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1
Q

what is happening in Laryngomalacia?

A

Intermittent collapse arytenoid cartilage during inspiration → increase turbulence of air → inspiratory stridor

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2
Q

When does stridor increase in laryngomalacia?

A

Stridor increases with crying and feeding (during increase air flow)

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3
Q

posterior dislocation of the humerus at the supracondylar level?

A

Supracondylar fracture → posterior dislocation of the humerus → damage to the median nerve and brachial artery.

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4
Q

anterior dislocation of humerus at supracondylar level?

A

Anterior dislocation of humerus → impingement of ulnar nerve ( rare form of supracondylar fracture)

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5
Q

Pheochromocytoma is associated with?

A

Pheochromocytoma is associated with VHL dx, MEN2, neurofibromatosis type 1

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6
Q

Treatment for frostbite

A
  1. rapid rewarming with warm bath.

2. Anelgesia and wound care. Thrombolysis in severe limb threatening cases

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7
Q

Treatment for mild hypothermia

A

passive external warming (remove wet clothes, cover with warm blankets

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8
Q

Treatment for moderate hypothermia

A

active external warming (warm blankets, heating pads, warm bath

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9
Q

treatment for severe hypothermia

A

active internal warming (warmed pleural or peritoneal irragation, warmified humified oxygen

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10
Q

Influenza complication for advanced age and chronic illness and Treatment?

A

Pneumonia → worse cough and dyspnea, leukocytosis, bilateral diffuse interstitial infiltrates on cxr.

Tx: hospitalization with supplemental oxygen and osteltamivir (antiviral)

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11
Q

Seizure + acute bacterial gastroenteritis should raise concerned for?

A

shigella

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12
Q

Ultrasound finding for Nonalcoholic fatty liver disease (NAFLD)

A

hypoechoic appearing liver which reflects hepatic fatty infiltrates

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13
Q

Criteria for Nonalcoholic fatty liver disease (NAFLD) and treatment

treatment?

A

Type 2 diabetes, obesity and elevated liver enzymes (AST/ALT <1)
treatment is weight loss

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14
Q

Mullerian agenesis is associated with?

A

associated with renal anomalies such as duplicated ureter so they need renal ultrasound

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15
Q

what to do after seeing HSIL on pap smear?

A

colposcopy

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16
Q

What to do if squamocolumnar junction cannot be seen or colposcopy is unsatisfactory?

A

endocervical curettage (endocervical sampling (sample tissue))

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17
Q

Genitopelvic pain/ penetration disorder (vaginismus)

feature?

A

Pain with attemped to vaginal penetration, inserting tampon, or during gyn examination
However no other medical problem

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18
Q

Genitopelvic pain/ penetration disorder Treatment?

A

desensitize therapy and kegel exercise

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19
Q

Acute hemolytic transfusion reaction

feature?

A

Fever, flank pain and dark urine after transfusion

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20
Q

what is the diagnostic test for acute hemolytic transfusion reaction?

A

direct coomb test

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21
Q

what is the treatment for acute hemolytic transfusion reaction?

A

stop transfusion, give fluid and supportive care

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22
Q

what is some complications from acute hemolytic transfusion reaction?

A

DIC and acute renal failure

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23
Q

Pt with chronic autoimmune disease such as SLE, sjogren dx are at risk for?

A

Non Hodgkin lymphoma due to persistent B cell stimulation and immune dysregulation
Lab finding = increased LDH

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24
Q

Friedreich’s ataxia symptoms?

A

Neurological dysfunction = loss of proprioception and vibration sense, ataxia, spastic weakness
Cardiomyopathy
DM
Scoliosis

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25
Q

who gets Anemia of prematurity?

A

premies

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26
Q

lab finding for anemia of prematurity?

what is the etiology?

A

Low hemoglobin, hematocrit and RBC but normocytic normochromic RBC

impaired ability to produce adequate erythropoietin (EPO)

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27
Q

Treatment for anemia of prematurity?

A

Tx: minimize blood draws, iron supplement and transfusion

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28
Q

which anticoagulant should be used for DVT/ PE patients with renal dx?

A

unfractionated heparin

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29
Q

Emphysematous cholecystitis treatment?

A

Surgical emergency → cholecystectomy now

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30
Q

Fever, RUQ pain, absent peritoneal signs with possible crepitus in the abdominal wall (rare)
Air fluid filled in gallbladder on U/S

A

Emphysematous cholecystitis

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31
Q

recurrent mild and unilateral mid cycle pain prior to ovulation. pain lasts hours to days

A

Mittelschmerz

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32
Q

amenorrhea, abdominal/pelvic pain, and vaginal bleeding
positive HCG
no intrauterine pregnancy on U/S

A

Ectopic pregnancy

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33
Q

sudden, onset severe unilateral lower abd pain, nausea and vomiting
unilateral tender adnexal mass on examination

A

ovarian torsion

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34
Q

what is the U/S finding for ovarian torsion?

A

enlarged ovary with decreased or absent blood flow

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35
Q

sudden onset severe unilateral lower abd pain right after strenuous exercise or sexual activity

A

rupture ovarian cyst

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36
Q

what is the U/S finding for rupture ovarian cyst?

A

pelvic free fluid

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37
Q

fever/chills, vaginal discharge, lower abd pain, and cervical motion tenderness

A

PID

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38
Q

Why is aldosterone not affected by Panhypopituitarism?

A

Aldosterone is not affected because it is regulated by RAAS and not hypopituitarism
Low T4, cortisol/ ACTH, FSH/LH for
Panhypopituitarism

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39
Q

Treatment for lichen planus?

A

topical high potency glucocorticoids

Seen on skin, oral mucosa, genitalia

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40
Q

how to diagnose and treat ovarian torsion?

A

U/S

emergency lap detorsion or cystectomy

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41
Q

treatment for prostatitis?

A

6 weeks of TMP- SMX or fluoroquinolone

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42
Q

diagnosis for prostatitis?

A

Diagnosis is confirmed by digital rectal exam (swollen tender prostate = anterior tenderness) but urine culture is needed to establish infected organism

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43
Q

C7 radiculopathy

A

Weakness in triceps extension and wrist flexion; numbness in index and middle fingers

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44
Q

C6 radiculopathy

A

Weakness in wrist extension and numbness in forearm and thumb

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45
Q

PPROM

<34 weeks (reassuring)

A

latent antibiotics, corticosteroids

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46
Q

PPROM

<34 weeks (nonreassuring)

A

delivery

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47
Q

PPROM

>34 weeks

A

delivery

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48
Q

neuroleptic malignant syndrome treatment

A

Stop antipsychotic or restart dopamine agent

Dantrolene or bromocriptine if refractory

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49
Q

neuroleptic malignant syndrome

A

Muscle rigidity, akinesia, tremor
Hyperthermia
Autonomic instability (tachycardia, labile blood pressure, tachypnea, diaphoresis, dysrhythmias)
Mental status change: confusion, delirium, reduced vigilance, stupor

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50
Q

pt has AF + acute limb ischemia. what is the treatment?

A

Treat with Factor Xa inhibitors (apixaban, dabigatran, rivarobaxan) to prevent embolic occluson such as acute limb ischemia
Oral anticoagulant

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51
Q

scaly plaques/nodules +/- hyperkeratosis or ulceration on skin

A

squamous cell carcinoma of skin

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52
Q

diagnosis for squamous cell carcinoma of skin

A

biopsy
dysplastic/ anaplastic keratinocytes
keratin pearls

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53
Q

a pregnant woman has ovarian torsion. what do you do for her and pregnancy?

A

Do oophorectomy
If the corpus luteum is removed before 10 weeks, must give progesterone to maintain pregnancy. Can discontinue after 10 weeks

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54
Q

progressive proximal muscle weakness and atrophy without pain or tenderness
normal ESR + CK

A

Glucocorticoids inducted myopathy

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55
Q

muscle pain and stiffness in shoulder and pelvic girdle
tenderness and decreased ROM at shoulder, neck and hip
respond with glucocorticoids

A

polymyalgia rheumatica

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56
Q

lab finding for polymyalgia rheumatica

A

elevated ESR and normal CK
negative rheumatoid factors and no autoantibodies
Normochromic anemia

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57
Q

Muscle pain, tenderness and proximal muscle weakness

skin rashes and inflammatory arthritis may be present

A

elevated ESR and CK

Polymyositis (PM): inflammatory myopathy affecting the proximal skeletal muscles
Dermatomyositis (DM): polymyositis, with the addition of skin involvement
Inclusion body myositis (IBM): both the proximal and distal skeletal muscles

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58
Q

prominent muscle pain/tenderness with or without weakness

rare rhabdomyolysis

A

statin induced myopathy

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59
Q

lab finding for statin induced myopathy

A

normal ESR and elevated CK

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60
Q

muscle cramps, pain, weakness of proximal muscles
delayed tendon reflex and myoedema
occasional rhabdomyolysis
features of hypothyroidism are present

A

hypothyroid myopathy

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61
Q

lab finding for hypothyroid myopathy

A

normal ESR and elevated CK

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62
Q

Sudden, severe loss of vision in the affected eye
funduscopic exam shows
dot-and-blot and/or flame-shaped hemorrhages in all four retinal quadrants
venous thickening (blood and thunder appearance)
Cotton wool spots
macular edema

A

Central retinal vein occlusion

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63
Q

Sudden, painless loss of vision in one eye (often described as a “descending curtain”)
funduscopic exam shows
Grayish-white (cloudy) discoloration of the entire retina
Cherry-red spot at the fovea centralis
Retinal plaques/emboli

A bruit over the carotid artery is a sign of carotid atherosclerosis.
An irregular pulse may indicate atrial fibrillation.
Scalp tenderness and/or jaw claudication is a sign of temporal arteritis.

A

central retinal artery occlusion

past hx of Amaurosis fugax

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64
Q

sudden, painless loss of vision that lasts for seconds to minutes and is followed by spontaneous recovery (mostly unilateral)

A

Amaurosis fugax

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65
Q

treatment for hyperemesis gravidarum

A

hospital admission

antiemetics and IV fluids

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66
Q

treatment for adjustment disorder

A

psychotherapy

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67
Q

Treatment for polymyositis?

A

Treatment for polymyositis includes glucocorticoids and glucocorticoids sparing agents such as methotrexate and azathioprine

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68
Q

Females (46 XX)
Birth: Ambiguous genitalia despite normal internal genital organs
Puberty: Impaired maturation of secondary sexual characteristics
Primary amenorrhea
Virilization (e.g., hirsutism, severe acne)
no ovarian mass

A

Aromatase deficiency

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69
Q

Drowning can cause?

A

ARDS and hypoxemia

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70
Q

what tumor marker is used to evaluate recurrence of thyroid cancer after thyroidectomy

A

Thyroglobulin

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71
Q

endometrial biopsy indication

> age 45

A

anyone with abnormal bleeding or postmenopausal bleeding

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72
Q

endometrial biopsy indication

< age 45

A

abnormal bleeding plus
unopposed estrogen (obesity, anovulation)
failed medical management
lynch syndrome (HNCR)

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73
Q

endometrial biopsy indication

< age 35

A

atypical granular cells on pap test

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74
Q

Irregular vaginal bleeding, pelvic pain and enlarged uterus + chest pain, hemoptysis and dyspnea
occur after pregnancy, abortion or hydatidiform mole

A

Choriocarcinoma

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75
Q

kids with Isolated speech delay; what is the next step?

A

hearing test

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76
Q

papule at scratch/bite site
regional adenopathy
+/- fever

A

cat scratch disease

bartonella henselae

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77
Q

Treatment for multiple sclerosis

A

high dose iv glucocorticoids

If unresponsive, use plasma exchange

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78
Q

Treatment for infant botulism

A

human derived botulism immune globulin

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79
Q

Treatment for foodborne botulism

A

equine derived botulism antitoxin

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80
Q

Treatment for idiopathic intracranial hypertension

A

Weight loss

acetazolamide

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81
Q

fever, irritability, limited function (limp), bone tenderness, swelling
elevated CRP, ESR, WBC count

A

osteomyelitis

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82
Q

definitive test for osteomyelitis

A

bone biopsy/ culture

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83
Q

Back pain, unilateral hearing loss (acquired), headache and femoral bowing

A

paget disease of bone

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84
Q

If lithium level is >2.5 or

Pt with lithium level >4 and creatine >2

A

treat with hemodialysis

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85
Q

Lithium toxicity

A

neurologic (AMS, seizure, fasciculation, ataxia, tremor) and GI signs (nausea and vomiting)

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86
Q

pregnant woman with syphilis treatment plan

A

Pregnant women should be desentized since doxycycline is contraindicated

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87
Q

Traveller with no vaccines who presents with nausea, vomiting, fever and abdomen pain followed by jaundice and pruritus

A

hepatitis A

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88
Q

Diagnosis of acute mesenteric ischemia

A

CT or MR angiography

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89
Q

abdomen pain out of proportion; leukocytosis, elevated amylase and phosphate level, elevated lactate (metabolic acidosis)

A

acute mesenteric ischemia

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90
Q

in acute mesenteric ischemia, how do you treat for hemodynamically unstable

A

emergency laparotomy

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91
Q

recurrent episodes of vertigo lasting 20 minutes to several hours
sensorineural hearing loss
Tinnitus and/or feeling fullness in the ear

A

meniere dx

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92
Q

treatment for meniere dx

A

salt restriction

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93
Q

pentamidine

A

alternative to TMP-SMX

Use during first trimester of pregnancy or in patients with sulfa drug allergy: atovaquone or dapsone

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94
Q

Cerebral toxoplasmosis treatment vs prophylaxis treatment

A

Treatment: Pyrimethamine + sulfadiazine + folinic acid (leucovorin)

Prophylaxis in patients with CD4+ T-cell count < 100 cells/μL: trimethoprim/sulfamethoxazole

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95
Q

primary CNS lymphoma is associated with which infection?

A

EBV

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96
Q

solitary ring-enhancing lesion on CT, EBV + on CSF suggest?

A

primary CNS lymphoma

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97
Q

treatment of CNS lymphoma

A

High dose methotrexate with/without whole brain radiotherapy

Oral/IV corticosteroids to control symptoms of raised ICP

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98
Q

colonoscopy finding on CMV colititis

A

linear ulcers

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99
Q

biopsy finding on CMV colitis

A

owl eyes; intracellular inclusions

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100
Q

CMV colitis clinical feature?

first step to do afterward?

A

CMV colitis typically presents with watery and explosive diarrhea, but if the distal colon becomes involved, the diarrhea may become bloody.
first step colonoscopy and owl eye inclusions on biopsy. to confirm

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101
Q

The presence of a hard mass just above the anal verge that bleed easily in an immunodeficient individual should raise suspicion of

A

anal carcinoma

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102
Q

treatment choice for anal carcinoma

A

The combination of chemotherapy and radiation is the treatment of choice for patients with anal squamous cell cancer

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103
Q

Treatment for aspiration pneumonia

A

Antibiotic treatment that covers anaerobes (e.g., ampicillin-sulbactam, carbapenems, or clindamycin)
metronidazole with amoxicillin, amoxicillin- clavulanate

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104
Q

treatment for PML

A

There is no specific treatment for PML. Supportive treatment and optimization of antiretroviral therapy is indicated

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105
Q

secondary malignancy that results from chronic lymphedema in patients who underwent radiation therapy and/or lymphadenectomy after mastectomy

Presents with multiple blue/purple, macular, and papular lesions in the area of the breast, chest wall, or upper extremity

A

lymphangiosarcoma

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106
Q

treatment for Bacillary angiomatosis

A

erythromycin or doxycycline

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107
Q

Bacillary angiomatosis

A

solitary or multiple, red, flesh-colored or colorless papules and nodules that bleed easily
+ Warthin-Starry stain is used to visualize bacilli and vascular proliferation on biopsy

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108
Q

Skin biopsy: spindle-shaped cells, leukocyte infiltration, and angiogenesis in HIV pt

A 
Kaposi sarcoma (HHV 8)
Malignant skin tumor associated with HIV
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109
Q

Treatment for Cryptosporidiosis

A

Antiparasitic therapy (e.g., nitazoxanide)

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110
Q

Treatment for Mycobacterium avium complex (MAC) infection

A

Macrolide (clarithromycin or azithromycin) plus ethambutol

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111
Q

Prevention of post-transplant infections

A

Universal prophylaxis
PCP prophylaxis with trimethoprim-sulfamethoxazole
CMV prophylaxis with ganciclovir or valganciclovir

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112
Q

contraindication to rotavirus vaccine

A

Rotavirus vaccine: severe combined immunodeficiency (SCID), history of intussusception; GI tract malformation (e.g., Meckel’s diverticulum)

ps: cystic fibrosis increased risk of intussusception

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113
Q

contraindication to pertussis- containing vaccines

A

unstable neurologic disorder (e.g., coma, uncontrolled seizures

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114
Q

contraindication to vaccinations

A

Severe, acute illness: e.g., infection with fever > 38.5°C (> 101.3°F)
Previous adverse reaction related to a vaccination: e.g. anaphylaxis

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115
Q

schedule vaccine for rotavirus

A

1st dose at 6 weeks
2nd dose at 4 months
3rd dose at 6 months

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116
Q

Hepatitis A vaccine recommendation

A

Hepatitis A vaccination is recommended for all children ages 12–23 months.

Current guidelines do not recommend HAV booster vaccination after successful primary immunization as it confers long-term immunity.

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117
Q

chickenpox vaccine recommendation

A

Live vaccine

Children: 1st dose at 12–15 months, 2nd dose at 4–6 years

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118
Q

Shingles vaccine recommendation

A

Live vaccine

≥ 50 years: zoster immunization is generally recommended

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119
Q

pneumococcal polysaccharide vaccine recommendation

A

For all adults age ≥ 65 with an immunocompromising condition, PCV13 vaccine followed by PPSV23 vaccine at least 8 weeks later is recommended.

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120
Q

pregnant with chronic hepatitis C

treatment

A

Individuals who have chronic liver disease such as hepatitis C can develop fulminant hepatitis if infected with hepatitis A. To prevent such complications, it is imperative that this woman receives the hepatitis A vaccine.

Combination therapy with ledipasvir/sofosbuvir and ribavirin or interferon a and ribavirin is indicated in patients with chronic hepatitis C infection. However, ribavirin has known teratogenic effects.

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121
Q

lung cancer screening

A

The US Preventive Services Task Force recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 55–80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years.

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122
Q

DTaP recommendation

A

The diphtheria and tetanus toxoids, acellular pertussis (DTaP) vaccine is given to children < 7 years of age as a 5-dose regimen at 2, 4, 6, and 15–18 months, and 4–6 years of age, respectively.

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123
Q

Hepatitis B vaccine recommendation

# of dose?
what about low birth weight?
A

The hepatitis B vaccine is typically given as a 3-dose regimen, with the first dose administered at birth, the second dose at 1–2 months, and the third dose at 6 months.

because the production of protective anti-HBs antibodies in infants with low birth weight is weakened, infants < 2000 g should not receive their first dose until they are 1 month of age (regardless of birth weight) or discharged from the hospital.

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124
Q

Tdap in pregnancy

A

All pregnant women should receive a single dose of Tdap at 27–36 weeks of gestation regardless of the interval since the last Tdap or Td vaccination.

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125
Q

initial test to do to confirm SLE

A

1ST get ANA, ds DNA, anti smith

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126
Q

are complement high or low in SLE

A

Low

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127
Q

basic treatment for SLE

A

Hydroxychloroquine

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128
Q

pt has sle flare; how do you treat

A

glucocorticoid steroids

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129
Q

diagnostic test for lupus nephritis

A

kidney biospy “wire loop” capilaries

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130
Q

treatment for lupus nephritis

A

IV cyclophosphamide

po mycophenolate

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131
Q

felty syndrome

A

RA, splenomegaly and neutropenia

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132
Q

anti scl -70 (anti-topoisomerase 1 antibody)

A

Diffuse scleroderma

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133
Q

anti centromere

A

CREST

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134
Q

Treatment for scleroderma

A

organ specific; symptomatic therapy
raynaud = ccb
esophageal = ppi
scleroderma renal crisis = ACEi

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135
Q

horseness + multiple finger shaped lesions on true vocal cord

A

laryngeal pappilomas due to reccurent respiratory pappilomatosis
(look at image)

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136
Q

laryngeal pappiloma are caused by

A

HPV 6 and 11

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137
Q

endometrial polyps and menses

A

endometrial polyps usually have bleeding between regular monthly menstrual cycles. polyps does not cause amenorrhea

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138
Q

fibroids and menses

A

fibroids pt have heavy regular menstrual bleeding

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139
Q

Vulvar lichen planus

A

chronic inflammatory disorder that presents with multiple glazed erythematous vulvar erosions bordered by white striae (wickham striae)

serosanguinous discharge

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140
Q

Vulvar lichen planus treatment

A

topical glucocorticoids

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141
Q

maternal estrogen effects on newborns

A

breast hypertrophy
swollen labia
physiologic leukorrhea
uterine withdrawal bleeding

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142
Q

complications of primary biliary cholangitis

A

malabsorption, fat soluble vitamin deficiencies
metabolic bone dx (osteoporosis, osteomalacia)
hepatocellular carcinoma

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143
Q

primary sclerosis cholangitis association

A

ascending cholangitis and CRC

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144
Q

primary biliary cholangitis association

A

antimitochondrial antibodies and hyperlipidemia

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145
Q

first line treatment for ascites due to cirrhosis

A

furosemide and spinorolactone

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146
Q

when is large volume paracentesis indicated

A

when pt is respiratory compromise or severe abdomen pain

ascites

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147
Q

treatment choice of lyme dx for pregnant pt

A

amoxicillin

148
Q

neurological manifestation of sarcoidosis

A

facial nerve palsy
central diabetes insipidus
hypogonatropic hypogonadism
bilateral parotid swelling

149
Q

cardiovascular manifestation of sarcoidosis

A

AV block, dilated or restrictive cardiomyopathy

150
Q

complication of short interpregnancy interval

A

PPROM
low birth weight
maternal anemia
premature birth

151
Q

risk of preeclampsia

A

prior preeclampsia
comorbid medical condition such HTN, DM
Nulliparity

152
Q 
microcephaly 
cleft lip and palate 
cardiac defect 
hypoplasia of nails and phalanges 
wide anterior fontanell
A

fetal hydantoin syndrome

from antiepilectic drugs

153
Q 
microcephaly 
small palpebral fissure
smooth philtrum 
midface hypoplasia 
thin vermillion border
A

fetal alcohol syndrome

154
Q

polysomnographic finding for MDD

A

Decreased REM latency (time to fall asleep in REM) and slow wave sleep
increased REM sleep duration and REM sleep density

155
Q

treatment for chronic stable angina

A

1st line = beta blocker
2nd line= CCB
Both acts by decreasing myocardial contractility

156
Q

jock itch or tinea cruris

A

pruritic rash at the groin sparing the scrotum
caused by dermatophytes Trichophyton rubrum
aggravated by sweating and warm temperature

157
Q

jock itch or tinea cruris diagnostic test

A

KOH prep

158
Q

jock itch or tinea cruris treatment

A

topical antifungals such as clotrimazole and tolnaftate

oral antifungals such as fluconazole for severe or refreactory cases

159
Q

erythema multiforme

A

acute inflammatory disorder characterized by erythematous round papules that evolve into target lesions

Infections: herpes simplex virus (HSV), Mycoplasma pneumoniae
Drugs: phenytoin; penicillins; sulfonamides

160
Q

painless thyroiditis

A

variant of hashimoto thyroiditis.

present as thyrotoxicosis with decrease radioactive iodine uptake

161
Q

painless thyroiditis TREATMENT

A

does not require therapy but beta blocker can be used to control symptoms of hyperthyroidism

162
Q

asymptomatic femoral hernia should be treated with

A

elective surgical repair to prevent emergency repair

163
Q

nontender clustered mass above testis

A

varicocele

164
Q

consequences of varicocele

A

reduced infertility due to increased scrotal temperature that can cause a reduced sperm count and decreased motility

165
Q

U/S finding of varicocele

A

retrograde venous flow
tortuous, anechoic tubules adjacent to testis
dilation of pampiniform plexus veins

166
Q

non-traumatic subarachnoid hemorrhage is commonly due to

A 
ruptured saccular (berry) aneurysm 
(look at CT)
167
Q

subarachnoid hemorrhage initial test

A

CT without contrast

168
Q

cyanide toxicity presentation

A

AMS, lactic acidosis, seizure and coma

169
Q

arrhythmia most specific to digoxin toxicity

A

atrial tachycardia + AV block

digoxin increase ectopy in atria or ventricle leading to arrhythmia

170
Q

diabetic foot should get what type of imaging

A

foot imaging (xray, MRI) to rule osteomyelitis. although the area is not erythematous or tender, you should still get it because this is due to neuropathy and poor pheripheral blood flow

171
Q

meds that can cause SIAH

A

desmopressin, carbamezepine, SSRI, NSAID

172
Q

Drugs that increase TBG concentration

A

estrogen, tamoxifen, raloxifene
heroin and methadone

therefore in pt with hypothyroidism, you must increase levothyroxine

173
Q

Drugs that decrease TBG concentration

A

androgens, glucocorticoids

anabolic steroids and slow release of nicotinic acid

174
Q

Drugs that increase thyroid hormone metabolism

A

rifampin, phenytoin, carbamazepine

175
Q

Drugs that decrease levothyroxine absorption

A

PPI, fe, Calcium, sucralfate, bile acid biding agents, AlOH,

176
Q

pH of bacterial vaginosis

A

> 4.5

177
Q

pH of trichomoniasis

A

> 4.5

178
Q

pH of candida vaginitis

A

normal pH (3.8 -4.5)

179
Q

step for uterine atony treatment

A
  1. bimanual uterine massage + high dose oxytocin
  2. tranexamic acid
  3. carboprost (2nd line)
180
Q

post delivery fever that does not resolve with antibiotics because you were thinking of endometritis

A

septic pelvic thrombophlebitis

SPT is thrombosis of the deep pelvic or ovarian veins that becomes infected

within a week after delivery

CT or MRI to confirm

181
Q

PID

A

fever, lower abd pain, purulent cervical discharge and cervical and adnexal tenderness

182
Q

Outpatient treatment for PID

A

IM ceftriaxone + oral doxycycline

183
Q

Inpatient treatment for PID

A

IV cefoxitin or cefotetan + oral doxycycline
or
IV clindamycin +gentamicin

184
Q

diffuse esopageal spasm

A

non-cardiac chest pain + dysphagia to solid and liquids

endoscopy is normal

185
Q

diffuse esopageal spasm diagnosis

A

manometry: intermittent peristalsis with multiple simultaneous contraction
esophagram: corkscrew pattern

186
Q

antibotics option for severe cases of salmonella

A

TMP-SMX

187
Q

antibotics option for severe cases of shigella

A

azithromycin, ceftriaxone, ciproflaxin

188
Q

risk factor for UE DVT

A

PICC line or central catheter
young athletics male (spontaneous)
thoracic outlet obstruction

189
Q

osteomyelitits in healthy children treatment

MRSA or no MRSA

A

low likely MRSA, Treat with nafcillin/oxacillin or cefazolin
high likely MRSA, Treat with vancomycin or clindamycin

190
Q

osteomyelitits in sickle cell children treatment

A

low likely MRSA, Treat with nafcillin/oxacillin or cefazolin
high likely MRSA, Treat with vancomycin or clindamycin
PLUS
3rd generation cephalosporins (ceftriaxione and cefotaxime)

191
Q

febrile neutropenia

A

Absolute Neutrophil Count <1500/μL
severe neutropenia ANC <500 uL
most likely cause by Pseudomonas aeruginosa

192
Q

febrile neutropenia treatment

A

antipseudomonal beta lactam such as cefepime, meropinem, piperacillin tazobactam

193
Q

febrile nonhemolytic transfusion

A

occur within 1-6 hrs

fever, chills and malaise without hemolysis

194
Q

myelomeningocele association

A

obstructive hydrocephalus

inferior displacement of medulla and cerebellum through foramen magnum

195
Q

neurofibromatosis type 1 association

A

optic pathway glioma
do MRI of brain and orbits to evaluate intracranial mass

wilms tumor, pheochromocytoma

196
Q

initial test to diagnose acoustic neuroma (NF2)

A

audiometry

197
Q

excessive daytime sleepiness, hypnagogic hallucinations (on falling asleep) and sleep paralysis

A

narcolepsy

198
Q

treatment for narcolepsy

A

sleep hygiene (scheduled naps, avoids alcohol, opiates)

modafinil

199
Q

mining, shipbuilding, insulation and pipe work

A

asbestosis

200
Q

nodular (cystic) acne treatment

mild/moderate/severe/refractory

A

Mild: Topical benzoyl peroxide
moderate: Topical benzoyl peroxide AND topical retinoids and antibiotics (e.g erythromycin)
severe: add oral antibiotics to above
unresponsive severe: oral isotretinoin

201
Q

glycemic management for type 2 DM pt with heart disease

A

metformin
GLP-1 agonists (exenatide, liraglutide)
SGLT 2 inhibitors (empaglifozin)

202
Q

step to diagnose ovarian cancer

A
  1. pelvic U/S
  2. Ca 125 measurement
  3. if Ca 125 is high, do imaging then surgical exploration (possible)
203
Q

sudden onset of severe abdomen pain with peritonitis and subdiaphragmatic free air on CXR

A

perforated viscus (perforated PUD)

204
Q

Breastfeeding Jaundice

presentation

A

unconjugated hyperbilirubinemia and dehydration in 1st week of life.
insufficient intake of breast milk

infant may have decreased urine output and delayed stooling

205
Q

Breastfeeding Jaundice

etiology

A

insufficient breast milk intake resulting in decrease elimination of bilirubin and increased enterohepatic circulation

206
Q

Breastfeeding Jaundice

treatment

A

continue breastfeeding

if bilirubin continue to rise, then use formula

207
Q

treatment for HIT

A

Stop all heparin products

switch to fondaparinux or the Xaban

208
Q

treatment for ectopic pregnancy stable pt

A

methotrexate

209
Q

treatment for ruptured ectopic pregnancy unstable pt

A

surgical exploration

210
Q

pt with hodgkin lymphoma can develop

A

a second malignancy such as lung, breast, colon, esophageal or gastric cancer

211
Q

increased A-a gradient, low lung compliance and increase Fi O2 does not correct hypoxemia (due to pulmonary edema)

A

ARDS

212
Q

increased A-a gradient, normal lung compliance and increase Fi O2 does not correct hypoxemia

A

PE or right to left shunt

213
Q

which diseases are apart of mixed connective tissue disease

A

SLE, systemic sclerosis and polymyositis

214
Q

anti U1 ribonucleoprotein

A

Mixed connective tissue disease

215
Q

mixed connective tissue disease treatment

A

systemic glucocorticoids and glucocorticoid sparing agents such as methotrecate

216
Q

dorsal displacement of radius as occurs in Colles fracture damage what structure?

A

median nerve

217
Q

squamous cell carcinoma of the skin can also rise from ?

SCC arising from burn wound is called

A

chronically wounded, scarred or inflammed skin

Marjolin ulcer

218
Q

cutaneous T cell lymphoma is also known as

A

mycosis fungoides

219
Q

cutaneous T cell lymphoma appears as

A

scaly prurustic patches (image)

220
Q

acoustic neuroma

presentation

A

hearing loss with imbalance (CN 8 dysfunction) decreased facial sensation (CN 5 dysfunction)

due to compression at the cerebellopontine angle

221
Q

viral rhinosinusitis vs bacterial rhinosinusitis

how to differentiate?

A

based of duration and severity of symptoms
viral = afebrile, improvement by day 5- 10
bacterial = high fever >3 days or persistent symptoms > 10 days or new or recurrent fever

222
Q

treatment for viral rhinosinusitis

A

supportive care; intranasal saline, saline irrigation and NSAID

223
Q

treatment for bacterial rhinosinusitis

A

add antibiotics (amoxicillin- clavulanate or amoxicillin)

224
Q

intensive glycemic control with insulin decrease?

A

risk of microvascular complication such as retinopathy and nephropathy

225
Q

very strict glycemic control <6.5 increase?

A

risk of hypoglycemia and cardiovascular mortality such as stroke and MI

226
Q

Women with granulosa cell tumors should also undergo

A

endometrial biopsy to rule out endometrial cancer since GCT can cause endometrial hyperplasia –> cancer

227
Q

mixed urinary incontinence treatment

A

initial test is to have a voiding diary to determine predominance of incontinence
if it is stress incontinence predominant = kegel exercise or midurethral sling surgery
it is urgency incontinence predominant = antimuscaranics

228
Q

risk factor for epithelial ovarian cancer

A

postmenauposal women and FH of breast or ovarian cancer

ex lap is done if there is high suspicious of EOC

229
Q

epithelial ovarian cancer can present with

A

pelvic mass and ascites

230
Q

how to differentiate between mesoconium ileus and hirshsrpung dx?

A 
contrast enema 
(look at evaluation for bilious emeneis) in your doc
231
Q

antibiotics prophylaxis for clean procedure (cardiac, neuro, ortho, vascular

A 
1st = cefazolin 
alternative = vancomycin or clindamycin
232
Q

antibiotics prophylaxis for clean-contaminated procedure (GI, GU, OB/GYN, head neck, thoracic)

A

based on surgery

broader coverage is indicated

233
Q

metastatic prostatic cancer

A

progressive low back pain, focal lumbar tenderness
increased ALK
sclerostic bone lesions suggesting osteoblastic bone dx

234
Q

oxidative triggers of G6PD

A

infections (activation of leukocytes released oxidative species)
meds (tmp-smx, nitrofuroitoin etc..)
foods (fava beans)

235
Q

treatment choice for anemia related to CKD

A

erythropoietin

236
Q

side effect of erythropoietin

A

HTN (new or worsening)

can lead to end organ damage (encephalothy and seizure)

237
Q

ppl on erythropoietin should have their —- monitored?

A

BP

238
Q

Disseminated gonnoccocal infection

A

purulent monoarthritis or triad of tenosynovitis, dermatitis and migratory polyarthritis

239
Q

most common valvular abnormality in pt with endocarditis

A

mitral valve prolapse with MR

240
Q

haemophilus ducreyi treatment

A

azithromycin or ceftraxione

241
Q

lymphogranuloma verenum treatment

A

doxycycline

242
Q

klebsiella granulomatis treatment

A

azithromycin

243
Q

HUS

A

hemolytic anemia
thrombocytopenia
acute kidney injury
bloody diarrhea

244
Q

cancer pain management

mild

A

non-opoids (acetaminophen or NSAID)

245
Q

cancer pain management

Moderate

A

weak opoids +/- nonopoids

codeine, hydrocodone, tramadol

246
Q

cancer pain management

severe or initial intervention failled

A

strong short acting opioids such as morphine or hydromorphone

if pain continues, add long acting opioids

247
Q

absolute contraindications for pregnancy and exercise

A 
amniotic fluid leaf
cervical insufficiency 
placenta abruptae 
placenta previa 
multiple gestation 
premature labor
preeclampsia/ gestational hypertension or dm
severe heart or lung disease
248
Q

unsafe activities for pregnancy and exercise

A

scuba diving
hot yoga
contact sports (basketball, soccer, ice hockey)
high fall risk (gymnastic, downhill skiing, horseback riding)

249
Q

early adverse effect of SSRI

A

nausea, diarrhea, increased anxiety, insomnia or somnolence
usually occurs in the 1st week
treat by decreasing the dose

250
Q

outpatient treatment of CAP
healthy?
comorbidities pt?

A

macrolide or doxycycline (healthy)

fluoroquinolone or beta lactam + macrolide (comorbidities)

251
Q

inpatient treatment of CAP

non- ICU

A

fluoroquinolone IV or

IV beta lactam + macrolide

252
Q

inpatient treatment of CAP

ICU

A

IV beta lactam + macrolide

IV beta lactam + fluoroquinolone

253
Q

HIV and non hodgkin lymphoma

A

diffuse lymphadenopathy ( and B symptoms (fever, night sweats and weight loss)

reactivation of EBV

254
Q

what is the most likely causative organisms in infants or young children with CF pneumonia?

A

staph aureus

255
Q

what is the most likely causative organisms in adults with CF pneumonia?

A

pseudomonas aeruginosa

256
Q

orbital floor fracture

A

entrapment of inferior rectus muscle

257
Q

seizure

A

LOC, loss of postural tone, postictal state with delayed return to baseline neurologic function.
tongue laceration occurs with tonic clonic movement s

258
Q

delirium agitation treatment

A

Haloperidol. However, it should not be used in patients with delirium that is due to alcohol or benzodiazepine withdrawal because it lowers the seizure threshold.

Alternative: atypical antipsychotics (e.g., olanzapine)

Lorazepam or other benzodiazepines should not be used in elderly pt as they may worsen the situation

259
Q

RA cervical myelopathy

A

pt with RA are at risk of atlantoaxial instability; neck extension during intubation can result in subluxation with cord compression and cervical myelopathy

260
Q

intracerebral hemorrhage in young patients is most commonly due to

A

ateriovenous malformation rupture

261
Q

acute pyelonephritis in pregnant pt

A

due to risk of fetal and maternal complication, do inpatient admission and IV antibiotics (ceftriaxone)

262
Q

first line treatment for alcohol disorder

A

naltrexone (mu-opoid receptor antagonist) and acomprosate (glutamate modulator)

263
Q

respiratory distress syndrome

risk factor

A

most important risk factor = prematurity

other risk factor = maternal diabetes, male sex, perinatal asphyxia and C-section without labor

264
Q

VHL association

A

cerebellar & retinal hemangioblastoma, pheochromocytoma, renal cell carcinoma

265
Q

if biospy of gastric ulcer confirms adenocarcinoma, what is the next step?

A

CT of abdomen and pelvis for staging and identify mestatasis specially to liver

266
Q

HTN, episodic headache, unexplained hyperglycemia

A

pheochromocytoma

cathecolamines inhibit insulin secretion –> hyperglycemia

267
Q

which alpha blocker facilitate stone passage

A

tamsulosin

268
Q

if renal stone is <10mm, what do you do?

A 
medical management 
hydration (there is no proof between IV or Oral hydration)
pain meds
alpha blockers
strain urine

you may send the pt home

269
Q

if renal stone is >10mm, what do you do?

A

urology consult

270
Q

if renal stone is <10mm and you did medical management but there is still pain and no passage of stone in 4-6 weeks

A

urology consult

271
Q

if there is a stone and pt is uroseptic, AKI, or complete obstruction, what to do?

A

urology consult

272
Q

presentation of bladder cancer

A

painless hematuria

hydronephrosis (unilateral; mainly due to compression bladder outlet or ureter obstruction by tumor)

voiding symptoms (nocturia, frequency, urgency and dysuria because tumor reduce bladder capacity –> hyperactivity of detrusor muscle)

273
Q

gold standart initial test for bladder cancer

A

cystoscopy

then abd CT for staging

274
Q

maniac behavior (agitation, grandiosity, loud, pressured speech) + sympathetic stimulation

A

cocaine intoxication

275
Q

first line treatment for MDD + psychosis

A

SSRI + antipsychotics (ex: sertraline + risperidone) or electroconvulsive therapy

276
Q

friedreich ataxia presentation

A

progressive gait ataxia and dysarthria + loss of vibration/position sense) in young adolescents

neurologic manisfestation is due to degeneration of spinal tracts (spinocerebellar tracts, posterior columns)

277
Q

most common cause of death in friedreich ataxia

A

cardiac dysfunction due to hypertrophyc cardiomyopathy

278
Q

neonatal conjuctivitis (Chemical)

onset
CF
TX

A

<24hrs
mild conjunctival irritation and tearing after silver nitrate ophthalmic prophylaxis

Tx: lubricant

279
Q

neonatal conjuctivitis (gonoccocal)

onset
CF
TX

A

2-5 days

marked eyelid swelling
profuse purulent discharge
corneal edema/laceration

tx: single dose of IM 3rd generation cephalosporin

280
Q

neonatal conjuctivitis (chlamydial)

A

5-14 days

mild eyelid swelling
watery, serosanguinous or mucopurulent eye discharge

tx: PO macrolide

281
Q

topical erythromycin is used to prevent

A

gonococcal conjunctivitis

282
Q

adolescent with back pain that is exacerbated by lumbar extension

A

spondylolisthesis

283
Q

eczema herpeticum

A

HSV 1

painful vesicular rash with punched out erosions and hemorrhagic crusting (image)

284
Q

molloscum contgiosum

A

Poxvirus

fleshed colored papules with central umbilication

285
Q

preeclampsia with severe features

presentation

A

Hypertension + proteinuria after 20 weeks gestation

headache with visual symptoms, ankle clonus, thrombocytopenia

286
Q

if NAAT is positive for chlamydia only, what do you do?

A

azithromycin only

287
Q

if NAAT is positive for gonorrhea only, what do you do?

A

azithromycin + ceftraxione

288
Q

hypoestrogenic postpartum state (MOA)

A

vaginal pain, dryness, dyspareunia

increased prolactin inhibits GnRH –> decreased LH, FSH, estrogen –> amenorrhea, anovulation, menopausal symptoms

289
Q

management for organophosphate poisoning

A

remove clothes and irragate skin
atropine to reverse muscarinic effect
pralidoxime to reverse nicotinic and muscarinic effect (given after atropine)

290
Q

hypothyroidism is associated with

A

hyperlipidimia

291
Q

pt with hypercholesterolemia should have their … measured?

A

serum TSH

292
Q

Ventricular fibrillation treatment

A

defibrillation

293
Q

pericardial effusion

A

distant muffled heart sound and signs of decreased cardiac output. enlarged cardiac silhouette on cxr

294
Q

C difficile treatment

A

PO vancomycin or fidaxomicin

295
Q

febrile non-hemolytic transfusion reaction

MOA

A

Cytokine accumulation during blood storage

296
Q

febrile non-hemolytic transfusion reaction

presentation

A

Fever and chills within 1-6 hrs

297
Q

anaphylatic (MOA)

A

Recipient anti IgA antibodies directed against donor blood IgA

298
Q

anaphylatic

presentation

A

angioedema, hypotension, respiratory distress/ wheezing, shock within seconds to minutes
IgA deficient recipient

299
Q

urticarial (MOA)

A

Recipient IgE against blood product component

300
Q

urticarial

presentation

A

urticaria

301
Q

Graft vs Host (MOA)

A

donor T lymphocytes

302
Q

Graft vs Host

presentation

A

rash, fever, GI symptoms, pancytopenia within weeks

303
Q

transfusion related acute lung injury (MOA)

A

donor anti leukocyte antibodies

304
Q

transfusion related acute lung injury

presentation

A

acute dyspnea, crackles and rales on auscultation,

diffuse bilateral pulmonary infiltrates within 6hrs

305
Q

test for urethral injury

A

retrograde urethrography

306
Q

EEG for absence seizure

A

3 Hz spike wave discharge during episodes

307
Q

epidural hematoma treatment

A

urgent surgical evacuation for symptomatic pt

308
Q

diagnosis of preeclampsia

A

urine protein/creatine ratio > 0.3 or a 24 hrs collection of total protein > 300 mg

309
Q

renal vein thrombosis is commonly associated with which nephrotic syndrome?

A

membranous glomerulopathy

loss of antithrombin III in urine increases the risk of venous and arterial thrombosis

310
Q

treatment for stress fracture

A

rest and simple analgesics such as acetaminophen

311
Q

a negative heterophile test does not rule out

A

infectious monocluneousis

312
Q

niacin is frequency prescribed with …..

A

aspirin because it can cause drug induced release of histamine and prostaglandins

313
Q

aspirin and statin is indicated for

A

Atherosclerotic cardiovascular disease (ASCVD) such as PAD, MI, angina, stroke, TIA

314
Q

ABI index that indicated PAD

A

<0.9

intermittent claudication

315
Q

surgical revascularition is indicated

A

failled medical management
limited daily activity
limb threatening complication such as nonhealing ulcers

316
Q

mitral valve prolaspe occurs due to

A

myxomatous degeneration of mitral valve leaflets and chordae

317
Q

arteriovenous fistula (moa)

A

allows blood to bypass high resistance of the systemic capillaries, SVR —> decreased afterload.
allows blood to pass into the right atrium quickly –> increased preload –> increased CO

318
Q

what is the consequences of large arteriovenous fistula?

A

high output heart failure

319
Q

CSF rhinorrhea

presentation

A

clear, unilateral rhinorrhea that increase with intracranial pressure such as bending over or bowel movement. pt may report salty or metallic taste.

320
Q

CSF rhinorrhea (etiology)

A

head trauma,
surgical trauma
elevated ICP

321
Q

CSF rhinorrhea diagnotic test

A

test for CSF proteins (beta 2 transferrin, beta trace protein.

then you can do image to localize

322
Q

CSF rhinorrhea treatment

A

inpatient management
elevated bed, bed rest and avoid straining

if does not resolve, then do lumbar drain placement or surgical repair

323
Q

cervicitis

A

mucopurulent cervical discharge and edematous friable cervix that bleed with manipulation

324
Q

pregnant women with fever, nausea, vomiting and right sided abd pain

A

acute appendicitis

right mid to upper quadrant pain or right flank pain

325
Q

treatment for pregnant women with acute appendicitis

A

appendectomy

326
Q

gastric bezoar

A

accumulation of undigestible materials such as hair, foreign objects in the stomach

can cause GOO = gastric outlet obstruction

327
Q

most common cause of gastric outlet obstruction

A

malignancy, mostly pancreatic adenocarcinoma with gastric or duodenal invasion

328
Q

warfarin induced skin necrosis

A

occur within few days after warfarin administration

cause rapid decline in protein C levels usually in pt with hereditary protein C deficiency

329
Q

warfarin induced skin necrosis

treatment

A

stop warfarin and give protein C concentrate

330
Q

complication of cryptorchidism

A

inguinal hernia
testicular torsion
sub-fertility (it does not affect puberty onset since it is regulated by HPA axis)
testicular cancer (the risk still remains even after orchioplexy)

331
Q

psychogenic non epileptic seizure (PNES)

A

Type of conversion disorder

feature: forced eyes close, side to side head to body movement, memory recall of event and lack of postictal confusion

332
Q

gold standard test for PNES

A

video EEG

333
Q

treatment of myastenia gravis crisis

A

first intubate
do not give them pyrostigmine because you want to reduce secretion while intubated and prevent aspiration
once stabilized you give them IVIG or plasmapheresis (preffered) in addition to glucocorticoids

334
Q

retinopathy of prematurity funduscopy

A

Demarcation line between vascularized and nonvascularized retina.
retinal neovascularization

335
Q

normal pregnancy cause which metabolic acid base disturbance

A

respiratory alkalosis

336
Q

active phase protraction

etiology of protraction and second stage of labor arrest

A

less than 1 cm cervical dilation in 2 hrs during active phase of labor

cause by cephalopelvic disproportion in which head is to large for maternal pelvis. other causes is inadequate contraction, maternal obesity or fetal malposition sucha as occiput posterior

337
Q

separation anxiety disorder

A

fear of separation with execessive concerns that something bad will happen and reluntance to leave person

338
Q

separation anxiety is normal at

A

9 -18 months

339
Q

premenstrual dysmorphic disorder

A

cyclical pattern of overeating, mood swings, and irritability which worsen prior to menstruation and resolve for a few weeks at time

severe form of PMS

340
Q

Treatment of Premenstrual dysphoric disorder

A

SSRI

341
Q

Polycythemia vera

A

Increased plasma volume, RBC mass
decreased EPO level

bone marrow aspiration

342
Q

renal cell carcinoma

polycythemia

A

Increased RBC mass, EPO level
normal plasma volume and O2 sat

CT abdomen

343
Q

open fracture of midshaft humerus and neurovascular compromise

A

open reduction and surgical exploration

344
Q

closed fracture of midshaft humerus

A

nonsurgical = closed reduction followed by arm immobilization

345
Q

posterior dislocation knee can injure what structure?

so what test do you do?

A

poplitel artery

ABI to see if there is any leg ischemia

346
Q

methotrexate side effect

A

hepatotoxicity
stomatitis
cytopenia

347
Q

leflunomide side effect

A

hepatotoxicity

cytopenia

348
Q

hydroxychloroquine side effect

A

retinopathy

349
Q

sulfasalazine side effect

A

hepatotoxicity
stomatitis
hemolytic anemia

350
Q

TNF inhibitors side effect

A

infection
demyelination
CHF
malignancy

351
Q

treatment for mediastinitis

A

resuscitation, IV antibiotic therapy, and surgical debridement

352
Q

mediastinitis CXR

A

Chest x-ray shows a widened mediastinum and mediastinal emphysema.

353
Q

if acute limb ischemia is diagnosed clinically, what is the next step

A

go straight to treatment= anticoagulation

IV heparin

354
Q

acute limb ischemia presentation

A 
Pain
Pallor
Pulselessness
Paralysis
Paresthesia
Poikilothermia
355
Q

test for traumatic aortic injury in hemodynamically stable patients

A

In hemodynamically stable patients: CT scan and contrast-enhanced CT angiography

356
Q

test for traumatic aortic injury in hemodynamically unstable patients

A

In hemodynamic unstable patients: transesophageal echocardiography (TEE)

357
Q

tinea corporis risk factor

A

immunocompromise: HIV, DM, systhemic glucocorticoid use

358
Q

treatment for otitis externa

A

topical Antibiotic: ofloxacin, ciprofloxacin, or gentamycin

359
Q

most common cause of otitis externa

A

pseudomona aeruginosa

360
Q

adenomyosis

presentation

A

Dysmenorrhea
Menorrhagia
Chronic pelvic pain, aggravated during menses
Uniformly enlarged uterus, tender on palpation

361
Q

treatment of adenomyosis

A

hysterectomy

362
Q

adenomyosis vs leimyoma vs endometriosis

A

adenomyosis = Uniformly enlarged uterus + chronic pelvic pain

leimyoma = irregular enlarged uterus + menorrhea

endometriosis = small non tender immobile uterus

363
Q

most common cause of gross lower GI bleed

A

diverticulosis

colon cancer= gross bleeding is less likely

364
Q

when IV access cannot be obtained, what to do next

A

obtain intraosseous line

easier done than central catheters

365
Q

hearing loss after meningitis

A

due to inflammatory damage to cochlea and/or labyrinth

366
Q

tuberous sclerosis association

A 
rhabdomyomas
angiomyolipomas
angiofibroma 
subependymal nodules
etc..

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