uworld Flashcards
(734 cards)
1
Q
Parenteral nutrition can provide total nutrition directly into the blood stream of patient’s who are unable to receive enteral nutrition. what is a common and serious complication?
A
Because it must be administered through a central venous catheter when given for >48 hrs there is risk of central line-associated bloodstream infection.
2
Q
Pt with CP, signs of decreased cardiac output, and pulsus paradoxus following viral infection most likely have what resulting in what arrhythmia?
A
likely pericarditis resulting in cardiac tamponade
may not have any murmur and lungs remain clear.
3
Q
CSF findings in HSV encephalitis?
A
Usually nonspecific; however classic findings are lymphocytic pleocytosis, elevated protein, elevated RBC count, and normal glucose.
the CSF RBC elevation is the result of hemorrhagic destruction of frontotemporal lobes
4
Q
what will you see on spirometry of someone with ILD? specifically in regards to FEV, FEV1, and ratio?
A
decrease in both FEV and FEV1 with normal ratio.
pts usually have hx of smoking, and you often hear fine bibasilar “crackles” (velcro like) on exam
5
Q
pt has HTN and hyperpigmentation associated with a mediastinal mass which suggests pulmonary malignancy with ectopic production of what?
A
ACTH
this is a polypeptide hormone - common with small cell lung cancer
pt will have manifestations of severe hypercortisolism including wide purple striae, fatigue, easy bruising, proximal muscle weakness, and central obesity (although hypermetabolic state associated with the malignancy may cause weight loss)
6
Q
Describe light criteria for pleaural effusions (transudate vs exudate)
A
Trans: Protein less than or equal to 0.5 and LDH = 0.6 (pleural/serum), LDH is = 2/3 upper limit of normal serum LDH.
Ex: pleural/serum protein ratio >0.5 and LDH >0.6, pleural LDH > 2/3 upper limit of normal serum LDH
Common causes of trans are hypoalbuminemia (cirrhosis, nephrotic syndrome) and CHF. For Exudate think Infection (parapneumonic, TB, fungal, empyema), malignancy, and PE
7
Q
What color is described with a chylothorax?
A
Milky white
8
Q
vaccines for adults with HIV?
A
HAV, HBV, HPV, Influenza (inactivated), Meningococcus, Pneumococcus, Tdap
9
Q
Lung malignancy pt with headache, facial swelling, and JVD without peripheral edema makes you think?
A
Sperior vena cava syndrome. Primary treatment is radiation therapy as a palliative measure
10
Q
Measures to prevent aspiration pneumonia in hospitalized pt includes…?
why not ng tube?
A
oral care
diet modification for pt with dysphagia, and compensatory techniques like elevated the head of the bed to 30-45 degrees
jejunal feeding reduces risk of aspiration but simple ng or percutaneous endoscopic gastrostomy tibes predispose to aspiration pneumonia
11
Q
how is SBP thought to develop? where does the infection come from?
typical treatment?
A
Enteric bacteria are thought to translocate across the intestinal wall and seed ascitic fluid within the peritoneal cavity.
treatment typicaly IV abx (3rd gen cephalosporins, flouroquinolones)
NOTE mental status changes common in SBP
12
Q
Bullous pemphigoid vs pemphigus culgaris - which has tense vs flaccid which is hemi and which is des?
A
BP is hemides with tense blisters
PV is desomosomes with flaccid (usually involvement of the oral cavity too.) will not typically see ANY intact blisters because skin is so fragile.
13
Q
Proximal muscle weakness (eg difficulty climbing up stairs) and pain is mild to absent with elevated muscle enzymes (CK, aldolase, AST) makes you think?
A
Polymyositis
confirm dx with ANA, anti-Jo-1 and biopsy showing endomysial infiltrate with patchy necrosis
14
Q
Age >50, systemic signs/symptoms, stiffness > pain in shoulders hip girdle and neck, associated with giant cell arteritis makes you think?
A
Polymyalgia rheumatica
will see elevated ESR, CRP and rapid improvement with gluccocorticoids
15
Q
combo of UMN and LMN signs is characteristic of what disease (sensation is usually intact)
A
ALS
16
Q
Absence seizures usually occur in children but what do you think of in an adult with staring spells (and maybe automatisms like lip smacking or chewing)
A
these would be complex partial seizures (complex due to LOC and partial involving local area of brain
may also experience postictal state or todd paralysis after
17
Q
recommended initial treatment for stable Vtach?
A
amiodarone
18
Q
pt presents with weakness and leg cramps after initiation of thiazide diuretic suggests?
A
significant hypokalemia
in setting of persistent HTN think Primary hyperaldosteronism
can manage with aldo antagonists like spironolactone or eplerenone.
19
Q
pt with sudden onset cholicy abdominal pain associated with eating after recent Roux-en-Y makes you think?
A
rapid weight loss induced gallstones with possible cholecystitis.
20
Q
differences in post strep GN vs IgA nephropathy?
A
bacterial vs viral and delayed vs early onset of sx’s
21
Q
Pt with hypocalcemia dn hyperphosphatemia in setting of CKD has typical presentation of ?
A
Secondary hyperparathyroidism
decreased production of VitD due to CKD leads to decreased absorption of calcium in gut. As GFR decreases kidney cant get rid of phosphate. increased phosphate binds up the circulating calcium which stimulates release of PTH which leads to parathyroid hyperplasia
22
Q
what would you prescribe to a pt with neurogenic bladder?
A
a cholinergic agonist. (bethanechol) to aid in bladder contraction and urethral relaxation.
muscarinics are for urge incontinence (detrusor overactivity) and relax bladder
pelvic floor exercises for stress incontinence
23
Q
Precipitating factors for Hepatic Encephalopathy?
A
Drugs (sedativesm narcs) Hypovolemia (diarrhea) Elecctrolyte changes (hypokalemia) Increased nitrogen load (GI bleed) Infection (PNA, UTI, SBP) Portosystemic shunting (TIPS)
24
Q
what is restrictive cardiomyopathy?
A
often caused by myocardial infiltrative diseases such as amyloidosis, sarcoidosis, or hemachromatosis
25
Young patient presents with recent viral illness, heart failure symptoms,, chest pain, or arrhythmia should make you think?
Myocarditis
most patients have at least partial recovery of myocardial function, but some will develop dilated cardiomyopathy
26
64 year old pt with fever, weight loss, night sweats, cough and fatigue with cavitary lesion in lung apex on imaging and disease in the spine. Pt also has hx of smoking but quit 15 years ago. Why is this more likely to be TB than primary lung malignancy?
abstinence from smoking for 15 years makes risk of lung cancer much less and fever is not a typical feature of lung cancer.
27
what lab test should be ordered in all pt's with afib particularly if they have weight loss as well?
TSH and T4
28
twisting knee injury with impaired extension, instability, and exacerbation of pain with squatting. on exam there is joint line tenderness and an effusion. what is likely dx?
meniscal tear.
also may have locking or catching when the joint is extended while under load.
dx with MRI
29
What is the best predictor of prognosis of pt with brain tumor astrocytoma of the following: size, metastatic disease, degree of anaplasia, location of tumor, or vascular invasion
degree of anaplasia (GBM is a grade IV astrocytoma with worst prognosis).
metastatic disease is rare because pt usually dies before this happens
size and location effect symptoms
neovascularity is negative prognostic factor but pt with vascular invasion does not necessarily have a worse prognosis
30
IL-1 receptor antagonists are useful in treatment of what?
RA
31
TNF-alpha inhibitors are useful in tx of what?
RA and Crohn's
32
What is Imatinib and what does it treat?
it inhibits the product of the BCR-ABL tyrosine kinase fusion gene in CML
reminder: CML presents with marked leukocytosis (predominantly neutrophil) whereas CLL is multiple chain lymphadenopathy, splenomegaly, mild cytopenias (anemia/platelets) and predominent lymphocytic leukocytosis (shows smudge cells on peripheral smear)
33
Pt with infective endocarditis may have bacterial emboli to lungs but what about pt with neurologic symptoms?
Brain abscess is possible as it is possible to have mitral valve involved not just tricuspid valve.
34
How could you tell if a pt's hyponatremia was from fluid loss or renal tubular necrosis based on labs?
hypovolemic pt with have stimulation of ADH and urine sodium of <20 whereas RTN pt will have severe hypotension and urine sodium >20
35
```
Common bugs associated with the following infections in sickle cell patients:
PNA
Osteomyelitis/septic arthritis
Bacteremia/sepsis
Meningitis
```
PNA-Strep pneumo
Osteo/septic arth-S. aureus and salmonella
Bacteremia/sepsis-S. pneumo and Hib
Meningitis-S. pneumo
36
who do you give abx prophylaxis to prevent infective endocarditis prior to invasive procedures such as dental procedures?
Those with:
- prosthetic heart valve
- Previous hx of IE
- Structurally abnormal heart valve in a transplanted heart
- Certain congenital disease (unrepaired cyannotic CHD, repaired CHD with prosthetic material within 6 mos of repair, repaired CHD with residual defects)
IT IS NOT recommended in pt with mitral valve prolapse, or other acquired valvular dysfunction (rheumatic fever), and relatively low-risk congenital heart disease( ASD, bicuspid)
37
How do you calculate sensitivty and specificity?
SN= TP/ (TP+FN)
SP= TN/ (TN+ FP)
38
What is the pharmacotherapy for acute dystonia in a pt treated with antipsychotic?
Benztropine or diphenhydramine
39
Injury to the radial nerve would cause what on exam?
wrist drop, decreased sensation over dorsum of hand
40
Which form of dementia is associated with impaired acteylcholine synthesis?
Alzheimer disease
41
How hypertensive would you expect to see a pt with renal artery stenosis?
severe htn >180/120
and recurrent flash pulmonary edema
42
young boy with trinucleotide repeat on the X chromosome makes you think?
fragile X syndrome
intellectual disability, autistic behavior, elongated face with large ear and enlarged testes
43
Pt with hx of breast cancer has labs that show thrombocytopenia, decreased fibrinogen, and increased INR which are indicative of what?
DIC
44
Pt with findings consistent with DIC (thrombocytopenia, decreased fibrinogen, and increased INR) also shows elevated LDH, reticulocyte count, and bilirubin which is consistent with what process and due to what mechanism?
consistent with hemolysis from MAHA (commonly associated with DIC, but can occur without DIC. Schistocytes on smear)
45
What pathology is associated with the following on cardiac auscultation: loud first heart sound, early diastolic sound after second heart sound, (opening snap) and low pitched mid-diastolic murmur best heard at apex.
Mitral Stenosis
46
What is the USPSTF recommendations for breast cancer screening?
Mammogram q2y for women 50-74
47
In adults, the most common cause of nephrotic syndrome is ?
FSGS
| particularly Af Am
48
teen who presents with progression from absence to myoclonic to generalized tonic-clonic seizures. Typically occur upon awakening. dx?
Juvenile myoclonic epilepsy
symptoms can worsen with sleep deprivation.
49
Why are nitrates used in MIs and angina?
preferential venodilation treats the pain caused by cardiac ischemia
50
what is febuxostat?
xanthine oxidase inhibitor used in gout to decrease uric acid production. Allopurinol is preferred so febuxostat reserved for those who cannot tolerate allopurinol
51
what is probenacid
a gout medication to increase uric acid excretion in the kidneys
52
decerscendo diastolic murmur along the left sternal border at the third and fourth interspace is due to what?
Aortic regurg
53
What kind of murmur do you hear with aortic root dilation and where is best spot to hear it?
decrescendo diastolic murmur just like in aortic regurg but with root dilation its best heard along the right sternal border (not the left like in AR)
54
when will you see xanthochromia in the CSF?
with subarach hem
55
what is factitious disorder
making it up to assume the sick role (no secondary gain)
56
Do you do further workup in pediatric population with sore throat, cough, runny nose, and oral vesicles?
no. likely viral, herpangina
57
Pheochromocytoma arises from what cells?
neuroendocrine cells of the adrenal medulla
58
pt presents with poor energy, weight gain and psychosis. What lab should you order to rule out possible cause
TSH r/o hypothyroid
59
treatment for pt with perforated ulcer?
urgent ex-lap
60
What is pubic symphysis diastasis?
can occur after traumatic delivery and presents with radiating suprapubic pain exacerbated by weight-bearing. Treatment is conservative with supportive care.
61
What is the most common malignancy diagnosed in patients exposed to asbestos?
Bronchogenic carcinoma
especially in smokers
62
delayed carotid pulses and midsystolic murmur over right sternal border suggest? What else might be seen in severe cases?
Aortic stenosis
In severe dz: diminished and delayed carotid pulse (pulsus parvus and tardus) due to blood flow obstruction. Mid- to late-peaking systolic murmur from turbulence due to the stenosis. Presence of soft and single second heart sound (S2)
63
Mid to late diastolic murmur at apex is suggestive of?
mitral stenosis
64
Autoimmune hemolytic disorder characterized by intravascular and extravascular hemolysis and hemaglobinuria?
Paroxysmal nocturnal hemoglobinuria
most patients present in 4th decade with: hemolysis leading to hemoglobinuria, Cytopenias (fatigue and dyspnea from anemia), Hypercoaguable stat (portal vein thrombosis etc causing acute abdominal pain)
65
after 6 mos of age, inadequate dietary intake becomes the most important cause of what deficiency?
Iron
(little kid drinking only cows milk with microcytic anemia
66
Diagnosis requires > or = how many of the 9 symptoms of depression and for how long?
5/9 for at least 2 weeks
in addition to support groups etc you have to recommend antidepressant therapy and pyschotherapy
67
Tinea versicolor is the only tinea infection NOT caused by what? and what causee Tinea versicolor?
not caused by a derpatophyte infection
it is caused by Malassezia furfur or Malassezia globosa
68
differential for anterior mediastinal mass?
4Ts: Thymoma, Teratoma (or other germ cell tumor), thyroid neoplasm, and terrible lymphoma
69
What lab would be elevated in a nonseminomatous germ cell tumor that would not be elevated in seminomatous germ cell tumor?
AFP is elevated in non-seminoma and will not be elevated in seminoma
beta-hcg will be elevated in both
70
child with recurrent bacterial infections, severe peridontitis, and marked leukocytosis is consistent with ?
Leaukocytosis adhesion deficiency (LAD)
caused by defective integrins
exam shows inflammation with lack of purulence.
first presentation of LAD is delayed umbilical cord separation
71
What management do you use if endometriosis is suspected and conservative treatment with NSAIDs and OCPs isnt helping pain/ sx's?
Laparoscopy indicated after failure of empiric therapy
72
What is Riluzole?
A glutamate inhibitor approved for use in ALS
73
Risk factors for ARDS other than intubated ICU pt?
Infection (sepsis), trauma, massive transfusion, acute pancreatitis
74
what is cutoff of normal thickness endometrial strip?
= 4mm
75
what is dactylitis?
(hand-foot syndrome) can be the earliest manifestation of vaso-occlusion in sickle cell disease pt.
usually presents at 6mos to 4 years with acute pain and severe swelling of hands and feet. Low grade fever sometimes present
76
what do you think of when you read endocardial cushion defect?
ASD
77
continuous flow murmur that is often asymptomatic and detected incidentally on routine cardiac auscultation?
PDA
78
What's the treatment for iron poisoning?
deferoxamine, binds ferric iron allowing urinary excretion
79
How do you treat BV in a pregnant pt?
same as non pregnant pt. Metronidazole
80
Benign intracranial HTN has what serious possible complication if ICP is not lowered?
blindness
81
differential dx for pt with marfanoid body habitus?
Marfan syndrome and Homocystinuria
homocystinuria is AR error in methionine synthesis. associated with intellectual disability and thrombosis (downward lens dislocation vs marfan which is upward lens dislocation)
82
High dose IV acyclovir can cause what renal injury?
crystal induced AKI where crystalluria can cause renal obstruction
administering IV fluids concurrently with the drug can help reduce the risk of acute kidney injury
83
Microcytic anemia , disproportionately elevated RBC count and peripheral smear with hypochromia and poikilocytes including target cells is indicative of?
Beta-thalassemia minor
84
child age 2-5 with abnormally low platelet count (<100,000) resulting in increased bruising and bleeding following viral infection?
ITP
no treatment needed
Glucocorticoids or IV immunoglobulin (IVIG) is first line treatment with mucosal bleeding
85
What BUN:Cr ratio is suggestive of pre-renal AKI?
>20:1
86
Which types of bacteria would you expect to see in early (<3months) vs delayed (3-12 months) prosthetic joint infection? how do the presentations differ other than timing?
acute (< 3 months) acute pain, wound infection or brreakdown, fever - S. aureus, G- rod, anaerobe
delayed (3-12mos) chronic joint pain, implant loosening, sinus tract formation - coagulase negative staph (like staph epi), propionibacterium, enterococci
87
pt with hx of gallstones presents with colicky pain, hyperactive bowel sounds, and peumobilia on CT, dx?
gallstome ileus
treatment is surgical
88
treatment of mild and severe or worsening croup?
mild-corticosteroids
severe - corticosteroids (dexamethasone) and nebulized epinepherine
89
Fluoxetine, Paroxetine, Sertraline, citalopram, escitalopram, and fluvoxamine are all??
SSRIs
90
Venlafaxine, desvenlafaxine and duloxetine are all???
SNRIs
91
Buproprion has what MOA?
Norepi and dopamine reuptake inhibitor
does not cause weight gain or sexual side effects
92
Phenelzine and Nortriptyline are ??
MAOIs
93
Vortioxetine is what kind of drug?
serotonin modulator
94
Placenta accreta typically occurs in pt's with what hx?
Prior c-section, myomecyomy or D&C
95
what is immediate tx for uterine inversion?
put it back manually with your hands!
utertonic administration before replacement may make uterine replacement impossible to perform!
96
Symmetric decel and return to baseline of fetal HR with contraction suggests what etiology?
fetal head compression
no treatment is necessary
97
Late decel that mirrors conrtaction has what etiology?
uteroplacental insufficiency
98
Variable decels with contractions indicate?
cord compression, oligo, or cord prolapse
99
dysgerminomas secrete ?
LDH or beta-hcg
100
Mature teratomas are concerning?
they are benign and may secrete thyroid hormone (struma ovarii)
101
Sertoli-Leydig cell tumors secrete?
androgens (testosterone and androtestenedione typically causing virilization
amenorrhea, deep voice, clitoromegaly in females
102
Yolk sac tumors secrete?
AFP
103
tomoxifen puts women at risk for what due to its MOA?
endometrial polyps in premenopausal and endometrial hyperplasia and cancer in post menopausal women due to estrogen agonist in the uterus.
104
inferior wall MI is due to occlusion of what coronary artery causing damage to what area of the heart?
Right coronary causing RV infarct
RV failure leads to decreased preload and resultant hypotension
105
What lab findings might you see in a pt with tubo-ovarian abscess?
nonspecific (leukocytosis, CRP, CA-125)
CA-125 elevation is nonspecific and does not indicate malignancy
also pt with fever suggests infection rather than malignancy
106
What do you see with kawasaki disease
what is tx?
aka mucocutaneous lymph node syndrome. It's a vasulitis characterized by FEVER >/= 5days in addition to at least 4 of the following:
Conjunctivitis (bilateral non exudative
Oral mucosal changes (erythemia, fissured lips, "strawberry tongue")
Rash
Extremity changes (erythema, edema, desquamation of the hands and feet
Cervical lymphadenopathy: > 1.5cm node
IV immunoglobulin should be started within 10 days of fever onset to help prevent coronary artery aneurysms
Aspirin indicated to help with inflammation and antiplatelet effect (even with risk of reye still give it).
107
Pt's with what hx are more susceptible to molluscum contagiosum infection?
Imparied CELLULAR immunity (HIV)
108
pt wit cold symptoms and cough that screams viral infection also has some crackles at one lung base. Management?
have to get chest xray to look for possible consolidation
109
Vaginal bleeding, malodorous discharge, and ulcerated vaginal lesion are concerning for what in post menopausal woman>
vaginal squamous cell carcinoma
need vaginal biopsy for dx
110
skin necrosis at injection site of a pt who recently started subQ hepain screams what?!
HIT
111
which biliary disease is assocaited with UC?
PSC
PBC is middle aged women with anti-mito antibodies
112
CKD pt with pleuritic chest pain, friction rub, and BUN 90 likely is suffering from what?
Uremic pericarditis - needs dialysis
typically happens with BUN >60
usually doesnt have the classic EKG findings associated with pericarditis
113
slowly developing back pain with neurologic dysfunction and palpable step off deformity in the lumbosacral area is typical for ?
spondylolisthesis
114
short stature, aortic coarctation, and absence of menarche in young girl likely due to?
turner syndrome 45 X
estrogen deficient risk of osteoporotic fracture
115
How would you differentiate a diverticular bleed from hemorrhoids?
diverticular bleeds are typically painless (hemorrhoids can also be painless) but hemorrhoids will not usually cause enough bleeding to compromise hemodynamic status (diverticular might)
116
Pt with itching after bathing, facial plethora and splenomegaly screams what? what is MOA of dz and what lab is characteristically DECREASED?
Polycythemia vera
JAK2 mutation for constitutive activation resulting in high erythrocytes (also high leukocytes and thrombocytes)
will have LOW EPO levels
117
Can a mom with HepC breast feed?
yes. Breastfeeding does not increase the risk of HCV transmission to the neonate
118
Are HepA and HepB vaccines safe in pregnancy?
Yes they are inactivated vaccines
119
Would you adjust a pt's levothyroxine if they become pregnant?
yes. Pt's with hypothyroidism should increase dose because in pregnancy you make more thyroid binding globulin andif you are hypothyroid you cant make extra hormone
120
Lithium and Valproate are first line for bipolar maintenance. In what pt population would you avoid either drug (ie what chronic disease would make you not prescribe either drug)
Lithium is avoided in pt's with renal dysfunction because it can lead to high levels and toxicity.
Valproate needs to be monitored for hepatotocixity and thrombocytopenia
121
Constipation, back pain, and lab evidence of anemia, renal insufficiency and hypercalcemia indicate what malignancy?
Multiple Myeloma
(pt will have M-spike) and peripheral smear with ROULEAUX
122
why does excess gastric acid in ZES lead to diarrhea and steatorrhea?
because of inactivation of pancreatic enzymes and injury to the mucosal brush border
123
Why are ace inhibitors given to CHF patients
to lessen ventricular remodeling
124
which traumatic penetrating wounds require emergent ex lap?
Any penetrating injury in the thorax below the level of the nipples has potential to involve the abdomen through the diaphragm and is assumed to involve both compartments until proven otherwise
125
If a suicidal teenager refuses hospitalization and asks you not to tell his parents about his plans what do you do?
Inform the parents and hospitalize him immediately with or without parental consent
126
PAP result comes back with high grade squamous intraepithelial lesion what is next step in management?
colposcopy to evaluate and visualize lesion
127
Osteoarthritis of the foot usually involves what areas?
the mid foot and first metatarsophalangeal joint
128
A young girl who presents with primary amenorrhea and male- range testosterone levels with no cervix on exam likely has what?
Androgen insensitivity syndrome (46XY)
129
What is the treatment for lymes in a patient <8yo
oral amoxicillin or cefuroxime
no flouroquinolones this young
130
Most common cause of acute and recurrent headaches in the pediatric population?
Migraines. First line treatment is Tylenol, NSAIDs and supportive management
triptans may be tried if these are not effective
131
What is somatic symptom disorder?
Excessive anxiety and thoughts about the seriousness of at least 1 somatic symptom.
132
What causes low FSH and estradiol in females with irregular menses and infertility?
Hypogonadotropic hypogonadism via loss of GnRH pulsatile secretion precipitated by weight loss, stress, or chronic illness.
133
What is false labor?
Mild irregular contractions that DO NOT cause cervical change (ie braxton hicks)
134
What labs will you see in someone suspected to have antiphospholipid syndrome?
prolonged PTT because the lupus anticoagulant binds phospholipids
this finding is artifact and does not correlate with bleeding.
20-40% will also have thrombocytopenia even though they are hypercoagulable
135
what is the initial test for someone with high likelihood of DVT?
Compression US
d-dimer is more helpful to rule out and is not very specific if positive
136
What happens to reticulocytes and platelets in aplastic crisis?
increased reticulocytes (compensatory) and decreased platelets (they are trapped in spleen)
137
What differences do you see in RDW and reticulocyte count with thalessemia vs iron deficiency anemia?
Thal will have normal RDW and retics might be slightly elevated or normal
Iron def will have increased RDW and low retics
138
When would you typically see a drug fever after administration of drug?
1-2 weeks post admin
139
pt population most at risk for osteosarcoma?
where do you usually see it on the bone? what does it look like?
it is the most common primary bone tumor in children and young adults. Boys between ages 13-16 are at higher risk
seen frequently at the metaphyses of long bones such as distal femur, proximal tibia, and proximal humerus.
typically see spiculated "sunburt" pattern and peristeal elevation (Codmans triangle)
140
what do you see on Xray with Ewing Sarcoma?
osteolytic lesion with a periosteal reacion - "onion skin" appearance
141
Bortholin duct systs are found in what area?
4 and 8 ocklock positions of the labia majora
142
Spondyloarthropathies are characterized by what type of pain?
back pain and stiffness that worsens with rest and improves with activity
(aka ankylosing spondylitis)
143
Limited upward gaze, upper eyelid retraction and pupils non reactive to light but reactive to accommodation indicated what?
Parinaud syndrome (like from pineal growth in the dorsal midbrain)
can also cause obstructive hydrocephalus resulting in headache and vomiting
144
When do you and when do you not prescribe oral antibiotics for kid with otitis media?
when are tubes necessary?
All infants <6mos and >/=6 mos w/ high fever, severe pain, or bilateral disease.
pt =6mos with low grade fever, mild or no pain, and unilateral disease gets analgesia and observation as an option.
Recommend tubes for >/=3 episodes of otitis in 6 mos or >/=4 episodes in 12 months
145
What are the first line treatments for smoking cessation?
Nicotene replacement therapy, varenicline, and bupropion.
Bupropion is contraindicated in pt with seizures or any pt who may have acitve bulimia
146
Acute onset of psychotic symptoms (bizarre behavior, auditory hallucinations) in a child or adolescent with neurological symptoms (slurred speech, drooling, or hand tremor) and abnormal LFTs are concerning for?
Wilson disease
147
Sickle cell pt with acute drop in hgb, low retic count, without splenomegaly is consistent with ?
aplastic crisis
functional systolic murmur may be present due to hyperdynamic blood flow
148
Vaccination for medically stable preterm infants should be given according to what age (gestational or chronilogic)
Chronologic age not gestational.
All stable preterm infants should receive the first dose of HepB at birth (unless weighs <2kg) and HepB dose 2, rotavirus, tetanus, diptheria, acellular pertussis, Hib, pneumococcal, and inactivated polio at 2 mos
149
treatment for symptomatic 3rd degree AV block?
temporary pacemaker to look for reversible cause then permanent pacemaker if no reversible cause found.
150
Will ECT pt most likely experience anterograde or retrograde amnesia?
Both
151
Acute renal transplant rejection (days) should be treated with?
IV steroids
152
What do you see with digoxin toxicity?
Diarrhea, nausea, and fatigue
typically presents with N/V decreased appetite, confusion and weakness.
may also have visual symptoms of scotomata, blurry vision with color changes or blindness.
153
Treatment for restless legs?
Iron supplementation for deficiency, conservative measures, and pharmacotherapy with dopamine agonsits (pramipexole) or alpha-2-de;ta calcium ligands (gabapentin)
154
hypercalcemia with low PTH is concerning for what in a pt with non specific symptoms
malignancy
155
Hemiparesis and aphasia after injury to the posterior pharynx are suspicious for what type of injury?
Injury to the cervical internal carotid artery, which is located directly lateral and posterior to the tonsilar pillars
injury can result in dissection or thrombus, which occurs over hours to days and can extend into the MCA and ACA. Pt may develop thunderclap headache and sx of ischemic stroke (hemiparesis, facial droop, aphasia). confirm dx with CT or MR angiography
156
What is Zenker's diverticulum?
most common in elderly patients, particularly men. occurs in posterior lower cervical esophagus near the cricopharyngeal muscle
Patients may complain of dysphagia and regurgitation often have halitosis and are at risk for aspiration pneumonia
157
what happens to amount of amniotic fluid if pregnancy goes past 41 weeks>
Uteroplacental insufficiency results in chronic fetal hypoxemia and CNS suppression that can lead to fetal demise. To prevent suppression, blood is preferentially distributed to the brain rather than the peripheral tissue. This redistribution can be evidenced on US as OLIGOHYDRAMNIOS as amniotic fluid is dependent on renal perfusion and urine production
158
What does HELLP stand for?
Hemolysis, Elevated Liver enzymes and Low Platelets
serious liver problems include centrilobular necrosis, hematoma formation, and thrombi in the portal capillary system. These processes cause swelling and distension of the hepatic (Glisson's) capsule, resulting in RUQ or epigastric pain
159
Treatment for intra-amniotic infection is?
broad spectrum abx and immediate delivery via augmentation of labor
C-section is reserved for standard OB indications (non-reassuring fetal tracing, breech presentation, prior uterine surgeries)
160
workup of baby with asymptomtic murmur likely due to VSD?
echo to evaluate location and rule out other defects. most small VSDs close spontaneously and require no treatment
161
Obese boy comes in with hip or knee pain of insidious onset causing limping. PE shows loss of abduction and internal rotation of the hip as well as external rotation of the thigh while the hip is being flexed. dx?
Slipped capital femoral epiphysis
displacement of the femoral head on the femoral neck due to disruption of the proximal femoral growth plate.
should be promptly treated with surgical pinning of the slipped epiphysis to lessen risk of avascular necrosis
162
lymphocytic predominant leukocytosis in a kid that had bad cough that made him puke but is otherwise afebrile and VS normal?
Pertussis aka whooping cough
tx is macrolides
163
What are the medications used to treat alzheimer disease
Donepezil, galantamine, and rivastigmine
cholinesterase inhibitors
164
pt is hyponatremic to 128 and is in DKA, what fluids do you give to correct sodium?
NS -
pt's in DKA can have pseudohyponatremia due to hyperglycemia
hypertonic saline is reserved for true (severe) hyponatremia
165
Pt with ESRD needs to be put on a blood thinner, what is preferred tx?
warfarin is preferred long term and to bridge use unfractionated heparin
LMWH (enoxaparin) and rivaroxaban are not recommended in ESRD because they are metabolized by the kidney and can reach toxic levels
166
abx tx of choice for human bite?
amoxicillin clavulanate due to good G- and G+ and beta lactamase producing organism coverage
167
Old man recently started on anti-depressant and cant pee, which drug was he given?
Amitriptyline (or another TCA)
a TCA with anticholinergic properties ca result in urinary retention
168
fever, back pain, and focal spinal tenderness suggest?
infection such as vertebral osteomyelitis
needs MRI
169
Most common cause of short stature and pubertal delay in adolescents?
Constitutional growth delay characterized by delayed growth spurt, delayed puberty, and delayed bone age.
170
GCS is scored of what three categories?
Eye opening, Verbal response, motor response
171
What labs do you order before starting Lithium?
BMP, UA, Calcium, pregnancy test (in women), and thyroid function tests.
172
first line therapy for social anxiety disorder?
SSRI or SNRI with CBT
beta blocker or benzo only for the performance subtype
173
60 yo female with adnexal mass and hx highly suspicious for ovarian cancer should uet what type of management>
Ex lap with surgical staging
biopsy could lead to rupture of the mass and resultant spreading of cancerous cells
174
What is hyposthenuia and what patients do you see it in?
Inability to concentrtae urine by the kidneys. Seen in sickle cell and sometimes sickle cell trait
In response to hypoxic, hyperosmolar conditions of the renal medulla, red blood cells sickle in the vasa recta, impairing free water reabsoprtion and countercurrent exchange. Pt typically has polyuria and nocturia despite fluid restriction. Urine osmolality is low; however, normal serum sodium is maintained due to intact ADH
175
Victims of smoke inhalation should be treated empirically for what kind of poisoning?
Cyanide poisoning. with an antidote such as hydroxycobalamin or sodium thiosulfite with nitrates to induce methemaglobinemia.
Hydrogen cyanide and carbon monoxide are the 2 major products of combustion in closed spaces.
176
How can antipsychotics contribute to infertility?
By blocking dopamine-2 receptors in the infundibular pathway, the production of prolactin increases which can result in galactorrhea, menstrual irregluarities, and infertility
177
Renal vein thrombosis is associated with causes of nephrotic syndrome but most commonly with which nephropathy?
Membranous glomerulopathy.
178
Adhesions and fibrosis of the shoulder joint synovial lining describe what pneomenon?
Adhesive capsilitis "frozen Shoulder"
persistent pain with decreased ROM in multiple planes. can be idiopathic or due to underlying pathology.
179
HSP is associated with what GI complication due to intestinal edema and bleeding
Intussusception
180
Hypercalcemia, hypophosphatemia, and elevated PTH are consistent with ?
Primary hyperparathyroidism
recommend parathyroidectomy if pt has complications such as osteoporosis, (Tscore 1mg/dL above normal, urinary excretion of calcium >400mg/day
181
features of cocaine withdrawal?
Predominantly psychological features: depression, fatigue, hypersomnia, increased dreaming, hyperphagia, impaired concentration, and intense drug craving
182
what is the most accurate method of determining gestational age?
First tri ultrasound with crown-rump length
183
Why do women get HELLP syndrome? MOA?
abnormal placentation, triggering systemic inflammation and activation of the coagulation system and complement cascade.
circulating platelets are rapidly consumed, MAHA it detrimental to the liver resulting in hepatocellular necrosis and trhombi in the portal system
184
Treatment for HELLP syndrome?
Delivery, Mg for seizure prophylaxis, and antihypertensives
185
What cardiac pt's cannot receive PDE-5 inhibitors for ED? (who doesn't get to have viagra?)
anyone on a nitrate or alpha blocker due to risk of hypotension
beta blockers are ok
186
Elderly pt with hypercalcemia, normocytic anemia, renal insufficiency, and protein gap (difference between total protein and albumin >4g/dL)
Multiple Myeloma
187
What are the contraindications to the rotavirus vaccine?
Previous anaphylaxis to ingredients, hx of intussusception, hx of uncorrected congenital malformation of GI tract (meckel's), SCID
188
Causes of NORMAL anion gap mebanolic acidosis
Diarrhea, fistulat (pancreatic, ileocutaneous etc), Carbonic anhydrase inhibitors, Renal tubular acidosis, ureteral diversion (ileal loop), iatrogenic
189
Non-anion gap metabolic acidosis in presence of conserved kidney function indicates?
Renal Tubular acidosis
190
Which type of RTA is seen in porrly controlled diabetes?
hyperkalemic RTA (type 4 RTA)
damage to the juxtaglomerular apparatus, causes state of hyporenimic hypoaldosteronism
low aldo causes retention of H+ and K+
191
Dilation of the papiniform plexus describes what?
A varicocele
soft, irregular mass ("bag of worms") that increases in size with standing and valsalva
more common on left side bc left spermatic vein drains to the left renal artery which then passes between the SMA and aorta prone to compression.
192
Most common causes of viral meningitis?
enteroviruses like coxsackievirus
193
An ovarian mass in a postmenopausal pt is very concerning for malignancy and should be investigated by?
pelvic US and CA-125 measurement
194
What is preferred option for renal transplant: living related donor, non-related donor, or cadaveric donor?
living related then living non then cadaver
195
Labs seen in pt with turner syndrome?
elevated FSH and LH with low estrogen, low testosterone
196
what is d-xylose test for?
test for intestinal malabsorption (celiac dz)
d-xylose is a monosach that can be absorbed in the proximal intestine without degradation and then excreted in urine. Pt with proximal intestinal mucosal dz (celiac) cannot absorb and urinary and serum levels of d-xylose will be low, Pt with malabsorption due to enzyme deficiency (pancreatitis) will have normal absorption.
197
Old person with UTI acting crazy, psychological dx?
Delirium
198
What is a restrictive pattern of PFTs?
what about obstructive?
reduced vital capacity and total lung capacity with normal FEV1/FVC ratio
obstructive: reduced FEV1(<80%) and FEV1/FVC (<70%)
199
Child with recurrent cutaneous and pulmonary infections with catalse positive bacterial and fungal organisms
Chronic granulomatous disease
Leukocyte, platelet, and B and T cell concentrations are normal
Dx made by oxidative burst testing (dihydrorhodamine or nitroblue tetrazolium testing) and confirmed by gene testing
pts should receive abx prophylaxis with TMP_SMX and itraconazole
200
What is Beckwith-Wiedmann syndrome?
overgrowth disorder characterized by predisposition to neoplasms. Most patients have sporadic or inherited alteration of chromosome 11p15, which includes genes that encode insulin-like growth factor 2, a growth promoting hormone similar to insulin. At birth, classic findings include
macrosomia, macroglossia, hemihyperplasia, and medial abdominal wall defects ( umbilical hernia, omphalocele)
201
Anorexia vs bulimia vs binge eating?
Anorexia-significantly low weight (binge/purge subtypes)
bulimia: recurrent binging with compensatory behavior like vomiting or exercise, worry about body and maintains NORMAL weight
binge-eating: no compensatory behavior just recurrent binging with lack of control
202
In child, viral URI followed by heart failure symptoms is most likely caused by?
Viral myocarditis (coxssackie B or adenovirus)
203
Because urine protein dipstick has high false-positive and false-negative during pregnancy the findings should be confirmed by?
Urine protein/creatinine ratio or 24-hour collection for total prtoein
204
difference in serous otitits media and acute otitis media?
Serous will not have inflammatory signs like fever tympanic membrane buldging just effusion following AOM treatment and if chronic can lead to hearing loss
205
In infants, areas of erythematous patches and plaques of yellow, oily scales, and mild pruritis on the scalp, eyelids, nasolabial folds, postauricular area, and umbilicus?
Seborrheic dermatitis caused by malassezia species
"cradle cap"
206
Why do obese people get non-alcoholic fatty liver disease? MOA?
increased transport of free fatty acides from adipose to the liver, decreased oxidation of FFA in the liver, or decreased clearance of FFA from the liver (due to decreased VLDL production).
frequently related to Insulin resistance leading to increased peripheral lipolysis, triglyceride synthesis, and hepatic uptake of fatty acides.
207
Hyperkeratotic papules on the soles of the feet that are painful when walking or standing most commonly in young adults and immunocomprimised
HPV
warts
208
overwhelming life event causes man to forget who he is or how he got to his current location, dx?
Dissociative amnesia
209
Pt with bad chest trauma post MVA with pneumomediastinum, and subcutaneous emphysema on physical exam despite placement of chest tube is consistent with?
Tracheobronchial rupture
esophageal rupture is more from ednoscopy or esophagitis not blunt force trauma
210
When does MG typically present in Males vs Females and with what sx's? what is the ice pack test?
6th-7th decade for men
2nd to 3rd decade for women
symptoms of extraocular (ptosis, diplopia) and bulbar (dysphagia, dysarthria) muscles. Weakness can be exacerbated by meds (aminoglycodsides, magesium, beta blockers, neuromuscular blocking agents), surgery (thymectomy), pregnancy, or infections
Ice pack test is when ice pack applied to eyelids for several minutes leads to improvement of sx's. Cold temp inhibits breakdown of ACh at neuromuscular junctionincreasing availability to nicotinic receptor. Pt with + test should get MG confirmed with AChR antibody testing.
211
Most common cause of unilateral bloody discharge from the breast without a coexisting breast mass?
Intraductal papilloma
212
What is fibromuscular dysplasia?
Non-inflammatory nonatherosclerotic condition most common in women 15-50. primarily affects renal arteries causing HTN. Involvement of the Cerebrovascular arteries (carotid, vertebral) can cause symptoms of brain ischemia (TIA, amaurosis fugax, stroke) or non specific sx's (HA, pulsatile tinnitus, dizziness).
DX confirmed by CT or US
213
Adverse effects of Tomoxifen (SERMs)
Hot flashes, Cenous Thromboembolis, Endometrial hyperplasia & carcinoma
214
Nodular pattern of radioactive isotope uptake on thyroid scan is indicative of what vs a diffuse pattern?
Toxic adenoma or multinodular goiter
diffuse indicated Graves (usually other sx's too like exopthalmos and pre-tibial myxedema)
215
Mom brings in kid concerned about possible developmental delay and pt only hx if multiple ear infections and eczema
check hearing for conductive hearing loss that is parading as developmental delay
216
Common symtpoms of hypertrophic cardiomyopathy include?
syncope, dyspnea, and chest pain
217
Peripheral neuropathy of the facial nerve is what Dx?
Bells palsy
inability to raise eyebrow or close eye, drooping of the mouth corner and disappearance of the nasolabial fold. If pt can still crinkle forehead this suggests central lesion
218
Atypical glandular cells on Pap testing in women >/=35 or <35 with risk factors (obesity, anovulation) requires evaluation for what? and how?
may be due to cervical or endometrial cancer
investigate with colposcopy, endocervical curettage, and endometrial biopsy to evaluate ectocervix, endocervix, and endometrium
219
Most commonly injured nerve with anterior shoulder dislocation? symptoms?
Axillary nerve
innervation to the teres minor and deltoid - weakness in abduction with injury
220
Do binge eating disorder pt's have compensatory behavior>
no
221
how do you evaluate secondary amenorrhea (pt had cycles before now >/=3 cycles or >=6 months of no period)
beta hcg to r/o pregnancy, then prolactin+TSH+FSH
222
Pt who wear contact lenses wakes with painful, red eye and opacification and ulceration of the cornea is typical of what?
contact lens associated ketatitis - most cases due to Pseudomonas and serratia
medical emergency needs to discard the lenses and get topical abx
cornea is usually spared in bacterial conjunctivitis infections associated with contact lenses
223
15 yo male presents with worsening articulation and ataxia, MSK exam shows scoliosis and absent deep tendon reflexes in the lower extremities, MRI shows atrophy of the medulla and dorsal columns of the spinal cord.
Dx and usual complication that can be fatal?
Friederich ataxia
GAA
clinical features include: cerebellar ataxia, dysarthria, loss of vibration and/or position sense, absent deep tendon reflexes, Hypertrophic cardiomyopathy, skeletal deformities (scoliosis), diabetes mellitus
most common COD is cardiac dysfunction
224
What is avoidant/restrictive eating disorder?
lack of interest and avoidance of eating based on the sensory characteristics of food, with onset in infancy or early childhood
225
What is the tx for Erb-duschene palsy (brachial plexus injury - waiter tip hand)
up to 80% of patients have spontaneous recovery within 3 months.
surgical intervention for infants with no improvement 3-6 months
226
Osteomyelitis in sickle cell pt most likely due to?
salmonella and Saureus
227
Prolonged administration of high doses of oxytocin can result in what complication?
water intoxication and hyponatremia
oxytocin looks like ADH
hyponatremic sx's include HA, abdominal pain, nausea, vomiting, lethargy, and tonic-clonic seizures.
treat with hypertonic saline
228
What drug therapies are used to prevent recurrent nephrolithiasis
Thiazide diuretic (less calcium excreted in urine), urine alkalinization (potassium citrate. bicarbonate salt), Allopurinol (for hyperuricosuria-related stones)
229
RA typically involves what area of the spine?
cervical spine
230
when do you start screening women with dexa scan for osteoporosis?
>=65 as well as <65 who have an equivalent risk of fx
231
single most important prognostic consideration in the treatment of pt with breast cancer?
Tumor burden (TMN staging)
232
pharmacotherapy for pagets disease?
bisphosphonates
233
what medications can cause pseudotumor cerebri aka IIH?
growth hormone, tetracyclines, and excessive vitamin A and its derivitives (isoretinoin, all-transretinoic acid)
234
what is pulsus paradoxus?
exaggerated fall in systemic BP >10 furing inspiration. it is found in carciac tamponade but also can occur in conditions without pericardial effusion such as severe asthma or COPD
235
key difference between dissociative amnesia and transient global amnesia>
DA: localized or selective amnesia for a particular event with inability to recall personal identity
TGA: anterograde amnesia for time and place but NO LOS OF PERSONAL IDENTITY. typically resolves in 24 hrs
236
Persistent pneumothorax and significant air leak following chest tube placement in pt with blunt force trauma to chest suggests? (hint pt has pneumomediastinum and subcutaneous emphysema)
tracheobronchial rupture
237
Delayed (slow-rising) and diminished (weak) carotid pulse ("Pulsus parvus and tardus"), presence of single and soft second heart sound (S2), Mid- to late- peaking systolic murmur with maxima intesity at the second right intercostal space ratiating to thecarotids
all suggestive of ???
Severe aortic stenosis
238
Pt received epidural for labor, 6 hrs later has continuous small amounts of urine since delivery, has edematous perineal area
how do you manage urinary sx's?
urethral catheter
drainage of >=150mL confirms retention, catheterization also decompresses the bladder
239
presenting features of herpetic whitlow?
tingling and burning of the hand associated with localized vesicular rash. Symptoms WOULD NOT BE bilateral and symmetric.
240
timeline of alcoholic withdrawal symptoms from 6hrs to 96 hrs
6-24hr: mild withdrawal-anxiety, insomnia, tremors, diaphoresis, palpitations, GI upset, intract orientation
12-24hr: seizures - single or multiple generalized tonic-clonic seizure
12-48: visual, auditory, or tactile hallucinations, intact orientation, stable vital signs
48-96hr: delerium tremens
241
Marfan pt with acute chest pain should be evaluated for???
acute aortic dissection
exam may show >20 variation in SBP between arms. pt with dissection or progressive aortic root dilatation can develop aortic regurgitation (early crescendo decrescendo diastolic murmur.
242
infant with anemia, increased MCHC, indirect hyperbili, and negative coombs is indicative of >
hereditary spherocytosis
243
what will muscle biopsy show for pt with duschene MD? is muscle biopsy the gold standard for DX?
will show absent dystrophin,
gold standard is genetic testing
244
What non stimulant can be prescribed in adult ADHD?
atomoxetine
245
which has low complement levels post strep GN or IgA nephropathy?
PSGN
246
eval for pt with blunt genitourinary trauma?
UA and if hematura and stable ctrast CT
247
severe symptomatic hypercalcemia (>14mg/dL) can cause what sx's?
tx?
weakness, GI upset and neuropsychiatric sx's (confusion, stupor, coma)
treat with saline hydration and calcitonin
248
treatment for placenta previa?
pelvic rest until 36-37 weeks then c section
249
female on day x of period presents with macular rash involving hands and soles as well as hypotension - dx?
TSS Staph aureus
250
What compound will be elevated in the blood of B12 deficiency? (homocystein, methionin, VMA or ferritin?)
homocysteine (needs B12 to go to methionine)
251
most likely cause of macrocytic anemia in pt with sickle cell?
folate deficiency
252
what is atlantoaxial instability?
malformation in 10-15% of downs syndrome pt due to excessive laxity in the posterior transverse ligament, which causes increased mobility between the atlas (c1) and axis (c2)
253
what are gross motor milestones at 18 months?
running, kicking a ball
254
treatment for narrow complex tachycardia (SVT)
adenosine
| amiodarone for wide complex tachy (VTACH
255
female with weight gain, proximal muscle weakness, HTN, easy bruisability, hyperpigmentation, and hyperandrogenism is indicative of?
cushings
also may see hyperglycemia, hypokalemia and alkalosis, and hypercortisolism
256
Any pt with UTI less than age 2 should get what as part of workup?
renal & bladder US to evaluate for anatomic abnormalities that could predispose to UTI
257
What do you hear on pulmonary exam of pleural effusion vs consolidation?
pleural effusion: decreased breath sounds and decreased tactile fremitus and dullness to percussion
consolidation: increased breath sounds, dullness to percussion, increased tactile fremitus
258
black and white rule in pediatric ethics regarding care that parent doesnt want to give?
Parent not allowed to refuse life saving treatment
259
Which antidepressant would you expect withdrawal symptoms from?
those with short half life like paroxetine
260
How do you differentiate normal grief from clinical depression?
With normal grief, sadness is typically focused on the deceased and decreases over weeks with intermittent waves mixed with positive memories
261
What do you expect to see as far as recurrence of symptoms in genital herpes in someone treated vs not treated?
treatment mostly makes outbreak shorter and helps reduce recurrence but even without treatment recurrence should be less frequent over time as cell mediated immunity is built up
262
What is a congenital melanocytic nevus?
benign proliferation of melanocytic cells. Present within the first few months of life, usually solitary with dense course hair
263
What is congenital dermal melanocytosis?
(mongolian spots) flat grey blue patches that are poorly circumscribed and will fade with time
264
Would you still be suspicious for pelvic inflammatory disease (like an abcess from ascending infection) in pt without leukocytosis or fever?
this would be very unlikely
265
what are modifiable risks of breast cancer?
alcohol use
nulliparity
Hormone replacement therapy
increased age at first live birth
266
what kind of prophylaxis should be given to people with hx of rheumatic heart disease?
Penicillin to prevent future strep A pharyngitis
267
inspiratory stridor and barky cough are indicative of ?
croup (parainfluenza)
268
What are the major and minor criteria for acute rheumatic fever?
Major: J<3NES - joints (migratory arthritis), carditis, nodules (subcutaneous, eryhtmea marginatum, syndenham chorea
Minor: fever, arthralgias, elevated ESR or CRP, prolonged PR interval
269
What is breast feeding jaundice?
in first week of life hyper unconjugated hyper-bili due to insufficient breast milk intake.
baby will be dehydrated
(conversely breast milk jaundice will appear with adequate intake and no sign of dehydration from 3-5 days and peak at 2 weeks)
270
What level of prolactin is diagnostic for prolactinoma?
>200 ng/dL
271
You start CPR, give O2 and attach AED to pt in carciac arrest. monitor reads asystole/PEA, next step?
CPR x 2 min, IV access, give epi, place advanced airway
272
What medication can be prescribed to pt with mild grave diasese?
methimazole
most graves will require radioactive iodine and thyroidectomy.
273
What is PBC associated with?
xanthelasmas, severe hyperlipidemia, pruritis, anti-mito antibody, may develop osteoporosis or asteomalacia
274
Chronic alcohol user with gait instability, truncal ataxia, and difficulty with rapid alternating movements - due to??
cerebellar dysfunction "alcoholic cerebellar degeneration"
275
neonate with painless, illuminescent, scrotal swelling that fluctuates with crying - dx and management?
hydrocele
observation
276
which antibody shows acute hepB infection
IgM anti-HBc
277
child with cafe au lait macules, axillary freckling, and monocular eye protptosis with vision changes likely has?
NF1 with optic pathway glioma
278
What is typical presentation of retinitis pigmentosa?
bilateral tunnel vision and eventually blindness
279
chest/abdominal pain with subcutaneous emphysema suggests?
esophageal perf
280
multiparous woman >40 with dysmenorrhea and heavy mesntrual bleeding (can progress to chronic pelvic pain) and on exam boggy (soft/f;accod) tender, uniformly enlarged uterus...dx?
adenomyosis
281
What would a uterus with fibroids feel like on exam?
nontender, firm, and irregularly enlarged.
282
Pt with hematologic malignancy starts chemo and develops hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia...why? what do you do for managment?
Tumor lysis syndrome
IV fluids to flush the kidneys and uric acid metabolism inhibitors like allopurinol and rasburicase
283
recent URI, dyspnea, elevated JVP, clear lung sounds, and increased cardiac silhoutte on CXR is suggestive of?
early cardiac tamponade due to pericardial effusion
284
pt with COPD and acute onset of SOB, hypoxia and unilateral decreased breath sounds likely has ??
secondary spontaneous pneumothorax
may also see CP and hyper-resonance on percussion
285
what are the VitK dependent factors?
II, VII, IX, and X
286
In the US, the most common cause of constrictive pericarditis is idiopathic or viral (>40%), radiation therapy (30%), cardiac surgery (10%), and connective tissue disorders. What is most common cause in developing countries like Africa, India, and China?
tuberculosis
287
What is abx treatment for Infective endocarditis?
most likely due to viridans strep (mutans) treat empirically with vanc then depending on susceptibility give IV penicillin G or IV ceftriaxone for 4 weeks
288
dermal blisters that are painless and heal with scarring, increased skin fragility on tha dorsal hands, facial hypertichosis and hyperpigmentation are all indicative of what? especially in a pt with underlying HepC...
Porphyria cutanea tarda
disorder of heme synthesis
leads to photosensitivity due to accumulation of porphyrinogens that react with oxygenon excitation by UV light
289
Precosious puberty, irregular cafe au lait macules confined to one side of body and polyostotic fibrous dysplasia (bone fractures) is consistent with ?
McCune-Albright syndrome
constant overproduction of pituitary homrones so can also lead to thyrotixicosis, acromegaly, and cushing syndrome
290
What is the first few steps of evaluating precosious puberty?
bone age?
if advanced then look at LH to determine peripheral (low LH) vs central (high LH)
if normal look at breast (thelarche) and pubic hari (adrenarche)
291
What increases the murmur in HCM?
things that decrease preload (valsalva, abrupt standing, and nitro)
increasing afterload or preload will decrease murmur (hand grip, squatting, and passive leg raise)
292
Bilateral hemiparesis, Diminished bilateral pain and temp, and intact bilateral proprioception, vibratory sensation, and light touch is indicative of ?
Anterior cord syndrome.
injury to the anterior spinal artery
293
Life threatening complication of retropharyngeal abscess characterized by fever, chest pain, odynophagia, and requires urgent surgical intervention?
Acute necrotizing mediastinitis
294
Commonly used immunosuppressant that can cause gingival hypertrophy and hirsutism among other things...
cyclocsporine
295
best contraceptive for breast cancer pt?
copper IUD
296
Pulmonary capillary wedge pressure is increased in what type of hemodynamic shock?
cardiogenic!
decrease in hypovolemic and normal or decreased in septic
297
labor contractions generating how many MVUs are considered adequate?
200MVUs
298
What is the definition of arrest of labor?
| What is management?
no cervical change for >= 4hrs with adequate contractions
OR
No cervical change for >=6 hrs with inadequate contractions
needs c-section
299
PDA hearing loss and cataracts in baby is indicative of what in uteru?
rubella infection
300
early descrescendo diastolic murmur at left sternal border indicative of what?
aortic regurg
301
pt in septic shock with compensated metabolic acidosis should get what IV managemnt?
Normal saline
only give sodium bicarb if pH <7.2
302
Uremic encephalopathy needs what management?
hemodialysis
303
What is initial treatment of chronic venous insufficiency with pitting edema?
leg elevation, compression stockings, and exercise.
diuretics likely to cause dehydration and are not recommended
304
cyanosis within 24 hrs of life with single S2 on auscultation indicates?
transposition of the great vessels, give prostaglandins to keep PDA open
305
Pt with recent cardiac cath presents with hemodynamic instability and flank/back pain ipsilateral to arterial puncture site located above the inguinal ligamnet...dx?
retroperitoneal hematoma
usually w/in 12 hrs of cath
306
Most common vaginal foreign body in children?
toilet paper
307
what is pertussis treatment and post-xposure prophylaxis for those involved?
if pt <1 month give azithromycin x 5days otherwise give azithromycin x5d or clarithro x7d or erythro x14d
give to al close contacts regardless of immunization status or symptoms
308
acute renal failure, fever, rash, wbc casts indicative of
allergic interstitial nephritis
309
do OCPs cause HTN
yes in 5% of pts
310
at what age do you start doing low dase CT for lung cacner screening
55-80 w/ >=30 year pack hx and current or quit w/in last 15 yrs
311
what is management of simple breast cyst?
aspiration if pt desires and breast exam f/u in 2 mos to check for reaccumulation
312
elderly pt in developed country develops iron deficiency anemia...why and what do you do for workup?
most likely due to a bleed. do an endoscopic eval
313
is breast milk jaundice conjugated or unconjugated hyperbili?
unconjugated
314
drug induced acne commonly involves what areas of the body?
upper back, shoulders, and upper arms
315
What percent of each hemaglobin (A, S, F) would you see on electrophoresis of a normal pt vs sickle cell pt?
normal is 99% HgbA
SCD is 85-98% HgbS and 5-15% HgbF
316
What is the treatment for trich? do you treat the partner too?
oral metronisazole and tinidazole are first line.
yes treat partner too
317
most common cause of SBO?
adhesions
318
help with smoking cessation, help with weight loss, and no sexual side effects describes what antidepressant commonly used?
Buproprion
319
What is the work-up for possible intestinal obstruction (bilious emesis) in new neonate?
abdominal xray to exclude pneumoperitoneum then barium enema
320
webbed neck, carpal and pedal edema, nail dysplasia and horshoe kidney indicate?
why do they get the hands and feet swelling?
Turner syndrome.
congenital lymphedema from lymphatic network dysgenesis
edema is non pitting due to high protein count
321
what are common lab findinsg in JIA?
elevated inflamm markers, hyperferritinemia, hyperagammaglobulinemia, thrombocytosis, ANEMIA
322
what is an easy way to differentiate Erysipelas from cellulitis just by looking at it?
erysiplelas will have sharply demarcated edges and cellulitis will have flat edges with poor demarcation
323
What would you expect the CD4 count to be in a pt with diarrhea from MAC or CMV
<50
CMV is bloody diarrhea and MAC is not
324
Very high urine hydroxyproline in a older gentlemen suggests what dz?
Paget
hydroxyproline is derived almost exclusively from breakdown of collagen, and levels will be increased in pagets
325
when do you expect baby blues to resolve?
14 days
326
What is pseudocyesis?
amenorrhea, breast fullness, morning sickness, and abdominal distention (early pregnancy symptoms) in a pt who believes she is pregnant but is not.
it is a somatization disorder from stress
327
What is pilonidal disease?
painful, fluctuant mass 4-5cm cephalad to anus in the intergluteal region with associated mucoid, purulent, or bloody drainage
this is not to be confused with perianal abscess that is located immediately adjacent to anus
328
Is fever always present in vertebral osteomyelitis?
no, only in 50% of cases!
329
which is bright and which is dark on non contrast CT
ischemia vs blood
blood is bright and ischemia is dark
330
young athletic woman with chronic anterior knee pain that is worse with climbing stairs or running is consistent with what dx and exam?
patellofemoral syndrome
pain elicited by extending the knee while compressing the patella
management is exercises to stretch and strengthen thigh muscles
331
is uncomplicated seizure following vaccine administration a contraindication to future vaccination?
no
332
congenital adrenal hyperlasia is caused by what deficiency and will have what labs?
21 hydroxylase deficiency
decreased aldo - dehydratio, salt wasting (hyponatremia and hyperkalemia)
decreased cortisol - fasting hypoglycemia
increased testosterone - virilization
**dehydration, salt wasting and virilization**
elevated 17 hydroxyprogesterone levels are diagnostic
333
What are the features of WPW?
short PR <0.12 (less than 3 little boxes)
Slurred and broad upstroke of QRS (delta wave)
QRS widening with ST/T wave changes
334
transplant pt with pulmonary symptoms, bloody diarrhea, and fever is indicative of what?
CMV
335
What will be seen on imaging of a pt with vascular dementia?
cortical and/or subcortical infarction with or without deep white matter changes from chronic ischemia
336
How do you treat PCP intoxication?
supportive management and benzo's for agitation
urinary acidification is not recommended because it does not work
337
What do you see with primary ovarian insufficiency as far as GnRH, FSH, and estrogen levels?
increase in GnRH and FSH
decrease in estrogen
low estrogen means no negative feedback for GnRH or FSH
338
Can procedures be performed on a deceased pt for the purposes of education?
with family permission and under supervision
339
Abrupt onset of regular tachycardia that resolves with cold water immersion is consistent with?
what is the most common form
PSVT
Atrioventricular nodal re-entrant tachycardia is most common form of PSVT. Vagal maneuvers increase parasympathetic tone in the heart and result in a temporary slowing of conduction in the AV node and increase in refractory period leading to termination
340
pt who experienced EPS with a first gen antipsychotic should be prescribed a second gen, which one?
ziprasidone is better than olanzapine as far as side effects
341
What is the difference between a missed abortion and a threatened abortion?
Missed will have no fetal cardiac activity or an empty sac and no bleeding
threatened will have fetal cardiac activity with bleeding
both have closed cervix
342
succinylcholine can cause what life threatening condition?
hyperkalemia with cardiac arrhythmia
343
horner syndrome with cervical paravertebral mass in pediatric pt is consistent with?
Neuroblastoma
344
best treatment to reverse warfarin in acutely bleeding pt?
fresh frozen plasma
345
best fluid choice for INITIAL resuscitation in severe hypovolemic hypernatremic pt?
normal saline.
346
Post op pt with new onset hypotension, JVD, and RBBB is indicative of what?
massive PE
347
what do you do when you see a new solitary pulmonary nodule on routine chest xray?
look at previous xray
if no previous or new then get chest CT to further characterize
348
What is the difference between a cherry angioma and a superficial hemangioma?
superficial hemangioma aka strawberry hemangioma is vascular birthmark in kids that regresses
cherry angioma is benign vascular proliferation in adults (basically they are the same only the cherry doesnt regress and you get more cherry's with age)
349
pt with COPD that gets supplemental O2 can have improvement of hypoxia but worsening of what?
hypercapnia causing respiratory acidosis
goal oxyhemaglobin sat in these pt's is 90-93%
350
18 month old with normal development then subsequent regression of speech, loss of purposeful hand movements (inability to feed or dress oneself), gait abnormalities, and stereotypical hand movements is indicative of?
Rett Syndrome
351
Normal internal genitalia, external virilization (clitoromegaly) and undetectable serum estrogen levels in female are consistent with dx of?
aromatase deficiency
352
pt with suspected neurocognitive impairment should undergo what testing?
neurocognitive testing
353
do OCPs cause weight gain?
no
354
what does neurocardigenic syncope mean?
a vasovagal episode resulting in syncope
355
What are some complications that small for gestational age infants are at risk for?
hypoxia, perinatal asphyxia, meconium aspiration, hypothermia, hypoglycemia, hypocalcemia, and polycythemia (increased EPO in response to fetal hypoxia)
356
which benzo do you give in alcohol withdrawal?
lorazepam
diazepam is longer acting
357
which mood stabilizer is used in bipolar and used specifically to treat bipolar depression that has a significant side effect of drug rash?
lamotrigine
SJS can happen in severe cases
358
breast abscess from untreated mastitis needs to be treated with?
needle aspiration and abx
359
breastfed babies are at increased risk for what vit deficiency that can cause skull bone abnormality?
VitD deficiency - called frontal bossing
genu varum is bowing of the legs
360
STI screening happens when in prenatal course?
first prenatal visit with HIV, HepB, GC chlamydia, and syphilis
361
Prematurity is important risk factor for RDS, what other risk factors?
male sex, perinatal asphyxia, maternal diabetes, and c-section delivery
362
Thrombocytopenia, MAHA, renal insufficiency, neurologic changes (HA, confusion, coma, stroke), and fever is pentad for what?
how do you treat it?
TTP
PT and PTT are normal - will see schistocytes on smear
treat with emergent plasma exchange
363
pt with severe resistant HTN with continuous bruit in the right periumbilical area is indicative of ?
renovascular disease
it is most common and correctable cause of resistant HTN
364
subperiosteal hemorrhage that occurs due to birth trauma particularly with forceps or vacuum-assisted deliveries, limited to surface of 1 cranial bone and appears as a scalp swelling with the following features:
firm, nontender, does not cross suture lines, no skin dicoloration
cephalohematoma
capput succedaneum refers to scalp swelling superficial to the periosteum that crosses suture lines. The edema usually involves the portion of the had presenting during vertex delivery and is typically identified at birth
365
numbness or pain between 3rd & 4th toes , clicking sensation when palpating space between 3rd and 4th toes when squeezing the metatarsal joints
Morton neuroma
(interdigital neuroma)
mechanically induced neuropathy that causes numbness, aching, and burning in the distal forefoot from the metatarsal heads to the third and fourth toes.
treatment is conservative
366
side effects associated with olanzapine
weight gain and metabolic adverse effects (hyperglycemia)
clozapine is also a second gen antipsychotic with side effects
ariprazole, lurasidone, and ziprasidone are associated with lower risk
367
what is the most effective emergency contraceptive?
copper IUD
368
UA results show urinary alkalization pH>8, what bugs are likely culprits?
urease producing organisms like Proteus mirabilis (most commonly) and Klebsiella pneumoniae
369
what is dacrocystitis?
infection of lacrimal sac (tear duct)
370
how do you treat malignant (necrotizing otitis externa (MOE)?
usually caused by Pseudomonas aeruginosa
treat with Ciprofloxacin
371
Where is Broca's area located? dominant? nondom side? frontal? occipital? parietal?
Dominant frontal lobe lesions can cause expressive (Broca's) aphasia
372
all nonpregnant pt's >25 with CIN3 require what treatment?
excision of the transformation zone (cone biopsy) due to high risk of progression to invasive squamous cell cervical carcinoma
373
Pt with asthma complains of sore throat, morning hoarseness, worsening cough only at night, and increased need for albuterol inhaler following meals indicates?
GERD
374
Crampy, postprandial epigastric pain (intestinal angina), food aversion, and weight loss in pt with atherosclerosis is indicative of?
chronic mesenteric ischemia
CT angio for dx
375
diarrhea dermatitis and dementia are the triad consistent with?
niacin deficiency (B3)
376
why do patients with OSA have increased hematocrit?
kidneys respond to hypoxemia by increasing EPO
377
what do you expect to see with MCV and RDW in a pt with iron deficiency anemia?
decreased MCV and increased RDW
378
pt >=13 with no period or secondary sexual characteristics... what is the workup?
first pelvic US to look for presence of a uterus
then FSH level to distinguish peripheral vs central causes of amenorrhea
379
what germ cell tumor produces AFP?
nonseminomatous
380
dome shaped, firm, freely moveable cyst or nodule with a small central punctum, can remain stable or gradually increase in size
may produce a cheesy white discharge
usually resolves spontaneously
dx?
Epidermal inclusion cyst
381
What is torus palantinus
benign bony growth (exostosis)
located on the midline suture of the hard palate
fleshy immobile mass
382
what is intermittent explosive disorder?
impulse control disorder
pt unable to control aggressive impulses, resulting in verbal or physical aggression that is out of proportion to the provocation.
383
what is management of adolescent with fibroadenoma?
re-examine breast mass after her menstrual period for a decrease in mass size or tenderness
384
what basic tests should be performed to evaluate hypertension
UA for occult hematuria and urine protein/creatinine ratio
chemistry panel
lipid profile
baseline EKG
these are used to evaluate for secondary causes
385
What is the management for caustic ingestion?
secure airway, breathing, circulation
decontamination (clothes etc)
chest xray if respiratory symptoms
endoscopy within 24 hours
386
primary amenorrhea in pubertal pt with cyclic lower abdominal pain,
pelvic exam reveals smoothe clue, bulging vaginal mass that swells with increased intraabdominal pressure
dx?
imperforate hymen
387
What meds are used to treat tourette's
antidopaminergic agents
(tetrabenazine, risperidone, haloperidol)
alpha-2 adrenergic agonists (guanfacine, clonidine) are also used but not as good
388
what trisomy has cutis aplasia
13 patau
389
How would you tell the difference between serum sickness from a mono pt treated with penicillin that gets a rash
serum sickness classic manifestations: fever, urticaria, and polyarthralgia and lymphadenopathy with no mucosal involvement, pt appears ill, typically 1-2 weeks after exposure
pt with mono that gets treated with penicillin can develop morbiliform rash on trunk, reash typically spares the extremities and arthralgia does not occur
390
pt with diffuse telangiectasias (ruby-colored papules that blanch with pressure), recurrent epistaxis, and widespread AVMs
pt has nosebleeds and oral lesions
dx?
Osler-Weber-Rendu syndrome
AVMs in the lungs can shunt blood from the right to the left side of the heart, causing chronic hypoxemia, digital clubbing, and a reactive polycythemia
Pulmonary AVMs can also present as massive, sometimes fatal hemoptysis
diagnosis must be considered in pt with recurrent nosebleeds and orla lesions
391
most common cause of heavy menstrual bleeding?
fibroids
392
precosious puberty with advanced bone age, high LH and FSH indicates?
central precocious puberty
from early activation of the hypothalamic-pituitary gonadal (HPG) axis
pt requires MRI of brain to evaluate for a hypothalamic or pituitary tumor activating the HPG axis
if MRI is negative the cause is most likely idiopathic precocious puberty, and GnRH therapy can be initiated
393
what is the MOA of MPGN type 2
deposits of C3 caused by IgG antibodies directed against C3 convertase of the alternative complement pathway
these antibodies reacting with C3 convertase lead to persistent complement activation and kidney damage.
394
abdominal pain, constipation, neuropsychriatric manifestations (forgetfulness), motor and sensory neuropathies (extensor weakness, stocking-glove distribution), and hematologic abnormalities (microcytic anemia) indicate what poisoning?
lead
disrupts heme synthesis and causes microcytic anemia
395
What is initial management of dumping syndrome? (a common post gastrectomy complication)
Small/frequent meals, replace simple sugars with complex carbs, incorporate high-fiber & protein-rich foods
symptoms of DS usually diminish over time. A minority of patients with refractory symptoms may benefit from a trial of octreotide or require reconstructive surgery, but this is usually not needed
396
adult pt with blunt chest trauma who presents with persistent jugular venous distention, tachycardia, and hypotension despite aggressive fluid resuscitation should raise suspicion for? chest xray with normal cardiac silhouette without tension pneumo
Acute cardiac tamponade due to small pericardial effusion
397
What is initial management after diagnosis of a solid testicular mass has been made (painless hard mass in testicle + suggestive US)
removal of the testis and its associated cord
398
management of preterm labor at <32 weeks (medical management rx)
corticosteroids (betamethasone): decrease the risk of neonatal respiratory distress syndrome
Tocolytics: at <32 weeks, indomethacin is thee first-line tocolytic of choice
Magnesium sulfate: provide fetal neuroprotection (CP)
399
A palpable, well-circumscribed, mobile breast mass in women age <30 suggests a benign process, most commonly ??
what would CONFIRM this dx?
a fibroadenoma
a biopsy
400
Initial management of abruptio placenta
aggressive fluid resuscitation and uterine displacement to optimize maternal circulation
401
episodic pounding sensation (due to flushing and associated rise in pulse rate), chronic diarrhea, weight loss, and valvular heart disease with tricuspid regurgitation is all consistent with?
carcinoid syndrome
402
treatment for lichen sclerosus
high potency topical corticsteroids
| eg clobetasol
403
Systemic sclerosis is divided into diffuse cutaneous and limited cutaneous subtypes. Although there is considerable overlap in disease manifestations between the 2, internal oran involvement such as (interstitial lung disease) is more common and more extensive in ?
diffuse cutaneous SS, leading to a worse prognosis
anti-scl-70 antibodies
anti-RNA polI antibodies
404
acute symmetric arthritis of the hands (MCP, PIP, and wrist), knees, and ankle joints in adult with exposure to children is likely due to??
Parvo B19 infection
405
Most common cause of both early onset (age <=7 days) and late-onset neonatal sepsis as well as meningitis in young infants?
GBS
406
Preeclampsia with severe features at <20 weeks gestation is concerning for what??
Hydatidaform mole
treatment is uterine evacuation
407
newborrn of mother with HBV infection should receive what treatment?
passive immunization with hepatitis immune globulin and active immunization with HBV vaccine within 12 hours of birth
408
Pt with TB also has hyperkalemia, hypoglycemia, and EOSINOPHILIA, all suggestive of ?
Primary adrenal insufficiency aka addisons disease
Addisons disease causes aldo deficiency and presents with non-anion gap hyperkalemic and hyponatremic metabolic acidosis
409
what is metatarsus adductus?
treatment?
most common congenital foot deformity, characterized by medial deviation of the forefoot with a normal neutral position of the hindfoot
reassurance - usually corrects spontaneously
410
joint fluid with clear appearance, 200-2,000WBCs, and 25% PMNs in pt with exertional pain and morning stiffness is due to?
osteoarthritis
411
Medications shown to improve long-term survival in patients with left ventricular systolic dysfunction include ??
beta-blockers, ACE inhibitors, ARBs, meralocorticoid receptor antagonists, and (in African AMerican patients ) a combination of hydralazine and nitrates
412
Pt from Mississippi who was initially thought to have sarcoidosis (cough, hilar adenopathy, erthema nodosum, and noncaseating granulomas in an African American Individual) but deteriorated after hihg-dose corticosteroid therapy is likely to really have?
Histoplasmosis
413
Corneal sensation is due to what nerve?
Trigeminal
414
Trouble with oxidative burst is charactistic of what pediatric disease?
how do you diagnose it?
chronic cranulomatous disease
diagnose by testing neutrophil function via detection or absence of an oxidative burst (eg dihydrorhodamine 123 or nitroblue tetrazolium test)
415
hyperkalemia in pt with hypertension and hypercholesterolemia taking hydrochlorothiazide, amiloride, and simvastatin - EKG with normal sinus and no other abnormalities - management?
change amiloride to amlodipine and recheck labs in 1 week
common offending medications include nonselective beta-adrenergic blockers, potassium sparing diuretics (triamterene, amiloride), angiotensin-converting-enzyme inhibitors, angiotensin II receptor blockers, and NSADs
**hydrochlorothiazide causes hypokalemia**
416
What muscle tear causes weakness of abduction, which can be appreciated in the drop arm test where pt arm is abducted above the head and the pt is asked to lower the arm slowly, pt unable to lower arm smoothly and it will drop rapidly around mid-adduction
complete supraspinatus tear
"rotator cuff tear"
417
Infertility and secondary amenorrhea after a hyerosopic myomectomy is likely due to ??
Asherman syndrome
developemtn of symptomatic intrauterine synechiae
418
After stopping offending agent what is next step in treatment of Neuroleptic malignant syndrome when symptoms are not improving?
dopaminergic agents that can reverse dopamine blockade, such as bromocriptine or amantadine, can be considered in pt's who do not respond to supportive care and withdrawal of medication
419
antibiotic prescribed for acne that cause phototoxicity?
tetracyclines
420
Which vitamin deficiency causes abgular cheilosis, stomatitis, glossitis, normocytic anemia, and seborrheic dermatitis
Riboflavin
| B2
421
newborn with blue extremities and pink body when assessing apgars? management?
reassurance
this is very common, benign, and can last for 1-2 days
in contrast, cyanosis of the face or central body should raise concern for hypoxia from respiratory or cardiac problems such as congenital heart disease
422
Episode of apnea precipitated by frustration, anger, or pain in child 6 months to 2 years is likely due to
breath holding spells
cyanotic or pallid
cyanotic classically presents with crying and breath-holding in forced expiration; followed by limpness, and loss of consciousness.
pallid typically triggered by a minor trauma, child experiences fleeting loss of consciousness followed by breath-holding, pallor, and diaphoresis. this lasts <1 minute with subsequent confusion and sleepines for a few minutes
423
triple bubble sign in pt with bilious vomiting ?
jejunal atresia
424
Pt with persistent anxiety about GI symptoms, despite multiple negative diagnostic evaluations and time-consuming preoccupation with her symptoms, is most consistent with ??
somatic symptom disorder
diagnosis requires >=1 somatic symptoms causing distress and functional impairment for >=6 months
425
most common HIV related nephropathy
nephrotic range proteinuria, azotemia, and normal sized kidneys
collapsing focal and segmental glomerulosclerosis
426
peripheral edema, increased JVP with prominent a wave, loud S2, right-sided heave, pulsatile liver from congestion, and tricuspid regurg in pt with COPD consistent with?
cor pulmonale
427
treatment of parkinson disease psychosis?
dose reduction in antiparkinson meds, med substitution, and/or addition of low potency antipsychotic medication
quetiapine, clozapine, primavanserin
428
most common side effects of carbidopa/levadopa therapy?
early side effects include hallucinations, confusion, agitation, dizziness, somnolence, and nausea
5-10 years later can have involuntary movements like dyskinesia and dystonia
429
What do see with levels of MSAFP. b-hCG, estriol, and inhibinA in trisomy 18 vs 21
18 everything decrease with normal inhibinA
21 is low MSAFP and estriol with high b-hCG and inhibinA
430
what normal renal changes are seen during pregnancy?
increase in GFR and Renal blood flow which cause serum BUN and Cr to become decreased compared to pre-pregnancy levels
431
Primary dose limiting side effect of hydroxyurea?
myelosuppression (neutropenia, anemia, thrombocytopenia
432
cyanotic spells in infant with harsh crescendo-decrescendo systolic mumur and singe S2 - dx?
TOF
433
Acute bacterial rhinosinusitis is diagnosed by one of what 3 criteria?
sx's (cough congestion) >=10days w/o improvement
sx's are severe in onset (fever >39 [102.2] + drainage) for >=3 days
sx's worsen following initial imrpovement (biphasic illness)
434
medical name for hair loss after pregnancy (or other stressful life event)
Telogen effluvium
435
Chronic, numb, hypopigmented lesion with peripheral nerve involement (nodular/painful nerve deformations with diminished sensory/motor activity).
leprosy
436
metabolic abnormalities associated with hypothyroidism?
hyperlipidemia, hyponatremia,
elevated CK and transaminases
437
After confirmatory testing of myasthenia gravis with acetylcholine receptor antibodies what should be done next?
Chest CT to r/o thymoma
438
HCM pt's with symptoms (syncope, HF, angina) should be treated with?
negative inotropic agents
(beta blockers, verapimil, disopyramide)
beta blockers most common monotherapy
439
initial management of stable pt with esophageal variceal bleed?
volume resuscitation, somatostatin analog (octreotide)
prophylactic abx in cirrhotic pt's
urgent endoscopy (within 12 hours) if uncontrolled bleeding
440
what is klumpke palsy?
injury to 8th cervical nerve and 1st thoracic nerves
complication of hand paralysis
sometimes associated with damage tot he sympathetic chain and ipsilateral horner syndrome
441
lab findings in pt with HUS
MAHA, thrombocytopenia and AKI
442
initial step to confirm cushings?
confirm hypercortisolism with a late night salivarycortisol assay, 24 hour urine free cortisol measurement, and/or overnight low-dose dexamethasone supression test
2/3 should be abnormal
next measure ACTH to determine dependent (cushings) vs independent (adrenal adenoma)
443
what treatment can worsen the eye symptoms in graves disease?
radioactive iodine
444
infant with eyelid swelling and bilateral eye drainage second week of life should be treated with?
oral macrolide like oral erythromycin
topical has high failure rate
445
difference between schizoaffective disorder and Bipolar I with psychotic features?
schizoaffective is schizophrenic symptoms in absence of mood symptoms and some mood symptoms for short duration
Bipolar I with psychotic features - psychotic symptoms occur exclusively during manic or depressive episodes
446
suprasellar tumor with caclifications on MRI?
craniophayngioma
447
what is the mechanism behind spider angioma and palmar arythema in pt with cirrhosis?
both arise from hyperestrinism due to impaired hepatic metabolism of circulating estrogens, a process that begins in the cytochrome P450 system
448
What are the target organs for graft vs host disease that are involved in typical acute graft-versus-host disease?
skin (maculopapular rash involving palms, soles, and face that may generalize)
intestine (blood-positive diarrhea)
Liver (abnormal liver function tests and jaundice)
449
Coombs-negative hemolytic anemia (low hemoglobin, reticulocytosis, jaundice/hyperbilirubinemia), splenomegaly and spherocytes on peripheral smear is concerning for?
Hereditary spherocytosis
key lab finding is MCH conccentration >36% due to cellular dehydration and membrane loss
current gold standard for dx is combo of eosin-5 malemide binding test (flow cytometry) with acidified glycerol lysis test
450
acute unilateral lymphadenitis in children is usually caused by?
bacterial infection
451
how can you differentiate CML from leukmoid reaction?
leukocyte alkaline phosphatase (LAP) score
in CML the neutrophils are cytochemically and functionally abnormal, so LAP score is usually low
452
how can you differentiate between adhesive capsulitis and rotator cuff tendonitis?
with adhesive capsulitis there will be lack of ROM even with passive
with tendonitis there will be increased pain with ROM but still able to go through ROM
453
What are the symptoms of lead poisoning? How is diagnosis confirmed?
anemia, abdominal pain, and encephalopathy
Capillary (finger stick) blood specimens are widely used in screening, but many false positives
confirm with venous lead level if capillary level >=5
454
At what lead levels would you use chelation therapy, EDTA, and succimer for treatment
chelation >45
Succimer 45-69
Dimercaperol with EDTA for levels >=70
455
amenorrhea, height <3rd% and weight 20%, tanner stage 1 hair, increased FSH, prepubertal uterus and small ovaries is indicative of?
Turner syndrome - complete androgen receptor insensitivity
456
Which SNRI is associated with dose dependent hypertension?
venlafaxine
457
first trimester screening raises suspicion for trisomy, what is the confirmatory diagnostic test for follow up at 15 weeks?
amniocentesis
458
management and treatment of peritonsillar abscess in stable pt
needle aspiration regardless of vitals then IV abx
459
pt comes home form vacation abroad with fever, N/V, and abdominal pain followed by jaundice and pruritis is indicative of what?
acute HepA infection
460
Pt routinely exposed to antique wood, has polyneuropathy, pancytopenia, mild transaminase elevation, and a variety of skin lesions is characteristic of what?
arsenic toxicity
toxic exposure is more likely through mining, pesticide manufacturing, metalworking, and working with antique pressure-treated wood preserved with arsenic
hypo- and hyperpigmentation of the skin occurs early and hyperkeratosis and scaling of the soles and palms is often seen later
Mees lines(horizontal striation of the fingernails) are characteristic
461
Does optimized glycemic control in diabetes reduce risk of microvascular or macrovascular complications? or both?
Microvascular (nephropathy, retinopathy)
macro effects uncertain
462
diagnostic test for Meckel's diverticulitis?
Technetium-99m pertechnetate scan
463
Pt on risperidone and experiencing extra-pyramidal side effects, dose reduction results in resoved EPS sx's but increased psychosis. Next step in management?
When dose reduction is not feasible, secondary parkinsonism can be treated with an anticholinergic antiparkinsonian medication such as benztropine
amantadine, a dopaminergic medication, and a weak N-methyl-Daspartate receptor antagonist can also be used
464
What would you expect to see on the peripheral smear of a pt with sickle cell disease?
Howell-Jolly bodies (nuclear remnants of RBCs)
465
What side in relation to the lesion will the pt experience -hemiparesis
- decreased proprioception, vibration, light touch
- decreased pain and temp
in Brown-sequard syndrome?
Ipsilateral hemiparesis: lateral corticospinal tract at the level of the injury
Ipsilateral decreased proprioception, vibration, light touch: dorsal columns at the level of the injury
Contralateral decreased and temp: lateral spinothalamic tract 1-2 levels below because decussation above.
466
What is electrical alternans with sinus tach and what does it correspond to?
varying amplitude of QRS complexes
corresponds to pericardial effusion
pt needs pericardiocentesis
467
would you expect to hear a 4th heart sound in pt with acute MI?
this is often heard due to left ventricular stiffening and dysfunction
468
What kind of carcinoma should be suspected in pt with significant smoking history, hypercalcemia, and a hilar mass?
squamous cell carcinoma
469
Child with a cold brought in with acute onset hallucinations. What should you expect as cause? (neurological exam is normal)
over the counter cold medications containing antihistamines (diphenhydramine, doxylamine) decrease nasal discharge but also have anticholinergic properties that can cause confusion and hallucinations
470
placental adherence and hemorrhage at time of attempted placental delivery in pt with previous c section and D&C is consistent with what pathology?
Placenta accreta,
uterine villi attach directly to the myometrium
471
complications of nephrotic syndrome other than edema?
hypercoagulation
increased platelet aggregation, hyperfibrinogenemia due to increased hepatic synthesis, impaired fibrinolysis
renal vein thrombosis is most common manifestation but arterial thrombosis and PE may also occur
472
painless thyroiditis is characterized by hyperthyroid phase due to release of preformed thyroid hormone, followed by a hyperthyroid phase or return to euthyroid state.
how do you treat it?
No specific therapy, but a beta blocker may by prescribed to control symptoms due to hyperthyroidism
473
treatment for localized non-bullous impetigo?
topical abx preferred for localized infection due to fewer side effects and less antibiotic resistance compared to oral therapy
474
what is icthyosis vulgaris and what is the treatment?
chronic, inherited skin disorder characterized by diffuse dermal scaling
skin looks like fish scales or reptile skin
treatment options include emollients, keratolytics and topical retinoids
475
What are the characteristics of primary adrenal insufficiency?
glucocorticoid and mineralcorticoid deficiency (fatigue, loss of appetite, weight loss) (othostatic hypotension, hyperkalemia, hyponatremia, elevated plasma renin activity)
476
Pt with low-grade fever, RUQ tenderness, nausea, and vomiting after recently undergoing a lap chole has findings concerning for what common complication?
Bile leak
associated leukocytosis and obstructive-appearing lever enzymes often present
477
Name clinical findings related to all congenital infections vs just CMV, Toxo, Syphilis, or Rubella
All: IUGR, hepatosplenomeg, jaundice, blueberry muffin rash
CMV: periventricular calcifications
Toxo: diffuse intracerebral calcifications, severe chorioretinitis
Syphilis: rhinorrhea, abnormal long-bone xray, desquamating or bullous rash
Rubella: cataracts, heart defects (PDA)
478
Management of blisters secondary to sunburn in adolescent?
prevent bacterial superinfection with topical agents such as silver sulfadiazine or mupirocin
479
Pt with eye symptoms associated with an erythematous, pustular rash affecting the central face, consistent with?
ocular rosacea
rosacea can present with primary manifestations:
erythematotelangiectatic rosacea: erythema and facial flushing, telangiectasias, roughness or scaling, and burning discomfort
papulopustular rosacea: small papules and pustules resembling acne
Phymatous rosacea: Chronic, irregular thickening of hte skin, usually involving the nose
Ocular rosacea: involvement of the cornea, conjunctiva, and lids with burning or foreign body sensations, blepharitis, keratitis, conjunctivitis, corneal ulcers, and recurrent chalazia
480
What is the etiology behind stress vs urge vs overflow incontinence?
stress is due to decreased urethral sphincter tone and urethral hypermobility
urge is detrusor hyperactivity
and overflow is impaired detrusor contractility or bladder outlet obstruction
481
between the choices of elevated alk phos, ggt, bili, and PTT which is most specific to acute liver failure?
increased PTT is most specific although all will likely be elevated
482
uncal herniation is due to hemorrhage where in the brain?
basal ganglia hemorrhage
ipsilateral dilated non reactive pupul due to compression of the third CN as temporal lobe (uncus) pushes down against tentorium cerebelli
further displacement causes midbrain compression and contralateral extensor posturing, coma, and respiratory comprimise.
483
what are signs of cerebellar tonsillar herniation?
neck tilt, flaccid paralysis, coma, blood pressure instability, and respiratory arrest
484
serotonin syndrome and neuroleptic malignant syndrome are easily confused. what physical exam findings set them apart?
serotonin syndrome wi;; have tremor, hyperreflexia, and myoclonus
NMS has muscular rigidity and bradyreflexia
485
Most common cause and etiology of postpartum fever?
Postpartum endometritis from infection of the decidua diagnosed by fever >24 hrs later, uterine tenderness, and purulent lochia
486
treatment for atypical pneumonia?
macrolide (azithromycin) or respiratory flouroquinolone
487
Narcolepsy is associated with what findings on sleep study (specifically regarding REM sleep)
decreased REM latency
pt entering REM sleep withing 15 minutes of sleep onset (normal is 90 minutes)
488
21 month old male with recurrent infections, eczema, and microthrombocytopenia (small platelet size on smear and low #) is consistent with?
Wiskott-Aldrich syndrome
x rec
489
pt presents with fatigue, arthropathy, hypogonadism (decreased libido and ED) and mild hepatomegaly. dx?
hematochromatosis
iron overload
classic diabetes hyperpigmentation and cirrhosis is rare
490
nausea, vomiting, constant epigastric pain partially relieved by leaning forward indicates?
acute pancreatitis
491
Differences in lambert eaton vs myasthenia gravis.
etiology, clinical, and associate neoplasm
Lambert: abs to PREsynaptic CALCIUM channels
proximal limb weakness, decreased or absent reflexes, improvement with contraction, autonomic dysfunctions (dry mouth) associated with small cell lung cancer
MG: abs to POST synaptic ACETYLCHOLINE receptors, muscle weakness (ovular-ptosis, diplopia. bulbar-dysphagia, dysrthria. Proximal libs arms>legs), normal reflexes, weakness WORSE with activity. associated with thymoma
492
inadequately treated AOM in child with fever, otalgia, and mastoid process inflammation with ear displacement is indicative of what and needs what treatment?
Mastoiditis needs IV abx
493
When would you see gas in the colon of a person with a SBO?
if its a partial SBO
494
most common dermal manifestation of antiphospholipid syndrome? what liver lab will be prolonged?
livedo reticularis (transient lattivelike rash on lower extremitites)
prolonged PTT
495
What female cancer do you suspect in pt with back pain, edema, lower uterine mass, and hydronephrosis?
cervical cancer
496
would you give steroids before or after biopsy in pt with suspected glomeruloonephritis>
after. have to confirm dx
497
basophilic stipling of RBC on smear is indicative od what poisoning>
lead
498
CT or MRI findings of focal nodular hyperplasia (most common benign nonvascular iver lesion)
hypo- or isodense lesion with arterial enhancement and a central stellate scar!
499
Imaging study to diagnose esophageal perf?
gastrografin-contrast esophogram or CT esophaogram
500
periosteal elevation in bone tumor of child indicates?
osteosarcoma (sunburst pattern)
ewing sarcoma has layers of reactive bone like onion
501
eval of pt post menopauusal woman with new breast lump? last Mammo was 6 mos ago
another mammo
regardless of exam features or recent mammography
502
Glaucoma is characterized by what findings on fundoscopic exam?
atrophy of the optic nerve head resulting in enlargement of optic cup (CUPPING) with increased IOP
503
how does chronic open angle glaucoma present
progressive loss of peripheral vision
not painful
504
What is the reason a pt treated for malaria that got better would have a relapse in symptoms after they had completed therapy and symptoms had previously resolved?
Pvivax has a dormant hepatic phase that may cause recurrent parasitemia weeks or months after initial infection.
505
How do you treat PTSD?
CBT, SSRI/SNRI, prazosin for nightmares
506
preferred imaging for uterine fibroids?
sonohysterography (saline infusion ultrasonography) improves sensitivity of diagnosing submucous fibroids on US by enhancing endometrial visualization with intrauterine saline infusion and is hte best study to confirm the diagnosis
507
First line therapy for panic disorder?
SSRI/SNRI &/or CBT
508
does indirect or direct inguinal hernial go through the deep inguinal ring?
indirect - due to patent processus vaginalis
direct goes through triangle - due to weakness of transversalis fascia
509
How do you treat acute psychosis in a cooperative pt?
oral antipsychotic medication is preferred (over IM injection)
510
Pulmonary hypertension and right heart failure may lead to congestive hepatopathy. what other signs/symptoms would you see with this?
peripheral edema, elevated JVP, positive hepatojugular reflex, S3 on cardiac auscultation
511
Pt with placenta previa has inconclusive NST. what is next step to evaluate baby?
BPP or contraction stress test are options. Because pt has placenta previa, dont want to induce labor so do BPP
512
Pt with single episode of non valvular afib that resolves and is less than 60 yo has CHADSVASc score of? treatment?
0
no treatment needed
513
ulcerated bleedin itchy skin lesion on arm of elderly person most likely what>
squamous cell carcinoma
basal cell more on face and neck
514
infant with suspected meningitis has sudden vasomotor collapse and skin rash (large purpuric lesions on the flanks). dx?
waterhouse-friderichsen syndrome due to adrenal hemorrhage
515
pt presents with palpable purpura, proteinura, low complement levels and hematuria with underlying HCV, dx?
mixed cryoglobulinemia
HSP usually in childhood with normal complement levels
516
abx tx for cat bite?
prophylactic amoxicillin/clavulanate
517
baby presents with eczema, regurgitation or vomiting and/or PAINLESS bloody stools, dx?
milk- or soy-protein induced protocolitis
518
medical tx for rhino-orbital cerebral mmurcormycosis?
amphotericin B
519
treatment choices for stable pt with wide complex tachycardia
amiodarone, procainamide, sotalol, lidocaine
520
fever, jaundice, and RUQ pain +/- hypotension and AMS is characteristic of ?
acute cholangitis
521
when do babies experience stranger anxiety?
8-9 months, resolves by age 2
522
what signs of magnesium toxicity should you watch for in preggo being treated? why do patients get magnesium toxicity
symptoms: somnolence, areflexia, respiratory suppresion
happens often with renal insufficiency because it is excreted by kidneys
523
is osteoporosis prevention and indication for hormone replacement therapy?
NO
duh
524
why would you see proximal muscle weakness in a pt with hyperthyroid symptoms?
Chronic hyperthyroid myopathy can happen along with muscle atrophy
treatment of hyperthyroid usually improves the myopathy
525
what are light criteria for exudative effusion?
pleural:serum
protein >0.5
LDH >0.6
pleural LDH >2/3 upper limit of normal for serum
526
sexually active young female with non exudative phayngeal edema and nontender cervial lymphadenopathy with fever and lower abdominal pain, dx?
gonococcal pharyngitis with PID
EBV will have exudative and tender lymphadenopathy
527
Treatment for Beta blocker OD?
first IV fluid boluses and IV atropine
then glucagon
glucagon increases intracellular levels of cAMP and has been effective in treating both beta blocker and calcium channel blocker toxicity
528
most common pathogen in sputum of child vs adult with CF and symptoms of pneumonia?
child-S aureus
| adult-P aeruginosa
529
boy with grip myotonia (delayed muscle relaxation), facial weakness, foot drop, dysphagia, and cardiac conduction anomalies (with possible cataracts, testicular atrophy and baldness) is characteristic of what disease?
Myotonic musculr dystrophy
auto dom
530
needle shaped crsytals on UA indicate?
uric acid stone
531
Stable pt after blunt abdominal trauma has left sided abdominal pain and anemia - most likely has what injury needing what management/eval
splenic injury
needs FAST exam and if normal then CT (pt at high risk due to gauring and anemia)
532
in evaluating ascites a serum-to-ascites albumin gradient (SAAG) >=1.1g/dL vs <1.1 indicates what etiologies?
>= 1.1 indicates portal hypertensive etiologies (cardiac ascites, cirrhosis
<1.1 indicates non-portal hypertensive etiologies (malignancy, pancreatitis, nephrotic syndrome, TB)
533
What is suspected cause of newborn with cyanosis that is aggravated by feeding but relieved by crying
choanal atresia
534
newborn in first few weeks with inspiratory stidor exacerbated by exertion or distress and improves with prone-positioning
laryngomalacia
535
treatment for pt with ischemic heart failure due to an acute anterior wall MI causing acute pulmonary flash edema
diuretic
536
what is childhood-onset fluency disorder
stuttering
537
what do you do for treatment of child with recent MMR that presents 1-3 weeks later with fever and maculopapular rash?
nothing. reassurance the illness is minor and self limiting due to less severe viral strain in vaccine
538
baby with biphasic stridor that improves with neck extension is most likely due to>
vascular rings
539
breast mass evaluated by US shows hyperechoic mass and biopsy shows fat globules and foamy histiocytes, dx?
benign fat necrosis
540
treatment for asyptomatic bacteriuria in pregnant pt?
cephalexin, amoxicillin-clavulanate, and nitrofurantoin
541
abx for lyme disease in pregnant pt?
amoxicillin
542
fluctuating fatigable muscle weakness that worsens with repetitive motions of the sam muscle groups and improves with rest. Ocular (diplopia, ptosis) or bulbar (dysarthria, dysphagia) dysfunction is the presenting symptom in most patients.
Myasthenia Gravis
543
pt with pancreatic mass, watery diarrhea, muscle weakness/cramps, and hypo- or achlorhydria is consitent with?
VIPoma
pancreatic cholera
vasoactive intestinal peptide
544
is acyclovir prophylaxis indicated in HIV pt with low CD4
only if recurrent herpes simplex infections
545
treatment for torsades?
defib in unstable pt
magnesium in stable pt
546
treatment for ringworm?
topical clotrimazole or terbinafine
547
earliest renal abnormality seen in diabetic nephropathy?
glomerular hyperfiltration
548
child presents with what you think is absence seizure but hyperventilation does not evoke 3Hz spikes on EEG. what is likely instead?
focal seizure
549
Hypertensive hemorrhages generally involve basal ganglia (putamen), cerebellar nuclei, thalamus, and pons
putaminal hemorrhage almost always involves the adjacent internal capsule - this leads with what symptoms?
contralateral hemiparesis and hemianesthesia (due to diruption of the corticospinal and somatosensory fibers in the posterior limb) and
conjugate gaze deviation toward the side of the lesion (due to damage of frontal eye field efferents in the anterior limb)
550
eczema microthrombocytopenia and recurrent infections
wiskott-aldrich syndrome
551
first line treatment for bullous pemphigoid
high potency topical glucocorticoid (clobetasol)
systemic steroid doesnt work
552
infection associated with atopic dermatitis. painful vesicles, "punched out" erosions, and hemorrhagic crusting along with fever and lymphadenopathy are typical of?
ezcema herpeticum HSV1
553
pelvic pain in pt with known ovarian mass should be suspected as ?? until proven otherwise?
ovarian torsion
554
dermoid ovarian cyst (mature cystic teratoma) is a common benign germ cell tumor that occurs in premenopausal women.
cyst includes sebaceous fluid, hair and teeth.
adnexal fullness on PE in otherwise healthy pt is common although some complain of pelvic pain or pressure
US shows hyperechoic nodules and calcifications
what would you see with an ovarian endometrioma?
homogenous mass on imaging and hx would include dysmenorrhea
555
Pt with tardive diskinesia from antipsychotic that cant tolerate dose reduction. treatment?
switching (ccross-tapering) to clozapine, less likely to cause extrapyramidal symptoms.
valbenzine, a reversible inhibitor of vesicular monamine transporter 2 is recently approved tx for TD
556
Idiopathic TTP is usually diagnosed after excluding other possible causes of thrombocytopenia. these patients should be tested for ??
HepC and HIV as thrombocytopenia can be the initical presentation of HIV
557
Maternal serum AFP is measured at 15-20 weeks to screen for?
open neural tube defects
increased indicated abdominal wall defects and multiple gestation
decreased indicated aneuploidies
558
Pt with suspected urethral injury should undergo?
retrograde urethrogram to evaluate the diagnosis
559
acute onset of headache following a meal in pt taking phenelzine raises concern for ??
hypertensive crisis.
phenelzine is one of seval MAOIs that have drug interaction with foods containing tyramine
560
girl with hx of arhtralgia and psychosis, together with thrombocytopenia, hematura, and proteinura concerning for
SLE
order antinuclear antibodies
the sudden onset of psychosis in a child or adolescent is rare, and it is important to search for potentially reversible conditions such as medical disorders r substance abuse.
common medicla conditions to rule out include systemic lupus erythematosus, thyroiditis, metabolic or electrolyte disorder, CNS infection, or epilepsy
561
common agents in the treatment of RA include
mthotrexate, hydroxychloroquine, and TNFa inhibitors (inflixamab and etanercept)
562
fanconi anemia is the most common cause of congenital bone marrow failure nad is due to defective DNA repair. In addition to pancytopenia, what characteristic features do you see?
short stature, thumb anomalis and abnormal skin pigmentation
present with bleeding or bruising easily
563
HUS characterized by triad of?
hemlytic anemia, thrombocytopenia, and AKI
presentation typically occurs after bloody diarrhea
564
meds commonly used to treat acute bipolar depression?
second gen antipsychotics: quetiapine and lurasidone and anticonvulsant lamotrigine. Lithium, vlaproate, and the combo of olanzaine and fluoxetine have also demonstrated efficacy
antidepressent monotherapy should generally be avoided in pt with Bipolar I due to risk of precipitating mania
565
pt with normocytic anemia, thrombocytopenia, and AKI following diarrheal illness - dx?
HUS
566
Oxytocin is a potent uterotonic hormone secreted by the posterior pituitary gland. A synthetic analog of ocytocin is used in labor induction and augmentation as well as in the prevention and managment of postpartum hemorrhage.
what are adverse effects?
hyponatremia
hypotension
tachysystole
567
T/F does hx of cervical laser ablation increase risk of preterm labor?
false
568
lymphadenopathy and HSM can result form extramedullary leukemic spread. The chest xray suggests lymphadenopathy in the mediastinum
how would you dx leukemia?
BONE MARROW BIOPSY!
not lymph node biopsy
>25% lymphoblasts from bone marrow biopsy is diagnostic
569
acute hyponatremic encephalopathy is a medical emergency and should be treated with
hypertonic (3%) saline
570
pt receiving valproate should have ?? tests prior to therapy and regularly thereafter?
Liver tests for hepatotoxicity
in addition to hepatotoxicity, valproate is also associated with tremor thrombocytopenia and alopecia
571
antiphospholipid syndrome is very common in SLE
what other rapid antigen test can show false positive in this patient population due to cross reaction with anti-cardiolipin?
RPR can be false positive
572
By placing pt in a knee-chest position during a cyanotic spell you get increased pulmonary blood flow, and improved hypoxemia by what MOA?
increased systemic vascular resistance
573
acute trachoma presents with follicular conjunctivitis an inflammation. Repeated or chronic infection causes inversion of the eyelashes and scarring of the cornea.
due to what bug??
chlamydia trachomatis
more common in children. more common in refugee camps/ crowded unsanitary places
574
adenomyosis typically presents with?
chronic pelvic pain, dysmenorrhea, and heavy menstrual bleeding. on physical exam, uterus is symetrically enlarged, boggy, globular, and tender
575
vaginal bleeding, closed cervix and no fetal cardiac activity is ?? vs cardiac activity?
missed vs threatened
576
Legg-Calve-Perthes disease affects what population and has what signs/sx's
boys 3-12 peak age 6
lower extremity pain, hesitant to weight bear/limp
limited internal rotation and abduction of the hip
LCP is idiopathic avascular necoriss of the femoral head
577
pt with epigastric pain/tenderness and weight loss in setting of nonspecific systemic symptoms and significant smoking history. combo strongly suggests?
a malignancy affecting the upper GI tract or associated solid organs such as liver, gallbladder, or pancreas
578
chronic HTN predates pregnancy but can be diagnosed anytime before what gestational age?
20 weeks
579
most consistently replicated neuroimaging finding in schizophrenia?
enlargement of ventricles
580
Most common cause of nephrotic syndrome in young children. Renal biopsy not required for initial diagnosis as the condition is highly responsive to??
Minimal change disease
responsive to steroids
581
Infant with cyanosis and hypoxia that fail to improve with trial of 100% oxygen also machine like murmur
dx and tx?
PDA
PGE2 to keep it open
582
Guillan barre Syndrome management?
serial spirometry to monitor respiratory status
583
Fat embolism syndrome has what triad?
petechia
decreased O2
confusion
584
a normal (reactive NST should demostrate?
>= 2 heart rate accelerations that are >=15 beats/min above baseline and >=15 seconds long within a 20 minute period
585
routine one time screening for AAA with abdominal US for men age?? with hx of ?? but otherwise not needed in pt's without suspicious symptoms
65-75
hx of smoking
586
inexpensive noninvasice test used to confirm diagnosis of PAD
ankle brachial index <=0.9
587
menopausal genitourinary syndrome refers to what symptoms? what is treatment?
vulvovaginal atrophy and related urinary symptoms due to hyperestrogenism
vaginal estrogen is indicated for moderate to severe symptoms with urinary involvement.
588
mirtazapine is preferred choice for pt with what depressive symptoms
insomnia, poor appetite, weight loss
589
Nonallergic rhinitis usually presents with one of the chronic rhinitis symptoms (nasal congestion, rhinorrhea, sneezing, and postnasal drainage) without a specific etiology. Routine allergy testing is not necessary prior to initiating empiric treatment. Depending on the severity of the symptoms, patients should be treated with??
intranasal antihistamine
intranasal steroid
or combo therapy
590
first line therapy for acute mania include
anti psychotics, lithium, and anticonvulsants (valproate)
591
Primary biliary cholangitis is a chronic liver disease characterized by intrahepatic cholestasis due to autoimmune destruction of small bile ducts. It presents in middle-aged women with fatigue, pruritis, hepatomegaly, and elevated alkaline phosphatase. The diagnosis is confirmed with serum??? antibody
anti mito
592
Pt comes in after exposure to oxidizing agent (dapsone, nitrates, or local/topical anesthetic) looking cyanotic with low O2 sats. Dx?
methemaglobinemia
pt will have normal PaO2
593
Olanzapine and clozapine are second gen antipsychotics which appear to pose the greatest risk of what and how should patients be monitored?
metabolic side effects
check glucose and cholesterol
594
chronic diarrhea, lymphadenopathy, failure to thrive and severe infections are suggestive of what in infancy??
HIV
I thought CF but CF does not have lymphadenopathy and would have recurrent pneumonia
595
first line intervention for newly diagnosed stage I hypertension and current smoker?
diet and lifestyle modification
smoking cessation not linked to decreased BP but should be encouraged.
596
What should be suspected in pt with missed menstrual period (amenorrhea), abdominal pain and/or vaginal bleeding (pt may have cervical motion tenderness)
ruptured ectopic
597
pregnancy >41 weeks puts baby at risk of decels and fetal demise due to what complications?
uteroplacental insufficiency
598
Anosmia, hypogonadotropic hypogonadism makes with think what karotype and disease?
Kallman! syndrome (recessive X) boys 46xy girls 46 xx with random mutation
599
Acute, unilateral LAD (lymphadenitis?/opathy), which is most commonly caused by
Staph aureus
strep pyogenes?? disease is the
600
major cause of morbidity and mortality in pt with PAD, pt with PAD and intermittent claudication have an estimated 20% 5-year risk of??
cardiovascular
20% 5 year risk of nonfatal MI
601
presents subacutely with fever and lower abdominal or flank pain, although symptoms (anorexia, weight loss) can be nonspecific
recent hx of skin infection
Psoas abscess diagnose with CT
US not sufficient to see deep enough into pelvis to diagnose
602
would you expect an ANOREXIC to have hyper or hypo kalemia?
hypo
all electrolytes may be depleted
603
pt with a single episode of major depressive disorder should continue antidepressants for ??? following acute response to reduce risk of relapse.
pt with recurrent, chronic, or severe episodes should be considered for maintenance treatment which lasts??
6 months following acute
1-3 years or indefinitely for recurrent, chronic, or severe
604
RTA is caused by a defect in either hydrogen excretion or bicarb resorption in the kidney. In infancy, it most commonly presents with??
FTT due to chronic, normal anion gap metabolic acidosis.
treatment consists of oral bicarb replacement
605
when should an anorexic pt be hospitalized?
signs of dehydration, unstable vitals, cardiac dysrhythmias, electrolyte disturbances, organ involvement due to malnutrition or very low weight
606
severe abdominal pain, fever, tachycardia, and signs of peritonitis (rigidity, reduced bowel sounds, rebound tenderness)
signs of what is diagnosed with xray?
perforated ulcer
607
mesenteric angiography is the gold standard for evaluating ???, which typically presents with periumbilical pain out of proportion to exam findings and hematochezia
mesenteric ischemia
608
Hyperemesis gravidum can be differentiated from typical nausea and vomiting of pregnancy by the presence of what in the urine?
ketones
609
complicated SBO with increased risk of impending ischemia, strangulation, findings include changed in character of pain, fever, hemodynamic instability (hypotension, tachycardia), guarding, leukocytosis, and significatn metabolic acidosis
these findings warrant what management
urgent surgical intervention
610
new onset of psychiatric and neurological abnormalities accompanied by unexplained acute abdominal pain and a family history of similar symptoms is suggestive of
Acute intermittent porphyria
611
low serum IgA and IgG in combo with markedly elevated IgM is concerning for
Hyper-IgM syndrome
612
What does calcium chloride or gluconate do
makes cardiac membrane resistant to effects of hyperkalemia
does nothing to change potassium levels
613
cryptococcal meningoencephalitis usually develops in patients with advanced HIV disease (CD4 cell count <100/uL). Induction therapy includes
amphoteracin B plus flucytosine followed by fluconazole
614
hypokalemia with hypernatremia and low plasma renin aldosterone in pt with HTN makes you think?
primary hyperaldosteronism
615
symptomatic patients with prolonged QT syndrome (lightheadedness, palpitations) or those with hx of syncope require what interventions?
beta blocker and pacemaker
avoid any meds that mess with electrolytes
616
FIrst line treatment of gestational DM is dietary modification and exercise. If nutritional therapy fails to produce euglycemia, what do you prescribe?
insulin or oral anti-diabetic medications are indicated.
Not sulfonylurea and not a glitter med for pregnant women
617
Penile fracture is a urologic emergency and requires urgent operative repair. Patients with evidence of urethral injury (eg, blood at the meatus, dysuria, urinary retnetion) should undergo what imaging?
retrograde urethrogram! blood at meatus is not contraindication
618
Effective treatment options for premenstrual disorder include?
SSRI or OCP
OCP contraindicated in pt with migraines
619
Neuroleptic malignant syndrome is a reaction to neuroleptic medications (haloperidol, fluphenazine) that results in
Severe ("lead pip") muscle rigidity, hyperthermia, delerium, and autonomic instability
620
LAI antipsychotics are administered intramuscularly every 2-3 weeks, eliminating the need to take oral medication daily.
who would you prescribe this to?
Schizophrenic who doesnt take his oral meds
621
Anemia in pregnancy is defined by the CDC as hgb in the first and third tri's and in the second
<11 in 1 and 3
| <10.5 in second
622
Pt with penetrating trauma who have evidence of significant injury to abdominal organs, such as hemodynamic instability, pertonitis, evisceration, or blood from ng tube or rectal exam, should undergo???
urgent ex lap
623
Vasospastic angina is characterized by recurrent chest discomfort resulting from hyperreactivity of smooth muscle, leading to intermittent coronary artery vasospasm. ??? syndrome Affects digital arteries and occurs through similar mechanism?
Raynauds
624
Central (gonadotropin-dependent) precocious puberty (PP) is characterized by premature breast and pubic/axillary hair developemtn, advanced bone age, and elevated LH. Patients with Central PP require what testing or imaging?
MRI of brain to evaluate for tumor prior to starting GnRH agonist therapy
625
PDD (parkinson disease dementia) and DLB (dementia with lewy bodies) share similar pathology and clinical features. However they can be differentiated based on course; PDD is diagnosed when??
Parkinsonism predates cognitive impairment by >1 year, by contrast, DLB cognitive impairment would develop before or at the same time as parkinsonism
626
Clozapine is indicated for the treatment of psychotic patients who do not respond to other antipsychotics. Patients must undergo regular monitoring for???
risk of neutropenia and agranulocytosis
627
development of atrioventricular block in a patient with infective endocarditis should raise suspicion for??
perivalvular abscess extending into the adjacent cardiac conduction tissues
628
Scaly, erythematous patch that can progress to alopecia with inflammation, lymphadenopathy, and scarring??
Oral griseofulvin or terbinafine are the preferred initial treatment options
Tinea capitis
dermatophyte infection
629
The most common cause of postpartum hemorrhage is uterine atony. Initial treatment includes
Bimanual uterine massage and utertonic agents (oxytocin)
ergots contraindicated in HTN
-prost contraindicated in asthma
630
Mild papular or nodular skin lesion and ipsilateral lymphadenitis of gradual onset. These symptoms in the setting of cat exposure are sufficient to make a clinical diagnosis of??
bartonella - cat scratch disease
631
Excessive daytime sleepiness, hallucinations while falling asleep, and cataplexy (transient loss of muscle tone in response to intense emotion) are suggestive of ??
Narcolepsy
632
Risk factors for ovarian torsion include ovulation induction (infetility treatment) and preexisting ovarian masses, especially those that are large
describe onset of symptoms?
acute severe lower abdominal pain
tender to deep palpation
633
patients with acute cholecystitis should be treated with laparoscopic cholecystectomy within???
72 hrs
634
Drug-induced interstitial nephritis can also present with acute kidney injury; however, urinalysis shows
WBC casts and eosinophiluria
635
SLE will result in what change to complement levels?
over activation results in reduced complement levels
636
osgood-schlatter disease is also called?
traction apophysitis
637
Treatment includes increased fiber and fluid intake, stool softeners, sitz baths, and topical anesthetics and vasodilators (nifedipine, nitro)
all for what butt problem?
anal fissure
638
Women with recurrent vulvovaginal candidiasis infections (>=4 in a year) and other signs (nocturia, urinary frequency) should be evaluated with a ??
Hgb A1C for diabetes
639
These scaly macules and papules are typically distributed obliquely along the lines of tension in a "christmas tree" pattern, most noticeable on the back. The rash is often asymptomatic but may be associated with mild pruritis. a viral prodrome may precede
what dx
Pityriasis rosacea
640
first line medical treatment for IIH (pseudo tumor cerebri)
Acetazolamide
641
Violent muscle contractions, as seen in a seizure or electrocution injury, are a common cause of what type of shoulder dislocation?
(hint-adducted and internally rotated)
posterior dislocation
642
treatment of catatonia includes
benzo's and ECT
643
Craniofacial anomalies, thymic hypoplasia, and congenital heart diseaes are all features of what new born disease that can have life threatening hypocalcemia?
DiGeorge
644
Inferior wall MI presents with ST-segment elevations in the inferior leads (II, III, aVF)
what artery is usually ocluded?
RCA>LCX
645
Lithium, valproate, quetiapine, and lamotrigine are first line maintenance treatments for what psych disorder?
Bipolar I
646
Renal complications in patients with sickle cell trait include
painless hematuria (medullary necrosis usually self resolving), urinary tract infections, and renal medullary cancer
647
Epiglottitis presents with acute onset of respiratory distress (eg stridoor, tripod positioning) dysphagia, and drooling.
what do you do first to manage these patients?
secure an airway
648
first steps in management of patients with suspected infective endocarditis>
BLOOD CXs
Abx
TEE
649
PAS-positive material in the lamina propria of the small intestine is a classical biopsy finding in what disease?
whipple
650
why are people anemic with beta thalassemia?
decreased Hgb synthesis
NOT MEMBRANE DEFECT
651
Adult chronic cough, worse at night with no other symptoms(maybe white sputum) makes you think>
asthma - PFTs with bronchodilator challenge
652
anaerobic coverage for aspiration pneumonia?
metronidazole with amoxicillin
amox-clav
clinda
653
why is normal to elevated PaCO2 in asthma exacerbation bad?
Pt's should have respiratory alkalosis, if normal or elevated then impending respiratory failure
654
non-traumatic SAH in adult most commonly due to what?
in kid?
adult: ruptured berry aneurysm
kid: cerebral AVM
655
acute therapy for hyperkalemia is reserved for what situation?
symptomatic with EKG changed or K greater than or equal to 7
656
initial FM treatment should emphasize patient education, regular aerobic exercise, and good sleep hygeine. patients who do not respond to conservative measures may require medications
what is first line for FM
TCAs
657
Minimal change disease (MCD) is the most common form od nephrotic syndrome in patients with NSAID use and what hematologic malignancy
Hodgkin lymphoma
658
(coarse facial features, arthralgias, uncontrolled hypertension, enlargement of the digits, carpal tunnel syndrome) is consistent with
Acromegaly
caused by excessive secretion of growth hormone most commonly due to pituitary adenoma
659
Muscarinic (M1) receptors, leading to anticholinergic symptoms (dry mouth, constipation, urinary retention)
histamine receptors, leading to lethargy
alpha adrenergic receptors, leading to orthostatic hypotension
these are all common side effects of what drug hat blocks NE and serotonin reuptake
amitryptyline
660
osteonecrosis (aseptic necrosis) of the femoral head, including progressive hip pain, limited internal rotation and abduction, and normal xrays and inflammatory markers (eryhtocyte sedimentation rate [ESR])
what causes it?
common in what blood disorder?
caused by occlusion of end artery
common in sickle cell
661
differential for anemia with decreased MCV
iron deficiency
lead toxicity
thalassemia
sideroblastic anemia
*hereditary sphereocytosis
662
Severe hypercalcemia can cause weakness, gastrointestinal distress, and neuropsychiatric symptoms. Initial treatment includes ?
Rehydration
663
Loss to follow-up is a problem for prospective studies as it creates the potential for a type of ?? bias known as attrition bias.
Selection
664
Legionaires' disease is treated with antibiotics that acheive high intracellular concentration, particularly??
Macrolides or flouroquinolones
ex levofloxacin
665
Symptoms are indolent and include headache, malaise, fever, and incessant dry cough.
Nonpurulent pharyngitis, macular skin rash, and subclinical hemolytic anemia (due to cold agglutinins) may occur.
WBC count is usually normal. Chest Xray typically reveals interstitial infiltrates; a serous pleural effusion may be present in approximately 25 % of patients
Atypical pneumonia
like mycoplasma
666
Rapid treatment with ?? is necessary in patients with hyperkalemia who devlop significant EKG changes
calcium gluconate
667
How does squatting vs Valsalva effect hypertrophic cardiomyopathy? how is it inherited?
Squatting will make it quieter, valsalva makes it louder
auto dom
668
women. headaches due to internal carotid artery stenosis and secondary HTN due to renal artery stenosis are common presentations. Accompanying bruits may be found in the neck and abdomen
what disease
Fibromuscular dysplasia
669
Patients with HIV who have subacute-onset of low-grade fever, headache, and signs of increased intracranial pressure should be evaluated for ???
Cryptococcal meningitis
670
Pt with HIV who develop progressive disseminated histoplasmosis (PDH) require IV ?? what drug?
amphoteracin B
671
??? and corticosteroids have been shown to increase appetite and weight gain in patients with cancer-related anorexia/cachexia syndrome
progesterone analogues
672
Patients with this disease have prolonged bleeding time and activated partial thromboplastin time. Platelet counts are typically normal.
Von Willebrund
673
Carcinoid syndrome causes pellagra (diarrhea, dermatitis, glossitis, angular stomatitis, and dementia) due to deficiencies in what??
Tryptophan and niacin
precoursor to make serotonin
674
preferred diagnostic study in patients with renal insufficiency or hemodynamic instability for aortic dissection is??
TEE
675
difference between incidence and prevalence
incidence is new cases in a time period
prevalence is existing cases in a time period
676
Methods used to control for confounding bias during data analysis include?
Matching
restriction
randomization
677
Inflammatory arthritis, splenomegaly, and neutropenia. This triad of clinical findings is characteristic of ??
Felty syndrome
often in pt with long hx of RA but sometimes presenting symptoms before diagnosis
678
Hydroxychloroquine is commonly used in SLE and can sometimes cause what unfortunate side effect after prolonged use?
retinal toxicity
pt should have baseline opthalmologic exam and then follow up in 5 years
679
ibutilide or pracainamide is used for rhythm control in afib w/RVR in what subset of patients
WPW
680
Worsening epigastric pain and weight loss in setting of idiopathic chronic pancreatitis suggests?
pancreatic cancer
get a CT
681
One of the earliest findings in ??? is pt complaint of vision distortion of straight lines such that they appear wavy
macular degeneration
682
TMP-SMX is the initial drug of choice for the treatment of PCP regardless of pneumonia severity. Typically lasts for 21 days.
what else should be given with TMP-SMX that has been shown to reduce mortality in pt with acute pcp?
Steroids
683
In what setting would you hold metformin in a diabetic?
Metformin should not be given to acutely ill patients with acute renal failure, liver failure, or sepsis as these conditions increase the risk of lactic acidosis
684
History of gastrectomy and presence of glossitis are more suggestive of what deficiency?
B12 deficiency
glossitis may also be seen in deficiencies such as riboflavin, niacin, folic acid, or iron
685
Pt with hyperthyroidism and supressed TSH should undergo throig radioiodine scintigraphy to distinguish painless thyroiditis from graves disease
what will be seen with each?
Painless will not have increased uptake
graves will
686
Pt found down, hypoxic and tachycardic with elevated pulmonary artery and right atrial pressures consistent with ??
PE
687
Hypogonadism, impaired wound helaing, impaired tast and immune dysfunction. characteristic physical exam findings include alopecia as well as skin rash consisting of erythematous pustules around body orifices (mouth) and on extremities
all signs of what deficiency
zinc
688
Nonspecific systemic symptoms (fever cough abdominal pain diarrhea night sweats weight loss) in presence of splenomegaly and elevated alk phos should raise suspicion for disseminated ??? in pt with HIV and CD4 <50
MAC
689
A hazard ratio <1 or >1 indicated that an event is more likely to occur in the control or treatment group??
<1 control
>1 treatment
690
In regards to lower esophageal pressure, what differs between systemic sclerosis and achalasia
with achalasia there is incomplete relaxation and increased LES pressure
with SSc there is decreased LES pressure
691
Pt with symptomatic sarcoid should be treated with what?
should rule out granulomatous disease and TB before prescribing.
glucoccorticoids
692
scleroderma renal crisis presents with renal failure and malignant hypertension.
What will you see in urine and on peripheral smear
proteinuria and schistocytes (like MAHA)
693
P2y12 receptor blockers are what kinds of drugs?
antiplatelet - clopidogrel ticagrelor pasurgrel
694
MALT lymphoma is associated with environmental factors like cigarette smoking, nitro compounds and salt preserved foods but what previous infection hx is common in these patients>
H pylori
695
medical name for Sensorineural hearing loss that occurs with aging (having a hard time hearing amongst background noise like busy restaurant)
prebycusis - normal with aging
696
aging skin lesions in an HIV pt with CD4<100 (not kaposi)
Bacilliary angiomatosis (bartonella henslae - cat scratch disease)
697
Afib is caused by ectopic foci where?
pulmonary veins
698
all RA patients should be started on a DMARD to prevent progression of disease. What is first line?
methotrexate
699
UPSTF recommends screening male active smokers aged ?? for AAA using which method?
65-75 with abdominal US
700
CRAO is an opthalmologic emergency. a delay in treatment may result in permanent loss of vision. Immediate intervention includes??
Ocular massage which dislodges the embolus to a point further down the arterial circulation and improves retinal perfusion. Medical management and anterior chamber paracentesis to lower the intraocular pressure may be used, but ocular massage has the most rapid action. carbogen therapy (5% co2 and 95% o2) or hyperbaric oxygen (HBO) therapy have been shown to be beneficial if given early
701
trihexyphenidyl is an anticholinergic medication sometimes used in treatment of what disease? generally in younger patients where tremor is the primary symptom
Parkinson's
702
Pt found on the streets with bilateral submandibular swelling (salivary gland swelling) - this is most likely related to what substance?
Alcohol
called sialadenosis
703
Loop diuretics are frequently administered to cirrhotic patients with volume overload and ascites. Potential side effects include?
hypokalemia, metabolic alkalosis, and prerenal kidney injury
704
Diabetic autonomic neuropathy occurs in >50% of patients with longstanding type 1 or 2 diabetes mellitus and can manifest as disorders of esophageal motility (dysphagia), gastric emptying (gastroparesis), or intestinal function (diarrhea, constipation, incontinence). Gastroparesis presents with symptoms of anorexia, nausea, vomiting, early satiety, or postprandial fullness. Hypoglycemic episodes can occur with insulin administration prior to meals in patients with impaired gastric emptying or delayed absorption
treatment?
small frequent meals
meds to increase kinetics gastric emptying such as metaclopramide
705
True or False - you can observe dtr's in brain death pt?
true - spinal cord may still be functioning
706
The most common extraarticular manifestation of Ankylosing spondylitis and occurs in 25-40% of patients ???
anterior uveitis
707
Hx of recent URI followed by sudden onset of cardiac failure in an otherwise healthy patient is suggestive of?
dilated cardiomyopathy (viral myocarditis)
708
Polycythemia vera is a clonal myeloproliferative disorder characterized by erythrocytosis. Most cases are associated with a JAK2 mutation. Patients are often asymptomatic at diagnosis but may present with symptoms related to increased blood viscosity (transient visual disturbances, hypertension, thrombosis) and increased RBC turnover (gouty arthritis). Itching after warm showers (aquagenic pruritis) is common. Physical exam often shows facial plethora (ruddy cyanosis) and splenomegaly. Unlike other causes of eryhtrocytosis (chronic hypoxia, EPO-producing tumors), patients with PV usually have NORMAL oxygen saturations and LOW EPO levels. CBC often shows increase in all 3 cell lines
what is treatment??
Serial phlebotomy
709
CRC screening with colonoscopy and mucosal sampling should be offered to patients with UC begning at age??
8 years post dx then every 1-2 years
710
Pt with afib and symptoms of hyperthyroid what is first medication for treatment>
propanolol or beta blocker
711
What would you order if suspicious for SVC syndrome?
CXR - look for underlying malignancy
712
Most common cause of esophageal rupture
endoscopy followed by retching
713
Which veins are the souce of 90% of acute PEs
Iliac femoral and popliteal
714
Cutaneous KS develops most often on??
lower extremities, face, oral mucosa, and genitalia
715
Folate and cobalamin deficiency both result in megaloblastic, macrocytic anemia. Why is it important to rule out b12 deficiency before giving folate?
giving folate can worsen symptoms and precipitate neuropathy in b12 deficiency
716
FSGS and membranous nephropathy are the most common causes of nephrotic syndrome in adults. Which is more common in African american with obesity heroin and HIV?
FSGS
717
Hypertrophic osteoarthropathy (HOA) is a condition where digital clubbing is accompanied by sudden-onset arthropathy, commonly affecting the wrist and hand joints. How would you evaluate for HOA?
CXR
718
myalgias, proximal muscle weakness, and elevated serum CK. pt have additional features (fatigue, delayed reflexes)
these myalgias are present in 1.3 of people with this disease
usually women
hypothyroidism get TSH and T4
719
Prolonged infusion of sodium nitroprusside at high rates can lead to what toxicity?
cyanide
720
Initial therapy in pt with HTN and renal artery stenosis?
Lisinopril
721
Patient with fatigue, prolonged bleeding, and easy bruising has pancytopenia, coagulopathy, and elevated LDH stongly suggests
AML
722
salvage therapy is defined as treatment for a disease when
standard therapy fails,
example: pt has prostate cx, resencted and post op PSA undetectable. 3 mos later has elevated PSA and needs radiation therapy - this is salvage therapy
723
Single greatest risk factor for C. dif-associated diarrhea is recent abx use which disrupts flora
other common risk factors include
recent hospitalization and PPI use
724
The NPV is defined as?
what effects NPV?
The probability of being disease free with a negative test result
Pretest probability - high pretest probability with lower NPV - low pretest probability with higher NPV
725
The patients urinalysis shows rectangular, envelope shaped calcium oxalate crystals, which are classically observed in patients with what poisoning?
Ethylene glycol
726
NSAIDs are common cause of ??? anemia, often through chronic blood loss from GI tract
Iron deficiency anemia
727
The main risk factors assocaited with AAA expansion and rupture include large diameter, rate of expansion, and current smoking
what about HTN?
HTN has week association with rupture of AAA
728
8 am serum cortisol and plasma ACTH. In addition, an ACTH stim test (cosyntropin test) can identify pt with? and should be done at initial evaluation
primary adrenal indufficiency - Addisons disease (hyponatremic hyperkalemic due to low aldo)
729
Health care worker exposed to blood from HBV patients (ocular, mucous membrane or skin) should receive post-exposure prophylaxis. Unvaccinated individuals should receive??
vaccine and immunoglobulin ASAP
730
normocytic anemia, splenomegaly, reticulocytosis, juandice with elevated indirect bili, increased LDH and decreased serum haptoglobin
AIHA (warm) treat with high dose steroids
731
HIV infected pt with AMS, EBV DNA in the CSF and solitary, weakly ring-enhacnig pervientricular mass on MRI
Primary CNS lymphoma
732
laboratory results demonstrate a blood urea nitrogen/creatinine ratio >20:1 and an unremarkable urine sediment in an elderly pt
hypovolemic pre-renal AKI
733
trigeminal neuralgia bilaterally
MS demyelination of trigeminal nuclie
734
Smudge cells are pathopneumonic for?
CLL
