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Step2CK Flashcards

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1
Q

Opening snap

A

Mitral stenosis

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2
Q

intraperitoneal extravasation
location
symptoms
tx

A

location - bladder dome
symptoms - chemical periotonitis (diffuse tenderness, guarding, rebound)
tx - ex lap & surgical repair

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3
Q

BAT: duodenal hematoma
symptoms -
timing -

A

kid, handle bar, SBO, epigastric pain & vom,

24-36 hours s/p injury

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4
Q

succussion splash

b/c -

A

retained gastric material b/c hollow viscus filled

b/c - gastric outlet obstruction

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5
Q

blunt trauma - abd pain, tachy, L chest wall pain, shoulder pain

A

splenic laceration

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6
Q

prerenal kidney injury BUN>Cr

A

BUN:Cr >20:1

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7
Q

emphysematous cholecystitis

A

air fluid levels in gallbladder & gas in gall bladder wall
also - fever & RUQ

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8
Q 
P.O.O.P 
increased pain with passive stretch
rapidly incr and tense swelling
parasthesia
tx =
A

compartment syndrome

tx = fasciotomy

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9
Q

BTT

esophageal rupture

A

s/p endoscopy

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10
Q

BTT

myocardial contusion

A

tachy, new BBB, arrythmia, +sternal fx

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11
Q

BTT

bronchial rupture

A

steering wheel

CXR - peristant pneumothorax, despite chest tube, pneumomediatinum, subcut emphysema

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12
Q

BTT

diaphragm rupture

A

bowel in chest (L), kehr sign

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13
Q

BTT

pulmonary contusion

A

white out within 48 hours

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14
Q

penile fracture

cause?

A

tear tunica albguinea –> rupture corpus cavernosum

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15
Q

two drugs that make long QRS

A

TCA & beta blocker

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16
Q

TCA overdose tx

A

sodium bicarb

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17
Q

beta blocker tx

A

glucagon

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18
Q

paralytic ileus - causes?

A
  1. incr splanchnic nerve sympathetic tone
  2. localized release of inflamm mediators
  3. opiod analgesics
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19
Q

peroneal nerve function

A

evert & dorsiflexion

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20
Q

SBO findings

A

dilated loop small bowel with air fluid levels

incr bowel sounds

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21
Q

myocardial contusion… PCWP?

A

incr PCWP bc CI shock

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22
Q

drug induced pancreatitis

A

thiazides and ACEi

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23
Q 
ICP lowering
head elevation - 
sedation - 
IV mannitol - 
hypervent - 
remove CSF
A

HE - venous outflow
sedation - decr metabolic demand
IV mannitol - extract free water from brain = osmotic diuresis
hypervent - CO2 washout = cerebral vasoconstriction
remove CSF - decr vol and press

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24
Q

initial hematuria

A

urethritis

trauma (cath)

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25
punctate hem, gingivitis, corskscrew hair, delayed wound healing
Vit C (ascorbic acid) deficiency
26
megaloblastic anemia with neuro
B12 (cobalamin) def
27
megaloblastic anemia with NTD
B9 (folate) def
28
radial sublax | tx
1. hyperpronate forearm | 2. supinate forearm & flex elbow
29
aplastic crisis vs vaso-occlusive crisis
aplastic crisis : decr retic; norm platelets | vaso-occlusis: incr retic; decr platelets
30
``` SCD osteomyelitits #1 #2 ```
``` #1 - S. Aureus #2 - salmonella ```
31
CAH: 17alphahydroxylase def which hormone increased? features?
incr aldo | fx: HTN, fluid and Na retention
32
CAH: 11 B hydroxylase def which hormone increased? features?
incr: 11 deoxycortisol fx: HTN, fluid and Na retention
33
decr MCV norm RDW incr retic
thalassemia minor
34
thalassemia minor (alpha) - Hg?
norm Hg electrophoresis
35
thalassemia mior (beta) - Hg?
incr HgA2
36
``` Friedrich Ataxia trinuc rpt? decr neuro? heart endo MSK ```
``` GAA neuro - dysarthria, ataxia, decr vib/proprio, decr DTR heart - HOCM endo - DM MSK - scoliosis ```
37
Juvenille Idiopathic Arthritis
``` symmetric arthritis x 6 weeks incr ferritin incr Ig thrombocytosis anemia * uveitis tx = MTX ```
38
Spondylolithesis -- Location?
L5 over S1
39
Sturge Weber Symptoms
``` Sporadic portwine stain Tram track Ca2 Unilateral Retardation Glaucoma/GNAQ Epilepsy (phCo) ```
40
SBO Risks (GIGI Home)
``` Prior Glsx IBD Gallstoneileus Intussception Hernia ```
41
Hg Electrophorosis (HgA HgS HgF) norm SCD SCT
``` HgA HgS HgF norm 99 0 1 SCD 0 85-95 15 SCT 50-60 35-45 <2% ^--hypostheuria, papnea/hemoturia ```
42
post MI - #1 cause of death
arrythmia - v fib
43
papillary muscle rupture - timing
acute or 3-5 days
44
new holosystolic murmur | severe pulmonary edema
papillary muscle rupture
45
inter ventricular septum rupture
acute or 3-5 days
46
increased O2 levels from RA to RV
inter ventricular septum rupture
47
new holosystolic murmur shock chest pain
inter ventricular septum rupture
48
free wall rupture - timing
5 days - 2 weeks
49
- distant heart sounds | - shock
free wall rupture
50
- stable angina | - ST elevations with deep Q
ventricular wall aneurysm
51
ventricular wall aneursym - timing
5 days to 3 months
52
infective endocarditis | - natiVe valve bug
strep Viridans
53
infective endocarditis | - Prosthetic valve bug
staph ePidermidis
54
infective endocarditis: intact valves - bug - virulence - acute/subacute?
iAHA | intact sAureus; hi viulence; acute
55
infective endocarditis: pre-existing lesions - bug - virulence - acute/subacute
VLS | s. Viridans; lo virulence; subacute
56
extraperitoneal extravasataion - locatin - symptoms - tx
loc - neck/ant wall symptoms - loc pain, hematuria, urinary retention tx - bed rest and foley
57
terminal hematuria
lower collecting system | urothelial cancer, cystitis, BPH, prostate cancer
58
clavicle fracture - artery in danger - nerves in danger - tx for mid - tx for distal
- subclavian artery - brachial plexus nerves - mid = non operative (brace) - distal = ORIF
59
tibial nerve - motor func - sensory innervation
flex knee, invert foot, plantar flx foot | sensory - lateral leg, plantar foot
60
hematuria throughout
upper collecting system - renal mass - glomerulonephritis - PCKD - urothelial cancer
61
on warfarin, need to reverse anticoagulant before surgery
FFP (to restore Vit K dependent factors)
62
long thoracic nerve - innervates - function - common injury
serratus anterior rot scapula bc penetrating trauma
63
Obturator nerve motor - sensory -
motor - adduction | sensory - medial thigh
64
BPP results 0-4 6 10
``` 0-4 = fetal hypoxia --> deliver 6 = equiv --> rpt 24 hours 10 = good --> rpt 1 week ```
65
chorionic villus sampling - timing - goal
10-13 weeks | definitive karyotype dx
66
amniocentesis - timing - goal
15-20 weeks | definitive karyotype dx
67
``` maternal preggo changes CO plasma volume SVR BP HR Hg TV FRC GFR Cr ```
``` CO incr plasma volume incr SVR decr BP decr HR incr Hg decr TV incr FRC decr GFR incr Cr decr ```
68
tamoxifen antag agonist
antag - breast | agonist - uterus (incr uterine hyperplasia), bone (decr bone loss)
69
raloxifen antag agonist
antag - breast, uterus | agonist - bone (decr bone loss)
70
MOA for incr TH during pregnancy
1. incr TBG bc estrogen stim TBG synthesis = incr total | 2. hCG stim TSH receptors = decr TSH release
71
OCPs incr risk decr risk
decr risk - endometrial, ovarian * ocp vowels = incr vowel cancer incr risk - breast, cervical breast
72
kallman | FSH, LH
decr FSH & LH
73
Mg toxicity
decr DTR somnolence decr respiration cause - usu b/c renal insufficiency
74
EBV - vs- gonorrhea | pharyngitis
EBV - exudative & tender cervical lymphadenpathy | gonorrhea - nontender cervical lymphadenopathy
75
pyelonephritis in pregnancy - tx
ceftriaxone
76
fibroids (leimyomata uteri)
proliferation of smooth muscle within myometrium
77
oxytocin toxicity
hypo natremia hypo tension tachy systole bc sim to ADH = water retention --> H20 tox --> seizure
78
adenomyosis
proliferation of endometria glands within myometrium
79
GI complication of infective endocarditis
splenic abscess (LUQ pain)
80
cell free fetal DNA - timing - goal
timing - >/= 10 weeks hi SN&SP for aneuploidy 13,18,21 * use if F > 35 yo
81
granulosa cell ``` functions (2) tumors effects (kid v adult) histo ```
1. secr aromatase (testosterone to estradiol) 2. secr inhibin to inhibit FSH tumor kid - precocious pub adult - AUB, postmen bleed bc endometrial hyperplasia histo - call exner bodies
82
Acute Fatty Liver Pregnancy 1. presentaion 2. timing 3. labs
1. N/V, RUQ pain, enceph 2. 3rd tmstr (early postpartum) 3. hypo glycemia, mild incr AST/ALT, bili * incr PT incr PTT
83
``` Tocolytics Mg timing MOA CI ```
< 32 wks - neuroprotect competitively competes inhibits Ca2+ dont give with CCB bc nifedipine will decr muscular contraction = respir depression
84
``` Tocolytics Indomethicin -timing - MOA - SE - CI ```
< 32 weeks NSAID (decr PG synth) close ductus arterious, digoxin CI = 3rd tmster
85
``` tocolytics Nifedipine - timing - MOA - SE - CI ```
32-34 weeks CCB (inhibit Calciuum influx into smooth muscle pulm edema, hypotension, flushing CI = hypotension
86
TTP - pentad - dx? results? - LDH? - haptoglobin? - path? - tx?
``` pentad: FATRN dx - blood smear --> schistocytes & microthrombi ldh incr haptoglobin - decr path - decr ADAMTs13 tx - plasma xchng ```
87
incr PT only
vit K def
88
decr MCV | decr RDW
thalassemia
89
decr plateletes only
ITP
90
ITP tx kid adult
``` kid - cutaneous only = observe - bleeding = GC or IVIG adult - skin + pltlt > 30k = observe - bleed + pltlt < 30k = GC or IVIG ```
91
``` Immune Hemolytic Anemia IgG warm v cold destruction location s/p? tx ```
warm spleen PCN, ceph, sulfa, rifampin, cancer tx - roids, splenectomy
92
decr MCV incr Fe decr TIBC incr ferritin
sideroblastic anemia
93
``` Immune Hemolytic Anemia IgM warm v cold descruction location associated with tx ```
cold liver mono & mycoplasma avoid cold; rituximab +/- fludrabine
94
incr BT | incr PTT
vWD
95
``` vWD - incr/decr inheritance girls v boys presentws ```
incr BT incr PTT AD females recurr epistaxis, heavy meness, petechiae
96
decr MCV decr Fe decr TIBC hi ferritin
ACD
97
decr MCV decr Fe incr TIBC decr ferritin
Fe def
98
incr PTT only
hemophilia
99
``` hemophilia incr/decr inheritance boys or girls presentation ```
incr PTT only XLR males bruising, hematuria, hemarthrosis
100
dark urine in AM path complications dx
``` paroxysmal nocturnal hematuria path - acquired defect myeloid stem cell = absent GPI = complement destruction dx - flow cytometry (-) CF55 complication - budd chiari ```
101
susceptible to oxidative stress cells? causes?
G6PD def heinz bodies and bite cells primaquine, sulfa, dapsone, nitrofurantoin
102
incr retic | incr MCHC
herediatry spherocytosis
103
``` hereditary spherocytosis incr/decr path 2 complications dx tx ```
incr retic, incr MCHC path - AD defect RBC cytoskeleton ankrin and spctrin complications 1. splenomegaly 2. bilirubin gallstones dx - incr osm fragility with acidified glycerol tx - splenectomy
104
multiple SAB & incr PTT skin findings tx
antiphospholipid/lupus anticoagulant livedo reticularis, vascular thrombosis tx - hep
105
post op --> decr platelets
HIT path - IgG to heparin bound to PF4 tx - stop heparin and start leuprolife and argotroban
106
``` #1 inheritied pro coaguable state path ```
F V Leiden | activated prot C resistance
107
CML vs leukamoid rxn
leuk count: CML >100k | LAP: CML decr
108
extrapulmonary sites for TB
liver, spleen, bone, adrenal gland
109
adrenal insufficiency | K? glucose? cells?
hyperkalemia hypoglycemia eosinophila
110
acid base addison's? conn's?
addisons - - normal gap met acidosis | conn's - met alkalosis
111
when to start long term oxygen therapy
1. PaO2 < 55 mmHg or SaO2 < 88% | 2. PaO2 < 59 or SaO2 <89 if: cor pulomale, RHF, hematocrit > 55%
112
cobalamin deficiency labs? three causes?
labs - incr MCV, incr homocysteine, incr MMA causes: 1. vegan 2. pernicious anemia (lack of intrinsic factor) 3. intestinal bacterial overgrowth (competes for cobalamin)
113
alpha-1-antitrypsin deficiency pathophys
loss of elastin in lung matrix
114
how to reverse warfarin? rapid? 12-24 hours? how to reverse heparin?
``` warfarin rapid: prothrombin complex concentrate 12-24 hours: vit K heparin protamine sulfate ```
115
Shy-Drager (Multiple system atrophy) tx?
1. parkinsonism 2. autonomic dysfunction 3. widespread neurological signs (cerebellar, pyramidal, LMN) * parkinsonism + orthosatic hypotension + impotence, incontence tx? fluids + fludracortisone, salt, alpha-agonists
116
Riley-Day (familial dysautonomia)
gross dysfunction of autonomic nervous system with severe orthostatic hypotension
117
acute pyelonephritis with urine pH > 8
proteus mirabilis or klebsiella
118
CURB65
``` Confusion Urea > 20 Respirations > 30 BP < 90/60 65+ ```
119
CAP | Outpatient tx
Healthy - macrolide or doxy Comorbidities - FQ or Blactam+macrolide
120
CAP | Inpatient (nonICU) tx
FQ or Blactam+macrolide
121
CAP | Inpatient (ICU) tx
Blactam+macrolide Or Blactam+FQ
122
Exudative effusion | Labs
LDH > 200 Pl:s LDH > 0.6 Pl:s protein > 0.5
123
TB pleural effusion
Hi lymphocytes Hi protein Li glucose
124
#1 cancer in nonsmokers
Adenocarcinoma
125
Small cell lung cancer | 3 manifestations:
1. superior sulcus syndrome 2. Lambert Eaton 3. SIADH
126
Anterior mediastinal mass
Germ cell tumor (nonseminoma) Thyroid (retrosternal) Thymoma Teratoma
127
Middle mediastinal masses
Tracheal tumor Bronchogenic cyst Aortic aneurysms Pericardial cyst
128
Posterior mediastinal masses
Neurogenic cyst Enteric cyst Esophageal Tum Diaphragmatic hernia
129
JVD, HA worse when leaving forward Dx? Assoc? To?
SVC syndrome Small cel lung cancer Radiation and stent
130
3 cardinal symptoms of COPD exacerbation? When do you give abx? Which abx?
1. Incr cough 2. Incr dyspnea 3. Sputum production (change in volume/color) *need abx if: 2+ cardinal symptoms or mech vent Abx: Macrolide (azithromycin) Respiratory FQ (levofloxacin) Pen/Blactam (amox/clav)
131
``` #1 type of kidney stone tx? (med and diet changes ```
``` calcium oxalate tx= HCTZ decr Na, decr oxalate, incr citrate ```
132
calcium oxalate stone opaque or lucent? shape?
opaque | envelope shapes
133
kidney stone type in kid with family history | pathophys?
cysteine | cant resorb amino acid
134
cysteine stone opaque or lucent? shape?
lucent hexagonal crystals *cysteine chapel is lucent and made of hexagonal window pieces*
135
kidney stone type: UTI or chronic indwelling catheter alkaline pee
struvite stone
136
kidney stone type: leukemia treated with chemo tx =
uric acid stone | tx = potassium citrate, alkalinize urine, hydration
137
uric acid stones opaque or lucent? shape?
lucent needle shaped * acid is a clear drug you shoot up with needles*
138
kidney stone type | s/p volvulus, resection, chrons, fat malabsorption
pure oxalate stone
139
kidney stone treatment (general)
< 5 mm = hydrate 5mm to 2 cm = shockwave > 2 cm = open.endoscopic surgical removal
140
``` CP - worse with inspiration, better with leaning forward dx? EKG? tx? contraindications to each tx? ```
pericarditis STelev and depressed PR NSAIDS (ci = ckd); colchicine (ci = diarrhea)
141
chemical stress drugs
adenosine and dobutamine
142
anterior STEMI | vessel and leads
LAD -- V1 - V4
143
lateral STEMI | vessel and leads
circumflex -- I, aVL, V4-V6
144
inferior STEMI | vessel and leads
RCA -- II, III, aVF
145
1st cardiac enzyme to rise? when does it peak? back to normal? use?
myoglobin 2 hours 24 hours best for repeat diagnosis
146
cardiac enzyme, longest lasting? peak? back to normal?
troponin 24-48 hours 7-10 days
147
does systolic or diastolic have normal EF? | EF of other?
``` diastolic = normal EF systolic = EF < 55% ```
148
three meds that improve survival in diastolic HF
1. ACEi - prevent remodeling by aldo 2. beta blockers - prevent remodeling by epi/NE 3. spirnolactone -
149
Hepatic encephalopathy Symptoms? TX?
AMS, Asterixis, Ataxia, Awake (sleep changes) | Tx = lactulose and rifaximin
150
Esophageal Dysphagia Solid to liquid? Solid and liquid?
TO = mechanical obstruction Dx= barium swallow/upper endo AND = motility disorder dx = barium swallow +/- mammonetry
151
beta 2 agonist effect on electrolytes
reduce serum potassium levels by driving potassium into cells
152
dubin johnson? | liver color?
conjugated hyperbilirubinemia bc defect in hepatic excretion liver dark, lysosomal pigment
153
gilbert syndrome
unconjungated hyperbilirbinemia | bc decreased bilirubin glucuronidation
154
rotor syndrome? | liver color?
conjugated hyperbilirubinemia | normal liver color
155
crigler najar
unconjugated hyperbilirubinemia | bc total deficiency
156
SVT tx?
1. vagal maneuivers 2. adenosine 3. shock
157
afib tx? unstable? stable?
unstable - cardiovert | stable - rate control ( CCB (diltazem/verapimil) or BBlkrs)
158
name (4) fast arrthymias? | which narrow and which wide QRS?
``` narrow: SVT Afib wide: Torsades Vtach ```
159
torsades tx?
Mg; shock
160
Vtach tx?
shock then amiodarone
161
what to check if patient has afib?
CHA2DS2VASc
162
CHADSVASc which count double? acroncym stands for?
double = age and stroke | CHF, HTN, Age > 75, DM, Stroke, Vasc dz, Age (65-74), Sex category
163
indication for: cardioversion? defibrillation?
cardioversion - a fib (persistant tachyarrythmia) | defibr- v fib -- provides random shock
164
(2) inherited long QT syndromes
1. jervell & lange-nielsen = AR, hearing loss | 2. romano-ward = AD
165
pulse difference btwn: left and right? UE and LE?
LandR = physiologic or aortic dissection | UE and LE = coarctation
166
pulse description for aortic stenosis
pulsus parvus et tardus = | delayed (slow rising) and diminished (weak) carotid pulse
167
pulse description for aortic regurgitation
widened pulse pressure (water hammer pulse)
168
pulse description in cardiac tamponade
pulsus paradoxus (decr SBP > 10mmHg with inspiration)
169
beta blockers contol angina via
reduce myocardial oxygen demand by 1. decrease HR 2. decrease myocardial contractility
170
asymptomatic carotid stenosis
asa and statin only do CEA if: symptomatic and >70% stenosis
171
JVD, hypotension, decr heart sounds | CXR?
pericardial tamponade | CXR clear lungs
172
fixed and split S2
ASD
173
dihydropyridine CCB
amlodipine | nifedipine
174
non-dihydropyridine CCB
diltiazem | verapamil
175
post MI | acute, severe hypotension, no pulse
ventricular free wall rupture
176
post MI | severe pulmonary edema
papillary muscle rupture
177
HOCM murmur
harsh, crescendo-decrescendo systolic murmur | heard at apex and LLSB
178
afferent vs efferent arterioles
afferent - towards | efferent - away
179
diffuse ST elevations, PR depression
pericarditis
180
pericarditis with electrical alterans with sinus tachy
pericardial effusion
181
diastolic CHF with pericardial knock
constrictive pericarditis
182
causes of constrictive pericarditis
recurrant pericarditis virus radiation TB
183
constricitve pericarditis - echo findings
pericardial thickening and calcifications
184
AIDs diarrhea crypto? MAC? CMV?
crypto: <180 ; sevr water MAC: < 50 ; watery, high fever (ppx = azithro) CMV: < 50 ; small bloody -- tx = ganciclovie or foscarnet
185
beta 1 receptor agonist
increase contractility via incr cAMP = incr calcium channel binding of actin myosin complex to tropnin C
186
primary adrenal insufficiency cortisol? ACTH? aldo?
cortisol - decr ACTH - incr aldo - decr
187
central adrenal insufficiency cortisol? ACTH? aldo?
cortisol - decr ACTH - decr aldo - normal
188
#1 cancer in asbestos exposure?
bronchogenic carcinoma
189
only known cause of mesothelioma
asbestos
190
reiculonodular processes in lower lobes with pleural plaques
asbestosis
191
restrictive lung dz with eggshell calcifications
silicosis
192
location of mesothelioma
unilateral
193
bone pain, unilateral hearing loss, femoral bowing
paget dz of bone
194
paget dz of bone: path?
increase in bone turnover | Oc --> oc/Ob --> Ob
195
paget dz of bone: bone pattern?
disorganized mosaic pattern of lamellar bone
196
osteomalacia: path?
malabsorpbtion of calcium and vitamin D = ababnormal mineralization
197
insulin effect on potassium
drives potassium into cels = hypokalemia
198
HHS tx
normal saline
199
estrogen effect on TBG
estrogen decrease clearance of TBG = increaesed TBG
200
``` myopathies ESR; CK glucocorticoid statin polymyalgia rheumatica inflammatory hypothyroid ```
``` GC - norm, norm statin - norm; incr PR - incr; norm inflamm - incr; incr hypothy - norm; incr ```
201
three drugs that improve quality of life in alzehimers pts and MOA
cholinesterase inhibitors: donepezil rivastigmine galantamine
202
absent CD55
PNH
203
most common origins of PE
proximal thigh - femoral, iliac, popliteal
204
arterial ulcer manifestiations
ulcer at tips of digits diminished pulses loss of hair intermittent claudication
205
pulsus parvus et tardus
aortic stenosis | = delayed and diminished carotid pulse
206
harsh ejection (crescendo-decresecndo) systolic ejection m urmur
aortic stenosis
207
disseminated gonoccocal triad
1. polyarthragia 2. tenosynovitis 3. painless vesiculopustular skin lesions
208
common age for SSSS? | bug?
<6yo | s aureus
209
wilson dz - what mineral accumulates? and where? old or young?
copper Liver, BG, cornea younger
210
two diseases with mallory hyaline
1. wilsons | 2. alcohol liver injury
211
two diseases with mallory hyaline
1. wilsons | 2. alcohol liver injury
212
constricitive pericarditis | causes?
radiation, recurrent pericarditis, TB
213
constricitive pericarditis | echo findings?
thickened pericardium and calcifications
214
nocardia gram stain
partially acid fast filamentous branching rods
215
nocardia tx
TMP-SMX
216
actinomyces gram stain
gram postive, filamentous NOT acid fast NOT branching
217
actinomyces unique characteristic
sulfur granules
218
actinomyces tx
penicillin G
219
bowel ischemia - 2 common signs
abd pain and bloody diarrhea
220
BMI to hospitlize an anorexic?
<15
221
dendritic ulcer around eye? | dendriform ulcer around eyye?
dendritic - herpes simplex keratitis | dendridform - herpes zoster opthlmicus
222
three factors predisposing postpartum patients to thrombosis
1. hypercoaguable state of preggo 2. pelvic venous stsis and dilation 3. endothelial damage from infection and/or trauma during delivery
223
persistant fever unresponsive to abx and negative infectious postpartum
septic pelvic thrombophlebitis
224
septic pelvic thrombophlebitis tx
broad abx and anticoagulant
225
OCPs decrease risk of which cancers?
endometiral and ovarian
226
NF1
``` cafe au lait clustered freckles (axilla, inguinal) lisch nodules neurofibromas optic glioma ```
227
tetraology of fallort vs choalnal atresia
tet - fine at rest; cyanotic with crying | choanal - cyanotic at rest; better with cry
228
case control | RR or OR?
OR
229
cohort | RR or OR?
RR
230
acute pancreatitis causes
``` ethos gallstone hyperTG drugs (valproic acid, thiazide) infections (CMV, legionella) iatrogenic (post ERCP) ```
231
CVID tx
IVIG
232
WAS tx
stem cell transplant
233
congential, recurrent skin abscesses
CGD
234
CGD tx
interferon gamma
235
ARDS | mechanically improve oxygenation by?
incr FiO2 | incr PEEP
236
chronic prostatitis tx
1. alpha blockers (tamulosin) 2. antibiotics (cipro) 3. 5alphareducatse inhibitors (finesterade)
237
irritative voiding symptoms, meatospermia, pain with ejaction NO UTI sx NO tender prostate
chronic prostatitis/chronic pelvic pain syndrome
238
long term intervention for: asthma? COPD?
asthma - inhaled corticosteroids | copd - long acting antichol inhaler
239
fever, leukocytosis, LUQ pain
splenic abscess
240
violent behavior horizontal and vertical nystagmus dissociation hallucination
PCP intox
241
visual halucinations euphoria panic tachy/htn
LSD intox
242
chest pain mydriasis seizures tachy/htn
cocaine intox
243
incr appt hypersomnia pschomotor retardation severe depression
cocaine withdrawl
244
violent behavior tooth decay choreform mvmnt psychosis
meth intox
245
``` incr appt slow reflexes conjunctival injection dry mouth tachy! ```
MJ intox
246
depressed miosis respir depression
heroine/opiod intox
247
N/V/D/cramp muscle aches druggie
heroine withdrawl
248
opiod overdose tx
naloxone
249
dilated pupils yawnlacrimation piloerection hyperactive bowel sounds
heroine withdrawl
250
alcohol withdrawl tx
lorazepem
251
tremor delirium insomnia
alchol withdrawl
252
BZ overdose tx
flumazenil
253
tremor anxiety perceptual disturbances insomnia
BZ withdrawl
254
three stages of alchol withdrawl (with timing)
6-24 hours - mild 12-48 hours - seizures and alc hallucinastions 48-96 hours - DT
255
``` dysphagia to solids vs dysphagia to solids and liquids vs dysphagia to liquids ```
solids - esophageal stricture solids and liquids - achalasia liquids - diffuse esophageal spasm
256
vascular ring vs laryngomalacia
VR - better with neck extension; biphasi stridor laryng - better when prone; inspiratory stridor
257
locations of hypertensive hemorrhages
basal ganglia (putamen) cerebellar nuclei thalamus pons
258
SLE test.. | SN? SP?
SN - anti nuclear | SP - anti ds dna
259
multiple areas of increased T2 weighted density in periventricular areas
multi-infarct dementia
260
antibodies for limited cutaneous sclerosis vs diffuse cutaneous
limited - anticentromere | diffuse - anti scl 70 (topo1)
261
MOA of finasteride
5-alpha-reductase inhibitor | blocks conversion of testosterone to dihydrotestosterone
262
abd pain with fever and subtle mental changes
think spontaneous bacterial peritonitis!
263
spontaneous bacterial peritonisits tx and ppx
TX - 3rd gen cheph (cefotaxime) | ppx - FQ
264
PE EKG findign
S1 Q3 T3
265
``` polycythemia vera lab findings? Hg? WBC? EPO? JAK2? ```
Hg - hi wbc - leukocytosis and thrombocytosis epo - low jak2 - (+)
266
liver cirrhosis path of: esophageal varices, splenomegaly, acites, caput medusae, anorectal varices
portal htn
267
liver cirrhosis path of: spider angiomata, gynecomastia, loss of sexy hair, testicular atroph, palmar erythema
hyper estrinism
268
liver cirrhosis path of: ecchymosis, edema
hepatic synthetic dysfunction
269
erythema multiform after which infection?
herpes simplex
270
CSF bacterial meningits cells? glucose? protein?
cells - PMN glucose - decr protein - incr
271
CSF viral meningitis cells? glucose? protein?
cells - lymphocytes glucose - norm protein - norm
272
CSF fungal meningitis cells? glucose? protein?
cells - lympphocytes glucose - decr protein - incr
273
dermatophytosis and onchymosis tx?
griseofulvin
274
complement levels in PSGN and why?
low C3 in serum bc C3 accumulates in glomerular deposits
275
calcium gluconate tx for what?
hyperkalemia
276
pneumoconioses with: parenchymal nodules? pleural plaques?
nodules - silicosis | plaques - asbestosis
277
lumbar punture of GBS
incr prot | albuminocytologic dissociation
278
nephrotic syndrome: | hep B and SLE?
membranous nephropathy
279
nephrotic syndrome: | NSAIDs and lymphoma
MCD
280
infective endocarditis vascular lesions? immunologic lesions?
vascular - janeway (nontender on palms and soles) | immunologic - osler nodes (painful on tips) and roth spots ( retinal hem)
281
tinea corporis (ringworm) tx for: first line/ local? second/extensive?
``` first - topical antifungal = clomtrimazole, terbinfine) second - oral antifungal = griseofulvin, terbinifine ```
282
water hammer pulse and widened pulse pressure
aortic regurgitation
283
raised sharp red borders | strep pyogenes
erysipelas
284
muddy brown casts
ATN
285
RBC casts
glomerulonephritis
286
WBC casts
interstitial nephritis and pyelo
287
fatty casts
nephrotic syndrome
288
broad waxy casts
chronic renal failure
289
hyaline casts
hypovolemia/dehydration
290
LDH level in PCP
incr
291
LAP level in CML and leukamoid rxn?
CML - low | leuk rxn - high
292
peripheral smear cells in CLL
smudge cells
293
CML tx? | MOA?
imatinib | moa = inhibits TyrKin
294
LDH level in AML?
incr
295
peripheral smear cells in AML
auer rods
296
``` bacterial meningitis empiric abx for anyone? 2-50? >50? immunocomp? neurosurg? ```
``` all - vanc 2-50 = + ceftriaxone > 50 = + ceftriaxone + amp immuncomp = +cefepime + amp neurosurg = + cefepime ```
297
for syphillis, which test quantitiate and which test qualitiative?
quant - nontrep (RPR, VDRL) | qual - trep (FTA-abs)
298
mirtazapine MOA
alpha 2 antag
299
which ulcer is worse with food? better with food?
worse? gastric | better? duod
300
two class 1C antiarrythmics
flecainide and propafenone
301
why is kidney damaged in DM?
glomerular hyperfiltration
302
MOA of riluzole
glutamate (excitatory) inhibitor
303
``` wegeners: real name? three effects ANCA? tx? ```
name - granulomatosis with polyangitis 1. upper repir - sinusitis/otitis, saddle nose deformity 2. lower respir - lung nodules/cavitation 3. renal - RPGN cANCA (PR3) tx = MTX and cyclophosphamide
304
loop diruretics: inhibit which channel? also decreases? also increases?
inhibits NaKCl2 also decreases - Mg, Ca also increase = urate, Li
305
thiazide diuretics: inhibit which channel? also increases?
inhibits NaCl | also increases - glucose, uric acid, Ca
306
allergic conjunctivitis
bilateral | vs viral and bacterial which are unilateral
307
normal: rhinne? weber?
rhinne - A>B | weber - midline
308
SNHL rhinne? weber?
rhinne - A > B | weber - lat to unaffected
309
conductive rhinne? weber?
rhinne - B>A | weber - lat to affected
310
case control
compare risk factor frequency
311
cohort (retrospective)
compare dz incidence
312
diffuse esophageal spasm manometry
periodic, high amplitude, non-peristaltic contractions
313
systemic sclerosis manometry
hypomobility and incompetence of LES | smooth muscle atrophy and fibrosis
314
decrease GFR and lack of improvement with volume resuscitation
hepatorenal syndrome
315
low TSH | high RAIU
diffuse - graves | nodular - toxic adenoma
316
toxic adenoma path
produce own TH
317
low TSH | low RAIU
hi TG - thyroiditis | lo TG - exogenous TH
318
thyroiditis path
preformed TH
319
bullous pemphigoid IgG against? pattern? tx
against hemidesmosomes linear tx = topical clobestol
320
pemphigus vulgaris IgG against? pattern?
against desmosomes | fish net
321
violaceous heaped up verrucoud or nodular lesions
disseminated blastomycosis
322
seborrheic dermatitis assoc with which two diseases?
parkinsons | HIV
323
which post MI complication can occurs months s/p MI
ventricular aneurysm
324
TTP tx
plasma exchange
325
interstitial lung dz path
alveolar spaces filled with fibroblasts
326
bronchiectasis path
brochical wall thickening with mucus plugs
327
hyponatemia with Sosm < 275 | three main categories
hypo, eu, and hypervolemic
328
hypovolemic hyponatremia
Una<40 = NONRENAL - vom, diarrhea, dehyd Una>40 = RENAL - diuretics, primary adl insuff
329
euvolemic hyponatremia
``` Uosm <100 - psych - beer Uosm >100 - SIADH ```
330
SIADH - what is Una?
Una >40
331
hypervolemic hyponatremia
CHF hepatic failure nephrotic syndrome
332
hyponatremia with normal Sosm
pseudohypo (incr lipids)
333
hyponatremia with Sosm >295
``` hyperglcemia expgenous solutes (mannitol) ```
334
drugs that cause SIADH
carbamazepine SSRI NSAIDs
335
area of atrophy in Alzhimers
temporal and parietal lobe
336
c diff - 3 risk factors
abx hospital ppi
337
path of c diff
orgnaism noninvasive but released exotoxin (enterotox a and cytotox B) that penetrate colonic epithelial cells = apoptosis of tight junctions
338
how to dx TTP
peripheral blood smear
339
SLE vs rosacea -- which gets in nasolabial folds? | which is affected by alcohol?
rosacea
340
polymyositis vs polymyalgia rheumatica | symptoms
polymyosists - more pain/weakness | PR - more stiffness
341
polymyositis dx
muscle biopsy = mononuclear infiltrate surrounding necrotic and regernating muscle fibers
342
argyll roberston pupil | pupils constrict with ___ but not ___
constrict with accomodation but not light
343
pearly, flesh coloroed nodule
basal cell carcinoma
344
most common skin cancer
basal cell carcinoma
345
ZE syndrome -describe tumor
gastrin secretin pancreatic tumor
346
symptoms of | focal nodular hyperplasia vs hepatic adenoma
FNH - asymptomatic | HA - RUQ pain, assoc with OC
347
aortic dissection diagnosis if: renal insufficiency or hemodynamic instability? hemodynamic stable?
renal insuff/unstable - TEE | table - CT angio
348
CLL dx?
flow cytometry
349
acutely elevated creatinine.. next best test?
renal u/s
350
causes of gout
1. incr urate production - idiopathic - myeloprliferative dz - tumor lysis - HGPRT def 2. decr urate clearance - CKD - thiazide and loop diuretics
351
digital clubbing with painful joint enlargement, periostosis of long bones, synovial effusions
hypertrophic osteoarthropathy
352
which liver problem, if rupture, can cause anaphylaxis?
echinoccocal cyst
353
FEV1/FVC | changes in each and overall for restrictive lung dz
``` FEV1 = decr FVC = decr decr FEV1/FVC = incr ```
354
dilated cardiomyopathy path? sys or dys? echo?
path - virus, etoh, wet beri beri systolic CHF echo = dilated ventricle with diffuse hypokinesia
355
aortic valve vegetation --> what murmur?
aortic regurgitation
356
clostridium botulinum
inhibits PREsynaptic Ach release
357
boutlism tx
equine serum heptavalent botulinum antitoxin
358
myasthenia gravis
autoantibodies to ACh receptors on postsynaptic
359
lambert eaton
autoantibodies to Ca channles at PREsynaptic
360
CMV retinitis vs HSV retinits pain? retinal findings?
CMV - painless; fluffy/granular lesions | HSV - painful; keratitis, central necrosis of retina
361
condyloma acunimata? lata?
acuminata - HPV (verrucous,papilliform, pink/skin colored) | lata - syphilis (flat pink/gray)
362
preventative meds for migraines
beta blockers topiramate TCA (amytriptaline) divalpoex
363
decr DLCO in: obstructive? restrictive?
obstructive - COPD | restrictive - ILD
364
``` amiodarone side effects cardiac? pulm? GI? ocular? derm? neruo? ```
``` cardiac - QT prolong pulm - chronic interstitial pneumonitis GI - elev LFT, hepatitis ocular - corneal microdeposits, optic neuropathy derm - blue-grey skin discoloration neruo - periph neuropathy ```
365
kidney issue in: sarcoidosis? wegeners?
sarcoid - interstitial nephritis | wegeners - glomerulonephritis
366
clostridium tetani MOA
blocks release of inhibitory nt (glycine and GABA)
367
atrophy of lenticular nucleus
wilsons dz
368
hyperviscosity, HSM, neuropathy, bleeding
waldenstrom macroglobilinemia
369
bone marrow biopsy for: | waldenstrom vs MM?
walden - >10% clonal B cells | MM - >10% clonal plasma cells
370
EKG of LVH
high voltage QRS, lateral ST depression, lateral T wave inversion
371
EKG of coarctation
LVH
372
which repiratory acid/base disturbance is becuase of: hypovent? hypervent?
hypovent - respir acidosis | hypervent - respir alkalosis
373
4 causes of cor pulmonale
#1 COPD - ILD - pulm vasc - OSA
374
antithyroid drugs (MMZ, PTU) SE?
both - agranulocytosis MMZ - 1st tmstr teratogen, cholestasis PTU - hepatic failulre, ANCA vasc
375
radioactive iodine SE
permanent hypothy | worsen opthalmopathy
376
thyroid surgery risks
permanent hypothy recurr laryngeal nerve dmg hypoparathy
377
brocas area location? | associtated features?
lateral left frontal lobe | assoc - right hemiparesis (face and upper limb)
378
ischemia of CN III effects? | nerve compression of CN III effects?
ischemia - EOM muscles ( down and out) | compression - abnormla pupil respone (mydriasis)
379
drugs that cause hearing loss
cisplatin aminoglycosides loops vancomycin
380
palpable purpura, arthralgias, glomerulonephritis in someone with HepC
mixed cryoglobulinemia
381
short systolic murmur at apex that disappears with squatting
MVP
382
rapid tx for hyperkalemia? | to stabilize heart/.
insulin and glucose | heart - calcium gluconate
383
difference in mumur between interventricular septal rupture and papillary muscle rupture?
intervent rupture - harsh holosystolic with palpable thrill | papillary muscle rupt - soft, MR
384
adenocarcinoma, nsaids, hepB, sle | which nephrotic?
membranous
385
salicylate intoxication acid/base disturb | tx?
1st - respiratory alkalosis 2nd - anion gap metabolic acidosis tx = alkalinization or dialysis
386
which aa can make niacin?
tryptophan
387
zenker's diverticulum path? dx?
path - motor dysfunction | dx contrast./barium esophagram
388
ZE syndrome path? tumor location?
path = gastrin producting tumor in pancreas or duodenum uncontrolled gastrin secretion = pariteal cell hyperplasia = excessive production gastric acind = inactivate pancreatic enzymes = diarrhea and steatorrhea
389
preseptal cellulits tx
oral doxy
390
``` hyperaldosteronism main features? diagnostic test? primary ratio? secondary ratio? ```
fx - HTN + hypokalemia diag - renin to aldo ratio primary = decr renin incr aldo secondary = incr renin incr aldo
391
differnce in presentation btwn methanol ? ehylene glycol?
methanol - visual blurring, centl scotomoa, APD, ams | ethylene glycol - flank pain, hematuria, CN palsy, calcium oxalate crystals
392
antibody for primary biliary cholanfitis
ant mitochondrial an
393
lesion that dimples in center when pinched
dermatofibroma
394
PE tx if: normal GFR? GFR < 30?
normal GFR - LMWH | GFR < 30 - unfractionated hep
395
most common valvular dz with infective endocarditis
MR and MVP
396
attributable risk percent
ARP = (risk in exposed - risk in unexposed)/risk in exposed or ARP = (RR-1)/RR
397
replacement for sever coagulopathy ( liver dz, DIC)
FFP
398
ways other than poor diet and alcohol to get folic acid deficiency?
drugs! phenytoin (impair folic acid absorption) MTX, TMP-SMX (antag folic )
399
tx for med and large sized varices ppx? tx of actively bleeding?
ppx - nonselective beta blocker (propranolo, nadolol) | active - octreotide ( somatostatin analogue)
400
path of ascending vs descending aortic aneursyms?
asc - cyctic medial necrosis (agin) or CT disorders | desc - atherosclerosis (htn, smoking, hi cholesterol)
401
when to add corticosteroids to PCP tx
pulse ox < 92% PaO2 < 70 Art-Alv >35
402
hi calcium algorithm:
1. check PTH 2. hi PTH = PTH dpndnt = primary hyperPTH or familial 2. Lo PTH - PTH independent --> check PTHtp and VitD == malig, vit d rox, thiazides, thyrotoxicosis, immobilization
403
lipid panel | when to start and how often
M > 35 F > 45 Q5y
404
INH -- two SE
hepatotox and periph neuropathy
405
BZ overdose vs opiod overdose
BZ - not as severe respir depression and normal pupil size ( btwn 2-4 mm)
406
esophageal cancer: two subtypes? location of each?
adenocarcinoma - distal (bc barretts) | squamous cell - anywhere
407
histoplasmosis - diagnosis?
urinary antigen testing
408
risk factors for MS
``` genetic vit D def geographic location (USA, europe) cold places ```
409
three complications of ankylosing spondylitis
OP/vertebral fractures aoritic regurgiation cauda equina
410
dx giardia | tx?
stool antigen testing (elisa) | tx = metronidazole
411
azathioprine - major toxicity?
dose related diarrhea, leukopenia, hepatotx
412
mycophenolate - major toxicity?
bon emarrow suppression
413
immunosuprresent with gingival hypertorphy an dhirsuitism? | which other immunosppresent works similarly but doesnt have these SE?
cyclosporine | other - tacolimus
414
test for pheochromocytoma
plasma fractionated metanephrine assay
415
three things that are PAS(+) | whats the difference?
whipples and MAC MAC - acid fast bacilli and ALL
416
drug to stabilize bony tumors? | MOA
bisphosphonates (-ate) | inhibit osteoclasts
417
asymptomatic liver cyst
echinoccocus (hydatic cyst)
418
echinoccocus cyst tx
albendazole and surgery to remove whole cyst | rupture = anaphylaxis
419
liver cyst with RUQ pain, fever,
entaemoeba histolyticsa
420
entamaeba histolytica tx
metronizaole (do not drain)
421
bug of acute epidiymitis <35 >35
<35 STC (gc/chlam | >35 bladder outlet obstuction with e.coli
422
brown sequard
ipsi hemiparesis ipsi decr vib/proprio contra decr P/t two levels below
423
cotton wool spots
central retinal vein hemorrhage
424
acid fast hyphae
aspergillus
425
scabies tx
topical 5% permethrin OR oral ivermectin
426
buzzwords for: actinitc keratosis seborrheic keratosis
AK - premalignant | SK - stuck on
427
three main findings of glucagonoma
1. necrolytic migratory erythema (face, perineum, extremities) 2. DM 3. GI -- diarrhea
428
sensory findings for lateral medullary syndrome
ipsi P/T face | contr body
429
``` carcinoid syndrome skin? GI? cardiac? pulm? misc? ```
``` skin - flushing, telangiectasias GI - diarhea, cramping vardiac - valvular (R>L) pulm - bronchospasm misc- niacin deficiency ```
430
carcinoid syndrome diagnosis? why?
elev 24 hours urinary excretion of 5HIAA | bc incr conversion of tryptophan to serotnin and 5HIAA
431
tx for agitated older patient? | what drugs are contraindicated?
tx = haldol | CI - bz
432
euthyroid sick syndrome - | TSH? T3? T4?
TSH - lo T3 - lo T4 - norm
433
sulfonylurea - side effects?
weight gain and hypoglycemia
434
pioglitazones - side effects?
CHF bone fracture bladder cancer weight gain and edema
435
diabetes med best for weight loss
GLP-1 receptor agonist | exentide
436
ulnar nerve entrapment location
at elbow where ulnar nerve meets medial epicondyle
437
optic disc pallor cherry red fovea boxcar segmentation of blood in retinal vein
CRAO
438
curtain coming down
retinal detachment
439
pancreatic cancer | location that presents with jaundice?
head of pancreas
440
dx for pancreatic caner
CT with contrast

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