Smartbook Flashcards
(390 cards)
1
Q
Dural based, extra-axial, well circumscribed mass in the brain that is partially calcified
A
Meningioma (resect it)
2
Q
Stress–> syncope. Cause? Tx?
A
Vasovagal syncope
Try counterpressure techniques (leg cross with tensing, hand/arm grip with tensing)
3
Q
Sudden onset of pain, redness and possible purulent discharge of medial epicanthus. Cause and Tx?
A
Dacrocystitis (infection of lacrimal sac)
Cause MC staph, strep–> Abx
4
Q
What marker(s) are needed to dx HepB?
A
HBsAg and IgM anti-HBc. Don’t use viral DNA
5
Q
SGA infants are at risk for what major problem and what is associated with it?
A
HYPOXIA–> polycythemia
also hypoglycemia, hypothermia, hypocalcemia
6
Q
1st step of tx for severe hypovolemic hypernatremia?
A
Normal saline (avoid cerebral edema)
7
Q
Anterior mediastinum masses? Where are bronchogenic cysts? What about gut, neural stuff?
A
Ant: T’s: Thymoma, Thyroid tumor, Teratoma, Terrible lymphoma. Bronchogenic/tracheal in middle mediastinum. Gut/neural is posterior
8
Q
HIV pt with painful keratitis and retinal necrosis?
A
HSV, VZV
CMV–> painless, no keratitis, hemorrhages and “fluffy” lesions on fundoscopy
9
Q
1st step in hepatic encephalopathy tx?
A
Correct electrolytes, replace fluid, underlying cause
10
Q
Cephalohematoma vs. Caput Succedaneum
A
Cephalohematoma: subperiosteal hemorrhage, 1 bone only, swelling w/out bruising
Caput S: Diffuse, ecchymotic scalp swelling
11
Q
Difference in stress fracture vs shin splint tenderness?
A
Point-tenderness vs. diffuse
(stress fracture= female athlete triad)
(shin splint= more likely overweight/underused)
12
Q
Asymmetric chest expansion, down left sided breath sounds, normal BP, no JVD in an intubated pt.
A
Right mainstem bronchus intubation (hypotension would be present with others)
13
Q
Garlic breath? Other Sxs? Tx?
A
Arsenic poisoning
Acute: vomiting, diarrhea, QTc prolongation
Chronic: Pigmentation change, hyperkeratosis, stocking-glove neuropathy
Tx: Dimercaprol, DMSA
14
Q
Proteinuria cause with long standing DM?
A
Diabetes… Don’t skip over this or overthink
15
Q
Hydroxyurea main SE(s)?
A
Myelosuppression (also feels like have the flu)
16
Q
3 RF associated with aortic aneurysm rupture (and expansion)?
A
1) Cigarette smoking
2) Size > 5.5 cm
3) >1 cm growth per year
17
Q
MCD association that is not kid?
A
Lymphoma
18
Q
What antiarrhythmics can be used with WPW syndrome?
A
Rhythm control only! Procainamide, ibutilide
19
Q
Best tx for diabetic neuropathic pain?
A
Gabapentin. TCA works, but lots of SE and not ok to use in old people
20
Q
Scattered macules, papules, pustules on baby body that is asx
A
Erythema toxicum neonatorum
21
Q
Most common and serious SE of TPN?
A
Bloodstream infxn (acute) Note: if keep using for >2 wks, cholestasis comes into play.
22
Q
Skin lesions associated with some infxn (?) that develop into non-tender nodules with central necrosis?
A
Ecthyma gangrenosum, pseudomonas
23
Q
Viral infxn–> loss of pulse with inspiration?
A
Cardiac tampanode from acute pericarditis
24
Q
Pleural effusion with very high protein (>4g), >70% lymphocytes, dec. glucose? What else could help?
A
TB, ADA
25
Relation of NG tube feeds to aspiration? Best way to prevent aspiration?
Increases it as does any gastric feed. Raise head of bed to prevent.
26
Ascites, fever, AMS. Mechanism?
SBP. Bacterial translocation across intestinal wall.
27
Ca > 12.
Malignancy
28
What does secondary hyperPTH look like?
High phosphate, low calcium, with CKD. Causes increased PTH which can cause bone resorption and pain
29
Name 3 main causes of hepatic encephalopathy in an already cirrhotic pt. Expand on 3rd.
1) Infection
2) Electrolyte abnormalities
3) Increased nitrogen: GI BLEED, increased dietary protein
30
Metabolic acidosis + GI hemorrage (diarrhea and hematemesis)
Iron poisoning.
| Also hepatotoxic and can cause bowel obstruction
31
Twisting injury of knee.
Meniscus
32
Tx of CLL?
Rituximab possible (anti-CD20)
33
On PE, how might you differentiate between hyponatremia caused by extrarenal fluid losses and SIADH?
Extrarenal: hypovolemic
SIADH: euvolemic
34
MC cause of sepsis in sickle cell? Osteomyelitis?
S. pneumo for sepsis.
| Osteo: S. aureus> salmonella
35
How does valvular stenosis appear on doppler?
Increased flow velocity across valve
36
Describe fragile X syndrome behavioral characteristics?
Austim-like
37
Eosinophils--> think what?
| Post catheterization?
Parasites, cholesterol emboli
38
When do we need to suspect listeria for meningitis?
Babys and old/immunocompromised
39
Wt. loss and iron deficiency anemia with chronic diarrhea?
Malabsorption likely
40
Fever + FND
Abscess (look for IVDA)
41
Three stages of HyperK EKG?
1) Peaked T waves
2) loss of P waves
3) Widened QRS (looks like sine-wave next to peaked T waves)
42
Neutropenia and fever, check for what?
Infxn.. Obvious, but could be deadly.
43
When is it ok to stop with V/Q scan in pregnant possible PE pts?
Only if it completely rules it out. ANything slightly, even a tad bit abnormal--> get CT
44
HIV drug with insomnia, weird dreams, depression, anxiety?
Efavirenz (NNRTI)
45
Leukocytoclastic vasculitis?
HSP
46
Widened mediastinum on CXR. What next? Stable vs. unstable.
Stable: CT scan or angio
Unstable: Thoracotomy now
47
What is MOA of ergot derivatives? Headache med to not give it with?
Serotonin somehow, don't give with triptans due to serotonin syndrome!
48
Loss of red reflex on eye exam?
Cataracts
49
Sterile pyuria and dysuria?
Chlamydia
50
Prolonged QT leads to what arrhythmia?
Torsades (Mg)
51
1) Injury to fear with supracondylar humerus fracture?
2) Surgical neck of humerus?
3) Midshaft?
1) Brachial artery (median nerve)
2) Axillary nerve (post. circumflex artery)
3) Radial nerve (deep brachial artery)
52
Pre-eclampsia before 20 wks.
Molar pregnancy
53
Epitrochlear nodes, gray mucous patches
Syphilis
54
What do you do with a positive capillary lead level?
Confirm with venous level. Capillary is only good for screening.
Tx: severe (>70) Dimercaprol + EDTA
Moderate (45-69): DMSA
55
Stent placement, recurrent MI days later. What happened?
Non-adherence to antiplatelet agents
56
Systemic disease + rapidly progressive ulcer?
Pyoderma gangrenosum
57
Toxo vs. CMV congenital infection brain calcification patterns?
Toxo: Diffuse
CMV: periventricular
58
Transplant patient on immunosuppressants with multi organ system problems including PNA?
Suspect CMV
59
Histo or Blasto can cause disseminated infection in immunocompetent?
Blasto (e.g. cutaneous nodules/plaques)
60
SE or cyclosporine vs. tacrolimus
Tacro: nephrotoxic, hyperK, HTN, tremor
Cyclosporine: same + HIRSUTISM + GUM HYPERTROPHY
61
Skin involvement location in CREST.
Only distal extremities. Trunk involvement is now scleroderma (interstitial lung disease before PAH unlike CREST)
62
Precocious puberty with advanced bone age and increased LH? Workup and Tx?
Central/Gonadotropin Dependent--> get MRI--> Tx with GnRH agonist continuous to preserve growth
63
Part of cerebellum that medulloblastoma effects?
Vermis (central)
64
Treatment of acute CHF
LMNOP (lasix, morphine, nitrates, oxygen, position)
| No B-blockers acutely
65
RA increases risk for what other bone problem? What is osteitis deformans?
Osteoporosis
| OD= Pagets
66
Anti-HBc and Anti-HBs signifies what?
Resolved infection (HBsAg stays positive in chronic infection state)
67
IBD + ank. spond?
```
Actually sacroileitis (just looks like ank spond)
Also: uveitis/episcleritis, pyoderma gangrenosum, other arthritis
```
68
What meds can cause SIADH? What common phenomena?
Meds: Carbamazepine, SSRIs, NSAIDs
| Pain/Nausea can cause it too
69
Bradycardia, hypotension, wheezing, hypoglycemia, delirium, seizures, cardiogenic shock. Tx?
Beta blocker OD.
1st: Atropine and IVF
Glucagon if profound/refractory hypotension
70
Hypokalemia EKG. Major med cause?
U waves, flattened T waves, PVCs
| Diuretics
71
Wiskott Aldrich Gene? What does it do?
WASP, cytoskeleton remodeling
72
1st step with confirmed hypercalcemia?
PTH level
73
What is sympathetic ophthalmoplegia?
One eye gets penetrating injury, "hidden" antigens are uncovered causing the second eye to be attacked by immune system
74
Dense deposit disease. What is it and what causes it?
MPGN type 2. C3 convertase with IgG against it casues persistent complement activation
75
What do you do for suspected acute spinal cord compression?
Emergency surgical consult and neuroimaging (spinal)
76
Rapidly enlarging thyroid mass with surrounding structure compression in a pt. with Hashimoto?
```
Thyroid lymphoma (primary)
Could also resemble anaplastic thyroid carcinoma
```
77
Abdominal trauma with negative fast scan and positive rebound tenderness. What next?
Ex-lap. Rebound tenderness is ominous sign
78
What happens if you give folate to B-12 deficient patient?
Megaloblastosis and anemia correct. Neuro sx worsen
79
What is required for milk-alkali syndrome?
Alkalosis... Hypercalcemia, renal insufficiency
80
Small fiber vs. large fiber DM.
```
Small= positive sx (pain, paresthesia, allodynia)
Large= negative sx (numbness, dec. reflexes, proprioception, vibration)
```
81
How do you diagnose PCP pneumonia?
Sputum, BAL stains. Do not culture.
| Note: LDH elevated with PCP pna
82
Unilateral varicocele that doesn't disappear when lay back? What else might you see?
Mass lesion.
| Renal cell carcinoma- blood in urine, polycythemia
83
1st line treatment for enuresis?
Desmopressin
84
Stridor that is better when prone, worse when supine.
Laryngomalacia
| Also exacerbated by URI, Feeding
85
Pt. has HepC with liver damage. What do you need to do? What is tx?
Prevent further damage: Vaccinate vs HepB, HepA, no alcohol
| Tx: sofosbuvir, velpatasvir
86
Tx for pancreatic pseudocyst?
Sx: drainage endoscopically
Asx: nothing
87
Female child with vulvar/perianal pruritis and rash at elbow and back of knee?
```
Still pinworm (even though she also has eczema)
Itches at night/bedtime
```
88
Felty syndrome
Inflammatory arthritis, splenomegaly, neutropenia
89
Dec. B/T cells, normal WBC, recurrent infxns in infant
SCID. Don't be fooled by normal WBC
90
Pain worsened with passive flexion of wrist or resisted extension
Lateral epicondylitis (extensors of wrist)
91
What must you exclude to diagnose ITP?
HIV, HepC
92
DBS vs. Fanconi Anemia
DBS: babies, anemia with low retic., congenital anomalies
Fanconi: 8 year olds, pancytopenia, cafe-au-lait, Missing thumbs, short stature, small head
93
Male hypogonadism with low LH/FSH.
Secondary: check for causes including prolactin level
94
Does NPH have asymmetric neuro lesions?
nope
95
Pronator drift is what type of sign?
UMN lesion (UMN innervates supinators more than pronators)
96
After cardiac surgery, fever, CP, leukocytosis, mediastinal widening on CXR. What do you do?
Acute mediastinitis: drain, surgically debride, prolonged abx
97
Do lacunar infarcts present with 2 months of HA/nausea?
No, consider mass lesion
98
Dyspnea, glomerulonephritis, increased Cr, painful fingertips, fever, fatigue.
Myocarditis- May have increased ESR, RF
99
Can you still get GBS meningitis after prophylaxis?
Yes. Ppx does not decrease horizontally spread, late-onset GBS
100
Immunosuppressed adult with herpes like rash
Zoster... Acyclovir
101
Hyperinflation of effected lung is associated with what?
Foreign body inhalation
102
Equilibrated diastolic intracardiac pressures
Tampanode
103
Air in the gallbladder wall suggests what? Next step?
Emphysematous cholecystitis
| Emergency surgery and abx w/ CLOSTRIDIUM coverage (e.g. amp-sulbactam)
104
Facial swelling and difficulty breathing in a HTN pt.
Look for ACE-i, angioedema can happen ANYTIME
105
Limited shoulder movements after fall on outstretched arm.
Consider rotator cuff- Get MRI
106
Next step if you suspect duodenal atresia?
Upper GI series
107
If pulm HTN is occurring secondary to LV dysfunction, what do you do?
Treat LV dysfunction (CHF)
108
Risk factor for C. diff besides recent abx/hospitalization?
PPI use (any gastric acid suppression)
109
What needs to be prophylaxed for in pts. getting immunosuppressants following solid organ transplant?
PCP- TMP-SMX
| Possibly CMV with gancylovir
110
TB with non-gap metabolic acidosis. What happened?
Primary adrenal insufficiency (most common worldwide cause). Decreased H+ excretion due to decreased aldosterone
111
Which type of aortic dissection is emergency surgery required?
Type A- ascending aorta involvement
- If stable, get a CT first
- Unstable get TEE
112
What is wrong with the head of a baby with Edwards syndrome?
Micrognathia
113
MOA of hepatorenal syndrome?
Splanchnic arterial dilation, dec. vasc. resistance, renal vasoconstriction (ultimately decreased perfusion)
114
What do you see on thyroid labs with euthymic sick syndrome most commonly?
Normal T4, TSH
| Decreased T3
115
Medications that can cause pancreatitis?
Diuretics, IBD drugs, HIV drugs, metronidazole, SEIZURE DRUGS (VPA esp.)
116
Location of stroke with HTN, contralateral hemiparesis and hemisensory loss, gaze palsy? What does pontine stroke look like?
Putamen/BG or Thalamus
| Pons-Pinpoint pupils + COMA
117
Do you need a bx to diagnose Sjogrens? If you get a bx, where do you get it from?
Not if clx + Ab. Get bx from minor glands of lip if needed (not major salivary glands)
118
Osteomyelitis organism if stepped on a nail?
Pseudomonas if went through shoe
119
What has to be covered/what is empiric treatment for febrile neutropenia?
Pseudomonas + broad
| Cefipime, meropenem, zosyn
120
Important next step with clavicle fractures?
Neurovascular check
121
Probable lupus: check ANA or ds-DNA first?
ANA (sensitive). Don't want to risk the false negatives with ds-DNA
122
Fanconi anemia genetics? Phenotype?
DNA repair genes (AR or XLR)
| Abn. thumbs, pancytopenia, hypogonadism, hyper/hypopigmentation, eye/ear abnormalities
123
What is the mentzer index?
MCV/RBC(millions)
>13 IDA
<13 thalassemia
124
What is the normal concentration of HbF in SS pts who are not treated?
5-15% (hydroxyurea >15%)
125
What happens to the murmur of AS with increasing severity?
1) Later in systole
2) Soft and single S2
Note: sxs indicate severe
126
Back pain that seems innocent but is associate with wt. loss. Next step?
x-ray (r/o malignant involvement)
127
1st step for preconception thalassemia r/o?
CBC (sensitive before specific)
128
Best thing lifestyle-wise to lower BP?
Wt. loss> DASH> exercise
129
What do you look for anytime you see nitroprusside treatment? Next step?
Cyanide toxicity (HA, confusion, arrhythmia, flushing, resp. depression). Thiosulfate to cure
130
Pain at shoulder prominence, hip, elbow, greater trochanter of femur. What do you suspect?
Enthesitis (inflammation at tendon insertion sites) as a manifestation of ankylosing spondylitis
131
Heat stroke vs. Heat exhaustion?
Stroke: + AMS, T>105 (thermoregulation fail)
Exhaustion: no AMS, T<104 (fail for adequate fluid/salt)
132
No liver failure but asterixis? Tx?
Consider uremic encephalopathy
| Dialysis (lactulose won't work)
133
Painful red nodules on leg? 22 y/o AA female? Next step?
Erythema nodosum, 28% associated with sarcoid, get a CXR
134
How do you treat prolonged QT syndromes? What are the two types, inheritance, and distinguishing factor?
1) Tx with B-blockers and pacing
2) Jervell-Lange-Nielsen (AR and hearing loss)
3) Romano-Ward (AD)
135
First step to dx suspected Cushings? (3 options)
1) low dose dexamethasone
2) 24 hr urine cortisol
3) late night salivary cortisol
136
What can worsen eye disease of Graves that is used for Tx? Prevention?
Radioactive iodine--> inc. TRAB antibodies. Prophylax with steroids
137
Generally, what do S3 and S4 represent?
S4: diastolic failure
S3: systolic (CHF from stiff ventricle)
138
What is the aldosterone level in adrenal insufficiency secondary to chronic steroid use?
Normal. RAAS still works normally with steroids and is not suppressed.
139
Drugs to use in HOCM?
B-blocker or CCB (anything to prolong diastole)
140
How do you treat pediatric constipation?
Fiber/laxatives (don't suggest juice--> fixes constipation but can cause a host of other problems)
141
HTN and bilateral upper abdominal masses in an adult?
Consider ADPKD
142
Tx for 1st degree AV block?
Observe unless sx or prolonged QRS (then get EP studies)
143
1st time seizure. Tox screen or EEG 1st?
Tox. screen. Rule out causes that are not primary seizures
144
What is a risk factor for NEC besides prematurity? AKA when might you see it in term infants?
Congenital heart disease +/- hypotension
145
Seborrheic dermatitis and normochromic, normocytic anemia are associated with what vitamin deficiency? What else will be there?
Riboflavin + angular chelitis, stomatitis, glossitis
146
Dx if you have mild prolactin elevation (e.g. 85) and decreased HPA axis otherwise?
Non-functioning adenoma
| Note: in medication induced prolactinemia, the HPA axis is otherwise unaffected
147
Most common vaccine travelers need?
HepA. Yellow fever if south america/sub-saharan Africa
148
Guidelines for AAA screening?
1 time abd. US for males 65-75 who have EVER SMOKED
149
What is the E in JONES criteria? What does it look like?
Erythema marginatum- evanescent pink rash with sharp edges
150
Name 5 finding sin Behcet syndrome.
1) Oral Ulcers
2) Genital Ulcers
3) Erythema Nodosum (interesting)
4) Thrombosis
5) Eye lesions
151
Tx for adjustment disorder? When is it MDD?
Psychotherapy, if 5/9 SIGECAPS are met
152
Rules for pneumococcus vaccines?
>65: sequential PCV-13, PPSV-23
<65 with chronic condition: PPSV-23, sequential at 65
<65 with immunosup, SS, cochlear implants, asplenia: Sequential before 65
Note PCV-13 is conjugated, PPSV-23 is polysaccharide
153
What will you see on x-ray of acute tampanade? Name the triad...
Normal. Only big heart in chronic.
| Triad: hypotension, JVD, dec. heart sounds
154
Hepatitis mentioned + skin blisters on back of hand, skin fragility and scarring
PCT (check porphyrins)
155
How do you treat infective endocarditis if cultures state that it is penicillin sensitive?
Still IV tx for 3-4 weeks. Ceftriaxone popular as it is only 1x/day
156
1st step in treating probable disc herniation?
Still NSAID trial- most resolve spontaneously
157
Suprapubic pain, gross hematuria, pelvic fracture, no peritonitis
Extraperitoneal bladder injury (trauma)
158
Name the inheritance and 5 thinks you see in NF-1.
AD
| Cafe-au-lait, axillary freckling, lisch nodules (eye), neurofibromas, optic gliomas.
159
Renal tumor with TS?
Angiomyolipoma
160
Acute thyrotoxicosis, non-tender/slightly enlarged thyroid with decreased radioiodine uptake
Painless thyroiditis
161
Top thing with pediatric stroke? What if lactic acidosis and increased CK present?
Sickle cell, MELAS (mitochondrial)
162
Flushing, diarrhea, wt. loss, cramps and pancreatic mass.
VIPoma (carcinoid not in pancreas and also causes wheezing)
163
What is winter's formula?
1.5xHCO3+8+/-2
164
What type of stroke is a lacunar stroke?
Ischemic (small vessel)
165
How do you treat SIADH normally? What sx make it severe and how do you treat it then?
Normal: fluid restrict
Severe: Any CNS sx, hypertonic saline (if the replacement fluid is not of greater osmolarity than the urine, you are making the hyponatremia worse)
166
Wallenberg is what location and what sx?
Lateral medullary: Hoarseness, dysphagia, loss of gag reflex, vestibulocerebellar impairment, Horner's, ips face and contra body sx.
167
What tips you off to medial medullary stroke? Lateral pontine?
MM: tongue deviation
LP: muscles of mastication and trigeminal nerve
168
Do you have to respect a patient who declines treatment and is serious threat to public health?
Nope, hold involuntarily
169
CXR--> linear atelectasis
Bronchiectasis (recurring infxns with high sputum volume)
170
Cocaine and alcohol night before, took aspirin for hangover and now vomits with blood in it.
Acute erosive gastropathy (blood in first instance of vomit since the vomiting is not what caused it unlike Mallory-Weiss)
171
supraclavicular fat pad
Most specific for Cushing's syndrome
172
Triad of hemolytic anemia, pancytopenia, thrombosis
PNH
173
What does the D-xylose test tell you? What might you need to rule out?
Decreased absorption in proximal small bowel (requires no breakdown). Good test for celiac, but may need a trial of rifaxamin to rule out Small intestine bacterial overgrowth
174
Varicella exposure in a healthy pt. with only 1/2 vaccinations, what do you do? When is the second one normally? What do you do for immunocompromised with exposure?
1) Give second vaccine (usually at 4 y/o)
2) Varicella Ig
Note: Kids <1 need nothing
175
Increased gastric residual volume, vomiting, abd distension, acidosis in 3 wk old preterm infant? What is on XR?
NEC
| XR: Pneumatosis intestinalis and PORTAL VENOUS AIR
176
Biggest lifestyle RF for pancreatic cancer?
Smoking
177
When do you brace low back pain? What are the first two steps?
Never... NSAIDS then Exercise therapy
| No pain meds, muscle relaxants
178
Home distilled whiskey + microcytic anemia + neuro sx. What else does this cause?
Lead poisoning, gout (inc. uric acid)
179
Bilateral hearing loss with tinnitus? What if vertigo present?
Without vertigo: Presbycusis
| With vertigo: Meniere's
180
Recommendations for recurrent renal stone patients?
Increased fluid, DECREASED Na intake, no change in Ca intake. Increased Na leads to increased Ca excretion. (Hyperoxaluria only comes into play with malabsorption)
181
Wt. loss, epigastric pain (gnawing) that is worse at night after head trauma a month ago.
Pancreatic cancer (don't be penalized by knowledge... Cushing ulcer is acute with GI bleed and neuro impairment)
182
PMR tx?
Low dose prednisone
183
LAD, peaked T waves on neonatal EKG with decreased pulmonary markings (murmur is present)
Tricuspid atresia. Must have ASD and VSD.
| Note: Normal newborn have RAD due to RV pumping blood to body in via PDA in utero
184
Aplastic anemia vs aplastic crisis
Aplastic anemia: pancytopenia (congenital, acquired, but not SS)
Aplastic Crisis: SS pts. with sudden anemia and dec. retic.
185
Acute abdominal pain, fever, hematuria in nephrotic syndrome patient?
Renal vein thrombosis (most commonly in MN)
186
Preferred imaging for vertebral osteomyelitis?
MRI
187
Different presentation of lipoma vs. epidermal inclusion cyst?
Lipoma: rubbery, irregular, persists
EIC: firm, mobile, may regress/recur, CENTRAL PUNCTUM often
188
Hepatic cyst with daughter cysts?
Echinococcus (internal septation actually)
189
Drop arm test? Muscles to abduct?
Supraspinatus.
1st 15 degrees is supraspinatus
Need serratus anterior to get >90 degrees
190
Postmenopausal pt. with suspicious ovarian mass: laparoscopy or CA-125?
CA-125 in unison with U/S before lap.
191
Where might fibromuscular dysplasia manifest other than kidney, what does it look like, and how do we diagnose it in general?
Brain: ischemia sx or non-specific (HA, tinnitus)
Dx: U/S or CTA
192
Pearly papule with rolled borders and central ulceration on skin?
BCC, BCC, BCC, BCC. Do not miss this
193
Claw hand vs. Waiters Tip. Name, roots involved?
Claw hand: Klumpke (plus horners, C8-T1)
| Waiter's Tip: Erb Ducheene (upper, C5,C6)
194
What supplements are required in breastfed babies? What about preterm?
Breastfed only (all): supplement Vitamin D
Preterm: supplement iron for 1 yr if breastfed only
If term: supplement iron beginning at 4 mo. if breastfed
195
What labs should you perform if diagnosing HTN?
U/A, BMP, Lipids, EKG (aka dont jump to wild stuff)
196
What is the effect of CHF on kidneys?
CHF--> RAAS activation--> constricted efferent renal arterioles
197
What do we use to decrease alcoholic cravings if actively drinking? What if in maintenance?
Active: naltrexone
Maintained: Acamprosate (glutamate)
198
What facts do you know about follicular and papillary thyroid cancer?
Follicular: hematogenous spread
Papillary: most common, psammoma bodies, histology
199
What if somebody cannot take warfarin/stay on schedule after DVT?
Go to direct Xa inhibitors
200
COPD heart sounds? CXR in regard to pulmonary arteries?
Distant due to hyperinflated lungs. Enlarged central pulmonary arteries.
201
Nephritic syndrome most associated with HepB?
Membranous Nephropathy (also most common in white people)
202
Solitary pulmonary nodule with high malignancy risk?
Surgical excision (if no LN palpable)
203
Why do infections with encapsulated bacteria increase in asplenic patients?
Deficits in antibody responds and antibody mediated phagocytosis/complement activation (opsonization decreased, not actual complement function)
204
Anemia with B6 deficiency?
Sideroblastic
205
What do you do if someone develops tardive dyskinesia?
Switch to clozapine
206
HSV infection after atopic dermatitis?
Eczema herpeticum
207
Pelvic bladder pain, dyspariunia, urinary frequency, urgency with normal UA (female)
Interstitial cystitis
208
Sx for milk-alkali syndrome?
N/V, constipation, polyuria, polydipsia, neuropsych. sx (essentially hypercalcemia...)
209
What is the next step if someone gets a needle stick with high HIV exposure risk?
PEP immediately. 3 rugs for 4 weeks (tenofovir, emtracitabine, raltegravir)
210
Mumps can cause parotitis, orchitis, and what?
Meningitis (aseptic)
211
How do you treat hypernatremia if euvolemic? Hypovolemic?
Euvolemic (free water supplementation
Hypovolemic + sx: NS until euvolemic, then D5W
Hypovolemic + asx: D5W
212
Difference in CXR with Histo and Coccidio?
Histoplasmosis is bilateral, coccidio is unilateral
213
How does pancreatitis cause hypotension?
Local/systemic vascular endothelial injury, vasodilation and vascular permeability
214
Dry eyes, dry mouth, dry vagina in premenopausal women.
Sjogrens (decreased lubrication).
| No estrogen deficiency if premenopausal
215
Severe pain after fracture of supracondylar humerus and pulses intact?
Watch for compartment syndrome
216
Tx for tourette?
alpha-2 agonists (clonidine, gaunfacine)
| Antipsychotics (risperidone)
217
STDEV first three?
68, 95, 99.7
218
Where is there not chloroquine resistance? What do we use? What malaria does hypnozoites and what do we use?
Not in mexico, argentina. Use doxy, mefloquine, atovaquone-proguanil elsewhere.
Vivax (primaquine)
219
Is fever normal with vertebral osteomyelitis?
No. Usually indolent
220
Tx for agitation with acute mania?
Antipsychotics
221
Acute pulmonary edema tx?
Lasix first (no beta blocker in acute CHF)
222
When can oseltamivir be used?
1st 48 hours of sx only
223
First step in cause of metabolic acidosis question?
Winters formula
224
How do we get rid of uric acid stones?
Alkalinize urine with K-Citrate
225
Catatonia Tx?
Benzo or ECT
226
Lateral neck XR finding for retropharyngeal abscess?
Paravertebral widening
227
Flank pain, low volume voids, alternated with high?
Obstructive uropathy
228
Stable patient with REGUALR narrow complex tachycardia?
Adenosine (or vagal)
229
Attrition bias is a form of what?
Selection bias
230
Suspect developmental dysplasia of hip. Next Step?
U/S of hips
231
Alternative cause for stress incontinence besides urethral hypermobility?
Mass lesion, e.g. fibroids pressing on bladder
232
What is the most common SE of girls with CF?
Recurrent/chronic rhinosinusitis (only 20% infertile)
233
Which has sharp borders: cellulitis or erysipelas?
Erysipelas (cellulitis is deeper, cannot see it all)
| Note: carbuncle is multiple furuncles
234
How do you differentiate CF from primary ciliary dyskinesia without CXR or studies?
Pancreatic insufficiency (exocrine) leads to vitamin deficiency in CF
235
Inability to close eye suggests what about facial nerve lesion?
Below pons
236
How does hepatic hydrothorax happen?
Theoretically there are small defects in diaphragm that let fluid through
237
Most common type of kidney stone?
Calcium oxalate
238
Timeline and treatment for 3 types of neonatal conjunctivitis?
<24 hr: chemical--> lubricant only
2-5 days: Gonorrhea (severe)--> IM ceftriaxone
5-14 days: Chlamydia (mild)--> Oral macrolide
239
How do you treat cyanide toxicity (3 options)?
Hydroxycobalamin, Thiosulfate, Nitrates (methemoglobinemia)
240
What type of eye infection is most common cause of worldwide blindness?
Trachoma: follicular conjunctivitis/inflammation that, if repeated, leads to inversion of eyelashes, corneal scarring, and blindness.
Cause: chlamydia trachomatis A, B, C
241
What can be said about choledocholithiasis if alk. phos. is normal?
Ruled out
242
Irregular scrotal mass separate from testicle, no transillumination, larger with standing/valsalva.
Varicocele (no transillumination)
243
How does vitamin D deficiency cause bone loss?
Impaired matrix mineralization
244
What is a factorial study design?
Multiple variables. Participants get multiple interventions
245
Reactive arthritis triad? What other two things? Tx?
Urethritis, arthritis, conjunctivitis
Enthesitis (relation to ank spond), oral ulcers
NSAIDs
246
When are fibrates indicated for hyper TG? What do you do otherwise?
Resistant or >1000 (pancreatitis risk). Otherwise use statin and lifestyle modification first (e.g. stop alcohol)
247
If you see hypertension and hypoK what do you suspect if only low dose HCTZ?
Inc. aldosterone, check renin/aldosterone concentrations
248
Midface hypoplasia, microcephaly, cleft lip/palate, digital hypoplasia, hirsutism, dev. delay birth defects?
Fetal hydantoin syndrome (phenytoin or other AEDs)
249
Relation of hashimoto to pregnancy?
High titers of anti-TPO antibodies can cause miscarraige regardless of thyroid status
250
Cause of PNA in CF pt? What age is the crossover?
<20: staph aureus
| >20: pseudomonas
251
If you see proteinuria and hematuria, what is the cause?
Glomerular path with any proteinuria
252
2 most common bugs in brain abscesses?
Staph a. and Strep viridans
253
1st step with suspected diaphragmatic hernia in newborn?
Intubate (bag mask can cause respiratory decline quickly)
254
Mastoiditis + nocturnal headaches, morning nausea. What is next step?
Possible brain abscess, get CT
255
What type of vaccine is yellow fever?
Live-attenuated
256
If a traveler goes to high risk area for meningococcus and has only had one shot, what do you do?
Give booster (usually recommended at 16-21)
257
If NSAIDs are not relieving cancer pain, what is next?
Short-acting opiods
258
What does ARDS do to lung compliance?
Decreases
259
What is the run-down on tetanus ppx after wound?
If at least 3 doses lifetime, toxoid vaccine if last dose >5 yrs ago for dirty wound or >10 yrs for minor
If not 3 doses lifetime: minor wound gets vaccine, severe gets vaccine+ IG
260
W/u for caustic ingestion?
EGD
261
What DM drug causes wt. loss? Which are wt. neutral? Wt. gain?
Loss: GLP-1 agonists (exenatide)
Neutral: DPP4 (gliptans), metformin
Gain: TZDs, sulfonylureas
262
If you think someone is having an MI, what do they get NOW?
ASA
263
Non-exudative pharyngitis plus lower abdominal pain.
Consider gonococcal pharyngitis and PID (note: this causes non-tender LAD unlike EBV)
264
If DVT with no PE, what is first: anticoagulation or compression U/S?
U/S (unlike in PE)
265
Tx for peritonsillar abscess?
Needle aspiration and IV abx
266
Upper GI pain, nausea, without regurgitation or dysphagia or change in bowel habits?
Most likely PUD (check for H. Pylori)
267
Fever, increased WBC, LUQ pain suggests what? What is associated?
Splenic abscess. Infective Endocarditis. Abscess can also cause pleuritic pain and effusion
268
Dullness to percussion plus increased breath sounds?
PNA
269
Malabsorption post bypass surgery with increased fecal fat and vitamin deficiencies?
small intestine bacterial overgrowth (Dumping syndrome= osmotic diarrhea post high carb meals)
270
When does C. diff get IV vancomycin?
Never ever (only oral)
271
Chronic, congenital growth that is hard on the hard palate?
Torus palatinus
272
What rhythm is associated with digoxin toxicity?
Atrial tachycardia with AV block
273
How do you treat acne?
Comedonal: topical retinoids
Next: benzoyl peroxide if inflammatory
Next: Topical abx--> oral abx
If nodular (>5mm, cystic) and unresponsive to above tx, then add oral isotretinoin
274
Inheritance of alports?
XLD
275
Crohn pt. does not improve on 5-ASA in three weeks. What now?
Add abx (metro +/-cipro)
276
What is the first step for suspected meningitis? What next?
1st: blood culture
2nd: steroids + abx
3rd: CT if papilledema (note: peds pt with fontanelles don't need this)
4th: LP
277
What type of deficiencies are associated with parenteral nutrition?
Trace mineral deficiencies (zinc, selenium, copper, chromium)
278
Name the deficiency:
1) alopecia, pustular skin rash, impaired taste, dec. wound healing
2) thyroid dysfxn, cardiomyopathy
3) brittle hair, depigmentation, neuro sx, sideroblastic anemia
4) impaired glucose control in DM
1) Zinc
2) Selenium
3) Copper
4) chromium
279
What should you check for in a patient with worsening somatic symptom disorder?
Other life stresses
280
Inflammatory, oligoarticular, asymmetric arthritis without positive gram stain?
Lyme. Note: JIA is symmetric
281
What is the most common cause of newborn hypothyroidism?
Thyroid dysgenesis is much more common than synthesis defects of TH (AR for synthesis)
282
What are the number one and two best lifestyle changes for hypertension?
1) Wt. loss
| 2) DASH diet (>exercise)
283
Down syndrome kid with loud S2, systolic ejection murmur at RUSB, holosystolic murmur at LLSB + bibasilar crackles?
Complete AV canal defect (TOF has outflow murmur only)
284
Which bleeds and swells more? ACL or meniscus?
ACL
285
What CBC findings go with scleroderma renal crisis? Tx?
MAHA and thrombocytopenia (similar to TTP). Treat with ACE-i even if Cr is increased
286
If aphasia is present, where is the stroke?
Big vessels (likely MCA)
287
Ear pain/drainage, granulation tissue on exam, facial nerve palsy + fever?
Malignant otitis externa (pseudomonas)
288
What do RBC casts indicate?
Glomerular damage
289
How do TCAs cause cardiac problems? What do we give to fix it and why does it work?
They bind fast sodium channels. Sodium bicarb does two things: the bicarb. increases pH and decreases the TCA, Na competes and forms large Na gradient to overcome TCA binding
290
Thick cord-like vessels that get red keep popping up all over body. What now?
Migratory thrombophlebitis, get CT to rule out abdominal tumor
291
IBD patient presents with systemic symptoms, bloody diarrhea, distension and peritonitis. What do we do?
Get x-ray to check for toxic megacolon
292
What increases stool osmotic gap? How is it calculated?
Any osmotically active substance that is no Na or K. (290- (Na+K)). Essentially measured osmoles minus the calculated osmoles based on Na and K
293
Boy with precocious puberty that is gonadotropin-independent and normal testicles?
CAH (21-hydroxylase def.)
294
What is the goal of scoliosis treatment?
Cobb angle < 40 degrees at skeletal maturity (if this goal is reached, leave it alone)
295
Tx for rheumatic fever with heart disease?
Continuous penicillin for 10 years or until 40 years old (whichever is longer). Pretty much zero cases of rheumatic heart disease get to stop tx anytime soon.
296
Cause of AV block on EKG in endocarditis patients?
Perivalvular abscess likely on the AORTIC VALVE
297
What type of drug is amikacin?
Aminoglycoside (nephro and oto toxic)
298
First step with signs and symptoms of adrenal insufficiency?
Cosyntropin (ACTH) stim test
299
When do you transfuse acutely bleeding GI patients?
Hb<7 if stable, if unstable Hb<9
300
Most common cause of aortic regurgitation in developed countries vs. non-developed?
Developed: Congenital bicuspid aortic valve
Non: Rheumatic heart disease
301
What do you do with non-concerning palpable LN in kids or young adults
Observe
302
Do infants typically need CT before LP?
No, fontanelles are protective vs. increased ICP
303
Bilateral lower extremity pains in a child 2-12 years old with no other symptoms?
Growing pains, no treatment besides reassurance
304
Mechanism of dobutamine, adenosine, and dipyridamole stress tests?
Dobutamine: increases HR and contractility
| Adeno/Dipyr: vasodilators (stenosed arteries cannot)
305
How many lesions go with Kaposi sarcoma?
Can be multiple (violaceous lesions are a good hint)
306
Tx of cutaneous larva migrans?
Ivermectin (ancylostoma caninum or A. braziliense)
307
Asx thin-walled, septated 12 cm cyst in ovary of 46 y/o?
Likely cystadenoma (benign)
308
Size of normal SI, LI, cecum?
3, 6, 9 rule: 3 cm SI, 6 cm LI, 9 cm cecum
309
Neonatal meningitis tx?
Amp + Gent + Acyclovir (if any risk for HSV)
310
Size of liver cyst that requires action if asx?
>4 cm (smaller ones leave alone, no rescreen even needed)
311
How do you differentiate cauda equina and conus medullaris syndromes?
Cauda equina: LMN--> hyporeflexia
| Conus Medullaris: UMN--> hyperreflexia
312
What congenital heard defects cause single S2? Egg- on a string CXR?
S2: ToGV (egg on a string), tricuspid atresia, truncus
Note: ToGV is MC congenital cyanotic heart defect
313
What might be the cause of a new onset RBBB?
PE
314
What causes cradle cap? Distribution?
Seborrheic dermatitis- rash where there are hair follicles
315
Does cirrhosis cause LE edema?
Duh. Albumin down
316
Describe peak airway pressure and plateau pressure mathematically? What is implied if plateau pressure changes? What if peak airway pressure changes with no change in plateau pressure?
PAP: resistive pressure + plateau pressure
Plateau= elastic pressure + PEEP
Plateau pressure changes with a change in compliance of some sort (e.g. ARDS). If it doesn't change and PAP does, then it is a change in resistance (since plateau pressure calculated during inspiratory hold- no resistance plays a role)
317
Cause of situational syncope? Another name for vasovagal?
Cause: autonomic response
| Vasovagal= neurocardiogenic
318
What is the arrangement of CN III?
Parasympathetic fibers are peripheral (easier access to blood supply) than middle motor fibers
319
Tx for the 4 types of EPS?
Dystonia: benztropine or diphenhydramine
Akathisia: Beta blocker or benzo
Parkinson: Benztropine or amantadine
TD: switch to clozapine
320
MC cause of urinary tract obstruction in young boys? Problem that is discovered with first binger?
Posterior urethral valve (includes a membrane)
| Ureteropelvic junction obstruction
321
Most likely cause among lower GI bleeds to cause hemodynamic instability?
Diverticulosis
322
Inheritance of myotonic dystrophy?
AD (trinucleotide repeat)
323
Temperature with opiod OD? What do you do?
Can be hypothermic, give naloxone and see if it gets better
324
Measurement of massive hemoptysis? What do you do?
>600 ml in 24 hrs or >100 ml/hr
ABCs--> bronchoscopic intervention
Only need surgery if bronchoscopic measures fail
325
Classic cause of hidden anaphylaxis with trauma?
Latex allergy (catheter)
326
Persistent pneumothorax despite chest tube after blunt trauma? Also have pneumomediastinum and subcutaneous emphysema.
Tracheobronchial rupture (right mainstem bronchus)
327
What is the toxic APAP dose? When is charcoal allowed?
>7.5 g, only in first four hours
328
Pneumonia in COPD patient cause?
H. influenzae
329
What do you do if IDA doesn't respond to iron?
Check GI for blood loss, eventually could move to IV iron
330
Best method to cool someone with heat stroke?
Immerse in cold water, evaporative methods (cooling blankets don't help)
331
What should you do after making a dx of osteosarcoma?
Get lung CT for mets
332
3 meds to give with variceal bleed?
PPI, octreotide, ceftriaxone (abx)
333
Post catheterization (cardiac): hypotension, tachycardia, flat neck veins, back pain
Retroperitoneal hematoma (get CT of abd/pelvis)
334
Does negative VDRL help much in early primary syphilis?
No, get darkfield or FTA-ABS (still very sensitive)
335
Anemia plus splenomegaly in an 18 year old AA male with no med hx one week after URI was treated by amoxicillin?
```
Warm AIHA (Abx, cancer, autoimmune)
No complications and big spleen significantly decrease chances of SS
```
336
How to tx frostbite? Is warm IV fluid ok?
Rapid rewarming in water. The IV fluid thing is for hypothermia, not frostbite
337
What do you do with severe bradycardia that accompanies hypothermia?
Just warm them, this will be resistant to pacing anyhow
338
Can you increase dose of SSRI after 2 weeks if not enough effect?
NO, give it 4-6 weeks to kick in
339
What could cause celiac disease confirmed with Bx that had negative antibody tests?
IgA deficiency (common association)
340
Name some things that increase Warfarin effectiveness?
NSAIDS, APAP, cranberry juice
341
Can you switch pyelonephritis to narrow spectrum therapy when the cultures come back?
You can if they are symptomatically improving after 48 hours (even ok to go to orals)
342
Causes of clubbing?
Lung malignancy, cystic fibrosis, R--> L cardiac shunts. COPD, hypoxia alone DO NOT CAUSE IT
343
What is the top stroke risk factor?
Hypertension for both types
344
First line treatment for vasospastic angina? Be specific.
Diltiazem (or other CCB): diltiazem is a powerful dilator of coronaries, less peripheral arteries
345
What is the relation of kidney stones to ileus?
Kidney stone colic--> vagal rxn--> ileus
| Either way, get CT (non-con)
346
Can tubulointerstilial nephritis have proteinuria?
Yes, and it is the correct answer if they are going for analgesic induced kidney failure (or papillary)
347
What do you do with a positive PPD followed by a negative CXR?
Treat latent TB with INH + B6 for 9 months
348
How do we deal with foreign vaginal body in kids?
Irrigation or alginate swab, otherwise need anesthesia. Never bimanual exam on kid (even with analgesia)
349
Most common location of ectopic focus of a. fib?
Pulmonary veins
350
What is a little known cause of secretory diarrhea?
Post-surgical change
351
How is NAFLD related to DM in regards to lipolysis?
Insulin resistance leads to increased peripheral lipolysis which causes it to come back to liver. Hepatic FFA cause increased oxidative stress and production of proinflammatory cytokines
352
How should you think of urinary Cl in alkalosis?
If kidney works (not hyperaldo, bartters, gitelmans), then HCO3 will be excreted in exchange for Cl in distal tubule and urinary Cl will be low
353
Can you do a vaginal delivery if no active herpes and no prodromal sx?
Yes, don't need ppx
354
Flexion hip contracture 20 degrees, 1 year of hip pain, narrowed joint space on x-ray. Subchondral sclerosis too. Pain not at rest
OA
355
What does the EMG show with ALS?
Fibrillation potential and widespread denervation
356
Severe hemolytic disease of newborn is caused by what?
Rh incompatibility
357
What predisposes to toxicity with the drug that can cause PVCs?
Hypokalemia (diuretics) predisopse to digoxin toxicity which can cause PVCs
358
Widespread molluscum warrants search for what?
HIV
359
Can bereaving people have auditory hallucinations?
Nope
360
If GBS was treated in pregnancy, what do you do at birth?
PPX
361
Is brisk, rotary nystagmus ok?
No, work it up
362
What do you do if BPH has orthostatic hypotension?
Skip the alpha blocker
363
Next step with raynauds?
ANA
364
What dietary recommendation should you make for diverticulosis patients?
High fiber (the nut/seed thing is not real anymore)
365
Corneal vesicles and dendritic ulcers?
Herpes simplex keratitis
366
Where might you see bacillary angiomatosis? Tx?
Skin usual, rarely organs such as liver, CNS, and bone. Tx with doxycycline, erythomycin
367
What is left ventricular filling pressure? What happens to it an acute MI with papillary muscle rupture?
It is the same as LV EDP, this increases in acute MR
368
What does breast feeding do for ovarian, endometrial and breast cancer risks?
Decreases ovarian and breast risk, not ovarian
369
What does breast feeding prevent in kids?
Disease, NEC, childhood cancer
370
How is blood pressure influenced in hypo and hyperthyroidism? Mechanism?
Hypertension in both
HYPERthyroid: increased CO, decreased SVR
HYPOthyroid: increased SVR
371
What does good glycemic control in diabetics protect against?
Only microvascular complications: nephropathy and retinopathy. No definitive evidence on how it effects macrovascular (stroke, MI) or overall mortality
372
Three requirements to diagnose acute liver failure?
1) Liver injury signs (increased enzymes)
2) Hepatic encephalopathy
3) Liver synthetic dysfunction (INR >1.5)
373
What is the CI interval required to avoid for RR/OR, what is the other circumstance?
RR/OR: cannot cross 1
| Mean difference: cannot cross 0
374
How long before you see EBV amoxicillin rash?
>24 hours (still watch for allergic rash earlier)
375
Name two comorbid conditions with absence seizures.
ADHD, anxiety
376
Attributable risk percent given RR
(rr-1)/rr
377
Use dependent QRS widening? Use dependent PR prolongation?
```
QRS: class 1C (flecanide, propafenone)
PR: CCBs
```
378
What are the approved appetite stimulants for cancer related cachexia syndrome?
Progesterones> steroids
379
Melanosis coli?
Laxative abuse
380
Complications/results of PBC?
Malabsorption (ADEK def), metabolic bone disease (osteoporosis), HCC
381
What type of CT used for kidney stone imaging?
NON_CONTRAST
382
Most common skin cancer in immunosuppressed? What if skin cancer is not on head/neck?
SCC for both
383
How do you differentiate herpangina from herpetic gingivostomatitis?
Both have fever and pharyngitis.
Herpangina: gray vesicles/ulcers on posterior oropharynx
Herpetic: red gingiva, clusters of small vesicles on anterior oropharynx
384
What do labs look like with chikungunya? What is the most common sx?
Look like tick borne (increased ALT/AST, thrombocytopenia, leukopenia). High fevers and polyarthralgias
385
First step with suspected infection with peritoneal dialysis?
Gram stain fluid
386
To and fro murmur with bounding pulses and widened pulse pressure?
PDA
387
Type of DM with DKA?
Type I
388
First treatment with PAD? ABI of severe?
Conservative: stop smoking and exercise. <0.4
389
When do you wean COPD patients from ventilator?
When normal abg (can retain CO2) and awake/alert
390
Just tried alcohol for the first time, now abdominal/ colicky pain?
Ureteropelvic junction obstruction (get US)
