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Flashcards in Test Deck (126):
1

TB effusions breakdown?

EXUDATIVE
- High protein levels (>4)
- Lymphocytic leukocytosis
- Low glucose levels (500)
- low pH

2

Empyema has high amount of what type of cells in effusion fluid?

neutrophils

3

reactive nonstress test (pregnancy)

- baseline fetal HR 110-160
- Mod variability (6-25/min)
- >=2 acceleration in 20 min each peaking >-15/min above baseline and lasting >=15 sec

4

HSV encephalitis findings in CSF?

- lymphocytic predominance
- WBC elevated, but not severely
- inc protein
- elevated RBC count (high)
- nL glucose

5

Acute bacterial meningitis CSF pattern?

- HIGH WBCs (1000s)
- Neutrophil predominence
- low glucose
- elevated protein

6

Chronic bacterial meningitis (ie TB) CSF findings?

- inc WBCs (100s)
- Lymphocytic predominence
- Very low glucose
- inc protein

7

neurogenic claudication is?

low extremity pain w/ extension of spine (walking, prolonged standing, etc)

8

neurogenic claudication (pseudoclaudication) - think?

spinal stenosis

9

pain on walking and prolonged standing w/ relief w/ leaning forward or walking up hill, think?

spinal stenosis

10

ACTH is what type of molecule

polypeptide

11

Calcitrol is what type of molecule?

Sterol vitamin

12

Cortisol is what type of molecule

steroid hormone

13

name some arachidonic acid derivatives?

-leukotrienes
-prostaglandins

14

AA derived hormone examples?

- serotonin
- NE
- Epi

15

amniotomy is aka?

artificial rupture of membranes

16

>=2 on CHADVASC w/ afib treat how?

oral anticoagulants

17

1 on CHADVASC w/ afib treat how?

none, aspirin, or oral anticoagulants -- discretionary

18

prophylaxis against MAC for CD4

Azithromycin

19

headache worse when leaning forward - think?

SVC syndrome

20

facial and upper extremity swelling, JVD, no peripheral edema, headache worse when leaning foward - think?

SVC syndrome

21

most common cause of SVC syndrome?

malignancy (lung or lymphoma)

22

Primary treatment for malignancy related SVC syndrome?

radiation therapy

23

concern for aspiration pna do what?

- diet modification
- elevated head of bed

* jejunal feeding can dec aspiration risk, but others (NG tube, PEG actually INC risk of aspiration)

24

greater than 250 neutrophils in ascitic fluid is?

Spontaneous bacterial peritonitis

25

subepidermal cleavage is?

bullous pemphigoid

26

intraepidermal clevage is?

pemphigus vulgaris

(+acantholysis)

27

neurodermatitis?

skin picking disorder

28

Ab against hemisdesmosomes?

bullous pemphigoid

29

Ab against desmosomes?

--> acantholysis

Pemphigus vulgaris

30

treatment of bullous pemphigoid?

high potency topical glucocorticoids

31

brain mets look like what on MRI?

peripheral, circumscribed, enhancing lesions w/ vasogenic edema surrouding

32

tension pneumothorax cardiovascular effect?

HypOtension due inc intrathoracic pressure --> DEC Venous return

33

evidence of denervation think what type of gen neuro disease?

LMN disease
(m. atrophy, fasciculations)

34

hyperreactive reflexes, UMN or LMN?

UMN

35

muscle atrophy, UMN or LMN?

LMN

36

complex seizures involve?

loss of consciousness

37

partial seixure involve

seizure activity w/in focal area of brain

38

Initial treatment for stable monomorphic V tach?

Loading dose of IV Amiodarone

39

adenosine used to treat what cardiac issue?

Supraventricular tachycardia

40

Pt w/ chest pain, hematemesis, SOB, L pleural effusion, post esophageal procedure -- think?

esophageal rupture

41

Associated w/ esophageal rupture (2)?

- pleural effusion (esp L)
- Pneumomediastinum --> mediastinitis

42

chronic pancreatitis usually due to?

alcoholism

43

simple non invasive test for Peripheral vascular disease?

Ankle brachial Index

1 - 1.3 = nL
0.4 - 0.9 = PVD

44

pts w/ strep gallolyticus endocarditis should also have what done?

Colonoscopy

45

strep gallolyticus infx inc risk for what two things?

- endocarditis
- colorectal cancer

46

most common organisms that can cause epiglottitis in adults (esp unvax)?

Hib
Step pyogenes

47

rupture of maternal dcidual vessels -->?

placental abruption

48

vaginal bleeding + hypertonic, distended, tender uterus -- think?

placental abruption

49

substances that inc risk of placental abruption?

cocaine
tobacco

50

painless vaginal bleeding after ROM - think?

vasa previa

51

painful 3rd trimester bleeding?

- placental abruption
- uterine rupture

52

painless 3rd trimester bleeding?

- vasa previa
- placenta previa

53

risky sex --> papule --> painless ulceration w/ painless inguinal denopathy -- think?

syphilis

54

painful ulcer + painful lymphadenopathy - think?

Chancroid (h. ducreyi)

55

painless genital ulcer w/ red, beefy base and NO adenopathy - think?

Granuloma inguinale (Klebsiella caused)

56

differences b/t granuloma inguinale and syphilis caused chancre?

S: adenopathy & ulcer will resolve on own w/o treatment (moving to 2nd stage of syphilis)

GI: NO adenopathy, will NOT resolve w/o abx

57

recurrent sinopulmonary and GI infx beginning after 6mo w/ small tonsils suggests?

X-linked agammaglobulinemia (Bruton's)

58

x-linked aggamaglobulinemia due to? causes?

defect in tyrosine kinase --> prevents dev of mature B cells

--> dec immunoglobulins and B cells (nL T cells) & NO response to vax

59

treatment of x-linked agammaglobulinemia?

monthly IVIG
+/- prohylactic abx (only if IVIG not protective enough)

60

what vaccines are contraindicated in x-linked agammaglobulinemia?

LIVE vax

can give others, but won't generate meaningul Ab response

61

which bugs associated w/ complement deficiencies?

disseminated bacterial infx particularly w/ ENCAPSULATED bacteria (ie strep pneumo, neisseria)

62

which ingx associated w/ CGD?

recurrent skina nd pulm infx w/ CATALASE-positive org (staph, serratia, etc)

63

adenosine deaminase deficiency effects what cells?

impaires T cell dev --> SCID

64

most common predisposing factor for acute bacterial sinusistis?

Viral upper respiratory infx

65

First line treatment for acute bacterial sinusisits?

Amoxicillin w. clavulanic acid

66

low PCWP, low RA pressure, inc SVR, and low mixed oxygen venous sat -- what type of shock?

Hypovolemic

67

inc RA pressure, inc PCWP, inc SVR, dec mixed venous osxygen sat - what type of shock?

cardiogenic

68

slight dec RA pressure and PCWP, dec SVR, inc mixed venous oxygen sat - what type of shock?

Septic shock

69

nL avg RA pressure?

4mm Hg

70

nl avg PCWP pressure?

9mm Hg

71

RA pressure and PCWP pressure can indicate what overall vascular situation?

preload

72

SVR indicates what greater vascular situation?

afterload

73

most common bacterial infx for kids w/ CF?

staph aureus! (20)

74

First line antiHTN meds in pregnancy?

- Beta blocker (labetalol)
- Methyldopa
- Hydralazine

*Calcium channel blockers (nifedipine) -- other 3 more common

75

contradindicated HTN meds in pregnancy?

- ACE inhibitors
- ARBs
- Aldosterone blockers
- Furosemide
- Direct renin inhibitors (aliskiren)

76

most common septic arthritis organisms birth - 3mo old?

- staph
- GBS
- Gram neg bacilli

77

abx for septic arthritis birth - 3mo old?

- antistaph agent (ie nafcillin or vanco)
AND
- Gentamicin or cefotaxime (cover for gram negs)

78

Most common septic arthritis organisms >3mo?

- staph
- strep A
- Strep pneumo

79

abx for septic arthritis >3mo?

Nafcillin clinda, cefazolin, or vanco

80

gradual loss resulting in tunnel vision think?

open angle glaucoma

81

cupping of optic disc - think?

open angle glaucoma

82

retinal detachment presents how?

unilateral blurred vision that progressively worsens

83

retina hanging in vitreous w/ unilateral blurred vision that has progressively been worsening?

retinal detachment

84

macular degeneration effects where in the vision?

central vision

85

distorted vision and central scotoma - think?

macular degernation

86

multiple sores in macular region w/ central scotoma?

atrophic macular degernation

87

new blood vessels in retina that are bleeding or scarring the retina w/ central scotoma think?

exudative macular degeneration

88

sudden, unilateral visual impairement usually noted upon waking in the morning - think?

Central retinal vein occlusion

89

disc swelling, venous dilation and tortuiosity, retinal hemorrhages, and cotton wool spots - think?

central retinal vein occlusion

90

microaneurysms, hemorrhages, exudates, and retinal or macular edema - think?

simple retinopathy

91

microaneurysms, hemmorrhages, macular edema, w/ cotton wool spots think?

preprolierative retinopathy

92

microaneurysms, hemorrhages, macular edema, exudates w/ newly formed vessels think?

proliferative or malignant retinopathy

93

n/v, abd pain, diffuse muscle aches w/ dilated pupils, yawning, piloerections, and lacrimation - think?

heroin withdrawal

94

inc appetite, hypersomnia, fatigued, irritable, severe depression - think?

stimulant withdrawal
(ie cocaine, meth)

95

epigastric pain w/ high BMI, ALT >150 and elevated alk phos -- think?

gallstone pancreatitis

96

hydrocele?

fluid collection w/in processus or tunica vaginalis

97

communicating vs non communicating hydrocele?

diff is whethere procesus vaginalis has obliterated or not

comm: PV NOT obliterated (so fluid can communicate w/ peritoneal fluid still - still a track there)

non comm: PV obliterated (canNOT communicate b/c no track, so just a fluid collection)

98

mass transilluminates in scrotum think?

hydrocele

99

treatment of hydrocele in infant?

reassure and observe, most will sponaneously resolve by 1yo

100

communicating hydrocele at 18 mo - treat?

surgical repair

communicating hydroceles that persist beyond 12mo of age are unlike to self resolve and --> inc risk of indirect inguinal hernia

101

1 episode of MDD that responds to acute treatment - how long due you treat for?

continue antidepressent for 4-9 months (continuation phase)

102

When do you choose maintenance phase for depression treatment and how long is it?

Maintenance treatment is 1-3 yrs on stable regimen

For:
- recurrent MDD (multi epi)
- chronic epi (>=2yrs)
- strong fam hx
- severe epi (ie suicide attempt)

103

when do you keep pts on antidepressants indefinitely?

Pt w/ hx of highly reccurent (>= 3 epi)

very severe, chronic maj depressive episodes (last a long time w/ severe symp - ie suicide attempt)

104

diff dx for t wave inversion? (5)

- MI
- Myocarditis
- Old pericarditis
- Myocardial contusion
- Digoxin toxcitiy

105

best treatment for acute low back pain likely due to disk herniation?

early mobilization and NSAIDs
- get back to daily activities ASAP

106

what type of gait in parkinson's disease?

hypokinetic w. narrow base and stooped posture w/ short steps that cause shuffling

107

waddling gait --?

muscular dystrophy due to weakness of gluteal m.

108

acute COPD exacerbation treat w/?

- O2
- short acting bronchodilators (b2 adrenergic agonist or anticholinergic agent)
- SYSTEMIC steroids
- abx as needed

109

sialadenosis is?

benign, noninflammatory swelling of the salivary glands (non tender)

110

what is sialadenosis associated w/

- advanced liver disease
- malnutrition (DM, bulemia, etc)

111

submandibular glandular swelling and pain w/ meals - think?

salivary gland stone

112

initial treatment of dermatitis herpetiformis?

Dapsone

113

atrophy of caudate nucleus - think?

huntington's

114

huntington typical finding on CT?

atrophy of caudate nucleus

115

diffuse atrophy of cerebral cortex feature of what disease?

alzheimer's

116

atrophy of lenticular nucleus feature of?

Wilson's disease

117

Atrophy of front and/or temporal lobes is a feature of ?

Pick's disease

118

Alzheimer's finding on CT head?

diffuse atrophy of cerebral cortex

119

bone pain + headache + unilateral hearing loss + femoral bowing - think?

Paget disease of bone

120

paget disease of bone due to?

osteoclast dysfunction --> inc bone breakdown and turnover

121

mosaic pattern of lamellar bone - most common?

Paget disease of bone (osteoclast dysfunction)

122

steatorrhea can --> bone pain, why?

stetorrhea --> malabsorption of vit D --> vid D deficiency --> 2ndary hyperparathyroidism (low Ca, low phos, high PTH) --> osteomalacia

123

urine hydroxyproline is from?

breakdown of collagen

124

what are levels of urine hydroxyproline in paget's disease?

elevated

125

paget disease serum Ca and Phosphate levels are?

NORMAL

126

high alk phos, high urine hydroxyproline, nL Ca and phos - think?

Paget disease of bone