Step 2 Flashcards
(458 cards)
1
Q
Once pt has PID, what to screen for?
A
HIV, syphilis, hep b, cervical cancer (pap). Hep C if Hx of IVDU
2
Q
MOA of ondansetron
A
Serotonin 5HT3 antagonist
3
Q
Pathogenesis of carpal tunnel syndrome
A
hypothyroidism - deposition of mucopolysaccharide protein complexes (matrix substances) pregnancy - increased fluid in tunnel amyloidosis - amyloid fibril deposition RA - tenosynovial inflammation acromegaly - synovial tendon hyperplasia
4
Q
Disease to screen for w/ Dx of carpal tunnel
A
hypothyroidism, espec if bilateral
5
Q
First indicator of hypovolemia
A
tachycardia
6
Q
head injury with lucid interval
A
acute epidural
7
Q
head injury w/ biconvex discs? semilunar?
A
Biconvex - epidural
Semilunar - subdural
8
Q
Labs expected in menopause or primary ovarian failure?
A
elevated FSH and LH (FSH more elevated than FSH)
9
Q
Down syndrome pt with UMN findings?
A
atlantoaxial instability
10
Q
Tx of absence seizures
A
valproate or ethosuximide
11
Q
Risk of bipolar manic episode
A
Gen pop - 1%
+Hx in first degree relative - 5-10%
12
Q
Tx of idiopathic hypercalciuria -> kidney stones
A
In order of importance: incr fluid intake nl/increased calcium in diet dietary sodium restriction decreased dietary protein/oxalate
13
Q
Medication used to induce spasms on diagnostic testing for either esophageal spasm or prinzmetal’s angina
A
Ergonovine
14
Q
Name 4 lacunar stroke syndromes & locations of lesions
A
Pure motor hemiparesis-Posterior limb of internal capsule
Pure sensory-VPL of the thalamus
Ataxic-hemiparesis-Anterior limb of internal capsule
Dysarthria-clumsy hand-Basal pons
15
Q
Enzyme deficient in galactosemia. Mild version (cataracts only)?
A
Galactosemia - galactose-1-phosphate uridyl transferase deficiency
Cataracts only - galactokinase deficiency
16
Q
Pathophysiology of hepatorenal syndrome?
A
portal hypertension -> NO release in splanchnic circulation -> generalized systemic vasodilation -> renal hypoperfusion and pre-renal renal failure
17
Q
Enzyme deficient in galactosemia. Mild version (cataracts only)?
A
Galactosemia - galactose-1-phosphate uridyl transferase deficiency
Cataracts only - galactokinase deficiency
18
Q
Pathophysiology of hepatorenal syndrome?
A
portal hypertension -> NO release in splanchnic circulation -> generalized systemic vasodilation -> renal hypoperfusion and pre-renal renal failure
19
Q
Gestational age at which you attempt external cephalic version for breach presentation
A
37 weeks
20
Q
Most common site of coronary artery occlusion
A
Left anterior descending artery
21
Q
Posterior descending coronary artery derives from?
A
70%-R coronary artery
10%-L circumflex artery
20%-anastamosis of RCA and circumflex
22
Q
During exercise, cardiac output increases by…
A
increasing stroke volume initially, then by increasing heart rate
23
Q
Normal PR interval
A
<0.2 sec
24
Q
Normal QRS complex
A
<0.12 sec
25
AE of statins
myositis, increased LFTs
26
AE of niacin
flushing, increased LFT, insulin resistance, gout
27
Medicines given in acute MI
```
IV morphine
supplemental O2
Nitroglycerin
Aspirin
Heparin if PCI, LMWH if not
B-Blocker
Statin
Anti-platelet (clopidogrel or ticagrelor)
Keep K >4 and Mg > 2
```
28
DDx for chest pain
```
C - cocaine/costochondritis
H - hyperventilation/herpes zoster
E - esophageal spasm/esophagitis
S - stenosis of aorta
T - trauma
P - PE, pneumonia, pericarditis, pancreatitis
A - angina, aortic dissection, AAA
I - infarction
N - neuropsychatric disease
```
29
Dressler syndrome
fever, pericarditis, and increased ESR 2-4 wks post MI
30
What should you consider before cardioversion for a-fib?
If in A-fib > 2 days, TEE should be performed first to r/o mural thrombus formation. If present, anticoagulate for 3-4 wks prior to cardioversion
31
When are PVC's concerning?
>3 per min or Hx of CAD (Tx w/ b-blocker)
32
Drugs that decr mortality in CHF
ACE-I, B-blockers, and spironolactone
33
Hypertensive urgency vs emergency
Both w/ BP > 180/120. Urgency is asymptomatic. Emergency is w/ renal failure, pulmonary edema, aortic dissection, encephalopathy, papilledema
34
Tx options for hypertensive urgency/emergency
nitroprusside, nitroglycerin, labetalol, diazoxide
35
Causes of secondary hypertension
young men - alcohol intake
young women - OCPs, fibrous dysplasia of renal artery
elderly - atherosclerosis -> renal artery stenosis
36
Test for pheochromocytoma
24 hr urine for catecolamine products (metanephrines, vanillylmandelic acid, homovanillic acid)
37
Conn's syndrome
Aldosterone secreting adrenal neoplasm. -> HTN, high aldosterone/low renin, hypokalemia, metabolic alkalosis
38
Which tests should be ordered on everyone with new Dx of HTN?
ECG - assess if heart has been affected (LV hypertrophy)
| CMP & UA - clues to possible secondary causes of HTN
39
Lab to differentiate insulinoma vs exogenous insulin?
C-peptide level high in insulinoma, low in exogenous
40
Describe the Somogyi effect
If too much NPH is given at night, glucose level at 3am will be low -> stress hormone release -> hyperglycemia at 7am.
41
Describe the Dawn phenomenon
hyperglycemia caused by normal secretion of growth hormone early in the morning -> nl glucose level at 3am but high at 7am.
42
How to manage DM pt's who are NPO for surgery?
1/3 to 1/2 of normal dose of insulin is given and glucose levels are monitored
43
How is LDL calculated?
LDL = total cholesterol - HDL - triglycerides/5
44
Differentiating AS and HOCM murmurs
AS - valsalva decreases murmur
HOCM - valsalva increases murmur
Both decrease with fist clenching
45
Causes of restrictive cardiomyopathy
Sarcoidosis
Amyloidosis
hemochromatosis
46
Causes of dilated cardiomypathy
```
Idiopathic
Alcohol
Beriberi
Coxsackie B, cocaine
Doxorubicin
HIV
Pregnancy
Hemocrhomatosis
Ischemic heart disease
Chagas
```
47
EKG in acute pericarditis
global ST elevation
| PR depression
48
Causes of acute pericarditis
viral, tuberculosis, SLE, uremia, neoplasm, post MI inflammation (dressler), medicaitons (isoniazid, hydralazine), radiation, recent heart surgery
49
Causes of cardiac tamponade
acute pericarditis, chest trauma, LV rupture post MI, dissecting aortic aneurysm
50
Beck triad
hypotension, distant heart sounds, and distended neck veins seen in cardiac tamponade
51
Causes of myocarditis
Viruses - coxsackie, parvo b19, HHV6, adeno, echo, EBV, CMV, influenza
Bacteria - Rickettsia
Fungi
Parasites - Trpanosoma cruzi (Chagas)
Drugs - doxorubicin, chloroquine, penicillin, sulfas, cocaine, radiation
52
Criteria for rheumatic heart disease
Hx of recent strep infxn w/ 2 major or 1 major and 2 minor criteria
```
Major (JONES):
Joints - polyarthritis
<3 heart - carditis, valvular damage
Nodules - Subcutaneous nodules
Erythema marginatum
Syndenham Chorea
```
```
Minor (PEACE):
Previous rheumatic fever
ECG with PR prolongation
Arthralgias
CRP and ESR elevated
Elevated temperature
```
53
Choice of HTN med in person w/ osteoporosis
thiazide diuretics - maintains high/normal serum calcium
54
Tx options for HTN in pregnancy
hydralazine, methyldopa, labetalol, nifedipine
55
HTN med to avoid in depression
B-blocker, may worsen sx
56
HTN med to avoid w/ gout
diuretic - increase serum uric acid
57
HTN med to avoid w/ asthma/COPD
nonselective b-blocker (propranolol, timolol) -> bronchoconstriction
58
HTN med to avoid in CHF
Ca channel blocker - reduced HR/contractility may exacerbate heart failure
59
HTN med to avoid in DM
thiazide diuretic - impaired glucose tolerance
| B-blocker - mask signs of hypoglycemia
60
Differentiating septic vs neurogenic shock
In neurogenic shock, there is vasodilation + bradycardia
61
Risk factors for polyarteritis nodosa? vessels affected?
Hep B&C, young>elderly, men>women
| small-medium (kidneys, heart, GI, muscles, nerves, joints)
62
Risk factors for temporal arteritis
>50, women>men. 1/2 also have polymyalgia rheumatica
63
Risk factors for takayasu arteritis? vessels affected?
asian. women age 10-40
| Aorta + branches (-> cerebrovascular/myocardial ischemia)
64
Small-medium vessel vasculitis with asthmatic Sx
Churg-strauss (allergic granulomatosis with angiitis or eosinophilic vasculitis)
Increased serum eosinophils, p-anca, lung biopsy may show eosinophilic granulomas
65
Risk factors for Henoch-Schonlein purpura? vessels affected?
More common in children
| IgA immune compelx-mediated vasculitis affecting arterioles, capillaries, and venules
66
S/Sx of Kawasaki disease?
fever for >5 days, lymphadenopathy, conjunctival lesions, mucositis, maculopapular rash, edema of hands/feet
67
Tx of Kawasaki disease?
ASA, IVIG
68
If temporal arteritis is suspected...
Do not wait for biopsy to start prednisone
69
Dx/Tx of legionnaire's disease
cough, fever >39 w relative bradycardia (80-90), GI Sx, confusion
Urine antigen or culture on charcoal agar
Tx: axithromycin/levofloxacin
70
Elevated L mainstem bronchus on radiograph
L atrial enlargement (i.e. from mitral stenosis 2/2 rheumatic heart disease)
71
Tx for human/dog bites
amox/clav
72
Most common organ injured in blunt abdominal trauma
1. spleen 2. liver 3. kidney
| Duodenum/pancreas are less commonly injured
73
Decreased DTR in pt with pre-eclampsia
Mg sulfate toxicity. Discontinue and give calcium gluconate
74
Infant with hypoglycemia, macrosomia, macroglossia, hemihyperplasia, umbilical hernia/omphalocele
Beckwith-Wiedemann syndrome (chromosome 11p15 anomaly)
| Screen with abd US for wilm's tumor and hepatoblastoma
75
Most common congenital cause of aplastic anemia? Other findings?
Fanconi anemia (chromosomal breaks)
Short, microcephaly, abnormal thumbs, hypogonadism, abnormal ears, hypopigmented spots
(note: it is a macrocytic anemia)
76
Breath holding spells seen in kids 6-18 months are a/w?
iron deficiency anemia
77
Complications of orbital cellulitis
Orbital abscess, intracranial infection, cavernous sinus venous thrombosis
78
Chromosome 5p deletion
Cri-du-chat. Microcephaly, hypotonia, short, cat-like cry
79
Colon cancer screening in UC pt's
Start 8 yrs after Dx, then repeated every 1-2 years. Done w/ random blind biopsies to detect dysplasia
80
"worst headache of life" with negative CT. What next?
lumbar puncture to r/o subarachnoid hemorrhage
81
Iron studies in iron deficiency
low iron, low ferritin, high TIBC, and low transferrin saturation
82
Most common causes of microcytic anemia
iron deficiency, anemia of chronic disease(micro or normocytic), thalassemia
83
Electrolyte abnormality seen in subarachnoid hemorrhage
hyponatremia 2/2 cerebral salt wasting and/or SIADH
84
DDx/Tx of pulmonary-renal syndromes
Wegeners - steroids and cyclophosphamide
Goodpasture's - plasmapheresis
Others: severe polyarteritis nodosa, idiopathic rapidly progressing glomerulonephritis
85
Labs in tumor lysis syndrome
hyperphosphatemia, hyperkalemia, hyperuricemia
| hypocalcemia
86
RSV infxn increases risk of...
asthma later in life
87
Management of pt w/ sign of infxn (ie fever/sore throat) in pt on antithryoid drug (propylthiouracil/methimazole)?
Stop drug and draw CBC to determine if infection from agranulocytosis (i.e. WBC <1000)
88
Lab finding with antiphospholipid antibody (lupus anticoagulant)
spuriously prolonged PTT (actually causes prothrombotic state)
89
Corneal vesicles and dendritic ulcers
herpes simplex keratitis
90
Tx of Giardia
metronidazole
91
MEN syndromes
I: pituitary, parathyroid, pancreas
II: medullary thyroid, pheo, parathyroid
III: medullary thyroid, pheo, mucosal neuromas, marfanoid habitus
92
Complication of giving glucose to an alcoholic
precipitating Wernicke's encephalopathy. Give thiamine first
93
Wernicke vs Korsakoff syndromes
Both 2/2 thiamine deficiency
Wernicke - reversible. ophthalmoplegia, nystagmus, ataxia, and/or confusion
Korsakoff - irreversible. psychosis with anterograde amnesia + confabulation
94
Tx of aspirin overdose
Alkalinization of the urine with sodium bicarbonate
95
Tx of SIADH
water restriction
| demeclocycline (induces nephrogenic DI)
96
What causes spurious (false) hyponatremia?
Lab value is low, but total body sodium is normal
hyperglycemia
hyperproteinemia
hyperlipidemia
97
Classic cause of hyponatremia in pregnant patients
Oxytocin, which has an anti-diuretic hormone like effect
98
When hypokalemia persists after replacement
check Mg levels. hypomagnesemia blocks retention of potassium
99
Correction for hypocalcemia in the setting of hypoalbuminemia
For every 1 unit decrease in albumin below 4, add 0.8 to calcium level
100
AE of MAOI's
serotonin syndrome
| hypertensive crisis with consumption of foods high in tyramine (aged meats/cheeses)
101
Diamond Blackfan Syndrome
macrocytic pure red cell aplasia a/w congenital anomalies including short stature, webbed neck, cleft lip, shielded chest, and triphalangeal thumbs
Defect -> incr apoptosis of erythroid progenitor cells
102
Concern for high flow O2 in COPD exacerbation
bringing O2 sat above 95% decreases resp drive ->hypercarbia -> lethergy/seizure/arrhythmia.
For same reason, use benzos/narcs sparingly
103
MOA of cyclosporine and tacrolimus
calcineurin inhibitors -> decreased IL2 production
104
Major AE of cyclosporine/tacrolimus
nephrotoxicity, hyperkalemia, HTN, tremor
Cyclosporine: add gum hypertrophy and hirsutism
Tacrolimus: add neurotoxicity
105
Major AE of azathioprine
diarrhea, leukopenia, hepatotoxicity
106
Major AE of mycophenolate
bone marrow suppression
107
Tests to order prior to starting lithium
Creatinine, thyroid function tests, pregnancy test
| AE of nephrotoxicity, hypothyroid, ebstein anomaly in fetus
108
Left sided varicocele that fails to empty when recumbent
Renal cell carcinoma
109
sinusitis is most common in which sinuses?
maxillary
110
Lab for mycoplasma pneumonia
positive cold agglutinin test
111
Differentiating emphysema with chronic bronchitis
Dlco is normal with chronic bronchitis but decreased in emphysema
112
COPD pt w/ resting O2 sat <88%
home O2 program
113
AE of clozapine (antipsychotic)
agranulocytosis
114
Tx of nondisplaced scaphoid fx? displaced?
wrist immobilization for 6-10 weeks. ORIF.
115
b-HCG level where you should see intrauterine pregnancy
1500-2000
116
Murmur of endocarditis in IVDU
tricuspid regurg -> systolic murmur that increases with inspiration
117
Which part of DTaP is a/w anaphylaxis, encephalopathy, or seizure?
Pertussis. give DT instead for next shot
118
headache, vision changes, and pulsatile tinnitus with normal head imaging
think of pseudotumor cerebri and order LP for high opening pressure
119
Use of d-xylose test
tests passive diffusion ability of small intestine. If it shows up in stool instead of being absorbed, think celiac disease, whipple disease, bacterial overgrowth
If normal, think pancreatic insufficiency
120
CT finding in huntington's
atrophy of caudate nucleus and putamen
121
Which medications may cause folate deficiency?
methotrexate, phenytoin, trimethoprim
122
Med to give if pt with MI gets vtach or vfib
lidocaine
123
Lung cancer metastasizes to
BLAB: bone liver adrenals brain
124
Paraneoplastic syndrome a/w squamous cell lung cancer
PTHrP -> hypercalcemia (others are all small cell)
125
Lab test in wegener's (granulomatosis with polyangiitis)
c-anca
| noncaseating granuloma on biopsy
126
Time cutoff for tracheostomy
if intubation required for >3 weeks
127
Steeple sign
subglottic narrowing on neck radiographs seen in croup
128
microbe that usually causes croup?
parainfluenza
129
Tx of croup?
supportive
| aerosolized epinephrine and inhaled corticosteroids in severe cases
130
Bleeding tendency with normal coagulation studies
uremia (causes platelet defect), vit c deficiency, chronic steroid use
131
Tx of hypertrophic cardiomyopathy
beta blockers and verapamil allow ventricle to fill
132
young person or one with minimal smoke exposure with emphysema
alpha-1 antitrypsin deficiency
133
pneumoconiosis that predisposes to TB
silicosis
134
Cause of normal pressure hydrocephalus
decreased CSF absorption
135
Dx of gitelman/Bartter syndromes
hypok, alkalosis, and increased urinary K/Cl concentration (defect is in Cl and K resorption)
renin and aldosterone are high due to hypovolemia
136
bilirubin in the urine indicates
conjugated hyperbilirubinemia
137
EKG findings in RV infarct
usually seen along with inferior infarct (II III aVF), but ST depression in I and aVL point to RV infarct
138
Medications to avoid in RV infarct
diuretics and nitroglycerin. W/ SA node involvement in RV infarct, they are dependent on preload for CO and are therefore given fluids
139
Tx of pagets
if symptomatic, bisphosphonates
140
dysphagia with decrease in lower esophageal sphincter tone and absence of peristaltic waves in the lower two-thirds of the esophagus
scleroderma
141
erythema nodosum in AA female
think sarcoid
142
diabetes, diarrhea, necrotic migratory erythema, weight loss
glucagonoma
143
time to do external cephalic version
after 37 wks gestation
144
Tx of cholangitis
supportive care and broad spectrum abx. if they worsen, biliary drainage with ERCP
145
Steroid dose where there is concern for acute adrenal crisis
prednisone >20mg (or its equivalent) for >3 weeks
146
when is the odds ratio close to the same value as relative risk
rare disease
147
Risk of TPN on gall bladder
no CCK release -> no gall bladder contraction -> stasis, stones. decreased enterohepatic circulation in small bowel resection also contributes (-> altered composition of bile)
148
Surveillance in compensated cirrhosis
US for hepatocellular ca +/- AFP q6 months
| EDG for varices
149
Tests for fetal lung maturity
lecithin:sphingomyelin ratio > 2
| phosphatidyl glycerol present
150
Complication of meningococcal meningitis
waterhouse-friedrichsen syndrome (adrenal hemorrhage -> vasomotor collapse)
151
Thyroid study results in normal pregnancy
Pregnancy -> incr TBG -> increased total T3 and T3, normal free T3 and T4, and normal TSH
152
How to calculate anion gap? Normal?
Na-(bicarb+Cl). Normal = 6-12
153
Hx c/w celiac (Event blunting of villi), but + travel history
tropical sprue
154
DDx for spherocytes on smear? How to differentiate?
HS, autoimmune hemolytic anemia
| Coombs test
155
Vesicles on palm of hand
herpetic whitlow
156
Nocardia Tx
trimethoprim-sulfamethoxazole (SNAP)
157
Actinomyces Tx
penicillin (SNAP)
158
Drug for emergency contraception? When can it be given?
levonorgestrel. up to 120 hours after intercourse
159
Tx of cerebral septic emboli (from endocarditis)
abx
160
Meds a/w pancreatitis
```
diuretics - furosemide, thiazides
IBD - sulfasalazine, 5-asa(mesalazine)
immunosuppresives - azathioprine, l-asparaginase
seizures - valproic acid
AIDS - didanosine, pentamidine
Abx - metronidazole, tetracycline
```
161
Dx of acute angle glaucoma
tonometry
162
test that determines presence of feto-maternal hemorrhage ?
| test for amount of hemorrhage? (to determine rho-gam dose)
presence - rosette test
| amount - Kleihauer-Betke stain
163
Tx of heavy, active vaginal bleeding in DUB
high dose estrogen
164
Management of congenital diaphragmatic hernia
intubate, then decompress stomach/bowel w/ ng tube
| Bag valve/blow by O2 contraindicated as it can inflate stomach/bowel and worsen resp status
165
AE of all 2nd generation antipsychotics
metabolic syndrome
166
AE of ziprasidone
metabolic syndrome
| QT prolongation
167
Tx of h. pylori
amoxicillin, clarithromycin, PPI
| amoxicillin, metronidazole, bismuth, PPI
168
serologic test for autoimmune hepatitis
anti-smooth muscle antibody
169
serologic test for primary biliary cirrhosis
antimitochondrial antibodies
170
management of penile fracture
urethrogram (assess for urethral injury) then surgery
171
Dx/Tx of hairy cell leukemia
Dx: TRAP stain
Tx: Cladribine
172
illicit drug causing hallucinations and vertical nystagmus
PCP
173
Choice of anticoagulation in AFib
```
CHADS2 score
CHF, HTN, age>75, DM, Stroke(2pts)
0: no anticoag(preferred) or aspirin
1: anticoagulation(preferred) or aspirin
2+: anticoagulate
```
174
Location of gastrin producing tumor in zollinger ellison syndrome?
duodenum (70%) or pancreas
175
Serology for celiac disease
| What if negative?
IgA antiendomysial and antigliadin antibodies
| if negative, think of concurrent IgA deficiency
176
Tx of tropical sprue
folic acid replacement, tetracycline
| removal of gluten has no effect
177
Biopsy results in whipple's disease
jejunal biopsy shows foamy macrophages on periodic acid-schiff stain and villous atrophy
178
Negative sudan test (no steatorrhea) and low stool pH
lactase deficiency
179
serology in inflammatory bowel disease
crohns - ASCA (anti yeast saccharomyces cerevisiae antibodies) frequently positive
UC - pANCA frequently positive
180
sites of carcinoid tumor
bronchopulmonary tree, ileum, rectum, appendix
181
Lab test for serotonin syndrome
urine 5-hydroxyindolacetic acid (5-HIAA)
182
mutation in FAP, gardner, and turcot syndromes
adenomatous polyposis coli (APC) gene
183
cancers seen in Gardner syndrome
FAP(colon) + bone/soft tissue tumors
184
cancers seen in Turcot syndrome
FAP(colon) + CNS tumors
185
What are the colonic polyps seen in peutz-jegher's syndrome
hamartomas w low risk of malignancy
186
What is removed in whipple procedure
pancreatic head, duodenum, prox jejeunum, common bile duct, gall bladder, distal stomach
187
Tx of stroke in sickle cell disease
exchange transfusion (-> decreased sickling to prevent further infarct). tPA unlikely to help as etiology is sludging, not true thrombus
188
use of leukocyte alkaline phosphatase
high in leukemoid reactions, low in CML
189
most common cause of infantile febrile seizures
roseola (sixth disease, HSV 6)
190
use of winter's formula
calculate expected PCO2 in metabolic acidosis
| PCO2 = 1.5 HCO3 + 8
191
When to use water soluble contrast instead of barium
when you expect perforation. Exception: in esophageal perforation, use barium (water soluble causes pneumonitis)
192
Gilbert/Crigler najjar - conj/unconj hyperbilirubinemia?
unconjugated
| due to deficiency in glucuronosyl transferase, the enzyme which conjugated bilirubin
193
Rotor/Dubin-Johnson - conj/unconj hyperbilirubinemia?
conjugated
| Due to defect in transporting conjugated bilirubin out of liver
194
what is struma ovarii
teratoma that secretes thyroid hormone
195
serology in hashiomoto's
antimicrosomal antibodies
196
features of mccune albright syndrome
ovarian cysts, pseudoprecocious puberty, polyostotic fibrous dysplasia of bone, cafe au lait spots
197
management of pheochromocytomas
stabilize with alpha, then beta blockers. then remove surgically
198
When to stop pt's metformin
acute renal failure, hepatic failure, or sepsis (all increase chance of developing lactic acidosis)
199
lab test in wilson's disease
low serum ceruloplasmin
200
medications that cause priapism
trazadone, prazosin
201
Risk of untreated thyroid toxic adenoma
tachyarrhythmias(a-fib), incr osteoclastic activity -> bone loss
202
AE of amiodarone
hypo&hyperthyroid, hepatotoxicity, pulmonary fibrosis, corneal deposits, skin discoloration
203
polyarthralgias, tenosynovitis, and vesiculpustular skin lesions
disseminated gonococcal infection
204
Kid w/ self limiting episodes of vomiting with no apparent reason w/ fhx of migraine headaches
cyclical vomiting
205
What other disorder to think about in an HIV pt with purple skin lesions besides kaposi sarcoma
Bartonella -> bacillary angiomatosis (cutaneous and visceral angioma-like blood vessel growths). abx->involution of lesions
206
use of SAAG (serum ascites albumin gradient)
if > 1.1 (transudative), ascites is due to portal hypertension
207
Tx of x linked agammaglobulinemia
regular infusions of IVIG
208
Risk to offspring of DES exposure
adenocarcinoma of vagina/cervix, cercial anomalies, uterine malformations
Males: cryptochordism, microphallus, hypospadias, testicular hypoplasia
209
immunostaining for ALL
```
terminal deoxynucelotidyltransferase (TdT) - present only in pre b and pre t lymphoBLASTS
The blasts are also PAS-positive
```
210
Drug that slows progression of ALS
Riluzole
211
How to distinguish primary biliary cirrhosis and primary sclerosing cholangitis
Gender - PBC female, PSC male
ERCP in PSC shows string of pearls
antimitochondial abs in PBC
UC a/w PSC
212
Tx of type II crigler-najjar
this is mild deficiency similar to gilbert
| phenobarbital -> incr hepatic synthesis of glucuronyltransferase
213
which type of kidney stone is radiolucent?
uric acid stones. Tx: alkalinization of urine w/ oral potassium bicarb/potassium citrate
214
diffuse telangiectasias, recurrent epistaxis, widespread AV malformations
```
hereditary telenagiectasia (osler-weber-rendu).
autosomal dominant
```
215
EKG in pericardial effusion
shows electrical alternans, where amplitudes of the QRS complexes vary from beat to beat
216
Abx prophylaxis in HIV pts
CD4 < 200: TMPSMX for PCP
| <50: azithromycin for MAC
217
Drugs most commonly responsible for SJS/TEN
sulfonamides, barbituates, phenytoin, NSAIDs
218
Tx of impetigo
topical mupirocin or oral erythromycin
219
test that distinguishes maternal vs fetal blood
apt test
220
Tx of cocaine induced chest pain
benzos, aspirin, nitro, Ca channel blockers
| B blockers are contraindicated
221
First line Tx of OCD
SSRI or clompiramine
222
when to perform gonadectomy in androgen insensitivity syndrome
after completion of breast development and attainment of adult height (after puberty)
223
Damage to good eye after penetrating image to other eye
Sympathetic ophthalmia - due to immunologic mechanism involving recognition of 'hidden' antigens
224
Hep B a/w...
polyarteritis nodosa, membranous glomerulonephritis
225
Tx of DI
central: ADH
nephrogenic: stopping offending medicine, give thiazide diuretics (paradoxically lowers urine output)
226
can't pee (urethritis due to chlamydial infection), can't see (uveitis), can't climb a tree (arthritis)
Reiter's syndrome
227
Serology in scleroderma
CREST: anticentromere antibody
diffuse: antitopoisomerase
228
CREST syndrome includes?
| Pulmonary manifestation?
```
calcinosis
Raynaud's
esophageal dysmotility
sclerodactyly (tight skin of fingers and toes)
telangectasias
pulm- interstitial fibrosis
```
229
medical Tx of prolactinoma
bromocriptine, cabergoline, or pergolide (dopamine agonists)
230
renal disease + deafness
Alport's syndrome
231
Preferred Tx of grave's
radioactive iodine (contraindicated in pregnancy and severe ophthalmopathy)
232
AE of OCPs
breakthrough bleeding, HTN, thromboembolism
| Not weight gain
233
Quad screen results in down syndrome
increased b-hcg and inhibin a
| decreased MSAFP and estriol
234
Pseudogout a/w ..?
hyperparathyroidism
235
Dark (strikingly black) liver
dubin-johnson syndrome
236
pt with bilat trigeminal neuralgia, you should think of...
MS
237
serology in dermatomyositis
anti-Mi-2 (anti helicase)
238
maligancies that -> incr erythropoietin
renal cell carcinoma
hepatocellular carcinoma
pheochromocytoma
hemangioblastoma
239
causes of normal anion gap acidosis
diarrhea, RTA, TPN, hypoaldosteronism
240
Causes of anion gap acidosis
```
MUDPILES
methanol
uremia
DKA
Paraldehyde
Isoniazid/Iron
Lactic acidosis
ethanol/ethylene glycol
salicylates
```
241
causes of metabolic alkalosis
vomiting, diuretics, cushing, hyperaldosteronism, adrenal hyperplasia
242
causes of hypernatremia
```
6 D's
diuretics
dehydration
DI
docs (iatrogenic)
diarrhea (and vomiting)
disease of kidney - hyperaldosteronism
```
243
Calculate expected rise in Na with correction of hyperglycemia
add 1.6 to Na level for every 100 mg/dL glucose >100. (i.e. if 300, add 3.2)
244
Sx of serum sickness
fever, urticarial rash, polyarthalgia, lymphadenopathy. occurs 10 days after administration of drugs i.e. penicillin, amox, TMPSMX, cafaclor in the setting of viral illness
245
Tx of lyme? What if pregnant or <8 yo?
doxycycline
| preg / <8yo - amoxicillin
246
dysphagia, iron deficiency anemia, glossitis
plummer vinson syndrome (dysphagia due to esophageal web)
247
Amsel criteria for dx of BV
```
3/4 of:
thin, gray-white vaginal discharge
vaginal pH > 4.5
whiff test with KOH
clue cells
```
248
Pt with pneumonia picture s/p bone marrow transplant (+/- colitis)
CMV pneumonitis
249
What to do with contacts of pt w/ pertussis
all close contacts get erythromycin for 14 days, regardless of age, immunization, or symptoms
250
Tx of dermatitis herpetiformis
gluten fre diet and dapsone
251
dry and rough skin with horny plates over extensor surfaces of the limbs (lizard skin)
ichthyosis vulgaris
252
Workup of primary amenorrhea after ultrasound
uterus present - FSH. if increased, karyotype. if decreased, cranial MRI
uterus absent - karyotype
253
Dx/Tx of enterobius vermicularis
this is pinworm, so positive scotch tape test
| albendazole
254
IgM spike on electropharesis + hyperviscosity of blood
waldenstrom's macroglobulinemia (remember MM is high IgA/IgG)
255
testicular pain relieved by supporting scrotum
points towards epididymitis over torsion
256
when to perform orchiopexy in cryptochordism
prior to age 5
257
What is the cause of leukocyte adhesion defect?
deficient expression of CD18 by leukocytes
258
Pt with sickle cell disease or trait with nocturia
hyposthenuria - sickling in vasa recta -> impaired free water reabsorption
259
Tx of myasthenia gravis
pyridostigmine (edrophonium is for Dx only)
260
Site of ectopic foci that cause a-fib?
pulmonary veins
261
CSF finding in MS
oligoclonal bands
262
metabolic abnromalities seen in hypothyroidism
hyperlipidemia, hyponatremia, asymptomatic elevations in CK, ALT, AST
263
bilateral solid ovarian masses during pregnancy
pregnancy luteoma. benign, may cause hirsutism
264
Complications seen in acromegaly
heart failure, DM, spinal cord compression, vission loss 2/2 pressure of tumor on optic nerve
265
GH should increase with ? and decrease with ?
should increase with insulin, and decrease with glucose administration
266
adrenal insufficiency + incr skin pigmentation
addison's disease (autoimmune destruction)
267
CAH that leads to aldosterone production only (amenorrhea in females, ambig genitalia in males)
17-a hydroxylase deficience
268
CAH that leads to sex hormone production only (+/- hypotension due to lack of mineralcorticoids)
21-a hydroxylase deficiency
269
CAH that leads to sex hormone overproduction and HTN due to some mineracorticoid excess
11-a hydroxylase deficiency
270
infant with poor feeding, jaundice, umbilical hernia, hypotonicity
think of cretinism (congenital hypothyroid)
271
things that shift hemoglobin curve to the right
-> increased O2 delivery to tissues
| acidosis, incr temp, high altitude, exercise
272
types of cells that are lymphoid in origin
T: prothymocyte, t lymphoblast, t cells
B: pre-b, b lymphoblast, b-cell, plasma cell
273
drugs that cause hemolytic anemia
penicillin, methyldopa, quinidine
274
drugs that decr folate
methotrexate, trimethoprim, phenytoin
275
antipseudomonals
cefepime, pip/tazo, aztreonam, ciprofloxacin, imipenem/cliastatin, gentamycin
276
premalignant lesion leading to squamous cell carcinoma of the skin
actinic keratosis
277
incr risk of cholangiocarcinoma
ulcerative colitis, liver flukes (clonorchis)
278
clues to histiocytosis
CD1 positive cells with birbeck granules(tennis racket inclusions)
279
Niemann-Pick vs Tay Sacks
Both: Cherry red macula, loss of milestones/retardation
Tay Sachs: Hexosaminidase A. hyperacusis, seizures.
Niemann Pick: Sphingomyelinase. protruding abd, hepatosplenomegaly, lymphadenopathy
280
Triad of kartegener's
recurrent sinusitis, bronchiectasis, dextrocardia
281
Tx of CML
imatinib (tyrosine kinase inhibitor)
| remember 9:22 translocation (philadelphia chromosome) -> abnormal tyrosine kinase activity
282
Pts with hashiomotos at incr risk for?
thyroid lymphoma
283
Tx for hep C
peginterferon + ribavirin +/- protease inhibitor (-avir)
284
large number of mulluscum contagiosum lesions should make you think of...
HIV (also seen in corticosteroid use/chemotherapy)
285
causes of sideroblastic anemia (ringed sideroblasts on smear)
genetic disorder in heme synthesis or alcohol, isoniazid, lead poisoning
286
mnemonic for types of hypersensitivity reactions
ACID: anaphylaxis, complement mediated (aka antibodies), immune complex mediated, delayed (t-cell/macrophages)
287
clotting factors not synthesized by the liver
vWF and factor VIII
288
MOA of clopidogrel/ ticlopidine
block ADP receptors to suppress fibrinogen binding to site of injury
289
MOA of abciximab
inhibits platelet GP IIB/IIIa receptors to block platelet aggregation
290
decreased ristocetin cofactor activity
von willibrand disease
291
recommendation for contact sports w/ mono
refrain until spleen no longer palpable (usually 1-3 months)
292
Tx of needle stick
prophylactic zidovudine and lamivudine +/- protease inhibitor
HIV Ab testing immediately, 6 wks, 3 months, and 6 months after exposure
293
management of infant born to HIV mother
zidovudine given to mother during labor, and infant for 6 weeks after birth. Test for presence of virus (not anti-HIV which will be present from mother) in first 6 months of life
294
HIV with odynophagia
candida esophagitis (white plaques), CMV (deep, linear ulcers), herpes, aphthous ulcers
295
MOA of raltegravir
integrase inhibitor (inhibits HIV integration into host DNA)
296
MOA of enfuvirtide
fusion inhibitor (inhibits viral ability to fuse with CD4 and enter cell)
297
MOA of miraviroc
CCR5 inhibitor (blocks entry into cell)
298
drugs that improve fertility in PCOS
clomiphene, metformin
299
Tx for fibromyalgia
exercise
| TCAs (amitriptyline). pregabalin, duloxetine, milnacipran are alternatives.
300
back pain + restrictive PFT pattern
Ankylosing spondylitis
301
if hypokalemia is difficulty to correct, think of...
hypomagnesemia
302
pt reports that straight grid lines appear curved
macular degeneration (also see drusen deposits)
303
Tx options for neutropenic fever
ceftazidime, cefepime, imipenem, meropenem, pip/tazo, or combo therapy (antipseudomonal beta lactam + aminoglycoside)
304
w/ Dx of mononucleosis, also consider
acute HIV infection
305
most common sequela of meningitis
hearing loss. need hearing eval after resolution
306
steeple sign on lateral neck xray
croup (laryngotracheitis caused by parainfluenza virus)
307
pseudomembranes in oral cavity + myocarditis
diphtheria
308
auer rods
AML
309
Tx of chlamydial conjunctivitis or pneumonia in newborn
oral erythromycin, despite risk of pyloric stenosis
310
timing of gonococcal vs chlamydial conjunctivitis
gonococcal - day 3-5 of life
| chlamydial - day 5-14
311
management of bed wetting
1. behavior modifications (no caffeine, no drinking before bed, reward system)
2. enuresis alarm
3. desmopressin
4. TCAs (imipramine)
312
Tx of cancer related anorexia/cachexia
progesterone analogs (megestrol acetate and medroxyprogesterone acetate) +/- steroids
313
Triad of wiskott-aldrich? inheritance pattern?
thrombocytopenia, eczema, recurrent bacterial infections
| x linked recessive
314
how is anti-rH antibody titer measured? cutoff for rhogam?
not useful if titer is > 1:6, which means sample diluted 6 times shows no antibodies. 1:6 solution has more antibodies than 1:2, which shows no antibodies after being diluted twice
315
meds to hold for 48 hrs prior to first cardiac stress test
b blockers, ca channel blockers, nitrates
316
differentiating methanol vs ethylene glycol ingestion
both-anion gap metabolic acidosis
methanol - dmgs the eyes
ethylene glycol - dmgs the kidneys
317
describe fetal hydantoin syndrome (seen w/ phenytoin use in pregnancy)
small body size, microcephaly, digital&nail hypoplasia, midfacial hypoplasia, clefting, hirsutism, rib anomalies
318
Reed sternberg cells (owl eyes) on lymph node biopsy
hodgkin lymphoma
319
starry sky appearance on lymph node biopsy
burkitt lymphoma (EBV related, t[8;14])
320
fragile skin, photosensitivity, vessicles/erosions on the dorsum of the hands
porphyria cutanea tarda - screen for HCV due to strong association
321
extrahepatic sequelae of HCV
porphyria cutanea tarda, cryoglobulinemia -> membranoproliferative glomerulonephritis, lichen planus, leukocytoclastic vasculitis
322
inability to release hand after handshake
myotonic muscular dystrophy. autosomal dominant
323
Rocky mountain spotted fever minus rash
ehrlichiosis. Tx: doxycycline
324
Tx of scabies
permethrin cream to whole body. tx all contacts as well. Preferred over lindane due to it's neurotoxicity.
325
Tx of tinea versicolor
selendium sulfide shampoo or topical imidazoles
326
Tx of lice
permethrin cream
327
Tx options for acne (in order)
topical benzoyl peroxide
topical clindamycin, oral tetracycline/erythromycin
topical tretinoin
oral isotretinoin
328
Tx of rosacea
topical metronidazole or oral tetracycline
329
psych disorder where people pull out their hair
trichotillomania
330
pruritic, purple, polygonal papules on the legs +/- oral mucosal lesions
lichen planus
331
location of CN nuclei
3,4: midbrain
5-8: pons
9-12: medulla
332
kid with cough >2 weeks without clear cause + one of: paroxysmal cough, inspiratory whoop, or post-tussive emesis?
confirmatory test?
pertussis
during first 4 weeks of illnes, nasopharyngeal culture and/or PCR
after 4 weeks of Sx, serology
333
Tx of pertussis?
macrolide abx - do not wait for lab confirmation before starting
334
Tx of frequent PVCs
asymptomatic: none
symptomatic: b blockers
335
cause of outflow obstruction in hypertrophic cardiomyopathy
hypertrophied interventricular septum and abnormal motion of mitral valve leaflets referred to as systolic anterior motion (SAM)
336
Causes of pulseless electrical activity (PEA)
```
Hypovolemia
Hypoxia
Hyper/hypokalemia
Hyperthermia
Hydrogen ions (acidosis)
Tamponade
Tension pneumothorax
Thrombosis (MI/PE)
Tablets/toxins
```
337
Veins accessed for pulmonary artery catheter (swan ganz)
L subclavian or R internal jugular vein
338
cause of nonhemoltyic febrile transfusion reactions? Tx?
antibodies to human leukocyte antigens (HLAs)
| acetaminophen
339
cause of delayed hemolytic transfusion reactions? (delayed 2-10 days after transfusion)
antibodies to Kidd or D (Rh) antibodies
340
cause of acute hemolytic transfusion reaction?
antibodies to ABO groups (clerical error)
341
Tx of idiopathic intracranial hypertension (pseudotumor cerebri)
acetazolamide (blocks choroid plexus carbonic anhydrase -> decr CSF production) +/- furosemide is 1st line
If failed, optic nerve sheath decompression or lumboperitoneal shunting
steroids and serial LPs only used as bridging Tx due to AEs
342
Tx of bipolar disorder
atipycal antipsychotics
lithium
valproic acid
can use any as monotherapy or atypical antipsychotic + one of the others for more severe disease
343
flushing of face with hot drinks, heat, emotion
rosacea
344
labs distinguishing folate and B12 deficiencies
both cause elevated homocysteine (involved in conversion of homocysteine to methionine)
B12 also causes elevated methylmalonic acid (involved in conversion of methylmalonyl-coa to succinyl-coa)
345
Tx of variant (prinzmetals) angina
Ca channel blockers/nitrates
| avoid nonselective b blockers and aspirin as they can promote vasoconstriction
346
type of conversion disorder where woman thinks she's pregnant, but isnt
pseudocyesis
347
Jervell lange nielson syndrome?
autosomal recessive prolonged QT syndrome + deafness
| Tx: b-blocker +/- pacemaker
348
Tx of diabetic neuropathy
TCAs. alternative is gabapentin
349
worrisome sequela of pseudotumor cerebri
vision loss
350
wrist/foot drop, think of...
lead toxicity
351
cause of hereditary angioedema? Tx?
autosomal dominant deficiency of C1 esterase inhibitor
acute Tx: subq epineprhine
long term Tx: androgens -> incr liver production of C1 esterase inhibitor
352
description of internuclear ophthalmoplegia
seen in MS due to demyelination of the medial longitudinal fasciculus
On lateral gaze in both directions, whichever eye is abducted has horizontal nystagmus
353
Tx of psotpartum endometritis
```
polymicrobial infection
IV clindamycin (anaerobes + gram +'s) and gentamycin (gram -'s)
```
354
Tx of toxic megacolon in UC
prompt IV steroids, NG decompression, fluid management, bowel rest
355
Tx of graft vs host disease
acute: steroids, tacrolimus, mycophenolate
chronic: thalidomide, hydroxychloroquine
356
prophylaxis for contacts of pt with neisseria meningitis
rifampin or ciprofloxacin
357
round eosinophilic inclusions in neurons
negri bodies, seen in rabies
| lewy bodies, seen in parkinson's & lewy body dementia
358
Chediak higashi syndrome?
AR defect in microtubule polymerization -> giant granules in neutrophils, infections, oculocutaneous albinism
359
herpes zoster in young adult, think...
HIV
360
chronic mucocutaneous candidiasis a/w ?
hypothyroidism
361
cause of isolated systolic hypertension seen in the elderly
decreased elasticity of the arterial wall
362
Live vaccine that can be given to HIV pts
MMR
363
A-a gradient calculation
(PAO2) - (PaO2) = (150-PaCO2/0.8) - PaO2
| Nl is <15
364
Tx of MS
Acute: steroids
chronic: beta-interferon or glatiramer acetate
365
Why do atypical antipsychotic meds have less extrapyramidal side effects?
Along with D2 blockade, they also bind to serotonin receptors
366
joint pain in hand, dactylitis (sausage digit), nail involvement
psoriatic arthritis
367
contraindications to buproprion
seizure hx or hx of anorexia/bulimia which predispose to seizures
368
low T3 with normal TSH & T4 after a severe illness
sick euthyroid syndrome
369
Tx of hepatic encephalopathy
lactulose, rifaximin, laxatives
370
contraindications to succinylcholine
hyperkalemia, or pts at risk for it (burn, crush injury, guillan barre, tumor lysis)
371
metabolic side effects of HCTZ
hyperglycemia, incr LDL and triglycerides
| hyponatremia, hypokalemia, hypercalcemia, hyperuricemia
372
umbilicated vesicles after being treated for atopic dermatitis
eczema herpeticum (form of primary HSV). can be life threatening, Tx with acyclovir promptly
373
Chondrocalcinosis can be cause by ?
idiopathic (pseudogout), hypomagnesemia, hyperparathyroidism, hemochromatosis
374
screening test for PKU
Guthrie test of the urine, tests metabolic products of phenylalanine
375
lab test for recurrent MI
CK-MB (typically returns to normal after 1-2 days). Troponin T takes 10
376
AE of hydroxychloroquine
retinopathy - requires eye exams every 6 months
377
Tx of beta blocker toxicity
First, IV fluids and atropine. Then, glucagon
378
seborrheic dermatitis a/w?
parkinsonism or HIV
379
EKG finding with digitalis toxicity
atrial tachycardia with AV block
380
DDx for anterior mediastinal mass
thymoma, teratoma, thyroid cancer, terrible lymphoma
381
How to differentiate between AS and MR murmurs
hand grip increases MR and decreases AS
382
Cancers seen in Lynch syndrome
colon, endometrial
383
physical exam test to differentiate liver vs cardiac cause of peripheral edema
hepatojugular reflux
384
Defect in huntington's disease
autosomal dominant. multiple CAG repeats on chromosome 4
385
Tx of alzheimer's
cholinesterase inhibitors (donepezil, rivastigmine, galantamine)
memantine
occupational therapy
386
NF 1 mnemonic
```
Cafe au lait spots
Optic glioma
Freckling
Fam Hx (AD)
Iris hamartomas
Skeletal lesions
```
387
Tumor seen in NF 2
bilateral acoustic schwannoma (also get cataracts)
388
Tx of narcolepsy
Modafinil (preferred), methylphenidate, meoline
TCAs to prevent cataplexy
regular sleep cycle w/ naps
389
amniotic labs in neural tube defect
increased amniotic AFP and acetylcholinesterase
390
differentiating etiologies of hematuria based on timing in the stream
initial - urethral damage
terminal - bladder/prostatic damage
total - renal/ureter damage
391
persistent ST elevation months after an MI
think of ventricular aneurysm
392
how to differentiate surreptitious vomiting from other causes of hypokalemia like diuretic abuse/bertter's/gittlemans'
urinary chloride will be low in vomiting, high in others
393
newly dx'ed myasthenia gravis, what to do next
chest ct for thymoma
394
Lab test to confirm heparin induced thromboycytopenia
serotonin release assay
395
Lifestyle modifications for tx of HTN in order of effectiveness
```
weight loss
dash diet
exercise
limit sodium
limit alcohol
```
396
Tx of cluster headaches
prophylaxis: verapamil. lithium, ergotamine
acute: 100% O2, subq sumatriptan
397
```
give Dx:
Muddy brown casts
RBC casts
WBC casts
Fatty casts
Broad/waxy casts
```
```
muddy brown - ATN
RBC - glomerulonephritis
WBC - interestitial nephritis or pyelonephritis
fatty - nephrotic syndrome
broad/waxy - CRF
```
398
CT showing multiple minute punctate hemorrhages with blurring of grey/white junction
diffuse axonal injury
399
Meds that cause hyperkalemia
```
nonselective b-blockers
ACE-Is/ARBs
K sparing diuretics
digoxin
NSAIDs
```
400
AE of levodopa/carbidopa
early: agitation, dizziness, hallucinations
| late (5-10 yrs into therapy): involuntary movements
401
pt with frequent changing of lens perscriptions
consider glaucoma
402
Tx of exudative macular degeneration
ranibizumab (anti veg F Ab)
| laser photocoagulation
403
Tx of breast cancer with HER2 amplification (after surgery)
trastuzumab
404
Tx options for primary hyperaldosteronism
adrenal adenoma: surgery
| bilat adrenal hyperplasia or non surgial candidate: spironolactone or eplerenone
405
lab markers in paget's disease (of bone)
alk phos: measurement of bone formation
urinary n telopeptide: measurement of bone breakdown
increased urinary hydroxyproline
406
Dx of acute intermittent porphyria
urine porphobilinogen
407
Tx of essential tremor
b blocker or primidone
| primidone may precipitate acute intermittent porphyria
408
PID in patient with IUD
consider actinomyces as cause
409
contraindications to HRT
unexplaiend vaginal bleeding
active liver disease
Hx of thromboembolism
Hx of endometrial or breast cancer
410
electrolyte abnormalities seen in refeeding syndrome
hypokalemia, hypophosphatemia, hypomagnesemia
411
small erythematous macule that progresses rapidly to larger, nontender nodules with necrosis (espec in immunocompromised)
ecthyma gangrenosum - caused by pseudomonas
412
does cardiac tamponade have to be from bleeding?
no - remember viral pericarditis as a cause
413
Describe the CSF fluid in an exudate 2/2 TB & differentiate from empyema
yellow fluid (not purulent), very high protein (>4), lymphocytic predominant, and glucose level just below serum level.
414
Tx of stable ventricular tachycardia
amiodarone
415
Tx of stable supraventricular tachycardia
adenosine
416
What prophylactic Tx do ppl need after gastric bypass
ursodeoxycholic acid reduces risk of gall stones from 40% to 2%. Can also just take their gall bladder during the surgery.
417
URI followed by nephritis - which 2 are high on ddx?
PSGN or IgA nephropathy
418
what labs will you see in chronic kidney disease (regarding parathyroid gland)
```
high phos (kidney can't secrete)
low Ca (low vit D)
high PTH (parathyroid hypertrophy 2/2 low Ca)
This -> renal osteodystrophy
```
419
differentiate somatic and visceral pain
somatic - well localized (peritoneal irritation)
| visceral - vague (stretching of abd viscera in SBO)
420
MOA of rituximab
anti CD20 ab. used in Tx of CLL
421
Sx of selenium deficiency
cardiomyopathy
422
Sx of vitamin A deficiency
blindness, dry skin, impaired immunity
423
Sx of zinc deficiency
alopecia, skin lesions, abnormal taste, impaired wound healing, impaired growth in kids
424
things that increase thyroxine requirement in hypothyroid pts
pregnancy
| estrogen replacement therapy
425
Tx of cat scratch disease
organism is bartonella
| Tx is azithromycin
426
describe juvenile myoclonic epilepsy
absence seizures begin around age 10, which progress to myclonic at 15 and generalized tonic clonic at 16. frequent limb jerking in the morning that is worsened by sleep deprivation
427
progression of EKG changes in hyperkalemia
peaked T waves, flattening of p wave, widening of QRS, sine wave, arrest
428
raloxifene effects
estrogen agonist on bone - 1st line agent for prevention of osteoporosis
estrogen antagonist on breast and vaginal tissue (decreases breast ca risk)
no change in endometrial ca risk
increases thromboembolism risk
429
pt w/ nephrotic syndrome suddenly gets worse w/ hematuria
consider renal vein thrombosis (from loss of ATIII). most commonly caused by membranous glomerulonephritis
430
what type of RBC transfusion should be given to someone w/ previous febrile nonhemolytic transfusion rxn?
IgA deficiency?
BMT recipients?
leukoreduced (also decreases CMV transmission and HLA alloimmunization)
washed
irradiated
431
clubbing in a pt w/ COPD
lung cancer
432
management of pt with ASCUS on pap smear
21-24: repeat in 1 yr
| >24: HPV test. pos, colpo. neg, repeat pap+HPV in 3 yrs
433
Tx of pen allergic pt with syphilis
doxycycline
| if pregnant, desensitization then penicillin
434
UTI with alkaline urine
proteus. may cause struvite stones
435
```
AE of these HIV meds:
lamivudine
abacavir
didanosine
efavirenz
```
lamuvidine - relatively few, but hepatotoxicity can occur
abacavir - lactic acidosis, hepatitis, hypersensitivity rxn w/ high mortality rate
didanosine - pancreatitis
efavirenz - insomnia with vivid, bizarre dreams
436
imaging study in stable pt after chest trauma w/ mediastinal widneing? unstable?
TEE or chest CT
| thoracotomy
437
lipid lowering med most effective for triglycerides
fibrates
438
Effects of OCPs on ca risk
decr risk - ovarian and endometrial
| slightly incr risk - breast and cervical
439
pathways involved in schizophrenia
mesolimbic (too much dopamine) - positive symptoms
mesocortical (too little dopamine) - neg symptoms
nigrostriatal - EPS
tubuloinfundibular - hyperprolactinemia
440
purple grey metallic rash over sun exposed areas and jaundice in a person on antipsychotics
chlorpromazine AE
441
prolonged QT and pigmentary retinopathy in a person on antipsychotics
thioridazine AE
442
Tx of akathisia due to antipsychotic
propranolol (1st line)
| benzos
443
Which antipsychotics don't affect weight?
ziprasidone (prolongs qtc)
| aripiprazole (incr akathisia)
444
antipsychotic most a/w weight gain?
olanzapine
445
antipsychotic w/ highest risk for EPS and prolactinemia
risperidone
446
antipsychotic that causes orthostasis and cataracts
quetiapine (alpha blocking properties)
447
meds that might cause depression
b blockers, a-methyldopa, IFN, OCPs, drugs of abuse
448
MOA of buproprion
Dopamine/norepi reuptake inhibitor
449
Tx of hypertensive crisis with MAOIs
phentolamine (a blocker)
450
bipolar pt develops n/v/d, coarse tremor, ataxia, confusion, slurred speech
lithium tox. usually precipitated by NSAIDs (use aspirin or sulindac instead)
451
EKG in lithium tox
t wave flattening or inversion
| u waves
452
Tx of PTSD nightmares (besides SSRI)
a blocker (ie prazosin)
453
antipsychotic a/w hypothermia (disrupts shivering mechanism)
fluphenazine
454
differentiating laryngomalacia vs vascular ring
laryngomalacia - worse in supine. improves in prone
| vascular ring - improves with neck extension, a/w cardiac abnormalities (50%)
455
Tx of meniere's
1st line: low salt diet
| diuretics, antihistamines, anticholinergics
456
1st test to order w/ new onset torticollis in children
cervical spine radiographs to r/o spine fracture/dislocation
457
indicators of poor nutitrion
weight loss
albumin
transferrin
458
DOC for wolf parkinson white
procainamide
