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1

lethal triad =

acidotic + hypothermic + coagulopathic

2

CT head shows gray-white blurring =

Diffuse axonal injury
-occurs via angluar trauma
-no treatment
-poor prognosis

3

How to calculate fluids for a burn patient?

Parchland Formula

4 x kg body weight x % surface area burned = fluids in 24 hr
-give first 50% in first 8h
-give next 50% in next 16h

To calculate % surface area burned = rule of 9s

4

infection prophylaxis for burn patients?

Topical mupirocin
Topical silver sulfadiazine

5

How to assess the long term treatment of someone with Afib

Rate control (Beta blocker), Rhythm control, Anticoagulation

Angicoagulation (CHA2DS2-VASc)
-CHF
-HTN
-Age >75
-DM
-Stroke
-Vascular disease
-Age 65-74
-Sex (female)

If score 0-1 = ASA only
If score 2+ = oral anticoagulation (NOAC, Warfarin with INR 2-3)

6

What does giving fluids to someone and then them becoming hypertensive, bradycardic and go into respiratory depression indicate?

Cushing's reflex = indicates elevated ICP

7

Blunt abdominal trauma leading to a GI perforation most commonly affects what portion of the tract?

Damage to mesenteric blood supply leads most commonly to jejunal ischemia

8

AFP? beta-hCG?
nonseminomatous germ cell tumor
seminomatous tumor

Nonseminomatous = elevated AFP, elevated beta-hCG
-embryonal (normal AFP)
-yolk sac tumors
-choriocarcinoma
-teratomas

Seminomatous = normal AFP, elevated beta-hCG, increased placental Alk Phos

9

calf is rapidly worsening, swollen, tense, exquisitely tender, pain worsened by passive extension, distal pulses intact =

compartment syndrome (soft tissue swelling)
-dx via measuring tissue pressure (>30 mmHg) or dela pressure (Diastolic BP - Compartment P <20-30 mmHg)
-tx = fasciotomy

DDX
-arterial embolism - absent pulses, pallor of affected limb
-DVT - vague aching pain

10

Emergent warfarin reversal

Fresh Frozen Plasma (FFP) - the most rapid method

Vit K - reverses slowly, depends on the synthesis of new vit K dependent clotting factors

Prothrombin Complex Concentrate (PCC) - has prothrombin for rapid reversal + Vit K for long term reversal - used for Intracranial hemorrhage

11

pathogenesis of vasovgal syncope

increased parasympathetic activity -> bradycardia -> peripheral vasodilation -> decreased CO -> syncope

12

Differential for Low Ca, High Phos

Low PTH - primary hypoparathyroidism
-2/2 post-surgical, autoimmune, defective receptor, non-autoimmune infiltrative destruction
-will have normal kidney function

Low Vit D 2/2 CKD
-results in secondary hyperparathyroidism (PTH will be high)
-will have poor kidney function (high Cr)

13

pathology of hyperventilation as a treatment for increased ICP

Hyperventilation -> decreases PaCO2 -> cerebral vasoconstriction -> decreased cerebral blood flow -> decreased cerebral blood volume -> decreases ICP

14

What is ICP consist of (3) and what are ways to reduce it

ICP = 3 compartments
-brain parenchyma (can reduce this pressure via mannitol)
-CSF (can reduce this pressure via therapeutic lumbar punctures)
-cerebral blood flow (can reduce this pressure via hyperventilation)

15

Ankle Brachial Index cut off for occlusive PAD

ABI greater than 0.90 is diagnostic for occlusive PAD

16

Fever, lower abdominal/flank pain, leukocytosis, increased pain when hip is extended, less pain when hip is flexed

Psoas abscess
-Dx = CT
-Treatment = drainage

17

metaclopramide - pro motility or anti motility?

Promotility - dopamine antagonist

18

Colonic watershed areas (2)

-Splenic flexure (superior mesenteric artery, inferior mesenteric artery)
-Rectosigmoid junction (sigmoid artery, superior rectal artery)

19

Premature infants with grunting, flaring, retractions, central cyanosis immediately after birth =

Treatment?

Respiratory Distress Syndrome

Treatment = continuous

20

Acrocyanosis =

Blue extremities + Pink body
-common
-benign
-may last for 1-2 days

21

Indomethacin contraindication =

intraventricular hemorrhage
-Indomethacin used to close PDA

22

To keep PDA open =

Which conditions require an open PDA to survive? (4)

prostaglandin E1

PDA is required in =
-transposition of great vessels
-tetralogy of fallot
-hypoplastic L heart
-coarctation of aorta

23

Pathogenesis of Fanconi anemia

Chromosomal breaks due to DNA repair problem
-congenital aplastic anemia
-pancytopenia
-macrocytosis
-cafe au lait spots
-absent thumbs
-short stature
-horseshoe kidney

24

Down syndrome + Upper motor neuron symptoms =

atlantoaxial instability

25

Treatment of strabismus

Strabismus = ocular misalignment
-tx: penilization therapy (cycloplegid drops to blur the normal eye), occlusion therapy to normal eye, prescription glasses, surgery
-may be normal up until age 5

26

dermal melanocytosis

Mongolian spot
-self resolving

27

Neuroblastoma vs Wilms Tumor

Neuroblastoma
-neural crest cell tumor
-abdominal mass that does cross midline
-yes systemic symptoms
-calcification seen on XR
-elevated urine and serum catecholamines

Wilms Tumor
-renal malignancy
-abdominal mass that does not cross midline
-asymptomatic

28

Physiologic jaundice causes (3)

-increased RBC concentration at birth and therefore increased breakdown (unconj BR)
-decreased amount/activity of enzyme (unconj BR)
-increased enterohepatic recycling because there are not enough colonic bacteria to make uroBR therefore increased reabsorption of conj BR (conj BR)

Arises >3 days after birth
Resolves within 1-2 weeks

29

Treatment of Impetigo

Impetigo -
-Nonbullous: Staph aureus or Group A Strep, painful nonpruritic pustules that become honey-crusted lesions
-Bullous: Staph aureus, rapidly enlarging flaccid bullae with yellow fluid, painful
-Tx: minor - topical mupirocin; severe - oral cephalexin, dicloxacillin, clindamyin
-Dx: clinical

30

Infant contraindication to breastfeeding =

Galactosemia
-Absence in galactose-1-phosphate uridyltransferase
-Accumulation of galactose 1-phosphate in liver, kidney, and brain
-increased risk for E coli neonatal sepsis

31

Centor Criteria

Used to diagnose Group A Strep Pharyngitis in adults
Criteria
-Fever (measured or via history)
-Tender anterior cervical lymph nodes
-Tonsillar exudates
-No cough

0-1 positive = no diagnosis, no treatment
2-3 positive = rapid strep antigen test, treat if positive
4 positive = treat

32

Treatment for Group A Strep Pharyngitis

Oral penicillin or amoxicillin

33

Traction apophysitis

Osgood Schlatter Disease
-caused by rapid growth which causes the quadriceps tendon to put traction on the apophysis of the tibial tubercle
-dx via xray

34

When is the varicella vaccine given

2 doses
-1 year old
-4 year old

35

palpable _ lymph nodes are always pathologic until proven otherwise

supraclavicular

36

exclusively breastfed infants require what supplementation?

-Vitamin D
-If premature, also require Iron for 1 year

37

Treatment of tourettes
-nonpharmacological
-pharmacological

Nonpharm:
-Habit reversal training (HRT)

Pharm:
-Alpha2 adrenergic agonists (Clonidine, Guanfacine)
-First generaltion antipsychotics (Haloperidol, Pimozide) - lots of side effects
-Second generation antipsychotics (Risperidone)

38

Floppy baby ddx

-Infant botulism (spores in honey or environment)
-Werding Hoffman Syndrome (degeneration of anterior horn cells and CN motor nuclei)
-Pompe disease (elevated ck, lactic acidosis)
-Prader Willi (hyperphagia, undescended testicles, missing Dad's chromosomes)

39

otitis externa (2 bugs)

tx =

otitis externa = "swimmer's ear"

-Pseudomonas aeruginosa
-Staph aureus

tx = remove debris, topical abx (fluoroquinolone), +/- topical glucocorticoid

40

recurrent skin infections and oral mucosal infections. lab shows marked neutrophilia.

Leukocyte Adhesion Deficiency

41

macrosomic fetus size

greater than 4.5 kg (9.9 lbs)

42

treatment for minimal change disease

steroids
-do not need to do a biopsy unless patient does not respond to steroids

43

Basophilic stippling (2)

-thalassemia
-heavy metal poisoning

44

Howel Jolley Bodies

people with functional asplenia or actually no spleen

45

Heinz bodies

-G6PD

46

How to work up developmental hip dysplasia

If less than 4 months old - ultrasound hips
If greater than 4 months old - XRay hips
Refer to ortho

47

Recurrent skin infections and oral mucosa infections. Takes a long time for injuries to heal.

Leukocyte Adhesion Deficiency (LAD)
-defect in chemotaxis of leukocytes
-may also present with delayed cord separation, no pus in wounds
-Leukocytosis with increased neutrophils in the blood (because they cannot get out)
-tx = bone marrow transplant

48

Treatment of Methemoglobinemia

Cyanotic, Pulse ox ~85%, Dark chocolate colored blood, Normal PaO2
Administration of oxygen will not improve symptoms

Path: decrease in O2 delivery to tissues

Tx = Methylene blue

49

Recurrent pulmonary and cutaneous infections

Chronic Granulomatous Disease
-XR
-Catalase positive orgnisms
-Dx: neutrophil function tests (Dihydrorhodamine test, Nitroblue tetrazolium test)

50

Strawberry hemangioma vs Cherry hemangioma

Strawberry = in infants/children
-present at birth
-may get larger but then spontaneously regresses
-benign

Cherry = adults/elderly
-may increase in number as we age
-benign

51

Symmetric dorsal swelling of hands and feet in an African American infant

Dactylitis
-vasooclusion in sickle cell diseae

52

Child with lymphadenopathy, splenomgaly, an increased number of blasts on peripheral blood and positive PAS and positive TdT

ALL
-most common in children

53

infant with acute abdominal distension, bilious vomiting, gasless abdomen on Xray = next step

Upper GI series (barium)
-volvulous = corkscrew
-malrotation = ligament seen on R instead of L

54

muscular dystrophy with testicular atrophy, facial muscle wasting

Myotonic Dystrophy
-AD
-grip myotonia, dysphagia
-associated with arrhythmia, cataracts, balding, testicular atrophy
-death from respiratory or heart failure

Duchenne and Becker are XR

55

When can external cephalic version of a baby be done?

37 weeks or greater

contraindications
-placental abnormalities
-oligohydramnios
-hyperextended fetal head
-fetal/uterine abnormalities
-multiple gestations

56

Tamoxifen VS Raloxefen

Both are SERMs and work to prevent breast cancer
sfx: hot flashes, VTE (2/2 protein C resistance leading to a hypercoag state)

Tamox - also has a sfx of endometrial hyperplasia
Ralox - also for post menopausal osteoporosis prevention

57

new onset dysmenorrhea in a woman over 40 yo who on exam has an enlarged uterus

Adenomyosis

58

What is a and what are contraindications to a contraction stress test (2)

Contraction stress test = oxytocin and nipple stimulation to try to elicit contractions - 2 within 10 min
Do it when the baby is less than 36 weeks

Contraindications
-placenta previa
-prior myomectomy

59

GBS swab is done at _-_ weeks

35-37 weeks

60

"lumpy uterus" (3)

-Endometrial polyps - inter-menstrual spotting
-Uterine sarcoma - very rare, post menopausal woman
-Leiomyomata uteri (Fibroid) - very common in reproductive age women, recurrent pregnancy loss, dysmenorrhea

61

in a post-menopausal woman, ultrasound pelvis shows thick septations, solid components and peritoneal free fluid

Epithelial ovarian ca
-usually already has mets by the time of discovery

62

side effects/adverse effects of oxytocin (3)

-Hyponatremia (may lead to seizures)
-Hypotension
-Tachysystole (abnormally frequent contractions - 6 in 10 minutes)

63

How to dx preeclampsia

Preeclampsia = proteinuria + HTN

Proteinuira dx via
-24 hr urine protein collection >300mg
OR
-urine protein/cr ratio >0.3
OR
-dipstick >1+

64

CA-125

tumor marker for epithelial cell ovarian tumor
-postmenopausal women
-appears late, often has mets
-dx: TVUS + tumor marker levels

65

Treatment of endometrial biopsy that shows endometrial hyperplasia (symptom: abnormal uterine bleeding)

Progesterone
-P is protective to the endometrium

66

Path and treatment of
-neurogenic/overflow incontinence
-urge incontinence
-stress incontinence

Neurogenic/Overflow - no contractions of the detrusor
-cholinergic agonist (Bethanechol)

Urge - random spasms of the detrusor
-bladder training
-muscarinic antagonist (Oxybutynin) or beta-agonist

Stress - weak pelvic floor
-kegel exercises
-pessaries
-surgery

67

Trisomy 21 on quad screen
-MS-AFP
-beta-hCG
-Estriol
-Inhibin A

-MS-AFP = low
-beta-hCG = high
-Estriol = low
-Inhibin A = high

68

Elevated MS-AFP on screening =

NTD or abdominal wall defect

69

Best test to test for Trisomy 21 in utero?

Cell-free fetal DNA test
-can be done >10 weeks
-non-invasive
-not diagnostic but has a high sensitivity and specificity for aneuploidy

70

antibiotics for chorioamnionitis

Chorioamnionitis = ascending infection while the baby is still in
-premature ROM + fever
-elevated IL-6, low glucose on amniocentesis
-tx: ampicillin + gentamicin

71

antibiotics for endometritis

Endometritis = ascending infection after the baby is out
-hx of premature ROM + current fever
-tx: clindamycin + gentamicin

72

At what beta-hCG can you see an intrauterine pregnancy on transvaginal ultrasound?

at greater than 1500

73

Do not give tocolytics after _ weeks

What are 4 different tocolytics and when can they be used?

Do not give tocolytics after 34 weeks
-Indomethacin - cox inhibitor (<32 weeks)
-Nifedipine - ccb (<32-34 weeks)
-Terbutaline - beta agonist - not used due to side effects
-Mag sulfate - very weak

74

Dx and treatment of hyperemesis gravidarum

Dx:
-first rule out molar pregnancy with ultrasound + beta-hCG
-evaluate labs: ketonemia, ketonuria, hyponatremia, hyokalemic, hypochloremic metabolic alkalosis

Tx:
not severe = it B6 + Doxylamine (Anti-histamine)
severe = anti-emetics + IVF

75

Child ingested unknown pills and now has nausea, vomiting with blood, green diarrhea

Iron poisoning
-GI symptoms are first: hemorrhagic because iron is caustic to the GI tract, green diarrhea because of the iron reaction
-later symptoms include: severe lactic acidosis, hepatotoxicity, and diffuse organ failure

76

adult with recent onset fatigue, weight loss, splenomegaly, diffuse lymphadenopathy, lymphocytic leukocytosis =

treatment =

CLL
-lymphocytic leukocytosis
-smudge cells
-treatment = monoclonal Ab against CD 20 antigen

CML = neutrophilic leukocytosis
-treatment = BCR-ABL tyr kinase inhibitors

77

Wide QRS indicates impulse is generated =

treatment for almost all wide complex tachycardias

in the ventricles

tx = amiodarone

78

main risk with parenteral nutrition via central line?

central line associated blood stream infection
-coagulase negative staph
-staph aureus
-gram negative (klebsiella, pseudomonas)
-candida

79

refeeding syndrome is due to _
and occurs in _

due to rapid fluid and electrolyte shifts
occurs in very malnourished patients

80

what is antifreeze

ethylene glycol

-HAGMA
-calcium oxalate crystals
-AKI

81

vasovagal syncope prodrome

nausea, pallor, diaphoresis

82

orthostatic hypotension prodrome

dizzy, blurry vision

hx of supine to standing or of new antihypertensive medications

83

viral pericarditis -> which heart defect

viral myocarditis -> which heart defect

viral pericarditis -> recurrent pericarditis -> cardiac tamponade

viral myocarditis -> dilated cardiomyopathy -> cardiogenic shock

84

Factitious disorder vs Malingering

Factitious disorder = gain is the attention you get as the sick person (internal reward)

Malingering = external reward

85

ovalomacrocytosis, neutrophil hyposegmentation indicates =

MDS - hematopoetic stem cell neoplasm
-may transform to acute leukemia
-dx via bone marrow biopsy

86

medical treatment of hyperprolactinemia

Bromocriptine (Dopamine agonist)

87

anti-endomyseal Ab =

celiac disease

88

hypoxia + tachypnea + tachycardia + clear lungs on exam =

PE

89

anemia most commonly associated with malginancy =

DIC

90

Buprenorphine

treatment for opioid overdose

91

Teardrop RBS on peripheral smear = (2)

-myelofibrosis
-beta thalassemia s/p splenectomy

92

most common cause of sterile pyuria + dysuria in a young sexually active female =

Chlamydia trachomatis
-eventually will lead to scaring of tubules

93

pathogenesis of central cyanosis

decreased arterial oxygen saturation
indicates congenital heart defect

94

most common cause of pediatric hemoptysis =

CF with bronchiectasis

95

Ectopic treatment
-stable/not ruptured
-ruptured/fluid in posterior cul de sac/hemodynamically unstable

-stable = methotrexate
-unstable = surgical exploration/laparotomy

96

misoprostol is used for

treatment of an incomplete abortion
-causes cervical dilation and myometrial contractions

97

Appropriate form of birth control for a pre-menopausal woman who is undergoing chemo for breast cancer

Hormonal birth control is avoided in someone with breast cancer because the breast tissue may respond to the E/P.
Especially true if the breast cancer is BRACA positive because those are most likely ER/PR positive as well.

Most appropriate birth control = copper IUD

98

withdrawal from what drug causes acute depression with suicidal ideation but no physical symptoms?

cocaine withdrawal
-fatigue
-hypersomnia
-increased dreaming
-hyperphagia
-impaired concentration

99

pseudohyphae with budding yeasts + skin infection

Candida

100

skin infection + septate hyphae

Tinea cruris

101

treatment for mild sunburn

cool compress, calamine lotion, NSAIDs, aloe vera

102

gout treatment and ppx

treatment:
first line = NSAIDs
if contraindicated, then
second line colchicine (sfx: dose dependent diarrhea)
-contraindicated if renal dysfunction

ppx:
-allopurinol
-febuxostat

103

9 weeks pregnant + vaginal bleeding + closed cervix + ultrasound confirms 9 week fetus and normal FHR =

threatened abortion
-may continue into normal pregnancy
-tx: observe and repeat ultrasounds

104

3Hz spike wave activity on EEG =

absence seizures

105

recent travel + diarrhea with blood and mucus + cramping + pain to deep palpation + antibiotics didn't work

E. histolytica
-dx via stool ova and parasite
-tx metro + paramycin

106

Child with eczema + recurrent infections + small platelets on peripheral smear =

Wiskott Aldrich Syndrome
-XR defect in WAS protein gene
-impaired cytoskeleton
-tx stem cell transplant

107

Wide QRS is > _ms

Wide QRS >100ms

108

treatment for acute pancreatitis

-IVF
-pain control

109

"loud pulmonary component of S2" =

indicates pulmonary HTN

110

most common solid malignancy in young men

Germ cell tumor/testicular cancer
-unilateral, painless testicular nodule
-firm, does not trans-illuminate
-usually asymptomatic and found incidentally after injury to groin or via sexual partner
-Dx: AFP and beta hCG and scrotal ultrasound
-Tx: radical orichetcomy + chemo

111

Liver mass with central scar =

focal nodular hyperplasia
-no treatment
-benign

112

child born with cleft lip and palate who has had numerous infections and is having seizures

Think of Di George Syndrome
-Cardiac defects(tetrallogy, tructus, interrupted aortic)
-Abnormal facies
-Thymic aplasia (T cell deficiency)
-Craniofacial abnormalities (cleft lip/palate)
-Hypocalcemia/Hypoparathyroidism (low Ca->seizures)

113

Painful erythematous lump along the eyelash line

Painless erythematous rubbery lump along the eyelash line

Painful swelling of the nasal aspect of the lower lid +/- purulen discharge

Painful lump = hordeolum - bacterial infection of an eyelash follicle, staph aureus

Painless rubbery lump = chalazion - granulomatous occlusion of meobmian tear gland, rubbery nodular lesion

Painful swelling = dacrocystitis - bacterial infection of the lacrimal gland, staph aureus, strep pneumo, H flu, can spread to cavernous sinus

114

adolescent boy with bone pain + imaging showing periosteal elevation =

Osteosarcoma - osteoblast/mesenchyma
-metaphasis of long bones
-suburst pattern
-may present with lung mets

115

adolescent boy with bone pain + imaging showing onion skinning + systemic symptoms =

Ewing Sarcoma - neuroectoderm
-Midshaft of long bones

116

Cupping of optic disc = (2)
-painless
-painful

Increased IOP -> atrophy of the optic nerve head
-open angle glaucoma = 2/2 decreased outflow of aqueous humor -> increased IOP, loss of peripheral vision, painless
-acute angle closure glaucoma = 2/2 occlusion of anterior chamber -> outflow obstruction -> rapid increase in IOP, opthalmologic emergency as it can lead to permanent blindless, painful, sudden blurring + n/v
-tx: tonometry to measure IOP

117

cherry red fovea + retinal pallor + acute painless monocular vision loss

central retinal artery occlusion
-key word is that current vision loss, NOT transient
-2/2 embolization from carotid artery
-tx: ocular massage to dislodge embolus, high flow O2

118

ERCP shows bead-like dilations of intra- and extra-hepatic bile ducts + jaundice + pruritis + weight loss + bloody diarrhea =

complications

Primary Sclerosing Cholangitis
-intra and extra hepatic bile duct thickening + lumenal narrowing
-chronic, idiopathic
-insidious onset/symptoms
-bx: fibrous replacement of bile ducts, onion skinning
-tx: liver transplant, cholestyramine for symptoms
-associated with ulcerative colitis (bloody diarrhea)

Complications
-colangiocarcinoma
-portal HTN
-liver failure
-colon cancer

119

destruction of intrahepatic bile ducts + autoimmune association + pruritis + xanthelasma =

Primary biliary cirrhosis
-anti-mitochondrial Ab
-associated with
-hepatocellular carcinoma
-metabolic bone disease - osteoporosis, osteomalacia
-liver biopsy to confirm diagnosis
-tx: cholestyramine and calcium/bisphosphonates for symptoms , ursodeoxycholic acid to slow progression, liver transplant

120

holosystolic murmur in the 4th intercostal space on the L sternal border with a palpable thrill =

VSD

121

startle myoclonus + dementia =

CJD

122

waxing and waning demenita ("good days and bad days") + shuffling gait + visual hallucinations

Lewy Body Dementia

123

lymphogranuloma venereum =

chalmydia trachomatis

124

sonohysterography is used for

used to dx intramural fibroids

125

SIADH labs

-LOW serum osmolality
-HIGH urine osmolality
-HIGH urine Na
-EUVOLEMIC clinically

126

smoker + cavitary lung lesion =

squamous cell carcinoma
-can be found in apex of lung
-cavitation on CXR
-hypertrophic osteoarthropathy - long bone pain

127

smoker + lung nodule =

small cell lung cancer
-hilar mass
-mediastinal lymphadenopathy
-often has extrinsic compressive symptoms

128

direct hernia occurs 2/2

weakness of transversalis fascia/inguinal canal floor
-older men
-bulge in inguinal area

129

indirect hernia occurs 2/2

laxity of the deep inguinal ring + patent process vaginalis
-young boys
-into scrotum

130

treatment of catatonia-type of schizophrenia

-benzo (lorazepam)
-ECT

131

Psychotherapy - exposure and response prevention
is used for _

OCD

132

Psychotherapy - Dialectical behavior therapy
is used for _

Borderline personality disorder

133

What drug can also cause serotonin syndrome?

MDMA, Ecstasy
sfx: HTN, tachycardia, hyperthermia, hyponatremia, serotonin syndrome

134

Treatment of acute dystonia

occurs shortly after starting an antipsychotic
tx = anticholinergic, antihistamine

135

Treatment of tardive dyskinesia

occurs after long term antipsychotic or metaclopromide use
tx = stop offending agent, switch to Clozapine

136

Treatment of akathesia

can occur at any point during an antipsychotic treatment
tx = beta blocker

137

smoking cessation treatment (3)

-nicotine replacement
-Varenecline - sfx: mood changes, suicide
-Bupropion - contraindicated in bullemia or seizure disorders

138

V Fib or Pulse-less V Tach ->

defibrillation followed by epi, vasopressin and amiodarone or lidocaine

139

yes pulse and V Tach ->

amiodarone and synchronized cardioversion

140

how to investigate a potentially suspicious malignant mole?

excisional biopsy

141

When can cervical cancer screening stop?

65 years old - as long as adequate negative prior screenings and no history of CIN2 or higher

pap+HPV co-test Q3 years from 21-65 yo
if both HPV and cytology are negative in women >30 yo, can test Q5 years

142

postpartum fever unresponsive to broad-spectrum antibiotics

Septic pelvic throbophlebitis vs abscess
-thrombophlebitis tx = IV heparin
-abscess = percutaneous drainage + continue abx

143

increased hemoglobin A2 and anemia =

thalassemia

144

koilocytosis (2)

-HPV
-CMV

145

rash develops after administration of Amp or Amox for sore throat =

EBV

146

painless palpable gallbladder + jaundice =

Courvoisier sign = pancreatic cancer

147

opthalmoplegia =

paralysis of extra-ocular muscles

148

calf erythema, tenderness, palpable "cord" =

superficial thrombophlebitis
-benign
-clot in a superficial vein
-does not cause PE
-tx: NSAIDs + warm compress

if recurrent, then it is a sign of underlying malignancy

149

Treatment for rosacia? (2)

-topical metronidazole
-oral tetracycline

150

what does paget's disease of the breast indicate?

underlying breast cancer that has traveled to the nipple
-invasive ductal carcinoma
-ductal carcinoma in situ

151

fissuring of the corners of the mouth=

angular stomatitis
stomatitis = inflammation of the mucous membranes of the mouth
-B deficiency - riboflavin, niacin, pyridoxine
-C deficiency

152

hearing loss + vertigo + tinnitus + nausea/vomiting
-dx
-tx

Meniere disease
tx:
-Benzo
-Scopolamine (Anticholinergic)
-Antihistamines (Meclizine, Dimenhydrinate)
-Thiazide diuretics

153

vesicles on tympanic membrane

Infectious myringitis (bullous myringitis)
-inflammation of TM
-Mycoplasma, Strep pneumo, viruses
-Tx: erythromycin, clarithromycin

154

hyperthyroidism + tender painful thyroid + preceeding viral infection =

subacute thyroiditis

155

what other 3 diseases are associated with Hashimoto?

-Hashimoto
-vitiligo
-pernicious anemia
-diabetes

156

triple therapy for H Pylori

-PPI
-Clarithromycin
-Amoxicillin

157

best imaging for head trauma =

noncontrast CT

158

penetrating trauma of the neck location and tx
-zone I
-zone 2
-zone 3

1 = base of clavicles to above clavicle -> arteriogram
2 = top of clavicle to angle of mandible -> OR
3 = angle of mandible to base of skull -> arteriogram

159

Tx of
hypertensive urgency
hypertensive emergency

Urgency - high BP with no symptoms
-PO furosemide, clonidine, captopril

Emergency - high BP with symptoms
-IV nitroprusside, labetalol, nicardipine

160

Hereditary Angioedema is a deficiency of _
-acute tx
-long term tx

Hereditary Angioedema = deficiency of C1 esterase inhibitor (compliment)
-C4 compliment levels are low (differentiating it from acquired angioedema)
-acute treatment = (similar to anaphylaxis) IM Epi, H1/H2 receptor blockers, steroids
-long term treatment = androgens (because it increases liver production of C1 esterase inhibitor)

161

what is the classic cause and symptoms of SCID?

cause: Adenosine deaminase deficiency (AR)

symptoms: B and T cell dysfunction

162

giant granules in neutrophils + oculocutaneous albinism + recurrent infections in a child

Chediak- Higashi syndrome
-AR
-abnormal protein trafficking leading to impaired phagocytosis

163

kidney disease that is most common in caucasian adults, granular deposits of IgG and C3 in BM

Membranous Nephropathy
-most common nephrotic in caucasian adults
-associated with HBV, syphilis, malaria, gold
-tx Prednisone

164

tram track BM kidney disease

Membranoproliferative nephropathy
-associated with HCV, cryoglobulinemiia, SLE, subacute bacterial endocarditis
-tx Prednisone

165

retinal findings of dot-blot hemorrhages, microaneurysms, neovascularization of the retina, macular edema =

Diabetes
-most common cause of blindness in adults under 50 yo

166

retinal findings of arteriolar narrowing, "wiring", cotton-wool spots =

HTN
-may lead to central retinal vein occlusion (acute painless, unilateral vision loss)

167

when is it indicated to give betamethasone to a pregnant mom

when is indicated to give mag to a pregnant mom

steroids: if preterm labor <34 weeks

mag: if preterm labor <32 weeks

168

Multiple Sclerosis
Chronic treatment
Acute treatment

Chronic = Interferon
Acute = high dose steroids

169

Treatment of trigeminal neuralgia

Carbamazepine

170

Stroke:
-pure motor =
-pure sensory =

-pure motor = internal capsule
-pure sensory = thalamus

171

nephrolithiasis diagnostic study of choice =

-ultrasound
-noncontrast CT

172

transient monocular vision loss, "shade pulled over one eye", painless

amaurosis fugax
-key word is transient
-occurs 2/2 embolus from carotid artery
-dx via carotid duplex us

173

fever + wheezing + elevated eosinophils + rash =

Churg Strauss
-Granulomatous vasculitis
-Dx - positive P-ANCA
-Treatment - systemic glucocorticoids

174

Differentiating factor between polymyalgia rheumatica vs polymyositis

Polymyalgia rheumatica does not have weakness. Polymyositis does have weakness.

PMR: pectoral and pelvic girdles, elevated ESR, EMG normal, associated with temporal arteritis, dx is response to steroid treatment

Polymyositis: proximal muscles, elevated ESR, abnormal EMG, dx via muscle biopsy, elevated CPK, increased risk of malignancy

175

what should you think about if you see a patient with unprovoked hypothermia

hypothermia <35 C

myxedema coma is a cause of hypothermia
-obtain appropriate thyroid labs
-low Na, high PaCO2
-tx: rapid administration of levothyroxine and glucocorticoids

176

3 things to think about that cause erythema multiforme

erythema multiforme = target lesions, may occur on palms/soles

-sulfa drugs
-penicillins
-HSV

177

3 things to think about that cause erythema nodosum

treatment

erythema nodosum = inflammation of subcutaneous tissue and skin, classically over the shins

-sarcoidosis
-cocci
-ulcerative colitis

treatment = symptomatic therapy - NSAIDs, leg elevation, compression bandages

178

amaurosis fugax vs central retinal artery occlusion

both are caused by occlusion of the retinal artery most often due to emboli from carotid artery

AF is very transient, curtain coming down over the eye
CRAO is when someone is complaining about current monocular vision loss that has not resolved
-will have particular occular findings (central pallor, cherry red macula)

179

"popcorn calcifications" on a solitary lung nodule =

hammartoma
-benign
-pt <40 yo with no risk factors

180

When you dx CPPD/Pseudogout, what 3 associated syndromes/diseases should you think of

-hemochromatosis
-hypothyroidism
-hyperparathyroidism

181

small bowel biopsy showing PAS positive material in the lamina propria =

Whipple Disease
-multisystem illness
-arthralgias + malabsorptive diarrhea + weight loss + fever + cough + myocardial/valvular issues + myoclonus + hyperpigmentation
-T whippelii

182

Hydroxycobalamin and Sodium Thiosulfate are treatments for what toxicity?

CN poisoning

183

Treatment of Paget's disease of bone =

Bisphosphonates

184

child with recurrent sinusitis + asthma + episode of giardia =

Common variable insufficiency - B cell problem
-tx: IVIG

185

Protamine sulfate

reversal of Heparin

186

Prothrombin complex concentrate (PCC)

reversal of Warfarin after an intracranial hemorrhage

-FFP and Vit K are the other Warfarin reversal agents

187

what does the "null hypothesis" indicate

that there is no association between the variables of interest

188

Tick-borne ascending paralysis vs Gullian Barre Disease

Tick-borne:
-asymmetrical
-occurs over hours
-no autonomic symptoms
-normal CSF
-normal sensation
-tx: look for tick

GBS:
-symmetrical
-occurs over days-weeks
-yes autonomic symptoms (tachycardia, urinary retention, arrhythmia)
-abnormal CSF
-normal sensation
-tx: IVIG and/or plasmapheresis

189

Pregnant woman in 3rd trimester with jaundice, nausea, vomiting, RUQ abdominal pain, leukocytosis, hypoglycemia, AKI =

Acute Fatty Liver of Pregnancy (AFLP)

190

Preeclampsia hypertension treatment (3)

-IV hydralazine
-IV labetalol - do not give if patient is bradycardic
-PO nifedipine - do not give if patient is having n/v (because it is PO)

191

protator drift indicates a _ lesion

UMN lesion - pyramidal/corticospinal tract

192

hypogonadotrophic hypogonadism indicates a problem _

in the hypothalamus or pituitary
tx: GnRH agonists

193

what to think about when there is an thoracic aorta repair/surgery =

risk of anterior spinal cord infarction due to loss of radicular arteries that come off the thoracic aorta that lead to the anterior spinal artery

194

Imaging tests after blunt abdominal trauma (2)

1)FAST
2)CT with contrast