Step 3 Flashcards
(572 cards)
1
Q
Differential of depressed mood
A
MDD: ≥2 weeks, ≥5 of 9 (depressed mood AND SIGECAPS)
PDD (dysthymia): ≥2 years of chronic depressed mood; ≥2 of the following: appetite disturbance, sleep disturbance, low energy, low self esteem, poor concentration, hopelessness
Adjustment disorder with depressed mood: w/in 3 mo of stressor. Marked distress/functional impairment BUT does not meet criteria for MDD
-treatment: counseling and brief psychotherapy
Normal stress response: Not excessive/out of proportion no functional impairment
2
Q
Workup of palpable breast mass
A
Age < 30:
- Ultrasound +/- mammogram
- simple cyst –> needle aspiration (if pt desires)
- complex cyst/mass or solid mass –> image-guided core biopsy
Age ≥ 30:
- Mammogram +/- ultrasound
- suspicious for malignancy –> core biopsy
3
Q
Congenital adrenal hyperplasia
A
MC GC A
21-hydroxylase: [ ↓ ] [ ↓ ] [ ↑ ]
- salt wasting from lack of aldosterone (vomiting, hypotension, low sodium, high potassium)
- hypoglycemia from lack of cortisol
- ambiguous genitalia in girls, precocious puberty in boys
- elevated 17-hydroxyprogesterone
- treatment: glucocorticoids and mineralocorticoids
11β-hydroxylase: [ ↑ ] [ ↑ ] [ ↑ ]
- hypertension, low K
- ambiguous genitalia in girls
- elevated 11-deoxycorticosterone and 11-deoxycortisol
17α-hydroxylase: [ ↑ ] [ ↑ ] [ ↓ ]
- hypertension, low K
- ambiguous genitalia in boys
- absent puberty
***Autosomal recessive deficiency in 21-hydroxylase is most common. The other two have HYPERtension
4
Q
Which type of congenital adrenal hyperplasia has salt wasting?
A
MC GC A
21-hydroxylase: [ ↓ ] [ ↓ ] [ ↑ ]
- salt wasting from lack of aldosterone (vomiting, hypotension, low sodium, high potassium)
- hypoglycemia from lack of cortisol
- ambiguous genitalia in girls, precocious puberty in boys
5
Q
Tetanus prophylaxis
A
≥3 tetanus toxoid doses:
- clean or minor wound: vaccine if last dose ≥10 years ago, no TIG
- dirty or severe wound: vaccine if last dose ≥5 years ago, no TIG
Unimmunized, uncertain, or <3 tetanus toxoid doses:
- vaccine only, no TIG
- vaccine PLUS TIG
TIG = tetanus immune globulin
6
Q
H. pylori treatment
A
No PCN allergy, no macrolide use: PPI + clarithromycin. + amoxicllin for 10-14d [triple therapy]
PCN allergy, no prior macrolide or metronidazole use: PPI + clarithromycin + metronidazole for 10-14d [modified triple therapy]
High macrolide or metronidazole resistance OR treatment failure after 1 course of therapy: PPI + bismuth + metronidazole + tetracycline for 10-14d [quadruple therapy]
MAKE SURE TO CONFIRM ERADICATION (breath test or stool test)
7
Q
Screening for HIV
A
Recommended test: p24 (HIV antigen) + HIV1/2 antibodies
1-4 weeks is window period, so should test 4 weeks after high-risk encounter
8
Q
When should postexposure prophylaxis be started for HIV?
A
Ideally 1-2 hours after (< 72 hours)
9
Q
What test is needed before starting ART for HIV?
A
Hepatitis B, since some regimens can target both
10
Q
Carotid artery dissection
A
Contributors: trauma, HTN, smoking, connective tissue disease
Presentation: unilateral head & neck pain, transient vision loss, ipsilateral partial Horner syndrome (ptosis and miosis without anhidrosis), signs of cerebral ischemia (e.g., focal weakness)
Diagnosis: CT or MR angiography
Treatment:
- thrombolysis (if ≤4.5 hrs after symptom onset)
- antiplatelet (aspirin) +/- anticoagulation
11
Q
Complex regional pain syndrome
A
Pain out of proportion to injury, temperature change, edema, abnormal skin color
12
Q
Cryptorchidism
A
- if still undescended at 6 months –> orchiopexy
- even with orchiopexy, there is a risk of malignancy
13
Q
Number needed to treat
A
NNT = 1/ARR
ARR = control group event rate – experimental group event rate
ARR = absolute risk reduction
14
Q
Absolute risk reduction
A
ARR = control group event rate – experimental group event rate
15
Q
Most common suppurative complication of acute otitis media
A
Mastoiditis
displacement of the auricle
Fever, ear pain, tenderness to the area
Treatment: IV antibiotics and surgical drainage (tympanostomy or mastoidectomy)
16
Q
Treatment of acute mania
A
Antipsychotics (e.g., risperidone)
17
Q
Most common pathogen identified in corneal foreign bodies
A
coagulase negative Staphylococcus
18
Q
Euthyroid sick syndrome
A
LOW T3, normal TSH and T4
Decreased peripheral conversion to T3
19
Q
TST (PPD) interpretation
A
LATENT TB
5 mm:
- HIV
- recent contact with TB
- fibrotic changes on CXR (suggestive of prior TB)
- organ transplant recipients
- immunocompromised
10 mm:
- recent immigration from high prevalence country
- injection drug user
- residents and employees of high-risk settings (prisons, homeless shelters, healthcare facilities)
- kids < 4
15 mm:
- no known risk factors
20
Q
BCG vaccine and TST (PPD)
A
Should rarely cause >15 mm induration. And it decreases significantly 15 years after vaccine is received
21
Q
Treatment of latent TB
A
3-4 months of rifamycin-based therapy
22
Q
Management of acute calculous cholecystitis
A
Diagnosis: RUQ US showing gallstones with GB wall thickening or sonographic Murphy sign
If US is negative or inconclusive –> HIDA scan
Patients should get surgery within 72 hours, but diagnosis should be confirmed first
23
Q
Urethral diverticulum
A
Dysuria, postvoid dribbling, dyspareunia, anterior vaginal mass
Associated with recurrent UTIs, hematuria, and stress urinary incontinence
Tender anterior wall vaginal mass that expresses bloody, purulent fluid on manipulation of the urethra
Diagnosis: MRI pelvis
24
Q
Who needs chemoprophylaxis for meningococcal meningitis?
A
- Household members
- roommates or inmate contacts
- child care center workers
- persons directly exposed to respiratory or oral secretions (kissing, mouth-to-mouth resuscitation, intubation)
- seated next to person ≥8 hours (flying)
Rifampin (alt: cipro or IM CTX)
25
Interpretation of odds ratio
OR < 1: exposure is associated with lower odds of the outcome compared to no exposure
OR = 1: exposure is not associated with the outcome
OR > 1: exposure is associated with higher odds of the outcome compared to no exposure
Confidence interval that excludes 1 is significant
26
Pediatric OSA
Due to adenotonsillar hypertrophy
Treatment: tonsillectomy/adenoidectomy
27
Neurofibromatosis type I
Acoustic neuroma (usually unilateral), cutaneous neurofibromas (hyperpigmented café au lait spots), axillary freckling, Lisch nodules
28
Neurofibromatosis type II
Bilateral acoustic neuromas (deafness), hypopigmented spots
29
Tuberous sclerosis
Congenital hypopigmented macule (ash-leaf spots), glial proliferation, and several organ hamartomas/cysts
PROGRESSIVE NEUROLOGIC IMPAIRMENT
TSC1/2 mutations
Derm: ash-leaf spots, Shagreen patches, angiofibromas of malar region
Neuro: CNS lesions, epilepsy (infantile spasms), intellectual disability, autism
Cardiac: rhabdomyomas
Renal: angiolipomas
Need regular tumor screening (MRI brain/kidney)
CAUSE OF DEATH: neurologic (epilepsy)
30
Sturge-Weber syndrome
Facial port-wine stain and leptomeningeal angiomatosis
31
Osler-Rendu-Weber syndrome
Multiple telangectasias and vascular lesions of the CNS
32
Postexposure prophylaxis for HIV
*Combination ART* within 1-2 hours of exposure, for 4 weeks
Then test for HIV at 6 weeks and 4 months
33
Diagnosis of menopause
≥1 year of amenorrhea
34
Who needs endometrial biopsy?
Women ≥45 with anovulatory bleeding
35
Pubertal gynecomastia
Resolves within 1 year
36
Hypoparathyroidism vs pseudohypoparathyroidism
HypoPTH: low PTH, low Ca, high phos
PseudohypoPTH: high PTH, low Ca, high phos
37
Hazard ratio interpretation
Likelihood of an event occurring in a treatment group relative to the control group
Null value = 1
HR < 1: event is less likely to occur in a treatment group than the control group
HR > 1: event is more likely to occur in a treatment group than the control group
Statistically significant: CI does NOT include 1
38
Immune thrombocytopenia
Presentation
- antecedent viral infection
- asymptomatic petechiae and purpura
- mucous membrane bleeding
Labs
- ISOLATED thrombocytopenia
- negative DAT
Treatment
- mild or no bleeding: observe
- moderate/severe bleeding: IVIG
- chronic ITP with no response to pharmacotherapy: splenectomy
39
Treatment of toxic megacolon
Medical unless there's perforation
40
Standard deviations and percentage of data set
- 1 to 1: 68%
- 2 to 2: 95%
- 3 to 3: 99.7%
41
Levels of prevention
Primordial: prevention of risk factors themselves
Primary: action taken before a patient develops a disease
(prevent occurrence of the disease)
Secondary: attempts to prevent the progression of a disease at its initial stage before irreversible pathologic changes occur
Tertiary: taking all actions available to limit impairments and disabilities
Quaternary: mitigate and/or limit the consequences of unnecessary or excessive intervention by the health system
42
Subclinical hyperthyroidism
Clinical characteristics
- suppressed TSH
- normal thyroid hormone levels
- hyperthyroid symptoms may or may not be present
Causes
- exogenous thyroid hormone
- Graves' disease
- nodular thyroid disease
Indications for treatment
- TSH persistently < 0.1
- TSH 0.1 - 0.5 PLUS additional risk factors
- ≥ 65
- heart disease
- osteoporosis
- nodular thyroid disease
43
Can physicians keep information about sexual activity of minors from parents?
Yes (unless there is suspicion of abuse, etc)
44
Acute appendicitis in pregnancy
Can present atypically since uterus displaces appendix upward (i.e. can lack McBurney point tenderness)
Image with ULTRASOUND (if inconclusive, MRI)
Appendiceal perforation increases the risks of spontaneous abortion, preterm labor, and preterm delivery. Also pylephlebitis (infective suppurative portal vein thrombosis)
45
Imaging for acute appendicitis in pregnancy
ULRTASOUND
If inconclusive, MRI
46
Complication of untreated appendicitis or other intraabdominal or pelvic infections
Pylephlebitis (infective suppurative portal vein thrombosis)
Fever, RUQ pain, jaundice, hepatomegaly
Elevated ALP and GGT
Imaging shows thrombus
Polymicrobial bacteremia is common
Broad spectrum antibiotics
47
Risk factors for UTI in kids
- female
- uncircumcised males
- urologic abnormalities (e.g., vesicoureteral reflux)
- bowel/bladder dysfunction (e.g., constipation)
48
Workup of pediatric UTI
If < 24 months and febrile:
| - renal and bladder ultrasound (and voiding cystourethrogram if abnormal)
49
Measles (rubeola)
1. Prodrome: cough, coryza, conjunctivitis, fever, Koplik spots
2. Maculopapular exanthem
- cephalocaudal and centrifugal spread
- spares palms/soles
Fever + rash (as opposed to roseola fever then rash)
Can give vitamin A in hospitalized patients
50
Kawasaki disease
≥5 days of FEVER + ≥ 4
- conjunctivitis
- mucosal changes
- lymphadenopathy (> 1.5 cm)
- rash
- extremity changes
Mnenomic: CRASH & Burn (5+ days of fever)
51
Erythema infectiosum
Parvovirus B19
Fever, cough --> slapped cheek rash and reticular truncal rash
School aged children
52
Roseola
Fever --> defervesce --> rash
HHV6
53
Scarlet fever
Streptococcus pyogenes
Fever, pharyngitis, sandpaper rash
54
Natural history of eczema (atopic dermatitis)
Resolved by adulthood
55
Healthy worker effect
Selection bias where the working population is healthier than the nonworking
56
Papular urticaria
Delayed hypersensitivity reaction to insect bites
(not true urticatia)
H1 blockers, topical corticosteroids
57
Lichen planus
Purutic, pink/purple, polygonal papules and plaques
58
Nummular eczema
Coin-shaped
59
Antithyroid medications in pregnancy
1st trimester: PTU
2nd/2rd trimester: methimazole
"Pregnant? PTU!"
60
Anterior uveitis (iritis)
Pain, redness, variable vision loss, constricted and irregular pupil
Slit lamp: leukocytes in anterior segment
61
Infectious keratitis
Severe photophobia and difficulty keeping eye open
Penlight: corneal opacity or infiltrate
62
Postoperative atrial fibrillation (following cardiac surgery)
Spontaneously converts so sinus rhythm within days
63
Foot drop
Peroneal nerve
64
Femoral nerve injury
Inability to extend the knee, loss of knee jerk reflex, sensory loss over the anterior and medial aspects of the thigh, medial aspect of shin, and arch of the foot
65
If patient comes in with signs/symptoms of Lyme disease
Early localized Lyme: Oral doxycycline (serologic testing is often negative in early disease, so early Lyme is a CLINICAL diagnosis)
Early and late disseminated: serologic testing prior to treatment
66
Order of Lyme testing
ELISA --> Western blot
67
Type of psychotherapy for OCD
Exposure and response prevention therapy
68
Treatment of fibroids
Depends on fertility goals
1. hormonal contraception
2. hormonal IUD
3. GnRH agonist (for preop)
4. surgery
5. uterine artery embolization
69
Sharp object ingestion
Urgent endoscopy (prevent esophageal perforation`)
e.g. fish bone
70
Prevention of fat emboli
Early immobilization and operative fixation of fractures
71
Fat embolism
- Respiratory insufficiency
- neurologic impairment
- petechial rash
Prevention: Early immobilization and operative fixation of fractures
72
Subclinical hypothyroidism
Elevated TSH with normal T4
Most common cause: Hashimoto thyroiditis
Anti-TPO antibodies can help establish diagnosis and determine whether to treat
Complications: recurrent miscarriages, severe pre-eclampsia, preterm birth, low birth weight, placental abruption
Whom to treat: significant elevations in TSH, goiter, convincing hypothyroid symptoms
TSH levels
- ≥10: treat
- 7-9.9
- < 70: treat
- > 70: treat if convincing hypothyroid symptoms
- upper limit of normal to 6.9
- < 70: treat if convincing hypothyroid symptoms, enlarging goiter, or elevated anti-TPO titer
- ≥ 70: do not treat (possible harm)
73
Most common cause of subclinical hypothyroidism
Hashimoto thyroiditis
74
When to use thyroid radionucleotide uptake scan
Workup of HYPERthyroidism
75
Complications of subclinical hypothyroidism
Recurrent miscarriages, severe pre-eclampsia, preterm birth, low birth weight, placental abruption
76
Elevated serum calcitonin
Medullary thyroid cancer
In isolation or part of MEN 2 (A or B)
77
Pretibial myxedema
NON-pitting edema of the legs
HYPERthyroidism
(DO NOT CONFUSE with myxedema coma which is hypothyroidism)
78
Enuresis
Urinary incontinence (primarily nocturnal) age ≥ 5
Primary nocturnal enuresis: the inability to have ever achieved nighttime dryness
Workup: urinalysis
- ultrasound is only needed if there are urinary symptoms (daytime incontinence, weak stream)
- creatinine is only needed if there are signs of renal disease (hypertension)
Treatment:
- treat comorbid conditions (constipation)
- behavioral modification (restrict evening fluids)
- enuresis alarm
- desmopressin
79
Workup of enuresis
Urinalysis
80
Anticoagulation during pregnancy
LWMH throughout pregnancy, UFH before delivery (since can be reversed with protamine)
Unless has mechanical valve, in which case warfarin 2nd and 3rd trimester (and then UFH before delivery)
81
Mechanical valve anticoagulation in pregnancy
LWMH in first trimester, warfarin in 2nd and 3td trimesters, UFH in the last few weeks before delivery
UFH is easily reversed with protamine
82
Mechanical vs bioprosthetic valve
Mechanical: more durable, lower risk of failure, but LIFELONG ANTICOAGULATION
Bioprosthetic valve: 3 months of anticoagulation
83
Warfarin and breastfeeding
OK: warfarin does NOT enter breastmilk
84
Management of adhesive capsulitis
Mild: range of motion exercises
Severe: steroid injections, surgery if refractory
85
Infectious mononucleosis diagnosis
Heterophile antibody test (Monospot)
25% false negative rate during first week of illness
86
Workup of normocytic anemia
Reticulocyte count
| production vs destruction
87
Treatment of Tourette syndrome
- antidopaminergic agents
- tetrabenazine (dopamine depleter)
- antipsychotics (dopamine receptor blockers)
- alpha-2 adrenergic receptor agonists
- behavioral therapy
88
Diagnosis of Tourette syndrome
BOTH vocal and motor tic (> 1 year, not necessarily concurrent)
Commonly comorbid with ADHD and OCD
89
Abruptio placentae
Placental detachment from the uterus before fetal delivery
RFs
- HTN, preeclampsia
- abdominal trauma
- prior AP
- cocaine and tobacco use
Presentation
- sudden onset vaginal bleeding
- abdominal or back pain
- high-frequency, low-intensity contractions
- rigid, tender uterus
Diagnosis
- clinical
- US: +/- retroplacental hematoma
Complications
- fetal hypoxia, preterm birth, mortality
- maternal hemorrhage, DIC
Acute AP with active bleeding is an indication for delivery
90
Placenta previa
When the placenta implants over the cervix
PAINLESS vaginal bleeding
91
Management of pressure ulcers
I/II: semipermeable dressings to maintain moist environment
III/IV: debridement of devitalized tissue
92
Which patients need endoscopy for dyspepsia?
Red flags and AGE (≥ 60)
93
Normal language development at age 2
≥50 words, use of 2-word sentences
94
If language delay in a child
Needs audiology evaluation
95
If thyroid nodule
TSH and US
If suspicious findings on US --> FNA
If normal or high TSH --> FNA
If low TSH --> radio-uptake scan
- if hot nodule --> treat hyperthyroidism
- if low or indeterminate --> FNA
96
Management of differentiated thyroid cancer (papillary, follicular)
Depends on extent of disease
Need ultrasound of neck and cervical lymph nodes for staging
Small <1cm cancers can be managed with lobectomy. Larger ones require total thyroidectomy. And extension into neck requires radical neck dissection.
97
Management of corticosteroid-induced psychiatric symptoms
Dose reduce, if possible (or stop altogether)
98
Polymyalgia rheumatica
Rapid-onset pain and stiffness in the shoulders and hips (+/- neck involvement)
- fatigue, weight loss, low-grader fever
- 10% associated with giant cell arteritis (headache, jaw claudication, visual symptoms)
- elevated ESR, CRP
Disorder of joints, bursae, and tendons, NOT muscle!
NORMAL STRENGTH AND CK
Treatment: glucocorticoids
Temporal artery biopsy IF symptoms of GCA
99
What to do if suspect giant cell (temporal) arteritis
Temporal artery biopsy, BUT biopsy should not delay the start of steroids
Start steroids first if high clinical suspicion
100
What to do if you see a patient subject to a potentially harmful treatment
Contact state medical board to report the physician
101
Characteristic of uterine rupture
Loss of fetal station
Also acute pain, vaginal bleeding, late decelerations, palpable fetal parts
Need emergency laparotomy for delivery and uterine repair
102
When to use amnioinfusion
Treat variable decelerations from umbilical cord compression
103
Trastuzumab-associated cardiotoxicity
REVERSIBLE
Due to "myocardial hibernation," not atherosclerosis
Not dose related
STOP if EF drops significantly
Treat with GDMT
104
Management of gallstone pancreatitis
Depends on severity
Mild [no organ failure or local or systemic consequences]: cholecystectomy within 7 days of clinical improvement (during hospitalization)
Severe: delayed cholecystectomy, may also need ERCP if persistently abnormal liver chemistries
105
Options for type II HIT
Direct thrombin inhibitors (argatroban, bivalirudin) or fondaparinux
106
Can patients with type II HIT ever get heparin again?
NO
Even though antibodies don't last long, it is life threatening
107
Can a grandparent consent for a child?
In non-emergent situations, no
Must be the PARENT or LEGAL GUARDIAN
108
Definition of hypoglycemia
≤ 60
(Remember Whipple's triad: low blood glucose, symptoms of hypoglycemia, symptomatic relief with administration of glucose)
109
Viral meningoencephalitis
Signs of meningitis and neuro abnormalities after viral infection
Most common: enteroviruses (coxsackie), HSV, adenoviruses
Treatment: empiric acyclovir + vanc + 3rd gen cephalosporin
110
Manifestations of sarcoidosis
Pulmonary
- bilateral hilar adenopathy
- interstitial infiltrates
Cutaneous
- papular, nodular, or plaue-like lesions
- erythema nodosum
Opthalmologic
- anterior uveitis (iridocyclitis or iritis)
- posterior uveitis
- keratoconjunctivitis sicca
Reticuloendothelial
- peripheral lymphadenopathy
- hepatomegaly
- splenomegaly
Musculoskeletal
- acute polyarthritis (usually ankles)
- chronic arthritis
Cardiovascular
- atrioventricular block
- dilated or restrictive cardiomyopathy
CNS/endocrine
- facial nerve palsy
- central diabetes insipidus
- hypercalcemia
Löfgren syndrome
- erythema nodosum
- hilar adenopathy
- migratory polyarthralgia
- fever
111
Confirmatory diagnosis of sarcoidosis
Biopsy from easiest accessible site (usually a lymph node or skin lesion)
If there is no accessible lesion, do bronch with biopsy
112
Preferred agent for awake intubations
Ketamine
Dissociation, amnesia, analgesia, sympathetic surge
113
Failed airway
Cricothyrotomy
114
Management of pelvic organ prolapse
Pessary vs surgery is equally effective. Depends on whether they are surgical candidate
115
Surgery for stress incontinence
Mid-urethral sling procedure
116
CRC screening in patients with a first-degree relative with CRC
10 years before they were diagnosed OR 40, *whichever comes first*
117
If positive stress test
Medical management (aspirin, statin, beta blocker, optimization of risk factors) and, if high risk features on stress test percutaneous coronary angiography
118
Postpartum hemorrhage
Causes
- uterine atony (most common)
- retained placenta
- genital tract laceration
- uterine rupture
- coagulopathy
Uterine atony:
- Heavy vaginal bleeding with soft, enlarged uterus above the umbilicus
- uterine massage and oxytocin
- second line: methylergonovine, carboprost, misoprostol
119
Uterine atony
Most common cause of postpartum hemorrhage
Heavy vaginal bleeding with soft, enlarged uterus above the umbilicus
Treatment: uterine massage and oxytocin
-second line: methylergonovine, carboprost, misoprostol
120
Odds ratio calculation
OR = (a * d) / (b * c)
121
Tumor lysis syndrome
High phosphorus, potassium, uric acid
Low calcium
AKI, cardiac arrhythmias, seizures
Pretreatment with allopurinol/febuxostat and fluids
Treat with IV fluids and rasburicase
122
Pheochromocytoma screening
Plasma or urine free metanephrine
If positive, get CT or MRI abdomen
- if positive: surgery, genetic testing, alpha then beta blocker,
- if negative: MIBG scan, octreotide scan, PET scan, whole body MRI
(Pheos are usually in the adrenals)
123
Management of hyper/hypotension during pheochromycytoma surgery
Hypotension: fluids (pressors if needed)
Hypertension: nitroprusside, phentolamine, or nicardipine
124
Indication for EPO in CKD
Hgb < 10
125
CKD and CAD
CKD increases the risk. Any may present atypically. Low threshold for stress testing.
126
Ferritin in thalassemia
High due to increased RBC turnover
127
Eczema herpeticum
HSV superinfection of atopic dermatitis
Also get fever and lymphadenopathy
Need systemic antivirals (acyclovir)
128
Acute myelopathy
transverse myelitis vs compressive (NOT GBS which would not have sensory level or bowel/bladder dysfunction)
If sensory level or bowel/bladder dysfunction, need MRI spine
129
Urinary schistosomiasis
Urinary symptoms, terminal hematuria, peripheral eosinophilia
Diagnosis: urinary sediment microscopy
Treatment: praziquantel
130
Acute vs chronic dysentery
Acute bloody diarrhea is most commonly due to BACTERIAL INFECTION
< 2 weeks
Begin with stool pathogens
Endoscopy if chronic
131
Pre-eclampsia
New onset HTN (≥140/≥90) at ≥20 weeks gestation
PLUS
proteinuria and/or end-organ damage
Severe features
- ≥160/≥110 (x2, 4hrs apart)
- thrombocytopenia
- elevated creatinine
- elevated transaminases
- pulmonary edema
- visual or cerebral symptoms
Management
- magnesium sulfate (seizure prophylaxis)
- antihypertensives
- without severe features: delivery at ≥37 weeks
- with severe features: delivery at ≥34 weeks
- ***MATERNAL STABILIZATION FIRST, THEN DELIVERY***
132
Most commonly injured nerve in shoulder dislocation
Axillary --> numbness/tingling over lateral aspect of shoulder
133
Treatment of strep pharyngitis
Amoxicillin (or penicillin)
134
If cervicitis
Treat empirically with CTX/doxy
Sexual partner(s) should also be treated
No need to remove IUD
135
Hirschprung disease on contrast enema
TRANSITION ZONE between normal caliber rectosigmoid and markedly dilated descending colon
136
Imaging for pyloric stenosis
Abdominal ultrasound
137
Problems with sputum AFB
Gold standard, but
1. low sensitivity (false negatives)
2. can't distinguish between TB and nmbTB
Need mycobacterial culture or NAAT
138
Management of actinic keratosis
Cannot be left untreated since can progress to squamous cell carcinoma
Individual lesions: cryosurgery, surgical excision, curretage
Numerous: 5-fluorouracil cream
139
Labs in anabolic steroid use
Low testosterone, FSH, LH
High LDL, low HDL
Erythrocytosis
140
Treatment of PAD
Step 1A
- smoking cessation
- BP and diabetes control
- aspirin
- high intensity statin (regardless of cholesterol level)
Step 1B
-supervised exercise therapy
Step 2
-Cilostozol (just for symptoms)
Step 3
-revascularization
141
Hawthorne effect
Awareness of being in study --> change in behavior
Threat to internal validity
142
Essential tremor treatment
Propranolol
143
Acute mania in pregnancy
Antipsychotics
ECT for treatment resistant or very severe cases
144
Lateral medullary (Wallenberg) syndrome
- Vertigo/nystagmus
- loss of pain and temperature sensation in the ipsilateral face and contrlateral body
- bulbar weakness
- ipsilateral Horner syndrome
"Don't pick a (PICA) horse (hoarseness) that can't eat (dysphagia)”
145
Medial medullary syndrome
- ipsilateral tongue weakness
| - contralateral arm/leg weakness
146
Myotonic dystrophy
Autosomal dominant CTG trinucleotide repeat expansion (with anticipation)
Adult: myotonia and weakness (face, hands, ankles)
Childhood: cognitive and behavioral problems (and then the development of classic symptoms)
Infants: hypotonia, respiratory failure, inverted V-shaped upper lip, contractures, club foot, cataracts
147
Treatment of polycystic kidney disease
ACE inhibitors
148
Treatment of localized squamous cell carcinoma of the glottis
Radiation and laser therapy
149
Acute stress disorder vs PTSD
1 month
150
When is exercise contraindicated in pregnancy
1. patients at risk for preterm delivery
- cervical insufficiency
- h/o preterm labor
- PPROM
2. patients at risk for antepartum bleeding
- placenta previa
- persistent second or third trimester bleeding
3. patients with underlying conditions that could be exacerbated with exercise
- severe anemia
- HTN disorders of pregnancy
- restrictive lung disease
- severe heart disease
151
What can provoke Torsades in patients with long QT
Bradyarrhythmia
152
Management of cryptococcal meningitis
Amphoterocin B and flucytosine, followed by fluconazole for a year
Serial LPs if high ICP
153
Reconstruction of cleft palate
Rule of 10s
- 10 weeks of age
- 10 lbs of weight
- 10g of hemoglobin
154
Treatment of urgency incontinence
Bladder training with timed voids
| caused by detrusor muscle overactivity
155
Lead level indication for chelation therapy
>45
156
ABO hemolytic disease
Mom: O+
Baby: A+ or B+
Mom has antibodies against A and B
Mild-moderate: phototherapy
Severe: bilirubin > 20: exchange transfusion
157
Treatment of allergic bronchopulmonary aspergillosis
Systemic glucocorticoids + itraconazole or voriconazole
158
Serotonin syndrome
- mental status changes
- autonomic dysregulation (diaphoresis, hypertension, tachycardia, hyperthermia, vomiting, diarrhea)
- neuromuscular hyperactivity (tremor myoclonus, hyperreflexia)
159
FMLA
can take time off for medical illness or taking care of sick family member
160
Who gets lichen sclerosus?
Hypoestrogenic states: pre-puberty and post-menopause
161
Bugs from human bites
- Eikenella corrodens
- viridans streptococci
- Staph aureus
- other anaerobes (Fusibacterium, Prevotella)
Amoxicillin-clavulanate
162
Treat human bite
Amoxicillin-clavulanate
163
SGLT-2 inhibitor side effects
- poluyria
- UTIs
- vulvovaginal candidiasis
164
Radioiodine uptake in subacute (De Quervain) thyroiditis
LOW (because of suppressed TSH)
165
Electrolyte abnormality associated with transfusions
Hypocalcemia, since citrate (anticogulant) is a chelator (hyperactive DTRs, muscle cramps, seizures)
166
Treatment of infant botulism
Botulism immune globulin
167
How long does it take for warts to go away with salicylic acid?
2-3 weeks
168
When are steroids indicated in Pneumocystis pneumonia
A-a gradient ≥ 35 on room air
SpO2 < 70
169
If lobular carcinoma in situ (LCIS)
Excisional biopsy
170
Fentanyl clearance
Liver
171
Treatment of tertiary hyperparathyroidism
Parathyroidectomy if:
- persistently elevated Ca, Phos, PTH
- soft tissue calcification or calciphylaxis (vascular calcification with skin necrosis)
- intractable bone pain or pruritis
172
If acute diverticulitis that doesn't improve in 2-3 days with antibiotics
CT scan
173
First step in the management of HHS
Aggressive fluid resuscitation
174
Initial workup of polycythemia
EPO level
- high: compensation for chronic hypoxia in pulmonary disease
- low: polycythemia vera
175
If suspect Paget disease of bone
Obtain calcium and alkaline phosphatase
- ALP: elevated
- Ca: normal
Also get radionucleotide bone scan
176
Treatment of Paget disease of bone
Bisphosphonates
177
Hypothyroid patients who become pregnant or go on OCPs
May need higher doses of levothyroxine since TBG is upregulated by estrogen
178
Diabetic gastroparesis
Longstanding diabetes, poor glucose control, autonomic symptoms, constipation
179
Treatment of PCP intoxication
Benzos
180
Tamoxifen side effects
- hot flashes
- VTE
- endometrial hyperplasia/carcinoma
181
Treatment of Lyme in pregnancy
Amoxicilin
182
Treatment of uncomplicated Zoster
7d of valacyclovir
183
Intubate at what GCS level
8 (or before if e/o resp failure)
184
Treatment of severe mania
Lithium/valproate PLUS antipsychotic
185
Causes of stress urinary incontinence`
- hypermobile urethra
| - decreased urethral sphincter tone
186
Infant cardiac complication of gestational diabetes
Transient hypertrophic cardiomyopathy
187
Prevention of cluster headaches
Verapamil
188
Ruling in vs out
Sensitivity: out
Specificity: in
SNOUT SPIN
189
Treatment of ischemic priapism
1. onset: urination, cold compresses
2. aspiration of the corpora cavernosa
3. intracavernosal injection of alpha agonist (phenylephrine)
190
Most common request for euthanasia/PAS
Loss of autonomy and control
191
Prophylaxis in chronic granulomatous disease
TMX/SMX + itraconazole
192
Empiric treatment of osteomyelitis in sickle cell disease
Anti staph agent (nafcillin/oxacillin or cefazolin for MSSA; clindamycin or vancomycin for MRSA) PLUS anti-salmonella (3rd gen cephalosporin CTX or cefotaxime)
193
When does Pap start?
21
194
If a consultant wants to change plan of care
Call PCP first
195
Preterm prelabor rupture of membranes
Leakage of fluid in < 37 weeks without contractions
Nitrazine positive fluid that ferns on microscopy
Likely due to subclinical intrauterine infection (BV is a RF)
Management
- ≥34 weeks: induction of labor
- <34 weeks: expectant management
- prophylactic latency abx (ampicillin + azithromycin)
- corticosteroids
196
Herpangina
Vesicles on posterior oropharynx
Coxsackie A
Supportive treatment
197
Buffalo hump in HIV
HIV-associated lipodystrophy
198
Treatment of acute multiple sclerosis
IV steroids
199
Amiodarone effect on warfarin
Increases effect, so need to decrease warfarin by 25%-50%
200
Pyloric stenosis risk factor
Macrolide antibiotics
201
Treatment of postpartum endometritis
Clindamycin + gentamicin
202
Treatment of intrapartum amniotic infection
Ampicillin + gentamicin
203
Risk factors for postpartum endometritis
- C section
- GBS
- intraamniotic infection
- prolonged ROM
- operative vaginal delivery
204
What is the kappa statistic?
Inter-rater reliability
205
Otitis-conjunctivitis syndrome
nontypeable H. influenzae
206
Diphtheria complication
Myocarditis
207
Neurologic findings in frontotemporal dementia
20% can have motor neuron disease with upper (fasiculations) and lower (hyperreflexia) signs
208
Culprit bugs in necrotizing fasciitis
- Streptococcus pyogenes (GAS)
- Staph aureus
- Clostridium perfringens
- polymicrobial
209
Management of complicated ureterolithiasis (obstruction, infection)
Perc neph tubes
210
Dashboard injury
PCL
211
Rheumatic fever criteria
Major: JONES
- joints (migratory arthritis)
- carditis
- nodules (subQ)
- erythema marginatum
- Sydenham chorea
Minor
- fever
- arthralgia
- ESR/CRP
- prolonged PR interval
Need penicillin until adulthood to clear GAS
212
Best test to diagnose pneumothorax
Bedside ultrasound
213
Treatment of malignant otitis externa
IV ciprofloxacin
214
Treatment of cataplexy
SNRIs, SSRIs, TCAs, sodium oxybate
215
Lichen planus is associated with
HCV
216
Best test after starting antithyroid meds
T3 and T4 (TSH can remain suppressed for some time)
217
Management of vertebral compression fracture
Pain control (NSAIDs, acetaminophen, opioids, calcitonin) and exercise (not bed-rest). Surgery only for persistent refractory pain
218
If high-grade squamous epithelial lesion on Pap
Colopscopy (or LEEP if ≥25, not pregnant, and done childbearing)
219
Treatment of TB in pregnancy
Isoniazid, rifampin, and ethambutol for 2 months, then INH and RIF for 7 months
220
Inadequate response to IV diuretics in ADHF
Vasodilator (IV nitroglycerin)
221
Cutaneous cryptococcosis
Papules with central umbilication, hemorrhagic crust
Diagnose with biopsy
222
Treatment of asymptomatic bacteriuria
- cephalexin
- nitrofurantoin
- amoxicililn or amoxicillin-clavulanate
- fosfomycin
NO fluoroquinolones
NO bactrim in 1st or 3rd trimesters
223
Workup of abusive head trauma
Head CT
224
Follow renal involvement in SLE
Complement levels and anti-dsDNA
225
Management of Charcot arthropathy
Casting
226
How long anticoagulation for provoked DVT?
At least 3 months
227
Can practices waive copays?
No, this is fraud
228
Most common cause of death at burn centers
Supraglottic edema
229
Mode of delivery for women with condylomata accuminata (genital warts)
Vaginal
230
Treatment of Candida endopthalmitis
Vitrectomy and amphotericin B
231
How to assess bone involvement in multiple myeloma
Whole body low-dose CT
232
Agents for UTI in pregnancy
- nitrofurantoin
- amoxicillin
- amoxicillin-clavulanate
- cephalexin
- fosfomycin
233
Can HIV positive women breastfeed?
No (regardless of ART/viral load)
234
Confirm scoliosis
x-ray
235
Normal Cobb angle
<10 degrees
| for scoliosis
236
To compare the mean of ≥3 groups
ANOVA
237
If isolated gastric varices
Think splenic vein thrombosis
Commonly associated with pancreatitis or pancreatic cancer
238
Per-protocol vs intention to treat
Per-protocol: only include those who adhered
Intention to treat: include everyone randomized
ITT is more conservative, but probably provides a more realistic real-world estimate
239
Standard deviations
68-95-99.7
240
Gout crystals
Negatively birefringent needle shaped
241
Which patients with atrial fibrillation need anticoagulation?
CHADsVASC ≥1
242
Diagnosis of chronic prostatitis
UA and Ucx
243
Are febrile seizures associated with epilepsy?
Yes
244
Thyroglobulin in exogenous thyroid hormone ingestion
Low
245
Features of testicular torsion
- elevation does not help pain
| - absent cremaster reflex
246
When to get RhoGAM
28 weeks and immediately postpartum
247
Positive glucose challenge test
≥140
Then do glucose tolerance test
248
Glucose targets in gestational diabetes
Fasting ≤95
1hr postprandial: ≤140
2hr: ≤120
249
Management of supratherapeutic INR
Depends on level
<4.5: hold warfarin
4.5-10: hold, and give oral vitK if risk of bleeding
>10: oral vitamin K
If bleeding, give vitK and PCC
250
Central pontine myelinosis causes
Locked in syndrome
| preserved wakefulness and awareness
251
Management of pituitary incidentaloma
Regular MRIs to follow (as long as no symptoms or hormonal changes)
252
Do we treat hepatitis B?
Not usually, unless immunocompromised, acute liver failure, or concommitant viral hepatitis C/D, or preexisting liver disease
253
If still high TSH on levothyroxine
Check celiac (malabsorption)
254
Positive predictive value
TP/(TP+FP)
255
Negative predictive value
TN/(TN+FN)
256
Sensitivity
TP/(TP+FN)
257
Specificity
TN/(TN+FP)
258
NPH vs long-acting
NPH has higher risk of hypoglycemia
259
Attributable risk percentage
ARP = (risk in exposed – risk in unexposed)/(risk exposed)
260
Relative risk
Risk exposed / risk unexposed
261
If child with balantitis
Test for diabetes
262
Treatment of blepharospasm
BoTox
263
If placental insufficiency
Immediate delivery
264
Doppler findings in placental insufficiency
Absent or reversed umbilical artery end-diastolic flow
265
How to prevent febrile nonhemolytic transfusion reactions
Leukoreduction
266
Most effective contraception
Progestin implant (good for 3 years, and more effective than IUD and tubal ligation)
267
When does viral conjunctivitis stop being contagious?
When eye discharge resolves
268
When does bacterial conjunctivitis stop being contagious?
After 24h of topical therapy
269
When to get surgery for scoliosis
Cobb angle ≥40
270
Screening and confirmation of lead toxicity
Screening: capillary lead level
Confirmatory: venous lead level
271
Biggest concern with lead toxicity
Cognitive impairment and behavioral problems
272
UA finding suggestive of AIN
Pyuria
273
Treatment of hypertrophic cardiomyopathy
Beta blocker
274
Autoimmune metaplastic atrophic gastritis
From pernicious anemia
- glandular atrophy (mostly body and fundus, NOT antrum)
- intestinal metaplasia
- inflammation
275
Positive tuberculin skin test in a healthcare worker
≥10 mm induration
This means latent TB
Treatment should be offered
276
Standardized incidence ratio
To determine if the occurrence of cancer in a small population is high or low relative to an expected value
SIR = observed cases / expected cases
277
Croup
Parainfluenza viral infection of the larynx and trachea
Symptoms
- inspiratory stridor
- barking cough
- hoarseness
Treatment
- mild: humidified air and corticosteroids
- moderate/severe: corticosteroids and nebulized (racemic) epinephrine
278
Hand-foot-and-mouth disease
Coxsackievirus infection
- Painful vesicles/ulcers on anterior oral mucosa
- macules/papules/vesicles on palms, soles, buttocks
- +/- systemic symptoms
279
How to select antibiotics for osteomyelitis
Bone biopsy with culture
280
If adrenal mass
Need to get labs to see if it's non-functional (which can be managed with serial monitoring) or functional (which needs surgical excision)
281
Patients with Lewy body dementia should not be given
Antipsychotics
282
Primary biliary cholangitis antibody
Antimitochondrial antibodies
283
Autoimmune hepatitis antibody
Anti-smooth muscle
284
Treatment of nonallergic rhinitis
Intranasal glucocorticoids
285
Postpartum blues vs depression
Blues: ≤2 weeks, and does not meet criteria for MDD
286
Levothyroxine in pregnancy
Empirically increase dose, then measure TSH every month
287
Risks of antipsychotics
Extrapyramidal symptoms
- parkinsonism
- dystonia
- akathesia
288
Aplastic crisis in sickle cell disease
Arrest of erythropeisis
Low reticulocytes
Other cell lines normal
289
Food protein-induced allergic proctocolitis syndrome
Blood-streaked stool in a well appearing infant ≤6 months old
- painless, blood-streaked stools that may contain mucus
- may have spitup
Non-IgE mediated allergy to cow's milk proteins (found in formula OR in breastmilk due to maternal dairy consumption)
Commonly presents age 1-4 weeks
Treatment
- if breastfeeding: remove dairy from maternal diet (can subsequently remove other allergens like soy or egg if symptoms persist) ; can also switch to hydrolyzed formula
- if formula feeding: switch to hydrolyzed formula
NOTE: don't switch to soy formula due to potential cross-reactivity between soy proteins and milk proteins
Can reintroduce offending protein around age 1
No long-term sequelae
290
First line treatment of restless leg syndrome
Gabapentin, pregabalin
291
Physiologic gynecomastia
Old men get breasts due to decreased testicular production of testosterone and an imbalance of estrogen relative to testosterone
292
Which TB screening test to use in BGC recipients
IGRA (no risk of false positives)
293
Tongue deviation is due to damage to which nerve
Hypoglossal (lick the lesion)
294
Treatment of WPW
Catheter ablation
295
Treatment of sulfonylurea overdose
Dextrose + octreotide (decreases insulin secretion)
296
Treatment of cocaine vasoconstriction
- benzos
- nitroglycerin
- aspirin
- NO BETA BLOCKERS!!!!
- calcium channel blockers for ongoing pain
- phentolamine for persistent HTN
- PCI for MI (when EKG is unchanged)
297
Falling onto an outstretched hand
Colles' fracture (distal radius) if dinner fork deformity; scaphoid fracture if pain at anatomic snuffbox
298
Central retinal artery occlusion
Pale fundus with cherry red spot
299
Central retinal vein occlusion
Blood and thunder
300
First line DMARD for rheumatoid arthritis
Methotrexate
301
Frenulum tear in a nonambulatory child
Suspect abuse
Need to report to CPS
302
If there is disagreement between team and family that ongoing care is futile
Ethics committee
303
Tuberculous meningitis eye findings
Choroidal tubercles: yellow-white nodules near the optic disc
304
Treatment of tuberculous meningitis
2 months of 4-drug therapy + 9-12 months of continuation therapy
Also 8 weeks of steroids
305
Tibial stress fractures on xray
Usually normal for first few weeks
306
Which vaccines are contraindicated in pregnancy
- MMR
- HPV
- varicella
- live attenuated influenza (intranasal)
307
Recommended vaccines in preganncy
- flu (inactivated)
| - Tdap
308
Treatment of scabies
Permethrin (or oral ivermectin)
309
Does actinic keratosis need biopsy?
yes if >1cm, are tender/indurated, exhibit rapid growth, or fail to respond to treatment (need to rule out SCC)
310
Thiazolinedinedione side effect
Fluid retention
311
Verification bias (workup bias)
When a study uses gold standard testing selectively in order to confirm a positive or negative result of a preliminary test. Can overestimate sensitivity and underestimate specificity.
To get around- perform test on random sample
312
Scromboid poisoning
If fish is stored in temperatures >15 C, histidine --> histamine:
- flushing
- throbbing headache
- palpitations
- abdominal cramps
- diarrhea
- oral burning
Patients may describe the fish as having a bitter taste
Skin erythema, wheezing, tachycardia, and hypotension may be present
313
First step in the workup of gross hematuria
UA and UCx
314
Diagnosis of orthostatic proteinuria
Split day-night 24h urine protein
315
Precautions for herpes zoster
Localized: standard until lesions are crusted
Disseminated: contact + airborne until lesions are crusted
316
Calculation of odds ratio
OR = ad/bc
317
Complication of anal abscess
Fistula
318
Treatment of akathesia
Dose reduce antipsychotic OR start propranolol
319
Congenital rubella
- sensorineural hearing loss
- cataracts
- patent ductus arteriosus
- blueberry muffin rash (purpuric lesions)
320
Treatment of bacterial conjunctivitis
Topical macrolide (azithromycin) or topical fluoroquinolone (if wears contacts)
321
Sickle cell trait
HgbS:HgbA 40:60
Asymptomatic
Does NOT cause anemia
322
Analgesic nephropathy
From NSAIDs
- chronic, but can present acutely
- hematuria
- pyuria
- proteinuria
- renal colic
323
Prognosis of sarcoidosis
>75% of cases resolve
324
If patient with hypertrophic cardiomyopathy can't take beta blockers (e.g., asthma)
Nondihidropyridine CCBs (verapamil)
325
When to give oseltamavir for influenza
<48h in low risk patients, or anybody hospitalized or are at high risk, regardless of symptom duration
326
Most common cause of pathologic nipple discharge
Papilloma
327
When to do LP in syphilis
If positive tests and neurologic symptoms
328
What to do in DKA if glucose falls below 200
Half the rate of the insulin drip and add dextrose
329
Can doctors date former patients?
They shouldn't. ALWAYS NO for psychiatrists
330
If persistent unilateral middle ear effusion
Nasal endoscopy to look for cancer
331
Which sexually transmitted infection can cause stroke?
Syphilis
332
Monitoring respiratory function in Guillain-Barré syndrome
Serial assessment of vital capacity via NIF- negative inspiratory force
333
What to watch for after VZV vaccination
Development of a rash which can be contagious to immunocompromised members of household
334
Thrombotic thrombocytopenic purpura
- renal failure
- neurologic manifestations
- fever
- abdominal pain/nausea
- petechial rash
Low ADAMTS13
Hemolytic anemia and thrombocytopenia
Treat with plasma exchange
335
Impaired LV function in mitral regurgitation
EF ≤60% (since the echo overestimates EF)
336
Long term complication of kidney donation
Gestational complications
337
Criteria for thrombolytics in acute ischemic stroke
≤4.5 hrs
Disabling symptoms
(radiologic studies may be negative)
338
Digoxin toxicity
- nausea/vomiting
- anorexia
- fatiuge
- confusion
- visual disturbances
- cardiac abnormalities
Causes: verapamil, quinidine, amiodarone
339
Treatment of HELLP syndrome
Magnesium sulfate
340
IRIS
HIV patient started on ART can have transient worsening of infectious symptoms several weeks after starting ART
341
Prenatal testing at 24-28 weeks
CBC (anemia) and glucose tolerance test
342
What does topical erythromycin at birth prevent?
Gonococcal, NOT chlamydial conjunctivitis
343
Treatment of neonatal clavicular fractures
Supportive (no long term sequelae)
344
Elevated insulin, C-peptide, and proinsulin
Endogenous insulin secretion
- tumor
- surreptitious oral hypoglycemic use
Sulfonylurea or meglinitide use most common (insulinoma is very rare)
345
Most sensitive test for SLE
anti-dsDNA
346
Which antibody correlates with disease activity in SLE?
anti-dsDNA
Also associated with the development of lupus nephritis
347
Treatment of tinea versicolor
Topical ketoconazole
348
Treatment of primary ovarian insufficiency
Oral or transdermal estrogen plus progestin
349
Treat salmonella?
No (unless immunocompromised)
350
Diagnosis of osteonecrosis of the femoral head
MRI
351
Late life depression is a risk factor for
Alzheimer's and vascular dementia
352
Treatment of lactational mastitis
dicloxacillin or cephalexin
353
Treatment of breast abscess
Ultrasound --> needle aspiration
NOT I&D
354
What to check before starting bisphosphonates
Calcium and vitamin D
355
What cancer is associated with Sjogren syndrome?
B-cell lymphoma
356
Diagnosis of sporotrichosis
Biopsy of lesion with culture
Treat: itraconazole
357
Net clinical benefit
Benefit - harm
358
Treatment of peri-infarction pericarditis
High dose aspirin
| Avoid NSAIDs and steroids which impair myocardial healing
359
Urgent warfarin reversal
prothrombin complex concentrate (plus IV vitamin K)
360
Treatment of acute hemolytic transfusion reaction
Stop transfusion and give normal saline
361
Adequate contractions
Every 2-3 min
362
Active labor
≥6 cm
Should progress ≥1 cm/2hrs
363
If inadequate contractions/prolonged labor
Oxytocin + amniotomy
364
Arrest of labor
>4hrs of adequate contractions or >6hrs with inadequate contractions
365
Who should be offered cell-free fetal DNA testing?
Women ≥35
366
What to do with women who have gestational diabetes once they deliver
STOP all antihyperglycemic therapy (since the disease is placenta mediated)
May have T2D though, so get GTT 6-12 weeks postpartum
367
What happens to thyroid hormone levels in pregnancy?
Increase
So may look on labs to have subclinical hyperthyroidism, but no need to do anything if clinically euthyroid
368
Treatment of Kawasaki disease
IVIG and aspirin
369
Vaccines and IVIG
Live vaccines should not be given until 11 months after IVIG
370
First line for insomnia
CBT
371
Features suggestive of tuberculous pleural effusion
- exudative
- lymphocyte predominant
- elevated adenosine deaminase
Need pleural biopsy
372
MAHA and thrombocytopenia =
TTP
373
Organophosphate poisoning
DUMBBELLS
- defecation
- urination
- miosis (pinpoint pupils)
- bronchospasm
- bradycardia
- emesis
- lacrimation
- salivation
374
Colonic angiodysplasia causing bleeding is associated with
- aortic stenosis
| - ESRD
375
Management of preterm labor
Defined as regular, painful contractions resulting in cervical dilation at <37 weeks
<32 weeks:
- antenatal corticosteroids
- penicillin if GBS+ or unknown
- tocolysis: indomethacin
- magnesium sulfate
32-24 weeks:
- antenatal corticosteroids
- penicillin if GBS+ or unkonwn
- tocolysis: nifedipine
34-37 weeks:
- +/- antenatal corticosteroids
- penicillin if GBS+ or unknown
376
Elevated AFP in pregnant women is associated with
Neural tube defects and ventral wall defects (low AFP is seen in aneuploidies)
Get ultrasound
377
Pediatric dyslipidemia screening
Starts at 9 yo in those with CV risk factors
378
Likelihood ratio
LR+ = sensitivity/(1-specificity)
| LR-=(1-sensitivity)/specificity
379
Who needs statins in diabetes?
Everyone ≥40
380
Diagnosis of dermatomyositis
Antibody testing:
- screening: ANA
- confirmatory: anti-Jo, anti-Mi2
Muscle biopsy only if uncertain diagnosis
381
If hyperkalemia with EKG changes
Calcium gluconate
382
Opioids in trauma for patients with opioid use disorder
Discuss risks and benefits of opioids with them
383
If bicuspid aortic valve
Screen for thoracic aortic aneurysm
384
Metformin and cardiac cath
STOP (d/t conrast renal risk, lactic acidosis)
385
Treat infertility in PCOS
Letrozole
386
Preeclampsia prevention
Aspirin starting at 12 weeks
387
Rapid spreading superficial bacterial infection
Erisypelas
Well demarcated and raised
Strep pyogenes
388
Physiologic anemia of infancy
Nadir 11 around 2-3 months
389
Central precocious puberty
Girls <8, boys <9
ADVANCED BONE AGE
Elevated FSH, LH
390
Can we use slides a pharma company gives us for a conference?
No, we need to make our own slides
391
If cryptogenic stroke
Ambulatory cardiac monitoring
392
If TIA
Medical emergency.
After CT, needs MRI, CT/MRA, EKG, echo, and antiplatelets
393
Deductible vs out of pocket maximum
Deductible: amount you need to pay
OOPM: amount you need to pay before insurance pays 100%
394
Management of hydatidiform mole
Suction curretage followed by weekly hCG. If decreasing, go to monthly for 6 months until undetectable
If increasing, diagnose gestational trophoblastic neoplasia
NEED CONTRACEPTION DURING THIS PERIOD
395
Which antihypertensives cause photosensitivity?
Thiazides
396
Management of subchorionic hematoma
Expectant
397
Posterior urethral valve
Abnormal insertion of the wolffian ducts into the urethra
Bilateral hydronephrosis, thickened and dilated bladder , dilated proximal urethra
398
If hypoxic on nonrebreather
Intubate
399
Valve abnormality in pulmonary embolism
Tricuspid regurgitation
400
"swinging fever"
subphrenic abscess
Also cough and shoulder tip pain will be seen
401
Diagnosis modality for cerebral palsy
MRI
402
If violent patients who do not respond to verbal de-escalation
Restrains and IM antipsychotics
403
Relative risk reduction
(risk in unexposed - risk in exposed) / risk in unexposed
404
Copay for preventive screenings
Zero
405
Treatment of tick paralysis
Remove tick
406
First-line treatment of alopecia areata
Intralesional corticosteroids
407
Definition of osteoporosis
T score ≤-2.5 OR history of low trauma hip/vertebral fractures REGARDLESS OF T SCORE
408
Options for BV
Metronidazole or clindamycin
409
Does treating BVin pregnancy prevent pregnancy complications?
No
410
When to start Pap
21
411
Intususception
- severe, intermittent abdominal pain
- palpable sausage-shaped mass in R abdomen
- currant jelly stools
Diagnosis/treatment: air enema
If unclear can do US
412
If clinical decompensation after air enema for intususception
AXR to look for perforation
413
Most common complication of TURP
Retrograde ejaculation
414
Treatment of gonorrhea vs chlamydia
Gonorrhea: ceftriaxone
Chlamydia: azithromycin
Gonorrhea + chlamydia: CTX + doxy
415
Ongoing symptoms after treatment of urethritis
Repeat urethral swab
416
If suspect SAH but CT negative
LP
417
Severe obstructive lung disease is characterized by
FEV1 < 40%
418
Most common cause of nonpurulent cellulitis
Strep pyogenes
419
If high suspicion for ACS but normal EKG and trops
Repeat EKG and trops
420
Treatment of acute dystonia
Benztropine or diphenhydramine
421
Corneal laceration
Fluorescein uptake followed by washout (Seidel sign)
Urgent ophtho consult
422
Stopping DOACs before surgery
Low bleeding risk: stop day of
Mod/high risk: stop 1-3 days prior
No bridge necessary
423
Treatment of cat scratch disease
Azithromycin
424
Chickungunya
- high fever and severe polyarthralgia
- headache, myalgia, conjunctivitis
- lymphopenia, thrombocytopenia, elevated LFTs
Supportive care
425
Eye involvement in sarcoidosis
Anterior uveitis
426
Toxic thyroid nodule (toxic adenoma)
Hyperthyroidism
Treat with beta blocker, antithyroid drugs (to get euthyroid), and then iodine ablation or surgery
Don't need biopsy because the risk of cancer in these is very low
427
Methimazole or PTU
Methimazole is better, unless first trimester of pregnancy
428
What is considered delayed puberty in boys?
Lack of testicular enlargement by 14
429
Treatment of pneumothorax
Chest tube (unless tension pneumo, in which case needle decompression followed by chest tube)
430
Pediatric pneumonia
Focal consolidation: amoxicillin
| Bilateral: azithromycin
431
Why do we get EKG in cardiac patients before undergoing noncardiac surgery?
Establish a baseline
432
If macrocephaly
head ultrasound (if open fontanelle)
433
Traumatic tap
High RBC without xanthochromia
434
If sudden sensorineural hearing loss
urgent ENT evaluation
Audiogram, steroids, MRI
435
Treatment of keloids
Intralesional glucocorticoids
436
GDMT but ongoing symptoms
Spironolactone
437
Papule that ulcerates and tracks along lymphatics
Sporotrichosis
438
Management of auricular hematoma
Prompt evacuation (or risk cauliflower ear and avascular necrosis)
Oral antibiotics for skin flora and Pseudomonas
439
Agents for treating UTI in pregnancy
- amoxicillin-clavulanate
- cephalexin
- fosfomycin
- nitrofurantoin
NO fluoroquinolones or tetracyclines, and NO TMP/SMX in 1st/3rd trimesters
440
When do steroids need taper
>3 weeks
441
Treatment of psoriatic arthritis
Methotrexate
Glucocorticoids are contraindicated because they can trigger pustular psoriasis
442
Harsh holosystolic murmur in L 4th ICS with associated thrill
VSD
443
Most common congenital heart defect
VSD
444
Treatment of lithium toxicity
>4: HD
| >2.5 with symptoms or renal failure: HD
445
Isoniazid adverse effect
Hepatotoxicity
446
Treatment of icthyosis vulgaris
Topical urea
447
Parts of Medicaire
A: inpatient
B: outpatient
C: enrollement in private insurance plans
D: meds
448
What do you need to monitor when you start someone with megaloblastic anemia on B12?
Potassium (can cause hypokalemia)
449
Treatment of aspiration pneumonia
CAP cpverage (ceftriaxone and azithromycin if inpatient)
DO NOT NEED ANAEROBE COVERAGE (unless empyema/abscess)
450
FeNa in ATN
>2 (salt wasting)
451
If metastatic cancer, where should biopsy come from?
Most distant site (lymph nodes are nice because they're easy to access)
452
Relative risk reduction
ARR/(control rate)
453
Shoulder dystocia
Obstetric emergency
Start with McRoberts maneuver: hyperflex maternal hips
454
If suspect neurofibromatosis type I
Get eye exam
455
Consequence of not treating IDA in children
Developmental delay
456
If right heart failure after CABG
Think constrictive pericarditis
457
Number needed to harm
NNH = 1/(absolute risk increase)
458
Treatment of inoperable head and neck cancer
Chemo AND radiation
459
When does DEXA start?
65 (unless risk factors)
460
Ecthyma gangrenosum
From pseudomonas bacteremia in immunocompromised hosts.
Rapid evolution of ≥1 skin lesion from an erythematous macule to a pustule or bullae and then into a nonpainful gangrenous ulcer
Systemic symptoms are common
461
Thyroglossal duct cyst
Fluctuant mass that moves superiorly upon swallowing
Need thyroid imaging to identify ectopic thyroid tissue
462
bhCG threshold to be seen on US
3,500
463
Arrest of second stage of labor
No fetal descent after nulliparous patients push ≥3h (≥4 with epidural)
Most commonly caused by cephalopelvic disproportion
Need C-section
464
Treatment of acute chest syndrome
- ceftriaxone and azithromycin
- IV fluids
- pain control
465
Treatment of tinea capitis
ORAL griseofulvin or terbinafine
466
PrEP is contraindicated in
Abnormal kidney function
467
Hyphema
Layering of blood in the anterior chamber
Caused by acute increased intracranial pressure (from trauma) that causes blood vessels to rupture
Admit to hospital for strict bedrest and monitoring of IOP
468
SN, SP, PPV, NPV
Sensitivity: TP/(TP+FN)
Specificity: TN/(TN+FP)
PPV: TP/(TP+FP)
NPV: TN/(TN+FN)
469
Treatment of clubfoot (tabes equinovarus)
Stretching and serial casting
470
Pathognomonic for Chagas cardiomyopathy
LV apical aneurysm
471
Change antiepileptics in pregnancy?
NO. Always change before, not during. Even if on valproate.
472
Can women on antiepileptics breastfeed?
Yes
473
Postural kyphosis
From slouching
Angle normal or slightly abnormal
Just correct with better posture
474
Treatment of diabetes from chronic pancreatitis
- metformin
- insulin
No DPP-4s of GLP-1s due to increased risk of pancreatitis
475
Nonsurgical options for squamous cell carcinoma of the skin
- cryotherapy
- electrosurgery
- radiation
476
Iodine-induced hyperthyroidism
Hyperthyroidism after exposure to iodine (e.g., cardiac cath)
Often develops after pre-existing nodular thyroid disease
Usually self-limited and doesn't need treatment. If persistent symptoms or heart disease, can treat with methimazole
477
Treatment of folic acid deficiency from methotrexate
Folinic acid (not folic acid)
478
Treatment of trichomonas
SINGLE DOSE ORAL 2g metronidazole
479
Breastfeeding while on metronidazole?
If on high dose (2g), pump and dump
480
Treatment of chronic bacterial prostatitis
6 weeks of ciprofloxacin
481
Lung cancer screening
50-80 in those with ≥20 pack years
482
Next step in inflammatory acne after benzoyl peroxide and topical retinoid
Topical antibiotics
483
Who cannot take rifampin?
Women on OCPs
484
Treatment of hyperviscosity from neonatal polycythemia refractory to conservative treatment
partial exchange transfusion
485
Dengue
Fever after travel to endemic area, associated with
- flu like febrile illness with marked myalgias/arthralgias
- diffuse maculopapular rash
- leukopenia
- POSITIVE TOURNIQUET TEST
Can progress to circulatory collapse
486
What disease has a positive tourniquet test?
Dengue
487
Asymptomatic elderly patient with significant lymphocytosis
Think CLL
488
Which test characteristics depend on prevalence?
PPV and NPV
489
When to perform external cephalic version for breech presentation
37 weeks
490
Kidney stone size to call urology
≥10 mm
491
Definitive test for brain death
Apnea test (even if everything else is met, need to do apnea test)
492
Bilateral nipple discharge and negative workup
Observe
493
Treatment of organophosphate poisoning
Atropine and pralidoxime
494
What should all patients diagnosed with scleoderma get
PFTs
495
Most common inherited thrombophilia
Factor V Leiden
496
If acute cholangitis
ERCP
497
Erythema in the diaper region sparing the skin folds
Irritant or contact dermatitis
Treat with zinc oxide barrier cream
498
Congenital toxoplasmosis
- chorioretinitis
- diffuse intracranial calcifications
- hydrocephalus
499
High-grade carotid stenosis
≥70%
Carotid endarterectomy
500
SGLT2 inhibitor side effect
Euglycemic DKA
501
Carbemazepine side effects
Neutropenia, bone marrow suppression, SIADH
502
Chest pain, EKG changes, normal coronaries
Think stress cardiomyopathy
503
Treatment of pediatric ADHD
3-5: behavioral therapy
| ≥6: pharmacotherapy
504
What to do prior to starting stimulants for ADHD
Cardiac history and exam
505
Order of Wernicke encephalopathy treatment
THIAMINE and then fluids and dextrose
506
Autoimmune hepatitis antibodies
ANA and anti-smooth muscle (F-actin)
507
PBC antibody
Antimitochondrial
508
Treatment of chlamydia in pregnancy
azithromycin
| doxy outside of pregnancy
509
When can babies sleep through the night?
4-6 months
510
If osteopenia
- Vitamin D and calcium
| - calculate FRAX (10-year fracture risk) and start bisphosphonate if positive
511
What age to consider PSA
55
512
Most effective contraceptive options for emergency contraception
IUD: copper IUD [MOST EFFECTIVE]- can be placed within 5 days
Pill: ulipristal- may be taken up to 5 days after
513
IUD contraindication
active pelvic infection
514
Medications after sexual assault
- ceftriaxone
- doxycycline
- metronidazole
- multidrug ART
- HepB vaccine +/- HepB Ig
515
Complication of compartment syndrome
Rhabdomyolysis and acute renal failure
516
Does STEC (Shiga toxin E. coli) diarrhea feature fevers?
No, or at least not high ones
517
Treatment of prolactinomas
Dopamine receptor agonists
518
Treatment of normal pressure hydrocephalus
LPs, and if successful, VP shunt
519
If postextubation stridor
Think laryngeal edema and reintubate if respiratory failure
520
Treatment of ocular melanoma
Radiotherapy
521
Treatment of onychomycosis
Oral terbafine (or itraconazole)
522
Prevention of recurrent hypertriglyceridemia associated pancreatitis
Long-term fibrate therapy
523
If pressure does not stop nosebleed
Next step is topical vasoconstrictor (oxymetazoline)
524
If isolated anti-HbC
get IgM anti-HbC
525
PMR treatment
LOW dose prednisone
Don't need temporal artery biopsy unless you suspect GCA
526
Strep treatment duration
10 days
527
TSH goal in follicular and papillary thyroid cancers
Low normal
528
Treatment of high risk squamous cell carcinoma of the skin
Mohs
529
If unknown time of coin ingestion
Endoscopic removal
530
When to repair AAA
- symptomatic
- size >2x the size of the diameter of the normal aortic segment
- size ≥5.5 cm
- expansion >0.5 cm in 6 months
531
Who needs parathyroidectomy for primary hyperparathyroidism?
- < 50
- symptomatic
- complications (e.g. osteoporosis)
- increased risk of complications
Otherwise can just get serial DEXA, creatinine, calcium
532
Most common cause of erythema multiforme
Infections, especially HSV
533
Cyanosis that occurs during feeding and improves with crying
Choanal atresia
Disgnosis: inability to pass NGT
534
First line test for PCP pneumonia
Induced sputum
535
Most common inherited thrombophilia
Factor V Leiden (protein C resistance)
536
Next test in metabolic aklalosis
Urine chloride
537
Diagnosis of PSC
Endoscopic cholangiogram
538
If positive anti-D titers
Alloimmunization has already occurred
RhoGAM will not work
539
Umbilical hernia in infancy
Usually goes away on its own
540
Primary goal of treating herpes zoster
Prevent postherpetic neuralgia
541
Most important risk factor for stroke
Prior stroke
542
Why hypotension in tension pneumothorax
Compression of IVC --> decreased venous return
543
Treatment of postpartum thyroiditis
Beta blockers
544
Conduct disorder
The precursor to antisocial personality disorder
545
Vestibular neuritis vs labirynthitis
Labirynthitis: associated with hearing loss
546
Best way to communicate abnormal labs/follow up plan to PCP
Phone call
547
Painful vs painless genital ulcers
Painful
- HSV
- chancroid (Haemophilus ducreyi)
Painless
- syphilis
- LGV (Chlamydia trachomatis L1-L3)
548
Prevent vertical transmission of HSV
If history of HSV, start acyclovir at 36 weeks, and do C-section only if active lesions (or prodromal symptoms)
549
Cupping of the optic disc
Open angle glaucoma
550
If suspect parvovirus B19 in pregnancy
Get serologies
551
Screen for risk of stroke in sickle cell disease
Transcranial Doppler
552
If positive PPD or IGRA
Need to screen for symptoms and get CXR to see if latent or active disease
553
Treatment of latent TB
Rifamycin-based therapy (preferred)
- rifampin x4mo
- rifampin + INH x3 mo
INH monotherapy x6-9mo
554
Nonreactive nonstress test
Lack of accelerations = fetal acidemia
Next step is biophysical profile
555
Workup of LUTS
- UA
| - PSA
556
Myositis, periorbital edema, eosinophilia
Trichinella
From undercooked meat (pork)
557
Treat tinea versicolor
Topical selenium sulfide
558
Chloroquine retinopathy
Bull's eye retinopathy
559
Pneumonia vaccines
PPSV 23: everyone ≥65, and anyone immunocompromised 19-64 (or with heart/lunglliver disease or AUD)
PCV13: all immunocompromised ≥65 (and then give PPSV 23)
560
Which heart conditions require antimicrobial prophylaxis for high risk procedures?
- prosthetic heart valves
- prior IE
- uncorrected cyanotic congenital heart defects
561
Which type of infective endocarditis requuires longer treatment?
Prosthetic valve IE (at least 6 weeks)
562
Antibiotic of choice for HACEK IE
Ceftriaxone (better G- coverage)
563
Treatment of femoral pseudoaneurysms
Utrasound guided thrombin injection
564
Gilbert, Dubin-Johnson, and Rotor: direct vs indirect
Gilbert: indirect (impaired conjugation of bilirubin- UDP-g deficiency)
Dubin-Johnson: direct (disorder of bilirubin excretion)
Rotor: direct (disorder of bilirubin excretion)
565
Oligohydramnios
Amniotic fluid index ≤5
566
Most common asbestos-related cancer
Bronchogenic carcinoma (way more common than mesothelioma)
567
Scleroderma antibodies
Anticentromere: CREST syndrome (diffuse)
| Anti-Scl-70: diffuse scleroderma (also indicate poor prognosis)
568
APML translocation
t(15;17)
569
CML translocation
t(9;22)
570
Low leukocyte alkaline phosphatase is seen in
CML
571
Treatment of CML
Imatinib
572
First line treatment of polycythemia vera
Phlebotomy, plus aspirin
Next line is hydroxyurea
