UWORLD Flashcards
(347 cards)
1
Q
conduct disorder
A
(can turn into antisocial disorder once >18)
patterns of behavior that violate the social rights of others with o sign of remorse. They destroy property, seal, get arrested and run away from home and they are <18
2
Q
Conduct Disorder
A
angry and irritable teenager who is angry towards authority figures. They are normal with their peers but they are aggressive towards adults. They do not actually break he law
3
Q
describe femoral neck stress fracture
A
this is a common fracture in adult athlete runners when they train extensively. Pain will be worse with activity and with passive internal and external rotation
4
Q
vitamin d deficiency can cause what bone problem and why
A
it can cause osteomalacia due to low vitamin d levels from malabsorption, intestinal bypass, celiac or chronic liver/kidney disease.
5
Q
thinning of the bone cortex and pseudo fractures is seen in what diagnosis
A
osteomalacia
6
Q
CAlcium: low
Phosphorus: low
PTH: High
A
this is vitamin D deficiency that is why both calcium and phosphorus are low while PTH is high
7
Q
hepatorenal syndorme
A
this is when there is cirrhosis which causes a generalized vasodilation and that decreases the amount of perfusion to the kidney which makes the kidney turn on renin (thinking that there is low blood volume) which further increases water retention, worsening the vasodilation.
8
Q
Lateral Medullary infarct, due to blockage of the vertebral arteries that causes falling of the patient to the side of the lesion, nystagmus, loss of pain and temperature on the ipsilateral face and contralateral limb and difficulty sitting without support
A
Wallenberg Syndrome
9
Q
How do oxalate forms stone
A
patients with malabsorption issues like celiac cannot correctly absorb calcium. Calcium is usually bound to oxalate, but when there is a lot of fat present in the colon, calcium binds this instead of oxalate, leaving oxalate to build up in the system firming stones
10
Q
what med would you give to a patient who needs pain relief on a daily basis
A
transdermal Fentanyl patch
11
Q
opiod addicts who require pain management after breaking a limb or intense surgery should receive what kind of analgesic
A
they should receive the same opioid management that others would get
12
Q
HBsAg+ IgM anti-HBc
A
acute hep b infection
13
Q
anti-HBs + anti-HBe + antiHBc
A
recovery stage of HEP B
14
Q
copper deficiency presnets with
A
brittle hair, skin depigmentation, osteoporosis, sidereoblastic anemia and peripheral neuropathy
15
Q
selenium deficiency presents with
A
`thyroid, cardiac and immune problems
16
Q
who can get a cholesterol emboli
A
patients with high cholesterol who undergo PCI, it will cause lived reticular, acute kidney injury, acute pancreatitis and mesenteric ischemia
17
Q
High dose IV Acyclovir can cause?
A
Acute kidney injury because in high doses it causes crystalurria because it has poor ruin solubility which leads to renal tubular obstruction
18
Q
a bright red rash around the anus of a child that is associated with fissures, pain and bleeding, and a possible contact who had a strep infection
A
Strep Perianal Dermatitis
19
Q
a man from south America eats undercooked pork meat and experiences seziures
A
neurocysticercosis
20
Q
treatment for neurocysticercosis
A
albendazole and phenytoin for the seizure
21
Q
when on lithium always check what
A
thyroid levels
22
Q
constant depression for more than 2 years without more than 2 months of no depression
A
persistent depressive disorder
23
Q
more than 2 years of periods of both hypomania and depression
A
cyclothymic disorder
24
Q
MEN 1
A
parathyroid
pancras
pituitary
25
MEN 2A
parathyorid
medullary thyroid CA
pheochomocytoma
26
MEN 2B
mucosal/neuroma tumors
medullary thyroid CA
pheochromocytoma
27
von hippel lindau presents with?
hemangioblastoma, renal cell clear cell CA, pheochromocytoma and pancreatic neuroendocrine tumors
28
if you suspect cervical ca in a pregnant woman how do you manage this
first do a colposcopy to visualize the cervix, if there is nothing wrong then leave them alone BUT if there is CIN then you would do a LOOP.
29
what is the treatment for warts (HPV 6 and 11)
trichloroacetic acid
30
what can causes a reticulocyte count <1% in a sickle cell patient
parvovirus B19 ( there may be no sign of viral symptoms, don't let this throw you off)
31
what drug has a low risk of hypoglycemia, is weight neutral and can be used in CKD
DPP-4 drugs (sitagliptin)
32
what drugs cause weight loss, decrease the risk of hypoglycemia and are the second line agent to use after metformin
GLP-1 drugs (exenatide)
33
iron poisoning, give
deferoxamine (Un-do-the iron-from-me)
34
copper top, give? (Wilsons)
penicillamine
35
TCA overdose, give
sodium bicarb
36
torsades de pointes, give?
magnesium
37
lithium toxicity, do?
dialysis
38
lead poisoning, give?
calcium EDTA
39
hyperkalemia, give?
calcium gluconate (Cardioprotective)
40
mild lead poisoning can be treated with
oral succorer
41
heparin toxicity, treat with
protamine sulfate
42
marfan's is associated with what heart complication
aortic dissection and aortic regurgitation
43
causes of bronchiectasis
decreases clearance of the lungs (antitrypsin def, or CF) or repeated infections
44
purulent sputum and hemoptysis and a chronic cough are the sxs of
bronchiectasis
45
you suspect bronchiectasis, what is first management step
CT scan, shows bronchial wall thickening
46
tanner 1
<10
47
tanner 2
10-11.5, breast buds
48
tanner 3
prepubescent (13-15
49
tanner 4
puberty (13-15)
50
tanner 5
adult (>15)
51
tx for HSV encephalitis
acyclovir IV
52
Acute interstitial nephritis takes how many days to form and what are the common causes
- 7-10 days
| - causes by drugs like penicillin, beta lactam drugs
53
what is a characteristic lab that you HAVE to see for the dx to be AIN
eosinophils
54
beefy red rash in the genital region of a child or baby that is present in the SKIN FOLDS and has SATELLITE lesions
candida
55
causes itching in the anal region at night in children and there is no perianal erythema present, what is the dx
pinworms ( Echinoccus Vermicularis)
56
what is the transmission of Neurocystercosis
parasitic eggs in contaminated food and water (fecal oral transmission)
57
in order to have toxo encephalitis the CD4 has to be?
<100
58
multiple ring enhancing lesions in an HIV patient with a CD4<100
toxoplasma encephalitis
59
a patient who is being treated for OM but seems to be having worsening ear pain, headaches upon wakening and vomiting in the morning as well as pain in the temple/neck or swollen mastoid is suspicious for
```
Brain abscess (morning HA and vomiting should clue into this) OM and Mastoiditis are risk factors for brain abscess
DX Brain Abscess: CT Scan
* do this before you do a mastoidectomy
```
60
a teenager is recently diagnosed with schizophrenia and the dad wants to know how to make sure their life is the same, what do you advise
family therapy (to minimize stress for the patient)
61
who is psychodynamic therapy for
this is used for patients who need to tap into the unconscious patterns that may have begun in childhood that cause anxiety (rape, abuse)
62
how do you differentiate cryptococcal infection vs. toxo infection in an aids patient
cryptococcal won't have any brain lesions
63
what diseases has ventricular enhancement and micronodules but no ring enhancing lesions
cmv encephalitis
64
what is a complication to watch out for on hydroxycholorquine
Retinal Toxicity, make sure to get serial eye exams in these patients because blindness can occur after 5 years
65
what baseline exam should you get when starting hydroxychloroquine
basic eye exam
66
what are the adverse effects of amiodarone
hyper/hypothyroidism
67
what lab work do you order when someone is on amiodarone
thyroid levels
68
13 yo with delayed growth, short stature, delayed puberty with tall parents, dad has a hx of slow puberty onset
constitutional growth delay
69
management for constitutional growth delay
follow up in 6 months don't give hormones or they will not grow to their full potential
70
how to differentiate hypothyroidism from constitutional growth delay
hypothyroidism would also have signs of brittle hair, fatigue, constipation and cold intolerance in addition to the shorter height
71
how to tx first degree heart block
atropine
72
how to treat mobitz type 1 (stable)
atropine
73
how to treat mobitz II
pacemaker
74
how to treat 3rd degree heart block
pacemaker
75
continuous prolongation of the PR interval leading to a dropped QRS
MObitz type 1
76
random drop of QRS without any prolongation of pr interval
MOBITZ II
77
QRS waves and pr don't match up at all
3rd degree heart block
78
how do you treat someone with dvt and ESRD
unfractioned heparin ( it is not metabolized through the kidney, LMWH is) and then bridge to warfarin
79
what are causes of fetal RDS
maternal diabetes can cause fetal hyperglycemia and this will cause an increase in insulin. Insulin decreases cortisol therefore decreasing
80
a man with hx of pyelonephritis, current pyuria a new murmur and janway lesions
infective endocarditis due to enterococci
81
bacteria associated with infective endocarditis with utilization history
enterococci
82
s. epidermis is associated with what kind of infective endocarditis
indwelling catheters
83
what infection causes Q fever
Coxiella Burnetti
84
what is an adverse side effect of OCP
tworsening HTN because it increases the risk for thromboembolism, stoke and MI
85
what are the two things that are decreased with the use of OCP
the chance of endometrial cancer (progesterone keeps the endometrium from being stimulated by estrogen) and ovarian cancer due to decreased ovulation
86
hyper echoic breast mass with a biopsy that shows foamy machrophages, the patient has a hx of a double mastectomy, what is the diagnosis and how do you manage it
- fat necrosis of the breast which is common after surgery or trauma, the mass will be firm and calcified
- management includes reassurance and f/u
87
HUS occurs after what kind of infection
E.Coli 0157 diarrhea
88
what are the sxs of HUS
acute kidney injury, thrombocytopenia, microangiopathic hemolytic anemia
89
autoimmune hemolytic anemia will show...
schistocytes
90
what is decreased in CKD and shows burr cells on smear
EPO
91
what is the most common brain tumor in children
pilocytic astrocytoma
92
what are the infratentorial tumors that are in children and present with ataxia
craniopharyngeoma, ependymioma, medulloblastoma
93
what are the child tumors that occur in the ventricles and spinal cord (mainly 4th ventricle)
ependymoma
94
can HCV patients breastfeed
yes, it doesn't transmit the virus (only don't breast feed if there is bleeding in the nipple)
95
what are the medication treatments for hep c
ribacvarin and interferon
96
what determines the transmission of Hep C
the viral load, not delivery
97
what is the difference between eczema herpaticum and impetigo
Eczema herpeticum is an HSV superimposed infection on someone with atopic dermatitis, it will present with painful vesicles on an erythematous base and will have LAD
Impetigo is due to staph (bullous) or strep and it will show yellow crusting, instead of the hemorrhagic crusting seen in e. herpeticum, and there will be no LAD
98
trichophyton ruburm (tinea) more commonly happens in patients who have?
atopic dermatitis
99
what is the 1st step in management in a patient with PROM <34 weeks, fetal compromise with an unknown GBBS
1. Antibiotics
2. Steroids
3. Magnesium (<32 weeks) "neuroprotective"
4. DELIVER!!
100
what is the 1st step in management in a patient with PROM <34 weeks, NO fetal compromise with an unknown GBBS
1. Antibiotics
2. Steroids
3. Fetal Surveillance (do not immediately deliver, give the baby more time)
101
what is the 1st step in management in a patient with PROM 34-37 weeks, with an unknown GBBS
1. Antibiotics
2. Steroids
3. DELIVER!!!!
102
When should amnioinfusion be used
where there is variable deceleration (indicating umbilical cord compression) DURING labor
103
do you use amnioinfusion when there is PROM?
NO
104
how do you manage a fetus that is in a transverse lie before 37 weeks
expectant management with an US at term to determine the fetal presentation
- by term (37 wks) most babies spontaneously rotate into a longitudinal lie (Cephalic Presentation) head toward the cervix
105
when can external cephalic version be reformed
only AFTER 37 weeks (most preterm babies, <37 weeks will spontaneously turn)
106
why should you not perform an external cephalic version before 37 weeks
there is a large risk of PROM and abruptio placenta
107
what is "Shock Liver" ?
this is when a patient is very hypotensive to the point that they need many transfusions and they develop Ischemic Hepatic Injury
108
what are the clinical clues in ischemic hepatic injury
rapid elevated trasnaminiases (in the thousands)
| - liver enzymes return to normal within 1-2 weeks
109
AST seen in alcoholic liver will usually be around what ranged
<300
110
what patient usually gets autoimmune hepatitis
women (young)
111
granulomatous liver diseases due to sarcoidosis and tb will show chronic hepatic damage but NOT?
massive elevations in transaminase
112
why do OCP cause HTN
because of the effects of estrogen on the liver which increases how much angiotensin the liver makes
113
a 3o year old woman with HTN after being on an OCP for years, what do you do
stop the OCP
- do not do a CT angiogram of the abdomen (only do this in difficult to control HTN)
- only coach diet and exercise if you take the patient off the OCP and they still have HTN after a year
114
a patient who has a reaction to a bee sting who receives epinephrine but is still having hives, wheezing and vomiting should receive what med
another does of IM epi
| -steroids is not the answer, they decrease inflammation but they have a delayed onset of action
115
what can an allergist give a patient with hymenoptera sting allergy to reduce the risk of repeat insect sting anaphylazxis
venom immunotherapy
116
what is the only antidepressant advised for use in the pediatric population
SSRI
| -not bupropion, venlafaxine, or mirtazipine
117
what is the MOST common predisposing factor for an acute bacterial sinusitis
a viral upper resp infection, because the bacteria cannot be cleared due to the inflammation from the viral infection which leads to a secondary viral infection
118
first line treatment for sinusitis
amoxicillin plus clavulonic acid
119
longitudinal tears at the gastroesophageal junction that are present when there is increased intrabdominal pressure like retching
Mallory Weiss tear
120
stress gastritis is usually seen when
in ICU patients or Burn victims
121
what is Tick Paralysis
this is when a tick is attached for 4-7 days and it causes a progressive ascending paralysis over hours to days and it can be more pronounced in 1 leg or arm. There is a normal CSF exam and NO fever and no autonomic dysfunction (tachycardia, urinary retention) like in Guillan Barre
122
what is the next step in management if tick paralysis is suspected
meticulous search for the tick - removal usually results in improvement within an hour and complete recovery in several days
123
what is the paralysis pattern in botulin positing
descending paralysis and early cranial nerve involvement (pupil problems)
124
signs of theophylline toxicity
headache, insomnia, seizures, nausea, vomiting and arrhythmia
125
meds that cause theophylline toxicity
- cipro
- verapimil
- eryhtromycin
126
theophylline is cleared through the ________ so problems with this organ can cause toxicity
liver
127
flumazinil is given for overdose with
benzo
128
explain the findings in Brown Sequard Syndrome
- ipsilateral hemiparesis
- diminished proprioception, vibration and light touch on ipsilateral side
- CONTRALATERAL loss of pain and temperature 1-2 levels BELOW the lesion
(a lesion at T8 will have LST problems at T10 and below)
* use where the LST problems are to determine what dermatome area was injured (it will be two above)
129
symptoms of anterior cord syndrome
- loss of pain and temperature and motor function on BOTH sides
- proprioception, light touch and vibration are intact because they are in the posterior cord
130
biggest risk factor for antiphospholipid syndrome is
SLE
131
Antiphospholipid can have a false positive ___ and why
RPR the RPR testing for syphilis also contains cardiolipin
132
two antibodies seen in antiphosphoilipd syndrome
anticardiolipin and anti-beta2 glycoprotein-1
133
1 kg loss of weight in a baby, equals how much fluid loss
1L
134
how do you manage a child or baby who is dehydrated and needs fluid replacement
```
with isotonic (normal) saline only!
- don't give d50 because first you need to fix the dehydration, then you can give dextrose later for maintenance
```
135
a cyanotic newborn with left axis deviation, and small/absent R waves should make you think
Tricuspid Atresia
- normal babies have a R axis deviation because the systemic circulation relies on the Right heart when the patent ductus is still open
- L axis deviation means that the right heart is hypo plastic
136
hypo plastic right ventricle and the underdevelopment of the pulmonic valve and artery is what dx?
tricuspid Atresia (hypo plastic Heart syndrome)
137
IN tricuspid atresia, there is a decreased amount of blood moving into the r ventricle which causes under circulation of the lungs, what will this show on X ray
CXR: decreased pulmonary markings
138
what is necessary for a baby to live with Tricuspid Atresia
ASD and VSD so that O2 blood will mix with deoxygenated blood to provide some oxygen rich blood to the circulation
139
Tricuspid valve atresia is common in patients with
a hx of congenital heart disease in the family
140
what condition has a defect that causes there to be an opening between both ventricles and their atriums, leading to cardiomegaly and excessive pulmonary blood flow
Complete atrioventricular canal defect
141
what are CXR findings in complete atrioventricular canal defect
increased pulmonary markings (because the atrium and ventricles are connected so more blood goes through the pulmonic artery)
142
right atrial enlargement because of the displaced tricuspid valve into the right ventricle
Ebsteins anomaly
143
Tall p waves and right axis deviation can be seen in what cardiac anomaly
Ebsteins Anomlay, because there is R atrial enlargement due to tricuspid regurg, making the right heart bigger
144
what is the difference between tricuspid valve atresia and TEF
TEF will have a normal right axis deviation and TVA will have left axis deviation
145
condition where all four pulmonary veins do not connect to the left atrium like they should and instead sends blood to the R atrium
total anomalous pulmonary venous return
146
what will ECG show in total anomalous pulmonary venous return
right axis deviation sure to R heart hypertrophy from blood coming from the pulmonary veins and from systemic circulation
CXR will show increased pulmonary markings
147
trunks arteriousus is associated with
digeorge syndrome
148
both ventricles give blood to both aorta and pulmonic artery
truncus arteriosus
149
complete atrioventricular canal defect is associated with
downs
150
placental ablution predisposes the mom to??
DIC because of the release of tissue factor from the decimal bleeding
151
if you suspect malignancy in the spine, what is the test you should order
Plain X Ray films not MRI, because X ray is faster
152
When should you get an MRI of the spine if you think malignancy
after you get an X-ray and it is abnormal or ESR is abnormal
153
patients with neurological deficits, epidural abscess and features of caudal equine syndrome (saddle anesthesia, urine retention) should get what diagnostic test
MRI of the spine
154
what test should be done in suspected MM in regards to the bones?
Skeletal survey, they will show lytic lesions everywhere, don't get a Bone Scan
155
what is the path in Wiskott Aldrich Syndrome
impaired cytoskeleton changes in leukocytes and platelets
156
what are the sxs of Wiskott Aldrich
thrombocytopenia
eczema
recurrent infections (bacterial, viral and fungal)
157
tx for wixkott aldrich
stem cell transplant
158
x linked recessive defect in WAS gene
wiskott aldrich syndrome
159
what is wrong with the WBC in wiskott aldrich
the cytoskeleton in the WBC is abnormal which causes immune dysfunction due to impaired cell migration and immune synapses formation
160
what is wrong with the platelets in wiskott aldrich
there is a problem with he cytoskeleton making them small and in decreased amounts
161
what is the problem in ataxia telangiectasia
there is a deficiency in T cells due to DNA repair problems , patients have cerebellar degeneration and have a high risk for cancer
162
severe T cell deficiency and decreased maturation of t cells in the thymus is seen in
SCID
163
New onset of psychiatric and neurological abonormalities accompanied by unexplained abdominal pain is seen in
acute intermittent porphyria
164
the common age for acute intermittent porphyria is
30-40
165
Acute intermittent porphyria affects
the nervous system causing neuropathy, pain in stomach and tachycardia
166
what is elevated in acute intermittent porphyria
urinary porphobilinogen
167
what is the most common psychiatric manifestation of Wilsons
depression
168
what does copper affect in wilsons
liver problems
| brain (psychiatric and neurologic) and the eye
169
disorder involving alterations in heme biosynthesis which causes intermittent neurovisceral symptoms
Acute Intermittent Porphyria
170
Hepatic Hydrothorax is seen in who
patients who have cirrhosis and portal hypertension
171
what is hepatic hydrothorax
a pleural effusion that is not due to cardiac or pulmonary problems
172
why does hepatic hydrothorax occur
because of small defects in the diaphragm in someone with cirrhosis and portal HTN, causing a transudate fluid in the lung (peritoneal fluid pass into to the pleural space)
173
fever associated with the use of drugs like antibiotics and anticonvulsants take how long to occur
1-2 weeks
174
what is the net step for any patient who is suicidal and has a risk of harming themselves if you send them home
immediately hospitalize them for close monitoring, you don't need consent
175
muscle WEAKNESS and elevated CK is seen in
polymyositis
176
muscle TENDERNESS of trigger points and a normal CK is seen in
Fibromyalgia
177
muscle STIFFNESS and elevated CK as well as an association with giant cell arteries is sen in
polymyalgia rehumatica
178
what can neuroinvasive west nile infection cause
myelitis, which causes an acute asymmetric flaccid weakness in the lime
179
what do you give to patients with an acute MS attack who are not responding to IV steroids
plasma exchange
180
long term disease suppression of MS is treated with
interferon beta and galatiramer
181
what is the process called when the right ventricle becomes part of the right atrium due to abstains anomaly
atrialization
182
how high do TG need to be to cause acute pancreatitis
>1000 (xanthomas are seen when TG is this high)
183
patients who have a strong family hx of ovarian cancer can be tested using what
BRACA1 and 2
184
what is the deficiency in galactosemia that leads to elevated levels of galactose
galactose 1 phosphate uridyl transferase
185
patients with galactosemia are at risk for
E coli neonatal sepsis
186
baby with cataracts, jaundice, vomiting, failure to thrive and hypoglycemia
galactose 1 phosphate uridly transferase deficiny (galactosemia)
187
baby with only cataracts
galactokinase deficiency
188
baby with cataracts, jaundice, vomiting, hypoglycemia, neural Deafness, and Hypotonia
uridyl diphosphate galactose-4-epimerase deficiency
189
treatment for galactosemia can prevent
cirrhosis and mental retardation
190
bacteria that cause reactive arthritis
- salmonlela
- shigella
- campy
- yersinia
191
three causes of Guillan Barre that aren't camp
- HSV
- Mycoplasma
- H Flu
192
breast fed infants have a lower rate of
infection (OM, gastroenteritis, UTI and rep infections)
193
breast feeding reduces the risk of which cancers and why
- breast
- ovarian
- endometrial
because of the decreased estrogen exposure
194
tx for otitis externa
fluoroquinolone drops (antipseudomonal)
195
what species is involved with otitis that is due to foreign bodies like hearing aids
candida
196
what should patients who have a cath done be advised
to avoid strenuous activity or lifting heavy things for a week to avoid local hemotoma
197
most cases of spinal epidural abscess are caused by
iv drug use spread of infection or cellulitis
198
the tighter the confidence interval the ______ results
more precise
199
what is characteristic about the syphilis rash
it includes the palms and the soles
200
what is the initial workup for osteomyeltits
- CBC
- blood culture
- ESR/CRP
- plain xray films
201
what is the best diagnostic test for osteomyeltitis
MRI of the spine
202
what heart condition is associated with PE
Afib
203
tx for IE due to viridian's strep
penicillin G
204
multiple small lesions in the grey white matter junction in the brain of a smoker
metatsitc lung cancer
205
diarrhea, LAD, fever, migratory arthritis
Whippels disease
206
what condition is uncommon but is seen in patients with Hashimotos and presents with a rapidly enlarging thyroid, firm goiter and compressive symptoms (hoarseness and dysphagia and facial congestion with arm elevation)
thyroid lymphoma
207
mild pain and tenderness in the thyroid gland, gland doesn't move with swallowing
thyroid lymphoma
208
what is a large clue that the problem is thyroid lymphoma and not subacute thyroiditis
there is retrosternal extension of the tumor which causes venous compression and distended neck veins and facial plethora when the arms are raised because they compress the subclavian between the clavicle and the large thyroid
209
what is redial thyroiditis
progressive fibrosis of the thyroid and surrounding tissues
210
thyroiditis that happens after a viral infection and causes fever, neck pain and a tender diffuse goiter
subacute thyroiditis
211
thyroiditis that has fever, erythema and severe pain at the thyroid gland often with asymmetric goiter because of an abscess
suppurative (infectious) thyroiditis
212
what are the three organs affected by GVHD
skin- rash
liver- jaundice
intestine- diarrhea
213
what is the path in GVHD
donor T cells are activated against host HLA antigens
214
rejection of the graft is done by
the HOST t cells
215
what is the mechanism responbile for Immunoblastic Lymphoma in a patient with a BM transplant
virus- induced lymphocyte proliferation due to EBV
216
what is the management for asymptomatic bartholin duct cyst `
observation, most drain by themselves
217
management for symptomatic bartholin cyst
incision and drainage
218
what is placed to decrease the chance of recurrence after the incision and drainage of a symptomatic bartholin duct cyst
word catheter
219
what should be done for women who develop recurrent bartholin cyst
marsupialization which is when take the edges of the cyst and attach them to the mucosal edges to increase drainage
220
referring syndrome is mainly due to what hormone
insulin
221
describe the path of referring syndrome
TPN or carb ingestion after starvation causes the pancreas to release insulin which will decrease phosphorous, potassium and magnesium
222
what is the main electrolyte deficiency in receding syndrome
phosphorus ( it is needed for energy)
223
what can refeeding syndrome lead to that is life threatening
cardiopulmonary failure (low K and Mg lead to heart problems )
224
what hormones are high during starvation
aldo and cortisol (they stimulate water reabsorption )
225
crampy, postprandial epigastric pain, weight loss and an eversion to food is a sign of
mesenteric ischemia
226
how do you dx mesenteric ischemia
CT angiography
227
in an infant with meningococcemia what should you watch out for
waterhouse-friderichsen syndrome (sudden hypotension and skin rash - large purpuric lesions on the flank)
228
what is the most likely cause of death in an infant with meningocococcemia
adrenal gland failure
229
decreasing bHCG levels is indicative of
demise, like a missed abortion
230
what is febrile neutropenia
when the neutrophil count is less than 1500 (20% neutrophils)
231
what is the most common pathogen that can affect someone with febrile neutropenia
pseudommonas
232
what is the medication to give if you see a patient with febrile neutropenia (common in chemo patients)
pip-tazo (anti-pseudommonal)
233
anti-HBs means
| and NO HBsAg
immune to HepB
234
glycogen accumulation in the kidneys, liver and intestine in a 3-4 month baby with hypoglycemia
Von Gierke Disease (Glucose-6-phosphatase deficiency)
235
what are the signs of glucose-6-phosphatase deficiency
```
hypoglycemia
seizures
lactic acidosis
doll-like face
protuberant belly (hepatomegaly)
```
236
glucocerebroside accumulation on the bone, liver and spleen macrophages causing cytopenias and bone pain is seen in
Gaucher Disease (glucocerecrosidase deficiency)
237
hypoketotic hypoglycemia during fasting (illness)
MCAD (can't break down fatty acids)
238
what is the most common form of PSVT
atrioventricular nodal reentrant tachycardia
239
what is the mechanism of cold water immersion on PSVT
it increases parasympathetic tone in the heart and slows the conduction in the AV node na increases the refractory period of the AV node
240
what can be done to stop PSVT that sent medication
- cold water
- pressing on eyeballs
- valsalva
- carotid sinus massage
241
how do you treat E histolytic (amebeosis)
oral metronidazole (DONT DRAIN)
242
how do you treat Echinococcus cyst (large hydatid cyst)
aspiration and albendazole
243
when a person manage unpleasant emotions through acts of service
altruism
244
being mad at your dad but instead shouting at your dog
displacement
245
attributing ones feelings onto another person
projection
246
channeling unacceptable thoughts into impulses that are "socially acceptable" channeling aggression to athletics
sublimation
247
what can TMP cause at high doses
increased potassium and an artificial increase in Cr
248
tx for minimal change disease
steroids
249
what is the test to evaluate renal function
renal scintigraphy
250
trauma to the vulva can cause
bartholin duct cyst
251
erythema and calling of the skin that causes bright red patches that gradually peel
erythroderma (exfoliative dermatitis)
252
when should an oral glucose test be given in pregnancy
24-28 weeks
253
antibodies against desmomsome s
pemphigus vulgaris
254
antibodies against hemidesmasomes (BM)
bellos pemphigoid
255
how should you treat patients with somatic symptom disorder
regular appointments to limit diagnostic testing (don't waste time on reassurance because these patients don't respond well to it)
256
mutation in FGFR3 causes
achondroplasia
257
mutation in fibrillar-1 cause
marfans
258
why do blood transfusions cause hypocalcemia
becuase the citrate in the transfused blood binds ionized calcium which is the active form
259
severe hyermagnesemia can cause what
hypocalcemia recuasse it inhibits PTH release, this is usually seen in magnesium infusions
260
what is the treatment for tar dive dyskinesia for a patient who is on an antipsychotic already and they have to continue their antipsychotic
switch to clozapine or quetiapine
261
drugs that cause tar dive dyskinesia
antipsychotics (DA blockers) and metoclopramide
262
what is the tx for tar dive dyskinesia
Valbenazine (reversible inhibitor of vesicular monoamine transporter 2) VMAT2
263
what can treat acute dystonia
benztropine
| diphenhyrdamine
264
treatment for akathisia (repeated leg crossing or pacing after antipsychotic)
beta blocker
265
what is the main difference between atrophic vaginitis and lichen sclerosis
in atrophic, the vaginal mucosa is pale and thin, sclerosis doesn't affect the vagina
266
what is the first line treatment for vuvlovaginal atrophy
lubricants and moisturizers
267
what is the treatment for modoert to severe vulvovaginal atrophy
local estrogen cream
268
what is a key phrase for lichen sclerosis
wrinkled cigarette paper skin
269
how to differentiate Kawasaki from viral myocarditis
kawasaki needs to also have
- mucositisis
- swelling palms and soles
- conjunctivitis
- rash
270
a hazy area in the lung of someone with a hx of breast caner is?
malignant effusion (pleural effusion)
271
what is the diagnostic difference between pleural effusion and consolidation
consolidation has increase tactile fremitus and pleural effusion has decreased tactile fremiuts
272
increased breath sounds
increased fremitus
dull percussion
consolidation
273
decrease breath sounds
decreased fremitus
dull percussion
pleural effusion
274
dec breath sounds
hyperressonant percussion
decreased fremitus
pneumothorax
275
what is the renin activity in primary hyperaldosteronism
low because of constant aldo simulation
276
why don't people with primary hyperaldosteronism have edema and very high sodium levels
because of the aldosterone escape mechanism which causes sodium loss
277
what can cause apparent hypokalemia in a patient who has primary hyperaldosteronism
the use of a diuretic
278
why does succinocholyine cause cardiac arrhythmia
because it causes severe hyperkalemia
279
to avoid hyperkalemia caused by succinylcholine what medication should be used instead
vecuronium or rocuronium (nondeoplarizing neuromuscular blocking agents )
280
why is halothane not used for anesthesia
because it causes acute liver failure
281
what drug blocks 11B-hydroxylase and can lead to adrenal insufficiency
Etomidate
282
why should propofol (sedation) not be used in patients with ventricular systolic dysfunction
because it causes myocardial depression and severe hypotension
283
what is the treatment for SEVERE sebhorreic dermatitis
topical antifungals and steroids
284
method used to compare two means
two sample t test
285
used to compare three or more means
ANOVA
286
first line tx for ovarian torsion
laparoscopy with detorsion
287
how to dx ovarian torsion
US with Doppler flow
288
what happens to a patient who is taking an MAIO and they eat tyramine (cheese/ wine)
they get severe HTN which presents first as a headache but can lead to intracranial bleed and death
289
what happens when MAIO are had around the same time as an SSRI
serotonin syndrome which causes hyperreflesxia and myoclonus
290
diffuse muscle rigidity in someone taking an antipsychotic
neuroleptic malignant syndrome
291
what is a large side effect of hydroxyurea
myelosupression
292
how do you diagnose an infant with HIV
DNA PCR not Elisa because they will have mom's antibodies
293
patients who are immunocompromised like those who have relied a transplant are at risk for what kind of infections
opportunistic ones like CMV and PCP
294
which drug should be given to patients after a transplant to prevent opportunistic infections
TMP SMX and Gancyclovir to prophylaxis against CMV
295
if you see hypokalemia after someone starts using a thiazide diuretic to treat their HTN and they are young, you think
primary hyperaldosteronsim
296
what are the two things that should be ruled out in an adult with first time seizure
hypoglycemia/electrolyte disturbances and amphetamine use or bento/alcohol withdrawal
297
malignant otitis externa is usually seen in what kind fo patient
old diabetics
298
what is the cause of malignant otitis external
pseudomonas
299
what is the characteristics manifestation of malignant otitis external
granulations in the ear canal
300
facial drooping Causing food to fall from someones mouth with malignant otitis external is due to?
involvement of the cranial nerves due to osteomyelitis to the base of the skull
301
Treatment for malignant otitis external
cipro
302
facial nerve palsy and vesicles in the auditory canal and auricle is called
Ramsey Hunt (HSV in the ear)
303
what is the treatment for ischemic colitis with no sign of necrosis
antibiotics, bowel rest and fluids
304
why does ischemic colitis spare the rectum
because of dual circulation
305
patients who have difficulty getting up early, and have excessive morning sleepiness, but left to their own they can sleep uninterrupted till 11am
delayed sleep-wake phase disorder
| "night owls"
306
inability to stay awake in the evening after 7 pm and early morning insomnia
Advanced sleep wake phase disorder
307
difficulty initiating and maintain sleep and producing daytime sleepiness is seen in
shift work disorder
308
what cancers are associated with Li Fraumeni syndrome (mutation in tp53-tumor suppressor gene)
adrenocortical carcinoma
brain tumors
breast cancer
309
how do patients with non classic Congenital adrenal hyperplasia present
in teen years with irregular periods, acne and hirtusism (no virilizatoin)
310
how do girls in classic congenital adrenal hyperplasia present
with salt wasting, virilization and a deficiency in 21-hydroxylase
311
partial deficiency of 21 hydroxylase
non classic CAH
312
what causes resistance to insulin in pregnancy
increased levels of placental somatomammotriopin (human placental lactose)
313
what is the single most important prognostic factor in a cancer patient
TNM staging
314
what level is increased in congenital adrenal hyperplasia
17 hydroxyprogesterone
315
early activation of the hypothalamic pituitary axis causing a pulsatile GnRH secretion and elevated FSH and LH
central precocious puberty
316
gonadal or adrenal release of excess sex hormones resulting in low FSH or LH due t negative feedback in someone with early puberty
peripheral precocious puberty
317
excess conversion of testosterone into estrogen resulting in precocious puberty in girls with a low FSH and LH is in
aromatase excess
318
how to diagnose vascular rings
barium shows compression of the trachea and esophagus
319
what disease is associated with the curvature of the spine in 2 planes
turners
320
what rules out white coat HTN
a high diastolic pressure
321
a patient from China with elevated JVP, decreased heart sounds, and accentuated sound directly after the second heart sound in early diastole
Constricitve Pericarditis due to TB
322
chugs disease causes what kind of heart failure
systolic and diastolic heart failure
323
sxs of digoxin toxicity
nausea
anoerxia
abdominal pain
324
color vision alterations are seen in toxicity with what
digoxin
325
what drugs increase digoxin levels and leads to toxicity
amiodarone
verapamil
quinidine
propefenone
326
what should be done if you start someone on amiodarone who is on digoxin
decease digoxin by 25-50% to avoid toxicity
327
severe periumbilical pain out of proportion to PE findings
mesenteric ischemia
328
Asbestos exposure, bibasilar reticulondular infiltrates, bilateral pleural thickening and pleural plaques
bronchogenic carcinoma
329
explain peritoneal mesothelioma
due to asbestos, and causes abdominal pain, tenderness and ascites
nodular peritoneal thickening is seen
330
explain pleural mesothelioma
- asbestos exposure
- unilateral pleural plaques
- large pleural effusion
331
explain bronchogenic carcinoma
- asbestos exposure in a SMOKER
- bilateral pleural plaques
- reticulonodular infiltrates
- parenchymal fibrosis
332
what happens when genital HSV isn't treated
they will recur but over time they will become less frequent
333
what can severe primary genital HSV cause
radiculopathy in the sacral nerves that lead to urinary retention, loss of sensation and neuralgia
334
what is Aprepitant
it is a P NK1 antagonist the is an antiemetic
335
what medications cause acute dystonia in a chemo patient who is being treated for vomiting
dopamine antagonist metoclopramide or prochlorperazine
336
what is hydroxyzine
an antihistamine that is an antiemetic
337
a dural based mass in the brain is likely a
meningioma
338
immobilization can cause what electrolyte abnormality
hypercalcemia due to increase osteoclastic bone resorption
339
hypoalbumin is associated with what calcium trend
low calcium
340
highalbumin is associated with calcium trend
high calcium
341
what is dexmedetomidine
it is an alpha 2 agonist that is used for sedation
342
what medication is used in severe cases of PCP intoxication
propofol
343
atrophy of the caudate is associated with
huntingtons
344
decreased volume of the hippocampus and the amygdala is seen in
schizophrenia
345
accelerated head growth and increased total brain volume is seen in
autism
346
structural abnormaliteit in the orbitofrontal cortex and basal ganglia are seen in
OCD
347
in stable patients with retropharyngeal abscess what test should be done to show the size of the abscess
CT with contrast
