Step 2 Ck flashcards
(500 cards)
1
Q
steroids
A
inhibit IL-1 production
2
Q
methotrexate
A
folic acid antagonist, inhibits DHF reductase, S-phase specific, inhibits DNA synthesis
3
Q
cyclosporine
A
calcineurin inhibitor; inhibits IL-2 production; nephrotoxic, gum hypertrophy, hursutism
4
Q
tacrolimus (FK506)
A
calcineurin inhibitor; inhibits signaling thru T cell receptor
5
Q
mycophenylate mofeil
A
prevents T cell activation
6
Q
azathioprine
A
antineoplastic; cleaved to mercaptopurine; inhibits DNA/RNA synthesis; BM suppression
7
Q
antithymocyte globulin (OKT3)
A
antibody against CD3 on T cells; causes pulmonary edema
8
Q
basiliximab, daclizumab
A
monoclonal antibody to IL-2 receptor
9
Q
fetal heart tones begin at
A
10-12 weeks
10
Q
fetal quickening (movement) occurs at
A
17-18 weeks
11
Q
4 measurements that can be taken from fetal US
A
crown-rump length, biparietal diameter, femur length, abdominal circumference
12
Q
abdominal circumference
A
most reliable parameter for set. fetal weight in cases of fetal growth restriction
13
Q
Gestational sac is visible by what gestational age?
A
five weeks
14
Q
b-hCG peaks when?
A
10 weeks GA
15
Q
average increase in weight during pregnancy
A
25 lb (11 kg)
16
Q
additional kcal needed during pregnancy
A
100-300 kcal/day
17
Q
when should supplemental iron be started in a pregnant woman?
A
first prenatal visit
18
Q
What 2 supplement to pregnant vegans need?
A
Vit D, Vit B12
19
Q
What cardiovascular parameters DECREASE during pregnancy?
A
blood pressure and peripheral vascular resistance
20
Q
What happens to electrolytes during pregnancy?
A
NOTHING! Remain unchanged.
21
Q
What causes herpangina?
A
coxsackievirus (an enterovirus)
22
Q
How do you screen for Hep C on the first prenatal visit? What about Hep B?
A
Hep C - history. Hep B - HBsAg
23
Q
When is gestational diabetes screened for in pregnancy?
A
weeks 24-28
24
Q
How are AFP results reported?
A
multiples of the median (MoM)
25
Quad screen shows "pan-low".
trisomy 18 (low AFP, low estriol, low b-hCG, low inhibin A)
26
Quad screen shows low AFP, low estriol, high b-hCG, high inhibin A.
Down syndrome
27
Risk of fetal loss during chorionic villus sampling
1%
28
Third trimester test used to detect presence of phosphatidylglycerol
amniocentesis
29
tetratogen that can cause lack of cranial ossification
ACEI
30
tetratogenic defects of streptomycin or kanamycin
hearing loss; CN VIII damage
31
2 tetratogens causing anotia or microtia
thalidomide, Vit A
32
can cause neonatal nasal hypoplasia an stippled bone epiphyses
warfarin
33
tetratogen assoc. w/ neonatal bowel atresia
cocaine
34
Woman with hyperhomocysteinemia loses a 19 week pregnancy. What enzyme is deficient?
methylene tetrahydrofolate reductase
35
Amount of caffeine required to cause spontaneous abortion
>500 mg/day
36
Deficiency of what hormone increases risk for spontaneous abortion? (estrogen, progesterone, growth hormone, testosterone, or FSH)
progesterone
37
Prophylactic med for toxo during pregnancy
spiramycin
38
Cardiac defect assoc. w/ congenital rubella
PDA
39
treatment for congenital CMV
postpartum ganciclovir
40
Pregnant HIV+ women should receive what prenatal meds?
AZT or nevirapine
41
When does an HIV+ women get a C-sec?
viral load >1000
42
eye disease in late congenital syphilis
interstitial keratitis
43
Tx for threatened AB
pelvic rest for 24-48 hrs, then follow up US
44
How can misoprostol be administered?
oral, vaginal, sublingual, buccal
45
2 meds used for first-trimester therapeutic abortions
misoprostol, mifepristone
46
How does oxytocin work to induce or augment labor?
binds receptors on myometrium, increases Ca influx to stimulate contractions
47
Components of a Bishop score
dilation, effacement, station, cervical position, cervical consistency
48
Prolonged active stage of labor due to
cephalopelvic disproportion
49
things that can decreases fetal heart rate variability
hypoxia, opioids, magnesium, sleep cycle
50
drug assoc. w/ a "pseudosinusoidal" variability pattern on fetal heart rate tracings
meperidine
51
complication of a supine nonstress test
maternal hypotension
52
What is "15-15-2-20"?
Normal "reactive" nonstress test: 2 FHR accelerations _ 15 bpm above baseline lasting _ 15 sec over a 20 min period
53
Next step if nonstress test is nonreactive?
biophysical profile
54
How can you induce contractions in a contraction stress test?
nipple stimulation or oxytocin
55
Next step if contraction stress test is positive
delivery
56
components of a biophysical profile
fetal tone, fetal breathing, fetal movement, amniotic fluid volume, nonstress test
57
what is a modified biophysical profile?
NST + amniotic fluid index
58
reversal of umbilical artery diastolic flow indicates what?
IUGR
59
nerve responsible for perineal pain during delivery
pudendal (S2-S4)
60
lab values seen in hyperemesis gravidarum
high b-hCG, high estradiol, large ketonuria (get a UA)
61
First step in dx of hyperemesis gravidarum?
rule out molar pregnancy w/ ultrasound +/- b-hCG
62
Tx for hyperemesis gravidarum
Vit B6, antihistamines (doxylamine, promethazine, dimenhydinate). If severe, metoclopramide, ondansetron, prochlorperazine. If dehydrated, IVFs, NPO, parental nutrition, IV dimenhydrinate.
63
First step in management of gestational diabetes
ADA diet, exercise, glucose monitoring. Insulin only if all this fails
64
Management of pregestational diabetic during labor
IV insulin drip and hourly glucose measurements
65
antihypertensive meds in pregnancy
methyldopa (#1), metoprolol, nifedipine, hyralazine
66
Most likely cause of hemolytic anemia, elevated liver enzymes, and thrombocytopenia in pregnancy
(HELLP syndrome) Vasospasm leading to hemorrhage and organ necrosis
67
Tx for preeclampsia if far from term?
modified bed rest and expectant management
68
How to administer magnesium for seizure prophylaxis in preeclampsia
continuous MgSO4- IV drip
69
Dx: Pregnant woman present w/ vaginal bleeding & abdominal pain. US shows a retroperitoneal clot.
placental abruption
70
Next step in management for mild placental abruption with premature fetus
bed rest
71
Management of placenta previa
No vaginal exam. Tocolytics. Betamethasone for lung maturity. C-sec delivery.
72
Next step in assessing a reproductive age woman w/ acute onset abdominal pain, + pregnancy test and empty uterus on US
serial hCG to confirm ectopic pregnancy
73
medical management for small, unruptured ectopic pregnancy
methotrexate
74
What should be given to an IUGR fetus near due date?
steroids (betamethasone) _ 48 hrs prior to delivery to accelerate fetal lung maturity
75
fetal anomalies assoc. w/ polyhydramnios
duodenal atresia, TE fistula, anencephaly
76
What can be done for Rh isoimmunization hemolysis prior to delivery?
intrauterine blood transfusion
77
Woman has gestational trophoblastic disease. What dietary modifications could have prevented this?
Increase dietary folate and/or beta-carotene
78
chemo tx for malignant gestational trophoblastic tumors
MTX or dactinomycin
79
Uterus is evacuated of a "mass of grapes." Next step?
weekly b-hCG
80
recoil of the perineum during second stage of labor indicates impending...
shoulder dystocia (this is called "turtle sign")
81
When is cervical ripening indicated?
failure to progress in latent stage; failure to have progressive cervical change
82
What medicine is used for cervical ripening?
misoprostol (a prostaglandin)
83
Next step if pregnant woman presents w/ "gush of blood"?
nitrazine paper test, fern test, or indigo carmine dye test
84
what is contraindicated on pts w/ PROM?
digital vaginal exam (increases risk for infection)
85
What effect does ABx have during tx of PROM, other than preventing infection?
they prolong the latency period
86
ABx given in cases of rupture of membrane
ampicillin and gentamicin
87
What is tachysystole?
> 5 uterine contractions in 10 min
88
ABx given for GBS ppx if preterm delivery is likely
penicillin or ampicillin
89
murmur likely heard in a premie
continuous machine-like murmur of PDA
90
fetal head position at risk for failure to progress
occiput posterior
91
#1 risk factor for fetal malpresentation
prematurity
92
Most common form of breech presentation?
frank breech: thighs flexed, knees extended
93
What should be given to decrease gastric acidity during c-sec?
sodium citrate
94
fistula assoc. w/ episiotomy
rectovaginal
95
First step in managing uterine atony
bimanual uterine massage
96
Difference btw placenta accreta/increta/percreta
accreta: partial invasion of myometrium, increta: further/full invasion, percreta: penetrates uterine serosa
97
Next step once Sheehan syndrome is diagnosed by MRI
cortisol replacement
98
When will lactose intolerance be evident?
Within 1 week postpartum. (Mature milk does not have lactose until 1 week)
99
ABx for mastitis
dicloxacillin, cephalexin
100
thelarche begins when?
8-11 years old
101
menarche begins when?
10-16 years old
102
What is the lipid profile during menopause?
high cholesterol, low HDL
103
What malignancy/malignancies are postmenopausal pts on HRT at risk for?
breast cancer
104
What malignancy/malignancies are postmenopausal pts on HRT protected from?
endometrial cancer, ovarian cancer
105
Name IUDs effective for 3, 5, and 10 years, respectively.
Implanon (progestin-only IUD) - 3 years, Mirena (IUD w/ progestin) - 5 years, Mirena (IUD w/ progestin) - 5 years
106
When must the "morning after pill" be taken to be effective?
within 120 hours (5 days) of unprotected sex
107
16 yo w/ amenorrhea has normal smell, negative pregnancy test, normal 46 XX karyotype and normal breasts. Next step?
bone age x-ray (PA left hand)
108
How do you treat premature ovarian failure?
combined estrogen/progestin HRT
109
Excess levels of what mediator are present in primary dysmenorrhea?
PGF-2a
110
MCC of infertility in menstruating women >30 years old
endometriosis
111
First line treatment for endometriosis. First line for adenomyosis.
Combined OCPs (endometriosis). NSAIDs (adenomyosis).
112
Major complication of adenomyosis
can progress into endometrial carcinoma (rare)
113
Postmenopausal woman w/ abnormal uterine bleeding has a 5 mm endometrium on US. Next step?
endometrial biopsy
114
Tx for CAH?
Glucocorticoids
115
What are the 17-ketosteroids?
DHEA and androstenedione
116
First enzyme in glucocorticoid synthetic pathway
cholesterol desmolase
117
CAH when 11-DOC is elevated
11b-hydroxylase deficiency
118
Woman with skin rash and US that shows subcapsular follicles in a "pearl necklace" pattern
PCOS (rash is acanthosis nigricans)
119
first line tx for ovulatory stimulation in PCOS
clomiphene +/- metformin
120
PCOS incr risk of what cancer(s)?
breast, endometrial (not ovarian)
121
Tx for asymptomatic Bartholin gland cyst
no treatment +/- warm soaks
122
Tx for trichomoniasis
single-dose PO metronidazole or TINIDAZOLE for pt and partner(s)
123
grayish-white vaginal discharge vs. yellow-green, frothy vaginal discharge
grayish-white = bacterial vaginosis, yellow-green, frothy = trichomoniasis
124
If not managed appropriately, TSS can lead to death by what mechanism?
ARDS (most common), or severe hypotension or hemorrhage 2_ to DIC.
125
Dx: 23 yo F present w/ vomiting, watery diarrhea, T 103F, and and desquamating rash. Blood cx negative.
toxic shock syndrome
126
What should women w/ fibroids be told re: pregnancy and menopause?
Fibroids may grow during pregnancy and shrink during menopause, as they are estrogen and progesterone sensitive.
127
Dx: 40 yo F present w/ urinary frequency, pelvic pressure and a "cobblestone uterus" on exam.
uterine leiomyoma (fibroids)
128
Medical management of BLEEDING assoc. w/ uterine fibroids
medroxyprogesterone acetate or danazol
129
poor prognostic factors for endometrial cancer
p53 gene mutation, serous or clear cell histology
130
When can cervical cancer screening stop
women _70 yo w/ 3 normal Paps, or total hysterectomy
131
T or F: Women who have had Gardasil no longer need to be screened for cervical cancer.
FALSE
132
A 30 yo F has had 3 consecutively normal Paps. Next step?
Pap once every 3 years
133
Next step if cervical cytology (Pap) shows ASCUS.
HPV DNA testing
134
Next step if cervical cytology (Pap) shows ASCUS and HPV DNA test is negative? Is positive?
If negative: repeat Pap in 1 year, If positive: colposcopy
135
Only time a pregnant woman should get colposcopy
Pap shows HSIL (high-grade squamous intraepithelial lesion)
136
HPV subtypes assoc. w/ vulvar cancer
16, 18, 31
137
Which is a risk factor for vulvar cancer: lichen planus or lichen sclerosus?
lichen sclerosus
138
Diagnosis of vulvar cancer
vulvar punch biopsy
139
female organ prolapse increases risk for what cancer?
vaginal cancer
140
Other than colon cancer, Lynch II syndrome (or HNPCC) is assoc w/ what other cancer(s)?
ovarian, endometrial, breast
141
benign or malignant: 5 cm calcified cystic Right adnexal mass with unilocular septations
benign
142
increased CA-125 is assoc. w/ what benign condition?
endometriosis
143
Tx for ovarian mass w/ LDH+ genetics
surgery + postop chemo + RADIATION (dysgerminoma)
144
what is "procidentia"?
marked uterine prolapse
145
MCC of infectious vulvovaginitis in kids
Group A strep
146
Dx: little girl has a "bunch of grapes" within the vagina
sarcoma botryoides (rhabdomyosarcoma)
147
Dx: 6 yo F w/ precocious puberty and dark skin spots that stop at the midline
McCune-Albright syndrome (precocious puberty, polyostotic fibrous dysplasia [bone disorder], unilateral cafe-au-lait spots)
148
mechanism of fibrocystic breast change
exaggerated stromal tissue response to hormones & growth factors
149
What dietary modification can be suggested to help w/ fibrocystic change?
reduce caffeine intake (methylxanthine abstention)
150
phylloides tumor is a subtype of what?
fibroadenoma (benign)
151
Tx for fibroadenoma & phylloides tumors
excision
152
dietary risk factors for breast cancer
high fat, low fiber
153
supraclavicular LAD indicates breast cancer stage ___
IV
154
comedocarcinoma is a subtype of what?
DCIS (ductal carcinoma in situ)
155
tumor markers for *recurrent* breast cancer
CEA, CA 15-3, CA 27-29
156
Breast cancer receptor status w/ poor prognosis
Triple negative: ER-, PR-, EGFR- (HER2/neu is an EGF receptor)
157
lumpectomy + axillary dissection + postop radiation has equal efficacy as what?
modified radical mastectomy (total mastectomy + axillary dissection)
158
MCC of infertility in menstruating women < 30 years old
PID
159
nodularities on the broad ligament and a retroverted uterus suggest
endometriosis
160
strawberry cervix or cervical petechiae
trichomonas
161
Tx for chlamydia
doxycycline x 7 days OR azithromycin once. If pregnant, erythromycin or azithromycin
162
T or F: Automatically give gonorrhea treatment to pts w/ chlamydial infection.
False. Give pts w/ gonorrhea infection treatment for suspected chlamydia.
163
Dx: normal looking 16 yo girl w/ breasts but no axillary or pubic hair and amenorrhea
androgen insensitivity
164
Tx for mastitis due to MRSA
Bactrim (TMP-SMX) or clindamycin
165
30 yo F who uses an IUD for contraception develops PID. Most likely organism?
Actinomyces israelii
166
A 20 yo F on OCPs requires elective surgery. What should you tell her about her OCP use?
Stop 1 month before surgery, and do not restart until 1 month after surgery.
167
Guy w/ skin fifth metacarpal fracture gets hand infection.
Boxer's fracture w/ human oral pathogens (Eikenella). Give ABx.
168
#NAME?
squeezing gastrocnemius elicits no foot plantar flexion; indicates Achilles rupture. (+ test may be a normal finding in elderly pts.)
169
Tx for carpal tunnel syndrome
splint wrist + NSAIDs. Surgery for intolerable symptoms.
170
subacromial bursa lies between acromion and
supraspinatus muscle
171
trochanteric bursitis located at insersion of what muscle?
gluteus medius
172
21 yo college student w/ painful, swollen elbow. No history of gout or trauma.
olecronon bursitis
173
most common site for lumbar disc herniation
L5-S1 (L4-L5 is second most common)
174
50 yo man w/ low back pain. X ray shows facet hypertrophy and degenerative changes. Next step?
(Spinal stenosis) NSAIDs and abdominal muscle strengthening
175
Dx: 65 yo M w/ knee pain and crepitus, X-ray shows subchondral bone cysts, aspiration of joint fluid is straw-colored.
osteoarthritis
176
Dx: During a Super Bowl party, a 40 yo M goes on a drinking binge and develops severe acute foot pain.
gout
177
anti-cyclic citrullinated peptide antibodies
rheumatoid arthritis (anti-CCP antibodies)
178
First line therapy for ACUTE gout attacks
NSAIDs (e.g., indomethacin)...NOT acetaminophen, which has no anti-inflammatory properties
179
Tx for gout: overproducers vs. undersecretors
overproducers: allopurinol
180
60 yo F w/ HTN on lasix gets acute foot pain
gout (remember, POSTmenopausal women!)
181
Tx of choice for acute gout in pts w/ renal disease
steroids (oral prednisone)
182
#NAME?
decr spinal flexion seen in ankylosing spondylitis
183
What are two extra-articular manifestations of ankylosing spondylitis?
anterior uveitis (or iridocyclitis), heart block
184
20 yo M w/ skin rash, dactylitis and abnormal hand x-ray
psoriatic arthritis ("pencil in cup" deformity)
185
Pts w/ dermatomyositis are at risk for what malignancies?
lung & breast cancer
186
Which of the following is assoc. w/ polymyositis and dermatomyositis? A. endocarditis B. myocarditis C. pericarditis
B. myocarditis
187
antibody assoc. w/ polymyositis & dermatomyositis
anti-Jo-1 antibodies
188
anti-smooth muscle antibody
autoimmune hepatitis
189
anti-RNP antibody
mixed connective tissue disease
190
anti-topoisomerase 1 antibody
scleroderma
191
anticentromere antibody
CREST syndrome
192
anti-Ro antibody
neonatal lupus
193
c-ANCA
Wegener's (granulomatosis w/ polyangiitis)
194
p-ANCA
microscopic polyangiitis
195
type of anemia assoc. w/ rheumatoid arthritis
anemia of chronic disease
196
Dx: 40 yo F w/ ulnar deviated hands, LUQ mass, and low WBC count
Felty's syndrome (RA, splenomegaly and neutropenia)
197
best initial disease-modifying antirheumatic drug (DMARD) for RA
methotrexate
198
Dx: inflammatory myopathy affecting M>F, distal muscles, loss of deep tendon reflexes and no autoantibodies
inclusion body myositis
199
anti-Mi-2 antibodies
polymyositis/dermatomyositis
200
anti-synthetase antibodies
another name for anti-Jo-1 antibodies assoc. w/ polymyositis/dermatomyositis
201
anti-signal recognition antibodies
cardiac conduction manifestations assoc. w/ polymyositis/dermatomyositis
202
features of CREST syndrome
calcinosis, Raynaud's, esophageal dysmotility, sclerodactyly, telangiectasias
203
drug used for cutaneous scleroderma
penicillamine
204
Tx for Raynaud's
CCBs (vasospasm)
205
Pt w/ calcinosis, Raynaud's, esophageal dysmotility, sclerodactyly and telangiectasias develops acute renal failure. What could have prevented this?
ACEIs (scleroderma renal crisis)
206
anti-leucine aminopeptidase antibody
Sjogren's syndrome
207
lupus often affects which heart valve?
mitral valve (Libman-Sacks endocarditis)
208
what tests should be ordered for neonates w/ lupus?
EKG and echo (for congenital heart block and transposition of great vessels, respectively)
209
involvement of which organ system(s) excludes drug-induced lupus?
CNS and/or renal (these are spared in drug-induced lupus)
210
temporal artery biopsy in giant cell arteritis will show what?
thrombosis, necrosis of media, presence of lymphocytes and/or plasma cells
211
<11 tender points in a 50 yo F w/ depression and anxiety
myofascial pain syndrome
212
cause of death in Duchenne muscular dystrophy
cardiac fibrosis -> high-output heart failure -> pulmonary congestion
213
What immunostain is used to diagnose Duchenne muscular dystrophy?
Western blot
214
endocrinopathy assoc. w/ slipped capital femoral epiphysis
hypothyroidism. Rule out w/ TSH
215
Tx for scoliosis based on degree of involvement
50 degrees: surgery
216
Dx: boy w/ arthritis, daily high/spiking fevers and an evanescent, salmon-colored rash
Still's disease (acute febrile/systemic juvenile idiopathic arthritis)
217
Tx for juvenile idiopathic arthritis
NSAIDs
218
Which organisms causing pneumonia can be diagnosed with a urine antigen test?
Legionella and Strep pneumo
219
Pneumonia diagnosed w/ serum cold agglutinin test
Mycoplasma
220
Dx: Pt w/ fever, productive cough, and sputum Gm stain shows lancet-shaped Gm+ diplococci
S. pneumoniae
221
Pt being treated for TB complains of new vision problems. Cause?
side effect of ethambutol is optic neuritis
222
Pt being treated for TB now has elevated liver enzymes. Cause?
side effect of INH is hepatitis
223
Who should be notified of new TB diagnosis
ALL cases of TB (both latent & active) must be reported to local and state health departments.
224
MCC of bacterial diarrhea? Tx?
Campylobacter. Erythromycin
225
Choroidal tubercles on eye exam in a pt w/ a cough suggests what?
miliary TB
226
Next step in TB pt treated w/ 2 months of RIPE.
4 months of INH + rifampin
227
What is an alternative to ethambutol in RIPE tx of TB?
streptomycin
228
Tx for strep throat
penicillin x 10 days
229
Dx: Pt w/ strep throat develops thrombophlebitis of the jugular vein
Lemierre's syndrome, due to oral anaerobe Fusobacterium
230
First-line tx for acute bacterial sinusitis
amoxicillin/clavulanicate 500 mg PO TID x 10 days
231
What are hemagglutinin and neuraminidase?
glycoproteins assoc. w/ influenza A
232
Antigenic drift is specific for which influenza virus(es)?
only influenza A
233
What phenomenon allows individuals to be affected w/ influenza more than once?
antigenic drift
234
How old do you have to be to get a flu shot?
_ 6 months old
235
When is LP contraindicated in meningitis?
papilledema or focal neurologic deficits
236
Close contacts of pts w/ meningococcal meningitis should receive what for ppx?
rifampin
237
Tx for seizures due to meningitis
benzos and phenytoin
238
What is the only live vaccine you can give an HIV+ patient?
MMR
239
Dx: HIV pt w/ cough and sputum stain shows folded cysts containing comma-shaped spores
Pneumocystis jiroveci pneumonia
240
T of F: Mycobacterium avium complex (MAC) is only a disease of immunocompromised individuals.
False. 1_ pulmonary MAC occurs in apparently healthy non-smokers (Lady Windermere syndrome)
241
What is the most common serious medical complication of pregnancy?
pyelonephritis
242
First-line med for uncomplicated pyelonephritis
PO fluoroquinolones
243
MCC of sepsis in IVDUs?
Staph aureus
244
mechanism of Gm+ shock? Gm- shock?
Gm+ is exotoxin. Gm- is endotoxin (lipopolysaccharide)
245
MCC of catheter-related sepsis?
Staph aureus or Staph epidermidis
246
Top 2 DDx for fever of unknown origin. If you're forced to choose 1, which is it?
infection (#1) and cancer (#2)
247
Tx for Lyme disease in children <8 yo and in pregnant pts?
oral amoxicillin
248
disease transmitted by American dog tick
Rocky Mountain Spotted Fever
249
RMSF is a disease of A. large arteries B. medium arteries C. medium veins D. large veins E. capillaries
capillaries
250
Tx for RMSF in pregnant women
chloramphenicol
251
Other than Pseudomonas, what causes otitis externa?
Enterobacteriaceae
252
mechanism of pulmonary anthrax
hemorrhagic mediastinitis
253
Vascular or immunologic: Janeway lesions? Roth spots? Osler's nodes?
Janeway lesions - vascular, Roth spots - immunologic, Osler's nodes - immunologic
254
Drug of choice for anthrax? Second-line?
Cipro first, then doxycycline
255
pneumonia-causing organism in COPD pts?
Haemophilus influenzae
256
Most likely cause of pneumonia in a college student or soldier?
Mycoplasma (atypical)
257
What is the primary Tx for Pneumocystic pneumonia? What are 3 alternatives?
TMP-SMX. Alternatives: pentamidine, atovaquone, dapsone
258
late, rare complication of measles
subacute sclerosing panencephalitis
259
osteochondritis of tibial tubercle
Osgood-Schlatter
260
Pt is started on hydroxychloroquine for treatment of rheumatoid arthritis. Next step?
eye exam every 6 months (retinal toxicity)
261
When should Rh typing be done in pregnancy?
first prenatal visit
262
Prenatal measurement that most accurately measures fetal age?
biparietal diameter
263
Name 3 conditions associate w/ postterm pregnancy (prolonged gestation)
anencephaly, oligohydramnios, placental sulfatase deficiency (x-linked ichthyosis)
264
Dx: proteinuria, edema, RUQ pain and hypertension at 12 weeks gestations
think hydatidiform mole (gestational trophoblastic tumor) OR choriocarcinoma
265
most important risk factor for developing preeclampsia
chronic kidney disease (from SLE or type 1 DM)
266
What test can be used to calculate the dose of RhoGAM to be given?
Kleinhauer-Betke test (quantifies the amount of fetal blood in maternal circulation)
267
dyslexia or alexia can result from stroke in what arterial distribution?
PCA
268
T or F: Pt must be 18 yo or older to get tPA for acute stroke.
TRUE
269
In the immediate postictal period, what hormone is likely to be elevated?
prolactin
270
low leukocyte alkaline phosphatase is assoc w/ what malignancy?
CML
271
large, globular (water bottle shaped) heart on CXR
pericardial effusion
272
treatment for nocardia
TMP-SMX
273
Pt reports severe dizziness after turning in bed and reaching overhead. What anatomical structure is involved?
posterior semicircular canals
274
What is meclizine (and other antivertigo meds) contraindicated in BPPV?
they inhibit central compensation
275
labyrinthitis is mimicked by a stroke in what artery?
AICA (lateral pontine syndrome)
276
vestibular neuritis is mimicked by a stroke in what artery?
PICA (lateral medullary syndrome, Wallenberg syndrome)
277
How are labyrinthitis and vestibular neuritis different?
Labyrinthitis includes auditory symptoms (unilateral tinnitus, ear fullness, hearing loss). Vestibular neuritis does not.
278
Dx: 25 yo pt has N/V, vertigo and unsteady gait. Bedside head impulse test shows left-beating nystagmus.
acute peripheral vestibulopathy (vestibular neuritis or labyrinthitis), on the RIGHT b/c nystagmus beats opposite of lesion
279
Dx: 22 yo F presents w/ 24 hrs of vertigo, N/V, and photophobia. She denies tinnitus, aural fullness or hearing loss. Her gait is normal. What other condition does she most likely have?
migraine headaches (this is a vestibular migraine)
280
Difference in muscle stimulation test in myesthenia gravis and Lambert-Eaton
MG: decremental response (worsens w/ repetitive stimulation. LE: incremental response (improves)
281
Lambert-Eaton antibodies attack what?
pre-synaptic Ca++ channels
282
Myesthenia gravis antibodies attack which type of receptors? A) muscarinic B) nicotinic C) calcium D) TSH E) presynaptic
nicotinic acetylcholine receptors
283
Drugs that can exacerbate myesthenia symptoms
antibiotics (aminoglycosides, tetracyclines), beta-blockers, anti-arrhythmics (lidocaine, procainamide, quinidine)
284
most common subtype of multiple sclerosis
relapsing-remitting
285
What would you tell a pregnant pt w/ MS about what to expect regarding her symptoms?
improvement of symptoms during pregnancy
286
Pt treated for MS develops severe CNS deterioration. Medication responsible?
Natalizumab (Tysabri) - risk for JC virus-mediated progressive multifocal leukoencephalopathy (PML)
287
What is the geographic assoc. w/ MS?
Incidence is greater at higher latitudes (more common with further distance from equator)
288
first line treatment for OCD
SSRIs
289
first line treatment for anxiety
SSRIs
290
first line treatment for post-traumatic stress disorder
SSRIs
291
mechanism of flumazenil
COMPETITIVE antagonist at GABA receptor (antidote to benzo intoxication)
292
Lactate (as in lactated Ringer's) can cause what psychiatric disorder?
panic attacks
293
Pt is has been treated for panic disorder with a bezno. Today, she is started on an SSRI. Next step?
Slowly taper benzo (Do Not stop "cold turkey")
294
1st and 2nd MCC of PTSD in men
1st - rape. 2nd - combat
295
What 2 neurotransmitters are deficient in Alzheimer's?
NE and ACh
296
An ICU pt is disoriented to person, place, and time. Once the underlying etiology is resolved, which will he regain orientation to first?
Person, then place, then time.
297
depression involves what cortex of the brain?
left prefrontal cortex
298
Dx: A pt is has been treated for a mood disorder for the last 2 years. Today she presents w/ poor appetite, sad mood, excessive guilt, weight gain and suicidal ideations.
Double depression (major depressive episode on top of dysthymia)
299
Is electroconvulsive therapy for depression safe in pregnancy?
YES
300
A 30 yo F undergoes ECT for major depression. What is the most likely adverse effect that she will experience?
anterograde amnesia
301
A 60 yo M has depression 6 months after a stroke. Which artery is most likely involved?
Anterior cerebral artery
302
T or F: hallucinations and illusions are a normal part of normal bereavement
True, as long as pt recognizes them as hallucinations/illusions
303
40 yo F is treated w/ fluoxetine for MDD. If she starts an MAOI, when should she stop taking fluoxetine?
5 weeks before starting MAOI (for other SSRIs, stop 2 weeks before)
304
A pregnant woman give birth to a baby who develops pulmonary hypertension. She was being treated for major depression. Most likely drug?
paroxetine
305
25 yo M treated for depression has BP of 130/110. Most likely cause?
Venlafaxine - causes diastolic hypertension
306
how does isocarboxazid treat depression?
inhibits monoamine oxidase (MAOI)
307
ICU pt w/ h/o depression is given an MAOI. BP is now 210/100. Best therapeutic step?
Phentolamine (alpha blocker)
308
What is the prevalence of bipolar type I?
1%
309
What percentage of bipolar pts commit suicide?
10-15%
310
If you have to choose between a mood stabilizer and an antidepressant to treat bipolar depression, which do you choose first? Why?
Mood stabilizer to avoid antidepressant-induced mania
311
Activity of what enzyme is decreased by lithium?
adenylyl cyclase
312
How is lithium eliminated from the body? What chronic condition precludes its use?
renally excreted; avoid in pts w/ poor renal function
313
Pt present w/ excessive thirst and "urinating a lot." UA shows low urine osmolality. Pt has h/o of bipolar disorder (treated). Dx?
diabetes insipidus caused by lithium, which acts as an ADH antagonist
314
Bipolar pt is started on a new medicine. 2 weeks later, her ammonium levels are way high. Cause?
Valproic acid
315
Dx: corpus callosum atrophy, decreased dendritic branching, chromosome 22, frontal hypoactivity, limbic hyperactivity
schizophrenia
316
Suicide rate among schizophrenics is
10%
317
hallucinations + "waxy flexibility"
catatonic schizophrenia
318
EEG pattern in schizophrenia
normal
319
antipsychotic causing retinal pigmentation
thioridazine (th-EYE-oridazine)
320
What test should be done before starting quetiapine?
slit lamp eye exam (risk of cataracts)
321
Most common side effect of atypical antipsychotics (risperidone, quetiapine, aripiprazole, etc)
weight gain (T2DM is #2)
322
Difference between pemozide and pemoline
pemozide - dopamine receptor antagonist used for Tourette's. pemoline - psychostimulant used for ADHD
323
What pediatric infection may lead to autism?
congenital rubella
324
MCC of inherited mental retardation
Fragile X syndrome
325
MCC of congenital mental retardation
Down syndrome
326
T or F: weight gain is not a side effect of combined oral contraceptive pills
TRUE
327
T or F: bilateral renal agenesis is incompatible with life
TRUE
328
First line treatment for cancer-causing anorexia
progestins
329
What secondary malignancy does Tamoxifen predispose to?
endometrial cancer
330
T or F: Reason UTIs are more common in females is closer proximity of urethra to anus.
False - It's b/c the urethra is shorter.
331
Withdrawal from what two substances can lead to nightmares and increased appetite?
amphetamines and cocaine
332
A pt in the ED is belligerent, threatening and has nystagmus. His urine toxicology screen is negative. He's given haldol and placed in isolation. He appears to calm down. 3 hours later, he becomes acutely violent. By what mechanisms did this occur?
PCP - recurrence due to reabsorption in GI tract
333
What street drugs have no withdrawal syndrome?
LSD and marijuana (So remember that the "munchies" occur during marijuana use, not withdrawal.)
334
T or F: caffeine withdrawal can lead to weight gain
TRUE
335
Pt in the ED says he just stopped "using" because he is engaged and no longer wants to be a druggy. His pupils are dilated, he has piloerection, rhinorrhea and excessive yawning. He is at risk for what? A. withdrawal seizure B. sudden cardiac death C. vivid flashbacks D. weight gain E. no life threatening event
Opioid withdrawal is not life-threatening and does not lead to seizures, weight gain, cardiac problems or flashbacks.
336
A 17 yo F gymnist w/ BMI 16 is admitted for electrolyte abnormalities. What cardiac condition is she most likely to develop? A. aortic stenosis B. mitral stenosis C. mitral valve prolapse D. hypertrophic cardiomyopathy E. aortic insufficiency
mitral valve prolapse is a common complication of anorexia nervosa
337
Dx: A man is arrested for rubbing his genitals on an old lady on the subway. He tells police he enjoys doing this all the time.
Frotteurism
338
Dx: A 40 yo F presents w/ strap-like red marks on her wrists, ankles and neck. She says she enjoys being bound before sex with her lover.
masochism
339
Sleep disorder w/ decreased REM sleep latency
narcolepsy (reach REM sleep faster)
340
Tx for cataplexy assoc. w/ narcolepsy
SSRI
341
Tx for obstructive vs. central sleep apnea
OSA: CPAP, weight loss. CSA: BiPAP (mechanical ventilation)
342
Pt has a new job working the night shift (8PM-6AM) at a convenient store. He says he cannot fall asleep when he gets home and wants to try melatonin. What should you tell him about melatonin? A. Take it when you get to work. B. Take it when you get home from work. C. Take it 5 1/2 hours before going to sleep. D. An SSRI would be a better choice. E. Take diphenhydramine 5 hours before going to sleep.
Take melatonin 4-6 hours before sleep in circadian rhythm sleep disorders
343
Number of specific complaints to diagnose somatization disorder
4 pain, 2 GI, 1 sexual, 1 neurologic
344
30 yo F present w/ 10lb weight gain. She started a new medicine for depression. She denies sexual dysfunction, N/V, tremor or insomnia. Most likely med?
mirtazapine
345
increased P wave amplitude
P pulmonale (right atrial enlargement)
346
increased P wave width, or notched P waves
P mitrale (left atrial enlargement)
347
2 pulmonary conditions where pulsus paradoxus is seen
asthma and COPD
348
Tx for A-fib
ABCD: Anticoagulant (warfarin), Beta blocker, Cardioversion/CCB, Digoxin
349
MCC of 2nd degree AV block Mobitz II
fibrosis of conduction system
350
If left untreated, what are pts w/ Mobitz II at risk for developing?
3rd degree AV block
351
cannon A waves
3rd degree AV block
352
Most common indication for pacemaker placement
sick sinus syndrome (tachycardia-bradycardia syndrome)
353
What are the CHADS2 criteria? What is it used for?
Risk for stroke in pts w/ A-fib. C - CHF (1) H - HTN (1) A - Age _ 75 (1) D - Diabetes mellitus (1) S2 - prior Stroke, TIA, or Thromboembolism (2)
354
When do you anticoagulate a pt w/ A-fib? When do you cardiovert?
Anticoagulate if CHADS2 score of 2 or more, or for A-fib >48hrs. Cardiovert for new A-fib (<48hrs), no left atrial clot, or after 3-6 weeks of warfarin w/ INR 2-3.
355
T or F: atrial rate is nearly twice the ventricular rate in atrial flutter
true (atrial rate 240-320, ventricular rate ~ 150)
356
What lifestyle modifications can reduce risk of A-fib?
decreased alcohol consumption
357
What is an example of atrioventricular reciprocating tachycardia?
WPW (ectopic connection btw atrium and ventricle)
358
Dx: 60 yo M c/o SOB and lightheadedness. EKG shows retrograde P waves and tachycardia.
atrioventricular reciprocating tachycardia
359
Tx of choice for symptomatic PVCs
beta-blockers
360
3 broad causes of PVCs
hypoxia, electrolyte abnormalities, hyperthyroidism
361
Drug of choice for wide-complex V-tach
amiodarone
362
A pediatric pt has congenital deafness and an abnormal EKG. Most likely arrhythmia to develop?
Torsades de pointes (assoc. w/ congenital deafness)
363
Treatment for acute pulmonary congestion in CHF
LMNOP: Lasix, Morphine, Nitrates, O2, Position (upright)
364
Pt has CHF and is "maxed out" on all available meds. His EF is now <35%. What is a reasonable next step?
implantable biventricular cardiac defibrillator (ICD)
365
What is torsemide?
Loop diuretic (same suffix as furosemide)
366
T or F: spironolactone, amiloride, and triamterene are all aldosterone receptor antagonists
F - only spironolactone. Amiloride and triamterene are K+ sparing ENaCs (sodium channel blockers)
367
Pt is on diuretics and has hemolysis with bite cells. He has an abnormally low G6PD level. Most causative agent?
acetazolamide (carbonic anhydrase inhibitor) - sulfa allergy
368
What complication of mannitol makes it contraindicated in CHF?
pulmonary edema
369
HIV pt present w/ SOB and nocturnal cough. He is compliant w/ all meds. CD4 count is 150. S3 gallop on exam. Echo shows dilated ventricles. Most causative agent?
AZT can cause dilated cardiomyopathy
370
Pt w/ acromegaly is at risk for developing what heart condition?
dilated cardiomyopathy (systolic HF)
371
What "heart meds" should be avoided during CHF?
CCBs
372
Hypertrophic cardiomyopathy is assoc w/ which of the following conditions? A. fragile X syndrome B. trisomy 21 C. trisomy 18 D. Friedreich's ataxia E. Marfan syndrome
Friedreich's ataxia
373
Pts w/ hypertrophic cardiomyopathy may have a defect in which protein? A. frataxin B. collagen C. elastin D. ankyrin E. hyaluronidase
frataxin
374
What chromosome is Friedreich's ataxia assoc with?
9
375
A 19 yo football player collapses during practice. ECG shows LVH. Echo shows a dynamic outflow obstruction. What med would you choose to start first?
beta blocker
376
Young pt comes in for a sports physical. Workup reveals hypertrophic cardiomyopathy. FHX is positive for early death of an uncle. Advice to pt: A. You are well enough to compete in sports. B. Follow up in 6 months. C. You may compete in non-contact events. D. You should avoid intense athletic competition and training.
Avoid intense athletic competition and training.
377
Restrictive cardiomyopathy is best described as A. autoimmune B. neoplastic C. infiltrative D. inflammatory E. obliterative
infiltrative (amyloidosis, sarcoidosis, hemochromatosis)
378
Pt w/ hereditary iron overload is diagnosed w/ restrictive heart disease. Most likely finding would be A. bibasilar crackles B. dullness to chest percussion C. neck vein distension D. history of nocturnal cough E. left atrial enlargement
neck vein distension. Right sided HF signs/symptoms are more predominant in restrictive cardiomyopathy
379
Pts w/ what conditions are considered to have "coronary artery disease risk equivalents"?
DM, symptomatic carotid artery disease, PAD, AAA
380
Describe the following features of Printzmetal's (variant) angina: ST changes, cardiac enzyme levels, mechanism of symptoms
ST-segment elevations, normal cardiac enzyme levels, coronary vasospasm
381
Which of following carry a mortality benefit in treating angina? A. beta blockers and aspirin B. ACEIs and ARBs C. CCBs D. supplemental oxygen E. heparin
beta blockers and aspirin
382
Cardiac enzyme levels in unstable angina
normal
383
How do abciximab, eptifibatide, and tirofiban work to treat angina?
inhibit glycoprotein IIb/IIIa
384
A 55 yo M has a new MI. What is the best predictor of survival?
left ventricular ejection fraction
385
Most sensitive & specific cardiac enzyme: A. CK-MB B. troponin I C. troponin T D. myosin light chain E. LDH
troponin I
386
Man presents w/ chest pain radiating to his neck and L arm. EKG shows ST depression in leads V1-V2. Next step?
posterior EKG (leads V7-V9) to asses for posterior wall/transmural MI (will see ST elevations in V7-V9)
387
Most common complication leading to death following acute MI is A. fatal arrhythmia B. ventricular free wall rupture C. interventricular septal rupture D. atheroembolic stroke E. ventricular septal defect F. papillary muscle rupture G. reinfarction
fatal arrhythmia
388
Dx: Pt presents for follow up 2 months from MI. T 101, chest discomfort. CXR shows pleural effusions. EKG shows diffuse ST elevations. WBC 12,000, ESR is 30. What is the Tx?
Dressler's syndrome (autoimmune). Tx is aspirin.
389
Lipid profile diagnostic of dyslipidemia
Total cholesterol >200, LDL > 130, HDL < 40, Triglycerides > 150
390
When should fasting lipid profiles occur?
Starting at age 35 if no CAD risk factors. Start at age 20 if CAD risk factors. Then repeat every 5 years.
391
Pt is started on a new cholesterol medicine. She presents to the ED the next day with facial swelling, wheezing, and decreased O2 sats. Most likely causative agent?
ezetimibe (cholesterol absorption inhibitor) can cause angioedema
392
Single most effective lifestyle modification for hypertension
weight loss
393
Single most effective lifestyle modification for hypertension in a non-obese patient
DASH diet
394
Pt has an aldosterone-secreting adrenal adenoma. Describe pH, K+ and renin levels.
metabolic alkalosis (incr pH), hypokalemia, low renin
395
What feature of labetalol makes it a good choice for hypertensive emergencies?
it's an alpha- and beta-blocker
396
ECG finding of pericarditis other than diffuse ST segment elevation
PR depression
397
A 50 yo M recently had an MI. He develops acute pericarditis on hospital day 3 and is started on daily corticosteroids. He is at risk for what?
ventricular free wall rupture due to corticosteroids
398
Which of the the following would you expect to be low in a pt on a beta blocker? A. aldosterone B. renin C. androstenedione D. angiotensin converting enzyme E. cortisol
beta blockers can decrease renin release
399
A man w/ HTN and DM is taking lisinopril and losartan. His WBC count today is 4500. Could this be an effect of the medicine?
Yes - ACEIs and ARBs can cause leukopenia
400
What determines the severity of cardiac tamponade?
the RATE of fluid formation
401
Dx: Pt presents w/ dyspnea and tachycardia. ECG shows electrical alternans
pericardial tamponade
402
MCC of valvular heart disease in the US
mechanical degeneration
403
Indications for valve replacement in aortic stenosis
ACS - angina, CHF, syncope
404
Dx: physical exam reveals a paradoxically split S2 sound
aortic stenosis (P2 then A2, delayed emptying of left ventricle)
405
What is a Duroziez's bruit (or Duroziez's sign)?
femoral bruit heard in aortic regurgitation
406
A 65 yo M w/ a 20 pack-year smoking history but quick 20 years ago. He has HTN and is here for a routine appointment. What screening, if any, should he receive?
A one-time abdominal ultrasound for AAA is recommended for all men ages 65-75 who have ever smoked.
407
murmur likely to be heard in a proximal aortic dissection
aortic regurgitation (early diastolic murmur)
408
Pt presents w/ "blue toes" after undergoing a carotid endarterectomy. Mechanism?
cholesterol atheroembolism ("blue toe syndrome")
409
Most likely reason that a pt's ABI could read 1.4 for example (normal is 0.9)
calcification of arteries
410
Most likely diagnosis if child present w/ lower extremity lymphedema
Milroy's disease (hereditary lymphedema of childhood)
411
Best initial management for lymphedema? A. prophylactic antibiotics B. diuretics C. exercise and massage therapy D. surgical decompression
exercise and massage therapy and pressure garments
412
Pt presents to ED w/ syncopal episode. Further workup reveal a cardiac origin. What is this pt's risk of sudden cardiac death in the next year? A. less than 5% B. greater than 5% but less than 20% C. 40% D. 75% E. >90%
up to 40%
413
T or F: Unstable angina is caused by increased O2 demand of myocardium.
False. O2 demand is unchanged in unstable angina, as opposed to stable angina where O2 demand is increased. Unstable angina is caused by reduced resting coronary BF.
414
Drug of choice for anticoagulation following and NSTEMI.
enoxaparin
415
What can be given during coronary angiography to induce Prinzmetal's angina?
IV ergonovine
416
Pt has chest pain and Q waves on EKG. This finding is specific for A. subendocardial injury B. transmural injury C. right heart injury D. necrosis E. panic-induced chest pain
necrosis (ST depression = subendocardial, ST elevation = transmural)
417
First EKG feature seen in MI
peaked T waves
418
Drug of choice for post-MI pericarditis
aspirin
419
As an alternative to ARBs in pts w/ CHF who are intolerable to ACEIs, what else can be given?
hydralazine/isosorbide dinitrate combination
420
Which post-MI dysrhythmia carries the worst prognosis? A. atrial fibrillation B. atrial flutter C. ventricular D. supraventricular tachycardia tachycardia E. sinus bradycardia
V-tach
421
Next step for V-fib? A. synchronized direct current cardioversion B. synchronized indirect current cardioversion C. unsynchronized direct current cardioversion D. unsynchronized indirect current cardioversion E. adenosine
defibrillation = unsynchronized direct current cardioversion
422
Good antiarrhythmic drug for WPW
procainamide (does not affect AV node)
423
how does atropine work to treat bradycardia?
blocks vagal stimulation to SA node
424
Most likely location of delay in first degree AV block is A. within the atrial myocardium B. in the SA node C. in the AV node D. in the bundle of His E. along either bundle branch
in the AV node
425
Vitamin and mineral deficiency assoc. w/ dilated cardiomyopathy
thiamine (wet beriberi), selenium
426
Dx: on physical exam, a bisferious pulse is seen in the carotid arteries
pulsus bisferiens can be seen in HOCM
427
What causes elevated and equal diastolic pressures in all 4 heart chambers?
pericarditis and/or tamponade
428
A pt w/ mitral stenosis present w/ hemoptysis. How can mitral stenosis cause hemoptysis?
elevated LA pressure can rupture anastomoses of small bronchial veins
429
Dx: 50 yo M w/ SOB and angina has a bobbing uvula on physical exam.
aortic regurgitation/insufficiency (this is MŸller's sign)
430
Dx: Pt has a Cullen sign, severe back pain, and BP 190/100.
AAA about to rupture (can cause Cullen or Grey Turner sign)
431
Lysosomal storage disease w/ hypotonia, cherry red spot and hepatomegaly? Deficiency?
Neimann-Pick. Sphingomyelinase deficiency
432
Lysosomal storage disease w/ hypotonia, cherry red spot, but not hepatomegaly. May have exaggerated startle response. Deficiency?
Tay-Sachs. Hexosaminidase deficiency
433
Erythema nodosum affects which of the following? A. dermal-epidermal junction B. subcutaneous fat C. dermal lymphatics D. epidermal granular layer E. periosteal matrix
subcutaneous fat (it is a panniculitis)
434
2 neoplasms that secrete ectopic ACTH
small cell lung cancer, (bronchial) carcinoid tumor, medullary thyroid carcinoma
435
A 50 yo F on long-term prednisone complains of weight gain and purple striations on her abdomen. Which of the following is most likely absent from her history or physical exam? A. unwanted facial hair B. depression C. retrocervical fat pad D. hypertension E. easy bruisability
Unwanted facial hair. Iatrogenic cushing's (syndrome) does not have the androgen excess seen in cushing's disease (ACTH-dependent Cushing's).
436
A pt has episodic HTN, palpitations, tremor and diaphoresis. A CT and MRI are negative for adrenal lesions. What other test could be done to make the diagnosis?
MIBG nuclear scan - able to locate extra-adrenal or metastatic pheochromocytoma/paragangliomas. Octreotide scan is also good for neuroendocrine tumors
437
Most common location for extra-adrenal pheo
aortic bifercation (organ of Zuckerkandl)
438
Pt w/ psych history present w/ dilute urine. After a water deprivation test, his urine osm increases. Dx?
psychogenic polydipsia. (note: in diabetes insipidus, urine osm would remain dilute after water deprivation test.)
439
A 30 yo F presents for routine checkup. She is drinking her third cup of coffee this morning, as is her usual. Today she appears jittery and diaphoretic. She recalls having palpitations at work that usually resolve throughout the day, but she often gets a headache at the end of the day. She does not smoke, drink alcohol or use drugs. She denies family history of cancer. BP 135/85, P 100, R 16, T 98.6. Plasma free metanephrines are normal. Urine vanillylmandelic acid is elevated. MRI of abdomen and MIBG scan are negative. Most likely diagnosis?
Coffee and tea can falsely elevate VMA. She is most likely experiencing symptoms related to her coffee.
440
A pt has hypercalcemia, elevated calcitonin levels, long arms and fingers, and mucosal neuromas. What chromosome is most likely implicated?
MEN 2B (here) and 2A are caused by RET proto-oncogene mutation. Located on chromosome 10. (Think "MEN on TEN")
441
Confirmatory test for adrenal insufficiency
8AM plasma cortisol level (will be low). Confirm w/ synthetic ACTH stimulation test (cortisol will fail to rise much).
442
Dx: A pt has weight loss, hypoglycemia and abdominal pain. Morning plasma cortisol is low and does not correct w/ ACTH stimulation. She is an asthmatic and takes a daily inhaled corticosteroid. She ran out of meds last week and has not had them refilled. Her BP is 120/80. She should receive
Adrenal insufficiency due to cessation of long-term glucocorticoids should be treated with replacement of glucocorticoids ONLY. Chronic use reduces ACTH, but mineralocorticoids are not ACTH-dependent, so they will be unchanged.
443
CBC finding in adrenal insufficiency?
eosinophilia
444
The presence of antibodies to which of the following confirms the diagnosis of diabetes mellitus?
anti-GAD (glutamic acid decarboxylase) antibodies are specific for DM. (anti-CCP = RA, anti-parietal cell = pernicious anemia, anti-transglutaminase = celiac disease. HLA-DR3 and -DR4 are assoc. w/ DM, but not assoc. w/ antibody production.)
445
Screening recommendations for diabetes in pts w/ NO RISK FACTORS:
HbA1c at age 45, then every 3 years
446
Before giving insulin to a pt in DKA, what should be given first?
potassium
447
What is the criteria for metabolic syndrome?
Abd. circumference: > 40in Men, >35in Women; HDL < 40 (M) OR < 50 (W); Trig _ 150; BP _ 130/85 or need for HTN meds; FASTING glucose _100
448
Mechanism of glipizide, glyburide, glimepiride
increased endogenous insulin secretion (Think "SELFonylureas")
449
Acarbose and miglitol act on what enzyme to treat hyperclycemia?
alpha-glucosidase inhibitors (a GI brush-border enzyme), reduce intestinal absorption of carbohydrates
450
Dx: A nurse has anti-insulin antibodies
surreptitious insulin use
451
Whipple's triad of hypoglycemia
1. fasting hypoglycemia with symptoms 2. blood glu < 50 during symptoms 3. giving glucose improves symptoms
452
What leukemia presents w/ a chloroma?
AML
453
Other causes of infectious esophagitis besides Candida
HSV, CMV
454
Risk factors for SCC of esophagus
smoking, alcohol (top 2); dietary deficiencies of thiamine (B1), beta-carotene, zinc, selenium; hot foods/beverages; nitrosamines; toxin-producing fungi
455
Why does esophageal cancer metastasize early?
it lacks serosa
456
Tx for esophageal cancer
chemoradiation and surgery
457
3 stimulator of HCl
ACh, histamine, gastrin
458
What are GERD "alarm symptoms"?
blood in stool, dysphagia/odynophagia, weight loss
459
What will bronchoscopic aspirate show in GERD pts?
lipid-laden macrophages from phagocytosis of fat in gastric contents
460
Type A chronic gastritis is assoc. what what malignancies?
gastric adenocarcinoma and carcinoid tumors
461
Pt has a elevated urine 5-HIAA and pernicious anemia. He most likely has pathology of which of the following?
gastric fundus - site of chronic gastritis type A, assoc. w/ pernicious anemia and carcinoid tumors
462
Most common location for chronic gastritis
antrum (type B) - where H. pylori lives
463
Which indicates CURRENT H. pylori gastritis: serum IgG antibodies or H pylori stool antigen?
H pylori stool antigen (current infection), IgG antibodies = history of exposure
464
Triple therapy for gastritis. What about pt allergies?
amoxicillin + clarithromycin + omeprazole (2 ABx + PPI). Metronidazole instead of amoxicillin if penicillin-allergic.
465
Krukenberg tumor is gastric SCC or adeno?
adeno
466
How do you treat MALT lymphoma?
antibiotics (only cancer curable with antibiotics) - give triple therapy (same as gastritis)
467
Blood types assoc. w/ PUD?
type O assoc. w/ duOdenal ulcers; type A assoc. w/ gAastric ulcers
468
45 yo F presents w/ a 5 yr h/o recurrent PUD, unresponsive to meds. Today she has dull, burning epigastric pain. What test show you order now?
serum gastrin level (look for MEN type 1 w/ gastrinoma/ZES)
469
Jejunal ulcers =
ZE syndrome (pathognomonic)
470
Stain used to detect diarrhea bugs in HIV pts?
acid-fast (Cryptosporidium and Isospora)
471
drug assoc. w/ pyloric stenosis in babies
erythromycin
472
Tx for traveler's diarrhea
Cipro
473
Pt w/ entamoeba histolytica causing diarrhea is treated w/ steroids. What is he at risk for?
fatal perforation
474
Why are ABx and anti-diarrheal therapy contraindicated in E. coli O157-H7 infections?
they increase risk of HUS
475
Infectious diarrhea preceded by a "prodrome"? Tx?
Salmonella. Tx: oral quinolone (cipro) or TMP-SMX
476
Dx: Young pt develops bloody diarrhea and febrile seizures.
Shigella
477
Dx: Pt has just recovered from a 3 day h/o vomiting and diarrhea that resolved without medication. He now has flatulence, diarrhea, low stool pH and an increased stool osmotic gap.
transient lactose intolerance following acute gastroenteritis
478
Amino acid deficiency in carcinoid syndrome
Tryptophan
479
Mechanism that prevents most carcinoid tumors from creating carcinoid syndrome
first pass metabolism by liver
480
Length of symptoms req'd for dx of IBS?
at least 3 months
481
Mechanism of leukocytosis in SBO
bowel ischemia/necrosis
482
Most likely location of thrombosis causing mesenteric ischemia? Most common risk factor?
proximal SMA; atherosclerosis
483
thumbprinting on abdominal Xray represents what, and is found in what disease?
bowel wall edema; mesenteric ischemia
484
What labs are elevated in mesenteric ischemia?
LDH, lactate, WBC, amylase, CK
485
Difference in Tx btw arterial vs. venous thrombosis causing mesenteric ischemia
arterial: anticoagulation + surgery (angioplasty or laparotomy). venous: anticoagulation alone
486
Imaging study of choice for CHILDREN and PREGNANT pts suspected to have appendicitis?
ultrasound (not CT)
487
Tx for appendiceal abscess
1. broad spec ABx, 2. PERCUTANEOUS drainage, 3. elective appy 6-8 weeks later
488
Tx for perforated diverticulitis
Hartmann's bowel resection w/ temporary colostomy
489
Which screening is indicated in a pt who is 2 years post-op from colon resection due to colon cancer?
Metastatic screening after colon cancer resection includes CEA, colonoscopy, LFTs, CXR and abdominal CT.
490
The majority of colorectal cancers begin as what premalignant lesion?
adenomatous polyps
491
A 48 yo M presents for routine follow up. He is asymptomatic. His dad was dx'd w/ colon cancer at age 38. What is your advice today?
colonoscopy today
492
Recommended screening for pediatric pts w/ FHX of familial adenomatous polyposis? HNPCC?
FAP: genetic testing @ age 10, colonoscopy every 1-2 yrs starting @ puberty. HNPCC: genetic testing @ age 21. If +, colonoscopy every 2 yrs until age 40, then every year.
493
Skin rash assoc. w/ IBD
pyoderma gangrenosum
494
Dx: 19 yo presents w/ bloody diarrhea, episcleritis and pseudopolyps on colonscopy.
ulcerative colitis. IBD can occur in teens! Episcleritis/uveitis and pseudopolyps are characteristic of UC vs. Crohn's.
495
character of diarrhea in UC vs. Crohn's
UC: bloody. Crohn's: watery
496
Pt presents w/ RUQ pain radiation to R scapula. He is 6 months post-op from emergent small bowel resection after a GSW. Abdominal US shows gallstones. Most likely mechanism?
loss of enterohepatically circulated bile after resection
497
40 yo F was diagnosed w/ AML 8 weeks ago. Her weight at dx was 135. Today her weight is 115. She is most at risk for GI disorder?
Rapid weight loss is a risk factor for gallstones
498
Cure for acalculous cholecystitis
percutaneous drainage
499
Mechanism of gallstone ileus is
erosive (cholecystoduodenal fistula)
500
Which is true about ERCP with regards to primary sclerosing cholangitis?
Both diagnostic and therapeutic. Shows multiple bile duct strictures and dilatations ("beading"). ERCP w/ dilation and stenting of strictures is helpful, but only liver transplantation is definitive treatment.
