardial ischemia via

1. Thallium pickup test (abnormal shows decreased uptake)

2. Echo (abnormal shows cardiac hypokinesis)

64

Prasugrel

P2Y-inhibitor best used alongside aspirin after coronary angioplasty or stenting

*Cannot use in pts >75yrs because of increased risk of hemorrhagic stroke

65

Ticlopidine

Used in pts. who are intolerant of aspirin and clopidogrel

ADRs: neutropenia, TTP

66

Medications to use on a pt. who does not tolerate an ACEI but has HF

Nitrates + Hydralazine

67

LDL goal w/ CAD

<70

68

Indications for cardiac revascularization

3 vessel disease

L. main disease

2 vessel disease in a diabetic

69

Pt w/ an acute DVT

Tx. w/ unfractionated heparin and warfarin; even if surgery has happened recently

70

Workup for Raynauds

CBC, BPP

Urinalysis

ANA

ESR, Complement levels

-Need to rule out sinister causes

71

First work-up for a palpable ovarian mass

Pelvic ultrasound

72

Infant w/ an elevated arterial blood level

Repeat w/ venous blood; false positives common w/ arterial blood

73

Granulosa cell tumor of the ovary

Malignant neoplasms that secrete ESTROGEN and can cause precocious puberty in young girls or bleeding/endometrial hyperplasia in postmenopausal women

74

Attrition bias

Type of SELECTION bias due to loss of patients to follow-up

Results can be skewed in certain directions depending on the populations

75

Factorial design

Involves 2 or more experimental interventions and measures 2 or more outcomes

76

Patient who has uremia and chest pain

Consider uremic pericarditis

These pts. should be started on dialysis

77

Tx of Torsades

IV magnesium

78

Pt. who is in his 50s, has a palpable retroperitoneal mass, and renal railure w/ HTN

Suspect ADPKD

79

Crescendo-decrescendo murmur along the left sternal border w/ no radiation

HOCM

80

Most important prognostic factor in breast cancer

TNM staging

81

Tx for cervicofacial Actinomyces

Penicillin

82

Clinical manifestations of hereditary hemochromatosis

Skin: Hyperpigmentation

MSK: Arthralgia, chondrocalcinosis
-IF YOU SEE THIS ON XRAY, GET A CBC TO ID THIS DISEASE

GI: Elevated hepatic enzymes =>> cirrhosis and cancer

Endocrine: DM, hypogonadism, hypothyroidism

Cardiac: Restrictive or dilated cardiomyopathy

Infections: Increased susceptibility to Listeria, Vibrio, and Yersinia

83

Best management for preeclampsia

DELIVERY

W/o severe features =>> @ 37 weeks

W/ severe features =>> @34 weeks

84

Urine protein/creatinine ratio indicative of preeclampsia

>.3

or

24 hours urine showing >300mg protein

85

CHAD-VASc

CHF
HTN
Age >75 (score +2)
DM
Stroke/TIA (Score +2)
Vascular disease (prior MI, PAD)
Age 65-74 (score +1)
Sex (female)

2 or greater requires oral anticoagulants; 1 may just need aspirin

86

Treatment of preeclampsia

Hydralazine

Labetalol

Nifedipine PO

87

JONES criteria

Joints (migratory arthritis)
Carditis
Nodules (subcutaneous)
Erythema marginatum (looks faint, erythematous and centrifugal)
Sydenham's Chorea

Minor:
Fever
Elevated ESR/CRP
Arthralgia
Prolonged PR interval

88

Management of postpartum urinary retention

Urethral catheterization

89

Treatment for Listeria

Ampicillin

90

Aztreonam coverage

Exclusively for gram negative bacteria

91

Strongest indicator other is directly correlated to the level of viral replication in HBV

HBe

92

Tx of chancroid

Azithromycin

93

Signs of peripheral Bell's Palsy

Loss of forehead and brow movements

Inability to close eyes and drooping of both eyelids

94

Most accurate dating of gestational age

First trimester ultrasound with crown-rump length measurement

95

Cephalohematoma

Subperiosteal hemorrhage limited to the surface of one cranial bone in a newborn infant

-Swelling becomes visible a few hours after birth

96

Caput succedaneum

Diffuse, ecchymotic swelling of the scalp of the newborn that DOES extend over cranial suture lines

97

Pt w/ fat malabsorption (diarrhea, bloating) and signs of hyperparathyroidism

Probably secondary to Vitamin D deficiency

Suspect increased PTH w/ decreased Calcium and Phosphorus

98

Lynch Syndrome Neoplasms

Colorectal cancer

Endometrial Cancer

Ovarian Cancer

99

FAP Neoplasms

Colorectal cancer

Desmoids/Osteomas

Brain tumors

100

vHL-Syndrome Neoplasms

Hemangioblastomas

Clear cell renal carcinoma

Pheochromocytoma

101

MEN 1 Cancers

PTH

Pituitary Adenomas

Pancreatic adenomas

102

MEN 2A Cancers

Parathyroid cancer

Medullary Thryroid Cancer

Pheochromocytoma

103

Tx of ventricular tachycardia in a stable patient

Amiodarone

104

Long term O2 therapy criteria

1. O2 sat <=88% on room air or PaO2 <55mmHg

2. O2 sat <=89 on room air or PaO2 <=59mmHg AND HAVE cor pulmonale, right heart failure, or Hct > 55%

105

Vertebral Osteomyelitis

Fever, back pain, focal spinal tenderness

*Do not need elevated WBC, fever

106

Joints most commonly affected by pseudogout

Ankle and knee

107

Manifestations of amyloidosis (primary and secondary)

Renal: Proteinuria (heavy), peripheral edema

Cardiac: Restrictive cardiomyopathy, AV block

CNS: Autonomic/peripheral neuropathy, stroke

GI: Hepatomegaly, malabsorption, GI bleed

Pulm: Nodules, effusions

MSK: ENLARGED TONGUE

Skin: Thickening (Waxy appearance), nodules, bruises

Heme: Anemia, thrombocytopenia

108

Other bacteria that can cause endocarditis and necessitates a colonoscopy afterwards

Clostridium septicum

109

When do you need surgery for endocarditis?

Rupture valve or tendinae

Prosthetic valve infxn

Fungal endocarditis

Abscess

AV block

Recurrent emboli

110

Tx for HACEK endocarditis

Ceftriaxone

111

Treatment of cardiac or neurologic Lyme disease

Ceftriaxone

112

Zidovudine ADR

Anemia

(NRTI)

113

Stavudine ADR

Peripheral neuropathy

Pancreatitis

(NRTI)

114

Didanosine ADR

Peripheral neuropathy

Pancreatitis

(NRTI)

115

Abacavir ADR

SJS

***TEST FOR HLA-B5701; will predict this rxn

116

Protease inhibitor ADRs

Hyperlipidemia, hyperglycemia

***These drugs end in -navir

117

Indinavir ADR

Nephrolithiasis

What class is this?

118

Tenofovir ADR

Renal insufficiency

Bone demineralization

(NRTI)

119

Anti-retroviral medication you can't use in pregnant women

Efavirenz

120

Tests for Aspergillosis

Galactomannan

B-D-glucan

PCR

121

Chikungunya fever

Joint pain, periarticular edema, rash, fever

122

Box-car shaped encapsulated rods

Bacillus anthracis

Can be:

1. Cutaneous (black eschar= self-limited)

2. GI (diarrhea, ulcerations)

3. Inhalation (widened mediastinum, pleural effusion)

123

Leptospirosis

Oliguria, elevated CK w/ muscle pain

Get from infected food from animal urine

124

Angioedema tx.

Acute: Epinephrine to stabilize airway; FFP, ecallantide, or icatibant

Chronic: Danazole; Stanazole

125

Manifestation of Hyper IgE Syndrome

Recurrent skin infxns w/ Staph.

126

Facets of a biophysical profile

Nonstress test (fetal heart rate)

Amniotic fluid volume

Fetal breathing

Fetal movement

Fetal tone

⭐️order there's with a non reactive stress test

127

STDs screened for at initial pregnancy visit

Hiv

HBV

Chlamydia

Syphilis

128

Acute, unilateral lymphadenitis causative agent

Staph aureus

129

Fibromyalgia

Middle-aged women w/ widespread pain, fatigue, and mood complaints

-Point tenderness is greater at insertion points of muscles

Tx: Education; aerobic exercise
****TCAs******

130

Malignant otitis externa (necrotizing)

Severe infxn of the external auditory canal and the base of the skull presenting w/ unrelenting ear pain, purulent drainage w/ granulation tissue, and conductive hearing loss on the affected side

Tx: IV Ciprofloxacin

131

Why does tucking knees into the chest fix a TOF babies problems?

It increases systemic vascular resistance causing more blood to go to the lungs

132

Attributable risk percent

(risk in exposed-risk in unexposed)/risk in exposed

133

Best test for someone w/ Addison's

8AM serum cortisol and ACTH stimulation test

134

Polymyositis

Proximal muscle weakness; NO PAIN PRESENT

Dx: Elevated CK, Aldolase (muscle enzymes)
(+)ANA, (+) anti-Jo-1
Biopsy: Endomysial infiltrate w/ patchy necrosis

135

Polymyalgia rheumatica

Presents in >50 year wold people w/ stiffness AND PAIN in the shoulders, hip, and neck; assoc. w/ GCA

Dx: Elevated ESR, CRP
RAPID IMPROVEMENT W/ GLUCOCORTICOIDS

136

Pt. who started medication for tremor and has visual disturbances

Consider trihexyphenidyl precipitating Acute Angle Closure Glaucoma

137

Patient who prevents w/ sudden unilateral lower abdominal pain that progresses to diffuse abdominal pain, shoulder pain, decreased Hcrt and has free fluid in the pelvis

Possible ruptured ovarian cyst

***Usually occurs in the second half of the menstrual cycle after the most recent luteal cyst has formed

138

Medications to give women in preterm labor at <32 weeks gestation

Betamethasone

Tocolytics (indomethacin, nifedipine)

Magnesium sulfate (neuroprotective properties for the fetus)

Penicillin

139

Stillborn fetus w/ multiple fractures, hypoplastic thoracic cavity, short limbs

Probably Type II Osteogenesis Imperfecta

Is typically fatal during delivery

140

Test to order prior to starting Trastuzumab

Echocardiogram

***Drug is highly cardiotoxic, although, it is reversible following discontinuation

141

"Irregularly enlarged uterus"

LEIOMYOMA

-Even if you look into the OS and see a mass, the uterus is probably just trying to expel one

142

Febrile Neutropenia

MAKE SURE TO COVER ALL BACTERIA INCLUDING PSEUDOMONAS

-Try Pip-Tao, Meropenem, Cefepime

143

Myotonic Dystrophy

AD expansion of a CTG trinucleotide on Cr. 19

Presents at age 12-30 w/ facial weakness, hand grip myotonia, and dysphagia

***May also have cataracts, balding, testicular atrophy, and arrhythmia

144

Pulseless Electrical Activity Management

CPR

Epi

Possible Advance Airway

*Manage like the patient is in asystole****

145

Indications for urgent dialysis

Acidosis (<7.1)

Electrolyte abnormalities (EKG probs; K>6.5)

Ingestion (alcohols, salicylate, lithium, Keppra, Carbamazepine)

Overload

Uremia (symptomatic w/ encephalopathy, pericarditis, or bleeding)

146

"Water bottle" shaped heart on X-ray

Pericardial effusion

Looks more like a canteen really

147

CML tx.

Imatinib

-TK inhibits the BCR-ABL gene product

148

Tx for nephrogenic DI

Tx underly cause and add..

HCTZ; amiloride; or NSAIDs (prostaglandin inhibitor)

149

Signs/Sx. of Acromegaly

Increased hat, ring, and shoe size

Carpal tunnel syndrome

OSA

Body odor due to sweat gland hypertrophy

Coarsened facial features

Deep voice

Macroglossia

Colonic polyps

Skin tags, hyperglycemia

Arthralgia

150

Best initial test for suspected acromegaly

IGF-1

Most accurate test is the glucose suppression test
=>Glucose should suppress GH levels

151

Tx of acromegaly

Transphenoidal resection

Meds:

Pegvisomant (GH receptor antagonist which inhibits IGF-1 release from the liver)

Octreotide/Somatostatin (inhibits GH release from pituitary)

Cabergoline (Dopamine inhibits GH release from pituitary)

152

CCB that can cause prolactinemia

Verapamil

153

Tests to run after high prolactin level

TFTs (high TRH can cause release)

Pregnancy test

BUN/Cr (kidney disease will elevate levels)

LFTs

-Afterwards, do an MRI

154

Subacute thyroiditis

Patient presents w/ a tender thyroid and elevated T4 but decreased TSH and RAIU

Tx: Aspirin

155

Thyroid storm tx

1. Propanolol (blocks target organ effects and peripheral T4=>T3 conversion)

2. Methimazole/PTU

3. Iodine (blocks release and peripheral conversion)

4. Steroids

156

Tx of Grave's Opthalmopathy

Steroids

157

Cinacalcet

Suppresses PTH release

Used to tx. hyperparathyroidism if sx. is not an option

158

Calcium and albumin correlation

For every point decrease in albumin, Ca2+ drops 0.8

159

Tx for unresectable pituitary causing hyperadrenalism

Pasireotide

-Somatostatin analog

160

What should you order if a high dose dexamethasone test does not suppress ACTH secretion?

CXR

161

Fludrocortisone

Useful steroid replacement in that it has increased mineralcorticoid activity

-Choose this if the patient has signs of postural instability

162

Testing for pheo

Initial: Plasma free metanephrines

Confirm: 24 hr urine metanephrine

163

Diabetes diagnosis

Two fasting blood glucose levels greater than 125

Single level greater than 200 and presence of symptoms

Increased glucose level on OGTT test

164

Pramlinitide

Amylin analogue that decreases gastric emptying, decreases glucagon levels, and decreases APPETITE

165

Incretins

Exenatide, liraglutide, dulaglutide

These act like GLP and increase insulin release while slowing gastric emptying (Early satiety) and DECREASING WEIGHT

166

DM Health Maintenance

Pneumococcal vaccine

Eye exam

Statins if LDL >100

ACEIs/ARBs if BP >140/90 and/or if urine is (+) for microalbuminuria

Aspirin at age >30

Foot exam

167

Tx of diabetic gastroparesis

Metoclopromide or erythromycin (increases gastric motility)

Presents w/ nausea, bloating, constipation, abdominal discomfort

168

PCOS diagnostic criteria

Clinical signs of hyperandrogenism and/or high testosterone/DHEA

Irregular menstruation

10 cysts on pelvic sonogram w/ an ovary >10cm

169

Postpartum endometritis

RFs: C-sec, Chorioamnionitis, GBS, prolonged rupture of membranes, operative vaginal delivery

CFs: Fever >24hrs postpartum, uterine fundal tenderness, purulent lochia

Tx: Clindamycin and gentamicin
-Infxn is polymicrobial usually

170

Pt w/ dyspnea, chest pain, tachycardia, hypoxia, clear lungs, and syncope

COULD BE MASSIVE PE

COULD LEAD TO R.HEART FAILURE

171

Tx for hypotension caused by an epidural during labor

Placement of the patient on their left side to improve VR

Fluid bolus

Vasopressors

172

Lead points for intussusception

Kid w/ recent illness: Hypertrophied Peyer's Patch

Normal Kid: Meckel Diverticulum

Adult: Small cell lymphoma

173

Asthmatic patient w/ recurrent episodes of brown-flecked sputum and transient infiltrates on x-ray

Allergic Bronchopulmonary Aspergillosis

Tx. w/ ORAL steroids

174

Outpatient pneumonia tx.

Azithromycin

or

Doxycycline

Comorbidities (COPD, asthma)

=>>Levo or Moxi

175

Inpatient Pneumonia tx.

Levo; Moxi

or

Ceftriaxone + Azithromycin

176

CURB 65

Confusion
Uremia
Respiratory Distress
BP low

65 years or older

*Needs 2 for admission

177

Exudate vs. Transudate

pH <7.2

LDH >60% of serum

Protein >50% of serum

178

Hospital Acquired Penumonia tx.

Cefepime/Ceftazidime

Pip-Tazo

Carbapenem

***JUST MAKE SURE THERE IS PSEUD COVERAGE

179

Ventilator-Associated Pneumonia tx.

1. Anti-pseudonomal B-lactam (ceftaz or cefepime, pip-tazo, carbapenem)

2. Second antipseudomonal (gentamicin, cipro/levo)

3. Vanc or Linezolid

180

Imipinem ADR

Seizure!

-Can occur w/ ESRD pts or pts. on meds that decrease renal fnxn

181

Tx for PCP if you cant use Bactrim

Clindamycin

or

Pentamadine

182

HIV pt. whos CD4 count rises to above 200 and stays for 6 months

You can stop medications

183

Patient w/ a positive PPD

Get a CXR

Only get a second PPD if they have never had a PPD before

Tx: Once active disease is ruled out w/ the CXR, tx. w/ isoniazid prophylaxis for 9 months

184

Interstitial Lung Disease w/ granuloma formation

Berylliosis

-Will respond to steroid tx.

185

Possible presentations of sarcoidosis

Erythema nodosum

Parotid gland enlargement

Facial palsy/CNS involvement

Iritis/Uveitis

Elevated ACE

Hypercalciuria/Hypercalcemia

186

Argatroban

Direct thrombin inhibitor

Use this if a patient has HIT

187

Tx for primary pulmonary HTN

Prostacyclin analogues (beraprost, iloprost)

Endothelin antagonists (bosentan)

188

Tx of ARDS

Low-tidal volume mechanical ventilation (6mL/kg)

PEEP (maintain plateau pressure <30cm H2O)

189

Pt who has a hip fracture but is medically unstable

Can delay surgery for up to 72 hrs; stabilize first

190

Most common cause of anemia in someone w/ SCD

Folate deficiency

BM can't keep up with rapid hemolysis

191

Pt. who has clear cervical mucous and a normal period

Could just be her ovulating and leaking juice

192

Mongolian Spot

Benign finding of dermal melanocytosis that appears as a flat, blue-grey patch present on the lower back and butt

Typically will fade spontaneously in the first decade of life

Benign finding

193

First test in someone w/ back pain that is worse at night

Still get an Xray first

MRI next

194

Tx of Guillan-Barre

IVIG

195

Fanconi Anemia

BM: Aplastic anemia

Appearance: Short, microcephaly, hypoplastic thumbs, hypogonadism

Skin: Irregularly pigmented areas, large freckles

*Occurs due to chromosomal breaks

196

Keratitis in a pt. w/ HIV

Think HSV

197

Riboflavin deficiency

Angular cheilosis, stomatitis, glossitis

Normocytic anemia

Seborrheic dermatitis

198

Boerhaave Syndrome

Spontaneous esophageal rupture usually following excessive vomiting or retching;

S/s: Odynophagia, fever, dyspnea, septic shock, subcutaneous emphysema

Labs: Gastrografin shows leakage
CXR shows widened mediastinum
Pleural fluid will have low pH, protein, and amylase

Tx: Sx

199

Digoxin toxicity

N/V

Decreased appetite

Confusion

Weakness

Also the blurry vision and color changes but if a pt. has the others and is on Digoxin; CHECK BLOOD LEVELS

200

MC morbidities w/ TPN

<14 days =>> Central-line associated bloodstream infection

>14 days =>> Cholelithiasis

201

Pt who was recently on chemo and now develops a dark, black legion w/ necrosis

Suspect ecthyma gangrenosum caused by Pseud.

202

Loss of palpable pulse during inspiration

Pulsus paradoxus (think cardiac tamponade)

203

TB pleural effusion

Exudative w/ increased LYMPHOCYTES

204

Spontaneous bacterial peritonitis

CFs: Fever, abdominal pain, AMS, hypotension, paralytic ileus

Ascitic fluid: PMNs (250, Positive culture, Protein <1, SAAG >1.1

Tx: 3rd gen. cephalosporins of FQNs

205

Tx of supraventricular tachycardia

Adenosine

206

Tx of ventricular tachycardia

Amiodarone

207

Pt who develops significant muscle weakness and parasthesias after being started on a thiazide

Probably has Primary Hyperaldosteronism; the thiazide made the condition worse

208

Pt w/ renal failure who starts developing hip and back pain

Renal osteodystrophy

Labs will show decreased Ca and increased PO4 BUT there is actually increased PTH

209

Pt w/ confusion and GI bleed

Probably have increased ammonia

210

Most important prognostic factor for astrocytoma

Tumor grade

Also, pt. age and functional states are important

211

Tx for CLL

Rituximab (anti-CD20)

212

Most common causes of infxn in SCD pts.

Pneumonia: S. pneumoniae

Osteomyelitis: S. aureus, S. enteritidis

Bactermia: S. pneumoniae, H. influenzae

Meningitis: S. pneumoniae

*Due to functional asplenia

213

Bacterial endocarditis prophylaxis

Prosthetic heart valvue

Hx. of IE

Structurally abnormal valve in a TRANSPLANTED HEART

***Just these

214

Rate control for A-fib

Metoprolol, emsolol

or

Diltiazem, Verapamil (nondihydropyridine CCBs)

215

Type II Membranoproliferative Glomerulonephritis

"Dense deposit disease"

Caused by anti-C3 (C3 nephritic factor) IgG targeted against C3 convertase

These complexes wind up getting deposited in the glomerular basement membrane

216

Pt w/ preeclampsia who becomes dyspneic and hypoxic

Likely pulmonary edema secondary to an increased workload being faced by the hear

217

Indications for renal/bladder US

Infants <24 months old w/ first febrile UTI

Recurrent febrile UTIs at any age

UTI in achild w/ family hx. of urologic disease, HTN, or poor growth

Children who do not respond to abx. therapy

218

Complete Atrioventricular septal defect

Most common congenital heart defect w/ Down Syndrome

-Failure of endocardial cushions to merge causes a VSD and ASD

Auscultation findings:

Loud S2
Systolic ejection mumur
Holosysytolic murmur from VSD

219

Hallmark of prolonged seizures (Status epliepticus)

Cortical laminar necrosis

Can lead to persistent neurologic defects and recurrent seizure

220

Alcohol withdrawal syndromes

Mild: Anxiety, insomnia, tremors, palpitations (6-24hrs)

Seizures: 12-48hrs

Alcoholic hallucinosis: 12-48hrs

DTs: 48-96hrs (confusion, agitation, fever, tachycardia, diaphoresis, hallucinations

221

Pt. w/ a positive Pap smear during their pregnancy

Still go ahead and perform a colposcopy

222

Acute cholangitis

Presents as fever, jaundice, RUQ pain, and elevated AP

Usually secondary to malignancy or gallstone

223

MCC of spontaneous lobar hemorrhage

Cerebral amyloid angiopathy

224

Normocytic anemia, thrombocytopenia, and acute renal injury following a diarrheal illness

Hemolytic Uremic Syndrome

225

Luteoma of pregnancy

Mom has yello-brown masses of lutein cells, ovarian mass on US, and new onset of hirsutism and acne

-Female fetus is at high risk of virilization

226

ADRs of cyclophosphamide

Acute hemorrhagic cystitis

Bladder carcinoma

Sterility

Myelosuppression


*****AVOID BLADDER ADRS BY DRINKING LOTS OF FLUIDS AND TAKING MESNA

227

Blocked vessel in inferior MI

RCA

Sometimes LCX

228

Solitary Pulmonary Nodule found on X-ray and it is changed from previous X-ray, what do you do?

Chest CT

229

Pt who has an ovarian mass and is postmenopausal, what should you do?

Get US and a CA-125

230

Most common cause of nephrotic syndrome in adults

Focal segmental glomerulosclerosis

-Pts. at increased risk are black, hispanics, obese ppl, HIV, and heroin users

-Pts. are at increased risk for thrombosis, infxn, and protein malnutrition

231

Pts. who are IC and present w/ signs of meningitis must also be covered for what organism?

Listeria monocytogenes

232

Spinal epidural abscess

Fever, progressive focal back pain, and neurologic deficits typically in an IV drug abuser

Labs: Elevated ESR


233

Child with pharnygeal erythema and some small vesicles

Probably Herpangina (Coxsackie A)

Just needs conservative management

234

Granulomatosis w/ polyangiitis

Sinusitis, lung nodules/cavitation, rapidly progressive GN, AND NONHEALING ULCERS OR LIVEDO RETICULARIS (4th manifestation)

Tx: Steroids; immune modulators

235

Insulin drips should contain what else when treating DKA?

K+

236

Pt. w/ elevated platelets a few months after abdominal surgery due to trauma

Likely reactive thrombocytosis which will resolve

If their spleen was removed, this could make the count even higher

237

In a patient w/ hyperprolactinemia but no visual sx., should you get a head CT?

No

Start off w/ lab work

238

Best medication to treat hypertriglyceridemia

Fibrates

239

Long-term benefits and risks of OCPs

Benefits: Endometrial/Ovarian cancer risk reduction
Fixed menstrual irregularities
Decreased risk of benign breast disease

Risks: DVT
HTN
Hepatic adenoma
Increased risk for cervical/breast cancer (for 10 years following discontinuation)

240

What should you start on a patient w/ mild bone pain probably secondary to metastatic malignancy>

Bisphosphonates

-Help to inhibit the osteoclastic activity of bone destructive tumors

241

ABG findings w/ postoperative atelectasis

ph: Increased

pCO2: Decreased

PO2: Decreased

-Hyperventilation gets rid of CO2; collapse of lung causes decreased O2 diffusion

242

Big difference b/w excess vomiting and diarrhea in labs

Vomiting =>> Alkalosis

Diarrhea =>> Acidosis

243

Fibromyalgia

Presents as chronic, widespread pain w/ fatigue and impaired concentration

***Pts. have tenderness on palpation and muscle insertion points

*Labs will be normal

244

Toxic Shock Syndrome

Risks: Tampon use, recent surgery, skin lesions/burns, sinusitis/nasal surgery

CFs: High fever, hypotension, diffuse macular rash involving the palms and soles, desquamation 1-3 weeks after onset, vomiting, diarrhea, AMS

Tx: Supportive; removal of any foreign bodies; antibiotics

245

Patients w/ palpable purpura, proteinuria, hematuria, and arthralgia should be tested for what?

HCV antibodies

-Sounds like this is mixed cryoglobulinemia

-Will also see decreased complement

246

How does IgA nephropathy present?

HEMATURIA

247

Nonclassical CAH

Can present w/ acne, irregular menses, and hirsutism

-Patients will present w/ increased 17-hydroxyprogesterone and increased testosterone and DHEA as well

248

Possible complications of HSP

GI hemorrhage

Intussusception

249

CN III palsy

Paralysis of levator muscle (ptosis)

Loss of 4 EOMs (down and out eye)

-If diabetic CN III palsy, pupillary response will be preserved because these fibers are on the outside of CN III

250

Why do patients w/ exudative pleural effusion have decreased glucose in the effusion?

High metabolic activity of WBCs

251

Felty Syndrome

RA

Splenomegaly

Neutropenia

252

Caplan Syndrome

RA

Pneumoconiosis

Lung nodules

253

MC nephrotic syndrome in SLE

Membranous glomerulonephritis

254

Pt. with signs of sclerosis who has a rapidly rising bp

Sclerodermic crisis

Get them ACE inhibitors yo

255

Dangerous complications of Sjogrens

Lymphoma; make sure to screen for this

256

HUS presentation

Antecedent diarrheal illness

=>>Microangiopathic hemolytic anemia
-Fatigue
-Pallor
-Schistocytes

Thrombocytopenia

AKI (oliguria, edema)

257

Zinc deficiency

Alopecia

Pustular skin rash

Hypogonadism

Impaired wound healing

Impaired taste

immune dysfnxn

258

Juvenile Myoclonic seizure

Generalized seizure most commonly w/ myoclonic jerks most prominent in the first hour after awakening

259

Patient who has only been sick w/ respiratory illness for a few days but has focal exam findings

Still get a CXR

260

Pt with asthma, eosinophilia, and pulmonary/renal sx.

Churg-Strauss Syndrome

261

Behcet's Syndrome

Oral and genital ulcers

Ocular lesions that can cause uveitis and/or blindness

Possible erhthema nodusm and arthritis

262

Septic arthritis of a prosthetic joint

Shows up as radio lucency on Radiographic imaging or it could just be a loose joint

Tx by removing joint, giving abx., and replacing it

263

Possible ADR to b12 or folate replacement

Hypokalemia

Secondary to rapid cell production

264

Management of SCD

Need folate, pneumococcal Vax, Hydroxyurea

Also give abx. Right when a fever develops or the WBC rises

265

Manifestation of sickle cell trait

Isosthenuria

Possible painless ️hematuria

266

Patient who cut foot near water source and develops septicemia, bullous lesions, and cellulitis w/ possible necrotizing fasciitis

Vibrio vulnificus (GNR)

-Increased risk in those w/ liver disease

Tx: IV ceftriaxone + doxycycline

267

CXR for pulmonary contusion

Patchy alveolar infiltrate; usually localized to injured area

*ARDS has the same BUT it manifests after 24-48 hours and will be diffuse

268

Difference b/w ovarian torsion and rupture cyst

Rupture presents w/ peritoneal signs such as rigid abdomen, pleuritic chest pain, involuntary guarding, and rebound pain

269

Pts. who are high risk for medications respond to what intervention the best?

Pharmacist-directed intervention

270

Treatment for breast engorgement for women who no longer wish to breastfeed

Supportive bra

Ice packs on nipples

NSAIDs

271

Vasovagal syncope

Presents in people who are subjected to stress (even emotional) or prolonged standing and is accompanied by a prodrome of pallor, nausea, and diaphoresis and is later followed by a rapid regaining of consciousness

Tx: Reassurance; counterpressure techniques

272

Meningococcoal vaccination

Patients get the first vax at age 11 w/ a booster at age 16-21

273

Wet beriberi

High output cardiac failure

Can also be "dry" presenting w/ peripheral neuropathy

274

Menke's Syndrome

Copper deficiency

Presents w/ MR and kinky hair

275

Selenium deficiency

CArdiomyopathy

Muscle pain

276

Patient who has been on prolonged antibiotics and develops bleeding w/ elevated INR

Vitamin K deficiency

Abx. therapy wiped out bacteria in gut that help absorb Vit. K

277

Tx of superficial thrombophlebitis

Conservative (ICE, NSAIDs, REST)

No increased risk for PE so no anticoagulation

278

Subclavian Steal Syndrome

Left subclavian artery obstruction proximal to vertebral artery origin

***W/ exercise/stress, pts. will have CNS complaints of syncope, dizziness, vertigo, ataxia due to blood being "stolen" to supply exercising muscles

279

MC testicular tumor

Seminoma

280

BPH treatment

alpha-1 blockade (tamsulosin, doxazosin, terazosin

5a-reductase inhibitors (finasteride)

TURP if very advanced

281

Best donor for a kidney transplant

Living, related donor

Cadaver acceptable tho

282

Buerger disease

Basically Raynaud symptoms in a young person

283

First work up for a postmenopausal women w/ vaginal bleeding

Pelvic ultrasound

284

Salvage radiation therapy

Treatment when other options have failed

285

Neoadjuvant therapy

Radiation given before standard therapy

286

Induction radiation therapy

Initial dose to rapidly kill tumor cells and send a patient into immediate remission

287

Estrogen effects on thyroid

May have increased T4 and normal TSH

This is due to the increase in TBG

288

Plan B

High dose oral levonorgestrel

289

MC risk factor for recurrent UTIs in children

Vesicoureteral reflux

290

Refeeding Syndrome

Patient who has started feeding again (usually after hospital admission or maybe some tragic accident where they were lost on an island) and has a massive release of insulin on exposure to the food

CFs: Arrhythmia, CHF, Pulmonary and peripheral edema, Seizure, Wernicke's Encephalopathy

Labs: Decreased phosphorus, K+, Mg2+, thiamine
Increased Na+

291

Management of meconium ileus

Abdominal X-ray (check for perfs)

Followed by contrast enema *******

292

Euthyroid sick syndrome

"Low T3 syndrome"

Pt. who has had caloric deprivation, severe illness, or elevated cortisol has decreased total and free T3

-Should return to normal when they get better

293

Top 3 lifestyle modifications for HTN

1. Weight loss

2. DASH diet

3. Exercise

294

Management of inflammatory acne

1. Topical retinoids + benzoyl peroxide

2. Topical erythromycin/clindamycin

3. Oral abx.

295

Quadruple screens on Trisomy 21

AFP: Decreased

b-HCG: Increased

Estriol: Decreased

Inhibin A: Increased

296

Ruxolitinib

JAK inhibitor used for refractory polycythemia vera

297

Treatment to add onto ALL tx.

Intrathecal chemo

Prevents any relapse in the CNS

298

Leukemia most likely to have an acute blast crisis

CML

299

Pelger-Huet Cell

A bilobed PMN found in MDS

-Can also see increased MCV, NRBCs, and few blasts

300

Non-hodgkin's Staging

I: One lymph node group

II: 2 or more lymph node groups on the same side of the diaphragm

III: Both sides of the diaphragm

IV: Metastatic and widespread

301

Tx. of advance non-Hodgkin's

Cyclophosphamide
Hydroxydaunorubicin (Adriamyacin)
Oncovin (vincristine)
Prednisone

AND Rituximab

302

Tx of Hodgkin's Lymphoma

Adriamycin (doxorubicin)
Bleomycin
Vinblastine
Dacarbazine

Treat relapses w/ chemo

303

Tx for Waldenstrom's

Plasmapheresis

Followed by prednisone

304

ITP tx.

No symptoms; greater than 30,000 =>> Nothing

Severe bleeding, <10,000 =>> IVIG

Mild bleeding, count greater than 30,000 =>> Steroids

*Splenectomy is last resort

305

Tx of esophageal spasms

CCBs

306

Two diagnoses for a ring narrowing the distal esophagus

Plummer-Vinson Syndrome: Assoc. w/ IDE; treat w/ iron

Schatzki ring: Assoc. w/ reflux and/or hiatal hernia; tx. w/ endoscopic procedure

307

Orthostasis definition

10+ rise in pulse when going from lying down to sitting up

or

Systolic pressure top of >15 points when sitting up

308

Drug to give for esophageal variceal BLEEDING

Octreotide

309

Tx. of a repeat episode of C. diff

Still use repeat metronidazole

310

Tx for Whipple's

Ceftriaxone; Bactrim

311

Tx for diarrhea-prominent IBS

Rifaximin

312

Tx of IBS

Increase fiber

Hyoscyamine/Dicyclomine

TCAs

313

Tx of constipation predominant IBS

Polyethylene glycol

314

Pt who has a history of osteoarthritis and has an elevated CR, mild proteinuria, and WBC casts

Suspect analgesic nephropathy

315

Pt. w/ syncope who has prolonged PR interval on EKG

Syncope likely due to bradyarrhythmia or intermittent AV block

316

Magnesium toxicity

N/V, flushing, headache, hyporeflexia, hypocalcemia, somnolence

=>> Possible respiratory paralysis and cardiac arrest

tx: Calcium Gluconate

-Can occur in pts. w/ renal failure

317

Simple Renal Cysts

Thin, smooth, regular wall

Unilocular

Homogenous

Absence of contrast enhancement

Asymptomatic

No follow-up needed

*IF it has other qualities, work up for malignancy

318

Baby who presents w/ signs of meningitis but was given a C-section

Could still be GBS; has high incidence of hand-hand transmission

319

CXR w/ reactive nodules and surrounding ground-glass opacities

"Halo sign"

-Suspect invasive aspergillosis

320

Strongest RF for stroke

HTN

321

Pt. w/ epigastric pain and RFs for cardiac disease

Still get an EKG before amylase and lipase

322

Antibody positive in Crohn's Disease

anti-saccharomyces cerevisiae ab

323

Peutz-Jeghers Syndrome

Multiple hamartomatous polyps

Melanotic spots on the lips and skin

Increased frequency of breast, pancreatic, and gonadal cancer

*Apparently do not need increased colonoscopy screening tho

324

SAAG levels of ascitic fluid

<1.1
-Infxn
-Cancer
-Nephrotic syndrome

>1.1
-Portal HTN
-CHF
-Hepatic vein thrombosis
-Constrictive pericarditis

325

MCCo Spontaneous Bacterial Peritonitis

E. coli

Typically gets treated w/ ceftriaxone

326

What do pts. w/ variceal bleeding and ascites need?

SBP prophylaxis

-Also, anyone who's ever had it gets lifelong prophylaxis

327

Hepatopulmonary Syndrome

Hypoxia due to liver failure

Pts. have orthodeoxia (hypoxia when sitting up straight)

328

Woman w/ fatigue, itching, elevated AP, and positive anti-mitochondrial antibody

Primary Biliary Cholangitis

Tx: Ursodeoxycholic acid

329

Test for suspected Primary Sclerosing Cholangitis

MRCP; will show beading of the biliary duct

330

AI hepatitis abs

Anit-smooth muscle antibodies

Tx: Prednisone

331

Med to start on an ischemic stroke when the patient is already on aspirin

Clopidogrel or dipyridamole

332

Cluster headache prophylaxis

Verapamil

Prednisone

333

CSF finding in MS

Oligoclonal banding

334

Pt. w/ chorioamnionitis and is having contractions

Give oxytocin; still no need for C-sec

335

Causes of prosthetic joint infxn

<3 months: S. aureus, GNRs, anaerobes

3-12 months: S. epidermidis, Propionibacterium, Enterococci
-May present as joint loosening or chronic pain

>12 months: S. aureus, GNRs, Strep. pyogenes

336

Large, polygonal thyroid cells w/ eosinophilic cytoplasm containing large amounts of mitochondria

Hurthle Cells

NONSPECIFIC finding of follicular thyroid cancer cause they can also bee seen in benign adenomas and Hashimoto's

337

MCCo Renal Vein Thrombosis

Membranous nephropathy

Presents as severe abdominal pain, fever, and gross hematuria

338

Management of a patient with psychosis on their Parkinson Meds

Start clozapine

Do not abruptly stop their meds

339

What drug is associated with the development of progressive multifocal Leukoencephalopathy

Natalizumab

a-4 integrin inhibitor sometimes used as suppressant medication for disorders like MS

340

CMT

Genetic denervation disorder w/ distal weakness, sensory loss, wasting in the legs, ️Decreased DTRs, and high plantar arches

341

Radial nerve palsy

Presents as wrist drop

Common causes are Saturday Night Palsy, crutches

342

Glycopyrrolate

Anticholinergic drug that inhibits the muscarinic receptors only

-Used to prevent ADRs of pyridostigmine, also for intubations to ️Decreased saliva

343

CSF with 14-3-3 protein

Creutzfeldt-Jakob Disease

344

RF of tamoxifen therapy

Endometrial carcinoma

345

Tx of a breast abscess from untreated mastitis

Needle drainage and abx.

IF no response, then do an Incision and drainage

346

Pt. who has a swollen area on the floor of his mouth and his tongue is displaced posteriorly

Ludwig angina

Rapidly progressive cellulitis of the submandibular space arising from dental infxn; infxn is typically polymicrobial in nature

347

IV drug abuser who presents w/ pulmonary sx., cavitary lesions on chest imaging, and systemic sx.

Probably septic emboli from IE

-Can also appear on imaging as abscesses, infarctions, or just infiltrates

348

Pt. who presents w/ hepatic failure following TB tx.

Likely secondary to the INH therapy

349

HIV pt. w/ Papilledema but has a normal MRI

Suspect Cryptococcus neoformans; organism obstructs the outflow of CSF

350

Difference b/w confounding and effect modification

Confounding: Both factors can cause disease possibly, but one thing certainly does

Effect modification: One thing by itself does not cause disease

351

Pt. w/ history of PUD and now presents w/ signs of an acute abdomn

Could be a perf.

Get an X-ray

352

Subcutaneous uric acid deposits that look like punched out lesions on bone radiographs

"Tophi"

Assoc. w/ gout

353

Disease polyarteritis nodosa is assoc. w/

HBV

354

Pediatric patient w/ uveitis, inflammatory arthritis, and negative RF

Rheumatoid arthritis; RF often negative in pauciarticular variant

355

Imaging for suspected urethral trauma

Retrograde urethrogram

356

Solitary lung nodule in pt. younger than 40, doesn't smoke or live in some endemic area

Probably a hamartoma

357

MC bone malignancy in pediatric patients

Osteosarcoma

358

Baby who has pink stains in their diaper but is otherwise eating fine

Uric acid crystals; very common after birth

-Called "brick dust"

359

Goals of mechanical ventilation in ARDS

1. Low tidal volume =>> decreases likelihood of overdistending the alveoli

2. Keep SpO2 >88%

360

Hemodynamic effects of hyperthyroidism

HTN

Increased cardiac contractility and CO

Decreased SVR

Increased myocardial O2 demand

361

Neonate w/ oral thrush, PCP, FTT, and diarrhea

Suspect HIV from mom

362

Follow-up on patient w/ amenorrhea and a negative pregnancy test

Serum prolactin, TSH, and FSH

363

Name of the protein that may be found on a hyaline cast

Tamm-Horsfall protein

-Normal; may present w/ dehydration causing concentrated urine and precipitation of this protein

364

Granular, muddy brown cast

Sign of ATN; these are collections of dead tubular cells

365

Best way to try to prevent contrast-induced nephropathy

Saline hydration

366

Urinary findings in contrast-induced nephropathy

Urine sodium (low); FENa <1%, urine SG (high)

This is because, in contrast to other forms of ATN, contrast causes afferent arteriole vasospasm and this induces the ATN w/ contrast-induced nephropathy

367

Pt who has cancer and is treated w/ chemo who subsequently develops renal failure

Hyperuricemia secondary to Tumor Lysis Syndrome

-Prevent w/ allopurinol, hydration, and rasburicase

368

Diagnostic test for cholesterol emboli affecting the kidneys

Eosinophilia

Decreased complement

Eosinophiluria

Bx. of purple skin lesion will show cholesterol crystals

Elevated ESR

369

Delivery for a patient w/ placenta previa

C-section at Weeks 36-37 to avoid any risks w/ labor

370

Vaccine refusal from a mom

Respect her decision in the test world and document that she's a fucking idiot

371

Gestational HTN vs. Primary HTN during pregnancy

Gestational HTN will be only AFTER Week 20; if it was present before, probably primary

372

HTN RFs during pregnancy

Maternal: Superimposed preeclampsia, pospartum hemorrhage, gestational diabetes, placental abruption, C-section

Fetal: FGR, perinatal death, preterm delivery, oligohydramnios

373

"Triple bubble" sign on a newborn

Likely jejunal atresia

374

Bruton's Agammablobulinemia

Patients have a decreased B-cell count w/ decreased Igs across ALL lines

-Typically presents w/ recurrent sinopulmonary and GI infxn after infant loses maternal antibodies at 6 months

*MAKE SURE TO TO LOOK AT B CELL COUNTS

Tx: IVIG; abx.

375

ADRs of Selective Estrogen Receptor Modulators (SERMs)

Tamoxifen and Raloxifene

Hot flashes

DVT

Endometrial carcinoma (w/ tamoxifen)

376

Tx for chemotherapy-induced nausea Odan

Odansetron (Serotonin Receptor ANTAGONIST)

377

Skin biopsy w/ blisters/microabscesses at the tips of the dermal papillae

Dermatitis herpetiformis

378

Problems not associated w/ a normal grief reaction

Feelings of worthlessness, psychomotor retardation, and suicidal ideation

379

Is a diagnosis of previous conduct disorder required to make a diagnosis of antisocial disorder as an adult?

Yes

380

If a question wants you to treat a COPD pt. w/ a beta blocker, what should you use?

Atenolol or Metoprolol

B1-selective

381

Pt. w/ nasal polyps and needs an NSAID

DO NOT GIVE ASPIRIN

382

Congenital disorders that EVERY state screens for

PKU

Hypothyroidism

383

Age at which you should start evaluating strabismus

3 months

384

Delayed puberty

Boys: Lack of testicular enlargement by 14 years

Girls: Lack of breast development or pubic hair by 12 years

385

Work up for cephalohematoma

Head X-ray/CT to rule out underlying fracture even tho there probably is not one

386

ADPKD manifestations

1. Hepatic cysts

2. Berry aneurysm

3. MVP or Aortic regurg.

4. Diverticulosis

5. Abdominal/inguinal hernia

387

Stroke in a young person

Do a work up for PAN

Kids may also have mononeuritis complex (damage to large, peripheral nerves)

Labs: Elevated ESR and CRP; anemia and leukocytosis

388

Medication to give when giving vitamin D to a renal failure pt.

Phosphate binders; otherwise you can worsen their hyperphosphatemia

389

Symptoms present in TTP but NOT HUS

Fever

Neurologic probs (AMS)

390

MCCoD in ADPKD

Renal Failure

391

Causes of euvolemic hyponatremia

Hyperglycemia (pseudohyponatremia)

*For every 100mg/dL of glucose; there is a 1.6mEq/L drop in Na+

Psychogenic polydipsia

Hypothyroidism

SIADH

392

Tx for chronic SIADH

Fluid restriction

+

Demclocycline

393

PE findings associated w/ Aortic Stenosis

Diminished and delayed carotid pulse (pulsus parvus and tardus)

Mid-to late peaking systolic murmur

Presence of a SOFT and single second heard sound
-Due to reduced mobility of the valve

394

Patient who has N/V, pneumobilia, and hyperactive bowel sounds

Probably a GALLSTONE ILEUS

-Pts. have colicky pain, dilated loops of bowel, and typically have a history of gallstones

Dx: Abdominal CT

Tx: Sx.

395

CHARGE Syndrome

Coloboma
Heart Defects
Atresia chonae (baby w/ cyanosis worsened by feeds)
Retardation of growth/development
Genito-urinary anomalies
Ear abnormalities/deafness

396

Adenomyosis

Endometrial glands trapped in the myometrium and cyclically shed; typically presents as dysmenorrhea w/ HEAVY menstrual bleeds that begins later in the reproductive years

CFs: Tender, UNIFORMLY enlarged uterus

Tx: OCPs; IUDs; Hysterectomy

397

Approach to sinus bradycardia in adults

IF UNSTABLE

-IV atropine

THEN

-IV dopamine, IV Epi, OR TRANSCUTANEOUS PACING

398

Missed abortion

Pregnancy loss at <20 weeks w/o expulsion of products of conception

Pts. may notice decreased pregnancy symptoms or have very light, scant vaginal bleeding

399

Threatened abortion

Bleeding and a closed cervix but US reveals an intrauterine gestation

400

Appearance of metastatic brain cancer

Several, discrete circumscribed lesions at the jnxn of the gray white matter w/ surrounding edema

401

Milk-alkali syndrome

Pts. have excessive calcium and absorbable alkali intake leading to renal vasoconstriction w/ decreased GRF and loss of Na+, H20, w/ reabsorption of HCO3-

CFs: N/V, constipation, polyuria, polydipsia, psych sx.

Labs: Hypercalcemia
Metabolic alkalosis
AKI
Suppressed PTH

Tx: Discontinue meds; saline + furosemide

402

Possible causes of lead poisoning

Battery manufacturing

Plumbing

Home restoration

Alcohol distilling

403

Lupus pt. w/ antiphospholipid ab syndrome and is trying to get pregnant

Get them on Heparin

-APLS actually increases likelihood of clots

404

Cyclic Vomiting Syndrome

Child w/ predictable pattern of vomiting that resolves spontaneously, is completely normal in b/w episodes, and has no lab abnormalities

-For some reason, parents who have migraines have kids with this

Tx: Antiemetics and hydration

405

How can stress fractures appear on imaging?

Sclerotic bone

406

Reflex sympathetic dystrophy

Pt. Who develops hyperesthesia and autonomic dysregulation in an extremely after a relatively mild injury

Dx and Tx: sympathetic nerve block (relief=diagnosis)

407

Ultraviolet keratitis

Pts. have a history of welding, using a tanning bed, or snow-skiing

CFs: Keratitis, foreign body sensation, tearing, red eye, and decreased bision

Tx: Eye patch and topical abx.

408

"Trigger words" for ALL

Pancytopenia, history of radiation therapy, Down Syndrome

409

Men IIB

Mucosal neuromas

Medullary Thyroid Cancer

Pheochromocytomas

410

Environmental RFs for Liver Cancer

Alcohol

Polyvinyl chloride (angiosarcomas)

Aflatoxins

411

Histological clue of serous cystadenocarcinoma

Psammoma bodies

412

Meigs Syndrome

Ovarian fibroma

+

Ascites

+

Right sided hydrothorax

413

Most common tumors in children

Cerebellar astrocytoma

Medulloblastoma

Ependymoma

414

Bunch of grapes coming out of the vagina of a child

Sarcoma botryoides

-Embyronal rhabdomyosarcoma

415

MCCo Thyroid Cancer

Papillary thyroid cancer

416

HHV-8

Kaposi's Sarcoma

417

CT differences b/w Wilm's Tumor and Neuroblastoma

Wilms: Arise from kidney; NO CALCIUM

Neuroblastoma: Arise from adrenals; CALCIUM

418

CD1

Marker for histiocytosis; will also see tennis rackets on microscopy

419

Management of diverticulitis complicated by abscess

CT guided percutaneous drainage

420

Management of endometriosis that has failed conservative management

Laparoscopy

421

Breastfeeding failure jaundice

Presents in the first week of life and is caused by lactation failure (can be due to mom or baby)

Path: Decreased bilirubin elimination
Increased enterohepatic circulation

CFs: Suboptimal breastfeeding
Dehydration
Brick-red urate crystals (can be normal but is a sign of dehydration)

Tx: Better breast feeding yah dingus

422

Breast milk jaundice

Starts at age 3-5 days and peaks at 2 weeks; due to high levels of B-glucuronidase in breast milk

CFs: Adequate breast feeding
Normal exam

423

Pt. who had a recent cardiac procedure and becomes hemodynamically unstable 12 hours later

Suspect retroperitoneal hematoma formation

Next thing to do: Get non-contrast CT of abdomen

Tx: Supportive

424

Mainstay of tx. for Polycythemia Vera

Serial phlebotomy

*This condition can also present w/ increased platelets and WBCs

425

CIs to OCPs

Migraine w/ aura

Cigarette smoking

HTN

HD

DM w/ end organ damage

Hx. of DVT

Anti-phospholipid antibodies (lupus)

Breast cancer

Cirrhosis/Liver Cancer

Major surgery w/ prolonged immobilization

426

What has the greatest mortality benefit in an asymptomatic pt with an extensive family history of breast cancer?

SERMs

427

Unvaccinated person gets stuck with dirty needle, what do you give them?

HBV-Ig And vaccinate

428

CAGE questions

Cut down
Angry
Guilty
Eye-opener

429

Possible causes of porphyria Cutanea Tarda

⭐️HCV

Alcoholism

Estrogen use

Hemochromatosis

430

Cardiac Risk factors for sx.

EF <35%

Recent MI in last 6 months

Signs of CHF (optimize pts. w/ ACEIs, BBs, and spironolactone)

431

Pulm Risk Assessment for Sx.

Lung disease? =>> PFTs

Smoker but no disease =?? Stop smoking for 6 weeks

432

SIRS criteria

Body temperature <36 or >38

HR >90

RR >20 or PCO2 <32

WBC <4000 or >12000

*Must meet 2 of these

*If confirmed infxn is present, then it is sepsis

433

Patient who suffered from head trauma and has raccoon eyes and/or bruising behind the ears

Basal skull fracture

434

MC overall cause of pancreatitis

TRAUMA

DO NOT FORGET THIS W/ EPIGASTRIC PAIN AND IT CAN BE HEMORRHAGIC SO HYPOVOLEMIA CAN BE PRESENT

435

Best initial test for acute mesenteric ischemia

X-ray

*Will see air in the bowel wall

436

Median Arcuate Ligament Syndrome

External compression of the celiac trunk by the median arcuate ligament

CFs: Severe abdominal pain
Weight loss
Nausea

*Is a diagnosis of exclusion BUT US can measure flow thru the celiac artery

Tx: Surgical decompression of the celiac artery

437

Hamman Sign

Crunching sign on palpation of the thorax due to subcutaneous emphysema

*Seen in Boerhaave syndrome

438

Most common location for Boerhaave syndrome

Posterolateral aspect of the distal esophagus

439

MC location for a Mallory-Weiss Tear

Gastroesophageal jnxn

440

What should you not R/O in a pt. over 60 w/ RLQ pain?

Cecal diverticulitis

441

Tx of acue ascending cholangitis

IV abx. followed by ERCP to removed obstruction

Followed by cholecystectomy

442

When can a fetal heart first be heard on US?

10-12 weeks

443

If a mom gets chickenpox before delivery, what should you give the infant?

Zoster immune globulin

444

Lab changes in pregnancy

Increased:
ESR
Total T4 and TBG (free t4 is the same)
Hgb and plasma volume (looks like hgb ️Decreases)
AP

Decreased: BUN; Cr

445

Pt. who is identified to have a short cervix on TVUS

Manage w/ Vaginal progesterone

-In future pregnancies, consider a cervical cerclage beforehand

446

Factor V Leiden

AD mutation in factor 5 that makes it unresponsive to activated protein C

=>>Thrombus formation

-Coag studies are usually normal

**If it asks why a patient is having clots and their coag studies are normal, this is a VERY LIKELY cause

447

Complications of Primary Biliary Cholangitis

Malabsorption and fat-soluble vitamin deficiencies

OSTEOPORSIS/OSTEOMALACIA

Hepatocellular carcinoma

448

Female on OCPs who has HTN

Suggest switching to a different form of BC

449

Tx of Nocardia

Bactrim

-Remember the sulfa eggs at the Nocardia shootout

450

IDE lab findings

MCV: Decreased

RDW: Increased

451

Can pts. w/ bronchogenic carcinoma have pleural plaques?

Yes; so do not reflexively answer mesothelioma on asbestos exposure

452

Injury to rule out w/ fracture of the clavicle

Subclavian artery or Brachial plexus injury

453

Woman who awakens in the night and has an acutely flexed and painful finger that is relief when she pops it

Trigger finger

Tx: Steroid injection

454

Post-op complications

Days 1-2: Atelectasis/Pneumonia (Wind)

Days 3-5: UTI (Water)

Days 5-7: DVT/Thrombophlebitis/PE (Walking)

Day 7: Wound infxn/Cellulitis (Wound)

Day 8-15: Drug fever/Deep abscess (Weird)

455

Most common EKG finding for PE

Non-specific ST changes

456

Young pt. who presents w/ recurrent candidal infxns of the skin and mucous membranes.

Chronic mucocutaneous candidiasis (T-cell dysfnxn)

457

Pt. w/ Crohn's Disease who develops a small-bowel obstruction...what is the most likely cause?

Fibrotic stricture

458

Pt who presents w/ polydipsia, polyuria, and weight loss despite increased appetite

DM Type I

459

Pt who has chronic pruritic ulcers around both ankles and starts getting breakdown of her skin

Stasis dermatitis due to chronic venous stasis

460

Pt. who has not had a bowel movement after bowel surgery and x-ray shows air-fluid levels

Paralytic ileus

Tx: NG tube decomprassion

461

Pt. who is high likelihood for PTX following trauma, what do you do?

Immediate needle decompression; get X-ray later

462

Best way to prevent UTI in elderly pt. in a long-term care facility

Dont use a cath; use diapers

IF you have to use a cath, change it daily

463

Pt. who starts taking thiazides and develops EKG changes

Probably due to hypokalemia

464

Most common location for an intracerebral hemorrhage

Basal ganglia

465

What does a pt. w/ a myelomeningocele almost certainly have?

Arnold-Chiari malfomation

466

EMG showing fasciculations

LMN lesion

467

EMG w/ no muscle activity at rest and decreased amplitude of muscle contraction upon stimulation

Intrinsic muscle disease (muscular dystrophy, inflammatory mypopathy)

468

Bilateral trigeminal neuralgia

Consider MS as a cause

469

Lesions in what location cause hemiballisumus?

Subthalamic nucleus

470

"Floppy baby" differential

Wernig-Hoffman: Congenital AR degeneration of anterior horn cells; all are affected by 6 moths
Tx: Supportive

Botulism: Sudden onset; organism can be found in feces
Tx: Spontaneous recovery BUT monitor respiratory fnxn

471

Why does NaHCO3 help in TCA OD?

It is ACTUALLY for the sodium; the sodium increases extracellular sodium decreasing the avidity of TCAs for the fast sodium channels in the cardiac tissue

472

Differences b/w SBP and Bowel obstruction

Bowel obstruction has diffuse abdominal pain and N/V alongside high-pitched bowel sounds

***Look for hx. of liver disease to point towards SBP as well

473

Dx of laryngomalacia in an infant

Clinical but can be confirmed w/ direct laryngoscopy

Tx: Will usually resolve by 18 months but until then, keep upright after feeds

474

Major ADRs of Amiodarone

Cardiac: Bradycardia, QT prolongation

Pulm: Interstitial pneumonitis (cough, fever, dyspnea, infiltrates)

GI: Hepatitis

Ocular: Corneal microdeposits, optic neuropathy

Derm: Blue-gray skin discoloration

Neuro: Peripheral neuropathy

Endo: Hypo or Hyperthyroidism

475

Histologic finding on Reye's Syndrome

Microvesicular fatty infiltration

476

Liver failure histologic findings

Macrovesicular steatosis, vacuolated hepatocellular nuclie, sometimes mallory bodies

477

Cerebral Palsy

Nonprogressive motor dysfnxn typically cause by prenatal insults to brain development; can suffer from vision, hearing, speech, and MSK impairments along w/ mix of UMN and LMN signs

RFs: PREMATURITY, IUGR, intrauterine infxn, antepartum hemorrhage, placental path, multiple gestation, maternal tobacco use

Tx: Therapy; possibly baclofen for spasticity

478

Pt. w/ increased hematocrit, blue lips covered in papules and digital clubbing, and chronic hypoxemia

Osler-Weber-Rendu syndrome (AD)

-Can also have severe hemoptysis

479

If you want to resuscitate a pt. and normal saline isn't an option, what should you pick?

LACTATED RINGERS

480

Treatment of Pityriasis Versicolor

Selenium sulfide shampoo

Topical ketoconazole

481

Pt. who has recurrent ear infxns and lives in a home w/ smoke

First step is to get them away from that fucking smoke

482

What should you do if a pancreatic mass is causing a small bowel obstruction?

First thing should still be nasogastric decompression

Deal w/ mass later

483

D-xylose test

Absorbable saccharide that can be absorbed w/o digestion in the proximal SI

-If it cannot be absorbed =>> likely Celiac Disease

If it is =>>think pancreatic insufficiency

484

Helpful hint if you cant see the delta wave on suspected WPW

Look for a shortened PR interval

485

Cyanotic Breath Holding Spell

Baby who cries intensely which is followed by breath holding, cyanosis, and LOC

-Normal; don't worry about it

486

Pallid Breath Holding Episode

Baby who suffers minor trauma and has LOC FOLLOWED BY breath holding, pallor, and diaphoresis

-Also benign tho

487

Pt. who has no sx. but you find signs of endometriosis

Don't worry about treating it unless they become symptomatic

488

What is abnormal uterine bleeding following menarche usually due to? (as long as their are no other physical abnormalities)

Immaturity of the developing HPA producing inadequate quantities of GnRH

489

McCune-Albright Syndrome

Precocious puberty

+

Cafe au lait spots

+

Bone defects (polyostotic fibrous dysplasia)

-Sporadic condition

490

Physiologic findings in ARDS

Decreased gas exchange

Decreased lung compliance (loss of surfactant and increased elastic recoil)

Increased pulmonary arterial pressure (Due to hypoxic vasoconstriction)

491

Trisomy 18

Microcephaly

Clenched fists

VSD

Rocker bottom feet

MICROGNATHIA

ID

492

Baby who has bilious vomiting, is stable, and has no signs of obstruction on x-ray

Order upper GI series

493

Ligament of Treitz on right side of the abdomen

Midgut volvulus

-Contrast will show corkscrew pattern

494

Immunologic manifestations of infective endocarditis

(+) RF

Immune complex-mediated glomerulonephritis

Osler nodes (painful pads on the fingertips)

495

Kidney problem HBV is associated w/

Membranous nephropathy

496

Gifts you can accept from reps

Small gifts that will directly benefit pts.

497

Pts. who have difficulty initiating a swallow and quickly regurgitate food; possibly thru there nose

Oropharyngeal dysphagia

Evaluate this w/ modified barium swallow

498

Eczema herpeticum

Painful vesicular rash w/ punched out erosions and hemorrhagic crusting

***Classically presents in a kid w/ atopic dermatitis as his scratch lesions get infected w/ HSV

-Lesions are vesicular and dark red looking

499

Black guy who randomly has grossly bloody urine which resolves entirely

Renal papillary necrosis

500

What are acanthocytes and burr cells classically associated w/?

Uremia

Abetalipoproteinemia

501

Plummer-Vinson Triad

Esophageal web

IDE

Glossitis

502

Management of sideroblastic anemia

Support + pyridoxine

503

Pt. who starts bleeding again after they have been transfused a massive amount of blood

Probably due to citrate binding calcium and preventing clotting

Could also be a dilutional thrombocytopenia

504

Drugs to not give pts. w/ Renal Artery Stenosis

ACEI

-Will ppt. ARF

505

What type of hypersensitivity is cryoglobulinemia?

Type III

506

HIV pt. who has sulfa allergy, what drug do you use for PCP prophylaxis?

Dapsone

or

Pentamadine

507

HIV pts. have an increased risk of developing what blood disorder?

Non-Hodgkin's Lymphoma

508

Tx of meningitis in a neonate

Ampicillin

+

Gentamicin

+

Ceftriaxone if GNR suspected

509

Tx for a pregnant woman w/ a confirmed Toxoplasma infxn

Spiramycin

510

Squamous cell bladder cancer in pt. from Middle East or Africa

Schistosome haematobium

511

Pt. w/ fever, muscle pain, eosinophilia, and periorbital edema after eating at an exotic restaurant

Trichinella spiralis

512

Food poisoning after eating raw seafood

Vibrio parahaemolyticus

513

Neurologic manifestations of tertiary syphilis

Argyll-Robertson pupil

Dementia

Paresis

Tabes dorsalis

Charcot joints

514

Emphysematous cholecystitis

Life-threatening variant of cholecystitis due to infxn w/ gas-forming bacteria (Clostridium, some E. coli strains) that presents w/ the fever, RUQ pain, N/V, and possibly CREPITUS on palpation of the RUQ

RFs: Vascular compromise, DM, Immunosuppression

Tx: Emergency cholecystectomy; broad-spectrum antibiotics (ampicillin-sulfabactam)

515

Lithium TOXICITY

Acute: N/V, diarrhea

Chronic: Confusion, ataxia, tremor, fasciculations

-Look for in a pt. who recently started an NSAID, ACEI, tetracycline, or has hypotension (decreased excretion of Li+)

516

Delayed sleep phase syndrome

Sleep-onset insomnia w/ excessive morning sleepiness in pts. who have a weird internal clock; can sleep normally when allowed to sleep on their own schedule

Typically describe themselves as "night owls"

***DIFFERENTIATE FROM SHIFT-WORK PROBS BECAUSE SHIFT-WORK DISORDER PTS. HAVE NO CIRCADIAN RHYTHM

517

Should you ever use 1/2 NS?

NO; IDGAF IF THEIR NA IS 170

518

Hyperosmolar, hyperglycemic state pts. have neuro sx. because of what lab abnormality?

High serum osmolality

519

First-step in management for pts. w/ intermittent claudication

Exercise therapy; smoking cessation

-Next step =>> Cilostazol

-PENTOXYFILLINE IS NOT RIGHT

520

Acid-base status of pts. w/ a PE

Respiratory Alkalosis

-Can cause a hypocalcemia due to Ca2+ binding to albumin

521

Baby w/ medial deviation of the forefoot and is bilateral

Metatarsus adductus; resolves on its own

-Feet will also be flexible in contrast to clubfeet

522

Baby w/ medial/upward deviation of forefoot and hindfoot; usually unilateral

Clubfoot; requires casting

523

Tolosa-Hunt Syndrome

Granulomatous inflammation of the cavernous sinus w/ ophthalmoplegia

-Look for eye pain and paralysis of III, IV, and VI

Dx: MRI

Tx: Steroids

524

Septic Jugular Thrombophlebitis

Infxn of Fusobacterium necrophorum from pharyngitis, peritonsillar abscess, or mastoiditis expands beyond the mouth to infect the neurovascular bundle around the jugular

Tx: Pip-Tazo

525

Management of anal fissures

High fiber diet; increased fluid intake

Stool softeners

Sitz batchs

Topical anesthetics + vasodilators (nifedipine, nitroglycerin)

526

Indications for parathyroidectomy w/ hyperparathyroidism

Age <50

Symptomatic hypercalcemia

Complications (osteoporosis, nephrolithiasis, CKD)

527

Management of gastric adenocarcinoma

CT abdomen/pelvis

Limited stage =>> Resection

Advanced stage =>> Chemo

528

Pt presenting w/ constitutional sx., bone pain that is not tender to palpation, hypercalcemia, and renal insufficiency

MM until proven otherwise

529

Indications for admission for PID

Pregnancy

Failed outpt. management

Inability to tolerate oral meds

Severe presentation (high fever, vomiting)

Complications (tubo-ovarian abscess, perihepatitis)

530

EKG finding for a ventricular aneurysm

Persisten ST-segment elevation after a recent MI and deep Q waves in the same leads

531

Paroxysmal Nocturnal Hemoglobinuria

Genetic defect in CD55 and CD59 =>> loss of inhibition of the activation of the coag cascade

CFs: Intra and Extravascular hemolysis
Venous thrombosis
Fatigue

Tx: Eculizumab
Iron supplements

532

Differences b/w methanol and ethylene glycol poisoning

Methanol =>> Visual disturbances

Ethylene glycol =>> Kidney failure

533

Most commonly torn muscle in the rotator cuff

Supraspinatus

-Make sure to check the empty beer can test

534

Pt. w/ ecchymosis and a visible bulge on their biceps

Possible rupture of the biceps tendon

-Needs surgery

535

Neer Test

Physician internally rotates pts. arm and lifts it straight above their head

Pain? =>> Subacromial impingement syndrome

536

Hawkins-Kennedy Test

Pts. arm is placed in 90 degrees of shoulder flexion w/ elbow flexed to 90 degrees; arm is then internally rotated

Pain? =>> Subacromial impingement syndrome

537

Cross arm/adductor test

Arm is elevated to 90 degrees and then adducted across the pt.

Pain? =>> AC joint separation/tear

538

FABER test

Pts. leg is placed in indian style on one side

Pain in the hip =>> Osteoarthritis

539

Apley Compression Test

Patient lies prone and has the knee flexed to 90 degrees; physician gives axial compression down into the knee

Pain? =>> Meniscal tear

540

Heel pain that is worse w/ the first few steps in the morning

Plantar fasciitis

541

Female athlete triad

Decreased bone density (possible stress fracture)

Hypoglycemia

Amenorrhea

542

Jones Fracture

Fracture of the 5th metatarsal at the jnxn of the metaphysis and diaphysis; occurs when the ankle is sprained and the heel is off the ground but the forefoot is planted

Tx: Cast and non-weight bearing

543

Tarsal Tunnel Syndrome

Pain, tingling, and burning w/ activity or at rest on the medial side of the sole of the foot

Cause: Entrapment of the tibial nerve under the flexor retinaculum due to tenosynovitis of the tibialis posterior, flexor digitorum longus, and/or flexor hallucis longus (Tom, Dick, and Harry)

Dx: EMG; Tinel's sign on the tarsal tunnel

Tx: NSAIDs, steroid injxn, tunnel release

544

Halllux valgus

Deformity causing pain over the great toe at the metatarsophalangeal joint; pain w/ walking and blisters can occur

"Bunion"

Tx: Orthotics and surgery

545

Pes anserine

Pain w/ palpation just inferior to the medial joint line of the knee where sartorius and semitendinosus inserts

-Assoc. w/ overuse

Tx: RICE

546

Pt. who has had a cough for >10 days and now has some red streaks in their originally white sputum but still has a clear CXR

Suspect bronchitis; can last for 4 weeks

Treat symptomatically unless other signs develop

547

Drugs capable of causing crystal-induced AKI

Acyclovir

Sulfonamides

MTX

Ethylene glycol

Protease inhibits (indinavir)

548

Secondary Spontaneous Pneumothorax

Chronic destruction of alveolar sacs (secondary to COPD, cigarette smoking, CF) causes formation of alveolar blebs that can rupture and leak air into the pleural space

CFs: Hyper-resonance on percussion
Unilateral decreased breath sounds
SOB, hypoxia
Possible contralateral wheezing

*Tracheal deviation is seen w/ trauma usually

Dx: CXR

Tx: Conservative but possible thoracotomy if they are acute

549

Cholangitis

Inflammation of the gall bladder tract usually caused by biliary obstruction w/ subsequent bile stasis and infxn

550

Pt. w/ abdominal trauma and has a positive FAST scan

Get em in surgery

551

Zones of the neck

I-Base

II-Middle

III-Top

-Surgery immediately performed in Zone II, Zone I and III get an arteriogram first UNLESS there is a rapidly expanding hematoma

552

Baby w/ congenital cataracts, neonatal sepsis, and vomiting after feeding

Suspect galactosemia

553

3 criteria for PID

1. Abdominal pain

2. Adnexal tenderness

3. Cervical motion tenderness

554

MC site for endometrioma

Ovaries

555

For gonorrhea and chlamydia, which one can you treat by itself w/o cotreatment?

Chlamydia

556

Dysfnxnal Uterine Bleeding

Diagnosis of exclusion; most commonly due to anovulatory cycles

557

Tx of hirsutism assoc. w/ PCOS

Spironolactone

558

Main risk associated w/ medical induction of ovulation

Multiple gestation pregnancy

559

When can you diagnose primary amenorrhea?

16 years

-R/o androgen insensitivity syndrome in pts. w/ no secondary sexual characteristics and no uterus

560

RFs of IUD

Ectopic pregnancy

PID

Rare uterine rupture during placement

561

Should you stop OCPs before surgery?

Yes; due to increased risk of DVT

562

If aniridia is seen on a newborns ophthalmologic exam, what should you test for?

Wilm's Tumor

563

WAGR Syndrome

Wilm's Tumor
Aniridia
Genitourinary malformations
Retardation

Defect on Cr. 11

564

Med to give an infant w/ transposition of the great vessels

Prostaglandins

Keeps the PDA open

565

Hypoplastic Left Heart Syndrome

Consists of left ventricular hypoplasia, mitral valve atresia, and aortic valve lesions

CFs: Absent pulses w/ single S2
Increased Right ventricle impulse
GRAY cyanosis

CXR: Globular shaped heart

Tx: Surgery

566

Kernicterus presentation

Hypotonia

Seizure

Choreoathetosis

Hearing loss

567

Upper GI series in pyloric stenosis (4 signs)

1. String sign

2. Shoulder sign (filling defect in the antrum due to prolapse of muscle inward)

3. Mushroom sign (hypertrophic pylorus)

4. Railroad sign (excess mucosa in pyloric lumen)

568

VACTERL

Vertebral anomalies
Anal atresia
CV anomalies
Tracheoesophageal fistula
Esophageal atresia
Renal anomalies
Limb anomalies

569

Tx of acute cocaine toxicity

IV Benzos

and

Supplemental O2

570

Intrahepatic cholestasis of pregnancy

Presents as intense pruritis in a pregnant lady w/o much other findings

Labs: Elevated bile acids
Elevated LFTs

*Diagnosis of exclusion

571

Pinealoma

Presents w/:

Parinaud's Syndrome (dumb fuckers cant look up)

Obstructive hydrocephalus (headache, visual disturbances, vomiting)

572

Differentiating b/w transient synovitis and Legg-Calves-Perthes Disease

Transient synovitis should NOT last >4 weeks

573

Drug to give a woman w/ urge incontinence

Oxybutinin: antimuscarinic that increases bladder capacity by decreasing detrusor activity

574

Pt. who has recurrent pneumonias in the same part of the lung and history of smoking

Get a chest CT; could be due to localized airway obstruction causing impaired bacterial clearance

575

Prophylaxis for contacts of someone w/ whooping cough

Macrolides

576

Psoas abscess

Presents as a subacute fever w/ abdominal pain radiating to the groin

-Pts. have increased pain w/ hip extension

-Pts. have leukocytosis and elevated inflammatory markers

Dx: CT scan

***DO NOT CONFUSE w/ APP

577

Pt. who is starting to have frequent variable decels w/ contractions

First line: Maternal repositioning

Then: Amnioinfusion

Don't do a c-sec until there is loss of FHR variability

578

Poor prognostic factors in heart failure

Clinical: Resting tachycardia, presence of S3, elevated JVP, hypotension, mitral regurg.

Labs: Hyponatremia, elevated BNP, renal insufficiency

EKG: QRS prolongation, LBBB

Echo: Severe LV Dysfnxn, reduced RV fnxn, pulmonary HTN

579

Differentiating b/w Laryngomalacia and Vascular Ring in infants

Laryngomalacia: INSPIRATORY stridor that improves when prone

Vascular ring: BIPHASIC stridor that improves w/ neck extension

580

Endometrial biopsy indications in someone <45

Hx. of unopposed estrogen exposure (obesity, chronic anovulation)

Failed medical management of AUB

Lynch Syndrome

581

X-linked hypophosphatemic Ricket's

Innate kidney defect causes inability to retain phosphate

=>>Bone mineralization cannot take place

-Pts. typically have normal Ca2+ levels

582

Neonatal CMV

Periventricular calcifications w/ microencephaly

Chorioretinitis

Hearing loss

Petechiae

583

Neonatal Toxoplasmosis

Chorioretinitis

Hydrocephalus

Multiple ring-enhancing lesions seen on CT

584

3 Stages of Whooping Cough

Catarrhal (14 days): Severe congestion and rhinorrhea

Paroxysmal stage (14-28 days): Severe coughing w/ whooping gasp for air that may be accompanied by vomiting

Convalescent stage (14 days): Decreasing frequency of coughing

*Erythomycin treatment will only help in the catarrhal stage

585

Tx for diptheria

Antitoxin

*ABx. DO NOT WORK

586

Pompe's Disease

Lysosomal acid maltase deficiency

CFs: Hypotonia
HCM

Tx: Enzym replacement

587

Mcardle's Disease

Muscle phosphorylase deficiency

CFs: Fatigue w/ exercise

Tx: Sucrose prior to physical activity

588

Gaucher's Disease

Deficiency of B-glucocerbrosidase (AR)

CFs: Hepatosplenomegaly
Aseptic necrosis of the femur
Lytic lesions
***GAUCHER CELLS (crumbly macrophages)

589

Female diaphragm

Contraceptive jelly is on it; needs to be in place for 6 hrs following sex

ADRs: Needs to be fitted, requires advance prep, dislodgment

590

Lichen sclerosis

White, thin skin extending from the female labia to the perianal area

-Increased risk of cancer

Tx: Topical steroids

591

Hyperkeratosis of vulva

Caused by itching from chronic vulvar pruitus; tx w/ sitz baths or lubricants

592

Bartholin Gland Cyst

"Pussy pimple"

Found on the lateral sides of the vulva; can be inflamed causing erythema, pain, tenderness, and dyspareunia

Tx: Drainage

593

Red lesion on the vulva w/ a superficial white coating

Paget's Disease

-Should perform a vulvectomy because although it is less likely to be cancerous here like it is in the breast, it is still possible

594

Tx of endometrial hyperplasia in a premenopausal woman who wishes to remain fertile

Progestin therapy

595

Renal Biopsy of Henoch-Schonlien

IgA deposition in the mesangium

596

Women at age >35 and at risk for aneuploidy should be offered what?

Cell-free fetal DNA testing

Noninvasive test performed at >10 weeks and is good at detecting polyploidys

597

Familial Hypocalciuric hypercalcemia

AD disorder caused by a mutation of the CaSR; this means that HIGHER Calcium is actually need to suppress PTH secretion since the Ca receptors suck

-Pts. will have decreased PO43- due to increased PTH

Calcium in urine is almost 0

598

Pt. who is chronically hypoxic, given O2 by mask, and then has a seizure

O2 has paradoxically caused CO2 retention by...

1. Vasodilating areas of poor gas exchange of the lungs

2. Increased oxyhemoglobin reduces uptake of CO2 from the tissues via the Haldane effect

3. Decreased respiratory drive =>> decreased minute ventilation

***This causes increased GABA and glutamine in the brain =>> altered consciousness or SEIZURE

599

WAS gene

Regulates cytoskeletal components involved in cell signaling

-Also dysfnxnal in immune cells which is why Wiskott-Aldrich kids get recurrent infxn

600

Test to get on lactose intolerant pts.

Hydrogen breath test

-Rise in H+ after eating lactose indicates bacterial carbohydrate metabolism

601

Pathology of Guillan-Barre Syndrome

Inflammatory demyelination of the peripheral motor neurons

602

Hyper-IgM Syndrome Pathology

Defect in the CD40L on T-cells that is necessary for binding to B cells to initiate Ig class switching

603

Pt. w/ a severe variceal hemorrhage and cannot stop vomiting blood

Intubate the pt. to prevent aspiration

THEN perform endoscopic procedures

604

Pt. who is affectionate towards others but otherwise expresses signs of autism

Probably still just an undetected hearing impairment

605

Kid w/ leukemia but parents don't want chemo

Take that shit to court

606

Causes of Minimal Change Disease in adults

NSAIDs

Lymphoma (Hodgkin's or Non-Hodgkins)

607

MCCo nephropathy w/ solid tumors

Membranous glomerulopathy

608

Tx of catatonia

Benzos

ECT is no response

609

Lobes affected by aspiration pneumonia

RLL

610

Cavitation of the apices of the lung should make you think of what?

TB

611

Sequelae of electrical burns

Rhabdomyolysis, acidosis, ARF

-Get EKG to r/o any dangerous arrhythmias from electrolyte abnormalities

-Hydrate w/ saline bolus to prevent ARF

612

J wave

Upward deflection at the end of the QRS seen in hypothermic pts.

613

Antidote for Lead OD

EDTA

614

Tx of precocious puberty

GnRH agonist (Leuprolide)

-This will avoid premature fusion of the growth plates

615

Dumping syndrome

Pt who develops sweating, tachycardia, nausea, sweating, and dizziness after eating and they have recently had a gastric bypass procedure

616

Bird beak narrowing of esophagus on swallowing study

Achalasia

617

Contrast to give if a GI perf is suspected

Gastrografin (water-soluble)

618

Vomit with what could be feces in it

Suspect meconium ileus

619

Naegle rule

LMP-3 months + 7 days

620

First sign of pregnancy on physical exam

Goodall sign

Softening of the cervix on pelvic exam

621

What causes morning sickness during pregnancy

Increase in estrogen, progesterone, and BhCG

622

Work up for solitary lung nodule

>8mm: If suspicious for malignancy, biopsy

5-7: Serial ct scans

<4: Serial ct scans only if suspicious for malignancy

623

Follow-up after drainage of a simple cyst

Repeat Breast exam in 2-4 months to examine for recurrence

624

Pt with poor vaccination history who has a fever, lymphadenopathy, and malaise which turns into a nonblanching Erythematous rash spreading caudally

Suspect Rubella

-Pts. May also have polyarthralgia

625

Patient with pain at Tendinous insertions and the iliac crests

Suspect ankylosing spondylitis

626

Treatment for Rh sensitized mother and has an Rh positive baby

Serial amniocentesis

If extremely elevated bilirubin is found, consider intrauterine transfusion

627

Pruritic urticarial papules and plaques of pregnancy

Erythematous papules within striae that spread outward to form urticarial plaques

-Typically occurs after 35 weeks and resolves by 14 days post partum

Tx: ️Topical corticosteroids

628

Congenital Zika

Microcephaly, facial disproportion, Hypertonia, seizures, irritability, sensorineural hearing loss

629

Prenatal testing done on diabetics

EKG

24 hour baseline creatinine

Hba1c

Eye exam

630

Third trimester care for a diabetic pregnant woman

32-35 weeks: Weekly NST and US

36: Twice weekly testing

37: L/S ratio

39: IOL

631

Abdominal imagining on a pt. w/ obstructive pancreatic cancer

Dilation of the intra and extra hepatic biliary trees

632

Tx of uric acid stones

1. Hydration

2. KCl (alkalizes the urine)

3. Low purine (protein) diet

633

First thing to check on a patient w/ declining kidney fnxn

BUN/Cr RATIO

THE RATIO

THE RATIO

634

Friedrich's Ataxia

AR disorder presenting w/ gait ataxia, frequent falls, dysarthria due to degeneration of the spinocerebellar tracts and posterior columns

-Pts. also develop CONCENTRIC hypertrophic cardiomyopathy, diabetes, scoliosis, and HAMMER TOES

635

Should you ever just do nothing for a solitary breast mass?

NO

Even if they are pubertal, do something

636

Pt. w/ signs of CHF following a viral infxn

Could be heart failure secondary to viral myocarditis; the most common cause of myocarditis

637

Pt. who is on risperidone and has hyperprolactinemia but also other signs of pituitary dysfnxn

Suspect pituitary adenoma

638

Tx for Lyme Disease in a patient under 8 years or pregnant woman

Oral amoxicillin

639

When should you use ceftriaxone for Lyme Disease?

ONLY IF THERE ARE NEUROLOGIC OR CARDIAC MANIFESTATIONS

-IDGAF ABOUT BONE MARROW APPARENTLY

640

Sequelae of electrical burns

Rhabdomyolysis, acidosis, ARF

-Get EKG to r/o any dangerous arrhythmias from electrolyte abnormalities

-Hydrate w/ saline bolus to prevent ARF

641

J wave

Upward deflection at the end of the QRS seen in hypothermic pts.

642

Antidote for Lead OD

EDTA

643

Tx of precocious puberty

GnRH agonist (Leuprolide)

-This will avoid premature fusion of the growth plates

644

Dumping syndrome

Pt who develops sweating, tachycardia, nausea, sweating, and dizziness after eating and they have recently had a gastric bypass procedure

645

Bird beak narrowing of esophagus on swallowing study

Achalasia

646

Contrast to give if a GI perf is suspected

Gastrografin (water-soluble)

647

Vomit with what could be feces in it

Suspect meconium ileus

648

Naegle rule

LMP-3 months + 7 days

649

First sign of pregnancy on physical exam

Goodall sign

Softening of the cervix on pelvic exam

650

What causes morning sickness during pregnancy

Increase in estrogen, progesterone, and BhCG

651

Work up for solitary lung nodule

>8mm: If suspicious for malignancy, biopsy

5-7: Serial ct scans

<4: Serial ct scans only if suspicious for malignancy

652

Follow-up after drainage of a simple cyst

Repeat Breast exam in 2-4 months to examine for recurrence

653

Pt with poor vaccination history who has a fever, lymphadenopathy, and malaise which turns into a nonblanching Erythematous rash spreading caudally

Suspect Rubella

-Pts. May also have polyarthralgia

654

Patient with pain at Tendinous insertions and the iliac crests

Suspect ankylosing spondylitis

655

Treatment for Rh sensitized mother and has an Rh positive baby

Serial amniocentesis

If extremely elevated bilirubin is found, consider intrauterine transfusion

656

Pruritic urticarial papules and plaques of pregnancy

Erythematous papules within striae that spread outward to form urticarial plaques

-Typically occurs after 35 weeks and resolves by 14 days post partum

Tx: ️Topical corticosteroids

657

Congenital Zika

Microcephaly, facial disproportion, Hypertonia, seizures, irritability, sensorineural hearing loss

658

Prenatal testing done on diabetics

EKG

24 hour baseline creatinine

Hba1c

Eye exam

659

Third trimester care for a diabetic pregnant woman

32-35 weeks: Weekly NST and US

36: Twice weekly testing

37: L/S ratio

39: IOL

660

Abdominal imagining on a pt. w/ obstructive pancreatic cancer

Dilation of the intra and extra hepatic biliary trees

661

Tx of uric acid stones

1. Hydration

2. KCl (alkalizes the urine)

3. Low purine (protein) diet

662

First thing to check on a patient w/ declining kidney fnxn

BUN/Cr RATIO

THE RATIO

THE RATIO

663

Friedrich's Ataxia

AR disorder presenting w/ gait ataxia, frequent falls, dysarthria due to degeneration of the spinocerebellar tracts and posterior columns

-Pts. also develop CONCENTRIC hypertrophic cardiomyopathy, diabetes, scoliosis, and HAMMER TOES

664

Should you ever just do nothing for a solitary breast mass?

NO

Even if they are pubertal, do something

665

Pt. w/ signs of CHF following a viral infxn

Could be heart failure secondary to viral myocarditis; the most common cause of myocarditis

666

Pt. who is on risperidone and has hyperprolactinemia but also other signs of pituitary dysfnxn

Suspect pituitary adenoma

667

Tx for Lyme Disease in a patient under 8 years or pregnant woman

Oral amoxicillin

668

When should you use ceftriaxone for Lyme Disease?

ONLY IF THERE ARE NEUROLOGIC OR CARDIAC MANIFESTATIONS

-IDGAF ABOUT BONE MARROW APPARENTLY

669

Pyschodynamic therapy indication

Builds insight into how unconscious conflicts and past relationships cause symptoms

*Uses transference; breaks down maladaptive defenses

***TONY SOPRANO

670

Removal of small foreign bodies in the vaginal cavity of children

Irrigation w/ warmed fluid

671

Calculation of A-a gradient

FiO2x (Patm-PH20)-(PaCO2/RR)

.21x(713)-(PaCO2/.8)

Then PAO2-PaO2

672

Tx of a positive PPD in an HIV pt.

Isoniazid + pyridoxine

-Only give the full gamut of tx. if they have sx. present

673

Management of suspected ADPKD

First, get abdominal US

674

Initial Tx. of Hyperthyroidism

Methimazole/PTU

BB

-Save Radioactive iodide for Grave's after levels stabilize cause the iodide can cause a transient worsening of levels

675

Can a herniated disc produce bilateral lower extremity neurologic signs?

Yes

676

Why are pts. in a study selected to match the same age, race, and social characteristics?

Do decrease potential confounders

677

Indications for heparin administration w/ chest pain

Unstable angina

Cardiac thrombus

Severe CHF

678

Late diastolic blowing murmur

Mitral stenosis

-May also have an opening snap, loud S1, LAE, or pulmonary HTN

679

Associated findings w/ mitral regurg.

Soft S1

LAE

PH

LVH

680

Associated findings w/ aortic stenosis

Slow pulse upstroke

S3/S4 ejection click

LVH

Cardiomegaly

Syncope

Angina

HF

681

Early diastolic decrescendo murmur at the apex

Aortic regurgitation

-May also see widened pulse pressure, LVH, LV dilation, S3

682

Estimation of A1c to plasma glucose

A1c x 7 = Average blood glucose

683

Management of an NPO diabetic scheduled for surgery

Give 1/3 the dose

684

What X-ray film should you get for an unstable pt. who is too sick to stand up?

AP film

-These can be done in bed

685

X-ray finding for osteomyelitis

Elevation of the periosteum

686

Tx of acute angle closure glaucoma

IV acetazolamide

IV mannitol

Pilocarpine

Laser iridotomy

687

Tx of retinal artery occlusion

100% O2 and ocular massage

then

Acetazolamide

then

Thrombolytics

688

Central retinal vein occlusion tx

Ranibizumab (VEGF inhibitor)

I dont know why but that's what the book said

689

Heart sound that may arise during an acute MI

S4

690

Erythema toxicum neonatorum

Asymptomatic, scattered erythematous macules, papules, and pustules throughout the body of a newborn; arises in the first 2 weeks of life

Tx: None

691

Main ADR of hydroxyurea

Myelosuppression

692

Different lab values for IDE vs. thalassemia

IDE: Decreased RBCs, increased RDW

Thalassemia: Both normal

693

MC predisposing factor for orbital cellulits

Bacterial sinusitis

694

Baby w/ an APGAR of <7

Start positive pressure ventilation and pulse ox monitoring

695

Pt. who received an organ transplant and develops a pneumonia w/ GI sx.

Think Invasive CMV

-May also see pancytopenia, mild hepatitis

Tx: Ganciclovir

696

Brain lesion that has central ring-enhancement and is in a young pt. w/ a fever

Think brain abscess caused by S. aureus or S. viridans

697

Tx for cyanide poisoning

Sodium thiosulfate

-Seen in the setting of a fire or occupational exposure

698

Crystals in the urine after ethylene glycol ingestion

Calcium oxalate crystals

699

Work-up for suspected Turner Syndrome

Get a pelvic US

***Will show streak ovaries

700

Serum calcium and phosphorus levels in Paget's

NORMAL

-AP and urine hydroxyproline are increased tho

701

Patient w/ late onset 21-a hydroxylase deficiency

Present ONLY w/ signs of HYPERANDROGENISM

-Their electrolytes are fine

702

Main ADR of hydroxychloroquine

Retinopathy

-Get an eye exam before starting a pt. on this disease-modifying antirheumatic drug

703

Neonatal polycythemia

Hcrt >65%

Caused by intrauterine hypoxia from maternal diabetes, HTN, or smoking (IUGR)

Could also be caused by delayed cord clamping, twin-twin transfusion syndrome, or thyroid probs

CFs: Ruddy skin
Hypoglycemia
Hyperbilirubinemia
Respiratory distress
Irritability
Abdominal distension
OR EVEN NO SX. (MOST COMMON)

Tx: IV fluids + glucose + exchange transfusion if severely distressed

704

Causes of hyponatremia

Hypovolemic: Dehydration, diuretics, Addison's

Euvolemic: SIADH, psychogenic polydipsia, oxytocin

Hypervolemic: HF, nephrotic syndrome, cirrhosis, toxemia, RF

705

Pregnant pt. who is about to deliver and has hyponatremia

Due to oxytocin

706

Med to give after saline for hypercalcemia

Furosemide

707

What part of the brain is damaged in Korsakoff syndrome?

The mamillary bodies

708

Retrospective study

Case-control

709

Study that is good for rare disease

Case series study

-Simply describes the clinical presentation of people w/ a certain disease

710

Chi-squared test

Used to compare percentages or proportions (nonnumeric data)

711

Developing a treatment strategy for cancer pts. is most useful to review what kind of studies?

Randomized, controlled clinical trials

712

Kids who do not react to skin testing

Lack Type IV HSN reaction which is T-CELL MEDIATED

-Therefore, pick a T-cell disease for this

713

Pt. w/ many ulcers and the question asks if you want to do a herpes culture

Yeah do it

714

Pt. w/ kidney stone but his vitals are stable

They can pass it at home as long as the pain medication works; just encourage fluid intake

715

Pt. w/ end stage cancer and their pain meds wear off

Bump up their meds; don't worry about an OD

Even in +80 year old pts

716

Baby w/ history of URI and has a larger split S1

Could just be his URI causing myocarditis?

717

Kid who is presenting w/ signs of cholinergic toxicty

ANSWER ATROPINE TO FIX IT

718

Newborn baby who is fussy after surgery; what should you do?

Analgesic therapy

719

Pt. w/ pancreatitis and is now acidotic

Probably ARDS

720

Pt. who wants a DNR but hasn't talked about it with anyone

Make sure he doesn't want to before you let him die

721

Pt. w/ IgA deficiency and develops respiratory distress, urticaria, and swelling of the tongue and throat after blood transfusion

Anaphylactic transfusion rxn

722

Vaccine to give someone w/ HIV

Pneumococcal vaccine; more important than Hep A

723

Health 40 year old woman who can squeeze out a little yellow discharge during a breast exame

"Physiologic discharge"

724

Adult pt. w/ molluscum contagiosum should be tested for what disease

HIV

725

Esophageal peristalsis w/ achalasia

Decreased

726

Pt. who is claustrophobic and wants to do an MRI

Give benzo first

727

Pt. who had a family member die but is acutely disorganized and hallucinating

Brief psychotic disorder

728

Pt. w/ diffuse maculopapular rash and hair loss while on PTN

Zinc deficiency

729

Diabetic pt. w/ adequately controlled BP but increased albumin:Cr ratio on urine testing

Start ACEI

730

Pt. who has been vomiting for days, sometimes bloody, and has abnormal vital signs? What caused them?

Hypovolemia

731

Spinal dysraphism

"Tethered spinal cord"

-Tight filum terminale, lipomeningomyelocele, dermal sinus tracts, adn dermoids

-Involves pulling of the spinal cord at the base of the spinal canal

CFs: Bilateral club feet, loss of sensation, lesions on the back, urinary irregularities

Tx: Surgery

732

Pt. who has developed progressive renal failure after starting Lasix...why?

Decreased renal blood flow

733

Well's Criteria

If more than 1 is positive =>> US

If 1 or less =>> D-dimer

Previously documented DVT

Active cancer

Recent immobilization

Localized tenderness along vein

Swollen leg

Calf swelling

Pitting edema

Collateral superficial nonvaricose veins

Alternate diagnosis more likely (-2 points)

734

Atropine in ophthalmology

Dilates the eye

AVOID IN ACUTE ANGLE CLOSURE

735

Copper IUD contraindication

Pts. w/ heavy menstrual bleeding; it can make it worse in these pts.

736

Isolated systolic hypertension

PT. w/ systolic pressure of >140 but diastolic is normal

-Occurs because of increased stiffness of the elastic and arterial walls in elderly pts.; decreases the ability of the pt. to dampen systolic pressures

737

Von-Gierke Disease

Glucose-6-phosphatase deficiency =>>decreased breakdown of glycogen to glucose

-Pts. present w/ hypoglycemia (resulting in seizure), lactica acidosis, hyperuricemia, and hyperlipidemia

PE: Doll-like face *******, thin extremities, FTT, protuberant abdomen from hepatomegaly

738

Description of Charcot Joint on X-ray

Effusions of the tarsometatarsal joints, large osteophytes, and several extra-articular bone fragments

739

If there is loss of sensation at T10, where has the spinal injury occurred?

T8

****Sensory nerves RISE TWO LEVELS

740

Homogenous, cystic mass seen on an ovary

Most likely an endometrioma

741

Pyoderma gangrenosum

Neutrophilic ulcerative skin disease that starts as an inflamed papule/pustule/vesicle and progresses into an expanding ulcer w/ a purulent base and ragged borders

-Typically triggered by local trauma

-Indicates underlying systemic disorder (like IBD, arthropathies, hematologic probs)

Dx: Skin Biopsy

Tx: Steroids

742

Ecthyma gangrenosum

Hemorrhagic pustules that involve into necrotic ulcers due to Pseudomonas aeruginosa

-Pts. have evidence of profound neutropenia

743

Pt. w/ brownish gray discharge at the nipple but has no evidence of masses on breast exam

Pregnancy test

Serum prolactin or TSH

Consider MRI of pituitary if necessary

744

Sympathetic ophthalmia

Immune-mediated inflammation of one eye after penetrating injury to the OTHER eye

CFs: Anterior uveitis, papillary edema, blindness

Path: Exposure of underlying antigens in the eye from previous injury cause body to attack other eye

745

Crescendo-decrescendo systolic murmur at the left sternal border on a baby w/ cyanosis

Probably Pulmonary Stenosis

Consider TOF

746

NFT manifestations

Cafe-au-lait spots

Clustered freckles

Lisch nodules

Neurofibromas (peripheral nerve sheath tumors)

Optic gliomas

747

Pt. w/ loss of consciousness and w/ prodromal nausea, warmth, and diaphoresis

Points towards neurally mediated syncope but make sure there are no abnormal EKGs and other shit

748

Splenic abscess

RFs: Infective endocarditis; other infxns
Hemoglobinopathy
Immunosuppression
IV Drug use
Trauma

CFs: Fever, leukocytosis, and LUQ abdominal pain (classic triad)
Left-sided pleuritic chest pain w/ pleural effusion
Splenomegaly
Evidence of S. aureus, Strep., or Salmonella infxn

Tx: Broad spectrum abx. + Splenectomy
CT drainage only if they are a poor surgical candidate

749

Tx of foodborne botulism

Equine antitoxin

750

Thyroid Lymphoma

Arises from previous Hasimoto's thyroiditis and presents w/ invasive symptoms (hoarseness, dysphagia, compression of the neck veins) along w/ B-sx.

-Presents similar to a superior sulcus tumor BUT if they give you the anti-TPO positive, DONT RULE THIS OUT

751

ADRs to EPO therapy

Worsening of HTN

Headache

Flu-like syndrome

Red cell aplasia (rare)

752

Pt. who ingested a caustic substance but is hemodynamically stable

Perform upper endoscopy to assess damage

753

What can cause false elevations of CA-125?

Endometriosis

Leiomyoma uteri

-Only get a CA-125 if you find an ovarian mass

754

Does PCP normally show up on sputum cytology

Nope

755

Tx indicated for Hep C

IFN-a

756

Inspiratory "rub" heard

Think some sort of pleural inflammation

757

Low back pain exacerbated w/ extension of the spine

Could be spondylolisthesis

758

Baby who has a runny nose but no fever, should you vax them?

Yeah

759

Neurologic finding that warrants follow up

Brisk nystagmus when looking to one side

760

Urinalysis findings after AGC damages those fuckers

Limited changes on dipstick (maybe 1+ blood and protein)

MA shows granular casts w/ renal tubular cells

761

Healthworker stuck w/ a Hep B positive needle BUT the healthworker has their vaccinations

Do not need to give any IG or repeat vax

762

EMG findings of ALS

Fibrillation in multiple muscles of multiple extremities

763

Cystic tender mass palpated in the mid-third of the vagina and a pt. who has urine leakage AFTER urinating

Urinary tract diverticulum

764

Anastomotic leak

Leakage b/w the anastomosis made b/w two segments of bowel following a colectomy

765

Pt. w/ a positive PPD but their X-ray shows no abnormalities and he has no know exposure to TB and has a negative sputum

TREAT LATENT TB STILL

766

What does a z-score tell you?

How many SDs above or below the mean you are

767

Standard Error of the mean

SD/Square root of the number of samples

768

To double the precision of a test, what must you do?

Increase the sample size by 4; this is because you have to divide by the square root for the SEM

769

Precision and Accuracy

Precision=Consistent

Accurate=Valid (sensitive and specific)

770

Berkson Bias

Using hospitalized pts. instead of selecting from a general population

-Solved by random selection

771

Treatment for Nephrogenic DI

Thiazides

772

Treatment for B-thalassemia major

️Chronic transfusions

May also need to give iron chelators

773

Infectious causes of AIHA

Mycoplasma

EBV

Syphilis

774

Kid who is bit by his neighbors cat; what should you do?

Give augmentin prophylaxis

775

Pt. who has been on chronic steroids, develops pneumonia-like sx., and has an elevated LDH

PCP

776

Tx for an asymptomatic Bartholin Duct Cyst

Observation

777

Pt. who has hypothermia and is severely bradycardic

Start w/ active rewarming STILL

-Bradycardia is usually refractory to atropine admin.

778

Baby who is transverse lie...will it convert to cephalic presentation?

Yes

779

Aplastic crisis in SCD

Pt. presents w/ decreased reticulocytes and signs of anemia

-Usually secondary to parvovirus infxn

780

MCCo pneumonia in children w/ CF

Staph. aureus

-Pseud. doesn't take over until approx. 20 years of age

781

Pseudocyesis

Pt. who presents w/ early signs of pregnancy, believes she is pregnant, but the office exam says otherwise

-Look for pts. w/ a history of infertility

782

Tx for arsenic poisoning

Dimercaprol

-Look for pts. w/ exposure to pesticides, well water, or pressure-treated wood (antiquing)

CFs: Garlic breath, vomiting, diarrhea, hyperkeratosis, hyperpigmentation, stocking-glove neuropathy

783

Management of first degree heart block

Observation

-All you see is a slightly prolonged PR interval

784

Abominal US screening age

65-75

785

Method by which BB decrease stress on the heart

Decrease myocardial contractility and HR

786

Can a baby w/ a Klumpke's palsy present w/ a Horner's?

Yes

787

Tx of NMS

Stop antipsychotics; start dopamine agent or dantrolene

788

Pt. who has orthostatic hypotension and urine shows elevated sodium and potassium

Salt-wasting likely due to diuretic use or adrenal insufficiency

-Normally, the urine would have less of these electrolytes

789

What medication will worsen proptosis?

Radioactive iodine

790

ADRs of PTU

Agranulocytosis

Hepatic failure

791

ARDs of methimazole

1st trimester teratogen

Cholestasis

792

Way to prevent worsening of ophthalmopathy when starting radioactive iodine tx. in Grave's pts.

Give prednisone w/ the radioactive iodine

793

Tx of amniotic fluid embolism

Respiratory and hemodynamic support

-May also need to treat DIC assoc. w/ amniotic fluid

794

Young patient presenting w/ a mass that seems like a fibroadenoma but they just finished lactating

Probs a galactocele

795

Pt. w/ an exquisitely tender mass in the inguinal region and signs of intestinal obstruction

Probably incarcerated hernia

796

Decreased afferent arteiorlar dilation

Only assoc. w/ NSAID use

797

Pt. who was given Lasix for CHF but later develops kidney failure and diminished breath sounds

Probably now hypovolemic; the pt. was dependent on high RV preload

798

Pt. w/ massive weight loss who develops amenorrhea (even if it is after a pregnancy)

Functional hypothalamic amenorrhea

-Pts. could also have infertility, vaginal dryness, stress fractures (Secondary to hypoestrogenism)

-Could also be due to excessive exercise, chronic illness, stress, anorexia

799

Pt. w/ elevated AP and bilirubin 7 days after a cholecystectomy but they show no signs of tract obstruction

Biliary leak

800

When you try to get a colleague to seek professional help and they won't, what should you do?

Report them to appropriate outlet

801

Angelman Syndrome

Disease of genetic imprinting presenting as developmental delay, jerky gait, happy demeanor, hand flapping, and seizures

802

Rett Syndrome

Mutation of MECP2 gene presenting as pts. w/ loss of communication and fine motor skills after 1 yr, deceleration of head growth, stereotypical hand movements, autistic features, sleep disturbance (excess crying)

803

Med to add when cancer pt. fails management w/ short-term opioid

Long term opioid

804

Pt w/ gout flare-up but they are on anticoagulation or have a heart condition

Colchicine

805

Pt. w/ rosacea and has burning sensations in eye, blepharitis, conjunctivitis, or corneal ulcers

Ocular rosacea

806

Pt. w/ uncontrolled contraction of the bladder and has sudden, overwhelming urges to urinate

URGE INCONTINENCE

Tx: Bladder training + Kegel exercise
Oxybutynin

807

Is advanced maternal age an RF for NTDs?

NO

-Just put folate deficiency you dumb fuck

808

Pregnant pt. who is presenting w/ some signs of depression

Go ahead and start SSRI after discussing risks; do not wait and monitor due to risk

809

Uncal herniation

Pt. who presents w/ unresponsive pupil, contralateral extensor posturing, coma, and respiratory compromise

-Pts. w/ hypertension may have stroke in the basal ganglia causing this

810

Best way to prevent perioperative pneumonia in a COPD pt.

Preoperative PT

811

Job Syndrome

Hyper IgE syndrome

-Recurrent skin and lung infxns

812

Pt. w/ a subtherapeutic INR and has a prosthetic valve

Prosthetic valve thrombosis

-Presents as obstructive thrombus that mimics a valvular stenosis presentation (HF, shock, severe thromboembolic events)

813

Preterm pt. w/ positive Fetal Fibronectin

GET THEM THE MEDS THEY NEED

814

Pt. w/ productive cough, dyspnea on exertion, and extensive smoking history

Get spirometry for COPD eval.

815

Coag times in APL syndrome

Prolonged aPTT

Normal PT

816

Classic manifestation of chronic hypocalcemia

Calcium deposits in the basal ganglia; can lead to movement disorders

817

Retained placenta

RFs: Early gestational age, stillbirth, placenta accreta, History of...

Comps: Postpartum hemorrhage (severe), endometritis

Tx: Manual extraction; DandC

818

Olecranon bursitis

Chronic pressure, friction, or overuse of the elbow

CFs: Normal, pain-free range of motion but an enlarged elbow

-Can get infected tho

819

Arterial pseudoaneurysm

Pt. who underwent cardiac procedure (or any other vascular intervention) and develops a soft, pulsatile mass w/ a bruit but is still hemodynamically stable

820

Initial management of osteoporosis

NSAIDs + PT (includes strengthening of local muscle groups)

821

Difference b/w a chalazion and hordeolum

Chalazion: Granulomatous rxn to blocked tear gland; swelling and erythema; it's a sty

Hordeolum: Acute inflammatory nodule arising from eyelish follicle and is due to an infxn; more painful than a sty

822

Will constitutionally small infants have any bad outcomes?

Typically no

-You have to look for other signs of placental insufficiency to predict this

823

Incisional hematoma

Presents as serosanguineous drainage and incisional pain; it is an abnormal collection of blood at the incision site due to inadequate surgical hemostasis

RFs: Obesity; hypocoagulability (Anticoagulation usually)

824

Pt. who presents w/ a breast mass and is on hormone replacement therapy

Do a mammogram before you take them off; if it is positive, then take them off

825

Pt. presenting w/ progressive loss of peripheral vision

Open-angle glaucoma

826

DRESS Syndrome

Drug- most commonly allopurinol (can be phenytoin/carbamazepine)
Reaction- Morbilliform eruption
Eosinophilia
Systemic
Symptoms =>> Fever, malaise, lymphadenopathy

-ADR that has a LONG latency (2-8 weeks)

Tx: Stop drug; supportive care

827

Oglvie Syndrome

Pt. presenting w/ nonoperative trauma, abdominal/pelvic surgery, or neurologic probs and has...

CFs: Abdominal distention, pain, N/V
Constipation/obstipation
Partial colonic dilation W/O evidence of obstruction (contrast goes thru entire colon)


"Pseudo-obstruction"

828

Pt. w/ enlarged uterus, elevated B-hCG level, and vaginal mass

Could be a vaginal met from choriocarcinoma

829

Dx study for aortic coarction

CXR

ECHO=CONFIRMATION

830

Vitals on transient synovitis

NORMAL; also typically no inflammatory findings

-If these are present, SUSPECT SEPTIC ARTHRITIS

831

Microscopic colitis

Frequent watery bowel movements, fecal urgency, incontinence, and NOCTURNAL DIARRHEA

RFs: Age >50
Female
Smoking
NSAIDs

Colonoscopy: Macroscopically normal BUT biopsy shows mononuclear infiltrate

Tx: Stop RFs; steroids

832

Pt. who presents w/ restlessness following tx. w/ antipsychotic OR antiemetic (prochlorperazine, metoclopramide, promethazine)

Akathisia

833

Myelodysplastic Syndrome

Pt. w/ stem cell neoplasms or previous chemo tx.

CFs: Cytopenias
Hepatosplenomegaly possibly

Dx: Dysplastic red and white blood cells on peripheral smear
BM shows hypercellular marrow

Tx: Transfusions
Chemo
BM transplant

(Differentiate from aplastic anemia via the BM and also that cells on the peripheral smear appear normal)

834

Drugs to NOT give AS pts.

Nitrates and BBs

835

Why does testicular torsion occur?

Inadequate fixation of the lower pole of the testis to the tunica vaginalis

=>> Compression of the pampiniform plexus and reduced venous outflow

836

Kid who is being aggressive to newborn baby

Tell mom to spend some more time with the daughter

837

Dx of leiomyoma

Sonohysterography (saline infusion U)

838

Pt. who has sudden syncope after traveling far a few days ago

Possible PE

Can have cardiac failure to to RV dysfnxn

839

Single pulmonary nodule OR cavitary lesion

Work-up for SCC

840

Can postviral cerebellar ataxia show one-sided sx.?

Yes

841

Indirect inguinal hernia

Presents in male infants

Due to paten processus vaginalis

Content protrudes thru DEEP INGUINAL RING and travels lateral to the inferior epigastric vessels

842

Direct inguinal hernia

Occurs in old men

Due to weakness of the transversalis fascia

Content protrudes thru Hasselbach's triangle MEDIAL to the inferior epigastric vessels

843

Pregnant pt. presenting w/ condyloma acuminata

Tx w/ topical treatment

-Don't use imiquimod or podophyllin

-Don't need colposcopy because it is a different strain of HPV

844

Treatment of Autistic Disorder Aggression

Risperidone

or

Aripiprazole

845

Disruptive Mood Dysregulation Disorder

Chronic, severe, persistent irritability w/ temper outbursts and angry, irritable, or sad mood b/w the outbursts

-Outbursts occur nearly daily and out of proportion to situation

846

Sleep pattern changes w/ MDD

Increased REM sleep

847

Tx of acute mania

Lithium

or if there are severe symptoms or if they have kidney problems

Atypical antipsychotic

848

Tx of bipolar depression

Quetiapine

849

Tx of atypical depression

MAOIs

-Be on the lookout for leaden paralysis, mood that is good in the morning and worse in the evening, increased sleep, increased weight

850

Tx of bereavement

Psychotherapy

851

Tx for Serotonin Syndrome

Stop SSRI

Tx fever, diarrhea, hypertension

CYPROHEPTADINE if no response

852

What receptors regulate the positive and negative sx. of schizophrenia?

Pos: Dopamine

Neg: Muscarinic

853

PET scan findings on schizophrenia

Hypoactive frontal lobes and hyperactivity in the basal ganglia

854

Meds to give non-compliant schizophrenic pts.

Long acting risperidone/ziprasadone/haloperidol/fluphenazine

-If the q says long-acting, pick it

855

Main ADR of ziprasidone

Increased risk of prolonged QT interval; do not use in pts. w/ conduction deficits

856

Which atypical antipsychotic also acts as a partial dopamine agonist?

Aripiprazole

-Is why it is sometimes used as adjunct tx. for MDD

857

Atypical antipsychotic to use in pregnant lady

Lurasidone

858

Atypical antipsychotics LEAST LIKELY to cause weight gain

Aripiprazole

and

Ziprasidone

859

Pt. who is about to go into emergency surgery and has an elevated INR due to warfarin therapy

Give FFP

-Need to correct this coagulopathy before sx.

860

Torticollis

Focal dystonia of the SCM specifically

861

Benefits of breastfeeding

Maternal: Decreased pospartum bleeding
Faster return to prepartum weight
Improved bonding
***Reduced risk of breast and ovarian cancer

Infant: Improved immunity
Improved GI fnxn
Prevention of otitis media, GI enteritis, respiratory illness, and UTIs
Decreased risk of childhood cancer, Type I DM, and necrotizing enterocolitis

862

Med to give when a rapid decrease in serum K+ is needed

Insulin and glucose

863

Pt. w/ signs of urinary stones and also signs of GI obstruction

Ureteral colic

-An ileus that occurs due to obstruction from the ureters?

Dx: CT scan

864

NTT

1/ARR

-When the ARR is a percentage, USE DECIMALS

Ex. 35%=.35

865

Only time you use octreotide

VARICEAL BLEEDING

-If it is a gastritis or gastric ulcer, NOT GONNA HELP

866

Modification to levothyroxine therapy during pregnancy

Increase the therapy

867

If you are given a lateral PA and you need to decide how to get something out that a kid swallow, what do you need to do?

Make sure you know what pipe it's in you jackass

868

If you have to use a TCA for OCD, what should you use?

Clomipramine

869

Specific benzos for alcohol withdrawal

Lorazepam

Oxazepam

-These are not hepatically metabolized

870

Exam used to screen for personality disorders

Minnesota Multiphasic Personality Inventory

871

MCCoD in anorexia

Arrhythmia

872

Tx for Binge Eating Disorder

Topiramate + Psychotherapy

873

NT that is decreased in insomnia

GABA

874

Systemic-Onset Juvenile Idiopathic Arthrits

Auto-inflammatory disease of childhood presenting w/ 2 weeks of fever, arthritis of at LEAST 1 joint, and a pink macular rash that coincides w/ the daily fever

-Joint pain gets better throughout the day; pts. can typically bear some weight on their joints

Labs: Leukocytosis
Thrombocytosis
Elevated ESR, CRP, Ferritin
Possible anemia

Tx: NSAIDs; glucocorticoids

875

Endophlamitis

Infxn of the eye; most likely the vitreous

-Common after surgery

876

MCCo LOBAR OR CORTICAL HEMORRHAGE

Cerebral amyloid angiopathy

IF IT IS IN THE BG IT IS HYPERTENSIVE

877

Behcet Disease Findings

Genital and oral ulcers (recurrent)

Uveitis

Erythema nodosum

Thrombosis

878

Torus Palatinus

Benign, bony growth located on the midline suture of the hard palate

-Can increase in size over life; IS CONGENITAL

Only operate if it interferes w/ activities of daily living

879

Can anemia of chronic disease occur w/ osteoarthritis?

No

880

Pt. w/ a RV infarct that develops hypotension, low JVP

Give them a saline bolus (wouldn't do for left-sided infarct)

DO NOT GIVE NITRATES

881

Emergency treatment for a patient who just ingested a bunch of pills in the past hour

Gastric lavage

DO NOT USE IF:

AMS

or

Caustic ingestion

882

Is Ipecac ever right?

NO

Only time you can use this is BEFORE COMING TO THE HOSPITAL

883

Is charcoal dangerous?

No; it can help remove toxic substances and is not bad

-If there isn't another obvious answer, this is a possible choice

884

Tx of aspirin OD

Alkalinize the urine

885

Drugs that can cause methemoglobinemia

Anesthetics

Nitrites

Dapsone

886

How does atropine work?

Blocks the effects of Ach

-This is why it is used in organophosphate or nerve gas poisoning

887

Digoxin toxicity

Hyperkalemia

GI probs

Confusion

Visual disturbance

Rhythm issues (AV block, bradycardia, arrhythmias)
*DOWNWARD SLOPING ST SEGMENTS

888

Lead toxicity is assoc. w/ what hematologic findings?

Basophilic stipling

Increased free erythrocyte protoporphyrin

889

Tx for mercury poisoning

Dimercaprol

890

Bite by brown recluse spider

CFs: Skin necrosis, bullae, blebs

Tx: Debridement, steroids, dapsone

891

Stress ulcer prophylaxis indications

HEAD TRAUMA

Burns

Endotracheal intubation

Coagulopathy w/ respiratory failure

892

Fluid replacement in burns

4mL x %BSA x Weight in kg

893

Asystole tx.

Epinephrine + CPR

894

Best initial step in SVT

Vagal maneuvers (carotid massage, Valsalva, ice immersion)

Then try adenosine

895

Therapy for WPW

Procainamide (short term)

Radiofrequency catheter ablation (long term)

896

Most important way to correlate risk of recurrence of ventricular arrhythmia after you treat it

Echocardiogram

897

Way to determine source of ventricular arrhythmias

EP studies

898

Pt with primary amenorrhea, lack of secondary sexual characteristics, and absence of a uterus

Androgen insensitivity syndrome

899

Test performed before starting estrogen replacement therapy

Endometrial biopsy or ultrasound

900

Ovarian tumor w/ signs of hyperandrogenism

Is likely producing DHEA-S which is being converted peripherally to Testosterone

901

Treatment for increased levels of homocysteine

Pyridoxine

-B6 is a cofactor for CBS which converts homocysteine to cysteine

902

Follow-up on avulsed umbilical cord after delivery

US; if it is normal, then there is likely no retained tissue

-A PPH in this situation would then probably be due to uterine atony

903

Expansion of CGG

Fragile X syndrome

904

MC cardiac anomalies w/ Turner Syndrome

Bicuspid aortic valve (1)

Aortic coarction (2)

Aortic root dilation (3) w/ increased risk of aortic dissection

905

Immediate interventions that improve long-term prognosis w/ MI involves what?

Rapid restoration of coronary blood flow

906

Complement levels in mixed cryoglobulinemia

Low C4

907

Type I cryoglobulinemia

Due to hematologic malignancy

-Pts. can have hyperviscosity (blurry vision), thrombosis (Raynaud's, Livedo reticularis), and purpura

Complement levels are normal

908

Pt. who presents w/ alkalosis days after being treated for ascites and fluid overload

Loop diuretic therapy

-Increased Na+ delivery to DCT causes increased H+ secretion

909

Tx for ureteral spasms w/ kidney stones

Tamsulosin (a1-antagonist)

910

CT showing peripancreatic fluid and possibly stranding

Sign of acute pancreatitis

-PROBABLY WILL NOT ILLUMINATE SINCE IT ISNT BLOOD SO LOOK CLOSELY

911

Pediatric viral myocarditis

Causes: Coxsackie B, Adenovirus

CFs: Viral prodrome + dyspnea, syncope, tachycardia, N/V

Dx: CXR =>> Cardiomegaly + pulmonary edema (maybe)
Echo =>> Decreased EF + diffuse hypokinesis

Tx: Supportive; diuretics if needed

912

New onset of psychiatric abnormalities and unexplained abdominal pain

Consider Acute Intermittent Porphyria

-Can also have sensory neuropathies

913

Indications for Noninvasive Positive-Pressure Ventilation

COPD (severe exacerbation but pt. has a normal mental status and is stable on physical exam)

Cardiogenic pulmonary edema

Acute respiratory failure

914

Benzodiazepine OD

Slurred speech

Unsteady gait

Drowsiness

Normal pupil size

Mild respiratory depression (unless used w/ alcohol)

915

Glomerulopathy that is HIGHLY ASSOCIATED WITH HIV

Focal segmental glomerulosclerosis

916

Possible outcomes of IUGR or being small for gestational age

Hypoxia

Perinatal asphyxia

Meconium aspiration

Hypothermia

Hypoglycemia

Hypocalcemia

Polycythemia (in response to hypoxia)

917

PTHrP

Squamous cell Cancer of the lung

918

ACTH or ADH producing tumor

Small cell Cancer of the lung

919

Stroke of a vertebral artery

Vertigo, N/V

Imbalance

Small ipsilateral pupil and ptosis

Nystagmus

Weakness of CN IX

Decreased contralateral sensation of the extremities

Decreased ipsilateral sensation of the face

920

"To and fro" murmur

PDA

-May also see a widened pulse pressure and bounding peripheral pulses

921

Pt. w/ decreased libido following bilateral salpingoopherectomy

Decreased androgens

922

Dehydrated boy who is orthostatic and oliguric

Could see hyaline casts due to the DEHYDRATION

923

BUN/Cr in analgesic nephropathy

Might only be 10:1 BUT the Cr should be really high

-Can also be due to aspirin or acetaminophen apparently

924

Striking JVD, holosystolic murmur, lifting systolic murmur of the septum

Suspect tricuspid atresia

925

Pt. w/ SUDDEN severe back pain, calcifications along their spine, tachycardia, but a normal BP

Ruptured AAA

926

Pt. who has 0 peripheral pulses, decreased ABI, but their is no necrosis of the skin

You can start conservatively w/ daily exercise program first

927

Most appropriate "Next Step" in management for a kid w/ Common Variable Immunodeficiency and an illness

IVIG

928

Pt. w/ severe back pain, osteoblastic lesions on multiple lumbar vertebrae, and marked tenderness

Metastatic prostate carcinoma

-Look for other lesions in other bones for MM?

929

Pt. who probably has cardiac tamponade; EKG shows non-specific ST changes, what do you want to order next?

Echo

930

In a patient w/ an enlarged prostate, what should you consider the cause of any organisms in their urine?

Outflow obstruction from the bladder

-Especially if it has been going on for months

931

After starting a pt. on IV saline who has hyperemesis gravidum, what is the next step?

Antiemetics

932

What should be routinely monitored on Lithium pts?

TSH

-Apparently more important than creatinine (unless maybe the pt. has decreased baseline renal fnxn)

933

Pt. who has a lobectomy, a high pCO2, but a normal pH and is on a ventilator; what do you want to do?

Wean them off the ventilator as tolerated

934

24 year old woman w/ soft, non-tender adnexal mass presenting late in their cycle? What do you want to do?

Get a pregnancy test

if negative

Reexamine in 2 weeks at start of cycle

935

Med to give in bonafide hypertensive emergency

Nitroprusside

936

"To and fro" murmur

PDA

-May also see a widened pulse pressure and bounding peripheral pulses

937

Pt. w/ decreased libido following bilateral salpingoopherectomy

Decreased androgens

938

Dehydrated boy who is orthostatic and oliguric

Could see hyaline casts due to the DEHYDRATION

939

BUN/Cr in analgesic nephropathy

Might only be 10:1 BUT the Cr should be really high

-Can also be due to aspirin or acetaminophen apparently

940

Striking JVD, holosystolic murmur, lifting systolic murmur of the septum

Suspect tricuspid atresia

941

Pt. w/ SUDDEN severe back pain, calcifications along their spine, tachycardia, but a normal BP

Ruptured AAA

942

Pt. who has 0 peripheral pulses, decreased ABI, but their is no necrosis of the skin

You can start conservatively w/ daily exercise program first

943

Most appropriate "Next Step" in management for a kid w/ Common Variable Immunodeficiency and an illness

IVIG

944

Pt. w/ severe back pain, osteoblastic lesions on multiple lumbar vertebrae, and marked tenderness

Metastatic prostate carcinoma

-Look for other lesions in other bones for MM?

945

Pt. who probably has cardiac tamponade; EKG shows non-specific ST changes, what do you want to order next?

Echo

946

In a patient w/ an enlarged prostate, what should you consider the cause of any organisms in their urine?

Outflow obstruction from the bladder

-Especially if it has been going on for months

947

After starting a pt. on IV saline who has hyperemesis gravidum, what is the next step?

Antiemetics

948

What should be routinely monitored on Lithium pts?

TSH

-Apparently more important than creatinine (unless maybe the pt. has decreased baseline renal fnxn)

949

Pt. who has a lobectomy, a high pCO2, but a normal pH and is on a ventilator; what do you want to do?

Wean them off the ventilator as tolerated

950

24 year old woman w/ soft, non-tender adnexal mass presenting late in their cycle? What do you want to do?

Get a pregnancy test

if negative

Reexamine in 2 weeks at start of cycle

951

Med to give in bonafide hypertensive emergency

Nitroprusside

952

Pts. who nearly drown in freshwater are at increased risk of what over the next 48 hrs?

ARDS

953

Pt. w/ aortic coarction that is symptomatic and they are young

Take em to surgery

954

Word that is added to the end of long-acting antipsychotics

Decanoate

955

Best way to prevent back pain

Lose weight

956

Pt. w/ SBP; can you gram stain their fluid?

Yessir

957

Best way to prevent back pain

Lose weight

958

Pt. w/ SBP; can you gram stain their fluid?

Yessir

959

Metyrapone test

Done for suspected Addison's

This test should cause a rise in ACTH due to inhibition of 11B-hydroxylase

960

Subclinical hypothyroidism

High TSH + normal T4

Treatment is still indicated

961

Med to start for symptomatic hypercalcemia after you have started saline

Bisphosphonates

Calcitonin is third

962

Med to give when surgery for Hyperparathyroidism is not possible

Cinacalcet (️Inhibits PTH release)

963

Elevated ACTH but no signs of pituitary or chest mass

Petrosal venous sinus sampling could detect increased ACTH due to a microscopic pituitary tumor

964

High dose Dexamethasone suppression test means the Hypercortisolism is due to what organ

Pituitary

965

High dose Dexamethasone suppression test means the Hypercortisolism is due to what organ

Pituitary

966

MIBG scanning

Scan that will detect a pheo that is not located in the adrenals

967

Med to start on pts with a pheo before they get surgery

Phenoxybenzamine; an alpha blocker

968

When do you add Canagliflozin to a diabetics meds?

When 2 or 3 other oral hypoglycemic drugs have failed

969

Is tinnitus a feature of presbycusis?

Yes; do not pick Meniere's unless there is a history of periodic vertigo

970

Breastfeeding contraindications

Active TB

Maternal HIV

Herpetic breast lesions

Active varicella infxn

Chemo/Radiation therapy

Active substance abuse (opioids, marijuana, cocaine)
-Marijuana while breastfeeding is assoc. w/ decreased muscle tone in the infant, poor suckling, sedation, and delayed motor development

971

Complications of cryptorchidism after orchiopexy

Testicular cancer

Subfertility

972

Are abdominal defects associated w/ trisomies?

No

973

Imagining modalities for a urinary stone

Abdominal US

or

NON-CONTRAST CT

974

Left-sided varicocele that fails to empty when a patient is recumbent

Think of renal vein obstruction; could be due to renal cell carcinoma

975

Renal Cell Carcinoma

Flank pain, hematuria, palpable abdominal renal mass

****Left-sided scrotal varicocele

Thrombocytosis + Erythrocytosis

Fever

Cachexia

976

Initial treatment for Antipsychotic-associated Parkinsonism

Benztropine

977

Multiple System Atrophy

1. Parkinsonism

2. Autonomic dysfnxn (postural hypotenxion, abnormal sweating/salivation/lacrimation, impotence, gastroparesis)

3. Widespread neurologic signs

Tx: Fludrocortisone; salt supplementation; a-agonists

978

Familial Dysautonomia

AR disease in Ashekenazi Jews characterized by severe postural instability in children

979

Stool Osmotic Gap

Elevated: Osmotic diarrhea

Normal: Secretory diarrhea
-Secretory diarrhea is also characterized by nighttime diarrhea

980

Can contact dermatitis present w/ vesicles?

Yes

981

How can you differentiate tracheobronchial disruption as a cause of flail chest?

There will be subcutaneous emphysema

982

Tx of inevitable abortion in a hemodynamically unstable pt.

Suction curettage

-If they're stable, then you can just do expectant management

983

RA pts. have increased risk of what disease?

Osteoporosis/Osteopenia

984

Broad waxy casts on urinalysis

Chronic renal disease

985

Defect in Alport syndrome

Type IV collagen defect

986

Causes of enlarged kidneys on US

Amyloid

HIV nephropathy

ADPKD

987

TTP disease associations

HIV

Cancer

Cyclosporine

Clopidogrel

Ticlopidine

988

2 causes of metabolic acidosis with a normal anion gap

RTA

Diarrhea (has a negative urine anion gap)

989

Tx for RTA Type II

Thiazide diuretics

Volume depletion will indirectly cause increased HCO3 reabsorption

990

Cystine stone management

Alkalinize the urine

Surgery

991

Antihypertensive to avoid in depressed people

BB

If possible

992

Test to be ordered on patient w/ precocious puberty

Brain MRI
-R/o any dangerous cause for it

-If it is confirmed to be idiopathic, then start GnRH therapy

993

Initial follow-up on a child w/ a positive dipstick for protein

Repeat the testing on two separate occasions

994

Pubic Symphysis Diastasis

RFs: Fetal macrosomia
Multiparity
Precipitous Labor
Operative vaginal delivery

CFs: Difficulty ambulating
Radiating suprapubic pain
Pubic symphysis tenderness
Intact neuro exam

Tx: NSAIDs; PT; pelvic support

995

Reason pts. w/ pneumonia are hypoxic

V/Q mismatch due to filling of the alveoli w/ inflammatory exudate

996

Type of anemia lead poisoning produces

Microcytic

997

Gonoccocal pharyngitis

Is an isolated disorder; widespread fever and lymphadenopathy are not common

998

PE findings for fibromuscular dysplasia

Abdominal and/or subauricular bruits

-This disease classically affects the renal and internal carotid arteries

999

Is weight gain associated w/ OCP use?

No.

1000

Paget's disease of the breast suggest underlying what?

Adenocarcinoma

1001

Atopic dermatitis

RFs: Low humidity; relatives w/ eczema or allergies

CFs: Infants =>> itchy, red, scaly rash w/ crusted lesions on trunk, cheeks, scalp, extensor surfaces
Child/Adult =>> Lichenified plaques in flexural creases

Tx: Topical emollients and/or steroid cream

1002

Obstetric complications of lupus in pregnanc

Preterm birth

C-sec

Preeclampsia

IUGR

Fetal demise

1003

Pulsus paradoxus

Arterial pressure drop of >10 w/ inspiration

-Associated w/ cardiac tamponade, asthma, COPD

1004

What test should you order for Ankylosing Spondylitis?

Xray of the sacroiliac joints

-HLA-b27 is not specific

1005

Pt who has acute pancreatitis but also elevated AP and bilirubin

Get a US to make sure we don't have gallstone pancreatitis

1006

Pulsus parvus et tardus

Assoc. w/ Aortic stenosis

1007

"Mass in the groin"

Either a femoral artery aneurysm of femoral hernia

1008

Methotrexate ADRs

Hepatotoxicity

Stomatitis (may present as ulcers)

Cytopenias

1009

Ventricular arrhythmias w/ MI

0-10 mins: Reentrant arrhythmia

10-60 mins: Abnormal automaticity

1010

Only patients to give hypertonic saline

Na <120 AND has CNS symptoms (confusion, seizure, coma)

1011

Efferent arteriolar resistance w/ hypolemia

Increased

1012

Sclerodermic crisis

Path: increased vascular permeability, activation of the Coag cascade, and increased renin secretion

Findings include sudden renal failure, malignant hypertension, microangiopathic hemolytic anemia with DIC

1013

Retrospective cohort study

Differs from case-control because risk factor exposure is determine BEFORE outcome is know

1014

Hemophilic arthropathy

Caused by iron and hemosiderin deposition leading to synovitis and fibrosis within the joint

-This is the process when it is a CHRONIC process; when acute, it is due to occult trauma

-Prophylactic treatment w/ factor concentrates may reduce risk of this developing

1015

Kid w/ Down's Syndrome who develops personality changes, urinary incontinence, and vertebrobasilar symptoms

Atlantoaxial instability

-May also see UMN signs (spasticity, hyperreflexia)

Dx: Lateral radiographs

Tx: Surgical fusion of C1 to C2

1016

Pt. who has become paralyzed and is now hypercalcemia

Hypercalcemia due to immobilization is a possibility

1017

Heart defects associated w/ DiGeorge

Transposition of the great arteries

and

Truncus Arteriosus

1018

Pt who ingested acetaminophen 4 hours ago and presents in the ER

Give activated charcoal

-Any later than 4 hours tho is too late

1019

"Flail mitral leaflet"

Means "rupture of the chordae tendinae"

NOT mitral regurg.

1020

Treatment for stress incontinence

Pelvic floor exercises

Pessary

Pelvic floor surgery

1021

Most common original location for atrial flutter

Tricuspid annulus

-Where is it for a-fib?

1022

How to calculate SAAG

Serum albumin-ascitic albumin

1023

Causes of warm AIHA

CLL

Lymphoma

Lupus

Phenytoin, sulfa drugs, rifampin

1024

Tx for cold AIHA

Keep pt warm,

Plasmapharesis and Rituximab

1025

Clots in an unusual place

Think paroxysmal nocturnal hemoglobinuria

Tx w/ steroids, Eculizumab, and bone marrow transplant if severe

1026

Tx in aplastic anemia in someone who can't have a bone marrow transplant

Cyclosporine

Tacrolimus

Alementuzumab

-Inhibit T cells from attacking BM

1027

Treatment of acute blast crisis in CML

Leukopheresis

1028

MCCo IUGR in the first trimester

Chromosomal abnormality

-Look for a mother who refused chromosomal analysis

1029

What is the pathology behind proximal muscle weakness in Cushing Syndromes?

Muscle atrophy due to the catabolic effects of androgens on muscle tissue

1030

Which anithyroid med is assoc. w/ agranulocytosis?

BOTH

-Methimazole also has cholestasis and 1st trimester teratogenicity

PTU also has hepatic failure and ANCA associated vasculitis

1031

In a pt. who is IC and develops pneumonia BUT the sputum shows nothing on gram stain, what should you do?

BAL

1032

PE findings w/ bicuspid valve

Young pts: Aortic regurgitation

Older pts: Aortic stenosis

1033

How do vagal maneuvers slower the HR in SVT?

Decreased AV node conductivity

1034

Pts. w/ carcinoid syndrome are at increased risk of what deficiency?

Niacin

-B3 is an enzyme cofactor for conversion of tryptophan to serotonin

1035

How long does it take for the rash to appear after treating EBV w/ amoxicillin?

24 hours

-If an immediate rash appears, it is a Type I HSN

1036

Management for pt. w/ embolus from IE

Antibiotics ONLY

-Sx. only w/ severe valvular disease or recurrent emboli

1037

A treatment for refractory CLL

Cyclophosphamide

Usually,Fludarabine and Rituximab are used tho

1038

ADRs of cisplatin

Renal and Ototoxicity

1039

How do you detect bence jones proteins

Urine immune electrophoresis

Not detected by dipstick

1040

Single best test for MM

BM biopsy

1041

What is the problem w MGUS

1% a year will transform into myeloma

1042

Tx of Waldenstroms Macroglobulinemia

Plasmapheresis

Rituximab or prednisone

1043

Irregular risocetin cofactor assay

vWD

1044

Platelet 4 antibodies

Associated with HIT

1045

Best initial test for confirming Antiphospholipid syndromes

Mixing study

-Coag times will not be corrected

1046

Prophylaxis for tick bites

Doxycycline ONLY if the tick has been on for at least 36 hrs

1047

MCCo dry cough

Post nasal drip

Asthma

GERD

1048

Beckwith-Wiedemann Syndrome

Deregulation of imprinted gene expression of chromosome 11p15

PE: Fetal Macrosomia with rapid growth (elevated percentile)
Omphalocele, umbilical hernia
Macroglossia
⭐️Hemihyperplasia

Comps: Wilms tumor
Hepatoblastoma

Management: Serum AFP
Abdominal and renal US
-Start at age 4; do it every 3 months

1049

Pt. who has a pressure of 150/45

WIDENED PULSE PRESSURE

-THIS IS INDICATIVE OF AORTIC REGURG.

-Pt. may also complain of a bounding heart

1050

RFs for shoulder dystocia

Maternal obesity

Excessive pregnancy weight gain

Fetal macrosomia

Gestational diabetes

Post-term pregnancy

1051

Sx typically absent from lacunar infarcts

Sensory deficits

-This is because lacunar infarcts typically occur in the internal capsule

1052

If you're unsure if a kid is having puberty problems, what should you remember

Thelarche
Adrenarche
Growth spurt
Menarche

-Also, menarche doesn't need to happen until age 15

1053

X-ray on kid with tuberous sclerosis

Intra-cranial calcifications

1054

Pt. w/ complete androgen insensitivity syndrome and has cryptorchid gonads right before puberty

Let them go thru puberty THEN take out those 'nads

1055

Diabetic medication to discontinue in any patient w/ declining renal function

Metformin

-Remember, it can cause lactic acidosis

1056

Specific type of CBT for OCD

Exposure and response prevention

1057

Pt. who has painless, bright-red rectal bleeding and is now hypotensive

Diverticulosis

-Hemorrhoids do not bleed enough to cause hypotension

1058

Long-term management of common variable immunodeficiency

IVIG

1059

Acute treatment of AF in WPW pts.

PROCAINAMIDE

-Obviously, DC conversion if unstable

1060

Riboflavin deficiency

Cheliosis

Glossitis

Seborrheic dermatitis

Pharyngitis

1061

Niacin deficiency

Stomatitis

Diarrhea

Dermatitis

Dementia

1062

Baby w/ left axis deviation, absent R waves, and decreased pulmonary markings on X-ray

Tricuspid atresia

-Normally on a newborn, there should be RIGHT axis deviation as circulation in utero is dependent on the right heart

-Pts. may also have tall, peaked P waves due to the necessary ASD

1063

Pt. who underwent surgery, childbirth, or trauma and presents w/ tachycardia, HTN, arrhythmia, tremor, lid lag

Thyroid storm

-Adrenal crisis will have hypotension

1064

Anti-mitochondrial antibodies

Primary biliary cholangitis

1065

Patient who had a surgery and is now acidotic

Post-ictal acidosis due to brief skeletal muscle hypoxia

-Reexamine levels in 2 hrs to check for improvement

1066

Immigrant w/ conjunctival injection, tarsal inflammation, and pale follicles

Trachoma

-Could also be nasopharyngeal infxn

Tx: Azithromycin

1067

Galactosemia

Deficiency of galactose-1 phosphate uridyl transferase =>> elevated blood galactose levels

Presentation: Vomiting, poor weight gain, bilateral cataracts, hepatosplenomegaly, jaundice, lethargy, and convulsions

-Pts. are at increased risk for E. col neonatal sepsis

1068

Carboxyhemoglobinemia

CO-bound hemoglobin

1069

Murmurs of VSD

Holosystolic murmur on left lower sternal border

Diastolic rumble at the apex

1070

Primary murmur of TOF

Harsh, systolic ejection murmur at the upper left sternal border

1071

CYP inhibitors

Acetaminophen, NSAIDs

Metronidazole

Amiodarone

Cimetidine

Gingko biloba, Cranberry juice

Omeprazole

SSRIs

1072

CYP inducers

Carbamazepine, phenytoin

Ginseng, St. John's Wort

OCPs

Rifampin

1073

Felty Syndrome

RA
-Includes erosive joint disease, rheumatoid nodules, and vasculitis (necrotizing skin lesions)

Neutropenia

Splenomegaly

Dx: Anti-CCP and RF (+)
Elevated ESR

1074

CT of Takayasu Arteritis

Thickening and luminal narrowing of large artery walls

-This commonly presents in Asian woman under 20

-Tx w/ steroids

1075

Tx of radial head subluxation

Supination of the forearm and Flexion of the elbow

OR

hyper pronation of the forearm

1076

Young pt. With history of panic attacks and CAD who presents with chest pain

Manage like it is a heart attack first

1077

MC complications of mumps

Aseptic meningitis

Orchitis

1078

Management for healthcare worker stuck with HIV needle

HIV serology now and immediately start 3-drug antiretroviral therapy

1079

When is the RR basically equal to the OR?

When incidence of a disease is low

1080

Test to order on PCOS pts