What is the best tx for Phyllodes tumor of breast?
Wide local excision; these are large polylobated tumors that look histologically like a fibroadenoma but can be benign or malignant
What is the gold standard to diagnose nephrotic syndrome
24 hour urine collection showing > 5 g of protein; note this is just to dx the nephrotic syndrome not the underlying etiology
How do you tx magnesium sulfate toxicity?
Calcium gluconate (i.e. decreased DTR or resp. depression, pulm edema)
What are 3 common risk factors for chorioamnionitis?
Nulliparity, Prolonged labor, multiple digital exams
What are 2 renal diseases lithium can be assoc with?
Nephrogenic DI; Membranous nephropathy (Tx is steroids and if severe, cyclophosphamide)
What is Vicarious Liability?
Hospital can get sued for actions of a single employee
How do you tx Type I RTA
Potassium citrate and sodium bicarbonate (recall, assoc. with SLE and other autoimmune phenomena)
What is the issue with smoking when you have CML?
Increases risk of developing blast crisis
What is the MC complication of an interscalene nerve block?
Blocking the phrenic nerve which can lead to respiratory distress though more likely due to phrenic nerve block than ptx still check CXR
How do you tx mild comedonal acne?
Benzoyl peroxide and if that fails then topical retinoids
How should kids ride in cars until age 2?
Rear seat in rear-facing seat
Leg length discrepancies less than ____ can be tx with heel lift
What is a major AE of the oral hypoglycemics that can cause weight loss
i.e. GLP-1 agonists cause pancreatitis
When is an annual low dose CT recommended for lung CA screening
pts 55-80 with a 30 pack year smoking Hx who are currently smoking or who have quit in the last 15 years
How do you tx severe PCP PNA? What are the indications (3)
IV TMP-SMX and steroids; PaO2 35
If you have a positive Thompson test and wish to confirm the dx what do you do? What is the tx?
MRI (achilles tendon rupture); long leg cast in plantarflexion for 6 weeks
Where is proper endotracheal tube placement in an adult?
4 cm above the carina
What dz has the pencil in cup deformity of PIP and DIP
Psoriatic arthritis also look for pitting of nails
Whats the deal with pap smears in a pt who has had total abdominal hysterectomy?
Can stop if the TOTAL abdominal hysterectomy was for benign dz i.e. fibroids if for CA you should continue
What is Heyde's syndrome?
Angiodysplasia of the colon with Aortic Stenosis and CKD
What if the HIV viral load in a woman in labor is >1000
That is an indication for c section
How do you tx acute bleeding in Hemophilia A?
What is the best mgmt of ACL tear?
PT to strengthen quads then surgery
Which ovarian tumors is inhibin the marker for? LDH?
Granulosa cell; Dysgerminoma
What is the first line nonpharmacologic tx of OA? Pharmacologic?
Exercise and weight loss; Acetaminophen
What are the Types of Inversion Ankle sprains
Type I = ATFL, Type II= ATFL and calcaneofibular, Type III= ATFL, calcaneofibular and PTFL
How do you tx pityriasis rosea? What else should you rule out
No tx it is self-limiting; check RPR or VDRL to rule out secondary syphilis
What if you have a microcytic anemia refractory to iron therapy in a mediterranean pt?
How do you tx low flow priapism i.e. that assoc with PDE-5 inh or trazodone/prazosin
Who gets erythrasma?
i.e. corynebacterium minitussiumum and it is normal skin flora that complicates DM and IC pts
What if a pt with meningococcal meningitis refuses tx
You can hospitalize them against their will bc it is highly communicable dz
What do Burton's lines in the gums suggest?
What is the MC cause of hypertrophic osteoarthropathy
Adenocarcinomas of the lung
What is the main concern in a pt who is developing Erythema multiforme?
That it will progress to SJS or TEN
By what age are most kids "potty trained"
48 months, i.e. 4 years of age
What is first line for acute otitis media? What if that fails? What if that fails?
Amoxicillin; Amoxicillin-clavulanate; CT scan of sinus
Describe Stage 0 through Stage 4 breast CA
0 = no ca, I = tumor less than 2 cm II a = tumor less than 2 cm with 1-3 nodes, II b = tumor 2-5 cm no nodes, III =more than 2 cm with nodes IV = distant mets
What is chordee? Assoc?
Ventral curvature of the penis, assoc. with hypospadias
How do you look for sperm after rape?
Saline prep for sperm is done and often check with a Wood's lamp? YOU DO THIS EVEN IF THE WOMAN HAS SHOWERED
How do you tx Kaposi sarcoma?
What is the classic EKG finding assoc with hypothermia?
J wave (Osborn wave)
What does erythrasma look like on Wood's lamp? What is the bug? G stain? Tx?
Coral red; Corynebacterium minitussimum; Gram positive club shaped rod, erythromycin
What CN is usually responsible for poor suckle response in a neonate?
How do you manage ovarian cysts in the pediatric population?
Repeat US; most spontaneously regress even if causing precocious puberty
How do you tx chancroid?
What are the empiric abx tx for NEONATAL meningitis?
Ampicillin and gentamicin
What is the most sensitive and specific test for ANY myasthenia gravis?
Single Fiber EMG
What is the MOA of topiramate (used for migraine ppx)
Inhibits voltage gated Na channels
What should you be thinking in a kid with neonatal HBV and ascites?
Membranous nephropathy due to HbeAg deposition in kidney
What if an NST is nonreactive and you do a CST which is reactive?
Indicates that fetal compromise is unlikely so you should just repeat fetal testing in 1 week
What is a major differentiator in the hx of a pt with preseptal cellulitis vs. orbital cellulitis?
Orbital cellulitis often has diplopia (MC predisposing factor is bacterial sinusitis)
What are the indications for steroids in addition to tmp smx for PCP pna?
What Cobb angle is assoc. with respiratory compromise? Cardiac?
Greater than 50 degrees, greater than 75
What is the separation of the nail from the nail bed?
What is the preferred tx for hypocalcemia
IV calcium gluconate by SLOW INFUSION
How do you deal with a misplaced central line? i.e. ended up in the subclavian
Place a new one and then after confirming placement of the new one, retrieve the old one
What is the deal in a pt with prolonged acute otitis media and neurologic deficit?
Temporal lobe abscess until proven otherwise
What is the best way to prevent post op DVT
What anti-inflammatory meds should be avoided in Crohns dz? Why? What serum abs are often positive in Crohn's?
NSAIDs can induce flares; Anti-Saccharomyces cerevisiae abs
What is the likely cause of sore throat in a pt recently treated for urethritis?
N. gonorrhea, ceftriaxone; suckin too much diiiiccckkk!!!
What end tidal CO2 on waveform capnography indicates that a pt coding is receiving adequate resuscitations? What indicates return of spontaneous circulation?
10-25 mmHg indicates adequate resuscitation; 35-40 indicates ROSC
Why would a pt whose mother took DES while pregnant have repeated abortions?
There is an increased risk of cervical incompetence as well as vaginal adenocarcinoma
What if a CT scan of solitary pulmonary nodule has high risk features?
Do surgery, skip the bronchoscopy
What are the earliest vasooclusive crises to present in sickle cell? How do you prevent?
Dactylitis (Swelling of hands and feet); Hydroxyurea
In what position does a post-dural puncture headache get better? What is the most effective tx?
When lying down (these are from accidental puncture of the dural membrane); Epidural blood patch
What dz is assoc with seropositivity for anti-saccharomyces cereviseae abs
When do you do the V spread technique?
For compression or malalignment of a cranial suture
What is the most likely cause of bloody vaginal discharge in a newborn
Circulating maternal estrogens, same deal if a newborn boy has little breast buds
Is glucosuria a normal finding in pregnancy?
Yes assuming glucose levels are normal, if they are elevated though you want to suspect GDM
Define Fever of Unknown Origin
T > 101 on several occasions greater than 3 weeks in duration with failure to reach a dx despite 1 week of inhospital tx
What are 5 vaccines that should be given to a pt with chronic liver dz
Tdap/Td, influenza, HAV, HBV, and PPSV23 x 1 with PCV13
How do you tx heavy acute uterine bleeding?
High dose estrogen
Name 3 extrahepatic sequelae of hcv
Mixed essential cryoglobulinemia; Porphyria cutanea tarda; and membranoproliferative glomerulonephritis
What is a normal Q angle? What does a Q angle greater than this suggest?
14-17, if greater than 17 think genu valgum
After a pt with a primary relative is screened initially for colon CA how often should they be re-screened?
i.e.. Dad had CA at 50 then initial screening of son is at 40 and then EVERY FIVE years rather than q10
How do you tx critical aortic coarctation?
i.e. presents early in life with cardiogenic shock and radiofemoral delay, give PGE1 to keep the ductus arteriosus open
What 3 drugs can be given for CAP in outpt setting?
macrolide, doxycycline, or quinolone
What is Sever's dz? Tx?
Osteochondritis at the insertion of the achilles on the calcaneal tuberosity in skeletally immature pts; conservative tx preferred
Where does sympathetic innervation to the lower extremities come from?
Why is there increased risk of Alzheimers in downs?
APP is on chromosome 21, they get a 3rd helping
How do you treat Lyme meningitis?
How can you tx hypotension in the setting of PE? What should you NOT give?
Inotropes; do NOT give fluids as it can worsen RV strain
What effect can hypothyroidism have on the voice?
What is the MC sacral dysfunction in a postpartum woman?
Bilateral sacral flexion
How do you tx cervical insufficiency in a woman who wants to get pregnant?
Cervical cerclage but must be around week 13
What is the adult TBSA for burns i.e. 1) Head 2) Arm 3) Leg 4) Trunk
1) Head is 9% as opposed to 18% in kids 2) Each arm is 9% just like kid 3) Each leg is 18% unlike 14% in kids 4) and the trunk is 36% with 18% anterior and 18% posterior same deal in kids
How do you tx DT's refractory to lorazepam? What is the next best step in a pt with status epilepticus refractory to lorazepam?
Barbiturates like phenobarbital; Fosphenytoin? Note the difference in pathology of DT vs status epilepticus
What is Breach of Duty
Negligence of a physician to an established pt
What is the tx for a displaced scaphoid fx
How can you tell the difference between prolactinoma and antipsychotic induced hyperprolactinemia based on prolactin levels
Prolactin levels in prolactinoma are usually > 200 whereas antipsychotic levels are usually far lower
What is Neer's test used for
Rotator cuff pathology
What causes the flourescence of semen under woods lamp when evaluating for rape?
What is the TBSA for a little kid in a burn for 1) Head 2) Arm 3) Leg and 4) trunk
1 )Head is 18% (as opposed to 9 for adult) 2) arm is 9% just like adult 3) leg is 14% as opposed to 18 in adult and 4) trunk is 36% like in adult with 18% ant and 18% post
5 cancers with psammoma bodies
Papillary thyroid CA, Meningioma, Mesothelioma, Endometrial CA, and serous cystadenocarcinoma
What is the deal with the timing of prenatal visits?
Monthly until 28 weeks, biweekly until 35 weeks then weekly until birth
Chronic NSAID abuse can lead to which RTA?
Type IV i.e. aldosterone def.
What is the MOA of the drug that tx's the dyskinesia of Huntington's chorea?
VMAT-2 inhibitor the drug is tetrabenazine
What is the best mgmt of acute aortic regurgitation?
Afterload reducers such as hydralazine and ACE-I
If a newborn is discharged early from hospital when is best time for follow up?
How do you manage hemodynamic instability in a pt with penetrating abdominal wound
What is the thompson test?
When you squeeze the calf and if no plantarflexion it indicates a positive test and a ruptured achilles tendon
What is the best way to confirm a dx of carpal tunnel
EMG with nerve conduction study
What HLA is DM I assoc with?
HLA DR3 and DR4
What is a common cause of PID after insertion of IUD?
Actinomyces israelii, tx is PCN G ive also seen ampicillin
What effect does scurvy have on coags and platelets
What is TACO how do you tx?
Transfusion Associated Circulatory Overload; Furosemide
What should you think in pt with advanced bone age, coarse axillary and pubic hair with severe cystic acne? Screening test? Confirm? Tx?
Non-Classical CAH due to partial 21 hydroxylase def; 17-OH-P, Cosyntropin stimulation test; Replace glucocorticoids and give fludricortisone
In which dz will you see Pappenheimer bodies?
How do you tx a first eclamptic seizure? Recurrent?
Magnesium Sulfate; add diazepam
What is a likely cause of low pleural LDH effusion in a pt with ascites?
Hepatic Hydrothorax; a transudative effusion that occurs due to the hypoalbuminemic state of cirrhosis
What is the most common cause of folliculitis? What is the MC cause of hot tob folliculitis?
S. aureus; P. aeruginosa
How do you tx black widow spider bites?
What is the acute tx of nonsevere PCP pna?
How much does each unit of PRBC increase Hgb by? What about Hct?
1 g; 3% recall that hct is essentially 3 times the hgb
How do you tx chorioamnionitis? How do you tx postpartum endometritis?
Ampicillin and gentamicin; clindamycin and gentamicin
Formication is most strongly assoc with overdose on what drug?
Cocaine (cocaine bugs)
What is the MC nerve injured during thyroidectomy? What muscle is paralyzed? How do you confirm the dx?
Recurrent laryngeal nerve; posterior cricoarytenoid; Fiberoptic laryngoscopy
What clinical test can elucidate the cause of vasovagal syncope in unclear cases?
Upright Tilt Table Testing
Why would a pt with aortic dissection have LE paraplegia?
Spinal ischemia due to occlusion of artery of Adamkiewicz
What is the least radiosensitive tissue in the body?
What is the most common pollen in the late summer or early fall?
Ingestion of raw meat in pregnancy is a risk factor for what?
Congenital toxoplasmosis; Hydrocephalus, intracranial calcifications, and chorioretinitis
What is the difference between onycholysis and onychorrhexis?
Onycholysis is splitting of nail from nail bed; onychorhexis is splitting the nail itself