Secrets

Question 1

Vitamin to give w/ any patient on Isoniazid therapy

Answer 1

B6

Question 2

Signs of end organ damage in hypertensive emergency

Answer 2

Headaches

Dizziness

Blurry vision

Papilledema

Cerebral edema

AMS

Seizure

Intracerebral hemorrhage (typically in the basal ganglia)

Renal failure

Angina

MI

HF

Question 3

First treatment in shock

Answer 3

IV fluids (along w/ O2 and monitoring)

UNLESS IT IS CARDIOGENIC SHOCK

Question 4

Virchow triad

Answer 4

Endothelial damage (surgery, trauma)

Venous Stasis (immobilization, severe HF)

Hypercoagulable state (birth control, malignancy, lupus anticoagulant)

-Increases likelihood of DVT

Question 5

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

Answer 5

Biopsy

Question 6

Best initial test to distinguish upper from lower GI bleeding

Answer 6

Nasogastric tube

Question 7

Tx for hereditary hemochromatosis

Answer 7

Therapeutic phlebotomy

Question 8

ADRs of steroids

Answer 8

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

Question 9

ADRs of contraception

Answer 9

Endometrial cancer

Hepatic adenoma

Glucose intolerance

DVT, stroke

Cholelithiasis

Depression

Weight gain

Pseudotumor cerebri

Teratogenesis

Increased risk of CAD and breast cancer

Question 10

Acute laryngotracheitis

Answer 10

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

Question 11

X-rays for smokers

Answer 11

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

Question 12

Odds ratio

Answer 12

(AxD)/(BxC)

Question 13

Relative risk

Answer 13

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

Question 14

Attributable risk

Answer 14

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

Question 15

Tx of acute dystonia

Answer 15

Antihistamine (Diphenhydramine)

Anticholinergic (benztropine)

Question 16

MCCo decreased maternal AFP

Answer 16

Incorrect dates

Question 17

Variable decelerations

Answer 17

Umbilical cord compression

Question 18

Late decelerations

Answer 18

Uteroplacental insufficiency

-Most worrisome

Question 19

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

Answer 19

US

-need to r/o placenta previa

Question 20

Neonatal conjunctivitis

Answer 20

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

Question 21

6 Ps of Compartment syndrome

Answer 21

Pain (out of proportion to injury)

Paresthesia

Pallor

Pressure

Paralysis (late, ominous sign)

Pulselessness (very late sign; MUST TREAT NOW)

Question 22

Pulsatile abdominal mass + Hypotension

Answer 22

Ruptured AAA

Tx: Sx.

Question 23

APGAR

Answer 23

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

Question 24

Tx for BB OD

Answer 24

Glucagon

Question 25

Tx for cholinesterase inhibitors

Answer 25

Atropine Pralidoxime

Question 26

Tx for digoxin toxicity

Answer 26

Correct K+ and other electrolytes Digoxin ab

Question 27

Deep, rapid breathing in a diabetic

Answer 27

Kussmaul respiration Sign of DKA

Question 28

Cherry- red spot on the macula w/o hepatosplenomegaly

Answer 28

Tay-Sachs Disease

Question 29

Cherry-Red spot on the retina w/ hepatosplenomegaly

Answer 29

Niemann-Pick disease

Question 30

Disease to think of when an infant has a meconium ileus

Answer 30

CF

Question 31

Cafe-au-lait spots w/ decreased IQ

Answer 31

McCune-Albright or Tuberous sclerosis

Question 32

Cafe-au-lait spots w/ a normal IQ

Answer 32

Neurofibromatosis

Question 33

Ambigous genitalia and hypotension

Answer 33

21a-hydroxylase deficiency

Question 34

Anaphylaxis from Ig therapy

Answer 34

IgA deficiency

Question 35

Postpartum fever unresponsive to broad-spectrum abs

Answer 35

Septic pelvic thrombophlebitis

Question 36

Low-grade fever in the first 24 hrs after surgery

Answer 36

Atelectasis

Question 37

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

Answer 37

MONO

Question 38

Facial port-wine stain and seizure

Answer 38

Sturge-Weber

Question 39

Beck triad

Answer 39

JVD Muffled heart sounds Hypotension ***SIGNS OF CARDIAC TAMPONADE

Question 40

Brudzinski sign

Answer 40

Pain on neck flexion

Question 41

Charcot triad

Answer 41

Fever/chills Jaundice RUQ pain *Cholangitis

Question 42

Chvostek sign

Answer 42

Tapping on the facial nerve elicits tetany ***SIGN OF HYPOCALCEMIA

Question 43

Cushing reflex

Answer 43

HTN Bradycardia Irregular respirations ***INCREASED ICP

Question 44

Leriche syndrome

Answer 44

Claudication and atrophy of the butt w/ impotence *Aortoilliac occlusive disease

Question 45

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

Answer 45

Chorionic villus sampling: Weeks 9-13 Amniocentesis: Weeks 15-20

Question 46

Pneumococcal polysaccharide vaccine (PPSV23)

Answer 46

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)

Question 47

Pneumococcal conjugate vaccine (PCV13)

Answer 47

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

Question 48

Pt. w/ IE who has history of heart murmur

Answer 48

Probably mitral regurg.

Question 49

RFs for C. diff

Answer 49

Antibiotics Hospitalization PPI use

Question 50

Studies that are known as a prevalence study

Answer 50

Cross-sectional -These studies simultaneously measure exposure and outcome

Question 51

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

Answer 51

NORMAL; due to maternal estrogen

Question 52

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

Answer 52

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

Question 53

Cauda equina syndrome

Answer 53

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)

Question 54

Conus medullaris syndrome

Answer 54

Pain is SUDDEN-onset and in the back Perianal anesthesia SYMMETRIC motor weakness HYPERreflexia EARLY-onset bowel dysfnxn ***DAMAGE is in the CONUS MEDULLARIS

Question 55

Leads w/ ST-elevation in LAD occlusion

Answer 55

I, aVL (lateral) V1-V4 (anterior)

Question 56

Cardiac manifestationsof sarcoidosis

Answer 56

Complete AV block (most common) Restrictive cardiomyopathy (early) Dilated cardiomyopathy (late) *Due to formation of cardiac noncaseating granulomas

Question 57

Problems w/ vesicoureteral reflux

Answer 57

Recurrent UTIs Renal scarring Renal insufficiency ESRD

Question 58

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

Answer 58

Mammogram

Question 59

"Egg on a string" heart on newborn CXR

Answer 59

Narrow mediastinum -Indicative of Transposition of the Great Vessels

Question 60

Hyperemesis gravidarum

Answer 60

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

Question 61

MDMA OD

Answer 61

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

Question 62

Extraperitoneal bladder injury

Answer 62

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

Question 63

Reasons for baseline EKG abnormality

Answer 63

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)

Question 64

Prasugrel

Answer 64

P2Y-inhibitor best used alongside aspirin after coronary angioplasty or stenting *Cannot use in pts >75yrs because of increased risk of hemorrhagic stroke

Question 65

Ticlopidine

Answer 65

Used in pts. who are intolerant of aspirin and clopidogrel ADRs: neutropenia, TTP

Question 66

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

Answer 66

Nitrates + Hydralazine

Question 67

LDL goal w/ CAD

Answer 67

<70

Question 68

Indications for cardiac revascularization

Answer 68

3 vessel disease L. main disease 2 vessel disease in a diabetic

Question 69

Pt w/ an acute DVT

Answer 69

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

Question 70

Workup for Raynauds

Answer 70

CBC, BPP Urinalysis ANA ESR, Complement levels -Need to rule out sinister causes

Question 71

First work-up for a palpable ovarian mass

Answer 71

Pelvic ultrasound

Question 72

Infant w/ an elevated arterial blood level

Answer 72

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

Question 73

Granulosa cell tumor of the ovary

Answer 73

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

Question 74

Attrition bias

Answer 74

Type of SELECTION bias due to loss of patients to follow-up Results can be skewed in certain directions depending on the populations

Question 75

Factorial design

Answer 75

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

Question 76

Patient who has uremia and chest pain

Answer 76

Consider uremic pericarditis These pts. should be started on dialysis

Question 77

Tx of Torsades

Answer 77

IV magnesium

Question 78

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

Answer 78

Suspect ADPKD

Question 79

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

Answer 79

HOCM

Question 80

Most important prognostic factor in breast cancer

Answer 80

TNM staging

Question 81

Tx for cervicofacial Actinomyces

Answer 81

Penicillin

Question 82

Clinical manifestations of hereditary hemochromatosis

Answer 82

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

Question 83

Best management for preeclampsia

Answer 83

DELIVERY W/o severe features =>> @ 37 weeks W/ severe features =>> @34 weeks

Question 84

Urine protein/creatinine ratio indicative of preeclampsia

Answer 84

>.3 or 24 hours urine showing >300mg protein

Question 85

CHAD-VASc

Answer 85

``` 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

Question 86

Treatment of preeclampsia

Answer 86

Hydralazine Labetalol Nifedipine PO

Question 87

JONES criteria

Answer 87

``` 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 ```

Question 88

Management of postpartum urinary retention

Answer 88

Urethral catheterization

Question 89

Treatment for Listeria

Answer 89

Ampicillin

Question 90

Aztreonam coverage

Answer 90

Exclusively for gram negative bacteria

Question 91

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

Answer 91

HBe

Question 92

Tx of chancroid

Answer 92

Azithromycin

Question 93

Signs of peripheral Bell's Palsy

Answer 93

Loss of forehead and brow movements Inability to close eyes and drooping of both eyelids

Question 94

Most accurate dating of gestational age

Answer 94

First trimester ultrasound with crown-rump length measurement

Question 95

Cephalohematoma

Answer 95

Subperiosteal hemorrhage limited to the surface of one cranial bone in a newborn infant -Swelling becomes visible a few hours after birth

Question 96

Caput succedaneum

Answer 96

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

Question 97

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

Answer 97

Probably secondary to Vitamin D deficiency Suspect increased PTH w/ decreased Calcium and Phosphorus

Question 98

Lynch Syndrome Neoplasms

Answer 98

Colorectal cancer Endometrial Cancer Ovarian Cancer

Question 99

FAP Neoplasms

Answer 99

Colorectal cancer Desmoids/Osteomas Brain tumors

Question 100

vHL-Syndrome Neoplasms

Answer 100

Hemangioblastomas Clear cell renal carcinoma Pheochromocytoma

Question 101

MEN 1 Cancers

Answer 101

PTH Pituitary Adenomas Pancreatic adenomas

Question 102

MEN 2A Cancers

Answer 102

Parathyroid cancer Medullary Thryroid Cancer Pheochromocytoma

Question 103

Tx of ventricular tachycardia in a stable patient

Answer 103

Amiodarone

Question 104

Long term O2 therapy criteria

Answer 104

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%

Question 105

Vertebral Osteomyelitis

Answer 105

Fever, back pain, focal spinal tenderness *Do not need elevated WBC, fever

Question 106

Joints most commonly affected by pseudogout

Answer 106

Ankle and knee

Question 107

Manifestations of amyloidosis (primary and secondary)

Answer 107

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

Question 108

Other bacteria that can cause endocarditis and necessitates a colonoscopy afterwards

Answer 108

Clostridium septicum

Question 109

When do you need surgery for endocarditis?

Answer 109

Rupture valve or tendinae Prosthetic valve infxn Fungal endocarditis Abscess AV block Recurrent emboli

Question 110

Tx for HACEK endocarditis

Answer 110

Ceftriaxone

Question 111

Treatment of cardiac or neurologic Lyme disease

Answer 111

Ceftriaxone

Question 112

Zidovudine ADR

Answer 112

Anemia | NRTI

Question 113

Stavudine ADR

Answer 113

Peripheral neuropathy Pancreatitis (NRTI)

Question 114

Didanosine ADR

Answer 114

Peripheral neuropathy Pancreatitis (NRTI)

Question 115

Abacavir ADR

Answer 115

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

Question 116

Protease inhibitor ADRs

Answer 116

Hyperlipidemia, hyperglycemia ***These drugs end in -navir

Question 117

Indinavir ADR

Answer 117

Nephrolithiasis What class is this?

Question 118

Tenofovir ADR

Answer 118

Renal insufficiency Bone demineralization (NRTI)

Question 119

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

Answer 119

Efavirenz

Question 120

Tests for Aspergillosis

Answer 120

Galactomannan B-D-glucan PCR

Question 121

Chikungunya fever

Answer 121

Joint pain, periarticular edema, rash, fever

Question 122

Box-car shaped encapsulated rods

Answer 122

Bacillus anthracis Can be: 1. Cutaneous (black eschar= self-limited) 2. GI (diarrhea, ulcerations) 3. Inhalation (widened mediastinum, pleural effusion)

Question 123

Leptospirosis

Answer 123

Oliguria, elevated CK w/ muscle pain Get from infected food from animal urine

Question 124

Angioedema tx.

Answer 124

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

Question 125

Manifestation of Hyper IgE Syndrome

Answer 125

Recurrent skin infxns w/ Staph.

Question 126

Facets of a biophysical profile

Answer 126

Nonstress test (fetal heart rate) Amniotic fluid volume Fetal breathing Fetal movement Fetal tone ⭐️order there's with a non reactive stress test

Question 127

STDs screened for at initial pregnancy visit

Answer 127

Hiv HBV Chlamydia Syphilis

Question 128

Acute, unilateral lymphadenitis causative agent

Answer 128

Staph aureus

Question 129

Fibromyalgia

Answer 129

Middle-aged women w/ widespread pain, fatigue, and mood complaints -Point tenderness is greater at insertion points of muscles Tx: Education; aerobic exercise ****TCAs******

Question 130

Malignant otitis externa (necrotizing)

Answer 130

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

Question 131

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

Answer 131

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

Question 132

Attributable risk percent

Answer 132

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

Question 133

Best test for someone w/ Addison's

Answer 133

8AM serum cortisol and ACTH stimulation test

Question 134

Polymyositis

Answer 134

Proximal muscle weakness; NO PAIN PRESENT Dx: Elevated CK, Aldolase (muscle enzymes) (+)ANA, (+) anti-Jo-1 Biopsy: Endomysial infiltrate w/ patchy necrosis

Question 135

Polymyalgia rheumatica

Answer 135

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

Question 136

Pt. who started medication for tremor and has visual disturbances

Answer 136

Consider trihexyphenidyl precipitating Acute Angle Closure Glaucoma

Question 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

Answer 137

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

Question 138

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

Answer 138

Betamethasone Tocolytics (indomethacin, nifedipine) Magnesium sulfate (neuroprotective properties for the fetus) Penicillin

Question 139

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

Answer 139

Probably Type II Osteogenesis Imperfecta Is typically fatal during delivery

Question 140

Test to order prior to starting Trastuzumab

Answer 140

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

Question 141

"Irregularly enlarged uterus"

Answer 141

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

Question 142

Febrile Neutropenia

Answer 142

MAKE SURE TO COVER ALL BACTERIA INCLUDING PSEUDOMONAS -Try Pip-Tao, Meropenem, Cefepime

Question 143

Myotonic Dystrophy

Answer 143

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

Question 144

Pulseless Electrical Activity Management

Answer 144

CPR Epi Possible Advance Airway *Manage like the patient is in asystole****

Question 145

Indications for urgent dialysis

Answer 145

Acidosis (<7.1) Electrolyte abnormalities (EKG probs; K>6.5) Ingestion (alcohols, salicylate, lithium, Keppra, Carbamazepine) Overload Uremia (symptomatic w/ encephalopathy, pericarditis, or bleeding)

Question 146

"Water bottle" shaped heart on X-ray

Answer 146

Pericardial effusion Looks more like a canteen really

Question 147

CML tx.

Answer 147

Imatinib -TK inhibits the BCR-ABL gene product

Question 148

Tx for nephrogenic DI

Answer 148

Tx underly cause and add.. HCTZ; amiloride; or NSAIDs (prostaglandin inhibitor)

Question 149

Signs/Sx. of Acromegaly

Answer 149

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

Question 150

Best initial test for suspected acromegaly

Answer 150

IGF-1 Most accurate test is the glucose suppression test =>Glucose should suppress GH levels

Question 151

Tx of acromegaly

Answer 151

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)

Question 152

CCB that can cause prolactinemia

Answer 152

Verapamil

Question 153

Tests to run after high prolactin level

Answer 153

TFTs (high TRH can cause release) Pregnancy test BUN/Cr (kidney disease will elevate levels) LFTs -Afterwards, do an MRI

Question 154

Subacute thyroiditis

Answer 154

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

Question 155

Thyroid storm tx

Answer 155

1. Propanolol (blocks target organ effects and peripheral T4=>T3 conversion) 2. Methimazole/PTU 3. Iodine (blocks release and peripheral conversion) 4. Steroids

Question 156

Tx of Grave's Opthalmopathy

Answer 156

Steroids

Question 157

Cinacalcet

Answer 157

Suppresses PTH release Used to tx. hyperparathyroidism if sx. is not an option

Question 158

Calcium and albumin correlation

Answer 158

For every point decrease in albumin, Ca2+ drops 0.8

Question 159

Tx for unresectable pituitary causing hyperadrenalism

Answer 159

Pasireotide -Somatostatin analog

Question 160

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

Answer 160

CXR

Question 161

Fludrocortisone

Answer 161

Useful steroid replacement in that it has increased mineralcorticoid activity -Choose this if the patient has signs of postural instability

Question 162

Testing for pheo

Answer 162

Initial: Plasma free metanephrines Confirm: 24 hr urine metanephrine

Question 163

Diabetes diagnosis

Answer 163

Two fasting blood glucose levels greater than 125 Single level greater than 200 and presence of symptoms Increased glucose level on OGTT test

Question 164

Pramlinitide

Answer 164

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

Question 165

Incretins

Answer 165

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

Question 166

DM Health Maintenance

Answer 166

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

Question 167

Tx of diabetic gastroparesis

Answer 167

Metoclopromide or erythromycin (increases gastric motility) Presents w/ nausea, bloating, constipation, abdominal discomfort

Question 168

PCOS diagnostic criteria

Answer 168

Clinical signs of hyperandrogenism and/or high testosterone/DHEA Irregular menstruation 10 cysts on pelvic sonogram w/ an ovary >10cm

Question 169

Postpartum endometritis

Answer 169

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

Question 170

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

Answer 170

COULD BE MASSIVE PE COULD LEAD TO R.HEART FAILURE

Question 171

Tx for hypotension caused by an epidural during labor

Answer 171

Placement of the patient on their left side to improve VR Fluid bolus Vasopressors

Question 172

Lead points for intussusception

Answer 172

Kid w/ recent illness: Hypertrophied Peyer's Patch Normal Kid: Meckel Diverticulum Adult: Small cell lymphoma

Question 173

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

Answer 173

Allergic Bronchopulmonary Aspergillosis Tx. w/ ORAL steroids

Question 174

Outpatient pneumonia tx.

Answer 174

Azithromycin or Doxycycline Comorbidities (COPD, asthma) =>>Levo or Moxi

Question 175

Inpatient Pneumonia tx.

Answer 175

Levo; Moxi or Ceftriaxone + Azithromycin

Question 176

CURB 65

Answer 176

Confusion Uremia Respiratory Distress BP low 65 years or older *Needs 2 for admission

Question 177

Exudate vs. Transudate

Answer 177

pH <7.2 LDH >60% of serum Protein >50% of serum

Question 178

Hospital Acquired Penumonia tx.

Answer 178

Cefepime/Ceftazidime Pip-Tazo Carbapenem ***JUST MAKE SURE THERE IS PSEUD COVERAGE

Question 179

Ventilator-Associated Pneumonia tx.

Answer 179

1. Anti-pseudonomal B-lactam (ceftaz or cefepime, pip-tazo, carbapenem) 2. Second antipseudomonal (gentamicin, cipro/levo) 3. Vanc or Linezolid

Question 180

Imipinem ADR

Answer 180

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

Question 181

Tx for PCP if you cant use Bactrim

Answer 181

Clindamycin or Pentamadine

Question 182

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

Answer 182

You can stop medications

Question 183

Patient w/ a positive PPD

Answer 183

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

Question 184

Interstitial Lung Disease w/ granuloma formation

Answer 184

Berylliosis -Will respond to steroid tx.

Question 185

Possible presentations of sarcoidosis

Answer 185

Erythema nodosum Parotid gland enlargement Facial palsy/CNS involvement Iritis/Uveitis Elevated ACE Hypercalciuria/Hypercalcemia

Question 186

Argatroban

Answer 186

Direct thrombin inhibitor Use this if a patient has HIT

Question 187

Tx for primary pulmonary HTN

Answer 187

Prostacyclin analogues (beraprost, iloprost) Endothelin antagonists (bosentan)

Question 188

Tx of ARDS

Answer 188

Low-tidal volume mechanical ventilation (6mL/kg) PEEP (maintain plateau pressure <30cm H2O)

Question 189

Pt who has a hip fracture but is medically unstable

Answer 189

Can delay surgery for up to 72 hrs; stabilize first

Question 190

Most common cause of anemia in someone w/ SCD

Answer 190

Folate deficiency BM can't keep up with rapid hemolysis

Question 191

Pt. who has clear cervical mucous and a normal period

Answer 191

Could just be her ovulating and leaking juice

Question 192

Mongolian Spot

Answer 192

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

Question 193

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

Answer 193

Still get an Xray first MRI next

Question 194

Tx of Guillan-Barre

Answer 194

IVIG

Question 195

Fanconi Anemia

Answer 195

BM: Aplastic anemia Appearance: Short, microcephaly, hypoplastic thumbs, hypogonadism Skin: Irregularly pigmented areas, large freckles *Occurs due to chromosomal breaks

Question 196

Keratitis in a pt. w/ HIV

Answer 196

Think HSV

Question 197

Riboflavin deficiency

Answer 197

Angular cheilosis, stomatitis, glossitis Normocytic anemia Seborrheic dermatitis

Question 198

Boerhaave Syndrome

Answer 198

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

Question 199

Digoxin toxicity

Answer 199

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

Question 200

MC morbidities w/ TPN

Answer 200

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

Question 201

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

Answer 201

Suspect ecthyma gangrenosum caused by Pseud.

Question 202

Loss of palpable pulse during inspiration

Answer 202

Pulsus paradoxus (think cardiac tamponade)

Question 203

TB pleural effusion

Answer 203

Exudative w/ increased LYMPHOCYTES

Question 204

Spontaneous bacterial peritonitis

Answer 204

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

Question 205

Tx of supraventricular tachycardia

Answer 205

Adenosine

Question 206

Tx of ventricular tachycardia

Answer 206

Amiodarone

Question 207

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

Answer 207

Probably has Primary Hyperaldosteronism; the thiazide made the condition worse

Question 208

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

Answer 208

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

Question 209

Pt w/ confusion and GI bleed

Answer 209

Probably have increased ammonia

Question 210

Most important prognostic factor for astrocytoma

Answer 210

Tumor grade Also, pt. age and functional states are important

Question 211

Tx for CLL

Answer 211

Rituximab (anti-CD20)

Question 212

Most common causes of infxn in SCD pts.

Answer 212

Pneumonia: S. pneumoniae Osteomyelitis: S. aureus, S. enteritidis Bactermia: S. pneumoniae, H. influenzae Meningitis: S. pneumoniae *Due to functional asplenia

Question 213

Bacterial endocarditis prophylaxis

Answer 213

Prosthetic heart valvue Hx. of IE Structurally abnormal valve in a TRANSPLANTED HEART ***Just these

Question 214

Rate control for A-fib

Answer 214

Metoprolol, emsolol or Diltiazem, Verapamil (nondihydropyridine CCBs)

Question 215

Type II Membranoproliferative Glomerulonephritis

Answer 215

"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

Question 216

Pt w/ preeclampsia who becomes dyspneic and hypoxic

Answer 216

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

Question 217

Indications for renal/bladder US

Answer 217

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

Question 218

Complete Atrioventricular septal defect

Answer 218

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

Question 219

Hallmark of prolonged seizures (Status epliepticus)

Answer 219

Cortical laminar necrosis Can lead to persistent neurologic defects and recurrent seizure

Question 220

Alcohol withdrawal syndromes

Answer 220

Mild: Anxiety, insomnia, tremors, palpitations (6-24hrs) Seizures: 12-48hrs Alcoholic hallucinosis: 12-48hrs DTs: 48-96hrs (confusion, agitation, fever, tachycardia, diaphoresis, hallucinations

Question 221

Pt. w/ a positive Pap smear during their pregnancy

Answer 221

Still go ahead and perform a colposcopy

Question 222

Acute cholangitis

Answer 222

Presents as fever, jaundice, RUQ pain, and elevated AP Usually secondary to malignancy or gallstone

Question 223

MCC of spontaneous lobar hemorrhage

Answer 223

Cerebral amyloid angiopathy

Question 224

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

Answer 224

Hemolytic Uremic Syndrome

Question 225

Luteoma of pregnancy

Answer 225

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

Question 226

ADRs of cyclophosphamide

Answer 226

Acute hemorrhagic cystitis Bladder carcinoma Sterility Myelosuppression *****AVOID BLADDER ADRS BY DRINKING LOTS OF FLUIDS AND TAKING MESNA

Question 227

Blocked vessel in inferior MI

Answer 227

RCA Sometimes LCX

Question 228

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

Answer 228

Chest CT

Question 229

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

Answer 229

Get US and a CA-125

Question 230

Most common cause of nephrotic syndrome in adults

Answer 230

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

Question 231

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

Answer 231

Listeria monocytogenes

Question 232

Spinal epidural abscess

Answer 232

Fever, progressive focal back pain, and neurologic deficits typically in an IV drug abuser Labs: Elevated ESR

Question 233

Child with pharnygeal erythema and some small vesicles

Answer 233

Probably Herpangina (Coxsackie A) Just needs conservative management

Question 234

Granulomatosis w/ polyangiitis

Answer 234

Sinusitis, lung nodules/cavitation, rapidly progressive GN, AND NONHEALING ULCERS OR LIVEDO RETICULARIS (4th manifestation) Tx: Steroids; immune modulators

Question 235

Insulin drips should contain what else when treating DKA?

Answer 235

K+

Question 236

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

Answer 236

Likely reactive thrombocytosis which will resolve If their spleen was removed, this could make the count even higher

Question 237

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

Answer 237

No Start off w/ lab work

Question 238

Best medication to treat hypertriglyceridemia

Answer 238

Fibrates

Question 239

Long-term benefits and risks of OCPs

Answer 239

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)

Question 240

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

Answer 240

Bisphosphonates -Help to inhibit the osteoclastic activity of bone destructive tumors

Question 241

ABG findings w/ postoperative atelectasis

Answer 241

ph: Increased pCO2: Decreased PO2: Decreased -Hyperventilation gets rid of CO2; collapse of lung causes decreased O2 diffusion

Question 242

Big difference b/w excess vomiting and diarrhea in labs

Answer 242

Vomiting =>> Alkalosis Diarrhea =>> Acidosis

Question 243

Fibromyalgia

Answer 243

Presents as chronic, widespread pain w/ fatigue and impaired concentration ***Pts. have tenderness on palpation and muscle insertion points *Labs will be normal

Question 244

Toxic Shock Syndrome

Answer 244

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

Question 245

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

Answer 245

HCV antibodies - Sounds like this is mixed cryoglobulinemia - Will also see decreased complement

Question 246

How does IgA nephropathy present?

Answer 246

HEMATURIA

Question 247

Nonclassical CAH

Answer 247

Can present w/ acne, irregular menses, and hirsutism -Patients will present w/ increased 17-hydroxyprogesterone and increased testosterone and DHEA as well

Question 248

Possible complications of HSP

Answer 248

GI hemorrhage Intussusception

Question 249

CN III palsy

Answer 249

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

Question 250

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

Answer 250

High metabolic activity of WBCs

Question 251

Felty Syndrome

Answer 251

RA Splenomegaly Neutropenia

Question 252

Caplan Syndrome

Answer 252

RA Pneumoconiosis Lung nodules

Question 253

MC nephrotic syndrome in SLE

Answer 253

Membranous glomerulonephritis

Question 254

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

Answer 254

Sclerodermic crisis Get them ACE inhibitors yo

Question 255

Dangerous complications of Sjogrens

Answer 255

Lymphoma; make sure to screen for this

Question 256

HUS presentation

Answer 256

Antecedent diarrheal illness =>>Microangiopathic hemolytic anemia - Fatigue - Pallor - Schistocytes Thrombocytopenia AKI (oliguria, edema)

Question 257

Zinc deficiency

Answer 257

Alopecia Pustular skin rash Hypogonadism Impaired wound healing Impaired taste immune dysfnxn

Question 258

Juvenile Myoclonic seizure

Answer 258

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

Question 259

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

Answer 259

Still get a CXR

Question 260

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

Answer 260

Churg-Strauss Syndrome

Question 261

Behcet's Syndrome

Answer 261

Oral and genital ulcers Ocular lesions that can cause uveitis and/or blindness Possible erhthema nodusm and arthritis

Question 262

Septic arthritis of a prosthetic joint

Answer 262

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

Question 263

Possible ADR to b12 or folate replacement

Answer 263

Hypokalemia Secondary to rapid cell production

Question 264

Management of SCD

Answer 264

Need folate, pneumococcal Vax, Hydroxyurea Also give abx. Right when a fever develops or the WBC rises

Question 265

Manifestation of sickle cell trait

Answer 265

Isosthenuria Possible painless ️hematuria

Question 266

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

Answer 266

Vibrio vulnificus (GNR) -Increased risk in those w/ liver disease Tx: IV ceftriaxone + doxycycline

Question 267

CXR for pulmonary contusion

Answer 267

Patchy alveolar infiltrate; usually localized to injured area *ARDS has the same BUT it manifests after 24-48 hours and will be diffuse

Question 268

Difference b/w ovarian torsion and rupture cyst

Answer 268

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

Question 269

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

Answer 269

Pharmacist-directed intervention

Question 270

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

Answer 270

Supportive bra Ice packs on nipples NSAIDs

Question 271

Vasovagal syncope

Answer 271

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

Question 272

Meningococcoal vaccination

Answer 272

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

Question 273

Wet beriberi

Answer 273

High output cardiac failure Can also be "dry" presenting w/ peripheral neuropathy

Question 274

Menke's Syndrome

Answer 274

Copper deficiency Presents w/ MR and kinky hair

Question 275

Selenium deficiency

Answer 275

CArdiomyopathy Muscle pain

Question 276

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

Answer 276

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

Question 277

Tx of superficial thrombophlebitis

Answer 277

Conservative (ICE, NSAIDs, REST) No increased risk for PE so no anticoagulation

Question 278

Subclavian Steal Syndrome

Answer 278

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

Question 279

MC testicular tumor

Answer 279

Seminoma

Question 280

BPH treatment

Answer 280

alpha-1 blockade (tamsulosin, doxazosin, terazosin 5a-reductase inhibitors (finasteride) TURP if very advanced

Question 281

Best donor for a kidney transplant

Answer 281

Living, related donor Cadaver acceptable tho

Question 282

Buerger disease

Answer 282

Basically Raynaud symptoms in a young person

Question 283

First work up for a postmenopausal women w/ vaginal bleeding

Answer 283

Pelvic ultrasound

Question 284

Salvage radiation therapy

Answer 284

Treatment when other options have failed

Question 285

Neoadjuvant therapy

Answer 285

Radiation given before standard therapy

Question 286

Induction radiation therapy

Answer 286

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

Question 287

Estrogen effects on thyroid

Answer 287

May have increased T4 and normal TSH This is due to the increase in TBG

Question 288

Plan B

Answer 288

High dose oral levonorgestrel

Question 289

MC risk factor for recurrent UTIs in children

Answer 289

Vesicoureteral reflux

Question 290

Refeeding Syndrome

Answer 290

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+

Question 291

Management of meconium ileus

Answer 291

Abdominal X-ray (check for perfs) Followed by contrast enema *******

Question 292

Euthyroid sick syndrome

Answer 292

"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

Question 293

Top 3 lifestyle modifications for HTN

Answer 293

1. Weight loss 2. DASH diet 3. Exercise

Question 294

Management of inflammatory acne

Answer 294

1. Topical retinoids + benzoyl peroxide 2. Topical erythromycin/clindamycin 3. Oral abx.

Question 295

Quadruple screens on Trisomy 21

Answer 295

AFP: Decreased b-HCG: Increased Estriol: Decreased Inhibin A: Increased

Question 296

Ruxolitinib

Answer 296

JAK inhibitor used for refractory polycythemia vera

Question 297

Treatment to add onto ALL tx.

Answer 297

Intrathecal chemo Prevents any relapse in the CNS

Question 298

Leukemia most likely to have an acute blast crisis

Answer 298

CML

Question 299

Pelger-Huet Cell

Answer 299

A bilobed PMN found in MDS -Can also see increased MCV, NRBCs, and few blasts

Question 300

Non-hodgkin's Staging

Answer 300

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

Question 301

Tx. of advance non-Hodgkin's

Answer 301

Cyclophosphamide Hydroxydaunorubicin (Adriamyacin) Oncovin (vincristine) Prednisone AND Rituximab

Question 302

Tx of Hodgkin's Lymphoma

Answer 302

Adriamycin (doxorubicin) Bleomycin Vinblastine Dacarbazine Treat relapses w/ chemo

Question 303

Tx for Waldenstrom's

Answer 303

Plasmapheresis Followed by prednisone

Question 304

ITP tx.

Answer 304

No symptoms; greater than 30,000 =>> Nothing Severe bleeding, <10,000 =>> IVIG Mild bleeding, count greater than 30,000 =>> Steroids *Splenectomy is last resort

Question 305

Tx of esophageal spasms

Answer 305

CCBs

Question 306

Two diagnoses for a ring narrowing the distal esophagus

Answer 306

Plummer-Vinson Syndrome: Assoc. w/ IDE; treat w/ iron Schatzki ring: Assoc. w/ reflux and/or hiatal hernia; tx. w/ endoscopic procedure

Question 307

Orthostasis definition

Answer 307

10+ rise in pulse when going from lying down to sitting up or Systolic pressure top of >15 points when sitting up

Question 308

Drug to give for esophageal variceal BLEEDING

Answer 308

Octreotide

Question 309

Tx. of a repeat episode of C. diff

Answer 309

Still use repeat metronidazole

Question 310

Tx for Whipple's

Answer 310

Ceftriaxone; Bactrim

Question 311

Tx for diarrhea-prominent IBS

Answer 311

Rifaximin

Question 312

Tx of IBS

Answer 312

Increase fiber Hyoscyamine/Dicyclomine TCAs

Question 313

Tx of constipation predominant IBS

Answer 313

Polyethylene glycol

Question 314

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

Answer 314

Suspect analgesic nephropathy

Question 315

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

Answer 315

Syncope likely due to bradyarrhythmia or intermittent AV block

Question 316

Magnesium toxicity

Answer 316

N/V, flushing, headache, hyporeflexia, hypocalcemia, somnolence =>> Possible respiratory paralysis and cardiac arrest tx: Calcium Gluconate - Can occur in pts. w/ renal failure

Question 317

Simple Renal Cysts

Answer 317

Thin, smooth, regular wall Unilocular Homogenous Absence of contrast enhancement Asymptomatic No follow-up needed *IF it has other qualities, work up for malignancy

Question 318

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

Answer 318

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

Question 319

CXR w/ reactive nodules and surrounding ground-glass opacities

Answer 319

"Halo sign" -Suspect invasive aspergillosis

Question 320

Strongest RF for stroke

Answer 320

HTN

Question 321

Pt. w/ epigastric pain and RFs for cardiac disease

Answer 321

Still get an EKG before amylase and lipase

Question 322

Antibody positive in Crohn's Disease

Answer 322

anti-saccharomyces cerevisiae ab

Question 323

Peutz-Jeghers Syndrome

Answer 323

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

Question 324

SAAG levels of ascitic fluid

Answer 324

<1.1 - Infxn - Cancer - Nephrotic syndrome >1.1 - Portal HTN - CHF - Hepatic vein thrombosis - Constrictive pericarditis

Question 325

MCCo Spontaneous Bacterial Peritonitis

Answer 325

E. coli Typically gets treated w/ ceftriaxone

Question 326

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

Answer 326

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

Question 327

Hepatopulmonary Syndrome

Answer 327

Hypoxia due to liver failure Pts. have orthodeoxia (hypoxia when sitting up straight)

Question 328

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

Answer 328

Primary Biliary Cholangitis Tx: Ursodeoxycholic acid

Question 329

Test for suspected Primary Sclerosing Cholangitis

Answer 329

MRCP; will show beading of the biliary duct

Question 330

AI hepatitis abs

Answer 330

Anit-smooth muscle antibodies Tx: Prednisone

Question 331

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

Answer 331

Clopidogrel or dipyridamole

Question 332

Cluster headache prophylaxis

Answer 332

Verapamil Prednisone

Question 333

CSF finding in MS

Answer 333

Oligoclonal banding

Question 334

Pt. w/ chorioamnionitis and is having contractions

Answer 334

Give oxytocin; still no need for C-sec

Question 335

Causes of prosthetic joint infxn

Answer 335

<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

Question 336

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

Answer 336

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

Question 337

MCCo Renal Vein Thrombosis

Answer 337

Membranous nephropathy Presents as severe abdominal pain, fever, and gross hematuria

Question 338

Management of a patient with psychosis on their Parkinson Meds

Answer 338

Start clozapine Do not abruptly stop their meds

Question 339

What drug is associated with the development of progressive multifocal Leukoencephalopathy

Answer 339

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

Question 340

CMT

Answer 340

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

Question 341

Radial nerve palsy

Answer 341

Presents as wrist drop Common causes are Saturday Night Palsy, crutches

Question 342

Glycopyrrolate

Answer 342

Anticholinergic drug that inhibits the muscarinic receptors only -Used to prevent ADRs of pyridostigmine, also for intubations to ️Decreased saliva

Question 343

CSF with 14-3-3 protein

Answer 343

Creutzfeldt-Jakob Disease

Question 344

RF of tamoxifen therapy

Answer 344

Endometrial carcinoma

Question 345

Tx of a breast abscess from untreated mastitis

Answer 345

Needle drainage and abx. IF no response, then do an Incision and drainage

Question 346

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

Answer 346

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

Question 347

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

Answer 347

Probably septic emboli from IE -Can also appear on imaging as abscesses, infarctions, or just infiltrates

Question 348

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

Answer 348

Likely secondary to the INH therapy

Question 349

HIV pt. w/ Papilledema but has a normal MRI

Answer 349

Suspect Cryptococcus neoformans; organism obstructs the outflow of CSF

Question 350

Difference b/w confounding and effect modification

Answer 350

Confounding: Both factors can cause disease possibly, but one thing certainly does Effect modification: One thing by itself does not cause disease

Question 351

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

Answer 351

Could be a perf. Get an X-ray

Question 352

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

Answer 352

"Tophi" Assoc. w/ gout

Question 353

Disease polyarteritis nodosa is assoc. w/

Answer 353

HBV

Question 354

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

Answer 354

Rheumatoid arthritis; RF often negative in pauciarticular variant

Question 355

Imaging for suspected urethral trauma

Answer 355

Retrograde urethrogram

Question 356

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

Answer 356

Probably a hamartoma

Question 357

MC bone malignancy in pediatric patients

Answer 357

Osteosarcoma

Question 358

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

Answer 358

Uric acid crystals; very common after birth -Called "brick dust"

Question 359

Goals of mechanical ventilation in ARDS

Answer 359

1. Low tidal volume =>> decreases likelihood of overdistending the alveoli 2. Keep SpO2 >88%

Question 360

Hemodynamic effects of hyperthyroidism

Answer 360

HTN Increased cardiac contractility and CO Decreased SVR Increased myocardial O2 demand

Question 361

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

Answer 361

Suspect HIV from mom

Question 362

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

Answer 362

Serum prolactin, TSH, and FSH

Question 363

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

Answer 363

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

Question 364

Granular, muddy brown cast

Answer 364

Sign of ATN; these are collections of dead tubular cells

Question 365

Best way to try to prevent contrast-induced nephropathy

Answer 365

Saline hydration

Question 366

Urinary findings in contrast-induced nephropathy

Answer 366

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

Question 367

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

Answer 367

Hyperuricemia secondary to Tumor Lysis Syndrome -Prevent w/ allopurinol, hydration, and rasburicase

Question 368

Diagnostic test for cholesterol emboli affecting the kidneys

Answer 368

Eosinophilia Decreased complement Eosinophiluria Bx. of purple skin lesion will show cholesterol crystals Elevated ESR

Question 369

Delivery for a patient w/ placenta previa

Answer 369

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

Question 370

Vaccine refusal from a mom

Answer 370

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

Question 371

Gestational HTN vs. Primary HTN during pregnancy

Answer 371

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

Question 372

HTN RFs during pregnancy

Answer 372

Maternal: Superimposed preeclampsia, pospartum hemorrhage, gestational diabetes, placental abruption, C-section Fetal: FGR, perinatal death, preterm delivery, oligohydramnios

Question 373

"Triple bubble" sign on a newborn

Answer 373

Likely jejunal atresia

Question 374

Bruton's Agammablobulinemia

Answer 374

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.

Question 375

ADRs of Selective Estrogen Receptor Modulators (SERMs) Tamoxifen and Raloxifene

Answer 375

Hot flashes DVT Endometrial carcinoma (w/ tamoxifen)

Question 376

Tx for chemotherapy-induced nausea Odan

Answer 376

Odansetron (Serotonin Receptor ANTAGONIST)

Question 377

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

Answer 377

Dermatitis herpetiformis

Question 378

Problems not associated w/ a normal grief reaction

Answer 378

Feelings of worthlessness, psychomotor retardation, and suicidal ideation

Question 379

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

Answer 379

Yes

Question 380

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

Answer 380

Atenolol or Metoprolol B1-selective

Question 381

Pt. w/ nasal polyps and needs an NSAID

Answer 381

DO NOT GIVE ASPIRIN

Question 382

Congenital disorders that EVERY state screens for

Answer 382

PKU Hypothyroidism

Question 383

Age at which you should start evaluating strabismus

Answer 383

3 months

Question 384

Delayed puberty

Answer 384

Boys: Lack of testicular enlargement by 14 years Girls: Lack of breast development or pubic hair by 12 years

Question 385

Work up for cephalohematoma

Answer 385

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

Question 386

ADPKD manifestations

Answer 386

1. Hepatic cysts 2. Berry aneurysm 3. MVP or Aortic regurg. 4. Diverticulosis 5. Abdominal/inguinal hernia

Question 387

Stroke in a young person

Answer 387

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

Question 388

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

Answer 388

Phosphate binders; otherwise you can worsen their hyperphosphatemia

Question 389

Symptoms present in TTP but NOT HUS

Answer 389

Fever Neurologic probs (AMS)

Question 390

MCCoD in ADPKD

Answer 390

Renal Failure

Question 391

Causes of euvolemic hyponatremia

Answer 391

Hyperglycemia (pseudohyponatremia) *For every 100mg/dL of glucose; there is a 1.6mEq/L drop in Na+ Psychogenic polydipsia Hypothyroidism SIADH

Question 392

Tx for chronic SIADH

Answer 392

Fluid restriction + Demclocycline

Question 393

PE findings associated w/ Aortic Stenosis

Answer 393

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

Question 394

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

Answer 394

Probably a GALLSTONE ILEUS -Pts. have colicky pain, dilated loops of bowel, and typically have a history of gallstones Dx: Abdominal CT Tx: Sx.

Question 395

CHARGE Syndrome

Answer 395

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

Question 396

Adenomyosis

Answer 396

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

Question 397

Approach to sinus bradycardia in adults

Answer 397

IF UNSTABLE -IV atropine THEN -IV dopamine, IV Epi, OR TRANSCUTANEOUS PACING

Question 398

Missed abortion

Answer 398

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

Question 399

Threatened abortion

Answer 399

Bleeding and a closed cervix but US reveals an intrauterine gestation

Question 400

Appearance of metastatic brain cancer

Answer 400

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

Question 401

Milk-alkali syndrome

Answer 401

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

Question 402

Possible causes of lead poisoning

Answer 402

Battery manufacturing Plumbing Home restoration Alcohol distilling

Question 403

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

Answer 403

Get them on Heparin -APLS actually increases likelihood of clots

Question 404

Cyclic Vomiting Syndrome

Answer 404

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

Question 405

How can stress fractures appear on imaging?

Answer 405

Sclerotic bone

Question 406

Reflex sympathetic dystrophy

Answer 406

Pt. Who develops hyperesthesia and autonomic dysregulation in an extremely after a relatively mild injury Dx and Tx: sympathetic nerve block (relief=diagnosis)

Question 407

Ultraviolet keratitis

Answer 407

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.

Question 408

"Trigger words" for ALL

Answer 408

Pancytopenia, history of radiation therapy, Down Syndrome

Question 409

Men IIB

Answer 409

Mucosal neuromas Medullary Thyroid Cancer Pheochromocytomas

Question 410

Environmental RFs for Liver Cancer

Answer 410

Alcohol Polyvinyl chloride (angiosarcomas) Aflatoxins

Question 411

Histological clue of serous cystadenocarcinoma

Answer 411

Psammoma bodies

Question 412

Meigs Syndrome

Answer 412

Ovarian fibroma + Ascites + Right sided hydrothorax

Question 413

Most common tumors in children

Answer 413

Cerebellar astrocytoma Medulloblastoma Ependymoma

Question 414

Bunch of grapes coming out of the vagina of a child

Answer 414

Sarcoma botryoides -Embyronal rhabdomyosarcoma

Question 415

MCCo Thyroid Cancer

Answer 415

Papillary thyroid cancer

Question 416

HHV-8

Answer 416

Kaposi's Sarcoma

Question 417

CT differences b/w Wilm's Tumor and Neuroblastoma

Answer 417

Wilms: Arise from kidney; NO CALCIUM Neuroblastoma: Arise from adrenals; CALCIUM

Question 418

CD1

Answer 418

Marker for histiocytosis; will also see tennis rackets on microscopy

Question 419

Management of diverticulitis complicated by abscess

Answer 419

CT guided percutaneous drainage

Question 420

Management of endometriosis that has failed conservative management

Answer 420

Laparoscopy

Question 421

Breastfeeding failure jaundice

Answer 421

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

Question 422

Breast milk jaundice

Answer 422

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

Question 423

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

Answer 423

Suspect retroperitoneal hematoma formation Next thing to do: Get non-contrast CT of abdomen Tx: Supportive

Question 424

Mainstay of tx. for Polycythemia Vera

Answer 424

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

Question 425

CIs to OCPs

Answer 425

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

Question 426

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

Answer 426

SERMs

Question 427

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

Answer 427

HBV-Ig And vaccinate

Question 428

CAGE questions

Answer 428

Cut down Angry Guilty Eye-opener

Question 429

Possible causes of porphyria Cutanea Tarda

Answer 429

⭐️HCV Alcoholism Estrogen use Hemochromatosis

Question 430

Cardiac Risk factors for sx.

Answer 430

EF <35% Recent MI in last 6 months Signs of CHF (optimize pts. w/ ACEIs, BBs, and spironolactone)

Question 431

Pulm Risk Assessment for Sx.

Answer 431

Lung disease? =>> PFTs Smoker but no disease =?? Stop smoking for 6 weeks

Question 432

SIRS criteria

Answer 432

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

Question 433

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

Answer 433

Basal skull fracture

Question 434

MC overall cause of pancreatitis

Answer 434

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

Question 435

Best initial test for acute mesenteric ischemia

Answer 435

X-ray *Will see air in the bowel wall

Question 436

Median Arcuate Ligament Syndrome

Answer 436

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

Question 437

Hamman Sign

Answer 437

Crunching sign on palpation of the thorax due to subcutaneous emphysema *Seen in Boerhaave syndrome

Question 438

Most common location for Boerhaave syndrome

Answer 438

Posterolateral aspect of the distal esophagus

Question 439

MC location for a Mallory-Weiss Tear

Answer 439

Gastroesophageal jnxn

Question 440

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

Answer 440

Cecal diverticulitis

Question 441

Tx of acue ascending cholangitis

Answer 441

IV abx. followed by ERCP to removed obstruction Followed by cholecystectomy

Question 442

When can a fetal heart first be heard on US?

Answer 442

10-12 weeks

Question 443

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

Answer 443

Zoster immune globulin

Question 444

Lab changes in pregnancy

Answer 444

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

Question 445

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

Answer 445

Manage w/ Vaginal progesterone -In future pregnancies, consider a cervical cerclage beforehand

Question 446

Factor V Leiden

Answer 446

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

Question 447

Complications of Primary Biliary Cholangitis

Answer 447

Malabsorption and fat-soluble vitamin deficiencies OSTEOPORSIS/OSTEOMALACIA Hepatocellular carcinoma

Question 448

Female on OCPs who has HTN

Answer 448

Suggest switching to a different form of BC

Question 449

Tx of Nocardia

Answer 449

Bactrim -Remember the sulfa eggs at the Nocardia shootout

Question 450

IDE lab findings

Answer 450

MCV: Decreased RDW: Increased

Question 451

Can pts. w/ bronchogenic carcinoma have pleural plaques?

Answer 451

Yes; so do not reflexively answer mesothelioma on asbestos exposure

Question 452

Injury to rule out w/ fracture of the clavicle

Answer 452

Subclavian artery or Brachial plexus injury

Question 453

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

Answer 453

Trigger finger Tx: Steroid injection

Question 454

Post-op complications

Answer 454

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)

Question 455

Most common EKG finding for PE

Answer 455

Non-specific ST changes

Question 456

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

Answer 456

Chronic mucocutaneous candidiasis (T-cell dysfnxn)

Question 457

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

Answer 457

Fibrotic stricture

Question 458

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

Answer 458

DM Type I

Question 459

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

Answer 459

Stasis dermatitis due to chronic venous stasis

Question 460

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

Answer 460

Paralytic ileus Tx: NG tube decomprassion

Question 461

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

Answer 461

Immediate needle decompression; get X-ray later

Question 462

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

Answer 462

Dont use a cath; use diapers IF you have to use a cath, change it daily

Question 463

Pt. who starts taking thiazides and develops EKG changes

Answer 463

Probably due to hypokalemia

Question 464

Most common location for an intracerebral hemorrhage

Answer 464

Basal ganglia

Question 465

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

Answer 465

Arnold-Chiari malfomation

Question 466

EMG showing fasciculations

Answer 466

LMN lesion

Question 467

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

Answer 467

Intrinsic muscle disease (muscular dystrophy, inflammatory mypopathy)

Question 468

Bilateral trigeminal neuralgia

Answer 468

Consider MS as a cause

Question 469

Lesions in what location cause hemiballisumus?

Answer 469

Subthalamic nucleus

Question 470

"Floppy baby" differential

Answer 470

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

Question 471

Why does NaHCO3 help in TCA OD?

Answer 471

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

Question 472

Differences b/w SBP and Bowel obstruction

Answer 472

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

Question 473

Dx of laryngomalacia in an infant

Answer 473

Clinical but can be confirmed w/ direct laryngoscopy Tx: Will usually resolve by 18 months but until then, keep upright after feeds

Question 474

Major ADRs of Amiodarone

Answer 474

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

Question 475

Histologic finding on Reye's Syndrome

Answer 475

Microvesicular fatty infiltration

Question 476

Liver failure histologic findings

Answer 476

Macrovesicular steatosis, vacuolated hepatocellular nuclie, sometimes mallory bodies

Question 477

Cerebral Palsy

Answer 477

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

Question 478

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

Answer 478

Osler-Weber-Rendu syndrome (AD) -Can also have severe hemoptysis

Question 479

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

Answer 479

LACTATED RINGERS

Question 480

Treatment of Pityriasis Versicolor

Answer 480

Selenium sulfide shampoo Topical ketoconazole

Question 481

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

Answer 481

First step is to get them away from that fucking smoke

Question 482

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

Answer 482

First thing should still be nasogastric decompression Deal w/ mass later

Question 483

D-xylose test

Answer 483

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

Question 484

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

Answer 484

Look for a shortened PR interval

Question 485

Cyanotic Breath Holding Spell

Answer 485

Baby who cries intensely which is followed by breath holding, cyanosis, and LOC -Normal; don't worry about it

Question 486

Pallid Breath Holding Episode

Answer 486

Baby who suffers minor trauma and has LOC FOLLOWED BY breath holding, pallor, and diaphoresis -Also benign tho

Question 487

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

Answer 487

Don't worry about treating it unless they become symptomatic

Question 488

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

Answer 488

Immaturity of the developing HPA producing inadequate quantities of GnRH

Question 489

McCune-Albright Syndrome

Answer 489

Precocious puberty + Cafe au lait spots + Bone defects (polyostotic fibrous dysplasia) -Sporadic condition

Question 490

Physiologic findings in ARDS

Answer 490

Decreased gas exchange Decreased lung compliance (loss of surfactant and increased elastic recoil) Increased pulmonary arterial pressure (Due to hypoxic vasoconstriction)

Question 491

Trisomy 18

Answer 491

Microcephaly Clenched fists VSD Rocker bottom feet MICROGNATHIA ID

Question 492

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

Answer 492

Order upper GI series

Question 493

Ligament of Treitz on right side of the abdomen

Answer 493

Midgut volvulus -Contrast will show corkscrew pattern

Question 494

Immunologic manifestations of infective endocarditis

Answer 494

(+) RF Immune complex-mediated glomerulonephritis Osler nodes (painful pads on the fingertips)

Question 495

Kidney problem HBV is associated w/

Answer 495

Membranous nephropathy

Question 496

Gifts you can accept from reps

Answer 496

Small gifts that will directly benefit pts.

Question 497

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

Answer 497

Oropharyngeal dysphagia Evaluate this w/ modified barium swallow

Question 498

Eczema herpeticum

Answer 498

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

Question 499

Black guy who randomly has grossly bloody urine which resolves entirely

Answer 499

Renal papillary necrosis

Question 500

What are acanthocytes and burr cells classically associated w/?

Answer 500

Uremia Abetalipoproteinemia

Question 501

Plummer-Vinson Triad

Answer 501

Esophageal web IDE Glossitis

Question 502

Management of sideroblastic anemia

Answer 502

Support + pyridoxine

Question 503

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

Answer 503

Probably due to citrate binding calcium and preventing clotting Could also be a dilutional thrombocytopenia

Question 504

Drugs to not give pts. w/ Renal Artery Stenosis

Answer 504

ACEI -Will ppt. ARF

Question 505

What type of hypersensitivity is cryoglobulinemia?

Answer 505

Type III

Question 506

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

Answer 506

Dapsone or Pentamadine

Question 507

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

Answer 507

Non-Hodgkin's Lymphoma

Question 508

Tx of meningitis in a neonate

Answer 508

Ampicillin + Gentamicin + Ceftriaxone if GNR suspected

Question 509

Tx for a pregnant woman w/ a confirmed Toxoplasma infxn

Answer 509

Spiramycin

Question 510

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

Answer 510

Schistosome haematobium

Question 511

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

Answer 511

Trichinella spiralis

Question 512

Food poisoning after eating raw seafood

Answer 512

Vibrio parahaemolyticus

Question 513

Neurologic manifestations of tertiary syphilis

Answer 513

Argyll-Robertson pupil Dementia Paresis Tabes dorsalis Charcot joints

Question 514

Emphysematous cholecystitis

Answer 514

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)

Question 515

Lithium TOXICITY

Answer 515

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+)

Question 516

Delayed sleep phase syndrome

Answer 516

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

Question 517

Should you ever use 1/2 NS?

Answer 517

NO; IDGAF IF THEIR NA IS 170

Question 518

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

Answer 518

High serum osmolality

Question 519

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

Answer 519

Exercise therapy; smoking cessation - Next step =>> Cilostazol - PENTOXYFILLINE IS NOT RIGHT

Question 520

Acid-base status of pts. w/ a PE

Answer 520

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

Question 521

Baby w/ medial deviation of the forefoot and is bilateral

Answer 521

Metatarsus adductus; resolves on its own -Feet will also be flexible in contrast to clubfeet

Question 522

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

Answer 522

Clubfoot; requires casting

Question 523

Tolosa-Hunt Syndrome

Answer 523

Granulomatous inflammation of the cavernous sinus w/ ophthalmoplegia -Look for eye pain and paralysis of III, IV, and VI Dx: MRI Tx: Steroids

Question 524

Septic Jugular Thrombophlebitis

Answer 524

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

Question 525

Management of anal fissures

Answer 525

High fiber diet; increased fluid intake Stool softeners Sitz batchs Topical anesthetics + vasodilators (nifedipine, nitroglycerin)

Question 526

Indications for parathyroidectomy w/ hyperparathyroidism

Answer 526

Age <50 Symptomatic hypercalcemia Complications (osteoporosis, nephrolithiasis, CKD)

Question 527

Management of gastric adenocarcinoma

Answer 527

CT abdomen/pelvis Limited stage =>> Resection Advanced stage =>> Chemo

Question 528

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

Answer 528

MM until proven otherwise

Question 529

Indications for admission for PID

Answer 529

Pregnancy Failed outpt. management Inability to tolerate oral meds Severe presentation (high fever, vomiting) Complications (tubo-ovarian abscess, perihepatitis)

Question 530

EKG finding for a ventricular aneurysm

Answer 530

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

Question 531

Paroxysmal Nocturnal Hemoglobinuria

Answer 531

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

Question 532

Differences b/w methanol and ethylene glycol poisoning

Answer 532

Methanol =>> Visual disturbances Ethylene glycol =>> Kidney failure

Question 533

Most commonly torn muscle in the rotator cuff

Answer 533

Supraspinatus -Make sure to check the empty beer can test

Question 534

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

Answer 534

Possible rupture of the biceps tendon -Needs surgery

Question 535

Neer Test

Answer 535

Physician internally rotates pts. arm and lifts it straight above their head Pain? =>> Subacromial impingement syndrome

Question 536

Hawkins-Kennedy Test

Answer 536

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

Question 537

Cross arm/adductor test

Answer 537

Arm is elevated to 90 degrees and then adducted across the pt. Pain? =>> AC joint separation/tear

Question 538

FABER test

Answer 538

Pts. leg is placed in indian style on one side Pain in the hip =>> Osteoarthritis

Question 539

Apley Compression Test

Answer 539

Patient lies prone and has the knee flexed to 90 degrees; physician gives axial compression down into the knee Pain? =>> Meniscal tear

Question 540

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

Answer 540

Plantar fasciitis

Question 541

Female athlete triad

Answer 541

Decreased bone density (possible stress fracture) Hypoglycemia Amenorrhea

Question 542

Jones Fracture

Answer 542

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

Question 543

Tarsal Tunnel Syndrome

Answer 543

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

Question 544

Halllux valgus

Answer 544

Deformity causing pain over the great toe at the metatarsophalangeal joint; pain w/ walking and blisters can occur "Bunion" Tx: Orthotics and surgery

Question 545

Pes anserine

Answer 545

Pain w/ palpation just inferior to the medial joint line of the knee where sartorius and semitendinosus inserts -Assoc. w/ overuse Tx: RICE

Question 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

Answer 546

Suspect bronchitis; can last for 4 weeks Treat symptomatically unless other signs develop

Question 547

Drugs capable of causing crystal-induced AKI

Answer 547

Acyclovir Sulfonamides MTX Ethylene glycol Protease inhibits (indinavir)

Question 548

Secondary Spontaneous Pneumothorax

Answer 548

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

Question 549

Cholangitis

Answer 549

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

Question 550

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

Answer 550

Get em in surgery

Question 551

Zones of the neck

Answer 551

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

Question 552

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

Answer 552

Suspect galactosemia

Question 553

3 criteria for PID

Answer 553

1. Abdominal pain 2. Adnexal tenderness 3. Cervical motion tenderness

Question 554

MC site for endometrioma

Answer 554

Ovaries

Question 555

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

Answer 555

Chlamydia

Question 556

Dysfnxnal Uterine Bleeding

Answer 556

Diagnosis of exclusion; most commonly due to anovulatory cycles

Question 557

Tx of hirsutism assoc. w/ PCOS

Answer 557

Spironolactone

Question 558

Main risk associated w/ medical induction of ovulation

Answer 558

Multiple gestation pregnancy

Question 559

When can you diagnose primary amenorrhea?

Answer 559

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

Question 560

RFs of IUD

Answer 560

Ectopic pregnancy PID Rare uterine rupture during placement

Question 561

Should you stop OCPs before surgery?

Answer 561

Yes; due to increased risk of DVT

Question 562

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

Answer 562

Wilm's Tumor

Question 563

WAGR Syndrome

Answer 563

Wilm's Tumor Aniridia Genitourinary malformations Retardation Defect on Cr. 11

Question 564

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

Answer 564

Prostaglandins Keeps the PDA open

Question 565

Hypoplastic Left Heart Syndrome

Answer 565

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

Question 566

Kernicterus presentation

Answer 566

Hypotonia Seizure Choreoathetosis Hearing loss

Question 567

Upper GI series in pyloric stenosis (4 signs)

Answer 567

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)

Question 568

VACTERL

Answer 568

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

Question 569

Tx of acute cocaine toxicity

Answer 569

IV Benzos and Supplemental O2

Question 570

Intrahepatic cholestasis of pregnancy

Answer 570

Presents as intense pruritis in a pregnant lady w/o much other findings Labs: Elevated bile acids Elevated LFTs *Diagnosis of exclusion

Question 571

Pinealoma

Answer 571

Presents w/: Parinaud's Syndrome (dumb fuckers cant look up) Obstructive hydrocephalus (headache, visual disturbances, vomiting)

Question 572

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

Answer 572

Transient synovitis should NOT last >4 weeks

Question 573

Drug to give a woman w/ urge incontinence

Answer 573

Oxybutinin: antimuscarinic that increases bladder capacity by decreasing detrusor activity

Question 574

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

Answer 574

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

Question 575

Prophylaxis for contacts of someone w/ whooping cough

Answer 575

Macrolides

Question 576

Psoas abscess

Answer 576

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

Question 577

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

Answer 577

First line: Maternal repositioning Then: Amnioinfusion Don't do a c-sec until there is loss of FHR variability

Question 578

Poor prognostic factors in heart failure

Answer 578

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

Question 579

Differentiating b/w Laryngomalacia and Vascular Ring in infants

Answer 579

Laryngomalacia: INSPIRATORY stridor that improves when prone Vascular ring: BIPHASIC stridor that improves w/ neck extension

Question 580

Endometrial biopsy indications in someone <45

Answer 580

Hx. of unopposed estrogen exposure (obesity, chronic anovulation) Failed medical management of AUB Lynch Syndrome

Question 581

X-linked hypophosphatemic Ricket's

Answer 581

Innate kidney defect causes inability to retain phosphate =>>Bone mineralization cannot take place -Pts. typically have normal Ca2+ levels

Question 582

Neonatal CMV

Answer 582

Periventricular calcifications w/ microencephaly Chorioretinitis Hearing loss Petechiae

Question 583

Neonatal Toxoplasmosis

Answer 583

Chorioretinitis Hydrocephalus Multiple ring-enhancing lesions seen on CT

Question 584

3 Stages of Whooping Cough

Answer 584

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

Question 585

Tx for diptheria

Answer 585

Antitoxin *ABx. DO NOT WORK

Question 586

Pompe's Disease

Answer 586

Lysosomal acid maltase deficiency CFs: Hypotonia HCM Tx: Enzym replacement

Question 587

Mcardle's Disease

Answer 587

Muscle phosphorylase deficiency CFs: Fatigue w/ exercise Tx: Sucrose prior to physical activity

Question 588

Gaucher's Disease

Answer 588

Deficiency of B-glucocerbrosidase (AR) CFs: Hepatosplenomegaly Aseptic necrosis of the femur Lytic lesions ***GAUCHER CELLS (crumbly macrophages)

Question 589

Female diaphragm

Answer 589

Contraceptive jelly is on it; needs to be in place for 6 hrs following sex ADRs: Needs to be fitted, requires advance prep, dislodgment

Question 590

Lichen sclerosis

Answer 590

White, thin skin extending from the female labia to the perianal area -Increased risk of cancer Tx: Topical steroids

Question 591

Hyperkeratosis of vulva

Answer 591

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

Question 592

Bartholin Gland Cyst

Answer 592

"Pussy pimple" Found on the lateral sides of the vulva; can be inflamed causing erythema, pain, tenderness, and dyspareunia Tx: Drainage

Question 593

Red lesion on the vulva w/ a superficial white coating

Answer 593

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

Question 594

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

Answer 594

Progestin therapy

Question 595

Renal Biopsy of Henoch-Schonlien

Answer 595

IgA deposition in the mesangium

Question 596

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

Answer 596

Cell-free fetal DNA testing Noninvasive test performed at >10 weeks and is good at detecting polyploidys

Question 597

Familial Hypocalciuric hypercalcemia

Answer 597

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

Question 598

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

Answer 598

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

Question 599

WAS gene

Answer 599

Regulates cytoskeletal components involved in cell signaling -Also dysfnxnal in immune cells which is why Wiskott-Aldrich kids get recurrent infxn

Question 600

Test to get on lactose intolerant pts.

Answer 600

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

Question 601

Pathology of Guillan-Barre Syndrome

Answer 601

Inflammatory demyelination of the peripheral motor neurons

Question 602

Hyper-IgM Syndrome Pathology

Answer 602

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

Question 603

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

Answer 603

Intubate the pt. to prevent aspiration THEN perform endoscopic procedures

Question 604

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

Answer 604

Probably still just an undetected hearing impairment

Question 605

Kid w/ leukemia but parents don't want chemo

Answer 605

Take that shit to court

Question 606

Causes of Minimal Change Disease in adults

Answer 606

NSAIDs Lymphoma (Hodgkin's or Non-Hodgkins)

Question 607

MCCo nephropathy w/ solid tumors

Answer 607

Membranous glomerulopathy

Question 608

Tx of catatonia

Answer 608

Benzos ECT is no response

Question 609

Lobes affected by aspiration pneumonia

Answer 609

RLL

Question 610

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

Answer 610

TB

Question 611

Sequelae of electrical burns

Answer 611

Rhabdomyolysis, acidosis, ARF - Get EKG to r/o any dangerous arrhythmias from electrolyte abnormalities - Hydrate w/ saline bolus to prevent ARF

Question 612

J wave

Answer 612

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

Question 613

Antidote for Lead OD

Answer 613

EDTA

Question 614

Tx of precocious puberty

Answer 614

GnRH agonist (Leuprolide) -This will avoid premature fusion of the growth plates

Question 615

Dumping syndrome

Answer 615

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

Question 616

Bird beak narrowing of esophagus on swallowing study

Answer 616

Achalasia

Question 617

Contrast to give if a GI perf is suspected

Answer 617

Gastrografin (water-soluble)

Question 618

Vomit with what could be feces in it

Answer 618

Suspect meconium ileus

Question 619

Naegle rule

Answer 619

LMP-3 months + 7 days

Question 620

First sign of pregnancy on physical exam

Answer 620

Goodall sign Softening of the cervix on pelvic exam

Question 621

What causes morning sickness during pregnancy

Answer 621

Increase in estrogen, progesterone, and BhCG

Question 622

Work up for solitary lung nodule

Answer 622

>8mm: If suspicious for malignancy, biopsy 5-7: Serial ct scans <4: Serial ct scans only if suspicious for malignancy

Question 623

Follow-up after drainage of a simple cyst

Answer 623

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

Question 624

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

Answer 624

Suspect Rubella -Pts. May also have polyarthralgia

Question 625

Patient with pain at Tendinous insertions and the iliac crests

Answer 625

Suspect ankylosing spondylitis

Question 626

Treatment for Rh sensitized mother and has an Rh positive baby

Answer 626

Serial amniocentesis If extremely elevated bilirubin is found, consider intrauterine transfusion

Question 627

Pruritic urticarial papules and plaques of pregnancy

Answer 627

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

Question 628

Congenital Zika

Answer 628

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

Question 629

Prenatal testing done on diabetics

Answer 629

EKG 24 hour baseline creatinine Hba1c Eye exam

Question 630

Third trimester care for a diabetic pregnant woman

Answer 630

32-35 weeks: Weekly NST and US 36: Twice weekly testing 37: L/S ratio 39: IOL

Question 631

Abdominal imagining on a pt. w/ obstructive pancreatic cancer

Answer 631

Dilation of the intra and extra hepatic biliary trees

Question 632

Tx of uric acid stones

Answer 632

1. Hydration 2. KCl (alkalizes the urine) 3. Low purine (protein) diet

Question 633

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

Answer 633

BUN/Cr RATIO THE RATIO THE RATIO

Question 634

Friedrich's Ataxia

Answer 634

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

Question 635

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

Answer 635

NO Even if they are pubertal, do something

Question 636

Pt. w/ signs of CHF following a viral infxn

Answer 636

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

Question 637

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

Answer 637

Suspect pituitary adenoma

Question 638

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

Answer 638

Oral amoxicillin

Question 639

When should you use ceftriaxone for Lyme Disease?

Answer 639

ONLY IF THERE ARE NEUROLOGIC OR CARDIAC MANIFESTATIONS -IDGAF ABOUT BONE MARROW APPARENTLY

Question 640

Sequelae of electrical burns

Answer 640

Rhabdomyolysis, acidosis, ARF - Get EKG to r/o any dangerous arrhythmias from electrolyte abnormalities - Hydrate w/ saline bolus to prevent ARF

Question 641

J wave

Answer 641

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

Question 642

Antidote for Lead OD

Answer 642

EDTA

Question 643

Tx of precocious puberty

Answer 643

GnRH agonist (Leuprolide) -This will avoid premature fusion of the growth plates

Question 644

Dumping syndrome

Answer 644

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

Question 645

Bird beak narrowing of esophagus on swallowing study

Answer 645

Achalasia

Question 646

Contrast to give if a GI perf is suspected

Answer 646

Gastrografin (water-soluble)

Question 647

Vomit with what could be feces in it

Answer 647

Suspect meconium ileus

Question 648

Naegle rule

Answer 648

LMP-3 months + 7 days

Question 649

First sign of pregnancy on physical exam

Answer 649

Goodall sign Softening of the cervix on pelvic exam

Question 650

What causes morning sickness during pregnancy

Answer 650

Increase in estrogen, progesterone, and BhCG

Question 651

Work up for solitary lung nodule

Answer 651

>8mm: If suspicious for malignancy, biopsy 5-7: Serial ct scans <4: Serial ct scans only if suspicious for malignancy

Question 652

Follow-up after drainage of a simple cyst

Answer 652

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

Question 653

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

Answer 653

Suspect Rubella -Pts. May also have polyarthralgia

Question 654

Patient with pain at Tendinous insertions and the iliac crests

Answer 654

Suspect ankylosing spondylitis

Question 655

Treatment for Rh sensitized mother and has an Rh positive baby

Answer 655

Serial amniocentesis If extremely elevated bilirubin is found, consider intrauterine transfusion

Question 656

Pruritic urticarial papules and plaques of pregnancy

Answer 656

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

Question 657

Congenital Zika

Answer 657

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

Question 658

Prenatal testing done on diabetics

Answer 658

EKG 24 hour baseline creatinine Hba1c Eye exam

Question 659

Third trimester care for a diabetic pregnant woman

Answer 659

32-35 weeks: Weekly NST and US 36: Twice weekly testing 37: L/S ratio 39: IOL

Question 660

Abdominal imagining on a pt. w/ obstructive pancreatic cancer

Answer 660

Dilation of the intra and extra hepatic biliary trees

Question 661

Tx of uric acid stones

Answer 661

1. Hydration 2. KCl (alkalizes the urine) 3. Low purine (protein) diet

Question 662

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

Answer 662

BUN/Cr RATIO THE RATIO THE RATIO

Question 663

Friedrich's Ataxia

Answer 663

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

Question 664

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

Answer 664

NO Even if they are pubertal, do something

Question 665

Pt. w/ signs of CHF following a viral infxn

Answer 665

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

Question 666

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

Answer 666

Suspect pituitary adenoma

Question 667

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

Answer 667

Oral amoxicillin

Question 668

When should you use ceftriaxone for Lyme Disease?

Answer 668

ONLY IF THERE ARE NEUROLOGIC OR CARDIAC MANIFESTATIONS -IDGAF ABOUT BONE MARROW APPARENTLY

Question 669

Pyschodynamic therapy indication

Answer 669

Builds insight into how unconscious conflicts and past relationships cause symptoms *Uses transference; breaks down maladaptive defenses ***TONY SOPRANO

Question 670

Removal of small foreign bodies in the vaginal cavity of children

Answer 670

Irrigation w/ warmed fluid

Question 671

Calculation of A-a gradient

Answer 671

FiO2x (Patm-PH20)-(PaCO2/RR) .21x(713)-(PaCO2/.8) Then PAO2-PaO2

Question 672

Tx of a positive PPD in an HIV pt.

Answer 672

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

Question 673

Management of suspected ADPKD

Answer 673

First, get abdominal US

Question 674

Initial Tx. of Hyperthyroidism

Answer 674

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

Question 675

Can a herniated disc produce bilateral lower extremity neurologic signs?

Answer 675

Yes

Question 676

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

Answer 676

Do decrease potential confounders

Question 677

Indications for heparin administration w/ chest pain

Answer 677

Unstable angina Cardiac thrombus Severe CHF

Question 678

Late diastolic blowing murmur

Answer 678

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

Question 679

Associated findings w/ mitral regurg.

Answer 679

Soft S1 LAE PH LVH

Question 680

Associated findings w/ aortic stenosis

Answer 680

Slow pulse upstroke S3/S4 ejection click LVH Cardiomegaly Syncope Angina HF

Question 681

Early diastolic decrescendo murmur at the apex

Answer 681

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

Question 682

Estimation of A1c to plasma glucose

Answer 682

A1c x 7 = Average blood glucose

Question 683

Management of an NPO diabetic scheduled for surgery

Answer 683

Give 1/3 the dose

Question 684

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

Answer 684

AP film -These can be done in bed

Question 685

X-ray finding for osteomyelitis

Answer 685

Elevation of the periosteum

Question 686

Tx of acute angle closure glaucoma

Answer 686

IV acetazolamide IV mannitol Pilocarpine Laser iridotomy

Question 687

Tx of retinal artery occlusion

Answer 687

100% O2 and ocular massage then Acetazolamide then Thrombolytics

Question 688

Central retinal vein occlusion tx

Answer 688

Ranibizumab (VEGF inhibitor) I dont know why but that's what the book said

Question 689

Heart sound that may arise during an acute MI

Answer 689

S4

Question 690

Erythema toxicum neonatorum

Answer 690

Asymptomatic, scattered erythematous macules, papules, and pustules throughout the body of a newborn; arises in the first 2 weeks of life Tx: None

Question 691

Main ADR of hydroxyurea

Answer 691

Myelosuppression

Question 692

Different lab values for IDE vs. thalassemia

Answer 692

IDE: Decreased RBCs, increased RDW Thalassemia: Both normal

Question 693

MC predisposing factor for orbital cellulits

Answer 693

Bacterial sinusitis

Question 694

Baby w/ an APGAR of <7

Answer 694

Start positive pressure ventilation and pulse ox monitoring

Question 695

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

Answer 695

Think Invasive CMV -May also see pancytopenia, mild hepatitis Tx: Ganciclovir

Question 696

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

Answer 696

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

Question 697

Tx for cyanide poisoning

Answer 697

Sodium thiosulfate -Seen in the setting of a fire or occupational exposure

Question 698

Crystals in the urine after ethylene glycol ingestion

Answer 698

Calcium oxalate crystals

Question 699

Work-up for suspected Turner Syndrome

Answer 699

Get a pelvic US ***Will show streak ovaries

Question 700

Serum calcium and phosphorus levels in Paget's

Answer 700

NORMAL -AP and urine hydroxyproline are increased tho

Question 701

Patient w/ late onset 21-a hydroxylase deficiency

Answer 701

Present ONLY w/ signs of HYPERANDROGENISM -Their electrolytes are fine

Question 702

Main ADR of hydroxychloroquine

Answer 702

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

Question 703

Neonatal polycythemia

Answer 703

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

Question 704

Causes of hyponatremia

Answer 704

Hypovolemic: Dehydration, diuretics, Addison's Euvolemic: SIADH, psychogenic polydipsia, oxytocin Hypervolemic: HF, nephrotic syndrome, cirrhosis, toxemia, RF

Question 705

Pregnant pt. who is about to deliver and has hyponatremia

Answer 705

Due to oxytocin

Question 706

Med to give after saline for hypercalcemia

Answer 706

Furosemide

Question 707

What part of the brain is damaged in Korsakoff syndrome?

Answer 707

The mamillary bodies

Question 708

Retrospective study

Answer 708

Case-control

Question 709

Study that is good for rare disease

Answer 709

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

Question 710

Chi-squared test

Answer 710

Used to compare percentages or proportions (nonnumeric data)

Question 711

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

Answer 711

Randomized, controlled clinical trials

Question 712

Kids who do not react to skin testing

Answer 712

Lack Type IV HSN reaction which is T-CELL MEDIATED -Therefore, pick a T-cell disease for this

Question 713

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

Answer 713

Yeah do it

Question 714

Pt. w/ kidney stone but his vitals are stable

Answer 714

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

Question 715

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

Answer 715

Bump up their meds; don't worry about an OD Even in +80 year old pts

Question 716

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

Answer 716

Could just be his URI causing myocarditis?

Question 717

Kid who is presenting w/ signs of cholinergic toxicty

Answer 717

ANSWER ATROPINE TO FIX IT

Question 718

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

Answer 718

Analgesic therapy

Question 719

Pt. w/ pancreatitis and is now acidotic

Answer 719

Probably ARDS

Question 720

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

Answer 720

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

Question 721

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

Answer 721

Anaphylactic transfusion rxn

Question 722

Vaccine to give someone w/ HIV

Answer 722

Pneumococcal vaccine; more important than Hep A

Question 723

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

Answer 723

"Physiologic discharge"

Question 724

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

Answer 724

HIV

Question 725

Esophageal peristalsis w/ achalasia

Answer 725

Decreased

Question 726

Pt. who is claustrophobic and wants to do an MRI

Answer 726

Give benzo first

Question 727

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

Answer 727

Brief psychotic disorder

Question 728

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

Answer 728

Zinc deficiency

Question 729

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

Answer 729

Start ACEI

Question 730

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

Answer 730

Hypovolemia

Question 731

Spinal dysraphism

Answer 731

"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

Question 732

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

Answer 732

Decreased renal blood flow

Question 733

Well's Criteria

Answer 733

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)

Question 734

Atropine in ophthalmology

Answer 734

Dilates the eye AVOID IN ACUTE ANGLE CLOSURE

Question 735

Copper IUD contraindication

Answer 735

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

Question 736

Isolated systolic hypertension

Answer 736

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

Question 737

Von-Gierke Disease

Answer 737

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

Question 738

Description of Charcot Joint on X-ray

Answer 738

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

Question 739

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

Answer 739

T8 ****Sensory nerves RISE TWO LEVELS

Question 740

Homogenous, cystic mass seen on an ovary

Answer 740

Most likely an endometrioma

Question 741

Pyoderma gangrenosum

Answer 741

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

Question 742

Ecthyma gangrenosum

Answer 742

Hemorrhagic pustules that involve into necrotic ulcers due to Pseudomonas aeruginosa -Pts. have evidence of profound neutropenia

Question 743

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

Answer 743

Pregnancy test Serum prolactin or TSH Consider MRI of pituitary if necessary

Question 744

Sympathetic ophthalmia

Answer 744

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

Question 745

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

Answer 745

Probably Pulmonary Stenosis Consider TOF

Question 746

NFT manifestations

Answer 746

Cafe-au-lait spots Clustered freckles Lisch nodules Neurofibromas (peripheral nerve sheath tumors) Optic gliomas

Question 747

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

Answer 747

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

Question 748

Splenic abscess

Answer 748

``` 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

Question 749

Tx of foodborne botulism

Answer 749

Equine antitoxin

Question 750

Thyroid Lymphoma

Answer 750

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

Question 751

ADRs to EPO therapy

Answer 751

Worsening of HTN Headache Flu-like syndrome Red cell aplasia (rare)

Question 752

Pt. who ingested a caustic substance but is hemodynamically stable

Answer 752

Perform upper endoscopy to assess damage

Question 753

What can cause false elevations of CA-125?

Answer 753

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

Question 754

Does PCP normally show up on sputum cytology

Answer 754

Nope

Question 755

Tx indicated for Hep C

Answer 755

IFN-a

Question 756

Inspiratory "rub" heard

Answer 756

Think some sort of pleural inflammation

Question 757

Low back pain exacerbated w/ extension of the spine

Answer 757

Could be spondylolisthesis

Question 758

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

Answer 758

Yeah

Question 759

Neurologic finding that warrants follow up

Answer 759

Brisk nystagmus when looking to one side

Question 760

Urinalysis findings after AGC damages those fuckers

Answer 760

Limited changes on dipstick (maybe 1+ blood and protein) MA shows granular casts w/ renal tubular cells

Question 761

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

Answer 761

Do not need to give any IG or repeat vax

Question 762

EMG findings of ALS

Answer 762

Fibrillation in multiple muscles of multiple extremities

Question 763

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

Answer 763

Urinary tract diverticulum

Question 764

Anastomotic leak

Answer 764

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

Question 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

Answer 765

TREAT LATENT TB STILL

Question 766

What does a z-score tell you?

Answer 766

How many SDs above or below the mean you are

Question 767

Standard Error of the mean

Answer 767

SD/Square root of the number of samples

Question 768

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

Answer 768

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

Question 769

Precision and Accuracy

Answer 769

Precision=Consistent Accurate=Valid (sensitive and specific)

Question 770

Berkson Bias

Answer 770

Using hospitalized pts. instead of selecting from a general population -Solved by random selection

Question 771

Treatment for Nephrogenic DI

Answer 771

Thiazides

Question 772

Treatment for B-thalassemia major

Answer 772

️Chronic transfusions May also need to give iron chelators

Question 773

Infectious causes of AIHA

Answer 773

Mycoplasma EBV Syphilis

Question 774

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

Answer 774

Give augmentin prophylaxis

Question 775

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

Answer 775

PCP

Question 776

Tx for an asymptomatic Bartholin Duct Cyst

Answer 776

Observation

Question 777

Pt. who has hypothermia and is severely bradycardic

Answer 777

Start w/ active rewarming STILL -Bradycardia is usually refractory to atropine admin.

Question 778

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

Answer 778

Yes

Question 779

Aplastic crisis in SCD

Answer 779

Pt. presents w/ decreased reticulocytes and signs of anemia -Usually secondary to parvovirus infxn

Question 780

MCCo pneumonia in children w/ CF

Answer 780

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

Question 781

Pseudocyesis

Answer 781

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

Question 782

Tx for arsenic poisoning

Answer 782

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

Question 783

Management of first degree heart block

Answer 783

Observation -All you see is a slightly prolonged PR interval

Question 784

Abominal US screening age

Answer 784

65-75

Question 785

Method by which BB decrease stress on the heart

Answer 785

Decrease myocardial contractility and HR

Question 786

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

Answer 786

Yes

Question 787

Tx of NMS

Answer 787

Stop antipsychotics; start dopamine agent or dantrolene

Question 788

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

Answer 788

Salt-wasting likely due to diuretic use or adrenal insufficiency -Normally, the urine would have less of these electrolytes

Question 789

What medication will worsen proptosis?

Answer 789

Radioactive iodine

Question 790

ADRs of PTU

Answer 790

Agranulocytosis Hepatic failure

Question 791

ARDs of methimazole

Answer 791

1st trimester teratogen Cholestasis

Question 792

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

Answer 792

Give prednisone w/ the radioactive iodine

Question 793

Tx of amniotic fluid embolism

Answer 793

Respiratory and hemodynamic support -May also need to treat DIC assoc. w/ amniotic fluid

Question 794

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

Answer 794

Probs a galactocele

Question 795

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

Answer 795

Probably incarcerated hernia

Question 796

Decreased afferent arteiorlar dilation

Answer 796

Only assoc. w/ NSAID use

Question 797

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

Answer 797

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

Question 798

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

Answer 798

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

Question 799

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

Answer 799

Biliary leak

Question 800

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

Answer 800

Report them to appropriate outlet

Question 801

Angelman Syndrome

Answer 801

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

Question 802

Rett Syndrome

Answer 802

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)

Question 803

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

Answer 803

Long term opioid

Question 804

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

Answer 804

Colchicine

Question 805

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

Answer 805

Ocular rosacea

Question 806

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

Answer 806

URGE INCONTINENCE Tx: Bladder training + Kegel exercise Oxybutynin

Question 807

Is advanced maternal age an RF for NTDs?

Answer 807

NO -Just put folate deficiency you dumb fuck

Question 808

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

Answer 808

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

Question 809

Uncal herniation

Answer 809

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

Question 810

Best way to prevent perioperative pneumonia in a COPD pt.

Answer 810

Preoperative PT

Question 811

Job Syndrome

Answer 811

Hyper IgE syndrome -Recurrent skin and lung infxns

Question 812

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

Answer 812

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

Question 813

Preterm pt. w/ positive Fetal Fibronectin

Answer 813

GET THEM THE MEDS THEY NEED

Question 814

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

Answer 814

Get spirometry for COPD eval.

Question 815

Coag times in APL syndrome

Answer 815

Prolonged aPTT Normal PT

Question 816

Classic manifestation of chronic hypocalcemia

Answer 816

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

Question 817

Retained placenta

Answer 817

RFs: Early gestational age, stillbirth, placenta accreta, History of... Comps: Postpartum hemorrhage (severe), endometritis Tx: Manual extraction; DandC

Question 818

Olecranon bursitis

Answer 818

Chronic pressure, friction, or overuse of the elbow CFs: Normal, pain-free range of motion but an enlarged elbow -Can get infected tho

Question 819

Arterial pseudoaneurysm

Answer 819

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

Question 820

Initial management of osteoporosis

Answer 820

NSAIDs + PT (includes strengthening of local muscle groups)

Question 821

Difference b/w a chalazion and hordeolum

Answer 821

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

Question 822

Will constitutionally small infants have any bad outcomes?

Answer 822

Typically no -You have to look for other signs of placental insufficiency to predict this

Question 823

Incisional hematoma

Answer 823

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)

Question 824

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

Answer 824

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

Question 825

Pt. presenting w/ progressive loss of peripheral vision

Answer 825

Open-angle glaucoma

Question 826

DRESS Syndrome

Answer 826

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

Question 827

Oglvie Syndrome

Answer 827

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"

Question 828

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

Answer 828

Could be a vaginal met from choriocarcinoma

Question 829

Dx study for aortic coarction

Answer 829

CXR ECHO=CONFIRMATION

Question 830

Vitals on transient synovitis

Answer 830

NORMAL; also typically no inflammatory findings -If these are present, SUSPECT SEPTIC ARTHRITIS

Question 831

Microscopic colitis

Answer 831

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

Question 832

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

Answer 832

Akathisia

Question 833

Myelodysplastic Syndrome

Answer 833

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)

Question 834

Drugs to NOT give AS pts.

Answer 834

Nitrates and BBs

Question 835

Why does testicular torsion occur?

Answer 835

Inadequate fixation of the lower pole of the testis to the tunica vaginalis =>> Compression of the pampiniform plexus and reduced venous outflow

Question 836

Kid who is being aggressive to newborn baby

Answer 836

Tell mom to spend some more time with the daughter

Question 837

Dx of leiomyoma

Answer 837

Sonohysterography (saline infusion U)

Question 838

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

Answer 838

Possible PE Can have cardiac failure to to RV dysfnxn

Question 839

Single pulmonary nodule OR cavitary lesion

Answer 839

Work-up for SCC

Question 840

Can postviral cerebellar ataxia show one-sided sx.?

Answer 840

Yes

Question 841

Indirect inguinal hernia

Answer 841

Presents in male infants Due to paten processus vaginalis Content protrudes thru DEEP INGUINAL RING and travels lateral to the inferior epigastric vessels

Question 842

Direct inguinal hernia

Answer 842

Occurs in old men Due to weakness of the transversalis fascia Content protrudes thru Hasselbach's triangle MEDIAL to the inferior epigastric vessels

Question 843

Pregnant pt. presenting w/ condyloma acuminata

Answer 843

Tx w/ topical treatment - Don't use imiquimod or podophyllin - Don't need colposcopy because it is a different strain of HPV

Question 844

Treatment of Autistic Disorder Aggression

Answer 844

Risperidone or Aripiprazole

Question 845

Disruptive Mood Dysregulation Disorder

Answer 845

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

Question 846

Sleep pattern changes w/ MDD

Answer 846

Increased REM sleep

Question 847

Tx of acute mania

Answer 847

Lithium or if there are severe symptoms or if they have kidney problems Atypical antipsychotic

Question 848

Tx of bipolar depression

Answer 848

Quetiapine

Question 849

Tx of atypical depression

Answer 849

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

Question 850

Tx of bereavement

Answer 850

Psychotherapy

Question 851

Tx for Serotonin Syndrome

Answer 851

Stop SSRI Tx fever, diarrhea, hypertension CYPROHEPTADINE if no response

Question 852

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

Answer 852

Pos: Dopamine Neg: Muscarinic

Question 853

PET scan findings on schizophrenia

Answer 853

Hypoactive frontal lobes and hyperactivity in the basal ganglia

Question 854

Meds to give non-compliant schizophrenic pts.

Answer 854

Long acting risperidone/ziprasadone/haloperidol/fluphenazine -If the q says long-acting, pick it

Question 855

Main ADR of ziprasidone

Answer 855

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

Question 856

Which atypical antipsychotic also acts as a partial dopamine agonist?

Answer 856

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

Question 857

Atypical antipsychotic to use in pregnant lady

Answer 857

Lurasidone

Question 858

Atypical antipsychotics LEAST LIKELY to cause weight gain

Answer 858

Aripiprazole and Ziprasidone

Question 859

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

Answer 859

Give FFP -Need to correct this coagulopathy before sx.

Question 860

Torticollis

Answer 860

Focal dystonia of the SCM specifically

Question 861

Benefits of breastfeeding

Answer 861

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

Question 862

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

Answer 862

Insulin and glucose

Question 863

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

Answer 863

Ureteral colic -An ileus that occurs due to obstruction from the ureters? Dx: CT scan

Question 864

NTT

Answer 864

1/ARR -When the ARR is a percentage, USE DECIMALS Ex. 35%=.35

Question 865

Only time you use octreotide

Answer 865

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

Question 866

Modification to levothyroxine therapy during pregnancy

Answer 866

Increase the therapy

Question 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?

Answer 867

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

Question 868

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

Answer 868

Clomipramine

Question 869

Specific benzos for alcohol withdrawal

Answer 869

Lorazepam Oxazepam -These are not hepatically metabolized

Question 870

Exam used to screen for personality disorders

Answer 870

Minnesota Multiphasic Personality Inventory

Question 871

MCCoD in anorexia

Answer 871

Arrhythmia

Question 872

Tx for Binge Eating Disorder

Answer 872

Topiramate + Psychotherapy

Question 873

NT that is decreased in insomnia

Answer 873

GABA

Question 874

Systemic-Onset Juvenile Idiopathic Arthrits

Answer 874

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

Question 875

Endophlamitis

Answer 875

Infxn of the eye; most likely the vitreous -Common after surgery

Question 876

MCCo LOBAR OR CORTICAL HEMORRHAGE

Answer 876

Cerebral amyloid angiopathy IF IT IS IN THE BG IT IS HYPERTENSIVE

Question 877

Behcet Disease Findings

Answer 877

Genital and oral ulcers (recurrent) Uveitis Erythema nodosum Thrombosis

Question 878

Torus Palatinus

Answer 878

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

Question 879

Can anemia of chronic disease occur w/ osteoarthritis?

Answer 879

No

Question 880

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

Answer 880

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

Question 881

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

Answer 881

Gastric lavage DO NOT USE IF: AMS or Caustic ingestion

Question 882

Is Ipecac ever right?

Answer 882

NO Only time you can use this is BEFORE COMING TO THE HOSPITAL

Question 883

Is charcoal dangerous?

Answer 883

No; it can help remove toxic substances and is not bad -If there isn't another obvious answer, this is a possible choice

Question 884

Tx of aspirin OD

Answer 884

Alkalinize the urine

Question 885

Drugs that can cause methemoglobinemia

Answer 885

Anesthetics Nitrites Dapsone

Question 886

How does atropine work?

Answer 886

Blocks the effects of Ach -This is why it is used in organophosphate or nerve gas poisoning

Question 887

Digoxin toxicity

Answer 887

Hyperkalemia GI probs Confusion Visual disturbance ``` Rhythm issues (AV block, bradycardia, arrhythmias) *DOWNWARD SLOPING ST SEGMENTS ```

Question 888

Lead toxicity is assoc. w/ what hematologic findings?

Answer 888

Basophilic stipling Increased free erythrocyte protoporphyrin

Question 889

Tx for mercury poisoning

Answer 889

Dimercaprol

Question 890

Bite by brown recluse spider

Answer 890

CFs: Skin necrosis, bullae, blebs Tx: Debridement, steroids, dapsone

Question 891

Stress ulcer prophylaxis indications

Answer 891

HEAD TRAUMA Burns Endotracheal intubation Coagulopathy w/ respiratory failure

Question 892

Fluid replacement in burns

Answer 892

4mL x %BSA x Weight in kg

Question 893

Asystole tx.

Answer 893

Epinephrine + CPR

Question 894

Best initial step in SVT

Answer 894

Vagal maneuvers (carotid massage, Valsalva, ice immersion) Then try adenosine

Question 895

Therapy for WPW

Answer 895

Procainamide (short term) Radiofrequency catheter ablation (long term)

Question 896

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

Answer 896

Echocardiogram

Question 897

Way to determine source of ventricular arrhythmias

Answer 897

EP studies

Question 898

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

Answer 898

Androgen insensitivity syndrome

Question 899

Test performed before starting estrogen replacement therapy

Answer 899

Endometrial biopsy or ultrasound

Question 900

Ovarian tumor w/ signs of hyperandrogenism

Answer 900

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

Question 901

Treatment for increased levels of homocysteine

Answer 901

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

Question 902

Follow-up on avulsed umbilical cord after delivery

Answer 902

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

Question 903

Expansion of CGG

Answer 903

Fragile X syndrome

Question 904

MC cardiac anomalies w/ Turner Syndrome

Answer 904

Bicuspid aortic valve (1) Aortic coarction (2) Aortic root dilation (3) w/ increased risk of aortic dissection

Question 905

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

Answer 905

Rapid restoration of coronary blood flow

Question 906

Complement levels in mixed cryoglobulinemia

Answer 906

Low C4

Question 907

Type I cryoglobulinemia

Answer 907

Due to hematologic malignancy -Pts. can have hyperviscosity (blurry vision), thrombosis (Raynaud's, Livedo reticularis), and purpura Complement levels are normal

Question 908

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

Answer 908

Loop diuretic therapy -Increased Na+ delivery to DCT causes increased H+ secretion

Question 909

Tx for ureteral spasms w/ kidney stones

Answer 909

Tamsulosin (a1-antagonist)

Question 910

CT showing peripancreatic fluid and possibly stranding

Answer 910

Sign of acute pancreatitis -PROBABLY WILL NOT ILLUMINATE SINCE IT ISNT BLOOD SO LOOK CLOSELY

Question 911

Pediatric viral myocarditis

Answer 911

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

Question 912

New onset of psychiatric abnormalities and unexplained abdominal pain

Answer 912

Consider Acute Intermittent Porphyria -Can also have sensory neuropathies

Question 913

Indications for Noninvasive Positive-Pressure Ventilation

Answer 913

COPD (severe exacerbation but pt. has a normal mental status and is stable on physical exam) Cardiogenic pulmonary edema Acute respiratory failure

Question 914

Benzodiazepine OD

Answer 914

Slurred speech Unsteady gait Drowsiness Normal pupil size Mild respiratory depression (unless used w/ alcohol)

Question 915

Glomerulopathy that is HIGHLY ASSOCIATED WITH HIV

Answer 915

Focal segmental glomerulosclerosis

Question 916

Possible outcomes of IUGR or being small for gestational age

Answer 916

Hypoxia Perinatal asphyxia Meconium aspiration Hypothermia Hypoglycemia Hypocalcemia Polycythemia (in response to hypoxia)

Question 917

PTHrP

Answer 917

Squamous cell Cancer of the lung

Question 918

ACTH or ADH producing tumor

Answer 918

Small cell Cancer of the lung

Question 919

Stroke of a vertebral artery

Answer 919

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

Question 920

"To and fro" murmur

Answer 920

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

Question 921

Pt. w/ decreased libido following bilateral salpingoopherectomy

Answer 921

Decreased androgens

Question 922

Dehydrated boy who is orthostatic and oliguric

Answer 922

Could see hyaline casts due to the DEHYDRATION

Question 923

BUN/Cr in analgesic nephropathy

Answer 923

Might only be 10:1 BUT the Cr should be really high -Can also be due to aspirin or acetaminophen apparently

Question 924

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

Answer 924

Suspect tricuspid atresia

Question 925

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

Answer 925

Ruptured AAA

Question 926

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

Answer 926

You can start conservatively w/ daily exercise program first

Question 927

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

Answer 927

IVIG

Question 928

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

Answer 928

Metastatic prostate carcinoma -Look for other lesions in other bones for MM?

Question 929

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

Answer 929

Echo

Question 930

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

Answer 930

Outflow obstruction from the bladder -Especially if it has been going on for months

Question 931

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

Answer 931

Antiemetics

Question 932

What should be routinely monitored on Lithium pts?

Answer 932

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

Question 933

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

Answer 933

Wean them off the ventilator as tolerated

Question 934

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

Answer 934

Get a pregnancy test if negative Reexamine in 2 weeks at start of cycle

Question 935

Med to give in bonafide hypertensive emergency

Answer 935

Nitroprusside

Question 936

"To and fro" murmur

Answer 936

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

Question 937

Pt. w/ decreased libido following bilateral salpingoopherectomy

Answer 937

Decreased androgens

Question 938

Dehydrated boy who is orthostatic and oliguric

Answer 938

Could see hyaline casts due to the DEHYDRATION

Question 939

BUN/Cr in analgesic nephropathy

Answer 939

Might only be 10:1 BUT the Cr should be really high -Can also be due to aspirin or acetaminophen apparently

Question 940

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

Answer 940

Suspect tricuspid atresia

Question 941

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

Answer 941

Ruptured AAA

Question 942

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

Answer 942

You can start conservatively w/ daily exercise program first

Question 943

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

Answer 943

IVIG

Question 944

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

Answer 944

Metastatic prostate carcinoma -Look for other lesions in other bones for MM?

Question 945

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

Answer 945

Echo

Question 946

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

Answer 946

Outflow obstruction from the bladder -Especially if it has been going on for months

Question 947

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

Answer 947

Antiemetics

Question 948

What should be routinely monitored on Lithium pts?

Answer 948

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

Question 949

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

Answer 949

Wean them off the ventilator as tolerated

Question 950

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

Answer 950

Get a pregnancy test if negative Reexamine in 2 weeks at start of cycle

Question 951

Med to give in bonafide hypertensive emergency

Answer 951

Nitroprusside

Question 952

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

Answer 952

ARDS

Question 953

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

Answer 953

Take em to surgery

Question 954

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

Answer 954

Decanoate

Question 955

Best way to prevent back pain

Answer 955

Lose weight

Question 956

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

Answer 956

Yessir

Question 957

Best way to prevent back pain

Answer 957

Lose weight

Question 958

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

Answer 958

Yessir

Question 959

Metyrapone test

Answer 959

Done for suspected Addison's This test should cause a rise in ACTH due to inhibition of 11B-hydroxylase

Question 960

Subclinical hypothyroidism

Answer 960

High TSH + normal T4 Treatment is still indicated

Question 961

Med to start for symptomatic hypercalcemia after you have started saline

Answer 961

Bisphosphonates Calcitonin is third

Question 962

Med to give when surgery for Hyperparathyroidism is not possible

Answer 962

Cinacalcet (️Inhibits PTH release)

Question 963

Elevated ACTH but no signs of pituitary or chest mass

Answer 963

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

Question 964

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

Answer 964

Pituitary

Question 965

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

Answer 965

Pituitary

Question 966

MIBG scanning

Answer 966

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

Question 967

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

Answer 967

Phenoxybenzamine; an alpha blocker

Question 968

When do you add Canagliflozin to a diabetics meds?

Answer 968

When 2 or 3 other oral hypoglycemic drugs have failed

Question 969

Is tinnitus a feature of presbycusis?

Answer 969

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

Question 970

Breastfeeding contraindications

Answer 970

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

Question 971

Complications of cryptorchidism after orchiopexy

Answer 971

Testicular cancer Subfertility

Question 972

Are abdominal defects associated w/ trisomies?

Answer 972

No

Question 973

Imagining modalities for a urinary stone

Answer 973

Abdominal US or NON-CONTRAST CT

Question 974

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

Answer 974

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

Question 975

Renal Cell Carcinoma

Answer 975

Flank pain, hematuria, palpable abdominal renal mass ****Left-sided scrotal varicocele Thrombocytosis + Erythrocytosis Fever Cachexia

Question 976

Initial treatment for Antipsychotic-associated Parkinsonism

Answer 976

Benztropine

Question 977

Multiple System Atrophy

Answer 977

1. Parkinsonism 2. Autonomic dysfnxn (postural hypotenxion, abnormal sweating/salivation/lacrimation, impotence, gastroparesis) 3. Widespread neurologic signs Tx: Fludrocortisone; salt supplementation; a-agonists

Question 978

Familial Dysautonomia

Answer 978

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

Question 979

Stool Osmotic Gap

Answer 979

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

Question 980

Can contact dermatitis present w/ vesicles?

Answer 980

Yes

Question 981

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

Answer 981

There will be subcutaneous emphysema

Question 982

Tx of inevitable abortion in a hemodynamically unstable pt.

Answer 982

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

Question 983

RA pts. have increased risk of what disease?

Answer 983

Osteoporosis/Osteopenia

Question 984

Broad waxy casts on urinalysis

Answer 984

Chronic renal disease

Question 985

Defect in Alport syndrome

Answer 985

Type IV collagen defect

Question 986

Causes of enlarged kidneys on US

Answer 986

Amyloid HIV nephropathy ADPKD

Question 987

TTP disease associations

Answer 987

HIV Cancer Cyclosporine Clopidogrel Ticlopidine

Question 988

2 causes of metabolic acidosis with a normal anion gap

Answer 988

RTA Diarrhea (has a negative urine anion gap)

Question 989

Tx for RTA Type II

Answer 989

Thiazide diuretics Volume depletion will indirectly cause increased HCO3 reabsorption

Question 990

Cystine stone management

Answer 990

Alkalinize the urine Surgery

Question 991

Antihypertensive to avoid in depressed people

Answer 991

BB If possible

Question 992

Test to be ordered on patient w/ precocious puberty

Answer 992

Brain MRI -R/o any dangerous cause for it -If it is confirmed to be idiopathic, then start GnRH therapy

Question 993

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

Answer 993

Repeat the testing on two separate occasions

Question 994

Pubic Symphysis Diastasis

Answer 994

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

Question 995

Reason pts. w/ pneumonia are hypoxic

Answer 995

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

Question 996

Type of anemia lead poisoning produces

Answer 996

Microcytic

Question 997

Gonoccocal pharyngitis

Answer 997

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

Question 998

PE findings for fibromuscular dysplasia

Answer 998

Abdominal and/or subauricular bruits -This disease classically affects the renal and internal carotid arteries

Question 999

Is weight gain associated w/ OCP use?

Answer 999

No.

Question 1000

Paget's disease of the breast suggest underlying what?

Answer 1000

Adenocarcinoma

Question 1001

Atopic dermatitis

Answer 1001

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

Question 1002

Obstetric complications of lupus in pregnanc

Answer 1002

Preterm birth C-sec Preeclampsia IUGR Fetal demise

Question 1003

Pulsus paradoxus

Answer 1003

Arterial pressure drop of >10 w/ inspiration -Associated w/ cardiac tamponade, asthma, COPD

Question 1004

What test should you order for Ankylosing Spondylitis?

Answer 1004

Xray of the sacroiliac joints -HLA-b27 is not specific

Question 1005

Pt who has acute pancreatitis but also elevated AP and bilirubin

Answer 1005

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

Question 1006

Pulsus parvus et tardus

Answer 1006

Assoc. w/ Aortic stenosis

Question 1007

"Mass in the groin"

Answer 1007

Either a femoral artery aneurysm of femoral hernia

Question 1008

Methotrexate ADRs

Answer 1008

Hepatotoxicity Stomatitis (may present as ulcers) Cytopenias

Question 1009

Ventricular arrhythmias w/ MI

Answer 1009

0-10 mins: Reentrant arrhythmia 10-60 mins: Abnormal automaticity

Question 1010

Only patients to give hypertonic saline

Answer 1010

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

Question 1011

Efferent arteriolar resistance w/ hypolemia

Answer 1011

Increased

Question 1012

Sclerodermic crisis

Answer 1012

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

Question 1013

Retrospective cohort study

Answer 1013

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

Question 1014

Hemophilic arthropathy

Answer 1014

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

Question 1015

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

Answer 1015

Atlantoaxial instability -May also see UMN signs (spasticity, hyperreflexia) Dx: Lateral radiographs Tx: Surgical fusion of C1 to C2

Question 1016

Pt. who has become paralyzed and is now hypercalcemia

Answer 1016

Hypercalcemia due to immobilization is a possibility

Question 1017

Heart defects associated w/ DiGeorge

Answer 1017

Transposition of the great arteries and Truncus Arteriosus

Question 1018

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

Answer 1018

Give activated charcoal -Any later than 4 hours tho is too late

Question 1019

"Flail mitral leaflet"

Answer 1019

Means "rupture of the chordae tendinae" NOT mitral regurg.

Question 1020

Treatment for stress incontinence

Answer 1020

Pelvic floor exercises Pessary Pelvic floor surgery

Question 1021

Most common original location for atrial flutter

Answer 1021

Tricuspid annulus -Where is it for a-fib?

Question 1022

How to calculate SAAG

Answer 1022

Serum albumin-ascitic albumin

Question 1023

Causes of warm AIHA

Answer 1023

CLL Lymphoma Lupus Phenytoin, sulfa drugs, rifampin

Question 1024

Tx for cold AIHA

Answer 1024

Keep pt warm, Plasmapharesis and Rituximab

Question 1025

Clots in an unusual place

Answer 1025

Think paroxysmal nocturnal hemoglobinuria Tx w/ steroids, Eculizumab, and bone marrow transplant if severe

Question 1026

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

Answer 1026

Cyclosporine Tacrolimus Alementuzumab -Inhibit T cells from attacking BM

Question 1027

Treatment of acute blast crisis in CML

Answer 1027

Leukopheresis

Question 1028

MCCo IUGR in the first trimester

Answer 1028

Chromosomal abnormality -Look for a mother who refused chromosomal analysis

Question 1029

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

Answer 1029

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

Question 1030

Which anithyroid med is assoc. w/ agranulocytosis?

Answer 1030

BOTH -Methimazole also has cholestasis and 1st trimester teratogenicity PTU also has hepatic failure and ANCA associated vasculitis

Question 1031

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

Answer 1031

BAL

Question 1032

PE findings w/ bicuspid valve

Answer 1032

Young pts: Aortic regurgitation Older pts: Aortic stenosis

Question 1033

How do vagal maneuvers slower the HR in SVT?

Answer 1033

Decreased AV node conductivity

Question 1034

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

Answer 1034

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

Question 1035

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

Answer 1035

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

Question 1036

Management for pt. w/ embolus from IE

Answer 1036

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

Question 1037

A treatment for refractory CLL

Answer 1037

Cyclophosphamide Usually,Fludarabine and Rituximab are used tho

Question 1038

ADRs of cisplatin

Answer 1038

Renal and Ototoxicity

Question 1039

How do you detect bence jones proteins

Answer 1039

Urine immune electrophoresis Not detected by dipstick

Question 1040

Single best test for MM

Answer 1040

BM biopsy

Question 1041

What is the problem w MGUS

Answer 1041

1% a year will transform into myeloma

Question 1042

Tx of Waldenstroms Macroglobulinemia

Answer 1042

Plasmapheresis Rituximab or prednisone

Question 1043

Irregular risocetin cofactor assay

Answer 1043

vWD

Question 1044

Platelet 4 antibodies

Answer 1044

Associated with HIT

Question 1045

Best initial test for confirming Antiphospholipid syndromes

Answer 1045

Mixing study -Coag times will not be corrected

Question 1046

Prophylaxis for tick bites

Answer 1046

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

Question 1047

MCCo dry cough

Answer 1047

Post nasal drip Asthma GERD

Question 1048

Beckwith-Wiedemann Syndrome

Answer 1048

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

Question 1049

Pt. who has a pressure of 150/45

Answer 1049

WIDENED PULSE PRESSURE - THIS IS INDICATIVE OF AORTIC REGURG. - Pt. may also complain of a bounding heart

Question 1050

RFs for shoulder dystocia

Answer 1050

Maternal obesity Excessive pregnancy weight gain Fetal macrosomia Gestational diabetes Post-term pregnancy

Question 1051

Sx typically absent from lacunar infarcts

Answer 1051

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

Question 1052

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

Answer 1052

Thelarche Adrenarche Growth spurt Menarche -Also, menarche doesn't need to happen until age 15

Question 1053

X-ray on kid with tuberous sclerosis

Answer 1053

Intra-cranial calcifications

Question 1054

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

Answer 1054

Let them go thru puberty THEN take out those 'nads

Question 1055

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

Answer 1055

Metformin -Remember, it can cause lactic acidosis

Question 1056

Specific type of CBT for OCD

Answer 1056

Exposure and response prevention

Question 1057

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

Answer 1057

Diverticulosis -Hemorrhoids do not bleed enough to cause hypotension

Question 1058

Long-term management of common variable immunodeficiency

Answer 1058

IVIG

Question 1059

Acute treatment of AF in WPW pts.

Answer 1059

PROCAINAMIDE -Obviously, DC conversion if unstable

Question 1060

Riboflavin deficiency

Answer 1060

Cheliosis Glossitis Seborrheic dermatitis Pharyngitis

Question 1061

Niacin deficiency

Answer 1061

Stomatitis Diarrhea Dermatitis Dementia

Question 1062

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

Answer 1062

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

Question 1063

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

Answer 1063

Thyroid storm -Adrenal crisis will have hypotension

Question 1064

Anti-mitochondrial antibodies

Answer 1064

Primary biliary cholangitis

Question 1065

Patient who had a surgery and is now acidotic

Answer 1065

Post-ictal acidosis due to brief skeletal muscle hypoxia -Reexamine levels in 2 hrs to check for improvement

Question 1066

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

Answer 1066

Trachoma -Could also be nasopharyngeal infxn Tx: Azithromycin

Question 1067

Galactosemia

Answer 1067

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

Question 1068

Carboxyhemoglobinemia

Answer 1068

CO-bound hemoglobin

Question 1069

Murmurs of VSD

Answer 1069

Holosystolic murmur on left lower sternal border Diastolic rumble at the apex

Question 1070

Primary murmur of TOF

Answer 1070

Harsh, systolic ejection murmur at the upper left sternal border

Question 1071

CYP inhibitors

Answer 1071

Acetaminophen, NSAIDs Metronidazole Amiodarone Cimetidine Gingko biloba, Cranberry juice Omeprazole SSRIs

Question 1072

CYP inducers

Answer 1072

Carbamazepine, phenytoin Ginseng, St. John's Wort OCPs Rifampin

Question 1073

Felty Syndrome

Answer 1073

RA -Includes erosive joint disease, rheumatoid nodules, and vasculitis (necrotizing skin lesions) Neutropenia Splenomegaly Dx: Anti-CCP and RF (+) Elevated ESR

Question 1074

CT of Takayasu Arteritis

Answer 1074

Thickening and luminal narrowing of large artery walls - This commonly presents in Asian woman under 20 - Tx w/ steroids

Question 1075

Tx of radial head subluxation

Answer 1075

Supination of the forearm and Flexion of the elbow OR hyper pronation of the forearm

Question 1076

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

Answer 1076

Manage like it is a heart attack first

Question 1077

MC complications of mumps

Answer 1077

Aseptic meningitis Orchitis

Question 1078

Management for healthcare worker stuck with HIV needle

Answer 1078

HIV serology now and immediately start 3-drug antiretroviral therapy

Question 1079

When is the RR basically equal to the OR?

Answer 1079

When incidence of a disease is low

Question 1080

Test to order on PCOS pts

Answer 1080

OGTT -Remember, Hyperandrogenism can present as loss of hair

Question 1081

Pt with cervical spine trauma and needs intubation

Answer 1081

Place tube with flexible bronchoscopy to reduce risk of further injury

Question 1082

Shock associated with pericardial TAMPONADE

Answer 1082

CARDIOGENIC shock

Question 1083

Findings on Gastrografin swallow with Mallory-Weis tear

Answer 1083

Normal

Question 1084

Feared complication of Boerhaave syndrome

Answer 1084

Acute mediastinitis

Question 1085

HIDA scan in cholecystitis

Answer 1085

Shows delayed emptying of the gallbladder

Question 1086

Management of acute Cholangitis

Answer 1086

IV antibiotics + MRCP -Look for hypotension and AMS to differentiate from cholecystitis

Question 1087

Make with contracted palmar fascia that cannot be extended

Answer 1087

Dupuytren contracture -Must be treated with surgery

Question 1088

Definitive therapy for ACL tear

Answer 1088

Arthroscopic surgery followed by rehab

Question 1089

Osteoporosis RFs

Answer 1089

``` No modifiable: Advanced age Post menopausal Low body weight White ethnicity Malabsorption disorder Hypercortisolism, Hyperparathyroidism Inflammatory disorders Chronic liver or renal disease ``` ``` Modifiable: Smoking Excessive alcohol intake Sedentary lifestyle Glucocorticoids Vitamin d or calcium deficiecny Estrogen deficiency ⭐️ Previous evidence of low-trauma fracture ```

Question 1090

Can you have bloating with H. Pylori infxn?

Answer 1090

Yes;

Question 1091

Anemia of prematurity

Answer 1091

Impaired EPO production with ️Decreased RBC lifespan - Usually asymptomatic but may have normal anemic symptoms 2-3 months following delivery - Labs show ️Decreased EPO and a Normocytic, normochromic anemia Tx: Minimize blood draws, iron supplementation, transfusion

Question 1092

Glycopyrrolate

Answer 1092

Long acting muscarinic antagonist usually used to decrease respiratory secretions with intubation -Works the same as Tiotropium or Ipratropium

Question 1093

Chest x ray showing tram tracks of bronchi

Answer 1093

Bronchiectasis

Question 1094

Treatment for ABPA

Answer 1094

ORAL steroids

Question 1095

Med given to break down mucous in CF patients

Answer 1095

Recombinant human deoxyribonuclease Breaks down nuclear DNA extruded from PMNs

Question 1096

Pneumonia bug associated with hoarseness

Answer 1096

Chlamydophila pneumoniae

Question 1097

Sputum growing an organism on charcoal yeast extract

Answer 1097

Legionella

Question 1098

What medication can you not use for any lung infxn?

Answer 1098

Daptomycin

Question 1099

Pts who have had ️CHRONIC low back pain for months should be offered what treatment

Answer 1099

Exercise therapy

Question 1100

Treatment of flash pulmonary edema secondary to MI

Answer 1100

Get them on Lasix as well as your usual meds for MI

Question 1101

Pt. Who you have ruled out all other causes for RLQ pain

Answer 1101

Get them to surgery

Question 1102

Antibiotic treatment for an asymptomatic patient with rheumatic fever

Answer 1102

Penicillin prophylaxis every 4 weeks (IM) W/o carditis: 5 years or until 21 (longer) W/ carditis but no valvular disease: 10 years or until 21 Carditis and valvular disease: 10 years or until 40

Question 1103

VSD on a newborn infant; what should you order?

Answer 1103

Echo; need to determine size of defect to decide if surgery is necessary

Question 1104

Path behind urge incontinence

Answer 1104

Detrusor hyperactivity -Is why a-blockers help

Question 1105

Colonoscopies for Lynch syndrome

Answer 1105

Every 1-2 years starting at age 20

Question 1106

Colonoscopies for IBD

Answer 1106

Colonoscopies every 1-2 years starting 8 years after diagnosis

Question 1107

TB drug to not use in pregnancy

Answer 1107

Pyrazinimide Also causes HYPERURICEMIA

Question 1108

Management of acute TB

Answer 1108

RIPE for 2 months RI for the next 4

Question 1109

Ramsay-Hunt syndrome

Answer 1109

Vesicles on the ear that are caused by a heroes infxn of CN VIII

Question 1110

Vesicles seen on the tympanic membranes

Answer 1110

Infectious myringitis Caused by mycoplasma Tx with erythromycin

Question 1111

Drugs that cause lupus like syndrome

Answer 1111

Isonaizid Hydralazine Procainamide

Question 1112

Patient with a plaque like, itchy skin rash and blood smear with Cerebriform nuclei

Answer 1112

Sezary syndrome/ Mycosis fungiodes

Question 1113

Krukenberg tumor

Answer 1113

Gastric cancer that metastasizes to the ovaries

Question 1114

CA 19-9 marker

Answer 1114

Assoc. With pancreatic cancer

Question 1115

Cyclosporine MOA

Answer 1115

️Inhibits IL-2 production

Question 1116

Tacrolimus MOA

Answer 1116

️Inhibits signaling thru the t-cell receptor

Question 1117

Azathioprine MOA

Answer 1117

️Inhibits DNA/RNA synthesis for b and T cells

Question 1118

Severe features of preeclampsia

Answer 1118

Bp >160/110 Thrombocytopenia Increased creatinine Increased LFTs Pulmonary edema Visual/CNS symptoms

Question 1119

Are all fibroids associated with pregnancy loss?

Answer 1119

No; subserosal fibroids are not

Question 1120

Management of biliary atresia

Answer 1120

Ultrasound Chol angiogram Tx: Kasai procedure; will eventually need liver transplant as well

Question 1121

APGAR interpretations

Answer 1121

1 minute: Conditions during labor and delivery 5 minute: Response to resuscitative efforts

Question 1122

Treatment for galactosemia

Answer 1122

Lactose-free diet

Question 1123

Transient tachypnea of the newborn

Answer 1123

Excess perinatal fluid on the baby's lungs is usually pressed out during vaginal delivery but with a c-section babies are at a higher risk of developing this condition

Question 1124

When should you operate on an umbilical hernia in a baby?

Answer 1124

If it isn't gone by age 4 or during incarceration

Question 1125

What should you do if you find a varicocele?

Answer 1125

US the other testicle, it is typically a bilateral disease

Question 1126

Two rapid pulses followed by a brief pause

Answer 1126

Pulsus bigeminus -Indicative of HOCM

Question 1127

Snowman sign on ️CXR

Answer 1127

TAPVR -Surgery needed

Question 1128

MC type of ASD

Answer 1128

Ostium secondum defect

Question 1129

Tx of prolonged QT syndromes

Answer 1129

BBs

Question 1130

HIV test to order

Answer 1130

Detects p24 antigen and HIV antibodies

Question 1131

Pt. With Uric acid in their urine

Answer 1131

These pts need a ct of their abdomen This is indicative of ureteral colic

Question 1132

TRICOPHYTON rubrum

Answer 1132

Causes ringworm, tinea pedis, and tinea manum

Question 1133

TRICOPHYTON rubrum

Answer 1133

Causes ringworm, tinea pedis, and tinea magnum

Question 1134

Virus that causes epidemics of explosive diarrhea that is short lived

Answer 1134

Norwalk

Question 1135

Treatment for a newborn with small left colon syndrome

Answer 1135

Small, frequent feeding

Question 1136

Management of legg-calve-Perthes

Answer 1136

Rest and NSAIDS Only surgery if severe necrosis is seen and if one hip Necroses, then the other eventually will too

Question 1137

Calcium replacement in vitamin d dependent Rickett's

Answer 1137

Ergocalciferol (1-25 OH2)

Question 1138

Vitamin b9

Answer 1138

Folate

Question 1139

Management for Cori's disease

Answer 1139

High protein diet Liver transplant if needed

Question 1140

Baby with liver failure by age 2

Answer 1140

Could be glycogen branching ️Enzyme deficiency Needs liver transplant

Question 1141

Deficient ️Enzyme in gay Sachs

Answer 1141

Hexosaminadase A Accumulation of gangliosides

Question 1142

Other finding in nieman-picks disease

Answer 1142

Foam in macrophages of bone marrow